Category: STDs

Describe the facts surrounding the Tuskegee Syphilis study

The Tuskegee syphilis study is the most controversial research ever performed on the black race. It was carried out in a small town of Tuskegee in Alabama. The participants of the study were completely ignorant of the experiment. The hope of treatment for the participants of the experiment was not in sight. In addition, these people died in their numbers for something they never understood.

The Tuskegee syphilis study was a complete disaster. There was a time when doctors in the United States believed that black Americans resistance to the effects of syphilis was not high when compared to the whites. This theory motivated the racial study of blacks in the United States. With the high rate of syphilis in Alabama, the government felt it was time to use these black folks as a pawn for their medical research.

The government of Alabama decided to conduct medical research on black Negroes who had syphilis. The victims of the Tuskegee syphilis study were told that they were treated on a free term. The study generated ethical questions on public health (Heintzelman, 1997).

There are some notable facts about the Tuskegee syphilis study:

1. The government of the United States of America abused the constitutional rights of the victims of the Tuskegee study.
2. The authorities of the Tuskegee study did not treat the patients who had syphilis.
3. These victims did not give their consent before the study.
4. The objective of the Tuskegee syphilis study was racially motivated.
5. Although the research was a comprehensive one, there were no regulations during the study.
6. There should be proper documentation of the research study and the progress of the study must be published on an annual basis.

Explain why the Tuskegee Syphilis study is considered an important milestone in the history of public health research

The Tuskegee experiment has changed the world in many ways. Research on humans has been re-examined. After the exposure of the Tuskegee study, medical research board raised various ethical questions as it regards the use of humans as research subjects. An ethical code of conduct for health practitioners was formulated and it was called the Nuremberg Code, it consists of 10 fundamental points of research. However, this ethical code did not prevent the doctors that performed an unethical study on the Tuskegee subjects.

One notable milestone achieved was based on the information given to the participants of the experiment. There were suggestions that all participants should have the right to know the reason for the experiment, the risks, and hazards associated with the experiment. Each participant has the right to accept or refuse to be part of the experiment. The use of deceit to lure a participant into a research program was termed unprofessional and unethical. The Tuskegee syphilis study became the pivot for much debate on the rights of human subjects used for experiments. The Nuremberg code of 1947 had loopholes and did not get international acceptance.

Although this code was passed in 1947, it did not stop the doctors in Alabama from performing their atrocities on the black race in Tuskegee (Heintzelman, 1997). The Tuskegee experiment came at a time when the economic situation for the black people in the States was below average. While doctors used the situation to give monetary tokens to the victims of the syphilis study. The major effect of the Tuskegee study was on the black race. After the failed experiment, black Americans are yet to come to terms with their loss. In addition, they oppose any form of treatment that includes vaccination.

Describe the need for ethical guidelines to govern health research

Guidelines are necessary for the success of any research. It is upon this set of rules that any research may be probed for its failures or success. The Nuremberg code of 1947 fell short of medical standards. Article 5 of the Nuremberg code had its own flaws; it states that an experiment can be done on an individual provided the medical investigator is ready to risk his/her life. You cannot take another persons life because you are ready to lose yours.

For example, if a man is drunk with alcohol, should he be allowed to drive other people to their death, because he is ready to risk his own life? This is a major loophole in the Nuremberg code of 1947. Article 10 stated that the medical investigator might stop the research if he sees any danger. There was no definite rule on when to stop, but a decision that lies solely with the investigators willingness to terminate the experiment if he wishes. This is another flaw in the 1947 Nuremberg code. By law, an experimental study on humans should be terminated if it is a risk to the life of the subject.

In order to safeguard the lives of people, health guidelines must be followed. In addition, there is a need for ethical guidelines to govern health research. The storyline in Miss Evers Boys portrayed the loopholes in the ethical guidelines that govern health research. The movie showed to the entire world the rot in the medical research field. The fact that experimental studies are meant for the good of the people, does not entail that lives should be lost in the study. There is no justification for causing the death of an individual used for an experiment.

The case of the Tuskegee syphilis was an example of misguided research. There was no proper documentation for the participants used for the experiment. Those who lost their lives in the experiment were not accounted for, neither were their names complied. The Tuskegee experiment lasted for 40 years and there was not a single journal that was published on the findings of the research.

This is a major setback for any meaningful research. Ethical guidelines limit the use of science to cause harm or take the life of a person. In 1974, the National Investigation Human Board was established and was in response to the Tuskegee syphilis saga. Alongside was the Tuskegee Health Benefit Program, it was set aside to help the victims of the Tuskegee experimental research.

What are the recognizable key Hypothesis that underlined contemporary research impacting the Tuskegee Syphilis study on health research

The hypothesis for any research should not be controversial or made on assumptions. The effect of using assumptions could affect the quality of the study. Unlike contemporary research guidelines, the key to a productive study rests on the tests of the hypothesis. In addition, it must be fruitful, unbiased, and will not be used to take lives. In conclusion, the Tuskegee syphilis study, which was performed in Miss Ever Boys film, will not be forgotten by the black community. Moreover, still raises questions about the ethical standards and guidelines used by researchers.

Reference

Heintzelman, C. (1997). The Tuskegee Syphilis Study and Its Implications for the 21st Century.

The study under analysis is called the Tuskegee Study of Untreated Syphilis in the Negro Male and it took place in Macon County, Alabama. The main purpose of the following study was to record the natural history of syphilis in Blacks (About the USPHS Syphilis Study, n.d., para. 1). However, at those times when the experiment started, there was no treatment for this disease and, moreover, people did not know that they suffer from it.

There were 600 participants, besides, all of them were black people. They were divided into two parts. The first one, which consisted of 399 people, became the experimental group. Moreover, every person in this group suffered from syphilis. The rest of the participants became control subjects. (About the USPHS Syphilis Study, n.d.). During the experiment, all black people lived under perfect conditions and had to accept all suggested procedures. However, there was no real treatment for them. Several years later the experiment was ended. However, there were several reasons for it.

First of all, it was called unethical as all participants were not informed about the conditions of the experiment and their illness. Moreover, a great number of patients died in the course of the experiment. The main purpose of this study was to analyze the aftermath of untreated syphilis, which is why patients were not informed about their disease. Their family members also suffered from it. However, this experiment became rather a controversial issue which led to some serious processes in society (LeNoir  NMA Pediatric Lecture Series, 2003). First of all, participants were promised to have free medical service. Moreover, the question of the moral side of different studies appeared. Tuskegee Syphilis Study Legacy Committee was created in order to improve the situation and try to change the current state of affairs.

Intrinsic Etiology

The likelihood of infection by the same level of exposure to the virus differs among individuals. Further, among HIV-infected individuals, there is a differential rate of progression. Both depend on a number of factors related to the virus, host, and the environment. An individuals genetic variability influences ones vulnerability or resistance to the virus. There are three categories of host genes that have been reported to influence the rate of HIV progression; they include genes encoding cell-surface receptors. Others include genes found in the human beings leukocyte antigens responsible for regulating ones immune response to an infection. The last category includes another cytokine, which are also referred to as the immune response genes. However, when it comes to herpes simplex -2 (HSV-2) no direct association between HSV-2 and virologic severity has been recorded; thus, the specific role of human variation in HSV-2 remains unclear (Kleinstein et al., 2019). However, it is evident that the presentation of herpes simplex type two among individuals depends on ones immune status at the time of exposure.

