Sunday, January 26, 2020
Factors of Acute Kidney Injury
Factors of Acute Kidney Injury 1. Introduction: Kidneys are the important two paired organs of our body that function normally under the physiological limits. Kidneys may lose its normal functioning under certain circumstances paving way to a disease state of kidney. These kidneys as termed filter units of the body function to excrete waste substances from the body. Similar to the other diseases of the body, kidney diseases result in life threatening dilemma of the society, with inclusive pathological causes and related social norms. In following section various aspects of acute kidney injury (failure) are discussed in detail. 2. Acute Kidney Injury: Studies related to ‘’acute kidney failure (ARF)’’ were jeopardized for over past decades due to the conflicting definitions and varied diagnostic criteria of the disease by different investigators, though, all reached to an agreement that a decline in renal function for over the time of hours to days is the distinct characteristic feature of ARF. In the year 2005, an initiative has been taken by Acute Dialysis Quality Initiative and the Acute Kidney Injury Network (AKIN) for replacing the term ‘’Acute Kidney Failure’’ to ’Acute kidney Injury (AKI)’’ (Mehta et al, 2007).However, this definition was further improved in the year 2007, which is mostly accredited to as the RIFLE criteria (Risk-Injury-Failure-Loss of function-End stage renal disease). Moreover, elevated serum creatinine level and deceased urine output are included in the diagnostic criteria. The first three stages of AKI including stage 1 – r isk, stage 2 – injury and stage 3 failure with diagnostic criteria are shown in the Figure 1 (Kellun et al, 2005). Acute renal failure (ARF) is defined as a rapid and reversible decline in glomerular filtration rate (GFR) ranging from few hours to weeks,that can occur in the setting of previously normal renal function (‘classic’ ARF) or in a patient with pre-existing chronic renal disease (‘acute-on-chronic’ renal failure). Clinically, ARF is further subcategorized in two distinct types, firstly on the basis of being oliguric (urine output 500 ml/day), and secondly on being dialysis dependence (Schrier et al, 2004). Patients are classified in three categories depending on their risk of renal dysfunction, type of kidney injury, and the degree of kidney failure, which is further associated with two clinical outcomes: Loss and End-stage renal disease (RIFLE). ARF (Loss) is defined as the requirement of renal replacement therapy (RRT) for a period of more than 4 weeks, whereas end-stage renal disease is defined as dependence on dialysis for a period of more than 3 months. Patients with acute renal dysfunction without presenting a baseline measure of renal function are evaluated for the presence of chronic renal disease. The Modification of Diet in Renal Disease formula is used to predict ‘normal’ GFR is there is no evidence of chronic renal disease, which thus is helpful in assessing the severi ty of the ARF episode (Lameire et al, 2006). 2.1. Incidence of Acute Kidney Injury: Evaluation of theaccurateand factual epidemiological characteristics of ARF is hinderedby various reasons such as, lack of a generally accepted definition, gender disparity, issue of lacking consult with a doctor, financial issues in transplantation and treatment and delayed treatment, especially in developing countries, which all together contribute in hampering proper assessment of incidence of acute kidney injury (Cerdà ¡ et al, 2008). Furthermore, deviation in catchment populations and methods used for case ascertainment also result in difficulties for ARI evaluation. The rate of acute kidney injury holds difference in the general population, designated differently as three groups, community-acquired acute kidney injury, the hospitalized patients and critically ill patients of intensive care unit (ICU). 