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Mebendazole and albendazole are benzimidazole carbamates that bind with high affinity to parasite-free B-tubulin to inhibit its polymerization and microtubule assembly. These agents also irreversibly inhibit glucose uptake by nematodes; the resulting glycogen depletion and decreased ATP production immobilize the intestinal parasite, which is then cleared from the GI tract.  Indications : Mebendazole is the drug of choice for the treatment of Trichuris trichuria (whipworm), Enterobius vermicularis (horse pinworm, pinworm), Ascaris lumbricoides (roundworm), as well as hookworm Ancylostoma duodenale and Necator americanus. For all these helminth mebendazole has success rates of at least 90 to 95%. It is also recommended for the treatment of Echinococcus granulosus and E. multilocularis infections Mebendazole is available in Pakistan in various brand names. Each brand name along with manufacturing pharmaceutical industry is given below. ALMEB ALSON PHARMACEUTICALS BELMENTIC

Biochemical assays for tumour-associated enzymes, hormones and other tumour markers in the blood are not diagnostic but help in determining the effectiveness of therapy. Carcinoembryonic antigen (CEA) is considered as tumour markers and is raised in the various tumour but it is also raised in various other benign conditions. Therefore, the Raised concentration of CEA in the blood is not a hallmark of Cancer. Causes of the high level of Carcinoembryonic antigen in Blood: 1) Malignant tumours: a) Breast cancer b) Colorectal carcinoma. c) Gastric cancer d) Pancreatic cancer 2. Benign conditions a) Hepatitis b) Alcoholic cirrhosis of the liver d) Crohn's disease e) Ulcerative colitis f) Healthy smokers

Esophageal (or Oesophageal) Varices: Definition: Oesophagal varices refer to dilated, tortuous mucosa or sub-mucosal esophageal veins. Causes: Portal hypertension is the main cause of dilatation of oesophagal veins. Portal hypertension is due to hepatic cirrhosis of any origin. Pathogenesis: Increased pressure in the portal vein results in the opening of collaterals veins between the portal and systemic venous system. Clinical features and signs: Dilated oesophagal veins may rupture and show clinical signs and symptoms. In un-ruptured condition, there will be no clinical symptoms. when rupture the patient present with hematemesis, oesophagal laceration, peptic ulcer, 40 % of patients die during the first episode of hematemesis. Treatment: Treatment of Esophageal varices in patients who have no history of oesophagal bleeding. 1. Betablockers: betablockers such as propranolol, timolol and nadolol are used provided that these agents are not contra-indicated (eg, because

Causes Of Infectious Esophagitis (Oesophagitis) 1. Bacteremia 2. Viremia 3. Herpes simplex 4. Cytomegalovirus 5. Candidiasis 6. Mucormycosis 7. Aspergillosis Causes of Chemical Esophagitis: 1. Ingested irritants (e.g alcohol, acids, alkalies and hot fluids) 2. Heavy smoking 3. Anticancer drugs 4. Uremia 5. Radiotherapy Morphology: 1. Non-specific features: a) Severe inflammation, b) Superficial necrosis c) Ulceration with the formation of granulation tissue and fibrosis 2. Specific features: a) Adherent grey-white pseudo-membranes (in case of candidiasis) b) Punched out ulcers of the oesophagal mucosa (in case of herpes infection) c) Tablet or capsule sticking in the oesophagus (in case of chemical or drug esophagitis) d) In the case of radiation esophagitis, there will be Mucosal atrophy, submucosal fibrosis and Vascular intimal thickening Clinical Features and signs (infectious esophagitis) 1. dysphagia 2. painful swallowing 3. heartburn 4. Naus

Barrett's oesophagus. red velvety appearance Barrett's Esophagus (Oesophagus) Definition and causes: It is an oesophagal disorder caused by prolonged gastro-oesophagal reflux disease, characterized by replacement of normal squamous epithelium by columnar epithelium at the lower end of the oesophagus. Morphology: Macroscopic and Microscopic study will reveal the following features. 1. Oesophagal mucosa appear red velvety 2. Metastatic columnar epithelium of the stomach is present at the lower end of the oesophagus. 3. Sometime Metastatic columnar Columnar epithelium contains intestinal goblet cells. 4. Low-grade or high-grade dysplasia may be present which may lead to adenocarcinoma. Complications: 1. Ulceration 2. Bleeding 3. Stricture 4. Development of adenocarcinoma Treatment: Following treatment options may be considered; 1. Proton pump inhibitors to control GERD ( gastroesophageal reflux disease) 2. Esophagectomy : that is the removal of the oesop

Reflux Esophagitis (Oesophagitis) Definition : It refers to chronic inflammation of the oesophagus (oesophagus) due to reflux of Gastric Acid. Causes and Predisposing Factors: 1. Decreased efficacy of oesophagal sphincter. 2. Use of drugs that cause CNS depression. 3. Hypothyroidism 4. Pregnancy  5. Alcoholism 6. Smoking 7. Nasogastric intubation 8. Delayed gastric emptying. Morphology: Under the microscope, you will notice the following aspects of reflux esophagitis. 1. Presence of neutrophils, eosinophils and lymphocytes in the epithelial layer. 2. Hyperplasia of the basal layers of the epithelium. 3. Elongation of papillae of lamina propria 4. Congestion. Clinical Features: 1. Dysphagia 2. Heartburn 3. Regurgitation 4. Hematemesis 5. Malena (black stool) 6. Chest Pain. Complications: 1. Bleeding 2. Strictures 3. Barrett esophagus Treatment. Following drugs are being used to treat reflux esophagitis. 1. Antacids : neutralize acids and decrease

