NEET MDS Synopsis
Anti-Infective and Anticariogenic Agents
PedodonticsAnti-Infective and Anticariogenic Agents in Human Milk
Human milk is not only a source of nutrition for infants but also contains
various bioactive components that provide anti-infective and anticariogenic
properties. These components play a crucial role in protecting infants from
infections and promoting oral health. Below are the key agents found in human
milk:
1. Immunoglobulins
Secretory IgA: The predominant immunoglobulin in human
milk, secretory IgA plays a vital role in mucosal immunity by preventing the
attachment of pathogens to mucosal surfaces.
IgG and IgM: These immunoglobulins also contribute to
the immune defense, with IgG providing systemic immunity and IgM being
involved in the initial immune response.
2. Cellular Elements
Lymphoid Cells: These cells are part of the immune
system and help in the recognition and response to pathogens.
Polymorphonuclear Leukocytes (Polymorphs): These white
blood cells are essential for the innate immune response, helping to engulf
and destroy pathogens.
Macrophages: These cells play a critical role in
phagocytosis and the immune response, helping to clear infections.
Plasma Cells: These cells produce antibodies,
contributing to the immune defense.
3. Complement System
C3 and C4 Complement Proteins: These components of the
complement system have opsonic and chemotactic activities, enhancing the
ability of immune cells to recognize and eliminate pathogens. They promote
inflammation and attract immune cells to sites of infection.
4. Unsaturated Lactoferrin and Transferrin
Lactoferrin: This iron-binding protein has
antimicrobial properties, inhibiting the growth of bacteria and fungi by
depriving them of iron.
Transferrin: Similar to lactoferrin, transferrin also
binds iron and plays a role in iron metabolism and immune function.
5. Lysozyme
Function: Lysozyme is an enzyme that breaks down
bacterial cell walls, providing antibacterial activity. It helps protect the
infant from bacterial infections.
6. Lactoperoxidase
Function: This enzyme produces reactive oxygen species
that have antimicrobial effects, contributing to the overall antibacterial
properties of human milk.
7. Specific Inhibitors (Non-Immunoglobulins)
Antiviral and Antistaphylococcal Factors: Human milk
contains specific factors that inhibit viral infections and the growth of
Staphylococcus bacteria, providing additional protection against infections.
8. Growth Factors for Lactobacillus Bifidus
Function: Human milk contains growth factors that
promote the growth of beneficial bacteria such as Lactobacillus bifidus,
which plays a role in maintaining gut health and preventing pathogenic
infections.
9. Para-Aminobenzoic Acid (PABA)
Function: PABA may provide some protection against
malaria, highlighting the potential role of human milk in offering broader
protective effects against various infections.
Rheumatic Fever - Major and Minor Criteria
Medicine
Rheumatic fever occurs after a streptococcal infection (usually caused by Group A Beta-Hemolytic Strep (GABHS)).
It is an inflammatory condition that affects the joints, skin, heart and brain.
Major criteria are referred to as Jones criteria
J – Joint involvement which is usually migratory and inflammatory joint involvement that starts in the lower joints and ascends to upper joints
O – (“O” Looks like heart shape) – indicating that patients can develop myocarditis or inflammation of the heart
N – Nodules that are subcutaneous
E – Erythema marginatum which is a rash of ring-like lesions that can start in the trunk or arms. When joined with other rings, it can create a snake-like appearance
S – Sydenham chorea is a late feature which is characterized by jerky, uncontrollable, and purposeless movements resembling twitches
Minor criteria include
C – CRP Increased
A – Arthralgia
F – Fever
E – Elevated ESR
P – Prolonged PR Interval
A – Anamesis
L – Leukocytosis
Diagnosis of rheumatic fever is made after a strep infection (indicated by either throat cultures growing GABHS OR elevated anti-streptolysin O titers in the blood) and:
Two major criteria OR
One major criterion and two minor criteria
Function of Calcium
Biochemistry
Function of Calcium
The major functions of calcium are
(a) Excitation and contraction of muscle fibres needs calcium. The active transport system utilizing calcium binding protein is called Calsequestrin. Calcium decreases neuromuscular irritability.
(b) Calcium is necessary for transmission of nerve impulse from presynaptic to postsynaptic region.
(c) Calcium is used as second messenger in system involving protein and inositol triphosphate.
(d) Secretion of insulin, parathyroid hormone, calcium etc, from the cells requires calcium.
(e) Calcium decrease the passage of serum through capillaries thus, calcium is clinically used to reduce allergic exudates.
(f) Calcium is also required for coagulation factors such as prothrombin.
(g) Calcium prolongs systole.
(h) Bone and teeth contains bulk quantity of calcium.
