Brugada Syndrome: Sudden Cardiac Death | Literature Review

Brugada Syndrome: Sudden Cardiac Death | Literature Review BRUGADA SYNDROME: SUDDEN CARDIAC DEATH Review of Literature and Case Report. Dr. Nanda Pai Dr. Sanjeeta Umbarkar Dr. Akshay Bafna Dr. Jinal Vaghela KEYWORDS: Brugada Syndrome, sudden unexpected death syndrome (SUDS) ABSTRACT Brugada Syndrome or Sudden Unexpected Death Syndrome was first discovered by P. Brugada and J. Brugada in 19921. It is a rare genetic disorder characterised by ST segment elevation in V1 – V3 leads on ECG, ventricular fibrillation and ventricular arrhythmias which can cause sudden unexpected death in an otherwise normal patient. We wish to highlight the fact that with thorough pre-operative anaesthetic and cardiac evaluation these potentially life threatening patients can be effectively treated for minor oral surgical procedures using regional anaesthesia with lignocaine thereby avoiding general anaesthesia. INTRODUCTION â€Å"In 1992, Pedro and Josep Brugada for the first time introduced a new clinical entity with ST segment elevation in V1 – V3 leads and right bundle branch block (RBBB) pattern associated with a high incidence of ventricular tachycardia/ventricular fibrillation (VT/VF)1†. This new entity was termed Brugada Syndrome (BrS) or Sudden Unexpected Death Syndrome (SUDS), occurring in structurally healthy hearts in young individuals, causing life threatening arrhythmias and sudden death. Most of the patients are between second and fourth decades of life however â€Å"the youngest patient clinically diagnosed with the syndrome is 2 days old and the oldest is 84 years old2†. There is a male predilection, â€Å"due to the presence of more prominent I ­to channels in males than in females3† and in many countries it is the 2nd highest cause of death in younger men after vehicular accidents. Signs and symptoms include presyncopal and syncopal attacks and cardiac arrest (many a times during sleep). Routine ECG shows ST segment elevation in leads V1 – V3. Fever may precede syncope or tachycardia. There are 3 types of Brugada ECG Patterns Type 1: coved type, where ST segment elevation > 2 mm. Type 2: saddle back type, where ST segment elevation > 2mm with positive ‘T’ wave. Type 3: coved or saddle back type, where ST segment elevation Brugada Syndrome is inherited as an autosomal dominant trait. In 1998, the Syndrome was linked to mutations in SCN5A, the gene that encodes the alpha subunit for the sodium channel and since then over 300 mutations of SCN5A have been identified4. Mutations of gene SCN5A cause loss of expression of sodium channel protein which decreases the sodium current resulting in slow conduction in the heart. Bezzina et al presented evidence supporting the theory that an SCN5A promoter polymorphism, common in Asian modulates, variability in cardiac conduction and may contribute to the high prevalence of Brugada Syndrome in Asian population5. CASE REPORT A 27 year old male patient reported in the department of dentistry, with excruciating pain in lower right second molar and insisted on getting it extracted. Clinical examination and orthopantomogram revealed an extremely carious second molar. The patient was a recently diagnosed case of Brugada Syndrome (Type 3). He gave a history of chest pain about 7 years ago, however, a couple of months ago he had persistent chest pain for which he was admitted in the intensive care unit for about 10 days, during which time he had 3 presyncopal attacks. On cardiac evaluation, ECG revealed an elevated ST segment in V1 – V3 leads and partial RBBB pattern but structurally normal heart valves with normal pericardium and absence clots or vegetation. His left ventricular ejection fraction was 60%. CST (Cardiac Stress Test) was performed by Bruce protocol where patient walked for 30 minutes with 10.1 METS which showed no angina/arrhythmia. Basal ECG showed RBBB persisted throughout the test. Howe ver there were no significant ST segment changes during the test. Adequate chronotropic and ionotropic response was achieved. CST was negative