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    Nano- phases can be classifed as order lasix 100mg line, medicine is an application of nanotechnology which works in the feld of health and medicine proven 100mg lasix. Nano-medicine makes use of nano materials buy lasix 40 mg amex, • Te nano material is called single phase solids. In the future, nano medicine will amorphous particles and layers are included in this class. Te medical area of nano science • Matrix composites, coated particles are included in multi-phase application has many projected benefts and is potentially valuable for solids. Certain nano scale particles are used as tags and labels, Manufacturing Approaches biological can be performed quickly, the testing has become more Te two major approaches [2] to get nano materials are -one is the sensitive and more fexible. Gene sequencing has become more efcient bottom up and the other is top down approach. Enormous amount of information With the help of nanotechnology, damaged tissue can be reproduced could be stored in devices build from the bottom up. Advanced biosensors with novel features can be developed with the help of Carbon nano tubes. Tese biosensors can be used for Top manufacturing involves the construction of parts through astrobiology and can throw light on study origins of life. Tis technology methods such as cutting, carving and molding and due to our is also being used to develop sensors for cancer diagnostics. Medical use of Nano Materials Nano medicine is a relatively new feld of science and technology. By interacting with biological molecules at nano scale, nanotechnology broadens the feld of research and application. Interactions of nano devices with bio molecules can be understood both in the extracellular medium and inside the human cells. Operation at nano scale allows exploitation of physical properties diferent from those observed at micro scale such as the volume/surface ratio. Two forms of nano medicine that have already been tested in mice and are awaiting human trials; use of gold nano shells to help Figure 6: Nanotechnology applications in stem cell biology and medicine. Similarly, drug detoxifcation is also another application for nano medicine which has been used of stem cell research. Medical technologies can make use of smaller have been successfully used to isolate and group stem cells. Quantum devices are less invasive and can possibly be implanted inside the body, dots have been used for molecular imaging and tracing of stem cells, and their biochemical reaction times are much shorter. As compared for delivery of gene or drugs into stem cells, nano materials such as to typical drug delivery nano devices are faster and more sensitive [8]. Unique nanostructures were designed for controllable regulation Drug Delivery of proliferation and diferentiation of stem cells is done by designed unique nano structures. All these advances speed up the development In nanotechnology nano particles are used for site specifc drug of stem cells toward the application in regenerative medicine [3]. In this technique the required drug dose is used and side-efects recent applications of nanotechnology in stem cell research promises to are lowered signifcantly as the active agent is deposited in the morbid open new avenues in regenerative medicine. Tis highly selective approach can reduce costs and pain valuable tool to track and image stem cells, to drive their diferentiation to the patients. Tus variety of nano particles such as dendrimers, and into specifc cell lineage and ultimately to understand their biology. Micelles obtained from block will hopefully lead to stem cell-based therapeutics for the prevention, co-polymers, are used for drug encapsulation. Similarly, nano electromechanical systems are utilized for the active release of drugs. Iron nano particles Nano devices can be used in stem cell research in tracking or gold shells are fnding important application in the cancer treatment.

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    By the time the patient is in the hands of subspe- systems for thinking buy cheap lasix 100mg online, knowing buy generic lasix 100mg line, and information processing: cialists order 40 mg lasix with amex, most of the uncertainty is removed. Their characteristics are listed in say that complete assurance ever prevails; in some areas 9 13 Table 1, adapted from Hammond and Stanovich. The system is fast, asso- For the purposes of the present discussion, we can make ciative, inductive, frugal, and often primed by an affective a broad division of medicine into 2 categories: one that component. Importantly, our first reactions to any situation deals with most of the uncertainty about diagnosis (e. These settings, therefore, deserve the closest scru- 13 situation (Table 2), and providing further characterization tiny. To examine this further, we need to look at the deci- of System 1 decision making. It encompasses processes of emotional regulation and implicit Statement of Author Disclosures: Please see the Author Disclosures 15 learning. Automaticity High Low The essential characteristic of this “nonanalytic” reason- Rate Fast Slow ing is that it is a process of matching the new situation to 1 Reliability Low High 18 of many exemplars in memory, which are apparently Errors Normative Few but distribution significant retrievable rapidly and effortlessly. As a consequence, it Effort Low High may require no more mental effort for a clinician to recog- Predictive power Low High nize that the current patient is having a heart attack than it Emotional valence High Low is for a child to recognize that a dog is a four-legged beast. Detail on judgment Low High process This strategy of reasoning based on similarity to a prior Scientific rigor Low High learned example has been described extensively in the lit- Context High Low 19,20 erature on exemplar models of concept formation. Adapted from Concise Encyclopedia of Information Processing in Overall, although generally adaptive and often useful for Systems and Organizations,9 and The Robot’s Rebellion: Finding Meaning 21,22 our purposes, in some clinical situations, System 1 in the Age of Darwin. Thus, it may be that under certain conditions, despite a rational judgment having been reached ● Processing takes place beyond conscious awareness ● Parallel processing: each “hard-wired” module can using System 2, the decision maker defaults to System 1. Disposed to believe rather than take the skeptic position; therefore look to confirm rather than disconfirm like the hard-wired, parallel-processing capabilities of Sys- (the analytic system, in