NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders

Walden University NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders                     

Whether one passes or fails an academic assignment such as the Walden University NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders                     

The introduction for the Walden University NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders                     

After the introduction, move into the main part of the NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders

NURS 6501 Assignment Knowledge Check Neurological and Musculoskeletal Disorders

Question 1

Scenario 1: Gout

A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

HPI: hypertension treated with Lisinopril/HCTZ .

SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.

PE:  remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm³ and uric acid 9.0 mg/dl.

Diagnoses the patient with acute gout.

Question:

Explain the pathophysiology of gout.

Your Answer:

Gout is caused by disorders of purine metabolism, increased uric acid production, and reduced uric

acid excretion, causing increased serum uric acid (sUA) levels. This forms monosodium urate (MSU) crystals deposited in the joints, kidneys, and other tissues. Gout occurs following the precipitation of monosodium urate crystals in a joint space (Clebak et al., 2020). The deposition of the urate crystals elicits activation of the immune system, causing the release of various inflammatory cytokines and the recruitment of neutrophils. Over time, the joint space becomes irreversibly damaged, causing chronic pain and disability with grossly deformed joints. Tophi may also form at the joint space. These are subcutaneous nodules containing monosodium urate crystals in a matrix of lipids, proteins, and mucopolysaccharides (Clebak et al., 2020). The first metatarsophalangeal joint is mostly affected.

Reference

Clebak, K. T., Morrison, A., & Croad, J. R. (2020). Gout: Rapid evidence review. American family physician, 102(9), 533-538.

Question 2

Scenario 1: Gout

A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

HPI: hypertension treated with Lisinopril/HCTZ .

SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.

PE:  remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm³ and uric acid 9.0 mg/dl.

Diagnoses the patient with acute gout.

Question:

Explain why a patient with gout is more likely to develop renal calculi.

Your Answer:

Gout patients commonly present with nephrolithiasis. The development of renal calculi in patients with gout is primarily related to high levels of uric acid. The ionized forms of uric acid form salts like monosodium urate, disodium urate, or potassium urate (Bardin et al., 2021). Sodium is the main cation in the extracellular fluid. Urine acidifies along the renal tubules, causing a portion of urate to convert to uric acid. The solubility of uric acid in an aqueous solution is lesser than that of urate, but the saturation increases markedly with the increase in the pH value of urine (Bardin et al., 2021). Gout patients with long-term high uric acid levels have increased urinary uric acid concentration and form crystals after surpassing the solubility, which gradually enlarges to shape calculus.

References

Bardin, T., Nguyen, Q. D., Tran, K. M., Le, N. H., Do, M. D., Richette, P., Letavernier, E., Correas, J. M., & Resche-Rigon, M. (2021). A cross-sectional study of 502 patients found a diffuse hyperechoic kidney medulla pattern in patients with severe gout. Kidney international, 99(1), 218–226. https://doi.org/10.1016/j.kint.2020.08.024

Jia, E., Zhu, H., Geng, H., Wang, Y., Zhong, L., Liu, S., Lin, F., & Zhang, J. (2021). Effect of alkalized urine on renal calculi in patients with gout: a protocol for a placebo-controlled, double-blinded randomized controlled trial. Trials, 22(1), 743. https://doi.org/10.1186/s13063-021-05721-8

Partial credit, I did not see Jia as an intext citation. Let me know if I overlooked this.

Question 3

Scenario 2: Osteoporosis

A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a  rabbit and made her fall. She attempted to try and break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local ER for evaluation. Radiographs revealed a Colles’ fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with ace bandage wrap and instructed to see an orthopedist for follow up.

Question:

Discuss what is osteoporosis and how does it develop pathologically? 

Your Answer:

Osteoporosis is a chronic metabolic disorder that presents with bone loss, causing a decreased bone density and increasing the risk of fracture. The commonly affected bones are the spine, hip, and wrist. Osteoporosis is diagnosed in a patient with a T-score at or below −2.5 (Akkawi & Zmerly, 2018). Common osteoporosis manifestations are loss of height, back pain with bending, lifting, or stooping, and fractures. Osteoporosis develops when bone resorption exceeds bone building, resulting in decreased bone mineral density (BMD). BMD decreases more rapidly in postmenopausal females due to decreased serum estrogen levels. Estrogen helps in preventing bone loss.

