Duetact

Per Ljungman, M.D., Ph.D.

• Professor of Hematology
• Karolinska Institutet
• Director
• Department of Hematology
• Karolinska University Hospital Stockholm
• Stockholm, Sweden

Calculus may develop either at the gum surface or in the crevice between the gum and a tooth; its presence may cause further plaque retention diabetic zucchini banana bread recipe discount 16 mg duetact overnight delivery. The buildup of plaque and calculus increases the likelihood of infection and subsequent inflammation diabetes mellitus precautions buy 17 mg duetact amex. Periodontal disease refers to inflammatory conditions involving the periodontium-the tissues that support the tooth in its bony socket diabetes high blood sugar buy generic duetact 17 mg line. The periodontium includes the gums (called gingiva) diabetes mellitus kezelése duetact 17 mg order overnight delivery, other connective tissues surrounding the tooth, and the bone underneath. Inflammation of the gums, called gingivitis, Signs and Symptoms Periodontal disease typically begins with gingivitis; the gums may bleed readily from brushing or flossing and be tender and swollen. The gap between an infected gum and a tooth usually deepens, allowing food particles to get caught easily. Dental plaque is an accumulation of bacteria and their by-products that grow on teeth and can lead to dental caries and gum disease. If bone is destroyed, the affected gums usually recede, and teeth may loosen or change position. Antimicrobial mouth rinses and topical antibiotics are often prescribed to control infection. Surgical approaches are sometimes necessary to remove plaque or calculus deposits underneath gum tissue or to replace tissues that have been destroyed. Dentures may be uncomfortable to wear, and ulcerations may develop where they contact the mouth. Dry mouth may cause a person to reduce food intake and thereby increase malnutrition risk. Saliva lubricates oral tissues and contains antimicrobial proteins to defend against bacteria and fungi. The calcium and phosphate concentrations of saliva help to prevent dissolution of enamel. Thus saliva helps to control plaque formation, prevent infection within the mouth, and maintain tooth enamel. If salivary secretions are low or absent, the risk of developing dental caries and periodontal disease increases. Antihistamines, antihypertensive agents, antidepressants, decongestants, and other medications can cause dry mouth. Radiation therapy used to treat head and neck cancers often damages salivary glands, sometimes permanently. Dental Health and Chronic Illness Maintaining dental health is sometimes challenging for a person with a chronic illness. As mentioned earlier, many medications can reduce salivary secretions, along with the immune protection that saliva provides. This section describes how several conditions may upset oral health and increase the risks of developing dental problems. Diabetes Mellitus For a number of reasons, periodontal disease is more prevalent among people with diabetes mellitus, especially those whose diabetes is poorly controlled. People with diabetes often have impaired immune responses and a greater susceptibility to infections. Diabetes also favors the growth of bacteria that tend to infect periodontal tissues. The damaging effects of hyperglycemia weaken the collagen structure of tissues, making them more vulnerable. In addition, people with diabetes tend to have 752 · Highlight 23 duces chewing ability). To minimize complications, dental care is often initiated before radiation therapy begins. Smoking is discouraged because it can increase periodontal disease risk nearly 10-fold in people with diabetes. Dental Health and Disease Risk Dental diseases may have adverse effects on health beyond their effects on teeth. Evidence supports a link between dental bacteria and other conditions, including the following: · Systemic inflammation. The inflammatory process induced by periodontal disease increases levels of cytokines and other mediators that have systemic effects.

Diseases

• Dementia pugilistica
• Contact dermatitis, photocontact
• Heart situs anomaly
• Hay Wells syndrome
• Syndactyly type 5
• Bonneau Beaumont syndrome

