A Young Lady With Feet Swelling Health And Social Care Essay

A 29-year-old Indonesian domestic assistant, Ms MH, was admitted to medical section, Queen Elizabeth Hospital, complaining of bilateral pess and mortise joints swelling and bubbling piss for 1 hebdomad. There was no hematuria, dysuria, urinary frequence, urgency, febrility, joint hurting, tegument roseolas, sore pharynx, recent upper respiratory piece of land symptoms or GI symptoms. She denied taking any herbs or nonprescription medicines. Her past medical history and household history were everyday. She was a non-smoker, and denied history of unprotected sex. She recalled that her first twenty-four hours of last catamenial period was approximately 2 hebdomads before the admittance. On scrutiny, she was afebrile, with bosom rate 103 beats per minute and blood force per unit area 144/71mmHg. She had periorbital hydrops, facial swelling and opposing hydrops of 4 limbs. There was no lividness. Her fundoscopic scrutiny was normal. Jugular venous force per unit area was elevated. On ausc ultation, her thorax was clear, her bosom beat was regular with a non-displaced cardiac vertex, and there was no bosom mutter. Abdominal scrutiny did non uncover any abdominal mass or bruit. She did non hold any skin roseolas or joint puffiness. Dipstick uranalysis showed 3+blood, 2+protein, and negative for glucose. Urine gestation trial was negative. Her blood trial showed normochromic, normocystic anemia ( haemoglobin degree 10.5g/dL ) and deranged nephritic map trial ( serum creatinine: 168i? ­mol/L ) . Her white cell count was 10.4 ten 10^9/L, the albumin degree was 24g/L and the liver map trial was normal. Her serum entire cholesterin degree was 5.2mmol/L, low denseness lipoprotein degree was 3.7mmol/L and fasting plasma glucose was 4.5mmol/L. The everyday microscopy of piss was positive for ruddy blood cell, ruddy cell dramatis personae, and was negative for white blood cell. The urine sum protein was 1.13g/day and the creatinine clearance was 10 mL/min. Mid-stream piss for civilization was negative. The clinical image was compatible with nephritic syndrome or quickly progressive glomerulonephritis ( RPGN ) , and anemia. Further probes showed that serum anti-nuclear antibodies ( ANA ) , antineutrophil cytoplasmatic antibodies ( ANCA ) , anti-streptolysin O ( ASO ) antibody, and anti-glomerular cellar membrane ( anti-GBM ) antibody titres were undetectable. Serum C3 and C4 complement degrees were normal. Hepatitis B surface antigen, anti-hepatitis C virus antibody, serum cryoglobulin and blood civilization were negative. Ultrasound scan of nephritic system revealed normal-sized kidneys with increased echogenicity, which was suggestive of nephritic parenchymal disease. Nephritic biopsy confirmed Immunoglobulin ( Ig ) A nephropathy. The reticulocyte count was normal, peripheral vilification showed mild poikilocytosis, and serum Fe profile was non implicative of Fe lack. Faecal supernatural blood trials were negative in all of the 3 stool specimens. Serum and urine paraprotein were n egative, and bone marrow scrutiny showed active marrow. Ms. MH was given low dose frusemide for diagnostic alleviation of peripheral hydrops, and was given angiotensin change overing enzyme inhibitor ( ACEI ) for control of blood force per unit area. She was assessed by nephrologist and was suggested to go on these medicines, and to mention to renal clinic for consideration of steroid therapy when serum creatinine is on increasing tendency or when albuminuria progresses to nephrotic scope. She tolerated the medicines and was on a regular basis followed up in the medical out-patient clinic. Discussion ** ( entire words for instance history and treatment must be 1000-2000 ) : Ms MH, a healthy 29-year-old lady, presented with 1 hebdomad history of dependent hydrops, high blood pressure, microscopic hematuria, and a low