The document discusses the benefits of exercise for mental health. It states that regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help boost feelings of calmness and happiness.
15-pathology of hemodynamicsHEMODYNAMIC DISORDERS.pptLearta Asani
Edema is excess fluid accumulation in interstitial spaces that can occur systemically or locally. It is caused by increased hydrostatic pressure, reduced plasma oncotic pressure, sodium retention, or lymphatic obstruction. Generalized edema with profound swelling is called anasarca. Thrombosis is the formation of a clot (thrombus) within a blood vessel. It results from an interaction of platelets, damaged endothelial cells, and activation of the coagulation cascade. The major influences predisposing to thrombosis are endothelial injury, blood stasis, and hypercoagulability.
Neonatal Jaundice Clinical Case by Slidesgo.pptxLearta Asani
This document appears to be a presentation template about neonatal jaundice. It includes sections on:
- Contents and introduction slides
- Identifying patient information
- Patient medical history
- Physical examination findings
- Discussion of findings
- Diagnosis of jaundice
- Treatment of phototherapy
- Monitoring the patient's progress
- Contraindications and indications for treatment
- Post-treatment outcomes
Pathology is the study of diseases and involves understanding the etiology or causes of diseases as well as the pathogenesis or development of diseases. It is related to other medical disciplines involving the study of anatomy, histology, microbiology, and laboratory medicine. The majority of a pathologist's workload involves examining biopsy specimens microscopically to make diagnoses that are important for guiding patient treatment. Specimens examined can include fluids, endoscopic samples, needle biopsies, surgical excisions, and entire organs obtained from surgical procedures. Understanding normal anatomy, histology, embryology, and physiology is essential for pathology education prior to examining actual specimens.
general pathology environmental pathology pptLearta Asani
This document discusses various types of environmental pathology including environmental pollution, injury from chemical and physical agents, and nutritional diseases. It provides examples of different types of environmental pollution like air pollution and tobacco smoke. It also examines several occupational lung diseases that can result from inhalation of mineral or organic dusts like coal workers' pneumoconiosis, silicosis, asbestosis, and berylliosis. Injury from chemical agents includes discussion of adverse reactions to therapeutic drugs as well as toxicity from non-therapeutic toxic substances like lead, alcohol, and carbon monoxide. Injury from physical agents includes mechanical trauma.
This PowerPoint template offers a stylish and affordable presentation to help promote a business. The template contains 5 placeholder slides for custom content along with instructions for adding text to the title slide. A thank you slide concludes the template.
This PowerPoint template offers a stylish presentation to help promote a business. The template includes sections for inserting text on title slides and content slides numbered 1 through 5. It concludes with a thank you slide. The template is designed to be customizable with the user's own text and content.
The document discusses the benefits of exercise for mental health. It states that regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help boost feelings of calmness and happiness.
15-pathology of hemodynamicsHEMODYNAMIC DISORDERS.pptLearta Asani
Edema is excess fluid accumulation in interstitial spaces that can occur systemically or locally. It is caused by increased hydrostatic pressure, reduced plasma oncotic pressure, sodium retention, or lymphatic obstruction. Generalized edema with profound swelling is called anasarca. Thrombosis is the formation of a clot (thrombus) within a blood vessel. It results from an interaction of platelets, damaged endothelial cells, and activation of the coagulation cascade. The major influences predisposing to thrombosis are endothelial injury, blood stasis, and hypercoagulability.
Neonatal Jaundice Clinical Case by Slidesgo.pptxLearta Asani
This document appears to be a presentation template about neonatal jaundice. It includes sections on:
- Contents and introduction slides
- Identifying patient information
- Patient medical history
- Physical examination findings
- Discussion of findings
- Diagnosis of jaundice
- Treatment of phototherapy
- Monitoring the patient's progress
- Contraindications and indications for treatment
- Post-treatment outcomes
Pathology is the study of diseases and involves understanding the etiology or causes of diseases as well as the pathogenesis or development of diseases. It is related to other medical disciplines involving the study of anatomy, histology, microbiology, and laboratory medicine. The majority of a pathologist's workload involves examining biopsy specimens microscopically to make diagnoses that are important for guiding patient treatment. Specimens examined can include fluids, endoscopic samples, needle biopsies, surgical excisions, and entire organs obtained from surgical procedures. Understanding normal anatomy, histology, embryology, and physiology is essential for pathology education prior to examining actual specimens.
general pathology environmental pathology pptLearta Asani
This document discusses various types of environmental pathology including environmental pollution, injury from chemical and physical agents, and nutritional diseases. It provides examples of different types of environmental pollution like air pollution and tobacco smoke. It also examines several occupational lung diseases that can result from inhalation of mineral or organic dusts like coal workers' pneumoconiosis, silicosis, asbestosis, and berylliosis. Injury from chemical agents includes discussion of adverse reactions to therapeutic drugs as well as toxicity from non-therapeutic toxic substances like lead, alcohol, and carbon monoxide. Injury from physical agents includes mechanical trauma.
This PowerPoint template offers a stylish and affordable presentation to help promote a business. The template contains 5 placeholder slides for custom content along with instructions for adding text to the title slide. A thank you slide concludes the template.
This PowerPoint template offers a stylish presentation to help promote a business. The template includes sections for inserting text on title slides and content slides numbered 1 through 5. It concludes with a thank you slide. The template is designed to be customizable with the user's own text and content.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
Creative operations teams expect increased AI use in 2024. Currently, over half of tasks are not AI-enabled, but this is expected to decrease in the coming year. ChatGPT is the most popular AI tool currently. Business leaders are more actively exploring AI benefits than individual contributors. Most respondents do not believe AI will impact workforce size in 2024. However, some inhibitions still exist around AI accuracy and lack of understanding. Creatives primarily want to use AI to save time on mundane tasks and boost productivity.
Organizational culture includes values, norms, systems, symbols, language, assumptions, beliefs, and habits that influence employee behaviors and how people interpret those behaviors. It is important because culture can help or hinder a company's success. Some key aspects of Netflix's culture that help it achieve results include hiring smartly so every position has stars, focusing on attitude over just aptitude, and having a strict policy against peacocks, whiners, and jerks.
