This document presents the orthodontic case of a 12-year-old female patient. She has a Class III skeletal pattern and dental malocclusion with crowding. Treatment aims to align the teeth through fixed appliances, extract four premolars to relieve crowding, and achieve a Class I canine and molar relationship while monitoring mandibular growth. Retention will involve permanent maxillary and mandibular retainers. The goal is to improve dental aesthetics and function through orthodontic camouflage of the mild skeletal discrepancy.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Personal Data
• Patient’s initials: M.S
• Gender: female
• Age: 12Yrs-5 months
• Career: Student
• Nationality: Jordanian
3. Chief Complaint
• I don’t like the appearance of my teeth , I have a displaced tooth “
4. Medical & Dental History
• Medical history:
denied any medical problems
• Dental history:
Previous visits to dental clinic for check ups
Fillings LL6,LR6
5. History
• Trauma :No history of dental trauma
• Habits :Grinding on maxillary central incisors
15. Transverse Assessment
• Equal medial and lateral
• Fifths
• -Interpupillary distance > the
width of the mouth.
• -The width of the nose > the
central fifth
16. Soft Tissue Examination
• Normal tongue size and function
• Frontonasal Angle:(115-135)
• 133 normal
• Nasolabial Angle: (90-110)
110 normal
• Labiomental Angle: (110-130)
• 120 normal
17. Facial and Dental Appearance
1. The face (macroesthetics)
2. Smile Frame (miniesthetics)
3. Teeth (microesthetics)
18. Smile analysis
The smile index = intercomisure width/ interlabial gap on
smiling
=9.00/.8=11.25 (Ackerman et al
)1998
** The lower the smile index, the less youthful the smile appear
Asymmetric smile
The buccal corridor ratio=(inner commissure width-visible
maxillary dentition)/inner commissure x 100%
(9-7.1)/9=22%
Medium- narrow
(Frush and Fisher) 1958
19. Facial And Dental Appearance
1. The face (macroesthetics)
2. Smile Frame (miniesthetics)
3. Teeth (microesthetics)
20. 3.Teeth (microesthetics)
• reduced incisal show at smile .
• Increased buccal corridor.
• Upper lip looks thin with no
vermillion display , lower lip is
fuller .
21. Tooth proportions
• gingival lines:
• Central incisors show almost
same gingival level
• UL2 gingival line lower than the
centrals
• UR2 gingival margin lower due
to cross bite
23. Intraoral Examination
• Fair Oral Hygiene
• Mild deposits of plaque around
gingival margins – initial
gingivitis
24. Intraoral Examination
• Central lines:
Upper and lower shifted to the right by 1
mm.
• Incisors classification:
Class III
• OJ:
1mm
OB:
zero
• Crossbites:
UR2
• No Displacement
40. Panoramic interpretation
-All wisdom teeth buds are present
-impeded eruption of LR5
-Amalgum restorations on LR6,LL6
-No other apparent pathologies
41. Possible etiology
A.Skeletal : (A-P) Class III skeletal pattern : Genetic (Litton et al 1970). 1/3
of patients with severe class III have a parent with class III problems but
there is no detected autosomal dominant or recessive method of
transmission.
B.Dental : (A-P)Class 2 molars and canine s : early loss of deciduous teeth ,
drift of posterior teeth
Reduced OJ , OB : features of class III skeletal pattern – no dental
compensation
Secondary crowding ; early loss of deciduous teeth , tooth size arch size
discrepancy.
C.Soft tissues : not envolved in etilogy but encourage dento lveolar
compensation .
44. Diagnostic Summary
• M.S 12yrs- 5 months old female pt , MF, dissatisfied with the
appearance and crowding of her teeth. Patient has fair-poor OH, a
class III incisal classification on a class III skeletal base with average
vertical dimension. she has a asymmetrical Face with compromised
smile esthetics. Complicated by crowded upper right canine and
upper right permenant lateral in crossbite . she has a ½ unit II molar
on left side, class II on right side. OJ is 1mm , OB is zero . Upper and
lower midlines are shifted 1 mm to the Rt. Upper arch has moderate
crowding and mild crowding in the lower.
