🧪 Glomerular Hematuria

💧 Nephrotic Syndrome

• Edema cause: Hypoalbuminemia
• Commonest cause (adults): Diabetes mellitus
• Lipid profile: ↓ HDL cholesterol
• Minimal change disease: No change on light microscopy
• Membranoproliferative GN: Tram-track appearance
• Membranous GN: Common in renal vein thrombosis
• Best test for renal vein thrombosis: CT angiography

🔬 Key Features & Forms

• Most infective form: Cavitary lesion
• Primary TB Presentation: Unilateral hilar lymphadenopathy
• Rich focus: Meninges (associated with TB meningitis)
• Cavitation: Absent in HIV-associated or primary TB

💡 Special Manifestations

• Hypersensitivity to Mycobacteria: Phlyctenular conjunctivitis
• Poncet’s disease: Joint pains without active arthritis
• Miliary TB: Mantoux test negative
• Recurrent hemoptysis source: Bronchial artery

💊 Drug Details

• Streptomycin: Not used in TB meningitis
• Bedaquiline: New drug for MDR-TB

Important Periodontal Indices

PMA Index

• Purpose: Assessment of gingival disease status
• Components: Papillary (P), Marginal (M), and Attached (A) gingiva scoring

Ramfjord Index

• Selected Teeth: 16, 21, 24, 36, 41, 44
• Rationale: Representative sampling of entire dentition

Merin's Classification

• Application: Patient recall scheduling based on periodontal status
• Categories: Maintenance intervals based on disease severity

Clinical Measurements

Gingival Sulcus Depth

• Primary Teeth: 1-2mm (shallower than permanent teeth)
• Permanent Teeth: 2-3mm in health

Level of Attachment

• Definition: Distance from cementoenamel junction (CEJ) to pocket base
• Clinical Significance: True measure of periodontal support loss

Fremitus Test

• Purpose: Diagnosis of tooth mobility
• Technique: Palpation during functional movements

Infection Timeline Post-BMT

Phase I: Pre-engraftment (0-30 days)

• Earliest infection: Herpes Simplex Virus (HSV)
• Other pathogens: Bacteria, Candida, Aspergillus
• Risk factors: Neutropenia, mucositis, central lines

Phase II: Early post-engraftment (30-100 days)

• ~7th week (50 days): Interstitial Pneumonitis peak incidence
• Causes: CMV, Pneumocystis jirovecii, idiopathic
• GVHD: Acute graft-versus-host disease peak

Phase III: Late post-engraftment (>100 days)

• Chronic GVHD: Major concern
• Encapsulated bacteria: Due to functional asplenia
• Varicella-zoster virus: Reactivation common

Specific Infectious Complications

CMV Disease

• Timeline: 30-100 days post-BMT
• High risk: CMV+ recipient or donor
• Manifestations: Pneumonitis, gastroenteritis, retinitis

Interstitial Pneumonitis (IP)

• Peak incidence: ~7th week (50 days) post-BMT
• Types:
  • CMV pneumonitis (most common infectious cause)
  • Idiopathic IP
  • Pneumocystis pneumonia
• Mortality: High, especially CMV pneumonitis

Prophylactic Strategies

• Antibacterial: Fluoroquinolones
• Antifungal: Fluconazole or newer azoles
• Antiviral: Acyclovir for HSV/VZV
• PCP prophylaxis: Trimethoprim-sulfamethoxazole
• CMV monitoring: Pre-emptive therapy based on viral load

GVHD Prevention

• Immunosuppression: Methotrexate + calcineurin inhibitors
• T-cell depletion: In some protocols
• HLA matching: Reduces risk significantly

Sharpening Stones

• Natural: India, Arkansas
• Artificial: Ruby, Carborundum, Ceramic

Surgical Equipment

• Dental loupes: 1.5 – 6× magnification
• Coe – pak working time: 15 – 20 minutes

Preventive Measures

• Calculus control toothpastes: Contain pyrophosphates
• Antibiotic prophylaxis: Amoxicillin 2.0g, 30 – 60 min before procedure

Abrasion Rates

• Dentin: 25× faster than enamel
• Cementum: 35× faster than enamel

Gingival crevicular fluid is an inflammatory exudate found in the gingival sulcus. It plays a significant role in periodontal health and disease.

A. Characteristics of GCF

• Glucose Concentration: The glucose concentration in GCF is 3-4 times greater than that in serum, indicating increased metabolic activity in inflamed tissues.
• Protein Content: The total protein content of GCF is much less than that of serum, reflecting its role as an inflammatory exudate.
• Inflammatory Nature: GCF is present in clinically normal sulci due to the constant low-grade inflammation of the gingiva.

B. Drugs Excreted Through GCF

• Tetracyclines and Metronidazole: These antibiotics are known to be excreted through GCF, making them effective for localized periodontal therapy.

C. Collection Methods for GCF

GCF can be collected using various techniques, including:

1. Absorbing Paper Strips/Blotter/Periopaper: These strips absorb fluid from the sulcus and are commonly used for GCF collection.
2. Twisted Threads: Placing twisted threads around and into the sulcus can help collect GCF.
3. Micropipettes: These can be used for precise collection of GCF in research settings.
4. Intra-Crevicular Washings: Flushing the sulcus with a saline solution can help collect GCF for analysis.