Chpt 7 part 1 - chemical nomenclature 042403phspsquires
The document provides an overview of chemical nomenclature and naming conventions for compounds. It discusses the need for a systematic naming system to 1) prevent confusion between compounds, 2) avoid complex formulas, and 3) group similar compounds into families. It then covers naming conventions for binary compounds containing two nonmetals, binary compounds containing a metal and nonmetal, and compounds named using the "ic/ous" method involving metal oxidation states. The goal is to establish a logical and consistent system for naming chemical compounds based on their formulas and elemental components.
Brief explanation of dybiosis and leaky gut syndrome. Herbal and dietary recommendations using Inno-Vita formulas. This information is for education purposes only. Herbal programs should be monitored by a qualified health professional.
Brief description of herbal and dietary protocols for inflammatory bowel disease. Information is provided for education purposes only. All health programs should be monitored by a qualified health professional.
Chpt 7 part 1 - chemical nomenclature 042403phspsquires
The document provides an overview of chemical nomenclature and naming conventions for compounds. It discusses the need for a systematic naming system to 1) prevent confusion between compounds, 2) avoid complex formulas, and 3) group similar compounds into families. It then covers naming conventions for binary compounds containing two nonmetals, binary compounds containing a metal and nonmetal, and compounds named using the "ic/ous" method involving metal oxidation states. The goal is to establish a logical and consistent system for naming chemical compounds based on their formulas and elemental components.
Brief explanation of dybiosis and leaky gut syndrome. Herbal and dietary recommendations using Inno-Vita formulas. This information is for education purposes only. Herbal programs should be monitored by a qualified health professional.
Brief description of herbal and dietary protocols for inflammatory bowel disease. Information is provided for education purposes only. All health programs should be monitored by a qualified health professional.
#6 digestive system general maintenance and disordersHome Makers
Sample herbal protocols for general maintenance and healing of the digestive system using herbal products from Inno-Vita and Systemic formulas. This information is for education purposes only and specific programs should be monitored by a qualified health professional.
Primera aproximación al uso de la arcilla, como material de modelado, con el alumnado del I nivel de lI ciclo de Educación Infantil. CEIP "El Morche" Torrox Costa, Málaga. Enero 2016
Cancer cell identity can be changed by macrophages through a process of cultural adaptation and renewal. This cellular adaptation allows cancer cells to survive under suboptimal conditions.
#6 digestive system general maintenance and disordersHome Makers
Sample herbal protocols for general maintenance and healing of the digestive system using herbal products from Inno-Vita and Systemic formulas. This information is for education purposes only and specific programs should be monitored by a qualified health professional.
Primera aproximación al uso de la arcilla, como material de modelado, con el alumnado del I nivel de lI ciclo de Educación Infantil. CEIP "El Morche" Torrox Costa, Málaga. Enero 2016
Cancer cell identity can be changed by macrophages through a process of cultural adaptation and renewal. This cellular adaptation allows cancer cells to survive under suboptimal conditions.
INIFD presented its GENNEXT fashion show at Lakme Fashion Week. Ritu Kochhar, the corporate director of INIFD, crowned Deepti Sati as Miss INDIA Talented. Deepti Sati was previously crowned Femina Miss India 2014.
The Basics of Protecting PHI - Best Practices When Working with Business Asso...Endeavor Management
Ultimately, transparency and explicit conversations about HIPAA compliance are critical for protecting patient information. Healthcare professionals should feel encouraged to ask specific questions about how PHI will be stored and managed to ensure compliance. This white paper outlines several tips in working with your vendors regarding the proper handling of PHI. Based on Gelb’s experience, we have outlined several tips (and perhaps requirements) for your projects moving forward.
