The document provides American College of Rheumatology guidelines for screening, treating, and managing lupus nephritis. It defines the disease burden, case definitions, and classifications. It recommends renal biopsy for untreated patients and outlines treatment principles based on disease classification. For classes III and IV, it recommends initial therapy with corticosteroids and immunosuppressants. It provides monitoring guidelines and addresses treatment of relapses, resistant disease, and different disease classes. The goal is to induce and maintain remission to prevent long-term kidney damage.
Disturbances of piturtary adrenal gonadal axis in hemodialysis ptalaa wafa
The kidneys play an important role in hormonal management. Endocrine disorders are one of the most crucial elements of ‘uraemic syndrome’ which is underestimated and has not been fully examined.
In CRF, there are complex endocrinal disorders related to hypothalamus and pituitary functions, and their relations to adrenal and gonadal functions also as far as sex hormones and adipose tissue hormones .
There is a great need for more randomized clinical trials to evaluate new and old treatment approaches, with the goal of developing better evidence-based practice guidelines.
Disturbances of piturtary adrenal gonadal axis in hemodialysis ptalaa wafa
The kidneys play an important role in hormonal management. Endocrine disorders are one of the most crucial elements of ‘uraemic syndrome’ which is underestimated and has not been fully examined.
In CRF, there are complex endocrinal disorders related to hypothalamus and pituitary functions, and their relations to adrenal and gonadal functions also as far as sex hormones and adipose tissue hormones .
There is a great need for more randomized clinical trials to evaluate new and old treatment approaches, with the goal of developing better evidence-based practice guidelines.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
This presentation focuses on main and most common oncological emergencies that are required by any stagiaire or junior doctor.
This presentation based on three books mainly, Davison’s principles and practice of medicine, pocket guide to oncological emergencies and ESMO hand book of oncological emergencies, in addition to some researches.
- English version of this lecture is available at:
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https://youtu.be/WzFZym9hDtQ
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Lupus nephritis update, classification, approach according to guidelines, different case scenarios with stress on algorithmic management of different presentations
Ahmed Yehia
Contrast Induce Nephropathy
its include information about the nephropathy thats caused by the contrast , like in patients undergo PCI or other method of imaging containing contrast
I will discuss the causes with the risk factors then explain the headline of the pathophysiology and clinical presentaion with the mangment,
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
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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 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
2. Disease Burden
• 35% of adults with SLE have clinical evidence
of nephritis at the time of diagnosis.
• 50–60% developing nephritis during the first
10 years of disease.
• Higher in men than in women.
• Survival with SLE - 95% at 5 years
3. Case definition
• Persistent proteinuria 0.5 gm per day
• Or greater than 3+ by dipstick
And/or
• Spot urine protein/creatinine ratio of >0.5
Active Urinary Sediment:
• >5 RBCs/hpf
• >5WBCs/hpf in the absence of infection
• cellular casts limited to RBC or WBC casts
4. Renal Biopsy
• All patients with clinical evidence of active LN,
previously untreated, undergo renal biopsy
(unless strongly contraindicated) so that
glomerular disease can be classified by current
ISN/RPS classification
• Evaluated for activity and chronicity and for
tubular and vascular changes
5.
6.
7. Principles of treatment
• Class I and Class II- do not require
immunosuppressive treatment.
• Class III And Class IV aggressive therapy with
glucocorticoids and immunosuppressive agents
• Class V when combined with class III or IV should
be treated in the same manner as class III or IV
• Class VI requires preparation for renal
replacement therapy rather than
immunosuppression
8. • All SLE patients with nephritis be treated with
a background hydroxychloroquine(maximum
daily dose of 6–6.5 mg/kg ideal body
weight)unless there is a contraindication
Rationale:
• Lower rates of Flare
• Reduced renal damage
• Less clotting events
9. • LN patients with proteinuria >0.5 gm per 24
hours should have blockade of the renin–
angiotensin system, which drives
intraglomerular pressure
Rationale:
• Reduces proteinuria by 30%, and
• Significantly delays doubling of serum
creatinine
• Delays progression to end-stage renal disease
10. • Control of hypertension, with a target of
<130/80 mm Hg
• Statin therapy be introduced in patients with
low-density lipoprotein cholesterol >100
mg/dl
11. Class I LN (minimal-mesangial LN)
• Treatment as dictated by the extrarenal
clinical manifestations of lupus
RATIONALE:
• Class I LN has no clinical kidney
manifestations.
