Clinical explanation of Bronchiectasis

Permanent dilatation and distortion of the bronchi is called bronchiectasis. What is it’s effect to human health?

Etiology and Pathogenesis:

Most of the cases of bronchiectasis result from acquired causes.

• Obstruction to the bronchus due to any cause leads to distal collapse of the pulmonary segment. The pull on the bronchi by the collapsed alveoli leads to dilatation of the bronchi. In the initial stages this is reversible and the bronchi regain their normal size when the lung expands. If the obstruction persists, accumulation of mucus occurs distally, infection supervenes and the bronchial wall is destroyed permanently.

This results in permanent dilatation. The infective organisms are streptococci, pneumococci, Klebsiella, and anaerobes.

• Bronchiectasis may follow several viral infections without passing through the obstructive phase.

• Congenital defects in the bronchial wall lead to bronchiectasis. The classical example is Kartagener’s syndrome, which is characterized by dextrocardia, sinusitis, and defects of ciliary function in the bronchi and non-motile sperms.

• Middle lobe bronchiectasis is a sequel to pulmonary tuberculosis. This is caused by obstruction to the middle lobe bronchus by tuberculous glands. This is called “middle lobe syndrome” or “Block’s syndrome”.

Clinical features:

The clinical picture is very chronic, extending over several years.

The common site of lesion is the left lower lobe. Though children may be affected, usually symptoms manifest in early adulthood or middle age. Males are affected more than females. Digital clubbing is a prominent sign, sometimes being associated with hypertrophic pulmonary osteoarthropathy.

Postural cough with the production of large quantities of purulent and foul smelling sputum is the presenting complaint in most cases. On keeping for sometime, the sputum settles into 3 layers as described under lung abscess. Hemoptysis may occur frequently. This may be mild or severe. Recurrent infections such as pneumonia may develop. Repeated affection of the same lobe or segment should suggest the possibility of underlying bronchiectasis. Bronchiectasis sicca is the condition in which bronchiectasis presents with mild or severe hemoptysis without purulent sputum.

Physical examination may reveal impairment of the percussion note and diminution of respiratory sounds over the presence of coarse, persistent leathery rales. At times bronchiectasis may present with one of its complications. These include massive hemoptysis, recurrent pneumonia, emphysema, septicemia brain abscess, and cor pulmonale. Anemia develops in long standing cases due to chronic sepsis and recurrent hemoptysis. In untreated cases secondary amyloidosis may develop.

Diagnosis:

Bronchiectasis should be diagnosed by the long history, presence of clubbing, postural cough, coarse leathery rales over the affected part and reasonably normal general health. Once established, bronchiectasis is not curable by medical treatment.

Differential diagnosis

Bronchiectasis should be distinguished from chronic bronchitis and emphysema, lung abscess, tuberculosis, congenital cystic disease of the lung and malignancy. Lung abscess generally develops acutely. The right lower lobe is affected more often and the signs are localized. Tuberculosis is more common in the upper lobes and clubbing is not prominent in uncomplicated cases. Features like digital clubbing and copious sputum are seen in tuberculous bronchiectasis. Cystic disease is not uncommon. All age groups are affected. A long history or recurrent respiratory disease is present in the majority of cases. Clubbing is not prominent. The cysts may be localized or generalized. Clinical distinction from bronchiectasis is difficult. The presence of cysts in other organs like the kidneys, liver, etc, suggests the probability of congenital cystic disease of the lung. X-ray reveals the presence of soap bubble-like or ring shadows.

Diagnosis is confirmed by bronchography. This procedure is absolutely essential for determining the extent and type of bronchiectasis. Plain X-ray of the chest is not a reliable investigation to assess the site and extent of bronchiectasis.

