Chemists prove chromones are effective against Alzheimer’s disease

RUDN chemists synthesized a range of biologically active molecules called chromones and demonstrated their use in the treatment of Alzheimer’s disease. The results of the work were published in the Bioorganic & Medicinal Chemistry journal.

Alzheimer’s disease is a progredient form of dementia causing irreversible deterioration of cognitive functions (attention, memory, orientation, and thinking) and resulting in complete disintegration of personality. According to the World Health Association, about 6-7 million people are diagnosed with Alzheimer’s disease annually. RUDN chemists with their colleagues from IPAC RAS and Lomonosov MSU synthesized new compounds that are able to stop the progression of this disease and studied their biological activity.

Alzheimer’s disease is associated with the damage of the central or peripheral nervous system. A special role in the work of the nervous system is played by a neurotransmitter called acetylcholine that helps a neural impulse move between neurons and then from neurons to muscles. Reduced levels of acetylcholine are one of the symptoms of Alzheimer’s disease. Today’s treatment methods are reduced to prolonging the activity of the remaining acetylcholine with drugs that slow down its disintegration and partially compensate for its loss.

The disintegration of acetylcholine is affected by several substances. The main role in the process is played by acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). In the course of development of the Alzheimer’s it’s the activity of BChE that increases. By reducing it, one may slow down the disintegration of acetylcholine. RUDN chemists managed to achieve this effect using chromones—biologically active molecules that have been previously successfully used in the treatment of other conditions. In their previous works the authors suggested a new way of synthesizing substituted chromones compounds, and in this research demonstrated their potential as an efficient anti-Alzheimer’s therapy.

“We found chromones interesting because of their pharmacological activity. Their derivatives appeared to have anti-cancer, anti-viral (including anti-HIV), anti-microbial, anti-fungal, anti-inflammatory, anti-diabetic, and antioxidant properties. It was especially important for our studies that chromones and their derivatives played an important role as antioxidants and acceptors of radicals,” said Larisa Kulikova, a candidate of chemistry, and a lecturer of the Faculty of Physics, Mathematics, and Natural Sciences at RUDN.

To evaluate the pharmacological activity of the obtained substances, the scientists used kinetic methods and modeling. The results of screenings showed that the new substances efficiently slowed down the activity of BChE. In the future the team hopes to improve the synthesis method and to obtain chemical compounds with antioxidant as well as BChE-suppressing properties. A substance like that would be able to slow down BChE and at the same time to reduce the so-called oxidative stress—the disbalance between the number of active oxygen or nitrogen compounds and the inability of the body to process them leading to massive cell death.

More information:
Galina F. Makhaeva et al. Synthesis, molecular docking, and biological activity of 2-vinyl chromones: Toward selective butyrylcholinesterase inhibitors for potential Alzheimer’s disease therapeutics, Bioorganic & Medicinal Chemistry (2018). DOI: 10.1016/j.bmc.2018.08.010

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COPD patients rarely receive pulmonary rehabilitation despite its health benefits

Only a tiny fraction of patients hospitalized for COPD, or chronic obstructive pulmonary disease, participate in a pulmonary rehabilitation program following hospitalization, even though such programs are recommended and Medicare covers their cost, according to new research published online in the Annals of the American Thoracic Society.

In “Participation in Pulmonary Rehabilitation Following Hospitalization for COPD among Medicare Beneficiaries,” Kerry A. Spitzer, Ph.D., MPA, and co-authors report that in 2012 only 1.9 percent of COPD patients nationally started a pulmonary rehabilitation within six months of being hospitalized for a COPD exacerbation. This despite the fact that two years earlier Medicare’s policy changed to provide coverage for pulmonary rehabilitation services, effectively offering pulmonary rehabilitation to millions of U.S. patients for the first time.

COPD is a chronic disease and the fourth leading cause of death in the U.S. Pulmonary rehabilitation provides exercise training, self-management advice, nutrition counseling and emotional support. Despite its proven benefits, an ATS-commissioned survey by Wakefield Research found that 62 percent of people diagnosed with COPD have never heard of pulmonary rehabilitation.

