Sickle Cell Anemia Case Study

Sickle Cell Anemia Case Study A 20-year-old Africa- America woman visits her physical complaining of episodes of extreme pain and discomfort in her legs and lower back. She has been experiencing these recurrent episodes, accompanied by extreme fatigue, since she was a child. On physical examination, she appears jaundiced and has a hematocrit of 23% and a hemoglobin level of 7g/dL. She reports she has family members who experienced the same symptom. Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by an inherited abnormal hemoglobin (an oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted (sickled) red blood cells. The sickled red blood cells are fragile and prone to rupture. When the number of red blood cells decreases from rupture (hemolysis), anemia is the result. This condition is referred to as sickle cell anemia. The irregular sickled cells can also block blood vessels causing tissue and organ damage and pain. Sickle cell anemia is one of the most common inherited blood anemias. The disease primarily affects Africans and African Americans. It is estimated that in the United States, some 50,000 African Americans are afflicted with the most severe form of sickle cell anemia. Overall, current estimates are that one in 1,875 U.S. African American is affected with sickle cell anemia. Sickle cell anemia is caused by a point mutation in the ÃŽÂ ²-globin chain of haemoglobin, causing the hydrophilic amino acid glutamic acid to be replaced with the hydrophobic amino acid valine at the sixth position. The ÃŽÂ ²-globin gene is found on the short arm of chromosome 11. The association of two wild-type ÃŽÂ ±-globin subunits with two mutant ÃŽÂ ²-globin subunits forms haemoglobin S (HbS). Under low-oxygen conditions (being at high altitude, for example), the absence of a polar amino acid at position six of the ÃŽÂ ²-globin chain promotes the non-covalent polymerisation (aggregation) of hae moglobin, which distorts red blood cells into a sickle shape and decreases their elasticity. The loss of red blood cell elasticity is central to the pathophysiology of sickle-cell disease. Normal red blood cells are quite elastic, which allows the cells to deform to pass through capillaries. In sickle-cell disease, low-oxygen tension promotes red blood cell sickling and repeated episodes of sickling damage the cell membrane and decrease the cells elasticity. These cells fail to return to normal shape when normal oxygen tension is restored. As a consequence, these rigid blood cells are unable to deform as they pass through narrow capillaries, leading to vessel occlusion and ischaemia. The actual anaemia of the illness is caused by haemolysis, the destruction of the red cells inside the spleen, because of their misshape. Although the bone marrow attempts to compensate by creating new red cells, it does not match the rate of destruction.[17] Healthy red blood cells typically live 90-120 days, but sickle cells only survive 10-20 days.[18] Normally, humans have Haemoglobin A, which consists of two alpha and two beta chains, Haemoglobin A2, which consists of two alpha and two delta chains and Haemoglobin F, consisting of two alpha and two gamma chains in their bodies. Of these, Haemoglobin A makes up around 96-97% of the normal haemoglobin in humans. In normal Haemoglobin A, glutamic acid is on the 6th position of the beta chain, while in sickle-cell disease, this glutamic acid is replaced by valine leading to the formation of sickle cells. This happens due to a one point mutation. This leads to polymerization of the two beta chains and therefore their appearance as puzzle pieces (or lock and key); which means they fit into each other forming a longitudinal polymer that would lead to the cell becoming deformed and very rigid leading to vessel occlusion. This process of polymerization can be activated by infections, hypoxia, acidosis, physical exercise, vasoocclusion due to cold as well as hypertonic dehydration. Diagnosis Sickle cell anemia is diagnosed through blood test, testing for hemoglobin S (the defective form of hemoglobin descriptive of the disease), the presence of other abnormal hemoglobin variants, evaluating status and number of erythrocytes, and/or determination of one of more altered hemoglobin gene copies. In the United States, this blood test is part of routine screening for newborns done in the hospital. However, older children and adults can be tested also. In adults, the blood sample is extracted from a vein in the arm. In young children and babies, blood is taken from a finger or heel. The testing itself is typically performed on a smear of blood utilizing a special low-oxygen preparation, known as sickle prep. Other prep tests can be utilized, including but not limited to solubility tests. [4,6] Another screening testing is the Hb S solubility test. In this procedure, a chemical is added to the blood sample which reduces the amount of its oxygen carrying capacity. In individuals carrying even one sickle gene, some hemoglobin S will be present. The reduced amount of oxygen will cause S-related polymers to form and affected erythrocytes will sickle. This test, in essence, detects for the presence of Hb S alone. However, this exam should not be performed on infants until age six months, as babies with sickle cell will not produce significant amounts of Hb S until several months after birth. [6] To confirm the diagnosis, DNA analysis can be utilized. This exam is used to detect alterations and mutations in the genes producing hemoglobin components. DNA analysis reveals one copy or two copies of the hemoglobin S gene, or copies of different hemoglobin variants. DNA analysis can be performed on the developing fetus in fourteen to sixteen weeks gestations via amniocentesis or through chorionic villus sampling.