NUDI3220 Clinical Nutrition

Define the terms epidemiology, epidemic, and pandemic.

Epidemiology is a branch of medicine that carries out the occurrence and with the predominance of diseases in a huge populace along with identifying the root and prompt of outbreaks of infectious diseases like SARS (Turner, 2017). On the other hand, an epidemic is the incidence of several instances of a illness which are anticipated (Schwensen, White, Thyssen, Menné & Johansen, 2015). For instance, a unforeseen acute epidemic of an illness like Severe acute respiratory syndrome is an epidemic. Pandemic is an outbreak that becomes prevalent and affects the entire region, continent or the world because of a vulnerable population (Fan, Jamison & Summers, 2016).

What is SARS?

A severe acute respiratory syndrome is a possibly life-threatening ailment and a viral disease that leads to flu-like symptoms (Hui, Memish & Zumla, 2014). This disease emerged in China in November 2003 and was identified in February 2003, and the outbreak spread to twenty-six countries where eight thousand people were affected and eight hundred died. The symptoms associated to SARS include chills, muscle aches, dry cough, pneumonia, emphysematous condition and a fever of above 100.4 F (38 C) (Maxwell, McGeer, Tai & Sermer, 2017).

A severe acute respiratory syndrome is produced by a pathogen called coronavirus (SARS-CoV) (Kindler, Thiel & Weber, 2016). This virus is spread when somebody who is infected coughs or sneezes and droplets spray into the air and someone else breaths the droplets or touches the particles. The incubation period 2-7 days although in few instances may be as long as ten days (Virlogeux et al., 2015). If the incubation period is short, it indicates severity in SARS.

What was the source of the infection? 

Two squads of scientists in 2005 separately uncovered a vast reservoir of virus-infected bats which they have connected to the peculiar epidemic of SARS infection (Drexler, Corman & Drosten, 2014). These researchers had discovered a secluded tunnel in Yunnan province which is the habitat to the horseshoe bats that bear a strain of coronavirus. The horseshoe bats have at least seven different strains of SL-CoVs which were found circulating within them. The strain contains all the genetic building blocks of the type that stimulated the world wide flare-up of SARS in 2002. Affected bats and uninfected civets came into contact at a market; the virus was transferred to civets and then increased and developed in civets in the public market until it ultimately dashed to humans (Drexler, Corman & Drosten, 2014). The index victim in a hospital eruption in Hong Kong of severe acute respiratory syndrome recovered after conventional antimicrobial therapy.

How is SARS transmitted? Discuss the routes of entry and exit. 

The ultimate procedure to the spread of SARS is through individual-to-individual touch. The coronavirus is transferred by respiratory globules produced when an affected individual sneezes or coughs (Wei et al., 2016). Its transmission could occur when sneeze beads or cough beads of an affected individual have thrust a little interspace via the space and dropped on the nose’s, eye’s or mouth’s  mucous membranes of people close to them. Furthermore, the virus could be transmitted in case an individual handles something desecrated with contagious globules and then contacts the mouth, nose or the eyes (Wei et al., 2016). The entry is through mucous membranes or inhalation.

How was the disease contained in 2003?

CDC did their investigation jointly with WHO in a worldwide attempt to remit the eruption of SARS in 2003 (Lee, Jang, Choi & Park, 2016). CDC took some actions to contain the epidemic. First, it triggered its Emergency Operations Centre to issue round-the-clock systemization and retaliation. It began a system for distributing health alert notices to travelers who may have been susceptible to SARS cases. Also, it offered help to local along with national health departments in researching potential instances of SARS in the United States. It participated in employing specialists, epidemiologists and medical officers to help with on-the-spot research and globally. Moreover, they coordinated a substantial laboratory examining of scientific specimens from SARS victims to discover the root of the infection. Finally, they devoted more than eight hundred therapeutic specialists and reinforcement team to an effort of getting SARS retaliation (Abubakar, Rangaka & Lipman, 2016).