The patient-tailored intervention has been shown to improve physical and psychological well-being and quality of life. Other studies have shown that pulmonary rehabilitation reduces COPD exacerbations that often lead to hospitalization. Clinical guidelines recommend that patients begin pulmonary rehabilitation within three weeks following discharge from the hospital.

According to study senior author Peter Lindenauer, MD, MSc, a hospitalist at Baystate Medical Center and director of the Institute for Healthcare Delivery and Population Science at the University of Massachusetts Medical School, there has been growing recognition of the benefits of pulmonary rehabilitation.

As hospitals and health systems, like ours, increase efforts to keep patients with COPD healthy and out of the hospital, we have prioritized enrolling patients into our rehabilitation program prior to hospital discharge,” Dr. Lindeauer said. “As a result, we are seeing improvements in readmission rates among patients with COPD.”

After reviewing the records of 223,832 patients hospitalized for COPD in 2012, the researchers found:

  • 4,225 (1.9 percent) received pulmonary rehabilitation within six months of being discharged from the hospital.
  • 6,111 (2.7 percent) received pulmonary rehabilitation within one year of being discharged from the hospital.
  • Whites, males, younger patients and those on home oxygen were more likely to receive pulmonary rehabilitation.
  • Smokers and those living farther than 10 miles away from a pulmonary rehabilitation program, belonging to lower socioeconomic groups and coping with additional chronic diseases and prior hospitalizations were less likely to receive pulmonary rehabilitation.
  • Among those who started pulmonary rehabilitation, more than half completed at least 16 sessions. Medicare will typically pay for up to 36 sessions.

Study limitations include the fact that researchers could not determine whether the low rates of pulmonary rehabilitation utilization were due to lack of physician referrals, patients choosing not to attend or a combination of the two factors.Dr. Spitzer, the lead study author and senior clinical research coordinator at Baystate, believes more research is needed to understand why patients are not receiving pulmonary rehabilitation.

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5 drinks that increase sexual energy

Sex is an important and enjoyable part of our lives, but sometimes we just don’t have the strength and energy in bed. Experts have called 5 surprising drinks that increase the level of this energy.

Apple juice. Due to the increased levels of an antioxidant flavonoid called quercetin, which is present in the Apple, is one of the best products to enhance the level of sexual energy. If you have a problem with her, often drink Apple juice.

Smoothie of bananas. By enzyme bromelaine, which is available in bananas, in the body improves libido and increases sexual energy. Bananas promote the production of sex hormones because they contain additional vitamins and minerals has a positive influence on sexual stamina and energy.

Ginger drinks. To make your love life more rich and colorful, the activity drink beverages that contain ginger. Ginger root increases blood flow throughout the body, especially the pelvis, which is a means of treatment of impotence and premature ejaculation. Ginger has a positive effect on a person’s sex life.

Med. Honey and drinks on its basis is very useful in enhancing the sexual life. Honey contains a lot of useful nutrients, which quickly increase energy levels in the body.

Watermelon juice. Watermelon has a positive effect on erection, almost repeating the action of viagra, since it is full of amino acid L-citrulline. Watermelon juice improves blood flow to the penile area, making erections more powerful. (READ MORE)

Obesity both feeds tumors and helps immunotherapy kill cancer

A groundbreaking new study by UC Davis researchers has uncovered why obesity both fuels cancer growth and allows blockbuster new immunotherapies to work better against those same tumors.

The paradoxical findings, published today in Nature Medicine, give cancer doctors important new information when choosing drugs and other treatments for cancer patients.

“It’s counter-intuitive because up to this point all of our studies showed that obesity resulted in more toxicities associated with immunotherapy treatments,” said William Murphy, a co-last author of the study and vice chair of research in the UC Davis Department of Dermatology. “This is a game-changer because when we personalize medicine and look at body mass index, in some situations it can be bad, and in some situations it can be helpful.”

Obesity, which is reaching pandemic levels and a major risk factor for many kinds of cancer, also is known to hasten cancer growth, promote cancer recurrence and worsen chances of survival. Obesity also is associated with impairment of the immune system. Previous studies of the use of immune-stimulatory immunotherapies have demonstrated that in obese animal models and in humans, these drugs overstimulate the immune system and cause serious side effects.

