Doctor's Notes: Tips for Reducing Holiday Heart Syndrome

In 1987, holiday heart syndrome was described from a study of 24 patients who presented to the hospital during the holiday season with atrial fibrillation (afib), a rapid abnormal heart rhythm in the upper heart chambers that’s associated with symptoms of palpitations, shortness of breath, chest pain, lightheadedness, stroke, and heart failure. All 24 were relatively healthy. However, they shared one thing in common: They drank alcohol heavily or regularly and then went on a binge during the holiday season.

Why Does Heavy Alcohol Consumption Cause Holiday Heart Syndrome?

The honest answer is we don’t fully know. There is some evidence that alcohol consumption is cardiotoxic. In susceptible individuals, the heart muscle can be severely weakened when exposed to alcohol. When the heart muscle weakens, the heart pressures increase, and the upper chambers stretch and develop afib. Fortunately, this scenario is uncommon. However, when alcohol is toxic to the heart, it can be profound. 

I cared for an elderly patient who died long ago. He was a Catholic priest. Occasionally, he would drink alcohol, and about one or two days afterward he would be in the intensive care unit with severe heart failure and afib. We would give his heart an electrical shock to restore a normal heart rhythm and then start medications to heal the heart and support the blood pressure. In a few weeks, and without any exposure to alcohol, his heart function was back to normal. He would do well for six months, and then he would drink alcohol again and restart the process. When I asked him why he drank knowing the consequences, he said he enjoyed wine too much to go a whole year without it.

There are other possible causes of afib after heavy alcohol consumption, such as surges in the body’s adrenalin (sympathetic output), rises in the level of free fatty acids, alterations of the electrical currents of the heart through altering how sodium moves in and out of the heart cells, and lowering the levels of sodium, potassium, and magnesium in the body through diuresis.


What Is the Definition of Heavy Alcohol Intake?

According to the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services, “binge drinking for 5 or more of the past 30 days” is considered heavy alcohol use.

Right about now you may be asking, "I heard alcohol is healthy for the heart?" It is but in low to moderate amounts. At one or two drinks a day for women and one to three drinks for men, alcohol has a protective effect on the heart and is associated with lower levels of coronary artery disease, cerebral vascular disease, and peripheral vascular disease.

Does Alcohol Alone Explain Holiday Heart Syndrome?

There are other risk factors for afib that are higher around the holidays as well. One of the most common problems is overeating. Eating a large amount of food at one sitting causes the stomach and bowels to stretch and distend to accommodate it. This activates the nervous system in our body called the vagal, or parasympathetic nervous system, which we use to digest food, rest, and sleep. When activated, this nervous system typically slows the heart rate. However, in people susceptible to afib, small areas in the upper chambers of the heart are triggered and actually begin to beat very fast, leading to the abnormal heart rhythm. These areas often reside in the small veins that drain blood from the lungs into the left upper heart chamber.

Another common problem is salt consumption. Our bodies need salt, but when we consume too much of it, we can hold onto fluid, which causes blood pressure to rise. In people with a history of high blood pressure, heart valve problems, or heart failure, the increase in blood pressure and the higher amount of fluid in the body can stretch the upper heart chambers and cause afib to develop.

Finally, heart injury or heart attacks are much more likely around the holidays. In fact, deadly heart attacks most commonly occur on December 25 compared with all other days of the year. The second most common day is December 26 and the third, January 1. Possible explanations for why these heart attacks occur during the holidays include these reasons:

• Delaying regular check-ups or doctor’s appointment
• Cold weather
• Overeating
• Depression

Regarding afib, any heart injury, including a heart attack, can irritate the upper heart chambers and cause the abnormal heart rhythm to develop.


Tips to Prevent Holiday Heart Syndrome and Enjoy the Time of Year

• First, if you have any heart symptoms, go to the hospital early this holiday season, including the day of a holiday itself.
• Avoid heavy alcohol consumption.
• Avoid alcohol entirely if you have afib.
• Pace yourself when eating and step away from the table when full.
• Avoid adding salt to your diet. Most of the food we eat, particularly if processed, already has sufficient to excessive amounts of salt.
• Finally, if you know someone who is depressed, alone, or isolated during the holiday season, reach out and cheer them up — it may be the best thing you do for their heart as well as yours.

