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OTHER IMMUNE CONDTIONS

OTHER IMMUNE CONDTIONS. HIV and AIDS LUPUS FIBROMYALGIA. HUMAN IMMUNODEFICIENCY VIRUS and AQUIRED IMMUNODEFICIENCY SYNDROME. AIDS. Immunodeficiency disorder caused by a virus that destroys T-Cells. The HIV Virus is harbored in the macrophage and Helper T-Cells.

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OTHER IMMUNE CONDTIONS

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  1. OTHER IMMUNE CONDTIONS • HIV and AIDS • LUPUS • FIBROMYALGIA

  2. HUMAN IMMUNODEFICIENCY VIRUS and AQUIRED IMMUNODEFICIENCY SYNDROME

  3. AIDS • Immunodeficiency disorder caused by a virus that destroys T-Cells. • The HIV Virus is harbored in the macrophage and Helper T-Cells. • The DNA of the virus directs the cells to create new viruses.

  4. CELLS OF THE IMMUNE SYSTEM

  5. CELLS OF THE IMMUNE SYSTEM

  6. ADAPTIVE IMMUNITY • Cytotoxic T-Cells • Specific Antigens • Natural Killer Cells • Any Antigen • Kills on Contact • Releasing Granules

  7. INFECTION • Bad Flu-like • Several weeks • ASYMPTOMATIC • 10 YRS • CLINICAL • AIDS • Infection of an opportunistic organism, not normally infectious

  8. EXERCISE CONCERNS in HIV and AIDS • DECONDITIONING • MUSCLE WASTING • LIPODYSTROPHY

  9. DECONDITIONING Deleterious effects of bed rest • Cardiovascular • Skeletal muscle • Bone and calcium metabolism • Metabolic and endocrine • Psychosocial

  10. WASTING • 5% Loss in Body Weight increases Mortality • Loss is directly related to lack of modern AIDS treatment • Decreased Strength • Decreased Muscle Mass

  11. LIPODYSTROPHY Fat Redistribution Syndrome • Loss of subcutaneous fat • Arms • Legs • Face • Increase in visceral abdominal fat

  12. LIPODYSTROPHY • Insulin Resistance • Elevated Glucose • Decreased HDL • Upper Body Obesity • Cardiovascular Disease • Stroke • Diabetes

  13. EXERCISE EFFECTIVENESS • Improve Physical Work Capacity • Improve Mood • Improve Immune Function • Decrease Chronic Disease Incidence • Increase Muscle Strength • Increase Muscle Mass Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  14. CONTROL • Maintain current level of activity • MODERATE INTENSITY • 60 min • 3/wk • 80% of Lactate Threshold • HEAVY INTENSITY • 3/wk • 30-40 min • 50% of VO2max – Lactate Threshold Cycle Ergometry Total Amount of Work Moderate = Heavy 6 weeks Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  15. SKIN REACTIVITY TESTS Area (mm2) Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  16. HIV VIRAL REPLICATION Copies /mL Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  17. QUALITY OF LIFE • How would you rate the quality of your life now? • How much longer do you want to live • How much longer do you think you will live? • Compared to one year ago, how much does your health limit your daily activities? (1=none; 5 = Very limited) • I look forward to the future with hope. (1=agree; 5 = disagree) • Overall, how would your rate your quality of life? (0=worst; 10 = best). • Which best describes how your feel about our life as a whole? (1=terrible; 7=delighted) Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  18. QUALITY OF LIFE Change in Score NS Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

  19. OTHER INTERVENTION STUDIES • CD4 COUNTS INCREASED IN THOSE pts WHO ADHERED • MacArthur, RD et al Med Sci Sports Exerc 25:684-688, 1993

  20. PHARAMCOLOGY HIGHLY ACTIVE ANTIRETROVIRAL THERAPY HAART • Nucleoside Reverse-Transcriptase Inhibitors (NRTI) • Nonnucleoside Reverse-Trancriptase Inhibitors (NNRTI) • Protease Inhibitors • 2-5 Meds • 1-4 doses/day • Eating & Drinking restrictions with 1-2 hrs of taking meds

  21. PHARAMCOLOGY ANABOLIC STERIODS Increase in Lean Mass (kg) • Nandrolone decanoate • Oxandrolone

  22. EXERCISE TESTING • BODY COMPOSITION • Lean Body Mass • Body Fat Distribution • Skinfold thickness at each site • FUNCTIONAL ASSESSMENT • Cardiovascular Endurance • 6 min walk • Stress Testing • Muscle Strength • Flexibility

  23. EXERCISE PRESCRIPTION • GOALS: • Improve Physical Work Capacity • Increase Muscle Mass • Increase Muscle Strength • Counteract lipodystrophy • Improve Immune Function