grade of albuminuria ( urine sum protein: 1.13g/day ) . Urine microscopy revealed white blood cell, ruddy blood cell and ruddy cell dramatis personae. This clinical image is compatible with glomerulonephritis, which can be loosely classified into renal-limited primary glomerulonephritis or secondary glomerulonephritis perplexing systemic disease. Further blood trial for serologic markers of glomerulonephritis, viz. ANA, ANCA, anti-GBM antibody, ASO titres, hepatitis serology, blood civilizations and cryoglobulin titres were undetectable, therefore excepting secondary glomerulonephritis. Nephritic biopsy remains the gilded criterion for unequivocal diagnosing of glomerulonephritis. The biopsy specimen can be examined under the light microscopy in order to find the primary histopathological hurt to the uriniferous tubule. Under light microscopy, immunofluorescence survey is able to place three major forms of deposition of Ig, viz. farinaceous, additive and dearth of immunofluorescence staining. Farinaceous deposition of Ig is a trademark of immune complex glomerulonephritis. Linear deposition of Ig along the glomerular cellar membrane is characteristic of anti-GBM disease. Dearth of Ig and positive circulating ANCA represent glomerulonephritis caused by ANCA-related vasculitis. ( 1 ) Ms MH was eventually diagnosed to hold IgA kidney disease, which is the commonest cause of primary glomerulonephritis throughout the universe. ( 2 ) Typical oncoming of the disease is in the 2nd and 3rd decennaries of life, as manifested by our instance. Majority of patients are diagnosed during an rating for symptomless microscopic hematuria or mild albuminurias. Macroscopic, and frequently perennial, hematuria that occurs shortly after an upper respiratory tract infection is a authoritative but less common presentation. Patient with IgA kidney disease may besides presented with nephrotic-range albuminurias, RPGN or, seldom, malignant high blood pressure. ( 3,4 ) As demonstrated by our instance, the complement degree is typically normal in IgA nephropathy. Light-microscopically, IgA nephropathy can change from mild mesangial proliferation and enlargement to spread proliferation with glomerular crescents. Immunofluorescence staining typically showed farinaceous deposition of Ig, decl arative mood of immune complex glomerulonephritis. ( 1 ) Ms MH was put on ACEI for blood force per unit area control. There are groundss that patterned advance of IgA kidney disease may be slowed by ACEI and angiotonin II receptor blockers ( ARB ) . ( 5,6 ) The drugs act by cut downing the intra-glomerular force per unit area and by straight bettering the size-selective belongingss of the glomerular capillary wall, lending to their anti-hypertensive and anti-proteinuric consequence. ( 1 ) In a randomized controlled test, 44 patients with biopsy-proven IgA kidney disease, proteinuria more than or equal to 0.5 gram/d, and serum creatinine less that or equal to 1.5 mg/dL ( 133 umol/L ) were indiscriminately assigned either to have Vasotec or to a control group in whom blood force per unit area was controlled with anti-hypertensives other than ACEI or ARB. At followup of about seven old ages, nephritic endurance, defined as lupus erythematosus that a 50 per centum addition in the serum creatinine concentration, was significantly more likely in the Vasotec group than in the control group: 92 % versus 55 % ( p & A ; lt ; 0.05 ) . There was a important lessening in albuminuria in the Vasotec group, whereas an addition in albuminuria was observed in the control group ( P & A ; lt ; 0.001 between groups ) . Control of blood force per unit area was similar in the two groups. In decision, ACEI significantly improves nephritic endurance in proteinuric IgA kidney disease with norm al or reasonably impaired nephritic map. ( 5 ) High blood pressure, albuminuria of more than 1 gram per twenty-four