PEPSICO Presentation to CAGNY Conference Feb 2024Neil Kimberley
PepsiCo provided a safe harbor statement noting that any forward-looking statements are based on currently available information and are subject to risks and uncertainties. It also provided information on non-GAAP measures and directing readers to its website for disclosure and reconciliation. The document then discussed PepsiCo's business overview, including that it is a global beverage and convenient food company with iconic brands, $91 billion in net revenue in 2023, and nearly $14 billion in core operating profit. It operates through a divisional structure with a focus on local consumers.
Content Methodology: A Best Practices Report (Webinar)contently
This document provides an overview of content methodology best practices. It defines content methodology as establishing objectives, KPIs, and a culture of continuous learning and iteration. An effective methodology focuses on connecting with audiences, creating optimal content, and optimizing processes. It also discusses why a methodology is needed due to the competitive landscape, proliferation of channels, and opportunities for improvement. Components of an effective methodology include defining objectives and KPIs, audience analysis, identifying opportunities, and evaluating resources. The document concludes with recommendations around creating a content plan, testing and optimizing content over 90 days.
How to Prepare For a Successful Job Search for 2024Albert Qian
The document provides guidance on preparing a job search for 2024. It discusses the state of the job market, focusing on growth in AI and healthcare but also continued layoffs. It recommends figuring out what you want to do by researching interests and skills, then conducting informational interviews. The job search should involve building a personal brand on LinkedIn, actively applying to jobs, tailoring resumes and interviews, maintaining job hunting as a habit, and continuing self-improvement. Once hired, the document advises setting new goals and keeping skills and networking active in case of future opportunities.
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
The document provides career advice for getting into the tech field, including:
- Doing projects and internships in college to build a portfolio.
- Learning about different roles and technologies through industry research.
- Contributing to open source projects to build experience and network.
- Developing a personal brand through a website and social media presence.
- Networking through events, communities, and finding a mentor.
- Practicing interviews through mock interviews and whiteboarding coding questions.
Google's Just Not That Into You: Understanding Core Updates & Search IntentLily Ray
1. Core updates from Google periodically change how its algorithms assess and rank websites and pages. This can impact rankings through shifts in user intent, site quality issues being caught up to, world events influencing queries, and overhauls to search like the E-A-T framework.
2. There are many possible user intents beyond just transactional, navigational and informational. Identifying intent shifts is important during core updates. Sites may need to optimize for new intents through different content types and sections.
3. Responding effectively to core updates requires analyzing "before and after" data to understand changes, identifying new intents or page types, and ensuring content matches appropriate intents across video, images, knowledge graphs and more.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
Creative operations teams expect increased AI use in 2024. Currently, over half of tasks are not AI-enabled, but this is expected to decrease in the coming year. ChatGPT is the most popular AI tool currently. Business leaders are more actively exploring AI benefits than individual contributors. Most respondents do not believe AI will impact workforce size in 2024. However, some inhibitions still exist around AI accuracy and lack of understanding. Creatives primarily want to use AI to save time on mundane tasks and boost productivity.
Organizational culture includes values, norms, systems, symbols, language, assumptions, beliefs, and habits that influence employee behaviors and how people interpret those behaviors. It is important because culture can help or hinder a company's success. Some key aspects of Netflix's culture that help it achieve results include hiring smartly so every position has stars, focusing on attitude over just aptitude, and having a strict policy against peacocks, whiners, and jerks.
PEPSICO Presentation to CAGNY Conference Feb 2024Neil Kimberley
PepsiCo provided a safe harbor statement noting that any forward-looking statements are based on currently available information and are subject to risks and uncertainties. It also provided information on non-GAAP measures and directing readers to its website for disclosure and reconciliation. The document then discussed PepsiCo's business overview, including that it is a global beverage and convenient food company with iconic brands, $91 billion in net revenue in 2023, and nearly $14 billion in core operating profit. It operates through a divisional structure with a focus on local consumers.
Content Methodology: A Best Practices Report (Webinar)contently
This document provides an overview of content methodology best practices. It defines content methodology as establishing objectives, KPIs, and a culture of continuous learning and iteration. An effective methodology focuses on connecting with audiences, creating optimal content, and optimizing processes. It also discusses why a methodology is needed due to the competitive landscape, proliferation of channels, and opportunities for improvement. Components of an effective methodology include defining objectives and KPIs, audience analysis, identifying opportunities, and evaluating resources. The document concludes with recommendations around creating a content plan, testing and optimizing content over 90 days.
How to Prepare For a Successful Job Search for 2024Albert Qian
The document provides guidance on preparing a job search for 2024. It discusses the state of the job market, focusing on growth in AI and healthcare but also continued layoffs. It recommends figuring out what you want to do by researching interests and skills, then conducting informational interviews. The job search should involve building a personal brand on LinkedIn, actively applying to jobs, tailoring resumes and interviews, maintaining job hunting as a habit, and continuing self-improvement. Once hired, the document advises setting new goals and keeping skills and networking active in case of future opportunities.
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
The document provides career advice for getting into the tech field, including:
- Doing projects and internships in college to build a portfolio.
- Learning about different roles and technologies through industry research.
- Contributing to open source projects to build experience and network.
- Developing a personal brand through a website and social media presence.
- Networking through events, communities, and finding a mentor.
- Practicing interviews through mock interviews and whiteboarding coding questions.
Google's Just Not That Into You: Understanding Core Updates & Search IntentLily Ray
1. Core updates from Google periodically change how its algorithms assess and rank websites and pages. This can impact rankings through shifts in user intent, site quality issues being caught up to, world events influencing queries, and overhauls to search like the E-A-T framework.
2. There are many possible user intents beyond just transactional, navigational and informational. Identifying intent shifts is important during core updates. Sites may need to optimize for new intents through different content types and sections.
3. Responding effectively to core updates requires analyzing "before and after" data to understand changes, identifying new intents or page types, and ensuring content matches appropriate intents across video, images, knowledge graphs and more.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
2. RAPIDNO PROGRESIVEN GLOMERULONEFRITIS
(GLOMERULONEFRITIS SO POLUMESECI - CRESCENTS)
• RPGN e klini~ki sindrom, a ne specifi~na forma na GN.
