1) The document discusses the evaluation of abnormal liver enzyme results in asymptomatic patients. It outlines the common causes of elevated aminotransferase levels such as alcohol abuse, chronic hepatitis B and C, autoimmune hepatitis, and medications.
2) The first step is to repeat the liver enzyme tests and evaluate the degree of elevation. If still abnormal, further history, examination, and targeted blood tests are needed to identify the underlying cause.
3) Common causes vary by population but include fatty liver, hepatitis C, alcohol use, and other conditions. Evaluation of enzyme patterns and additional testing can usually identify the cause.
Breakthroughs in the treatment of acute promyelocytic leukemia: curable disea...spa718
1) Studies have shown that arsenic trioxide combined with ATRA is an effective treatment for acute promyelocytic leukemia (APL) when used as a frontline treatment or for relapsed cases.
2) Recent trials have found that using arsenic trioxide and ATRA without chemotherapy results in high remission rates and long-term survival for non-high risk APL similar to standard regimens using chemotherapy.
3) Oral formulations of arsenic have been developed and shown to be effective with improved tolerability compared to intravenous arsenic trioxide.
The patient presented with breathlessness and swelling of the face and legs. Examination revealed elevated jugular venous pressure, bilateral pitting edema, and crepitations in both lung bases. Investigations showed cardiomegaly, bilateral pleural effusion, and hypothyroidism. The patient was diagnosed with heart failure, acute left ventricular failure, and hypothyroidism and started on diuretics, antihypertensives, and thyroxine replacement.
Mycophenolate mofetil or intravenous cyclophosphamideNahid Sherbini
This study compared the effectiveness of mycophenolate mofetil (MMF) versus intravenous cyclophosphamide (IVC) for treating lupus nephritis. Over 24 weeks, MMF was found to be as effective as IVC in achieving remission, with fewer severe side effects like infections. While not blinded, MMF had a more favorable safety profile compared to IVC which had several hospitalizations due to dehydration from gastrointestinal symptoms. However, the study was limited by its short duration and not assessing long-term outcomes of remission.
The management of advanced prostate cancer has been revolutionized by the translation of the rapid progress made in understanding the biology of the disease into new therapies. While these developments are unprecedented, many challenges remain, including our need to understand how best to utilize these new treatments, how to integrate them into current treatment paradigms and how to demonstrate the most cost effective ways to use these new drugs. Dr. Dreicer briefly reviews the most important of the new developments, progress to date in integrating these new therapies, and speculates how these developments will translate into improvements in patient outcomes.
This document discusses drug-induced liver injury (DILI) caused by anti-tuberculosis (ATT) drugs. It notes that ATT drugs, particularly isoniazid, rifampin, and pyrazinamide, are common causes of DILI. Isoniazid metabolism varies depending on acetylator status, and its toxicity may be due to reactive metabolites. Rifampin induces liver enzymes and its toxicity is often seen in combination with other ATT drugs. Pyrazinamide toxicity depends on dose and can cause fatty liver. Presentations of ATT-induced DILI range from asymptomatic elevations in enzymes to acute liver failure. Careful screening and monitoring of patients on ATT is needed to prevent DILI
The document discusses several cases of glomerular disease:
1) A 27-year-old male with nephrotic syndrome and a kidney biopsy showing IgG and C3 deposits along the glomerular basement membrane consistent with membranous nephropathy.
2) A 78-year-old female admitted with nephrotic syndrome after a history of NSAID use, with a biopsy showing focal segmental glomerulosclerosis.
3) A 26-year-old male with nephrotic syndrome and renal impairment, whose biopsy demonstrated membranoproliferative glomerulonephritis with C3 deposition and subendothelial electron dense deposits. Follow up showed elevated
All-trans retinoic acid related complications in a patient with acute promy...Choying Chen
1) The patient, a 6-year-old female, presented with generalized petechiae and prolonged epistaxis. Laboratory results showed high white blood cell count with 46% blasts and 44% promyelocytes containing Auer rods, consistent with acute promyelocytic leukemia (APL).
2) She received induction therapy for APL per the TPOG-APL-2001 protocol including all-trans retinoic acid (ATRA) and chemotherapy. She experienced complications including fever, pleural effusion, and later pseudotumor cerebri, thought to be related to a drug-drug interaction between ATRA and fluconazole.
3) Her course
Breakthroughs in the treatment of acute promyelocytic leukemia: curable disea...spa718
1) Studies have shown that arsenic trioxide combined with ATRA is an effective treatment for acute promyelocytic leukemia (APL) when used as a frontline treatment or for relapsed cases.
2) Recent trials have found that using arsenic trioxide and ATRA without chemotherapy results in high remission rates and long-term survival for non-high risk APL similar to standard regimens using chemotherapy.
3) Oral formulations of arsenic have been developed and shown to be effective with improved tolerability compared to intravenous arsenic trioxide.
The patient presented with breathlessness and swelling of the face and legs. Examination revealed elevated jugular venous pressure, bilateral pitting edema, and crepitations in both lung bases. Investigations showed cardiomegaly, bilateral pleural effusion, and hypothyroidism. The patient was diagnosed with heart failure, acute left ventricular failure, and hypothyroidism and started on diuretics, antihypertensives, and thyroxine replacement.
Mycophenolate mofetil or intravenous cyclophosphamideNahid Sherbini
This study compared the effectiveness of mycophenolate mofetil (MMF) versus intravenous cyclophosphamide (IVC) for treating lupus nephritis. Over 24 weeks, MMF was found to be as effective as IVC in achieving remission, with fewer severe side effects like infections. While not blinded, MMF had a more favorable safety profile compared to IVC which had several hospitalizations due to dehydration from gastrointestinal symptoms. However, the study was limited by its short duration and not assessing long-term outcomes of remission.
