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LO 11: Lo 11: Describe process involved when a research question/ hypothesis is identified, tested and reviewed and how new knowledge is implemented and evaluated  

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LO 11: Lo 11: Describe process involved when a research question/ hypothesis is identified, tested and reviewed and how new knowledge is implemented and evaluated  

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Research questions should be developed and research goals should be written.

Read related literature regarding research topic, searching for ideas and theories based on analysis of theories of how test behavior is likely to change during certain situations (constructs)

Establish construct validity evidence, meaning ensuring that your test are truly measuring the variable that needs to be measured

Panel of experts should read and review the survey instrument and offer feedback

Test the survey instrument on a similar population, ensuring validity and reliability

Choose sample that is representative of the population that is in question and determine a sample size.

Perform survey, after ensuring that the proper authorities have signed off on conducting the trial.

SOURCES:

Testing A Research Questionnaire (ukessays.com)

https://www.bing.com/newtabredir?url=https%3A%2F%2Fwww.thevenusproject.com%2Fmultimedia%2Fthe-scientific-method%2F

What Are "Peer-Reviewed" Articles? - CHEM 6C: General Chemistry III (Brydges, Spring 2022) - LibGuides at University of California San Diego

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Find high-quality images, photos, and animated GIFS with Bing Images

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ASSESSMENT
-partial thickness burn over perineum.
-full thickness over right leg.
-layers of skin have been irreversibly damaged.

PLAN
-Referral to bones unit.
-regular monitoring of temperature.
-under care of a multi professional team.
-sterile dressings and frequent hand washing.
-monitoring fluid status.
-Ensuring a diet with an appropriate amount of protein
-Skin autograph (first removing dead skin).
-OT and physio educating the mother on how to prevent contractures.
-using evidence to develop health promotion strategies in communities ->
(educating on how to treat burns with  cooling water instead of using aloe vera and/or oil).

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PARAGRAPH 1
-Imizamo Yethu (low SES,housing,income,migration ,unemployment.)
-cooking with a primer stove (low SES)
-Red Cross hospital (access to health care .Public vs private health.)
-Communal stan pipe
-Shack (low SES)
-Oil and aloe vera (Treatment and care of burns) (level of education )
-red blistered
-skin (importance of protein and diet in skin recovery)

PARAGRAPH 2
-partial/full thickness bone
-admission to the burn unit

PARAGRAPH 3
-hypothermic
-infection
-appropriate amount of protein (link between diet and skin recovery. Food security, noticed that she does not have adequate amounts)
-fluid status
-split skin autograph (preventative measures taken)
-contractures (management to prevent)
-educate mother (low SES, access to education .Health advocacy )

PARAGRAPH 4
-informal settlement (low SES)
-large population (50000 ,of which 10000 are children).
(large population in a confined space, living closely together ,linked to SES).

PARAGRAPH 5
-fires are common (prevalence of fire in community)
-shacks built from flammable material (prevalence of fires in community)
-shacks are grouped very closely together
-24 admissions of children from the settlement in 2017 ,36 in 2018.
-15% of all injury related deaths ->burns (under 5 years old )

PARAGRAPH 6
-community health promotion strategies
-Increasing incidents of burns
- recent migrants. )(low SES, unemployment cause of them migrating)

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LEARNING OBJECTIVE 9. Explain why cool water is the appropriate immediate care (first aid) for burns

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LEARNING OBJECTIVE 9. Explain why cool water is the appropriate immediate care (first aid) for burns

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From Physiology of Burns Lecture Slides presented on 4 August

The effectiveness of cool running water as an early management tool in treating burns:

Ø  Treatment should use cool running water of 2 – 15 ⁰C for a full 20 minutes

Ø  Ice or icy water should not be applied to burns as this can lead to hypothermia

Benefits:

Ø  Decreased wound depth

Ø  Reduced time for wound re-epithelialisation

Ø  Decreased hospital stay/ visits

Ø  Decreased requirement for grafting and scar management

Mechanism of action:

A.     Decreased pain from damaged nerve endings - blood vessels dilate due to high temperature

B.     Decrease immediate cell death due to high temperatures - proteins denature due to high temperature

C.     Decrease release of cytokines from damaged cells which activate inflammatory cascade

D.     Prevent blood vessels shutting down in zone of stasis and stabilise vasculature

E.     Prevent release of histamine from activated mast cells

F.      Decrease or prevent oedema formation - blood vessels being more permeable

Resource pack:

Reading 2: Wright EH et al. Human model of burn injury that quantifies the benefit of cooling as a first aid measure. BJS 2019; 106:1472–1479. (Adapted for teaching)

Ø  Cooling with cold water is the most widely employed first aid measure and has been shown to reduce the severity of acute symptoms and the need for skin grafting – cooling reduced the clinical and histological depth of burn injury. This cooling temperature and duration consistently reduced blistering, erythema and oedema of the burned skin

Ø  Early cooling with 10 - 20 minutes of cool running water up to 3 hours after a burn has a direct impact on the depth of the burn and therefore on the clinical outcome of the injury.

Reading 3: Fiandeiro D et al. Prehospital cooling of severe burns: Experience of the Emergency Department at Edendale Hospital, KwaZulu-Natal, South Africa. SAMJ June 2015, Vol. 105, No. 6. (Adapted for teaching)

Ø  Early cooling of burns leads to less clinical and histological tissue necrosis, improves burn healing, and helps relieve pain.

Ø  This cooling temperature and duration consistently reduced blistering, erythema, and oedema of the burned skin.

Ø  This phenomenon suggests that the model is dynamic, and that the microvasculature initially remains patent and perfused. It is possible that cooling helps to maintain this perfusion, allowing the survival of more dermis.

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(3) SES : SES
BURNS : primer stove
(6) SANTATION : communal stan pipe
(2) BURN TREATMENT : skin autograph,
-importance of protein in diet.
-removing burned skin.
(5) FIRE PREVENTION :
(1) BURN PHYSIOLOGY :
-degrees of burns
-types of burns
-contractures
-thickness of burns
(4) BIOPSYCHOSOCIAL:
-psychological effects on mother and victim

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LO 8: Explain the relationship between protein structure and function with specific reference to haemoglobin, myoglobin, collagen and elastin   	                                                                

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LO 8: Explain the relationship between protein structure and function with specific reference to haemoglobin, myoglobin, collagen and elastin   	                                                                

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Haemoglobin (Hb) is a protein made from four polypeptide chains and contains four Haem binding sites. It plays a role in the transport of Oxygen (O2). Haem is a hydrophobic prosthetic group (non-polypeptide group binds to specific protein and is required for function) for Haemoglobin and provides iron with the binding site for oxygen.

[Affinity is the tendency to bind]
Haemoglobin (Hb) transports oxygen in blood from lungs where there is high pO2 (partial pressure of oxygen) to peripheral tissues (low pO2), this is possible due to Haemoglobins high (changes) affinity, at high pO2 (in the lungs) Hb is fully saturated with Oxygen and becomes less saturated in peripheral tissues due to its low affinity enabling it to release oxygen to peripheral tissues.

Haemoglobin also binds to oxygen cooperatively due to conformation changes of the subunits. When one haem binds to oxygen, the affinity of the other haems increase in the lungs at high pO2.

The converse occurs in the peripheral tissues where there is a low pO2, the release of oxygen in one haem increases the tendency for oxygen to dissociate from the remaining haems.

Myoglobin (Mb) is a protein that is made from a single polypeptide chain and has one Haem binding site, it plays a role in the storage of Oxygen (O2). Haem is a hydrophobic prosthetic group (non-polypeptide group binds to specific protein and is required for function) for Myoglobin, it provides iron with the binding site for oxygen. The polypeptide chains surrounding Haem protect the Haem iron (Fe 3+) from oxidation. Myoglobin binds tighter.

