Pathophysiology of Systemic Lupus Erythematosus

Pathophysiology of Systemic Lupus Erythematosus Introduction This essay will explore the pathophysiology relating to a call I attended while on practice placement as a student technician. The initial call details were that it was a 45 year old female in pain. On our arrival the patient was sat in a chair and was breathing rapidly and had a very flushed face. After introducing ourselves and gaining the patients consent we then proceeded to take her basic observations and take her history. Most of her observations were within acceptable limits however her blood pressure was slightly high, she had a raised pulse at 120 beats per minute and slightly high temperature at 38 degrees Celsius. On questioning the patient had a localised pain score of 8/10 in her back and a pains in her joints and muscles with a pain score of 4/10. When questioned about her medical history, she stated she had a condition called systemic lupus erythematosus. This is not a condition I had heard of before I, therefore, questioned her more about it. Differential Diagnosis A 20 year-old women patient presented with fatigue, heart palpitations and anxiety. Reviewing the patient’s history revealed that she started experiencing anxiety, fatigue and heart palpitations approximately two years ago when she was still pregnant and she arranged to visit her own doctor. At that time her doctor stated that this was was due to stress. However, her symptoms became worse after she had another child. She stated that before going into labour she experienced premature contractions, headaches, increased fatigue, and swelling of her legs. Her doctor advised her to stay off work and have some bed rest. Shortly after giving birth to her third child, the patient began experiencing several new symptoms. Her knees and ankles started swelling, she also developed sever pain in her knees, wrists, elbows, and fingers. During the winter the patient started feeling painful and her peripheral joints became discolored whenever exposed to cold. She had recently been admitted to hospital in order for tests to be carried out and although she was still waiting for a definative outcome, a rhueamatology consultant she was under stated he was fairly certain that she had stemic lupus erythematosus. Epidemiology According to Somers et al (2007) approximately five people in every ten thousand suffer from systemic lupus erythematosus. Ninety percent of patients who are diagnosed with systemic lupus erythematosus are female (GinzlerTayar 2012; Blank et al 2009). It most commonly develops in women aged between 20 and 40 although anyone of any gender and age can develop it at any time. With regards to ethnic origin systemic lupus erythematosus is more prevalent in those with Afro-caribean, Asian or Chinese ancestry. Although there is a possibility of having a genetic pre-disposition to the disease only 3 of 100 children of those diagnosed with systemic lupus erythematosus will go on to develop it. According to National Health and Nutrition Examination Survey (2004) a survey in which it was observed that 100% of patients with System lupus erythematosus were receiving treatment. Aetiology Although there is no definate cause of systemic lupus erythematosus (Giannouli 2006), there is thought to be several factors increasing the likelihood of developing systemic lupus erythematous they include Genetics {where members of the family have lupus this condition will often increase the childs chances of developing it} (Hemminki 2009). It is also thought it can also be triggered by environmental factors such as trauma, ultraviolet rays and also emotional stress. Gender and hormones is thought to be the biggest factor affecting the chances of developing systemic lupus erythematous as it is proven that it mostly affects women than men especially when they are in menstrual periods or in their pregnancy, it is said to occur nine times more to women in comparison to men (GinzlerTayar 2012). Pathophysiology System lupus erythematosus is an autoimmune disease. The autoimmune system is responsible for fighting foreign and often harmful bacteria in the human system. However with systemic lupus erythematosus the immune system will attack itself, the pathology of this disease is similar to that of rheumatoid arthritis and can affect any part of the body (GinzlerTayar 2012). Systemic lupus erythematosus may also occur in the form of periarticular inflammation that affects the tendon sheaths, the illness causes the patient to experience coexisting fibromyalgia that results to poor sleep, chronic disease, inactivity ,mood problems and depression (Knott 2012). Patients who suffer from this condition have abnormalities when it comes to their immune system, this includes the B cell function, apoptosis and also the T cell function. Systemic lupus erythematous mostly attacks the blood vessels, the skin, the heart, nervous system, liver, lungs and the kidneys (Knott 2012). Unfortunately when System lupus erythematous persists without effective treatment it may result in serious complications such as stroke, heart inflammation, lung damage, blood clots and if the patient is female it may result in miscarriage or pregnancy complications. Research shows that the exact cause of immune deregulation is not yet clear but it may be as a result of interference of endogenous metabolism that affects the function of antigens in the human system (GinzlerTayar 2012). The abnormalities caused by System lupus erythematosus may vary from one ethnic