IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Includes the essential sepsis sepsis workup,starting from simple tests to more advanced and more specific tests to identify the source of sepsis, and accordingly apply the effective and specific management
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Includes the essential sepsis sepsis workup,starting from simple tests to more advanced and more specific tests to identify the source of sepsis, and accordingly apply the effective and specific management
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
Chronic kidney diseases CKD is a progressive and irreversible deterioration of renal function. Patients with CKD are prone to a variety of infections. Further chronic hemodialysis increases the infections and related morbidity and mortality. The present study was conducted to assess the probability of infection episode in CKD patients in patients with or without haemodialysis. A Cross sectional observational study was conducted with a total 56 patients with CKD. Clinical and biochemical data related to infections were collected from the individual patient records. The results showed that the chills and rigors, increased TLC, and elevated ESR were found to more in CKD patients on chronic haemodialysis. Further, our results suggested that CKD patient population showed increased-risk for the development of lethal sepsis. Hence, identification of the causes of infection and the appropriate treatment based on the severity of symptoms are essential for CKD patients who are on dialysis. Punit Gupta | Swati Sharma | Ashish Deo "Comparison of Infection Episodes in CKD Patients with or without Hemodialysis from Tribal Population" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-1 , December 2018, URL: http://www.ijtsrd.com/papers/ijtsrd19000.pdf
http://www.ijtsrd.com/medicine/other/19000/comparison-of-infection-episodes-in-ckd-patients-with-or-without-hemodialysis-from-tribal-population/punit-gupta
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Evaluation of POSSUM scoring system in patients with perforation peritonitis ...Kundan Singh
Background: Continuous audit of clinical practice is an essential part of making improvements in medicine and
enhancing patient care. Recently, physiological and operative severity score for the enumeration of mortality and
morbidity (POSSUM) scores has been developed, which would help to identify those patients who are at increased
risk of developing complications and deaths. This scoring system is based on 12 physiological characteristics of
patient and 6 characteristics of the surgery performed.
Methods: This study was done in Department of surgery at Patna medical college, Patna, Bihar, India from April
2014 to October 2015 on 100 patients. Physiological variables were collected prior to induction of anesthesia and
operative variable collected during operation chi-square test was used for expected and actual mortality differences.
Results: In present study 100 patients of peritonitis due to different cause of intestinal perforation were studied.
Comparison of observed and POSSUM predicted mortality and morbidity rates were done. Observed to expect
mortality and morbidity ratio was 1.005 and 1.001 respectively and there was no statistically significant difference
between the predicted and observed values.
Conclusions: This study confirms and validates the findings of previous work that POSSUM is an accurate and
reliable tool for estimating in-hospital mortality.
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...dbpublications
Background : Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection which is one of the most important cause of mortality & morbidity in critically ill patients. In this study clinical profiles of the sepsis patients admitted in ICU in this part of India have been evaluated. Methods & Materials: This prospective hospital based observational study was undertaken in the department of Emergency Medicine ICU of Gauhati Medical College & Hospital, over a period of one year from August 2014 to July 2015 after obtaining institutional ethical committee clearance.
RESULTS: Clinical profiles of 50sepsis patients, with male preponderance (56%) & mortality rate 36% were studied. Mean age was 48.36 years (SD ±17.16). fever & tachycardia were present in all patients. 30 patients (60%) required ventilatory support, 28 patients (56%) required inotropic support, 10 patients (20%) required dialysis. Gram negative bacteria were found to be the predominant pathogens associated with sepsis(73.4%) where most common organism responsible was Klebsiella (36.8%). Conclusion : assessment of clinical signs & initial serological & radiological investigations are of utmost importance to detect more critically ill patients as early as possible to intervene earlier for saving the life of the sepsis patients.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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.
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.
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
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.
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
- 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.
