COVID-19 (PART -2)

Written by : Dr. Urusa I Inamdar

Using mask and sanitizer

  • Person not showing any symptoms :

A medical mask should not be used as it creates a false sense of security that can lead to neglecting other essential measures . Resort to other measures like – washing hands , cover your nose and mouth while sneezing , monitor your body temperature and oxygen levels .

  • So when should you use medical mask ( apart from medical health care workers ) :

When a person develops symptoms like cough or fever , while visiting a health care facility .

Taking care of an ill person .

If your family member is a suspected or confirmed case undergoing home care .

ENSURE PROPER FIT OF MASK
  • Washing your hands :

Washing your hands frequently is essential . Use soap and water for atleast 20 seconds for most effective results .

  • Sanitizing your hands :

Hand sanitizers are to be used , when hand wash was not possible . An alcohol based sanitizer with 70% alcohol content must be used for 20 seconds .

  • REFERENCES:
  1. Self notes
  2. World health organization
  3. Google.com
  4. ayush.gov.in
  5. IGOT ( Integrated Government Online Training )
  6. AIMS , New Delhi

COVID -19 (Part-1)

Written by : Dr. Urusa I Inamdar

Steps to control spread of Infection

  • Regularly and thoroughly clean your hands with an alcohol based hand rub or wash them with soap and water , specially after coming from outside . Avoid touching your eyes , nose and mouth .
  • Maintain atleast 4-6 feet distance between yourself and anyone who is coughing or sneezing . Avoid handshakes .
  • Follow a good respiratory hygiene . This means covering your mouth and nose with your bent elbow or tissue when you cough/ sneeze . Then dispose of the used tissue immediately .
  • Avoid or restrict unnecessary travel , participation in public gatherings . If you have fever , cough and difficulty in breathing , seek medical attention .
  • Practice social distancing . Keep a distance between you and other people so that you do not come in contact with their infected droplets . Avoid crowded places . Do not organize events where people have to get together . When people are at a crowded place , they touch objects , each other and may even exhale / inhale droplets .

Precautions and symptoms

Reference

  • Self notes
  • ayush.gov.in

NRT DRUGS

Written by : Dr. Urusa I Inamdar

Nicotine gum

Nicotine polacrilex .

  • Buccal absorption
  • 4 mg of nicotine ( India )
  • Two varieties in India : gutkha and mint flavour
  • Duration of treatment is 4-6 weeks ; start weaning after 2-3 months .
  • Brand name : nicorette , nulife , nicotex

Nicotine patch ( transdermal )

  • Ready absorption of nicotine across the skin .
  • 3 of the patches are for 24 hr use and one is for 16 hr ( waking ) use .
  • Starting doses are 21-22 mg/ 24 hr patch and 15 mg/ 16 hr patch .
  • The recommended total duration of treatment is usually 6-12 weeks .
  • Brand name : habitrol , nicodern – cq , nicotrol

Patient instruction for nicotine patch:

  • Do not smoke while using the patch .
  • Rotate the patch site to minimize skin irritation .
  • If insomnia occurs , remove patch before going to bed or use 16 hr patch .
  • Apply a new patch every day ( remove old patch ) in a location between the neck and waist that is relatively hairless and where the skin is not broken . Apply to a different location each day .

Nicotine nasal spray

  • 8-40 dosage per day .
  • Nasal irritation may occur .
  • Treatment time : 3-6 months .
  • Brand name : nicotrol nasal spray

Nicotine inhaler

  • 6-16 cartridges /day
  • Mouth and throat irritation may occur .
  • Treatment time : upto 6 months .
  • Brand name : nicotrol inhaler

References

  • Dental notes
  • Google.com

HYDROGEN PEROXIDE

Written by : Dr. Urusa I Inamdar

It is used as a whitening agent in dentistry . It is available in concentration between 5 and 35% .

It is classified into organic and inorganic .

They are strong oxidizers and can be considered as the products of hydrogen peroxide (H2O2) when hydrogen atoms are substituted with metals or with organic radicals .

Mechanism of action

H2O2 has a low molecular weight and hence can penetrate dentin and release oxygen that breaks down the double bond of inorganic and organic compounds inside the tubule .

Properties

  • Clear , colourless , odorless liquid , stored in lightproof amber bottles .
  • It is unstable and should be kept away from heat .
  • It should be stored in sealed refrigerated containers .
  • It has ischemic effect on skin and mucous membrane which causes burn . It is especially painful if it comes in contact with nail bed or the soft tissue under the fingernail .

About 1-2 ml amount is required for bleaching operation .

Discard the remaining solution , once treatment has been completed .

Hydrogen peroxide concentrations ranging from 3-7.5 % are used for home bleach .

It can be used alone or mixed with sodium perborate into a paste for use in the walking bleach technique .

Reference

  • Grossman’s Endodontic Practice
  • Google.com

INTERNAL RESORPTION

Written by : Dr. Urusa I Inamdar

Definition

Condition associated with either a physiologic or a pathologic process resulting in loss of dentin , cementum or bone .

