Knowledge Related to Half and Half Nail

Half and half nails (also known as "Lindsay's nails") show the proximal portion of the nail white and the distal half red, pink, or brown, with a sharp line of demarcation between the two halves.:785 Seventy percent of hemodialysis patients and 56% of renal transplant patients have at least one type of nail abnormality. Absence of lunula, splinter hemorrhage, and half and half nails were significantly more common in hemodialysis patients, while leukonychia was significantly more common in transplant patients.

:785:659.

• Other Related Knowledge of Hemodialysis

Selected works of Hemodialysis

Palmer, Suetonia C., Sankar D. Navaneethan, Jonathan C. Craig, David W. Johnson, Marcello Tonelli, Amit X. Garg, Fabio Pellegrini et al. "Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease." Annals of internal medicine 153, no. 1 (2010): 23-33.

Palmer, Suetonia C., Sankar D. Navaneethan, Jonathan C. Craig, David W. Johnson, Marcello Tonelli, Amit X. Garg, Fabio Pellegrini et al. "Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease." Annals of internal medicine 153, no. 1 (2010): 23-33.

Ravani, Pietro, Suetonia C. Palmer, Matthew J. Oliver, Robert R. Quinn, Jennifer M. MacRae, Davina J. Tai, Neesh I. Pannu et al. "Associations between hemodialysis access type and clinical outcomes: a systematic review." Journal of the American Society of Nephrology 24, no. 3 (2013): 465-473.

Palmer, Suetonia, Mariacristina Vecchio, Jonathan C. Craig, Marcello Tonelli, David W. Johnson, Antonio Nicolucci, Fabio Pellegrini et al. "Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies." Kidney international 84, no. 1 (2013): 179-191.

Palmer, Suetonia C., Jonathan C. Craig, Sankar D. Navaneethan, Marcello Tonelli, Fabio Pellegrini, and Giovanni FM Strippoli. "Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis." Annals of internal medicine 157, no. 4 (2012): 263.

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Bioethical considerations of Hemodialysis

The development of artificial uteri and ectogenesis raises a few bioethical and legal considerations, and also has important implications for reproductive rights and the abortion debate.

Artificial uteri may expand the range of fetal viability, raising questions about the role that fetal viability plays within abortion law. Within severance theory, for example, abortion rights only include the right to remove the fetus, and do not always extend to the termination of the fetus. If transferring the fetus from a woman's womb to an artificial uterus is possible, the choice to terminate a pregnancy in this way could provide an alternative to aborting the fetus.

There are also theoretical concerns that children who develop in an artificial uterus may lack "some essential bond with their mothers that other children have"; a secondary issue to woman's rights over their own body.

In the 1970 book The Dialectic of Sex, feminist Shulamith Firestone wrote that differences in biological reproductive roles are a source of gender inequality. Firestone singled out pregnancy and childbirth, making the argument that an artificial womb would free "women from the tyranny of their reproductive biology."

Knowledge Related to Half and Half Nail 1

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History of Hemodialysis

This condition was originally termed nephrogenic fibrosing dermopathy as initially only skin involvement in patients with impaired kidney function was observed, and later renamed nephrogenic systemic fibrosis to better describe its systemic nature. The term "gadolinium-associated systemic fibrosis" has also been proposed to reflect the fact that impaired kidney function is not in itself the cause of NSF.

The first cases of NSF were identified in 1997, but it was first described as an independent disease entity in 2000. In 2006, the link between NSF and gadolinium-based MRI contrast agents was made. As a result, restrictions on use of GBCAs in patients with an estimated glomerular filtration rate (a measure of kidney function) under 60 and especially under 30 mL/min/1.73 m2 have been recommended and NSF is now considered rare.

After several years of controversy, during which up to 100 Danish patients suffered gadolinium poisoning after use of the contrast agent Omniscan, the Norwegian medical company Nycomed admitted that they were aware of some dangers from using gadolinium-based agents in their product.

With both Gadopentetic acid (gadopentetate dimegulumine (Magnevist)) and Gadodiamide (Omniscan) the risk was considered to outweigh the benefits and, as a result, the EMA recommended the licence for intravenous gadopentetic acid and Gadodiamide be suspended.

Following a legally binding decision issued by The European Commission and applicable in all EU Member States (Commission decision date: 23/11/2017), Intravenous Magnevist and Omniscan is now no longer authorised for use in Europe. Magnavist is, however, still authorised in Europe as an intra-articular MR contrast medium. The authorised indication for the use of linear chelated media gadobenic acid (also known as gadobenate dimeglumine; MultiHance) and gadoxetic acid (Primovist) has been limited to delayed phase liver imaging only.

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Further reading of Hemodialysis

Lakhanpal, Sharad; Ginsburg, William W.; Michet, Clement J.; Doyle, John A.; Moore, S.Breanndan (1988). "Eosinophilic fasciitis: Clinical spectrum and therapeutic response in 52 cases". Seminars in Arthritis and Rheumatism. 17 (4): 221231. doi:10.1016/0049-0172(88)90008-X. ISSN0049-0172. PMID3232080.

Barnes L, Rodnan GP, Medsger TA, Short D (August 1979). "Eosinophilic fasciitis. A pathologic study of twenty cases". The American Journal of Pathology. 96 (2): 493518. PMC2042453. PMID474708.

Doyle JA, Ginsburg WW (September 1989). "Eosinophilic fasciitis". The Medical Clinics of North America. 73 (5): 115766. doi:10.1016/S0025-7125(16)30625-3. PMID2671538.

Michet CJ, Doyle JA, Ginsburg WW (January 1981). "Eosinophilic fasciitis: report of 15 cases". Mayo Clinic Proceedings. 56 (1): 2734. PMID7453247.

Bennett, R M; Herron, A; Keogh, L (1977). "Eosinophilic fasciitis. Case report and review of the literature". Annals of the Rheumatic Diseases. 36 (4): 354359. doi:10.1136/ard.36.4.354. ISSN0003-4967. PMC1006697. PMID901033.

Falanga, Vincent; Medsger, Thomas A. (1987). "Frequency, levels, and significance of blood eosinophilia in systemic sclerosis, localized scleroderma, and eosinophilic fasciitis". Journal of the American Academy of Dermatology. 17 (4): 648656. doi:10.1016/S0190-9622(87)70251-5. ISSN0190-9622. PMID3668010.

Varga J, Khri VM (November 1997). "Eosinophilia-myalgia syndrome, eosinophilic fasciitis, and related fibrosing disorders". Current Opinion in Rheumatology. 9 (6): 56270. doi:10.1097/00002281-199711000-00013. PMID9375286.

Kent, Lawrence T.; Cramer, Stewart F.; Moskowitz, Roland W. (1981). "Eosinophilic fasciitis". Arthritis & Rheumatism. 24 (5): 677683. doi:10.1002/art.1780240508. ISSN0004-3591. PMID6972219.

Moulton SJ, Kransdorf MJ, Ginsburg WW, Abril A, Persellin S (March 2005). "Eosinophilic fasciitis: spectrum of MRI findings". AJR. American Journal of Roentgenology. 184 (3): 9758. doi:10.2214/ajr.184.3.01840975. PMID15728627.

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IncumbentsEvents of Hemodialysis

Monarch: Juan Carlos I

Prime Minister: Jos Mara Aznar LpezFebruary5: Endesa and Iberdrola, two electrical companies announce that the merger process that began in October 2000 has stopped and will not be finalized.

11: 7 Technicians of the Compaa Lrica die in a traffic accident.

13: Javier Bardem is nominated for an Academy Award for his role in Julian Schnabel's film Before Night Falls, being the first Spanish actor to do so.

22: Terrorist group ETA execute a car bombing that kills two employees of the company Elektra in San Sebastin.April7: The Partido de Accin Socialista (PASOC) agrees to abandon its federal congress within the United and Alternative Left.

23: Madrid is chosen to be a World Book CapitalMay13: The EAJ-PNV/EA coalition (Basque Nationalist Party and Eusko Alkartasuna) attains a great victory during the Basque regional elections, forming a government for the next four years. Juan Jos Ibarretxe stays on as president the autonomous community of the Basque Country.

August24: Singer Joaquin Sabina suffered a minor stroke because of excessive drug use that would lead him to the brink of death.

31: After the death of twelve patients undergoing hemodialysis in Valencia, Madrid and Barcelona, The Department of Pharmacy decides granting a protective detention of a dialyzer marketed by multinational Baxter.DecemberThe Orquesta Ciudad de Almera, OCAL (City Orchestra of Almeria) is founded in the Province of Almera,

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Career of Hemodialysis

Rao started working at SUNY Downstate Medical Center as a nephrologist, and because of his extensive contribution to medical literature, and services to the university, he was promoted as professor of medicine, and associate director of renal diseases. he was also the director of hemodialysis services at Kings County Hospital, and a consultant in nephrology at Brooklyn Veterans Administration Hospital. He has published more than 130 scientific articles and chapters in text books. He is the founding member, past president, board of trustees, and CME chairman of the American Association of Physicians of Queens and Long Island chapter.

Rao was the nephrologist who cared for Jayaprakash Narayan when he visited the United States. He was also nephrologist in charge of Honorable M. G. Ramachandran, Chief Minister of Tamil Nadu, and Honorable Chenna Reddy, Chief Minister of Andrapradesh, both of whom underwent renal Organ transplantation at Downstate Medical Center in United States. He was also consultant for the Governor of Pondicherry who suffered renal insufficiency.

