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Thursday, July 19, 2018

Pathophysiology of Chronic Obstructive Pulmonary Disease AKA COPD

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The pathophysiology of chronic obstructive pulmonary disease (COPD) or chronic obstructive pulmonary disease is primarily a change in the airway, but there may also be changes in pulmonary parenchymal tissue and pulmonary vasculature. Most cases of COPD are caused by exposure to harmful substances, most often caused by cigarette smoke. The pathophysiologic mechanism remains unclear, but is thought to be caused by many factors.

Damage to the Respiratory Tract

Health Lung and Lung with COPD
Structural alterations of the airway are atrophy, squamous cell metaplasia, ciliary abnormalities, plain muscle cell hyperplasia, mucosal gland hyperplasia, inflammation and bronchial wall thickening. Chronic inflammation in chronic bronchitis and emphysema is characterized by an increase in the number of CD8 T-lymphocytes, neutrophils, and monocytes / macrophages.

In comparison, inflammation in asthma is characterized by elevated CD4 lymphocyte T cells, eosinophil and interleukin (IL) -4 and IL-5. However this can not be used for diagnosis, because there are conditions of asthma that develop into COPD.

Lung Parenchymal Damage

Emphysema causes damage to the distal structure of the terminal bronchioles. This structure consists of bronchioles, ductus alveoulus, and saccus alveoli which are overall called asinus. Damage to the alveoli will cause air flow disruption through two mechanisms, namely by decreasing the elasticity of the airway wall and airway narrowing. There are 3 patterns of morphologic Emphysema, namely:
1. Centracinar
Characterized by damage to the bronchioles and central parts of the acini. This type of emphysema is usually found in smokers and the upper lobe is the most severely damaged part.
2. Panacinar
Characterized by extensive damage to all parts of the acinus. This type usually causes severe damage to the lower lobe and is usually found in patients with alpha 1 antitrypsin deficiency.
3. Distal Acinar
Damage occurs in the distal structures of the airway, ductus and alveolar saccus. This type of emphysema is localized to septa fibrous or pleura and will lead to bullae formation. A ruptured apical bullae can cause spontaneous pneumothorax.

Pulmonary vascular damage
Changes in pulmonary vascular hyperplasia of intima tunica and smooth muscle due to chronic vasoconstriction of small pulmonary arteries triggered by hypoxia. [1, 2]

Reference
1. UpToDate. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. February 2017 [Cited 2017 14 March]; Available from: http://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-definition-clinical-manifestations-diagnosis-and-staging

2. MedScape. Chronic Obstructive Pulmonary Disease (COPD). March 2017 [ Cited 2017 14 March]; Available from : http://emedicine.medscape.com/article/297664

Causes and Symptoms of COPD

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What Is COPD ?
Chronic obstructive pulmonary disease (COPD) is a lung inflammatory disease that develops over a long period of time. This disease prevents airflow from the lungs due to blocked swelling and mucus or phlegm, so that sufferers difficult to breathe.

Most COPD people are middle-aged people and smokers. Patients with this disease have a risk for heart disease and lung cancer.

What Causes COPD?

The etiology of chronic obstructive pulmonary disease (COPD) is damage to the airway or damage to the pulmonary parenchyma. This damage can be caused by:

COPD Causes By Smoke
Smoking is still a major cause of COPD, including second-hand smoke. World Health Organization (WHO) estimates that in 2005, 5.4 million people died from cigarette consumption. Cigarette-related deaths are expected to increase to 8.3 million deaths per year by 2030 [3].

Smoking stimulates macrophages to release the neutrophil and elastase chemotactic fators that will cause tissue destruction. A study showed that pulmonary function impairment and pulmonary structural changes in patients who smoked had occurred long before clinical symptoms of COPD emerged.