for stress induced reversible ischaemia/and for arrhytmia. His family history revealed sudden death of his father at a younger age (42 years) with unknown cause. However, there was no diagnosed case of Brugada Syndrome in the family. His past surgical history revealed an appendicectomy and septoplasty. He was a chronic smoker and occasionally consumed alcohol. Since it was a minor dental surgical procedure and given the patient’s history, the tooth extraction was planned under local anaesthesia using lignocaine hydrochloride with adrenaline (1:2, 00,000) thereby avoiding general anaesthesia and the various drugs used with it that could trigger ventricular tachycardia in a BrS patient. Given the patient’s history of chest pain and diagnosis of Brugada Syndrome, patient was thoroughly evaluated by the anaesthetist and cardiologist prior to the dental treatment. High risk fitness was obtained. The patient was taken up in the intensive care unit. A ventilator and a defibrillator were kept standby. A 12 lead ECG was attached and was monitored continuously throughout the procedure. An I.V. line was secured. The anaesthetist and cardiologist along with the maxillofacial surgeons formed the surgical team. A right inferior alveolar nerve block was given using 3 ml lignocaine with adrenaline solution. Another 1 ml was used for intra-pulpal infiltration. After checking for subjective and objective signs the tooth was surgically extracted after sectioning the roots. The wound was closed using 3 – 0 vicryl. Patient tolerated the procedure well. Intra operatively patient was given 4 mg Dexamethasone along with injection Augmentin (Amoxicillin Clavulanate) 1.2 gm. Post operatively he was put on oral tablet Augmentin 625 mg and tablet Paracetamol twice a day. Patient was discharged the same day and was followed up in the dental department. DISCUSSION Brugada Syndrome is a major cause of sudden unexplained death syndrome (SUDS) and death is caused by ventricular tachycardia and fibrillation (a lethal arrhythmia) in the heart which appears with no warning. The diagnosis in Brugada Syndrome is based on the characteristic patterns on an electrocardiogram, which may be routinely precipitated by administration of certain drugs (ajmaline or flecainide). Brugada ECG pattern is very often hidden, but certain factors can unmask or trigger it like sodium channel blockers, febrile state, vagotonic agents, autonomic nervous system changes, excessive stress, tricyclic or tetracyclic antidepressants, first generation antihistamines (dimenhydrinate), a combination of glucose and insulin, hyperkalaemia, hypokalaemia, hypercalcaemia, alcohol toxicity, heavy meals at night just before sleeping, excessive vomiting, hot humid climatic conditions6. According to Nademanee and Veerakul6, north-eastern part of Thailand where SUDS is prevalent and where temperatures can soar to 41oC a study is underway to gauge the climatic influences on occurrence of SUDS and they feel that physicians should factor in temperature as a cause of arrhythmogenesis in BrS. Several drugs could precipitate ventricular tachycardia and fibrillation which are listed in world Brugada registry in http://www.brugadadrugs.org (Accessibility verified July 04, 2014). All Brugada patients and their treating physicians should be aware of these precipitating drugs at all times. Many Brugada patients are asymptomatic and the classical pattern on ECG is picked up only by an experienced and trained physician. This pattern should be correlated with age of patient, family history, chest pain, fever and presyncopal/syncopal attacks. Bupivacaine has been reported to unmask Brugada like ECG patterns when administered epidurally7. Hence we avoided bupivacaine and used lidocaine with adrenaline (1:2, 00,000 dilution) instead for our patient which was well tolerated by him. Lignocaine (class 1b antiarrythmic agent) displays rapid dissociation kinetics and produces little to no ST segment elevation in patients with congenital BrS8. The ventricular tachycardia in BrS can be prevented by avoiding certain