The management of advanced prostate cancer has been revolutionized by the translation of the rapid progress made in understanding the biology of the disease into new therapies. While these developments are unprecedented, many challenges remain, including our need to understand how best to utilize these new treatments, how to integrate them into current treatment paradigms and how to demonstrate the most cost effective ways to use these new drugs. Dr. Dreicer briefly reviews the most important of the new developments, progress to date in integrating these new therapies, and speculates how these developments will translate into improvements in patient outcomes.
This document discusses drug-induced liver injury (DILI) caused by anti-tuberculosis (ATT) drugs. It notes that ATT drugs, particularly isoniazid, rifampin, and pyrazinamide, are common causes of DILI. Isoniazid metabolism varies depending on acetylator status, and its toxicity may be due to reactive metabolites. Rifampin induces liver enzymes and its toxicity is often seen in combination with other ATT drugs. Pyrazinamide toxicity depends on dose and can cause fatty liver. Presentations of ATT-induced DILI range from asymptomatic elevations in enzymes to acute liver failure. Careful screening and monitoring of patients on ATT is needed to prevent DILI
The document discusses several cases of glomerular disease:
1) A 27-year-old male with nephrotic syndrome and a kidney biopsy showing IgG and C3 deposits along the glomerular basement membrane consistent with membranous nephropathy.
2) A 78-year-old female admitted with nephrotic syndrome after a history of NSAID use, with a biopsy showing focal segmental glomerulosclerosis.
3) A 26-year-old male with nephrotic syndrome and renal impairment, whose biopsy demonstrated membranoproliferative glomerulonephritis with C3 deposition and subendothelial electron dense deposits. Follow up showed elevated
All-trans retinoic acid related complications in a patient with acute promy...Choying Chen
1) The patient, a 6-year-old female, presented with generalized petechiae and prolonged epistaxis. Laboratory results showed high white blood cell count with 46% blasts and 44% promyelocytes containing Auer rods, consistent with acute promyelocytic leukemia (APL).
2) She received induction therapy for APL per the TPOG-APL-2001 protocol including all-trans retinoic acid (ATRA) and chemotherapy. She experienced complications including fever, pleural effusion, and later pseudotumor cerebri, thought to be related to a drug-drug interaction between ATRA and fluconazole.
3) Her course
This document summarizes 4 cases of patients who developed neutropenia after undergoing liver transplantation and being prescribed the immunosuppressive drug Mycophenolate Mofetil (MMF). In all 4 cases, the neutropenia resolved after discontinuing MMF. The mean time from starting MMF to developing neutropenia was 4 months. Therapeutic drug monitoring is recommended when using MMF due to the risk of hematologic toxicity.
Puoti Claudio. FAD HT 2012. Come interpretare alterazioni lievi di laboratori...Gianfranco Tammaro
The document discusses diagnostic approaches for liver disease. It outlines three common diagnostic scenarios: 1) a patient referred for clinical symptoms, 2) a patient referred for signs of liver disease, and 3) a patient found to have abnormal liver enzymes incidentally. It then reviews various causes of liver disease including viruses, autoimmunity, and other etiologies. Key diagnostic tests are outlined including imaging, biopsy, virological tests, and genetic testing. Liver enzymes are discussed in depth including their origin and interpretation of abnormal values.
This document describes a case of a 48-year-old woman with autoimmune hepatitis type 1 who was admitted with abdominal pain, vomiting, and loose stools. She had been diagnosed with autoimmune hepatitis in July 2017 and had multiple admissions since then. On physical examination, she had jaundice and hepatosplenomegaly. Her labs showed features of hepatitis and anemia. She was treated with IV fluids, blood transfusions, and continued steroids. Her condition improved and she was discharged on steroid monotherapy.
1) The risk of contrast-induced acute kidney injury (CI-AKI) was assessed in a propensity score-matched cohort study.
2) The study found that use of RAAS blockade medications like ACE inhibitors and ARBs was associated with a 43% higher risk of CI-AKI.
3) Other independent risk factors for CI-AKI included chronic kidney disease, hemoglobin level <10 g/dL, albumin level <3.5 g/dL, higher contrast volume, and diuretic use.
Differentiation Therapy in Acute Promyelocytic LeukemiaYaashviny Nair
This document summarizes the usage of differentiation therapy in treating acute promyelocytic leukemia (APL). It discusses how APL develops, how differentiation therapy works to treat it using all-trans retinoic acid and arsenic trioxide, and the positive and negative impacts of this therapy. It also reviews successful case studies and challenges, as well as the future direction of differentiation therapy.
1) The document discusses response rates and outcomes for patients with chronic myeloid leukemia (CML) treated with various tyrosine kinase inhibitors (TKIs) like imatinib, dasatinib, nilotinib, and bosutinib.
2) It reports that achieving a major cytogenetic response or deeper molecular response (e.g. MMR) at certain timepoints (e.g. 12 months) on imatinib is associated with improved progression-free and overall survival.