Este documento describe diferentes alternativas para resolver conflictos como la negociación, mediación, conciliación y arbitraje. La negociación implica que las partes en conflicto traten de resolver sus diferencias directamente a través de un proceso de comunicación dinámico. La mediación involucra a un tercero imparcial que ayuda a las partes a identificar sus intereses y encontrar un acuerdo mutuamente aceptable. La conciliación implica que las partes acudan a un centro de conciliación para que un evaluador neutral les aclare la situación litigios
This document provides an overview of network defense for the US Army Enterprise in Southwest Asia. It describes the tiered architecture of the network and the major threats faced, including unauthorized access, denial of service attacks, and insider threats. It then discusses the defense in depth approach used across three tiers, with different tools and techniques employed at each level, such as intrusion detection/prevention systems, firewalls, encryption, and vulnerability management. The goal is to implement multiple overlapping security layers to mitigate risks and slow threats until administrators can respond.
This document discusses a clinical case of a man with advanced liver disease and sepsis who is experiencing worsening coagulopathy. It then reviews several potential causes of acquired bleeding disorders including liver disease, vitamin K deficiency, disseminated intravascular coagulation (DIC), massive transfusion, uremia, acquired hemophilia, and acquired von Willebrand disease. For this patient, the likely contributing factors are coagulopathy of liver disease, vitamin K deficiency, DIC, and the effects of his low-dose aspirin. The management outlined is vitamin K supplementation, holding blood products unless bleeding occurs, and discontinuing aspirin if possible.
Objective: Design projects to seek balance between technical and administrative aspects.
Implement a sub-basin approach.
Avoid decisions based on achieving a quick fix.
Be focused but also flexible.
Use environmental projects as a starting point for cooperation on other issues.
Design projects to actively involve countries.
Consider the full impacts of the project, including poverty alleviation.
For Instructional Skills Workshops, after discussing lesson plans, we discuss the characteristics of good feedback and create a charter for working with each other. After this, I model a mini-lesson.
This patient with newly diagnosed myeloma presented with a large gluteal hematoma one week following a bone marrow biopsy. Initial workup found decreased factor XIII antigen and activity levels. Further testing showed evidence of amyloid deposits on fat pad biopsy and cardiac MRI consistent with amyloidosis, which can cause acquired bleeding disorders through effects on coagulation factors and platelets. The differential diagnosis includes evaluating for qualitative or quantitative platelet disorders, coagulation factor deficiencies, and structural causes of bleeding in the setting of a paraproteinemia like myeloma.
Coag testing for hema fellows mskcc 10 15 2015 dr peerschkederosaMSKCC
1) Coagulation screening tests such as PT, APTT, fibrinogen and thrombin time are used to identify underlying coagulation defects, monitor anticoagulation therapy, and evaluate for disorders involving coagulation and fibrinolysis.
2) Prolonged screening test results require follow up with mixing studies and specific factor assays to determine if the cause is a factor deficiency, inhibitor, or circulating anticoagulant.
3) Lupus anticoagulant testing involves two assays based on different principles, such as a dilute Russell's viper venom time and a sensitive activated partial thromboplastin time, to diagnose the presence of antibodies against phospholipids.
Hemophilia fellow talk2015 dr parameswaranderosaMSKCC
This document provides an overview of hemophilia, including its history, genetics, clinical presentation, complications, treatment, and future directions. It discusses the case of Alexis Nicolaievich, the hemophilic heir to the Russian throne in 1904. It then reviews factor replacement therapy, prophylaxis, complications like inhibitors, and emerging therapies like gene therapy. The document is intended to define hemophilia, review its treatment over time from 1904 to the present, and discuss ongoing research directions.
Drug induced hemolytic anemia cc 10 8-15 - dr mehta-shahderosaMSKCC
A 59-year-old woman presented with new-onset jaundice and anemia 10 days after undergoing surgery for uterine cancer. Laboratory workup found evidence of hemolysis including a positive direct Coombs test. Further testing revealed the patient's red blood cells were sensitizied to the antibiotic cefotetan, indicating drug-induced immune hemolytic anemia. She was treated with transfusions and the hemolysis resolved after discontinuing the offending drug. Drug-induced immune hemolytic anemia is a rare but serious complication that can be triggered by certain antibiotics like cefotetan through non-immune or immune mediated mechanisms.