aggravating factors like medication, drugs, fever and excessive stress. Brugada patients need to be regularly followed up over a long period of time. In severe cases the only line of treatment is placement of an implantable cardioverter defibrillator (ICD). Kloesel et al9 in 2011 did a literature search and compared results of previous reports with theirs regarding outcomes of patients with BrS who underwent surgeries and anaesthetic care and found 21 case reports and 4 case series. They collected data of 52 anaesthetics and 43 patients. In our literature search we found mention of only 2 patients of BrS who underwent surgeries in the maxillofacial region. 1) Plate fixation for mandibular fracture in 56 year old male. 2) Tooth extraction, incision and drainage of odontogenic infection in 55 year old male10. However both these patients were treated under general anaesthesia. We decided to avoid general anaesthesia thereby keeping the drugs to be used to the minimum. By thorough pre-anaesthetic evaluation, proper patient counselling, intra-operative pain control using optimum amount of lignocaine, 12 lead ECG continuously monitored at all times during procedure, constant blood pressure monitoring, avoiding use of certain drugs like bupivacaine, keeping a defibrillator standby and by having a cardiologist and anaesthetist in your surgical team these patients can be successfully managed. Post-operatively ICU monitoring is must for a minimum of 4 hours. There is a dearth of articles in the Maxillofacial and Dental literature regarding the management of these patients and we feel there is a need of more awareness of this not so rare cardiac condition among the dental and maxillofacial surgeons. With proper planning these patients with potentially life threatening and unique cardiac conditions can be safely and efficiently managed by maxillofacial surgeons for dental treatment. FUNDING None. COMPETING INTERESTS None declared. ETHICAL APPROVAL Not Required. ACKNOWLEDGEMENTS The authors would like to thank Dr. Kuldeep and Dr. Arvind Singh, 1st year Residents, Department of Cardiology, KEMH; Dr. Yogesh Naik, Assistant Professor, Department of Anaesthesia, KEMH for their support throughout the treatment and co-operation. REFERENCES Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. A multicenter report. J. Am Coll Cardiology 1992: 20: 1391-1396. Antzelvich C, Brugada P, Borggrefe M, Brugada J, Brugada R, Coraddo P, et al. Brugada Syndrome: Report of the second consensus conference. Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association Circulation 2005: 111: 659-70. Diego J M, Condiero J M, Goodrow R J, Fish J M, Zygmunt A C, Perez G J, et al. Ionic and cellular basis for the predominance of the Brugada Syndrome phenotype in males. Circulation 2002: 106: 2004-11. Chen Q, Kirsch G E, Zhang D, et al. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation nature. 199: 392: 293. C R Bezzina, W Simizu, P Yang, Tamara T, Koopmann M Tanck, et al. Common sodium channel promoter haplotype in Asian subjects underlies variability in cardiac conduction. Circulation 2006: 113: 338-344. Gumpanart Veerakul M D, Koonlawee Nademanee M D. Brugada Syndrome: two decades of progress. Circ. Journal 2012: 76: 2713-2722. Phillips N, Priestly M, Denniss A R et al. Brugada type electrocardiographic pattern induced by epidural bupivacaine. Anaesthesia Analogue. 97: 264: 2003. 8. Hideki Itoh, Keiko Tsuji,Tomoko Sakaguchi,Iori Nagaoka,Yuko Oka,et al . A paradoxical effect of lidocaine for the N406S mutation of SCN5Aassociated with Brugada syndrome. International Journal Of Cardiology. 2007: 121 (3): 239-248. Benjamin Kloesel, Michael J Ackerman, Juraj Sprung, Bradly J. Narr, Toby N. Weingarter. Anaesthetic management of patients with Brugada Syndrome: A case series and literature review. Can Journal Anaesthesia / Can Anaes 2011. 58: 824-836. Nicholas Theododu, Joseph E. Cillo. Brugada Syndrome (Sudden Unexpected Death Syndrome): Perioperative and Anaesthetic Management in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg. 2009: 67 (9): 20121-25.