Extrinsic Etiology

Herpes complex as other related infections can be considered as a socio-economic challenge since its spread is linked to social and economic factors. Some of the aspects closely related to the spread of the virus include culture, religion, tradition, and poverty. An interplay of the elements plays a significant role in the development of the epidemic. For instance, where communities practice polygamy and wife inheritance, there is a likelihood of a relatively higher rate of herpes infections. Further, poverty is likely to lead to increased exposure and infection rates where individuals have to engage in sex for money so as to feed and cater to their other household needs. This probably explains why the rates of herpes simplex infections are higher in populations with lower socioeconomic status. These environmental influences can exacerbate peoples vulnerability to the virus or worsen the outcomes of the infection.

Other factors that have a direct influence of herpes simplex type two infection include an individuals sex, race, age, and the level of education. Individuals with higher levels of education are more likely to understand the disease, particularly how it is spread, and thus take the necessary precautions to stay safe. Further, they are more likely to understand the severity of the infection and avoid risky sexual behavior that may lead to disease. Regarding age, the overall seroprevalence of the illness is higher among older patients compared to younger ones, including teenagers (Rawre et al., 2018). In terms of age, women are almost six times more likely to get herpes simplex type two infection compared to men for the same exposure levels (Rawre et al., 2018). Additionally, when considering race, black women are more likely to contract herpes simplex type two compared to other races, including whites and Asians. This might explain why the prevalence of herpes simplex two is unevenly distributed in different geographical regions.

Idiopathic Etiology

The etiology of herpes simplex type two is clear, with multiple studies indicating the various ways through which one might get infected. There are no documented unknown mechanisms or factors that may contribute to the disease. Further, it is unclear whether herpes simplex type two coinfection with HIV accelerates the severity of the latter. Additionally, it remains to be confirmed whether herpes simplex type two can be spread through water, such as in the case of type one.

References

Kleinstein S. E., Shea P. R., & Allen A. S. (2019). Genome-wide association study (GWAS) of human host factors influencing viral severity of herpes simplex virus type 2 (HSV-2). Genes and Immunity, 20(2), 112-120. Web.

Rawre, J., Rai, M., Namdeo, D., Das, R., Khanna, N., & Dar, L. (2018). Herpes simplex virus type 2 and cytomegalovirus perigenital ulcer in an HIV infected woman. Indian Journal of Medical Microbiology, 36(3), 441-443. Web.

Introduction

The purpose of this essay was to develop a care plan for Kendall Lakes Windshield Community based on the public health issue of Chlamydia. A public health nurse approach has been selected for the care plan. Community health nursing focuses on care provided to patients outside healthcare facilities, but nurses must adopt creative strategies to deliver care. Strong clinical skills are required with thorough knowledge of the community receiving care. Nurses require self-reliance, adaptability, analysis, and critical thinking to cope with certain unique healthcare needs (Gerber, 2012). The community nurse must develop an effective relationship to handle notable cases of Chlamydia, which is the most prevalent communicable disease in the Windshield Community. The relationship must be a partnership and significantly differs from other approaches used in healthcare settings. Within the community setting, patients may have more control relative to hospital settings. For instance, Chlamydia is a sexually sensitive issue among the public, and therefore patients may not feel free to discuss their conditions and may opt to or not to follow medication schedules, healthy sexual practices, and other treatment regimens recommended (Rubin et al., 2011).

Community nurse, therefore, has the responsibility of assisting the public to internalize the relevance of healthy sexual behaviors by teaching and reviewing the care plan to meet the needs of specific individuals or an individual.

One advantage is that community health nursing provides more holistic care with a wide focus on clients. For instance, the care plan will target all members of the Windshield Community, including families, youth, individuals, and even seniors who are still sexually active. Thus, nurses must understand various attributes of a given community and adapt a care plan to work in such environments. A nonjudgmental strategy is recommended to enhance effective communication between nurses and their patients (Gerber, 2012).

For nurses who work in healthcare settings, they must also consider services outside such environments to focus on communicable disease management in communities (Gerber, 2012). This is public health nursing. While Windshield Community is large and experiences a wide range of communicable diseases, Chlamydia is the most appropriate for nurse intervention because it is the most reported in the community relative to others. Nevertheless, nurses can still screen for other conditions, manage family planning and evaluate for chronic conditions such as hepatitis, HIV/AIDS, hypertension, and obesity among others. Thus, management and control of communicable diseases are a priority for the nurse. Apart from providing care at the site, nurses may also visit patients at their homes, especially individuals identified to be at high risks for communicable diseases (Stanhope & Lancaster, 2008). Public health nurses can therefore address the challenge of widespread Chlamydia in the Windshield Community. They can offer mass education to all members of the community.

Community Assessment

During the community assessment, Chlamydia was identified as the most common communicable disease in Windshield Community. Community assessment requires the nurse to possess strong interviewing and listening skills. Nurses will have to collect relevant information about patients, as well as their cultural, physical, psychological, daily life events and environments (Gerber, 2012). The nurse must establish a rapport with members of the community because they will share sensitive information about their sexual activities, partners, and other data related to Chlamydia and communicable diseases like gonorrhea.

For communities who will visit the onsite care center, nurses will interview them. Clients will have to provide exhaustive information about their medical and sexual history, sexual intercourse, partners, frequency of urination, other STIs, medication status, menstruation, and sexual orientation among others. The nurse must listen and collect information about the sexual concerns of clients. Studies show that clinicians must be able to make risk assessments on their patients who may have an asymptomatic disease (Whelan, 1988, p. 877). In most cases, Chlamydia is not diagnosed and therefore infected individuals may continue to spread the disease to other sexual partners and their neonates (Whelan, 1988). In addition, physical examination is also necessary to reveal the effects of the disease. The nurse must encourage patients to bring their partners for assessment too. Further, nurses should encourage community members to test for other sexually transmitted diseases, especially community members who have tested positive for Chlamydia and gonorrhea.

A baseline study has determined that youth had a high burden related to STIs, but clinicians did not screen females consistently and rarely screen male youth (Rubin et al., 2011). Nurses therefore must focus on both male and female screening consistently.

Community Nursing Diagnoses

Nurses will focus on social challenges to understand communicable diseases in Windshield Community. For instance, a focus will shift to changes in community health nursing diagnosis to highlight sexual behaviors and patterns. Individuals with multiple sexual partners should learn from public education about the risks associated with such practices. In addition, nurses must explore knowledge deficits on sexual behaviors among community members to address cases of reported communicable diseases.

Further, the diagnosis must also evaluate pain associated with infection of Chlamydia and other STIs. Community members must also be diagnosed with anxiety related to fear of having Chlamydia and other unknown infections. Nurses should also assess situational self-esteem associated with guilt and shame of infections and infecting others with Chlamydia and potential STIs. Diagnoses must also address poor sexual habits and behaviors, specifically cases that lead to re-infection.

