Why people refute the notion of evolution

The Darwinian theory of evolution has for long acted as the keystone of modern science which has been accepted by the scientific fraternity for more than one and half centuries. Majority of the population in the United States, according to Sampson (2005), believe that the theory is supported by evidence whereas others believe that living things have existed the way they are presently since the beginning of time. This brings about a profound disconnection between scientists and the general public. Tutors and academic experts blame this educational tragedy on religious right. Endeavors to enlighten the general public concerning biological evolution have long gone through an extreme crisis of significance of religious influence, a crisis which continues unabated. Even for people who acknowledge its authenticity, evolution is widely regarded as a historical process containing concepts that have little if any meaning on human beings, let alone the future of earths multiplicity. This failure, as asserted by Sampson (2005), in education is complicated by factors such as long history of disintegration and compartmentalization on academia leaving people with a space between two significant ideas evolution and creation.

Evolution as well as creation theory of life are the major points of controversy in this issue. Many people believe that evolution theory is based on scientific aspects. These people believe that evolution is a theory supported by research findings of science, whereas creation is perceived as a belief based on faith. Opponents however, claim that research findings do not support the evolution theory. Opponents of this theory allege that findings over the last 20 years or so clearly contradict the primary assumptions of this theory. They state that this theory cannot be used to explain life. Opponents acknowledge the presence of a divine creator who is the source of all life.

Anti-Darwinisms are mostly religious people who believe in God. They claim that the human mind cannot be tested using any form of scientific apparatus developed so far. Darwins theory tends to establish a fact that the universe existed and developed without God. Science according to opponents cannot be used to disprove the presence of God. They believe that life proceeds from God and there is nothing like evolution or life without God.

Darwinism theory according to opponents does not provide a good rational description of how life began in the first place, how new life forms come into being and where the universe originated from. This theory also does not offer a logical reason why at some instances in the geological record a variety of explosions occurred. Opponents argue that this theory is therefore incomplete. They state that the question about life and its origin is beyond the capability of human mind and therefore Darwinism cannot provide an explanation. Proponents of evolution cannot give logical theories that explain evolution. They cannot also show natural mechanisms which can lead to development of new designs and evolve new living things. Proponents have also been unable to reveal a process of genetic which can evolve a new thing. Opponents of evolution theory claim that there exists no evidence to prove that the assumed evolution of all life actually occurred. Yahya (2003), states that people also come to reject evolution as a sense of distinctiveness and belonging to a crowd that has a non-logical anti-evolutionally code of belief as an element of their social toolkit. They refute the science behind evolution because it challenges a set of beliefs they uphold as distinguishing aspects of their tribe.

Diabetes Type II

Diabetes is a condition characterized by individuals having elevated levels of blood sugar resulting from the body not producing sufficient insulin or the body cells not effectively responding to the insulin already present in the body (Kilvert  Fox, 2007). Insulin, a hormone produced in the pancreases, enables the body cells to take up glucose and oxidizes it into energy (Zieve  Wexler, 2009). Lack of this glucose uptake by the body cells will result to the accumulation of glucose in the blood, a condition known as hyperglycemia (Kilvert  Fox, 2007). Hyperglycemia leads to a number of other serious complications.

In type II diabetes also known as non-insulin-dependent diabetes mellitus (NIDDM) results from the body cells becoming resistant to insulin or the insulin that is produced in the body is insufficiency (Kilvert  Fox, 2007).  The onset of diabetes type II can be characterized by individuals having general weakness, chronic fatigue, malaise and lethargy. Frequent urination is not unusual and individuals often complain of excessive thirst. Excessive movements in the bowel and unexplained weight loss have been observed among individuals afflicted by the condition (Mayo Clinic, 2009). The individuals suffering from diabetes type II start having blurred vision caused by the alteration in the shape of the lens due to osmotic factors chiefly the elevated levels of blood glucose. Frequent thirst leads to the affected individual taking a lot of fluids.

Diabetes type II is known to be a genetic disease although medical causes have been explained (Kilvert  Fox, 2007). There is an observation of an increased risk of developing diabetes type II in families where the parents have the disorder. A mutation in the gene known as the Amyloid Polypeptide gene lead to the early signs of the condition and makes the progress to a more severe diabetes type II condition possible (Kilvert  Fox, 2007). Apart from genetics, the condition can be caused by an alteration in the metabolism and deranged cell processes.

Environmental factors have also been blamed to cause diabetes type II particularly some diets and weight (Zieve  Wexler, 2009). Some drugs have been identified to increase the risk of diabetes type II such as the thiazide diuretics, which inhibit the secretion of insulin because of the hypokalemic condition they cause. Thiazides also increase the insulin resistance due to elevated levels of mobilization of free fatty acids (Mayo Clinic, 2009). Other drug agents that can be blamed for drug induced hyperglycemia include beta blockers, somatropin, protease inhibitors, phenothiazines, flouroquinolones, corticosteroids, antipsychotics and calcium channel blockers.

Treatment of Diabetes Type II
The immediate objective of treating diabetes type II is to reduce the elevated levels of blood glucose while the long-term goal of diabetes treatment is the prevention of diabetes-related conditions, which arise after individuals have developed the complication. Diet and exercise remain the primary ways of managing diabetes (Ligaray  Isley, 2010). The afflicted individuals should be able to accurately test and record their levels of blood glucose. The knowledge on what to eat and what medications to use should be well known by people suffering from the disease. The patients should get important information from their doctors.

Individuals with diabetes type II are recommended to eat at the same times every day and their meals should be consistent in terms of the type of foods they choose to eat (Ligaray  Isley, 2010). The adherence of the meal intervals and the type of foods eaten help prevent the increase or decrease in the levels of blood sugars. Individuals can plan their meals by eating the right quantity of foods, choosing healthy foods and eating the meals at the required time. Another aspect is the weight management. It has been observed that some people after cutting weight can stop taking medications even when they still have diabetes. In extreme overweight individuals, bariatric surgery may be recommended. Gastric bypass surgery and laparoscopic gastric banding are some of the weight reduction procedures that can be recommended in the management of diabetes (Ligaray  Isley, 2010).

For diabetics, regular physical exercise is imperative (Mayo Clinic, 2009). It has been observed that aerobic exercise carried out regularly can help reduce the levels of blood sugars without the need of any medication. Exercise help to burn any excess fats and calories and therefore individuals with diabetes can easily manage their weight through exercises. Blood pressure and blood flow, which may be seen as a problem in diabetes type II can be improved (Mayo Clinic, 2009). Exercise decreases the insulin resistance in body cells without necessarily having any body loss. The bodys energy level is also said to improve with exercise and the ability to handle stress as well as lowering of tension are some of the benefits of exercise.

When all the options of exercise and diet have failed, individuals may opt for medications that are prescribed by physicians. The drugs acting against diabetes function to lower the blood sugar levels in a number of ways (Ligaray  Isley, 2010). Physicians may prescribe for patients more than one type of medication because of the different modes of action of the different agents used in diabetes management. The drugs are also prescribed along with insulin when it is required.

