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Pulmonary embolism Definition, Risks, Prevention, Causes, Signs and symptoms

Pulmonary embolism: definition

Pulmonary embolism is obstruction of one or both of the pulmonary arteries by a blood clot (thrombosis). It has mostly migrated from a vein in the lower limbs reached by phlebitis also called venous thrombosis (70% of cases *). These two events - embolism and thrombosis - are part of the same disease, venous thromboembolism (VTE).

Depending on the level of obstruction, and the diameter of the clot, or any part of the lung is deprived of blood. This obstruction results in a subsequent heart block with acute respiratory failure and heart failure that can be fatal: that massive pulmonary embolism with cardiac arrest immediately.

Pulmonary embolism: risks and consequences


The venous thromboembolic disease affects about 150,000 people per year. Following him, pulmonary embolism (PE) causes 20,000 deaths; this is the third leading cause of cardiovascular death after myocardial infarction and stroke (source: interviews Bichat, 2010).

The risk depends on the importance of the private territory of pulmonary blood, so the percentage of obstruction by clots or migrants. Advanced age is a risk factor for death.

Only 10% of EP are fatal in one hour. But in half of the cases they cause insufficient heart more or less well tolerated in time and absolutely require good care. A distance embolism treated, the risk of pulmonary hypertension is 5% *.


Pulmonary embolism: origins and causes

One or more blood clots in the pulmonary arteries block during passage of the blood to be oxygenated. Lacking the blood blocked upstream, the heart fails to work properly, then it should just provide an extra effort to correct this lack of blood throughout the body.

About 70% of cases of pulmonary embolism are caused by the migration of a clot from phlebitis of the lower limbs (DVT). To meet and consider embolism, it is still necessary that the phlebitis of the legs occurs, it is the case for less than one out of four *. More often we are dealing with phlebitis of the pelvis or the inferior vena cava (large vein in the abdomen) totally invisible. But in this case the risk of embolism is massive high.

Venous clots of thromboembolic disease appear particularly susceptible individuals by genetic background (personal or family history) or suffering from cancer. Genetic disorders of coagulation causes are increasingly recognized in this disease.

But the great cause of phlebitis venous stasis. First by bed rest, he must follow an illness or surgery; then by poor circulation or varicose field. Phlebitis is also feared as a cast of the lower limbs or in a long-haul air travel in a dry atmosphere (dehydration makes the blood less fluid), even if it is followed by a trek at altitude dehydration persistence (total effort and the dry atmosphere). All situations causing hyperviscosity are at risk of thrombosis (caillotage), so pulmonary embolism: smoking, obesity, pregnancy, childbirth and after, heart failure, oral contraception days.

Venous clot breaks off more easily since it was formed less than 5 days and it moves at sunrise after prolonged bed rest (home or hospital) for example.

Signs and symptoms of pulmonary embolism

Pulmonary embolism is often understated: there must be at least 30 to 40% of the pulmonary arteries to be clogged that the signs are visible. Therefore, pulmonary embolisms are rarely diagnosed. Only "big" are noticed. The diagnosis is made during a pulmonary imaging (CT, MRI) for another reason.

The classic table combines a sudden difficulty breathing (dyspnea) with a sharp chest pain, like a stitch or a dagger that increases on inspiration. Shortness of breath sudden unexplained is the only sign still present (pain may be missing). It may be added tachycardia (rapid heartbeat), unexplained anxiety, cough, fever 38%, cyanosis of the extremities (bluish fingers), one or coughing up blood (hemoptysis).

Chest pain stabbing and difficulty breathing enough to evoke a pulmonary embolism even if one is not aware of phlebitis. The urgent consultation of doctor or emergency services if necessary.

Pulmonary embolism are more frequent in winter, due to an increase in clotting related to winter infections, reduced physical activity and venous constriction caused by the cold.

Not to be confused with what?

Acute bronchitis, pericarditis (inflammation of the lining around the heart), asthma, myocardial infarction, pulmonary disease or infection of the gallbladder (cholecystitis) can simulate a pulmonary embolism.

Will it prevent a pulmonary embolism?


Yes. This is identical to that of the lower limb vein thrombosis.

Early up after surgery or childbirth, the active mobilization of the lower limbs, wearing stockings or compression socks; and prescription of heparin called "low molecular weight" (LMWH) in high-risk situations: bed rest, plaster, surgery.

In pul monaires recurrent embolism, it can be a filter in the inferior vena cava to prevent the rise of any clots from leg veins.

When to call the doctor?


Emergency after the occurrence of sudden unexplained like a stitch or stabbing chest pain; especially if it is accompanied by difficulty breathing, coughing and discomfort. But also occurs when an unexplained respiratory difficulty.

How to prepare the consultation?

Summarize his treatment, the events of recent weeks (phlebitis or circumstances conducive to phlebitis), provide medical and possibly his last book electrocardiogram.

What does the doctor facing a suspicion of pulmonary embolism?

It confirms the signs suggestive of pulmonary embolism and evaluates its general tolerance. He can do an electrocardiogram to add arguments to the diagnosis.

