Dokumen tersebut merupakan contoh format pengkajian resep obat di puskesmas yang mencakup persyaratan administrasi, farmasi, dan klinis. Persyaratan administrasi meliputi identitas pasien dan dokter. Persyaratan farmasi meliputi nama obat, dosis, cara pemakaian. Persyaratan klinis meliputi indikasi, mekanisme kerja, efek samping obat. Dokumen ini digunakan untuk menilai kesesuaian resep obat berdasarkan literatur.
Hepatitis C virus infection is associated with many renal diseases. Renal disease caused by :•Virus itself •Drugs used for treatment of hepatitis c •Associated condition with hepatitis → advanced liver cell failure.
Inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract. While they share some characteristics, they have distinct pathogenic mechanisms. Treatment involves medications to reduce inflammation like 5-ASA agents, glucocorticoids, immunosuppressants, and anti-TNF therapy. Each drug has its own mechanisms of action, dosing regimens, and potential side effects. Managing IBD requires considering the individual patient's disease severity and response to treatment.
Dokumen tersebut merupakan contoh format pengkajian resep obat di puskesmas yang mencakup persyaratan administrasi, farmasi, dan klinis. Persyaratan administrasi meliputi identitas pasien dan dokter. Persyaratan farmasi meliputi nama obat, dosis, cara pemakaian. Persyaratan klinis meliputi indikasi, mekanisme kerja, efek samping obat. Dokumen ini digunakan untuk menilai kesesuaian resep obat berdasarkan literatur.
Hepatitis C virus infection is associated with many renal diseases. Renal disease caused by :•Virus itself •Drugs used for treatment of hepatitis c •Associated condition with hepatitis → advanced liver cell failure.
Inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract. While they share some characteristics, they have distinct pathogenic mechanisms. Treatment involves medications to reduce inflammation like 5-ASA agents, glucocorticoids, immunosuppressants, and anti-TNF therapy. Each drug has its own mechanisms of action, dosing regimens, and potential side effects. Managing IBD requires considering the individual patient's disease severity and response to treatment.
This document is the fifth edition of the WHO laboratory manual for the examination and processing of human semen. It provides standardized procedures for semen analysis, including sample collection and handling, initial macroscopic and microscopic examination, assessment of sperm motility, vitality, concentration and morphology. It also describes optional procedures such as sperm preparation techniques, cryopreservation, quality assurance measures, and research methods. The manual aims to promote quality and uniformity in semen testing across laboratories worldwide.
O documento explica as diferenças entre raio, relâmpago e trovão, e descreve outros tipos de raios como raio bola e raio esférico. Também fornece dicas para prever raios e destaca a importância dos raios para o desenvolvimento das plantas devido ao nitrogênio contido neles.
Steroid Sparing Regimens in Kidney TransplantationAbdullah Ansari
Mechanisms of action of steroids
Rationale for steroids minimization
Steroid minimization strategies
Very low maintenance dosages
Complete withdrawal early after transplantation (three to six months post-surgery)
Complete withdrawal later after transplantation (six months to one year post-surgery)
Steroid free maintenance, after rapid withdrawal within a week
Complete avoidance
This document is the fifth edition of the WHO laboratory manual for the examination and processing of human semen. It provides standardized procedures for semen analysis, including sample collection and handling, initial macroscopic and microscopic examination, assessment of sperm motility, vitality, concentration and morphology. It also describes optional procedures such as sperm preparation techniques, cryopreservation, quality assurance measures, and research methods. The manual aims to promote quality and uniformity in semen testing across laboratories worldwide.
O documento explica as diferenças entre raio, relâmpago e trovão, e descreve outros tipos de raios como raio bola e raio esférico. Também fornece dicas para prever raios e destaca a importância dos raios para o desenvolvimento das plantas devido ao nitrogênio contido neles.
Steroid Sparing Regimens in Kidney TransplantationAbdullah Ansari
Mechanisms of action of steroids
Rationale for steroids minimization
Steroid minimization strategies
Very low maintenance dosages
Complete withdrawal early after transplantation (three to six months post-surgery)
Complete withdrawal later after transplantation (six months to one year post-surgery)
Steroid free maintenance, after rapid withdrawal within a week
Complete avoidance
2. Dolzarbligi
Ayiruv tizimi tuberkulyozi ushbu kasallikning barcha
ekstrapulmonar shakllari tarkibida birinchi o'rinni egallaydi.
Bu asosan yosh, mehnatga layoqatli yoshdagi odamlarda
uchraydi, ammo so'nggi yillarda 20 yoshgacha bo'lgan
bemorlar sonining sezilarli darajada kamayishi va 50
yoshdan oshgan bemorlarning ko'payishi kuzatilmoqda.
Ko'pgina vrachlar ikkala jins vakillari orasida siydik sil
kasalligining bir xil chastotasini ta'kidlaydilar.
