THE RESPIRATORY SYSTEM Chapter 12 Introduction Multimedia

Total Page:16

File Type:pdf, Size:1020Kb

THE RESPIRATORY SYSTEM Chapter 12 Introduction Multimedia THE RESPIRATORY SYSTEM Chapter 12 Memorise Understand Importance * Basic structures and function * Basic functions: thermoregulation, Medium level: 8% of GAMSAT Biology gas exchange, etc. questions released by ACER are related to * Protection against disease, particulate matter content in this chapter (in our estimation). * Breathing mechanisms: diaphragm, rib cage, * Note that approximately of the differential pressure; Henry’s Law 75% questions in GAMSAT Biology are related * Resiliency and surface tension effects to just 7 chapters: 1, 2, 3, 4, 7, 12, and 15. * The carbonic acid-bicarbonate buffer Introduction The respiratory system permits the exchange of gases with the organism's environment. This critical process occurs in the microscopic space between alveoli and capillaries. It is here where molecules of oxygen and carbon dioxide passively diffuse between the gaseous external environment and the blood. As you have done before, get familiar with the basics and then the practice questions will have you exercising your reasoning and graph-analysis skills which you can apply to many other GAMSAT-question types and topics. Multimedia Resources at GAMSAT-Prep.com Open Discussion Boards Flashcards Special Guest THE BIOLOGICAL SCIENCES BIO-227 12.1 Overview There are two forms of respiration: cel- • the filtration of incoming particles lular respiration which refers to the oxidation • to help control the water content and of organic molecules (see BIO 4.4 - 4.10) temperature (= thermoregulation) of the and mechanical respiration where the gases incoming air related to cellular respiration are exchanged to assist in speech production, the between the atmosphere and the circulatory • sense of smell, and the regulation of pH. system (O2 in and CO2 out). The respiratory system is composed of The respiratory system, which is con- the lungs and a series of airways that connect cerned with mechanical respiration, has the the lungs to the external environment, deliver following principal functions: air to the lungs and perform gas exchange. • providing a conducting system for the exchange of gases 12.2 The Upper Respiratory Tract The respiratory system can be divided space behind the nose, contains a ciliated into an upper and lower respiratory tract mucous membrane (= a form of respiratory which are separated by the pharynx. The epithelium) to entrap smaller particles and upper respiratory tract is composed of the prevent infection (this arrangement is com- nose, the nasal cavity, the sinuses, and the mon throughout the respiratory tract; for cilia Medium-level Importance nasopharynx. This portion of the respiratory see the Generalised Eukaryotic Cell, BIO system warms, moistens and filters the air 1.2). The nasal cavity adjusts the humid- before it reaches the lower respiratory sys- ity and temperature of incoming air. The tem. The nose (nares) has receptors for the nasopharynx helps to equilibrate pressure sense of smell. It is guarded by hair to entrap between the environment and the middle ear coarse particles. The nasal cavity, the hollow via the eustachian tube (BIO 6.2.3). 12.3 The Lower Respiratory Tract The lower respiratory tract is com- into smaller airways (→ 2o bronchi → 3o bron- posed of the larynx which contains the vocal chi → bronchioles → terminal bronchioles). cords, the trachea which divides into left and The terminal bronchioles are the most distal right main bronchi which continue to divide part of the conducting portion of the respira- BIO-228 CHAPTER 12: THE RESPIRATORY SYSTEM GAMSAT MASTERS SERIES Figure IV.A.12.1: Illustra- Medium-level Importance tion representing the lower respiratory tract including the Figure IV.A.12.2: Chest x-ray of an adult male smoker. dividing bronchial tree and Notice the coin-shaped shadow in the right lung which grape-shaped alveoli with presented with coughing blood. Further tests confirmed blood supply. Note that “right” the presence of a right lung cancer. Cancer-causing refers to the patient’s perspective which means the left side from your chemicals (carcinogens) can irritate any of the cells lin- perspective. ing the lower respiratory tract. tory system. Starting from respiratory bron- between the alveolar airspace and the capil- chioles → alveolar ducts → alveolar sacs