Net Siibawi

Pum cawlcanghnak (exercise) tuah a thatnak kong tlawmpal
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Exercise tuah cu a tha tiah theih lengmang asi nain zei ruangah dah a that i exercise tuah tik ah pum chungah zeitin dah rian a tuan ti kha mi tampi nih cun kan theih lem lai lo. Cucaah tlawmpal in cu kong cu kan langhter lai. Pum chung ummi titsa hi hman loin caan sau deuh chung chiah tik ah titsa pawl cu a zawr (a hme deuh) thluahmah. Mizaw ihkhun cungah cawl loin saupi a it ko sicun a der deuh zungzal. A titsa kha a hman lo caah asi. Titsa cu k*t le ke, cun pum cawlcanghnak ca long siloin thawdawp/thawchuahnak ca zongah hman asi. Cu lengah thi kuatnak ca zongah a si fawn. Cucaah pum chung ummi titsa vialte cu cawl le riantuanter peng a hau.

Kan pum kan cawl i kan hmang deuhdeuh kan titsa pawl an ngan deuhdeuh i an thong deuhdeuh ve. Cucaah fak piin exercise a tuahmi pawl khi an titsa a thang i an thong deuhnak asi. Titsa chungah thi kalnak thihri a um i, cun titsa cawl kho seh tiah nawl petu thluak thahri zong a um fawn. Thluak thahri cu titsa kip he aa peh tikah kan pum kan cawl deuhdeuh titsa le thluak thahri an ipehnak a fek deuhdeuh ve. Cu tikah duhning le fawi deuh in cawlcang thiam asi. Cu ve thiam in titsa a thang deuhdeuh titsa chungah a lutmi thihri a thang i a karh deuhdeuh ve. Cu tik ah pum chungah thi cu fawi deuh in a lut/chuak kho i lung nih caan hman tein le fawi deuh in pum chung dihlak cu thi a kuat khawh ve. Cun thawdawp/thawchuahnak zong a thatter deuh rih. Cu lengah pum cawlcanghnak nih pum chung ummi thau zong a zawrter deuh fawn. Cu long siloin thazang sernak caah a herh bikmi ATP timi zong fawi deuh in a chuahter khawh i pum chung a lutmi ti le rawl zong thazang caah that deuh in le tlamtling tein a sersiam khawh (metabolism).

Atu lio Chinram emergency in Covid ral dohnak caah bawmtu tha ngai asi lai tiah ka ruahmi cu khuakip pengkip ah a tanglei hmanthlak i vun langhter chihmi Oxygen Concentrator khi tam deuh piin c**k in ichiah kho cio hna usihlaw a tha tuk hnga. Oxygen rawn hau loin i electric mei bunh in minute pakhat ah oxygen liter 6 tiang a chuah khomi oxygen chuahnak seh hmete asi. Oxygen level 95 % tiang tiang a bawm kho i a man zong a tam tuk lo, $ 1500 hrong long asi. Si kho sehlaw India ram ah c**k in mizo ram lei khin luhpi khawh sisehlaw a tha tuk hnga.
Hika link https://dir.indiamart.com/.../philips-oxygen-concentrator... tam deuh piin information zoh khawh asi.

Covid-19 hi zoh sawh awk a tha ti lo. Lairam ah atu lio kan ral ngan bik pakhat bantuk in a hung lang cang. Tuan deuh piin biatak deuh in rak timhlamh cia le iralring ding kan rak sinain kan sining cio nih a tlinh ve lo caah zei ti awk tha lo. Atu zong hi kan tlai tuk cang tiin um sawh awk a tha hrim lo. Hi nak in a zual chin kho mi asi caah fak deuh le rianrang deuh in hma lak kan hau. A voikhatnak Coivid-19 a chuahlanghning zoh tikah mino deuh lei paoh cu virus nih a rak tei kho theng hna lo. Nain virus muisam le umtuning cu zeimaw a vun ithleng (mutate) cang tikah mino pawl zong virus nih a tei thluahmah cang hna ti cu hmuh khawh asi cang. Mino te zong nih ngamh sawh awk a tha ti lo. Cun sifahnak ram (Lairam) ah khua a sami tampi cu siibawi te sinah kal in kan ngandamnak kong kan ichek bal lo tikah kan ngandamnak kong zong kanmah lila nih kan itheih dih lo. Cu tikah chunglei damlonak pakhat khat (tch. kal, thin, cuap tbk.) kan ngei le ngei lo zong kan ithei dih lo. Cu ruangah lenglei rungrul le sivai thalo hna nih kan pum chung titsa fa tete (cells) a hrawh nakhnga lo tiah a zohkhentu immune system a thawng le thawng lo zong kan thei kho ti lo. Chunglei damlonak phunphun (taksa, thinlung le thlarau) ruangah immune system thazang cu a der ngaingai kho i cu immune system thazang a der tikah virus phunphun nih kan pum cu fawi tein a tei khawh. Mino te si ko zongah chunglei damlonak pakhat khat ngei ahcun immune system thazang a der ngai kho i Covid-19 nih fawi tein a tei khawh ve ko tihi philh lo ding asi. Cucaah atu lio tihnung ngaimi Covid-19 kongah fak deuh in khua ruah le cawlcangh kan hau.
 Kawl ralkap kan doh hna bantuk in Chinmi dihlak ibawm in doh ve kan hau cang. Budget zong tampi chiah piak ve kan hau.
 Zapi nih a ran khawh chungin Covid-19 vaccine ichunkhawhnak lam kawl kan hau
 Pakhat le pakhat zawn iruah in zawtnak ichawn khawh lonak lam phunphun kawl kan hau
 Virus kongah cawnnak le theihhngalhnak a ngeimi hna sinin zapi nih thilsining tampi theih le hngalh kan hau
 Zawtnak kan ilak sual tikah izahpi hrim loin tha tein chim le phuan, cun mah te zongin damnak ding caah izohkhenh thiam kan hau. Ka dam kho ti lai lo timi ruahnak ngei hrim lo ding. Cancer in a zaw cuahmah mi hmanh Covid-19 in an dam than timi hi philh hrim lo ding.
 Hrial dingmi thil le tuah hrimhrim dingmi thil pawl kha tha tein kan iralring a biapi tuk.
 Zawtnak kong fiang tein theih tung loin midang sinah ruahnak cheuh le ithlopbulning kong chim le rel iralring deuh kan hau.

