کرونا یا سندرم تنفسی خاورمیانه

با کشف موارد جدید بیماری کرونا ویروس  coronavirus نگرانی سازمان بهداشت جهانی در این خصوص افزایش یافته است .

تاریخچه : اولین مورد بیماری در سپتامبر ۲۰۱۲ در مردی ۶۰ ساله در عربستان سعودی کشف شد که به مرگ بیمار انجامید . این مرد چند روز قبل از آن به دبی سفر کرده بود و دومین مورد در مردی ۴۹ ساله در قطر که او نیز در گذشت . و کشف بیماری اولین بار در آزمایشگاه Health Protection Agency's  در Colindale لندن به تایید رسید .

پیشنهاد شده است که این بیاری به نام سندرم نارسایی تنفسی خاورمیانه یا Middle East respiratory syndrome coronavirus  که با  اختصار MERS-CoV نامگذاری شود .

عده ای از پزشکان این بیماری را از نوع بیماری سارس می دانند که حدود سالهای ۲۰۰۳ در خاور دور شایع بود . بیماری سارس نیز دارای علایم تنفسی است که می تواند منجر به مرگ انسان شود . ویروس سارس نیز از خانواده coronavirus ها می باشد .

تاریخچه coronavirus ها : این خانواده ویروسی اولین بار در سال ۱۹۶۰ کشف شده است که موجب بروز بیماریهایی از خانواده سرما خوردگی در انسان و حیوانات می گردد و از ویژگی آنها زوائد تاج مانند بر روی سطوح دیواره ویروسها می باشد .

علائم اصلی بیماری MERS-CoV : اگر چه به گفته WHO علایم این بیماری هنوز ناشناخته می باشد ولی از علایم اصلی این بیماری تب ، سرفه ، تنگی نفس و مشکلات حاد تنفسی می باشد. بیمار ممکن است سرفه های چند روزه ظاهرا بدون دلیل نیز داشته باشد . در موارد حاد مشکلات گوارشی نظیر اسهال ،  نارسایی حاد تنفسی ، اختلالات انعقادی ، پریکاردیت و نارسایی کلیه نیز گزارش شده است که مورد اخیر در صورت بروز بیمار را به همودیالیز نیازمند می سازد .

دوره کمون این بیماری حدود ۷ روز می باشد .

درمان MERS-CoV : هنوز هیچ درمان تایید شده ای برای این بیماری شناخته نشده است و تنها توصیه به حمایت تنفسی در بیمارستان در بیماران دارای مشکلات حاد تنفسی می تواند چاره ساز باشد و در واقع مراکز پزشکی موارد حاد بیماری را صرفا درمان علامتی می نمایند .

نحوه انتقال بیماری  MERS-CoV : اطلاعات ما در این باره هنوز کامل نیست ولی روشهای انتقال بیماری از انسان به انسان شبیه بیماری آنفلوآنزا می باشد . از طریق سرفه و عطسه . اما احتمال انتقال بیماری در فضای باز بسیار محدود بوده و موارد انتقال انسان به انسان در مواردی اتفاق افتاده است که افراد به مدت طولانی در فضای بسته در کنار فرد بیمار بوده اند مانند افرادی که در بیمارستانها با بیماراندر ارتباط بوده اند .

هنوز مشخص نیست که این بیماری اولین بار از طریق حیوانات به انسان منتقل شده است یا از طریق سطوح آلوده به ویروس .

نحوه حفاظت از ویروس MERS-CoV و پاکسازی ویروس : با توجه به این که کل اطلاعات در مورد این بیماری حداکثر به ۳ ماه گذشته بر می گردد ، هنوز نمی توان با قاطعیت در این خصوص اظهار نظر کرد ولی لازم است افراد بیمار ایزوله شوند و کارکنان بهداشتی که در تماس با بیماران قرار دارند همه ی موارد حفاظتی نظیر استفاده از لباس مخصوص ، دستکش و حتی عینکهای ایمنی را مد نظر قرار دهند .

این ویروس بسیار شکننده بوده و در خارج از بدن انسان و حیوانات بعد از ۲۴ ساعت از بین می رود . همچنین مواد شوینده و ضد عفونی کننده ساده می توانند به راحتی coronavirus را نابود نمایند .

 

 

Apgar

About the Apgar Score

The Apgar score, the very first test given to your newborn, occurs in the delivery or birthing room right after your baby's birth. The test was designed to quickly evaluate a newborn's physical condition and to determine any immediate need for extra medical or emergency care.

Although the Apgar score was developed in 1952 by an anesthesiologist named Virginia Apgar, you may have also heard it referred to as an acronym for: Appearance, Pulse, Grimace,Activity, and Respiration.

