Renal Failure
Main Functions of the Kidneys

The kidneys are bean-shaped organs, 12 centimeters long, which lie at the sides of the spinal column behind the abdominal cavity (Merck 2010). Their main function is to maintain the proper balance of water and minerals in the body. Their other major functions include filtration and elimination of wastes and toxins, regulation of blood pressure and secretion of some hormones. The amount of water taken into the body must match the amount being eliminated. If the balance is not maintained, water will accumulate fast and illness or death may occur. Excess water will dilute the body's electrolyte and inadequate amount will concentrate electrolytes. The kidneys regulate and help maintain the precise concentrations (Merck).

The kidneys' second major function consists of filtration and excretion (Merck 2010). They pass out urea, a main waste product from protein metabolism. Urea moves through the glomerulus and into the tubuluar fluid…...

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BIBLIOGRAPHY

DHS 2008, 'Developmental disabilities nursing,' Department of Human Services

[Online] Available at  http://www.oregon.gov/DHS/spd/provtools/nursing/ddmanuel/companion.pdf ?

Franz 2009, 'Nursing care plan -- renal failure,' Nursing Crib [Online] Available at  http://nursingcrib.com/nursing-care-plan/nursing-care-plan-renal-failure 

Hudson, K 2007, 'Acute renal failure -- nursing CEs,' Dynamic Nursing Education

Renal failure, or commonly referred to as kidney failure, is a condition in which the kidneys do not sufficiently filter out the toxins and waste products that are transported in the body's blood stream. There are two basic forms of renal failure. The first is when there is an acute injury prevents the kidneys from functioning properly. The next is a more serious condition in which the kidneys are chronically inflicted. Chronic kidney disease has the potential to be irreversible and requires immediate medical attention. Some of the symptoms of renal failure include (Lin, 2011):
Appetite loss

General ill feeling and fatigue

Headaches

Itching (pruritus) and dry skin

Nausea

eight loss without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten worse, include:

Abnormally dark or light skin

Bone pain

Brain and nervous system symptoms:

Drowsiness and confusion

Problems concentrating or thinking

Numbness in the hands, feet, or other areas

Muscle twitching or cramps

Breath odor

Easy bruising, bleeding, or…...

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Works Cited

Lin, H. (2011, September 21). Medline Plus. Retrieved from Chronic Kidney Disease:  http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm 

MedlinePlus. (2011, September 21). Chronic Kidney Disease. Retrieved from MedlinePlus:

These clinics will have to be set up over a number of years as funding becomes available for each. It is envisioned that the combination of clinics and learning programs will help the community to achieve better overall health. Indeed, clinics that focus on the specific health issues faced by the Hispanic community will remove some of the burden from general-purpose clinics and hospitals.
Conclusion

In conclusion, it is projected that the above-outlined prevention strategies can go a long way towards significant improvements in the health of the Hispanic community. In addition to addressing specific renal failure problems, prevention measures and better access to clinics can also result in a better overall health and lifestyle experience for the Hispanic community. It is therefore proposed that these measures be implemented and thoroughly researched for both short- and long-term effectiveness.

eferences

Bibby, M. (2009). Advocacy strategies for government sponsored public health agencies: The BCCDC a…...

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References

Bibby, M. (2009). Advocacy strategies for government sponsored public health agencies: The BCCDC a case study. Simon Frasier University. Retrieved from:

 http://summit.sfu.ca/system/files/iritems1/9582/ETD4602.pdf ?

DaVita Healthcare (2014). Risks for CKD in Hispanic-Americans. Retrieved from:

  -- hispanic-americans&articleID=5009http://www.davita.com/education/article.cfm?educationMainFolder=causes-of-kidney-disease&category=assessing-your-risk&articleTitle=risks-for-ckd-in 

Acute renal failure is a serious medical condition. The gravity of the condition is manifested itself in the fact that the survival rate for renal failure has not improved for more than forty years. It occurs in 5% of all hospitalized patients and dialysis treatment is required in approximately .5 of cases. Dialysis is required to sustain "fluid and electrolyte balances, minimize nitrogenous waste production and sustain nutrition Infection accounts for 75% of deaths in patients with acute renal failure, and cardiorespiratory complications are the second most common cause of death" (Agrawal & Swartz 2000). Pathophysiology can vary depending upon the type: "patients who develop AKI can be oliguric or nonoliguric, have a rapid or slow rise in creatinine levels, and may have qualitative differences in urine solute concentrations and cellular content.... Oliguria is defined as a daily urine volume of less than 400 mL/d and has a worse prognosis,…...