Rungrul (Virus)
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Host cell = minung, saram le thingkung tbk. chungah a ummi a nung mi cell.

Rungrul asiloah Mirang holh in “virus” cu nunnak a ngei lomi thil (particle) hmete pakhat asi. Virus cu a hme tuk hringhran caah zeihmanh bawmtu (tahchunhnak ah microscope) um loin mit sawhsawh lawngin cun hmuh khawh asi lo. Virus phun tampi lakah Covid-19 hi a tu lio tih a nung bikmi virus phunkhat asi. Fawi tein le rianrang tuk in a karh khawh caah tih a nung khunnak asi. HIV (human immunodeficiency) hi damh khawh asi lomi tih a nung ngaimi virus phunkhat asi, nain iralring thiam ahcun Covid-19 le a dangdang cuap lei virus pawl bantuk in thaw (respiration or breathing) in pakhat le pakhat ichawnh khawh asi lo. Virus cu minung le saram sin long siloin thingkung le ramhnah tbk. hna sin zongah zawtnak phunphun a chuahter ve.

Minung pum le virus lei kong he pehtlai in cawnnak le fimthiamnak a ngeimi tam deuh nih cun nunnak ngei lo tiah an ruah, a ruang cu nunnak caah a herhmi (tck. thaw) zeihmanh a tlinh lo. A nungmi thil (tck. cell) pakhat khat tel loin amah longin a thang kho lo, cun a karh zong a karh kho fawn lo. A nungmi cell cungah a um tik longah let tampi in a karh chin khawh. Virus nih amah a karhnak ding caah a hmanmi a nungmi cells cu “host cell” tiah auh asi (inntek cell kan ti lai cu). Virus cu nunnak a ngei lo caah a dang thil (organisms) bantuk in min pek asi lo. Virus phunphun a um bantuk in min an pek tikah virus nih zawtnak a chuahter mi phun le hmunhma zoh chih in min pek asi.

Virus cu muisam a phunphun in a um. Zei bantuk muisam a kenmi an si zongah virus phun poah nih an ngeihmi cu chunglei ummi a muru (nucleic acid) le cu a muru a zualtu a cung phaw (capsid) hna an si. Cheukhat a ngan deuhmi virus pawl cu a hlei in cunglei phaw (envelope) thapkhat an ngei chap rih (tahchunhnak ah covid-19). Nucleic acid timi a muru chungah RNA (Ribonucleic acid) asiloah DNA (Deoxyribonucleic acid) a um. Virus pakhat cu tampi aa chuah khawhnak ding caah a herhmi thilri (genetic materials) cu hi RNA le DNA chung ah hin a um. Capsid timi a cung phaw hi protein le a dangdang thilri in aa siammi asi i cu protein pawl an umtuning cungah ihngat in virus muisam cu aa sersiam ve.

Virus cu bawmtu (host cell) um loin amah te longin cun a karh kho lo caah a karhnak ding caah host cell pakhat khat chungah a lut a hau. Cu ti a luh khawhnak ding caah a pakhat nak a herh mi cu host cell cungah aa benh khawh hmasat a herh. Capsid timi virus a cung phaw cungah a ummi protein cu host cell cungah a benh khawhnak ding caah tuanvo ngeitu asi. Virus phunkhat le phunkhat cung i a ummi protein hna cu an idang cio bantuk in host cell phunkhat le phunkhat cungah a ummi protein hna zong an idang cio ve hna.

Cucaah minung cuap chungah a ummi host cell i protein umtuning cu pawpi chungah a ummi host cell i a protein a umtuning he aa khat lo. Cu ruangah cuap chungah a lut i cuap zawtnak a chuahter khotu virus phun cu paw (chungril) chungah a lut tikah chungril lei zawtnak a chuahter kho lo. A fawinak in chim ahcun host cell nih a ngeihmi protein le virus nih a ngeihmi protein hna cu tawh inn le tawhfung bantuk an si a hau. Tawhfung phunkhat cu tawh inn phun kip caah a si kho lo bantuk in virus phunkhat nih cell (host cell) phun kip cungah aa benh kho lo i a hrawk kho lo. Amah virus phun he aa khatmi cell cung longah aa benh khawh.

Virus nih amah aa benh khawhnak host cell aa hmuh tikah cu host cell cungah aa benh i a hnu ah virus chungah a ummi RNA asiloah DNA cu a nungmi cell (host cell) chunglei a lut. Cun host cell chung ummi RNA le DNA hna kha hmangin virus cu a karh chin. Cu hnu ah host cell kha a rawk i virus nih a chuah tak, cun a dang host cell sinah a lut than i a karhter chin rih.