2.1.1. Community Acquired Acute Kidney Injury: Generally, ARF occurs rarely in community settings. After exclusion of those who suffered chronic renal failure, ARF was found developed in 172 adults per million people (pmp) per year in an unselected population(Singbartl et al., 2000).The incidence ranged between 17 pmp/year and 949 pmp/year for adults (less than 50 years of age) and those aged between 80 years and 89 years, respectively. Acute dialysis was administered to 22 pmp(Liano et al) and it was foundin a research study conducted for over a period of 9 months at 13 tertiary care hospitals in Madrid, Spain that the overall incidence of ARF is about 209 cases pmp. Moreover, it has been reported that community-acquired ARF in the US account for 1% of hospital admissions(Schnermann, 2003). Pre-renal ARF and acute-on-chronic renal failure have been reported to be associated with dehydration particularly in elderly people, use of drugs such as angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers in highrisk patients, and heart failure(Schnermann, 2003). Also, 0.69% of admissions of African Americans were accounted for de novo ARF. The incidence of community acquired ARF in this population was 3.5 times more than that of hospital-acquired ARF; with several patients having underlying medical conditions(Noiri et al., 2001).Disasters in particular earthquakes, many other causes of crush syndromes such as accidents, rhabdomyolysis resulting from infections, coma, and seizures, usage of drugs particularly nonsteroidal anti-inflammatories, and vascular events such as thrombosis of vessels are associated with community-acquired ARF. Furthermore, hemolytic uremic syndrome secondary to infection with Escherichia coli or Shigella is a common cause of ARF, as is poststreptococcal glomerulonephritis in children. Diarrheal diseases, hemolysis, tropical and non-tropical infections, and snake bites are causative factors of ARF in tropical areas such as India and Africa. The overall incidence of obstet ric-related ARF has declined for over many years (Melnikov et al., 2001; Wang et al., 2003). Medicines that are prescribed by traditional healers which mostly comprise mixture of herbs and unidentified chemicals for oral administration or as enemas constitute a distinct class of nephrotoxins in Africa and Asia(Jha V and Chugh2003) 15. Venoms of sea snakes, viper snakes and stinging insects, and raw gallbladder and bile of carp and sheep are present in common animal-derived nephrotoxins. Moreover, common edible plants such as djenkol beans, and mushrooms and medicinal herbs including impila, as well as cat’s clawcomprise botanical nephrotoxins (Melnikov et al., 2001).Nephrotoxicity which is caused by different chemicals can be due to accidental exposure to chemical such as chromic acid in industrial work places or due to use of chemicals such as copper sulphate, ethylene dibromide or ethylene glycol with suicidal or homicidal intent. 2.1.2. Hospital-acquired: The incidence of hospital acquired ARF surpasses that of community-acquired ARF by 5–10 times, being 0.15–7.20% in hospitalized patients (Nash et al., 2002). Surveysthat are used for hospital-acquired ARF under estimate the true incidence, as cases that include terminal patients are not either referred for treatment for ARF or are not screened for ARF. Out of 311 unselected hospitalized patients with ARF, 22% were referred to a nephrologist in an assessment in unselected patients. Age and comorbidities of patients at presentation influenced the referral(Zuk et al., 2001) and by different referral patterns to the site of care including district general hospital, tertiary referral centre, general ICU, and cardiothoracic ICU. In a prospective hospital-based study of ARF, the estimated incidence with need for RRT was reported to be 203 pmp/year, having patients with acute-on-chronic renal failure inclusive (Metcalfe et al., 2002). A significant elevated level in the inciden ce of hospital-acquired ARF has been observed over the period of past decades. The US National Center for Health Statistics National Hospital Discharge Survey reported that the number of hospitalizations with a diagnosis of ARF has increased dramatically, from 35,000 in 1979 to more than 650,000 in 2002, depicting an yearly rate of increase of over 13% which may be due tovarious comorbidities of the hospitalized population, increasing age of the population, increased occurrence of risk factors for ARF including chronic kidney disease and diabetes, and furtherprevalent use of intravenous contrast agents for imaging and cardiovascular techniques. Ischemic and/or toxic acute tubular necrosis (ATN) are marked the main causes of hospital-acquired ARF. Most of the time, there involves multi factorial causes including, encompassing postsurgical ATN, chemotherapy-induced ARF, ARF secondary to sepsis, contrast agents or drugs such as antibiotics, allopurinol, nonsteroidal anti-inflammatories and proton-pump inhibitors, and ARF due to a clot or atheroembolism. In spite of the shift in the etiology of hospital-acquired ARF over last few decades, prerenal conditions having manifestationsuch as reduced rates of renal perfusion stays to be leading causative factor of ARF (about 40% of cases). The trend in developed countries towards an elevated incidence of ARF in hospitalized patients due to drugs, different infections and surgeries has been observed in China(Wang et al., 2005)as well as in India (Prakash et al., 2003). 