hours, impaired nephritic map at the clip of diagnosing, relentless microscopic hematuria, and high glomerular histopathological tonss stand out as consistent and strong forecasters of hapless nephritic endurance harmonizing to literatures and cohort surveies from around the universe. ( 3,7,8 ) Ms MH demonstrates the first three hapless predictive factors of the above list and therefore she is expected to be at hazard of holding progressive disease in following few old ages. IgA kidney disease is a global disease and the cause of end-stage nephritic failure in 15-20 per centum of patients within 10 old ages and in 30 to 40 per centum of persons within 20 old ages from evident oncoming of disease. Harmonizing to Cochrane Database of Systemic Reviews in the 3rd one-fourth of 2009, the optimum direction of IgA nephropathy remains unsure. Consequences from small-scaled randomised controlled tests favoured the usage of immunosuppressive intercessions, with the most promising agent being steroids, which were associated with a lower hazard of patterned advance to end-stage nephritic failure ( comparative hazard [ RR ] 0.44, 95 % assurance interval [ CI ] 0.25 to 0.8 ) and lower urinary protein elimination ( leaden mean difference [ WMD ] -0.49 g/day, 95 % CI -0.72 to -0.120 ) . Urinary protein elimination was lower for patients treated with alkylating agents or cyclosporin compared to placebo or no intervention. Further survey is necessary to determine which pa tients would profit from these intercessions. ( 9 ) Tables and figures ( non more than 2 ) : Reference ( non more than 10 ) : ** Brady HR, O'Meara YM, Brenner BM. Glomerular diseases. In: Kasper DL, Braunwald E, Fauci AS, et Al, explosive detection systems. Harrison ‘s rules of internal medical specialty, 16th edition. New York: McGraw-Hill, 2005:1674-94. Julian BA, Waldo FB, Rifai A, Mestecky J. IgA kidney disease, the most common glomerulonephritis worldwide. A ignored disease in the United States? Am J Med, 1988 ; 84:129-132. Donadio JV, Grande JP. IgA nephropathy. N Engl J Med 2002 ; 347:738-48. Li PKT, Lai KN. IgA nephropathy in Hong Kong. Journal of the Hong Kong Medial Association, 1989 ; 1:93-5. Praga M, Gutierrez E, Gonzalez E, Morales E. Treatment of IgA nephropathy with ACE inhibitors: A randomized and controlled test. J Am Soc Nephrol, 2003 ; 14:1578-83. Li PK, Leung CB, Chow KM, Cheng YL, Fung SK, Mak SK, Tang AW, Wong TY, Yung CY, Yung JC, Yu AW, Szeto CC ; HKVIN Study Group. Hong Kong survey utilizing Diovans in IgA nephropathy ( HKVIN ) : a double-blind, randomized, placebo-controlled survey. Am J Kidney Dis, 2006 ; 47:751-60. Li J, Zhang H, Zhou Y, Li G, Zou W, Wang H. Natural history of Ig A kidney disease and prognostic factors of forecast: a long-run follow up of 204 instances in China. Nephrology, 2008 ; 13:242-6. Chacko B, John GT, Neelakantan N, Korula A, Balakrishnan N, Kirubakaran MG, Jacob CK. Presentation, forecast and result of IgA kidney disease in Indian grownups. Nephrology, 2005 ; 10:496-503 Barkat R, Molony DA, Samuels JA. Immunosuppressive agents for handling IgA kidney disease. Cochrane Database of systematic Reviews. 3rd One-fourth, 2009No of words ( excepting mentions ) : ____1260 _____**The instance study will be REJECTED if the campaigners fail to adhere to the above format.DeclarationI do solemnly and unfeignedly declare that the instance study submitted represents my ain work. I have been in clinical contact with the instance selected. The instance study has non been submitted to any assessment board or publication and it is NOT related to my 2nd forte ( Internet Explorers ) , if any. My consent is herewith given to the College to maintain a transcript of my instance study, in written and/or electronic, at the College Secretariat and let the populace to hold free entree to the work for mention.______________________( Signed by _______________ )