Virus cu host cell chungah a thar in aa siam i a karh tikah phun hnih (lytic cycle and lysogenic cycle) in a karh kho. Hiti chim tikah virus phunkhat kha lytic cycle he lysogenic cycle he a phun hnih in a duhning poah in a karh khawh tinak siloin virus phun cheukhat hna cu lytic cycle in a karh i a dang virus phun cheukhat pawl cu lysogenic cycle hmangin a karh ti duhnak asi.

Lytic cycle nih sml. pakhat hmanh rau longin let 200 tiang a karh kho i cu ti a karh tikah host cell chung ummi thilri (genetic materials or DNA and RNA) pawl kha a hman dih hnu ah cu host cell zong cu a hrawh chih cawlh ve. Covid-19 cu hi lam in a karhmi asi. Lysogenic cycle lam zulh in virus a karh ning cu virus chung ummi RNA asiloah DNA kha host cell chungah a lut i host cell a DNA (or chromosome) sin aa fonh ve. Cu ti cun host cell kha hrawh cawlh loin caan saupi (a k*m in) tiang a nung. Host cell nih a thar in cell a chuah/siam tikah visrus DNA kha aa tel ve lengmang. Caan a rauh deuh tikah virus nih rian a tuan (active) i host cell cu a hrawh hna. “Herpes simplex virus” cu lysogenic cycle lam zulh in a karkmi phun asi.

Thikai zawtnak
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Immune system
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A tu hrawng cu COVID-19 ruangah mi tampi nih ”immune system” timi biafang cu theih pah lengmang asi. Cucu zeidah asi ti kha hika ah tlawmpal in fianternak kan tuah lai. Immune system cu kan Laiholh in a um lo caah biafang pahnih te long hmangin vun leh dingah a har deuh. Cucaah sau nawn in kan vun leh lai. Immune system cu kan pum chungah titsa (cells and tissues) a rawk asiloah ningcang loin aa sersiam i zawtnak phunkhat ah aa chuah nakhnga lo siseh, cun lenglei in a lutmi pum caah hnahnawhnak le zawtnak a chuahpi kho tu rungrul phunphun (virus (e.g. COVID-19), bacteria, parasites, fungy etc.) hna nih pum chung ummi titsa a hrawh nakhnga lo le zawtnak phunphun a chuahpi nakhnga lo a zohkhenhtu le a humhaktu asi. Ningcang loin cells aa siam i ngol theih loin a thang pengmi cu “cancer cells” ti asi.

Kan pum chungah immune system hi um hla seh law rungrul phunphun nih kan titsa (organism, cells, tissues etc.) pawl cu fawi tein a hrawh hna lai i a tu le tu fawi tein kan zaw lengmang hnga. Hi immune system nih mithar mikhual bantuk asi mi lenglei in a lutmi rungrul phunphun cu pum chungah an lut tikah titsa pawl kha hrawk kho loin a kham hna. Lenglei in a lutmi rungrul hrawh le kham long siloin pum chung a um cia mi cells pawl ningcang loin a thangmi le aa cawlcangmi hna zong zawtnak phunphun an chuahpi nakhnga lo a kham ve hna.

Immmune system cu kan thin kan lung tbk. in amah pakhat long cawlcangh in rian a tuanmi asi lo. Titsa (cells and proteins) phunphun ifonh in hmunkhat ah rian a tuan timi an si. Cu ruangah immune ti long siloin immune system ti asi. System in rian a tuan tikah hi immune system cu a rawk kho ve i ningcang loin rian a tuan caan zong a um ve. Cu tikah pum caah a tha lomi pawl rungrul phunphun hrawh le kham long kha si ti loin pum chung ummi cells a dam liomi zong kha a hrawh chih tawn ve. Cucu “autoimmune disease“ tiah auh asi.

Immune system a riantuanning hi a fawinak in tahchunnak kan lak ahcun ram pakhat, khua pakhat le buu pakhat tbk. caah humhimnak (security system) an ser i palik, ralkap le cawngtu (innka, k*tka, ramri tbk.) an chiah bantuk khi asi. Humhimnak caah hitin palik, ralkap le cawngtu phunphun an um bantuk khin immune system zong cells le protein phunphun ifonh in kan pum humhimnak caah rian a tuanmi an si. Misual le thil tha lo nih khua le ram le a chung ummi minung le thilri an hrawh i hnahnawh buaibainak, rawhralnak le thihlonak phunphun an chuahter bantuk in pum le pum chung ummi titsa phunphun a hrawk khotu rungrul le a dangdang tampi a um ve. Humhimnak caah tuanvo ngeitu palik, ralkap le cawngtu phunphun nih humhimnak lei ah za ah za (100 %) in tuanvo an lak dih kho lo bantuk in immune system zong nih pum caah 100 % in humhimnak a tuah kho ve lo. Cu ruangah mi cheukhat sinah COVID-19 rungrul pum chungah a lut tik immune system nih tuanvo lak kho loin cuap le a dangdang organ chung ummi titsa pawl cu a hrawh hna i thihnak tiang a chuahter.

Thisen kan hmuhmi chungah khin amah thisen long siloin a dangdang cells phunphun le ti tampi aa tel ve. Cucu a tlangpi in thisen tlang (red blood cells), thirang (white blood cells), platelets le ti (plasma) tiin then an si. Hi hna pawl cu phun tampi in aa then chin i an dihlak in ruh a saumi chung i a um i thlek (bone marrow) chungah an isiam. Hika zawn i thirang (white blood cells or leucocytes) hi immune system timi cu asi. Thirang cu phun 5 (T-cells, B-cells, NK cells, neutrophils, le monocytes/macrophages) in then asi i anmah le phun cio in tuanvo rian an ngei cio (palik le ralkap an rian an idang bantuk khin). Hi thirang cheukhat hna cu thlek chungah aa siam nain a puitling rih lo caah tang le hngawng karlak ummi organ phunkhat asi mi thymus tbk. ah puitling chuak lak in an iser chuah. Hi hnu ah thihri le lymphatic vessels timi chungah an lut i palik le ralkap bantuk in ral doh ding le misual le thil tha lo kawl dingah an ithawh.

