Cerebral palsy (CP)

Stem Cell Treatment for Cerebral Palsy

What is cerebral palsy or CP?
Cerebral palsy is usually associated with events that occur before (in utero) or during birth, (congenital) but may be acquired during the first few months (infancy) or years of life (childhood to adult) as the result of head trauma (injury to the head) or infection (pathogenic microorganisms invade and cause infection).

Cerebral palsy means "brain paralysis". It causes fault development and damage motor areas in the brain, which result in a number of chronic neurological disorders. The symptoms of cerebral palsy (CP) differ from person to person and evolve or alter as children and the nervous system matures in children. The severity of the symptoms is related to the severity of the brain damage.

Common Symptoms

Symptoms of cerebral palsy can be as simple as having difficulty with fine motor tasks like writing or using scissors, or as profound as being unable to maintain balance or walk. Other common symptoms are speech problems, vision problems, and different levels of paralysis of the limbs.

Severely afflicted patients may have involuntary movements, such as uncontrollable hand motions and drooling. Others suffer from associated medical disorders, such as seizures and mental retardation.

Source: http://www.stemcellspuhua.com/contact.shtml

External links:
http://imeu.org/article/maysoon-zayid-actor-and-comedian
http://harpercollins.co.in/Arun Shourie's book about his son Aditya
http://en.wikipedia.org/wiki/Evan_O'Hanlon
http://en.wikipedia.org/wiki/RJ_Mitte
http://www.independent.co.uk/francesca-martinez-a-wobbly-girl
https://www.greatwomenspeakers.com/speakers/geri-jewell
http://www.cbsnews.com/news/Abbey Curran pageant-is-her-crowning-achievement/
http://en.wikipedia.org/wiki/Jack_Carroll_(comedian)
http://en.wikipedia.org/wiki/Josh_Blue

King Hussein Cancer Foundation (KHCF)

Jordan

http://www.khcf.jo/showcontent.aspx?ContentId=217

Renal Replacement Therapy

When renal failure is severe, and about 90% of renal function is lost, a patient requires a form of renal replacement therapy to survive: a renal transplant or dialysis.

Serum creatinine is frequently used to monitor renal function.

Table 1 lists the serum creatinine values and clearance rates that correspond to diagnoses of mild, moderate, and severe renal failure.

External links:

Creatinine and Creatinine Clearance
http://www.venofer.com/VenoferHCP/Venofer_kidneyFunction.html

Patients' comments on their Blood Creatinine Test Results (KAP of kidneys patients)
KAP = knowledge, attitude and practice
https://comments.medicinenet.com/creatinine_blood_test/patient-comments-1064.htm

Kidneys

First posted online on 4 January 2010

Updated online on 24 January 2019

Kidney disease can take a long time to develop and suddenly show an acute crisis when conditions are severe.

Chronic kidney disease (CKD) occurs in otherwise apparently healthy-looking individuals. It is sometimes at a clinic appointment for hypertension that such a CKD patient is picked up for Acute Kidney Injury (AKI) with mild to severe hydronephrosis. 

Investigations are BUSE (blood urea, serum electrolytes) or RFT (renal function test - Na+, K+, urea, creatinine, Cl-, PO43-), VBG (venous blood gas), FBC (full blood count, HbA1c, Hb), sputum C&S, urine C&S, etc. TRO TB, tumour, cancer, etc. BUSE is done 2x a day initially and then once daily.

The renal system comprises the 2 kidneys, the 2 ureters, a urinary bladder and the urethra.

Normal kidney structure is available from online image libraries.

Imaging techniques to view the kidneys are:

1. Ultrasound (Ultrasound KUB) and 
2. CT scan (CT scan KUB). KUB = Kidney, Ureters, Bladder.
3. CT Urology

A Toshiba Prime Aquilion CT scanner
(each unit is approx. RM640k)
HUSM has 2 CT scanners, the other unit is a Siemens.

In CT scan, contrast media is used to view better details. A base scan is first performed and then an iodine contrast media injected intravenously (pink cap line) and images captured for viewing. The blue cap is used for children and is not appropriate for use in CT scan with contrast media in adults.

