Dr debasish Kapuria

Dr debasish Kapuria postgraduation preperation

07/10/2023

Functional gb diasorder:
Here exclution of stone or microlithiasis is needed.
Usg is done to exclude gall bladder stone.
Endoscopic usg is done to exclude distal bile duct stone.
Exclution of other diseases like pud,pancreatitis is needed.
Pt may complain biliary type of pain.
This pain remits spontaneously.
Pt education is important.
Pt councelling is needed.
Analgesic
Antispasmodic
Neurotropic agent
----these may b tried.
Cholecytectomy is the last resort of treatment.

cholesterosis:
Lipid diposition occurs in submucosa and mucosa layer of gall bladder.
Lipid diposits are yellow in colour.
So Gall bladder mucosa becomes strawberry colour.
This is known as strawberry gall bladder.
Pt is asymptomatic
Sometimes there may b upper abd pain.
Because this lipid deposits protrudes from submucosa to mucosa.
May b deposited in lumen after rapture.
This is like deposition of cholesterol stone.
Usg may show filling defect.
Differentiation from cholesterol stone needs experience.
After cholecystectomy, diagnosis is confirmed by biopsy and histopathology.
Cholesystectomy is advised if there is symptoms.

Adenomyosis of gall bladder:
There is proliferation of mucosa and muscle layer of gb.
Protrution occurs from muscle to mucosal layer.
These protrutions are sinus like.
These r known as RA (.....aschoff) sinuses.
Wall becomes irregular.
Gall bladder is deformed.
Sometimes there may b upper abd pain.
Sometimes these process occurs at fundus of gall bladder or other local area.
If fundus is involved this fundus area is termed as phrygean cap.
Holo or ring like opacity is found on usg.
Cholecystectomy is advised.

01/09/2023

Primary sclerosing cholangitis:
Eta ekta auto immune disease.
Eta male e beshi hoy.
Age range:20 to 40 years
Child der CLD er ekta main cause.
Eta extrahepatic mainly and intrahepatic biliary tree invlove hoi.
Chronic inflammation,fibrosis,obstruction,cholestasis develop kore.
Etar kichu diagnostic criteria ache:
Multifocal stricture thake.
No history of gall stone.
No history of carcinoma.
No history of surgery.
Bo history of long term follow up.

Abar secondary sclerosing cholangitis er kichu cause thake---
Bile stone.
Bile duct e kono tumour.
5 flurodeoxyuridine infution korle.
Hydatid cyst e formalin infution
Alcohol insertion in tumour
Clonorchis sinensis infection
HIV rogi der cytomegalovirus or cryptosporidia infection.

Pathogenesis:
Ei rogi der ulcerative colitis thake.
Etar karoner colon wall fragine,thin hoye zai
As a result gut theke toxic and infectious agent portal circulation hoye bile duct circulation e chole ase.
Eta ke gut dysbiosis bole.
Genetic susceptibility is a factor.
Haplotype A1B8DR3DRWB15A responsible.
Extra and intrahepatic fibrosis and cholestasis theke cirrhosis and portal hypertention develop kore.
Ulceralive colitis,colorectal cancer,cholangiocarcinoma,gall bladder cancer egulo associated.
right sided colitis hole psc hote pare.
Pancolitis or extensive colitis hole ei rog hobar chance bere zai.
Crohns colitis er khetre eta sadharonot hoi na.

Symptoms :
Ei rogi der past history of ulcerative colitis thake.
Rogi r intermittent jaundice thake
Itching thake ( due to cholestasis)
Fatigue thake ( chronic inflammation er karone)
Upper abd pain or discomfort.
Features of cirrhosis or portal hypertention thake.
( haematemesis,malena,ascites,edema,splenomegaly)
Fat soluble vitamin gulo sothik bhabe absorb hoi na.fat malabsorbtion hoi. As a result weight loss hoi.
Acute cholangitis hole pt er fever thake.

Investigations:
On the background of ulcerative colitis
Autoimmune hepatocyte injury hole serum transaminase level barte pare.
Serum Alp level bare ( acute cholangitis e beshi bare)
Serum conjugated bilirubin level bare.
Serum peri nuclear ANCA level ta bare.eta k leading ekta test hisebe dhora jai. Tobe khub ekta specific na. Autoimmune hepatitis er khetre 50 percent e eta present thakte pare.
Serum ANA present thakte pare.
Serum Anti smooth muscle antibody may b present.
Serum anti mitochondrial antibody ta present thake na.
Mrcp korle stricturing and dilatation pawa jai biliart tree te.eta ke putir malar moto dekha jai.
Survellience test hisebe usg of hepatobiliary system kora jai. For detection of gall bladder polyp,colangiocarcinoma.
Ulcerative colitis na thakleo colonoscopy should be done.

