“Hemochromatosis is a metabolic disorder that affects over 1 million Americans.”

HEMACHROMATOSIS.org

Hemochromatosis is a disorder where too much iron builds up in your body. Sometimes it’s called “iron overload.”   Hemo meaning blood and chromatosis means pigmentation specifically : deposit of pigment in a normally unpigmented area or excessive pigmentation in a normally pigmented site.

Normally, your intestines absorb just the right amount of iron from the foods you eat. But in hemochromatosis, your body absorbs too much, and it has no way to get rid of it. So, your body stores the excess iron in your joints and in organs like your liver, heart, and pancreas. This damages them. If it’s not treated, hemochromatosis can make your organs stop working.

There are two types of this condition — primary and secondary.

Primary hemochromatosis is hereditary, meaning it runs in families. If you get two of the genes that cause it, one from your mother and one from your father, you’ll have a higher risk of getting the disorder.

Secondary hemochromatosis happens because of other conditions you have. These include:

• Certain kinds of anemia
• Liver disease
• Getting a lot of blood transfusions
• White people of northern European descent are more likely to get hereditary hemochromatosis. Men are 5 times more likely to get it than women.
  

  Symptoms

  Up to half of people who have hemochromatosis don’t get any symptoms. In men, symptoms tend to show up between ages 30 and 50. Women often don’t show signs of this condition until they’re over 50 or past menopause. That may be because they lose iron when they get their periods and give birth.

  Symptoms of hemochromatosis include:

  • Pain in your joints, especially your knuckles
  • Feeling tired
  • Unexplained weight loss
  • Skin that has a bronze or gray color – pigmentation
  • Pain in your belly
  • Loss of sex drive
  • Loss of body hair
  • Heart flutter
  • Foggy memory

  Sometimes people don’t get any symptoms of hemochromatosis until other problems arise. These may include:

  • Liver
  • Diabetes
  • Abnormal heartbeat
  • Arthritis
  • Erectile dysfunction (difficulty having a erection)

  If you take a lot of vitamin C or eat a lot of foods that contain it, you can make hemochromatosis worse. That’s because vitamin C helps your body absorb iron from food.

  White people of northern European descent are more likely to get hereditary hemochromatosis. Men are 5 times more likely to get it than women.

   

“Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms as well as treatments. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid. In rare instances, diseased heart muscle tissue is replaced with scar tissue.”

American Heart Association

Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure.

The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices or, in severe cases, a heart transplant —this would all depend on which type of cardiomyopathy you have and how serious it is.

Symptoms

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

• Breathlessness with exertion or even at rest
• Swelling of the legs, ankles and feet
• Bloating of the abdomen due to fluid buildup
• Cough while lying down
• Fatigue
• Heartbeats that feel rapid, pounding or fluttering
• Chest discomfort or pressure
• Dizziness, lightheadedness and fainting

Signs and symptoms tend to get worse unless treated. In some people, the condition worsens quickly; in others, it might not worsen for a long time.

When to see a doctor

See your doctor if you have one or more signs or symptoms associated with cardiomyopathy. Call 911 or your local emergency number if you have severe difficulty breathing, fainting or chest pain that lasts for more than a few minutes.

Because some types of cardiomyopathy can be hereditary, if you have it your doctor might advise that your family members be checked.

Causes

Often the cause of the cardiomyopathy is unknown. In some people, however, it’s the result of another condition (acquired) or passed on from a parent (inherited).

Contributing factors for acquired cardiomyopathy include:

• Long-term high blood pressure
• Heart tissue damage from a heart attack
• Chronic rapid heart rate
• Heart valve problems
• Metabolic disorders, such as obesity, thyroid disease or diabetes
• Nutritional deficiencies of essential vitamins or minerals, such as thiamin (vitamin B-1)
• Pregnancy complications
• Drinking too much alcohol over many years
• Use of cocaine, amphetamines or anabolic steroids
• Use of some chemotherapy drugs and radiation to treat cancer
• Certain infections, especially those that inflame the heart
• Iron buildup in your heart muscle (hemochromatosis)
• A condition that causes inflammation and can cause lumps of cells to grow in the heart and other organs (sarcoidosis)
• A disorder that causes the buildup of abnormal proteins (amyloidosis)
• Connective tissue disorders