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References

Epstein, Murray. (1997). Alcohol's impact on kidney function. Alcohol Research and Health21. 1 (1997): 84-91.

Malay, Agrawal & Richard Swartz. (2000). Acute Renal Failure. American Family

Physician. Retrieved October 29, 2011 at  http://www.aafp.org/afp/20000401/2077.html 

Page, Timothy F. & Robert S. Woodward. (2009). Cost-effectiveness of Medicare's coverage of immunosuppression medications for kidney transplant recipients.

Part 2: Additional Evidence (Narrative)Justification of EvidenceThe evidence presented in the concept map is relevant to the case study of a patient with renal failure related to DM. Acute renal failure interventions are proposed by the National Kidney Foundation (NKF), and they emphasize early detection and management of acute kidney injuries. This is particularly relevant to our case study, where the patient\\\'s renal failure is a direct consequence of poorly managed DM, a metabolic condition that affects glucose regulation and can lead to nephropathy (Genco & Borgnakke, 2020).Hyperglycemia: Likewise, with respect to hyperglycemia, the American Diabetes Association (ADA) standards of medical care in diabetes offer recommendations for the diagnosis and management of patients with diabetes. Given that hyperglycemia is a glucose-related aspect of our case study, these guidelines are directly relevant (Schwartz et al., 2023). The evidence used is the best available because it is derived from academic, professional and…...

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ReferencesAmpofo, A. G., Khan, E., & Ibitoye, M. B. (2020). Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart & Lung, 49(5), 537-547.Genco, R. J., & Borgnakke, W. S. (2020). Diabetes as a potential risk for periodontitis: association studies. Periodontology 2000, 83(1), 40-45.Schwartz, X., Porter, B., Gilbert, M. P., Sullivan, A., Long, B., & Lentz, S. (2023). Emergency Department Management of Uncomplicated Hyperglycemia in Patients without History of Diabetes. Journal of Emergency Medicine, 65(2), e81-e92.Yuen, K. C., Samson, S. L., Bancos, I., Gosmanov, A. R., Jasim, S., Fecher, L. A., & Weber, J. S. (2022). American Association of Clinical Endocrinology Disease State Clinical Review: evaluation and management of immune checkpoint inhibitor-mediated endocrinopathies: a practical case-based clinical approach. Endocrine Practice, 28(7), 719-731.

CT scan or MA may result in the clinician oversight of some of the more subtle findings. It is expensive and the availability is limited.
It is possible to evaluate AS via angiogram, bet evaluation of the size of the stenosis tends to be imprecise. Additionally, angiography does not allow a cross-sectional assessment of the stenosis, and in the case of FMD, it is not possible to distinguish the different histological types, although intervention at the time of assessment is a possibility. Doppler sonography is able to measure the amount of blood flow, and is non-invasive. It tends to be highly invasive and is able to demonstrate problems with slow patterns and other issues which are highly suggestive of significant stenosis. Doppler ultrasound tends to be very operator dependent and the exam takes a significant amount of time. Additionally, the exam may be limited by abdominal girth, patient movement and…...

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Reference:

1. Paven G; Waugh R; Nicholson J; Gillin a; Hennessy a Nephrology (Carlton). 2006; 11(1):68-72

2. Agency for Healthcare Quality and Research (AHRQ)

Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: AHRQ Executive Summary,), Rockville, Maryland;  http://hcup.ahrq.gov/HCUPnet.asp 

3. Dejani H, Eisen TD, Finkelstein FO: Revascularization of renal artery stenosis in patients with renal insufficiency. Am J. Kidney Dis 2000 Oct; 36(4): 752

Mayor, S. (2009). "UK sees rise in people donating a kidney to unknown recipients." British medical journal 338(7710), pp. 1521.

In this brief yet highly relevant article, the author describes a recently observed trend of increasing live-donor kidney donations for unknown recipients. hough living donors for family members with a need for transplant have been relatively common for sometime, the idea of donating a kidney while still living for a person unknown to the donor is a very recent development in kidney translation and availability. hough the reasons for this increase are not yet clear, as no research has been undertaken to determine the causal effect of this observed trend, initial results suggest that simple awareness of the need for renal donation and the normalcy of life following the donation of a kidney is a major factor.

Nakamura, Y.; Konno, O.; Matsuno, N.; Yokoyama, ., et al. (2008). "How can we increase…...

