#Clinical manifestation for COPD

[diginerve]

Respiratory Medicine: Current Trends in Asthma and COPD Management

Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory conditions that are very common, not just in people of one country but worldwide.

Though both problems are distinct, sometimes COPD is mistaken as asthma because the two have almost the same symptoms.

Below is the information that will help you differentiate both: 

Asthma is a chronic inflammatory disease that affects the airways at both a cellular and molecular level. Asthmatics often suffer from allergies, and their symptoms begin in childhood.

COPD, on the other hand, is characterized by impaired airflow that cannot be reversed. It usually develops later in life.

After gaining some insight into the impact of both diseases on health, you might get concerned about the situation. But the good news is that with the increasing number of asthma and COPD patients, awareness and research for better treatment for these conditions have also increased. To ease the lives of people suffering from these issues, our scientists work day and night to create Oral and intravenous corticosteroids. Additionally, students pursuing an MD in medicine put in their 100% effort so that in the future, they can do more advanced-level research and invent new drugs. 

The following are the current Asthma and COPD Management trends that you should be aware of!

Current Trends in Asthma & COPD Management 

Asthma & COPD management aims to control symptoms, prevent exacerbations, and minimize the risk of persistent airflow limitation and asthma-related death.

The following are the current trends in management that you should be aware of if you are interested in studying Respiratory Medicine:

Inhalers and Nebulizers: Inhalable medications such as Fasenra, Dupixent, Ventolin, salbutamol, and terbutaline are the first-line treatments for respiratory diseases. With the advancement of medical science, the market has seen a surge in the development of more efficient and user-friendly inhaler devices, which ensure better compliance and improved drug delivery.

Despite the initial treatment, if you still struggle with the issue, consult with your doctor to pursue a second line of action.

For Asthma, second-line drugs include heliox, magnesium sulfate, ketamine, and inhalational anesthetics.

For COPD,second-line options include tiotropium, salmeterol (Serevent), formoterol (Foradil), ipratropium, albuterol/ipratropium (Combivent), and levalbuterol (Xopenex).

Biologics Medicine: The emerging trends in therapies for lung diseases have pointed toward the use of monoclonal humanized antibodies, which are referred to as biologics.

These therapies target the specific immune system components responsible for asthma and COPD, increasing the chances of better outcomes.

Digital Health Solutions: The digital revolution is not only uplifting our lifestyle but also playing a critical role in improving our health. Now, with the invention of wearable devices that can track respiratory health, patients can help themselves escape serious respiratory conditions where they have to rush to the hospital.

Personalized medicine: Another prominent trend is treatment tailored to the patient's unique genetic and molecular profile. Because every person might have different causes of problems, symptoms, and responses toward particular drugs, this approach should become more common in the coming years. 

Apart from the treatment listed above, for people suffering from asthma and COPD, it is possible to manage their condition before the problem gets out of hand.

The following are the steps they can take:

Identify and avoid triggers like allergens, irritants like smoke and pollution, and respiratory infections.

Get regular vaccinations for influenza and pneumonia.

Quit Smoking

Control weight

Summary: We hope you found the above information helpful. Though the information in the article was basic, if you want in depth knowledge of the Clinical manifestation for COPD and the management of Asthma attack, enroll in our medicine md online course now!

Opt for a Medicine MD course!

This course is designed to address the gaps in clinical skills and help students grasp the subject fully.

The course covers various medical specialties, including Neurology, Cardiology, Gastrointestinal Surgery, Hepatology, Pulmonary and Chest Medicine, and rheumatology. 

So, don’t wait to take a step closer to your dress, enroll in the course now! 

[acehomoeopathy]

How Homeopathic Remedies Can Alleviate Bronchitis Symptoms

Bronchitis is a respiratory condition characterized by inflammation of the bronchial tubes, which carry air to and from the lungs. It can be acute or chronic, often causing symptoms such as coughing, wheezing, chest discomfort, and difficulty breathing. While conventional medicine offers treatments such as antibiotics and cough suppressants, many individuals are turning to homoeopathic remedies for their gentle yet effective approach to managing bronchitis.

Common Causes of Bronchitis

Viral Infections: The most frequent cause of acute bronchitis is viral infections, such as influenza viruses (flu), respiratory syncytial virus (RSV), and rhinovirus (common cold virus). These viruses infect the lining of the bronchial tubes, causing inflammation and increased mucus production.

Environmental Factors: Exposure to certain irritants and pollutants in the air can contribute to bronchitis. This includes cigarette smoke, air pollution, dust, and fumes from chemicals or solvents.

Allergies: Some individuals may develop bronchitis as a result of allergies to substances such as pollen, mold, pet dander, or certain foods. Allergic reactions can lead to inflammation in the bronchial tubes, which may result in bronchitis symptoms.

Chronic Conditions: Chronic bronchitis is often associated with long-term exposure to irritants, such as cigarette smoke or industrial pollutants. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) and is characterized by long-term inflammation and irritation of the bronchial tubes.

Watch video for more information about Bronchitis:

Homoeopathy Treatment for Bronchitis?

Homoeopathy treatment for bronchitis focuses on individualized remedies that aim to address the underlying causes and symptoms of the condition. Bronchitis treatment in Gurgaon through homoeopathy involves holistic approaches, considering factors such as the patient's overall health, symptom profile, and medical history. Homoeopathic remedies are selected based on their ability to stimulate the body's self-healing mechanisms and restore balance.

Individualized Approach: Homeopathy treats bronchitis by considering the individual's unique symptoms, medical history, and constitution. In Gurgaon, experienced homeopaths tailor treatment plans to address the specific manifestation of bronchitis in each patient.

Symptom Management: Homeopathic remedies aim to relieve symptoms such as persistent cough, wheezing, chest tightness, and difficulty breathing associated with bronchitis. Remedies like Antimonium tartaricum, Bryonia, and Phosphorus are commonly used based on symptom presentation.

Boosting Immunity: Homeopathy focuses on enhancing the body's immune response to fight off infections causing bronchitis. This approach aids in reducing the frequency and severity of bronchitis episodes over time.

Safe and Non-Toxic: Homeopathic medicines are derived from natural sources and are non-toxic when prescribed correctly. They do not cause dependency or adverse side effects, making them suitable for all age groups, including children and the elderly.

Why Choose Ace Homeopathy?

Choosing Ace Homeopathy means opting for excellence in holistic healthcare in Gurgaon. As the top rated homeopathy clinic in Gurgaon, Ace Homeopathy offers unparalleled expertise and personalized treatment plans tailored to each patient's unique needs. With a focus on natural healing and comprehensive care, Ace Homeopathy ensures effective remedies for various health concerns, from chronic conditions to acute ailments. Patients benefit from the clinic's commitment to quality, compassionate approach, and proven track record of success. Whether seeking relief from allergies, skin disorders, or respiratory issues, Ace Homeopathy stands out for its dedication to promoting well-being through safe and reliable homeopathic treatments.

[breathclinic]

Elderly Pneumonia: Risk Factors, Symptoms, and Special Considerations

Elderly pneumonia presents unique challenges due to age-related factors that weaken the immune system and increase susceptibility to respiratory infections. At the Breath Clinic, spearheaded by Dr. Pankaj Gulati, a distinguished pulmonologist in Jaipur, comprehensive care is offered to address the specific needs of elderly patients battling pneumonia.

Risk factors for elderly pneumonia include advanced age, underlying health conditions such as chronic obstructive pulmonary disease (COPD), heart disease, diabetes, and compromised immune function. Additionally, factors like smoking, living in long-term care facilities, and aspiration due to swallowing difficulties further elevate the risk.

Symptoms of pneumonia in the elderly may differ from younger individuals, often presenting with subtle or atypical manifestations. Common symptoms include cough, fever, fatigue, confusion, shortness of breath, and a decline in functional status. However, elders may exhibit fewer typical symptoms, making diagnosis challenging.

Special considerations are essential when managing pneumonia in the elderly. Early detection is paramount, as delayed diagnosis can lead to severe complications. Diagnosis typically involves a combination of physical examination, chest X-rays, and laboratory tests to confirm the presence of infection and identify the causative agent.

Treatment for elderly pneumonia requires a tailored approach, considering the individual's overall health status and any underlying medical conditions. Antibiotics are prescribed based on the suspected or confirmed cause of infection, and close monitoring is crucial to assess treatment response and prevent complications.

Supportive care plays a vital role in managing elderly pneumonia, focusing on hydration, pain management, and respiratory support as needed. Dr. Gulati and his team at the Breath Clinic prioritize patient comfort and well-being, providing compassionate care and addressing any concerns or challenges that arise during treatment.

Preventive measures are also emphasized to reduce the risk of pneumonia in the elderly. These include vaccination against common pathogens, promoting good hygiene practices, ensuring adequate nutrition, and minimizing exposure to environmental pollutants.

Regular follow-up visits with Dr. Gulati are recommended for ongoing monitoring of respiratory health and to address any lingering symptoms or concerns. Through personalized care and expertise, Dr. Gulati and the Breath Clinic strive to optimize outcomes and improve the quality of life for elderly patients battling pneumonia.

[healthcaremedical12]

Best Pulmonologist in Gurgaon-Mayom Hospital

Pulmonology is a vital branch of medicine focusing on respiratory health. Within this field, finding the best pulmonologist in Gurgaon is crucial for comprehensive care. In Gurgaon, Mayom Hospital stands out as a premier destination for pulmonary expertise.

Understanding Pulmonology

Pulmonology encompasses the diagnosis and treatment of respiratory conditions. From asthma to chronic obstructive pulmonary disease (COPD), pulmonologists address a wide array of disorders affecting the lungs and respiratory system.

Mayom Hospital: A Hub for Pulmonology

Established with a commitment to excellence, Mayom Hospital boasts a rich history of providing the best hospital in gurgaon. Within its walls, patients find specialized care tailored to their pulmonary needs.

Qualities of the Best Pulmonologist

The best pulmonologists blend extensive expertise with a compassionate bedside manner. At Mayom Hospital, patients benefit from the care of dedicated professionals who prioritize both medical proficiency and empathy.

Dr. Mayank Kapur Leading Pulmonologist at Mayom Hospital

 Dr. Mayank Kapur, a cornerstone of Mayom Hospital's pulmonology department, brings forth a wealth of experience and a stellar track record of patient satisfaction. Patients commend Dr. Mayank Kapur commitment to their well-being and commendable bedside manner.

Diagnostic Procedures in Pulmonology

To accurately diagnose respiratory conditions, pulmonologists employ various diagnostic tools, including pulmonary function tests, imaging studies, and bronchoscopy.

Treatment Options for Respiratory Disorders

From medication management to surgical interventions, pulmonologists at Mayom Hospital offer a comprehensive array of treatment options tailored to each patient's unique needs.

Innovations in Pulmonary Care at Mayom Hospital

Mayom Hospital stays at the forefront of pulmonary care by embracing advanced technologies and actively participating in research endeavors and clinical trials.

Community Outreach and Education

Beyond clinical care, Mayom Hospital engages in community outreach initiatives, raising awareness about respiratory health and offering support groups for patients and caregivers.

Insurance and Financial Assistance

Navigating healthcare expenses can be daunting, but Mayom Hospital offers various coverage options and financial aid programs to ensure patients receive the care they need without added financial stress.

FAQs about Pulmonology and Mayom Hospital

What are the common symptoms of respiratory disorders?

