Author: Hellen P

Case Study 2

A 43-year old male sheep-farmer presents to his general practitioner complaining that he is “going yellow”. He first noticed this one week previously. He has no other symptoms.

Until last year this man lived and worked in rural Greece, but he retired to the United Kingdom to be close to his family. Other than coming to the UK he has never travelled outside mainland Europe.

Physical examination reveals mild jaundice and a moderately enlarged liver, which is otherwise entirely normal. An abdominal ultrasound examination reveals the presence of a 9cm fluid-filled cavity within the right lobe of his liver and dilated intrahepatic bile ducts, and is otherwise normal. Computed Tomography (CT) scanning confirms the presence of a 9cm liver cyst and dilated bile ducts, but again is otherwise normal.

What two parasitic (i.e. helminthic or protozoan) diseases are most commonly associated with large fluid-filled masses in the liver?

The most common causes of fluid filled masses in the liver are Echinococcus granulosus and Entamoeba histolytica.

Based on epidemiology and clinical findings, which is the most likely parasitic diagnosis in this case, and why?

The most likely diagnosis is Echinococcus granulosus as the patient has developed a liver cyst which the parasite is most commonly associated with. Entamoeba histolytica is more commonly associated with liver abscesses.

Describe in detail how this disease is acquired

Echinococcus granulosus is most common in areas of sheep and cattle farming. The eggs of Echinococcus granulosus are ingested by humans by contact with faeces from an infected animal (usually dogs and sheep), by direct contact with animals that are infected (e.g. contaminated fur) or by plants that have faecal contamination containing the eggs of the organism.

The disease (Cystic Echinococcosis) is caused by the metacestode stage of the life cycle, this is a cyst containing hydatid fluid. Soon after ingestion of the eggs the metacestode develops, this begins as a small vesicle and over time inflates in size until a granulotomous reaction in the host is induced. A fibourous tissue reaction follows along with the development of a connective tissue layer called a pericyst (Eckert & Deplazes 2004). The cyst gradually grows in size over time, and a range of symptoms can be observed mainly due to the pressure applied to the liver (Goering et al 2008).

4. Give a full account of the diagnostic methods that are available to confirm this diagnosis, and suggest specific test(s) that should be undertaken in this patient.

CT or ultrasound scans and radiography are important in detecting cysts caused by this organism and a CT scan was performed with the patient. Serological tests can also be performed for the diagnosis of Echinococcus granulosus, including ELISA, hydatid immunoelectrophoresis, latex agglutination and indirect haemagglutination test, but the results for these are sometimes not reliable. Immunoelectrophoresis and immunoblotting are now along with ELISA more common to use in diagnosis. The condition can also be diagnosed morphologically by staining with trichrome stain or Ziehl-Neelsen stain. These stains make the protoscoleces (hooklets) more easily recognisable. Finding these protoscoleces in fluid leaked out from the cyst is another way to confirm the presence of the organism (Brown 1996 & Goering et al 2008, Eckert & Deplazes 2004, Zhang et al 2003). An ELISA test could be performed to detect any antibodies to the parasite. Immunoblotting could also be performed to confirm the diagnosis.

5. Describe the life cycle of the infecting organism as fully as possible, using appropriate terminology. Compare and contrast this life cycle with that of Taenia saginata, the beef tapeworm.

The adult phase of the organism is a tapeworm that resides in the digestive tract of dogs. The adult tapeworm releases eggs into the faeces that are unknowingly consumed by an intermediate host e.g. sheep, pigs, or humans etc. The eggs then hatch in the host intestine and the oncospheres larva pass through the gut wall. The oncospheres travel to the liver via the blood or lymphatic vessels, but can also cause problems in the lungs, eyes, brain and other organs. The oncospheres then reach the liver and continue to grow, and becomes encysted becoming the metacestode phase. The parasite is usually passed back to the canid by the consumption of offal from the intermediate host. The consumption of herbivores e.g. sheep by humans results in the transmission of the parasite and the human host is a dead end for the life cycle. (Goering et al 2008, Brown 1996, Eckert & Deplazes 2004, Zhang et al 2003).

