Total parenteral nutrition (TPN) involves providing patients with essential nutrients intravenously when they cannot eat normally. It is indicated when oral feeding is not possible due to conditions that prevent digestion or absorption of nutrients from food. TPN can be administered either peripherally or centrally depending on the patient's needs and condition. Close monitoring is required when a patient is on TPN to avoid complications like infection, metabolic imbalances, and overfeeding. Nutrition is an important part of medical treatment that should not be neglected for critically ill patients.
Patient control epidural analgesia Al Razi hospital KuwaitFarah Jafri
This is the Patient Controlled Epidural Analgesia protocol at Al Razi Hospital. This presentation was done before initiating the PCEA as a pain control modality in the hospital.
Patient control epidural analgesia Al Razi hospital KuwaitFarah Jafri
This is the Patient Controlled Epidural Analgesia protocol at Al Razi Hospital. This presentation was done before initiating the PCEA as a pain control modality in the hospital.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Parenteral Nutrition for the oral and maxillofacial surgery patientMaxfac Center
Nutritional deficit that occurs after starvation or trauma and the various nutritional supplementation given parenterally to minimise morbidity and mortality. This topic covers the Parental Nutrition.
Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India
Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri
Email : maxfacmail@gmail.com
this is a detailed presentation on the principles of surgical nutrition. the presentation started with surgical metabolism and epidemiology of malnutrition in surgical patients. Furthermore, the aetiology of malnutrition was discussed in surgical patients. Finally, the various types of nutritional support, enteral and parenteral, was discussed under indications, types, access, advantages, disadvantages, complications and monitoring.
After this presentation, you should be able to:
Critically evaluate the scientific rationale regarding dietary Na+, P, K+, and fluid restrictions in HD patients, and why these restrictions may be misguided.
Better communicate with HD patients and clinic staff the nuances of these dietary restrictions.
Promote efficacious physical activity programs for hemodialysis patients.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Nutrition
• Nutrition allows the body to be
provided with all basic nutrients
substrates and energy required for
maintaining or restoring all vital body
functions from carbohydrate and fat
and for building up body mass from
amino acid.
2Prof. Dr. RS Mehta, BPKIHS
7. Total Parenteral Nutrition Indication
• When normal oral feeding is not possible.
e.g.: Chron’s disease, gastric & esophageal carcinoma,
paralytic ileus, generalized peronitis, GI. obstruction, intractable
vomiting.
• When food is incompletely absorbed.
e.g.: Major burns, multiple injuries, radiation therapy,
ulcerative colitis, chemotherapy treatment, short bowel
syndrome.
• When food intake is undesirable, in case it is
prudent to rest the bowel.
e.g.: Post GIT surgery, chronic inflammatory diseases,
intractable diarrhea.
7Prof. Dr. RS Mehta, BPKIHS
8. Total Parenteral Nutrition Indication
• In patients who are able to ingest food, but
refuse to do so.
e.g.: Geriatric post-operative patients, adolescents
with anorexia nervosa, some psychiatric patients
with prolonged depression.
• In patients who, as a consequence of their
illness are going to be, or have been NPO for
5 – 7 days.
8Prof. Dr. RS Mehta, BPKIHS
9. Indications for TPN
Short-term use
• Bowel injury, surgery, major trauma or burns
• Bowel disease (e.g. obstructions, fistulas)
• Severe malnutrition
• Nutritional preparation prior to surgery.
• Malabsorption - bowel cancer
• Severe pancreatitis
• Malnourished patients who have high risk of
aspiration
Long-term use (HOME PN)
• Prolonged Intestinal Failure
• Crohn’s Disease
• Bowel resection
9Prof. Dr. RS Mehta, BPKIHS
10. Parenteral Nutrition
Central Nutrition
• Subclavian line
• Long period
• Hyperosmolar solution
• Full requirement
• Minimum volume
• Expensive
• More side effect
Peripheral nutrition
• Peripheral line
• Short period < 14days
• Low osmolality
< 900 mOsm/L
• Min. requirement
• Large volume
• Thrombophlebitis
10Prof. Dr. RS Mehta, BPKIHS
11. Routes of TPN
Central TPN
(usual osmolarity = 2000 mosmol/L)
Advantages:
Can provide full nutritional support (No limits in
concentration of dextrose and amino acids)
No risk of thrombophlebitis, No pain.
Disadvantages:
Requires surgery
More risk of sepsis than peripheral TPN
High risk of mechanical complications
11Prof. Dr. RS Mehta, BPKIHS
12. Routes of TPN
Peripheral TPN
maximum osmolarity;
neonates = 1100/L, Pediatrics = 1000/L, Adults = 900/L
Advantages:
Does not require surgery
Less risk of sepsis than central TPN
No risk of mechanical complications
Disadvantages:
High risk of thrombophlebitis
Painful
Does not provide full nutrition support.
Needs more fluids to provide more nutrition. (maximum dextrose =
7.5% and AA = 2.5%).
12Prof. Dr. RS Mehta, BPKIHS
13. Note
PPN can infuse through central line but
central TPN can NOT infuse through
the peripheral line
13Prof. Dr. RS Mehta, BPKIHS
14. Prof. Dr. RS Mehta, BPKIHS
Calculating the Osmolarity of a
Parenteral Nutrition Solution
Multiply the grams of dextrose per liter by 5.
