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By L. Riordian. University of Sioux Falls.

The symptoms of fetal alco- hol syndrome include facial abnormalities cheap midamor 45 mg mastercard pulse pressure is calculated by quizlet, neurological and cognitive impairments discount midamor 45mg free shipping blood pressure explained, and decient growth with a wide variation in the clinical features (44) midamor 45mg with mastercard pulse pressure points diagram. Not much is known about the prevalence in most countries but buy midamor 45 mg with amex hypertension benign essential, in the United States, available data show that the prevalence is between 0. Though there is little doubt about the role of alcohol in this condition, it is not clear at what level of drinking and during what stage of pregnancy it is most likely to occur. Hence the best advice to pregnant women or those contemplating pregnancy seems to be to abstain from drinking, because without alcohol the disorder will not occur. In its usual form it starts in an insidious, progressive way with signs located at the distal ends of the lower limbs: night cramps, bizarre sensations of the feet and the sufferer is quickly fatigued when walking. This polyneuropathy evolves to a complete form with permanent pain in the feet and legs. The signs of evolution of alcoholic polyneuropathy are represented by the decit of the leg muscles leading to abnormal walk, exaggerated pain (compared to burning, at any contact) and skin changes. The onset of the peripheral neuropathy depends on the age of the patient, the duration of the abuse and also the amount of alcohol consumed. The excessive abuse of this substance determines the central and/or peripheral nervous lesions. Wernicke s encephalopathy Wernicke s encephalopathy is the acute consequence of a vitamin B1 deciency in people with severe alcohol abuse. It is due to very poor diet, intestinal malabsorption and loss of liver thiamine stores. The onset may coincide with an abstinence period and is generally marked by somnolence and mental confusion; which gradually worsens, together with cerebellar signs, hypertonia, pa- ralysis and/or ocular signs. The prognosis depends on how quickly the patient is given high-dose vitamin B1 (by intravenous route, preferably). A delay or an absence of treatment increases the risk of psychiatric sequelae (memory disorders and/or intellectual deterioration). If the treatment is too late, the consequences could be an evolution to a Wernicke Korsakoff syndrome, a dementia. Alcohol and epilepsy Alcohol is associated with different aspects of epilepsy, ranging from the development of the condition in chronic heavy drinkers and dependent individuals to an increased number of seizures in people already with the condition. Alcohol aggravates seizures in people undergoing withdrawal and seizure medicines might interfere with tolerance for alcohol, thereby increasing its effect. Though small amounts of alcohol might be safe, people suffering from epilepsy should be advised to abstain from consuming this agent. After an episode of weeks of uninterrupted drinking, sudden abstinence may lead to epileptic seizures and severe coma, delirium tremens. Detoxication should be under medical supervision and possibly with medication to decrease the risk of this potentially life-threatening condition. In terms of relative risk, much more is known about alcohol and epilepsy than other conditions. There is little difference between abstainers and light drinkers in the risk for chronic harmful alco- hol-related epilepsy. Risk is highest at levels of consumption which exceed 20 g of pure alcohol (or two drinks) per day for women and 40 g for men. Acknowledg- ing that eradicating poverty is easier said than done, there are some strategies that can be used to prevent some of the micronutrient deciencies. There are three principal ways of approaching a potentially micronutrient-decient diet: Diversication include other micronutrient-rich food items in the diet. This method is used with vitamin A in a large number of low income countries, linked to the immunization programme. Worldwide efforts to cope with the most appalling micronutrient deciencies are ongoing. Adding iodine to all salt has been a very successful way of preventing neurological complications caused by iodine deciency. Supplementation of vitamin A for children under ve years of age is another successful strategy to prevent blindness as a result of vitamin A deciency. In societies with more resources and more centralized food distribution, fortication of our with folate has been shown to decrease the occurrence of neural tube defects. In populations with restricted food choice, such as refugee populations in camps surviving on food rations, surveillance is needed to detect and correct vitamin deciencies. Another pos- sibility is the development of a genetically modied atoxic variety that could prevent the problem. In the case of insufciently processed toxic cassava, this solution does not seem so attractive, as low-toxic varieties are not as reliable in producing food for the family; the approach should concentrate on the proper processing of cassava. For alcohol, the focus needs to be on restricting alcohol consumption, at least during pregnancy. The large majority of the malnutrition-related neurological disorders can be avoided by simple measures, such as the following recommended actions