Planning/Interventions

Generally, a care plan for the community is normally wider in scope and more complex relative to plans for patients in healthcare facilities. As the numbers of involved nurses and community members increase, the care plan becomes expensive but leads to a stronger patient-nurse relationship.

Nurses must ensure that interventions for Chlamydia are flexible and are developed to meet the specific needs of community members and individuals. It must account for lifestyles, sexual behaviors, and social activities, as well as economic factors. The care plan must contain sexual health education, counseling, and referral services for community members who may require further nursing care (Stanhope & Lancaster, 2008).

The care plan must contain expected outcomes. For instance, outcomes after interventions may include reduced rates of infections and few reported cases while individuals may indicate increased self-esteem, quick reporting of new cases once symptoms have appeared, and shifts to safe sexual practices.

A care plan must be planned and implemented. Therefore, nurses will have to screen and teach patients about Chlamydia and other STIs. In addition, they must ensure that patients use correct dosage, observe medication time, and must insist on full dosage even if patients no longer feel symptoms of the disease. Further, any dietary recommendations must be observed, including restrictions. Therefore, nurses must emphasize the need for patients to adhere to medications, discuss their feelings and concerns regarding the diagnosis of Chlamydia. It is imperative to demonstrate that diagnosis should not impair the self-esteem and self-worth of community members. In addition, nurses must educate the community about engaging in safe sex, talking with other sexual partners, and teaching children about STIs.

Evaluation

The care plan evaluation is necessary to determine its effectiveness. For nurses who will serve a large population of Windshield Community, evaluation could be more difficult. In such cases, patient progress could be slow while several other variables are also involved. Evaluation is usually simple in a case where only a few patients are involved. In addition, community outcomes may not be readily apparent, and they could take several weeks, months, or years. Community nurses must therefore plan for a long-term evaluation care plan.

Constant follow-up visits are necessary to get patients status and medication adherence. It would help nurses to understand if patients have changed their behaviors and risky habits.

Nurses will utilize feedback obtained from the evaluation process to improve future community care plans for the same population.

A study conducted in California for Chlamydia care practices established that many primary care providers did not adhere to current clinical guidelines strictly (Guerry, et al., 2005). Therefore, nurses should use their feedback to improve care plan practices.

Conclusion

The purpose of this essay was to develop a care plan for Kendall Lakes Windshield Community based on the public health issue of Chlamydia. A public health nurse approach was adopted for the care plan. Chlamydia was selected because it was the most reported case in the community and it is known for asymptomatic tendencies.

The care plan will meet the specific needs of the community and address specific risk factors associated with Chlamydia and other STIs. All the required steps that incorporate assessment, diagnoses, planning/intervention, implementation, and evaluation have been included in the care plan. Nurses can use results to improve future public health nursing activities.

References

Gerber, L. (2012). Community health nursing: A partnership of care. Nursing Career Directory, 42(1), 19-20.

Guerry, S. L., Bauer, H. M., Packel, L., Samuel, M., Chow, J., Rhew, M., & Bolan, G. (2005). Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California. Journal of General Internal Medicine, 20(12), 11021107.

Rubin, S. E., Alderman, E. M., Fletcher, J., Campos, G., OSullivan, L. F., & McKee, M. D. (2011). Testing Adolescents for Sexually Transmitted Infections in Urban Primary Care Practices: Results from a Baseline Study. Journal of Primary Care & Community Health, 2(3), 209212.

Stanhope, M., & Lancaster, J. (2008). Public Health Nursing: Population-Centered Health Care in the Community (7th ed.). St. Louis, MO: Mosby.

Whelan, M. (1988). Nursing management of the patient with Chlamydia trachomatis infection. Nursing Clinics of North America, 23(4), 877-83.

Introduction

Herpes simplex virus 2 (HSV-2) is a virus that causes genital herpes. It belongs in the same genus and family with herpes simplex virus 1. The virus has several mechanisms that enhance its virulence. Its interaction with the immune system is complex, thus rendering the development of a vaccine difficult. Treatment involves the administration of antiviral drugs, even though drug resistance is encountered sometimes. Infection can be prevented by using condoms during sexual intercourse and abstaining from vaginal, anal, and oral sex.

Description of Organism

Herpes simplex virus 2 (HSV-2), taxonomically referred to as the alphaherpesvirus 2 is a virus that causes genital herpes. It belongs to the Herpesviridiae family, the Herviviricetes class, and the simplexvirus genus. It belongs to the same family as simplex virus 1 that also causes herpes. HSV-2 is a large, spherical, double stranded DNA virus that comprises a four-layered structure: a core, a capsid, an envelope, and a tegument (Serdaroglu, & Kutlubay, 2017). It is wrapped in a protein cage called a capsid, which is surrounded by a lipid bilayer, commonly referred to as the envelope (Tognarelli et al., 2019). The capsid and the envelope are joined together by means of a tegument. The virus contains approximately 74 genes that encode proteins that form the capsid, the envelope, and the tegument. In clinical tests, quantitative real-time polymerase chain reaction (qPCR) is to detect the virus (Tognarelli et al., 2019). Gram staining techniques are usually used for detecting bacteria and fungi, and they are usually ineffective in the diagnosis of viral infections because viruses lack the cell wall.

Virulence factors

The HSV-2 has undergone evolution for thousands of years, and their prevalence in the population is relatively high. The virus has the ability to persist and recur in healthy individuals because of the virulence factors that they have evolved over the years. These viruses cause lifelong infections because of their ability to establish latency in neurons and subsequent reactivation that is associated with episodes of viral shedding. Their virulence factors include interfering with toll-like receptor sensing functions, hampering the ability of non-Toll-like receptors (TLRs) to identify viral nucleic acids, interfering with the hosts interferon response, and down-modulating the activities of innate immune cells (Tognarelli et al., 2019). The infected cell protein (ICP) 34.5 prevents the maturation of dendritic cells while surface glycoproteins on the viral envelope mimic host cells to avoid activation and elimination (Zhu & Viejo-Borbolla, 2021).

Molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) are sensed by structures known as Toll-like receptors (TLRs), which initiate the expression of antiviral activity. HSV-2 interferes with the functioning of these receptors, thus rendering the host unable to recognize viral infection (Tognarelli et al., 2019). Viral nucleic acids play an important role in immunity because they activate signaling pathways that initiate antiviral responses against infections. HSV-2 is highly virulent because it hampers the ability of non-TLR receptors to recognize the nucleic acids of viruses after infection. HSV-2 also interferes with the host interferon response by encoding several molecular factors that affect the production, secretion, and the activity of interferons (IFNs) (Tognarelli et al., 2019). Interferons play a key role in fighting infections by triggering antiviral responses that prevent the replication of viruses. HSV-2 also inhibits the proper functioning of innate immune cells and the complement system (Tognarelli et al., 2019). The virus stops the reactions of the complement system by preventing protein activations that are important in the formation of a membrane attack complex (MAC) on the pathogens surface or infected cells.

Immunity

The Innate and the adaptive immune systems are responsible for protecting individuals against HSV-2 infections. The innate immune system is a fast and non-specific defense mechanism that includes the skin and the mucus membrane (Ike et al., 2020). Secretions such as fatty acids and sweat are toxic to pathogens. The adaptive immune system is more effective because of its specificity and memory properties. The system is primarily comprised of T-lymphocytes that oversee the cellular immune response and B-lymphocytes that secrete antibodies and mediate the humoral immune response (Ike et al., 2020).