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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
Serum Procalcitonin as a marker of infection in chronic kidney disease patients on hemodialysis in sepsis
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. I (Dec. 2015), PP 45-49
www.iosrjournals.org
DOI: 10.9790/0853-141214549 www.iosrjournals.org 45 | Page
Serum Procalcitonin as a marker of infection in chronic kidney
disease patients on hemodialysis in sepsis
Shaikh Mohammed Aslam S1
, Satyanarayana Garre2
1
Associate Professor, Department of Medicine, M.S.Ramaiah Medical college, Bangalore, India
2
Junior Resident, Department of Medicine, M.S.Ramaiah Medical college, Bangalore, India
Abstract:
Introduction: The use of Procalcitonin (PCT) as a bacterial diagnostic marker is controversial in patients on
hemodialysis (HD). Infections account for considerable morbidity and mortality in patients on HD. Hence, early
diagnosis of bacterial infections is important to make a prognostic assessment of its severity. If PCT can be used
as a primary marker for bacterial infections in patients on HD, these infections can be diagnosed and treated
early. Therefore, we investigated whether PCT could function as a primary diagnostic marker of bacterial
infections in patients on HD.
Aim: 1) To measure and show that serum procalcitonin levels will be increased in patients with chronic kidney
disease in sepsis on hemodialysis, and will be clinically significant. 2) To compare the serum procalcitonin
levels in patients on hemodialysis with sepsis; with procalcitonin level of patients on hemodialysis without
sepsis
Methods: A total of 80 patients of chronic kidney disease on hemodialysis admitted in M S Ramaiah Hospital
during the period October 2012 to september2014, were included in the study and were divided into 40 cases
and 40 controls considering the inclusion and exclusion criteria.
Results: Raised Serum procalcitonin was significantly more associated with CKD patients on hemodialysis in
sepsis with P<0.001. When procalcitonin was measured in CKD patients on hemodialysis in sepsis, the
sensitivity and specificity was 92.50, and 100.00 respectively, with a cut-off >5ng/ml.
Conclusion: Procalcitonin is a good marker of bacterial infection even in patients undergoing hemodialysis. In
patients undergoing hemodialysis, procalcitonin cut off level of >5ng/ml indicates sepsis.
Keywords: Chronic kidney disease; Hemodialysis; Procalcitonin; Sepsis.
I. Introduction
Chronic kidney disease (CKD) is common, and its prevalence is increasing.[1]
Infection is a major
cause of mortality in end-stage renal disease (ESRD) and hospitalization at all stages of CKD. The second
commonest cause of death among patients with ESRD is septicemia, and patients with ESRD are at increased
risk of death from infection compared to the general population.[2-4]
Epidemiological studies suggest that ESRD
patients have a higher risk of contracting bacterial infections and that the three most commonly seen infectious
complications are urinary tract infections (UTI), pneumonia, and sepsis. Overall, the annual percentage of
mortality secondary to sepsis is approximately 100 to 300 fold higher in dialysis patients.[4]
The use of PCT as a bacterial diagnostic marker is controversial in patients on hemodialysis (HD).[5-7]
Infections account for considerable morbidity and mortality in patients on HD.[8]
Hence, early diagnosis of
bacterial infections is important to make a prognostic assessment of its severity. If PCT can be used as a primary
marker for bacterial infections in patients on HD, these infections can be diagnosed and treated early. Therefore,
we investigated whether PCT could function as a primary diagnostic marker of bacterial infections in patients on
HD. We investigated whether serum PCT levels were influenced by HD and determined the cut-off level of PCT
in patients on HD.
Aims and Objectives
1. To measure and show that serum procalcitonin levels will be increased in patients with chronic
kidney disease in sepsis on hemodialysis, and will be clinically significant.
2. To compare the serum procalcitonin levels in patients on hemodialysis with sepsis to procalcitonin
level of patients on hemodialysis without sepsis.
II. Materials And Methods
The study was a prospective observational cross-sectional analytical study, where continuous data was
enumerated after fulfilling the inclusion criteria. A total of 80 patients of chronic kidney disease on
hemodialysis admitted during the period October 2012 to September 2014, were included in the study and were
divided into 40 cases and 40 controls considering the inclusion and exclusion criteria.
