This document summarizes a study that assessed reversible risk factors for acute-on-chronic renal failure. The study evaluated 100 patients admitted to a tertiary hospital over one year. Majority of patients had more than one reversible risk factor, most commonly urinary tract infection and sepsis. Conservative management and treatment of reversible factors resulted in significant improvement in renal function for most patients. Maximum reversibility was seen in patients with GFR between 15-29 ml/min, and least reversibility in those under 5 ml/min. The study concluded that identifying and treating reversible risk factors can help restore renal function and delay the need for renal replacement therapy in many patients experiencing acute decline on top of chronic kidney disease.
This slides contains 3 sections:
a. measurement of renal dysfuntion in cirrhosis
b. Evolution of hepatorenal syndrome
c. treatment of hepatorenal Syndrome
Comparative Study of Hscrp in Chronic Kidney Diseaseiosrphr_editor
Chronic kidney disease (CKD) is a global threat to health mainly in developing countries because therapy is expensive and lifelong. over 1 million people worldwide are on dialysis or with a functioning graft. Early detection of Chronic kidney disease (CKD) and its consequent complications can prevent its grave complications . It causes not only significant morbidity but also it causes high mortality. Because of increase in incidence of Diabetes mellitus, hypertension, obesity and an aging population there is increase in progression of chronic kidney disease to end stage renal disease (ESRD). . Cardiovascular disease (CVD) is the major cause of mortality in haemodialysis patients and so it has become imperative to have a screening programme at all levels to detect CKD at an early stage and to initiate specific therapy to reduce the progression of renal disease and also the burden of ESRD (1). High sensitive C-Reactive protein (Hs CRP) assay is useful for sensitive detection of inflammatory state (2,3). This study aims at estimating Hs CRP as a marker of inflammation in CKD patients...
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Steroid Sparing Regimens in Kidney TransplantationAbdullah Ansari
Mechanisms of action of steroids
Rationale for steroids minimization
Steroid minimization strategies
Very low maintenance dosages
Complete withdrawal early after transplantation (three to six months post-surgery)
Complete withdrawal later after transplantation (six months to one year post-surgery)
Steroid free maintenance, after rapid withdrawal within a week
Complete avoidance
This slides contains 3 sections:
a. measurement of renal dysfuntion in cirrhosis
b. Evolution of hepatorenal syndrome
c. treatment of hepatorenal Syndrome
Comparative Study of Hscrp in Chronic Kidney Diseaseiosrphr_editor
Chronic kidney disease (CKD) is a global threat to health mainly in developing countries because therapy is expensive and lifelong. over 1 million people worldwide are on dialysis or with a functioning graft. Early detection of Chronic kidney disease (CKD) and its consequent complications can prevent its grave complications . It causes not only significant morbidity but also it causes high mortality. Because of increase in incidence of Diabetes mellitus, hypertension, obesity and an aging population there is increase in progression of chronic kidney disease to end stage renal disease (ESRD). . Cardiovascular disease (CVD) is the major cause of mortality in haemodialysis patients and so it has become imperative to have a screening programme at all levels to detect CKD at an early stage and to initiate specific therapy to reduce the progression of renal disease and also the burden of ESRD (1). High sensitive C-Reactive protein (Hs CRP) assay is useful for sensitive detection of inflammatory state (2,3). This study aims at estimating Hs CRP as a marker of inflammation in CKD patients...
