- Acute kidney injury (AKI) is a common and serious problem in hospitalized patients, especially those in the ICU, with mortality rates over 50% in dialyzed ICU patients.
- The RIFLE and AKIN classification systems provide criteria for staging AKI severity based on changes in serum creatinine and urine output.
- Biomarkers like NGAL and IL-18 allow for earlier diagnosis of AKI than serum creatinine, detecting injury within hours compared to the days it takes creatinine levels to rise. Promising biomarkers indicate proximal tubule injury.
- While supportive care remains the primary treatment, new anticoagulants and agents targeting apoptosis, inflammation and
Acute kidney injury, previously known as acute renal failure, encompasses a wide spectrum of injury to the kidneys, not just kidney failure. The definition of acute kidney injury has changed in recent years, and detection is now mostly based on monitoring creatinine levels, with or without urine output. Acute kidney injury is increasingly being seen in primary care in people without any acute illness, and awareness of the condition needs to be raised among primary care health professionals.
Acute kidney injury is seen in 13–18% of all people admitted to hospital, with older adults being particularly affected. These patients are usually under the care of healthcare professionals practising in specialties other than nephrology, who may not always be familiar with the optimum care of patients with acute kidney injury. The number of inpatients affected by acute kidney injury means that it has a major impact on healthcare resources. The costs to the NHS of acute kidney injury (excluding costs in the community) are estimated to be between £434 million and £620 million per year, which is more than the costs associated with breast cancer, or lung and skin cancer combined.
Acute Kidney Injury epidemiology, pathophysiology and management based on current evidence. The presentation is suitable for internal medicine trainees and nephrology fellows.
Sudden impairment of kidney function occurring over a period of hours to days.
AKI is present in 7% of all hospitalized patients, and up to 30% of patients in ICU
The incidence is increasing at an alarming rate
That's why we need ideal biomarker to diagnose the AKI as early as possible and deliver better treatment to the patient.
‘Think Kidneys': Improving the management of acute kidney injury in the NHS Renal Association
‘Think Kidneys': Improving the management of acute kidney injury in the NHS
Presented by Dr Richard Fluck, National Clinical Director (Renal) – NHS England
Acute kidney injury, previously known as acute renal failure, encompasses a wide spectrum of injury to the kidneys, not just kidney failure. The definition of acute kidney injury has changed in recent years, and detection is now mostly based on monitoring creatinine levels, with or without urine output. Acute kidney injury is increasingly being seen in primary care in people without any acute illness, and awareness of the condition needs to be raised among primary care health professionals.
Acute kidney injury is seen in 13–18% of all people admitted to hospital, with older adults being particularly affected. These patients are usually under the care of healthcare professionals practising in specialties other than nephrology, who may not always be familiar with the optimum care of patients with acute kidney injury. The number of inpatients affected by acute kidney injury means that it has a major impact on healthcare resources. The costs to the NHS of acute kidney injury (excluding costs in the community) are estimated to be between £434 million and £620 million per year, which is more than the costs associated with breast cancer, or lung and skin cancer combined.
Acute Kidney Injury epidemiology, pathophysiology and management based on current evidence. The presentation is suitable for internal medicine trainees and nephrology fellows.
Sudden impairment of kidney function occurring over a period of hours to days.
AKI is present in 7% of all hospitalized patients, and up to 30% of patients in ICU
The incidence is increasing at an alarming rate
That's why we need ideal biomarker to diagnose the AKI as early as possible and deliver better treatment to the patient.
‘Think Kidneys': Improving the management of acute kidney injury in the NHS Renal Association
‘Think Kidneys': Improving the management of acute kidney injury in the NHS
Presented by Dr Richard Fluck, National Clinical Director (Renal) – NHS England
Over the last decades, more than 35 different definitions have been used to describe acute kidney injury (AKI). Multiple definitions for AKI have obviously led to a great disparity in the reported incidence and mortality of AKI making it difficult or even impossible to compare the various published studies focusing on AKI. Therefore, it became crucial to establish a consensual and accurate definition of AKI that could desirably be used worldwide. Recent consensus criteria for AKI definition and classification [the Risk Injury Failure Loss of kidney function End-stage kidney disease (RIFLE) and the Acute Kidney Injury Network (AKIN) classifications] have led to more consistent estimates of its epidemiology. This review will present and critically discuss current literature about AKI diagnosis and epidemiology.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Urine Neutrophil Gelatinase-Associated Lipocalin Moderately Predicts Acute Kidney Injury in Critically Ill Adults
Edward D. Siew*, Lorraine B. Ware, Tebeb Gebretsadik, Ayumi Shintani, Karel G. M. Moons, Nancy Wickersham, Frederick Bossert and T. Alp Ikizler
he Citrate Story
David Gattas gives an update on today's go-to anti-coagulant for renal replacement therapy: Citrate
David is a key figure in the ANZICS CTG, with a growing list of publications and was involved in the RENAL and POST-RENAL studies.
Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial is available free.
This talk was recorded live at an ICN NSW / ANZICS meeting in September 2014.
ShearWave™ Elastography in Chronic Liver Diseases: Clinical Research Literatu...Joel Gay
By the end of 2016, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) reached a track record of over 100 peer-reviewed publications focusing on the evaluation of liver fibrosis severity in patients with chronic liver diseases. Therefore, it has become the most clinically studied shear-wave based elastography technique for liver fibrosis assessment.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within the field of chronic liver diseases.
CT coronary angiography in ED chest pain patientskellyam18
CT coronary angiography is the new kid on the block for assessing emergency department patients with chest pain. How accurate is it? What are the down sides? How useful is it? Which patients is it suitable for? This presentation attempts to answer these questions in light of current evidence.
In this multinational, randomized, controlled trial in patients with chronic kidney disease who were undergoing angiography, researchers found no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over oral placebo for the prevention of death, need for dialysis, or persistent kidney impairment at 90 days or for the prevention of contrast-associated acute kidney injury or other secondary end points.
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
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.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
- 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
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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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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
1. DR. SHERIF ALY Consultant (A) Nephrology Assir central hospital Abha 10/10/10 Acute Renal Failure UPDATE
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6. The Effect of AKI on Mortality Green bars are unadjusted, blue bars are age and gender adjusted, and gray bars are multivariable adjusted. Multivariable analyses adjusted for age, gender, diagnosis-related group (DRG) weight, CKD status, and ICD-9-CM codes for respiratory, gastrointestinal, malignant, and infectious diseases; n = 1564, 885, 246, and 105 for change in SCr 0.3 to 0.4, 0.5 to 0.9, 1.0 to 1.9, and 2.0 mg/dl. Chertow et al, JASN 2005
7. The Effects of AKI on Hospital Costs Green bars are unadjusted, blue bars are age and gender adjusted, and gray bars are multivariable adjusted. Multivariable analyses adjusted for age, gender, diagnosis-related group (DRG) weight, CKD status, and ICD-9-CM codes for respiratory, GI, malignant, and infectious diseases; n = 1564, 885, 246, and 105 for change in SCr 0.3 to 0.4, 0.5 to 0.9, 1.0 to 1.9, and 2.0 mg/dl. Chertow et al, JASN 2005
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11. Conceptual Model for AKI Normal Increased risk Damage ↓ GFR Kidney Failure Death
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15. Biomarkers: AMI versus AKI Multiple Therapies 50% ↓ Mortality Supportive Care High Mortality Need early biomarkers of AKI for improved understanding, early treatment and better outcomes Period Acute Myocardial Infarction Acute Kidney Injury 1960s LDH Serum creatinine 1970s CPK, myoglobin Serum creatinine 1980s CK-MB Serum creatinine 1990s Troponin T Serum creatinine 2000s Troponin I Serum creatinine
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18. Serum and Urinary Biomakers for AKI SG Coca etal kid. International 2008 73 , 1008 -1016