Management

General measures include high protein diet, treatment of intercurrent infections, and removal of focal sepsis from the upper respiratory tract. Principles of specific therapy include postural drainage, administration of antibodies, respiratory exercises and in selected cases surgical excision. Postural drainage helps in clearing the bronchi and brings about relief. The patient should be instructed to practice postural drainage regularly. This gives relief of cough and also the foul smell. The fetid odor of the breath can be controlled by administering steam inhalations containing tincture benzoin or eucalyptus oil. The choice of antibiotic is determined by microbiological studies. Intermittent antibiotic therapy is required to clear infection and prevent exacerbation. The site of lesion may have to be excised if medical treatment fails.

Indications for surgery:

The following are the indications for surgery.

• The disease is localized to one lung or one segment and is not amenable to medical therapy.
• Socio-economic factors such as non-compliance by the patient
• Uncontrollable hemoptysis in which the site of origin of blood may be detected by emergency bronchoscopy and surgical resection has to be planned;
• To reduce the area of infection-even in bilateral disease sometimes surgical resection may have to be done on the more affected side, with a view to reducing the surface area of infection; and
• To remove an obstructive lesion which tends to perpetuate the condition, eg, bronchial growth or bronchostenosis?

I am Funom Theophilus Makama. I advertise through writing. As a platinum expert Author, I write lots of articles and hence promote interested websites, companies, groups, organizations, and communities through publishing and distributing my articles

Benefits of Wedding Car Hire

Car rentals have gone beyond the realm of tourism and have grown to become an essential part of any big occasion. The Wedding car hire is a trend that has steadily gained popularity over the last decade. Choosing just the right wedding day car has become as important as choosing the right Decor and the right wedding dress as the kind of car one chooses indicates a lot about the individuals personality. Finding the perfect car for the newlyweds to drive away in at the end of the ceremony only enhances the picture-perfect culmination to a very special day. Choosing the wedding cars is not confined to just the car the bride and groom would use; picking the right ones is not as simple as it seems. The vehicles need to complement the overall theme of the wedding while simultaneously serving a functional purpose. One may need to hire bigger wagons to partake in the much required wedding shopping and to move things from one venue to another.

Similarly people can hire Luxury cars to take guests to the wedding venue from their respective houses or take them from one venue to another.

It is best to use wedding car hire services can provide you with a wide variety of vehicles, so that you can avail discounts when you hire numerous cars together. The necessary information can easily be found online by using any search engine.

On ones wedding day there are always things that can go wrong last minute, you don’t need to add your car rental to add to that list. To ensure that car hiring doesn’t prove to be counterproductive it is essential that the cars hired are fuel efficient, in good condition and come with a qualified chauffeur attached.

It is important to check the background of the car hire company and go through customer reviews so that you have a hassle free wedding day.

The type of car one hires for their wedding day indicates a lot about their personality and adds to the theme of the wedding significantly. Old models and luxury cars are considered the most fashionable. Vintage cars are most often used for classical weddings. They render a sense of impactful simplicity to the bridal party’s entrance. Expensive luxury vehicles infuse the theme with a touch grandeur, sophistication and lavishness. Limos dominate the list of the favorite wedding vehicles, most likely due to their size and exceptional design. They are the best choice when it comes to transporting wedding guests together as they comfortably seat up a relatively large number of guests.

Car rental companies that cater to such occasions give brides and grooms the opportunity to ride in rare and trendy car models to commemorate this joyous occasion. They do so by providing clients with deals and reasonable fees. With car rental companies around, it is now possible to have an exquisite wedding ceremony no matter how tight your budget.

Modern Bathroom Renovation Ideas

If you are getting a bathroom renovation then this is one of the very best ways to transform your home and make it look like a show home or a home of tomorrow. The bathroom is one of the rooms that is the quickest to date and which often looks the most out of place. At the same time it is one of the rooms (like the kitchen) where you spend a lot of time and where there are a lot of features that can be updated to look more modern. By smartly choosing your bathroom renovation features you can make it a feature rich experience that looks and feels modern and that at the same time is even more of a joy to use.

