Will list out all the happenings around the pharma world. Updates related to the Pharma changes and Medicine related news. This site is still under development phase. Please wait for more updates. You can also visit my channel ( prensentations on various pharma related topics ). http://www.authorstream.com/saieshphaldesai/Pharma_Discussions/
Sunday, November 10, 2013
Mary Wu Chang, MD Reviewing Tinkle BT et al., Pediatrics 2013 Oct 132:e1059
Guidance on diagnosis, referral, and patient advising of these children.
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Marfan syndrome, a multisystem connective tissue disorder affecting the ocular, musculoskeletal, and cardiovascular systems, occurs in 1 in 5000 individuals. Transmission is autosomal dominant, but one quarter of cases result from new mutations. Most cases are caused by defects in FBN1, the gene that encodes for fibrillin. The phenotypical spectrum is wide, and features can present at any age. These authors offer guidance on recognizing and managing Marfan syndrome in children.
Diagnosis is clinically based utilizing well-defined (revised Ghent) criteria. Aortic root aneurysm and ectopia lentis (dislocated lens) are considered the cardinal features. In the absence of family history, the presence of these two features is sufficient for the unequivocal diagnosis of Marfan syndrome. Genetic testing is reserved for patients in whom there is strong clinical suspicion but full criteria are missing. Because some features are age-dependent, children and adolescents may be categorized as “potential Marfan syndrome” and evaluated periodically in lieu of genetic testing.
Excessive linear growth of the long bones is characteristic. Patients are taller than expected given familial height (mean final height: males, 75 inches; females, 69 inches). Growth of tubular bones is accelerated, leading to disproportionate features, including arachnodactyly (long, slender fingers) and pectus excavatum/carinatum (sunken or protruding chest). Scoliosis occurs in over half of patients. Facial features can be variable, subtle, and evolve over time. Ocular manifestations include ectopia lentis, retinal detachment, glaucoma, and cataracts.
Cardiovascular complications — aortic dilation/rupture, aortic valve insufficiency, and pulmonary artery enlargement — are the major source of morbidity and mortality and require lifelong monitoring. Aortic dilation is progressive; it is usually discernible before age 18 but can occur at any age. Mitral valve prolapse with congestive heart failure is the leading cause of cardiovascular morbidity and mortality in young children.
Stretch marks and inguinal hernias are common, despite the slender habitus. Recurrent hernias or hernias at surgical repair sites are a hallmark of Marfan syndrome and other connective tissue disorders.
Contact and competitive sports, activity requiring “burst” movement (e.g., sprinting), and intense static exertion (e.g., weight-lifting) should be avoided due to high cardiovascular risk. High-impact sports (e.g., boxing) carry a high risk for ocular trauma.
Intelligence is normal, and life expectancy can approach normal range.
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Mary Wu Chang, MD Reviewing Tinkle BT et al., Pediatrics 2013 Oct 132:e1059
Guidance on diagnosis, referral, and patient advising of these children.
|
Marfan syndrome, a multisystem connective tissue disorder affecting the ocular, musculoskeletal, and cardiovascular systems, occurs in 1 in 5000 individuals. Transmission is autosomal dominant, but one quarter of cases result from new mutations. Most cases are caused by defects in FBN1, the gene that encodes for fibrillin. The phenotypical spectrum is wide, and features can present at any age. These authors offer guidance on recognizing and managing Marfan syndrome in children.
Diagnosis is clinically based utilizing well-defined (revised Ghent) criteria. Aortic root aneurysm and ectopia lentis (dislocated lens) are considered the cardinal features. In the absence of family history, the presence of these two features is sufficient for the unequivocal diagnosis of Marfan syndrome. Genetic testing is reserved for patients in whom there is strong clinical suspicion but full criteria are missing. Because some features are age-dependent, children and adolescents may be categorized as “potential Marfan syndrome” and evaluated periodically in lieu of genetic testing.
Excessive linear growth of the long bones is characteristic. Patients are taller than expected given familial height (mean final height: males, 75 inches; females, 69 inches). Growth of tubular bones is accelerated, leading to disproportionate features, including arachnodactyly (long, slender fingers) and pectus excavatum/carinatum (sunken or protruding chest). Scoliosis occurs in over half of patients. Facial features can be variable, subtle, and evolve over time. Ocular manifestations include ectopia lentis, retinal detachment, glaucoma, and cataracts.
