This document discusses various anaerobic organisms and infections they can cause in the head and neck region. It describes key anaerobes like Bacteroides, Prevotella, Peptostreptococcus, Fusobacterium, Clostridium, Actinomyces and infections associated with them such as peritonsillar abscess, actinomycosis, acute necrotizing ulcerative gingivitis. It also discusses complications of anaerobic head and neck infections that can spread locally or hematogenously. The approach to patients involves considering proximity of infection to colonized mucosal sites and polymicrobial nature of infections that often involve both aerobic and anaerobic organisms.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
surgical anatomy of nose is a humble attempt to make the anatomy of nose simpler and easy for medical students and fellow physicians. at the end of the presentation the students will be able to identify all the structures.
The document discusses the use of the Hadad-Bassagasteguy (HB) flap in reconstructing anterior skull base defects after endonasal skull base surgery. The HB flap uses the vascularized nasal septal mucoperiosteum to repair defects. In a study of 53 patients who underwent HB flap reconstruction, only 2 patients (3.8%) experienced post-operative cerebrospinal fluid leaks. The study found the HB flap to be effective at preventing post-operative CSF leaks across a variety of patient profiles and skull base surgery types. The HB flap is becoming a standard technique for reconstructing anterior skull base defects due to its high success rate and versatility.
This document discusses different types of fungal sinusitis, including invasive and noninvasive forms. Invasive fungal sinusitis is characterized by fungal hyphae growing within sinus tissues and can be acute, chronic, or chronic granulomatous. Noninvasive types include allergic fungal sinusitis and fungal balls. Imaging findings on CT and MRI are described for each type. Treatment involves surgical removal of fungal material and antifungal medications, with the most aggressive form requiring extensive debridement and high doses of amphotericin B due to its high mortality risk if left untreated. Potential side effects of antifungal drugs are also noted.
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document provides information on juvenile nasopharyngeal angiofibroma (JNA), including its epidemiology, pathology, theories of origin, clinical features, diagnosis, staging systems, treatment options, surgical approaches, and complications. JNA is a benign but locally aggressive tumor most commonly seen in adolescent males. Surgical removal is the primary treatment, with endoscopic approaches used for early-stage tumors and open approaches for more advanced cases. Recurrence rates remain high due to the tumor's vascularity and location near vital structures, so adjuvant therapies may also be used.
Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal rhinosinusitis seen in young, atopic patients presenting with chronic rhinosinusitis and nasal polyps. It is characterized by eosinophilic mucin containing fungal hyphae and positive fungal cultures. Diagnosis involves CT scans showing sinus opacification and bone erosion along with endoscopic examination of allergic mucin. Treatment involves functional endoscopic sinus surgery along with post-operative steroids to reduce the high recurrence rate associated with AFRS. Long-term follow up is needed given the risk of recurrence requiring repeat surgery.
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
surgical anatomy of nose is a humble attempt to make the anatomy of nose simpler and easy for medical students and fellow physicians. at the end of the presentation the students will be able to identify all the structures.
The document discusses the use of the Hadad-Bassagasteguy (HB) flap in reconstructing anterior skull base defects after endonasal skull base surgery. The HB flap uses the vascularized nasal septal mucoperiosteum to repair defects. In a study of 53 patients who underwent HB flap reconstruction, only 2 patients (3.8%) experienced post-operative cerebrospinal fluid leaks. The study found the HB flap to be effective at preventing post-operative CSF leaks across a variety of patient profiles and skull base surgery types. The HB flap is becoming a standard technique for reconstructing anterior skull base defects due to its high success rate and versatility.
This document discusses different types of fungal sinusitis, including invasive and noninvasive forms. Invasive fungal sinusitis is characterized by fungal hyphae growing within sinus tissues and can be acute, chronic, or chronic granulomatous. Noninvasive types include allergic fungal sinusitis and fungal balls. Imaging findings on CT and MRI are described for each type. Treatment involves surgical removal of fungal material and antifungal medications, with the most aggressive form requiring extensive debridement and high doses of amphotericin B due to its high mortality risk if left untreated. Potential side effects of antifungal drugs are also noted.
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
This document provides information on juvenile nasopharyngeal angiofibroma (JNA), including its epidemiology, pathology, theories of origin, clinical features, diagnosis, staging systems, treatment options, surgical approaches, and complications. JNA is a benign but locally aggressive tumor most commonly seen in adolescent males. Surgical removal is the primary treatment, with endoscopic approaches used for early-stage tumors and open approaches for more advanced cases. Recurrence rates remain high due to the tumor's vascularity and location near vital structures, so adjuvant therapies may also be used.
Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal rhinosinusitis seen in young, atopic patients presenting with chronic rhinosinusitis and nasal polyps. It is characterized by eosinophilic mucin containing fungal hyphae and positive fungal cultures. Diagnosis involves CT scans showing sinus opacification and bone erosion along with endoscopic examination of allergic mucin. Treatment involves functional endoscopic sinus surgery along with post-operative steroids to reduce the high recurrence rate associated with AFRS. Long-term follow up is needed given the risk of recurrence requiring repeat surgery.
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
This document discusses fungal sinusitis, including its causes, types, symptoms, diagnosis, and treatment. It notes that fungal sinusitis can occur in both immunocompromised and immunocompetent patients, and is caused by fungi such as Aspergillus, Mucormycosis, and Candida. There are two main types - invasive fungal sinusitis, which is more serious, and non-invasive forms like allergic fungal sinusitis. Diagnosis involves medical history, symptoms, imaging scans, and identification of fungal elements. Treatment requires surgical removal of infected tissue combined with antifungal medication.
This document provides classifications in various areas of ENT, including head and neck cancer TNM staging, otology classifications like chronic otitis media and presbyacusis, rhinology classifications like nasal polyps and fungal sinusitis, head and neck benign classifications like tonsil size grading and pharyngeal pouch classification, paediatric ENT classifications like croup grading and hemifacial microsomia, and other miscellaneous ENT classifications. The classifications are used for staging diseases, making management decisions, predicting outcomes, monitoring progress, and comparing data.
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
Rigid esophagoscopy, bronchoscopy, and direct laryngoscopy are generally performed under general anesthesia for both diagnostic and therapeutic reasons. These procedures allow examination and biopsy of the larynx, lungs, and esophagus. Rigid esophagoscopy uses a 25cm rigid scope to examine the esophagus for tumors, strictures, or foreign bodies. Rigid bronchoscopy requires passing a rigid tube between the vocal cords into the trachea and main bronchi to remove foreign bodies or biopsy lung lesions. Direct laryngoscopy examines the larynx using small or large laryngoscopes inserted through the mouth. These procedures have risks of injury, bleeding, perforation, or other complications if not performed carefully.
This document provides an overview of endoscopic nasal anatomy. It begins with a brief introduction to endoscopy and its historical evolution. It then describes the external nose, nasal septum, lateral nasal wall including the inferior, middle, and superior turbinates. Various anatomical variations are also discussed. The paranasal sinuses, anterior skull base, and endoscopic approaches to different nasal and sinus structures like the frontal sinus and sphenoid sinus are summarized. Key landmarks and variations are highlighted to provide a concise yet comprehensive summary of the essential endoscopic nasal anatomy concepts covered in the document.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document outlines various potential complications of chronic rhinosinusitis that can affect the orbit, intracranial cavity, and bones. It describes orbital complications such as preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Intracranial complications discussed include meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis, and sagittal sinus thrombosis. Bone complications include osteomyelitis (Pott's puffy tumor). Chronic complications include mucocoeles.
Tympanoplasty is defined as a procedure to eradicate disease in the middle ear and reconstruct the hearing mechanism, with or without grafting of the tympanic membrane. The goals are to achieve a dry ear and improve hearing by closing perforations and reconstructing the ossicular chain. Ossiculoplasty aims to correct ossicular chain abnormalities to improve hearing. Various graft materials, classifications of ossicular defects, surgical techniques, and complications are discussed.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
CerebroSpinal Fluid Rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity due to a skull base defect. CSF leaks can be caused by trauma, tumors, congenital defects, or idiopathic increased intracranial pressure. Diagnosis involves analyzing fluid samples for beta-2 transferrin or beta-trace protein and imaging studies using intrathecal dyes. Treatment begins with conservative measures to reduce CSF production and pressure but often requires surgical repair via an endoscopic, extracranial, or intracranial approach depending on the location and size of the defect. Endoscopic techniques have high success rates with less morbidity compared to open cranial
This document summarizes biofilms and their role in ENT diseases. It discusses the formation and development of biofilms, mechanisms of antibiotic resistance, and how biofilms are involved in diseases like chronic rhinosinusitis, otitis media, tonsillitis and infected implants. Detection methods like SEM, FISH and CLSM are described. Treatment focuses on physically removing biofilms, using macrolide antibiotics or disrupting quorum sensing, though developing effective anti-biofilm treatments remains a challenge.