until lary lumen. The blood-gas barrier is composed the level of the alveolus, these are considered of three layers: type I pneumocyte cells, fused the respiratory portion of respiratory system, basal laminae and the endothelium of capil- where gas exchange takes place. laries. Alveolar macrophages are phagocytes which help to engulf particles which reach the It is in these microscopic air sacs called alveolus. A surfactant is secreted into alveoli alveoli that O2 diffuses through the alveolar by special lung cells (pneumocytes type II). walls and enters the blood in nearby capillaries The surfactant reduces surface tension and (where the concentration or partial pressure of prevents the fragile alveoli from collapsing. O2 is lowest and CO2 is highest) and CO2 dif- fuses from the blood through the walls to enter Sneezing and coughing, which are the alveoli (where the partial pressure of CO2 reflexes mediated by the medulla, can expel is lowest and O2 is highest). Gas exchange particles from the upper and lower respiratory occurs by diffusion across the blood-gas barrier tract, respectively. THE BIOLOGICAL SCIENCES BIO-229 The lungs are separated into left and reduce friction while breathing. The lungs con- right and are enclosed by the diaphragm and tain the air passages, nerves, alveoli, blood the thoracic cage. It is covered by a mem- and lymphatic vessels of the lower respiratory brane (= pleura) which secretes a lubricant to tract. 12.4 Breathing: Structures and Mechanisms Inspiration is active and occurs accord- leaving it relatively negative; iv) the relatively ing to the following main events: i) nerve positive atmospheric pressure forces air into impulses from the phrenic nerve cause the the respiratory tract thus inflating the lungs. muscular diaphragm to contract; as the dome shaped diaphragm moves downward, the Expiration is passive and occurs ac- thoracic cavity increases; ii) simultaneously, cording to the following main events: i) the di- the intercostal (= between ribs) muscles and/ aphragm and the accessory respiratory mus- or certain neck muscles may contract further cles relax and the chest wall pushed inward; increasing the thoracic cavity (the muscles ii) the elastic tissues of the lung, thoracic mentioned here are called accessory respira- cage, and the abdominal organs recoil to their tory muscles and under normal circumstances original position; iii) this recoil increases the the action of the diaphragm is much more pressure within the lungs (making the pres- important); iii) as the size of the thoracic cavity sure relatively positive) thus forcing air out of increases, its internal pressure decreases the lungs and passageways. Medium-level Importance Figure IV.A.12.3: Breathing. BIO-230 CHAPTER 12: THE RESPIRATORY SYSTEM GAMSAT MASTERS SERIES 12.4.1 Control of Breathing Though voluntary breathing is possible anhydrase (about 75%). The reaction is (!), normally breathing is involuntary, summarised as follows: rhythmic, and controlled by the respiratory - + centre in the medulla of the brain stem. The CO2 + H2O ↔ H2CO3 ↔ HCO3 + H respiratory centre is sensitive to pH of the carbonic bicarbonate cerebrospinal fluid (CSF). An increase in acid blood CO2 or consequently, decrease in pH of the CSF, acts on the respiratory centre and According to Henry’s Law, the concen- stimulates breathing, returning the arterial tration of a gas dissolved in solution is directly pCO2 (partial pressure of carbon dioxide) proportional to its partial pressure. From the back to normal. The increase in blood CO2 preceding you can see why the respiratory and the decrease in pH are two interrelated system, through the regulation of the partial Medium-level Importance events since CO2 can be picked up by pressure of CO2 in blood, also helps in main- hemoglobin forming carbaminohemoglobin taining pH homeostasis (= a buffer). More (about 20%, BIO 7.5.1), but it can also be generally, the carbonic acid-bicarbonate buf- converted into carbonic acid by dissolving in fer is the most important buffer for maintain- blood plasma (about 5%) or by conversion ing acid-base balance in the blood and helps in red blood cells by the enzyme carbonic to maintain pH around 7.4. 