This document discusses haemodialysis versus haemodiafiltration (HDF) for end-stage renal disease therapy. It provides historical context on the development of dialysis. It describes how HDF combines diffusion and convection to clear small molecules as well as middle and larger molecules like beta-2 microglobulins that standard haemodialysis cannot. Several studies comparing HDF and haemodialysis are summarized that have had mixed results, with some showing benefits of HDF like reduced symptoms and beta-2 microglobulin levels but not clear improvements in mortality. For HDF to provide benefits, a minimum convective volume of 20 litres per session is recommended. Barriers to wider adoption of HDF include cost and infrastructure requirements.
Establishing and maintaining normal extracellular volume (ECV) is required to achieve normotension. The achievement of an optimal fluid status, as expressed by "dry weight" (DW), should allow for controlling blood pressure (BP) in the large majority of HD patients
Establishing and maintaining normal extracellular volume (ECV) is required to achieve normotension. The achievement of an optimal fluid status, as expressed by "dry weight" (DW), should allow for controlling blood pressure (BP) in the large majority of HD patients
Basic science of fluid therapy - Robert Hahn - SSAI2017scanFOAM
A talk by Robert Hahn at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Historical background
The concept of incremental dialysis
The residual kidney function and its significance
Incremental hemodialysis
Observational studies on incremental HD
The candidates for incremental HD
The potential benefits and risks associated with incremental HD
Incremental peritoneal dialysis
The intact nephron hypothesis in reverse
A brief presentation on the Management of Haemophilia with a focus on bypassing agents. The presentation covers the disease, its available treatment options, intro to bypassing agents, and clinical evidence.
Hyperphosphatemia in CKD patients; The Magnitude of The Problem - Prof. Alaa ...MNDU net
Hyperphosphatemia in CKD patients; The Magnitude of The Problem
Prof. Alaa Sabry - Professor of Nephrology
Mansoura Nephrology and Dialysis Unit (MNDU) Course
Sample size and how to calculate it
- Why sample size is important
- Alpha and beta errors
- Main outcome and Effect size
- Practical examples using Means-Proportions-Correlation- Confidence Interval
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
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.
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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.
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.
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
4. Current ESRD Therapy
Delivers 10-15% GFR equivalency
Is pro-inflammatory
Is intrusive on patient life-style
Is associated with significant intradialytic
complications and interdialytic symptoms
6. Historical Background
• 1913:
– John J. Abel first dialysis attempt on animals.
• 1924:
– Georg Haas: first dialysis attempt in human, 6
patients and all died.
• 1945:
– Kolf: first 15 patients died, but the 16th, survived
after 11 hours of dialysis.
7. Recent Technological Advances in
RRT
High efficiency/high flux membranes
Biocompatible membranes
Alterations in internal dialyzer geometry to
increase efficiency
On-line replacement solution production
for continuous therapies for AKI or
hemofiltration for ESRD
On-line monitoring of dialysis dose and
vascular access function
9. HD & HDF
• Introduced in 1970s (Henderson et al 1974 &
Leber et al 1978).
• It combines both diffusion and convection.
• HD: mainly diffusion, hence effective for small
size molecules (urea, electrolytes, acid base,
water correction).
• HDF: convection, middle and larger size
molecules (e.g. B2 microglobulins)
25. Wizemann et al 2000
• HDF vs low flux HD.
• Limited number (44).
• Negative outcome (only reduction of B2
microglobulins).
26. Schiffl 2007
• HDF vs high flux HD.
• Limited number (76).
• Cross over RCT each modality for 24 month.
• Negative outcome in terms of mortality.
• Kt/V and B2 microglobulins were better with
HDF.
27. Canaud et al 2006 (DOPPS)
• Adequate number (2165).
• 4 Groups, low flux HD, low efficiency HDF, high
flux, high efficiency HDF.
• Observational study with inherent selection
bias.
• Better survival with high efficiency HDF, (RR
0.65).
28. Locatelli et al 2010
• HDF/HF vs low flux HD.
• Limited number (40/36/70).
• Outcome is stable intradialytic blood pressure
in convective therapy vs HD.