After the CT scan and use of contrast media, the patient needs to take AEN for 3 days (2 tablets per day). This is a smelly tablet and smells of scrap rubber or burnt Japanese slippers. When dissolved in some water, it forms an orange-flavoured fizzy drink.

Pink cap

Smelly tablets dissolving in water.
Stenac Effervescent Tablets, 600 mg
(Acetylcysteine 600mg)
Reg. No. : MAL09011475X
Synmosa Biopharma Corporation 

In CT Urology, phase contrast will show how urine is filtered by the various sections of the kidney. It will provide evidence as to where a blockage is located, if any.

A blockage in the renal system may not necessarily arise from a renal stone but a soft tissue mass which grows around the ureters, thus constricting the ureters and causing urine to flow back into the kidneys, and over a long time. causing hydronephrosis of the kidneys and ureters. The kidneys appear inflammed and smaller then normal size, while the ureters have a thick proximal or distal surrounding soft tissue mass, covering at least 3 cm to 4 cm of the 25 cm normal length of the ureters. These tissue masses surrounding the ureters can be visualised on CT scan.

Hydronephrosis can be detected by ultrasound and CT scan.

Hydronephrosis is an inflammed condition of the kidney. The central region of the kidney is filled with urine for long periods, and the kidney becomes damaged in this process. As more regions of the kidney is inflammed and affected by hydronephrosis, kidney function begins to go down. The kidney can barely cope to secrete waste products in urine even though it may still produce sufficient urine.

The kidney is an encapsulated organ. The renal capsule is normally thin. However, in hydronephrosis, the renal capsule can be thicker than normal. The cause of this thickening is unknown.

Both ultrasound and CT scan will show hydronephrosis and hydroureter(s). In hydroureter, the ureter may be affected proximally, leaving the remainder of the ureter normal (unaffected).

Hydronephrosis of both kidneys plus hydronephrosis of the promixal right ureter may not give any renal colic, back pain or flank pain. So it is difficult to rapidly pick up patient with CKD, AKI and hydronephrosis at a hypertension clinic.

Whether upper respiratory tract infection (URTI) or the common sore throat will affect kidneys and renal function remains unknown. But in susceptible individuals, frequent sore throats may affect the kidneys and lead to hydronephrosis in the long run.

So a history of common colds, severe flu and URTI with and without renal involvement should be looked into for possible causes of CKD, AKI and hydronephrosis in individuals who have hypertension and are on long term anti-hypertensive treatment (eg Twynsta or Amlodipine alone).

Elective surgery to place a ureteral stent in a thickened pelvic junction may not be a good thing if urine output is not affected. The stent may not be able to correct the high urea and creatinine levels in hypertensive individuals who have URTI and AKI with hydronephrosis.

Such patients may first show increasing urea and creatinine levels, which suddenly jump to high levels, mimicking uremia and creatininemia, which are toxic to brain, liver and heart. This condition is worsened by high potassium levels (hyperkalemia). Venous blood gas (VBG) will show Metabolic Acidosis.

Severe dehydration will give a dry wrinkled skin in the elderly. This is corrected by intravenous saline drip and adequate fluid intake (eg 1 litre water intake + 2 litres drip and 3 litres urine output). One week is sufficient for rehydration and continuing for another week minus iv drip works fine. In the second week, water intake can be increased to 2 litres (minus iv saline drip) and urine output 2 litres. Monitoring input and output for 1-2 weeks is fine.

Re-purposed saline bottle, graduated, to collect urine

Metabolic acidosis is treated with a cocktail (one by one) dextrose, lactate and actimed? Calcium carbonate tablet (500mg) is taken orally.

Hyperkalemia is treated with Kalimate (calcium polystyrene  sulfonate, 5g per sachet; Japan). 3 sachets of total 15g white powder is mixed in little water and consumed.

Kalimate, 5g per sachet

URTI is treated with iv Augmentin, and then continued with oral intake for 1 week.