Zawtnak phunphun ruangah immune system a riantuannak thazang cu a zor/tum kho i a tla kho. Cun k*m a hung upa deuhdeuh immune system thazang cu a tum deuhdeuh ve. Zawtnak le k*m upa lei sang si ruang long siloin ei le din, cun thutdirning (cawlcanghnak lei) cung zongah immune system thazang cu aa hngat mi asi.

Chronic Kidney Disease
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“Chronic” timi cu caan saupi a um cangmi tinak asi. Cucaah “Chronic Kidney Disease (CKD)” cu caan saupi a um cangmi kaal zawtnak ti kha a chim duhmi asi. Zei bantuk kaal zawtnak phun dah CKD kan ti khawh ti cun a tlawm bik thla 3 chung kaal a riantuannak a hman lo (a tumchuk) asiloah kaal a muisam le umtuning (structure) a rawk. Hitin dam kho ti loin thla 3 chung pehzulh in a um cangmi kha CKD ti khawh asi. Hi zawtnak nih zawtnak dangdang asi mi lung zawtnak (heart disease), thikai zawtnak (hypertension) le thisen tlawm tuk zawtnak (anemia), thahri lei zawtnak tbk. a chuahter duh ngai. Cucaah fak tuk in kaal a rawk hlanah hi zawtnak cu hmuh khawh in zohkhenh cawlh a biapi ngaingai. Kaal a rawk tuk cang hnu cun sii le eidin lei ralrinnak longin zohkhenh le damter khawh asi ti lo i seh hmangin thi tawlpiak a hau cang (dialysis) asiloah kaal thlenpiak a hau (kidney transplant). Tuanah hi zawtnak hmuh le hngalh khawhnak ding caah a biapi ngaimi cu thitum le thikai icheck pah lengmang a hau (blood pressure), zun i sick/check a hau (urine albumin and serum creatinine). Hihi thikai le zunthlum zawtnak a ngeimi nih tuah a herh ngaimi asi. Vawleicungah zunthlum zawtnak le thikai zawtnak a karh chin lengmang tikah CKD zawtnak zong a karh chin lengmang ve.

Zawtnak a chuahtertu a ruang pawl (Causes)
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• Zunthlum zawtnak (diabetes) hi CKD zawtnak a chuahter duh bikmi asi. Chim duhmi cu zunthlum zawtnak ngei ahcun CKD zawtnak ngei chih a fawi ngai.
• Thikai zawtnak (hypertension) zong nih CKD zawtnak cu a chuahter duh ngai ve.
• Amah kaal zawtnak phunkhat lila asi ve mi “chronic glomerulonephritis” zong nih CKD zawtnak cu a chuahter ve thiam.
• Cu ve bantuk in a dangdang kaal zawtnak phun pawl zong nih CKD cu an chuahpi khawh ve.

Zawtnak a langhning le hngalh khawhning (Signs & symptoms)
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Zawtnak a zual tuk hlan ahcun mizaw nih pum rethei ngaiin intuarpi mi a um theng lo. Cun kaal chungah titsa zeimaw a rawk i rian a tuan khawh ti lo hmanh ah a tang rihmi kaal titsa pawl nih tha tein rian a tuan rih tikah hi zawtnak cu zawkzawk in theih le hngalh asi lem lo. Cucaah siibawi te sinah icheck lo ahcun theih khawh cawlh asi lo. Caan a hung rau deuh i a zual deuh tikah a tanglei pawl hi CKD zawtnak a langhtertu asi kho.
• Kaa a thaw lo
• Tha a ba, tha a dih asilaoh tha a uai
• Mit a ku peng i ih peng a duh (somnolence)
• Lung a fim lo bantuk in um asi i khuatuaknak thazang a der.
• Cawl loin dai tein ke a um thiam lo, cawlcang le tongtham lengmang a duh.
• Ke le kemit tbk. a phing
• Zan ih lio ah tit a cat (muscle cramps)
• Takvun a ro i a thak
• Zinglei thawhka ah mit pawngkam a phing bantuk in a um
• Zun a chuak duh ngai, a bik in zanah, cun zunzun tikah zun a tlawm.
• Luak a chuak asiloah luakluak
• Zan ah ih sia a rem lo
• Thi a kai
• Tang a fak
• Thawchuah a rang

Zawtnak dothlatning le fianterning (Diagnostics)
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• Kaal a riantuannak a hman le hman lo tahnak caah hman tawnmi cu “Glomerular Filtration Rate (GFR)” timi asi. Hihi zun s*k/check in tah asi i ngandamnak lei he pehtlai in cawnnak a ngeimi nih tuah a hau. Kaal zawtnak a ngei lomi upa cu GFR hi 120 in 130 mL/min/1.73m2 asi awk asi. GFR 60 nak in a tlawm deuhmi cu kaal a riantuannak cheuhnih chungah cheukhat cu a rawk cang tinak asi.
• ULtrasound seh hmangin kaal hmanthlaknak.
• Cun thi le kaal chung ummi titsa lak in checknak tuah.