Myoglobin has a high (constant) affinity for oxygen, this allows it to bind to oxygen at low pO2 and have a high oxygen saturation. This is essential as it allows Mb to store oxygen and release it when needed such as during exercise to be used by mitochondria for energy generation. Myoglobin is therefore able to bind and store oxygen released from arterial blood in the peripheral tissues (at low pO2).

Elastin forms elastic connective tissue, it enables elastic fibres to be able to stretch and recoil to original length when a force is removed. Elastin is rich on non-polar (hydrophobic residues) for example Gly, Ala and Val. The ability of elastic fibres to recoil after the removal of a force is due to the internalisation of hydrophobic side chains which form hydrophobic forces (interactions). A common feature of elastin is conformational disorder and irregular secondary structures (10% α-helices, approx. 35% β strands and 55% undefined conformations).Cross links limit the extent to which the elastic fibres can stretch and are formed by Lys residues.

Collagen fibres provide tensile strength to connective tissue of the skin. Collagen is composed of tropocollagen which is made up of 3 left-handed helices wound around each other to form a right-handed triple helix. The tropocollagen provides strength and resists unwinding, it is stabilised by inter-chain hydrogen bonds between the backbone C=O and NH groups (terminals). The tropocollagen molecules pack side-by-side in a staggered array for added strength to form microfibrils. A large number of microfibrils assemble to form fibrils, many fibrils assemble to form collagen fibres. Collagen fibres also has medical uses such as bone grafts, tissue regeneration, reconstructive surgical uses and wound care (as burn dressing).

Source: Lecture slides: Protein structure and function 1 & 2

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LO 5:Outline the classification of burns and the changes in appearance, structure, and function that occur when skin is burned to different depths.                                                                                                                                                                                                                                                                                                                

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LO 5:Outline the classification of burns and the changes in appearance, structure, and function that occur when skin is burned to different depths.                                                                                                                                                                                                                                                                                                                

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CHANGE IN FUNCTION

– Loss of fluid and electrolyte balance: massive fluid loss (Treatment – fluids and electrolytes) – Reduced thermoregulation: increased fluid loss means evaporative cooling and more energy needed to keep up body temperature (Treatment: keep warm, extra nutrients) – Reduced protection from infection: widespread bacterial infection or sepsis (Treatment: antibiotics, skin graft.

CHANGE IN STRUCTURE

Some burns may leave permanent scars and/or keloids. During keloid formation, there is a prolonged inflammatory phase (due to immune cell infiltration into the scar tissue).  Leads to excess fibroblast activity and increased deposition of the extracellular matrix (ECM), resulting in the tissue projecting beyond the original wound margin.

case: stayed for 4 weeks (28 days), anesthetised. leg=mixture of thicknesses (the leg is red-1st, blistered-2nd, and black-3rd), all layers of skin irreversibly damaged. perineum=partial thickness (2nd)

treatment: skin autograft

Source: Histology of the skin , slide 44-48
Histology of the Skin (uct.ac.za)

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paragraph 1
-primer stove (paraffin stove)
-oedematous (swelling )
-perineum (The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female.)

paragraph 3
-split screen autograph (using healthy skin to layer over burnt area ,usually from thigh)
-contractures (Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area.)

paragraph 6

-recent migrants (Settlers as well as settlement fairly new, only arrived recently )

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SUBJECTIVE
-age - 5years
-Information given by mother -they were cooking, rushed back saw stove had fallen over.
-they come from- Imizamo Yethu
-neighbour put oil over burned area.
-They got burned.

OBJECTIVE
-skin around perineum is red and blistered.
-right leg is red and blistered, dried blood and blackened appearances in certain places.