Indonesia - Geography, History, and More

Indonesia - Geography, History, and More Population: 240,271,522 (July 2009 estimate)Capital: JakartaMajor Cities: Surabaya, Bandung, Medan, SemarangArea: 735,358 square miles (1,904,569 sq km)Bordering Countries: Timor-Leste, Malaysia, Papua New GuineaCoastline: 33,998 miles (54,716 km)Highest Point: Puncak Jaya at 16,502 feet (5,030 m)Indonesia is the worlds largest archipelago with 13,677 islands (6,000 of which are inhabited). Indonesia has a long history of political and economic instability and has only recently begun to grow more secure in those areas. Today Indonesia is a growing tourist hotspot because of its tropical landscape in places such as Bali.Indonesias HistoryIndonesia has a long history that began with organized civilizations on the islands of Java and Sumatra. From the 7th to the 14th century, Srivijaya, a Buddhist Kingdom grew on Sumatra and at its peak it spread from West Java to the Malay Peninsula. By the 14th century, eastern Java saw the rise of the Hindu Kingdom Majapahit and its chief minister fr om 1331 to 1364, Gadjah Mada, was able to gain control of much of what is present-day Indonesia. Islam however, arrived in Indonesia in the 12th century and by the end of the 16th century, it replaced Hinduisim as the dominant religion in Java and Sumatra.In the early 1600s, the Dutch began growing large settlements on Indonesias islands and by 1602, they were in control of much of the country (except East Timor which belonged to Portugal). The Dutch then ruled Indonesia for 300 years as the Netherlands East Indies.By the early 20th century, Indonesia began a movement for independence which grew particularly large between World Wars I and II and Japan occupied Indonesia during WWII. Following Japans surrender to the Allies during the war though, a small group of Indonesians proclaimed independence for Indonesia. On August 17, 1945 this group established the Republic of Indonesia.In 1949, the new Republic of Indonesia adopted a constitution that established a parliamentary system of government. It was unsuccessful though because the executive branch of Indonesias government was to be chosen by parliament itself which was divided among various political parties. In the years following its independence, Indonesia struggled to govern itself and there were several unsuccessful rebellions beginning in 1958. In 1959, President Soekarno re-established a provisional constitution that had been written in 1945 to provide broad presidential powers and take power from the parliament. This act led to an authoritarian government termed Guided Democracy from 1959 to 1965.In the late 1960s, President Soekarno transferred his political power to General Suharto who eventually became Indonesias president in 1967. The new President Suharto established what he called the New Order to rehabilitate Indonesias economy. President Suharto controlled the country until he resigned in 1998 after years of continued civil unrest.Indonesias third president, President Habibie, then took power in 1999 and began rehabilitating Indonesias economy and restructuring the government. Since then, Indonesia has held several successful elections, its economy is growing and the count ry is becoming more stable. Government of IndonesiaToday, Indonesia is a republic with a single legislative body that is made up of the House of Representatives. The House is split into an upper body, called the Peoples Consultative Assembly, and lower bodies called the Dewan Perwakilan Rakyat and the House of Regional Representatives. The executive branch is comprised of the chief of state and the head of government- both of which are filled by the president.Indonesia is divided into 30 provinces, two special regions and one special capital city.Economics and Land Use in IndonesiaIndonesias economy is centered on agriculture and industry. The main agricultural products of Indonesia are rice, cassava, peanuts, cocoa, coffee, palm oil, copra, poultry, beef, pork and eggs. Indonesias largest industrial products include petroleum and natural gas, plywood, rubber, textiles and cement. Tourism is also a growing sector of Indonesias economy.Geography and Climate of IndonesiaThe topography of Indonesias islands varies but it consists mainly of coastal lowlands. Some of Indonesias larger islands (Sumatra and Java for example) have large interior mountains. Because the 13,677 islands that make up Indonesia are located on the two continental shelves, many of these mountains are volcanic and there are several crater lakes on the islands. Java for example has 50 active volcanoes.Because of its location, natural disasters, especially earthquakes, are common in Indonesia. On December 26, 2004 for example, a 9.1 to 9.3 magnitude earthquake struck in the Indian Ocean which triggered a large tsunami that devastated many Indonesian islands (images).Indonesias climate is tropical with hot and humid weather in lower elevations. In the highlands of Indonesias islands, temperatures are more moderate. Indonesia also has a wet season that lasts from December to March.Indonesia Facts Indonesia is the worlds fourth most populous country (behind China, India and the United States)Indonesia is the worlds largest Muslim countryLife expectancy in Indonesia is 69.6 yearsBahasa Indonesia is the countrys official language but English, Dutch and other native languages are spoken as well To learn more about Indonesia visit the Geography and maps section of this website. References Central Intelligence Agency. (2010, March 5). CIA - The World Factbook Indonesia. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/id.html Infoplease. (n.d.). Indonesia: History, Geography, Government, and Culture - Infoplease.com. Retrieved from infoplease.com/ipa/A0107634.html United States Department of State. (2010, January). Indonesia (01/10). Retrieved from state.gov/r/pa/ei/bgn/2748.htm

