نتقدم بخالص العزاء والمواساة لزميلتنا / زهراء عبدالحكيم الشعيبي في وفاة المغفور لها بإذن الله أختها 💔
سألين من الله عز وجل ان يرحمها ويغفر لها ويسكنها في اعلى مراتب الفردوس الاعلى مع الصديقين والشهداء
وان يلهم اهل وذويها الصبر والسلوان و يثبتهم ويعصم قلوبهم بهذا المصاب الجلل
وإنا لله وإنا إليه راجعون 😭💔

Bradykinin is converted into inactive metabolites by
#Angiotensin_converting_enzyme
therfore ACE-Is :
#Angiotensin_converting_enzyme_inhibitors
(Captopril, Ramipril, Enalapril , Moxeipril...etc)
lead to accumulation of bradykinin ----> Irritation of cough receptors----> Dry Cough
------------------------------------------------------------------------
N.B :
In case of intolerance to ACE-Is due to dry cough, the good alternative vasodilators are
#Angiotensin_receptors_blockers(ARBs) (Candesartan, Olmesartan, Valsartan....etc)
__________________________________

#فارما

إذا جالك مريض بياخد
Theophylline (or Aminophylline)
ممنوع تديه أي Antibiotic من الخمسة هذي
Erythromycin , Clarithromycin , Ciprofloxacin Pefloxacin and Rifampicin.
-------------------------------------------------------------------------
لإن ببساطه ال
Theophylline ------------> Narrow theraputic index
يعني الفرق
بين ال Therapeutic dose وال Toxic dose صغير جدا واحنا عارفين إن ال
🍃Erythromycin
🍃Clarithromycin
🍃Ciprofloxacin
🍃Pefloxacin

are Enzyme Inhibitors (CYP 1A2 & CYP 3A4)

N.B
🍂Rifampicin
is enzyme inducer Not inhibitor
-------------------------------------------------------------------------
وبالتالي إذا استخدمت أي واحد من أول_أربعة هيقلل
Clearance of Theophylline
وبالتالي يزيد مستواه ف البلازما ومن هنا تبدأ تظهر ال
Serious_side_effects
e.g : Tachycardia, Tremors , Convulsions , Cardiac arrest , Respiratory failure...etc

أما إذا استخدمت Rifampicin ده مش هيظهر ال
Side effects
لكنه هيقلل ال Effect بتاعة ال Theophylline
------------------------------------------------------------------------
إذاً بإختصار
ال Antibiotics الممنوعين من عيلة ال Quniolones
" Ciprofloxacin and Pefloxacin "
لكن تقدر تستخدم
Levofloxacin, Moxifloxacin ,Gemifloxacin.....etc
------------------------------------------------------------------------
وال Antibiotics الممنوعين من عيلة ال Macrolides
" Erythromycin and Clarithromycin "
لكن تقدر تستخدم
Azithromycin
---------------------------------------------------------------

#فارما

السلام عليكم 🍀🍀

تعديل في ملخص ال Anti cancer
صفحة 12
Small separated dose ❎

Small pulsatile dose ✅
____________________________
🛑للتوضيح :
في ملخص ال DM صفحة 60
الدكتور قال إنه مريض الديابتس لما يكون عنده سكر الدم أقل من خمسة وأربعين بيكون في حالة كوما لذلك نعطيه خمسة وسبعين مل من.
""(dextrose 20%)"" هذا اسمه...
وإنه متوفر في أمبولات كل أمبول يحوي عشرين مل ،،،،،، وقال إنه مش شرط نعطيه الكمية كامل يعني مش شرط نعطيه الخمسة والسبعين مل كامل . قال ممكن نعطيه أمبولتين ونص وهكذا....