Cardiovascular complications — aortic dilation/rupture, aortic valve insufficiency, and pulmonary artery enlargement — are the major source of morbidity and mortality and require lifelong monitoring. Aortic dilation is progressive; it is usually discernible before age 18 but can occur at any age. Mitral valve prolapse with congestive heart failure is the leading cause of cardiovascular morbidity and mortality in young children.
Stretch marks and inguinal hernias are common, despite the slender habitus. Recurrent hernias or hernias at surgical repair sites are a hallmark of Marfan syndrome and other connective tissue disorders.
Contact and competitive sports, activity requiring “burst” movement (e.g., sprinting), and intense static exertion (e.g., weight-lifting) should be avoided due to high cardiovascular risk. High-impact sports (e.g., boxing) carry a high risk for ocular trauma.
Intelligence is normal, and life expectancy can approach normal range.
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Dr. Paul Sax highlights a phase II study that yielded “pretty spectacular results” for treating hepatitis C in his HIV and ID Observations blog.
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According to the results of a recent study, an interferon-free regimen — a fixed-dose combination of sofosbuvir and ledipasvir — has the potential to cure most patients with genotype-1 HCV infection. Although we should avoid overstating the importance of this particular treatment approach, says Dr. Paul Sax in HIV and ID Observations, there is reason to be “ecstatic” about these findings.
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Robert W. Rebar, MD Reviewing Williams CL et al., N Engl J Med 2013 Nov 7; 369:1819
Risk for certain rare neoplasms may be modestly increased, but this must be confirmed in future studies.
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Children born after assisted reproductive technology (ART) are at slightly increased risk for prematurity, low birth weight, and congenital malformations, but information about long-term risks for rare but serious diseases is sparse. In a population-based study, investigators linked data on all children born after ART in Britain from 1992 through 2008 with national registry data on childhood tumors to determine incidence of cancer before age 15 in these children compared with those in the general population during the same period.
The cohort consisted of 106,000 children born after nondonor ART (mean follow-up, 6.6 years). A total of 108 cancers were identified in this group compared with 109.7 expected cancers (standardized incidence ratio [SIR], 0.98; 95% confidence interval, 0.81–1.19). Risks for leukemia, neuroblastoma, retinoblastoma, central nervous system tumors, renal tumors, and germ cell tumors were not increased. Excess risks for hepatoblastoma (SIR, 3.64; 95% CI, 1.34–7.93) and rhabdomyosarcoma (SIR, 2.62; 95% CI 1.26–4.82) were observed, and were not associated with imprinting disorders. Hepatoblastoma was associated with low birth weight.
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Robert W. Rebar, MD Reviewing Williams CL et al., N Engl J Med 2013 Nov 7; 369:1819
Risk for certain rare neoplasms may be modestly increased, but this must be confirmed in future studies.
|
Children born after assisted reproductive technology (ART) are at slightly increased risk for prematurity, low birth weight, and congenital malformations, but information about long-term risks for rare but serious diseases is sparse. In a population-based study, investigators linked data on all children born after ART in Britain from 1992 through 2008 with national registry data on childhood tumors to determine incidence of cancer before age 15 in these children compared with those in the general population during the same period.
The cohort consisted of 106,000 children born after nondonor ART (mean follow-up, 6.6 years). A total of 108 cancers were identified in this group compared with 109.7 expected cancers (standardized incidence ratio [SIR], 0.98; 95% confidence interval, 0.81–1.19). Risks for leukemia, neuroblastoma, retinoblastoma, central nervous system tumors, renal tumors, and germ cell tumors were not increased. Excess risks for hepatoblastoma (SIR, 3.64; 95% CI, 1.34–7.93) and rhabdomyosarcoma (SIR, 2.62; 95% CI 1.26–4.82) were observed, and were not associated with imprinting disorders. Hepatoblastoma was associated with low birth weight.
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Tuesday, August 20, 2013
EMPOWER Phase III ALS drug trial of
dexpramipexole has failed to meet its
primary endpoint.
