Breast Cancer

What Is Breast Cancer?

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Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Where breast cancer starts?

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Breast cancers can start from different parts of the breast. The breast is an organ that sits on top of the upper ribs and chest muscles. There is a left and right breast and each one has mainly glands, ducts, and fatty tissue. In women, the breast makes and delivers milk to feed newborns and infants. The amount of fatty tissue in the breast determines the size of each breast.

The breast has different parts:

• Lobules are the glands that make breast milk. Cancers that start here are called lobular cancers.
• Ducts are small canals that come out from the lobules and carry the milk to the nipple. This is the most common place for breast cancer to start. Cancers that start here are called ductal cancers.
• The nipple is the opening in the skin of the breast where the ducts come together and turn into larger ducts so the milk can leave the breast. The nipple is surrounded by slightly darker thicker skin called the areola. A less common type of breast cancer called Paget disease of the breast can start in the nipple.
• The fat and connective tissue (stroma) surround the ducts and lobules and help keep them in place. A less common type of breast cancer called phyllodes tumor can start in the stroma.
• Blood vessels and lymph vessels are also found in each breast. Angiosarcoma is a less common type of breast cancer that can start in the lining of these vessels. The lymph system is described below.

A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas and are not really thought of as breast cancers.

How breast cancer spreads?

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Breast cancer can spread when the cancer cells get into the blood or lymph system and then are carried to other parts of the body.

The lymph (or lymphatic) system is a part of your body’s immune system. It is a network of lymph nodes (small, bean-sized glands), ducts or vessels, and organs that work together to collect and carry clear lymph fluid through the body tissues to the blood. The clear lymph fluid inside the lymph vessels contains tissue by-products and waste material, as well as immune system cells.

The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:

• Lymph nodes under the arm (axillary lymph nodes)
• Lymph nodes inside the chest near the breastbone (internal mammary lymph nodes)
• Lymph nodes around the collar bone (supraclavicular [above the collar bone] and infraclavicular [below the collar bone] lymph nodes)

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread (metastasized) to other parts of your body. Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes might develop metastases later.

Types of breast cancer

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There are several different types of breast cancer, including:

• Infiltrating (invasive) ductal carcinoma. Starting in your milk ducts of your breast, this cancer breaks through the wall of your duct and spreads to surrounding breast tissue. Making up about 80% of all cases, this is the most common type of breast cancer.
• Ductal carcinoma in situ. Also called Stage 0 breast cancer, ductal carcinoma in situ is considered by some to be precancerous because the cells haven’t spread beyond your milk ducts. This condition is very treatable. However, prompt care is necessary to prevent the cancer from becoming invasive and spreading to other tissues.
• Infiltrating (invasive) lobular carcinoma. This cancer forms in the lobules of your breast (where breast milk production takes place) and has spread to surrounding breast tissue. It accounts for 10% to 15% of breast cancers.
• Lobular carcinoma in situ is a precancerous condition in which there are abnormal cells in the lobules of your breast. It isn’t a true cancer, but this marker can indicate the potential for breast cancer later on. So, it’s important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
• Triple negative breast cancer (TNBC). Making up about 15% of all cases, triple negative breast cancer is one of the most challenging breast cancers to treat. It’s called triple negative because it doesn’t have three of the markers associated with other types of breast cancer. This makes prognosis and treatment difficult.
• Inflammatory breast cancer. Rare and aggressive, this type of cancer resembles an infection. People with inflammatory breast cancer usually notice redness, swelling, pitting and dimpling of their breast skin. It’s caused by obstructive cancer cells in their skin’s lymph vessels.
• Paget’s disease of the breast. This cancer affects the skin of your nipple and areola (the skin around your nipple).

What are the early signs of breast cancer?

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Breast cancer symptoms can vary for each person. Possible signs of breast cancer include:

• A change in the size, shape or contour of your breast.
• A mass or lump, which may feel as small as a pea.
• A lump or thickening in or near your breast or in your underarm that persists through your menstrual cycle.
• A change in the look or feel of your skin on your breast or nipple (dimpled, puckered, scaly or inflamed).
• Redness of your skin on your breast or nipple.
• An area that’s distinctly different from any other area on either breast.
• A marble-like hardened area under your skin.
• A blood-stained or clear fluid discharge from your nipple.

Some people don’t notice any signs of breast cancer at all. That’s why routine mammograms and are so important.

What causes breast cancer?

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Breast cancer develops when abnormal cells in your breast divide and multiply. But experts don’t know exactly what causes this process to begin in the first place.

However, research indicates that are several risk factors that may increase your chances of developing breast cancer. These include:

• Age. Being 55 or older increases your risk for breast cancer.
• Sex. Women are much more likely to develop breast cancer than men.
• Family history and genetics. If you have parents, siblings, children or other close relatives who’ve been diagnosed with breast cancer, you’re more likely to develop the disease at some point in your life. About 5% to 10% of breast cancers are due to single abnormal genes that are passed down from parents to children, and that can be discovered by genetic testing.
• Smoking. Tobacco use has been linked to many different types of cancer, including breast cancer.
• Alcohol use. Research indicates that drinking alcohol can increase your risk for certain types of breast cancer.
• Obesity. Having obesity can increase your risk of breast cancer and breast cancer recurrence.
• Radiation exposure. If you’ve had prior radiation therapy — especially to your head, neck or chest — you’re more likely to develop breast cancer.
• Hormone replacement therapy. People who use hormone replacement therapy (HRT) have a higher risk of being diagnosed with breast cancer.

There are many other factors that can increase your chances of developing breast cancer. Talk to your healthcare provider to find out if you’re at risk.

How is breast cancer diagnosed?

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Your healthcare provider will perform a breast examination and ask about your family history, medical history and any existing symptoms. Your healthcare provider will also recommend tests to check for breast abnormalities. These tests may include:

• Mammogram. These special X-ray images can detect changes or abnormal growths in your breast. A mammogram is commonly used in breast cancer prevention.
• Ultrasonography. This test uses sound waves to take pictures of the tissues inside of your breast. It’s used to help diagnose breast lumps or abnormalities.
• Positron emission tomography (PET) scanning: A PET scan uses special dyes to highlight suspicious areas. During this test, your healthcare provider injects a special dye into your veins and takes images with the scanner.
• Magnetic resonance imaging (MRI): This test uses magnets and radio waves to produce clear, detailed images of the structures inside of your breast.

If your healthcare provider sees anything suspicious on the imaging tests, they may take a biopsy of your breast tissue. They’ll send the sample to a pathology lab for analysis.

What are the breast cancer stages?

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Staging helps describe how much cancer is in your body. It’s determined by several factors, including the size and location of the tumor and whether the cancer has spread to other areas of your body. The basic breast cancer stages are:

• Stage 0. The disease is non-invasive. This means it hasn’t broken out of your breast ducts.
• Stage I. The cancer cells have spread to the nearby breast tissue.
• Stage II. The tumor is either smaller than 2 centimeters across and has spread to underarm lymph nodes or larger than 5 centimeters across but hasn’t spread to underarm lymph nodes. Tumors at this stage can measure anywhere between 2 to 5 centimeters across, and may or may not affect the nearby lymph nodes.
• Stage III. At this stage, the cancer has spread beyond the point of origin. It may have invaded nearby tissue and lymph nodes, but it hasn’t spread to distant organs. Stage III is usually referred to as locally advanced breast cancer.
• Stage IV. The cancer has spread to areas away from your breast, such as your bones, liver, lungs or brain. Stage IV breast cancer is also called metastatic breast cancer.

