Transfusion in the patient with Sickle cell Disease Essay

Transfusion in the patient with Sickle cell Disease - Essay Example e, transfusion strategy is applied to prevent the recurrence, or the first occurrence, of stroke which is a major crisis in SCD, and to manage pulmonary hypertension and other sources of morbidity and mortality. Exchange transfusions are used to reduce the sickle cell haemoglobin (HbS) levels during crisis. Several situations also exist wherein the indication for red cell transfusion is controversial, uncertain, or downright injudicious. Many side effects of transfusion have been identified and methods to overcome them have been developed. Iron overload (remedy: iron chelation), and alloimmunisation (remedy: phenotypical matching of transfused blood) are two notable examples. Association of haemoglobinopathies and neurologic sequelae after transfusion is also known. At the present time, bone marrow transplant is the only curative procedure available for both SCD and ÃŽ ²-thalassaemia major. Potential therapies involving stem cell transplantation and gene techniques are being vigorous ly researched. A detailed discussion of the current status of clinical management strategies as applied to inherited haemoglobin-related diseases in particular, sickle cell disease and the thalassaemias, is presented in this paper. Anaemia is a syndrome characterised by a lack of healthy red blood cells or haemoglobin deficiency in the red blood cells, resulting in inadequate oxygen supply to the tissues. The condition can be temporary, long-term or chronic, and of mild to severe intensity. There are many forms and causes of anaemia. Normal blood consists of three types of blood cells: white blood cells (leucocytes), platelets and red blood cells (erythrocytes). The first generation of erythrocyte precursors in the developing foetus are produced in the yolk sac. They are carried to the developing liver by the blood where they form mature red blood cells that are required to meet the metabolic needs of the foetus. Until the 18th week of gestation, erythrocytes are produced only by liver

Eulogy For My Grandfather Speech or Presentation

Eulogy For My Grandfather - Speech or Presentation Example My grandfather was born in the United States and was rightly named John for in him I have seen a gracious (behindthename.com) man not only to his children and grandchildren but to every person he encountered. When he was two years old, his parents brought him back to Poland where I came from and stayed there for the rest of his life touching lives in the small things he could do. As I was growing up, I witnessed him give away his personal possessions like clothes, shoes and even food to the needy saying they need them more than he does. Grandfather John was not wealthy but had a decent job delivering goods and foods from stores to hotels and restaurants which provided for the family's needs and food on the table. With this kind of job, he sometimes comes home with food provided by generous people who somehow knew his need or were just simply glad for his goodness and services. He always shared his blessings with the whole family and did not hide them away from any of us. Instead, he prioritized others before attending to his own need and this is what drew me even closer to him.When he was growing old, his affections to his family and most especially to me, have grown fonder and sweeter so that he reminds me of James Garfield who said, â€Å"If wrinkles must be written on our brows, let them not be written upon the heart. The spirit should never grow old.†. Truly, he has shown this through his life and proven that growing old is not as dim and dismal as Matthew Arnold pictured in his poem "Growing Old".... If to the poet growing old is golden days declined (Arnold), to my grandfather they are turning to diamonds (antithesis). If to the former it is to weep and feel the fullness of the past (Arnold), to the latter it is to brighten up and face what miracles the coming years would bring (antithesis, parallelism). If to one it is to spend long days in weary pain (Arnold), to the other it is to enjoy every moment for life is short (antithesis, parallelism). Grandfather always has been in good spirits, always happy and wanting to share his jokes to anyone who would listen to him, brightening their days and giving a piece of advice when needed. For me, he has always been a great help as a counselor in times when I needed to make decisions that seemed confusing or simply too great for me to consider. And as I look back to those special days I spent with him, what I remember most is the cup of tea he usually prepares for me which is very sweet yet I drank it all up to my grandfather’s c ontentment who said the tea will sweeten my heart (personification) and bring out good things from me. I guess it did and I will never forget how the tea tasted but more so, I will never forget the man whose simple ways are even sweeter, encouraging me to emulate him and be good to everyone I meet, serving them the cup of tea that I have been drinking to the fill of my heart (metaphor). When my grandfather turned fifty, his leg was amputated because of gangrene and two years later, his other leg was also removed. I expected him to change in his attitude but his condition seemed to have never mattered to him because he has always been the cheerful and joyful grandfather I have always known. He never became