contrast, is able to undo tem 1, System 2 is a linear processor that follows explicit acceptance) computational rules. It corresponds to the software of the ● Higher cognitive (intellectual) ability appears to be brain, i. A series of studies have shown that “pure” System 1 and System 2 thinking are error prone; a combination of the 2 is closer to optimal. A simple repeated use of analytic (System 2) outputs can allow them example suffices: the first time a student answers the ques- 13 tion “what is 16 x 16? Thus, the effortless pattern recognition that characterizes compute slowly and methodically by long multiplication. If the clinical acumen of the expert physician is made possible the question is posed again soon after, the student recog- by accretion of a vast experience (the repetitive use of a nizes the solution and volunteers the answer quickly and System 2 analytic approach) that eventually allows the pro- accurately (assuming it was done correctly the first time) 16,17 cess to devolve to an automatic level. Therefore, it is important for S26 The American Journal of Medicine, Vol 121 (5A), May 2008 decision makers to be aware of which system they are using tions and conclusions they have reached, rather than take a and its overall appropriateness to the situation. This is referred to as con- use this mode, for example, to put a man on the moon; only 36 firmation bias, which is one of the most powerful of the System 2 would have worked. Not surprisingly, it takes far more mental analytical System 2 approach in an emergent situation, effort to contemplate disconfirmation (the clinician can only where rapid decision making is called for, may be paradox- be confident that something isn’t disease A by considering 16 ically irrational. In this situation, the rapid cognitive style all the other things it might be) than confirmation. Harken- 25 known popularly as “thin-slicing” that characterizes Sys- ing back to the self-assessment literature, one can only tem 1 might be more expedient and appropriate. Recent assess how much one knows by accurately assessing how studies suggest that making unconscious snap decisions 37 much one doesn’t know, and as Frank Keil says, “How (deliberation-without-attention effect) can outperform more 26,27 can I know what I don’t know when I don’t know what I deliberate “rational” thinking in certain situations. People’s judgments level, their output, once seen, can be consciously modulated were better calibrated (there was less overconfidence) when by adding a System 2 approach. Engagement of System 2 28 they were obliged to take account of disconfirming evi- may occur when it “catches” an error in System 1. This consider-the- Overconfident judgment by clinicians is 1 example of many opposite strategy appears to be one of the more effective cognitive biases that may influence reasoning and medical debiasing strategies.

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    Over many years lasix 40mg, there is increase in mesangial matrix caus- Membranous glomerulonephritis ing hyalinization of glomeruli and loss of nephrons order lasix 100mg overnight delivery. Definition Clinical features This is the one of the two most common causes of Patients may present with asymptomatic proteinuria discount 40 mg lasix visa, nephrotic syndrome in non-diabetic adults (together or (in most cases) nephrotic syndrome. The idiopathic form causes ∼20% usually with mild to moderate mesangial proliferation. Silver stains classically show ‘spikes’ where basement membrane has grown between subepithelial deposits. Alternatively large plasma proteins may leak through the capillary wall, accumulate in the subendothelial space and compress the capillary Prognosis lumen. Some patients develop a rapidly progressive course loss of the function of that nephron. These may develop later in the course of drome in adults and the second most common cause the illness. Incidence/prevalence Causes ∼20% of cases of nephrotic syndrome in adults Macroscopy/microscopy and children. Increase in the mesangial matrix in glomeruli in a focal segmental pattern, with collapse of the adjacent capillary loop. It is thought to be part first, the disease may be missed on renal biopsy (and of a physiological response to glomerular hyperfiltra- hence a diagnosis of minimal change disease made). Steroid resistant cases action to the drug, with lymphocytes and eosinophils may respond to ciclosporin, and steroid-dependent infiltrating the interstitium causing tissue oedema. The cases may benefit from the addition of ciclosporin or tubular epithelium undergoes acute necrosis. High Patients with marked proteinuria, tubular atrophy, in- dose steroids may be given. Chronic renal failure may progress to end-stage renal disease and re- Acute Chronic quire renal replacement therapy. See also Renal Tubu- depletion, polyuria and immunodeficiency secondary lar Acidosis (see below). Water and r Phosphate transport defects: There are several types, anions such as aminoacids follow sodium. Osmotic di- usually X-linked, although occasional sporadic inher- uretics and carbonic anhydrase inhibitors act at this site. Treatment is with oral phosphate supple- condition characterised by glycosuria with normal ments with vitamin D or 1,25 dihydroxyvitamin D blood glucose. Thick ascending loop of Henle: Sodium is pumped Glycosuria is a normal response during pregnancy. The most important single defect is cystinuria, an concentration gradient within the medulla of the kid- autosomal recessive condition which predisposes to ney, which draws water out of the collecting duct and urinary stone formation (see page 270). Loop diuretics such as with high fluid intake and alkali ingestion, because the furosemide act from within the lumen of the ascending cystine is more soluble in alkaline conditions. There may be potassium results in high urinary sodium loss, dehydration, Chapter 6: Disorders of the kidney 253 secondary hyperaldosteronism and hypokalaemic dioxide). Even when bicarbonate levels fall to as low This results in a similar syndrome of sodium loss, de- as 10 mmol/L or below, the urine remains relatively hydration and hypercalciuria as Bartter type I; how- alkaline (pH ≥ 5. If untreated, persistent metabolic ever, hypokalaemia only occurs after treatment with acidosis leads to increased mobilisation of calcium sodium supplements. Once 3 collecting duct resulting in a hypokalaemic metabolic plasma bicarbonate levels fall to about 12–16 mmol/L, alkalosis. This The main problems occur due to the loss of other is under the influence of aldosterone which increases substances such as amino acids and phosphate.