Siydik-Ayiruv tizimining organlaridan buyraklar ko'pincha
zararlanadi, kamroq hollarda siydik yo'llari va siydik pufagi.
3. Bu spesifik mikroorganizm (Mycobacterium
tuberculosis) tomonidan kelib chiqqan buyrak
to'qimalarining infeksion zararlanishi.
Odatda, buyrak tuberkulyozi 3-10 yil
birlamchi sil kasalligidan keyin rivojlangan
o'pka yoki suyak tuberkulyozi bilan
og'rigan bemorlarda ikkilamchi holatda
uchraydi.
1.Buyrak sili
4. Классификация
Buyraklar parenximasining sil kasalligi
1-bosqich, nodestruktiv shakl, po’stloq va medullar zonasida bir nechta
kichik yallig'lanish o'choqlari mavjudligi bilan tavsiflanadi va faqat
konservativ davo qilinadi.
Очаг специфического туберкулезного воспаления
5. Tuberkulyoz papillit
2-bosqich, cheklangan-destruktiv shakl, unda patologik jarayon
papillaga tarqaladi. Konservativ davolanadi, asoratlar bo'lsa jarrohlik
usulida davolanadi.
Рис. 6. Экскреторная урограмма.
Туберкулезный папиллит верхней чашечки правой
почки.
Рис.7. Экскреторная урограмма правой почки.
Туберкулезный папиллит.
6. Kavernoz nefrotuberkulyoz
3-bosqich, destruktiv shakl
Рис.9. Каверна в среднем
сегменте левой почки
Рис.8. Операционный препарат
верхнего сегмента правой почки на
разрезе при кавернозном туберкулезе
почки: видны крупные каверны
(указаны стрелкой), заполненные
казеозно-гнойными массами.
7. Рис.11. Правосторонняя
ретроградная пиелограмма при
кавернозном туберкулезе правой
почки: в верхнем сегменте почки
видны заполненные
рентгеноконтрастным веществом
каверны (1), шейка верхней
почечной чашки сужена (2),
почечная лоханка деформирована и
расширена (3).
8. Polikavernoz nefrotuberkulyoz
4-bosqich, keng tarqalgan destruktiv shakl- organ funktsiyasining keskin
pasayishiga olib keladigan bir nechta kavernalar mavjudligini ko'rsatadi.
Рис.12.Поликавернозный
нефротуберкулез.
Nefrotuberkulyozning asoratlari:
SBY
AG
Buyrak bo'shlig'ining perirenal bo'shliqqa kirib borishi, bu bel mintaqada oqma paydo
bo'lishiga olib keladi.
9. 2. Siydik chiqarish yo'llarining sil kasalligi
Bu shish, yara,
chandiqlanish, infiltratsiya
bilan kechuvchi kosacha
jom tizimi, yuqori va
pastki siydik yo’llarining
M.tuberculosis va M.bovis
tomonidan
qo’zg’atiladigan infeksion-
allergik yallig’lanishi.
10. Siydik nayi sili
Pastki uchdan birida rivojlanadi, vesikouretral
og’izchasiga ta'sir qiladi. Siydik nayining ko'plab
zararlanishlari ham kuzatilishi mumkin, bu esa
strikturalarning rivojlanishiga va buyrakning tez
o'limiga olib keladi.
Siydik pufagi tuberkulyozi 4 bosqichga bo'linadi:
1.tuberkulyar-infiltrativ
2. eroziv va yarali
3.spastik sistit (qovuqning giperaktivligi)
4.qovuqning haqiqiy bujmayishlari - to'liq
obliteratsiyaga qadar.
11. Patogenez
MBT ning buyraklarning kortikal qatlamiga kirib borishi
Tuberkulyoz granulomaning shakllanishi
(buyrak parenximasining sil kasalligi)
Jarayonning medulla va papillalarga tarqalishi (silli
papillit)
Jomga ochiladigan bo'shliqning shakllanishi
(buyrakning kavernoz tuberkulyozi)
Sil do’mboqchalari va yangi chirish bo'shliqlarining
shakllanishi (silli pielonefroz)
Jarayonning tarqalishi - urodinamikaning buzilishi
(“O’chgan buyrak")
12. KLINIKA
Dastlabki bosqichlarda buyrak tuberkulyozi
yashirin ko’rinishga ega bo'lishi mumkin yoki
umumiy holatning buzilishi bilan tavsiflanadi:
yengil buzuqlik, charchoq, past darajadagi isitma
va progressiv vazn yo'qotish.
Buyraklardagi destruktiv o'zgarishlar og'riqsiz
umumiy gematuriya bilan birga keladi. Qon ketishi
piyelit yoki pyelonefrit rivojlanishini ko'rsatadi,
ko'pincha pyuriya bilan almashinadi.
Og'riq hissi tabiatan to’mtoq, ammo siydikning
chiqishi buzilishi bilan ular buyrak kolikasiga
o'tishi mumkin.
