Thursday, June 22, 2017

ក្រិនសរសៃឈាម (Atherosclerosis)


ក្រិនសរសៃឈាម (Atherosclerosis) 


Atherosclerosis (ដែលត្រូវបានគេស្គាល់ផងដែរថា ជា Arteriosclerotic Vascular Disease or ASVD) ជា ជម្ងឺសរសៃឈាមដែលត្រូវបានសម្គាល់ដោយការកកកុញនៃបន្ទះនៅក្នុងសរសៃឈាមក្រហម ។


(សរសៃឈាមក្រិនដោយសារបន្ទះនៅក្នុងសរសៃឈាមក្រហមប្រែជារឹង ហើយបណ្តាលអោយសរសៃឈាមបាត់បង់នូវភាពយឺត - elasticity)

 Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of a normal artery. Figure B shows an artery with plaque buildup. The inset image shows a cross-section of an artery with plaque buildup.
រូបភាព A បង្ហាញពីសរសៃឈាមធម្មតាដែលមានលំហូរឈាមធម្មតា។ 
រូបភាព B បង្ហាញពីសរសៃឈាមអារទែដែលមានផ្ទុកបន្ទះ។


បន្ទះនេះបង្កើតឡើងដោយជាតិខ្លាញ់ កូលេស្តេរ៉ុល ជាតិកាល់ស្យូម និង សារធាតុដទៃទៀតដែលត្រូវបានរកឃើញនៅក្នុងឈាម។ យូរ ៗ ទៅបន្ទះនេះប្រែជារឹង ហើយបង្រួមស្រទាប់ខាងក្នុងនៃសរសៃឈាម។ បន្ទះនេះរារាំងដល់លំហូរនៃឈាមសម្បូរទៅដោយអុកស៊ីហ្សែនសម្រាប់ ផ្កត់ផ្គងអោយសរីរាង្គ និង ផ្នែកផ្សេងទៀតនៃរាងកាយ។




ជម្ងឺទាក់ទងនឹងជម្ងឺក្រិនសរសៃឈាម រួមមាន

  • Coronary Heart Disease ត្រូវបានគេស្គាល់ផងដែរថា ជា Coronary Artery Disease - ជម្ងឺសរសៃឈាមបេះដូង
  • Carotid Artery Disease - ជម្ងឺសរសៃឈាម Carotid (ជាសរសៃឈាមក្រហមដែលស្ថិតនៅផ្នែកខាងមុខនៃកញ្ចឹងក)
  • Peripheral Artery Disease - ជម្ងឺសរសៃឈាមធំ ដែលមិនស្ថិតនៅក្នុងចំណោមសរសៃឈាម បេះដូង សរសៃឈាមអ័រតូតា (Aortic Arch)  ឬ ខួរក្បាល
  • Chronic Kidney Disease - ជម្ងឺតម្រងនោមរ៉ាំរ៉ៃ


អត្ថបទដើម Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of the body.

ជម្ងឺខ្សោយបេះដូង (Heart Failure)


បច្ចុប្បន្ន គ្មានការព្យាបាលណាមួយអាចព្យាបាលជម្ងឺខ្សោយបេះដូងអោយជាដាច់នោះឡើយ ទោះជាយ៉ាងណាក្តីការព្យាបាលដោយថ្នាំ និង ការផ្លាស់ប្តូររបៀបរស់នៅ (lifestyle changes) អាចជួយស្ថានភាពរស់នៅរបស់អ្នកជម្ងឺមានសកម្មភាពរស់រវើក និង រស់នៅបានយូរតែប៉ុណ្ណោះ។

Image result for heart failure'

តើជម្ងឺខ្យោយបេះដូងជាអ្វី?

ពាក្យថា "ជម្ងឺខ្សោយបេះដូង" មិនមានន័យថាបេះដូងរបស់យើងបានឈប់ ឬ ជិតឈប់ដំណើរការនោះទេ តែវាជាស្ថានភាពដែលបេះដូងមិនអាចច្របាច់ឈាមគ្រប់គ្រាន់ដើម្បីបំពេញតាមតម្រូវការរបស់រាងកាយ។ ក្នុងករណីមួយចំនួន គឺ បេះដូងមិនអាចបំពេញដោយឈាមបានគ្រប់គ្រាន់ ឬ ទទួលបានឈាមគ្រប់គ្រាន់នោះឡើយ។ ក្នុងករណីផ្សេងទៀត បេះដូងបាត់បងនូវសមត្ថភាពកន្ត្រាក់ និងច្របាច់ឈាមទៅរាងកាយដោយកម្លាំងគ្រប់គ្រាន់។ អ្នកជម្ងឺខ្លះអាចជួបប្រទះនឹងស្ថានភាពទាំងពីរដូចបានរៀបរាប់ខាងដើម។