Power in Shakespeare

Power has significantly marked the society where we are in current development. Power is one of the best ways to control a society, yet it impacts the society in a negative way when it comes to distributing rights and opportunities. That is, since it involves the worst issues within the government known as corruption. In William Shakespeare’s play, Richard III, and Aristophanes’ play, Lysistrata, both authors employ the major role and concept of power.Both Shakespeare’s and Aristophanes’ approach to power has influenced the understanding of power and through their examples; one can employ their ideas as to why sometimes I feel powerless or powerful in my current life of a student. The views expressed by these authors are focused politically to power, which make people reflect on what power means; this involves attraction and subjugates provocation. The power is so great that it will always be seen negatively. With power one can organize groups but, there n eeds to be an authority.For example, like those with the political, economic, military or religious power. Yet, the problem comes when the abuse of power arises and when having too much power, the mind can be corrupted. It is necessary that one should have a good posture when power comes into hand and one should see it as something to improve on rather than to enhance on the small things that one does not need. Power should be seen as the ability to control to do the right thing and for that reason, be able to accomplish positive changes for the rest of the community.As a student, one has the ability to have power or not to have power either by sitting in a regular classroom or being at the university in general. At the university, there are laws, rules and authority that needs to be followed and for that reason a student could sometimes feel powerless. For instance, there is a rule at FAU that a student can’t be absent from a class for a certain amount of days. The student i s able to feel powerful because he or she has the ability to not go to class.Yet, once he or she reaches or passes the amount of days, the student will be automatically dropped out and in addition will receive a penalty for it. So a student can feel powerless because it has no other choice but to go to the class just so he or she wouldn’t get penalized. In other words, one could explain how different styles of power could have similar characteristics through the norms and rules that exist today. For example, the power exerted from a government of any country must be abided by the people who inhabit it through compliance ith the same laws and standards. Also, the student of any university must also follow the same rules and laws established by the university. As you can see, this example represents a power running scheme of a major and minor scale, but with a similar goal, which is how to maintain order where there is always power. The penalty is always the consequence, that i s, if you decide to take too much power into your own hands. If one has power, he or she should be able to manipulate it well enough to not let it go into the wrong hands.Similarly in Richard III, Shakespeare employs Hastings as a lord with honor who always remains loyal and trustworthy to the family. But when he gives all his trust and all his power to Richard, Richard ends up killing him. With power comes a consequence, and coinciding to this idea, that is why with power, corruption always occur. To that reason, a student will feel powerless because he or she has no other choice but to attend class. In order to be able to advance and be successful in class, you have to depend on your surroundings rather than self-advancement.One should be able to find peers and ask them what they did the whole class. Also, one is able to get the notes and basically get everything of what the teacher did without being in class. This being said, a student will feel powerful only if they have their s urroundings by the palm of their hand. If the student is going to use his or her power, it will need to depend on its surroundings in order to be able to get the power that he or she wants. As said by Shakespeare, â€Å"Which done, God take King Edward to his mercy, and leave the world for me to bustle in, for then I’ll marry Warwick’s youngest daughter† (5).At school, one cannot depend on himself or herself, but on the teacher and on the peers. In Shakespeare view, he is showing how Richard views his power and Richard needs his surroundings and his superiority in order to get to King Edward’s throne. As for Aristophanes, Lysistrata would have never been able to succeed if she did not have the help of the other women. Her use of manipulation helped her gain power and she was able to take back her man and bring peace to the city. In addition, manipulating is being able to handle, control, or use someone or something cleverly and skillfully for one's own ad vantage.A student can exercise the power to manipulate other students not to follow the rules or establish academic programs. Students who do not have responsibility and honesty are able to induce other students not to follow their school schedule, for example the student’s class attendance. The student’s friends will tell them to not attend class, go to the beach, or miss class just to miss it. And likewise, they are able to decrease the academic level in their classes because they assume no responsibility and maturity with the commitment to remain in a serious institution such as a university.These students still depend on their parents and since they know their parents will pay everything for them, they get low self-esteem and they won’t be able to value themselves and appreciate what they have. For this reason, they are people who have no responsibility and have no commitment when it comes to effort and it will be reflected once they attend the university. T herefore, that is why they influence other