For his achievements he has been awarded honorary degrees from Madras University, and Manipal University. He is also honorary visiting professor at Rajiv Gandhi University in Karnataka state..y of Nephrology, Indian Association of Long Island, and Bangalore Medical College Alumni Association. He has delivered scientific lectures in Japan, Israel, Paris, Holland, India and other countries.

He has been honored by Indian Society of Nephrology, American Nephrologists of Indian Origin, Nassau County of NY,

Knowledge Related to Half and Half Nail 2

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Education of Hemodialysis

His early schooling was in Channapatna, Karnataka. He graduated from high school in First Class, establishing a record for highest marks scored in Channapatna, and in the top 15 in Karnataka State. He graduated in First Class in Pre-University studies at National College in Bangalore, and was admitted to Bangalore Medical College. He stayed in Ramakrishna Vidhyarthi Mandiram throughout his student career. He completed his Medical degree from Bangalore Medical College as the top student with 5 gold medals. After completing one year of House Surgeoncy, he left for United States in June 1967. He completed 4 years of Medical Residency at New Jersey College of Medicine hospitals in Newark and East Orange, N.J. From 1971 to 1973, he was a fellow in Renal Medicine at State University of New York (SUNY), Downstate Medical Center and Kings County Hospitals. After passing the American Board of Internal Medicine, he was awarded a fellowship from the American College of Physicians. Subsequently, he was also board certified in the sub-specialty of Nephrology. During his fellowship he published his original work on heroin-associated nephropathy in the prestigious New England Journal of Medicine. In 1984, he described for the first time renal disease in patients with acquired immunodeficiency syndrome (AIDS). His original work AIDS Associated Nephropathy was published in the New England Journal of Medicine in 1984

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Diagnosis of Hemodialysis

There is no specific imaging finding for NSF, and the diagnosis is a clinicopathological one, based on presentation and histological findings.

Microscopic pathologyAt the microscopic level, NSF shows a proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers, and deposits of mucin. More recent case reports have described the presence of sclerotic bodies (also known as elastocollagenous balls) in skin biopsies from NSF patients. While not universally present, this finding is believed to be unique to patients exposed to gadolinium, although not necessarily limited to areas involved by NSF.

Differential diagnosisThe differential diagnoses for NSF include diffuse cutaneous or limited cutaneous systemic sclerosis, scleromyxedema, lipodermatosclerosis, scleroedema diabeticorum, graft versus host disease, eosinophilic fasciitis; eosinophilia-myalgia syndrome; porphyria cutanea tarda, and other disorders. The nearly universal absence of facial skin involvement in NSF, presence of yellow plaques on the sclera of the eyes, absence of Raynauds phenomenon, and other differences in presentation can aid the proper diagnosis. History of exposure to GBCAs would favor NSF as the differential diagnosis.