ជម្ងឺខ្សោយបេះដូងវិវឌ្ឍទៅតាមពេលវេល និង សកម្មភាពកន្ត្រាក់របស់បេះដូងធ្លាក់ចុះខ្សោយ ហើយ ជាធម្មតាស្ថានភាពនេះ អាចប៉ះពាល់ដល់ផ្នែកខាងស្តាំនៃបេះដូងតែប៉ុណ្ណោះ ក៏ប៉ុន្តែវាអាចប៉ះពាល់ដល់ផ្នែកទាំងពីរនៃបេះដូងផងដែរ។ ករណីភាគច្រើនជម្ងឺខ្យោយបេះដូងគឺពាក់ព័ន្ធនឹងផ្នែកទាំងសងខាងនៃបេះដូង។

ភាពខុសគ្នានៃជម្ងឺខ្យោយបេះដូងខាងស្តាំ និង ខាងឆ្វេង


  • ជម្ងឺខ្សោយបេះដូងខាងស្តាំ (right side heart failure) កើតមានឡើង ប្រសិនបើបេះដូងមិនអាចកន្រ្តាក់ច្របាច់ឈាមគ្រប់គ្រាន់ទៅសួតដើម្បីទទួលយកអុកស៊ីហ្សែន។ 



  • ជម្ងឺខ្សោយបេះដូងខាងឆ្វេង (left side heart failure) កើតមានឡើង ប្រសិនបើបេះដូងមិនអាចកន្រ្តាក់ច្របាច់ឈាមដែលសម្បូរដោយអុកស៊ីហ្សែនទៅគ្រប់តំបន់នៃរាងកាយ ។

ជម្ងឺខ្សោយបេះដូងខាងស្តាំអាចបណ្តាលអោយមានការកកកុញនូវវត្ថុរាវ (fluid build-up) នៅក្នុងជើងទាំងសងខាង ភ្នែកគោល (ankles) ថ្លើម ពោះ និង សរសៃឈាមខ្មៅ (veins) នៅកញ្ជឹងក។

ជម្ងឺខ្សោយបេះដូង គឺ ជារោគសញ្ញានៃជម្ងឺដ៏ស្មុគស្មាញមួយ ដែលអាចរួមមាន

  • អស់កម្លាំងហ្អឹតហ្អៃ  (Fatigue) 
  • មិនអាចដកដង្ហើមបានគ្រប់គ្រាន់ខណៈធ្វើសកម្មភាពភាពណាមួយ (Shortness of breath on exertion) ដូចជា ប្រែខ្លួន ឬ ងើបឈក្តី  
  • ភាពពិបាកដកដង្ហើមនេះអាចមានសភាពធូរស្រាលប្រសិនបើអង្គុយត្រង់ខ្លួន ឬ ឈរជំហរឈរត្រង់ (orthopnea)
  • ពិបាកដកដង្ហើមនៅពេលយប់ (nocturnal dyspnea)
  • ងើបនោមពេលយប់ (nocturia)
  • ផ្លាស់ប្តូរស្ថានភាពផ្លូវចិត្ត (mental status changes)
  • កង្វះ ឬ បាត់បង់ចំណង់អាហារ (anorexia)
  • ឈឺពោះ 
មូលហេតុចម្បងនៃជម្ងឺខ្សោយបេះដូងគឺបណ្តាលមលពជម្ងឺមួយចំនួនដែលបានធ្វើឱ្យប៉ះពាល់ដល់សុខភាពបេះដូង រួមមានជម្ងឺសរសៃឈាមបេះដូង (coronary heart disease) ជម្ងឺលើសឈាម (high blood pressure) និង ជម្ងឺទឹកនោមផ្អែម (diabetes) 

ប្រភពនៃអត្ថបទ

  "What Is Heart Failure?" (https://www.nhlbi.nih.gov/health/health-topics/topics/hf/)


Australian Guide to Healthy Eating

An image of the Australian Guide to Healthy Eating food plate poster


Australian Dietary Guidelines 1 - 5


There are five principal recommendations featured in the Australian Dietary Guidelines. Each Guideline is considered to be equally important in terms of public health outcomes.

Guideline 1

To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs

  • Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly.
  • Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.

Guideline 2

Enjoy a wide variety of nutritious foods from these five groups every day:

  • Plenty of vegetables, including different types and colours, and legumes/beans
  • Fruit
  • Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
  • Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
  • Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years)
And drink plenty of water.