Thlopning (Treatment)
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Hi zawtnak thlop tikah amah CKD zawtnak long si ti loin, hi zawtnak nih zawtnak dang a chuahter chinmi zong kha thloppiak ve a hau. Cu ve bantuk in zawtnak dangdang zong nih hi zawtnak a zualter chin nak hnga lo zohkhenh le thloppiak chih a herh ve. Tahchunnak ah thikai zawtnak nih hi zawtnak cu a chuakter khawh bantuk in hi zawtnak zong nih thikai zawtnak cu a chuahter khawh ve thiam. Cu ruangah thikai zawtnak cu thlop chih ve a herh. Mizaw pakhat le pakhat sining tampi aa dang caah amah mizaw sining zohchih in thlop le zohkhenh thiam a biap ngaingai. Zeitluk a zual cangmi dah asi ti theihnak caah a dotdot (stages) in then asi i cu thenmi dot he zohchih in thlop le zohkhenh asi. A tanglei ah a huap piin kan vun langhter hna lai.
• Eidinnak lei:
1. Protein a tlawmmi ti le rawl phun pawl eidinpiak khawh a biapi ngaingai.
2. Thikai zawtnak, lung zawtnak phunkhat asi mi “congestive heart failure” asiloah zun a tlawm tukmi zawtnak “oliguria” a ngeimi cu cite tlawm deuh in eipiak a hau.
3. Potassium, phosphate le magnesium aa telmi rawl phun pawl sawh deuh a hau. Hi rawl phun pawl cu: banhla, aaluu, ngasa, thawpat (cheese) le cawhnuk in chuah/sermi rawl phun pawl, arsa phun pawl (poultry) tbk. Hihi Laica in vun tial ding ahcun a har deuh ngai. Ngasa zong hi phun tampi a um tikah ngasa phun paoh khi siloin cheukhat ngasa phun pawl long khi asi. Cu ve thiam in a dangdang sa phun pawl zong protein a tlawm deuhmi le a tam deuhmi an um ve thiam.
4. Hi bantuk kaal zawtnak a ngeimi caah cun tidin zong iralring ngai a hau. Tamtuk in tidin zong a tha lo i tlawm tuk in din zong a tha fawn lo. Mizaw sining zohchih a biapi ngai nain buaktlak in 500 mL in 800 mL karlak hrawng hi nikhat ah dinpiak a tha. 500 mL cu liter a cheu tinak asi i 800 mL cu liter pakhat nak in a tlawm deuh, nain a cheu nak in atam deuh.
• Sii:
1. Thikai zawtnak a ngeimi caah hman tawnmi sii phunkhat “angiotensin-converting enzyme (ACE) inhibitors” hi hman khawh asi. Hi zawtnak cu thikai zawtnak nih a chuahter khawh i a zualter duh ngai caah thi kaiter lo ding a biapi ngaingai. Thikai zawtnak a ngeimi caah cun ACE inhibitors cu a biapi khun.
2. Zunthlum zawtnak a ngeimi cu sii in siseh cun ti le rawl zongin siseh tha tein zohkhenh in sugar level cu kaiter lo ding a biapi ngaingai.
3. Thisen a tlawm tuk ahcun sii hmangin thloppiak a hau
4. Thi chungah thau phunkhat asi mi “cholesterol” a tam tuk ahcun “statins” sii hmangin thloppiak khawh asi.
• Kuak zuk lo ding a biapi tuk fawn.
• Kaal a rawk ngai cang i a herhning in thi a tawl khawh ti lo ahcun seh hmangin tawlpiak a hau cang (dialysis), asiloah kaal thlenpiak a hau (kidney transplant)

Kaal chung lung ummi (Kidney stones)
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Kaal chungah lung a ummi khi ”kidney stones” tiah auh asi i ”nephrolithiasis (or renal calculi)” ti zongin auh asi. Hi bantuk lung (stones) cu a dangdang zun a luan/kalnak lam (urinary tract) chungah aa siam kho ko nain a tam bik cu kaal chungah aa thawk/siam hmasa. Lenglei zun chuahter khawh loin a khamtu bik cu hi bantuk lung um ruangah hin asi bik. Hi zawtnak cu mi tampi sinah a chuak duh ngaimi asi i kaal lei he aa pehtlaimi zawtnak phun chungah a chuak duh bikmi pathumnak asi.

Kaal chungah lung a ummi hi a leng i lung sawhsawh kan hmuh tawnmi bantuk khi siloin minung pum chungah a ummi chemical dat phunphun (polycrystalline aggregates, e.g. calcium oxalate) cawh in an ifonh i lung bantuk in a siam/chuakmi asi. Cucu a fawinak in kaal chung lung (kidney stone) timi cu asi. Kaal nih zun a siam/chuah tawnmi chungin a chuakmi asi.

Zawtnak a chuahtertu a ruang (causes)
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Zeiruang theng le zeitindah hi bantuk lung cu aa siam khawhning asi ti cu fiang tein theih asi lo. Hihi a si kho men tiah zumh le ruahmi hna cu:
• Hi bantuk lungah aa siam duhmi dat phun pawl thi le zun chungah a tam tuk.
• Kaal, zun luannak lam le paang umtuning (structures) aa thleng (normal a si lo)
• Pum chungah dat phunphun thlennak a um ruangah (metabolic and endocrine influences)
• Pawpi le ril chungin titsa dangdang lei ti le rawl luhnak lei he pehtlainak a um lai tiah ruah asi (dietary and intestinal absorption factors).
• Kaal, zunlam le paang ah a por khomi zawtnak a um ruangah (urinary tract infections)
Chim khawhmi a ruang pahnih a um:
1. Zun aa siam tikah zun chungah aa telmi hnawm pawl (calcium salts, uric acid, cystine etc.) a tamtuk. Chim duhmi cu zun chungah a ummi ti (fluids) kha a tlawm tuk tikah hnawm pawl kha a kalpi dih kho hna lo (supersaturated urine meaning too many salts and not enough fluids in urine). Hihi pum chunglei ti (fluids) a lutmi a tlawmtuk ruangah asi kho.
2. Cun pawngkam thil a si mi lung a thantertu um ruangah.
Pakhatnak hi zun chungah hnawm pawl a tamtuk long siloin a dangdang ruang zongah aa hngat rih, tck. ah “pH” level cungah zongah aa hngat mi asi.

