This document provides an overview of peritoneal dialysis, including:
1. Peritoneal dialysis removes waste and fluid from the blood through diffusion and ultrafiltration across the peritoneal membrane in the abdomen.
2. The peritoneal membrane contains pores that allow transport of water, small solutes, and macromolecules. Transport is assessed through the peritoneal equilibration test.
3. Prescriptions are tailored based on membrane transport characteristics, with more frequent exchanges for high transporters to optimize fluid removal and clearance of waste.
The evaluation of peritoneal membrane is very important for selection of appropriate modality of peritoneal dialysis. Peritoneal membrane is a living membrane so periodic evaluation is important.
Historical background
The concept of incremental dialysis
The residual kidney function and its significance
Incremental hemodialysis
Observational studies on incremental HD
The candidates for incremental HD
The potential benefits and risks associated with incremental HD
Incremental peritoneal dialysis
The intact nephron hypothesis in reverse
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
The evaluation of peritoneal membrane is very important for selection of appropriate modality of peritoneal dialysis. Peritoneal membrane is a living membrane so periodic evaluation is important.
Historical background
The concept of incremental dialysis
The residual kidney function and its significance
Incremental hemodialysis
Observational studies on incremental HD
The candidates for incremental HD
The potential benefits and risks associated with incremental HD
Incremental peritoneal dialysis
The intact nephron hypothesis in reverse
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
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
- 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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
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
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
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.
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.
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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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Overview of peritoneal dialysis
1. Overview of Peritoneal DialysisOverview of Peritoneal Dialysis
Piti Niyomsirivanich, MD.
Cardiology Fellowship of Maharat Nakhon Ratchasima Hospital
4. •Ultra-small or transcellular pores (0.4-0.6 nm.)
• Exist in small numbers and constitute 1-2 % of all pores
•Transport water only (sieving) :aquaporin-1(water channel)
Michael F. FlessnerAm J Physiol Renal Physiol 288: F433–F442, 2005
Free water
5. •Small pores (4.0-6.0 nm.)
• Exist in large numbers and constitute 95% of all pores
•transport small solutes and water: interendothelial cleft
Michael F. FlessnerAm J Physiol Renal Physiol 288: F433–F442, 2005
Small solute
e.g. Na ,K , Cr
6. •Large pores (20-24 nm)
•Exist in small numbers and constitute < 3% of all pores
•Transport macromolecules and anatomically large clefts
between endothelial cells : convection
Michael F. FlessnerAm J Physiol Renal Physiol 288: F433–F442, 2005
albumin
16. Peritoneal Equilibration TestPeritoneal Equilibration Test
PET Prescription
High
Transporter
Short dwell time
Increase cycle
High Average NIPD/CAPD
Low Average High dose CAPD/CCPD
Low High dose CCPD+RRF
Switch to HD without RRF
23. Dialysis related peritonitisDialysis related peritonitis
• Diagnosis (2 of 3)Diagnosis (2 of 3)
1. Clinical : Fever, Abdominal pain,
Cloudy dialysate
2. PDF cell diff/cell count : WBC ≥ 100
(PMN ≥ 50%), in dwell time for 4 hr
3. PDF Culture : Positive
24. Investigation
CBC
Elyte , BUN , Cr , alb
H/C
CXR
Film KUB
PDF fluid : cell diff , cell count , culture
gram stain (for Dx fungal infection)
25. Route of InfectionRoute of Infection
• Transluminal Hx Touch contamination
• Periluminal exit site infection, tunnel infection ?
• Transmural diarrhea ? Constipation ?
• Transvaginal leukorrhea , PID ?
• Hematogenous other source of infection
26. DDx. In Cloudy DialysateDDx. In Cloudy Dialysate
1. Culture-positive infectious peritonitis
2. Culture-negative Infectious peritonitis
3. Chemical peritonitis
4. Eosinophilia of the effluent
5. Hemoperitoneum
6. Malignancy (rare)
7. Chylous effluent (rare)
8. First drainage after break in period
29. • หลักการให้ Antibiotic
–Empiric antibiotics:
• Cover Gram+ve & Gram-ve organisms
• Center-specific selection of empiric therapy
• History of sensitivities of organisms causing
peritonitis
–Gram +ve : 1st
Cephalosporin
–Gram -ve : 3rd
Cephalosporin or
Aminoglycoside
PD related peritonitisPD related peritonitis
30. • Empiric regimen:Empiric regimen:
Cefazolin 1 gm i.p.