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    You should question any decision or action that you consider d keep up to date with relevant guidance might be unsafe lasix 40mg fast delivery. You should explain incidents and near misses involving medicines the use of unlicensed medicines buy 100 mg lasix mastercard, and departures and devices can allow performance and systems from authoritative guidance or recommended issues to be investigated purchase 100mg lasix amex, problems rectifed treatments and provide both the general and lessons learned. This does manufacturers of relevant adverse drug not relieve you of your duty to ensure that reactions and patient safety incidents. You should consider and take 50 You should respond to requests from the Drug appropriate action on information and advice Safety Research Unit for prescription-event from pharmacists and other healthcare monitoring data and information for studies on professionals who have reviewed patients’ use specifc safety or pharmacovigilance issues. In Northern Ireland they should be reported to Northern Ireland Adverse Incident Centre; and in Scotland to Health Facilities Scotland online incident reporting. Good practice in prescribing and managing medicines and devices Repeat prescribing and prescribing e patients who need further examination or with repeats assessment are reviewed by an appropriate healthcare professional 55 You are responsible for any prescription you sign, including repeat prescriptions for medicines f any changes to the patient’s medicines are initiated by colleagues, so you must make sure critically reviewed and quickly incorporated that any repeat prescription you sign is safe and into their record. You should consider the benefts of prescribing with repeats to reduce the need for 58 At each review, you should confrm that the repeat prescribing. This may be particularly the patient what medicines are appropriate and important following a hospital stay, or changes how their condition will be managed, including to medicines following a hospital or home visit. You should make clear why You should also consider whether requests for regular reviews are important and explain to the repeat prescriptions received earlier or later than patient what they should do if they: expected may indicate poor adherence, leading to inadequate therapy or adverse effects. You should keep a record of dispensers You must make clear records of these discussions who hold original repeat dispensing prescriptions and your reasons for repeat prescribing. You must consider: d only staff who are competent to do so prepare repeat prescriptions for authorisation a the limitations of the medium through which you are communicating with the patient 23 See Saving time, helping patients: A good practice guide to quality repeat prescribing (2004), Dispensing with repeats: a practical guide to repeat dispensing (2008) and service improvement guides and other resources available at www. You should make sure that any instructions, for example Prescribing unlicensed medicines for administration or monitoring the patient’s 67 The term ‘unlicensed medicine’ is used to condition, are understood and send written describe medicines that are used outside the confrmation as soon as possible. They are also used, less frequently, in other previously provided them with face-to-face care, areas of medicine. Examples include medicines to the public by prescribing via (but are not limited to), for example, where:26 websites that breach advertising regulations. Good practice in prescribing and managing medicines and devices i there is no licensed medicine applicable c make a clear, accurate and legible record of to the particular patient. For example, all medicines prescribed and, where you are if the patient is a child and a medicine not following common practice, your reasons licensed only for adult patients would for prescribing an unlicensed medicine. In emergencies or where medicine would not meet the patient’s there is no realistic alternative treatment and need; or such information is likely to cause distress, it may not be practical or necessary to draw iv the patient needs a medicine in a attention to the licence. In other cases, where formulation that is not specifed in prescribing unlicensed medicines is supported an applicable licence. This may arise where, for example, questions from patients (or their parents or there is a temporary shortage in supply; or carers) about medicines fully and honestly. This does not preclude the provision of made for another suitable doctor to do so any care or treatment where your intention is to 27 The Medicines for Children leafets on unlicensed medicines produced protect or improve the patient’s health. The British Pain Society publishes Using medicines beyond licence: Information for patients. The manuscript of The Death of Humane Medicine was completed a few days before his death. Born in Czechoslovakia he acquired a doctorate from Charles University and worked as a forensic toxicologist. He had almost finished his medical studies when in 1968, whilst he and his wife, Vera, were in Ireland, the Russians entered Prague. They decided to remain in Ireland and Petr enrolled in the College of Surgeons medical school and qualified at the Society of Apothecaries.

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