Grand Canyon National Park.pptx
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This document discusses common medical issues that may occur at the Grand Canyon. It notes that the Grand Canyon is one of the seven natural wonders located in Arizona and receives over 4 million visitors annually. Some common medical encounters discussed include electrolyte disturbances, orthopedic injuries, rhabdomyolysis, hypoxia, heat injuries, and acute renal failure. For each condition, symptoms, risks, diagnosis, and treatment approaches are outlined. The document emphasizes the importance of hydration, monitoring electrolytes and urine output, and transferring patients as needed for more advanced care.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
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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
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- 11. Common Medical Encounters Electrolyte Disturbances Orthopedic Rhabdomyolysis Hypoxia Heat Injuries Acute Renal Failure
- 19. Electrolyte Disturbances Hyponatremia – Na < 134 meQ/L Acute Causes – too much water, no salts Symptoms – Vomiting, weakness, confusion, headache Risk associated – Seizures Treatment – slow correction to avoid Central Pontine Myelinolysis if greater than 48 hours duration Isotonic Normal Saline - Monitor electrolytes/ urine output
- 23. Orthopedic Ankle Sprain/Fracture Foot Injuries Falls – Forearm Fractures Dislocations Diagnosis/Treatment X-ray / Splint / Crutches / Pain Medications Reduce if needed – shoulder/elbow
- 28. Rhabdomyolysis Muscle Breakdown Symptoms – Cramping, pain Diagnosis – CK level Treatment – Hydration, Monitor Electrolytes, Monitor Urine Output
- 33. Hypoxia High Altitude – 6,800 ft / 2072 m Risks – Underlying Cardiovascular/Pulmonary Dz, Sea level dwellers, Elderly Symptoms – Shortness of breath, DOE, Chest Discomfort What to do? History, Medications, Vital Signs, EKG, PE, Oxygen Diagnosis ? Treatment – Portable Oxygen, Move to Lower Altitude
- 38. Heat Injuries Heat Cramps Check Vital Signs, Labwork Hydrate, Monitor Urine Output Heat Exhaustion Vitals, Labwork Hydrate, Urine Output, Cool Patient, Monitor Electrolytes Heat Stroke Medical Emergency IV Access, Reduce Core Temperature, Transfer
- 44. Acute Renal Failure Medical Emergency Vomiting, Confused, Muscle Pain Vital Signs, Labwork, EKG prn, IV Access ABC’s Treatment – IV fluids, Monitor Electrolytes, Monitor Urine Output, Transfer (air vs ground)
Editor's Notes
- Hypovolemic hyponatremia: decrease in total body water with greater decrease in total body sodium • Euvolemic hyponatremia: normal body sodium with increase in total body water • Hypervolemic hyponatremia: increase in total body sodium with greater increase in total body water