students to do the same. Aristophanes explains how the women were able to manipulate the power and strength of their husbands and warriors, exerting some manipulation of their womanhood and wife.Similarly, Shakespeare speaks of Elizabeth’s power over King Edward. By then, Richard is seeing the king as being weak and being handled by women. â€Å"Why, this it is, when men are ruled by women; my Lady Grey his wife, Clarence, ‘tis she that tempers him to this extremity† (Shakespeare 3). Comparing the previous texts, a student to a certain extent, can manipulate by being able to respect and enforce the university rights. For example, receiving an academic background in the area specified and chosen by the student and freely expressing its ideas and not being able to get punished because of them.This is why universities should take responsibility to train professionals and specialists in various areas of knowledge, as well as the formation of authentic citizens with moral and ethical responsibilities committed to the social reality around them. In Lysistrata, the women had a hard time being heard by the town and similarly, I have that same problem with my life as a college student. Just as the commissioner said in Lysistrata, â€Å"you expect me to take orders from a woman. I’d die first† (Aristophanes 91).The men during that era did not take the women into consideration and they were never taken into account. They were always ignored and predominated the power of men. Aristophanes portrayed the women into another new level by giving them the importance that they needed. Although they were only valued as a house wife, Aristophanes took into consideration how important sex is in the life of men, and gave power to the women using their ingenuity. Due to the fact that FAU has a great amount of tudents not only in the school in general but in the classes as well, the professors cannot provide a personalized education for each student. For that reason, that is why students sometimes feel ignored. It is very complicated for a professor to dictate a class with an abundance of students and the time assigned by the university because it limits them to give just a general class. In the other hand, it is not the professor’s fault but it is the university’s in general as to why most students are ignored. It is up on our time to go to the professor’s office hours just to have a conversation from person to person.People usually ask what they have to do in order to get to power while having the connections and influences and at the same time being a normal and ordinary person. For me, the answer or explanation to this question is due to my presence here at Florida Atlantic University because it is obtained through preparation, school work, and knowledge. For that reason, there is a famous phrase said by nearly everyone today that â€Å"knowledge is power†. Yet, through the knowledge that I gain, I have the ability and power to make my own decisions. Power in Shakespeare Power has significantly marked the society where we are in current development. Power is one of the best ways to control a society, yet it impacts the society in a negative way when it comes to distributing rights and opportunities. That is, since it involves the worst issues within the government known as corruption. In William Shakespeare’s play, Richard III, and Aristophanes’ play, Lysistrata, both authors employ the major role and concept of power.Both Shakespeare’s and Aristophanes’ approach to power has influenced the understanding of power and through their examples; one can employ their ideas as to why sometimes I feel powerless or powerful in my current life of a student. The views expressed by these authors are focused politically to power, which make people reflect on what power means; this involves attraction and subjugates provocation. The power is so great that it will always be seen negatively. With power one can organize groups but, there n eeds to be an authority.For example, like those with the political, economic, military or religious power. Yet, the problem comes when the abuse of power arises and when having too much power, the mind can be corrupted. It is necessary that one should have a good posture when power comes into hand and one should see it as something to improve on rather than to enhance on the small things that one does not need. Power should be seen as the ability to control to do the right thing and for that reason, be able to accomplish positive changes for the rest of the community.As a student, one has the ability to have power or not to have power either by sitting in a regular classroom or being at the university in general. At the university, there are laws, rules and authority that needs to be followed and for that reason a student could sometimes feel powerless. For instance, there is a rule at FAU that a student can’t be absent from a class for a certain amount of days. The student i s able to feel powerful because he or she has the ability to not go to class.Yet, once he or she reaches or passes the amount of days, the student will be automatically dropped out and in addition will receive a penalty for it. So a student can feel powerless because it has no other choice but to go to the class just so he or she wouldn’t get penalized. In other words, one could explain how different styles of power could have similar characteristics through the norms and rules that exist today. For example, the power exerted from a government of any country must be abided by the people who inhabit it through compliance ith the same laws and standards. Also, the student of any university must also follow the same rules and laws established by the university. As you can see, this example represents a power running scheme of a major and minor scale, but with a similar goal, which is how to maintain order where there is always power. The penalty is always the consequence, that i s, if