Internal Medicine Other

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Doctor's Notes: Tips for Reducing Holiday Heart Syndrome

13 mënyra për të parandaluar diabetin

13 mënyrat më të mira për të prevenuar diabetin do i cekim më poshtë, janë forma të leta që secili nga ne mund të i realizoj më pak përkushtim.

Aktiviteti fizik:  e ulë sheqerin në gjak dhe rrit kërkesën për insulinë. Sipas ADA (Shoqatës amerikane për diabet) ndihmës të madhe japin kombinimi i ushtrimeve. ADA rekomandon ushtrime apo aktivitet të letë fizik për vetëm 30 minuta në ditë për 5 javë, një studim 16 vjeçar Universitetin e Harvardit erdhën në përfundim që vetëm një ecje për një kohë të gjatë mund të ulë rrezikun për diabet tip 2 për 30%. Për këtë pikë ju mjafton vetëm durimi dhe vullneti.

Konsumo drithëra: Buka e bardhë, orizi dhe patatet padyshim që kanë nivel të lartë të glukozës andaj dhe duhet mënjanu këto produkte pasi mund të rrisin glikeminë në gjak. Një studim i ber në Shangai të Kinës ( në rreth 75.000 gra) erdhën në përfundim që gratë të cilat kanë përdorur dieta të pasura me glukoze kishin një rriskë për zhvillim të diabetit tip 2 për 21% më shumë sesa ato që në dietat e tyre nuk kishin sasi të lartë të glukozës . Konsumo produkte që përmbajnë më pak glukoze si p.sh: kokërr buke, makarona dhe drithëra. Një studim që u krye në Harvard në 160.000 infermiere erdhën në përfundim që grupi i cili kishin konsumuar 2-3 racione kokërr buke e kishin ulur rrizkun për zhvillimin e diabetit tip 2 për 30% në krahasim me ato të cilat nuk kishin konsumuar.

Përdore uthullën:  dy lugë uthull molle në ditë ulë rrezikun për diabet pohon Carol Johnston Ph.D. Por mos të keqkuptohet jo të merret direkt, sigurisht të merret duke e kombinuar me ndonjë sallatë.

Erëzat: Një studim i kryer nga hulumtues Pakistanez së bashku me Richard Anderson erdhën në përfundim që 1 gram kanellë ( lloj Erze) në ditë ulë rrezikun për diabet. Këtë që sapo u shkrua e vërtetuan dhe studime të kryera në SHBA, pra rekomandojnë që ne dietën diabetike të jetë dhe kjo Erze.

Pini më shumë kafe: Një studim i kryer në Harvard në 125.000 pjesëmarrës ( 84.276 ishin femra), ata të cilët konsumuan mbi 6 kafe në ditë, të kemi parasysh konsumimi i tepërt i kafeve shkakton probleme tjera shëndetësore. Kafja ka shumë antioksidant duke përfshirë edhe acidin Klorogenik dhe magnezin ( të cilët ndihmojnë në ndjeshmërinë ndaj insulinës).

Konsumoni pemë e perime: në dietën diabetik hynë dhe disa perime si: fasulja, arra, fara etj. Dr.Jampolis këshillon një dietë anti-inflamatore drithëra, pemë dhe perime, duke ju shmangur yndyrave, kimikateve dhe ushqimeve të përpunuara. Dr.Vagini preferon një dietë të ulët me Karbohidrate, pak kripë, dietë mesdhetare e cila e cila është e pasur me peshk vaji e erëza.  ADA rekomandon një dietë të pasur me vitamina, minerale dhe fibra, ndërsa dietë të ulur me yndyra të ngopura që promovon kontrollin e peshës.