Treatment:
Ursodeoxycholic acid dea jai (13-15 mg/ kg/ day) dea jai.300 mg 8 hourly ( ursocol or uliv name pawa jai).cholestasis ta improve hoi.progression to colorectal carcinoma prevent hoi.
Pt may complain itching. Sei khetre cholestyramin (4-16 gm daily before and after breakfast mixed with orange juice nea jai),rifampicin (150 to 600 mg daily can be tried. Be cautious about liver function test),natrexone (opioid antagonist)25 to 300 mg daily can be given.
Fat soluble vitamin gulo replace korte hbe.
Metabolic bone disease osteoporosis thakle ( bisphosphonate with ca and vit d can b tried)
Interventional Ercp can be tried if any major constriction is detected in mrcp for brush cytology ( to differentiate between inflammation and neoplasm) and for intervention ( balloning is preferred because stenting korle acute cholangitis hobar chance thake)
Acute cholangitis hote pare. Sei khetre antibiotic ciprofloxacin is recommended.
Proper treatment of ulcerative colitis is needed.
extrahepatic bile duct resection with biliary reconstruction can be tried but khub beshi successful kichu na.
End stage liver failure er khetre liver transplantation can be tried. Eta te 5 year survival rate 80 theke 90 percent.
Abar 20 percent khetre disease can come back to transplanted liver.
Cholangicarcinoma is a contraindication to liver transplantation.
Liver transplant korle colorectal carcinoma hobar chance bere jai.karon jekono transplantation e immunosuppressive medication nite hoi.eta ekta carcinoma development er jonno ekta predisposing factor.

PBC vs PSC:
PBc eta meyeder beshi hoy.
Etar sathe hypothyroidism jorito bole fatigue beshi thake beshir bhag rogi der.
Etar non organ specific auto immune disease like sjogren syndrome jorito.
Eta 50 to 55 years age group e beshi hoi.
Eta te Ama present thake.

PSC:
Eta chele der beshi hoy.
Eta 20 to 40 years age group e beshi hoy.
Eta sathe ulcerative colitis rog ta jorito jeita hosse ekta organ specific disease.
Eta te anti peri neuclear anca present thake
Ama absent thake.

Way to reach definitive diagnosis:
Young age, male patient
Ulcerative colitis er history thake pt er.
Cholestasis thakbe
S.conjugated bilirubin, ALP level ta beshi hobe.
S perinuclear anti Anca pawa jete pare.
Mrcp korle biliary tree te multiple beading pawa jete pare.

26/08/2023

Autoimmune Hepatitis

Eta ekta auto immune disease.
ekhane immnune mediated hepatocyte injury hoye thake.
rog ta female der beshi hoye thake.
20 years e hote pare abar 60 years eo hote pare.
Etar acute and chronic dui ta form ache.
Chronic er khetre relapse and remission hoi.
Etar sathe ero kicu autoimmune disease er somporko ache.

Pathogenesis:
Keno immune tolerance nosto hoye jai seta ekhono ojana.
Tobe maximum khetre ei sokol khetre genetic and environmental component thake.
Ekhaneo etar exception nei.
HLA Dr3 and 4 er sathe ei rog ta somporkito.ei gene jader ache tader khetre ei rog ta beshi hoye thake.
Abar jara nitrofurantoin antibiotic user tader ekta small proportion er khetreo rog ta hoye thake.
Hepatitis A virus, EB virus infection jader hoi tader khetreo eta hote pare.
Ekhne kichu auto reactive t lymphocyte thake jara self cellular protein k destroy kore.
Pt er blood e igG level ta onek beshi bere jai.

Symptoms:
Eta ekdom early stage e asymptomatic thake.
Kichu non specific symptom thakte pare like fatigue,anorexia,nausea,arthalgia.
Erpor hepatitis er moto symptom prokas pete pare.
Tobe normal acute viral hepatitis 4 to 6 weeks er moddhe subside kore jai kintu etar khetre emn ta hobe na.
Pt er acute attack er khetre liver e khub druto necrosis hote pare.as a result acute liver failure hote pare.
Abar karo karo khetre disease ta self limiting na hole chronicity develop korte pare.
Tokhn hepatosplenomegaly, spider naevi thakbe ( result of portal hypertention).liver porer dik e fibrosed hoye choto hoye jai.
Ascites hote pare.thakte pare variceal bleeding.
Kichu rog k mathai niye ei disease ta deal korte hbe:
Hashimoto thyroiditis
Type 1 DM
RA
SLE
Coeliac disease.
Ulcerative colitis.
Dermatomyositis
Coombs positive haemolytic anemia.