فلو اعطيناه الكمية كامل بتكون أربع إلا ربع (3.75) أمبول
____________________________
وايضا ملخص ال DM صفحة 64
Osmolality of blood
>320 mmol/l ❎
>320 mOsm/l ✅
________________________

🛑بالنسبة للإضافات من ملخص العام الماضي :
في قسم ال infectious diseases
في اختلافات في الأدوية وغيره... لذلك لم تضاف
وبقسم ال
Anti cancer & female diseases in endocrine
في مواضيع كثيرة درسوها العام الماضي واحنا ما درسناه وخصوصا في الكانسر و سألنا الدكتور أكثر من مرة بخصوصها و قال عليكم بما درستم......
_____________________

#فارما
#اللجنة_العلمية

Mucinous & serous tumors of the ovary

🐾🐾Several vertically transmitted infections are included in the (TORCH) complex, which stands for:

T – Toxoplasmosis / Toxoplasma gondii.
O – Other infections (see below)
R – Rubella
C – Cytomegalovirus
H – Herpes simplex virus-2 or neonatal herpes simplex

"Other infections" include:

Parvovirus B19
Coxsackievirus
Chickenpox (caused by varicella zoster virus)
Chlamydia
HIV

#فيروسات
#مايكرو

Owl's eye appearance of inclusion bodies, which is highly specific for cytomegalovirus infection

#فيروسات

🌸 One of the herpsviridae characters is Latency ;

🌸Virus latency is the ability of a pathogenic virus to lie dormant within a cell.

Until There is an endogenous Reactavation like Stress , ..etc
... it Shows secondary infection

Where it remains Dormant ?!

✨ HSV-1 :- Trigminal Ganglia ( OroFacial)
✨ HSV - 2 :- Sacral Ganglia ( Urogenital)
✨VSV :- Dorsal roat Ganglia
✨ EBV :- B- cells ( 3Bs)
✨ CMV :- Leukocytes and kidney ( organ Transplant )
✨ HHV-6 / HHV-7 :- T Lymphocytes
✨ HHV -8 :- Endothelial cells ( Kaposi's Sarcoma )

#فيروسات
#مايكرو

⭐️ DNA viruses Characters:-

( ALL , Except )

1- All DNA viuses are( Double stranded) DNA except : ❗️Parvovirus B19 ; (single stranded )

2- All DNA viruses are (linear )except ❗️Papovavirus ;( Circular)

3- All DNA viuses are ( Ichosahedral ) except ❗️ Poxviruses ; ( Complex: Brick shaped)

4- All DNA viruses or All Viruses is small and seem by( Electron microscope) except ❗️ Poxviruses is large ,seen by ( light Microscope)

5- All DNA viruses replicate innside the nucleus and therefore, Have ( intranuclear ) Inclusion Bodies Except; ❗️Poxviruses ; replicate in the cytoplasm because it has its own Transcriptase [ DNA dependent RNA polymerase] and therefore has ( Intracytoplasmic ) Inclusion Bodies.

6- All DNA viruses are (Enveloped) except ❗️ Adenoviruses , Papovaviruses , Parvovirus b19 are ( Naked)..

7- HSV-2 is transmitted vertically during labour through the Birth canal not transplacentally .. can by Avoided by Cesarean ..

🛑Note:- Poxviruses have 3 Exceptions

#فيروسات
#مايكرو

💊 Summary of DNA viruses Treatment:-

🌺 Herpsviridae:-

1- HSV-1 :- Acyclovir, avoid Steroids

2- HSV-2 :- Acyclovir , if Pregnant ( cesarean section)

2- VZV :-
a) Acyclovir or Valacyclovir or New version ( Fscavir ) .. Foscarnet ( doesn't require Kinase) .
b) calamine lotion
c) Antihistamine
d) Antibiotics for secondary infection
e) Avoid [ Aspirin ] , Cut nails

3) EBV : ❗️ No treatment

4) CMV :- Ganciclovir

🌺 Poxviruses: eridicated : No treatment

🌺 Adenoviruses: No treatment

🌺 Papovavirus:-
1- For skin Warts ( Verruca Vuligaris ) :- liquid Nitrogen
2- Electrocautery
3- Podophyllin , Trichloroacetic Acid ,Bichloroacetic Acid

🌺 Parvovirus B19:- transfusion of packd red Blood cells

#فيروسات
#مايكرو

🌼Diseases caused by DNA viruses :-

🌼 Herpsviridae:-

1- HSV-1 :- ( OroFacial)
💥 1- Herps Labialis
💥 2- Keratoconjunctivitis >> dendritic ulcer >> Bindness
💥 3- Gingivostomatitis
💥4- Herpetic Whitlow on Finger
💥 5- complication : Ecephalitis , Aseptic meningitis

