Malnutrition and respiratory function.

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Consequences of Malnutrition in the Critically Ill Patient
Both young and breeding animals may be affected. With frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition Chronic pasteurellosis, particularly during fattening, is also a direct or indirect cause of diarrhoea and mortality in rabbits. Intermittent productive cough with acute infection requiring a course of antibiotics at least twice a year The intermediate hosts are certain snails found in grass from marshy areas Fasciola spp. These bacteria cannot live very long outside the body, making sanitary isolation effective. It is well recognized that malnutrition is associated with adverse clinical outcomes.

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The disease was first described in Queensland, Australia; areas in which Q fever is known to be endemic include Australia, the western United States, Africa, England, and the Mediterranean countries. Animal infection is widespread and involves a large variety of domestic farm animals, particularly cattle and sheep, and some wild animals.

Transmission is believed to occur between mammals through ticks and mice. Human disease, which is uncommon, is probably acquired through inhalation of infected material. Laboratory workers and employees in slaughterhouses are particularly at risk.

Q fever is usually a mild and self-limited disease, requiring only symptomatic treatment. There are at least three reasons why the lungs are particularly liable to be involved in allergic responses. First, the lungs are exposed to the outside environment, and, hence, particles of foreign substances such as pollen may be deposited directly in the lungs; second, the walls of the bronchial tree contain smooth muscle that is very likely to be stimulated to contract if histamine is released by cells affected by the allergic reaction; and, third, the lung contains a very large vascular bed, which may be involved in any general inflammatory response.

It is therefore not surprising to find that sensitivity phenomena are common and represent an important aspect of pulmonary disease as a whole. The most common and most important of these is asthma. Asthma is characterized by spasmotic contraction of the smooth muscle of the airways, by increased production of an abnormally viscous mucus by bronchial mucous glands, and, in severe attacks, by airway obstruction from mucus that has accumulated in the bronchial tree.

This results in a greater or lesser degree of difficulty in breathing. One approach to classifying asthma differentiates cases that occur with an identifiable antigen , in which antigens affect tissue cells sensitized by a specific antibody , and cases that occur without an identifiable antigen or specific antibody. The former condition is known as extrinsic asthma and the latter as intrinsic asthma. Extrinsic asthma commonly manifests first in childhood because the subject inherits an atopic characteristic: Exacerbation of extrinsic asthma is precipitated by contact with any of the substances to which sensitization has occurred; airway obstruction is often worse in the early hours of the morning.

The other form of asthma, intrinsic, may develop at any age, and there may be no evidence of specific antigens. Persons with intrinsic asthma experience attacks of airway obstruction unrelated to seasonal changes, although it seems likely that the airway obstruction may be triggered by infections, which are assumed to be viral in many cases. Asthma attacks may be precipitated by food.

For example, in small children, sensitivity to milk may stimulate an attack, and, in some adults, sensitivity to sulfite compounds found in some foods and wine may stimulate an attack. A subgroup of asthmatics are so sensitive to aspirin acetylsalicylic acid that ingestion of this chemical may lead to a life-threatening attack. In some people, asthma is acquired as the result of occupational exposure a special form of intrinsic asthma.

Exposure to solder resin used in the electronics industry, to toluene diisocyanate used in many processes as a solvent , to the dust of the western red cedar in which plicatic acid is the responsible agent , and to many other substances can initiate an asthmatic state, with profound airflow obstruction developing when the subject is challenged by the agent. Individuals affected by any type of asthma may exhibit airflow obstruction when given aerosols of histamine or methylcholine at much lower concentrations than provoke airflow obstruction in healthy people.

Individuals with asthma may also develop airflow obstruction while breathing cold air or when exercising. These characteristics are used in the laboratory setting to study the airway status of patients. The severe acute asthmatic attack is characterized by acute difficulty in breathing in which mucus clogs the air passages in such a way that air can be inspired but not expired.

Despite the severe respiratory difficulty, the patient remains fully conscious. The most dangerous form of the condition is known as status asthmaticus. The bronchial spasm worsens over several hours or over the course of an entire day, during which the bronchi become plugged with thick mucus and airflow is progressively more obstructed. The affected person becomes fatigued, arterial oxygen tension falls, and carbon dioxide accumulates in the blood leading to drowsiness.