Hospitalization is required to confirm and treat pulmonary embolism. The electrocardiogram (ECG), chest radiograph, a study of blood gases, blood levels of certain markers ("D-dimer") and a Doppler ultrasound of the lower limbs are always facts.

Examinations have certainty as appropriate and availability: a lung scan, angio-CT, angiography (opacification of vessels) or transcardially ultrasound. Support resuscitation depends on the severity of the embolism.

Once the diagnosis is confirmed, it is possible to surgically remove a large clot or destroy thrombolysis. In all cases, the treated venous thromboembolic disease, causing embolism, by anti-coagulants (heparin) to effective dose. That pose a risk of bleeding, imposing strict controls and good patient compliance.

Due to the high risk of recurrence, anticoagulation was continued several months with venous contention, changing heparin by anti-vitamin K or a new class of anti-coagulant: the "anti-Xa" type or "anti-IIa." Prescription and monitoring is specialist business.

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Urinary calculi (kidney and bladder), Definition, Risks, Causes, Symptoms and signs, infection, prevention

Urinary calculi: Definition

Urinary calculi (or urolithiasis) are salt crystals that form in the urinary tract. Kidney, ureter (connecting the kidney to the bladder), the bladder or urethra (connecting the bladder urinary meatus) are involved in the formation of urinary stones.

The small stones are eliminated naturally but the biggest are responsible for pain when they can not be removed: we speak of renal colic.

Risks and health issues of urinary calculi

2-3% of the general population suffer from urolithiasis. Men are slightly more affected than women and the left kidney is more often affected than the right kidney.

In case of recurrence of the crisis, the risk is a breach of the kidney itself with decreased functioning (renal failure).

Causes of urinary calculi

Various types of computations are involved according to their composition. One distinguishes calculations related to the crystallization of calcium, uric acid or cystine.

A high protein diet promotes calculations; a low intake of drinks is causing concentrated urine conducive to the formation of stones. Similarly, certain blood disorders with excess calcium or uric acid promote urinary calculi.

Symptoms and signs of urinary calculi

Urinary calculi may be asymptomatic, form and eliminate naturally it comes to small stones. Otherwise, the symptoms are three in number.

Pain

The pain is the first symptom; this is called colic. The pain from the lower back (lumbar) and radiates to the external genitalia. The crisis is brutal and very violent.

Hematuria

The second symptom is the presence of blood in the urine or hematuria. In most cases, hematuria is not visible to the eye but detected by a urine dipstick or analysis. In case of large amount of blood, it can be noticed by the patient.

Urinary infection

Finally, a urinary tract infection can complicate the urinary calculi with burning on urination, more frequent urination and cloudy urine. Fever may occur and aggravate the table (prostatitis in men, acute pyelonephritis in both sexes).

With what should we be confused?

Lumbar pain should not be confused with a "back strain" or lumbago. It is therefore desirable to provide a urine dipstick test for the presence of blood, while signing the diagnosis of renal colic.
Similarly, a strong feeling and renal colic pain may be due to aneurysms of the abdominal aorta.

Will it possible prevention?

The lifestyle measures are fundamental and always recommended.
Beverage intake should be between 1.5 and 2 l l per day (increase in hot weather or sweating the normal color of urine should be colorless or pale yellow).
A balanced diet includes a sufficient intake of calcium (800 mg to 1 g) of animal protein in moderation and not too much salt.

Depending on the nature of the calculation, some guidance will be given specifically, such as limiting the use of chocolate in the case of oxalate or calcium limit if excessive inputs.

When you consult?

The pain is so in case of renal colic that consultation is needed urgently.
In case of fever or anuria (more urine), consultation is also needed urgently to avoid complications (kidney destruction, widespread infection ...).

What is the doctor?

The examination on the type of pain, its location and evolution (crisis ...) is suggestive of the diagnosis of urinary stones. Reactive dipstick dipped in urine, the firm, confirm the presence of blood and / or infection.

Then tests can directly visualize the calculations. This is urinary ultrasonography (hyperechoic images), radiography of the abdomen without preparation or ASP, of intravenous urography (IVU) and finally the scanner or abdominal CT scan. The scanner has the advantage of highlighting other causes of pain (differential diagnosis). Of urinalysis as Urine culture or urinalysis complete the balance sheet, and a blood test to check the concentration of calcium, uric acid and phosphorus as well as renal function.

Different therapeutic options are available, from simple monitoring to surgery through the extracorporeal lithotripsy to dissolve stones. Treatment by natural means also allow extraction or stone fragmentation through the urinary tract.

How to prepare my next visit?
When a single monitoring is recommended, the position calculation is controlled by ultrasound or radiography regularly (a few days to a month or more). Meanwhile, sufficient hydration is necessary.

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Hair Dandruff treatment, remedies, causes, tips solution

Origin of Hair Dandruff

As the skin, scalp renews itself continuously eliminating "dead" cell surface, or dander. This phenomenon is called flaking normally pass unnoticed.

When the elimination of these cells becomes more important, the scales are larger and thicker, clump together and become very visible, they remain attached to the hairline or fall on their shoulders.