Thereafter diabetes symptoms and signs discount 17 mg duetact free shipping, fluid needs can be estimated by measuring urine output and adding about 500 milliliters to account for the water lost from skin diabetes type 2 best medicine duetact 17 mg purchase fast delivery, lungs diabetes test baby buy cheap duetact 17 mg line, and perspiration diabetes mellitus type 2 article pdf generic duetact 16 mg. Generally, the potassium intake should be restricted to 2000 to 3000 milligrams daily. In patients with oliguria, sodium may be restricted to between 1100 and 3300 milligrams per day; the sodium intake can be adjusted to match urinary sodium losses unless edema is present. As mentioned previously, oliguric patients who experience diuresis at the beginning of the recovery period may need electrolyte replacement to compensate for urinary losses. Enteral and Parenteral Nutrition Some patients need enteral or parenteral nutrition support to obtain adequate energy. Enteral nutrition (tube feeding) is generally preferred over parenteral nutrition because it is less likely to cause infection and sepsis. Enteral formulas for patients with renal failure are more kcalorically dense and have lower protein and electrolyte concentrations than standard formulas. Total parenteral nutrition is necessary only if patients are severely malnourished or cannot consume food for more than 14 days. Acute renal failure is treated with medications, dialysis, and dietary modifications. Chronic Kidney Disease Chronic kidney disease is also known as chronic renal failure. Unlike acute renal failure, in which kidney function declines suddenly and rapidly, chronic kidney disease is characterized by gradual, irreversible deterioration. Because the kidneys have a large functional reserve, the disease typically progresses over many years without causing symptoms. Patients are typically diagnosed late in the course of illness, after most kidney function has been lost. Polycystic kidney disease, characterized by the formation of multiple cysts in both kidneys, is a common hereditary condition that accounts for about 5 to 10 percent of chronic kidney disease cases. She was first seen in the emergency room with severe edema, headache, nausea and vomiting, and a rapid heart rate. She reported an inability to pass more than minimal amounts of urine in the past two days. Her son, who drove her to the emergency room, reported that she had missed work for several days and seemed confused and unusually tired. Garber had begun taking penicillin earlier in the week, the physician diagnosed acute renal failure, probably caused by a reaction to the medication. Is her reaction to penicillin considered a prerenal, intrinsic, or postrenal cause of renal failure? Anorexia Fatigue Headache Hypertension Itching Kidney inflammation or nephrotic syndrome Nausea and vomiting Proteinuria, hematuria (blood in urine) Advanced Stages · · · · · · · · · · · Anemia, bleeding tendency Cardiovascular disease Confusion, mental impairments Electrolyte abnormalities Fluid retention Hormonal abnormalities Metabolic acidosis Peripheral neuropathy Protein-energy malnutrition Reduced immunity Renal osteodystrophy Consequences of Chronic Kidney Disease In the early stages of chronic kidney disease, the nephrons compensate by enlarging so that they can handle the extra workload. As the nephrons deteriorate, however, there is additional work for the remaining nephrons. The overburdened nephrons continue to degenerate until finally the kidneys are unable to function adequately, resulting in kidney failure. Table 28-3 lists the common clinical effects of the early and advanced stages of chronic kidney disease. Symptoms of chronic kidney disease may not appear until over 75 percent of kidney function is lost. Levey and coauthors, National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification, Annals of Internal Medicine 139 (2003): 137­147. Reminder: Parathyroid hormone helps to regulate serum concentrations of calcium and phosphorus. Elevated parathyroid hormone stimulates bone turnover and the release of calcium from bone into blood. Altered Electrolytes and Hormones Fluid and electrolyte disturbances may not develop until the third or fourth stage of chronic kidney disease (see Table 28-4). A number of hormonal adaptations also help to regulate electrolyte levels, but these changes may cause complications of their own. The increased secretion of aldosterone helps to prevent increases in serum potassium but contributes to the development of hypertension (in patients who were not previously hypertensive).

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Preston and coauthors blood sugar checker order duetact 17 mg overnight delivery, Influence of environmental tobacco smoke on vitamin C status in children metabolic disease transplant buy duetact 16 mg amex, American Journal of Clinical Nutrition 77 (2003): 167­172 diabetes mellitus overview discount duetact 16 mg line. This highlight focuses on efforts to prevent childhood obesity and the development of heart disease and type 2 diabetes diabetes mellitus virus buy 16 mg duetact otc, but the benefits extend to other obesity-related diseases as well. The years of childhood (ages 2 to 18) are emphasized here, because the earlier in life health-promoting habits become established, the better they will stick. Invariably, questions arise as to what extent genetics is involved in disease development. For heart disease and type 2 diabetes, genetics does not appear to play a determining role; that is, a person is not simply destined at birth to develop these diseases. Instead, genetics appears to play a permissive role-the potential is inherited and will develop if given a push by poor health choices such as excessive weight gain, poor diet, sedentary lifestyle, and cigarette smoking. Many experts agree that preventing or treating obesity in childhood will reduce the rate of chronic diseases in adulthood. Without intervention, most overweight children become overweight adolescents who become overweight adults, and being overweight exacerbates every chronic disease that adults face. Type 2 diabetes is most likely to occur in those who are obese and sedentary and have a family history of diabetes. In type 2 diabetes, the cells become insulin-resistant-that is, the cells become less sensitive to insulin, reducing the amount of glucose entering the cells from the blood. The complications of diabetes, especially when encountered at a young age, can shorten life expectancy. The activity and dietary suggestions to help defend against heart disease later in this highlight apply to type 2 diabetes as well. Atherosclerosis Most cardiovascular disease involves atherosclerosis (see the glossary, p. If it progresses, atherosclerosis may eventually block the flow of blood to the heart and cause a heart attack or cut off blood flow to the brain and cause a stroke. During adolescence, these fatty streaks may begin to accumulate fibrous connective tissue. By early adulthood, the fibrous plaques may begin to calcify and become raised lesions, especially in boys and young men. As the lesions grow more numerous and enlarge, the heart disease rate begins to rise, most dramatically at about age 45 in men and 55 in women. From this point on, arterial damage and blockage progress rapidly, and heart attacks and strokes threaten life. In short, the consequences of atherosclerosis, which become apparent only in adulthood, have their beginnings in the first decades of life. Early lesions may either progress or regress, depending on several factors, many of which reflect lifestyle behaviors. Smoking, for example, is strongly associated with the prevalence of fatty streaks and raised lesions, even in young adults. Cholesterol values at birth are similar in all populations; differences emerge in early childhood. Standard values for cholesterol in children and adolescents (ages 2 to 18 years) are listed in Table H15-1 (p. In general, blood cholesterol tends to rise as dietary saturated fat intakes increase. Blood cholesterol also correlates with childhood obesity, especially abdominal obesity. These relationships are apparent throughout childhood, and their magnitude increases with age. Children who are both overweight and have high blood cholesterol are likely to have parents who develop heart disease early. Both those with family histories of heart disease and those with multiple risk factors need intervention. Children with 2 Plaques can begin the highest risks of developing heart disease are to form in a person sedentary and obese, with high blood pressure A healthy artery provides an open as young as 15. High blood pressure may signal an underlying disease or the early onset of hypertension.

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References

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