This document presents a case study of a 50-year-old male patient with chronic kidney disease due to diabetic nephropathy. The patient has a 15-year history of type 2 diabetes and non-proliferative diabetic retinopathy. Diagnostic tests show elevated blood sugar, creatinine, and signs of kidney damage. The patient is assessed as having progressed chronic kidney disease due to diabetic nephropathy. His treatment plan includes insulin, medications to protect the kidneys and manage symptoms, and lifestyle changes to control his diabetes and slow disease progression.
case presentation on Acute Kidney Injury.
AKI is reservisible loss of kidney function which leads to increase in serum creatinine and BUN over the course of hours to weeks.
viral hepatitis is one of the chronic disease and can cured with proper treatment and care .Here is the case study on viral hepatitis for pharmacy students .
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
thank u
Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
case presentation on Acute Kidney Injury.
AKI is reservisible loss of kidney function which leads to increase in serum creatinine and BUN over the course of hours to weeks.
viral hepatitis is one of the chronic disease and can cured with proper treatment and care .Here is the case study on viral hepatitis for pharmacy students .
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
thank u
Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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.
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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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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.
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
case presentation on CKD
1. CASE PRESENTATION ON CHRONIC KIDNEY
DISEASE WITH DIABETIC NEPHROPATHY
Presented By
Percy Arpitha.B
Pharm-D IIIYr
12Y01T0019
1
2. DEMOGRAPHIC DATA
NAME: xxx
AGE: 50 yrs
GENDER: male
I.P. NO: 8998/14
D.O.A: 8-1-14
D.O.D: Not Known
WARD: Delux Ward
CONSULTANT: Dr. V. Venkata Ranga Reddy
REFERRED TO : Dr. Nemali Ravi Kumar Reddy
Dr. Venkata Pakkir Reddy
2
4. CHIEF COMPLAINTS
C/O loss of appetite( anorexia) since
a month
C/O Generalized weakness &
fatigue
HISTORY OF PRESENT ILLNESS
H/O fever (night time) since 15
days
4
5. PAST MEDICAL HISTORY:
Type II diabetes mellitus(DM) since
15 yrs and not on regular medication
NPDR(Non Proliferative Diabetic
Retinopathy)
PAST MEDICATION HISTORY: not known
PAST SURGICAL HISTORY: Nil
5
6. PERSONAL HISTORY AND HABITS:
Chronic smoker and alcoholic since
20yrs
FAMILY HISTORY:
Father suffered with DM &
HTN
6
8. GENERAL EXAMINATION
PHYSICALEXAMINATION
Date 8-1-15 9-1-15 10-1-15
Temp N N N
B.P in mm of
Hg
120/80 140/90 110/70
P.R 92/min 86/min 86/min
R.R 24/min 22/min 24/min
SYSTEMEXAMINATION
Cvs: s1,s2 +
Rs: ↓↓ breath sounds (dull note)
8
9. DIAGNOSTIC INVESTIGATIONS
COMPLETE BLOOD PICTURE
TEST TEST VALUE NORMAL VALUE
Hb 10 g/dl 13-17g/dl
RBC 3.79 million/cumm 4.5-5.5million/cumm
TLC(WBC) 15600 cells/cumm 4000-
11000cells/cumm
Differential Leukocyte
Count
Neutrophils 89 % 40-80%
Lymphocytes 08 % 20-40%
Eosinophils 01 % 0-6%
Monocytes 02 % 2-10%
ESR 38 mm/hr 0-20mm/hr
9
10. TEST TEST VALUE NORMAL VALUE
TOTAL BILIRUBIN 0.7 mg/dl 0.0-1.0mg/dl
DIRECT BILIRUBIN 0.2 mg/dl 0.0-0.25mg/dl
INDIRECT BILIRUBIN O.5 mg/dl 0.3-1.0 mg/dl
SGPT 55 IU/L 0-45 IU/L
SGOT 23 IU/L 0-40 IU/L
ALKALINE
PHOSPHATASE
222 IU/L 30-170 IU/L
TOTAL PROTEIN 7.8 g/dl 6-8g/dl
ALBUMIN 3.0 g/dl 3.5-5.5g/dl
GLOBULIN 4.8 g/dl 2.3-3.6g/dl
LIVER FUNCTION TESTS
10
11. TEST 8-1-15 9-1-15 10-1-15 NORMAL
VALUE
FASTING 240 mg/dl 210 mg/dl 60-110mg/dl
RANDOM 255 mg/dl 315 mg/dl 80-150mg/dl
BLOOD SUGAR TEST
RENAL FUNCTION TESTS
TEST 8-1-15 9-1-15 Normal value
BUN 67 mg/dl 10-50mg/dl
Creatinine 1.8 mg/dl 1.9 mg/dl 0.6-1.6mg/dl
11
16. Based On Subjective And Objective Evidence The Patient Is A
Known Case Of Diabetes Mellitus And Newly Diagnosed To Have
Progressed Chronic Kidney Disease Due To Diabetic Nephropathy
16
20. EPIDEMIOLOGY
Over 40% of new cases of end-stage renal disease (ESRD) are attributed
to diabetes.
In 2001, 41,312 people with diabetes began treatment for end-stage renal
disease.
In 2001, it cost $22.8 billion in public and private funds to treat patients
with kidney failure.
Minorities experience higher than average rates of nephropathy and
kidney disease
20
21. PATHOPHYSIOLOGY
Three major histologic changes occur in the glomeruli of persons with diabetic
nephropathy.
