Systemic Scleroderma Essay

ASC is caused by a combination of three particular impairments, each of which can vary in severity

The average reported mortality rate of SJS is 1-5%. In order to standardize the evaluation of risk and prognosis in patients with SJS, the SCORTEN scale is now the most widely used scoring system and evaluates age, malignancy, tachycardia, initial body surface area of epidermal detachment, serum urea, serum glucose, and

Data from all the literature review was evaluated and determined there is significant difference between the two cognitive screening tools warranting the team to consider changing their current tool. This information will be used so the team can use the most appropriate tool when trying to diagnosing MCI. Since the results speak for themselves there is no need to continue the comparison of the two tools at the end of the study. The EHR will contain both the cognitive tools so the clinicians can have the freedom to pick the best one for their patient.

This is a 50 year-old male who required inpatient hospitalization due to dizziness, abdominal pain, headache, and nausea after taking atenolol. Mr. A came to the Emergency Department with complaints of some dizziness two-day prior to admission and collapsed several times. For the past 2 weeks, he had not been taking his blood pressure medications due to financial reasons. He was given clonidine and atenolol from his dialysis center while he was unable to afford his normal hypertension medication. He was dialyzed three times a week through his arteriovenous fistula and had not missed any sessions. He also had increased dyspnea on exertion over the past 3 weeks, orthopnea and usually sleeps on several pillows which worsened between his dialysis. His medical history is significant for hypertension, diabetes mellitus type II, morbid obesity and end stage renal disease on dialysis.

Scleroderma is a broad term used to describe a spectrum of disorders identified by skin fibrosis (Succaria, Kurban, Kibbi & Abbas, 2013). It is a serious condition that is classified as either being a systemic or localised autoimmune disease of collagen tissue impacting both internal and external organs (Oksel & Gündüzoğlu, 2014). Due to the vast divergency of this disease there will be brief discussion on the various forms of both systemic and localised scleroderma however, the main focus is to investigate findings based on localised scleroderma, delving into the knowledge of the conditions with particular focus on the aetiology of the disease and its clinical features, followed by differential diagnosis of how this condition can be misdiagnosed

These scoring systems have the advantage to take into account different aspects of the disease at the same time increasing the amount of information on the status of the single patient. However, to date none of the proposed systems can be considered extent of limitations. In fact, some of the published studies are limited by their retrospective nature or by the relative small numbers of analyzed prospective cohorts. Availability of prospective data from the large database of recent clinical trials has partially overcame these limitations. However, this studies have generally enrolled mild or moderate patients that might not represents the "real life" clinical setting missing advanced and rapidly progressing disease forms and therefore might underestimate the real disease burden of

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease which involves several organs, including the skin and the kidneys. A singular cause for SLE is not yet known, but several have been proposed, including a genetic component [1] or the improper removal and/or cleanup of apoptotic and necrotic cells [2]. This causes nuclear antigens, such as double-stranded DNA, the SS-A/RO and SS-B/La proteins and endoplasmatic reticulum fragments [3], to be exposed to the immune system, inducing the production of antibodies. Eventually the antigen-antibody complexes can form plaques in several tissues, causing damage through tissue-specific mechanisms [4]. The damage to the tissues ultimately manifest as symptoms that allow diagnosis of SLE.

There are many distinct clinical signs that are associated with IBC and are characterised by rapid progression. One of the most common clinical signs is erythema, where the skin of the breast takes on a red or pink patchy appearance. Erythema is also associated with a release of heat and an increase in size of the affected breast (Figure 1). IBC and the resulting edema also causes the skin to take on the appearance of orange peel (typically called peau d’orange), which is characterised by a dimpled texture to the skin. This is caused by the exaggeration of the hair follicle pits which are associated with edema (Robertson et al., 2015).

The term ‘neurocognitive disorder’ was recently established by the DSM-V and is divided into major neurocognitive disorders and mild neurocognitive disorders. The DSM-V has grouped the terms ‘delirium, dementia, and amnestic and other cognitive disorders’ that were previously used in the DSM-IV-TR into one term known as ‘neurocognitive disorders’ (Mcanulty, 2013). Major neurocognitive disorder consisted of the term dementia in the DSM-IV-TR while minor neurocognitive disorder was a diagnosis not previously included in the DSM. Major neurocognitive disorders will affect an individual's everyday life significantly, while a mild neurocognitive disorder may not. Neurocognitive disorders primarily affect an individual’s cognitive abilities acquired

“Medications, brain surgery, problems in the brain, confusion, and nerve damage from trauma or chronic diseases such as diabetes can change the interpretation of pain without changing awareness of the sensation. For example, persons may feel sensation, but it does not bother them” (Kopec, 2006)

Earlier this semester, I was assisting in the clinic when a potentially difficult situation could have arisen if there was any lack of professionalism. A highly educated, older gentleman was in the clinic for treatment of caries. Priorities soon changed upon examination. A bone spur or some exposed bone was observed inferior to number 30 on the mandible. He had been treated for this before by one of the specialty departments here and was a little upset that it hadn’t healed yet. The medical history was thoroughly gone through, and potential healing inhibitors were identified and elucidated to the patient in a way he could understand. A long history of cancer, smoking, and corticosteroids presented large red flags for osteonecrosis of the jaw.

Colchicine can inhibit the accumulation of collagen by blocking the conversion of procollagen to collagen, and by stimulation of collagenase production [15]. But the data available do not support a role for colchicine in treating scleroderma. In an open trial, 20 of 23 patients treated with colchicine improved, but a short term trial showed progression of skin, musculoskeletal, and pulmonary involvement under colchicine therapy [4,16].

Systemic sclerosis (SSc) is a heterogeneous disease, with early involvement of the vascular endothelium. Among other factors, inflammation and oxidative stress contribute to the endothelial dysfunction, one of the most important pathogenic pathways in the development of SSc. The increase of TNF (tumour necrosis factor)-alpha expression induces the production of ROS (reactive oxygen species), resulting in endothelial dysfunction in many pathophysiological conditions, including SSc. Myeloperoxidase (MPO) is a hem enzyme, released by activated neutrophils, monocytes and macrophages. Lipoprotein-associated Phospholipase A2 (Lp-PLA2) is an enzyme secreted by various inflammatory cells. MPO and Lp-PLA2 activities were found to be correlated with endothelial dysfunction.

The sample age that was used in this study is appropriate for the subject at hand (AD) because as stated before, AD mainly affects older adults. There was a large sample size (784), but the authors do not elaborate on other demographic factors such as patient race, or socioeconomic status (Wattmo et al., 2012). The time given for data collection was adequate; 6 months, and the authors were diligent about monitoring patients for medication changes and excluded those participants appropriately (Wattmo et al., 2012). Again, this study used the MMSE, which is a reliable tool to use when monitoring the cognitive status of patients (Wattmo et al., 2012). This study includes a clear description of the independent variable, which is the administration

The discussion at the first Key Symposium on mild cognitive impairment prompted the formulation of revised core criteria for this condition. The expanded Mayo Clinic criteria for mild cognitive impairment were no longer focused on memory impairment alone yet were expanded to include impairment in other areas of cognitive functioning. Now the additional cognitive syndromes incorporated into the definition of MCI also led to identification of the essentially preserved general cognitive functioning criterion.