2. Serum Procalcitonin as a marker of infection in chronic kidney disease patients on hemodialysis…
DOI: 10.9790/0853-141214549 www.iosrjournals.org 46 | Page
Inclusion criteria
1. Chronic kidney disease patients on hemodialysis with sepsis
2. Should satisfy criteria for 1) Sepsis or
2) Severe sepsis or
3) Septic shock
As per International guidelines for management of severe sepsis and septic shock: 2008 published by
Society of Critical Care Medicine.[9]
3. Should satisfy criteria for chronic kidney disease as per guide lines of Kidney Disease Outcome Quality
Initiative of the National Kidney.[10]
Exclusion criteria
1. Patients age below 18 years.
2. Patients who underwent major surgery.
3. Patients with severe burns.
4. Patients on treatment with OKT3 antibodies
Laboratory methods
Serum procalcitonin, blood cultures, blood urea, serum creatinine, complete blood count, chest x-ray,
urine routine, serum electrolytes were done in all the patients.
Statistical methods
Descriptive and inferential statistical analysis was carried out in the present study. Results of
continuous measurements are presented as mean SD (min-max) and results of categorical measurements are
presented in numbers (%). Significance is assessed at 5 % level of significance. Student t test (two tailed,
independent) was used to find the significance of study parameters on continuous scale between two groups
(Inter group analysis) on metric parameters. Chi-square/ Fisher Exact test was used to find the significance of
study parameters on categorical scale between two or more groups.
III. Results
The mean age of patients in cases was 51.98±14.84 and the mean age of patients in controls was
54.48±12.23. 58 patients (72.5%) in the study group were men and 22 patients (27.5%) were women. Fever
(100.0%) was the most common presenting symptom in our study group, followed by cough (30.0%) and
burning micturition (17.5%). In our study, diabetes mellitus and hypertension were most common co-morbid
conditions (Table 1). The cases group had fulfilled the SIRS criteria with mean heart rate of 111.05±13.37 beats
per minute, mean temperature being 100.11±1.67 in Fahrenheit, mean respiratory rate being 24.73±6.19, and the
mean total count being 15156.23±8059.46 cells/cubic millimeter (Table 2). Pallor and edema were most
common clinical signs seen in the patients. Pallor was seen in 65% and 67.5% in cases and controls respectively.
Edema was seen in 30% and 25% in cases and controls respectively. In cases bronchopneumonia was the most
common cause of sepsis (32.5%), followed by urosepsis in 27.5% and septic encephalopathy in 12.5% (Table3).
In our study anemia of chronic disease was seen in both cases and controls with mean hemoglobin
being 8.46±1.61 in cases and 8.65±1.12 in controls. Leukocytosis was predominantly associated with sepsis
group when compared to the non sepsis group with significant p value. The mean creatinine value was high in
sepsis group when compared to the non sepsis group with moderately significant p value. The mean platelet
count was less in sepsis group when compared to the non sepsis group with moderately significant p value
(Table 4). In cases 7(17.5%) had sputum culture positive and 11(27.5%) had blood culture positive and
8(20.09%) had urine culture positive (Table 5). ESBL Escherichia coli was the most common organism isolated
from blood and urine, whereas pseudomonas was the most common organism isolated from sputum. In cases all
the patients had procalcitonin level more than 5 and in controls 32(80.0%) had procalcitonin between 0.5-2 and
8(20.0%) between 2 and 5 (Table 6).