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An Introduction to HemodialysisHospital General de la Plaza de la Salud (HGPS) is a non-profit entity with self-management in the selection and recruitment of staff and in the formulation and use of its budget. It is located on Avenida Ortega y Gasset Ensanche La Fe, Santo Domingo, Distrito Nacional of the Dominican Republic.The HGPS is technically and administratively managed by a board set up by Decree No. 131, April 18, 1996 and ratified by Congress through Law No.78-99, dated 24 July 1999. The Board is composed of distinguished doctors, businessmen, and individuals dedicated to serving the Dominican community as well as ex officio members: the Secretary of State for Public Health and Social Welfare, the Director of the Dominican Social Security Institute, the Chairman of National Council of Businessmen and the Secretary of Labor.Under the supervision of the Board, the HGPS has an organizational structure headed by the Executive Directorate, responsible for coordinating the planning and management to achieve its goals. Dependent on this Directorate are the Financial Management and Administration Directorate, Medical Directorate and the Directorate of Hospital Support. These in turn have different departments headed by managers and service units under the supervision of their heads.HGPS medical staff is composed of specialists, sub-specialists and general or internal practitioners, grouped into the following departments: Internal medicine and specialties, General Surgery and specialties, OB-GYN, Gastroenterology and Endoscopy, Pediatrics and specialties, Family Medicine Education and Research, Orthopedics and Traumatology. Other services offered are: Diagnostic Imaging, Pathology, Geriatrics, Physical medicine and rehabilitation, Dentistry, Laboratory and Blood Bank, Cardiology, Onco Hematology, Ophthalmology, Breast Pathology, Emergency Medicine, nursing, pharmacy, nutrition and social work.Each year, the HGPS benefits more than 13,000 low-income patients who receive up to a 40 percent discount or are exempt from payment according to their financial condition. The HGPS receives a grant from the Dominican Government that covers the annual cost of exemptions and discounts to patients with limited resources.Since 2003, the HGPS is a teaching facility and has three medical residency programs in the areas of Family and Community Medicine, Medical Emergency and Disasters and Rehabilitation Medicine, supported by the Universidad Iberoamericana (UNIBE). At present, the HGPS has become a major center for training and education for the health sciences faculties of major universities in the country: UNIBE, INTEC, UNPHU, UCE, UASD, and the Catholic University Santo Domingo (UCSD), for both its undergraduate and graduate programs.The HGPS is recognized as a center of excellence in Dominican medicine, setting quality standards for the entire country.Criticism of HemodialysisSince its inception, the HGPS has been perceived by the Dominican people as being a State-run facility that should offer free services as it was initially built using State funds. However, by decree, the HGPS was created to provide non-profit medical assistance and uses the fees for services to continue to run its day-to-day operations. While the HGPS receives a government grant to cover services offered to low-income patients at discount or free of charge, the cost of operations can only be met charging a below market fee for its renown medical services.HGPS Highlights of HemodialysisIt has helped more than 140,000 low-income patients with discounts and waivers of its health treatment plans, helping to improve their quality of life and their physical and emotional well-being.Blood Bank with a high level of reliability and credibility, as well as the creation of the section of Cryopreservation of stem cells at the Blood Bank, which supports the HGPS's bone marrow transplant services (only one in the country).It is a teaching hospital facility with a board of educational programs in the following specialties: Family and Community Medicine, Medical Emergency and Disasters and Rehabilitation Medicine.Conducts a yearly Scientific Symposium to present the institution's research and medical advances.CENTOX, the first Poison control center in the Dominican Republic.Followed the successful pregnancy, delivery and birth of the first sextuplets in the Dominican Republic with only 26 and a half weeks of gestation. The children are now 4 years of age and healthy (2009).Pediatric intensive care unit (PICU) as a national reference of care.Pacemaker ClinicHemodialysis UnitCenter for Integrated medicineThorax Pain UnitOrgan and tissue transplantation program., which has a Transplant Counsel and an Organ Captivity Coordination Unit. The program achieved the first kidney transplant from a deceased donor in the country, liver transplants from deceased donors and corneal transplantation.Physical Medicine and Rehabilitation Hospital, with Urodynamics and Isokinetic Diagnostics units.Volunteerism unit to work with the hospital community with a high degree of solidarity and commitment.First Primary Care Center of the Dominican Republic.The country's first outpatient surgery program.The permanence of the only functioning hospital bioethics committee in the country, meeting regularly since 1997.Implementation of the first free hip and knee replacement program in the country called Operation Walk, a medical mission for patients with limited resources. It was led by a team of local and international specialists from Brigham and Women's Hospital and since 2008, has benefited over 80 Dominican patients and their families.Units of Care and Solidarity (UNASOL), offering medical assistance to thousands of people affected by tragedies of force majeure.Diabetic foot Clinic to prevent and treat all foot diseases in any patient.Dengue Clinic, as a national reference for all those who present symptoms.
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Introduction to Hemodialysis
Introduction to Hemodialysis
1. Criticism of HemodialysisSince its inception, the HGPS has been perceived by the Dominican people as being a State-run facility that should offer free services as it was initially built using State funds. However, by decree, the HGPS was created to provide non-profit medical assistance and uses the fees for services to continue to run its day-to-day operations. While the HGPS receives a government grant to cover services offered to low-income patients at discount or free of charge, the cost of operations can only be met charging a below market fee for its renown medical services.------2. Caramboxin of HemodialysisCaramboxin (CBX) is a toxin found in star fruit (Averrhoa carambola). Individuals with some types of kidney disease are susceptible to adverse neurological effects including intoxication, seizures and even death after eating star fruit. Caramboxin has been identified as the neurotoxin responsible for these effects. Caramboxin is a non-proteinogenic amino acid that stimulates the glutamate receptors in neurons. Its chemical structure is similar to the amino acid phenylalanine. Caramboxin is an agonist of both NMDA and AMPA glutamatergic ionotropic receptors with potent excitatory, convulsant, and neurodegenerative properties.Due to a possible interaction between caramboxin and oxalic acid in starfruit leading to both neurotoxic and nephrotoxic effects, eating starfruit or drinking its juice on an empty stomach is not recommended, even for individuals with normal kidney function.------3. Nephrogenic systemic fibrosis of HemodialysisNephrogenic systemic fibrosis is a rare syndrome that involves fibrosis of skin, joints, eyes, and internal organs. NSF is caused by exposure to gadolinium in gadolinium-based MRI contrast agents (GBCAs) in patients with impaired kidney function. Epidemiological studies suggest that the incidence of NSF is unrelated to gender or ethnicity and it is not thought to have a genetic basis. After GBCAs were identified as a cause of the disorder in 2006, and screening and prevention measures put in place, it is now considered rare.------4. James Cimino of HemodialysisJames E. Cimino (1928-2010) was a physician who specialized in palliative care. He is best known for his invention of the Cimino fistula and for his work as an administrator at Calvary Hospital into the Palliative Care Center it is today.Cimino did his residency in Buffalo, in internal medicine, then moved back to the Bronx to work at the Bronx Veterans Administration Medical Center where he started a program on dialysis. He developed techniques for employing Arteriovenous fistula in patients with chronic kidney failure, which led to a presentation in 1966 at the convention of the American Society for Artificial Internal Organs. His presentation at first was met with indifference, but eventually was established as an important contribution to the field.------5. Death of HemodialysisBarbosa suffered from a severe form of diabetes and was being treated for a hospital bacteria and other illnesses. He performed hemodialysis daily at the Hospital Miguel Couto, in Rio de Janeiro and died there, aged 51. His body was flown to Recife on February 8, 2020. The Cmara Municipal de Olinda decreed three days of mourning as a tribute to the percussionist. His body was first shown in the town hall of Olinda, then driven to the Cemitrio do Guadalupe and was buried there. Outsider musician Pedro Higino Marques da Silva, also known as Pedro Ole, kissed Edwin's forehead during the funeral..------6. Attempt on his life of HemodialysisOn 10 May 2007, Muneer A. Malik was watching TV at 3:00 am at his home in DHA when he heard bullets being fired that hit the upper portion of his house where his son and other family members were present. Windows of his house were broken and bullets signs were present outside the wall of his house as well as inside the home. His daughter and his family members remained safe..------7. Cause of HemodialysisMost cases are idiopathic, but several triggers might related to the development of Eosinophilic fasciitis, such as strenuous exercise, initiation of hemodialysis, infection with Borrelia burgdorferi, some medications such as statins, phenytoin, ramipril, and subcutaneous heparin.------8. Areas of Exposure for the Student's Related Learning Experience of HemodialysisObstetrics and Gynecology wardsPediatric wardsMedical-Surgical wardsSemi-Pay and Charity wardsOut Patient Department and ClinicsGeriatric HomeIntensive Care UnitCoronary Care UnitNeurology Intensive Care UnitNeonatal Intensive Care UnitEmergency RoomDelivery RoomNurseryOperating RoomPost Anesthesia Care Unit (PACU)Heart Institute-Telemetry UnitHemodialysis UnitOther Areas/Departments: EEG, Nuclear Medicine, Heart Station, Physical Medicine and Rehabilitation, Endoscopy, Pulmonary, Ultrasound, CT Scan, MRI, Radiation Oncology, Laboratory. Etc.Outside AffiliationsPhilippine Heart CenterPhilippine Orthopedic CenterSan Lazaro HospitalNational Center for Mental HealthQuezon City Health DepartmentEast Avenue Medical CenterTondo Medical CenterBulacan Medical Center------9. Ralph Shackman of HemodialysisRalph Shackman (29 March 1910 - June 1981), was the first Professor of urology at the Hammersmith Hospital, who did significant research in kidney failure, hemodialysis, and kidney transplantation. With Jim Dempster, in 1960, he performed one of Britain's first human kidney transplantation.------10. Ectogenesis of HemodialysisEctogenesis (from the Greek ecto, "outer," and genesis) is the growth of an organism in an artificial environment outside the body in which it would normally be found, such as the growth of an embryo or fetus outside the mother's body, or the growth of bacteria outside the body of a host. The term was coined by British scientist J.B.S. Haldane in 1924.------11. Legionella cincinnatiensis of HemodialysisLegionella cincinnatiensis is a Gram-negative, non-spore-forming, aerobic bacterium from the genus Legionella which was isolated in Cincinnati from an open lung biopsy specimen from a patient who had hemodialysis because of an end-stage renal disease and suffered from bronchopneumonia.