1. Mesangial cell expansion directly induced by hyperglycemia
2. Thickening of the glomerular basement membrane
3. Glomerular sclerosis is caused by intraglomerular hypertension
21
22. Uncontrolled diabetes leading to persistent Hyperglycemia induces ,
Endothelial NO uncoupling
Activation of Pkc
Formation of advanced glycation end products
Activation of polyol pathway
22
28. GLOMERULOSCLEROSIS
-Hardening of glomerulus due to scarring
-Disturbs filtering process
-2 types
• Focal segmental
• Nodular (significant in diabetes)
-Nodules of pink hyaline material formed in glomerular capillary
loops
28
29. CLINICAL PRESENTATION
You may not experience any symptoms until your kidney
disease progresses to ESRD. Symptoms of ESRD may include:
Microalbuminuria
-First laboratory finding of DN
-Moderate increase in level of urine albumin
-Occurs when kidney leaks small amount of albumin into
urine
Anorexia
Nausea and vomiting
General ill feeling
Fatigue
Headache
Itchy and dry skin
Swelling of arms and legs 29
30. Chronic Kidney Disease (CKD)
Or
Chronic Renal Failure(CRF)
DEFINITION
Chronic kidney disease (CKD), also known as chronic renal disease, is a
progressive loss in renal function over a period of time. The three most common
causes of CKD are,
-Diabetes mellitus
-Hypertension and
-Glomerulonephritis.
Together, these cause about 75% of all adult cases.
30
31. 31
PATHOPHYSIOLOGY
Involves 2 broad sets of mechanisms
Initiating mechanisms specific to underlying etiology
Progressive mechanisms, involving hyperfiltration and
hypertrophy of viable nephrons
37. 37
Complications Related To Case
Uremic pericarditis
o Results frominflammationof visceral & parietal membranes of the pericardialsac.
o There is a correlation b/wdegree of azotemia(BUNis usually>60)althoughpathogenesis
is poorlyunderstood
Emphysematous pyelonephritis(EPN)
o Severe infection of renal parenchymathat causes gas accumulation in the tissues.
o However UTI’sare common in persons withdiabetes, but not all of these infections lead
to EPN
o Factors predisposing to EPN
-Uncontrolled diabetes
-High levels of glycated Hb
-Impaired host immune mechanism
38. 38
Typical presenting features of EPN include thefollowing:
• Fever (79%)
• Abdominal or flankpain(71%)
• Nausea and vomiting (17%)
• Dyspnea (13%)
• Acute renal impairment (35%)
• Alteredsensorium(19%)
• Shock(29%
Laboratory findings include the following:
• Leukocytosis with a left shift
• Pyuria
39. 39
TREATMENT
SLOWING PROGRESSION
Treatment of underlying cause
Glycemic targets need to be relaxed
Blood pressure control is vital. Agents that block RAAS are imp in
proteinuric disease
Oral alkali therapy in slowing CKD progression if acidemia is
present
Modify Loading And Maintenance Doses Of Drugs That Are
Excreted Through Renal Route.
40. 40
NON PHARMACOLOGICAL
Dietary management
Protein restriction : Decrease protein intake to 0.6-0.8g/kg/day in
patients with GFR <30ml/min
Phosphate restriction : Food like cola beverages,nuts,beans,meat
should be limited.To reduce soft tissue calcification (avoid milk, egg)
Salt & water restriction : Moderate sodium restriction to control BP
and edema
Potassium restriction : If CKD is moderate to severe (avoid food like
banana,citrus,coconut water, papaya etc.)
41. 41
o Smoking and alcohol cessation
o Diet and weight management
o Regular exercise
PHARMACOLOGICAL
o Target BP in both diabetic and non-diabetic patients is <140/90 mm of Hg
and in patients with urine albumin excretion >/=30mg/24hrs,target BP is
consistently <130/80mm of Hg
Tab.Furosemide 40-160mg/day or
Tab.Amlodipine 5-20mg/day or
Tab.Atnelol 50-100mg/day (contraindicated if concomitant
cardiomyopathy with failure.
o In both diabetic and non diabetics with albuminuria >300mg/24hrs –
ACE inhibitor/ARB with or without a diuretic is preferred.
42. 42
Treatment Of ESRD
When GFR declines to 5-10ml/min with or without uremic
symptoms
Renal Replacement Therapy
• Hemodialysis
• Peritoneal dialysis
• Kidney transplantation
Pancreatic Transplantation
can produce insulin independence which slow or reverse microvascular
disease
Medical Management
43. 43
Treatment Of Pericarditis
• Uremic pericarditis is an absolute indication for initiation of dialysis.
• Heparin-free dialysate should be used.
Treatment Of Anemia
• Look for common aggravating causes of anemia eg: GI blood loss, iron
deficiency and chronic infections & treat accordingly.
• Iron supplementation to ensure adequate response to EPO
• Inj.EPO s/c 80-120units/k/week(divided into 2-3 times a week)
• The target Hb should be 10-12g/dl
44. 44
Monitoring And Interventions
Treatment with metformin should be withdrawn
when creatinine is ↑ than 1.7mg/dl.This increases
lactic acidosis
Long acting sulphonyl urea's are replaced by short
acting which are metabolised rather than excreted
Monitor dosing of renally eliminated drugs
Drug toxicity may develop as renal clearence
worsens;in particular ,since insulin is renally cleared
,hypoglycemia may develop& can be life theatening in
patients with diabetes
45. 45
In DN for reducing arterial HTN
- In type I DM - ACE inhibitors provide
greater benefit
-In type II DM – ARB’s shows same effect
• But these cause hyperkalemia and renal artery
stenosis sometimes hence Non dihydropyridine
ca+2 antagonists (diltiazem, verapamil)are
suitable alternatives.