Surgical notes
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🌺 Management of HbA1c levels :-

Patients should then be offered lifestyle advice ( Diet - sport )and drug treatment to support them to achieve and maintain their target HbA1c.

Haemoglobin A1c (HbA1c) testing to diagnose diabetes

An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. 

A value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests.

If HbA1c levels are not controlled with a single drug and rise to 58mmol/mol (7.5%) or more, healthcare professionals should reinforce advice about diet, lifestyle and drug adherence and intensify drug treatment with the aim of reducing HbA1c to 48mmol/mol (6.5%)

في هذي الحالة اذا زاد عن ( 7.5%) يعطوه انسولين

HbA1c levels should be monitored at three- to six-monthly intervals until levels are stable on unchanging therapy.

الدكتور عدنان
#فارما
🌺Drug treatment :

The revised guidance states that all patients with type II diabetes should be offered standard -release 💊metformin as initial treatment, with a gradual increase in dose over several weeks to minimise the risk of gastrointestinal side-effects. If gastrointestinal intolerance occurs, prescribers should consider a trial of modified-release metformin as an alternative.

If metformin is contraindicated or not tolerated, patients may begin drug treatment with :

💊sulfonylurea ( glibenclamide ,glyburide, Diabinese)

قال هذا في حال طلع ال HbA1c اكثر من ( 6.5%) بس ما وصلش لل ( 7.5%)

💊Thiazolidinedione : pioglitazone 

💊( Gliptins ) :DPP-4 inhibitor class include sitagliptin, saxagliptin, linagliptin, and alogliptin .

الاثنين الاخيرين يستخدموا في حال حصل Hypoglycemia مع ال metformin ..

الدكتور عدنان ^^
#فارما
🌹🌹Women suffering from polycystic ovary syndrome have been treated with 💊metformin💊
Benefits include:
lipid lowering effects, reduction in systolic blood pressure, hyperinsulinemia and insulin resistance syndrome . Metformin has also been shown to aid in normal menstrual regulation and pregnancy.

#فارما
🍃Polycystic ovary syndrome (PCOS):

is a condition that affects a woman's hormone levels.

Women with PCOS produce higher-than-normal amounts of male hormones. 
The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

🍃Signs and symptoms :

- irregular periods
-Excess androgen : Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.

🍃 Causes : the main cause is not known . Factors might play rule include:

- hereditary
- Excess androgen
- PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens.
- Excess insulin might increase androgen production, causing difficulty with ovulation.

🍃Complications:

-Infertility

-Gestational diabetes or pregnancy-induced high blood pressure

-Miscarriage or premature birth

-Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver

-Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular diseaseType 2 diabetes or prediabetes

-Sleep apnea

-Depression, anxiety and eating disorders

-Abnormal uterine bleeding

-Cancer of the uterine lining (endometrial cancer)

🍃 Treatment:

Lifestyle changes: weight lose - exercise - limit carbohydrates

Medication: follows

يمكن #باثو. .. يمكن #فارما
💊Medication for Polycystic ovary syndrome ( PCOS)💊 :

عتكون ثلاث حاجات :
✏️To regulate menstrual cycle:

📝Compained contraceptives :
can lower risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne

📝 Progestin therapy :

regulate periods and protect against endometrial cancer. 


✏️To help ovulation :

📝Clomiphene (Clomid) .This oral anti-estrogen medication is taken during the first part menstrual cycle.

📝Metformin (Glucophage) : هذا اللي جابنا لهذا الموضوع :

🔴🔴Metformin can enhance ovulation and regulate menstrual cycles
Metformin may even improve cholesterol and hirsutism symptoms like acne and excess hair growth.

📝Letrozole : This breast cancer treatment can work to stimulate the ovaries.

📝Gonadotropins . These hormone medications are given by injection


✏️ To reduce excessive hair growth and acne :

📝 Contraceptives as been said ^

📝 Spironolactone (Aldactone) : This medication blocks the effects of androgen on the skin.
Spironolactone can cause birth defect >> contraindicated with pregnancy or planning for ..

📝 Metformin. ^^

#فارما
للتذكير :


💊💊Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low . Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalemia (low potassium levels in the blood)

💊Spironolactone is a moderate antiandrogen. That is, it is an antagonist of the androgen receptor (AR),
#فارما
#الأنزيمات_البكتيرية :-
تعتبر الأنزيمات عوامل حدة تفرزها بعض البكتيريا فتساعد على إنتشارها في الجسم والتسبب بالمرض، ومنها...

