DIABETES MELLITUSAn - old boy on ho

DIABETES MELLITUS
An - old boy on holiday in the location, was brought into Accident and Emergency(A & E) by his worried parents. Prior to admission he had complained of tiredness, insomnia and his mother had noticed that despite a good appetite he had become thinner. On the morning of admission he suffered abdominal pain, nausea and vomiting, his breathing had become irregular and at times he appeared semiconscious. Further questioning of the parents indicated the patient had recently developed polydipsia and polyuria.
On admission he was conscious and hyperventilating; he was dehydrated and his breath had the fruity odour of ketones. Blood and urine samples were analysed and quickly indicated clinically significant levels of glycosuria, hyperglyceamia and ketonaemia. W’s condition was diagnosed as diabetic ketoacidosis and emergency treatment was commenced.
Vital signs on admission
Public Dral temp BP110/70
98 per minute 36 độ C
Blood glucozes urine 3+ Hyperventilating
28 mmol/litre ketones
He was given an initial intravenous infusion of 6 units of soluble insulin followed by 6 units hourly. His fluid and electrolyte loss were replaced by an intravenous saline infusion. His blood glucoses was monitored hourly and electrolytes 2 hourly in the initial phase of treatment. When his blood glucose reached its normal valve. He was given a saline infusion of 5% Dextrose containing 20 mmol KCL litre-1. The dose of insulin was adjusted according to the hourly blood glucose results.
W’s parent were informed their son was suffering from type 1 diabetes mellitus also known as insulindependent diabetes mellitus (IDDM), a chronic incurable condition brought on by a failure of the pancreatic islets to produce insulin.
Once recovered from his acute attack he was referred to the diabetic clinician for advice on insulin therapy and his GP was informed. He responded well to advice and now self-administers two daily injections of insulin. His regimen was adjusted to avoid hypoglyceamia and gvie good glyceamic control. Both injections consist of a mixture of short and intermediate-acting insulins. The first before breakfast and the second before his evening meal.

AGING AND THE HEART
The heart muscle becomes less efficient with age, and there is a decrease in both maximum cardiac output and heart rate, although resting levels may be more than adequate. The health of the myocardium deppends on its blood supply, and with age there is likelihood that atherosclerosis will narrow the coronary arteries. Atheroselerosis is the deposition of cholesterol on and in the walls of the arteries, which decreases blood flow and forms rough surfaces that may cause intravascular clot formation.
High blood pressure ( hypertension) causes the left ventricle to work harder; it may enlarge and outgrow its blood supply, thus becoming weaker. A weak ventricle is not an efficient pump, and such weakness may progress to congestive heart failure;such a slow, or progression may be may be rapid. The heart valves may become thickened by fibrosis, leading to heart murmurs and less efficient pumping. Arrhythmias are also more common with age, as the cells of the conduction pathway become less efficient.

High Blood Pressure – Hypertension – Attempt 1
Hypertension (HT) is commonly called high blood pressure, nowadays (2005 on) defined as above 140/85 mmHg; or if one is a diabetic, over 135/80. About 38% of Uk adults have hypertension.Advice and treatment include s exercise,lifestyle changes, and I or diet changes, as well as drugs.
Possibly as many as 16 million UK people have high blood pressure, and the proportion of the population is slowly increasing over the years. About 5% have an obvious underlying cause such as kidney disease. Most of the rest have no single obvious cause. Some have a genetic component, with hypertension tending to run in families. In addition there are environmental and lifestyle factors. The most important causes are being obese, smoking, too much alcohol, too much salt, stress, lack of exercise, poor diet, too little potassium, and family history of relatives with hypertension. Oily fish with omega-3 fatty acids is protective against high blood pressure and heart disease.
Five self-help measures are suggested :
Avoid being overweight
Reduce salt intake
Keep alcohol down
Exercise reduce your blood pressure and help to keep your weight down . Start slowly and build up. Walking is excellent. Aim for 20 to 30 minutes activity at least three times a week. Or even better than more intense exercise for a shorter time
Don’t smoke.