Reference

Akkawi, I., & Zmerly, H. (2018). Osteoporosis: Current Concepts. Joints, 6(2), 122–127. https://doi.org/10.1055/s-0038-1660790

Question 4

Scenario 3: Rheumatoid Arthritis

A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.

FH: Grandmothers had “crippling” arthritis.

PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.

Diagnosis: rheumatoid arthritis.

Question:

The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA? 

Your Answer:

RA is a chronic, gradual, systemic inflammatory autoimmune disorder affecting synovial joints. It is characterized by inflammation of connective tissue in the synovial joint. It is a systemic disease that affects the body system and usually involves several joints and other tissues. Rheumatoid factors (RFs) are formed and attack healthy tissues, particularly synovium, causing inflammation (Scherer et al., 2020). The disease then involves the articular cartilage, joint capsule, and surrounding ligaments and tendons. This explains the patient’s symptoms of generalized joint pain, stiffness, and swelling, in her hands as well as boggy proximal interphalangeal joints and swelling and warmth of the metatarsals in her feet also exhibited swelling and warmth.

Osteoarthritis (OA) presents with deep joint pain secondary to extensive joint use. It manifests with a reduced range of motion (ROM) in affected joints and Heberden nodes. Joint stiffness in OA occurs during rest, and it also has joint stiffness in the morning that lasts less than 30 minutes (Yunus et al., 2020). On the other hand, RA presents with morning joint stiffness lasting more than an hour. RA presents with systemic symptoms, like a low-grade fever, anorexia, fatigue, and weight loss, which do not occur in OA.

References

Scherer, H. U., Häupl, T., & Burmester, G. R. (2020). The etiology of rheumatoid arthritis. Journal of autoimmunity, 110, 102400. https://doi.org/10.1016/j.jaut.2019.102400

Yunus, M., Nordin, A., & Kamal, H. (2020). Pathophysiological Perspective of Osteoarthritis. Medicina (Kaunas, Lithuania), 56(11), 614. https://doi.org/10.3390/medicina56110614

As posted, RA …..spell out when first introduced as content.

Question 5

Scenario5: Multiple Sclerosis (MS)

A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have become worse over the course of the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI or UTI

PMH: non-contributory

PE: CN-IV palsy. The fundoscopic exam reveals edema of right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short term memory loss with listing of familiar objects.

DIAGNOSIS: multiple sclerosis (MS).

Question:

Describe what is MS and how did it cause the above patient’s symptoms?

Your Answer:

MS is a chronic demyelinating disorder of the central nervous system (CNS). It is an autoimmune disorder that affects the myelin sheath and CNS conduction pathway. It is characterized by central areas of inflammation, demyelination, proliferation and activation of glial cells, and degeneration caused by immune-mediated attacks (Fernández et al., 2020). The clinical manifestations of MS include muscle weakness and spasticity, intention tremors, fatigue, inability to direct or limit movement, reduced sensitivity to pain, paresthesia, and decreased motor coordination. In addition, MS is characterized by changes in peripheral vision, reduced visual and hearing acuity, bowel and bladder dysfunction, altered sexual function, and cognitive changes.

Optic nerve and brainstem involvement can be attributed to the patient’s vision problems with blurred vision. The difficulty in voiding is due to a loss of neural control. Besides, demyelination in the cerebral cortex causes difficulties in concentration and focusing, which are present in the patient (Fernández et al., 2020). Demyelination in the cerebellum causes imbalance, incoordination, vertigo, and tremors, which explains the patient’s fine hand tremors and weakness. The difficulty in voiding can be attributed to the involvement of the spinal cord because the peripheral and spinal connections control the voiding reflex (Preziosi et al., 2018).