The first idea for modern bathroom renovations that is an absolute must is to get a walk in shower. Walk in showers are basically shower cubicles that are not elevated off the ground and that are often inside a glass enclosure.

You can use these easily by walking in and you will be surrounded by light as it comes in through the glass. This means that the first and most impressive benefit of these kinds of showers is that you won’t feel at all claustrophobic – in fact you are likely to feel very spacious and this makes it easier to relax and makes it feel more natural. At the same time you will find that walk in shower enclosures are easier in many ways to keep clean etc. This is because there is no shower screen which can leak water and because you won’t need to step in and out of them and that makes it much easier.

There are other factors that can improve your shower too. For instance, why not get extra jets that can spray you from different angles. These are normally synonymous with spa retreats, but modern innovation has meant that they’re now cheap enough that we can afford them in our own home and enjoy the feeling of powerful blasts of water coming from every angle on our back. At the same time this will often be enough to help us to clean other areas that often get forgotten so it also improves hygiene.

What’s more common these days though is to have jets in the bath and this way you have created a spa tub in your bathroom. The bubbles create a highly relaxing sound, improve your bubble bath and massage your muscles into relaxation making them perfect for relaxing in after a long day and they are of course another feature that will make your bathroom seem very modern and all-singing and dancing.

Another option is to have a glass sink. This won’t change the effectiveness of the sink, but it will make it look very modern and it can almost be like an optical illusion at times when completely clean as it looks as though there is just a semi circle of water floating in the bathroom. If you also have a glass shower enclosure then you’ll find that the two match.

Medical Equipment Marketplace

The medical equipment marketplace is replete with broad selections of equipment and supplies for medical, dental, and beauty salon equipment. There are several websites devoted to supplying such items. Trade networks exist within social commerce climates that constantly move products in this category every hour of every day. It is a highly competitive market and the information provided regarding the products is sometimes reliable and in other situations it is unreliable.

Within this market it is important to know certain facts. In order to learn these facts, you might have to critically shop around and ask many questions. When you do this, you will find contradictory information as well as useful information. You will see that some businesses selling these products are reliable and others are not. Ultimately it is confusing. One of the best companies that I have seen is Crystal Medical http://www.crystalmedical.co.uk.

Crystal Medical has a special niche in the medical equipment marketplace. They offer an exceptional variety of products in many categories including dental, medical, surgical, opthamalic, nursing, homecare, veterinary, pharmaceutical, and software categories. All of the products they offer are of high quality. Their dental equipment line is comprehensive and takes quality seriously.

Perhaps one of their best features is the flexible payment plans. With Crystal Medical, you may purchase medical equipment, dental equipment, and beauty salon equipment outright or you may rent the products on agreement for nominal fees. They have their payment plans set up in such a way that the equipment you purchase can pay for itself with added profit. Often these upgrades in equipment yield better business profits, easily offsetting the cost of the equipment itself.

Naturally, there are other organizations that offer similar equipment. You should research those as well. I believe you will discover that Crystal Medical offers the best products and the most practical payment plans. Considering the fact that they offer a 5 year warranty on all of the products they sell, it is a deal worth considering. Advance the technology of your healthcare practice with a reliable company and you will be assured better quality and cost.

Careers & Employment Information

There are excellent careers and employment opportunities available to recent graduates at universities across the country. These graduates will find these positions using the careers & employment information that is posted on many Internet employment websites.

These graduates will begin to suspect that a great career is ahead of them, when they see the pay scales offered in some of the careers and employment information that they see. Some of these young graduates might not be totally familiar with what a yearly salary should be in their field, and will take the careers and employment information about pay and benefits when they are first offered, without giving it a second thought.

There are many companies that are listed on these employment websites, and all of them are interested in hiring people with stellar qualifications, and they are clearly focused on getting them hired on with their company at the lowest salary price possible. They are not concerned with the careers and employment opportunities that these people have dreamed of for such a long time.