OTHER
community uses aloe vera to treat burns

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-SES ->(Socio economic status. People grouped together with similar levels of education, income (would be a low income in the case) ,type of housing (in this case an informal settlement) ,occupation.)
-where does the graft skin come from
-link between healthcare and SES -> (income determines whether if you can get private or public healthcare. Under resourced although it accommodates 85% of the population.)
-BURNS -> how to treat burns
-SANITATION -> avoid wounds getting septic
FIRES-> usage of sand to extinguish fires.
PRIMER STOVE -> using alternative methods of cooking ,not leaving child alone. Again links with SES,moter not having enough resources,she had to leave the child alone.

GAPS IN KNOWLEDGE
-degrees of burns
-usefulness of aloe vera
-3rd degree burns in the case
-partial thickness and full thickness burn
-anatomy of the skin.
-burn treatment.
-types of burns (for example chemical burns vs burns from boiling water).
-figures regarding admissions of burn victims. Mortality rate of burns.
-importance of protein and diet in the healing of skin
-proteins and their structures.
-aloe vera usage (origin?)
-hypothermic when having burns.
-social and psychological effects of being a burn patient.
-psychological effect on mother for having to take care of the child's wounds.
-effect fire had on the community (neighbours).
-frequency of fires in informal settlements vs formal housing.
-access people in this settlement have to emergency services.
-Burn physiology
- what temperature range affects the functioning of proteins

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LO 1: Epidemiology of burns of children 

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LO 1: Epidemiology of burns of children 

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Epidemiology: study of the distribution  and determinants of health related states and events in specified population, and the application of this study to the control of health problems

Distribution:

24 admissions of children in Imizamo Yethu 2017 & 36 in 2018 (frequency)

30 children under age of 5 die from burns each year in the Western Cape (absolute)

15% of all injury-delated deaths in under 5's are because of burns  (relative)

Determinants:

Causes: Shacks are built form flammable materials

Primus stoves used to cook and boil water, very unstable and flammable as well

Children are left unsupervised

Risks: shacks are built very close to each other thus fires spread easily and are difficult to stop

Treatments typically used in community: aloe vera- community and depends on the degree of burn, water-health workers, oil

Prevention and treatment:

Health promotion

Improving living conditions

Education

health related state or events: poverty, indigenous practice

specified populations: imizamo yethu's children

epidemiology triad: agent: flames. host: child. env: informal settlement. vector: primus stove.

SOURCES: Week 1, Public Health – Introduction to burns Case 1,  Mpho Tlali

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LO7 describe and explain protein structure

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LO7 describe and explain protein structure

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all proteins are made from combinations of 20 amino acids and the amino acid chain folds to give the protein its structure, and hence its function

primary structure:
chain of amino acids bonded by peptide bonds

secondary structure
determined by hydrogen bonds between the carbonyl and amide residues in the peptide backbone. 2 types of secondary structure:
1. alpha helix: rod-like structure with peptide chain tightly coiled backbone and side chains extending outward from the axis of the spiral. H bond between the hydrogen bonded to the nitrogen and the carbonyl group. average 3.6 amino acid residues per turn of helix, winds in right handed manner.
2. beta-pleated sheet: H bonds formed between peptide bonds in different chains, these chains become parallel or antiparallel to each other. pleated because C-C bonds are tetrahedral and cant exist in the same planar config.

tertiary structure
folding because of the side chain interactions: disulphide bonds (cysteine with SH group in side chain), H bonds, electrostatic interactions, ionic interactions, hydrophobic interactions.

quaternary structure
compact folding formed by interactions between peptide chains, held by non-covalent or disulphide bonds, stabilised by the same interactions as tertiary structures.

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SKIN: largest and most visible organ of the human body.

