In a previous post I wrote about blood diseases and classificationhttps://dentowesome.wordpress.com/2020/10/23/blood-diseases/. This particular post I shall include write about Pernicious Anemia.
In the next coming days I shall add on various more different variants of anemia in further posts
Reff Textbook of clinical medicine for dental students. Chugh
🔗Refer Asthma First Aid & Prevention tips on Page 2‼️
ASTHMA
Mild intermittent
💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations when needed.
💊 Anticholinergics (e.g. Ipratropium, Tiotropium) inhalations when needed, alone or in addition to beta-2 agonists
💬 Patient is asymptomatic between the dyspnoea episodes, so no daily medication required!
ASTHMA
Mild persistent
💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations ➕ Corticosteroid inhalation (low dose)
💊 Short acting β2-agonists ➕ Mast cell stabilizer or Leukotriene antagonist or Theophylline sustained release
💬 Beta-2 agonist inhalation is needed every day, so once daily corticosteroid inhalation if given for asthma control.
ASTHMA
Moderate persistent
💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (low to high dose)
💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (medium dose)
💬 The dose of corticosteroid inhalations depends on the severity of symptoms.
ASTHMA
Severe persistent
💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup
💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup
💬 Systemic corticosteroids have significant adverse effects, so after adequate asthma control, are gradually withdrawn.*
ASTHMA
Acute severe asthma
💊 Oxygen 60% ➕ Nebulized beta-2 agonists (e.g. Salbutamol) in high dose ➕ Systemic corticosteroids
💬 An emergency condition, earlier called as status asthmatics. Aminophylline is no longer recommended.
* After adequate control of severe persistent asthma, systemic corticosteroids are withdrawn, and the patient then would be managed as moderate persistent type. This is called "step down" approach of management. In this approach, it is considered better to manage patients assuming in the next higher type and then, after reviewing in 1-6 months, to step-down, instead of "step-up" after failure in asthma control.
Aspirin induced
asthma
💊 Leukotriene antagonists (e.g. Montelukast, Zafirlukast)
Exercise induced
asthma
For Prophylaxis: Mast cell stabilizers or beta-2 agonists or Leukotriene antagonists💊
COPD
Dry cough
💊 Cough suppressants (e.g. Dextromethorphan) + Treat the cause e.g. post nasal drip by antihistaminics and decongestants.
Productive cough
💊 Expectorants (e.g. Pot iodide) &/or Mucolytics (e.g. Acetylcysteine) ➕ Treat the cause e.g. allergy by antihistaminics and bacterial infection by antibiotics
References: CLASSIFICATION OF DRUGS WITH DRUGS OF CHOICE 3RD EDITION BY VIKAS SETH
Angina:
A medical term that refers to the chest pain or discomfort that is caused by reduced blood flow to the heart
Drugs of choice for angina💊
References: KD TripathiEssentials of Medical Pharmacology 7th Edition
Blood diseases are some of the most common questions throughout dental career. Especially in the first three years. I have complied the classification and Oral Manifestations of certain common symptoms.
STUDY NOTES ⚕️
1️⃣ History Taking:
History taking is an important aspect of Medicine.
One should learn to take a complete and thorough history of the patient.
2️⃣ Physical Examination:
The Clinician should know all the techniques of physical examination.
The positive and negative physical signs should be examined and noted so as to come to some conclusion at the end of the examination.
3️⃣ Terminology:
The exact terminology used in medical science should be used and followed.
That in itself is a key to diagnosis of various diseases.
4️⃣ Skill:
The Clinician should be able use the laboratory instruments as well as the therapeutic aspects judiciously.
One has to learn the skill in the most sophisticated application of laboratory technology or use of the latest therapeutic modality.
5️⃣ Art of Medicine:
In a variety of symptoms the patient presents with, the doctor should have an intuition as to follow which sign/symptom/laboratory finding and to know what to ignore, ultimately excelling at the art of ‘decision-making’.
This kind of strong and methodical intuitive nature of the Clinician is expected.
6️⃣ Patient-Doctor Relationship:
Students should not treat patients as just ‘cases’ or ‘diseases’ but as people undergoing suffering and should be treated with empathy.