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17ophthalmgmcri
The document discusses the anatomy, physiology, and disorders of the Eustachian tube. It describes the Eustachian tube's embryological development and details its adult anatomy including measurements, parts, musculature, and blood supply. Regarding function, it ventilates the middle ear and drains secretions. Dysfunctions include tubal blockage from various mechanical or functional causes like adenoids, cleft palate, or barotrauma. Tests to evaluate Eustachian tube function include Valsalva, Toynbee, and tympanometry. Disorders include tubal blockage, retraction pockets, and a patulous tube.
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
This document discusses phonosurgery techniques including vocal fold injection and laryngeal framework surgery. It provides details on the intrinsic laryngeal musculature and the expansion of phonosurgery over the last 50 years to primarily improve or restore the voice. Type I thyroplasty for vocal fold medialization is described in detail, including indications, surgical technique of making a window in the thyroid cartilage and placing different types of implants, advantages, complications, and pitfalls. The goal of type I thyroplasty is to improve voice and prevent aspiration by medializing the vocal fold to mimic the function of the thyroarytenoid muscle.
This document discusses the history of stapes surgery and recent concepts. It covers the key individuals who advanced the field from the 1700s onwards, including the development of stapedectomy and stapedotomy procedures. It then describes different types of otosclerosis, techniques for stapes surgery including laser vs drill fenestration and prosthesis options. Potential complications of surgery are outlined such as perilymphatic gusher, sensorineural hearing loss and vertigo. Outcomes of stapedectomy versus stapedotomy are compared.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
This document discusses different surgical techniques for treating vocal cord paralysis, including vocal cord injection, type I thyroplasty, and arytenoid adduction. Vocal cord injection involves injecting materials like fat, collagen or calcium hydroxyapatite gel to medialize the paralyzed vocal cord. Type I thyroplasty places an implant like Gore-Tex or cartilage in the thyroid cartilage to close the anterior glottic gap. Arytenoid adduction addresses the posterior gap by suturing the arytenoid cartilage. The document also covers evaluations, complications, and techniques for unilateral versus bilateral vocal cord paralysis.
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
Malignant otitis externa is an aggressive infection of the soft tissues of the external ear that can spread to involve the skull base. Pseudomonas aeruginosa is the causative organism in 95% of cases. Risk factors include diabetes mellitus and immunosuppression. Clinically, patients experience long-standing ear pain and drainage. The infection can spread to involve cranial nerves and potentially spread to the brain. Diagnosis involves clinical examination, biopsy, and imaging tests like CT, MRI, and bone scans. Treatment involves long-term intravenous and oral antibiotics, sometimes with the addition of surgery to debride infected tissues and hyperbaric oxygen therapy.
This document provides guidance on examining the oral cavity and oropharynx. Key areas to examine include the lips, checking for color, consistency, lesions or abnormalities; the buccal mucosa, looking for lesions; the gingiva, noting color, tone and architecture; the hard and soft palates; the tongue, checking all surfaces for lesions or signs of nutritional deficiencies; the floor of the mouth, visualizing and palpating for lesions or masses; and the oropharynx, checking for normal color and consistency of tissues. The lateral borders of the tongue and floor of the mouth are the most common sites for oral cancer, so these areas require close examination. A systematic and complete examination of all oral tissues
This document discusses fungal sinusitis, including its causes, types, symptoms, diagnosis, and treatment. It notes that fungal sinusitis can occur in both immunocompromised and immunocompetent patients, and is caused by fungi such as Aspergillus, Mucormycosis, and Candida. There are two main types - invasive fungal sinusitis, which is more serious, and non-invasive forms like allergic fungal sinusitis. Diagnosis involves medical history, symptoms, imaging scans, and identification of fungal elements. Treatment requires surgical removal of infected tissue combined with antifungal medication.
This document provides classifications in various areas of ENT, including head and neck cancer TNM staging, otology classifications like chronic otitis media and presbyacusis, rhinology classifications like nasal polyps and fungal sinusitis, head and neck benign classifications like tonsil size grading and pharyngeal pouch classification, paediatric ENT classifications like croup grading and hemifacial microsomia, and other miscellaneous ENT classifications. The classifications are used for staging diseases, making management decisions, predicting outcomes, monitoring progress, and comparing data.
1) Nasal endoscopy is used to examine the nasal passages and paranasal sinuses using specialized equipment like rigid or flexible endoscopes and a light source.
2) The examination involves inserting the endoscope into the nasal cavity to visually inspect different areas like the inferior meatus, nasopharynx, sphenoethmoidal recess, and middle meatus.
3) Nasal endoscopy is useful for evaluating and treating inflammatory diseases of the sinuses, detecting tumors, locating the source of epistaxis, and assisting with other procedures like sinus surgery or skull base repairs. It provides information that CT scans cannot by allowing direct visualization of mucosal changes.
Rigid esophagoscopy, bronchoscopy, and direct laryngoscopy are generally performed under general anesthesia for both diagnostic and therapeutic reasons. These procedures allow examination and biopsy of the larynx, lungs, and esophagus. Rigid esophagoscopy uses a 25cm rigid scope to examine the esophagus for tumors, strictures, or foreign bodies. Rigid bronchoscopy requires passing a rigid tube between the vocal cords into the trachea and main bronchi to remove foreign bodies or biopsy lung lesions. Direct laryngoscopy examines the larynx using small or large laryngoscopes inserted through the mouth. These procedures have risks of injury, bleeding, perforation, or other complications if not performed carefully.
This document provides an overview of endoscopic nasal anatomy. It begins with a brief introduction to endoscopy and its historical evolution. It then describes the external nose, nasal septum, lateral nasal wall including the inferior, middle, and superior turbinates. Various anatomical variations are also discussed. The paranasal sinuses, anterior skull base, and endoscopic approaches to different nasal and sinus structures like the frontal sinus and sphenoid sinus are summarized. Key landmarks and variations are highlighted to provide a concise yet comprehensive summary of the essential endoscopic nasal anatomy concepts covered in the document.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document outlines various potential complications of chronic rhinosinusitis that can affect the orbit, intracranial cavity, and bones. It describes orbital complications such as preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Intracranial complications discussed include meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis, and sagittal sinus thrombosis. Bone complications include osteomyelitis (Pott's puffy tumor). Chronic complications include mucocoeles.
Tympanoplasty is defined as a procedure to eradicate disease in the middle ear and reconstruct the hearing mechanism, with or without grafting of the tympanic membrane. The goals are to achieve a dry ear and improve hearing by closing perforations and reconstructing the ossicular chain. Ossiculoplasty aims to correct ossicular chain abnormalities to improve hearing. Various graft materials, classifications of ossicular defects, surgical techniques, and complications are discussed.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
CerebroSpinal Fluid Rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity due to a skull base defect. CSF leaks can be caused by trauma, tumors, congenital defects, or idiopathic increased intracranial pressure. Diagnosis involves analyzing fluid samples for beta-2 transferrin or beta-trace protein and imaging studies using intrathecal dyes. Treatment begins with conservative measures to reduce CSF production and pressure but often requires surgical repair via an endoscopic, extracranial, or intracranial approach depending on the location and size of the defect. Endoscopic techniques have high success rates with less morbidity compared to open cranial
This document summarizes biofilms and their role in ENT diseases. It discusses the formation and development of biofilms, mechanisms of antibiotic resistance, and how biofilms are involved in diseases like chronic rhinosinusitis, otitis media, tonsillitis and infected implants. Detection methods like SEM, FISH and CLSM are described. Treatment focuses on physically removing biofilms, using macrolide antibiotics or disrupting quorum sensing, though developing effective anti-biofilm treatments remains a challenge.
