#hemodialysis charges

[nefronkidneycare]

An arteriovenous fistula (AV fistula) is a vascular access used for hemodialysis treatments in people with end stage renal disease (ESRD). It is the preferred vascular access type for hemodialysis because it is associated with fewer complications and better long-term outcomes than other types. Contact us now.

[freshrn]

[Encore] ICU Equipment Deep Dive: A Revisit with Sean Dent

In this episode, we are re-sharing an episode where we sit down with Sean Dent, DNP ACNP APRN, a highly experienced ICU nurse practitioner. We dig deep into the types of equipment you’ll run into in the ICU. These include:

Arterial lines

Different options for monitoring fluid status

Cooling devices

CRRT

Hemodialysis catheters

Impellas and aortic balloon pumps

Internal pacing

Proning devices 

These episodes were originally recorded in 2019, but the information is still incredibly relevant today for ICU nurses. This content is for informational purposes only; best practices may have changed. 

For ALL of our ICU nursing content: ​​https://www.freshrn.com/critical-care-icu-nursing/ 

For our free mini-course ICU Drips For Beginners, click here: https://courses.freshrn.com/p/icu-drips-for-beginners 

To learn more about our comprehensive ICU prep course, Breakthrough ICU: A Crash Course For New ICU Nurses, click here: https://courses.freshrn.com/p/breakthrough-icu 

Learn more about the FreshRN All-Access Pass here - https://courses.freshrn.com/p/membership

To see our latest course catalog (med-surg, ICU, precepting, charge nurse, ortho, cardiac, neuro courses and more), click here: https://courses.freshrn.com/

Get weekly tips, encouragement, stories from the bedside, and more - just for nursing students and new nurses at: https://www.freshrn.com/email-sign-up/ 

Connect With Me Online!

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Music credit: Keep My Cool by Benj Heard

  Check out this episode!

[brookstonalmanac]

Events 3.9

141 BC – Liu Che, posthumously known as Emperor Wu of Han, assumes the throne over the Han dynasty of China. 1009 – First known mention of Lithuania, in the annals of the monastery of Quedlinburg. 1226 – Khwarazmian sultan Jalal ad-Din conquers the Georgian capital of Tbilisi. 1230 – Bulgarian Tsar Ivan Asen II defeats Theodore of Epirus in the Battle of Klokotnitsa. 1500 – The fleet of Pedro Álvares Cabral leaves Lisbon for the Indies. The fleet will discover Brazil which lies within boundaries granted to Portugal in the Treaty of Tordesillas in 1494. 1701 – Safavid troops retreat from Basra, ending a three-year occupation. 1765 – After a campaign by the writer Voltaire, judges in Paris posthumously exonerate Jean Calas of murdering his son. Calas had been tortured and executed in 1762 on the charge, though his son may have actually died by suicide. 1776 – The Wealth of Nations by Scottish economist and philosopher Adam Smith is published. 1796 – Napoléon Bonaparte marries his first wife, Joséphine de Beauharnais. 1811 – Paraguayan forces defeat Manuel Belgrano at the Battle of Tacuarí. 1815 – Francis Ronalds describes the first battery-operated clock in the Philosophical Magazine. 1841 – The U.S. Supreme Court rules in the United States v. The Amistad case that captive Africans who had seized control of the ship carrying them had been taken into slavery illegally. 1842 – Giuseppe Verdi's third opera, Nabucco, receives its première performance in Milan; its success establishes Verdi as one of Italy's foremost opera composers. 1842 – The first documented discovery of gold in California occurs at Rancho San Francisco, six years before the California Gold Rush. 1847 – Mexican–American War: The first large-scale amphibious assault in U.S. history is launched in the Siege of Veracruz. 1862 – American Civil War: USS Monitor and CSS Virginia (rebuilt from the engines and lower hull of the USS Merrimack) fight to a draw in the Battle of Hampton Roads, the first battle between two ironclad warships. 1908 – Inter Milan was founded on Football Club Internazionale, following a schism from A.C. Milan. 1916 – Mexican Revolution: Pancho Villa leads nearly 500 Mexican raiders in an attack against the border town of Columbus, New Mexico. 1933 – Great Depression: President Franklin D. Roosevelt submits the Emergency Banking Act to Congress, the first of his New Deal policies. 1942 – World War II: Dutch East Indies unconditionally surrendered to the Japanese forces in Kalijati, Subang, West Java, and the Japanese completed their Dutch East Indies campaign. 1944 – World War II: Soviet Army planes attack Tallinn, Estonia. 1945 – World War II: A coup d'état by Japanese forces in French Indochina removes the French from power. 1945 – World War II: Allied forces carry out firebombing over Tokyo, destroying most of the capital and killing over 100,000 civilians. 1946 – Bolton Wanderers stadium disaster at Burnden Park, Bolton, England, kills 33 and injures hundreds more. 1954 – McCarthyism: CBS television broadcasts the See It Now episode, "A Report on Senator Joseph McCarthy", produced by Fred Friendly. 1956 – Soviet forces suppress mass demonstrations in the Georgian SSR, reacting to Nikita Khrushchev's de-Stalinization policy. 1957 – The 8.6 Mw  Andreanof Islands earthquake shakes the Aleutian Islands, causing over $5 million in damage from ground movement and a destructive tsunami. 1959 – The Barbie doll makes its debut at the American International Toy Fair in New York. 1960 – Dr. Belding Hibbard Scribner implants for the first time a shunt he invented into a patient, which allows the patient to receive hemodialysis on a regular basis. 1961 – Sputnik 9 successfully launches, carrying a dog and a human dummy, and demonstrating that the Soviet Union was ready to begin human spaceflight. 1967 – Trans World Airlines Flight 553 crashes in a field in Concord Township, Ohio following a mid-air collision with a Beechcraft Baron, killing 26 people. 1974 – The Mars 7 Flyby bus releases the descent module too early, missing Mars. 1976 – Forty-two people die in the Cavalese cable car disaster, the worst cable-car accident to date. 1977 – The Hanafi Siege: In a 39-hour standoff, armed Hanafi Muslims seize three Washington, D.C., buildings. 1978 – President Soeharto inaugurated Jagorawi Toll Road, the first toll highway in Indonesia, connecting Jakarta, Bogor and Ciawi, West Java. 1987 – Chrysler announces its acquisition of American Motors Corporation 1997 – Comet Hale–Bopp: Observers in China, Mongolia and eastern Siberia are treated to a rare double feature as an eclipse permits Hale-Bopp to be seen during the day. As the comet made its closest approach to Earth on March 26, all 39 active members of the Heaven's Gate cult committed ritual mass suicide over a period of three days, in the belief that their spirits would be teleported into an alien spacecraft flying inside the comet's tail. 1997 – The Notorious B.I.G. is murdered in Los Angeles after attending the Soul Train Music Awards. He is gunned down leaving an after party at the Petersen Automotive Museum. His murder remains unsolved. 2011 – Space Shuttle Discovery makes its final landing after 39 flights. 2012 – A truce between the Salvadoran government and gangs in the country goes into effect when 30 gang leaders are transferred to lower security prisons.

[newspress24-blog]

The Cashier in Dubai

Investigative report tracks tangled route for money flowing to offshore companies from Moldova.

Part One

Moldovan oligarch Vladimir Plahotniuc left his home country in 2019 to avoid corruption charges. But an investigation into his business affairs, supported by newspress24-blog, shows that money continued to flow into his pockets long after he fled.

Black Box Plus, the investigative show of Moldova’s independent Tv channel TV8, acquired documents showing that Plahotniuc profited from every document Moldova’s Public Services Agency (ASP) issued between 2014-2019. Black Box TV followed the traces left by the businessman Alexandru Vilcu and Vladimir Andronachi, a former lawmaker with the Democratic Party (PD).

Documents show that the money reached Plahotniuc via Garsų Pasaulis, the Lithuanian printing house that won the public procurements for supplying blank cards the ASP uses to issue Moldovan documents, including passports. The financial circuit leads to a network of offshore companies registered in Cyprus, Hong Kong and the United Arab Emirates (UAE).

In the summer of 2020, the scheme Plahotniuc built over the years was taken over by two Bulgaria-registered companies that appeared overnight.

These companies were the identical financial offshore vehicles through which Plahotniuc, former leader of the PD, raised alleged dividends from the auctions organised by the state telecom company Moldtelecom, the purchase of electricity from the breakaway region of Transnistria, the public-private partnership for hemodialysis services and the so–called heist of one billion US dollars from the Moldovan banking system.

The Lithuanian UAB (an acronym of uždaroji akcine bendrove, or private limited company) started supplying blank cards for Moldovan passports following tenders in 2014 and 2017. The main beneficiary of the Garsu Pasaulis company is Albert Mario Karaziwan, a Belgian citizen who owns Semlex Europe, an identification document and biometric device production company whose business practices have come under scrutiny. The Syrian-Belgium businessman has been targeted in several countries in criminal corruption cases and journalistic investigations by Reuters and OCCRP.

In 2014, Moldova’s minister of information and communications technology was Plahotniuc’s fellow party member Pavel Filip. The CRIS Registru state enterprise which in 2017 was re-organised as ASP, was headed by Sergey Railean, godfather of Filip's older son.

Between 2014 and 2021, ASP transferred 59.5 million euros to the Garsu Pasaulis company "for raw material, blank cards and personalisation services," according to documents obtained by Black Box.

ASP also paid the Lithuanian company a royalty fee for software developed for Moldova and used on three types of documents. For example, the royalty fee for each passport issued was 13.61 euros (14.49 US dollars). On October 22, 2021, prosecutors opened a criminal case against nine people from the Public Services Agency “targeted in a criminal case of abuse of office”. Prosecutors estimated that the state lost around 41 million euros (43.6 million dollars) in the case.

A LONG AND TANGLED PATH

A note from the Moldovan service for the Prevention and Combating of Money Laundering obtained by Black Box shows that more than 24 million euros (25.54 million dollars) did not stop in the company's accounts in Vilnius but ended up in Cyprus and the UAE.

“Of the 135 payments made throughout this period [2014-2019], I can tell you that the final beneficiary is obvious. At least, from what the criminal investigation bodies say, it is clear that the actual beneficiary is Vladimir Plahotniuc,” said ASP director Mircea Esanu.

Sergey Railean, the ASP former director under whose mandate the two contracts with Garsu Pasaulis were signed, said that he knew nothing about benefits for Plahotniuc.

"The tender took place according to the procedures. Therefore, nothing was outside the law," Railean said.

Told that Black Box reporters had established money transfers from Garsu Pasaulis to offshore companies affiliated with Plahotniuc, Railean was asked if he knew anything about it.

"No, absolutely not. Now it is a criminal case. The file must be completed after the trial,"he said. “[…] We did not order any software."

Railean added that ASP paid royalty fees to Garsu Pasaulis "because that was the contract".