Military Dictatorship and Hieratical Political Leaders Essay Example for Free

Military Dictatorship and Hieratical Political Leaders Essay Military dictatorship and hieratical political leaders failed in Bangladesh Military dictatorship and hieratical political leaders failed in Bangladesh to institutionalize democracy and ensure development and liberty for the people. It looks like that we have to restart from the beginning. As early as 1965 the late Akhter hamid Khan of Comilla Academy had a vision to take government to the doorstep of common people through a local government and micro- enterprises under cooperative with management support from a rural based bureaucrats and reduce the revenue urden of the central government a corresponding reduction of members in the centralized bureaucratic administration. To invoke public propositions and opinion in this regard, the following few points have been innumerate to be further developed in future. . Bangladesh was liberated by the toiling masses at great sacrifices primarily by farmers, labors and students, though history did not credit them for their role and instead placed all laurels and benefits of the liberation war to the army, politicians, bureaucrats, greedy elitist and business community to whom all the ealth and privileges and legal concessions of all the Governments have been showered upon. Another liberation war is necessary to liberate real peoples and ensure their development. 2. points were fundamental basis of ensuring all right, entitlement Justice to peoples of a promised Sonar Bangla. On that same basis we have to restructure reform our executive Judicial functions with maximum autonomy power to local government leaving only such functions as National security, Foreign affairs, Currency, reserve bank federal financi al affairs, Planning upport and coordination, One integrated national Industrial corporation for development of Basic large Industries, One integrated R D council for development of Science and technology, with major emphasis on empirical research. One National Multimode integrated Transport Network System, One National IT Centre for networking all ministerial local government functions, archiving and retrieving data and information etc. 3. Democracy, Socialism, non-alignment and secularism were the basis of our constitution which was tempered and tailored many times by all Governments to suit certain specific objective of some leaders and their party. The basic principles of a constitution should be sealed for any amendment except through referendum only. The 1st constitution of Bangladesh had some clauses with embedded party interest such as preventive detention under article 33, unrestricted tenure for PM;s office article 57, Local Govt. structure and power as in article 59 60, blind following of party line as in article 70 and many others. Though all parties derive certain benefits from these, they must be recast to reflect public pinion on them. . The chapters and clauses on part VI Judiciary contains no structural, Judicial and procedural reforms to ensure dispensing timely Justice within affordable cost. The system has become single biggest obstacle towards prevention of vices and chapters and clauses on part IX Services of Bangladesh contains no structural and procedural reforms to convert the servants of the colonial masters to respectable employees of the Peoples Republic of Bangladesh. Myopic planning, redtapism and fund crumpling are common causes of all or most project failures in Bangladesh. PSC failure to recruit proper personnel on the basis of personnel integrity, meritocracy, accountability and preference to generalist in place of function based specialist are major causes for rise of a elitist, high living and corrupt bureaucrats who hold every thread of power over political government and who will never allow local government function to be within control of elected local government as the same will hamper their financial interest. . Reorganization of Statutory bodies ; state owned enterprise, public undertakings including banking, securities, and non banking inancial enterprises in Bangladesh is essential as they have substantial bearing on our economy caused due to drainage of capital through loans given to be subsequently classified. Project failure and loss of employment, flight of capital and money laundering, low FDI, management failure, undisciplined labor, lack of accountability and transferency etc. 7. Prepare a total guide line proposal for long, medium and short term development plan for developing Bangladesh with a vision to raise it to a modern state with an egalitarian society by dismantling the existing horrible wealth gap between rich and poor.