12.4.2 Henry’s Law, Pop and The Bends Higher gas pressure and lower tem- pleasant, because of the loss of carbonic perature cause more gas to dissolve in a acid due to the release of carbon dioxide liquid. When a carbonated drink (soda/pop) bubbles/fizz. is manufactured, water is chilled, optimally to just above freezing, in order to permit the So pop is stored in a way to seal pres- maximum amount of carbon dioxide to dis- sure, preventing gas escape and maintain- solve. Then CO2 is pumped in at high pres- ing the supersaturation of CO2 in the solvent. sure, the pressure is maintained by closing It is pressure and temperature that drive the the container (can or bottle), which forces outgassing process. the carbon dioxide to dissolve into the liq- uid, creating carbonic acid (Le Chatelier’s Diving underwater exposes the body to principle; CHM 9.9) and giving ‘pop’ its tang. increasing pressure (PHY 6.1). A diving cyl- Flat soda tastes strange, or at least less inder (scuba tank) is used to store and trans- THE BIOLOGICAL SCIENCES BIO-231 port high
Recommended publications
  • Human Physiology an Integrated Approach
    Gas Exchange and Transport Gas Exchange in the Lungs and Tissues 18 Lower Alveolar P Decreases Oxygen Uptake O2 Diff usion Problems Cause Hypoxia Gas Solubility Aff ects Diff usion Gas Transport in the Blood Hemoglobin Binds to Oxygen Oxygen Binding Obeys the Law of Mass Action Hemoglobin Transports Most Oxygen to the Tissues P Determines Oxygen-Hb Binding O2 Oxygen Binding Is Expressed As a Percentage Several Factors Aff ect Oxygen-Hb Binding Carbon Dioxide Is Transported in Three Ways Regulation of Ventilation Neurons in the Medulla Control Breathing Carbon Dioxide, Oxygen, and pH Infl uence Ventilation Protective Refl exes Guard the Lungs Higher Brain Centers Aff ect Patterns of Ventilation The successful ascent of Everest without supplementary oxygen is one of the great sagas of the 20th century. — John B. West, Climbing with O’s , NOVA Online (www.pbs.org) Background Basics Exchange epithelia pH and buff ers Law of mass action Cerebrospinal fl uid Simple diff usion Autonomic and somatic motor neurons Structure of the brain stem Red blood cells and Giant liposomes hemoglobin of pulmonary Blood-brain barrier surfactant (40X) From Chapter 18 of Human Physiology: An Integrated Approach, Sixth Edition. Dee Unglaub Silverthorn. Copyright © 2013 by Pearson Education, Inc. All rights reserved. 633 Gas Exchange and Transport he book Into Thin Air by Jon Krakauer chronicles an ill- RUNNING PROBLEM fated trek to the top of Mt. Everest. To reach the summit of Mt. Everest, climbers must pass through the “death zone” T High Altitude located at about 8000 meters (over 26,000 ft ). Of the thousands of people who have attempted the summit, only about 2000 have been In 1981 a group of 20 physiologists, physicians, and successful, and more than 185 have died.
    [Show full text]
  • Everest and Oxygen—Ruminations by a Climber Anesthesiologist by David Larson, M.D
    Everest and Oxygen—Ruminations by a Climber Anesthesiologist By David Larson, M.D. Gaining Altitude and Losing Partial Pressure with Dave and Samantha Larson Dr. Dave Larson is an obstetric anesthesiologist who practices at Long Beach Memorial Medical Center, and his daughter Samantha is a freshman at Stanford University. Together they have successfully ascended the Seven Summits, the tallest peaks on each of the seven continents, a feat of mountaineering postulated in the 1980s by Richard Bass, owner of the Snowbird Ski Resort in Utah. Bass accomplished it first in 1985. Samantha Larson, who scaled Everest in May 2007 (the youngest non-Sherpa to do so) and the Carstensz Pyramid in August 2007, is at age 18 the youngest ever to have achieved this feat. Because of varying definitions of continental borders based upon geography, geology, and geopolitics, there are nine potential summits, but the Seven Summits is based upon the American and Western European model. Reinhold Messner, an Italian mountaineer known for ascending without supplemental oxygen, postulated a list of Seven Summits that replaced a mountain on the Australian mainland (Mount Kosciuszko—2,228 m) with a higher peak in Oceania on New Guinea (the Carstensz Pyramid—4,884 m). The other variation in defining summits is whether you define Mount Blanc (4,808 m) as the highest European peak, or use Mount Elbrus (5,642 m) in the Caucasus. Other summits include Mount Kilimanjaro in Kenya, Africa (5,895 m), Vinson Massif in Antarctica (4,892 m), Mount Everest in Asia (8,848 m), Mount McKinley in Alaska, North America (6,194 m), and Mount Aconcagua in Argentina, South America (6,962 m).
