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F. Grubuz, MD

Medical Instructor, University of California, Merced School of Medicine

In our society also even though its health impacts are not so pronounced it still has series health damage. Tobacco smoking affects not only those who are actively smoking but it also has an adverse consequence on the health of those who are by the vicinity of the smoker. Active Smoking and disease the cigarette smoke that is taken through the mouth into the lung has several types of chemicals that have diverse & serious effects on our health. The composition depends on the type of tobacco, length of the cigarette, and presence and effectiveness of filter tips. Usually present are (1) Carcinogens whose effects have been verified in lower animals. And the less common effects are peptic ulcer, Cancer that can originate from larynx, esophagus, pancreas, bladder & kidneys. Systemic arteriosclerosis and other forms of cancer are also diseases caused by cigarette smoking, which collectively contribute to many deaths. In general smoking is the single most important cause of cancer mortality in the United States. Several studies have shown that maternal smoking could cause low birth weight, prematurity, still birth and infant mortality. Moreover other complications of pregnancy like abruptio placentae, placenta previa, and premature rupture of membranes have been found to be caused by maternal smoking. Coronary heart disease causes most of the deaths 238 when it comes to effects of cigarette smoking. Involuntary smoke exposure (Passive Smoking) the effect of passive smoking has been identified during the last few decades. Its effect comes when non-smoking people inspire the ambient air, which is polluted by cigarette smoke. The health impact depends on the volume of the air in the room, number of active smokers, rate of air exchange and duration of exposure. Children & infants of smoking mothers will have an obvious intense exposure and hence retardation of physical and intellectual growth is likely to occur. Benefits of cessation or reducing exposure to cigarette smoke When a person stops smoking the risks of diseases and subsequent death start to decline the risk to reach to that of non-smoking people may take 20 years of smoke-free period. The amount of cigarettes smoked daily, and duration of smoking determines the rate of decrease of risks. The relative risk of lung cancer and laryngeal cancer start to decline after 1 to 2 smoke free years. However considering lung cancer former smokers will have slightly higher risk than non-smokers even after 30 years of smoke-free years. When it comes to coronary diseases the decline of risk is rapid and it can level with those of non-smokers after 5 to 20 years. Chemical & Drug injury Injuries due to chemicals can be from therapeutic agents and nontherapeutic agents. Adverse drug reactions Injuries due to therapeutic agents are known as adverse drug reactions. Adverse drug reactions are any response to a drug that is noxious and unintended and that occurs at doses used in humans for prophylaxis, diagnosis, or therapy. Exaggeration of the intended pharmacologic effect which are largely predictable effects 2. The 1st one-encompasses all adverse reactions, which result from use of powerful drugs used to treat potentially fatal diseases like cancer. For example use of large dose daunorubicin or doxorubicin to treat some forms of cancer may cause cardiotoxicity. The reactions is called idiosyncrasy and is due to an abnormal immunologic response to the drug or un predictable cytotoxicity caused by the drug. Possible examples will be extensive hepatic necrosis, which develops after intake of therapeutic dose of acetaminophen, or anaphylaxis, which develop after therapeutic dose of penicillin. Non-therapeutic agents Ethyl alcohol A large percentage of our population is a social drinker and still a significant number of individuals are alcoholic or alcohol dependent. Alcohol has an obvious acute effect but has also an effect of a long-standing use of alcohol on organs and tissues.

