This can affect nerves, joints, muscles, blood vessels or connective tissues of the hand and forearm:
Tingling whiteness or numbness in the fingers (blood vessels and nerves affected): This may not be noticeable at the end of a working day, and in mild cases may affect only the tips of the fingers. As the condition becomes more severe, the whole finger down to the knuckles may become white. Feeling may also be lost. Fingers change colour (blood vessels affected): With continued exposure the person may experience periodic attacks in which the fingers change colour when exposed to the cold. Initially the fingers rapidly become pale and feeling is lost. This phase is followed by an intense red flush (sometimes preceded by a dusky bluish phase) signalling the return of blood circulation to the fingers and is usually accompanied by uncomfortable throbbing. Loss of manual dexterity (nerves and muscles affected): In more severe forms, attacks may occur frequently in cold weather, not only at work, but during leisure activities, such as gardening, car washing or even watching outdoor sports and may last up to an hour causing considerable pain and loss of manual dexterity and reduced grip strength.In extreme cases, the affected person may lose fingers. The effects are cumulative. When symptoms first appear, they may disappear after a short time. If exposure to vibration continues over months or years, the symptoms can worsen and become permanent. Prevention
The Control of Vibration at Work Regulations 2005, created under the Health and Safety at Work etc.
For aspirin users who required endoscopic treatment for bleeding peptic ulcer, there is two times increased risk of rebleeding but with 10 times reduced risk of death at 8 weeks following the resumption of aspirin. For those who were on double antiplatelet agents for indwelling stent in blood vessels, both antiplatelet agents should not be stopped because there is a high risk of stent thrombosis. For those who were under warfarin treatment, fresh frozen plasma (FFP), vitamin K, prothrombin complex concentrates, or recombinant factor VIIa can be given to reverse the effect of warfarin. High doses of vitamin K should be avoided to reduce the time for rewarfarinisation once the stomach bleeding has stopped. Prothrombin complex concentrates are preferred for severe bleeding. Recombinant factor VIIa is reserved for life-threatening bleeding because of its high risk of thromboembolism. Direct oral anticoagulants (DOAC) are recommended instead of warfarin as they are more effective in preventing thromboembolism. In case of bleeding caused by DOAC, activated charcoal within 4 hours is the antidote of choice. Epidemiology
The lifetime risk for developing a peptic ulcer is approximately 5% to 10% with the rate of 0.1% to 0.3% per year. Peptic ulcers resulted in 301,000 deaths in 2013, down from 327,000 in 1990.In Western countries, the percentage of people with H. pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80, etc.).