Eustachian tube, anatomy, test and disorders, dr.vijaya sundarm, 20.03.17ophthalmgmcri
The document discusses the anatomy, physiology, and disorders of the Eustachian tube. It describes the Eustachian tube's embryological development and details its adult anatomy including measurements, parts, musculature, and blood supply. Regarding function, it ventilates the middle ear and drains secretions. Dysfunctions include tubal blockage from various mechanical or functional causes like adenoids, cleft palate, or barotrauma. Tests to evaluate Eustachian tube function include Valsalva, Toynbee, and tympanometry. Disorders include tubal blockage, retraction pockets, and a patulous tube.
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
This document discusses phonosurgery techniques including vocal fold injection and laryngeal framework surgery. It provides details on the intrinsic laryngeal musculature and the expansion of phonosurgery over the last 50 years to primarily improve or restore the voice. Type I thyroplasty for vocal fold medialization is described in detail, including indications, surgical technique of making a window in the thyroid cartilage and placing different types of implants, advantages, complications, and pitfalls. The goal of type I thyroplasty is to improve voice and prevent aspiration by medializing the vocal fold to mimic the function of the thyroarytenoid muscle.
This document discusses the history of stapes surgery and recent concepts. It covers the key individuals who advanced the field from the 1700s onwards, including the development of stapedectomy and stapedotomy procedures. It then describes different types of otosclerosis, techniques for stapes surgery including laser vs drill fenestration and prosthesis options. Potential complications of surgery are outlined such as perilymphatic gusher, sensorineural hearing loss and vertigo. Outcomes of stapedectomy versus stapedotomy are compared.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
This document discusses different surgical techniques for treating vocal cord paralysis, including vocal cord injection, type I thyroplasty, and arytenoid adduction. Vocal cord injection involves injecting materials like fat, collagen or calcium hydroxyapatite gel to medialize the paralyzed vocal cord. Type I thyroplasty places an implant like Gore-Tex or cartilage in the thyroid cartilage to close the anterior glottic gap. Arytenoid adduction addresses the posterior gap by suturing the arytenoid cartilage. The document also covers evaluations, complications, and techniques for unilateral versus bilateral vocal cord paralysis.
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
Malignant otitis externa is an aggressive infection of the soft tissues of the external ear that can spread to involve the skull base. Pseudomonas aeruginosa is the causative organism in 95% of cases. Risk factors include diabetes mellitus and immunosuppression. Clinically, patients experience long-standing ear pain and drainage. The infection can spread to involve cranial nerves and potentially spread to the brain. Diagnosis involves clinical examination, biopsy, and imaging tests like CT, MRI, and bone scans. Treatment involves long-term intravenous and oral antibiotics, sometimes with the addition of surgery to debride infected tissues and hyperbaric oxygen therapy.
This document provides guidance on examining the oral cavity and oropharynx. Key areas to examine include the lips, checking for color, consistency, lesions or abnormalities; the buccal mucosa, looking for lesions; the gingiva, noting color, tone and architecture; the hard and soft palates; the tongue, checking all surfaces for lesions or signs of nutritional deficiencies; the floor of the mouth, visualizing and palpating for lesions or masses; and the oropharynx, checking for normal color and consistency of tissues. The lateral borders of the tongue and floor of the mouth are the most common sites for oral cancer, so these areas require close examination. A systematic and complete examination of all oral tissues
This document discusses non-spore forming anaerobic bacteria. It begins by introducing anaerobic bacteriology and some of the challenges associated with culturing and identifying anaerobes. It then covers the different types of anaerobes including obligate, aerotolerant, and microaerophilic bacteria. The document discusses the classification of various anaerobic bacteria and some of the human infections they can cause. It also touches on methods for diagnosing anaerobic infections and techniques for anaerobic culture.
This document provides information and guidance on conducting research for polysomnography. It discusses the differences between library databases and websites on the internet, and emphasizes that library databases contain peer-reviewed articles while websites can contain unreliable information. It also outlines the CRAP test for evaluating websites. Search techniques for library databases like PubMed and DynaMed are described. Finally, it provides tips for reviewing research articles and assistance available from the library.
Polysomnography involves the simultaneous recording of multiple physiological parameters during sleep to diagnose sleep disorders and study sleep physiology. It involves recording EEG, EOG, EMG, respiratory effort, airflow, and oxygen saturation. Sleep is then staged into wake, N1, N2, N3, and REM sleep based on these recordings. Polysomnography is useful for diagnosing sleep disorders like sleep apnea, narcolepsy, and parasomnias. It provides information on sleep architecture and respiratory and movement events during sleep.
This document provides information about sexually transmitted infections (STIs). It discusses the definitions and differences between STIs and STDs. It also lists some of the most common bacterial, viral, parasitic and fungal STIs such as chlamydia, gonorrhea, herpes, HIV, and trichomoniasis. The document discusses transmission routes, risk factors, prevalence rates among different age groups, and potential complications of untreated STIs. It also describes some common signs and symptoms of STIs for both males and females.
Polysomnography (PSG) is the gold standard test for diagnosing sleep disorders like obstructive sleep apnea. It involves simultaneous monitoring of multiple physiologic parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. PSG is used to diagnose sleep disorders, determine appropriate treatments like CPAP, and assess treatment effectiveness. It provides valuable information about sleep architecture and respiratory events that can help characterize a patient's condition.
This document provides an overview of oral manifestations of systemic diseases categorized into infectious diseases, collagen-vascular and granulomatous disorders, and fungal infections. Key points include:
- Common viral infections that can cause oral lesions include herpes simplex, herpes zoster, infectious mononucleosis, hand foot and mouth disease, measles, and mumps. Bacterial infections like tuberculosis, syphilis and leprosy can also manifest in the oral cavity.
- Collagen-vascular disorders such as Sjogren's syndrome, systemic lupus erythematosus, sarcoidosis and Wegener's granulomatosis can present with oral signs and symptoms.
- Op
The document discusses 6 bacterial diseases: syphilis, tuberculosis, leprosy, actinomycosis, cancrum oris (noma), and gonorrhea. It provides details on the causative bacteria, pathogenesis, clinical features, and treatment for each disease. Syphilis is caused by Treponema pallidum and has primary, secondary, tertiary, and congenital stages. Tuberculosis is caused by Mycobacterium tuberculosis and can cause oral lesions. Leprosy is caused by Mycobacterium leprae and has a spectrum of manifestations. Actinomycosis is caused by Actinomyces israelii and usually follows trauma. Cancrum oris
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document discusses various oral manifestations of systemic diseases. It begins by classifying systemic diseases into 14 categories that can present with oral lesions. Several infectious diseases are then discussed in detail, including viral infections like herpes simplex, herpes zoster, herpangina and hand foot mouth disease. Bacterial infections such as tuberculosis, syphilis and leprosy are also mentioned. Clinical features, diagnosis and treatment are provided for many of the infectious diseases.
This document discusses diseases that affect poultry. It describes ante mortem inspection procedures conducted on farms before birds are transported to slaughterhouses. Veterinarians examine flocks and issue certificates to determine if birds require special handling. The document outlines notifiable diseases according to OIE lists and details inspection procedures at slaughterhouses. It provides information on several bacterial, viral and parasitic diseases that impact poultry, including salmonellosis, fowl typhoid, tuberculosis, colibacillosis and mycoplasmosis. Zoonotic potential and meat condemnation policies are discussed for major diseases.
This document provides information on endoscopic gastrointestinal biopsies and their interpretation. It discusses endoscopy techniques and tools used to visualize the gastrointestinal tract and obtain biopsies. Key points include types of endoscopes, handling of biopsy specimens, processing for histological examination, common indications for endoscopy of the upper gastrointestinal tract, and histological findings and interpretations for conditions of the esophagus and stomach, including chronic gastritis, Helicobacter pylori infection, Barrett's esophagus, and polypoid lesions.