Through GOARN, WHO organized the development of some connections which confirmed crucial in establishing mechanisms together with basics for the control of SARS. Also, WHO and its GOARN associates organized field staffs to reinforce epidemic feedback in Taiwan, China, Vietnam, Hong Kong, and Singapore. All through the epidemic, WHO persisted in working jointly with GOARN making sure there is on-going aid to health authorities and GOARN staff maintained in the field till the series of conveyance were definitely shattered (Abubakar, Rangaka & Lipman, 2016). The Western Pacific Regional Office of WHO bore the burden of feedback by employing one hundred and sixteen extra specialists as interim consultants throughout the epidemic.

What is your interpretation of the blood pathology? Focus your answer on the results of the blood investigations outside the normal readings.

High red blood cell count shows that the liquid component of blood which is the plasma is low since the red blood cells become concentrated. It also suggests an increase in oxygen-carrying cells in the blood and can result to a situation that limits the supply of oxygen or a condition that increases red blood production directly (Holcomb et al., 2015). Low hemoglobin levels are referred to as anemia and do not affect a person, but if it gets severe and results in symptoms, it shows signs of anemia. What may lead to low hemoglobin include loss of blood, abnormal hemoglobin structure, nutritional deficiency, kidney failure and bone marrow issues (World Health Organization, 2015).

Total iron-binding capacity is a test of blood to examine whether the blood has too little or too much of iron. High total iron-binding capacity indicates a low iron level in the blood which may be caused by increased blood loss, chronic disease or lack of iron in the diet (Mohus et al., 2018). Transferrin is a protein made by the liver, and it happens to be the primary protein that binds to the iron that is absorbed from food and transports it all over the body. However, transferrin saturation is the calculation representing the percentage of this transferrin which is saturated with iron. Low levels of transferrin saturation indicate that one is likely to be suffering from iron deficiency (Boshuizen et al., 2018). On the other hand, ferritin is a protein found in cells, and it binds to iron and is responsible for storing iron in the body. Low levels of ferritin indicate a reduction in the iron storage and the body cannot produce enough hemoglobin to meet the demands of the cells and this associated with iron deficiency (Felipe et al., 2015).

What are other issues noteworthy at the presentation? 

His agony settles after self-medicating with indigestion antacids indicating the presence of ulcers of the stomach or duodenum since antacids neutralize the acid responsible for irritating the sores and causing pain. He feels tired lately meaning that there is slow bleeding from peptic ulcers which eventually leads to anemia. Smoking causes ulcers and gastritis which may lead to bleeding causing anemia (Hakim, Reddy, Batke, Polidori & Cappell, 2017). Also, it causes significant vitamin C reduction in the body which is vital in iron absorption. Drinking too much beer of more than two bottles per day leads to defective red blood cells which are destroyed before the end of their natural lifespan. Drinking beer increases the absorption of iron damaging the liver. Furthermore, it has a direct toxic impact on the production of blood mainly affecting the bone marrow and suppressing the normal making of red blood cells.

What do you think is the most likely diagnosis?

Tests of red blood cell size and color, hemoglobin, Ferritin, and hematocrit should be conducted. For the presence of anemia, red blood cells are smaller and paler in color, hemoglobin of below 13.5 g/dl, ferritin of below 12 ng/ml and low hematocrit of below 38.8% in men (Peyrin-Biroulet, Williet & Cacoub, 2015).

What could other tests be performed to confirm this diagnosis? 

Alternative tests to be administered are computed tomography, endoscopy, and colonoscopy. Doctors may examine bleeding from a hiatal hernia which is an ulcer or a stomach with the help of endoscopy. During this process, a thin, lighted tube which is facilitated with a video camera is moved down the throat to the stomach which enables the doctor to scrutinize the esophagus and stomach to check for cases of bleeding (Joosten, 2018). A process called colonoscopy is recommended to rule out lower internal roots of bleeding. Here, a thin pliable tube facilitated with a video camera is infused into the rectum and lead to the colon.

During this test, a person is sedated, and the doctor can look inside of the rectum and colon to identify any internal bleeding. For patients who cannot undergo endoscopy or colonoscopy, computed tomography is helpful in determining lymph node abnormalities related to certain kinds of anemia. This is helpful in detecting the causes of bleeding like gastrointestinal malignancies (Joosten, 2018). Another test may be body magnetic resonance imaging (MRI) which helps in evaluating the concentration of iron in the liver and heart specifically in victims with several blood transfusions and concern for an overload of iron.