for policy-makers. A preventive approach should include adapted communication with the aim of changing be- haviour, strengthening capacities and reducing the incidence of some chronic diseases such as frequent neurological complications. The following activities are possible examples: specic nutritional programmes for children and pregnant and nursing women; rapid diagnosis of nutritional deciencies in vitamins and minerals that could have a severe impact on mother and child and alter their mental and physical status and development; nationwide measures such as those for the prevention of iodine deciency and its conse- quences. In many countries, the mass interventions against iron, vitamin A and iodine deciencies among children (those under ve years of age and older ones as well) and pregnant and nursing women, must be reinforced. At the other end of the scale, much remains to be done for adults and elderly people. Improving the dialogue between public and private sectors should be an important approach to emphasize in every country. Efforts remain to be made for a comprehensive salt iodization as recommended by international organizations. This implicates obligatory reinforcement of policies for legislation, standards, application and control. Regulations on the advertising of beers, wines, other alcoholic drinks and tobacco must be reinforced, especially during sports and cultural events. Nigerian President Olusegun Obasanjo has lent his support to the goal of reducing death from chronic dis- ease: Governments have a responsibility to support their citizens in their pursuit of a healthy, long life. It is not enough to say: we have told them not to smoke, we have told them to eat fruit and vegetables, we have told them to take regular exercise. We must create communities, schools, workplaces and markets that make these healthy choices possible. Lessons learnt from other integrated programmes (for both noncommunicable and communicable diseases) could serve as a model for neurological disorders associated with malnutrition. It is essential to set up a multidisciplinary task force surrounding neurologists and nutritionists. This team should be supplemented by clinicians who are concerned with the secondary causes of neurological diseases related to nutrition, i. Social scientists would also have an important role, for a better understanding of knowledge, attitudes and practices. Specialists in communication would be involved in the initiative, so as to reach, educate and sensitize the population. Other sectors such as education, private and public sectors, civil society, community leaders and nongovernmental organizations will all have a part to play to contribute to the concretization and reinforcement of the strategies and interventions. Schools constitute a favourable environment because they provide access to teachers and pupils who can carry the message home at household level. The capacities of nongovernmental organizations, community organizations and the education sector must be reinforced and developed so as to target the prevention of nutritional problems.

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Manuscript in a microform Availability for Individual Manuscripts (optional) General Rules for Availability Enter the phrase "Located at" followed by a colon and a space Give the name of the library or archive 45 mg midamor with mastercard blood pressure of 120/80, preceded by any subsidiary division(s) order midamor 45mg with amex heart attack at 25, and followed with a comma and a space order 45 mg midamor with visa heart attack ekg. Bibliotyeka purchase midamor 45 mg without prescription blood pressure chart dental treatment, Rossiiskaia Akademiia Meditsinskikh Nauk [Library, Russian Academy of Medical Sciences] or Manuscripts 651 [Library, Russian Academy of Medical Sciences] Translate names of organizations in character-based languages such as Chinese and Japanese. If you choose an angelicized form for a city name or choose a country code, use that same form or code throughout all references. Manuscript with information on availability 652 Citing Medicine Language for Individual Manuscripts (required) General Rules for Language Give the language of the manuscript if other than English Capitalize the language name Follow the language name with a period Examples for Language 12. Manuscript with title in a language other than English with optional translation Notes for Individual Manuscripts (optional) General Rules for Notes Notes is a collective term for any type of useful information given after the citation itself Complete sentences are not required Be brief Specific Rules for Notes Information about any restrictions on use Other types of material to include in notes Box 32 Information about any restrictions on use A library or other archive may place a variety of restrictions on the use of manuscripts, or the donors of the manuscripts may restrict use. No part of this manuscript may be quoted without the written permission of the Director of the Schlesinger Library and Helen Brooke Taussig, M. Box 33 Other types of material to include in notes Notes is a collective term for any useful information given after the citation itself. Examples include: If the manuscript was translated, provide the name of the original document Heister, Lorenz. Apparently written by a military doctor providing a concise history of the origins and progress of an