Category: Sciences 2502

Introduction

Hypothyroidism is one of the most common deficiency disorders among canines although it can not be easily diagnosed. It was first diagnosed in canines (dogs) in the 1970s (Volhard, & Volhard, 2011). It is mainly caused by an impairment of the thyroid gland responsible for the production and secretion of essential thyroid hormones (Bell, Latimer, LeRoy & Moore, 2005). This results in a significant decrease in the rate of metabolism. The disease is the most common endocrinopathy of the cat, dog, and other canines. Veterinary experts observe that the disorder is very common in canines (Mecklenburg, Linek & Tobin, 2009). The effects of hypothyroidism are so vast that they can spread through other body organs and hence altering their normal functioning. This explains why the disorder is associated with so many other medical problems. In dogs, the thyroid gland exists as two halves. The shape as well as the functions of the gland is similar to that in human beings.

Hypothyroidism in dogs may be classified into; primary hypothyroidism, secondary and tertiary hypothyroidism. The classification depends on where the cause lies; either in the thyroid gland, pituitary gland or in the hypothalamus (Flood & Hoover, 2009). The thyroid gland is situated in the trachea, located just below the larynx. The hormone released from this gland can either be active or inactive. The active hormone is referred to as triiodothyronine (T3) while the inactive form is commonly known as T4 (thyroxine) (PetWellbeing, 2011). Once the inactive hormone is released into the blood stream, it is soon converted into T3 and can then penetrate specific body tissues. The amount of T4 produced is normally regulated by the anterior pituitary gland. The research paper will analyze hypothyroidism in canines in terms of its causes, signs and symptoms, diagnosis and available treatment options. Due to the large number of species that can potentially be affected by this disorder, this paper will focus mainly on dog hypothyroidism.

Causes of Hypothyroidism

Common causes of hypothyroidism in dogs have been established and they are responsible for about 95% of all primary hypothyroidism (Day, 2008). Lymphocytic Thyroiditis and Idiopathic Atrophy are the two most known causes of hypothyroidism due to thyroid gland disorder. According to research findings, Lymphocytic Thyroiditis is a genetic predisposition to hypothyroidism and accounts for about 50% of all primary hypothyroidism cases (Mecklenburg et al., 2009; Day, 2008). It is believed that its cause may be associated with autoimmune polyglandular syndrome in some animals. This is a situation where the body system releases and circulates harmful antibodies that fight the thyroid gland. An impaired thyroid gland results in decreased production of thyroid glands. Lymphocytic thyroiditis is characterized by the infiltration of immune cells that automatically produces antibodies to the thyroid tissue. Inflammatory cells also infiltrate into the thyroid gland where they interact with hormones. It is this interaction that is responsible for the formation of immune complexes in the thyroid gland resulting in inflammation and series of biochemical reactions that in turn damage and degenerate the thyroid gland (Day, 2008). Studies estimate that about 42% to 59% of all dogs suffering from thyroiditis have antithyroglobulin antibodies (Mecklenburg et al., 2009). This dangerous process marks the onset of hypothyroidism. Hypothyroidism has been found to affect large and gigantic breeds of dogs which include the Great Dane, Douge de Bordeaux, English Mastiff, Leonberger and Golden Retriever (Coile, 2009).

Idiopathic Atrophy, on the other hand, is believed to mark the last ages of lymphocytic thyroiditis. It is characterized by sudden increase in the number of small thyroid follicles which are normally responsible for the synthesis of hormones (Ward, 2007). Due to their very small sizes, little hormones will be synthesized. Any attack on the thyroid gland causes low circulation of thyroid hormones and lack of feedback inhibition resulting in the formation of thyroid-stimulation hormone (TSH). The TSH then stimulates the gland triggering an increase in the number of the small follicles. This chain of reactions causes the thyroid tissue to fail in its functions.

Neoplasia is another cause of primary hypothyroidism although not very common. The Squamous Cell Carcinoma infiltrate into the thyroid gland and subsequently destroys the thyroid tissue. Thyroid Carcinoma also enters the same gland cause extensive damage. However, studies have shown that these tumors are not known to synthesize hormones (Coile, 2009). This implies that the destruction of the thyroid tissue and not hormones are responsible for the onset of hypothyroidism in animals.

Decreased secretion of normal (TSH) by the pituitary gland causes a special type of thyroid disorder known as secondary hypothyroidism. The result is the weakening and degeneration of the thyroid gland causing this category of hypothyroidism. However, this cause is responsible for less than 5% of hypothyroidism prevalence. The pituitary gland regulates a number of glands in the body including the adrenal and gonadal glands. Any problems with the pituitary will most likely result in several clinically significant signs associated with other abnormalities. Moreover, the pituitary gland is affected by any neurological deficiencies due to its nearness to the base of the brain (Ward, 2007). Generally, secondary hypothyroidism is caused by genetic malformation which is present at birth, malnutrition, use of certain drugs, and neoplastic invasion or destruction. There has been no scientific proof that tertiary hypothyroidism can occur in dogs. This has been occasioned by the lack of reliable assays that can effectively measure the circulating Thyroid-releasing hormone (TRH) (or TSH). Research into the development of the assays is ongoing. Proper diagnosis and understanding of the causes of hypothyroidism in canines are critical for successful treatment (Bonham, 2005).

Signs and Symptoms of Hypothyroidism

Given the role of thyroid hormones in virtually all organ systems of the body, any insufficiency will cause abnormalities in these organs (Volhard, & Volhard, 2011). This makes it easy to identify most of the signs and symptoms of thyroid disorder. However, the many signs and symptoms accompanying hypothyroidism makes it to be easily mistaken for many other diseases with similar manifestations like cancer and diabetes (Flood & Hoover, 2009). This calls for a very keen diagnosis of hypothyroidism disorder. Several signs and symptoms of hypothyroidism have been documented by veterinary specialists. An infected dog will show mental dullness or sudden changes in behavior, sluggishness, and increased appetite causing obesity or weight gain. Over 75% of dogs suffering from hypothyroidism have increased levels of blood cholesterol (Case, 2005). More signs include the dogs inability to tolerate low temperatures, septic wounds due to poor healing, shaggy skin and hair coat, abnormality in hair turnover or loss of hair, the hair becomes brittle and dull, and pigment alteration. The sick dog will also have an oily or dry skin and the skin may be thickened due to a swelling as a result of abnormal dermal milieu turnover (myxedema) (Gross, 2005). Generally sad expression on the face, odiferous and itchy skin caused by secondary bacterial and yeast dermatitis, diarrhea, or constipation, and occasional bleeding are other common manifestations of hypothyroidism disorder.

The signs may also be neurological characterized by seizures and nervous system deficits. Problems in the nervous system may cause blindness, droopy eyelids, paralysis of eyelids and low production of tears resulting in the irritation, reddening, and drying of the eyes, staggering due to vestibular deficits, dragging of feet, general body weakness, and problems in swallowing on some occasions (Coile, 2009). These signs and symptoms are generally easily to identify but further physical examination and laboratory work will yield even more symptoms of hypothyroidism.

These cardiovascular signs can be arrhythmia and bradicardiya, which are abnormal electrical activity in the heart. Heart arrhythmia which is characterized by slower rate of heart beat, anemia, and high levels of serum cholesterol are some of the signs that may manifest upon further examination (Ward, 2007). There are also neurological symptoms that can come along with this disease as well. This may include such problems as those associated with the central nervous system, focal neuropathy or polyneuropathy. Focal neuropathy is caused when there is an increase in pressure on the skull or spinal cord. On the other hand, failure of the nerves to conduct normal nerve impulses in the body causes polyneuropathy. Furthermore, there are ocular signs such as increased blood pressure and cornea dystrophy, which causes the covering of the eye to become slightly bluish (Flood & Hoover, 2009). Although no fixed age marks the onset of hypothyroidism, research has shown that the disease occurs mostly in dogs between 4 and 10 years of age. All these signs and symptoms may coexist and this explains why the diagnosis of the disease can be quite difficult.

A specific case can be obtained from a study published by Flood and Hoover (2009) in the Canadian Veterinary Journal. They carried their investigation on an old male Alaskan malamute by monitoring it for two weeks. They found out that the eight-year-old malamute exhibited symptoms of lethargy, inappetence and had a swollen abdomen. After physical examinations were done, the dog was found to be obese and the heart sounds were muffled due to an arrhythmia (atrial fibrillation). Atrial fibrillations were confirmed by performing an electrocardiogram. The rapid and irregular heartbeats caused poor flow of blood to the rest of the body. This was found to occur when beats of the upper and the lower chambers of the heart were out of synch (Flood & Hoover, 2009). Moreover, the dog had facial myxedema usually caused by the accumulation of mucopolysaccharides in the skin.

To conclude that the dog had hypothyroidism, several tests were performed. After the atrial fibrillation was confirmed, a complete blood cell count revealed moderate leukocytes. A serum biochemical profile showed increased alanine aminotransferase and creatine kinase. The researchers also measured the levels of T3, T4, free thyroxine and free triiodothyronine. The results indicated that there was a decrease in the total thyroxine, triiodothyronine and free thyroxine and an increase in TSH. Upon analysis of the results, it was confirmed that they were consistent with severe primary hypothyroidism. It is evident from this study that many other problems accompany hypothyroidism which in turn affects several other body organs.

