Hi!
Hi everyone! The most efficient way I've noticed within the other cases is if we all picked a question (having to double up as we have 5 people) and used the group's papers to complete it. What does everyone think? Nancy
Ok I agree. I can do the fourth question!
Hey everyone. I think the first question doesn't even count as a section. We just need to have a consensus on what we want to report like fever as or sign or symptom. I don't mind doing the second question however someone else will likely have to be one it as well. Also about secondary site of infection I think we should see what Dr. Kelly says in regards to it. Its hard to figure when to consider it a secondary site of infection since the bloodstream can take it all over the body. The paper I reported said it can invade deeper into the blood vessels affecting smooth muscle cells (of blood vessels and organs) so I took that as secondary site of infection.
I can do the third question
Oh you're right Alysha, Number one is pretty standard, meaning there's only 3 questions, and 5 people. Maybe we should all just work on all of them together (in order to make sure we all do a fair amount)? I started a google doc if you guys want to do this: https://docs.google.com/document/d/1-TDAlnqcZCHqAKXZ6-riA4g4uajSsoeS8mjHQMSys-g/edit?usp=sharing
As for secondary sites, I had organized it as blood vessels and vascular smooth muscle was primary, and that the effects on other body parts due to the systemic infection was secondary (though not really infected, but affected). Yeah, we should wait to see what the feedback says!
Yeah I debated with that question a lot so it will be interesting what Dr. Kelly response is. I think we can start working on consolidating the information and then see what Dr. Kelly has as comments for everyone's assignments and then maybe have to add more information in.
Yup I agree with all the information Nancy said for the secondary sites of infection. As for the mechanism how in depth should it be, as I noticed for our responses it wasn't really into the molecular biology cause that would be covered in another group's question (3).
Hey guys, I can do question 2 with Alysha. I noticed that most of you guys only listed vascular system as the normal system that was affected. I had lymphatic system in mine as my sources says that this bacteria affects the lymphatics too. However, I feel like most of my remaining sources describe pathologies based on the vascular system. What do you guys think? I don't want to add extra work if you guys disagree or want to focus on one system more. Esp. for people doing question 3!!
Also, thanks nancy for making the google docs!
Hey Walden, for question 3 I think just go over the systematic obstruction caused by the pathogens. As you said, question 3 group will cover the mechanisms.
Either way, like we all agree, we should wait for the feedback and then converge our answers. If possible we should post our comments on the google docs or share them somehow so we can adjust for the mistakes when we integrate our group answers.
Great suggestion Desmond! Awaiting for our papers back.
Kk sounds good,
The review i read in 2007 said lymphatic system is most likely, but no evidence and there is no known mechanism for direct transmission as with endothelial cells (question 4)
Okay comments I got:
Laboratory findings are not usually associated with signs/symptoms. They are objective markers that complement the signs/symptoms that the patient presents with.
What other aspect of the circulatory system does RMSF involve?
I think that it was very good to focus specifically on the endothelial cells, as the primary site of infection. However, I think that given it does affect the circulatory system, a brief overview of the components would be helpful for context.
Prior to getting to the target cell, how does the bacteria get there? What parts of the circulatory system are affected after the tick bite?
Organizing the disturbances in normal function would enable readers to understand the relative contributions. What are many of the complications due to?
What are the downstream effects of this (eg. Potentially resulting in complications of the infection)? (referring to hypovolemia/hypotension)
How do the Rickettsia infect the cells, causing the endothelial damage? Although they can disseminate in circulation to get to distant sites, after a local cells are infected, how do they get to adjacent cells?
Overall what I took from comments is to go more in depth about the circulatory system as a body function and "list secondary sites of infection and pathogen characteristics that enable it to disseminate and correlate with signs and symptoms"
Hey I also got the same comment about Number one, so I guess we have to keep lab findings out of signs/symptoms.
For number two: I got some of the same comments for circulatory system, describing their functions in more depth "What are the other components of the blood vessel, and briefly, what would their function be?"
For three,
"What about the immune function of the endothelial cells? Are they affected?"