 

References

Fernández, Ó., Costa-Frossard, L., Martínez-Ginés, M., Montero, P., Prieto, J. M., & Ramió, L. (2020). The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. Frontiers in neurology, 11, 152. https://doi.org/10.3389/fneur.2020.00152

Preziosi, G., Gordon-Dixon, A., & Emmanuel, A. (2018). Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degenerative neurological and neuromuscular disease, 8, 79–90. https://doi.org/10.2147/DNND.S138835

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

• • Stroke
  • Multiple sclerosis
  • Transient Ischemic Attack
  • Myasthenia gravis
  • Headache
  • Seizure disorders
  • Head injury
  • Spinal cord injury
  • Inflammatory diseases of the musculoskeletal system
  • Osteoporosis
  • Osteopenia
  • Bursitis
  • Tendinitis
  • Gout
  • Lyme Disease
  • Spondylosis
  • Fractures
  • Parkinson’s
  • Alzheimer’s

Three basic bone-formations:

• • Osteoblasts
  • Osteocytes
  • Osteoclasts

Photo Credit: Getty Images/Science Photo Libra

Complete the Knowledge Check By Day 7 of Week 7

To complete this Knowledge Check:

Module 5 Knowledge Check

Next Week

To go to the next week:

Week 8

 Week 7: Concepts of Neurological and Musculoskeletal Disorders – Part 1

Anatomists often use the analogy of a house to explain the human body, with skeletal systems, respiratory systems, and circulatory systems represented as a home’s framing structure, ventilation, and piping, respectively. Such analogies further emphasize the point that relationships between systems can result in complications when issues arise in one system.

With hundreds of diseases that can impact the brain, spine, and nerves, neurological disorders represent a complicated array of issues that present significant health concerns. Disorders such as strokes and Parkinson’s disease not only affect the nervous system, however; they can have secondary impacts in other areas, especially the musculoskeletal system.

This week, you examine fundamental concepts of neurological disorders. You explore common disorders that impact these systems and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Learning Objectives

Students will:

• Analyze concepts and principles of pathophysiology across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6501 Assignment Knowledge Check: Neurological and Musculoskeletal Disorders

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

• Chapter 15: Structure and Function of the Neurologic System
• Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
• Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
• Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
• Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
• Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review
• Chapter 47: Structure, Function, and Disorders of the Integument (section on Lyme Disease)

Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Required Media (click to expand/reduce)

Module 5 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 5 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Assignment. (3m)

Khan Academy. (2019b). Ischemic stroke . Retrieved from https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke 

Note: The approximate length of the media program is 8 minutes.

Osmosis.org. (2019, June 12). Osteoporosis  – causes, symptoms, diagnosis, treatment, pathology [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo 

Note: The approximate length of the media program is 9 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 15, 16, 18, and sections of Chapters 44 and 45 that relate to the neurological and musculoskeletal systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Gout refers to chronic inflammatory arthritis characterized by the deposition of monosodium urate monohydrate crystals in tissues. Gout is relatively common with an estimated global prevalence of 1 to 4% (Dehlin et al., 2020). In the United States, gout affects more than 2 million adults (Dehlin et al., 2020). The incidence of gout increases with age as well as a family history of gout. Additionally, gout is slightly male preponderance with up to 2 to 6 times higher in males than females. The pathophysiology of gout is considered complex and multifactorial. Factors implicated in the development of gout include alcohol, medications, hypertension, hyperlipidemia, obesity, diabetes mellitus, cardiovascular disease, diet, chronic kidney disease, advanced age, ethnicity, family history, and male gender (Dehlin et al., 2020). Gout is contemplated as a disorder of metabolism resulting in the accumulation of urate and uric acid in blood and tissues. Consequently, tissues become supersaturated leading to the precipitation of urate salts forming monosodium urate crystals. The deposition of these crystals occurs in an array of tissues although the synovium, kidney, bone, ligament, skin, tendon, and cartilage are among the most common sites. Uric acid is less soluble under low temperatures and acidic conditions. Finally, microcrystals may be shed from preexisting tophi initiating an inflammatory response.

Explain why a patient with gout is more likely to develop renal calculi

Individuals with gout have high levels of urate and uric acid in their plasma. Uric acid is a weak organic acid. It exists in a less soluble non-ionized form in acid conditions such as in urine. Physiologically, uric acid production is from purine metabolism in the liver with a slight contribution from the small intestines. Similarly,  the glomerulus filters almost all the urate. As a result, the entire pool of urate is managed by renal excretion in steady-state conditions. Hyperuricemia increases the urate pool which causes supersaturation and precipitation of uric acid and the formation of uric acid calculi. According to Cicerello (2018),  hyperuricemia,  diminished fractional excretion of uric acid, and constantly low urinary pH levels are common in patients with gout which leads to uric acid nephrolithiasis. For instance, a reduction in pH induces alterations in uric acid dissolution and acid-base status while a reduction in urine output leads to highly concentrated urinary solutes resulting in precipitation (Cicerello, 2018). Finally, individuals with gout may also develop renal calculi due to hyperuricosuria and a decrease in crystallization inhibitors such as urinary glycosaminoglycans.