Thyroid dysfunction can result in numerous problems in other body organs due to little or lack of thyroid hormone which is responsible for metabolism (Flood & Hoover, 2009). The destruction of the thyroid gland causes hypothyroidism in most animal species especially canines. Hypothyroid dogs have been found to manifest numerous signs and symptoms that are as a result of failure of not only the thyroid gland but also other organs like the Central Nervous System (CNS), Reproductive organs, and the Skeletal system (The Merk Veterinary Manual, 2011). Thyroid hormones play a crucial role in ensuring the growth and development of the skeletal system as well as the CNS. This is particularly so during the fetal stage through the first few months of postnatal stage of life. Congenital as well as juvenile-onset hypothyroidism is largely responsible for the impairment of the CNS and the skeletal system (Bonham, 2005). They are characterized by disproportionate dwarfism, impaired cognitive development, and general loss of coordination in movement. Goiter is associated with hereditary hypothyroidism which is characterized by the swelling of the thyroid gland. The disorder causes a generally poor development of epiphyses in the entire length of the long bones, very short vertebral bodies, as well as delay in the closure of epiphyseal. In female dogs, hypothyroidism causes failure to cycle, infertility, premature births, and high litter mortality rate (Kustritz, 2009). Male dogs, on the other hand, lack libido, develop testicular atrophy/degeneration, infertility, and hypospermia. However, research has shown that hypothyroid male dogs can return to normal fertility after being put on proper thyroid hormone supplements (Kustritz, 2009).

Diagnosis

Hypothyroidism has been identified as one of the most common endocrinopathy in small animal practice. The diagnosis of this disorder can be quite challenging because most clinical signs of other diseases as well as conditions may be confused with those of hypothyroidism (Gross, 2005; Flood & Hoover, 2009). The administration of exogenous thyroid hormone can help improve these signs in dogs. There is no single biochemical test that may be used to diagnose hypothyroidism. Hormonal tests that may be performed must be interpreted with both historical and physical findings in mind. A veterinarian would first review the dogs history and /or carry out physical examinations to determine the possibility of hypothyroidism. As a preliminary diagnosis, blood tests are usually performed (Coile, 2009). This initial tests help determine the levels lipids and cholesterol in blood. High levels of both are strong indicators of hypothyroid disorder. According to research findings, about 50% of dogs suffering from hypothyroidism also suffer from anemia (Case, 2005). Therefore, this condition is also usually checked during the diagnosis process.

To establish a definitive judgment, according to Gross, specific testing of thyroid function must be performed especially on the various signs linked to hypothyroidism (2005). Diagnosis of hypothyroidism in dogs is more accurate when thyroid tests are carried out. If the level of TSH is high while those of T4 and fT4 are low, then there is high likelihood that the dog could be suffering from the disorder (The Merk Veterinary Manual, 2011). The same article points out that a special TSH stimulation test may be conducted to confirm a diagnosis of thyroid disorder. When this TSH stimulation is done, the levels of T4 will not increase if the dog is suffering from this condition.

Despite the numerous tests available for the diagnosis of the endocrine disorder in canines, the process has never been easy and relying on a single test has resulted in over-diagnosis/misdiagnosis of hypothyroid disease (Mecklenburg et al., 2009). Research findings have demonstrated that the accuracy of a given diagnostic test is influenced by drugs, obesity, as well as other medical conditions. Any veterinarian must know the effects of drugs since it will facilitate correct interpretation of results and reduce incidences of erroneous diagnosis of hypothyroid disorder. It has been recommended that a combination of multiple tests usually increases the accuracy of diagnosing hypothyroidism (Daminet and Ferguson, 2003). In the veterinary field, there are a number of tests used in the diagnosis of thyroid disease. They include total thyroxine (TT4), free T4 (fT4),total 3,5,3-tri-iodothyronine (TT3), endogenous canine thyroid stimulating hormone (cTSH), TSH response test, TRH response test, T4 and T3 autoantibodies, antithyroglobulin antibodies, nuclear scintigraphy, and thyroid gland biopsy (Coile, 2009). The most commonly preferred tests are TT4, fT4 by dialysis, and cTSH.

According to an article by Foster and Smith Educational Staff (2010), a number of diagnostic tests may be used to diagnosis hypothyroidism. The first is the Baseline T4 test which is one of the most common. A blood sample is obtained from the dog by a veterinarian and the levels of T4 thyroid hormone in the blood are determined by a process known as radioimmunoassay. Thyroid gland is the only organ that produces T4 hormone. Dogs with malfunctioned thyroid gland will have very low levels of T4 hormone which is a strong indicator of hypothyroidism. To determine the decreased level of T4, the veterinarian must have prior knowledge of the normal T4 level of the suspected hypothyroid canine. However, the weakness of this particular test is that low levels of T4 may be due to other causes other than hypothyroidism. This implies that once the test is positive for the endocrine disorder, another more discriminating test should be done for confirmation purposes.

The second test identified is Baseline T3 which can be run on a suspected hypothyroid dog. As mentioned earlier, T3 is a type of thyroid hormone circulating in the bloodstream. This test may be used alternatively with that of T4 when performing a screening test. The major difference in these two tests, however, is that T3 is not reliable when it comes to detecting early cases of the disorder. Occasionally, the levels of T3 will be found to be normal while a T4 test records reduced levels. The only appropriate time when this test can be used is together with TSH level or TSH stimulation test.

Another diagnostic test discussed in the article is free T4 (fT4) by equilibrium dialysis. The T4 hormone exists in the body in two forms. The first is commonly referred to as the bound form. It is attached to proteins found in the blood and is therefore not able to penetrate cells. The free T4 hormone is the other form and, unlike the T4, it is not connected to proteins in blood. This makes it easy to infiltrate into cells and perform its functions. The amount of fT4 in the bloodstream is usually quite small. However, advances in veterinary medicine have seen the development of equilibrium dialysis which is a special laboratory test that can accurately measure the fT4 in the blood.

The fourth test employed in the diagnosis of hypothyroidism is the TSH level. It is a blood test that determines the amount of TSH circulating in the bloodstream. In a dog suffering from hypothyroid disorder, the TSH level will be high due to the reaction of the body is trying to stimulate the thyroid gland to release more thyroid hormone needed for the proper functioning of other organs in the body, especially for metabolism. Once it is found that the levels of the Baseline T4 as well as Baseline T3 are much lower than normal and the TSH level is significantly high, then a veterinarian can conclude that the dog is hypothyroid.

The fifth and the last diagnostic test discussed in the article is the TSH Stimulation which is a reliable hypothyroidism confirmation test when it has already been established that the levels of T4 and T3 are low. It is performed by injecting a small amount of TSH into the vein. The level of T4 is in the blood is then determined after six hours. A dog with no thyroid disorder but with other diseases that may cause a lot of T4 will register high levels of T4 after the procedure. When the level of T4 thyroid hormones remains relatively constant after the TSH is injected, the hypothyroidism test is positive. The results showing changes in the concentration of thyroid hormone(T4) should be interpreted while taking into consideration the history as well as the clinical signs exhibited by the dog especially the one that is under medication (Daminet & Ferguson, 2003). Some of the most important drugs that influence diagnosis include glucocorticoids, Phenobarbital, sulfonamides, propranolol, potassium bromide and carprofen. Another important factor to consider during diagnosis is the duration of treatment and the amount of drug dosage. Daminet and Ferguson (2003) note that the mechanisms by which the drugs interfere with the functioning of the thyroid are yet to be understood fully. Generally, there are other diagnostic tests for hypothyroidism but they are usually effective when used in humans but not in canines.

Treatment of Hypothyroidism

This is one of the most critical stages when it comes to caring for animals. It is strictly required that only licensed veterinarians perform the treatment of animals (Coile, 2009). They should also update their knowledge by consulting the latest literature and newly developed pharmacological formularies before any treatment protocol is initiated (Bell et al., 2005). Although hypothyroidism disorder may be difficult to diagnose, it is one of the easiest treatable diseases. According to the article by Foster and Smith Educational Staff (2010), a hypothyroid canine (dog) is placed on a dose of a synthetic thyroid hormone known as thyroxine (levothyroxine) which is to be administered daily for the rest of its life. This helps in the replacement of the reduced or missing thyroid hormone. The drug comes under a number of brand names. Normally, the severity of the hypothyroid disorder determines the dosage frequency. The other determinant of drug dosage is the response to the drug by individual dog. The prescription of the drug takes into account the animals weight, usually 0.02 mg/kg orally at intervals of 12 hours (Bell et al., 2005; Day, 2008). Once the dog has been put on medication, the veterinarian takes blood samples periodically to monitor the response and adjustment to the dose made accordingly.

