Dialysis

You Will Never Believe These Bizarre Truth Of Dialysis And Renal Replacement Therapy

Dialysis

Dialysis is a treatment that filters and purifies the blood using a machine. This helps keep your body in balance when the kidneys can’t do their job Properly functioning kidneys prevent extra water, waste, and other impurities from accumulating in your body. They also help control blood pressure and regulate the levels of chemicals in the blood, such as sodium, or salt, and potassium. They even activate a form of vitamin D that improves the absorption of calcium.

When your kidneys can’t perform these functions due to disease or injury, dialysis can help keep the body running as normally as possible.

Dialysis is an artificial way of cleaning your blood. There are two different types of dialysis:

  • Hemodialysis
  • Peritoneal Dialysis

Hemodialysis

Hemodialysis is the most common type of dialysis. It uses an artificial kidney, known as a hemodialyzer, to remove waste and chemicals from your blood. To get the blood to flow to the artificial kidney, your doctor will surgically create a vascular access, or an entrance point, into your blood vessels. This vascular access will allow a larger amount of blood to flow through your body during hemodialysis treatment. This means more blood can be filtered and purified.

Dialysis

The two type of vascular access designed for long-term dialysis treatments are an arteriovenous (AV) fistula, which connects an artery and a vein and an AV graft, which is a looped tube. For short-term use, a catheter may be inserted into the large vein in your neck.

Hemodialysis treatments usually last three to five hours. The treatment is typically needed three times per week. However, hemodialysis treatment can also be done in shorter, more frequent sessions.

Most hemodialysis treatments are done at a hospital, doctor’s office, or dialysis center. The length of treatment depends on your body size and the amount of waste in your body.

After you’ve been on hemodialysis for an extended amount of time, your doctor may feel that you’re ready to give yourself dialysis treatments at home. This option is more common for people who will need long-term treatment.

Peritoneal Dialysis

Peritoneal dialysis involves surgery to implant a catheter into your belly area. During treatment, a special fluid called dialysate flows into your abdomen. Once the dialysate draws waste out of the bloodstream, it’s drained from your abdomen.

Peritoneum

There are numerous different types of peritoneal dialysis, but the main ones are continuous ambulatory peritoneal dialysis and continuous cycler-assisted peritoneal dialysis. In continuous ambulatory peritoneal dialysis, your abdomen is filled and drained multiple times each day. Continuous cycler-assisted peritoneal dialysis, however, uses a machine to cycle the fluid in and out of your abdomen. It’s usually done at night while you sleep.

Peritoneal dialysis can be done at home. You’ll receive training on how to perform the steps of the treatment.

Renal replacement therapy

Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called renal failure and includes acute kidney injury and chronic kidney disease. Renal replacement therapy includes dialysis (hemodialysis or peritoneal dialysis), hemofiltration, and hemodiafiltration, which are various ways of filtration of blood with or without machine. Renal replacement therapy also includes kidney transplantation, which is the ultimate form of replacement in that the old kidney is replaced by a donor kidney.

Renal replacement therapy

These treatments are not truly cures for kidney disease. In the context of chronic kidney disease, they are more accurately viewed as life-extending treatments, although if chronic kidney disease is managed well with dialysis and a compatible graft is found early and is successfully transplanted, the clinical course can be quite favorable, with life expectancy of many years. Likewise, in certain acute illnesses or trauma resulting in acute kidney injury, a person could very well survive for many years, with relatively good kidney function, before needing intervention again, as long as they had good response to dialysis, they got a kidney transplant fairly quickly if needed, their body did not reject the transplanted kidney, and they had no other significant health problems. Early dialysis (and, if indicated, early renal transplant) in acute renal failure usually brings more favorable outcomes.

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Thalassemia

The Latest Updates in Thalassemia Disorder

Thalassemia are inherited blood disease characterized by abnormal haemoglobin production. Hemoglobin is the protein molecule in purple blood cells that carries oxygen.

The disorder result is excessive destruction of red blood cells, which lead to anemia. Anemia can result in feeling tired and pale skin. There may also be done problem, yellowish skin, dark urine, enlarged spleen, and among children slow growth.

Types of thalassemia:

There are two main types of thalassemia

  • Alpha
  • Beta

Alpha-globin Thalassemia:

In alpha thalassemia, the haemoglobin does not produce that much protein.

Alpha-globin are sub-divided into four types:

  • One faulty gene
  • Two faulty gene
  • Three faulty gene
  • Four faulty gene
One faulty gene:

You have no signs of thalassemia. But it will affect your childrens.