As a result, the acidity of the arterial blood increases to dangerous levels that could lead to cardiac arrest. Prompt treatment with intravenous corticosteroids and bronchodilators is usually sufficient to relieve the attack, but in some cases ventilatory assistance is required. In a few cases, death from asthma is remarkably rapid. The exact mechanism of death in these cases is not completely understood.

Asthma may interrupt normal activities and schooling and provide intense or sustained anxiety, especially in individuals who have experienced one or more severe attacks. It tends to diminish in severity with age, and people who had quite severe asthma in childhood may lead normal lives after the age of Developed countries around the world are reporting a disturbing increase in the prevalence , severity, and mortality of asthma.

For example, today more than 7 percent of children and about 9 percent of adults in the United States suffer from asthma. For example, children who regularly attend day care or preschool programs acquire more respiratory infections but are less likely to develop asthma later in life.

Hay fever is a common seasonal condition caused by allergy to grasses and pollens. It is frequently familial, and the sensitivity is often to ragweed pollen. Conjunctival infection and edema of the nasal mucosa lead to attacks of sneezing. Allergic inflammation and the development of polyps in the nasal passages represent a severer form of hay fever that is often associated with asthma. Hypersensitivity pneumonitis is an important group of conditions in which the lung is sensitized by contact with a variety of agents and in which the response to reexposure consists of an acute pneumonitis, with inflammation of the smaller bronchioles, alveolar wall edema, and a greater or lesser degree of airflow obstruction due to smooth muscle contraction.

In more chronic forms of the condition, granulomas, or aggregations of giant cells, may be found in the lung. Inflammation can lead to widespread lung fibrosis and chronic respiratory impairment. This causes an acute febrile illness with a characteristically fine opacification clouding, or becoming opaque in the basal regions of the lung on the chest radiograph. Airflow obstruction in small airways is present, and there may be measurable interference with diffusion of gases across the alveolar wall.

If untreated, the condition may become chronic, with shortness of breath persisting after the radiographic changes have disappeared. Education of farmers and their families and the wearing of a simple mask can completely prevent the condition.

A similar group of diseases occurs in those with close contact with birds. An acute hypersensitivity pneumonitis may also occur in those cultivating mushrooms particularly where this is done below ground , after exposure to redwood sawdust, or in response to a variety of other agents. It is occasionally attributable to Aspergillus , but sometimes the precise agent cannot be identified. The disease may present as an atypical nonbacterial pneumonia and may be labeled a viral pneumonia if careful inquiry about possible contacts with known agents is not made.

Acute bronchitis most commonly occurs as a consequence of viral infection. It may also be precipitated by acute exposure to irritant gases, such as ammonia , chlorine , or sulfur dioxide. In people with chronic bronchitis—a common condition in cigarette smokers—exacerbations of infection are common.

The bronchial tree in acute bronchitis is reddened and congested, and minor blood streaking of the sputum may occur. Most cases of acute bronchitis resolve over a few days, and the mucosa repairs itself. Bronchiolitis refers to inflammation of the small airways. Bronchiolitis probably occurs to some extent in acute viral disorders, particularly in children between the ages of one and two years, and particularly in infections with respiratory syncytial virus.

In some cases the inflammation may be severe enough to threaten life, but it normally clears spontaneously, with complete healing in all but a very small percentage of cases. In adults, acute bronchiolitis of this kind is not a well-recognized clinical syndrome, though there is little doubt that in most patients with chronic bronchitis, acute exacerbations of infection are associated with further damage to small airways.

In isolated cases, an acute bronchiolitis is followed by a chronic obliterative condition, or this may develop slowly over time. This pattern of occurrence has only recently been recognized. In addition to patients acutely exposed to gases, in whom such a syndrome may follow the acute exposure, patients with rheumatoid arthritis may develop a slowly progressive obliterative bronchiolitis that may prove fatal. An obliterative bronchiolitis may appear after bone marrow replacement for leukemia and may cause shortness of breath and disability.

Exposure to oxides of nitrogen, which may occur from inhaling gas in silos , when welding in enclosed spaces such as boilers, after blasting underground, or in fires involving plastic materials, is characteristically not followed by acute symptoms. These develop some hours later, when the victim develops a short cough and progressive shortness of breath.