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Steroid Sparing Regimens in Kidney TransplantationAbdullah Ansari
Mechanisms of action of steroids
Rationale for steroids minimization
Steroid minimization strategies
Very low maintenance dosages
Complete withdrawal early after transplantation (three to six months post-surgery)
Complete withdrawal later after transplantation (six months to one year post-surgery)
Steroid free maintenance, after rapid withdrawal within a week
Complete avoidance
When to dialyse a patient and with what modality of dialysis will be topic of discussion.The recent advances and debates surrounding the topic will be discussed in detail
Newer Oral Anticoagulant in Chronic Kidney DiseaseAbdullah Ansari
Kidney specific mechanisms leading to atrial fibrillation
Possible mechanism of CKD progression in atrial fibrillation
Atherosclerosis Risk in Communities (ARIC) study
Guidelines
Pulmonary embolism & deep vein thrombosis
Nephrotic syndrome
Problems with Vit K antagonists in CKD
Non Vit K oral anticoagulants
Site of action of NOACs and VKAs
Pharmacology of Direct Oral Anticoagulants
Trials for NOACs
Dose NOACs according to renal function
Laboratory monitoring of NOACs
Anticoagulant reversal of NOACs
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Acquired hemophilia is a rare disorder and if missed can cost lives. This presentation has been prepared keeping in view the non hematologist health care workers to broaden their index of suspicion and increase their awareness. The target people are medical residents those who work in ER and ICUs.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
John B. Buse, MD, PhD; David Cherney, MD, PhD, FRCP(C); and Mikhail Kosiborod, MD, FACC, FAHA, prepared useful Practice Aids pertaining to SGLT2 inhibitors for this CME activity titled “Complex Cases in Contemporary Practice: Applying New Evidence for SGLT2 Inhibitors in the Management of Patients With Comorbid Cardiometabolic Diseases.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/3dFKZhs. CME credit will be available until July 22, 2021.
When to dialyse a patient and with what modality of dialysis will be topic of discussion.The recent advances and debates surrounding the topic will be discussed in detail
Newer Oral Anticoagulant in Chronic Kidney DiseaseAbdullah Ansari
Kidney specific mechanisms leading to atrial fibrillation
Possible mechanism of CKD progression in atrial fibrillation
Atherosclerosis Risk in Communities (ARIC) study
Guidelines
Pulmonary embolism & deep vein thrombosis
Nephrotic syndrome
Problems with Vit K antagonists in CKD
Non Vit K oral anticoagulants
Site of action of NOACs and VKAs
Pharmacology of Direct Oral Anticoagulants
Trials for NOACs
Dose NOACs according to renal function
Laboratory monitoring of NOACs
Anticoagulant reversal of NOACs
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Acquired hemophilia is a rare disorder and if missed can cost lives. This presentation has been prepared keeping in view the non hematologist health care workers to broaden their index of suspicion and increase their awareness. The target people are medical residents those who work in ER and ICUs.
When to Initiate RRT in Patients with AKI - Does Timing Matter?Apollo Hospitals
Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT.
John B. Buse, MD, PhD; David Cherney, MD, PhD, FRCP(C); and Mikhail Kosiborod, MD, FACC, FAHA, prepared useful Practice Aids pertaining to SGLT2 inhibitors for this CME activity titled “Complex Cases in Contemporary Practice: Applying New Evidence for SGLT2 Inhibitors in the Management of Patients With Comorbid Cardiometabolic Diseases.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/3dFKZhs. CME credit will be available until July 22, 2021.
On DPP-Inhibitor ,case study on Linagliptin,Safe and affective class of drug for Management of Type II Diabetes as Monotherapy and add on therapy with OHA and Insulin,It can be added to SGLT2 Inhibitor also.
GLP-1 is an incretin (hormone that increases insulin secretion in response to a meal), which is a 30-amino acid peptide secreted in response to the oral ingestion of nutrients by intestinal L cells.
GLP-1 receptors (GLP-1R) are located in islet cells, central nervous system, and other organs. GLP-1 is metabolized by the enzyme dipeptidyl peptidase-4 (DPP-4).
Incretin effect is a phenomenon whereby a glucose load delivered orally produces a much greater insulin secretion than the same glucose load administered intravenously.
This presentation is an overview of the entire GLP-1 system, followed by an introduction to leveraging its therapeutic potential using GLP-1 analogues (Exenatide, Liraglutide, Lixisenatide, Albiglutide, Dulaglutide) and DPP-4 inhibitors (Sitagliptin, Vildagliptin, Saxagliptin, Linagliptin, Anagliptin, Teneligliptin, Alogliptin, Trelagliptin, Omarigliptin).