Discuss what is osteoporosis and how it develops pathologically

Osteoporosis refers to low bone mineral density as a result of altered bone microstructure. Osteoporosis predisposes patients to fragility and low-impact fractures. Globally, osteoporosis affects over 200 million individuals with its incidence increasing with age. Generally, women are more affected. Osteoporosis can be primary or secondary. According to Pouresmaeili et al. (2018), primary osteoporosis is a consequence of aging and a reduction in sex hormones while other disease processes cause secondary osteoporosis. Osteoporosis develops from an imbalance between bone formation and resorption. An interplay of several factors including genetic, lifestyle, intrinsic and exogenous factors interact to cause an imbalance between bone resorption and formation leading to decreased skeletal mass (Pouresmaeili et al., 2018). For instance, with aging, bone resorption exceeds bone formation. Physiologically, bone mass peaks in the third decade. Consequently, factors that cause osteoporosis result in failure to achieve a normal peak bone mass as well as an acceleration of bone loss.

The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA 

The patient had articular manifestations of rheumatoid arthritis such as polyarthralgia, morning stiffness, swelling of joints, ulnar deviation of her hands, and boggy proximal interphalangeal joints. According to Bullock et al. (2018),  rheumatoid arthritis mostly affects metacarpophalangeal joints and proximal interphalangeal joints but rarely distal interphalangeal joints. Additionally, rheumatoid arthritis is a systemic disorder and hence commonly presents with constitutional symptoms such as fatigue. Rheumatoid arthritis refers to a chronic inflammatory autoimmune disorder that principally affects the joints but also causes extraarticular features (Bullock et al., 2018). On the other, osteoarthritis is a degenerative disease that results from the biochemical breakdown of articular cartilage.  Osteoarthritis typically involves weight-bearing joints such as the hip, knee, and lower back while rheumatoid arthritis can affect any joint although common in hands, wrists, and feet. Similarly, osteoarthritis develops gradually over several years while rheumatoid arthritis develops acutely.

Describe what is MS and how did it cause the above patient’s symptoms

Multiple sclerosis is a chronic autoimmune disease of the central nervous system distinguished by demyelination, inflammation, neuronal loss, and gliosis (Lane & Yadav, 2020). The exact etiology of multiple sclerosis is unknown although environmental, immune, and genetic factors are involved in its pathogenesis. In multiple sclerosis, there is focal inflammation that is injurious to the blood-brain barrier and causes macroscopic plaques (Lane & Yadav, 2020). Similarly, there is microscopic injury as a result of the degeneration of various CNS components such as neurons, axons, and synapses. The aforementioned processes explain the multifocal nature of injury in multiple sclerosis and the neurological symptoms observed in this patient such as blurring of vision, tremors, difficulty concentrating, memory impairment, weakness, and difficulty voiding (Lane & Yadav, 2020). Finally, the course of multiple sclerosis varies considerably and can be remitting, relapsing, or progressive.

References

Bullock, J., Rizvi, S. A. A., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J. (2018). Rheumatoid arthritis: A brief overview of the treatment. Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre, 27(6), 501–507. https://doi.org/10.1159/000493390

Cicerello, E. (2018). Uric acid nephrolithiasis: An update. Urologia, 85(3), 93–98. https://doi.org/10.1177/0391560318766823

Dehlin, M., Jacobsson, L., & Roddy, E. (2020). Global epidemiology of gout: prevalence, incidence, treatment patterns, and risk factors. Nature Reviews. Rheumatology, 16(7), 380–390. https://doi.org/10.1038/s41584-020-0441-1

Lane, M., & Yadav, V. (2020). Multiple Sclerosis. In Textbook of Natural Medicine (pp. 1587-1599.e3). Elsevier. https://doi.org/10.1016/b978-0-323-43044-9.00199-0

Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A comprehensive overview of osteoporosis and its risk factors. Therapeutics and Clinical Risk Management, 14, 2029–2049. https://doi.org/10.2147/TCRM.S138000