Different types of films

Dry dandruff
Dry dandruff, sometimes called "tinea capitis simplex" (but unrelated to the fungus causing tinea versicolor), are small, white and falling "snow" on clothing. They are usually associated with a dry scalp.

Oily dandruff
Oily dandruff (or tinea steatoid) are larger, thicker, often yellowish. They occur on oily scalps with overproduction of sebum. Films agglomerate with excess sebum, to form a thick layer that sticks to the scalp and hairline.

Risks and consequences of hair dandruff

The presence of dandruff on the scalp, the accumulation of sebaceous secretions, lesions due to scratching, causing a "vicious" circle with inflammation that promotes superinfection with bacteria or fungi, and this increases superinfection dandruff .

Why were films in our hair?

When external aggression or internal disturbances irritate or dry out the scalp, it reacts by producing and eliminating more cells.

Local causes
Anything that irritates the scalp can cause dandruff: sweating, heat (sun exposure, use a hairdryer or repeated too high temperature), air conditioning or heating excessive exposure to dust laden atmospheres, coloring, poor hygiene of scalp, aggressive shampoos, often wearing caps, hats or "charlotte" gripping the hair in certain professions (medical or paramedical, food industry ... etc.).

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The poor condition

The scalp is very sensitive to hormonal changes during puberty, pregnancy, menopause or birth control pills, as well as poor diet, lack of sleep, active or passive smoking. Situations of anxiety or stress can cause dandruff.

Can you prevent dandruff?

The term hairy "leather" should not forget that it is almost as fragile as the skin and as such should not be attacked. Shampoos must rid the hair and scalp of impurities and accumulated sebum, but not excessive: products that dry the scalp, even if greasy hair, cause a reaction by increased sebum secretion.
We must not listen to the myth that recommends "not to wash your hair too not to attack the scalp" gentle shampoo more often, every 2 days for example, often used to control an easy dandruff.
Especially, shampoo should be rinsed and the hair dryer used at low temperatures.

With what should we not confuse dandruff?

It is easy to recognize films that should not however be confused with:
1- seborrheic dermatitis is an inflammatory disease of the skin and scalp; it is caused by hypersecretion of the sebaceous glands which encourages the development of a fungus that perpetuates and aggravates seborrheic dermatitis. Thick films are accompanied by red and oozing lesions of the scalp and often severe itching.
2- psoriasis is a skin disease causing dander in various parts of the body, including the scalp. The scales are thick and very limited. The existence of scaly lesions in other parts of the body (elbows, knees especially) helps make the diagnosis.

When to call your doctor?


When the films are very heavy or do not go away with dandruff shampoo. Or when the itching is hard to calm down, and very red scalp.

The doctor confirmed that it is dandruff and not psoriasis or seborrheic dermatitis. He is looking for the cause of dandruff and offers treatment tailored to the type of scalp.

Rebel films can motivate a dermatological consultation because it is sometimes difficult to distinguish between simple and seborrheic dermatitis dandruff: in this case, medicated shampoo containing ketoconazole or ciclopirox olamine issued only on prescription are helpful.

What is the action taken against dandruff?

Must refrain from seeking to eliminate dandruff by scraping or brushing the scalp vigorously.

The supply of dandruff shampoos is particularly rich: you choose a gentle dandruff shampoo, preferably with frequent use. If dry scalp shampoos course have "special dry hair", it seems preferable to use on oily scalp shampoo hair greasy or normal but not too dry. Do not completely eliminate the sebum that normally has a protective vis-à-vis the hair and scalp role.

Parallel is taken to a sleep pattern and a balanced diet.

Prescription shampoo or products to treat secondary infection by bacteria or fungus, or to reduce sebaceous hypersecretion is the responsibility of the physician.

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3 Health Tips to prevent Diabetes with your diet


KITCHEN - The type 2 diabetes is a chronic disease that affects 4%. To protect you, you can pay attention to your diet. Follow our advice.

Diabetes is a chronic disease that, affects 3 million people, or 4.6% of the population. Type 2 diabetes is the most common. It affects 2.5 million. These figures are also rising steadily between 1999 and 2016, the number of people treated for diabetes increase by 44%. This would increase to 38% due to the increase in obesity.

Obviously, "all overweight people are not diabetic," says dietician to MetroNews CHU Toulouse Jacqueline Delaunay. But environmental factors add to genetic factors. Result: "By practicing physical activity and paying attention to your diet, you limit the discovery of diabetes." Then follow the guide.

Avoid sugary foods, soda with chocolate bars

Rule number one: "Do not skip meals to avoid snacking." Because if you start to nibble, we know very well that you goinfrerez sugary snacks like chocolate bars or cakes, or swallow amount of soft drinks and syrups.

But there is nothing worse than the sugary liquids to high glycemic index "They tend to raise blood sugar, they require a response insulin largest fast and long sursollicitent the pancreas. " Not to mention that the consuming you will tend to gain weight.
preventing diabetes diet plan, best diet to prevent diabetes
Follow the 1/3 rule meat, 1/3 vegetable, 1/3 starch

For glucose rises slower, it calls less insulin and uses less strongly the mechanism of pancreatic prefer green vegetables, fiber, starch, in the form of whole grains and legumes, and pasta long as they are al dente. "A balanced plate, leading to a feeling of satiety, that is one third of meat, vegetables third, one third of starches."

