Mr. Dijkstra, 23 years old, is affected by cystic fibrosis (CF). Besides frequent pulmonary exacerbations, Mr. Dijkstra also has exocrine pancreatic insufficiency, frequent abdominal pain and nasal polyps. Mr. Dijkstra is followed at the CF policlinic for adults at the UMCG, where he receives a checkup every 3 months. For the last 6 years, Mr. Dijkstra has had elevated liver enzymes and increased echogenicity on liver echography. He was told that he may have a mild degree of cystic-fibrosis liver disease (CFLD) and he was given ursodeoxycholic acid (UDCA) 20 mg/kg/day. He was told that this treatment could perhaps prevent further progression of his liver disease. However, this year, his yearly liver echography brought bad news: Mr. Dijkstra had developed liver cirrhosis.
Mr. Dijkstra developed progression of CFLD despite treatment with UDCA. Mr. Dijkstra was handled according to the UMCG CF guidelines. These guidelines do not report any other prophylactic or curative treatment for CFLD than UDCA, and further specify that treatment with UDCA is controversial.
We reviewed the literature concerning the management of CFLD and hypothesized that a possible preventative treatment for CFLD could be probiotics. Our research question is: “Can treatment with probiotics delay the development of CFLD?”
The world saw the biggest oil slick in its history in April 2010 in the Gulf of Mexico. The blast happened in an oil well of British Petroleum and it is evaluated that very nearly 4.9 billion barrels of oil was spilled to the Atlantic Ocean amid the initial three months since the occurrence. The oil slick had pulverizing impacts of the economy and condition of America and the organization needed to confront extreme feedback from over the world group. Full scale natural variables influencing BP Political Environment English Petroleum has kept down its profit payout to its prime partners as they had been experiencing tension from the United States government with respect to the oil slick that had happened in the Gulf of Mexico. The organization had consented to offer of 30 billion worth of resources for pay off its tidy up bills. The organization will continue its prime partner profit payout at 7 pennies/share. English Petroleum is anticipating offer two of its key refineries in the United States. Joined States have undermined to supplant BP from the undertaking to seal the detonated well in the deepwater skyline. Obama recognized that the Gulf of Mexico contributes a noteworthy of its local generation; he included that seaward oil penetrating can be sought after just with a confirmation that staggering occurrences like the British Petroleum oil slick won’t happen in future. Monetary Environment English Petroleum oil slick has brought about immense lose as far as Share value fall and it is assessed to be around $25 bn. Out of this tremendous sum very nearly 15 bn is account under encouraging clean water supply for the destitute individuals around. To comprehend the span of sum acquired it is fundamental to take a gander at what precisely the worldwide online monster Google makes every year ($20 bn). Aside from this an extra cost is probably going to bring about, BP will be compelled to spend an approx measure of $300 mn to top the pill and one additionally thing this does not consider the consequences. This would be proportional to cost of purchasing fuel to drive a SUV around the world for 60,237 times English Petroleum has seen an esteem disintegration of £8 billion after the declaration made by the president himself that the organization needs to pay the cleanup expenses of the enormous oil slick. The organization saw a fall of 11 % since the impact. English Petroleum has finished with lost $4.9bn (£3.1bn) amid 2010, this is out of the blue the organization is bringing about misfortune since 1992. Social Environment English Petroleum was censured for not being a socially dependable. Pax World, who is thought to be a savvy financial specialist, sold out its 8,000 offers of British Petroleum to demonstrate its reaction toward the debacle. Numerous different financial specialists officially sold their offers even before the oil slick since they were certain that the organization isn’t following legitimate wellbeing controls and also social obligation. After the spill vast number of investors particularly corporate financial specialists sold off their offers as keeping down their offers in BP would influence their picture too. A large number of individuals who lived along the coastline lost their vocations because of the spill. Demise of oceanic life left the anglers families with no profit. Additionally numerous individuals who worked in ocean bottom businesses likewise lost their employments. The spill likewise causes extreme medical problems among the general population who are related with expelling the substance dispersants. The most conspicuous issue is that it causes interior discharge which brings about steady passing. Along these lines the oil slick can likewise demonstrate deadly for individuals. Mechanical Environment The oil slick made the organization to think of numerous mechanical developments that could help it to settle or possibly kill a portion of the impacts. The organization concocted various gadgets for halting the oil stream. The topping stack was the most conspicuous gadget which filled this need. BP built up a radio repeater framework which stretches out from Florida Panhandle to Louisiana. This framework is valuable for laborers inside the system to impart among themselves and settle the inquiries rapidly. This will enhance the productivity of issue taking care of framework along these lines lessening the odds of blunder. The organization additionally outlined specific instruments that are equipped for working underneath water surface even at a profundity of 5000 feet. Numerous un-tested strategies were utilized after the oil slick. The Macondo prospect attempted to shear the harmed riser funnels which had inch-thick dividers even at profundity