Post CoViD complex

Post CoViD complex is a cluster of conditions which may effect a person convalescing from active CoViD infection, 4 or more weeks after the initial infection. The initial may or may not be clinically detectable. As this is an evolving disease and not much definitive research has been done, we are still finding newer and varied conditions, causation of which  is not otherwise explainable. 

According to the information on the CDC USA website, there can be 2 types of symptoms

1. New symptoms

2. Ongoing symptoms

New Symptoms - These are the symptoms which were not present during the initial infection period and have arisen 4 weeks after that. 

Ongoing Symptoms - These are the symptoms which started during the initial infection and never completely went away after the initial infection. 

Following is a list of common symptoms 

1. Difficulty breathing or shortness of breath
2. Tiredness or fatigue
3. Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
4. Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
5. Cough
6. Chest or stomach pain
7. Headache
8. Fast-beating or pounding heart (also known as heart palpitations)
9. Joint or muscle pain
10. Pins-and-needles feeling
11. Diarrhea
12. Sleep problems
13. Fever
14. Dizziness on standing (lightheadedness)
15. Rash
16. Mood changes
17. Change in smell or taste
18. Changes in menstrual period cycles

Prevention

The best way to prevent post-CoViD conditions is to prevent COVID-19 illness.

Source - National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

Radiation Terrorism Part 2

Types of Contamination

It can be of 3 types

• Whole body exposure
• External
• Internal

1. Whole body exposure
• Gamma rays, x-rays and neutrons which can penetrate through the body and cause severe tissue damage.
2. External contamination
• Effects body surface, clothing, skin, and hair.
• This is the main thing to be concerned about in a radioactive terrorist strike.
• These consist mainly of alpha and beta radiation.
• Alpha particles cause surface burns only.
• Beta particles can cause cutaneous burns and scarring.

More on Internal contamination in my next post. 

Radiation Terrorism Part 1

Types of Radio-isotopic Radiation

4 main types viz.

• alpha
• beta
• gamma
• neutrons.

1. Alpha radiation - 
• These are positively charged particles, with 2 protons and 2 neutrons.  
• Large particles, so they have limited penetrating power.
• If internalized, they can cause significant cellular damage.
2. Beta radiation - 
• Negatively charged particles consisting of electrons.
• Penetrating power depends on their energy.
• A good example is radioactive iodine released in nuclear plant accidents.
• They can cause a burn (similar to a thermal burn and is treated as such)
3. Gamma rays and x-rays (both photons) - 
• Gamma rays are uncharged electromagnetic radiation discharged from a nucleus as a wave or photons of energy.
• X-rays are the product of abrupt mechanical deceleration of electrons striking a heavy target such as tungsten.
• Both travel easily through matter, high penetrating power.
4. Neutron particles - 
• These are heavy and uncharged, often emitted during nuclear detonation.
• Ability to penetrate tissues is variable, depending on their energy.

Treatment of Malaria in India

1. Uncomplicated Malaria (sensitive to chloroquine)
P. vivax – chloroquine 25 mg/kg over 3 days + Primaquine 0.25 mg/kg OD for 14 days
P. falciparum - chloroquine 25 mg/kg over 3 days + Primaquine 45 mg single dose

2. Uncomplicated Malaria (chloroquine resistant)
Artemisinin Combination Therapy (ACT) i.e Artesunate 50 mg + Sulfadoxine 500 mg + Pyrimethamine 25 mg for 3 days

3. Severe Malaria
Artesunate- 2.4 mg/kg @ 0 hrs, 1.2 mg/kg @ 12 hrs, 24 hrs, then OD, IV/IM
Quinine- LD:20 mg/kg, MD:10 mg/kg, both in 5% Dextrose
Artemether- 3.2 mg/kg IM on day 1, then 1.6 mg/kg IM OD
ab Arteether- 150 mg daily i.m. for 3 days in adults only
Switch to oral anti-malarials as soon as condition improves

Hypersplenism

Condition in which spleen removes circulating RBCs, granulocytes and platelets in excess quantity.

Diagnosis:

1. Pancytopenia
2. Normal or hypercellular bone marrow
3. Splenomegaly
4. Correction of cytopenias after splenectomy

Classification

1. Primary – when no aetiology for enlarged spleen is found.
2. Secondary –
1. Portal hypertension
2. Infiltrative disease, lymphoma, myelofibrosis
3. Hemolyitc anaemias, hematological disorders
4. Rheumatoid arthritis (Felty’s syndrome)
5. Tropical splenomegaly syndrome

Pathogenesis

When splenic size increases, there is increases pooling of blood in an environment with relatively reduced availability of nutrients but full of phagocytes.

This leads to exaggerated sequestration and destruction of cells leading to

1. Pancytopenia
2. Hemolysis
3. Increased plasma volume

Treatment

Therapy needed when cytopenias become severe and symptomatic

Treatment of underlying causes

Splenectomy if underlying cause cannot be corrected or treated