Good defense

1. Upper respiratory tract

1.1. Consist of

1.1.1. Nostril

1.1.2. Nasal cavity

1.1.3. Mouth

1.1.4. Throat ( pharynx)

1.1.5. Voice box ( larynx)

1.2. Common microbiota

1.2.1. Gram +ve bacteria

1.2.1.1. Staphylococcus spp.

1.2.1.2. Corynebacterium spp.

1.2.1.3. Streptococcus spp.

1.2.2. Gram -ve bacteria

1.2.2.1. Haemophilus spp.

1.2.2.2. Moraxella spp.

1.3. Common infections

1.3.1. Nasopharyngitis (common cold)

1.3.2. Laryngotracheitis

1.4. Bacteroides spp.

2. Lower respiratory tract

2.1. Consist of

2.1.1. Windpipe ( trachea)

2.1.2. Lung

2.2. Common infections

2.2.1. Tracheitis

2.2.2. Bronchitis

2.2.3. Pneumonia

2.2.4. Lung abscesses

3. CAM

3.1. Abbreviation of Complementary and alternative medicine

3.2. Describes therapies that have typically not been part of conventional western medicine

3.3. Complementary Vs Alternative

3.3.1. Complementary

3.3.1.1. If a non-mainstream practice is used together with conventional medicine

3.3.2. Alternative

3.3.2.1. If a non-mainstream practice is used in place of conventional medicine

3.4. CAM can be divided into

3.4.1. Natural products

3.4.1.1. Dietary supplements

3.4.1.2. Herbal remedies

3.4.2. Mind and body practices

3.4.2.1. Meditation

3.4.2.2. Prayer

3.4.2.3. Art therapies

3.4.2.4. Osteopathic manipulation

3.4.2.5. Massage

3.4.2.6. Energy therapies

3.5. Other complementary health approaches

3.5.1. Ancient healing systems

3.5.1.1. Ex: Ayurveda

3.5.2. Homeopathy

3.5.2.1. Small doses of a drug that stimulate the body defense

3.5.3. Naturopathy

3.5.3.1. Noninvasive treatments that help body self- healing

3.6. Why are some doctors hesitant about CAM ?

3.6.1. Healthcare providers are not trained to use CAM

3.6.2. Not well studied

3.6.3. Some CAM practitioners make exaggerated claims about curing diseases

3.6.4. CAM practitioners may ask patients to forgo treatment from their conventional doctor

3.7. Cultural competence skills

3.7.1. It is the ability of the doctor to ask about various patients' beliefs and incorporate new awareness into diagnosis and treatment planning

