Immuno-Pathologic Basis of COVID-19 and the Management of Mild and Moderate Cases
Srijan Goswami, Chiranjeeb Dey in COVID-19 and SARS-CoV-2, 2022
SARS-CoV-2 is an enveloped coronavirus having positive-sense single-stranded RNA (+ssRNA) as the genetic material. It has four membrane proteins out of which the spike (S) protein is of major concern from a pathophysiological perspective. The spike protein helps SARS-CoV-2 attach to the membrane of the host cell by a specialized receptor angiotensin converting enzyme-2 (ACE-2) receptor. The virus colonizes the nasopharynx from which it spreads by respiratory droplets and aerosols. The virus that contains droplets is produced by speaking, coughing, or sneezing. After exposure, the mean incubation period is about five days, which can be extended up to 14 days (Kumar and Al Khodor, 2020). The shedding of viral particles begins ~two to three days before the onset of symptoms until five days after the appearance of symptoms. The infected individual may be completely symptomatic or may show serious clinical symptoms. Patients have fever, cough, myalgia, headache, anosmia, dysgeusia, and diarrhea. Severe patients may present with COVID pneumonia with hypoxia and thrombotic episodes. Extrapulmonary manifestations affect nearly every organ, for example, cardiac complications include thrombosis, myocardial infarction, myocarditis, and arrhythmias. Neurologic complications can include myoclonus, seizures, delirium, and encephalitis. Renal damage is common, with about one-third of patients who require mechanical ventilation also requiring renal dialysis. Finally, death can occur due to ARDS and multiorgan failure (WHO, 2014, 2020a, c, d).
Fluid balance and continence care
Barbara Smith, Linda Field in Nursing Care, 2019
Certain abnormalities occur in the production and the elimination of urine: Polyuria: this is the production by the kidneys of abnormally high amounts of urine, sometimes as much as several litres per day. Polyuria is usually associated with diseases such as diabetes mellitus, diabetes insipidus and chronic nephritis (inflammation of the nephrons within the kidney).Oliguria: this is decreased urine output, usually less than 500 mL a day or 30 mL an hour. Oliguria often indicates impaired blood flow to the kidneys or impending renal failure and should be dealt with immediately.Anuria: this is the absence of urine production. Anuria is a serious medical condition that usually follows oliguria. It must be treated immediately in order to prevent death from renal failure. Renal dialysis is used when the kidneys are no longer able to filter blood.
The politics of the big bang
Rudolf Klein in The New Politics of the NHS, 2019
The continued dependence of Ministers and managers on the co-operation of the medical profession was, in one important respect, reinforced by the 1991 reforms.121 Rationing emerged as a headline issue. There was nothing new about the fact of rationing, defined as decision-making about the allocation of scarce resources.122 It was built into the very design of the NHS: rather than demands (professional and public) driving the budget, a fixed budget made it necessary to choose among the competing demands for treatment. The case of renal dialysis (see pages 62–3) illustrates the point. Here a deliberate decision was taken to limit the availability of the service: to ration access. But such rationing attracted little debate. It was accepted as one of the facts of life in the NHS. And it was accepted as such largely because political decisions about the allocation of resources were translated into clinical decisions about which patients should get treated and how. Ministers and managers were able to shelter behind the doctrine of clinical judgement. The care that patients received (or did not receive) was presented to them as reflecting their doctor’s assessment of the appropriateness of particular interventions rather than the scarcity of resources. Doctors, in turn, internalised scarcity in their judgements about appropriateness.123 Only waiting lists gave visibility to the fact of scarcity in the NHS: rationing by delay.
Effect of bioelectrical impedance technology on the prognosis of dialysis patients: a meta-analysis of randomized controlled trials
Published in Renal Failure, 2023
Kaibi Yang, Shujun Pan, Nan Yang, Juan Wu, Yueming Liu, Qiang He
We conducted two searches using PubMed, Cochrane, and Embase databases for relevant English articles published up to March 18, 2022. In the first search, we used the English search terms ‘dialysis’ with ‘renal dialysis’ [Mesh] as the subject terms and ‘dialysis renal,’ ‘renal dialyzes,’ ‘dialyzes renal,’ ‘hemodialyses,’ ‘hemodialysis,’ ‘dialysis extracorporeal,’ and ‘dialyzes extracorporeal,’ as free words. In the second search, we search ‘bioelectrical impedance’ with ‘electric impedance’ [Mesh] as the subject terms, and ‘impedance electric,’ ‘electrical impedance,’ ‘impedance electrical,’ and ‘impedance,’ as free words. Complete details of the search strategy are presented in Figure 1 and Table 1. This meta-analysis was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42022330022).
Efficacy and safety of expanded hemodialysis in hemodialysis patients: a meta-analysis and systematic review
Published in Renal Failure, 2022
Yuchao Zhao, Liangying Gan, Qingyu Niu, Mengfan Ni, Li Zuo
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase databases for relevant studies published from inception to 19 May 2021. The search language was limited to English. The following search terms were used in PubMed and were changed depending on the rules of each database: (HDx) OR (Expanded HD) OR (HDx) OR (Medium cut off) OR (Mid cutoff) OR (Medium-cut off) OR (Mid-cut off) OR (MCO) OR (Mid cutoff) OR (MCO-HD) OR (MCO HD) OR (Theranova).(HD OR Renal Dialysis [MeSH Terms]) OR (HD) OR (Dialyzer) OR (Dialyzer) OR (Membrane).1 AND 2.
The effects of prenatal and lactational bisphenol A and/or di(2-ethylhexyl) phthalate exposure on female reproductive system
Published in Toxicology Mechanisms and Methods, 2022
Gizem Ozkemahli, Aylin Balci Ozyurt, Pinar Erkekoglu, Naciye Dilara Zeybek, Nilgun Yersal, Belma Kocer-Gumusel
DEHP was first introduced in the 1940s to blood bags. This phthalate derivative is now present in medical devices like such as dialysis bags and tubing, intravenous tubing and bags, nasogastric tubes, IV catheters, blood bags and transfusion tubing, and air tubes (Tickner et al. 2001). Due to high exposure of ICU and NICU patients, health concerns are now being expressed about the leachates of DEHP transported directly to the bloodstream of the patient, particularly in those who are in need of extensive infusions (CJ et al. 2014). Moreover, hemophiliacs and kidney dialysis patients are clearly at high risk (Rock et al. 1986; Tickner et al. 2001). On the other hand, prenatal and/or early life exposures to BPA can also cause serious health consequences. The use of certain medical devices and interventions could increase BPA exposure in pediatric intensive care patients. Although urinary total and free BPA levels and fBPA/tBPA ratio of children varies between different medical procedures, all procedures lead to detectable levels of BPA (Ayar, Yalçın, Emeksiz, et al. 2021; Ayar, Yalçın, Yırün, et al. 2021). On the other hand, co-exposure to these chemicals should also be taken into account. Although there are several reports that point out the possible toxic effects of phthalate and bisphenol derivatives in both animals and humans, there is lack of data for the combined exposure. There is a clear need to reconsider the possible additive, antagonistic or synergistic effects of EDC mixtures today (Tassinari et al. 2021).
Related Knowledge Centers
- Acute Kidney Injury
- Chronic Kidney Disease
- Renal Replacement Therapy
- Toxin
- Uremia
- Blood
- Kidney Transplantation
- Creatinine
- Solution
- Glomerular Filtration Rate