DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
Dyspnea derives from Greek for “ “ shortness of breath hard breathing ”. It is often also described as ”. This is a subjective sensation of breathing, from mild discomfort to feelings of suffocation. It is a sign of a variety of disorders and is primarily an indication of ventilation or of inadequate insufficient amounts of oxygen in the circulating blood .
Dyspnea happens when a “mismatch” occurs between afferent and efferent signaling. As the brain receives afferent ventilation information, it is able to compare it to the current level of respiration by the efferent signals. If the level of respiration is inappropriate for the body’s status and need, then dyspnea might occur
Acute respiratory failure happens quickly and without much warning. It is often caused by a disease or injury that affects your breathing, such as pneumonia, opioid overdose, stroke, or a lung or spinal cord injury. Respiratory failure can also develop slowly
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. INTRODUCTION
Dyspnea denotes the feeling of an ‘uncomfortable
need to breathe’ .
The American Thoracic Society consensus
statement defines dyspnea as
a “subjective experience of breathing discomfort that
consists of qualitatively distinct sensations that vary in
intensity. The experience derives from interactions
among multiple physiological, psychological, social,
and environmental factors and may induce secondary
physiological and behavioral responses.”
Respiratory or cardiac dysfunction, or manifestation
of psychological distress , anaemia, thyrotoxicosis or
metabolic acidosis .
4. Mechanisms:
- stimulation of intrapulmonary afferent nerves by
interstitial inflammation or thromboembolism.
- mechanical loading of respiratory muscles by
airflow obstruction or reduced lung compliance in
fibrosis.
- hypoxia due to ventilation/perfusion mismatch,
stimulating chemoreceptors.
14. APPROACH
HISTORY :
Onset
- Instantaneous : pneumothorax, pulmonary embolus or
acute allergy.
- Over hours : asthma,acute pulmonary oedema or acute
infections.
- Insidious : Effusions, interstitial diseases and tumours.
- Acute, intermittent episodes :myocardial ischemia,
bronchospasm, or pulmonary embolism,
- Chronic persistent - COPD, interstitial lung disease, and
chronic thromboembolic disease.
15. Variation:- Effect of position, infections, and
environmental stimuli
- Nocturnal dyspnea suggests CHF or asthma.
- Comfortable at rest and when asleep but struggle
with exertion – COPD.
- Breathlessness on lying down (orthopnoea) -
heart failure ,severe airflow obstruction or
diaphragmatic weakness , obesity, or asthma
triggered by esophageal reflux.
- Platypnea (dyspnea in the upright position with
relief in the supine position) - Left atrial myxoma
or hepatopulmonary syndrome
16. PND
PND is the occurrence of dyspnea during
sleep where typically, a patient is woken
up few hours into sleep with transient
acute pulmonary edema.
In contrast to orthopnea it can last up to half
an hour or so.
PND is relieved by assuming upright position
17. MECHANISM
Absorption of edema fluid with increase in Rt
ventricular output causing over filling the lungs
Diminished sympathetic drive of sleep,
decreasing LV contractility
Nocturnal arrhythmia
Sleep apnea
18. ORTHOPNEA
It refers to dyspnea on supine position
It results from increase in hydrostatic pressure
in lung that occurs in assumption of supine
position.
Sitting up leads to rapid relief of symptom.
19. It is related to increase in venous return to the
heart in supine position.
Increase in venous return which can not be
handled by failing left ventricle.
It is a sign of LV dysfunction
20. It is associated with cough which is called as
nocturnal cough.
The transient rise in left ventricular pressure
results in transient lung stiffness and
consequent cough.
The severity can be graded by the number of
pillow used at night, ex. Three pillow
orthopnea
It can also be seen in COPD and condition
21. CAUSES
Left heart failure
COPD
Constrictive pericarditis
Severe ascites
B/L Diaphragmatic paralysis
22. PHYSICAL EXAMINATION
Vital signs
- Fever - infectious or inflammatory process
- Hypertension in the setting of a heart failure - diastolic dysfunction
- Tachycardia - fever, cardiac dysfunction, and deconditioning
- Resting hypoxemia - hypercapnia, ventilation-perfusion mismatch,
shunt, or impairment in diffusion capacity
Pulsus paradoxus - COPD, acute asthma, or pericardial disease.
Anemia
Cyanosis
Cirrhosis (spider angiomata, gynecomastia).
Respiratory rate
Clubbing - interstitial pulmonary fibrosis , bronchiectasis,
Joint swelling or deformity - collagen-vascular disease.
23. RESPIRATORY SYSTEM EXAMINATION
Chest - symmetry of movement
Inability to speak in full sentences - impairment of the ventilatory
pump.
Increased work of breathing (supraclavicular retractions; use of
accessory muscles of ventilation; and the tripod position) - increased
airway resistance or stiffness of the lungs and chest wall.
Percussion :-
- Dullness - pleural effusion
- Hyperresonance - emphysema
Auscultation :
- Wheezes, prolonged expiratory phase, and diminished breath
sounds - disorders of the airways
- Rales - interstitial edema or fibrosis
24. CARDIAC EXAMINATION
Signs of elevated right heart pressures :
- jugular venous distention, edema, accentuated
pulmonic component to the second heart sound).
left ventricular dysfunction (S3 and S4 gallops)
Valvular disease (murmurs).
25.
26. INVESTIGATIONS
CHEST IMAGING
Lung volumes :
- Hyperinflation - obstructive lung disease,
- Low lung volumes - interstitial edema or fibrosis,
diaphragmatic dysfunction, or impaired chest wall motion.
Evidence of interstitial disease, infiltrates, and emphysema.
Prominent pulmonary vasculature in the upper zones -
pulmonary venous hypertension
Enlarged central pulmonary arteries - pulmonary arterial
hypertension
Enlarged cardiac silhouette - dilated cardiomyopathy or
valvular disease.
Bilateral pleural effusions - CHF ,collagen-vascular disease.
Unilateral effusions - carcinoma , pulmonary embolism ,heart
failure or parapneumonic effusion.
28. Differentiating Cardiovascular and
respiratory cause :
cardiopulmonary exercise test (CPET) - incremental
symptom-limited exercise (cycling or treadmill) with
measurements of ventilation , pulmonary gas exchange,
pulmonary vascular pressures and cardiac output.
If, at peak exercise, the patient achieves predicted
maximal ventilation, demonstrates an increase in dead
space or hypoxemia, or develops bronchospasm -
respiratory system.
If the heart rate is >85% of the predicted maximum, if the
anaerobic threshold occurs early, if the blood pressure
becomes excessively high or decreases during exercise,
if the O2 pulse (O2 consumption/heart rate) falls, or if
there are ischemic changes on the electrocardiogram -