This document provides information about nephrotic syndrome including its definition, causes, signs and symptoms, investigations, management, and complications. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be caused by primary/idiopathic conditions like minimal change disease or secondary causes such as SLE, diabetes, or drugs. Management involves dietary modifications, diuretics, steroid therapy, and immunosuppressive drugs depending on disease severity and response to treatment. Complications include thrombosis, peritonitis, and hypovolemia which require prompt intervention.
Nephrotic syndrome, Characterized by heavy proteinuria>3.5g/m/day in adults,>...FarsanaM
Nephrotic syndrome, in paediatric patients(children), mainly Minimal change nephrotic syndrome (MCNS),Characterized by heavy proteinuria>3.5g/m/day in adults,>1g/m/day in children, hypoalbuminemia <2.5g/dL, oedema, hyperlipidemia 200mg/dL, Pathogenesis of MMCNS injury to the glomerular visceral epithelial cell( Podocyte) foot processes
Nephrotic syndrome, Characterized by heavy proteinuria>3.5g/m/day in adults,>...FarsanaM
Nephrotic syndrome, in paediatric patients(children), mainly Minimal change nephrotic syndrome (MCNS),Characterized by heavy proteinuria>3.5g/m/day in adults,>1g/m/day in children, hypoalbuminemia <2.5g/dL, oedema, hyperlipidemia 200mg/dL, Pathogenesis of MMCNS injury to the glomerular visceral epithelial cell( Podocyte) foot processes
Toxemia of pregnancy: Definition,risk factors,Clinical features,management of pre-eclampsia. Nursing students will understand toxemia of pregnancy .Jasleen Kaur
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Toxemia of pregnancy: Definition,risk factors,Clinical features,management of pre-eclampsia. Nursing students will understand toxemia of pregnancy .Jasleen Kaur
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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.
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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3. AETIOLOGY
Primary or Idiopathic Secondary causes
70-90% of cases 10% of cases
Minimal change disease Membranous nephropathy
- SLE
- Diabetes mellitus
- Hepatitis B
- Sjogren’s disease
- Drugs
- Malignany
Focal segmental glomerulosclerosis
- Diabetes mellitus
- Obesity
- Kidney loss
- HIV
- Hypertensive nephrosclerosis
4. History
◦ AGE : < 6 years old (peak of age)
◦ Symptoms : Tiredness, Edema, Breathless, Oliguria, Frothy urine
◦ Signs : Xantelasma, Periorbital edema, Ascites, Pedal Edema
◦ Family history : Family that having similar presentation
◦ Any clues for complications : Generalize anasarca, Peritonitis, Thrombosis
5. Examinations ??
◦ Height & Weight : Gross edematous can cause increase weight
◦ Blood Pressure : High in AGN & normal in NS
◦ Edema : Periorbital, sacral, genital (scrotum,labium), lower limb
◦ Oral : Injected pharynx and tonsil enlargement post infectious or recurrent infection
◦ Neck : Cervical lymphadenopathy & JVP for fluid overload
◦ Lung : Reduce A/E ?, Crepitation
◦ Abdomen : Distended ? Soft ? Ascites ? (shiffting dullnes / Fluid trill)
6. Full Blood Count TWC – infection , Hb - Anemia
Renal profile : Urea, Electrolyte,
Creatinine
Renal Impairment (AKI) or Electrolyte
Imbalance
Serum Cholesterol Hyperlipidemia
Liver Function Test : Albumin Hypoalbunimia
Urinalysis, Urine Culture Why?? – Haematuria, Proteinuria
Quantitative urinary protein excretion Why?? – for diagnosis
What to expect ? More > 200mg/mmol
If urine PCI sent, still need to send 24H urine
protein collection? Yes
Issues with 24H urine collection? – Observe
proteinuria (worsening or improving)
7. Serum complement (C3, C4) level What to expect?
C3 level – low at onset symptom, normalizes
by 6 weeks
C4 level – usually normal limit in post
streptococcal AGN
ASOT titres Why?? ( ASOT > 200 IU/ml)
What are significant titre – Post streptococcal
infection
Antinuclear factor / anti-dsDNA What to expect? Positive to exclude SLE
9. Management
Non- pharmacological Pharmacological
Penicillin V
(Prophylaxis/
treatment)
125mg BD (1-
5years), 250mg BD
(6-12years), 500mg
BD (>12years)
recommended
Human albumin
(20-25%)
0.5-1g/kg can be use in
symptomatic, grossly
oedematous case,
together with
IV Frusemide at 1-
2mg/kg
Diuretic Steroid therapy
Steroid-sparing
agents
10. Prednisolone 60mg/m2/day for 4 weeks
(max dose 60mg/day)
Followed by alternate-day prednisolone 40mg/m2/day for 4 weeks (max dose 40mg/day), the taper
over 4 weeks and stop
12. Infrequent
Relapse
< 2 relapse within
6 month or < 4
relapse within 1
years
Induction with
prednisolone at
dose 60mg/m2/day
(max dose
60mg/day) until
remission
THEN
40mg/m2/EOD
(max dose
40mg/day) for 4
weeks then stop
Frequent
Relapse
≥2 relapses within
6 month or ≥4
relapses within 1
years
Induction with
prednisolone at
dose 60mg/m2/day
(max dose
60mg/day) until
remission,
THEN
40mg/m2/EOD
(max dose
40mg/day) for 4
weeks only.
