Dr. Osama El-Shahat is the head of the nephrology department at New Mansoura General Hospital and vice president of the Dakahlia Nephrology Group. The document discusses kidney disease (CKD), transplantation, dialysis, and recommendations. It provides examples of how some animals fast during certain periods by not eating and reducing activity. It also discusses fasting guidelines for patients with illnesses, noting that those with more severe illnesses should generally be exempted from fasting. The document analyzes a study on the effects of Ramadan fasting on renal function in CKD patients and notes that more large studies are needed. It also reviews a case of a hypertensive patient wanting to fast for Ramadan
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Diabetes Mellitus Management in CKD (Clinical Tips) - Dr. GawadNephroTube - Dr.Gawad
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My Nephrology Registrar Seminar Talk from September 2013
Topics Covered
Pathogenesis of Diabetic Nephropathy
Other Renal Disease in Diabetes
Treatment of Diabetic Kidney Disease + The Joint Renal Diabetic Clinic
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SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
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Diabetes Mellitus Management in CKD (Clinical Tips) - Dr. GawadNephroTube - Dr.Gawad
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My Nephrology Registrar Seminar Talk from September 2013
Topics Covered
Pathogenesis of Diabetic Nephropathy
Other Renal Disease in Diabetes
Treatment of Diabetic Kidney Disease + The Joint Renal Diabetic Clinic
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/Zb6WISbvE2k
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https://youtu.be/4IvvrbC31Q4
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SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Insights from the FIGARO-DKD and FIDELIO-DKD trials - Dr. GawadNephroTube - Dr.Gawad
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Define Chronic Renal Failure.
Mention the main causes of Chronic Renal Failure.
Know the signs and symptoms of renal failure.
Know the treatment options of CRF
Know new definition of CKD
The DCCT Landmark Trial
The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-term Complications in Insulin Dependent Diabetes Mellitus
Ramadan fasting is ritual for all muslims worldwide , where there is abstinace from eating , drinking and smoking from dawn to dusk , daily for one month, frequently , hypertensives asking about their fasting and medications during Ramadan, in the lecture , some focus on the effect of Ramadan on blood pressure , heart rate and other cardiovascular risk factors and lastly general instruction for hypertensives during Ramadan .
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Fasting ramadan nephrology prospective prof. osama el shahate
1. Dr. Osama El-Shahat
Head of Nephrology Department
New Mansoura General Hospital (international)
Vice president Of Dakahlia Nephrology Group
ISN Educational Ambassador
6. A young medical student has a viral
upper respiratory tract infection. His
temperature was 38.9oC. Congested
throat. Chest: clear. Day 1 Ramadan.
What is your advice?
7. Generally, patients are dispensed from fasting.
The illness is the intense one that increases by
fasting, or recovery is delayed. Ahmad Bin Hanbal
was asked, when is the patient dispensed from
fasting. “If he could not” he answered. They
asked: fever, for example?. He answered: “What
disease is more severe than fever?”.
Ibn Godamah. Al-Maghny
Al-Torky & Al-Helo. eds, 1408,4:403-4
8. Patients who are not harmed by fasting,
and their recovery is not delayed
(e.g., Type 2 DM )
9. Patients who are harmed by fasting or
their treatment cannot be given with
fasting (e.g., pregnant lady, acute MI,
advanced liver failure).
10. Patients who are not harmed by fasting
but their treatment could be adjusted
for proper control (e.g., hypertension,
epilepsy, OA).
11. A 60-year-old male with long- standing
hypetension who was on irregular
treatment. He was on Metoprolol 50 mg
BD, Frusemide 40 mg QD, Diltiazem 90
mg BD. His serum creatinine was 4.5 mg,
Na 131, K 4.5. He wants to fast Ramadan.
What is your advice?
22. This study done on small number of patients
Ramadan fasting may be injurious to renal
tubules, but only for those with CKD.
Large studies are recommended to determine the
extent of tubular injury and renal function in
CKD patients during Ramadan fasting
23.
24.
25.
26.
27.
28.
29.
30. This study done on small number of patients (31
patients).
Done during winter months
Some improvement in the eGFR during and past
fasting, however, fasting should be under close
medical supervision with strict attention to fluid
intake, daily activity and adjustment of drug
regimen .
Special attention for the management of diabetic
CKD patients
45. Controversies in CKD) and hemodialysis patients
Absence of strict guidelines
Renal transplant recipients with stable kidney
function for 1 year post-transplantation
Concern in hot weather for patients with kidney
stone diseases.
CKD stages 4 and 5 and CKD stage 3 patients:
very high risk and high risk categories,
respectively: ? To be exempted from fasting.
52. I do not advise Fasting:
Acute kidney injury
Uncontrolled BP
Generalized edema
Polyuria
Metabolic decompensation
Fast progressors stage 3 CKD
DKD (eGFR < 45)
Recurrent stone passer
Stage 4 or higher
Dialysis
Renal allograft dysfunction
Polypharmacy that can’t be distributed to sunset and down
53. I’ll advise fasting
◦ CKD stage 1 or 2 with controlled blood pressure
on ≤ 2 drugs provided that the patient is stable
after starting fast and there is no urine
concentrating defect
54. CKD Patients Who should not Fast:
?? GFR < 30
?? GFR < 15
CKD with other associated problems:
Liver Disease
Diabetes
CVD
Neurological Disease
What if the patient insisted to fast??
66. A smallbody mass loss is a frequent, but not universal, outcome of
Ramadan. During the daylight hours of Ramadan fasting, practising
Muslims are undoubtedly dehydrating, but it is not clear whether
they are chronically hypohydrated during the month ofRamadan.
No detrimental effects on health have as yet been directly attributed
to negative water balance at the levels that maybe produced during
Ramadan.
67. International Journal of Nephrology and Renovascular Disease 2015:8 53–57
Fasting Ramadan:
CKD (n 131)