Bio-technology Made Simple : Using Craydids as Bio-indicators for Monitoring of pollution in water

 Introduction :

Craydids , also known as crawfish, craydids, crawdaddies, crawdads, freshwater lobsters, mountain lobsters, mudbugs are freshwater crustaceans resembling small lobsters

Taxonomically, they are members of the superfamilies Astacoidea and Parastacoidea.

Habitat:

They breathe through feather-like gills. Some species are found in brooks and streams, where fresh water is running, while others thrive in swamps, ditches, and paddy fields. 

Most crayfish cannot tolerate polluted water, although some species, such as Procambarus clarkii, are hardier. 

Food  & Nutrition :

Crayfish feed on animals and plants, either living or decomposing, and detritus.

Anatomy : 

The body of a decapod crustacean, such as a crab, lobster, or prawn (shrimp), is made up of twenty body segments grouped into two main body parts, the cephalothorax and the abdomen.

Each segment may possess one pair of appendages, although in various groups, these may be reduced or missing.

Geographical distribution and classification

The three families of crayfish

Astacidae: Austropotamobius pallipes

Cambaridae: Procambarus alleni

Parastacidae: Cherax pulcher.

Three families of crayfish are described, two in the Northern Hemisphere and one in the Southern Hemisphere. 

The Southern Hemisphere (Gondwana-distributed) family Parastacidae, with 14 extant genera and two extinct genera, live(d) in South America, Madagascar, and Australasia. 

Uses of Crayfish to humans :

Crayfish as Bioindicators for Monitoring level of pollution and ClO2 :

Monitoring of Pollution :

The Protivin brewery in the Czech Republic uses crayfish outfitted with sensors to detect any changes in their bodies or pulse activity in order to monitor the purity of the water used in their product. 

The creatures are kept in a fish tank that is fed with the same local natural source water used in their brewing. 

If three or more of the crayfish have changes to their pulses, employees know there is a change in the water and examine the parameters.

Scientists also monitor crayfish in the wild in natural bodies of water to study the levels of pollutants there.

Crayfish as Bioindicators for Monitoring ClO2 :

The research was conducted by : 

Research Institute of Fish Culture and Hydrobiology, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, 

Faculty of Fisheries and Protection of Waters, 

University of South Bohemia in České Budejovice, , Czech Republic

The effect of long-term exposure of signal crayfish to different levels of ClO2 were investigated and assessed through the observation of heart rate, diurnal rhythm and mortality.

The study showed the changes in the heart rate of unstimulated spiny lobster and the ClO2 exposed signal crayfish were similar in the premolting period.

The heart rate of an unaffected lobster increased 1–2 h before molting to a peak of 80–120 bpm and declined about 15 min before the beginning of molting. 

Other uses of Cray fish :

Food :

Crayfish are eaten worldwide. Like other edible crustaceans, only a small portion of the body of a crayfish is eaten. In most prepared dishes, such as soups, bisques and étouffées, only the tail portion is served. 

Bait :

Crayfish are preyed upon by a variety of ray-finned fishes,and are commonly used as bait, either live or with only the tail meat. They are a popular bait for catching catfish ,largemouth bass, smallmouth bass, striped bass,perch & pike.

Transporting crayfishes as live bait has also contributed to the spread of zebra mussels in various waterways throughout Europe and North America, as they are known to attach themselves to exoskeleton of crayfishes.

Pets

Crayfish are kept as pets in freshwater aquariums. They prefer foods like shrimp pellets or various vegetables, but will also eat tropical fish food, regular fish food, algae wafers, and small fish that can be captured with their claws. 

CARDIAC FAILURE : MANAGEMENT OF HEART FAILURE

 MANAGEMENT OF HEART FAILURE

Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help patients live longer. 

Lifestyle changes — such as exercising, reducing sodium in diet, managing stress and losing weight — can improve quality of life.

Treatment

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. 

Medications

Usually heart failure is treated by a combination of one or more medications.

These may include the medications given below:

Angiotensin-converting enzyme (ACE) inhibitors. 

These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).

Angiotensin II receptor blockers. 

These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who can't tolerate ACE inhibitors.

Beta blockers. 

This class of drugs not only slows heart rate and reduces blood pressure but also limits or reverses some of the damage to heart if a pt have systolic heart failure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).

