The kidney can concentrate urine by continuing to excrete solutes while reabsorbing more water, producing urine 4-5 times more concentrated than plasma. This ability is essential for terrestrial mammals to survive on land. The countercurrent mechanism in the loops of Henle and vasa recta allows solutes like urea to accumulate in the renal medulla, establishing a high osmotic gradient for water reabsorption. When ADH increases collecting duct permeability, this gradient enables production of highly concentrated urine, minimizing water loss and fluid intake needs.
Factors responsible for erythropoiesis. Development and maturation of erythrocytes require mostly three types of factors
1. General factors 2. Maturation factors 3. Factors necessary for hemoglobin formation.
Factors responsible for erythropoiesis. Development and maturation of erythrocytes require mostly three types of factors
1. General factors 2. Maturation factors 3. Factors necessary for hemoglobin formation.
# Diluting & Concentrating of urine. plus Acidification of Urine.
# what will happen if body water increased or decreased the role of collecting and distal convulated tube.
Urine Formation | Human Excretory System.pdfRaj Kumar
Urine formation is an intricate and vital process that takes place in our kidneys. It involves the filtration of blood, reabsorption of essential substances, and the secretion of waste products. This remarkable mechanism ensures the balance of fluids and electrolytes in our bodies, aiding in the maintenance of overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
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
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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
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2. Concentrated Urine
The ability of the kidney to form a urine that is more concentrated
than plasma is essential for survival of mammals that live on land,
including humans.
Water is continuously lost from the body through various routes,
including the lungs by evaporation into the expired air, the
gastrointestinal tract by way of the feces, the skin through
evaporation and perspiration, and the kidneys through the
excretion of urine.
Fluid intake is required to match this loss, but the ability of the
kidney to form a small volume of concentrated urine minimizes the
intake of fluid required to maintain homeostasis, a function that is
especially important when water is in short supply.
3. Concentrated Urine
When there is a water deficit in the body, the kidney forms a
concentrated urine by continuing to excrete solutes while
increasing water reabsorption and decreasing the volume of
urine formed.
The human kidney can produce a maximal urine concentration
of 1200 to 1400 mOsm/L, four to five times the osmolarity of
plasma.
Some desert animals, such as the Australian hopping mouse,
can concentrate urine to as high as 10,000 mOsm/L.
This allows the mouse to survive in the desert without
drinking water
4. Obligatory Urine Volume
The maximal concentrating ability of the kidney dictates how
much urine volume must be excreted each day to rid the body
of waste products of metabolism and ions that are ingested.
minimal volume of urine that must be excreted, called the
obligatory urine volume, - 0.5 L/Day
(1) a high level of ADH, which increases the permeability of
the distal tubules and collecting ducts to water, thereby
allowing these tubular segments to avidly reabsorb water, and
(2) a high osmolarity of the renal medullary interstitial fluid,
which provides the osmotic gradient necessary for water
reabsorption to occur in the presence of high levels of ADH.
5. Concentrated Urine
The renal medullary interstitium surrounding the collecting
ducts normally is very hyperosmotic, so that when ADH levels
are high, water moves through the tubular membrane by osmosis
into the renal interstitium;
from there it is carried away by the vasa recta back into the
blood.
The countercurrent mechanism depends on the special
anatomical arrangement of the loops of Henle and the vasa recta.
In the human, about 25 per cent of the nephrons are
juxtamedullary nephrons, with loops of Henle and vasa recta
that go deeply into the medulla before returning to the cortex.
6. Countercurrent Mechanism
The osmolarity of interstitial fluid in almost all parts of the body
is about 300 mOsm/L, which is similar to the plasma osmolarity.
The osmolarity of the interstitial fluid in the medulla of the
kidney is much higher, increasing progressively to about 1200 to
1400 mOsm/L in the pelvic tip of the medulla.
This means that the renal medullary interstitium has
accumulated solutes in great excess of water.
Once the high solute concentration in the medulla is achieved, it
is maintained by a balanced inflow and outflow of solutes and
water in the medulla.
7. Countercurrent Mechanism
1. Active transport of sodium ions and co-transport of
potassium, chloride, and other ions out of the thick portion of
the ascending limb of the loop of Henle into the medullary
interstitium
2. Active transport of ions from the collecting ducts into the
medullary interstitium
3. Facilitated diffusion of large amounts of urea from the inner
medullary collecting ducts into the medullary interstitium
4. Diffusion of only small amounts of water from the medullary
tubules into the medullary interstitium
8.
9. Countercurrent Mechanism
Because the thick ascending limb is almost impermeable to
water, the solutes pumped out are not followed by osmotic
flow of water into the interstitium.
Thus, the active transport of sodium and other ions out of
the thick ascending loop adds solutes in excess of water to
the renal medullary interstitium.
There is some passive reabsorption of sodium chloride
from the thin ascending limb of Henle’s loop, which is also
impermeable to water, adding further to the high solute
concentration of the renal medullary interstitium.
10. Countercurrent Mechanism
The descending limb of Henle’s loop, in
contrast to the ascending limb, is very
permeable to water, and the tubular fluid
osmolarity quickly becomes equal to the renal
medullary osmolarity.
Therefore, water diffuses out of the
descending limb of Henle’s loop into the
interstitium, and the tubular fluid osmolarity
gradually rises
11. Countercurrent Mechanism
First, the loop of
Henle is filled with
fluid with a
concentration of 300
mOsm/L,
the same as that
leaving the proximal
tubule
12. Countercurrent Mechanism
Next, the active pump of the
thick ascending limb on the
loop of Henle is turned on,
reducing the concentration
inside the tubule
raising the interstitial
concentration;
this pump establishes a 200-
mOsm/L concentration
gradient between the tubular
fluid and the interstitial fluid
13. Countercurrent Mechanism
Step 3 is that the tubular fluid
in the descending limb of the
loop of Henle and the
interstitial fluid quickly reach
osmotic equilibrium because
of osmosis of water out of the
descending limb.