3) For patients who become resistant or intolerant to imatinib, the second-generation TKIs dasatinib, nilotinib and bosutinib have response rates ranging from
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
This document discusses the prevention of venous thromboembolism (VTE) in hospitalized patients. It notes that while prevention is not necessary for all patients, those at high risk include patients undergoing surgery, those with cancer or trauma, patients in the ICU or with spinal cord injuries. Studies show medical patients have a 10-20% risk of DVT, while risks are higher, 40-80%, for other groups like trauma or arthroplasty patients. Meta-analyses found anticoagulants reduced PE, fatal PE, symptomatic DVT and overall VTE compared to placebo, without increasing major bleeding risk. For stroke patients, benefits were smaller due to many asymptomatic VTE cases, so number needed to treat was higher
Journal Presentation , After the party’s overআহমেদ শাহেদ
A 35-year-old woman presented to the emergency department with vomiting, diarrhea and abdominal pain after drinking vodka and tonic at an office party. She was diagnosed with acute gastroenteritis and discharged. She returned two days later with worsening kidney function and symptoms. Further evaluation revealed thrombotic microangiopathy (TMA). A prior similar illness 16 months ago was reviewed, suggesting quinine-induced TMA from the tonic component of the vodka and tonic drink. The patient was treated with plasma exchange, hemodialysis and steroids.
1) ATT induced hepatitis refers to drug-induced liver injury caused by anti-tuberculosis treatment medications like isoniazid, rifampin, and pyrazinamide.
2) These drugs can cause a spectrum of liver damage from asymptomatic transaminase elevations to acute liver failure via both idiosyncratic and dose-dependent mechanisms including intracellular calcium disruption and apoptosis.
3) Risk factors for tuberculosis drug-induced liver injury include older age, female sex, extra-pulmonary or meningeal tuberculosis, malnutrition, alcohol use, viral hepatitis coinfection, and certain genetic factors. Careful monitoring of liver enzymes is recommended during treatment.
Anti tuberculosis drug - induced hepatitis – A Case Studyvelspharmd
This case report describes a 32-year-old male patient who developed hepatotoxicity after being administered first-line anti-tuberculosis drugs to treat pulmonary tuberculosis. The patient also had a history of heavy alcohol use. Laboratory tests showed elevated liver enzymes and abdominal ultrasound revealed grade IV fatty liver infiltration. The patient was diagnosed with anti-TB drug-induced hepatitis exacerbated by alcohol-induced liver damage. His condition improved after discontinuing the anti-TB medications and alcohol, receiving supportive care, and standard treatment. The case report discusses the risk of hepatotoxicity from anti-TB drugs and importance of considering patient risk factors like alcohol use.
The document summarizes key information about prostate cancer including incidence, mortality rates, clinical stages, risk groups for localized prostate cancer, treatment options for advanced disease including hormone therapy and chemotherapy, and results from clinical trials of chemotherapy agents like docetaxel and cabazitaxel.
The document discusses the long-term side effects of androgen deprivation therapy (ADT) for prostate cancer, including increased risks of osteoporosis, cardiovascular events, sarcopenic obesity, and bone loss. It provides evidence that ADT increases standard cardiovascular risk factors and cardiovascular events. While the effect on cardiovascular mortality is disputed, age and pre-existing conditions are the main risk factors. Exercise and drugs like SERMs may help mitigate side effects, but do not reduce cardiovascular events. Careful management of known risk factors is important when treating with ADT.
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.
The document discusses renal cancer (kidney cancer) and advances in its treatment. It describes several targeted drugs that have improved outcomes for metastatic renal cell carcinoma (mRCC) compared to previous immunotherapy options. Drugs include tyrosine kinase inhibitors like sunitinib, sorafenib, pazopanib and axitinib as well as the mTOR inhibitor temsirolimus. Clinical trials have established these as standard first and second line options depending on a patient's risk level and prior treatment history. Ongoing research focuses on optimizing treatment sequencing and identifying biomarkers to guide more personalized therapy selection.
El documento contiene varios mensajes de error de una impresora, indicando que no hay tinta, que el rodillo está manchado de tinta, y que el usuario cometió errores. Le pide al usuario que sea paciente, compre tinta original, y deje de forzar a la impresora dañada a funcionar.
Pipenet es un servicio complementario del Programa PIPE que busca potenciar la exportación a través de la optimización del uso de las nuevas tecnologías. Pipenet ayuda a las empresas a mejorar la visibilidad, reducir costos, mejorar la eficacia y el control de las acciones promocionales, y mejorar el servicio a clientes y proveedores a través del uso de herramientas tecnológicas como boletines electrónicos, mercados en línea y estrategias de marketing digital. Pipenet también brinda consultoría para ayudar
This document summarizes 4 cases of patients who developed neutropenia after undergoing liver transplantation and being prescribed the immunosuppressive drug Mycophenolate Mofetil (MMF). In all 4 cases, the neutropenia resolved after discontinuing MMF. The mean time from starting MMF to developing neutropenia was 4 months. Therapeutic drug monitoring is recommended when using MMF due to the risk of hematologic toxicity.
Puoti Claudio. FAD HT 2012. Come interpretare alterazioni lievi di laboratori...Gianfranco Tammaro
The document discusses diagnostic approaches for liver disease. It outlines three common diagnostic scenarios: 1) a patient referred for clinical symptoms, 2) a patient referred for signs of liver disease, and 3) a patient found to have abnormal liver enzymes incidentally. It then reviews various causes of liver disease including viruses, autoimmunity, and other etiologies. Key diagnostic tests are outlined including imaging, biopsy, virological tests, and genetic testing. Liver enzymes are discussed in depth including their origin and interpretation of abnormal values.
This document describes a case of a 48-year-old woman with autoimmune hepatitis type 1 who was admitted with abdominal pain, vomiting, and loose stools. She had been diagnosed with autoimmune hepatitis in July 2017 and had multiple admissions since then. On physical examination, she had jaundice and hepatosplenomegaly. Her labs showed features of hepatitis and anemia. She was treated with IV fluids, blood transfusions, and continued steroids. Her condition improved and she was discharged on steroid monotherapy.
1) The risk of contrast-induced acute kidney injury (CI-AKI) was assessed in a propensity score-matched cohort study.
