Acute kidney injury (AKI), formerly known as acute renal failure, is defined as a sudden deterioration of kidney function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be caused by prerenal issues affecting blood flow to the kidneys, intrinsic renal parenchymal damage, or postrenal urinary tract obstruction. The incidence of AKI varies globally and it commonly occurs in critically ill children with coexisting conditions. Etiologies include pre-renal causes like decreased intravascular volume, intrinsic renal diseases affecting glomeruli or tubules, and post-renal obstruction. Diagnosis involves lab tests of kidney and liver function as well as imaging studies. Treatment focuses on fluid management, electrolyte
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Acute Kidney Injury (AKI): Definition
Formerly referred to as acute renal failure (ARF).
Defined as an “sudden deterioration in kidney function
results in the inability to maintain fluid and electrolyte
homeostasis”
3. Kidney function is dependent on
Adequacy of blood supply to the kidney
– Prerenal
Integrity of renal parenchyma
– Renal
Patency of urinary tract
– Post renal
5. The incidence of AKI varies in different regions of
the world.
Estimates range from 20 cases per year per
1,00,000 population in neonates to as low as 2
cases per year per 1,00,000 population in older
children
The co-existence of AKI with critical illness occurs
at a rate of 10% and has 50% mortality in children
requiring dialysis.
8. Pre Renal AKI
Also called prerenal azotemia, is characterized by
diminished effective circulating arterial volume, which
leads to inadequate renal perfusion and a decreased
GFR .
The kidneys are intrinsically normal, and prerenal failure
is reversible once the blood volume and hemodynamic
conditions are restored to normal.
11. 1. OBSTRUCTION OF RENAL ARTERIES AND
VEINS
Bilateral renal arterial thrombosis may occur after
umbilical artery catheterisation in neonates
Renal vein thrombosis may be a complication of IDM
especially following dehydration.
In older children, renal vein thrombosis may occur
with nephrotic syndrome with anasarca and
dehydration.
Gross haematuria, enlargement of kidneys and
azotemia are typical manifestation.
12. 2. INVOLVEMENT OF RENAL
MICROVASCULATURE
HUS is a common cause of AKI in chidren.
Causes thrombotic microangiopathy
2 types- D+HUS and D-HUS
Common causes of D+HUS – EHEC(in developed countries),
Shigella dysentriae type I (in India)
Following dysentery shigella-toxin enters the circulation and leads
to endothelial injury in microvasculature .
Localized coagulation and deposition of platelet thrombi and fibrin
occurs in glomeruli causing decrease in GFR.
14. 4. ACUTE INTERSTITIAL NEPHRITIS
Usually occurs due to hypersensitivity reaction to some
drugs (ampicillin, cephalosporins, sulfonamides,
quinolones, NSAID’s, phenytoin etc)
The patient may have fever , arthralgia , rash and
eosinophilia : urine often shows eosinophils
Renal biopsy should be done if it is strongly suspected.
15. 5. Acute Tubular Necrosis
Characterized by renal tubular injury, may occur due to
ischaemia/hypoperfusion or due to injury froms drugs or
toxins.
Ischaemic ATN is a continnum of physiologic responses
that is observed in prerenal azotemia.
If the hypoperfusion is severe and prolonged, ATN can progress to
renal infarction and irreversible renal damage
16. The course is subdivided into 4 phases :
Initiation
Extension
Maintainance
Recovery
17. (C) POST RENAL
It includes a variety of disorders characterized by
obstruction of the urinary tract.
In a patient with 2 functioning kidneys, obstruction must
be bilateral to result in AKI.
Relief of the obstruction usually results in recovery of
renal function except in patients with associated renal
dysplasia or prolonged urinary tract obstruction.
18. Causes of post renal AKI
Posterior urethral valves
Ureteropelvic junction obstruction
Ureterovesicular junction obstruction
Ureterocele
Tumor
Urolithiasis
Hemorrhagic cystitis
Neurogenic bladder
20. Clinical features range from asymptomatic with
mild to moderate elevation in S.creatinine to
anuric renal failure
Decrease or no urine output
Fluid overload
Hypertension
Uraemia, dyselectrolytemia
21. HISTORY
H/o blood loss, diarrhea, vomitting – prerenal aki.
Past h/o pharyngitis with gross hematuria, edema,
hypertension – acute PSGN.
Dysentery, petechiae, pallor- HUS.
Sudden passage of dark red urine, pallor and jaundice
with h/o drug exposure – acute intravascular hemolysis
(G6PD def.).
Rash with arthritis – SLE or HSP.
22. H/o prolonged hypotension or exposure to nephrotoxic
drugs – ATN.
H/o poor urinary stream with palpable UB or kidney –
obstructive uropathy.
Abdominal colic, haematuria, dysuria – urinary tract
stones.