Investigations:
Ekhane serum AST,ALT level ta barbe ( karon autoimmune hepatocyte injury hbe)

ANA positive hbe( SLE er sathe connected)

Anti smooth muscle ab positive hote pare.

Anti liver kidney microsomal ab positive hote pare.( hepatocyte membrane ekta molecule er against e ei Ab develop kore.
Bacchader khetre eta beshi positive hoi.ei variant er disease ta treatment resistant)

Anti soluble liver antibody positive hote pare.( eta latest ekta test)

Pt er igG level ta onek beshi hbe.eta disease activity k nirdes kore.echara treatment response bujha jabe.pt cure er dik e gele titer aste aste komte thakbe.

Kono kichu positive pawa jasse na kintu highly suspicious sei khetre liver biopsy korte hbe.( ekhane portal tract er surroundings e lymphocyte and plasma cell pawa jabe.portal tract theke lobule er dik e inflammation spread korle eta k interphase hepatitis bola hoye thake.)

Treatment:
Prednisolone 30 to 40 mg daily acute attack er khetre dea hoye thake.jokhn symptom subside kore jokhn dose reduce kore nie asa hoi.

Budisonide may b a alternative if pt is intolerant to prednisolone.

Treatment maintain kora hoi azathioprine die jetar dose hosse 1 to 2 mg / kg / day
Or
Azathioprine plus prednisolone less than 5 mg per day diyeo maintain kora jai.

Jodi Azathioprine e pt response na kore tahole mycophenolate mofetil hosse second option.

Jodi etateo kaj na hoi tahole tacrolimus ta dea jai in resistant case e.

Treatment duration : 3 years or more.

24/08/2023

Hepatic Encephalopathy :

এটা একটা neuropsychiatric disorder.
এই disorder এ gut derived neurotoxin গুলো brain এ চলে যায়।কারন liver এগুলো কে ভাংতে পারে না।আবার portosystemic circulation অ্যাক্টিভ থাকে।আবার bbb সঠিক ভাবে কাজ করতে পারে না।যেই chemicals গুলো এই disorder করে এগুলো maximum ই nitrogenous substance like ammonia.এছাড়া marcaptan,octopamide,fatty acid, amino acid,GABA এগুলো হতে পারে।cerebral edema হয়ে যায়।
এই রোগি দের mild symptom থেকে coma পর্যন্ত হতে পারে
Pt এর inability to concentrate
Pt এর disorientation হয়
Pt এর delution হয়
Pt এর slurring of speech হয়
Pt এর unconsciousness and coma develop করে
Pt এর constructional apraxia থাকে।
সে একটা স্টার draw করতে পারে না।
সে simple arithmetic task করতে পারে না।
Pt এর astexis থাকে যেটা হচ্ছে flapping tremor.
যেহেতু upper motor neuron এর involvement থাকে pt এর hyperrefexia থাকতে পারে।
Pt এর extensor plantar response থাকতে পারে।
Pt এর rarely convultion হতে পারে।

কিছু কিছু ক্ষেত্রে pt এর degenerative disorder of brain থাকার কারনে
Dementia
Spastic gait
এগুলো থাকে।

Pt এর unconsciousness এরন্য কারন থাকতে পারে:
Drug intoxication
alcohol intoxication
Fall followed by subdural haematoma হতে পারে

Alcohol withdrawal
Wernicks encephalopathy
Pt এর কোন psychological disorder থাকতে পারে like hcr.
Pt এর hypoglycemia থাকে এটা হতে পারে।
Pt এর wilsons disease থেকেও এমন হতে পারে।

