Research Korner: Medical Case Study

Case Study on Typhus

Case Study on Typhus   Medical research reveals that typhus is a term used to   describe various health conditions which caused by bacteria that belong to the Rickettsiae family.  There are several kinds of typhus; and the major types are epidemic typhus, murine or endemic typhus, Brill-Zinsser disease and scrub typhus.   Each type of typhus can be transmitted to humans through infected insects.  The first type of typhus which is the epidemic typhus is resulted by a contact with body lice.  This kind of bacteria lives in the human’s body while lice defecate.  And, these feces contain bacteria that cause typhus among humans.  Lice have caused   wounds and when it will be scratched, the feces are rubbed in the wounds. This type of typhus is normally affecting a number of people; as lice spread immediately into crowded areas where people do not take a bath in a regular basis. The symptoms of epidemic typhus include headache, fever, muscle aches, and weakness.  Rashes consisting of bumps and spots may also develop. These rashes start on the chest, back, and abdomen and spread to the legs and arms. The brain or heart muscle may also get swollen in extreme cases, which   may lead to death if not treated early. The next type of typhus is the Brill-Zinsser disease. It is a form of typhus that is actually a reactivation of a previous typhus infection when a person’s immune system is weakened by the former. This may occur as a complication of illness, surgery, or simply through aging process. Usually, this form of typhus affects individual’s years after having overcome epidemic typhus and is quite mild. Symptoms include a week-long fever and light rashes all over the body.  The third type is the endemic typhus; this is passed on to humans through fleas or parasites.  This is the same as epidemic typhus, where the flea defecates and through scratching the wounds, the feces are being transferred into the wounds. This form of typhus is most common in warm coastal regions, such as California and Texas in the United States. It typically causes a fever that lasts for about twelve days and is accompanied by a headache and chills. In some cases, a light rash may also develop. The fourth kind is the scrub typhus which is carried by chiggers or mites.  These insects enable to deposit bacteria in the human skin. This type of typhus is widespread in Southeast Asia and Japan, particularly during the wet season. This is one of the most common causes of illness for people visiting these regions. (http://www.wisegeek.com/what-is-typhus.htm) In this regards, the primary symptoms include headache, fever, muscle pains and aches, abdominal pain, cough, diarrhea, nausea, and vomiting.  Other patients may even develop flat or bumpy rashes with spots on the body. Furthermore,   another study showed that typhus has always been associated with war.  Typhus truly is a disease of humans and lice.  Humans become infected by rubbing or scratching the lice feces into their skin or into their mucous membranes. It is an interesting disease because even though lice imbibe human blood, the parasite is not transmitted to humans during this process. Most of the other diseases carried by insects are transmitted through the bite. Moreover, the conditions of war result to typhus to become prevalent because of poverty, crowding, mass migrations, inadequate housing and malnutrition.   Many people have wrong notions about “typhus”, it is more often equate with typhoid or typhoid fever.  By all means, this is a wrong idea by many. Although, both have the same symptom of high fever; but the causes, transmission and pathology of these diseases are quite different; for typhoid is caused by Salmonella. (http://www.medicinenet.com/typhus/page2.htm) According to medical research made, NSAID medications commonly used to control pain and fever in both adults and children.   Although they differ largely in dosage, to treat typhus are acetaminophen which reduces fever and pain.  However, taking this drug is not recommended if a patient is alcoholic, has a liver disease or an allergy to the drug.  On the other side, aspirin decreases the pain, fever as well as the inflammation.  It is also nonsteroidal anti-inflammatory medication (NSAID).  Similarly, taking Ibuprofen, Ketoprofen and Naproxen will result the same effect to the patients.  In this relation, taking extra precautions is necessary if the patient   is pregnant or breastfeeding has allergies, asthma, peptic ulcer disease, stomach ulcers, esophageal ulcers and bleeding problems.  It is best to consult a physician before taking these medicines for proper medical treatment and management.  Above all, people must be aware of the warning signs of typhus such as worsening fever, rashes, both legs are swelling, both arms are swelling, facial swelling, chest pain, having breathing difficulty, fainting, seizures and confusions. (http://www.freemd.com/typhus/home-care-pain-and-fever-children.htm)   References: (http://www.wisegeek.com/what-is-typhus.htm) (http://www.medicinenet.com/typhus/page2.htm) (http://www.freemd.com/typhus/home-care-pain-and-fever-children.htm)

Case Study on Typhus

Case Study on Typhus Medical research reveals that typhus is a term used to describe various health conditions which caused by b...