The drugs used in diabetes treatment are either given intravenously or orally. For instance, biguanides sold as metformin is used to decrease the hepatic production of glucose (Mayo Clinic, 2009). The rationale of biguanides is to make the fat cells, hepatic cells and the muscle cells to absorb more glucose from the bloodstream hence lowering the total blood sugar levels. Alpha-glucosidase inhibitors are also important agents that lower the carbohydrate absorption from the digestive tract. This lowers the glucose levels especially after the meals. Sulfonylureas help in triggering the pancreases to produce more insulin and they are administered by oral route (Ligaray  Isley, 2010). Other agents used in diabetes management include the thiazolidinediones, pramlintide and exenatide and meglitinides.

Insulin is only prescribes to patients who fail to respond to other methods of disease management such as diet monitoring, exercise and other medications (Mayo Clinic, 2009). In addition, insulin may be recommended for individuals who have poor reactions towards other medications used. Usually, insulin is injected under the skin by the use of an insulin pen device or a syringe. Insulin is never administered orally as proteolytic enzymes in the stomach may act on the hormone hence affecting the efficacy.

In diabetes type II, the body cells fail to respond effectively to insulin even when it is present (Ligaray  Isley, 2010). This is typically seen in type II diabetes mellitus where the resistance is cause by post-receptor derangements. Post-receptor effect implies that the insulin is sufficiently produced but the cells which should physiologically respond to the molecule have a problem recognizing the insulin (Ligaray  Isley, 2010).

There is a general observation that the increased glucose production in the liver particularly in inappropriate times contributes to the inability of the body cells to respond to the ligand, insulin (Ligaray  Isley, 2010). This process, the conversion of glycogen to glucose affects the insulin level, which is important in hepatic function. The reduced insulin-dependent glucose transport especially in muscles and adipose tissues also contributes to the problem of diabetes type II. Similarly, there is an impaired function of beta-cells in the early phase of insulin release following the hyperglycemic stimuli.

Diabetes type II is a condition which not only affects the regulation glucose levels but also other important body systems such as the immune system, renal function, reproductive system and cardiovascular system are largely affected (Kilvert  Fox, 2007). The immune system is hampered among the individuals suffering from diabetes type II. This can be seen in situations where diabetic individuals take a longer healing from the wounds and minor surgical incisions.

The incidences of coronary artery complications as well as the arterial diseases are common among the individuals suffering from diabetes type II (Zieve  Wexler, 2009). Renal failure can be the most disturbing complication of diabetes type II where individuals may require dialysis for blood purification (Mayo Clinic, 2009). Diabetes type II has also been identified to be causing erectile dysfunction which can be a major problem in marriages.

In general, diabetes type II is a problem which affects a number of body systems and leaves the affected individual and the family members and friends with a great burden. It is a condition of economic importance and effective approach should be directed to its prevention and treatment. The social aspect of the patients and those close to them is affected. Although medications have been developed to manage the condition, effective treatments have not been developed,  which can completely treat the problem. This calls for extensive research to come up with ways to manage diabetes type II.

The Relationship between Atoms, Molecules and Cells

This paper tackles the relationship between atoms, molecules and cells, as well as the differences betweens organs and tissues, and the structure of organ systems. Moreover, it explains the anatomy and physiology of the skin and two of its structures  the epidermis and the dermis.

An atom is the fundamental piece of matter, which is anything that can be physically touched. Everything in the universe with the exception of energy is made up of matter, which means that everything in the universe is composed of atoms (Propulsion, n.d.). Only one type of atom makes up a material called a chemical element, or an element. An atom is the smallest particle of an element that still retains the qualities and characteristics of that element (Atoms and Elements, n.d.). Certain elements such as Calcium, Hydrogen, Oxygen, Nitrogen, Phosphorus and Sulfur make up all living matter. These are the elements found in bulk form and are considered essential for life. There are also some elements found in trace quantities in a great number of organisms and are very likely also essential for life  Calcium, Manganese, Iron, and Iodine. These elements almost always combine into biomolecules and provide for a huge variety of chemical structure as well as reactivity.

The biomolecules formed from the numerous combinations of the chemical elements essential for life are classified into nucleic acids, proteins, and polysaccharides (Biochemistry, n.d.) which are all found in biological cells. In short, these biomolecules are the ones that make up the cells and they function for storage and transfer of genetic information within the cell, the catalysis of biochemical reactions, the maintenance of the physical structure of the cell, intracellular transport, and protection.

The Differences between Organs and Tissues
Groups of cells with similar structure and function come together to form a tissue such as blood, muscles and nerves. Blood tissue, for example, contain a variety of cells RBC for carrying oxygen, WBC for protection and destruction of harmful bacteria, and platelets to facilitate clotting.

Tissues with similar function and structure group together to form a specialized body known as an organ such as the heart, the stomach and the brain.

The Organ System
The organ system is formed when various organs come together to perform a specific functions. One example of organ system in animals is the circulatory system which carries blood to every part of the body. The circulatory system is made up of the heart, the veins, the arteries, the capillaries and blood. The term system refers to a group of interrelated parts working together for a harmonious whole. There are actually 10 organ systems in the human body.

One of the organ systems is the skeletal system, made up of bones and cartilage, provides support for the body and protects the delicate internal organs. Second, the muscular system, made up of the skeletal, smooth and cardiac muscles, functions for support and movement. Third, the circulatory system, which was previously mentioned, transports nutrients, gases and hormones throughout the body. Fourth, the nervous system, composed of the brain, spinal cord, and peripheral nerves, relays electrical signals from the body to the brain. Fifth, the respiratory system, made up of the nose, trachea and lungs, provides gas exchange between the circulatory system and the environment. Sixth, the digestive system, made up of the mouth, esophagus, stomach and the intestines, has the role of breaking down food and the consequent absorption of nutrients for growth and maintenance of the body. Seventh, the excretory system, made up of kidneys, ureters, bladder, and urethra, functions for the filtering out of cellular wastes, excess water and toxins out of the circulatory system. Eighth, the endocrine system, made up of the endocrine glands, control and regulate growth and nutrient absorption throughout the body. Ninth, the reproductive system, which refers to the ovaries and related organs in females and the testes and related organs in males, has one function and that is to manufacture cells for the perpetuation of the species. Lastly, the lymphatic or immune system, made up of WBC, lymph nodes and vessels, and T- and B- cells, serves as the bodys defense against harmful microorganisms.

The Skin, the Epidermis and the Dermis
The skin is the largest organ of the body and it performs a number of different functions. These functions include thermoregulation, sensation, metabolic functions and protection. The two regions of the skin are the epidermis and the dermis. The most superficial layer of the skin is called the epidermis and it is considered the first barrier of protection from harmful substances.

