This document discusses renal replacement therapy options for patients with kidney failure, including dialysis and transplantation. It provides details on the two main types of dialysis: peritoneal dialysis, which uses the peritoneal membrane as a filter, and hemodialysis, which uses an artificial kidney to filter blood outside the body. Kidney transplantation is also covered, noting it requires patients first be on dialysis and listing the surgical procedure and common complications.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Review of new alerts on PROTON PUMP INHIBITORS (PPI) adverse effects 2016 UPD...PAWAN V. KULKARNI
Last Updated: 15th MAY: ALL NEW STUDIES INCLUDED. After more than 2 decades of USE, ABUSE, OVERUSE.... PPIs are under scanner. Not just Osteoporosis, other complications but Proton pump inhibitors have been confirmed to cause insistent Kidney failure/disease, heart attacks to name a few. This new revelations should open the eyes of so many consumers and several doctors.
peritoneal dialysis, management of chronic renal failureSapana Shrestha
Peritoneal dialysis is a technique of dialysis in which solute and fluid exchange occurs between peritoneal capillary blood and dialysis solution in the peritoneal cavity via peritoneal layer with the help of peritoneal catheter.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
Renal Replacement Therapy for Kidney diseasesachintutor
Renal replacement therapy is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney disease.
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.
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
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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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.
3. SOEPEL
• S- O 65years old Saudi male. he complained of pain in her upper abdominal
from 4 day with nausea, loos appetite and bone pain.
• O- taking history and physical examination
• E- peptic ulcer, eosophegitis, AKD
• P- cbc, urinalysis and creatinine level in plasma
• E- hemofiltration
• L- renal replacement therapy
5. Types of dialysis
Dialysis is a way to clean blood of wastes, fluids and salts that build up in the body when
the kidneys fail. There are 2 kinds of dialysis:
• Peritoneal dialysis:
• Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and
lines the abdominal wall. This takes place inside the body and requires placement of a
catheter in the peritoneal cavity to allow fluid to be instilled and drained out.
• Hemodialysis:
• Uses a dialyzer or artificial kidney to filter the blood. This takes place outside the body and
requires some form of access to the circulatory system. Accomplished with the use of a
sophisticated computerized control unit.
6. • Kidney transplantation:
• To be placed on a transplant list the patient must be on some form of
renal replacement therapy, whether it is peritoneal dialysis or
hemodialysis
• Once a patient is accepted for transplant, the date of start of dialysis is
the date they are active on the list
• If the patient has a living donor who has been accepted as healthy
donor, it is possible to have a pre-emptive transplant, bypassing
dialysis.
• No treatment or palliative care
7. Peritoneal dialysis
• Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and
lines the abdominal wall. The membrane size is 1 – 2 m2 and approximates the body surface
area. Uses the following principles:
• Diffusion: movement of solutes across the peritoneal membrane from an area of higher
concentration to an area of lower concentration
• Osmosis: movement of water across the peritoneal membrane from an area of lower solute
concentration to an area of higher solute concentration.
• Ultrafiltration: water removal related to an osmotic pressure gradient with the use of various
concentrations of dialysate fluid.
8. • Fluid called DIALYSATE is put into the abdomen
through a PD catheter. This fluid is left to dwell in the
peritoneum for several hours.
• While in the abdomen, the fluid collects wastes that
have been filtered through the peritoneal membrane.
These wastes pass from the body when the fluid is
drained.
9. Peritoneal dialysis
• Performed daily, by the patient at home, more physiological
• Allows for independence, patients can work or travel
• Fewer fluid and dietary restrictions
• Often fewer medications or lower doses required
• Residual renal function preserved
• Ministry of health funded home therapy
10. Peritoneal dialysis
Patients
• Must have a clean room to perform exchanges and a large
enough area to store all supplies
• No pets allowed in the room
• Must learn to monitor their own weight and blood pressures
• Must be able to follow important instructions to prevent
infection in the peritoneum
• Must also be able to determine the choice of dialysate fluid
and when to use it
13. Types of peritoneal dialysis
CAPD ~ continuous ambulatory peritoneal dialysis
• The blood is cleaned constantly by dialysate fluid while it is in the abdomen.