More about the lungs and respiratory system
Breathing patterns are altered when there is infection,disease,blockage,or injury to the respiratory system. The ability of the lung accommodate a sufficient intake of air is known as pulmonary capacity. This is measured terms of volume. Several types of lung volumes are used to assess and diagnose the heath or illness of the lungs. There include inspiratory volume,functional residual volume,vital capacity and total capacity. The rate at which the lungs in inflate and deflate (the ventilation rate) can be affected by inflection or other disease and by various other stimuli. Factors that may increase the rate and depth of ventilation include increased or decreased levels of arterial blood gases, an increase in prolonged pain,and a decrease in blood pressure,factors that can decrease or inhibit the rate and depth of ventilation include severe pain causing apnea,decreased body temperature,increased blood pressure,and increased levels of arterial blood gases.
Health professionals recognize the importance of assessing for and ensuring adequate oxygenation for health and healing. Any impairment in respiratory system,particularly, the lungs,adversely affects every other organ and cell of the body. Disease of any part of the lung can affect the pH balance of the body. The term pH stands for the potential hydrogen in the body. Human blood is rated at 7.4 on the pH scale. A reading of less than 7(7) indicates alkalinity.
The respiratory systems has its own capacity to protect itself from toxins,viruses,bacteria,and other disease-causing agents. This is accomplished through the system's ability to secrete mucous. It is the system's most significant protective mechanism. Mucous traps toxins and attempt to isolate or expel them. It is then expelled from the body by the process of sneezing and coughing. Phlegm,on the other hand,it is a sticky secretion of mucous that originates only in the lungs. When expelled by the cough,it is referred to as sputum.

RELATIVE RISK
“It was a tight pain around my chest, just kike when I had my heart attack 40 years ago”. He went on to give a textbook history of cardiac chest pain, which had kept him awake all night two night previously. When I asked him why he had not sought help sooner, he told me that he had been looking after his son’s pets while he was away for an important job interview. I proceeded to ask about risk factors for ischaemic heart diease, starting with smoking. “Yes, I did smoke, but then again, everyone did then… you would have too”.
Intrigued, I asked what he meant. “I was a Spitfire pilot during the war. Not the normal planes, but the ones on the aircraft carriers. The landing deck was only about 300 feet (about 100m) long and about 75 feet wide. What made it even harder was that it was a moving target in rough seas. When you’ve done that, chest pain doesn’t seem quite so bad”.
His blood troponin concentration was elevated at 1.73ug/l, and we advised hospital admission for observation and optimisation of his medication. “No thanks, doc.” He replied. “It’s the Bowls Club Christmas dinner tonight – I don’t want to miss it”. We counselled him as to the risks, but he would not stay. It was all we could do to stop him walking the short distance home, rather than waitng for transport.
Although I was initially concerned by his refvial to stay, on reflection, I think he made the correct decision. We work in a risk averse environment and often lose perspective. For him, the risk of another ischaemic event or arrhythmia was taken in the context of what he had been through all those years ago. He could not contemplate the possibility of his son missing out on a valuable job opportunity, or not catchin up with his friends at their annual dinner, just so that he could stay in hospital.
He has taught me a valuable lesson – risk is relative.

THE URINARY SYSTEM
Mr G, an engineer recently returned from working in the Middle East, was admitted to Accident and Emergency in pain and clutching his right side. He had been awoken during the night by an excruciating pain in his right flank radiating to the iliac fossa and right testicle. In the past two days, he had developed severe urethral pain and dysuria associated with haematuria. Fluid intake made the pain worse and he had been vomiting. Mr G had recently been treated with antibiotics by his GP for bacteriuria and diagnosed as suffering from obstructive uropathy. His condition had become acute whilst waiting for his referral appointment. On admission he required immediate analgesia for severe pain and administered lOmg morphine i.m. He was kept in overnight for observation and transferred to the Urology Unit the following morning.

