This document provides an overview of desquamative gingivitis (DG), a clinical sign characterized by redness and scaling of the gingiva. It discusses the various diseases that can present as DG, including lichen planus, pemphigus, pemphigoid, linear IgA disease, and lupus erythematosus. It outlines the diagnostic process and significance of DG, noting that the associated disorders can impact oral health and require systemic treatment with corticosteroids or immunosuppressants, increasing risk of complications. Proper diagnosis of the underlying condition is important for effective management of DG lesions and systemic disease.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
The skin is not only the largest organ of the body, but it also forms a living biological barrier with several functions.
Pyodermas are any pyogenic skin disease (has pus). Skin infections can be caused by bacteria (often Staphylococcal or Streptococcal) either invading normal skin, or affecting a compromised skin barrier
Some bacterial skin infections resolve without serious morbidity. However, skin infections can be severe and result in sepsis or death, particularly in vulnerable patient groups.
Most deep fungal infections have their primary foci in the lungs, therefore those presenting with distant organs or skin involvement should be managed aggressively as untreated or severe disease can lead to severe scarring, disfigurement and even death.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
5. Introduction
• DG is a clinically relevant entity…..
• DG can be associated with a wide range…..
• Because the majority of disorders causing DG…..
6. • Chronic desquamative gingivitis is characterized by intense redness and
desquamation of the surface epithelium of the attached gingiva.
Chronic desquamative gingivitis
7.
8. Etiology
• Dermatological diseases
• Endocrine disturbances
• Abnormal responses to
bacterial plaque
• Chronic infections
• Idiopathic
• Aging
(“desquamtive gingivitis- a clinical sign in mucous membrane pemphigoid: report of case and review of literature:
shamimul hassan”)
10. Epidemiological features
Pemphigus
vulgaris – 3%
to 15%
Oral lichen
planus – 24%
to 45%
Mucous
membrane
pemphigoid –
35% to 48%
“(Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis
Lucio Lo Russo et al”)
11. Diagnosis of desquamative gingivitis:
Clinical
history
Clinical
examination
Biopsy
Microscopic
Examination
Immunofluore-
scence
13. Treatment
∆ Local treatment
Plaque control
Use of corticosteroid ointments and creams
∆ Systemic treatment
High dose therapy
Moderate dose
therapy
18. ORAL MANIFESTATIONS:
Radiating white or gray, velvety, thread-like papules in
a linear, annular or retiform arrangement forming
typical lacy, reticular patches, rings and streaks over
the buccal mucosa, lips, tongue and palate.
Vesicle and bulla formation.
21. DI- Linear-fibrillar deposits of fibrin in thebasement membrane zone.
Scattered immunoglobulin-staining cytoid bodies in the upper areas of the lamina
propria.
Serum tests using indirect immunofluorescenceare negative in lichenplanus.
22. TREATMENT:-
The keratotic lesions of oral lichen planus are asymptomatic and do not
require treatment.
The erosive, bullous, or ulcerative lesions of oral lichen planus are treated with high-
potency topical steroid such as 0.05% fluocinonide ointment (Lidex, three times daily).
It can also be mixed 1:1 with carboxymethyl cellulose (Orabase) paste or other adhesive
ointment.
23. • SEVERE CASES - Intralesional injections of triamcinolone acetonide (10 to 20 mg) or
short-term regimens of 40 mg prednisone daily for 5 days followed by 10 to 20 mg
daily for an additional 2 weeks.
• Topical tacrolimus
24. PEMPHIGOID
Cutaneous, immune-mediated, subepithelial bullous diseases that are
characterized by a separation of the basement membrane zone, including
bullous pemphigoid pemphigoid
gestationis
mucous membrane
pemphigoid
25. Cicatricial pemphigoid.
Chronic, vesiculobullous autoimmune disorder
It predominantly affects women in fifth decade of life.
Five subtypes:-
28. ORAL MANIFESTATIONS
• Desquamative gingivitis with areas of
erythema, desquamation, ulceration, and
vesiculation of the attached gingiva.
• Bullae- thick roof- rupture in 2-3 days
leaving irregular shaped areas of ulceration;
healing- 3 weeks or longer.
29. • Separation of epithelium and C.T.occursatthebasementmembranezone.
• EM- shows spilt in basal lamina
31. • Topical steroids – main Rx for mucous memb. Pemphi.
• Fluocinonide(0.05%) and Clobetasol propionate (0.05%) in an adhesive
vehicle can be used 3 times a day for 6 mnths.
33. Oral Manifestations
• Oral lesions – less frequently in BP than in CP
• Presence of vesicles and areas of erosion and ulceration
• Lesion- painful
• Gingival tissues appear extremely erythematous….
Bullae on gingiva
35. IgG&C3 immune deposits along epithelial basement membrane and circulating IgG
antibodies to the epithelial basement membrane.
Direct immunofluorescence is positive in 90% to 100% of these patients, whereas
indirect immunofluorescence is positive in 40% to 70% of affected patients
36. • control signs and symptoms
• Primary Rx –moderate dose of systemic prednisone
• Steroid sparing strategies (Prednisone + immunomodulatory drugs)…
• For localized lesions of bullous pemphigoid,….
37. • PEMPHIGUS - Group of autoimmune bullous disorders - cutaneous and/or mucous
membrane blisters
Types
P. vulgaris P. foliaceous
P. vegetans
P. erythematosus
38. • Lethal chronic condition
• Predilection in women(after 4th decade of life)
39.
40. • Range from small vesicles to large bullae
• Rupture of bullae leads to extensive areas of
ulceration
• Any area of oral cavity involved- Oral
lesions confine less often to gingival
tissues
• Nikolsky’s sign….