COPD Causes By Environmental Factor
COPD Causes
COPD can occur in patients who have never smoked. Environmental factors are suspected to be the cause but mechanisms are not known for sure. In countries with moderate to high income, smoking is a major cause of COPD, but in low-income countries exposure to air pollution is the cause. Risk factors originating from the environment include indoor pollution, outdoor pollution, chemicals and dust in the work environment, as well as recurrent lower respiratory tract infections at the age of the child.

Alpha1-antitrypsin (AAT) enzyme deficiency
AAT is an enzyme that serves to neutralize the effects of elastase neutrophils and protect the lung parenchyma from elastase effects. AAT deficiency is a predisposing factor in heat type Emphysema. Severe AAT deficiency will cause premature emphysema at a mean age of 53 years for non-smokers and 40 years in smokers.

Other COPD causes

Other things that can cause COPD are:
  • Hyperresponsive airway
  • Intravenous drug use
  • Immunodeficiency syndrome
  • Vasculitis syndrome
Chronic Obstructive Lung Disease Symptoms
In the early stages, COPD rarely shows any specific symptoms or signs. The symptoms of this disease only appear when there has been significant damage to the lungs, generally within years.

There are a number of symptoms of COPD that can occur and should be wary of:
  • Cough with phlegm that does not heal with mucus color phlegm colored slightly yellow or green.
  • Breathing is often short of breath, especially during physical activity.
  • Wheezing or breathing congestion and rang.
  • Limp.
  • Weight loss.
  • Chest pain.
  • The legs, ankles, or legs become swollen.
  • Lips or fingernails are blue.

Referensi

1. UpToDate. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. February 2017 [Cited 2017 14 March]; Available from: http://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-definition-clinical-manifestations-diagnosis-and-staging

2. MedScape. Chronic Obstructive Pulmonary Disease (COPD). March 2017 [ Cited 2017 14 March]; Available from : http://emedicine.medscape.com/article/297664

3. WHO. Chronic obstructive pulmonary disease (COPD). November 2016 [Cited 2017 15 March]; available from: http://www.who.int/respiratory/copd/

gastroenteritis prevention

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Prevention of gastroenteritis

Here are some ways you can do to prevent the occurrence of intestinal infection:
  • Washing hands. Wash the whole hand (including the sidelines of the nail) to clean. Use soap, then rub
    your hands for about 20 seconds, and rinse with clean water. If there is no soap and water, use a cleaning wipes or hand sanitizer.
  • Always wear personal equipment. It is advisable to use your own cutlery and drinkware, such as cups, plates, spoons, and forks. Avoid wearing cutlery alternately with others. Make sure every family member has their own towels.
  • Keep the distance. If you are forced to make contact with a person infected with gastroenteritis, try to keep a distance from it. Do not touch items used by an infected person.
  • Cleaning stuff. Clean items, places, and also surfaces touched by an infected person. Objects such as table surfaces, taps, door handles, spoons, forks, and other equipment used by gastroenteritis patients living in your home can become a medium of transmission of the virus.
  • Rotavirus vaccine. This vaccine is given to prevent diarrhea due to rotavirus. There are two types of rotavirus vaccine spread in Indonesia, namely rotateq and rotarix. Rotateq is given three doses at infants aged 6-14 weeks, 4-8 weeks later, and 8 months of age. While rotarix is ​​given two doses at the age of 10 weeks and 14 weeks (6 months).

In addition to some of the above efforts, there are some things you can consider to prevent gastroenteritis. If you are traveling or in a public place, you should be careful in choosing foods and beverages that you consume. Here are some things to avoid:
  • Avoid eating raw foods, either vegetables or fruits that have been peeled or touched by the hands of others.
  • Do not eat meat that is half-baked.
  • Buy bottled water to avoid consuming contaminated water. Including when you brush your teeth, it is advisable to keep using bottled water.
  • Avoid consuming ice cubes that are not guaranteed cleanliness, because it could be the water used to make ice is contaminated by the virus.

who are at high risk of gastroenteritis

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What is Gastroenteritis
Gastroenteritis is an infection of the stomach and intestines caused by several types of viruses and bacteria. This condition is also known as flu or gastric flu. Gastroenteritis can cause nausea, vomiting, diarrhea,
abdominal cramps, or indeed fever in the sufferer.