How is breast cancer treated?

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There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. What’s right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. It’s not uncommon to receive a combination of different treatments, too.

Breast cancer surgery

Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:

• Lumpectomy. Also called a partial mastectomy, a lumpectomy removes the tumor and a small margin of healthy tissue around it. Typically, some of the lymph nodes — in your breast or under your arm — are also removed for evaluation. People who have a lumpectomy often have radiation therapy in the weeks following the procedure.
• Mastectomy. Removal of your entire breast is another option. In some cases, doctors can perform a nipple-sparing mastectomy to preserve your nipple and areola (the dark skin around your nipple). Many women choose to undergo either immediate or delayed breast reconstruction following their mastectomy.
• Sentinel node biopsy. Because early detection of breast cancer has resulted in the lymph nodes being negative (for cancer) in most cases, the sentinel node biopsy was developed to prevent the unnecessary removal of large numbers of lymph nodes that aren’t involved by the cancer. To identify the sentinel lymph node, doctors inject a dye that tracks to the first lymph node that cancer would spread to. If that lymph node is cancer-free, then other lymph nodes don’t need to be removed. If that lymph node has cancer in it, it may be necessary to remove additional lymph nodes. Often, there’s more than one sentinel node identified, but the fewer lymph nodes removed the lower the chance of developing swelling in your arm (lymphedema). A sentinel lymph node biopsy can be done with either a lumpectomy or a mastectomy.
• Axillary lymph node dissection. If multiple lymph nodes are involved by the cancer, an axillary lymph node dissection may be done to remove them. This means removing many of the lymph nodes under your arm (your axilla).
• Modified radical mastectomy. During this procedure, your entire breast is removed in addition to your nipple. Nearby lymph nodes in your underarm area are also removed, but your chest muscles are left intact. Breast reconstruction can often be an option if desired.
• Radical mastectomy. This procedure is rarely performed today unless the breast cancer has spread to your chest wall muscles. During a radical mastectomy, your surgeon removes your entire breast, your nipple, underarm lymph nodes and chest wall muscles. People who undergo this procedure may choose to have breast reconstruction as well.

Chemotherapy for breast cancer

Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, it’s given after surgery to kill any remaining cancer cells and reduce the risk of recurrence (coming back). If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.

Radiation therapy for breast cancer

Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.

Hormone therapy for breast cancer

Some types of breast cancer use hormones — such as estrogen and progesterone — to grow. In these cases, hormone therapy can either lower estrogen levels or stop estrogen from attaching to breast cancer cells. Most often, healthcare providers use hormone therapy after surgery to reduce the risk of breast cancer recurrence. However, they may also use it before surgery to shrink the tumor or to treat cancer that has spread to other parts of your body.

Immunotherapy for breast cancer

Immunotherapy uses the power of your own immune system to target and attack breast cancer cells. Treatment is given intravenously (through a vein in your arm or hand). Your healthcare provider might use immunotherapy for breast cancer in combination with chemotherapy.

Targeted drug therapy for breast cancer

Some drugs can target specific cell characteristics that cause cancer. Your healthcare provider might recommend targeted drug therapy in cases where breast cancer has spread to other areas of your body. Some of the most common drugs used in breast cancer treatment include monoclonal antibodies (like trastuzumab, pertuzumab and margetuximab), antibody-drug conjugates (like ado-trastuzumab emtansine and fam-trastuzumab deruxtecan) and kinase inhibitors (such as lapatinib, neratinib and tucatinib).

Artificial intelligence (AI) and related technologies are increasingly prevalent in business and society, and are beginning to be applied to healthcare. These technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organisations.

There are already a number of research studies suggesting that AI can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. Today, algorithms are already outperforming radiologists at spotting malignant tumours, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. In this article, we describe both the potential that AI offers to automate aspects of care and some of the barriers to rapid implementation of AI in healthcare.

How AI works in healthcare?

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AI is able to analyze large amounts of data stored by healthcare organizations in the form of images, clinical research trials and medical claims, and can identify patterns and insights often undetectable by manual human skill sets.

AI algorithms are “taught” to identify and label data patterns, while NLP allows these algorithms to isolate relevant data. With DL, the data is analyzed and interpreted with the help of extended knowledge by computers. The impact of these tools is huge, considering a Frost & Sullivan analysis indicated artificial intelligence and cognitive computing systems in healthcare will account for $6.7 billion this year from the market compared to $811 million in 2015.

The use of AI is supporting many stakeholders in healthcare:

• Teams of clinicians, researchers or data managers involved in clinical trials can speed up the process of medical coding search and confirmation, crucial in conducting and concluding clinical studies.
• Healthcare payers can personalize their health plans by connecting a virtual agent via conversational AI with members interested in customized health solutions.
• Clinicians can improve and customize care to patients by combing through medical data to predict or diagnose disease faster.

Top 10 uses of AI in healthcare

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AI supports medical imaging analysis

AI is used as a tool for case triage. It supports a clinician reviewing images and scans. This enables radiologists or cardiologists to identify essential insights for prioritizing critical cases, to avoid potential errors in reading electronic health records (EHRs) and to establish more precise diagnoses.

A clinical study can result in huge amounts of data and images that need to be checked. AI algorithms can analyze these datasets at high speed and compare them to other studies in order to identify patterns and out-of-sight interconnections. The process enables medical imaging professionals to track crucial information quickly.

AI provides valuable assistance to emergency medical staff

During a sudden heart attack, before ambulance arrival is crucial for recovery. For an increased chance of survival, emergency dispatchers must be able to recognize the symptoms of a cardiac arrest in order to take appropriate measures. AI can analyze both verbal and nonverbal clues in order to establish a diagnostic from a distance.

Corti is an AI tool that assists emergency medicine staff. By analyzing the voice of the caller, background noise and relevant data from medical history of the patient, Corti alerts emergency staff if it detects a heart attack. Like other ML technologies, Corti does not search for particular signals, but it trains itself by listening to many calls in order to detect crucial factors.

Based on this learning, Corti improves its model as an ongoing process. The technology Corti is equipped with can detect the difference between background noise, such as sirens, and clues from the caller, or the patient sounds in the background.

AI analyzes unstructured data

Clinicians often struggle to stay updated with the latest medical advances while providing quality patient-centered care due to huge amounts of health data and medical records. EHRs and biomedical data curated by medical units and medical professionals can be quickly scanned by ML technologies to provide prompt, reliable answers to clinicians.

In many cases, health data and medical records of patients are stored as complicated unstructured data, which makes it difficult to interpret and access. AI can seek, collect, store and standardize medical data regardless of the format, assisting repetitive tasks and supporting clinicians with fast, accurate, tailored treatment plans and medicine for their patients instead of being buried under the weight of searching, identifying, collecting and transcribing the solutions they need from piles of paper formatted EHRs.

AI supports health equity

The AI and ML industry has the responsibility to design healthcare systems and tools that ensure fairness and equality are met, both in data science and in clinical studies, in order to deliver the best possible health outcomes. With more use of ML algorithms in various areas of medicine, the risk of health inequities can occur.

Those responsible for applying AI in healthcare must ensure AI algorithms are not only accurate, but objective and fair. Since many clinical trial guidelines and diagnostic tests take into account a patient’s race and ethnicity that a debate has arisen:

Is the selection of these factors evidence-based? Is race and ethnicity data more likely to solve or to increase universal health inequities? It is established that ML comprises a set of methods that enables computers to learn from the data they process. That means that, at least in principle, ML can provide unbiased predictions based only on the impartial analysis of the underlying data.