Shashikiran Umakanth delivered this talk at Manipal on 30th November, 2015
Type 2 diabetes - A 2016 update by Zeena NackerdienZeena Nackerdien
The International Diabetes Federation maintains that one in two adults are undiagnosed for diabetes and that estimates that one in eleven people had diabetes in 2015. If one takes into account that most of the cases involves the preventable condition of Type 2 diabetes, it comes as no surprise that many countries are being hit by staggering socioeconomic costs. Diabetes sites, chat rooms, aps, and ads for ever-evolving and increasingly complex disease management schemes are commonplace on Google. But what does all the information mean? The American Diabetes Association, American Association of Clinical Endocrinologists, The Canadian Diabetes Association, WebMD, and the International Diabetes Federation resources served as the major resources for this accompanying slide deck that tries to unpack some of the major subtopics related to prediabetes and Type 2 diabetes. The slide deck is organized according to disease definition, epidemiology, etiology/pathophysiology, diagnosis, treatment, and prevention. Particular topics such as the early use of insulin could be expanded into several separate slide decks narrating benefits and risks with supporting evidence. However, this deck is meant to provide interested readers with an overview of the Type 2 diabetes literature landscape, with the caveat that specific cases and Type 2 diabetes-related complications should always be discussed with a healthcare provider.
Image credits: slideteam.net; Wikimedia
SGLT2 Inhibitors (Gliflozins): A New Class of Drugs to treat Type 2 Diabetes:Naina Mohamed, PhD
Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).
A ppt about contrast nephropathy: basics, risk factors, comparison of preventive strategies.
critical review of POSEIDON trial and brief about PRESERVE trial.
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
A case study on essential dosage adjustment in chronic renal insufficiencySriramNagarajan16
Renal disease alters the effects of many drugs. Drug doses of certain drugs have to be appropriately adjusted depending upon
the degree of renal impairment. Drug dosing errors in patients with renal impairment are common and can lead to
accumulation and toxicity leading to adverse effects and poor outcomes. A case of a 72 years old male patient with chronic
renal failure with other co morbid disease states like systemic hypertension, diabetes mellitus, osteoporosis and peripheral
artery disease has been discussed. Laboratory data revealed both elevated serum creatinine and urea levels. On the day of
admission the patient was in end stage renal disease as his calculated GFR was 12ml/min. Modified Diet for Renal Disease
equation was used to calculate the GFR and dose adjustments were made accordingly. Drugs prescribed to the patients
included ceftriaxone 1 g, Pentoxifylline 400 mg, Tapendadol 50 mg, Levocarnitine 500 mg, Alprazolam 0.5 mg, Alpha
calcidiol 0.25 mg, Atorvastatin 20 mg, Cilostazol 50 mg, Tramadol 50 mg, Esomeprazole 40mg, Calcium 250 mg, A
systematic medication chart review revealed that pentoxyfylline is the drug of choice with altered dosing recommendations in
this patient. Therapeutic duplication in the form of using pentoxyfylline and cilostazole to treat peripheral vascular disease
was also noted. Alprazolam was started at a higher dose for the geriatric patient.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days.It's most common in those who are critically ill and already hospitalized.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. Assessment of reversible risk factors
causing
acute-on-chronic renal failure
N Nand*, M Shrama**, H Kumar***
Prity Mehta****
PGIMS, Rohtak - 124 001,
Haryana.
Journal, Indian Academy of Clinical Medicine l Vol. 13, No. 3 l July-September, 2012
By
………. RAMESH NAYAK……… 28/03/2014
for dept of physiology JNMC @ aditya
3. Functions of kidney
1. Excretory function
2. Regulatory function
3.Endocrine function
4.Metabolic function
H
O
M
E
O
S
T
A
S
I
S
for dept of physiology JNMC @ aditya 3
5. a. Acute Renal Failure
- abrupt in onset and reversible
- AZOTEMIA most common
. indicator
- Depending upon the cause
. 3 types:
Prerenal
Postrenal
Renal
for dept of physiology JNMC @ aditya 5
6. b. Chronic Renal Failure
- progressive and represents irreversible kidney structural damage.
- signs and symptoms occur gradually
kidney has amazing compensatory ability.
- characterized by GFR reduction, reflects
reduction in the number of functional nephrons.
for dept of physiology JNMC @ aditya 6
7. Stages of progression of CRF:
1. Diminished Renal
Reserve
2. Renal Insufficiency
3. Renal Failure and
4. End-Stage Renal
Disease(ESRD)
CKD
STAGE 1
CKD
STAGE 2
CKD
STAGE 3
CKD
STAGE 4
eGFR
mL/min ≤50% ≤(50-20)% ≤20% ≤5%
serum BUN &
creatinine levels
still normal.