For big eaters, here some tips: Play on the size of your plate, measure volumes with a spoon and cut your bread before the meal. If you eat more starchy foods, eat less bread - and vice versa. Another tip: Use your green vegetables in larger quantities to fill your plate.

Do not eat a fatty food per meal

It is also important to limit your intake of saturated fat. You have to choose between ham, cheese, sauce and fried. In the end, it is better not exceed a fatty food per meal. Avoid cream and butter and vary oils (sunflower, olive, rapeseed ...) to season your vegetables.

Attention oil and margarine, it's for flavor but in no case for cooking: "No need of additional fat Especially there are utensils that do not stick.". So Broil, bake or steam the en papillote. Please note, "it is not to be against traditional dishes." On the contrary, the dietician ordered to revisit stews , tagines , pot-au-feu and pho because they taste, with spices and herbs, and allow to eat vegetables. It remains to choose their pieces of meat and to involve the plain rice or steamed potatoes. Enjoy your meal!

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3 Health Advice to reduce the risk of Heart attack in women


INFARCTION
- Pain squeezed in the chest, jaw and arm, are the most common heart attack symptoms. But in women, coronary accidents occur with other signs. Follow the leader.

Infarction does not affect men between 50 and 60 years who smoke, do some exercise and are overweight. It is also a female disease: one in three women will die of cardiovascular disease. By comparison, a twenty-five succumb to breast cancer. And while cases of myocardial infarction have been declining in men, the reverse is true among women over 55 years. Follow our tips to recognize that cardiovascular accident.


Smoking and stress, know the risk factors

The risk factors are smoking, high blood pressure (and stress), cholesterol, obesity, physical inactivity and alcohol. As for the man. But they do not have the same effect on the arteries of the woman, told MetroNews Professor Claire Mounier-Vehier, first vice-president of the Federation of Cardiology (FC).

The reason is physiological. The arteries of women are thinner and tear more easily. In addition, five years after menopause, the protective effect of natural estrogen, allowing the arteries to be flexible, dilated and prevent clots, disappears. In parallel, the rate of triglycerides and bad cholesterol increase. Result: "The arteries thicken, stiffen and are dirty."

Stomach pain and shortness of breath, recognize the symptoms

Now that you know that myocardial also affects women, learn to recognize the symptoms . The most common is chest pain, the feeling of grip in the chest. But women also develop other symptoms such as stomach pain may suggest a gastric ulcer, vomiting, shortness of breath on exertion or palpitations. Well beware, they may also reflect cardiac risk.

Call 15 and follow a cardiac rehabilitation

What worries the vice-presidency of the (FC) is that women are "sitters." When one of them has symptoms of heart attack, it takes an hour longer than a man before calling the ambulance. But it is important to act quickly to unclog arteries and limit the extent of infarction. To do this, you'd better call the ambulance, which will take the patient directly to a cardiology department.

Another problem, "we must give them kicking butt so they follow a rehabilitation after stroke, whereas it reduces the risk of recurrence. " In fact, only one in ten women following rehabilitation. A glimmer of hope remains: "Women become informed vectors prevention among their friends and colleagues." Have a ball.

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Disease Ebola hemorrhagic fever or African

Up to date, the ebola virus was a half-dozen sources violent outbreaks especially in West Africa. - The Ebola virus was first identified in 1976 in Sudan as well as Nzara Yambuku northern Zaire. June November 1976, the Ebola virus infected 284 people in Sudan by 117 deaths. In Zaire, there were 318 cases with 280 deaths in October from September. An isolated case occurred Tandala in Zaire in 1977 and a second blaze broke out in Sudan in 1979.

- In 1989 and 1990, a filovirus named Ebola-Reston was isolated from macaque monkeys quarantined laboratories in Reston (Virginia), Alice (Texas) and Philadelphia (Pennsylvania) in the USA.
These monkeys all came quarantine export licenses dune near Manila in the Philippines where the virus was also isolated.

- A large epidemic occurred in Kikwit in Zaire in 1995, there were 315 infections including 244 deaths.

- An isolated case of Ebola hemorrhagic fever and epidemic among chimpanzees were also observed in Ivory Coast in 1994.

- In Gabon, the first outbreak of Ebola haemorrhagic fever virus was identified in 1994, other outbreaks were documented in February 1996 and July 1996.

- No infection with Ebola virus navait been reported until this epidemic quéclate Gulu in Uganda in the fall 2000.

In total, approximately 1,100 cases with 800 deaths have been identified since the discovery of the virus.
virology


The haemorrhagic fever viruses are divided into four families: The flaviridés the bunyaridés the Arenaviridae and Filoviridae which are the longest virus that we know.

Ebola belongs to the family of filoviridae, gender filoviruses which includes several different biotypes: the débola Zaire virus (called Mayinga), Ebola Sudan and Ebola Reston.

Ebola virus is an enveloped single-stranded RNA viruses (helical nucleocapsid) which is similar to the morphology of Marburg virus antigenic structure but differs.
It can measure up to 1500 nm long with a diameter of 80 nm.