Infectious Disease Information

HSV-2 causes genital herpes, a disease that is characterized by blisters or lesions that appear on the surface of the mouth, rectum, or genitals. Tender sores appear after the lesions break, prior to which the individual experiences a burning or itching sensation (Serdaroglu, & Kutlubay, 2017). In certain cases, the disease is asymptomatic. However, in cases where symptoms appear, genital or anal blisters are observed. Complications that could develop if the disease is untreated include bladder problems, meningitis, yeast infections, rectal inflammation (proctitis), and sexually transmitted diseases such as AIDS.

Epidemiology

The virus infects more than 500 million people across the globe, with approximately 50 million coming from the United States. The transmission of HSV-2 occurs through sexual contact with the genitals, skin, or anal surfaces of an infected individual. The virus can be transmitted, even though the skin does not have lesions as it is transferred between hosts without the presence of symptoms (Serdaroglu, & Kutlubay, 2017). In some cases, HSV-2 is shed in the genital tract, and transmitted during sexual intercourse. Moreover, transmission occurs through contact with a herpes sore, genital fluids from an infected person, and saliva from an infected person (Serdaroglu, & Kutlubay, 2017). The virus cannot be transmitted by touching the surfaces of objects such as toilet seats and beddings.

Prevention

Scientists have conducted several clinical tests for vaccines against genital herpes. However, none of them has been successful so far. In that regard, the unavailability of a vaccine means that individuals have to use preventive means to avoid infection. The two main strategies for the prevention of genital herpes are sexual abstinence and the use of protection during intercourse (Serdaroglu, & Kutlubay, 2017). The avoidance of vaginal, anal, and oral sex is the most effective preventative measure against genital herpes. Another strategy is the practice of monogamy; sexually active people should ensure that they remain monogamous and use condoms during intercourse (Serdaroglu, & Kutlubay, 2017). In certain cases, condoms could be ineffective because the skin can shed the virus in areas that do not have sores. In that regard, condoms are effective only in cases that involve transmission through the male sexual organ.

Treatment

Genital herpes does not have a specific eradication modality. However, there are three classes of drugs that are used for treatment purposes: acyclic guanosine analogues, pyrophosphate analogues, and nucleotide analogues. The treatment of the disease involves the administration of antiviral drugs that interfere with the replication of the virus and shorten outbreaks (Serdaroglu, & Kutlubay, 2017). Moreover, they mitigate the severity of lesions and reduce the risk of transmission to healthy individuals. Studies conducted have shown that the use of drugs such as acyclovir and valaciclovir on a daily basis lowers the rate of viral activation (Serdaroglu, & Kutlubay, 2017). Treatment failure usually results from the development of drug resistance due to the prolonged use of a specific drug. The administration of antiviral medicines is the only remedy because a vaccine to prevent infection has not yet been developed. The vaccines that have been tried have not shown any substantive results, hence they cannot be approved for use.

Clinical Relevance

HSV-2 is effectively treated using antiviral drugs such as acyclovir. However, resistance to the drug has been reported in certain cases. Immunocompromised individuals and patients who have undergone allogeneic bone marrow transplant have shown resistance to the drug, thus rendering treatment ineffective (Serdaroglu, & Kutlubay, 2017). This is due to mutations on either thymidine kinase (TK) or DNA polymerase. In the majority of the reported cases, resistance to ACV is caused by mutation in the TK genes (Serdaroglu, & Kutlubay, 2017). Research has shown that this challenge can be mitigated by using another type of medication that has a different mechanism of action. The effects of resistance include more severe infections among immunocompromised patients. It is important for scientists to develop more effective methods of detecting resistance to antiviral drugs for improved health outcomes.

Conclusion

HSV-2 is a virus that causes genital herpes and that establishes latency in neurons, therefore reactivating and causing new infections. Infected individuals experience sores or lesions on infected regions. Transmission occurs through contact with the genitals or the skin of an infected individual. Moreover, transmission occurs through contact with a herpes sore, genital fluids, and saliva from an infected person. The virus infects more than 500 million people worldwide. Treatment involves the administration of antiviral drugs that prevent viral replication. A vaccine has not yet been developed, though several have unsuccessfully undergone clinical trials.

References

Ike, A. C., Onu, C. J., Ononugbo, C. M., Reward, E. E., and Muo, S. O. (2020). Immune response to Herpes simplex virus infection and vaccine development. Vaccines, 8(2), 302. Web.

Serdaroglu, S., & Kutlubay, Z. (Eds.). (2017). Fundamentals of sexually transmitted infections. Books on Demand.

Tognarelli, E. I., Palomino, T. F., Corrales, N., Bueno, S. M., Kalergis, A. M., and Gonzalez, P. A. (2019). Herpes simplex virus evasion of early host antiviral responses. Frontiers in Cellular and Infection Microbiology, 9 (127), 1-24. Web.

Zhu, S., & Viejo-Borbolla, A. (2021). Pathogenesis and virulence of herpes simplex virus. Virulence, 12(1), 2670-2702. Web.

Abstract

Herpetic keratitis is an inflammation of the cornea caused by the herpes simplex virus, which is a neurodermotropic virus that has been present in the human body since childhood. Herpes simplex virus is the most common infectious cause of blindness in developing countries, and a high titer of specific antibodies is a sign of herpes virus infection. Most babies are born with antibodies to the herpes simplex virus due to their presence in mothers, and during the first six months of their life, antibodies to herpes disappear. The overall purpose of the paper is to assess the herpes simplex keratitis of the PAM case. Most adults are healthy carriers of the virus, and with certain indicators of immunity, the herpes virus does not cause disease until its virulence intensifies.

Keywords used: microbial keratitis, neurotrophic keratopathy, viral keratitis, herpes simplex virus.

Introduction

Herpes simplex keratitis or, as it is also called, keratitis of the herpes simplex virus is one of the common ophthalmic diseases. The herpes simplex virus, getting into the eye tissue, actively multiplies in the cells of the corneal epithelium. An active inflammatory reaction ultimately leads to the appearance of the clouding of the cornea, superficial or deep, and decreased vision. In some cases, episcleritis, secondary glaucoma, herpetic keratoiritis, complicated cataracts, retinitis, neuritis, leading to a significant decrease in vision, can develop. Factors such as hypothermia, stress, ultraviolet radiation, and neuroendocrine shifts usually contribute to the activation of the virus. The disease is often a systemic lesion of the eyes, mucous membranes, central and peripheral nervous systems. Herpetic pathology manifests itself in the form of primary herpes, and in this case, there are no antibodies to this virus in the body. In addition, the disease manifests itself in the form of post-primary herpes, that is, the infection has already occurred, and the patient has cellular and humoral immunities.