• Class I LN is not associated with long-term
impairment of kidney function
12. Class II LN (mesangial-proliferative LN)
• Treat patients with class II LN and proteinuria
<1 g/d as dictated by the extrarenal clinical
manifestations of lupus.
• Class II LN with proteinuria >3 g/d be treated with
corticosteroids or CNIs as described for MCD.
RATIONALE:
There are no evidence-based data on the
treatment of class II LN.
13. Class III LN (focal LN) and class IV LN
(diffuse LN)
• Initial therapy with corticosteroids , combined
with either cyclophosphamide or MMF
• if patients have worsening LN (rising SCr,
worsening proteinuria) during the first 3
months of treatment, a change be made to an
alternative recommended initial therapy, or a
repeat kidney biopsy be performed to guide
further treatment
17. Duration of Therapy
• There is no evidence to help determine the
duration of maintenance therapy.
• The average duration of immunosuppression
was 3.5 years in seven RCTs.
• Immunosuppressive therapy should usually be
slowly tapered after patients have been in
complete remission for a year.
• Immunosuppression should be continued for
patients who achieve only a partial remission.
18. Predictors of Response to Treatment of
Class III/IV LN
Predictors for not achieving remission:
• SCr at the start of treatment
• Magnitude of increase in SCr during relapse
• Delay in starting therapy for more than 3
months after a clinical diagnosis of LN.
• Severity of proteinuria
• Failure to achieve complete remission a major
risk factor for kidney relapse.
19. Monitoring Therapy of Class III/IV LN
• Proteinuria
• SCr
• Urine sediment
• C3 and C4,
• Anti–double-stranded DNA antibodies
20. Class V LN (membranous LN)
• Patients with class V LN,normal kidney
function, and non–nephrotic-range
proteinuria be treated with antiproteinuric
and antihypertensive medications, and only
receive corticosteroids and immunosup-
pressives as dictated by the extrarenal man-
ifestations of systemic lupus.
21. • Pure class V LN and persistent nephrotic
proteinuria be treated with corticosteroids
plus an additional immunosuppressive agent:
• cyclophosphamide
• CNI
• MMF
• Azathioprine
23. Class VI LN (advanced sclerosis LN)
• Treated with corticosteroids and immuno-
suppressives only as dictated by the extrarenal
manifestations of systemic lupus.
24. Relapse of LN
• Relapse of LN after complete or partial
remission be treated with the initial therapy
followed by the maintenance therapy that was
effective in inducing the original remission
• If resuming the original therapy would put
the patient at risk for excessive lifetime
cyclophosphamide exposure, then we suggest
a non cyclophosphamide based initial regimen
be used.
25. • Consider a repeat kidney biopsy during
relapse if there is suspicion that the histologic
class of LN has changed, or there is
uncertainty whether a rising SCr and/or
worsening proteinuria represents disease
activity or chronicity.
26.
27. Treatment of resistant disease
• In patients with worsening SCr and/or protei-
nuria after completing one of the initial
treatment regimens, consider performing a
repeat kidney biopsy to distinguish active LN
from scarring.
• Treat patients with worsening SCr and/or
proteinuria who continue to have active LN on
biopsy with one of the alternative initial treat-
ment regimens.
28. • Nonresponders who have failed more than
one of the recommended initial regimens may
be considered for treatment with rituximab,
i.v.immunoglobulin, or CNIs.