Osteomyelitis Etiology Pathogenesis Differential Diagnosis And Treatment Biology Essay

Osteomyelitis Etiology Pathogenesis Differential Diagnosis And Treatment Biology Essay Osteomyelitis presents as an infection of the bone that is caused by different forms of bacteria. The infection of the cortical and medullary bone can often lead to distinct forms of necrosis, formation of new bone, and obliteration of the bone in its entirety. (3) It is a disease that can cause morbidity. Cases are usually based on a causative agent, the infections duration, the anatomy of the infected bone, and the path the organisms follow in order to gain passage into the bone. (4)With the increasing cases of osteomyelitis being linked to diabetes, peripheral vascular disease, and the aging population, this disease is becoming more difficult to treat and cure. (1,2,3,4,5,6) Over the past few decades, osteomyelitis has changed its form. Evolving into a disease with many backgrounds, this disease takes heed amongst many polymicrobials. In the past, osteomyelitis cases involved a link to strains of Staphylococcus Aureus. Although Staphylococcus Aureus, also known as S. Aureus, a bacterium, is still the most common organism involved in this disease, a number of infections have been caused by gram negative organisms. These cases would find treatment in surgical debridement and therapy for 4 to 6 weeks of methicillin.(1) Some organisms include mycobacterium, Pseudomonas Aeruginosa, which is found in drug addicts, and organisms that are active in the Gastrointestinal Tract of the elderly. Coagulase-negative staphylococci are pathogens whom also play a distinct role in the presentation of osteomyelitis. (1,4) Pathogenesis   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Osteomyelitis is caused by microorganisms entering the bone by various mechanisms. These mechanisms include inoculation by distant substances, direct transmission from neighboring soft tissue infection, and hematogenous dissemination via bacteriemia. (3) Ischemia, trauma, and foreign substances can expose vulnerable sites to which bacteria penetrates defenses set by the host. Enzymes are released by a number of phagocytes that attempt to hold the infection. Bacteria can connect tightly to damaged bone. Through interaction with the damaged bone, bacteria withdraws from the host defenses and enters inside the osteoblasts. Furthermore, the infection can lead to sensitive neutrophils, congested blood vessels, and microorganisms which is the basis for acute osteomyelitis.(2) Acute osteomyelitis is an infection that may develop over a short span of time. In children, this osteomyelitis may present as fever, chills, and even pain. The feature that is known to disting uish chronic osteomyelitis is the depletion of living osteocytes also known as necrotic bone.(3) This can occur when osteomyelitis is not properly treated, thus the chronic type of infection may occur.(1) Moreover, two classification systems exist in the Waldvogel and Cierny-Mader Classification in regards to osteomyelitis.   Waldvogel classifies adult osteomyelitis by chronicity and its pathogenesis. These categories of osteomyelitis are labeled hematogenous osteomyelitis, osteomyelitis secondary to a contiguous focus of infection, and chronic osteomyelitis. Acute Hematogenous Osteomyelitis involves a single bone, usually the tibia or femur, and is where bacteria resides in the metaphysis of growing bones. Hematogenous infection in adults is uncommon for the long bones and thus involves the diaphysis. It accounts for 20% of cases of osteomyelitis and is the main cause for children.(3) The common site that affects the adults the most is the vertebrae where hematogenous ostemyeliti s thrives. Patients with this infection tend to have pain in the neck and back. Osteomyelitis secondary to a contiguous focus of infection occurs mostly in adults and accounts for about 80% of all cases.(3) This can occur through bites, wounds and open fractures. The main group of focus here are the individuals who have Peripheral Arterial Disease and Diabetes. This can result in numerous amputations for diabetics. The patient here does not have the proper knowledge to know that the infection is flourishing inside the bone. Trauma and sores can make the foot vulnerable to diabetic neuropathy. In regards to chronic osteomyelitis, about 5% of cases from acute hematogenous osteomyelitis leads to chronic osteomyelitis.(3) Chronic infection tends to have a more contiguous-focus origin than that of a hematogenous osteomyelitis due to the presence of foreign substances inhabiting the infection for a significant amount of time. Furthermore, Cierny- Mader classifies by condition of the patie nt by an anatomic stage and a physiological stage. (3,5) Differential Diagnosis   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Diagnosis of osteomyelitis may involve numerous procedures. These procedures should be a factor in patients with fever, inflammatory reactions, regional skeletal pain, and positive blood cultures. Blood tests are usually done in order to determine the amount of white blood cells present to battle with the infection. Blood is cultured to reveal the causative bacteria in the specimen. Moreover, an Erythrocyte Sedimentation Rate (ESR), blood cell count, and C-reactive protein test can help to indicate osteomyelitis. (2,3)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Scanning examinations such as Magnetic Resonance Imaging(MRI), x-rays, three phase bone scans , and other radionuclide studies, may help determine bone inflammation. Bone inflammation is witnessed through injection of radioactive elements into the blood stream. Biopsies can also be performed in order to determine various bacteria lurking in the area. (1,2)The differential diagnosis for osteomyelitis is neuroarthropathy of the foot. On radiographs, bone infections are equivalent to bone lesions. However, if there is no ulcer present, the diagnosis can be viewed as damage to the bone and thus, is a result of neuroarthropathy. (2,3) Treatment   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The two forms of treatment of osteomyelitis most commonly used are surgical therapy and antibiotic therapy. Surgical therapy is distinguished based on the infections extent. When dealing with acute osteomyelitis, the key component deals with debridement of the dead tissue. In regards to chronic osteomyelitis, there is a resection of foreign substances, and also debridement of soft tissue.(1,2,3,4) Skin and bone grafts may be used to potentiate the start of new bone growth by covering the wound. Furthermore, surgical approach may increase the chances for re-ulceration. This surgical approach is understood with help from biomechanics of foot function. (2)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Antibiotic therapy is used to kill bacteria. There is oral and intravenous therapy used to target these causative organisms. Intravenous antimicrobial therapy is the treatment of choice for chronic osteomyelitis. In adults, four to six weeks of intravenous antibiotic treatment is needed along with sufficient bed rest. Usually, surgery may be needed to drain the pus accumulated and to clean the affected areas. (4)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Alternative treatments also exist in attempts to treat osteomyelitis. Some have recommended that increasing the use of particular vitamin supplements, garlic extracts, herbal remedies such as Echinacea, golden seal, and even ginseng may help to relieve certain pains associated with infections. Homeopathic remedies may be useful in counter acting inflammation. (7) Antibiotic-impregnated acrylic beads have also been used for bone infection treatment. The beads should be used along with certain antibiotics. This requires adequate surgical placement in the area specified. Non-biodegradeable beads may be removed surgically after 2-4 weeks. While biodegradeable beads do not require surgical removal and may help for an extended period of time. (3,7) Conclusion   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Osteomyelitis requires excellent care of injuries and wounds. It may require surgical treatment and antibiotic therapy in order to reduce its effects. Osteomyelitis accounts for a great percentage of cases in adults. Typically, diagnosis of osteomyelitis presents with pain, fever, and other inflammatory signs due to bony infection. This disease has surfaced in Peripheral Arterial Disease and in the small bones of diabetics. Once a bone infection is confirmed by efficient procedures such as biopsy, treatment should follow accordingly. Following protocol consisting of debridement and appropriate IV antibiotics for 4 to 6 weeks helps in the general outreach of proper osteomyelitis management. (1,2,3,4,5,6)  

