#membranous croup

[onecopyoneyearinadvance]

Chillicothe Independent, Volume 6, Number 4, 29 October 1881

There was a serious diphtheria, also referred to as Membranous Croup, outbreak in the area October 1881, with several deaths mentioned in the paper each week. I doubt this worked, but it's hard to blame people for grasping for solutions

[nursingwriter]

Epiglottitis is caused by cartilage covering the trachea, or windpipe, and is sometimes also called croup syndrome. In is most common in children that are between two and six years of age and usually is caused by the bacterium Haemophilus influenzae, although other bacteria or viruses may cause it. Epiglottitis is rather rare, although it can even occur in adults, and because of its rarity it is often overlooked as a possible diagnosis even if the signs and symptoms are present. For newborn babies, it can be quite devastating. In the United States, the incidence of epiglottitis is on the decline, but those that get the disease will find that it can have a rather rapid progression. The main reason for the decline in the number of cases, however, is the fact that the Hib vaccine has become routine in the vaccination schedule of all children. This occurred in the late 1980s and has helped greatly, although not all children are immunized, and epiglottitis can occur before immunization takes place as well. Even though many people are not that aware of epiglottitis, it can be life threatening quite quickly. It begins with a very sore throat and a high fever. Once this occurs, the epiglottis, which is located at the back of the tongue and works to close off the windpipe when someone swallows, can swell, and this can severely hamper the breathing of that individual. As the epiglottis continues to swell, breathing can become difficult rather rapidly, and respiratory distress can occur. In adults, the condition is still very dangerous, but they are capable of indicating that they need help. Newborns cannot do this, and any signs or symptoms of epiglottitis require immediate treatment, usually with hospitalization in the intensive care unit (www.nlm.nih.gov,2004). The larynx is a framework of muscle, mucous membranes, and cartilage that forms the entrance to the windpipe. The epiglottis works like a lid to keep food and drink from getting into that windpipe, which could be very serious. When someone swallows, the epiglottis closes, sealing off the larynx, which is why individuals cannot swallow and breathe at the same time. When no swallowing is occurring, the epiglottis is lifted slightly so that breathing can take place, but when it becomes swollen it is like a permanent state of swallowing, and air cannot get past. If it is only slightly swollen, the infant or child can still breathe, but with some difficulty. If it becomes severely swollen, however, breathing is stopped and death can come within minutes without treatment. The bacteria that most commonly causes epiglottitis is also contagious, so care must be taken around anyone that has the problem, so that others in the family and work environments do not contract it (www.cnn.com,2004). As for the treatment of epiglottitis, it is necessary, because no treatment can result in death. For those that receive prompt treatment, however, the prognosis is generally very good. Treatment involves ensuring that enough air is getting through as a first priority. Sometimes, an oxygen mask can be enough for this, but other times more severe cases require a breathing tube. The tube is inserted through the nose or mouth and may have to stay in place for several days until the swelling in the epiglottis has gone down sufficiently to allow for adequate airflow to the lungs. For severe cases that are extreme emergencies, it may become necessary to cut a hole in the trachea that will bypass the larynx and allow air into the lungs. This is only done as a last resort, but there are times when it must be done to save a life. Antibiotics are also part of treatment, as they are used to make the swelling go down so that the body can begin to heal and adequate airflow can be restored. In infants and very young children, this is an extremely serious problem, as they are growing and developing so quickly that enough oxygen is essential. The best thing that can be done, however, is to work on prevention. Making sure that babies are immunized against epiglottitis and other diseases is one of the most significant and important things that any parent can do for their child to help them grow up happily and give them a good start toward a long and enjoyable life (www.cnn.com,2004). Works Cited www.cnn.com.(2004). Epiglottitis. Retrieved 8 February 2005 at http://www.cnn.com/HEALTH/library/DS/00529.html. A www.nlm.nih.gov.(2004). Retrieved 8 February 2005 at http://www.nlm.nih.gov/medlineplus/ency/article/000605.htm. Read the full article

[valgasnewsthings]

Do not joke with urticaria.

 And in my hubby is chronic urticaria, as his body covering with a small bladder, which causing strong itch, he's using anti histamines,and in a few days all stopping. Why this is happening? Maybe  this is symptom of disease and how this is tied?

 A nettle rash or urticaria as collective name,and including in itself are rows other diseases as with redness, bladders, like of nettle burn. And such rashes having on the mouth membranes, throat as false croup , in nasopharynx, tongue, mouth, mucus stomach, and bowel answers immunologist Treskunov,and which rashes spreading on all body as of big or giant sizes.And if membranes on rashes having and bowel with belly aches, nausea, sickness, diarrhoea, and in throat edema as croup  a displaying hoarse breath, dyspnoe,and this is risk for life condition,where is using intubation as entering in trachea a endotracheal tube or artificial lungs ventilation.And in reasons for chronic , acute recidiving urticaria are parasitoses as stomach  infection and bowel with bacteria as helico bacteria pylori and he is a reason chronic gastritis and stomach cancer, bowel, and bad enduring NSAID, antibiotics, sulfonamides or products, cold,staying on sun, bites of bees, insects, physical loads, nerve stresses.

And urticaria sometimes is a first symptom of acuting a sleeping in cells of organism a virus infection Hepatitis B, or C, and from urticaria behind a pseudo tuberculosis or yersinos , which for person infecting are mouses through not manufacturing thermic vegetables, and serious reason for urticaria are staying oncologic tumor or beginning autoimmune disease as autoimmune thyroiditis, malignant lymph,and idiopathic urticaria,when a reason for diseases is not succumb for definition. And when a pill of anti histamine liquidates diseases, thus not worry,and not search ,where to search diseases source, when reason for urticaria have not been found , thus her attacks are periodically recidiving,thus needing finding to care for inside pathology,which allows immune system reacts to this way of . And different allergy tests are not ability finding a  base reason for diseases, and on skin tests are not using,ache skin reacts on a using substance and not informative and immune ferment blood test for a finding allegro specifical immune globulins E ,and in diagnosis put doctor orienting on a data of patient s questioning.

And in a cure for nettle rash having are two pribciples as ethyological,when a reason found onm a which you can to affect  asymptomatically, and a most often using, when reason is not clear. And for symptomatic cure are having lots of antihistamines ,as a symptom for disease displaying after the outburst a histamine as reason for itch,  edema, hyperaemia, selecting anti histamine remedies with a calculation a whole rows factors is doing allergist doctor.

And first generation anti histamines as dimedrol, suprastin, diazolin as with a big side effects,causing sleepiness, heart rhythm bad, provoking glaucoma recidives epilepsy, and not using in gastrointestinal inflammation, and in driving, working with hard mechanisms.

Anti histamines for second generation ,thitd, four are loratadin, cetirizin, ebastin, zodac, xyzal, astemizol which a having lots of dignities as effecting more longer till 24 hours , and not causing sleepiness, heart arrhythmia, addiction, and third,that erius, xyzal are faster absorbing from gastrointestinal,thus his effect regarding as instantaneous.And on the hard cases is short course till a week use glucocorticosteroids  as prednisolone,  in daily dosage on 30 ml or methypred as his dosage depending on from rashes expression and itch. And better use pill after meal, with alkaline mineral water drinking, and in urticaria symptoms disappearing thus right away cancel corticosteroids , that to avoid side effects cause, as in an  urticaria cure a syndrome for  cancellation is not having.

And you can to see, that with urticaria  jokes are very bad!

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[biomedicool]

Diphtheria

Diphtheria is a nonencapsulated, nonmotile, gram-positive bacillus; t Corynebacterium diphtheriae. Pathogenic strains can result in severe localised upper respiratory infection, localised cutaneous infections, and rarely systemic infection.

Usually spread by direct contact or through the air.

Symptoms are due to a toxin produced by the bacterium

and start two to five days after exposure.

Symptoms often come on fairly gradually, beginning with a sore throat and fever.

In severe cases, a grey or white patch develops in the throat.

Which can block the airway and create a barking cough as in croup.

Neck may swell due to enlarged lymph nodes

Complications may include myocarditis, inflammation of nerves, kidney problems, and bleeding problems due to low levels of platelets.

Myocarditis may result in an abnormal heart rate and inflammation of the nerves may result in paralysis

Pathology

C diphtheria adheres to mucosal epithelial cells where the exotoxin, released by endosomes, causes a localised inflammatory reaction followed by tissue destruction and necrosis. 

The toxin is made of two joined proteins. The B fragment binds to a receptor on the surface of the susceptible host cell, which proteolytically cleaves the membrane lipid layer enabling segment A to enter. 

Fragment A inhibits an amino acid transfer from RNA translocase to the ribosomal amino acid chain, thus inhibiting protein synthesis.

DT causes a catalytic transfer of NAD to diphthamide, which inactivates the elongation factor, resulting in the inactivation eEF2, which results in protein synthesis blockage and subsequent cell death.

Local tissue destruction enables the toxin to be carried lymphatically and hematologically to other parts of the body. Elaboration of the diphtheria toxin may affect distant organs such as the myocardium, kidneys, and nervous system. 

[sameersingh7]

FOOT ZONE BENEFITS THE CERVICAL BONES & CERVICAL NERVES 1-7 FUNCTIONS

The backbone is a series of individually aligned bones known as our vertebrae.  The spinal cord is housed in two-thirds of these vertebrae, and the peripheral nerves extend out from the spinal cord and all vertebrae, and extend to their prospective targets.  When a vertebra bone becomes misaligned, it can pinch one of the peripheral nerves responsible for specific functions.

Cervical

The cervical vertebrae form the neck.  There are seven cervical vertebrae and eight cervical nerves.  The seven vertebrae in the neck and the eight cervical nerves extend beyond the neck region to service parts of the head, brain, face, throat, neck, shoulder, and arms.

C1- If you are experiencing dizziness, headaches, including migraines, poor circulation in the brain, or high blood pressure, it may be due to misalignment of the C1 vertebra, pinching off the 1st and 2nd cervical nerves.

C2- If you are experiencing eye problems, ear pains, or deafness, as well as sinus issues, this may be due to misalignment of the C2.  The second nerve services the eyes, including the optic nerves, the ears, including the auditory nerves, the mastoid bones, sinuses, and the forehead, tongue, and heart.

C3- If you feel pain in your facial nerves, have neuralgia, tinnitus, bleeding gums, bad teeth, and plaque, your third cervical nerve may be compressed.

C4- If you are experiencing hearing loss, are constantly cold, constantly have chapped lips, or adenoid issues, this may be due to a pinched 4th cervical nerve.  This nerve services the eustachian tube of the ears, nose, lips, mouth, mucus membranes, and a portion of the respiratory system.

C5- This nerve services glands in your neck as well as your pharynx and vocal cords.  If you are experiencing a sore throat, hoarseness, chronic cold, or laryngitis, it may be related to your 5th cervical nerve.

C6- This nerve affects the tonsils, muscles to the neck, the lungs, and arms.  If you are experiencing tonsillitis, a goiter, croup, a stiff neck, or pain in your upper arms, a compromised 6th cervical nerve may be a contributor.

C7-This nerve services the thyroid, shoulder, and arms.  If you have thyroid disease, depression, easily get colds, or bursitis in the shoulder or elbow regions, these conditions may be related to a compromised 7th cervical nerve.

C8- This is the last peripheral nerve extending from the cervical neck vertebrae.  Cervical nerve 8 services the same regions as Cervical nerve 7, the thyroid gland, shoulder bursa and the elbow.  If compromised, you may experience many of the same symptoms as a compromised cervical nerve 7.

At wellness Life Zone, Foot Zone Academy, we have acupressure points for all the vertebrae and peripheral nerves in the body, including the cervical vertebrae and cervical nerves.  

If you are experiencing issues as listed above, you many want to try foot zone therapy.  Foot zoning acupressure points such as the cervical vertebrae and cervical nerves stimulate the original blueprint of the body to make structural adjustments to the body, allowing the natural flow of the nervous system and relieve these symptoms.

To find a qualified Foot Zone Practitioner, visit our directory at wellnesslifezone.com.

[plurdledgabbleblotchits]

Reddit had this for translation:

Ague = feverish illness, often malaria

Apoplex = stroke (the rupture or clogging of a blood vessel in the brain), paralysis resulting from a stroke - sometimes also refers to other spontaneous causes of internal bleeding like burst aneurysms

Meagrom = migraine, severe headache - this obvious symptom could be deadly if it originated from things like a brain tumor, bleeding within the brain / stroke, concussion / TBI / swelling within the brain...

Bloody flux, scowring, flux = dysentery / bloody diarrhea or otherwise severe diarrhea, often from diseases like cholera

Childbed = death during or shortly after giving birth

Chrisomes = death of unbaptized infant / death of infant less than a month old

Colick, stone, and strangury = severe abdominal pain, bladder/kidney stones, rupture in abdomen (appendicitis, bladder rupture, etc)

Consumption = tuberculosis

Cut of the stone = died during/from the surgery to cut out bladder/kidney stones

Dropsie and swelling = edema, swelling of a body part

Falling sickness = epilepsy, seizures

Flocks and small pox = smallpox, other diseases causing pustules over the body like cowpox and chickenpox

French pox = syphilis

Jaundies = jaundice, yellowing of the skin and eyes often a symptom of liver failure

Jawfain = "jaw fallen" / lockjaw, often tetanus

Impostume = abscess, a deep infection full of pus

King's Evil = scrofula, aka tuberculosis infection of the neck glands. The touch of a king was said to cure this disease.

Lethargie = depression?

Livergrown = unknown, some think it might have been another term for rickets or it could be from diseases which resulted in a swollen, enlarged liver - things like chronic alcoholism, hepatitis, or congestive heart failure.

Made away themselves = suicide

Murthered = murdered

Over-laid = infant that died after being unintentionally smothered / parent rolled onto them while sleeping

Starved at nurse = insufficient breast milk, or the child had a disease that caused them to "fail to thrive" / not gain weight and die even though being fed

Palsie = palsy, paralysis or other muscle difficulties

Piles = hemorrhoids

Planet = aka planet-struck, any very sudden severe illness or paralysis that was thought to result from the "influence" of a planet. Like how the moon (luna) was once thought to cause insanity (creating lunatics).

Pleurisie = swollen, inflamed pleura - the membranous tissue surrounding the lungs

Purples = bruising, especially wide-spread - many causes

Spotted feaver = typhus or meningitis

Quinsie = tonsillitis / inflamed tonsils, especially when abscessed and obstructing breathing

Rising of the lights = as an organ meat, lungs are often called "lights" because they are very light-weight organs. Nobody's sure about what exactly "rising of the lights" was, but it may be related to severe coughing and the perception that during a cough the lungs would rise up in the chest. Perhaps croup, a respiratory disease causing a severe 'barking' cough.

Suddenly = unknown sudden death

Surfet = overeating / gluttony, vomiting from overeating. Aside from direct "death from overeating" it may have been a grouping for many types of death that often went along with being overweight - death from untreated diabetes, cushing's disease, heart failure, etc. "Surfet" also might have been the cause-of-death given if someone over drank, passed out, and died from aspirating their own vomit.

Teeth = dental infection leading to death

Thrush = yeast overgrowth / yeast infection of mouth (or genitals)

Tympany = either abdominal tumor growth, or other bloating/distension of the abdomen - especially when air or gas is caught within the abdomen or intestines, causing a hollow sound when thumped

Tissick = cough, can also refer to the coughing and wasting away of tuberculosis

Causes of death, London, 1632. 11 people died of grief, 1 of vomiting, 470 of teeth, 12 of French Pox.

[X]

[acuguy]

COVID-19 What you Should Know.

By: Emmanuel Arroyo, LAc                                                           3 March 2020 8:22 PM EST

Queens, New York

What is a Coronavirus?

Coronavirus, discovered in 1960,[1] is a positive-sense RNA virus that mainly targets the upper respiratory tract except for SARS which causes upper and lower tract infections and gastroenteritis. A positive-sense RNA is also known as positive-strand RNA virus[2]. The name is given due to its single strand of RNA while positive refers to genetic information carried for replication. Coronavirus causes the common cold, except for SARS and MERS, and now COVID-19.

Coronavirus (CoV) belong to the order of Nidovirales, which includes Coronaviridae, Arteriviridae, and Roniviridae families. CoV is divided into two subfamilies, CoV and the second subfamily Torovirinae. CoV has a cap (let’s call it head) which carries all the information needed for replication, while the tail has all the information related with structure and functions. The tail contains four important structures, S (spike), M (membrane), E (envelope), and N (nucleocapsid) proteins. The S structure is the one that attaches to the host cell receptors. The M structure gives the shape/form. The E structure is important for assembly and release of the virus; some virus need the M structure for pathogenesis. Structure N facilitates binding and affinity to viral or non-viral RNA. Both N and M work synergistically and facilitate replication and diffusion of the virus in the host.[3]

For binding, CoV mainly uses aminopeptidase as receptors except SARS and NL63 that use angiotensin-converting enzyme and MERS uses dipeptidyl-peptidase-4.

The Wuhan-coronavirus is new and is identified as 2019-nCoV, also known as COVID-19. COVID-19 stands for COronaVIrus Disease and is the full blown manifestation of SARS-COV2. SARS-CoV2 is a mutated coronavirus where the S structure attaches to Angiotensin Converting Enzyme 2 (ACE2) and it contains two subunits attaching to furin which makes it similar to Ebola, HIV, and avian influenza virus.[4] Furin is a protease found inside a cell and is known as Proprotein Convertase (PC) which develops the synthesis of prohormones, neurotrophic factors, serum proteins, regulation of hair, teeth, sweat glands, embryogenesis, calcium, pH, and interesting enough it also determines how virulent or infectious a bacteria or virus will be. It determines cancer aggressiveness and creates amyloid which are a key of Alzheimer’s.[5] Furin also regulates Insulin Growth Factor in upper respiratory tract and colon.