Common symptoms of respiratory disorders Respiratory disorders can manifest in various ways, but some common symptoms include persistent coughing, shortness of breath, wheezing, chest tightness, and frequent respiratory infections. If you experience any of these symptoms, it's essential to consult a pulmonologist for proper evaluation and management.

How often should I undergo pulmonary function tests?

Frequency of pulmonary function tests The frequency of pulmonary function tests (PFTs) depends on several factors, including the severity of your respiratory condition, your overall health status, and your pulmonologist's recommendations. Generally, if you have a chronic respiratory condition like asthma or COPD, your pulmonologist may recommend periodic PFTs to monitor lung function and disease progression. However, the specific frequency of testing should be determined by your healthcare provider based on your individual needs.

Does Mayom Hospital offer telemedicine services?

Yes, Mayom Hospital offers telemedicine services to provide convenient access to healthcare for patients, especially during times when in-person visits may be challenging or restricted. Through telemedicine appointments, patients can consult with healthcare providers remotely via video calls or phone calls, receive medical advice, discuss treatment plans, and even get prescriptions refilled without needing to visit the hospital in person.

Are there support groups available for COPD patients?

Yes, Mayom Hospital recognizes the importance of providing comprehensive care for patients with chronic obstructive pulmonary disease (COPD). As part of their commitment to patient well-being, they offer support groups specifically tailored to COPD patients. These support groups provide a supportive environment where individuals living with COPD can share experiences, receive encouragement, learn coping strategies, and access valuable resources to better manage their condition.

What insurance plans does Mayom Hospital accept?

Mayom Hospital accepts a wide range of insurance plans to ensure that patients can access quality healthcare without financial barriers. Some of the common insurance plans accepted at Mayom Hospital 

 It's advisable to contact Mayom Hospital's billing department or check their website for a comprehensive list of accepted insurance plans and any specific requirements or limitations associated with coverage.

Can I schedule a consultation with Dr.Mayank Kapur online?

Yes, you can schedule a consultation with Dr. Mayank Kapur, a renowned pulmonologist at Mayom Hospital, through their online appointment booking system. Mayom Hospital understands the importance of convenience and accessibility for patients seeking medical care. By offering online appointment scheduling, patients can easily book consultations with Dr. Mayank Kapur at their preferred date and time without the hassle of phone calls or in-person visits. Simply visit Mayom Hospital's website, navigate to the appointment booking section, select Dr. Mayank Kapur as your preferred healthcare provider, choose an available time slot, and provide necessary details to confirm your appointment.

Conclusion

In conclusion, when it comes to pulmonary care in Gurgaon, Mayom Hospital stands as a beacon of excellence. With a team of skilled pulmonologists led by Dr. Mayank kapur patients can trust in receiving top-tier care tailored to their specific needs.

[nursingscience]

UTERINE PROLAPSE - 3rd Year GNM, Midwifery and Gynecological Nursing (Definition, Causes, Stages, Sign and Symptoms, Diagnosis,Treatment and Prevention)

1. DEFINITION:

Uterine prolapse is a condition where the uterus slips from its normal position and pelvic cavity into the vagina. It happens when your tissue or muscle of the uterus becomes weak.

Complete uterine prolapse in which the uterus protrudes through the vaginal hymen is known as procidentia.

2. ETIOLOGY/CAUSE:

▪️Pregnancy / childbirth with normal or complicated vaginal delivery

▪️Weakness in the pelvic muscle due to age

▪️Weakening tissue tone due menopause

3. RISK FACTOR:

• Chronic obstructive Pulmonary Disorder (COPD)

• Obesity

• Chronic cough

• Pelvic tumors

• Straining due to Constipation

• Heavy lifting

• Using tobacco and smoking makes your lungs condition bad and due to chronic cough you may leads to uterine prolapse.

4. STAGES:

⇨First degree: The cervix drops into the vagina.

⇨Second degree: The cervix drops to the level just inside the opening of the vagina.

⇨Third degree: The cervix is outside the vagina.

⇨Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia.

5. Sign and Symptoms/ Clinical Manifestation:

Most of the people with uterine prolapse have not experience any sign or symptoms but some uterine prolapse symptoms are listed below:

• A feeling of fullness or pressure in the pelvis.

• Pain in pelvis or in the lower back.

• Pain during sex or intercourse.

• Urination problems, Pee incontinence.

• Constipation

If the situation goes to the level of procidentia then symptoms may include- bleeding, vaginal discharge, ulceration.

6. Diagnostic Evaluations:

• History collection

• Physical examination

• Vaginal examination often with a speculum

• Pelvic exam

• Urine culture

• Ultrasound

• MRI

7. MANAGEMENT:

⇒Non-surgical Management:

▪️Exercise: Pelvic Floor Muscle Training (PFMT) or Kegel exercises can help strengthen your pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse.

▪️Vaginal pessary: A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of your uterus. This device helps prop up your uterus and hold it in place.

▪️Diet and Lifestyle: Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grains to avoid constipation and avoid too much heavy lifting or do that correctly.

▪️Estrogen cream helps in restoring strength of vaginal tissue some time doctors may prescribe this cream to heal uterine prolapse.

⇒Surgical Management :

Hysterectomy - surgical removal of uterus

Prolapse repair without hysterectomy

9. PREVENTION:

Exercise regularly

Avoid becoming constipation

Take healthy diet

Maintain healthy weight

[ekg-rhythms-cheat-sheet-bu]