CORONARY HEART DISEASE
Coronary heart disease is the end result of the accumulation of plaques within the walls of the arteries that supply the muscle of the heart with oxygen and nutrients. The symptoms and signs of coronary heart disease are noted in the advanced state of disease. But most individuals with coronary heart disease show no evidence of disease for decades. The disease progresses unnoticed until the first onset of symptoms, often a "sudden" heart attack, finally arise. After decades of progression, some of these plaques may rupture

Kết quả (Việt) 1:

DIABETES MELLITUS
An - old boy on holiday in the location, was brought into Accident and Emergency(A & E) by his worried parents. Prior to admission he had complained of tiredness, insomnia and his mother had noticed that despite a good appetite he had become thinner. On the morning of admission he suffered abdominal pain, nausea and vomiting, his breathing had become irregular and at times he appeared semiconscious. Further questioning of the parents indicated the patient had recently developed polydipsia and polyuria.
On admission he was conscious and hyperventilating; he was dehydrated and his breath had the fruity odour of ketones. Blood and urine samples were analysed and quickly indicated clinically significant levels of glycosuria, hyperglyceamia and ketonaemia. W’s condition was diagnosed as diabetic ketoacidosis and emergency treatment was commenced.
Vital signs on admission
Public Dral temp BP110/70
98 per minute 36 độ C
Blood glucozes urine 3+ Hyperventilating
28 mmol/litre ketones
He was given an initial intravenous infusion of 6 units of soluble insulin followed by 6 units hourly. His fluid and electrolyte loss were replaced by an intravenous saline infusion. His blood glucoses was monitored hourly and electrolytes 2 hourly in the initial phase of treatment. When his blood glucose reached its normal valve. He was given a saline infusion of 5% Dextrose containing 20 mmol KCL litre-1. The dose of insulin was adjusted according to the hourly blood glucose results.
W’s parent were informed their son was suffering from type 1 diabetes mellitus also known as insulindependent diabetes mellitus (IDDM), a chronic incurable condition brought on by a failure of the pancreatic islets to produce insulin.
Once recovered from his acute attack he was referred to the diabetic clinician for advice on insulin therapy and his GP was informed. He responded well to advice and now self-administers two daily injections of insulin. His regimen was adjusted to avoid hypoglyceamia and gvie good glyceamic control. Both injections consist of a mixture of short and intermediate-acting insulins. The first before breakfast and the second before his evening meal.

AGING AND THE HEART
The heart muscle becomes less efficient with age, and there is a decrease in both maximum cardiac output and heart rate, although resting levels may be more than adequate. The health of the myocardium deppends on its blood supply, and with age there is likelihood that atherosclerosis will narrow the coronary arteries. Atheroselerosis is the deposition of cholesterol on and in the walls of the arteries, which decreases blood flow and forms rough surfaces that may cause intravascular clot formation.
High blood pressure ( hypertension) causes the left ventricle to work harder; it may enlarge and outgrow its blood supply, thus becoming weaker. A weak ventricle is not an efficient pump, and such weakness may progress to congestive heart failure;such a slow, or progression may be may be rapid. The heart valves may become thickened by fibrosis, leading to heart murmurs and less efficient pumping. Arrhythmias are also more common with age, as the cells of the conduction pathway become less efficient.

High Blood Pressure – Hypertension – Attempt 1
Hypertension (HT) is commonly called high blood pressure, nowadays (2005 on) defined as above 140/85 mmHg; or if one is a diabetic, over 135/80. About 38% of Uk adults have hypertension.Advice and treatment include s exercise,lifestyle changes, and I or diet changes, as well as drugs.
Possibly as many as 16 million UK people have high blood pressure, and the proportion of the population is slowly increasing over the years. About 5% have an obvious underlying cause such as kidney disease. Most of the rest have no single obvious cause. Some have a genetic component, with hypertension tending to run in families. In addition there are environmental and lifestyle factors. The most important causes are being obese, smoking, too much alcohol, too much salt, stress, lack of exercise, poor diet, too little potassium, and family history of relatives with hypertension. Oily fish with omega-3 fatty acids is protective against high blood pressure and heart disease.
Five self-help measures are suggested :
Avoid being overweight
Reduce salt intake
Keep alcohol down
Exercise reduce your blood pressure and help to keep your weight down . Start slowly and build up. Walking is excellent. Aim for 20 to 30 minutes activity at least three times a week. Or even better than more intense exercise for a shorter time
Don’t smoke.