• Capd does not require the use of a machine, the exchanges are completed manually.
Apd ~ automated peritoneal dialysis
• Requires the use of a machine called a cycler
• The CYCLER is used during the night and is set to deliver the fluid in and out of the
abdomen.
14. • Indications
1. bleeding tendency
2. Hypotension
3. Diabetic nephropathy
• Complications
1. Peritonitis
2. Injury of viscus
3. Abdominal hernia
4. Leakage of dialysate into pleural cavity or scrotom
15. Hemodialysis
• Blood is circulated through an artificial kidney which has two compartments:
blood & dialysate, separated by a thin semi-permeable membrane
• Waste and excess water pass from the blood side to the dialysate side and is
discarded in the drain the cleaned blood is returned to the patient.
• Usually done 3x /week ~ 4hrs m-w-f or t-th-sat
16. • Hemodialysis treatments every other day are not as physiological as
peritoneal dialysis
• Requires a trip to the hospital up to 3 times weekly
• Patients can travel to other units but must be pre-arranged and space is
not always available
• Patients are more restricted in dietary and fluid intake between treatments
• Medication requirements different than for those on peritoneal dialysis
e.G. Require more antihypertensive meds, higher doses of erythropoietin
17.
18.
19.
20. Hemodialysis
• Requires access to the blood stream
• Arterio – venous fistula
• Arterio – venous graft
• Temporary catheter
• Long – term catheter
23. Temporary hemodialysis catheter
Exit site at
surface of the
skin
Inserted in
the jugular
vein
Tip located
at junction
of SVC and
right Atrium
24. Tunneled hemodialysis catheter
Exit site
Catheter tunnel
Inserted in
the jugular
vein
Tip located
at junction
of SVC and
right Atrium
Dacron cuff
25. INDICATION
• ARF
• CRF
• HYPERKALEMIA
• HYPERCALCEMIA
• DRUG TOXICITY
• SEVER TEMPERATURE DISORDER
26. COMPLICATION
1. A-V shunt complication:
· Throbmosis. · Infection.
· Aneursysm. · HF.
2. bleeding.
3. Hepatitis B, C.
4. Loss of folic acid, vit B complex & hormones .
5. Dialysis disequilibrium syndrome.
7. Al dementia due to chronic dialysis using hard water to dissolve dialysate.
8. Hypotension.
9. Air embolism.
10. Depression.
28. • Technique:
Source:
Living related donor with HLA & ABO matching.
. Unrelated donor with hla.With paratial matching.
. Cadaveric kidney.
• Operative
. Nephrectomy
. The kidney is perfused with cold solution till transplantation(cold ischemic time)
. The kidney is placed in iliac fossa & anastmosed to iliac vessels & ureter is
placed in
Bladder.
• Indications
all patients of ESRD without contraindications for transplantation & with
available donor.
29. Common complications of transplantation
Early complications
Surgical complications
Delayed or slow graft function
Lymphocele
Allograft rejection
Hyper acute rejection (antibody-mediated rejection) : within min. To hr of
perfusing of allograft
- Due to preformed antibodies to the ABO & HLA antigens.
Acute rejection – within 3 months of transplant
Chronic rejection
31. Metabolic complications- hypomagnesaemia, hypophosphatemia, hypercalcemia,
hyperkalemia, RTA, dyslipidemia
Malignancy- post transplant lymphoproliferative disorder
Recurrence of primary disease in the allograft- FSGS, MPGN, atypical HUS
Treatment :csa, cyclophosphamide.
Chronic allograft dysfunction
32. Surgical complications
Lymphocele
Perirenal serous fluid collection
Hematoma
Graft thrombosis:
Caused by thrombosis of donor renal artery or vein.
Usually happens in first week.
Diagnosed by ultrasound with doppler studies.
Almost always requires explant of kidney.