The epidermis consists of cells called keratinocytes and five layers namely stratum germinativum, stratum spinosum, stratum granulosum, stratum lucidum, and the stratum corneum at the topmost. Other cells that make up the epidermis include the melanocytes, the Merkel cells, and the Langerhans cells. The keratinocytes, which make up around 95 of all the epidermal cells, typically function for holding the physical structure of the epidermis as well as the other types of cells and may even function as immunomodulaters.

The dermis, on the other hand, is the one responsible for thermoregulation and vascular support of the otherwise avascular epidermis. The dermis is typically composed of the papillary dermis and the reticular layer where one finds the fibroblasts responsible for the secretion of collagen, elastin and ground substance that provide support and elasticity to the skin. The papillary dermis houses the vascular networks that support the avascular epidermis and provide a thermoregulation network. There are also free sensory nerve endings in the highly sensitive areas of the papillary dermis. The reticular layer, aside from containing the fibroblasts that provide skin elasticity and strength, houses other epithelial structures such as the sweat and sebaceous glands as well as the hair follicles.


Prokaryotes are group of organisms lacking with cell nucleus or any membrane-bound organelles. Most of the prokaryotic organisms are unicellular (singled cell), but few of them are multicellular such as mycobacterium. Their body size ranges between 1 m and 10 m. In some cases, they can vary in size from 0.2 m to 750 m (i.e. E. coli). One of the distinct features of prokaryotic organisms is flagellum.  Flagellum contains homologues of actin and tubulin, i.e. MreB and FtsZ. The helically arranged building blocks of the flagellum, i.e. flagellin, provides structural backgrounds of chemotaxis. Chemotaxis is the basic cell physiological response of bacteria. Membrane systems such as vacuoles are also found in cytoplasm of prokaryotes. It may function to serve as a reservoir for food and waste products. It also functions to special metabolic properties in prokaryotes such as photosynthesis or chemolithotrophy.

Eukaryotes are membrane-bounded organisms with true nucleus. The genetic material is contained inside its nucleus or nuclear envelope. The nucleus of a typical plant cell is described with a large spherical and oval shaped organelle containing its genetic material and the site of DNA and RNA biosynthesis. Most eukaryotic cells also contain other membrane bound organelles such as ribosomes, Golgi apparatus, chloroplast and endoplasmic reticulum. The structure of endoplasmic reticulum contains a network of membrane enclosed channels continuous with the nuclear pore. It functions to process and transport proteins from one site in the cell to another. In addition, endoplasmic reticulum in a plant cell contains enzymes responsible for detoxifying substances that gain entry to the cell.    

The Effect of Thawing Permafrost on the Ocean

Thawing means the process whereby something is changed from solid form to liquid form by heat and permafrost is a ground that is permanently frozen. Permafrost is also defined on thermal and temporal criteria. In this case, the term refers to a variety of materials like mineral and organic soil, rock and ice among others. Permafrost thawing is highly dependent on the climate change the change in the air temperature which is often caused by surface disturbance for example after vegetations have been cleared. Temperature change can also be caused by removal of insulating organic layer, forest fires among other factors.  This paper will discuss the effects of thawing permafrost on the ocean, an issue which has caused alarm to many scientists.
According to Stranahan (2008), the scientists have believed that permafrost thawing in frozen soils is likely to release quite a huge amount of methane which is a potential green house gas. More often than not, the heat-trapping gas usually accelerates global warming. Stranahan says that the scientists are watching with a great concern as the methane begins to bubble up from the bottom of the fast melting Arctic Ocean.  Currently, these scientists are concerned with the methane time bomb on the land. This happens when the arctic temperatures are warming gradually and melts the permafrost. It causes the frozen vegetation to decay, releasing methane and carbon dioxide. The methane time bomb bursts from the floor of the sea where there is the shallow arctic continental shelf.
It is estimated that by 2100, thawing permafrost may cause an increase in emission of the intoxicating greenhouse gas from 20 to 40 percent. This is beyond what can be generated by all natural and man made sources.

According to a recent climate research, it is clear that science is complex and the opinions of different scientists always vary. Some scientists hypothesized that during periods of rapid sea-ice loss, temperatures are likely to increase as far as 900 miles inland thus accelerating the rate of terrestrial permafrost thaw.  There is so little data that is available on frozen oceans and the world watching the fuse being lit on a marine methane bomb and therefore there is no scientist with certain information on the same. However researchers like Shakhova from Alaska University together with a participant in some of the Liberian shelf scientific cruises are concerned of the undersea permafrost layer. This layer has become unstable and it leaks methane.

The effects
According to Hyndman (2009), warming of the oceans is normally a pattern or trend that can not be easily kept back. The very warm oceans can be cooled only if it was possible for the atmosphere above to be made extensively cooler. However, this is not possible because the oceans are such a huge heat sink that covers about two thirds of the earths surface and therefore cannot cool the atmosphere enough so as to be able to cool the ocean.
As stated in the introduction part, thawing of the permafrost usually releases methane gas and carbon dioxide. When these two gases reach the atmosphere, they help trap the heat on the earth resulting to greenhouse effect.  This trapped heat leads to thawing of more permafrost. As the temperature continues to rise, the permafrost melts the more and this creates a vicious cycle. This is causing alarm to geologists and also the scientists.
This gas (methane and carbon dioxide) causes global warming. They are usually trapped in the soil and so bubbles out in huge amounts because of thawing permafrost. They seem to trigger what the researchers warn is a climate time bomb.  It is also said that the amount of carbon that is normally trapped in some types of permafrost called yedoma in Siberia is so common and it may be one hundred times more than the amount of carbon that is emitted into the atmosphere yearly as a result of burning of fossil fuels. The organic carbon deposits into the bottom of lakesseas usually provides food for bacteria that later produces methane. It happens that as these organic matters becomes exposed to the air it accelerates global warming very fast which causes climate change that triggers a sequence of so many consequences.
The increasing temperature in the atmosphere has always been moderated by the fact that there are water bodies like the oceans which soak up more than 80 percent effects of global warming.  The oceans absorb heat slowly from the atmosphere and it mounts up slowly contributing to a lot of energy that causes storms for example the hurricanes. These storms might become more frequent in future if global warming becomes severe.
The rising air temperatures first create a frost heave that normally turns the flat permafrost in series of hollows and hummocks. When the permafrost starts to melt, the water that collects on the surface begins to melt down and forms ponds that are prevented from draining away by the frozen marsh beneath. Then the ponds merge into large lakes and finally the remaining parts of permafrost melts and the lakes drains underground.
The warming of the atmosphere also causes a lot of evaporation from the ocean which increases the water vapor from the ocean into the atmosphere and therefore this also causes increased global warming. This is said to double the warming effect due to increased emission of carbon dioxide. In addition, there are the effects of intense flooding, mud flow and coastal erosions that are more severe especially on the west coast. Low rainfalls and drier vegetations leading to more thunderstorms, more fires, incidents of draughtfamine and so on. There can also be more drought and more rains depending on the balance between the precipitationrains and evaporation.
The floods and debris usually flow to the nearest coastal towns thus causing a lot of damage in that the buildings collapse and roads, telephone and electricity lines amongst other thing especially in areas where there mountains around are damaged. This damage leads so many other consequences in that, people die, properties in the buildings are destroyed, the countries lag behind in development as they attempt to restore what was lost and so forth.
According to Cullen (2005), some scientists have predicted that melting of ice leads to seasonal opening of the pathways of the ship. That is, they are usually destroyed and so it becomes hard for trading since ships cannot sail smoothly. A good example is the North West passage that offers potential trade route with Asia. Also animals living in the sea are usually at risk and they often die. For instance, as the ice melts then the home of an animal like the polar bear among other animals living in the oceans also disappear. Polar bears existed in large numbers a few decades ago but since the ice started melting, it is hard to find them.
With there is increased global warming, the water gradually warms causing the sea ice, green land glaciers and frozen ground to melt faster thus leading to increased water in the ocean. When the glacier ice melts, the water pours down the crevasses and holes in the ice whereby some of it freezes while some fall below the glacier causing more icebergs into the ocean.
Increases in global warming as a result of permafrost thawing causes high humidity and also brings about a considerable difference in that it limits peoples ability to cool by perspiration. The effect of this is often dramatic especially at temperatures near or above core temperatures of a human being. This is very dangerous since it can lead to death.  For example the temperature of India sometimes back had risen to 49.6 degree centigrade and 884 people died.

