تحقیق درموردمتن انگلیسی برونشیت مزمن انگلیسی

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Chronic Bronchitis

What is chronic bronchitis?

Chronic bronchitis is a long-term inflammation of the bronchi, which results in increased production of mucus, as well as other changes.

To be classified as chronic bronchitis:

cough and expectoration must occur most days for at least three months per year, for two years in a row.

other causes of symptoms, such as tuberculosis or other lung diseases, must be excluded.

Chronic bronchitis is an inflammation, or irritation, of the airways in the lungs. Airways are the tubes in your lungs that air passes through. They are also called bronchial tubes. When the airways are irritated, thick mucus forms in them. The mucus plugs up the airways and makes it hard for you to get air into your lungs. Symptoms of chronic bronchitis include a cough that produces mucus (sometimes called sputum), trouble breathing and a feeling of tightness in your chest.

What causes chronic bronchitis?

Cigarette smoking is the main cause of chronic bronchitis. When tobacco smoke is inhaled into the lungs, it irritates the airways and they produce mucus. People who have been exposed for a long time to other things that irritate their lungs, such as chemical fumes, dust and other substances, can also get chronic bronchitis.

What are the symptoms of chronic bronchitis?

The following are the most common symptoms for chronic bronchitis. However, each individual may experience symptoms differently. Symptoms may include:

cough

expectoration (spitting out) of mucus

Chronic bronchitis may cause:

frequent and severe respiratory infections

narrowing and plugging of the breathing tubes (bronchi)

difficult breathing

disability

Other symptoms may include:

lips and skin may appear blue

abnormal lung signs

swelling of the feet

heart failure

The symptoms of chronic bronchitis may resemble other lung conditions or medical problems. Consult your physician for a diagnosis.

What are the causes of chronic bronchitis?

In acute bronchitis, bacteria or viruses may be the cause, but in chronic bronchitis there is no specific organism recognized as the cause of the disease.

Cigarette smoking is cited as the most common contributor to chronic bronchitis, followed by:

bacterial or viral infections

environmental pollution

Chronic bronchitis is often associated with other pulmonary diseases such as:

pulmonary emphysema

pulmonary fibrosis

asthma

tuberculosis

sinusitis

upper respiratory infections

How is chronic bronchitis diagnosed?

In addition to a complete medical history and physical examination, your physician may request the following:

pulmonary function tests - diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that the person must breathe into, and may include the following:

spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:

to determine how well the lungs receive, hold, and utilize air

to monitor a lung disease

to monitor the effectiveness of treatment

to determine the severity of a lung disease

to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)

peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

arterial blood gas (ABG) - a blood test that is used to evaluate the lungs' ability to provide blood with oxygen and remove carbon dioxide, and to measure the pH (acidity) of the blood.

pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for chronic bronchitis: Signs and symptoms

A cough that brings up yellowish-gray or green mucus (sputum) is one of the main signs of bronchitis. Mucus itself isn't abnormal — your airways normally produce up to several tablespoons of mucus secretions every day. But these secretions usually don't accumulate, because they're continuously cleared into your throat and swallowed with your saliva.

When the main air passageways in your lungs (bronchial tubes) are inflamed, they often produce large amounts of discolored mucus that comes up when you cough. If this persists for more than three months, it is referred to as chronic bronchitis. Mucus that isn't white or clear usually means there's a secondary infection.

Still, bronchitis symptoms can be deceptive. You don't always produce sputum when you have bronchitis, and children often swallow coughed-up material, so parents may not know there's a secondary infection. Many smokers have to clear their throat every morning when they get up. While they may think this is normal for everyone, it's not. If it continues for more than three months, it may be chronic bronchitis.

Accompanying symptoms of an upper respiratory infectionAcute bronchitis also may be accompanied by common signs and symptoms of an upper respiratory infection, including:

Soreness and a feeling of constriction or burning in your chest

Sore throat

Chest congestion

Sinus fullness

Breathlessness

Wheezing

Slight fever and chills

Overall malaise

Sometimes chronic sinusitis — an ongoing infection in the lining of one or more of the cavities in the bone around your nose — can mimic bronchitis. That's because the signs and symptoms of chronic sinusitis include a thick, yellow or green postnasal discharge and a chronic cough that's triggered when you try to clear your throat of mucus draining from your sinuses, instead of your lungs, as is the case with bronchitis.