Once the treatment has been made for sometime, most of the symptoms of hypothyroidism disappear but this can only be sustained as long as the dog is under medication. A good example is the 8-year-old, male, Alaskan malamute whose myocardial function and improvement in facial myxedema as well as effusions resolved with the administration of levothyroxine (Flood & Hoover, 2009). According to Bell and others, clinical improvement is the most reliable indicator of the effectiveness of the therapy (2005). These include improvement of metabolic signs like mental dullness and lethargy within a fortnight since the commencement of the therapy. Some abnormalities especially dermatologic signs, however, may take relatively longer to resolve. The overall effect of thyroid hormone replacement treatment is notable decrease in the concentration of cholesterol and triglyceride in the bloodstream as well as an increase in the red blood cell (RBC) count (Bell et al., 2005). However, this indicator is not reliable for confirming the efficacy of the therapy. The best way to treat hypothyroidism in canines is by regularly doing blood tests. This will ensure that early detection is made and medication initiated before it reaches the chronic stages where all manifestations explode (Volhard & Volhard, 2011). Other preventive measures include feeding the dogs and cats on proper diet, avoiding excessive spraying using potentially harmful chemicals, and running blood tests on a puppy before acquisition to eliminate chances of congenital hypothyroidism.

Conclusion

The research paper has elaborately discussed the causes, signs and symptoms of hypothyroidism disorder, and the organ systems that this disease could harm. The various diagnostic procedures for hypothyroid dogs have also been discussed. The functioning of the organ systems including the nervous system, cardiovascular, and skeletal is severely influenced by hypothyroidism, the most common hormone deficiency disease in dogs. Thyroid hormone plays a significant role in the body especially metabolic processes which are required by the entire body. It has also emerged from the above discussion that hypothyroidism is one of the most difficult disease to diagnose and easier to treat. The T4, T3, free T4 (fT4), TSH level, and TSH Stimulation tests are some of the diagnostic methods that can be used to determine the presence of hypothyroidism. The paper has pointed out that there is no single test for hypothyroidism but a combination of two or more can lead to accurate diagnosis. However, research on advanced diagnostic alternatives for hypothyroidism is ongoing to develop a single-test procedure for diagnosing hypothyroidism. Levothyroxine is a very common treatment option for hypothyroid dogs. The dosage of the treatment depends on the age, weight, and severity of the condition of the hypothyroid dog. Among the canines, hypothyroidism disorder is more prevalent among dogs. The main causes of hypothyroidism are genetically induced or due to an autoimmune system attack on the thyroid gland. The paper has also discussed the two most known causes of hypothyroidism disorder. This disorder must be given the attention it deserves due to the vast impact it has on other body organs. The good news with this disease is that once it is properly diagnosed and therapy started, the dog is not at risk of dying.

References

Bell, E., Latimer, K. S., LeRoy, B. E., & Moore, H. (2005). Canine hypothyroidism: an overview. Veterinary Clinical Pathology Clerkship Program

Bonham, M. H. (2005). Bring me home! Dogs make great pets. John Wiley and Sons

Case, L. P. (2005). The dog: its behavior, nutrition, and health (2^nd ed.). Wiley-Blackwell

Coile, C. (2009). The golden retriever handbook (2^nd ed.). Barrons Educational Series

Daminet, S. & Ferguson, D. C. (2003). Influence of drugs on thyroid function in dogs. Journal of Veterinary Medicine, 17: 463-472. Web.

Day, M. J. (2008). Clinical immunology of the dog and cat (2^nd ed.). Manson Publishing.

Flood, J. A. & Hoover, J. P. (2009). Improvement in myocardial dysfunction in a hypothyroid dog. Canadian Veterinary Journal, 50: 828-834. Web.

Foster & Smith Educational Staff (2010). Thyroid Diseases: Hypothyroidism in Dogs. Web.

Gross, T. L. (2005). Skin diseases of the dog and cat: clinical and histopathologic diagnosis (2^nd ed.). Wiley-Blackwell

Kustritz, M. V. R. (2009). Clinical canine and feminine reproduction: evidence-based answers. John Willey and Sons

Mecklenburg, L., Linek, M. & Tobin, D. J. (2009). Hair loss disorders in domestic animals. John Wiley and Sons

PetWellbeing (2011). Dog Hypothyroidism (Canine Hypothyroidism. Web.

The Merk Veterinary Manual (2011). Hypothyroidism. Web.

Volhard, J. & Volhard, W. (2011). Dog training for dummies (2^nd ed.). For Dummies

Ward, C. R. (ed) (2007). The thyroid. Veterinary Clinics of North America Small Animal Practice. WB Saunders Co., Philadelphia PA

Introduction

Acromegaly is a medical complication characterized by excess secretion of a Growth Hormone. Growth in human beings is facilitated by this hormone. Acromegaly term is borrowed from Greek word akros implying extremities and megas- meaning enlarged or big. The term was introduced by Pierre Marie, a neurologist from France in 1886 (Cahynur et al. 2011). The following diagrams show the effect of acromegaly (Acromegaly 2011).

After puberty, excess secretion of the hormone results in enlarged soft tissues and other related medical complications. The common etiology is the pituitary adenoma which increases Growth Hormone production and increased IGF-I concentration in serum. Acromegaly, patients are described by overgrowth in soft tissue and in the limbs. Other complications include headache, visual defects, asthenia and sweating. During the later stages, the condition is characterized by the increased size of the head and limbs. Acromegaly patients facial appearance is coarse and thickened (Chason, Leselbaum, Blumberg & Schaison 2000). They have an enlarged nose, protruded mandible, skin thickening and may have splenomegaly, hepatomegaly and enlarged kidneys. When untreated, acromegaly may turn deadly. It is a treatable condition for most patients, especially when diagnosed early. Due to its sneaky onset, it is often either misdiagnosed or not be diagnosed early. The condition is approximated to affect over eighty five thousands adults in US and Europe (Antisense Therapeutics, 2011).

This paper delineates acromegaly, its epidemiology and aetiology, diagnosis, treatment management and lastly, presents the current implications about acromegaly.

Epidemiology and Aetiology

Acromegaly is described as a rare condition. Its prevalence is approximated to be 60 cases per million with incidences of approximately 4 cases per million. 99% acromegaly condition is a consequence of benign adenoma in the pituitary gland caused by monoclonal expansion of somatroph cells. Statistics approximate that 40% of somatotrophinomas are due to mutation in the GNASI gene (gsp oncogene) (Cahynur et al. 2011).

Other causes of acromegaly in adults may be due to ectopic secretion of GH- releasing hormone or GH from carcinoid tumors or tumors of the hypothalamus, pancreas, lung and adrenal glands. Macroadenomas prevalence is higher than Microadenomas. Recent research indicated a prevalence rate of up to 130 cases per million to 1000 cases per million for biochemical acromegaly (Murray & Melmed 2008). However, the prevalence appears to be distributed equally among both sexes with a mean age approximated to be 44 years. More so, the condition has been recorded in all stages of life; starting from infancy through childhood to old age. The average delay in diagnosis is due to the duration symptoms take to manifest, and it is said to be around 8 years (Holdaway, Rajasoorya, Gamble, & Gamble 1999).

Pathology

Acromegaly condition as mentioned above occurs due to over secretion of GH in the pituitary. The pituitary gland also secretes other important hormones in the body. Such hormones include those involved in reproduction, metabolism and growth and development. GH regulates growth of the body. Metabolic pathway involved in the secretion of GH hormone begins from the brain in the hypothalamus. Hypothalamus secretes hormones, which regulate the pituitary. This hormone is referred to as Growth Hormone releasing Hormone (GHRH). The hormone stimulates the pituitary gland to secret GH: secretion of GH by the pituitary into the bloodstream, in turn, stimulates the liver to secrete an insulin-like growth factor I (IGF-I) (National Endocrine and Metabolic Diseases Information Services, 2006, p.1&2). This hormone is responsible for tissue growth in the body.

Hypothalamus also secretes the somatostatin hormone. This hormone inhibits GH production and releases: GHRH, somatostatin, GH and IGF-I levels regulate each other through certain conditions such as sleep, exercise, stress, dietary and blood sugars levels (Levy, 2004, p. 52). If one of the systems malfunctions; it alters the other mechanisms resulting in an increased level of GH, subsequently, IGF-I. As described above, Secretion of growth hormone is regulated by factors involving the interaction of somatroph- cells. Any genetic changes in somatroph cells bring about chromosomal instability and epigenetic alterations (Levy 2004).

Over 90 % of acromegaly patients are diagnosed with a benign monoclonal GH- secreting pituitary adenoma. This adenoma is surrounded by non-hyperplastic pituitary tissue. Clinical manifestations depend often, on the location of the tumor. For example, a tumor in the upward, will put pressure on the optic nerves causing visual complications. It is important to note that pituitary tumors only happen self-generated and are inherited from ancestors (Reid 2009). They only arise due to mutation change in a sole pituitary cell resulting in increased cell division and tumor formation (Reid et al., 2009). Most of the mutations are post-birth and mainly on the gene that controls chemical signals transmission in the pituitary cells. The alteration permanently switches on the cell, making it divide and secrete GH. Research is being carried out on the events that lead to disordered pituitary cell growth and the overproduction of GH (Hurley & Ho 2004).