    [Show full text]
  • DEATH ZONE FREERIDE About the Project
    DEATH ZONE FREERIDE About the project We are 3 of Snow Leopards, who commit the hardest anoxic high altitude ascents and perform freeride from the tops of the highest mountains on Earth (8000+). We do professional one of a kind filming on the utmost altitude. THE TRICKIEST MOUNTAINS ON EARTH NO BOTTLED OXYGEN CHALLENGES TO HUMAN AND NATURE NO EXTERIOR SUPPORT 8000ERS FREERIDE FROM THE TOPS MOVIES ALONE WITH NATURE FREERIDE DESCENTS 5 3 SNOW LEOS Why the project is so unique? PROFESSIONAL FILMING IN THE HARDEST CONDITIONS ❖ Higher than 8000+ m ❖ Under challenging efforts ❖ Without bottled oxygen & exterior support ❖ Severe weather conditions OUTDOOR PROJECT-OF-THE-YEAR “CRYSTAL PEAK 2017” AWARD “Death zone freeride” project got the “Crystal Peak 2017” award in “Outdoor project-of-the-year” nomination. It is comparable with “Oscar” award for Russian outdoor sphere. Team ANTON VITALY CARLALBERTO PUGOVKIN LAZO CIMENTI Snow Leopard. Snow Leopard. Leader The first Italian Snow Leopard. MC in mountaineering. Manaslu of “Mountain territory” club. Specializes in a ski mountaineering. freeride 8163m. High altitude Ski-mountaineer. Participant cameraman. of more than 20 high altitude expeditions. Mountains of the project Manaslu Annapurna Nanga–Parbat Everest K2 8163m 8091m 8125m 8848m 8611m The highest mountains on Earth ❖ 8027 m Shishapangma ❖ 8167 m Dhaulagiri I ❖ 8035 m Gasherbrum II (K4) ❖ 8201 m Cho Oyu ❖ 8051 m Broad Peak (K3) ❖ 8485 m Makalu ❖ 8080 m Gasherbrum I (Hidden Peak, K5) ❖ 8516 m Lhotse ❖ 8091 m Annapurna ❖ 8586 m Kangchenjunga ❖ 8126 m Nanga–Parbat ❖ 8614 m Chogo Ri (K2) ❖ 8156 m Manaslu ❖ 8848 m Chomolungma (Everest) Mountains that we climbed on MANASLU September 2017 The first and unique freeride descent from the altitude 8000+ meters among Russian sportsmen.
    [Show full text]
  • Deadly High Altitude Pulmonary Disorders: Acute Mountain Sickness
    Research Article Int J Pul & Res Sci Volume 1 Issue 1 - April 2016 Copyright © All rights are reserved by Michael Obrowski DOI : 10.19080/IJOPRS.2016.01.555553 Deadly High Altitude Pulmonary Disorders: Acute Mountain Sickness (AMS); High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE): A Clinical Review Michael Obrowski1* and Stephanie Obrowski2 1Doctor of Medicine (M.D. – 2000); Assistant Professor of Anatomy; CEO, Chief Physician and Surgeon of Wilderness Physicians, European Union 2Doctor of Medicine (M.D. – 2019); Medical University of Łódź; President of Wilderness Physicians, European Union Submission: January 26, 2016; Published: April 15, 2016 *Corresponding author: Michael Obrowski, M.D., Doctor of Medicine (M.D. – 2000); Assistant Professor of Anatomy; CEO, Chief Physician and Surgeon of Wilderness Physicians, European Union, 43C Żeligowskiego Street, #45, Łódź, Poland 90-644, Email: Abstract Acute Mountain Sickness (AMS); High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). These three disorders, withMountain relatively Sickness, unimportant also smallcalled variationsHigh Altitude seen Sickness, in some isPulmonology specifically aTextbooks, triad of different because disorders, these are inso orderserious, of increasingthey are all seriousness: potentially deadly pulmonary disorders and we will discuss these three major, deadly disorders. Each one, starting with AMS, can progress rapidly to HAPE and then HACE. The two authors of this article have over half a century of high altitude mountaineering experience. They have also alsohad anddisaster still domedicine. have, for Since the lastspring twenty is rapidly years, approaching an NGO, Non-Profit and many Medical “weekend Organization backpackers” (Wilderness will start Physicians going into www.wildernessphysicians.