Guideline 3

Limit intake of foods containing saturated fat, added salt, added sugars and alcohol

a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips,
crisps and other savoury snacks.
  • Replace high-fat foods which contain predominantly saturated fats such as butter, cream, cooking margarine, coconut and palm oil with foods which contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/pastes and avocado.
  • Low fat diets are not suitable for children under the age of 2 years.
b. Limit intake of foods and drinks containing added salt.
  • Read labels to choose lower sodium options among similar foods.
  • Do not add salt to foods in cooking or at the table.
c. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and
sports drinks.
d. If you choose to drink alcohol, limit intake. For women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option.

Guideline 4

Encourage, support and promote breastfeeding

Guideline 5

Care for your food; prepare and store it safely

វិធីចំនួន ១០ ដើម្បីកាត់បន្ថយភាពតានតឹង - Ten Ways to Reduce Stress

វិធីចំនួន ១០ ដើម្បីកាត់បន្ថយភាពតានតឹង ការថប់បារម្ភ ការព្រួយបារម្ភ ហើយដែលអាចលើកកម្ពស់ភាពស្ងប់ស្ងាត់ផ្លូវចិត្ត និង អារម្មណ៏របស់យើង ។ 


ពាក្យចាស់លោកពោលថា "ព្យាយាមទើបបានសម្រេច" ម្ល៉ោះហើយការកាត់បន្ថយភាពតានតឹង ការថប់បារម្ភ ការព្រួយបារម្ភ ការរក្សាភាពស្ងប់ស្ងាត់ផ្លូវចិត្ត និង អារម្មណ៏របស់យើង គឺ តម្រូវអោយមានការព្យាយាម ការខិតខំប្រឹងប្រែងអនុវត្ត និងការប្តេជ្ញាចិត្តរបស់យើងផងដែរ ទើបអាចម្រេចបាននូវលទ្ធផលជាវិជ្ជមាន ។ អ្វីដែលយើងគួរកត់សម្គាល់នោះ គឺ បុក្គលដែលផ្លូវចិត្តរបស់គេស្ងប់ស្ងាត់ គេមិនសូវមានបញ្ហាសុខភាព បើប្រៀបធៀបទៅនិងបុក្គលដែលមានភាពតានតឹងផ្លូវចិត្ត ឬ ថប់បារម្ភ្។

