NS and config

pages/Acute Kidney Injury.md

@@ -0,0 +1 @@
+alias:: AKI

pages/Disease.md

@@ -44,14 +44,12 @@
 		- ### Expected Course
 			- #### With Treatment
 			- #### Without Treatment
+				- ##### Possible Complications
+				- ##### Long-Term Effects
 		- ### Survival Rates
 			- #### With Treatment
 			- #### Without Treatment
 		- ### Quality of Life Considerations
-	- ## Complications
-	  background-color:: blue
-		- ### Possible Complications
-		- ### Long-term Effects
 	- ## Prevention
 	  background-color:: blue
 		- ### Health Education

pages/Echocardiography.md

@@ -5,6 +5,7 @@ alias:: ECG, EKG
 	- [[The Only EKG Book You’ll Ever Need]]
 	- https://litfl.com/
 	- https://en.ecgpedia.org/
+	- {{video https://www.youtube.com/watch?v=yLhO60Us3bo}}
 - ECG Sheet
 	- sheet
 		- interval of 2.5 seconds

pages/Gall Ink.md

@@ -0,0 +1,6 @@
+# Procedure
+	- crush oak galls
+	- let them soak in distilled water(traditionally rain water) for few days for a brownish liquid to form
+	- Mix in the distilled water with ferrous salt
+	- Dilute the ink with some more distilled water with gum arabic in dissolved in it
+	- Follow disinfection at all steps to prevent mould formation

pages/Generalized Edema.md

@@ -0,0 +1 @@
+definition:: Accumulation of fluid in serous cavities giving rise to ascites, pleural & pericardial effusion

pages/Haemoconcentration.md

@@ -0,0 +1 @@
+definition:: Contraction of intravascular volume

pages/Library.md

@@ -7,6 +7,7 @@
 		- [[Differential Diagnosis of Common Complaints]]
 		- [[Paediatrics]]
 			- [[Step on to Paediatrics]]
+			- [[Nelson Textbook of Pediatrics]]
 	- [[Surgery]]
 		- [[General Surgery]]
 			- [[Bailey & Love's Short Practice of Surgery]]

pages/Medicine.md

@@ -1,3 +1,4 @@
+- {{video https://www.youtube.com/watch?v=3iZ4tKD4C9A}}
 - Cardiovascular System
 	- [[Hypertension]] #fahim
 	- [[Heart Failure]]  #fahim

pages/Minimal Change Nephrotic Syndrome.md

@@ -0,0 +1 @@
+alias:: MCNS

pages/Nelson Textbook of Pediatrics.md

@@ -0,0 +1 @@
+- ![Nelson Textbook of Pediatrics.pdf](../assets/Nelson_Textbook_of_Pediatrics_1731793708172_0.pdf)

