Clinically Isolated Syndrome and MS

Clinically Isolated Syndrome and MS CHAPTER 1 – GENERAL PRINCIPLES 1.1 Terminology Clinically isolated syndrome (CIS) is a central nervous system demyelinating event isolated in time that is may or may not lead to the development of multiple sclerosis (MS). It is a term that describes a first clinical episode with features suggestive of multiple sclerosis (MS). It usually occurs in young adults (19-30 years old) and affects optic nerves, the brainstem, or the spinal cord. Although patients usually recover from their presenting episode. (1) The term â€Å"clinically isolated syndrome† (CIS) is used to describe a first episode of neurologic episode that lasts at least 24 hours and is caused by inflammation and demyelination in one or more sites in the central nervous system (CNS). CIS may be presented as monofocal or multifocal: Monofocal episode:The person experiences a single neurologic sign or symptom such as an attack of optic neuritis that is caused by a single lesion. Multifocal episode:The person experiences more than one sign or symptom such as an attack of optic neuritis accompanied by weakness on one side of the body (hemiparesis) that is caused by lesions in more than one place in CNS. Individuals who experience a CIS may or may not go on to develop MS. In diagnosing CIS, the physician faces two challenges: first, to determine whether the patient is experiencing a neurologic episode caused by damage of the CNS, and second, to determine the possibility that a person experiencing this type of demyelinating episode is having high risk to develop MS. Of the people who are eventually diagnosed with MS, 85% experienced a first attack that is referred to as a clinically isolated syndrome (CIS). (1) If an MRI scan of the brain and spinal cord shows evidence suggestive of MS at the time of a clinically isolated syndrome or at the time of a second episode, then MS will be diagnosed. However, not all patients who experience a clinically isolated syndrome will go to develop MS (2). For many patients, there will be no MRI evidence suggestive of MS and no further symptoms or episodes. 1.2 history The first journal article including the term â€Å"clinically isolated syndrome† appeared only 20 years ago .Increasing availability of  magnetic resonance technology in the 80s improved diagnosis of  CNS  demyelinating disorders, and the arrival of disease-modifying medications for  multiple sclerosis  starting in mid-90s increased the importance of correct diagnosis and treatment. Long term follow up studies of patients presenting with an isolated clinical syndrome characteristic of multiple sclerosis led to the identification of risk factors for conversion to clinically definite multiple sclerosis (3). Today, no uniform consensus definition for a clinically isolated syndrome exists. In 2008, a panel of multiple sclerosis experts recommended that a clinically isolated syndrome be defined as a monophasic presentation with suspected underlying inflammatory demyelinating disease and recommended 5 subtypes based on monofocal or multifocal symptoms, presence or absence of asymptomatic MRI lesions, or patients without symptoms but with a suggestive MRI (3,4). 1.3 Epidemiology A study was made to determine whether the incidence of clinically isolated syndrome (CIS) the precursor form of multiple sclerosis (MS) that encompasses optic neuritis and transverse myelitis as well as other clinical presentations, varies by race/ethnicity in a multi-ethnic, population-based cohort (5). The methods that was used is based on electronic record searches and complete medical records review to identify all newly diagnosed CIS and MS cases in the population-based, multiethnic membership of Southern California Kaiser Permanente (KPSC) between 2008 and 2009. The KPSC membership contributed 7,410,754 person-years of observation during the study period and the racial/ethnic distribution was 36.5% white, 8.6% black, 43.4% Hispanic, 9.3% Asian/Pacific Islanders (Asian/PI) and 1.9% other (6). The results were the identification of 254 incident cases of CIS cases who did not yet met McDonald criteria for MS and did not have other obvious causes (viral, lupus, ischemia). The most common clinical presentation was optic neuritis (48.4%) followed by transverse myelitis (32.7%), other