2 types:

Thick (hairless) - palms, soles, finger tips

Thin (hairy) - most of body

Layers: (Histology Slides)

Epidermis - keratinised, stratified, squamous epithelium
1. Stratum basale - deepest, simple cuboidal/columnar, stem cell-like
2. Stratum spinosum (prickle cell)- multi-layered polygonal keratinocytes, ovoid nuclei
3. Stratum granulosum - flattened keratinocytes, degenerating organelles
4. Stratum lucidum - dead keratinocytes, only found in thick skin, additional toughness
5. Stratum corneum - multiple layer of corneocytes, hard protein envelope, shedding dead cells
(deepest to superficial)

Dermis - connective tissue (collagen & elastin) with skin appendages
1. Papillary Region - 20% of dermis (thin), loose areolar tissue, dermal papillae and nerve endings
2. Reticular Region - deeper, dense, irregular connective tissue, collagen fibre and skin appendages

Subcutaneous Layer/Hypodermis
deepest layer, loose connective tissue and adipose tissue, attach skin to underlying organs

Specialised Cells: (Histology Slides)

Keratinocytes - 90% of epidermal cells, produce keratin, responsible for healing, protected by melanin

Melanocytes - neural crest derived, 8% of epidermal cells, produce melanin, basement membrane & hair follicles and absorb UV light/responsible for colour of skin

Intraepidermal Macrophages - dendrite immune cells, protect against microbes (recognise & present antigens, allergies & inflammation, phagocytosis)

Tactile Epithelial/Merkel Disc - contact with afferent myelinated nerve, responsible for touch and sensation

Skin appendages: (Histology Slides)

Hair - most surfaces, dead keratinised epidermal cells, responsible for protection, heat regulation and touch sensation, associated with glands

Nails - plates of packed, dead, keratinised epidermal cells, clear solid covering

Glands
1. Sebaceous - ducts into hair follicle or skin, not on palms or soles (scalp & face), hormonally responsive, holocrine secretion, lubricates, kills bacteria and prevent brittle hair
2.a) Sweat Glands (Merocrine/Eccrine) - abundant, stratified cuboidal epithelial cells in deep dermis/upper hypodermis, myoepithelial cells (contraction), merocrine secretion
2.b) Sweat Glands (Apocrine) - larger gland, in axillae, areolae, genitals and ear canals, deep dermis/upper hypodermis, duct has 2 layers cuboidal cells (no myoepithelium) & bulb has 1 layer cuboidal cells (myoepithelial for contraction), merocrine secretion, fatty acids & protein secreted due to stress, pain, arousal, nerves and hormones

both use merocrine secretion method

Nerve Supply: (Histology Slides)

Meissner's Corpuscle - Mechanoreceptor
Dermal Papillae, palms, soles, areola & lips

Pacinian Corpuscle - Mechanoreceptor
Deep dermis/hypodermis, ovoid structure, weight-bearing and sensitive areas

Merkel's Disc - Tactile receptor
Fingertips and lips

Ruffini end Organ - Mechanoreceptor
Skin and joint capsule

Free Nerve Endings -
Epidermis and Corneal epithelium

Peritrichial Nerve Ending -
Base of Hair Follicle

Krause End Bulb - Thermoreceptor

Other: (Histology Slides)

Dermo-epidermal Junction:
1. Dermal Papillae - tiny mounds from dermis to epidermis, strengthen epidermal, dermal attachment
2. Epidermal Ridges - project from epidermis to dermis, increase surface area, form ridges and grooves (finger prints)

perineum: thin skin
partial thickness=second degree=epidermis and dermis

keloid

Video Links

https://youtu.be/p4hnFf_jmvU
https://youtu.be/qmR1Sk-b4Bs

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(FROM THE SKIN PHYSIOLOGY and histology LECTURE SLIDES)
THE FOLLOWING ARE FUNCTIONS OF THE INTERGUMENTARY SYSTEM (CRITICAL FOR PROTECTING UNDERLYING ORGANS AND MAINTINING HOMEOSTASIS)
Protection:

·         Biological barrier - Langerhans cells, chemokines, cytokines, keratinocytes, phagocytes- The skin also has an immune response to microorganisms through the transient T lymphocytes and Langerhans cells, which stimulate T-cells and are involved in the immune response.