Anticonvulsant Drugs
Pharmacology
Anticonvulsant Drugs
A. Anticonvulsants: drugs to control seizures or convulsions in susceptible people
B. Seizures: abnormal neuronal discharges in the nervous system produced by focal or generalized brain disturbances
Manifestations: depend on location of seizure activity (motor cortex → motor convulsions, sensory cortex → abnormal sensations, temporal cortex → emotional disturbances)
Causes: many brain disorders such as head injury (glial scars, pH changes), anoxia (changes in pH or CSF pressure), infections (tissue damage, high T), drug withdrawal (barbiturates, ethanol, etc.), epilepsy (chronic state with repeated seizures)
C. Epilepsy: most common chronic seizure disorder, characterized by recurrent seizures of a particular pattern, many types (depending on location of dysfunction)
Characteristics: chronic CNS disorders (years to decades), involve sudden and transitory seizures (abnormal motor, autonomic, sensory, emotional, or cognitive function and abnormal EEG activity)
Etiology: hyperexcitable neurons; often originate at a site of damage (epileptogenic focus), often found at scar tissue from tumors, strokes, or trauma; abnormal discharge spreads to normal brain regions = seizure
Idiopathic (70%; may have genetic abnormalities) and symptomatic epilepsy (30%; obvious CNS trauma, neoplasm, infection, developmental abnormalities or drugs)
Neuropathophysiology: anticonvulsants act at each stage but most drugs not effective for all types of epilepsy (need specific drugs for specific types)
Seizure mechanism: enhanced excitation (glutamate) or ↓ inhibition (GABA) of epileptic focus → fire more quickly → ↑ release of K and glutamate → ↑ depolarization of surrounding neurons (=neuronal synchronization) → propagation (normal neurons activated)
Terminology related to Anatomy
AnatomyA. Anatomic position-erect body position with the arms at the sides and the palms upward
B. Plane or section
1. Definition-imaginary flat surface formed by an extension through an axis
2. Median plane-a vertical plane. that divides a body into right and left halves
3. Sagittal plane
Any plane parallel to the median plane
Divides the body into right and left portions
4. Frontal plane
Vertical plane that forms at right angles to the sagittal plane
Divides the body into anterior and posterior sections
Synonymous with the term coronal plane
5. Transverse plane
Horizontal plane that forms at right angles to the sagittal and frontal planes
Divides the body into upper and lower portions
Synonymous with the term horizontal plane
C. Relative positions
1. Anterior
Nearest the abdominal surface and the front of the body
Synonymous with the term ventral
In referring to hands and forearms, the terms palmar and Volar are used
2. Posterior
Back of the body
Synonymous with the term dorsal
3. Superior
Upper or higher
Synonymous with the term cranial (head)
4. Inferior
Below or lower
Synonymous with the term caudal (tail)
In referring to the top of the foot and the sole of the foot. the terms dorsal and plantar are used respectively
5. Medial-near to the median plane
6. Lateral-farther away from the median plane
7. Proximal-near the source or attachment
8. Distal-away from the source or. attachment
9. Superficial-near the surface
10. Deep-away from the surface
11. Afferent-conducting toward a structure
12. Efferent-conducting away from a structure
Cerebral palsy and Treatment
PedodonticsCerebral palsy (CP) is a neurological disorder resulting from damage to the
brain during its development before, during, or shortly after birth. This
condition is non-progressive, meaning that it does not worsen over time, but it
manifests as a range of neurological problems that can significantly impact a
child's mobility, muscle control, and posture.
Causes:
The primary cause of CP is any factor that leads to decreased oxygen supply
(hypoxia) to the developing brain. This can occur due to various reasons,
including complications during pregnancy, childbirth, or immediately after
birth.
Classification of Cerebral Palsy:
Based on Anatomical Involvement:
Monoplegia: One limb is affected.
Hemiplegia: One side of the body is affected.
Paraplegia: Both legs are affected.
Quadriplegia: All four limbs are affected.
Based on Neuromuscular Involvement:
Spasticity: Characterized by stiff and tight muscles; this
is the most common type, seen in 70% of cases. Affected individuals may
have limited head movement and a limp gait.
Athetosis: Involves involuntary, writhing movements, seen in
15% of cases. Symptoms include excessive head movement and drooling.
Ataxia: Affects balance and coordination, seen in 5% of
cases. Individuals may exhibit a staggering gait and slow tremor-like
movements.
Mixed: A combination of more than one type of cerebral
palsy, seen in about 10% of cases.
1. Spastic Cerebral Palsy (70% of cases)
Characteristics:
Limited Head Movement: Individuals have restrictions in moving their
head due to increased muscle tone.