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Though various methods and schema for renal transplantation exist, this study points out the benefits of living donor donation in the combating of end-stage renal failure, in Japan specifically. Citing a decreased need for recipient medication and an increased likelihood of successful transplantation when kidneys used in transplantation come from living donors, the authors of this study examine various methods for increasing rates of living donorship. A new surgical procedure developed by the authors limits the invasiveness and the blood loss in an elective living donor surgery, and combined with higher donorship rates could greatly increase the successful treatment of renal disease.

Testa, G.; Angelos, P.; Crowley-Matoka, M. & Siegler, M. (2009). "Elective surgical patients as living donors: A clinical and ethical innovation." American journal of transplantation 9(10), pp. 2400-5.

An innovative new schema for encouraging organ donation is put forth in this article. Specifically, the authors suggest that patients slated for laporoscopic cholecystectomy be given the opportunity to undergo a more invasive surgical correction and donate a kidney as a living donor at the same time. This would eliminate (or greatly reduce) the need for living donors to become surgical candidates with no health benefit to them; the same surgery and level of invasiveness would both correct the patients' problem and allow for donorship. This is the reverse of the current living donor schema, in which donors become surgical candidates specifically for donor purposes, raising ethical and medical concerns.

Quality Improvement: Complications and DeathsIntroductionThis quality improvement (QI) initiative focuses on reducing complications and deaths related to heart failure in a hospital setting. The two graphs provided illustrate the death rates for heart failure patients from August to December, and show a trend that calls for immediate action. This QI is to address these issues by means of the Plan-Do-Study-Act (PDSA) approach, which supports implementing, evaluating, and refining the initiative, as needed.PlanTopic: Selection and ationaleThe topic selected for this QI project is Complications and Deaths at a Hospital with a specific focus on heart failure patients. This topic was chosen due to the observed upward trend in death rates for heart failure patients, as shown in the provided data below (bar chart and line graph). To improve patient outcomes, it is necessary to understand what can be done to reduce negative outcomes for this type of patientationale for SelectionHeart failure…...

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ReferencesDoshi, S., & Wish, J. B. (2021). Strategies to reduce rehospitalization in patients with CKD and kidney failure. Clinical Journal of the American Society of Nephrology, 16(2), 328-334.Jaarsma, T., Hill, L., Bayes?Genis, A., La Rocca, H. P. B., Castiello, T., ?elutkien?, J., ... & Strömberg, A. (2021). Self?care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, 23(1), 157-174.Roger, V. L. (2021). Epidemiology of heart failure: a contemporary perspective. Circulation research, 128(10), 1421-1434.Thaker, R., Pink, K., Garapati, S., Zarandi, D., Shah, P., Ramasubbu, K., & Mehta, P. (2022). Identify early and involve everyone: interdisciplinary comprehensive care pathway developed for inpatient management and transitions of care for heart failure patients reported using SQUIRE 2.0 guidelines. Cureus, 14(1).Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., ... & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9), e139-e596.

Congestive Cardiac Failure: Nursing Perspective
Congestive heart failure is a congenital condition that affects millions of American's every year. Heart failure often manifests in a chronic condition for victims of the disease.

There are several nursing interventions important for control and maintenance of the condition. Congestive heart failure can result in serious complications including edema, respiratory disorders and can lead to premature death. Treating congestive heart failure appropriately is critical to a patient's outcome. Perhaps even more critical to a patient's outcome is patient education targeted at prevention and healthy living. Nursing management of the condition depends upon appropriate medical evaluation, medication administration, monitoring and patient education. These ideas are explored in greater detail below.

Congestive heart failure is often congenital in nature. Congestive heart failure usually manifests when the cardiac muscle is old and tired and stops circulating properly. This may result from damage to the heart; alternatively myocarditis and cardio…...

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References

AMA. (2004). "Congestive Heart Failure." American Heart Association, Inc. {Online} Available:  http://www.americanheart.org/presenter.jhtml?identifier=4585 

Adomeit, A; Baur, A; Salfeld, R. (2001). "A New Model for Disease Management." The McKinsey Quarterly.

Antoni, M; Ironson, G; Saab, P; Schneiderman, N. (2001). "HEALTH PSYCHOLOGY: Psychosocial and Biobehavioral Aspects of Chronic Disease Management." Annual Review of Psychology

Arocha, J; Patel, V. (1995). "Novice Diagnostic Reasoning in Medicine: Accounting for Evidence." Journal of the Learning Sciences, Vol. 4

6. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurse's response to changes in the level of consciousness and increasing respiratory distress.