On May 5, 2022 the Moldovan anti-corruption prosecutor's office announced that Railean had the status of accused in the so-called passport affair.

Filip, who held the post of prime minister in 2016-2019, did not answer the phone calls or requests for comment.

In May 2018, during a TV show broadcast by Prime, one of Plahotniuc's TV stations, Filip hinted that the state signed a more advantageous contract with Garsu Pasaulis than the previous one agreed in 2011 with a French company.

In 2011, Garsu Pasaulis had in fact tried to win a tender, but its application failed as it did not meet ASP’s criteria. A key condition was that applicants had experience manufacturing electronic passports for at least three European countries, as established by a decision of the Supreme Court of Justice. Garsu Pasaulis did not meet this requirement.

Garsu Pasaulis replied via e-mail that the company won the tenders and successfully delivered blank passport cards for ASP.

“As for the exact details of other commercial contracts, we cannot provide any details as confidentiality commitments bind us,” Andrius Lukosevicius, director of Garsu Pasaulis’ printing security department, wrote. “However, we can confirm that we have never had and do not currently have commercial or other relations with Mr Plahotniuc and [Romanian businesswoman] Mrs Ileana-Mihaela Burcea.”

The passport cash headed south, to the UAE firm Prime Union Solutions FZ LLC. Between January 1, 2018 and July 30, 2019 itreceived transfers for over 4.7 million euros ( five million dollars) from Garsu Pasaulis. The money continued to flow into Plahotniuc's coffers even after he fled Moldova in June 2019 when his name was linked to the disappearance of over a billion dollars - nearly one-eighth of Moldova's GDP - from the country's biggest banks between 2012 and 2014.

Employees at the Moldovan Money Laundering Prevention and Combating Service obtained information from their colleagues in Dubai and stated that the company's majority shareholders were the Romanian citizen Ileana-Mihaela Burcea and the company Inter Gnathonize Limited.

Between October 29, 2018, and July 30, 2019, a total of seven million euros (about 7.4 million dollars) were credited into Prime Union Solutions’ UAE bank account, largely sent from Garsu Pasaulis. The money then traveled to Burcea’s private account in UAE and six other offshore companies.

In liaison with UAE and Cyprus’ authorities, Moldova’s law enforcement agencies determined that Garsu Pasaulis transferred another 19.6 million euros (20.8 million dollars) to another Cyprus offshore company, Gnathonize Limited, also connected to Burcea.

The Cypriot firm opened a bank account in July 2014, four months after Garsu Pasaulis won the Moldova tender. The Lithuanian firm was the main contributor to the account until August 2018. After that, the money was transferred to the company Prime Union INC LTD in Hong Kong and marked as a "dividend payment".

Part Two

Documents from the Hong Kong public registry show that Burcea was one of Prime Union’s shareholders and in 2014-2019 the director. In 2020, Burcea requested the closing of the company. In 2018, over 600,000 euros (639,000 dollars) were transferred from one of Prime Union’s bank accounts to another offshore in Gibraltar.

In addition, 1.5 million euros (1.6 million dollars) arrived in Burcea`s personal account in the UAE and almost 800,000 euros (852,600 dollars) were directed to Recon Business Data Service, a company registered in Dubai led by Burcea. The company was closed in December 2019.

Burcea’s lawyer Cristina Savulescu declined to comment on the financial transfers from Garsu Pasaulis to her client. She also did not comment on Burcea’s connection with Plahotniuc. Savulescu said that any association of her client with an alleged criminal case was damaging to her client's image.

"The judicial procedure in any criminal case, from the time of notification to the competent bodies until the time of sending a particular person to court, is non-public and confidential, meaning that third parties cannot know the content of the carried-out procedures," Savulescu said.

Documents obtained by Black Box with the support of the OCCRP network of investigative journalists show that Plahotniuc used the same infrastructure of offshore companies to take yet more funds out of Moldova.

The former politician used the offshore network for the money obtained from other auctions organised by state enterprises including Moldtelecom, Moldova’s largest telecommunication operator, gas supplier Energocom and the health ministry for dialysis-related services.

The UAE’s Recon Business Data Services, connected to Burcea, was also involved in the financial circuit of money leaked by Plahotniuc from another scheme related to Moldtelecom, concerning public tenders won by Bass Systems SRL in PD`s ruling period.

Between March 2017 to January 2019 the Chisinau-based IT company delivered technical equipment and services for Moldtelecom worth about 41 million euros (43.6 million dollars). Out of this amount, eight million euros (8.5 million dollars) and six million dollars followed the same route to the UAE through Recon Business Data Services.

OFFSHORE ACCOUNTS

Another document obtained from the Moldovan service for the Prevention and Combating of Money Laundering shows that the Dubai-based company made several transactions to two offshores used by Plahotniuc: the UAE-based Vanguard International LTD and Vanguard International Group, registered in Samoa.

Both companies appeared in Plahotniuc's wealth statements in 2018. However, in the document submitted to Moldova’s Central Electoral Commission on the eve of the February 24, 2019 parliamentary elections, the oligarch declared 4.5 million euros (4.78 million dollars), over 11 million lei (around 585,000 dollars) and 347,000 dollars as dividends obtained from the Dubai-based Vanguard International Ltd.

Moldovan prosecutors established the origin of the money collected by Plahotniuc as "dividends".

Vanguard International LTD received 8.2 million euros (8.72 million dollars) and 2.5 million dollars from UAE-registered RECON SPC LIMITED from December 2017 to May 2019.

Burcea and another Romanian citizen, Silviu Tutuianu, were behind the company in different periods. Almost the entire amount came from the other similarly named firm, the Dubai-based Recon Business Data Service.

Plahotniuc also collected "dividends" worth 1.7 million euros (1.80 million dollars) and almost 350,000 US dollars through another offshore company, TGME INVESTMENTS SPC LTD, managed by Tutuianu.

All these companies were liquidated between the end of 2019 and the beginning of 2020, after Plahotniuc fled Moldova. The Moldovan anti-corruption prosecutor's office opened a case for the purchase of equipment and services by Moldtelecom from SRL Bass Systems. The prosecutors confirmed that Burcea was interviewed in this criminal case, but did not disclose her status.

Burcea also managed a company that benefited from transfers from Plahotniuc’s Cyprus-registered Asia Pacific Textile Limited. This had transactions with the Cypriot offshore Melopmania Limited, the founder of BB-Dializa, a company which managed the dialysis services for the Moldovan health ministry.

BB Dializa also benefited from legal services from Cyprus-registered Kinanis offshore, founded by Burcea. The company also provided secretarial and legal services for Assentis Holdings Limited, one of the founders of Bass Systems SRL.

Asia Pacific Textile LTD received money from the Energokapital shell company. Between 2014 and 2016, the firm was used by Plahotniuc and Evgheni Shevciuk, former leader of Moldova’s breakaway region of Transnistria, to sell the electricity produced by the Russian-owned Moldgres Power Plant to Moldovan consumers.

The Black Box team tracked Energokapital's connections with Plahotniuc and the involvement of former DP deputy Vladimir Andronachi in the company's management.

Moldova’s service for the Prevention and Combating of Money Laundering established the connection between Burcea and two other offshore companies involved in looting a billion dollars from the country’s banking system: Sharp Prospects Limited and Lazomar Trading Limited, registered in Hong Kong and Cyprus respectively.

According to an international independent financial audit named the Kroll report, the Lazomar company received 5.6 million dollars in transfers to a Cypriot bank account. The Kroll report was commissioned by the National Bank of Moldova to investigate the theft that ravaged the country’s banking system.

Plahotniuc did not respond to requests for comment. His lawyer Lucian Rogac said that the former politician pleaded not guilty in the case generically called "blank passport cards".

"An indictment was presented to us. Other evidence to prove guilt was not shown by the prosecution. The only comment I can give you is that my client pleads not guilty to the charges," Rogac said.

In September 2022 Plahotniuc received an arrest warrant in absentia regarding the "blank passport cards" case, alongside Vladislav Zara, former director of the civil registry ASP, ex-PD deputy Andronachi and businessman Alexandru Vilcu. All of them have fled the country. According to Moldova’s ministry of justice, Plahotniuc is currently in Northern Cyprus.

[rmlnewstimes]

The Cashier in Dubai

Investigative report tracks tangled route for money flowing to offshore companies from Moldova.

Part One

Moldovan oligarch Vladimir Plahotniuc left his home country in 2019 to avoid corruption charges. But an investigation into his business affairs, shows that money continued to flow into his pockets long after he fled.

Black Box Plus, the investigative show of Moldova’s independent Tv channel TV8, acquired documents showing that Plahotniuc profited from every document Moldova’s Public Services Agency (ASP) issued between 2014-2019. Black Box TV followed the traces left by the businessman Alexandru Vilcu and Vladimir Andronachi, a former lawmaker with the Democratic Party (PD).

Documents show that the money reached Plahotniuc via Garsų Pasaulis, the Lithuanian printing house that won the public procurements for supplying blank cards the ASP uses to issue Moldovan documents, including passports. The financial circuit leads to a network of offshore companies registered in Cyprus, Hong Kong and the United Arab Emirates (UAE).

In the summer of 2020, the scheme Plahotniuc built over the years was taken over by two Bulgaria-registered companies that appeared overnight.

These companies were the identical financial offshore vehicles through which Plahotniuc, former leader of the PD, raised alleged dividends from the auctions organised by the state telecom company Moldtelecom, the purchase of electricity from the breakaway region of Transnistria, the public-private partnership for hemodialysis services and the so–called heist of one billion US dollars from the Moldovan banking system.

The Lithuanian UAB (an acronym of uždaroji akcine bendrove, or private limited company) started supplying blank cards for Moldovan passports following tenders in 2014 and 2017. The main beneficiary of the Garsu Pasaulis company is Albert Mario Karaziwan, a Belgian citizen who owns Semlex Europe, an identification document and biometric device production company whose business practices have come under scrutiny. The Syrian-Belgium businessman has been targeted in several countries in criminal corruption cases and journalistic investigations by Reuters and OCCRP.

In 2014, Moldova’s minister of information and communications technology was Plahotniuc’s fellow party member Pavel Filip. The CRIS Registru state enterprise which in 2017 was re-organised as ASP, was headed by Sergey Railean, godfather of Filip's older son.

Between 2014 and 2021, ASP transferred 59.5 million euros to the Garsu Pasaulis company "for raw material, blank cards and personalisation services," according to documents obtained by Black Box.

ASP also paid the Lithuanian company a royalty fee for software developed for Moldova and used on three types of documents. For example, the royalty fee for each passport issued was 13.61 euros (14.49 US dollars). On October 22, 2021, prosecutors opened a criminal case against nine people from the Public Services Agency “targeted in a criminal case of abuse of office”. Prosecutors estimated that the state lost around 41 million euros (43.6 million dollars) in the case.