Permafrost thawing is an on going process that more often than not causes increase of surface water reservoirs which mobilizes the organic carbon from the soil pool to the rivers and to the ocean.  This process leads to global warming which is caused by climate change thus causing many negative effects that become a cycle.


Bacterial pneumonia is up till now a considerable factor of morbidity and death in patients infected with HIV in the period of antiretroviral combination therapy. The advantage of tobacco withdrawal on the bacterial pneumonia risk has not been measured in such people, who are exposed to other significant threat factors such as HIV-related immunodeficiency. The purpose of the paper was to evaluate the result of tobacco withdrawal on the bacterial pneumonia risk among HIV-infected people. In developed countries, approximately ten percent of the causes of serious morbidity and five percent of the death causes are connected to bacterial pneumonia. Generally, smoking tobacco is recognized as a main risk factor that results in infections of respiratory tract. A noteworthy decrease in the proportion and total numbers of lymphocytes of CD4 count and CD8 count is caused due to the pulmonary infections in smokers mediated by local inflammatory modifications.

The incidence of smoking tobacco is greater among HIV-infected people, normally stated around 50 percent in European partners with HIV, in contrast to 27 percent in the common population of similar age and sexual category. Latest studies have established the consequence of smoking on infections of respiratory tract in people infected with HIV, and encouraged quitting smoking as a main concern. In the study, all patients of the French prospective hospital-based cohort with minimum 2 appointments during the period 2000-2007, without bacterial pneumonia in the initial appointment and with accessible data on consumption of tobacco were included. Status of tobacco smoking is documented at inclusion (tobacco smoking history and present condition) and at every visit (present condition only) with biological, clinical, and therapeutic information. Cases of pneumonia disqualified tuberculosis and mycobacteria. For this study, the bacterial pneumonia that was considered was divided into two groups confirmed (clinical and particular radiological signs collectively by means of a bacteriological evidence) or probable (clinical and particular radiological signs collectively with a winning antibacterial treatment). Status of smoking was described as present smokers, not at all smokers, and past smokers at every follow-up appointment. Depending on the CD4 cell count, 4 classes of immunological conditions were identified 1) less than 200 cellsL, 2) 200-349 cellsL, 3) 350-499 cellsL and 4) greater than or equal to 500 cellsL. Bacterial pneumonia first event time was estimated as the differentiation between the first appointment date in 2000-2007 periods and bacterial pneumonia diagnosis date, or the last appointment date within the analysis. Status of tobacco smoking was considered in the study as a variable of time dependent since quitting attempts and reversions are recurrent in people infected with HIV.

Explanatory variables comprised gender, first visit age, infection of HIV via intravenous drug use and, for variables of time dependent, past AIDS diagnosis, antiretroviral combination therapy, cotrimoxazole prophylaxis, CD4 cell count, plasma HIV RNA, and statin treatment are considered.ResultsIn French prospective hospital-based cohort, 4365 patients were enrolled, who were seen minimum for one time in 2000-2007. Out of 4365 patients, 3336 (76 percent) were involved in the study. 20 percent or 855 individuals had no information available on status of tobacco smoking, 1 percent or 30 patients showed a bacterial pneumonia in the initial appointment and 3 percent or 144 had just one appointment in the period 2000-2007 (Benard et al., 2010). The 1029 not-included individuals did not vary considerably from the available 3336 individuals for the examination with respect to Age forty years old normal in both the groupsProportion of antiretroviral combination therapy treated patients 64 percent vs. 67 percentCategories of HIV transmission heterosexual - 36 percent vs. 30 percent, users that inject drug - 20 percent vs. 21 percent Mean CD4 cell count 449 vs. 450 cells LPlasma HIV RNA 54 percent vs. 50 percent with e 1000 copiesml and Percentage of individuals with an earlier diagnosis of AIDS 21 percent in both the groupsThe not-included individuals were less often male (68 percent when compared to 74 percent in the sample  analysis, p0.001). Amongst the 53 percent (1779 patients) current tobacco smokers included in the study, 16 percent (277 patients) individuals discontinued smoking for a minimum one year during the study period and were regarded as past smokers. Amongst the 12 percent (411 patients) past smokers included in the study, 40 percent (164 patients) deteriorated while follow-up. Amongst the 34 percent (1146 patients) non-smokers included in the study, 4 percent (41 patients) did begin smoking while study period. During 3.3 years of median follow-up and twelve visits of median number, 135 first bacterial pneumonia events were reported. In these 135 cases, 38 percent (51 patients) needed hospitalization. In 104 bacterial pneumonia events identified in smokers, 37 percent (38 patients) needed hospitalization as examined to 50 percent in past and non-smokers. On the whole, 77 percent or 104 bacterial pneumonia episodes were categorized as possible. Of the 23 percent (31 individuals) with recognized bacteria, Streptococcus pneumoniae (twenty two occurrences) was much widespread. Other organisms recognized were Pseudomonas (six occurrences), Staphylococcus aureus (two occurrences) and Haemophilus influenza (one occurrence). 58 percent (78) pneumonia events were identified between the months November-April, that is period of influenza virus outbreaks. Bacterial Pneumonia overall occurrence per 1000 patient-years was 12. The occurrence of bacterial pneumonia per 1000 patient-years when participants were smoking - 15.9 for past smokers  7.9 for non-smokers - 5.9 28.8 among participants with less than 200 CD4 cellsL 16.5 among participants with CD4 cellsL 200 to 349 and 7.7 among participants with greater than or equal to 350 CD4 cellsL.In the multivariate investigation, the relation between CD4 cell count and status of tobacco smoking was not noteworthy. The bacterial pneumonia adjusted hazard was considerably lesser in past smokers when examined with present smokers. It was considerably lesser in non-smokers when compared to present smokers. The bacterial pneumonia hazard was greater when CD4 cell count was less than 200 cellsL, when CD4 cell count was between 200 and 349 mm3 as compared to when CD4 cell count greater than or equal to 500 cellsL.