The life cycle of Taenia saginata has distinct similarities and differences. The parasite resides in the intestine of animals and humans and they shed proglotids which contain many eggs which are subsequently passed out along with the faeces. This results in the contamination of soil and water where the proglotids release the eggs. These are consumed without knowledge by the intermediate host which is very similar to Echinococcus granulosus. The eggs hatch in the intestine and the oncospheres pass through into the blood to reach other tissues and organs in the body and become encysted. This is also very similar to the equivalent life cycle stage of Echinococcus granulosus. The main difference is that humans are not a dead end host as if the meat contaminated with cysts of Taenia saginata is ingested the cysticerci are released at an adult tapeworm develops after attachment to the gut wall. This completes the life cycle of Taenia saginata (Cox, FEG 2002).

Give a full account of the treatment options that are available for this disease, and the possible complications of the disease and/or its treatment.

Surgery is the most desired treatment to remove the cyst from the liver and can result in the complete eradication of the parasite. Before surgery is performed, albendazole and praziquantel is sometimes given and then for one month and two weeks respectively after surgery. This should also be given after surgery for the same amount of time, the reason for this being that by sterilising the cyst the risk of anaphylaxis due to the release of fluid from the cyst is reduced along with the tension of the cyst. This can also decrease the risk of the cyst reappearing after surgery by eliminating the organism (Pan & Hunter 2007). If surgery is not performed correctly and larvae are released they can go on to cause infection in other parts of the body (Goering et al 2007). Surgery is not possible in some cases of the disease, for example if a patient has multiple cysts or is unable to undergo surgery for whatever reason. In these cases PAIR (Puncture-aspiration-injection-reaspiration) technique can be preformed, this involves the puncture of the cysts with a needle, this allows some drainage of the cyst. An antiparistiocidal solution is then injected into the cysts, this solution consists mainly of ethanol but NaCl can be used alternatively. There is then reaspiration of the fluid in the cyst. During and after this procedure albendazole should be given to prevent secondary infection. Percutaneous thermal ablation is also a technique which could be used.

For patients where cysts are inoperable, treatment with benzimidazoles is undertaken. After this treatment the patient may relapse but the disease can be treated again (Eckert & Deplazes 2004).

References

Brown,S (1996). Medical Microbiology. 4th Edition. Churchill Livingstone Inc. USA. Accessed from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=mmed&part=A4689#A4698 on 11th November 2009.

Cox, FEG (2002). History of Human Parasitology. Clinical Microbiology Reviews. 15(4): 595-612

Eckert, J & Deplazes, P (2004). Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern. Clinical Microbiology Reviews. 17(1): 107-135

Goering, RV, Dockrell, HM, Zuckerman, M, Wakelin, D, Roitt, IM, Mims, C & Chiodini, PL (2008) Mim’s Medical Microbiology. 4th Edition. Elsevier, China.

Z. Pan & W. J. Hunter (2007): Hydatid Cyst Of The Liver: A Case Report And Review Of The Literature. The Internet Journal of Parasitic Diseases. Volume 2; Number 1. Accessed from http://www.ispub.com/journal/the_internet_journal_of_parasitic_diseases/volume_2_number_1_48/article/hydatid_cyst_of_the_liver_a_case_report_and_review_of_the_literature.html. on 11th November 2009.

Zhang, W, Li, J & McManus, DP (2003). Concepts in Immunology and Diagnosis of Hydatid Disease. Clinical Microbiology Reviews. 16(1): 18-36

Love is usually coupled with a number of ups and downs. It is this series of ups and downs that have fascinated one of the greatest songwriters of musical theater Ted Sperling, who is an award winner of the Tony Awards to create a song cycle titled “A Broadway Romance.” The show was first performed at the Café Carlyle with the graceful performances of Rebecca Luker as Mary Poppins and Howard McGillin as the Phantom of the Opera. The music cycle is from a selection of only 14 tunes portraying how couples struggle with relationships.