A LONG AND TANGLED PATH

A note from the Moldovan service for the Prevention and Combating of Money Laundering obtained by Black Box shows that more than 24 million euros (25.54 million dollars) did not stop in the company's accounts in Vilnius but ended up in Cyprus and the UAE.

“Of the 135 payments made throughout this period [2014-2019], I can tell you that the final beneficiary is obvious. At least, from what the criminal investigation bodies say, it is clear that the actual beneficiary is Vladimir Plahotniuc,” said ASP director Mircea Esanu.

Sergey Railean, the ASP former director under whose mandate the two contracts with Garsu Pasaulis were signed, said that he knew nothing about benefits for Plahotniuc.

"The tender took place according to the procedures. Therefore, nothing was outside the law," Railean said.

Told that Black Box reporters had established money transfers from Garsu Pasaulis to offshore companies affiliated with Plahotniuc, Railean was asked if he knew anything about it.

"No, absolutely not. Now it is a criminal case. The file must be completed after the trial,"he said. “[…] We did not order any software."

Railean added that ASP paid royalty fees to Garsu Pasaulis "because that was the contract".

On May 5, 2022 the Moldovan anti-corruption prosecutor's office announced that Railean had the status of accused in the so-called passport affair.

Filip, who held the post of prime minister in 2016-2019, did not answer the phone calls or requests for comment.

In May 2018, during a TV show broadcast by Prime, one of Plahotniuc's TV stations, Filip hinted that the state signed a more advantageous contract with Garsu Pasaulis than the previous one agreed in 2011 with a French company.

In 2011, Garsu Pasaulis had in fact tried to win a tender, but its application failed as it did not meet ASP’s criteria. A key condition was that applicants had experience manufacturing electronic passports for at least three European countries, as established by a decision of the Supreme Court of Justice. Garsu Pasaulis did not meet this requirement.

Garsu Pasaulis replied via e-mail that the company won the tenders and successfully delivered blank passport cards for ASP.

“As for the exact details of other commercial contracts, we cannot provide any details as confidentiality commitments bind us,” Andrius Lukosevicius, director of Garsu Pasaulis’ printing security department, wrote. “However, we can confirm that we have never had and do not currently have commercial or other relations with Mr Plahotniuc and [Romanian businesswoman] Mrs Ileana-Mihaela Burcea.”

The passport cash headed south, to the UAE firm Prime Union Solutions FZ LLC. Between January 1, 2018 and July 30, 2019 itreceived transfers for over 4.7 million euros ( five million dollars) from Garsu Pasaulis. The money continued to flow into Plahotniuc's coffers even after he fled Moldova in June 2019 when his name was linked to the disappearance of over a billion dollars - nearly one-eighth of Moldova's GDP - from the country's biggest banks between 2012 and 2014.

Employees at the Moldovan Money Laundering Prevention and Combating Service obtained information from their colleagues in Dubai and stated that the company's majority shareholders were the Romanian citizen Ileana-Mihaela Burcea and the company Inter Gnathonize Limited.

Between October 29, 2018, and July 30, 2019, a total of seven million euros (about 7.4 million dollars) were credited into Prime Union Solutions’ UAE bank account, largely sent from Garsu Pasaulis. The money then traveled to Burcea’s private account in UAE and six other offshore companies.

In liaison with UAE and Cyprus’ authorities, Moldova’s law enforcement agencies determined that Garsu Pasaulis transferred another 19.6 million euros (20.8 million dollars) to another Cyprus offshore company, Gnathonize Limited, also connected to Burcea.

The Cypriot firm opened a bank account in July 2014, four months after Garsu Pasaulis won the Moldova tender. The Lithuanian firm was the main contributor to the account until August 2018. After that, the money was transferred to the company Prime Union INC LTD in Hong Kong and marked as a "dividend payment".

Part Two

Documents from the Hong Kong public registry show that Burcea was one of Prime Union’s shareholders and in 2014-2019 the director. In 2020, Burcea requested the closing of the company. In 2018, over 600,000 euros (639,000 dollars) were transferred from one of Prime Union’s bank accounts to another offshore in Gibraltar.

In addition, 1.5 million euros (1.6 million dollars) arrived in Burcea`s personal account in the UAE and almost 800,000 euros (852,600 dollars) were directed to Recon Business Data Service, a company registered in Dubai led by Burcea. The company was closed in December 2019.

Burcea’s lawyer Cristina Savulescu declined to comment on the financial transfers from Garsu Pasaulis to her client. She also did not comment on Burcea’s connection with Plahotniuc. Savulescu said that any association of her client with an alleged criminal case was damaging to her client's image.

"The judicial procedure in any criminal case, from the time of notification to the competent bodies until the time of sending a particular person to court, is non-public and confidential, meaning that third parties cannot know the content of the carried-out procedures," Savulescu said.

Documents obtained by Black Box with the support of the OCCRP network of investigative journalists show that Plahotniuc used the same infrastructure of offshore companies to take yet more funds out of Moldova.

The former politician used the offshore network for the money obtained from other auctions organised by state enterprises including Moldtelecom, Moldova’s largest telecommunication operator, gas supplier Energocom and the health ministry for dialysis-related services.

The UAE’s Recon Business Data Services, connected to Burcea, was also involved in the financial circuit of money leaked by Plahotniuc from another scheme related to Moldtelecom, concerning public tenders won by Bass Systems SRL in PD`s ruling period.

Between March 2017 to January 2019 the Chisinau-based IT company delivered technical equipment and services for Moldtelecom worth about 41 million euros (43.6 million dollars). Out of this amount, eight million euros (8.5 million dollars) and six million dollars followed the same route to the UAE through Recon Business Data Services.

OFFSHORE ACCOUNTS

Another document obtained from the Moldovan service for the Prevention and Combating of Money Laundering shows that the Dubai-based company made several transactions to two offshores used by Plahotniuc: the UAE-based Vanguard International LTD and Vanguard International Group, registered in Samoa.

Both companies appeared in Plahotniuc's wealth statements in 2018. However, in the document submitted to Moldova’s Central Electoral Commission on the eve of the February 24, 2019 parliamentary elections, the oligarch declared 4.5 million euros (4.78 million dollars), over 11 million lei (around 585,000 dollars) and 347,000 dollars as dividends obtained from the Dubai-based Vanguard International Ltd.

Moldovan prosecutors established the origin of the money collected by Plahotniuc as "dividends".

Vanguard International LTD received 8.2 million euros (8.72 million dollars) and 2.5 million dollars from UAE-registered RECON SPC LIMITED from December 2017 to May 2019.

Burcea and another Romanian citizen, Silviu Tutuianu, were behind the company in different periods. Almost the entire amount came from the other similarly named firm, the Dubai-based Recon Business Data Service.

Plahotniuc also collected "dividends" worth 1.7 million euros (1.80 million dollars) and almost 350,000 US dollars through another offshore company, TGME INVESTMENTS SPC LTD, managed by Tutuianu.

All these companies were liquidated between the end of 2019 and the beginning of 2020, after Plahotniuc fled Moldova. The Moldovan anti-corruption prosecutor's office opened a case for the purchase of equipment and services by Moldtelecom from SRL Bass Systems. The prosecutors confirmed that Burcea was interviewed in this criminal case, but did not disclose her status.

Burcea also managed a company that benefited from transfers from Plahotniuc’s Cyprus-registered Asia Pacific Textile Limited. This had transactions with the Cypriot offshore Melopmania Limited, the founder of BB-Dializa, a company which managed the dialysis services for the Moldovan health ministry.

BB Dializa also benefited from legal services from Cyprus-registered Kinanis offshore, founded by Burcea. The company also provided secretarial and legal services for Assentis Holdings Limited, one of the founders of Bass Systems SRL.

Asia Pacific Textile LTD received money from the Energokapital shell company. Between 2014 and 2016, the firm was used by Plahotniuc and Evgheni Shevciuk, former leader of Moldova’s breakaway region of Transnistria, to sell the electricity produced by the Russian-owned Moldgres Power Plant to Moldovan consumers.

The Black Box team tracked Energokapital's connections with Plahotniuc and the involvement of former DP deputy Vladimir Andronachi in the company's management.

Moldova’s service for the Prevention and Combating of Money Laundering established the connection between Burcea and two other offshore companies involved in looting a billion dollars from the country’s banking system: Sharp Prospects Limited and Lazomar Trading Limited, registered in Hong Kong and Cyprus respectively.

According to an international independent financial audit named the Kroll report, the Lazomar company received 5.6 million dollars in transfers to a Cypriot bank account. The Kroll report was commissioned by the National Bank of Moldova to investigate the theft that ravaged the country’s banking system.

Plahotniuc did not respond to requests for comment. His lawyer Lucian Rogac said that the former politician pleaded not guilty in the case generically called "blank passport cards".

"An indictment was presented to us. Other evidence to prove guilt was not shown by the prosecution. The only comment I can give you is that my client pleads not guilty to the charges," Rogac said.

In September 2022 Plahotniuc received an arrest warrant in absentia regarding the "blank passport cards" case, alongside Vladislav Zara, former director of the civil registry ASP, ex-PD deputy Andronachi and businessman Alexandru Vilcu. All of them have fled the country. According to Moldova’s ministry of justice, Plahotniuc is currently in Northern Cyprus.

Part Three

The scheme was taken over in the summer of 2020 by two Bulgarian companies.

In May 2020, the Lithuanian company UAB Garsu Pasaulis transferred the right for using the blank cards software to Optimo Service Ltd in Bulgaria, which ASP had co-opted to manage the documents’ personalisation programme.

"ASP proposed to have a third party take over the maintenance of the software from us. At the same time, we received proposals for cooperation from Optimo in Bulgaria," Garsu Pasaulis’ executive Andrius Lukosevicius said in a statement.

"Therefore, we wanted to avoid having any direct relationship with Optimo. While ASP persisted with its complaints [about improper maintenance of the software], we proposed to the client [ASP] that it consider entering into an agreement with Optimo (without us being involved in such a relationship) whereby Optimo would take over the software from us and its maintenance. We would no longer be responsible for this," he concluded.

Headquartered in Sofia’s luxury district of Manastirski Livadi, Optimo Service Ltd was founded on November 27, 2019, half a year before taking over the right to manage the software from Garsu Pasaulis. The founder is Russian citizen Sergey Pirojkov, while the manager is Bulgarian citizen Tsvetan Stoyanov Dimitrov.

The Bivol Investigative Journalism Centre reporter in Bulgaria, one of Black Box's partners in this investigation, went to the company's headquarters to talk to the owners. According to the documents detailing the company’s address, the offices are on the top floor of a residential building, where a beauty salon is also located. There is no plaque indicating the presence in this location of businesses involving ASP and Garsu Pasaulis.

In November 2022, a Bivol reporter knocked on the door. An employee of the beauty salon opened it and said that at the end of the corridor there was an office where "two Russian guys are working on computers, Serioja and Anton". The two men "rarely come to work".