1-الكولاجينيز Collagenase
يحطم ألياف الكولاجين ويعزز من إنتشار العدوى
(Cl. perfringens).

2-الليسيثنيز Lecithinase يحطم الليسيثين، المكون الأساسي لغشاء البكتيريا
(Cl. perfringens).

3-الكوأقيليز Coagulase يكون جدار من ألياف الفيبرين حول مكان الإصابة يحمي الميكروب من عملية البلعمة.
(S. aureus).

4-الفيبرينولايسين Fibrinolysin أو الستربتوكينيز Streptokinase يحلل خيوط الفيبرين للمساعدة في إنتشار البكتيريابعد تحسن الظروف.
( S. pyogenes).

5-الهيالورونيديز Hyaluronidase يحلل حمض الهيالورونيك الرابط للأنسجة فيساعد في إنتشار البكتيريا
(Clostrdia,Streptococci).

6-الستربتودورنيز Streptodornase أو الديوكسي ريبونيكلييز Deoxyribonuclease يحطم DNA المتجمع في القيح Pus فيساعد على إنتشار البكتيريا.
(S. pyogenes).

7-البروتييز Protease أو الأمينوجلوبيلين أ Aminoglobulin A يحطم الجسم المضاد IgA المفرز من الأسطح المخاطية فيزيل تأثيره المضاد للبكتيريا.
(N. gonorrhoea).

#بكتيريا
#مايكرو
#respiratory_patho

Summary about pathology leacture

Bronchiectasis:abnormal..permanent..dilation of bronchi

😃asossciated with🦠suppurative inflammation+necrotic change


😁Causes:bronchial obstruction-acute infection-cystic fibrosis

📛affect lower lobes of lung (bilateral).
#باثو
#respiratory

♦️Pulmonary edema:
accumulation of fluid in alveolar space


♦️Cause by 3 maim mechanism:
1-increase hydrostatic p due to LHF
2- decrease the osmotic p due to liver cirrhosis
3-increase alveolar capillary permeability

♦️pathological features :
Cross..heavy ..bullky ..wet
Histologically ..dilated alveoli filled with fluid...congested alveolar capillary...Heart failure cells
#باثو
#Endocrine

💊Octerotide:somatostain derivetive
*Uses for
1-carcinode tumor 🦠
2-gaintism
3-acromegaly
4-esophageal bleeding
5-glucagonoma & VIPoma
#فارما
#Endocrine
#pituitary

💊ADH: Vasopressin
1-Desmopressin: act in V2 R
*uses:
1- primary D inspidues
2- hemophilia A
3-von Willebrand disease

S.E:hypontremia+water toxicity

2-Terlypressin:
Act in V1 R

*uses:
1-esophegeal bleeding
2- management of low blood pressure when norepinephrine does not help

S.E:hypertension

#فارما
#Endocrine
#calcium_effecting_hormones

♦️clinical features of hypercalcemia:
Bones,stones ..abdominal groans ,moans
.
Treatment:
💊N . S
💊bisphonate as pamidronate
💊calcitonine
💊furosemide

#فارما
#Endocrine
#calcium_effecting_hormones

♦️Clinical uses of calcitonine:
1-Hypercalceuria
2-osteoprosis
3-pagets disease
#فارما
#Endocrine

💊Bromocriptin :

Is dopamine agonist

Uses: acromegaly
Stoping the Lactation 👼

S.E: nausea🤢
Vomiting🤮

#فارما
#Endocrine
#calcium_effecting_hormones

💊Sn...(strotium ranolat)
Uses in osteoprosis

S.E:bone pain
#فارما
#Endocrine

♦️GH:

Has short time side effect is D.M

Long time side effect is acromegaly

#فارما
#Endocrine
#calcium_effecting_hormones

♦️idiopathic hypercalciuria..hypocalcemia is treatment by Thiazide diuretics

♦️familial hyperclacemia hpocalciuria (FHH)
No has treatment

#فارما
🦠Important Pseudomonas aeruginosa infection:
يمكن جمعها بكلمه BE PSEUDO
1-Burns
2- Endocarditis
3-Pneumonia
4-Sepsis
5-External malignant otitis media
6-UTI
7-Diabetic Osteomyelitis

#بكتيريا
#مايكرو
#GIT
#oral_cavity

📛 Leukoplakia:whitish-thicking-mucosal patches ,caused by hperkeratosis & parakeratosis ,and can,t be scarped off.

📛 Association with chronic irritation .
📛 Asually represented:
1-displasia
2-carcinoma in situ

#باثو