Table 1: Co morbid conditions
Co morbid conditions
Cases
(n=40)
Controls
(n=40) P value
No % No %
Diabetes 28 70.0 32 80.0 0.302
Hypertension 27 67.5 33 82.5 0.121
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DOI: 10.9790/0853-141214549 www.iosrjournals.org 48 | Page
Table 6: Serum Procalcitonin
Serum
Procalcitonin
Cases Controls
No % No %
0.5-2 0 0.0 32 80.0
2-5 0 0 8 20.0
5-50 23 57.5 0 0.0
51-100 3 7.5 0 0.0
>100 14 35.0 0 0.0
Total 40 100.0 40 100.0
IV. Discussion
Procalcitonin is the prohormone of the hormone calcitonin. In healthy people, plasma PCT
concentrations are found to be below 0.05 ng/ml, but PCT concentrations can increase up to1000 ng/ml in
patients with sepsis, severe sepsis or septic shock. PCT values in the range of 0.5 and 2ng/ml represent a grey
zone with uncertainty as far as the diagnosis of sepsis is concerned. PCT levels more than 2ng/ml are highly
suggestive of an infectious process with systemic consequences. Concentrations more than 10ng/ml are almost
exclusively found in patients with severe sepsis or septic shock. Bacterial endotoxins and pro-inflammatory
cytokines are powerful stimuli for the production of PCT.
Since the mid-1990s, there has been an increasing use of PCT measurements in identifying systemic
bacterial infections. The short half-life (25–30 hours in plasma) of PCT, coupled with its virtual absence in
health and specificity for bacterial infections, gives it a clear advantage over the other markers of bacterial
infection. Recent data demonstrated that serum PCT is also an accurate indicator of severe infection and sepsis
in patients with chronic kidney disease (CKD) requiring intermittent hemodialysis (HD).[5,6]
Moderately
increased PCT was observed in CKD with and without renal replacement therapy (RRT) in the absence of
infections. [6]
However, the extent of PCT elevation in CKD with and without RRT, its underlying factors and
the origin of PCT under these conditions remain to be elucidated
Serum Procalcitonin as a diagnostic marker of sepsis has been largely studied in adult population and
is an established marker of sepsis with a sensitivity of 90-96%. Studies in the patients on maintenance
hemodialysis are lacking in this regard in the country and worldwide. Hence this study was conducted in our
hospital to study the usefulness of serum PCT in the diagnosis of sepsis in the chronic kidney disease on
maintenance hemodialysis.
In our study, diabetes mellitus and hypertension were the two most common co-morbid conditions.
This is in concordance with study done by Borja Quiroga et al where diabetes mellitus was the most common co
morbid condition.[11]
In our study, bronchopneumonia (32.5%) was the most common cause of sepsis. This is in
concordance with studies done by Stefan Herget‐Rosenthal et al and Ken -Ichi Mori et al, where pneumonia was
the most common cause of sepsis.[6,12]
In our study, the mean WBC count was higher in infection group when
compared to the non infection group, this is in correlation with the study done by Ken-Ichi Mori et al, were the
infection group had significantly higher WBC counts (P <0.01).[12]
This finding is also in correlation with the
study done by Stefan Herget‐Rosenthal et al where all the patients with severe infections and sepsis had higher
values of WBC than patients without infections.[6]
In our study, raised Serum procalcitonin was significantly
more in sepsis group with P value <0.001. This correlates with a study done by Ken-Ichi Mori et al where the
infection group had significantly higher procalcitonin (P <0.01).[12]
Similar finding was noted by Stefan
Herget‐Rosenthal et al and Borja Quiroga et al where patients with severe infections and sepsis showed
significantly higher procalcitonin values.[6,11]
In our study, gram negative bacteria like pseudomonas (7.5 %)
was the most common organism isolated from sputum in patients with sepsis. This is in concordance with the
study done by Ren W et al where gram negative bacteria like E coli (15.85%) and pseudomonas (14.63%) were
the most common organisms isolated. [13]
In our study, ESBL E.coli (10%) was the most common organism
isolated from urine in patients with sepsis. This is in concordance with a study done by Falah S et al where
E.coli (15%) was the most common organism isolated from urine.[14]
The normal reference range for procalcitonin is < 0.5, but in our study, 80% of the controls had
procalcitonin between 0.5-2 and 20% had procalcitonin between 2 and 5. This is in concordance with a study
done by Handan Akbulut et al. [15]
In their study, mean plasma concentration of procalcitonin in CKD patients
on hemodialysis was 2.13±0.7 ng/mL. This can be explained by the fact that CKD is a chronic inflammatory
state which causes raised procalcitonin level in CKD patients without sepsis.