AI and ML algorithms can be educated to decrease or remove bias by promoting data transparency and diversity for reducing health inequities. Healthcare research in AI and ML has the potential to eliminate health-outcome differences based on race, ethnicity or gender.

AI can forecast kidney disease

Acute kidney injury (AKI) can be difficult to detect by clinicians, but can cause patients to deteriorate very fast and become life-threatening. With an estimated 11% of deaths in hospitals following a failure to identify and treat patients, the early prediction and treatment of these cases can have a huge impact to reduce life-long treatment and the cost of kidney dialysis.

AI uses data collected for predictive analytics

Turning EHRs into an AI-driven predictive tool allows clinicians to be more effective with their workflows, medical decisions and treatment plan. NLP and ML can read the entire medical history of a patient in real time, connect it with symptoms, chronic affections or an illness that affects other members of the family. They can turn the result into a predictive analytics tool that can catch and treat a disease before it becomes life-threatening.

AI builds complex and consolidated platforms for drug discovery

AI algorithms are able to identify new drug applications, tracing their toxic potential as well as their mechanisms of action. This technology led to the foundation of a drug discovery platform that enables the company to repurpose existing drugs and bioactive compounds.

By combining the best elements of biology, data science and chemistry with automation and the latest AI advances, the founding company of this platform is able to generate around 80 terabytes of biological data that is processed by AI tools across 1.5 million experiments weekly.

The ML tools are created to draw insights from biological datasets that are too complex for human interpretation, decreasing the risk for human bias. Identifying new uses for known drugs is an appealing strategy for Big Pharma companies, since it is less expensive to repurpose and reposition existing drugs than to create them from scratch.

AI accelerates the discovery and development of genetic medicine

AI is also used to help rapidly discover and develop medicine, with a high rate of success. Genetic diseases are favored by altered molecular phenotypes, such as protein binding. Predicting these alterations means predicting the likelihood of genetic diseases emerging. This is possible by collecting data on all identified compounds and on biomarkers relevant to certain clinical trials.

AI can decrease the cost to develop medicines

Supercomputers have been used to predict from databases of molecular structures which potential medicines would and would not be effective for various diseases. By using convolutional neural networks, a technology similar to the one that makes cars drive by themselves, AtomNet was able to predict the binding of small molecules to proteins by analyzing hints from millions of experimental measurements and thousands of protein structures.

This process enabled convolutional neural networks to identify a safe and effective drug candidate from the database searched, reducing the cost of developing medicine.

What is Nutrition?

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nutritionists use ideas from molecular biology, biochemistry, and genetics to understand how nutrients affect the human body.

Nutrition also focuses on how people can use dietary choices to reduce the risk of disease, what happens if a person has too much or too little of a nutrient, and how allergies work.

Nutrients provide nourishment. Proteins, carbohydrates, fat, vitamins, minerals, fiber, and water are all nutrients. If people do not have the right balance of nutrients in their diet, their risk of developing certain health conditions increases.

Macro-nutrients

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Micro-nutrients are essential in small amounts. They include vitamins and minerals. Manufacturers sometimes add these to foods. Examples include fortified cereals and rice.

Carbohydrates sugar, starch, and fiber are types of carbohydrates.

Sugars are simple carbs. The body quickly breaks down and absorbs sugars and processed starch. They can provide rapid energy, but they do not leave a person feeling full. They can also cause a spike in blood sugar levels. Frequent sugar spikes increase the risk of type 2 diabetes and its complications.

Fiber is also a carbohydrate. The body breaks down some types of fiber and uses them for energ; others are metabolized by gut bacteria, while other types pass through the body.

Fiber and unprocessed starch are complex carbs. It takes the body some time to break down and absorb complex carbs. After eating fiber, a person will feel full for longer. Fiber may also reduce the risk of diabetes, cardiovascular disease, and colorectal cancer. Complex carbs are a more healthful choice than sugars and refined carbs.

Proteins

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Proteins consist of amino acids, which are organic compounds that occur naturally.

There are 20 amino acids. Some of these are essential Trusted Source, which means people need to obtain them from food. The body can make the others.

Some foods provide complete protein, which means they contain all the essential amino acids the body needs. Other foods contain various combinations of amino acids.

Most plant-based foods do not contain complete protein, so a person who follows a vegan diet needs to eat a range of foods throughout the day that provides the essential amino acids.

Fats

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Fats are essential for:

• lubricating joints
• helping organs produce hormones
• enabling the body to absorb certain vitamins
• reducing inflammation
• preserving brain health

Too much fat can lead to obesity, high cholesterol, liver disease, and other health problems.

However, the type of fat a person eats makes a difference. Unsaturated fats, such as olive oil, are more healthful than saturated fats, which tend to come from animals.

Water

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The adult human body is up to 60% water, and it needs water for many processes. Water contains no calories, and it does not provide energy.

Many people recommend consuming 2 liters, or 8 glasses, of water a day, but it can also come from dietary sources, such as fruit and vegetables. Adequate hydration will result in pale yellow urine.

Requirements will also depend on an individual’s body size and age, environmental factors, activity levels, health status, and so on.

Minerals

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The body needs carbon, hydrogen, oxygen, and nitrogen. It also needs dietary minerals, such as iron, potassium, and so on. In most cases, a varied and balanced diet will provide the minerals a person needs. If a deficiency occurs, a doctor may recommend supplements. Here are some of the minerals the body needs to function well.

Potassium

Potassium is an electrolyte. It enables the kidneys, the heart, the muscles, and the nerves to work properly. Too little can lead to high blood pressure, stroke, and kidney stones.Too much may be harmful to people with kidney disease. Avocados, coconut water, bananas, dried fruit, squash, beans, and lentils are good sources.

Sodium

Sodium is an electrolyte that helps:

• maintain nerve and muscle function
• regulate fluid levels in the body

Too little can lead to hyponatremia. Symptoms include lethargy, confusion, and fatigue. Too much can lead to high blood pressure, which increases the risk of cardiovascular disease and stroke. Table salt, which is made up of sodium and chloride, is a popular condiment. However, most people consume too much sodium, as it already occurs naturally in most foods. Experts urge people not to add table salt to their diet. Current guidelines recommend consuming no more than 2,300 mg of sodium a day, or around one teaspoon. This recommendation includes both naturally-occurring sources, as well as salt a person adds to their food. People with high blood pressure or kidney disease should eat less.

Calcium

The body needs calcium Trusted Source to form bones and teeth. It also supports the nervous system, cardiovascular health, and other functions.

Too little can cause bones and teeth to weaken. Symptoms of a severe deficiency include tingling in the fingers and changes in heart rhythm, which can be life-threatening. Too much can lead to constipation, kidney stones, and reduced absorption of other minerals. Current guidelines for adults recommend consuming 1,000 mg a day, and 1,200 mg for women aged 51 and over. Good sources include dairy products, tofu, legumes, and green, leafy vegetables.

Phosphorus

Phosphorus is present in all body cells and contributes to Trusted Source the health of the bones and teeth. Too little phosphorus can lead to bone diseases, affect appetite, muscle strength, and coordination. It can also result in anemia, a higher risk of infection, burning or prickling sensations in the skin, and confusion. Too much in the diet is unlikely to cause health problems though toxicity is possible from supplements, medications, and phosphorus metabolism problems. Adults should aim to consume around 700 mgTrusted Source of phosphorus each day. Good sources include dairy products, salmon, lentils, and cashews.