The Cold War essays

The Cold War essays The Cold War was an extremely long war that last from 1945 until 1990. It did not clearly start until 1945, but strained relations remained between the United States and the Soviet Union since 1917. The ending of WWII and the struggle between Communism and Capitalism, led to this unique war. This unparalleled war was between the Capitalist countries, including the United States, or the Eastern bloc and the Communist countries, including the Soviet Union, also referred to as the Western bloc. It was a unique war because it was not exactly declared war of battles, advances, and retreats. It was a war of ideas between the Free World and Communism (Lucas, P 1). Suspicion, mutual distrust, and misunderstandings between the United States, the Soviet Union, and their allies characterized the war. These conditions almost led to a Third World war at certain times. The United States and the Soviet Union both accused each other their ways because the United States wanted a free world wit h independence and democratic parties while the Soviet Union tried to control most of Eastern Europe, which was considered crucial to the country's interest. The United States was angered with the Soviet Union for wanting to expand Communism across the globe, and the Soviet Union was angered by the United States trying to stop revolutionary activity in other countries and practicing imperialism. In 1917, the Soviet Union became communist and established a Communist dictatorship. Throughout the 1920's and 1930's, the Soviet Union wanted the destruction of capitalism and world revolution, which was totally against the United States ways. Because of this, the United States would not even give the Soviet Union diplomatic recognition. These reasons made strained relations between the United States and the Soviet Union, and it led to the Cold War. The Cold War started in Europe after the Soviet Union lengthened its control throughout Central and Eastern...

Ideal Community Essay Example | Topics and Well Written Essays - 750 words

Ideal Community - Essay Example To construct such a community we need individuals with specific traits and qualities who work for the task assigned to them beyond their personal beliefs. Such individuals work solely for the purpose and cause of constructing an ideal community with its underlying principles focused primarily on service of humanity. An ideal community has to be perfect in many ways that it shouldn’t be only ideal for the individual that house in it but also for others who view its system and functioning from outside aswell. For this following facts are needed to be considered and worked upon The individuals settling in my ideal community can belong to any age group, sex and ethnicity. The individuals residing in the community shall hold ownership of homes as this gives assurity of their activities and actions as they reside permanently in the community. Interested renters with family shall have chances of occupying residence in the community. Residents should be have an adjusting, respectful and accepting attitude. The community shall be located at a place which should be safe from much pollution, crimes and other hazardous activities while at the same time have all the important resources required by the occupants nearby like grocery stores, bus stands, subway stations, health care centers, congregation sites, cafes and recreational centers nearby. The residents of the community should take part in the direct voting process and vote for the good of the nation rather than their individual benefits. The community should work with the government and support its step which benefits the nation as a whole. Community will have facilities that shall promote recreational activities of the residents. Various recreational centers shall be established furnishing the needs of majority residents. This way the residents will have chance to interact and develop relationships. Residents are supposed to adhere to the laws of the country along with observing

Strategic Planning in Uncertain and Dynamic Environments Research Paper

Strategic Planning in Uncertain and Dynamic Environments - Research Paper Example This process is called strategic planning and has been proved to result in different outcomes for different organizations, depending on the nature of the organization and the environment in which the organization operates.   Strategic planning is a systematic and documented process that is adapted for making decisions on what key decisions an organization must get right in order to ensure that the organization thrives in the future. The process of strategic planning leads to a strategic plan, which is a set of statements that describe the purpose and ethical conduct of an organization together with the different strategies that have been designed in order to achieve the targets that the organization has set (Pearce II, et al 1987). To achieve the best outcome, an organization should ensure that its strategic planning is effective, and is capable of sustainable strategic decisions. This is important as it might reduce the risk level for the organization, and improve the long-term performance of the organization. Different organizations have utilized the process of strategic planning differently, and have experienced varying results. Today, apart from large corporations, smaller organizations are equally adopting the process of strategic planning. While some organizations have successfully used strategic planning and experienced a positive outcome, other organizations have failed to realize a positive outcome with strategic planning. Therefore, strategic planning in this regard cannot be viewed as an ultimate or absolute effective process for organizational decision making and improved performance.  