Example: 100 g of dextrose x 5 = 500 mOsm/L
Multiply the grams of protein per liter by 10.
Example: 30 g of protein x 10 = 300 mOsm/L
Multiply the (mEq per L sodium + potassium +
calcium + magnesium) X 2
Example: 80 X 2 = 160
Total osmolarity = 500 + 300 + 160 = 960 mOsm/L
14
15. Parenteral Nutrition
• Peripheral Parenteral
Nutrition (15 lit D5W/day for a
70 kg !!!)
• Central Parenteral Nutrition
(TPN)
– Needs CV-line to administer
hyperosmolar solutions
15Prof. Dr. RS Mehta, BPKIHS
16. Estimation of energy expenditure
Harris-Benedict equations:
• BEE (men) (kcal/day): 66.47+13.75W+5H-6.76A
• BEE (women) (kcal/day): 655.1+9.56W+1.85H-4.68A
• TEE (kcal/day):
BEE × Stress factor × Activity factor
• Stress factors: Surgery, Infection: 1.2 Trauma: 1.5
Sepsis: 1.6 Burns: 1.6-2
• Activity factors: sedentary: 1.2 , normal activity: 1.3,
active: 1.4 , very active: 1.5
16Prof. Dr. RS Mehta, BPKIHS
17. Stress level
• Normal/mild stress level: 20-25 kcal/kg/day
• Moderate stress level: 25-30 kcal/kg/day
• Severe stress level: 30-40 kcal/kg/day
Pregnant women in second or third trimester:
Add an additional 300 kcal/day
17Prof. Dr. RS Mehta, BPKIHS
19. Protein (amino acids)
• Maintenance: 0.8-1 g/kg/day
• Normal/mild stress level: 1-1.2 g/kg/day
• Moderate stress level: 1.2-1.5 g/kg/day
• Severe stress level: 1.5-2 g/kg/day
• Burn patients (severe): Increase protein until
significant wound healing achieved
• Solid organ transplant: Perioperative: 1.5-2
g/kg/day
20Prof. Dr. RS Mehta, BPKIHS
20. Protein need in Renal failure
• Acute (severely malnourished or
hypercatabolic): 1.5-1.8 g/kg/day
• Chronic, with dialysis: 1.2-1.3 g/kg/day
• Chronic, without dialysis: 0.6-0.8 g/kg/day
• Continuous hemofiltration: ≥ 1 g/kg/day
21Prof. Dr. RS Mehta, BPKIHS
21. Protein need in Hepatic failure
• Acute management when other treatments
have failed:
– With encephalopathy: 0.6-1 g/kg/day
– Without encephalopathy: 1-1.5 g/kg/day
• Chronic encephalopathy
– Use branch chain amino acid enriched diets only if
unresponsive to pharmacotherapy
• Pregnant women in second or third trimester
– Add an additional 10-14 g/day
22Prof. Dr. RS Mehta, BPKIHS
22. Fat
• Initial: 20% to 40 % of total calories
(maximum: 60% of total calories or 2.5
g/kg/day)
– Note: Monitor triglycerides while receiving
intralipids.
• Safe for use in pregnancy
• I.V. lipids are safe in adults with pancreatitis if
triglyceride levels <400 mg/dL
23Prof. Dr. RS Mehta, BPKIHS
23. Components of TPN Formulations
Macro:
Calorie: Dextrose 20%, 50%
Intralipid 10%, 20%
Protein: Aminofusion 5%, 10%
Micro:
Electrolytes (Na, K, Mg, Ca, PO4)
Trace elements (Zn, Cu, Cr, Mn, Se)
24Prof. Dr. RS Mehta, BPKIHS
24. Dextrose
• 20%, 50% ( from CV-line)
• 3.4 kcal/g
• 60-70% of calorie requirements should
be provided with dextrose
25Prof. Dr. RS Mehta, BPKIHS
32. Prof. Dr. RS Mehta, BPKIHS
Transitional Feeding
• Maintain full PN support until pt is tolerating 1/3 of needs
via enteral route
• Decrease TPN by 50% and continue to taper as the enteral
feeding is advanced to total
• TPN can reduce appetite if >25% of calorie needs are met
via PN
• TPN can be tapered when pt is consuming greater than 500
calories/d and d-c’d when meeting 60% of goal
• TPN can be rapidly decreased if pt is receiving enteral
feeding in amount great enough to maintain blood glucose
levels
33
33. TPN
• Doctors decide patient needs it
• Dietitian sees patient
• Decides best regime
• Orders bag from pharmacy
• Made up aseptically to requirements
• Start low and build up
• Monitor bloods
34Prof. Dr. RS Mehta, BPKIHS
34. Access for PN
• Usually central line in ICU – keep a clean port
if PN may be needed. 5 lumen
• Short term PN – can have PIC (need a different
formula) or PICC
• Long-term TPN – tunnelled subclavian
catheter (Hickman) or subcutaneous port is
usually inserted – OBSERVE STRICT ASEPSIS if
handling these lines.
35Prof. Dr. RS Mehta, BPKIHS
38. Conclusion
• Do not forget about feeding
• Keep an eye on whether nutritional
targets are being met
• Speak to the surgeons and dietician
• Do not be reluctant to start PN in a
supplemental capacity
• Avoid hyperglycaemia
• Nutrition is often neglected
39Prof. Dr. RS Mehta, BPKIHS