SARS-CoV2 Spike structure is genetically similar to the Spike structure to a Guangdong pangolin, while its genetic sequence is similar to a bat betacoronavirus of the genus sarbecovirus and is namedRaTG13. SARS-CoV2 has an ancestor which has been labeled Type-S. This ancestor is less aggressive and propagates slower. The aggressive SARS-CoV2 is dubbed Type-L and it is unknown if the Type-S mutation to Type-L occurred in the animal or in the human. 

How many human coronaviruses are known?[6],[7]

In the past CoV was classified according to the immune reaction, hence the Alpha, Beta, Delta, and Gamma nomenclature. 

There are seven known human coronaviruses:

1.       Alpha coronavirus:

a.       229E (1960) – causes common cold

b.       NL63 (2004) – causes croup hence it targets kids. Similar genome to 229E. Uses angiotensin converting enzyme. Is a recombination of PEDV. Hast two variants.

2.       Beta coronavirus:

a.       OC43 (1960) – causes common cold. It is believed it evolved from bovine CoV.

b.       HKU1(2005)

c.       SARS-CoV (2003) uses angiotensin converting enzyme 2.

d.       MERS-CoV (2012)

3.       SARS-COV2 - uses Angiotensin Converting Enzyme 2, the Spike structure has subunits attaching to furin.

There is no vaccine for any, the only vaccine created was for SARS and it was an attenuated virus.

China has been using a drug produced in Cuba known as Alpha Interferon which intention was for HIV, Human Papilloma Virus, Hepatitis B and C, and some cancers. This medication has been used successfully and China claims that it has cured 1,500 cases as of February.[8] China uses Kaletra or Aluvia (liponavir and ritonavir) with Rivabirin which are medications for HIV and Hepatitis. The use of HIV meds and Tamiflu is another cocktail in use. The medication for malaria, Cloquonine, is also used for COVID-19. Another medication added to the cocktail is Thymosin, a medication that assists in the maturation of T-cells.

Do Animals get Coronavirus?

Yes, animals do get infected with coronavirus, but it is difficult for getting infected with HUMAN coronaviruses. Some of the coronaviruses in animal are the following:

·       Porcine epidemic diarrhea virus (PDEV)

·       Porcine Transmissible gastroenteritis virus (TGEV)

·       Porcine Haemagglutinating encephalomyelitis virus (PHEV)

·       Feline infectious peritonitis virus (FIPV)

·       Canine coronavirus

·       Mouse hepatitis virus (MHV)

·       Bovine coronavirus

·       Bat SARS

·       AvianCoV

Which Disinfecting Wipes?[9]

·       Lysol claims it product kills[10]

o   Virus: Herpes simplex virus type 1, Human coronavirus, influenza A virus

o   Bacteria: Streptococcus pyogenes (Strep), Staplylococcus aureus (Staph), Escherichia coli O157: H7 (E. coli), Methicillin resistant staphylococcus aureus (MRSA), Salmonella enterica (Salmonella)

·       Clorox Healthcare®Bleach Germicidal Disinfectants and Clorox Healthcare® Bleach Germicidal Wipes[11]

o   Virus: Adenovirus Type 2, Avian influenza A, Canine parvovirus, Enterovirus D68, Feline Panleukopenia, Hepatitis A, Hepatitis B, Hepatitis C, Herpes simplex type 2, Human coronavirus, Human immunodeficiency virus type 1, Influenza A, Influenza B, Measles, MERS-CoV, Norovirus, Poliovirus type 1, Respiratory syncytial (RSV), Rhinovirus, Rotavirus, SARS-CoV.

It is important to point that CoV killed by Clorox are SARS, MERS and that H-CoV mentioned by Lysol® and Clorox®are the ones that cause common cold. [12]

China and SARS, A Lesson on How to Treat

When SARS (Severe Acute Respiratory Syndrome) hit China the treatment response was multifactorial; China used an integrated approach of Chinese medicine and Western medicine. This integrated approach consisted on nutritional support, Chinese herbal medicine, and a regime of oxygen supplementation, corticosteroids (methylprednisolone), antibiotics (azithromycin, cefotaxime, amoxycillin-clavulanic acid, ciprofloxacin, demethylvancomycin), immunoglobulin, and thymosin. The medications used were according to severity and symptomatology. From the western approach we can determine that healthy eating habits are important. The use of antibacterial, corticosteroids, and thymosin is evidence that herbal, vitamins, mineral, and amino acid supplementation with antibacterial, anti-inflammatory, analgesic, immunomodulatory properties are paramount as prophylactic measures.

From a Traditional Chinese Medicine (TCM) perspective SARS was diagnosed as Wen Yi Bing or Warm Pestilential Disease.[13] The differential diagnosis used was Four Divisions (Wei-Qi, Ying-Qi, Xue, Yuan) and the Triple Heater or San Jiao. The aim of the Chinese herbal formulas was to expel pathogen, clear heat, and dissolve dampness therefore the herbal formulas used back in 2003 for SARS were the following:

·       San Ren Tang (Three-Nut decoction) + Shen Jiang San (Ascending-Descending Powder)

o   Ingredients: Xing Ren (Semen Pruni Armeniacae), Bai Dou Kou (Fructus Cardamomi Rotundi), Sheng Yi Yi Ren (Semen Coicis), Hua Shi (Talcum), Tong Cao (Medulla Tetrapanacis Papyriferi), Zhu Ye, (Herba Lophateri Gracilis), Hou Po Hua (Flos Magnolia Officinalis), Fa Ban Xia (Rhizoma Pinelliae Ternatae), Jiang Can (Bombyx Batricatus), Chan Yi or Chan Tui (Periostracum Cicadae), Pian Jiang Huang (Rhizoma Curcuma Longae), Cang Zhu (Rhizoma Atractylodis), Huang Qin (Radix Scutellariae Baicalensis).

 ·       Yin Qiao San (Honeysuckle and Forsythia Powder) + Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) + Sheng Jiang San (Ascending-Descending Powder).

o   Ingredients: Sheng Ma Huang (Herba Ephedrae), Xing Ren (Semen Pruni Armeniacae), Sheng Shi Gao (Gypsum), Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) Jiang Can (Bombyx Batrycarius), Chan Yi or Chan Tui (Periostracum Cicadae), Bo He (Herba Menthae), Lian Qiao (Fructus Forsythiae Suspensae), Jin Yin Hua (Flos Lonicerae), Huang Qin (Radix Scutellariae Baicallensis), Lu Gen (Rhizoma Phragmitis Communis) Shen yi Yi Ren (Semen Coicis), Pain Jiang Huang (Rhizoma Curcumae Longae).

 ·       Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxin)

o   Ingredients: Sheng Shi Gao (Gypsum), Xing Ren (Semen Prunus Armeniacae), Hua Shi (Talcum), Huang Qin (Radix Scutellariae Baicallensis), Chai Hu (Radix Bupleuri), Yin Chen Hao (Herba Atemisae Capillaris), Shi Chang Pu (Rhizima Acori Graminei), Fa Ban Xia (Rhizoma Pinelliae Ternatae), Hu Zhang (Radix et Rhizoma Polygoni Cuspidati), Bai Dou Kou (Frucuts Cardamomi Rotundi), Jiang Can (Bombyx Batricatus), Chan Yi or Chan Tui (Periostracum Cicadae), Cang Zhu (Rhizoma Atractylodis), Jiang Huang (Rhizoma Curcuma Longae).

 ·       Hao Qin Qing Dan Tang (Artemisia Annua and Scutellaria Decoction to Clear Gallbladder)

o   Ingredients: Qing Hao (Herba Artemisiae Apiaceae), Zhu Ye (Herba Lophateri Gracilis), Fa Ban Xia (Rhizoma Pinealliae Ternatae), Chi Fu Ling (Sclerotium Poriae Cocos Rubrae), Huang Qin (Radix Scutellaria Baicalensis), Chen Pi (Pericarpium Citri Reticulatae), Xing Ren (Semen Pruni Armeniacae), Sheng yi Yi ren (Semen Coicis), Hua Shi (Talcum), Qing Dai (Indigo Pulverata Levis), Cang Zhu (Rhizoma Atractylodis), Yu Jin (Tuber Curcumae).

 ·       Wu Hu Tang (Five Tiger Decoction) + Ting Li Da Zao Xie Fei Tang (Descurainia and Jujuba Decoction to Drain the Lungs) + Lian Po Yin (Coptis and Magnolia Bark Decoction)

o   Ingredients: Zhi Ma huang (Herba Ephedrae), Sheng Shi Gao (Gypsum), Xing Ren (Semen Pruni Armeniacae), Zhi Gan Cao (Radix Glycyrrhizae Praeparatae), Lu Cha (Folium Thea Sinensis), Ting Li Zi (Semen Tinglizi), Chuan Lian Zi (Fructus Meliae Toosendan), Hou Po or Chuan Po (Cortex Magnolia Officinalis), Zhi Shi (Fructus Aurantii Immaturus), Shan Zhi Zi (Fructus Gardenia Jasminoidis), Dan Dou Chi (Semen Sojae Praeparatum), Shi Chang Pu (Rhizoma Acori Graminei), Lu Gen (Rhizoma Phragmitis Communis), Fa Ban Xia (Rhizoma Pineallia Ternatae), Jie Geng (Radix Platycodonis).

·       Qing Ying Tang (Clear the Nutritive level Decoction) + Sheng Mai Yin (Generate the Pulse Decoction)

o   Ingredients: Shui Niu Jiao (Cornu Bubali), Sheng Di Huang (Radix Rehmanniae Glutinosae), Xuan Shen (Radix Scrophulariae Ningpoensis), Jin Yin Hua (Flos Lonicerae Japonica), Xi Yang Shen (Radix Panacis Quinquifolii), Mai Men Dong (Tuber Ophiopogonis Japonici), Shan Yu Rou (Fructus Corni Officinalis)

It is important to remind the aforementioned formulas are used according to pattern discrimination, but a quick analysis of the herbs used will show some herbs or classification of herbs are used frequently in all the formulas. They are herbs that clear heat, drain dampness, transform phlegm, and regulate Lung Qi. The most used herbs in these formulas are Huang Qin, Pian Jiang Huang, Bai Dou Kou, Jin Yin Hua, Lu Gen, Ban Lan Gen, Fa Ban Xia, Chan yi or Chan Tui, Yi Yi Ren, Xing Ren, Shi Gao, and Hua Shi. Once heat passes to the Ying or Xue level damage to Qi and Yin has taken place manifesting as diarrhea, headaches, and/or shaking/tremors. From a six-division perspective Tai Yin, Yang Ming, Jue Yin damage has taken place once the pathogen surpasses the Tai Yang level. The SARS is a Phlegm-Heat pathogen that causes shortness of breath, fatigue, and can cause delirium, collapse or fainting, and bleeding which are quite like the presentation of COVID-19. This experience provides us with a diagnosis of a Wen Bing Phlegm-Damp-Heat pathogen for COVID-19.

CoVid-2019 Signs and Symptoms[14]

Some of the signs and symptoms reported are:

Flu like presentation:

·       Runny nose

·       Nasal congestion

·       Low grade fever

·       Body aches

Pneumonia presentation:

·       Shortness of breath

·       Chest tightness

·       Wheezing

·       Cough

·       Fatigue

·       High fever

·       Dry mouth

·       Bitter taste

Signs and Symptoms, Chinese Medicine and CoVid-19

In China, COVID-19 is diagnosed as phlegm-damp heat pestilential qi. The tongue has a thick yellow fur and a red and wet body. The signs and symptoms are runny nose, sneezing, sore throat, fever, and difficulty breathing leading, wheezing, chest tightness, fatigue, dry mouth, bitter taste, and diarrhea.[15],[16],[17] The main feature is difficulty breathing and x-ray or CT-Scan showing bilateral lung ‘infiltrates' or 'ground-glass opacities.' These opacities are pockets filled with thick mucus which prevents breathing. It takes 2 to 14 days to show any sign and symptoms, but it has been reported cases were takes longer to show any sign and symptoms. COVID-19 starts as common cold, then switches to flu like symptoms and then pneumonia. It is calculated that 2 people can infect 2.5 people a day, the infection increase rate is 53% per day.[18] The mortality rate is low but has a high infection rate. In the Hubei Provincial Hospital of Integrated Traditional Chinese Medicine and Western Medicine COVID-19 has been divided into 4 Stages: Prevention (this stage is common cold), Influenza, Pneumonia, and Recovery Stage. Each Stage has a set of herbal formulas and pattern discrimination. Below I have summarized their recommendations, for detail information please read How COVID-19 (2019-nCoV) is Currently Treated in China with TCM by John K Chen.

·       Prevention Stage: Diagnosis is damp cold in the Lung and the recommended formula is a modified Yu Pi Feng San.

·       Influenza Stage: The diagnosis is Exterior Wind-Cold invasion, Toxic heat invading the Lung, or Damp Cold in the Lung,  The formulas recommended are Ge Gen Tang (Kudzu Decoction), Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction), Huo Xiang Zhen Qi San, Yin Qiao San (Honey Suckle and Forsythia Powder), Qing Wei Bai Du San (Clear Epidemics and Overcome Pathogenic Influences Powder).

·       Pneumonia Stage: Is diagnosed as Shao Yang Syndrome with Damp, Damp-Heat Distressing the Lung, Toxic Stagnation Hampering the Lung or Hot Type Closed Disorder with Devastated Yang. The formulas recommended are Xiao Chai Hu Tang (Minor Bupleurum Decoction), San Ren Tang (Three-Nut Decoction), Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxins), Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction), Xiao Xian Xiong Tang (Minor Sinking into the Chest Decoction), Cao Guo Zhi Mu Tang (Tsaoko and Anemarrhena Decoction), Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction), Si Tu Tang (Four Wild Decoction), Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction Plus Ginseng), An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone), Zi Xue San (Purple Snow Powder).

·       Recovery Stage: Qi and Yin Deficiency with closed collaterals. Recommended formula is Sha Shen Mai Dong Tang (Glehnia and Ophiopogonis Decoction).

  The herbs that were used the most were Huang Qin, Huang Lian, Ma Huang, Bai Zhu, Bai Dou Kou, Jin Yin Hua, Chen Pi, Fa Ban Xia, Yi Yi Ren, Xing Ren, Gua Lou, Sheng Jiang, Dan Zhu Ye, and Zhi Mu. An analysis of these herbs shows Heat-Pathogen invading the Lung and damaging fluids causing phlegm, chest tightness and shortness of breath which in normal parlance is pneumonia. The heat damages the Spleen which generate dampness and disturbs digestion; during this stage the pathogen causes what we know as enteritis leading to diarrhea. As the Heat-Pathogen advances, the person collapses. Is during this state that the person has entered the Jue Yin level, has damaged Shao Yin and a diagnosis of Closed Heat-Type Collapse with Devastated Yang is given or as John Chen calls it Closed Interior and Abandoned Exterior. Heat shuts the orifices (consciousness) and enters the Pericardium/Heart. The formulas have the purpose of eliminating the pathogen. Plants bioactive compounds are their antigen, their immune system developed to fight pests and it is theses bioactive compounds that have healing properties.

Herbs that are effective against the CoV are rich in triterpene glycosides such as saikosaponins A, B2,C, and D or phenolic compounds. The herbs are the followings:[19],[20]

·       Radix Bupleurum (Chai hu) – early stage infection of 229E

·       Radix Scrophularia (Xuan shen) -early stage infection of 229E

·       Lycoris Radiata (Shi Suan) – SARS

·       Herba Artemisia annua (Huang hua hao or Qing hao) - SARS

·       Folium Pyrrosia lingua (Shi wei) – SARS

·       Radix Lindera aggregata (Wu yao) – SARS

·       Isatidis indigotica (Ban lan gen, Cao da qing, Ma lan) – SARS

·       Torreya nucifera or Semen Torreyae (Fei zi) – SARS

·       Radix Dioscorea spp – SARS

As precaution you might use Gan mao ling and Yu Ping Feng San. The ingredients in Gan mao ling are gang mei geng or wan dian jin (Radix Iicis asprellae), wu zhu he (Folium Evodia), shan pu he or wu zhi gan (Folium viticis) ban lan gen (Radix Isatidis), ju hua (Flos Chrysanthemum), jin Yinn hua (Flos Lonicerae), and bo he (Herba Mentha). This formula clears heat, toxins, and opens the chest. Ban lan gen and jin Yinn hua have immunomodulatory properties.[21]

As reported by R. K. Ganjhu et al:

Also, if we glance through the different plant preparations reported in this review, we will notice that most of them represent extracts made of more than one plant species. That draws our attention to the uniqueness of each plant species and their constituents, which together with other plants make a formulation effective in treating a plethora of viral infections. An in-depth analysis of such formulations along with a bio-activity guided isolation of active components shall definitely give a better idea about the active principles responsible for a varied antiviral action. Research in this direction is in progress as collated from different papers. There are ample reports revealing immunomodulatory properties of many plant extracts mediated through induction and release of pro-inflammatory cytokines, IL-6 and IL-12. IL-12, produced by activated monocytes/macrophages and dendritic cells, stimulate cell-mediated immunity to release IFN-c, promote Th-1 responses, and enhance CD8 + cytotoxic T cell activity, thereby playing a pivotal role in controlling viral replication. There also exist evidence on IL-6 production by macrophages in response to virus infections, in addition to reports justifying its role in clearing viral infection from the physiological system.[22]

I would like to quote John Chen:

From the Western Han Dynasty to the end of the Qing Dynasty, at least 321 large-scale plagues occurred in China. Chinese medicine has served to wage life-and-death battles against various plague consistently through time and has successfully contained the spread of epidemics in a limited area and time. There has never been a similar tragedy in China’s history, such as the Spanish flu or the Black Death in Europe.  These are examples of global plagues that killed tens of millions of people.