ORAL LESIONS:-
Soft palate > buccal mucosa > tongue > lower labial mucosa > gingiva
43. TREATMENT
• Systemic corticosteroids with or without other immunosuppressive agents
• Steroid sparing therapies- pt not responsive to corticosteroid.
• Optimal oral hygiene
• Pts in maintenance phase- prednisone before oral prophylaxis and periodontal surgery
to prevent flare ups.
44. CHRONIC ULCERATIVE STOMATITIS
• 1990
• Condition presents with chronic oral ulcerations
• Predilection for women(4th decade)
• Erosions and ulcerations in oral cavity- few cases
with cutaneous lesions
ORAL LESIONS
•Painful, solitary small blisters and erosions with surrounding erythema – mainly
on gingiva and lateral border of the tongue ; hard palate may also present similar
lesions.
45. TREATMENT
• Mild cases- topical steroids (fluocinonide, clobetasol propionate) and topical
tetracycline
• Severe cases- systemic steroids
• Hydroxychloroquine sulfate 200-400 mg/ day – Rx of choice for complete,
long lasting remission
46. LINEAR IgA DISEASE (LINEAR IgA DERMATOSIS)
• Uncommon mucocutaneous disorder with
predilection in women
C/F
• Pruritic Vesiculo bullous rash, during middle to
late age..
47. ORAL LESIONS
• Vesicles, Painful ulcerations or erosions and erosive gingivitis/chelitis
• Hard and soft palate commonly affected →
tonsillar pillars, buccal mucosa, tongue and gingiva
• Rarely, oral lesion may be the only manifestation for several years; before
cutaneous lesions
48. Combination of
Sulfones and
Dapsone
Small amounts of
Prednisone (10-
30mg/day) canbe
added
tetracycline
(2g/day)
combined with
nicotinamide (1-
5g/day)
Mycophenolate(1g
twice daily) +
prednisolone
(30mg daily)
49. Chronic condition
Young adults (20-30years)
Slight predilection formales.
Bilateral and symmetric pruriticpapules/vesicles…
Oral lesions - Painful ulcerations preceded by collapse of ephemeral
vesicles/bullae to erythematous lesions.
50. HISTOPATHOLOGY
Focal aggregates of neutrophils and eosinophils amidst deposits of fibrin at the apices
of the dermal pegs.
IMMUNOFLUORESENCE
Direct immunofluoresence show that IgA &C3 are present at the dermal papillary apices.
There is clear association with celiac disease & circulatory anti endomysial and anti
gliaden antibodies may be of diagnostic value.
59. • Target or iris lesions with central clearing
Oral lesions
• 70% of patients with skin involvement (McCarthy 1980)
• Multiple, large, painful ulcers with an erythematous border
• Hemorrhagic crusting of vermilion border of lips
60. Buccal mucosa > tongue >lower labial mucosa > floor of the mouth > palate > gingiva.
61. Steven Johnsons Syndrome
• Severe bullous form
• Abrupt occurrence of fever, malaise, photophobia and
eruptions of oral mucosa, genitilia and skin
• Oral lesions → rupture → surfaces covered with thick white
or yellow exudate
• Lips - ulceration with bloody crusting
• ANUG
63. DRUG ERUPTIONS
• Drug acts as an allergen either alone or in combination, sensitizes the tissues and
then causing the allergic reaction.
• TYPES
- Stomatitis medicamentosa - mouth or parenterally
- Stomatitis venenata(contact dermatitis) – local use.
70. Clinical significance
• Painful gingival and oral lesions…..
• This can increase the inflammation associated with DG lesions,….
• The potential direct effects of DG-associated disorders on periodontal status have been investigated
rarely.
71. • It seems that the presence of DG lesions….
• In addition, systemic/topical…..
• Oral hygiene procedures should be performed avoiding trauma because many immune-mediated
disorders associated with DG are characterized by the Koebner phenomenon,
72. • Systemic complications also are important…..
• Systemic corticosteroids and/ or other immune suppressive drugs….
• A small but increased risk for malignant transformation of the oral mucosa….
“(Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis
Lucio Lo Russo et al”)
73. • From a theoretic point of view, disorders causing DG may have potential harmful
• In fact, DG lesions are typically chronic and often associated to a wide range of oral
symptoms….
• In the instance of such an indirect effect…..
74. • On the other hand, a direct effect of DG lesions on periodontitis …..(Kornman, 2008).
• Immune-inflammatory mechanisms are also critical for the pathogenesis of most of DG-associated
disorders (Lo Russo et al, 2008), which often involves common molecules⁄cytokine networks [e.g. TNF-
a for OLP (Sugerman et al, 2002; Sugermann et al, 1996; Khan et al, 2003)].
75. • (Tricamo et al, 2006) showed that…...
• (Akman et al, 2008)…..
78. references
•Carranza clinical periodontology 12th edition
•Shafer's oral pathology 5th edition
•Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis
J Periodontol 2008;79:4-24.
•Position Paper Oral Features of Mucocutaneous Disorders
J Periodontol 2003;74:1545-1556.
•Desquamative Gingivitis: Investigation, Diagnosis and Therapeutic Management in Practice
Perio 2005; Vol 2, Issue 3: 183–190
•Periodontal Implications: Mucocutaneous Disorders
Ann Periodontol 1996;1:401-438
• Desquamative Gingivitis − Aetiology, Diagnosis and Management;
Lewis Winning, Amanda Willis, Brian Mullally and Christopher Irwin
• Desquamtive gingivitis- a clinical sign in mucous membrane pemphigoid: report of case and review of
literature: Shamimul Hassan