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the effect of common skin disease on the QOL of patient in the local setting” And my adviser also wants to modify the statement of the problem. Modifications are: STATEMENT OF THE PROBLEM 1.     What are the common dermatologic problems that patients seek for treatment @ Lucena Skin Center 2.     What extent does the dermatologic problem affects their life a.     performance of activities of daily living b.     relationship with people c.     how he perceives him self     3. Is there a significant difference among the 3 factors identified and the level of impairment?   Can you make those modifications for me in 7 days? Can you also limit the number of pages to 25 including the statistical computation, because of my budget limitations? Thankyou my advicer wanted our thesis change from comparative to descriptive correlational study.                                             Abstract STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to: a.     Age. b.     Gender c.     Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?   LOCALE OF THE STUDY:           This study will be conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.               RESPONDENTS: The sampling technique used was criterion sampling. Both the inclusion and exclusion criteria for patient selection were adopted form the source. Consecutive patient's, age 15 and above, whether old or new, consulting for any skin problem were included in the study. The patient's companions whose ages were also 15 and above served as control subjects (Those who do not have skin diseases). The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no apparent disability. Excluded in the study were those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   SIGNIFICANT FINDINGS:           The study was conducted among 263 respondent's patient and 47 controls (no skin disease) in Lucena Skin Center Clinic, Lucena City.           The demographic data were analyzed using descriptive statistics (N=263) for the patient and (N=47) for the controls. Majority of the patients where females, 142 (54%) and 121 (46%) were males. The respondents were aged from 15 to 78 years. 237 (90%) were aged less than 65 years where as 26 (10%) fell into the geriatric age group (age > = 65). For the control subset, 38 (81%) were female and 9 (19%) were males.           A total of 263 subjects responded to the IKPAS (Translated Dermatology Life Quality Index in Filipino). The average time to complete it was 5 minutes. Unanswered item was observed for item 9 on sexual activity. The difference of the mean score between 15-64 y/o group (mean score= 7.5) and 65-78 y/o group (mean score= 8.07) were not statistically significant however, the difference of the mean score between male (mean score= 7.4) and female (mean score= 26.19) were statistically significant. Among the diseases, the findings with the highest mean score (greatest effect on the quality of life) were seen in Atopic Dermatitis (11.5) and the lowest mean score in Viral Warts (4.5). IKPAS was also completed by 47 healthy control subjects. Reliability was measured in the translated instrument using the 's alpha Coefficient and it showed internal consistency with  alpha Coefficient of a=0.71 (acceptable is >0.7). There was a significant difference between       mean scores of patients (7.86) and healthy subjects (0.89) (p=0.000), demonstrating construct validity. Quality of life scores were higher in inflammatory skin diseases such as Atopic dermatitis, Contact dermatitis, Erythroderma and Lichen Simplex Chronicus as compared to Acne, Viral warts and Keloids.           The first null hypothesis was: "There is no difference in the Quality of Life of patients with skin disease when respondents were group according to their demographic profiles".           The researchers reject the first null hypothesis.           The second hypothesis is: "There is no difference in the quality of life of patients with skin disease and those without skin disease"           The studies second null hypothesis was also rejected by the researchers.                             CHAPTER ONE THE PROBLEM AND ITS SETTING   BACKGROUND OF THE STUDY: During our duties in clinics and hospitals, we often encounter patients with skin diseases. We have observed that these patients were irritable, restless, and shy. They were treated for their skin problems only.           The nurses were instructed by the Physician/ Dermatologist how to take care of the patient's skin lesions and rashes but their emotional and psychological problem were not taken into consideration.           We were wondering whether the stress of having the skin disease affect their quality of life.           The concept of quality of life was developed to interpret data obtained about the impact of diseases on patients well being. This was fostered by the World Health Organizations (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. It usually utilizes a patient- administered questionnaire with items evaluating the effect of a disease and its treatment on patient's symptoms, feelings and daily activities. (called domain) over a well-defined period of time. [3] The response options are arbitrary and employ a scoring system for interpretation. [4]           This study was undertaken to examine the quality of life of patients with skin disease against those who do not have skin diseases.           By studying the impact of skin diseases on the quality of life of patients with skin diseases, the researcher hope to be able to modestly contribute to the enhancement of not only the nursing profession but also the medical profession and as well as the improvement of patient care quality to uplift their quality of life.   STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to? a. Age           b. Gender           c. Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?     SIGNIFICANCE OF THE STUDY:           Research is the best way to find solutions to nursing problems and to set standards for nursing practice. The problem that we have observed during our stints in hospitals and clinics led as to conceptualize a study that will answer our curiosity. The results of this study will therefore, benefit the following sectors; NURSES- Expertise will increase as additional knowledge will be gain when educators will formulate effective psychological and emotional counseling which will be incorporated in nursing curriculum because of the output of this study. NURSING EDUCATION- Nursing schools will be able to incorporate the results of this study into their nursing psychiatry curriculum. PATIENTS or CLIENTS- there will be increased patients care quality. This in turn, will create increased patient satisfaction and will reflect a positive view of the hospital or clinic by the community. MEDICAL EDUCATION- Medical schools will be able to incorporate results of this study into their medical psychiatry curriculum. MEDICAL PROFESSION- Dermatologist will now be more aware and sensitive about their patient emotional and psychological problem brought about by their skin condition.     SCOPE AND DELIMITATION OF THE STUDY:           This study is conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.           A primary limitation of the study is posed by the source of the sample population which is from one local clinic only.   DEFINITION OF TERMS: ·        Quality of Life- it refers to the satisfaction derived by the respondents in terms of their performance in the activities of daily living namely; shopping/ marketing, the way they dress, socializing, participation in sports activities, going to work and school and performing sexual activity and cognitive functioning. ·        Cognitive functioning- In some forms of psychometrics, particularly those related to the  Type Indicator, the cognitive functions (sometimes known as mental functions) are defined as different ways of experiencing and thinking about the             world. They are defined as "thinking", "feeling", "sensing" and "intuition". ·        Demographic profile-  refers to the gender and age of the patient                                       CHAPTER TWO THEORETICAL BACKGROUND   REVIEW OF RELATED LITERATURE AND STUDIES   RELATED LITERATURE:           Quality of Life is the degree of enjoyment or satisfaction experienced in everyday life. [5] In biblical times lepers had to live outside of society. In medieval times they had to ring a bell and call "unclean" wherever they went. Catching leprosy requires living in close contact for a long time and many labeled as lepers probably had diseases like eczema or psoriasis that are not infectious. The stigmatization of lepers was not a public health measure to control the spread but a reflection on how people view those with skin disease. Simply having skin disease is bad enough but the social response of others makes it much more difficult. [6]           As early as 1985, Quality of life has been employed as a major endpoint to evaluate and compare therapies along with clinical outcome measures such as efficacy and survival. [7] In cancer therapy, for instance, the emphasis is on the side-effect and quality of life. [8]           In dermatology where most patients are seen in the ambulatory, care setting survival is not a major end point [9] and because the therapeutic modalities here have comparable efficacies, the use of quality of life became even more important. Several well-validated dermatology-specific questionnaires have been developed, the first being 's Dermatology Life Quality Index in 1983.   RELATED STUDIES: The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa. (.; ) Skin diseases can greatly affect the quality of life (QoL). Little is known, however, of their impact on QoL in the developing world. This study was designed to assess the effect of skin diseases in such a setting. A questionnaire survey of patients using the Dermatology Life Quality Index (DLQI) modified to the cultural needs of the population. The adapted instrument was translated into Afrikaans and Xhosa. Six hundred and seven patients attending general dermatology clinics at  Hospital and 53 controls were recruited. Influences on QoL of clinical severity, employment, education, age, sex, and home language were examined. Participants included 313 (52%) English-speaking, 215 (35%) Afrikaans-speaking, and 79 (13%) Xhosa-speaking dermatology patients. Independent risk factors for having a high disability score were dermatologists' assessment of severity, younger age, unemployment, and language (odds ratio, 0.13; 95% confidence interval (CI) of 0.03–0.5 for Xhosa speakers compared to Afrikaans speakers). Gender was not associated with a high score, but females were more likely to report effects of skin disease on self-esteem, clothing choice, treatment problems, and     In this multicultural setting, social class and language group, but not gender, influenced the impact of skin disease on overall QoL. Xhosa speakers were apparently less affected than other patients. This could be due to cultural differences in the experience of skin disease and in the perception of disability, or to biases in questionnaire responses. Anxiety and depression were relevant dimensions of QoL in this study and should be considered for inclusion in future research. The adapted and translated DLQI was valid and reliable. [10] Eczema impairs quality of life in children to same extent as kidney disease. Children with serious skin conditions feel their quality of life is impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes, according to research published in the July issue of British Journal of Dermatology. A team of Scottish researchers surveyed 379 five to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents. They asked the children and their parents how much the condition impaired the child’s quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.   