Nuclear medicine

Best example for human friendly use of nuclear energy:

by Shyamal INDIKE DE SILVA

Myocardial Perfusion Scan

Have you ever heard of Nuclear Medicine? No doubt you must be familiar with the words "Nuclear bombs" or "Nuclear reactors". But, what do we know about Nuclear Medicine?

Nuclear Medicine is a vast field in the medical world. But unfortunately this special field's popularity is almost limited to the western and many other developed countries. But even in our neighbouring countries such as India, Pakistan and Nepal this is widely used.

Nuclear Medicine is basically for diagnostic as well as the treatment purposes.

This is widely used to screen estimate functions of organs and structures in the body. And also to analyze human blood samples to assay hormone levels. It also covers the treatment of hyperthyroidism, thyroid carcinoma and as a pain relief in cancer patients.

The field of Nuclear Medicine part can be divided mainly in to two, such as in- vivo and in-vitro. In vivo is the imaging part of the field as In-vitro brings us the finest blood hormonal tests, pain relief treatment, thyroid gland treatment and cancer treatment.

Nuclear Medicine differs from radiology as these scans call transmitting scans (means patient is the radiation source) and all the other radiology scans are transparent scans (means using an external source to expose patient for the scan). Nuclear images are of two categories.

That is functional images and static images. For many of the cases nuclear medicine give the final answer and it reflects the popularity of this field all over the world.

In Nuclear Medicine imaging, trace amounts of radio isotopes (some selected unstable chemical elements which emit gamma rays) mixed with non radioactive pharmaceuticals are used.

It travels through the blood stream to the particular areas or organs of the body and emits rays which in turn is captured by a special machine called gamma camera. Currently Technetium (Tc99m) and Iodine (131I) isotopes are popular.

But in the past many other isotopes have been used for this purpose.Can we do scans by injecting pure isotopes? The answer is 'yes' but only for some scans.

DMSA Renal Scan Image (A Static Kidney Scan)

(Eg. Thyroid scans, gastric emptying scans). For other scans previously mentioned non-radioactive pharmaceuticals should be mixed and they are the carriers of radio isotope to the targeted organs or areas of the body.

Normally these pharmaceuticals are naturally attractive chemicals to the specific organ which we are interesting. (Eg. thyroid gland likes iodine and we use same iodine but in radioactive isotope form).

When we combine pharmaceutical with gamma emitting radio isotope and administer intravenously or by orally it goes directly and locate in the cells of particular organ.

That is how it provides us cellular level information. Why is this cellular level information important? Because of any defect or any disease begins first in cells of the particular organ.

While imaging the gamma camera receives these transmitting gamma rays and it creates the images in its computers.

Whether it is dynamic or static scan basic theory is the same.

These scan information is quite different from the other scans as they are more specific and informal for early diagnosis.

In-vitro side of the nuclear medicine includes the treatment and pain killing sides in patients. We can administer Iodine (I131) as a treatment, especially for thyroid cancer patients who are suffering from thyroid carcinoma and 'thyrotoxicosis' (excessive production of thyroxine by the thyroid gland- also called hyperthyroidism).

For thyroid excessive cancer we give high therapy doses such as 100mCi or 200mCi to kill cancer cells in the gland.

To control production of thyroid hormones we administer around 10mCi to reduce the function of the gland.

This is called the treatment dose to the hyperthyroidism.

Either after the first dose or second, a nuclear medicine scan can be performed without administering extra doses to the patient for future references. For pain management for end stage cancer patients Isotope called phosphorous (P32) is costly but an effective solution.

In contrast, Nuclear Medicine is a highly interesting area in the medical field which gives a lot of benefit the patients by submitting final and specific details to the doctor.

A Tc99m Thyroid Scan Image

At present nuclear medicine has developed to the next generation called PET (Positron Emitting Tomography) images and popular in many countries.

In Sri Lanka, we are still one generation behind PET, with SPECT (Single Photo Electron Computerized Tomography) gamma cameras.

One SPECT tomography Dual head (Dual detector) gamma camera and four single Detector gamma cameras are available in Sri Lanka. One private hospital and four other government institutes facilitate this service in the island.