A chest radiograph shows patchy inflammatory change, and the lesion is an acute bronchiolitis. Symptomatic recovery may mask incomplete resolution of the inflammation. An inflammation around the small airways, known as a respiratory bronchiolitis, is believed to be the earliest change that occurs in the lung in cigarette smokers , although it does not lead to symptoms of disease at that stage. The inflammation is probably reversible if smoking is discontinued. It is not known whether those who develop this change after possibly only a few years of smoking are or are not at special risk of developing the long-term changes of chronic bronchitis and emphysema.

Bronchiectasis is thought to usually begin in childhood, possibly after a severe attack of pneumonia. It consists of a dilatation of major bronchi. The bronchi become chronically infected, and excess sputum production and episodes of chest infection are common. In some cases, clubbing swelling of the fingertips and, occasionally, of the toes may occur.

The disease may also develop as a consequence of airway obstruction or of undetected and therefore untreated aspiration into the airway of small foreign bodies, such as parts of plastic toys. Bronchiectasis may also develop as a consequence of inherited conditions, of which the most important is the familial disease cystic fibrosis. Cystic fibrosis is due to the production of an abnormal protein called cystic fibrosis transmembrane conductance regulator, or CFTR. This protein normally serves as a channel for the transport of chloride into and out of cells and regulates the activity of other transport channels, including sodium channels.

Defects in the transport of chloride, sodium, and other ions result in unusually high levels of ions inside the cells of the lungs. Thus, fluids are absorbed into the cells from the airways, causing the airways to become dehydrated and impairing the ability of the lungs to clear foreign materials and debris.

The most important consequence of cystic fibrosis, apart from the malnutrition it causes, is the development of chronic pulmonary changes, with repetitive infections and bronchiectasis as characteristic features.

This condition does not progress to pulmonary emphysema but rather causes obliteration and fibrosis of small airways and dilation and infection of the larger bronchi. Thick, viscid secretions in the bronchial tree are difficult to expectorate. Management of the condition includes antibiotics to fight lung infections, medications to dilate the airways and to relieve pain, enzyme therapy to thin the mucus, and postural drainage and percussion to loosen mucus in the lungs so it can be expelled through coughing.

These therapies, in addition to others, have helped control pulmonary infections and have markedly improved survival in affected persons, many of whom, who would formerly have died in childhood, now reach adult life. Chronic obstructive pulmonary disease COPD refers broadly to a group of conditions that cause irreversible respiratory impairment by increasing obstruction to airflow through the bronchi of the lungs.

This condition occurs most commonly in current or former regular cigarette smokers and affects some million people worldwide. COPD typically has two components which may be present to varying degrees: Individuals who predominantly have emphysema experience symptoms that differ in detail from those who predominantly have chronic bronchitis; however, both disorders contribute to shortness of breath during exercise and to general disability.

But the striking increase in mortality from chronic bronchitis and emphysema that occurred after World War II in all Western countries indicated that the long-term consequences of chronic bronchitis could be serious. This common condition is characteristically produced by cigarette smoking. After about 15 years of smoking, significant quantities of mucus are coughed up in the morning, due to an increase in size and number of mucous glands lining the large airways.

The increase in mucous cells and the development of chronic bronchitis may be enhanced by breathing polluted air particularly in areas of uncontrolled coal burning. The changes are not confined to large airways, though these produce the dominant symptom of chronic sputum production.

Changes in smaller bronchioles lead to obliteration and inflammation around their walls. All these changes together, if severe enough, can lead to disturbances in the distribution of ventilation and perfusion in the lung, causing a fall in arterial oxygen tension and a rise in carbon dioxide tension.

By the time this occurs, the ventilatory ability of the patient, as measured by the velocity of a single forced expiration, is severely compromised; in a cigarette smoker, ventilatory ability has usually been declining rapidly for some years. It is not clear what determines the severity of these changes. Some people can smoke for decades without evidence of significant airway changes, whereas others may experience severe respiratory compromise after 15 years or less of exposure.

This irreversible disease consists of destruction of alveolar walls. It occurs in two forms, centrilobular emphysema, in which the destruction begins at the centre of the lobule, and panlobular or panacinar emphysema, in which alveolar destruction occurs in all alveoli within the lobule simultaneously.