This patient case involves a 56-year-old man with a history of JAK2 V617F+ essential thrombocythemia who developed severe anemia and was found to have myelodysplastic syndrome/myelofibrosis. He presented with transfusion-dependent anemia and was found to have concurrent warm autoantibody-mediated hemolytic anemia and delayed hemolytic transfusion reaction due to alloimmunization to the Kell blood group antigen. He required intensive care for management of his conditions.
This document discusses work-life balance, burnout, and wellness among physicians. It begins by defining key terms like burnout, work-life balance, and wellness. It then discusses the high prevalence of burnout and work-life dissatisfaction among physicians compared to the general population. Some consequences of physician distress include medical errors, poorer patient outcomes, and reduced workforce. The document considers tensions between a culture that values productivity and the need for self-care. It provides strategies for building resilience through stress management, prioritizing wellness, developing social support, and creating a culture that supports physician well-being.
This document provides guidance on the management of acute gastrointestinal bleeding. It discusses:
1) Performing a thorough history and physical exam to assess bleeding severity, risk factors, and stability. Guaiac testing has limited utility for inpatients.
2) Initial stabilization including IV access, fluid resuscitation, PPI administration, and consideration of ICU care for unstable patients.
3) Etiologies of upper and lower GI bleeding and their typical clinical presentations. Endoscopic therapies are usually first-line but angiography or surgery may be needed for active or refractory bleeding.
This document provides guidance on evaluating a patient presenting with anemia. It recommends:
1. Calculating the reticulocyte index to determine if the cause is blood loss, red blood cell destruction, or impaired red blood cell production.
2. If production is impaired, check the mean corpuscular volume to identify microcytic, macrocytic, or normocytic anemia.
3. Order targeted labs depending on the mean corpuscular volume to identify causes like iron deficiency anemia, vitamin B12 or folate deficiency, or bone marrow disorders.
This document provides an overview of abnormal liver function tests (LFTs), biliary tract disease, and ascites. It discusses the common causes and patterns of abnormal LFTs, including hepatocellular and cholestatic patterns. Specific diseases that can cause these patterns like acute viral hepatitis, autoimmune hepatitis, and primary biliary cholangitis are outlined. Procedures for evaluating biliary tract disease like ultrasound, MRCP, and ERCP are mentioned. The document also reviews when and how to perform paracentesis for ascites, how to analyze the fluid for spontaneous bacterial peritonitis, and guidelines for albumin replacement after large volume paracentesis.
This document provides guidance on evaluating abdominal pain and summarizes 7 clinical cases presenting with abdominal pain. It outlines an approach to the initial assessment of abdominal pain, including differentiating between serious or surgical causes versus non-surgical causes and priorities for pain control. It also reviews high-risk features of abdominal pain and provides a template for the history, physical exam, differential diagnosis, appropriate labs and imaging to evaluate abdominal pain. The 7 cases serve as examples to demonstrate the application of this approach.
This document provides an overview of immunotherapy and how it works to treat cancer. It discusses the roles of T cells, antigen presenting cells, and cytokines in the immune response. It describes how tumors evade immune surveillance and strategies used in immunotherapy to overcome tumor resistance, such as blocking inhibitory receptors like CTLA-4 and PD-1 to reactivate T cells. Several studies are summarized that show improved survival outcomes for cancers like melanoma when treated with immunotherapies like nivolumab compared to chemotherapy. Combination approaches blocking multiple pathways are also discussed.
This document provides an overview of immunotherapy and how it works to treat cancer. It discusses the different types of T cells like CD4+ helper T cells and CD8+ cytotoxic T cells. It describes antigen presenting cells and their role in activating T cells. It explains how tumors evade immune surveillance and the factors that allow this. It discusses different immunotherapy approaches like blocking the CTLA-4 and PD-1 pathways with drugs like ipilimumab and nivolumab. Clinical trial results are summarized that show improved survival with these immunotherapies compared to chemotherapy in cancers like melanoma. Combination approaches are also discussed.