ekg rhythms cheat sheet trainer LZ5C&

💾 ►►► DOWNLOAD FILE 🔥🔥🔥🔥🔥 Jun 30, - Use this EKG interpretation cheat sheet that summarizes all heart arrhythmias in an easy-to-understand fashion. Download now! ekg nurse onfire free quick reference guide from: download for free at: basic rhythms common formal rhythm names second rhythm strip. PR Interval. P and QRS Correlation. Pacemaker. Our free EKG interpretation cheat sheet is great to improve ECG reading skills whether you're a student or a medical professional. Click here to download it. 9 Use this EKG interpretation cheat sheet that summarizes all heart arrhythmias in an easy-to-understand fashion. An EKG uses electrodes attached to the skin to detect electric current moving through the heart. These signals are transmitted to produce a record of cardiac activity. Arrhythmia or dysrhythmia are disturbances in the normal cardiac rhythm of the heart which occurs as a result of alterations within the conduction of electrical impulses. These impulses stimulate and coordinate atrial and ventricular myocardial contractions that provide cardiac output. Ever wonder how nurses and doctors be able to read ECG papers at ease? How they differentiate atrial tachycardia from atrial fibrillation or on how to even know what atrial fibrillation or tachycardia is? Sinus tachycardia is a heart rate greater than beats per minute that originated from the sinus node. Causes of sinus tachycardia may include exercise, anxiety , fever , drugs, anemia , heart failure , hypovolemia and shock. Sinus tachycardia is often asymptomatic. Management however is directed at the treatment of the primary cause. Carotid sinus pressure carotid massage or a beta blocker may be used to reduce heart rate. It has the following characteristics. Causes may include drugs, vagal stimulation, hypoendocrine states, hypothermia , or sinus node involvement in MI. This arrhythmia may be normal in athletes as they have quality stroke volume. It is often asymptomatic but manifestations may include: syncope, fatigue , dizziness. Management includes treating the underlying cause and administering anticholinergic drugs like atropine sulfate as prescribed. Premature Atrial Contraction are ectopic beats that originates from the atria and they are not rhythms. Cells in the heart starts to fire or go off before the normal heartbeat is supposed to occur. These are called heart palpitations and has the following characteristics:. Causes includes coronary or valvular heart diseases, atrial ischemia, coronary artery atherosclerosis, heart failure, COPD, electrolyte imbalance and hypoxia. Usually there is no treatment needed but may include procainamide and quinidine administration antidysrhythmic drugs and carotid sinus massage. Atrial flutter is an abnormal rhythm that occurs in the atria of the heart. It has sawtooth appearance. QRS complexes are uniform in shape but often irregular in rate. Causes includes heart failure, tricuspid valve or mitral valve diseases, pulmonary embolism , cor pulmonale, inferior wall MI, carditis and digoxin toxicity. Management if the patient is unstable with ventricular rate of greater than bpm, prepare for immediate cardioversion. If patient is stable, drug therapy may include calcium channel blocker, beta-adrenergic blockers, or antiarhythmics. Anticoagulation may be necessary as there would be pooling of blood in the atria. Atrial fibrillation is disorganized and uncoordinated twitching of atrial musculature caused by overly rapid production of atrial impulses. This arrhythmia has the following characteristics:. Causes includes atherosclerosis, heart failure, congenital heart disease , chronic obstructive pulmonary disease , hypothyroidism and thyrotoxicosis. Atrial fibrillation may be asymptomatic but clinical manifestation may include palpitations, dyspnea, and pulmonary edema. Nursing goal is towards administration of prescribed treatment to decrease ventricular response, decrease atrial irritability and eliminate the cause. Premature Junctional Contraction PJC occurs when some regions of the heart becomes excitable than normal. Causes of PJC may include myocardial infarction or ischemia, digoxin toxicity, excessive caffeine or amphetamine use. Management includes correction of underlying cause, discontinuation of digoxin if appropriate. AV blocks are conduction defects within the AV junction that impairs conduction of atrial impulses to ventricular pathways. The three types are first degree, second degree and third degree. First degree AV block is asymptomatic and may be caused by inferior wall MI or ischemia, hyperkalemia, hypokalemia , digoxin toxicity, calcium channel blockers, amiodarone and use of antidysrhythmics. Management includes correction of underlying cause. Administer atropine if PR interval exceeds 0. Clinical manifestations include vertigo, weakness, and an irregular pulse. This may be caused by Inferior wall MI, cardiac surgery , acute rheumatic fever , vagal stimulation. Treatment includes correction of underlying cause, atropine or temporary pacemaker for symptomatic bradycardia and discontinuation of digoxin if appropriate. Clinical manifestations same as Mobitz I. Causes includes: severe coronary artery diseases, anterior wall MI, acute myocarditis and digoxin toxicity. Treatment includes: atropine, epinephrine, and dopamine for symptomatic bradycardia. Discontinuation of digoxin if appropriate. Installation of pacemaker. Manifestations include: hypotension , angina and heart failure. Management includes atropine, epinephrine, and dopamine for bradycardia. Installation of pacemaker may also be considered. Early or premature ventricular contractions are caused by increased automaticity of ventricular muscle cells. PVCs usually are not considered harmful but are of concern if more than six occur in 1 minute, if they occur in pairs or triplets if they are multifocal or if they occur or near a T wave. Clinical manifestations includes palpitations, weakness, lightheadedness but it is most of the time asymptomatic. Management includes assessment of the cause and treat as indicated. Treatment is indicated if the client has underlying disease because PVCs may precipitate ventricular tachycardia or fibrillation. Assess for life threatening PVCs. Administer antiarrhythmic medication as prescribed. Clinical manifestations of VT includes lightheadedness, weakness, dyspnea and unconsciousness. Causes includes MI, aneurysm , CAD, rheumatic heart diseases, mitral valve prolapse, hypokalemia, hyperkalemia, and pulmonary embolism. Anxiety may also caused VT. Management with Pulse VT : If hemodynamically stable, follow ACLS protocol for administration of amiodarone, if ineffective, initiate synchronized cardioversion. Ventricular fibrillation is rapid, ineffective quivering of ventricles that may be rapidly fatal. Causes of ventricular fibrillation is most commonly myocardia ischemia or infarction. It ma result from untreated ventricular tachycardia, electrolyte imbalances, digoxin or quinide toxicity, or hypothermia. Clinical manifestations may include loss of consciousness, pulselessness, loss of blood pressure, cessation of respirations, possible seizures and sudden death. Start CPR is pulseless. Download the printable cheat sheet for EKG interpretation below. To download, simply click on the images below and save. Once opened, right click to save. I am doing a project on detection and classification of cardiac arrhythmia using deep learning techniques. I have understood the basics but I am confused about a few things regarding the detection of cardiac arrhythmia using an ECG. I was wondering if you could assist me with them. I would really appreciate your help on this. Thank you Kavya Kaushik. How to download? Please help me. I enjoy reading and help me to remember everything. Thank you so much. Please log in again. The login page will open in a new tab. After logging in you can close it and return to this page. Matt Vera is a registered nurse with a bachelor of science in nursing since and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since , his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively. Hello Hope you are doing well. Close dialog. Session expired Please log in again. Irregular atrial and ventricular rhythms. Normal P wave preceding each QRS complex. Normal variation of normal sinus rhythm in athletes, children, and the elderly. Can be seen in digoxin toxicity and inferior wall MI. Atrial and ventricular rhythms are regular. Normal physiologic response to fever, exercise, anxiety, dehydration , or pain. May accompany shock, left-sided heart failure, cardiac tamponade, hyperthyroidism, and anemia. Atropine, epinephrine, quinidine, caffeine, nicotine, and alcohol use. Correction of underlying cause. Beta-adrenergic blockers or calcium channel blockers for symptomatic patients. Regular atrial and ventricular rhythms. Normal in a well-conditioned heart e. Increased intracranial pressure; increased vagal tone due to straining during defecation, vomiting , intubation, mechanical ventilation. Follow ACLS protocol for administration of atropine for symptoms of low cardiac output, dizziness, weakness, altered LOC, or low blood pressure. Atrial and ventricular rhythms normal except for missing complex. Pause not equal to multiple of the previous rhythm. Infection Coronary artery disease, degenerative heart disease, acute inferior wall MI. Treat symptoms with atropine I. Temporary pacemaker or permanent pacemaker if considered for repeated episodes. Atrial and ventricular rhythms vary slightly. Irregular PR interval. QRS complexes uniform in shape but irregular in rhythm. Rheumatic carditis due to inflammation involving the SA node. Digoxin toxicity Sick sinus syndrome. No treatment if patient is asymptomatic Treatment of underlying cause if patient is symptomatic. Premature, abnormal-looking P waves that differ in configuration from normal P waves. P wave often buried in the preceding T wave or identified in the preceding T wave. May prelude supraventricular tachycardia. Stimulants, hyperthyroidism, COPD, infection and other heart diseases. Usually no treatment is needed. Treatment of underlying cause if patient is symptomatic. Carotid sinus massage. P waves regular but aberrant; difficult to differentiate from preceding T wave. P wave preceding each QRS complex. Physical exertion, emotion, stimulants, rheumatic heart diseases. Intrinsic abnormality of AV conduction system. Digoxin toxicity. Use of caffeine, marijuana, or central nervous system stimulants. If patient is unstable prepare for immediate cardioversion. Adenosine by rapid I. If patient has normal ejection fraction, consider calcium channel blockers, beta-adrenergic blocks or amiodarone. Atrial rhythm regular, rate, to bpm Ventricular rate variable, depending on degree of AV block Saw-tooth shape P wave configuration. QRS complexes uniform in shape but often irregular in rate. Heart failure, tricuspid or mitral valve disease, pulmonary embolism, cor pulmonale, inferior wall MI, carditis. If patient is stable, drug therapy may include calcium channel blockers, beta-adrenergic blocks, or antiarrhythmics. Anticoagulation therapy may be necessary. Ventricular rhythm grossly irregular, rate to bpm. PR interval indiscernible. No P waves, or P waves that appear as erratic, irregular base-line fibrillatory waves. Heart failure, COPD, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis , pulmonary embolus , rheumatic heart disease, hypertension , mitral stenosis, atrial irritation, complication of coronary bypass or valve replacement surgery. If stable, drug therapy may include calcium channel blockers, beta-adrenergic blockers, digoxin, procainamide, quinidine, ibutilide, or amiodarone. Anticoagulation therapy to prevent emboli. Dual chamber atrial pacing, implantable atrial pacemaker, or surgical maze procedure may also be used. Atrial rate 40 to 60 bpm. Ventricular rate usually 40 to 60 bpm. P waves preceding, hidden within absent , or after QRS complex; usually inverted if visible. Inferior wall MI, or ischemia, hypoxia, vagal stimulation, sick sinus syndrome. Acute rheumatic fever. Valve surgery Digoxin toxicity. Atropine for symptomatic slow rate Pacemaker insertion if patient is refractory to drugs Discontinuation of digoxin if appropriate. Atrial and ventricular rhythms are irregular. P waves inverted; may precede be hidden within, or follow QRS complex. QRS complex configuration and duration normal. MI or ischemia Digoxin toxicity and excessive caffeine or amphetamine use. QRS complex normal. Inferior wall MI or ischemia or infarction, hypothyroidism , hypokalemia, hyperkalemia. Use of quinidine, procainamide, beta-adrenergic blockers, calcium. Correction of the underlying cause. Possibly atropine if PR interval exceeds 0. Cautious use of digoxin, calcium channel blockers, and beta-adrenergic blockers. Atrial rhythm regular. Ventricular rhythm irregular. Atrial rate exceeds ventricular rate. PR interval progressively, but only slightly, longer with each cycle until QRS complex disappears. PR interval shorter after dropped beat. Severe coronary artery disease, anterior wall MI, acute myocarditis. Atropine, epinephrine, and dopamine for symptomatic bradycardia. Temporary or permanent pacemaker for symptomatic bradycardia. Ventricular rhythm regular and rate slower than atrial rate. No relation between P waves and QRS complexes. No constant PR interval. QRS interval normal nodal pacemaker or wide and bizarre ventricular pacemaker. Premature QRS complexes occurring singly, in pairs, or in threes; alternating with normal beats; focus from one or more sites. Ominous when clustered, multifocal, with R wave on T pattern. Heart failure; old or acute myocardial ischemia, infarction, or contusion. Myocardial irritation by ventricular catheters such as a pacemaker. Hypercapnia, hypokalemia, hypocalcemia. Drug toxicity by cardiac glycosides, aminophylline, tricyclic antidepressants , beta-adrenergic. Caffeine, tobacco, or alcohol use. Psychological stress, anxiety, pain. If warranted, procainamide, lidocaine , or amiodarone I. Treatment of underlying cause. Discontinuation of drug causing toxicity. Ventricular rate to bpm, regular or irregular. QRS complexes wide, bizarre, and independent of P waves P waves no discernible May start and stop suddenly. Myocardial ischemia, infarction, or aneurysm Coronary artery disease Rheumatic heart disease Mitral valve prolapse, heart failure, cardiomyopathy Ventricular catheters. Hypokalemia, Hypercalcemia. Pulmonary embolism. Digoxin, procainamide, epinephrine, quinidine toxicity, anxiety. If with pulse : If hemodynamically stable, follow ACLS protocol for administration of amiodarone; if ineffective initiate synchronized cardioversion. Ventricular rhythm and rate are rapid and chaotic. QRS complexes wide and irregular, no visible P waves. Myocardial ischemia or infarction, R-on-T phenomenon , untreated ventricular tachycardia, Hypokalemia, hyperkalemia, Hypercalcemia, alkalosis, electric shock, hypothermia. Digoxin, epinephrine, or quinidine toxicity. If pulseless : start CPR, follow ACLS protocol for defibrillation, ET intubation, and administration f epinephrine or vasopressin, lidocaine, or amiodarone; ineffective consider magnesium sulfate. No atrial or ventricular rate or rhythm. Myocardial ischemia or infarction, aortic valve disease, heart failure, hypoxemia , hypokalemia, severe acidosis, electric shock, ventricular arrhythmias, AV block, pulmonary embolism, heart rupture, cardiac tamponade, hyperkalemia, electromechanical dissociation. Cocaine overdose.

[cadkilop]

Epro ontime

#EPRO ONTIME PRO#

Within RR, the inspiratory muscle training (IMT) has received special interest, showing benefits in maximum inspiratory pressure, perception of well-being, and health status in patients with chronic heart disease, respiratory diseases, and dyspnea during exercise. The latest updates of national and international guidelines for the management of COPD reveal the importance of respiratory rehabilitation (RR) and its role in improving symptoms, quality of life, and psychosocial sphere of patients. Furthermore, they provide evidence of performance enhancements in competitive cyclists after inspiratory muscle training.Ĭhronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to personalize the assessment and treatment of these patients. These results support evidence that specific inspiratory muscle training attenuates the perceptual response to maximal incremental exercise. After the intervention, the inspiratory muscle training group experienced a reduction in the perception of respiratory and peripheral effort (Borg CR10: 16 +/- 4% and 18 +/- 4% respectively compared with placebo, P a double-blind, placebo-controlled design, 16 male cyclists (VO2max = 64 +/- 2 ml x kg(-1) x min(-1) mean +/- s(x)) were assigned at random to either an experimental (pressure-threshold inspiratory muscle training) or sham-training control (placebo) group. This interface offers a clear overview on the tablet that is efficient for clinicians and is fully compliant, recording a complete audit trail centrally in our Clin’Form application.įor more details of the potential of Kayentis eCOA devices, please click here.We evaluated the effects of specific inspiratory muscle training on simulated time-trial performance in trained cyclists. In a new version eCOA 1.4 Kayentis introduces an enhanced interface to review patients questionnaires on a tablet. Once reviewed, the audit trail clearly indicates timestamps, and the reviewer’s user information of the tablet. In Clin’Form, the Kayentis webportal solution, it is possible not only to see patients’ data but also to notify whether the data have been reviewed or not. The tablet will alert the clinician if a previous questionnaire has not been reviewed at the time of initiation of the next visit.īy ensuring on-time and complete review of patients’ questionnaires, the eCOA is an advantage not only for clinicians but also for other study stakeholders. Clinicians can easily review the questionnaires and confirm that the review is complete. By default, the clinician is shown unreviewed PROs but can also display all PROs.Īll questions and answers are displayed in the study site’s preferred language. At next login, clinician will see how many questionnaires have to be reviewed and can either proceed or delay the review.

#EPRO ONTIME PRO#

How is the review of PRO data handled on a tablet using Kayentis’ solution?Īs soon the patient has completed a questionnaire and entered data using an eCOA device, the data are available for review. It would be advantageous to clinicians to be able to easily review patients’ data directly on the same device. When patients complete questionnaires using a tablet, the use of different device or interface for the review step adds complexity for the clinician as well as delaying the review or even resulting in no review being performed. It is essential that clinicians review PRO data. Kayentis announces a breakthrough feature available in ePRO clinical trials: clinician review of data on a tablet device

[proffbon]

Schlatt - At War With Body and Mind

c!Schlatt is one of if not the only character that is not only portrayed as being at odds with his mental health but also with his physical health, so I thought that it would be interesting to try to figure out what exactly is wrong with the man.