In the Chinese history, whenever a plague is rampant, Chinese medicine practitioners are always on the front lines to battle the disease. Many survived with the help of Chinese Medicine; so in this fight with the insidious and novel Coronavirus, Chinese Medicine once again should take a primary role in effective treatment and must not be absent in action!

  Essential Oils and Viruses

Hinokitiol is an essential oil of from the wood of Cupressacea trees. This oil, when it enters in contact with zinc it elicits the interchange of zinc ions and stops viral replication, in this instance SARS-CoV, and inhibits lung cancer cell growth.[23] Cupressacea trees refers to Cypress, it has 30 genera and 133 varieties.[24] It includes the following trees: Fitzroya, Pilgerodendron spp, Arbovitae spp, Austrocedrus, Cupressus spp, Callitris, Widdringtonian spp,Tetraclinis, Thujopsis, Chamaecyparis spp, Calocedrus, Juniperus spp, Athrotaxis, Cryptomeria, Cunninghamia, Sequoiadendrum, Sequoia, Metasequoia, Taxodium.

Essential oils with antiviral or antiseptic or immunomodulatory properties according to Schnaubelt, PhD are:[25]

·       Cinnamon (Cinnamomum ceylanicum) – antiseptic. From a Traditional Chinese Medicine (TCM) perspective is warms Kidney yang (bark) and regulates the coronary arteries. Rou gui and Gui zhi are the Pin Yin for cinnamon in Chinese medicine.

·       Clove (Eugenia caryophyllata) – antiseptic, “broad spectrum of action against bacteria; antiviral, strengthening.” (sic)

·       Eucalyptus radiata – expectorant, antiviral. In TCM terms it strengthens Lung qi, opens the chest and transforms phlegm.

·       Eucalyptus globulus and polybractea – expectorant. From a TCM perspective it tonifies Lung-Tai Yin Qi, regulates qi in the chest, and transforms phlegm.

·       Frankincense (Boswellia carteri) – anti-asthmatic, strengthens the immune system. For Chinese medicine savvy readers Frankincense expands the chest and boost Wei-qi or Defensive qi.

·       Hyssop (Hyssopus officinalis var decumbens) – strong antiviral effects and antiasthmatic. In TCM terms hyssop tonifies Lung-Tai Yin Qi and Wei-Qi therefore it treats shortness of breath, fatigue, and boost immune system.

·       Laurel (Laurus nobilis) – is anti-infective (sic), it enhances the qualities of the other antiviral and antibacterial oils. In TCM, it is said that laurel moves qi and transforms phlegm.

·       Myrrh (Commiphora molmol) – antiviral, anti-inflammatory (sic). TCM view on myrrh is that it strengthens the Spleen-Tai Yin meridian and drains dampness.

·       Palmarosa (Cymbopogon martini) – effective against bacterial and viral illnesses of throat and lungs (sic). In Chinese medicine parlance it nourishes Yin and clears heat.

·       Ravensare (Ravensare aromatica) – expectorant and antiviral (sic).

·       Tea tree (Melaleuca alternifolia) – anti-infective agent with very broad spectrum of action (sic). It tonifies Lung qi and Wei-Qi therefore boosting the immune system functions and treating fatigue, or lethargy.

·       Vetiver (Vetiveria zizanoides) – strengthens a weakened immune system. In TCM words, vetiver nourishes Yin and clears heat.

Note: previous essential oils information are direct quotes from Schnaubelt, PhD.

An excellent way of prevention is diffusing essential oil of Eucalyptus radiata, E. globulus, E. citriodora, Laurel, Tea tree, Hyssop, and Palmarosa.[26] A synergy of Eucalyptus spp, Tea tree, Laurel, Hyssop, and Palmarosa with Jojoba oil as a carrier and applied to acupuncture points Lung 1, Lung 5, and Lung 9 (See Diag 1, Diag 2 and Diag 3).

You can make your own synergy. You need the essential oils previously mentioned (7 in total), a 10 ml bottle and jojoba oil. The synergy’s dilution would be 10%. The ratio depends on how you want to do the blend but keep in mind that 1 ml is approximately 20 drops hence 10 ml bottle fits 200 drops and a 10% dilution yields a total of 20 drops. These 20 drops must be divided between Eucalyptus spp, Laurel, Tea tree, Palmarosa, and Hyssop. In theory, you can pour 2 to 3 drops of each essential oil.

Where you can obtain your essential oils? I get my oils from one of these 3 sources: Ananda Apothecary in Colorado, Enfleurage 237 West 13th Street New York, NY, and New York Institute of Aromatherapy in New York City at 530 E 13th Street, New York, NY 10009. Another good source of essential oils is Floracopeia. All are reliable sources who are committed to quality.

Diag 1 Lung 1

Diag 2 Lung 5 on elbow’s crease lateral to bicep tendon.

Diag 3 Lung 9

Supplements and The Immune System

Supplements can assist regulating, harmonizing, and boosting the immune system. My favorite combination is taking a multivitamin and mineral, adding an extra dose of 25 mg of zinc, selenium, and manganese while adding 1,500 mg of L-Carnitine. L-Carnitine is converted to L-Acetylcarnitine[27],[28],[29] which has immunomodulator, sedative, and analgesic effects. It regulates dopamine, serotonin, and GABA and has an affinity for the hippocampus and hypothalamus. Zinc, selenium, and manganese are the minerals needed to produce super oxidase dismutase and glutathione peroxidase, two antioxidants produced by the human; L-Glutamine[30], an amino acid, is involved in the production of glutathione peroxidase as well.

When zinc ions[31] enter in contact with other substances such as hinokitiol, Pyrrolidine DioThioCarbamate (PDTC),[32] and zinc pyrithione (PT) it exerts a dynamic response which promotes antioxidant, anticancer, and antiviral response.

DPTC[33] is a metal chelating agent that passes through the blood brain barrier and stimulates astrocytes, regulates production of glutathione, increases copper at a cellular level, and regulates nitric oxide synthetase. DPTC targets the hippocampus as well. DPTC has been shown to reduce effects of Alzheimer and stop viral replication of SARS-CoV. PT is zinc pyrithhione and has been noticed that in combination with zinc2+, hinokitiol, and PDTC it inhibits replication of SARS-CoV. It can be assumed that a regime involving vitamin/mineral supplementation, a good diet and hygiene, plenty of rest, and use of essential oils can be our best allies in staying healthy.

Nature’s Sunshine® offers an ample selection on supplements to support lung functions, regulate the immune system and fight viruses. My recommendation as a prophylactic measure is ALJ® and Enviro-Detox®. ALJ® enhances lung functions, cleanses the lung, and aids with allergies while Enviro-Detox® has antiviral properties.

  Precautionary Approaches

  Wash your hands thoroughly. Hand washing dislodges any bacteria, virus or any other pathogen from our hands. If you use Lysol or Clorox wipes you can add ethanol to them. Ethanol and HCL have shown strong antiviral activity. Avoid shaking hands, cover your mouth when sneezing. Stay home if you are sick. Drink ginger tea[34], studies show that ginger tea has anti-inflammatory properties and reduces inflammation markers including Nuclear Factor. Fresh ginger enhances catalase, superoxidase dismutase, and glutathione peroxidase.[35] Ginger treats even common cold.[36] Last, always gargle.

    Biography:

 Emmanuel Arroyo is a Licensed Acupuncturist in the State of NY, Certified in Iridology and Aromatherapy. Has a Master degree in Oriental Medicine and is Member of NCCAOM and ASNY.

If you are interested in having an essential oil synergy with antiviral and antibacterial properties or need a immune booster acupuncture treatment you can reach me at:

Dr.agujas@gmail.com

www.arroyosacupuncture.com

References:

[1] Division of Disease Surveillance. Maine Center for Disease Control & Prevention. Accessed 28 January 2020. https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml

[2] Shiel, William C, MD, FACP, FACR. Medical Definition of Positive-strand RNA virus. Accessed 28 January 2020. https://www.medicinenet.com/script/main/art.asp?articlekey=22952

[3] Fehr, Anthony R, Perlman, Stanley. Coronaviruses: An Overview of Their Replication and Pathogenesis. Methods Mol Biol 2015; 1282:1-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/

[4] Karlis, Nicole. Why COVID-19 is more insidious than other coronaviruses. Salon. February 28, 2020 12:35 AM (UTC) Accessed March 3, 2020. https://www.salon.com/2020/02/27/why-covid-19-is-more-insidious-than-other-coronaviruses/

[5] Thomas, Gary. Furin At The Cutting Edge: From Protein Traffic to Embryogenisis And Disease. Nat Rev Mol Cell Biol.2002 Oct; 3(10):753-766.

[6] Centers for Disease Control and Prevention. Accessed 28 January 2010. https://www.cdc.gov/coronavirus/types.html

[7] Coronavirus. Wikipedia. Accessed 28 January 2020. https://en.wikipedia.org/wiki/Coronavirus

[8] Interfero de Cuba Cura Coronavirus. 2 March 2020, accessed March 3, 2020. http://espanol.almayadeen.net/news/politics/1383512/interferón-de-cuba-cura-coronavirus?fbclid=IwAR2jTX-e17__mC4OAoULX4cxjKipG6xFN4jytWKU-YHDhCHUs3RCYB3Jq_I

[9] https://prudentreviews.com/clorox-vs-lysol/

[10] Lysol https://www.lysol.com/products/disinfecting-wipes/lysol-disinfecting-wipes-crisp-linen/

[11] Clorox Healthcare®Bleach Germicidal https://www.cloroxpro.com/products/clorox-healthcare/bleach-germicidal-disinfectants/?msclkid=a9f5e73eb84d1e1935abb90e42b76ef2&gclid=CNCi0pTup-cCFUPrswod6fIAlw&gclsrc=ds

[12] Virus and Bacteria that Clorox kills http://www.apex-reps.com/assets/site/uploads/cIoZUYBLIG.pdf

[13] Lin Lin, De-ping He, Yun Han, Ju-yin Xu, Zhi-xiu Lin. Treating Severe Acute Respiratory Sydrome with Integrated Chinese Medicine and Western Medicine – A Report on 103 Hospitalised Cases at the Second Affiliated Hospital of Guangzhou Universit of Chinese Medicine, China. Journal of Chinese Medicine Number 72 June 2003.

[14] Harvard Health Publishing. Harvard Medical School. Coronavirus Resource Center. Accessed March 3, 2020. https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center

[15] https://www.health.govt.nz/our-work/diseases-and-conditions/novel-coronavirus-2019-ncov accessed 29 January 2020

[16] Centers for Disease Control and Prevention. Accessed 28 January 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

  [17] World health Organization. Accessed 28 January 2020. https://www.who.int/ith/2020-24-01-outbreak-of-Pneumonia-caused-by-new-coronavirus/en/

[18] Coronavirus Geometric Progression Suggests 100,000 in a Week. Accessed 29 January 2020. https://moneymaven.io/mishtalk/economics/coronavirus-geometric-progression-suggests-100-000-infections-in-a-week-jzcZTq6Je0GpmioumMXSyg

[19] Liang-Tzung Lin, Wen-Cha Hsu, Chun-Ching Lin. Antiviral Natural Products and Herbal Medicines. Journal of Traditional and Complementary Medicine. 4(1):24-35.

[20] Chen K John. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press, Inc. 2004.

[21] Chen K John. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press, Inc. 2004.

[22] Rajesh Kumar, Ganjhu et al. Herbal plants and plant preparations as remedial approach for viral diseases. Virus Dis. (October-December 2015) 26(4):225-236.

[23] Li L-H, Wu P, Lee J-Y, Li P-R, Hsieh W-Y, et al. (2014) Hinokitiol Induces DNA Damage and Autophagy followed by Cell Cycle Arrest and Senescence in Gefitinib-Resistant Lung Adenocarcinoma Cells. PLoS ONE 9(8): e104203. doi:10.1371/journal.pone.0104203

[24] Cupressacea. Britannica. Accessed 29 January 2020. https://www.britannica.com/plant/Cupressaceae

  [25] Schnaubelt, PhD. Advanced Aromatherapy. Rochester: Healing Arts Press. 1995.

  [26] Schnaubelt, PhD. Advanced Aromatherapy. Rochester: Healing Arts Press. 1995.

[27] Santina Chiechio, Pier Luigi Canonico, and Mariagrazia Grilli.L-Acetylcarnitine: A Mechanistically Distinctive and Potentially Rapid-Acting Antidepressant Drug. International Journal of Molecular Sciences. 2018, 19:11.

[28] Acetl-L-carnitine deficiency in patients with major depressive disorder. Carla Nasca, et al. PNAS. August 2018. Vol. 115, No. 34 pp 8627-8632.

[29] Null, Gary PhD. The Clinician’s Handbook of Natural Healing. New York: Kensington Publishing Corp. 1997.

[30] YU Jian-Chun, JIANG Zhu-Ming and LI De-Min. Glutamine: a precursor of glutathione and its effect

on liver. WJG, World Journal of Gastroenterology. 1999. April; 5(2):143-146.

[31] te Velthuis AJW, van den Worm SHE, Sims AC, Baric RS, Snijder EJ, et al. (2010) Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLoS Pathog 6(11): e1001176. doi:10.1371/journal.ppat.1001176

[32] Liddell et al. Pyrrolidine dithiocarbamate activates the Nrf2 pathway in astrocytes. Journal of Neuroinflammation (2016) 13:49

[33] Jin-dong Qin, Zhi-hong Cao, Xue-feng Li, Xiao-lin Kang, Yan Xue, Yue-ling Li, Dong Zhang, Xin-Yuan Liu, and Yong-zhi Xue. Effect of ammonium pyrrolidine dithiocarbamate (PDTC) on NF-jB activation and CYP2E1 content of rats with immunological liver injury. Pharmaceutical Biology, 2014; 52(11):1460-1466.

[34] Chen, John K, and Chen, Tina T. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press. 2001.

[35] Nur Fatin Nabilah Mohd Sahardi and Suzana Makpol. Ginger (Zingiber officinale Roscoe) in the Prevention of Ageing and Degenerative Diseases: Review of Current Evidence-Based Complementary and Alternative Medicine. Vol 2019, Article ID 5054395, 13 pages.

Https://www.elotus.org/article/how-covid-19-2019-ncov-currently-treated-china-tcm

[36] Nuñez Meléndez, Esteban PhD. Plantas Medicinales de Puerto Rico. San Juan: Editorial de la Universidad de Puerto Rico. 1982.