Types of cardiomyopathy include:

• Dilated cardiomyopathy. In this type of cardiomyopathy, the pumping ability of your heart’s main pumping chamber — the left ventricle — becomes enlarged (dilated) and can’t effectively pump blood out of the heart.Although this type can affect people of all ages, it occurs most often in middle-aged people and is more likely to affect men. The most common cause is coronary artery disease or heart attack.
• Hypertrophic cardiomyopathy. This type involves abnormal thickening of your heart muscle, particularly affecting the muscle of your heart’s main pumping chamber (left ventricle). The thickened heart muscle can make it harder for the heart to work properly.Hypertrophic cardiomyopathy can develop at any age, but the condition tends to be more severe if it becomes apparent during childhood. Most affected people have a family history of the disease, and some genetic mutations have been linked to hypertrophic cardiomyopathy.
• Restrictive cardiomyopathy. In this type, the heart muscle becomes rigid and less elastic, so it can’t expand and fill with blood between heartbeats. This least common type of cardiomyopathy can occur at any age, but it most often affects older people.Restrictive cardiomyopathy can occur for no known reason (idiopathic), or it can by caused by a disease elsewhere in the body that affects the heart, such as when iron builds up in the heart muscle (hemochromatosis).
• Arrhythmogenic right ventricular dysplasia. In this rare type of cardiomyopathy, the muscle in the lower right heart chamber (right ventricle) is replaced by scar tissue, which can lead to heart rhythm problems. It’s often caused by genetic mutations.
• Unclassified cardiomyopathy. Other types of cardiomyopathy fall into this category.

Risk factors

There are a number of factors that can increase your risk of cardiomyopathy, including:

• Family history of cardiomyopathy, heart failure and sudden cardiac arrest
• Long-term high blood pressure
• Conditions that affect the heart, including a past heart attack, coronary artery disease or an infection in the heart (ischemic cardiomyopathy)
• Obesity, which makes the heart work harder
• Long-term alcohol abuse
• Illicit drug use, such as cocaine, amphetamines and anabolic steroids
• Certain chemotherapy drugs and radiation therapy for cancer
• Certain diseases, such as diabetes, an under- or overactive thyroid gland, or a disorder that causes the body to store excess iron (hemochromatosis)
• Other conditions that affect the heart, such as a disorder that causes the buildup of abnormal proteins (amyloidosis), a disease that causes inflammation and can cause lumps of cells to grow in the heart and other organs (sarcoidosis), or connective tissue disorders

Complications

Cardiomyopathy can lead to other heart conditions, including:

• Heart failure. Your heart can’t pump enough blood to meet your body’s needs. Untreated, heart failure can be life-threatening.
• Blood clots. Because your heart can’t pump effectively, blood clots might form in your heart. If clots enter your bloodstream, they can block the blood flow to other organs, including your heart and brain.
• Valve problems. Because cardiomyopathy causes the heart to enlarge, the heart valves might not close properly. This can lead to a backward flow of blood.
• Cardiac arrest and sudden death. Cardiomyopathy can lead to abnormal heart rhythms. These abnormal heart rhythms can result in fainting or, in some cases, sudden death if your heart stops beating effectively.

Prevention

In many cases, you can’t prevent cardiomyopathy. Let your doctor know if you have a family history of the condition.

You can help reduce your chance of cardiomyopathy and other types of heart disease by living a heart-healthy lifestyle and making lifestyle choices such as:

• Avoiding the use of alcohol or cocaine
• Controlling high blood pressure, high cholesterol and diabetes
• Eating a healthy diet
• Getting regular exercise
• Getting enough sleep
• Reducing your stress

“The number of overweight or obese infants and young children (aged 0 to 5 years) increased from 32 million globally in 1990 to 41 million in 2016. In the WHO African Region alone the number of overweight or obese children increased from 4 to 9 million over the same period.

The vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries.”