Describe the pathophysiology of this condition and the treatment protocol? 

Pathophysiology

Anemia is because of iron deficiency in the blood. In pure iron deficiency, depleted iron stores are as a result of the disparity between the ingestion along with application of iron. However, anemia may be absent because of iron recycling from erythrocyte turnover (Lopez, Cacoub, Macdougall & Peyrin-Biroulet, 2016). The adequacy of iron repletion and management of the iron deficiency causes results to resolution while the persistence of a negative balance results to hypochromic and microcytic anemia. On the contrary, functional iron deficiency is because of the release of impaired iron into the circulation of macrophages, hepatocytes, and enterocytes. Erythropoiesis is iron-restricted, and anemia thrives despite the adequate iron stores, and erythropoiesis may occur microcytic or normocytic.

The basis of anemia of chronic infection tenderness results to the overexpression of hepcidin obstructing the iron intake enterocytes along with its dispensation from hepatocytes and macrophages. Therefore, intravenous iron is recommended since oral iron is ineffective. However, the reason why intravenous iron is preferred is that the gut is bypassed allowing swift repletion. After administration of intravenous iron ferritin expression rises shortly and reaches a higher level when compared with the oral iron that could decrease the lasting frequency of iron deficiency anemia. Considering some victims, inflammation together with iron deficiency may lead to significant anemia which must be put into consideration at the time of therapy and management (Lopez, Cacoub, Macdougall & Peyrin-Biroulet, 2016).

Iron deficiency anemia is also caused by loss of blood due to ulcers and what is advised most in the pathophysiology of peptic ulcers is the heterogeneity. Erosions together with acute ulcers present objectively with gastrointestinal bleeding (Kulshreshtha, Srivastava & Singh, 2017). Local ischemia is the earliest discovered gross lesion and most medicine elicited ulcers result in the stomach. Chronic peptic ulcers normally present with abdominal pain and in chronic corpus gastric ulcer imperfect defense chemical change like atrophic gastritis along with duodenogastric reflux are known to be more vital compared to aggressive parameters. However, antisecretory treatments alleviate the ulcers therapeutic.

Treatment protocol

Taking iron supplements like Fergon and making changes to the diet such as eating red meat, lentils, peas, and cereals are recommended. In case loss of blood is the underlying result of iron deficiency the genesis of the bleeding has to be identified and ceased which may involve surgery (Peyrin-Biroulet, Williet & Cacoub, 2015). Vitamin C improves iron absorption, and thus it is instructed to the patient to take the Fergon with a glass of orange juice. To replenish the iron reserves, iron supplements should be considered for a more extended period (Peyrin-Biroulet, Williet & Cacoub, 2015).  Treating iron deficiency anemia involves antibiotics which eliminate helicobacter pylori bacteria if present and other drugs to remedy ulcers.

 To treat ulcers transfusion of red blood cells along with hospitalization be initiated to restore the blood lost and reduce the symptoms (Chan & Lau, 2016).  Also, medicines such as proton pump inhibitors obstruct the stomach from producing any acid and medical procedure for eradication of fibroids, bleeding polyp or a growth is recommended (Caplan, Fett, Rosenbach, Werth & Micheletti, 2017). The patient should re-examine the complete blood count every three months for a year. Consequently, if the red blood cell and hemoglobin indices remain normal, one additional complete blood count should be obtained twelve months later.

References

Abubakar, I., Rangaka, M. X., & Lipman, M. (2016). Investigating emerging infectious diseases. Infectious Disease Epidemiology, 87.

Boshuizen, M., Binnekade, J. M., Nota, B., van de Groep, K., Cremer, O. L., Tuinman, P. R., … & Juffermans, N. P. (2018). Iron metabolism in critically ill patients developing anemia of inflammation: a case-control study. Annals of intensive care, 8(1), 56.

Caplan, A., Fett, N., Rosenbach, M., Werth, V. P., & Micheletti, R. G. (2017). Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Gastrointestinal and endocrinologic side effects. Journal of the American Academy of Dermatology, 76(1), 11-16.

