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Renal replacement therapies are a set of interventions and techniques aimed at replacement of the filtering function of the kidneys. These include both dialysis and renal transplant. In this presentation we will talk about the indication and modalities of dialysis. This includes hemodialysis, peritoneal dialysis and continuous renal replacement therapies. The circuit diagram of each modalities along with its procedure and complications are also discussed.
Acute respiratory distress syndrome is characterised by rapid onset dyspnea, bilateral infiltrates on chest x-ray and respiratory failure. This may be due to conditions which directly affect the lung such as pneumonia, aspiration and near drowning. It may also be due to indirect lung injury, as in conditions like sepsis, pancreatitis, trauma and poisoning. The diagnostic criteria of ARDS, often described as the Berlin criteria is discussed in this presentation along with various management aspects of ARDS including ventilation strategies and use of antibiotics and diuretics. Finally prognostic features and alternative strategies are also discussed.
Hyponatremia is defined as a serum sodium of less than 135 Meq per litre and occurs in upto 22 % of hospitalised patients. The causes of hyponatremia may be understood based on the pre-existing volume status of the patient which may either be hypovolemic, euvolemic or hypervolemic hyponatremia. This presentation discusses in detail, the causes of these underlying conditions. Also mentioned are the clinical features and management options and therapeutic sodium targets in patients with hyponatremia. Drugs such as demeclocycline and vaptans (Tolvaptan, Conivaptan) are also mentioned as management options which may be used on a case to case basis. Finally, the all important targets of sodium correction over 24 hours are also mentioned, along with a practical formula for calculation of sodium deficit which is explained with an example.
Diabetic ketoacidosis is an acute complication of uncontrolled hyperglycaemia characterised by high anion gap metabolic acidosis, dehydration and other metabolic abnormalities. Upto half of patients with Type 1 diabetes mellitus may have DKA. The incidence in T2DM is also rising. Precipitants include acute illness such as myocardial infarction, trauma and infection. Paitents of diabetic ketoacidosis may present with vomiting, pain abdomen and lethargy. Mental obtundation may also be present. Management of diabetic ketoacidosis revolves around administration of IV normal saline, insulin, replacement of potassium with frequent monitoring of sugars and electrolytes.
A detailed description of the causes and diagnosis of pleural effusion. The presentation includes a discussion of the causes and exudative and transudative pleural effusions. Light's criteria and its modification are described along with definition and clinical implication of pleural fluid acidosis, glucose, adenosine deaminase, hemorrhagic pleural effusion and protein and LDH as well.
A detailed description of Adrenal insufficiency (Addison's disease) including basic physiology of the HPA axis, causes of primary and secondary insufficiency, clinical features of acute and chronic adrenal insufficiency. Lab testing for Addison's disease is also dealt with in detail. The management, both short term and long term are discussed in detail.
A detailed description of the Hepato-pulmonary syndrome including its definition, pathophysiology, diagnosis and treatment. The pathophysiology includes nitric oxide in the pulmonary vasculature which results in intrapulmonary vasodilatation. This causes the classical and unique symptom of platypnea and orthodeoxia.
A brief description of the mechanisms, types and assessment of chromosomal analyses. Techniques such as standard cytogenetic testing, FISH and array methods are discussed. Indications for testing in prenatal, neonatal and adult periods are also discussed. Deletions, translocations, inversions etc are described, as are mosaicism and aneuploidy.
Corneal cross-linking (CXL) is an in-office eye procedure that strengthens the cornea if it's been weakened by keratoconus, other corneal disease, or (rarely) a complication of LASIK surgery. Alternative and brand names for the procedure include corneal cross-linking, corneal collagen cross-linking, C3-R, CCL and KXL.