There are many favorites that are missing from this honeyed potpourri but the musical exploration of a fictitious relationship of a couple yields the satisfying rewards. In the musical cycle Luker and McGillin tap effortlessly into the feelings that loving couples experience in their opening numbers of “Something’s Coming” by Leornard Bernsteins and Stephen Sondheim and “The Man I Love” by Ira and George Gershwin. Then the couple brings in the reminisces of meeting that special person for the first time by singing two songs by Jerry Bock and Sheldon Harbnick titled “Will He Like Me” and “Tonight at Eight.”

The cycle continues for a total of 70 minutes with the song choice ranging from the slightly predictable songs of first love to the least expected. However the best moment of the cycle is brought out when the performers are brought together to make a group of true magic. They portray how the love grows into something bigger and the joy of having kids in the process. They also tease if there is a way that one cam leaves the other but there is no reason. Instead they sing “Getting Married Today” symbolizing how important it is to get married.

In a nutshell, listening to “A Broadway Romance” puts you in a position of being totally in love. It is a song cycle arranged and organized which makes you feel like you are almost in love.

Read Also: Finding Nemo: Sample Movie Review

The growth of physical infrastructures in many countries has been on the realm of focus in the past two decades. It has been established that the effect of civil construction spans across the primary sectors that greatly influence the economy of any country. This ranges from infrastructural developments, telecommunication systems, sewerage and water supply systems. In all these sectors, career opportunities found for civil contractors is immense.

There has been a misconception that the civil construction industry only employs engineers and other unskillful laborers. But in reality, engineers are only the integral part of any construction work with the other departments requiring graduates with other qualifications such as accounting, financing, inventory management, township administration, garnering resources and even lawyers. Some of the career options in civil construction include:

Project Management

Any construction project requires a construction management profile which can manage all the aspect and organization of the project from the start to the end. The responsibilities of a project manager include managing employees, getting new contractors, creating a budget for the project, coming up with regular reports on the progress of the project and organizing the usage of the equipment. If you are willing to enter the construction industry as a project manager, you have to take a course that trains you the above skills and proper application of the skills.

Software programmers

There are a wide range of software and applications used in civil construction. With the dynamism in technology and the increased demand for simplifying work, new softwares are being introduced every day. As a software programmer or system analyst, you can place your skills to the edge of the job market by coming up with software needed in a given construction project. Taking an extra course in building codes and standards, contract administration and value analysis can be helpful in acquiring an opportunity as a software programmer.

Financial management

There is no project that can run without any funding. No matter how much funds the vendor gives out, there is still need for a person to handle the monetary or financial aspects of the projects. Career options in this department include financial analyst, accountant, financial consultant, tax consultant and give any financial guidance required in the project.

Legal consultant

Every project requires a person to handle legal aspects. Being proficient in the law can allow you to become a legal advisor to explain all the law provisions of the civil construction industry. You can also be a lawyer to handle all the legal disputes that may arise in the day to day activities. Furthermore, it will be your duty to guide the project vendors in acquiring licenses and title to the project.
To sum it up, the civil construction industry is not constrained to engineers only. There are also other career options that a person can grow into. However, working in the civil construction industry requires a person be proficient in Algebra, English, Math and Social Studies.

Read Also: Sample Article Review

The American Composers Orchestra which is popularly known as ACO is an American orchestra band based in New York. It has been in the music industry for quite a long time of duration since the 1970s. The orchestra is known widely for being the only band in the world which is solely dedicated to creating, performing, preserving and promulgating music made by the American composers. The orchestra is large and organizes some of the biggest concerts in the U.S.

