New guidelines drop the "P" from CPR
After 50 years of loyal service, traditional CPR is being replaced by
a new, bare-bones version of the life-saving emergency procedure.
The American Heart Association has created a short web tutorial that
shows how to do effective CPR. It's available at handsonlycpr.org/.
Thursday, November 18, 2010
Thursday, November 4, 2010
Tuesday, May 25, 2010
Sunday, April 4, 2010
Live Kidney Donors With Preexisting Glucose Intolerance
The Consequences for Live Kidney Donors With Preexisting Glucose Intolerance Without Diabetic Complication: Analysis at a Single Japanese Center
Background. Because of lack of deceased donors in Japan, there has been a need to expand the eligibility criteria for live kidney donation. To assess the indications for live kidney donation in glucose intolerance (GI), we analyzed perioperative complications associated with donor nephrectomies performed at our institution and followed up the long-term consequences.
Methods. The 444 live kidney donors were divided into two groups based on the results of the 75-g oral glucose tolerance test: a GI group (n=71) who showed a diabetic (n=27) or impaired glucose tolerance (n=44) pattern, and a non-GI group (n=373) who showed a normal oral glucose tolerance test pattern. Perioperative complications, long-term survival rate, and frequencies of hypertension, diabetes, hyperlipidemia, and renal dysfunction in long term were compared in each group.
Results. The incidence of perioperative complications was not higher in the GI group than in the non-GI group (4.3% vs. 5.4%, respectively; NS). Survival rates in the GI group at 5, 10, and 20 years were 98.3%, 95.1%, and 89.2%, respectively, whereas those in the non-GI group were 98.0%, 96.1%, and 91.5%, thus showing equivalent mortality. None of the patients in the diabetes mellitus group had developed severe diabetic complications or end-stage renal disease at a mean follow-up point of 88+/-71 (range, 14-225) months.
Conclusions. Our results suggest that individuals who have GI without diabetic complication may be able to donate their kidney safely with little surgical complication and little major morbidity if strict evaluation is performed before transplant.
Background. Because of lack of deceased donors in Japan, there has been a need to expand the eligibility criteria for live kidney donation. To assess the indications for live kidney donation in glucose intolerance (GI), we analyzed perioperative complications associated with donor nephrectomies performed at our institution and followed up the long-term consequences.
Methods. The 444 live kidney donors were divided into two groups based on the results of the 75-g oral glucose tolerance test: a GI group (n=71) who showed a diabetic (n=27) or impaired glucose tolerance (n=44) pattern, and a non-GI group (n=373) who showed a normal oral glucose tolerance test pattern. Perioperative complications, long-term survival rate, and frequencies of hypertension, diabetes, hyperlipidemia, and renal dysfunction in long term were compared in each group.
Results. The incidence of perioperative complications was not higher in the GI group than in the non-GI group (4.3% vs. 5.4%, respectively; NS). Survival rates in the GI group at 5, 10, and 20 years were 98.3%, 95.1%, and 89.2%, respectively, whereas those in the non-GI group were 98.0%, 96.1%, and 91.5%, thus showing equivalent mortality. None of the patients in the diabetes mellitus group had developed severe diabetic complications or end-stage renal disease at a mean follow-up point of 88+/-71 (range, 14-225) months.
Conclusions. Our results suggest that individuals who have GI without diabetic complication may be able to donate their kidney safely with little surgical complication and little major morbidity if strict evaluation is performed before transplant.
Sunday, March 21, 2010
Is Kidney Donation Safe?
Is Kidney Donation Safe?
Long-term survival of donors is similar to that of healthy controls.
Availability of cadaveric kidneys is not increasing substantially, so live kidney donation (usually to a relative or close friend) is becoming more common. Researchers used a U.S. national registry to identify more than 80,000 live donors (from 1994 to 2009) and another national registry to identify an equal number of healthy controls (matched for demographic characteristics and comorbidities).
The number of live donors increased over time, from about 3000 to 6000 annually during the study period. Ninety-day postoperative mortality was 3.1 per 10,000 donors (in comparison, 90-day mortality is 18/10,000 for laparoscopic cholecystectomy and 260/10,000 for nondonor nephrectomy) and did not change over time even though average age at donation rose. Postoperative mortality was roughly three times higher in men than in women and in black donors than in white or Latino donors. Long-term mortality was similar in donors and in healthy controls.
