The document summarizes techniques and complications of arteriovenous (A-V) fistulas used for hemodialysis. It discusses types of fistulas including autogenous and graft fistulas. It describes surgical techniques for creating different types of fistulas such as side-to-side, end-to-side, and end-to-end anastomoses. Common complications include early failure from thrombosis, aneurysm formation, infection, ischemic changes causing steal syndrome, and venous hypertension. Care of the fistula involves exercises and avoiding blood pressure checks or intravenous lines in the fistula arm.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
TURP step by step operative urology series
for more resources:
www.uronotes2012.blogspot.com
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This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
TURP step by step operative urology series
for more resources:
www.uronotes2012.blogspot.com
enter your mail & press follow us by mail to receive our daily feeds
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Vascular access in Haemodialysis (2).pptxMithunAhmed5
national institute of kidney disease and urology (nikdu)
Dialysis access refers to the creation of an entrance way into the bloodstream so that the blood can be cleansed by the dialysis procedure. It is well established that dialysis cannot be provided without access.
The attainment and maintenance of a single reliable, long-lasting dialysis access with minimal complications continue to be challenging.
Achievement of such an access is associated with optimal patient clinical outcomes, superior quality of life, and minimal costs.
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
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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
1. A-V Fistula in HeamodialysisTechniques and ComplicationsDr- Saeed Al-ShomimiKing Faisal University Saudi Arabia2003
2. Introduction Definition Abnormal connection between artery and vein which bypasses capillary bed Aetiology congenital acquired:- surgically created for haemodialysis- penetrating trauma- iatrogenic eg following surgical dissection of artery, cannulation of artery or vein
3. Introduction The advent of hemodialysis in the early 1960 has provided longevity for many patients with CRF Quinton and his associates -> external A-V shunt 1963 , Shaldon -> femoral vien catheter
12. General Principles Preferable to use the arm vessels rather than the leg vessels When possible the non-dominant arm Access site should be placed as distally as practical in the limb , so that proximal sites will be available for subsequent procedures. 3. Inadequate or atherosclerotic arteries should be avoided , and a long section of patent vein is required to accommodate multiple cannulation site.
16. Peritoneal catheter required during the time that the permanent access are maturing prior to use.
17. General Principles Anticoagulation is not necessary during routine access operations , except for graft thrombectomy and revision procedures, or patients who do not have the usual hypocoagulable state of chronic renal failure. 8. Prophylactic antibiotics are used for all cases involving insertion of prosthetic material.
39. Procedures Side to side brachiocephalic fistula: When construction of fistula at the wrist is not possible , anastomosis of the cephalic vein to the brachial artery immediately proximal to the cubital fossa will provide satisfactory access A transverse incision is made proximal to the cubital fossa The brachial artery is mobilized untill it reaches the bifurcation at the level of bicipital tendon The median nerve lies medial and posterior to the artery and should be carefully protected The anastomosis is similar to the radiocephalic but the veenotomy and arteriotomy should be limited to about 5 – 7 mm to minimize the incidence of steal syndrome
40. Procedures Basilic vein – radial artery fistula: Mobilization of the basilic vein in the forearm and anastomosis of its end to the radial artery also may be used to provide access for heamodialysis The basilic vein is mobilized along the ulner border of the forearm to about the middle of the forearm. A subcutanious tunnel is prepared between the vein and the radial artery These vessels are then anastomosed attaching the vein end to either the end or the side of the artery
41. This technique of fistula formation may be used in patients who have an obliterated cephalic vein or distal radial artery It is possible to anastomose the basilic vein to the ulner artery, however if there has been a previous radiocephalic fistula in that arm , there is a danger that circulation in the hand will be compromized
49. complications Aneurysm: Pseudoaneurysm formation may occur at puncture sites following dialysis However , the incidence is much lower than that of prosthetic grafts True aneurysm are much rare but have also been reported in few occasions in the vein distal to the anastomosis These can be treated with resection and either end to end anastomosis Placement of short segment graft
50.
51. complications Infection: Infection of autogenous fistula are rare compared to prosthetic graft They present with: Fever Erythema Tenderness And complications (such as thrombosis and aneurysm ) The most common infecting organism is staph aureus Managed by systemic antibiotics , drainage and revision as necessary
52. complications Ischemic changes: Steal symptoms may occur in around 4% of patients with autogenous fistula The incidence is higher in : Diabetic patients Atherosclerotic patients And in anticubital fistulas The symptoms may only manifested during dialysis and as such may be managed by observation and by using low flow rate At its worst , gangrene may occur requiring amputation To avoid the problem of retrograde flow through the palmar arch in wrist fistula , ligation of the radial artery distal to the anastomosiscan be performed . Alternatively an end to end anastomosis can be constructed
53.
54. complications Venous hypertension: Another vascular complication is the development of venous hypertension syndrome , where the hand distal to the fistula become swollen and uncomfortable with thickning of the skin and hyperpigmentation Venous hypertension may be avoided by forming an end to end anastomosis Or to ligate the enlarged venous tributaries causing the hypertension of the distal digits , so preserving the fistula
55. complications Cardiovascular complication: High output cardiac failure is a rare complication which may occurs particularly in patients displaying a combination of low heamatocrit, cardiomyopathy from diabetes and the presence of high flow fistula Treatment usually involves sacrificing the fistula
56. Care of A-V Fistula Keep the fistula arm raised on a pillow to reduce swelling. The dressing should remain intact and dry at all times. As soon as post operative pain has subsided, start arm exercises Do not allow blood pressure, blood taking or intravenous administration on the fistula arm. Check for thrill