------12. XPNPEP2 of HemodialysisXaa-Pro aminopeptidase 2 is an enzyme that in humans is encoded by the XPNPEP2 gene.Aminopeptidase P is a hydrolase specific for N-terminal imido bonds, which are common to several collagen degradation products, neuropeptides, vasoactive peptides, and cytokines. Structurally, the enzyme is a member of the 'pita bread fold' family and occurs in mammalian tissues in both soluble and GPI-anchored membrane-bound forms. A membrane-bound and soluble form of this enzyme have been identified as products of two separate genes.------13. Epidemiology of HemodialysisNSF affects males and females in approximately equal numbers and has been reported in patients of different ethnic and geographic regions. It most often affects middle-aged individuals, but there are reports of cases occurring from childhood to senescence.------14. T. K. Sreepada Rao of HemodialysisDr. T. K. Sreepada Rao (born 4 June 1943) is a well known nephrologist of Indian origin in the U.S. His biggest scientific achievement is discovering two new renal diseases namely Nephropathy associated with Intravenous heroin addiction in early 1970s, and Nephropathy associated with HIV infection in early 80's. His professional achievement was to transport two cadaver donor kidneys from New York to Bombay, and participate in the renal transplantation when such concept was unknown in India. He has more than 130 scientific publications to his credit. He is one of the few International Medical Graduates who has a Tenured Professorship in a Medical School in the United States------15. Early life of HemodialysisRao was born in a Madhwa family in Kolar, Karnataka, India. He was the 5th child of T.K. Krishnamurthy Rao and Nagamma. His father was Railway Station master who died of a Heart attack when Sreepad was 6 year old------16. Prevention of HemodialysisThe only known measure for prevention of NSF is the non-use or cautious use of GBCAs in patients with renal impairment, including preferential use of safer, macrocyclic GBCAs. Performing dialysis immediately after the MRI exam is recommended for patients already in dialysis treatment, but there is no evidence for introducing dialysis in non-dialytic patients for prevention of NSF. Screening for impaired kidney function is routinely conducted and has drastically reduced the incidence of NSF..------17. Signs and symptoms of HemodialysisAs it is a rare disease, a clear set of symptoms is difficult to define. Usually, patients show severe pain and swelling is reported but clinical presentations vary. It can have an 'orange peel' like appearance. Less common features are joint pain and carpal tunnel syndrome------18. Role in reinstatement of Chief Justice Iftikhar Muhammad Chaudhry of HemodialysisAfter the suspension and arrest of Iftikhar Chaudhry on 9 March 2007, Muneer Malik was one of the first people to contact him and assure the unconditional support of lawyers. The same day, Malik declared, "This is a callous conspiracy of the highest order against superior judiciary ."For his role in the lawyers' movement he has been decorated with a number of awards, including the Dorab Patel Rule of Law Award conferred by the Human Rights Commission of Pakistan, the Human Rights Defender Award of the Asian Human Rights Commission that he shared with successor as President SCBA, Aitzaz Ahsan and the 2008 Gwangju Prize for Human Rights.------19. Bull regime of HemodialysisJ. G. G. Borst in Amsterdam and Bull and his colleagues in London based their dietary therapy on 3 principles: (1) restrict the patient's intake of fluid to precisely balance the patient's output of fluid; (2) eliminate the patient's dietary protein and provide adequate calories to reduce the patient's endogenous breakdown of proteins; (3) give the patient no electrolytes except to replace known losses. Bull achieved these 3 objectives by feeding the patient a carefully measured, synthetic 'diet' consisting of glucose, peanut oil, and water.Calculating fluid intake so that it does not exceed insensible loss plus urine output, is probably the most important part of the 'Bull regime'. An individual calculation is made for each patient to allow for variation in body build, pyrexia, and extra-renal losses, but the average permissible intake during complete anuria is 500 ml. per 24 hours.------20. Steal syndrome of HemodialysisSteal syndrome may refer to:Cardiac steal syndromeSubclavian steal syndrome, often associated with fainting, and typically due to atherosclerosisVascular access steal syndrome, a problem related to a surgically created vascular access (fistula) for hemodialysis------21. Mechanism of HemodialysisDe-chelation of Gd(III) is responsible for the toxicity associated with gadolinium complexes such as GBCAs, and the toxicity appears to be a consequence of Zn2, Cu2, and Ca2 transmetallation in vivo. This hypothesis is supported by acute toxicity experiments, which demonstrate that despite a 50-fold range of LDse values for four Gd(III) complexes, all become lethally toxic when they release precisely the same quantity of Gd(III). It is also supported by subchronic rodent toxicity experiments, which demonstrate a set of gross and microscopic findings similar to those known to be caused by Zn2 deficiency. Under the transmetallation hypothesis, we can expect that subtle changes in formulation can affect the intrinsic safety of gadolinium complexes, which is indeed observed.------22. Munir A. Malik of HemodialysisMunir A. Malik (sometimes spelled Muneer) is a Pakistani lawyer who has served as the 30th Attorney General of Pakistan. He was a key leader of the Lawyers' Movement in Pakistan. He is the former President of the Supreme Court Bar Association of Pakistan. He was the leader of the legal defence team of Chief Justice Iftikhar Muhammad Chaudhry when the latter was dismissed by General Pervez Musharraf after receiving payment from the establishment.when?------23. Career of HemodialysisBarbosa was known for exploring nag, maracatu, caboclinho along other percussion rhythms. He entered Valena's band in 1988, where he remained for 26 years. Valena made a tribute song to Barbosa while he was alive, titled Quando Edwin desde a ladeira. He also was present at solo works along with partners Stanley Jordan and at Perc Pan festival, playing with Nan Vasconcelos, Gilberto Gil and Carlinhos Brown. In 2013, he was given the Trofu Luiz Gonzaga, granted by the Cmara Municipal de Olinda, for "his relevant role in the enlargement of the Northeast music and culture". He also ran for state deputy for Pernambuco in 2010..------24. Half and half nail of HemodialysisHalf and half nails (also known as "Lindsay's nails") show the proximal portion of the nail white and the distal half red, pink, or brown, with a sharp line of demarcation between the two halves.:785 Seventy percent of hemodialysis patients and 56% of renal transplant patients have at least one type of nail abnormality. Absence of lunula, splinter hemorrhage, and half and half nails were significantly more common in hemodialysis patients, while leukonychia was significantly more common in transplant patients.:785:659.------25. Treatment of HemodialysisCommon treatments include corticosteroids such as prednisone, though other medications such as hydroxychloroquine have also been used.The prognosis is usually good in the case of an early treatment if there is no visceral involvement.------26. Lawsuit with Alceu Valena of HemodialysisHis son, Edwin Santos, published on Instagram that Barbosa died without his rights of retirement, because he was not recognized for his role in Valena band. Since 2014 there was a legal lawsuit about the matter.
2021 06 25
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Introduction to Hemodialysis
Introduction to Hemodialysis
1. Caramboxin of HemodialysisCaramboxin (CBX) is a toxin found in star fruit (Averrhoa carambola). Individuals with some types of kidney disease are susceptible to adverse neurological effects including intoxication, seizures and even death after eating star fruit. Caramboxin has been identified as the neurotoxin responsible for these effects. Caramboxin is a non-proteinogenic amino acid that stimulates the glutamate receptors in neurons. Its chemical structure is similar to the amino acid phenylalanine. Caramboxin is an agonist of both NMDA and AMPA glutamatergic ionotropic receptors with potent excitatory, convulsant, and neurodegenerative properties.Due to a possible interaction between caramboxin and oxalic acid in starfruit leading to both neurotoxic and nephrotoxic effects, eating starfruit or drinking its juice on an empty stomach is not recommended, even for individuals with normal kidney function.------2. Bull regime of HemodialysisJ. G. G. Borst in Amsterdam and Bull and his colleagues in London based their dietary therapy on 3 principles: (1) restrict the patient's intake of fluid to precisely balance the patient's output of fluid; (2) eliminate the patient's dietary protein and provide adequate calories to reduce the patient's endogenous breakdown of proteins; (3) give the patient no electrolytes except to replace known losses. Bull achieved these 3 objectives by feeding the patient a carefully measured, synthetic 'diet' consisting of glucose, peanut oil, and water.Calculating fluid intake so that it does not exceed insensible loss plus urine output, is probably the most important part of the 'Bull regime'. An individual calculation is made for each patient to allow for variation in body build, pyrexia, and extra-renal losses, but the average permissible intake during complete anuria is 500 ml. per 24 hours.------3. History of HemodialysisThe medical institutions of the Plaza de la Salud: the General Hospital (HGPS) and the Centers for Diagnostics and Advanced Medicine and Medical Conferences and Telemedicine (CEDIMAT), part of the concept created by Dr. Juan Manuel Taveras Rodriguez, a world-renowned Dominican medical specialist, considered the father of Neuroradiology. In 1996, President Joaqun Balaguer, by decree designated an area of 221,030.62 square feet (20,534.417m2) for these buildings. The area is divided into equal parts between HGPS and CEDIMAT and shares its grounds with other health institutions such as the Pan American Health Organization (PAHO / WHO), the Emergency Operations Center (COE) and the Presidential Commission for AIDS (COPRESIDA) among others. The initial construction was built with funds by the Dominican State.Law 163-03, dated February 10, 2003, approved the grant contract between the Dominican State and the Boards of both HGPS and CEDIMAT for the assignment and transfer of land of the Plaza de la Salud. The law was promulgated by the Executive Power, dated 13 September 2003.------4. Arrest of HemodialysisMalik was arrested after Musharraf declared a state of emergency. He was initially admitted at Pakistan Institute of Medical Sciences on 25 November 2007, seriously ill and under treatment for kidney failure requiring dialysis. He was transferred to Sindh Institute of Urology and Transplantation in Karachi, where he still requires renal replacement therapy in the form of hemodialysis. Some reports indicate that he has developed liver dysfunction also. He complained about psychological abuse.clarification neededImran Khan has expressed concern about Malik's health and has blamed the government. He has criticized government to deny him of access to clean drinking water when he was under arrest in Attock jail. However, the doctors at the Pakistan Institute of Sciences (PIMS) conducted a toxicology screen and ruled out any foul play. Munir Malik has not pursued any charges against an individual or the Pakistani government and neither has sought an independent medical opinion.------5. Bioethical considerations of HemodialysisThe development of artificial uteri and ectogenesis raises a few bioethical and legal considerations, and also has important implications for reproductive rights and the abortion debate.Artificial uteri may expand the range of fetal viability, raising questions about the role that fetal viability plays within abortion law. Within severance theory, for example, abortion rights only include the right to remove the fetus, and do not always extend to the termination of the fetus. If transferring the fetus from a woman's womb to an artificial uterus is possible, the choice to terminate a pregnancy in this way could provide an alternative to aborting the fetus.There are also theoretical concerns that children who develop in an artificial uterus may lack "some essential bond with their mothers that other children have"; a secondary issue to woman's rights over their own body.In the 1970 book The Dialectic of Sex, feminist Shulamith Firestone wrote that differences in biological reproductive roles are a source of gender inequality. Firestone singled out pregnancy and childbirth, making the argument that an artificial womb would free "women from the tyranny of their reproductive biology."