The Apgar test is usually given to a baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition or the score at 5 minutes is low, the test may be scored for a third time at 10 minutes after birth.

Five factors are used to evaluate the baby's condition and each factor is scored on a scale of 0 to 2, with 2 being the best score:

1. appearance (skin coloration)
2. pulse (heart rate)
3. grimace response (medically known as "reflex irritability")
4. activity and muscle tone
5. respiration (breathing rate and effort)

Doctors, midwives, or nurses add these five factors together to calculate the Apgar score. Scores obtainable are between 10 and 0, with 10 being the highest possible score.

Apgar Scoring
Apgar Sign	2	1	0
Heart Rate (pulse)	Normal (above 100 beats per minute)	Below 100 beats per minute	Absent (no pulse)
Breathing (rate and effort)	Normal rate and effort, good cry	Slow or irregular breathing, weak cry	Absent (no breathing)
Grimace(responsiveness or "reflex irritability")	Pulls away, sneezes, coughs, or cries with stimulation	Facial movement only (grimace) with stimulation	Absent (no response to stimulation)
Activity (muscle tone)	Active, spontaneous movement	Arms and legs flexed with little movement	No movement, "floppy" tone
Appearance (skin coloration)	Normal color all over (hands and feet are pink)	Normal color (but hands and feet are bluish)	Bluish-gray or pale all over

The seven types of anaemia

There are several different types of anaemia, each with different causes and treatments.

 

 

 

The most common types of anaemia are

• Iron deficiency anaemia
• Thalassaemia
• Aplastic anaemia
• Haemolytic anaemia
• Sickle cell anaemia
• Pernicious anaemia
• Fanconi anaemia

Iron Deficiency Anaemia

Overview

The most common form of anaemia is iron deficiency anaemia which is usually due to chronic blood loss caused by excessive menstruation. Increased demands for iron, such as foetal growth in pregnancy, and children undergoing rapid growth spurts in infancy and adolescence, can also cause iron deficiency anaemia.

This condition is treated with iron supplementation as well as the treatment of the underlying cause of the iron deficiency.

Causes

Iron deficiency occurs when the rate of loss or use of iron is more than its rate of absorption and use. The reasons for this are

• Chronic blood loss: Most commonly due to excessive menstruation or bleeding into or from the gut as a result of a peptic ulcer, gastritis, haemorrhoids or in children, worm infestation.

• Increased use of iron: In pregnancy, due to the growth of the foetus or children undergoing rapid growth spurts in infancy and adolescence.

• Decreased absorption of iron

  • after a partial or total removal of the stomach;

  • lack of stomach acid;

  • chronic diarrhoea; or

  • malabsorption.

Signs and symptoms

The most common symptoms of chronic anaemia include tiredness, weakness, shortness of breath and sometimes, a fast heartbeat. The tongue may also become smooth, shiny and inflamed - this is called glossitis. Angular stomatitis (erosion, tenderness and swelling at the corners of the mouth) may also occur. In some instances, the patient also suffers from pica, a craving for strange foods such as starch, ice and clay.

The symptoms of the underlying cause of the iron deficiency may be present such as heavy menstrual bleeding or abdominal pain due to peptic ulceration.

Treatment

Treatment for iron-deficiency anaemia will depend on the cause and severity of the condition. Treatments may include dietary changes and supplements, medicines, and surgery. Severe iron-deficiency anaemia may require treatment in hospital, blood transfusions, iron rejections, or intravenous iron therapy.

Risk

Infants and young children, women, and adults who have internal bleeding are at highest risk for iron-deficiency anaemia.

Aplastic Anaemia

Overview

Aplastic anaemia is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. This may result in a number of health problems including arrhythmias, an enlarged heart, heart failure, infections and bleeding.

Aplastic anaemia is a rare but serious condition. It can develop suddenly or slowly and tends to worsen with time, unless the cause is found and treated.

Causes

Damage to the bone marrow's stem cells causes aplastic anaemia. In more than half of people who have aplastic anaemia, the cause of the disorder is unknown.

A number of acquired diseases, conditions, and factors can cause aplastic anaemia including

• Toxins, such as pesticides, arsenic, and benzene
• Radiation and chemotherapy
• Medicines such as chloramphenicol
• Infectious diseases such as hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV
• Autoimmune disorders such as lupus and rheumatoid arthritis

Inherited conditions, such as Fanconi anaemia, Shwachman-Diamond syndrome, dyskeratosis congenital and Diamond-Blackfan anaemia may also cause aplastic anaemia.