The research, which involved studies using animal models and human patients, analyzed the effect of a different class of immunotherapies called checkpoint inhibitors. These drugs work by blocking pathways called immune checkpoints that cancers use to escape the immune system. They include drugs like Keytruda (pembrolizumab), which have dramatically improved survival in many lung cancer and melanoma patients. In the current study checkpoint inhibitors had a different effect than other immunotherapies, and in fact, resulted in better survival in those who are obese than in those who are not.

Why this happens, they discovered, relates both to the effect that obesity has on the immune system and to the way that checkpoint inhibitors do their jobs.

Cancers can cause increased expression of checkpoint proteins that keep T cells in check, preventing them from attacking cancer cells. Checkpoint inhibitors block those proteins, in effect releasing the immune system’s brakes so that the T cells can go after cancer cells.

The research team discovered that because obesity also causes suppression of the immune system and increased expression of checkpoint proteins, the action of checkpoint inhibitors is enhanced in animal models and humans who are obese.

https://youtube.com/watch?v=o_Dw09YXvBs%3Fcolor%3Dwhite

They first studied the differences in T-cell function in obese and non-obese mice and found that T-cell function was diminished and the expression of the PD-1 protein on the T-cells was higher than in the non-obese control mice. They saw a very similar pattern when the same studies were done in both macaque monkeys and in human volunteers.

Additional studies also found that tumors grew more aggressively in obese mice, regardless of tumor type.

“In obese animals cancer grows faster because there are more nutrients for tumors and because the immune system is more suppressed,” said Murphy.

Drilling down, Murphy and his colleagues also found that the T-cell dysfunction was driven in part by leptin, a weight-regulating hormone produced by the body’s fat cells. The research showed that increased leptin levels in obese mice and humans also correlated with increased expression of PD-1 checkpoint protein.

When obese mice with tumors were given checkpoint inhibitors designed to block the action of PD-1, they survived significantly longer than the non-obese control mice in the study. A study involving 251 patients with melanoma who were treated with checkpoint inhibitors also found marked improvements in the clinical outcomes of obese patients that were not observed in non-obese patients.

“Overall these findings suggest that obesity may be a very important biomarker for response to checkpoint inhibitor immunotherapy,” said Arta Monjazeb, associate professor in the UC Davis Department of Radiation Oncology and co-last author on the study. “We are not advocating for obesity as improving prognosis for cancer patients. But obesity appears to induce immune suppression and accelerated tumor growth through mechanisms that can be successfully reversed by checkpoint inhibitor immunotherapy.”

Murphy cautioned that while the findings are an important step in better targeting immunotherapies, there are many other factors that likely influence how effective a certain drug will be for a given patient. Those may include gender, the type of diet consumed, their individual microbiome and the timing of their treatment.

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E-alerts dramatically cut heart attack rate for people hospitalized with A-fib

(HealthDay)—A simple pop-up alert on a computer screen could help save the brains and hearts of many hospital-bound people with an irregular heartbeat, a new clinical trial reveals.

Rates for heart attack and stroke plunged by close to 90 percent in people helped by the new program, the study found.

The computer alert warns doctors of the high stroke risk borne by individual patients who suffer from atrial fibrillation, a quivering heart rhythm that allows blood to pool and clot inside the heart.

Doctors who received this alert were nearly three times as likely to prescribe blood thinners to hospitalized patients with a-fib, said Dr. Gregory Piazza, a cardiovascular specialist with Brigham and Women’s Hospital in Boston.

As a result, rates for heart attack and stroke among the a-fib patients fell by 87 percent and 88 percent, respectively, over the three-month trial, Piazza’s group reported Saturday at the American Heart Association’s annual meeting in Chicago.

The magnitude of the reduction in risk of these life-threatening health problems surprised researchers, as it was “really beyond what we expected to see with the increase of anticoagulation,” Piazza said.

Blood thinners are very important to prevent stroke in a-fib patients, but prior studies say at least 30 percent have not been prescribed such a medication, researchers said in background information.

