The document provides guidelines for flight surgeons on hematological requirements and conditions for airmen and patients undergoing aeromedical evacuation. It states that hemoglobin levels below 10.5-11 g/L should be considered unfit to fly. While hemoglobinopathy traits are generally acceptable, conditions like sickle cell disease, leukemia, lymphoma and bleeding disorders may restrict certification depending on severity and treatment. It emphasizes maintaining adequate oxygen-carrying capacity and platelet counts for safe flying and provides prevention measures for issues like deep vein thrombosis during transport.
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
General information about DLBCL treatment and care for internists. Not meant for hematologist, though.
Sorry for lagging of explanation but what in the slide should be sufficient.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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Biological screening of herbal drugs: Introduction and Need for
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Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
3. Hematologic requirements
“blood must carry sufficient oxygen to satisfy metabolic
requirements at rest, during exertion and anxiety, both at
ground level and at altitude.”
Hb < 10.5 - 11 g/L should be considered as unfit.
Hemoglobinopathic trait or thalassemia minor is
genera%y acceptable.
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
4. Common condition
G-6-PD deficiency Hemoglobinopathy
Polycythemia vera
Acute leukemia
Chronic leukemia
Lymphoma
Bleeding diathesis
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
5. Common condition
G-6-PD deficiency Hemoglobinopathy
Polycythemia vera
Acute leukemia
Chronic leukemia
Lymphoma
Bleeding diathesis
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
7. Approach to anemia
History
Family history of anemia
On set: acute vs chronic
Physical exam
Pa%or
Liver and spleen
8. Key point
Family Hx su'ests congenital disease e.g. thalassemia
Acute onset su'ests blood loss or hemolysis e.g. G-6-PD
deficiency, AIHA, UGIB
Chronic onset usua%y causes no symptom and more likely
due to decrease production
Liver and spleen also su'est thalassemia or hereditary
spherocytosis
11. Key point
Hct > Hb x 3 : su'ests hemoglobin H disease
MVC < 80 : su'ests iron def. of thalassemia
RDW > 12 : su'ests anisocytosis
Normal RDW could be thalassemia trait of ACD
MCHC > 34 g/dL su'ests hereditary spherocytosis
PMN predomination reflects normal marrow function
12. G-6-PD deficiency
X-linked recessive inherited
Send for G-6-PD level to make diagnosis
May considered as fit to fly if can avoid food or
medication that cause hemolysis
Fava
Sulfa
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
13. Polycythemia vera
Hb > 18.5 g/dL in male or > 16.5 g/dL in female
Presence of JAK2V617F or Jak2 exon 12 mutation
Panmyelosis marrow with prominent erythroid,
granulocytic and megakaryocytic proliferation
Low EPO level
Endogenous erythroid colony formation in vitro
Swerdlow SH, et al, ed. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. 2008.
14. Polycythemia vera
Genera%y considered as unfit due to risk of
thromboembolic episode
May considered a restricted certification if we% control
by blood letting, aspirin, and hydroxyurea
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
15. Acute leukemia
Why do you ask?
Event cured case sti% has a risk of late complication of
chemotherapy and radiation
Cataract
Pulmonary fibrosis
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
16. Chronic leukemia
CML may be considered restricted certification
CLL may be assessed as fit as long as they remain
asymptomatic
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
17. Lymphoma
If cured, restricted certification may be issued a*er two
years a*er treatment
Hodgkin lymphoma, diffuse large B-ce% lymphoma, etc.
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
18. Bleeding disorder
Platelets < 75,000/mcL is disqualified
ITP in remission a*er 6 months of treatment is
acceptable
Moderate to severe hemophilia or other congenital
bleeding disorder is disqualified
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
19. Thromboembolism
Pulmonary embolism required 6 months of treatment
before reconsideration as fit
Recurrent pulmonary embolism is considered as unfit
History of deep vein thrombosis require fu%
investigation for underlying cause before consideration
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
20. Anticoagulant & antiplatelet
W arfarin or coumarin use is incompatible with
certification
Low dose low molecular weight heparin may be
acceptable (e.g. enoxaparin 40 mg OD)
Aspirin in low dose is acceptable but clopidogrel or other
more potent antiplatelet a bar to flying
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
21. Hemoglobinopathy
A% trait is acceptable for certification
Sickle ce% disease in any form is disqualified
Thalassemia disease is usua%y disqualified due to low
hemoglobin level
Manual of cicil aviation medicine. 3rd ed. ICAO. 2012.
23. Hematologic physiology
G Y
LO
TO R!!
A E
EM PT
H A
N O CH
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
24. Hemoglobin & hypoxia
Oxygen-carrying capacity(mL O2/100 mL)
= (1.34 x Hb x SaO2) + (PaO2 x 0.0031)
Norma%y 20 ml O2/100 ml blood
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
25. Hemoglobin & hypoxia
O2 carrying capacity(mL O2/100 mL)
= (1.34 x Hb x SaO2) + (PaO2 x 0.0031)
Norma%y 20 ml O2/100 ml blood (at Hb 15 g/dL)
If Hb 7 g/dL O2 carrying capacity is only 9.8 ml O2/100
ml blood
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
26. What can we do??
Raise Hb level
Raise PaO2 level
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
27. Preparing
Hb < 7 g/dL should be contraindicated to fly
Transfusion to keep Hb > 10 g/dL before flight
If transfusion is not available altitude restriction is
mandatory
O2 supplement to keep O2Sat > 90% is helpful in most
patients with mild anemia or cardiac disease
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
28. Sickle cell disease
Sickle ce% crisis occur at desaturation
Threshold is PaO2 < 60 mmHg (alt. 10,000 feet)
Most commercial flights are pressurized to 8,000 feet
But if patient with underlying pulmonary disease may
desaturate at 4000 feet
Genera%y O2 supplement is recommended for a% patients
Davis JR, ed. Fundamentals of aerospace medicine 4th ed. LippincottWi%iams&Wilkins. 2008.
29. Bleeding diathesis
Aspirin usua%y does not cause bleeding problem
Platelet below 50,000/mcL should be transfused before
flight
Coagulogram more than 1.5 time of control should be
corrected before flight
30. In flight DVT prevention
avoidance of constrictive
clothing around the lower
extremities or waist
maintenance of adequate
hydration
.equent calf muscle
contraction
Hirsh j, et al. ACCP evidence-based clinical practice guidelines 8th ed. Chest 2008;133;71-109.
31. Thromboembolism
Hx of DVT or high risk of DVT should be prophylaxis
with below-knee graduated compression stocking or low
molecular weight heparin during a long-haul flight*
Un.actionated heparin can be used to treat
thromboembolism patient with monitoring before and
during flight
Protamine can be used to neutralized heparin if bleeding
*Hirsh j, et al. ACCP evidence-based clinical practice guidelines 8th ed. Chest 2008;133;71-109.
32. Dose of protamine
Protamine 1 mg for 100 units of accumulated heparin
Accumulated heparin = 2 x rate
Anaphylactic reaction can occur with protamine
34. For airman
Acceptable Hb is not less than 10 - 15 g/dL
Most hematologic diseases are disqualified
Hemoglobinopathy trait is not a disease
Only low dose aspirin is acceptable
35. For evacuation
Keep Hb > 10 g/dL, Plt > 50,000/mcL, coagulogram < 1.5
times of normal range
O2 supplement for mild anemia or high risk for ischemia
Altitude restriction if transfusion is unavailable
DVT prophylaxis measure for long-haul flight