Të tjerat javën tjetër

Punoi: D.Zeqiraj             

Albanian Article

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13 mënyra për të parandaluar diabetin

General Considerations for Iron deficiency Anemias

Iron deficiency is the most common cause of anemia worldwide. Aside from circulating red blood cells, the major location of iron in the body is the storage pool as ferritin or as hemosiderin in
macrophages. The average American diet contains 10–15 mg of iron per day. About 10% of this amount is absorbed in the stomach, duodenum, and upper jejunum under acidic conditions.
Dietary iron present as heme is efficiently absorbed (10–20%) but non heme iron less so (1–5%), largely because of interference by phosphates, tannins, and other food  constituents. The major iron transporter from the diet across the intestinal lumen is ferroportin, which also facilitates the transport
of iron to apotransferrin in macrophages for delivery to erythroid cells prepared to synthesize hemoglobin. Hepcidin, produced during inflammation, negatively regulates iron transport by
promoting the degradation of ferroportin. Small amounts of iron—approximately 1 mg/day—are
normally lost through exfoliation of skin and mucosal cells. With hemorrhage, there is decreased oxygen delivery to the kidneys resulting in stabilization of a hypoxia-inducible factor in the kidneys and increased erythropoietin  generation in the kidneys and liver. The erythropoietin stimulates erythropoiesis, leading to an increased synthesis of erythroferrone. In turn, erythroferrone suppresses hepcidin synthesis leading to ferroportin stability and enhanced iron transport across the gastrointestinal lumen.
Menstrual blood loss plays a major role in iron metabolism. The average monthly menstrual blood loss is approximately 50 mL but may be five times greater in some individuals.
To maintain adequate iron stores, women with heavy menstrual losses must absorb 3–4 mg of iron from the diet each day. This strains the upper limit of what may reasonably be absorbed, and women
with menorrhagia of this degree will almost always become iron deficient without iron supplementation.
In general, iron metabolism is balanced between absorption of 1 mg/day and loss of 1 mg/day. Pregnancy and lactation upset the iron balance, since requirements increase to 2–5 mg of iron per day. Normal dietary iron cannot supply these requirements, and medicinal iron is needed during pregnancy and lactation. Decreased iron absorption can also cause iron deficiency, such as in people
affected by celiac disease, and it commonly occurs after gastric resection or jejunal bypass surgery.
The most important cause of iron deficiency anemia in  adults is chronic blood loss, especially menstrual and gastrointestinal blood loss. Iron deficiency demands a search for a source of gastrointestinal bleeding if other sites of blood loss (menorrhagia, other uterine bleeding, and
repeated blood donations) are excluded. Prolonged aspirin or nonsteroidal anti-inflammatory drug use may cause it even without a documented structural lesion. Celiac disease (gluten enteropathy), even
when asymptomatic, is an occult cause of iron deficiency through poor absorption in the gastrointestinal tract. Zinc deficiency is another cause of poor iron absorption. Chronic hemoglobinuria may lead to iron deficiency, but this is uncommon; traumatic hemolysis due to a prosthetic cardiac valve and other causes of intravascular hemolysis (eg, paroxysmal nocturnal hemoglobinuria) should also be considered. The cause of iron deficiency is not found in up to 5% of
cases.
Pure iron deficiency might prove refractory to oral iron replacement. Refractoriness is defined as a hemoglobin increment of less than 1 g/dL (10 g/L) after 4–6 weeks of 100 mg/day of elemental oral iron. The differential diagnosis in these cases includes malabsorption from autoimmune gastritis, Helicobacter pylori gastric infection, celiac disease, and hereditary iron-refractory iron deficiency
anemia. Iron-refractory iron deficiency anemia is a rare autosomal recessive disorder due to mutations in the transmembrane serine protease 6 (TMPRSS6) gene, which normally down-regulates hepcidin. In iron-refractory iron deficiency anemia, hepcidin levels are normal to high and ferritin
levels are high despite the iron deficiency

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General Considerations for Iron deficiency Anemias

Cilat janë llojet e alergjisë

Një problem që e ndjek  mjaft njeriun është edhe alergjia, prandaj zgjodhëm si temë që të
shtjellojmë se cilat janë llojet e alergjisë.

1. Riniti alergjik: Manifestohet me ajtje dhe inflamacion  të hundës, bllokim i hundëve, sy të përlotur, vjen nga  shumë shkaktarë si të mbyllur ashtu edhe të hapur.

2. Sinusitis: Inflamacioni i sinuseve që dinë të lidhen në rinitin alergjik apo astmën. Megjithatë mbi gjysma e sinusiteve kronike nuk lidhen me astmen dhe rinitin alergjik.

3. Astma: Inflamacion i mushkërive apo rrugëve të frymëmarrjes, apo shtrëngim i tyre, agjentët janë të ngjashëm me ata të rinitit alergjik. Manifestohet me ngushtim në gjoks, kollitje e gulçime.