Keep in mind that most things in this post will be speculations, almost headcanons because we can’t actually run any diagnostics on the man and I am not yet a qualified professional, so let’s get started.  (Everything in the post is /rp /dsmp unless stated otherwise)

Physical Health

First and foremost, a lot of Schlatt’s health issues can be glimpsed from Fundy’s diary. Fundy believed that Schlatt had some sort of “muscle atrophy” that made his body ache. Schlatt drank and smoked to numb it.

Schlatt probably suffered from some type of muscular dystrophy that he couldn’t just control or fix by exercising meaning it was most likely genetic. It is very unclear what type of dystrophy Schlatt had as we don’t know which muscle groups were affected, at what age the condition manifested or what are the symptoms exactly. It is also unclear which level of severity the condition was at as Schlatt was able to do quite heavy exercises but wasn’t able to swim at the same time. My best guess for the exact type of condition would be myotonic muscular dystrophy (MMD), one of the most common for young adults. One of the things Schlatt is famous for is his “Schlatt-walk” and while it is sort of a meme and a way to avoid getting hungry in-game I like to add it to my speculations. So Schlatt apparently suffered from some sort of muscle pain. But at the same time, we could see him doing quite heavy labor (buildings demolition, gardening) although he refused to sprint and couldn’t seem to swim properly. Schlatt also worked out a lot by using dumbbells but canonically skipped leg day, Schlatt in general refused to do cardio (as seen by the Big Man Gym dialogue). So this makes me think that the main cause of this laid in Schlatt’s legs or at least that was the site of the most severe pains which caused Schlatt to intentionally and unintentionally reduce the strain on them. Intense pain in the lower back and legs is a common symptom of MMD. A lot of types of muscular dystrophy can also lead to heart diseases and breathing problems which would fit into Schlatt’s clinical picture.

We actually have something that Schlatt said about his health himself. We all know about his almost iconic panting/shortness of breath. During the presidential rally, he was resting on a bed and had another episode of those. In-between the pants he said “I have COPD”. Schlatt didn’t really like discussing his health and often said that he’s “right as rain” when asked. But at the time Schlatt was actually half-hungover/half-already-drunk and the alcohol might have loosened his tongue a bit. COPD also fits really well in the narrative as Schlatt showed symptoms of it (coughs, shortness of breath, physical activity limitations) and also smoked (smoking being one of the primary causes of COPD).

Now we can’t be so sure about two other instances of Schlatt speaking about his health as he was sober while telling that and also tried to find an excuse for the situation. The stream at which these events occurred was also a really casual one.

1) Schlatt claimed to have Alzheimer's during his call with Pogtopians because Tubbo almost revealed that he was actually at Pogtopia. In character it could have been done to make Pogtopians believe that Schlatt would forget about that or excusing his general forgetfulness. Out of character it might have been Schlatt trying to preserve the plot and playing into his sick-old-man stereotype. (Possible conditions: early-onset Alzheimer’s, early-onset dementia, memory issues due to alcohol abuse/decreased blood flow - the last one is the most probable)

2) While talking with Fundy Schlatt mentioned suffering from multiple strokes already so his brain wasn’t working that well. This might be Schlatt finding an excuse to not knowing things Fundy does and yet again playing into the stereotype. (Possible conditions: several strokes, more likely TIAs, due to alcohol abuse)

Let’s get back to the deduction. One of the complications of COPD that is quite relevant to our discussion is chronic heart failure - due to complications in the lungs it becomes very hard for a heart to pump blood properly so it gets weaker, blood starts flowing slower and there are a lot more chances of random blood clots forming (this could have worsened the muscle pains as symptoms like intermittent claudication are common for chronic heart failure). Tubbo’s comment about Schlatt’s hand discoloration being possibly caused by blood flow problems (which Schlatt tried to adamantly deny) can also play into the narrative of some sort of vascular problems caused by the mentioned condition (although it could’ve been just discoloration caused by nicotine). This also will play the part in Schlatt’s cause of death.   We’re getting to the good stuff. During his final minutes, Schlatt was playing out the symptoms of a stroke (”Does anyone smell toast?”) while we already know that his death was written as a heart attack. Even though it was probably just cc!Schlatt confusing the symptoms I like to use it for my speculations as well. There is indeed a chance of having a heart attack and a stroke at the same time (or have a heart attack that manifests in stroke-like symptoms). It is called cardio-cerebral infarction. It starts with a heart attack (mostly caused by a blood clot or an atherosclerotic plaque in the heart’s arteries), as heart tissue starts to die the production of more blood clots increases and one of them may end up in the brain causing damage there. Alternatively, the brain tissue may start to die because of the general decrease of blood going into it as the heart starts dying and can’t work properly.

It is unknown what triggered this vicious cycle of conditions: it could have been Schlatt taking up drinking and smoking (just as a fun/cool thing to do or due to some psychological issues in his life) and then progressively increasing the substance use as his health suffered from it or it may have been the muscle condition which caused him taking up those. Either way, as Schlatt was trying to right what was wrong with his body the only way he knew how he just made everything worse and suffered fatal consequences as a result.

Addictions

The most common description of Schlatt that is used by the fandom and the characters alike is “an alcoholic”. Now, alcoholism is not just an unfortunate personality trait. It is a disorder. And considering that Schlatt used alcohol as a way to deal with physical (and sometimes emotional) pain and drank almost constantly we can assume that the addiction was already not only psychological but a physical one. Also, there are a couple of possible instances of him mixing it with the whey protein he used for his workouts. As was said above this was only worsening the state he was in.

Post-Festival Schlatt also had a problem with anabolic steroids overuse. He injected himself to the point of his mouth and hands "vibrating" and him becoming hyperactive and hyperaggressive. Knowing cc!Schlatt, he was probably playing out the so-called “roid-rage” during the White House argument. Schlatt possibly kept on using the anabolics even after the said incident so we can assume that Schlatt might have suffered from prolonged anabolics abuse side-effects which would include aggression, mania, delusions and even depression (or at least it would worsen his already existing psychological problems). It also could have contributed to his heart problems.

This is a minor thing compared to others but after the Festival Schlatt has been consuming extreme amounts of things (laxatives, creatine, whey protein) that often result in digestive problems like belching, stomach upset, diarrhea and bloating so Schlatt’s guts took a toll from his exercises as well.

Even if not as prominent as his alcoholism Schlatt also suffered from tobacco addiction to the point that he would smoke 10 bundled up cigarettes in 30 seconds at one point. As I said before it could have been the cause of his COPD and the possible cause of vascular problems following it but as he kept using cigarettes as a way to alleviate pain and stress the effects only worsened.

Psychological Health

A lot of Schlatt’s psychological issues are linked to his physical health or substance abuse.

Firstly Schlatt was aware of his conditions but wouldn't admit to having any most of the time and was too prideful to get himself checked out. Instead, he turned to self-medication through alcohol and smoking. The first time we see Schlatt working out (aka actively trying to get stronger) is after the festival. As his body got progressively weaker Schlatt got more afraid of people perceiving him as weak not only physically but mentally. Instead, Schlatt tried to overwork himself by working out, injecting himself with anabolics to try and MAKE his body not weak even though it just caused more damage. As more people left Schlatt’s side the more he felt the need to be stronger by himself.

Overall Schlatt showed signs of a typical product of “boys don’t cry” treatment/mentality. Schlatt equated “being a man” to being strong (physically and mentally), not showing vulnerability, not being a coward and getting your way. People who “cried about it”, complained and couldn’t achieve peak physical form he considered “low T soy boy betas”. Not only he applied this standard to others but also to himself, which became a great detriment to his overall health. It can be seen even in something as small as crying. In the story, Schlatt is seen crying only two times. The first time it happens, he locks himself in Casa de Putas, hiding from the rest of the cabinet and begins to drink excessively. When he comes out and is questioned by his cabinet about crying earlier he pretends not to hear it and changes the topic. The second time is just seconds before Schlatt’s death, while he desperately tries to continue working out while his heart finally gives out. It is very telling that Schlatt begins to preach the “manly man” rhetoric after the Festival, the same time he starts his workouts and his descent.

Schlatt also probably suffered from some form of paranoia or was just constantly under huge amounts of stress. Even though he rarely showed it Schlatt knew that people wanted him dead from day one. This and the fact that everyone around him could be a spy might have put a toll on him, might have even increased the amount of alcohol and tobacco he was consuming. One of Schlatt’s biggest flaws (not paying enough attention/not caring enough/being bad at reading people) might have been worsened by him simply drinking his problems and worries away. As a result, he not only didn’t care about what his enemies thought of him but about his allies too.

The Festival was surely part of the rapidly increasing speed of Schlatt’s descent. He might have his suspicions about Tubbo but still felt extremely betrayed when everything about his right-hand man was uncovered (or at least he was very annoyed/angry at Tubbo for trying to trick him for such a long time while pretending to be loyal to Schlatt). Since the Festival, Schlatt started developing trust issues and ultimately decided that he needs to focus most of his power on himself as no one could be trusted (he already had these issues from the start but Tubbo’s betrayal (and possibly Schlatt losing a canon life) only made it worse). The next betrayal put an even bigger toll on him as Quackity was arguably the person he trusted the most and who he considered his “partner in crime”. By the point of the Pogtopia vs Manberg war, the only ones Schlatt knew were on his side were Karl and Fundy. He faced the cruel truth about the latter just mere minutes before his death.

This one may seem like quite a stretch but Schlatt has developed a fear of death. I already said that his first death at the festival played into his complex of being perceived as weak and the unhealthy need to prove to everyone and himself that he’s not. Not only that but at this point Schlatt had to face his own mortality, realize that death is something permanents and painful. He didn’t initially react to his second death but it might have been due to him still being under the influence of an ungodly amount of anabolics which kinda dampened his fear and clouded his judgment. During the war Schlatt is seen to be putting on his bravado of a strong fighter but becomes very antsy and jumpy when seeing the enemies coming near him, this is probably one of the reasons he prefers to use ranged weapons. This might be the reason he escaped in the middle of the battle when long-distance fire exchange ceased and Pogtopia entered direct combat, to drink, smoke and work out – to do things that made him feel like he wasn’t weak or scared. During the Camarvan confrontation, when Tommy aimed a crossbow at Schlatt we can hear Schlatt saying “Don’t kill me, I’m scared of that”. Considering in what state he was (drunk and nearing his death) it could have been genuine fear increased by the fact that the second death he suffered from was a shot by the arrow from his most trusted man.

Bonus round!

This one might be the most headcanony one of all. So. You know how Glatt says his own name randomly throughout conversations. Some people actually interpreted this as a verbal tic. And while tics can be manifestations of genetic disorders and inherited neurological conditions it probably wasn’t the case with Schlatt. After all, such a noticeable tic developed only after his death. But some tics can develop after a person experiences something that causes damage to certain parts of the brain. And I’d like to remind you according to my interpretation Schlatt died while having a stroke, in other words, he experienced ischemic brain damage which sometimes can be a cause of motor and verbal tics. Thus that could have residually affected his dead self.

[macgyvermedical]

Can you give some examples of a clinically indicated need for BiPAP/CPAP?

Thanks!

Good question-

Let’s start with CPAP:

CPAP (Continuous Positive Airway Pressure) is a therapy in which a machine delivers a continuous stream of pressurized air through a mask strapped tightly over the mouth and nose. This pressurized air holds the airway (particularly the throat and tiny air sacs in the lungs called alveoli) open in situations where the patient may not be able to maintain their airway on their own, allowing them to breathe uninterrupted.