Involvement of Cerebral Cortex: Indicates that the motor control areas
of the brain (especially those concerning voluntary movement) are affected.
Limping Gait with Circumduction of the Affected Leg: When walking, the
patient often swings the affected leg around instead of lifting it normally,
due to spasticity.
Hypertonicity of Facial Muscles: Increased muscle tension in the facial
region, contributing to a fixed or tense facial expression.
Unilateral or Bilateral Manifestations: Symptoms can occur on one side
of the body (hemiplegia) or affect both sides (diplegia or quadriplegia).
Slow Jaw Movement: Reduced speed in moving the jaw, potentially leading
to functional difficulties.
Hypertonic Orbicularis Oris Muscles: Increased muscle tone around the
mouth, affecting lip closure and movement.
Mouth Breathing (75%): The individual may breathe through their mouth
due to poor control of oral musculature.
Spastic Tongue Thrust: The tongue pushes forward excessively, which can
disrupt swallowing and speech.
Class II Division II Malocclusion (75%): Dental alignment issue often
characterized by a deep overbite and anterior teeth that are retroclined,
sometimes accompanied by a unilateral crossbite.
Speech Involvement: Difficulties with speech articulation due to muscle
coordination problems.
Constricted Mandibular Arch: The lower jaw may have a narrower
configuration, complicating dental alignment and oral function.
2. Athetoid Cerebral Palsy (15% of cases)
Characteristics:
Excessive Head Movement: Involuntary, uncontrolled movements lead to
difficulties maintaining a stable head position.
Involvement of Basal Ganglia: Damage to this area affects muscle tone
and coordination, leading to issues like chorea (involuntary movements).
Bull Neck Appearance: The neck may appear thicker and less defined,
owing to abnormal muscle development or tone.
Lack of Head Balance, Drawn Back: The head may be held in a retracted
position, affecting posture and balance.
Quick Jaw Movement: Involuntary rapid movements can lead to difficulty
with oral control.
Hypotonic Orbicularis Oris Muscles: Reduced muscle tone around the mouth
can lead to drooling and lack of control of oral secretions.
Grimacing and Drooling: Facial expressions may be exaggerated or
inappropriate due to muscle tone issues, and there may be problems with
managing saliva.
Continuous Mouth Breathing: Patients may consistently breathe through
their mouths rather than their noses.
Tissue Biting: Increased risk of self-biting due to lack of muscle
control.
Tongue Protruding: The tongue may frequently stick out, complicating
speech and intake of food.
High and Narrow Palatal Vault: Changes in the oral cavity structures can
lead to functional difficulties.
Class II Division I Malocclusion (90%): Characterized by a deep bite and
anterior open bite.
Speech Involvement: Affected due to uncontrolled muscle movements.
Muscle of Deglutition Involvement: Difficulties with swallowing due to
affected muscles.
Bruxism: Involuntary grinding or clenching of teeth.
Auditory Organs May be Involved: Hearing impairments can coexist.
3. Ataxic Cerebral Palsy (5% of cases)
Characteristics:
Slow Tremor-like Head Movement: Unsteady, gradual movements of the head,
indicative of coordination issues.
Involvement of Cerebellum: The cerebellum, which regulates balance and
motor control, is impacted.
Lack of Balance Leading to Staggering Gait: Individuals may have
difficulty maintaining equilibrium, leading to a wide-based and unsteady
gait.
Hypotonic Orbicularis Oris Muscles: Reduced muscle tone leading to
difficulties with oral closure and control.
Slow Jaw Movement: The jaw may move slower, affecting chewing and
speech.
Speech Involvement: Communication may be affected due to poor
coordination of the speech muscles.
Visual Organ May be Involved (Nystagmus): Involuntary eye movements may
occur, affecting visual stability.
Varied Type of Malocclusion: Dental alignment issues can vary widely in
this population.
4. Mixed:
Mixed cerebral palsy involves a combination of the above types, where the
individual may exhibit spasticity, athetosis, and ataxia to varying degrees.
Dental Considerations for Mixed CP:
- Dental care for patients with mixed CP is highly individualized and depends on
the specific combination and severity of symptoms.
- The dentist must consider the unique challenges that arise from the
combination of muscle tone issues, coordination problems, and potential for
involvement of facial muscles.
- A multidisciplinary approach, including occupational therapy and speech
therapy, may be necessary to address oral function and hygiene.
- The use of sedation or general anesthesia might be considered for extensive
dental treatments due to the difficulty in managing the patient's movements and
ensuring safety during procedures.
Associated Symptoms:
Children with CP may exhibit persistent reflexes such as the asymmetric tonic
neck reflex, which can influence their dental treatment. Other symptoms may
include mental retardation, seizure disorders, speech difficulties, and joint
contractures.