2.1.3. ARF in critically ill patients admitted to the ICU Patients in ICU, exhibit ARF many times associated with multi-organ dysfunction syndrome (JoannidisMetnitz, 2005). The findings of a multinational epidemiological study of ARF presented results that showed occurrence of ARF in 1,738 (5.7%) patients during their stay in ICU out of total sample size of 29,269 patients in ICUs of 54 study centers in 23 countries(Uchino et al., 2005), with period prevalence ranging from 1.4% to 25.9% in all study centers. 1,260 (4.2%) of the patients out of overall patients with ARF were treated with RRT. Many ICU patients were considered for ATN in the setting of multi-organ failure (Mehta et al., 2004). 2.2. Pathogenesis: The pathogenesis of acute kidney injury most importantly comprises two mechanisms that include loss of autoregulation and increased renal vasoconstriction. In experimental animals, acute ischemic injury is found associated with a considerable loss of renal autoregulation (Abuelo, 2007). Also, in case of decrease in renal perfusion pressure, there occurs normal autoregulatory renal vasodilation, evidence has been reported exhibiting renal vasoconstriction in case of ischemic kidney. Moreover, acute ischemic insult has been found associated with rise in the response to renal nerve stimulation (Abuelo, 2007). The increase vasoconstrictor response has been observed to the exogenous norepinephrine and endothelin, in the acute ischemic kidney (Basile, 2007). These vascular anomalies experienced during ischemic kidney are related to the resultant elevation of cytosolic calcium observed in the afferent arterioles of the glomerulus. The pathogenetic role of elevated cytosolic calcium concentr ation in the afferent arteriole of the ischemic kidney is supported by the observation that intrarenal calcium channel blockers can reverse the loss of autoregulation and the subsequent rise in sensitivity to renal nerve stimulation (Abuelo, 2007). The mitochondrial calcium build-up in the ischemic kidney is found to be reversed by calcium channel blockers administration (Starkov et al., 2004). Moreover, calcium channel blockers have been shown to lessen renal dysfunction and toxicity associated with the immunosuppressive drug cyclosporine following cadaveric renal transplantation, when administrated prior to the ischemic insult (Starkov et al., 2004). 2.2.1. Outer medullary congestion: The outer medullary congestion of the kidney is yet one of the vascular hallmark of acute renal ischemia. Previous research studies have proposed that the outer medullary congestion of the kidney further worsens the relative hypoxia in the outer medulla and subsequently the hypoxic injury in the S3 segment of the proximal tubule and the thick ascending limb of the Henle loop (Heyman et al., 2010). Up-regulation of adhesion molecules termed related to outer medullary
Saturday, January 18, 2020
Difference Between Freud vs Erikson
In this essay, I am going to compare and contrast two famous theorists Erik Erikson and Sigmund Freud. I will be talking about each of these theorists and their famous theories of psychosocial and psychosexual, since they both are well known development theories. I will provide enough information about both and explain the differences of each, as well. First off, Freud had inspired Erickson who had theories that were in a number of ways different than Freud’s. Freud and Erickson have similarities and differences in the things that do or explore within their theories and the way they do things. Freud was the most well known person to be called The Father of Psychology. He is the one who had introduced his theory of psychoanalysis that gave psychology a new name for the future or the new era. Freud used psychoanalysis as the method to understand how our minds work, as well as the way they grow and develop throughout the stages of development. Psychoanalysis is the behavior, feelings or personality that we try to be understood in order to help with mental problems. Freud’s theory tries