They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group. Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.    Key findings included: ·        The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in 31 per cent impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20 per cent impairment and acne at 18 per cent impairment. ·        From the parent’s perspective, eczema was the biggest skin problem at 33 per cent, followed by urticaria at 28 per cent, psoriasis at 27 per cent and hair loss at 19 per cent. ·        When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38%. Generalized eczema and kidney disease both scored 33%t. ·        Cystic fibrosis also made the top five (32%t), followed by urticaria and asthma (28%), psoriasis (27%), epilepsy and bed wetting (24 %), diabetes, hair loss and localized eczema (19%) and acne (16%). ·        When children with psoriasis, and their parents, were asked to chose the things that affected the child’s quality of life most, parents rated bullying third and children rated bullying fourth. ·        Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.   ·        The biggest concern for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry. “Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses” says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.           “Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying. “Some skin conditions can also disturb children’s sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older. “Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives.” According to co-author Dr , Consultant Dermatologist at Ninewells Hospital, Dundee and British Skin Foundation spokesperson: Measuring quality of life can be a powerful political tool as it provides the patient’s perspective on the health impact of different diseases. “This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people’s lives as other illnesses. “Our study clearly shows the profound effect skin diseases can have on children’s quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them.”  of the British Skin Foundation agrees: “All too often, people think of skin diseases like eczema as nothing more than a mere annoyance. Sadly, this simply is not the case. “We frequently hear of children who cry all night because of their itchy, flaky skin. This in turn leads to a lack of sleep and extreme emotional upset for their parents too. “The psychological impact of visible skin diseases can be massive, with children facing bullying because of the way their skin looks. We even hear of children not wanting to swim or take part in sports because they don’t want to have to reveal their skin in the changing rooms. Of course, this can lead to enormous stress for the patient’s family also. “This is why as a charity we are dedicated to raising money for research to end the diseases that blight millions of people’s lives in the UK.” [11]   THEORETICAL & CONCEPTUAL FRAMEWORK: We theorize that skin diseases affect patients' well-being and their ability to perform activities of daily living just like any other medical problem in the local setting. The concept of quality of life was developed to interpret data obtained about the impact of disease on the patient's well being. This was fostered by the World Health Organization (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. We conceptualize that quality of life can be measured by asking patients to answer a questionnaire which measures the effect of skin disease and its treatment on a patient symptoms, feelings and daily activities over a specified time.           The theoretical framework guiding this research is the concept that skin disease has an adverse impact on the quality of life of the patient.   HYPOTHESIS:           The null hypothesis that was used to guide this study was: 1.     There is no difference in the quality of life of patients with skin diseases when respondents are grouped according to their demographic profile. 2.     There is no difference in the level of the quality of life of patients with skin diseases and those without skin diseases               CHAPTER THREE METHODOLOGY RESEARCH DESIGN:           This non-experimental study uses the prospective quality of life survey and analysis.   LOCALE OF THE STUDY:             The setting of the study was at the Lucena Skin Center. A Dermatology Clinic manned by a Fellow of the Phil. Dermatological Society and a Fellow of the Phil. Leprosy Society. The clinic is situated in Lucena City.   