group to another for instance East Asians who have this problem they have extra cytotoxic T lymphocyte antigen-4 while the white populations abnormalities is observed through having more Fc-Y receptors (Hemminki 2009) . For effective diagnosis of System lupus erythematosus it is of essence to deal with specific autoantibodies in order to treat the root cause of the disease (GinzlerTayar 2012). The symptoms of systemic lupus erythematosus will vary from patient to patient as the signs and symptoms displayed will depend on the body part or system that is being affected by the systemic lupus erythematosus (Arthritis Research UK 2014). However there are some generalised symptoms and these are about to be discussed. Dermatological symptoms caused by systemic lupus erythematosus could include rashes and in some cases a specific rash to the cheeks known as a â€Å"butterfly rash† can be identified (Knott 2012). Another common issue for the majority of people with systemic lupus erythematosus find that they become much more sensitive to sunlight. It is also common for the blood vessels under the skin in the joints to become inflamed and this can lead to poor circulation to these areas (this is called Raynauds phenomenon)(GinzlerTayar 2012). Oral ulceration can sometimes occur for this very reason. Blood disorders have been known to develop especially in children, the most common being anaemia. Having anaemia would obviously cause lethargy and low mood (Giannouli 2006). Patients with systemic lupus erythematosus are much more at risk of developing cardiac issues than the general public as the disease often causes inflammation of the blood vessels within the heart, thus increasing the risk of developing atherosclerosis which in turn could lead to a myocardial infarction if one of the blood vessels was to become blocked(Blank et al 2009). If the kidneys were to become inflamed due to the systemic lupus erythematosus, this could cause symptoms including haematuria (blood in the urine). Also, if the kidneys become inflamed this could lead to the patient developing a kidney infection which will result in the patient having moderate to severe back pain (GinzlerTayar 2012). The most common issue for patients suffering from systemic lupus erythematosus is to do with their joints (Somers et al 2007). Most people suffering from systemic lupus erythematosus will develop pain in their muscles, joints and peripheral joints such as joints in their hands and knees can often become inflamed. This can be due to a condition known as Osteonecrosis developing due to the systemic lupus erythematosus (Giannouli 2006). Osteonecrosis is a condition that develops when there is a reduced blood supply to the bones. Osteonecrosis will affect the bones ability to replace old bone with new bone and if an injury is sustained it may never be able to heal properly (Knott 2012). Most patients find that it is worse when they wake up in the morning and as this is a chronic condition, it can often feel better in periods of remission and more painful during a relapse period (GinzlerTayar 2012). Diagnosis The process involves the blood tests including antibody tests, urinalysis and a chest X-ray which is mostly overseen by Rheumatology Consultants whose area of specialisation is autoimmune diseases and also soft tissue treatment. Musculoskeletal symptoms are analysed when trying to diagnose System lupus erythematous and it can be manifested as arthritis or arthralgia in which the patient expresses it as stiffness and pain, when it occurs in System lupus erythematous it can be in the form of migratory or transient pain and it is difficult to be diagnosed since it may be present when the patient makes the appointment with a doctor only to be resolved in the process of evaluation(Ginzler Tayar 2012 and Knott 2012). Systemic lupus erythematosus caused fewer erosions or fixed deformities unlike rheumatoid arthritis which is much more degernerative to the joints (GinzlerTayar 2012). There is also the possibility of around 4% of the patients will suffer from myositis ( which is the inflamat ion of the muscle tissue) and this can be examined by taking a biopsy of muscle tissue (Giannouli 2006). Pharmacology and associated treatment: Unfortunately there is no cure for Systemic lupus erythematosus and the treatment plan is based on symptom relief as opposed to direct treatment of the disease(GinzlerTayar 2012, Blank et al 2007, Knott 2012). Treatment of Systemic lupus erythematosus is very specific to the individual patient and it always depends in manifestation of the symptoms, the disease severity and most importantly the specific organ affected(Giannouli 2006). In order to devise the most appropriate treatment plan the rheumatology consultant will perform a number of diagnostic tests and depending on what the results are will influence the treatment plan (Giannouli 2006). Patients suffering from systemic lupus erythematosus will often need to take a group of medications called non-steroidal anti inflammatory drugs (Knott 2012). This group of medications work by reducing the inflammation in the affected joints and hopefully reducing the amount of pain the patient is in. Some common non-steroidal anti inflammatory drugs are ibuprofen, aspirin and diclofenac sodium (these are all available without a prescription from a pharmacy), the rheumatology consultant may recommend Naproxen or pirixicam in certain circumstances (BNF 2014). With non-steroidal anti inflammatory drugs there is a risk that they may cause damage to the lining of the