Image result for peace of mind

(អត្ថបទដើម) Ten Ways to Reduce Stress

The following are some wonderful ways to reduce anxiety, agitation and stress and promote relaxation, calm and peace within yourself. Some techniques take practice, and most require some commitment on your part to achieve results. However, the results are well worth any effort, as a calm and relaxed body and mind are less prone to health issues than an agitated body and mind.
1) Breathing strongly influences mind, body and moods. By simply focusing your attention on your breathing, and without doing anything to change it, you move in the direction of relaxation. There are many worse places to have your attention – on your thoughts, for one, since thoughts are the source of much of our anxiety, guilt and unhappiness. Get in the habit of shifting your awareness to your breath whenever you find yourself dwelling on upsetting thoughts. Try these breathing exercises.
2) Progressive relaxation is a way of releasing tension in muscles. Often taught in yoga and exercise classes, on self-help tapes and by various instructors – from massage therapists to psychologists – there are many variations of progressive relaxation. A common technique is the following:
  • Lie on your back in a comfortable position.
  • Take a series of deep slow breaths and focus your awareness on different parts of the body, in turn, becoming aware of any muscular tension and releasing it. One way to do this is to first tense a muscle deliberately and then relax it. Start with the front of the body, tensing and relaxing the muscles of the upper face, then moving on to the jaw, neck, chest, front of the arms, abdomen, thighs, lower legs, feet and toes. Then, do the same down the back of the body.
  • Finally, lie still with the eyes closed, concentrating on your breath and enjoying the feeling of peace and freedom from tension.
You can easily learn to do this on your own, but it is pleasant to follow spoken instructions from someone with a soothing voice. You can incorporate progressive relaxation into your daily routine and find ways to make it more portable. For instance, you can modify it for a sitting position and do it at your place of work.
3) Exercise. For many people, exercise is their main method of reducing stress and promoting relaxation. One of the benefits of regular aerobic exercise is its moderating effect on emotions. This is a long-term benefit, but aerobic and nonaerobic exercise can also work in acute situations as a symptomatic treatment. If you feel angry or upset, a brisk walk or run or a half hour of lifting weights will often put you back in a good mood. While exercise is a great way to burn up excess energy, it does not teach you how to process stress differently. For that reason, it is not recommended as your sole method of relaxation, but as a complement to another technique, such as breathing, visualisation or yoga, for instance. Yoga is an excellent promoter of relaxation as well as a good form of nonaerobic body conditioning. It perfectly complements aerobic exercise. It requires a commitment to a formal practice and is best done with an instructor, at least at the start.
4) Massage and bodywork. For a wonderful, relaxing experience, get a massage or other form of body work. In order to gain full benefit, you need to be totally passive and surrender to the touch of a skilled therapist. There is a great deal of evidence that the state of the mind and nervous system is reflected in the state of the musculature – body work is one route into the unconscious mind. Some kinds of massage are more relaxing than others. Some of the best for this purpose are Trager work, a system that uses rocking and bouncing movements to lull the recipient into a very dreamy altered state, and watsu, done in warm water. Like exercise, massage is more a symptomatic treatment than a lasting change. It is also limited in its application, since few of us are able to go to a massage therapist on a daily basis, and most of us need to practice relaxation skills every day.
5) Visualisation and guided imagery. While we all look at our internal images from time to time, especially when we daydream or fantasise, few of us have learned how to develop our imaging capacity and take advantage of its ability to affect our minds and bodies. Visualisation and guided imagery have you concentrate on images held in the mind’s eye and work with the connection between the visual brain and the involuntary nervous system. When this portion of the brain (the visual cortex at the back of the head) is not occupied with input from the eyes, it seems to be able to influence physical and emotional states.
You can learn the technique for visualisation and guided imagery from books, self-help tapes or an instructor. For relaxation and stress reduction you may want to start with images you get from books or tapes, as long as they feel right for you. Or simply recall a scene from the past when you were supremely content, secure and centred. Close your eyes, take a few deep breaths, and picture yourself back there. Try to make the image bright and clear and try to hear, feel and smell the surroundings. How long you focus on it is less important than how regularly you do it – a few minutes every day practising your visualisation will reap greater benefits than if you spend an hour at it every so often.
The best times for practice are the transition states between sleeping and waking. Just before falling asleep and just after waking up, try to concentrate on your peaceful image. At these times it passes more easily into your unconscious mind, where it can relax your nervous system and body. Of course, try it during the day, too, especially if external stress gets you down and you become aware of the internal tension.
6) Biofeedback. The idea of biofeedback is clever and simple: by using technology to help you learn faster relaxation, you can develop sensory awareness of an involuntary function and learn to change it. In a common biofeedback setup, temperature sensors are connected to your fingers, and skin temperature is converted to an audible signal, perhaps a beep tone: the faster the beeps, the higher the temperature. Your job is to make the beeps go faster by raising your skin temperature. The tone gives your ears and brain feedback from a body function that is ordinarily unconscious and beyond the reach of your will. Skin temperature is a measure of blood flow into the hands, and that is determined by the size of little arteries. The autonomic nervous system regulates this flow by causing arteries to constrict (sympathetic influence) or dilate (parasympathetic influence). In order to raise your skin temperature, you have to relax your sympathetic nervous system. Unless you do this on a regular basis, you will have wasted your time and money, because the point is to incorporate what you learn into daily life. Ideally, you should spend 15 to 20 minutes a day at this practice, preferably after a few minutes of progressive relaxation, visualisation or meditation to set the stage.
Biofeedback works best for people whose tension is expressed in bodily complaints such as migraineshypertension, cardiac arrhythmias, ulcers, chronic intestinal problems, Raynaud’s disease and bruxism. It may also benefit those who feel they need outside help in learning to reduce anxiety and internal stress, or who doubt they can do it on their own. A typical biofeedback training program consists of 10 hour-long sessions, often spaced a week apart.
7) Meditation is directed concentration. Meditators learn to focus their awareness and direct it onto an object: the breath, a phrase or word repeated silently, a memorised inspirational passage, or an image in the mind’s eye. Researchers have documented immediate benefits in terms of lowered blood pressure, decreased heart and respiratory rate, increased blood flow, and other measurable signs of the relaxation response.
While the potentials of meditation are vast, not everyone should practice it as a way to relax: many people are not ready to meditate. The first step is to work to improve the diet, develop good exercise habits, and learn how to breathe properly. Some people may benefit from simpler techniques for relaxation, ones that give immediate results with less effort.
If you want to give meditation a try, shop around for a form of it that seems comfortable – one that suits you and does not conflict with your belief system. All forms of meditation require regular, daily practice over a long period of time before they deliver the big rewards. Try to meditate every day without fail, 20 to 30 minutes being a reasonable length of time.
Many newcomers to meditation think the goal is to stop all thoughts. That is not possible. What you want to learn is to withdraw attention from the endless chains of associated thoughts that stream through the mind, putting attention instead on the object of meditation. Whenever you become aware that your attention has strayed (to images, sensations, thoughts of dinner, etc.) gently bring it back to your chosen object. The work that meditation requires is just this constant running after your attention and bringing it back.
8) Mantram is the practice of repeating over and over in the mind certain syllables, words or phrases that help unify consciousness and counteract negative mental states. Repetition of a verbal formula is a way of focusing the thinking mind and counteracting the damage done to both mind and body by thoughts that produce anxiety, agitation and unhappiness.
Repetition of a mantram provides a comforting focus for the mind. It is a totally portable technique, requires no training or equipment, and can be used in any circumstance, so long as you don’t practice it during something that otherwise requires your undivided attention. Mantram is especially helpful for people with restless minds, whose turbulent thoughts keep them from relaxing, concentrating and falling asleep. Try experimenting with it.
9) Hypnotherapy. Though hypnosis, or hypnotherapy, has fallen in and out of favour over the past few hundred years, it is currently accepted as a useful method of relaxation, pain control and management of habits like smoking and overeating. In fact, the use of trance and suggestion to affect the unconscious mind – and through it the regulatory systems of the body – has many more potential applications in the treatment of disease. However, few hypnotherapists are willing to tackle interesting physical ailments, and instead limit themselves to control of pain, stress and habits. Keep in mind that hypnotherapists do not put you into a trance – they just arrange circumstances to increase the likelihood of your shifting into a trance state, which is part of the normal repertory of human consciousness.
If you are interested in hypnotherapy, first sound out a hypnotherapist to make sure he or she does not have fears of loss of control that will get in the way of successful therapy. Also, do not enter into this work unless you feel totally comfortable with the therapist, and understand that you will have to implement the program by committing to regular practice on your own.
Hypnotherapy is a good choice for people who think they have no idea what it feels like to relax and for those with stress-related health problems. A few sessions of hypnotherapy can also teach you how to use visualisation for self-improvement and can help you begin a meditation practice.
10) Drugs are used by many to relax but are not as safe or effective as the methods described above. While tranquillizers seem to have become more common, there are natural substances that you may want to try. Spearmint and chamomile teas are both mildly relaxing, and you can drink as much of them as you want. A stronger remedy is passionflower, made from a plant (Passiflora incarnata) native to the southeastern United States. Passionflower products are available at herb and health food stores. The dose is one dropperful of the tincture in a little water or two capsules of a standardised extract up to four times a day as needed. Passionflower is not sedating.