Two faulty gene:

Your thalassemia signs will be mild. This condition is called as alpha-thalassemia trait.

Three faulty gene:

Your signs will be moderate to severe.

Four faulty gene:

This type of signs is rare. Affected fetuses have extreme anemia and commonly are stillborn. Babies born with this situation often die shortly after birth or require lifelong transfusion therapy. In rare cases, a baby born with this situation may be handled with transfusions and a stem telephone transplant, which is also called a bone marrow transplant.

Beta Thalassemia:

We need two globin genes to make beta-globin chains, one from each parents. If one or both faulty, beta thalassemia will occur.

Severity depends on how many genes are mutated.

Beta-globin are sub-divided into two types :

  • One faulty gene
  • Two faulty gene
One faulty gene:

This is called beta thalassemia minor.

Two faulty genes:

There may be moderate or severe symptoms. This is known as thalassemia major. It used to be called Colley’s anemia.

Beta thalassemia is more common among people of Mediterranean ancestry. Prevalence is higher in North Africa, West Asia, and the Maldive Islands.

Symptoms for Thalassemia:

Thalassemia signs and symptoms may include:

  • Weakness
  • Fatigue
  • Pale or yellow skin
  • Slow growth
  • Dark urine
  • Abdominal swelling
  • Facial bone deformities
  • Chest pain
  • Cold hand and feet
  • Leg cramps
  • jaundice and pale skin
  • drowsiness and fatigue
  • dizziness and faintness
  • poor feeding
  • shortness of breath
  • rapid heart beat
  • delayed growth
  • headaches
  • greater susceptibility to infections

Several type of thalassemia exist, Such as thalassemia intermedia, Cooley anemia and alpha-thalassemia. Some children show signs and symptoms of thalassemia at birth, while others may also improve them during the first two years of life. Some humans who have only one affected hemoglobin gene don’t experience any thalassemia symptoms.

Treatment for Thalassemia:

The treatment for thalassemia based on the type and severity of disorder involved. People who have alpha or beta thalassemia trait have mild or no symptoms. They did not required treatment.

There are three common standard treatments for severity of thalassemia. They are:

  • Blood transfusions
  • Iron chelation therapy
  • Folic acid supplements

Blood Transfusions:

Blood transfusion is the main treatment for people who have severe or moderate thalassemia. This treatment gives the healthy blood.

During a treatment, a needle is used to insert a intravenous line into one of your blood vessels. This process will take 1 to 4 hours. After the treatment t you will receive the healthy blood.

Red blood cells lives up to 120days. So, you need to continue the transfusion every 2 month to maintain the healthy blood cells.

If you have beta thalassemia intermedia or haemoglobin H disease, you may need blood transfusion on occasion.

Iron Chelation Therapy:

Regular blood transfusion can lead to excess of iron in the blood. This process is called iron overloaded. It will damage the heart, liver and other parts of the body. The red blood cell involves haemoglobin is an iron-rich protein.

To recover this damage, doctors use the iron chelation therapy. It will remove the excess of iron from the body. Iron chelation therapy uses two medicines to cure the damages:

  • Deferoxamine
  • Deferasirox

Folic Acid Supplements:

Folic acid is vitamin B that will help you to built the healthy red blood cells. Doctor may recommend floic acid supplements in addition to treatment with iron chelation therapy and/ or blood transfusion.

Other Treatments:

Blood and Marrow Stem Cell Transplant:

The healthy stem cells comes from you is called an autologous transplant. The stem cells comes from the other person is called donor. It is also known as allogeneic transplant.  Bone marrow transplant commonly used for blood cancers or blood related disease that reduce the number of healthy blood cells in the body. These procedures is also used for other disease.

For allogeneic transplant, your doctor will find a donor related to your blood. Your doctor consider using the cells from your close family members, who have registered with the national marrow donor program and who are not  related to you or form publicly stored umbilical cord blood.

Bone marrow transplant are commonly performed in hospital. Generally, You need to stay in hospital for one to two weeks before the transplant to prepare. During the treatment, We will insert a narrow tube in one of your large vein. Doctor will give the sleep medicine while the processing.  And then you receive the special medicines to destroy the abnormal stem cells and to weaken your immune system so it won’t reject the donor cells after the transplant.