One of the main reasons to slowdown the implementation of Nuclear Medicine facilities in Sri Lanka is the unavailability of radio-pharmaceutical production and radio isotope factories in our own as this is a byproduct of nuclear reactors.

But still it is feasible to import and use these items if we have a very efficient system to handle as the radio isotopes are constantly decaying with time.

When we talk about our country, the nuclear medicine history goes back to 1972 when late Dr. Rienziel Piyasena one who graced our country by chairing a former top post in IAEA (International Atomic Energy Agency- Vienna) founded the Nuclear Medicine Dept. in University of Peradeniya (He is the person who helped to start this technique in many other countries).

This is the only department in Sri Lanka which covers both in-vitro and in-vivo fields under one roof even now. Along with late Prof. T.W. Wikramanayake he has started radio-immunoassay techniques as the pioneer head of the department.

For the in-vitro field, still only two other centres are functional in the country. Peradeniya, Sri Lanka's first Nuclear Medicine department now has taken steps to include this subject in medical degrees and postgraduate degrees of Sri Lanka.

In summing up, I feel this marvellous field should be popularised within the medical community and spread all over the country like in other countries to give a valuable healthcare service to our people. This is one of the best examples of using creative techniques of nuclear energy in a very useful, peaceful and harmless manner for the betterment of human beings.

(The writer is the Nuclear Medicine Technologist, Lanka Hospitals)

Contraceptive supply and unintended pregnancies

Rates of unintended pregnancies and abortions decrease significantly when women receive a one-year supply of oral contraceptives, instead of being prescribed one-or three-month supplies, a UCSF study shows.

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one - or three-month supplies.

The researchers speculate that a larger supply of oral contraceptive pills may allow more consistent use, since women need to make fewer visits to a clinic or pharmacy for their next supply.

"Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, "said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynaecology and Reproductive Sciences. "Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month."

Foster also is director of research for Advancing New Standards in Reproductive Health, part of the UCSF Bixby Center for Global Reproductive Health.

The researchers linked 84,401 women who received oral contraceptives in January 2006 through Family PACT (Planning, Access, Care, Treatment), a California family planning program, to Medi-Cal data showing pregnancies and births in 2006.

Through Family PACT, some family planning clinics are able to dispense a one-year supply of pills on-site.Oral contraceptive pills are the most commonly used method of reversible contraception in the United States, the team states. While highly effective when used correctly (three pregnancies per 1,000 women in the first year of use), approximately half of women regularly miss one or more pills per cycle, a practice associated with a much higher pregnancy rate (80 pregnancies per 1,000 women in the first year of use), according to the team.The findings of this study have implications for women using oral contraceptives across the country.

Most oral contraceptive users in the United States get fewer than four packs at a time; nearly half need to return every month for resupply, according to a 2010 study published in Contraception.

Making oral contraceptive pills more accessible may reduce the incidence of unintended pregnancy and abortion, while saving taxpayers' dollars, the researchers state.

If the 65,000 women in the analysis who received either one or three packs of pills at a time had experienced the same pregnancy and abortion rates as women who received a one-year supply, almost 1,300 publicly funded pregnancies and 300 abortions would have been averted, according to the team. "The evidence indicates that health plans and public health programs may avoid paying for costly unintended pregnancies by increasing dispensing limits on oral contraceptives," said Foster. "Improving access to contraceptive methods reduces the need for abortion and helps women to plan their pregnancies."

Source: Karin Rush-Monroe University of California - San Francisco

MEDICARE 2011:

Asian miracle in healthcare

by Nilma DOLE

The one-of-a-kind medical exhibition - and convention sponsored by the Sunday Observer, Medicare 2011 ends today. Chairman of the Organising Committee Dr. Amal Harsha de Silva said that Sri Lanka has created an Asian miracle in healthcare by holding this National Healthcare Exhibition.

He said, "Our infant mortality and maternal mortality rates are on par with the developed world and it is definitely above all our neighbouring countries. We are providing free healthcare to our people at the point of delivery."

The Medicare exhibition will be held for the second consecutive year, organised by the Department of Health - Western Province under the patronage of the Ministry of Health. "We have a unique aspect in this exhibition where we invited all health ministers, past and present, to come together on one platform to make this exhibition a reality.