Canadas Independence from Britain

Canadas Independence from Britain Canada: An Independent Nation â€Å"A British subject I was born, a British subject I will die,† As said by the founding father of our nation, Sir John A. MacDonald, 1891. Like Sir John A. MacDonald, many Canadians have expressed full support and loyalty to Britain, as â€Å"Mother Empire.† Canada is one of the oldest established colonies of Britain and a senior member of the imperial family. Over the course of history beginning with Confederation Canada has developed a bond with Britain. This connection is rooted in common history, family ties, shared values and traditions. Though expressed support to Britain, Sir John A. MacDonald believed that Canada could be a â€Å"powerful auxiliary to the Empire,† in other words; he believed that Canada can be a powerful support to Britain as an independent country. Subsequently, it is without a doubt, that earlier on in history, Canada was meant to be a sovereign country. Certain battles and laws prove that Canada is, after all, a self-governing n ation. For this reason, the three most significant defining moments in Canadian history would be the Battle of Vimy Ridge, the Statute of Westminster and D-Day when Canada emerged under the shadow of Britain, becoming a strong and independent nation. The 1917 Battle of Vimy Ridge proves that Canada is a united and independent country through its ability to pull through a tough battle, as one unit. Even under British leadership, Canada was able to achieve control and gain victory at Vimy Ridge. Yet many had low expectations from Canadian troops from the start. This proves that Canadian troops are tough, well trained and can pull through any battle they are faced with. Vimy Ridge is a difficult location to capture – due to its strategic ridge – the territory was an advantage if captured. Even with restrictions, this was the first total Canadian victory under Canadian leadership with no British involvement. With the help of Canadian General Arthur Currie, Canadians created and mastered the â€Å"Vimy Glide,† a military technique used to help successfully capture the ridge. After all circumstances, the capture of Vimy Ridge became more significant due to the fact that other countries such as France and Britain fa iled to capture the ridge – and above all, Canada was successful. This helped increase Canada’s reputation as a strong, independent and professional nation, gaining the respect from many people. The Battle of Vimy Ridge is a battle contributing to Canada’s international reputation and as a united country, the first step to the growth of Canada’s independence. The Statute of Westminster, passed on December 11, 1931, officially proves that Canada is a self-governing, independent country from Britain. This law gave Canada its freedom to control it own foreign affairs and was no longer a colony of Britain. This British law outlined Canada’s full independence and freedom from â€Å"the Empire†. It is an important, defining moment in Canadian history, because it gave Canada the freedom to make decisions on their behalf, with no British involvement. Hence, this freedom was generally established during World War Two, when Canada was not automatically at war when Britain was, and was able to decide as an independent country. The Statue of Westminster contributed to Canada’s full independence from â€Å"the Empire,† revealing a supreme nation ready for anything that comes its way. The 1944 battle of D-Day is an important event for Canadians, proving the strength Canada has as a newly formed independent nation. It is one of the toughest, important battles Canadian troops had faced. Not only was battle of D-Day the largest, planned invasion against Germany, but also the turning point and end to World War Two. Being a part of this event, as an independent country, was significant for Canada. This battle made up for the Canadian efforts of the failed 1942 Dieppe raid. June 6, 1944 Canadian troops were assigned to capture â€Å"Juno Beach,† one of the five beaches of Normandy. Since Juno Beach was one of the central beaches, the most deadliest fighting took place here. Many Canadian soldiers drowned even before reaching the beach, just to show the harsh conditions experienced by the courageous troops. Although the beach was typically flat, Canadian troops had to go through a series of obstacles to advance this territory, for instance, barbed wire, mines and beach obstacles that prevented Canadian advance. As a result, Canadians successfully accomplished the mission given to them, particularly driving the Germans off the territory and capturing Juno Beach. The battle of D-Day proves to one important battle, demonstrating Canada’s independence and ability to carry out a mission. Although this was a tough battle, Canada was able to prevail during an important battle of World War Two. The Battle of D-Day proves Canada’s strength as an independent nation. In the long run, Canada gradually and peacefully emerged under the shadow of Britain, becoming a self-governing nation. As a part of the imperial family, Canada has demonstrated loyalty to Britain and has always been very close to the Empire. Events in history prove that Canada is, after all, an independent country. It was only a while ago when Canada fought alongside Britain during World War One and when Canada fought as an independent country during World War Two, proving that Canada has surely become a sovereign nation. Early on, fears of Canadian involvement in Britain’s foreign affairs were present even back to the late 1800s to the early 1900s. These fears were soon destroyed as the nation grew, revealing the true, independent side of Canada. That is to say, there was a time when Canada was dependent on Britain for most of their battles. Through the battle of Vimy Ridge, the Statute of Westminster and the invasion of Normandy when Canada grew, and developed into an indep endent nation, becoming one of the strongest, successful countries in the world.