These employment office hiring specialist are interested in the employment information that is contained on their resumes though. They are looking for the best value return on their hiring dollars, and generally prefer to hire people with a lot of experience in the position that they are hiring for.

Many of these career opportunities can be found using the search engines that are offered on many Internet websites. If a person is interested in working for a Government agency, then all they would need is to find the government website that lists all of the careers and employment information for the positions that they are hiring for.

The career information that Government agencies list might be very brief in nature and may seem incomplete. Government hiring agencies will generally list the date that the position became opened, and will also provide the closing date that it will use to determine the last day that applicants can send in their applications.

A position description is normally part of the employment description that is provided on a Government job notice. Any other pertinent requirement to make a suitable application will also be listed in the careers & employment information on the Government website.

Some of the information provided on Government job announcements will also provide preferences for military service too. These are definitely good paying positions of employment and the careers and employment information is always read completely before an interview.

The Top Tip For Career Employment and College Success

According to the study Workforce 2020, the number skill employers are seeking from college graduates is leadership closely followed by critical thinking, problem solving and team participation skills. Yet most career employment tips look to building impressive resumes to interviewing well because these more technical skills will get you on your path toward career employment. This belief is rooted in what I call the Osmosis learning factor because through absorption you will get everything you need.

The number one top tip for career employment and to secure college success is hardly if not rarely ever discussed. Why? Because those leading the discussion are just as clueless as those soon to be college graduates.

If you want college success (that being defined as graduating from college in 4 years and securing your ideal career employment, then your action is to write both a career and personal life plan. By taking this action, you are demonstrating leadership, critical thinking and problem solving skills.

Unfortunately, the majority of people in this country including college students place more value in the common written grocery list than they do planning their futures. Just think what happens when that written list of must buy items is left at home or the office?

* More money is spent
* More time is wasted
* More items are purchased that are not needed
* More emotions are wasted
* More energy is wasted

Let’s face it, the common written grocery list has more value than the future for the majority of citizens.

However this can be changed very quickly by establishing the goals you want for successful career employment and college success. For example, invest the time to writ down the following:

* Where do I see myself in 3 to 5 years?
* What company do I want to work for?
* What type of experience will I need?
* What type of person do I want to work for?
* How much money do I need to begin a successful career?

Then consider some or all of these action items:

1. Do you research about the industry, the job, the company and the people who work or are connected to the company (Career Coaching Tip: The Internet makes this far simpler than in years past.)
2. Begin using social media to connect with these individuals especially LinkedIn since this site is visited by more business people and recruiters than any other site. (Career Coaching Tip: Make sure your LinkedIn profile is 100% complete. Do not use your summary section as a resume. This is a big mistake. Your summary is where you share your compelling story, where you market without selling yourself, and also includes some results if possible.)
3. Start if you have not and continue business to business networking so that you begin to establish and further develop critical future business relationships
4. Make sure you have the sales skills, yes sales skills because this is all about the company buying you. (Career Coaching Tip: Everyone is in sales. It’s just some people get paid to be sales people.)
5. Invest the time to practice your communication skills with others such as friends, family members and even professional colleagues in the business world not necessarily the academic world. (Career Coaching Tip: Your non-verbal cues may torpedo any chances for that best job ever. Understand basic neuro-linguistic programming (NLP).)
6. Put together a schedule based upon your goals such as each Monday I will personally connect with 5 people, identify 5 positions, etc.
7. Work your plan and continue to plan your work by monitoring, measuring and managing your results

By being proactive you are now taking and creating your destiny because you have far more control that you probably realize. Through your predetermined thoughts and actions you are demonstrating you are a forward thinking leader and that is the first step to successful career employment and life success.

Houston Is A Transformed City After Dark

Rewind a decade back and we dare say that if someone suggested heading downtown Houston after dark, there would be many questions. There were not many reasons why one would actually leave the house for downtown.