forms of mono-regional CIS (9.8%) and poly-regional CIS (9.1%). The average age at diagnosis with CIS was 42.9 years (range 14.8-80.8) and 70.5% were women. Among CIS cases, the racial/ethnic distribution was 47.6% white, 12.6% black, 33.1% Hispanic, 4.3% Asian/PI and 2.4% other. The incidence of CIS was 3.4 per 100,000 person-years. Incidence of CIS was higher in black (5.1, 95%CI=3.5-7.1) and white, non-Hispanic individuals (4.5, 95%CI=3.7-5.3) compared with white, Hispanic (2.6, 95%CI=2.1-3.2) and Asian/PI individuals (1.6, 95% CI = 0.8 2.9; p In conclusion the incidence of CIS is 3.4 per 100,000 person-years in a multi-ethnic, population-based cohort of Southern Californians. The incidence of CIS is higher in black and white individuals compared with Hispanic and Asian/PI individuals.6) 1.4 Risk of developing multiple sclerosis after clinically isolated syndrome Studies suggest that people who experienced a clinically isolated syndrome have a less than 50% risk of developing MS within five years of experiencing the initial symptoms (7). There is no single examination that can determine whether a person who experiences a clinically isolated syndrome will or will not go to develop MS. However, researchers have tried to identify factors that might influence the possibility of developing MS and help differentiate between people who have a higher and lower risk to develop MS. Though these classifications do not establish absolute risk of developing MS, they may help to guide people in making decisions about further testing or treatment (1,7). Figure 1: Progression of the disease for CIS and MS types. Source https://sbvimprover.com Factors that influence the likelihood of developing MS: 1. Type of clinically isolated syndrome Many studies have shown that different types of clinically isolated syndrome (i.e. transverse myelitis, optic neuritis, brainstem syndrome) in relation to the risk of developing MS. These studies suggest that optic neuritis is associated with a lower risk of developing MS and better long-term outcome than other types of clinically isolated syndromes (7). 2. Symptoms experienced during a clinically isolated syndrome Isolated sensory symptoms, which include tingling, numbness, or visual impairment are thought to be associated with a lower risk of developing MS compared to the presence of symptoms of motor system involvement , which are associated with a higher risk .(1) 3. MRI markers A brain MRI scan at the time of the clinical episode of CIS is thought to be the most useful predictive tool. A normal MRI scan showing no lesions is associated with a lower risk of developing MS. In the other hand, a brain scan that shows a high number or volume of lesions is associated with a higher risk of developing MS (1,7). 4. Laboratory markers A test that is used to confirm or rule out a diagnosis of MS is a lumbar puncture. A lumbar puncture involves removing and analyzing a sample of cerebrospinal fluid (CSF), specific markers in the cerebrospinal fluid have the ability to indicate MS activity. Studies have investigated whether analysis of CSF can help predict the possibility of developing MS after a clinically isolated syndrome. One of these studies was based on the data of 40 patients who presented with a clinically isolated syndrome and have been examined with MRI scanning and CSF analyzing within the following two months. Of the 15 patients who developed MS, 14 had abnormalities on MRI and 13 tested positive for markers of disease activity in their CSF. The risk of developing MS was significantly higher in patients who tested positive in CSF analysis and had abnormalities on their first MRI scan compared to patients who were negative for both or one of the tests (7,8). However, because it is less useful as a predictive tool than MRI, a lumbar puncture is not routinely recommended in cases of CIS as described in Table (1). High risk Low risk Motor system symptoms Isolated sensory symptoms High number and volume of brain lesion on MRI Normal brain MRI Table (1): Symptoms in high risk and low risk to develop MS In conclusion motor system symptoms and high number and volume of lesion on brain MRI are indicative of high risk of developing MS, in the other hand isolated sensory symptoms and normal brain MRI are most probably with low risk of developing MS (7).