Natural Reservoir

Primary human cases result from contamination from an animal reservoir and then the very high contagiousness of the disease is responsible for a large diffusion.
The natural reservoir of the Ebola virus seems to inhabit rainforests and dAfrique Dasie, but it has not yet been identified.

Related to Ebola filoviruses were isolated from cynomolgus monkeys (Macacca fascicularis) that had been imported from the Philippines to the United States of America in 1989. But the virus kills primates too quickly for them is a good tank .

Recent work by a team of CNRS Rennes in collaboration with the Institut Pasteur in Bangui, have uncovered sequences of the virus in different organs of 242 small mammals.

Transmission

After the accidental contamination of a first man, the virus is then transmitted from the body fluids of a patient in clinical phase through direct contact with blood, secretions, organs or semen infected (saliva, blood, urine, faeces of patients are rich in virus) or by contact with the aerosol, and vomit may be sweat. The ingestion of infectious materials is associated with a risk of infection and a high fatality rate. Potential transmission through sexual contact with a patient cured is not determined, but it was shown that the Ebola virus is found in the genital secretions of convalescents several weeks after illness. Contamination therefore has a strong family or nosocomial. - Family Transmission: In families, the two major risks patient care and funeral toilet. - Transmission caregivers: During epidemics, lack of hygiene, lack of sterilization of equipment and especially needles and syringes contaminated facilitated nosocomial transmission of the virus.

Airborne transmission has been particularly studied in the survey conducted in the families of 34 cases of Nzara in 1979. This survey showed no risk due to a simple cohabitation in the same room and a five times higher risk for people with physical contact due to patient care compared to those with only "family" contacts.

Clinical signs

Incubation time: 2 to 21 days - 5 to 12 days in most cases.
Duration of illness: from 6 to 10 days in fatal forms.

Ebola hemorrhagic fever occurs in most patients within a few days after infection by a sudden rise in temperature, with fatigue, muscle pain, headache, and diarrhea.
Some patients may show sore throat, hiccups, rash, vomiting blood and bloody diarrhea (called "red diarrhea" in Francophone Africa). Other symptoms may occur: conjunctivitis injected dysphagia.

The patient is extremely asthenic quickly and has a significant weight loss, due to both the lack of nutrition of this weakness in the absence of food and the disease itself.

Followed by vomiting, diarrhea, maculopapular rash, kidney and liver damage and bleeding diathesis; liver damage, pancreatic, kidney, and to a much lesser extent, of the CNS and of the heart; leukopenia, thrombocytopenia and elevated transaminases.

Fever, often undulating in the early days, may disappear in the terminal phase.

Death is preceded by the appearance of tachypnea, hypotension, tachycardia, and anuria. The limited data available do not show pulmonary explaining tachypnea, and blood loss due to hemorrhage is still too low to explain the hypotension.

Diagnosis

The diagnosis is difficult because précoses symptoms such as red eyes and itchy eyes are nonspecific. If someone shows symptoms mentioned above and the Ebola virus infection is suspected, several laboratory tests are to be made (ELISA, virus isolation).

"Lhospitalisation of isolation with appropriate measures, including during transport, SimPose to viral haemorrhagic fever clinical suspicion: recent fever quickly create an accompanying rash (4-5 th day) and hemorrhagic signs superficial and visceral (6-7 th day) an epidemic quickly taking shape step by step in the population. "(therapeutic protocol support for victims, record No. 6" Agents of viral haemorrhagic fevers ").

The fatality rate is between 50 and 90%. Most often, death is caused by a cerebral embolism (stroke).

Processing


There is no specific treatment or vaccine. There is no serotherapy.

Severe cases are placed in the intensive care unit: these patients are dehydrated and need to be placed on a drip for rehydration.

Maintain kidney function Treatment aims and electrolyte balance and combat hemorrhage and shock. Replacement of coagulation factors and platelets can be useful.

For patients who survive, recovery is accompanied by intense fatigue and arthralgia migrants often affecting large joints.

Prevention and safety

Suspected cases should be isolated from other patients and caregivers should operate under conditions of high security. Hospital staff should wear gowns, gloves and masks individual. Gloves and masks should not be reused unless they have been disinfected. Very important for certain actions such as the installation of an infusion risk, handling of blood and secretions, catheters and suction devices, which must be carried out in conditions of high security. The dead must be buried or cremated quickly.

Conclusion

Viruses such as Ebola existed for millions of years, long before the appearance of man. They can not live in free society and they rarely come out of their tank because they do not have the ability to easily colonize new host species.

Meet other species is an accident that does not result in the long term sustainability of the virus into a new species.

Low risk to the human population except where the possibility of coexisting primary contamination, poor hygiene and social structures disrupted.

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Transmission, symptoms, treatment: understanding the Ebola virus

FOCUS - With its unprecedented scale and because of the dispersion of foci of infection, epidemic hemorrhagic fever worries the international community.

When the virus appear?