2) The study found that use of RAAS blockade medications like ACE inhibitors and ARBs was associated with a 43% higher risk of CI-AKI.
3) Other independent risk factors for CI-AKI included chronic kidney disease, hemoglobin level <10 g/dL, albumin level <3.5 g/dL, higher contrast volume, and diuretic use.
Differentiation Therapy in Acute Promyelocytic LeukemiaYaashviny Nair
This document summarizes the usage of differentiation therapy in treating acute promyelocytic leukemia (APL). It discusses how APL develops, how differentiation therapy works to treat it using all-trans retinoic acid and arsenic trioxide, and the positive and negative impacts of this therapy. It also reviews successful case studies and challenges, as well as the future direction of differentiation therapy.
1) The document discusses response rates and outcomes for patients with chronic myeloid leukemia (CML) treated with various tyrosine kinase inhibitors (TKIs) like imatinib, dasatinib, nilotinib, and bosutinib.
2) It reports that achieving a major cytogenetic response or deeper molecular response (e.g. MMR) at certain timepoints (e.g. 12 months) on imatinib is associated with improved progression-free and overall survival.
3) For patients who become resistant or intolerant to imatinib, the second-generation TKIs dasatinib, nilotinib and bosutinib have response rates ranging from
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
This document discusses the prevention of venous thromboembolism (VTE) in hospitalized patients. It notes that while prevention is not necessary for all patients, those at high risk include patients undergoing surgery, those with cancer or trauma, patients in the ICU or with spinal cord injuries. Studies show medical patients have a 10-20% risk of DVT, while risks are higher, 40-80%, for other groups like trauma or arthroplasty patients. Meta-analyses found anticoagulants reduced PE, fatal PE, symptomatic DVT and overall VTE compared to placebo, without increasing major bleeding risk. For stroke patients, benefits were smaller due to many asymptomatic VTE cases, so number needed to treat was higher
Journal Presentation , After the party’s overআহমেদ শাহেদ
A 35-year-old woman presented to the emergency department with vomiting, diarrhea and abdominal pain after drinking vodka and tonic at an office party. She was diagnosed with acute gastroenteritis and discharged. She returned two days later with worsening kidney function and symptoms. Further evaluation revealed thrombotic microangiopathy (TMA). A prior similar illness 16 months ago was reviewed, suggesting quinine-induced TMA from the tonic component of the vodka and tonic drink. The patient was treated with plasma exchange, hemodialysis and steroids.
1) ATT induced hepatitis refers to drug-induced liver injury caused by anti-tuberculosis treatment medications like isoniazid, rifampin, and pyrazinamide.
2) These drugs can cause a spectrum of liver damage from asymptomatic transaminase elevations to acute liver failure via both idiosyncratic and dose-dependent mechanisms including intracellular calcium disruption and apoptosis.
3) Risk factors for tuberculosis drug-induced liver injury include older age, female sex, extra-pulmonary or meningeal tuberculosis, malnutrition, alcohol use, viral hepatitis coinfection, and certain genetic factors. Careful monitoring of liver enzymes is recommended during treatment.
Anti tuberculosis drug - induced hepatitis – A Case Studyvelspharmd
This case report describes a 32-year-old male patient who developed hepatotoxicity after being administered first-line anti-tuberculosis drugs to treat pulmonary tuberculosis. The patient also had a history of heavy alcohol use. Laboratory tests showed elevated liver enzymes and abdominal ultrasound revealed grade IV fatty liver infiltration. The patient was diagnosed with anti-TB drug-induced hepatitis exacerbated by alcohol-induced liver damage. His condition improved after discontinuing the anti-TB medications and alcohol, receiving supportive care, and standard treatment. The case report discusses the risk of hepatotoxicity from anti-TB drugs and importance of considering patient risk factors like alcohol use.
The document summarizes key information about prostate cancer including incidence, mortality rates, clinical stages, risk groups for localized prostate cancer, treatment options for advanced disease including hormone therapy and chemotherapy, and results from clinical trials of chemotherapy agents like docetaxel and cabazitaxel.
The document discusses the long-term side effects of androgen deprivation therapy (ADT) for prostate cancer, including increased risks of osteoporosis, cardiovascular events, sarcopenic obesity, and bone loss. It provides evidence that ADT increases standard cardiovascular risk factors and cardiovascular events. While the effect on cardiovascular mortality is disputed, age and pre-existing conditions are the main risk factors. Exercise and drugs like SERMs may help mitigate side effects, but do not reduce cardiovascular events. Careful management of known risk factors is important when treating with ADT.
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.
The document discusses renal cancer (kidney cancer) and advances in its treatment. It describes several targeted drugs that have improved outcomes for metastatic renal cell carcinoma (mRCC) compared to previous immunotherapy options. Drugs include tyrosine kinase inhibitors like sunitinib, sorafenib, pazopanib and axitinib as well as the mTOR inhibitor temsirolimus. Clinical trials have established these as standard first and second line options depending on a patient's risk level and prior treatment history. Ongoing research focuses on optimizing treatment sequencing and identifying biomarkers to guide more personalized therapy selection.
El documento contiene varios mensajes de error de una impresora, indicando que no hay tinta, que el rodillo está manchado de tinta, y que el usuario cometió errores. Le pide al usuario que sea paciente, compre tinta original, y deje de forzar a la impresora dañada a funcionar.