to explain the determination of the complex relationship within the body and mind that helps explain the unconscious and roles of emotions that need to be understood. So basically, Psychoanalysis is the part where it tries to explain the how, what, and why we behave towards ourselves and others. Erik Erikson, on the other hand, was famous for his theory of psychosocial development and to learn about the identity crisis back in that time. Erikson’s theories are one of the most used theories throughout the world, as of today. Erik Erikson had believed that his theory development had an impact on personality and that it grows in stages. That is why; Erikson came up with the Eight Stages of Psychosocial Development. His theory had described that lifespan was at an impact in an experience in socialism. Erikson was a man who learned from Freud and became a better person and made a living out of helping determine personality, behaviors and so much more. Freud’s Psychosexual Stage is of the human development that began in the early 19th century. He developed such a general theory for psychosexual development that starts from infancy and goes to adulthood. As for Erikson’s Psychosocial Stage of Development which impact the human development in humans. Erikson takes the importance of placing the social and cultural components of a human’s development experiences. Each of these theorists had various stages that went from just being born to adulthood. And I will compare and contrast each one, as well. The first stage is birth to 1 years old and between Freud and Erikson it seems to be about the same, but different. For instance, Freud’s stage is of Oral in which the child has a primary source of pleasure that comes through their mouth from tasting, eating and/or sucking. As for Erikson’s stage is the trust vs. mistrust stage that has the child to learn to gain the trust or mistrust of their parent’s or caregivers. The second stage is 1 to 3 years old and in the Freud stage it is the anal stage. In the anal stage for Freud, the children get a sense of power to control and learn how to potty train themselves to become masters at a sense of growing up. In Erikson’s stage it is Autonomy vs. Doubt. Autonomy vs. Doubt contributes to children controlling their activities like going to the bathroom, eating, talking, and so much more. The third stage is from ages 3 to 6 years old and in Freud’s stage it is the phallic stage that brings the focus of energy on the genitals where children start to identify their sex of the same parent. In Erikson’s stage it is Initiative vs. Guilt stage that the child takes on more control of their environment atmosphere. The fourth stage is from ages 7 to 11 years old and in Freud’s case it is the latent stage. In the latent stage the child is focused on activities that have to do with school, hobbies or friends, instead of something important. In Erikson’s stage it is the Industry vs. Inferiority where the child or children develop a new sense of mastering new skills on their own. The fifth stage is from the adolescence stage. In the adolescence stage for Freud it is the genital stage that the children become explorative within their bodies, as well as in relationships. In Erikson’s stage it is the identity vs. Role confusion stage. In this stage the child onfirms to find their sense and identify their personal self. Within the sixth stage it has to do with adulthood and Freud had believed that this stage was to balance out throughout all areas of our lives. Erikson’s stage was intimacy vs. isolation where young adults would find their companionship, as well as their soul mates. Erikson also in this stage had Generativity vs. Stagnation that was toward middle aged adults who had the ability to nurture other middle aged adults and help within our society by giving back. The integrity vs. espair by Erikson was the stage that reflected on older adults in their 50’s and up to look back on their life and get the sense of their years of growing up in fulfillment and bitterness of the good and bad. In conclusion, I have compared and contrasted on two well-known theorists Freud and Erikson and also went through each stage of their developments they have created within psychology. They have taught a lot of people the way our personality, mind and behaviors work, as we grow into adults from infants. I know that I have learned a lot from them, as well and will inspire others to know the same information that I know today.