Magnesium

Magnesium contributes to Trusted Source muscle and nerve function. It helps regulate blood pressure and blood sugar levels, and it enables the body to produce proteins, bone, and DNA. Too little magnesium can eventually lead to weakness, nausea, tiredness, restless legs, sleep conditions, and other symptoms. Too much can result in digestive and, eventually, heart problems. Nuts, spinach, and beans are good sources of magnesium. Adult females need 320 mg Trusted Source of magnesium each day, and adult males need 420 mg.

Zinc

Zinc plays a role in the health of body cells, the immune system, wound healing, and the creation of proteins. Too little can lead to hair loss, skin sores, changes in taste or smell,and diarrhea, but this is rare. Too much can lead to digestive problems and headaches. Adult females need 8 mg Trusted Source of zinc a day, and adult males need 11 mg. Dietary sources include oysters, beef, fortified breakfast cereals, and baked beans. For more on dietary sources of zinc,

Iron

Iron is crucial for the formation Trusted Source of red blood cells, which carry oxygen to all parts of the body. It also plays a role in forming connective tissue and creating hormones. Too little can result in anemia, including digestive issues, weakness, and difficulty thinking. Learn more here about iron deficiency. Too much can lead to digestive problems, and very high levels can be fatal. Good sources include fortified cereals, beef liver, lentils, spinach, and tofu. Adults need 8 mg Trusted Source of iron a day, but females need 18 mg during their reproductive years.

Manganese

The body uses manganese to produce energy Trusted Source, it plays a role in blood clotting, and it supports the immune system. Too little can result in weak bones in children, skin rashes in men, and mood changes in women. Too much can lead to tremors, muscle spasms, and other symptoms, but only with very high amounts. Mussels, hazelnuts, brown rice, chickpeas, and spinach all provide manganese. Male adults need 2.3 mg Trusted Source of manganese each day, and females need 1.8 mg.

Copper

Copper helps the body Trusted Source make energy and produce connective tissues and blood vessels. Too little copper can lead to tiredness, patches of light skin, high cholesterol, and connective tissue disorders. This is rare. Too much copper can result in liver damage, abdominal pain, nausea, and diarrhea. Too much copper also reduces the absorption of zinc. Good sources include beef liver, oysters, potatoes, mushrooms, sesame seeds, and sunflower seeds. Adults need 900 microgramsTrusted Source (mcg) of copper each day.

Selenium

Selenium is made up of over 24 selenoproteins, and it plays a crucial roleTrusted Source in reproductive and thyroid health. As an antioxidant, it can also prevent cell damage. Too much selenium can cause garlic breath, diarrhea, irritability, skin rashes, brittle hair or nails, and other symptoms. Too little can result in heart disease, infertility in men, and arthritis. Adults need 55 mcg Trusted Source of selenium a day.

Hepatitis

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Hepatitis is an inflammation of the liver. Alcohol consumption, several health conditions, and some medications can all cause this condition.

However, viral infections are the most common cause of hepatitis.

Safe and effective vaccines are available to prevent hepatitis B virus (HBV). This vaccine also prevents the development of hepatitis D virus (HDV) and given at birth strongly reduces transmission risk from mother to child. Chronic hepatitis B infection can be treated with antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival. Only a proportion of people with chronic hepatitis B infection will require treatment. A vaccine also exists to prevent infections of hepatitis E (HEV), although it is not currently widely available. There are no specific treatments for HBV and HEV and hospitalization is not usually required. It is advised to avoid unnecessary medications due to the negative effect on liver function caused by these infections.

Hepatitis C (HCV) can cause both acute and chronic infection. Some people recover on their own, while others develop a life-threatening infection or further complications, including cirrhosis or cancer. There is no vaccine for hepatitis C. Antiviral medicines can cure more than 95% of persons with hepatitis C infection, thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment remains low.

Hepatitis A virus (HAV) is most common is low- and middle-income countries due to reduced access to clean and reliable water sources and the increased risk of contaminated food. A safe and effective vaccine is available to prevent hepatitis A. Most HAV infections are mild, with the majority of people recovering fully and developing immunity to further infection. However, these infections can also rarely be severe and life threatening due to the risk of liver failure.

What is hepatitis?

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Hepatitis refers to an inflammatory condition of the liver. It is commonly the result of a viral infection, but there are other possible causes of hepatitis.

These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

The five main viral classifications of hepatitis are hepatitis A, B, C, D, and E. A different virus is responsible for each type of viral hepatitis.

The World Health Organization (WHO) estimates that 354 million Trusted Source people currently live with chronic hepatitis B and C globally.

Hepatitis A

Hepatitis A is the result of an infection with the hepatitis A virus (HAV). This type of hepatitis is an acute, short-term disease.

Hepatitis B

The hepatitis B virus (HBV) causes hepatitis B. This is often an ongoing, chronic condition. The Centers for Disease Control and Prevention (CDC) estimates that around 826,000Trusted Source people are living with chronic hepatitis B in the United States and around 257 million people worldwide.

Hepatitis C

Hepatitis C comes from the hepatitis C virus (HCV). HCV is among the most common bloodborne viral infections in the United States and typically presents as a long-term condition.

Hepatitis D

This is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus (HDV) causes liver inflammation like other strains, but a person cannot contract HDV without an existing hepatitis B infection.

Hepatitis E

Hepatitis E is a waterborne disease that results from exposure to the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply.

Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

How is viral hepatitis spread?

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Hepatitis A and hepatitis E usually spread through contact with food or water that was contaminated with an infected person’s stool. You can also get hepatitis E by eating undercooked pork, deer, or shellfish.

Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone who has the disease. Hepatitis B and D may also spread through contact with other body fluids. This can happen in many ways, such as sharing drug needles or having unprotected sex.

Who is at risk for hepatitis?

The risks are different for the different types of hepatitis. For example, with most of the viral types, your risk is higher if you have unprotected sex. People who drink a lot over long periods of time are at risk for alcoholic hepatitis.

How is hepatitis diagnosed?

To diagnose hepatitis, your health care provider:

• Will ask about your symptoms and medical history
• Will do a physical exam
• Will likely do blood tests, including tests for viral hepatitis
• Might do imaging tests, such as an ultrasound, CT scan, or MRI
• May need to do a liver biopsy to get a clear diagnosis and check for liver damage

What are the treatments for hepatitis?

Treatment for hepatitis depends on which type you have and whether it is acute or chronic. Acute viral hepatitis often goes away on its own. To feel better, you may just need to rest and get enough fluids. But in some cases, it may be more serious. You might even need treatment in a hospital.

There are different medicines to treat the different chronic types of hepatitis. Possible other treatments may include surgery and other medical procedures. People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis leads to liver failure or liver cancer, you may need a liver transplant.

Blood Donation

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Blood donation is a vital part of worldwide healthcare. It relates to blood transfusion as a life-sustaining and life-saving procedure as well as a form of therapeutic phlebotomy as a primary medical intervention. Over one hundred million units of blood are donated each year throughout the world. This article will concisely discuss a short history of blood donation origin and purpose, blood testing, donor eligibility and selection, adverse effects of donation, blood donation as a primary medical intervention, and a brief discussion of pathogen reduction and inactivation for donated blood.

Blood donation is most often performed by inserting a large bore needle (16G or 18G) into a peripheral vein, usually within the antecubital fossa. Veins on the dorsum of the hand or other prominent veins may be used in some individuals who do not have an otherwise easily accessible antecubital vein.