+
Cetazidime 1 gm.i.p
in PDF 2,000 ml ,dwell time ≥ 6 hours
• In Clinical Severe SepsisIn Clinical Severe Sepsis
Cefazolin + Cetazidime i.p. and i.v. Loading dose
Then if clinical improve only i.p. route
PD related peritonitisPD related peritonitis
31.
32. Empirical antibioticEmpirical antibiotic
Clinical Assessment on day 3-5Clinical Assessment on day 3-5
Microbes Isolated from culture ,Adjust antibioticsMicrobes Isolated from culture ,Adjust antibiotics
Clinical improvement
& evaluate exit site and tunnel
Clinical improvement
& evaluate exit site and tunnel
No clinical improvement
Reculture and evaluate
No clinical improvement
Reculture and evaluate
No clinical improvement by
day 5 after appropriate
antibiotic
: off catheter
No clinical improvement by
day 5 after appropriate
antibiotic
: off catheter
Exit site or tunnel infection
Off catheter
Exit site or tunnel infection
Off catheter
clinical improvement
Continue antibiotics
clinical improvement
Continue antibiotics
33.
34.
35.
36.
37.
38.
39. Empirical antibioticEmpirical antibiotic
Clinical Assessment on day 3-5Clinical Assessment on day 3-5
Microbes Isolated from culture ,Adjust antibioticsMicrobes Isolated from culture ,Adjust antibiotics
Clinical improvement
& evaluate exit site and tunnel
Clinical improvement
& evaluate exit site and tunnel
No clinical improvement
Reculture and evaluate
No clinical improvement
Reculture and evaluate
No clinical improvement by
day 5 after appropriate
antibiotic
: off catheter
No clinical improvement by
day 5 after appropriate
antibiotic
: off catheter
Exit site or tunnel infection
Off catheter
Exit site or tunnel infection
Off catheter
clinical improvement
Continue antibiotics
clinical improvement
Continue antibiotics
40. < 4 weeks , different organism
< 4 weeks , same organism
> 4 weeks , same organism
43. Equivocal exit site infections
purulent or bloody
drainage is only
present in the sinus
and cannot be
expressed outside.
44. Acute exit site infection
characterized by redness,
swelling and tenderness.
The erythema is more than
twice the diameter of the
catheter and there is
regression of the
epithelium in the sinus.
45. Chronic infection
ent both externally and in the sinus of the exit site in chronic infections. The exit is sometimes covered by a large, persistent crust or scab. There is usually no
Granulation tissue is
typically present
both externally and
in the sinus of the
exit site in chronic
infections.
47. ESI Scoring System
0 point 1 point 2 points
Swelling 0 < 0.5 cm > 0.5 cm
Crust 0 < 0.5 cm > 0.5 cm
Redness 0 < 0.5 cm > 0.5 cm
Pain 0 Slight Severe
drainage 0 Serous Purulent
Score = or > 4 : ESI ; purulent drainage ESI
Score < 4 may or may not represent ESI
48.
49.
50. UF failure
1.Compliance (oral Na , drug) ?
2.Cardiovascular cause ?
3.Evaluate residual renal function (nephrotoxic
drug ) ?
4.Mechanic Failure ?
a. Obstruction ,Entrapment , Malposition
b. Hernia , leakage
5.Peritoneal Function ?
51. Evaluation
• Hx
– Cardiovascular disorder ?
– Lean body mass
– Salt and water
– Residual renal function (nephrotoxic agent ?)
• PE
– Exit site leakage
– Hernia pericatheter ,genital ,inguinal ,femoral area
– Edema : generalized , unilateral , localized , decrease
BS ,abdominal wall ,inguinal area , genitalia
Ultra-small or transcellular pores (4-6 A) are water channels or aquaporin-1. They are numerous and resemble the water channels present in red blood cells and renal proximal tubules. They transport water only (sieving) and are present in the endothelial cells of the peritoneal capillaries.
Sodium concentration in dialysate as a function of dwell time t. Dashed lines, clinical data (means ± SD); solid lines, model results.
Intraperitoneal volume of dialysate (left) and glucose concentration in dialysate (right) as a function of dwell time t. Dashed lines, clinical data (means ± SD); solid lines, model results.