Specific treatment for chronic bronchitis will be determined by your physician based on:

your age, overall health, and medical history

extent of the disease

your tolerance for specific medications, procedures, or therapies

expectations for the course of the disease

your opinion or preference

تحقیق درموردمتن انگلیسی دوپینگ انگلیسی

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Contents

IntroductionA. The present state of affairsB. Numerous determining factorsConclusionRecommendations

IntroductionPierre de Coubertin, founder of the modern Olympic games, was one of the first to point out the necessity of protecting sport from the dangers threatening it as an institution. In 1923, in a speech delivered in Rome, he denounced "the intrusion of politics into sports, the increasingly venal attitude towards championship, the excessive worshipping of sport, which leads to a belief in the wrong values, chauvinism, brutality, overworking, overtraining, and doping".The recent doping scandal of the last Tour de France cycling competition drew the attention of the media to practices which, until then, had remained covert. This media coverage has increased public awareness of this phenomenon. Indeed, due to their scope and sophistication, doping practices are a threat to more than just the world of sport. Though first considered to be no more than a cheating problem, the doping issue has reached such proportions that it now concerns society as a whole. As the stakes involved in sport grow higher and the phenomenon more widespread, the moral values attached to sport are increasingly called into question and the health of athletes increasingly at risk.Furthermore, the close link observed between doping and addiction underscores the former's social and sanitary impact. This report shows that far from being limited to the world of high-ranking athletes, doping is an important public health issue. A. The present state of affairs1. The scope of the problemA few examples are enough to give an idea of the scope of the problem: in 1986, a physician and two pharmacists were indicted for having sold over 2,000 phials of Tonedron, at 150 times their normal price. On December 2, 1995, near Lille, customs officers seized nearly 200,000 tablets and phials of anabolic drugs meant for the muscle-building club market. An article by P. Laure published in the magazine "Sport et Vie" n°44 (September 1997), analyzes in de tail the new opportunities offered by Internet: twenty-odd servers presenting all sorts of drugs, including anabolic steroids, corticoids and beta-blockers. A synthetic graph provides the market prices for these drugs — from 50 to 3,800 francs for the minimal dose — and shows that it is possible to obtain drugs listed among French prescription only drugs (lists I and II) as well as illegal drugs.However, the empirical data presently available does not allow us to accurately assess the phenomenon. In 1966, 37 champions from 2 sports federations were tested and 12 were tested positive. In this small sample, the percentage of doped athletes was 37%. In 1992, 8,000 tests were carried out in 56 federations and only 69 tested positive: in this case, the rate fell to 1%. Indirect data, such as the seizure of banned drugs, the dismantling of distribution networks, as well as the tragic fate of some champions — between 1987 and 1990, "18 Belgian and Dutch cyclist champions died, apparently due to the use of erythropoietin" (Laure, 1995, p.136) — lead us to believe that the low percentage of positive tests does not mean that doping has disappeared, but that it is now possible to hide it. The percentages of doped athletes given in the press vary from 10 to 90%. But the level of the athletes or even the precise source of these figures are never mentioned, which only shows that the extent of the doping phenomenon is impossible to assess. It is thus all the more difficult, except in very rare cases, to cross the dependent variable "doping" with the independent variables which are necessarily taken into account in a sociological approach to the issue. The variations of doping behaviour according to gender, age, sociocultural background, education and other characteristics are unknown.In short, the lack of objective data makes it difficult to carry out a sociological analysis of the issue; there is more information concerning opinions on the subject and efforts to control the phenomenon than on the phenomenon itself. There are several reasons for this: when carrying out a survey among people who are well-known, it is very difficult to maintain anonymity, since the questions asked concern the type of sport practised, the level attained, previous accidents, etc. Furthermore, there is the risk that revealing the phenomenon could possibly encourage its spread.II. The aimsIn order to enhance their performance, sportsmen use specific "methods" which optimize the qualities needed for their sport, on the basis of various physiological, biological, and psychological factors.According to a widespread opinion, "upstream" doping, used for the above-mentioned aim, is "bad" and should be distinguished from "downstream", or "good" doping, meant to help athletes recover their physiological and biological balance. In fact, both types of doping are complementary, since they artificially boost the body's abilities, the second type of doping aiming to make up for the negative effects of the former.Aerobic potential can be increased by increasing the blood's oxygen transfer capacity. This is very important in sports requiring staying power, rely on the body's energy metabolism, or require intense effort and varying sources of energy. After long-lasting or intense effort, glycogen reserves must be restored. A specially adapted nutritional strategy and drugs are then needed to modify the metabolic process. Methods include altitude training, self-transfusion, more recently, recombinant EPO, and of course glucocorticoids, etc.When the aim is to increase strength and muscular power and improve technique, protein, natural or synthetic anabolic agents are frequently used, in combination with hyperprotein diets and muscle-building exercises. The balance between the increase in muscle mass and the loss of fat mass can be maintained thanks to growth hormones associated with aminoacids or other drugs with anabolic properties (but whose initial medical purpose is other), or with nutritional supplements.To postpone fatigue and enable the body to reach its utmost limits, one can use antalgics, cardio-respiratory analeptics, central nervous system stimulants, several of which are strong anti-depressants and stimulants.IIn sports where body features or size, tall or short, are important, such as body-building, the shape of the body can be modified through hormonal manipulations.Various drugs are used to fight stress, facilitate sleep, remain in good physical shape, such as benzodiazepine derivatives and amphetamines, cannabinoids, alcohol, beta-blockers. For disciplines where it is important to stay alert, the sleeping-waking rhythm can be controlled thanks to amphetamines or more recent drugs.Last, cultural and invidual factors also play a role in drug-taking behaviour. On the one hand, as concerns men, value is placed on the mesomorphic body type and muscular strength; physical stereotypes are spread by the media and the athletic subculture. On the other hand, one must take into account factors such as low self-esteem, or other psychological problems linked to for example to one’s body image and which existed prior to drug-taking.Illicit drugs are of course taken on the sly. Several ways of hiding the fact exist: diluting urine, hemodilution, reducing kidney tubular secretions or the testosterone/epitestosterone ratio. III. The growing competition between technical and biological research and detection methods1. The rules enforced by the medical commission of the IOCThe definition of doping established by the medical commission of the "International Olympic Committee" is based on the prohibition of certain types of pharmaceuticals. This definition also bans new substances which may have been developed by laboratories specifically for doping purposes.In France, the list of banned substances and methods is given in an amendment to the appendix of the Convention contre le dopage of November 16, 1989, approved in Strasbourg on February 28, 1998, which entered in force on March 15, 1998.Table I shows the new list (decree n°98-464, Journal Officiel de la République Française, 17 juin 1998).