------6. Biography of HemodialysisBorn on Pingelap in February 1931, Robert studied at the University of Hawaii, graduating with a BA in education in 1964. He contested the first elections to the Congress of the Trust Territory of the Pacific Islands in 1965, winning a seat in the House of Representatives, representing the 11th District of Ponape, which covered Kosrae and Pingelap. He was defeated by Joab Sigrah in the 1966 elections. During the 1960s he was also a member of the Ponape District Legislature.Robert subsequently worked for the Ponape Education Department, serving as Associate Assistant Director of the Ponape branch of the Community College of Micronesia between 1973 until 1976. He also returned to the University of Hawaii, earning an MA in educational administration in 1975. However, when he returned to the territory the same year, he became a patient at the hemodialysis unit at Majuro Hospital. He died in June 1978 and was buried on Ponape, survived by his wife Elihna and six children.------7. AURORA trial of HemodialysisThe AURORA trial (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) was a randomized, double-blind, placebo-controlled study investigating the use of rosuvastatin in the prevention of cardiovascular disease among patients undergoing chronic hemodialysis.The trial was undertaken because although patients with end-stage renal disease (ESRD) are at high risk of adverse cardiovascular events, no large clinical trial had confirmed the benefit of lipid-lowering agents. The AURORA trial sought to fill this gap.The trial was conducted across 280 medical centers in 25 countries. The study randomized 2776 patients, aged 5080 years and undergoing maintenance hemodialysis, to one of two groups. One group received rosuvastatin 10mg daily and the other group received a placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Although the mean LDL cholesterol was reduced by 43% in the rosuvastatin arm of the study at three months, no difference in the primary end point was demonstrated at an average follow-up of 3.8 years.The trial was sponsored, in part, by AstraZeneca, the marketer of Crestor.------8. Mechanism of HemodialysisDe-chelation of Gd(III) is responsible for the toxicity associated with gadolinium complexes such as GBCAs, and the toxicity appears to be a consequence of Zn2, Cu2, and Ca2 transmetallation in vivo. This hypothesis is supported by acute toxicity experiments, which demonstrate that despite a 50-fold range of LDse values for four Gd(III) complexes, all become lethally toxic when they release precisely the same quantity of Gd(III). It is also supported by subchronic rodent toxicity experiments, which demonstrate a set of gross and microscopic findings similar to those known to be caused by Zn2 deficiency. Under the transmetallation hypothesis, we can expect that subtle changes in formulation can affect the intrinsic safety of gadolinium complexes, which is indeed observed.------9. Diagnosis of HemodialysisThere is no specific imaging finding for NSF, and the diagnosis is a clinicopathological one, based on presentation and histological findings.Microscopic pathologyAt the microscopic level, NSF shows a proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers, and deposits of mucin. More recent case reports have described the presence of sclerotic bodies (also known as elastocollagenous balls) in skin biopsies from NSF patients. While not universally present, this finding is believed to be unique to patients exposed to gadolinium, although not necessarily limited to areas involved by NSF.Differential diagnosisThe differential diagnoses for NSF include diffuse cutaneous or limited cutaneous systemic sclerosis, scleromyxedema, lipodermatosclerosis, scleroedema diabeticorum, graft versus host disease, eosinophilic fasciitis; eosinophilia-myalgia syndrome; porphyria cutanea tarda, and other disorders. The nearly universal absence of facial skin involvement in NSF, presence of yellow plaques on the sclera of the eyes, absence of Raynauds phenomenon, and other differences in presentation can aid the proper diagnosis. History of exposure to GBCAs would favor NSF as the differential diagnosis.------10. Eosinophilic fasciitis of HemodialysisEosinophilic fasciitis (/isnflk fiats, io-, -fsi-/), also known as "Shulman's syndrome", is a form of fasciitis, the inflammatory diseases that affect the fascia, the connective tissues surrounding muscles, blood vessels and nerves. Unlike other diseases in that category, it is limited to the arms and legs, and usually resolves itself, although some cases require corticosteroids, and some cases are associated with aplastic anemia.The presentation of eosinophilic fasciitis is similar to scleroderma or systemic sclerosis. However, unlike scleroderma, it affects the fascia, not the skin (dermis). The characteristic and severe effects of scleroderma and systemic sclerosis, such as Raynaud's syndrome, involvement of the extremities, prominent small blood vessels (telangiectasia), and visceral changes such as swallowing problems, are absent.It was first characterized in 1974, and it is not yet known whether it is actually a distinct condition or just a different presentation. However, it remains used for diagnostic purposes.Several cases have been reported after strenuous exercise.------11. Human embryos and fetuses of HemodialysisEctogenesis of human embryos and fetuses would require an artificial uterus. An artificial uterus would have to be supplied by nutrients and oxygen from some source to nurture a fetus, as well as dispose of waste material. There would likely be a need for an interface between such a supplier, filling this function of the placenta. An artificial uterus, as a replacement organ, could be used to assist women with damaged, diseased or removed uteri to avail the fetus to be conceived to term. It also has the potential to move the threshold of fetal viability to a much earlier stage of pregnancy. This would have implications for the ongoing controversy regarding human reproductive rights.Ectogenesis could also be a means by which homosexual and single men could have genetic offspring without the use of surrogate pregnancy or a sperm donor, and allow women to have children without going through the pregnancy cycle.------12. Risk factors of HemodialysisImpaired kidney function reduces the clearance of GBCAs and is the major risk factor for the development of NSF. The etiology or duration of renal failure seems not to be relevant, but NSF risk greatly depends on the residual kidney function. The majority of NSF cases have been identified in patients with stage 5 CKD, but NSF has also developed in patients with stage 4 and 3 CKD, and those with acute kidney injury, even if kidney function subsequently returned to normal following GBCA administration. Thus NSF should be considered as a differential diagnosis in any patient who has been exposed to a GBCA, regardless of the kidney function level.Three GBCAs have been principally implicated in NSF: gadodiamide, gadopentetate dimeglumine, and gadoversetamide, though cases have been reported with majority of GBCAs on the market. High doses in individual GBCA administrations and high cumulative doses of GBCA over the lifetime of patients with renal dysfunction are associated with increased risk of NSF.
2021 06 25
read more
Introduction to Hemodialysis
Introduction to Hemodialysis
1. Caramboxin of HemodialysisCaramboxin (CBX) is a toxin found in star fruit (Averrhoa carambola). Individuals with some types of kidney disease are susceptible to adverse neurological effects including intoxication, seizures and even death after eating star fruit. Caramboxin has been identified as the neurotoxin responsible for these effects. Caramboxin is a non-proteinogenic amino acid that stimulates the glutamate receptors in neurons. Its chemical structure is similar to the amino acid phenylalanine. Caramboxin is an agonist of both NMDA and AMPA glutamatergic ionotropic receptors with potent excitatory, convulsant, and neurodegenerative properties.Due to a possible interaction between caramboxin and oxalic acid in starfruit leading to both neurotoxic and nephrotoxic effects, eating starfruit or drinking its juice on an empty stomach is not recommended, even for individuals with normal kidney function.------2. Bull regime of HemodialysisJ. G. G. Borst in Amsterdam and Bull and his colleagues in London based their dietary therapy on 3 principles: (1) restrict the patient's intake of fluid to precisely balance the patient's output of fluid; (2) eliminate the patient's dietary protein and provide adequate calories to reduce the patient's endogenous breakdown of proteins; (3) give the patient no electrolytes except to replace known losses. Bull achieved these 3 objectives by feeding the patient a carefully measured, synthetic 'diet' consisting of glucose, peanut oil, and water.Calculating fluid intake so that it does not exceed insensible loss plus urine output, is probably the most important part of the 'Bull regime'. An individual calculation is made for each patient to allow for variation in body build, pyrexia, and extra-renal losses, but the average permissible intake during complete anuria is 500 ml. per 24 hours.------3. History of HemodialysisThe medical institutions of the Plaza de la Salud: the General Hospital (HGPS) and the Centers for Diagnostics and Advanced Medicine and Medical Conferences and Telemedicine (CEDIMAT), part of the concept created by Dr. Juan Manuel Taveras Rodriguez, a world-renowned Dominican medical specialist, considered the father of Neuroradiology. In 1996, President Joaqun Balaguer, by decree designated an area of 221,030.62 square feet (20,534.417m2) for these buildings. The area is divided into equal parts between HGPS and CEDIMAT and shares its grounds with other health institutions such as the Pan American Health Organization (PAHO / WHO), the Emergency Operations Center (COE) and the Presidential Commission for AIDS (COPRESIDA) among others. The initial construction was built with funds by the Dominican State.Law 163-03, dated February 10, 2003, approved the grant contract between the Dominican State and the Boards of both HGPS and CEDIMAT for the assignment and transfer of land of the Plaza de la Salud. The law was promulgated by the Executive Power, dated 13 September 2003.------4. Arrest of HemodialysisMalik was arrested after Musharraf declared a state of emergency. He was initially admitted at Pakistan Institute of Medical Sciences on 25 November 2007, seriously ill and under treatment for kidney failure requiring dialysis. He was transferred to Sindh Institute of Urology and Transplantation in Karachi, where he still requires renal replacement therapy in the form of hemodialysis. Some reports indicate that he has developed liver dysfunction also. He complained about psychological abuse.clarification neededImran Khan has expressed concern about Malik's health and has blamed the government. He has criticized government to deny him of access to clean drinking water when he was under arrest in Attock jail. However, the doctors at the Pakistan Institute of Sciences (PIMS) conducted a toxicology screen and ruled out any foul play. Munir Malik has not pursued any charges against an individual or the Pakistani government and neither has sought an independent medical opinion.