কিছু কিছু factor এটাকে বাড়িয়ে দেয়:
যেমন constipation এর কারনে gut bacteria গুলো proliferate করে।তখন এরা বেশি বেশি toxin তৈরি করে।
এই টক্সিন গুলো পরবর্তী তে এই ডিজওর্ডার করে থাকে।
আবার excessive ascitic fluid withdraw করা হলে,
Diuretics type কোন ড্রাগ দেয়া হলে pt dehydrated হয়ে যেতে পারে।তখন brain এ circulation কমে যায়।as a result encephalopathy বেড়ে যায়।
আবার কিছু কিছু drug like sedative and anxiolytics গুলোর কারনে brain বাধাপ্রাপ্ত হয়।এগুলোর সাইড ইফেক্ট বেড়ে যায় কারন এগুলো লিভার এ মেটাবলিজম হয়।অসুস্থ লিভার এই ওষুধ গুলো কে মেটাবোলাইজ করতে পারে না।ফলে রক্তে এদের ঘনত্ব বেড়ে যায় এবং এরা বেশি করে ব্রেইন এ যায়।ফলে encephalopathy বেড়ে যায়।
hyponatraemia and hypokalaemia এগুলোর কারনে sodium and pottasium এর সাথে excess পানি বের হয়ে যায় pt dehydrated হয়ে যেতে পারে।আবার কোন কারনে যদি GI bleeding হয় যেমন esophageal varix rapture এর কারনে সেই ক্ষেত্রে nitrogenous load টা বেড়ে যেতে পারে।
Investigation: এটা আসলে একটা clinical diagnosis.খুব try করতে ইচ্ছা করলে electroencephalogram করা যেতে পারে।সেই ক্ষেত্রে generalized slowing of alpha wave হয়,new progression of delta wave হয়।আবার serum ammonia level টাও করা যেতে পারে।এটার লেভেল অনেকটা বেড়ে যায়। তবে এটা খুব একটা sensitive test না।
Treatment :
Etar aggravating factor গুলো কে correct করতে হবে।( band ligation, diuretics বন্ধ করে দেয়া ,electrolyte disorder থাকলে সেগুলো correct করা)
Syp lactulose (15 to 30 ml 8 hourly দেয়া যায় এতে করে constipation releive হয়।ammonia absorbtion হতে পারে না কারন gut এর ph কমে যায়।ammonia টা bacteria এর ভেতরে ঢুকে যায়।)
Lactulose এ কাজ না হলে phosphate e***a টা ট্রাই করা যেতে পারে।
আমাদের target হওয়া উচিত bowel at least 2 বার move করবে।
একটা antibiotic আছে যেটা gut থেকে absorbহয় না,locally কজ করে,bacteria culprit গুলো কে destroy করে ফেলে। Rifaximin 550 mg twice daily দেয়া হয়ে থাকে।
L ornithine L arginine combination can be tried.
খুব বেশি protein restriction করে কোন লাভ হয় না।
Unconscious rogi দের ক্ষেত্রে intubation করতে হবে।
যদি কোন treatment এই কাজ না হয় ( chronic or resistant encephalopathy) তাহলে liver transplantation করতে হবে।

Way to go-to definitive diagnosis:
On the background of cirrhosis of liver যদি কোন রোগি এর altered consciousness thake,
Search for contructional apraxia
Asterixis or flapping tremor
Serum ammonia level টা যদি বেড়ে যায়
EEg করে investigation এর মাধ্যমে diagnosis এ reach করা যায়।

24/08/2023

Fibromyalgia:

Introduction :
Disease of uk, usa
Females are affected(10:1)
বয়স বাড়ার সাথে সাথে এটা বাড়তে থাকে
যেই বিষয় গুলো রোগ টির সাথে জড়িত:
s*xual abuse
Low income
Marital disharmony
Injury
Assault
Poor sleep

Pathophysiology:
এই রোগ টির আসল কারন এখনো ঠিক ভাবে জানা যায় নাই।তবে দুই টি বিষয় রোগ টির সাথে জড়িত।
যদি ঘুম ঠিক ভাবে না হয় এবং কোন ব্যক্তির যদি ব্যথা র প্রতি সংবেদনশীলতা বেড়ে যায় তাহলে এটা হতে পারে।

Clinical features:
Widespread neck and back pain
Morning stiffness
Feeling of swelling of hand
Distal finger numbness
এই ব্যথা কোন ব্যথানাশক এ যায় না অথবা ফিজিওথেরাপি তে ভাল হয় না বরং খারাপ হতে পারে।
distressed
Fatigued
Low restorative sleep এর কারনে pt এর কাজে অমনোযোগীতা,low affect এগুলো থাকতে পারে।
রোগি এর non throbbing bifrontal headach থাকে।
রোগি এর irritable bowel disorder থাকতে পারে।as a result bloating, abd pain and altered bowel habit থাকে।
রোগি এর bladder irritable থাকে।এই কারনে bladder টা সব সময় full লাগে and nocturnal frequency হতে পারে।
রোগি এর touch sensitivity থাকে।এই কারনে pt feels pain on touch.এটা কে বলা হয় allodynia.
Pt s*xual life distressful হয়ে যায়।কারন রোগি এর dyspareunia থাকে।