RESPONDENT AND SAMPLING PROCEDURE:           Respondents were consecutive patients, age 15 and above, whether old or new, consulting for any skin diseases were included in the study. The patients companions whose ages were also 15 and above served as the control (those who do not have skin diseases) subjects. Both the inclusion and exclusion criteria for patient's selection were adopted from the source. As in the original, the criteria for the selection of the controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem or other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   RESEARCH INSTRUMENT:           We reviewed 3 different well validated dermatology-specific quality of life tools for possible translation. Both developed in the U.S, the Dermatology Specific Quality of Life (DS8QL) [12] had 52 items for acne and contact dermatitis cohorts while the revised SKINDEX [13] had 29 item tests for patients with any skin disease. The revised Skindex Categorized domain/scale into emotion, symptom, and functioning, and had 5 responses choices. Dermatology Life Quality Index [14] [15] [16] (DLQI), a tool developed in UK, was similar to Skindex in terms of generic coverage, domains, and responses choices but consisted only of 10 items which fit on a single sheet of paper, and was those chose for translation. Quality of Life research measures the effect of a disease and its treatment on a patient's symptoms, feelings and daily activities over a specified time. The Dermatology Life Quality Index (DLQI) questionnaire is a non-skin disease specific Quality of Life tool developed by Dr. Finlay. It consist of 10 questions and can be analyzed under the following headings: Symptoms and feelings (items 1 and 2), daily activities (items 3 and 4), leisure (items 5 and 6), work and school (item 7), personal relationships (item 8 and 9), and treatment (item 10). It is calculated by summing the score of each question (scored from 0 to 3) resulting in a maximum of 30 for the 10 items and a minimum of 0. The higher the score, the more quality of life is impaired.   TRANSLATION:           The original questionnaire was sent to 4 independent bilingual (English and Filipino) translators and their output were later "translated-back" by a bilingual lay panel consisting of 2 persons. The first item refers to the Symptoms (itchiness, pain, discomforts) while the second item on "hiya", which loosely translates in English as "embarrassments". Item 3 evaluates the effect on shopping or household chores while item 4 in the way of dressing. The fifth item is on social and leisure and the sixth item on sports and exercise. Items 7, 8, 9 and 10 concerns on work, school, relationships, Sexual difficulty, and treatment respectively. The following modifications were noted: (1) the tool was renamed IKPAS (Indeks ng Kalidad ng Pamumuhay ng may sakit sa balat), (2) the general patient data was omitted on the questionnaire except age, sex, and diagnosis to save on space, (3) a confidentiality clause was inserted on the introductory statement and includes the aim of the study. (4) 2 Filipino words ("Gaano" and "Paano") were used to encompass "How much" in the original, (5) and although the attempt was to do a literal translation without any loss of the concept, for item on household chores of house keeping, buying at the market ("Pamamalengke") was included; for item on leisure activities, watching movie ("Panunuod ng Sine") was given as an example; For the item on sports, the word "Ehersisyo" (Exercise) was incuded; "Sex" was used in the context of sexual difficulties in the original; and on the item relationship, "Asawa" (Spouse) was used for "Partner". Response choices scales were structured similar to the original and used the same scoring system: "Sobra-sobra" (score=3), "Sobra" (score=2), "Medyo/Oo" (score=1), "Wala/Hindi" (score=0), "Walang kinalaman" (score=0), and no answer (score=0). A higher score (total=30) indicated a lower unfavorable quality of life.   DATA COLLECTION:           The researchers collected the data from Lucena Skin Centers Clinic. Both the inclusion and exclusion criteria for patient selection were adopted from the source. Consecutive patients, age 15 and above, whether old or new, consulting for any skin disease were included in the study. The patients' companions whose ages were also 15 and above served as control subjects. The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem on other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.           The time needed to complete the questionnaire ranged from 1 to 36 minutes with the mean at 5.23 minutes. However, it is significant to note that 205 respondents (78%) took less than 5 minutes and another 39 (15%) took between 5 and 10 minutes to answer the questionnaire. This leaves only 19 (7%) who took more than 10 minutes to answer the questionnaire.   DATA PROCESSING AND ANALYSIS           Consecutive patients who passed the entire inclusion and exclusion criterion were politely asked to answer the IKPAS (translated questionnaire) after giving their permission.           When all the data were at hand, we computed the reliability of our translated questionnaire using the 's alpha Coefficient and then we analyze our findings on the effect of the skin disease on the quality of life of patients with skin disease and compare the findings with those without skin diseases. There was a significant difference between scores of the patients (6.89, SD: 4.55) and controls (0.89, SD: 1.8) (p=0.000), demonstrating construct validity.   RELIABILITY TEST TOOL:           When analyzing the reliability of your instrument, the best is to retest the subjects using the same instrument to see if the subjects are consistent with their answer. But researchers have devised a formula to compute the reliability of a survey instrument. The reliability test is called 's alpha coefficient. Its formula is:

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the eff...