Sunday, June 18, 2017

ប្រភេទនៃជម្ងឺបេះដូង (Types of Heart Disease)


កត្តាហានិភ័យទូទៅ (common risk factors)  នៃជម្ងឺបេះដូងរួមមាន  

ជក់បារី សម្ពាធឈាមខ្ពស់ (high blood pressure) កូលេស្តេរ៉ុលខ្ពស់ (high cholesterol) ជម្ងឺទឹកនោមផ្អែម (diabetes) ធាត់ជ្រុល (obesity) អសកម្មរាងកាយ (physical inactive) 

ប្រភេទនៃជម្ងឺបេះដូង (Types of Heart Disease)

ជម្ងឺសរសៃឈាមបេះដូង (Coronary Heart Disease)
សរសៃឈាមរាំងស្ទះ (blocked) បណ្តាលអោយលំហូរឈាមទៅកាន់បេះដូងមានកំណត់ និង បង្អត់ការផ្គត់ផ្គងអុកស៊ីហ្សែន និង សារធាតុចិញ្ចឹម (nutrients) ដល់កោសិកានៃសាច់ដុំបេះដូង (cells of the heart)

ចង្វាក់បេះដូងលោតមិនទៀងទាត់ ឬ មិនប្រក្រតី (Arrhythmia) 

ជម្ងឺខ្សោយបេះដូង (Heart Failure) 
បេះដូងមិនអាចបូមដូចប្រក្រតី ដើម្បីផ្គត់ផ្គង់រាងកាយនូវអុកស៊ីហ្សែន និង សារធាតុចិញ្ចឹមដែលបណ្តាលឱ្យសាច់ដុំបេះដូងធ្វើការងាររបស់គេហួសពីធម្មតា (overwork) ហើយចុះខ្សោយ (weaken)

ជម្ងឺវ៉ាល់ ឬ សន្ទះបឹទបើកនៃបេះដូង (Heart Valve Disease)
វ៉ាល់មួយ ឬ វ៉ាល់/សន្ទះបឹទបើកទាំង ២ នៃបេះដូង ដែលគ្រប់គ្រងលំហូរឈាមចូលទៅក្នុង និង ចេញពីបេះដូងមិនដំណើរការ

ជម្ងឺីរីកបេះដូង (Cardiomyopathy)
បេះដូងរឹកធំ ឬ ឡើងរឹង (stiff) ឬ បាត់បង់នូវភាពយឺត (inelastic) ឬ មានកម្រឹតក្រាស់ពីធម្មតាបណ្តាលឱ្យបេះដូងបូមខ្សោយពីធម្មតា ហើយជួនកាលនាំឱ្យមានជម្ងឺខ្សោយបេះ ដូង ឬ ចង្វាក់មិនទៀតទាត់