Comment: Clinicians reasonably can reassure patients who are considering kidney donation that, beyond a small postoperative mortality risk, no excess long-term mortality is evident. The elevated postoperative mortality risk in certain subgroups, although still small compared with that of many surgical procedures, might require more detailed discussions.
Long-term survival of donors is similar to that of healthy controls.
Availability of cadaveric kidneys is not increasing substantially, so live kidney donation (usually to a relative or close friend) is becoming more common. Researchers used a U.S. national registry to identify more than 80,000 live donors (from 1994 to 2009) and another national registry to identify an equal number of healthy controls (matched for demographic characteristics and comorbidities).
The number of live donors increased over time, from about 3000 to 6000 annually during the study period. Ninety-day postoperative mortality was 3.1 per 10,000 donors (in comparison, 90-day mortality is 18/10,000 for laparoscopic cholecystectomy and 260/10,000 for nondonor nephrectomy) and did not change over time even though average age at donation rose. Postoperative mortality was roughly three times higher in men than in women and in black donors than in white or Latino donors. Long-term mortality was similar in donors and in healthy controls.
Comment: Clinicians reasonably can reassure patients who are considering kidney donation that, beyond a small postoperative mortality risk, no excess long-term mortality is evident. The elevated postoperative mortality risk in certain subgroups, although still small compared with that of many surgical procedures, might require more detailed discussions.
Monday, March 8, 2010
Sunday, March 7, 2010
11th March World Kidney Day
11th March World Kidney Day
Kidney diseases are Treatable
Detection: Kidney disease can be detected early. Simple laboratory tests are done on small samples of blood (to measure creatinine content and estimate GFR) and on urine (to measure creatinine and albumin excretion). The majority of individuals with early stages of CKD (chronic kidney disease) go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or cardiovascular problems occur.
Screening: Screening must be a priority for those people considered to be at high risk of kidney disease, namely:
Patients with diabetes mellitus and hypertension
Individuals who are obese or smoke
Individuals over 50 years of age
Individuals with a family history of kidney disease, diabetes mellitus or hypertension
Current kidney protective treatments should now be extended to those with early stages of CKD.
Key preventative measures have been defined and proven successful in protecting against both renal and cardiovascular disease, such as:
Reduction of high blood pressure: the lower the blood pressure, the slower the GFR decline
Specific medications to reduce proteinuria as well as lower blood pressure – ACE inhibitors/ARBs
Reduce salt intake to lower blood pressure
Control of glucose, blood lipids and anemia
Smoking cessation
Increased physical activity
Control of body weight
Treatment: Clinical research over the last decade has shown the potential benefit of blockade of the renin–angiotensin system by angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) to significantly reduce the burden of disease from cardiovascular disease (CVD), diabetes, hypertension and CKD at relatively low cost
Kidney diseases are Treatable
Detection: Kidney disease can be detected early. Simple laboratory tests are done on small samples of blood (to measure creatinine content and estimate GFR) and on urine (to measure creatinine and albumin excretion). The majority of individuals with early stages of CKD (chronic kidney disease) go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or cardiovascular problems occur.
Screening: Screening must be a priority for those people considered to be at high risk of kidney disease, namely:
Patients with diabetes mellitus and hypertension
Individuals who are obese or smoke
Individuals over 50 years of age
Individuals with a family history of kidney disease, diabetes mellitus or hypertension
Current kidney protective treatments should now be extended to those with early stages of CKD.
Key preventative measures have been defined and proven successful in protecting against both renal and cardiovascular disease, such as:
Reduction of high blood pressure: the lower the blood pressure, the slower the GFR decline
Specific medications to reduce proteinuria as well as lower blood pressure – ACE inhibitors/ARBs
Reduce salt intake to lower blood pressure
Control of glucose, blood lipids and anemia
Smoking cessation
Increased physical activity
Control of body weight
Treatment: Clinical research over the last decade has shown the potential benefit of blockade of the renin–angiotensin system by angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) to significantly reduce the burden of disease from cardiovascular disease (CVD), diabetes, hypertension and CKD at relatively low cost
Sunday, February 28, 2010
Court orders action against quackery
Court orders action against quackery
The Madras High Court verdict has said that the Indian Medical Association (IMA) may furnish the names of all those who are prescribing allopathic medicine without a valid licence, and using the prefix Dr to their names, to the Deputy Superintendent of Police and the District Medical Officer (DMO) concerned. The news was published in the Chennai edition of The Hindu, Wednesday, February 24, 2010.
