...Treatment: Management is mostly symptomatic. Raynaud's phenomenon can be treated with calcium channel blockers while proton pomp inhibitors are given for gastric reflux. Low doses of corticosteroids with immunosuppressive agents may be needed in cases with progressive lung fibrosis. Pulmonary vasodilators are given in case of pulmonary arterial hypertension.(17) Regarding lung involvement in Systemic Sclerosis,the decision about whether to start treatment or not is often the most difficult challenge for the pulmonologists. Patients having a short duration of disease with recent deterioration in DLCO are candidates for immunosupressive therapy.(71) Various drugs including cyclophosphamide ,glucocorticoids ,azathioprine, rituximab and mycophenolate mofetil are widely used.Still,the treatment of SSc associated ILD is not well established. Anti-fibrosing treatments have failed to demonstrate any benefit and cyclophosphamide, which has been used for many years ,has been evaluated in two prospective randomised studies which showed a significant but modest effect on pulmonary function. (72) A multicenter, prospective, randomized, double-blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide(CYC) followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma did not demonstrate significant improvement in the primary or secondary end...
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...Alterations in Blood Flow Circulatory System: * Primary function: transport of oxygen and nutrient and removal of metabolic waste products * Requires complex circuitry of vessels powered by heart General Mechanisms That Alter Flow: * Flow reduction in systemic circuit creates ischemia, leading to hypoxia * Flow reduction in venous system alters waste removal and increases systemic pressure * Venous engorgement or venous obstruction * Flow reduction in lymphatic system causes edema * Changes to lymphatic vessels and lymph circulation * Blood vessel obstructions * Blood vessel structural alterations Lymphatic Vessels: * Lymphatic circulation overwhelmed when changes in capillary or interstitial oncotic pressures increase filtration, or when fluid movement at capillary bed is impaired * Causes edema * Causes wide variety of conditions * Lymphedema- lymphatic flow alteration due to impairment in lymph circulation Blood Vessel Obstructions: * Alteration of blood flow may involve impedance of arterial or venous flow * Some obstructions specific to arterial or venous * Others form on both sides * Will now cover those that affect arteries and veins- specific later * Thrombus= blood clot attached to vessel wall * Thromboembolus- detached thrombus * Develop where conditions activate hemostasis * Different triggers for arteries and veins * Shock can lead to thrombi ...
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...osteoporosis on 8/5/2010. Along with her arthritis pain, she has other conditions such as: Raynaud syndrome, irritable bowel syndrome-associated constipation (IBS-C), gastroesophageal reflux (GERD), and chronic urinary tract and upper respiratory infections. She has gained weight because of the lack of exercise she has performing. Wright complains she is too tired to work out and gets tired throughout the day performing normal activities. She also insists she cannot work out because she always gets hot flashes from her menopause and is simply too hot to work out. Wright also explained she lives alone and cannot always go to see a physician because she cannot get someone to drive her there. She is no longer taking the three medications, hydroxychloroquine, methotrexate, and prednisone, prescribed by Dr. Ruppert. She explains she had experienced intolerable side effects, including reflux, alopecia, and severe photosensitivity. Dr. Ruppert ordered a comprehensive laboratory evaluation and identified the following: IgG4 food-specific antibodies, essential fatty acid and amino acid imbalances, nutrient and essential element deficiencies, and dysbiosis, in addition to elevated antinuclear antibodies (ANA) and high sensitivity c-reactive protein (hs-CRP). Mrs. Wright is present for further workup, evaluation, and treatment of the symptoms listed above. REVIEW OF SYSTEMS: Allergy/Immunologic: Raynaud syndrome Cardiovascular: Negative Pulmonary: Upper respiratory infection...
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...Complementary and Alternative medicine is not considered part of conventional medicine. They aren’t considered to be the normal way to treat a patient that is in need of medical help. Alternative medicine is using a different type of medication outside of the standard ones that health care professionals would normally use. Complementary medicine is a way of using not only standard methods but by using the standard methods side by side to help with the treating a patient. The herb I picked that was found on both websites was Ginkgo. Ginkgo could be possibly effective for: Alzheimer’s Disease as well as other types of dementia, PMS, poor blood flow maybe causing leg pain, Glaucoma, Raynauds Syndrome, and improving thinking in old and young age people. There is not enough information to have effectiveness of Ginkgo. Two side effects and warnings from the webpage is some warnings are that this herb should not be taking with the combination of certain medications. The major one is medications that are involved with blood clotting especially. The medications that should be watched are Coumadin, Ibuprofen and anticoagulants. Other warnings and precautions that are associated with ginkgo is pregnancy and breastfeeding, why it’s considered to be a precaution is because gingko is involved with blood circulation so it can cause more bleeding during delivery and can cause someone to go into labor earlier than expected. Surgery is also a warning for ginkgo because it can affect...