Rarely is acromegaly caused by non-pituitary tumors. Non-pituitary tumors include tumors in the lungs, abdomen, pancreas and other parts of the brain. Research has indicated that the tumors can also result in high GH levels either through secretion of the hormone themselves, or produces GHRH hormone responsible for pituitary stimulation to release GH. Surgical removal of these tumors causes a decrease in GH levels, and so, improved acromegaly symptoms. It is common for patients with non-pituitary tumors to have enlarged pituitary. This can be mistaken for a tumor. Therefore, physicians should analyze carefully pituitary before performing any surgery (Melmend 2006).

The clinical manifestations of acromegaly include are acrawl overgrowth, jaw prognathism, swelling of the soft tissue, and arthralgias. Other symptoms include pituitary enlargement, visual defects, headache, visceromegaly of the tongue, salivary glands, liver, kidney, spleen, thyroid gland and prostrate (Gordon, n.d.). It may also affect somatic systems including the thickness of soft tissue, gigantism, and proximal myopathy (Chanson et al. 2009). The condition may also affect the endocrine and metabolic systems such as menstrual abnormalities, galactorrhea, hyperparathyroidism, pancreatic islet cell tumors and thickened skin, deepening of the voice due to enlarged sinuses and vocal cords, Fatigue and weakness, decreased libido and erectile dysfunction (Antisense Therapeutics, 2011). Other common problems associated with acromegaly include diabetes, high blood pressure, cardiovascular diseases, colon polyps, and arthritis (National Endocrine and Metabolic Diseases Information Services, 2006, p. 3).

Diagnosis

Diagnosis is done mainly through recognition of the somatic features. Blood tests include measuring GH level to check whether it is elevated. The test must be repeated since GH secretion in the pituitary is known to be in impulses because its secretion varies from time to time. It is common to diagnose a healthy person with increased GH or acromegaly patients with normal GH levels. Accurate results are obtained only when GH tests are done under conditions known to suppress GH secretion (Melmed et al. 2009).

The most common method used by physicians is an oral glucose tolerance test. Normally, intake of 75-100g of glucose solution should lower blood GH levels to less than 1ng/nm in healthy individuals. Those with GH overproduction have shown this suppression. This method is highly reliable in confirming acromegaly diagnosis (Levy 2004).

After diagnosing using measuring GH or IGF-I levels, the condition is confirmed using a magnetic resonance imaging (MRI) scan of the pituitary. This is mainly to locate and check the size of the tumor responsible for GH overproduction. This method is a very sensitive imaging technique. Computerized tomography (CT) scans can also be used in the absence of MRI. A perfect example is for acromegaly patients with implants containing metals such as pacemakers. Such patients may not use MRI scans due to the powerful magnets contained in the scan. Where the head scan indicates no presence of such tumors, the physician should check for pituitary ectopic tumors in the abdomen, pelvis, or in chest using a CT scan and examining GHRH I levels in the blood. It is rare to find a tumor secreting GH that cannot be detected even with sensitive MRI scans (National Endocrine and Metabolic Diseases Information Services, 2006).

Treatment

Acromegaly treatment is very challenging. Most patients fail to achieve normalization of IGF-I serum concentrations even with the multimodality therapy approach. The main goal for treatment is to minimize excess hormone production to a normal range. Secondly, to release pressure the growing tumor could be exerting on the surrounding brain areas. More so, preserve pituitary for its normal functions and to improve acromegaly symptoms. Various consensus statements have been published delineating the best criteria for disease management. Some of the strategies include surgery, pharmacological therapy and radiotherapy (Vasilev, Daly, Zacharieva & Beckers 2010).

The first-line treatment for acromegaly is transsphenoidal surgery for patients with microadenomas and benign macroadenomas. Surgery has been shown to normalize GH levels with approximated efficacy in 56-70% of appropriate patients. Tumor size and invasiveness are the major indicators for surgery outcomes. Well-circumscribed acromegaly patients show about 95% success whilst macroadenomas are controlled by 50 %( Melmed 2006).

Recent technology has developed technological advances. These technologies include endoscope-assisted microsurgery, three-dimensional navigation and intra-operative magnetic resonance imaging. However, more comparative studies on these techniques are insufficiently explored (Nomikos, Buchfelder & Fahlbusch 2005).

Drugs used to manage acromegaly include SRLs, GH receptor antagonists and dopamine agonists. Pharmaceutical therapy is only offered when surgery fails. It is often classified as a primary medical therapy. In the past, pharmacological therapy was prescribed to patients with contraindications or those unwilling to undergo surgery. A recent research has placed SRLs into the same position for surgery as the first-line therapy (Vasilev, Daly, Zacharieva & Beckers 2010).

Somatostatin receptor ligands (SRLs) work in a similar way to natural somatostatin. They bind to somatostatin receptors (SSTRs) on pituitary somatroph cells. This way, they suppress GH secretion. These drugs include Octreotide and Lanreotide. The drugs lower GH levels to less than 1microgram/liter in 57% of the patients and normalize IGF-I levels in approximately 67% of patients. SRLs also lower tumor size (Holdway & Rajasoorya 2004).

However, there are controversies over SRLs being used as pre-operative treatment. Carlsen et al investigation show 50% cure rate to patients treated with pre-operative octreotide in patients with macroadenomas in comparison to 23% non-treated patients. Currently, there are other molecules under clinical trials. These are pasireotide which analogs somatostatin but with a higher binding affinity to SSTR1 [2, 3&5]. Dopastatin is the second SRLs under investigation which acts on SSTR2 and on type2 dopamine receptor ligand (Bevan 2005).

Pegvisomant is a GH receptor antagonist. It acts by blocking GH effects on the periphery and in the serum IGF-I production. Currently, it is only offered when another treatment fails to normalize IGF-I. The drugs efficiency in suppressing the IGF-I levels is up to 97%. However, the drugs mechanism has raised a concern about tumor growth. The recent studies on this concern are re-assuring but regular examination of tumor mass should be done. Dopamine antagonist is used for the management of acromegaly for over three decades. However, the drug has low efficacy and its use as monotherapy is highly discouraged (Trainer et al. 2009).

Acromegaly treatment is incomplete without mentioning radiotherapy. It is often employed as a third or second-line treatment of tumor recurrent victims or those who portray intolerance to the pharmacological agents. The disadvantage with this method is that it is associated with hypopituitarism and holds a high risk of developing secondary brain tumors or worse still may cause mortality due to cerebrovascular disease (Castinetti et al. 2009).

Current implications

Significant achievements in acromegaly management have been realized in the past recent years improving the prognosis of the chronic disease. The combined pharmaceutical therapy has facilitated in managing disease control and even achieving a complete cure in a large proportion of acromegaly patients. The vast spectrum of clinical studies has unleashed lots of evidence on the efficacy of the present treatment strategies (Anat & Melmed 2008).

The primary preferred means of treating acromegaly is transsphenoidal surgery by an experienced neurosurgeon (Reid et al. 2009, p.208). Adjunctive medical therapy is only employed if the transsphenoidal surgery fails. SRLs are preferred for first-line medical therapy. Pegvisomant is also very efficient in biochemical control. However, its use is restricted by quite high prices. Despite the progress in management, acromegaly is still underdiagnosed and under-recognized. Therefore, physicians should take acromegaly diagnosis circumspectly (Reid et al. 2009).

Conclusion

Acromegaly is a serious condition that requires early diagnosis for a complete cure to the patients. Due to its sneaky onset, it is often either misdiagnosed or not be diagnosed early. If left untreated, Acromegaly results in severe complications and often premature death. It is a treatable condition for most patients especially when diagnosed early. Therefore, physicians should take acromegaly diagnosis circumspectly. Clinical guidelines are available delineating the best criteria for disease control. Strategies to aid the physicians to achieve effective treatment have been outlined carefully with surgery, pharmaceutical therapy and radiotherapy being employed to manage the disease.

References

Acomegaly 2011, The Symptoms of Acromegaly. Web.

Anat, B & Melmed, S 2008, Acromegaly, Endocrinology Metabolism & Clinical, vol. 37, no. 1, pp. 101-22.

Antisense Therapeutics 2011, Summary Back ground and development update. Available from: <www.antisense.com.au>. [10 November 2011].

Bevan, J 2005, Clinical Review: The antitumoral effects of somatostatin analog therapy in acromegaly, The Journal of Clinical Endocrinolology & Metabolism, vol. 90, no. 3, pp. 1856-63.

Cahynur et al. 2011, Diagnosis and management of Acromegaly: Giant Invasive Adenoma, Acta Med Indones, vol. 43, no. 2, pp. 122-128.

Castinetti et al. 2009, Long term results of stereotactic radio surgery in secretory pituitary adenomas, Journal of clinical Endocrinology & Metabolism, vol. 94, no. 9, pp. 3400-7.

Chanson et al. 2009, French consensus on the management of acromegaly, Ann Endrocrinology, vol. 70, no. 1, pp. 92-106.

Chason, P, Leselbaum, A, Blumberg, J & Schaison, G 2000, Efficacy and Tolerability of the long acting somatostatin analog lanreotide in acromegaly; A 12-month multicenter study of 58 patients, Pituitary, vol. 2, no. 4, pp. 269-276.

Gordon, D n.d., Acromegaly. Web.

