This document provides an overview of the management of anemia in chronic kidney disease. It defines anemia according to WHO criteria and notes that nearly 90% of CKD patients with a GFR below 30 mL/min have anemia. The main causes of anemia in CKD are decreased erythropoietin production and a shorter red blood cell lifespan. Treatment with erythropoiesis-stimulating agents or ESAs like epoetin and darbepoetin can help increase hemoglobin levels and improve outcomes. The goals of ESA therapy are to raise hemoglobin by 1-2 g/dL per month until it reaches 10-11.5 g/dL without exceeding 13 g/dL. Iron supplementation is
Hyertension in patients on regular hemodialysisEhab Ashoor
Everything about hypertension in patients on regular hemodialysis, including management, Resistant hypertension, Intra-dialytic hypertension and Hypertensive urgencies.
- Recorded videos of this lecture:
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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
Hyertension in patients on regular hemodialysisEhab Ashoor
Everything about hypertension in patients on regular hemodialysis, including management, Resistant hypertension, Intra-dialytic hypertension and Hypertensive urgencies.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/JQllk5Ad07E
Arabic Language version of this lecture is available at:
https://youtu.be/KXlJoMDi3ko
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
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
Anemia of renal disease is common and is associated with significant morbidity and death. It is mainly caused by a decrease in erythropoietin production in the kidneys and can be partially corrected with erythropoiesis-stimulating agents (ESAs). However, randomized controlled trials have shown that using ESAs to target normal hemoglobin levels can be harmful, and have called into question any benefits of ESA treatment other than avoidance of transfusions.
anemia is a very common marker of underlying diseases. it's sometimes gone under diagnosed due to lack of knowledge. here's an overview of the different types and causes of anemia and the pharmacists approach in addressing such problem.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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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
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
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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.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Management of anemia in chronic kidney disease -
1. Management Of Anemia
In Chronic Kidney
Disease
Presented By:
Boushra M. Alsaor
[Pharm D intern]
Al Maaefa college
2. Definition
Anemia has been defined by the World Health
Organization (WHO) as a hemoglobin (Hgb) concentration:
<13.0 g/dL for adult males and postmenopausal women
<12.0 g/dL for premenopausal women .
3. Prevalence
Based upon these criteria, nearly 90 percent of patients
with a glomerular filtration rate (GFR) <25 to 30 mL/min
have anemia, many with Hgb levels <10 g/dL.
4. Several factors are responsible for anemia in CKD
Decreased erythropoietin production (most important).
Shorter life span of RBCs.
Blood loss during dialysis.
Iron deficiency.
Anemia of chronic disease.
Renal osteodystrophy.
5. Treatment of anemia in CKD can
Decrease morbidity/mortality.
Reduce left ventricular hypertrophy.
Increase exercise tolerance.
Increase quality of life.
6. Anemia work-up
Initiate evaluation when CrCl is less than 60 mL/minute or
hemoglobin is less than 11 g/dL.
Hemoglobin/hematocrit.
Mean corpuscular volume.
Reticulocyte count.
Iron studies:
Transferrin saturation (total iron/total iron-binding capacity)—Assesses available
iron.
Ferritin—Measures stored iron.
Stool guaiac.
8. Erythropoiesis-stimulating agents (ESAs)
Epoetin-α
Same molecular structure as human erythropoietin (recombinant DNA
technology).
Binds to and activates erythropoietin receptor.
Administered either SC or IV.
Darbepoetin-α
Molecular structure of human erythropoietin has been modified from 3 N-
linked carbohydrate chains to 5 N-linked carbohydrate chains; increased
duration of activity. The advantage is less-frequent dosing.
Binds to and activates erythropoietin receptor.
9. When to start ESA and Hemoglobin goal
Risk vs benefit.
Address all correctable causes of anemia (including iron deficiency and
inflammatory states) prior to initiation of ESA therapy.
In non dialysis Patients:
Consider starting ESA treatment only when the Hgb level is <10 g/dL and reduce or
stop the ESA dose if the Hgb level exceeds 10 g/dL.
For patients on dialysis:
Initiate ESA treatment when the Hgb level is <10 g/dL and reduce or interrupt the ESA
dose if the Hgb level approaches or exceeds 11 g/dL
Try to maintain goal Hgb levels between( 10.0 and 11.5 g/dL). Avoid
hemoglobin concentration greater than 13 g/dL.
10. Dosing
Epoetin-alfa or epoetin-beta dosing usually starts at:
20 to 50 IU/kg body weight three times a week.
Darbepoetin-alfa dosing usually starts at:
0.45 mg/kg body weight once weekly by SC or IV administration.