Anemia develops in CKD, AKI and hydronephrosis as the kidney fails to produce erythropoietin (EPO) which is needed for erythropoiesis. Iron supplement (ferrous fumarate, 200mg x 2 tablets) will help to overcome anemia. Reduce to 1 tablet and alternate days as needed. Obimin is a better alternative for some elderly women.

Folate is needed for rbc.

Amlodipine (5 or 10 mg) can be switched wtih Felodipine (5 or 10 mg) as appropriate and then switched back if headaches develop while on Felodipine. Amlodipine (5 mg) usually works fine in patients who have taken Twynsta for a long time.

Loratadine is only needed temporarily for 1-2 days to reduce runny nose in URTI.

Vit C?

Vit B?

External links:

Renal ultrasound - Hydronephrosis
https://youtu.be/N750NAEmEso

Radiology Assistant
http://www.radiologyassistant.nl/en/p5a3056eebe646/normal-values-ultrasound.html

Distal Renal Tubular Acidosis (distal RTA)
https://www.ncbi.nlm.nih.gov/m/pubmed/6807085/?i=5&from=/8558697/related

Hydronephrosis
https://en.m.wikipedia.org/wiki/Hydronephrosis
https://www.kidney.org/atoz/content/hydronephrosis

Low Purine Diet
https://www.healthline.com/health/tips-for-following-low-purine-diet#1

Anemia and Chronic Kidney Disease
https://www.kidney.org/atoz/content/what_anemia_ckd

Ureteral Stenting
https://www.radiologyinfo.org/en/info.cfm?pg=ureteralNephro
https://www.mskcc.org/cancer-care/patient-education/ureteral-stent-placement

Patients' comments about Kidney Pain
https://comments.medicinenet.com/kidney_pain/patient-comments-4627.htm

Dialysis

Dialysis is a mechanical process that performs the work of healthy kidneys. In a clinical context Dialysis is a method for removing waste such as urea from the blood when the kidneys can no longer do the job.

Before dialysis can begin, the doctor has to create a dialysis access. In hemodialysis, the access is the place where the dialysis needles are inserted, to carry the blood to and from the dialysis machine. For the best access, the doctor builds a connection, called a fistula, between an artery and a vein in the forearm. Or the doctor uses a tube called a graft to connect the artery and a vein. Sometimes a plastic tube (central venous catheter) is placed in the neck.

The two types of dialysis are: hemodialysis and peritoneal dialysis.

Hemodialysis and peritoneal dialysis may be used to treat people with diabetes who have kidney failure. It works by having the blood flow along one side of a semi-permeable membrane, with the dialysis solution (usually a highly concentrated saline) flowing along the other side. Due to the difference in osmolarity between the two liquids, water traverses the membrane in order to dilute the dialysis liquid, carrying along the unwanted blood contents.

Hemodialysis

Hemodialysis uses a man-made membrane (dialyzer) to remove wastes and extra fluid from the blood. It also restores the proper balance of certain minerals in the blood (electrolytes). The fluid used to filter or clean the blood is called dialysate. Hemodialysis is usually done in a hospital or dialysis center.
In hemodialysis, the patient's blood is passed through a tube into a machine that filters out waste products. The cleansed blood is then returned to the body.

Peritoneal dialysis

In peritoneal dialysis, a special solution is run through a tube into the peritoneum, a thin tissue that lines the cavity of the abdomen. The body's waste products are removed through the tube.

There are three types of peritoneal dialysis:

• Continuous ambulatory peritoneal dialysis (CAPD), the most common type, needs no machine and can be done at home.
• Continuous cyclic peritoneal dialysis (CCPD) uses a machine and is usually performed at night when the person is sleeping.
• Intermittent peritoneal dialysis (IPD) uses the same type of machine as CCPD, but is usually done in the hospital because treatment takes longer.

External links:
http://www.doctorslounge.com/nephrology/procedures/dialysis.htm
http://myhealth.ucsd.edu/library/healthguide/en-us/support/topic.asp?hwid=zm2610
http://www.renalpatients.co.uk/capd.htm

Metabolic Syndrome (MS)

Metabolic syndrome is a term we apply to anyone having 3 of the following 5 criteria: 

• abdominal obesity,
• elevated triglyceride levels, 
• low HDL cholesterol (also known as "good cholesterol") levels, 
• high blood pressure, or 
• high blood glucose after fasting.