Eastern Religions Analysis Essay

Modern western medicine is based on knowledge and technological innovations appeared in 19th and 20th centuries. In contrast to eastern traditions, modern western medicine rejects the role of mind and soul in treatment trying to explain everything form Rationalist point of view. Recent years, eastern religious traditions penetrate into modern medicine brining new understanding of diseases and their causes. Alternative medicine is a ‘branch’ of modern medicine which applied eastern religious traditions into professional medical practice. The main advantage of eastern religious traditions (Daoism, Hinduism, etc.) is interpretation of mind-body interaction which sees human mind and body as a part of the world order, nature and cosmic environment. Following eastern religious traditions, modern medicine uses meditation techniques and relaxation as the main tools to treat many incurable diseases. They program mind towards positive thinking and health. Eastern teaching includes unconscious ideas that shape everyday behavior, namely the right decision, the right attitude and truth. â€Å"By going to a practitioner skilled in one of these arts [eastern practices], patients feel that they are getting a complete doctor – someone to treat their medical condition and to give them wise advice about life as well† (Dworkin 2001, 3). As the most important, eastern religious traditions use herbal substances and other natural ingredients as an alternative to surgical treatment methods. Today, more and more drugs consist of herbs and vitamins as the most effective and safe measures of treatment. Eastern religious traditions prove that chemical substances are ineffective if a person (patient) cannot change his attitude towards life and his diseases. Dworkin explains: â€Å"Alternative medicine stands between medical science and organized religion, and therefore stands between what is known and what is unknown† (Dworkin 2001, 3). In spite of great knowledge, the role of eastern religious traditions and their practical application is still limited by rational knowledge of western society. Modern India is influenced by globalization and westernization processes which changed social ideals and beliefs of modern generations. The remarkable feature of modern society is that it does not reject and ignore old beliefs and values applying new traditions and innovation to its cultural heritage. Following Frawley, it is possible to interpret Hinduism as: â€Å"the Dharmic soul of India, [which helps] to rise up from deep sleep and realize its true heritage† (Frawley 2002, 113). Popular culture of social and intellectual elite is primarily viewed by strong traditions of people, as well as religious dogmas, and Hinduism is the source that influences popular culture. After the period of colonialism and Communism, this change in national consciousness and mind is a result of the collapse of a stable world-view created during 20th century, which led to panic and moral decay. In modern India, social norms play greater role than Hinduism and are seen as a priority. Some critics admit that some Hindus are distance themselves from religious traditions â€Å"avoiding being seen going to temples, Yet â€Å"†¦ may go to churches and mosques as a demonstration in their universality of religion.† (Frawley, 16 cited Thaiyar 2002, 113). This tendency shows that modern generations are free to practice a high degree of ethical pluralism in their personal life choosing personal religion and way of life. Changing ideologies required changes of common people who are the base of popular culture. Still, Hinduism has a tremendous impact on cultural and social life of Hindus as a part of historical development and national identity. In general modern society is suppressed by social changes which influence world perception and culture, but, at the same time and again are associated with the â€Å"reformed† religion, which demands strict code of ethics and beliefs. Today, most Hindus subconsciously follow Hinduism traditions and philosophy, way of life and food patterns as a part of national culture they cannot change. Hinduism penetrates all spheres of social life and cultural norms reshaping modern nation and its values formed during the 1950s. References Dworkin, R.W. (2001). Science, Faith and Alternative Medicine. Policy Review, p. 3. Thaiyar, S. (2002). Arise Arjuna: Hinduism and the Modern World. International Journal of Humanities and Peace, 18, p. 113.   