The interstitial osmolarity is
maintained at 400 mOsm/L
because of continued
transport of ions out of the
thick ascending loop of Henle.
14. Countercurrent Mechanism
Step 4 is additional flow
of fluid into the loop of
Henle from the proximal
tubule,
which causes the
hyperosmotic fluid
previously formed in
the descending limb to
flow into the ascending
limb
15. Countercurrent Mechanism
Once the fluid is in the
ascending limb, additional
ions are pumped into the
interstitium, with water
remaining behind,
until a 200-mOsm/L
osmotic gradient is
established, with the
interstitial fluid
osmolarity rising to 500
mOsm/L
16. Countercurrent MechanismThen, once again, the fluid in
the descending limb reaches
equilibrium with the
hyperosmotic medullary
interstitial fluid
as the hyperosmotic tubular
fluid from the descending limb
of the loop of Henle flows into
the ascending limb,
Still more solute is
continuously pumped out of
the tubules and deposited into
the medullary interstitium
17. Countercurrent MechanismThese steps are repeated over
and over, with the net effect of
adding more and more solute to
the medulla in excess of water;
this process gradually traps
solutes in the medulla and
multiplies the concentration
gradient established by the active
pumping of ions out of the thick
ascending loop of Henle,
eventually raising the interstitial
fluid osmolarity to 1200 to 1400
mOsm/L
18.
19. Countercurrent Mechanism
the repetitive reabsorption of NaCl by the thick
ascending loop of Henle and
continued inflow of new NaCl from the proximal
tubule into the loop of Henle is called the
countercurrent multiplier.
NaCl reabsorbed from the ascending loop of Henle
keeps adding to the newly arrived NaCl, thus
“multiplying” its concentration in the medullary
interstitium.
20. Role of Distal Tubule and Collecting Ducts
When the tubular fluid leaves the loop of Henle and flows
into the DCT in the renal cortex, the fluid is dilute, with an
osmolarity of only about 100 mOsm/L
The early distal tubule further dilutes the tubular fluid
because this segment, like the ascending loop of Henle,
actively transports NaCl out of the tubule but is relatively
impermeable to water.
As fluid flows into the cortical collecting tubule, the amount
of water reabsorbed is critically dependent on the plasma
concentration of ADH
21. Role of Distal Tubule and Collecting Ducts
In the absence of ADH, this segment is almost impermeable
to water and fails to reabsorb water but continues to
reabsorb solutes and further dilutes the urine.
When there is a high concentration of ADH, the cortical
collecting tubule becomes highly permeable to water, so
that large amounts of water are now reabsorbed from the
tubule into the cortex interstitium, where it is swept away
by the rapidly flowing peritubular capillaries.
These large amounts of water are reabsorbed into the
cortex, rather than into the renal medulla, helps to
preserve the high medullary interstitial fluid osmolarity.
22. Role of Distal Tubule and Collecting Ducts
As the tubular fluid flows along the medullary collecting ducts,
there is further water reabsorption from the tubular fluid into the
interstitium, but the total amount of water is relatively small
compared with that added to the cortex interstitium.
The reabsorbed water is quickly carried away by the vasa recta
into the venous blood.
When high levels of ADH are present, the collecting ducts become
permeable to water, so that the fluid at the end of the collecting
ducts has essentially the same osmolarity as the interstitial fluid of
the renal medulla — about 1200 mOsm/L
Thus, by reabsorbing as much water as possible, the kidneys form a
highly concentrated urine.
23.
24. Urea Contributes
When there is water deficit and blood concentrations of
ADH are high, large amounts of urea are passively
reabsorbed from the inner medullary collecting ducts into
the interstitium.
As water flows up the ascending loop of Henle and into the
distal and cortical collecting tubules, little urea is reabsorbed
because these segments are impermeable to urea.
In the presence of ADH, water is reabsorbed rapidly from the
cortical collecting tubule and the urea concentration
increases rapidly because urea is not very permeant in this
part of the tubule.
25. Urea Contributes
Then, as the tubular fluid flows into the inner medullary
collecting ducts, still more water reabsorption takes place,
causing an even higher concentration of urea in the fluid.
This high concentration of urea in the tubular fluid of the
inner medullary collecting duct causes urea to diffuse out
of the tubule into the renal interstitium.
This diffusion is greatly facilitated by specific urea
transporters - UT-AI - activated by ADH, increasing
transport of urea out of the inner medullary collecting
duct
26. Urea Contributes
people who ingest a high-protein diet, yielding
large amounts of urea as a nitrogenous “waste”
product, can concentrate their urine much
better than people whose protein intake and
urea production are low.
Malnutrition is associated with a low urea
concentration in the medullary interstitium and
considerable impairment of urine concentrating
ability.
29. Countercurrent Exchange
1. The medullary blood flow is low, accounting for
less than 5 per cent of the total renal blood flow.
This sluggish blood flow is sufficient to supply the
metabolic needs of the tissues & helps to minimize
solute loss from the medullary interstitium.
2. The vasa recta serve as countercurrent
exchangers, minimizing washout of solutes from the
medullary interstitium.
30. Countercurrent Exchange
- As blood descends into the medulla, it becomes
progressively more concentrated, partly by solute entry
from the interstitium and partly by loss of water into the
interstitium.
- By the time the blood reaches the tips of the vasa recta,
it has a concentration of about 1200 mOsm/L, the same
as that of the medullary interstitium.
- As blood ascends back toward the cortex, it becomes
progressively less concentrated as solutes diffuse back
out into the medullary interstitium and as water moves
into the vasa recta.