A 69-year-old man with metastatic pancreatic cancer presented with coagulopathy, hypotension, and melena. He had been receiving enoxaparin for DVT but now had markedly elevated PT and aPTT due to accumulation of enoxaparin from renal impairment, vitamin K deficiency from poor nutrition, and possible DIC. Hematology recommended administering protamine to reverse the effects of enoxaparin, 4-factor prothrombin complex concentrate to correct the coagulopathy, and continued vitamin K to address the deficiency. The patient's coagulopathy improved after these interventions but his renal function did not.
This document discusses the treatment of anemia and the need for red blood cell substitutes. It begins by outlining the reasons to treat anemia and discusses the mortality risk of anemia versus the morbidity of red blood cell transfusions. Current possibilities for red blood cell substitutes are then summarized, including hemoglobin-based oxygen carriers (HBOCs) such as Hemopure, Polyheme, and Sanguinate. Toxicities of HBOCs like vasoconstriction and nitric oxide depletion are also noted. The document concludes by discussing protocols for managing severe anemia in the interim before fully developed red blood cell substitutes, and the potential of in vitro production of red blood cells as a future option.
This document discusses three cases of von Willebrand disease (VWD) and provides details on evaluating and diagnosing the condition.
Case 1 is an 18-year-old woman with easy bruising and heavy menses, who has type 1 VWD. Case 2 is a 32-year-old pregnant woman with a family history of bleeding, who has type IIN (VWD Normandy). Case 3 is a 55-year-old woman with life-long severe bleeding who has type 3 VWD.
The document then provides in-depth information on VWD classification, laboratory evaluation, clinical presentation, treatment options including DDAVP and Humate-P, and modifiers like blood type and comor
This document provides an overview of evaluating and managing chest pain. It discusses the many potential causes of chest pain including cardiac, pulmonary, gastrointestinal and psychiatric conditions. Key points include that up to 30% of cardiac catheterizations for suspected coronary artery disease are negative. The diagnostic workup involves considering the patient's history, symptoms, physical exam, ECG, cardiac biomarkers, imaging and ruling out life-threatening causes like aortic dissection and pulmonary embolism. For suspected acute coronary syndrome, treatment involves antiplatelet agents, anticoagulants, nitroglycerin, beta-blockers, oxygen and considering cardiac catheterization if within 90 minutes of symptoms.
1. Neutropenic fever and tumor lysis syndrome are hematologic oncologic emergencies that require prompt assessment and treatment to prevent complications and death.
2. Patients at high risk for complications from neutropenic fever should receive inpatient empiric antibiotics targeting pseudomonas such as an antipseudomonal beta-lactam with vancomycin.
3. For persistent fevers, the treatment regimen should be modified based on cultures and the patient should be reassessed for new infections, including invasive fungal infections if fevers persist for more than 4 days. Catheter-related bloodstream infections also require prompt management.
Empiric antibiotic management for major infectionsderosaMSKCC
This document provides guidance from an infectious diseases physician on various infectious disease topics. It addresses appropriate workups, empiric antibiotic choices, and treatment durations for common infections seen at MSKCC including bloodstream infections, pneumonia, intra-abdominal infections, C. difficile colitis, skin and soft tissue infections, and febrile neutropenia. Emphasis is placed on obtaining appropriate cultures prior to antibiotics and tailoring treatment based on culture results and patient risk factors.
This document discusses various types and classifications of pneumonia, including community acquired pneumonia (CAP), hospital acquired pneumonia (HAP), healthcare associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). It then presents four clinical case studies of patients presenting with pneumonia and discusses the likely pathogens involved, appropriate testing, and treatment recommendations for each case. Key considerations included distinguishing between various pneumonia types and selecting initial empiric antibiotic therapy based on likely pathogens and patient risk factors or comorbidities.
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