Dexpramipexole, a treatment for amyotrophic
lateral sclerosis (ALS), did not meet its
primary endpoint of a joint rank analysis of
function and survival, and no efficacy was
seen in individual components of function or
survival, the drug company announced today.
... The trial also failed to show efficacy in its
key secondary endpoints. As such, Biogen
Idec has said it will abandon development of
dexpramipexole in ALS.
Biogen Idec Research and Development
executive vice president Dr Douglas Williams
said; "We share the disappointment of
members of the ALS community, who had
hoped that dexpramipexole would offer a
meaningful new treatment option.
"Nevertheless, the EMPOWER trial represents
a significant contribution to ALS research,
and Biogen Idec is committed to advancing
ALS science. We continue to work with
researchers around the world to understand
the causes of ALS and find potential
treatments for people with ALS."
The EMPOWER trial was a randomised,
double-blind placebo-controlled Phase III
trial of 943 people with ALS in 81 sites,
covering 11 countries. Patients were
randomised on a one-to-one basis to receive
either dexpramipexole or placebo.
Biogen Idec Neurodegeneration Clinical
Research director Dr Douglas Kerr said; "As
a physician who has treated people with ALS,
I hoped with all my heart for a different
outcome. While these results were not what
we expected, we hope these data will provide
a foundation for future ALS research."
The company intends to present detailed
results at a future medical conference.
Sunday, January 27, 2013
Suture production
All Sewn Up: Postcesarean Skin Staples vs. Subcuticular Sutures Subcuticular closure was associated with lower risk for wound complications.
As the cesarean delivery rate climbs, we are increasingly obliged to determine best practices for the procedure. In particular, averting wound-related complications would lower postcesarean morbidity considerably. Whether skin staples are better than subcuticular suture closure is not known; thus, investigators in Alabama conducted a randomized, controlled trial of the two methods in 393 women undergoing scheduled or unscheduled cesarean deliveries.
Regardless of maternal body-mass index (BMI; mean, 36 kg/m 2 ), women in the staple group were more likely than those in the suture group to suffer wound disruption or infection by 4 to 6 weeks postpartum (14.5% vs. 5.9%; relative risk, 2.5). Most complications consisted of wound disruption (RR, 3.8), and much of the difference in outcomes occurred before hospital discharge. Use of subcuticular closure added 10 minutes to median operating time (from 48 to 58 minutes; P <0.001). Patient-centered measures such as pain, cosmesis, and satisfaction did not differ between groups.
Comment: As we scrutinize the quality of care that we provide for its impact on patient safety and satisfaction, trials such as this are especially valuable. Although the study population was enriched for factors associated with wound complications (e.g., high body-mass index), the benefits of subcuticular closure persisted even in low-risk women (BMI <30, primary cesarean, no preceding chorioamnionitis). As the authors note, the costs associated with longer operative times are probably rivaled by costs associated with wound morbidity, the surgical stapler itself, and the time required to remove staples. This trial adds to the mounting evidence that subcuticular suturing is the best method for postcesarean skin closure.
Sunday, January 6, 2013
DISCUSSION ON RADIOISOTOPE & RADIOPHARMACEUTICAL: IT’S USES
Radiopharmaceuticals are drugs containing a radionuclide and are used routinely in nuclear medicine for the diagnosis and therapy of various diseases. Depending upon their medical applications radiopharmaceuticals are divided into two classes’ viz. diagnostic radiopharmaceuticals and therapeutic radiopharmaceuticals. They are briefly discussed below.
Diagnostic radiopharmaceuticals are molecules which are tagged with a gamma ray emitting radioisotope. Such agents when administered into the body localize in certain organs or tissue, for which they are designed for, and the radiation emitted by the associated radionuclide could be detected from outside with the help of suitable instrument like gamma camera. The analysis of the resultant images obtained from the gamma camera could reveal useful information regarding the disease condition of the patient.