NCI

The National Cancer Institute-supported Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial is designed to show whether the use of certain screening tests can reduce the number of deaths caused by those cancers.

Oncology lab tests

• Alpha fetoprotein

• Beta- HCG

• CA 125

• CA 15-3

• CA 19-9

• CA 27-29

• CEA

• NSE

• PSA

http://www.doctorslounge.com/oncology/labs/index.htm

PSA

Prostate-specific antigen (PSA)

Prostate-specific antigen (PSA) is present in low concentrations in the blood of all adult males. It is produced by both normal and abnormal prostate cells. Elevated PSA levels may be found in the blood of men with benign prostate conditions, such as prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH), or with a malignant (cancerous) growth in the prostate. While PSA does not allow doctors to distinguish between benign prostate conditions (which are very common in older men) and cancer, an elevated PSA level may indicate that other tests are necessary to determine whether cancer is present.

PSA levels have been shown to be useful in monitoring the effectiveness of prostate cancer treatment, and in checking for recurrence after treatment has ended. In checking for recurrence, a single test may show a mildly elevated PSA level, which may not be a significant change. Doctors generally look for trends, such as steadily increasing PSA levels in multiple tests over time, rather than focusing on a single elevated result.

Researchers are studying the value of PSA in screening men for prostate cancer (checking for the disease in men who have no symptoms). At this time, it is not known whether using PSA to screen for prostate cancer actually saves lives. For prostate cancer, this NCI-based trial is looking at the usefulness of regular screening using digital rectal exams and PSA level checks in men ages 55 to 74.

Researchers are also working on new ways to increase the accuracy of PSA tests. Improving the accuracy of PSA tests could help doctors distinguish BPH from prostate cancer, and thereby avoid unnecessary follow up procedures, including biopsies.

Prostate cancer is the second-leading cancer killer of men, killing 221,000 every year globally, with 679,000 new cases diagnosed. It is easily cured in early stages with surgery or radiation. For prostate cancer that has spread, drugs that interfere with cancer-fueling hormones are prescribed.

In the United States, adding radiation therapy is already standard, said Dr. Howard Sandler, chair of Radiation Oncology at Cedars-Sinai Medical Center in Los Angeles and a spokesman for the American Society of Clinical Oncology.

http://www.doctorslounge.com/oncology/labs/psa.htm

CEA

Carcinoembryonic Antigen (CEA)

Carcinoembryonic antigen (CEA) is normally found in small amounts in the blood of most healthy people, but may become elevated in people who have cancer or some benign conditions. The primary use of CEA is in monitoring colorectal cancer, especially when the disease has spread (metastasized). CEA is also used after treatment to check for recurrence of colorectal cancer. However, a wide variety of other cancers can produce elevated levels of this tumor marker, including melanoma; lymphoma; and cancers of the breast, lung, pancreas, stomach, cervix, bladder, kidney, thyroid, liver, and ovary.
Elevated CEA levels can also occur in patients with noncancerous conditions, including inflammatory bowel disease, pancreatitis, and liver disease. Tobacco use can also contribute to higher-than-normal levels of CEA.

http://www.doctorslounge.com/oncology/labs/cea.htm
http://www.onemedplace.com/blog/archives/609

CA 125

CA 125 is produced by a variety of cells, but particularly by ovarian cancer cells. Studies have shown that many women with ovarian cancer have elevated CA 125 levels. CA 125 is used primarily in the management of treatment for ovarian cancer. In women with ovarian cancer being treated with chemotherapy, a falling CA 125 level generally indicates that the cancer is responding to treatment. Increasing CA 125 levels during or after treatment, on the other hand, may suggest that the cancer is not responding to therapy or that some cancer cells remain in the body. Doctors may also use CA 125 levels to monitor patients for recurrence of ovarian cancer.
Not all women with elevated CA 125 levels have ovarian cancer. CA 125 levels may also be elevated by cancers of the uterus, cervix, pancreas, liver, colon, breast, lung, and digestive tract. Noncancerous conditions that can cause elevated CA 125 levels include endometriosis, pelvic inflammatory disease, peritonitis, pancreatitis, liver disease, and any condition that inflames the pleura (the tissue that surrounds the lungs and lines the chest cavity). Menstruation and pregnancy can also cause an increase in CA 125.