In our study all the patients of CKD with sepsis had a procalcitonin level of more than 5, hence a cut
off of more than 5 for procalcitonin was calculated as a marker of sepsis in these patients with a Sensitivity of
5. Serum Procalcitonin as a marker of infection in chronic kidney disease patients on hemodialysis…
DOI: 10.9790/0853-141214549 www.iosrjournals.org 49 | Page
92.50,Specificity of 100.00, AUC=96.1%, SE=0.023 with P value <0.001. But in a study conducted by Stefan
Herget‐Rosenthal et al, patients with and without infections were well discriminated by the PCT cut‐off value of
1.5 ng/ml. [6]
The difference in the cut-off value was attributed to the difference in the kit used to estimate the
procalcitonin level in the two studies. Each laboratory should investigate the transferability of the expected
values to its own patient population and if necessary determine its own reference ranges.
V. Conclusions
Procalcitonin is a good marker of bacterial infection even in patients undergoing hemodialysis.
Procalcitonin should be used as marker of sepsis in all patients of chronic kidney disease on hemodialysis in
sepsis. Furthermore, the mean plasma concentration of procalcitonin was elevated in chronic kidney disease,
patients on maintenance hemodialysis compared to reference range, so in our study we had observed that the
procalcitonin cutoff level should be set at 5ng/mL to indicate sepsis.
References
[1]. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P et al. Prevalence of chronic kidney disease in the United States.
JAMA 2007;298(17):2038–47.
[2]. Collins AJ, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A et al. excerpts from the united states renal data
system 2007 Annual data report. Am J Kidney Dis. 2008;51(1 suppl 1):S1-320.
[3]. Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population.
Kidney Int 2000;58(4):1758–64.
[4]. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest 2001;120(6):1883–7.
[5]. Sitter T, Schmidt M, Schneider S, Schiffl H. Differential diagnosis of bacterial infection and inflammatory response in kidney
diseases using procalcitonin. J Nephrol 2002;15(3):297–301.
[6]. Herget-Rosenthal S, Marggraf G, Pietruck F, Hüsing J, Strupat M, Philipp T et al. Procalcitonin for accurate detection of infection
in hemodialysis. Nephrol Dial Transplant 200;16(5):975–9.
[7]. Dahaba AA, Rehak PH, List WF. Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients
undergoing hemodialysis. Intensive Care Med 2003;29(4):579-83.
[8]. Khan IH, Catto GR. Long-term complications of dialysis: infection. Kidney Int Suppl 1993;41:S143–8.
[9]. Dellinger RP , Levy MM, Carlet JM , Bion J , Parker MM ,Jaeschke R et al. Surviving sepsis campaign: international guidelines for
management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34(1):17-60.
[10]. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. National Kidney
Foundation. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
[11]. Quiroga B, Villaverde M, Vega A, Abad S, Reque J, López-Gómez JM. Procalcitonin as an early predictor of acute infection in
hemodialysis patients. Nefrologia 2014;34(3):341-6.
[12]. Mori K, Noguchi M, Sumino Y, Sato F, Mimata H. Use of Procalcitonin in patients on chronic hemodialysis: Procalcitonin is not
related with increased serum calcitonin. ISRN Urol 2012;2012:431859.
[13]. Ren W, Pan H, Wang P, Lan L, Chen W, Wang Y et al. Clinical analysis of pulmonary infection in hemodialysis patients. Exp Ther
Med 2014;7(6):1713-1717.
[14]. Manhal FS, Mohammed AA, Ali KH. Urinary tract infection in hemodialysis patients with renal failure. Fac Med Baghdad
2012;54(1):38-40.
[15]. Akbulut H, Celik Ü, Ozden M, Dogukan A, Bulut V. Plasma Procalcitonin levels in chronic haemodialysis patients. Turk J Med Sci
2005;35:241-4.