Most cases occur subclinically or are manifested only by an increase in body temperature, malaise, and symptoms of upper respiratory tract damage. Blepharoconjunctivitis may develop, often proceeding favorably and spontaneously resolving. In rare cases, micro-tree-like infiltrates on the cornea develop. Post-primary herpes is most commonly detected in children from 3 years. In adults, the development of post-primary herpes occurs against a background of weak antiherpetic immunity. The greater the number of previous herpes attacks, the higher the risk of relapse. Post-primary herpetic keratitis is manifested by a feeling of moderate discomfort in the eye, lacrimation, decreased vision, and the sensitivity of the cornea decreases¹. With a superficial process, infiltrates of a characteristic tree-like form appear in the cornea, either in the formation of single or multiple vesicles. In more severe cases, the pathological process may cover deeper and larger areas of the cornea. The process may be accompanied by the occurrence of non-healing defects due to toxic damage, the insufficient regenerative ability of corneal tissue. The epithelial form is the most common form of the disease, usually its initial stage. At first, point opacities or vesicles appear  small vesicles in the corneal epithelium. Further, the bubbles, merging, form on the surface of the eye a pattern resembling branches of a tree, therefore this keratitis is also called tree-like.

As the disease progresses, the number of vesicles increases and superficial ulceration develops, which, as a rule, affects the optical zone and begins to capture the superficial stroma of the cornea. At this stage, iridocyclitis may occur. Treelike keratitis is accompanied by photophobia, lacrimation, blepharospasm, neuralgic pain². Corneal ulceration leads to a significant decrease in vision. Herpetic keratitis is a severe disease, faced with which it is essential to make an appointment with an ophthalmologist on time and begin treatment.

In some cases, delaying even a couple of days can result in complete blindness. During the initial appointment, an ophthalmological center specialist collects an anamnesis and examines the patient, after which he concludes what other laboratories or instrumental studies need to be done to confirm the diagnosis. Depending on the diagnostic results, conservative or surgical treatment can be prescribed. In the first case, ophthalmologists successfully use antiviral and immunotherapy. Some patients have to resort to surgical treatment  removal of a pathologically altered zone, that is, therapeutic keratoplasty.

Differential Diagnoses

The differential diagnoses include:

• microbial keratitis
• neurotrophic keratopathy
• viral keratitis

Microbial keratitis is an infectious disease of the cornea caused by bacteria, fungi, amoeba, or viruses. Keratitis is manifested by pain and inflammation and, in severe cases, can lead to loss of vision or blindness. The key risk factors for developing this type of serious infection are improper storage or routine use of contact lenses. This is an acute inflammation of the cornea of the eye of bacterial origin. It is clinically manifested by acute pain in the eye, edema, corneal syndrome, severe inflammatory injection of the eyeball, the presence of mucopurulent discharge, corneal opacity, superficial or deep ulceration³. Diagnosis of bacterial keratitis includes biometrics of the eye, microbiological examination of a smear from the cornea, confocal and endothelial microscopy, pachymetry, keratometry, corneal topography, determination of the sensitivity of the cornea. Priority in the treatment of bacterial keratitis is local and systemic antibiotic therapy, supplemented by the use of specialized instruments, epithelizing agents, mydriatics, and in case of complications  surgical intervention. Bacterial keratitis is the most common corneal disease. There is primary and secondary, endogenous and exogenous, superficial and deep bacterial keratitis. With microbial damage to the cornea, in addition to edema and purulent infiltration, increased vascularization, the formation of a stromal abscess, erosion, and ulceration with possible tissue necrosis are noted in it. Bacterial keratitis is a serious problem of practical ophthalmology, as in most cases, it causes temporary disability, and in the future, it can lead to a decrease in visual acuity and blindness.

Neurotrophic keratopathy is a degenerative disease of the epithelium and stroma of the cornea, causing a violation of the sensitivity of the cornea. In turn, a decrease in sensitivity leads to the occurrence of chronic or recurrent erosion of the epithelium, and then ulcers and perforation of the cornea⁴. The reasons for the development of neurotrophic keratopathy may be the use of local medications, the presence of a prolonged course of diabetes mellitus, lesions of herpes zoster or herpes simplex, neurological diseases, or localized trauma. As a treatment, patients with Neurotrophic keratopathy are prescribed instillations of an antibiotic solution, an artificial tear preparation that does not contain preservatives, with a bandage or bandage contact lens. In cases where a topical treatment is ineffective, systemic administration of doxycycline, treatment with autologous blood plasma, application of the amniotic membrane, as well as the use of a conjunctival flap is recommended. Herpetic keratitis, the state after some eye operations, and wearing contact lenses can be listed among the ocular causes of the development of the condition. Among the reasons for the development of the disease, the leading place is occupied by neurosurgical operations, prolonged anesthesia, and conditions after an acute cerebrovascular accident. The clinical picture of neurotrophic keratopathy is characterized by the presence of epithelial defects  from a single superficial punctate keratopathy in the initial stage, confluent erosion, and corneal ulcers to the development of its thinning and perforation. Diagnosis of neurotrophic keratopathy is quite painstaking work and begins with a thorough history taking, with an emphasis on questioning the presence of processes that alter neurotrophy. Since the causes of neurotrophic keratopathy are very diverse, the patients medical history should be thoroughly studied.

Viral keratitis arises as a result of infection with the herpes simplex virus or herpes zoster. The pathological process of the cornea of an inflammatory nature that causes a viral infection is expressed by a rash of a bubbling nature, swelling, ulcers, and clouding of the cornea, redness of the eyes, pain, and also visual impairment. It is mainly found in children and young patients. In severe cases of the disease, complications such as corneal dying, abscess, ulcerations develop. The most severe illness is caused by the viruses of simple and herpes zoster. The causative agents of the disease can be adenovirus and herpetic infections, chickenpox viruses, and measles. If untreated on time, viral keratitis is also able to cause adenoviral conjunctivitis. If the integrity of the cornea is broken or the immune system is weakened, the body is often affected by stress, or there was hypothermia  the risk of developing the disease increases⁵. Herpetic keratitis can even cause an acute respiratory viral infection or influenza, which reduces immunity and activate the causative agent of latent infection. The disease has a long course and can often recur. The characteristic signs of the disease are a blistering rash, infiltrates of irregular and treelike forms, as well as a decreased sensitivity of the cornea.

Discussion

To properly treat and manage herpes simplex keratitis, it is important to understand its key epidemiological, clinical, symptomatic, and diagnostic features. It is stated that approximately 500000 American citizens suffer from herpes simplex keratitis each year⁶. However, primary forms of the disease are mostly mild and even asymptomatic⁷. Therefore, complications are not common, but the instances can be overwhelming. It is especially true in the case of individuals with AIDS, who lack a strong immune system, and thus, they are more likely to suffer from herpes simplex keratitis⁸. Its pathophysiology and clinical features include a sensitivity decrease in the cornea, irritation, and viral presence of the herpes simplex virus. Signs and symptoms can vary depending on their prominence, but it is important to note that conducting diagnosis solely based on symptomatic characteristics can be highly challenging. Characteristic symptoms include eye irritation symptoms such as lacrimation, photophobia, and blepharospasm. In addition, there is the presence of precorneal hyperemia or mixed, combined with conjunctival redness, and possibly clouding of the cornea, accompanied by a violation of specularity, gloss of the cornea. In old age, a herpetic ulcer may occur asymptomatically, redness of the eye is small or maybe absent, the pain is minor. In childhood, on the contrary, herpetic lesion of the cornea is accompanied by sharp pain, severe eye irritation, photophobia.