Therapeutic Radiopharmaceuticals are very similar much to the diagnostic radiopharmaceuticals but the only difference being the use of a therapeutic radionuclide instead of a diagnostic radionuclide. In this case the primary aim is not to get diagnostic information but to deliver therapeutic doses of ionizing radiations to specific diseased sites. Further discussion on therapeutic radiopharmaceuticals is beyond the scope of present work. The various isotope used as therapeutic, diagnostic or research work are listed below in table-1 [6]
ISOTOPE
|
t1/2
|
APPLICATION
|
198Au
|
2.7 d
|
Therapeutic
Diagnostic
|
14C
|
5700 Y
|
Research
|
45Ca
|
165 d
|
Diagnostic
|
47Ca
|
4.5 d
|
Diagnostic
|
57Co
|
270 d
|
Diagnostic
|
58Co
|
71 d
|
Diagnostic
|
60Co
|
5.27 y
|
Therapeutic
Diagnostic
|
51Cr
|
27.8 d
|
Diagnostic
|
121Cs
|
9.7 d
|
Diagnostic
|
137Cs
|
30 y
|
Research
|
18F
|
1.7 H
|
Diagnostic
|
3H
|
12.3 y
|
Diagnostic
Research
|
59Fe
|
45 d
|
Diagnostic
|
197Hg
|
2.7 d
|
Diagnostic
|
203Hg
|
46.9 d
|
Diagnostic
|
125I
|
60 d
|
Diagnostic
Therapeutic
|
131I
|
8.08 d
|
Diagnostic
Therapeutic
Research
|
113In
|
1.66 h
|
Diagnostic
|
192Ir
|
74.4 d
|
Therapeutic
|
42K
|
12.4 h
|
Research
|
99Mo
|
2.8 d
|
Source of 99mTc
|
22Na
|
2.6 y
|
Diagnostic
|
24Na
|
15 h
|
Diagnostic
|
32P
|
14.3 d
|
Diagnostic
Therapeutic
Research
|
226Ra
|
1620 y
|
Therapeutic
|
86Rb
|
18.8 d
|
Diagnostic
|
222Rn
|
3.8 d
|
Therapeutic
|
35S
|
88 d
|
Research
|
75Se
|
120 d
|
Diagnostic
|
85Sr
|
64 d
|
Diagnostic
|
90Sr
|
28 y
|
Therapeutic
|
182Ta
|
115 d
|
Therapeutic
|
99mTc
|
6.0 h
|
Diagnostic
|
90Y
|
2.6 d
|
Diagnostic
Therapeutic
|
169Yb
|
32 d
|
Diagnostic
|
65Zn
|
245 d
|
Research
|
There are many practical applications to the use of radioactivity/radiation. Radioactive sources are used to study living organisms, to diagnose and treat diseases, to sterilize medical instruments and food, to produce energy for heat and electric power, and to monitor various steps in all types of industrial processes.
Tracersare a common application of radioisotopes. A tracer is a radioactive element whose pathway through which a chemical reaction can be followed. Tracers are commonly used in the medical field and in the study of plants and animals. Radioactive Iodine-131 can be used to study the function of the thyroid gland assisting in detecting disease.
Nuclear reactorsare devices that control fission reactions producing new substances from the fission product and energy. Recall our discussion earlier about the fission process in the making of a radioisotope. Nuclear power stations use uranium in fission reactions as a fuel to produce energy. Steam is generated by the heat released during the fission process. It is this steam that turns a turbine to produce electric energy.
Sterilization of medical instruments and food is another common application of radiation. By subjecting the instruments and food to concentrated beams of radiation, we can kill microorganisms that cause contamination and disease. Because this is done with high energy radiation sources using electromagnetic energy, there is no fear of residual radiation. Also, the instruments and food may be handled without fear of radiation poisoning.