• Brz i progresiven gubitok na bubre `nata funkcija,so izrazena oligurija
i ako ne se lekuva so smrt od bubre`na slabost vo tek na nekolku nedeli
ili meseci.
• Histolo{kata slika se karakterizira so prisustvo na polumeseci vo
najgolemiot broj na glomeruli (glomerulonefritis so polumeseci).
• Patogeneza.RPGN mo`e da e primaren ili sekundaren.
• Glomerularnata povreda e imunolo{ki posreduvana.
• RPGN: tri grupi, vrz baza na imunolo{kite naodi. Vo sekoja grupa,
bolesta mo`e da e povrzana so druga poznata bolest ili da e idiopatska.
• Tip 1 RPGN - anti-GBM bolest;
• Linearni depoziti od IgG i C3 na GBM.
• Anti-GBM antitelata se vrzuvaat i za kapilarnata bazalna membrana na
belodrobnite alveoli, predizvikuvaj}i belodrobni krvarewa = sindrom
na Goodpsture, za razlika od t.n, idiopatski slu~ai, vo koi
zafa}aweto na bubrezite se javuva vo otsustvo na belodrobna bolest.
Anti-GBM antitelata se prisutni vo serumot i pomagaat vo
potvrduvawe na dijagnozata, a so plazmafereza se otstranuvaat
patogenite antitela od cirkulacijata.
3. RAPIDNO PROGRESIVEN GLOMERULONEFRITIS
(GLOMERULONEFRITIS SO POLUMESECI - CRESCENTS)
• Tip 2 RPGN -posreduvan so imuni kompleksi,kako
komplikacija na imuno kompleksni nefritisi, vklu~uvaj}i
DPGN, SLE, IgA nefropatija i HenochShonlein purpura.
Vo site slu~ai DIF poka`uva karakteristi~en granularen
tip na obojuvawe. Kaj ovie pacienti plazmafereza ne
pomaga, a epotrebna terapija na osnovnata bolest.
• Tip 3 RPGN, poznat kako pauci-imun tip na RPGN,
zaradi otsustvo na anti-GBM antitela ili imuni kompleksi
so DIF i EM. Pacienti imaat vo serumot antitela protiv
citoplazmata na neutrofilite (antineutrophil cytoplasm
antibodies - ANCA) koi imaat uloga pri vaskulitidi. Tip 3
RPGN e komponenta na sistemski vaskulitis: poliarteritis
nodoza ili Wegener-ova granulomatoza, ili pauci imuniot
RPGN e limitiran na bubregot i e nare~en idiopatski.
• Okolu 12% od pacientite imaat anti-GBM bolest so ili bez
zafa}awe na belodrobieto; 44% imaat tip 2 RPGN, 44%
imaat pauci imun tip 3 RPGN.
4. RAPIDNO PROGRESIVEN GLOMERULONEFRITIS
(GLOMERULONEFRITIS SO POLUMESECI - CRESCENTS)
• Morfologija. Golemi i bledi bubrezi, so petehijalni hemoragii. SM:
fokalna nekroza i tromboza, difuzna ili fokalna endotelna
proliferacija i mezangijalna proliferacija.
• Vo histolo{kata slika dominira sozdavaweto na raspoznatlivi
polumeseci (crescents). Polumesecite nastanuvaat so proliferacija na
parietalnite kletki i migracija monociti vo Bowmann-oviot prostor,
ponekoga{ so pove}ejadreni gigantski kletki. T kletki isto taka se
najdeni vo polumesecite. Se smeta deka vo pauci imuniot tip tie
igraat uloga vo regrutiraweto na makrofagi vo glomerulot.
Polumesecite obi~no go obliteriraat Bowmann-oviot prostor i gi
potiskaat glomerulite. Fibrinski lenti se natalo`eni megu sloevite na
kletki vo polumesecot.
• EM mo`e da poka`e vo nekoi slu~ai subepitelni , jasni rupturi na
GBM.
• So tek na vreme, polumesecite mo`e da poretrpat oluznuvawe.
• Klini~ki tek: nefriti~en sindrom,so oligurija i azotemija.
• Proteinurija, anurija sopotreba za dijaliza ili transplantacija.
Prognozata mo`e grubo da korelira so brojot na polumesecite.
• Plazmafereza
5. Ig A NEFROPATIJA (BERGER-OVA BOLEST)
• Deca i mladi vozrasni; so makroskopska hematurija
koja se javuva vo rok od 1 do 2 dena po nespecifi~na
infekcija na gorniot respiratoren trakt. Tipi~no
hematurijata trae nekolku denovi, a potoa se povlekuva,
za da odnovo se javi na sekoi nekolku meseci.
• Pridru`ena so slabinska bolka.
• Patogenen beleg e depozicija na IgA vo mezangiumot.
Berger-ovate bolest e lokalizirana varijanta na Henoch-
Sconlein-ovata purpura - sistemski sindrom koj ja
zafa}a ko`ata (purpuren isip), GIT (abdominalna
bolka), zglobovite (arthritis) i bubrezite.
• Patogeneza. povrzana so abnormalnosti vo
produkcijata i klirensot na IgA, koj e zgolemen kaj
30% od pacientite so Ig A nefropatija.
• Cirkulira~ki kompleki koi sodr`at Ig;
• Genetsko vlijanie - odredeni familii i kaj HLA
identi~ni bliznaci, zgolemenata frekvenca za
opredelena HLA i komplement fenotipovi vo nekoi
populacii.
• Naru{ena glikolizacijata na IgA, proces koj bi go
redeuciral klirensot na IgA od plazmata.
6. Ig A NEFROPATIJA (BERGER-OVA BOLEST)
• Prominentnata mezangijalna depozicija na IgA sugerira
fa}awe na IgA imuni kompleksi vo mezangiumot, a
otsustvoto na C1q i C4 vo glomerulite naso~uva kon
aktivacija na alternativniot pat na komplementot.
Zemeni zaedno, ovie naodi sugeriraat genetska ili
ste~ena abnormalnost so imuna regulacija, doveduvaj}I
do zgolemena sinteza na IgA kako odgovor na
respiratorna ili gastrointestinalna ekspozicija kon
agensi od okolinata (pr.virusi, bakterii, protein od
ishranata).