ជម្ងឺីរលាកស្រោមបេះដូង (Pericarditis)
រលាកភ្នាសទ្រនាប់ស្តើងនៃបេះដូងមួយ (Pericardium) ឬ មួយចំនួនដែលបណ្តាលឱ្យបេះដូង

ជម្ងឺីអាកទែបេះដូង (Aorta / Aorte = ភាសាបារាំង) Aorta Disease


ផ្នែកមួយនៃជញ្ជាំងអាកទែ (aortic wall) បានចុះខ្សោយ ហើយប៉ោងបង្កើតជាប៉េងប៉ោងសរសៃឈាម

ជម្ងឺីសរសៃឈាម (Vascular disease)
ជម្ងឺីបេះដូងតែងតែទាក់ទងទៅនឹងជម្ងឺីនៃប្រព័ន្ធចលនាឈាម (Circulatory System) ឬ ឈាមរត់ រួមទាំងសរសៃឈាមខ្មៅ (Arteries) និង សសៃរឈាមក្រហម (Veins) សសៃរនៃប្រព័ន្ធលសិកា (Lymph / Lymphe= ភាសាបារាំង) និង ជម្ងឺឈាម




Saturday, June 17, 2017

Dietary Guideline for Americans 2015 - 2020





Image result for 2015-2020 Dietary Guidelines
The 2015-2020 Dietary Guidelines provides five overarching Guidelines that encourage healthy eating patterns, recognise that individuals will need to make shifts in their food and beverage choices to achieve a healthy pattern, and acknowledge that all segments of our society have a role to play in supporting healthy choices. 
These Guidelines also embody the idea that a healthy eating pattern is not a rigid prescription, but rather, an adaptable framework in which individuals can enjoy foods that meet their personal, cultural, and traditional preferences and fit within their budget


The Guidelines 

1. Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. 

2. Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts. 

3. Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns. 

4. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain. 


5. Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.

Key Recommendations: 


Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. A healthy eating pattern includes: 

• A variety of vegetables from all of the subgroups— dark green, red and orange, legumes (beans and peas), starchy, and other 

• Fruits, especially whole fruits 

• Grains, at least half of which are whole grains 

• Fat-free or low-fat dairy, including milk, yoghurt, cheese, and/or fortified soy beverages 

• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products 

• Oils

Importance of Calorie Balance Within Healthy Eating Patterns 

Image result for 2015-2020 Dietary Guidelines
Managing calorie intake is fundamental to achieving and maintaining calorie balance—the balance between the calories taken in from foods and the calories expended from metabolic processes and physical activity. The best way to determine whether an eating pattern is at an appropriate number of calories is to monitor body weight and adjust calorie intake and expenditure in physical activity based on changes in weight over time. 


These components are of particular public health concern in the United States, and the specified limits can help individuals achieve healthy eating patterns within calorie limits: 

• Consume less than 10 percent of calories per day from added sugars 

• Consume less than 10 percent of calories per day from saturated fats 

• Consume less than 2,300 milligrammes (mg) per day of sodium 

• If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.

In tandem with the recommendations above, Americans of all ages including children, adolescents, adults, and older adults should meet the Physical Activity Guidelines for Americans to help promote health and reduce the risk of chronic disease. 

Americans should aim to achieve and maintain a healthy body weight. The relationship between diet and physical activity contributes to calorie balance and managing body weight. As such, the Dietary Guidelines includes a Key Recommendation to meet the Physical Activity Guidelines. 






Friday, June 16, 2017

ឱសថព្យាបាលជម្ងឺលើសឈាម - ប្រភេទ βeta Blockers


Image result for How Do Beta Blockers Work






សកម្មភាពនៃប្រភេទឱសថ βeta Blokers គឺ ទប់ស្កាត់ម៉ូលេគុល β នៅក្នុងភ្នាសកោសិកនៃបេះដូង សរសៃឈាមបេះដូងសរសៃឈាមក្រហម សួត លំពែង ក្រលៀនខួរក្បាលនិងថ្លើម 

βeta Blokers បន្ថយចង្វាក់បេះ ដូង, សម្ពាធឈាម និង ការកន្រ្តាក់នៃបេះដូង កាត់បន្ថយអាត្រាកម្រិត ឬ កម្លាំងនៃសកម្មភាពកោសិកាដែលស្ថិតនៅក្នុងជញ្ជាំងនៃផ្នែកខាងស្តាំនៃបេះដូង (Sinus Node Rate) បន្ថយល្បឿនចលនាអគ្គិសនីតាមរយៈ atrioventricular (AV)  Node និងពន្យារពេលយន្តការឆ្លើយតបស្វ័យប្រវត្តនៃចលនាអគ្គិសនី