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...It can affect many part of the body and show a wide spectrum of non-specific cause symptoms(5). Lungs, heart, kidney, skin, brain, joints, and blood vessels can all be affected by SLE(5). People with SLE have flares of disease followed by remission periods which means symptoms vary from mild to life threatening symptoms(2)(4)(5). According to a study of SLE patients in 7 European countries over a 10 year period (1990-2000), the most common SLE symptoms were arthritis (48.1%), malar rash (31.1%), active nephropathy (27.9%), neurologic involvement (14.9), fever (16.6%), Raynaud phenomenon (16.3%), serositis (16.0%), thrombocytopenia (13.4%), and thrombosis (9.2%)(1). Moreover, SLE patients may have different symptoms such as muscle pain, swollen joints, bone density reduction, and blood...
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...Maria G. Lopez 6 hrs Dear friends, I'm asking for your precious prayers. This is my story,,, Three months ago I went for my regular cleaning at the dentist office ( I go every three months to keep my teeth healthy), when the dentist went to the room to check on the hygienist work he found a brownish dark spot on the palate, flat not bumpy just a spot. he didn't know what to say and asked me if I accidentally hurt my self while brushing and of course I said no. He then took several pictures of the spot and asked me to come back in 2 weeks to check on it, and hopefully by that time he was confident the spot will be gone. Went back and the spot was still there, he could't explain the source of it and I told him that the other purple-blueish spot on my left gum I showed to him a year ago was expanding, he then got worried and told me he was going to send the pictures to his friend who is an Oral Surgeon. I waited over a month because his friend was in Guatemala in a medical mission. On December 1st I finally went to see the oral surgeon and he performed right there a biopsy of the palate and I had a cone beam test. I was told to come back for results in 2 weeks but after week and a half I was told to come back because the Oral Pathologist asked for two more biopsies from different parts of the palate so he could have a more reliable diagnose . I went back for those biopsies and waited 2 more weeks for final results. Finally on December 29, 2015 at the oral surgeon office I found out that...
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...Case Brief Internal Entrepreneurship at Dow Chemical Description With the 2001 merger with Union Carbide, Dow Chemical Company became the largest chemicals and Plastics Company in the world. The merged company had sales of $27.8 billion specializing in chemical, plastic and agricultural products. Prior to the merger, growth had become a priority for Dow Chemical. In the years prior to 2000, the firm’s turnover dropped from $20 billion to $18.4 billion as the Net profit margin eroded to 7.1% from 10.3%. The e-epoxy.com venture was one of the many new growth initiatives Dow Chemical launched to bolster growth during this period. E-epoxy.com was conceived by Ian Telford to target the underserved market of small customers that are cost conscious. Evaluation EP&I Division: The epoxy business is a high margin but also highly capital-intensive business for Dow chemical. With 20% of the customers generating 80% of the division’s revenue and the cyclical nature of the epoxy market, the business is very susceptible to downturns. The concentration of revenues from a few customers would intuitively put customers in a position of strength during price negotiations; however Dow Chemical did not disclose prices charged to other customers. Dow Chemical maintained relationships with key clients by providing value added services (integrated supply chain, technical assistance, and volume rebates). The added services were necessary to differentiate Dow’s product. With highly...
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...The Lupus Foundation of America approximates that there are around 1.5 million Americans affected by a form of lupus (Rooney 54). There are two main factions of lupus: systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). The popular depiction of lupus as a disease associated with lesions and superficial symptoms is not necessarily an accurate portrait. Although Lupus Erythematosus gets its name from the Latin word lupus (wolf) because the lesions resembles the pattern of a wolf bite, the most common form of the disease is SLE which does not require lesions as a criteria for diagnosis (Rooney 56). The underlying concern that both DLE and SLE share is their label as an autoimmune disease. Autoimmune diseases work by attacking self antigens and tissues as if they were foreign (McKinley, O’Loughlin and Bidle 856). By analyzing a deconstructed look at lupus we hope to gain an insight into lupus’ pathological effect on the body and its relation to the immune system. SLE occurs when the body begins to attack its own tissues without known cause. Although there is not a definitive known cause for SLE, autoantibodies can combine to form immune complexes which can effectively damage internal tissue and the hyperactivity of b-cells contributes to the symptoms (Pullen, Brewer and Ballard 23) (Porth 1422). Genetic predisposition to SLE is evidenced by an increased concordance rate in twins (10-fold), increased incidences within family members (10%-16%), and increased...