    [Show full text]
  • Outcomes from the 2015 Round Table on Sepsis
    The official daily newsletter of the 35th ISICEM Thursday 19 March 2015 Day 3 Outcomes from the 2015 Round Table on sepsis uring the opening session on Tues- day morning, Simon Finfer (Royal North Shore Hospital of Sydney and Sydney Adventist Hospital, Sydney, Australia) was joined by Steven DOpal (Memorial Hospital of Rhode Island, RI, USA) to summarize the major outcomes of the two-day Round Table discussion “This will be a on sepsis. This was a joint conference significant part of our conducted between ISICEM and the Inter- national Sepsis Forum, with representa- research agenda in the tives from every continent highlighting the future – making sure global nature of the problem. Beginning by addressing the current that our patients are state of knowledge in the epidemiology of doing well after they sepsis, Professor Finfer noted that we know leave the hospital.” surprising little, but that obtaining this data will be crucial if any meaningful strategy is Steven Opal to be developed: “To some degree we have data from developed countries, possibly far less than you would expect or think,” he said. “But there are certainly places in, notably, Africa, where we are completely devoid of data.” The reasons for this lack of data can in part be understood by an appreciation of how patient data are currently characterized and treated, with the Global Burden of Disease Project emerging as a central player in generating evidence and guiding is surprising because we believe that sepsis kills one comes into your ICU with community-acquired global health policy. more people than prostate cancer, breast cancer, pneumonia, you treat the pneumonia; maybe they “The only reference to sepsis in these sta- and many other high profile diseases.
    [Show full text]
  • Mount Everest's Death Zone
    Mount Everest’s Death Zone Climate change and crowds of climbers are making the world’s tallest mountain more dangerous than ever Mara Grunbaum ast year, 73-year-old Tamae Watanabe of Japan became the oldest woman to climb Mount Everest, the world’s tallest mountain. In L 2010, 13-year-old Jordan Romero of California became the youngest to reach the top. All sorts of people of varying abilities scale the massive mountain in Asia these days. That may not be a good thing—for Everest or the climbers. Last year, more than 500 people reached the top of the Himalayan mountain, which towers 8,850 meters (29,035 feet) above sea level. Hundreds more climbed partway up. While it’s a great achievement to scale Everest, it can sometimes cause problems for the climbers and the mountain itself. Everest is changing. Warming Up Why is Everest becoming more dangerous to climb? One reason is changes in its environment. Much of the mountain is covered in huge sheets of ice called glaciers. Lately, warmer temperatures in the region have been melting these glaciers. Some places that used to be covered in ice year-round are now completely ice-free in the summer. Shrinking glaciers put climbers at risk. As glaciers melt, snow, ice, and rock are more likely to tumble down the mountain in huge avalanches. These snowslides can injure or even kill climbers. “As it gets warmer, more debris tends to fall down,” says American climbing guide Freddie Wilkinson. He’s one of a number of people who think that climbing Everest is becoming too risky.
    [Show full text]
  • Into the Clouds
    Into the Clouds ALSO BY TOD OLSON THE LOST® SERIES: Lost in the Pacific, 1942 Lost in Outer Space Lost in the Amazon Lost in the Antarctic Into the Clouds The Race to Climb the World’s Most Dangerous Mountain TOD OLSON New York Copyright © 2020 by Tod Olson All rights reserved. Published by Scholastic Focus, an imprint of Scholastic Inc., Publishers since 1920. SCHOLASTIC, SCHOLASTIC FOCUS, and associated logos are trademarks and/ or registered trademarks of Scholastic Inc. The publisher does not have any control over and does not assume any responsibility for author or third- party websites or their content. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. For information regarding permission, write to Scholastic Inc., Attention: Permissions Department, 557 Broadway, New York, NY 10012. Library of Congress Cataloging-in-Publication Data Names: Olson, Tod, author. Title: Into the clouds : the race to climb the world’s most dangerous mountain / Tod Olson. Description: New York, NY : Scholastic Focus, 2020. | Audience: Age 10-14. Identifiers: LCCN 2019002127 (print) | LCCN 2019014682 (ebook) | ISBN 9781338207378 (E-book) | ISBN 9781338207361 (hardcover : alk. paper) Subjects: LCSH: K2 (Pakistan : Mountain)—Juvenile literature. | Mountaineering—Pakistan—K2 (Mountain)—Juvenile literature. Classification: LCC GB546.K13 (ebook) | LCC GB546.K13 O55 2020 (print) | DDC
    [Show full text]
  • Human Factors in High-Altitude Mountaineering