epidemic of measles and scarlet fever that swept through the city of Queretaro, Mexico, during the summer and early fall of 1825. Manuscript with supplemental note included Examples of Citations to Individual Manuscripts 1. Manuscript author name or secondary author name with designations of rank within a family Heister, Lorenz. The basic sciences: their relationship to the control and regulation of the healing arts. Manuscript with no authors found Arzneybuchlein von mancherley bewarthen und erfahrnen Arzneyen, fur allerley Zufalle und Krankheiten des menschlichen Leibs dienstlich. Descripcion y plan curativo de la epidemia que ha reinado en Queretaro desde fines de junio de este presente ano, hasta la fecha en que esto se escribia [Description and treatment plan for the epidemic that occurred in Queretaro in June of this year, until the date of this writing]. Arzneybuchlein von mancherley bewarthen und erfahrnen Arzneyen, fur allerley Zufalle und Krankheiten des menschlichen Leibs dienstlich. Manuscript with title in a language other than English with optional translation De la grippe et de son traitement par le sulfate de quinine: 2 e partie. Manuscript with translators and other secondary authors Berengario da Carpi, Jacopo. Manuel des operations de chirurgerie par monsieur De Puys premier medicine du Royal Hopital de la Marine de Rochefort [Surgical operations manual of Monsieur De Puy, chief of medicine of the Royal Hospital de la Marine de Rochefort]. Manuscript date with month or month and day provided Kansas Legislative Council, Research Department. Relations of the war to medical science: the annual address delivered before the Westchester Co. Descripcion y plan curativo de la epidemia que ha reinado en Queretaro desde fines de junio de este presente ano, hasta la fecha en que esto se escribia [Description and treatment plan for the epidemic that occurred in Queretaro from the end of June of this year, until the date of this writing]. Apparently written by a military doctor providing a concise history of the origins and progress of an epidemic of 660 Citing Medicine measles and scarlet fever that swept through the city of Queretaro, Mexico, during the summer and early fall of 1825. Chabert came to Paris where he taught at and, in 1780, took over the Royal Veterinary School. In two sections: the first is mainly Greek Orthodox Christian prayers for clergy members for the benefit of sick laypersons in their care; the second half contains recipes for medicines and directions for therapies, also written for clergy. Original manuscript of the printed article found in the Indian Medical Gazette, June 1920. Sample Citation and Introduction to Citing Manuscript Collections The general format for a reference to a manuscript collection, including punctuation: Examples of Citations to Manuscript Collections A manuscript refers to any type of work, either handwritten or typewritten, that is not published. Titles for collections of manuscripts are unusual in that they are assigned by the library or other Manuscripts 661 archive housing the collection. Although they are thus constructed titles, they are not placed in square brackets as are constructed titles for books. If a manuscript collection is not available in any public archive, most authorities recommend placing references to it within the running text, not as a formal end reference. Place the source information in parentheses, using a term or terms to indicate clearly that the citation is not represented in the reference list. For example: material gathered from a collection of papers of Harold Jones (private collection; unreferenced, see "Notes") that The rules below apply when a manuscript collection is included in a reference list rather than within the text as described above. Note that most of the examples for citations provided in this chapter are taken from the Modern Manuscripts Collection of the National Library of Medicine. Citation Rules with Examples for Manuscript Collections Components/elements are listed in the order they should appear in a reference. Box 35 Other surname rules Keep prefixes in surnames Lama Al Bassit becomes Al Bassit, Lama Jiddeke M. Box 42 No author can be found If no person or organization can be found as the author but a compiler is present, begin the reference with the name of the compiler. Follow the same rules as used for author names, but end the list of names with a comma and the word compiler. Manuscripts 667 If no person or organization can be identified as the author or compiler and no translators are given, begin the reference with the title of the manuscript collection. Box 47 Names for cities and countries not in English Use the English form for names of cities and countries whenever possible. Manuscript collection with items not in English Type of Medium for Manuscript Collections (required) General Rules for Type of Medium Indicate the specific type of medium (microfilm, microfiche, etc. Manuscript collection in microform Secondary Author for Manuscript Collections (optional) General Rules for Secondary Author A secondary author modifies the work of the author. Box 52 Secondary author performing more than one role If the same secondary author performs more than one role: List all the roles in the order they are given Separate the roles by "and" End secondary author information with a period Example: Jones, Albert B. Box 53 Non-English names for secondary