It 255 Final Project

Dear Richman Investments Senior Management, It has come to my attention that your corporate security policy for the firm is out of date and that it needs to be updated. In my time here as an intern I have reviewed the security policy and revised it to keep up with all of the technological updates going on in the internet world today. I was assigned this project and being that we have 5000 employees operating in different locations and different parts of the country; I have noticed that some of the other branches do not follow the firms’ policies as they should.Some branches operate on their own policies. I have drafted up a new and improved corporate security policy that covers emails, mobile devices, computer usage, email retention policies, passwords, etc. I hope this will help streamline our security policy across the board so that everyone is on the same page and so there is no misinterpretation of the firm employee or otherwise. RICHMAN INVESTMENTS CORPORATE SECURITY POLI CY Use of Phone and Mail Systems Personal use of the telephone for long-distance and toll calls is not permitted.Employees should Practice discretion when making local personal calls and may be required to reimburse The Firm for any charges resulting from their personal use of the telephone. The mail system is reserved for business purposes only. Employees should refrain from sending or receiving personal mail at the workplace. To ensure effective telephone communications, employees should always use the approved greeting and speak in a courteous and professional manner. Please confirm information received from the caller, and hang up only after the caller has done so.Computer and E-mail Usage Computers and other media of electronic communications (â€Å"Media†) are the property of the Firm which has a legitimate business interest in the proper utilization of its property. Therefore, any use of the Firm's property, and any electronic communications sent or received, may be mo nitored by persons authorized by the Firm. Employees who use such Media for private, non-work related purposes do so at their own risk. The Firm encourages such Media to be used for business purposes and forbids the waste or monopolization of such resources.Electronic communications, including computer files, voicemail and electronic mail (â€Å"e-mail†), are not anonymous: sender and receiver can be determined, and the content of any message may be viewed by others within the Firm. A password is not intended to ensure the privacy of electronic communications. Instead, it serves to provide a minimum level of security to the Firm's Media by restricting access to those who bear valid passwords. Preventing a person from outside of the Firm from gaining access to the Firm's Media is not the same as affording privacy to the communications of Media users.The Firm strives to maintain a workplace which is free of harassment and sensitive to the diversity of its employees. Therefore, the Firm prohibits the use of computers and the e-mail system in ways that are disruptive, offensive to others, or harmful to morale. For example, the display or transmission of sexually explicit images, messages, and cartoons is not allowed. Other such misuse includes, but is not limited to, ethnic slurs, racial comments, off-color jokes, or anything that may be construed as harassment or showing disrespect for others.In addition, e-mail may not be used to solicit others for commercial ventures, religious or political causes, outside organizations, or other non-business matters. E-MAIL IS NOT A PRIVATE COMMUNICATION WITHIN THE FIRM. NEVER USE E-MAIL TO SEND PERSONAL INFORMATION OR DISCUSS PRIVATE MATTERS ABOUT ANYONE, INCLUDING YOURSELF, UNLESS DISCLOSURE OF THAT INFORMATIONWITHIN THE FIRM IS ACCEPTABLE TO YOU. THIS PROHIBITION ALSO APPLIES TO VOICEMAIL AND COMPUTER FILES. ANY DEFAMATORY, INSULTING OR DEROGATORY REMARK ABOUT ANY PERSON OR GROUP OF PERSONS IS PROHIBITED.Email Retent ion Policy Because the volume of e-mails sent and received continues to rise, the size of attachments Continues to grow, and pictures and images consume significant amounts of storage space, the Firm has Adopted an Email Retention Policy that addresses retaining, deleting and saving e-mail in an effort to Advance the Firm's technology objectives and ensure that a reliable network exists for rapid message exchange and communication. The Email Retention Policy allows a faster, more responsive e-mail system and ensures that, in the event of a disaster (i. . hardware failure, natural disaster events, etc. ), our messaging services can be quickly restored to operation. This policy also encourages organization of e-mail through the use of email folders. The policy is designed to automatically delete information from only the Inbox, Sent Items and Deleted Items as they age. The Table below illustrates the policy and aging and flow of email items from those folders. Software Policy The Firm will not tolerate any employee making unauthorized copies of software.The Unauthorized