Gastroenteritis can spread through contact with people who have been contaminated with the virus. These infections are easy to use in public spaces, such as in classrooms, child care, or general care rooms.

Causes of Gastroenteritis
Overcooked foods are left too long in room temperature can also be the cause of the emergence of gastroenteritis bacteria. These infections are often characterized by nausea, vomiting, and diarrhea. This condition is often referred to as food poisoning. Gastroenteritis rarely causes complications. However, this condition can be fatal or even deadly if it occurs in infants, parents, and people who have problems with their immune system.

Here are some groups of individuals who are at high risk of gastroenteritis, including:

  • Small children. Children are more susceptible to viral infections because they do not have a strong immune system.
  • School children and living in dormitories. This infection can be transmitted easily in places where there are many people gathered at close range.
  • The elderly. The immune system in the elderly will decrease. These infections can easily be transmitted to the elderly if they live close to the person potentially spreading the germs.
  • People with weak immune systems. People with certain medical conditions, such as HIV and chemotherapy, are at higher risk of contracting infections because their immunities are attacked by the conditions they are suffering.

Diagnosis and Treatment of Gastroenteritis

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Diagnosis of Gastroenteritis
Doctors may be able to detect gastroenteritis from symptoms experienced, as well as through physical examination. If necessary, the doctor may recommend a useful stool test to determine the type of organism that causes gastroenteritis. In addition to viruses, gastroenteritis can also be caused by bacteria and parasites.

Treatment of gastroenteritis
The main purpose of treatment of gastroenteritis is to prevent the occurrence of dehydration. Therefore,
patients are encouraged to drink plenty of water. If the dehydration is severe enough, the patient may need to be admitted to the hospital to get fluids through the IV.

Salt and sugar (Oralite) may be given to aid rehydration. This drug contains the electrolytes and minerals needed by the body. Although ORS can be bought freely in the market, be sure to always follow the rules of use written on the packaging. If necessary, ask your doctor or pharmacist for more information.

Antibiotic medicines are not effective against viruses. In addition, do not give aspirin to relieve symptoms of pain in patients who are under the age of 16 years. To help alleviate the symptoms of gastroenteritis, do some of the following tips at home:

  • Try to always drink more fluids. If drinking difficulties directly from the glass, use a straw. Avoid eating fruit juice because this drink can actually increase the symptoms of diarrhea experienced.
  • Consumption of foods in small amounts and easily digested, such as bananas, porridge, and fish. It aims to provide recovery time for your stomach. Stop eating if the nausea begins to feel again.
  • Use more time to rest.
  • Children and adults can consume energy drinks to replace electrolytes in the body. Oralit is also highly recommended for treating infants and children. Avoid ice cream or soft drinks because it can aggravate diarrhea in children.
  • In patients with children, gastroenteritis should be treated as early as possible because the disease contributes to mortality in children who are quite high in Indonesia. Symptoms to watch out for include easy drowsiness, lips and mouth become dry, their hands and feet also feel cold. If that happens to your child, rush to the hospital for the best treatment.

The doctor will provide fluid intake to your child with nasograstic or NG tube, which is a tube inserted through the nose to the abdomen. The fluid intake can also be administered to your child directly with intravenous therapy injected through the blood vessels.

You can also do self-care by administering fluids to infants, 15-20 minutes after they have vomiting or diarrhea. This time lag is required for the baby's stomach to rest for a moment. Breast milk can be given to a baby if he is still breastfed. In addition to breast milk, oral acid or formula can also be given if the baby can drink from the bottle.

Read Also : What is Gastroenteritis? - Diagnosis and Treatment of Gastroenteritis - Gastroenteritis Prevention

Wednesday, July 18, 2018

Contains Salmonella, Hy-Vee recalls Spring Salad

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The U.S. Food and Drug Administration said Wednesday the West Des Moines-based grocery chain discovered potential salmonella contamination on Monday night and pulled the product from its shelves.

After 20 people got salmonella in Minnesota, South Dakota, Nebraska and Iowa, Midwest grocery store chain Hy-Vee Inc. has recalled its store-brand spring pasta salad.

The states are Iowa, Minnesota, Nebraska and South Dakota -- where the salmonella illnesses occurred -- and Illinois, Missouri, Kansas and Wisconsin.

The product was produced between June 1 and July 13. The packages have expiration dates between June 22 and August 3. Customers should dispose of the product or return it to a Hy-Vee store.

Symptoms of salmonella infection include diarrhea, fever and abdominal cramps, and typically present 12 to 72 hours after exposure to the bacteria. The company first learned of the potential link to the illnesses Monday night and voluntarily pulled the salad from stores.

Symptoms last four to seven days, and although most people improve without treatment, some may require hospitalization because of severe diarrhea. Hy-Vee's phone number is 1-800-772-4098. It has more than 245 stores.

5 Amazing Facts About Human Brain

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The human brain is one of the most mysterious, amazing, complicated and most valuable organs. Organ that serves as the body's propulsion machine also has a lot of uniqueness. Let's see more about the following brain facts!

Read Also : How to Exercise Your Brain
Read Also : Sweating Trigger Brain more creative

The facts about the human brain you may not know

 1. The brain needs a lot of blood supply
To be able to work optimally, the brain needs a lot of blood supply that should not be stopped. In fact, 30% of the blood flow from the heart will be directly channeled to the brain. This blood flow makes the brain capable of producing a reaction or an action in just 1 per 10 thousand seconds. Wow, that's quick!

2. Exercise is good for the brain
Exercise is not only good for your body and heart health, you know! Basically, exercise makes the heart work harder to pump blood. Well, as explained above, the brain needs nonstop blood intake in order to function properly.

More blood flow after your diligent exercise can help maintain brain health. Hmm .. That's why if you lack movement, the brain can be "slow" because the lack of blood that flows into the head.

More unique, the brain will learn and remember every muscle movement as you move for the sport. This then allows you to move on to the next sports sessions.

Then, when is the right time to exercise if you want to maintain brain health? Morning. Exercise in the morning can help the brain receive more blood intake so as to increase your ability to focus and concentrate work throughout the day.

3. The more eating fat, the healthier your brain
Remember, not all fats are evil and should be avoided. Good fat intake, especially omega-3 and omega-6 from fish and fruits such as avocado, works to reduce inflammation in the brain while supporting the strength of the immune system. In fact, omega-3 fatty acids are the main nutrients that help the functioning of the brain.

The composition of the brain comprises about one-quarter of fat produced by DHA, a fatty acid belonging to the Omega-3 group. DHA plays a role in supporting gray matter of the brain associated with intelligence. DHA also establishes the sensitivity of neurons that help convey information quickly and accurately.

A study shows that increased intake of omega-3 fatty acids from foods such as fish and vegetable oils may help counteract the risk of Alzheimer's. Other studies have also found that people who consume fish oil supplements are better protected from the risk of brain weakening (atrophy) than people who do not consume fish oil.

4. The brain can still function 3-5 minutes after the head is decapitated
In addition to blood, the brain's work is also supported by glucose and oxygen that comes transported in the bloodstream. Sugar and oxygen are the main fuels for the brain. That's why if you eat less or skip meals, or rarely exercise, work the brain will gradually decrease.

Permanent brain damage can occur after 3-5 minutes without oxygen or glucose intake at all. No wonder when the head of a person beheaded, the brain can still work temporarily because it has not experienced permanent damage or death function in the first few minutes.

5. Brain operation does not make the brain so stupid, but can change the personality
Facts about this brain may be a bit weird and unique. But did you know, that brain surgery, or hemisferektomi, aim to lift some of your brain? Hemisferektomi is a very rare surgery performed to overcome seizures.