At the same time, the doctor should also be careful as to not pay utmost attention to the most exaggerating patients.
There should be a mutual trust between the patient and the doctor.
A healthy professional relationship with the doctor makes the patient feel at ease and helps in the patient co-operation and recovery.
SOURCE: Textbook of Clinical Medicine by Chugh (5th edition)
~Sunantha✍️
STUDY NOTES ⚕️
Clinical Presentation:
👩⚕️ Chronic cough often with hemoptysis.
👨⚕️ Pyrexia of unknown origin.
👩⚕️ Unresolved Pneumonia.
👨⚕️ Exudative pleural effusion.
👩⚕️ Asymptomatic (diagnosis on chest radiograph)
👨⚕️ Weight loss, general debility.
👩⚕️ Spontaneous Pneumonia.
Time from infection and Manifestations:
🕗 3 – 8 weeks ➡️ Primary Complex, Positive tuberculin skin test.
🕕 3 – 6 months ➡️ Meningeal, miliary and pleural disease.
🕒 Upto 3 years ➡️ Gastrointestinal, bone and joint and lymph node disease.
🕣 Around 8 years ➡️ Renal tract disease.
🕞 From 3 years onwards ➡️ Post primary disease due to reactivation or reinfection.
SOURCE: Davidson’s Principles and Practice of Medicine (19th edition)
~Sunantha✍️
Dr. Mehnaz Memon🖊
References: Davidson’s Principles and Practice of Medicine Textbook
A wide range of viruses may cause liver inflammation (hepatitis) and several
are relevant to dentistry. Here, I describe the recognized family of hepatitis viruses A to G.
Hepatitis A virus (HAV)
The hepatitis A virus is:
Transmission
• Fecal-oral transmission.
• Endemic worldwide.
Diagnosis
• Demonstration of HAV antigen in feces.
• Serology: detection oflgM anti-HAV.
Clinical features
• The incubation period is 2-7 weeks.
Many infections are asymptomatic. Clinical disease is mild with few complications. There is no carrier state.
Prevention and Control
Good hygienic measures and sanitary disposal of excreta.
Passive immunization gives immediate protection for 3-6 months.
Active vaccination: the formalin-inactivated vaccine provides protection for up to 10 years.
HAV is not a major cross-infection hazard in dentistry but is a hazard if traveling, especially to the tropics.
Hepatitis B virus (HBV)
This highly infectious blood-borne virus poses a major cross-infection hazard
in surgery and dentistry:
• It is a member of the hepadnavirus family.
• The intact viral particle (Dane particle) has a double-shelled structure, with the outer hepatitis B surface antigen (HBsAg) coat surrounding the central hepatitis B core antigen (HBcAg), DNA, and DNA polymerase.
• Peripheral blood of infected patients also contains non-infective spherical and filamentous particles of HBV
Transmission
• HBV can be present in blood, saliva, cervical secretions, and semen.
• Spread is via the parenteral route, especially by intravenous drug use, but transmission by intimate contact and sexual activity also occur.
• Perinatal infection is important in certain parts of the world, for example east and southeast Asia.
• There is a large reservoir of unidentified carriers within the population.
• Infected patients may have up to 1010 Dane particles per ml of blood; as little as 0.0001 ml of blood may transmit the infection.
• HBV has been transmitted in dentistry, to patients and dental staff. Some have died from infection.
Diagnosis
• Serological.
• Initial screening is for HBsAg; if present, it indicates infection with HBV.
• Screen then for HBeAg. If present, the person is at high risk for transmission.
• A minority who are HBeAg negative can also transmit infection. Hepatitis B carriers produce HBsAg and, in high-risk carriers, HBeAg for many years.
• Development of anti-HBs, anti-Hbe, and anti-HBc antibodies is associated with recovery. The incubation period is 2-3 months duration. There are a number of possible outcomes of exposure to HBV:
• Subclinical infection (65%).
• Acute hepatitis B with full recovery (30%).
• Chronic carriage (up to 9% of adults): this gives a long-term risk of cirrhosis, liver failure, and hepatocellular carcinoma. Carriers remain infectious to others.