World Health Organization (WHO)

It is shown that there are high rates of obesity worldwide which have been attributed to a combination of genetics and environment. Myriad environmental exposures may contribute to obesity, including calorie-rich diets, sedentary behavior, stress, and overuse of antibiotics. Just as important as the types of exposures is the timing. The period from conception to adolescence is known to be especially sensitive to obesity risks influenced by maternal fitness and childhood diet and physical activity. Parental experiences and fitness before conception, generational effects, and early-life events can also affect adult health.

The “CDC-Centers for disease control and prevention” have obesity facts they present as follows:

• “Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.
• The prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents.
• The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012, now 18.4%.   Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period, now is 20.6%.
• In 2012, more than one third of children and adolescents were overweight or obese.
• Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.
• Obesity is defined as having excess body fat.
• Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.”

WEB M.D. states “One third of children in the U. S. is overweight or obese, and this number is continuing to rise. Children have fewer weight-related health and medical problems than adults. However, overweight children are at high risk of becoming overweight adolescents and adults, placing them at risk of developing chronic diseases such as heart disease and diabetes later in life. They are also more prone to develop stress, sadness, and low self-esteem.

Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. A physical exam and some blood tests can rule out the possibility of a medical condition as the cause for obesity.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors such as eating and activity habits.

A child’s total diet and activity level play an important role in determining a child’s weight. Today, many children spend a lot time being inactive. For example, the average child spends approximately four hours each day watching television. As computers and video games become increasingly popular, the number of hours of inactivity may increase.”

The effects of childhood obesity impact a short time (if handled quick enough and obesity resolved) as opposed to a long lifetime of obesity. Childhood obesity has both immediate and long-term effects on a person’s health and well-being.

Presently by CDC, they state in this topic the following:

Childhood obesity is a serious problem in the United States putting children and adolescents at risk for poor health. Obesity prevalence among children and adolescents is still too high.

For children and adolescents aged 2-19 years¹:

• Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%).
• Non-Hispanic Asians (11.0%) had lower obesity prevalence than non-Hispanic blacks and Hispanics.

Here are childhood effects that can occur:

• Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease versus if one of your parents has cardiac disease one out of a 4 children family are at risk of getting it (25%) just based on the parents history.
• Obese adolescents are more likely to have pre-diabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.
• Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

Long-term health effects that can occur:

• Children and adolescents who are obese are likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.  One study showed that children who became obese as early as age 2 were more likely to be obese as adults. Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.
• One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of your entire family. Treating and preventing childhood obesity helps protect the health of your child now and in the future.

The KEY to stopping childhood obesity into adulthood from is through Prevention (which starts in childhood):

• Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.
• The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries.
• Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors.

To prevent obesity and overweight in children we need our communities throughout the world to:

• Promote improvements to the nutritional value of the food children eat in schools, child care centers and after-school programs.
• Support increasing children’s physical activity through improved compliance with physical education mandates by New York City schools, as well as through making physical activities available in after-school programs and City parks and playgrounds.
• To increase education for children and parents about good nutrition, why healthy food choices are important, and how to combat obesity.
• To support efforts that help all in every state of America and in the world making healthy food choices, such as laws eliminating trans-fats, and policies to tax or limit the sizes of sugary beverages. Which has already started in many areas but we need to keep doing it and making it stronger for the children health now in their future.

“Acute lower respiratory infections include pneumonia (infection of the lung alveoli), as well as infections affecting the airways such as acute bronchitis and bronchiolitis, influenza and whooping cough. They are a leading cause of illness and death in children and adults across the world. The importance of lower respiratory infections may be underestimated.”

European Lung Foundation – ELF

Acute lower respiratory infections are a leading cause of sickness and mortality both in children and adults worldwide. Unfortunately, acute lower respiratory infections are not uniformly defined and this may hamper a true appreciation of their epidemiological importance. From an epidemiological point of view, the definition of acute lower respiratory infections usually includes acute bronchitis and bronchiolitis, influenza and pneumonia.

Lower respiratory tract infection (LRTI), while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue.

There are a number of symptoms that are characteristic of lower respiratory tract infections. The two most common are bronchitis and edema

Acute bronchitis can be defined as an acute illness that occurs in a patient without chronic lung disease. Symptoms include cough (productive or otherwise) and other symptoms or clinical signs that suggest lower respiratory tract infection with no alternative explanation (e.g. sinusitis or asthma).