4. Alergjia ushqimore: Në fakt nuk njihen si alergji duke qënë se nuk kanë një reaksion alergjik të dukshëm. Manifestohen me vjellje, diarre, ejtje të fytyrës,  kollitje, sukqje. Jo të gjitha ushqimet shkaktojnë alergji, mund të ndodh që një produkt  ushqimorë tek një individ të shkaktojë alergji ndërsa tek tjetri jo. 

5. Alergjia në thumbime: Lloji i alergjisë që shkaktohet nga thumbimi i insekteve të ndryshme e në veçanti nga bleta. Eshtë një alergji e rënde që shumë lehtë mund të dergojë drejtë vdekjes. Zakonisht individët që janë thumbuar duhet të mjekohen sa më parë me adrenalinë.

6. Alergji nga barnat: Disa nga medikamentet qe jepen mund të japin alergji, më së shpeshti një gjë te tillë e bën penicilian (ndaj të cilës duhet të kemi kujdes kur e japim), pastaj alergji mund të shkaktojnë disa suflonaminde e me rrallë aspirina.

7. Dermatiti i Kontaktit: Nga vetë fjala kuptohet që kemi të bëjmë me një lloj alergjie të drejtëpërdrejtë. Si manifestim është skuqja në vendin e kontaktit. Në këtë grup hyjnë një numër i madh faktorësh si acidet e ndryshme, detergjentët, nikeli e byzheterit, antibiotikët, anestetikët, parfumet e ndryshme, kozmetika e shumë faktorë të tjerë.

8. Ekzantema: Lloji i alergjise që manifestohet me lëkurë të thatë të luspuar, shfaqje e zonave të skuqura të vogla me ndjesi djegeje.

9. Konjuktiviti alergjik: Shaktohet nga kontakti i  drejtepredrejtë si me shampot e ndrysheme,
kozmetikën, tymi, klori i pishinave e faktorë të tjerë. Pra është inflamacion i konjuktivave të syrit. Që
manifestohet me skuqje të syve.

10. Njdeshmëria kimike: Nuk mund të thuhet se është një reaksion alergjik, por është një
pamundësi tolerimi të agjentëve kimik si ndaj pesticideve, tymit e ndotësve të tjerë të ajrit. Manifestohet me dhimbje koke, probleme me frymëmarrjen, mosfunksionim të punës se zemrës, lodhje etj.

Albanian Article

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Cilat janë llojet e alergjisë

Disease Risk Reduction of Vitamin D

Bone disorders
Adequate amounts of vitamin D throughout one's life - in combination with exercise, proper nutrition, calcium, and magnesium - are necessary for building up and maintaining bones and preventing bone loss. Vitamin D is needed to properly absorb calcium. Studies have shown that low levels of vitamin D and insufficient sunlight exposure (fewer than 20 minutes per day) are associated with osteoporosis.  Calcium, together with vitamin D, has been shown to help heal bone fractures from osteoporosis and decrease the risk of future bone breaks. In addition, vitamin D has demonstrated a beneficial effect on muscle function and strength and thereby reduces the risk of falling. Moreover, vitamin D is well known to protect against ‘rickets’ and ‘osteomalacia’, diseases of severe vitamin
deficiency.

Cancer
Studies in test tubes have indicated that vitamin D may have anti-cancer effects, while clinical study findings on vitamin D and specific cancers such as colorectal cancer have been inconsistent. However, some studies have shown strong evidence that high doses of vitamin D supplements may reduce the risk of colorectal cancer.  In addition, some population studies have suggested that supplementation with vitamin D may improve survival rates in those with a history of breast cancer. Other studies indicated that vitamin D3 supplementation might be effective in treating skin cancer. However, this research is still in the experimental stages.

Autoimmune diseases
Research suggests that vitamin D deficiency or a low vitamin D status may be linked to an increased risk of developing autoimmune diseases, overactive immune responses of the body attacking its own cells and organs. Clinical studies evaluating the use of vitamin D for some forms of arthritis (e.g. rheumatoid arthritis and osteoarthritis) have found vitamin D to have preventive effects. Observational data has suggested that vitamin D from foods and sunlight may help protect against multiple sclerosis (MS), a disease in which the body's immune response attacks a person's brain and spinal cord. Research has shown that supplementing infants and children with high doses of vitamin D may protect against the development of type 1 diabetes, a disease in which the body’s immune system destroys the insulin-producing cells.

