BIOL122 Subject Questions and Answers
Question 1 for Depression.
The condition/disease identified in the case is depression and early onset of Alzheimer's disease.
Pathophysiology of both disease
Major depression is a serious disorder of enormous sociological and medical relevance, an impairment in central monoaminergic function was the key-wound core to the disorder. Both medical and social logical factors can be the reason for the disease that can influence genetic.
Intracellular neurofibrillary tangles and extracellular amyloidal protein stores as the decrepit plaques depict it pathologically. Accumulations of A? are amyloid plaques in the cerebrum parenchyma and in the cerebral veins where it is referred to as congophilic angiopathy otherwise called cerebral amyloid antipathy. NFTs shaped the matched helical fibers with hyperphosphorylated tau proteins. These NFTs described by the neuronal and synaptic misfortune and some specific particular injuries. Different medicines are accessible for the illness which incorporate acetylcholinesterase inhibitors (rivastigmine, galantamine, donepezil) and N-methyl D-aspartate receptor enemy (memantine).1 Traditionally, Alzheimer's malady considered as clutters in which escalating loss of neurons and neurotransmitters continues in particular anatomical loci, bringing about various phenotypes.
Sign and symptoms of depression
Mary –Lou lost her husband over a year ago due to cancer that might be prime reason for her suffering from depression, and her friend noticed she is very teary and has very low self-esteem, and lost interest in thing she is used to love, disturbed sleep take wine every night to sleep. That’s the only thing that help her relax and make her happy. Though the amount of wine taken Mary is increased as she now take 2-3 glass at night, and started drinking during a day. As we know that general symptoms of depression comprise lost in interest, sleep problems, anxiety, irritation, appetite changes, alcohol abuse, etc. these symptoms were found in Mary-Lou case.
Sign and symptoms of Alzheimer disease
Short term memory loss, facing challenges in solving problem, confusion, Mary-Lou forgetting things where they are kept and disorientation.
Fluoxetine/Prozac is antidepressant
effect by preventing serotonin re-uptake in the synapse by requisite to the re-uptake pump on the neuronal membrane to increase its accessibility and improve neurotransmission. Modifying the amount of serotonin helps brain cells transfer messages to each other, and this result in better and more stable mood. It also marks the region dentate gyrus in which more neurons being present in a region of the brain, part of the hippocampal formation. The hippocampus plays a role in forming memories. It is effective medicine to treat depression in adults.
As Mary-Lou was diagnosed with early onset of Alzheimer disease, prescribed cholinesterase inhibitors. Most employments of cholinesterase inhibitors depend on a typical instrument of activity started by hindrance of acetylcholinesterase (AChE). Broad hindrance of this protein prompts amassing of the synapse acetylcholine and upgraded incitement of postsynaptic cholinergic receptors. The cholinesterase inhibitors is suitable medication for people suffering from Alzheimer as it aim to increase communication between the nerve cells and to try to improve common symptoms of the Alzheimer disease. As alcohol can worse the Mary-Lou condition the doctor prescribed diazepam for alcohol withdrawal, the diazepam Diazepam is a benzodiazepine that applies anxiolytic, narcotic, musclerelaxant, anticonvulsant and amnestic impacts. The vast majority of these impacts are thought to result from an assistance of the activity of gamma aminobutyric corrosive (GABA), an inhibitory synapse in the focal sensory system. This medication help in withdrawing alcohol abuse.
Fluoxetine has non-linear Pharmacokinetic profile, and observed well after oral intake and has large volume of distribution, along these lines, the medication ought to be utilized with alert in patients with a decreased metabolic ability (for example hepatic brokenness). Interestingly with its impact on the pharmacokinetics of different antidepressants, age doesn't influence fluoxetine pharmacokinetics. This finding along with the better mediocrity profile of fluoxetine (contrasted and tricyclic antidepressants) makes this medication especially appropriate for use in old patients with sadness. Moreover, the pharmacokinetics of fluoxetine are not influenced by either corpulence or renal disability. Based on aftereffects of plasma focus clinical reaction relationship considers, there has all the earmarks of being a restorative window for fluoxetine. Centralizations of fluoxetine in addition to nor fluoxetine over 500 micrograms/L have all the earmarks of being related with a more unfortunate clinical reaction than lower fixations. Fluoxetine communicates with some different medications. Attendant organization of fluoxetine expanded the blood convergences of antipsychotics or antidepressants. Cholinesterase inhibitors are also has non-linear pharmacokinetics. Specific consideration needed to be is to ensure that patient aware of side effect of both drugs to avoid the any consequences. As the cholinesterase drug interaction with fluoxetine are not an excellent choices because of drug-drug interaction that can result from CYP 2C9 inhibition and responsible for reducing metabolism that are prescribed parallel, though doctor can replace the medicine with citalopram or venlafaxine as it has less CYP inhibition. As through warfarin or other drugs, fluoxetine hinder CYP 2C9 that might be point of consideration. Administrating common side effects such as dry mouth, urinary retention, blurry vision, etc. doctor can prescribe the time of medication need to be taken to avoid the side effects or simply prescribe other antidepressant such as citalopram for more suitable drug-drug interaction.