No symptoms
seen.
earliest
symptom
isosthenuria
azotemia,
anemia &
hypertension
begin to
appear.
kidneys cannot
regulate volume &
solute composition
edema, metabolic
acidosis &
hyperkalemia develop.
uremia may ensue
with neurologic,
GI and CV
manifestation
Histologically
reduction in
renal
capillaries.
Atrophy and
fibrosis in
tubules.
kidney mass
usually reduced.
TO,1. Diminished Renal
Reserve
2. Renal Insufficiency
3. Renal Failure and
4. End-Stage Renal
Disease(ESRD)
CKD
STAGE 1
≤50%
for dept of physiology JNMC @ aditya 7
10. ACUTE-ON-CHRONIC RENAL FAILURE
Any sudden decline in renal functions in patients with known chronic kidney
disease
Each episode of acute attack - can be attributed to - one or more reversible risk
factors.
Various reversible risk factor contributing to acute-on-chronic renal failure are:
Volume depletion
Urinary tract obstruction
Infection
Hypotension
Electrolyte imbalance
Accelerated hypertension
Nephrotoxic drugs
for dept of physiology JNMC @ aditya 10
11. Renal function tests:
1. Urine analysis
(physical, chemical and microscopic examination)
2. Blood analysis
(blood urea, plasma creatinine, serum protein, cholesterol and
. electrolyte)
3. Renal clearance tests
(to measure GFR and RBF)
4. Radiology and renal imaging
5. Renal biopsy
for dept of physiology JNMC @ aditya 11
12. Management of renal failure:
1) Conservative management
- preventing deterioration of remaining renal function and
- helps the body in compensating for the existing impairment.
2) Renal replacement therapy
- Dialysis and
- Renal transplantation
for dept of physiology JNMC @ aditya 12
14. Assessment of reversible risk factors causing
acute-on-chronic renal failure
1.PREVALENCE:
ESRD reached epidemic proportions – treatment becoming an
unbearable health care burden.
conservative estimate of ESRD burden - population of 1.1 billion - around
1,650,000 people develop ESRD in india annually.
Taking conservative approach, if all patients were to be treated - cost
burden over $6.5 billion annually - health care budget for all of India $3.5
billion.
QUEST india | DaVita’s Clinical Journal for Nephrologists July 2007 Issue 9 By H. Sudarshan Ballal, M.D.
for dept of physiology JNMC @ aditya 14
15. 2.Introduction
Any sudden decline in renal functions in patients with
known chronic kidney disease (CKD)
Each episode of acute attack can be attributed to one or
more reversible risk factors.
Timely management - renal function brought back to basal
level- preventing from ESRD - reducing the cost of renal
replacement therapy.
for dept of physiology JNMC @ aditya 15
16. 3.OBJECTIVE:
- Evaluate risk factors - their degree of reversibility - in cases
of acute-on-chronic renal failure
admitted to a tertiary care hospital, over a period of one
year, i.e., from November, 2006 to October, 2007.
for dept of physiology JNMC @ aditya 16
17. 4.MATERIAL AND METHODS:
MATERIAL:
The study included 100 cases of acute-on-chronic renal failure
mean age of (48.69 ± 16.02) years.
62 men and 38 women.
The diagnosis of acute-on-chronic renal failure was based on , patients with CRD
- presenting with sign and symptoms of acute renal failure or
- who presented with
0.5 mg/dl, if baseline serum creatinine was < 3 mg/dl
rise in serum creatinine of
1 mg/dl, if baseline was > 3 mg/dl with in one week period.
for dept of physiology JNMC @ aditya 17
18. METHODS:
admitted in the ward - average period of 14.62 days (range: 9 to 24 days)
. - managed conservatively following thorough
clinical evaluation and investigations.
Specific management of reversible factor(s) and haemodialysis, whereever
needed was also done.
Observations of various parameters were recorded at baseline and subsequently
at 1 week and 2 week periods which included 24-hour
urine volume, blood urea, serum creatinine, and creatinine clearance.
for dept of physiology JNMC @ aditya 18
19. To compare the degree of reversibility, the patients were divided into 4
groups
depending upon their GFR;
GFR (30 - 59 )ml/min group 3
GFR (15 - 29 )ml/min group 4
GFR (5 – 15) ml/min group 5a and
GFR < 5 ml/min group 5b.