·         Chemical - Salt, acid mantle - The sweat released by the skin contains salt and is acidic and antibacterial.  The melanocytes in the skin, but particularly melanin provides protection against UV radiation from the sun as a result, protects deeper tissues from damage. The sebum released by the sebaceous glands releases bactericidal substances.

·         Mechanical barrier - skin is intact- keratinized (keratin layer is a tough fibrous protein) stratified squamous epithelium of the epidermis. Waterproof (by Lamellar granules. Keratinocytes produce lamellar granules) -prevent uptake or loss of fluids through the skin. The epidermal layer (stratum germinativum layer) has mitotically dividing stem cells; when cells are lost due to friction or abrasion they are replaced.

stratified and keratin: protection function

Sensation:

Ø  The number and type of different receptors(exteroceptors) located in the dermis and epidermis relate to its function as a sensory organ (it is the largest sensory organ in the body). Each cell type is receptive to a certain cutaneous sense (either pain, pressure, temperature, touch)

Ø  Enables nervous system to perceive changes in body’s internal or external surroundings; Receptors detect potentially harmful stimuli (heat, cold, and pain) that could lead to tissue damage; this is critical for maintaining homeostasis

Thermoregulation: Humans operate in an environment colder than our body temperature. Our bodies need to generate heat internally to maintain body temperature. Normal body temperature is considered to be averaged at 37°C.

·         The large vascular supply of the skin is conducive to its thermoregulation function. By increasing the flow rate, more heat can be lost, thus controlling body temperature.

·          The layer of subcutaneous fat also acts as an insulator to keep heat in.

·          The hair on the surface of the skin also acts as an insulator.

·          Changes in body temperature in either direction alter cell activity – an increase in temperature causes and increase or decrease cellular reactions and vice versa. Because cells are so sensitive to changes in temperature, the body homeostatically maintains its temperature. Exposure to extreme conditions can affect the core temperature. Heat input must match heat output to maintain thermodynamic balance, and a stable core temperature.

·         Heat input can either be due to internal heat generation (muscle movement or metabolism) or heat gained from the external environment.

·         Heat loss is heat lost via the exposed body surfaces to the external environment. Heat exchange with the external environment takes place via either: radiation, convection, conduction and evaporation.

·          The hypothalamus is the body's thermostat. It receives information from various afferent inputs and initiates adjustments to heat gain and heat loss mechanisms to correct the core temperature from variations from normal. The hypothalamus monitors the core and peripheral temperatures via various thermoreceptors.

Ø  The posterior region of the hypothalamus is activated by cold, triggering reflexes that mediate heat production and heat conservation.

Ø  The anterior region is activated by warmth, triggering reflexes that mediate heat loss.

Ø   Heat promoting mechanisms: Constriction of the cutaneous vessels: blood vessels in skin are constricted, keeping blood in the deeper body areas. The subcutaneous layer insulates – preventing heat loss from deep tissues Shivering: rhythmic muscle contractions that generate heat. These muscles can generate up to 5 times the amount of heat as resting muscle. Behavioural modifications: wear warmer clothes, engage in physical activity, reduce exposed body surface area, drink hot fluids]

Ø  Heat loss mechanisms: Dilation of cutaneous vessels: blood vessels in the skin dilate, increasing blood flow to the skin surface. Heat is lost via radiation, convection and conduction Enhanced sweating: increased blood flow to skin stimulates sweat glands, secretory output is increased, and heat loss through evaporation increases. Stimulation of respiratory centres: respiratory centres in the medulla are activated, depth of respiration increased, breathing through mouth rather than nose. This increases evaporative heat loss through lungs. Behavioural modifications: seek a cooler environment, drink cool fluids, reduce activity, wear lighter, cooler clothing.

Blood reservoir:

·         The skin is highly vascularised and contains 5% of the total blood volume (TBV).