For this study, Piazza and his team created a program that analyzes computer chart data of patients with atrial fibrillation to calculate what is known as a CHADS-VASC score.

This commonly used diagnostic algorithm assesses risk factors for stroke in a-fib patients, said Dr. Mary Norine Walsh, medical director of the heart failure and cardiac transplantation program at the St. Vincent Heart Center in Indianapolis.

The test program issues a pop-up alert to doctors indicating that their a-fib patient has a high CHADS-VASC score. It even estimates their annual risk of stroke.

The pop-up then requires doctors to either prescribe a blood thinner or give a reason why such a medicine shouldn’t be used. Possible reasons include “bleeding risk is too high,” “patient is at high risk for falls,” or “patient refuses anticoagulation.”

To see whether the alert would make a difference, the researchers randomly assigned 458 a-fib patients so about half would have their records reviewed by the program.

About 19 percent of patients in the alert group had a prescription for blood thinners during hospitalization, at discharge and three months later, researchers found. By comparison, only 7 percent of the control group had been prescribed blood thinners.

By three months after hospitalization, the alert group had a dramatic effect on patients’ odds for heart attack or stroke, although that didn’t translate to a lessening of the death rate, the team noted.

Still, the study showed that reminder systems like this actually really work to cut the odds for cardiac events, said Walsh, who is president of the American College of Cardiology.

“We as physicians can’t keep everything in our brains all the time,” she said. “It’s clear in medicine if we have reminders, we more commonly prescribe drugs and take action.”

But even though doctors are moving toward the use of electronic health records, it’s not clear how easily hospital data centers could incorporate such an alert into their usual systems, Walsh said.

“All electronic health records could do it probably, but not all are set up to do it,” Walsh said. “I can tell you, my electronic health record doesn’t do this kind of thing. It’s not an automatic thing that happens.”

Adding such an alert system might be costly for some hospitals, Piazza added.

“Implementation of alert-based [computerized decision support] requires an investment in programming and medical informatics infrastructure which may not be available at some medical centers,” Piazza said.

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High fat diet has lasting effects on the liver

Consuming a high-fat, high-sugar diet causes a harmful accumulation of fat in the liver that may not reverse even after switching to a healthier diet, according to a new study by scientists from Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center.

For the study, published Oct. 3 in Science Translational Medicine, the investigators developed a nanosensor that can detect and noninvasively track the accumulation of fat in the liver. They used the sensor to assess the effects of a high-fat, high-sugar diet on the livers of mice. They then evaluated the outcomes when the mice returned to a healthy diet. Unexpectedly, the researchers found that, while the fat accumulation decreases after returning to a healthy diet, some residual fat remains in certain liver cells long afterwards.

“Going on a short-term unhealthy diet binge is a bad idea,” said senior author Dr. Daniel Heller, an associate professor in the Pharmacology and Physiology, Biophysics and Systems Biology program at the Weill Cornell Graduate School of Medical Sciences and head of the Cancer Nanomedicine Laboratory at Memorial Sloan Kettering Cancer Center. “The liver remembers.”

Nonalcoholic fatty liver disease (NAFLD) affects up to 30 percent of people in the United States, where a high-fat, high-sugar diet is common. Patients with NAFLD develop an accumulation of excess fat in their livers. The condition can progress to a more serious disease involving inflammation, scarring and even liver cancer (called nonalcoholic steatohepatitis, or NASH). People who accumulate fat inside liver cells called Kupffer cells, specifically a part of these cells named lysosomes that act like cellular garbage collectors, appear more likely to progress to serious liver disease.

“Fatty liver disease is a growing concern in the clinic and has rapidly become one of the top causes of liver disease in the United States and Europe,” said co-author and hepatologist Dr. Robert Schwartz, an assistant professor of medicine at Weill Cornell Medicine and an assistant professor in the Physiology, Biophysics and Systems Biology program at the Weill Cornell Graduate School of Medical Sciences. “Currently, we have no medical therapies for fatty liver disease. We tell our patients to eat better and to exercise more, which, as you can imagine, is not very effective.”

