pirimlikbilgi

  Glucagon-like peptide-2 analogue  —  We reserve the use of teduglutide to patients with SBS who are unable to be weaned from parenteral nutrition despite aggressive use of the more conventional measures, particularly in those SBS patients who have developed significant complications or describe severe impairment in quality of life related to parenteral nutrition use (eg, loss of vascular access sites, recurrent catheter-related bloodstream infections, and liver disease). Teduglutide is a long-acting GLP-2 analogue. GLP-2, an enteroendocrine peptide released in response of luminal nutrients, initiates and maintains small bowel adaptive responses to resection and improves nutrient absorption . Teduglutide is available in the United States and Europe for adult and pediatric SBS patients as a long-term aid to parenteral nutrition weaning. The duration of its use will vary depending upon its effectiveness and tolerance but is generally administered for at least ...

 GLP-1 : GLP-1 exerts its main effect by stimulating glucose-dependent insulin release from the pancreatic islets . It has also been shown to slow gastric emptying , inhibit inappropriate post-meal glucagon release , and reduce food intake  GLP-1 exhibits a short half-life of one to two minutes due to N-terminal degradation by the enzyme dipeptidyl peptidase 4 (DPP-4). Synthetic GLP-1 receptor agonists are variably resistant to degradation by the enzyme DPP-4, and therefore have a longer half-life, facilitating clinical use.   GIP :  In the postprandial state, GIP is cosecreted with GLP-1, and they appear to interact in an additive fashion to potentiate glucose-induced insulin secretion . However, GIP exhibits different effects than GLP-1 on glucagon secretion. In the euglycemic or hypoglycemic states, GIP enhances glucagon activity     Combination with oral agents – GLP-1 receptor agonists can be combined with metformin and most oth...

     

    Koagülasyon sisteminin aktive olmasına karşın, genelde trombozlar sıkça görülmez ancak kanser, travma ve bazı obstetrik nedenler bu kuralın dışında kalır. Trombozların büyük bir çoğun- luğu venöz tromboz şeklindedir ancak arteryel tromboz ve non-bakteryel trombotik endokardit (marantik endokardit) de görülebilir (8). Purpura fulminans DİK’nin en şiddetli formu olup primer ve sekonder olmak üzere iki bölüme ayrılır (9,10). Primer purpura fulminans genelde viral enfeksi- yonlardan sonra görülmekte ve kendini başlangıçta ekstremitelerde ağrılı kırmızı lekeler şeklinde göstermekte ancak kısa bir süre içersinde bunlar siyah-mor iskemik lezyonlara dönüşmektedir  Dissemine intravasküler koagülasyonda en sık görülen kanama tipi, peteşi ve purpuralardır ancak mukozal kanamalar, yara yerlerinden kanama, intravenöz kateterlerin etrafından kanamalar da görülebilir. Şiddetli olgularda; gastrointestinal sistemden, akciğerlerden ve SSS’de olan kanamalar hayatı olumsuz yönde etkileye...

  CBD: common bile duct; ERCP: endoscopic retrograde cholangiopancreatogram; EUS: endoscopic ultrasound; IOC: intraoperative cholangiogram; IOU: intraoperative ultrasonography; MRCP: magnetic resonance cholangiopancreatogram. * A common bile duct measuring more than 6 mm in a patient with a gallbladder in situ and more than 8 mm in those that have had a cholecystectomy. Δ If no stone is visualized on MRCP but suspicion for a CBD stone remains moderate to high (eg, in a patient whose laboratory tests are not improving), EUS is an appropriate next step. ◊ Decision is based on available expertise.

  Bikarbonat Açığı :   If the bicarbonate distribution space could be determined, then the quantity of bicarbonate required to elevate the serum bicarbonate concentration by any given amount can be estimated from the bicarbonate deficit:  HCO 3  deficit  =  HCO 3  space  x  HCO 3  deficit per liter When the serum bicarbonate concentration is normal or only moderately reduced, the apparent bicarbonate space is approximately 55 percent of lean body weight. Thus, in a healthy 70 kg individual, the infusion of one vial of 8.4 percent sodyum bikarbonat  will raise the serum bicarbonate concentration by approximately 1.5 mEq/L. However, for a number of complex reasons related to the body's bicarbonate buffering mechanisms, and because the bicarbonate-carbon dioxide acid-base pair is an "open" system (ie, carbon dioxide can be added or removed in great quantities through ventilation), the bicarbonate space is not fixed; rather, i...

  Lökositi azaltılmış eritrosit süspansiyonları: Eritrosit süspansiyonları içerisinde bulunan lökositlere bağlı olarak febril komplikasyonlar, alloimmünizasyon, akciğer hasarı (TRALI) ve sitomegalovirus infeksiyonu geçişi gibi komplikasyonlar gelişebilir. Bu amaçla lökosit sayısının ürün içerisinde azaltılması için değişik yöntemler kullanılmaktadır. Ciddi ve tekrarlayan febril nonhemolitik reaksiyonu olan hastalar lökositten fakir kan ürünleri almalıdırlar Alloimmünize olma olasılığı yüksek olan hastalar (örneğin uzun süreli ve sık transfüzyon gereksinimi olanlar) profilaktik olarak lökositten fakir kan ürünü kulanımına adaydırlar. Alloimmünizasyonu önlemek amacıyla profilaktik olarak lökositten fakir kan ürünü kullanma kararı ilk kan transfüzyonu yapılmadan önce verilmelidir. İmmün sistemi baskılanmış (örneğin kök hücre transplantasyon alıcıları ve premature yenidoğanlar) CMV seronegatif hastalarda transfüzyona sekonder ciddi CMV hastalığı gelişme riski daha yüksektir.  L...

  Renal Tübüler Asidoz (RTA) Distal (Tip 1 ) RTA : – For adult patients with a serum bicarbonate <16 mEq/L, a reasonable starting dose is 30 mEq of bicarbonate or citrate (which is a bicarbonate precursor) four times daily (120 mEq total per day). If the initial serum bicarbonate is >16 mEq/L, a reasonable starting dose is 40 mEq of bicarbonate or citrate twice daily (80 mEq total per day). There are multiple options for attaining this dose of alkali therapy . The serum bicarbonate should be measured at approximately one week. The dose can then be titrated up or down depending upon the initial response, rechecking the bicarbonate at weekly intervals until a maintenance dose is attained (with a goal serum bicarbonate concentration of 22 to 24 mEq/L). This maintenance dose of bicarbonate (or citrate) is generally between 30 and 50 mEq twice daily. Proksimal (Tip 2) RTA : Management Patients with Fanconi syndrome — Treatment of the metabolic acidosis is more ...

    A kut metabolik asidoz — We initiate bicarbonate therapy when acute metabolic acidosis has generated severe acidemia (ie, pH less than 7.1 ). We also generally suggest bicarbonate therapy for patients with less severe acidemia (eg, pH 7.1 to 7.2 ) who have severe acute kidney injury (ie, a twofold or greater increase in serum creatinine or oliguria); bicarbonate therapy in such patients can potentially prevent the need for dialysis and may improve survival  . * Rapid infusions of sodyum bikarbonat may increase the partial pressure of carbon dioxide ( PCO 2 ), lower the ionized calcium , expand the extracellular space, and raise the serum sodium concentration. Ayrıca , paradoxical fall in intracellular pH, increased lactate production, and myocardial depression olabilir . Thus, many clinicians initiate treatment of metabolic acidosis when the bicarbonate level is very low (eg, <5 mEq /L) and the pH is below 7.1 . We do not generally us...