Dr.vijaysundaram,acute & chronic infections larynx ,12.09.16ophthalmgmcri
The document discusses acute and chronic infections of the larynx. Viral infections are the most common cause of acute larynx, while reflux is the most common cause of chronic laryngitis. Candidal laryngitis can occur in non-immunocompromised patients. Chronic laryngitis can be caused by bacterial, fungal, mycobacterial, or non-infectious factors like smoking or reflux. Systemic diseases can also manifest with laryngeal symptoms like hoarseness or airway issues, mimicking laryngeal carcinoma.
Spirochetes are elongated, motile bacteria that are twisted in a spiral shape along their long axis. They are found in the genera Treponema, Borrelia, and Leptospira, which include human pathogens. Treponema species cause diseases like syphilis, yaws, pinta, and endemic syphilis. Treponema pallidum specifically causes syphilis, which has primary, secondary, and tertiary stages and can also be congenital. Syphilis is diagnosed through microscopy, serology tests, and symptoms. Treatment involves penicillin or erythromycin. Borrelia species can cause relapsing fever and Lyme disease.
This document provides information about Chlamydia, an obligate intracellular parasite. It discusses its characteristics such as lacking ATP and biosynthetic pathways. It also covers its life cycle and developmental stages. The document further details the different species of Chlamydia, including C. trachomatis, C. psittaci, and C. pneumoniae. It discusses diseases each species can cause such as trachoma, pneumonia, and lymphogranuloma venereum. The laboratory diagnosis and treatment of Chlamydial infections is also summarized.
Echinococcus granulosus is a tapeworm that causes hydatid cysts in humans. It is most common in temperate sheep-raising areas like South America, East Africa, and central Russia. The highest prevalence is seen in Kenya. Humans typically become infected by ingesting E. granulosus eggs from sheep dog feces. The adult tapeworm lives in the small intestine of dogs. Eggs are passed in dog feces and can infect sheep. If humans ingest the eggs, the larvae can develop into cysts in organs like the liver and lungs. Symptoms depend on the location and size of the cysts. Diagnosis involves examination of cyst fluid for scolices or serological tests. Treatment involves
This document provides information on the genus Chlamydia, including C. trachomatis, C. psittaci, and C. pneumoniae. It describes their morphology, life cycles, diseases caused, epidemiology, pathogenesis, diagnosis, treatment and prevention. Chlamydia are obligate intracellular parasites that cause respiratory infections like pneumonia as well as sexually transmitted diseases. Diagnosis involves culture, antigen detection, serology and nucleic acid tests. Treatment is with tetracycline or erythromycin. Prevention focuses on treatment, vaccination, and improving sanitation.
This document provides information on various benign anorectal diseases. It discusses the anatomy of the rectum and anal canal and describes common conditions such as hemorrhoids, anal fissures, anorectal abscesses, anal fistulas, proctitis, pruritis ani, and rectal prolapse. For each condition, it covers definitions, causes, symptoms, examinations, investigations and treatments. The document also provides details on the clinical features, diagnosis and management of various anorectal diseases.
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Sexually transmitted diseases include infections transmitted through sexual contact such as syphilis, gonorrhea, chlamydia, herpes, and human papillomavirus. These diseases are caused by bacteria, viruses, or parasites and can affect the genitals, mouth, or rectum. Common symptoms include sores, discharge from the penis or vagina, and rashes. Diseases are diagnosed through tests of bodily fluids or tissues and treated with antibiotics or antiviral medications. Untreated STDs can lead to serious health problems.
Non-sporing anaerobes can be commensal or pathogenic bacteria that require low oxygen conditions to grow. They are commonly found on mucous membranes and can cause infection when they breach barriers. The document discusses classification of non-sporing anaerobes and their roles as normal flora and pathogens, describing diseases associated with different genera. It also outlines methods for laboratory diagnosis and isolation of anaerobes, as well as treatment which commonly involves metronidazole or carbapenems.
This document discusses various postpartum infections. It begins by defining postpartum infection as a septic wound infection distinguished by the anatomical features of the female reproductive organs during pregnancy. It then classifies postpartum infections by prevalence, localization, and infection type. Risk factors that make patients susceptible to infection are also discussed, including changes in vaginal biota during late pregnancy and pregnancy-related immunodeficiency. Various specific postpartum infections are then described in detail such as endomyometritis, parametritis, thrombophlebitis, obstetric peritonitis, and postpartum sepsis. Diagnosis and treatment approaches are provided for each infection type.
1. Nematodes are roundworms that can infect humans and animals. Common human nematode infections include intestinal nematodes like ascariasis, trichuriasis, hookworm infections, and tissue-dwelling nematodes like filariasis.
2. Intestinal nematode infections are transmitted via ingestion of infective eggs from soil or food contaminated with human feces. They often cause asymptomatic infection but can also result in abdominal pain, diarrhea, and malnutrition.
3. Diagnosis is via identification of eggs in stool samples. Treatment involves anthelmintic medications like mebendazole or albendazole. Prevention relies on improved sanitation and hygiene to reduce transmission.
This document discusses endometriosis, defined as the presence of functioning endometrial tissue outside the uterus. It most commonly involves the ovaries and pelvic peritoneum. Theories for its development include retrograde menstruation and celomic metaplasia. Symptoms include pelvic pain and infertility. Diagnosis involves laparoscopy and histological examination of biopsied lesions. Staging uses the revised American Fertility Society classification from I to IV. Treatment aims to manage pain and preserve fertility, and may involve surgery, medical therapy such as hormonal contraceptives, or assisted reproduction.
This document discusses the anatomy and diseases of the pharynx and larynx. It provides detailed information on the structure, blood supply, innervation and functions of the pharynx and larynx. It also describes common diseases that can affect these areas like adenoid hypertrophy, tonsillitis, pharyngitis and their clinical presentation, investigations, and treatments.
This document discusses genital tuberculosis, which presents as chronic, painful sores on the genitals. It can also involve the cervix, fallopian tubes, and endometrium. Diagnosis involves biopsy and testing for acid-fast bacilli. Treatment consists of a multi-drug antibiotic regimen for 24-36 months. Surgery may be needed for masses that do not resolve or for complications like fistulas. Prognosis for survival is good with treatment but fertility is often poor.
Surgical diseases of Abdominal in childrenEneutron
This document discusses urgent surgical diseases of the abdominal cavity in children, focusing on acquired intestinal obstruction and intussusception. It provides classifications of intestinal obstruction, describes the stages and causes. For intussusception, it covers the history, classification, etiology, typical clinical presentation, diagnosis using ultrasound and x-rays, and treatment options of conservative disinvagination or surgery. With adequate treatment, the letality rate of these conditions is 1-3%; without treatment, intussusception can be fatal within 2-5 days.
1. The document discusses various deep neck spaces and infections that can arise within them, including Ludwig's angina (submandibular space infection), retropharyngeal abscess, and parapharyngeal abscess.
2. These deep neck space infections commonly arise from dental infections or tonsillitis and can spread rapidly, potentially causing airway obstruction.
3. Management involves intravenous antibiotics, incision and drainage of abscesses, and tracheostomy if needed to secure the airway. Proper identification of the involved neck space guides surgical drainage approach.
This document discusses neoplasms (tumors) of the salivary glands. It begins by describing the major and minor salivary glands. The most common benign tumors are pleomorphic adenoma, Warthin's tumor, and oncocytoma. The most common malignant tumors are mucoepidermoid carcinoma and adenoid cystic carcinoma. Factors like size and location of the gland affect likelihood of malignancy. Surgery is the main treatment and complications can include facial nerve paralysis, fluid collections, and Frey's syndrome.
This document discusses various types of noisy breathing and causes of hoarseness and stridor. It describes laryngomalacia as the most common congenital laryngeal anomaly manifesting as inspiratory stridor that is often relieved by prone positioning. For management of obstructed airways, it recommends techniques such as Heimlich maneuver, oropharyngeal/nasal airways, intubation, cricothyroidotomy, tracheostomy based on the level and severity of obstruction. Intubation is preferred over tracheostomy for short term airway issues in children due to easier decannulation and lower risk of subglottic stenosis.
The document summarizes the anatomy and functions of the larynx. It discusses the laryngeal cartilages, muscles, membranes and subdivisions. It describes the intrinsic and extrinsic muscles of the larynx and their functions. It also outlines the nerve supply, blood supply, lymphatic drainage and main functions of the larynx, which include protection of the lower airways, phonation, respiration, and chest fixation during actions like coughing.