The Leaked Secrets to Autobiography Essay Samples Discovered

The Leaked Secrets to Autobiography Essay Samples Discovered Last, you've got to generate an outline of your upcoming essay. You are able to download absolutely free sample essay papers and learn more concerning the reasons to get essays from ProfEssays.com. It might be hard to choose just what to chat about as the essay should depend on some impressions one wants to tell about due to some certain reason. Your essay has to be simple to understand that's the reason it's far better to avoid long complicated sentences and phrases. Make the reader want to read the entire essay in 1 breath. Nearly all writers seek the expert services of copy editors. The introduction is just one of the most crucial parts since it is the point where the reader receives the very first impression of you. Regardless of the simple fact that you compose a story about yourself, you still must stick to some requirements and build an excellent structure of the essay. No matter why you need to write it, the overall format is going to be the exact same in all circumstances. Don't underestimate the significance of each function. Select an aspect or facets of your life to contemplate in a broader view. Apart from the main requirements you must follow if you would like to compose an exemplary essay, there are a few additional details that are crucial. Reread the timeline and determine whether there are any unnecessary details you want to remove, or if there are events you should include to earn your story make sense. Below is a good example of what you might put in your socio-autobiography. But, for such a job, you should give us as many specifics about that component of your life that you want to highlight as you're able to. Employ a seasoned copy editor to make certain that your book will have that expert polish. It is going to also contain information regarding the author and the way you would like to advertise the book. Putting it all in an outline makes it simpler for you to deal with the story from the beginning to the conclusion of the exact same. Writing an autobiography for each man or woman is a distinctly individual experience but there are a few topics that are vital to cover. Autobiography is the ideal way to do this. The Christian Autobiography Example is for people who have lived a perfect life and people who mattered. Agreeableness The results say that I believe it is effortless to express irritation with other individuals. It's also quite a tough job to write about one's life coherently as there are so many events and memories to sift through. Thus, when you plan your autobiography, be certain you concentrate on events that had significant influence on your life and totally ignore the tidbits. Study your notes and pick out three of the absolute most essential things about your life. You might not have had the most fascinating childhood in the Earth, but everyone has had a few memorable experiences. Or are you single, searching for a husband, or wife, have you ever suffered heartbreak, etc. When written, there'll be as many life stories since there are people. But these were unable to heal my depression. Have a veterinarian or knowledgeable friend explain to you how to track down the quick. Quite simply, it focuses on one definite moment in an individual's life. If you don't find out how to compose an autobiography, the most reasonable decision is to become familiar with the autobiography example. As already said above, every individual has to know how to write autobiography. What Autobiography Essay Samples Is - and What it Is Not Then there's a Funny side of Autobiographies that can help you in that regard. They fall into the nonfiction category.

Relationship Between Management And Labor - 1301 Words

Toyota, a car manufacture as well as a family owned global corporation, meets its goals fundamentally rooted from a creed called â€Å"The Toyota way†(2005). â€Å"Respect for the people† and â€Å"continuous improvement†(2005) a motto that not only defines â€Å"The Toyota way† but also serves as the backbone of Toyota’s success and proves through it’s fruition regarding how constructive the relationship between management and labor truly is. Through this analytical essay, interaction between management and labor are identified throughout the progression and current polices, arrangements, and procedures in Toyota’s business. For example, a labor dispute in 1950 (2008) which led to the staple of trust and respect between management and labor by the â€Å"Labor-management joint declaration† establishing in 1962. â€Å"The Toyota way† is expressed in the organization’s culture through implementing procedures and pl ans that improve employee self worth and awareness (2008). Several examples of procedures and plans are examined from researching the company. Following Toyota’s two major keys, â€Å"respect for the people† and †continuous improvement,† communication between employees and management serves in a purpose to centralize the concept of which the individual’s effort essentially creates the team’s final outcome. (2008) In regards to the team everyone may not work in the same department and yet no department is regarded with more importance thus creating a equal environment leading to higher awarenessShow MoreRelatedRelationship Between Labor And Management843 Words   |  4 PagesLabor Relations â€Å"The keystone of successful business is cooperation. Friction retards progress† (Penney, n.d., para. 1). Stagnant relationships between labor, management and the unions at Ellard Williams, Incorporated (EWI) is causing employee motivation to decrease while the number of union-filed grievances increases. 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