These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help  live longer.

Diuretics. 

Often called water pills, diuretics make patient urinate more frequently and keep fluid from collecting in the body. Diuretics, such as furosemide (Lasix), also decrease fluid in lungs so pt can breathe more easily.

Aldosterone Antagonists. 

These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer. They can cause hyperkalemia so monitoring of potassium levels is important in the blood.

Inotropes. 

These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.

Digoxin (Lanoxin).

 This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.

Heart Failure : Causes , Investigations And NYHA / ACP Classifications

 CAUSES OF HEART FAILURE

Any of the following conditions can damage or weaken the heart and can cause heart failure. 

Coronary artery disease and heart attack. 

High blood pressure (hypertension)

Faulty heart valves

Damage to the heart muscle (cardiomyopathy)

Myocarditis

Heart defects /congenital heart defects

Abnormal heart rhythms (heart arrhythmias)

Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure.

INVESTIGATIONS IN HEART FAILURE

BLOOD TESTS : Raised levels of chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) .

Chest X-ray will shaow Cardiomegaly and Pulmonary congestion.

Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes .It will show arrythmias in CCF.

Echocardiogram. An echocardiogram measures your ejection fraction, an important measurement of how well your heart is pumping, and which is used to help classify heart failure and guide treatment.

CLASSIFICATION OF HEART FAILURE

New York Heart Association classification:

This symptom-based scale classifies heart failure in four categories. 

In Class I heart failure, you don't have any symptoms. 

In Class II heart failure, you can perform everyday activities without difficulty but become winded or fatigued when you exert yourself. 

With Class III, you'll have trouble completing everyday activities, and Class IV is the most severe, and you're short of breath even at rest.

American College of Cardiology/American Heart Association guidelines. 

This stage-based classification system uses letters A to D. The system includes a category for people who are at risk of developing heart failure.

For example, a person who has several risk factors for heart failure but no signs or symptoms of heart failure is Stage A. A person who has heart disease but no signs or symptoms of heart failure is Stage B. Someone who has heart disease and is experiencing or has experienced signs or symptoms of heart failure is Stage C. A person with advanced heart failure requiring specialized treatments is Stage D.

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CONGESTIVE CARDIAC FAILURE : INTRODUCTION, SYMPTOMS AND TYPES

 CONGESTIVE CARDIAC FAILURE : INTRODUCTION, SYMPTOMS AND TYPES

Heart failure, sometimes known as congestive heart failure, occurs when heart muscle doesn't pump blood as well as it should.

Certain conditions, such as narrowed arteries in heart (coronary artery disease) or high blood pressure, gradually leave heart too weak or stiff to fill and pump efficiently.

SYMPTOMS OF CONGESTIVE CARDIAC FAILURE

Heart failure can be ongoing (chronic), the condition may start suddenly (acute).

Heart failure signs and symptoms may include:

Shortness of breath (dyspnea) when on exertion or on lying down

Fatigue and weakness

Swelling (edema) of legs, ankles and feet

Rapid or irregular heartbeat

Reduced ability to exercise

Persistent cough or wheezing with white or pink blood-tinged phlegm.

Increased need to urinate at night.

Swelling of abdomen (ascites).

Very rapid weight gain from fluid retention

Lack of appetite and nausea.

Difficulty concentrating or decreased alertness.

Sudden, severe shortness of breath and coughing up pink, foamy mucus.

Chest pain if heart failure is caused by a heart attack

TYPES OF HEART FAILURE

Left-sided heart failure:

Fluid may back up in your lungs, causing shortness of breath.

Right-sided heart failure:

Fluid may back up into your abdomen, legs and feet, causing swelling.

Systolic heart failure:

The left ventricle can't contract vigorously, indicating a pumping problem

Diastolic heart failure:

Also called heart failure with preserved ejection fraction.

The left ventricle can't relax or fill fully, indicating a filling problem.

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Reporting of Deaths and Completion of Death Certificates ( UK & Scotland )

 Reporting of Deaths and Completion of Death Certificates ( UK & Scotland )

Which deaths should be reported to the coroner / Procurator fiscal in Scotland

Un natural deaths

Violent Deaths

Suspicious deaths

Deaths due to infected pressure sores

Cause of death is not known

Deceased was not seen by the certifying doctor either after death or within the 14 days before death.