After the transplant, doctor will check the blood count every day to check the new blood cells have started to grow in your bone marrow.  You want to stay near the hospital or you must come and check the blood cells in hospital for week or months. Before you leave the hospital, doctor will give the detailed instruction that you must follow to cure the prevent infection. Doctor will monitoring you until you become healthy.

 

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Bariatric surgery

Bariatric surgery part-2

May lead to conditions that increase energy expenditure.Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

Adjustable Gastric Band

The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.

Adjustable -Gastric Band

The Procedure

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

adjustable gastric band

Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally.

Benefits

weigth loss

  1. Reduces the amount of food the stomach can hold.
  2. Induces excess weight loss of approximately 40 – 50 percent.
  3. Involves no cutting of the stomach or rerouting of the intestines.
  4. Requires a shorter hospital stay, usually less than 24 hours.
  5. Is reversible and adjustable.
  6. Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures.
  7. Has the lowest risk for vitamin/mineral deficiencies.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

Duodenal Switch

The Procedure

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal small intestine is then brought up and connected to the outlet of the newly created stomach. Roughly three-fourths of the small intestine is bypassed by the food stream.

Biliopancreatic Diversion with Duodenal Switch

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients  as well as nutrients and vitamins dependent on fat for absorption. Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control.

Benefits

weight loss

  1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up.
  2. Allows patients to eventually eat near “normal” meals.
  3. Reduces the absorption of fat by 70 percent or more.
  4. Causes favorable changes in gut hormones to reduce appetite and improve satiety.
  5. Is the most effective against diabetes compared to RYGB, LSG, and AGB.

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Bariatric Surgery

Bariatric surgery part-1

May lead to conditions that increase energy expenditure.Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

The most common bariatric surgery procedures are a gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.

  • Gastric Bypass
  • Sleeve Gastrectomy
  • Adjustable Gastric Band
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

Gastric Bypass

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.

bariatric

The Procedure

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Benefits

 

  1. Produces significant long-term weight loss (60 to 80 percent excess weight loss).
  2. Restricts the amount of food that can be consumed.
  3. May lead to conditions that increase energy expenditure.
  4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety.
  5. Typical maintenance of >50% excess weight loss.

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

bairatical

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food  that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Sleeve Gastrectomy

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Benefits

  1. Restricts the amount of food the stomach can hold.
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with the maintenance of >50%.
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB).
  4. Involves a relatively short hospital stay of approximately 2 days.
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety.

 Bariatric Surgery  continues in Part – 2   –  Click Here

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cancer-treatment

What Everyone Ought To Know About cancer – Part 2

Treatments for Cancer

Cancer treatment depends on the type of cancer, the stage of cancer , age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If cancer has not metastasized, it is possible to completely cure a patient by surgically removing cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Innovations continue to be developed to aid the surgical process, such as the iKnife that “sniffs” out cancer. Currently, when a tumor is removed surgeons also take out a “margin” of healthy tissue to make sure no malignant cells are left behind. If there are no clear margins, the surgeon has to go back in and remove more tissue (if possible). Scientists from Imperial College London say the iKnife may remove the need for sending samples to the lab.

For surgeons to distinguish between cancerous and healthy tissue. Viewed through the glasses, cancer cells appear to glow blue under a special light, thanks to a fluorescent marker injected into the tumor that attaches only to cancerous and not to healthy cells. Also, the lighter the shade of blue, the more concentrated the cancer cells are.

Promising results of an early small trial at Duke University Medical Center in Durham, NC have suggested a new injectable agent that makes cancer cells in a tumor fluoresce. Tests continue to be carried out.

Radiation Radio Therapy

Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide.

Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process – damaging proteins or DNA – so that cancer cells will commit suicide. These treatments target any rapidly dividing cells, but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting.  Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options

Immunotherapy

Immunotherapy aims to get the body’s immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation can also be considered immunotherapy because the donor’s immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone Therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone

Gene Therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

Targeting Cancers For New Drug Therapies

Researchers at The Institute of Cancer Research reported in the journal Nature Reviews Drug Discovery that they have found a new way of rapidly prioritizing the best druggable targets online. They managed to identify 46 previously overlooked targets.

The researchers used the database together with a tool and were able to compare up to 500 drug targets in a matter of minutes. With this method, it is possible to analyze huge volumes of data to discover new drug targets, which can lead to the development of effective cancer medications.

The scientists analyzed 479 cancer genes to determine which ones were potential targets for medications. Their approach was effective – they found 46 new potentially “druggable” cancer proteins.

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