Due to the high sensitivity of PCR diagnostics and serological studies, false-positive results are possible. The determination of the herpes simplex virus nucleic acid in biological material is the current gold standard for clinical diagnosis. PCR diagnostics is the most expensive method, but the fastest, most accurate, and reliable method for determining viral DNA with herpetic keratitis due to its high specificity and sensitivity. With superficial herpetic keratitis, it allows for very accurate monitoring of the effectiveness of treatment. The typical clinical picture of keratitis correlates well with a positive PCR result, especially with epithelial defects or tree keratitis. In half the cases of atypical keratitis, a positive PCR result is determined. With DNA epithelial keratitis, the herpes simplex virus is detected in all cases, with active stromal keratitis in half the cases. It is not detected in the case of stromal keratitis or endothelium.

When infected with the herpes virus, sequential synthesis is observed, and their main effect is aimed at blocking the pathogen due to the formation of antigen-antibody immune complexes and thereby reducing its pathogenetic effect on epithelial cells and the body as a whole. The mechanism of action of antibodies is aimed at HSV and cells infected by it, inhibition of pathogen reproduction in the focus of its penetration, prevention of the spread of infection through intercellular spaces, reduction of viremia in the body, but humoral mechanisms cannot completely prevent the activation of latent herpes simplex virus. In relapses, the same sequence of immunoglobulin formation is observed as in the initial infection, the synthesis of which occurs against the background of existing antibodies to the virus, which leads to an increase in their level during exacerbations⁹. In cases of subclinical or unrecognized herpetic infection, a serological determination of class G immunoglobulins may be useful. Isolation and cultivation of the pathogen in cell cultures provide the possibility of direct observation and analysis of the spread of the herpes simplex virus in laboratory animals and human embryonic tissues. A biological test is the rarest type of diagnosis and, as a rule, is used to reproduce herpetic keratitis in experimental animals.

DNA diagnostics is a commercially available, quick, and reliable method for determining the etiological cause of the disease in patients with superficial forms of keratitis and some types of stromal keratitis. PCR diagnostics is necessary not only to determine treatment tactics but also for accurate monitoring and correction of therapy, taking into account laboratory results. With deep pathological changes in the cornea and the absence of damage to the surface epithelium, it is less likely to detect virus DNA in a tear¹⁰. Therefore, despite the highest sensitivity and specificity of PCR, it is not possible in all cases of herpetic keratitis to determine the DNA of the virus in a tear. For this reason, it is advisable to also determine immunoglobulins to the virus in the blood of patients with suspected herpetic keratitis.

Conclusion

In conclusion, the herpes simplex virus infected most of the world population, and this infection is often asymptomatic, but the ocular form of the disease with the virus leads to a complex pathology with significant damage to the cornea. The herpes simplex virus is considered the leading cause of blindness in developed countries. Herpetic eye diseases manifest a diverse clinical picture: treelike keratitis, persistent epithelial erosion, disciform keratitis, endothelins, which creates difficulties in making a diagnosis. Confirmation of the herpetic nature of the infection is based on the clinical picture, supported by laboratory tests. There are several methods of laboratory diagnosis of herpes such as PCR diagnostics, serological studies, isolation and cultivation of the pathogen in cell cultures, and biological samples.

References

Salmon, J. Kanskis clinical ophthalmology: a systematic approach. Elsevier. 2019.

Valls-Sole, J., Defazio, G. Blepharospasm: update on epidemiology, clinical aspects, and pathophysiology. Front Neurol. 2016; 7(45):1-8.

Lakhundi, S., Siddiqui, R., Khan, NA. Pathogenesis of microbial keratitis. Microbial Pathogenesis. 2017; 104: 97-109.

Versura, P., Giannaccare, G., Pellegrini, M., Sebastiani, S., Campos, EC. Neurotrophic keratitis: current challenges and future prospects. Eye Brain. 2018; 10:37-45.

Austin, A., Lietman, T., Rose-Nussbaumer, J. Update on the management of infectious keratitis. Ophthalmology. 2017; 124(11): 1678-1689.

Azher, TN., Yin, XT., Tajfirouz, D., Huang, AJ., Stuart, PM. Herpes simplex keratitis: challenges in diagnosis and clinical management. Clin Ophthalmol. 2017; 11:185-191.

Jester, JV., Morishige, N., BenMohamed, L., Brown, DJ., Osorio, N., Hsiang, C., Perng, GC., Jones, C., Wechsler, SL. Confocal microscopic analysis of a rabbit eye model of high incidence recurrent herpes stromal keratitis (HSK). Cornea. 2016; 35(1):81-88.

Burcea, M., Gheorghe, A., Pop, M. Incidence of herpes simplex virus keratitis in HIV/AIDS patients compared with the general population. J Med Life. 2015; 8(1):62-63.

Lobo, AM., Agelidis, AM., Shukla, D. Pathogenesis of herpes simplex keratitis: the host cell response and ocular surface sequelae to infection and inflammation. The Ocular Surface. 2019; 17(1): 40-49.

Carroll, KC., Jorgensen, JH., Pfaller, MA. Manual of clinical microbiology. ASM Press. 2015.

From 1932 to 1972, the United States Public Health Service (PHS) conducted a clinical study that was aimed at observing and learning more about the natural process and history of untreated syphilis. The leakage of such a process resulted in numerous questions and criticism. It still remains one of the most infamous experimental studies of all time in the United States. This paper gives a detailed analysis of the ethical, legal, and health implications of this clinical trial.

Legal and Ethical Principles

The researchers and agencies involved in this study violated several principles that are critical for any research process. First, such scholars and leaders failed to consider the implemented policies and guidelines regarding the inclusion of human subjects in medical trials. Second, they deceived the participants that they would receive treatment for syphilis (Paul & Brookes, 2015). Third, the concept of informed consent was ignored since these people were not requested to be part of the process. Fourth, the study targeted African American males from impoverished regions or neighborhoods. Such a move amounted to racial abuse and discrimination. Finally, they tracked the participants and ensured that they were unable to receive treatment elsewhere.

HIC and Hepatitis

It is agreeable that new experimentations such as the Tuskegee Syphilis Study could take place today. Such an outcome is possible since the global community has partnered to identify individuals who might be having this condition (Yip, Han, & Sng, 2016). Within the healthcare sector, researchers could deceive their patients that they are receiving various treatments for their conditions while monitoring their health outcomes. They could also use control groups characterized by people who do not have the disease (Paul & Brookes, 2015). However, chances of identifying and exposing such studies are higher in comparison with what took place during the time of the Tuskegee Syphilis Study.

Benefits

Several unethical and illegal studies have been conducted in the past that have ignored the rights of the involved subjects. However, some stakeholders remain divided regarding whether such studies are beneficial or not. The acquired information could be important or applicable in different settings to treat patients and provide them with honest information (Paul & Brookes, 2015). While others believe that such experimentations are erroneous and unethical, the consideration of the acquired ideas could become a new opportunity to improve healthcare delivery (Anekwe, 2015). Additionally, such researches are important since they forced different agencies and governments to remove all loopholes and ensure that no other unethical study is completed in the future.