ឱសថមួយចំនួននៅក្នុងក្រុម β (Beta) Blokers រួមមាន: Atenolol, Bisoprolol, Carvedilol, Esmolol, Labetalol, Metoprolol, Nebivolol, Oxprenolol, Pindolol, Propranolol, Sotalol

ឱសថព្យាបាលជម្ងឺលើសឈាម - ប្រភេទ Calcium Channel Blockers


Image result for CA Channel Blockers


អត្ថបទនេះរៀបរាប់អំពីឱសថមួយចំនួននៅក្នុងក្រុម Calcium Channel Blockers រួមមាន៖

ប្រភេទ Dihydropyridines: Amlodipine, Clevidipine, Felodipine, Lercanidipine, Nifedipine និង 
Nimodipine

មិនមែនជាប្រភេទ Dihydropyridines (Non-dihydropyridines) Diltiazem និង  Verapamil


សកម្មភាពនៃប្រភេទឱសថ Calcium Channel Blockers គឺ រារាំងចរន្តកាល់ស្យូមទាំងស្រុង ។ Calcium Channel Blockers កាត់បន្ថយចរន្ត (អគ្គីសនី) នៅក្នុងបេះដូង កាត់បន្ថយកម្លាំងនៃការកន្ត្រាក់ (decrease the force of contraction) នៃកោសិកាសាច់ដុំរបស់បេះដូង និង ធ្វើឱ្យបំពងសរសៃឈាមរីកធំឡើង (Vasodilation) ។ ការធ្វើឱ្យបំពងសរសៃឈាមរីកធំឡើង កាត់បន្ថយសម្ពាធឈាម (reduce blood pressure) ដូច្នោះការខិតខំប្រឹងប្រែងរបស់បេះដូង គឺ សំដៅទៅលើការបូមឈាម ។

រាំងខ្ទប់ចរន្តកាល់ស្យូមចូលទៅក្នុងកោសិការរលោងនៃសសៃរឈាមបេះដូង (Cells in the vascular smooth muscle)  សាច់ដុំបេះដូង (Myocardium) និង ប្រព័ន្ធចរន្តបេះដូង (Cardiac conducting system) តាមរយះជន្លងកាលស្សូមប្រភេទ L-type

ថ្នាំប្រភេទ Dihydropyridines ធ្វើសកម្មភាពទៅលើសាច់ដុំរលោងនៃសសៃរឈាម ដើម្បីកាត់បន្ថយសម្ពាធទៅលើសរសៃឈាម និង សម្ពាធឈាម ។

ថ្នាំដែលមិនមែនជាប្រភេទ Dihydropyridines (Non-dihydropyridines) ដូចជា diltiazem និង verapamil ធ្វើសកម្មភាពលើបេះដូងនិងសាច់ដុំរលោងនៃសរសៃឈាម។ ពួកគេកាត់បន្ថយការការក្ត្រាក់របស់បេះដូង ចង្វាក់ បេះដូង និង ប្រព័ន្ធចរន្តសសៃរបេះដូង 

ឱសថព្យាបាលជម្ងឺលើសឈាម - ប្រភេទ Sartans


Image result for block binding of angiotensin II to type 1 angiotensin (AT1) receptors.
អត្ថបទនេះរៀបរាប់អំពីឱសថមួយចំនួននៅក្នុងក្រុម Sartans ដែលត្រូវបានគេស្គាល់ផងដែរថាជា សារធាតុដែលរំខាន ឬ រារាំងសកម្មភាពសរីរៈរបស់ Angiotensin ទី ២ និង ម៉ូលេគុល Angiotensin នៅក្នុងភ្នាសកោសិកា (ARRA).

អត្ថបទនេះរៀបរាប់អំពីឱសថមួយចំនួននៅក្នុងក្រុម Sartans រួមមាន៖


  • Candesartan Eprosartan Irbesartan
  • Losartan Olmesartan Telmisartan និង Valsartan


សកម្មភាពនៃប្រភេទឱសថ Sartans គឺ រារាំងទាំងស្រុងនៃសកម្មភាពសរីរៈរបស់ Angiotensin ទី ២ ពីការតភ្ជាប់ទៅនិងជំពូកម៉ូលេគុល ទី ១ (AT1) នៅក្នុងភ្នាសកោសិការបស់ Angiotensin ។ ឱសថនេះកាត់បន្ថយផលប៉ះពាល់នៃការបំព្រួញបំពងសសៃរឈាមអោយរួមតូច ដែលបានបង្កឡើងដោយសារ អរម៉ូន Angiotensin ២ ការស្រូបចូលវិញនៃជាតិសូដ្យូម (Sodium Concentration) នៅក្នុងឈាម ព្រមទាំងបឈ្ឈប់ការរំញោចសកម្មភាពនៃអរម៉ូន Aldosterone ។