Currently, some imaging tools like ultrasound or magnetic resonance imaging can help identify people with fatty livers, but these techniques often provide less detailed information. Dr. Heller’s nanosensor is the first to noninvasively detect fat in the lysosomes of the Kupffer cells, potentially identifying those most at risk of progressing.

The tiny sensor is about 1,000 times smaller than the width of a human hair and made of single-stranded DNA wrapped around a single-walled carbon nanotube. Fat accumulation in the lysosomes changes the color of light emitted by the nanosensor, and was first observed in live cells in Dr. Heller’s lab by MSKCC research associate Prakrit Jena and Weill Cornell Graduate School of Medical Sciences student Thomas Galassi, the first author of the paper.

When the nanosensors are injected into a mouse, the liver filters them out of the blood and then are consumed by the organ’s lysosomes. Shining a near-infrared flashlight-like device on rodents injected with these nanosensors causes the sensors to glow. The color of the light corresponds to the fat content in the liver, allowing Dr. Heller and his colleagues to measure fat non-invasively using the device.

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NC reports the first death from Hepatitis A outbreak

North Carolina has reported its first death from Hepatitis A, a virus-borne infection that can be prevented by vaccination.

The death, which occurred in October, is part of a multistate outbreak of the potentially fatal disease, the N.C. Department of Health and Human Services said Tuesday.

The state health agency does not provide any details about the death to protect the privacy of the family affected.

The hepatitis A outbreak is associated with person-to-person transmission primarily among three risk groups: people who use drugs by injecting or other ways, people who are homeless, and men who have sex with men.

To stop the spread of the disease in North Carolina, county health departments are offering free vaccinations to people who are uninsured and in the high-risk groups, said Heidi Swygard, viral hepatitis medical director in the Public Health Division at NC DHHS.

North Carolina doesn’t require vaccinations against hepatitis A, Swygard said, and many Americans haven’t developed immunity to the diseases because it’s not widely circulating.

Hepatitis A is a liver infection that can pass in a few weeks as a mild illness or develop into a serious illness and last several months, according to DHHS. The agency said hepatitis A is usually transmitted through food or water that has been contaminated by feces from a contagious person.

The outbreak, announced in March 2017 by the U.S. Centers of Disease Control, has caused a spike in North Carolina hepatitis infections, primarily in Mecklenburg County.

This year, North Carolina had reported 64 hepatitis cases as of Oct. 31.

The state’s annual average for total hepatitis infections between 2013 and 2107 was 41 hepatitis cases a year.

Of the 37 cases associated with the outbreak, 20 have been reported in Mecklenburg County. Six have been reported in the Triangle: three in Wake County, two in Johnston and one in Durham.

Hepatitis A symptoms include fever, fatigue, nausea, loss of appetite and stomach pain. Some patients develop jaundice and discolored urine and feces.

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With 2 simple knee Exercises, you prevent joint pain

Our knees need to withstand quite a lot: every Day, we bow down to you, on average, more than 1000 Times. Each time you walk the multiple rests of our body weight on them. The largest and most complex joints in spite of continuous load fit, we should be active.

Millions of people complain of inflamed, swollen or aching knees. No wonder: No other joint is daily burdened and stressed like this. Not just Sprinting, or skiing, it must keep the face of tremendous pressure: At each knee flexion the largest and most complex of our joints wearing the Seven – to-eight times our weight.

So it crunches in the short or long-each time you Bend or stretch, pinches or hurts, movement is important. A good Alternative to the gym or sports field offer aerobics or Zumba: The combination of dance and Fitness brings the body into swing, can the pounds and promotes flexibility and strength.

The benefit not least to the knees: Regular exercise also improves the metabolism and blood circulation of the knee joint. In addition, a strengthened muscles protects the knee joint injuries and diseases.

In order to prevent Overuse of the musculoskeletal system, we recommend a moderate, age-appropriate and not too intense workout. In the case of existing complaints of the feet or knee joints, you should avoid, however, be on sports completely, or with an orthopedic surgeon, a gentle approach discuss.