1. Obstructive Sleep Apnea: CPAP's most well known use is for obstructive sleep apnea, a condition in which the upper airway (throat) collapses when a person sleeps, causing the patient to briefly (10-30 seconds at a time) but frequently (up to 400 times per night) stop breathing. While not immediately life threatening, sleep apnea causes extremely poor quality sleep, extreme fatigue during the day, and contributes to other health problems like high blood pressure, diabetes, and stroke. The CPAP machine, worn while sleeping, holds these patients’ airways open and allows them to breathe normally through the night.

2. Pulmonary Edema: Pulmonary edema is a fancy word for swelling in the lungs. This can be caused by many problems, including heart failure, infections (pneumonia), poisons (irritants), high altitude (HAPE, a medical emergency where ascending to a high altitude without proper adjustment periods causes a fast-onset pulmonary edema), allergic reactions (causing inflammation in the lung passages), and injuries to the lung tissue.

You can think of the lungs as made of sponge-like tissue, filled with passages that split many times into smaller and smaller tubes that ultimately end in tiny air sacs called alveoli. It is in the alveoli that tiny blood vessels pick up oxygen from the air we breathe and release carbon dioxide to be breathed out (a process called gas exchange). In pulmonary edema, swelling in the lung passages and alveoli make it incredibly difficult to get air all the way to the blood vessels. The hardest part of this is re-opening the alveoli with each breath. The pressurized air pushed in by a CPAP machine can help keep these passages and alveoli open and decrease the work of breathing.

3. Chest Trauma: We breathe in when our diaphragm (a muscle that covers the bottom part of our ribcage) pulls downward, creating extra space within the ribcage that is filled by air entering the lungs. This process requires a mostly-intact ribcage. If the ribcage is significantly damaged (say, flail chest or badly broken ribs), the lungs may not inflate completely, or may not inflate in certain areas. If the lung passages do not inflate fully, not only is the patient not getting all the oxygen/carbon dioxide exchange they might need, but those areas are at risk for developing pneumonia. A CPAP can again keep these passages open and decrease the need for an intact chest while the chest ribcage heals. 

Now let’s talk about NIV:

NIV (Non-Invasive Ventilation, sometimes known by the trade name BiPAP) is a therapy that is similar to a CPAP, but instead of a constant flow of pressurized air into the person’s airway, it alternates between two different pressures over the course of a breath- The pressure is higher when the person breathes in and lower when the person breathes out.

Like CPAP, this pressure (both high and low), can “splint” the airway open, decreasing the work of breathing. Unlike CPAP, however, NIV can also monitor a person’s breathing and force them to take a breath if they go too long without taking one themselves. In this way, it is similar to a ventilator (in fact, most ventilators have an NIV setting)- the breaths are just delivered through a mask worn on the face or a full-head “helmet” instead of a tube that goes down the person’s throat.

NIV is used for:

1. Prior to/weaning from an endotracheal (ET) tube: The least amount of time a patient has an ET tube in their throat, the better off they will be. Tubes are extremely uncomfortable, require a lot of medication to make them tolerable for patients, require the patient to be immobilized which leads to increasing muscle weakness the longer the patient goes without moving, and they can cause sores and other injuries to the airway.

NIV can be used to support breathing until a patient absolutely needs an ET tube, and it can be used when the patient no longer needs the tube but still needs support breathing. Both of these decrease the total amount of time the person needs a tube down their throat, which hopefully makes their outcome better. NIV can also be used (to a limited degree) as an alternative for people who refuse an ET tube but still need breathing support.

2. CO2 buildup/respiratory failure not responding to CPAP: If a person can’t get rid of enough CO2 (for example, in a COPD exacerbation or acute respiratory failure) a CPAP and medication alone might not be enough to correct this problem. In this case, CO2 builds up in the blood, causing it to become acidic, which can quickly become dangerous. Since NIV has a lower pressure when breathing out, it can help encourage the patient to “blow off” some of the excess CO2 when they exhale and return their CO2 levels to normal.

3. Neuromuscular diseases: Some people have diseases that cause their breathing muscles to be too weak to breathe adequately, or have had an accident that left them paralyzed and unable to breathe enough to support themselves. In this case, they may wear an NIV mask constantly or while sleeping to support or take over the work of breathing.

4. Central sleep apnea: Unlike obstructive sleep apnea (OSA), which is a problem with the airway, central sleep apnea is a problem where the brain doesn’t always correctly send signals to the breathing muscles during sleep. It manifests similarly to OSA (excessive daytime fatigue, increased risk for various chronic illnesses) but instead of a device that just keeps the airway open, central sleep apnea also requires a device that can initiate breaths if the patient doesn’t take them on their own.

[myartofhealthyliving]

What is an Oxygen Concentrator and How Does It Work? (Uses and Reasons)

On account of the field of medication's extraordinary progressions, the oxygen concentrators today are smaller, little, peaceful and lightweight, yet at the same time give the most extreme consistence and elite. More established oxygen concentrators are cumbersome and substantial, making it hard for patients requiring oxygen treatment while voyaging or outside their home.

Today, you can browse at-home stationary concentrators and portable oxygen concentrators (POCs), which can go any place you go without any problem.

What is an Oxygen Concentrator?

Oxygen concentrator definition: An oxygen concentrator is a kind of clinical gadget utilized for conveying oxygen to people with breathing related problems. People whose oxygen fixation in their blood is lower than ordinary regularly require an oxygen concentrator to supplant that oxygen.

By and large, you can't accepting an oxygen concentrator over the counter. A specialist should endorse it after they've finished an exhaustive clinical assessment. The specialists will likewise regularly tell the patients the best way to viably utilize these concentrators while voyaging and in their homes.

Oxygen concentrators channel encompassing air, packing it to the necessary thickness and afterward conveying sanitized clinical grade oxygen into a heartbeat portion conveyance framework or ceaseless stream framework to the patient.

It's likewise outfitted with uncommon channels and sifter beds which assist with eliminating Nitrogen from the air to guarantee conveyance of totally cleansed oxygen to the patient. These gadgets likewise accompany an electronic UI so you can change the degrees of oxygen focus and conveyance settings. You then, at that point breathe in the oxygen through the nasal cannula or uncommon cover.

You by and large measure the oxygen concentrator yield in LPM (liters each moment). Your primary care physician will figure out what level of oxygen you need, which might change very still, during rest, and when you work out.

What are the Uses and Reasons for an Oxygen Concentrator?

There are numerous purposes behind an oxygen concentrator and specialists can prescribe oxygen treatment to their patients for different ailments. Ordinarily, your lungs ingest the air's oxygen, moving it into your circulation system.

On the off chance that you've had bloodwork or beat oximetry as of late performed to survey your oxygen immersion levels, and you were found to have low degrees of blood oxygen, your primary care physician might suggest present moment or long haul oxygen treatment.

You're presumably thinking about what is an oxygen concentrator utilized for? Intense conditions generally require transient oxygen treatment. These conditions ordinarily run for a brief timeframe. They might have an unexpected beginning of manifestations versus persistent conditions where things happen bit by bit. Be that as it may, some respiratory or persistent conditions require long haul oxygen supplementation.

Acute Conditions Requiring an Oxygen Concentrator

A couple instances of intense conditions where you would require the utilization of an oxygen concentrator for transient oxygen treatment are:

Asthma: This condition is the place where your aviation routes become aggravated and start delivering a great deal of bodily fluid, which makes it harder to relax. While there are various drugs that can treat and control asthma, an oxygen concentrator can siphon undeniable degrees of oxygen into the circulation system of the patient while they're having or have effectively had an asthma assault.

Pneumonia: Pneumonia is a contamination where you foster irritation in possibly either of your lungs' air sacs and as a rule, top them off with liquid. Numerous pneumonia patients have been recommended oxygen treatment and have seen great clinical results.

Respiratory pain condition (RDS): RDS is a breathing problem for the most part influencing infants, especially the individuals who are conceived at least a month and a half before their conveyance date. Babies experiencing RDS don't make sufficient surfactant (a lung covering fluid), causing their lungs to fall and making them work more diligently to relax. Oxygen treatment utilizing oxygen concentrators assist with siphoning oxygen into the children's circulation system and lungs to decrease further confusions.

Bronchopulmonary dysplasia (BPD): Newborns experiencing RDS likewise have a higher danger of creating BPD. This is a serious lung condition needing long haul breathing help.

At times, after medical procedure, you might require oxygen for a brief timeframe.

Chronic Diseases that Require Oxygen Therapy

Some chronic conditions requiring long-term oxygen concentrator uses are:

Chronic obstructive pulmonary disease (COPD): COPD affects around 16 million people, but an oxygen concentrator can be an effective treatment. When you have COPD, you have chronic lung damage which makes it difficult for your lungs to absorb enough oxygen. As a result, you can have difficulty breathing, and oxygen therapy through a concentrator can help.

Cystic fibrosis: You inherit this life-threatening condition. It causes digestive system and lung damage. It’s a rare condition that affects the body’s cells responsible for producing mucus, sweat, and digestive juices. The fluids are changed which results in a stickier, thicker solution that plugs the ducts, tubes, and passageways of the individual infected.

Sleep Apnea: Sleep apnea is a sleeping disorder that can be serious and cause the individual’s breathing to sporadically stop and start during their sleep. Usually, treatment for this condition is continuous positive airway pressure (CPAP), weight loss, and physical exercise, though some people with sleep apnea may require oxygen therapy.

How Does an Oxygen Concentrator Work?

Think of an oxygen concentrator as a window air conditioner — it takes air in, changes it, and delivers it in a different form. The oxygen concentrator takes air in and purifies it for use by individuals who require medical oxygen because of low levels of oxygen in their blood.

It works by:

Compressing air as the cooling mechanism keeps the concentrator from becoming overheated

Taking air in from its surroundings

Using an electronic interface to adjust delivery settings

Removing nitrogen from the air through sieve beds and a filter

Delivering purified oxygen through a mask or nasal cannula

Patients who required oxygen therapy in the past mainly relied on pressurized oxygen tanks. Even though these tanks are extremely effective, they’re also fairly inefficient with the suppliers having to visit the patients regularly to replenish their oxygen supply in their tank.

The TOP 5 Best Stationary Oxygen Concentrators

1. Sanrai Oxypure 5 Liter Oxygen Concentrator

Sanrai OxyPure 5L is a reliable and robust FDA-Approved 5-liter stationary home oxygen concentrator. Our patient-centric R&D team ensured that the OxyPure 5L is suitable for all your oxygen prescription needs. Designed and developed in the USA, this device results from our 14 years of experience in the home respiratory care industry.

Sanrai’s OxyPure 5L stationary oxygen concentrator was built with your needs in mind, no matter where you are. The Sanrai OxyPure 5L home oxygen concentrator can perform optimally at high altitudes and in areas with high humidity with ease. FDA-approved and conforming to ISO guidelines, our product goes through several hours of burn-in and performance tests to ensure quality, efficiency, and reliability at all times.