Bacterial pneumonia hazard did not vary among patients who had CD4 cell count in between 350 and 499 cells L and among patients who had CD4 cell count greater than or equal to 500 cellsL. In the last model, the bacterial pneumonia hazard was also greater among patients with plasma HIV RNA e1000 copiesml (against 1000 copiesml), among intravenous drug users vs. others, among women vs. men, and among patients who has age between 50-60 years and those aged above or equal to 60 years compared to the patients aged less than 30 years.  

DiscussionThe main reason of morbidity in people infected with HIV in the era of antiretroviral combination therapy is bacterial pneumonia. In this study, the bacterial pneumonia occurrence per 1000 patient-years was 12, differentiating with outcomes reported in earlier analysis (8 to 20). The study identified 3 independent bacterial pneumonia risk factor categories non changeable risk factors like gender, age and infection through IDU tobacco smoking, and HIV infection.As earlier reported, people infected through intravenous drug use had a greater risk of bacterial pneumonia than other people. The reason for this may be antiretroviral therapy observance might be poorer in these people.

In addition, daily consumption of cannabis, a common following in this group of patients, may add to this elevated rate of bacterial pneumonia. Women infected with HIV showed a greater bacterial pneumonia risk than men. After changing for bacterial pneumonia major risk factor, this outcome was observed. However, the study was not adjusted for uncertain socio-economic circumstances and belated ability to approach for care, which is much common in females than males and might raise the bacterial pneumonia risk. The study cannot eliminate greater bacterial pneumonia vulnerability in women infected with HIV, but additional research is necessary to discover this assumption.

According to the study, HIV infection raises bacterial pneumonia risk all the way by means of the virus and by means of the associated immunodeficiency. As documented in previous cohort studies, it was monitored that the bacterial pneumonia risk was greater in people who have plasma HIV RNA more than 1000 copiesml. According to one assumption, infection of HIV is related to lungs humoral immunity defects, resulting to an increased vulnerability to infections. Immunodeficiency is normally reported as the main bacterial pneumonia risk factor in individuals infected with HIV. In this study, the occurrence of bacterial pneumonia noticeably raised in people who had CD4 count less than 350 cellsL contrast to those people who had CD4 cell count more than this threshold. Therefore, this highlights the necessity for early diagnosis of HIV and beginning of antiretroviral therapy at greater CD4 cell count levels, so as to conserve cellular immunity.However, there are different methods to prevent bacterial pneumonia in patients infected with HIV.

According to the recent studies, pneumococcal vaccine was efficient for patients infected with HIV. In this analysis, the most normally reported bacterium was Streptococcus pneumonia. In addition, the study reported that 59 percent of episodes of bacterial pneumonia were detected during influenza virus outbreaks period, which is a threat factor for infections of respiratory tract. Influenza vaccination use would also be a significant choice particularly in the environment of epidemic situation although information is missing on its experimental effectiveness and wellbeing in patients infected with HIV.Finally, the study shows the factors that prevent bacterial pneumonia in patients infected with HIV. Initially, for the first time in HIV affected people, the study showed that for minimum 1 year of smoking self-denial, the bacterial pneumonia risk considerably decreased and contrasts to the risk noticed in non smoking people. In the second place, as recorded by the lack of relation between status of tobacco smoking and HIV stimulated immunodeficiency, quitting tobacco smoking is efficient in avoiding bacterial pneumonia, whatsoever the immunodeficiency level. These are proofs for supporting cessation of tobacco smoking in patients infected with HIV. Though, the analysis demonstrated that a great percentage of past smokers relapsed while follow-up, yet after minimum 1 year of quitting. This strengthens the necessity for precise tobacco stopping associations in such people to reduce the bacterial pneumonia trouble.

Swine Flu and other Flu Epidemics Article Critique

In 2009, the world faced the latest strain variant in the family of influenza viruses, the H1N1 swine flu, and an event which eventually reached the level of being a pandemic or a worldwide-affecting epidemic. Citizens around the globe were worried of the threats that the said pandemic may bring but it seemed that insufficient information regarding public health issues are possessed by the population. In this paper, the work of McNeil, published in the New York Times, and that of Krause, which was retrieved from the website of the Center for Disease Control and Prevention (CDC), will be discussed and compared on the manner by which their articles reveal data about swine flu and other epidemics to the public.

Mcneils (2009) article discussed the historical and future implications of the continuous surge of influenza viruses. It mentioned about the Black Death, 1918 Spanish flu, other influenza pandemics, and the impending progress of the avian flu. McNeil explained that the general reaction of the public upon knowing a medical threat is to find a scapegoat and blame to this person or situation the causation of the disease. He said that it was proven in history that affected individuals tend to persecute the perceived cause or origin of the disease, an event which marks the lack of substantial knowledge to educate these group of people. Krause (2006) agreed to this idea by saying that it is essential for researchers to present up-to-date information regarding public health issues, a goal that is being fulfilled today when a number of efforts are being executed by various research centers which seek to investigate the nature and dimensions of influenza diseases. The article of Krause (2006) focused more on the technical and experimental aspect of the influenza disease investigation and vaccine development in the 20th century.

By analysis, it can be said that the two articles were in congruence with the idea of providing scientific knowledge regarding the effects and potential threats of influenza diseases specially swine flu. However, the Finding a scapegoat when epidemics strike by McNeil was written in a way that will attract the attention of the laymen and this is because of the fact that technical terms were not intently used in the text but are replaced with more familiar words or were revealed by the writer in a more reader-friendly manner. The Swine flu episode and the fog of epidemics by Krause, on the other hand, was written in an approach that is fit for the consumption of the scientific community. The text was filled with technical terms and medical jargons in order to support the integrity of the investigation. Furthermore, the fact that the article of Krause came from peer-reviewed journals justify its nature of possessing serious and formal approach which is contrary to McNeils light discussion. In general, it can be inferred that medical and public health experts have their own ways of revealing disease information depending on their target audience. What is important is that the integrity and accuracy of the information was fully maintained in the writing process.

Nutrition Guidelines

Healthy foods have been associated with healthy lifestyles. Several diets have been implicated for various disorders in humans while others have been identified as remedies to some health conditions which may arise after infections or mistakes in metabolic pathways in the body. Nutritionists have argued that the closer the food is to its natural state, the higher the benefits to human health. For instance, when an individual seriously craves for sweets, he or she can take berries and other fresh fruits to neutralize the craving.