On October 26, 2020, Optimo Service transferred its commitments to ASP to another Bulgarian company, Optimo IT Solutions LTD, whose owner is none other than Stoyanov, Optimo Service’s manager.

Two weeks before this deal, Stoyanov bought an older company and changed its name to Optimo IT Solutions.

Almost two months after Stoianov’s take over, the ASP funds began to flow into the accounts of Optimo IT Solutions as royalty fees for delivering the IDs and passports

According to documents seen by the Black Box team, between November 24, 2020, and August 13, 2021, ASP made 19 payments totaling 5.6 million euros (5.96 million dollars), to the newly established Optimo IT Solutions LTD.

The director of ASP, Mircea Esanu, told Black Box about the shady software rights transfer to Bulgarian companies.

"I assume who is [the beneficiary of those companies]. I have yet to see documents demonstrating where the money went from those accounts of the Bulgarian companies. But for me, it is strange when a company, even a printing house, sells practically for free to a Bulgarian company created overnight and later collects 5.6 million euros (5.96 million dollars) for a year,” he said.

On the same day in November 2022, the Bivol reporter returned to Optimo IT Solutions’ offices in central Sofia, to talk to the company's owner. The office is in an old building and access to the courtyard is prohibited. Employees of the company providing the space for rent refused to grant allow the reporter inside the building. The accountant of the same company refused to give any details.

Black Box called Optimo IT Solutions headquarters to talk to Stoyanov. The company secretary said to send questions by e-mail, but reporters did not receive an answer.

NEW MANAGEMENT

Returning to the summer of 2020, Optimo Service took over the royalty scheme. One month after transferring the rights to the document personalisation software, the Bulgarian company decided to take a Moldovan partner to represent its interests with ASP.

The company wrote to ASP that IT-LAB GRUP SRL would manage the software. The connections led to the Moldovan businessman Alexandru Vilcu.

According to the letter sent to the ASP by the Bulgarian company, IT-LAB GRUP was to deal not only with the technical servicing of the software but to also manage the entire business administration process.

Furthermore, the Moldovan business would be allowed to hold the Optimo Service company stamp, sign documents, and receive and make payments on behalf of the Bulgarian enterprise.

In November 2022, the founder of IT-LAB GRUP, Alexey Cioban, told Black Box that he did not provide any services to ASP because he no longer cooperated with the Bulgarian company. He claims that he was contacted directly from Sofia but did not say with whom he negotiated.

"We had some discussions about a potential partnership. I also went to ASP, and we discussed concluding a contract, but [we did not], with neither ASP nor the Bulgarian company. We did not reach an agreement. We didn't do any work. We didn't get any money and wanted to avoid collaborating with this company [Optimo],” Cioban said. "We had to take care of the technical part, the software, and the equipment installed at ASP. I talked with ASP, found out more details, and said it differs from our line of work. We refused."

Documents however show that the partnership between Optimo Service and IT-LAB lasted half a year and their collaboration contract was terminated in January 2021.

Cioban's firm, delegated by the Bulgarians to defend their interests in Moldova, has its legal address in Chisinau’s Rascani neighbourhood. According to the land registry, the building in which IT-LAB operates belongs to Tehnovin, a machinery manufacturing company owned by Vilcu.

Cioban categorically denied he ever collaborated with Vilcu in the business of Moldova’s public service agency.

In an exchange of messages with Black Box, Vilcu admitted that he tried to arrange a partnership with the company from Bulgaria and proposed a collaboration with IT-LAB. This contradicts Cioban, who denied his partner's involvement in the ASP case.

"We tried with Alexei [Cioban] to partner with those from Lithuania, but after an analysis, Alexei understood that he would not be able to cope with this and refused. And there, believe me, there was no mention of the figures I read in the files and the press,” Vilcu said.

He added it was a "decent proposal for Moldova," about "tens of thousands, not millions".

In September 2020, Vilcu received an arrest warrant in absentia; he did not appear at the hearing as requested by prosecutors.

Vilcu denies allegations that he was one of the beneficiaries of the ASP scheme and claims he initiated his own investigation to find out who benefited from the money stolen from the passports.

"I want to assure you that I did not participate in this affair. I had nothing to do with passports or other documents from Moldova. I have never dealt with a business that is outside the law. I was less interested in the Bulgarian company. I was more interested in the documents based on which the criminal file was opened against me," Vilcu said.

MULTIPLE CONNECTIONS

Another character targeted in the passport blanks case was the former deputy Vladimir Andronachi.

The anti-corruption prosecutor's office has established connections between the Bulgarian companies Optimo Service and Optimo IT Solutions with Andronachi and relationships with businessman Alexandru Vilcu.

The prosecutor's office stated that it is verifying Andronachi and Vilcu’s involvement in the ASP scheme.

“We inform you that a preliminary link of connection has been established between these natural and legal persons, but the criminal prosecution body still verifies the factual circumstances of these links. In this sense, requests for rogatory commissions are to be formulated," the statement read.

An official source said that the connection between Andronachi and the companies in Bulgaria was ensured by his family’s lawyer, Carolina Andriuta, who allegedly managed the Bulgarian companies from Chisinau. Black Box reporters have not been able to independently verify these allegations.

The anti-corruption prosecutor's office confirmed that Andriuta is accused in the criminal case “for complicity in the abuse of office and money laundering” but stated that the investigation continues.

Andriuta managed several companies connected to Andronachi. Currently, she is on the accused bench in a case concerning bank fraud, together with Nadejda Andronachi, Vladimir Andronachi’s wife.

Oleg Mita, Vladimir Andronachi’s lawyer, who was recently detained in Ukraine and extradited to Moldova on November 2, 2022 did not respond to questions.

Andronachi remains in prison and Mita states that he pleads not guilty in the “passport affairs” case.

"Mr Andronachi had been officially charged in this case. But he does not admit his fault. He explained to the prosecutors that he knew nothing about such actions related to so-called passport forgery schemes," the lawyer said.

Mita is also Carolina Andriuta's lawyer. Mita claims that Andriuta was not accused and also pleaded not guilty.

Melvin Kramer

[best-multi-speciality-hospital]

The Quest for Quality: Finding the Best Dialysis Center in India

Introduction: Navigating the Landscape of Dialysis Centers

In a country as vast and diverse as India, seeking out the best dialysis center in India is akin to finding a needle in a haystack. With a myriad of options available across the nation, patients grappling with renal issues are often faced with the daunting task of selecting a facility that not only provides top-notch medical care but also offers a compassionate and supportive environment. Amidst this maze of choices, one name shines brightly: Preethi Hospitals, Madurai. Let's delve deeper into what makes it stand out in the realm of dialysis care.

Unraveling Excellence: The Distinctive Features of Preethi Hospitals

Cutting-Edge Technology

At the heart of any reputable dialysis center lies its technological infrastructure. Preethi Hospitals, Madurai, boasts state-of-the-art equipment and facilities, ensuring that patients receive the most advanced treatment available. From hemodialysis to peritoneal dialysis, the center is equipped to cater to diverse patient needs, employing innovative techniques to optimize outcomes.

Expert Medical Team

While individual doctors may not be named, it's essential to highlight the caliber of the medical professionals at Preethi Hospitals. Led by seasoned nephrologists and supported by skilled nurses and technicians, the medical team exemplifies excellence in the field of renal care. Their collective expertise, coupled with a patient-centric approach, forms the cornerstone of the center's success.

Comprehensive Care

Beyond the realm of dialysis treatment, Preethi Hospitals adopts a holistic approach to patient care. Recognizing that renal health encompasses various facets of well-being, the center offers comprehensive services ranging from nutritional counseling to psychosocial support. This holistic framework not only addresses the physical aspects of the disease but also attends to the emotional and psychological needs of patients and their families.

Patient-Centric Philosophy: Putting Patients First

Personalized Treatment Plans

No two patients are alike, and Preethi Hospitals understands this implicitly. Tailoring treatment plans to suit individual needs, the center prioritizes personalized care, ensuring that each patient receives the attention and support they deserve. Whether it's adjusting dialysis schedules or accommodating special requirements, the focus remains steadfastly on the well-being of the patient.

Emphasis on Education

Empowering patients with knowledge is key to managing renal conditions effectively. Preethi Hospitals goes the extra mile in this regard, offering comprehensive educational programs aimed at enhancing patients' understanding of their condition and treatment options. By fostering a culture of informed decision-making, the center empowers patients to take charge of their health journey.

Transparent Communication

Effective communication lies at the heart of any successful patient-provider relationship. At Preethi Hospitals, transparency is not just a buzzword but a guiding principle. Patients are kept informed every step of the way, with clear explanations provided regarding their diagnosis, treatment plan, and prognosis. This open dialogue fosters trust and confidence, laying the foundation for a collaborative approach to care.

Beyond Boundaries: Reaching Out to Remote Communities

In a country as diverse as India, access to quality healthcare remains a significant challenge, particularly for those in remote or underserved areas. Recognizing this disparity, Preethi Hospitals has extended its reach beyond urban centers, bringing specialized renal care to the doorsteps of rural communities. Through outreach programs and telemedicine initiatives, the center endeavors to bridge the gap and ensure equitable access to life-saving treatments.

Conclusion: A Beacon of Hope in the Landscape of Dialysis Care

In the vast expanse of India's healthcare landscape, Preethi Hospitals, Madurai, stands out as a beacon of hope for patients battling renal disease. With its unwavering commitment to excellence, patient-centric philosophy, and outreach efforts, the center embodies the epitome of quality dialysis care. As patients embark on their journey towards better renal health, they can find solace in knowing that they are in capable hands at Preethi Hospitals.

[shekhawatiurologyhospitaljaipur]

Navigating Life with Kidney Challenges: A Comprehensive Guide to Managing Kidney Disease

Introduction:

Living with kidney challenges can be a daunting experience, but with the right information and resources, individuals can effectively manage their condition and lead fulfilling lives. In this comprehensive guide, we will explore essential aspects of kidney disease management, with a focus on the top hospitals in Jaipur, including the acclaimed Super Multispeciality hospital, recognized as the Best Hospital in Jaipur, that specialize in comprehensive renal care. These distinguished medical institutions bring together cutting-edge technology, experienced healthcare professionals, and a patient-centric approach to offer unparalleled services in the field of nephrology. Whether it's diagnostics, treatment options, or advanced procedures like dialysis and transplantation, individuals in Jaipur have access to world-class healthcare facilities. This guide aims to empower individuals with the knowledge they need to make informed decisions about their kidney health, guiding them toward the best hospital in Jaipur for personalized and top-notch renal care.

Understanding Kidney Disease:

Kidney disease is a silent threat that often goes unnoticed until it reaches advanced stages. It is crucial to understand the risk factors, symptoms, and different types of kidney disorders. From chronic kidney disease (CKD) to acute kidney injury (AKI), awareness is the first step toward effective management.