pages/Nephrotic Syndrome.md

@@ -1,39 +1,188 @@
-- alias::
-  ICD-11_Code::
+alias:: NS
+source:: ((67391705-7e88-4abf-84ec-c43365722458)) [[Nelson Textbook of Pediatrics]] 
+ICD-11_Code::
+Here by Nephrotic Syndrome, [[Minimal Change Nephrotic Syndrome]] is meant for most of the parts
+
 - ## Etiology
   background-color:: blue
-	- ### Causative Agents
-	- ### Risk Factors
+	- ## Idiopathic Nephrotic Syndrome
+		- Minimal Change Disease
+		- Mesangial Proliferation
+		- Focal Segmental glomerulosclerosis
+		- Membranous nephropathy
+		- Glomerulonephritis associated with nephrotic syndrome membranoproliferative glomerulonephritis, crescentic glomerulonephritis, immunoglobulin A nephropathy
+	- ## Secondary causes
+		- ### Infections
+			- Endocarditis
+			- Post- streptococcal
+			- Hepatitides B, C
+			- HIV- 1
+			- Infectious mononucleosis
+			- Cytomegalovirus
+			- Malaria
+			- Syphilis (congenital and secondary)
+			- Toxoplasmosis
+			- Tuberculosis
+			- Schistosomiasis
+			- Filariasis
+		- ### Drugs
+			- [[Captopril]]
+			- [[Penicillamine]]
+			- [[Gold]]
+			- [[NSAIDS]]
+			- [[Pamidronate]], other bisphosphates
+			- [[Interferon]]
+			- [[Mercury]]
+			- [[Heroin]]
+			- [[Lithium]]
+			- [[Rifampicin]]
+			- [[Sulfasalazine]]
+		- ### Immunological or Allergic Disorders
+			- [[Vasculitis Syndromes]]
+			- [[Castleman Disease]]
+			- [[Kimura Disease]]
+			- [[Bee Sting]]
+			- [[Snake Venom]]
+			- Food Allergens
+			- [[Serum Sickness]]
+			- Poison ivy
+			- Poison oak
+		- ### Associated with Malignant Disease
+			- *[[Wilms Tumor]]*
+			- [[Lymphoma]]
+			- [[Pheochromocytoma]]
+			- [[Leukemia]]
+			- [[Thymoma]]
+			- Solid Tumors
 - ## Epidemiology
   background-color:: blue
 	- ### Incidence
+		- The commonest kidney problem in children
+		- Incidence: 2-7 per 100, 000 children <16 years of age
+		- Common in between 2 to 8 years
+		- Peak age of onset: Around 3 year
+		- 85% of total nephrotic syndrome in children is [[MCNS]]
+		- ((673919e2-2a88-45ae-ba9f-a2b48d3e4a8e))
+		  ((67391a0f-8b9c-4d27-950e-64c7a30f6688))
 	- ### Prevalence
 		- ### Demographics
 	- ### Geographic Distribution
 - ## Pathophysiology
   background-color:: blue
 	- ### Mechanism of Disease
+		- Pathogenesis
+			- Immune-mediated
+			  logseq.order-list-type:: number
+			- Systemic circulating factors (eg, suPAR)
+			  logseq.order-list-type:: number
+			- Podocyte related factors (eg, ANGPTL4)
+			  logseq.order-list-type:: number
+			- Genetic Variants
+			  logseq.order-list-type:: number
+		- Mutant proteins play roles in
+			- Nucleus
+			  logseq.order-list-type:: number
+			- Mitochondria
+			  logseq.order-list-type:: number
+			- Lysosomes
+			  logseq.order-list-type:: number
+			- Actin
+			  logseq.order-list-type:: number
+			- Slit diaphragm
+			  logseq.order-list-type:: number
+			- Basement membrane
+			  logseq.order-list-type:: number
 	- ### Affected Systems/Organs
+		- Damage to the podocytes (effacement of foot process)
+		- Increase permeability of GFB
+		- ↑↑passage of albumin across GFB into the urinary space
+		- This massive albumin loss in urine(Albuminuria) gives rise to hypoalbuminemia with fall of plasma Colloidal osmotic pressure. As a result, fluid shifts from plasma to interstitial space, resulting in
+			- [[Generalized Edema]]
+			- [[Haemoconcentration]] as reduced blood colloidal osmotic pressure
+		- Further retaining of fluid leading to Edema
+			- The Haemoconcentration in turn activates the renin angiotensin aldosterone system and promotes release of ADH
+			- This causes the body to retain more fluid, reduced GFR and oligouria
+		- Raised Cholesterol and Triglycerides
+			- Hypoalbuminaemia induces lipoprotein synthesis in liver which causes elevation of cholesterol and triglycerides in blood
+- # Essential Characteristics of MCNS
+	- No appreciable glomerular pathology, noted in light microscopy but effacement of foot processes of podocytes in GBM seen under electron microscope
+	- Prompt respose to steroid but high tendency to relapse
+	- Not associated with hypertension, hematuria and azoteaemia
 - ## Clinical Features
   background-color:: blue
 	- ### Signs and Symptoms
+		- The affected children may present as initial case or may present with History of recurrent attacks(replapse) with
 		- #### Symptoms
+			- Anorexia
+			- Irritability
+			- Abdominal pain
+			- Diarrhoea
+			- Scanty urination (color usually normal)
 		- #### Signs
+			- Facial puffiness, massive peri-orbital swelling
+			- Generalized oedema
 	- ### Stages or Classification
 	- ### Diagnostic Criteria
 - ## Diagnosis
   background-color:: blue
 	- ### Clinical Diagnosis
 		- #### Classical Presentation
-			-
+			- Following minor infections and uncommonly reactions to insect bites, bee stings, or poison ivy
+			- Mild edema, initially periorbital which decreases throughout the day and the edema becomes generalized
+			  possibly misdiagnosed as allergic disorder
+			- Anorexia, irritability, abdominal pain, diarrhoea
 		- #### Probable Diagnosis
+		- Diagnosis other than [[MCNS]] should be considered in children <1 year of age, with a positive family history of nephrotic syndrome, and/or presence of extrarenal findings (e.g., arthritis, rash, anemia), hypertension or pulmonary edema, acute or chronic renal insufficiency, and gross hematuria
 	- ### Laboratory Tests
+		- Urine RME with the first morning urine : 3+ or 4+ (20% sensitive)
+		- 24 hour timed collection of urine for protein quantification
+		- spot Urine Protein : Creatinine ratio >2.0
+		- Creatinine : normal
+		  may be abnormally elevated if there is diminished renal perfusion from contractiion of teh intravascular volume
+		- Serum Albumin : < 2/5 g/dL
+		- Serum Cholesterol and Triglycerides : elevated
+		- complement C3 and C4 levels : normal
+		  (decreased C3 in glomerulonephritis)
+		- CBC
+		- Serum electrolytes
+		- BUN
+		- Glomerular filtration rate
+		- Antinuclear and anti-streptococcal antibodies
+		- Antineutrophilic cytoplastic antibodies
 	- ### Imaging Studies
+		- Kidney ultrasound may be considered to exclude renal maformations and venous thrombosis but is not mandatory
+	- ### Renal Biopsy
+		- Renal biopsy is not routinely performed if the patient fits the standard clinical picture of MCNS
+		- should be considered for renal biopsy if
+			- Age <1 year or >12 years
+			- Persistent or sustained elevation in creatinine
+			- Significant hematuria or gross hematuria
+			- sustained hypertension
+			- Hypocomplementemia
+			- Findings indicative of another autoimmune disease
+			- Infection with Hepatitis B or C, HIV, or tuberculosis
+			- Glucocorticoid resistance
+			- [[AKI]]
+			- Arthritis
+			- Rash
 	- ### Differential Diagnosis
+		- #### Differential Diagnosis
+		  *child with marked edema*
+			- Protein losing enteropathy
+			- Hepatic Failure
+			- Heart Failure
+			- Acute or chronic glomerulonephritis
+			- Protein malnutrition
 	- ### Confirmation of Diagnosis
+		- labs, imaging and biopsy not necessary
 - ## Management and Treatment
   background-color:: blue
+	- First episode of nephrotic syndroem and mild to moderate edema may be managed as outpatients.
+	- But, not practiced as outpatient, as educating parents regarding all aspects of the condition can require a short period of hospitalization
+	- The child's parents must be able to recognize the signs and symptoms of the complications of the disease and may be taught how to use a dipstick and interpret the results to monitor for the degree of proteinuria
 	- ### Medical Treatment
+		- More than 95% of children with minimal change disease respond to corticosteroid therapy
+		- Tuberculosis must be ruled out before starting immunosuppressive therapy with corticosteoids by placing a purified protein derivative skin test or obtaining an interferon-gamma release assay and confirming a negative result
 	- ### Surgical Options
 	- ### Lifestyle and Dietary Recommendations
 	- ### Follow-up
@@ -42,9 +191,18 @@
 	- ### Expected Course
 		- #### With Treatment
 		- #### Without Treatment
+			- Cough & respiratory distress (pneumonia, pleural effusion, huge ascites)
+			- Abdominal pain(gut ischemia, peritonitis, renal vein thrombosis)
+			- Pain, redness & tendreness of skin(cellulitis)
+			- Fever & dysuria (UTI)
+			- Diarrhoea(impaired absorption of foods due to oedema of the bowel wall)
+			- Neurodeficit like hemiplegia (stroke from thrombo-embolism due to haemoconcentration)
 	- ### Survival Rates
 		- #### With Treatment
+			- Remission achieved after 8 week of oral corticosteroid therapy : 90%
 		- #### Without Treatment
+			- ##### Possible Complications
+			- ##### Long-Term Effects
 	- ### Quality of Life Considerations
 - ## Complications
   background-color:: blue