Death due to an accident

Death due to neglect by self or others.

Suicide

Death due to abortion

Death due to an industrial disease which happened due to profession of the patient.

Death that occurred after a surgical procedure or before recovery from effects of anesthetic

Death that occurred shortly after police detention or prison custody.

Who fills the death certificate:

Part 1 is filled by someone from the medical team directly responsible for the patient care.

It should include as much accurate details of death as possible and circumstances leading to the death.

It should also include information on whether the coroner has been informed or not.

Part 2 needs to be filled by a Medical practitioner with atleast 5 years experience.

The person completing part 2 will have to contact the person completing part 1 of the certificate as well a another nurse practitioner or a doctor involved in patient care to exclude any suspicious cirmcumstances involed in the death of the patient under consideration.

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Counselling skills : Counselling a relative about sudden cardiac arrest and death of their husband

 Counselling a relative about sudden cardiac arrest and death of their husband

You are a junior doctor in the cardiac arrest team.

Mr X a 80 year old man was admitted with end stage Cardiac failure 5 days ago.

He suddenly suffered a cardiac arrest and resuscitation attempts ere not successful.

The charge ward sister wants you to speak to wifeof Mr X that he has died

Key principles :

Quiet room

No disturbance

Take nurse with you.

Leave your bleep and turn off the mobile phone.

The room should ideally be in the ward with accessibility to a landline phone.

There should be supply of tissue papers

Introduce yourself to the patient”s relative / wife and also the member of the staff & confirm her identity as well.

Also explain your role in the care pathway of the patient ie Junior doctor of Cardiac arrest team.

Exact relationship to the patient should be sought ie wife or daughter.

Be very elaborative in explaining exactly what has happened 

The patient had been doing poorly recently and then suddenly suffered a cardiac arrest.

Resuscitation was attempted but was futile and patient has died.

As this could be traumatizing and unexpected for the patient , hence let the information sink in and let the patient asks any questions .

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Introduce

Ask her what she knows about her husband already.

Poor state at time of admission.

It could be that the nurse might have not told her that her husband has actually died and only phoned her that he is doing poorly and she should come to the hospital immediately.

So it is very important to explore from her , how much she knows already or why she has been called to the hospital in order to take it from there.

After the wife understands, she may have some questions to ask

Why did this happen

Explain that his heart had been weak since he had advanced CCF

As a result his heart had not been able to pump efficiently and was unable to pump blood to the vital organs of the body and itself had grown weaker over time.

Wife may ask : What did you do to treat it

Explain when a cardiac arrest call was made , we gave him Oxygen and performed a cardiac massage and gave intravenous medications to try to help the heart back to its normal function and rhythm.

We also pressed up and down on the heart / chest to ensure blood keeps pumping blood to vital organs of the body.

Apart from that we gave  an electric shock called defibrillation to the heart to try to get the heart its electrical activity.

But all these measures proved futile and unfortunately his heart could not start to function again and he passed away and we are very sorry about it.

Wife may ask : did he feel any pain during the resuscitation

Answer : He became unconscious and it is unlikely he would have felt any pain at all.

Wife may ask : The resuscitation shown on TV is usually very successful

Explain in real life the figures are very low.

Heart beat inly returns to normal only in 30 % of pateints  who have cardiac arrest inside hospital and  resuscitation is successful.

And out of these 30 % only half actually survive and are fit enough later for a discharge.

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HYPOGLYCEMIA : INVESTIGATIONS , HISTORY TAKING & MANAGEMENT

 HYPOGLYCEMIA : INVESTIGATIONS , HISTORY TAKING & MANAGEMENT

Usual investigations include confirmation of hypoglycemia by finger prick testing or venous blood glucose levels.

Other useful tests include :

Serum Insulin levels

Serum C-peptide levels

HISTORY TAKING IN HYPOGLYCEMIA

Patients in hypoglycemic shock may be unable to give a history.

After treatment and resuscitation , they may provide some history but not complete details.

Hence it is important to take a collateral history from immediate relatives who may give best possible account of what happened.  

Ask about if the patient has diabetes or not and any predisposing factors for hypoglycemia.

Has the patient developed any recent infections ?

Has the patient changed his dose for insulin and treatment of diabetes.