Blood donation is a procedure wherein a person donates his blood to save a fellow human. The blood is then adequately stored in the blood bank and used to transfuse whenever necessary.

Blood Typing

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People have different blood types. Blood type is determined by whether certain antigens (complex sugar or protein molecules that can trigger an immune response) are present on the surface of red blood cells. Blood cell antigens include blood group antigens A and B and Rh factor.

The four main blood types are A, B, AB, and O (distribution in general population)

• A: Antigen A (but not B) is present. (40%)
• B: Antigen B (but not A) is present. (10%)
• AB: Antigens A and B are present. (5%)
• O: Neither antigen A nor B is present. (45%)

Also, blood may be Rh-positive (Rh factor is present on the surface of the red blood cells, 85% of people) or Rh-negative (Rh factor is absent, 15% of people).

Normally, if people lack an A and/or a B antigen, they have naturally occurred antibodies against the antigen or antigens that they lack. For example, people with blood type A have naturally occurring anti-B antibody, and people with blood type O (who lack both A and B antigens) have naturally occurring anti-A and anti-B antibodies. In addition to A and B antigens, there are several other blood group antigens also present on red blood cells. However, people do not have naturally occurring antibodies against these antigens. Such antibodies develop only if people are exposed to these antigens by transfusion.

Blood Transfusion

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Transfusion medicine is a specialized branch of hematology that is concerned with the study of blood groups, along with the work of a blood bank to provide a transfusion service for blood and other blood products. Across the world, blood products must be prescribed by a medical doctor (licensed physician or surgeon) in a similar way as medicines.

Much of the routine work of a blood bank involves testing blood from both donors and recipients to ensure that every individual recipient is given blood that is compatible and is as safe as possible. If a unit of incompatible blood is transfused between a donor and recipient, a severe acute hemolytic reaction with hemolysis (RBC destruction), kidney failure and shock is likely to occur, and death is a possibility. Antibodies can be highly active and can attack RBCs and bind components of the complement system to cause massive hemolysis of the transfused blood.

Patients should ideally receive their own blood or type-specific blood products to minimize the chance of a transfusion reaction. It is also possible to use the patient’s own blood for transfusion. This is called autologous blood transfusion, which is always compatible with the patient. The procedure of washing a patient’s own red blood cells goes as follows: The patient’s lost blood is collected and washed with a saline solution. The washing procedure yields concentrated washed red blood cells. The last step is reinfusing the packed red blood cells into the patient. There are multiple ways to wash red blood cells. The two main ways are centrifugation and filtration methods. This procedure can be performed with microfiltration devices like the Hemoclear filter. Risks can be further reduced by cross-matching blood, but this may be skipped when blood is required for an emergency. Cross-matching involves mixing a sample of the recipient’s serum with a sample of the donor’s red blood cells and checking if the mixture agglutinates, or forms clumps. If agglutination is not obvious by direct vision, blood bank technologist usually check for agglutination with a microscope. If agglutination occurs, that particular donor’s blood cannot be transfused to that particular recipient. In a blood bank it is vital that all blood specimens are correctly identified, so labelling has been standardized using a barcode system known as ISBT 128.

The blood group may be included on identification tags or on tattoos worn by military personnel, in case they should need an emergency blood transfusion. Frontline German Waffen-SS had blood group tattoos during World War II.

Rare blood types can cause supply problems for blood banks and hospitals. For example, Duffy-negative blood occurs much more frequently in people of African origin, and the rarity of this blood type in the rest of the population can result in a shortage of Duffy-negative blood for these patients. Similarly, for RhD negative people there is a risk associated with travelling to parts of the world where supplies of RhD negative blood are rare, particularly East Asia, where blood services may endeavor to encourage Westerners to donate blood.

Who is a suitable candidate for blood donation?

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Blood donation is a noble cause. Though most of us may want to do it, not everybody is eligible. In India, a blood donor must be at least 18 years of age, in good health and at ideal weight.

The hospital staff takes a sample of your blood to check for your eligibility. They evaluate the amount of haemoglobin in the blood, and if the levels are low, you may not be allowed for blood donation.

The hospital will also ask you various questions to map your medical history. These are targeted to understand if you have higher chances of carrying bloodborne infections.

The following situations may bar a person from donating blood:

• Consuming drugs or steroids in the past three months
• A person suffering from congenitalcoagulation deficiency
• Testing positive for HIV
• In a sexual relationship with a person suffering from viral hepatitis
• A history of babesiosis

Why Is Blood Donation Conducted?

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Blood plays a crucial role in our body. It is responsible for all the other functions in the body that keep us alive. However, some situations lead to a lack of blood, and when the same is not transfused into the body within the stipulated time, the person may lose his life.

Deaths due to blood loss during accidents, calamities, pregnancy, childbirth, major surgery, and severe anemia are avoidable deaths. In all these situations, the availability of blood could save lives. As considerate humans, we must realize that preventable deaths are the worst, and blood donation can help cope with this situation.

What Are the Different Kinds of Blood Donation?

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Voluntary blood donation is of four types. These include whole blood, plasma, red blood cells, and platelet donations.

• Whole blood donation

The whole blood donation procedure is the most common one you can witness. People with all blood groups are eligible for this procedure, wherein half a liter of blood is taken. The blood is either transfused as a whole or separated into red blood cells, platelets, and plasma.

• Platelets donation

Platelets are tiny cells in your body—these help to stop bleeding by clotting the blood. People with clotting problems, cancer, organ transplants, and major surgeries may need platelets. Once donated, platelets have to be used within five days.

An apheresis machine collects your platelets with some plasma: the red blood cells and most of the plasma return to your body.

• Plasma donation

People suffering from liver conditions, severe bacterial infections, or burns require plasma donations. These conditions need plasma for clotting the blood and stopping bleeding. Like platelet donation, plasma is also taken through the apheresis machine, and the other blood components are returned to the donor.

Plasma from the AB blood group is high in demand as it can be transfused to any person regardless of the blood group. One can donate plasma every 28 days.

• Red blood cell donation

Red blood cells play a crucial role in carrying oxygen to every part of the body and hence are highly vital. Patients who lose a major chunk of their blood through excessive trauma, major surgery, or acute anemia may require blood donation from red blood cells.

Here too, red blood cells are extracted from the blood through the apheresis machine while the rest is returned to the donor. Your body will require significant time to replace red blood cells. Hence, doctors advise you to maintain a gap of 168 days before your next blood donation.

If you think of opting for any of the above blood donation types, meet a doctor for expert advice.

Are There Any Benefits of Blood Donation?

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The most significant benefit of donating blood is that you get to save lives. People stuck in disasters, calamities, and fatal diseases can live longer with blood transfusion. For many, it can help to prevent deaths from fatal accidents and trauma.

While you will be helping people, there are also multiple benefits to your own body. Blood donation is healthy for the donor. Regular blood donation offers the following benefits.

• Better emotional wellbeing

Blood donation helps you think positively about life. It is an act that can save a stranger’s life, making you feel worthwhile.

• Improvement in cholesterol levels

Though the reason for the same is yet to be unearthed, donating blood does make way for good cholesterol.

• Lower the iron levels

For some people, high iron levels can be a cause of worry. Donating blood can reverse the condition by removing red blood cells, consequently lowering the iron levels.