Two Exercises for healthy knees

1. Flat on your back and raise one leg. The foot towards the buttocks. After a few seconds stretch out. The Whole thing a dozen Times with each foot repeat.

2. Sit on the table and the legs swing freely. As a result, the joint is spread grease over the entire cartilage surface of the knee joint. Cartilage nutrition is significantly improved.

The best sports for healthy knees

Whether Zumba, Running, or Jogging – regular exercise, without excessive ambition, the best medicine is “”. Muscles, Tendons and ligaments to be strengthened in a healthy way – a slow warm – up and training. As particularly knee-friendly apply

  • Swimming
  • Hiking
  • Gymnastics or water aerobics

    To the PDF guide

Simple measures in everyday life

Of the (knee)health and conducive to regular Cycling to work or for shopping. Improper loading, such as when Running can occur are virtually eliminated. All of the muscles that stabilize the knee, to be trained.

But smaller steps can achieve quite a lot. One of the simplest Precautionary measures: often times take the stairs instead of the lift. Each stage strengthens the muscles, invigorates the knee metabolism and thus prevents osteoporosis.

Long hours of Sitting in the car, office or TV chair increases the need to be active: Remains of a joint in a rigid Position, so that the cartilage layer is loaded permanently on a body and to lose excessive joint fluid. This happens more often in the day, so the risk of cartilage damage is increasing rapidly, as when a clothing is claimed always in the same place and a hole forms.

  • You can change as often as possible the work or the position of the seat.
  • Get up once in a while.
  • You are going short distances.
  • Stretch at your Desk more often the knee.

The less strain on the joints

In addition to a lack of exercise is a prolonged Standing “poison” for the knee. Because then the full body weight rests on the connection point between the upper and lower leg bones. Better time to take a breather in the Sitting load, and several times a day, the legs dangle. This promotes the formation of synovial fluid.

Should avoid, to the extent possible, longer Work in stop position (for example, when Mounting or crafts), as well as a strong knee flexion, so the cross-legged or with frequent Squatting. Problematic is also the following sports are:

  • Football
  • Handball
  • Squash
  • Tennis
  • Rowing
  • Skiing

In the case of rotational movements of the knee under load, typically for the Kick, or skiing, are the the cartilage protective menisci are especially prone to injury.

Instead of high shoes that make it difficult to straighten the joints, better flat shoes with soft sole wear. They dampen vibration while walking and protect the joints. The Same is true for an “acceptable” body weight. Because obesity is one of the main risk factors for osteoarthritis or other knee ailments.

About the expert

Sven Ostermeier Orthopaedics and accident surgery, sports medicine, chirotherapy and special orthopedic surgery. The shoulder and knee expert, works as a senior orthopaedic surgeon of the joint-clinic Gundelfingen. He is also the instructor of the German Association for arthroscopy.

What’s dangerous about mineral water

Mineral water is freely available produktowych stores – the majority of buyers takes her, focusing on personal preferences. Meanwhile, the mineral water can be dangerous, ipred neupotrebljiva the right to consult with aspecialist. Too much consumption of mineral water can cause problems with health and health.

You should know that mineral water which is available for sale, shares of nativida of depending on adaderana salts. Water with high concentration of salts may be injurious to health having been drunk in large quantities.

Mineral water. It salt content – more than one gram nality.

Medicinal-table mineral water. The concentration of salt – до10граммов nality.

According to experts, drinking mineral water can freely drink anduse of deprecatory food. With regard to medicinal-table mineral water, it can only drink – strictly ogranichennom quantity.

Medicinal mineral water. The salt content in the water – more 10граммов nality. Drink aemono only after the interview with the doctor.

The doctors explained that uncontrolled drinking LECHEBNO medical-table mineral water may be unsafe. In particular, you may experience such unpleasant symptoms, kashrut sustavah, insomnia, lethargy and weakness. The abuse of this mineral water is dangerous because it is often the result of dysfunction of the stomach, gall bladder, kidneys bladder mochevogo.

“It is especially dangerous wrong drink mineral water rich in sodium salts can be for people with nephritis, hypertension serdechno-vascular diseases, accompanied by edema”, – informed professionals.
Earlier Magicforum wrote about the fact that products with cocoa can protect people from developing many diseases.