Data Use

Although this unethical study delivered questionable research data, it would be appropriate to rely on the acquired information and apply it in healthcare. The only benefit people can get from such a process is ensuring that the collected ideas are translated into better care delivery and treatment models that resonate with the demands of more people with syphilis (Paul & Brookes, 2015). Such insights could also be useful in guiding and empowering citizens to protect themselves against this sexually transmitted disease (STD). However, policymakers and government agencies will have to prevent similar studies in the future.

Conclusion

The above discussion has identified and described the Tuskegee Syphilis Study as one of the most notorious and unethical experimentations ever completed by mankind. The process was unethical, targeted minority citizens, and failed to advocate or protect the participants rights. While the acquired information and data could be useful in clinical practice, there is a need for future researchers and policymakers to ensure that similar studies do not take place in the future.

References

Anekwe, O. (2015). Artists statement: Tuskegee men. Academic Medicine, 9(5), 621.

Paul, C., & Brookes, B. (2015). The rationalization of unethical research: revisionist accounts of the Tuskegee Syphilis Study and the New Zealand Unfortunate Experiment. American Journal of Public Health, 105(10), e12-e19.

Yip, C., Han, N. R., & Sng, B. L. (2016). Legal and ethical issues in research. Indian Journal of Anaesthesia, 60(9), 684-688.

Introduction

Ethical behavior has always been assumed to be the foundation of a productive and well functional society. Ethics are especially significant in medical circles since unethical practices can have dire impacts on the society. One of the most infamous unethical research studies in American history was the Tuskegee Syphilis Study.

This study resulted in research abuses on the test subjects and had dire consequences that continue to be felt to date. This paper shall review the Tuskegee Syphilis Study (TSS) which resulted in widespread outcry over allegations of gross unethical practices. The paper shall begin by a brief description of the study and its findings. The unethical aspects that characterized the experiment shall then be reviewed.

Description of the Study

The now infamous Tuskegee Syphilis Study was commissioned by the United States Public Health Service (USPHS) and the study was conducted from 1932 through to 1972.

The motivation for this study was the prevalence of syphilis among blacks and the possibility of coming up with mass treatment of the condition. Macon County, Alabama was chosen as the town of choice due to the fact that it had the highest syphilis rate in the counties surveyed. The main aim of the study was to test the effects of untreated syphilis over a long period of time.

The test subjects were 399 sharecroppers from Alabama who were all African American (Katz, 2009). The study sought to determine the natural course of syphilis and as such, the test subjects were all suffering from syphilis before the study began. 200 uninfected men served as controls for the study. Another aim of the experiment was to demonstrate that antisyphilic treatment was unnecessary for treating latent syphilis.

Ethical Issues

From the very onset, TSS was characterized by blatant lying to the subjects by the experimenters. The test subjects were not informed of their involvement in an experiment. Instead, they were told that they suffered from “bad blood” and they were required to regularly attend the clinic for free treatment.

In reality, the subjects were not being treated for syphilis but were instead given placebo treatments so as to give the researchers a chance to observe the progression of their syphilis. The subjects therefore unwittingly participated in the study under the guise of treatment.

Another ethical issue from this experiment was that the study subjects were denied access to physicians who could have correctly diagnosed them with syphilis and proceeded to give them the necessary treatment.

Brandt (1978) reveals that in the course of the 40year experiments, the experimenters colluded with local physicians to ensure that the text group was not given medical care. Letters were distributed requesting that the subjects be referred back to the USPHS (where the study was taking place) if they sought health care from other hospitals.

While at the onset of the study in 1932 there was no widely available cure for syphilis, penicillin emerged as the preferred treatment for syphilis in the early 1950s. Gray (1998) reveals that despite this, the men who were a part of the TSS did not receive any therapy. This was unethical since the health status of the men was known and the physicians could have intervened to restore the health of the test subjects. This action went against the basic code of nonmaleficence which obligates physicians not to do harm.

Discussion and Conclusion

Unethical conducts have many adverse effects both to the individual and the society at large as was demonstrated by the TSS. Katz et al (2009) reveals that the TSS resulted in great mistrust for public health efforts by African American’s. In addition to this, the black community began to demonstrate great reluctance for clinical research studies; a legacy that continues to date.

This paper set out to discuss the TSS which is hailed as one of the most unethical studies carried out in American history. From this paper, it is clear that unethical practices can result in great loses for the society and the individual. The Tuskegee Syphilis Study is one of the research studies whose unethical nature resulted in the death of subjects as well as mistrust by the black community for public health initiatives.

References

Brandt, A. M. (1978). “Racism and Research: The Case of the Tuskegee Syphilis Study”. Hastings Center Magazine.

Gray, D.F. (1998). The Tuskegee Syphilis Study: the real story and beyond. NewSouth Books.

Katz, V.R. et al. (2009). “Exploring the “Legacy” of the Tuskegee Syphilis Study: A Follow-up Study from the Tuskegee Legacy Project.” Journal of the National Medical Association Vol. 101, NO. 2, 179.

Introduction

Syphilitic aneurism of the aortic arc refers to a syphilis induced abnormal bulge of the aorta. This occurs when a weakness emanates from the wall of the thoracic arc of the aorta. The disease manifests itself during the tertiary stage of syphilis when the patient has not been treated.

Etiology of the lesion

As the name suggests, the lesion emanates from syphilis; however, the disease should be in its tertiary phase. At this point, the sections of the aorta known as the vasa vasorum and the adventitia inflame. This causes weakness of the media and the formation of an aneurysm. The aneurysm comes after the medial muscle fibres have been scarred. The lesion may manifest as a cylindrical swelling on the arc of aorta or may also occur as a saccular distension.

Macroscopic and microscopic findings

Diagnosis and evaluation of the condition aims at analysing the features (morphology) of the aorta and the structures surrounding it. It also entails examining the size and character of the aneurysm as well as the characteristics of the blood vessel.

Patients need to do a CT scan of their thoracic aorta in order to assess the thickness of their walls and detect the presence of aneurysms. The radiologist ought to examine the mean, maximum and minimum diameter of the aorta. Usually, the arch of aorta is approximately 2cm. If it is abnormally large, then a syphilitic aneurysm should be suspected. Once the aneurysm has been detected, one must determine the part of the aorta that it belongs to. If it occurs on the arch, then the condition should be further expected. The nature of the aneurysm must be studied by looking at three layers: the intima, adventitia and the media. If these three layers do not exist, then the aneurysm may be a false one.

The intima should have a nodular shape like a tree bark, and it should also look irregular for positive confirmation of the disease (Taufiek et al. 1258). The media has a high degree of vascularisation for Syphilitic aneurysms. The pathologist must also look at the relationship of the blood vessel to others as well as the effect on other structures. In this regard, one must determine whether new complications arose such as ruptures. A rupture often arises when the size of the aneurysm is quite large. Laplace’s law states that wall tension is proportional to an aorta’s diameters. Therefore, the larger the size of the aneurysm, the higher the chances of rupture. A rupture will be seen in the CT scan through a highly attenuated hematoma. Alternatively, an aneurysm that is just about to rupture may be seen as a crescent within the mural thrombus. A contained rupture may also be seen as a draped aorta.

