Foiling Earthquake Based Tsunami Devastation

On any given day, ocean waves crash upon our shores. Among the greatest of these waves are tsunamis. According to the National Oceanic and Atmospheric Administration (NOAA), a tsunami is “a set of ocean waves caused by a large, abrupt disturbance of the sea-surface ” (Bernard, n.d., ¶ 1). If the tsunami is close to the shore, any coastal communities could be demolished within as little as a few minutes. When a tsunami arrives, it typically is a rapidly rising turbulent surge of water. Tsunamis need to have an occurrence such as earthquake-induced movements of the ocean floor, landslide, volcanic eruption, or an asteroid to create the dangerous waves. A tsunami is a natural event that is difficult to predict, resulting in many lives lost and shores destroyed despite the advancement in technology over the previous years. Tsunamis have been occurring on Earth for thousands of years. Over the past decade, there have been ten major tsunamis, killing more than 4,000 people in the Pacific Basin (Yanagi, ¶ 6). According to the National Geophysical Data Center (NGDC), from 1500-2007 there have been 59 confirmed tsunami runups affecting 1,070 communities as they made landfall on our United State’s shorelines (NGDC 2008). A tsunami can occu

Autoimmune Subepidermal Bullous Diseases of the Skin and Mucosae: Clinical Features, Diagnosis, and Management.

Autoimmune subepidermal blistering diseases of the skin and mucosae constitute a large group of sometimes devastating diseases, encompassing bullous pemphigoid, gestational pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, and anti-p200 pemphigoid. Their clinical presentation is polymorphic. These autoimmune blistering diseases are associated with autoantibodies that target distinct components of the basement membrane zone of stratified epithelia. These autoantigens represent structural proteins important for maintenance of dermo-epidermal integrity. Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease of the skin and mucosae. Although the disease typically presents with a generalized blistering eruption associated with itch, atypical variants with either localized bullous lesions or "non-bullous" presentations are observed in approximately 20% of patients. A peculiar form of BP typically associated with pregnancy is pemphigoid gestationis. In anti-p200 pemphigoid, patients present with tense blisters on erythematosus or normal skin resembling BP, with a predilection for acral surfaces. These patients have antibodies targeting the 200-kDa basement membrane protein. Epidermolysis bullosa is a rare autoimmune blistering disease associated with autoantibodies against type VII collagen that can have several phenotypes including a classical form mimicking dystrophic epidermolysis bullosa, an inflammatory presentation mimicking BP, or mucous membrane pemphigoid-like lesions. Mucous membrane pemphigoid (MMP) is the term agreed upon by international consensus for an autoimmune blistering disorder, which affects one or more mucous membrane and may involve the skin. The condition involves a number of different autoantigens in the basement membrane zone. It may result in severe complications from scarring, such as blindness and strictures. Diagnosis of these diseases relies on direct immunofluorescence microscopy studies and immunoserological assays. Management of affected patients is often challenging. We will here review the clinical and immunopathological features as well as the pathophysiology of this group of organ-specific autoimmune diseases. Finally, we will discuss the diagnostic approach and the principles of management in clinical practice