• Celija~na bolest; crnodrobnata bolest - naru{en
hepatobilijaren klirens na IgA kompleksite
(sekundarna IgA nefropatija).
• Morfologija. Glomerulite mo`e da se normalni ili da
poka`at pro{iruvawe na mezangiumot i segmentalna
inflamacija ograni~ena na nekoi glomerulusi (fokalen
GN); difuzna mezaangijalna proliferacija (mezangio-
proliferativen); ili poretko, izrazen GN so polumeseci.
7. Ig A NEFROPATIJA (BERGER-OVA BOLEST)
• Karakteristi~na DIF: mezangijalna depozicija na
IgA, ~esto pridru`ena so C3 i properdin i pomali
koli~estva na IgG ili IgM. Ranite komponenti na
komplementot obi~no se otsutni. EM: prisustvo
na elektron-gusti depoziti vo mezangiumot.
• Klini~ki tek. Deca i mladi vozrasni;
• Makroskopska hematurija po infekcija na
repiratorniot trakt ili poretko gastrointestinalen ili
urinaren trakt;
• Do 10% razvivaat tipi~en akuten nefriti~en
sindrom.
• Hematurijata trae nekolku dena, potoa se
povlekuva, a potoa se javuva na rastojanie od po
nekolku meseci.
• Bavna progresija kon HBI se javuva kaj 25% do
50% od slu~aite vo tek od 20 godini.
8. HEREDITAREN (NASLEDEN) NEFRITIS
• HN - grupa nasledni familijarni bubre`ni bolesti asocirani
primarno so glomerularna povreda.
• Alport-oviot sindrom: nefritis so nervna gluvost i razli~ni
naru{uvawa na okoto (dislokacija na le}ata, zadna
katarakta i kornealna distrofija). Ma`ite se po~esto i
pote{ko zaboleni od `enite;
• Na vozrast od 5 - 20 godini - makrosskopska ili
mikroskopska hematurija i proteinurija;
• Izrazena HBI -na vozrast me|u 20 - 50 godini.
• H vrzana, avtozomno recesivno ili avtozomno dominantno.
• Morfologija. SM - segmentalna glomerularna proliferacija
i/ili skleroza, i zgolemuvawe na mezangijalniot matriks.
• Intersticijalnite kletki dobivaat penest izgled od
akumulacija na neutralni masti ili mukopolisaqharidi
(penesti kletki).
• So progresija na bolesta - glomeruloskleroza,, vaskularno
stesnuvawe, tubularna atrofija i intersticijalna fibroza.
9. HEREDITAREN (NASLEDEN) NEFRITIS
• EM: baalnata membrana na glomerulite e tenka i
atenuirana;
• So naprednata vozrast - bazalnata membrana poka`uva
iregularni fokusi na zadebeluvawe ili atenuacija so
naglaseno raskinuvawe i laminacija na lamina denza, {to
dava izgled na pletena ko{nica.
• Defektot na bazalnata membrana kaj pacientite so H-
vrzanata bolest se dol`i na mutacija na genot koj go kodira
alfa5 lanecot na kolagenot tip IV. Ma{kite pacienti obi~no
se so perzistentna hematurija, koja naj~esto e
asimptomatska i sledi benigen tok. Kaj nekoi pacienti se
javuvaat dodatni mutacii vo alfa6 kolagenskiot lanec.
• Avtozomno recesivnata forma: povrzana so homozigotni
defekti na genite koi kodiraat alfa3 i alfa4 tip na kolagen
IV. Ovie geni se lokalizirani glava do glava na hromozomot
2.
• Vo retki slu~ai heterozigoten defekt kaj niv e asociran so
perzistentna ~estopati, familijarna hematurija i so benigen
tok (benigna familijarna hematurija).
10. HRONI^EN GLOMERULONEFRITIS
• Razli~nite formi na glomerularna bolest - eden od nivnite
nesre}ni ishodi, hroni~en glomerulonefritis (HGN). Toj e va`na
pri~na za end-stage bubre`na bolest manifestirana so hroni~na
bubre`na slabost (HBS ili HBI).
• Trieset do 50% pacienti na hemodijaliza ili transplantacija
imaat dijagnoza na HGN.
• HGN - glomerularnite promeni se naprednati do toj stepen {to e
nevozmo`no da se naseti prirodata na po~etnata lezija.
• Krajna faza na brojni entiteti, RPGN, FGS, MGN ili MPGN.
Okolu 20% od slu~aite se bez istorija na simptomatska
bubre`na bolest.
• Obi~no prvo se zabele`uva kaj mladi i pacienti na sredna
vozrast.
• Morfologija. Bubrezite se simetri~no skvr~eni a nivnata
povr{ina e crveno kafeava i difuzno zrnesta.
• SM: naj~estiot beleg vo site slu~ai e naprednatoto oluznuvawe
na glomerulite i Bowman-ovite prostori., ponekoga{ do to~ka
na kompletmo zamenuvawe ili hijalinizacija na glomerulite.
11. HRONI^EN GLOMERULONEFRITIS
• Opstrukcijata na krvotekot me|u aferentnite i eferentnite arterioli, doveduva do
nazna~ena intersticijalna fibroza, asocirana so atrofija i zamestuvawe na brojni tubuli vo
korteksot.
• Sitnite ili srednite pogolemi arterii se so zadebeleni zidovi i stesneti lumeni. Limfocitna
(poretko i plazma kletki) infiltrati se prisutni vo intersticijalnoto tkivo.
• Vaka zabele`itelno o{tetenite bubrezi se ozna~eni kako ”end stage” bubrezi.
• Klini~ki tek: HGN se razviva nezabele`itelno i se otkriva docna so projava na HBI.
• Proteinurija, hipertenzija ili azotemija pri rutinski medicinski pregledi.
• Poretko tranzitorni epizodi na nefriti~en ili nefrotski sindrom.
• Edemi.
• Nefroti~niot sindrom stanuva se poredok kaj naprednata bolest. Izvesna proteinurija,
hipertenzija mo`e da dominiraat vo klini~kata slika.
• Mikroskopska hematurija po pravilo e prisutna.