Healthy eating has widely been accepted by doctors and nutritionist as a channel to longevity and prosperous health. Eating is therefore an important event in everyday life and it is part of the human culture. It is the food the humans eat that provides them with the energy to perform tasks. From the foods, humans can fight infections and maintain good health and vigor. Although humans are born with a strong desire to eat and grow up with great eating traditions, they have not mastered which foods may harm them or which ones may affect them. Perhaps the confusion has come from health experts who may advise on a little alcohol to fight heart disease and also warn of alcohol in cancer causes.

It is recommended to take whole vegetables for they have plenty of vitamins as well as mineral salts. This implies that individuals are likely to stay healthy when taking more fresh and green vegetables as well as fruits. It has also been observed that food eaten by individuals can sometimes cause conflicts. This is the reason why most parents are cautious about what their children are eating they may even bribe the children to eat healthy foods. Nutritional experts have identified healthy foods as well as those foods that can be dangerous to human health.

Healthy foods have been said to fight against free radicals which might cause a lot of harm to the body. Free radicals are chemicals containing oxygen and an impaired or free electron. The free electron makes the free radicals to be highly reactive to the human DNA, cell membranes and some other cell machineries. This as a result causes immense oxidative damages such as protein dysfunction, DNA mutations and organelles and membrane distortions. The mistakes in DNA replication and regulation can result to dangerous effects which can range from reduced functionality to a complete shut down in function. Citrus fruits and a range of vitamin C containing fruits and vegetables can help silence the oxidative effect of the radicals.

It is the lack of eating healthy that people age quickly. Healthy eating protects individuals from factors that promote aging. The foods can prevent age-related disorders such as cardiovascular diseases, cancer, and collapse of the immune system, cataracts and brain dysfunction. Some of the dangers that may contribute to aging are oxidative free radicals such as hydroxyl radicals, hydrogen peroxide, singlet oxygen, lipid hydroperoxides, lipid epoxides, lipid alkoyl, oxides and hydroxyl radicals. Fortunately, the food available to man can counter all these harmful compounds either produces in normal metabolic processes or obtained from the foods eaten.

An example of diseases that is related to the foods eaten by humans is coronary heart disease. The disease is characterized by the blockade of the coronary arteries which ultimately result into a reduced blood flow to the muscles of the heart. This immensely deprives the heart of the critically needed oxygen. The clogging of the coronary arteries, also known as arteriosclerosis, is a condition which begins with the streaking in of fats in the layers that line the arterial walls. These streaks are slowly transformed into plaque-fatty tissue with a scar which bulges into the opening of the artery.

An increasing debate has been witnessed in the area of cholesterol and the foods that are rich in cholesterol. Perhaps to narrow down, bad cholesterol which doctors refer to low density lipoproteins (LDL) is the foremost enemy of human health (Harvard School of Public Health, 2010). This compound can be found in eggs and other fatty foods with trans fats. The explanation makes it clear that it is not the amount of fats one consumes that causes diseases but the type of fats.

The trans fats or the saturated fats have been found to increase the propensity of some poor health conditions while polyunsaturated and monounsaturated fatty acids or good cholesterol or high density lipoproteins (HDL) have been found to reduce risks of disease attacks. Therefore avoiding trans fats is recommendable for good health. However, as much as cholesterol may be perceived as an enemy to human health, it is essential in membrane stabilization and cell-to-cell communications. People can readily obtain the polyunsaturated and monounsaturated fatty acids from fish and nuts and these food sources can greatly lower the existing levels of LDL.

Nutrition has also been identified to be an important factor in the boosting of the brain power. Scientists have been able to study the ability of humans to remember and linked this capacity to some biomolecules specifically in the biomembranes. The lipopolysaccharides and neurotransmitters such as norepinephrine and dopamine have been found to cause attentiveness or alertness in individuals which can increase the concentration level which is important in learning process. In general, the brain power in humans is characterized by the alertness, concentration and how energetic the brain response to specific tasks is. Serotonin, another neurotransmitter calms the brain and makes the brain fuzzy and drowsy.

Important foods that contain isoflavonones can protect the human body against cancer effects. Soy beans provide a good source of isoflavones although the content of the compound varies with the time of harvest as well as the geographic location. The isoflavones which are important anticancer belong to a general class of flavonoids which almost resemble the female hormone estrogen in structure. Doctors have drawn an important hypothesis that isoflavonoids such as daizein and genistein act by blocking estrogen from binding to its targets. The binding of estrogen to the receptors is an important step in the cause of breast cancers which are hormone-dependent.

In general, foods can provide good health to humans and at the same time cause disorders. It all depends on how man will be able to differentiate between the good foods and the bad foods. Junk foods can be sweet but they can cause detrimental problems in humans. Individuals eating too much junk end up growing obese and increases chances of heart attack. Basically, it is recommended that people eat lots of roughages and take plenty of fluids which can help in the digestion. Fruits play important roles in fighting infections as they contain a number of vitamins. Proteins which are also important classes of foods and found in beef, milk and eggs are important sources of building biomolecules that act as enzymes, hormones and important macromolecules.

Answering Given Questions

Question 1
As people become old, osteoporosis becomes a major decisive factor in the quality of life lived by an individual. Just like a muscle becomes bigger and stronger as one uses, so does a bone becomes denser and stronger when regularly exercised. Running helps to prevent the probability of getting osteoporosis since it increases coordination of the person. The strength of the muscles also gradually increases with increase in the duration of training which a crucial factor in stability of the person. With appropriate training procedure, the person is able to keep proper balance thus decreasing the likelihood of unprecedented falls during old age that may lead to broken and fractured bones.
In addition, running is an important, effective and a feasible exercise that strengthens bones by increasing their density. Denser bones increase the resistance of being fractured easily. Again, the resistance exercise (running) stimulates the bone formation. This is because the bones experience the physical impacts and support of body weight during the training that acts as major factors of bone formation. However running does not help all the skeletal system but the individual bones that are involved in the exercise.

Question 2
The biological purpose of PTH (parathyroid hormone) is to regulate the blood calcium level and secondly to regulate the bone calcium contents. Its crucial to regulate the above named because their extremes in the blood can be lethal. In hyperparathyroidism, the excessive production of PTH elevates the quantity of osteoblasts. The consequence of this chronic secretion of the PTH hormone leads to decalcification of the bones, loss of bone mass and the making them porous.
Vitamin D is used for maintenance of normal blood levels of calcium and aids in the process of absorption of calcium that helps in the formation and maintenance of strong bones. In this regard, provision of vitamin D gives protection from osteoporosis. It is hard to get too much vitamin D from sunlight or food consumed. However it can be gotten as a result of taking supplements of vitamin D in large dosages of which doesnt help but may lead to excessive calcification of bones, bone pains, thirst and urge to urinate frequently.