·         It uses this relatively large TBV% to control thermoregulation.

·         Shunt blood to areas that demand it if necessary

Excretion and Absorption:

·         Excrete salt, water, and nitrogenous waste through sweat glands

·          Limited absorptions: UV light ,Salts of heavy metals ,Lipid soluble substances, Organic solvents

Metabolic functions:

·         Keratinocytes inactivates certain carcinogens and activates certain steroid hormones

·          Skin makes important proteins such as antioxidants and collagenase.

·         Vitamin D synthesis: UV converts cholestrol to inactive vit D, goes to liver, hydroxylated. hydroxylated vit D makes calcitriol in kidneys. calcitriols NB for absorption of Ca2+ and P

Fluid homeostasis:

·         INSENSIBLE WATER LOSS

Ø  Unnoticeable H2O loss

Ø   Occurs through lungs, skin, oral mucosa

Ø  Passive process

·         SENSIBLE WATER LOSS

Ø  Active process

Ø  Body temperature rises

Ø  Sweating increases vaporization of water

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2. Understand and apply (in various contexts) the definitions of the following measures of extent of disease:

Understand and apply (in various contexts) the definitions of the following measures of extent of disease:

• Cumulative incidence (incidence risk, incidence proportion)

- Proportion of disease-free population that become newly affected by the disease over a specified time period. Number of new people who burn/Risk of burning.
36/10000 for 2018.

Incidence rate (incidence density)

The rate at which people develop a new disease

The incidence rate is calculated by dividing the number of new cases over a specific time period by the sum of the length of time which each person is at risk of the disease. Thus it would be the amount of people who burn during a specific time period, divided by the time which they are at risk of burning.

Prevalence (prevalence rate)

Interpret text and tables where these measures are used to describe the extent of disease.

Prevalence is the measure of the amount of people who actually have the disease at a particular time ,also known as the disease burden.

Thus prevalence is the number of existing cases, in this case it would be the number of people who currently burn victims in SA.

incident (new infections) and prevalent (existing) are numbers, incidence and prevalence are proportions

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LO6: Describe how the skin contributes to the immune response: address how different immune cells control an immune challenge and how molecules produced by these cells contribute to this control.

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LO6: Describe how the skin contributes to the immune response: address how different immune cells control an immune challenge and how molecules produced by these cells contribute to this control.

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The surface of the skin provides immunity to the body;

·         The first line of defense is the epidermis

·         The epidermal surface is made acidic by sweat and sebum, which may contain antibacterial enzymes

·         It provides physical  and chemical (first line of defense) protection

·         The skin has keratinocytes which serve as a barrier

·         It also can initiate immune response

The immune response is divided into two major arms, innate and adaptive immunity.

Innate immunity

·         Innate immunity serves as the second line of defense and is a more general response (fever and inflammation).

·         Non- immunological memory responses

Adaptive immunity

·         adaptive immunity allows for a very specific detection and elimination of pathogens and imparts immunological memory. All immune cells develop from a cell in the bone marrow.

Keratinocytes secrete;

·         cytokines which help maturation of T-cells in the epidermis

·         chemokines which attract other cells to the site of infection

Langerhans Cells

·         are responsible for antigen uptake and present antigen to helper T cells

The lymphoid lineage

B cells

·         Mature B-cells differentiate into plasma cells (secrete antibodies) and memory cells

·         Recognize antigen via B Cell Receptor

NK cells

·         Of the innate immune system, detect virus infected cells and kill them

T-cells

·         Memory T-cells help the body to have a faster immune response to future infections

·         Helper T-cells secrete cytokines that boost the adaptive immune response

·         CD4 T(receptor)-cells secrete cytokines which rapidly boost the immune response when a past challenge arises

·         CD8 T (effector) cells recognise virally infected cells and kill them

The myloid lineage
-From the bone marrow

·         Neutrophils capture and kill microorganisms throughout the body and activate bacterial mechanisms

·         Monocytes further differentiate to give rise to macrophage( tissue resident cells, they control the body in cleaning up infections, antigen presentation and activating other cells) and dendritic cells. Dendritic cells are phagocytic cells that are responsible for antigen uptake and presentation

Inflammatory mediators

·         The eosinophil release cytokines  and kill antibody coated parasites.