you decide to take too much power into your own hands. If one has power, he or she should be able to manipulate it well enough to not let it go into the wrong hands.Similarly in Richard III, Shakespeare employs Hastings as a lord with honor who always remains loyal and trustworthy to the family. But when he gives all his trust and all his power to Richard, Richard ends up killing him. With power comes a consequence, and coinciding to this idea, that is why with power, corruption always occur. To that reason, a student will feel powerless because he or she has no other choice but to attend class. In order to be able to advance and be successful in class, you have to depend on your surroundings rather than self-advancement.One should be able to find peers and ask them what they did the whole class. Also, one is able to get the notes and basically get everything of what the teacher did without being in class. This being said, a student will feel powerful only if they have their s urroundings by the palm of their hand. If the student is going to use his or her power, it will need to depend on its surroundings in order to be able to get the power that he or she wants. As said by Shakespeare, â€Å"Which done, God take King Edward to his mercy, and leave the world for me to bustle in, for then I’ll marry Warwick’s youngest daughter† (5).At school, one cannot depend on himself or herself, but on the teacher and on the peers. In Shakespeare view, he is showing how Richard views his power and Richard needs his surroundings and his superiority in order to get to King Edward’s throne. As for Aristophanes, Lysistrata would have never been able to succeed if she did not have the help of the other women. Her use of manipulation helped her gain power and she was able to take back her man and bring peace to the city. In addition, manipulating is being able to handle, control, or use someone or something cleverly and skillfully for one's own ad vantage.A student can exercise the power to manipulate other students not to follow the rules or establish academic programs. Students who do not have responsibility and honesty are able to induce other students not to follow their school schedule, for example the student’s class attendance. The student’s friends will tell them to not attend class, go to the beach, or miss class just to miss it. And likewise, they are able to decrease the academic level in their classes because they assume no responsibility and maturity with the commitment to remain in a serious institution such as a university.These students still depend on their parents and since they know their parents will pay everything for them, they get low self-esteem and they won’t be able to value themselves and appreciate what they have. For this reason, they are people who have no responsibility and have no commitment when it comes to effort and it will be reflected once they attend the university. T herefore, that is why they influence other students to do the same. Aristophanes explains how the women were able to manipulate the power and strength of their husbands and warriors, exerting some manipulation of their womanhood and wife.Similarly, Shakespeare speaks of Elizabeth’s power over King Edward. By then, Richard is seeing the king as being weak and being handled by women. â€Å"Why, this it is, when men are ruled by women; my Lady Grey his wife, Clarence, ‘tis she that tempers him to this extremity† (Shakespeare 3). Comparing the previous texts, a student to a certain extent, can manipulate by being able to respect and enforce the university rights. For example, receiving an academic background in the area specified and chosen by the student and freely expressing its ideas and not being able to get punished because of them.This is why universities should take responsibility to train professionals and specialists in various areas of knowledge, as well as the formation of authentic citizens with moral and ethical responsibilities committed to the social reality around them. In Lysistrata, the women had a hard time being heard by the town and similarly, I have that same problem with my life as a college student. Just as the commissioner said in Lysistrata, â€Å"you expect me to take orders from a woman. I’d die first† (Aristophanes 91).The men during that era did not take the women into consideration and they were never taken into account. They were always ignored and predominated the power of men. Aristophanes portrayed the women into another new level by giving them the importance that they needed. Although they were only valued as a house wife, Aristophanes took into consideration how important sex is in the life of men, and gave power to the women using their ingenuity. Due to the fact that FAU has a great amount of tudents not only in the school in general but in the classes as well, the professors cannot provide a personalized education for each student. For that reason, that is why students sometimes feel ignored. It is very complicated for a professor to dictate a class with an abundance of students and the time assigned by the university because it limits them to give just a general class. In the other hand, it is not the professor’s fault but it is the university’s in general as to why most students are ignored. It is up on our time to go to the professor’s office hours just to have a conversation from person to person.People usually ask what they have to do in order to get to power while having the connections and influences and at the same time being a normal and ordinary person. For me, the answer or explanation to this question is due to my presence here at Florida Atlantic University because it is obtained through preparation, school work, and knowledge. For that reason, there is a famous phrase said by nearly everyone today that â€Å"knowledge is power†. Yet, through the knowledge that I gain, I have the ability and power to make my own decisions.

