Objectives To have a group presentation regarding the promotion of AIDS awareness To discuss the different types of autoimmune deficiencies
AUTOIMMUNE DEFICIENCIES Are conditions wherein antibodies are formed against endogenous antigens that result in tissue injury
RHEUMATOID ARTHRITIS Its autoimmune reaction occurs in the synovial joint. Greater incidence in women Phagocytosis produces enzymes that break down collagen causing edema, proliferation of the synovial membrane and pannus formation which destroys cartilage and degrades the bone. Sx: joint pain, swelling, warmth, erythema, lack of function, deformities Classic sign: joint stiffness in the morning
Diagnosis: positive rheumatoid factor, elevated ESR, he rate at which red blood cells precipitate in a period of 1 hour, a non-specific measure of inflammation Mgt: Early stage: rest and exercise, analgesics Moderate/erosive: physical therapy,cyclosporine Persistent: surgery, corticosteroids Surgery includes: Synovectomy Tenorrhaphy Arthrodesis Arthroplasty Advanced/unremitting: immunosuppressive agents
Systemic Lupus Erythematosus 10 times more frequent in women, 3 times more frequent in African-americans It is a result of disturbed immune regulation that causes an exaggerated production of autoantibodies which is brought about by a combination of genetic, hormonal, environmental and drug-related causes. Sx: Affetcts different body systems MS: arthralgia and arthritis, joint swelling Skin: discoid SLE-erythematous papules and scaling, butterfly rash in scalp,face and neck Lesions worsen (excacerbate) upon exposure to sunlight/UV light
Hashimoto’s thyroiditis Or chronic thyroiditis, occurs in women more frequently and in between 30-5- years of age an autoimmune disease in which the thyroid gland is gradually destroyed by a variety of cell and antibody mediated immune processes, was first described by Dr. Hakaru Hashimoto, in 1912. Blood drawn from patients with Hashimoto's throiditis reveals an increased number of antibodies to the enzyme, thyroid peroxidase an enzyme found within the thyroid gland. As result of the antibodies' interaction with the enzyme, inflammation develops in the thyroid gland, the thyroid gland is destroyed, and the patient ultimately is rendered hypothyroid
Sx: weight gain, depression, mania, sensitivity to cold, fatigue, panic attacks, bradycardia, tachycardia, high cholesterol, reactive hypoglycemia, constipation, migraines, muscle weakness, cramps, memory loss, infertility and hair loss. Dx: T3 and T4, anti-thyroid peroxidase antibodies to aid in the diagnosis. Mgt: thyroid hormone therapy, surgery
MULTIPLE MYELOMA A malignancy involving plasma cells in bone marrow. Exact etiology is unknown .Abnormal plasma cells proliferate in the bone marrow where they release osteoclast activating factor causing a breakdown of bone cells and increasing blood calcium levels and risk for pathologic fractures. The cells release two types of proteins, one of them, the Bence-jones proteins impair renal tubules and result to renal failure.The other, M-type protein compromises the production of immunoglobulins .
Sx: bone pain, relieved by rest, pathologic fractures, fatigue, weakness, renal calculi Diagnosis:X-ray, high calcium levels, low blood cell counts, positive bence-jones protein in the urine Mgt: Steroids and anti-cancer drugs, radiation, analgesics, bone marrow transplants
IMMUNIZING AGENTS Vaccine- suspension of live or dead organism Toxoid-bacterial toxin that has been rendered non toxic Immune globulin-sterile solution containing antibodies from human blood Antitoxin- solution of antibodies derived from serum of animals immunized from specific antigens
In live attenuated vaccines, the organism in the vaccine is alive but unable to infect a person with a normal immune system. Patients with impaired immunity-such as those with immune deficiencies, on chemotherapy for cancer, or with AIDS-and pregnant women must not be given live vaccines. Examples of live attenuated vaccines are measles, mumps, rubella, and oral polio.