Recipient safety

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Donors are screened for health risks that could make the donation unsafe for the recipient. Some of these restrictions are controversial, such as restricting donations from men who have sex with men (MSM) because of the risk of transmitting HIV. In 2011, the UK (excluding Northern Ireland) reduced its blanket ban on MSM donors to a narrower restriction which only prevents MSM from donating blood if they have had sex with other men within the past year.[ A similar change was made in the US in late 2015 by the FDA. In 2017, the UK and US further reduced their restrictions to three months. Autologous donors are not always screened for recipient safety problems since the donor is the only person who will receive the blood. Since the donated blood may be given to pregnant women or women of child-bearing age, donors taking teratogenic (birth defect-causing) medications are deferred. These medications include acitretin, etretinate, isotretinoin, finasteride, and dutasteride.

Donors are examined for signs and symptoms of diseases that can be transmitted in a blood transfusion, such as HIV, malaria, and viral hepatitis. Screening may include questions about risk factors for various diseases, such as travel to countries at risk for malaria or variant Creutzfeldt–Jakob disease (vCJD). These questions vary from country to country. For example, while blood centers in Québec and the rest of Canada, Poland, and many other places defer donors who lived in the United Kingdom for risk of vCJD, donors in the United Kingdom are only restricted for vCJD risk if they have had a blood transfusion in the United Kingdom.

Donor safety

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The donor is also examined and asked specific questions about their medical history to make sure that donating blood is not hazardous to their health. The donor’s hematocrit or hemoglobin level is tested to make sure that the loss of blood will not make them anemic, and this check is the most common reason that a donor is ineligible. Accepted hemoglobin levels for blood donations, by the American Red Cross, is 12.5g/dL (for females) and 13.0g/dL (for males) to 20.0g/dL, anyone with a higher or lower hemoglobin level cannot donate. Pulse, blood pressure, and body temperature are also evaluated. Elderly donors are sometimes also deferred on age alone because of health concerns. In addition to age, weight and height are important factors when considering the eligibility for donors. For example, the American Red Cross requires a donor to be 110 pounds (50 kg) or more for whole blood and platelet donation and at least 130 pounds (59 kg) (males) and at least 150 pounds (68 kg) (females) for power red donations (double red erythrocytapheresis). The safety of donating blood during pregnancy has not been studied thoroughly, and pregnant women are usually deferred until six weeks after the pregnancy.

What is an ICU?

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ICU cares for people who have life-threatening conditions, such as a serious injury or illness, where they receive around-the-clock monitoring and life support. It differs from other hospital wards in that:

• ICU provides 24-hour care from a highly-trained team of specialists
• there are fewer beds, with lots of equipment to monitor and care for critically ill patients
• fewer visitors are allowed

History of ICU

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The concept of ICU was first developed in 1854, during the Crimean war where seriously injured patients were separated from less injured persons by Florence Nightingale^[1]. This simple step reduced mortality from 40 percent to 2 percent on the battle field. The first Intensive Care Unit in the world was formed in Copenhagen in 1953^[2]. The pioneer was the Danish anesthetist, Bjorn Ibsen. This was developed when an epidemic of polioout-break happened in Denmark.

When intensive care is needed

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Intensive care is needed if someone is seriously ill and requires intensive treatment and close monitoring, or if they’re having surgery and intensive care can help them recover.

Most people in an ICU have problems with 1 or more organs. For example, they may be unable to breathe on their own.

There are many different conditions and situations that can mean someone needs intensive care.

Some common reasons include:

• a serious accident – such as a road accident, a severe head injury, a serious fall or severe burns
• a serious short-term condition – such as a heart attack or stroke
• a serious infection – such as sepsis or severe pneumonia
• major surgery – this can either be a planned part of your recovery, or an emergency measure if there are complications

Admission criteria for ICU

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The ICU is a special area of the hospital where the focus is on intense observation and treatment with increased staff and resources. This helps healthcare providers to respond immediately during emergency conditions. The trained doctors and nurses with the help of a multi-disciplinary team makes sure that the critical patient recovers rapidly and goes home. Patient who needs close monitoring and treatment are admitted to an Intensive Care Unit (ICU). Some examples of patients needing ICU care include:

• Patients with difficulty in breathing needing special machines called, ventilators
• Patients with low blood pressureneeding monitoring and medicines to treat it
• Patients with infections causing septic shock
• Patients who need close observation after certain surgeries, such as brain surgery, heart bypass and trauma surgery.

ICU is a place where patients are monitored acutely. ICU patients are monitored and treated by critical care team which include critical care specialists (intensivists), resident doctors, nurses, respiratory therapists, etc. Other staff at ICU include dieticians, physiotherapists, clinical pharmacists and other supportive staff like cleaning staff, security guards, etc. Fortunately, modern technology has progressed a lot and we can get intricate details of a patient’s vital parameters like heart rate, breathing rate, oxygen level and blood pressure. This is done by making use of multiple devices with numerous wires that are seen, which are constantly monitoring the patient.

Types of Intensive Care Units (ICUs)

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Intensive care units can be organised based on the pathologies/conditions treated (e.g. neurological, trauma, burns, medical or surgical ICUs) or by the age group of the patient admitted (adult or paediatric).^[2] Specialized intensive care units include medical, surgical, pediatric and neonatal intensive care units.

Medical intensive care unit

The medical intensive care unit is dedicated to the care of adult patients with medical conditions requiring frequent observation, specialized monitoring and medical treatment. These include illnesses such as diabetic ketoacidosis, gastrointestinal bleeding, drug overdose, respiratory failure, sepsis, stroke and cancer.

Surgical intensive care unit

The surgical intensive care unit is dedicated to the management of postoperative patients, including postoperative patients who have undergone major abdominal surgeries, craniotomy patients, thoracotomy patients, unstable multiple trauma patients and any surgical patient who requires continuous monitoring or life support.

Pediatric intensive care unit

Critically ill children are managed in the paediatric intensive care unit. Children who had just undergone surgery and are at risk of deterioration are also managed in the pediatric intensive care unit.

Neonatal intensive care unit

The neonatal intensive care unit is responsible for the management of premature, high-risk and critically ill infants.^[9] Neonates with congenital disorders and birth complications are also managed in the neonatal intensive care unit.

Why are people admitted to the ICU?

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A person is likely to be admitted to ICU if they are in a critical condition and need constant observation and specialised care. This can happen:

• after major surgery
• following an accident (e.g. car accident, severe burn)
• during a chronic or terminal illness (e.g. heart or kidney failure, stroke, heart attack)
• during a serious infection (e.g. pneumonia, sepsis)
• if a baby is born prematurely or with a serious illness – there is usually a special ICU for babies called the neonatal intensive care unit, or NICU

What happens in the ICU?

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ICU can be daunting to both the person being admitted and their visitors due to the lines, tubes, wires and monitoring equipment.

ICU patients can be connected to a wide range of machines, the most common being a heart monitor and artificial ventilators (when patients can’t breathe for themselves). Many ICU machines beep and make loud noises and alarms to let staff know if a patient’s condition changes.

There are also likely to be several tubes either putting fluid and nutrients into the patient or taking other fluids out.

There are many medical staff in ICU. Each patient usually has a dedicated specialist nurse, who regularly checks the equipment and any life support systems.

The ICU healthcare team understands how distressing ICU can be and is available to support immediate family.

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Hemodialysis

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In haemodialysis, a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately. Hemodialysis (he-moe-die-AL-uh-sis) is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.

With haemodialysis, you’ll need to:

• Follow a strict treatment schedule
• Take medications regularly
• Make changes in your diet

Haemodialysis is a serious responsibility, but you don’t have to shoulder it alone. You’ll work closely with your health care team, including a kidney specialist and other professionals with experience managing haemodialysis. You may be able to do haemodialysis at home.