Many believe that with the removal of some "portion" of the brain, the intelligence of the person can decline. This is wrong. Hemisferektomi does not cause an intelligence disorder, but it can alter a bit of your brain function after surgery. For example a change in your memory, sense of humor, or personality.

Read Also : How to Exercise Your Brain
Read Also : Sweating Trigger Brain more creative

Q A : treat chronic mastoiditis without surgery?

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Question: how to treat chronic mastoiditis, is there any effective way without surgery? explanation please

Answer: Mastoiditis is an inflammation caused by infection of the mastoid bone located behind the ear. This condition can arise due to complications from an untreated middle ear infection (otitis media) that spreads in this area.

Bone infections can cause a collection of pus even damage to the bone so that the symptoms are felt such as fever, pain in localized areas, swelling, redness and hearing loss can occur. Treatment that can be done is to deal with infection with antibiotics adequately thoroughly.

However, in some cases where extensive damage and no response to antibiotic treatment may be performed a mastoidectomy (removal of some mastoid bone) to avoid further damage.

Discuss this complaint to the ENT doctor who handles you, so that you immediately get the appropriate treatment, given if left too long then the complications will be worsened.

The doctor will perform a detailed examination to deal with disturbances in the ear area and surrounding areas to ascertain the cause of the complaint. You can read related articles about otitis media here, hopefully useful

Otitis Media in Child

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Most cases of otitis media rarely cause dangerous complications. But if it occurs in young children, the risk of complications is quite high. This is caused by their immune system that is still developing and not yet fully formed.

The following are some of the possible complications of otitis media:

Disturbance in speech or language development. This condition can occur if your child has frequent ear infections and affects their sense of hearing as a child.

Labyrinthitis. The labyrinth is a delicate structure deep inside the ear. Sometimes, the infection can spread to this area. This condition is known as labirintitis. Symptoms of labyrinthitis may include dizziness, vertigo, hearing loss, and loss of balance. These symptoms will disappear within a few weeks, but you may be prescribed medication to relieve these symptoms.

Hole in the eardrum. Under certain conditions, pressure or damage that occurs in the middle ear can tear the eardrum. Although this condition can recover within 72 hours by itself, there are some severe cases that require the sufferer to undergo surgery to restore it.

Mastoiditis. Mastoid is the bone behind the ear. If the infection is spread to this area, then known as mastoiditis. Symptoms of mastoiditis are fever, headache, loss of hearing, and swelling, redness, and pain in the back of the ear. This condition can be treated with antibiotics given by blood vessels or by surgery.

Cholesteatoma. Cholesteatoma is a collection of abnormal skin cells in the ear. This condition may arise from frequent or frequent chronic middle ear infections. If left unchecked, cholesteatomas can damage the ear structure and impair the hearing function. Symptoms of cholesteatoma are hearing loss, paralysis of the facial half, dizziness, and tinnitus or rippled ears. Surgical removal of cholesteatomas will be necessary in most of these cases.

Meningitis. If the infection is spread to the protective membrane of the brain and spinal cord, it will appear a condition called meningitis. Complications of this type of otitis media are quite rare. Symptoms from meningitis are severe headache, fever, nausea, stiff neck, rapid heart beating and sensitivity to light. See your doctor immediately if you suspect meningitis.

Brain abscess. A brain abscess is a pus filled with pus and appears in the brain. This is a rare complication of otitis media. Symptoms include severe headache, paralysis on one side of the body, fever, confusion, and convulsions. This is an emergency condition that requires hospital handling. Treatment is usually done through the administration of antibiotics and surgery to remove pus in the brain.

Facial paralysis. Facial nerves are a group of nerves that pass through the cranium and are used to control facial expressions. Swelling that occurs due to middle ear infections can suppress the facial nerves, although this condition is very rare. Due to the pressure, the patient can not move part or all of their faces. This condition will recover if the infection has been treated.
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