As soon as you give way to laughter, electrical impulses are triggered by nerves in your brain, which set off chemical reactions there and in other parts of the body. Your endocrine (glandular) system orders your brain to secrete its natural tranquilizers and relieve pain. Other substances released in the wake of laughter aid digestion, while others make the arteries contract and relax, improving blood flow (except for patients with asthma), and possibly alleviating high blood pressure. To say laughter is the best remedy for what all you are going too far, but if you call it good medicine, few doctors will disagree.
Figure is Ultrastructural morphology of SARS-Co V-2
Pathophysiology of COVID-19 Infection:
SARS-CoV-2 is a single-stranded RNA virus that belongs to the Orthocoronavirinae subfamily. It consists of 16 nonstructural proteins and 4 structural components: spike glycoprotein (S), envelope protein, membrane glycoprotein, and nucleocapsid phosphoprotein (N). However, the viral types can differ across infections at different times and at least 116 mutations have been identified in the beginning of 2021. The S proteins are critical for binding to the host cell surface receptors, whereas the N proteins are essential for viral survival and expansion.
How Virus Works:
SARS-CoV-2 is transmitted through exposure to respiratory droplets from a person with COVID-19 that are inhaled or deposited on the host’s mucous membranes. Respiratory droplets may be airborne or can land on surfaces and objects, which when exposed to a host cell with the entry receptor ACE2 (angiotensin-converting enzyme 2) in the presence of TMPRSS2 (transmembrane protease serine 2) interacting with its spike protein to gain entry. Upon binding to the ACE2 receptor, the SARS-CoV-2 spike protein is activated through proteolytic cleavage by TMPRSS2, inserted into the cell membrane, and fuses the viral and cellular membranes so that transfer of the viral RNA into the host cell cytoplasm can occur, followed by viral replication. The cell then releases the new viruses to infect more cells.
In addition to varying entry routes into host cells, questions remain regarding how SARS-CoV-2 gains access into the central nervous system (CNS), referred to as neurotropism or the ability to infect nerve tissue. The nasal-olfactory nerve route, blood-nervous stem barrier breakdown, blood-nerve barrier or blood-cerebrospinal fluid barrier permeability, lymphatic drainage system of the brain, retrograde transmission from the enteric, lung, or kidney nerve routes, or macrophage/ monocyte cargo routes have all been suggested pathways by which the SARS-CoV-2 virus reaches the CNS.
The immune system has several layers of defense, including killer T cells, which attack cells overcome by viruses. Eventually, new antibodies are created that can neutralize viruses before they infect cells. When reproducing viruses can make mistakes in their genetic material or even reassort with other viruses. Mutation can create new viruses that the immune system can’t recognize.
For now, general precautions (masks, social distancing, and frequent handwashing) remain in place to control the virus, as COVID-19 vaccinations are taking place worldwide. Testing for COVID-19 infection remains a critical component of the COVID-19 detection and surveillance efforts. In the meantime, we have learned to live with the pandemic, which has changed our lives in ways large and small.
The principles for determining when patients with end-stage cardiac disease require end-of-life care, are actually similar to those for determining prognosis of patients with advanced pulmonary disease.
Disabling Dyspnea or Chest Pain
Dyspnea or chest pain with rest or minimal exertion and can therefore classified as New York Heart Association class IV (NYHA class IV)
Ejection fraction less or equal 20%, if available
Persistent symptoms despite optimal medical management with vasodilators and dialectics, or
Inability to tolerate optimal medical management due to hypotension and/or renal failure
The increased interest in physician aid in dying/assisted suicide is one of the reasons for the growth in palliative care and hospice care.
The word euthanasia is combination of the Greek eu= good, and thanatos = death. Literally and etymologically it therefore means “good death”. Historically and scholarly, euthanasia in the strict- and in the Dutch context the only proper- sense refers to the situation in which a doctor kills a person who is suffering “unbearably” and “hopelessly” at the latter’s explicit request (usually by administering a lethal injection)… and euthanasia is in the Netherlands reserved for killing on request. In concrete terms, euthanasia invovles injecting the patient with two types of eubstances: barbiturates to induce coma, followed by neuromuscular blockers which cause respiratory muscle paralysis. The consequent anoxia and cardiac arrest bring on immediate death.
Disabling Dyspnea or Chest Pain