Friday, January 10, 2020
Regina V. G and Another Case Brief
Case Title: Regina v. G and another (Appellants) (On Appeal form the Court of Appeal (Criminal Division)) Citation: [2003] UKHL 50 Procedural History (PH): The appellants were charged on 22nd August 2000; without lawful excuse damaged by fire; commercial premises and being reckless as to whether such property would be damaged. The appellants stood trial before Judge Maher in March 2001. The appellants’ case at trial was that they expected the fire to extinguish itself on the concrete.It was accepted that neither of them conceived that there was any risk of the fire spreading. At the start of the trial submissions were made on the meaning of â€Å"recklessness†. The judge ruled that he was bound to direct the jury in accordance with R v Caldwell . The Judge then directed the jury on the three matters he listed. The jury was unable to come to a decision on the same day but returned on another day and convicted the appellants. Upon receiving the verdict the judge adjourned the proceedings for a pre-sentence report.The judge made a one year supervision in the case of each appellant. Facts: On the night of 21st -22nd August 2000, the appellants, then aged 11 and 12 respectively went camping without the permission of their parents’, they entered the back yard of the Co-op Shop in Newport Pagnell. They lit some newspapers that they had found. Both defendants threw some lit newspaper under a large plastic wheelie-bin. The defendants left the yard before putting the fire to rest.As a result the newspapers caught fire to the first wheelie-bin which then spread to the other wheelie-bin then spread to the eave, guttering, fascia and the roof and eventually spread to the adjoining buildings. The damages approximated to a sum of 1million Pounds Sterling. Issues: 1. Did the defendant damage by fire the building and the commercial premises? 2. Would the risk created by the defendant been obvious to an ordinary, reasonable, bystander? 3. Had the defendant g iven any thought to the possibility of there being a risk in doing what he did?Judgment: The Appellants succeeded in having their conviction quashed. By the reasons given by Lord Bingham of Cornhill, with the support of Lord Browne-Wilkinson, Lord Steyn, Lord Hutton, and Lord Rodger of Earlsferry. Rule(s) of Law: 1. Did the defendant damage by fire the building and the commercial premises? The appellant did damage the building and commercial premises by fire. During the proceedings, the judge pointed out that there was no doubt in the appellants damaging the building and premises by fire. 2.Would the risk created by the defendant have been obvious to an ordinary, reasonable, bystander? It is accepted that the reasonable bystander is an adult with no particular expertise with the common knowledge and reasoning capabilities. The jury agreed that the reasonable bystander would have been able to foresee the possibility of the fire spreading. Thus the appellants were convicted under stan ding test . The jury was inclined to accept that intention could be shown by proof of reckless disregard of an act perceived by the reasonable man as a risk. 3.Had the defendant given any thought to the possibility of there being a risk in doing what he did? It was agreed on appeal that the boys did not foresee any risk of the fire spreading in the way it eventually did. Many leading academic writers on English criminal law have believe that the criminal law should punish people only for those consequences of their acts, which they foresaw at the relevant time. Supporting Argument: Actus non facit reum nisi mens sit rea. Actus non facit reum nisi mens sit rea translates to; the act does not make a person guilty unless the mind is also guilty.It is a constructive principle that conviction of serious crime should rely on evidence not merely that the defendant caused an detrimental effect to another but rather that his state of mind when so acting was blameworthy. Willingly disregardin g an appreciated and unacceptable risk of causing a detrimental effect or a methodical and purposeful ignorant state of mind to such risk would also be considered blame worthy. In contrast it is not distinctively culpable to do something that encompasses the gamble of grievance to another in the event of one authentically not identifying the said gamble.Did the judge’s direction transgress the decision of the jury? It can be debated that since R v Caldwell the case at hand precisely outlines that Lord Diplock’s direction is capable of persuading evident unfairness. The trial judge admitted to the regret of his direction to the jury which transgressed the decision of the jury. The jury may have inferred that persons the same age of the appellants would have understood the risk involved however this was not their decision. However the jury