stomach and could even cause ulceration in the stomach when taken over long periods of time in high doses(Knott 2012). If the patient is taking frequent non-steroidal anti inflammatory drugs they may be prescribed a proton pump inhibitor medication in order to protect the stomach. These medications work by reducing the amount of acid the stomach produced and thus protecting the lining of the stomach (Knott 2012). Common proton pump inhibitor medications include; omperazole, lansoprazole, pantoprazole and esomeprazole (BNF 2014). A further treratment that a rheumatology consultant may consider is the use of a medication called hydroxychloroquine (Giannouli 2006). Hydroxychloroquine was originally an anti-malarial drug however it has recently started being used to treat the symptoms of systemic lupus erythematosus and is a disease modifying anti-rheumatic drug (also known as DMARD)(Knott 2012). Hydroxychloroquine works by reducing the response from the immune system which is causing the symptoms (this is probably the closest treatment to treating the cause as opposed to just the symptoms). It is used as a long term treatment to try and prevent relapses or flare ups of the disease (GinzlerTayar 2012). Corticosteroids may be used in severe systemic lupus erythematosus (GinzlerTayar 2012). They may be prescribed during relapses of the disease. Corticosteroids work by blocking the normal function of the white blood cells and reducing the inflammation response(Knott 2012). However the negative aspect of this is that it leaves patients very vulnerable to infections(GinzlerTayar 2012). Other side effect could include the patients bones becoming more fragile, the skin becoming thinner, hypertension and also weight gain. For this reason corticosteroids will only be used to treat flare ups at the minimum effective dose and then reduce the dose slowly as the symptoms ease. Corticosteroids used in the treatment of this disease are hydrocortisone and predniselone(BNF 2014). Often used in conjunction with corticosteroids during a relapse are a group of medications called immunosuppressants . These medications will work by reducing the action of the immune system and will be used when the immune system is attacking a healthy part of the patients body(Knott 2012). Again these medications will reduce the pateints ability to fight harmful infections and can cause many side effects. Immunosuppresent medications used include: azathioprine, mycophenolate mofetil and cyclophosphamide (BNF 2014). The final medication to be discussed is called Rituximab. Rituximab was originally created to treat blood cancer however an â€Å"off-label† use for this medication is to treat autoimmune diseases. The way Rituximab works is by destroying the B-Cells(The B-Cells which cause the release of antibodies resulting in the symptoms). As with all the other medications there could be side effects the most common being dizziness and vomiting. Rituximab can only be administered intravenoulsy so will normally require hospital admission for the patient to receive it . (Knott 2012) Other interventions include an advice session from the doctor regarding the patients lifestyle and diet may be of vital importance this may help the patient and minimise lifestyle related stress (GinzlerTayar 2012) . The patient may be suggested to work with a support group or even receive counselling as the condition can cause severe and life limiting symptoms while in relapse. Most patients with systemic lupus erythematosus are also advised to avoid the sun as it can aggravate and skin symptoms(Knott 2012). Conclusion Systemic Lupus Erythematosus is a very complex disease and can present itself in many different ways depending on the patient and the part of the body affected. In the pre-hospital environment it is very important to get a detailed history in order to identify whether they have been diagnosed with this disease. Clinicians must remember systemic lupus ertythematosus can limit a patients quality off life while they are having a relapse so it is important to assess each patients individual symptoms and if necessary administer pain relief and position them so they are comfortable. It is also important for ambulance clinicians to be mindful of the patients joints when using moving and handling techniques as this could obviously cause the patient discomfort or even pain due to the condition. References: Arthritus Research UK. (2014). Systemic Lupus Erythematosus. Available: http://www.arthritisresearchuk.org/arthritis-information/drugs/hydroxychloroquine/what-it-is.aspx. Last accessed 20/03/2014. Blank M, Shoenfeld Y, Perl A. 2009. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses in systemic lupus erythematosus. Lupus. Nov;18 (13):1136-43 Giannouli, S (2006) Annals of rheumatic disease, Anaemia in systemic lupus erythematosus from pathophysiology to clinical diagnosis. 65(2) p144-148 Ginzler E, Tayar J. 2012. Systemic lupus erythematosus (lupus). Updated: January 2012. Available at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/lupus.pdf#search=sle. [Accessed on February 21, 2014 at 21:30] Hemminki K, Li X, Sundquist J, Sundquist K (February 2009). Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions. Arthritis Rheumatology. 60 (3): 661–8 Knott, L. (2012). Systemic Lupus Erythematosus. Available: http://www.patient.co.uk/health/systemic-lupus-erythematosus. Last accessed 20/03/2014. Somers E, Thomas L, Smeeth L .2007. Incidence of systemic lupus erythematosus in the United Kingdom, Arthritus Rheum 15;57(4) p612 – p618.