authors Translate the word found for editor, translator, illustrator, or other secondary author into English whenever possible. Manuscript collection with author and compiler Date for Manuscript Collections (required) General Rules for Date Give the date range of the items in the collection Enter the earliest date of the items in the collection, a hyphen, and the latest date of the items. Manuscript collection with dates estimated Extent (Pagination) for Manuscript Collections (optional) General Rules for Pagination Give the total number of the items in the collection End with a semicolon and a space if Physical Description is provided; end with a period if there is no physical description Specific Rules for Pagination Collection bound in volumes Number of items unknown Box 58 Collection bound in volumes A collection of manuscripts may be bound in volumes rather than being placed in boxes or other containers. When this occurs: Express extent as the number of volumes Abbreviate volume to vol. Box 59 Number of items unknown A collection may be so large that an exact count of the number of items in it has not been made. Manuscript collection with extent estimated Physical Description for Manuscript Collections (optional) General Rules for Physical Description Give the total number of containers holding the collection and/or the total number of linear feet of shelf space the collection occupies Follow with the type of container or the words linear feet, such as 3 boxes or 10 linear feet End with a period Give information on the total number and physical characteristics of the items in the collection if they reside in a microform, such as 26 microfiche: black & white, 4 x 6 in. Typical words used include: color black & white positive negative Manuscripts 679 4 x 6 in. Box 61 More than one type of medium If a manuscript collection is in a microform such as microfilm or microfiche, place the name of the type of microform after the title in square brackets Alchemy collection [microfilm]. Manuscript collection with physical description Availability for Manuscript Collections (required) General Rules for Availability Enter the phrase "Located at" followed by a colon and a space Give the name of the library or archive, preceded by any subsidiary division(s), and followed by a comma and a space. Bibliotyeka, Rossiiskaia Akademiia Meditsinskikh Nauk [Library, Russian Academy of Medical Sciences] or [Library, Russian Academy of Medical Sciences] Translate names of organizations in character-based languages such as Chinese and Japanese. Manuscript collection with availability Language for Manuscript Collections (required) General Rules for Language Give the language of the collection if not English Capitalize the language name Follow the language name with a period Specific Rules for Language Collections with items in more than one language Box 62 Collections with items in more than one language If the items in the collection appear in more than one language, give all languages found, separating them by a comma and a space Examples: von Diringshofen, Heinz. Box 66 Collections with restrictions on use A library or other archive may place a variety of restrictions on the use of manuscript collections, or the donors of the manuscripts may restrict use. Gertrude Henle required to quote, cite, paraphrase, or publish any of the unpublished material during her lifetime. Box 67 Other types of material to include in notes Notes is a collective term for any type of useful information given after the citation itself.

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Theophylline Despite its long use and popularity in this age group buy generic midamor 45 mg line pulse jet pressure, few data are available on theophylline effectiveness in infants buy generic midamor 45mg blood pressure medication cause erectile dysfunction. Studies comparing theophylline to sodium cromolyn in children under 5 years of age ( 71) have reported that cromolyn is superior to theophylline in controlling symptoms 45 mg midamor with mastercard blood pressure under 80. However best midamor 45 mg blood pressure 70 over 50, theophylline is superior to ketotifen and placebo in controlling symptoms in this age group ( 72). Concern about theophylline side effects ranging from mild nausea, insomnia, and agitation to life-threatening cardiac arrhythmias and encephalopathic seizures have limited its use now that safer medications are available ( 73). Checking serum concentrations of theophylline is necessary to achieve maximal benefits without significant side effects, and minor symptoms are not predictive of elevated levels ( 74). Most serious side effects occur when the serum concentration of theophylline exceeds 20 mg/dL. Corticosteroids Corticosteroids are potent antiinflammatory medications that have profound effects on asthma. They decrease inflammatory mediators, reduce mucus production, decrease mucosal edema, and increase b-adrenergic responsiveness. Clinically, they improve lung function, reduce airway hyperreactivity, and modify the late-phase asthmatic response. The use of oral or intravenous corticosteroids for acute exacerbations of wheezing in infants is controversial. Numerous studies clearly do not demonstrate an effect when these drugs are used for bronchiolitis ( 76,77), and some studies do not show an effect in a broad population of wheezing infants under 18 months of age ( 78). Asthmatic infants