Diagnostic Procedures:

Jaipur boasts some of the best hospitals equipped with state-of-the-art facilities for diagnosing kidney conditions. Learn about the diagnostic procedures, including blood tests, imaging studies, and urine tests, that help healthcare professionals assess kidney function and identify underlying issues.

Treatment Options:

Once diagnosed, individuals have access to a range of treatment options. From medication management to lifestyle modifications, understanding how to navigate the treatment landscape is essential. This guide will shed light on the latest advancements in kidney disease treatment available in Jaipur's top hospitals.

Dialysis and Transplantation:

For those in advanced stages of kidney disease, dialysis and transplantation become crucial aspects of their healthcare journey. Discover the comprehensive renal care services offered by the best hospitals in Jaipur, including information on hemodialysis, peritoneal dialysis, and kidney transplantation.

Lifestyle Modifications:

Beyond medical interventions, lifestyle modifications play a pivotal role in managing kidney disease. Explore dietary recommendations, exercise routines, and stress management techniques that can contribute to overall well-being and improved kidney function.

Jaipur's Best Hospitals for Renal Care:

Highlighting the best hospitals in Jaipur for managing kidney disease is essential for individuals seeking quality healthcare. Discuss the expertise, facilities, and patient-centric approach of these hospitals, emphasizing their commitment to providing comprehensive renal care services.

Conclusion:

Navigating life with kidney challenges requires a proactive and informed approach. By understanding the nuances of kidney disease management and availing services from the best hospitals in Jaipur, especially from a renowned Super Multispeciality hospital in Jaipur, individuals can take charge of their health and embark on a journey towards improved well-being. Choosing a hospital with a super multispeciality focus ensures comprehensive care, bringing together a team of experts from various medical disciplines to address all aspects of kidney health. This guide aims to empower individuals with the knowledge they need to navigate life with kidney challenges successfully, emphasizing the importance of seeking care from a super multispeciality hospital in Jaipur for a holistic and integrated approach to renal health.

[gujaratmultispecialityhospital]

Navigating Kidney Dialysis: A Lifeline of Hope at Gujarat Multispeciality Hospital, Godhra

At Gujarat Multispeciality Hospital Godhra, we recognize the vital role that kidney health plays in overall well-being. Our commitment to providing comprehensive healthcare extends to cutting-edge treatments, including kidney dialysis, a life-saving intervention for those grappling with kidney failure.

Understanding Kidney Dialysis: A Crucial Lifeline

The kidneys, essential for filtering waste and excess fluids from the blood, are critical to maintaining a healthy internal balance. When these vital organs fail to function optimally, kidney dialysis emerges as a beacon of hope. Dialysis is an artificial replacement for kidney function, ensuring that the body's waste products are efficiently removed.

Types of Kidney Dialysis

There are two primary types of kidney dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves the use of a dialysis machine that filters the blood, while peritoneal dialysis uses the body's abdominal lining to perform the filtration process. Both methods are effective, and the choice depends on individual health conditions and preferences.

Recognizing Signs of Kidney Failure

Timely recognition of signs and symptoms of kidney failure is crucial for initiating prompt treatment. Symptoms may include fatigue, swelling, changes in urine patterns, and nausea. Early diagnosis ensures a smoother transition into dialysis and enhances the effectiveness of the treatment.

The Dialysis Process Unveiled

Hemodialysis typically requires the creation of access points, such as AV fistulas, AV grafts, or catheters. The dialysis machine then filters the blood, removing toxins and excess fluids. Peritoneal dialysis involves a catheter inserted into the abdominal cavity, where a special fluid facilitates the removal of waste.

Life on Dialysis

Adjusting to life on dialysis involves lifestyle modifications and dietary restrictions. Patients become adept at managing dialysis sessions and balancing medical requirements with everyday life. The emotional and psychological impact of dialysis is also addressed, emphasizing the importance of a holistic approach to patient care.

Godhra’s Gujarat Multispeciality Hospital's Dialysis Center: A Beacon of Excellence

Our hospital boasts state-of-the-art facilities for kidney dialysis, equipped with advanced machines and a team of skilled professionals. Our personalized care approach ensures that each patient receives individualized attention and support throughout their dialysis journey.

Conclusion: Prioritizing Kidney Health for a Fulfilling LifeAs we navigate the complexities of kidney health, Gujarat Multispeciality Hospital Godhra stands as a pillar of support for those in need of dialysis. By educating our community about the importance of recognizing kidney failure symptoms and embracing timely interventions, we strive to empower individuals to take charge of their health. Kidney dialysis may be a challenging journey, but at Gujarat Multispeciality Hospital, it is a journey accompanied by expert care, cutting-edge technology, and unwavering compassion.

[nefronkidneycare]

Are you looking for the best renal biopsy centre in Siliguri. Then Nefron provides best renal biopsy treatment with affordable price. Contact now.

[phantomtutor]

SOLUTION AT Academic Writers Bay 1.) Written Assignment Requirements: 12 pt. Times New Roman Double Space All margins must be one inch each Assignment A health club decided recently to offer a yearly membership. Separate fees would be charged for nutrition counseling, tennis court use, and aerobic instruction. How might this organization implement: (a) a prestige pricing strategy? (b) a bundled price strategy? and  (c) price lines? In a one page or more summary, discuss pricing strategies and how this organization can implement each of the named pricing strategies. Be as detailed as possible. 2.) Discussion Questions Week 6 (Chapters 21-24) 1. Why is it necessary to consult a travel medicine clinic well in advance of traveling? 2. What is a BMI and what BMI is considered normal? What are some measures one can take to lose weight? 3. What are some programs that enhance health that you might expect to find at a wellness center? 4. What is the difference between peritoneal dialysis and hemodialysis? 5. What can society do to encourage organ donation? 3.) Visit the Mississippi State Department of Health website at www.healthyms.com (Links to an external site.) Find two programs or services of interest that are offered by the Mississippi State Department of Health and write two paragraphs about each of the programs you chose.    “CUSTOM PAPER” CLICK HERE TO GET A PROFESSIONAL WRITER TO WORK ON THIS PAPER AND OTHER SIMILAR PAPERS CLICK THE BUTTON TO MAKE YOUR ORDER

[mghospital]

Best Nephrology Hospital in Narasaraopet for Kidney Disease Treatment | Mahathma Gandhi Hospitals

Mahathma Gandhi hospital is one of the best Super specialty hospitals in Narasaraopet where we have accumulated solutions for various health issues with the best professional team for each medical sector. Whether you are struggling with a kidney disorder or seeking a kidney specialist, Mahathma Gandhi hospital is the only solution for your search. 

What does a Nephrologist do?

The nephrologist is the kidney specialist. He works in the hospital and is responsible for the medical aspect, but not the surgery (it is the urologist who performs the surgeries on the kidneys or the urinary tract). For this, he performs numerous medical procedures. first, he questions his patient, in particular, to obtain information on any family or medical history:

he performs a rigorous clinical examination

he may perform or order examinations, such as an ultrasound of the kidneys and urinary tract, a CT scan, a renal biopsy

he follows dialysis patients, takes care of the post-operative consequences of a kidney transplant

he also prescribed drug treatments and offered dietary advice

  When should you consult a nephrologist?

You should consult a nephrologist for all pathologies affecting the kidneys:

acute or chronic renal failure (CRF)

renal colic

presence in the urine of blood (hematuria)

hematuria (presence of blood in the urine)

nephritic syndrome

glomerulonephritis or repeated urinary tract infections.

Some people are at greater risk for kidney disease. Here are some factors are known to increase risk:

diabetes

high blood pressure

smoking

obesity

Collaborating with other specialists as appropriate (resuscitators, cardiologists, diabetologists, etc.), the nephrologist then takes charge of these diseases. Based on examinations to refine his diagnosis, he can prescribe medications, recommend an appropriate diet, and follow dialysis or transplant patients. Pace Hospitals has excellent nephrology and dialysis (hemodialysis and peritoneal dialysis) services, which combine medical competence and patient support, including dietetic support, which is essential in cases of Chronic renal failure (CRF).

For more details

Call: 08647230007

Visit: https://mahathmagandhihospitals.com/contact-us/

[whump-a-la-mode]

Villian-Sicle | Part 3

I didn’t expect to continue this beyond part 2, but I’ve come to love these characters. I hope you guys enjoy! Heed the warnings, this one contains a lot of medical stuff.

CW//Superhero whump, villain whumpee, hypothermia, hospital setting, cardiac arrest, blood, dialysis, talk of death, talk of “pulling the plug”

Taglist:

@whatwhumpcomments

@sola-whumping

@professional-idiocy

The machine was too loud.

Talking over it made Leader feel that they were tearing apart their vocal chords. Then again, the stress of the situation wasn’t exactly aiding in that respect-- they could practically feel their tense muscles tightening around their windpipe.

“They’re going to be okay, then?” Their tone was rushed and pressing.

“I don’t want to guarantee anything.” The Head Doctor bit their lip. “Really, I can’t guarantee anything. By all accounts, the patient should already be dead. Human body temperatures shouldn’t be able to get that low...”

“Humans shouldn’t be able to fly, either.” Medic shook their head, gesturing at Leader, who tucked in their wings, not even realizing that they had unfolded. “But here we are.”

“There’s nothing particularly unusual about their physical anatomy, though?” Head Doctor raised an eyebrow.

“Enhanced people have different anatomy by default. Higher heart rate, for one thing.” Medic provided, glancing towards the heart monitor sitting next to the hospital bed. The spikes were shallow, and abnormally close together, but none the less steady.

“Yes.” Head Doctor dipped their head. “Well, then, that would explain how our patient is still breathing.”

“They should remain that way, then, right?” Leader fretted.

“I have high hopes. We’re doing everything we can. It’s up to them, now. If their body temperature can raise before it’s too late.”

The conversation ended on the same worried note as it had began, and the groups’ gazes seemed to unanimously drift downwards, as if they had simply forgot that they were standing over a body halfway between humanity and corpsehood.

Villain’s skin was horribly pale, translucent, even, as if it were on the verge of melting away. The restraints on their wrists and ankles-- Leader had insisted as to their presence-- seemed far too loose around their captive’s thin structure, but they simply couldn’t be tightened any further.

The only patch of Villain’s body that did not lack color was their chest, in which a catheter of at least an inch in diameter had been inserted. The skin around was red with irritation, resisting feebly against the roaring machine drinking blood from the line, only to return it at the same access point.

The whole spectacle was horribly grisly, with tubes filled with scarlet draped over Villain’s chest in a gruesome web. The machine itself, sat off to the side, seemed to whine and groan with every feeble heartbeat its victim managed to make.

Hemodialysis, the doctor had called the process. Manually warming the blood in an attempt to warm the body. Despite its vampiric appearance, somehow, the process was keeping Villain alive.

A chill ran through Leader’s body at the very thought. Villain was a stubborn asshole, one they’d been pursuing doggedly for months. Somehow, regardless of what trap they placed or what situation they were thrown into, Villain made it out.