45. Problem List
• Skeletal and dental problems in transverse plane:
o
o Facial assymetry
o Upper and Lower midlines are shifted 1mm to the right
o
• Skeletal and dental problems in A-P plane:
• Skeletal class III base relationship
• Oj 1mm
o Canines : Rt full unit II left ½ II
o Rt molar ¾ II lt ½ unit II
o Incisor class III
• Skeletal and dental problems in vertical plane:
o Reduced OB
o Slight increase in LAFH
Pathological problems:
• Pathological problems:
• Poor OH
• Initial gingivitis with cervical plaque deposites .
• Developmental problems
DevePatient’s concern the malaligned teeth
soft tissues : thin upper lip, obtuse NL angle.
• Smile esthetics: compromised smile complicated by
buccally displaced UR3 and UR2 in anterior crossbite
• Reduced incisal show .
• Alignment and symmerty:
o Fairly symmetric lower arch with minimum crowding
o Asymmetric upper arch with moderate crowding
o Rotated teeth
o Buccaly erupted UR3
o UR2 in crossbite
46. Treatment Aims
• Improve Oral hygiene
• Relief crowding in upper and lower arches , and align the teeth (C/C)
• Accept class 3 skeletal pattern , moniter growth .
• Improve patients smile by creating more normal gingival relationships , and smile symmetry , increase incisal show .
• Correct rotated teeth
• Correct upper and lower lower midline shift
• achieve better facial profile through improving upper teeth inclination
• Achieve 3mm OJ
• Achieve class II molar and class I canine relationship
• Achieve class 1 incisor relationship
• Achieve normal OB
• Finishing and detailing of occlusion.
• Retain corrected results
47. Treatment plan
“Orthodontic camouflage – extraction case”
1. OHI
2. Upper, Lower fixed appliance(Straight arch wire technique , MBT
perscription)
3.Extraction
4. Absolute anchorage “ indirect anchorage “
5. Retention : upper and lower permanent retainers
upper and lower HR.
4 4
*monitor growth of the mandible
48. • Monitoring the growth of mandible
Serial Clinical measurements like OJ
Serial Study models
Serial Photograph or 3D stereo photogrammetry
Serial Ceph (not justified)
Growth Treatment Response Vector (GTRV) analysis
49. Retention Protocol
• Short term:
Upper modified HR , lower regular HR , worn full time for 6 months ,
part time for 6 months .
• Long term :
Upper and lower permeant retainers from 3-3 (braided steel wire of
17.5 mil
50. Justification
1. OHI
to stabilize patients periodontal health before
comprehensive orthodontic treatment .
Visible plaque deposits on gingival margins.
51. 2.Camouflage
• Patient has passed the optimal age for protraction Facemask –not
applicable .
• Mild skeletal class 3.
• Acceptable profile.
• Good vertical proportions
• Normal SNB
• Concerned with dental problems only
• No dental compensation
52. 3. Extraction :
• Moderate crowding in the upper arch ( -7.5 mm)
• Extraction spaces will be used to relief crowding and correct molar
relationship – ¾ II left ½ II right .
• Mild crowding in the lower arch , space can be gained from IPR .
• No extraction in lower arch to keep the cop of decompensation if
orthodontic-orthognathic approach is decided later on.
53. • Regarding extraction and smile width : studies have looked at
whether or not extraction causes a “ dark buccal crridor “ and found
that this is not the case – Johnson & smith ,1995 ; Gianelly , 2003.
• Extraction and patients profile : latest cochrane review published in
American Journal of orthodontics states that no significant
difference between 2 groups of patients designed to an extraction
group and non in terms of facial esthetics – lared W, koga da silva et
al – American journal of orthodontics 2017 .