An idiopathic , slow or fast progressive resorptive process occurring in the dentin of the pulp chamber or in the root canals of the teeth .

Cause

Cause is not known , but such patients have a history of trauma .

Symptoms

In root : it is asymptomatic

In crown : manifested as a reddish area called pink spot . This reddish area represents the granulation tissue showing through the resorbed area of the crown .

Diagnosis

Diagnosed during routine radiographic examination . The appearance of the pink spot occurs late in the resorptive process . The radiograph usually shows a change in the appearance of the wall in the root canal or pulp chamber , with a round or ovoid radiolucent area .

Treatment

Extirpation of the pulp .

Routine endodontic treatment is indicated , but obturation of the defect requires a special effort , preferably with a plasticized gutta – percha method . In many patients , the condition is unobserved as it is painless , until the root is perforated . In such cases , mineral trioxide aggregate (MTA) is recommended to repair the defect . When repair has been completed , the canal with its defect is obturated with plasticized gutta – percha .

Prognosis

The prognosis is best before perforation of the root or crown occurs .

Reference

  • Grossman’s Endodontic Practice (13th edition)
  • Dental notes
  • Google.com

KHOURY TECHNIQUE

Written by : Dr. Urusa I Inamdar

It is also called as split bone block technique / shell technique.

  • Mandibular bone blocks ( external oblique ridge ), which consists primarily of cortical bone and a low percentage of cancellous bone , are more resistant to revascularization and consequently may have poor regeneration potential . For this reason , the harvested thick bone blocks with the diamond disk according to the split bone block technique of the biologic concept of grafting procedures.
  • Splitting the thick blocks into two thin blocks not only increases the number of bone blocks , offering the possibility to graft more surfaces in different forms , but also improves revascularization and regeneration.
  • The thin blocks were stabilized at the recipient site with microscrews , and any gaps were filled with autogenous bone chips harvested from the donor site with a bone scraper .
  • No biomaterials or membranes are used .
  • This technique with pure autogenous bone , which has been used for 20 yrs , has shown a high success rate .

Reference:

  • International institute of dental research
  • Dental notes
  • Google.com

PARACETAMOL

Written by : Dr. Urusa I Inamdar

Introduction:

Paracetamol and acetaminophen are two official names of the same chemical compound derived from its chemical name : N-acetyl-para-aminophenol . It is an aniline derivative and the most extensively used over-the-counter and prescription analgesic worldwide . It has analgesic and anti-pyretic properties similar to non – steroidal antiinflammatory drugs (NSAIDS) but contrary to them , it does not possess any antiinflammatory properties .

Pharmacodynamics:

It acts mainly in the CNS by inhibiting cyclo oxygenase ( COX-2 ) . It acts by preventing the oxidation of inactive COX to active COX and thereby preventing prostaglandins synthesis through an active metabolite influencing cannabinoid receptors .

Pharmacokinetics:

It is rapidly absorbed from the gastrointestinal tract . The peak plasma concentrations are reached in about 2-3 hrs after rectal administration and reaches total serum concentrations of 5-20 micro g/ml . It is primarily metabolized in the liver by conjugation to gluconide and sulfate .

Indications:

  • Analgesic
  • Antipyretic

Contraindications:

  • Alcoholism
  • Hepatic disease
  • Viral hepatitis
  • Hypertension

Drug interactions:

Paracetamol interacts with enzyme inducing substances , such as isoniazid , carbamazepine , phenytoin or barbiturates , as well as chronic alcohol excess which increases N-acetyl-p-benzoquinone imine production and the risk of toxicity .

Adverse reactions:

  • Allegic dermatitis
  • Thrombocytopenia
  • Agranulocytosis
  • Hepatic necrosis

Dosage and administration:

As directed by the physician

Presentation:

Each suppository contains Paracetamol 125 mg

Reference:

  • CIMS – prescribers handbook
  • Kulkarni R et al. Indian J Pharmacol 2007
  • Cullen S et al Arch Dis Child
  • Roberts E et al. Ann Rheum Dis. 2016

ANTIBIOTIC GROUPS ( Part 2 )

