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"
Peritoneal dialysis is the most common form of renal replacement therapy performed in the home. Peritoneal dialysis is the process of removing excess fluid and metabolic by-products from the body by circulating dialysis solution through the peritoneal cavity using a peritoneal catheter.
lecture presented at Al-Mahmoudiya General hospital in the 30th Aug 2023
based upon recent governmental protocols of antibiotic selection, dosage forms conversion by MOH 2023
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
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.
Follow us on: Pinterest
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
5. Paired Blood Cultures
or
When a peripheral blood sample
cannot be obtained
From the
catheter
From
Dialysis
circuit
2 quantitative blood cultures of
samples obtained through
2 catheter lumens
6. Culture Results
Results Diagnosis
Same organism from both samples CRBSI Confirmed
Both negative CRBSI Unlikely
Negative peripheral blood culture
BUT
Positive central blood culture
Probably contamination
(don’t treat EXCEPT if
Staph. Aureus)
12. Empirical Antibiotics
Antibiotic To cover Condition
Vancomycin MRSA for institutions in with preponderance of MRSA
Gentamycin
(if absolutely
contraindicated use
Quinolones)
Gram –ve
---------------------
Meropenem, Imipenem
or Etrapenem
or
Piperacillin/Tazobactam
in community with low
incidence of antibiotic
resistance
MDR Gram –ve In neutropenic patients, severely ill patients with
sepsis, or patients
known to be colonized with such pathogens
Fluconazole or
Echinocandin
Candidemia total parenteral nutrition, prolonged use of
broad-spectrum antibiotics, hematologic
malignancy, receipt of bone marrow or solid-
organ transplant, femoral catheterization,
or colonization due to Candida species at
multiple sites
13. Alternatives to vancomycin as a first
choice broad spectrum
Condition Alternative
the preponderance of MRSA
isolates have vancomycin
minimum inhibitory
concentration (MIC) values 12
mg/mL
Daptomycin
16. Dialyziability & Residual Renal
Function Effect
• Vancomycin is not removed by HD; gentamicin
is.
• Measure gent levels daily (levels will decrease
sooner in patients with significant residual
function).
• Monitor predialysis trough levels if possible
2017
26. Duration of Systemic and
Antibiotic Lock
Pathway 1:
Catheter Salvage
If catheter is retained for a
patient with S. aureus CRBSI
Continue systemic and antibiotic
lock therapy for 4 weeks
27. Duration of Systemic and
Antibiotic Lock
Pathway 1:
Catheter Salvage
If catheter is retained for a
patient with any other organism
No clear data for systemic and
antibiotic lock therapy salvage
duration
28. Antibiotic Lock Special Situation
Multiple positive catheter blood culture
BUT concurrent negative peripheral
blood cultures
Antibiotic lock therapy without systemic
therapy for 10–14 days
29.
30. guide wire
Start Empirical Antibiotics
as in salvage pathway
Reassess after 2-3 days:
Clinically (fever) & Lab (WBC, CRP)
Improving?
Yes
Exchange on
guide wire
Continue antibiotics
Pathway 3:
Surveillance
No
Pathway 4:
Catheter removal
Pathway 2:
Exchange on guide wire
Duration of
Systemic and
Antibiotic
Lock
31. Duration of Systemic and
Antibiotic Lock
If catheter is exchanged for a
patient with any organism
No clear data for systemic and
antibiotic lock therapy salvage
duration
Pathway 2:
Exchange on guide wire
32.
33. Pathway 3:
Surveillance
bloodstream infection that continues
despite >72 h of antimicrobial therapy
to which the infecting microbes are
susceptible
2 sets of blood cultures obtained on a
given day
34. Pathway 3:
Surveillance If the catheter has been retained
Surveillance blood cultures 1 week after
completion of an antibiotic course
If blood cultures +ve →
the catheter should be removed
New, long term dialysis catheter after
additional –ve blood cultures
35.
36. Pathway 4:
Catheter removal
Remove catheter and
culture tip (5 cm)
Start empirical antibiotics as
in salvage pathway
Is access is needed urgently for dialysis?
Yes
Insert
temporary
catheter in
another site
for short
period of time
No
Continue antibiotics
Insert long term catheter
ONLY if:
1- afebrile for 48-72 hours
2- CRP is normal
3- Blood cultures are -ve
Duration?
38. Persistent fungemia or
bacteremia >72 h after catheter
removal
4 to 6 weeks of
antibiotic therapy
should be administered
Additional TEE should
be obtained
Catheter Removal Special Situation (1)
39. Catheter Removal Special Situation (2)
Catheter tip grows S. aureus
but
Initial peripheral blood cultures -ve
5–7-day course of antibiotics
Close monitoring for signs and symptoms of ongoing infection,
including additional blood cultures, as indicated
42. Prevention - Catheter
• Strict aseptic circumstances.
• Avoid as much as possible:
– using non-tunneled catheters.
– using femoral
• Monitor the catheter:
– visually when changing the dressing
– or by palpation through an intact dressing on a
regular basis.
43. Prevention – Exit Site
• Application of antibiotic ointment at the exit
site until the insertion site has healed
• The catheter exit site should be covered by a
dressing as long as the catheter remains in
place.
44. Prevention – Antimicrobial Lock
• Its use is debated.
• Its use may be saved to patients with:
– history of multiple CRBSI
– those with high risk of severe sequelae (patients
with pacemakers, prosthetic valve or IV devices).
• Citrate locks have, for the time being, most
extensively been studied. (The 4% solution seems
to offer at present the best benefit/risk ratio).
45. Prevention – Staphylococcus
• Eradication of Staphylococcus carriage (nasal
mupirocin cream).
• Consider IV antibiotics at insertion for patients
with Staphylococcal skin colonisation.