Holdaway, I, Rajasoorya, R & Gamble, G 2004, Factors influencing mortality in acromegaly, The Journal of Clinical Endocrinolology & Metabolism, vol. 89, no. 2, pp. 667-74.

Holdway, I & Rajasoorya, C 1999, Epidemiology of acromegaly, Pituitary, vol. 2, pp. 29-41.

Hurley, D & Ho, K 2004, Pituitary disease in adults, The Medical journal of Australia, vol. 180, no. 8, pp. 419-425.

Levy, A 2004, Pituitary disease: Presentation, diagnosis and management, Journal of Neurology, Neurosurgery and psychiatry, vol. 75, no. 1, pp. 47-52. d

Melmed et al. 2009, Guidelines for acromegaly management an update, Clinical Endocrinology & Metabolism, vol. 94, no. 1, pp. 1509-17.

Melmed, S 2006, Medical progress: acromegaly, New England Journal of Medicine, vol. 355, no. 24, pp. 2558-2573.

Murray, RD & Melmed, S 2008, A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly, Journal Clinical endocrinology & Metabolism, vol. 93, no. 8, 2975-2968.

National Endocrine and Metabolic Diseases Information Services 2006, Acromegaly. Web.

Nomikos, P, Buchfelder, M & Fahlbusch, R 2005, The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical cure, European Journal of Endocrinology, vol. 152, no. 3, 379-87.

Nussey, S & Whitehead, S 2001, Chapter 7 The Pituitary gland. Web.

Reid et al. 2009, Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006; Acromegaly remains under recognized and under-diagnosed, Clinical Endocrinol (Oxf), vol. 72, no. 2, pp. 203-208.

Trainer et al. 2009, A randomized, controlled multicentre trial comparing pegvisomant alone with combination therapy of pegvisomant and long acting octreotide in patients with acromegaly, Clinical Endocrinol (Oxf), vol. pp. 71, 549-557.

UCLA 2011, Conditions & Treatments. Web.

Vasilev, V, Daly, A, Zacharieva, S & Beckers, A 2010, Management of acromegaly, Medicine Reports, vol. 2, no. 54 pp. 1-14.

There are theories and ideas that are considered to be of major importance, as they provide an explanation of the way our world functions. Einsteins Relativity, Steven Hawkings Black Holes in Astronomy, and Darwins Origin of Species are a few examples of the ideas that, at some point, fundamentally changed our perception of the laws of nature. There are also multiple other theories, which, for some unknown reason, are not as popular as the above mentioned. For instance, the theory of plate tectonics explains in detail the way our planet influences numerous aspects of human activities. In the 21^st century, people have to examine Earths features more if we are desperate in our desire to address environmental issues.

Plate tectonics explains the motion of several plates of Earths lithosphere. It differs significantly from the underlying asthenosphere in terms of the transfer heat and a few other factors. According to Savage, convection of Earths mantle causes the development of thermal boundary layers and tectonic plates at the surface (549). The lithosphere consists of several plates that move separately, riding on the asthenosphere. Harrison states that there has been a huge growth in the number of plates, which were thought to exist. Each of the tectonic plates has a top crust layer. There are two major types of crust: oceanic and continental. Most plates contain different mixes of both types of the crust.

Each of the plates constantly moves and influences other plates directions. Nevertheless, the total surface of the lithosphere remains the same. Jagoda and Rutkowska argue that the estimation of tectonic plate motion has become an important field of geodesy for numerous reasons (151). The plates movement is possible due to the lateral density variations in different parts of the outer layers of the Earth. Moreover, the Sun and Moon also have some influence on the way the plates move.

The most important part of the theory, as far as the current environmental problems are concerned, is, arguably, the plate boundary. This term is used to denote a specific area where the plates meet and interact with each other, which causes multiple unpleasant events, such as earthquakes, tsunamis, and others. Most of the volcanoes are also located on such boundaries. The Pacific Plates Ring of Fire is the most vivid example of an area where numerous volcano eruptions often happen due to the volcanos location between several tectonic plates.

On the whole, there are three main types of plate boundaries: divergent boundaries, convergent boundaries, and transform boundaries. First, divergent boundaries are formed when two neighboring plates move in opposite directions. Convergent boundaries, on the contrary, are created when one of the plates slides over another one. Finally, a transform boundary is created when the plates grind past each other and do not actually create anything.

Plate tectonics is relatively new compared to some other big ideas. Livermore states that during the 1960s and 1970s, the theory of the plates was erected on the foundations laid by earlier researchers, notably Arthur Holmes (4). Oceanography managed to support the idea behind the theory of tectonic plates by exploring seafloor spreading. In 1947, a group of scientists proved that there was a substantial rise in the middle of the Atlantic Ocean. The crust there did not resemble the one they were used to. Moreover, the oceanic crust turned out to be much thinner than the continental. These discoveries raised questions about the nature of seafloor spreading and the formation of the crust itself.

Bruce Heezen described the continuing creation of the ocean floor in his 1960 paper. This idea revolutionized much in Oceanography and led to the creation of expanding Earth theories, as it was hard to realize that the lithosphere stays the same, and that the theory of tectonic plates is the only suitable explanation. The idea that the creation and destruction of the crust happen simultaneously and are caused by the motion of the tectonic plates allowed for even more discoveries in this sphere. Nowadays, for instance, seismic anisotropy represents a record of deformation within the Earth (Schaeffer et al. 904). There are numerous other fields of study which owe to the discoveries of the 1960s.

The slow drift of tectonic plates has created the geography as we know it today and has always shaped human history. For instance, it created the mountains, which changed the climate and prevented large-scale wars between nations; it also leads to volcano activities, which also causes climate change. Moreover, the motion of the tectonic plates continues to influence the lives of millions of people, usually threatening them. A large portion of the world population lives in the areas that are vulnerable to tsunamis caused either by the tectonic plate drift itself or the volcano eruption.

People who live by the plate boundaries have always been terrified by the earthquakes and tsunamis and even came up with some brilliant devices which were designed to warn about the future disaster. For instance, the Chinese invented the seismoscope in the 2nd century. It shows the importance of such natural calamities to the wellbeing of society. For example, it is now possible to predict that millions of people (especially in Southeast Asia) will face devastating floods, which can be exacerbated by tsunamis, earthquakes, and volcano eruptions, in the near future. Infrastructure in most of the vulnerable regions does not provide the opportunity to evacuate people in a timely manner. Even Japan, which has a high-income economy and possesses great infrastructure, is still vulnerable when a tsunami hits.

The theory of tectonic plates should be included in several school subjects, as it explains much more than a few processes which may be of interest only to geologists. History as a subject, for instance, should be focused more on the environment people used to live in and their everyday activities, not solely on the rulers and the dates of wars. Modern people should have the opportunity to broaden their horizons by learning about the lifestyles our ancestors had. To do this, climate, agriculture, and the role of natural calamities and diseases should be emphasized in history books. Moreover, people should be aware of the direct impact of their current decisions on the environment. For instance, satellite data shows that human activities cause the rapid warming of the oceans, which results in more natural calamities.

We currently live under strange circumstances, as we are now as vulnerable to natural calamities and climate change as our ancestors were several thousand years ago. Despite having numerous advanced technologies, we should still be aware of the astonishing power that our planet also has. The tectonic plates have been moving for centuries, shaping the conditions people have to adapt to. Some of the outcomes of the continental drift turned out to be a blessing (such as geysers in Iceland), but most of them have always been extremely dangerous. Therefore, the theory of tectonic plates should become a vital basic subject for the rapidly increasing number of people whose professional choices have something to do with saving peoples lives from the threats of the 21^st century.

Works Cited

Harrison, Christopher G. A. The Present-day Number of Tectonic Plates. Earth, Planets and Space, vol. 68, no. 1, 2016.

Jagoda, Marcin, and MiBosBawa Rutkowska. Use of VLBI Measurement Technique for Determination of Motion Parameters of the Tectonic Plates. Metrology and Measurement Systems, vol. 27, no.1, 2020, pp. 151-165.

Livermore, Roy. The Tectonic Plates are Moving!. Oxford UP, 2018.

Savage, Brian. A Seismic Shift in Continental Tectonic Plates. Science, vol. 357, no. 6351, 2017, pp. 549-550.

Schaeffer, Andrew J., et al. Azimuthal Seismic Anisotropy in the Earths Upper Mantle and the Thickness of Tectonic Plates. Geophysical Supplements to the Monthly Notices of the Royal Astronomical Society, vol. 207, no. 2, 2016, pp. 901-933.

Introduction

Multifactorial traits refer to distinguishing human attributes that involve several factors or causes, especially about a condition or disease resulting from the interaction of many genes (Cummings, 2015). The environment contributes a lot to the development of human traits. Research has established that most traits exhibited by human beings belong to this category. Attributes such as height, hair color, and skin complexion belong to this category because they tend to vary from one person to another (Brown, 2007). This is also the case for certain diseases such as cancer, diabetes, heart conditions, and defects. Although human characteristics are often passed through subsequent generations, research has established that genes and the immediate environment of an individual have a lot of influence on the way they are expressed. Research has established that traits expressed by human beings have similar characteristics, but not the same (Brown, 2007). This phenomenon is attributed to human genetic variations; whereby people tend to have certain common traits albeit with a certain level of inconsistency. Multifactorial traits are often influenced by a combination of genes from both parents, as well as several environmental factors (Cummings, 2015). Multifactorial traits play a very important role in understanding human genetic variation. The traits that people exhibit depend a lot on the kind of distribution the genes from both parents will have from the time of conception (Rosenberg, 2012). This explains the reason why some people are taller than others, more intelligent than others, and have different skin colors.