ឱសថព្យាបាលជម្ងឺលើសឈាម - ប្រភេទ ACE inhibitors


Image result for ACE inhibitors

មានថ្នាំជាច្រើនប្រភេទដែលត្រូវបានប្រើដើម្បីព្យាបាលជម្ងឺលើស ឈាម (Hypertenion or High Blood Pressure) អាស្រ័យលើជម្រើសរបស់លោកវេជ្ជបណ្ឌិតនិងស្ថានភាពសុខភាពអ្នកជម្ងឺ។ 

ឱសថទាំងនោះត្រូវបានគេចែកចេញជាក្រុម រួមមាន៖

  • ក្រុម ACE inhibitors ក្រុម Sartans ក្រុម Calcium channel blockers និង Beta-blockers

អត្ថបទនេះរៀបរាប់អំពីឱសថមួយចំនួននៅក្នុងក្រុម ACE inhibitors រួមមាន៖
  • Captopril, Enalapril, Fosinopril, Lisinopril, Perindopril, Quinapril, Ramipril, Trandolapril


សកម្មភាពនៃប្រភេទឱសថ ACE inhibitors គឺ ទប់ស្កាត់ការបម្លែងនៃអរម៉ូន Angiotensin ១ ទៅជាអរម៉ូន  Angiotensin ២ ។ ឱសថនេះកាត់បន្ថយផលប៉ះពាល់នៃការបំព្រួញបំពងសសៃរឈាមអោយរួមតូច ដែលបានបង្កឡើងដោយសារអរម៉ូន Angiotensin ២ និង កំហាប់នៃជាតិសូដ្យូម (Sodium Cocentration) នៅក្នុងឈាម ព្រមទាំងបឈ្ឈប់ការរំញោចសកម្មភាពនៃអរម៉ូន Aldosterone ផងដែរ ។ 

ប្រព័ន្ធ Renin-Angiotensin-Aldosterone System (RAAS) និង សម្ពាធឈាម




Renin-Angiotensin-Aldosterone System (RAAS) គឺ ជាប្រព័ន្ធអ័រម៉ូន (hormone system) ទាក់ទងទៅនឹងកំហាប់ប្លាស្មាសូដ្យូម (plasma sodium concentration) និង សម្ពាធឈាម (arterial blood pressure) ។ សមាជិកដ៏សំខាន់នៃប្រព័ន្ធនេះរួមមាន ១) Renin ២) Angiotensin និង ៣) Aldosterone ៤) Angiotensin Converting Enzyme។ 


Renin-angiotensin system.

នៅពេលដែលសម្ពាធឈាមធ្លាក់ចុះដោយសារមូលហេតុណាមួយ កោសិកាពិសេសនៅក្នុងតម្រងនោម សម្គាល់ការផ្លាស់ប្តូរ ហើយបញ្ចេញ Renin ចូលទៅក្នុងចរន្តឈាម។ Renin បម្លែងទម្រង់បែបបទអសកម្មនៃ Angiotensin ដែលផលិតដោយថ្លើមនោះទៅជា Angiotensin I បន្ទាប់មកបម្លែងទៅជា Angiotensin II ។ ការបម្លែងប្តូរទីពីរនេះ គឺ កើតឡើងនៅក្នុងសួតតាមរយៈម៉ូលេគុលមួយទៀតហៅថា Angiotensin Converting Enzyme (ACE) ។


Angiotensin II គឺជាអ័រម៉ូនដែលអាចធ្វើសកម្មភាពដោយផ្ទាល់ទៅលើសរសៃឈាមធ្វើអោយកំណើននៃសម្ពាធឈាមហើយមុខងារដ៏សំខាន់មួយទៀតគឺជំរុញអោយមានការបញ្ចេញ Aldosterone ។Aldosterone បង្កអោយសសៃរឈាមរួមតូចហើយសម្ពាធឈាមឡើងខ្ពស់ទន្ទឹមនិងនោះរោះវាអាចផ្លាស់ប្តូរសកម្មភាពរបស់តម្រងនោម។ Aldosterone បណ្តាលអោយតម្រងនោមរក្សាសារជាតិអំបិលនិង ទឹក នោះធ្វើអោយបរិមាណទឹកនៅក្នុងរាងកាយកើនឡើង។ ការកើនឡើងនេះបង្កើនកម្រឹតនៃសម្ពាធឈាម។