"Of the numerous potential effects of Rickettsia, what would be the primary pathology resulting in many of the symptoms? The hypercoaguable state is a feature of Rickettsial infections, but are complications such as severe bleeding/hemorrhage as common as other complications?"
So, should we get started compiling some answers? :)
i havent got my feedback yet :(
Odd. I am going to work on putting info together for question 2. I will put it into the sharing document. Do we want to include lymphatics?
Ok I finally received it.
For Q1: Do you think that the rash is solely a sign and not a symptom?
In general, another way to think about signs and symptoms is that a sign is what the doctor actually sees, and a symptom is what the patient tells the doctor they are experiencing.
Laboratory findings are not usually associated with signs/symptoms. They are objective markers that complement the signs/symptoms that the patient presents with.
For Q2
This is a good overview of the vascular system. I think that summarizing these findings may be much more useful for understanding these concepts. The review article that you have cited is a good review article, and describes very complex ideas. When this happens, there tends to be difficulty in rephrasing the article. I think that’s why this section could benefit from point form summaries of each component, rather than paragraph form.
For Q3: Is there something specific that results in response to the leaky vasculature? In referring to increased sodium concentrations in serum
I say we don't include lymphatics.
Okay so I have tried to put all our information together for question 2 while minimizing repetition. It still needs a read through but gives an idea of what we could do with this section. I will put it into the shared document.
Awesome Alysha, I'm looking over it now, and adding/editing if you dont mind! And I'm getting started on the rest.
PS since this is such a big group and we only really have three questions, I think we should all work on all of them together, in order to make sure everyone gets a fair share! thanks
I'll have my bit up by Thursday night!
Thanks guys, this is great
Hey, I got my answers back too, in question 3, the prof wants more info on leaky vasculture perhaps more specifics so, I was wondering whether I should do a small section on that in question 3?
yea use this reference http://cid.oxfordjournals.org/content/45/Supplement_1/S39.full.pdf+html it gets pretty detailed into the mechanisms for the dysfunctional endothelial cell lining
full reference here
Walker, D. H. (2007) Rickettsiae and rickettsial infections: the current state of knowledge. Clinical Infectious Diseases, 45(Supplement 1), S39-S44. Retrieved March 15, 2015 from: http://cid.oxfordjournals.org/content/45/Supplement_1/S39.full.pdf+html
Not sure if Desmond is going to work with me on question 3. I agree since there are not many questions we should work together. However, it may get confusing if so many people are working on one question. I agree we should read over all sections and give input to the main people working on it. Seems like Nancy and Walden are working on question 4. Neil is working on question 3. Not sure what Desmond is working on.
Hey here's my feedback comments:
Question 2: - What other characteristic makes the capillaries ideal for exchange of nutrients, water and gases
Question 3: - For a list such as this with significant histological/pathology terms, how would you relate these back to the infection or the case? -What may be potential reasons for the hyponatremia and abnormal liver enzymes related to RMSF?
Question 4: - How do the Rickettsia infect the cells, causing the endothelial damage? Although they can disseminate in circulation to get to distant sites, after a local cells are infected, how do they get to adjacent cells? - How common would excessive bleeding occur in RMSF?
Yup, I'll work on question 2. I got "Excellent overview. Enough detail to be comprehensive, but very easy to read." for question 2, so I'll add lymphatics and dig up more info on it. I'll double check your work too.
We just got our feedback yesterday, so don't worry guys I'll work on it from today onwards. We should have the entire thing written up by Saturday afternoon (say no later than 3 pm?) From then on we'll just edit and proofread until deadline. Let's aim for no later than 11pm.
Hey since I'm doing the lymphatics in question 2, I can do lymphatic-related topics for question 3 as well. Save you the trouble Walden!! You can then double check my work to see if it fits to your style for question 3
sounds good, yeah I hope you guys dont mind I add in little comments/questions :)
awesome. i blended some of your parts into my revised version Nancy.
I just wanted to focus on the symptoms experienced by Rick and not speculate about the cerebral and pulmonary edema? Or do you think I should include them cause I can.
Hey Alysha thanks for removing repetitive information in the combined answer for question 2!
On top of adding the lymphatics, I'm also going to merge some of the sections. Right now we have 2 sections describing tunics so im just going to merge them into distinctive paragraphs!