Pipenet es un servicio complementario del Programa PIPE que busca potenciar la exportación a través de la optimización del uso de las nuevas tecnologías. Pipenet ayuda a las empresas a mejorar la visibilidad, reducir costos, mejorar la eficacia y el control de las acciones promocionales, y mejorar el servicio a clientes y proveedores a través del uso de herramientas tecnológicas como boletines electrónicos, mercados en línea y estrategias de marketing digital. Pipenet también brinda consultoría para ayudar
Este álbum de fotos muestra varias imágenes tomadas por el sistema de cámaras de seguridad de una tienda minorista durante un período de una semana. Las fotos capturan a clientes en la tienda y empleados trabajando en diferentes secciones. El álbum proporciona una visión general de la actividad diaria en la tienda a través de las imágenes de vigilancia.
This document outlines a presentation on Android. It begins with an introduction to Android, describing it as a mobile operating system developed by Google, based on Linux and designed for touchscreen devices. It then discusses Android's history, the Open Handset Alliance collaboration, key features, applications, development process, versions and reception. In conclusion, it notes Android is becoming the dominant smartphone OS and envisions continued growth in mobile internet usage.
Emobella Engineering Nigeria Ltd is an indigenous engineering company that provides services to the construction, energy, and oil & gas industries, including fabrication, welding, mechanical installation, and maintenance. The document outlines the company's profile, services, team, and environmental responsibility. It provides details on projects completed for clients in areas like installation of pipelines, generators, and storage tanks. The company aims to be a leading engineering services provider in Nigeria and Africa through safety, excellence, relationships, and integrity.
Essays are a legitimate literary genre with hundreds of years behind them. But we think of essays as nothing more than dull academic exercises. The five-paragraph essay is fine as a starting point, but we must get high school students to move beyond the five-paragraph model.
Cystatin C as a marker of Cardio metabolic disorder in obese South Indian ind...iosrjce
Human obesity is strongly associated with cardio metabolic disease. Cystatin C is a
naturally occurring protease inhibitor and marker of cardiovascular disease. The main objective of present
study was to estimate the serum levels of Cystatin C in individuals with normal BMI, and obese, aged between
18-39 Yrs and to compare the levels of serum Cystatin C among these individuals and to correlate the levels of
serum Cystatin C with cardio metabolic risk factors.
Material & Methods: The study population was taken from healthy volunteers of Mysore city, aged between 18-
39 years of either sex. The study population was divided into 2 groups based on BMI. Each group contains
sample size of 45. Fasting serum sample was analyzed for Blood glucose, Total cholesterol, Total Triglycerides,
Direct HDL cholesterol, Direct LDL Cholesterol by enzymatic method and serum Cystatin-C by
immunoturbidimetric method using auto analyser.
Results: The serum Cystatin C levels was significantly increased in obese groups, p value<0.001. The mean
serum Cystatin C levels in normal BMI group was 0.78±0.03, and in Obese group is 1.15±0.09. In the study
serum Cystatin C showed a positive correlation with serum glucose(r=0.61) serum triglycerides (r=0.7),
Atherogenic index of plasma (AIP) (r=0.80), TCHOL: HDL (r=0.71), HDL: LDL (r=0.70) respectively and
negative correlation with serum HDL (r=-0.52)
Solucom offices receive a breath of fresh “Air”Wavestone
Solucom overhauled its Paris offices to create a new workspace concept called "Air" that promotes a more agile, digital, and innovative work environment. The redesign included open floor plans with increased natural light, comfortable shared workspaces, and varied private spaces to suit different work situations. Employees were involved throughout the process to provide feedback and ensure the new offices met real needs through creative workshops. The goal of the Air project was to improve Solucom's corporate image and create an attractive environment that reflects the company's ambitions.
This document discusses integral human development and how it can be applied in organizations. It presents an integral human development framework that identifies seven forms of well-being: bodily, cognitive, emotional, social, aesthetic, moral, and spiritual. For each form of well-being, it provides a brief description of how that form can be nurtured in the workplace. It then provides exercises for individuals and managers to assess the nurturing of well-being using the framework and discusses applying integral human development in schools and work organizations.
En esta nueva entrega del curso de Interacción Persona-Ordenador se explica una de las fases más características de todo modelo de Diseño Centrado en el Usuario, el prototipado.
Aquí podremos ver el gran abanico de técnicas disponibles así cómo muchos ejemplos prácticos.
Esta nueva entrega del curso de Interacción Persona-Ordenador entra en la primera de las fases del modelo de Diseño Centrado en el usuario MIPu+a, que no es otra que la de los requisitos.
En ella se muestran cuales son las principales actividades necesarias para realizar una definición de los requisitos de acorde a las necesidades de los usuarios.
Esta presentación muestra el gran abanico de técnicas disponibles para realizar evaluaciones de usabilidad, de accesibilidad y, en genreal, de todo lo relacionado con la experiencia de usuario. Recordemos que esta presentación pertenece al curso de Interacción Persona-Ordenador.
El documento describe los principios del diseño de pensamiento y la innovación centrada en el usuario. Explica que la innovación disruptiva es clave para aumentar la capacidad de adaptación de los negocios centrales y que los equipos multidisciplinarios son importantes para el aprendizaje colectivo. También enfatiza la necesidad de una cultura de aprendizaje, la importancia de los prototipos y pruebas, y el valor de aprender de los errores.
This document provides an overview of plant tissue culture techniques. It discusses the history and milestones of tissue culture, including the development of the Murashige and Skoog medium. The document describes the various types of tissue culture, choice of explant, regeneration pathways, and applications. It also discusses hairy root culture and the recognition of tissue culture facilities. The techniques of sterilization, culture growth, and plant regeneration are outlined. Advantages and disadvantages of tissue culture are presented.
A 27-year-old male presented to the emergency department with vomiting, abdominal pain, altered mental status, and fatigue. He had recently been depressed and empty bottles of various drugs were found in his bedroom. He was diagnosed with suspected acetaminophen toxicity. Acetaminophen toxicity can cause liver damage and is a common cause of acute liver failure. Treatment for overdose involves administering activated charcoal and N-acetylcysteine to prevent liver injury if caught early.