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...UNIVERSITY OF THE WEST OF SCOTLAND NURSE PRESCRIBING V150 CASE STUDY COURSE: NURS09125 BANNER NUMBER: B00113677 DATE OF SUBMISSION 13/12/10 COURSE LEADER FRANCES DOWNER WORD COUNT: 3745 CONTENTS PAGE 1. INTRODUCTION & GENERAL OVERVIEW, Pgs3-4. 2. ASSESSMENT PROCESS, Pgs 5-8 3. TREATMENT OPTIONS, Pgs 9-12. 4. EVALUATION, Pgs 13-16 5. CONCLUSION. Pg 17 6. COPY OF PRESCRIPTION, Pg 18 7. REFERENCE SECTION, Pgs 19-23 8. BIBLIOGRAPHY, Pg 24. INTRODUCTION In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of prescribing in the community setting. The author a (trainee nurse prescriber) will display the need for a robust assessment, exploring all areas of health and well-being in order to achieve a safe outcome. The author will further follow current guidelines and be mentored by a senior nurse prescriber throughout the process. The aim of the case study is to display the implications involved in issuing a nurse prescription if deemed appropriate. With regard to writing a prescription as a qualified practioner, the author will adhere to the guidance within the Nursing and Midwifery Council (NMC 2006a) standards for safe prescribing. To protect this patient’s identity and maintain confidentiality, she will be referred to as Mrs X throughout the...
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...nucleated in vitro. Both gammaTuRC-mediated nucleation and binding of the gammaTuRC to preformed microtubules block further minus-end growth and prevent microtubule depolymerization. The gammaTuRC therefore acts as a minus-end-capping protein, as confirmed by electron-microscopic examination of gold-labelled gammaTuRCs. These data support a nucleation model for gammaTuRC function that involves capping of microtubules The organization and dynamics of microtubules (MTs) are essential for different cellular processes such as migration or division. In animal cells, MT nucleation usually occurs at the centrosome, where γ-tubulin plays a key role. This protein is organized in multiprotein complexes (Moritz et al., 1995; Zheng et al., 1995; Raynaud-Messina and Merdes, 2007). In Drosophila melanogaster, two main complexes have been characterized (Oegema et al., 1999). The γ-tubulin small complex (γ-TuSC) is composed of γ-tubulin and two other proteins, Dgrip84 and -91. The γ-tubulin ring complex (γ-TuRC) is formed of γ-TuSCs associated with additional grip motif polypeptides, Dgrip75, -128, and -163, and a WD motif protein, Dgp71WD. Components of the γ-TuSC are highly conserved in eukaryotes. Deletion of any γ-TuSC subunit is lethal both in fungi and in Drosophila. This loss of function results in the accumulation of cells in mitosis, which is associated with defects such as monopolar spindles, impairment in centrosome maturation, and...
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...Global Warming: What you need to know about the warming of the earth, what's at stake, and how it's affecting us. Introduction: Global warming occurs when greenhouse gases predominantly carbon dioxide, and as well as smaller amounts of methane, water vapor and sulfur oxide all acts as a heating agent for the Earth surface, captivating warmth and warming it. (Hansen, 2016). Greenhouse gases and additional air contaminants accumulate in the stratosphere and captivate the suns energy and solar emission that have reflected off the earth’s ground level ozone (Weller, 2016). Generally, these emission would have been released into outer space, but then again these gases, which remain in the atmosphere for possibility centuries, meanwhile trapping heat and causing the planet to get warmer as decades come to past (Hansen, 2016). Of the numerous heat-trapping gases, carbon dioxide places us at the jeopardy of irreparable modifications if it continues to gather persistently in the atmosphere provided that the global economy remains in need of fossil fuels for its energy needs (Hansen, 2016). Consequently, sea levels are expanding, glaciers are melting, cloud forests are desiccating, and nature is scrambling to keep pace of the environmental change (Hansen, 2016). Scientist have discover that mankind have caused the warming of the earth in the previous decades past due to the releasing of heat-trapping emission as we produce energy for today’s way of living. These heating agents...