Tender spots:
Trapezius muscle এর mid এর skin fold
2 nd to 3 rd costochondral junction
Distal to lateral epicondyle
C4 c5 interspinous ligament
L4 L5 interspinous ligament
Mid gluteal region
Upper medial টিবিয়া

ডাক্তার যদি প্যাশেন্ট এর ব্যথার জায়গা গুলো তে যথেষ্ট প্রেশার দেয় ( pressure adequate to whiten the nail)
তাহলে রোগি ব্যথা অনুভব করবে।

Investigation :
এই diagnosis করতে অন্য diagnosis গুলো exclude করতে হবে
cbc, lft,rft করা যেতে পারে for generalized disease screen.
Cbc এর পাশাপাশি imaging করা যেতে পারে যদি প্যাশেন্ট এর symptom এটা করার ক্ষেত্রে গাইড করে।
RA: rf,anti ccp করতে হবে
Sle: Anf,ab level to extracted nuclear antigen করতে হবে।এছাড়া c3,c4 level করা যেতে পারে কারন sle এর active stage এ এগুলো কমে যেতে পারে।
Antiphospholipid ab syndrome: anti cardiolipin ab and lupus anticoagulant করতে হবে
Thyroid disorder দেখতে TFT করতে হবে
Hyperparathyroidism: serum pth level করতে হবে
Osteomalacia: s.ca,po4 level, 25 oh vit d level,
alp,alb level করতে হবে
Sarcoidosis: s ace level করতে হবে
Inflammatory bowel disease এর ক্ষেত্রে faecal calprotectin level করতে হবে
রোগি কে over investigation করানো যাবে না।over investigation রোগি এর চিন্তা বাড়িয়ে দিতে পারে।
ঘুম বেশি হলে ব্যথা কমে যাবে এটা রোগি কে বুঝাতে হবে।
এই পেইন এ কোন tissue damage, inflammation হয় না এই বিষয়টা রোগি কে বুঝাতে হবে।

Management:
Education about the disease
Control of the pain
Sleep improvement
Psychological stress management
Aerobic exercise
Cognitive behaviural therapy
Relaxation therapy: physically and mentally relax থাকতে হবে।
Self help strategy: রোগি কে নিজে থেকে এই রোগ টা নিয়ন্ত্রণ করতে হবে।

Amitriptiline : 10 to 75 mg at night
With or without
Fluxetin.
এগুলো delta sleep কে ইম্প্রুভ করে
Spinal wind up কে কমায়( cord দিয়ে ব্যথা ব্রেইন এ পৌছাতে পারে না।)
Duloxetin,pregabalin,gabapentin,tramadol এগুলো খুব একটা ফলপ্রসূ না।

How to do definitive diagnosis:
This is diagnosis of exclution.
Tender point গুলো মাথায় রাখতে হবে।
রোগির পারসোনাল লাইফ এর হিস্ট্রি নেয়া টা গুরুত্বপূর্ণ।
রোগি যদি মহিলা হন তাহলে এই রোগ টা মাথায় রাখা উচিত।(পুরুষ :মহিলা=১:১০)
ব্লাডার বাওয়েল হ্যাবিট টা আস্ক করতে হবে।
অন্য সম্ভাব্য ডায়াগোনসিস exclude করতে হবে।

21/02/2023

rna virus---( complete)
segmented genome:
arena
rio: rota
orthomyxo virus: influenza A,B and C
bunya virus --- californian encephalitis virus,hanta virus.(AROB)

virus having polarity:
picorna virus: hepatitis A virus,coxasackie
calci virus-- noro virus
rio : rota virus
flavi virus: hepatitis c,dengue, yellow fever
toga : rubella
retro: hiv and human t cell lymphotrophic virus
corona

influenza:enveloped rna virus
influenza A and B
A kore pandemic. rimantidine e response kore.responds to neroaminidase inhibitor.can undergo antigenic shift and drift.vaccination life long protection dei na.
B kore endemic.
surface spike gulo hemagglutinin and neuroaminidase carry kore.
antigenic shift and drift hoi
shift 8 theke 10 bosor por por hoi
drift 1 theke 2 bosor por por hoi.
it causes rti.
enter kore airborne droplet hisebe
viremia not common
eta established infection kore na.
associated with bac infection.