Inactivated or killed vaccines contain dead, but intact, organisms, so the immune system can still recognize them. Most vaccines are inactivated.
Pneumonia Is an inflammatory process of lung parenchyma with many causes including aspiration of food and fluid, inhalation of toxic chemicals and gases S.pneumonia,S. aureus, H. influenza, P. aeruginosa are some of the common pathogens pathogens Risk factors: smoking, air pollution, URTI, prolonged immobility, immunocompromised, aspiration, chronic disease
Pneumonia according to location: Bronchopneumonia- involves terminal bronchioles and alveoli Segmental-one or more segents of a lobe Lobar- one or more lobes of lung Bilateral- lobes or segments of both lungs Mgt: Promote airway patency, breathing exercises Increase fluid intake antibiotics
DIPHTHERIA Is severe localized throat infection caused by corynebacterium diphtheria or the Klebs-Loeffler bacillus It is common in temperate climates, and in overcrowded populations Mode of transmission: droplet infection Sx: Classic sign: psudomembrane covering the posterior pharynx Others: headache, sore throat, fever
Diagnosis: swabbing and culture Mgt: Antibiotics and antitoxin Maintain patent airway Analgesics and antipyretics Keep emergency tracheostomy set available at bedside
TUBERCULOSIS One of the leading causes of death worldwide According to the World Health Organization, the Philippines ranks fourth in the world for the number of cases of tuberculosis and has the highest number of cases per head in Southeast Asia. Almost two thirds of Filipinos have tuberculosis, and up to five million people are infected yearly in our country. (DOH, NTP)
Pulmonary TB is suspected if a person has symptoms of cough for more than 2 weeks, fever, chest and back pains, poor appetite, loss of weight and hemoptysis. He should seek medical consultation and his sputum should be examined to detect the presence of Mycobacterium tuberculosis. Mode of transmission: droplet infection Diagnosis: mantoux test, sputum exam, chest x-ray
Mantoux Test: Or tuberculin test, or purified protein derivative Given intradermally, when the skin reacts to it, it means that the person has been infected with tuberculosis Prevention: Cover nose and mouth when coughing, sneezing or laughing BCG, bacillus calmette-guerin
Extrapulmonary TB also exists. Infections are characterized by the formation of gray, translucent tubercles / granulomas which gradually become necrotic, liquefies and coughed out as sputum and the nodule becomes an air filled cavity. Primary infection First the person gets infected Gohn tubercle/Gohn complex may be formed Secondary/Reinfection
Sx: Fatigue, anorexia, weight loss, low grade fever, chills and night sweats, dyspnea, hemoptysis, chest pain
Tuberculosis is a curable disease. Patients are prescribed with appropriate regimen to render them non-infectious and cured, as early as possible. The treatment for TB is a combination of 3-4 anti-TB drugs. NEVER should we prescribe a SINGLE DRUG for TB treatment! This will worsen the patient’s condition.
DISORDERS AFFECTING THE GASTROINTESTINAL SYSTEM
CHOLERA Caused by organism Vibrio cholera Transmitted by contaminated food and water It is characterized by copious diarrhea, ”rice watery stool” up to 1 liter per hour which may result to dehydration and cardiopulmonary collapse. Prevention: Drink only safe and clean water. If unsure, boil drinking water (Upon reaching boiling point, extend boiling for two or more minutes), or Do water chlorination.
Keep food away from insects and rats by covering it. Wash and cook food properly. Sanitary disposal of human waste. Use toilet properly and clean toilet everyday. Management: Replace lost body fluid by giving Oral Rehydration Solution (ORESOL) or a homemade solution composed of 1 teaspoon of salt, 4 teaspoons of sugar mix to 1liter of water.
TYPHOID FEVER Caused by organism Salmonella typhi Mode of transmission: ingestion of contaminated food Sustained high fever headache malaise (weakness) anorexia (loss of appetite) diarrhea or constipation and abdominal discomfort
Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test, demonstration of salmonella antibodies against antigens O-somatic and H-flagellar Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin