30- JOB'S SYNDROME

i was just going thru the book and came across this syndrome which i myself have never heard so i thought i ll let u know .

RECURRENT STAPHYLOCOCCAL CUTANEOUS INFECTIONS ARE MORE COMMON AMONG INDIVIDUALS WHO HAVE EOSINOPHILIA AND ELEVATED SERUM LEVELS OF IMMUNOGLOBULIN E. THIS IS CALLED JOB'S SYNDROME ..

god y do we humans get so many diseases.......?????????

29- prevention of opportunistic infections in AIDS

1- pneumocytis carinii - trimethoprim and sulphamethoxazole

2-isoniazid sensitive mycobacterium tuberculosis - isoniazid and pyridoxine

3- isoniazid resistant mycobacterium tuberculosis - rifabutin or rifampin

4- mycobacterium avium complex- azithromycin and clarithromycin

5-toxoplasma gondi - trimethoprim and sulfamethoxazole

6- prior toxoplasma encephalitis - sulfadiazine + pyrimethamine + leucovorin

7- varicella zoster virus - varicella zoster immunoglobulin

8- cryptococcus neoformans - fluconazole

9-histoplasma capsulatum - itroconazole

10-coccidiodies immitis - fluconazole

11-salmonella species - ciprofloxacin

12- cmv virus- ganciclovir

--------------------------------------------

VACCINES RECOMMENDED IN HIV PATIENTS

1- hepatitis b to all susceptible patients

2-hepatitis a to all susceptible patients with chronic hepatitis c or at increased risk for hepatitis a

3-influenza virus - all patients annually

4-streptococcus pneumoniae - to all patients

VACCINES RECOMMENDED FOR PREVENTION OF SEVERE OR FREQUENT RECURRENCES

1- HERPES SIMPLEX

2-CANDIDA

28-mais, tell me the diagnosis

mais, this x ray is for u , look at the x ray and ct and tell me the diagnosis . a small clue for u - this x ray and ct show the classical water lily sign which is seen in ________?

27- blood supply of the stomach

the stomach is supplied by many arteries like

a- short gastric arteries - branches of the splenic artery - supply the fundus of stomach

b-left gastro epiploic artery - branch of the splenic artery - supply the greater curvature of the stomach .

c- left gastric artery which is a direct branch of the coeliac trunk that arises from the aorta . supplies the lesser curvarture.

d- right gastric artery which is a branch of the common hepatic artery - supplies the lesser curvature.

e- right gastro epiploic artery which is a branch of the gastro duodenal artery which is again a branch of the common hepatic artery- supplies the greater curvature

--------------------------------------

the branches of the COELIAC TRUNK are

1-common hepatic artery

2-left gastric artery

3-splenic artery

--------------------------------------

the branches of splenic artery are:

1-short gastric branches

2-left gastro epiploic artery

--------------------------------------

the branches of the common hepatic artery are

1-hepatic artery proper

2-right gastric artery

3-gastroduodenal artery

-------------------------------------

the branches of the gastroduodenal artery are

1-right gastro epiploic artery

2-superior pancreatico duodenal artery

-------------------------------------

just for the sake of information the INFERIOR PANCREATICO DUODENAL ARTERY is a branch OF THE SUPERIOR MESENTRIC ARTERY .

--------------------------------------------------------

26- blood supply of the rectum

rectum is supplied mainly by three arteries they are :

a- SUPERIOR RECTAL OR HEMORRHOIDAL ARTERY - which is a branch of the INFERIOR MESENTRIC which arises from the ANTERIOR SURFACE OF THE AORTA .

b-MIDDLE RECTAL OR MIDDLE HEMORRHOIDAL ARTERY - which is a branch of the INFERIOR VESICAL ARTERY which is a branch of the INTERNAL ILIAC ARTERY .

c- INFERIOR RECTAL OR INFERIOR HEMORRHOIDAL ARTERY - which is a branch of the INTERNAL PUDENDAL ARTERY which is a branch of the INTERNAL ILIAC ARTERY.

25- down's syndrome

Down syndrome, also known as Trisomy 21 due to the presence of a third twenty-first chromosome, is one of the most common and well known birth anomalies. One in every 650 children born will be effected by this syndrome.

Characteristics
Some of the facial features which identify an individual as having Down syndrome include:

• Low set ears
• Up slanting palpebral fissures
• Low nasal bridge and dorsum
• Abnormal and excessive facial fat distribution
• Protruding, enlarged tongue

Frequency of Dysmorphic Signs in Neonates with Trisomy 21

Dysmorphic sign Frequency (%) Flat facial profile 90 Poor Moro reflex 85 Hypotonia 80 Hyperflexibility of large joints 80 Loose skin on back of neck 80 Slanted palpebral fissures 80 Dysmorphic pelvis on radiographs 70 Small round ears 60 Hypoplasia of small finger, middle phalanx 60 Single palmar crease 45

trisomy 21 - down syndrome , trisomy 18 - edwards syndrome , trisomy 13 - patau syndrome

24- hirschsprung disease

1-Hirschsprung disease is a developmental disorder of the enteric nervous system and is

characterized by an absence of ganglion cells in the distal colon resulting in a functional obstruction.

2-Most cases are now diagnosed in the newborn period. Hirschsprung disease should be considered in any newborn who fails to pass meconium within 24-48 hours after birth. Although contrast enema is useful in establishing the diagnosis, full-thickness rectal biopsy remains the criterion standard. Once the diagnosis is confirmed, the basic treatment is to remove the poorly functioning aganglionic bowel and create an anastomosis to the distal rectum with the healthy innervated bowel (with or without an initial diversion).

3-Hirschsprung disease should be considered in any newborn with delayed passage of meconium or in any child with a history of chronic constipation since birth. Other symptoms include bowel obstruction with bilious vomiting, abdominal distention, poor feeding, and failure to thrive.

4-Surgical management of Hirschsprung disease begins with the initial diagnosis, which often requires a full-thickness rectal biopsy. Traditionally, treatment also includes creating a diverting colostomy at the time of diagnosis, and, once the child grows and weighs more than 10 kg, the definitive repair is performed.

This standard of treatment was developed in the 1950s after reports of relatively high leak and stricture rates with the single stage procedure were initially described by Swenson. However, with the advent of safer anesthesia and more advanced hemodynamic monitoring, a primary pull-through procedure without a diverting colostomy is increasingly being performed. Contraindications to a one-stage procedure include massively dilated proximal bowel, severe enterocolitis, perforation, malnutrition, and inability to accurately determine the transition zone by frozen section.

For neonates who are first treated with a diverting colostomy, the transition zone is identified and the colostomy is placed proximal to this area. The presence of ganglion cells at the colostomy site must be unequivocally confirmed by a frozen-section biopsy. Either a loop or end stoma is appropriate, usually based on the surgeon's preference.

A number of definitive procedures have been used, all of which have demonstrated excellent results in experienced hands. The 3 most commonly performed repairs are the Swenson, Duhamel, and Soave procedures. Regardless of the pull-through procedure chosen, cleaning the colon prior to definitive repair is necessary.

• Swenson procedure

• The Swenson procedure was the original pull-through procedure used to treat Hirschsprung disease.
• The aganglionic segment is resected down to the sigmoid colon and the remaining rectum, and an oblique anastomosis is performed between the normal colon and the low rectum.

• Duhamel procedure

• The Duhamel procedure was first described in 1956 as a modification to the Swenson procedure.
• Key points are that a retrorectal approach is used and a significant portion of aganglionic rectum is retained.
• The aganglionic bowel is resected down to the rectum, and the rectum is oversewn. The proximal bowel is then brought through the retrorectal space (between the rectum and sacrum), and an end-to-side anastomosis is performed on the remaining rectum.

• Soave (endorectal) procedure

• The Soave procedure was introduced in the 1960s and consists of removing the mucosa and submucosa of the rectum and pulling the ganglionic bowel through the aganglionic muscular cuff of the rectum.
• The original operation did not include a formal anastomosis, relying on scar tissue formation between the pull-through segment and the surrounding aganglionic bowel. The procedure has since been modified by Boley to include a primary anastomosis at the anus.

• Anorectal myomectomy

• For children (and occasionally adults) with ultrashort-segment Hirschsprung disease, removing a strip of posterior midline rectal wall is an alternative surgical option.
• The procedure removes a 1-cm wide strip of extramucosal rectal wall beginning immediately proximal to the dentate line and extending to the normal ganglionic rectum proximally.
• The mucosa and submucosa are preserved and closed.

• Procedures for long-segment Hirschsprung disease
  • Patients with total colonic involvement require modified procedures to bypass the aganglionic colon yet preserve the absorptive surface area and allow for proper growth and nutritional support.
  • Most procedures include a side-to-side anastomosis of the ganglionic/propulsive small bowel to a short segment of the aganglionic/absorptive colon.
  • Whether a short right colonic patch or a small bowel-to-rectal wall Duhamel anastomosis is created is perhaps less important than maintaining a short patch length (<10>
  • Long-segment anastomoses, such as the Martin procedure, are no longer advocated.

• A laparoscopic approach to the surgical treatment of Hirschsprung disease was first described in 1999 by Georgeson. The transition zone is first identified laparoscopically, followed by mobilization of the rectum below the peritoneal reflection. A transanal mucosal dissection is performed, followed by prolapsing of the rectum through the anus and anastomosis. Functional outcomes appear to be equivalent to open techniques based on short-term results (Georgeson, 1999; de Lagausie, 1999; Curran, 1996).
• Transanal pull-through in which no intra-abdominal dissection is performed has also been described (Langer, 1999; De La Torre-Mondregan, 1998). The entire procedure is performed from below in a manner similar to perineal rectosigmoidectomy. The transition zone is identified and anastomosis is performed. Similar to the laparoscopic approach, outcomes have been similar to open single stage approaches with the benefits of minimal analgesia and shortened hospital stays (Langer, 2000; De La Torre, 2000; Langer, 2003).
• ---------------------------------------------

23- menghini's needle

this menghini 's needle is mainly used to do liver biopsies.

THE INDICATIONS OF LIVER BIOPSY ARE :

Liver biopsy, in combination with history and physical examination data, is a powerful clinical tool for diagnosing and treating liver disease. Indications for obtaining a biopsy specimen are listed in as follows. These are divided according to the type of clinical question framed.

• Evaluation of abnormal hepatic laboratory test results
• Confirmation of diagnosis and prognostication
• Suspected hepatic neoplasm
• Diagnosis of cholestatic liver disease
• Evaluation of infiltrative or granulomatous disease
• Following a case of liver transplantation to evaluate and manage rejection
• To evaluate unexplained jaundice or suspected drug reactions

The biopsy specimen may be used to identify or exclude possible etiologies for physical or laboratory abnormalities. Although various disease states may present similarly, diagnostic histologic patterns exist when used in the context of clinical presentation. For example, infiltration of the hepatic parenchyma by fat may exist in diseases due to alcohol abuse, hepatitis C, diabetes, and/or obesity. For each disease state, histologic clues exist that distinguish one from the other.

Liver biopsy plays little role in the determination of the organism responsible for systemic infection because blood cultures generally are revealing. The notable exceptions are intrahepatic tuberculosis and Mycobacterium avium complex (MAC).

Another indication for biopsy is the determination of the extent of histologic change present in a biopsy specimen. This involves scoring systems for the degrees of inflammation and fibrosis noted by the pathologist. Many systems exist for describing the microscopic findings, ranging from simplistic to complex. The majority of scoring systems report the degree of inflammation as the grade of the disease and the amount of fibrosis as the stage. An example here would be the finding of moderate inflammation (grade 3) in a specimen from a cirrhotic (stage 4) liver.

The third set of indications is the monitoring of the progression of disease or of treatment efficacy. For example, liver biopsy specimens frequently are used to evaluate and treat rejection following liver transplantation. Repeated biopsies are used less frequently to monitor progression of diseases such as primary biliary cirrhosis, chronic hepatitis C, or alcoholic liver disease.

Regardless of the indication for the biopsy, identifying which information the procedure is anticipated to yield is important.

CONTRAINDICATIONS OF LIVER BIOPSY ARE :

Contraindications to percutaneous liver biopsy are relatively few, but identifying contraindications is important to avoid the major complications associated with the procedure. Contraindications to liver biopsy include the following:

• Increased prothrombin time, international normalized ratio (INR) greater than 1.6
• Thrombocytopenia, platelet count less than 60,000
• Ascites (transjugular route preferred)
• Difficult body habitus (transjugular route preferred)
• Suspected hemangioma
• Suspected echinococcal infection
• Uncooperative patient

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22- types of biological transmission

There are four types of biological transmission , they are :

A- PROPOGATIVE TRANSMISSION - in this type of transmission only multiplication of the organism takes place in the host without any kind of development that is change in form . example for this type of transmission is THE PLAGUE BACILLUS IN THE RAT FLEA.

B -CYCLOPROPOGATIVE TRANSMISSION - in this type of transmission not only does the parasite multiply vigorously it also changes its form . example for such type of transmission is

malaria parasite undergoing its sexual life cycle in the female anopheles mosquito.

C-CYCLODEVELOPMENTAL TRANSMISSION - in this type of transmission the parasite only undergoes change in form or development in the host but does not multiply .example for this type of transmission is the FILARIAL PARASITE IN CULEX MOSQUITO .

D- MECHANICAL TRANSMISSION - in this type of transmission there is neither change in the form of the parasite in the host nor multiplication of the parasite in the host .

22- types of biological transmission

21- sterlising techniques3

-the lippe's loop which is a type of contraceptive intrauterine device is sterilised by

using 1/2500 AQEOUS SOLUTION OF IODINE. -the thermometer is sterilised by

using the SAVLON 1 IN 6 IN SPIRIT FOR 3

MINUTES.

20- sterlising techniques 2

the glass feedin bottles were used in 1930. the chemical used to sterilise these infant feeding

bottles is SODIUM HYPOCHLORITE.

19- sterlising techniques

the black catheters are ageold catheters which were used way back in 1940 and 1960 s.

the coloured one is the latest ultrasound cardiac catheter .

normally ETHYLENE OXIDE is used to sterilise these catheters.

18-human breast milk- advantages

COMPOSITION OF BREAST MILK :

WATER ---------------- 87 % -- 86 % ( IN COLOSTRUM )

CARBOHYDRATE - 7.5 %-- 3.2 % (IN COLOSTRUM )

FAT-----------------------3.2 %-- 2.3 % ( IN COLOSTRUM )

PROTEIN --------------1.2 %-- 8.6 % (IN COLOSTRUM )

- THE COLOSTRUM IS THE DEEP YELLOW SEROUS FLUID SECRETED BY THE BREASTS WHICH STARTS

DURING PREGNANCY AND IS SECRETED TILL TWO DAYS AFTER DELIVERY . ALSO CALLED FIRST MILK OR

BEESTINGS.

ADVANTAGES OF BREAST MILK --------

MATERNAL ADVANTAGES :

1-maternal bonding

2-less cost than substitute products

3-more appropriate child spacing due to a decrease in fertility

4-portable and resists spoilage while in the breast .

FETAL ADVANTAGES :

1-infant bonding

2-decreased incidence of diarrhea , wheezing bronchitis , necrotizing enterocolitis

3-bactericidal effect of lysozyme

4-presence of c3 and c4 components of the complement,lactoferin , secretory Ig A
and small amounts of Ig M and Ig G .

5-lower morbidity in the first year of life

6-bifidus factor stimulates the growth of L .bifidus in the gut.

7-Iron better absorbed and less anaemia found

8- lower incidence of tetany due to calcium/phosphorus ratio

9- less obesity and lesser chances of marasmus .

10-more digestible

11- decrease in food allergy compared to cows milk ( which has high beta - lactoglobulin )

12-composition tailor made for organ development ( renal function ) and growth (term compared with premature infant )
------------------------------------------------------

17-FREI TEST

THE ABOVE PICTURE SHOWS SUPPURATING LYMPH NODE IN LYMPHOGRANULOMA VENERUM.

Previously, the Frei test was the only method available to identify a chlamydial infection. Currently, the Frei intradermal test is only of historical interest.

• The test was based on a positive hypersensitivity to an intradermal standardized antigen, lymphogranuloma venereum, which indicated past or present chlamydial infection. The Frei test would become positive 2-8 weeks after infection.
• 
  
• Unfortunately, the Frei antigen is common to all chlamydial species and is not specific to LGV. Commercial manufacturing of Frei antigen was discontinued in 1974.
• ---------------------------------------------------
  

16- prion related diseases

prion is a protein particle which is infectious without any nucleic acids or virus like structure or properties. the diseases caused by prions are :

• In animals:
  • Scrapie in sheep and goats^[26]
  • Bovine spongiform encephalopathy (BSE) in cattle (known as mad cow disease)^[26]
  • Transmissible mink encephalopathy (TME) in mink^[26]
  • Chronic wasting disease (CWD) in elk and mule deer^[26]
  • Feline spongiform encephalopathy in cats^[26]
  • Exotic ungulate encephalopathy (EUE) in nyala, oryx and greater kudu^[26]
  • Spongiform encephalopathy of the ostrich^[27]
• In humans:
  • Creutzfeldt-Jakob disease (CJD)^[26] and its varieties: iatrogenic Creutzfeldt-Jakob disease (iCJD), variant Creutzfeldt-Jakob disease (vCJD), familial Creutzfeldt-Jakob disease (fCJD), and sporadic Creutzfeldt-Jakob disease (sCJD)
  • Gerstmann-Sträussler-Scheinker syndrome (GSS)^[26]
  • Fatal familial insomnia (fFI)^[26]
  • Sporadic fatal insomnia (sFI)^[28]
  • Kuru^[26]
  • Alpers syndrome^[27]

-------------------------------------------------------------

Disease	Host	Mechanism
Kuru	Human	Cannibalism
Sporadic CJD	Human	Spontaneous PrPC to PrPSc conversion or somatic mutation
Iatrogenic CJD	Human	Infection from prion-containing material, eg, dura mater, electrode
Familial CJD	Human	Mutations in the PrP gene
vCJD	Human	Infection from BSE
GSS	Human	Mutations in the PrP gene
FFI	Human	D178N mutation in the PrP gene, with M129 polymorphism
Sporadic fatal insomnia	Human	Spontaneous PrPC to PrPSc conversion or somatic mutation
Scrapie	Sheep	Infection in susceptible sheep
BSE	Cattle	Infection from contaminated food
TME	Mink	Infection from sheep or cattle in food
CWD	Mule, deer, elk	Unclear
Feline spongiform encephalopathy	Cats	Infection from contaminated food
Exotic ungulate encephalopathy	Nyala, oryx, kudu	Infection from contaminated food

---------------------------------------------------

15- kiesselbach's plexus ( little's area )

t

the keisselbach's plexus is an area of rich arterial anastomosis seen in the ANTERIO INFERIOR REGION OF THE NASAL SEPTUM . the most common cause of epistaxis is injury to this site . the arteries that anastomose here are -

1- ANTERIOR ETHMOIDAL ARTERY

2-SUPERIOR LABIAL ARTERY

3- SPHENOPALATINE ARTERY

4- GREATER PALATINE ARTERY .

---------------------------------------------

14- myiasis

Myiasis is an animal or human disease caused by parasitic dipterous fly larvae feeding on the host's necrotic or living tissue. Colloquialisms for Myiasis include "fly-strike" and "fly-blown".

Blowfly strike, known as myiasis, is a common disease in sheep, especially in areas where there are hot and wet conditions. The female flies lay their eggs on the sheep in damp, protected areas soiled with urine and faeces, mainly on the breech. It takes approximately 8 hours to a day for the eggs to hatch, depending on the conditions. This results in sores as the larvae lacerate the skin and this is the primary reason for the early removal of lambs' tails. The larvae then tunnel into the host's tissue causing irritating lesions. After about the second day bacterial infection occurs and if left untreated causes toxemia or septicemia. This leads to anorexia and weakness and if untreated will lead to death. Blowfly strike accounts for over $170 million a year in losses in the Australian sheep industry and so prevention measures such as mulesing are practiced.

German entomologist Fritz Zumpt describes myiasis as "the infestation of live human and vertebrate animals with dipterous larvae, which at least for a period, feed on the host's dead or living tissue, liquid body substances, or ingested food."

13- RICHTER'S HERNIA

These are the pictures of a type of hernia called the richter's hernia . it involves the herniation of only one side wall of the intestine which can lead to gangrene and perforation but there will be no symptoms of intestinal obstruction. named after German surgeon August Gottlieb Richter (1742-1812).

RICHTER'S HERNIA IS SEEN MOST COMMONLY IN FEMORAL HERNIA.

12- CEREBRO SPINAL FLUID

1- CSF is normally produced in the choroid plexus of the ventricles and is drained at the archnoid villi .

2- normal csf volume in an adult - 150 ml

3- normal csf pressure ----------- 50 to 180 mm of water.

4- are red blood cells normally present in csf ? NO , THE PRESENCE OF RBC IN THE CSF INDICATES PATHOLOGY .

5- are white blood cells normally found in csf ? YES , 0 TO 5 MONONUCLEAR CELLS PER mm3.

6- are neutrophils normally present in csf ? NO , ONLY MONONUCLEAR CELLS LIKE LYMPHOCYTES ( 60-70 % ) AND MONOCYTES ( 30 - 50 % ) are present. SO MULTINUCLEATED CELLS ARE GENERALLY ABSENT IN NORMAL CSF.

7- amount of glucose in the csf ? normally----- 40 - 70 mg/dl

8- amount of total lumbar csf protein ? normally ---- 15- 50 mg/dl

9- amount of lactate in the csf ? normally ----- 10 -20 mg/dl.

11- vincent's angina

Vincent's Angina of the Left Tonsil. The ulcer is friable and bleeds easily when swabbed.

Vincent's Angina ia an acute necrotizing infection of the pharynx caused by a combination of fusiform bacilli (Fusiformis fusiformis - a Gram -ve bacillus) and spirochetes (Borrelia vincentii ). These are the same organisms that cause a gingivostomatitis known as trench mouth.

The patient complains of unilateral sore throat that increases in intensity over several days with an associated referred earache on the same side. In addition, the patient complains of a bad taste in the mouth and a fetid bad breath.

On examination, there is a deep well circumscribed unilateral ulcer of one tonsil. The base of the ulcer is gray and bleeds easily when scraped with a swab. There may also be an associated submandibular lymphadenopathy.

Vincent angina is diagnosed using a gentian violet-stained smear of the pharyngeal exudate, which demonstrates the presence of Fusobacterium and spirochetes.

Penicillin or Clindamycin and surgical debridement are the recommended treatment.