Mary –Lou lost her husband over a year ago due to cancer that might be prime reason for her suffering from depression, and her friend noticed she is very teary and has very low self-esteem, and lost interest in thing she is used to love, disturbed sleep take wine every night to sleep. That’s the only thing that help her relax and make her happy. Though the amount of wine taken Mary is increased as she now take 2-3 glass at night, and started drinking during a day. This might get worse if not treated. The physical and psychological sign and symptoms of the alcohol addiction are memory impairment, diverting engage from work and family, social isolation, etc. In Mary-Lou case she started avoiding her friends, stop doing things that she love such as gardening. Thus, these sign and symptoms indicates that Mary-Lou was at risk of alcohol addiction.
A femoral neck fracture can tear the veins and remove the blood flexibly to the femoral head. In the event that the blood flexibly to the femoral head is lost, the bone tissue will pass on (a procedure called avascular rot), prompting the possible breakdown of the bone. This led to crepitus which is condition in which air bubbles forming in the joint gap are the most mutual reason of popping noises. This noise arises at joints where there is a layer of fluid unravelling the two bones. Joints can be enforced separately by natural daily movements or intentionally such as at the hands of an osteopath. When this occurs, the low burden in the joint space roots gases inside the synovial fluid that is common lubricant in the joint to form a gas cavity, which includes oxygen, carbon dioxide, and nitrogen. This is due to neck injury and its sign and symptoms include paint in inflammation and difficulty in movement. The condition is caused by broken of femur neck.
The aetiology of this joint disease is different from other joint disease is because this joint disease can be caused by femur neck fracture or hip fracture. In the given case study Mary-Lou joint pain was caused by fracture in femur that occur due to weak bones, generally elder people suffer from this condition to weak bones, recovery rate is also slow, the fracture occur below the hip joint that disconnect the thing bone from the ball, surgery is most common treatment for the fracture and its treatment /surgery depend on severity of fracture and person age. However, other fracture, for instance, distal femur fracture comprise broken thigh bone above the knee joint where the bone stick out, this fracture can cause by injury in young people, however older people can suffer from this due to weak bone, non-surgical treatment is possible in this condition such as skeletal traction and bracing and casting to hold bones is supportive in treatment of the fracture, because of new technologies the surgical treatment can be also effective in elder patients. Femoral neck fracture repaired through arthroplasty and internal fixation, on other hand other joint disease through only internal fixation or through medication only.
The reason why Mary-Lou fracture may take longer than someone who is half of her age is for the reason that Specific cells got osteoclasts ingest destroyed bone cells, expelling them continually from the bone. All the while, different cells called osteoblasts take calcium from the blood and redistribute it upon the bone. ... This 'losing pattern' of bone expulsion and substitution clarifies why it takes elder people longer to heal. Basically, Aging affects the inflammatory response in the course of fracture healing through senescence of the immune response and increased systemic pro-inflammatory status. Significant cells of the inflammatory reaction, T cells, macrophages, mesenchymal stem cells, have established essential age-related alterations that could influence fracture healing. Also, angiogenesis and vascularization are decreased in fracture healing of the elder people. The two complication of hip fracture are blood clots in legs or lungs, Urine infection, etc.