Why it’s done

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Your doctor will help determine when you should start hemodialysis based on several factors, including your:

• Overall health
• Kidney function
• Signs and symptoms
• Quality of life
• Personal preferences

You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue. Your doctor uses your estimated glomerular filtration rate (eGFR) to measure your level of kidney function. Your eGFR is calculated using your blood creatinine test results, sex, age and other factors. A normal value varies with age. This measure of your kidney function can help to plan your treatment, including when to start haemodialysis.

Haemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, haemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.

Common causes of kidney failure include:

• Diabetes
• High blood pressure (hypertension)
• Kidney inflammation (glomerulonephritis)
• Kidney cysts (polycystic kidney disease)
• Inherited kidney diseases
• Long-term use of nonsteroidal anti-inflammatory drugs or other medications that could harm the kidneys

However, your kidneys may shut down suddenly (acute kidney injury) after a severe illness, complicated surgery, heart attack or other serious problem. Certain medications also can cause kidney injury.

Some people with severe long-standing (chronic) kidney failure may decide against starting dialysis and opt for a different path. Instead, they may choose maximal medical therapy, also called maximum conservative management or palliative care. This therapy involves active management of complications of advanced chronic kidney disease, such as fluid overload, high blood pressure and anemia, with a focus on supportive management of symptoms that affect quality of life.

Other people may be candidates for a pre-emptive kidney transplant, instead of starting on dialysis. Ask your health care team for more information about your options. This is an individualized decision because benefits of dialysis may vary, depending on your particular health issues.

Haemodialysis Procedure

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During treatments, you sit or recline in a chair while your blood flows through the dialyzer ― a filter that acts as an artificial kidney to clean your blood. You can use the time to watch TV or a movie, read, nap, or perhaps talk to your “neighbours” at the centre. If you receive haemodialysis at night, you can sleep during the procedure.

• Preparation: Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then renters your body during treatment — is cleansed.
• Starting: During haemodialysis, two needles are inserted into your arm through the access site and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.
• Symptoms: You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have gained a significant amount of fluid in between dialysis sessions. If you’re uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your haemodialysis, your medication or your haemodialysis fluids.
• Monitoring: Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment.
• Finishing: When haemodialysis is completed, the needles are removed from your access site and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you’re free to go about your usual activities until your next session.

Benefits of haemodialysis

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Aside from allowing people to continue living a relatively normal life, haemodialysis has other benefits, such as:

Haemodialysis requires less time than peritoneal dialysis

Haemodialysis treatments may occur at a hospital, dialysis center or your own home three times a week, with each session lasting between three and five hours. This leaves most of the week dialysis-free. By contrast, peritoneal dialysis takes between 10 and 12 hours every day.

Haemodialysis carries a relatively low risk of infection

Haemodialysis uses and arteriovenous (AV) fistula, which is the gold standard vascular access used to access a person’s blood. Common complications of peritoneal dialysis include infections of the abdominal lining or at the site where the catheter is inserted to carry the cleansing fluid.

Haemodialysis requires less surgical interventions

AV fistulas for dialysis last many years, longer than transplanted kidneys and catheters for peritoneal dialysis. This type of dialysis does not typically require additional surgeries.

Advin Hemodialysis Setup

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• Dialysis chair
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Diagnostic Radiology

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Radiology, also known as diagnostic imaging, is a series of tests that take pictures or images of parts of the body. The field encompasses two areas — diagnostic radiology and interventional radiology — that both use radiant energy to diagnose and treat diseases. While there are several different imaging exams, some of the most common include x-ray, MRI, ultrasound, CT scan and PET scan.

A radiologist will look at the outcome of a certain imaging test to find a relevant image that evaluates and supports a diagnosis. These individuals are usually medical doctors (MDs) with highly specialized training focused on the interpretation of medical imaging. Radiologic technologists also aid in this process, as they use and manage the machines in the course of producing an image. After a patient undergoes imaging tests, radiologists will give reports of their interpretations to the referring clinical doctors.

History of Radiology

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Radiology began in Germany in 1895 when Wilhelm Conrad Röntgen made an energized, lightproof cathode ray tube that started to fluoresce when situated a couple of feet away from a screen painted with fluorescent material. He knew the screen was responding to unknown rays transmitted throughout the room, which he called “x-rays.” After Röntgen’s discovery, people began creating radiographic images that started as a burst of ionizing radiation and created a contrast image on a piece of film.

What Is Radiology Used for?

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Radiology is used for a wide range of conditions, and is classified depending on the type of radiology and the exact imaging test used. The various imaging exams include:

• Radiographs: X-rays to look at bones, the chest or the abdomen.
• CT (Computed Tomography): A CT captures multiple x-ray angles of the patient using a doughnut-shaped machine, then creates computer-processed images.
• MRI (Magnetic Resonance Imaging): An MRI uses magnetic fields and radio waves with computer processing to create images.
• Mammograms: Specially powered x-rays that look at breast tissues.
• Ultrasound: An ultrasound uses sound waves to create moving images that display on a monitor, commonly used for echocardiograms and examining the womb during pregnancy.
• Fluoroscopy: X-rays that make moving images of the body in real time. This imaging is crucial for many procedures, especially those involving the gastrointestinal tract.
• Nuclear medicine: These are short-acting radioactive substances that generate light from bodily processes. A camera collects the light, so a computer can process it and develop an image.

Diagnostic radiology uses these imaging results to identify a wide range of problems, from broken bones to heart conditions and blood clots. Interventional radiology also uses imaging such as CT scans, MRI and ultrasounds to guide medical procedures. Patients are typically awake during these procedures, whether it’s treating cancer, back pain, or liver and kidney problems. In some cases, interventional radiology eliminates the need for surgery and scopes.

Diagnostic Imaging

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Diagnostic radiology refers to the field of medicine that uses non-invasive imaging scans to diagnose a patient. The tests and equipment used sometimes involves low doses of radiation to create highly detailed images of an area.

Examples of diagnostic radiology include:

• Radiography (X-rays)
• Ultrasound
• Computed Tomography (CT) Scans
• Magnetic Resonance Imaging (MRI) Scans
• Nuclear Medicine Scans

Diagnostic radiology can be used to identify a wide range of problems. Broken bones, heart conditions, blood clots, and gastrointestinal conditions are just a few of the problems that can be identified by diagnostic imaging.

In addition to identifying problems, doctors can use diagnostic radiology to monitor how your body is responding to a current treatment. Diagnostic radiology can also screen for diseases such as breast cancer and colon cancer.

Technology Used in Radiology

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The technology and machinery used in radiology varies from method to method. Some use radiation while others do not.

The most common machines used in radiology are:

• X-ray Machine: Uses X-rays, a type of electromagnetic radiation, to produce images of the interior of the body without having to make any incisions.
• CT Scanner: Uses X-ray equipment to create a sequence of cross-sectional images of the body. Often used when a doctor needs highly detailed images to study in order to identify the source of a problem, especially on soft tissue.
• MRI Machine: Uses a magnetic field instead of radiation to produce images of the inside of a body. Used for parts of the body that CT scanners cannot produce clear images of, such as bones.

Some of the diagnostic tests may require compounds to be ingested or chemicals to be injected for a clear view of your blood veins. Other tests may require anaesthesia and a scope in order for a doctor to clearly determine the problem.