The collaborative team here would consist of a primary care physician / geriatrician, pain management specialist, laboratory specialists, and x-ray team. Additional consultants may be neurologist, neurosurgeon, gastroenterologist, psychologist, and drug and alcohol detoxification specialist.

In the case of increasing respiratory distress, the nurse is advised to continue or modify the interventions: to continue to teach patient how to breath and cough correctly; to summon a productive cough; to attempt to clear lungs to auscultation; and to achieve symmetric chest excursion of at least 4 cm; also that her respirations and pulse beats should be regular, and that she should inhale a normal volume of air. This is done by encouraging Fowler or semi-Fowler's position; monitoring the respiratory…...

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Sources

Eliopoulos, C. (2001). Gerontological nursing Philadelphia: Lippincott,

Kandel, J. (2009). The encyclopedia of elder care New York, NY: Facts on File,

Marvin J.A. (1995). Pain assessment vs. measurement. J Burn Care Rehabil 16, 348-357

Melzack R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1, 277-299

Pharmacology Case StudiesScenario 1: Mary\\\'s Hypothyroidism ManagementProblem DescriptionMary, aged 35, has been diagnosed with hypothyroidism, as evidenced by an elevated Thyroid-Stimulating Hormone (TSH) level of 20. Alongside, she suffers from iron deficiency anemia, as indicated by low MCV, MCHC, Ferritin, and high Total Iron Binding Capacity (TIBC) values. Her current regimen includes non-prescription Kelp tablets, ibuprofen as needed, and a contraceptive pill.Medication PrescriptionGiven Marys high TSH levels and symptoms, I would initiate treatment with Levothyroxine to regulate her thyroid function (Wilson et al., 2021). An appropriate starting dose considering her condition (assuming she weighs around 70 kg) would be the following prescription.Medication OrderLevothyroxine 75 mcg orally, once daily in the morning on an empty stomach, do not eat for 30 minutes post-administration.Monitoring and Follow-UpMonitoring would involve checking TSH and free T4 levels in 6-8 weeks post-initiation to adjust the dosage accordingly. Continuous monitoring every 6-12 months after stabilization would be…...