I made a bunch of changes in question 2 to merge things and make things flow coherently. Could you double check my work again Alysha! Thanks!!
Hey guys, I noticed you guys are also putting down what you guys inputted into the final document. Aside from the lymphatics its kind of hard and messy to distinguish what Alysha did and what I did. So I'm just saying this now because I dont want to make it messy but I also don't want you guys to think I didnt contribute haha. I guess that's what happens when 5 people are doing 3 questions :(
Also I'm not well versed with coding so I will have my references on my parts listed as (author, year) to make things more simple. I honestly do not think they it matters if we reference it like wiki style or not. The last time Nancy and I worked on a case question we left it like that format and we were still able to achieve a high grade. I say this now because in my last case some group members had called me out that I "didn't do the references" just because I didn't code it like wiki-style.
Oh I never did wiki style and haven't had an issue. I have a reference manager so I just did APA. I think it is the easiest way to go. I will read over question 2. I wouldn't worry about people not thinking you contributed. Everybody should read all the messages and it clearly said you were going to go over my section and add lymphatics (if you still did). Let me know if you want me to organize references or something for this section.
Yup I agree with APA style! Yup sounds good Alysha, I'll work on the references tonight but could you double check question 2 for me tonight or tomorrow to see if anything is missing or awry. Thanks!! :D
Hey I am almost done. Please see my comments give me about ten more minutes. No rush tho. So far mainly just minor changes in sentence structure.
Okay just another thought I think endothelial cells should be separate like vascular system and lymphatics. Also maybe we should move that discussion to the end of the section because endothelial cells are found in both the vascular system and lymphatic system.
um i know the coding so i can work with the references
hey alysha i dont think we should include lymphatic system, i understand that endothelial cells are found in the lymphatic system but I don't see or have any papers how damage to the lymphatic system correlates to rick's symptoms. if you have any studies relating the pathophysiology to the damage in the lympathic, it could work
also if possible can we copy the google doc to the wiki? it'll be a lot easier to work with
Not precisely damage, but can we correlate inflammation/headache/abdominal pain/ so forth with changes and involvement of the lymphatic system? or is that too far of a stretch?
i think that's stretching it a bit too much, but if you have any articles supporting it that yeaa. but the review i posted in this convo in 2007, said lymphatic may be involved but there was no evidence
Oh Walden I actually meant we could've just kept it simple without the coding. But if you'd like to do it like that then go on ahead and thank you!
I've also added a new reference for question 2 in the part about lymphatic vessel movement. Here is the reference:
Barrett K.E., Boitano S, Barman S.M., Brooks H.L. (2012). Chapter 31. Blood as a Circulatory Fluid & the Dynamics of Blood & Lymph Flow. In Barrett K.E., Boitano S, Barman S.M., Brooks H.L. (Eds), Ganong's Review of Medical Physiology, 24e. Retrieved March 27, 2015 from http://accessmedicine.mhmedical.com.ezproxy.library.ubc.ca/content.aspx?bookid=393&Sectionid=39736777.
kk thanks =)
Wasn't sure if someone was doing question 1, so I put in a general answer, though I did want to know if any of you got any feedback on question 1. I omitted lab findings as both Alysha and I got feedback to say its not usually included. For now its a simple list, but when we write it into wiki I will make it into a nice looking chart!
PS So we're putting our references into Wiki form?
yupp!
Hey guys I put most of our stuff in the wiki, you guys can edit on the google doc still and just update me, I'll be busy till around 6 pm tomorrow. But I can help with the editing, all our references are in wiki form now =)
Sounds good, thanks for the help and contribution Walden!
Thanks Nancy for inputting Question 1! Yeah i got the same remark about the lab findings. Are there anymore signs that we need to include then?
I touched briefly in my own case study, and he didn't comment or care... lol
Hey guys
I'll have my stuff up by tomorrow afternoon, sorry fr no input yet, I've been swamped with work from other classes this week. Thanks for understanding.
Neil
No problem man!
Yup Neil its okay. End of semester is coming up, not surprised in being swamped haha. Just get everything in preferably before tomorrow evening so we can proofread before deadline!