Dental Problems:
Children with cerebral palsy often experience specific dental challenges:
They may have a higher incidence of dental caries (tooth decay) due to
difficulty in maintaining oral hygiene and dietary preferences.
There is a greater likelihood of periodontal disease, often exacerbated
by medications like phenytoin, which can lead to gum overgrowth and dental
issues.
Dental Treatment Considerations:
When managing dental care for children with cerebral palsy, dentists need to
consider:
Patient Stability: The child’s head should be stabilized, and their back
should be elevated to minimize swallowing difficulties.
Physical Restraints: These can help manage uncontrolled movements during
treatment.
Use of Mouth Props and Finger Splints: These tools can assist in
controlling involuntary jaw movements.
Gentle Handling: Avoid abrupt movements to prevent triggering the
startle reflex.
Local Anesthesia (LA): Administered with caution, ensuring stabilization
to prevent sudden movements.
Premedication: Medications may be given to alleviate muscle
hypertonicity, manage anxiety, and reduce involuntary movements.
General Anesthesia (GA): Reserved for cases that are too challenging to
manage with other methods.
Postnatal Developmental
PedodonticsPostnatal Period: Developmental Milestones
The postnatal period, particularly the first year of life, is crucial for a
child's growth and development. This period is characterized by rapid physical,
motor, cognitive, and social development. Below is a summary of key
developmental milestones from birth to 52 weeks.
Neonatal Period (1-4 Weeks)
Physical Positioning:
In the prone position, the child lies flexed and can turn its head
from side to side. The head may sag when held in a ventral suspension.
Motor Responses:
Grasp reflex is active, indicating neurological function.
Visual Preferences:
Shows a preference for human faces, which is important for social
development.
Physical Characteristics:
Face is round with a small mandible.
Abdomen is prominent, and extremities are relatively short.
Criteria for Assessing Premature Newborns:
Born between the 28th to 37th week of gestation.
Birth weight of 2500 grams (5-8 lb) or less.
Birth length of 47 cm (18 ˝ inches) or less.
Head length below 11.5 cm (4 ˝ inches).
Head circumference below 33 cm (13 inches).
4 Weeks
Motor Development:
Holds chin up and can lift the head momentarily to the plane of the
body when in ventral suspension.
Social Interaction:
Begins to smile, indicating early social engagement.
Visual Tracking:
Watches people and follows moving objects.
8 Weeks
Head Control:
Sustains head in line with the body during ventral suspension.
Social Engagement:
Smiles in response to social contact.
Auditory Response:
Listens to voices and begins to coo.
12 Weeks
Head and Chest Control:
Lifts head and chest, showing early head control with bobbing
motions.
Defensive Movements:
Makes defensive movements, indicating developing motor skills.
Auditory Engagement:
Listens to music, showing interest in auditory stimuli.
16 Weeks
Posture and Movement:
Lifts head and chest with head in a vertical axis; symmetric posture
predominates.
Sitting:
Enjoys sitting with full truncal support.
Social Interaction:
Laughs out loud and shows excitement at the sight of food.
28 Weeks
Mobility:
Rolls over and begins to crawl; sits briefly without support.
Grasping Skills:
Reaches for and grasps large objects; transfers objects from hand to
hand.
Vocalization:
Forms polysyllabic vowel sounds; prefers mother and babbles.
Social Engagement:
Enjoys looking in the mirror.
40 Weeks
Independent Sitting:
Sits up alone without support.
Standing and Cruising:
Pulls to a standing position and "cruises" or walks while holding
onto furniture.
Fine Motor Skills:
Grasps objects with thumb and forefinger; pokes at things with
forefinger.
Vocalization:
Produces repetitive consonant sounds (e.g., "mama," "dada") and
responds to the sound of their name.
Social Play:
Plays peek-a-boo and waves goodbye.
52 Weeks
Walking:
Walks with one hand held and rises independently, taking several
steps.
Object Interaction:
Releases objects to another person on request or gesture.
Vocabulary Development:
Increases vocabulary by a few words beyond "mama" and "dada."
Self-Care Skills:
Makes postural adjustments during dressing, indicating growing
independence.
Haemolysis due to drugs and chemicals
General Pathology
Haemolysis due to drugs and chemicals
This can be caused by :
1. Direct toxic action.
-> Naphthalene.
-> Nitrobenzene.
-> Phenacetin.
-> Lead.
Heinz bodies are seen in abundance.
2. Drug action on G-6-PD deficient RBC
3. Immunological mechanism which may be :
-> Drug induced autoantibody haemolysis, Antibodies are directed against RBC.
-> Hapten-cell mechanism where antibodies are directed against which is bound to cell surface e.g. Penicilin.