duplication of software violates software licensing agreements and federal copyright laws. Such conduct is not only against the Firm's policy, it is a federal criminal offense. No employee shall install any software on any computer at the offices of the Firm unless the installation is approved in writing in advance of the installation. Social Media Policy Although this is not a complete or exhaustive list, employees should consider the following guidelines prior to using social media (including Firm operated social media) while an employee of the Firm.Employees should be aware that while not always apparent, work-related issues may often be implicated by their use of social media. In all instances, employees are expected to use good judgment and to consider the effect their social media use has on others and the way in which others perceive them. Stay Legal – Employees should make sure tha t their use of social media complies with all applicable laws. When in doubt, the employee should find out whether what he/she is doing is legal before proceeding.Confidentiality – An employee's confidentiality obligations extend to his/her online activities. Accordingly, employees should be familiar with the Firm's policies regarding confidential information. Generally speaking, an employee should not disclose to any third party any information related to the Firm or its employees, products, services, clients, partners, suppliers, or other business interests unless that information is already public knowledge.Even if the information is public, an employee should avoid discussing the Firm's clients, suppliers, and partners without their permission. If in doubt about whether particular information may be disclosed, contact a Managing Partner. Copyrights, Trademarks, and Intellectual Property – Employees should not make any use or reproduction of any copyright, trademark , or intellectual property belonging to any other person or entity, except in accordance with applicable law. NO EXPECTATION OF PRIVACYFirm employees should have no expectation of privacy with respect to any information created, viewed, distributed, received, uploaded, downloaded, accessed, or otherwise facilitated by the Firm's Computer or Information Systems (phone, computer, hand-held devices, etc. ). Similarly, employees should have no expectation of privacy with respect to information that is generally available online. The Firm reserves the right to monitor and maintain any content created, viewed, distributed, received, uploaded, downloaded, accessed, or otherwise involving any Firm Computer or Information System or resource.DISCIPLINARY ACTION Any violation of this policy may result in disciplinary action, up to and including termination of employment. Internet Policy For those employees who are provided access to the internet, the Firm encourages the use of the internet for business purposes. Non-business use (such as net surfing for personal enjoyment, entertainment, or children's school projects) should be kept to a minimum and generally restricted to non-working time. Personal use of the internet that adversely affects an employee's productivity is prohibited.No employee may use the internet during working time or during non-working time to access or convey information in violation of any Firm policy. Examples of the types of information that would violate Firm policies include information that is sexually explicit or offensive, or which is offensive, hostile, or harassing with respect to anyone's race, religion, color, creed, marital status, sex, ancestry, national origin, age, disability, sexual orientation or preference, veteran's status, or any other aspect that is protected by law or by the Firm's policies.No employee may use the internet during working or non-working time to access or convey information in an unlawful manner or for any unlawf ul purpose, such as downloading or copying information or programs in violation of copyright and software licensing laws, or using the internet to distribute or receive destructive programs such as viruses. Remember that you should not expect any â€Å"privacy† in your use of the internet.The Firm has the ability to monitor your internet access (all messages sent, sites accessed, and information downloaded). The Firm reserves the right to review and disclose such records or information with or without prior notice or consent. Your hard drive contains a history of sites recently visited and information (such as text and graphics) from those sites. This information is the Firm's property.The Firm has the right to enter your workstation or office, with or without notice or consent, at any time, and to access, monitor, review and take possession of your hard drive and any data storage medium. (For example, hard drives, floppy disks, CD-ROMs, videotapes, cassette tapes, etc. ) Any thing on Company premises is presumed to be Company property and is covered by this policy. I hope this proposal meets all of your contractual needs and gets everyone on the same page. Thank you.

