The document discusses acute kidney dysfunction (AKD) in intensive care unit patients. It defines AKD and describes the RIFLE criteria for classifying its severity. Common risk factors for AKD include hypovolemia, hypotension, and exposure to nephrotoxins. The document outlines prevention and treatment strategies and notes that mortality is high for patients requiring renal replacement therapy for AKD.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
A urinary tract infection (UTI) is an infection in any part of your urinary system that is your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra.
Polycystic disease of the kidney (PKD) is a disorder in which major portion of the renal parenchyma is converted into cysts of varying size .
Fluid-filled cysts distributed over the kidney results in massive enlargement of the kidneys.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
A urinary tract infection (UTI) is an infection in any part of your urinary system that is your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra.
Polycystic disease of the kidney (PKD) is a disorder in which major portion of the renal parenchyma is converted into cysts of varying size .
Fluid-filled cysts distributed over the kidney results in massive enlargement of the kidneys.
Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.It's most common in those who are critically ill and already hospitalized.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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!
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.
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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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Acute Kidney Dysfunction
1. Acute Kidney Dysfunction in the ICU Slide Sub-Title John A. Kellum, MD Director, Molecular Core Laboratory Associate Professor of Critical Care Medicine and Medicine Intensivist, Cardiothoracic and Liver Transplant ICUs The CRISMA Laboratory Critical Care Medicine School of Medicine Health Policy and Management Graduate School of Public Health University of Pittsburgh
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5. RIFLE Criteria for Acute Kidney Dysfunction R isk I njury F ailure L oss E SRD Increased creatinine x 1.5 or GFR decrease >25% End Stage Renal Disease GFR Criteria* Urine Output Criteria UO <.3ml/kg/h x 24 hrs or anuria x 12 hrs UO <.5ml/kg/h x 12 hrs UO <.5ml/kg/h x 6 hrs Increased creatinine x 2 or GFR decrease >50% Increase creatinine x 3 or GFR dec >75% or creatinine 4mg/dl (Acute rise of 0.5 mg/dl) High Sensitivity High Specificity Persistent AKD** = complete loss of renal function > 4 weeks www.ADQI.net Oliguria Bellomo R, et al. Crit Care. 2004;8:R204–R212.
6. RIFLE Creatinine is expressed in mg/dL and (mcmol/L). AKD is classified according to the worst grade for each domain (creatinine or urine output). If baseline serum creatinine is abnormal, a smaller relative increase is required to reach “failure.” Bellomo R, et al. Crit Care. 2004;8:R204–R212. Baseline 0.5 (44) 1.0 (88) 1.5 (133) 2.0 (177) 2.5 (221) 3.0 (265) Risk 0.75 (66) 1.5 (133) 2.3 (200) 3.0 (265) 3.8 (332) --- Injury 1.0 (88) 2.0 (177) 3.0 (265) --- --- --- Failure 1.5 (133) 3.0 (265) 4.0 (350) 4.0 (350) 4.0 (350) 4.0 (350)
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10. Types of Kidney Dysfunction Biochemical indices useful to distinguish a pre-renal from a renal ARF episode pre - renal renal osm u (mOsm/kg) > 500 < 400 Na u (mmol/L or meq/L) < 20 > 40 BUN/s creatinine > 20 < 10 u/s creatinine > 40 < 20 u/s osmolality > 1.5 > 1 FeNa (%)* < 1 > 2 ________________________________________________________________ * ( (u Na / s Na) / (u creat / s creat) ) X 100 u for urinary, s for serum, Fe = fractional excretion
11.
12. Cellular Injury and Repair in acute tubular necrosis (ATN) * very few necrotic cells are observed from patients with ATN Propagation Inflammation Proliferation And Redifferentiation Normal Tubular Cells De- Differentiated Cells Apoptotic Cells Injured Cells Necrotic * Cells Exfoliation Into the Urine Recovery (rapid) Recovery (slow) Injury
13. Presence of AKD is Strongly Associated with Hospital Mortality After adjusting for differences in comorbidity, AKD was associated with a 5.5 times greater chance of death compared to matched controls without AKD. Levy et al. JAMA. 1996;275:1489-94 .
14. Metnitz et al. Intens Care Med. 2002 Need for Renal Replacement Therapy (RRT) is Strongly Associated with Hospital Mortality
19. Dopamine is not Effective Harm Benefit Kellum & Decker, Crit Care Med. 2001; 29:1526-1531. 0.1 1 10 Death All Studies Excludes Radio-contrast Heart Disease Only ARF Hemodialysis All Studies Excludes Radio-contrast Heart Disease Only Excludes Outliers All Studies Excludes Radio-contrast Heart Disease Only Excludes Outliers
30. Birck et al. Lancet. 2003;362:598-603. NAC reduces the risk of AKD (increased creatinine) by 50%.
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32. Does isotonic sodium bicarbonate work better than isotonic sodium chloride solution for prevention of AKD after radiocontrast? N=154 Merten et al. JAMA. 2004;291:(19).
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36. Ronco et al. Lancet. 2000; 355:26-30. Cumulative Survival vs. Ultrafiltration Rate 100 90 80 70 60 50 40 30 20 10 0 Group 1(n=146) ( Uf = 20 ml/h/Kg) Group 2 (n=139) ( Uf = 35 ml/h/Kg) Group 3 (n=140) ( Uf = 45 ml/h/Kg) 41 % 57 % 58 % p < 0.001 p n.s. p < 0.001
37. Survival Time (Days) 50 40 30 20 10 0 1.0 .9 .8 .7 .6 .5 .4 .3 .2 .1 .0 Group 1 Group 3 Group 2 (p = 0.0007) (p = 0.0013) Ronco et al. Lancet. 2000; 355:26-30. Cumulative Proportion Survival
38. Adapted from Shiffl et al. N Engl J Med. 2002;346:305-10. Survival vs. Dialysis Dose In Intermittent Hemodialysis 100 90 80 70 60 50 40 30 20 10 0 3/wk HD wKT/V = 3.6 7/wk HD wKT/V = 7.4 54 % 72 %
40. Continuous vs. Intermittent RRT Insufficient evidence from published studies to determine which therapy is best. However, CRRT appears to be superior under most sets of assumptions. Kellum et al. Intens Care Med . 2002;28:29-37. Unadjusted severity threshold quality threshold all studies Adjusted quality raw quality wgt severity both q & s Treatment of x-overs* as CRRT excluded 0.2 0.6 1 1.4 Relative Risk of Death Favors CRRT Favors IRRT
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