  24. EXERCISE PRESCRIPTION ENDURANCE STRENGTH MODECVResistance FREQUENCY3/wk3/wk DURATION15-25 min45 min INTENSITY65-85%60-80% RM

  25. PRECAUTIONS • Intercurrent Illness • Decrease Intensity • Discontinue • Fever >100o • Acute Symptoms • Nausea • Vomiting • Uncontrolled Diarrhea • Dehydration • Injury (wasting)

  26. LUPUS • LUPUS ERYTHEMATOSUS • Chronic Autoimmune Disease • Produces Antibodies to Fight own Tissues • INCIDENCE: • 1.4 – 1.5 Million • 16,000 / year • 90% Women • 15-45 years old • 2-3x in Minorities

  27. TYPES OF LUPUS • DISCOID • Affects the Skin • Rash • Abnormal Skin Biopsy • Can evolve to Systemic in 10% of cases • DRUG-INDUCED • Only 4% who take • Hydralazine • Procainamide • SYSTEMIC • Any Organ of the Body • Predominantly Skin & Joints • Heart, Lungs, Kidneys, Blood

  28. Sx: • Arthraligia (achy joints) 95% • Fever >100o 90% • Arthritis (swollen joints) 90% • Prolonged or Extreme Fatigue 81% • Skin Rashes 74% • Anemia 71% • Kidney Involvement 50% • Butterfly Rash on cheeks/nose 42% • Sun or Light Sensitivity 30% • Abnormal blood clotting 20% • Raynaud’s Phenomenon 17% • Seizures 15% • Mouth or Nose Ulcers 12%

  29. ETIOLOGY • Susceptible Genes • Environmental Factors • Infectious Agents • Meds • Anticonvulsants • Penicillins • Estrogen Therapy • Excessive Ultraviolet Light • Physical Trauma • Emotional Stress

  30. DIAGNOSIS • Medical History • Physical Examination • Blood Tests • RHEUMATOLOGIST must rule out • Chronic Fatigue Syndrome • Mononucleosis

  31. POSITIVE: • Butterfly Rash • Sun Sensitivity • Kidney Disorder • Blood Abnormalities • +4/11 other criteria

  32. THE ELEVEN CRITERIA • Malar Rash Cheeks • Discoid Rash Red Raised Patches • Photosensitivity • Oral Ulcers Nose or mouth • Arthritis Nonerosive >2 peripheral joints • Serositis Inflamation of lining of lung or heart • Renal Disorder Excessive protein in urine • Neurologic Disorder Seizures and/or psychosis

  33. Hematologic Disorder Anemia or Leukopenia or lymphopenia or thrombocytopenia • Antinuclear Antibody + antibodies • Immunologic Disorder + anti-DNA test + anti-SM test false +syphilis test + antiphospholipid antibody

  34. TREATMENT • Medications • Aspirin • Non-Steroidal Anti-Inflammatory (NSAIDs) • Acetaminophen (tylenol) • Antimalarials • Corticosteroids • Anticoalgulants • Avoid Sunlight • Eat Healthy Diet • Exercise • Minimize Stress • Bone Marrow Transplant (experimental)

  35. FIBROMYALGIA Mostly associated with Rheumatic Diseases • Pain in Muscles and Joints • Poor Sleep • Headaches • Stiffness • Muscle Aches • Sensitivity to • Bright Light • Loud Noise • Meds • Fatigue • 5% of Population • More common in Women • Women of Child Bearing Ages

  36. CLINICAL FEATURES • 90-100% • Generalized Pain • Fatigue • Stiffness • Morning Fatigue

  37. 70-90% • Post-exertional malaise • Sleep disturbances • Morning stiffness • Headaches • Tenderness • Swollen Feeling in tissues • Numbness & tingling • Cognitive Impairment • Dizziness • Sensitivity to Noise • Sensitivity to Smell & Stress • Menstrual cramping • Dry mouth

  38. 50-70% • Irritable bowel syndrome • Blurred Vision • Mood Swings • Heart Palpatations • Cold Extremities • Feverous feeling • Allergies

  39. 15-50% • Restless legs • Muscle twitches • Itchy skin • Hearing disturbances • Night sweats • Migraines • Breathing problems • Skin rashes • TMJ dysfunction • Chemical sensitivities

  40. CLINICAL FEATURES • Below 15% • Major depression

  41. DIAGNOSIS 11/18 + POINTS

  42. TREATMENT • Medications • Sleep Meds • Seritonin • NSIADs • Exercise • Relaxation Techniques • Educational Programs • Diet

  43. EXERCISE MODE Walking, Jogging, Cycling Swimming, Flexibility, ROM FREQUENCY 4/wk DURATION up to 60 min INTENSITY Moderate Exercise in the afternoon or early evening

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