Rheumatoid Case Study

 

 

 

 

 

 

Scenario 2: A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. Patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.

 

Develop a 1- to 2-page case study analysis in which you:

Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.

 

 

Sample Solution

The patient’s symptoms likely arose from his medications and underlying rheumatoid arthritis. The large doses of prednisone, which is a steroid hormone treatment for reducing inflammation, can weaken the immune system making it more susceptible to infection (Wolters Kluwer Health 2020). Additionally, methotrexate is an immunosuppressant that treats RA; however this drug has also been linked with increased risk of fungal infections such as Aspergillosis (Kumar et al., 2019). It is possible the patient inhaled spores of this fungus due to working outdoors at a farm cooperative. Invasive Aspergillosis typically presents with fever, chills and sweats which are consistent with what this patient reported. In addition to these systemic signs, there may be localized symptoms in the lungs and sinuses depending on severity or if there are predisposing factors like COPD or asthma present (Mayo Clinic nd.).

What was “new” about the New South?

The accompanying will talk about what, on the off chance that anything was new about the New South that rose in the United States after 1877. Before the American Civil War the old South had overwhelmingly been an agrarian economy in which blacks were slaves who had taken a shot at the cotton ranches, plants, or had been residential hirelings. Cotton had been the real ware of the economy, which had chiefly been traded to Britain. The American Civil War had been battled about the issue of subjugation and whether the Southern States reserved the privilege to surrender from the United States to safeguard the establishment of bondage (Hobsbawm, 1975 p.184). The Civil War conveyed social and monetary changes toward the South. Its cotton trades had been definitely decreased, its horticultural and mechanical yield declined strongly, while quite a bit of its framework was decimated. Amid the common war President Lincoln had declared the liberation everything being equal, while blacks had battled with unique excellence on the Union side. The obliteration conveyed toward the South by the common war implied that a time of recreation was required a short time later. Driving white Southerners, for example, Henry Grady required a New South. The blacks that were liberated, because of the Confederate States losing the common war, likewise foreseen a New South. The blacks in the Southern States anticipated that their lives should be better after the Union’s triumph and the period of remaking. In numerous regards solid contentions can be exacerbated that their lives showed signs of improvement. Du Bois for one battled that blacks “had battled bondage to spare popular government and afterward lost vote based system in another and vaster subjugation” (Du Bois, 1935 Chapter 1).

The consequence of the American Civil War in principle was that the four and a half million blacks in the United States were all free and equivalent with the white populace. In any case, the finish of the Reconstruction made those equivalent rights a joke in the New South (Brogan, 1999, p.348).

That the New South was not another spot for the better for its dark populace was because of the manner by which the American Civil War finished. Lincoln’s death was the South’s retribution for losing the War. Lincoln’s successor, Andrew Johnson was less equipped for guaranteeing that the South changed in manners that profited its dark populace. From his administration onwards, the North did next to no to guarantee Southern blacks had any significant rights (Brogan, 1999, p.348). Southern blacks were just ready to practice their political rights while the Union powers stayed in the South, those rights stopped to exist as a general rule once the South was left to run itself. The concealment of Southern blacks was ostensibly more awful once they had been formally liberated than when they had been slaves. Racial segregation, the dread of brutality and destitution implied that the New South was no superior to anything the Old South had been (Hobsbawm, 1975, p.143). Neither the South when all is said in done or its curbed dark populace specifically, picked up as much from the United States fast industrialisation from the 1870s onwards as the North did (Hobsbawm, 1987, p.35).

In the New South there was a powerful urge among the crushed Confederate States to make its dark populace subject to its exacting political and financial controls for whatever length of time that conceivable. The abrogation of subjection had not seen the finish of the cotton ranches. In any case, employments and better pay were given to the whites as opposed to blacks. Blacks were given the least paid employments and they could be rebuffed for not taking them. For some blacks the freshness of the New South was the expanded cruelty of the separation they were exposed to. While the whites in the New South had been unfit to vanquish the Union amid the American Civil War, they were in a situation to make life extremely upsetting for the dark populace of the New South. Much separation was given legitimateness through the ‘Dark Codes’ of the Southern councils that seriously confined the privileges of previous slaves. Subjection had, in numerous regards, been reestablished in a more subtle structure (Brogan, 1999, p.352). Those blacks that endeavored to practice their lawful rights found legitimate and political impediments set before them, which adequately denied them of each one of those rights. They likewise confronted viciousness and terrorizing all the time (Bradbury and Temperley, 1998, p.153). The Southern states had the capacity to keep the Constitutional Amendments that nullified bondage and gave liberated slaves their rights having a positive effect as they were in charge of their authorization, instead of the national government (Murphy et al, 2001, p.315). States, for example, Louisiana had no goal of giving blacks any rights on the grounds it was unlawful to do as such (Du Bois, 1935, p.454). A progression of measures which were known as Jim Crow laws were utilized by the Southern States to isolate and stifle their dark populaces. Despite the fact that they guaranteed the isolated administrations were of equivalent quality, this was a hoax to pardon ignoring their dark networks (Cobb, 1992). Generally speaking Jim Crow Laws deferred the monetary advancement of the New South, while they systematized racial separation and isolation. The expense of giving isolated administrations brought down the nature of training, lodging, and transport in the New South. Isolation had even been embraced by the Supreme Court insofar as administrations were of equivalent quality, which few tried to check. Such separation was in opposition to the manner in which Henry Grady trusted the New South ought to have created. Grady contended that the most ideal approach to industrialize the New South was to regard blacks as equivalent accomplices instead of inferiors. In this manner social equity and fairness were similarly as vital as capital and apparatus in structure the New South (Mauk and Oakland, 1995 p. 108). Grady trusted that the New South would be the ideal majority rules system as long blacks were dealt with similarly. The common war had been an open door for the South to stop its obsolete dependence on bondage and cotton (Harris, 1890 p. 15). Isolation, just as being ethically faulty, kept the South generally poor and in reverse in connection to the remainder of the nation (Hobsbawm, 1975 p.184).

Destitution was another element of the New South. Destitution incomprehensibly enough had not been an issue for blacks in the South when they had been slaves. In spite of the fact that, they had no opportunity, slaves were furnished with essential dimensions of convenience and nourishment, on the sensible premise that undesirable slaves did not fill in just as solid ones. Southern slave proprietors had commonly treated their slaves all around ok for their numbers to increment at a similar rate as the white populace (Bradbury and Temperley, 1998 p. 153). Protectors of subjugation had kept up that it kept the Southern states monetarily aggressive, kept the dark populace at subsistence, while guaranteeing that every white man could discover paid work (Brogan, 1999, p.371). Neediness, as liberated slaves found to their expense, was as prohibitive of their opportunity as real shackles had been. Liberated slaves needed to contend with whites to pick up employments. Destitution was firmly connected with racial separation, in that whites were given better employments and better working conditions, notwithstanding when there were better-qualified blacks to carry out the responsibilities. Separation in the arrangement of instruction, lodging and restorative consideration likewise added to keep the blacks subdued and in neediness (Cobb, 1992). Blacks were disappointed by their neediness, while escape clauses were utilized to guarantee that poor whites kept the vote (Hobsbawm, 1987, p.24).

Another new component of the New South was the expanded dimensions of urbanization. Urban areas, for example, New Orleans and Birmingham expanded in size amid the recreation time. The urbanization of the New South was aftereffect of the modern development supported by the Southern states and th

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