23. PHYSICAL EXAMINATION
Obtaining a thorough physical examination is extremely
important . Clues may be found in any of the following –
Skin
Eyes
Ears
Respiratory system
Cardiovascular system
Abdomen
32. Urinanalysis
Pre-Renal Renal
Urinary sodium (mEq/l) < 20 > 40
Urinary osmolality (mOsm/kg) > 500 < 350
Blood urea to creatinine ratio >20:1 < 20:1
Fractional excretion of sodium < 1 > 1
Specific gravity >1.020 <1.010
33. Imaging
Ultrasound of KUB - evaluates renal size, able to detect
masses, obstruction, stones.
X-ray Abdomen
Renal Scintigraphy
DTPA : the differential functions of each kidney can be
derived.
DMSA : gives excellent images of cortex and useful to define
areas of inflammation
34. RENAL BIOPSY
Indicated in
Patient in whom the etiology is not identified.
Unremitting AKI lasting longer then 2-3 wks or
in assessing the extent of renal damage and
outcome.
Suspected drug induced AKI in a patient
receiving therapy with a potentially nephrotoxic
drugs.
36. Role of Biomarkers in AKI
Early prediction and diagnosis of AKI
Identify the primary location of injury
Pinpoint the duration and severity
Identify the etiology of AKI
Monitor response to intervention and treatment
37. Serum Creatinine
Serum creatinine alone is a poor indicator of renal
function
It varies widely with age, gender, diet, muscle mass,
medications, and hydration status
Up to 50% of kidney function may be lost before serum
creatinine even begins to rise
40. Renal Angina Index
The renal angina index is a predictive tool, performed on
admission to the pediatric intensive care unit, and used
to assess the risk for subsequent severe AKI (≥ doubling
of serum creatinine) 72 h later (Day-3 AKI).
The angina index is a composite of risk strata and
clinical signs of injury.
It consists of 3 risk factors and 2 markers of renal injury,
which are assigned points. Score more than 8 predicts
severe AKI.
43. Management Goals
A. Maintenance of electrolyte and fluid balance.
B. Avoidance of life-threatening complications.
C. Adequate nutritional support.
D. Treatment of the underlying cause.
44. Management: FLUIDS
If no evidence of volume overload or cardiac failure :
Fluid challenge of IV NS , 20 mL/kg over 30 min
No void within 2-4 hr points to intrinsic or postrenal ARF
Vigorous fluid resuscitation may be needed in sepsis
Diuretics if no void with adequate circulation.
In absence of urine output, strict fluid restriction.
Renal dose of dopamine (2-3 μg / kg / min)
45. Hyperkalemia
1. Severe hyperkalemia (>7.0 mEq/L):
Electrocardiographic changes or peripheral muscle
weakness
Can be life-threatening and requires immediate
attention.
2. Acute management includes administration of:
IV calcium to stabilize the cardiac membrane; and/or
glucose/insulin infusion,
Sodium bicarbonate or Glucose-Insulin infusion
(promotes extracellular K shift into the cells)
Kayexalate (an anion exchange resin): removes excess
K from the body.
46. Acidosis
1. In children with AKI:
impaired acid excretion
increased acid production (shock and sepsis)
2. Sodium bicarbonate should only be administered with
life threatening acidosis or hyperkalemia.
3. HCO3 > 12 mEq/L and/or arterial pH greater than 7.2
do not require immediate intervention.
47. Hypertension
Most often a result of hyper-reninemia or from
expansion of fluid volume.
Most commonly seen with AGN and HUS
Management :
Salt and water restriction.
Diuretic adminiistration
Anti-Hypertensives
48. Hyponatremia
Most commonly dilutional
Management:
Fluid restriction
3% Hypertonic saline to symptomatic patients or sodium
less than 120 mEq/L
mEq sodium required = 0.6 X weight(kg) X ( 125-serum
sodium in
mEq/L )
49. Hypocalcemia
Primarily treated by lowering the serum phosphate
levels.
Phosphate binders can be administered.
IV calcium should be avoided
Aluminium-based binders should also be avoided.
50. Nutrition
Sodium, potassium and phosphorous should be
restricted.
Protein intake should also be moderately decreased.
Adequate calories are needed to promote recovery
Renal replacement therapy if sufficient calories cannot
be achieved (patient with oliguria or anuria)
Patients with inappropriate nutrition have poorer
prognosis.
51. Indications for dialysis in ARF
Severe fluid overload unresponsive to management
Persistent hyperkalemia
Severe met.acidosis unresponsive to management.
Neurologic symptoms (altered mental status, seizures)
BUN >100-150 mg/dL (or lower if rapidly rising)
Ca:PO4 imbalance, with hypocalcemic tetany.
Nutritional support in a child with oliguria or anuria.
52. 3 types of dialysis-
a. intermittent haemodialysis (IHD)
b. peritoneal dialysis(PD)
c. CRRT.
a. Intermittent Haemodialysis:
Preffered in patients with relatively stable
hemodynamic state.