Question 3
Scoliosis can be gotten by asymmetric weakness of the back muscles. The human spine is an engineering phenomenon that supports the body weight and holds the whole body together. This spinal column comprises of a hoard of small bones ranging from 2-3 inches to 5-6 inches size in diameter. Scoliosis happens whenever the spinal column curves to the side when you look at it from the front view, and the comprising vertebra also twists on its neighbor in a corkscrew fashion.

Lordosis is the one that can result from pregnancy since a persons lower back naturally has an inward curve. If there is an excessive inward curve the condition is referred to as lordosis. Besides pregnancy, lordosis can be caused by spinal problems inherent at birth, excessive weight and staying sitted for long periods. The body gets used to these positions and as a result, some muscles get shorter, stiffer, stretched and ultimately weaker. Hitherto, the person concerned may start experiencing lower back pains since it gets all the support work which results in fatigue and pain as sometimes portrayed by pregnant women.

Question 4
In the lower limb there are three bones that make up ankle joint.The long bones that point straight and upward are known as the tibia and the fibula. These bones do connect with the top most part of the foot that is called the talus. The interconnections of these bones form a very significant joint the hinge joint. According to the mechanism of hinge joints, they allow movement in one direction of which in this case its medial thus the ease of moving the foot medially with ease.
The wrist joint being one of the most complex joints in the body, is actually made up of multiple joints and bones that enables us to use our hands to perform many different  tasks and move them in different directions. The joint is made by the proximal row comprising of the carpal bones connecting with the radius and the ulna (bones of the forearm).The arrangement of these multiplicity joints in the wrist enables it to move efficiently-- medially than laterally since they can cover a winder angle of a sweep.


According to the World Health Organization in their Pandemic Preparedness article, a disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease.1 More specifically, an epidemic is a temporary increase of the occurrence of a disease or disorder affecting man to a great extent that indicates an imbalance in the forces regulating the occurrence of the disease in the population. The affirmation of its existence is based on the comparison of the number of cases presently occurring with the number of cases considered as usual for that place in a specific age group at a given time. For example, a rise in the number of diseases is not alarming if it coincides with the season that is considered normal for that disease.

Presently, with the current trends in globalization wherein global transport is no longer impossible and trading of goods and services occurs worldwide, a pandemic is typically to occur and spread faster. Urbanization likewise results in the congestion of cities that serves as the center of economics and commerce and results in overcrowding in some areas that further facilitate the spread of diseases.

On the other hand, modernization and developments in medicine also has a positive effect in the control and eradication of diseases. Before, pandemics and epidemics resulted in many deaths and social disruption. Now, with good surveillance and monitoring of diseases worldwide, people are more prepared and aware on the proper control and prevention of diseases. Vaccines have also been developed that has been proven effective in the eradication of deadly diseases as exemplified by the eradication of the smallpox virus as well as the control of many diseases through immunization programs for children.

In summary, if a pandemic occurs today it is expected to spread rapidly due to globalization. On the other hand, such diseases can also be controlled and prevented with proper surveillance and health practices through the combined efforts of people worldwide.

Organizational Issues Safety Culture and the Human-Centered Process

Safety Culture
Considering that one is working for an insulation installation company, it must be understood that there are several safety issues related to ones job. One issue which can be seen is the issue of whether the employees of the insulation installation company are properly trained. It could be said that if they are not properly trained, they could pose harm to themselves and to their clients, for the insulation they install may be weak or faulty.

Another issue is whether the employees are properly briefed about safety measures whenever they are on their job. It is important that the company is encouraging employees to protect themselves whenever they are working, since installation safety is very important into ensuring that the employees are not exposed to potential hazards. In fact, according to the Bureau of Labor Statistics, U.S. Department of Labor (2010), installation workers can experience quite a number of illnesses and injuries from their jobs, since their work involves exposure to insulating irritants. Also, another safety issue would be whether the employees are provided with the proper equipment, as well as the proper protection devices in order to prevent or minimize the negative effects of their exposure to the irritants. This is necessary because, as said in the previous paragraph, exposure may cause illnesses.

Amongst these issues, the most vital would be the issue regarding whether the employees are properly briefed on safety measures. It must be understood that if the employees are not properly briefed, they might experience accidents or perhaps contract illnesses due to the nature of their work. If this issue would be viewed using the functionalism approach, it could be said that the company needs to do communicate safety measures to its employees because the company is not really a company without its employees. The functionalism approach states that all aspects of society should work together in order to properly function in analogy to the insulation installation company, all of its aspects employees included should work together in order to meet the common goal.

Elements of the Human-Centered Design
The human-centered design is described as the process of the ensuring that the values, perceptions, and concerns in a certain  design effort are all balanced and taken into consideration. While user-centered design focuses on a the primary stakeholder in the design effort, the human-centered process is more focused on every single stakeholder in the design. It is suggested that the success (or failure) of a design, a product, or a service is largely dependent not merely on one individual. Other team players, such as those involved in the  process of design, development, fielding, and ongoing use of products and services  also have a lot of influence on the probable outcome.

Given this information, it could be said that the various individuals whom are part of the processes are among the most important elements for the design of a system, or perhaps a product such as consumer technology. However, apart from the individuals themselves, there are other essential elements to the human-centered process.

Another essential element is that human-centered design should enable the enhancement of human abilities. The ultimate end, of course, is to create a product for consumers however, in order to be able to do such, the human-centered design must be able to enhance humans abilities in order this goal to be met. Another essential element is that the human-centered design should be able to help  overcome human limitations such as the human weakness of making mistakes. This element states that it is inevitable for humans to make mistakes therefore, the human-centered process should be able to lessen, if not completely eliminate this weakness. Lastly, the human-centered process should be able to  foster human acceptance. In order for organizations or companies to be able to design systems for consumer products, they must be able to make it absolutely clear, that all parts of the elements of the human-centered design process is vital to striving towards success.

Aeromonas necrotizing fasciitis

General Characteristic of the species
Aeromonas species are ubiquitous water borne organisms. Aeromonas is a human pathogen causing extra-intestinal infection such as gastrointestinal infection, endocarditis, cellulites, wound infection, peritonitis, meningitis and supportive arthritis in patients, who are suffering from leukemia. Aeromonas hydrophila is a rod shaped, heterotrophic bacterium found mainly in warm climate in fresh, salt, marine, estuarine, chlorinated and un-chlorinated water.

Gram Reaction Aeromonas is a gram negative organism.
Respiration (aerobe or anaerobe)  Aeromonas hydrophila is able to live both in anaerobic and aerobic environment.

Sporulation Nonreverting beta-lactamase interrupts sporulation and cause fails to discharge free spores from sporangia. Endospores cannot be produced by Aeromonas hydrophila and it survives in 4 degree Celsius temperature.