A ho sinah ah dah a chuak duh deuh i zeiruang ah dah a chuak duh deuh?
• Nu le pa, cun pi le pu sinah a rak ngei bal cangmi
• Hliahcang phing zawtnak phunkhat asi mi “gout” zawtnak a ngeimi
• Ril phing zawtnak phunkhat asi mi “Crohn’s disease” a ngeimi.
• Awr (hngong) ah a ummi “parathyroid gland” timi chungah zawtnak phunkhat asi mi “hyperparathyroidism” zawtnak a ngeimi
• Kaal zawtnak phunkhat asi ve mi “type 1 renal tubular acidosis (RTA)” a ngeimi
• Kaal caah a tha lomi sii a hman tawnmi
• Pa asi mi: nu nak in pa sinah a chuak duh deuh
• Kaal le zun kalnak lam chungah a por khomi zawtnak a ngeimi (urinary tract infection)
• Kaal zawtnak a chuahter duhmi ti le rawl a eidin tawnmi.

Zawtnak phun
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Hi kaal chung lung ummi zawtnak cu phun 4 in then asi:
1. Calcium stones: Hihi a chuak duh bikmi asi i chemical dat phunkhat asi mi “calcium oxalate” asiloah “calcium phosphate” in aa siam/chuakmi asi. A pahnih komh zongin aa siam duh ngai.
2. Uric acid stones: Pahnihnak a tam bikmi asi. Zun chungah “uric acid” dat a tamtuk ruangah a chuakmi asi. Cun Hliahcang phing zawtnak phunkhat asi mi “gout” zawtnak ruang zongah a chuak.
3. Struvite stones: Hihi kaal le zun kalnak lam chungah a por khomi zawtnak (urinary tract infection) a um ruangah a chuakmi asi. Zun pH level hi normal in cun 6 asi awk asi. Asinain a phunphun ruangah 4.5 in 8 tiang hi cu a dammi ah ruah asi. Zun pH cu 8 nak in a sang deuh ahcun “alkaline urine” ti asi. Hi alkaline urine ruangah struvite stones cu a chuak kho ve.
4. Cystine stones: Hihi mi tlawmte (1 %) sin longah a chuakmi asi i ngakchia sin deuh ah hmuh asi. Nu le pa cii lei in chuahpi mi zawtnak phunkhat asi ve mi “cystinuria“ in a chuakmi asi. Hi zawtnak cu chemical dat phunkhat asi mi “amino acid cystine” kha zun chungah a tamtuk caah a chuakmi asi.

Kaal chung lung ummi cu 0.5 cm nak in a fa deuh ahcun thlop hau loin amah chuak in a lengah zun in a chuak than khomi asi. Asinain 1 cm nak in a ngan deuh ahcun amah tein in chuak timi hi a tlawm ngai cang. Kaal chungah vawikhat lung a um cangmi cu a hnu ah (k*m 10 chungah) a chuak than duh ngai (50%). Cucaah ti tampi in dinpiak lengmang a hau (nikhat ah 2 L lengmang in). Zun ah uric acid level a sang tuk mi caah cun Allopurinol (Zyloprim) sii hmanpiak ah a tha. Calcium stones phun asi ahcun rawl eimi zong iralring a hau. Oxalate a tammi rawl phun pawl isum deuh a hau. Cun fawi deuh in zun a luanter khotu sii phun asi mi “thiazide diuretics” hmanpiak khawh asi.

Zawtnak a langhning (signs & symptoms
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• Kaal chung lung ummi theih khawhnak bik cu keng a tanglei deuh zawnah a fak hmasa, cun paang le a tanglei deuh zawn hrong zong a fak chih. Cu a fakmi cu ruah lopi in aa thawk i caan rau hlanah a fak chin thluahmah. Cu tin a fah tikah thutpi sawh khawh asi lo i ilehthalpi lengmang in um asi.
• Lauk a chuak, cun luak zong luak asi (mizaw cheukhat sinah)
• Zun ah thi aa tel (mizaw cheukhat sinah)

Zawtnak dotlatning le fianternak (diagnosis)
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• Zun in dothlatnak tuah asi (urine analysis and urine culture)
• CT-canner, X-ray, renal ultrasonography, intravenous pyelogram, cun plain radiograph pawl hmangin dothlatnak tuah asi.