Radiation sources are extremely important to the manufacturing industries throughout the world. They are commonly employed by nondestructive testing personnel to monitor materials and processes in the making of the products we see and use every day. Trained technicians use radiography to image materials and products much like a dentist uses radiation to x-ray your teeth for cavities. There are many industrial applications that rely on radioactivity to assist in determining if the material or product is internally sound and fit for its application. Radioactive isotopes have many useful applications. In medicine, for example, cobalt-60 is extensively employed as a radiation source to arrest the development of cancer. Other radioactive isotopes are utilized as tracers for diagnostic purposes, as well as in research on metabolic processes. When a radioactive isotope is added in small amounts to comparatively large quantities of the stable element, it behaves exactly the same as the ordinary isotope chemically; it can, however, be traced with a Geiger counter or other detection device. Iodine-131 has proved effective in locating brain tumours, measuring cardiac output, and determining liver and thyroid activity. Another medically important radioactive isotope is carbon-14, which is useful in studying abnormalities of metabolism that underlie diabetes, gout, anemia, and acromegaly. In industry, radioactive isotopes of various kinds are used for measuring the thickness of metal or plastic sheets; their precise thickness is indicated by the strength of the radiations that penetrate the material being inspected. They also may be employed in place of large X-ray machines to examine manufactured metal parts for structural defects. Other significant applications include the use of radioactive isotopes as compact sources of electrical power—e.g., plutonium-238 in cardiac pacemakers and spacecraft. In such cases, the heat produced in the decay of the radioactive isotope is converted into electricity by means of thermoelectric junction circuits or related devices
read more: http://www.pharmatutor.org/articles/isolation-extraction-purification-characterization-alkaline-protease-neurospora-crassa-enzyme-assaySee More
DISCUSSION ON RADIOISOTOPE & RADIOPHARMACEUTICAL: IT’S USES
Radioactive nuclides, or radionuclides, are species of unstable atomic nuclei without the restriction of being forms of the same element. Radioactive nuclides consist of all the sets of radioactive isotopes. Radiochemistry a subdivision of chemistry which deals with the study of radioactive substances. it includes the nuclear transformation involved, transmutation of one element into another,and the nature and properties of the radiation emitted. it also deals with the use of this radiation in chemical tracer analysis, for geological & archeological (chemical dating), and for initiation of cross-lining(polymerazation) [1] Spontaneous nuclear transformation of nuclide into another nuclide, accompanied by emission of nuclear radiation ,either corpuscular or electromagnetic. it may be natural, as with radium, artificial (caused bybombardment of a stable nucleus with neutrons or deuterons), or induced, as in radioactive carbon.the emanations are in the form of alpha, beta, gamma rays. the natural radioactive elements are uranium, radium, radon and thorium(the principal members of the uranium decay series), the ultimate end products being stable isotope of elements,e.g.,sodium,iodine etc., can be made radioactive by bombardment with neutrons, deuterons.or other heavy particles. Radionuclides, mainly 3H & 14C, are widely used as tracers in analysis, and in distribution and metabolism studies of drugs in animals.such isotope with long half-lives are not suitable for use in human medicine,but a number of radioisotopes with comparatively short half-lives, measured in hours or days,are now widely used in radiopharmaceutical preparations as diagnostic agents and in the treatment of neoplastic disease. these include 32P,51Cr,57Co,59Fe,75Se,125I.131I & 99mTc. [2] Isotopes are generally distinguished by three analytical means. The first of them makes use of radioactive isotopes, such as tritium (3H), 14C, 32P etc. This is a highly sensitive technique, but special facilities are required to handle radioactive material. Mass spectroscopy can also be used to detect isotopes. This is also a highly sensitive technique. When the fragmentation pattern of a compound is known, mass spectral data provide a wealth of information. The third, and at present the most frequently used technique is nuclear magnetic resonance. This technique requires an NMR active nucleus such as 2H, 13C, 17O etc. and is relatively less sensitive. But the ease of operation more than compensates for its limitations.[3]
Some radioactive nuclides that have very long half lives were created during the formation of the solar system (~4.6 billion years ago) and are still present in the earth. These include 40K (t½ = 1.28 billion years), 87Rb (t½ = 48.8 billion years), 238U (t½ = 447 billion years), and 186Os (t½ = 2 x 106 billion years, or 2 million billion years).
Cosmogenic isotopes are a result of cosmic ray activity in the atmosphere. Cosmic rays are atomic particles that are ejected from stars at a rate of speed sufficient to shatter other atoms when they collide. This process of transformation is called spallation. Some of the resulting fragments produced are unstable atoms having a different atomic structure (and atomic number), and so are isotopes of another element. The resulting atoms are considered to have cosmogenic radioactivity. Cosmogenic isotopes are also produced at the surface of the earth by direct cosmic ray irradiation of atoms in solid geologic materials.