Identifying the ways by which obesity, unhealthy diet, and physical inactivity increase cancer risk and quantifying the magnitude of such risks are areas of active research investigation (161). Beyond cancer, obesity increases the risk of developing several other health problems including type 2 diabetes, high blood pressure, heart disease, stroke, liver disease, and kidney disease (169). In the United States, 42 percent of adults age 20 and older were obese in 2018, and according to a recent projection, by the year 2030, nearly 50 percent of all U. Three percent of overall cancer cases in the United States can be attributed to physical inactivity (110). According to a recent report, being sedentary (inactive) for 13 or more hours per day can increase the risk of dying from cancer by 82 percent (194). Engaging in recommended amounts of physical activity can lower the risks for developing nine types of cancer (see Figure 8, p. For example, research shows that replacing just 30 minutes of sedentary behavior with a moderately intense physical activity such as biking can reduce the risk of dying from cancer by 30 percent (194); running, even once a week, can significantly reduce the risk of dying from cancer and cardiovascular diseases (195). Considering this evidence, it is concerning that more than 1 in 7 adults across all U. It is imperative that health care professionals and policy makers work together to increase awareness of the benefits of physical activity and support efforts to implement programs and policies to facilitate a physically active lifestyle for all Americans. Future efforts focusing on public education and evidencebased policy interventions, such as regulating alcohol retail density, taxes, and prices, need to be implemented along with effective clinical strategies to reduce the burden of cancer related to alcohol abuse. Alcohol can also increase levels of estrogen and other hormones that are associated with breast cancer (204). Concurrent with increases in consumption, rates of alcohol-related deaths have also increased at an alarming rate (208)(209). Beyond the United States, alcohol poses a significant public health challenge globally. In fact, alcohol-use disorders are now the most prevalent of all substanceuse disorders worldwide (213), and in 2016, 4. These data underscore the 46 For Adults All adults should avoid inactivity; some physical activity is better than none. In the United States, melanoma incidence has been rising for decades among non-Hispanic whites (2)(218). Cancer survivors should consult their physicians and follow modified guidelines adapted for their specific cancers and treatment. The following are reference beverages that are one alcoholic drink-equivalent: Female Breast cancer Heavy Drinking: 4 drinks on any day or 8 drinks per week for women and 5 drinks on any day or 15 drinks per week for men Binge Drinking: 4 drinks within 2 hours for women and 5 drinks within 2 hours for men Liver cancer Colorectal cancer Excessive alcohol consumption, which includes binge drinking, heavy drinking, and any drinking by pregnant women or those under 21 years of age, was responsible for an average of 93,296 deaths each year in the United States, during 2011 to 2015 (210). However, according to a recent survey, while many of the survey respondents report being asked by their health care provider about alcohol consumption and binge drinking during checkups, 80 percent of these individuals received no advice to reduce their drinking (211). Notably, even in 2015, more than 35 percent of adults reported experiencing sunburns, in the past year, either through outdoor exposure or indoor tanning (222). It is also concerning that even though 68 percent of Americans know that skin cancer is the most common cancer in the United States, only 42 percent put sunscreen on parts of their bodies exposed to the sun (223). Continued efforts from all sectors are necessary to identify and implement more effective interventions to promote sun-safe behavior and reduce the burden of skin cancers. In the United States, about 3 percent of all cancer cases are attributable to infection with pathogens while globally, an estimated 13 percent of all cancer cases are attributable to infections (110)(226). Individuals can significantly lower their risks by protecting themselves from infection or by obtaining treatment, if available, to eliminate an infection (see sidebar on Preventing or Eliminating Infection with the Four Main Cancer-causing Pathogens, p. Compared to the health and economic benefits of a ban just for minors, the benefits from such a broader restriction are more than 3 times higher (225). The annual rate of hepatitis C infection has tripled between 2009 and 2018, with infection rates highest among individuals ages 20 to 39 (228). People with continued risk, such as injection drug use, need to be screened regularly. Moreover, recent data indicate that in addition to directly protecting individuals who receive the vaccine, increased levels of vaccination may also promote herd immunity among the unvaccinated (232). Adapted from (57) Kaposi sarcoma and non-Hodgkin lymphoma Anal, cervical, head and neck, larynx, oral, oropharyngeal, penile, vaginal, and vulvar cancers T-cell leukemia and lymphoma Skin cancer N/A 690,000 3,600 N/A data from Ref. A single shot regimen can potentially improve vaccination rates and reduce health care and associated costs.

In shock, the mean arterial pressure is less than 60 mmHg or the systolic blood pressure is less than 90 mmHg. The end results are hypotension followed by impaired tissue perfusion and cellular hypoxia. Reduction in circulating blood volume results in the reduction of the preload which leads to inadequate left ventricular filling, reflected as decreased left & right ventricular end diastolic volume and pressure. The reduced preload culminates in decreased cardiac out put which leads to widespread tissue perfusion (shock). Causes of hypovolumic shock include: a) b) c) d) e) Haemorrhage Diarrhoea & vomiting Burns Trauma etc the effect of haemorrhage depends on the rate and amount of blood loss. A normal healthy adult can lose 550ml (10%of blood volume) without significant symptoms. But loss of 25% or more of the blood volume (N=1250ml) results in significant hypovolemia. Cardiogenic shock Definition: this is shock that results from severe depression of cardiac performance. Usually shock occurs in this conditioin if 40% of the left ventricular mass & more on the right ventricle is involved by infarction. Mycocarditis Dilated cardiomyopathy/hypertrophic cardiomyopathy Myocardial depression in septic shock Etc. Aortic stenosis, hypertrophic cardiomyopathy b) Reduction in forward cardiac output E. Aortic or mitral regurgitation c) Arrhythmia ii) Extracardiac this can be called obstructive shock. Distributive shock Definition: Distributive shock refers to a group of shock subtypes caused by profound peripheral vasodilatation despite normal or high cardiac output. But before discussing septic shock in detail it would be useful to know some aspects of sepsis briefly. Bactermia is the presence of viable bacteria in the blood as evidenced by blood culture. Septicemia is systemic infection due the presence of microbes and their toxin the blood. Sepsis is a systemic response to severe infection mediated via macrophage-derived cytokines that target end organ receptors in response to infection. It results from the spread & expansion of an initially localized infection like pneumonia into the blood stream. Most causes of septic shock (~70%) are caused by endotoxin-producing gram-negative bacilli, hence the term endotoxic shock. Analogues molecules in the walls of grampositive bacteria & fungi can also elicit septic shock. Mechanisms o A variety of neurohumoral mechanisms operate: i) A decrease in cardiac output will stimulate peripheral & central baro receptors with subsequent intense sympatho-adrenal stimulation. The hypoxic cells leak glucose leading to insulin-resistant hyperglycaemia and increased glycogenolysis. In shock, there is widespread tissue hypoperfusion involving various organs such as the heart, brain, & kidney. In septic shock, the skin will initially be warm & flushed because of peripheral vasodilation.