virus causing c. cold:
rhino
adeno
corona
influenza
para influenza
respirstory cell k destroy kore

virus causing respirstory tract infection:
influenza
adeno
respiratory syncitial virus( ARI)

measles:
paramyxo virus
pathognomonic sign: kopliks spot.
subscute sclerosing panencephalitis : rare complication
multinucleated giant cell form kore
cell mediated immunity komie dei.
complication: encephalitis, pneumonia,
bronchopneumonia,otitis media,deafness,mental retardation,vit A deficiency, diarrhea.
s/s:
fever
rash on face
conjunctivitis
eosinophilia thake na
ab titer raised
no response on acyclovir
vaccination er maddhome prevent kora hoi

multinucleated giant cell form kore :
herpes simplex 1 and 2
varicella zoster virus
Cytomegalovirus
measles
respiratory syncytial virus
hiv

Latent infection kore:
Herpes simplex 1
Herpes simplex 2
Ebsten barr virus
Varicella zoster virus
Cytomegalovirus
Adeno
Hiv

mumps:following complication gulo hoi---
meningitis
labirynthitis
myocarditis
pancreatitis
orchitis
transient hearing loss
sterility
abortion

epi schedule e mumps ni.****

egulo hosse covid er vaccine:
protein subunit vaccine
viral vector vaccine
nucleic acid vaccine

rubella te----
microcephaly
micro opthalmia
retinopathy
glaucoma
cataract
sensory neural deafness
patent ductus arteriosus
Ventricular septal defect
pul artery stenosis
thrombocytopenia

rubella:
maternal mortality barai na
eta severe fetal conge***al anomaly kore
vaccination decrease incidence
repeated miscarriage kore.
type 2 dm develop kore na.
vesicular rash kore na
eta heart anomaly kore.
cord blood e ab toiri kore.
foetal diagnosis e help kore.
Highly contagious
Increase the risk of abortion
Most common abnormity is fetal hearing loss
Increase the risk of abortion
Eta k german measles bola hoi.

Vesicular rash produce kore following :
Herpes simplex 1 and 2
Pox virus
Varicella zoster virus

***** rabies e human diploid cell vaccine hosse best.
Duck embryo vaccine: immunogenicity kom
Nerve tissue vaccine myelin sheath er sathe reaction kore.eta k bola hoi allegic encephalomyelitis.

AIDS:

hiv 1
and 2 causes aids
helper t lymphocyte k loss kore,
macrophage,monocyte,dendritic cell k o loss kore.
contain reverse trancriptase enzyme
most complex genome
transmitted s*xually contact
window period e blood hiv carry kore kintu ab pawa jai na ei somoy.
pnumocystis zerovesi pneumonia and caposi sarcoma,candida,pneumocystis carini,tb.
--- commonest opportunistic infection
transmition:s*xual contact,blood transfution,anal intercourse,infection feeding,transplacental,kidney transplantation.
Hypergamaglobulinaemia hoi and cytokine abnormality hoi.

s/s: pt is asymptomatic chronic carrier.
genome integrated into dna of cd4 tcell
acute infection e pt symptomatic thake
cd4 t cell high turn over
viral load besi hole prognosis kharap
viral transmition to others hoi.

Cd4 count 500 r niche tb,non hodgkin lymphoma,non typhoidal salmonellosis.

common bac infection:
staph aureus
streptococcus pneumoniae
hemophilus influenzae
mycobacterium tuberculosis

oral candidiasis
gingivitis
oral hairy leucoplakia
---- oral manifestation

diarrhoea:
salmonella
shigella
crystosporidium parvum
giardia lamblia
cytomegalovirus

cancer Association :
kaposi sarcoma
cervical cancer
non Hodgkin lymphoma
primary lymphoma of brain

complication:
lymphoma
tb
kaposi sarcoma

toxoplasmosis
isosporiasis
malaria----
cotrimoxazole debo.

flow cytometry and micro chips cd4 counting method die dekhbo----- cd4 helper cell count kora hoi.

helper t cell e viral infection hole aids hoye thake.

Hepatitis sob gulo rna virus
Sudhu matro hepa B hosse dna virus.
Hepa A non enveloped rna
Hepa B enveloped dna virus
Hepa E hosse enveloped rna virus.

hepatitis A acute liver failure kore na
chronic liver disease kore na
prevented by vaccination
prodromal period ase
does not cause cholestatic jaundice

hepatitis B transmitted to foetus
hepatitis E fulminant hepatic failure kore
bacchader prematurity hoi na
hepatitis E not virulent.

post exposure prophylaxis :
hepatitis A
hepatitis B
rabies

21/02/2023

Vit A, vit c,vit E,vitK,ceruloplasmin,catalase--- egulo sob anti oxidants.