Thlopning (treatment)
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• A fa deuhmi lung (0.5 cm nak in a fa deuh mi) cu amah tein zun in a chuak than kho. Cu lung a chuah hlan caan karlak ah fahnak a pek mi daiternak caah IV morphine le parenteral NASIDs (e.g. ibuprofen, acetaminophen (or paracetamol), naproxen etc.) sii tbk. fahnak a daitertu sii hman khawh asi. Fawi deuh in lung a chuak khawhnak ding caah “Alpha-1 blocker” sii zong hman khawh asi.
Hi zawtnak phun le zawtnak umtuning zoh chih zongin thlop a hau ve. A fak tuk lomi (mild to moderate pain) mizaw cu ti tampi din piak khawh asi. A fak tuk cang i a luak zong aa luak chih cangmi mizaw cu thihri chungah rawnmi ti phunkhat asi mi “intravenous fluids (or IV fluids)” rawn an hau. Cun seh hmangin lung a umnak zawn kha kawl a hau. Nithum chungah amah tein a chuak lo ahcun hlaipiak (urology) a hau kho men. Zun chuah khawh lo tiang in lung nih zun vialte cu a phih/kham peng i a faktuk peng ahcun hlaipiak (surgery) cawlh a hau. Cun 2 cm nak in a ngan deuhmi lung cu a mah tein a chuak kho ding asi lo caah hlaipiak a hau. Lung a fa deuhmi (0.5 in 2 cm karlak asi mi) cu lung khuainak seh phunkhat asi mi “extracorporeal shock wave lithotripsy” hmangin khuai piak khawh asi. Lenglei zun a chuah/hlonh kho ti lo i a dang rungrul le sivai thalo zong a lut cang, cun kaal a riantuannak zong a tha ti lo i a rawk ding asi ahcun a rannak in kaal chunglei khairiat pep phunkhat asi mi “nephrostomy tube“ hmangin zun cu a lengah chuahpiak zawkzawk a hau.

Kaal zawtnak phunkhat a si mi "Acute Kidney Injury"
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http://netsiibawi.com/2020/10/07/acute-kidney-injury/

Acute kidney injury (AKI) cu caan rau loin rang tak in kaal a riantuannak a tum asiloah a rawk i kaal nih a herhning bantukin rian a tuan kho ti lomi kaal zawtnak phunkhat asi. Hihi “renal failure” ti zongin auh a si. A rannak in thlop lo ahcun thihnak tiang a chuahpi khawh. AKI cu zeitindah theih le hngalh khawh a si ti cun nihnih (sml. 48) chungah kaal a riantuannak cu fak piin a tumchuk. Cu ti a tumchukmi theih khawhnak cu zun a tlawm, serum creatinine level a sang (chim duhmi cu thi chung ummi hnawm a tam deuh), cun seh (machine) hmangin thi kha tawlpiak a hau (dialysis).

AKI phun le a chuahtertu a ruang (causes)
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AKI cu phun 3 in then asi: 1) prerenal AKI, 2) postrenal AKI le 3) intrarenal AKI tiin. AKI a chuahtertu a ruang cu hi a phun cungah aa hngatmi a si.

Prerenal AKI: AKI lak ah prerenal AKI hi a chuak duh bikmi a si. Hi zawtnak a si tiah langhter khawhnak bik cu kaal lei thi a lut mi kha fak piin a tumchuk. Zawtnak a ruang kha theih in thlop than cawlh ahcun kaal kha rawk lo tein a dam than kho.
Prerenal AKI a chuahtertu a ruang hna cu:
• Pum chung ummi cell lengah a ummi ti (extracellular fluid) a tlawm tuk ruangah (hypovolemia). Cucu pum chunglei asiloah lenglei ah thi a chuak i thi a tlawm tuk ruangah a si kho (hemorrhage), cun pum chung ummi ti a tlawm tuk ruang zongah a si kho ve thiam (dehydration). Dehydration a chuahtertu cu chungthlet ruangah a si kho, luakluak ruang zong a si kho, cun ti dinmi a tlawm tuk ruang zongah a si kho i zun tam deuhnak caah hman mi sii (diuretic) tam tuk in hman ruang zongah a si kho thiam.
• Allergic zawtnak phun a si mi “analphylactic shock” ruangah
• Septic shock. Pum chungah a por khomi zawtnak (infectious disease) a um tikah cu zawtnak thatlo a dohtu (immune system) nih pum kha khamh dingah aa zuam i zawtnak thatlo cu a doh. Hi nih fak tuk in a doh sual tikah pum caah tih a nung ngai i organ pawl a hrawk khotu “sepsis” timi a chuak. Cu sepsis nih septic shock kha a chuahter.
• Lung zawtnak (heart failure & cardiogenic shock)
• Sii hmanmi phunphun ruangah. Hihi sii thatlo zong a si kho i zawtnak thlopnak caah hmanmi sii zong a si kho ve thiam.
Hi AKI phung cu theih khawhnak bik cu kaal nih zun a chuah mi kha fak piin a zor (zun a tlawm ngaingai), cun “blood uria nitrogen (BUN)” kha tam deuh piin a kai (BUN a let in a kai deuh).

Intrarenal AKI: Hi zawtnak cu kaal chungah rawhralnak pakhat khat a um ruangah a chuakmi a si. A chuahtertu a ruang pawl cu:
• Caan saupi chung tlamtling tein kaal chung ummi titsa (tissues) chunglei thi a kuat khawh lo ruangah (prolonged renal ischemia)
• Kaal caah a thalo mi sivai thalo tampi a lut ruangah (drugs, heavy metals, organic solvents).
• Kaal chung ummi thi luhchuahnak lam a pihtertu hna, hemoglobinuria, myoglobinuria, myeloma light chains asiloah uric acid casts ruangah.
• Amah kaal zawtnak dangdang lila ruangah. Hi kaal zawtnak phun tampi lakah acute tubular necrosis (ATN) cu Intrarenal AKI a chuahter duh bikmi a si.
ATN cu kaal chungah cell phunkhat a si mi “tubular epitheial cell” a rawkmi kha a chim duhmi a si. Hi cell a rawk tikah kaal a riantuannak zong kha a rawk asiloah aa thleng ve. Hi tin cell a rawkral mi cu tuan ah tha tein thlop ahcun kaal cu amah ning tein a dam than kho. Tuan ah tha tein thlop lo ahcun a dam kho ti lomi kaal zawtnak (chronic kidney disease) ah aa cang kho pinah mah le mah ihngalh loin thihpi khawh a si.