Chan, F. K., & Lau, J. Y. W. (2016). Peptic ulcer disease. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders.

Drexler, J. F., Corman, V. M., & Drosten, C. (2014). Ecology, evolution, and classification of bat coronaviruses in the aftermath of SARS. Antiviral research, 101, 45-56.

Fan, V. Y., Jamison, D. T., & Summers, L. H. (2016). The inclusive cost of pandemic influenza risk (No. w22137). National Bureau of Economic Research.

Felipe, A., Guadalupe, E., Druso, P., Carlos, M., Pablo, S., Oscar, C., … & Federico, L. (2015). Serum ferritin is associated with metabolic syndrome and red meat consumption. Oxidative medicine and cellular longevity, 2015.

Hakim, S., Reddy, S. R. R., Batke, M., Polidori, G., & Cappell, M. S. (2017). Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy. World journal of gastrointestinal endoscopy, 9(10), 521.

Holcomb, J. B., Tilley, B. C., Baraniuk, S., Fox, E. E., Wade, C. E., Podbielski, J. M., … & Cohen, M. J. (2015). Transfusion of plasma, platelets, and red blood cells in a 1: 1: 1 vs. a 1: 1: 2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Jama, 313(5), 471-482.

Hui, D. S., Memish, Z. A., & Zumla, A. (2014). Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Current opinion in pulmonary medicine, 20(3), 233-241.

Joosten, E. (2018). Iron deficiency anemia in older adults: A review. Geriatrics & gerontology international, 18(3), 373-379.

Kindler, E., Thiel, V., & Weber, F. (2016). Interaction of SARS and MERS coronaviruses with the antiviral interferon response. Advances in virus research (Vol. 96, pp. 219-243). Academic Press.

Kulshreshtha, M., Srivastava, G., & Singh, M. P. (2017). Pathophysiological status and nutritional therapy of peptic ulcer: An update. Environmental Disease, 2(3), 76.

Lee, K. M., Jang, W. J., Choi, Y. J., & Park, K. H. (2016). Emerging Infectious Diseases Require Biosafety Awareness and Procedures. Journal of Bacteriology and Virology, 46(2), 104-107.

Lopez, A., Cacoub, P., Macdougall, I. C., & Peyrin-Biroulet, L. (2016). Iron deficiency anemia. The Lancet, 387(10021), 907-916.

Maxwell, C., McGeer, A., Tai, K. F. Y., & Sermer, M. (2017). No. 225-Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS). Journal of Obstetrics and Gynaecology Canada, 39(8), e130-e137.

Mohus, R. M., Paulsen, J., Gustad, L., Askim, Å., Mehl, A., DeWan, A. T., … & Damås, J. K. (2018). Association of iron status with the risk of bloodstream infections: results from the prospective population-based HUNT Study in Norway. Intensive care medicine, 44(8), 1276-1283.

Peyrin-Biroulet, L., Williet, N., & Cacoub, P. (2015). Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. The American journal of clinical nutrition, 102(6), 1585-1594.

Schwensen, J. F., White, I. R., Thyssen, J. P., Menné, T., & Johansen, J. D. (2015). Failures in risk assessment and risk management for cosmetic preservatives in Europe and the impact on public health. Contact dermatitis, 73(3), 133-141.

Turner, B. S. (2017). Epidemiology. The Wiley?Blackwell Encyclopedia of Social Theory, 1-1.

Virlogeux, V., Fang, V. J., Wu, J. T., Ho, L. M., Peiris, J. M., Leung, G. M., & Cowling, B. J. (2015). Incubation period duration and severity of clinical disease following severe acute respiratory syndrome coronavirus infection. Epidemiology (Cambridge, Mass.), 26(5), 666.

Wei, P., Cai, Z., Hua, J., Yu, W., Chen, J., Kang, K., … & Ji, K. (2016). Pains and gains from China’s experiences with emerging epidemics: from SARS to H7N9. BioMed research international, 2016.

World Health Organization. (2015). Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. 2011. Geneva: WHO Google Scholar.