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ReferencesRoss, D. S. (2022). Treating hypothyroidism is not always easy: when to treat subclinical hypothyroidism, TSH goals in the elderly, and alternatives to levothyroxine monotherapy. Journal of Internal Medicine, 291(2), 128-140.Wiesner, A., Gajewska, D., & Pa?ko, P. (2021). Levothyroxine interactions with food and dietary supplements–a systematic review. Pharmaceuticals, 14(3), 206.Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: Diagnosis and treatment. American family physician, 103(10), 605-613.Scenario 2: Joe\\\\\\\\\\\\\\\'s Type II Diabetes and Renal ConcernsProblem DescriptionJoe, a 48-year-old male with Type II Diabetes Mellitus, presents with poorly controlled blood glucose levels as indicated by a fasting blood glucose of 225 mg/dL and HbA1c of 7.5%. Additionally, he has chronic kidney disease (CKD) with an eGFR of 28 and elevated creatinine levels.Treatment Plan and MedicationsGiven Joe\\\\\\\\\\\\\\\'s diabetic condition coupled with CKD, a careful choice of antidiabetic medication is crucial. Metformin is generally first-line; however, his renal function prohibits its use (Song et al., 2021). A suitable alternative would be:Medication OrderDapagliflozin 10 mg orally, once daily before breakfast.Monitoring and Follow-UpJoe\\\\\\\\\\\\\\\'s response to Dapagliflozin should be closely monitored through regular kidney function tests and HbA1c levels every 3 months to assess efficacy and kidney health (Jabbour et al., 2020). Blood pressure and cardiovascular status should also be regularly evaluated.Patient EducationIt is important to educate Joe on recognizing signs of hypoglycemia and the importance of maintaining a balanced diet alongside medication. He should also be informed about the potential for increased urination and signs of urinary tract infections, as these are common side effects of SGLT2 inhibitors like Dapagliflozin (Mayhoub et al., 2022).ReferencesJabbour, S. A., Frías, J. P., Ahmed, A., Hardy, E., Choi, J., Sjöström, C. D., & Guja, C. (2020). Efficacy and safety over 2 years of exenatide plus dapagliflozin in the DURATION-8 study: a multicenter, double-blind, phase 3, randomized controlled trial. Diabetes Care, 43(10), 2528-2536.Mayhoub, H., BouBou, A., & Kaddar, N. (2022). Assessment of Genital and Urinary tract infections in patients with Type 2 Diabetes Mellitus treated with Dapagliflozin. Bulletin of Pharmaceutical Sciences. Assiut, 45(2), 953-965.Song, A., Zhang, C., & Meng, X. (2021). Mechanism and application of metformin in kidney diseases: An update. Biomedicine & Pharmacotherapy, 138, 111454.Scenario 3: Management of Diabetes Mellitus in a Commercial DriverProblem and Plan for JoseJose, a 55-year-old truck driver with poorly controlled Type II Diabetes Mellitus, presents with significant hyperglycemia (fasting blood glucose of 325 mg/dL, HgA1C = 10.6%). His current regimen of Metformin and Glipizide is inadequate for controlling his glucose levels.Medication AdjustmentConsidering his current regimen and the need for stricter glucose control, an addition of a sodium-glucose cotransporter 2 (SGLT2) inhibitor could be beneficial. However, given his sulfa allergy and the possible sulfa cross-reactivity in some SGLT2 inhibitors, careful selection is essential. Empagliflozin, which has no known sulfa allergy concerns, can be initiated (Shi et al., 2022).PrescriptionEmpagliflozin 10 mg PO daily, to be taken in the morning.MonitoringThere should be a monthly follow-up for the first three months to monitor fasting blood glucose and HgA1C. There should also be regular monitoring of renal function and signs of urinary tract infections or dehydration (Refardt et al., 2020).Patient EducationJose should be informed about the importance of maintaining his medication schedule, recognizing signs of hypoglycemia and hyperglycemia. He should also be given to understand the importance of regular exercise and diet control. Additionally, he should be educated about the potential side effects of Empagliflozin, including the risk of genital infections and dehydration (Meyer et al., 2022).ReferencesMeyer, K. S., Roberts, J., & Sasser Croley, K. (2022). Part Four: Identifying, Managing, and Preventing Adverse Effects of Diabetes Medications. The Senior Care Pharmacist, 37(8), 310-316.Refardt, J., Imber, C., Sailer, C. O., Jeanloz, N., Potasso, L., Kutz, A., ... & Christ-Crain, M. (2020). A randomized trial of empagliflozin to increase plasma sodium levels in patients with the syndrome of inappropriate antidiuresis. Journal of the American society of nephrology, 31(3), 615-624.Shi, F. H., Li, H., Shen, L., Xu, L., Ge, H., Gu, Z. C., ... & Pu, J. (2022). Beneficial effect of sodium-glucose co-transporter 2 inhibitors on left ventricular function. The Journal of Clinical Endocrinology & Metabolism, 107(4), 1191-1203.Scenario 4: Management of GERD in an Elderly WomanProblem and Plan for JennyJenny, a 63-year-old woman, is experiencing persistent symptoms of GERD despite using OTC Prevacid. Her symptoms suggest a need for a more potent acid suppressive therapy and lifestyle modifications.Medication AdjustmentGiven the partial response to Prevacid and severity of symptoms, especially nocturnal symptoms, switching to a more potent Proton Pump Inhibitor (PPI) could be warranted (Rettura et al., 2021).PrescriptionEsomeprazole 40 mg PO daily, 30 minutes before breakfast.MonitoringThere should be a follow-up after 4 weeks to assess symptom control. There should also be an annual review or sooner if symptoms persist or worsen (Naik et al., 2020).Patient EducationJenny should be advised to avoid eating late at night and to elevate the head of the bed to reduce nocturnal symptoms. She should avoid foods that can exacerbate GERD symptoms, such as fatty foods, chocolate, caffeine, and spicy foods. She should be made aware of the potential side effects of long-term PPI use, including the risk of osteoporosis and vitamin B12 deficiency, should be communicated (Castellana et al., 2021).ReferencesCastellana, C., Pecere, S., Furnari, M., Telese, A., Matteo, M. V., Haidry, R., & Eusebi, L. H. (2021). Side effects of long-term use of proton pump inhibitors: practical considerations. Pol Arch Intern Med, 131(6), 541-549.Naik, R. D., Meyers, M. H., & Vaezi, M. F. (2020). Treatment of refractory gastroesophageal reflux disease. Gastroenterology & Hepatology, 16(4), 196.Rettura, F., Bronzini, F., Campigotto, M., Lambiase, C., Pancetti, A., Berti, G., ... & Bellini, M. (2021). Refractory gastroesophageal reflux disease: a management update. Frontiers in medicine, 8, 765061.