Https://www.lifeextension.com/protocols/infections/2019-novel-coronavirus-sars-cov2-covid-19?utm

Https://emcrit.or/pulmcrit/lopanivir

Http://www.salon.com/2020/02/27/why-covid-19-is-more-insidiuos-than-other-coronaviruses/

Https://www.delawareonline.com/story/news/2020/02/10/delaware-companys-disinfectant-equipment-headed-china-fight-coronavirus/4690454002

https://news.sky.com/story/coronavirus-what-x-rays-and-ct-scans-reveal-about-how-covid-19-kills-11955988

[siva3155]

300+ TOP RESPIRATORY Objective Questions and Answers

RESPIRATORY Multiple Choice Questions :-

1)Your body couldn't breathe without this system.Which one is it? A. It is the Perspiration system. B. It is the Respiratory system. C. It is the Photosynthsis D. It is the Urinary system. Ans: B 2)The Respiratory system is made up of trachea, the lungs, and the ______________. A. liver. B. diaphragm. C. esophagus. D. pancreas. Ans: B 3)When you breath in air, you bring oxygen into your lungs and blow out_________________. A. carbon dioxide. B. carbon monoxide. C. oxygen. D. hydrogen. Ans: A 4)When you inhale, your lungs _________________. A. inflate B. turn purple C. deflate D. disappear. Ans: A 5)What is the name of the tiny air sacs in the lungs? A. The name of the tiny air sacs in the lungs is called Bronchioles. B. The name of the tiny air sacs in the lungs is called Ravioli. C. The name of the tiny air sacs in the lungs is called Alveoli. D. The name of the tiny air sacs in the lungs is called Bronx. Ans: C 6)_________________ is not good for lungs. A. Exercising B. Singing C. Smoking D. Yelling Ans: C 7)The trachea is also called the ________________. A. lungs. B. Diaphragm. C. Windpipe. D. Bronchus. Ans: C 8)The tiny hairs that keep mucus and dirt out of your lungsare called _____________. A. lung hairs. B. stubble. C. Bronchioles D. Cilia Ans: D 9)The vioce box is also known as the ______________________. A. Alveoli B. Larynx C. Trachea D. Motormouth Ans: B 10)As you breathe, this contracts and flattens to give your lungs room to fill up with air ____________________. A. Laxynx. B. Lung balloon. C. Diaphragm D. Bronchiole Ans: C

RESPIRATORY MCQs 11)What happens when you breathe in? A. When you breathe in your diaphragm expands and your ribcage contracts. B. When you breathe in your diaphragm contracts and your ribcage expands. C. When you breathe in your diaphragm explodes and your ribcage contradicts. D. When you breathe in your diaphragm does not move and your ribcage expands. Ans: B 12)Air enters your lungs through the _________________. A. Trachea. B. Esophagus. C. Alveoli. D. Laxynx. Ans: A 13)How many lungs do humans have? A. Humans have four lungs. B. Humans have one lung. C. Humans have three lungs. D. Humans have two lungs. Ans: D 14)What are bronchial tubes? A. Bronchial tubes are air passages inside your lungs. B. Bronchial tubes are blood vessels inside your body. C. Bronchial tubes are tiny air sacs that deliver oxygen to the blood . D. Bronchial tubes are large air sacs that deliver oxygen to the blood. Ans: A 15)What muscles allow you to breathe in and out? A. The muscles that allow you to breathe in and out is the nose. B. The muscles that allow you to breathe in and out is the trachea. C. The muscles that allow you to breathe in and out is the tongue. D. The muscles that allow you to breathe in and out is the diaphragm. Ans: D 16)Which can not be stored by the body? A. Vitamin s can not be stored by the body. B. Energy can not be stored by the body. C. Minerals can not be stored by the body. D. Oxygen can not be stored by the body. Ans: D 17)When you breathe out, what gas does the body get rid of? A. When you breathe out your body gets rid of nitrigen gas. B. When you breathe out your body gets rid of carbon dioxide gas. C. When you breathe out your body gets rid of oxygen gas. D. When you breathe out your body gets rid of carbon monoxide gas. Ans: B 18)What are capillaries? A. Capillaries are tiny lung sacs in your lungs. B. Capillaries are tiny blood vessels in your lungs. C. Capillaries are tiny blood cells in your lungs. D. Capillaries are large blood cells in your lungs. Ans: B 19)What are alveoli? A. Alveoli are tiny cells. B. Alveoli are large blood vessels. C. Alveoli are tiny blood vessels. D. Alveoli are tiny sacs in the lungs. Ans: D 20)What disease can be caused by smoking? A. The disease that can be caused by smoking is Emphysema. B. The disease that can be caused by smoking is Bronchitis. C. The disease that can be caused by smoking is Alveolitis. D. The disease that can be caused by smoking is Diabetes. Ans: A 21)Labored breathing from lying down is? A. apnea B. hyperpnea C. tachypnea D. orthopnea (Your Answer) Ans: D 22)Severe chest pain, fever and shallow breathing are symptoms of? A. cleft palate B. tonsillitis C. pleurisy D. hypoxia Ans: C 23)To clear the upper respiratory tract, one would? A. cough B. hiccup C. sneeze D. yawn Ans: C 24)During inspiration, A. there is decreased thoracic volume B. the thoracic pressure decreases C. external intercostals relax D. diaphragm relaxes and lowers Ans: B 25)Actual gas exchange takes place in the? A. trachea B. diaphragm C. bronchi D. alveoli Ans: D 26)The job of the concha is? A. to separate the nasal and oral cavities B. to increase surface area to allow more air movement C. trap pathogens and debris D. warm air and removes water Ans: B 27)Chemoreceptors for oxygen are not found in the? A. carotid artery B. aorta C. lungs Ans: C 28)Barrel chest is from? A. alveoli losing elasticity B. overexchange of gases C. TB Ans: A 29)What does oxygen bind to on a blood cell? A. the antigen B. the hemoglobin C. the antibody D. the nucleus Ans: B 30)When standing, respiration is? A. higher B. lower C. unchanged Ans: A 31)Gas exchange between the blood and the cells is? A. pulmonary ventilation B. external respiration C. gas transport D. internal respiration Ans: D 32)How does the larynx produce sound? A. vibrations B. folds flip open and close C. swells D. relaxes and contracts Ans: A 33)The part of the body that consists of the nose, mouth, pharynx, epiglottis, larynx, and trachea is the..? A. Upper Quadrant B. Lower Respiratory System C. Upper Respiratory System D. Nasal Cavity Ans: C 34)What is the lid-like structure that closes to allow food to pass through the esophagus? A. Tonsils B. Epiglottis C. Larynx D. Pharynx Ans: B 35)How many lobes does the right lung contain? A. 4 B. 2 C. 1 D. 3 Ans: D 36)What are the thin hairs inside the nostrils? A. Cilia B. Mucus C. Tonsils D. Mucous membrane Ans: A 37)The medical term for the Voice Box? A. Tonsils B. Larynx C. Trachea D. Pharynx Ans: B 38)Medical term for Windpipe? A. Trachea B. Bronchi C. Epiglottis D. Esophagus Ans: A 39)The act of bringing air into and out of the lungs? A. Exhaling B. Coughing C. Breathing D. Inhaling Ans: C 40)Breathing disorder characterized by coughing and wheezing. A. Emphysema B. Asthma C. Bronchitis D. Smoker's Respiratory Syndrome Ans: B 41)Acute Respiratory Syndrome in children? A. Influenza B. Allergic Rhinitis C. Pertussis D. Croup Ans: D 42)A nosebleed? A. Epistaxis B. Rhinorrhea C. Sinusitis D. Diphtheria Ans: A 43)Medical term for a runny nose? A. Pertussis B. Sinusitis C. Rhinorrhea D. Dysphoria Ans: C 44)Inflammation of the Bronchial walls? A. Bronchorrhea B. Bronchitis C. Bronchioles D. Bronchorrhagia Ans: B 45)Pain in the Pleura. A. Pleuralgia B. Pleurisy C. Pleuritis D. Pleuroma Ans: A 46)Infection that attacks the lungs and results in the coughing up of blood. A. Hemothorax B. Tuberculosis C. Pneumorrhagia D. Hemoptysis Ans: B 47)The 3 lobes of the right lung are..? A. Top, Middle, Bottom B. 1, 2, 3 C. uno, dos, tres D. Superior, Middle, Inferior Ans: D 48)Inflammation of lungs where air sacs fill with pus and other liquid. A. Pneumonia B. TB C. Cystic Fibrosis D. Pulmonary Edema Ans: A 49)Also known as Black Lung Disease. A. Silicosis B. Byssinosis C. Anthracosis D. Abestosis Ans: C 50)Genetic disorder in which the lungs are filled with thick mucus. A. Anoxia B. Cystic Fibrosis C. Pulmonary Fibrosis D. Silicosis Ans: B RESPIRATORY Objective Questions with Answers 51)Another term for suffocation. A. Aphyxia B. Anoxia C. Airway Obstruction D. Asphyxiation Ans: D 52)Visual examination of the Larynx. A. Bronchoscopy B. Laryngoscopy C. Laryngectomy D. Laryngitis Ans: B 53)Medical term for the mucus that is secreted by tissues in the Respiratory Passages. A. Mucus B. Cilia C. Phlegm D. Mucous Ans: C 54)Surgical reconstruction of the Nasal Septum. A. Septoplasty B. Pharyngoplasty C. Laryngoplasty D. Sinusotomy Ans: A 55)An opening on a body surface. A. Pore B. Stoma C. Lobe D. Ventilator Ans: B 56)Surgical removal of the Larynx. A. Laryngectomy B. Larngotomy C. Laryngoplasty D. Laryngalgia Ans: A 57)Suturing of the Trachea. A. Tracheostomy B. Tracheotomy C. Tracheorrhaphy D. Tracheoplasty Ans: C 58)The mechanism that establishes the medullary osmotic gradient depends most on the permiebility properties of the? A. loop of henle B. glomerular filtration membrane C. collecting duct D. distal convoluted tubule Ans: A 59)Urine passes through the? A. renal hilum to the bladder to the ureter B. pelvis of kidney to ureter to bladder to urethra C. glomerulus to ureter to renal tubule D. hilum to urethra to bladder Ans: B 60)Which of the following is not associated with the renal corpuscle? A. podocyte B. vasa recta C. a fenestrated capillary D. an efferent arteriole Ans: B 61)An increase in the permeability of the cells of the collecting tubule to water is due to a(n) A. decrease in the production of ADH B. increase in the production of ADH C. increase in the production of aldosterone D. decrease in the conentration of the blood plasma Ans: B 62)The urinary bladder is composed of __________ epithelium? A. transitional B. simple squamous C. stratisifed squamous D. pseudostratified columnar Ans: A 63)The kidneys are stimulated to produce renin? A. when the pertibular capillaries are dialted B. when the pH of the urine decreases C. by a decrease in the blood pressure D. when the specific gravity of urine rises above 1.10 Ans: C 64)Which of the choices below is not a function of the urniary system? A. helps maintain homeostatis by controlling the compositon, volume, and pressure of blood B. regulates blood glucose levels and produces hormones C. maintains blood osmolarity D. eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat Ans: D 65)Which gland sits at top of kindeys? A. adrenal B. thymus C. pituitary D. pancreas Ans: A 66)The _____________ artery lies on the boundry between the cortex and medulla of the kidney? A. lobar B. arcuate C. interlobar D. cortical radiate Ans: B 67)The glomerulus differs from other capillaries in the body in that it? A. has a basement membrane B. is impermeable to most substances C. is drained by an efferent arteriole D. has a blood pressure much lower than other organ systems Ans: C 68)The descending limb of the loop of henle? A. is not permeable to water B. is freely permeable to sodium and urea C. pulls water by osmosis into the lumen of the tubule D. contains fluid that becomes more concentrated as it moves down into the medulla Ans: D 69) Select the correct statement about ureters? A. ureters contain sphincters at the entrance to the bladder to prevent the backflow or urine B. the epithelium is stratified squamous like the skin, which allows a great deal of stretch C. the ureters are capable of peristalsis like that of the gastrointestinal tract D. the ureter is innervated by parasympathetic nerve endings only Ans: C 70)The fatty tissue surrounding the kidneys is important because it? A. ensures adequate energy for the adrenal glands to operate efficiently B. stabalizes the position of the kidneys by holding them in their normal position C. is necessary as a barrier between the adrenal glands and kidneys D. produces vitamin D Ans: B 71)The renal corpsucle is made up of? A. bowmans capsule and glomerulus B. the descending loop of henle C. the renal pyramid D. the renal papilla Ans: A 72)The functional and stuctural unit of the kidneys is the? A. nephron B. loop of henle C. glomerular capsule D. basement membrane of the capillaries Ans: A 73)The juxtaglomerular apparatus is responsible for? B. the secretion of acids and ammonia C. reabsorption of organic molecules, vitamins, and water D. regulating the rate of filtrate formation and controlling systemic blood pressure (Correct Answ Ans: D 74)The cheif force pushing water and solutes out of the blood across the filtration membrane is? A. the design and size of the podocytes B. the thickness of the capillary endothelium C. glomerular hydrostatic pressure (glomerular blood pressure) D. the size of the pores in the basement membrane of the capillaries Ans: C 75)Which of the following statements desbribes the histology of th ureters? A. they are trilayered (mucosa, muscularis, and adventitia) B. they are actually an extension of the visceral peritoneum C. they are made up of several layers of endothelium D. they are made up entirely of muscle tissure because they need to contract in order to transport urine efficiently. Ans: A 76)Which of the following statements is a false or incorrect statement? A. the male urethra services both the urinary and reproductive systems at the same time B. the male urethra serves both the urniary and reproductive systems but at different times C. the male urethra is longer than the female urethra D. the male urethra is a passageway for both urine and semen Ans: A 77)Which of the following acts as the trigger for the intitiation of micturition (voiding)? A. the stretching of the bladder wall B. motor neurons C. the pressure of the fluid in the bladder D. the sympathetic efferents Ans: A 78)The filtration membrane includes all except? A. glomerular endothelium B. podocytes C. renal fascia D. basement membrane Ans: C 79)The mechanisms of water reabsortption by the renalubules is? A. active transport B. osmosis C. solvent drag D. cotransport with sodium ions Ans: B 80)Most electrolyte reabsorption by the renal tubules is? A. not Tm limited B. in the distal convoluted tubule C. hormanally controlled in distal tubule segments D. completed by the time of the loop of henle is reached Ans: C 81)The macula densa cells respond to? A. aldosterone B. antidiuretic hormone C. changes in the pressure in the tubule D. changes in solute content of the filtrate Ans: D 82)Which of the following is not reaborbed by the proximal convoluted tublue? A. Na+ B. K+ C. glucose D. creatine Ans: D 83)The fluid in the glomerular (bowmans) capusle is similar to plasma except that it does not contain a significant amount of? A. glucose B. hormones C. electrolytes D. plasma protein Ans: D 84)Alcohol acts as a diuretic because it? A. is not reabsorbed by the tubule cells B. increases the rate of glomerular filtration C. increases secretion of ADH D. inhibits the release of ADH Ans: D 85)The function of angiotensin II is to? A. constrict arterioles and increase blood pressure B. decrease the production of aldosterone C. decrease arterial blood pressure D. decrease water absorption Ans: A 86)A disease caused by inadequate secretion of anitdiuretic hormone (ADH) by pituitary glands with symptoms of ployuria is? A. diabetes mellitus B. diabetes insipidus C. diabetic acidosis D. coma Ans: B 87)An important characteristic of urine is its specific gravity or density which is? A. 1.0041-1.073 B. 1.001 - 1.035 C. 1.030 - 1.040 D. 1.000 - 1.015 Ans: B 88)Place the following in correct sequence from the formation of a drop of urine to its elimination from the body. major calyx minor calyx nephron urethra ureter collecting duct A. 3,1,2,6,5,4 B. 6,3,2,1,5,4 C. 2,1,3,6,5,4 D. 3,6,2,1,5,4 Ans: D 89)Select the correct statement about the nephrons? A. the parietal layer of hte glomerular capsule is simple squamous epithlium B. the glomerulus is correctly described as the proximal end of the proximal convoluted tublue C. podocytes are the branching epitheilal cells that line the tubules of the nephron D. filtration slits are the pores that give fenestrated capillaries their name Ans: A 90)What would happen if the capsular hydrostatic pressure were increased above normal? A. net filtration would increase above normal B. net filtration would decrease C. filtration would increase in proportion to the increase in capsular pressure D. capsular osmotic pressure would compensate so that filatration would not change Ans: B 91)Which of the following is not a part of the juxtaglomerular apparatus? A. granular cells B. macula densa C. podocyte cells D. mesangial cells Ans: C 92)Tubular reaborption? A. includes substances such as creatiinine B. by active mehanisms usually invovlves movement against an electrical and or chemical gradient C. by passive processes requires ATP to move solutes form the interior of the tubule to the blood D. is a way for the body to get rid of unwanted wast Ans: B 93)Which of the following is not a reason why substances are either not reaborbed or are incompletley reabsorbed from the nephron? A. they lack carriers B. they are not lipid soluble C. they are too lare too pass thorugh the fenestrations D. they are extremely complex molecules Ans: D 94)Reabsorbption of high levels of glucose and amino acids in the filtrate is accomplished by? A. facilitated diffusion B. passive transport C. countertransport D. secondary active transport Ans: D 95)Which of the choices below is a function of the loop of henle? A. form a large volume of very concentrated urine or a small volume of very dilute urine B. form a large volume of very dilute urine or a small volume of very concentrated urine C. absorb electrolytes activley with an automatic absorption of water by osmosis D. none of these Ans: B 96)Fetal kidneys do not have to work very hard because? A. fetuses do not have any waste to excrete B. there are not functional nephrons until after birth C. the placenta allows the mothers urniary system to clear the waste from fetal blood D. there is no way a fetus could excrete urine until the seventh month of development Ans: C 97)Which of the following best describes kidney function in older adults (70 yrs or older)? A. kidney function remains the same throughout life, regardless of age B. only about 3% of older adults have any loss of kindey function C. only obese and diabetic older adults have any kidney dysfunction D. kidney function decreases due to kidney atrophy Ans: D 98)The factor favoring filtrate formation at the glomerlus is the? A. colloid osmotic pressure of the blood B. glomerular hydrostatic pressure C. capsular hyrodtatic pressure D. myogenic mechanism Ans: B 99)If the Tm for a particular amino acid is 120 mg /100ml and the concentration of that amino acid in the blood is 230 mg/ 100ml the amino acid will? A. be actively secreted into the filtrate B. be completly reabsorbed by the tubule cells C. appear in the urine D. be reabsorbed by secondary active transport Ans: C 100)If one says that the clearance value of glucose is zero, what does that mean? A. the glucose molecule is too larege to be filtered out of the blood B. most of the glucose is filtered out of the blood and is not reaborbed in the convoluted tublues C. normally all the glucose is reabsorbed D. the clearance value of the glucose is realtively high in a healthy adult Ans: C RESPIRATORY Questions and Answers Pdf Download Read the full article

[valgasnewsthings]

Principles for rational therapy.

 1. And if a tie having  and countless synergies between are all cells and all  organs, as naively give rights by citizen any  evidentiary medicine, and medicine directing on isolating organ. And not a having local diseases, and panaritium even is a not local disease. 

2. A clinic is a not ability having without a full physiology.A full physiology is a not reached, if for her a not show a role and place, which she is deserving.

A. In a life and capillaries function.

B. in diaphragm role.

C. in extracellular and intracellular liquids.

D. Hide kidney failure.

E. In hypoxemia spreading.

G. IN Skin functions.

No a disease,to which a use effective cure, as without attention are earlier receiving knowledges. 