24 hours in the emergency room: The difficulty of the everyday life of Doctors and nurses

In emergency rooms the patient numbers are increasing – an increasing burden for the staff. FOCUS-Online-editor Anika, Jonas accompanied the everyday life in a Munich emergency room. There showed, what is the real challenge for Doctors and nurses – and why it is a good sign, when a Patient has to wait longer.

Monday, 20.29 PM: At the reception of the emergency Department in Großhadern suddenly happens all at once: A 60-Year-old comes in hobbling, in the Wake of his wife and son. His leg was between two cars crushed. Another man rushes excitedly into the room: His girlfriend has become in front of the toilets passed out. At the same time a rescue comes in the back entrance of the emergency room cart. He brings a patient with a suspected stroke.

I sit together with an emergency nurse Nele Schmid* on the so-called Triage counter, where she takes new arrivals in reception, the Severity of their injuries, evaluates and acquires data. Schmid has the late shift. A few minutes has passed, your colleague from the next room, where the rescue will arrive the car, in the evening. Schmid is now responsible for both areas.

If she could, she would now probably three parts. But she remains calm. After more than five years in the emergency room she does not know to distinguish the urgent cases from the non-critical, will take care of everything at the same time, but each patient in the appropriate order.

The emergency room at Klinikum Großhadern

In the emergency room at the Klinikum Grosshadern (Munich) to be handled annually about 40,000 patients. More than 100 people a day. Round-the-clock Doctors from different subject areas in this interdisciplinary emergency Department, neurology, trauma surgery, Internal medicine and abdominal surgery. More Doctors are available on call in the house. Per shift, five to six nurses to come also.

Those who have to wait may be lucky

So you can be the man with the trapped leg, despite the pain, his face twisted in time to sit and search for a free treatment room for the patient in the ambulance. How the victim feels, I can well understand. I remember my first visit to an emergency room. That was eight years ago. I had cut the little Finger on a tin can. He got three stitches. At the time, I was shocked to some extent, that upon my arrival in the emergency room, not at once all life support measures were taken. Instead, I should put me in the waiting area – with a blood Finger?!

Today I know: That was a good sign. If it takes a little longer, that means in an emergency room, you will survive the day. Worse it would be if Doctors and nurses are provided with a deck, slips, syringes. As it is in the patient of the case that has probably suffered a stroke. With him, every Minute can make the difference between life and death.

20.39 PM: Nele Schmid is back at the Triage counter. It takes a short time to fill up water bottle. This is their second break since the start of the Shift four hours ago. Meanwhile, the Stroke Team takes the patient from the ambulance, the blood. Thereafter, in the computer tomography images of the brain are created.

“The true face of the company”

21.33 clock: All treatment rooms are occupied. In one of the rooms, a 40-year-old woman with systemic scleroderma, a connective tissue disease is seated. At the time of their arrival in the emergency room they prayed continuously to God, he was barely responsive.

In the waiting area of ten patients were able to talk to any doctor, sit. Including a mathematics student who is feeling burned out, a woman with stomach pain, a cancer patient who has lost the car, the orientation to short-term, a woman who cut herself while cooking in the Finger.

“In the emergency room, you will see the true face of the society, the entire range, starting from people needs, about asylum-seekers to the Upper Class with their own set of problems,” tells me emergency nurse Sandra’s reputation*. You experience dramatic stories, as a result, the work was very stressful, she says.

The work takes energy

Tuesday, 7.22 PM: Outside it’s cold, over night it snowed. In such weather, the emergency room is often visited in the morning. A man fell down in the snow slide. A woman is caught with your car on the slippery road and hit the collision with another car the Arm. These are the most typical accidents in this weather, explains Matthias Klein, senior physician and head of the emergency room Großhadern.

12.38 PM: The lunch break falls short today. Because a colleague moves to another Department, there is the farewell to sandwiches and pastries. Most of the employees take just ten minutes to refuel shortly. A 59-year-old woman with a suspected brain haemorrhage is the arrival of the wagon at any Moment with the rescue. As time to enjoy lunch.