A 27-year-old male presented to the emergency department with vomiting, abdominal pain, altered mental status, and malaise. Many empty drug bottles were found in his bedroom. Toxicology testing did not find an overdose but acetaminophen toxicity was suspected due to the patient's recent depression and use of over-the-counter drugs. Acetaminophen toxicity can cause liver damage and is a common cause of acute liver failure in both the US and Saudi Arabia. Early identification and treatment with N-acetylcysteine can prevent liver injury if started soon after overdose.
This document provides guidelines for evaluating abnormal liver chemistries. It defines key liver enzymes and what they indicate, such as ALT and AST indicating hepatocellular injury and alkaline phosphatase indicating cholestatic injury or obstruction. The guidelines recommend testing patients for various liver diseases based on the degree of elevation of their liver enzymes. For mild elevations under 5 times the upper limit of normal, the guidelines recommend testing for viral hepatitis, NAFLD, hemochromatosis, and other conditions. For moderate elevations from 5-15 times the upper limit, they recommend additional testing for acute hepatitis. For severe elevations over 15 times the upper limit or over 10,000 IU/L, testing for acetaminophen toxicity
This document provides an overview on evaluating and managing elevated liver enzymes. It discusses the prevalence of liver disease in the US and the importance of identifying abnormal liver enzymes. The document reviews how to interpret different liver enzymes and develop a differential diagnosis for acute vs chronic conditions. Clinical cases are presented to demonstrate how to investigate the underlying cause of elevated enzymes. The conclusion emphasizes that stable elevated enzymes do not exist and screening is important given rising rates of HCV and NASH.
This document defines and describes Fulminant Hepatic Failure (FHF), also known as Acute Liver Failure (ALF). It provides definitions for different types of liver failure based on duration and presence of pre-existing liver disease. The document discusses the etiology, pathogenesis, clinical manifestations and stages of hepatic encephalopathy in FHF. It outlines the diagnostic workup and management approach for FHF, including initial stabilization, monitoring for complications, supportive care to maximize survival, and consideration of liver transplantation.
it includes the diagnostic uses of the enzyme which is a very helpful and safe technique. a technique that is a natural one and have no harm impact on body of human being , means radioactivity or the dangerous rays like X rays or Gamma rays.
1. A 65-year-old male presented with fever, abdominal pain, distension, and jaundice for 4 weeks. Imaging showed a diffuse process in the liver. Liver biopsy revealed adenocarcinoma infiltration of the liver.
2. A 58-year-old female with diabetes and elevated liver enzymes was evaluated. She had a history of elevated enzymes attributed to lipid medication years ago. Current labs showed elevated AST and ALT with normal ALP and GGT. She had weight gain and abnormal lipid profile.
3. The first case describes a patient with diffuse liver lesions found to be metastatic adenocarcinoma on biopsy. The second case involves a patient with metabolic risk factors and elevated amin
This document discusses steatohepatitis (fatty liver disease), which can be alcoholic or non-alcoholic in origin and can present as mild hepatitis. It also discusses acute autoimmune hepatitis (AIH), noting that it accounts for a small percentage of liver transplants. AIH has a severe natural history if untreated and various genetic and environmental triggers are discussed. Simplified diagnostic criteria for AIH include autoantibodies, elevated IgG, histological findings, and exclusion of viral hepatitis. The three main types of AIH are described based on demographics, autoantibodies, associated conditions, and severity.
This document discusses a comparative study of several serum enzymes and bilirubin levels in patients with hepatobiliary diseases. The study aimed to evaluate the usefulness of serum 5' nucleotidase (5'NT) compared to other established markers like alkaline phosphatase, aminotransferases, and bilirubin for diagnosing hepatobiliary diseases. The introduction provides background on alcoholic liver disease and secondary liver cancer as common hepatobiliary disorders. It also discusses the importance of identifying enzymes and metabolites that can serve as early and specific indicators of hepatobiliary disease.
Serum Alkaline Phosphatase Activity And Its Iso Enzymes InAurelian Udristioiu
- Serum alkaline phosphatase (ALP) exists in different isoenzyme forms that originate from various tissues like liver, bone and leukocytes. Measuring specific isoenzymes can help identify abnormal increases of total ALP and determine their tissue of origin.
- Neutrophil alkaline phosphatase (NAP) is an isoenzyme found in leukocytes. Abnormal NAP levels can indicate various inflammatory conditions and cancers. Semi-quantitative assays are used to measure NAP in serum.
- Differentiating between liver-derived ALP, bone ALP and other isoenzymes is important for correctly diagnosing diseases affecting those tissues that cause high total ALP levels, such as liver disease
This document discusses various liver biochemical tests and what they indicate about liver health and function. It covers tests of bilirubin, aminotransferases, alkaline phosphatase, synthetic functions, and fibrosis markers. Elevations in these tests can suggest conditions like viral hepatitis, alcoholic liver disease, cirrhosis, and others. No single test fully assesses liver function, so a battery of tests is needed to evaluate the liver and distinguish between different disease types and severities.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and blood work to determine the specific cause and guide treatment, which ranges from intravenous fluids to dialysis depending on severity.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and renal indices to help determine the underlying cause and guide treatment, which depends on the identified etiology. Dialysis may be needed for severe cases.
Medical emergency on paracetamol poisoningIndhu Reddy
This document provides information on paracetamol (acetaminophen) poisoning, including its introduction, mechanisms of action, toxicity, clinical features, investigations, management, and antidote. It discusses that paracetamol is metabolized to a toxic metabolite that can cause liver damage if glutathione levels are depleted. Patients presenting with elevated liver enzymes and international normalized ratio following ingestion should receive N-acetylcysteine to replenish glutathione levels based on standardized treatment protocols. Timely administration of N-acetylcysteine within 10 hours of ingestion can prevent liver injury from paracetamol poisoning.