Now...

The machine was plugged into the wall with a single cord. Just a wire, just some electrons passing through metal. Something that could so easily be severed. A single tug, a clumsily placed foot. The fight would be over. Would it be so wrong? Villain had done such wrong... and they wouldn’t feel a thing. They’d part in an unconscious pool of their own delusion.

Leader bit their tongue.

━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ 

“You okay?”

Hero watched the small flame of force flicker between their fingertips, their eyes nearly crossed with focus. They had hardly realized that somehow had spoken to them, and it took several awkwardly long seconds for them to look up.

“Hm?”

“Are you okay? You looked distracted.” Counselor furrowed their brow.

“I think I’m... always distracted.”

“I know. Just... that was a lot, back there. And you looked stressed.”

“Just worried, I guess.”

“About Villain?”

“There’s not much else to be worried about.”

“I’m worrying about you, right now.”

“I think... Villain is the one that we need to worry about, right now.” Hero chewed their cheek. “You were in there, right?”

“For a minute, yeah.”

“Are they okay?”

“Alive. They were alive. But with Medic there-- well, I don’t think there’s a better authority on Enhanced biology on the seven continents. I think it’ll turn out okay.”

Hero chuckled humorlessly.

“That’s another thing I’m worried about.”

“What? Medic?”

“Yeah. Medic kind of. More Leader. Medic is... I mean, I love ‘em, and they’re the biggest hardass out there, but they’re a doctor more than anything else. Hippocratic oath and all that. But Leader...”

“You’re worried because Leader... isn’t a doctor?”

“No, no, it’s not that. Leader just seems so much more worried about the fight, and the mission, and the good of humanity, than, well, than anything that’s right in front of them. I’m just worried that...”

“That Leader’s going to make a bad choice?”

“Something like that.”

“I agree that they can be... a hardass. But they’re not a bad person. I don’t think they’d execute someone. Not like this. Not after everything.”

Hero’s gaze turned to Counselor. They hadn’t expected their friend to come to the base of their concerns with such speed.

Counselor gave a small smile in return.

━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ 

Head Doctor left the room.

They had made their leave hurriedly, ensuring that they would be back in just a few minutes, to press the Code Blue button if anything happened. Leader had nodded along, hardly processing any of it.

They were focused on the person before them.

Over the last few minutes, by some miracle or curse, Villain’s heart rate had begun to stabilize. Though the beats came just as quickly, they were stronger than they had been. Not quite normal, but on their way.

Medic seemed fixed on the monitor, eyes narrowed as though they watched prey. The screen had more than just a heartrate reading. Alongside that, it showed a series of other graphs-- breathing rate, oxygen levels, among some that Leader was clueless as to the meaning of.

They glanced to the door. It was firmly closed. Certainly, the rest of the hospital would be too busy with the recent break-in to intrude.

“Medic?”

The doctor raised an eyebrow, but continued their fixation on the readings.

“Yes?”

“What would you say is the... the percentage we’re working with here.”

“The percentage?”

“Of survival.”

“Well... I suppose I can’t make an exact predication, but it’s climbing every minute. 80 percent? 85? They’re not completely out of the woods, yet, but their temperature is raising steadily. The dialysis is working.

“80 percent.” Leader hummed. “So... 20 percent chance that they don’t make it?”

“That is how math works, yes.”

“That’s not an insignificant percentage.”

“We’re doing everything we can. As I said, it’s rising, and quickly. If we can get their temperature back up into the 90s, I would say that continued survival is almost guaranteed.”

“Is that so?”

“What’s got you acting so weird, all of a sudden?” Medic finally turned from the screen, glancing to Leader.

Leader gulped.

“Do you remember when we were in Denver?”

“At the telecommunications hub? Yeah.”

“And in Vancouver?”

“Yes?”

“And at the bank, in Phoenix?”

“Leader, I assure you, my memory is fine.”

“No, no, I mean, Villain did all those things, right?”

“They had help.”

“But they led the charge?”

“I suppose so, yes.”

“They’ve hurt a lot of people. Destroyed a lot of places... brought them to the ground. Leveled a city block, once.”

“Seriously, what is this about?”

Leader’s gaze glanced down to the Villain, pale, restrained, with a tube skewering their flesh, then back at Medic.

“No.”

“What?”

“No. No, no, no. I let you restrain them like some kind of beast, which, for your information, is completely against medical protocol. I’m not letting you kill Villain.”

“And why not?”

━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ 

Outside the hospital room, in a pair of plastic chairs, Hero and Counselor sat with far more relaxation between them. They watched passively as Head Doctor left the room, hurrying off to another room.

Hero took a fidget rope from a coat pocket and began twisting it between their hands.

“What do you think they’re going to do with Villain, then?” Counselor’s voice was considerably quieter, as if they were telling a secret. They stared off, down the hallway, instead of meeting Hero’s eyes.

“I just hope they let us have some input in this whole thing.”

“Me too. But... what would you prefer? If you had the choice?”

“I mean...” Hero sighed. “They haven’t been the best person, I think we can all agree on that. They’re dangerous. But I also think that... they’re scared. They’re scared, Counselor, really scared.

If it was up to me, I think we should help them. While in our custody, but, I think they need help. And maybe then, they can help us? I mean, they must know something about Supervillain. It’d be nice to have an informant.

Really, I just want to see them okay again. Even if it does mean that they go back to being an asshole.”

“That’d be nice.”

Hero nodded.

“I think Medic mentioned that, once Villain’s stable, we’re gonna move them back to base. Where we have the special medical equipment, the Enhanced care stuff.”

“Yeah. I think Leader is definently going to want to keep them in custody.”

“If they try to hurt them, though... I’m not gonna let that happen. If we have to keep them prisoner, we can at least be humane about it.”

“Yeah. Yeah, of course.”

“I just hope Leader agrees.”

“Me too.”

━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ 

“It’d be a waste.”

The answer was too analytical. Leader had expected to be yelled at, to get an earful about morality and ethics and other crap. Not something so simple, so factual.

“What do you mean?” Leader’s tone wasn’t accusing, at least they didn’t intend for it to be. It was far more dumbfounded in nature.

“Everything in this world runs on technology. Those lights, that door, this machine, everything. Everyone has a phone. Every building has a network, of both electricity and information. Villain can patch into all of that. You said it yourself, they leveled a whole city block. What else can they do?”

“What are you... what are you implying?”

“We keep them, and we use them.”

A garbled voice resounded throughout the room. Leader whirled around, half expecting Supervillain to be right behind them, before turning back.

“Was that y-” They began to ask, but didn’t quite get the chance.

“Code Blue! Code Blue!” Medic snapped. “Don’t be useless, press the damn button!”

It took Leader’s confused mind a moment to note the emergency that Medic was responding to-- that of a horrible, electric screech. The heart monitor was no longer showing a steady pulse.

At the sight, Leader’s own heart rate sped up. They nearly tripped over their own feet as they rushed to the blue button on the wall, jabbing it with their finger multiple times in a frenzied panic. Once they were satisfied that they spiraling terror had been registered properly, they returned to Medic’s side.

The doctor had their hands positioned on Villain’s chest, one over the other, slamming downwards repeatedly. In between, Leader could see a sharp rise in the chest-- they were still breathing. But for how much longer?

Dammit, dammit, don’t think like that, it’s someone’s life!

A resounding crash burst through the room as the door was slammed open. They rushed to the bedside, seemingly ready to continue CPR, before Medic raised an arm, preventing them.

“No, no, they’re okay.” Medic panted breathlessly. Leader raised their eyes to the heart monitor-- sure enough, a slow, steady rhythm was returning.

They’d made it.

“Mmm..”

Leader panted for breath, trying in vain to calm their racing heartrate.

“Mmm... whaaa...”

Leader’s shaking gaze shifted to the source of the noises--only to find their eyes locked with the wide ones of Villain.

[writerkimwilkes-blog]

Taking The Chill Out Of Raynaud’s Disease

By Kimberly Wilkes

Raynaud's (pronounced ray-nodes) isn't a disease you hear about very often. Yet, an estimated 28 million people in the U.S.—including 20 percent of all women in their childbearing years—have Raynaud's phenomenon, or Raynaud's syndrome as it's also called. What's more, four out of five people who have the disease suffer without getting medical help for the condition.1

What exactly is Raynaud's phenomenon, who is at risk and how can you reduce the symptoms naturally? Read on to find out.

The Big Chill

Named for a French physician Maurice Raynaud, who first identified the disease in 1862 while he was still a medical student, Raynaud's leaves anyone afflicted with the disorder extremely sensitive to cold temperatures.2 During a Raynaud's attack, smaller arteries that deliver blood to your fingers and toes—and in some cases other areas such as the nose, ears and tongue—narrow when exposed to cold temperatures or emotional stress.3These spasms in the blood vessels decrease circulation. Often, the skin turns white, then blue, then bright red. It's usually painful, too, and a Raynaud's episode also may include numbness, swelling or tingling. Holding a cold drink, reaching into the freezer, stepping into an air-conditioned room or going outside on a cold day all can trigger the attacks, which last anywhere from minutes to hours.  

If you have this disease, you can blame the pain and color changes in your skin on a malfunctioning autonomic nervous system. This part of the nervous system oversees bodily functions that you don't consciously control such as breathing, heartbeat and digestion. When the autonomic nervous system isn't working properly, it directs the blood vessels in affected areas such as the fingers and/or toes to constrict, starving those areas of blood supply. Blood delivers oxygen to tissues, so without the proper blood supply, tissues can undergo damage and in severe cases develop gangrene. Over the years, the small arteries feeding your hands, feet, nose and ears may thicken as they pay the price of the ongoing spasms. Not as much blood can flow through these thickened arteries.4

Who's At Risk?