Does Global warming exist Essay Example | Topics and Well Written Essays - 1250 words

Does Global warming exist - Essay Example Global warming usually occurs when greenhouse gas emissions such as carbon dioxide is trapped in the atmosphere thus causing a thickening blanket that traps the heat from the sun, making the planet earth to warm up continuously over a period of time (National Research Council (U.S.), 2010). There is clear evidence that there has been a marked change in the composition of greenhouse gases in the atmosphere that currently stands at 390 ppm and even higher levels have been recorded at 400ppm at Mauna Loa, Hawaii in May 2013. It can now be proven that the average global temperature has undergone a change of about 1.4 °F in the last one hundred years (National Research Council (U.S), 2010). While the American National Oceanic and Atmospheric Administration (NOAA) found that, the period between years 2000 and 2010 was the warmest on record with 2005 and 2010 being the warmest (Giese, 20113). Scientists also project that Earth's average temperatures will raise between 2 and 12 degrees Fahrenheit by 2100 which will be disastrous to human life and all the animal life on the planet earth (National Research Council (U.S.), 2011).The rise in the global temperature has been shown through the changes in weather and ultimately the climate of regions such as changes in rainfall pattern and intensity. The oceans, seas and glaciers have equally undergone changes while the oceans have become more acidic, the glaciers and ice caps on mountains and the Polar Regions have melted while the sea levels have risen (United States. (2010). These changes can be attributed to climate change have been due to human activities and natural variations in the weather and climate of a place. It is important to observe that the earth goes through a natural cycle of cooling, warming that may be attributed to factors such as changes in solar system, and acts such as volcanic activity and these cannot be the only explanation for the rise in temperatures (U.S. Global Change Research Program and Karl, 2009).   According to the National Research Council (U.S) (2010), the biggest cause of the increase in the global temperature of the earth is the trapped greenhouse gases in the air that trap the warmth leading to heating. This has been proven using satellite technology to measure the fluctuations in the energy from the sun; scientists have proven that the sun’s contribution is minimal as compared to human activities. The upshot of this is that the increase in temperatures currently experienced globally is due to the warming properties from greenhouse gases such as carbon dioxide that trap heat in the atmosphere. The increased concentration of carbon dioxide and other greenhouse gas emissions increase the amount of water vapor in the atmosphere that also aids in the trapping and retention of the excess greenhouse gas emissions. Because water vapor is a greenhouse gas, it leads t o further warming through a

The Crash of American Airlines Essay Example for Free

The Crash of American Airlines Essay A good example involving with human error is the crash of the American Airlines flight 587. On 12 November 2001, at approximately 9:17 a. m. ocal time, American Airlines flight 587 crashed into the Belle Harbor area of Queens, New York, several minutes after taking off from JFK International Airport. The plane was on a scheduled flight to Santo Domingo, Dominican Republic. All nine crew members and 251 passengers on the aircraft were killed, including five infants. Five people on the ground were also killed. Let examine the summary of events that the NTSB determined led to the crash in order to identify the probable causes. â€Å"The A300-600, took off just minutes after the Japan Airlines Boeing 747 on the same runway, flew into the larger jets wake, an area of very turbulent air. The first officer attempted to keep the plane upright with aggressive rudder inputs. The strength of the air flowing against the moving rudder stressed the aircrafts vertical stabilizer and eventually snapped it off entirely, causing the aircraft to lose control and crash. The National Transportation Safety Board concluded that the enormous stress on the rudder was due to the first officers unnecessary and excessive rudder inputs, and not the wake caused by the earlier Japan Airlines 747 that had crossed that area. Airbus charges that the crash was mostly Americans fault, because the airline did not train its pilots properly about the characteristics of the rudder. Aircraft tail fins are designed to withstand full rudder deflection in one direction at maneuvering speed. They are not usually designed to withstand an abrupt shift in rudder from one direction to the other. Most American pilots believed that the tail fin could withstand any rudder movement at maneuvering speed. The NTSB indicated that American Airlines Advanced Aircraft Maneuvering Program tended to exaggerate the effects of wake turbulence on large aircraft. Therefore, pilots were being trained to react more aggressively than was necessary. † (Mysterious Crash) Since the investigation by the National Transportation Safety Board, American Airlines has modified its pilot training program. Training methods have been reviewed and changed as a result of the accident. Despite rapid gains in technology, humans are ultimately responsible for ensuring the success and safety of the aviation industry. They must continue to be knowledgeable, flexible, dedicated, and efficient while exercising good judgment.