• Bez terapija prognozata e lo{a so progresija kon uremija i smrt.
• Mo`e da pominat i 10 ili pove}e godini za razvivawe na HBI.
• Bubre`nata dijaliza i transplantacija se razbira go menuvaat ovoj tek i ovozmo`uvaat
dolgoro~no pre`ivuvawe.
12. BOLESTI KOI GI ZAFA]AAT TUBULITE I
INTERSTICIUMOT
• Mnogu formi na tubularna povreda go zafa}aat i intersticiumot i tie }e bidat
razgledani zaedno. Pod zaedni~ki naslov }e bidat pretstaveni bolesti
karakterizirani so: 1. inflamatorno zafa}awe na tubulite i intersticiumot
(intersticielen nefritits) i 2. ishemi~nata ili toksi~na tubularna povreda, koja
vodi do akutna tubularna nekroza i akutna bubre`na insuficiencija.
• TUBULOINTERSTICIELEN NEFRITIS
• TIN pretstavuva grupa na inflamatorni zaboluvawa na bubregot koi primarno gi
zafa}aat intersticiumot i tubulite.
• Glomerulite mo`e da bidat celosno po{tedeni ili zafateni docna.
• TIN predizvikan so bakteriska infekcija glavno ja zafaka bubre`nata karlica -
ottuka i opisniot termin pyelonephritis (pyelo - karlica).
• Intersticielen nefritis e rezerviran za slu~ai so neinfektivno poteklo (povredi
predizvikani so lekovi, metabolni naru{uvawa kako {to e hipokaliemija, fizi~ki
povredi kako {to e iradijacijata, kako i imuni reakcii).
• TIN, bez ogled na etiolo{kiot agens: akuten i hroni~en.
13. AKUTEN PIELONEFRITIS
• Akuten pielonefritis: gnojno vospalenie na bubregot
i bubre`nata karlica (pielonot),
• Toj e va`na manifestacija na infekcija na urinarniot
trakt (IUT): zafa}awe na dolniot (cistitis, prostatitis,
uretritis) i gorniot (pielonefritis) urinaren trakt, ili na
obata. Pielonefritisot skoro vo site slu~ai e asociran
so infekcija na dolniot urinaren trakt.
• Patogeneza: gram negativnite bacili. Escherichia
coli; Proteus, Klebsiella, Enterobacter i
Psudomonas;
• rekurentni infekcii pri manipulacija vo urinarniot
trakt ili imaat kongenitalni ili steknati anomalii na
dolniot urinaren trakt.
•
• Stafilokoki i Streptococcus faecalis
14. AKUTEN PIELONEFRITIS
• Dva pata na infekcija: niz krvotekot (hematogeno) i od dolniot
urinaren trakt (ascedentna infekcija).
• Hematogenoto {irewe e poretko, i e rezultat na rasevka od bakterii
pri septikemii ili infektiven endokarditis.
• Ascendentnata infekcija: Prvata stapka e adhezija na bakteriite na
povr{inata na mukozite, so kolonizacija na distalnata uretra i
(introitusot kaj `enite). Ottuka mikroorganizmite vleguvaat vo
mo~niot meur, so ekspanziven rast na koloniite i so dvi`ewe protiv
strujata na urinarniot tek.
• Instrumentacija na uretrata, (kateterizacija i cistoskopija)
• IUT po~esto gi zafa}a `enite: sosedstvoto na uretrata so rektumot;
kusata uretra i trauma na uretrata pri seksualen kontakt.
15. AKUTEN PIELONEFRITIS
• Urinata vo urovezikata e sterilna poradi antimikrobnite svojstva na
ligavicata i na ispiraweto so periodi~noto praznewe na urinata.
• Opstrukcija na ottekot ili disfunkcija na vezikata gi naru{uva
prirodnite odbrambeni mehanizmi.
• Nekompletno praznewe i zgolemen rezidualen volumen na urina.
Vo prisustvo na staza, bakteriite vneseni vo vezikata mo`e da se
razmno`uvaat nepre~eno.
• Bakteriite se iska~uvaat dol` ureterite da go inficiraat bubre`niot
pielon i parenhimot.
• IUT e ~esta kaj pacienti so benigna hipertrofija na prostata ili pri
prolaps na matkata.
16. AKUTEN PIELONEFRITIS
• Veziko-ureteralniot otvor funkcionira kako ednonaso~na valvula koja spre~uva
retrograden tek na urinata, osobeno vo vreme na mikcijata, koga intravezikalniot
protisok e poka~en.
• Nekompetenten veziko-ureteralen otvor (kongenitalen defekt) dozvoluva refluks
na urinata od mo~niot meur vo ureterite (vezikoureteralen refluks - VUR). Toj
se sre}ava kaj 35%-45% kaj mladi deca so IUT.
• VUR mo`e da bide i steknat - poradi povreda vo rbetniot mozok.
• Efektot na VUR: prazneweto ostanuva rezidualna urina vo urinarniot trakt, {to
pretstavuva povolna podloga za bakteriski rast i dozvoluva gotov mehanizam so
koj inficiranata urina e potisnata vo renalniot pelvis i ponatamu vo renalniot
parenhim preku otvorenite duktusi na vrvovite od papilite (intrarenalen refluks).
• Zgolemen rizik od seriozni komplikacii na pielonefritot -bolni so dijabet.
17. AKUTEN PIELONEFRITIS
• Morfologija: Eden ili obata bubrega; so normalna
golemina ili zgolemen.
• Diskretni, `oltenikavi, oddignati abscesi na povr{inata
na bubregot, ili mo`e da se spojuvaat i da formiraat
edine~na golema povr{ina na gnoewe.
• SM: supurativna nekroza ili formirawe na abscesi vo
bubre`niot parenhim.
• Vo ranite fazi gnojniot infiltrat e ograni~en na
intersticiumot, no podocana abscesite rupturiraat vo
tubulite - leukocitarni cilindri vo urinata.
• Glomerulite se otporni na infekcijata.
• Koga postoi nazna~en element na obstrukcija, gnojniot
eksudat ne e mo`no da se izdrenira po urinarnite
pati{ta, go ispolnuva renalniot pelvis, ~a{kite i
ureterot, sozdavaj}i pionefroza.