3. And in vital organism is a having a big reserve force, which a clinical therapy is must to bee a free,removing all hindrances,as not allowing for breath functions, feeding,secretion. Naively and dangerous  trying curing just medicaments,ideal a true clinical therapy is must to be big and big shortening for pharmacy  dynamic arsenal and change  remedies with simple events. And a timely needing giving a warm, or cold, looking by needing, prompting activity capillaries, free a blocked diaphragm,stimulating are not with a hard remedies, but a a right regime and diet of kidneys activity, learning and getting in attention a skin physiology.

And in pharmacy you are not buy a health.A need to support organism ,help him in a condition for adapting to surrounding environment ,to atmosphere, feed, emotional factors.Premorbid condition of organism decides a possibly for attacks of infection diseases .For example four persons are have been sicked or overeaten, in a first is croup pneumonia, and a high prothrombin in liver, or much thrombocytes in blood. In second is catharal lungs inflammation, as his having a long time are nose membranes inflamed,pharynx, long time legs are kept cold, liver have been  inhibited .A third is overexcited an own vegetative nerve system and portal circulation of abundant eating, alcohol, sex addiction, cold very and very hot drink, he having a gall stone,and firth for an abundant  pressed irritated parents or teachers, he having meningitis, encephalitis or lung tuberculosis.

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Remedy Spotlight: Spongia tosta 🧽 Spongia is a homeopathic remedy that is made from a roasted sea sponge.  It is a great remedy for croup that is accompanied by a dry, barking cough (like a saw cutting through wood or a seal barking). Mucous membranes are dry.   It is helpful in breathing problems because the patient feels as if they are breathing through a sponge.  This difficulty in breathing causes anxiety and they gasp for air.  In the night, they wake up feeling suffocated.  Cough better warm drinks, eating sweets and worse before midnight.   Patient is chilly. . . @homeopathy_school_in_toronto . . #traditionalmedicine #homeopathicmedicine #homeopathicremedy #homeopathy #homeopathic #homeopati #homeopatia #homeopathie #homeopatia #homeopath #homeopathichealth #homeopathicremedies #ilovehomeopathy #homeopathyworksforme #homeopathyworks #homeopathyheals #homeopathyrocks #homeopathyforall #naturalmedicine #naturalmedicines #naturalmedicinecabinet #ilovenaturalmedicine #naturopathicmedicine #naturopath #naturopathy #alternativehealth #alternativehealing #complimentarymedicine #mindbodyconnection #unlockyourbody (at Toronto , Ontario , Canada , North America , Earth , Galaxy , Etc :P) https://www.instagram.com/p/B5Fg_HlFmZr/?igshid=1uef8ofpcmt2x

[paganismtoday-blog]

10 Herbs and Spices for Digestive Problems

Sometimes we get stomach aches. Some times it goes beyond such a simple description and becomes an unpleasant reminder that no matter what our beliefs, at some point we will be paying homage to the porcelain goddess located in the sacred bathroom space. As someone with IBS (Irritable Bowel Syndrome), I thought I would research a list of herbs that have worked for me in the past and let my first real post on this blog hopefully help some people out.

(Disclaimer: The information presented herein by Paganism Today is intended for educational purposes only. These statements have not been evaluated by the FDA and are not intended to diagnose, cure, treat or prevent disease. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.)

1. Coriander: Coriander (aka cilantro in the USA) is a wonderful herb that is from the parsley family and is thought to have profound effects on the digestive system by treating various sorts of disorders. When made into tea, coriander is believed to relieve nausea, bloating, gas, heartburn, upset stomachs as well as promote better bowel movements. In Germany, coriander is widely accepted as a treatment for flatulence, dyspeptic complaints, and mild gastrointestinal pains.

2. Cinnamon: Cinnamon is native to China, and is a popular and coveted spice that can help with stomach ailments and stimulate digestion. It’s often taken as a tea or with warm honey.

3. Chamomile: Another calming herb, chamomile is a member of the daisy family.

4. Ginger: Native to India, ginger has been used for thousands of years. Whether taken raw, pickled, candied, in a tincture, or as a tea, ginger is effective for nausea and good for the digestive system. It also affects the circulatory system and should be avoided by people with gallbladder conditions or those taking blood thinners.

5. Peppermint: Peppermint and its close relative spearmint are used to calm both the stomach and a stressful mind. It also helps ease common cold symptoms. People with heartburn or acid reflux should avoid it, however, due to its volatile oils.

6. Rosemary: This fragrant shrub is thought to be very good for the stomach and digestion in general. It promotes better and stronger digestion by detoxifying the liver and stimulating bile production. Aside from its ability to enhance appetite, rosemary also helps to relieve dyspepsia, bloating, constipation and stomach cramps. It also relaxes the muscles of the digestive tract thereby relieving stomach discomfort.

7.  Cardamom: Cardamom is a popular spice in Asia and is often found in Indian food such as red lentil Dal. With its antispasmodic and analgesic properties, cardamom makes an effective remedy for many conditions affecting the digestive system of the body. It contains volatile oil components that are considered to be beneficial for soothing the intestines and the stomach. Cardamom is also known to relieve upset stomachs, dysentery, indigestion, flatulence, constipation and other digestive problems.

8.  Mustard: Mustard Seed has long been relied upon to improve the digestive system and to promote a healthy appetite. As an irritant, Mustard stimulates the gastric mucous membrane and increases the flow of gastric juices (also having some effect on pancreatic secretions), all of which help to advance good digestion. Herbalists have also used Mustard Seed to relieve obstinate hiccups. The mucilage content in Mustard Seed may help to calm an upset stomach due to acid indigestion and also produces a laxative action. Mustard Seed is a stimulant that warms and invigorates the circulatory system.  It helps to dilate blood vessels, encourages blood flow and is also said to aid in the metabolism of fat in the body.   Mustard Seed is also considered a diaphoretic, an agent that helps to increase perspiration, which can lower fever and cleanse toxins from the body through the skin. This factor is also used for colds and flu. One of the oldest uses of Mustard Seed has been as an emetic, a medicine that provokes vomiting. This is especially valuable when used in narcotic poisoning when it is desirable to empty the stomach without the accompanying depletion and depression of the system. Used externally, Mustard Seeds are famous for their rubefacient properties by dilating the blood vessels and increasing the blood flow toward the surface of the skin, warming and reddening the affected area and encouraging the removal of toxins.  Poultices and Mustard plasters are a tried-and-true remedy to relieve the pain of arthritic joints, rheumatism, sciatica, neuralgia, neck pain, backache, "charley horse" and muscle pain. Mustard Seed's topical use also extends to the relief of respiratory infections when used in baths, poultices and mustard plasters.  Mustard Seed helps treat bronchitis, chest congestion, pneumonia, croup, and pleurisy.

9. Thyme: Thyme also works by relaxing the muscles of the stomach which help relieve gastrointestinal conditions like indigestion, loss of appetite and chronic gastritis. As a good source of antioxidants, thyme also contains nutrients like Vitamin K, fiber, chromium, manganese, calcium, iron and bioflavonoids which are beneficial to the body.

10. Dandelion: Dandelion is a powerhouse of valuable health nutrients, dandelion is a wonderful herb that contains riboflavin, ascorbic acid, zinc, iron, manganese, protein, phosphorus, carotene, calcium, B-vitamins, sterols, and flavonoids. Known for its diuretic, blood purifying and liver cleansing effects, dandelion is also thought to be effective in cleansing the lymphatic system of the body as well as in promoting better digestion. Furthermore, this herb is known for aiding those suffering from diarrhea. Dandelion leaves are commonly used to increase the level of hydrochloric acid in the stomach and prevent the occurrence of tummy aches. In addition to its ability to promote better and stronger digestion, dandelion can also be used to strengthen the functioning of the liver, gall bladder and stomach. Dandelion also aids intestinal gas and upset stomachs. Dandelion makes a wonderful digestive tonic and natural laxative that promotes regular bowel movements.

[smartchoicenow-blog]

Causes, Symptoms, Remedies and Treatment for a Sore Throat

Your sore throat may just be a minor setback or it could be a sign of a more serious illness like a strep throat which depends on its cause. Rarely, a sore throat is considered an emergency.

If you or someone you know experience difficult breathing, difficulty swallowing and drooling, visit your nearby hospital with immediate effect. Otherwise you can easily get your sore throat treated at any urgent or emergency care in Jacksonville, FL provider.

Sore or Strep Throat Causes:

Pharyngitis is another term for the typical sore throat that may be accompanied by scratchiness, difficult or painful swallowing, tonsil swelling, and hoarseness. Some causes include:

1.      Viruses like influenza, the common cold, or mononucleosis.

2.      Allergens like pollen, pet dander, dust or post-nasal drip.

3.      Bacterial infections like an upper respiratory infection.

4.      Most sore throats are caused by a viral infection like a flu or cold. Other viral infections that can cause sore throats include the measles, chickenpox, croup, and mononucleosis.

5.   When it comes to a bacterial infection, some of the likely causes include strep bacteria, diphtheria, or whooping cough—an infection of the mucous membranes. Environmental factors, such as allergens or other illnesses can also play a role.

Symptoms:

The symptoms include difficulty swallowing, fever, hoarseness lasting longer than one week, soreness for longer than one week, earache, difficulty in opening mouth, a rash, or lump in the neck. These are some of the more-serious symptoms that should be evaluated by a doctor. Although strep throat shares many of the same symptoms as sore throat but the soreness in this scenario is caused by a type of bacteria called streptococcus. Remember, strep throat can result in serious complications. That’s why it is important to seek medical help in relation to a sore throat that lasts longer than one to two days. A course of antibiotics may be required if it turns out to be caused by the strep bacteria.

Remedies and Treatment:

Sore Throat- Taking acetaminophen, ibuprofen, or naproxen; sucking on throat lozenges; gargling with warm salt water; using a humidifier are some of the remedies and medicines for soreness caused by a virus or environmental factors.

Strep Throat- When it comes to strep throat treatment or soreness caused by bacteria, the usual sore throat remedies are insufficient. You most likely will be prescribed antibiotics if your sore throat is caused by strep or other bacteria. It is important to continue the full course of antibiotics even if you start to feel better after a few days which will prevent bacteria from returning as well as the development of drug-resistant bacteria which is a global problem.

If your sore throat lasts longer than one to two days, or is accompanied by other symptoms like joint pain, difficult breathing, abdominal pain, rash, or fever, seek immediate medical help such as one provided by Smart Choice in Jacksonville. Smart Choice offers fast, efficient, and cost-effective care for sore throats from many causes. Our team of highly qualified medical professionals are always ready to serve you. We can evaluate your sore throat and other symptoms, and tailor treatment specific to your condition.

We offer in-house lab testing, x-ray services, spirometry, IV fluids, urgent medical care and family doctor in Jacksonville, FL services. Call us on (904) 322-8555 for more information.

[paullassiterca]

Whooping Cough Symptoms, Causes and Treatments

Table of Contents

What Is Whooping Cough?

Whooping Cough Causes

Is Whooping Cough Contagious?

How Long Is Whooping Cough Contagious?

Whooping Cough Symptoms

What Does Whooping Cough Sound Like?

Whooping Cough Diagnosis

Whooping Cough Treatments

Whooping Cough Prevention

Diet for Whooping Cough

Croup Versus Whooping Cough

Whooping Cough FAQs

Coughing fits can be irritating and embarrassing, especially when you’re in a public place. There may be instances when you could not control it, but know that coughing is the body’s way to get rid of foreign particles or mucus from your lungs.

Commonly caused by viruses, a cough may ease on its own without having to be medicated.1 But when a cough persists or you get a “whoop” as you inhale, it may not be a mild cough anymore ��� it could be that you have whooping cough.

What Is Whooping Cough?

Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious respiratory disease brought on by the Bordetella pertussis bacterium. Its name was derived from the prolonged and intense coughing fits that produce a whooping sound when inhaling.

A person with pertussis can infect up to 15 people2 when the whooping cough bacteria3 spread from their coughing or sneezing. It generally starts off with cold-like symptoms such as mild fever and occasional cough, but the coughing spells can last for more than two weeks.4

Whooping Cough Causes: How Does It Spread?

As mentioned, the Bordetella pertussis bacterium causes whooping cough. When an infected person coughs or sneezes, the droplets of fluid with the bacteria coming from their mouth or nose spread into the air and get inhaled by people close by. When inhaled, the bacteria will reproduce in the cells of the nose and throat. This process generates toxins that inhibit the clearing of airways in the lungs and windpipe.5

A milder illness that’s similar to whooping cough is caused by Bordetella parapertussis. Though parapertussis has a shorter duration and is less common,6 both can be fatal when acquired.7,8

Is Whooping Cough Contagious?

Whooping cough is highly contagious and is a common infectious disease in the United States. A recent peak in the number of cases occurred in 2012, with 48,277 reported cases of pertussis,9 although there was a 37 percent decrease in the number from 2014 to 2015.10 The latest report shows 18,975 cases in 2017.11

Outbreaks in day care centers and schools that happen annually12 may have contributed to the significant increase in the number of pertussis cases in 13- to 16-year-olds. But among age groups, the majority of deaths occurred in babies younger than 3 years old.13

How Long Is Whooping Cough Contagious?

Infected people may likely spread the disease during the first stage of the illness, known as the catarrhal stage, and two weeks after the coughing fits start. This is when coughing fits begin to get worse and the “whooping” sound is produced.14

Whooping Cough Symptoms You Should Look Out For

Symptoms of whooping cough in adults may be determined through the three stages that an infected person undergoes.15,16

Catarrhal stage — Lasting for one to two weeks, symptoms may include sneezing, occasional cough, runny nose and nasal congestion. In some cases, mild fever may occur.

Paroxysmal stage — The common symptoms are vomiting, exhaustion, bluish discoloration of the skin or mucous membrane, choking and acute coughing. The whooping sound may also be evident in this phase.

Convalescent stage — At this point, the prolonged coughing fits become less intense.

Other symptoms of pertussis may include:17

Dehydration

Loss of appetite

Inflammation of the middle ear

In many cases, babies do not cough but they experience apnea, a condition that turns their skin blue and causes their breathing to temporarily stop.18

What Does Whooping Cough Sound Like?

The whooping cough sound may be characterized by a high-pitched “whoop” when you breathe in. This sound may be heard after coughing fits during the paroxysmal stage of the disease.19 Not everyone infected with pertussis may produce this sound, though, and some may not even cough, according to the U.S. Centers for Disease Control and Prevention (CDC).20

Whooping Cough Diagnosis

If you have been coughing for 14 days or more, it is important to consult with your health care provider to verify if you have pertussis.21 A number of laboratory tests will determine pertussis including culture, polymerase chain reaction (PCR) and serology.22 Other tests that you may undergo are blood tests and chest X-rays.23

Whooping Cough Treatments You May Follow

Babies who have been infected by whooping cough may need hospitalization or attentive care from their physician, as this can become a very serious condition for a baby.24 For children and adults, who may not need to be admitted to a hospital, here are lifestyle and home remedies for whooping cough that you may follow:25,26,27,28

• To decrease vomiting, eat small, frequent meals.

• Avoid foods that trigger mucus production such as peanuts and wheat. Even healthy foods like raw milk and eggs should be temporarily avoided or minimized while you’re suffering from the symptoms.

• Consume vitamin C-rich foods such as lime, tangerine, berries, bell pepper and broccoli to boost your immune system. A study published in the Canadian Medical Association Journal29 found that vitamin C, when taken in substantial doses, may help ease coughing fits in the paroxysmal stage of pertussis.

• To avoid dehydration, drink at least 70 ounces of pure water per day if you’re a 75-kilogram (165 pounds) individual. Refrain from consuming commercial fruit juices and sports drinks, as they not only may contain inflammation-causing sugars, but are lacking in a variety of organic nutrients.

• Get rid of irritants in your home that may cause coughing fits, such as aerosol sprays and smoke from tobacco and stoves.

• Rest and relax in a cool and quiet bedroom.

• Help ease coughing fits by using a cool-mist vaporizer.

A 2014 study found that antihistamines, pertussis immunoglobin and salbutamol may not help ease coughing fits caused by pertussis.30 If you plan to take these medications to help relieve whooping cough, seek your health care provider’s advice before doing so.

Also, unless advised by your doctor, cough medicines are not recommended to be taken by people with pertussis, especially children under 6 years old. Coughing is the body’s way of clearing airways, which is why it must not be suppressed.31

Whooping Cough Prevention: Is There a Way to Restrain This Disease?

Whooping cough is an airborne respiratory disease that targets the immune system. Simply inhaling the tiny droplets released from an infected person’s mouth might put you at risk. Here are some ways to help prevent acquiring this disease:32

If you have pertussis, cover your mouth and nose when sneezing or coughing — doing this may help restrain the spread of bacteria in the air.

Promote proper hygiene everywhere you go. Pertussis is as contagious as the common cold. As much as possible, wash your hands using mild soap and water. While many hospitals and health care factions also endorse using hand sanitizers, actually many of these sanitizers contain isopropyl alcohol, which can dry your hands and increase your risk of absorbing toxins, so if you do use sanitizers, do it minimally.

A 2007 study showed that whooping cough in infants is largely transmitted from household members — including asymptomatic persons who were fully vaccinated33 — who come in close contact with the babies.34 To avoid this, keep infants away from known infected persons, especially those in the early stages of the disease.35

Boost your immune system by getting enough sleep and including foods rich in B vitamins, protein, vitamins A, C and D, fiber and probiotics to your diet.

Diet for Whooping Cough: Which Kinds of Food Should You Eat?