Bronchiolitis is the most common lower respiratory tract infection and the most common cause of admission to hospital in the first 12 months of life.

Influenza affects both the upper and lower respiratory tracts.

Antibiotics are the first line treatment for pneumonia; however, they are not effective or indicated for parasitic or viral infections. Acute bronchitis typically resolves on its own with time.

“Stay away from me! I don’t want to get sick, too.” Most of us have had to utter those words to a family member, friend, or colleague who was sneezing or coughing incessantly. But how do we know how great the chances of catching someone’s cold or other illness really are? A medical review published in the New England Journal of Medicine tells us when to exercise concern over eight respiratory tract infections.

You can do a number of things to help prevent infection:

• Avoid close contact with people who are ill with infections spread through large-droplets.
• Unless ventilation is good, avoid shared space with people who are ill with infections spread through tiny-droplets.
• Wash your hands after greeting someone with a viral infection or after handling an object held by someone infected with Bronchiolitis or a cold.
• Encourage children to wash their hands. Kids are more likely than adults to spread infection within a family.

“Anyone can get MRSA; MRSA most often causes skin infections but can cause pneumonia (lung infection) & other infections.  In 2017, VRE caused an estimated 54,500 infections among hospitalized patients and 5,400 estimated deaths in the United States.  Whose most likely at risk for either MRSA or VRE?  People who have been previously treated with antibiotics, including vancomycin, for long periods of time, people who are hospitalized, have undergone surgical procedures, or have medical devices inserted in their bodies (such as catheters), people with weakened immune systems.”

Centers of Disease Control and Prevention

1-MRSA Infection

Methicillin-resistant Staphylococcus aureus (MRSA), also known as multidrug resistant S. aureus, includes any strain of S. aureus that has become resistant to the group of antibiotics known as beta-lactam antibiotics. Included in this group are the penicillins (methicillin, amoxicillin, oxacillin) and cephalosporins. Staphylococcus aureus includes gram-positive, nonmotile, non-spore-forming cocci that can be found alone, in pairs, or in grapelike clusters.

Methicillin-resistant Staphylococcus aureus.

When penicillin was first introduced in the early 1940s, it was considered to be a wonder drug because it reduced the death rate from Staphylococcus infection from 70% to 25%. Unfortunately, by 1944, drug resistance was beginning to occur, so methicillin was synthesized, and, in 1959, it became the world’s first semisynthetic penicillin. Shortly thereafter in 1961, staphylococcal resistance to methicillin began as well, and the name “methicillin-resistant S. aureus” and the acronym MRSA were coined. Although methicillin was discontinued in 1993, the name and acronym have remained because of MRSA history.

MRSA is now the most common drug-resistant infection acquired in healthcare facilities. In addition to becoming more problematic as a top HAI in recent years, transmission of MRSA has also become more common in children, prison inmates, and sports participants. Community-associated MRSA (CA-MRSA) most often presents in the form of skin infections (see Figure 5). Hospital-acquired MRSA (HA-MRSA) infections manifest in various forms, including bloodstream infections, surgical site infections, and pneumonia. Although approximately 25–30% of persons are colonized in the nasal passages with Staphylococcus, less than 2% are colonized with MRSA.

MRSA are extremely resistant and can survive for weeks on environmental surfaces. Transfer of the pathogen can occur directly from patient contact with a contaminated surface or indirectly as healthcare workers touch contaminated surfaces with gloves or hands and then touch a patient.

Risk factors for healthcare-acquired MRSA infection include advanced age, young age, use of quinolone antibiotics, and extended stay in a healthcare facility. Those with diabetes, cancer, or a compromised immune system are also at increased risk of infection.

Symptoms of MRSA infection vary depending on the type and stage of infection and the susceptibility of the organism. Skin infections may appear as painful, red, swollen pustules or boils; as cellulitis; or as a spider bite or bump. They can be found in areas where visible skin trauma has occurred or in areas covered by hair. Patients may also have fever, headaches, hypotension, and joint pain. Complications of MRSA-related skin infections include endocarditis, necrotizing fasciitis, osteomyelitis, and sepsis.