18. AKUTEN PIELONEFRITIS
• Vtor (i za sre}a redok) oblik na pielonefritis: nekrozata na
bubre`nite papili ili nekrotizira~ki papilitis ili papilarna
nekroza.
• ^esto kaj dijabeti~ari so akuten pielonefritis i mo`e da go
komplicira akutniot pielonefritis koga postoi zna~ajna
obstrukcija na urinarniot trakt.
• Kaj hroni~niot intersticijalen nefritis asociran so
zloupotreba na analgeti~ki lekovi.
• Lezijata se sostoi od kombinacija na ishemi~na i
supurativna nekroza na vrvovite na bubre`nite piramidi
(papili).
• Makroskopski beleg: ostro ograni~ena sivo-beli~esta
nekroza na apikalnite dve tretini od piramidite (edna papila
ili pove}e papili).
• Mikroskopski, vrvovite na papilata poka`uvaat
kasrakteristi~na koagulativna nekroza so okolen infiltrat
od neutrofili.
19. AKUTEN PIELONEFRITIS
• Infekcija na mo~niot meur: akuten ili hroni~en cistitis.
• Pri dolgotrajni slu~ai asocirani so opstrukcija, mo~niot meur mo`e da e
makroskopski hipertrofiran, so trabekulacija na zidovite ili mo`e da e isten~en i
zna~itelno distendiran od retencija na urinata.
• Klini~ki tek: po~etokot e obi~no brz, so bolka vo kosto-vertebralniot agol i
sistemski znaci za infekcija.
• Naodite vo urinata se piurija i bakteriurija.
• Indikacii za iritacija na mo~niot meur (dizurija, za~esteno mokrewe). Duri i bez
tretman so antibiotici, bolesta poka`uva tendencija kon benigen tok i sponatno
ozdravuvawe. Simptomati~nata faza na bolesta ne trae podolgo od edna nedela,
iako bakteriurijata mo`e da perzistira mnogu podolgo.
• Vo slu~ai so predisponira~ki vlijanija, bolesta mo`e da se pretvori vo rekurentna
ili hroni~na, osobeno koga e bilateralna.
• Nekrotizira~ki papilit: znatno polo{a prognoza; ovie pacienti imaat dokaz za
masivna sepsa i, ~estpati, bubre`na slabost.
20. HRONI^EN PIELONEFRIT I REFLUKSNA NEFROPATIJA
• Hroni~niot pielonefritis -morfolo{ki entitet so predominantno intersticijalnata
inflamacija i oluznuvawe, pridru`eno so makroskopski vidlivi luzni i deformiteti
na pelvikalicealniot sistem (sistemot na pielonot i ~a{kite).
• Va`na pri~ina za HBI.
• Dva vida: hroni~en obstruktiven pielonefritis i hroni~en so refluks povrzan
pielonefritis.
• Hroni~en opstruktiven pielonefritis. Rekurentni infekcii poradi obstruktivni
lezii doveduvaat do povtoruvani vospalenija so sozdavawe na luzni , koi na
krajot doveduvaat do hroni~en pielonefrit.
• Bilateralen: kongenitalni anomalii na uretrata (zadni uretralni valvuli),
• Unilateralen: kalkulusi i unilateralni opstruktivni anomalii na ureterot.
• Hroni~en pielonefritis asociran so refluks (refluksna nefropatija): Po~esta
forma; rezultat od superponirawe na IUT vrz kongenitalen vezikoureteralen
refluks.
• Unilateralen ili bilateralen;
• Doveduva do hroni~na renalna insuficiencija.
21. HRONI^EN PIELONEFRIT I REFLUKSNA NEFROPATIJA
• Morfologija: eden ili obata bubrega, difuzno ili vo
delovi. Neednakvoto formirawe na luzni za razlika od
posimetri~no skvr~enite bubrezi predizvikani od
vaskularna skleroza (ozna~eni kako benigna
nefroskleroza) i hroni~niot GN.
• Najva`en znak: luznite koi gi zafa}aat pielonot i ~a{kite,
ili i edniot i drugite, doveduvaj}i do zna~itelni
deformiteti na ~a{kite.
• SM: nespecifi~ni promeni:
• Neramnomerna fibroza na intersticiumot i inflamatoren
infiltrat od limfociti, plazma kletki i ponekoj neutrofil.
• Dilatacija ili kontrakcija na tubulite, so atrofija na epitelot
koj gi oblo`uva.
• Mnogu od dilatiranite tubuli sodr`at rozovi do sinkasti
staklesti PAS+ cilindri, poznati kako koloidni cilindri, koi
davaat izgled na tireoidno tkaewe. Ovaa pojava e
nare~ena tireoidizacija.
• ^estopati, vo tubulite se sre}avaat i neutrofili.
22. HRONI^EN PIELONEFRIT I REFLUKSNA NEFROPATIJA
• Hroni~en inflamatoren infiltrat i fibroza vo mukozata i zidot
na~a{kite.
• Hijalina ili proliferativna arterioskleroza, zaradi pridru`enata
hipertenzija.
• Glomerulite mo`e da se normalni, no vo mnogu slu~ai se
sre}ava glomeruloskleroza vo podra~jata na poso~uvaniot
renalen parenhim (renalna ablaciona glomerulopatija).
• Klini~ki tek: se dijagnosticira relativno docna poradi
postepen po~etok na bubre`na insuficiencija so naod na znaci
na bubre`na bolest pri rutinski laboratoriski testovi.
• Hipertenzija i prethodi na bubre`nata bolest.
• Ultrasonografijata: goleminata i oblikot na bubrezite.
Pielogramite: zaboleniot bubreg e asimetri~no skvr~en, so
izvesen stepen na deformitet vo ~a{kite (kaliektaza).
• Sken so radioaktiven tehnicium: rano oluznuvawe na
bubre`niot parenhim - korteks.
• Otsustvo na bakteriurija ne isklu~uva postoewe na hroni~en
pielonefritis.
• Poliurija i nokturija.