Amathophobia :: Eliot Wasteland Maddy Future Present Past Essays

Amathophobia Death is the great equalizer. We all have unique experiences in life, but we each succumb to the same final fate. Rich or poor, strong or weak, exalted or scorned; everyone is humbled when faced with his own mortality. Death does not play favorites, and Death will find everyone. Though often frightening, some argue that the thought of death also heightens appreciation of life. British novelist EM Forster wrote, "Death destroys a man, the idea of Death saves him." Indeed, knowing that time on earth is limited can motivate people to take risks. The term "carpe diem" implies that life is short, and every moment must be captured before it expires. The urgency of this phrase stems from the common fear of leaving things unfinished or unattempted. Fear is a powerful motivator, and death is the ultimate fear. Death is the primary theme in TS Eliot’s The Wasteland. Written just four years after the conclusion of World War I, The Wasteland mirrors the despair felt by much of the post-war generation. The poem begins with a section titled "Burial of the Dead." In this section Eliot deems April "the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain." With these lines, Eliot suggests that springtime’s regeneration of life only causes people to remember what was lost in the past. Eliot again addresses death in the very next stanza: What are the roots that clutch, what branches grow Out of this stony rubbish? Son of man, You cannot say, or guess, for you know only A heap of broken images, where the sun beats, And the dead tree gives no shelter, the cricket no relief, And the dry stone no sound of water. Only There is shadow under this red rock, (Come in under the shadow of this red rock), And I will show you something different from either Your shadow at morning striding behind you Or your shadow at evening rising to meet you; I will show you fear in a handful of dust. This stanza is teeming with biblical allusions. The speaker is talking to Jesus, "the Son of man," about a "dead tree [that] gives no shelter," thereby hinting that Christ’s death on the cross (or "dead tree") yields little comfort. Eliot also mentions a "dry stone" with "no sound of water." In John 4:7-26, Jesus tells a Samaritan woman that whomever drinks the living water he provides will never thirst again.

Fundamentals of Macroeconomics

Fundamentals of Macroeconomics Lisa Rasch ECO/372 June 18th, 2012 Sigmund Karczewski Fundamental of Macroeconomics Part 1 * Gross Domestic Product (GDP)- GDP is the value of all goods and services that have been produced in a country within a period of time. * Real GDP- Real GDP refers to the value of all goods and services that has been adjusted for inflation or deflation. * Nominal GDP- Nominal GDP refers to the value of all goods and services that has not been adjusted for inflation or deflation. Unemployment Rate- Unemployment rate refers to the percentage of people in a country who want to work and are able to work but cannot find jobs. * Inflation Rate- Inflation rate is the rate of price increases within a period of time. * Interest Rate- An interest rate is the amount of money a person pays in order to borrow money. Part 2 Purchasing Groceries The purchasing of groceries has an effect on the United States’ economy and its three sectors; businesses, households, and gove rnment. Purchasing groceries effects households and businesses the most however government is also effected.Government is responsible for creating the rules and regulations surrounding the production of the groceries (food safety laws, etc. ). Businesses then produce the groceries within the government regulations increasing value for that business. After the businesses have produced the goods, the goods are then purchased by other businesses to be sold to consumers. Generally, a grocery store (a business) will purchase the groceries from vendors (other businesses), increasing the value of their business; that inventory is then sold to households (consumers).Once the goods are sold to consumers, the value of the goods is then transferred to the consumers. Massive Layoffs of Employees A massive layoff of employees also has an effect on the three sectors of the U. S. economy. A massive layoff affects households the most although the other two sectors are also affected. Households suff er a loss in income as a result of a layoff and the loss of income will translate to a reduction of purchasing power for the household.The reduced purchasing power will affect businesses because the households that suffered layoffs will not have the money to purchase goods or services from businesses. The government will also see a reduction in revenue from the layoffs because the households will pay less money in income taxes. The government will also be affected by the lack of sales taxes from purchasing goods and services and the reduction in taxes being paid by the businesses; the less sales the business reports the lower the