New list of banned substances and methods

1. List of banned substances

A. StimulantsB. Narcotics, both natural and syntheticC. Anabolic agentsD. DiureticsE. Peptide and glycoprotein hormones and analogs

II. Banned methods

A. Blood dopingB. Pharmacological, chemical or physical manipulation

III. List of substances under restriction

A. AlcoholB. MarijuanaC. Local anestheticsD. CorticosteroidsE. Beta-blockers

All physicians have access to the detailed list, since it is quoted on p. 6 of the 1998 edition of the VIDAL medical dictionary ("Banned substances and methods").2. Drugs which are detectable thanks to present testing methodsAll natural or synthetic doping drugs (a to e) have a common physical and chemical characteristic, which is low molecular weight (under 500) (see table II). They can thus be detected by the usual analytical methods, such as gas chromatography, together with mass spectrometry.The only problem with the detection of xenobiotics is the fact that analysts have to work with small samples, which are not always best suited to this type of testing. However, as concerns endogenous substances, their detection does not constitute sufficient proof of doping for the institutions in charge of enforcing the law.Table II: example of the molecular weight of several molecules

Type of active substance

Example of substance

Molecular Mass (Mw)

a. Stimulants

AmphetamineCocaine

135303

b. Natural or synthetic anabolic agents

NandroloneTestosterone

274288

c. Narcotics and analgesics

DextromoramidePropoxypheneMorphine

392339285

d. Beta-blockers

PindololAcebutol Propanolol

248336259

e. Diuretics and masking drugs

Ethacrinic acidFurosemideCanrerone

303330340

f. Peptide hormones

HGHLHEPO

22,40030,00030,400