------5. Bioethical considerations of HemodialysisThe development of artificial uteri and ectogenesis raises a few bioethical and legal considerations, and also has important implications for reproductive rights and the abortion debate.Artificial uteri may expand the range of fetal viability, raising questions about the role that fetal viability plays within abortion law. Within severance theory, for example, abortion rights only include the right to remove the fetus, and do not always extend to the termination of the fetus. If transferring the fetus from a woman's womb to an artificial uterus is possible, the choice to terminate a pregnancy in this way could provide an alternative to aborting the fetus.There are also theoretical concerns that children who develop in an artificial uterus may lack "some essential bond with their mothers that other children have"; a secondary issue to woman's rights over their own body.In the 1970 book The Dialectic of Sex, feminist Shulamith Firestone wrote that differences in biological reproductive roles are a source of gender inequality. Firestone singled out pregnancy and childbirth, making the argument that an artificial womb would free "women from the tyranny of their reproductive biology."------6. Biography of HemodialysisBorn on Pingelap in February 1931, Robert studied at the University of Hawaii, graduating with a BA in education in 1964. He contested the first elections to the Congress of the Trust Territory of the Pacific Islands in 1965, winning a seat in the House of Representatives, representing the 11th District of Ponape, which covered Kosrae and Pingelap. He was defeated by Joab Sigrah in the 1966 elections. During the 1960s he was also a member of the Ponape District Legislature.Robert subsequently worked for the Ponape Education Department, serving as Associate Assistant Director of the Ponape branch of the Community College of Micronesia between 1973 until 1976. He also returned to the University of Hawaii, earning an MA in educational administration in 1975. However, when he returned to the territory the same year, he became a patient at the hemodialysis unit at Majuro Hospital. He died in June 1978 and was buried on Ponape, survived by his wife Elihna and six children.------7. AURORA trial of HemodialysisThe AURORA trial (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) was a randomized, double-blind, placebo-controlled study investigating the use of rosuvastatin in the prevention of cardiovascular disease among patients undergoing chronic hemodialysis.The trial was undertaken because although patients with end-stage renal disease (ESRD) are at high risk of adverse cardiovascular events, no large clinical trial had confirmed the benefit of lipid-lowering agents. The AURORA trial sought to fill this gap.The trial was conducted across 280 medical centers in 25 countries. The study randomized 2776 patients, aged 5080 years and undergoing maintenance hemodialysis, to one of two groups. One group received rosuvastatin 10mg daily and the other group received a placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Although the mean LDL cholesterol was reduced by 43% in the rosuvastatin arm of the study at three months, no difference in the primary end point was demonstrated at an average follow-up of 3.8 years.The trial was sponsored, in part, by AstraZeneca, the marketer of Crestor.------8. Mechanism of HemodialysisDe-chelation of Gd(III) is responsible for the toxicity associated with gadolinium complexes such as GBCAs, and the toxicity appears to be a consequence of Zn2, Cu2, and Ca2 transmetallation in vivo. This hypothesis is supported by acute toxicity experiments, which demonstrate that despite a 50-fold range of LDse values for four Gd(III) complexes, all become lethally toxic when they release precisely the same quantity of Gd(III). It is also supported by subchronic rodent toxicity experiments, which demonstrate a set of gross and microscopic findings similar to those known to be caused by Zn2 deficiency. Under the transmetallation hypothesis, we can expect that subtle changes in formulation can affect the intrinsic safety of gadolinium complexes, which is indeed observed.------9. Diagnosis of HemodialysisThere is no specific imaging finding for NSF, and the diagnosis is a clinicopathological one, based on presentation and histological findings.Microscopic pathologyAt the microscopic level, NSF shows a proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers, and deposits of mucin. More recent case reports have described the presence of sclerotic bodies (also known as elastocollagenous balls) in skin biopsies from NSF patients. While not universally present, this finding is believed to be unique to patients exposed to gadolinium, although not necessarily limited to areas involved by NSF.Differential diagnosisThe differential diagnoses for NSF include diffuse cutaneous or limited cutaneous systemic sclerosis, scleromyxedema, lipodermatosclerosis, scleroedema diabeticorum, graft versus host disease, eosinophilic fasciitis; eosinophilia-myalgia syndrome; porphyria cutanea tarda, and other disorders. The nearly universal absence of facial skin involvement in NSF, presence of yellow plaques on the sclera of the eyes, absence of Raynauds phenomenon, and other differences in presentation can aid the proper diagnosis. History of exposure to GBCAs would favor NSF as the differential diagnosis.------10. Eosinophilic fasciitis of HemodialysisEosinophilic fasciitis (/isnflk fiats, io-, -fsi-/), also known as "Shulman's syndrome", is a form of fasciitis, the inflammatory diseases that affect the fascia, the connective tissues surrounding muscles, blood vessels and nerves. Unlike other diseases in that category, it is limited to the arms and legs, and usually resolves itself, although some cases require corticosteroids, and some cases are associated with aplastic anemia.The presentation of eosinophilic fasciitis is similar to scleroderma or systemic sclerosis. However, unlike scleroderma, it affects the fascia, not the skin (dermis). The characteristic and severe effects of scleroderma and systemic sclerosis, such as Raynaud's syndrome, involvement of the extremities, prominent small blood vessels (telangiectasia), and visceral changes such as swallowing problems, are absent.It was first characterized in 1974, and it is not yet known whether it is actually a distinct condition or just a different presentation. However, it remains used for diagnostic purposes.Several cases have been reported after strenuous exercise.------11. Human embryos and fetuses of HemodialysisEctogenesis of human embryos and fetuses would require an artificial uterus. An artificial uterus would have to be supplied by nutrients and oxygen from some source to nurture a fetus, as well as dispose of waste material. There would likely be a need for an interface between such a supplier, filling this function of the placenta. An artificial uterus, as a replacement organ, could be used to assist women with damaged, diseased or removed uteri to avail the fetus to be conceived to term. It also has the potential to move the threshold of fetal viability to a much earlier stage of pregnancy. This would have implications for the ongoing controversy regarding human reproductive rights.Ectogenesis could also be a means by which homosexual and single men could have genetic offspring without the use of surrogate pregnancy or a sperm donor, and allow women to have children without going through the pregnancy cycle.------12. Risk factors of HemodialysisImpaired kidney function reduces the clearance of GBCAs and is the major risk factor for the development of NSF. The etiology or duration of renal failure seems not to be relevant, but NSF risk greatly depends on the residual kidney function. The majority of NSF cases have been identified in patients with stage 5 CKD, but NSF has also developed in patients with stage 4 and 3 CKD, and those with acute kidney injury, even if kidney function subsequently returned to normal following GBCA administration. Thus NSF should be considered as a differential diagnosis in any patient who has been exposed to a GBCA, regardless of the kidney function level.Three GBCAs have been principally implicated in NSF: gadodiamide, gadopentetate dimeglumine, and gadoversetamide, though cases have been reported with majority of GBCAs on the market. High doses in individual GBCA administrations and high cumulative doses of GBCA over the lifetime of patients with renal dysfunction are associated with increased risk of NSF.
2021 06 25
read more
Introduction to Hemodialysis
Introduction to Hemodialysis
1. Criticism of HemodialysisSince its inception, the HGPS has been perceived by the Dominican people as being a State-run facility that should offer free services as it was initially built using State funds. However, by decree, the HGPS was created to provide non-profit medical assistance and uses the fees for services to continue to run its day-to-day operations. While the HGPS receives a government grant to cover services offered to low-income patients at discount or free of charge, the cost of operations can only be met charging a below market fee for its renown medical services.------2. Caramboxin of HemodialysisCaramboxin (CBX) is a toxin found in star fruit (Averrhoa carambola). Individuals with some types of kidney disease are susceptible to adverse neurological effects including intoxication, seizures and even death after eating star fruit. Caramboxin has been identified as the neurotoxin responsible for these effects. Caramboxin is a non-proteinogenic amino acid that stimulates the glutamate receptors in neurons. Its chemical structure is similar to the amino acid phenylalanine. Caramboxin is an agonist of both NMDA and AMPA glutamatergic ionotropic receptors with potent excitatory, convulsant, and neurodegenerative properties.Due to a possible interaction between caramboxin and oxalic acid in starfruit leading to both neurotoxic and nephrotoxic effects, eating starfruit or drinking its juice on an empty stomach is not recommended, even for individuals with normal kidney function.------3. Nephrogenic systemic fibrosis of HemodialysisNephrogenic systemic fibrosis is a rare syndrome that involves fibrosis of skin, joints, eyes, and internal organs. NSF is caused by exposure to gadolinium in gadolinium-based MRI contrast agents (GBCAs) in patients with impaired kidney function. Epidemiological studies suggest that the incidence of NSF is unrelated to gender or ethnicity and it is not thought to have a genetic basis. After GBCAs were identified as a cause of the disorder in 2006, and screening and prevention measures put in place, it is now considered rare.------4. James Cimino of HemodialysisJames E. Cimino (1928-2010) was a physician who specialized in palliative care. He is best known for his invention of the Cimino fistula and for his work as an administrator at Calvary Hospital into the Palliative Care Center it is today.Cimino did his residency in Buffalo, in internal medicine, then moved back to the Bronx to work at the Bronx Veterans Administration Medical Center where he started a program on dialysis. He developed techniques for employing Arteriovenous fistula in patients with chronic kidney failure, which led to a presentation in 1966 at the convention of the American Society for Artificial Internal Organs. His presentation at first was met with indifference, but eventually was established as an important contribution to the field.------5. Death of HemodialysisBarbosa suffered from a severe form of diabetes and was being treated for a hospital bacteria and other illnesses. He performed hemodialysis daily at the Hospital Miguel Couto, in Rio de Janeiro and died there, aged 51. His body was flown to Recife on February 8, 2020. The Cmara Municipal de Olinda decreed three days of mourning as a tribute to the percussionist. His body was first shown in the town hall of Olinda, then driven to the Cemitrio do Guadalupe and was buried there. Outsider musician Pedro Higino Marques da Silva, also known as Pedro Ole, kissed Edwin's forehead during the funeral..------6. Attempt on his life of HemodialysisOn 10 May 2007, Muneer A. Malik was watching TV at 3:00 am at his home in DHA when he heard bullets being fired that hit the upper portion of his house where his son and other family members were present. Windows of his house were broken and bullets signs were present outside the wall of his house as well as inside the home. His daughter and his family members remained safe..------7. Cause of HemodialysisMost cases are idiopathic, but several triggers might related to the development of Eosinophilic fasciitis, such as strenuous exercise, initiation of hemodialysis, infection with Borrelia burgdorferi, some medications such as statins, phenytoin, ramipril, and subcutaneous heparin.