Since pertussis is an airborne disease, it is essential to boost your immune system to prevent it. One way to do this is by keeping an eye on what you eat. To help reduce the risk of having pertussis, here are the kinds of nutrients that you may need to consume:

• Protein — Commonly found in lean meat, bone broth, fish, eggs, nuts and seeds, protein may help fight infections. However, be mindful of your protein consumption, as too much protein can also be detrimental to your health, putting you at risk of insulin sensitivity and even cancer.

• Vitamin C — Good sources of vitamin C include broccoli, berries, leafy greens, citrus fruits and bell peppers.

• Vitamin A — Add carrots, squash, sweet potatoes, cantaloupe, organic, pastured eggs, grass fed beef and dark, leafy vegetables to your diet to lower your risk of infection.

• Fiber — Help balance your gut microbiome by adding fibrous foods like blueberries, cucumbers, nuts, celery, carrots, banana, papaya and mango to your diet.

• Vitamin D — Best acquired through sun exposure, vitamin D may help support your immune response. Raw grass fed milk, wild-caught Alaskan salmon and organic, pastured eggs also contain vitamin D.

• Probiotics — Fermented foods are rich in probiotics that help balance the intestinal bacteria. These include fermented vegetables, natto, kimchi, pickles, miso, kefir, tempeh and raw grass fed yogurt.

• B vitamins — Boost your immunity by consuming foods with vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B7 (biotin), B9 (folic acid) and B12 (cobalamin) such as dark, leafy greens, mackerel, sardines, anchovies, pastured organic chicken, yogurt, cheese and raw, organic grass fed milk.

Croup Versus Whooping Cough: What’s the Difference?

Whooping cough, as mentioned, is a respiratory disease caused by Bordetella pertussis. Its notable symptoms are runny nose, mild fever and coughing bouts that produce a “whoop” sound when inhaling.36

On the other hand, croup is another name for laryngotracheobronchitis and laryngotracheitis. Croup is commonly caused by the parainfluenza virus, but respiratory syncytial virus (RSV), rhinovirus, enterovirus, influenza and adenovirus may also lead to croup. It is an infection that interferes with breathing and is common in children because they have small airways.

Croup symptoms include nasal congestion, rhinorrhea and fever. An infected person may develop a hoarse voice, a high-pitched wheezing sound or stridor and a seal-like cough. Similar to pertussis, croup may be fatal to infants, but it is rare.37

Unlike whooping cough, croup may not be as serious. Home treatments may help ease it, and only about 5 percent of infected children will require hospitalization.38

Frequently Asked Questions (FAQ)

Q: How is whooping cough spread?

A: Bordetella pertussis, the type of bacterium that can cause whooping cough, spreads when tiny drops of fluid are released from an infected person’s mouth or nose when they cough or sneeze. These droplets are then inhaled by other people nearby, leading to infection.39

Q: How long does whooping cough last?

A: The coughing fits caused by pertussis may last for 10 weeks or more.40

Q: How is whooping cough diagnosed?

A: Whooping cough may be diagnosed through medical tests such as culture test, polymerase chain reaction (PCR) test, serology,41 blood tests or chest X-rays.42

Q: Can adults get whooping cough

A: Yes. In fact, adults comprise 25 percent of pertussis cases. They experience milder symptoms compared to children.43

Q: How can you get rid of whooping cough?

A: Lifestyle and home remedies that may help mitigate pertussis include eating small, frequent meals, avoiding mucus-triggering foods such as eggs, milk, peanuts and wheat, consuming vitamin C-rich foods, drinking pure water to avoid dehydration, using a cool-mist vaporizer and eliminating irritants in your home such as tobacco and stove smoke and aerosol sprays.

Q: Can you get whooping cough twice?

A: While it was once believed that once you had pertussis, you would always be immune to it except in rare cases, recent research has found that loss of immunity is more widespread than originally thought. Additionally, it’s been found that immunity from a vaccine has even shorter duration.44

Q: Is croup similar to whooping cough?

A: Yes, they are similar in a way that they both affect mostly children or babies rather than adults. But whooping cough is caused by Bordetella pertussis bacterium and is more fatal to babies, while croup is a less serious infection caused by parainfluenza virus.45

Q: Is whooping cough a virus or bacterium?

A: As mentioned, whooping cough is a disease caused by the Bordetella pertussis bacterium.

Q: What are the three stages of whooping cough?

A: The three stages of pertussis are:

Catarrhal — Characterized by mild fever, occasional cough and nasal congestion

Paroxysmal — Symptoms are “whoop” sound when inhaling, vomiting, exhaustion and acute coughing

Convalescent — less intense coughing fits

Q: How serious is whooping cough?

A: Acquiring whooping cough may be severe and fatal especially in babies. They may not cough at all, but instead may experience apnea or temporary breathing pauses. On the other hand, adults generally experience prolonged coughing fits that may lead to rib fracture and blood vessel breakage.46

Q: Is whooping cough worse at night?

A: According to WebMD, whooping cough may be worse at night, specifically in its paroxysmal stage.47

Q: How contagious is whooping cough?

A: Whooping cough is a highly contagious disease. Tiny drops of fluid that carry the bacteria spread in the air when an infected person laughs, sneezes or coughs. When you inhale these drops or when you touch the infected person’s mouth or nose, it may be possible to have pertussis.48

Diseases Directory

from Articles http://articles.mercola.com/sites/articles/archive/2019/02/24/xdjm18-whooping-cough.aspx source https://niapurenaturecom.tumblr.com/post/183018150301

[jakehglover]

Whooping Cough Symptoms, Causes and Treatments

Table of Contents

What Is Whooping Cough?

Whooping Cough Causes

Is Whooping Cough Contagious?

How Long Is Whooping Cough Contagious?

Whooping Cough Symptoms

What Does Whooping Cough Sound Like?

Whooping Cough Diagnosis

Whooping Cough Treatments

Whooping Cough Prevention

Diet for Whooping Cough

Croup Versus Whooping Cough

Whooping Cough FAQs

Coughing fits can be irritating and embarrassing, especially when you're in a public place. There may be instances when you could not control it, but know that coughing is the body's way to get rid of foreign particles or mucus from your lungs.

Commonly caused by viruses, a cough may ease on its own without having to be medicated.1 But when a cough persists or you get a "whoop" as you inhale, it may not be a mild cough anymore — it could be that you have whooping cough.

What Is Whooping Cough?

Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious respiratory disease brought on by the Bordetella pertussis bacterium. Its name was derived from the prolonged and intense coughing fits that produce a whooping sound when inhaling.

A person with pertussis can infect up to 15 people2 when the whooping cough bacteria3 spread from their coughing or sneezing. It generally starts off with cold-like symptoms such as mild fever and occasional cough, but the coughing spells can last for more than two weeks.4

Whooping Cough Causes: How Does It Spread?

As mentioned, the Bordetella pertussis bacterium causes whooping cough. When an infected person coughs or sneezes, the droplets of fluid with the bacteria coming from their mouth or nose spread into the air and get inhaled by people close by. When inhaled, the bacteria will reproduce in the cells of the nose and throat. This process generates toxins that inhibit the clearing of airways in the lungs and windpipe.5

A milder illness that's similar to whooping cough is caused by Bordetella parapertussis. Though parapertussis has a shorter duration and is less common,6 both can be fatal when acquired.7,8

Is Whooping Cough Contagious?

Whooping cough is highly contagious and is a common infectious disease in the United States. A recent peak in the number of cases occurred in 2012, with 48,277 reported cases of pertussis,9 although there was a 37 percent decrease in the number from 2014 to 2015.10 The latest report shows 18,975 cases in 2017.11

Outbreaks in day care centers and schools that happen annually12 may have contributed to the significant increase in the number of pertussis cases in 13- to 16-year-olds. But among age groups, the majority of deaths occurred in babies younger than 3 years old.13

How Long Is Whooping Cough Contagious?

Infected people may likely spread the disease during the first stage of the illness, known as the catarrhal stage, and two weeks after the coughing fits start. This is when coughing fits begin to get worse and the "whooping" sound is produced.14

Whooping Cough Symptoms You Should Look Out For

Symptoms of whooping cough in adults may be determined through the three stages that an infected person undergoes.15,16

Catarrhal stage — Lasting for one to two weeks, symptoms may include sneezing, occasional cough, runny nose and nasal congestion. In some cases, mild fever may occur.

Paroxysmal stage — The common symptoms are vomiting, exhaustion, bluish discoloration of the skin or mucous membrane, choking and acute coughing. The whooping sound may also be evident in this phase.

Convalescent stage — At this point, the prolonged coughing fits become less intense.

Other symptoms of pertussis may include:17

Dehydration

Loss of appetite

Inflammation of the middle ear

In many cases, babies do not cough but they experience apnea, a condition that turns their skin blue and causes their breathing to temporarily stop.18

What Does Whooping Cough Sound Like?

The whooping cough sound may be characterized by a high-pitched "whoop" when you breathe in. This sound may be heard after coughing fits during the paroxysmal stage of the disease.19 Not everyone infected with pertussis may produce this sound, though, and some may not even cough, according to the U.S. Centers for Disease Control and Prevention (CDC).20

Whooping Cough Diagnosis

If you have been coughing for 14 days or more, it is important to consult with your health care provider to verify if you have pertussis.21 A number of laboratory tests will determine pertussis including culture, polymerase chain reaction (PCR) and serology.22 Other tests that you may undergo are blood tests and chest X-rays.23

Whooping Cough Treatments You May Follow

Babies who have been infected by whooping cough may need hospitalization or attentive care from their physician, as this can become a very serious condition for a baby.24 For children and adults, who may not need to be admitted to a hospital, here are lifestyle and home remedies for whooping cough that you may follow:25,26,27,28

• To decrease vomiting, eat small, frequent meals.

• Avoid foods that trigger mucus production such as peanuts and wheat. Even healthy foods like raw milk and eggs should be temporarily avoided or minimized while you're suffering from the symptoms.

• Consume vitamin C-rich foods such as lime, tangerine, berries, bell pepper and broccoli to boost your immune system. A study published in the Canadian Medical Association Journal29 found that vitamin C, when taken in substantial doses, may help ease coughing fits in the paroxysmal stage of pertussis.

• To avoid dehydration, drink at least 70 ounces of pure water per day if you're a 75-kilogram (165 pounds) individual. Refrain from consuming commercial fruit juices and sports drinks, as they not only may contain inflammation-causing sugars, but are lacking in a variety of organic nutrients.

• Get rid of irritants in your home that may cause coughing fits, such as aerosol sprays and smoke from tobacco and stoves.

• Rest and relax in a cool and quiet bedroom.

• Help ease coughing fits by using a cool-mist vaporizer.

A 2014 study found that antihistamines, pertussis immunoglobin and salbutamol may not help ease coughing fits caused by pertussis.30 If you plan to take these medications to help relieve whooping cough, seek your health care provider's advice before doing so.

Also, unless advised by your doctor, cough medicines are not recommended to be taken by people with pertussis, especially children under 6 years old. Coughing is the body's way of clearing airways, which is why it must not be suppressed.31

Whooping Cough Prevention: Is There a Way to Restrain This Disease?

Whooping cough is an airborne respiratory disease that targets the immune system. Simply inhaling the tiny droplets released from an infected person's mouth might put you at risk. Here are some ways to help prevent acquiring this disease:32

If you have pertussis, cover your mouth and nose when sneezing or coughing — doing this may help restrain the spread of bacteria in the air.

Promote proper hygiene everywhere you go. Pertussis is as contagious as the common cold. As much as possible, wash your hands using mild soap and water. While many hospitals and health care factions also endorse using hand sanitizers, actually many of these sanitizers contain isopropyl alcohol, which can dry your hands and increase your risk of absorbing toxins, so if you do use sanitizers, do it minimally.

A 2007 study showed that whooping cough in infants is largely transmitted from household members — including asymptomatic persons who were fully vaccinated33 — who come in close contact with the babies.34 To avoid this, keep infants away from known infected persons, especially those in the early stages of the disease.35

Boost your immune system by getting enough sleep and including foods rich in B vitamins, protein, vitamins A, C and D, fiber and probiotics to your diet.

Diet for Whooping Cough: Which Kinds of Food Should You Eat?

Since pertussis is an airborne disease, it is essential to boost your immune system to prevent it. One way to do this is by keeping an eye on what you eat. To help reduce the risk of having pertussis, here are the kinds of nutrients that you may need to consume:

• Protein — Commonly found in lean meat, bone broth, fish, eggs, nuts and seeds, protein may help fight infections. However, be mindful of your protein consumption, as too much protein can also be detrimental to your health, putting you at risk of insulin sensitivity and even cancer.

• Vitamin C — Good sources of vitamin C include broccoli, berries, leafy greens, citrus fruits and bell peppers.

• Vitamin A — Add carrots, squash, sweet potatoes, cantaloupe, organic, pastured eggs, grass fed beef and dark, leafy vegetables to your diet to lower your risk of infection.

• Fiber — Help balance your gut microbiome by adding fibrous foods like blueberries, cucumbers, nuts, celery, carrots, banana, papaya and mango to your diet.

• Vitamin D — Best acquired through sun exposure, vitamin D may help support your immune response. Raw grass fed milk, wild-caught Alaskan salmon and organic, pastured eggs also contain vitamin D.

• Probiotics — Fermented foods are rich in probiotics that help balance the intestinal bacteria. These include fermented vegetables, natto, kimchi, pickles, miso, kefir, tempeh and raw grass fed yogurt.

• B vitamins — Boost your immunity by consuming foods with vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B7 (biotin), B9 (folic acid) and B12 (cobalamin) such as dark, leafy greens, mackerel, sardines, anchovies, pastured organic chicken, yogurt, cheese and raw, organic grass fed milk.

Croup Versus Whooping Cough: What's the Difference?

Whooping cough, as mentioned, is a respiratory disease caused by Bordetella pertussis. Its notable symptoms are runny nose, mild fever and coughing bouts that produce a "whoop" sound when inhaling.36

On the other hand, croup is another name for laryngotracheobronchitis and laryngotracheitis. Croup is commonly caused by the parainfluenza virus, but respiratory syncytial virus (RSV), rhinovirus, enterovirus, influenza and adenovirus may also lead to croup. It is an infection that interferes with breathing and is common in children because they have small airways.

Croup symptoms include nasal congestion, rhinorrhea and fever. An infected person may develop a hoarse voice, a high-pitched wheezing sound or stridor and a seal-like cough. Similar to pertussis, croup may be fatal to infants, but it is rare.37

Unlike whooping cough, croup may not be as serious. Home treatments may help ease it, and only about 5 percent of infected children will require hospitalization.38

Frequently Asked Questions (FAQ)

Q: How is whooping cough spread?

A: Bordetella pertussis, the type of bacterium that can cause whooping cough, spreads when tiny drops of fluid are released from an infected person's mouth or nose when they cough or sneeze. These droplets are then inhaled by other people nearby, leading to infection.39

Q: How long does whooping cough last?

A: The coughing fits caused by pertussis may last for 10 weeks or more.40

Q: How is whooping cough diagnosed?

A: Whooping cough may be diagnosed through medical tests such as culture test, polymerase chain reaction (PCR) test, serology,41 blood tests or chest X-rays.42

Q: Can adults get whooping cough

A: Yes. In fact, adults comprise 25 percent of pertussis cases. They experience milder symptoms compared to children.43

Q: How can you get rid of whooping cough?

A: Lifestyle and home remedies that may help mitigate pertussis include eating small, frequent meals, avoiding mucus-triggering foods such as eggs, milk, peanuts and wheat, consuming vitamin C-rich foods, drinking pure water to avoid dehydration, using a cool-mist vaporizer and eliminating irritants in your home such as tobacco and stove smoke and aerosol sprays.

Q: Can you get whooping cough twice?

A: While it was once believed that once you had pertussis, you would always be immune to it except in rare cases, recent research has found that loss of immunity is more widespread than originally thought. Additionally, it's been found that immunity from a vaccine has even shorter duration.44

Q: Is croup similar to whooping cough?

A: Yes, they are similar in a way that they both affect mostly children or babies rather than adults. But whooping cough is caused by Bordetella pertussis bacterium and is more fatal to babies, while croup is a less serious infection caused by parainfluenza virus.45

Q: Is whooping cough a virus or bacterium?

A: As mentioned, whooping cough is a disease caused by the Bordetella pertussis bacterium.

Q: What are the three stages of whooping cough?

A: The three stages of pertussis are:

Catarrhal — Characterized by mild fever, occasional cough and nasal congestion

Paroxysmal — Symptoms are "whoop" sound when inhaling, vomiting, exhaustion and acute coughing

Convalescent — less intense coughing fits

Q: How serious is whooping cough?

A: Acquiring whooping cough may be severe and fatal especially in babies. They may not cough at all, but instead may experience apnea or temporary breathing pauses. On the other hand, adults generally experience prolonged coughing fits that may lead to rib fracture and blood vessel breakage.46

Q: Is whooping cough worse at night?

A: According to WebMD, whooping cough may be worse at night, specifically in its paroxysmal stage.47

Q: How contagious is whooping cough?

A: Whooping cough is a highly contagious disease. Tiny drops of fluid that carry the bacteria spread in the air when an infected person laughs, sneezes or coughs. When you inhale these drops or when you touch the infected person's mouth or nose, it may be possible to have pertussis.48

Diseases Directory

from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2019/02/24/xdjm18-whooping-cough.aspx

[jerrytackettca]

Whooping Cough Symptoms Causes and Treatments

Table of Contents

What Is Whooping Cough?