23. INTERSTICIJALEN NEFRITIS PREDIZVIKAN SO LEKOVI
• AKUTEN INTERSTICIJALEN NEFRIT PREDIZVIKAN
SO LEKOVI
• Nepovolna reakcija na bilo koj lek;
• Sintetski penicilini (meticilin, ampicilin), sintetski antibiotici (rifampin),
diuretici (tijazidi), nesteroidni antiinflamatorni lekovi (fenilbutazon), kako i
drugi lekovi (fenindion, cimetidin).
• Bolesta zapo~nuva okolu 15 dena (opseg od 2-40 dena) po ekspozicija na
lekot so treska, eozinofilija (koja mo`e da bide tranzitorna), isip kaj
pribli`no 25% od pacientite i bubre`ni abnormalnosti.
• Bubre`nite naodi vklu~uvaat hematurija, minimalna ili otsutna
proteinurija, i leukociturija (vklu~itelno i eozinofili).
• Poka~en kreatinin ili ABI so oligurija (50% od pacientite).
• Prekinot na davawe na lekot e sleden so oporavok, iako mo`e da pominat
pove}e meseci dodeka bubre`nata funkcija se vrati vo normala.
24. INTERSTICIJALEN NEFRITIS PREDIZVIKAN SO LEKOVI
• Morfologija: Vo intersticiumot ima nazna~en edem i
infiltracija so mononuklearni kletki, limfociti i makrofagi,
eozinofili i neutrofili.
• Nekoi lekovi (meticilin, tijazidi, rifampin) - granulomi so
gigantski kletki.
• Glomerulite se normalni, osven kaj nesteroidni
antiinflamatorni agensi - minimalni promeni i nefrotski
sindrom.
25. INTERSTICIJALEN NEFRITIS PREDIZVIKAN SO LEKOVI
• Patogeneza: Imun mehanizam na povreda
• Latenten period, eozinofilija i isip, po~etok na nefropatijata koj ne e
zavisen od dozata, kako i povtoruvawe na hipersenzitivnosta po povtorna
ekspozicija.
• Serumski IgE se poka~eni kaj nekoi pacienti (tip 1 hipersenzitivnost)
• Mononuklearniot ili granulomatozniot infiltrat sugeriraat tip 4 reakcija na
preosetlivost.
• Najverojatno: lekot dejstvuva kako hapten koj pri sekrecija od tubulite,
kovalentno se vrzuva so nekoja citoplazmatska ili ekstracelularna
komponenta na tubularniot epitel i postanuva imunogen. Povredata e potoa
predizvikana so IgE i kleto~no posreduvan imun odgovor kon tubularnite
kletki i nivnite bazalni membrani.
26. ANALGEZI^NA NEFROPATIJA (AN)
• Konsumirawe golemi koli~ini na analgetici razvivaat hroni~en intersticijalen
nefritis ~esto pridru`en so bubre`na papilarna nekroza.
• - edine~en tip na analgetik ili me{avina koja sodr`i kombinacii na fenacetin,
aspirin, acetaminofen, kafein i kodein.
• Aspirinot i acetaminofenot se glavnite vinovnici.
• Preegzistentna bubre`na bolest izgleda deka e neophoden preduslov za
bubre`na insuficiencija od zloupotreba na analgetici.
• Patogeneza.: ne e sosem jasna.
• Papilarnata nekroza e po~eten nastan a intersticielniot nefritis vo parenhimot
nad papilata e sekundaren fenomen. Acetaminofenot gi o{tetuva kletkite preku
kovalentno vrzuvawe i oksidativno o{tetuvawe.
• Aspirinot ja inhibira sintezata na prostaglandini soinhibirawe na
vazodolatatornite efekti na prostaglandinite, predisponiraj}i ja papilata kon
ishemija.
• Taka, papilarnata povreda mo`e da e predizvikana od kombinacija na direkten
toksi~en efekt na fenacetinskite metaboliti so ishemi~na povreda na
tubularnite kletki i krvnite sadovi.
27. ANALGEZI^NA NEFROPATIJA (AN)
• Morfologija: Nekroti~nite papili se `oltenikavo-kafeavi
poradi akumulacija na raspadnite produkti na fenacetinot i
drugi pigmenti sli~ni na lipofuscin.
• Podocna papilite mo`e da se nabr~kaat, da otpadnat i da
otpadnat vo bubre`nata karlica.
• SM: papilite poka`uvaat koagulativna nekroza so gubitok na
kleto~nite detali, no so so~uvana kontura na tubulite. Vo
nekroti~nite oblasti mo`e da se javat fokusi na distrofi~na
kalcifikacija. Delot od korteksot dreniran niz nekroti~nata
papila poka`uva tubularna atrofija, intersticijalni luzni i
inflamacija. Malite sadovi vo papilite i submukozata na
urinarniot trakt poka`uvaat karakteristi~no PAS pozitivno
zadebeluvawe na bazalnata membrana (analgezi~na
mikroangiopatija).
• Klini~ki belezi: HBI, hipertenzija i anemija.
• Prekidot na vnes na analgetici mo`e da ja stabilizira ili duri i
da ja podobri bubre`nata funkcija.
• Zgolemenata incidenca na karcinom od preodniot epitel.
28. AKUTNA TUBULARNA NEKROZA
• ATN e klini~ki patolo{ki entitet - destrukcija na tubularnite epitelni kletki, a
klini~ki so akutna supresija na bubre`nata funkcija ili ABI.
• ABI - akutno potisnuvawe na bubre`nata funkcija, so pad na la~eweto na urina
pod 400 ml za 24 ~asa (oligurija).
• Drugi pri~ini za ABI: (1) RPGN, (2) difuzni bubre`ni vaskularni bolesti kako
poliaretritis nodoza i akutni tromboti~ni angiopatii, (3) akutna papilarna nekroza
asocirana so akuten pielonefritis, (4) akuten intersticijalen nefritis predizvikan so
lekovi, (5) difuznata kortikalna nekroza.
• ATN e reverzibilna bubre`na lezija koja se javuva pri niza klini~ki sostojbi.
• Akuten pankreatit, septikemija - silna hipotenzija i {ok; transfuzija na krv i drugi
hemoliti~ki krizi, kako i mioglobulinemija.
• ATN asociran so {ok e nare~en ishemi~na ATN.