Has the patient been drinking excessive alcohol.

Has the patient taken overdose of Insulin or Antidiabetic medications By Accident or deliberately.

MANAGEMENT OF HYPOGLYCEMIA

Start with the ABC approach ie Airway , Breathing and Circulation.

Exclude Opioid toxicity : pinpoint pupils and low respiratory rate.

Do a prick test to measure blood glucose levels.

If the patient is unconscious and has blood glucose (fingerprick ) / glucometer of less than 2.5 mmol/l , 50 ml of 50 % Dextrose should be given immediately via intra venous route.

In case intravenous access is not possible , intramuscular glucogon 1 mg should be given . But it will not be effective in hypoglycemia due to alcohol.

In case of hypoglycemia due to oral hypoglycemics and medium or long acting Insulins , the patients should not be discharged immediately after becomin conscious. Rather glucose should be monitored for a few hours and aim should be to maintain blood glucose at 5 mmol/l – 10 mmol/l by giving a dextrose infusion.

In case of treating hypoglycemia in malnourished or alcoholic patients , first intravenous thiamine should be given before glucose to avoid development of Wernickes encephalopathy.

METABOLIC MEDICINE : HYPOGLYCEMIA

 METABOLIC MEDICINE : HYPOGLYCEMIA

DEFINITION , SIGNS & SYMPTOMS,CLINICAL FEATURES,CAUSES

HYPOGLYCEMIA:

Hypoglycemia is a condition in which blood sugar (glucose) levels are lower than normal.

Glucose is the main energy source in the body

Hypoglycemia needs immediate treatment when blood sugar levels are low. Usually, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below indicates hypoglycemia and means urgent treatment should be started.

CAUSES OF HYPOGLYCEMIA :

DIABETIC PATIENTS

INSULIN

ORAL HYPOGLYCEMICS

EXCESSIVE EXERCISES

INCREASED ALCOHOL INTAKE

INFECTIONS

NON DIABETIC PATIENTS

INSULINOMA

SEPSIS

HYPOPITUITARISM

HEPATIC FAILURE

ADRENOCORTICAL INSUFFICIENCY

HYPOTHYROIDISM

CONCEALED INSULIN ADMINISTRATION

MEDICATIONS

SALICYLATE OVERDOSE

QUININE

ORAL HYPOGLYCEMICS

PENTAMIDINE

CLINICAL FEATURES/SYMPTOMS OF HYPOGLYCEMIA

Symptoms

If blood sugar levels become too low, signs and symptoms can include:

An irregular or fast heartbeat

Fatigue

Pale skin

Shakiness

Anxiety

Sweating

Hunger

Irritability

Tingling or numbness of the lips, tongue or cheek

As hypoglycemia worsens, signs and symptoms can include:

Confusion, abnormal behavior or both, such as the inability to complete routine tasks

Visual disturbances, such as blurred vision

Seizures

Loss of consciousness

RESPIRATORY MEDICINE MADE SIMPLE : TREATMENT OF PULMONARY EMBOLISM

 

TREATMENT OF PULMONARY EMBOLISM

Anticoagulation for Pulmonary Embolism

Unfractionated heparin therapy

In patients with acute PE, anticoagulation with IV UFH, LMWH, or fondaparinux is preferred over no anticoagulation. Most patients with acute PE should receive LMWH or fondaparinux instead of IV UFH. If IV UFH is chosen, an initial bolus of 80 U/kg or 5000 U followed by an infusion of 18 U/kg/h or 1300 U/h should be given, with the goal of rapidly achieving and maintaining the aPTT at levels that correspond to therapeutic heparin levels. Fixed-dose and monitored regimens of subcutaneous UFH are available and are acceptable alternatives.

Low-molecular-weight heparin therapy

Current guidelines for patients with acute PE recommend LMWH over IV UFH (grade 2C) and over SC UFH (grade 2B).  In patients being treated with LMWH, once-daily regimens are preferred over twice-daily regimens (grade 2C). The choice between fondaparinux and LMWH should be based on local considerations to include cost, availability, and familiarity of use.

LMWHs have many advantages over UFH. These agents have a greater bioavailability, can be administered by subcutaneous injections, and have a longer duration of anticoagulant effect. A fixed dose of LMWH can be used, and laboratory monitoring of aPTT is not necessary.