In advanced cases of either type, this distinction can be difficult to make. The Edwin Smith papyrus , case 6. The Edwin Smith papyrus , case 1. The Edwin Smith papyrus , case Maspero, Etudes de mythologie et d'achéologie égyptiennes III , , pp. Maspero, Etudes de mythologie et d'achéologie égyptiennes III , , p.

The Edwin Smith papyrus, case 7. The Offering of Uha c. Statue inscription of Udjahorresne M. Extensive pulmonary haemorrhage in an Egyptian mummy , Virchows Arch The healers and their art The medical knowledge The diseases Dietary deficiencies Herbal medicine Surgery Dentistry Prostheses The role of Egyptian medicine in history Search new window Printout For best results save the whole page pictures included onto your hard disk, open the page with Word 97 or higher, edit if necessary and print.

Hesi Re, Physician and scribe ca. Not that an Egyptian's chances of survival would have been significantly better than those of his foreign contemporaries, but at least he had the satisfaction of being treated by physicians whose art was renowned all over the ancient world. Unlike the injuries caused by accidents or fighting, which were dealt with by the zwn. The Egyptians explained them as the work of the gods, caused by the presence of evil spirits or their poisons, and cleansing the body was the way to rid the body of their influence.

Incantations, prayers to the gods - above all to Sekhmet , the goddess of healing, curses, and threats, often accompanied by the injection of nasty smelling and tasting medicines into the various bodily orifices, were hoped to prove effective. Montemhet, 4th prophet of Amen , put his faith in the god he served: I bow down to your i.

Amen's name, May it be my physician, May it drive pain away from me. Milk and milk products were just occasionally consumed, as were legumes, seeds and oil.

First, to discover the nature of the particular entity possessing the person and then attack, drive it out, or otherwise destroy it. This was done by some powerful magic for which rituals, spells, incantations, talismans and amulets were used. Sekhmet priests seem also to have been involved in the prevention of plagues, inspection of sacrificial animals and even veterinary medicine. Other healers like the zwn. The role deities and their servants played in the healing process is described in the apocryphal story of Bentresh , a daughter of the chief of Bekhten, who fell ill, and Ramses II sent her Thutemhab, a scribe experienced in his heart, who can write with his finger.

This god arrived in Bekhten in a full year and five months. Then the chief of Bekhten came, with his soldiers and his nobles, before Khonsu-the-Plan-Maker. He threw himself upon his belly, saying: Then he wrought the protection of the daughter of the chief of Bekhten. She became well immediately. Physical medicines such as herbs were mostly expected to assuage the pain only, while magic effected the cure.

One spell, recited before taking an herbal remedy, reads as follows: Come thou who expellest evil things in this my stomach and in these my limbs! Magic is effective together with medicine. Medicine is effective together with magic.

The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases.

It has also been suggested that the Houses of Life , associated with Sekhmet, were teaching centres for physicians. Pharaoh asked him many [things] and he answered them all. A few days later it happened that the chief physician went to his fathers i. But occasionally women succeeded not just in acquiring medical knowledge but also in climbing to the top of the scribal hierarchy. Many of the poorer Egyptians probably had little contact with real physicians and called for the local medic, a workman like Paheripedjet at Deir el Medina who was frequently excused from his normal duties to attend to the sick.

He seems to have had some medical knowledge, knew how to prepare medicines and made home visits. The Edwin Smith Papyrus describing surgical diagnosis and treatments, the Ebers Papyrus on ophthalmology, diseases of the digestive system, the head, the skin and specific maladies like aAa , which some think may have been a precursor of aids and others, perhaps more reasonably, consider to have been a disease of the urinary tract, a compilation of earlier works that contains a large number of prescriptions and recipes, the Kahun Gynaecological Papyrus , the Berlin Medical Papyrus , the London Medical Papyrus.

The treatments in these texts are often organized into groups. The Edwin Smith Papyrus for instance opens with eight texts concerning head wounds, followed by nineteen treatments of wounds to the face forehead, eyebrows, nose, cheeks, temples, mouth, chin , six descriptions of how to deal with injuries to throat and neck, five dealing with collar-bones and arms, and seven with chest complaints.