Transient (is it normal flora in human body) Aeromonas has transient intestinal colonization of which there are many phenotypes of Aeromonas species during the life of first week of human body.
Scientific name of the pathogen Aeromonas hydrophila . The five pathogens of aeromonas hydrophila, A. veronii A. caviae, A. schubertii A. jandaei. A. sobria. Aeromonas subsp  strains are A.
218, 495A2, A1, A6,ATCC 14715  LMG 13663, ATCC 14715
Taxonomy, Species Aeromonas hydrophila, Unlprot,

Virulence factors and activity of each Aeromonas hydrophila is isolated from warmer areas of southern Italy, but it also can be taken from different sources like human diarrhea cases and sea sedimentary areas. It has characteristics of production of protein virulence factors such as cytotoxins, dermonecroting factor, cytotonic toxins, hemolysins so that it can bind to intestinal 407 cells in vitro.
Capsule Aeromonas salmonicida grows in medium which is having surplus glucose by carbon source and it tends to produce capsular and has contact with contaminated water exocellular polysaccharides in which the capsular polysaccharide is composed of rhamnose, N-acetylmannosamine and manuronic acid, glucose and mannose.

Toxin Aeromonas salmonicida exoenzyme, which is a protein toxin, belongs to the family of ADP-ribosylating toxin.

Enzymes Aeromonas secretes enzymes like -lactamases, lipases, hemolytic enterotoxins, proteases, chitinases, nucleases and amylases.

Pili Aeromonas hydrophila has fimbriae (pili) which help aceria to attach the host organism to invade the cells. Aerolysin are activated by A.hydrophila when it attaches to organs or cells.

Flagella  Aeromonas hydrophila has two distinctive features namely a polar flagellum to swim in liquid and multiple lateral flagella to swim over surface areas.

Disease description Necrotizing fascitis is uncommon and highly life threatening soft tissue infection with high mortality rate. It is also known as flesh eating disease. Aeromonas hydrophila infection may cause necrotizing fascitis in patients with bones, trauma in aquatic regions and in patients with immune suppressed system. In severe cases, it mainly develops myonecrosis of lower limb along with toxic shock. It is seen in wound infections due to direct contact with brackish water.

Pathology When the Aeromonas hydrophila bacterium enters the body of victim, travels in the blood steam and it is ready to produce Aerolysin Cytotoxic Enterotoxin. This toxin causes tissue damage and mediates the pathogenic mechanism. Aeromonas hydrophila is considered as opportunistic pathogens because it infects the host when immune responses grow weaker. Type 3 secretion systems (TTSS) play a vital role in aeromonas pathogenesis by exporting virulence factor directly mediated to host cell.

Symptoms The three main major symptoms are cellulites, ecthyma gangrenosum and myonecrosis. In this condition the lower limb has worsened oedema and dermatoneurosis of the whole lower extremity. Early symptoms which we find in cellulities are progressive skin change  like skin ulceration ,fluid filled blisters as bullae ,necrotizing eschar. This infection results in gangrene at the site of necrotizing soft tissue

There is sudden onset of redness and swelling along with pain at the site of the wound. Infection of it results in fever. Diarrhoea,abdominal cramps,vomting  .

Mortality rate  Due to delayed treatment of septic shock there is an increase in morbidity and mortality rate. The positive predators of mortality confined by multivariate logistic regression analysis shows the presence of vibro infection, aeromonas infection, malignancy and hypotension. The presence of haemorraghic bullae is the negative predators of mortality rate. It significantly shows that there is decrease in mortality rate.

Population Effected The people who are believed to be susceptible having gastroenteritis, although it is more often seen in very young children.

People who are with impaired immune systems or underlying malignancy are  more susceptible to  severe infections would effect  by this bacterium.

Out comeThe outcome is frequent in which poor prognosis is seen in untreated fascitis  death and severe morbidity is high. In necrotizing fascitis mortality rate may be high 25. In patient with sepsis and renalfailure along with necrotizing fascitis mortality rate rate as high as  70. In multidrug resistance organisms and infection with MRSA may also have high morbidity and mortality rate.

Reservoir Aeromonas is predominantly found in salt and fresh water, sewage and soil. The bacterium is grown in warm climate, chlorinated, unchlorinated water and estuarine.

Mode of transmission Transmission occurs when it gets in contact with contaminated water, soil, food, feco oral route, injection of infected reptiles and fishes. It can also spread from person to person eg play groups, families etc.., where there is a breakdown of hand hygiene practices.

Season common for the disease Mainly it causes diseases during winter season.

Diagnosis Aeromonas hydrophila can be cultured and identified by necrotizing fascitis samples and blood.

Culture Real-time PCR is conducted to detect A.hydrophila ahh1 using DNA sample which was extracted from blood and isolated from necrotizing tissue in which ahh1 was positive.
Tissue biopsy It shows necrosis in the soft tissue muscles and fascia, subcutaneous abscess formation and hemorrhage and acute inflammation. In tissue culture it reveals that there is presence of both aerobic and anaerobic bacteria.

ELISA test In this three murine MAbs 6F6, 9C10 and 6H4 usually screened by r-28 antigen based enzyme linked immunosorbent assay able to recognize vp28 vial protein on western bolt. In this an antigen capture ELISA (AC-ELISA) is developed by MAbs virtue.

Antibody triter Aeromonas hydrophila in which serum human T-cell lymph tropic virus type III antibody titer is positive in stools culture, so the organism is susceptible.

Treatment Necrotizing fascitis can be promptly identified and the foremost surgical intervention is the only treatment available. After surgical intervention, that includes anti-biotic therapy and supportive care. If the condition of lower extremity is worsened with severe oedema then dermatoneurosis amputation at the thigh is the only possible way to keep the patient alive. Debriment of the infected necrotizing soft tissue and fasciotomies should be done. Then initially the septic shock should be treated in emergency department and later surgical intervention is suggestible. Blood pressure need to be stabilized by giving vasopressors and broad spectrum antibiotics to control infection.

Antibiotic therapy To control the infection substances like florenicol, tetracycline, chloramphenacol, sulfonamide, nitrofurane and pyrodinecarboxyli acid are used. Terramycin placed in fish food by the time of hatchery operations is one of the chemotherapeutic agents.

Drug susceptibility A.Hydrophila is septable to broad spectrum aminoglycosifdes, cabamapenems, tetracyclines, trimethoprim-sulfamethoxale and quinnoles, cephalosporine.

Resistance to Aeromonas hydrophila is resistant to Penicillin, ticarcillin, carbapencillin, ampicillin.
Susceptible to disinfectant 70 ethanol, 2 glutaral-dehydephenoles, iodines, 1 sodium hypochlorite and formaldehyde. Aeromonas hydrophila organism can be killed by using 2 calcium hypochlorite and 1sodium hypochlorite.

Immunization There is no specific vaccination to prevent this disease.
Conclusion Necrotizing fascitis is a rapidly progressive soft tissue infection mainly characterized by extensive myonecrosis of soft tissue and gangrenous lesion. Patients with clinical features of necrotizing fascitis should need deep biopsy specimen collected from necrotizing plaques to confirm the disease. To reduce the mortality and morbidity, the patient should immediately undergo surgical intervention.