Whooping Cough Causes

Is Whooping Cough Contagious?

How Long Is Whooping Cough Contagious?

Whooping Cough Symptoms

What Does Whooping Cough Sound Like?

Whooping Cough Diagnosis

Whooping Cough Treatments

Whooping Cough Prevention

Diet for Whooping Cough

Croup Versus Whooping Cough

Whooping Cough FAQs

Coughing fits can be irritating and embarrassing, especially when you're in a public place. There may be instances when you could not control it, but know that coughing is the body's way to get rid of foreign particles or mucus from your lungs.

Commonly caused by viruses, a cough may ease on its own without having to be medicated.1 But when a cough persists or you get a "whoop" as you inhale, it may not be a mild cough anymore — it could be that you have whooping cough.

What Is Whooping Cough?

Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious respiratory disease brought on by the Bordetella pertussis bacterium. Its name was derived from the prolonged and intense coughing fits that produce a whooping sound when inhaling.

A person with pertussis can infect up to 15 people2 when the whooping cough bacteria3 spread from their coughing or sneezing. It generally starts off with cold-like symptoms such as mild fever and occasional cough, but the coughing spells can last for more than two weeks.4

Whooping Cough Causes: How Does It Spread?

As mentioned, the Bordetella pertussis bacterium causes whooping cough. When an infected person coughs or sneezes, the droplets of fluid with the bacteria coming from their mouth or nose spread into the air and get inhaled by people close by. When inhaled, the bacteria will reproduce in the cells of the nose and throat. This process generates toxins that inhibit the clearing of airways in the lungs and windpipe.5

A milder illness that's similar to whooping cough is caused by Bordetella parapertussis. Though parapertussis has a shorter duration and is less common,6 both can be fatal when acquired.7,8

Is Whooping Cough Contagious?

Whooping cough is highly contagious and is a common infectious disease in the United States. A recent peak in the number of cases occurred in 2012, with 48,277 reported cases of pertussis,9 although there was a 37 percent decrease in the number from 2014 to 2015.10 The latest report shows 18,975 cases in 2017.11

Outbreaks in day care centers and schools that happen annually12 may have contributed to the significant increase in the number of pertussis cases in 13- to 16-year-olds. But among age groups, the majority of deaths occurred in babies younger than 3 years old.13

How Long Is Whooping Cough Contagious?

Infected people may likely spread the disease during the first stage of the illness, known as the catarrhal stage, and two weeks after the coughing fits start. This is when coughing fits begin to get worse and the "whooping" sound is produced.14

Whooping Cough Symptoms You Should Look Out For

Symptoms of whooping cough in adults may be determined through the three stages that an infected person undergoes.15,16

Catarrhal stage — Lasting for one to two weeks, symptoms may include sneezing, occasional cough, runny nose and nasal congestion. In some cases, mild fever may occur.

Paroxysmal stage — The common symptoms are vomiting, exhaustion, bluish discoloration of the skin or mucous membrane, choking and acute coughing. The whooping sound may also be evident in this phase.

Convalescent stage — At this point, the prolonged coughing fits become less intense.

Other symptoms of pertussis may include:17

Dehydration

Loss of appetite

Inflammation of the middle ear

In many cases, babies do not cough but they experience apnea, a condition that turns their skin blue and causes their breathing to temporarily stop.18

What Does Whooping Cough Sound Like?

The whooping cough sound may be characterized by a high-pitched "whoop" when you breathe in. This sound may be heard after coughing fits during the paroxysmal stage of the disease.19 Not everyone infected with pertussis may produce this sound, though, and some may not even cough, according to the U.S. Centers for Disease Control and Prevention (CDC).20

Whooping Cough Diagnosis

If you have been coughing for 14 days or more, it is important to consult with your health care provider to verify if you have pertussis.21 A number of laboratory tests will determine pertussis including culture, polymerase chain reaction (PCR) and serology.22 Other tests that you may undergo are blood tests and chest X-rays.23

Whooping Cough Treatments You May Follow

Babies who have been infected by whooping cough may need hospitalization or attentive care from their physician, as this can become a very serious condition for a baby.24 For children and adults, who may not need to be admitted to a hospital, here are lifestyle and home remedies for whooping cough that you may follow:25,26,27,28

• To decrease vomiting, eat small, frequent meals.

• Avoid foods that trigger mucus production such as peanuts and wheat. Even healthy foods like raw milk and eggs should be temporarily avoided or minimized while you're suffering from the symptoms.

• Consume vitamin C-rich foods such as lime, tangerine, berries, bell pepper and broccoli to boost your immune system. A study published in the Canadian Medical Association Journal29 found that vitamin C, when taken in substantial doses, may help ease coughing fits in the paroxysmal stage of pertussis.

• To avoid dehydration, drink at least 70 ounces of pure water per day if you're a 75-kilogram (165 pounds) individual. Refrain from consuming commercial fruit juices and sports drinks, as they not only may contain inflammation-causing sugars, but are lacking in a variety of organic nutrients.

• Get rid of irritants in your home that may cause coughing fits, such as aerosol sprays and smoke from tobacco and stoves.

• Rest and relax in a cool and quiet bedroom.

• Help ease coughing fits by using a cool-mist vaporizer.

A 2014 study found that antihistamines, pertussis immunoglobin and salbutamol may not help ease coughing fits caused by pertussis.30 If you plan to take these medications to help relieve whooping cough, seek your health care provider's advice before doing so.

Also, unless advised by your doctor, cough medicines are not recommended to be taken by people with pertussis, especially children under 6 years old. Coughing is the body's way of clearing airways, which is why it must not be suppressed.31

Whooping Cough Prevention: Is There a Way to Restrain This Disease?

Whooping cough is an airborne respiratory disease that targets the immune system. Simply inhaling the tiny droplets released from an infected person's mouth might put you at risk. Here are some ways to help prevent acquiring this disease:32

If you have pertussis, cover your mouth and nose when sneezing or coughing — doing this may help restrain the spread of bacteria in the air.

Promote proper hygiene everywhere you go. Pertussis is as contagious as the common cold. As much as possible, wash your hands using mild soap and water. While many hospitals and health care factions also endorse using hand sanitizers, actually many of these sanitizers contain isopropyl alcohol, which can dry your hands and increase your risk of absorbing toxins, so if you do use sanitizers, do it minimally.

A 2007 study showed that whooping cough in infants is largely transmitted from household members — including asymptomatic persons who were fully vaccinated33 — who come in close contact with the babies.34 To avoid this, keep infants away from known infected persons, especially those in the early stages of the disease.35

Boost your immune system by getting enough sleep and including foods rich in B vitamins, protein, vitamins A, C and D, fiber and probiotics to your diet.

Diet for Whooping Cough: Which Kinds of Food Should You Eat?

Since pertussis is an airborne disease, it is essential to boost your immune system to prevent it. One way to do this is by keeping an eye on what you eat. To help reduce the risk of having pertussis, here are the kinds of nutrients that you may need to consume:

• Protein — Commonly found in lean meat, bone broth, fish, eggs, nuts and seeds, protein may help fight infections. However, be mindful of your protein consumption, as too much protein can also be detrimental to your health, putting you at risk of insulin sensitivity and even cancer.

• Vitamin C — Good sources of vitamin C include broccoli, berries, leafy greens, citrus fruits and bell peppers.

• Vitamin A — Add carrots, squash, sweet potatoes, cantaloupe, organic, pastured eggs, grass fed beef and dark, leafy vegetables to your diet to lower your risk of infection.

• Fiber — Help balance your gut microbiome by adding fibrous foods like blueberries, cucumbers, nuts, celery, carrots, banana, papaya and mango to your diet.

• Vitamin D — Best acquired through sun exposure, vitamin D may help support your immune response. Raw grass fed milk, wild-caught Alaskan salmon and organic, pastured eggs also contain vitamin D.

• Probiotics — Fermented foods are rich in probiotics that help balance the intestinal bacteria. These include fermented vegetables, natto, kimchi, pickles, miso, kefir, tempeh and raw grass fed yogurt.

• B vitamins — Boost your immunity by consuming foods with vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B7 (biotin), B9 (folic acid) and B12 (cobalamin) such as dark, leafy greens, mackerel, sardines, anchovies, pastured organic chicken, yogurt, cheese and raw, organic grass fed milk.

Croup Versus Whooping Cough: What's the Difference?

Whooping cough, as mentioned, is a respiratory disease caused by Bordetella pertussis. Its notable symptoms are runny nose, mild fever and coughing bouts that produce a "whoop" sound when inhaling.36

On the other hand, croup is another name for laryngotracheobronchitis and laryngotracheitis. Croup is commonly caused by the parainfluenza virus, but respiratory syncytial virus (RSV), rhinovirus, enterovirus, influenza and adenovirus may also lead to croup. It is an infection that interferes with breathing and is common in children because they have small airways.

Croup symptoms include nasal congestion, rhinorrhea and fever. An infected person may develop a hoarse voice, a high-pitched wheezing sound or stridor and a seal-like cough. Similar to pertussis, croup may be fatal to infants, but it is rare.37

Unlike whooping cough, croup may not be as serious. Home treatments may help ease it, and only about 5 percent of infected children will require hospitalization.38

Frequently Asked Questions (FAQ)

Q: How is whooping cough spread?

A: Bordetella pertussis, the type of bacterium that can cause whooping cough, spreads when tiny drops of fluid are released from an infected person's mouth or nose when they cough or sneeze. These droplets are then inhaled by other people nearby, leading to infection.39

Q: How long does whooping cough last?

A: The coughing fits caused by pertussis may last for 10 weeks or more.40

Q: How is whooping cough diagnosed?

A: Whooping cough may be diagnosed through medical tests such as culture test, polymerase chain reaction (PCR) test, serology,41 blood tests or chest X-rays.42

Q: Can adults get whooping cough

A: Yes. In fact, adults comprise 25 percent of pertussis cases. They experience milder symptoms compared to children.43

Q: How can you get rid of whooping cough?

A: Lifestyle and home remedies that may help mitigate pertussis include eating small, frequent meals, avoiding mucus-triggering foods such as eggs, milk, peanuts and wheat, consuming vitamin C-rich foods, drinking pure water to avoid dehydration, using a cool-mist vaporizer and eliminating irritants in your home such as tobacco and stove smoke and aerosol sprays.

Q: Can you get whooping cough twice?

A: While it was once believed that once you had pertussis, you would always be immune to it except in rare cases, recent research has found that loss of immunity is more widespread than originally thought. Additionally, it's been found that immunity from a vaccine has even shorter duration.44

Q: Is croup similar to whooping cough?

A: Yes, they are similar in a way that they both affect mostly children or babies rather than adults. But whooping cough is caused by Bordetella pertussis bacterium and is more fatal to babies, while croup is a less serious infection caused by parainfluenza virus.45

Q: Is whooping cough a virus or bacterium?

A: As mentioned, whooping cough is a disease caused by the Bordetella pertussis bacterium.

Q: What are the three stages of whooping cough?

A: The three stages of pertussis are:

Catarrhal — Characterized by mild fever, occasional cough and nasal congestion

Paroxysmal — Symptoms are "whoop" sound when inhaling, vomiting, exhaustion and acute coughing

Convalescent — less intense coughing fits

Q: How serious is whooping cough?

A: Acquiring whooping cough may be severe and fatal especially in babies. They may not cough at all, but instead may experience apnea or temporary breathing pauses. On the other hand, adults generally experience prolonged coughing fits that may lead to rib fracture and blood vessel breakage.46

Q: Is whooping cough worse at night?

A: According to WebMD, whooping cough may be worse at night, specifically in its paroxysmal stage.47

Q: How contagious is whooping cough?

A: Whooping cough is a highly contagious disease. Tiny drops of fluid that carry the bacteria spread in the air when an infected person laughs, sneezes or coughs. When you inhale these drops or when you touch the infected person's mouth or nose, it may be possible to have pertussis.48

Diseases Directory

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[ourhaileydavies]

Study of Laryngotracheal Stenosis and its Management in 25 Cases-Juniper publishers

Abstract

Introduction: Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma, or autoimmune disease. In this modern era, airway trauma has increased by considerable number owing to increased ventilator care in many emergency situations [1]. Anaesthetist's timely intubation saves the life of a patient but he must also be able to foresee the chaotic life of a prolongedly intubated patient who might develop stenosis.

Objectives of the study: Clinical study of LTS was done to observe the various etiological causes for it and major concentration was towards the post intubational stenosis. With increasing ventilatory support for varied reasons in present day intensive care setup, the incidence of stenosis following intubation has equally increase. Management of these cases needs a great surgical expertise, due to high failure rate as well as many complications. T-tube stenting has shown to be relatively easier modality of surgical treatment and it has also sub serves the purpose of regaining voice producing ability after tracheostomy. Apart from observing other types of treatments, T-tube stenting, its complications, their management and results have been studied.

Results: Out of 25 cases that were studied 12(48%) were males and 13(52%) were females, showing no significant sexual preponderance.Out of 25, there were 4 pediatric cases ageing below 12 years. Speaking of aetiology, post intubational stenosis is the cause in 64%. Reasons for intubation being diverse from blunt trauma (8%), congenitall (4%), and caustic ingestion induced stenosis (4%), after repair of cut throat injury (20%), idiopathic stenosis (8%). Infectious diseases as cause in 8% and organophosphorous poisoning in 36%. Subglottis and proximal trachea were the most common sites for stenosis, followed by distal trachea, glottis and supraglottis in the descending order. Out of 25 cases, 2 cases were followed conservatively without tracheostomy, 4 cases were managed conservatively with tracheostomy, 17 cases were managed surgically definitively and death in 2 cases. Various surgical modalities used were laser excision (2 cases), T tube stenting (13 cases), Radiofrequency ablation (1 case) and resection and reconstruction in 1 case. Out of 17 surgically managed cases, failure was seen in 4 cases.

Keywords: Laryngotracheal stenosis; T tube stenting; Laser excision

Introduction Pathophysiology

The recommended limits to minimize damage to the trachea are 15-25cm H2O (10-18mmHg). Tracheal capillary pressure lies between 20 and 30mmHg [2]. It suffers impairment at 22mmHg and total obstruction at 37mmHg. In intubated patients Endotracheal tube cuff pressure being exerted on the tracheal wall, becomes the main culprit in majority of the cases. Complications of continued cuff over inflation include tracheal stenosis, trachealmalacia, and tracheosophageal or tracheoinominate fistula, desensitisation of the larynx and potential loss of the cough reflex.

Poiseuille's law

a) R = resistance

c) l = length

d) r = radius

[Because of the fourth power in the denominator, resistance increases rapidly as diameter decreases] [3].

Thus, this equation proves how the tracheal lumen narrowing by stenosis affects resistance.

The process of post-intubation tracheal stenosis is best described as the laryngotracheal bed sore. Transient irritation of tracheal wall by the tube results in edema which heals spontaneously. High pressure cuffs may cause ulceration of mucosa which initiates healing process leading to tracheal stenosis which may take 3-6 weeks.

Etiology

There are many factors that can lead to laryngotracheal stenosis (LTS). Most cases of adult LTS result from external trauma or prolonged endotracheal intubation. External trauma causes cartilage damage and mucosal disruption with hematoma formation. These hematomas eventually organize and result in collagen deposition and scar tissue formation. Endotracheal intubation can cause direct injury, and mucosal damage through pressure necrosis can result from the pressure ofthe endotracheal tube or cuff. Mucosal ulceration also leads to healing through collagen deposition, fibrosis, and scar tissue formation. Lesions from endotracheal intubation are usually located in the posterior part of the glottis, where the tube most often contacts mucosa, or in the trachea, where the cuff or tube tip causes mucosal damage. Low-pressure endotracheal tube cuffs have somewhat reduced the rate of cuff-induced damage. The length of intubation, tube movement, tube size, and gastroesophageal reflux can also contribute to the development of LTS [4,5].

Clinical Presentation

Tracheal stenosis can present very insidiously or as a catastrophic near death episode requiring cardiopulmonary resuscitation. Children with congenital tracheal stenosis present with biphasic stridor, tachypnoea, retractions, nasal flaring, apnea, cyanosis, wheezing, noisy breathing, persistant croup and pneumonia. Dysphagia and failure to thrive may be seen occasionally [6].

Patients with acquired stenosis are diagnosed from a few days to 10 years or more following initial injury [7]. Majority are diagnosed within a year; some are misdiagnosed with asthma and recurrent bronchitis. High index of suspicion should arise when history of intubation is noted [8,9] (Table 1).

Classification

The Myer-Cotton staging system [11] is useful for mature, firm, circumferential stenosis confined to the subglottis. Four grades of stenosis are described with this system: (Table 2) (Figure 1).

The McCaffrey system [12] classifies laryngotracheal stenosis based on the sub sites involved and the length of the stenosis. Four stages are described (Table 3).

LANO system [13] is based on number of subsites involved (Table 4).

Diagnostic Assessment

The evaluation of LTS must begin with a meticulous history and physical examination. Since most cases of LTS result from laryngotracheal trauma or endotracheal intubation, the timing of the predisposing incident should be recorded. The entire upper aerodigestive tract must be carefully examined in a patient with suspected LTS [14,15]. Indirect laryngoscopy and flexible fiberoptic laryngoscopy offer critical information regarding the supraglottic airway and mobility of the true vocal folds [16].