    Journal of Human Performance in Extreme Environments Volume 12 Issue 1 Article 1 Published online: 5-8-2015 Human Factors in High-Altitude Mountaineering Christopher D. Wickens Alion Science and Technology, [email protected] John W. Keller Alion Science and Technology, [email protected] Christopher Shaw Alion Science and Technology, [email protected] Follow this and additional works at: https://docs.lib.purdue.edu/jhpee Part of the Industrial and Organizational Psychology Commons Recommended Citation Wickens, Christopher D.; Keller, John W.; and Shaw, Christopher (2015) "Human Factors in High-Altitude Mountaineering," Journal of Human Performance in Extreme Environments: Vol. 12 : Iss. 1 , Article 1. DOI: 10.7771/2327-2937.1065 Available at: https://docs.lib.purdue.edu/jhpee/vol12/iss1/1 This document has been made available through Purdue e-Pubs, a service of the Purdue University Libraries. Please contact [email protected] for additional information. This is an Open Access journal. This means that it uses a funding model that does not charge readers or their institutions for access. Readers may freely read, download, copy, distribute, print, search, or link to the full texts of articles. This journal is covered under the CC BY-NC-ND license. Human Factors in High-Altitude Mountaineering Christopher D. Wickens, John W. Keller, and Christopher Shaw Alion Science and Technology Abstract We describe the human performance and cognitive challenges of high altitude mountaineering. The physical (environmental) and internal (health) stresses are first described, followed by the motivational factors that lead people to climb. The statistics of mountaineering accidents in the Himalayas and Alaska are then described.
    [Show full text]
  • Safe Sojourns to High Altitudes: the Risks of Annual Religious Pilgrimages in Jammu and Kashmir, India- Clinical Diagnostics and Treatment
    Research Article JOJ Pub Health Volume 2 Issue 1 - May 2017 Copyright © All rights are reserved by SM Kadri Safe Sojourns to High Altitudes: The Risks of Annual Religious Pilgrimages in Jammu and Kashmir, India- Clinical Diagnostics and Treatment SM Kadri1*, Saleem-ur-Rehman2, Michael W Popejoy3 and Christoph S Eberle4 1Division of Epidemiology and Public Health, Integrated Disease Surveillance Programme, India 2Department of Health Services, Fellow WHO Director, India 3Department of Health Promotion and Disease Prevention, Florida International University, USA 4National Academy of Clinical Biochemistry, Associate Fellow, USA Submission: May 04, 2017; Published: May 26, 2017 *Corresponding author: SM Kadri, Division of Epidemiology and Public Health, RFPTC Building, Barzulla, Srinagar 190005, Kashmir, India, Email: Abstract increasing prevalence for this type of illness. In The behavioral characteristics of high altitude climbers and the precautions necessary to This article addresses the clinical diagnosis and clinical treatment plan for several diseases that afflict high altitude climbers and the described; then, the common treatment regimens for climbermal adaptation for high altitude sickness are covered. The conclusion explored inprevent the discussion death from is thatthe high no one altitude need sportdie from activities high altitude are introduced; sickness iffirst; proper then. planning The clinical and manifestationsgood judgment ofare different applied diseaseto climbing complexes protocols; are and, that these rules are
    [Show full text]
  • A Fundamental Concept in COVID-19 Lung Disease
    1 Pneumolysis: a fundamental concept in COVID-19 lung disease Gustavo R. Zubieta-Calleja1, Natalia Zubieta-DeUrioste1, Felipe de Jesús Montelongo2, Manuel Gabriel Romo Sanchez2 & Murray Epstein3 1. High Altitude Pulmonary and Pathology Institute (IPPA), La Paz, Bolivia. 2. Hospital General de Ecatepec “Las Américas”, ISEM, México 3. University of Miami Miller School of Medicine, Miami, USA Keywords: HAPE, SARS-CoV-2, ACE-2, EPO, Lung sequelae, Kawasaki disease COVID-19 tongue Running title: Pneumolysis in COVID-19 lung disease Corresponding author: Prof. Dr. Gustavo R. Zubieta-Calleja Director High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA) www.Altitudeclinic.com Av. Copacabana - Prolongación # 55, Teleféricos Celeste y Blanco, Estación Av. Del Poeta, La Paz, Bolivia. E-mail: [email protected]; Cel: 591-73258026. Prof. Dr. Gustavo Zubieta-Calleja ORCID: 0000-0002-4283-6514 Dr. Natalia Zubieta-DeUrioste ORCID: 0000-0003-2675-5025 Declaration of interest: None. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not- for-profit sectors. 2 ABSTRACT Background COVID-19 severe lung compromise often evolves to life-threatening hypoxia. The experience led to the implementation of standardized protocols assuming similarity to SARS-CoV. Impulsive use of ventilators ended in up to 88% fatality. Methods COVID-19 pathophysiology and histopathological lung biopsy photomicrographs are analyzed. Results Pneumolysis is defined as progressive alveolar-capillary destruction resulting from the CoV-2 attack on pneumocytes. The histopathological results show the presence of Masson bodies, alveolar coating cells with nuclear atypia, reactive pneumocytes, reparative fibrosis, intra- alveolar hemorrhage, moderate inflammatory infiltrates, microabscesses, microthrombus, hyaline membrane remnants, and emphysema.