Features and Benefits

FDA-Approved

Portability

Reliability

Quality

Whisper-Quiet

Lightweight

Low Cost

Easy-to-use

High-Output

Safe

2 Sanrai Oxyflow 5 - 5 Liter Oxygen Concentrator

The OxyFlow 5 is one of the most reliable and robust stationary concentrators in the world. The OxyFlow 5 delivers up to 5 LPM continuous flow oxygen. This innovative oxygen concentrator delivers oxygen up to 96% purity and weighs only 14 kgs, making it a truly lightweight and compact design. With a noise level of less than 45 dB, it is one of the quietest machines in the world.

Features and Benefits

In use since last 17 years worldwide.

Meeting the regulatory requirement of most stringent medical market of Japan.

Designed and marketed by Sanrai International.

Easy maintenance.

Salter lab humidifier bottle and crush proof nasal cannula provided with unit.

Low Oxygen purity alarm provided.

3. Drive Medical DeVilbiss 10 Liter Oxygen Concentrator

Built upon the reliable features of the popular 525 concentrator, the Drive Medical DeVilbiss 10L Oxygen Concentrator delivers optimal oxygen delivery for patients requiring higher concentrations of oxygen. This innovative machine has a high capacity and a wide range of useful features.

Substantially smaller in size than other high-capacity concentrators on the market, the flame-retardant DeVilbiss weighs only 42 pounds and comes in the same shell as the 5-liter size, yet is still compatible with cylinder transfill systems. It delivers 87% to 96% of oxygen purity ranging from 2 to 10 LPM, resulting in adaptive use for an array of patients with varying needs, from home use to hospitals and long-term care facilities.

Standard on every unit, the exclusive DeVilbiss Oxygen Sensing Device (OSD) system ensures dependable performance and patient safety with real-time monitoring of the oxygen produced. Easily accessible patient controls and bright LEDs make operation a breeze, and a front-located knob facilitates simple air-flow adjustments with its flow meter positioned directly below to verify setting selections.

This oxygen concentrator integrates several safety alarms to further ensure proper operation of the device, and these alarms will sound when there is high pressure, low oxygen, high gas temperature, low-high flow, when the power goes out, and if service is required.

Its cleverly-designed recessed humidifier nook and protected cannula port guard against accidental damage. Convenient handles on the top and side enable easy portability for rolling or carrying.

Features and Benefits

10-liter capacity for users requiring higher oxygen concentration levels

Adjusts from 2-10 LPM for multiple patient usages

Small and compact for a 10-liter capacity

Oxygen Sensing Device provides real-time monitoring

Safety alarms to alert users to problems

Easy-to-read and bright LED display

Accessible patient controls

Recessed humidifier nook and protected cannula port

Handles and wheels for transport

4. Drive Medical DeVilbiss 5 Liter Oxygen Concentrator

Built upon a legacy of reliable, field-proven concentrator models, the DeVilbiss 5 Liter Oxygen Concentrator was designed with enhanced quality, durability and simplicity in mind

Patented DeVilbiss Turn-Down Technology minimizes wear on internal components, reduces power consumption by 15% or more and extends the life of the concentrator

Exclusive DeVilbiss OSD (Oxygen Sensing Device), standard on every unit, ensures patient safety and reliability for longer service intervals

Readily accessible patient controls, protected cannula fitting and recessed humidifier nook to prevent damage

Alarms Audible and visual high/low pressure, low flow, low oxygen, power fail, Oxygen Sensing Device

5. Philips EverFlo 5 Liter Oxygen Concentrator

The Philips EverFlo Oxygen concentrator weighs in at only 31 pounds, reducing shipping and storage costs and risk of injury.

EverFlo's ergonomic design takes up less space and doesn't draw as much attention.

EverFlo is part of the Right Fit, a complete portfolio of oxygen products and programs inspired by patients and built for business.

No homecare provider filter change for two years. Patients do not ever have to change filters.

The system uses less electricity and produces less heat.

The platform is designed to be compatible with all bottle styles and features an easy-to-use closure.

Recessed flow meter reduces accidental breakage.

Durable metal cannula is less likely to break

EverFlo is available with or without oxygen purity indicator. This OPI (Oxygen Percentage Indicator) ultrasonically measures oxygen output as a purity indication.

[exolitecbdoil]

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Exolite CBD Oil

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Exolite CBD Oil At the point when this shower is done, an individual then to be take some ice (enveloped with the fabric) and apply it to your butt-centric floor. This causes a bringing down of the related with blood is really not streaming for the territory; additionally ice can have a desensitizing impact an individual a much more alleviation from torment. Exolite CBD Oil Back rub treatment has for some time been known to successfully mitigate torment including sorts. May be will unquestionably occasions of agony are caused generally by stress and back rub medicines are an awesome pressure reliever. Make certain to have the option to a back rub specialist who functional information in coccyx relief from discomfort so with get total advantages of back rub measure. Exolite CBD Oil Bound Angle is a situated posture. The posture is known essentially in light of the fact that Baddha Konasana. It is incredible for working the hips and crotch area. This sitting posture will help improve blood stream, incitement to your stomach zone, adaptable thigh muscles, disposing of feeling tires, and Pain Relief from the sciatica. It is also a decent posture for ladies have alongside their level feet and those that have copd indications.

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[usman-1234]

Stem Cell Treatment for COPD: Possible Benefits, Cost

Introduction:

Stem cell-based therapies that have been effectively applied to different infections are another methodology for COPD and degenerative lung illnesses treatment. Stem cells may convey a few signs to have cells, instigating a regenerative instrument against alveolar pulverization in the COPD lung

What is COPD?

Chronic Obstructive Pulmonary Disease, or COPD, is a reformist lung infection. As the condition deteriorates, it turns out to be increasingly harder for patients to relax. The condition isn't phenomenal, with in excess of 15 million Americans battling with COPD and a large number around the world. COPD is generally a sweeping term that alludes to a more explicit lung condition – frequently bronchitis or emphysema. A few people battle with the two conditions simultaneously. In one or the other case, COPD presents awkward manifestations that can hinder your personal satisfaction. Perhaps the greatest issue confronting individuals with COPD is that there is at present no known cure. In any case, ongoing examination and R3's research experience have indicated that stem cell therapy might be an astounding alternative for individuals who want to deal with their COPD.

COPD traditional treatment:

For most people with COPD, short-acting bronchodilator inhalers are the primary treatment utilized. Bronchodilators are meds that make breathing simpler by unwinding and enlarging your aviation routes. There are 2 kinds of short-acting bronchodilator inhalers: beta-2 agonist inhalers –, for example, salbutamol and terbutaline.

Stem cell therapy for COPD:

There are a couple of reasons stem cell therapy may be valuable for helping individuals who battle COPD. Patients frequently battle with irritation in the lungs and may have harmed tissue in the lungs. Shockingly, stem cells won't fix scar tissue. In any case, they can help with helping existing lung tissue work much better. Additionally, they can essentially hinder more scar tissue from framing.

“The idea behind this therapy is that you take stem cells and use them to create new alveolar cells. It’s going to become a reality for treating COPD, but we’re not there yet,” Hatipoglu says.

Benefits of stem cell therapy for COPD patients:

These are some benefits by which medical researchers accept that stem cell therapy is best for COPD patients in Pakistan.

●       Stem cells, particularly mesenchyme cells, are known to lessen aggravation. On account of COPD, this can assist with improving relaxation.

●       Stem cells help to revive and recover tissue. For COPD patients, they could assist with re-establishing wellbeing to some harmed lung tissue. As a reference, it won't "fix" scar tissue.

●       Stem cells may assist with creating fresh blood vessels in the lungs. This would build bloodstream into the lungs and oxygen stream out of the lungs, making it simpler to oxygenate the body.

●       lessening inflammation in the aviation routes, which may help forestall further harm

●       Fabricating new, sound lung tissue, which can supplant any harmed tissue in the lungs

●       Stimulating the development of new vessels, which are little veins, in the lungs; may prompt improved lung work.

 COPD stem cell treatment cost:

The most ideal choice for COPD patients is to discover persistent supported clinical preliminaries for COPD or chronic inflammation. Stem cell treatment for COPD can cost somewhere in the range of $10000 - $35,000 relying upon the idea of the treatment and the facility.

Conclusion:

As per a report done by the Lung Institute called Autologous Stem Cell Therapy and its Effects on COPD, more than 82% of patients that endeavored stem cell treatment had perceptible upgrades in their personal satisfaction after their treatments.

Shifa Regenerative & Rejuvenation Clinic is best for treating major diseases including COPD

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[torriwilson]

Pulse Oximeters May Be Helpful For People With COVID-19—Here's What to Know Before You Buy One

The at-home gadget can be valuable for observing coronavirus manifestations, alongside other respiratory conditions

 You may not perceive the name, however you've likely observed a pulse oximeter previously (most likely in a specialist's office or emergency clinic setting). Much like a thermometer peruses your temperature, a pulse oximeter—a little rectangular gadget that cuts onto your finger—peruses your blood oxygen levels and pulse. Yet, in contrast to a thermometer, which numerous individuals as of now have in their homes, pulse oximeters aren't a backbone in many medication cupboards. COVID-19, notwithstanding, may change the entirety of that.

 "Everyone is attempting to abstain from going out—particularly to go to the specialist," Sharon Chekijian, MD MPH, a crisis medication specialist with Yale Medicine, discloses to Health, including that those with mellow side effects are regularly asked to remain at home and counsel their primary care physicians by means of telemedicine. Yet, some of the time it's difficult to recognize milder side effects from those that warrant crisis clinical consideration—that is the place a pulse oximeter can become possibly the most important factor. "Numerous specialists have been prompting patients, particularly those with troubling indications or incessant wellbeing conditions like heart or lung issues, to purchase a pulse oximeter for home to screen their oxygen levels without journeying to the specialist or [emergency department]," says Dr. Chekijian.

 Richard Levitan, MD, is one of those specialists. The crisis doctor composed an opinion piece for The New York Times enumerating his experience chipping in at New York City's Bellevue Hospital, where he saw a mind-boggling measure of basically sick patients who showed up at the medical clinic with hazardously low oxygen levels. It's in cases like these, he composed, when a pulse oximeter can help. "Across the board pulse oximetry screening for COVID pneumonia—regardless of whether individuals check themselves on home gadgets or go to facilities or specialists' workplaces—could give an early admonition framework to the sorts of breathing issues related with COVID pneumonia," he composed, including that all patients who test positive for COVID-19—and even patients who show indications however have not had testing—ought to have pulse oximetry observing for about fourteen days, since that is commonly when COVID-19 pneumonia can create.

 While pulse oximeters are in no way, shape or form a need for the normal sound individual—however a few specialists may propose them to those with prior breathing issues like asthma, COPD, or other lung illnesses—they might be useful during the COVID-19 pandemic. Likewise significant: All specialists aren't in concession to whether pulse oximeters are a smart thought for across the board home-observing, however this is what you have to know whether you're keen on putting resources into one.

 What is a pulse oximeter?

 A pulse oximeter (likewise called a "Pulse Ox") is a gadget that estimates oxygen levels (or oxygen immersion) in your blood, as per Johns Hopkins Medicine—explicitly the fringe oxygen immersion, since it's distinguished incidentally (remotely) on the finger, toe, or ear. That is significant, per the World Health Organization, in light of the fact that your blood (explicitly proteins in your red platelets) hefts oxygen around your body and conveys it to your tissues.

 Pulse oximeters additionally measure pulse rate, as far as pulses every moment—this can likewise show how well the body's tissues are "perfused" or provided with blood, and at last, oxygen.