·         Mast cells release granules contain histamine and active agents -respond to infection or tissue damage

Source:

·         Immunology Lecture 1,  Week 1

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LO 10. Explain how the four levels of prevention can be used for the control of burns in children

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LO 10. Explain how the four levels of prevention can be used for the control of burns in children

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(resource pack reading 6)

The public health model of prevention includes four steps, namely:

defining the problem (its size and scope)

24 admissions of children from Imizamo Yethu to the Burns Unit in 2017 and 36 in 2018

30 children under the age of 5 years die from burns in the Western Cape each year, accounting for 15% of all injury-related deaths in children under 5

identifying causes (the aetiology of the problem forms the foundation for theory; risk factors and protective factors provide important information about vulnerable groups)

shacks are often built from flammable materials

households use primus stoves to cook and boil water.

developing and testing interventions (feasibility and pilot studies)

recent journal articles explaining how scientists tested the hypothesis that the best immediate treatment for burns

three main strategies to reduce harm from burn injury

Product design/modification-- address unsafe cooking devices by for exampling placing regulations on the selling of those devices; electrification of townships

Environmental change/legislation-Provide access routes, fire breaks and water hydrants, improve housing conditions

Education to bring about behavior/lifestyle changes- increase awareness of burn injury.

implementing and evaluating interventions.

Implementing adequate safety legislation with policing shows immediate effect.

posters displayed in waiting rooms

radio messages

school lessons and talks in antenatal clinics

all of these lifestyle changes are necessary, but they take time

Community-based interventions in the form of multi-strategy, multi-focused programs are expected to result in a reduction in population-wide injury rates.

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LO12: Explain the importance of indigenous knowledge systems

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LO12: Explain the importance of indigenous knowledge systems

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The study and usage of IKS  provide explanations of disease, health implications of food and medical ethnobotanical knowledge as the indigenous knowledge systems are used to maintain good health. These knowledge systems provide protective, preventive and curative care. We use indigenous knowledge from many traditions like Indian, Egyptian, Chinese, Islamic, Hindu, Roman, Greek, European & African cultures that have been incorporated into what we call “Western Medicine” today
. Public Health lecture & definition google.

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8 Explain the relationship between protein structure and function with specific reference to haemoglobin, myoglobin, collagen and elastin.

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8 Explain the relationship between protein structure and function with specific reference to haemoglobin, myoglobin, collagen and elastin.

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LEARNING OBJECTIVE 10: Explain how the four levels of prevention can be used for the control of burns in children.

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LEARNING OBJECTIVE 10: Explain how the four levels of prevention can be used for the control of burns in children.

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Levels of prevention:

i.          Primordial (not only disease specific, improvement of societal and structural risk factors)

Ø  Improved living conditions for healthy people by better housing and poverty reduction

Ø  Changing methods of cooking/ heating to reduce use of paraffin and primus stoves

ii.          Primary

Ø  Health promotion and prevention in healthy, at-risk people of burns

Ø  Safety health promotions

iii.          Secondary

Ø  Early diagnosis and prompt treatment – first aid treatment

Ø  Neighbours put oil over the burnt area and then called the ambulance

Ø  Multidisciplinary team handles the case further (biopsychosocial)

iv.          Tertiary

Ø  Prevention of complications –treatment and rehabilitation

Ø  Skin graft

Ø  Temperature monitoring

Ø  Fluid status

Ø  Protein diet

Ø  Family members educated on management after hospital release

Ø  Prevent contractures

Ø  Psychological and social support