Clinical anatomy of facial nerve and facial nerve palsy Ramesh Parajuli
The facial nerve is a mixed nerve that originates in the brainstem and has motor, sensory, and parasympathetic functions. It has several segments as it exits the brainstem and travels through the skull and internal auditory canal before exiting behind the ear. It gives off several branches and terminates in branches that innervate the muscles of facial expression. Facial nerve palsy can result from various causes like Bell's palsy, trauma, infection, tumors, or iatrogenic injuries. Clinical assessment and electrical tests can localize the site of injury which guides management including medications, physical therapy, or surgical interventions like decompression or repair.
The inner ear consists of two parts - the bony labyrinth within the temporal bone, and the membranous labyrinth contained within. The bony labyrinth includes the cochlea, vestibule and semicircular canals. The membranous labyrinth contains the cochlear duct, utricle, saccule and semicircular ducts filled with endolymph. These structures contain specialized sensory cells that detect sound (cochlear hair cells) and linear/angular acceleration (vestibular hair cells), transmitting signals to the brain.
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
This document discusses tumours of the ear, including both benign and malignant types. It provides details on the epidemiology, risk factors, pathology, diagnosis and treatment of various tumours such as basal cell carcinoma, squamous cell carcinoma, melanoma, and others. Treatment options discussed include surgical excision with various techniques depending on tumour size and location, Mohs surgery, radiation therapy, and reconstruction after tumour removal. Staging criteria and classifications of temporal bone tumours are also presented.
This document discusses evaluation and management of deaf children. It begins by defining different types and degrees of childhood hearing loss. Early diagnosis is important as it allows for early intervention, which research shows improves outcomes for language development and education. Universal newborn hearing screening within the first 3 months of life is now standard practice. Diagnostic tests include otoacoustic emissions testing and auditory brainstem response testing. Causes of childhood hearing loss can be genetic syndromic or non-syndromic causes. Proper evaluation involves history, physical exam, and potential genetic or imaging studies to determine the etiology.
Pharyngeal pouch, also known as Zenker's diverticulum, is a pulsion diverticulum that arises between the thyropharyngeus and cricopharyngeus muscles in an area of weakness. It is the most common type of posterior pharyngeal pouch. Zenker's diverticulum usually presents in older adults, affecting men more often than women. Symptoms include dysphagia, regurgitation of food, and halitosis. Treatment involves surgical excision of the diverticulum. While the exact cause is unknown, it is hypothesized to be related to the large size and oblique orientation of the pharyngeal muscles in humans, creating regions of weakness where the divert
Blood transfusion, Nutrition and water & electrolyte balanceRamesh Parajuli
This document discusses blood products and transfusion. It defines blood products as therapeutic substances prepared from human blood, including whole blood, blood components, and plasma derivatives. It describes the major blood groups (ABO and Rh) and components found in whole blood. The effects of storage on whole blood and its components are outlined. Indications, contraindications, and administration of various blood products like packed red blood cells, platelet concentrates, and leukocyte-depleted red blood cells are summarized. Processing and preparation of these blood products is also briefly explained.
This document provides information about different laryngoscopy techniques. It begins with a brief history of laryngoscopy and then describes techniques such as indirect laryngoscopy using a mirror, direct laryngoscopy using a laryngoscope, and flexible and rigid fiber-optic laryngoscopy. Indirect laryngoscopy is described as the simplest examination method for visualizing the larynx and vocal cords. Flexible fiber-optic laryngoscopy allows for examination of the entire hypopharynx and larynx and is well-tolerated by patients. The document also covers laryngoscopy equipment, techniques, common mistakes, advantages and limitations of the different methods.
This document discusses the importance of keeping up to date with medical literature for physicians. It notes that over 10,000 new articles are published per week, making it impossible for doctors to read everything. The document then provides guidance on critically evaluating medical literature, including understanding study designs and assessing validity, results, and applicability. It emphasizes applying a systematic approach to identify relevant information and avoid bias. Specific guidance is provided on appraising different study types, such as randomized trials, diagnostic tests, systematic reviews, cohort studies, and case-control studies.
This document provides an overview of allergic rhinitis. It defines allergic rhinitis as an IgE-mediated hypersensitivity disease characterized by sneezing, nasal discharge and obstruction. The document notes that allergic rhinitis prevalence is 15-20% globally, with higher rates in children. It affects quality of life by impacting school/work performance. Risk factors include genetics, family history of atopy, environmental irritants and allergens. Diagnosis involves history, exam, skin prick tests and blood tests. Management includes environmental control, nasal irrigation, medications like antihistamines, decongestants, steroids and immunotherapy.
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
1. ANAEROBIC ORGANISMS,ANAEROBIC ORGANISMS,
DIPHTHERIA, MYCOBACTERIADIPHTHERIA, MYCOBACTERIA
& TREPONEMA IN ENT& TREPONEMA IN ENT
Dr. Ramesh Parajuli, MSDr. Ramesh Parajuli, MS
Otorhinolaryngology, Head & Neck Surgery
Chitwan Medical College Teaching Hospital, Bharatpur-10, Chitwan, Nepal
2. Corynebacterium DiphtheriaeCorynebacterium Diphtheriae
Aerobic, Gram-positive rod,Aerobic, Gram-positive rod,
non spore forming, non motilenon spore forming, non motile
Club shaped, palisades (v or lClub shaped, palisades (v or l
shaped) or “shaped) or “Chinese letter”-Chinese letter”-
tellurite medium(D)tellurite medium(D)
Granules-loeffler’s medium(SGranules-loeffler’s medium(S))
3. 2 phenotypes- toxigenic(tox+ ve) and non2 phenotypes- toxigenic(tox+ ve) and non
toxigenic(tox-ve)toxigenic(tox-ve)
Diphtheria-nasopharyngeal & skin infection causedDiphtheria-nasopharyngeal & skin infection caused
by c.diphtheriaeby c.diphtheriae
Toxigenic:pharyngeal diphtheriaToxigenic:pharyngeal diphtheria
Non-toxigenic:cutaneous diphtheriaNon-toxigenic:cutaneous diphtheria
Lysogenic conversion by bacteriophage ‘tox’ geneLysogenic conversion by bacteriophage ‘tox’ gene
4. 3 strains: Gravis ,3 strains: Gravis ,
Intermedius & MitisIntermedius & Mitis
Gravis and intermediusGravis and intermedius
types-higher mortalitytypes-higher mortality
CornebacteriumCornebacterium
ulcerans:- infected byulcerans:- infected by
bacteriophagebacteriophage
diphtheria likediphtheria like
presentationpresentation
5. Mechanism of action of DiphtheriaMechanism of action of Diphtheria
ToxinToxin
9. Clinical FeaturesClinical Features
Age : Rare over 10 yearsAge : Rare over 10 years
Malaise ,Sore throat andMalaise ,Sore throat and
PyrexiaPyrexia
Membrane over theMembrane over the
Faucial pillarsFaucial pillars
Progressive DysphagiaProgressive Dysphagia
and Toxemiaand Toxemia
Inspiratory Stridor andInspiratory Stridor and
Barking coughBarking cough
Cough – Paroxysmal andCough – Paroxysmal and
ExhaustingExhausting
10.
11. DeathDeath
-Acute airway obstruction-Acute airway obstruction
-circulatory failure-circulatory failure
Acute Toxic MyocarditisAcute Toxic Myocarditiscardiaccardiac
dysfunctiondysfunction
-2-2ndnd
weekweek
Peripheral NeuropathyPeripheral Neuropathy
--Recurrent laryngeal nerve palsyRecurrent laryngeal nerve palsy
-Palatal Paralysis most common-Palatal Paralysis most common
-Presents with nasal regurgitation-Presents with nasal regurgitation
& hyper nasal speech& hyper nasal speech
21. IMPORTANT ANAEROBESIMPORTANT ANAEROBES
Bacteroides-Bacteroides-
B. fragilis- most frequently isolatedB. fragilis- most frequently isolated
Resistant to beta lactamsResistant to beta lactams
Prevotella: newly named & previously BacteroidesPrevotella: newly named & previously Bacteroides
B. melaninogenicus (Recently PrevotellaB. melaninogenicus (Recently Prevotella
melaninogenicus )- black, brown colonies Majormelaninogenicus )- black, brown colonies Major
group in oral flora.group in oral flora.