Signs and symptoms

The most common symptoms of aplastic anaemia are

• Fatigue
• Shortness of breath
• Dizziness
• Headache
• Coldness in your hands or feet
• Pale skin, gums and nail beds
• Chest pains

Treatment

Treatment for aplastic anaemia includes blood transfusions, blood and marrow stem cell transplants, and medication. These treatments can prevent or limit complications, relieve symptoms, and improve quality of life.

In some cases, a cure may be possible. Blood and marrow stem cell transplants may cure the disorder. Removing a known cause of aplastic anaemia, such as exposure to a toxin, may also cure the condition.

Risk

People of all ages can get aplastic anaemia. However, it is most common in adolescents, young adults and the elderly. Men and women are equally likely to have it.

A person's risk for aplastic anaemia is higher if you have

• Been exposed to toxins
• Taken certain medicines or had radiation or chemotherapy treatment
• Certain infectious diseases, autoimmune disorders, or inherited conditions

Haemolytic Anaemia   >>>

پلاسمای تازه منجمد شده

Blood Component Therapy

Fresh Frozen Plasma (FFP) and Thawed Plasma

Description
One unit of FFP or thawed plasma is the plasma taken from a unit of whole blood. FFP is frozen within eight hours of collection. FFP contains all coagulation factors in normal concentrations. Thawed plasma may be transfused up to 5 days after thawing and contains slightly decreased levels of Factor V (66+/-9%) and decreased Factor VIII levels (41+/-8%). Plasma is free of red blood cells, leukocytes and platelets. One unit is approximately 250mL and must be ABO compatible. Rh factor need not be considered. Since there are no viable leukocytes, plasma does not carry a risk of CMV transmission or Graft Vs. Host Disease (GVHD).

Indications
Plasma transfusion is indicated in patients with documented coagulation factor deficiencies and active bleeding, or who are about to undergo an invasive procedure.

Deficiencies may be congenital or acquired secondary to liver disease, warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with red blood cells and crystalloid/colloid solutions. FFP should not be used for Hemophilia B (Factor IX) deficiency unless Factor IX concentrate is not available. FFP, but not thawed plasma, can be used for Factor V deficiency. Recombinant or Factor VIII concentrates should be used to replace Factor VIII.

Usually, there is an increase of at least 1.5 times the normal PT or PTT, or an INR ≥ 1.6 before clinically important factor deficiency exists. This corresponds to factor levels <30% of normal.

Reversal of warfarin anticoagulation with plasma is indicated only if significant bleeding or risk is present. Often it will require recurrent transfusion to maintain normal factor levels. Otherwise, reversal can be achieved by giving Vitamin K or holding warfarin two to three days prior to a planned procedure. Rapid reversal for life threatening bleeding may be achieved with recombinant Factor VIIa (Novo7®).

Plasma is indicated in the treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange.

Plasma should not be used for volume expansion unless the patient also has a significant coagulopathy and is bleeding. Pediatric patients dosing is 10-15mL/kg, to provide ~15-20% rise in factor levels.

Plasma - Dosage

Volume of 1 Unit Plasma: 200-250 mL
1 mL plasma contains 1 u coagulation factors
1 Unit contains 220 u coagulation factors
Factor recovery with transfusion = 40%
1 Unit provides ~80 u coagulation factors
70 kg X .05 = plasma volume of 35 dL (3.5 L)
80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dL

In a 70 kg Patient:
1 Unit Plasma increases most factors ~2.5%
4 Units Plasma increase most factors ~10%

Initial Dose of FFP
10cc/Kg (round up to nearest 200cc) = #units FFP / 200 cc/unit FFP

Therapeutic Effect
Usually an increase in factor levels of at least 10% will be needed for any significant change in coagulation status, so the usual dose is four units, but the amount will vary depending on the patient's size and clotting factor levels. Hematology consultation is advised concerning the dose of plasma.

Recommended Coagulation Parameters for Common Procedures
	Platelet Count*	INR
Lumbar Puncture	≥50,000	≤1.5
Paracentesis	≥30,000	≤2.0
Thoracentesis	≥50,000	≤1.5
Transbronchial Lung Biopsy	≥50,000	≤1.5
Subclav/IJ Line	≥30,000	≤1.5
Renal Biopsy	≥50,000	≤1.5
Liver Biopsy	≥50,000	≤1.5
Hickmann, Groshong Catheters	≥50,000	≤1.5

* These numbers assume normal platelet function. Conditions that may affect platelet function include renal failure, medications, leukemias and myelodysplasias, and congenital disorders. Bleeding Time is a poor predictor of surgical bleeding. The Usefulness of Platelet Function Analysis (PFA) in predicting surgical bleeding is unknown.