10- schirmer's test

e

the schirmers test is a test done to diagnose dry eyes which can occur due to a whole hell lot of reasons.it is also called tear test. if the paper is dry even after 15 minutes it indicates sjogren syndrome which is one of the causes of dry eyes . but has to be confirmed . Dry eyes or lack of sufficient tear production, is a common eye problem in the Middle East. It could be due to very trivial cause like staying inside an air-conditioned room poor humidification, prolong reading or working on the computer with lack of adequate blinking or due to poor lid hygiene. It can also be due to more serious eye problems due to various diseases like, Rheumatoid arthritis, Sjogren's syndrome, Systemic lupus erythematosus, psoriatic arthritis, juvenile chronic arthritis, polymyositis and thyroiditis. Chronic use of antihistaminic for cold and allergy can also cause dry eyes. The tear film consists of three layers, the top one is the oily layer, the bottom one is the mucous layer and in between is the water layer. Poor lid hygiene leads to the blockage of the oil producing glands in the lids and subsequent excessive evaporation of the tear film due to lack of oil protection over the water layer. There are conditions of the eye when the mucous layer is defective such as Vitamin A deficiency and ocular pemphigus. Sometime chemical burns, especially alkali burns (e.g. drain cleaner, ammonia containing cleaning agents etc.) The most common symptoms of dry eyes are irritation, itching, foreign body sensation, burning, presence of stringy mucous discharge, transient blurring of vision, intolerance to sunlight and heavy feeling over the eyelids.

SOMETIMES THIS TEST CAN ALSO BE APPLIED TO TEST THE FACIAL NERVE AS THE PARASYMPATHETIC SUPPLY (SECRETOMOTOR FIBRES) TO THE LACRIMAL GLAND IS THRU THE FACIAL NERVE.

9-hutchinsons triad

medicine some times looks so easy . just by looking at the two incisors u can make a diagnosis . this picture shows the hutchinsons incisors which are characteristic of CONGENITAL SYPHILIS . by the way the diagnostic criteria of the congenital syphilis are called the hutchinsons triad and they are

a- HUTCHINSONS TEETH - AS U CAN SEE ABOVE

b- INTERSTITIAL KERATITIS

c- EIGTH NERVE DEAFNESS ( VESTIBULO COCHLEAR NERVE )

AIDS opportunistic infections

the first photo shows the lesions of kaposi sarcoma which is common in aids patients.

1- a cd4 count of less than 350 cells / microlitre is an indication to start the antiretroviral therapy in aids patients .

2- a cd4 count of less than 200 cells /microlitre is an indication that the patient is highly susceptible for pneumocystis carinii .

3- a cd4 count of less than 50 cells /microlitre is an indication that the patient is highly susceptible for CMV and mycobacteria of the mycobacterium avium complex.

4- as the cd4 count falls the opportunistic infections which will occur in an aids patient in the correct order as the count falls are

a- HERPES SIMPLEX VIRUS

b- HERPES ZOSTER

c- CRYPTOSPORIDIOSIS

d- KAPOSI SARCOMA

e- CRYPTOCCAL MENINGITIS

f- CANDIDIAL OESOPHAGITIS

g- PRIMARY PNEUMOCYSTIS CARINII PNEUMONIA( less than 200 cells/ microlitre - cd4 count)

h- NON HODGKIN LYMPHOMA

i- AIDS DEMENTIA COMPLEX

j- PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY

k- WASTING SYNDROME

l- TOXOPLASMA GONDII ENCEPHALITIS

m- CMV RETINITIS ( less than 50 cells / microlitre )cd4 count.

n- SECONDARY PNEUMOCYSTIS CARINII PNEUMONIA

0- MYCOBACTERIUM AVIUM COMPLEX BACTEREMIA( less than 50 cells / microlitre )cd4 count.

leprosy

1- world leprosy day - january 28

2- other name of leprosy - HANSEN'S DISEASE

3- treatment of leprosy

a)- tuberculoid leprosy( paucibacillary leprosy )

- ----->WHO regimen 1982------ DAPSONE - 100 mg/day - unsupervised +

RIFAMPICIN - 600 mg/month - supervised

( both for 6 months ) .

------>MORE INTENSIVE REGIMEN --------

DAPSONE - 100 mg/day for 5 years ...

b) lepromatous leprosy ( multibacillary leprosy )

- -----> WHO regimen 1982------

DAPSONE - 100 mg/day +

CLOFAZIMINE - 50 mg/day ( unsupervised )

RIFAMPICIN - 600 mg +

CLOFAZIMINE - 300 mg/month ( monthly supervised )

both for 1 t0 2 years.