There are two types of Raynaud's syndrome: primary and secondary. The most common form, primary Raynaud's is not associated with any other diseases. Secondary Raynaud's occurs along with other diseases, often autoimmune diseases such as scleroderma, lupus and rheumatoid arthritis. Secondary Raynaud's is usually a more severe form of the disease than primary, has worse symptoms, is more likely to cause tissue damage, and is less likely to respond to treatment.5However, even the primary form can be disabling in some people.6The primary form also usually affects all fingers, whereas in the secondary form only some fingers might suffer from the vessel spasms.7

Risk factors for Raynaud's are different for each form. Women are more likely to develop primary Raynaud's compared to men. Primary Raynaud's also usually develops in people aged 15 to 30 years old, although it can arise at any age. If you live in a colder climate or have a history of the disease your risk also goes up.8

Having an autoimmune disease such as scleroderma, lupus or rheumatoid arthritis is a risk factor for secondary Raynaud's. Unlike primary Raynaud's, secondary most often develops at a more advanced age, usually around 40 years old. If you have a job where you operate tools or machinery that vibrate such as tipping hammers, jackhammers, chain saws and machinery such as tractors, power shovels and bulldozers you're at a greater risk of developing the secondary form of the disease.9Ditto for any activity you perform regularly at home that involves repetitive movements such as typing or playing the piano. People who have carpel tunnel syndrome also are more susceptible.4

In people older than 60, secondary Raynaud's syndrome is often caused by atherosclerosis obstructing the arteries.3 Other arterial disorders such as Buerger's disease, caused by inflammation of the blood vessels of the hands and feet, and pulmonary hypertension, which impacts the arteries of the lungs, are also associated with secondary Raynaud's.4

In addition, certain drugs are linked to secondary Raynaud's including the drug OROS-methylphenidate used for attention deficit hyperactivity disorder (ADHD),10beta-blockers for high blood pressure, migraine medications containing ergotamine or sumatriptan, some chemotherapy drugs and over-the-counter cold medications that narrow blood vessels.4

Finally, other risk factors include smoking, which narrows blood vessels, hand or foot trauma including wrist fractures, surgery or frostbite, hemodialysis for kidney disease and exposure to certain chemicals such as vinyl chloride, a common environmental pollutant.4,11

The Homocysteine Connection

High levels of the amino acid homocysteine are linked to a number of health concerns, including cardiovascular disease, Alzheimer's, diabetes and osteoporosis. And now you can add Raynaud's to that list. Levels of this amino acid are typically high in both primary and secondary Raynaud's, even in teenage patients with the disease.12-17

Homocysteine injures the blood vessels in part by producing damaging free radicals, so researchers believe it could play a role in the development of Raynaud's. It also causes blood cells to clump together, interfering with circulation.18

Conventional Treatments

Simply dressing warmer during cold weather, and bundling up the feet and hands in warm socks and gloves is often enough for mild forms of Raynaud's. Conventional doctors will usually treat more severe cases by prescribing the class of blood pressure medications known as calcium channel blockers. These drugs act as vasodilators—in other words, they dilate the blood vessels. However, they can cause side effects such as rapid heartbeat, headaches, dizziness, fatigue, nausea, constipation and swelling in the feet and lower legs.19 Calcium channel blockers are also linked to lesions in the esophagus and gastrointestinal reflux disease (GERD).20

Conventional doctors also may prescribe drugs like prazosin (Minipress®) and doxazosin (Cardura®), which belong to a class of blood pressure medications known as alpha-adrenergicblockers. These drugs help dilate the blood vessels by blocking the action of norepinephrine, a blood-vessel-constricting hormone. However, this class of drugs also has its own share of side effects such as nausea, dizziness, headache, heart palpitations and low blood pressure.7 Another class of blood-vessel-dilating drugs are called prostaglandins. But higher doses can cause headaches, flushing and nausea.7For skin ulcers, nitroglycerin cream is used topically on the base of the fingers. In some people, the cream can cause dizziness, flushing, slow heartbeat, chest pain and fainting.21

In some cases, doctors recommend surgery to remove the nerves around the blood vessels. But this surgery doesn't work for everybody.22  Doctors also may inject anesthetics or Botox into the hands or feet to block the activation of nerves in those areas. This comes with its own set of side effects including swelling or bruising at the injection site, headaches or flu-like symptoms and the possibility that the toxin in the medication may spread to other areas of the body leading to symptoms similar to botulism such as muscle weakness, trouble speaking or swallowing, difficulty breathing and inability to control the bladder.22,23

Natural Support for Raynaud's

If you prefer natural options, there are a number of ways you can improve your circulation and keep yourself warm. Here are some suggestions, based on research and what alternative and integrative doctors have found helpful in their practices.

Circulation-Boosting Socks

The first step is to keep your feet warm. Incredisocks are a special type of foot covering invented by a chiropractor. Incredisocks work as thermoregulators to increase or decrease temperature in the feet. They also improve blood flow, feeding the tissues with enhanced oxygen.24This not only results in greater comfort and reduced swelling in people who are concerned about circulation, it also results in healthier skin tone and color in oxygen-deprived areas.

Incredisocks are made with a blend of bamboo charcoal, used in traditional Chinese medicine to improve circulation, and germanium, which has a long history of use in Japan to support healthy blood flow. When this combination is heated by the body anions are released.  An anion is an ion with more negatively charged electrons than positively charged protons, resulting in a net negative charge. These anions increase blood flow and nourish tissues with oxygen—the same process that occurs when a physical therapist uses infrared on an injured knee or body part. Although infrared exposes injured areas to negative ions for only a short time, the circulation socks constantly bathe the feet in these beneficial anions for as long as the socks are worn.

The improved circulation that occurs after anions are generated results in more oxygen being supplied to local tissues. Combined with the increase in blood flow, this allows the body to regulate temperature much easier. Thermographic image testing comparing regular socks to Incredisocks shows that the maximum area temperature of feet not wearing Incredisock was 29.4 degrees while the maximum area temperature of feet wearing Incredisock was 32.6 degrees.25

Acupuncture

There's a mixed bag of research on whether or not acupuncture can help people with Raynaud's. But one study indicates it's something worth looking into to see if it works for you. The controlled, randomized study investigated the effects of acupuncture on patients with primary Raynaud's syndrome for 23 weeks in winter. Seventeen patients were given seven acupuncture treatments during weeks 10 and 11 of the study and compared to 16 controls. Throughout the study, subjects noted in a diary every day whether they had experienced an attack, how long the attack lasted and how severe it was. In the acupuncture-treated subjects, there was a significant drop in the number of attacks experienced per day. The patients undergoing acupuncture also experienced other improvements in their blood flow.26

The study authors concluded, "These findings suggest that traditional Chinese acupuncture is a reasonable alternative in treating patients with primary Raynaud'ssyndrome."

Control Your Stress

Relaxation techniques can help Raynaud's patients chill out in more ways than one. Stress can trigger Raynaud's attacks so it's a good idea to find ways to cope with stress. One option is biofeedback, a mind-body technique that shows you how to control your autonomic nervous system. One randomized study investigated biofeedback in patients who had secondary Raynaud's together with systemic sclerosis. Eight Raynaud's patients participated in biofeedback three times a week for four weeks and experienced reduced scores for disease severity.27

In one review of the medical literature, scientists concluded that thermal biofeedback is effective in reducing the severity and frequency of Raynaud's attacks. The scientists came to this conclusion after reviewing a number of studies, including three randomized controlled trials performed in independent laboratories.28

Basically, anything you can do to reduce or manage your stress, including meditation, not pushing yourself too hard at work or deep-breathing exercises can help keep the Raynaud's attacks at bay.

Hyperbaric Oxygen

In this type of therapy, patients inhale oxygen while in a chamber. Because the tissues of Raynaud's patients are starved of oxygen, it makes sense that a therapy that can boost oxygen levels may reduce symptoms.29,30In one study, researchers treated six women between the ages of 46 and 71 with two, two-hour daily sessions of hyperbaric oxygen for 10 to 14 days. The hyperbaric oxygen not only improved the Raynaud's symptoms—the improvement lasted for more than a month after the treatments ended.30 Alternative practitioners report good success using this type of therapy.

A Circulation-Boosting Botanical

If you want to use nutritional supplements to improve circulation, one of your best bets is Ginkgo biloba, which supports healthy blood flow. A couple of trials show it may help people who have Raynaud's. In one of those studies, even though Ginkgo wasn't as effective as a standard drug, when researchers gave Ginkgo to primary Raynaud's patients for eight weeks, 31 percent of the patients improved.31

In another study, researchers randomly assigned primary Raynaud's patients to receive either Ginkgo bilobaextract or a placebo for 10 weeks. Both before and during the study, the subjects recorded how often the attacks occurred, their severity and how long they lasted. Subjects taking the Ginkgo experienced significantly less attacks down from an average of 13.2 per week to 5.8 per week. There were 56 percent less attacks in ginkgo group and only 27 percent less in the placebo group.32

Homocysteine-Lowering Vitamins

As mentioned earlier in this article, high homocysteine levels are linked to Raynaud's. When your body is deficient in folate, vitamin B12 and vitamin B6, it's not able to easily breakdown homocysteine, leading to high levels of this amino acid. People who have primary Raynaud's syndrome have lower levels of folate.13

To keep homocysteine from building up in the body, it's a good idea to take a good B-complex vitamin, ideally one that contains 5-MTHF, a more bioavailable form of the vitamin.

Help from the Sea

Fish oil protects the blood vessels of Raynaud's patients against low oxygen. In one double-blind, placebo-controlled study in 32 patients with primary or secondary Raynaud's, researchers gave subjects every day either an olive oil placebo or 12 fish oil capsules, which contained a total of 3.96 g eicosapentaenoic acid (EPA) and 2.64 g docosahexaenoic acid (DHA). The researchers evaluated the effects of the fish oil at six, 12 and 17 weeks by measuring the systolic blood pressures and blood flow in the fingers of the subjects at room temperature and in cold water baths. The study authors also timed how long it took for the patients to have a Raynaud's attack after exposure to the cold water.

In the fish oil group, it took longer to have a Raynaud's attack. Prior to supplementing with the fish oil, it took about 31.3 minutes for the subjects to have an attack. After taking the fish oil for six weeks, that time increased to 46.5 minutes. Subjects with the primary form of the disease who took fish oil capsules had the largest increase in the amount of time to an attack compared to patients with the secondary form. In fact, five of 11 patients with primary Raynaud's who took the fish oil capsules no longer had Raynaud's attacks beginning at six or 12 weeks into the study compared to 1 of 9 patients in the olive oil group.33

According to the study authors, "We conclude that the ingestion of fish oil improves tolerance to cold exposure and delays the onset of vasospasm in patients with primary, but not secondary, Raynaud'sphenomenon."

New Use for the Sunshine Vitamin

Vitamin D is another nutrient no Raynaud's patient may want to do without. Researchers have found many Raynaud's patients suffer from vitamin D deficiency. What's more, supplementing with this vitamin may actually improve symptoms. A recent randomized, placebo-controlled study investigated the effects of giving Raynaud's patients 600,000 IU of vitamin D3 per month for two months in the winter. The researchers randomly divided 42 patients deficient in vitamin D into two groups. One group received the vitamin D, the other group received a placebo. The patients receiving the vitamin D3 experienced an increase in their vitamin D levels and an improvement in their Raynaud's symptoms.34

Adding to the evidence that vitamin D deficiency may play a role in Raynaud's is the finding that as many as 80 percent of people with systemic sclerosis are deficient in Vitamin D.35

Raising Nitric Oxide

Nitric oxide is one of the chemicals in your body responsible for dilating blood vessels. However, in secondary Raynaud's, nitric oxide levels are low.7

When trying to boost nitric oxide levels, one good choice is the supplement L-arginine. A couple of medical journal articles have reported upon L-arginine's benefits in people who have secondary Raynaud's. One group of researchers reported uponfour cases in which  L-arginine supplementsimproved symptoms in patients with severe Raynaud's, including reversing the death of tissue.36

In another study, patients with secondary Raynaud's who also had systemic sclerosis, experienced several improvements after taking L-arginine including increased dilation of the blood vessels in their fingers and higher levels of tissue-type plasminogen activator, a protein that helps break down blood clots.37  

Boost Circulation, Warm Your Cold Hands and Feet

Improving blood flow and lowering emotional stress—or finding effective ways to cope with it—can reduce the number of Raynaud's attacks. Acupuncture, biofeedback and hyperbaric oxygen therapy may all help replenish oxygen-starved tissues while certain botanicals, vitamins and nutrients can give your blood vessels a helping hand.  