[6] Treatment Treatment of sickle cell anemia is done by blocking the red blood cells from stacking together. the health professional maintenance helps the patients to begin with early diagnosis of the disorder, preferably during the newborn period. Penicillin prophylaxis, vaccination against pneumococcus bacteria, and folic acid supplementation is standard. [2] Treatment of sickle cell complications includes ,vitamin supplementation, intravenous fluids, blood transfusion, supplemental oxygen, surgery (splenectomy) and psychosocial support. Management is best accomplished via multidisciplinary program of care. [2,3,5] Blood transfusions benefit by reducing recurring pain crises, risk of stroke, and other complications. Blood transfusions increase the amount of normocytic erythrocytes in circulation, helping relieve the anemic state. However, since erythrocytes contain iron and the body does not possess a natural process for its elimination, patients can accumulate iron in the blood. Thus, possible iron toxicity must be closely screened and methods to remove excess must be executed. Excess iron is removed artificially through administration of the drug Deferasirox (Exjade ÂÂ ®) orally in patients two years of age and older. If this is not checked, the excessive iron can accumulate in the heart, liver, and various other organs causing organ damage. [3] Other treatments for this disease include finding a substance that prevents erythrocytes from sickling without producing deleterious effects to other body areas. The medication hydroxyurea has been found to reduce the frequency and severity of pain, acute chest syndrome, and decrease the need for blood transfusions in adult patients. Droxia ÂÂ ® (prescription name brand formulation of hydroxyurea) was approved by the Food and Drug Administration in 1998 and is currently available for adult patients. Studies are currently being conducted to determine the proper dosage in pediatric patients. However, there is concern in this medication that chronic usage may facilitate tumor growth or leukemia in certain individuals. [5] Other pharmacological therapies include antibiotics and pain relievers. Regarding antibiotics and aforementioned earlier, children benefit from penicillin at age two months and usually continue medication until age five. Prophylactic antibiotic treatment helps in preventing pneumonia. For adults, prophylactic antibiotic treatment can aide in fighting certain infections that they would normally fight provided they had normal erythrocytes. [2,3,5] Non-pharmacotherapy treatments are bone marrow transplant and supplemental oxygen therapy. Bone marrow transplant procedure offers the only potential cure for sickle cell anemia. Replacing the system with unaffected bone marrow aids the body in producing normocytic erythrocytes. However, finding a donor provides difficult even with the advent of registries. Also, the extraction of bone marrow possesses serious risk, including death. After the procedure, a mandatory lengthy hospital stay is required. In the hospital and upon leaving, the patient will be administered medications to help prevent rejection of the donated marrow. The procedure is currently only used for those possessing serious symptoms and problems with sickle cell anemia. Regarding supplemental oxygen therapy, this proves beneficial by forcefully increasing oxygen content in the blood via oxygen mask. Supplemental oxygen can be helpful in acute chest syndrome or sickle cell crisis.[2,3,5] Surgical treatment involve splenectomy to remove a possible damaged spleen from the sickle cells or eye surgery for vision problems associated with sickled cell damage. New sickle cell treatments on the horizon include gene therapy, the pharmacological treatments of butyric acid, clotrimazole, nitric oxide, and nicosan. [3] Since sickle cell anemia is caused by a defective gene, researchers speculate that insertion of a normal gene into bone marrow of people with sickle cell anemia will result in the production of normal hemoglobin. Another gene therapy possibility is turning off the defective gene, while reactivating another gene responsible for production of fetal hemoglobin (a type of hemoglobin found in newborns) that prevent sickle cells from forming. [3] Butyric acid, normally utilized as a food additive, may increase the amount of fetal hemoglobin in the blood in some patients. [3] Clotrimazole, the over-the-counter antifungal medication may help prevent loss of water from erythrocytes, possibly reducing the number of sickle cells formed. [3] Nitric oxide is decreased in sickle cell anemia, a gas that normal causing vasodilatation. Administration of this agent would prevent the sticking of sickled cells to one another.[3] Nicosan, an herbal treatment in early trials in the United States, is currently being used to prevent sickle crisis in Nigeria (West Africa). [3] Reference section Sickle Cell Anemia: Treatments and Drugs MayoClinic.com. Sickle Cell Anemia. Mayo Clinic, 1 Apr. 2009. Web. 13 July 2010. http://www.mayoclinic.com/health/sickle-cell-anemia/DS00324/DSECTION=treatments-and-drugs Smith WR, Penberthy LT, Bovbjerg VE, et al. (Jan 2008). Daily assessment of pain in adults with sickle cell disease. Ann. Intern. Med. 148 (2): 94-101. ISSNÂÂ  0003-4819. PMID1819533 Sickle Cell Tests. American Association for Clinical Chemistry (2006). Lab Tests Online. American Association for Clinical Chemistry, 20 Aug. 2006. Web. 13 July 2010. The case study was taken from first aid usmile step1 What Is Sickle Cell Disease. About Sickle Cell Disease. Sickle Cell Disease Association of America SCDAA Home, 2005. Web. 13 July 2010. http://www.sicklecelldisease.org/about_scd/