Patient history of admission to a healthcare facility is useful in diagnosing HA-MRSA. Definitive diagnosis of MRSA is made by oxacillin/methicillin resistance that is shown by lab culture and susceptibility testing. Specimens submitted for testing vary depending on the site of suspected infection and may include tissue, wound drainage, sputum, respiratory secretions, and blood or urine cultures.

Treatment for MRSA infections varies based on site of infection, stage of infection, and age of the individual. Treatment includes drainage of abscesses, surgical debridement, decolonization strategies, and antimicrobial therapy with antibiotics such as vancomycin #1 in alot of cases, clindamycin, daptomycin, linezolid, rifampin, trimethoprim-sulfamethoxazole (TMP-SMX), quinupristin-dalfopristin, telavancin, and tetracyclines (limited use). MRSA is rapidly becoming resistant to rifampin; therefore, this drug should not be used alone in the treatment of MRSA infections. Consultation with an infectious disease specialist is recommended for treatment of severe MRSA infections.

The CDC recommends healthcare personnel follow these guidelines to help prevent MRSA infections:

• Follow procedures to recognize previously colonized and infected patients.
• Follow appropriate hand hygiene practices and isolation precautions (see discussion on hand hygiene and isolation precautions later in this course). The CDC has not made a recommendation on when to discontinue contact precautions. Healthcare workers should check with their individual institution’s infection control policies.
• Place patients in single rooms, or, if a single room is not available, cohort patients with the same MRSA in the same room or in the same patient care area. If cohorting patients with the same MRSA is not possible, place MRSA patients in rooms with patients who are at low risk for acquisition of MRSA and are likely to have short lengths of stay.
• Keep skin wounds of MRSA patients clean and covered until healed.
• Handle equipment and instruments/devices used for MRSA patients appropriately, with care and attention to disinfection according to institution infection control policy. Ensure that equipment is properly cleaned and disinfected before being used with another patient.

2-VancoResistantEnterococci

Vancomycin-Resistant Enterococci Infection (VRE)

Enterococci (formerly known as Group D streptococci) are non-spore-forming, gram-positive cocci that exist in either pairs or short chains. They are commonly found in the human intestine or the female genital tract. The most common organism associated with vancomycin-ressistant enterococci (VRE) infection in hospitals is Enterococcus faecium. Enterococcus faecalis is also a cause of human disease. VRE infections can occur in the urinary tract, in wounds associated with catheters, in the bloodstream, and in surgical sites. Enterococci are a common cause of endocarditis, intra-abdominal infections, and pelvic infections.

VRE was first reported in Europe in 1986, followed in 1989 by the first report in the United States. Since then it has spread rapidly. Between 1990 and 1997, the prevalence of VRE in hospital patients increased from less than 1% to 15%.

VRE, which is found predominantly in hospitalized or recently hospitalized patients, are difficult to eliminate because they are able to withstand extreme temperatures, can survive for long periods on environmental surfaces, and are resistant to vancomycin. Transmission of VRE occurs most commonly in the form of person-to-person contact by the hands of healthcare workers after contact with the blood, urine, or feces an infected individual. VRE is also spread from contact with environmental surfaces, or through contact with the open wound of an infected person.

People most at risk for infection with VRE include the elderly and those with diabetes, those with compromised immune systems, and those who are already colonized with the bacteria. Prolonged hospitalization, catheterization (urinary and intravenous), and long-term use of vancomycin or other antibiotics also increase a person’s risk of infection.

Symptoms of VRE infection vary depending on the site of infection and may include erythema, warmth, edema, fever, abdominal pain, pelvic pain, and organ pain. Definitive diagnosis is made by culture and susceptibility testing with specimens obtained from suspected sites of infection. Treatment of VRE infection may include drainage of abscesses; removal of prosthetic devices, IV lines, or catheters; and antibiotic therapy with one or more appropriate antibiotics that show activity against VRE. Consultation with an infectious disease specialist is recommended for treatment of patients with serious infections or VRE that is resistant to other antibiotics.

To prevent infection from VRE, the CDC recommends healthcare professionals use vancomycin prudently and promptly detect and report VRE infections. Healthcare providers in direct contact with patients should follow steps for proper hand hygiene and contact precautions (see the discussion on these topics later in this course).