Critical evaluation of An Inspector Calls Essay -- English Literature

Critical evaluation of An Inspector Calls An Inspector Calls ‘An Inspector Calls’ is a play set in the mystery/ detective thriller genre. It is set in 1912 however it was written by J.B Priestly in 1945 and staged in Moscow. As he lived through both wars he could see what had actually happened in the time the play was set. J.B Priestly uses the characters to express his views on the issue of social responsibility, morality and about class divisions with many themes including greed, regret, guilt and blame. ‘An Inspector Calls’ is about the Birling family who are quite wealthy. They are celebrating their daughters engagement with her fiancà ©, Gerald. An Inspector arrives and breaks up the party, questioning the family on the death of a young Eva Smith, who had killed herself by drinking disinfectant. Upon questioning each member of the family seems to be involved in her death and is slowly forced to confess. When the Inspector finally leaves they find out that he is a fake. But at the very end they get a phone call telling them that a young woman has just killed herself and that there is an Inspector on his way to speak to them about it. An Inspector Calls is what is known as a well made play. Its progression is that from ignorance to knowledge (for both the audience and the characters). During the course of the play the action is mostly focused on Eva Smith/ Daisy Renton. At the beginning of the play Sheila is described as a pretty girl in her early twenties, very pleased with life and rather excited. The reader gets the impression that she is a very relaxed, spoilt, and innocent girl who is very naà ¯ve. At the start of the play Sheila has a very good, happy relationship with her family and fianc... ...ing about the public finding out and if the inspector is real or fake. Sheila is the character which is explored in this essay. Responsibility is developed through her character as her reactions and responses are compared to her family’s. Although she is the youngest, she behaves in a mature manner answering the Inspector’s questions whereas her family refuses. She understands what has happened and takes responsibility for her actions. Change is developed from the beginning to the very end. In the beginning Sheila is carefree, innocent and naà ¯ve. She has no worries or concerns. However towards the end she develops a social conscience and an understanding of the real world. She is emotionally stronger and has doubts about her parents. She has learnt a lot from her experience and even though the inspector was a fraud she is still aware of her actions.

Agricultural Policy and the European Union :: Political Politics

Agricultural Policy and the European Union Discuss the relative merits/demerits of an agricultural policy oriented to price reform rather than one based upon structural reorganisation "The common market shall extend to agriculture and trade in agricultural products. 'Agricultural products' means the products of the soil, of stock-farming and of fisheries and products of first-stage processing directly related to these products....The operation and development of the common market for agricultural products must be accompanied by the establishment of a common agricultural policy among the Member States" (1) >From the beginning of the European Union, EU policy has given emphasis to the agricultural sector. To this end, a Common Agricultural Policy (CAP) was established in 1963. (2) Provisions for this policy were made in the Treaty of Rome. The aims of this policy were to increase agricultural productivity, to ensure a fair standard of living for the agricultural community, to stabilise markets and to ensure reasonable prices for the consumer. (3) This is unusual in the context of the Treaty of Rome which provided for free trade and movement of resources. Agriculture was ill-adapted for this approach. Protection was given, not only by customs duties, but also by a variety of agricultural policies. This essay will discuss the merits and demerits of a the pre-1992 CAP with its emphasis on price reform, in comparison with the post-1992 CAP which was oriented to structural reform. It cannot be denied that there were merits of the pre-1992 price reform policy. There was a bountiful food supply with an increased variety and quantity of food. Farmer's yields increased, particularly the large farmers. Producers were protected from the external market due to community preference and, therefore, domestic agriculture could develop. There were also spin offs in food production. Although some of the policies created good returns for farmers, the demerits of said policies far outweighed any advantages they had. The core-periphery divide was widened, quantity became more important than quality and consumers had to pay higher prices. Agricultural practices caused damage to the environment and international trading relations were strained. Until 1993 the EU rarely supported farmers by paying them direct subsidies from the taxpayers. (4) Instead the 30 billion ECU (and often more) was spent in the buying up of surplus commodities at minimum official prices and was also used to pay subsidies to traders to sell surpluses on the lower-priced world markets. (5) During the 1960's the price system was devised. The first problem with price policies is that of fluctuating and differing exchange rates. "Green Money" was the first solution to be developed to counter the problem of differing exchange rates.