------> INTENSIVE REGIMEN -----

RIFAMPIN - 600 mg/day ( for 3 years ) +

DAPSONE - 100 mg/day ( indefinitely ) . -------------------------------------------------------------------

a small beautiful quote from BABA AMTE - JOY IS MORE INFECTIOUS THAN

LEPROSY ........... beautiful isn't it?

oral rehydration solutions

the concentration of various components of oral rehydration solution is

A- SODIUM CHLORIDE - 3.5 grams//////// - Na + CONC - 90 mmol/litre.

B- TRISODIUM CITRATE --- 2.9 grams////////- CITRATE CONC - 10 mmol / litre.

C- POTASSIUM CHLORIDE - 1.5 gms ///////- POTASSIUM CONC - 20 mmol /litre.

D- POTASSIUM CHLORIDE - 1.5 gms///////- CHLORIDE CONC - 80 mmol/litre.

E- GLUCOSE ---------------- 20 gms ///////- GLUCOSE CONC - 110 mmol/litre.

all these in the above said concentrations shud be dissolved in 1 litre of water.

------------------------------------------------------------------------------------

try remembering this using the pnemonic --- 110 - 20 = 80 + 10 = 90 .

anti viral chemotherapy and prophylaxis - little more

1- drug of choice for respiratory syncitial virus

( paramyxovirus - negative sense single strand

RNA virus) ----------------------------------------- RIBAVARIN.

2- drug of choice for CMV retinitis in AIDS patient --- GANCICLOVIR AND VALGANCICLOVIR.

3- drug of choice in influenza A and B -

PROPHYLAXIS- AMANTIDINE OR RIMANTIDINE.

TREATMENT - ZANAMIVIR AND OSELTAMIVIR.

4- drug of choice in chronic hepatitis b - INTERFERON ALPHA 2 B + LAMIVUDINE

5- drug of choice in chronic hepatitis c - INTERFERON ALPHA 2B + RIBAVARIN.

6- drug of choice in chronic hepatitis d - INTERFERON ALPHA 2B OR ALPHA 2A .

7- drug of choice in condyloma acuminatum - INTERFERON ALPHA 2B OR ALPHA NE3.

anti viral chemotherapy and prophylaxis

1- drug of choice in varicella ( immunocompetent host ) - ACYCLOVIR

2- drug of choice in varicella ( immunocompromised host) - ACYCLOVIR

3-drug of choice in herpes simplex encephalitis ------------ ACYCLOVIR

4- drug of choice in neonatal herpes simplex --------------- ACYCLOVIR

5- drug of choice in genital herpes simplex -

a- primary treatment -----------ACYCLOVIR

b-recurrent treatment ----------ACYCLOVIR

c-recurrent suppression -------- ACYCLOVIR

6-drug of choice in mucocutaneous herpes simplex------

a-immunocomprimised host------ACYCLOVIR

b-prevention of recurrences

during intense immuno suppression----ACYCLOVIR

HERPES SIMPLEX OROLABIALIS RECURRENT ----- PENCICLOVIR

7- drug of choice in herpes zoster opthalmicus -------------- ACYCLOVIR

8- drug of choice in herpes zoster -----
a- immunocompromised host ---- ACYCLOVIR

b- IMMUNOCOMPETENT HOST ------ VALACYCLOVIR.

9- DRUG OF CHOICE FOR HERPES SIMPLEX KERATITIS - TRIFLURIDINE.

-------------------------------------------------------------------------------------

Treatment of herpes viruses infection

1-drug of choice for herpes simplex keratitis is TRIFLURIDINE, VIDARABINE.

2- drug of choice for herpes simplex orolabialis ( recurrent ) - PENCICLOVIR, VALACYCLOVIR, FAMCICLOVIR AND DOCOSONAL.

3- drug of choice in immunocompetent patients with herpes zoster- VALACYCLOVIR , FAMCICLOVIR AND ACYCLOVIR.

4- for the rest of all type of infections in immuno compromised and immunocompetent patients and even in recurrent conditions caused by the HSV-1 , HSV-2 and VARICELLA ..... the drug of choice is ACYCLOVIR.

herpesviridae classification

Human Herpesvirus (HHV) classification
Type	Synonym	Subfamily	Pathophysiology
HHV-1	Herpes simplex virus-1 (HSV-1)	α (Alpha)	Oral and/or genital herpes (predominantly orofacial)
HHV-2	Herpes simplex virus-2 (HSV-2)	α	Oral and/or genital herpes (predominantly genital)
HHV-3	Varicella zoster virus (VZV)	α	Chickenpox and shingles
HHV-4	Epstein-Barr virus (EBV), lymphocryptovirus	γ (Gamma)	Infectious mononucleosis, Burkitt's lymphoma, CNS lymphoma in AIDS patients, post-transplant lymphoproliferative syndrome (PTLD), nasopharyngeal carcinoma
HHV-5	Cytomegalovirus (CMV)	β (Beta)	Infectious mononucleosis-like syndrome,[5] retinitis, etc.
HHV-6, -7	Roseolovirus	β	Sixth disease (roseola infantum or exanthem subitum)
HHV-8	Kaposi's sarcoma-associated herpesvirus (KSHV), a type of rhadinovirus	γ	Kaposi's sarcoma, primary effusion lymphoma, some types of multicentric Castleman's disease