pages/Surgery.md

@@ -1,3 +1,3 @@
+- {{video https://www.youtube.com/watch?v=0rYNCAWORro}}
 - [[ENT]]
-- [[Opthalmology]]
--
+- [[Opthalmology]]

pages/hls__Nelson_Textbook_of_Pediatrics_1731793708172_0.md

@@ -0,0 +1,22 @@
+file:: [Nelson_Textbook_of_Pediatrics_1731793708172_0.pdf](../assets/Nelson_Textbook_of_Pediatrics_1731793708172_0.pdf)
+file-path:: ../assets/Nelson_Textbook_of_Pediatrics_1731793708172_0.pdf
+
+- Chapter 567
+  ls-type:: annotation
+  hl-page:: 3257
+  hl-color:: yellow
+  id:: 67391705-7e88-4abf-84ec-c43365722458
+- [:span]
+  ls-type:: annotation
+  hl-page:: 3259
+  hl-color:: yellow
+  id:: 673919e2-2a88-45ae-ba9f-a2b48d3e4a8e
+  hl-type:: area
+  hl-stamp:: 1731795421003
+- [:span]
+  ls-type:: annotation
+  hl-page:: 3260
+  hl-color:: yellow
+  id:: 67391a0f-8b9c-4d27-950e-64c7a30f6688
+  hl-type:: area
+  hl-stamp:: 1731795463500