On behalf of the government, the court was assured that the authorities concerned would take necessary steps.
The First Bench, consisting of Chief Justice H L, Gokhale and Justice K K Sasidharan, passed the order while disposing of a writ petition by the IMA, represented by K Prakasam, Chairman, IMA Quackery Eradication Committee, Tamil Nadu State Branch.
The petitioner sought a direction to the official authorities to consider the representations sent last year and initiate criminal prosecution against paramedical technicians, paramedical practitioners and physiotherapists who are prescribing allopathic medicine and administering allopathic treatment and using ‘Dr.’ before their names in prescriptions and advertisements.
In its order, the Bench said when a similar matter came up before the High Court and it disposed off the petition on January 5, directing the petitioner to furnish to the authorities the names of those who were allegedly practising medicine without a valid licence.
The authorities were directed to take action against such persons on receiving the information.
Similarly, the IMA may also furnish the names of such persons to the police and the DMO concerned.
The Madras High Court verdict has said that the Indian Medical Association (IMA) may furnish the names of all those who are prescribing allopathic medicine without a valid licence, and using the prefix Dr to their names, to the Deputy Superintendent of Police and the District Medical Officer (DMO) concerned. The news was published in the Chennai edition of The Hindu, Wednesday, February 24, 2010.
On behalf of the government, the court was assured that the authorities concerned would take necessary steps.
The First Bench, consisting of Chief Justice H L, Gokhale and Justice K K Sasidharan, passed the order while disposing of a writ petition by the IMA, represented by K Prakasam, Chairman, IMA Quackery Eradication Committee, Tamil Nadu State Branch.
The petitioner sought a direction to the official authorities to consider the representations sent last year and initiate criminal prosecution against paramedical technicians, paramedical practitioners and physiotherapists who are prescribing allopathic medicine and administering allopathic treatment and using ‘Dr.’ before their names in prescriptions and advertisements.
In its order, the Bench said when a similar matter came up before the High Court and it disposed off the petition on January 5, directing the petitioner to furnish to the authorities the names of those who were allegedly practising medicine without a valid licence.
The authorities were directed to take action against such persons on receiving the information.
Similarly, the IMA may also furnish the names of such persons to the police and the DMO concerned.
Dr Good Dr Bad
Dr Good Dr Bad
Situation: A diabetic patient, who was recently hospitalized, came for a vaccine consult.
Dr Bad: No further vaccine is needed.
Dr Good: You need a repeat of pneumonia vaccine.
Lesson: Individuals with diabetes who are or have been recently hospitalized and other immuno–compromised states, such as after transplantation are candidates for repeat pneumococcal vaccination. (Source: ADA Standards of Care 2009)
Situation: A diabetic patient, who was recently hospitalized, came for a vaccine consult.
Dr Bad: No further vaccine is needed.
Dr Good: You need a repeat of pneumonia vaccine.
Lesson: Individuals with diabetes who are or have been recently hospitalized and other immuno–compromised states, such as after transplantation are candidates for repeat pneumococcal vaccination. (Source: ADA Standards of Care 2009)
Thursday, February 18, 2010
Kidney stone of less than 5 mm size needs no treatment
A stone in the kidney passage of less than 5mm should not be treated as it will invariably pass in the next four weeks, as per the new kidney stone international guidelines, said Dr. K K Aggarwal, President, Heart Care Foundation of India, and Editor eMedinewS.
A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone of more than 10mm invariably require a non–medical intervention.
Dr. Aggarwal said that new avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are Nifedipine (calcium channel blocker), alpha–blockers and steroids.
Uptil now it was thought that the best investigation for renal stone is intravenous pyelography. But now it has been prove beyond doubt that when a patient presents with kidney pain and a renal stone is suspected the undisputed investigation of choice is unenhanced CT scan of the abdomen. As per the guidelines, open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.
North India is considered a stone belt, with maximum cases of kidney stones in India.
A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone of more than 10mm invariably require a non–medical intervention.
Dr. Aggarwal said that new avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are Nifedipine (calcium channel blocker), alpha–blockers and steroids.