The T score indicates the Osteoporosis and the pathogenesis of osteoporosis as a complex disorder is the result of genetic, hormonal, dietary, way of life and physical components. Grown-up bone is the aftereffect of the pinnacle bone mass, procured right off the bat throughout everyday life, and the support of bone thickness and skeletal structure in grown-up age. Hindrance of bone collection during skeletal development as well as unevenness of components preferring bone resorption versus bone arrangement in grown-up bone might be liable for skeletal delicacy. Hereditary qualities impact fundamentally bone accumulation and the pinnacle bone mass, while foundational hormones (chiefly parathyroid hormone [PTH] overabundance and withdrawal of estrogens) or neighbourhood cytokines are for the most part liable for bone remodelling imbalance. The administration of bisphosphonate is vital in osteoporosis as it avoid bone breaking and increase bone strength, bisphosphonates have been proven to avoid fractures in patients with developed osteoporosis or in those who are at high risk of fracture. In given condition, administrating the bisphosphonate in femur fracture complication are very low.
The two triggers of in Hilda condition are cold environment and stress that triggered her condition. As body's response to stress triggers the immune system and result in the release of certain hormones. This can lead to inflammation within the airways of the lungs, triggering an asthma attack. Living with asthma may also cause stress and anxiety. Thus, we can say they are interrelated. Symptoms of asthma due to stress include coughing, wheezing difficulty in breathing. Also dry airways become swollen and irritated which worsens asthma symptoms. Cold air also causes person airways to produce a substance called histamine, which is the same chemical body creates during an allergy attack. Histamine triggers wheezing and other asthma symptoms.
The difficulty in breathing and lip turning blue are the sign and symptoms of Hilda disease. Asthma includes numerous pathophysiologic factors, incorporating bronchiolar aggravation with aviation route narrowing and opposition that shows as episodes of hacking, brevity of breath, and wheezing. Asthma can influence the trachea, bronchi, and bronchioles. Aggravation can exist despite the fact that undeniable signs and side effects of asthma may not generally happen. Bronchospasms, edema, extreme bodily fluid, and epithelial and muscle harm can prompt bronchoconstriction with bronchospasm. Characterized as sharp constrictions of bronchial smooth muscle, bronchospasm makes the aviation routes slender; edema from microvascular spillage adds to aviation route narrowing. Aviation route vessels may widen and release, expanding emissions, which thus causes edema and weakens bodily fluid freedom. Asthma likewise may prompt an increment in bodily fluid discharging cells with extension of bodily fluid emitting organs. Expanded bodily fluid emission can cause thick bodily fluid fittings that obstruct the aviation route. Injury to the epithelium may cause epithelial stripping, which may bring about outrageous aviation route hindrance. Loss of the epithelium's boundary work permits allergens to infiltrate, making the aviation routes become hyper responsive—a significant component of asthma. The level of hyper responsiveness relies to a great extent upon the degree of irritation and the person's immunologic reaction.
Corticosteroid is anti-inflammatory drugs work by reducing inflammation, mucus production in the airway and swelling, of a person with asthma. As a result, the airways became less inflamed and less likely to react to asthma triggers, permitting individuals with symptoms of asthma to have better control over their condition. Quality intervened impacts of corticosteroids are started by receptor-restricting which causes a course impact modifying DNA interpretation, RNA, mRNA and proteins or catalysts representing drug impacts. Models for such conduct have been created in creatures for hepatic tyrosine aminotransferase catalyst action.
The two measure that can minimise the chances of Hilda contracting coronavirus are-
Personal protective equipment use by the professionals, as we know that coronavirus can spread through coming in contact with person who is infected, therefore it is important to use personal protective equipment such as mask, gloves, and frequent sanitization is vital to avoid risk of spreading the risk of disease. Also having separate ward for patient suffering from COVID-19 is minimise the risk of spreading of virus to other patients. As we know that in hospital there are chances of virus to spread from person to person both inside and outside the hospital and in order to stop the spread of infection it is vital that patient and their family and friends also take significant precaution by using the personal protective equipment and sanitization, by ensuring that only one to two family member present/visit patient to avoid spreading of the infection, keeping hand clean, avoid touching object in the hospital, health professionals and other hospital staff need to ensure that hospital hygiene and sanitization is up to mark to avoid contamination of the COVID-19, safe injection practice such as not using the syringe on more than one patient, safe disposal of tool/stuff used, appropriate handling of linen and safe waste management. Also it is vital for health care professional to educate patients who are admitted to the hospital for different conditions other than COVID-19 about the common symptoms so that patient can monitor the symptoms and thus, further contamination can be avoid immediately. Thus, applying basic principles of hygiene helped in avowing the transmission of the COVID-19, Hilda contracting coronavirus is minimum.