Interventional Radiology

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Interventional radiology uses imaging technology such as CT scans, MRI, and Ultrasounds to help guide medical procedures. This technology eliminates the need for surgery and scopes to diagnose and treat certain conditions. Instead, patients are often awake during the procedure or under very mild sedation.

Common uses for interventional radiology include:

• Treating cancers
• Treating blockages in arteries or veins
• Treating back pain
• Treating liver and kidney problems

Interventional radiologists are highly specialized radiologists who have extra training and experience to safely and accurately perform these procedures.

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Circumcision

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Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common for newborn boys in certain parts of the world, including the United States. Circumcision after the newborn period is possible, but it’s a more complex procedure.

For some families, circumcision is a religious ritual. The procedure can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring.

Why it’s done

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Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care.

Sometimes there’s a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. In other cases, particularly in parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

Circumcision might have various health benefits, including:

• Easier hygiene.Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.
• Decreased risk of urinary tract infections.The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.
• Decreased risk of sexually transmitted infections.Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.
• Prevention of penile problems.Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.
• Decreased risk of penile cancer.Although cancer of the penis is rare, it’s less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis.

Circumcision might not be an option if certain blood-clotting disorders are present. Also, circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery or for babies born with abnormalities of the penis.

Circumcision doesn’t affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.

How you prepare

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Before circumcision, the doctor will explain the risks and benefits of the procedure. Whether you’re planning to have your son circumcised or you’re pursuing circumcision for yourself, you’ll likely need to provide written consent for the procedure.

What you can expect

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During the procedure

New-born circumcision is often done in the hospital nursery, usually within 10 days after birth.

For new-born circumcision, your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an aesthetic will be injected into the base of the penis or applied to the penis as a cream. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed.

Afterward, the penis will be covered with an ointment, such as a topical antibiotic or petroleum jelly, and wrapped loosely with gauze. The procedure generally takes about 10 minutes.

Circumcision is similar for older boys and adults. However, the procedure might need to be done under general anaesthesia, recovery might take longer and the risk of complications might be greater when done later in life.

After the procedure

It usually takes seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. You might notice a small amount of yellow fluid on the tip of the penis as well.

If your new-born is fussy as the aesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis.

It’s OK to wash the penis as it heals. For new-borns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Change your baby’s diaper often, and make sure the diaper is loosely fastened.

If there’s a plastic ring instead of a bandage, it will drop off on its own — usually within about a week. Once the penis heals, wash it with soap and water during normal bathing.

Problems after circumcision are uncommon. Contact the doctor if:

• Normal urination doesn’t resume within 12 hours of the circumcision
• There’s persistent bleeding
• There’s foul-smelling drainage from the tip of the penis
• The plastic ring remains in place two weeks after the circumcision

What are the benefits of circumcision?

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Circumcision has several benefits. Not only does it help aspects of penis health, but it can improve hygiene. That’s because a circumcised penis is simpler to clean and wash, especially for children.

The specific health benefits of circumcision include a lower risk of:

• Certain penis conditions: · These penile disorders include balanoposthitis (inflammation of the glans and foreskin), paraphimosis and phimosis, when the foreskin gets stuck out of place.
• Cervical cancer for partners: Female sex partners of circumcised men are less likely to get cervical cancer.
• Penile cancer: Men who had circumcisions are less likely to get cancer of the penis.
• Sexually transmitted infections: Men who had circumcision have a lower risk of certain STIs, including HIV.
• Urinary tract infections: UTIs are more common in uncircumcised males.

Advin Instrument Use In Circumcision

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• Metzenbaum Scissors
• Adson Forceps
• Tissue Forceps
• Kelly Forceps
• Mayo Hagar Needle Holder
• Allis Tissue Forceps
• Tissue Forceps
• Mosquito Forceps
• Scalpel Handle
• Plastibell Circumcision
• Circumcision Stapler

What are kidney stones?

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Kidney stones are hard, pebble-like pieces of material that form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional.

Kidney stones vary in size and shape. They may be as small as a grain of sand or as large as a pea. Rarely, some kidney stones are as big as golf balls. Kidney stones may be smooth or jagged and are usually yellow or brown.

A small kidney stone may pass through your urinary tract on its own, causing little or no pain. A larger kidney stone may get stuck along the way. A kidney stone that gets stuck can block your flow of urine, causing severe pain or bleeding. Learn more about your urinary tract and how it works.

If you have symptoms of kidney stones, including severe pain or bleeding, seek care right away. A doctor, such as a urologist, can treat any pain and prevent further problems, such as a urinary tract infection (UTI).

Do kidney stones have another name?

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The scientific name for a kidney stone is renal calculus or nephrolith. You may hear health care professionals call this condition nephrolithiasis, urolithiasis, or urinary stones.

What type of kidney stones do I have?

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You probably have one of four main types of kidney stones. Treatment for kidney stones usually depends on their size, location, and what they are made of:

Calcium stones

Calcium stones, including calcium oxalate stones and calcium phosphate stones, are the most common types of kidney stones. Calcium oxalate stones are more common than calcium phosphate stones.

Calcium from food does not increase your chance of having calcium oxalate stones. Normally, extra calcium that isn’t used by your bones and muscles goes to your kidneys and is flushed out with urine. When this doesn’t happen, the calcium stays in the kidneys and joins with other waste products to form a kidney stone.

Uric acid stones

A uric acid stone may form when your urine contains too much acid. Eating a lot of fish, shellfish, and meat—especially organ meat—may increase uric acid in urine.

Struvite stones

Struvite stones may form after you have a UTI. They can develop suddenly and become large quickly.

Cystine stones

Cystine stones result from a disorder called cystinuria that is passed down through families. Cystinuria causes the amino acid cystine to leak through your kidneys and into the urine.

How common are kidney stones?

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Kidney stones are common and are on the rise.

Who is more likely to develop kidney stones?

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Men are more likely to develop kidney stones than women. If you have a family history of kidney stones, you are more likely to develop them. You are also more likely to develop kidney stones again if you’ve had them once.

You may also be more likely to develop a kidney stone if you don’t drink enough liquids.

People with certain conditions

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You are more likely to develop kidney stones if you have certain conditions, including:

• a blockage of the urinary tract
• chronic, or long-lasting, inflammation of the bowel
• cystic kidney diseases, which are disorders that cause fluid-filled sacs to form on the kidneys
• cystinuria
• digestive problems or a history of gastrointestinal tract surgery
• gout, a disorder that causes painful swelling of the joints
• hypercalciuria, a condition that runs in families in which urine contains unusually large amounts of calcium; this is the most common condition found in people who form calcium stones
• hyperoxaluria, a condition in which urine contains unusually large amounts of oxalate
• hyperparathyroidism, a condition in which the parathyroid glands release too much parathyroid hormone, causing extra calcium in the blood
• hyperuricosuria, a disorder in which too much uric acid is in the urine
• obesity
• repeated, or recurrent, UTIs
• renal tubular acidosis, a disease that occurs when the kidneys fail to remove acids into the urine, which causes a person’s blood to remain too acidic

People who take certain medicines

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You are more likely to develop kidney stones if you are taking one or more of the following medicines over a long period of time:

• diuretics, often called water pills, which help rid your body of water
• calcium-based antacids
• indinavir, a protease inhibitor used to treat HIV infection
• topiramate, an anti-seizure medication

What are the complications of kidney stones?

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Complications of kidney stones are rare if you seek treatment from a health care professional before problems occur.

If kidney stones are not treated, they can cause

• hematuria, or blood in the urine
• severe pain
• UTIs, including kidney infections
• loss of kidney function