Direct thrombin inhibitors and factor Xa inhibitors

Apixaban, dabigatran, rivaroxaban, and edoxaban are alternatives to warfarin for prophylaxis and treatment of PE. Apixaban, edoxaban, and rivaroxaban inhibit factor Xa, whereas dabigatran is a direct thrombin inhibitor.

Rivaroxaban

Rivaroxaban (Xarelto) is an oral factor Xa inhibitor approved by the FDA in November 2012 for the treatment of DVT or PE, and to reduce risk of recurrent DVT and PE following initial treatment.

Fondaparinux

In patients with acute PE, fondaparinux as initial treatment is favored over IV UFH and over SC UFH.The choice between fondaparinux and LMWH should be based on local considerations to include cost, availability, and familiarity of use. Fondaparinux is a synthetic polysaccharide derived from the antithrombin binding region of heparin. Fondaparinux catalyzes factor Xa inactivation by antithrombin without inhibiting thrombin.

 

Warfarin therapy

A vitamin K antagonist such as warfarin should be started on the same day as anticoagulant therapy in patients with acute PE. Parenteral anticoagulation and warfarin should be continued together for a minimum of at least five days and until the INR is 2.0.

The anticoagulant effect of warfarin is mediated by the inhibition of vitamin K–dependent factors, which are II, VII, IX, and X. The peak effect does not occur until 36-72 hours after drug administration, and the dosage is difficult to titrate.

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RESPIRATORY MEDICINE MADE SIMPLE : PREVENTION OF PULMONARY EMBOLISM

 PREVENTION OF PULMONARY EMBOLISM

Prevention

Preventing clots in the deep veins in  legs (deep vein thrombosis) will help prevent pulmonary embolism. For this reason, most hospitals are aggressive about taking measures to prevent blood clots, including: https://www.amazon.ae/b?node=17525046031&ref_=pe_27500621_482106381?tag=XXXX

Blood thinners (anticoagulants).

These medications are often given to people at risk of clots before and after an operation — as well as to people admitted to the hospital with medical conditions, such as heart attack, stroke or complications of cancer.

Compression stockings.

Compression stockings steadily squeeze your legs, helping your veins and leg muscles move blood more efficiently. They offer a safe, simple and inexpensive way to keep blood from stagnating during and after general surgery.

Leg elevation.

Elevating your legs when possible and during the night also can be very effective. Raise the bottom of your bed 4 to 6 inches (10 to 15 cm) with blocks or books.

Physical activity.

Moving as soon as possible after surgery can help prevent pulmonary embolism and hasten recovery overall. This is one of the main reasons your nurse may push you to get up, even on your day of surgery, and walk despite pain at the site of your surgical incision.

Pneumatic compression.

This treatment uses thigh-high or calf-high cuffs that automatically inflate with air and deflate every few minutes to massage and squeeze the veins in your legs and improve blood flow.

Prevention while traveling

The risk of blood clots developing while traveling is low, but increases as long-haul travel increases. If you have risk factors for blood clots and you're concerned about travel, talk with your doctor.

Drink plenty of fluids.

Water is the best liquid for preventing dehydration, which can contribute to the development of blood clots. Avoid alcohol, which contributes to fluid loss.

Take a break from sitting.

Move around the airplane cabin once an hour or so. If you're driving, stop every so often and walk around the car a couple of times. Do a few deep knee bends.

Fidget in your seat. Flex your ankles every 15 to 30 minutes.

Wear support stockings. They  help promote circulation and fluid movement in your legs. Compression stockings are available in a range of stylish colors and textures. There are even devices, called stocking butlers, to help you put on the stockings.

COMPLICATIONS OF PULMONARY EMBOLISM

Complications

Pulmonary embolism can be life-threatening. About one-third of people with undiagnosed and untreated pulmonary embolism don't survive. When the condition is diagnosed and treated promptly, however, that number drops dramatically.

Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in your lungs and in the right side of the heart is too high. When you have obstructions in the arteries inside your lungs, your heart must work harder to push blood through those vessels, which increases blood pressure and eventually weakens your heart.

In rare cases, small emboli occur frequently and develop over time, resulting in chronic pulmonary hypertension, also known as chronic thromboembolic pulmonary hypertension.