http://www.doctorslounge.com/oncology/labs/ca125.htm
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9627.htm

Lab tests

• A1C (Glycated hemoglobin)
• Albumin
• Alfa feto protein
• ALT
• Beta- HCG
• Bilirubin
• CA 125
• CA 15-3
• CA 19-9
• CA 27-29
• CEA
• Complete blood count
• Coomb's test
• C-reactive protein
• Creatine kinase
• Creatinine
• ESR
• Glucose (blood)
• Glucose tolerance test
• Hematocrit
• Hemoglobin
• Hepatitis B
• INR (International normalization ratio)
• LDH
• NSE
• Pregnancy test
• PSA
• Thyroid function tests
• Troponin
• Urea
  
  
  http://www.doctorslounge.com/primary/labs/list.htm

Urinalysis

Urinanalysis

Normal Ranges

Specific gravity

Normal range: 1.003-1.029

pH

Normal range: 4.5-7.8

Protein

Normal range: Negative / trace (in concentrated urine)

Glucose

Normal range: Negative

Ketones

Normal range: Negative

http://www.doctorslounge.com/urology/labs/urine_analysis.htm

Creatinine

Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). 

Creatinine in blood is filtered by the kidneys for excretion in urine. If the filtering mechanism of the kidney is deficient, clearance of blood creatinine is affected, and blood creatinine levels rise. 

Doctors accept that high blood creatinine levels is an indicator of poor renal function in patients. However, this should be interpreted based on the patient's background and daily activities. Blood creatinine is not the sole marker of renal function. Muscular persons who do physical activities or workouts tend to have higher blood creatinine than less muscular persons who do activities and workouts.

There are lab tests, calculations and imaging investigations for determining renal function (function of the kidneys).

1. Blood creatinine
2. Creatinine clearance (calculated, need both blood & urine creatinine values)
3. Creatinine clearance (calculated based on age and blood creatinine)
4. Urea
5. Urea/Creatinine ratio
6. Cystatin C
7. Renal Function Tets (RFT) (routine panel of blood tests: sodium, potassium, chloride, phosphate, urea and creatinine)
8. Ultrasound of the kidneys, ureters and urinary bladder (KUB)
9. CT Scan 
10. CT Urography

Measuring serum creatinine is a simple test and it is the most commonly used indicator of renal function. 

It should be remembered that rise in blood creatinine levels is observed only with marked damage to functioning nephrons; therefore this test is not suitable for detecting early kidney disease. 

A better estimation of kidney function is given by the creatinine clearance test, which, however, is less convenient and unsuitable as a screening test because it requires the collection of urine over 24 hours (24-hour urine).

Reference range and interpretation

• The reference range for creatinine is 50 to 110 μmol/L (0.8 - 1.4 mg/dl). 
• Men tend to have higher levels of creatinine because they have more skeletal muscle than women. 
• Serum creatinine is not affected by diet or activity level.

External links

Creatinine

http://www.doctorslounge.com/nephrology/labs/creatinine.htm

Urea, Creatinine and Urea/Creatinine Ratio

https://acutecaretesting.org/en/articles/urea-and-creatinine-concentration-the-urea-creatinine-ratio

DoctorsLounge

Doctors Lounge - Nephrology Answers

"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
http://www.doctorslounge.com/nephrology/forums/backup/topic-6481.html

MedEdWorld

Medical Education

Welcome to MedEdWorld

an international network through which organisations, medical schools and individual teachers can share ideas, experiences and expertise and collaborate in the further development of medical education

http://www.mededworld.org/

Destination Doctor

Yahoo Group

This is a medical discussion forum moderated by Dr Mazlyn Mustapha, Dept of Physiology, School of Medical Sciences, USM (mazlynm@yahoo.co.uk).