ASPIRIN AND SALICYLATE POISONING

ASPIRIN AND SALICYLATE POISONING   OBJECTIVE 1: OUTLINE THE PHARMACOKINETICS OF ASPIRIN   ANSWER:               Pharmacokinetics in general describes the way that the body reacts to introduction of drugs, from absorption, to metabolism, to elimination from the body. It is a branch of pharmacology, the science of drugs. Although this concept is usually applied in external substances taken in by the body , pharmacokinetics also covers any chemical compound naturally existing in the body (hormones and secretions). Pharmacokinetics includes a description of how the substance entered the body, which for medicines, is the process of administering the drugs.  There are several possible routes of entry, including intravenous (dextrose), oral (pills, capsule, syrup etc.), rectal (suppository), inhalational, etc. Pharmacokinetics also considers the metabolism of the substance in question. Metabolism refers to the process by which the substance is broken down into different component/s inside the body. The excretion of the substance is a process also shown by pharmacokinetics.   In 1899, Aspirin was introduced into the field of medicine in light of its numerous beneficial effects: it relieves pain, prevents inflammation, reduces fever, and helps minimize blocked artery. The usual way of ingesting aspirin is orally and is available as film-coated tablets, extended release tablets, or as a chewable tablet ( 2000). For children, aspirin may be administered as a suppository since they might find it difficult or uncomfortable to swallow aspirin pills. Upon reaching the gastrointestinal tract, it is generally absorbed fast and easily, although the PH level of gastric juice affects the speed of absorption. The dosage and intragastric concentration are also absorption rate factors.   In the initial pass, aspirin is hydrolyzed to salicylic acid in the liver. About 99 % of the ingested Aspirin is metabolized to Salicylate and other by-products. This is distributed to most tissues of the body. Aspirin have low plasma concentration, it doesn’t usually reach a plasma concentration level higher than 20 µg/ml if normal dosage was administered, and this may be attributed to the rapid hydrolysis ( 2005). This low range of bonding with plasma helps to achieve anti-inflammation feature of the drug and to keep the adverse effects to the minimum (1978).  Salicylate starts to form in serum at about 5 to 30 minutes after oral administration. The Salicylate level reach its highest in a period of 2 hours in the case of uncoated aspirin, while for the extended release tablets (such as enteric-coated aspirin), it may take longer.    An important term that has a direct bearing on elimination from the body is biological “half-life”.  In biology, half-life refers to the time it takes for the amount of a substance taken in by a living organism to decrease by 50 % by means of the organism’s metabolism and other biological process. If ingested in low dosage, the half-life of Salicylate is maintained at 2 to 3 hours, but at higher doses, saturation of the enzymes utilized in metabolism occurs and the half-life stretches to about 15 to 30 hours ( 2000). How are Salicylate and other components eliminated? The hydrolyzed salicylic acid joins with glycine and glucuronic acid, resulting in new byproducts: salicyluric acid and salicyl phenolic glucuronide, which facilitates excretion of Aspirin components through the urinary tract. The exact salicylate components in urine are summarized as follows: free salicylic acid -10%, salicyluric acid - 75%, salicylic phenolic - 10%, acyl - 5%,  glucuronides and gentisic acid – less than 1% ( 2005).   OBJECTIVE 2: DISCUSS THE PATHOPHYSIOLOGY OF SALICYLATE POISONING   ANSWER:   Pathophysiology involves the changes in the normal functions and processes inside a body as a result of a disease or poisoning. The changes mentioned may include disturbance of the regular physical and biochemical processes of the body. In the case of poisoning, pathophysiology can be viewed as a reverse description of pharmacokinetics. The latter shows what the body does to a substance that gets in the body, the former describes what the substance does to the body.               The term “symptom” has a relation to pathophysiology since the former also refers to the detectable changes as direct results of a disease. Generally, the first symptoms exhibited by person suffering from Salicylate poisoning include nausea, vertigo, vomiting, fever, tinnitus, loss of hearing, agitation, and hyperventilation (1989). Salicylate toxicity affects numerous organ systems such as pulmonary, cardiovascular, hepatic, renal and metabolic system by means of opposing Krebs cycle enzymes, restricting amino acid synthesis, and uncoupling oxidative phosphorylation ( 2004). Krebs cycle and phosporylation are body processes involved in breaking down glucose. The fever is a result of the uncoupling of oxidative phosporylation ( 1985). Let us discuss the effects in specific system and organs.               