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Regression Modeling Data FloorArea (Sq.Ft.) Offices Entrances Age AssessedValue ($' Cases Studies 3 & 4 – Primary Care A 47-year-old male patient (A) presents to your office c/o painful and bleeding defecation that started a couple of days ago. Pt also states that he noticed some intermittent pruritus on his back. Pt comes accompanied by his male husband of 45 years old (B), who states that he had noticed a painless “blister” on his genital area, but he is not quite sure when it appeared. Patient A: with no past or family relevant history and NKA Patient B: PMH of seasonal allergic rhinitis and NKS. No other family or relevant history.

On complete physical examination: On Patient A: a visible anal fissure in the inferior region of the sphincter was noted. It is also noticed disseminated papules in the trunk and macules on palms and soles. Patient B: A visible ulceration in the genital area noted and patient denies pain on palpation. No adenopathy noted or reported by patient (B). Since patients are a marital couple, you proceed with serological testing for each patient (A &B) because you suspect a sexually transmitted disease.

Both patients deny having or being treating in the past for STD’s Lab Results: Patient A: Leukocytosis - Treponema (Positive) – Non-Treponema (Positive) – HIV (Negative) – Hepatitis (Negative) Patient B: Treponema (Positive) – Non-treponema (Negative) – HIV (negative) – Hepatitis (Negative) --------------------- Do not include the above section in your paper. ONLY THE QUESTIONS BELOW------- Please answer the following questions in APA format and include in-text references. 1) What serological lab works would you order to obtain the above results? (Be specific with the lab names) 2) What is the diagnosis for Patient A? 3) What is the diagnosis for Patient B? 4) What is the differential diagnosis for patient A and patient B? 5) How are you going to treat Patient A? (Be specific and include the time of treatment) 6) How are you going to treat Patient B? (Be specific and include the time of treatment) 7) What would be the possible cause of this infection if both patients did not have any sexual encounter outside their relationship in the last year?

Paper For Above instruction

In the context of sexually transmitted infections (STIs), serological testing plays a pivotal role in diagnosing diseases such as syphilis and HIV, particularly in patients presenting with characteristic clinical findings. For the presented case, specific serological tests need to be ordered for accurate diagnosis and treatment planning for both patients.

Firstly, the serological testing for syphilis, which appears to be pertinent given the positive Treponema pallidum tests, typically involves non-treponemal tests such as the Rapid Plasma Reagin (RPR) or the Venereal Disease Research Laboratory (VDRL) test. These are screening tests that detect nonspecific antibodies that react with cardiolipin-lecithin-cholesterol antigen (CDC, 2020). Confirmatory testing involves treponemal-specific assays such as the Fluorescent Treponemal Antibody Absorption (FTA-ABS) test or the Treponema pallidum particle agglutination assay (TPPA). In this case, ordering both non-treponemal and treponemal tests is crucial for confirming active infection (CDC, 2020).

Additionally, HIV testing should include initial screening via fourth-generation HIV antigen/antibody combination assays, such as the HIV Ag/Ab Combo test, which detects p24 antigen and antibodies, enhancing early detection (CDC, 2021). If positive, a supplemental HIV differentiation immunoassay confirms the diagnosis. Testing for hepatitis B and C viruses should also include serologies such as hepatitis B surface antigen (HBsAg) and anti-HCV antibodies, respectively, to evaluate potential co-infections (WHO, 2022).

Regarding Patient A’s diagnosis, the positive Treponema pallidum and non-treponemal tests, along with clinical findings like genital ulcerations and disseminated papules, strongly suggest secondary syphilis. This stage often involves skin rashes, mucous membrane lesions, and systemic symptoms (Workowski & Bolan, 2015). For Patient B, a positive Treponema pallidum test with negative non-treponemal results and genital ulceration indicates a diagnosis of primary syphilis, characterized by a painless chancre in the initial stages (Marra et al., 2019).

The differential diagnosis for Patient A includes other dermatologic conditions such as psoriasis, herpes simplex virus, or other ulcerative anorectal diseases like Crohn’s disease. For Patient B, differential diagnoses encompass chancroid, genital herpes, Behçet’s disease, and lymphogranuloma venereum, but clinical presentation and positive serologies point toward syphilis.

The treatment for Patient A involves administering intramuscular benzathine penicillin G, 2.4 million units in a single dose, which is standard for secondary syphilis. If there is a concern for neurosyphilis, a lumbar puncture should be considered, and IV penicillin may be necessary. The typical course involves a single dose, and follow-up serologies are recommended at 6 and 12 months to confirm treatment success (CDC, 2015).

For Patient B, diagnosed with primary syphilis, the recommended treatment is also benzathine penicillin G, 2.4 million units IM in a single dose. However, for penicillin-allergic patients, doxycycline 100 mg orally twice daily for 14 days can be prescribed as an alternative (Workowski & Bolan, 2015). Follow-up serological tests are essential to ensure treatment efficacy.

In cases where both partners do not have outside sexual encounters within the last year, the possible cause of infection could be transmission within their current relationship, possibly due to undiagnosed or asymptomatic infections in either partner, emphasizing the importance of partner notification and testing (Hook & Marra, 2020). It also highlights the need to consider non-sexual modes of transmission, although less common, such as through contaminated blood products or from maternal transmission if pregnant, but in this scenario, sexual transmission remains most likely.

References

  • Centers for Disease Control and Prevention (CDC). (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and Reports, 64(RR-03), 1-137.
  • Centers for Disease Control and Prevention (CDC). (2020). Syphilis: Laboratory testing. https://www.cdc.gov/std/treatment-guidelines/syphilis.htm
  • Centers for Disease Control and Prevention (CDC). (2021). HIV Testing Resources. https://www.cdc.gov/hiv/testing/index.html
  • World Health Organization (WHO). (2022). Hepatitis B and C factsheets. https://www.who.int/news-room/fact-sheets/detail/hepatitis
  • Hook, E. W., & Marra, C. M. (2020). Ocular syphilis. The New England Journal of Medicine, 382(14), 1332-1342.
  • Marra, C. M., Tantalo, L. C., & Godornes, C. (2019). RPR and treponemal serology for syphilis diagnosis. Clinical Infectious Diseases, 68(2), 234-238.
  • Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and Reports, 64(RR-03), 1-137.
  • World Health Organization (WHO). (2022). Hepatitis B and C factsheets. https://www.who.int/news-room/fact-sheets/detail/hepatitis

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