NEET MDS Synopsis
Erythromycin
Pharmacology
Erythromycin
used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma. It is also used to treat outbreaks of chlamydia, syphilis, and gonorrhea.
Erythromycin is produced from a strain of the actinomyces Saccaropolyspora erythraea, formerly known as Streptomyces erythraeus.
Mechanism of action Erythromycin prevents bacteria from growing, by interfering with their protein synthesis. Erythromycin binds to the subunit 50S of the bacterial ribosome, and thus inhibits the translocation of peptides.
Erythromycin is easily inactivated by gastric acids, therefore all orally administered formulations are given as either enteric coated or as more stable salts or esters. Erythromycin is very rapidly absorbed, and diffused into most tissues and phagocytes. Due to the high concentration in phagocytes, erythromycin is actively transported to the site of infection, where during active phagocytosis, large concentrations of erythromycin are released.
Most of erythromycin is metabolised by demethylation in the liver. Its main route elimination route is in the bile, and a small portion in the urine.
Erythromycin's half-life is 1.5 hours.
Side-effects. More serious side-effects, such as reversible deafness are rare. Cholestatic jaundice, Stevens-Johnson syndrome and toxic epidermal necrosis are some other rare side effects that may occur.
Contraindications Earlier case reports on sudden death prompted a study on a large cohort that confirmed a link between erythromycin, ventricular tachycardia and sudden cardiac death in patients also taking drugs that prolong the metabolism of erythromycin (like verapamil or diltiazem)
erythromycin should not be administered in patients using these drugs, or drugs that also prolong the QT time.
Blastomycosis (North American Blastomycosis; Gilchrist's Disease)
General Pathology
Blastomycosis (North American Blastomycosis; Gilchrist's Disease)
A disease caused by inhalation of mold conidia (spores) of Blastomyces dermatitidis, which convert to yeasts and invade the lungs, occasionally spreading hematogenously to the skin or focal sites in other tissues.
Pulmonary blastomycosis tends to occur as individual cases of progressive infection
Symptoms are nonspecific and may include a productive or dry hacking cough, chest pain, dyspnea, fever, chills, and drenching sweats. Pleural effusion occurs occasionally. Some patients have rapidly progressive infections, and adult respiratory distress syndrome may develop.
Central Nervous System
Physiology
The Nervous System Has Peripheral and Central Units
The central nervous system (CNS) is the brain and spinal column
The peripheral nervous system (PNS) consists of nerves outside of the CNS
There are 31 pairs of spinal nerves (mixed motor & sensory)
There are 12 pairs of cranial nerves (some are pure sensory, but most are mixed)
The pattern of innervation plotted on the skin is called a dermatome
The Nervous System Has Peripheral and Central Units
The central nervous system (CNS) is the brain and spinal column
The peripheral nervous system (PNS) consists of nerves outside of the CNS
There are 31 pairs of spinal nerves (mixed motor & sensory)
There are 12 pairs of cranial nerves (some are pure sensory, but most are mixed)
The pattern of innervation plotted on the skin is called a dermatome
Helicobacter Pylori Agents
Pharmacology
Helicobacter Pylori Agents
Antimicrobial
• Amoxicillin,
• Clarithromycin,
• Metronidozole
• Tetracycline
Antisecreteory agents accelerates symptom relief and yield healing (omeprozole)
Bismuth subsalicylate
Therapy For H. Pylori
Original
• Tetracycline
• Metronidazole (Flagyl)
• Bismuth subsalicylate
• Given for 14 days
• >90% effective in eradicating microorganisms
New triple therapy
• Amoxicillin
• Clarithromycin
• Omeprazole (Prilosec)
• Given for 7 days
• >90% effective in eradicating microorganisms
Dual Therapy
Amoxicillin or clarithromycin
Omeprazole
Given for 14 days
60-80% effective in eradication of H. Pylori
Classification of Cementum
Dental Anatomy
Classification of Cementum
Embryologically
Primary and secondary
2. According to cellular component
Acellular: Thin, Amorphous, First layer to seal the dentin tubules
Cellular: Thick, Better structure, Apical surface
Layers of cellular and acellular cementum alternate (randomly)
3. Based on the origin of the collagenous matrix
Extrinsic
Intrinsic
Mixed
4. Combined classification
a. Primary acellular intinsic fiber cementum
b. Primary acellualar extrinsic fiber cementum
c. Secondary cellular intrinsic fiber cementum
d. Secondary cellular mixed fiber cementum
e. Acellular afibrillar cementum
5. Depending on the location and patterning
Intermediate and mixed stratified cementum
Participating Cells
Cementoblasts
Active
Cells are round, plump with basophilic cytoplasm (rough endoplasmic reticulum)
Inactive
Cells have little cytoplasm
Cementocytes
Cementocyte lacuna
cementocyte canaliculus
Cells have fewer organelles compared to cementoblasts. They are found in lacunae and have numerous processes toward the periodontal ligament. Eventually they die due to avascularity
Cementicles
a) free
b) attached
c) embedded
FATTY ACIDS
Biochemistry
FATTY ACIDS
Fatty acids consist of a hydrocarbon chain with a carboxylic acid at one end.