With regard to the pathology of the aorta, a person with this condition may have scattered plasma cells as well as lymphocytes. In other words, infiltration of these cells will occur. Sometimes the cells may collect on regions that are close to blood vessels. Adventitial vessels will possess lymphocytic cuffing as well as endarteritis. The latter signs are typical of syphilis in patients. Additionally, one will find elastic fibres have been lost; fibrosis may occur here. When the fibrosis is extensive, it may involve the aortic valve and the cusps. An examination of the aorta should also show a tree-bark change of the aorta. The aorta should also be working insufficiently because of constriction or diameter changes. This manifests as reduction of blood flow.

The x-ray will show a calcified aorta on its lining. It will also demonstrate a wide aortic root. When physically examining the patient, one will hear a loud tambour of the second sound of the aorta.

Symptoms and signs

Since the condition affects the thorax, then most symptoms will involve this area. A patient will feel pain in the anterior and posterior parts of the chest. He or she will have a hoarse voice owing to the paralysis of the vocal chords or laryngeal nerve compressions. Some may find it difficult to swallow food and drinks. Most individuals may report dyspnea and coughing that emanate from compression of the trachea. Additionally a rapture of the aneurysm may occur, and this may affect the bronchus thus leading to haemoptysis. Others may report angina, which comes from lesions of the aortitis. Lastly, the disease may manifest as shock when the aneurysm ruptures and affects the pleural space. At this point, heart failure can occur and the patient will die (Kent & Romanelli 230).

Someone with Syphilitic aneurism of the aortic arch will possess unequal pulses or blood pressure of the extremities. In the third or second intercostal space, the person will have palpable pulsations of the chest wall. Additionally, one is likely to report increased cases of tracheal deviations. Patients may also show conditions of vocal chord paralysis

Treatment

Patients should be given penicillin for the treatment of syphilis. After completion of the medication, the person should undergo surgical repair. In this regard, the section of the artery wall that bulges should be cut and Dacron fibre sawn on to replace the vessel wall that has been cut. The surgical option should occur after continual monitoring of the size of the aneurysm, or after observation of other symptoms. Once the aneurysm has exceeded 5.5 cm, then surgery ought to be considered. The monitoring process can start early if symptoms are not prevalent. CT scans can be done annually. The doctor ought to determine whether the rate of the growth of the aneurysm exceeds 1cm; when this occurs, then surgery is plausible. Annual growth rates of 0.07cm to 0.42cm may not warrant surgical repair. If the medical practitioner underestimates the need for surgery or when the condition has worsened tremendously, then the aneurysm could rupture. When this occurs, approximately 50% of patients die. There are also risks in performance of surgery because 1-2% of patients that undergo the procedure often die.

If the character of the blood vessels, structures and aneurysm do not warrant surgery, then the patient should be treated for syphilis. Since this condition will occur at late stages, then weekly administration of penicillin G for a period of 21 days ought to be done. The treatment will prevent further deterioration of the disease.

Relevance to dental practice

A dentist ought to alter his or her treatment plan in accordance with this condition. One should also know what to do during emergencies. When a person has the condition, the use of antibiotics should be minimised. As stated earlier, severe cases of the condition may lead to diminished blood flow, a dental surgeon may handle a patient with ischemic conditions. The person may experience intense and severe chest pains. The dentist must call for emergency service and stop the dental activity. The patient ought to be given oxygen and allowed to stabilise. If the pain refuses to subside, the dental surgeon must consider cardiopulmonary resuscitation (Munoz et al. E302).

Works Cited

Kent, Margaret & Francis Romanelli. “Re-examining syphilis: an update on epidemiology, clinical manifestations and management.” Annual Pharmacother 42.2 (2008): 226-236. Print

Munoz, Maria, Yolanda Soriano, Rafael Roda & Garcia Sarrion. “Cardiovascular diseases in dental practice: Practical considerations.” Med. Oral Patol Oral Cir Bucal 1.13(2008): E296-302. Web.

Taufiek, Rajab, B. Chir, & Robert Gallegos. “Giant Syphillic Aortic Aneurysm.” The New England Journal of Medicine 364(2011): 1258. Web.

Any activity such as study, policy or project with the hope of success must involve participants at all stages. In a project, participants ought to be involved in needs assessment, project identification, planning, monitoring and evaluation. When making policies, the subjects to the policy should be involved right from policy planning and formulation, up to evaluation.

This ensures that the beneficiaries own the entire process of the study, project or policy and that they give their consent for the study to advance (Annas & Grodin, 1992). Creation of a good rapport between researchers and the target population enhances goal achievement. This paper outlines a brief summary of the Tuskegee Syphilis Study.

The Tuskegee syphilis study brought the unethical nature of some researchers into the limelight of the society. The study involved 400 African American males between 1932 and 1972. The United States Public Health Service carried out the study (Gray, 1998).

It derives its name from the area where it was conducted-Tuskegee in Alabama. The sole intent of the study was to expose the effects of untreated syphilis. The researchers felt that by studying the effects of the disease, they would come up with its “natural course.”

The government researchers never informed the participants about the aim of the study nor did they get their consent. The researchers did not ask them to participate, and the subjects did not do it voluntarily. Furthermore, the researchers duped the subjects into thinking that government doctors were sufficiently philanthropic to offer them free treatment (Gray, 1998).

In fact, many participants thought that they were getting a perfect cure for “diseased blood” from the investigators. Participants were not aware that they were suffering from syphilis, and nobody told them about the development and treatment of the disease.

This was extremely unethical of the researchers. As if that were not enough, they ensured the study involved the blacks who did not have adequate resources for quality medical attention.

One can deduce that the researchers targeted the vulnerable population in society; the poor, semiliterate people of African origin. They failed to give the patients antibiotics, which would have improved their health significantly (Aschengrau & Seage, 2008).

Previously, patients suffering from syphilis got treatment in the form of “heavy metals” but with the invention of antibiotics, there were high hopes of better healthcare among the patients. They knew they would get instant treatment for their conditions.

The study came to an end in 1972, after having taken place for more than two decades. This came after the national media criticized the government researchers, who could not even administer penicillin to the patients, leave alone notifying them about their illness. Such a study is widely unacceptable.

However, it served as an eye opener to many ethical-concerned institutions, and it marked the beginning of the concept of informed consent (Gray, 1998). This is the right of participants in a study to understand the nature, as well as, risks and benefits of a research process.

The issue of informed consent also marked advancements in the field of social research. There was the incorporation of ethics into this field, and rarely do researchers conduct their studies without an informed consent.

In summary, the moral integrity of any researcher is crucial in a study. It is quintessential to involve all participants of a study in the whole process of study. They ought to be told clearly about the goals and benefits of a research. This enhances their participation as they feel they are working with reputable people.

References

Annas, G. & Grodin, M. (1992). The Nazi Doctors and the Nuremberg Code. New York: Oxford University Press.

Aschengrau, A., & Seage, G. R., III (2008). Essentials of Epidemiology in Public Health (2nd ed.). Sudbury, MA: Jones and Bartlett.

Gray, F. (1998). The Tuskegee Syphilis Study. Montgomery, AL: Black Belt Press.