 Regarding COVID-19, a pulse oximeter can help identify or screen breathing issues related with COVID-19 or COVID-19 pneumonia. The gadgets can be particularly useful for those encountering windedness with analyzed COVID-19—either to watch out for progress or to decide when it merits a trauma center visit.

 How would you utilize a pulse oximeter?

 In case you're utilizing an at-home pulse oximeter, the gadget will cut onto your finger, toe, or ear cartilage. "Most usually, it is a clasp to put on your finger and it communicates frequencies of light to a sensor which precisely ascertains your blood oxygen immersion," George Fallieras, MD, clinical overseer of BioCorRx and specialist at LA Surge Hospital. That frequency is focusing on hemoglobin, a protein in your blood that conveys oxygen—and the light consumed by the blood differs with the oxygen immersion of hemoglobin, per the WHO, which at that point sends a perusing

 The most ideal way direct the test is to do as such while plunking down, says Dr. Chekijian. "The best finger to utilize it on is the center finger," she includes. Make a point to remove any nail clean, abstain from utilizing on cool fingers, sit still. "In the event that your fingers are cold, you are wearing nail clean, or in the event that you are moving near, it may not get a right perusing," she clarifies. Likewise, on the off chance that you use another person's gadget make certain to purify altogether when use.

 Another significant thing to check for during a perusing is that there is a following on the gadget that resembles a sine or nonstop wave, Dr. Chekijian educates. "The wave fluctuates with your relaxing. This implies the gadget is truly getting the correct signs. This is particularly significant if the perusing looks low so you don't misjudge it." If the perusing is low, yet you see a squiggly line rather than a standard sine wave, you are most likely not getting an incredible perusing.

 What is an ordinary pulse oximeter perusing?

 As indicated by Dr. Chekijian, for a sound individual without lung issues, a perusing between 96-100% would connote a typical degree of oxygen in the blood. The WHO brings down that by 1%, saying that anything between 95-100% is typical, and anything under 94% ought to be assessed by a clinical expert. A pulse oximeter perusing of anything beneath 90% is viewed as a "clinical crisis," per the WHO and ought to be dealt with critically.

 "On the off chance that you do think you have COVID and you're utilizing the pulse oximeter to quantify your oxygen level, make certain to cause a log of the readings so you to can check whether there are any changes," Dr. Chekijian proposes. Likewise, the numbers aren't the main thing you should concentrate on. She recommends noticing how you were feeling at the hour of the perusing—like on the off chance that you felt fine or in the event that you were encountering windedness.

 It's imperative to monitor the subsequent number, your pulse, as well. "That is useful to note also so you can report it to your primary care physician," says Dr. Chekijian. As per the WHO, a typical pulse in those ages 10 and more seasoned reaches between 60 to 100 beats for every moment.

 Are there any drawbacks to utilizing an at-home pulse oximeter?

 Likewise with any at-home test, there is consistently space for flawed readings or off base use. The WHO recognizes this, and prompts clinical experts to depend on their own clinical judgment versus a perusing on the gadget. On the off chance that you get a bizarre perusing at home (and you're not feeling sick), you can check the gadget's exactness on another sound relative—however in case you're uncomfortable with a perusing and how you're feeling, it's ideal to look for clinical consideration.

 It's likewise significant not to let a decent pulse oximeter perusing to give you a misguided sensation that all is well and good in case you're feeling unwell. In case you're feeling inferior—windedness, hack, fever—and you haven't been determined to have COVID-19, it's ideal to check in with your medicinal services supplier. The uplifting news: Sometimes a decent pulse oximetry perusing can be a consolation in the event that you are feeling terrible with a COVID-19 finding, to show you aren't deteriorating.

 Where would you be able to get a pulse oximeter?

 That is the million-dollar question at the present time. Since they're so sought after, pulse oximeters, which are typically purchased on the web, at sedate stores, or by means of clinical gadget providers, can be elusive at this moment. "In the event that you think you need one, call ahead [to your favored store] so you don't go on a totally pointless pursuit and open yourself to superfluous hazard all the while," Dr. Chekijian desires.

 Your present smartest option is to look at Amazon or different sites for accessible pulse oximeters. As indicated by Wirecutter, some portion of The New York Times, you can look at gadgets recorded on the Food and Drug Administration's 510(k) Premarket Notification Database via looking "oximeter."

 For the time being, it's additionally best to adhere to at-home finger pulse oximeter gadgets—while there are some applications for cell phones that guarantee to gauge oxygen levels, ongoing examination from the Oxford COVID-19 Evidence Service Team has discovered that that none of them are dependable enough to fill in for the genuine article.

 On the off chance that you can't discover a pulse oximeter because of the deficiency, and you're stressed over your levels, you can (and should) check in with your primary care physician to check whether you can get a perusing. "On the off chance that you have a feeling that you can't slow down or are short of breath with movement please visit brief center, earnest consideration, or call your primary care physician to check whether you can be seen," says Dr. Chekijian. "On the off chance that it's nightfall, call 911 or continue to the crisis division so we can check your levels for you."

 The data in this story is precise as of press time. Be that as it may, as the circumstance encompassing COVID-19 keeps on developing, it's conceivable that a few information have changed since distribution. While Health is attempting to stay up with the latest as could be expected under the circumstances, we additionally urge perusers to remain educated on news and suggestions for their own networks by utilizing the CDC, WHO, and their nearby general wellbeing office as assets.

[sakibhasanworld-blog]

What is cough?

Sudden and noisy expulsion of air from lung is known as cough. it may be voluntary or involuntary. Cough is a sign/ symptom but not disease it self.

Mention the causes of cough.Cough may manifest as clinical feature in following pathological condition.

Pharynx: e.g. post-nasal drip.

Larynx: e.g. Laryngitis, Tumor, Whooping cough.

Trachena: e.g. Tracheitis.

Bronchi: e.g. Bronchitis, COPD, Asthma, Bronchial Carcinoma.

Lung parenchyma: e.g. Tuberculosis, Pneumonia, Bronchiectasis, Pulmonary oedema, Interstitial fibrosis.

Drus side effect e.g. ACE inhibitors.

Mention treatment of the cough.a) General management

General management.

Warm water gurgle may help to reduce.

Vitamin C enriched nutritious diet.

Green/Black tea may help.

Use handkerchief during cough.

b) Medication

Cough suppressant: e.g. Butamirate sulphate, dextromethorphan, etc

Expectorant cough preparations; e.g. Cough suppressant, decongestant and antihistamine combined preparation.

[irispublisherscardiovascular]

A Rare Manifestation of Common Disease: Cardiac Cirrhosis

Authored by Richmond R Gomes*

Abstract

The relation between diseased heart and liver may manifests as acute liver injury, chronic congestive hepatopathy, even cardiac cirrhosis. Congestive hepatopathy caused from impaired blood return to the right ventricle with increased filling pressure. Chronic liver disease (CLD) is the most frequent presentation of hepatobiliary disease. Very rare cause, like long term right heart failure may also be a cause of underlying disease for CLD. We present a case of a 54-year-old female with cardiac cirrhosis. Initial workup was negative. Later thoracic imaging and echocardiography showed chronic obstructive pulmonary disease (COPD) with evidence of pulmonary hypertension. We will briefly discuss the literature on cardiac causes of liver cirrhosis. Our case will present such a short report or cardio-hepatic relations.

Keywords:Congestive hepatopathy; Cardiac Cirrhosis; CLD; COPD; Pulmonary hypertension

Introduction

Chronic right sided congestive heart failure may cause chronic liver injury and cirrhosis of liver but is very uncommon. In long term right heart failure there is elevated venous pressure that is transmitted to liver sinusoids via inferior vena cava and hepatic veins. This leads to long term passive congestion and relative ischemia due to poor circulation eventually leading to necrosis and fibrosis of liver predominantly of centrilobular region. Patient generally presents with clinical features of congestive heart failure and portal hypertension but very rarely presents with variceal hemorrhage or encephalopathy [1]. But our case patient presented with evidence of variceal hemorrhage. Also, the overall prognosis of cardiac cirrhosis is not well established, and treatment of cardiac cirrhosis is mainly aimed at managing underlying heart failure, so it becomes important to distinguish it from other cause of cirrhosis1. The timely diagnosis of a cardiac etiology of liver dysfunction is important because such dysfunction is potentially reversible if the underlying cardiac disease is treated before the development of frank cirrhosis [2,3].

Case Report

A 54 year old lady, home maker, hailing from rural Bangladesh, not known to have diabetes, hypertension or coronary artery disease, chronic smoker (beedi-local hand-rolled cigarettes) presented with progressively increasing abdominal distension for last 6 months, bilateral leg swelling for 1 month and H/O two episodes of passage of black tarry stool since then. On repeated enquiry she also revealed of chronic cough and breathlessness with winter exacerbation for last 10 years and episodes of pedal edema relieving after local medicine. There was no history of alcohol intake, high risk sexual behavior, jaundice, tuberculosis, long term drug or herbal intake, surgery, or blood transfusion. There was no significant family history. On general examination patient was cooperative and well oriented with poor nutrition. Pallor, mild icterus, and bi-pedal pitting edema was present. Cyanosis, clubbing, lymphadenopathy were absent. Pulse-70/ min regular, microvolumes, normal in character and vessel wall normal. Blood pressure-100/ 70 mmHg. Neck vein was engorged, and pulsatile and jugular venous pressure raised. On abdominal examination, abdomen was distended diffusely with eversion of umbilicus and prominent veins in flanks and epigastrium with blood flow from below upwards. Abdominal striae were seen. There were no scar marks. No superficial tenderness present. Splenomegaly was present of 4 cm, firm, non-tender with smooth surface. Liver was also palpable 2 cm from right costal margin along right mid clavicular line, firm, tender with smooth surface and regular margin. No other lump present. Fluid thrill was present. On cardiovascular examination precordium seemed to be normal. Apex beat in 5th intercostal space 2 cm. Lateral to mid clavicular line normal in character. Thrill or para-sternal heave absent. On auscultation 1st and 2nd heart sound audible with loud pulmonary component of 2nd heart sound. The holosystolic, high-pitched, blowing murmur of tricuspid insufficiency best heard at the lower left sternal border. The murmur intensifies with inspiration and decreases with expiration. On respiratory examination chest bilaterally symmetrical with decreased movement on both sides. Trachea central and no deformity of spine seen. Respiratory rate of 26 /min. With use of accessory muscles seen. Vocal fremitus equal on both sides. Hyper-Resonant note heard on percussion. Bilaterally decreased breath sounds with diffuse rhonchi heard over lung fields. Vocal resonance decreased bilaterally. Nervous system examination reveals no abnormality.