Kuona, An African Perspective on Religions: J.N.K. Mugambis Contributi

Kuona, An African Perspective on Religions: J.N.K. Mugambi's Contribution ABSTRACT: Kuona is a Shona (one of Zimbabwe’s major languages) verb meaning "to see." In poetic constructions, it is often used as an ocular metaphor meaning insight or understanding. This ocular metaphor can be used to describe Mugambi’s assessment of the exclusivistic claims one often encounters in the Abrahamic religions. Such claims often arise from a strongly held belief that the adherent is one of God’s chosen. Mugambi has emerged as one of the most articulate philosophical theologians in the African continent. His reflections, ubiquitous in classrooms on the continent, deserve a much broader audience. My paper seeks to introduce Mugambi’s perspective on religion. Part of Mugambi’s project has been to make an assessment of this notion of chosenness in the Abrahamic religions. He does so particularly with reference to the relationship between Christianity and the African religious heritage. Kuona is a Shona (one of Zimbabwe's major languages) verb meaning to see. In poetic constructions it is often used as an ocular metaphor meaning insight or understanding. This ocular metaphor, it seems to me, can be used to describe Mugambi's assessment of the exclusivistic claims one often encounters in the Abrahamic religions. "Only those who believe as we do have any hope of an eternity with God." "We are the ones destined or predestined for heaven." These and such claims often arise from a strongly held belief that the adherent is one of God's chosen ones. Part of Mugambi's project has been to make an assessment of this notion of chosenness in the Abrahamic religions. He does so particularly with reference to the relationship between Christianity and the... ...on mark on the Mosaic religions, Mugambi proceeds to suggest that other religious traditions may be propounding perspectives closer to the divine ideal. He assesses he religions of the Orient — especially Buddhism — as being immensely tolerant and respectful of the humanity and integrity of others. The African religious heritage, he finds to be also inclusive rather than exclusive. Realizing that his challenge is bound to evoke a charge of Universalism on the part of many evangelical Christians in the North Atlantic areas, Mugambi contends that his insights are not such as to bring shame on those who accept them. He declares that when Christians of non-EuroAmerican cultures seek a synthesis of the Christian faith with their own heritage, a charge of universalism may after all turn out to be a virtue rather than a vice. In the final analysis God is the final arbiter.