treated with steroids have a significantly reduced need for hospitalization (79) and markedly improved symptom scores when compared with placebo (80). As with all studies involving treatment of wheezing in this age group, the heterogeneity of the underlying cause of the acute wheezing is probably the reason for the wide discrepancy seen in results. It appears evident that the younger the infant, the less likely that steroids will have an effect, and that those with true bronchiolitis do not respond as well to steroid treatment. Despite these inconclusive data, infants with acute wheezing who have a history consistent with infantile asthma should be treated with systemic steroids. Intramuscular dexamethasone may be used in those infants who do not tolerate oral steroids ( 81). Inhaled steroids provide many of the beneficial antiinflammatory properties of corticosteroids without numerous unwanted side effects. However, newer inhaled steroids such as fluticasone ( 83) and budesonide are reported to be effective in this age group. Treatment of 1- to 3-year-old children with inhaled budesonide using a face mask spacer for 10 days at the first sign of a viral upper respiratory infection leads to a significant decrease in wheezing, cough, noisy breathing, and breathlessness ( 87). Studies of short-term linear growth in children on inhaled steroids suggest some decrease in growth velocity. However, the long-term effects on adult height remain unknown because catch-up growth may occur during puberty ( 88,89). There is no evidence of altered adrenal function due to inhaled steroids in infants or small children except in very low birth weight premature infants ( 90). The use of inhaled steroids and the recent increased availability of nebulized inhaled steroids (such as with budesonide) offer a significant advance in the management of infantile asthma. However, the potential for growth effects and other problems due to systemic absorption in these considerably smaller patients could be increased. For these reasons, these medications should be reserved for those infants who have failed nonsteroidal antiinflammatory medications. Pulmonary function tests demonstrate that infants exposed to passive smoke in utero have decreased lung functions after birth ( 91). This may partially explain why these infants are at higher risk for wheezing during infancy. Infants with low compliance values were significantly more likely to go on to wheeze in the first 2 years of life compared with nonwheezing infants (92). Infants genetically predisposed to asthma or exposed to passive smoking have decreased compliance at 1 month of age. Increased pulmonary function measurements are noted in those infants who started wheezing in the first year of life and then improve compared with those who continue to wheeze (93). Availability of infant pulmonary function tests in the future may help diagnose asthma in infants and assist in therapeutic decision making. Most studies have focused on determining clinical risk factors for persistent asthma in children. Maternal asthma and a history of atopic dermatitis or allergic rhinitis are associated with late onset or persistent wheezing ( 93). In fact, childhood bronchial reactivity and poorer lung functions are highly correlated with adult bronchial hyperreactivity and decreased lung functions ( 95). The loss of bronchial reactivity in childhood may be a key factor in outgrowing asthma ( 96). Overall, one third of asthmatic children present with symptoms prior to 18 months of age and one half of asthmatic children present prior to 3 years of age ( 98). Other investigators note a strong association with asthma in children who continue to wheeze or present with wheezing after 3 years of age ( 99). Prevalence and severity of asthma, rhinitis, and atopic eczema: the north east study. Asthma hospitalization rates and socioeconomic status in New York State (1987 1993). Trends in pediatric asthma hospitalization rates: regional and socioeconomic differences. Decrease in hospitalization for the treatment of asthma with increased use of anti-inflammatory treatment, despite an increase in prevalence of asthma. Risk of preschool asthma: incidence, hospitalization, recurrence, and readmission probability. Cisapride treatment changes the evolution of infant asthma with gastroesophageal reflux. The influence of a family history of and parental smoking on airway responsiveness in early infancy. Maternal smoking in early childhood: a risk factor for bronchial responsiveness to exercise in primary-school children. Prevalence of asthma and wheezing in public schoolchildren: association with maternal smoking during pregnancy. Maternal smoking during pregnancy, environmental tobacco smoke exposure and childhood lung function. Risk factors for exacerbations and hospital admissions in asthma of early childhood. Symptoms of respiratory illness in young children and the use of wood-burning stoves for indoor heating. Development of IgE and IgG antibodies to food and inhalant allergies in children at risk of allergic disease. Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma. Natural course of sensitization to food and inhalant allergens during the first 6 years of life. Factors relating to the severity of symptoms at 5 yrs in children with severe wheeze in the first 2 yrs of life. Long-lasting sensitization to food during the first two years precedes allergic airway disease.