It appears that all this knowledge dates to the third millennium BCE, even though the papyrus itself is of a much later date. Some important notions concerning the nervous system originated with the Egyptians, a word for brain is used here for the first time in any written language: The Edwin Smith papyrus , case 6 Acting conservatively, they knew how to treat injuries to the brain without killing the patient, but on the whole their understanding of the brain and its functions was superficial: Sometimes their knowledge was either not very exact or unfortunately expressed.

One will wonder for a few moments underneath what the bronchi were to be found: Their heads are attached to the upper bone of his breast to his throat, over which is the flesh of his gorge, that is the flesh that is over his bosom. Skeletons with broken arms that had been set, a man who had survived the amputation of a leg by fourteen years and another brain surgery by two years. For the evacuation of the belly: To remedy the bowels: To refresh an aching head: Flour, 1; incense, 1; wood of wa , 1; waneb plant, 1; mint?

To renew bowel movements in a constipated child: An old book, boil in oil, apply half on the belly to reestablish evacuation. Moreover they had a tried and true spell to go with it May you flow out, catarrh, son of catarrh, who breaks the bones, who destroys the skull, who hacks in the marrow, who causes the seven openings in the head to ache. The following charm has been interpreted as referring to the plague, as one of its symptoms is a dark discoloration of the skin: Spell for the disease of the Asiatics: Who is all-knowing like Re?

Who is thus all-knowing? This god who blackens the body with char-coal? May this Highest God be seized! This disease was not very prevalent but caused immense suffering to its victims. Infectious diseases were rampant in the relatively densely populated Nile valley, where practically the whole population lived within a narrow strip of land along the river, which at times was only a few hundred metres wide, and their incidence was dependent to some degree on the seasons.

The ubiquity of water during the inundation brought with it a different set of ailments, chief among them probably malaria, which were the main cause for mortality in late autumn; while the cooler weather of autumn and winter seems to have favoured the outbreak of respiratory illnesses.

Some think that leprosy originated in Egypt and spread to the Levant and Europe along the migration and trade routes, others contend that there is no proof of its existence in ancient times. The various kinds of malignant tumors were almost as frequent then as they are nowadays in comparable age and gender groups.

Eye infections are a common complaint in Africa. In ancient Egypt they were at least in part prevented by the application of bactericidal eye paint. The ingredients of some of the remedies may not have been as difficult to come by in a civilisation, where the brain of the dead was removed in little bits from the skull during mummification and discarded, as it would be in a modern western country: Prescription for the eye, to be used for all diseases which occur in this organ: Human brain, divide into its two halves, mix one half with honey, smear on the eye in the evening, dry the other half, mash, sift, smear on the eye in the morning.

The hard physical toil, often repetitive, caused great harm to the bones and joints of the labourers after only a few years of being subjected to it. Their causes may have been environmental, nutritional or social. Inbreeding , not infrequent among the royals, was probably also not rare among the common people largely bound to the soil: Open wounds were often treated with honey, but sepsis was one of the commonest causes of death.

When lockjaw set in due to a tetanus infection, physicians knew they were powerless against this affliction: Thou shouldst say regarding him: An ailment not to be treated.

Whole-grain carbohydrates give your body energy and maintain steady blood sugar levels, which helps prevent type 2 diabetes, notes Harvard School of Public Health. Liquid fasting diets can rob your body of the energy it needs to maintain physical activity levels, which is detrimental to a healthy heart.

Side effects of eliminating carbohydrates can include fatigue and dizziness due to blood sugar fluctuations. Although percent fruit and vegetable juices may offer the same vitamins and minerals as whole vegetables and fruits, you lose much of the beneficial fiber. Fiber serves several important functions. Water-soluble fiber helps remove low-density lipoprotein, LDL, or bad cholesterol from your bloodstream to prevent high cholesterol. Insoluble fiber aids digestion by pushing waste through your intestines to prevent constipation.

Liquid fasting diets greatly reduce your intake of fiber, leading to digestion problems and increasing your risk for high cholesterol. Malnutrition is a significant and dangerous side effect of liquid fasting diets. All-liquid diets greatly reduce your intake of calories and the nutrients your body needs to maintain organ function and your immune system.

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