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...Blood Viscosity Earlier, More Accurate Prediction of Cardiovascular Event Risk Pushpa Larsen, ND [pic]Ralph Holsworth, DO, recently shared a story with me about a patient he had in Colorado many years ago. He was an intern in a Denver hospital when he admitted a patient diagnosed as having a blood clot in his leg. Dr Holsworth started him on low-molecular-weight heparin subcutaneous injections concurrently with warfarin sodium. He worked the patient up for congenital thrombophilias, cancer, hypothyroidism, and other conditions, and consulted with hematology-oncology on the case. When the patient’s prothrombin time–international normalized ratio exceeded 2.0, Dr Holsworth was instructed by hematology-oncology to discharge the patient. A few minutes later, Dr Holsworth’s pager buzzed. His patient had just collapsed in the parking lot. He rushed down to the emergency department, where cardiopulmonary resuscitation was in progress and assisted in the code. The patient was pronounced dead after several attempts at resuscitation. A mandatory autopsy revealed that the patient had a major pulmonary embolism, resulting in his sudden death. It was not until several years later that Dr Holsworth learned of the role of whole blood viscosity (WBV) in the formation of thrombi. Dr Holsworth recalled that his aforementioned patient had been discharged with normal vital signs and laboratory test results that provided no indication of the evolving danger. Dr Holsworth later became one...
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...Global Warming General Chemistry I Bret Lynn For millions of years the changes in Earth’s climate have been driven by forces of nature. Although, for the last century and a half, Earth’s average temperature has been rising faster than any time in the past 10 thousand years. “We’re on a track to 700 parts-per-million of carbon dioxide on the planet, we haven’t seen that for 50 million years”(1). The signs are everywhere: droughts in the American southwest, rising seas in Louisiana, tropical diseases spreading north, and extremes of weather from Florida to France. There are people that still say “global warming need not concern us” and “if it is happening at all, it is a natural trend there is not much we can do about it.” However, there is now hard evidence, which shows that the warming is not only real, it’s accelerating. The warming is altering the climate’s most basic chacteristics like rainfall, days of sunshine, and nighttime temperatures. These changes are damaging the environment and agricultural production, threatening wild species into extinction, and putting at risk human lifestyle, health, and cities near the sea. It starts with the warming. In the Artic, reports of heat waves and droughts seem far away. Over the last 100 years, the world has seen a 1 degree Fahrenheit rise in its average temperature (2). However, in Alaska and Canada, winter temperatures have increased by as much as 5-7 degrees Fahrenheit in the past 50 years (2). Global warming is...
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...I: Introduction I. A: Rationale/Motivation Over the past two decades, cross-border or international mergers and acquisitions (IM&As) have become the favored method of foreign direct investment (FDI). The form shows that IM&As go both ways: toward developing countries and from them, reshaping the world’s economic boundaries. Trends notwithstanding, researchers suggest that, overall, the expected financial benefits of M&As are often not recognized. The highest rate of failures has been linked mainly to the fact that “M&As are still designed with business organization and financial fit as primary conditions, leaving psychological and cultural issues as secondary concerns”. While as new countries start out into the free-market economic system, paying attention to cultural factors in IM&As is becoming essential. The wider cultural gap and the current trend of IM&Asbetween developed and developing countries increases the urgency of understanding the effects of civilization on the dynamics of IM&As and on issues such as corporate organization and local adaptation strategy. The present research is designed in response to this shortcoming. It examines the effects of culture on the outcome of IM&As and the variability of these effects during the different phases of an IM&A. The research focuses on the international aspect of cultural conflicts—the differentiating factor between domestic mergers and acquisitions (M&As) and IM&As. It measures success from an organization’s internal...
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...Volume 3, number 2 What is critical appraisal? Sponsored by an educational grant from AVENTIS Pharma Alison Hill BSC FFPHM FRCP Director, and Claire Spittlehouse BSc Business Manager, Critical Appraisal Skills Programme, Institute of Health Sciences, Oxford q Critical appraisal is the process of systematically examining research evidence to assess its validity, results and relevance before using it to inform a decision. q Critical appraisal is an essential part of evidence-based clinical practice that includes the process of systematically finding, appraising and acting on evidence of effectiveness. q Critical appraisal allows us to make sense of research evidence and thus begins to close the gap between research and practice. q Randomised controlled trials can minimise bias and use the most appropriate design for studying the effectiveness of a specific intervention or treatment. q Systematic reviews are particularly useful because they usually contain an explicit statement of the objectives, materials and methods, and should be conducted according to explicit and reproducible methodology. q Randomised controlled trials and systematic reviews are not automatically of good quality and should be appraised critically. www.evidence-based-medicine.co.uk Prescribing information is on page 8 1 What is critical appraisal What is critical appraisal? Critical appraisal is one step in the process of evidence-based clinical practice. Evidencebased clinical practice...
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