Zen Style

Zen Interior Design is a way of designing a space through meditative concepts in an attempt of giving the space a feel of enlightenment. The definition of this design is ambiguous compared to the other discipline in Interior Design. According to Shaolin-Wahnam Institute (n. d. , para 1) Zen basically means â€Å"meditation†. Meditation promotes flow of energy which is translated into space with Zen Interior Design. Over all design emulates a mind who is in an enlightened state, clearing it from the unnecessary load giving it harmony. The design strategy is to conform a space in such a way that it would be like a concrete picture of a mind will look like when it reaches a harmonious state. Origin Zen design was developed in China and spread into Japan in the twelfth century it gave its name to a style of Japanese architecture that was based in one of China’s dynasty called Song; the earliest recorded Zen design architecture was Jizodo Shokofuji (1404). Such influence came to existence because at that time the wide use of Zen Buddhism was rampant. If you would study the culture of Japan, Zen Buddhism is embedded everywhere. Moffett, Fazio, and Wodehouse, 2003, chap 4) Zen is also seen as similarly associated with the concept of Feng Shui which in English is literally â€Å"wind† and â€Å"water†. Feng Shui follows certain rules and principles that are sometimes thought of as practical solutions in order to keep the correct ch’i of the space. In Zen, the ultimate purpose of design is meditation that results in harmony and balance. Feng Shui aims to correct the living conditions in order to promote physical and psychological well-being to the dweller. Marie T. , Feng Shui simplified, para 3) Design Techniques Zen in Interior designing has no standard rule. Design is being done in the context of harmony. Its application is limitless in terms of space; it can be done for a whole house. An isolated room or even a space in you work area. It can be applied through the choice of color palette, space management and space use. All of this can be done be keeping it to what is just essential and natural. That is why Zen is often affiliated with the minimalist design. Colors are kept natural and limited, trying to keep it as light and as close to nature as possible. Strong colors must be kept at bay and everything that can be seen should be relaxing to the eye. Spaces ought to be open and free, up to the point that the designer should induce the illusion of it. Strategically placing mirrors and windows that will help spread light is one of the known strategies to achieve this. Allowing the space to be simple and close to its use is another technique often applied in this type of design. Applying Zen to Interior Decorating, para 1) Modern Developments Zen design is currently widely used in the industry of Interior Design. It was again largely noticed in the recent years entering 21st century. In residential homes it is simply not utilized for its beauty and charm but it gives the dweller a personal space as their own sanctuary, from today’s common busy lifestyle. (Mcevoy, Interior Design Style, para 5). Not only that, today’s housing especially in most of the South East Asian are getting smaller. With this kind of design on these houses a lot of issues can be addressed. Dwellers will be comfortably situated in their houses even if space is limited. The business sector benefits from this as well. Their commercial and industrial facilities, adapt some of its design because its parameters contribute to a lot of things like efficiency of flow in a workspace and improvement of or working environment. To them it affects the worker’s psyche which entails operation cost reduction, which is has a great impact to businesses.

List of Death Quotations From Shakespeare

Shakespeares tragedies have some deeply moving death-quotes. His quotations on death bring tears rolling down the cheeks. The sadness in the quotes moves you so much that you feel as though you have experienced a great loss. Here is a page of some of Shakespeares most moving death quotes. A Midsummer Nights Dream, Act V, Sc. IThis passion, and the death of a dear  friend, would go near to make a man look sad.Hamlet, Act V, Sc. IIThis fell sergeant, death,Is strict in his arrest.Hamlet, Act II, Sc. IIThey are the abstract and brief chronicles of the time: after your death, you were better have a bad epitaph than their ill report while you live. Hamlet,  Act III, Sc. I For in that sleep of death what dreams may come,When we have shuffled off this mortal coil,Must give us pause. Julius Caesar, Act II, Sc. IICowards die many times before their deaths;The valiant never taste of death but once.Julius Caesar,​ Act II, Sc. IIWhen beggars die, there are no comets seen;The heavens themselves blaze forth the death of princes.King Henry IV. Part II, Act I, Sc. III were better to be eaten to death with a rust than to be scoured to nothing with perpetual motion.Macbeth, Act V, Sc. VTo-morrow, and to-morrow, and to-morrow,Creeps in this petty pace from day to day,To the last syllable of recorded time;And all our yesterdays have lighted foolsThe way to dusty death. Out, out, brief candle!Lifes but a walking shadow.Macbeth, Act V, Sc. VIThose clamorous harbingers of blood and death.Othello, Act II, Sc. IIf after every tempest come such calms,May the winds blow till they have wakend death!The Merchant of Venice, Act IV, Sc. II am a tainted wether of the flock,Meetest for death: the weakest kind of fruitDrops earliest to the ground. Twelfth Night, Act III, Sc. IVOut of the jaws of death. Measure for Measure,   Act III, Sc. 1  If I must dieI will encounter darkness as a bride,And hug it in mine arms. Richard II, Act III, Sc. IIWoe, destruction, ruin, and decay;The worst is death, and death will have his day. Romeo and Juliet,  Act V, Sc. IIIEyes, look your last!Arms, take your last embrace! and lips, O youThe doors of breath, seal with a righteous kissA dateless bargain to engrossing death. Cymbeline,   Act IV, Sc. 2Golden lads and girls all must,As chimney-sweepers, come to dust. Henry VI, Part III, Act V, Sc. 2My sick heart showsThat I must yield my body to the earth,And, by my fall, the conquest to my foe.Thus yields the cedar to the axes edge,Whose arms gave shelter to the princely eagle;Under whose shade the ramping lion slept:Whose top-branch overpeerd Joves spreading tree,And kept low shrubs from winters powerful wind.