3.7.2. It aims in building trust between the doctor and the patient relationship

4. Vaccines

4.1. Types

4.1.1. Live attenuated

4.1.2. Inactivated (killed)

4.1.3. Toxoids

4.1.4. Conjugated

4.1.5. Subunit

4.2. Routes of administration

4.2.1. SC

4.2.1.1. Measles

4.2.1.2. Yellow fever

4.2.2. ID

4.2.2.1. BCG

4.2.3. IM

4.2.3.1. D TwP, DTap, DT , Td, TT

4.2.3.2. Hepatitis B

4.2.3.3. IPV

4.2.3.4. Hib

4.2.3.5. PCV-7

4.2.4. Oral

4.2.4.1. OPV

4.2.4.2. Rotavirus

4.2.5. Intranasal

4.3. Contraindications

4.3.1. Live vaccines

4.3.1.1. Immunocompromised patients

4.3.1.2. Malignancy

4.3.1.3. Pregnancy

4.3.2. Toxoids

4.3.2.1. Encephalopathy

4.3.3. Haptitis B

4.3.3.1. Allergy to baker's yeast

4.3.4. HPV

4.3.4.1. Pregnancy

4.3.4.2. Allergy to yeast

4.3.5. MMR , Zoster & Varciella

4.3.5.1. Pregnancy

4.3.5.2. Immunodeficiency

4.3.5.3. Allergy to gelatin or neomycin

4.3.5.4. Untreated active tuberculosis ( only for varicella)

4.4. Complications

4.4.1. Injection site reactions

4.4.1.1. Pain

4.4.1.2. Swelling

4.4.1.3. Erythema

4.4.2. Retrovirus vaccine ( oral)

4.4.2.1. Mild diarrhea

4.4.2.2. Vomiting

4.4.3. Varicella & Zoster vaccines

4.4.3.1. Skin rash

4.4.4. Hepatitis A & B , human papilloma virus and meningococcal vaccine

4.4.4.1. Guillain - Barre syndrome ( GBS)

4.4.4.2. Autoimmune destruction of myelin sheath surrounding peripheral nerves

5. Relative risk reduction

5.1. Proportion of risk reduction attributable to the intervention as compared to a control

5.2. Formula

5.2.1. RRR= (risk in controls - risk in treatment group) /risk in controls

5.2.2. Or

5.2.2.1. RRR= (1-RR )* 100 where RR= risk in exposed / risk in unexposed

6. Antibodies

6.1. Structure

6.1.1. Consist of 4 polypeptides

6.1.1.1. 2 heavy chains

6.1.1.2. 2 light chain

6.1.2. Variable region

6.1.2.1. Antigen binding site

6.1.2.2. Composed of 110 to 130 AA

6.1.3. Constant region

6.1.3.1. Differ from one class to the other

6.2. Classes of antibodies

6.2.1. IgG

6.2.1.1. Gamma H.chain

6.2.1.2. Most common

6.2.1.3. Found in serum

6.2.1.4. Categorized into 4 subclasses ranging from 1-4

6.2.1.5. Responsible for resistance against many kinds of viruses, bacteria and bacterial toxins

6.2.1.6. Crosses the placenta

6.2.1.7. Half life in serum around 23 days

6.2.2. IgM

6.2.2.1. Mu H. chain

6.2.2.2. First antibody type secreted after an an antigen arrives

6.2.2.3. Protects against blood-born pathogens

6.2.2.4. Binds complement

6.2.2.5. Have half life around 2-3 days

6.2.2.6. First Ig synthesized by the infants

6.2.3. IgD

6.2.3.1. Delta H. chain

6.2.3.2. Located on the surface of B cells

6.2.3.3. Monomer antibody

6.2.3.4. Mostly found as a part of B lymphocytes

6.2.3.5. Have immuno- regulatory function

6.2.4. IgA

6.2.4.1. Alpha H.chain

6.2.4.2. Found in serum and body secretions

6.2.4.3. Transported across the epithelium via transcytosis

6.2.4.4. Exists as a dimmer in the body secretions

6.2.4.5. Provides a protective coat for the mucous surface against microbial colonization and adherence

6.2.4.6. Transfer via breast milk

6.2.5. IgE

6.2.5.1. Epsilon H.chain

6.2.5.2. Monomer

6.2.5.3. Short half life of 2 days

6.2.5.4. Present respiratory & intestinal epithelia

6.2.5.5. Bind to mast cells

6.2.5.5.1. Release histamine

6.2.5.6. Plays a role in parasitic helminthic infections

7. Whooping cough

7.1. Features of bordetella pertussis

7.1.1. Gram negative coccobacillus

7.1.2. Strict aerobe

7.1.3. Highly infectious

7.1.4. Human pathogen of ciliated respiratory epithelium

7.1.5. Transmitted by respiratory droplets from infected individuals

7.1.6. Occurs in primarily previously vaccinated individuals whose immunity has waned or unvaccinated ones

7.1.7. The most severe disease occurs in unvaccinated infants

7.2. Pathogenesis

7.2.1. Attachment

7.2.1.1. Pertactin and filamentous hemagglutinin

7.2.2. Tracheal cytotoxins