Peptostreptococcus-Peptostreptococcus-
-Normal flora of skin ,mucus membrane-Normal flora of skin ,mucus membrane
Species- P. micros, P. anaerobius P. magnusSpecies- P. micros, P. anaerobius P. magnus
(abscess)(abscess)
23. Infection due to anaerobes- mostly polymicrobialInfection due to anaerobes- mostly polymicrobial
Abscess cavity or necrotic tissueAbscess cavity or necrotic tissue
Failure of abscess to yield organism on routineFailure of abscess to yield organism on routine
cultureculture clue for anaerobic organismclue for anaerobic organism
Abscess in deeper body tissueAbscess in deeper body tissue
Putrid smelling infection site or dischargePutrid smelling infection site or discharge
26. Acute Necrotizing infection of PharynxAcute Necrotizing infection of Pharynx
Usu.a/w ulcerativeUsu.a/w ulcerative
gingivitisgingivitis
C/F:fever,sore throat,foulC/F:fever,sore throat,foul
breath,badbreath,bad
taste,sensation of chokingtaste,sensation of choking
O/E: Greyish membraneO/E: Greyish membrane
over Tonsillar pillars thatover Tonsillar pillars that
peel easilypeel easily
Lymphadenopathy &Lymphadenopathy &
LeucocytosisLeucocytosis
May spread to larynxMay spread to larynx
27. PeriPharyngeal spacePeriPharyngeal space
infectioninfection
Peritonsillar abscessPeritonsillar abscess
- Complication of Tonsillitis orComplication of Tonsillitis or
De novoDe novo
- Mixed flora containing bothMixed flora containing both
Anaerobes & GABHSAnaerobes & GABHS
- Association betweenAssociation between
Periodontal disease (sourcePeriodontal disease (source
of anaerobic organism) andof anaerobic organism) and
PTA.PTA.
- Ludwig’s AnginaLudwig’s Angina
28. ActinomycosisActinomycosis
Member of normal oral flora-Member of normal oral flora-
gingival crevicesgingival crevices
G+ve, anaerobic,branchingG+ve, anaerobic,branching
rodsrods
A.israelii-most common.A.israelii-most common.
A.naeslundii,A.naeslundii,
A.odontolyticus,A.viscous etcA.odontolyticus,A.viscous etc
29. Disruption of mucosalDisruption of mucosal
barrierbarrierlocal infectionlocal infectionslowlyslowly
progressiveprogressivechronic phasechronic phase
with single or multiple induratedwith single or multiple indurated
lesionslesions
Trauma, F.B. poor oral hygieneTrauma, F.B. poor oral hygiene
Chronic granulomatousChronic granulomatous
infectioninfection
30. Firm indurated mass- central necrosis withFirm indurated mass- central necrosis with
fibrotic ‘wooden wall’(neutrophils & sulfurfibrotic ‘wooden wall’(neutrophils & sulfur
granules)granules)
Multiple sinus tract which discharge pusMultiple sinus tract which discharge pus
Usu. angle of jaw involvedUsu. angle of jaw involved
31.
32. Sulphur granules-characteristicSulphur granules-characteristic
D/D- Malignancy or GranulomatousD/D- Malignancy or Granulomatous
diseasedisease
Any mass lesion or relapsing infection inAny mass lesion or relapsing infection in
head & neck regionhead & neck regionrule outrule out
actinomycosisactinomycosis
33. Sinusitis &OtitisSinusitis &Otitis
Anaerobes implicated in (0-88)% of CRSAnaerobes implicated in (0-88)% of CRS
(Doyle, Ramadan, Brook)(Doyle, Ramadan, Brook)
anaerobes in CRS (0 to 52%)(Harrison 17anaerobes in CRS (0 to 52%)(Harrison 17thth
edn.)edn.)
Peptostreptococcus, Fusobacterium & P.Peptostreptococcus, Fusobacterium & P.
acnesacnes
COMCOM
- Anaerobes in Upto 50% casesAnaerobes in Upto 50% cases
- B.fragilis in upto 28% cases of COMB.fragilis in upto 28% cases of COM
34. Complications of AnaerobicComplications of Anaerobic
Head & Neck InfectionHead & Neck Infection
Continuous spreadContinuous spread
- Craniad: Osteomyelitis of skull /mandible orCraniad: Osteomyelitis of skull /mandible or
intracranial complications(brainintracranial complications(brain
abscess,subdural empyema)abscess,subdural empyema)
- Caudal :Mediastinitis or PleuropulmonaryCaudal :Mediastinitis or Pleuropulmonary
infectioninfection
- Hematogenous disseminationHematogenous dissemination
- Lemierre’s Syndrome-Lemierre’s Syndrome- Fusobacterium necrophorumFusobacterium necrophorum
35. Approach to the patientsApproach to the patients
Harmless commensals, disease proximityHarmless commensals, disease proximity
to mucosal site colonisedto mucosal site colonised
Site of lower oxidation-reduction potentialSite of lower oxidation-reduction potential
Polymicrobial naturePolymicrobial nature
Negative cultureNegative culture ‘clue’‘clue’
Foul or putrid infection site or dischargeFoul or putrid infection site or discharge
diagnosticdiagnostic
36. DiagnosisDiagnosis
3 critical steps3 critical steps
1.1. Proper specimenProper specimen
collectioncollection
2.2. Rapid transportRapid transport
preferably in anaerobicpreferably in anaerobic
mediamedia
3.3. Proper handling ofProper handling of
specimen by the labspecimen by the lab
37. Specimen collectionSpecimen collection
Sterile body fluid – blood,Sterile body fluid – blood,
pleural, peritoneal fluid,CSFpleural, peritoneal fluid,CSF
and aspirates or biopsies fromand aspirates or biopsies from
normally sterile sitesnormally sterile sites
Specimen unacceptable:Specimen unacceptable:
expectorated sputum ,nasalexpectorated sputum ,nasal
tracheal suction, bronchoscopytracheal suction, bronchoscopy
specimen,voided urine &specimen,voided urine &
faecesfaeces
38. Ways of eliminating oxygen gasWays of eliminating oxygen gas
Gas pac jarGas pac jar : -: - Contains aContains a
packet of sodiumpacket of sodium
borohydride, sodiumborohydride, sodium
bicarbonate & citric acid.bicarbonate & citric acid.
- Addition of water causes- Addition of water causes
production of H2, CO2 gas &production of H2, CO2 gas &
displaces air (and thusdisplaces air (and thus
oxygen).oxygen).
39. Gas exchange jar : Air in theGas exchange jar : Air in the
jar is replaced with O2-freejar is replaced with O2-free
gas (from a tank).gas (from a tank).
Glove box:Glove box: Box is filled withBox is filled with
anaerobic (O2-free) gasanaerobic (O2-free) gas
,usually a mixture of H2 and,usually a mixture of H2 and
CO2.CO2.
-Positive pressure-Positive pressure
keeps O2 outkeeps O2 out
42. Mycobacterium TuberculosisMycobacterium Tuberculosis
Rod shaped, obligateRod shaped, obligate
aerobes ,slow growingaerobes ,slow growing
Acid-fast – high contentAcid-fast – high content
of mycolic acidof mycolic acid
Low cell wallLow cell wall
permeability topermeability to
antibioticsantibiotics
43. No exotoxin norNo exotoxin nor
endotoxinendotoxin
Damage done byDamage done by
immune system (CMI)immune system (CMI)
Tuberculin(surfaceTuberculin(surface
protein) along withprotein) along with
mycolic acidmycolic aciddelayeddelayed
type hypersensitivity &type hypersensitivity &
CMICMI
44. Nasal TuberculosisNasal Tuberculosis
ROUTES OFROUTES OF
SPREADSPREAD
- Direct inoculation:- Direct inoculation:
Nose Pricking orNose Pricking or
Finger nail TraumaFinger nail Trauma
- Droplet Spread:- Droplet Spread:
Coughing, SneezingCoughing, Sneezing
- Haematogenous- Haematogenous
disseminationdissemination
46. 1.Nodular1.Nodular
Begins in VestibuleBegins in Vestibule
APPLE JELLY NODULEAPPLE JELLY NODULE
Untreated-scar and deformityUntreated-scar and deformity
2.Ulcerative form2.Ulcerative form
Usually cartilaginous septum or inferior TurbinateUsually cartilaginous septum or inferior Turbinate
Septal PerforationSeptal Perforation
3.Sinus granuloma3.Sinus granuloma
Isolated sinus involvement without any sign and symptomsIsolated sinus involvement without any sign and symptoms
in the nose.in the nose.