Now, a decade later, the scene has changed. Everything’s so much more lively and fun downtown Houston. Charter bus, party bus or even luxury limousines are used for bar hopping adventures, bachelor parties or just a fun time with friends and family members. That is the kind of transformation that has seen Houston’s tourism industry growing by leaps and bounds. Tens of millions of people from out of town and foreign countries make their way here all year round. The pleasant year-long weather has a huge role to play for that decision.

A huge financial push in the real estate industry – One of the biggest reasons for the sudden tourism boom is the real estate industry. More people, more fun, more entertainment. Another great transformation is the pumping of funds into maintaining, developing and promotion of some of the largest tourist attractions in the city like the Minute Maid Park, Toyota Center and not to mention world class parks like the Discovery Green Park.

Bayou, where worlds meet – Although the public transportation system in Houston is mostly reliable and affordable, it makes more sense for large groups to make use of charter buses when visiting crowded attractions during the holidays. Wide acceptance of Houston’s growth was encouraging; hence the emergence of places like Bayou Place. Bayou is a vibrant place which was opened up in 1997 and measures, according to official stats, up to one hundred and thirty thousand square feet in total. It is the place where tourist can find all sorts of entertainment, including theaters, malls, comedy shows, restaurants, cafes, and night spots too. During peak periods, parking can be a huge problem and that is when using a Houston charter bus comes highly recommended.

Mosaic – DJing things up – If you are heading over looking for a fun nightspot, then consider Rocbar or Mosaic. These are DJ hot spots, which mean that there is often a showcase or showdown between talented DJs all year round. It is classy and casual at the same time. Big names in the DJ world has made their way here before in the past and who knows, you might get lucky and get to spend the night listening to a popular DJ spinning the songs out for you all night long while you enjoy your drinks.

Things have definitely changed for Houston and it is really more apparent during the night. No longer are the locals considered low-laying individuals with no time for partying, it is now a vibrant city filled with young people looking out for fun things to do too.

Small Business Web Design – Enhance Online Presence

With an efficiently designed website, small business dealers can create a good impression and attract more people to their business. Small business web design services are now provided by leading companies in the field which aim at enhancing the online presence of their clients, thereby bringing more visitors to these websites.

Small business web design companies utilize the services of web developers and talented SEO professionals. Depending on the business owners’ needs, they carry out any sort of web design including data driven, custom, multimedia, flash, and E commerce. These providers can also redesign your existing website for a better look.

With creatively designed websites, proper communication with the website visitors can be attained. An ideal designer highlights the company products and information, appropriately blending graphics and advertising tools. Web designers take care of all aspects involved such as planning, designing, page layout and final finishing touches.

Besides having search engine optimized content, websites have to be effectively designed if you want to attract the right people to your business. To draw more customers, web designers normally utilize effective web design tools. Java, Flash, Video, Audio, CSS based and fast loadable websites are designed by the professionals. Incorporating innovative technology programs such as XML, MySQL, XHTML, PHP, and Javascript, they provide attractive website designs.

Professional website designing is available for all kinds of websites such as those dealing with real estate, finance, E-commerce, education, medicine, family, teens and more. Nowadays these services are available at economical rates to meet the needs of small businesses and home based businesses.

A perfectly designed website will be search engine friendly, meta tag optimized and properly linked with the other pages. So, if you wish to redesign your existing website or are planning to design a new one for your small business, ensure that you associate with a reliable and experienced web design service provider.

Airport Apps: A Win-Win for the Travel Industry

Unpredictable weather, long security lines and extremely time sensitive logistical planning makes it easy to imagine that your last trip to the airport could have involved overstressed airport staff rescheduling a flight for a bunch of cranky travelers that cannot understand why they have to spend the night in Frankfurt and pay 10 euros for a 4-pack of batteries.

It’s not the same at every airport, but I have a feeling we’ve all been there at some point in our travel history. This being said, mobile apps provide airports with a huge opportunity to simplify the travel experience as well as provide travel services and tools to minimize stress.