Chronic Illness Research Paper

Wiskott-Aldrich syndrome is an X-linked recessive immunodeficiency disorder usually inherited by males from their mother. This syndrome involves both T- and B-lymphocytes characterized in one third of patients by the triad of recurrent bacterial sinopulmonary infections, eczema (atopiclike dermatitis), and a bleeding diathesis caused by thrombocytopenia and platelet dysfunction.The characteristic triad of bleeding, eczema, and recurrent infections in Wiskott-Aldrich syndrome generally become evident during the first year of life, with petechiae and ecchymoses of the skin and oral mucosa and bloody diarrhea being the first clinical signs. Bone marrow transplant improves prognosis of Wiskott-Aldrich syndrome. Investigators reported that before hematopoietic stem cell transplantation, cutaneous manifestations occurred frequently, with the most common lesion being eczema similar to atopic dermatitis (71%), followed by petechiae and/or ecchymosis (58%) and cutaneous infections (17%).The c lassic triad of symptoms was seen in 46% of the boys, who were later treated with hematopoietic stem cell transplantation. The chronic underlying medical needs, the unpredictable nature of the disease, with its share of life threatening emergencies, all contribute to a stressful life for the family. These families need support from physicians, family, friends, teachers, clergy, neighbors and sometimes professional counselors to help them cope with the disease.Families living with Wiskott-Aldrich Syndrome are challenged by many stressors and often struggle with the imbalance it causes. Some of the stressors of WAS include variability of the disease's presentation, sudden and unexpected onset of the symptoms (infection, bleeds, malignancies and autoimmunity), the lack of consensus in the medical community on how best to treat WAS, and the incurable nature of the syndrome without bone marrow transplantation that in itself carries significant risk of serious side effects including death .They also struggle with the potentiality that their child's symptoms may increase or worsen with age, and, because of the rarity of the syndrome, families are often dealing with a disease that is not well understood and specialists that are often hard to find. These types of acute and prolonged stressors naturally challenge the safety and predictability within the family system and also the emotional stability of all members within including the child affected with WAS as he ages. Although each family is unique and each family member is different in the ways in which he or she esponds to the stress and trauma associated with WAS, many experience moderate to profound grief, anxiety and or depression. Some experience hyper-vigilance, avoidance of situations or places reminiscent of traumatic events associated with WAS, have nightmares or recurring intrusive traumatic thoughts or images associated with the trauma and or isolation. While others may experience panic attacks, sleep distu rbances, eating disorders, ADHD-like symptoms, under performance at work or school and or symptoms of oppositional defiance.Management of infection includes antibiotics and possibly intravenous immunoglobulin G (IVIG). The decision to use prophylactic antibiotics and/or IVIG is made case-by-case, based on incidence and severity of infection in the individual patient. Postsplenectomy, prophylactic antibiotics are mandatory, although the patients who undergo splenectomy remain at considerable risk for overwhelming sepsis despite of prophylaxis. The nurse must teach that immunization is mandatory.Varicella-zoster immune globulin is administered within 48 hours if possible, although it may be effective until 96 hours post exposure. To manage acute bleeding the nurse’s role is to administer platelet transfusions and packed erythrocytes. The nurse must also insure that she and the healthcare team are minimizing exposure to allogeneic cells in the patient for whom stem cell reconsti tution is planned is important because such exposure increases graft rejection rates.The nurse must teach the parents how to manage symptoms of eczema at home along with an oral antiviral that the child will be receiving. Parents are taught to treat eczema with conventional topical moisturizing creams and topical steroids. Nurses also advise that milk and other potential food allergens may be eliminated from the diet on a trial basis to observe for improvement. Clinical services provided for the family and child coping with Wiskott Aldrich Syndrome include, groups such as the Wiskott Adlrich Foundation.This foundation is awarded grants to help unraveling the mysteries of WAS, explore avenues for improved cures and find ways to improve the quality of life for those who are impacted by WAS. Resources provided in the U. S. include financial assistance, fundraising assistance, housing-travel and medication, wish granting organizations, and educational scholarships. These assistive progr ams provide the family with detailed information about their disease, and financial supports to cope with the stresses that come with treating and the management of WAS.When dealing with WAS the family is taught that nothing is more important to the health of a child with WAS than warding off potential infections. Basic precautions including: keep the child away from crowds, dirty environments and sick people; use protective face masks at the recommendation of the child’s doctor; following a strict hand washing regimen for the child, family, and visitors. These actions are taken because the child’s body does not have healthy B cells that produce antibodies against infection, they may also need regular infusions of the antibody immunoglobin.Works Cited Boztug, K. (n. d. ). Stem-cell gene therapy for the wiscott-aldrich syndrome. (2010). The NewEngland Journal of Medicine, Retrieved from http://www. nejm. org Schwartz, R. (n. d. ). Pediatric wiskott-adrich syndrome. (201 3). MedScape Reference, Retrieved from http://emedicine. medscape. com/article/ Brickwall, P. , & Katz, D. (n. d. ). Wiskott-aldrich syndrome: current research concepts. (2001). Wiley Online Library, 101(4), 603-608. Retrieved from http://onlinelibrary. wiley. com