classification of viruses

This is the baltimore classification------------

Virus classification

DNA viruses

• Group I: viruses possess double-stranded DNA and include such virus families as Herpesviridae (examples like HSV1 (oral herpes), HSV2 (genital herpes), VZV (chickenpox), EBV (Epstein-Barr virus), CMV (Cytomegalovirus)), Poxviridae (smallpox) and many tailed bacteriophages. The mimivirus was also placed into this group.
• Group II: viruses possess single-stranded DNA and include such virus families as Parvoviridae and the important bacteriophage M13.

Virus Family	Virus Genus	Virion- naked/ enveloped	Capsid Symmetry	Type of nucleic acid
1.Adenoviridae	Adenovirus	Naked	Icosahedral	ds
2.Papovaviridae	Papillomavirus	Naked	Icosahedral	ds circular
3.Parvoviridae	B 19 virus	Naked	Icosahedral	ss
4.Herpesviridae	Herpes Simplex Virus, Varicella zoster virus, Cytomegalovirus, Epstein Barr virus	Enveloped	Icosahedral	ds
5.Poxviridae	Small pox virus, Vaccinia virus	Complex coats	Complex	ds
6.Hepadnaviridae	Hepatitis B virus	Enveloped	Icosahedral	ds circular
7.Polyomaviridae	Polyoma virus (progressive multifocal leucoencephalopathy)	?	?	ds

[edit] RNA viruses

For more details on this topic, see RNA virus.

• Group III: viruses possess double-stranded RNA genomes, e.g. rotavirus. These genomes are always segmented.
• Group IV: viruses possess positive-sense single-stranded RNA genomes. Many well known viruses are found in this group, including the picornaviruses (which is a family of viruses that includes well-known viruses like Hepatitis A virus, enteroviruses, rhinoviruses, poliovirus, and foot-and-mouth virus), SARS virus, hepatitis C virus, yellow fever virus, and rubella virus.
• Group V: viruses possess negative-sense single-stranded RNA genomes. The deadly Ebola and Marburg viruses are well known members of this group, along with influenza virus, measles, mumps and rabies.

Virus Family	Virus Genera	Virion- naked/ enveloped	Capsid Symmetry	Type of nucleic acid
1.Reoviridae	Reovirus, Rotavirus	Naked	Icosahedral	ds
2.Picornaviridae	Enterovirus, Rhinovirus, Hepatovirus, Cardiovirus, Aphthovirus, Parechovirus, Erbovirus, Kobuvirus, Teschovirus	Naked	Icosahedral	ss
3.Caliciviridae	Norwalk virus, Hepatitis E virus	Naked	Icosahedral	ss
4.Togaviridae	Rubella virus	Enveloped	Icosahedral	ss
5.Arenaviridae	Lymphocytic choriomeningitis virus	Enveloped	Complex	ss
6.Retroviridae	HIV-1, HIV-2, HTLV-I	Enveloped	Complex	ss
7.Flaviviridae	Dengue virus, Hepatitis C virus, Yellow fever virus	Enveloped	Complex	ss
8.Orthomyxoviridae	Influenzavirus A, Influenzavirus B, Influenzavirus C, Isavirus, Thogotovirus	Enveloped	Helical	ss
9.Paramyxoviridae	Measles virus, Mumps virus, Respiratory syncytial virus	Enveloped	Helical	ss
10.Bunyaviridae	California encephalitis virus, Hantavirus	Enveloped	Helical	ss
11.Rhabdoviridae	Rabies virus	Enveloped	Helical	ss
12.Filoviridae	Ebola virus, Marburg virus	Enveloped	Helical	ss
13.Coronaviridae	Corona virus	Enveloped	Complex	ss
14.Astroviridae	Astrovirus	Naked	Icosahedral	ss
15.Bornaviridae	Borna disease virus	Enveloped	Helical	ss

[edit] Reverse transcribing viruses

For more details on this topic, see Reverse transcribing virus.

• Group VI: viruses possess single-stranded RNA genomes and replicate using reverse transcriptase. The retroviruses are included in this group, of which HIV is a member.
• Group VII: viruses possess double-stranded DNA genomes and replicate using reverse transcriptase. The hepatitis B virus can be found in this group.