Uptil now it was thought that the best investigation for renal stone is intravenous pyelography. But now it has been prove beyond doubt that when a patient presents with kidney pain and a renal stone is suspected the undisputed investigation of choice is unenhanced CT scan of the abdomen. As per the guidelines, open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.
North India is considered a stone belt, with maximum cases of kidney stones in India.
Monday, February 15, 2010
Kidney patients should not take any medicine without their doctor’s advice
New Delhi, Tuesday, February 16, 2010: People with failing kidneys often use "natural", ayurvedic, homeopathic products; over–the–counter medications and/or allopathic pain killers that could worsen their kidney function said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.
A study published in the American Journal of Kidney Diseases of 87 patients with chronic kidney insufficiency found 65 instances of drug–related problems. The results suggest that routine documentation and monitoring of over–the–counter medications and natural products by community pharmacists is warranted.
Over–the–counter drugs, herbal medicines and other natural products can be particularly risky in patients with poorly functioning kidneys, known medically as "chronic renal insufficiency". These medications may directly cause kidney damage or may interact harmfully with other drugs the patient is taking.
The researchers interviewed 46 patients with moderate renal insufficiency and 41 with severe renal insufficiency. Overall, the patients were taking 66 different over–the–counter drugs and 25 different natural products, usually for pain relief or to treat coughs and colds. Forty–nine percent of the over–the–counter drugs had been recommended by a doctor or pharmacist, as had 19 percent of the natural products.
Eight patients reported using at least one over–the–counter drug that should not have been used, while 27 were using an over–the–counter drug that should have been used with caution. Three patients were using herbal medicines that should not have been used, while seven were using herbal medicines that should have been used with caution.13 percent of the potentially dangerous over–the–counter drugs were recommended by a doctor or pharmacist, as were 6 percent of the potentially dangerous natural products.
The researchers identified 65 drug–related problems. Forty–two involved at least one product, most commonly calcium or magnesium; 23 involved one or more natural products, including glucosamine, which can affect blood sugar measurements; garlic supplements, which can interact with blood–thinning drugs; and echinacea, which can directly affect kidney function.
A study published in the American Journal of Kidney Diseases of 87 patients with chronic kidney insufficiency found 65 instances of drug–related problems. The results suggest that routine documentation and monitoring of over–the–counter medications and natural products by community pharmacists is warranted.
Over–the–counter drugs, herbal medicines and other natural products can be particularly risky in patients with poorly functioning kidneys, known medically as "chronic renal insufficiency". These medications may directly cause kidney damage or may interact harmfully with other drugs the patient is taking.
The researchers interviewed 46 patients with moderate renal insufficiency and 41 with severe renal insufficiency. Overall, the patients were taking 66 different over–the–counter drugs and 25 different natural products, usually for pain relief or to treat coughs and colds. Forty–nine percent of the over–the–counter drugs had been recommended by a doctor or pharmacist, as had 19 percent of the natural products.
Eight patients reported using at least one over–the–counter drug that should not have been used, while 27 were using an over–the–counter drug that should have been used with caution. Three patients were using herbal medicines that should not have been used, while seven were using herbal medicines that should have been used with caution.13 percent of the potentially dangerous over–the–counter drugs were recommended by a doctor or pharmacist, as were 6 percent of the potentially dangerous natural products.
The researchers identified 65 drug–related problems. Forty–two involved at least one product, most commonly calcium or magnesium; 23 involved one or more natural products, including glucosamine, which can affect blood sugar measurements; garlic supplements, which can interact with blood–thinning drugs; and echinacea, which can directly affect kidney function.
Sunday, February 14, 2010
Saturday, February 13, 2010
What is treatment of acute renal failure in malaria?
The treatment of ARF includes guidelines initiation of appropriate antimalarials, at the earliest, and maintenance of fluid and electrolytes: Recording of intake and output chart, prevention of fluid overload, and secondary infection including pneumonia. Appropriate treatment of acquired infection with antibiotics. To prevent fluid overload a central venous pressure (CVP) line can be established.
Fluid challenge: 1. If any patient is dehydrated, he should be given a fluid challenge of upto 20 ml/kg of 0.9% saline infused over 60 minutes. In order to prevent fluid overload, auscultation of lungs and jugular venous pressure (JVP) measurements (and if possible, CVP measurements) should be performed after every 200 ml of fluid. The CVP should always be kept between 0 and +5. If there is no urine output after fluid replacement, an intravenous diuretic challenge may be given.