Neck X-Ray

The anteroposterior airway is superb for examining the glottic and subglottic areas. Cross-sectional imaging also adequately shows the airway. Configuration of the airway on axial or transverse images varies depending on the level of the image. At the level of the epiglottis and aryepiglottic folds, the airway is elliptic. Approaching the false cords, the airway narrows and assumes a teardrop shape. The airway becomes elliptic at the true cords. Below the cricoid cartilage, the airway appears circular. The posterior membrane of the trachea may posteriorly flatten, and the normal esophagus occasionally indents the airway silhouette [17] (Figure 2).

Other modalities

Although imaging studies such as airway radiographs, computed tomography, and magnetic resonance imaging occasionally provide useful information, the most valuable diagnostic assessment stems from the examination of the patient with endoscopy, either flexible fibre optic or rigid endoscopy.

CT, MRI, VIRTUAL BRONCHOGRAM are equally useful radiological investigation to reconstruct the images of airway in 3d format. Technological advances in CT scanning and MRI have greatly improved radiologist's ability to image the upper airway Spiral CT scanning and fast MRI techniques allow the use of rapid acquisition speeds that decrease degradation motion artifacts caused by patients  breathing and swallowing and carotid artery pulsations. Spiral CT scanners rapidly, in less than 10 seconds, acquire the complete data set through the larynx, limiting the time during which the patient needs to remain motionless. Images can then be reconstructed to create overlapping sections, and coronal, sagittal, and even 3-D images can be generated from the same data set [18].

Helical CT scanning with 3-D reconstruction and virtual endoscopy in neonates and infants can prevent additional diagnostic tracheobronchoscopyin a high percentage of such patients who have tracheobronchial lesions (Figure 3).

Treatment of Laryngotacheal Stenosis

Medical

Prior to airway reconstruction, it is recommended that all pediatric patients be evaluated for GER with a dual 24hr pH probe [11]. In adults it is important to evaluate the patients general medical condition prior to performing any reconstructive procedures. It is important to consider each patient's case on an individual basis and make the decision to proceed with surgery based on sound judgment.Relative contraindications to LTR in adults are renal failure, diabetes, severe coronary artery disease, severe COPD or restrictive lung disease, obstructive sleep apnea, and systemic steroid use [19].

Observation

Patients (children and adults) with Cotton-Myer grade I and mild grade II subglottic stenosis may sometimes be managed with close observation (Walner and Cotton, 1999).

Surgical treatment options for subglottic stenosis:

a) Tracheostomy

b) Endoscopic

i. Dilation

ii. Endoscopic laser excision

c) Open procedure

i. E xpansion procedure27 (one-stage or with stent placement)

a. Anterior cricoid split +- cartilage graft

b. Posterior cricoid split +- cartilage graft

c. Anterior and posterior cricoid split + cartilage graft

d. Four quadrant LTR

ii. Segmental resection (cricotracheal resection - CTR)

A. Primary CTR

B. Salvage CTR

C. Extended CTR

Endoscopic treatment

Some areas of LTS are amenable to endoscopic treatment techniques such as laser vaporization and dilation, excision using a microtrapdoor technique, or serial dilation with radial incisions of the stenotic segment. Intralesional corticosteroids may also be injected under endoscopic guidance [20].

Owing to its precision (small spot size) and availability, the carbondioxide laser, which produces light in the mid-infrared region, remains the instrument of choice in the endoscopic management of LTS. It can be used to coagulate vessels up to 0. 5mm in diameter. If the stenotic area is vascular, a laser with better hemoglobin absorption, such as the potassium titanyl phosphate/532 (KTP/532) or neodymium: yttrium-aluminum garnet (Nd:YAG), is recommended [21].

Open surgical techniques

Severe areas of LTS that do not respond to endoscopic techniques require an open surgical procedure. Open techniques attempt to either excise the stenotic segment and reanastomose the airway or augment the circumference of the stenotic segment with transplanted tissue. In the high risk patients, a tracheostomy may be the most prudent choice of management.

Tracheal resection and reanastomosis

Areas of cervical tracheal stenosis up to about 5cm can generally be excised, and the proximal and distal tracheal segments reanastomosed primarily.

Laryngotracheal stents

Laryngeal and tracheal stents are solid or hollow absorbable or nonabsorbable tubes of various shapes, sizes, and materials. Stents are used as primary treatment for lumen collapse or to stabilize a reconstructive effort of the larynx or trachea to prevent collapse.

Types of stents [20]: Different stents have different indications. Types include primarily laryngeal stents, primarily tracheal stents, combination tracheal and laryngeal stents, and stents that can be used either in the larynx or trachea.

Laryngeal stents: If stenosis is confined to the larynx (i.e., glottis, subglottis), stenting can be short- or long-term. Shortterm stenting is defined as stenting for less than 6 weeks. Longterm stenting is defined as stenting for more than 6 weeks. Use short-term stenting for stabilization of cartilage grafts following laryngotracheal reconstruction (LTR) and/or for separation of mucosal surfaces during healing following laryngeal trauma, repair of web formation or atresia, or excision of a laryngeal lesion. Stents for these indications include Aboulker stents, silicone stents, Montgomery laryngeal stents, endotracheal tubes, and laryngeal keels (Figure 4).

Occasionally, long-term stenting is required when the trachea above the tracheotomy tube requires stenting for either collapse or stenosis following reconstruction. In this case, a long stent wired to the trachea, shown in the images below, or a tracheal tube (T-tube), such as the Montgomery T-tube, shown below, can be used.

Materials and Methods

This study is conducted at GOVT.ENT HOSPITAL, KOTI, Hyderabad between 2012 october & 2016 January. A total number of 25 patients were studied among which 12 were males and 13 were females. Only 4 children (below 12 years) were among the group. All the patients presenting with strid or, difficulty to breathe (Patients with malignant tumors of airway, Foreign bodies in air passage and paralytic conditions of the vocal cords were excluded from the study) were evaluated.

Among the 25 patients with airway obstruction due to airway stenosis evaluated, majority of the patients presented with history of intubation for various reasons highlighting the crux of intubation hazards on airway. 5 cases presented with traumatic history {2 blunt trauma and 3 cut throat injury}. One rare case of congenital stenosis with aberrant subclavian artery is noted. Two cases showed marked stenosis due to granulomatous diseases. All patients presented with shortness of breath (progressive in some and acute onset in few cases) necessitating the role of tracheostomy.

Bronchoscopic evaluation was the investigation of choice and x ray neck aided further in diagnosis. Role of CT neck and virtual bronchogram was limited and the patients included in this were from a lower socioeconomic class who could not afford those costly investigations. In 2 patients of lowtracheal stenosis, emergency tracheostomy could not serve the purpose where we had to loose the patients. Tracheostomy saves the patient's life and also relieves him/her from the dyspnoea and stridor, but only at the cost of loss of speech, which now becomes the major desire for the patient.

In a patient of supraglottic stenosis due to caustic ingestion difficulty in swallowing, occasional coughing and breathlessness on exertion were present. She was followed up by regularly without any intervention and the patient is doing well. 2 patients of glottis stenoses (laryngeal web) were addressed by LASER followed by keel placement for 6weeks and they are doing well. 2 patients of idiopathic stenosis on tracheostomy were managed by steroids.

Resection and anastamosis was done in one case in the hands of a well trained surgeon and patient is normal at follow ups. Rest all cases owing to patient's desire of regaining voice producing ability, surgeon's choice, patient's affordability; MONTGOMERY T-tube stenting was done. Of which, 9 patients showed good response while 4 suffered from granulations from walls of airway Topical application of mitomycin C after surface removal of these granulations showed good results in these cases along with steroid nebulisations. Frequent follow up of these stent patients was done using a 70 degree endoscope to visualize both upper and lower ends of the tube. Cases were followed up regularly after discharge until decanulation. T tube was maintained for atleast an year to 18 months before decannulation.

Observation and Results

Age and sex incidence

Out of 25 cases that were studied 12(48%) were males and 13(52%) were females, showing no significant sexual preponderance. Out of 25, there were 4 pediatric cases ageing below 12 years (Table 5).

Aetiology

There were varied causes for the development of stenotic airway among which post intubational stenosis was predominant. It shares 64% of the incidence. Reasons for intubation being diverse, its role is not significant. One case of congenital origin and one case of caustic ingestion induced stenosis was reported. 2cases each of blunt trauma induced and idiopathic induced stenosis were noted. And 3 out of 25 cases developed after repair of cut throat injury (Figure 5). When the history for intubation was taken statistics obtained are as follows... (n=16) (Table 6).

Site of lesion

Supraglottis, glottis and subglottic areas are subsites of larynx while trachea has been classified as proximal and distal trachea i.e with reference as 6th tracheal ring. Depending on the nature of etiology, site of lesion varies (Figure 6). [As most of subglottis lesions were associated with proximal tracheal lesions, they are combined with subglottic lesions while distal lesions are separately listed.]

Nature of lesion

Subglottis and trachea being slightly ovoid structures stenotic segments were mostly circumferential, very few were partial and also pinhole type of stenoses. Glottis lesions were in the form of anterior webs. Supraglottis was distorted due to multiple adhesions to surrounding structures.

Management

Depending on varied treatment options for LTS, each having its own limitations, multiple modalities of management were practiced owing to patient factors, surgeons factors, economic factors etc (Figure 7). 17 cases were managed surgically by various modalities which are given below (Figure 8).

T-tube management is commonly practiced at our institute for varied reasons among which the results are as mentioned below (Figure 9) (Table 7).

Granulations were the main problems in few cases which might have been the result of infection, excessive movement of tube against tracheal wall allergic reaction to stent They were noted both above as well as below the tube. Overall percentages of results are summarized below (Table 8).

Discussion

In this current study, 25 cases of airway stenosis with various etiologies have been observed. Tracheal stenosis should be considered in the differential diagnosis of any patient who has recently been in an intensive care unit and who presents with exertional dyspnoea or monophonic wheeze, particular when it is unresponsive to bronchodilators as already suggested in shahnazafrosa et al. [22]. In this study Male to female ratio was nearly 1:1. The gender influence has been controversial in the literature. A predominance of female with tracheal stenosis has been reported in two series by McCaffrey et al. [12] and Mehta et al. respectively contradicting our statistics. Two out of two cases of idiopathic stenosis in this study were females. Female predominance is also reported in cases of idiopathic subglottic stenosis. There were no apparent risk factors like diabetes, smoking, alcoholism, chronic illness in any of the cases for development of these lesions except for the striking etiological cause (post intubational/ post tracheostomy etc.) as already been mentioned in poetkar DM et al [23].

MacEwen first reported endotracheal intubation for anesthesia in 1880 [25]. Lindholm reported injuries to the larynx and trachea after intubation in 1969.Patients usually remain asymptomatic until the trachea has stenosed to 30% of its original diameter, and it may take as long as three months before the diagnosis according to Spittle & McCluskey et al. [25] supporting this study where diagnosis after extubation ranged from 5 days to 1 year. All of our patients had severe (>50%) tracheal stenosis with an average degree of stenosis of more than 70%. But the incidence of Severe tracheal stenosis prevalence should be very low especially since the introduction of large volume, low pressure endotracheal tube cuffs, elimination of heavy ventilatory connecting equipment, and meticulous care of the tracheostomy as suggested in the article by Sajal & Sarmista de et al. [26] A study by Norwood et al who followed 48 intubated patients for 30 months found that only 1 patient (2%) developed severe tracheal stenosis, while mild to moderate stenosis was detected in 14 (29.3%) patients. Our series reflects a large referral network and does not necessarily reflect the true prevalence of the condition.

The site of the stenosis varies according to whether the patient has had tracheostomy or only endotracheal intubation or other etiology. Stenosis that developed as a web around an endotracheal tube cuff is longer and more uniform than the stenosis around a tracheal stoma where granulation tissue can extent from a fissure in the anterior trachea or grow into a bulky granulomatous formation surrounding a fracture cartilage [27]. On comparision tracheostomy induced stenoses were relatively lesser than post intubational stenosess in our study i. e., 3:13 cases only One particular case in this study showed development of tracheal stenosis even after 2days of intubation, which can be supported by study of D R Miller & G Sethi [18] in 1969 which shows development of tracheal lesion after 36 hours of intubation.

The determinant of treatment methods is whether postintubation damage extends to tracheal cartilage or not. For now, there is no accurate diagnostic study for viability of cartilage preoperatively. In the literature, symptoms due to airway stenosis occurred rapidly within one month in the case of patients with necrosis of tracheal cartilage [28]. So it is concluded that the period between extubation and development of symptoms is very informative in the management of post-intubation tracheal stenosis.

All patients irrespective of mode of permanent treatment assorted were maintained on steroids. Conservatively managed cases which were under steroid cover had a non progressing lesion thereafter as mentioned in Braidy et al. [29]-" but the inflammatory nature of the lesion (as suggested by endoscopy and radiology), the progressive deterioration in symptoms over one month, and the rapid response to corticosteroids (five days) suggest a therapeutic response to steroids”.

Most of our patients (13cases) underwent silicon T-tube stenting [30] following stenotic segment release either by cold steel technique or radiofrequency ablation followed by stenting with Montgomery T-tube of which 9 cases (70%) are doing well. Rest of the four cases have suffered from granulations following stenting. According to Cynthia et al the occurrence of obstructing granulation tissue after stenting is reported to be 12% to 28% in patients with benign disease and this study results are correlating with it. One of the main drawbacks of these surgeries is the risk of recurrence of tracheal stenosis due to granulation and fibrotic tissue. Silicon tubes considered to be foreign bodies are responsible for infections and granulations (as a reparative process or due to bacterial infection) [31]. 4 out of 13 cases in this study developed granulations after stenting.

Both in vitro and in vivo, Mitomycin C have been proven to be a potent inhibitor of human fibroblasts at concentrations of 0.04mg/L. It has been used with some success in inhibiting the vigorous granulation response noted after airway injury in animal models and pediatrics [32]. Application of topical medications to shrink the granulation tissue can be effective too. These medications may include steroids, which can be applied directly to the tissue or injected just beneath the granulation tissue. In addition, other medications decrease the number of fibroblast cells, which help to create granulation tissue [33]. In 4 cases of stenting where granulations posed a problem, topical mitomycin was used and 3 cases showed reduction in bulk of granulation tissue along with post op steroid nebulisations.

Crusting and complete occlusion of T-tube is also noted. Humidification of inspired oxygen, regular suctioning of both limbs of the T-tube, and lavage with normal saline have been recommended to prevent encrusting of the tube- Appadurai et al. [34]. Even in this study 2cases of tube blockage have been reported when emergency removal of t tube had to be done . Apart from other modalities of treatment, as considered by Puma et al. [35], T tube stenting is one of the best alternatives. Silicon T tube stenting is not just for primary management but can also be used to support the reconstructed airway after laryngotracheal resections and complex stenoses. But in this study all cases were stented as a part of primary management only. Subjects on silicon tube were decanulated between 12-24 months which is well between the span as suggested in Fransesco and colleagues as 9-70 months [35].

In this current study 2 cases of glottic web were managed by laser excision and keel placement for 6weeks are doing well with 1year follow up without any recurrence similar to Benmansour et al. [36]. Resection and an astamosis done in 1case is doing equally good without any recurrence.

Many papers and articles by Grillo, Mehta, Mccaaffrey prove that open surgical techniques and the results of 1st stage procedure are high relatively than a lesion undergoing repeated interventions. As most of this study is inclined towards T tube, discussion and comparisions are limited to it. "T-tubes are a satisfactory alternative to tracheal resection and are preferred over interbronchial stents for tracheal stenosis as T-tubes have decreased rate of migration, allow for frequent irrigation and suctioning, are easily removed in case of acute obstruction, and maintain a tracheostomy stoma”-suggested by Julie M Schrader [37]. "The use of a T-tube in some patients with tracheal stenosis a very good therapeutic method which should be used at present in indicated cases” by Fiala P et al. [38]. Thus results of this study are well substantiated from these evidences.

Finally in the review of literature it is found that "A bioresorbable stent that scaffolds the airway lumen and dissolves after the remodeling process is completed has advantages over metallic and silicone stents”. Kuoshungliu and colleagues designed and fabricated a new mesh type bioresorbable stent with a backbone of polycaprolactone (PCL), and evaluated its safety and biocompatibility in a rabbit trachea model [39].

Conclusion

i. Post intubational airway stenosis - most common cause. Shortest span of intubation-2 days ; longest span of intubation-17days ; median span of intubation - 9 days.

ii. Post intubational stenosis;onset of symptoms. Earliest- 5days after extubation; maximum duration- 1year after extubation.

iii. As tracheostomy was commonest & earliest intervention to save life,regaining normal sound production was common desire of all the patients.

iv. T-tube stenting is the best and relatively cheaper mode of treatment for selective lesions.

v. Regular humidification & frequent suctioning with NAHCO3 in initial stages may be required to prevent T-TUBE blockage by dry crusting.

vi. T-Tube suctioning is practically difficult for the patient who got used to cleaning the inner tube of silver jackson's.

vii. All those cases which developed granulations after stenting were aged less than18years.

viii. Frequent follow ups of stenting cases by Bronchoscopy in a public sector hospital with busy O.T is a bit difficult job, so usage of a 70degree endoscope through stent has been practiced.

ix. Application of topical mitomycin c for 6min after excision of granulations by radiofrequency/electrocautery reduced the incidence of granulations.

x. LASER- usage for this kind of cases is the best alternate to prevent reccurence, but needs experienced practiotioner and it is a costly procedure.

xi. RESECTION & ANASTAMOSIS is best procedure for selective lesions but only in hands of a well trained surgeon.

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