Written by : Dr. Urusa I Inamdar

  1. Macrolides : inhibits bacterial protein synthesis by reversible binding to the 50s ribosomal subunit . Example : azithromycin, clarithromycin, erythromycin
  2. Monobactams : inhibit synthesis of peptidoglycan causing osmotic lysis , resistant to beta lactamases and active against gram negative rods. Example: aztreonam
  3. Nitrofurantoin : block aerobic energy production and synthesis of proteins , DNA ,RNA and cell walls . Example : nitrofurantoin
  4. Oxacephalosporins : bind to penicillin – binding proteins (PBP) of bacteria , inhibit bacterial cell wall peptidoglycan synthesis and activate bacterial cell wall autolytic enzymes. Example : flomoxef , latamoxef
  5. Oxazolidinones : cause faulty bacterial protein synthesis by binding to the 50s ribosomal subunit . Example : linezolid , tedizolid
  6. Penicillins : inhibit synthesis of peptidoglycan causing osmotic lysis . Example : Amoxicillin, ampicillin,dicloxacillin
  7. Penicillins with beta lactamase inhibitors : bind to penicillin binding proteins (PBP) of bacteria , inhibit bacterial cell wall peptidoglycan synthesis and activate bacterial cell wall autolytic enzymes. Example : Amoxicillin + clavulanic acid
  8. Quinolones : inhibit topoisomerases that are essential for bacterial DNA replication and transcription, inhibit DNA gyrase . Example : Ciprofloxacin, ofloxacin
  9. Sulfonamides : competitive inhibition of folic acid synthesis by acting as structural analogue of para-aminobenzoic acid (PABA) . Example : sulfabenzamide , sulfathiazole
  10. Tetracyclines : bind reversibly to receptors on the 30s subunit of the bacterial ribosome inhibiting protein synthesis. Example : minocycline , doxycycline
  11. Tyrocidins : alter cytoplasmic membrane causing cellular leakage . Example : bacitracin , tyrothricin

Reference:

  • Essentials of medical pharmacology – K D Tripathi
  • CIMS – prescribers handbook
  • Dental notes

ANTIBIOTIC GROUPS ( Part 1 )

Written by : Dr. Urusa I Inamdar

  1. Aminoglycosides : irreversible inhibition of protein synthesis by binding to receptors on the 30s subunit of bacterial ribosome. Example : amikacin , gentamicin , kanamycin
  2. Carbacephems : inhibit synthesis of peptidoglycan causing osmotic lysis. Example : loracarbef
  3. Cephalosporin : bind to penicillin – binding proteins (PBP) of bacteria , inhibit bacterial cell wall peptidoglycan synthesis and activate bacterial cell wall autolytic enzymes. Example : cefaclor , cefadroxil , cefalexin , cefazolin , cefepine
  4. Cephalosporins with Beta lactamase inhibitors : bind to penicillin – binding proteins (PBP) of bacteria , inhibit bacterial cell wall synthesis. Example : cefoperazone + sulbactam , cefuroxime + clavulanic acid
  5. Chloramphenicol : bind reversibly to a receptor site on the 50s subunit of bacterial ribosome . Example : chloramphenicol
  6. Cyclic Lipopeptides : bind to bacterial membranes and cause a rapid depolarisation of membrane potential . Hence , inhibit the protein , DNA and RNA synthesis which result in bacterial cell death . Example : daptomycin
  7. Diaminopyridines : inhibits dihydrofolic acid reductase of bacteria and blocks metabolic sequences in DNA synthesis . Example : trimethoprim
  8. Glycopeptides : prevent further elongation and cross linking of bacterial peptidoglycan synthesis , active against gram positive bacteria including methicillin-resistant Staphylococci. Example : oritavancin
  9. Glycylcyclines : bind reversibly to receptors on the 30s subunit of the bacterial ribosome inhibiting protein synthesis . Example : tigecycline
  10. Ketolides : inhibits bacterial protein synthesis by reversible binding to the 50s ribosomal subunit. Example : telithromycin
  11. Lincosamides : inhibit protein synthesis by interfering w/ initiation complexes and translocation reactions on the bacterial 50s subunit . Example : clindamycin , lincomycin
  12. Macrocyclic antibiotics : inhibit bacterial protein synthesis by inhibiting RNA polymerase sigma subunit. Example : fidaxomicin

References

  • Essentials of medical pharmacology – K D Tripathi
  • CIMS – prescribers handbook
  • Dental notes

POTENTIAL DIAGNOSTIC CLUES TO CAUSES OF ACUTE LOCALISED INFECTIONS

Written by : Dr. Urusa I Inamdar

  • ENT
  1. Tonsillar enlargement
  2. Exudate sinus tenderness
  3. Ear discharge
  4. Appearance of drum , mastoid tenderness
  • Cardiovascular
  1. New or changing murmur
  2. Peripheral signs of endocarditis
  • Hepatobiliary
  1. Tender hepatomegaly
  2. Murphy’s sign

https://youtu.be/2T0XUQ1M-x0

  • Genitourinary
  1. Suprapubic tenderness
  2. Renal angle tenderness
  3. Vaginal discharge
  4. Cervical motion tenderness
  • Skeletal
  1. Localised bone tenderness
  2. Mono arthritis
  • Dental
  1. Periapical swelling and tenderness
  • Respiratory
  1. Crackles
  2. Bronchial breath sounds
  3. Egophony
  4. Pleural effusion (unilateral)
  • Abdomen
  1. Tenderness in a specific quadrant
  2. Tender lump
  3. Guarding , rigidity
  • Skin and soft tissue
  1. Cellulitis
  2. Necrotising fascitis
  3. Discoloration
  4. Bullae , crepitance
Cellulitis of skin
Necrotising Infection
Bullous skin
  • Lymph nodes
  1. Lymphadenopathy in a single region.

Reference

  • Dental notes
  • Gsk – webevent console
  • YouTube.com
  • Google search