Syndromes

• Iron deficiency
• Tropane alkaloids
• 2 tablespoons sugar or rice powder
• Lymph node aspiration
• The surgeon injects numbing medicine around the eye so you do not feel pain during the surgery.
• Paralysis
• Your child will usually be asked not to drink or eat anything after midnight the night before surgery.
• Do not use your injectable epinephrine on anyone else. They may have a condition (such as a heart problem) that could be negatively affected by this drug.
• Loss of hearing?
• Carpal tunnel syndrome

This case is not reportable since there is no indication that the patient has current disease. The discharge summary and face sheet states history of cancer and there is no other information within the chart to indicate active or stable disease. This case is not reportable because the patient has a history of cancer with no evidence of active disease. The patient had a mastectomy for breast cancer 8 years ago and there is no evidence of recurrent or metastatic disease. This case is not reportable because there is no indication that the patient has current disease. This case is not reportable because there is no information regarding whether the patient has current lung cancer. The physician orders state prostate cancer, but the bone scan report states no evidence of disease. Do not report this case since there is no evidence of disease and no mention of current treatment. The discharge summary states that the patient has recently been diagnosed with prostate cancer and is in the process of deciding treatment options. This case is reportable because even though the radiology report shows no abnormal findings, the discharge summary states the patient has prostate cancer. A patient was diagnosed with adenocarcinoma of the stomach in 1985 with no evidence of recurrent or metastatic disease. In 2018, the patient was admitted and diagnosed with small cell carcinoma of the lung. The lung cancer is reportable for 2018 because the patient has active lung cancer. All laboratory findings are negative for active disease, but one radiology report indicates active disease compatible with malignancy. This case is reportable because according to the radiology report the patient has active disease. The H&P states the patient was diagnosed with metastatic lung cancer four months prior to admission. A patient comes to your facility for port-a-cath insertion to allow for chemotherapy for a malignancy. This case is reportable because the patient has active disease and is receiving cancer directed therapy, even though the therapy may be given at a different facility. Patient with a recent excisional biopsy for melanoma of skin of arm is admitted to your facility for a wide excision. This case is reportable because the wide excision is considered treatment for the melanoma. She is still being treated with Tamoxifen which was part of the first course of treatment. Note: When Tamoxifen or other hormonal therapy, such as Arimidex, is used as adjuvant therapy for breast cancer it is generally prescribed for 5 years. It has been shown that when taken for 5 years it reduces the chance of the original breast cancer coming back in the same breast or metastasizing. It is known that the diagnosis of breast cancer was greater than 5 years ago and there is no evidence of disease, and no evidence of other treatment being given at the time of admit, it is not necessary to report the case. Report this case because the patient is on treatment that could be related to the history of prostate cancer. The physician orders state the patient was recently diagnosed with prostate cancer. Regardless of the results, report this case since the patient was stated to be recently diagnosed; the bone scan is being done for staging purposes. Summary If there is any indication within the medical record that the patient has evidence of disease, or is on cancer directed treatment, the case is reportable except for those morphologies listed under nonreportable neoplasms on page 47. This would include but not limited to radiology reports, pathology reports, consults, history and physicals, and clinic notes. Note: Use the 2018 Solid Tumor coding rules to determine the number of primaries to abstract and the histology to code for cases diagnosed 1/1/2018 and forward: seer. However, there will be times when a physician is not certain or the documented language is not definitive.