Tailored Hydration Regimens for Preventing Contrast-Induced Acute Kidney Injury
Tailored hydration regimens, such as LVEDP-guided and UFR-guided hydration, have been investigated in high-risk patients for contrast-induced acute kidney injury. This study focuses on a randomized trial comparing these two approaches in patients at risk for CI-AKI, with the aim of improving efficacy and safety. The study population includes patients with chronic kidney disease or at high risk for CI-AKI based on specific criteria. The trial protocol involves pre-procedure, intra-procedure, and post-procedure hydration regimens for optimal kidney protection.
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DISLOCATIONS I (LUXATIONS) Dr. Archana Kumari Asstt. Prof. cum Junior Scientist Veterinary Surgery and Radiology BVC, BASU, Patna
Dislocations (luxation) is the separation of articular surfaces of bones. When there is only a slight change in the relationship of the articular surfaces of bones it is called a partial dislocation or subluxation. (The Latin word locare means to place. Dislocation means displacement. The word luare in Latin means to dislocate and hence luxation means dislocation.)
CLASSIFICATION 1. Complete dislocation: A dislocation in which the articular surfaces are completely separated. 2. Partial dislocation (Incomplete luxation; or subluxation): When some parts of the articular surfaces are still in contact. 3.Acute (recent) luxation: When it is of recent occurrence. 4. Chronic luxation: A dislocation that has been in existence for a long time.
5. Recurrent luxation: Showing recurrence after correction of an earlier occurrence. 6. Simple (closed) luxation When there is no open wound communicating with the joint. 7. Compound luxation: When the joint communicates with the external air through a penetrating wound. 8. Complicated luxation: When luxation is associated with other important injuries like fracture.
9. Fracture dislocation: Dislocation combined with fracture of the related bones close to their articular surfaces. Examples: Luxation of the vertebral joints are usually combined with fracture of one or more articular processes. Dislocation or hip slmultaneously with fracture of head of femur. 10. Pathological dislocation: A dislocation resulting from paralysis or some other local pathological lesion. (Note: Luxations of immovable joints (synarthrosis) like the symphysis pelvis are commonly referred to as fractures.)
INCIDENCE Dislocation are not so common when compared to fractures. Diarthroidal joints like hip, shoulder, elbow etc. are more commonly affected. Rare in vertebral joints. The frequency of occurrence of common dislocation in different species are: Canine: phalangeal joints, (4) very rarely, the cervical vertebrae, and (5) other joints. (1) Hip, (2) shoulder, (3) rarely,
ETIOLOGY 1. Direct violence as may be caused during jumping, accidental slipping, etc. (Traumatic dislocation). 2. Due to some pathological condition affecting the joint, articular ligaments or paralysis of certain muscles (Pathological dislocation). 3. Dislocation sometimes occur congenitally (Congenital dislocation).
PROGNOSIS In congenital and pathological dislocation the prognosis is unfavourable. dislocation the prognosis is guarded. In traumatic
SYMPTOMS 1 In a dislocation there is usually rupture of the joint capsule and sprain of the articular ligaments.. 2. There is either immobility or restricted mobility of the affecte. Sometimes increased mobility of a dislocated bone can be produced if all the articular ligaments and the joint capsule are ruptured. 3. Functional interference. There is inability symptom of dislocation. 4. Deformity of the limb as a whole. 5. Inflammatory swelling may be noticed around the joint
Differential Diagnosis Differential diagnosis between fracture and dislocation are: 1. the pain due to dislocation is constant; there is no period of numbness as in fracture. 2.The tenderness present in dislocation is less intense and more diffuse than it is in a fracture. 3. In fracture, when the concerned extremities are moved there is crepitation, whereas in dislocation there is rather a rocking noise. In dislocation crepitation is absent unless there is associated fracture also. (Sometimes, however, a fracture and dislocation may occur together involving the same bones.) 4. A fracture when reduced recurs immediately unless properly supported. A dislocation once reduced has very little tendency to re-occur provided rest is given.
5. A rather constant muscle spasm and rigidity about the injured part is maintained in dislocation 6. The local symptoms of dislocation are noticed in the viscinity of a joint. In fracture it need not be so, unless it is close to the joint. 7. The normal appearance of the joint is altered in dislocation. For example, in the posterior dislocation of the elbow joint when the olecranon is displaced from the corresponding fossa of the humerus the usual triangular relationship between the olecranon and the condyles of the humerus is altered.
Cont. 8. In dislocation the limb is often fixed in a particular posture and movement is generally restricted; abnormal and free mobility is characteristic of fracture. 9. The abnormal posture of the limb is fairly suggestive of the type of dislocation. 10. Radiography or fluorosecopy may be necessary to confirm the diagnosis in certain cases.
PROGNOSIS The prognosis varies according to the nature of dislocation and the extent of injury to the articular ligaments and other soft tissues. If correction of displacement is delayed, the articular cavity may be filled with blood-tinged inflammatory exudates. When a dislocation is not corrected, a false joint (pseudoarthorsis) may form When there is an open wound communicating with the joint, it sometimes leads to septic arthristis