2- HSV-2 :- ( Urogenital)
💥1- Genital Herps
💥2- Neonatal herps through Birth canal
💥3- Cervical cancer


3- VZV:-
💥1- Primary infection:- Vericella ( Chickenpox) generalized rash

💥2- Reactivated infection: Zoster or Shingles ( A belt roses from hell )

4- EBV
💥1- most cases Subclinical
💥2- infectioue Mononucleosis ( Glandular fever ) making B- cell immortal producing Hetrophill antibodies , lymphosytosis with Atypical lymphocytes
💥 Infectious mononucleosis:- may cause Hepatitis ( Viral Hepatitis)
💥 3- Oral hairy Leukoplakia in AIDS patients
💥4- Burkitt's Lymphoma in Negroes
💥5- Nasopharyngeal carcinoma

5- CMV :-
💥1- in normal host :-
a) Asymptomatic, latent
b) Infectious mononucleosis like syndrome including Hepatitis
c) Restenosis of Coronary angioplasty

💥2- In immunecompramised
a ) Retinitis ( Blindness)
b) Pnemonia

💥3- Congenital infection :-
<24 w Abortion
> 24 w Stll birth
* Cytomegalic Inclusion Disese :-
a) Blindness
b) Diffness
c) Mental retardation
d) Hepato- spleenomegaly


6- HHV- 6 :-
💥 Roseola Infantum ( Subitem) >> Sixth disease of Exanthematic Diseses
[ Rose Rash ]

7- HHV-7 :-
💥Roseola Infantum like

8- HHV-8 :-
💥 Kaposi's Sarcoma in patients with AIDS .. ( Endothelial cell tumor )
Multiple vascular nodules

🌼 Poxviruses:-

☄1- Orthopoxvirus :- eridicated
💥a) Smallpox ( variola ) virus
💥b ) cowpox
💥c) vaccine virus

☄ molluscum contagiosm :-
Human soft Warts ( Benign skin nodules) >> Umblicated Papules

🌼 Adenoviruses:-
more than 50 antigenic type
Effects epithelial cells :-

☄1- upper respiratory tract + Eye :-

💥 a) Febrile respiratory disease (4,7,14,21) :
Rhinitis , pharyngitis, bronciolitis , croup [ larynx , trachea ,Bronchi) >military recruits

💥b) pharyngeo- conjunctival fever (3,7) > Swimming pool

💥 Keratoconjunctivitis ( second +HSV-1)

☄ GIT :-
💥Gastroenteritis ( 40,41 )
Diarrhea, vomiting, fever >> infantile Gastroenteritis > Intussusception

☄ UT :- ( 11,21)
💥 Heamorrhagic Cystitis
Dysuria , Frequency, Heamaturia

☄immunecompramised:-
💥Fetal Pnemonia, Gastroenteritis

🌼 Papovavirus:-

☄pa :- Papilloma >> rapid growth of cells ( Warts )

💥1) Skin warts .. ( Verruca Vuligaris)
1,2,3,4,10
💥 2) Genital warts ... ( Condyloma accuminta )
6,11,18,33
💥3 ) Cervical carcinoma ( 16,18) 6,11

☄ po : polyoma
💥1) JC : John Cunningham
Heamorrhagic Cystitis, Nephropathy

💥2) Bk : Brennan Korhn
Progressive multifocal Luekoencephalopathy

🌼 Parvovirus B19 :-
1- slapped Cheek appearance ..fifth Exanthematic Diseses
2- Arthritis
Due to deposition of Immune complexes
3- Transient Aplastic crisis in patients with severe Anemia ( ex :sickle cell anemia)
4- Hydrops fetalis

#فيروسات
#مايكرو

🛑 Note :

❗️DNA viruses may be Oncogenic

🛑Cervical cancer may be due to :-
1- HSV-2
2- HPV ( 16,18,6,11 )

🛑 Keratoconjunctivitis:-
By :-
1- HSV-1
2- Adenoviruses

#فيروسات
#مايكرو

📛 Exanthematic Diseses: 6

( MS.VRPR)