According to  (2004), Salicylate is considered a neurotoxin in large amount, and thus it attacks the Central Nervous System (CNS). In the said symptoms, tinnitus, loss of hearing, disorientation, and agitation are the manifestation of CNS problems. Hyperthermia (or simply fever) and comatose condition can also be expected as the central nervous system become susceptible to the toxicity (1998). Encephalopathy or syndromes that affect the brain causing confusion, lethargy, and seizures can also be attributed to salicylate intoxication ( 1991).  In severe cases, fluid may accumulate in the brain causing swelling of the brain, also called cerebral edema (1985).    The respiratory system also gets stimulated by Salicylates in a variety of ways, and these respiratory problems are collectively known as ARDS or Acute Respiratory Distress Syndrome (1998). Hyperventilation, which causes the person affected to draw sharp quick breaths, are well associated with Salicylate poisoning. Another term used by doctors to describe the rapid breathing is hyperpnea. The rapid breathing cause increased gas exchange in the lungs leading to respiratory alkalosis, a condition where the blood or other body fluid gains high alkalinity. Therefore, respiratory alkalosis is a tell-tale sign of salicylate intoxication. The poisoned person could also acquire fluid accumulation in the lungs and difficulty of breathing. These characterize salicylate-induced pulmonary edema or SIPE (1998).     We can also expect Salicylate poisoning to cause disturbance in the gastric area because primarily, that is where the salicylates accumulate. Pylorospasm occurs after serum level goes high enough, making the patient vomit. Dehydration can be brought about by excessive vomiting. The patient may also suffer from reduction in motility (spontaneous movement) of the gastro-intestinal tract. Problems in the blood and circulation can also be encountered. Examples of this are hemorrhagic or bleeding problems and hemolysis or rapid destruction of red blood cells in the bloodstream (1986). The permeability of the capillary to protein can also be disrupted, thus high protein concentrations can be seen on the fluid in the lungs and in the urine ( 1989). There is also the possibility of bleeding in upper gastro-intestinal area (1998). The bleeding problems are related to the hemostatic defects. The hemostatic defect, as well as renal failure, was reportedly present in salicylate poisoning cases (1988). Renal failure occurs when the kidney is unable to excrete waste materials and maintain the balance of chemical composition in the body. The problem might arise from a defect in a kidney tubule.   Overall, the pathophysiology of Salicylate poisoning features several organ/system failures, and thus, experts observed that it shows a pseudo-sepsis syndrome. It is easy to mistake salicylate poisoning as a case of sepsis because of the similarity between the evident body reactions of the two. Specifically, the common points between the two are: fever, low failure of the lungs, failure of the kidney, shock, and death (1991).   OBJECTIVE 3: EXPLAIN THE CLINICAL INFORMATION AND LABORATORY INVESTIGATION OF THE PATIENT IN THE CASE STUDY   ANSWER:               Mr.  was exhibiting the normal symptoms of Aspirin overdose toxicity. The buzzing in the ears (tinnitus) is one of the early manifestations of the poisoning ( 1989). The lethargy was a result of the deteriorating condition of the central nervous system ( 1984). The pain in the epigastric region (the upper portion of the abdominal area) was probably a result of reduced gastro-intestinal tract motility and the pylorospasm. The rapid heartbeat in relation to rapid breathing was expected due to several possible factors: 1. salicylate poisoning stimulates the respiratory center of the brain , 2. The oxidative phosporylation results in greater oxygen usage and thus greater demand for oxygen. The respiration problems and the fever are common complication of salicylate poisoning (  1988). Let us discuss each laboratory investigation result one by one.               It is important that immediate test for Salicylate level be done as early as possible by means of the fluorescence polarization technique or spectrophotometrically (1991). Mr.  plasma salicylate level is much higher as compared to the normal level of 150-300 mgl-1. That alone indicates that salicylate poisoning is the problem. Aside from that, another standard test procedure is to measure the partial pressure of Carbon Dioxide in the blood. The pressure is signified by the term PCO2. His PCO2 reading indicates a level lower than normal. The normal level is about 5.3 kPa. The reduction of Carbon Dioxide in the blood stream was a result of the rapid breathing and the increase in gas exchange. The low level of Mr. arterial PH reading was a result of respiratory alkalosis. It was also shown by studies that excessive salicylate displaces plasma bicarbonate and lower serum potassium concentration ( 2004). The results of measurement in plasma bicarbonate, plasma potassium and plasma sodium are therefore conclusive about Mr.  Salicylate poisoning.

ASPIRIN AND SALICYLATE POISONING

ASPIRIN AND SALICYLATE POISONING OBJECTIVE 1 : OUTLINE THE PHARMACOKINETICS OF ASPIRIN ANSWER: Pharmacokinetics ...