In the meantime, I’ve found: The biggest challenge in a emergency room, the serious illnesses and injuries with which patients arrive. The violence is not the willingness of some patients under the influence of alcohol or drugs. For Doctors and nurses to be trained in their training, learning certain operations and handles, applying them routinely in their everyday work.

What is the training not prepared for the many: The work robs immense energy that is missing in your private life. Doctors and nurses to sacrifice their own quality of life, so that other people get a better quality of life.

“The work is exhausting, and you often feel exhausted”, tells me Sandra’s reputation. It is every second weekend on duty, Early, Late and night shifts. So it is with people in many Professions – but not everyone is in his Job for the lives of other people. “If we miss something, is the life in the worst case, a threat to the patient,” says the sister. At night around three o’clock, she often leaves the force. Your shift lasts five hours.

12.47 PM: The 59-year-old patient has arrived. She is barely responsive. Your sister-in-law has not elected to the emergency, because they responded to calls and messages. The emergency doctor and his assistant found the woman unconscious in her living room, she had slipped from the Sofa.

Now the 59-Year-old surrounded by a ten-member Team of Doctors in the so-called shock room. Because it is not able itself to take off, cut nurses her pink T-Shirt and grey Jogging pants. The patient is connected to monitors to observe your heart rate and the oxygen saturation in the blood. A blood sample comes to the evaluation to the laboratory.

13.07 PM: The patient is in the computer tomograph pushed. It is still unclear exactly what is wrong with her. Senior physician Matthias Klein comes to me now a little like Sherlock Holmes. Together with a neurosurgeon, neurologist and radiologist, he is puzzled on the basis of the previous findings, what the woman might be sick.

13.22 PM: Small lays: The patient probably has an infection of the sinuses taken. The infection had eaten through the skull plate and now they are attacking the brain. She comes back in the shock room. A doctor picks her brain fluid from the back to secure the diagnosis.

The patient needs to be on this day in surgery and is in need of a bed on the intensive care unit of neurology. However, the is full. No bed during the day, you need to deal with the nurses on the ward to a patient’s more – an additional, unplanned burden for the staff.

More and more patients come to the emergency room

Around 1600 euros net a care worthy of power. In a city like Munich, where rents are rising steadily, is for many too little to live on. Consequently, there is a lack of hospitals to care staff. If at the same time, the number of patients increases, attributed to the more pressure and responsibility on the shoulders of the existing forces. Some drag themselves to work sick, so that colleagues do not need to fill in.

The growth in patient numbers, not necessarily the fact that people get hurt more often, or more often become ill. “Patients nowadays are demanding a fast diagnostic classification,” says Matthias Klein. A violation of the patient take today is not easy. You want round-the-clock best possible care.

21.13 PM: In one of the treatment rooms sits a 22-year-old woman for a few days, a strange feeling in the chest. As if she had swallowed an object, she says. In the room next door, an elderly lady accompanied by her husband. Your foot is numb. Now she is afraid to plunge.

Many patients in the emergency room are not “true emergencies,” says a senior physician Matthias Klein. “You feel but all as an emergency. Of the patients, we can’t expect that you consider yourself to be.“ So the emergency room treated both patients with epileptic seizures or a stroke, as well as the retiree who decides after twenty years of back pain one Night, to come to the emergency room, because he has the time.

“I am looking forward to the slowness”

Performance pressure and Stress, the loads on the personnel, are not felt in the emergency room. Everyone is working quietly and patiently. Nele Schmid kids counter with the new patient at Triage, to take you to the fear. However, one learns of the immense pressure in conversations: “When I retire, will I get back my life”, tells me Sandra’s reputation. She has no husband, no children.

After so many years in the service, you will be happy to work on the little things. On a relaxing Sunday on the couch, take a walk, to a concert that you missed, because she has a late service, and the colleagues not to change. “I’m most looking forward to the slowness,” she says. Many of your colleagues will not even consider it until retirement in your profession. You switch after a few years in other hospital areas, or a completely different Job.

*Name changed by the editors

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