13. Asosiy diagnostika nuqtalari:
Epid. Anamnez: : sil infektsiyasi bilan aloqa qilish, turli
lokalizatsiyadagi oldingi yoki hozirgi sil kasalligi,
giperergik tuberkulin testlari bo'lgan bolalarning oilasida
mavjudligi.
Tibbiy anamnez: Jinsiy ayiruv tizimining uzoq muddatli
infektsiyasi, standart terapiyaga chidamli, tez-tez
retsedivlar bilan; pielonefrit bilan og'rigan bemorda
doimiy dizuriya, siydik pufagi hajmining progressiv
pasayishi, tosh bo'lmaganda buyrak sanchig'i,
gematuriya.
Jismoniy tekshiruv: har qanday lokalizatsiyada
oqmalar.
14. Qon analiz deyarli ma'lumotga ega emas. Siydikdagi
o'zgarishlar o'ziga xos xususiyatlarga ega
nefrotuberkulyoz bilan: siydikning kislotali
reaktsiyasi xarakterlidir - pH = 5,0-5,5, piuriya tez-
tez uchraydi (50% hollarda), leykotsituriya,
proteinuriya, eritrotsituriya
Bakteriologik tekshiruv
1.Бактериоскопия:
•yorug'lik (Ziehl-Neelsen bo'yicha rang
berish);
•lyuminestsent;
•2.Бак. посев (oziqlantiruvchi muhit Anikin,
Finn-2, Levenshtein-Yensen)
Laboratoriya tekshiruvi
15. Patologik tadqiqot
1. Van Gison bo'yicha gematoksilin-eozin bilan
to'qimalarni bo'yashda jarrohlik va biopsiya
materialini patomorfologik o'rganish;
2. Sil-Nilsen bo'yicha to'qimalarni bo'yash bilan
jarrohlik va biopsiya materialini patomorfologik
o'rganish.;
3. To'qimalarni immunogistokimyoviy o'rganish
16. Nur tadqiqotlari
Buyrak tuberkulyozini tashxislashda rentgen diagnostikasi muhim
rol o'ynaydi. Tadqiqot, qoida tariqasida, buyraklar va siydik
pufagining rentgenografiyasi bilan boshlanadi.
Obzor rentgenografiyadan keyin ekskretor urografiya qilinadi.
Silni aniqlash uchun angiografiya, radioizotop va ultratovush
tadqiqot usullari ham qo'llaniladi.
18. Patogenetik davolash
Kortikosteroid gormonlar keng qo'llaniladi, yallig'lanishga qarshi
, desensibilizatsiya qiluvchi ta'sir qilish va kollagen hosil bo'lishini
sekinlashtirish (fibrozni oldini olish ) hususiyati bor.
Siydik yo’llari disfunktsiyasi bo'lsa, unda rezorbsiya va reparatsiya
jarayonlarni rag'batlantiradigan
, shuningdek, to'qima tuzilmalarining mikrosirkulyatsiyasi
va o'tkazuvchanligi yaxshilaydigan dori vositalaridan foydalanish
tavsiyalanadi :
Aloe ekstrakti, lidaza, ronidaza, gialuronidaza, natriy
tiosulfat, shuningdek, fizioterapiya.
Spastik siydik bilansiydik pufagi organning trofizmini yaxshilash,
siydik imperativ chiqarishni bostirishga alfa retseptorlari blokatorlari
va antixolinergiklar ishlatiladi.
19. Jarrohlik bilan davolash
Siydikning chiqishi buzilganda
buyrak siydik nayini stentlash yoki
nefrostomiyani talab qiladi.
Buyrakda mahalliy destruktiv
jarayon rivojlangan taqdirda
konservativ terapiya zararlangan
segmentni sanatsiya qilish
(kavernotomiya) yoki buyrakning
qisman rezektsiyasi
(kavernektomiya) bilan to'ldiriladi.
Organni butunlay destruksiyasida
nefrektomiya ko'rsatma
hisoblanadi.
20. Xulosa
Buyraklar va siydik yo'llarining sil
kasalligi silning ekstrapulmonar
shakllari orasida birinchi o'rinda turadi.
Prognoz kasallikning bosqichiga
bog'liq. Buyrak parenximasining sil
kasalligi va tuberkulyoz papillit bilan
konservativ terapiya to'liq davolanishga
olib kelishi mumkin. O'z vaqtida
bajarilgan organlarni saqlovchi
aralashuvlar (rezeksiyalar,
kavernotomiyalar, kavernektomiyalar)
dan keyin ham prognoz juda “yoqimli”,
(agar bu vaqtga qadar siydik yo'llarida
siydikning buyrakdan chiqishiga
to'sqinlik qiladigan chandiqli-sklerotik
o'zgarishlar rivojlanmagan bo’lsa).