thought it unfair to convict them.It is not considered moral or just to convict a defendant s a result of what another may have under stood if the defendant had no such understanding himself. Was the interpretation of â€Å"recklessly†wrong? In section 1 of the Act, it was shown that the interpretation of â€Å"recklessly†to have been misleading. Had the misinterpretation not conflicted with any principle or had not intensified an injustice; the misinterpretation would not have had any impact, however it resulted in the opposite.Thus it is vital for the correction of the misinterpretation of â€Å"recklessly†. Losing Argument: Should the rule in R v Caldwell be modified? The modification would defy the principle that conviction depends on the mens rea of the defendant. If the principle was modified to accommodate children on the grounds of naivety it would be uncharacteristic if no modification was made to include the mentally handicapped on the grounds of their narrow ability of perception.Implementing modifications of this classification will encourage challenging and controversial debate with regard to the qualities and characteristics plausible for comparison. The implementation of this modification will replace one misinterpretation for another. Were the appellants reckless? A person is said to be reckless if knowing that there is a risk that an event may occur as a consequence of their conduct as defined by The Merriam Webster dictionary .A defendant is only considered to have acted recklessly by the advantage of their failure to give any thought to the risk or property damage that may have been apparent had they given any thought to the matter. Determining if a risk would have been apparent to the defendant is very unpredictable. The tribunal of fact should not acknowledge the defendant’s proclamation that it never occurred to them that there was risk of property damage providing that the conditions, prospects, and evidence point that the thought process must have crossed their mind. Obiter Dicta’ The meaning of â€Å"maliciously†It is unde rstood by the court that use of the term ‘maliciously’ requires proof of intension. Malice necessitates an authentic objective to do a precise kind of destruction. The court accepts that â€Å"maliciously†introduces consciousness that an act may have the consequence of causing substantial impairment to some other person despite if the impairment foreseen was reasonably minimal.
Thursday, January 2, 2020
How to Learn the Russian Alphabet
The Russian alphabet is based on Cyrillic and Glagolitic scripts, which were developed from Byzantine Greek in order to facilitate the spread of Christianity during the 9th and 10th centuries. Some letters in the modern Russian alphabet look familiar to English speakers  Õ, à £, ÃÅ¡, à  while other letters do not resemble any characters in the English alphabet. Russian Alphabet Sounds The Russian alphabet is relatively easy to learn thanks to its principle of one letter per sound. This principle means that most phonemes (sounds that convey meaning) are represented by their own letters. The spelling of Russian words typically reflects all of the sounds that are part of that word. (This will get more complicated when we move onto allophonesâ€â€variations of possible pronunciations.) Get to know the Russian alphabet by studying all three columns below. The first column provides the Russian letter, the second column provides an approximate pronunciation (using English characters), and the third column gives an idea of what the letter sounds like, using an example from an English word. Russian Letter Pronunciation Closest English Sound , a Ah or aah Far, lamb , B Boy , V Vest , Gh Guest , D Door E, e Yeh Yes , Yoh York , Zh pleasure, beige , Z Zoo , E Meet , Y Toy , K Kilo , L Love , M Mop , N No , O Morning , P Pony , R (rolled) , S Song , T Train , Ooh Boo , F Fun , H Loch , Ts Ditzy , Ch Cherish , Sch Shhh , Sh (softer than ) Shoe , hard sign (non-vocalized) n/a , Uhee no equivalent sound , soft sign (non-vocalized) n/a , Aeh Aerobics , Yu You , Ya Yard Once you have learned the Russian alphabet, you should be able to read most Russian words, even if you don’t know their meaning. Stressed and Unstressed Vowels The next step is to learn how Russian words are stressed, which simply means which vowel in the word is emphasized. Russian letters behave differently under stress and are pronounced more distinctly according to their alphabet sound. Unstressed vowels are reduced or merged. This difference is not reflected in the spelling of Russian words, which can be confusing to beginner learners. While there are several rules governing the way unstressed letters are pronounced, the easiest way to learn is to expand your vocabulary as much as possible, naturally acquiring a sense of stressed vowels along the way.
Subscribe to:
Posts (Atom)