The discovery of the virus dates back to 1976, when the first recorded outbreak in Zaire, now the Democratic Republic of Congo in a near Ebola, the disease got its name River area. He then hit 318 people and killed 280. Its origin is debated to this day. A widely accepted hypothesis, some species of bats living in the tropical forests of Central Africa and West Africa, are the natural hosts of Ebola. Other animals also participate in the transmission cycle. Five viral species have been identified since then, but both are responsible for the vast majority of contamination: the Zaire strain - one mutation now raging - and the Sudan strain.

Which countries are involved?Ebola Virus Prevention

Ebola comes sporadically and at irregular intervals. The latest resurgence starting date of the year. The outbreak was first reported in Forest Guinea before spreading in Liberia, Sierra Leone and Nigeria. Until recently, the virus raged mainly in central and eastern Africa. From 1976 to 2012, in addition to the Democratic Republic of Congo and Sudan, three other countries had been affected by serious epidemics: Gabon, Uganda and Congo. Together, they have killed more than 2,200 people in forty years, much less than the AIDS virus or malaria. The fatality rate is itself much higher: it varies from 25% to 90%, depending on the strain. According to WHO, it currently stands at 54%.

What are the symptoms?

Symptoms of infection with Ebola are impressive: internal and external bleeding, mucosal bleeding, vomiting and diarrhea, often accompanied by blood. Poorly perfused, organs eventually become necrotic, and the skin soften and tear. The current epidemic in West Africa nevertheless induces slightly different symptoms. "Vomiting and diarrhea are predominant in this epidemic, says Herve Raoul, director of the Inserm-P4 laboratory in Lyon. Observed less profuse bleeding, and it would be more correct to speak this time of infection with Ebola virus, not hemorrhagic fever. "

How is the virus spread?

Transmission between humans is the main driver of the epidemic. "Transmission occurs through contact with body fluids of an infected person, adds Herve Raoul. Just as blood, secretions or feces come into contact with mucous membranes or wounds so that the infection spreads to a new host. "The contamination is thus most often among relatives or caregivers. But the people who died are contagious and a physical contact with a corpse is dangerous. Funeral rites and play a very important role in the transmission of the disease.

How the epidemic is it treated?

Currently, no treatment exists. In hospitals and treatment camps, caregivers simply help the body fight infection. "We unfortunately can not do much to treat disease and the symptoms, says Geraldine Bégué. We often simply hydrate patients intravenously and isolate them from the rest of the population to avoid contagion. "Molecules and vaccines have already yielded some results on animals, but no results on humans n 'is still available. A serum called ZMapp, the American firm Mapp Biopharmaceutical, administered experimentally in two American patients. And the United States has partially lifted restrictions on another experimental treatment Tekmir of Canadian society, but placing it on the market could take several months.

Why this new epidemic she worried?


The actors of this health crisis are likely to worry about the latter resurgence of the virus. WHO estimates Ebola should continue to spread for several months. However, it is already the worst epidemic in the history of this disease since its discovery and the number of victims grows exponentially. Especially as its dispersion and multiplication of homes make it difficult to curb the phenomenon. Many experts also worry that for the first time the disease thrive in urban areas. The work of health personnel is also complicated by the suspicion of the local population vis-à-vis Western caregivers.

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Screening for colon cancer medical online guidelines

March is the month of the national screening for colorectal cancer, a campaign that speaks to all people between 50 and 74 years. Why? What are the issues? How not to confuse detection and prevention, screening and diagnosis of cancer?

Information on colon cancer screening

Screening is to detect cancer at its earliest possible stage. In the case of colorectal cancer, it is also the detection of pre-cancerous tumor that represents a colon polyp in the process of malignant transformation. Benign polyps (adenomas) colon cancer but not in cancerous potential in 60-85% of cases. It is therefore preferred to withdraw whenever it finds.

Implemented since 2009 throughout the country, screening for colorectal cancer is open to all men and women aged 50 to 74, every two years. It is widespread and systematic, as opposed to individual screening practiced by physicians in their patient base. Nearly 17 million people are involved in this program under the responsibility of the Ministry of Health and managed by the Directorate General of Health (DGS).

It is a measure of the Cancer Plan 14 government (2009-2013), all the more crucial that the turnout is low spontaneously: the cancer is far! Better not think about it ... Only 5 million people (about 17 million invitations) did the test in 2009-2010, 34%. Or desirable to reduce significantly (15-20%) deaths rate is higher than 50%. Ideally, it should reach 65% of 50-74 years.

Risks and consequences of colon cancer

Colorectal cancer is the third most common cancer with 40,000 new cases estimated in 2010 after breast cancer (71,500 new cases) and prostate cancer (52,500 cases). It causes 17,400 deaths annually (estimated number in 2010), is the second leading cause of cancer death, after lung cancer.
His prognosis is good, however when taken in time; "cure" is the rule in the majority of cases (90% of patients alive at 5 years). A fortiori if one removes a polyp or a pre-cancerous stage; recovery is 100% true then.

However, taken at a late stage of invasion of viscera (liver damage and pancreas) and / or distant metastases, it is difficult to control and requires mutilating surgical cuts. This may result in a definitive stoma.

Through screening undertaken since 2003, more than 13,500 cancers were detected, and more than 54,000 adenomas (polyps) in which 31,000 degeneration.