• Significant increase of predialysis systolic BP in
HDF compared to HD and HF (+4.2/-0.6/-1.8
mmHg).
29. Grootenman et al 2012
(CONTRAST Trial)
• OL-HDF vs low flux HD RCT
– Adequate number (714).
– Negative outcome in terms of all cause mortality.
– For the first time it highlighted the importance of
the convective volume (>20 litres/session).
30.
31. OK et al 2012
(Turkish Trial)
• OL-HDF vs high flux HD RCT.
• Adequate number (782).
• Negative outcome.
• Highlighted again importance of convective
volume (>17.4 litres, better cardiovascular and
overall mortality).
• Selection bias (patients >17.4 L have less
diabetes, higher blood flow rate, higher serum
albumin, lower serum phosphate, lower
interdialytic weight gain).
33. Maduell et al 2013
ESHOL Trial
• OL-HDF vs high flux HD.
• Adequate number (906).
• Positive survival advantage 30 % reduction of all cause
mortality in favour of OL-HDF.
• Convective volume >18 litres.
• Survival advantage independent of middle molecule
clearance (no difference between the 2 arms).
• OL-HDF arm with less DM, less catheters, slightly
younger, low Charlson morbidity score.
• 39% discontinued treatment.
35. Wang et al 2014
Systematic Review
• 16 Trials including 3,220 patients.
• HDF did not reduce all cause mortality or cardiac
events significantly.
• It reduced symptomatic hypotension and B2
microglobulin level.
• No impact on small molecule clearance (Kt/V).
• Increased chances to receive a kidney transplant for
HDF patients but non significant.
• Limitations: suboptimal quality trials, underpowered,
imbalance in some prognostic variables at baseline.
• Benefits of HDF vs HD for CVS outcomes and mortality
remain unproven.
36. Nistor et al 2014
Systematic Review
• 35 Trials (4,039 participants).
• Convective dialysis may reduce cardiovascular
but not all-cause mortality.
• Effects on nonfatal cardiovascular events and
hospitalization are inconclusive.
• Treatment effects of convective dialysis are
unreliable due to limitations in trial methods
and reporting.
37. Siriopol et al 2015
HDF Romanian Experience
• Retrospective analysis incident and prevalent
HDF vs HD.
• Survival benefit in both incident and prevalent
HD. (HR 0.58 and 0.24)
• Adequate number 1546 prevalent and 2447
incident patients.
38. Mercadal et al 2015
HDF French Experience
• Retrospective analysis of incident HDF vs HD.
• REIN registry HDF/HD (5526/28407) from
2008-12.
• HR of all cause and cardiovascular mortality in
HDF patients 0.84 and 0.73 respectively.
39. OL-HDF Prevalence
• Europe: 50800/294400 (as of 2010)
• Japan: 2013: 31 371/ 314 438. (Masakane et al 2015)
• USA:
– Increased 5X over 2 years.
41. Optimal Convective Volume
• DOPPS >15 l/session (retrospective
observational study).
• Contrast and Turkish trials (subgroup analysis
survival advantage > 17 & 22 l/session).
• ESHOL > 22 l/session.
• Standardizing convective volume to body
surface area correlated well with survival
(Davenport et al 2015, Peters et al 2015).
43. Minimum Convection Volume
- <20% of the processed blood volume
(high flux).
- >20% of the processed blood volume
(HDF).
- Minimum is 20 litres to achieve the
desired effect.
- High flux: UF coefficient 20ml/h/mm
Hg/m2 and sieving coefficient of 0.6 B2
microglobulin.
50. KDOQI HD Adequacy Guideline
2015 Update
Further study is needed before HDF can be
recommended.
51. Adequacy of Renal Replacement
Therapy
Electrolyte &
Acid/base Control
Anaemia
Status
Nutritional
status
Middle molecule
clearance
Small molecule
clearance
Adequacy
Volume Control
Blood Pressure
Control
Well Being
Quality of Life
Quality of
Sleep
Long Term
Survival
Before we discuss dialysis quality, what are methods of waste clearance?
Dialysis and filtration, diffusion and conviction, osmotic gradient and pressure gradient.