This document provides a critical evaluation of laboratory tests used in the diagnosis and assessment of acute pancreatitis. It discusses the advantages and limitations of commonly used tests like serum amylase and lipase. While amylase remains an important initial test due to its availability and sensitivity, it lacks specificity. Lipase has greater sensitivity in alcoholic pancreatitis and late presentations, but can also be nonspecifically elevated. No single test can accurately diagnose, assess severity, or determine the etiology of acute pancreatitis. Multiple tests and factors like time of testing must be considered.
Abnormal liver function tests can indicate underlying liver disease but may also be caused by extrahepatic factors. A thorough evaluation is needed and includes considering the pattern of test abnormalities, severity of changes, and potential etiologies. For hepatocellular predominant abnormalities, further workup may include tests for viral hepatitis, autoimmune disease, and iron overload. Liver biopsy may be needed if initial testing is unrevealing. Proper diagnosis guides management and treatment of underlying liver conditions.
A 9-year-old boy was referred for evaluation of recurrent gum bleeding and nose bleeds, and was found to have elevated liver enzymes, hypergammaglobulinemia, and autoantibodies consistent with autoimmune hepatitis. A liver biopsy showed findings characteristic of autoimmune hepatitis. He was started on prednisone and azathioprine for treatment of autoimmune hepatitis type 1.
PRCA post renal transplant-a case and reviewVishal Golay
Partha Choudhary, a 48-year-old male, developed progressive anemia after a liver transplant in 2011. His hemoglobin levels gradually decreased from 9.2 to 5.4 over a year despite EPO treatment. Testing found he was positive for Parvovirus B19 and negative for other potential causes. A bone marrow biopsy showed an absence of erythroblasts, consistent with a diagnosis of pure red cell aplasia caused by Parvovirus B19 infection. Treatment for this type of virus-induced PRCA typically involves intravenous immunoglobulin therapy.
Similar to Evaluación de resultados anormales en enzimas hepaticas en pacientes asintomaticos (20)
This document summarizes new concepts in hemostasis, which is the process of blood clotting and wound healing. It discusses three phases of coagulation - initiation, amplification, and propagation. The initiation phase begins when tissue factor is exposed by damaged blood vessels, forming a complex with factor VIIa that activates small amounts of factors IX and X. This generates low levels of thrombin, starting the amplification phase where feedback loops dramatically increase coagulation factor activity through activation of factors V and VIII. High levels of thrombin then propagate fibrin clot formation. The document also reviews platelet activation and interactions with endothelial cells that regulate thrombus formation and coagulation.
Hougie 2004-journal of-thrombosis_and_haemostasisLAB IDEA
The document provides historical context on the development of the cascade/waterfall hypothesis of blood coagulation. It discusses the landmark 1964 papers by Macfarlane and Davie & Ratnoff that independently proposed the cascade model. Macfarlane described coagulation as a "cascade" and "photochemical amplifier", while Davie & Ratnoff termed it the "waterfall" concept. Both proposed coagulation occurs through a series of enzymatic reactions between clotting factors. The collaboration between clinical researcher Ratnoff and biochemist Davie led to the influential "waterfall" paper.
El documento resume el sistema de coagulación, incluyendo la hemostasia secundaria, los componentes como plaquetas y factores de coagulación, y los mecanismos como la cascada de coagulación. También describe la regulación de la hemostasia a través de sistemas anticoagulantes como la antitrombina III y la proteína C, y la evaluación por laboratorio incluyendo pruebas como el tiempo de sangrado, recuento de plaquetas, y tiempos de protrombina y tromboplastina parcial activada.
Este documento resume información sobre parasitosis intestinales. Explica que los parásitos intestinales incluyen protozoos, helmintos y pueden causar cuadros clínicos variables, desde infecciones asintomáticas hasta afectar uno o más órganos. Describe en detalle la amibiasis intestinal causada por Entamoeba histolytica, incluyendo su ciclo de vida, manifestaciones clínicas, diagnóstico y tratamiento. También menciona brevemente la balantidiasis.
CLASE ASCITIS
DR. RAUL CARRILLO ORTIZ
MODULO MEDICINA INTERNA
ROTACIÓN PATOLOGÍA CLÍNICA
DEPARTAMENTO DE MEDICINA Y NUTRICIÓN
UNIVERSIDAD DE GUANAJUATO
Las enfermedades musculares esqueléticas incluyen una variedad de condiciones que causan debilidad muscular. El diagnóstico adecuado requiere historia clínica, marcadores musculares como enzimas y proteínas, electromiografía y biopsia muscular para diferenciar alteraciones musculares de las neurológicas. Existen diferentes mecanismos fisiopatológicos involucrados como fenómenos autoinmunes, y condiciones pueden ser congénitas o adquiridas. El laboratorio juega un papel importante en el
Este documento describe la enfermedad hepática grasa no alcohólica (EHGNA), también conocida como esteatosis hepática. Define la EHGNA como la acumulación de grasa en el hígado en ausencia de consumo excesivo de alcohol. Explica que la EHGNA puede evolucionar a esteatohepatitis no alcohólica, cirrosis y hepatocarcinoma si no se corrigen los factores de riesgo subyacentes. Finalmente, discute las opciones de tratamiento, que incluyen cambios en el estilo de
Historical perspective and future direction of coagulation researchLAB IDEA
This document provides a historical perspective on the advances made in coagulation research over the past 100 years. Remarkable progress has been achieved, starting from early clinical observations of rare bleeding disorders to current understanding involving complex reaction pathways. Key developments include the discovery of coagulation factors and inhibitors through study of patient plasma, development of laboratory tests enabling factor assays, and evolving cascade models incorporating new knowledge. Recent technologies like gene targeting and stem cells promise further insights. Close collaboration between basic scientists and clinicians has been important to research progress and clinical applications. Future areas may include gene and cell-based therapies building on past successes translating basic research into improved patient care.