• Extraction treatment did not result in a narrow maxillary dental
arches – Akyalcin et at 2011
54. 4.Fixed appliance
• To enable 3D control of tooth movement .
• Bodily tooth movement required
• To close extraction spaces and midline shift
• Orthodontic problems such as :Crowding , rotations , anterior
crossbite , ectopic LR5 are best addressed by fixed appliances .
55. MBT system
• Upper palatal root torque
• Lower labial root torque
Camouflag class 3
56. •Why not pendulum (distalization )?
Reduced OB
Right molar is in ¾ class 2 relationship
7s are erupted
Oral hygiene still to be improved , pendulum
carries the potential of food impaction and
loss of compliance. .
57. Why to extract maxillary first premolars (4s) not 5s ?
Space is conveniently sighted to relief crowding (closer to labial
segment).
3 to 5 contact is generally considered acceptable .
More anchorage loss when 5s are extracted in prefereance to 4s.
5s are extracted to avoid retro inclination of upper incisors in class 3
malocclusion , this can be avoided by correct and proper mechanics .
58. Absolute Anchorage
• Absolute anchorage is needed to move upper buccal segments into
full unit class II without altering incisal A-P position .
• Patient reached the age of bone maturity suitable for TADS ( 11 years
old ) , according to proffit .
• Indirect vs direct : indirect anchorage is used to stabilize anterior
segment to preserve position and inclination while closing coil spring
is run from a stabilized anterior segment to a hook soldered mesial to
the upper buccal segment .
59. Retention
• Upper and lower Hawley retainer
VFR ineffective to retain extrusion of teeth ( which is needed for this
patient ).
• Permenant retainer
Prolonged retention is needed because of reduced OB , labial canine
, to prevent late mandibular crowding in the lower arch .
60. Treatment details and mechanics
1. Full records
2. separators around 6’s
3. Band selection , Banding 7`s to increase posterior anchorage to retract lower
dentition
4. To aid derotation of upper molars :
• Position the band in an offset position so that rigid SS
wires can easily pass through the molar tubes , then
reposition the band to correct the axial inclination of
the molars gradually .
• Use molar band with convertible tubes allow sliding of
the non fully seated arch wire through the molar tubes
, this aid molar derotation
61. 4. Direct bonding of the brackets( upper Lower MBT) positioning the
bracket in middle facial third with good angulations and vertical
placement to help transmit true torque values .
5. invert UR2 bracket to reverse torque values
6. Swap lower canines brackets to reverse tip values .
7. Consider early lace backs and cinch backs in the lower arch to avoid
lower incisors proclination .
8. Normal wire sequence through aligment and leveling stage :
14 or 16 superelastic Niti , 16 steel with COS ,
62. Treatment details and mechanics
6. Sliding mechanics
• 19*25 SS wire left passive for a visit , check for it to swivel , start sliding mechanics in upper arch .
• Open space for UR2 via open coil spring , align UR2 via piggy back over main arch wire ,
• posterior bite raising while aligment of UR2
• Close residual space in upper arch via forward movement of posterior segments utilizing indirect anchorage .
• Stabilize anterior segment (3-3) to miniscrews inserted distally to upper canines .and run closing coil spring ( active
tieback ) to soldered hook mesial to (UR5-UR6) ,( UL5 –UL6) – to avoid upper rotroinclination.
• If UR2 needs more torque , apply 3rd order bend .
in lower arch , keep LR5 space via passive open coil spring throughout aligment and
levelling . open space for LR5 on passive S.S wire , then carry lower IPR , place round SS
wire in the lower arch with a power chain to preserve lower retro inclination .
7.Check for root parallelism on OPG
21*25 M NITI
63. 8.Finishing and detailing
TMA wire .021* .025
short class III elastics can be used to retrocline LLS and move UBS
mesially .
Settling by anterior elastics using upper light wires – to increase
incisal show .
12. Debonding
Impression for retainers
Short term: HR
Long term upper , lower permanent .0175 inch s.s wire