0.75 mg/kg body weight once every 2 weeks by SC administration.
In patients with a history of CVD, thrombo-embolism or seizures, or
in those with high blood pressure, the initial doses should be in the
lower range.
11. The objective of initial ESA therapy is a rate of increase in Hb
Concentrations of 1.0 to 2.0 g/dl (10 to 20 g/l) per month.
The rise in Hb of greater than 2.0 g/dl (20 g/l) over a 4-week period
should be avoided.
Rapid rising of Hgh can induce hypertension and seizures.
Hemoglobin raising with ESA:
12. Dosing adjustment
Epoetin-alfa or epoetin-beta dosage may subsequently be increased
every 4 weeks by a weekly dose of 320 IU/kg if the increase of Hb is
not adequate.
Increases in dose should not be made more frequently than once a
month. If the Hb is increasing and approaching 11.5 g/dl (115 g/l), the
dose should be reduced by approximately 25%.
If the Hb continues to increase, doses should be temporarily withheld
until the Hb begins to decrease, at which point therapy should be
reinitiated at a dose approximately 25% below the previous dose.
13. Adjuvant Therapies
KDOQI guideline recommend not using androgens as an adjuvant
to ESA treatment.
Also suggest not using adjuvants to ESA treatment including
vitamin C, vitamin D, vitamin E, folic acid, L-carnitine, and
pentoxifylline.
14. ESA Monitoring
1. Hemoglobin concentrations initially every 1–2 weeks and then every
2–4 weeks when stable.
2. Monitor BP because it may rise (treat as necessary).
3. Iron stores:
A. Ferritin: HD target is 200–500, and peritoneal dialysis/CKD target is
100–500.
B. Transferrin saturation target is greater than 20% (upper limit of 50%
removed from recent guidelines).
15. Common causes of inadequate response to ESA therapy
1. Iron deficiency is the most common cause of erythropoietin
resistance.
2. Infection and inflammation.
3. Other causes: chronic blood loss, renal bone disease, aluminum
toxicity, folate or vitamin B12 deficiency, malignancies,
malnutrition, hemolysis, and vitamin C deficiency.
16. Risk of ESA
Higher chance of death was reported and an increased number of blood
clots, strokes, heart failure, and heart attacks was reported in patients with
chronic kidney failure when ESAs were given to maintain hemoglobin levels
of more than 12 grams per deciliter.
Higher chance of death and an increased rate of tumor growth were
reported in patients with advanced head and neck cancer receiving radiation
therapy and in patients with metastatic breast cancer receiving
chemotherapy, when ESAs were given to maintain hemoglobin levels of
more than 12 grams per deciliter.
Higher chance of death was reported and no fewer blood transfusions were
received when ESAs were given to patients with cancer and anemia not
receiving chemotherapy.
Higher chance of blood clots was reported in patients who were scheduled
for major surgery and given ESAs.
17. Iron Therapy
Iron therapy is important to replete iron store.
Parenteral iron therapy improves response to ESA and reduce the
dose required to achieve and maintain target indices.
18. Parenteral VS oral iron therapy
Parenteral therapy is the recommended route for all CKD patients.
Most patients with CKD who are receiving erythropoietin therapy
require parenteral iron therapy to meet needs (increased
requirements, decreased oral absorption).
Oral therapy is limited by poor absorption and non adherence with
therapy due to adverse effects.
Consider oral supplemental iron in ND or PD patient without IV access
or as maintenance therapy for ND or PD patients.
Oral route is not recommended in HD patients.
19. Iron Therapy:
Oral: 200mg elemental iron per day (= 600 mg Ferrous fumarate,1.8g ferrus
gluconate or 1gm ferrous sulphate ).
Parenteral:
20. Adverse effects of iron therapy
Allergic reaction.
Hypotension.
Dizziness.
Dyspnea.
Headache.
Low back pain.
Arthralgia.
Syncope.
Arthritis.
Some side effects can be reduced by decreasing the dose or rate of infusion.
Sodium ferric gluconate or iron sucrose has better safety profile than iron dextran.
21. Red blood cell transfusion
ESA therapy is ineffective (e.g., hemoglobinopathies, bone marrow
failure, ESA resistance).
The risks of ESA therapy may outweigh its benefits (e.g., previous or
current malignancy, previous stroke).
When rapid correction of anemia is required to stabilize the patient’s
condition (e.g., acute hemorrhage, unstable coronary artery disease).
When rapid pre-operative Hb correction is required.
Transfusion should be directed toward reduction of anemia sign and
symptoms rather than achieving specific target.