of 50,000 feet. Natural Effects The most wrecking impact of the oil slick was on the earth. The organization heard extreme feedback for the environmental effects of the oil slick. The earth of Gulf of Mexico was totally harmed from the spill. Huge amounts of species are being influenced by the spill out of which ten are in the skirt of annihilation. Some of them incorporate dolphins, pelicans, microscopic fishes, shellfish and so on. Since clams and shrimps frame a critical piece of the ocean bottom industry, the spill in expansive way influences the American ocean depths advertise moreover. The American territory of Louisiana which is closest to the oil well is the most influenced by the episode. According to the state authorities, around 400 km long coastline of Louisiana is dirtied by the oil spilled from the oil wells. In the initial a month and a half after the blast, around 491 feathered creatures, 227 turtles and 27 vertebrates, including dolphins, have been discovered dead along the US Gulf drift. The majority of them in this rundown were at that point in the jeopardized species list. Since the vast majority of the ocean creatures have a place with the essential level of evolved way of life, any impact on them would influence the entire natural pecking order. Along these lines it could convey hereditary impacts even to individuals. The undersea amphibian life isn’t the main territory which is being influenced. The oil spilled from the wells cleaned up the beach front wetlands which were at that point confronting obliteration from the overdevelopment, contamination and remaining impacts of sea tempest Katrina. Key Decisions for Future English Petroleum needed to devise a key arrangement that would help them to illuminate the issues that were caused by the oil slick and additionally increment the organization picture. As a piece of this procedure, the organization should present various methodologies in various zones. The principal procedure must be in fixing the oil well and keeping any further break. The tidying up of the oil spill should likewise be done flawlessly so commentators can’t think of any more faults. The organization had just performed well fixing positively and according to BP authorities; this issue was handled by July 2010. BP additionally should take additional care with a specific end goal to stay away from any such issue later on in light of the fact that even a little blunder would put all the torment taken till now futile. The best worry after the oil slick was on the impact it had on condition. It is an enormous assignment for the organization to comprehend the impacts on condition the same number of them are hopeless. However, as a piece of the procedure, the organization must spotlight on various territories identified with condition that were seriously influenced. The shorelines and the shorelines that were attacked by oil must be cleaned as an underlying advance since open can witness the state of these spots. So any imperfection in their cleaning would acquire boundless feedback from general society. Essentially measures must be taken to diminish the harm caused to condition, untamed life and in addition biological framework. The cases and protestations of individuals who were straightforwardly or in a roundabout way influenced by the oil slick should likewise be managed. This will be very useful in diminishing general society outrage towards the organization. The financial specialists will likewise be fulfilled by this measure. The occupations of numerous individuals like the anglers and the individuals who worked in the ocean depths manufacturing plants were lost because of the spill. The organization must take measures to reestablish their lives back by furnishing them with work openings or different methods for living. These ways the organization must come nearer to the general public and revamp their picture. Going into social activities would keep up their name as a socially dependable organization which will acquire more financial specialists moreover. Showcasing plan to recoup from the catastrophe and to recover individuals certainty It is basic that the organization seek after a more client driven advertising design since organization require reestablish it mark esteem. English Petroleum reaction toward the ecological issue goes to a point just beneath idiotic. The time has come to go past and locate an elective answer for the natural issues looked by the British Petroleum Sharing Concern English Petroleum’s Chief Executives are showing up not to demonstrate his individual fear but rather to pass on the message that the organization is currently reacting to the natural issue. It will assist the organization to representation itself with being all the more circumspectly reacting to the natural issue. The organization comprehends the effect of deplorable stun on clients and that on high need Loss help The organization had taken measure to help the groups of the gave up and harmed. Money related guides are set up for the general population who lost their activity in view of this debacle. It takes administration in empowering different organizations in a similar segment to stream new security measures and arrangements to keep away from advance episodes like this. BP ought to likewise make greater business chance to help the neighborhood occupants who depended on marine sources to win their day by day bread. Reestablishing the misfortune English Petroleum should join hand with NFWF (National Fish and Wild Life Foundation) by giving help to protect the species for the most part influenced by the oil slick in the deepwater occurrence and as a result of this episode a portion of these animal groups like shorebirds, water fowls, swamp flying creatures, ocean turtles and other marine vertebrates living at this piece of sea got only wiped out. Thinking about this point, British Petroleum should contact with marine and natural life preservationist associations to renew the lost populace of those marine species. T>