Originally published in Whole Health Insider.

References:

1. Raynaud's Association. www.raynauds.org

2. Bakst R, et al. J Am Acad Dermatol. 2008 Oct;59(4):633-53.

3. Belch JJ, Ho M. Drugs. 1996 Nov;52(5):682-95.

4. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/causes/con-20022916

5. Herrick A. Curr Treat Options Cardiovasc Med. 2008 Apr;10(2):146-55.

6. Sprynger M. Rev Med Liege. 2004 Jun;59(6):378-84.

7. Baumhäkel M, Böhm M. Vasc Health Risk Manag. 2010 Apr 15;6:207-14.

8. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/risk-factors/con-20022916

9. Matoba T. Ind Health. 2015;53(6):522-32.

10. Bayram Ö, Hergüner S. J Child Adolesc Psychopharmacol. 2015 Aug;25(6):521-2.

11. Czupryniak A, et al. Kidney Blood Press Res. 2005;28(1):27-31.

12. Lazzerini PE, et al. Autoimmun Rev. 2010 Jan;9(3):181-7.

13. Levy Y, et al. J Rheumatol. 1999Nov;26(11):2383-5.

14. Danese S, et al. J Rheumatol.2000Aug;27(8):2051.

15. Vayá A, et al. Clin Hemorheol Microcirc. 2014;56(2):153-9.

16. Cheng TT, Chiu CK. Clin Rheumatol. 2002 Jun;21(3):251-4.

17. Kutilek S, et al. Rev Bras Reumatol. 2012 Jan-Feb;52(1):128-30.

18. Stanger O, et al. Clin Chem Lab Med. 2003Nov;41(11):1392-403.

19. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/calcium-channel-blockers/art-20047605?pg=2

20. No authors listed. Prescrire Int. 2015 Sep;24(163):210-1, 213.

21. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682346.html  

22. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/treatment/con-20022916

23. Mayo Clinic. http://www.mayoclinic.org/tests-procedures/botox/basics/risks/prc-20009036

24. The test of acceleration in blood circulation by Taiwan Textile Research Institute tells that the speed of blood flowing increases above 50 percent. <The authentication No: FK991116-00.IMG, TFF4G123, TFF4K288>

25.  Tested 4/22/2010 Thermal Imaging Consultants LLC, Reno Nevada <Taiwan Textile Research Authentication: Fk99116-00, TFF4G123, TFF4K288)>

26. Appiah R, et al. J Intern Med. 1997 Feb;241(2):119-24.

27. Sporbeck B, et al. Rheumatol Int. 2012 May;32(5):1469-73.

28. Karavidas MK, et al. Appl Psychophysiol Biofeedback. 2006 Sep;31(3):203-16.

29. Ratner GL, Slutsker GE. Fiziol Zh. 1991 Jul-Aug;37(4):123-7.

30. Dowling GB, et al. Proc R Soc Med. 1967 Dec;60(12):1268-9.

31. Choi WS, et al. Clin Rheumatol. 2009 May;28(5):553-9.

32. Muir AH, et al. Vasc Med. 2002;7(4):265-7.

33. DiGiacomo RA, et al. Am J Med. 1989 Feb;86(2):158-64.

34. Hélou J, et al. Rheumatol Int. 2013 Mar;33(3):751-5.

35. Viswanath V, et al. Indian J Dermatol. 2013 Jul;58(4):255-68.

36. Rembold CM, Ayers CR. Mol Cell Biochem. 2003 Feb;244(1-2):139-41.

37. Agostoni A, et al. Int J Clin Lab Res. 1991;21(2):202-3.

[omahadiabetesdoctor]

Discovering a Diabetes Doctor

If you are trying to find a diabetes physician, you should understand the different kinds as well as find out about the different tests that can be performed. After you have actually identified the types of doctors, you must likewise find out about diet regimen adjustments. It's important to locate a medical professional that fits you and your way of life, as discovering the appropriate medical professional will spend some time. However if you're not pleased with your current physician, you ought to think about seeking a new one.

Concerns to ask a diabetes doctor

Prior to your visit, prepare your list of concerns in advance. You could be struggling with blood sugar level control at particular times. Or you may be interested about brand-new treatment choices and also drugs. Regardless of your factor, you ought to plan for a lengthy and also thorough conversation with your physician. To aid you prepare, keep your listing of concerns in a note pad or on an index card in your glucose meter. After that, you can conveniently describe it throughout your visit.

Types of diabetes mellitus doctors

The shortage of diabetes mellitus medical professionals has actually resulted in a much longer waiting period for individuals, specifically those who have type 2 diabetes mellitus While primary care doctors have little time to deal with such an intricate condition, they can make solid debates in your place. Along with making the wait much less difficult, diabetes physicians specialize in endocrinology, which is the branch of medicine that focuses on treating diseases associated with the endocrine system.

Tests to diagnose diabetes mellitus.

There are numerous various examinations to identify diabetes mellitus. Amongst the most popular examinations for grownups is the hemoglobin A1c examination. In grownups, the examination is dependable. However, this is not the instance in youngsters.

The life-span of red blood cells can be reduced because of several things, including pregnancy, blood transfusion, sickle cell condition, hemodialysis, and erythropoietin (ESA) medicine. Generally, two sorts of tests are utilized to validate a diagnosis of diabetes mellitus.

Dietary modifications

In addition to a correct diet as well as workout, people with diabetes can also implement dietary modifications. Diabetes drug, such as insulin injections, alpha-glucosidase inhibitors, as well as antidiabetics, may be needed. Along with the diabetes drugs, nutritional modifications are valuable for heart health and wellness, cholesterol, as well as high blood pressure. Lifestyle interventions for diabetes mellitus include consuming fruits, vegetables, as well as whole grains. On top of that, individuals must cut down on alcohol and smoking.

Endocrinologists specialize in hormone therapies

Endocrinologists are clinical doctors that specialize in illness associated with the body's hormones. These specialists can deal with or detect disorders of the thyroid, adrenal, pancreatic, and also endocrine glands. Hormonal agents are in charge of regulating a number of bodily functions, consisting of development, metabolism, as well as reproduction. Throughout growth and also the adult years, the body produces a variety of hormonal agents, consisting of those required for diabetes mellitus The adrenal glands are located on top of the kidneys. They are split into right and left-sided crescent-shaped areas. Adrenal hormonal agents control the reproductive system, consisting of menstrual cycle, fertility, and menstrual cycle. Pharmacologists can help handle diabetes mellitus.

Pharmacists can give patients with a selection of diabetes-related solutions, including screening, ongoing disease-state monitoring, and education and learning. The existing number of individuals with diabetes is boosting, while the capability of typical care companies reduces, as well as governments are seeking cost-efficient methods to manage blood sugar levels and prevent difficulties. Several pharmacists are educated to provide diabetes mellitus education and medication therapy. They can assist patients with diabetes mellitus reach their objectives via their different services.

omahaintegratedhealth.com

[kaipule]

The role of air sterilizer purifier in our life

Classification of air sterilizer purifiers

Filter adsorption type air sterilizer purifier: Use porous filter materials, such as non-woven fabrics, filter paper, fibers, foam cotton, etc., to absorb suspended particles and harmful gases in the air, thereby purifying the air.

Electrostatic dust collection type air sterilizer purifier: Charge the pollutants in the air through static electricity, and then use the dust collector to capture the air dust that has adsorbed the charged particles to achieve the purpose of purifying the air.

Compound air sterilizer purifier: Purify the air by filtering and electrostatic precipitation at the same time.

Ozone sterilization type air sterilizer purifier: Use the strongly oxidizing properties of ozone to sterilize the air, remove odors, and remove formaldehyde, bacteria, molds, and other harmful components in the air, so that the air can be disinfected and purified.

Ozone sterilization filter type air sterilizer purifier: filter suspended particles in the air through the filter, use the strong oxidizing property of ozone to sterilize the air, remove odor, remove formaldehyde, bacteria, mold, and other harmful components in the air, make the air to be disinfected and decontaminated.

Among them, the ozone sterilizer air sterilizer purifier has a strong purification function for smoke, suspended particles, bacteria, and viruses, especially the bacteria in the air. It is widely used in hospitals, public places, schools, and industrial production workshops. The ozone sterilization filter type air sterilizer purifier is suitable for public places and households with small spaces. The above is the classification of air sterilizer purifiers.

Scope of application of air sterilizer purifier

Medical and health care: operating room, ICU, NICU, neonatal room, delivery room, burn ward, supply room, interventional treatment center, isolation ward, hemodialysis room, infusion room, biochemical room, laboratory, etc.

Others: biopharmaceuticals, food production, public places, conference rooms, etc. The above is the scope of application of an air sterilizer purifier.

Advantages of air sterilizer purifier

Efficient bactericidal

YD1500D plasma air sterilizer purifier has very strong sterilization and disinfection effect and has a short action time, which is far less than that of high-intensity ultraviolet rays.

Environmentally friendly

YD1500D plasma air sterilizer purifier works continuously for sterilization and disinfection, will not generate ultraviolet rays and ozone, and avoid secondary pollution of the environment.

Efficient degradability

YD1500D plasma air sterilizer purifier can degrade harmful and toxic gases in the air while sterilizing the air. The test report of the China Center for Disease Control and Prevention shows that the degradation rate within 24 hours: is formaldehyde 91%, benzene 93%, ammonia 78%, and Xylene 96%. At the same time, it can effectively remove pollutants such as flue gas and smoke smell.

Low energy consumption

The power of the YD1500D plasma air sterilizer purifier is 1/3 of that of the UV sterilizer, which is very power-saving. For a room of 150m3, the plasma machine is 150W, the ultraviolet machine is more than 450W, and the electricity cost is more than 1,000 yuan a year.

Long service life The YD1500D plasma air sterilizer purifier has a designed service life of 15 years under normal use, while the UV sterilizer is only 5 years old. The above are the advantages of an air sterilizer purifier.

Excellent supplier of air sterilizer purifier

From the above, we can learn about the classification of air sterilizer purifiers, the advantages of air sterilizer purifier and the scope of application of air sterilizer purifier. How can we buy a high-quality air sterilizer purifier? I would recommend an excellent supplier of air sterilizer purifier Suzhou Bager Environmental EcoTech Co., Ltd., this supplier specializes in producing high-quality air sterilizer purifier, you are welcome to visit and buy.

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