People affected by colorectal cancer screening

The screening is for people 50 to 74 years of both sexes, provided they have no specific risk factors to cancer. That is to say they have no evidence suggestive and do not have a history. They are called medium risk as the only factor used is age: the cancer is (essentially) a disease of aging cells.

If they are part of a family colonic polyps and / or colorectal cancer frequent if they have already had one or more polyps or colon cancer, so they follow a monitoring program apart. As well as people with diseases that may irritate (inflammation) lasting the gut, thus promoting cell carcinogenesis.

Screening for colorectal cancer: what are the principles?

Colonic cancers bleed, but often capriciously. Thus research of blood in the stool, knowing that many other causes can bleed the digestive tract. But we will move to a different diagnosis after checking that there is no colo - rectal cancer.

Having visible blood in the stool should lead quickly to the consultation of the attending physician, who will decide on the way forward. This is not the most common and generally corresponds with advanced cancers. Most often the bleeding is occult in early cancer development.

The test used by the health management is the Hemoccult II®, said "guaiac test", it detects the presence of blood invisible to the naked eye in the stool. It is currently under discussion because of the analytical techniques progress. However, no change is likely before two or three years because of administrative procedures, in particular the assessment of the cost of a more expensive immunological procedure.

How are screened?

Every two years, the county association in charge of screening for people involved an invitation to remove the test from their physician.

The next step is to make yourself at home spreading a little stool on a stamp pad with three stools away. Then everything is mailed to the processing laboratory. In case of constipation, performing the test is longer because the seats are spaced. In case of diarrhea, it is the opposite. As you need your test handy during this time, it is advisable to do so for a holiday.

The test is free but not consulting the doctor. The mailing is free. His analysis is free.

If the test is negative (97% of cases), the person will be requested again two years later.
In case of a positive test, the person is invited to consult your doctor to prescribe that a screening colonoscopy (gold standard), also free.

While colonoscopy is positive (presence of polyps and / or cancer), the patient enters a custom protocol followed.
If colonoscopy is negative, the test is no longer required before five years (mean time to development of polyps) provided that doctors (and treating gastroenterologist) agree.

Taken together, these measures represent a total cost of 70 million euros in 2010 supported 100% by the Ministry of Health and health insurance.

What are the differences between screening, diagnosis and prevention?


Screening research disease or pre-disease. It identifies presence or suspects sign, but he did not assert. It can be individual case by case, to be organized systematically in the whole population so widespread.

The diagnosis is the certainty of a perfectly identified disease. It is rare that a screening procedure also gives the definite diagnosis. But it is the case during a colonoscopy because the doctor can see the tumor and formally recognized. In the wake of it the fee in whole or in part when it is too big (biopsy). The sample is then examined by a histologist (or pathologist) confirms the visual diagnosis and gives a name to the tumor. Sometimes it is necessary to make additional laboratory tests on the tumor to refine its identity, and thus prognosis. For the development and severity of cancers depend on their cellular nature.

Prevention involves behaviors that limit cancer cell transformation. For example, do not smoke and do not live in a free environment is the best way to reduce the risk of lung cancer. However, few cancers caused by a single factor heavily. Most often it is a combination of small factors that accelerates carcinogenesis, as in rectal cancer co-lo is known that residues of the digestion of meat, especially overcooked or charred (BBQ) increase the risk.; it is also the case with chronic bowel disease by persistent inflammation they cause.

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Mold - health impact and health, Definition, Prevention, Consultation

Definition of mold

Mildew usually means all fungi in the environment. These microorganisms can enter directly into homes, or get inside in the form of spores in the air; Then they play a vital role in the development of certain diseases or allergies. Allergy defined by an immune response of the body, inappropriate and exaggerated, then touches their eyes, skin, and respiratory system as the nose or bronchi.

Alternatively, other molds enter the body and multiply in the form of filaments causing tissue destruction or inflammation.

Risks and consequences of mold growth

The number of allergies is increasing in industrialized countries. Respiratory allergies are the most common, as it is estimated that about one in four has clinical symptoms of respiratory allergy, and mold are responsible for many of them.

The growth of fungi and mold requires a moist environment: basements, kitchens and bathrooms are ideal area to development. Other factors are also found as a flood, leaks from the roof or plumbing, or poor ventilation.

Origins of mold growth

A number of factors, nutritional and environmental factors must be present for mold to develop. The main molds found in homes are Stachybotrys, Aspergillus sp., Penicillium sp., Fusarium sp., And other Trichoderma sp.

Then pathogenicity mold is twofold:

- First, they can cause allergies with a necessary first step referred awareness is the first meeting of the body or with the mold. Subsequent contacts result in an allergic reaction, which occurs by releasing a substance, histamine, causing the symptoms. The action of histamine can be blocked by specific drugs called "antihistamines."

- Second, molds can cause infections, athlete's foot easy to very serious lung infections in immunocompromised individuals, such as aspergillosis.

Mold - Prevention

How it does it manifest?

