Combined diseases of military therapy.

Done by Donesan Gowripriyan

Group 52
Acute radiation sickness

 is a collection of health effects due to exposure to high amounts of ionizing

radiation over a short period of time . Symptoms can begin within an hour and
may last for several months . Symptoms within the first few days typically
include nausea, vomiting, and loss of appetite. This is followed by a few hours
or weeks with little symptoms which later develops into additional symptoms
followed by either recovery or death.
 It is generally divided into three types; bone marrow, gastrointestinal, and
neurovascular syndrome, with bone marrow syndrome occurring at 0.7 to 10
Gy , and neurovascular syndrome occurring at doses that exceed 50 Gy .The
cells that are most affected are generally those that are rapidly dividing. At
high doses, this causes DNA damage that may be irreparable. Diagnosis is
based on a history of exposure and symptoms . Repeated complete blood
counts (CBCs) can indicate the severity of exposure.
Signs and Symptoms
 There are three main syndromes.
 Hematopoietic. This syndrome is marked by a drop in the number of blood cells,
called aplastic anemia. This may result in infections due to a low number of
white blood cells, bleeding due to a lack of platelets, and anemia due to too few
red blood cells in the Conventional trauma and burns resulting from a bomb blast
are complicated by the poor wound healing caused by hematopoietic syndrome,
increasing mortality.
 Gastrointestinal .The signs and symptoms of this form of radiation injury include
nausea, vomiting, loss of appetite, and abdominal pain.Vomiting in this time-
frame is a marker for whole body exposure Without treatment such as bone
marrow transplant, death with this dose is common.

 Neurovascular. It presents with neurological symptoms such as dizziness,

headache, or decreased level of consciousness, occurring within minutes to a few
hours, and with an absence of vomiting. It is fatal.
Management and prognosis.

 Management : usually involves supportive care with possible symptomatic

measures employed. The former involves the possible use of antibiotics, blood
products, colony stimulating factors, and stem cell transplant.
 Prognosis : The prognosis for ARS is dependent on the exposure dose, with
anything above 8 Gy being almost always lethal even with medical care .
Radiation burns from lower-level exposures usually manifest after 2 months,
while reactions from the burns occur months to years after radiation
treatment . Complications from ARS include an increased risk of developing
radiation-induced cancer later in life. According to the linear no-threshold
model, any exposure to ionizing radiation, even at doses too low to produce
any symptoms of radiation sickness, can induce the cancer due to cellular and
genetic damage. The probability of developing cancer is a linear function with
respect to the effective radiation dose. Radiation cancer may occur following
ionizing radiation exposure following a latent period averaging 20 to 40 years.
Chronic radiation sickness

 health effects of radiation that occur after months or years of chronic exposure
to high amounts of radiation. Chronic radiation syndrome develops with a speed
and severity proportional to the radiation dose received, i.e., it is a
deterministic effect of exposure to ionizing radiation, unlike radiation-induced
cancer. It is distinct from acute radiation syndrome in that it occurs at dose
rates low enough to permit natural repair mechanisms to compete with the
radiation damage during the exposure period. Dose rates high enough to cause
the acute form (> ~0.1 Gy/h) are fatal long before onset of the chronic form.
 Symptoms of chronic radiation syndrome would include, at an early stage,
impaired sense of touch and smell and disturbances of the vegetative functions.
At a later stage muscle and skin atrophy and eye cataract follow, with possible
fibrous formations on the skin in case of previous radiation burns. Solid cancer or
leukemia due to genetic damage may appear at any time
 Atomic veteran
 An atomic veteran is a veteran who was exposed to ionizing radiation while
present in the site of a nuclear explosion during his/her active duty. The U.S.
Department of Veterans Affairs defines an atomic veteran "who, as part of his
or her military service: Participated in an above-ground nuclear test, 1945–
1962; or was part of the U.S. military occupation forces in/around
Hiroshima/Nagasaki before 1946; or was held as a POW in or near Hiroshima
or Nagasaki (certain cases).
 The definition also includes service personnel from other nations, including
the United Kingdom, Australia, New Zealand, France, China, and Russia who
were similarly exposed during their active service.
Common disorders military veterans
suffer from after war.
 Al amyloidosis
 Brucellosis
 Hodgkin’s disease
 Amyotrophic lateral sclerosis
 Parkinson disease
 Traumatic brain injury
 Post traumatic stress disorder
Al Amyloidosis
 Amyloid light-chain (AL) amyloidosis, also known as primary amyloidosis, is the
most common form of systemic amyloidosis in the US. The disease is caused when
a person's antibody-producing cells do not function properly and produce
abnormal protein fibers made of components of antibodies called light chains.