Critical Pathway: Chronic enal Failure
Advanced Pathophysiology

egents Online Degree Program

Critical Pathway: Chronic renal failure

Chronic renal failure is often occasioned by chronic kidney disease, immune disorder, trauma among other conditions. It does not have any specific symptoms and might include feeling unwell generally and experiencing a reduced appetite. It is diagnosed following screening of individuals who are identified to be at risk of kidney problems, like individuals with diabetes or high blood pressure and others who have blood relative with chronic kidney disease. It always seems complex when trying to come up with the right diagnosis for a patient.

M.A. is a 60-year-old man who has a stage V chronic kidney disease mainly as a result of diabetic nephropathy and a 12-year of type 2 diabetes. He has symptomatic peripheral vascular insufficiency, and 3 years ago he had undergone coronary artery bypass 3. Within the ten months that passed, Mr. M.A. had been…...

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References

Ahern J, Kruger DF, Gatcomb P, Petit W, Tamborlane W.,(1989). The Diabetes Control and Complications Trial (DCCT): the trial coordinators perspective. Diabetes Educ 15:236 -- 281

Bassilios N, Launay-Vacher V, Khoury N, et al. (2001) Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrol Dial Transplant.

Blum RA, Comstock TJ, Sica DA, et al.(1994). Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clin Pharmacol Ther;56(2):154-159

Brawek B, Loffler M, Dooley DJ, Weyerbrock A, Feuerstein TJ.(2008) Differential modulation of K (+)-evoked (3)H-neurotransmitter release from human neocortex by gabapentin and pregabalin. Naunyn Schmiedebergs Arch Pharmacol.:376(5):301-307

Pathologists are often called 'the doctor's doctor ' -- when other doctors are experiencing an impasse, they go to a pathologist for advice, to provide clarity. As someone who has always enjoyed working as a teacher and preparing teaching materials, I look forward to this role in relation to my fellow physicians.
pon arriving in the nited States to practice medicine, I gained experience in the field of pathology-related research, collecting data about survival rates of patients with colorectal cancer and inflammatory bowel disease. I came to learn how pathology touches all fields of medicine. Even in my work with patients suffering substance abuse and psychiatric problems, I saw how the progression of the addiction created a pathology in terms of the way that the body responded to the patient's negative behaviors. I hope that this residency program will expose me to the laboratory and clinical aspects of the field,…...

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Upon arriving in the United States to practice medicine, I gained experience in the field of pathology-related research, collecting data about survival rates of patients with colorectal cancer and inflammatory bowel disease. I came to learn how pathology touches all fields of medicine. Even in my work with patients suffering substance abuse and psychiatric problems, I saw how the progression of the addiction created a pathology in terms of the way that the body responded to the patient's negative behaviors. I hope that this residency program will expose me to the laboratory and clinical aspects of the field, and give me the ability to learn from -- and perhaps to teach -- others who are grappling with issues spanning from cancer to nephrology to infertility to lifestyle-related illnesses.

From birth to death, I have seen the many varied states the human body can take in health and illness. My desire to engage in a pathology rotation is based upon these past, formative experiences and my desire to place this diversity within the uniquely helpful paradigms particular the discipline. By the end of the residency I know I shall not have realized my goal of becoming a 'doctor's doctor' but I am eager to enter upon the path and begin this lifelong journey.

J. Carlos Manivel, "Choosing pathology as a specialty," the University of Minnesota, May 2, 2010, [August 21, 2010] http://residency.pathology.umn.edu/

Tylenol Overdose
Health Sciences 101

The Health Impact of Acetaminophen Overdose

Acetaminophen (APAP) is a common over-the-counter (OTC), antipyretic, anti-inflammatory, analgesic that is more commonly known as Tylenol®, a product of Johnson & Johnson1. Overseas the drug is called paracetamol and is manufactured and sold by countless generic drug makers.

A number of concerns regarding the safety of APAP have arisen over the past several years, including liver and kidney toxicity and adverse cardiovascular and cardiopulmonary effects. This essay will provide an overview of APAP, its uses, and safety issues, with an emphasis on the cardiopulmonary system.

Mechanisms of APAP Activity

The analgesic and antipyretic activity of APAP was thought to be similar to other non-steroidal anti-inflammatory medications because it was believed to inhibit prostaglandin (PGE2) synthesis2,3. This assumption has not withstood the test of time, for either APAP or other popular OTC non-steroidal anti-inflammatory drugs (NSAIDs). The main evidence against NSAIDs affecting PGE2 synthesis is…...