Hasbro in Brazil

With 41. 9% of Hasbro sales revenue being generated internationally, it is essential that they work to maintain positive relationships with countries throughout the world. The international arena is becoming increasingly important to their revenues. Brazil is one of several international markets that Hasbro has expanded into over the last 5 – 10 years. Not only are they shipping products to Brazil, but in around 2007 they also opened an office in Brazil.Even with this being the case, Brazil has taken governmental measures to promote and strengthen the national traditional toys and games industry and stimulate further local production. In 2010, Brazil approved the reduction of import taxes from 20% to 2% on components to produce traditional toys and games such as electronic mechanisms and later the government increased import taxes on manufactured products from 20% to 35% to inhibit further imports, mainly from China (Toys and Games in Brazil, 2011). In a bid to remain competit ive and increase market share, seven large domestic companies considered the possibility of merging to form the largest toys and game manufacturer in Brazil. While the project is still under consideration despite the challenges involved merging seven companies, three other companies, Baby Brink, Rosita and Acalanto, merged in April 2010 to create the group BBRA† (Toys and Games in Brazil, 2011). With measures such as these in place, it causes a disfavor to companies such as Hasbro.It requires them has to work twice as hard to gain acceptance in a country that is promoting growth for their national companies. Hasbro identified one opportunity for the locals of Brazil to view them in a light other than one of an â€Å"outsider. † In 2011, Hasbro partnered with Operation Smile Create Smiles to provide free medical treatment and toys and games for children born with cleft palate. â€Å"The medical mission in Brazil was made possible because of Hasbro. Our patients and fami lies in Brazil are incredibly warm and vibrant, and yet the laughter and smiles of these children were hidden behind their clefts.Today, their futures are full of hope and opportunity, and they will always remember that Hasbro helped make that happen†, said Dr. Bill Magee, Co-Founder and Executive Chairman of Operation Smile (Kraft, Jessica, 2011). By taking steps to increase their social responsibility in Brazil, Hasbro is promoting themselves in a way that will allow them to gain an increased acceptance rating and hopefully, not only make 100 children’s smiles brighter but also their bottom line.

Rogerian Argument for Video Games - Free Essay Example

Sample details Pages: 4 Words: 1249 Downloads: 9 Date added: 2019/02/20 Category Society Essay Level High school Tags: Rogerian Argument Essay Did you like this example? Over the last few years, there have many advances in technology, and video games have become a staple as far as entertainment for children and adults alike. There are many studies that show that the average age range for â€Å"gamers† is eight years old to forty (ESRB). As each year passes, the technology that makes video game possible grows and expands. Don’t waste time! Our writers will create an original "Rogerian Argument for Video Games" essay for you Create order The technology that also creates the graphics or the videos games grows and advances as well. This has made the realism of the video games extraordinary. This realism has caused the video game line of business to become a multibillion dollar enterprise. While all the technological advancements have catapulted the video game industry, there are some negative effects that have come along with this jump in video game sales and usage in our society. Violent video games, and other video games labeled â€Å"mature†, do bring some issue to the table. When first introduced, there was much controversy over the possibility of these violent video games producing violent behaviors in their users. This is still a large debate even today. Video games have the potential to develop coordination, creativity, and even increase motor skills. When did video games break onto the scene? Back in the late 1940’s the first â€Å"video† game was introduced. Basically, it was a missile stimulator and its name was Cathode Ray Tube. The Cathode Ray Tube utilized WWII radar displays. Since its release, video games have grown and advanced to become more life-like, worldly, and refines. Nowadays, video games involve in-depth and sophisticated story lines. These tory-lines help players escape their average, everyday life. A great deal of violent video games are well known around the globe. These titles include: Call of Duty, Halo, and Grand Theft Auto, just to name a few. The characters of these games are also well known. Today, video games have found their way into everyday life and are even topic on popular family game shows and even in sports. The video game industry has a tremendous influence on the young people of today. With all the technological advances of late, gamer can actually feel like they are in the game. There is an issue that comes along with these technological advances and that that the player may want and try to act out what they see or what they