 These light chains come together to form amyloid deposits which can cause
serious damage to different organs. Abnormal light chains in urine are sometimes
referred to as Bence Jones protein.
 Signs and symptoms
 AL amyloidosis can affect a wide range of organs, and consequently present
with a range of symptoms. The kidneys are the most commonly affected organ
in AL amyloidosis. Symptoms of kidney disease and kidney failure can include
fluid retention, swelling, and shortness of breath.
 In addition to kidneys, AL amyloidosis may affect the heart, peripheral nervous
system, gastrointestinal tract, blood, lungs and skin. Heart complications, which
affect more than a third of AL patients, include heart failure and irregular heart
beat. Other symptoms can include stroke, gastrointestinal disorders, enlarged
liver, diminished spleen function, diminished function of the adrenal and other
endocrine glands, skin color change or growths, lung problems, bleeding and
bruising problems, fatigue, and weight loss.
 Treatment : autologous bone marrow transplants with stem cell rescues and
chemotherapy.
Brucellosis
 Brucellosis is a highly contagious zoonosis caused by ingestion of
unpasteurized milk or undercooked meat from infected animals, or close
contact with their secretions It is also known as undulant fever, Malta fever,
and Mediterranean fever.
 Brucella species are small, Gram-negative, nonmotile, nonspore-forming, rod-
shaped (coccobacilli) bacteria. They function as facultative intracellular
parasites, causing chronic disease, which usually persists for life. Four species
infect humans: B. abortus, B. canis, B. melitensis, and B. suis. B. abortus is
less virulent than B. melitensis and is primarily a disease of cattle. B. canis
affects dogs. B. melitensis is the most virulent and invasive species; it usually
infects goats and occasionally sheep. B. suis is of intermediate virulence and
chiefly infects pigs.
 Signs and symptoms

 The symptoms are like those associated with many other febrile diseases, but with
emphasis on muscular pain and night sweats. The duration of the disease can vary
from a few weeks to many months or even years.
 In the first stage of the disease, bacteremia occurs and leads to the classic triad
of undulant fevers, sweating (often with characteristic foul, moldy smell
sometimes likened to wet hay), and migratory arthralgia and myalgia (joint and
muscle pain). Blood tests characteristically reveal a low number of white blood
cells and red blood cells, show some elevation of liver enzymes such as aspartate
aminotransferase and alanine aminotransferase, and demonstrate positive Bengal
rose and Huddleston reactions. Gastrointestinal symptoms occur in 70% of cases
and include nausea, vomiting, decreased appetite, unintentional weight loss,
abdominal pain, constipation, diarrhea, an enlarged liver, liver inflammation,
liver abscess, and an enlarged spleen.
 may include arthritis, spondylitis, thrombocytopenia, meningitis, uveitis, optic
neuritis, endocarditis, and various neurological disorders collectively known as
neurobrucellosis
 Treatment and Prevention
 Antibiotics such as tetracyclines, rifampin, and the aminoglycosides streptomycin
and gentamicin are effective against Brucella bacteria. However, the use of more
than one antibiotic is needed for several weeks, because the bacteria incubate
within cells.
 daily intramuscular injections of streptomycin 1 g for 14 days and oral
doxycycline 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg
by intramuscular injection once daily for 7 days is an acceptable substitute when
streptomycin is not available or contraindicated.Another widely used regimen is
doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the
advantage of oral administration. Doxycycline is able to cross the blood–brain
barrier, but requires the addition of two other drugs to prevent relapse.
 The main way of preventing brucellosis is by using fastidious hygiene in producing
raw milk products, or by pasteurizing all milk that is to be ingested by human
beings, either in its unaltered form or as a derivative, such as cheese.
Hodgkin's disease