------8. Areas of Exposure for the Student's Related Learning Experience of HemodialysisObstetrics and Gynecology wardsPediatric wardsMedical-Surgical wardsSemi-Pay and Charity wardsOut Patient Department and ClinicsGeriatric HomeIntensive Care UnitCoronary Care UnitNeurology Intensive Care UnitNeonatal Intensive Care UnitEmergency RoomDelivery RoomNurseryOperating RoomPost Anesthesia Care Unit (PACU)Heart Institute-Telemetry UnitHemodialysis UnitOther Areas/Departments: EEG, Nuclear Medicine, Heart Station, Physical Medicine and Rehabilitation, Endoscopy, Pulmonary, Ultrasound, CT Scan, MRI, Radiation Oncology, Laboratory. Etc.Outside AffiliationsPhilippine Heart CenterPhilippine Orthopedic CenterSan Lazaro HospitalNational Center for Mental HealthQuezon City Health DepartmentEast Avenue Medical CenterTondo Medical CenterBulacan Medical Center------9. Ralph Shackman of HemodialysisRalph Shackman (29 March 1910 - June 1981), was the first Professor of urology at the Hammersmith Hospital, who did significant research in kidney failure, hemodialysis, and kidney transplantation. With Jim Dempster, in 1960, he performed one of Britain's first human kidney transplantation.------10. Ectogenesis of HemodialysisEctogenesis (from the Greek ecto, "outer," and genesis) is the growth of an organism in an artificial environment outside the body in which it would normally be found, such as the growth of an embryo or fetus outside the mother's body, or the growth of bacteria outside the body of a host. The term was coined by British scientist J.B.S. Haldane in 1924.------11. Legionella cincinnatiensis of HemodialysisLegionella cincinnatiensis is a Gram-negative, non-spore-forming, aerobic bacterium from the genus Legionella which was isolated in Cincinnati from an open lung biopsy specimen from a patient who had hemodialysis because of an end-stage renal disease and suffered from bronchopneumonia.------12. XPNPEP2 of HemodialysisXaa-Pro aminopeptidase 2 is an enzyme that in humans is encoded by the XPNPEP2 gene.Aminopeptidase P is a hydrolase specific for N-terminal imido bonds, which are common to several collagen degradation products, neuropeptides, vasoactive peptides, and cytokines. Structurally, the enzyme is a member of the 'pita bread fold' family and occurs in mammalian tissues in both soluble and GPI-anchored membrane-bound forms. A membrane-bound and soluble form of this enzyme have been identified as products of two separate genes.------13. Epidemiology of HemodialysisNSF affects males and females in approximately equal numbers and has been reported in patients of different ethnic and geographic regions. It most often affects middle-aged individuals, but there are reports of cases occurring from childhood to senescence.------14. T. K. Sreepada Rao of HemodialysisDr. T. K. Sreepada Rao (born 4 June 1943) is a well known nephrologist of Indian origin in the U.S. His biggest scientific achievement is discovering two new renal diseases namely Nephropathy associated with Intravenous heroin addiction in early 1970s, and Nephropathy associated with HIV infection in early 80's. His professional achievement was to transport two cadaver donor kidneys from New York to Bombay, and participate in the renal transplantation when such concept was unknown in India. He has more than 130 scientific publications to his credit. He is one of the few International Medical Graduates who has a Tenured Professorship in a Medical School in the United States------15. Early life of HemodialysisRao was born in a Madhwa family in Kolar, Karnataka, India. He was the 5th child of T.K. Krishnamurthy Rao and Nagamma. His father was Railway Station master who died of a Heart attack when Sreepad was 6 year old------16. Prevention of HemodialysisThe only known measure for prevention of NSF is the non-use or cautious use of GBCAs in patients with renal impairment, including preferential use of safer, macrocyclic GBCAs. Performing dialysis immediately after the MRI exam is recommended for patients already in dialysis treatment, but there is no evidence for introducing dialysis in non-dialytic patients for prevention of NSF. Screening for impaired kidney function is routinely conducted and has drastically reduced the incidence of NSF..------17. Signs and symptoms of HemodialysisAs it is a rare disease, a clear set of symptoms is difficult to define. Usually, patients show severe pain and swelling is reported but clinical presentations vary. It can have an 'orange peel' like appearance. Less common features are joint pain and carpal tunnel syndrome------18. Role in reinstatement of Chief Justice Iftikhar Muhammad Chaudhry of HemodialysisAfter the suspension and arrest of Iftikhar Chaudhry on 9 March 2007, Muneer Malik was one of the first people to contact him and assure the unconditional support of lawyers. The same day, Malik declared, "This is a callous conspiracy of the highest order against superior judiciary ."For his role in the lawyers' movement he has been decorated with a number of awards, including the Dorab Patel Rule of Law Award conferred by the Human Rights Commission of Pakistan, the Human Rights Defender Award of the Asian Human Rights Commission that he shared with successor as President SCBA, Aitzaz Ahsan and the 2008 Gwangju Prize for Human Rights.------19. Bull regime of HemodialysisJ. G. G. Borst in Amsterdam and Bull and his colleagues in London based their dietary therapy on 3 principles: (1) restrict the patient's intake of fluid to precisely balance the patient's output of fluid; (2) eliminate the patient's dietary protein and provide adequate calories to reduce the patient's endogenous breakdown of proteins; (3) give the patient no electrolytes except to replace known losses. Bull achieved these 3 objectives by feeding the patient a carefully measured, synthetic 'diet' consisting of glucose, peanut oil, and water.Calculating fluid intake so that it does not exceed insensible loss plus urine output, is probably the most important part of the 'Bull regime'. An individual calculation is made for each patient to allow for variation in body build, pyrexia, and extra-renal losses, but the average permissible intake during complete anuria is 500 ml. per 24 hours.------20. Steal syndrome of HemodialysisSteal syndrome may refer to:Cardiac steal syndromeSubclavian steal syndrome, often associated with fainting, and typically due to atherosclerosisVascular access steal syndrome, a problem related to a surgically created vascular access (fistula) for hemodialysis------21. Mechanism of HemodialysisDe-chelation of Gd(III) is responsible for the toxicity associated with gadolinium complexes such as GBCAs, and the toxicity appears to be a consequence of Zn2, Cu2, and Ca2 transmetallation in vivo. This hypothesis is supported by acute toxicity experiments, which demonstrate that despite a 50-fold range of LDse values for four Gd(III) complexes, all become lethally toxic when they release precisely the same quantity of Gd(III). It is also supported by subchronic rodent toxicity experiments, which demonstrate a set of gross and microscopic findings similar to those known to be caused by Zn2 deficiency. Under the transmetallation hypothesis, we can expect that subtle changes in formulation can affect the intrinsic safety of gadolinium complexes, which is indeed observed.------22. Munir A. Malik of HemodialysisMunir A. Malik (sometimes spelled Muneer) is a Pakistani lawyer who has served as the 30th Attorney General of Pakistan. He was a key leader of the Lawyers' Movement in Pakistan. He is the former President of the Supreme Court Bar Association of Pakistan. He was the leader of the legal defence team of Chief Justice Iftikhar Muhammad Chaudhry when the latter was dismissed by General Pervez Musharraf after receiving payment from the establishment.when?------23. Career of HemodialysisBarbosa was known for exploring nag, maracatu, caboclinho along other percussion rhythms. He entered Valena's band in 1988, where he remained for 26 years. Valena made a tribute song to Barbosa while he was alive, titled Quando Edwin desde a ladeira. He also was present at solo works along with partners Stanley Jordan and at Perc Pan festival, playing with Nan Vasconcelos, Gilberto Gil and Carlinhos Brown. In 2013, he was given the Trofu Luiz Gonzaga, granted by the Cmara Municipal de Olinda, for "his relevant role in the enlargement of the Northeast music and culture". He also ran for state deputy for Pernambuco in 2010..------24. Half and half nail of HemodialysisHalf and half nails (also known as "Lindsay's nails") show the proximal portion of the nail white and the distal half red, pink, or brown, with a sharp line of demarcation between the two halves.:785 Seventy percent of hemodialysis patients and 56% of renal transplant patients have at least one type of nail abnormality. Absence of lunula, splinter hemorrhage, and half and half nails were significantly more common in hemodialysis patients, while leukonychia was significantly more common in transplant patients.:785:659.------25. Treatment of HemodialysisCommon treatments include corticosteroids such as prednisone, though other medications such as hydroxychloroquine have also been used.The prognosis is usually good in the case of an early treatment if there is no visceral involvement.------26. Lawsuit with Alceu Valena of HemodialysisHis son, Edwin Santos, published on Instagram that Barbosa died without his rights of retirement, because he was not recognized for his role in Valena band. Since 2014 there was a legal lawsuit about the matter.
2021 06 25
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Know About Hemodialysis
Know About Hemodialysis
An Introduction to HemodialysisHospital General de la Plaza de la Salud (HGPS) is a non-profit entity with self-management in the selection and recruitment of staff and in the formulation and use of its budget. It is located on Avenida Ortega y Gasset Ensanche La Fe, Santo Domingo, Distrito Nacional of the Dominican Republic.The HGPS is technically and administratively managed by a board set up by Decree No. 131, April 18, 1996 and ratified by Congress through Law No.78-99, dated 24 July 1999. The Board is composed of distinguished doctors, businessmen, and individuals dedicated to serving the Dominican community as well as ex officio members: the Secretary of State for Public Health and Social Welfare, the Director of the Dominican Social Security Institute, the Chairman of National Council of Businessmen and the Secretary of Labor.Under the supervision of the Board, the HGPS has an organizational structure headed by the Executive Directorate, responsible for coordinating the planning and management to achieve its goals. Dependent on this Directorate are the Financial Management and Administration Directorate, Medical Directorate and the Directorate of Hospital Support. These in turn have different departments headed by managers and service units under the supervision of their heads.HGPS medical staff is composed of specialists, sub-specialists and general or internal practitioners, grouped into the following departments: Internal medicine and specialties, General Surgery and specialties, OB-GYN, Gastroenterology and Endoscopy, Pediatrics and specialties, Family Medicine Education and Research, Orthopedics and Traumatology. Other services offered are: Diagnostic Imaging, Pathology, Geriatrics, Physical medicine and rehabilitation, Dentistry, Laboratory and Blood Bank, Cardiology, Onco Hematology, Ophthalmology, Breast Pathology, Emergency Medicine, nursing, pharmacy, nutrition and social work.Each year, the HGPS benefits more than 13,000 low-income patients who receive up to a 40 percent discount or are exempt from payment according to their financial condition. The HGPS receives a grant from the Dominican Government that covers the annual cost of exemptions and discounts to patients with limited resources.Since 2003, the HGPS is a teaching facility and has three medical residency programs in the areas of Family and Community Medicine, Medical Emergency and Disasters and Rehabilitation Medicine, supported by the Universidad Iberoamericana (UNIBE). At present, the HGPS has become a major center for training and education for the health sciences faculties of major universities in the country: UNIBE, INTEC, UNPHU, UCE, UASD, and the Catholic