Reversibility of these parameters was then statistically analysed.
for dept of physiology JNMC @ aditya 19
20. 5.RESULTS :
Majority of patients were found to
have more than one reversible risk
factor
Average being 2.62 (ranging
. from 1to 4)
however, only one factor was
taken as the major factor depending
upon the clinical situation.
for dept of physiology JNMC @ aditya 20
21. Table II depicts degree of reversibility in patients having specific
aggravating factors
for dept of physiology JNMC @ aditya 21
22. Maximum reversibility was found in patients in stage 4 and
least in stage 5b .
GFR (30 - 59 )ml/min group 3
GFR (15 - 29 )ml/min group 4
GFR (5 – 15) ml/min group 5a
GFR < 5 ml/min group 5b.
for dept of physiology JNMC @ aditya 22
23. 6.DISCUSSION:
Patients presenting in severe uraemic state - not suffering from end-stage renal
. disease; rather – had significant degree of reversibility of renal function .
study showed, majority of patients were having more than one reversible
risk factor (average 2.62).
Conservative management + haemodialysis and correction of reversible
risk factor(s) , resulted in significant improvement in mean creatinine clearance
after 2 weeks of follow-up.
proved better chances of reversibility even in patient with stage 3 and
. stage 4 of CRF.
However, in the earlier studies, the net degree of reversibility was found to be low –
probably because the patients included were of advanced renal
failure (creatinine clearance < 15 ml/min)
for dept of physiology JNMC @ aditya 23
24. a)Sepsis
Most common and major factor infecting urinary tract,
identified in the present study.
Established that patients with CKD - increased risk of sepsis - causes
acute deterioration of renal function.
(which is due to renal vasoconstriction caused by endothelin )
However the most common site of infection in previous studies was found
to be different by different investigators.
for dept of physiology JNMC @ aditya 24
25. b)Accelerated Hypertension
Found to be major factor in 19 patients and had lower degree of
reversibility, although it was statistically significant.
Causes mucoid intimal proliferation and fibrinoid necrosis in renal
vasculature which is irreversible.
It was observed by many investigators that patients presenting with
acute-on-chronic renal failure had a poor outcome due to accelerated
hypertension.
While others observed that with long term control of blood pressure,
renal function recovers sufficiently to allow for withdrawal of dialysis.
for dept of physiology JNMC @ aditya 25
26. c)Volume depletion
was found to be a major factor in 10 patients with maximum degree of
reversibility,
whereas patients who had hypotension along with volume depletion
had a lower degree of reversibility.
Results of heart failure and bleeding were not statistically significant
because number of observation was less than 5.
Mc Innes observed that patients with pre-renal failure had 60%
recovery, whereas patients with intrinsic renal failure had 48% mortality.
for dept of physiology JNMC @ aditya 26
27. d)Electrolyte disturbance
• Salt depletion - aggravating factor & found
hyponatraemia - most common electrolyte disturbance
• Burkhard - hyponatraemia was the most common electrolyte imbalance
It was not a strong predictor of renal function decline
Hypernatraemia was found to be a stronger predictor.
• Hyponatraemia - most common electrolyte disturbance in the present study
- found minimum degree of reversibility in patients with electrolyte
disturbance
for dept of physiology JNMC @ aditya 27
28. e)Obstructive uropathy
Many investigators have observed
good reversibility of renal function on release of obstruction.
However, Mc Innes
found poor outcome in these patients
which was probably due to malignant disease in the pelvis.
In this study, 14 patients had obstructive uropathy as a major cause,
. and it was second most reversible factor.
for dept of physiology JNMC @ aditya 28
29. 7.CONCLUSION
On the basis of results of the present study it can be concluded
that:
- Patients presenting in a severe uraemic state may not be suffering
from ESRD and each patient should be investigated for the presence of
reversible risk factor(s).
so that * renal function can be restored and
* the need of renal replacement therapy can be
. delayed.
- Volume depletion and urinary tract infection were found to be the
most reversible aggravating factors observed by the study.
for dept of physiology JNMC @ aditya 29
30. 8.CRITICAL APPRAISAL
• Type of study not mentioned.
• Place where study done, not mentioned clearly.
• Basis of inclusion criteria not explained.
• Method of statistical analysis not mentioned.
for dept of physiology JNMC @ aditya 30
31. Refrences:
Medical Physiology by Indu Khurana
Pathophysiology (Concepts of altered health status) by Carol Mattson
for dept of physiology JNMC @ aditya 31