Rheumatic Fever/ Rheumatic Heart Disease:  Definition: Rheumatic Fever is an acute, immune-mediated disease that occurs after an episode of beta-hemolytic  streptococcal pharyngitis and often involves the heart. Major Clinical Manifestations/ Criteria for Diagnosis. 1. Migratory polyarthritis of large joints. 2. Carditis 3. Subcutaneous nodules 4. Erythema marginatum 5. Sydenhom chorea ( it is a neurological disorder with involuntary purposeless movements.) Minor Clinical manifestations/ Diagnostic criteria 1. Fever 2. Arthralgias. 3. Elevated acute phase reactants. Jones Criteria for diagnosis of Rheumatic Fever. A physician should diagnose Rheumatic fever if there is 1. History of beta-hemolytic streptococcal infection. 2. Presence of Two major manifestations or one major and two minor manifestations. Morphology : 1. Aschoff bodies (foci of fibrinoid necrosis) 2. Anitschkow cells (these are plasma cells surrounded by macrophages) 3. Pancarditis 4. Bread and b

Phases Of Bacterial Growth In A Culture Medium Bacterial growth is studied by analyzing the growth curve of microbial culture. Because no fresh medium is provided during incubation, nutrient concentrations decline and concentration of wastes increase. The growth of microorganism reproducing by binary fission can be plotted as the logarithm of the number of viable cells versus the incubation period. The resulting curve has four distinct phases. Phase 1: The Lag Phase. When microorganisms are introduced into a fresh culture medium, usually no immediate increase in cell number occurs, and therefore this period is called the lag phase. Although cell division does not take place right away and there is no net increase in mass, the cell is synthesizing new components. A lag phase prior to the start of cell division can be necessary for a variety of reasons. The cell may be old and depleted of ATP, essential co-factors and ribosomes; these must be synthesized before growth can begin

TORCH Kit Torch Test is used to detect antibodies against various infectious agents and their concentration in blood. antibodies are the protein molecules that the body produces in response to an infectious agent. These antibodies help to kill or eradicate the infectious agent out of the body. Torch test is sometimes referred to as torch panel. Its name Torch Test is derived from the names of five infectious agents. 1. T oxoplasma gondi 2. O ther infectious agents 3. R ubella 4. C ytomegalovirus 5. H erpes simplex virus. Other infections which are tested usually include: Hepatitis B, Syphilis, Epstein bar virus, Coxsackie virus, Varicella zoster virus and human parvovirus. TORCH Test is a screening test. Its purpose is to find out whether the newborn has got an infection from either of the above mention organisms or not. Usually, a blood sample is taken to measure the concentration of antibodies. But sometimes other specimens (e.g urine, CSF or tissue )  are taken to c

Trichiasis : The term trichiasis means the abnormal direction of the eyelashes. The abnormal lashes rub against the corneal surface of the eyeball with resultant irritation, watering and potential damage to the cornea. Causes: All causes of entropion (entropion = lid margins turn inward) produce trichiasis, for example, spasm of the muscle of riolan, fibrosis of palpebral conjunctiva, loss of tone and elasticity of lid margins, Steven Johnson's syndrome. Pure trichiasis occurs in the following conditions 1 . Congenital Trichiasis: It is also called Distichiasis. In this disorder, an extra row of cilia is present behind the grey line in the place of ducts of the meibomian glands. Meibomian glands are absent. 2. Acquired Causes: a) Trachoma , due to fibrosis distorting the follicles. b) Ulcerative blepharitis: due to fibrosis near the follicles. Symptoms and signs: 1. Sandy or foreign body sensation 2. Photo-phobia 3. Lacrimation (watering) Complications : 1. Chro

Streptococcus Pneumonia: Morphology : Shape : The individual organism is lancet-shaped. Arrangement:

Positive quellung test under microscope Laboratory Diagnostic Tests. (Laboratory diagnosis Of Streptococcus pneumoniae Specimens : Blood, sputum, pus or CSF. Tests: 1. Microscopy: Gram stain smear of rusty sputum is seen under a microscope. Gram-positive diplococci, neutrophils, and red blood cells Can be identified. Capsule can be demonstrated by "Negrosin staining or Indian Ink." 2. Culture: Specimens are cultured on blood agar and chocolate agar , It causes alpha hemolysis on blood agar. It forms small round colonies, at first dome-shaped, later develop a central plateau with an elevated rim in chocolate agar . 3. Quellung's Test. It is the capsule swelling test. Fresh emulsified sputum is mixed with specific anti-capsular polysaccharide antibodies. If capsule swells markedly it means test is positive. 4. Optochin Disk Test. This test differentiates between alpha hemolytic pneumococci and alpha hemolytic streptococcus viridans. The optochin disk is laid down on

Sjogren's syndrome: Sjogren's syndrome (Sjogren's syndrome) refers to a pathological condition, characterized by: 1. Dry eyes, 2. Dry mouth 3. Lack of moisture at sites where it normally present Cause : Dry eyes occur due to the autoimmune destruction of Lacrimal glands and dry mouth occurs due to the autoimmune destruction of salivary glands. Autoimmune destruction means the immune system of the body kills its own cells instead of killing only foreign cells.