Highly efficient, 1 session completes in 3-4 hrs
Can be done 3-7 times/week
Complication : hypotension, bleeding, thrombosis.
53.
54. b. Peritoneal Dialysis:
Most commonly used in infants & neonates.
For 1 session→1 cycle of 45-60 min needs to be
repeated for 2-4 times/day.
The infused volume of the diasylate is 800-
1100ml/m2
No need for anticoagulation , so ↓sed risk of
bleeding , may cause abdominal pain & peritonitis
55. c. CRRT:
Continuous renal replacement therapy (CRRT) is
associated with reduced mortality.
CRRT usually involves the removal and return of
blood through a single cannula placed in a large vein
(venovenous therapy); arteriovenous therapies are
seldom used.
CRRT causes less haemodynamic instability, because
fluid removal is slower and there is time for fluid to re-
equilibrate between body compartments.
56. Indications - hemodynamic instability, sepsis,
extensive trauma, MODS.
Continuous removal of solutes ,fluid & electrolytes
3 types:
CVVH - based on convection
CVVHD - based on diffusion
CVVHDF - based on convection and
diffusion.
57.
58. Outcomes
Mortality rates from 30-50% have been reported from
developing countries.
But the results have markedly improved at tertiary centers
with proper expertise and modern facilities.
Outcome depend upon underlying cause.
Prognosis is favourable in ATN from volume depletion,
intravascular hemolysis, acute interstial nephritis and drugs or
toxin related AKI especially when complicating factor are
absent .
In cresentic GN, atypical HUS, and AKI associated with
sepsis, multi organ failure the prognosis is less satisfactory .
59. Take Home Message
AKI is a common and serious problem
All AKI are Not equal
The diagnosis of AKI is often delayed.
Earlier recognition and treatment of AKI sequelae may
improve outcome
Novel biomarkers are providing tools for the early
prediction of AKI and outcomes, and for testing
therapies
Sudden = 48 hours to 7 days....sudden and sustained decline in GFR
HEPATORENAL SYNDROME
Most common causes in our country are...volume loss...HUS....and Infections
In critical care settings, AKI is most commonly caused bby secondary renal injury---ACUTE TUBULAR NECROSIS
The initiation phase --- primary insult resulting in drop in GFR and tubular dysfunction
Maintainance phase --- oligoanuria.
The recovery phase ---restoration of GFR and Tubular functions and manifests with polyuria initially, after which the urine output returns to normal
Gfr= k X ht / S.creatinine.........V x U / p ---- urine creatinine x blood flow / s. cratinine
FO = [(Fluid IN – Fluid OUT (L)) / (Admit weight in kilograms)] * 100
SCORE MORE THAN 8 PREDICTS POOR OUTCOME
400ml/m2/day + urine output + extra body fluid losses
Sodiyn Polysterene sulphate resin—Kayexelite---exchanges potassium with sodium---can lead to Hypernatremia
Isradipine....beta blockers....calcium channel blockers.....
In hypertensive emergencies...nicardipine, sodium nitroprusside
Lethargy seizures
Calcium carbonate...calcium oxalate...
Avoided for tetany
High sodium :: ............, Low sodium.........
High potassium::...........low pottasium........
High phosphorous::...........low phosphorous::.......
Haemodialysis :Used to remove nitrogenous wastes from the body
The dialysis machine contains a number of tubes with semi permeable lining, suspended in a tank filled with dialysing fluid
This fluid has the same osmotic pressure as blood,except that it lacks nitrogenous wastes.
One line connected to the artey is connected to the one end of dialysis device where blood is collected from patient for filtration
During this passage,the waste products from the blood pass into the dialysing fluid by diffusion.
The purified blood is pumped into the vein of the patient which is connected to the other end of the dialysis device.
this is similar to the function of the kidney but it is different in the way that no reabsorption is involved.
Normally,in a healthy adult,the intake filtrate in the kidneys is 180 litres.
However,the volume is actually only a litre or two a day because the remaining filtrate is reabsorbed in the kidney tubules.
In the dialyser are thousands of fine fibre tubes that mimic the body's own glomeruli and filter the blood as it flows through them. They are semi-permeable and allow the small molecules of fluids and soluble wastes to move through tiny holes in the membrane into the surrounding canister which is continuously flushed with dialysis fluid.
peritoneal dialysis uses the peritoneum as the filter.
A tube called the catheteres (tenckhoff) surgically placed through the wall of the abdomen.
About 3-4 inches is left outside.
A special solution Hypertonic diasylate flows from the catheter into the peritoneal cavity.
As the solution remains in the peritoneal cavity,waste products and excess fluid pass from the blood through the peritoneal membrane into the filtering device. After a certain number of hours,solution is drained out of the peritoneal cavity.
Small molecule removed by convection diffusion
Middle: convection
Large: convection
Extra large: minimal by crrt