Skutki zdrowotne ekspozycji na promieniowanie jonizujące

Cel: W publikacji omówiono skutki działania promieniowania jonizującego na organizm ludzki. W przeświadczeniu autorów przedstawienie problematyki zdarzeń radiacyjnych od strony skutków napromieniowania pozwoli na lepsze przygotowanie na wypadek ich wystąpienia, a w konsekwencji bezpieczniejsze działanie w trakcie tego zagrożenia. Wprowadzenie: Coraz szersze zastosowanie materiałów promieniotwórczych i urządzeń wytwarzających promieniowanie jonizujące w wielu obszarach naszego życia niesie za sobą ryzyko narażenia na działanie niebezpiecznych dla zdrowia dawek promieniowania. Dawki te mogą być generowane wskutek uszkodzenia źródeł promieniowania lub postępowania z nimi w nieodpowiedni sposób. Nie można również wykluczyć narażeń wynikających z intencjonalnego wykorzystania materiałów promieniotwórczych w działaniach kryminalnych lub terrorystycznych. Narażenie na promieniowanie jonizujące może wywołać negatywne skutki zdrowotne – zarówno u ofiar zdarzenia radiacyjnego, jak i u ratowników udzielających ofiarom pomocy. Istniejące zagrożenia wymagają więc odpowiedniego przygotowania medycznych służb ratowniczych. Jednym z elementów tych przygotowań jest poznanie specyfiki zagrożeń radiacyjnych, w tym źródeł promieniowania, mechanizmu działania poszczególnych form promieniowania jonizującego, a także rodzaju obrażeń radiacyjnych, które wywołują. Metodologia: W artykule przedstawiono właściwości promieniowania jonizującego, najbardziej istotne z punktu widzenia ratownictwa medycznego. Omówiono zagadnienia związane z kontaktem ze źródłem promieniowania, skażenia zewnętrznego i wewnętrznego, pomiaru wielkości ekspozycji i dawek pochłoniętych oraz zaprezentowano wzajemne zależności pomiędzy nimi. Szczegółowo opisano mechanizm bezpośredniego i pośredniego działania promieniowania jonizującego na struktury komórkowe (DNA, mRNA, błony cytoplazmatyczne) enzymy wewnątrzkomórkowe. Przedstawiono konsekwencje zdrowotne dla organizmu w postaci uszkodzeń ostrych (deterministycznych) i zmian późnych (stochastycznych). Wnioski: Szczególną uwagę zwrócono na ostry zespół radiacyjny (ang. Acute Radiation Syndrome, ARS). Szczegółowo omówiono zależność poszczególnych postaci ARS od wielkości pochłoniętej dawki. Przedstawiono każdą z faz ARS: wstępną, utajoną, rozwiniętych objawów i zdrowienia (śmierci) oraz czas ich wystąpienia, długość trwania i moment zakończenia. Scharakteryzowano mechanizm uszkodzenia poszczególnych narządów i układów. Wskazano najczęstsze objawy, ich nasilenie i przyczyny zagrożenia życia w poszczególnych postaciach ARS. Obok skutków ogólnoustrojowych opisano zmiany miejscowe pod postacią radiacyjnego zespołu skórnego (ang. Cutaneous Radiation Syndrome, CSR).Purpose: The effects of ionising radiation on the human body has been discussed. The authors believe that the understanding of the radiation incidents from the perspective of its effects is crucial for better preparation, and therefore safer and more effective responses to incidents involving such threats. Introduction: The increasing use of radioactive materials and radiation producing devices in many areas of our lives carries the risk of exposure to high doses of radiation being hazardous to our health due to possible damage to radiation sources or improper handling. Exposure resulting from the intentional use of radioactive materials for criminal or terrorist purposes cannot be excluded, either. Exposure to ionising radiation may cause adverse health effects both to victims of a radiation incident and for rescuers providing emergency care. Such threats require the proper preparation of emergency medical services (EMS). Part of these preparations is to examine the specifics of radiation hazards, including radiation sources, the mechanism of injury of ionising radiation and the type of radiation damage. Methodology: The publication presents the properties of ionising, corpuscular and electromagnetic types of radiation, which are the most important from EMS’s perspective. The dangers of contact with a radiation source, the problem of external and internal contamination, the estimation of the amount of absorbed radiation were discussed, and the interrelationships between them were presented. The mechanism of direct and indirect action of ionising radiation on cell structures (DNA, mRNA, cytoplasmic membranes) and intracellular enzymes was thoroughly discussed. The authors presented health consequences of radiation for the body in the form of acute (deterministic) lesions and late (stochastic) lesions. Conclusions: Particular attention was paid to acute radiation syndrome (ARS). The dependence of ARS on the amount of absorbed radiation was discussed in detail. Four stages of ARS were presented: initial, latent, manifest illness and recovery (or death) as well as the time of their onset, duration and end. The mechanism of damage to individual organs and systems was also analysed. The most common symptoms, their severity, and causes of life-threatening conditions, resulting from radiation damage in particular syndromes of ARS, were indicated. In addition to systemic effects, local changes in the form of Cutaneous Radiation Syndrome (CSR) were discussed

The attractiveness of family medicine among Polish medical students

Background: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. Objectives : To investigate the career choices of Polish students in different stages of their medical education. Methods : Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. Results : A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. Conclusion: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six

Biomarkers of trastuzumab-induced cardiac toxicity in HER2- positive breast cancer patient population

SIMPLE SUMMARY: Trastuzumab administered as a (neo)adjuvant therapy in radically treated Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer patients improves overall survival. This study aimed to assess if factors commonly thought to play a role as biomarkers of trastuzumab-induced cardiotoxicity (TIC) are pathognomonic for this injury. Data obtained for 130 HER2-positive breast cancer patients do not support an influence of N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), or myoglobin on the frequency of TIC. Suggestions for trastuzumab therapy include: close cooperation between cardiologists and oncologists; not using NT-proBNP, CK-MB, or myoglobin as standard TIC predictive markers; organizing prospective studies assessing the role of these parameters as TIC predictive markers in the case of HER2 blockage in conjunction with doublet immunotherapy or other anti-HER2 agents. ABSTRACT: Trastuzumab-induced cardiotoxicity (TIC) can lead to early treatment discontinuation. The aim of this study was to evaluate: N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), myoglobin, and selected biochemical and clinical factors as predictors of TIC. One hundred and thirty patients with HER2-positive BC receiving adjuvant trastuzumab therapy (TT) were enrolled. Measurement of cardiac markers and biochemical tests as well as echocardiography were performed prior to TT initiation and every three months thereafter. Cardiotoxicity leading to treatment interruption occurred in 24 patients (18.5%). While cardiotoxicity caused early treatment discontinuation in 14 patients (10.8%), the TIC resolved in 10 (7.7%) and TT was resumed. The most common complication was a decrease in left ventricular ejection fraction of more than 10% from baseline or below 50% (7.7%). In patients with TIC, there was no increase in the levels of NT-proBNP, myoglobin, and CK-MB. BMI, hypertension, ischemic heart disease, diabetes, age, cancer stage, type of surgery, use of radiotherapy, chemotherapy, and hormone therapy were shown to not have an effect on TIC occurrence. NT-proBNP, myoglobin, and CK-MB are not predictors of TIC. There is an ongoing need to identify biomarkers for TIC