bac vaccine:
rota
bcg

live viral vaccine :
measles
mumps
rubella
polio.
influenza
yello fever
varicella zoster
adeno

recombinant viral vaccine :
influenza
hepatitis b
varicella
human papilloma

oncogenic dna virus:

human.papilloma
hepatitis b virus.
ebastein barr virus.
hhv 8

oncogenic rna virus:
human t cell lymphotrophic birus
hiv

dna enveloped virus:
herpes virus family.
hepadna virus: hepatitis b virus.
pox virus

dna non enveloped:
parvo virus
adeno
papilloma virus

rna enveoped virus:
orthomyxovirus : influenza a,b and c
measles, para influ,nipah- para myxo
corona
toga- rubella
rhabdo: rabies
flavi virus: dengue, yellow fever, hepatitis c
flio
delta
adeno
bunya
ebola
retro:hiv and human t cell lymphotrophic virus

rna non enveloped virus:
picorna: polio, hepatitis a virus,cixasackie,rhino, rota.

dna virus er sokol e double stranded.
parvovirus b19 hosse single stranded.
all rna virus r single stranded
except rio: rota virus hosse double stranded virus
pox virus cytoplasm ecreplicate hoi.baki dna virus gulo nucleus replicate hoi.
retro and influenza egulo rna virus,replicate hoi nucleus e. baki rna virus gulo cytoplasm e replicate hoi.

immunocompromised child der jesob vaccine dea hoi:
killed vaccine
toxoid vaccine
live attenuated vaccinevdea jbe na

inclution body two types: intracytoplasmic and intranuclear.
rabies,( negri body),small pox( guarnia body) ( intracytoplasmic)

intranuclear: herpes simplex virus, adeno virus, varicella zoster virus human papilloma virus,polio

both: measles and cytomegalovirus, nipah, yellow fever.

hepatitis b,c,d
cytomegalovirus
rubella -----
egulo chronic infection kore

varicella,ebstein barr,measles, mumps, rubella,small pox---
egulo life long immunity dei.

dna virus genime detection
southern blot
pcr

rna virus genome detection--
northern blot
reverse teanscriptase
brached dna
nucleic acid based amplification

herpes simplex virus 1 causes--
herpes labialis
cold sore

herpes simplex 2 kore--
ge***al ulceration.

herpes simplex 3 :
chicken pox and shingles kore.

human herpesvirus 8 kore kaposi sarcoma.

varicella zoster: unilatetal
scar formation kore
life long immunity kore.
vescicular rash
multinucleated giant cell form kore.
eta theke neuralgia hoi.
painful.blister formation hoi.

herpes simplex virus 1
herpes simplex virus2
coxasackie
varicella zoster
chicken pox -----
egulo vesicular rash form.kore.

about cytomegalo virus---
sob route e transmit hoi
latent infection kore
super ag form kore
giant cell form kore
aids patient der blindness kore.
eta teratogenic
infectious mononucleosis kore.
foeral.and new born infection besi kore.karon transplacental route e transmit hoi.

ebsten barr virus----
infect kore b lymphocyte k
it causes nasopharyngeal carcinama
burrkits lymphoma
infectious mononucleosis kore.
oral hairy leucoplakia
x linked lymphoproliferative diseaee kore.

severe pharygeal edema
hepatitis
transverse myelitis
agranulocytosis
------ egulo hosse complication

adeno virus die
phrygitis
conjunctivitis
pneumonia

glomerulonephritis and encephalitus hoi na.***

small pox ----
cytoplasm e multuply kore
one ag ic type
inapparent infection rare.
effective and safe vaccine
eta live attenuated vaccine

human pappiloma virus:
non envelpoed
double stranded dna virus
skin to skin and ge***al contact
koilocyte formation kre
etar recombinant vaccine available.
etar replication e amantadine er kono vumika ni.
oral,anoge***al,cervical cancer kore.
nasophryngeal,oropharynx and cervical cancer kore.

21/02/2023

pancreatic acinar cell
plasma cell
fibroblast e------

rogh er thake

func: protein
phospholipid
glycoprotein
multichin protein
carbohydrate ------ synthesis kore.
post translational modification kore protein er

adrenal cortex
liver cell
straite muscle cell
----- smooth er thake

func of smooth er:
protein er lipid metabolism related kaj kore.
lipid synthesis kore.
steroid hormone synthesis kore.
synthesis of cholesterol
contraction process of muscle
utilization of glucose from glycogen
oxydation
conjugation
methylation---- kore

golgi complex:
2 parts. cys and trans.
cys die kono kicu vetore dhuke.etar shape convex.
trans die kono kicu baire ber hoi.eta concave.