• Vtor vid, nefrotoksi~na ATN: razli~ni otrovi, vklu~itelno i te{ki metali
(pr.`iva); organski rastvoruva~i (pr. Jaglen tetrahlorid); lekovi kako gentamicin i
drugi, kontrastni sredstva za radiografski ispituvawa.
• ATN se javuva dosta ~esto; nejzinata reverzibilnost go potencira nejzinoto
klini~ko zna~ewe, bidej}i soodvetno lekuvawe zna~i razlika me”u potpoln
oporavok i smrt.
29. AKUTNA TUBULARNA NEKROZA
• Patogeneza: Kriti~en nastan ATN se smeta deka se 1) tubularna povreda, i (2)
perzistentno i silno naru{uvawe na krvniot tek.
• Tubularnite epitelni kletki se osetlivi na anoksija, a se vulnerabilni i na toksini.
• Obemna povr{ina za tubularna reapsorpcija, aktiven sistem za transport na joni i
neorganski kiselini, kako i sposobnost za efektivna koncentracija.
• Ishemijata predizvikuva strukturni promeni vo epitelnite kletki. Gubitokot na
kleto~niot polaritet doveduva do redistribucija na membranskite proteini
(pr.Na+,K+-ATP-aza) od bazolateralnata kon luminalnata povr{ina na
tubularnite kletki, so rezultira~ko zgolemeno izla~uvawe na natrium vo distalnite
tubuli, koj so tubulo-glomerularniot fid bek sistem, predizvikuva
vazokonstrikcija.
• Natamo{noto o{tetuvawe na tubulite i tubularniot debri mo`e da go blokira
ottekot na urinata i da go zgolemi intratubularniot pritisok, predizvikuvaj}i
namalena stapka na glomerularna filtracija. Te~nosta od o{tetenite tubuli
protekuva vo intersticiumot i go zgolemuva instersticijalniot pritisok i kolaps na
tubulite. Ishemi~nite tubularni kletki isto taka ekspresiraat citokini i adhezivni
molekuli koi slu`at da gi regrutiraat i imobiliziraat leukocitite.
30. • Ishemi~nata bubre`na povreda ja namaluva stapkata na
glomerularna filtracija.
• - intrarenalna vazokonstrikcija, koja predizvikuva reduciran
tok na plazmata i reducirano snabduvawe so kislorod na
funkcionalno va`nite tubuli vo nadvore{niot del na medulata.
• Vazokonstriktorni pati{ta: (1) Renin-angiotenzin,
norepinefrin,(2) zgolemenoto koli~estvo na natrium vo
distalnite tubuli; (3) vazokonstrikcija posreduvana so
subletalna endotelna povreda, koja doveduva do zgolemeno
koli~estvo na endotelen vazokonstriktor endotelin i smalena
produkcija na nitri~en oksid.
• Postojat dokazi za direkten efekt na ishemijata ili toksinite vrz
glomerulot, predizvikuvajki reducirana stapka na glomerularna
ultrafiltracija, verojatno poradi redukcija na efektivnata
filtraciona povr{ina.
31. • Morfologija:
• SM kaj ishemi~nata ATN:
• Nekroza vo praviot del na proksimalniot tubul i na ascedentniot debel
krak, no nieden segment na proksimalnite ili distalnite tubuli ne e
po{teden.
• Tubularnata nekroza ~estopati e obi~no asocirana so te{ko
raspoznatliva ruptura na bazalnata membrana (tubuloreksa).
• Markanten dodaten naod: proteinski cilindri vo distalnite tubuli i
sobirni kanal~iwa (Tamm-Horsfall-ovi proteini, hemoglobin i drugi
plazmatski proteini).
• Kra{ povreda - cilindrite se sostaveni od mioglobin.
• Vo intersticiumot - generaliziran edem so blag vospalitelen infiltrat od
leukociti, limfociti i plazma kletki.
• SM kaj toksi~nata ATN: Nekrozata e najizrazena vo proksimalnite
tubuli, a tubularnite bazalni membrani se obi~no po{tedeni.
• Ako pacientot pre`ivee edna nedela, epitelnata regeneracija stanuva
vidliva vo forma na pokrov od nizok kubi~en epitel i mitotska
aktivnost vo preostanatite tubularni epitelni kletki. Osven vo slu~ai so
uni{tena bazalna membrana, regeneracijata e totalna i kompletna.
32. • Klini~ki tek: 3 fazi:
• Po~etnata faza, trae okolu 36 ~asa, kaj ishemi~nata forma na ATN obi~no dominira
perdizvikuva~kiot medicinski, hirur{ki ili obstetri~en nastan. Edinstven pokazatel za
zafa}awe na bubregot e blagoto sni`uvawe na produkcija na urina, so poka~uvawe na
ureata vo krvta. Vo ovaa to~ka, oligurijata mo`e da se objasni so tranzitornoto
smaluvawe na krvotekot vo bubrezite.
• Fazata na odr`uvawe, me|u 2 i 6-ti den. Produkcijata na urina dramati~no pa|a, me|u 50
i 400 ml/dnevno.
• Kompletna anurija e retka. Oligurijata trae nekolku dena, no mo`e da perzistira i do tri
nedeli.
• Vo klini~kata slika: uremija i optovar so te~nosti. Vo otsustvo na tretman ili dijaliza,
pacientite mo`e da umrat vo ovaa faza.
• Fazata na oporavok po~nuva so poka~uvawe na volumenot na urinata, dostignuvaj}i 3
litri dnevno, vo tek na nekolku dena. Tubularnata funkcija seu{te e naru{ena i mo`e da
nastanat seriozni elektrolitni disbalansi i osetlivost na infekcii. Poradi ovie pri~ini,
okolu 25% od smrtnite slu~ai od ATN se javuvaat vo ovaa faza.
• Za vreme na krajnata faza, postoi postepeno vra}awe na pacientot kon normala.
Volumenot na urinata se vra}a vo normalata; no suptilni funkcionalni naru{uvawa na
funkcijata mo`e da perzistiraat so meseci. So sovremenite metodi na nega, pacientite koi
ne umiraat od precipitira~kiot nastan imaat 90 do 95% {ansa za kompleten oporavok od
ATN.