More about the lungs and respiratory system
Breathing patterns are altered when there is infection,disease,blockage,or injury to the respiratory system. The ability of the lung accommodate a sufficient intake of air is known as pulmonary capacity. This is measured terms of volume. Several types of lung volumes are used to assess and diagnose the heath or illness of the lungs. There include inspiratory volume,functional residual volume,vital capacity and total capacity. The rate at which the lungs in inflate and deflate (the ventilation rate) can be affected by inflection or other disease and by various other stimuli. Factors that may increase the rate and depth of ventilation include increased or decreased levels of arterial blood gases, an increase in prolonged pain,and a decrease in blood pressure,factors that can decrease or inhibit the rate and depth of ventilation include severe pain causing apnea,decreased body temperature,increased blood pressure,and increased levels of arterial blood gases.
Health professionals recognize the importance of assessing for and ensuring adequate oxygenation for health and healing. Any impairment in respiratory system,particularly, the lungs,adversely affects every other organ and cell of the body. Disease of any part of the lung can affect the pH balance of the body. The term pH stands for the potential hydrogen in the body. Human blood is rated at 7.4 on the pH scale. A reading of less than 7(<7) indicates an acidic imbalance called acidosis;while a reading of greater than 7(>7) indicates alkalinity.
The respiratory systems has its own capacity to protect itself from toxins,viruses,bacteria,and other disease-causing agents. This is accomplished through the system's ability to secrete mucous. It is the system's most significant protective mechanism. Mucous traps toxins and attempt to isolate or expel them. It is then expelled from the body by the process of sneezing and coughing. Phlegm,on the other hand,it is a sticky secretion of mucous that originates only in the lungs. When expelled by the cough,it is referred to as sputum.

RELATIVE RISK
“It was a tight pain around my chest, just kike when I had my heart attack 40 years ago”. He went on to give a textbook history of cardiac chest pain, which had kept him awake all night two night previously. When I asked him why he had not sought help sooner, he told me that he had been looking after his son’s pets while he was away for an important job interview. I proceeded to ask about risk factors for ischaemic heart diease, starting with smoking. “Yes, I did smoke, but then again, everyone did then… you would have too”.
Intrigued, I asked what he meant. “I was a Spitfire pilot during the war. Not the normal planes, but the ones on the aircraft carriers. The landing deck was only about 300 feet (about 100m) long and about 75 feet wide. What made it even harder was that it was a moving target in rough seas. When you’ve done that, chest pain doesn’t seem quite so bad”.
His blood troponin concentration was elevated at 1.73ug/l, and we advised hospital admission for observation and optimisation of his medication. “No thanks, doc.” He replied. “It’s the Bowls Club Christmas dinner tonight – I don’t want to miss it”. We counselled him as to the risks, but he would not stay. It was all we could do to stop him walking the short distance home, rather than waitng for transport.
Although I was initially concerned by his refvial to stay, on reflection, I think he made the correct decision. We work in a risk averse environment and often lose perspective. For him, the risk of another ischaemic event or arrhythmia was taken in the context of what he had been through all those years ago. He could not contemplate the possibility of his son missing out on a valuable job opportunity, or not catchin up with his friends at their annual dinner, just so that he could stay in hospital.
He has taught me a valuable lesson – risk is relative.

THE URINARY SYSTEM
Mr G, an engineer recently returned from working in the Middle East, was admitted to Accident and Emergency in pain and clutching his right side. He had been awoken during the night by an excruciating pain in his right flank radiating to the iliac fossa and right testicle. In the past two days, he had developed severe urethral pain and dysuria associated with haematuria. Fluid intake made the pain worse and he had been vomiting. Mr G had recently been treated with antibiotics by his GP for bacteriuria and diagnosed as suffering from obstructive uropathy. His condition had become acute whilst waiting for his referral appointment. On admission he required immediate analgesia for severe pain and administered lOmg morphine i.m. He was kept in overnight for observation and transferred to the Urology Unit the following morning.

CORONARY HEART DISEASE
Coronary heart disease is the end result of the accumulation of plaques within the walls of the arteries that supply the muscle of the heart with oxygen and nutrients. The symptoms and signs of coronary heart disease are noted in the advanced state of disease. But most individuals with coronary heart disease show no evidence of disease for decades. The disease progresses unnoticed until the first onset of symptoms, often a "sudden" heart attack, finally arise. After decades of progression, some of these plaques may rupture