Antibiotics Families and Spectrums

 

Causes of Oedema

 

Liddle's Syndrome

 

• it's inherited form of hypertension

• it's inherited in the form of Autosomal dominant pattern
• it's caused by mutation in the  SCNN1A, SCNN1B, SCNN1G genes
• these genes provide instruction for making subunit of protein complex called epithelial sodium channel ( ENaC ) may found on surface of kidney cells

• Normally ENaC open in response to signals that Na level in the blood is too low, which allow reabsorption of Na back to the bloodstream

• if mutations occure, the ENaC will increase on cell surface leading to increase Na reabsorption and K exceartion

Features :- 

• Begins usually early in life often in the childhood, some people aren't diagnosed until adulthood

• may be no additional signs or symptoms, but overtime if untreated, may develop heart disease or cerebrovascular accidents

• may suffer from signs and symptoms of hypokalemia as

                                      * muscle weakness

                                      * fatigue

                                      * constipation

                                      * heart palpitations

                                     * metabolic alkalosis
                           

Differential diagnosis of Hematuria

 

Scheme of Thyroid Activities

 

Brugada Syndrome

 

• it's channelopathy disorder in the form of reduce sodium current
• inherited in the form of Autosomal dominant, typically in young, male, and othewise healthy normal
• it's a cause of polymorphic ventricular tachycardia which can develop to ventricular fibrillation leading to sudden death
• syncope and cardiac arrest are the most common clinical presentations
• nightmares may be found
• may subtle abnormality in right ventricle reported
• if you suspect Brugada syndrome do :- 

             * 12-lead ECG in all patient 
             * Drug challengewith sodium channel blocker if syncope with                          obvious cause

             * Electrophysiologic study

             * Serum K, Ca, CK-MB

             * Genetic test for mutation in SCN5A

Feature on ECG :- 

• incomplete RBBB
• ST elevation in anterior leads

three types of Brugada

• Type 1 .... pronounced elevation of j point ( coved st ) and inverted t wave 
• Type 2 .... saddleback st elevated by more than 1mm
• Type 3 .... st elevated less than 1mm

Treatment :- 

the only treatment is implantable cardioversion defibrillator  ICD.    

                

Endothelin ... ET

 

• Family of 21 amino acids vasoconstrictors peptides

• three isoforms  ET-1   ET-2    ET-3
• mediate their actions via two receptors  ET-A  ET-B
• ET-1 id the most potent 
• ET-1 .....the major source is enfothelial cells then macrophages, fibroblast, cardiac myocyte, and neurons
• ET-2 ......Expressed in intestinal cells and at lower level in the heart
• ET-3 .....Expressed in brain neurons, kidney, and intestinal epithelial cells
• ET-2 & ET-3 differ from ET-1 in two and six amino acid repectively
• endothelin show very close structral and functional relationship to the snake venom peptide
• endothelins are released in the form of preproendothelin then undergone sequential prolytic processing by endothelin converting enzyme ECE
• ET-1 & ET-2 have the same affinity to ET-A but duffer to ET-B
• ET-3 binds to ET-B receptor so hence can be considered selective ET-B