The allergy is usually manifested by mild symptoms such as rhinitis (runny nose, sneezing) or conjunctivitis (red eyes, watery) or respiratory symptoms like asthma. These symptoms occur readily in places rich in mold, and in any case, even in a single place (the symptoms resolve when the patient goes on holiday, for example).

Other fungal infections such as result in skin damage, inflammatory or squamous between toes or on the skin.

With what should we be confused?

It should not be confused with mold bacteria or viruses. Molds, and fungi are "micro-organisms" (such as bacteria, viruses, parasites) and most are harmless. Some are used in foods (originally cheeses like Roquefort) or to produce medicines such as antibiotics. Mold does not mean mandatory diseases.

Will it possible prevention?

Humidity promotes the development and growth of mold. Reducing the moisture content must be a priority, with an optimum relative humidity between 30% and 50%. We must therefore ventilate showers and other water facilities outwards use dehumidifiers and exhaust fans, insulate cold surfaces to prevent condensation on pipes and windows.

If flood or leak, clean quickly (within 48 hours). Do not use water or limit its use for cleaning carpets and rugs.

Finally, in case of allergy, avoid contact, particularly when cleaning poorly ventilated rooms.

Molds - Consultation

When to consult?

While most allergies are not emergencies, especially for mold allergies, allergic or anaphylactic shock or asthma attack are true emergency. Symptoms are noisy with difficulty breathing, generalized edema and a drop in blood pressure. The appeal to the SAMU-Centre 15 is essential for medical management.
Similarly, some molds can trigger pneumonia with fever, cough and chest pain. This is aspergillosis requiring emergency treatment, sometimes administered resuscitation.

What is the doctor?

The doctor guides the diagnosis and suspected link with mold. In case of allergy, it may possibly lead to an allergist to identify the allergen or allergens cause, and implement treatment. The allergy consultation through careful questioning and physical examination; depending on the suspected allergens, tests called prick tests or skin tests may be offered.

At the same medical diagnosis, environmental diagnosis of the house is often necessary to search for common signs of damage caused by water and the presence of mold. Visual inspection is simple and reliable: discolorations, dark circles, darker areas or stains on surfaces.

The treatments include the allergen avoidance. So-called antihistamines fight against allergy symptoms. Desensitization (or specific immunotherapy) is difficult in the case of the proposed bit and mold.

The treatment and prevention of mold in the home is also a priority, wearing a mask and rubber gloves during cleaning, and call a specialist if the amount of mold is important (surfaces to be treated).

How to prepare for my next visit?

To facilitate the allergy survey, it is useful to identify and record the symptoms and triggering circumstances. This will find the allergen and avoid it, and thus guide the doctor.

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Care Reimbursement Tips

Reimbursement of care: what is it?

The patient should set itself the amount of its care from health professionals that he uses. This is the principle of the advance fee. It is up to him to be then reimbursed by the Social Security Agency and its mutual.

However, in case of hospitalization, occupational disease or accident, the patient can be taught to do this upfront fee. This is what we call the third-party payer. In this case, the patient pays only the co-payment, that is to say, the amount remaining in office, the refundable portion of care is paid directly to the provider and the health insurance agency.

What are the economic and human issues?

One of the few developed to promote direct payment for health care professionals and health reimbursement on insured countries. Numerous studies have shown that not having to do the upfront fee facilitates access to care, particularly for the most disadvantaged.

However, with the widespread use of third-party payment and use of increasingly common Vitale card, the actual cost of care is becoming increasingly difficult to design for people who benefit from it, even though each insured person's finances collectively their Social Security taxes.

In 2007, total health expenditure French amounted to $226.5 billion, which represents nearly 11% of the national wealth and that puts our country in third expenditure in terms of health among developed after the United States (15.3%) and Switzerland (11.3%). country

These expenses increased by 4.7% compared to 2006.

What does it take to be reimbursed?

In general, to be repaid, care or health products including drugs must be on the list of acts or products reimbursed by social security, be prescribed by a doctor (or a dentist or a midwife), and dispensed by a health care professional to do so.

To be reimbursed, it is sufficient if the rights to health insurance to the insured are open to apply by filling out the sheet of care delivered by the health professional, attesting fees received and the payment the amount of benefits. On the address with the order and supporting documents may be required, at the center of Social Security.

With the Carte Vitale, all of these procedures are done automatically. Just present it to health professionals.

In which case a prior agreement is needed?

Some treatments require to be repaid, an agreement of insurance before being made ​​disease. This is what is called the prior agreement.

It is indispensable for acts of Dentofacial Orthopedics, for certain laboratory or medical equipment for ambulance transport serial or over long distances, and from 30 sessions massokinésithérapie.

The request for prior agreement is filled with the health professional and addressed by the insured to the health maintenance organization, which has a period of fifteen days to respond. Failure to respond within this period amounts to an agreement.

When can we benefit from the third-party payment?

Legal paying client is mainly reserved for patients who have suffered an accident at work or an occupational disease, those who benefit from the complementary Universal Health Coverage (CMUc) and beneficiaries of the State Medical Aid ( AME).

It is also applied to in-patients.

It is increasingly common in pharmacies and medical laboratories. But in this case it depends on agreements between health professionals and health insurance providers. Its management is also often offered by mutuals.

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