Discussion

Research has established that the environment has a lot of influence on the way human beings exhibit certain traits (Brown, 2007). For example, people with albinism are very vulnerable to excess heat, thus do not have very many hours of contact with direct sunlight. Other conditions such as body weight can be influenced by the ability of individuals to engage in physical activities in their places of work or residence. One of the main features of multifactorial traits is the fact that they occur again in families (Rosenberg, 2012). This means that closely related family members have a high chance of exhibiting the same condition or physical feature. The main reason for this is the fact that multifactorial traits do not exhibit Mendelian ratios (Cummings, 2015). Some of the traits that closely related people have a higher chance of sharing include fingerprint patterns, height, eye color, and skin complexion. Fingerprints are often used as a means for knowing the identity of a person, as well as distinguishing between different people (Brown, 2007). As a multifactorial trait, the pattern of fingerprints can be slightly different, especially in the case of identical twins due to the effect of environmental factors.

According to experts, the prevailing environmental factors when a woman is pregnant, or the period from conception to birth can lead to dermatoglyphic changes (Rosenberg, 2012). Over the years, fingerprints have been used by law enforcement authorities to track down criminals (Rosenberg, 2012).

Height is also a very important multifactorial trait that helps in identifying and distinguishing people. Height varies a lot across all populations because we have short, tall, and medium height people. According to experts, some of the notable environmental factors that influence the variability of this trait across populations are health and dietary choices (Rosenberg, 2012). People tend to have a height measuring in between that of their parents. People who do not have any health conditions at birth or during their childhood tend to develop normally, thus their height is never compromised. On the other hand, people born with certain health conditions tend to experience stunted growth, which affects their ability to reach their maximum height (Paterson, 2010). Nutrition also influences the ability of human beings to grow to their maximum height. Good dietary choices are very important for the strong development of bones and other body organs. Over the years, height has been used as an element for describing, categorizing, and distinguishing people. Height plays a vital role in the life of human beings because it also defines roles for certain people, especially in sports and law enforcement-related duties (Cummings, 2015).

Eye and skin color is also important multifactorial trait among human beings. Research has established that eye color is an inheritable character that is controlled by several genes at once (Brown, 2007). The same case applies to skin color because its main influencing factor is melanin, an insoluble pigment that accounts for the color of an individuals skin. Variations in the level of distribution account for the differences in peoples skin colors (Paterson, 2010). One of the environmental factors that have the most impact on skin color is sunlight. Research has established that exposure to sunlight for prolonged periods can make the color of the skin lighten or deepen (Brown, 2007). Although skin color has been widely used to predict the ethnicity of people in various parts of the world, scientists argue that it cannot be used to tell the genetic history of an individual (Cummings, 2015). The main significances of skin color are identification, distinction, and relation. Psychologists argue that people living in highly diverse communities tend to develop relations more easily with people of the same skin color because they believe in common ethnicity (Rosenberg, 2012). However, it is important to note that skin color is one of the multifactorial traits that have been abused the most across the world, as very many people have been subjected to racism in different parts of the world.

Bodyweight is also a multifactorial trait that has grown in significance over the years. For example, obesity has been a growing challenge in the United States of America, despite numerous campaigns sensitizing people about healthy life choices (Paterson, 2010). Research has established that bodyweight is a trait that depends a lot on ones genes and a few environmental factors. Bodyweight is controlled by a hormone called Leptin, whose main role is in regulating appetite and the metabolic rate within the body (Paterson, 2010). People whose bodies produce this hormone in abnormal quantities often have issues with managing their body weight. High levels of Leptin increase someones appetite and decrease the rate of metabolism, thus leading to obesity. Research has established that the environment also controls body weight (Brown, 2007). Some weather conditions motivate people to engage in vigorous physical activities, while others limit people from being active. Physical activity is very important in the management of body weight. Bodyweight is very significant concerning the concept of human development because it influences the ability of the body to carry out its other functions. For example, obese people are very vulnerable to various heart conditions due to the high concentration of fat within the body. In addition, maintaining a good body weight is very important for healthy development, especially among children (Cummings, 2015). Research has established that obese parents often have a higher chance of having children with the same condition, a phenomenon that shows the effect of interaction between several genes (Brown, 2007).

Conclusion

Multifactorial traits play a very significant role in understanding human development and genetic variations witnessed in people. Experts argue that all human beings share the same traits, albeit with several variations. Height is a good example of such a trait since there are short and tall people. The same case applies to intelligence, whereby some people have a better ability to understand and profit from an experience more than others. Over the years, multifactorial traits have been used as a basis for identification, differentiation, and classification. Traits such as height, skin color, and body weight are often to describe someone. However, it is important to note that the variability in these traits has made them very desirable to the extent of causing harm. A good example is people who suffer from conditions such as skin cancer through tanning. Some tanning effects happen from exposure to sunlight, while others seek medical assistance to achieve the same. People need to accept the variability in the traits that define them because every human being is unique in their way.

References

Brown, J.R. (2007). Comparative Genomics: Basic and Applied Research. New York: CRC Press.

Cummings, M. (2015). Human Heredity: Principles and Issues. New York: Cengage Learning.

Paterson, A.H. (2010). Molecular Dissection of Complex Traits. New York: CRC Press.

Rosenberg, L.E. (2012). Human Genes and Genomes: Science, Health, Society. California: Academic Press.

Whether triggered by negligence or caused by any other external factors, medical errors affect patients drastically, causing a vast variety of negative results, from minor ones, such as nausea, to lethal cases. Unfortunately, medical errors still occur despite improved services and advanced technology (Siriwardena 156), which the case of Ellie Prudence shows in a very graphic way. To address the issue, the root cause analysis (RCA) must be used and the qualitative and quantitative factors are both to be taken into consideration.

To organize the RCA team, it will be necessary to define the problem that has emerged. According to the classification provided by Nicolini, Waring and Mengis (The Challenges of Undertaking Root Cause Analysis 36), the case can be identified as a medication issue. Therefore, it will be necessary that a nurse, a physician, and, most importantly, a pharmacist should be chosen as the members of the RCA (Nicolini, Waring and Mengis Policy and Practice 218). At the beginning of the meeting, the group specified above will be provided with the facts regarding the case in point. Though Nicolini, Waring and Mengis demand that the PA should also be present, seeing how there has been no lethal outcome, there is no need for the PA to be present during the analysis. Distributing the roles and responsibilities of the participants, one must give the pharmacist the task of analyzing the harm done, assign the nurse with checking the medical records and suggest the physician conduct interviews with the family and the nurse that made the injection.

The process of data acquisition is clearly an essential part of the RCA meeting preparation. For the Root Cause Analysis to be exercised efficiently, it will be required to analyze both qualitative and quantitative data (Brown, Smith and Sherfy 14). The latter can be acquired from the reports and receipts. For instance, it will be necessary to check the report statement concerning the amount of the medicine (morphine) that was used to make an injection. The rest of the quantitative data, such as the time when the patient received the shot, the amount of medicine that the patient had taken previously, etc. will be received in the same way, i.e., through the analysis of the existing records. However, apart from the quantitative information, qualitative data will also be necessary for conducting an objective and all-embracive assessment of the problem. Thus, it will also be crucial to conduct qualitative research among those involved in the incident. The latter, in its turn, will be conducted with the help of such a tool as a personal interview and a relations diagram (American Society of Quality para. 9). A very easy, comparatively time-saving and providing opportunity to gain more information about the incident from both the person causing it (i.e., the nurse) and the victims (i.e., the parents), this method is rather effective. In addition, the buddy system will be used to design the methods for avoiding instances of medical errors in the future (The Buddy System para. 1). The process of defining information objectivity is going to be especially hard, seeing how the participants are most likely to be very emotional. However, the two tools specified above, i.e., report analyses and interviews, seem to be the most adequate choice at present, with their high speed of data retrieval and the amounts of data that they can provide.

Works Cited

American Society of Quality. Quality Tools. n. d. Web.

Brown, Judy E., Nancy Smith and Beth Sherfy. Decreasing Mislabeled Laboratory Specimens Using Barcode Technology and Bedside Printers. Journal of Nursing Care Quality 26.1 (2011), 1321. Web.

Nicolini, Dabvide, Justin Waring and Jeanne Mengis. Policy and Practice in the Use of Root Cause Analysis to Investigate Clinical Adverse Events: Mind the Gap. Social Science & Medicine, 73.2 (2011), 217225. Web.

Nicolini, Dabvide, Justin Waring and Jeanne Mengis. The Challenges of Undertaking Root Cause Analysis in Health Care: A Qualitative Study. Journal of Health Services Research & Policy 16.1 (2011), 3441. Web.