func:
sob kicu jomai
modification of protein
lysosome produce hoi.
acrosome of spermatozoa produce kore.
enz package kore.

lysosome: nam er sese ase thake
protease
neclease
phosphatase
beta glucoronidase
sulfatease
lipase

primary and sec lysosome

suicidal bag of cell
primary ta digesion e kaj kore na and sec ta digesion e kaj kore.

peroxisome:
enz er nam er sese oxydase thake except catalase.
erekta nam microbody

cytoskeleton:
microtubule
microfilament
intermediate filament

microtubule alpha and beta tubulin Secrete kore.
shape,polarity and track of organelle of cell maintain kore
cilia and flagella te thake
axon, basal body,centriole egulo provide kore.

microfilament globular G actin toiri kore.
microvilli and stereocillia te thake

intermediate filament :
various alpha helical rod like protein toiri kore.
monomeric form.
eta cell k strength dei
cell er shape maintain kore
cell er sathe nucleus er shape o maintain kore.

stage of interphase e 3 ta
g1,s and g2
g1 er name presynthesis stage.25 hours-- duration(o pre dekhe or somoy sobtheke besi)
s er name hosse dna synthesis.duration:8 hours
g2 er nam.hosse post dna duplication.duration: 2.5 to 3 hours.

mitosis in somatic cell e hoi
meiosis s*x cell.e hoi

mitosis e 2ta daughter cell hoi
meisis e 4 ta

mitosis e diploid cell hoi
meiosis e haploid

mitosis e inter phase lomba.
meiosis e short.

mitosis e ekta phase.
meisis e 2 ta complete phase thake

mitosis e chromosome visible na
meiosis e visible

basement membrane:
2 ta lamiba.
basal.lamina and reticular lamina.
type 4 collagen,intrectin,perlecaine,laminin--- basal lamina
type 1 and 3 collagen thake reticular lamina te

intercellular junction: 3 ta thake

communicating junction: gap junction( nexus) die communicate kore.connexin protein thake.kono filament thake na.

impermeable junction:tight junction or zona occludens.zona occluding protein thake.actin filament thake.

zona adherens:adherin and cadherin,catenin protein thake.actin filament thake
desmosome: cadherin family.actin filament thake.intermediate filament thake.
hemidesmosome ( epi cell and basal layer er junction): integrin protein thake.intermediate filament thake.

-----adhering junction

microvilli:
eta numerous microfilaments die toiri.
proximal tubule of kidney ( cuboidal cell)
collumnar epithelium of small intestine.

stereocilia: epididymis
ductus deferens

cilia: respiratory tract
oviduct
hair cell of vestibular apparatus of inner ear.

flagella:
spertozoa of human body.

epithelial cell:no nerve supply
no blood supply
damage er por renew hoi.
replace after damage.

epithelial cell having surface modification:
simple columnar epi
simple cuboidal epi
psudostratified columnar epithelium

stratified columnar epithelium:
site: conjunctiva and male urethra

◾virus:
obligate intracellular
strongly antigenic
enveloped or non enveloped
antibiotic resistant
interferon sensitive
binary fission e reproduction hoi na
replication er maddhome reproduce hoi.
sob virus hosse haploid except retrovirus.
polio k culture kora jai bki der culture kora jai na
segmented genome pai rota virus er influenza.

virus either dna or rna.
may have an envelope.
have enz for replication
virus infected cell may b transformed.
onno kono protein thake na.
metabilic function ni.
cytopathic change hoi in cell culture.
sob virus anviral agent e sensitive noi.
eder kono cell wall ni.
some virus cause cancer.

non enveloped virus k naked virus bola hoi.
detergent,solvent er heat e enveloped virus gulo besi sensitive.
ebs barr virus,cytomegalovirus,mouse virus,mammary virus, retro virus super ag toiri kore.
defective virus onno virus er help sara replicate kore na.
jmn hepatitis d virus

prion:
filamentous rod like.
uv ray eke inactive kore na.
eder nucleic acid ni.
era only protein
ab response toiri kore na.
cns infection kore slow viral disease kore.
attack animal and human.

disease: egulo prion die hoi---
kuru
cruetzfeld Jacob disease.
fatal familial insomnia.
garstman straussler seinkar syndrome.

slow viral disease:
progressive multifocal leucoencephalopathy ( aids e hoi)
aids
subacute sclerosing panencephalitis

latent infection caused by:
ebstein barr virus
cytomegalovirus
varicella zoster virus
hsv 1 and 2
hiv
adeno virus

site of latency:
neuron
liver
lymphocyte

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Rk Mission Road, Faridpur
Faridpur
10560

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