    [Show full text]
  • Clinical Review
    BMJ 2011;343:d4943 doi: 10.1136/bmj.d4943 Page 1 of 10 Clinical Review CLINICAL REVIEW Acute altitude illnesses Chris Imray professor of vascular and endovascular surgery 1, Adam Booth general practioner 2, Alex Wright consultant physician 3, Arthur Bradwell professor of immunology 4 1Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; 2Jiggins Lane Medical Centre, Birmingham, UK; 3Medical School, University of Birmingham, Birmingham; 4Immunodiagostic Research Laboratory, Medical School, University of Birmingham Acute altitude illnesses are potentially serious conditions that exceptions, most altitude related illnesses occur when there has can affect otherwise fit individuals who ascend too rapidly to been insufficient time to acclimatise at altitudes over 3000 m. altitude. They include high altitude headache, acute mountain sickness, high altitude cerebral oedema, and high altitude What are the altitude related illnesses? pulmonary oedema. The number of people travelling to altitude for work (soldiers, miners, construction workers, and The common altitude specific illnesses are high altitude astronomers) or for recreation (skiing, trekking, mountain biking, headache and acute mountain sickness. Much rarer, but more and climbing) is rising, and increased media attention towards serious, are high altitude cerebral oedema and high altitude these activities has also raised the profile of altitude related pulmonary oedema. illness. Typical scenarios in which such illness might occur are a family trek to Everest base camp in Nepal (5360 m), a fund High altitude headache raising climb of Mount Kilimanjaro (5895 m), or a tourist visit High altitude headache is defined by the International Headache to Machu Picchu (2430 m).
    [Show full text]
  • Breathing at Extreme Altitudes. Scientific Projects “EVEREST” (First Part)
    Review Breathing at extreme altitudes. Scientific projects “EVEREST” (First part) Breathing at extreme altitudes. Scientific projects “EVEREST” (First part) Eduardo Garrido1,2, Oriol Sibila3, Ginés Viscor2,4 1Servicio de Hipobaria y Fisiología Biomédica. Universidad de Barcelona. 2Instituto de Estudios de Medicina de Montaña. Barcelona. 3Servicio de Neumología. Hospital de la Santa Creu i Sant Pau. Barcelona. 4Departamento de Biología Celular, Fisiología e Inmunología. Universidad de Barcelona. Received: 03.03.2017 Summary Accepted: 31.05.2017 Climbing to the highest height on Earth, the Mt. Everest (8.848 m), without supplementary oxygen equipment involves a physiological demand that is close to the maximum human tolerance. Exposures at extreme altitudes drastically conditions lung function, stores of oxygen and physical performance. This review brings interesting aspects about respiration, blood gases and aerobic exercise reported by those scientific projects that have carried out physiological measurements between 8,000 m and 8,848 m above sea level, under real or simulated altitude: the Operations “Everest I” (1946), “Everest II” (1985), “Everest III-COMEX” (1997), and the Expeditions “AMREE” (1981), “British 40th Anniversary Everest” (1993), and “Caudwell Xtrem Everest” (2007). These fascinating scientific research events, along with other outstanding biomedical expeditions perfor- med above 5,500 m, like especially the “Silver Hut” (1960-61), “Italiana all’Everest” (1973), and “British Everest Medical” (1994), including those pioneer scientific reports made on the XIX century until the most recent research projects performed, have laid the foundations and knowledge on the human tolerance to such extreme levels of hypobaric hypoxia, where the lung, breathing and respiratory chain takes on a major role requiring fine physiological adjustments to ensure cellular oxygenation.
    [Show full text]