Siriwardena, Niro A. Using Quality Improvement Methods for Evaluating Health Care. Quality in Primary Care 17.3 (2009), 155159. Retrieved from the Walden Library using the CINAHL Plus with Full-Text database.

The Buddy System. n. d. Vanderbilt Nursing. Web.

Many professions have embraced the use of quantitative research methodologies and seem to have dismissed qualitative research strategies altogether. In particular, Johnson & Waterfield (2004:121) highlight that only four physiotherapy journals published between 1996 and 2001 employed qualitative research techniques. Is it fair to suppose that quantitative work provide more trustworthy work than qualitative research?

Despite the perceived weaknesses of qualitative methodologies, they still bear strengths in their revelation of qualitative aspects of the subject of research that researchers cannot quantify (Grbich, 1999:11). For instance, there has been a paradigm shift in the contemporary healthcare towards evidence-based practice. In order to comprehend the complex issues that surround this practice, qualitative research provides an important platform where human interaction analysis is possible and accurate (Goodwin & Horowitz, 2002:40). This includes professions dominated by interpersonal communication.

Besides, qualitative research perceives reality as socially constructed. As such, it is difficult to measure reality using quantitative research. Waterfield & Johnson (2004:122) explicate that social construction requires interpretation rather than measurement. Qualitative therefore interprets reality as is without attempting to quantifying it into numerical data. This attribute of qualitative research facilitates therapists to be effective by prescribing the accurate therapeutic treatment for patient without necessarily having to depend on quantitative data (Waterfield & Johnson, 2004:127). Besides, they are able to establish positive therapeutic relationships with the patients that results to improved treatment.

Purposive sampling is typical of qualitative research and it assists the researcher to understand the diversity of the sample rather than focusing on the representativeness of the same (Kelly & Long, 2000: 59). Marshall & Rossman (1999:39) assert that representativeness is a characteristic of quantitative research that focuses on probability sampling and fails to consider cultural diversity of the sample.

Essentially, it is unfair to regard quantitative research as more trustworthy than qualitative research. The latter methodology of research is important in highlighting qualitative aspects such as interpersonal communication, therapeutic treatment as well as comprehending the diversity of the research while the former has its strengths and weaknesses.

References

Goodwin, J & Horowitz, R. 2002. Introduction: the methodological strengths and dilemmas of qualitative sociology. Qualitative Sociology, 25:3347. Print.

Grbich, C. 1999. Qualitative Research in Health: An Introduction. London: Sage Publications. Print.

Johnson, R & Waterfield, J. 2004. Making words count: the value of qualitative research. Physiotherapy Research International, 9(3) 121131. Print.

Kelly, B & Long, A. 2000. Quantity or quality? Nurse Researcher; 7: 5367. Print.

Marshall, C & Rossman, B. 1999. Designing Qualitative Research. 3^rd Edition. Thousand Oaks: Sage Publications. Print.

PLOS One is an international, interdisciplinary, peer-reviewed, open-access scientific journal that publishes scientific research and reviews in the natural and medical sciences.

Currency: The latest update was on July 24, 2020. The articles correspond to the advances, new surveys in the field of medical science.

Relevance: The journal publishes original scientific research, well-founded hypotheses, comments of scientific experts on a specific topic, notes on discoveries, reviews.

Authority: The editor-in-chief of the magazine is Joerg Heber. There are no prominent scientists in the council, and the majority of its members are people under the age of 50. There is also a community of editors to provide writing advice.

Accuracy: All articles in the journal are licensed under the Creative Commons CC-BY-SA 4.0 license. The journal is one of the largest in the world in terms of the number of published articles per year.

Purpose: The journal intends to inform all interested audiences, who have a desire to self-educate and stay current with the latest updates in this domain.

Yuan, M., Yin, W., Tao, Z., Tan, W., & Hu, Y. (2020). Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PloS one, 15(3), e0230548.

Currency: The date of publication is March 19, 2020. It is stated that the article is peer-reviewed.

Relevance: The information is an in-depth examination. The audience should be well-informed and professional in the case to understand the results of the survey being advanced.

Authority: The authors are a group of scientists from the Department of Pulmonary and Critical Care Medicine.

Accuracy: the data are reliable as there is evidence, graphs, charts that can determine the results. Besides, the article was cited several times. There is also a reference list, including 22 sources. The authors outline the methods and data used in their analysis.

Purpose: The information presented in the article aims to inform and give statistical details being useful for further research.

Both the journal and the article can be considered reliable as several points prove their credibility and solidity.

Reference

Yuan, M., Yin, W., Tao, Z., Tan, W., & Hu, Y. (2020). Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PloS one, 15(3), e0230548.

The success of science depends on continuous research aimed at upgrading existing knowledge. As such the biological fields of science are undertaking such projects. One such project human genome project (HGP), one of the most important discoveries is aimed at not only identifying and defining all types of human genes numbering 20.000-25.000, as well as isolating the chemical partnering in these cells (See Fig 1). Human genome cells have been found to contain valuable information that can be useful in a number of scientific fields. Such application of knowledge includes in fields such as improved health care by providing better medical therapy as well as helping in finding particular mutation in diseases causing cells.

HGP has gone on for a number of years with concerted efforts to make findings. However, it is in the year 2001 that the first official report was issued by scientists. This reported as seen in Fig 2 describes the much of the basic configuration of the humans genome, which has also provide further knowledge and opportunities for improvements. The report has an initial hypothetical weakness. The report presupposed, hypothetically that human genomes have a higher number of genes than a number of certain known organisms. This initial conclusion has been disapproved by the findings resulting from HGP. A series of studies done after this reports have revealed a number of interesting finding in genetics. They include the findings that human cells have a lower number of genes that initially expected. Actually human genes have a similar number similar number of genes as most of these organisms. Secondly it was also found out that the genome distribution in human cells was oddly arranged: some part of the chromosomal cells. Furthermore, while human proteins code in threes, animal proteins only code one. Furthermore, the human genes have been found to be more complicated than their animal counterparts. Despite their complexity it has been found out that about nucleotide sequences of human genes are similar in all individuals regardless of race. This is in addition to about 1.5 % of all human cells that are involved in encoding of proteins. This means that human males have an increased risk of having cell mutation that their female counterparts (Vargas, 2002).

Scientists in the past have made concerted efforts to study genetics as a means of looking for solutions to a number of solutions in the medical as well in other fields that could manipulate that knowledge. This includes biologists who have made significant gains in identifying and categorising genetic diseases. The results have lead to the classification of about three classes of diseases being classified. Chromosomal aberrations are a class of genetic disorders that result from the alterations of in the configuration of chromosomal cells. This can also result from an alter qualities of theses cells in the human bodies. Another class of genetic diseases is the Multifactorial disorders. This class of disorders is caused by mutations in the allele of a unitary gene. They can also be caused by other factors associated with the surrounding natural environment. This means that the natural environment has the ability to adversely affect the genetic make of organism. The third class of genetic disease is the single gene disorders. Unlike Multifactorial disorders, this class of diseases resulted from the mutations in allele of a single gene. This means that they cannot result from any external environment. As such they are inherited from the parent of the gene. These findings were however recorded before the HGP, which has resulted in yet another class of genetics based disorders. The somatic cell genetic disease has been added as the fourth class of genetically diseases due to the improved knowledge of the structural of the DNA resulting from HGP. This class of genetic diseases are assisted with a number of genetic cases in human being. They are the congenital malformation (acquired through inherence), auto immune process as well as the process of aging in people. Human genome project has also lead to the discovery of the nucleotide polymorphisms (SNPs). SNPs are type of nucleotides that identify the dissimilarities in the progression of the human DNA. They also identify similar individuals with coupled chromosomal cells. These findings have lead to a better understanding of the causes of having a high level of gene based variation in human chromosomal cells. In addition the discoveries of the nucleotide polymorphisms are used to locate any haplotypes that cold be connected to any genes that cause diseases. This is only possible though if a plan of existing SNPs consisting about 30.000 to 500.000 SNPs.

The human genome project has also been advantageous to scientist as it has helped them to identify the amount of human proteins encoded o in the human genomes. This means that scientists have been able to mark the structural make up of these proteins. This mean that information necessary for protein formations will be understood further and as such genetic engineering will be taken a notch higher (Vargas, 2002).

Another significant HGP finding is the microarray technology otherwise popularly known as the gene chips. Gene chips were developed after the unearthing of the numerous proteins contained in the human genome. A gene chip is developed from a high number of DNA progression coded from the human genes. Scientist will thus be able to use the gene chip which will also be paired with a messenger RNA to identify which of the gene chip is active in specific human chromosomal cells. This information that has helped in the development of the gene chip will be useful in the study cancer cells. Thus the future of the cures of cancer looks promising (Collins, 1999)

This means that the knowledge of identifying which particular genomes are active in specific cells are useful in increasing the medical knowledge of diseases contained in disease causing cells. The information will thus be very useful in development of genetic drugs to cure some incurable diseases such as cancer. This it will be useful in the development of the pharmacogenetics approach to health care solutions (Wang et al., 2004).