19. Scoring system for validity used in this systematic review Validity Criterion Explanation Scoring Comments Participant recruitment Was recruitment based on presenting symptoms, results from previous tests, or fact that participants received index tests? Presenting sx=1 Previous tests or index tests=0 Based on presenting symptoms in all 31 studies. Participant sampling Was it study population or a convenience sample or a consecutive series? Consecutive series=1 Convenience sample=0 Based on convenience sample in 5 10, 19, 20, 22, 25, 37 studies. Data collection Was data collection planned before the index test and reference standard were performed prospectively or retrospectively? Prospective=1 Retrospective=0 Planned and performed prospectively in all 31 studies. Reference standard Was the rationale for the reference standard stated? Stated=1 Not stated=0 Not stated for two 12, 18 studies. Materials and methods Were technical specifications of material and methods stated including how and when measurements were taken? Stated=1 Not stated=0 Stated in all but one 19 of the articles. Index test Were the definitions of and rationales for the units, cutoffs, and/or categories of the results of the index tests stated? Stated=1 Not stated=0 Not stated in two 12, 19 of the 31 articles. Blinding Were readers of index test and reference standard blinded? Blinded=1 Not blinded or not stated=0 Stated that the readers of index test and reference standard were blinded in 17 10, 11, 19, 29, 30, 35, 36, 37, 38, 39 articles. Completion Was the number of participants that did not undergo index tests (no. of tests vs sample size) stated? Stated=1 Not stated=0 Stated in all but one 19 of the studies. Time interval Was the time interval from index test to reference standard stated? Stated=1 Not stated=0 The time interval between index test and reference standard (clinical diagnosis of AKI or severity end point such as dialysis or death) was not stated in five 19, 20, 25, 34, 36 articles. Distribution of severity of disease Was there a representative distribution of severity of disease? (mild, moderate, severe AKI; non-oliguric vs oliguric) Yes=1 No=0 A broad distribution of disease severity was found in all but four 12, 25, 27, 37 of the studies.
20. Studies of biomarkers for the early diagnosis of AKI References Biomarker Clinical setting Subjects Sensitivity/specificity Area under ROC Positive LR Quality score Serum Herget-Rosenthal et al. 9 Cystatin C ICU 85 0.82/0.95 NR 16.4 9 Ahlstrom et al. 24 Cystatin C ICU 202 NR 0.901 N/A 9 Mazul-Sunko et al. 25 Cystatin C ICU 29 0.5/0.5 NR 1.0 6 Mazul-Sunko et al. 25 ProANP(1-98) ICU 29 NR/NR NR N/A 6 Mishra et al. 11 NGAL Cardiac surgery in children 71 0.70/0.94 NR 11.6 10 Rinder et al. 27 Neutrophil CD11b Cardiac surgery 75 NR NR 62.6 † 8 Urine Mishra et al. 11 NGAL Cardiac surgery in children 71 1.0/0.98 0.998 50.0 10 Wagener et al. 28 NGAL Cardiac surgery 81 0.73/0.78 0.8 3.3 9 Zappitelli et al. 38 NGAL Critically ill children 140 0.77/0.72 0.78 2.75 10 Parikh et al. 29 NGAL Post-transplant 63 0.9/0.83 0.9 5.3 10 Parikh et al. 10 IL-18 ICU 138 0.5/0.85 0.73 3.3 9 Parikh et al. 29 IL-18 Post-transplant 63 NR 0.9 N/A 10 Parikh et al. 30 IL-18 Cardiac surgery 71 0.5/0.94 0.75 8.3 10 Han et al. 40 IL-18 Critically ill children 137 0.25/0.81 0.54 1.3 10 Han et al. 37 KIM-1 Cardiac surgery 40 0.74/0.90 0.83 3.16 8 Han et al. 37 NAG Cardiac surgery 40 1.0/0.3 0.69 1.43 8 Han et al. 37 MMP-9 Cardiac surgery 40 NR 0.50 N/A 8 Eijkenboom et al. 31 GST Cardiac surgery 84 NR NR N/A 9 Westhuyzen et al. 32 -GT ICU 26 1.0/0.9 0.95 10.0 9 Westhuyzen et al. 32 -GST ICU 26 1.0/0.9 0.929 10.0 9 Westhuyzen et al. 32 -GST ICU 26 0.75/0.9 0.893 7.5 9 Westhuyzen et al. 32 AP ICU 26 0.5/0.95 0.863 10.0 9 Westhuyzen et al. 32 NAG ICU 26 1.0/0.81 0.845 5.3 9 Westhuyzen et al. 32 LDH ICU 26 0.5/0.95 0.688 10.0 9
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25. * In development. Currently not for sale in US ® * Phase 3 Transition: Plasma NGAL Kit