University Santo Domingo (UCSD), for both its undergraduate and graduate programs.The HGPS is recognized as a center of excellence in Dominican medicine, setting quality standards for the entire country.Criticism of HemodialysisSince its inception, the HGPS has been perceived by the Dominican people as being a State-run facility that should offer free services as it was initially built using State funds. However, by decree, the HGPS was created to provide non-profit medical assistance and uses the fees for services to continue to run its day-to-day operations. While the HGPS receives a government grant to cover services offered to low-income patients at discount or free of charge, the cost of operations can only be met charging a below market fee for its renown medical services.HGPS Highlights of HemodialysisIt has helped more than 140,000 low-income patients with discounts and waivers of its health treatment plans, helping to improve their quality of life and their physical and emotional well-being.Blood Bank with a high level of reliability and credibility, as well as the creation of the section of Cryopreservation of stem cells at the Blood Bank, which supports the HGPS's bone marrow transplant services (only one in the country).It is a teaching hospital facility with a board of educational programs in the following specialties: Family and Community Medicine, Medical Emergency and Disasters and Rehabilitation Medicine.Conducts a yearly Scientific Symposium to present the institution's research and medical advances.CENTOX, the first Poison control center in the Dominican Republic.Followed the successful pregnancy, delivery and birth of the first sextuplets in the Dominican Republic with only 26 and a half weeks of gestation. The children are now 4 years of age and healthy (2009).Pediatric intensive care unit (PICU) as a national reference of care.Pacemaker ClinicHemodialysis UnitCenter for Integrated medicineThorax Pain UnitOrgan and tissue transplantation program., which has a Transplant Counsel and an Organ Captivity Coordination Unit. The program achieved the first kidney transplant from a deceased donor in the country, liver transplants from deceased donors and corneal transplantation.Physical Medicine and Rehabilitation Hospital, with Urodynamics and Isokinetic Diagnostics units.Volunteerism unit to work with the hospital community with a high degree of solidarity and commitment.First Primary Care Center of the Dominican Republic.The country's first outpatient surgery program.The permanence of the only functioning hospital bioethics committee in the country, meeting regularly since 1997.Implementation of the first free hip and knee replacement program in the country called Operation Walk, a medical mission for patients with limited resources. It was led by a team of local and international specialists from Brigham and Women's Hospital and since 2008, has benefited over 80 Dominican patients and their families.Units of Care and Solidarity (UNASOL), offering medical assistance to thousands of people affected by tragedies of force majeure.Diabetic foot Clinic to prevent and treat all foot diseases in any patient.Dengue Clinic, as a national reference for all those who present symptoms.
2021 06 25
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Discovery of a Female Cat with Testicles Among Weirdest Pet Claims
Discovery of a Female Cat with Testicles Among Weirdest Pet Claims
A North Shore pet owner got the shock of her life to learn her female cat also had testicles. Along with the discovery of a hermaphrodite cat, other owners have been left perplexed after discovering their pets had consumed anything from a roll of dental floss, compact mirror, blanket, sewing needle to a chicken skewer. These discoveries were among the weirdest PetCare claims received by Southern Cross last year. Lisa Newlands adopted her domestic long haired cat Cameo in 2014 with the reassurance she had been spayed. But at the end of last year, Newlands became suspicious about whether it the standard neutering had worked when her usually feisty cat started befriending a stray male. After Cameo became really sick with a high temperature and stopped eating for the second time in two months, an ultrasound revealed she had a large mass in her stomach area. The ginger cat underwent surgery and for the first time in her vet's 13 year career, she discovered two cancerous testicles in the female feline. Cancerous testicles emit oestrogen, which was why the tom cat was hanging around. "The vet was just bamboozled. She had never seen anything like this in her entire career," Newlands said. Cameo's total vet bill was $2531, but Newlands said fortunately $2013 was covered by pet insurance. Newlands estimated Cameo had racked up almost $10,000 in vet bills since she had owned her because she was notorious for getting in fights with other cats and was grateful most of it had been covered by her pet insurance. Another pet owner also claimed on a hefty $8000 vet bill after their german shepherd cut its leg on a metal shoe rack as it tried to escape from two cats. The traumatic incident resulted in the dog having to undergo two surgeries and receive post operative care. In another case, a labrador retriever went under the knife to remove pieces of a blanket it had eaten from its stomach at a cost of $6000. Another owner commented that they were amazed that the chicken skewer eaten by their miniature poodle came out whole after being endoscopically removed. And a hungry beagle's desire to snaffle up a tasty fruit cake also backfired on it after the raisins caused it to have renal failure. The wee beagle had it's kidneys flushed at the vet. But the list of weird claims gets crazier after a french bulldog ate a whole roll dental floss it had found in a visitor's bag and a Shetland sheepdog had to be treated for munching on dish cloths on two separate occasions. The mischievous mutt managed to escape surgery and was given drugs to help it either poo or vomit the rags out. And it wasn't just playful pooches causing their owners angst, a domestic long haired cat also required surgery to remove a sewing needle it had swallowed and devon rex cat had 46 hair ties surgically removed from its stomach. Both treatments cost their owners more than $2000 each. Southern Cross Pet Insurance general manager Anthony McPhail said everyday, unexpected accidents could end up costing pet owners a lot of money at the veterinary clinic. McPhail said while most of the claims processed were for typical illnesses and routine checks, the ones where pets had managed to eat something they shouldn't have still surprised them. He said the stories could be amusing, but still caused quite a lot of stress to the pet and both its owner and their wallet. "We recommend owners prepare for those unexpected veterinary visits by either setting some money aside or considering pet insurance," McPhail said.
2021 07 27
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Citing Privacy Concerns, U.S. Panel Urges End to Secret DNA Testing
Citing Privacy Concerns, U.S. Panel Urges End to Secret DNA Testing
NEW YORK (Reuters) - They're called discreet DNA samples, and the Elk Grove, California, genetic-testing company easyDNA says it can handle many kinds, from toothpicks to tampons. Blood stains from bandages and tampons? Ship them in a paper envelope for paternity, ancestry or health testing. EasyDNA also welcomes cigarette butts (two to four), dental floss ("do not touch the floss with your fingers"), razor clippings, gum, toothpicks, licked stamps and used tissues if the more standard cheek swab or tube of saliva isn't obtainable. If the availability of such services seems like an invitation to mischief or worse - imagine a discarded tissue from a prospective employee being tested to determine whether she's at risk for an expensive disease, for instance - the Presidential Commission for the Study of Bioethical Issues agrees. On Thursday it released a report on privacy concerns triggered by the advent of whole genome sequencing, determining someone's complete DNA make-up. Although sequencing "holds enormous promise for human health and medicine," commission chairwoman Amy Gutmann told reporters on Wednesday, there is a "potential for misuse of this very personal data." "In many states someone can pick up your discarded coffee cup and send it for (DNA) testing," said Gutmann, who is the president of the University of Pennsylvania. "It's not a fantasy to think about how, without baseline privacy protection, people could use this in a way that would be really detrimental," such as by denying someone with a gene that raises their risk of Alzheimer's disease long-term care insurance, or to jack up life insurance premiums for someone with an elevated genetic risk of a deadly cancer that strikes people in middle age. "Those who are willing to share some of the most intimate information about themselves for the sake of medical progress should be assured appropriate confidentiality, for example, about any discovered genetic variations that link to increased likelihood of certain diseases, such as Alzheimer's, diabetes, heart disease and schizophrenia," Gutmann said. The commission took on the issue because whole genome sequencing is poised to become part of mainstream medical care, especially by personalizing medical treatments based on a patient's DNA. That has been driven in large part by dramatic cost reductions, from $2.5 billion per genome in the Human Genome Project of the 1990s and early 2000s to $1,000 soon. Several companies, including Illumina Inc. and Life Technology's Ion Torrent division, sell machines that can sequence a genome for a few hundred dollars, but that does not include the analysis to figure out what the string of 3 billion DNA "letters" means. A three-year-old federal law prohibits discrimination in employment or health insurance based on someone's genetic information but does not address other potential misuses of the data. Without such privacy protection, said Gutmann, people may be reluctant to participate in genetic studies that do whole genome sequencing, for fear their genetic data will not be secure and could be used against them. Recommendations from such panels are not binding but have been used as the basis for policy and legislation. One scenario the panel offers is a "contentious spouse" secretly having a DNA sample sequenced and using it in a custody battle "as evidence of unfitness to parent," perhaps because the DNA showed a genetic risk for mental illness or alcoholism. There are no federal laws against that. Or, the panel said, DNA information might be posted in a social networking site "by a malicious stranger or acquaintance," possibly hurting someone's "chance of finding a spouse, achieving standing in a community, or pursuing a desired career path." The bioethics panel recommends a dozen forms of privacy protection, including that "surreptitious commercial testing" be banned: No gene sequencing or other genetic testing should be permitted without consent from the person the DNA came from, it said. About 25 states currently allow such DNA testing. Critics of the lack of genetic privacy thought greater urgency was needed. "The report lays out a lot of important best practices and does endorse further state and federal regulations, but it doesn't offer a timeline," said Jeremy Gruber, president of the Council for Responsible Genetics, a private group that monitors genetic issues. "What will inevitably happen is whole genome sequencing will enter greater use and we won't have proper regulations to insure privacy." A bill introduced in California, home to many DNA testing companies, by state Senator Alex Padilla would ban surreptitious testing, requiring written authorization from the person the genetic sample was taken from. It is not clear how many labs are willing to analyze DNA without that authorization. In practice, well-known genetic testing companies such as privately held 23andMe test only saliva samples that are too large to acquire surreptitiously, such as from a drinking glass or licked stamp. "A person would really know that they are spitting into a tube," said 23andMe spokeswoman Jane Rubinstein. The full report from the presidential commission is at www.bioethics.gov.
2021 07 28
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