THEN taper dose
every 2 weeks and
keep on as low on
alternate day dose
as possible for 6
month
Relapse Nephrotic
Syndrome
Urine albumin
excretion
40mg/m2/hour or urine
dipstick > 2+ for 3
consecutive days
No need admission
unless having grossly
edematous or
complication
13. Short stature
Striae
Cataract
Glaucoma
severe cushingoid features
≥2 consecutive relapses
occurring during steroid taper
or within 14 days of cessation
of steroids.
Steroid Dependent
Nephrotic Syndrome
Steroid Non-toxic
Re-induce with steroid
and maintain on as low a
dose alternate day
prednisolone as possible
Steroid Toxic
Consider for steroid-
sparing agent
14. Steroids-Sparing agents
Cyclophosphamide Therapy
Dose : 2-3mg/kg/day for 8-12
weeks (cumulative dose
168mg/kg)
Side effect leucopenia, alopecia,
hemorrhagic cystitis
Counseled about effectiveness
Need to monitor FBC and
urinalysis by 2 weekly
Relapse post
Cyclophosphamide
Treated as for relapse following
the initial diagnosis of nephrotic
syndrome, IF child does not have
sign of steroid toxicity.
Levamisole
Dose 2.5mg/kg on alternate days
for at least 12 month
Calcineurin inhibitor
Cyclosporin
Tacrolimus
Rituximab
17. REFERENCE
Paediatric protocols for Malaysian Hospital 4th Edition
Essential Medicine Concise Clinical Notes on Understanding & Managing Disease
Robbins and Cotran, Pathologic Basis of Disease, 8th Edition
18.
19.
20.
21.
22.
23. NEPHRITIC
Characterized by inflammation in glomeruli that present with :
◦ Edema : Facial puffiness
◦ Hypertension
◦ Oliguria
◦ Azotemia : High level nitrogen-containing compound
◦ Microscopic / Macroscopic hematuria : Tea colour-urine / Cola like colour / Smoky
24. AETIOLOGY
POST STREPTOCOCCAL AGN ( Group A Beta Hemolytic Streptococci )
◦ Comment causes of acute nephritic syndrome, mainly due to post-streptococcal
Pharynx or skin infection
◦ Commonest at 6-10 years age
◦ Latent period :
◦ After sore throat : 1-2 weeks
◦ After skin infection : 2-3 weeks
25. Major Symptoms
◦ Hematuria (most frequent)
◦ Gross/microscopic >5 RBCs/HPF
◦ Urine Color : deep red-brownish, smoky, cola like color
◦ Hypertension (60-80%)
◦ Monitoring BP 4 Hourly
◦ Due to : General vasospasm, Hypervolemia or Salt water retention
◦ Oliguria (50%) <0.5mk/kg/h. Occur due to reduce GFR
◦ Edema
◦ Course : Begin with puffy eye in morning & LL edema at night
26. Investigation
◦ Urinalysis
◦ Hematuria : present in all patient
◦ Protenuria (trace to 2+, but mayb in nephrotic range)
◦ Red blood cell casts
◦ Pyuria may present
◦ Evidence Streptococcus infection
◦ Throat & Skin swab culture
◦ Raised ASOT (Anti Streptolysin O test) >200IU/ml
◦ Increased anti-DNAse B : better serological marker of preceding streptococcal skin infection
◦ Renal Function Test
27. Investigation
◦ Full Blood Count
◦ Leukocytosis may present
◦ Anaemia
◦ Complement Level
◦ C3 level : Low at onset of symptom, normalies within 6 weeks
◦ C4 level : Usually normal limits in post-streptococcal AGN
28. Management
◦ Strict monitoring : Fluid intake, Urine output, daily weight, BP (Nephrotic chart)
◦ Penicillin V x10/7 to eliminate B-haemolytic streptococcal infection
◦ Fluid restriction to control oedema and circulatory overload during oliguric phase until child diureses
and blood pressure controlled
◦ Day 1 : up to 400ml/m2/day. DO NOT administer IV or oral fluid if child has pulmonary edema
◦ Day 2 : till patient diureses – 400ml/m2/day
◦ When child diureses - allowed free fluid
29. Management
◦ Diuretics (Frusemide) should given pt that having pulmonary edema. Usually needed for treatment
hypertension
◦ Diet – NO added salt to diet. Protein restriction unnecessary
◦ Watch Out for Complication post-streptococcal AGN
30. Follow Up
◦ Atleast 1 year
◦ Monitor BP every visit
◦ Do urinalysis and renal function to evaluate recovery
◦ Repeat C3 levels 6 weeks later if not already normalized by time discharge
31. RENAL BIOPSY
Kidney biopsy is a procedure where a
doctor takes a tiny piece of kidney tissue
using a special needle. The tissue is
examined under a microscope in the
laboratory
32. Risk of Procedure
Kidney biopsies are usually low-risk procedures. The risk may increase depending on your child’s
condition, age and health.
◦ bleeding into the urine
◦ bleeding around or into the kidney
◦ infection
◦ needle injury to any other nearby organ
◦ urine leak from the kidney
◦ kidney damage
33. Procedure
1. Your child will be lying prone.
2. The interventional radiologist uses ultrasound to view the kidneys.
3. Local anaesthetic is then injected into the skin to numb the biopsy area.
4. Then, while watching the kidney using the ultrasound, the interventional radiologist passes a special
thin needle into one of the kidneys to get samples. Usually two or three samples are taken
5. The samples are about 2 to 3 centimeters (1 inch) long, and look like a piece of thread. These kidney
samples are then sent to the lab for examination.
6. You child will usually not need any stitches. A small bandage is placed over the biopsy site.
7. A kidney biopsy usually takes 45 minutes to one hour