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Under any circumstance order 45 mg midamor otc blood pressure chart in europe, challenge testing is contraindicated due to safety considerations when spirometry shows anything less than minimal abnormalities proven 45mg midamor useless eaters hypertension zip. In patients who do not report symptoms consistent with hyper-reactivity or asthma or who have significant abnormalities on spirometry or chest imaging buy discount midamor 45 mg line blood pressure chart urdu, pulmonary function tests including full lung volumes and diffusing capacity are recommended as the next diagnostic test after spirometry and instead of methacholine challenge testing midamor 45mg lowest price hypertension medscape. However, there may be widespread interest amongst those exposed to have chest radiographs as new baselines. Invasive Diagnostic Methods Induced sputum, bronchoalveolar lavage and/or biopsy following exposure in asymptomatic and symptomatic rescue workers have been used to demonstrate increased markers of inflammation and particle deposition exposure. While these measures may have value in a research setting, they have limited diagnostic or prognostic value. In a clinical setting, bronchoscopy should be performed on those with significant abnormalities on chest imaging or when there is failure to respond to therapy. Most patients have reported symptoms and required treatment for involvement of at least two of the above organ systems. Fine particles and coarse particles: concentration relationships relevant to epidemiologic studies. Improved nasal clearance among pulp-mill workers after the reduction of lime dust. Acute effects of routine firefighting on lung function Am J Ind Med 1986;9:333 340. Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation. Lung function in firefighters: a six year follow up in the Boston fire department. Helens eruptions: the acute respiratory effects of volcanic ash in a North American community. Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey. Air levels of carcinogenic polycyclic aromatic hydrocarbons after the World Trade Center disaster. Comparisons of the Dust/ Smoke Particulate that Settled Inside the Surrounding Buildings and Outside on the Streets of Southern New York City after the Collapse of the World Trade Center, September 11, 2001. Polycyclic aromatic hydrocarbons and other semivolatile organic compounds collected in New York City in response to the events of 9/11. Occupational exposures to air contaminants at the World Trade Center disaster site--New York, September-October 2001. Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster. Centers for Disease Control and Prevention: Use of respiratory protection among responders at the World Trade Center site--New York City, September 2001. Induced Sputum Assessment in New York City Firefighters Exposed to World Trade Center Dust. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program Environ Health Perspect: doi:10. Early respiratory abnormalities in emergency services police officers at the World Trade Center site. Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site. Self-reported increase in asthma severity after the September 11 attacks on the World Trade Center- -Manhattan, New York, 2001. Bronchial hyperreactivity and other inhalation lung injuries in rescue/ recovery workers after the World Trade Center collapse. Permanent respiratory impairment and upper airway symptoms despite clinical improvement in patients with reactive airways dysfunction syndrome. Diagnosis and treatment of chronic cough due to gastro-esophageal reflux disease and postnasal drip syndrome. World Trade Center dyspnea: bronchiolitis obliterans with functional improvement: a case report. Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust. Acute cyanide poisoning in prehospital care: New challenges, new tools for intervention. Terrorism involving cyanide: the prospect of improving preparedness in the prehospital setting. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The dispersion of radioactive particles can occur during an accident involving a nuclear facility, such as a nuclear power plant, or by a man-made radiological dispersion device that is detonated for the purpose of harming others. Radiological dispersion devices, or dirty bombs, consist of radioactive materials that are placed around a conventional explosive charge. It is important to note that dirty bombs are not nuclear weapons and are not weapons of mass destruction. Their adverse health effects depend upon the type and amount of explosive used, the type and amount of radioactive material used and atmospheric conditions at the time of detonation. Most injuries from a dirty bomb will come from the blast effects of the conventional explosion. The risk of developing cancer following a dirty bomb attack is low because for most such devices the radiation exposure dose would be minimal. Long-term psychological trauma is likely to occur among some members of a population that have been exposed to radioactive material from a "dirty bomb. A nuclear explosion results from nuclear fission or from thermonuclear fusion, in which a tremendous amount of energy is suddenly released in the form of heat, blast and radiation. Human injury is caused by exposure to a combination of these three forms of energy following a nuclear detonation. The radiation exposure from a nuclear explosion can be very intense and lead to a life-threatening acute radiation illness, in addition to radiation burns, thermal burns and blast injuries. For survivors, radiation exposure from a nuclear explosion can also result in the development of various long-term health effects such as leukemia, thyroid cancer and other malignancies. Acute radiation illness is a serious, complex, life-threatening illness that occurs shortly after a high-dose radiation exposure, such as may occur following a nuclear explosion. In general, the higher the radiation dose, the greater the severity of acute effects, the higher the probability of delayed illnesses and the higher the mortality rate. It is essential that any physician who may be called upon to treat these seriously ill patients following a nuclear explosion be familiar with this unique illness. Health care workers must be educated to understand that their exposure to this dirty dust is of minimal risk as long as they do not inhale or ingest it. All of the patient s clothing must be removed and discarded into a clearly-labeled and secure container, so that it does not further contaminate people and surroundings after removal. This simple soap-and-water process has been shown to be effective in removing more than 95% of residual radioactive material from radiation-exposed patients. Internal radiation contamination can occur by the inhalation, ingestion or transdermal penetration of radioactive material. Internal organs commonly affected by internal radiation contamination are the thyroid, the lung, the liver and bone.

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