Postrenal AKI: Hi zawtnak cu kaal nih zun a chuahmi a lenglei a hlawnh khawh lo ruangah a chuak mi a si. Kaal le paang (urine bladder) karlak zun kalnak lam a pit ruangah a si kho i, cu thiam in paang le nupa chiatha karlak lam pit ruang zongah a si kho. Paang chung zongah zawtnak a um kho i cu zawtnak ruang zongah zun kalnak lam kha a phih khawh thiam rih. Hi tin zun kalnak lam a pihter tawn tu hna cu; lung (stone or calculi) asiloah titsa a bomi (tumor) hna an si. Tuan ah thlop ahcun kaal kha rawk loin a dam than cawlh khawh.

Zawtnak a langhning (signs & symptoms)
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Hi zawtnak a langhning cu a tanglei pawl hi an si:
• Zun a tlawm deuh ngaingai, ke a phing, tha a dih/uai
• Luak a chuak, tang a fak bantukin a um, thawchuah a har pah bantukin a um
• A zual deuh tikah lung a fim lo, cun chung a thlet

Zawtnak dothlatning le fianternak (Diagnosis)
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AKI nih zawtfahnak phunphun le thihlonak a chuahpi ngai caah a rannak in dothlatnak tuah in tha tein zohkhenh le thlop cawlh a biapi ngaingai. Cucaah hi zawtnak ngah khawhnak lam he a nai deuhmi pawl, tck. ah kaal zawtnak a rak ngei bal cangmi le zunthlum zawtnak a ngeimi hna cu AKI an ngahnak hnga lo siibawi sinah icheck lengmang an hau. Hihi zawtnak an ngei ruangah siloin zunthlum zawtnak le kaal zawtnak caah an hmanmi sii ruang tu ah a si deuh. Sii hmannmi phunphun nih kaal cu a hrawk duh ngaingai. A dang sii phun a si ve mi “non-steroidal anti-inflammatory drugs (NSAIDs)” zong nih kaal cu a hrawh khawh ve caah a tu le tu asiloah caan hman tein a hmangtu nih AKI a ngah sualnak hnga lo icheck ve lengmang an hau. NSAIDs cu lu le taksa hna a fak tikah siseh, cun a phingmi le tak a linmi daiter deuh nak caah hman tawnmi sii phun pawl khi an si i hi chungah aa telmi pawl cu: Aspirin, Ibuprofen, Naproxen sodium, diclofenac, cun a dangdang phun tampi a um rih. Hi sii phun cu over-the-counter (OTC) an si i mah tein siidawr ah c**k khawh a si (siibawi te nih sii c**k khawhnak nawl pek a hau lo).

AKI zawtnak a ngeimi cu zun in theih khawh a si. Cucaah zun kha tah le test a hau. Cun thi zong s*k chih a hau. Hi hnu ah a herhningin ultrasound le CT tbk. hmanthlak (dathmang saih) ding. Cun renal biopsy zong test chih khawh ahcun a tha fawn. Mizaw cheukhat sin ahcun “renal arteriography” hmangin dothlatnak tuah a si.

Thlopning le zohkhendning (Treatment)
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A bik in hmanmi AKI thlopning cu zawtnak a chuahtertu a ruang kha fiang tein theih le hngalh hmasa kha a si. Cu hnu cun a herhning in thlop le zohkhenh a si. Sii hmanmi (tck. NSAIDs) ruang a si cun cu sii cu a si khawh chungin hrial a hau. Zawtnak dangdang (tck. lung zawtnak) ruangah a chuakmi a si ahcun cu zawtnak kha thloppiak ding a si.

Thikai zawtnak (hypertension) a ngeimi nih a hlei in iralring a herhmi cu a cunglei 120 in 140 karlak, cun a tanglei 80 in 90 karlak ah umter khawh lengmang ding a biapi ngaingai.

Ti (fluids) ding tik ah iralring a hau. Kaal le pum nih a herh zat te longin din piak a hau. Hitin theih khawhnak ding caah lam pakhat a ummi cu rihnak (weight) kha itah lengmang ding a si. Cun a lutmi le a chuakmi ti kha tha le tuaktan ding. Lung zawtnak phunkhat a si mi “congestive heart failure (CHF)” a ngeimi cu ti tamtuk in din lo ding a si.

A por khomi zawtnak phunphun (infections), tahchunhnak ah COVID-19 ruangah cu AKI mizaw caah tih a nung ngaimi a si caah iralring ngaingai a herh. A zual deuhmi mizaw cu siizung ah a herhningin zohkhenh an si. Cun a herhning in seh (machine) hmangin thi zong tawlpiak an si (dialysis: https://www.youtube.com/watch?v=EU2skU3bgS8).

AKI ralrinnak caah theih a herhmi le mah tein tuah khawhmi
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• Pakhat khat dam lo ruangah sii a hmang lengmangmi na si ahcun thi icheck pah lengmang ding.
• Zunzun mi a tlawm le tam kha check le tuaktan ding (a vawi tam le tlawm long siloin zun a tlawm le tam zong kha check a hau)
• Na luak na luak tikah zun aa tel ahcun siibawi sinah ipiah cawlh ding.
• A herh zat tein ti dingpiak philh lo ding
• Zunthlum zawtnak (diabetes) le thikai zawtnak a ngeimi cu siibawi sinah ipiah lengmang ding.

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