Cardiovascular disease and High blood pressure 
Data from clinical studies have suggested a link between low levels of vitamin D and high blood pressure. Moreover, low vitamin D status (as measured by the 25(OH)-vitamin D plasma level) is thought to be independently associated with all-cause and cardiovascular mortality or a higher risk of a heart attack.

Other disorders 
Although the information is limited, studies have suggested that vitamin D supplementation may also be helpful to prevent Seasonal Affective Disorder (SAD), a form of depression that occurs during the winter months because of lack of sunlight, and tuberculosis, an infectious disease.

Internal Medicine

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Disease Risk Reduction of Vitamin D

Infusion Dosages

Heparin Infusion = 5 -10 Units/kg/hr

Fentanyl Infusion = 0.5 -2 mcg/kg/hr

Morphine infusion = 0.01-0.04 mg/kg/hr

Midazolam Infusion = 0.25 -1.5 mcg/kg/min, 0.05-0.1 mg/kg/hr

Vecuronium Infusion = 0.8 -1.4 mcg/kg/min, 0.1-0.3 mg/kg/hr

Atracurium Infusion = 5-10 mcg/kg/min

Propofol Infusion = 100-300 mcg/kg/min, ICU sedation 5-80 mcg/kg/min

Etomidate = 5-20 mcg/kg/min

Sodabicarb Infusion = 2-5 mEq/kg over 4-8 hours

Paracetamol Infusion = 10-15 mg/kg/dose

Dexemedetomidine Infusion = 0.2-0.7 mcg/kg/hr

Ketamine Infusion = 5-30 mcg/kg/min, 1-2mg/kg/hr

Tranexamic acid = 1 mg/kg/hour

Calcium gluconate = 0.5 mg/kg/hour

Calcium chloride = 5-15 mg/kg/hr

Lasix infusion = 0.5-2 mg/kg not to exceed 6 mg/kg/dose

Insulin infusion = 0.05-0.1unit/kg/hr

Nitroglycerine infusion = 0.1-7 mcg/kg/min

Sodium Nitroprusside = 0.1-2 mcg/kg/min

Dopamine infusion = 3-12 mcg/kg/min

Dobutamine infusion = 2-20 mcg/kg/min

Adrenaline infusion = 0.01-0.3 mcg/kg/min

Noradrenaline infusion = 0.03-0.2 mcg/kg/min

Phenylephrine infusion = 0.5-10 mcg/kg/min

Esmolol infusion = 100-300 mcg/kg/min

Amiodarone infusion = 5-15 mcg/kg/min

Xylocard infusion = 20-50 mcg/kg/min

Milrinone infusion = 0.375-0.75 mcg/kg/min

Isoprenaline infusion = 0.02-20 mcg/kg/min

Vasopressin = 0.0002-0.005 units/kg/hr

Levosimendan = 8-24 mcg/kg/min

Prostaglandin E1 = 0.05-0.4 mcg/kg/min

Epoprostenol PGI2 = 2-10 ng/kg/min

Phentolamine infusion = 1-20 mcg/kg/min

Tolazoline infusion = 0.5-10 mg/kg/hr

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Infusion Dosages

Examination of Olfactory Nerve (CN 1)

Smell, if tested, requires soft musks, floral and ketone smells rather than astringents, such as ammonia or cloves. The reason for this is that astringents are also noxious. They may stimulate trigeminal (CN V) nerve endings in the nose, causing perception of the stimulus even with completely severed CN 1. Each nostril is tested individually and not necessarily with a different scent, so that the patient is asked if the test scent is the same or different in each nostril. Often the patient will say they are different when they are the same, making interpretation difficult. A CN 1 palsy should alert the GP to the possibility of a meningioma of the olfactory groove. This is a slow growing tumour that may be ignored because its effects come on slowly. The patient may not be aware that they have lost the sense of smell. Loss of smell, associated with the flu, may be permanent. Sensation of smell and taste are intertwined so a patient complaining of altered taste
may be identifying problems with smell.

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Examination of Olfactory Nerve (CN 1)