The ACO usually organizes its concerts mainly at the Carnegie Hall though there are also other venues where a couple of things are done including New Music Readings, educational programs, radio broadcast and recording. From these events, the orchestra is able to identify the new emerging and unknown composers from different regions to expose to the industry. In essence the aim here is to establish the lesser-known composers from the regional status and take them to a national or international status of orchestra music. They also expose the composer to the new trending styles reflecting the geographical differences and the temporal diversity.

In addition ACO is also an incubator of ideas where composers can deposit their ideas to be grown to something bigger and better. There is a lot of talent and research in the orchestra which acts as a catalyst to the growth and changes of the orchestra therefor the ACO acts as an advocate to the American composer and the music that they compose. Up to date ACO has held numerous concerts in which numerous performances from more than 500 new American composers been presented. These performances also include more than 100 performances of newly commissioned work and world premieres.

In a nutshell, attending the ACO concerts can have many benefits especially if you are a newly talented composer. Furthermore if you love orchestra music then this is one concert that you would never want to miss.

Read Also: Logos, Ethos, and Pathos

Retail management

1. Cite the Article:

Enders, A., & Jelassi, T. (2009). Leveraging Multichannel Retailing: The Experience of Tesco.com. Mis Quarterly Executive, 8(2), 89-100

2. Summarize the highlights of the article

Objective/hypothesis

The article aims to get detailed understanding of how Tesco.com has achieved its present success.  What they are doing to stand out when their competitors are being swept from the market. I also aimed to find out how they manage to keep their online retailing approach afloat while their competitors tried and failed. How they maintain their customers and acquire customer loyalty.

Method of data collection

It relied on and used two types of data collection, that is, primary data and secondary data. Primary data involved the use of interviews from the top management team of Tesco.com and the customer who shop in Tesco.com. Secondary data from Tesco.com website and public relations material to get more insights on the research topic.

Findings

Learning by practicing and advancing E-business operations strategies time and time again should enables Tesco.com to know the right time to upgrade their facilities to suit the demand at a given time hence, viability is achieved. It’s vital to take initiatives of handling the existing Online and Offline Channel Conflicts because it will likely be decreased especially when managers of physical stores take part in the revenues acquired by the online channel. Online channels are important as they contribute a lot to the success of the physical channel. The sales obtained from online sales of a given store can be attributed to that store.

I found out that in order to trace the attainment of any online business, Tesco.com apportions only the costs that were initiated by the addition of the online fulfillment service to the offline channel.

Tesco.com offers a simple shopping experience to its consumers especially when it comes to online transactions.  It makes it easy for its shoppers to identify the products they need from the online site since the procedure is understandable.

Tesco.com always retrieves data online about their shoppers, even on the goods they looked up but didn’t buy. These helps those to strategize on the products highly demanded and those that are not.

3. Explain the Significance of the article

The article fills a huge void that existing literature doesn’t provide because it clearly outlines the procedures on how successful online retailing can be achieved. It provides information on the vital considerations that should be put in place to make online retailing viable. For those who have tried online retailing and failed, the article clearly explains the possible reasons for their failure and what strategies to put in place in order to succeed.

4. Evaluation of the article

The article is well written because it gives full details of its main subject. It clearly elaborates how the research did their research, that is, the methods they used to collect their data. It explains the elements of its findings by using figures that facilitate in-depth understanding. It also gives a brief description of the authors and their qualifications, which are impressive. There is no harm in doing more research as it a source of more discoveries, but the article is good enough to assist many business people interested in online retailing.  It provides information on how one can remain afloat in their businesses using online retailing. It is a strategy that is vital in business management mainly to prevent it from closing down.

5. How the article relates to the course

The article provides valuable information to Retail Management as a course. It conveys trends that shape the retail landscape, services offered, and how to use the opportunities available to exploit the existing marketing gaps. It provides information on how a business can remain afloat and optimize profits using online retailing strategies.

Read Also: Sample Case Study Analysis