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English to Hindi: Pneumonia General field: Medical Detailed field: Medical: Health Care
Source text - English From Wikipedia, the free encyclopedia
Pneumonia
Pneumonia is a common illness which occurs in all age groups, and is a leading cause of death among the elderly and people who are chronically and terminally ill. Additionally, it is the leading cause of death in children under five years old worldwide.[3] Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the appropriate treatment, any complications, and the person's underlying health.
Contents [hide]
1 Classification
1.1 Early classification schemes
1.2 Combined clinical classification
1.2.1 Community-acquired pneumonia
1.2.2 Hospital-acquired pneumonia
1.3 Other types of pneumonia
2 Signs and symptoms
3 Cause
3.1 Viruses
3.2 Bacteria
3.3 Fungi
3.4 Parasites
3.5 Idiopathic
4 Diagnosis
4.1 Investigations
4.2 Combining findings
4.3 Differential diagnosis
5 Prevention
6 Treatment
6.1 Bacterial pneumonia
6.2 Viral pneumonia
6.3 Aspiration pneumonia
7 Complications
7.1 Respiratory and circulatory failure
7.2 Pleural effusion, empyema, and abscess
8 Prognosis
8.1 Clinical prediction rules
9 Epidemiology
10 History
11 Image gallery
12 See also
13 References
14 External links
Classification
This section needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (August 2009)
Pneumonias can be classified in several ways. Pathologists originally classified them according to the anatomic changes that were found in the lungs during autopsies. As more became known about the microorganisms causing pneumonia, a microbiologic classification arose, and with the advent of x-rays, a radiological classification. Another important system of classification is the combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease and underlying systemic disease, and whether the person has recently been hospitalized.
Early classification schemes
Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of the lung, either by direct inspection at autopsy or by its appearance under a microscope.
A lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Lobar pneumonia is often due to Streptococcus pneumoniae (though Klebsiella pneumoniae is also possible.)[4]
Multilobar pneumonia involves more than one lobe, and it often causes a more severe illness.
Bronchial pneumonia affects the lungs in patches around the tubes (bronchi or bronchioles).
Interstitial pneumonia involves the areas in between the alveoli, and it may be called "interstitial pneumonitis." It is more likely to be caused by viruses or by atypical bacteria.
The discovery of x-rays made it possible to determine the anatomic type of pneumonia without direct examination of the lungs at autopsy and led to the development of a radiological classification. Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray findings can be used to help predict the course of illness, although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone.
With the advent of modern microbiology, classification based upon the causative microorganism became possible. Determining which microorganism is causing an individual's pneumonia is an important step in deciding treatment type and length. Sputum cultures, blood cultures, tests on respiratory secretions, and specific blood tests are used to determine the microbiologic classification. Because such laboratory testing typically takes several days, microbiologic classification is usually not possible at the time of initial diagnosis.
Combined clinical classification
Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. This is useful because chronic pneumonias tend to be either non-infectious, or mycobacterial, fungal, or mixed bacterial infections caused by airway obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as Streptococcus pneumoniae), the atypical pneumonias (such as the interstitial pneumonitis of Mycoplasma pneumoniae or Chlamydia pneumoniae), and the aspiration pneumonia syndromes.
Chronic pneumonias, on the other hand, mainly include those of Nocardia, Actinomyces and Blastomyces dermatitidis, as well as the granulomatous pneumonias (Mycobacterium tuberculosis and atypical mycobacteria, Histoplasma capsulatum and Coccidioides immitis).[5]
The combined clinical classification, now the most commonly used classification scheme, attempts to identify a person's risk factors when he or she first comes to medical attention. The advantage of this classification scheme over previous systems is that it can help guide the selection of appropriate initial treatments even before the microbiologic cause of the pneumonia is known. There are two broad categories of pneumonia in this scheme: community-acquired pneumonia and hospital-acquired pneumonia. A recently introduced type of healthcare-associated pneumonia (in patients living outside the hospital who have recently been in close contact with the health care system) lies between these two categories.
Community-acquired pneumonia
Main article: Community-acquired pneumonia
Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not recently been hospitalized. CAP is the most common type of pneumonia. The most common causes of CAP vary depending on a person's age, but they include Streptococcus pneumoniae, viruses, the atypical bacteria, and Haemophilus influenzae. Overall, Streptococcus pneumoniae is the most common cause of community-acquired pneumonia worldwide. Gram-negative bacteria cause CAP in certain at-risk populations. CAP is the fourth most common cause of death in the United Kingdom and the sixth in the United States. The term "walking pneumonia" has been used to describe a type of community-acquired pneumonia of less severity (because the sufferer can continue to "walk" rather than require hospitalization).[6] Walking pneumonia is usually caused by the atypical bacterium, Mycoplasma pneumoniae.[7]
Hospital-acquired pneumonia
Main article: Hospital-acquired pneumonia
Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission. The causes, microbiology, treatment and prognosis are different from those of community-acquired pneumonia. Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. Hospitalized patients may have many risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances. Additionally, the microorganisms a person is exposed to in a hospital are often different from those at home . Hospital-acquired microorganisms may include resistant bacteria such as MRSA, Pseudomonas, Enterobacter, and Serratia. Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired pneumonia. Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonia. VAP is pneumonia which occurs after at least 48 hours of intubation and mechanical ventilation.