taxes they owe to the government. Still, the hardest hit sector for massive layoffs will be the households.The reduced income for households will have a trickledown effect on the rest of the economy because â€Å"households are the most powerful economic institution† (Colander, 2010). Decrease in Taxes A decrease in taxes will have an effect on the t hree sectors of the U. S. economy as well. The sector that will be affected the most by a decrease in taxes will be the government. A decrease in taxes will reduce the amount of revenue collected by the government which will reduce the amount of goods and services the government is able to provide for households and businesses.The government collects taxes in order to have the funds to pay for services such as unemployment insurance and the welfare system as well as infrastructure such as roads and street lights. A decrease in taxes will have a positive effect on household income however; the reduction in government infrastructure and services might have a negative effect on households. If the government does not have the money to pay for infrastructure it could result in households having to pay more money to maintain their property; pot holes not being repaired quickly could cause higher car maintenance costs.Businesses will also be affected by a decrease in taxes. Lower taxes wil l mean businesses will have more money to spend on increasing their labor force or making improvements to their businesses. The increased revenue for businesses and households will put more money back into the economy. The decrease in taxes will decrease revenue for the government while increasing revenue for households and businesses. Reference Colander, D. C. (2010). Macroeconomics (8th ed. ). Boston, MA: McGraw-Hill/Irwin.

Geography Internal Assessment Of A World Map Within The...

Geography Internal Assessment Task 1: Describe the (spatial or temporal) pattern from a world map within the geographic topic (malaria) at a global scale. Malaria is concentrated throughout equatorial regions (except ocean) i.e. countries in the vicinity of the equator. It is mostly concentrated in the African continent, although the northern and southern regions of Africa are not affected by malaria as it is too cold. All areas that are concentrated with Malaria are tropical areas. Other areas such as mountains and deserts are sparsely affected by Malaria. Another area that has a concentrated amount of Malaria is the Philippines. So temperature is a very important part of the environments. However there are some countries such as the United States of America that do not have any malaria despite some of the land mass having suitable temperatures. This is where a cultural environment worked to eradicate malaria through the application of money (in spray programmes and other education programmes) and determination. This is an example of a temporal pattern. Other cultural factors interact with malaria susceptible countries to make the situation much worse. For example countries that have been impoverished by war, including civil war, suffer more than other countries. Angola is an example of this. Therefore countries in Africa have a denser malaria concentration if there is great poverty which is often combined with civil war. This is an example of a spatial pattern.Show MoreRelatedManaging Information Technology (7th Edition)239873 Words   |  960 PagesServices Pvt. Ltd. Printer/Binder: Edwards Brothers Cover Printer: Leghigh-Phoenex Color Text Font: 10/12, Times Credits and acknowledgments borrowed from other sources and reproduced, with permission, in this textbook appear on appropriate page within the text. Microsoft ® and Windows ® are registered trademarks of the Microsoft Corporation in the U.S.A. and other countries. Screen shots and icons reprinted with permission from the Microsoft Corporation. This book is not sponsored or endorsedRead MoreGsk Annual Report 2010135604 Words   |  543 Pagesdevelopment Pipeline summary Products, competition and intellectual property Regulation Manufacturing and supply World market GSK sales performance Segment reviews Responsible business Financial review 2010 Financial position and resources Financial review 2009 Risk factors Governance and remuneration Our Board Our Corporate Executive Team Governance and policy Dialogue with shareholders Internal control framework Committee reports Remuneration policy Director terms and conditions Director and Senior ManagementRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 PagesLinda Shopes, eds., Oral History and Public Memories Tiffany Ruby Patterson, Zora Neale Hurston and a History of Southern Life Lisa M. Fine, The Story of Reo Joe: Work, Kin, and Community in Autotown, U.S.A. Van Gosse and Richard Moser, eds., The World the Sixties Made: Politics and Culture in Recent America Joanne Meyerowitz, ed., History and September 11th John McMillian and Paul Buhle, eds., The New Left Revisited David M. Scobey, Empire City: The Making and Meaning of the New York City Landscape