1- M : measles by Rubeloa virus
2-S : scarlet fever by erythrogenic toxins of Streptococcus pyogens
3-V: Vericella by VSV
4- R: rubella
5- P: Parvovirus b19 , slapped Cheek appearance ( fifth disease)
6-R: Roseola Infantum ( Sixth disease) by HHV-6/7

#فيروسات
#مايكرو

💉 Summary of DNA viruses prevention :-

🌺 Herpsviridae:-

1- HSV-1 :-
a) Avoid contact with herpetic lesions
b) Avoid kissing
c) hand washes
d) personal purposes

2- HSV-2 :-
a) Avoid Adultery
b) Cesarean section for new born

2- VZV :- ( Active / Passive immunization)
🍃a) Active:-
❗️For Vericella: 1995 children
Varivax >> Live attenuated >> 2Doses

❗️ For Zoster : old age
a) Zostavax (2006 ) >> live attenuated >> single ... over 60y
b) Shingrix ( 2017 ) >> recombinant

🍃 Passive:-
( VZIG )
Immunoglobulin for Immunocompromized , mother before delivery , neonatel


3) EBV :
a) Avoid kissing
b) vaccine under trail

4) CMV :-
a) blood transfusion free of CMV
b) Donor and recipient of organ Transplant free of CMV
c) vaccine under trial
2018 positive phase1

🌺 Poxviruses : no vaccine

🌺 Adenoviruses:
a) Avoid overcrowded
b) hand washing
C) chorination of Swimming pool
d) vaccne type 3,4&7 which was ceased ( Stopped ) 1999

🌺 Papovavirus:-
1- human Papilloma virus prevention:
a) Quadrivalent (6,11,16,18 ) for female ( 0 , 2 & 6 months )
b) Bivalent ( Cervarix) for Type 16,18 ( Recombinant)

🌺 Parvovirus B19:-
a) Screening of Blood transfusion for patients with chronic anemia , AIDS , anemic pregnant women
b) Vaccine ( 0 ,1 &6 ) recombinant

#فيروسات
#مايكرو

🛑 Note for the DNA viruses we have vaccines for 4 Viruses only :-

1- VZV
2- Adenoviruses ( Stopped )
3- human Papilloma virus
4- Parvovirus


And for EBV ,CMV :- Vaccines under trail

#فيروسات
#مايكرو

🙂🙂🙂
For
HSV-1
HSV-2
VZV
Direct virus demonstration:
By scrapping the ulcer of from Vesicular fluids
Under light microscope:-
Tzanck smear
Shows ( Multinucleated Gaint cells )
Stained by Geimsa stain

#فيروسات
#مايكرو

Most commonly:

Laboratory diagnosis methods used :-

1) PCR
2) Viral atigens by DIF

#فيروسات
#مايكرو

🤕 common skin rashes :-

1- macule : small ,flat
2- papule : small ,raised ( solid)
Maculopapule Both^
3- vesicle : small , elevated ( with clear fluid)
4- pastule : vesicle filled with pus
5- Nodule: large , raised, Solid


🤕 Differences between Droplets / Airborne :-

Droplets : Large >5 microns
Surface contamination
Removed by hand wash

Airborne:- smaller ( Droplet nuclei )
<5 microns
Still in the air ( more dangerous)

#فيروسات
#مايكرو

🤔For EBV :

Anti - VCA IgM / IgG :- Anti viral capsid

IgM :- Acute infection then disappears
IgG ; may be Occurs in Acute infection, remains in convalescent


anti-EBNA IgG ( EB nuclear antigen)
Only occur in convalescent and indicates previous infection

#فيروسات
#مايكرو

🛑 Lymphocytosis is suspected lymphoma utill proven otherwise ..

🛑 Lymphocytosis with Atypical T lymphocytes ..." feel safe "
It is infectioue Mononucleosis

🛑 to Differentiate between infectioue Mononucleosis, and Infectious mononucleosis like syndrome

Infectious mononucleosis, With heterophills Antibodys in EBV

Infectious mononucleosis like, without Hetrophills antibodies in CMV

Both shows symptoms of:
Sore throat, fever , fatigue, lymphadenopathy , enlarged spleen , Hepatitis

#فيروسات
#مايكرو