Anthropogenic isotopes result from human activities, such as the processing of nuclear fuels, reactor accidents, and nuclear weapons testing. Such testing in the 1950s and 1960s greatly increased the amounts of tritium (3H) and 14C in the atmosphere; tracking these isotopes in the deep ocean, for instance, allows oceanographers to study ocean flow, currents, and rates of sedimentation. Likewise, in hydrology it allows for the tracking of recent groundwater recharge and flow rates in the vadose zone. Examples of hydrologically useful anthropogenic isotopes include many of the cosmogenic isotopes mentioned above: 3H, 14C, 36Cl, and 85Kr.
Radiogenic isotopes are typically stable daughter isotopes produced from radioactive decay. In the geosciences, radiogenic isotopes help to determine the nature and timing of geological events and processes. Isotopic systems useful in this research are primarily K-Ar, Rb-Sr, Re-Os, Sm-Nd, U-Th-Pb, and the noble gases (4H, 3H-3He, 40Ar).
Production of radioisotopes includes three principle categories, which are (1) neutron activation (bombardment), (2) fission product separation, and (3) charged particle bombardment. Nuclear bombardment constitutes the major method for obtaining industrially important radioisotope materials. Radioisotopes may exist in any form of matter, with solid materials comprising the largest group.
Three main type of radiation from radioactive substance are alpha(α),beta(β) and gamma(γ) rays.most source emit more than one type of emission, The penetrating power of each radiation varies considerably according to it’s nature and it’s energy. Alpha particle are completely absorbed in a thickness of a few micrometers to some tens of micrometer of solid or liquid. Beta particle are completely absorbed in a thickness of several millimeter to several centimeter. Gamma rays are not completely absorbed but only attenuated. The denser the absorbent , the shorter the range of alpha, beta particle and greater the attenuation of gamma rays.[5]
In general, radionuclides (RN) with shorter half-lives are desirable for use in diagnostic nuclear medicine (NM) because they usually produce less total dose to the patient, thus yielding reduced biological impact compared to longer-lived radionuclides. Radionuclides that are selected for diagnostic NM procedures preferably emit photonic radiation (usually gamma rays) that have an energy in the approximate range from 100 to 150 keV. This energy is desirable since it is high enough to ensure reasonable penetration of the human body so that photons are able to reach the imaging device, usually a gamma camera; additionally this energy is detected with high efficiency by the detectors in the cameras and is low enough so that camera collimators work effectively to record primarily photons moving in a direction more-or-less perpendicular to the face of the detector. This is necessary in order to obtain acceptably sharp images without appreciable blurring. A final desirable property is that the radionuclide emits minimal amounts of particulate radiation such as beta particles and alpha particles so as not to produce excess patient dose while doing nothing to improve image quality. There are both long- and short-lived radionuclides that could fulfill these recommendations.
Nanoparticle drug-delivery systems are the popular ones as are able to increase the selectivity and stability of therapeutic agents. However reticuloendothelial system (RES) uptake, drug leakage, immunogenicity, hemolytic toxicity, cytotoxicity, hydrophobicity restrict the use of these nanostructures. These shortcomings are overcome by surface engineering the dendrimer such as Polyester dendrimer, Citric acid dendrimer, Arginine dendrimer, Glycodendrimers, PEGylated dendrimers, etc.The field of Dendrimers has recently emerged as the most commercially viable technology of this century because of its wide-ranging potential applications in many fields such as: healthcare, electronics, photonics, biotechnology, engineering products, pharmaceuticals, drug delivery, catalysis, electronic devices, environmental issues and nanotechnologies. Dendrimer as a drug delivery agent is a promising, safe and selective drug delivery option.
Radioactive isotope, also called radioisotope, any of several species of the same chemical element with different masses whose nuclei are unstable and dissipate excess energy by spontaneously emitting radiation in the form of alpha, beta, and gamma rays. Radioisotopes are elements that are atomically unstable and radioactive. Radioisotopes stabilize by releasing energy and matter. Natural radioisotopes, which have relatively low radioactive energy, have been largely replaced by artificially produced radioisotopes. Artificially produced radioisotopes are widely utilized as sources of radiation for radiography, gauging, and as tracers for a multitude of measurements that are not easily made by other methods. Radiopharmaceuticals are drugs containing a radionuclide and are used routinely in nuclear medicine for the diagnosis and therapy of various diseases. Presented article is concerned with brief discussion about the radioisotope & Radiopharmaceuticals.