 Hodgkin lymphoma (HL) is a type of lymphoma in which cancer originates

from a specific type of white blood cells called lymphocytes Symptoms may
include fever, night sweats, and weight loss. Often there will be non-painful
enlarged lymph nodes in the neck, under the arm, or in the groin.Those
affected may feel tired or be itchy.

 There are two major types of Hodgkin lymphoma: classical Hodgkin lymphoma
and nodular lymphocyte-predominant Hodgkin lymphoma.[5] About half of
cases of Hodgkin lymphoma are due to Epstein–Barr virus (EBV) and these are
generally the classic form. Other risk factors include a family history of the
condition and having HIV/AIDS. Diagnosis is by finding Hodgkin cells such as
multinucleated Reed–Sternberg cells (RS cells) in lymph nodes. The virus-
positive cases are classified as a form of the Epstein-Barr virus-associated
lymphoproliferative diseases.
 Signs and symptoms

 Lymphadenopathy: the most common symptom of Hodgkin is the painless enlargement of one or
more lymph nodes.The nodes may also feel rubbery and swollen when examined. The nodes of the
neck and shoulders (cervical and supraclavicular) are most frequently involved (80–90% of the time,
on average). The lymph nodes of the chest are often affected, and these may be noticed on a chest
radiograph.
 Itchy skin
 Night sweats.
 Unexplained weight loss of at least 10% of the person's total body mass in six months or less.
 Low-grade fever.
 Fatigue (lassitude).
 Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms; thus,
presence of these indicate that the person's stage is, for example, 2B instead of 2A.
 Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease.
 Back pain: nonspecific back pain (pain that cannot be localised or its cause determined by
examination or scanning techniques) has been reported in some cases of Hodgkin lymphoma. The
lower back is most often affected.[citation needed]
 Cyclical fever: people may also present with a cyclical high-grade fever known as the Pel–Ebstein
fever, or more simply "P-E fever". However, there is debate as to whether the P-E fever truly exists.
 Management
 People with early stage disease (IA or IIA) are effectively treated with radiation
therapy or chemotherapy. The choice of treatment depends on the age, sex,
bulk and the histological subtype of the disease.[citation needed] Adding
localised radiation therapy after the chemotherapy regimen may provide a
longer progression-free survival compared with chemotherapy treatment alone.
People with later disease (III, IVA, or IVB) are treated with combination
chemotherapy alone. People of any stage with a large mass in the chest are
usually treated with combined chemotherapy and radiation therapy.
 Prognosis
 Treatment of Hodgkin's disease has been improving over the past few decades.
Recent trials that have made use of new types of chemotherapy have indicated
higher survival rates than have previously been seen. In one recent European
trial, the 5-year survival rate for those people with a favorable prognosis (FFP)
was 98%, while that for people with worse outlooks was at least 85%.
Amyotrophic lateral sclerosis
 Amyotrophic lateral sclerosis (ALS), also known as motor neurone disease
(MND) or Lou Gehrig's disease, is a disease that causes the death of neurons
controlling voluntary muscles. Some also use the term motor neuron disease
for a group of conditions of which ALS is the most common. ALS is
characterized by stiff muscles, muscle twitching, and gradually worsening
weakness due to muscles decreasing in size. It may begin with weakness in the
arms or legs, or with difficulty speaking or swallowing. About half of the
people affected develop at least mild difficulties with thinking and behavior
and most people experience pain. Most eventually lose the ability to walk, use
their hands, speak, swallow, and breathe.