Lipoprotein (a) [Lp(a)] levels are strongly associated with cardiovascular disease risk. Lp(a) consists of an LDL-like particle bound to apolipoprotein(a) [apo(a)]. Apo(a) is produced in the liver and its production rate is the main determinant of plasma Lp(a) levels. Recent studies show that ligands of the farnesoid X receptor can significantly lower Lp(a) levels by inhibiting apo(a) transcription. While lowering Lp(a) may reduce cardiovascular risk, consensus reports have been cautious about routinely measuring Lp(a) due to lack of intervention studies demonstrating that lowering Lp(a) reduces hard endpoints and lack of effective medications to lower Lp(
This document summarizes the pathophysiology, diagnosis, and management of metabolic acidosis. It describes how metabolic acidosis is characterized by a reduction in serum bicarbonate and secondary decreases in arterial carbon dioxide partial pressure and blood pH. Acute metabolic acidosis lasting minutes to days is more common and often due to organic acid overproduction, while chronic metabolic acidosis lasting weeks to years usually reflects bicarbonate wasting or impaired renal acidification. Diagnosing the cause involves calculating the serum anion gap to classify disorders as normal or elevated. Adverse effects differ between acute and chronic forms. Treatment of acute metabolic acidosis with base administration is controversial due to lack of benefit and potential complications, while chronic metabolic acidosis treatment
El documento describe la alcalosis metabólica. Explica que es un trastorno metabólico frecuente en pacientes hospitalizados que causa un aumento de los niveles de bicarbonato en la sangre. Las causas incluyen la infusión de bicarbonato, pérdidas gástricas o renales de ácidos, y el uso de diuréticos. El tratamiento se enfoca en corregir la causa subyacente, restaurar los niveles de cloro y tratar las complicaciones como la hipopotasemia.
El documento describe los tres sistemas principales que regulan la concentración de iones de hidrógeno (H+) en el cuerpo: 1) los sistemas amortiguadores químicos de los líquidos orgánicos, 2) el centro respiratorio, y 3) los riñones. Los sistemas amortiguadores químicos reaccionan en segundos, el aparato respiratorio actúa en minutos, y los riñones tienen la respuesta más lenta en horas o días. Los riñones juegan un papel clave al secretar iones de hid
El documento resume los conceptos clave de acidosis y alcalosis, incluyendo las definiciones de acidosis y alcalosis, las causas de acidosis metabólica, y formulas y medidas utilizadas para evaluar trastornos del equilibrio ácido-base como el anión gap, gap osmolal urinario y brecha delta.
La lesión renal aguda (LRA) se define como la pérdida rápida de la función renal dentro de las 48 horas, lo que resulta en la retención de desechos en la sangre como la creatinina y la urea. La LRA puede ser prerrenal, causada por una perfusión renal inadecuada; intrínseca, causada por daño al riñón; u obstructiva posrenal, causada por una obstrucción del tracto urinario. El diagnóstico incluye exámenes clínicos y de laboratorio como la medición de creatin
El documento resume varios artículos y libros sobre lesión aguda renal, incluyendo Waikar S.S., Bonventre J.V. (2016) que discute la lesión aguda renal en el libro Harrison. Principios de Medicina Interna, 19e. También se mencionan artículos de Kidney International Supplements (2012) y Lancet (2012) que tratan sobre este tema.
TRASTORNOS DE LA COAGULACION EN HEPATOPATIASLAB IDEA
Este documento describe los trastornos de la coagulación que pueden ocurrir en pacientes con enfermedad hepática, incluyendo alteraciones plaquetarias, disminución en la síntesis de factores de coagulación, disfibrinogenemia e hiperfibrinólisis. Explica que estos trastornos ocurren cuando los niveles plasmáticos de los factores de coagulación están por debajo del 30-40% de los niveles normales. Finalmente, resume los tratamientos utilizados para corregir estos trastornos, como
El documento describe la hepatitis B, un virus que causa inflamación del hígado. El virus de la hepatitis B es un DNA envuelto que puede causar infección aguda o crónica. La transmisión ocurre principalmente a través del contacto con sangre o fluidos corporales. La infección aguda generalmente se resuelve espontáneamente, mientras que la infección crónica puede conducir a cirrosis o cáncer de hígado. El diagnóstico se realiza mediante pruebas serológicas y la carga viral. No existe un tratamiento
Fasting is not routinely required for determination of a lipid profileLAB IDEA
This document provides a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine regarding fasting vs. non-fasting lipid profiles. It finds that observational data indicate maximal mean changes after meals are small and not clinically significant. It recommends the routine use of non-fasting lipid profiles to improve patient compliance, while fasting may be considered if non-fasting triglycerides are over 5 mmol/L. Abnormal non-fasting concentrations that should be flagged are outlined.
La trombocitopenia idiopática es un trastorno caracterizado por la producción de autoanticuerpos contra las plaquetas. Puede presentarse en niños de 2 a 4 años después de infecciones respiratorias o en adultos, especialmente mujeres entre 15 y 40 años. Los síntomas incluyen petequias, equimosis y sangrado de las encías. El tratamiento incluye corticoesteroides, inmunoglobulina o esplenectomía.
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.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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