Differences Between Culture, Race, And Class - 1329 Words

This paper will focus on the similarities and differences in cultures and how it relates to schooling, family, religion, education and language. The purpose of this paper is to highlight the effects that culture, race, and class have on human’s behaviors, resilience, struggles and faith. . The cross culture countries of analysis will be Guyana and Portugal which are situated at two opposite ends of the world. Which makes this comparison even more compelling? With worlds so distant, one might expect to have fewer similarities. But as I began to categorize the similarities and difference on chart exhibit A, I was pleasantly surprised with the commonalities. First I developed a chart and compare the similarities and differences,†¦show more content†¦According to the text Understanding Human Differences by Koppelman stated â€Å"For every talent that poverty has stimulated it has blighted a hundred† (p. 264). Secondly, the difference that was recognizable was the religious aspect. Even though Claudio was raised a Roman Catholic and I an Anglican, we both believe in the same God. Our views on heaven and hell totally differ relating to religious beliefs. From my perspective I, believe in heaven and a hell. Coupled with, being accountable to someone when you depart this world. As the saying goes, everyone was put on this earth for a reason and we as individuals should achieve and accomplished the purpose we were meant to achieve. If for some reason, we did not achieve our purpose while we were on earth, then there should be consequences for our actions or missteps when our souls depart this earth. Claudio on the other hand, whose early years were deeply engrossed in becoming a priest, has drawn a connection from his own life experience. For instance, he seems to come to the conclusion that there is a heaven, but not a hell. He also elaborated that the persecution that humans endure during their lifetime on earth is the hell we sometimes describes when

Holdens Self-Alienation In The Rye - 956 Words

While Holden’s academic negligence and evasive tactics are firm exemplars of his desire to hold on to his childhood, they are not as prominent as his self-alienation contrivances throughout the novel. A prime example of this, is his red hunting cap, which dually serves as a symbol of his individuality and nonconformism, because of the peculiar style of the hat and the manner in which he wears it â€Å"with the old peak swung way around to the back† (Salinger 18), as well as his attachment to childhood and bitterness. Holden mentions it is a â€Å"people shooting hat† (Salinger 19), which shows how deeply he is affected by the exclusion and victimization he feels from the world around him. It also uncovers the sense of superiority he identifies with,†¦show more content†¦He isolates himself to say that he is above everyone else and interactions with them, but in actuality he is distraught and overwhelmed because he is often not taken seriously or listened to. For example, when he asks a cab driver about where ducks go in the winter and after that, to join him for a cocktail and he is shut down and made to feel silly for asking: I m so damn absent-minded, I gave the driver my regular address, just out of habit and all--I mean I completely forgot I was going to shack up in a hotel for a couple of days and not go home till vacation started. I didn t think of it till we were halfway through the park. Then I said, Hey, do you mind turning around when you get a chance? I gave you the wrong address. I want to go back downtown. The driver was sort of a wise guy. I can t turn around here, Mac. This here s a one-way. I ll have to go all the way to Ninedieth Street now. I didn t want to start an argument. Okay, I said. Then I thought of something, all of a sudden. Hey, listen, I said. You know those ducks in that lagoon right near Central Park South? That little lake? By any chance, do you happen to know where they go, the ducks, when it gets all frozen over? Do you happen to know, by any chance? I realized it was only one chance in a million. He turned around and looked at me like I was a madman. What re yaShow MoreR elatedAnalysis Of Salinger s The Catcher Rye 1074 Words   |  5 PagesSalinger’s The Catcher in the Rye has been pronounced a literary classic for its atypical portrayal of adolescence, to effectively convey the protagonist’s alienation and confusion. The introduction of The Catcher in the Rye is underpinned by disorder and confusion through a stream-of-consciousness narration, which digresses from one subject to another. Consequently, Holden’s multitudinous thoughts and feelings appear to lack a cohesive pattern. 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