We work on common ground to exchange ideas and knowledge on one platform because health is a national issue and we need to work together to make our country a healthy nation," he said.

Health and health technological advances are now significantly becoming bigger and better and it is with such aims that this medical exhibition will cater. "Our goal is to ensure that the public is getting timely, accurate and important information with regard to health issues and to be updated on the latest technological innovations pertaining to health.

This in turn, will promote a healthy lifestyle for the benefit of all," said Dr. De Silva.

The key features of this exhibition is that it will have various seminars from professionals and doctors in the medical industry and it will also have medical equipment from genuine and authentic service and product providers. "Medical professionals can also get updated on the latest time-tested technologies available at the National Healthcare Exhibition. Whilst at the same time, we are having some key interactive events between the public and healthcare providers," said the doctor.

He said, "We would promote good doctor-patient relationships and allow other professionals to see how best they can help each other."Medicare 2011 will have a unique feature as the year 2011 has been declared the 'Visit Sri Lanka' year where plenty of tourists and Sri Lankans living abroad will discover and rediscover our peaceful nation.

What's more, rather than just offering traditional tourism, Sri Lanka's medical tourism is quickly gaining recognition and it's safe to say that plenty of medical professionals are now thought of as examples for others to follow.

"Our health indicators are on par with the West such as maternal health, life expectancy, etc. Sri Lanka is not being seen as an example and outlines among neighbouring countries such as India, Pakistan, Bangladesh and the Maldives. Our professionals have experience tackling a variety of medical problems. Both public and private sector, have improved drastically within the past two decades," said Dr. de Silva.

"Our advice is to get the public to tell us what they want to hear and give us the strength to help them help themselves. You can't always buy the best medical knowledge so we must ensure that the right message is going to the right patient," he said.

The Chairman of the organising committee said that we are creating a brain gain with the conditions looking favourable for health policy strengthening after the dawn of peace. "It is safe to say that even Sri Lankan expatriates and foreigners are now becoming highly impressed with our healthcare and especially since it's all for free," he said.

Dr. de Silva said, "Education and awareness is the key to having a healthy nation and the Medicare 2011 exhibition is important on how best us doctors can help you help yourself!"

Tomatoes, the new superfood

Eating more tomatoes and tomato products can make people healthier and decrease the risk of conditions such as cancer, osteoporosis and cardiovascular disease, according to a review article the American Journal of Lifestyle Medicine, (published by SAGE).

Of all the non-starchy vegetables, Americans eat more tomatoes and tomato products than any others. Researchers Britt Burton-Freeman, PhD, MS, and Kristin Reimers, PhD, RD of the National Center for Food Safety and Technology, Illinois Institute of Technology and ConAgra Foods, Inc., looked at the current research to discover the role tomato products play in health and disease risk reduction.

The researchers found that tomatoes are the biggest source of dietary lycopene; a powerful antioxidant that, unlike nutrients in most fresh fruits and vegetables, has even greater bioavailability after cooking and processing. Tomatoes also contain other protective mechanisms, such as antithrombotic and anti-inflammatory functions. Research has additionally found a relationship between eating tomatoes and a lower risk of certain cancers as well as other conditions, including cardiovascular disease, osteoporosis, ultraviolet light-induced skin damage, and cognitive dysfunction.

Tomatoes are widely available, people of all ages and cultures like them, they are cost-effective, and are available in many forms.

"Leveraging emerging science about tomatoes and tomato products may be one simple and effective strategy to help individuals increase vegetable intake, leading to improved overall eating patterns, and ultimately, better health," write the authors.

"Tomatoes are the most important non-starchy vegetable in the American diet. Research underscores the relationship between consuming tomatoes and reduced risk of cancer, heart disease, and other conditions," the authors conclude.

"The evidence also suggests that consumption of tomatoes should be recommended because of the nutritional benefits and because it may be a simple and effective strategy for increasing overall vegetable intake.

"The article is particularly timely since the recently released Dietary Guidelines for Americans 2010 moved tomatoes to a newly established category of "orange/red" fruits and vegetables to encourage higher consumption of these healthy foods.

(Source: Ashley Wrye SAGE Publications)