do in the game. There have been studies in the past that have focused on mental health problems such as depression, as well as aggression. In these studies, the participants were mainly preadolescent. One specific study collected data from approximately 5,146 fifth grade students, as well as their caregivers. The study discovered that those students which reported that they played high violence video games for less than two hours each day had a much higher rate of depressive symptoms than those students who reported playing low or non-violence video games less than two hours each day (Tortolero). This study also found that, not only was depression a major issue for the players of violent games, but aggression was a major issue as well. Violent video games raise aggression and lower pro-social outcomes, while pro-social video game have the exact opposite effect (Greitemeyer). A great deal of parents do not seem to believe that violent video games have a negative effect on their children. A large number of parents discount the fact that is actually a ESRB rating for each video game. This rating is a guideline for what ages should play that specific video game. Violent video games are generally rated â€Å"M† for mature. The counter argument to this is that many people say that violent games actually relieve stress. A study of students from New York revealed that the students said that is they are under stress, for example picked on at school and bullied, when they play a violent video game it actually relieves and decreases their stress levels. Another counterargument is that video games can also help motor skills, decision making, and even hand-eye coordination. This counterargument especially applies to violent video games because of the skill required to shoot and follow a target, etc. It is also said that just a few short rounds of a first per son shooting game will develop an individual; reaction times. While violent games do aid in the development of certain skills, the game does not need to be violent to develop these same skills. Many non-violent video games help with developing these same skills. The crucial factor is that parents need to learn the ESRB rating system and implement that system with their child. This rating system has been put into action to protect young children from game that are beyond their years. The ESRB rating system is as follows: â€Å"C† – early childhood, â€Å"E† – everyone, â€Å"E10+† – everyone over 10, â€Å"T† – teenager 13 years and up, â€Å"M† for mature which is 17 years old and up, and finally â€Å"A† – adults age 18 and over. This system helps parents and caregivers to pick out age appropriate game for their children. The expanding technology has also made it a great deal easier for parents to provide age appropriate video games for their children. Over the years, some people have suggested putting laws into place to govern these video games. Many people believe, without a shadow of a doubt, that these violent video game are causing pre-teens and teenagers alike to be violent and act out violent behaviors. Laws do not need to be put into place, this rating system allows a way of governing video games. It is the parents who need to take responsibility for their children, for what their children play, and for their children’s actions. Children have an ever growing and every developing mind. These young, developing minds absorb and soak in everything that they see and hear. Parents, and caregivers alike, should be aware of what games they are buying for their children and of the games others are buying for their children. They need to make absolutely sure thee video games fall within the correct ERB rating for their child’s age. The rating system is a good one, and one that is effective; however, there should be more information about this rating system made readily available to parents so they can completely understand the ins and outs of it and to make sure that they are aware of the rating system. With all the technological advances, and the many more to come in the future, as well as with the human races dependence upon technology there is no doubt that video games are going to be a continuing staple in our lives and in our children’s lives. With that being said, more people need to be educated a to the negatives of these games and the consequences for not following the ESRB rating system. Works Cited Tortolero, Susan R., et al. Daily Violent Video Game Playing and Depression in Preadolescent Youth. Cyberpsychology, Behavior Social Networking 17.9 (2014): 609-615.Business Source Complete. Web. 18 Oct. 2014. Greitemeyer, Tobias, and Dirk O. Mà ¼gge. Video Games Do Affect Social Outcomes: A Meta-Analytic Review Of The Effects Of Violent And Prosocial Video Game Play.Personality Social Psychology Bulletin 40.5 (2014): 578-589. Education Research Complete. Web. 18 Oct. 2014. Kids call video games a stress reliever. New York Amsterdam News 05 June 2003: 20. Academic Search Premier. Web. 18 Oct. 2014. VIOLENT Video Games Make KIDS SMARTER – More Violent the BETTER. †¢ The Register. N.p., n.d. Web. 19 Oct. 2014 ESRB Ratings Guide. Rating Categories, Content Descriptors, and Interactive Elements from ESRB. N.p., n.d. Web. 18 Oct. 2014.