Unilateral , Maxillary Sinus- usuallyUnilateral , Maxillary Sinus- usually
47. Tuberculous Otitis MediaTuberculous Otitis Media
Incidence < 1% COMIncidence < 1% COM
Spread: Insuffalation via E.tube,Spread: Insuffalation via E.tube,
Hematogenous, contiguousHematogenous, contiguous
Presentation:Presentation:
-Chronic Otorrhoea-Chronic Otorrhoea
-Hearing loss (moderate to severe-Hearing loss (moderate to severe
CHL, mixed)CHL, mixed)
-Dizziness-Dizziness
48. O/EO/E
Multiple perforations (hall mark)-Multiple perforations (hall mark)-
later coalesce into a single largelater coalesce into a single large
perforationperforation
AbundantAbundant pale granulationpale granulation
tissue - characteristictissue - characteristic
Handle of Malleus- denudedHandle of Malleus- denuded
Middle ear mucosa- paleMiddle ear mucosa- pale
Complications:Complications:
-Profound SNHL-Profound SNHL
-Facial n. palsy-Facial n. palsy
49. Diagnosis-HPEDiagnosis-HPE
- ME Mucosal biopsy & Aural polpectomy- ME Mucosal biopsy & Aural polpectomy
specimen positive in 30% & 35%specimen positive in 30% & 35%
respectivelyrespectively
- Management:Management:
- ATT- ATT
- Mastoidectomy- Mastoidectomy
50. Tuberculous Cervical AdenitisTuberculous Cervical Adenitis
Most common Cause of LNMost common Cause of LN
swelling in neckswelling in neck
Children & young adultsChildren & young adults
Primary foci – usually tonsilsPrimary foci – usually tonsils
90% single LN group usually90% single LN group usually
Deep Jugular chainDeep Jugular chain
Stages:Stages:
Stage of LymphadenitisStage of Lymphadenitis
Stage of Periadenitis includingStage of Periadenitis including
“collar stud”“collar stud” abscessabscess
Stage of sinus formationStage of sinus formation
53. Oropharyngeal TuberculosisOropharyngeal Tuberculosis
Secondary to coughingSecondary to coughing
heavily of infected sputumheavily of infected sputum
Oral lesion – not commonOral lesion – not common
-Ulceration :dorsum of tongue-Ulceration :dorsum of tongue
-Painless , irregular-Painless , irregular
,granulating floor,granulating floor
Pharynx-not commonPharynx-not common
- Site of primary infectionSite of primary infection
(Tonsils, Adenoids)(Tonsils, Adenoids)
54. Mycobacterial infection of theMycobacterial infection of the
Salivary glandsSalivary glands
Etiology.: atypical or NTMEtiology.: atypical or NTM
Parotid, submandibular glandsParotid, submandibular glands
Presentation :Presentation :
-Children age group 3 – 4 years-Children age group 3 – 4 years
-Painless mass in neck or face-Painless mass in neck or face
-Skin breakdown &sinus-Skin breakdown &sinus
formationformation
55. TB Esophagitis:TB Esophagitis:
-swallowed sputum or direct-swallowed sputum or direct
spread from adjacent LNspread from adjacent LN
-stricture,fistula, mucosal-stricture,fistula, mucosal
irregularitiesirregularities
GranulomatousGranulomatous
cheilitis-cheilitis- rarerare
56. TB LarynxTB Larynx
Nearly always aNearly always a
complication of advancecomplication of advance
cavitatory PTBcavitatory PTB
C/F:C/F:
-Dysphonia-Dysphonia
-Pain on swallowing &-Pain on swallowing &
speakingspeaking
-Otalgia-Otalgia
69. 22NDND
LINE TREATMENT OR NEWER DRUGSLINE TREATMENT OR NEWER DRUGS
AMINOGLYCOSIDES: Capreomycin,amikacin,kanamicinAMINOGLYCOSIDES: Capreomycin,amikacin,kanamicin
THIOAMIDES: Ethionamide,prothionamideTHIOAMIDES: Ethionamide,prothionamide
PAS(Para-Aminosalicyclic acid)PAS(Para-Aminosalicyclic acid)
CYCLOSERINE (or trizidone)CYCLOSERINE (or trizidone)
FLUOROQUINOLONES-FLUOROQUINOLONES-
ofloxacin,ciprofloxacin,sparfloxacinofloxacin,ciprofloxacin,sparfloxacin
&Gatifloxacin,Sparfloxacin-latest(improved activity)&Gatifloxacin,Sparfloxacin-latest(improved activity)
Rifabutin, RifamycinRifabutin, Rifamycin
ThiocetazoneThiocetazone
Rifapentine- latest one 600mg/weeklyRifapentine- latest one 600mg/weekly
Macrolide- clarithromycin.Macrolide- clarithromycin.
Linezolide :Oxazolidinone antibioticLinezolide :Oxazolidinone antibiotic
70. MDR-MDR- TBTB
MDR suspected :MDR suspected :
-History of irregular multi-drug therapy and sputum-History of irregular multi-drug therapy and sputum
remaining positiveremaining positive
-No good response in a smear positive case put-No good response in a smear positive case put
on standard re-treatment regimen.on standard re-treatment regimen.
- Sputum- Sputum
C/S testC/S test
Causes:Causes:
- inappropriate regimen ,non compliance,interruption of drug- inappropriate regimen ,non compliance,interruption of drug
supply,lack of diagnosis and free treatmentsupply,lack of diagnosis and free treatment
71. XDR-TBXDR-TB
Extensively drug resistant TB:TB that has developedExtensively drug resistant TB:TB that has developed
resistance to at least rifampicin & isoniazid as well as toresistance to at least rifampicin & isoniazid as well as to
any member of the quinolone family & at least one of theany member of the quinolone family & at least one of the
following 2following 2ndnd
line anti-TB injectable drugs:line anti-TB injectable drugs:
kanamycin,capreomycin or amikacinkanamycin,capreomycin or amikacin
(Global Task Force on XDR-(Global Task Force on XDR-
TB,WHO,2006)TB,WHO,2006)
11STST
line drug misused, mismanagedline drug misused, mismanaged MDR- TBMDR- TB
22NDND
line drug misused, mismanagedline drug misused, mismanaged XDR-TBXDR-TB
72. POTENTIAL NEWER THERAPIES FORPOTENTIAL NEWER THERAPIES FOR
TUBERCULOSISTUBERCULOSIS
Protein kinase inhibitors: pyridomycin, RifadineProtein kinase inhibitors: pyridomycin, Rifadine
Pyridine analogues like NAD (NicotinamidePyridine analogues like NAD (Nicotinamide
adenine dinucleotide) and Streptolydigin whichadenine dinucleotide) and Streptolydigin which
inhibits initiation of RNA synthesis.inhibits initiation of RNA synthesis.
Cytokine Immunotherapy: IL-2- subcutaneous lowCytokine Immunotherapy: IL-2- subcutaneous low
dose for patients with active tuberculosis todose for patients with active tuberculosis to
augment the immune cell response.augment the immune cell response.
IFN Gammatherapy by aerosol toIFN Gammatherapy by aerosol to
accelerateaccelerate M.tuberculosisM.tuberculosis killing.killing.
Interleukin-12: for restoring impaired cellularInterleukin-12: for restoring impaired cellular
immune function in AIDS and tuberculosis.immune function in AIDS and tuberculosis.