 The cause is not known in 90% to 95% of cases, but is believed to involve both
genetic and environmental factors.
Parkinson's disease

 Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative

disorder of the central nervous system that mainly affects the motor system.
As the disease worsens, non-motor symptoms become more common. The
symptoms usually emerge slowly. Early in the disease, the most obvious
symptoms are shaking, rigidity, slowness of movement, and difficulty with
walking. Thinking and behavioral problems may also occur. Dementia
becomes common in the advanced stages of the disease. Depression and
anxiety are also common, occurring in more than a third of people with PD.
Other symptoms include sensory, sleep, and emotional problems. The main
motor symptoms are collectively called "parkinsonism", or a "parkinsonian
syndrome“.
Traumatic brain injury.
 A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to
the brain caused by an external force. TBI can be classified based on severity,
mechanism (closed or penetrating head injury) or other features (e.g., occurring in
a specific location or over a widespread area). Head injury is a broader category
that may involve damage to other structures such as the scalp and skull. TBI can
result in physical, cognitive, social, emotional and behavioral symptoms, and
outcomes can range from complete recovery to permanent disability or death.

 Causes include falls, vehicle collisions and violence. Brain trauma occurs as a
consequence of a sudden acceleration or deceleration within the cranium or by a
complex combination of both movement and sudden impact. In addition to the
damage caused at the moment of injury, a variety of events following the injury
may result in further injury. These processes include alterations in cerebral blood
flow and pressure within the skull. Some of the imaging techniques used for
diagnosis include computed tomography (CT) and magnetic resonance imaging
(MRIs).
 Prevention measures include use of seat belts and helmets, not drinking and
driving, fall prevention efforts in older adults and safety measures for
children. Depending on the injury, treatment required may be minimal or
may include interventions such as medications, emergency surgery or surgery
years later. Physical therapy, speech therapy, recreation therapy,
occupational therapy and vision therapy may be employed for rehabilitation.
Counseling, supported employment and community support services may also
be useful.
 TBI is a major cause of death and disability worldwide, especially in children
and young adults. Males sustain traumatic brain injuries around twice as often
as females.The 20th century saw developments in diagnosis and treatment
that decreased death rates and improved outcomes.
Post traumatic stress disorder.
 Posttraumatic stress disorder (PTSD)is a mental disorder that can develop
after a person is exposed to a traumatic event, such as sexual assault,
warfare, traffic collisions, child abuse, or other threats on a person's life.
Symptoms may include disturbing thoughts, feelings, or dreams related to the
events, mental or physical distress to trauma-related cues, attempts to avoid
trauma-related cues, alterations in how a person thinks and feels, and an
increase in the fight-or-flight response. These symptoms last for more than a
month after the event. Young children are less likely to show distress, but
instead may express their memories through play. A person with PTSD is at a
higher risk for suicide and intentional self-harm.
 Prevention may be possible when counselling is targeted at those with early
symptoms but is not effective when provided to all trauma-exposed individuals
whether or not symptoms are present. The main treatments for people with
PTSD are counselling (psychotherapy) and medication. Antidepressants of the
selective serotonin reuptake inhibitor type are the first-line medications.
 Symptoms of PTSD generally begin within the first 3 months after the
inciting traumatic event, but may not begin until years later.In the typical
case, the individual with PTSD persistently avoids trauma-related
thoughts and emotions, and discussion of the traumatic event, and may
even have amnesia of the event.[citation needed] However, the event is
commonly relived by the individual through intrusive, recurrent
recollections, dissociative episodes of reliving the trauma ("flashbacks"),
and nightmares.While it is common to have symptoms after any traumatic
event, these must persist to a sufficient degree (i.e., causing dysfunction
in life or clinical levels of distress) for longer than one month after the
trauma to be classified as PTSD (clinically significant dysfunction or
distress for less than one month after the trauma may be acute stress
disorder).Some following a traumatic event experience posttraumatic
growth.
Thank you