• Fatal fulminant hepatitis (1 %).
Prevention and Control
• Modifications to behavior.
• Adequate infection control procedures in clinical practice.
• Passive immunization: hyperimmune hepatitis B immunoglobulin is used following a single acute exposure in an unprotected individual.
• Active immunization. Hepatitis B vaccine consisys of20 mg ofHBsAg given intramuscularly at 0, l, and 6 months. Boosters have been recommended at 5-year intervals. All vaccinees should have their serum antibody level assessed after vaccination. High-risk carriage of HBV should be excluded in non-responders who are health care workers.
• Interferon may be effective in the treatment of chronic HBV infection.
Hepatitis C virus (HCV)
This blood-borne virus, discovered in 1989, is responsible for most cases of what was previously known as parenterally transmitted non-A, non-B hepatitis(NANBH). Is an enveloped RNA virus.
• Is related to animal pestiviruses and human flaviviruses.
• Has multiple genotypes.
• Cannot be grown in tissue culture.
Diagnosis
• Serological.
• Initial detection of HCV antibodies.
• Confirmation by PCR for HCV RNA.
Transmission
• The prevalence of HCV antibodies among UK blood donors is 0.1-0.3%.
• In recipients of blood products and among intravenous drug users the seroprevalence is high(> 80%).
• Parenteral transmission is the major route, especially in intravenous drug use.
• Sexual transmission is inefficient.
• Occupational transmission may be through needlestick injuries, though it is less infectious than HBV.
• Undefined routes: in a significant number ofHCV-infected individuals, the route of infection is unknown.
Clinical features
• The mean incubation period is 6-12 weeks.
• Acute disease is mild and often subclinical.
• Chronic disease is common (> 60%). These patients may develop longterm liver disease, including hepatocellular carcinoma. Some patients may develop oral disorders similar to Sjogren’s syndrome or lichen planus.
Prevention and Control
• Changes in behavior, e.g. needle exchange schemes for intravenous drug users.
• Screening of donated blood.
• Effective universal infection control in health care settings.
• No vaccine is available.
• Treatment of chronic carriers with interferon and ribavirin is effective in
about 40% of cases.
Hepatitis D virus (HDV)
• A defective, independently transmissible agent which requires hepatitis B virus for replication.
• In developed countries it is mainly a problem among intravenous drug users.
• The genome is single-stranded RNA.
• Transmission is primarily parenteral, either at the time of first infection with HBV (co-infection) or during a subsequent exposure in a patient already infected with HBV (superinfection).
• HDV increases the severity of HBV infection and fulminant hepatitis is common.
• HDV has been transmitted in dentistry, to patients and dental staff. Dental patients have died from infection.
Hepatitis B vaccination is protective.
Hepatitis E virus
This recently discovered virus causes the disease described previously as enterically transmitted non-A, non-B hepatitis:
• It is a spherical, non-enveloped, RNA virus.
• Transmission is via fecal!y contaminated drinking water.
• The incubation period is 2-9 weeks.
• It mainly affects young adults.
• Infection is usually self-limiting.
• There are no chronic carriers.
• Infection carries a high mortality (up to 20%) in pregnancy.
• It is not a major cross-infection risk in surgery.
Hepatitis G virus
• Hepatitis G is a flavivirus, first isolated in 1995 from a patient with chronic hepatitis.
• Seroprevalence studies show evidence of infection in 3% of blood donors in the United Kingdom, 18% of hemophiliacs, and 33% of intravenous drug users.
• Hepatic damage appears mild or absent and the virus is not considered an important pathogen.
• It is not a major cross-infection risk in surgery.
Dr Iswarya V
General Practitioner,
Trivandrum.
Reference : Oxford Clinical Dentistry
Indications for cardiac surgery in Infective Endocarditis:
🔅 Heart Failure due to valve damage
🔅 Failure of antibiotic therapy
🔅 Large vegetations
🔅 Abscess formation
Dr. Mehnaz Memon🖊
References: Davidson’s Principles and Practice of Medicine Textbook
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