Receive delay notifications on your mobile before leaving the house
Look for alternative flights when your flight is cancelled
Pre-purchase your ticket for the Heathrow Express on your tablet
Breeze through security with your digital boarding pass
Forward yourself your flight, hotel and car rental info an automatically create a travel itinerary
Snap a pic of your parking spot and tag on a map with GPS
Receive a discount coupon from Starbucks after checking-in at the airport via Facebook

What’s really exciting about this space is that all the features listed above already exist and would impact your travel experience in such a positive way.

But if you took a second to think about what’s to come with NFC, QR codes and ERP solutions – mobile could literally revolutionize what we know today as ‘just another trip to the airport.’

Airport apps: It’s win-win

While the ‘Time Killer App’ you played during your 2-hour delay in Amsterdam was a life-saver, the reality now-a-days is that we are always connected to our mobile devices. Airports can take advantage of this opportunity to positively impact their bottom line pre-during-and-post travel by:

Leveraging the unique power of mobile to increase revenue generation
Creating a richer channel for affiliate merchants to reach the consumer
Anticipating delay drivers, plan preventive actions and take recovery measures
Providing cutting edge customer service

http://www.amadeus.com/airlineIT/the-always-connected-traveller/docs/mobile_infographic.jpg

This means push notifications for final boarding calls, rich promotional splash pages for seasonal offers, coupon system for airport shops, integrating booking engines for flights, hotels and transportation as well as providing city guides, airport maps and weather information for all arrival and departure cities.

How to get it right

This is a business critical app that would differentiate any airport from its peers if it effectively aligned business priorities with the evolving needs of their customers.

Accurate real-time data mixed with valuable content
Entice travelers to purchase and pre-reserve products or services
Ensure travelers get the most out of their airport visit

From there – the sky is the limit.

Alcohol Addiction Facts ? Rehab

If you are suffering from an alcohol addiction, you are not alone. Alcoholism is a word that sometimes has negative social connotations, and just because a person drinks alcohol does not mean that they are an alcoholic. The amount of alcohol consumed varies greatly from person to person that develops alcoholism, and is also affected by genetic predisposition, and social and emotional health. Alcohol by definition is a disease that results from a persistent use of alcohol despite negative personal, emotional, financial, and professional consequences. Heavy alcohol use accompanied by dependence and symptoms of withdrawal, and the inability to recognize that every bad thing has been related to an alcohol addiction.

The sometimes uncontrollable urge to drink leads to constant preoccupation with the drug. Also leads to arrests for drunk driving and extra expenses for a good dui lawyer

According to numerous online sources, the most common substance of abuse resulting in dependence in patients presenting for treatment is alcohol. Overcoming an addiction to anything can be difficult, but there is help and hope available to people who want to stop drinking and get their lives back on track. The mind is more powerful than any drug, and to discover this is to truly be on the road to recovery. Addicts have to make a conscious choice to get and stay sober, one day at a time, and learn how to control the cravings. It’s not something that can be done alone, which is why there are treatment facilities all over the country, most of which are privately owned substance abuse recovery centers. The philosophy of AA or Alcoholics Anonymous has proven to be helpful to many alcoholics in their fight against alcohol addiction, and the program is often used as an adjunct treatment with other therapies, such as in an inpatient setting. AA also encourages communication with a sponsor to help guide the addict through the recovery process, and provide support while working through the program.

Learn more about effects of alcohol as well as alcohol facts and the truth about alcohol addiction and drunk driving. Some online literature discusses at length what drives alcohol addiction, detailing the effects of alcohol and describes some of the research being done to correct drinking problems. Alcohol continues to be the most greatly abused substance despite the wide-spread negative consequences. Even after public outbursts, divorce, loss of employment, revocation of driving privileges, and loss of life and limb, alcoholics continue to drink because it is so highly addicted in people who are predisposed to this disease. If you or someone you know is giving part of their life to alcohol, encourage them to get help. It may take a series of bad events to get the point across, and for many alcoholics, this is what it takes to see their illness in a different light.