73. Recent Advances in theRecent Advances in the
Diagnosis & Management ofDiagnosis & Management of
Tuberculosis:Tuberculosis:
1.BACTEC TM 460-liquid culture method1.BACTEC TM 460-liquid culture methoddetectsdetects
radiolabeled CO2 releasedradiolabeled CO2 released
2.MGIT(mycobacterial growth indicator tube)2.MGIT(mycobacterial growth indicator tube)
3.PCR3.PCR
4.PA-824 :a nitroimidazopyran compound related to4.PA-824 :a nitroimidazopyran compound related to
metronidazole activity against both slow &rapidlymetronidazole activity against both slow &rapidly
dividing mycobact.dividing mycobact.may enter human testingmay enter human testing
soonsoon
74. 5.Rifacinna5.Rifacinna
6.Benzofuro(2,3-b) quinolone derivative6.Benzofuro(2,3-b) quinolone derivative
7.Interferon gamma release assay(IGRAs)-mtb-7.Interferon gamma release assay(IGRAs)-mtb-
specific antigens,ESAT-6 & CFP-10specific antigens,ESAT-6 & CFP-10
8.Dipiperidines8.Dipiperidines
9.Multiplex SNaphot technique-identification of9.Multiplex SNaphot technique-identification of
diff.species of mycobacteriadiff.species of mycobacteria
10.R207910(TMC207)-a lead compound10.R207910(TMC207)-a lead compound
75. Atypical MycobacteriaAtypical Mycobacteria
Mycobacteria other than M.tuberculosis & M.bovisMycobacteria other than M.tuberculosis & M.bovis
Mycobacteria Other Than Tuberculosis(MOTTS)=NonMycobacteria Other Than Tuberculosis(MOTTS)=Non
Tuberculous MycobacteriaTuberculous Mycobacteria
Oppurtunistic infection in human beingsOppurtunistic infection in human beings
Non contagiousNon contagious
4 groups-based on pigment production & rate of growth4 groups-based on pigment production & rate of growth
1.1. Photochromogens – yellow orange colonies in lightPhotochromogens – yellow orange colonies in light
eg.M.kansasii , M. marinumeg.M.kansasii , M. marinum
2. Scotochromogens –pigment in dark eg. M scrofulaceum2. Scotochromogens –pigment in dark eg. M scrofulaceum
3. Nonchromogens –no pigments,eg.MAC3. Nonchromogens –no pigments,eg.MAC
4. Rapid growers –eg M.Fortuitum ,M. chelonei4. Rapid growers –eg M.Fortuitum ,M. chelonei
76. Mycobacterium LepraeMycobacterium Leprae
Hansen (1868)-first bacterial pathogen ofHansen (1868)-first bacterial pathogen of
humans to be describedhumans to be described
Acid fast rodAcid fast rod
Obligate intracellular-can’t be cultured inObligate intracellular-can’t be cultured in
vitro, but in mouse footpadvitro, but in mouse footpad
Optimum temp.growth-less than bodyOptimum temp.growth-less than body
temptemp preference for skin, mucosa &preference for skin, mucosa &
superficial nervesuperficial nerve
83. TREPONEMATREPONEMA
trepos=turn, nema= threadtrepos=turn, nema= thread
Spiral, round or pointed endsSpiral, round or pointed ends
Member of genera SpirochetesMember of genera Spirochetes
subspecies:subspecies:
1.Pallidum- venereal Syphilis1.Pallidum- venereal Syphilis
2.Endemicum - endemic Syphilis2.Endemicum - endemic Syphilis
(bejel)(bejel)
3.Pertenue- Yaws3.Pertenue- Yaws
4.Carateum-4.Carateum- PintaPinta
84. Treponema PallidumTreponema Pallidum
Thin walled spiral organismThin walled spiral organism
Motile : endoflagella(axialMotile : endoflagella(axial
filaments)filaments)
Thin not reliably seen in gramThin not reliably seen in gram
stain,stain,
darkfield microscopy ordarkfield microscopy or
immunofluorescenceimmunofluorescence
Not grown on bacteriologic mediaNot grown on bacteriologic media
or cell cultureor cell culture
88. Tertiary SyphilisTertiary Syphilis
Most common stage ofMost common stage of
nasal syphilisnasal syphilis
Bony portion of NasalBony portion of Nasal
SeptumSeptum
Gumma –pathognomicGumma –pathognomic
punched out ulcerpunched out ulcer
89.
90. Congenital SyphilisCongenital Syphilis
EARLY:EARLY:
first 3mos of life,manifestfirst 3mos of life,manifest
as snufflesas snufflesnasalnasal
discharge purulentdischarge purulent
LATE:manifest at pubertyLATE:manifest at puberty
gummatous lesiongummatous lesion
destroys nasal structure,destroys nasal structure,
Keratitis,deafness,hutchisoKeratitis,deafness,hutchiso
n’s teethn’s teeth
91. Syphilitic PharyngitisSyphilitic Pharyngitis
May be congenital or acquired by sexualMay be congenital or acquired by sexual
intercourseintercourse
Secondary stage most likelySecondary stage most likely
incidence rising– Mainly in HIV positiveincidence rising– Mainly in HIV positive
92. Primary SyphilisPrimary Syphilis
Extragenital sites : lips,Extragenital sites : lips,
tongue, buccal mucosatongue, buccal mucosa
and tonsilsand tonsils
Begins as a Papule,Begins as a Papule,
breaks down to form abreaks down to form a
painless ulcer withpainless ulcer with
indurated marginindurated margin
(chancre)(chancre)
Non tender cervicalNon tender cervical
lymphadenopathylymphadenopathy
Spontaneous healingSpontaneous healing
93. Secondary SyphilisSecondary Syphilis
-is infectious-is infectious
Hyperemia and inflammation ofHyperemia and inflammation of
pharynx and soft palatepharynx and soft palate
Snail Track ulcer :-OralSnail Track ulcer :-Oral
cavity and oropharnyxcavity and oropharnyx
-Ulcerated leison covered with-Ulcerated leison covered with
greyish white membranegreyish white membrane
which when scraped haswhich when scraped has
pink basepink base
with no bleeding.with no bleeding.
94. Tertiary SyphilisTertiary Syphilis
Typically painless .Typically painless .
No lymphadenopathy unless secondaryNo lymphadenopathy unless secondary
infection.infection.
GUMMA are characterstic.GUMMA are characterstic.
- Seen in Hard palate, Nasal septum- Seen in Hard palate, Nasal septum
,Tonsil ,PPW or larynx.,Tonsil ,PPW or larynx.
VDRL may be negativeVDRL may be negative
96. Syphilis LarynxSyphilis Larynx
Rarely involvedRarely involved
Secondary & Tertiary more commonSecondary & Tertiary more common
Hoarseness & Dysphagia – commonHoarseness & Dysphagia – common
O/EO/E
- Epiglottis & Aryepiglottic folds- Epiglottis & Aryepiglottic folds
principally involvedprincipally involved
97. DiagnosisDiagnosis
1.Immunoflurorescence or dark field microscopy1.Immunoflurorescence or dark field microscopy
2. Biopsy:2. Biopsy:
3.Serology:3.Serology:
Non-treponemal antibody tests:VDRL,RPR,ARTNon-treponemal antibody tests:VDRL,RPR,ART
For screening and treatment follow upFor screening and treatment follow up
Treponema specific antibody tests:forTreponema specific antibody tests:for
confirmation,usu.remains positive for life,confirmation,usu.remains positive for life,
FTA-ABS test,TPHAFTA-ABS test,TPHA
98. Stage of SyphilisStage of Syphilis TreatmentTreatment
Primary, secondary, or earlyPrimary, secondary, or early
latentlatent
Penicillin G benzathine (singlePenicillin G benzathine (single
dose of 2.4 mU IM)dose of 2.4 mU IM)
Late latent (or latent ofLate latent (or latent of
uncertainuncertain
duration), cardiovascular, orduration), cardiovascular, or
benign tertiarybenign tertiary
benzathine Penicillin Gbenzathine Penicillin G
(2.4 mU IM weekly for 3 weeks)(2.4 mU IM weekly for 3 weeks)
Procain penicillin- 1.2mu for 20Procain penicillin- 1.2mu for 20
days.days.
Alternative drugsAlternative drugs Doxycycline- 100mg bd/ 15 daysDoxycycline- 100mg bd/ 15 days
Erythromycin- 500mg qid for 15Erythromycin- 500mg qid for 15
days.days.
Ceftriaxone1gm/ im/ 7-15 daysCeftriaxone1gm/ im/ 7-15 days