Lab reports revealed: Heamoglobin-9.1 gm/dl, Total leucocyte count-3,800/dl, Differential count-neutrophil-58%, Lymphocytes-30%, Platelet’s count-117,000/dl. Random Blood sugar-6.6 mmol/L, Serum Sodium-131 mmol/l, Serum Potassium-4.1 mmol/l, Serum Creatinine-0.9 mg/dl Liver Function Test-S. Bilirubin-3.9 gm/dl, SALP-106 IU, SGPT-111 IU, Serum Protein—5.5 gm/dl, Serum Albumin-2.7 gm /dl Ascitic Fluid Examination—TLC-110/ cc, DLC-N35% L65%, Protein-1.3 gm/ dl, SAAG-1.4 ADA 12.1U/L (normal <30U/L) Prothrombin time: patient 18 secs, control 12 secs. Viral markers (HbsAg, HCV)— Negative Chest X-ray-Cardiac Enlargement with accentuation of bronchovesicular marking bilateral mild pleural effusion, ECG-Rate of 70/min with regular rhythm, ABG-pH-7.38, pCO2-65, pO2-74, SpO2-88%, USG Abdomen-Liver-17.16 cm, coarse parenchyma, Portal vein-12.9 mm & tortuous, Gross spleenomegaly—15.1 cm., Splenic vein—14.2 mm, tortuous & dilated with multiple collaterals in perihilar splenic region. Gross peritoneal collection. 2-D Echo- Grade 3 Tricuspid regurgitation, Severe Pulmonary Arterial Hypertension (PASP 40 mm Hg, dilated right ventricle and right atrium (Figure 1). Upper GI Endoscopy-Esophagus shows grade II × III columns of esophageal varices (Figure 2). Pro BNP was 15656 pg/ml (normal <400 pg/ml). TSH was normal (0.829 IU/ml, normal 0.350-3.40 IU/ml) Pulmonary Function Test-FEV1-52%, FVC-79%, FEV1/FVC-0.66 and improvement in FEV1 after use of bronchodilator was 7% suggesting of chronic obstructive airway disease stage II of GOLD criteria. Fibroscan of liver; Median stiffness was 37.4 Kpa, IQR/MED-10%, which correlate with stage-4 fibrosis, that is cirrhosis. Our final diagnosis was cardiac cirrhosis.She was started salt and fluid restrictions (daily 1000 ml/day) along with oral diuretics containing frusemide and spironolactone combination. Oral nitrates were advised to prevent further variceal bleeding as b-blockers are avoided in patients with respiratory airway diseases. Long acting b-agonist inhalers, montelukast and doxophyline were given to relieve broncho-constriction. Proton pump inhibitor prescribed to reduce acid production and prevent further damage due to acid reflux. Lactulose prescribed to prevent constipation and related complications. She was also transfused with 1 unit packed red cells and 4 units of fresh frozen plasma. Patient was given education regarding diet, precautions and follow up after discharge.

Discussion

Term cardiac cirrhosis denotes any type of hepatic fibrosis occurring in cardiac patient [4]. Our case report is in agreement with the previous observations of chronic liver injury due to long term congestive heart failure. It is a very uncommon cause of CLD and it’s difficult to distinguish from other causes of liver cirrhosis [5]. The most important mechanisms responsible for the development of congestive hepatopathy are hepatic congestion, decreased hepatic blood flow and hypoxemia 5 followed by atrophy, necrosis of hepatocytes, thrombi resulting due to cholestasis [6]. Causes of cardiac cirrhosis are valvular heart disease, cardiomyopathy, pericardial disease, ischemic heart disease, primary lung disease [7]. With decrease in incidence valvular heart disease, cardiomyopathy in etiology of cardiac cirrhosis has increased [8].

Our case had primary lung disease due to chronic smoking which resulted in pulmonary hypertension leading to chronic congestive heart failure. This further leads to passive congestion and relative ischemia due to poor circulation eventually leading to necrosis and fibrosis of liver predominantly of centrilobular region [9]. Usually, cases of cardiac cirrhosis do not develop variceal hemorrhage or encephalopathy, but our case had unusual presentation of melena suggesting variceal bleeding. Our case had Obstructive airway disease of stage II according to GOLD10 staging evidenced from deranged Pulmonary Function Test, Abnormal Blood Gas analysis. Evidence of Pulmonary hypertension was evident clinically in form of loud P2 and murmur of tricuspid regurgitation which was established on 2D Echocardiography. Chronic congestive heart failure established on long history of 5 years for which he is taking treatment (? diuretics) from quack of which records were not available and raised pro-BNP level.

Later he developed congestive hepatopathy and signs of portal hypertension as evidenced by splenomegaly, progressive ascites which was transudative with SAAG> 1.113, jaundice, dyspnea, engorged neck vein, hepatomegaly, pedal oedema, normal alkaline phosphatase levels, raised AST, ALT and serum bilirubin. Metabolic and synthetic functions of liver were also compromised evident from decreased serum albumin and deranged PT/INR [7]. In congestive hepatopathy, liver function tests do not show the specific pattern as in patient with hypoxic hepatopathy [11]. Cholestatic enzymes together with low albumin and high bilirubin are the strongest risk factor for poor outcome, in case of chronic heart failure [12]. Chest X-ray was suggestive of congestive cardiac failure as there was bilateral pleural effusion. Splenomegaly was associated with hypersplenism as evident from pancytopenia in blood picture. As our patient was suffering from chronic congestive heart failure and ascites, transabdominal liver biopsy is at risk and Transjugular liver biopsy is not practiced at our setting for the evaluation of cirrhosis. So, fibro scan was done, and result was suggesting liver cirrhosis. Usually, cases of cardiac cirrhosis does not develop variceal bleeding, but our case presented with variceal bleeding evident from history of melana which was established on upper gastro-intestinal endoscopy in which therapeutic banding could not be done due to financial constraints [13].

The timely diagnosis of a cardiac etiology of liver dysfunction is important because such dysfunction is potentially reversible if the underlying cardiac disease is treated before the development of frank cirrhosis [2,3]. Moreover, early treatment of underlying cardiac disease might also prevent the development of hepatocellular carcinoma as suggested by an interesting case study in which a patient with negative hepatitis serologies and cirrhosis secondary to constrictive pericarditis developed hepatocellular carcinoma confirmed by biopsy [14].

Conclusion

This case study illustrates to gastroenterologists the need to consider a cardiac etiology in the work-up of cirrhosis especially when the most common causes are not found. A patient with COPD developing chronic right sided heart failure due to pulmonary hypertension causes passive congestion on hepatic veins, eventually lead to hepatic fibrosis, and raised portal hypertension. Though variceal bleed is uncommon in portal hypertension due to cardiac cirrhosis but may be presenting complain in rare case as seen in our case. Thought COPD and cardiac cirrhosis both are very uncommon, our interest was to highlight the cardiac cause should be evaluated in a dysphonic adult, where the causes of CLD were not certain.

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[helvaticacare]

COVID-19 TREATMENT AND RECOVERY

COVID-19 is known as a new viral infection. One of the vital biological characteristics of SARS-CoV-2 and various other viruses is the ubiquity of spike proteins that enable viruses to penetrate host cells and cause infection. The most significant medical concern is a secondary bacterial strain that manifests during or after a viral infection(s), leading to adverse outcomes and sometimes fatal clinical complications.

Research and development of clinical trials focus mainly on the primary pathogen and any neglected secondary infections. Several individuals are contracting COVID-19 worldwide, resulting in an unusual number of intensive care units (ICU). To treat mild or moderate COVID-19, scientists are continually working on new antiviral medications. There already are drug and non-drug interventions that can assist individuals in coping with COVID-19 symptoms.

EFFECTS OF COVID-19

On the Immune System: It causes a massive release of cytokines known as the cytokine storm – cell hormones that destroy their tissues, cause oedema. It reduces protective functions due to a sudden decline in lymphocytes cells that usually fight the virus.

On the Respiratory System: Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus SARS-CoV. It generates pneumonia due to the destruction of lung tissue, leading to respiratory failure and acute distress syndrome ARDS.

On an Organism as a Whole: It increases inflammatory processes, exacerbates chronic disorders, which are hazardous for people with pre-existing comorbidities such as cardiovascular, weakened liver function, respiratory infections and metabolism issues

A recent study on the Prevalence of Comorbidities in Patients and Mortality Cases Affected by SARS-CoV2 found that 42% of patients with Covid-19 had comorbidities. Furthermore, 61% of those with Covid-19 admitted to the Intensive Care Unit had comorbidities, and 77% of those who died had comorbidities. Hypertension was the most prevalent comorbidity (affecting 32% of patients). Other common comorbidities included diabetes (22%), heart disease (13%), and COPD (8%).

Particularly at the early stage or for non-intubated patients, experts recommend close monitoring of the symptoms of secondary infection, especially in critically ill patients who have been admitted to ICU for more than 48 hrs.

Moreover, considering the long-term impact of antimicrobial resistance development due to the unnecessary usage of antimicrobial agents, the most common bacterial and fungal infections could complicate COVID-19, knowing their expected antibiogram and strictly monitoring the development rate of resistant bacterial strains.

Here is a glimpse at some of the available COVID-19 treatments and how to get more information about them. It is essential to talk to your health care provider about feasible treatment options if you have contracted COVID-19. Your health care provider will identify the best option for you based on your symptoms, risks, and health history. The symptoms of Covid-19 usually are some mix of fever or chills, cough, shortness of breath, headache, lethargy, sore throat, congestion or runny nose, muscle or body aches, diarrhoea, or nausea. It is important to note that many people, often described as asymptomatic, often have hardly any symptoms at all and may be unaware that they have been infected. This is because their immune system has been strong enough to fight the infection off at an early stage. This is why it is important to maintain a healthy immune system.

MONOCLONAL ANTIBODY TREATMENT

Clinical researchers are fledging new therapies to treat mild to moderate COVID-19, including monoclonal antibodies(MAbs). To combat the invading pathogens such as the virus, specific molecules are produced in a lab to mimic those usually made by a body’s immune system. Monoclonal antibody drugs identify and neutralise the SARS-CoV-2 virus that prompts COVID-19.

The FDA has granted emergency use authorisation (EUA) to several monoclonal antibody medications for mild or moderate COVID-19. The FDA has determined that the known or potential benefits outweigh the known or possible risks based on carefully evaluating the available scientific evidence.

Monoclonal antibody medications are commonly administered by intravenous IV infusion at an outpatient infusion centre. The whole treatment process can take about two to three hours, with the IV delivery of the drug, which can take about an hour. A strain of monoclonal antibodies supports the immune system, reducing the uncertainty that someone will need to be hospitalised and lessening the odds of dying.

WHO IS ELIGIBLE TO RECEIVE MONOCLONAL ANTIBODY TREATMENT

According to clinical studies, treating mild or moderate COVID-19 in adults and children aged 12 years and over and weighing at least 40 kg who have tested positive for COVID-19 within the last ten days and are at high risk for advancing to severe COVID-19 state —the FDA has sanctioned the use of several monoclonal antibody therapies, hospitalisation, or both.

Individuals at heightened risk include 65 years and older and with underlying medical conditions like lung disease, cancer, chronic kidney disease, liver disease, lung disease, dementia, or other neurological disorders. In addition, patients may also need a referral from their healthcare provider for individuals meeting these criteria to receive monoclonal antibody treatment.

OTHER TREATMENTS FOR MILD OR MODERATE COVID-19

In extreme circumstances, doctors may treat patients who have mild or moderate COVID-19 with the following:

1. Corticosteroids

Dexamethasone is an effective immune modulator; as it reduces inflammation in the body by controlling the immune response. To treat a mild or moderate COVID-19 case, several pieces of evidence suggests that some people who require supplemental oxygen from a mask or an oxygen cannula may profit from receiving a steroid such as dexamethasone. Pulmonary fibrosis, pneumonia, cystic fibrosis, and sleep apnea are some conditions requiring supplemental oxygen. A short course of a comparatively low dose of corticosteroids helps patients heal faster and have a better outcome.

Original Source: https://www.h-h-c.com/covid-19-treatment-and-recovery/