TELL: The technique involves verbal explanation of procedures in phrases appropriate to the development level of the patient.
SHOW: Demonstrations for the patient of the visual, auditory, olfactory & tactile aspects of the procedure in a carefully defined, non threatening sett.
DO: And then, without deviating from the explanation & demonstration, completion of the procedure.
This technique is used with communication skills (verbal and nonverbal) & positive reinforcement.
( Positive reinforcement is the presentation of reinforces which increases the frequency of desired behavior)
*Background* : Children with HIV are a special group with limited access to care and high prevalence of dental caries. Silver Diamine Fluoride (SDF) is approved universally for the management of asymptomatic carious lesions but research on the psychological impact of black staining is scarce.
*Aims* : Effect of silver diamine fluoride (SDF) application as an interim caries management on the child’s oral health-related quality of life of children with HIV over a period of 4 months until definitive care was provided.
*Settings and Design* : A pilot study conducted among children with HIV in a care home. It was a pilot trial to check the acceptability of SDF among these children.
*Methods and Material* : Forty-two children (12.3 ± 3.5 years) participated in this pilot study. Prevalence of caries (DMFT), candidiasis, gingival inflammation, and cervical lymphadenitis was evaluated. OHRQoL inventory (COHIP-SF) was completed by the students at baseline, immediately, 4 months after SDF application.
*Statistical Analysis Used:* One-way ANOVA with post hoc Tukey HSD test.
*Results and Conclusion* : Poor oral hygiene was universal and mean DMFT was 3.2 ± 2.5. OHRQoL was not significantly affected at baseline (26.2 ± 6.4), but immediately following SDF application, OHRQoL was significantly poor (48.7 ± 8.2), remained poor even after 4 months (42.6 ± 6.1). Emotional wellbeing was significantly impacted negatively following SDF application (p < 0.001); whereas oral health, functional wellbeing dimensions were not impacted. SDF should be used with caution among special children as the black discoloration of the teeth can cause emotional trauma and negatively impacting their OHRQoL while trying to improve the same.
Stephen Hawking was diagnosed with Amyotrophic Lateral Sclerosis (ALS), a Motor Neuron Disease. But it never stopped him from becoming the greatest physicist of his time!
This is a progressive disease of unknown origin in which there is degeneration of motor neurons of the spinal cord and cranial nerve nuclei and of pyramidal neurons in the motor cortex.
CAUSES:
👉 95% of the cases – Viral infection, trauma, exposure to toxins and electric shock. (Though no Strong evidence exists)
👉 5% of the cases – Familial showing autosomal dominant inheritance. Defect lies in Chromosome 21 on the enzyme SOD1 (Superoxide dismutase)
CLINICAL FEATURES:
👩⚕️ Usually affects people above 50 years of age. Very uncommon before 30.
👨⚕️ Male predominance.
👩⚕️ Dysarthria and Dysphagia.
👨⚕️ Wasting and fasciculation of muscles.
👩⚕️ Weakness of tongue, face, palate and limb muscles.
👨⚕️ Spasticity, extensor plantar reflexes and excessive tendon reflexes are seen in case of pyramidal tract involvement.
👩⚕️ External ocular muscles and sphincters usually remain intact.
👨⚕️ No sensory deficit objectively seen.
👩⚕️ Intellectual impairment is not seen in most cases.
INVESTIGATIONS:
🧐 Differential diagnosis: diabetic amyotrophy, multifocal neuron disease, spinal disorders should be excluded.
🧐 Electromyography – helps confirm fasciculation and denervation.
🧐 Spinal imaging and brain scanning – to exclude focal spinal or cerebral disease.
🧐 A slightly elevated protein concentration is seen in the CSF examination sometimes.
MANAGEMENT:
💊 Riluzole 100 Mg per day appears to be modestly effective in prolonging the life of the patient.
💊 Helps the Quality of life of patients: Psychological and physical support, speech therapist, physiotherapist.
💊 Mechanical aids: Splints, wheelchairs, walking aids, communication devices.
PROGNOSIS:
⚠️ Motor Neuron Disease is progressive; the mean time from diagnosis to death is 1 year.
⚠️ Most patients die within 3-5 years after the onset of symptoms.
⚠️ Death is usually from respiratory infection and failure, and the complications of immobility.
SOURCE: Davidson’s Principles and Practice of Medicine (19th edition)
Highly effective and most widely used antitubercular agent.
MoA
Uses
First- line drug for treatment of TB. Used for chemo prophylaxis of TB.
Adv. E
Hepatotoxicity : Common in alcoholics, elderly people, rapid acetylators. Symptoms like anorexia, nausea, vomiting, and jaundice are seen. Reversible on discontinuation of drug.
PERIPHERAL NEURITIS : Competitively interferes with utilization of pyridoxine due to structural similarity. Peripheral neuritis is common in slow acetylators.
Pyridoxine 10mg/day + INH is given to reduce risk
3. Other side effects : Fever, skin rashes, arthralgia, anemia, GI disturbances, psychosis and rarely convulsions.
INH inhibits metabolism of pheytoin, carbamazepine, warfarin etc. ➡️ increases plasma levels of these drugs ➡️ may result in toxicity.
REFERENCE:
Pharmacology 4th Ed: Tara V Shanbhag, Smita Shenoy
Dentowesome 