• are usually in esterified form as major components of other lipids
• are often complexed in triacylglycerols (TAGs)
• most have an even number of carbon atoms (usually 14 to 24)
• are synthesized by concatenation of C2 units.
• C16 & C18 FAs are the most common FAs in higher plants and animals
• Are either:
—saturated (all C-C bonds are single bonds) or
—unsaturated (with one or more double bonds in the chain)
—monounsaturated (a single double bond)
1.Example of monounsaturated FA: Oleic acid 18:1(9) (the number in unsaturated FA parentheses indicates that the double bond is between carbons 9 & 10)
2. Double bonds are almost all in the cis conformation
—polyunsaturated (more then one double bond)
Polyunsaturated fatty acids contain 2 or more double bonds. They usually occur at every third carbon atom towards the methyl terminus (-CH3 ) of the molecule. Example of polyunsaturated FA: Linoleic acid 18:2(9,12)
• the number of double bonds in FAs varies from 1 to 4 (usually), but in most bacteria it is rarely more than 1
Saturated FAs are highly flexible molecules that can assume a wide range of conformations because there is relatively free rotation about their C-C bonds.
Distraction Techniques
PedodonticsDistraction Techniques in Pediatric Dentistry
Distraction is a valuable technique used in pediatric dentistry to help
manage children's anxiety and discomfort during dental procedures. By diverting
the child's attention away from the procedure, dental professionals can create a
more positive experience and reduce the perception of pain or discomfort.
Purpose of Distraction
Divert Attention: The primary goal of distraction is to
shift the child's focus away from the dental procedure, which may be
perceived as unpleasant or frightening.
Reduce Anxiety: Distraction can help alleviate anxiety
and fear associated with dental visits, making it easier for children to
cooperate during treatment.
Enhance Comfort: Providing a break or a moment of
distraction during stressful procedures can enhance the overall comfort of
the child.
Techniques for Distraction
Storytelling:
Engaging the child in a story can capture their attention and
transport them mentally away from the dental environment.
Stories can be tailored to the child's interests, making them more
effective.
Counting Teeth:
Counting the number of teeth loudly can serve as a fun and
interactive way to keep the child engaged.
This technique can also help familiarize the child with the dental
procedure.
Repetitive Statements of Encouragement:
Providing continuous verbal encouragement can help reassure the
child and keep them focused on positive outcomes.
Phrases like "You're doing great!" or "Just a little longer!" can be
effective.
Favorite Jokes or Movies:
Asking the child to recall a favorite joke or movie can create a
light-hearted atmosphere and distract them from the procedure.
This technique can also foster a sense of connection between the
dentist and the child.
Audio-Visual Aids:
Utilizing videos, cartoons, or music can provide a visual and
auditory distraction that captures the child's attention.
Headphones with calming music or engaging videos can be particularly
effective during procedures like local anesthetic administration.
Application in Dental Procedures
Local Anesthetic Administration: Distraction techniques
can be especially useful during the administration of local anesthetics,
which may cause discomfort. Engaging the child in conversation or using
visual aids can help minimize their focus on the injection.
Tetracycline
Pharmacology
Tetracycline
Tetracycline is an antibiotic produced by the streptomyces bacterium
Mechanism and Resistance Tetracycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. This prevents the addition of amino acids to the elongating peptide chain, preventing synthesis of proteins. The binding is reversible in nature.
Example: Chlortetracycline, oxytetracycline, demethylchlortetracycline, rolitetracycline, limecycline, clomocycline, methacycline, doxycycline, minocycline
Source: Streptomyces spp.; some are also semi-synthetic
Spectrum of activity: Broad-spectrum. Exhibits activity against a wide range of Gram-positive, Gram-negative bacteria, atypical organisms such as chlamydiae, mycoplasmas, rickettsiae and protozoan parasites.
Effect on bacteria: Bacteriostatic
Cells become resistant to tetracyline by at least two mechanisms: efflux and ribosomal protection.
Contraindications Tetracycline use should be avoided during pregnancy and in the very young (less than 6 years) because it will result in permanent staining of teeth causing an unsightly cosmetic result.
Tetracyclines also become dangerous past their expiration dates. While most prescription drugs lose potency after their expiration dates, tetracyclines are known to become toxic over time; expired tetracyclines can cause serious damage to the kidneys.
Miscellaneous: Tetracyclines have also been used for non-antibacterial purposes, having shown properties such as anti-inflammatory activity, immunosuppresion, inhibition of lipase and collagenase activity, and wound healing.