7.2.2.1. Mucus accumulation

7.2.3. Pertussis toxins and adenylate cyclades toxin

7.2.3.1. Inhibit early function of neutrophils & macrophages

7.2.4. Vasodilation

7.2.4.1. Narrowing air path

7.2.5. Pertussis toxins

7.2.5.1. Increase lymphocytosis

7.3. Complications

7.3.1. Pressure related from paroxysms

7.3.1.1. Subconjunctival hemorrhage

7.3.1.2. Rectal prolapse

7.3.1.3. Hernia

7.3.1.4. Epistaxis

7.3.2. Respiratory

7.3.2.1. Sinusitis

7.3.2.2. Pneumonia

7.3.2.3. Pneumothorax

7.3.3. Neurological

7.3.3.1. Seizures

7.3.3.2. Encephalitis

8. Acquired immunity

8.1. B lymphocytes

8.1.1. Produced in bone marrow

8.1.2. Activate the humoral response

8.1.3. Produce plasma cells

8.1.3.1. Antibodies

8.1.3.1.1. Each B cell have only one type of antibodies on its surface

8.1.4. Memory B cells

8.1.5. Acts as antigen presenting cells

8.1.6. Produce cytokines

8.2. T lymphocytes

8.2.1. Matures in thymus

8.2.2. Mainly of 2 types

8.2.2.1. T helper cells ( CD4 )

8.2.2.1.1. Activated by antigen presenting cells

8.2.2.1.2. Secrets cytokines to activate other immune cells

8.2.2.2. T cytotoxic cells (CD8)

8.2.2.2.1. Binds to MHC1

8.2.2.2.2. Kill target cells by secreting a protein called perforin

9. Levels of prevention

9.1. Primary

9.1.1. Preventing disease before it occurs

9.2. Secondary

9.2.1. Reduce the impact of a disease or injury

9.3. Tertiary

9.3.1. Soften the impact of ongoing illness or injury that has lasting effect

10. Normal WBC count

10.1. Adults 4800-10800 Per microliter of blood

10.1.1. Differential count= % of each WBC in the blood

10.1.1.1. Neutrophils 40-75%

10.1.1.2. Lymphocytes 15-40%

10.1.1.3. Monocytes 2-10%

10.1.1.4. Eosinophils 1-6%

10.1.1.5. basophils 0-2%

10.2. Higher in neonate and children

11. Azithromycin

11.1. WHO’s list of essential medicines

11.2. Class

11.2.1. protein synthesis inhibitors

11.3. Subclass

11.3.1. macrolide

11.4. Rout of administration

11.4.1. oral

11.4.2. IV

11.4.3. ophthalmic

11.5. Mainly bacteriostatic

11.5.1. with increased concentration it becomes bactericidal

11.6. Used to treat

11.6.1. Community-acquired pneumonia

11.6.1.1. Chlamydia pneumonia

11.6.1.2. mycoplasma pneumonia

11.6.1.3. streptococcus pneumonia

11.6.2. Urethritis

11.6.3. cervicitis

11.6.4. Pelvic inflammatory disease

11.6.5. Tonsillitis

11.6.6. Otitis media

11.7. Adverse Effects

11.7.1. CNS

11.7.1.1. vertigo

11.7.1.2. headache

11.7.1.3. fatigue

11.7.2. CV

11.7.2.1. palpitation

11.7.2.2. chest pain

11.7.3. GI

11.7.3.1. abdominal pain

11.7.3.2. vomiting

11.7.3.3. diarrhea

11.7.4. GU

11.7.4.1. candidiasis

11.7.4.2. vaginitis

11.7.4.3. nephritis

11.7.5. Skin

11.7.5.1. rash

11.7.5.2. photosensitivity

11.8. Work in 3 ways

11.8.1. Neutralization

11.8.1.1. Block the binding of toxins or the bacteria to host cells

11.8.2. Opsonisation

11.8.2.1. Coating antigens and allow it to be exposed to macrophages to be engulfed by phagocytosis process

11.8.3. Complement Activation

11.8.3.1. Enhance phagocytosis

12. Development of Disease

12.1. Incubation period

12.1.1. The interval between the initial infection and the first appearance of any signs or symptoms

12.2. Prodromal period

12.2.1. Appearance of early, mild symptoms. Relatively short

12.3. Period of illness

12.3.1. Most severe. Exhibition of overt signs and symptoms. WBC increase

12.4. Death

12.4.1. OR

12.4.1.1. Period of decline

12.4.1.1.1. Signs and symptoms subside. Patient is vulnerable to secondary infections

12.5. Period of convalescence

12.5.1. Regaining strength, recovery

13. Iceberg Phenomenon

13.1. Definition

13.1.1. It is the portion of disease that remains undetected or unrecorded despite physician’s diagnostic endeavors

13.2. Causes

13.2.1. Site of bacteria

13.2.2. Immune system

13.2.3. Genetics

13.2.4. Predisposing factors

13.2.4.1. sex

13.2.4.2. age

13.2.4.3. nutrition