Other types of pneumonia
Severe acute respiratory syndrome (SARS)
SARS is a highly contagious and deadly type of pneumonia which first occurred in 2002 after initial outbreaks in China. SARS is caused by the SARS coronavirus, a previously unknown pathogen.
Bronchiolitis obliterans organizing pneumonia (BOOP)
BOOP is caused by inflammation of the small airways of the lungs. It is also known as cryptogenic organizing pneumonitis (COP).
Eosinophilic pneumonia
Eosinophilic pneumonia is invasion of the lung by eosinophils, a particular kind of white blood cell. Eosinophilic pneumonia often occurs in response to infection with a parasite or after exposure to certain types of environmental factors.
Chemical pneumonia
Chemical pneumonia (usually called chemical pneumonitis) is caused by chemical toxicants such as pesticides, which may enter the body by inhalation or by skin contact. When the toxic substance is an oil, the pneumonia may be called lipoid pneumonia.
Aspiration pneumonia
Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating foreign objects which are usually oral or gastric contents, either while eating, or after reflux or vomiting which results in bronchopneumonia. The resulting lung inflammation is not an infection but can contribute to one, since the material aspirated may contain anaerobic bacteria or other unusual causes of pneumonia. Aspiration is a leading cause of death among hospital and nursing home patients, since they often cannot adequately protect their airways and may have otherwise impaired defenses.
Dust pneumonia
Dust pneumonia describes disorders caused by excessive exposure to dust storms, particularly during the Dust Bowl in the United States. With dust pneumonia, dust settles all the way into the alveoli of the lungs, stopping the cilia from moving and preventing the lungs from ever clearing themselves.
Necrotizing pneumonia, although overlapping with many other classifications, includes pneumonias that cause substantial necrosis of lung cells, and sometimes even lung abscess. Implicated bacteria are extremely commonly anaerobic bacteria, with or without additional facultatively anaerobic ones like Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pyogenes.[5] Type 3 pneumococcus is uncommonly implicated.[5]
Opportunistic pneumonia includes those that frequently strike immunocompromised victims. Main pathogens are cytomegalovirus, Pneumocystis jiroveci, Mycobacterium avium-intracellulare, invasive aspergillosis, invasive candidiasis, as well as the "usual bacteria" that strike immunocompetent people as well.[5]
Signs and symptoms
Main symptoms of infectious pneumoniaPeople with infectious pneumonia often have a cough producing greenish or yellow sputum, or phlegm and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by them. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms; for instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In elderly people manifestations of pneumonia may not be typical. They may develop a new or worsening confusion or may experience unsteadiness, leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite.[8]
Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.Symptoms of pneumonia need immediate medical evaluation. Physical examination by a health care provider may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a high heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention.
Physical examination of the lungs may be normal, but often shows decreased expansion of the chest on the affected side, bronchial breathing on auscultation with a stethoscope (harsher sounds from the larger airways transmitted through the inflamed and consolidated lung), and rales (or crackles) heard over the affected area during inspiration. Percussion may be dulled over the affected lung, but increased rather than decreased vocal resonance (which distinguishes it from a pleural effusion).[8] While these signs are relevant, they are insufficient to diagnose or rule out a pneumonia; moreover, in studies it has been shown that two doctors can arrive at different findings on the same patient.[9][10]
English to Bengali: Visa Rules General field: Law/Patents Detailed field: Law (general)
Source text - English Specific Information about
the Process for Subsequent Applications
You have submitted a subsequent asylum application following on from the legally valid decision pertaining to your first application.
For this subsequent application, special regulations relating to the procedure may apply. The special regulations correspond to the individual criteria of your subsequent application. These special regulations could be, for example:
1. If your original asylum application was refused on grounds of another country being responsible (for example because you had already made an application in another EU country), you cannot be entitled to any de facto legal protection against repatriation during the processing of your subsequent application. Despite your latest application, you may therefore still be a transferred to the country responsible. However, your subsequent application will also be thoroughly checked. Whether you are to be questioned again by the police or the asylum office is decided on the basis of the particular circumstances of your subsequent application.
2.If the reasons for leaving your country of residence have already been checked in your original asylum application and this application was rejected, in certain circumstances, you may be notified by the asylum office verbally that de facto protection against deportation has been be disallowed in the case of a subsequent application. In this case, there will always be an interview with an employee of the asylum office.
In this interview, you should particularly give new or other reasons since the last decision that speak against your return to your country of origin. Withdrawal of the right of protection against deportation leads to automatic review of this decision by the asylum court. Despite your subsequent application, you may be repatriated to your country of origin. However, your subsequent application will be examined thoroughly.
If, however, you have submitted your subsequent application up to 18 days before a deportation date that can be shown to have been already known to you, other procedural regulations may apply. Despite your application, it can be that you will have no de facto protection against deportation from the law in the procedure relating to your subsequent application.
English to Bhojpuri: THE HERMIT AND THE WOLF General field: Art/Literary Detailed field: Poetry & Literature
Source text - English THE HERMIT AND THE WOLF
A hermit drew a line in the sand and said:
"You may not cross this line."
Then he drew a circle saying:
"You must stay in this circle.
You can cross it, but not over the line".
Then the tempest came and the line disappeared.
A wolf was standing in the circle.
Cold and rain had exhausted him, but he did not move.
He did not know whether the line still exists,
when it is no longer drawn in the sand.
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