2. Diuretic challenge: The loop diuretic (furosemide or bumetanide) 40 mg is given initially and then in incremental dose of 100, 200 and 400 mg at half–hourly intervals. If there is still no urine flow, dopamine 2.5–5 mg/kg/min may be tried. Antimalarials
1. Quinine, chloroquine and artemisinin are the mainstay of therapy. Even in the presence of pregnancy and acute renal failure (ARF), quinine should not be withheld for fear of toxicity. Quinine should be given in a dose of 10 mg/kg 8 hourly during the first 48 hours of treatment. However, when it needs to be given beyond this period, the dose should be reduced to two–thirds or one-half. The dose should not be reduced in the initial 48 hours.
2. Cardiotoxicity of quinine must be of concern in malaria patients with ARF after 3 days of quinine therapy, and ECG monitoring during quinine infusion is recommended in all severe malaria patients with persistent ARF. If there is any arrhythmia, the infusion should be discontinued.
Dialysis: Dialysis has improved the survival of the cases when instituted early in the course. Clearance of urea and other molecular waste products is much faster with hemodialysis as compared to peritoneal dialysis. However, peritoneal dialysis has certain advantages such as: Peritoneal dialysis does not need a special set up, it can be started immediately, it may prove to be life saving. Thus, in the absence of facilities for hemodialysis whenever indicated, peritoneal dialysis should be started as early as possible.
Other associated conditions requiring attention:
Hypervolemia
Hyperkalemia
Metabolic acidosis
Anemia
Infection
Fluid challenge: 1. If any patient is dehydrated, he should be given a fluid challenge of upto 20 ml/kg of 0.9% saline infused over 60 minutes. In order to prevent fluid overload, auscultation of lungs and jugular venous pressure (JVP) measurements (and if possible, CVP measurements) should be performed after every 200 ml of fluid. The CVP should always be kept between 0 and +5. If there is no urine output after fluid replacement, an intravenous diuretic challenge may be given.
2. Diuretic challenge: The loop diuretic (furosemide or bumetanide) 40 mg is given initially and then in incremental dose of 100, 200 and 400 mg at half–hourly intervals. If there is still no urine flow, dopamine 2.5–5 mg/kg/min may be tried. Antimalarials
1. Quinine, chloroquine and artemisinin are the mainstay of therapy. Even in the presence of pregnancy and acute renal failure (ARF), quinine should not be withheld for fear of toxicity. Quinine should be given in a dose of 10 mg/kg 8 hourly during the first 48 hours of treatment. However, when it needs to be given beyond this period, the dose should be reduced to two–thirds or one-half. The dose should not be reduced in the initial 48 hours.
2. Cardiotoxicity of quinine must be of concern in malaria patients with ARF after 3 days of quinine therapy, and ECG monitoring during quinine infusion is recommended in all severe malaria patients with persistent ARF. If there is any arrhythmia, the infusion should be discontinued.
Dialysis: Dialysis has improved the survival of the cases when instituted early in the course. Clearance of urea and other molecular waste products is much faster with hemodialysis as compared to peritoneal dialysis. However, peritoneal dialysis has certain advantages such as: Peritoneal dialysis does not need a special set up, it can be started immediately, it may prove to be life saving. Thus, in the absence of facilities for hemodialysis whenever indicated, peritoneal dialysis should be started as early as possible.
Other associated conditions requiring attention:
Hypervolemia
Hyperkalemia
Metabolic acidosis
Anemia
Infection
Proteinuria predicts mortality in kidney patients
Proteinuria is a useful predictor of outcomes in patients with chronic kidney disease, a new study found. A Canadian cohort study included more than 900,000 adults who had at least one outpatient serum creatinine measurement and did not require dialysis at baseline. Data were gathered in a 2002–2007 registry that included estimated glomerular filtration rates (eGFRs) and proteinuria measurements. The study was published in the Feb. 3 issue of JAMA, the journal of the American Medical Association. The study showed that patients with heavy proteinuria and normal eGFR have worse outcomes than those with moderately reduced eGFR and no proteinuria. Although current guidelines call for staging chronic kidney disease (CKD) based on eGFR, they should perhaps be revised, given that use of that measurement alone may miss clinically relevant gradients in risk.
Sunday, February 7, 2010
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