For a very long period of time biologist as well as other scientists have been making concerted efforts to try and gain a deeper understanding of the history of human evolution. Analysing the human DNA has been one of the means. The disadvantage of these methods is that the DNA analysis can only generate data about the genetic configuration of the human beings as well as the family lineage. HGP has come at time that it will be very useful in helping scientist gain better understanding of the human evolution stages (Collins, 1999).

Forensic science is another field that will greatly benefit from the HGP. The ability of the HGP to identify the dissimilarities of the number of reported airing in the chemical formation the scientists will be able to generate hard evidence from scenes of crime. As such HGP will have been useful in another non biological fields (Salas et al., 2007).

The issue of paternity especially in parenting disputes will be greatly helped by this project. The increased understanding of the human genome will be greatly lead to the improvement of the comparisons between genetic make of individual. As such scientist will be able to use the alleles of the father and if theirs any similarity between those of the father and those of the child then that will be sufficient proof that he is the biological parent (Vargas, 2002).

As previously stated in an earlier part of this paper, HGP will be very useful source of information that will be very helpful to health care provider in developing of genetic drug for previously incurable diseases such as cancer. Other than advancing healthcare provision for these diseases, HGP will be useful in the development of new technological tools for extremely improved rehabilitation of diseases and as such cloning of cells will be useful improved cell biology (See Fig 3). Furthermore the procedure of cloning cell will also enable biologist to revamp and as such help in the modification of diseased cells. This will greatly improve pharmacology. Furthermore it will be useful in developing of better vaccines as it will be useful to genetically modify human genes. To ad to this scientists will generate infection necessary for utilisation by pharmacist in mass development of genetic drugs (Tolstoi, 1999; Vargas, 2002).

Therefore not only will HGP have great benefits in the field of biological research, but also useful in other fields such as forensic science as well as crime scene investigation. This is because other than understanding the chemical make up of genes it also provides clear information about the paring of proteins in these cells. The improved understanding of SNPs will be beneficial to in understanding the disparities between the genetic make up of individuals. This will be more useful in solving paternity issues. Furthermore, the intelligence generated about the genetic coding will help in isolating specific protein functioning in various chromosomal cells. As such it will lead to increased understanding of the structural configuration of the human cell. HGP will also have result to the development of the gene chip which will also be useful in understanding cells related to various diseases as well as in improved knowledge of the evolution history of human beings. The pharmacists will also be benefited by this project as it will help them in producing genetic drugs en mass and as such not only will health care solution be improved but also affordable. HGP has many benefits and there are possibilities for its utilisation with advancement in sciences. As such it cane be said to be a worthy project to undertake

Bias means deviations of outcome or conclusions from the reality or lack of internal authenticity in epidemiological studies. Selection, information and confounding are three types of biases (Recall bias can be a threat to Retrospective and Prospective Research Designs, 2011). Recall bias is a variety of information bias that threatens the internal authenticity of the investigation using self-reported numbers, and can be introduced during the data compilation stage of the exploration (Bias in analytic research, 2011).There may be premeditated or unintended discrepancy in recall of information regarding the conclusion leading to misclassification of the subjects under study with respect to outcome variables. Recall of information is memory based, so faulty and untrustworthy. Retrieving information from old memories can be difficult. The longer the time spans, the higher the chances of incorrect recalls, thus creating errors in epidemiological inquiries (Bradburn, Rips, & Shevell, 1987). This review aims to discuss recall bias in epidemiological studies, possible ways to minimize them, and an analysis of paper methodology for recall bias, report findings and impact.

Recall bias in epidemiological studies. Recall bias is a chief anxiety in case control studies, but may be found in certain circumstances of prospective cohort and clinical trial designs (Bias and causal associations in observational Research, 2011). These may occur in examples like that of occurrence of important disease as cancer or genetic malformation; a particular exposition as an important factor to the causation of the disease, media publicity for a unsure connection of a factor with a disease, and exposure to the factor under study is publicly unlikable such as illegal drug abuse (Methodologic problems and standards in case control research, 2011).

To minimize recall bias one has to clearly define and express the research problem irrespective of the design used. The planning stage must be well refined with respect to the feedback form for a response, interview process and personal qualities (Design and analysis of case control studies, 2011). In case control inquiries, recall bias may be minimized by adopting various strategies like nested case control design, choosing new diagnosed cases to respond, the correct control group, standardized data collection methods, using a validated instrument for exposure review, conduct a sub-group analysis, allowing time for response, deleting proxy answers and verification of the information with a reference (Investigator bias and Interviewer bias: the problem of reporting systematic error in epidemiology, 2011).

Analysis of paper methodology for recall bias, report findings and impact. Rockenbauer studied for cancer or gene defects in infants, found recall bias after analyzing reported figures on drug intake during pregnancy by mothers questioned few months after birth than when compared to drug intake data recorded in a log-book during pregnancy. The sensitivity of disclosure reporting was higher for cases than for controls when there was a better recall by mothers of cases, so higher number of truly exposed mothers in cases than controls. The lower specificity of self reported experience for cases than controls indicated over reporting and the proportion of truly unexposed mothers were lower in cases than controls. Parental reporting may nullify recall bias in childhood diseases (Fathers occupational exposure to carcinogenic Agents and childhood acute leukemia: a new method to assess exposure (a case control study), 2011). Recall bias cannot be ignored and the results should be carefully analyzed as there is possibility of inflating the expected risk ascribed to the contact under investigation (King, 2010).

References

Bias and causal associations in observational Research. Web.

Bias in analytic research. (2011). Pubmed.gov. Web.

Bradburn, N. M., Rips, L. J., & Shevell, S. K. (1987). Answering autobiographical Questions: the impact of memory and inference on surveys. Science, 236, 157-161.

Design and analysis of case control studies. (2011). Pubmed.gov. Web.

Fathers occupational exposure to carcinogenic Agents and childhood acute leukemia: a new method to assess exposure (a case control study).

Investigator bias and Interviewer bias: the problem of reporting systematic error in epidemiology (2011). Pubmed.gov.Web.

King, G. (2010). A Hard Unsolved Problem? Post-Treatment Bias in Big Social Science Questions. Web. 

Methodologic problems and standards in case control research. Web.

Recall bias can be a threat to Retrospective and Prospective Research Designs. Internet Scientific Publications. Web.

Lesbian, gay, bisexual, and transgender (LGBT) individuals represent a significant portion of modern society, and these people often face numerous social challenges. As a result, various empirical articles address the issue, and the quantitative one by Hatzenbuehler et al. (2017) is among them. The research analyzes how social support for same-sex marriages affects the LGBT populations smoking habits and overall health conditions. The present paper will comment on the sampling method that was utilized in the study.

Researchers typically draw significant attention to ensure that their sampling approach is adequate. As for Hatzenbuehler et al. (2017), the authors relied on the Gallup Daily tracking survey, and the following information will comment on the sampling procedure used in it. Thus, a probability sampling approach was used because randomly selected individuals were interviewed via their phones. The randomization was achieved using a Random Digit Dialing method that covered both landline and cell phone users. This strategy allowed extracting data from more than 373 000 individuals who represented all 50 states and the District of Columbia.

It is possible to admit that the strategy above has contributed to the studys generalizability. On the one hand, Yegidis et al. (2018) report that randomization allows the creation of a sample that is as close to the entire population as possible. This fact denotes that the findings can be generalized to the population, which increases the articles external validity (Yegidis et al., 2018). On the other hand, Hatzenbuehler et al. (2017) report that their study has a decent level of generalizability because their sample represents close to 90% of the United States adult population (p. 512). Consequently, there is sufficient evidence to claim that the studys findings can be applied to the whole population.

Even though the sampling procedure above implies a high generalizability level, it still has some limitations. Firstly, it refers to a low average response rate of 11% (Hatzenbuehler et al., 2017, p. 512). This state of affairs can affect the studys external validity and reliability. It is so because the low number implies that a significant portion of the LGBT population did not participate in the research. Secondly, another limitation refers to the fact that more than 9,000 respondents refused to disclose their sexual orientation (Hatzenbuehler et al., 2017). It can mean that interviewers failed to establish contact with the interviewees.

Thus, it is necessary to offer a solution to manage the effect of the limitations above. In the article, it was not mentioned how the interviewers started the survey. It relates to the fact that opening statements are of significance to establish contact with respondents. For example, it can be useful to make the interviewees feel special, which will make them want to participate. In particular, such statements as The current research needs your assistance or Please take a few minutes to answer the questions can make some people feel respected and participate in the survey.

In conclusion, the paper has demonstrated that the research by Hatzenbuehler et al. (2017) relied on a probability sampling technique. The scholars dealt with randomization to increase their studys generalizability which is necessary to apply the findings to the population. However, a low response rate and the presence of respondents who failed to disclose their sexual orientation imply some issues with the articles reliability and external validity. However, drawing more attention to establishing contact between an interviewer and interviewee can address the problems.

References

Hatzenbuehler, M. L., Flores, A. R., & Gates, G. J. (2017). Social attitudes regarding same-sex marriage and LGBT health disparities: Results from a national probability sample. Journal of Social Issues, 73(3), 508-528. Web.

Yegidis, B. L., Weinbach, R. W., & Myers, L. L. (2018). Research methods for social workers (8^th ed.). Pearson.