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Dr Ram Bechan Shah, Kathmandu (2025)

31/05/2025

A MONTH COURSE OF ANTI TUBERCULOSIS DRUGS, SENSITIVITY & RESISTANCE
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Mycobacterium tuberculosis is an aerobic, + ve rod shaped, non motille, non capsulated 2 × 0 2 un have nucleus, cytoplasm envelope cell membrane, cell wall composed of peptidoglycans, arabinoglactan MYCOLIC ACID lipids ,and micosides , acid fast bacillus once stained with hot carbolic fuchsin resist to decolourise by dilute mineral acid or alcohol due presence of mycolic acid lipids
SENSITIVITIES of M .TB to ATT
1 Inhibit cell wall synthesis - vancomycin, cycloserin
2 Inhibit protein synthesis- linezolid
3 Disrupt m RNA codes & affect permeability- strptomycin ,kananycin
4 Inhibit DNA gyrase - Fluoroquinolons
5 Interfere with DNA & RNA functions- Rifampicin ,Rifabutin
6 Interfere with DNA synthesis - Idoxuridine
7 Intertere with intermediary metabolism- para amino salycylic acid ,Ethambutol
8 Inhibit the synthesis of mycolic acid - Isoniazid , Pyrazinamide ,Ethambutol
9 Tuberculocidal and pe*****te tubercular cavities - streptomycin
10 Tuberculostatic - Thiocetazone
11 Most potent drugs - Bedaquilin , Linezolid
Anti TB drugs can be divided into
1 1st line - HRZES - Isoniazid, Rifampicin ,Pyrazinamide, Ethambutol, streptomycin
2 2nd line - cycloserine, kanamycin ,Amikacin , capreomycin ,Fluroquinolones, Delamanid ,Azithro ,clarithro, pa, tan, Etm
Thus suggestive synergistic wise use of ATT may kills Mycobacterium within a month for cat 1 ie.Att 2nd line for 14 days followed by 1st line for 14 days ( complete successful 1 months treatment ) when approved by WHO ie. Killing of M . Tuberculosis's DNA ,PROTEINS ,RNA ,METABOLISM, CELL WALL above described
RESISTANCE ---
Unwise use of ATT soon develop resistance by 1 Mutational changes M Bacterial genome 2 Transmission of resistance steaints 3 with Inadequate treatment ,4 Non compliance 4 poor quality drugs 5 poor

30/05/2025

CANCER AND VACCINE
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Due offensive process abnormal and abrupt multiplication of cells, invades surroundings, metastasize to distal organs, secretions toxin to normal cells termed CANCER mostly affects Lungs ,colon , re**um , Breast , prostate ,uterine and ulcers when chronic exposed to environmental, genetic , dietary, debilated, with physical ,chemicals ,Biological carcinogenic agents
Vaccines means contents of micro dose antigens in the form of live ,killed, live attenuated rendered harmless which when introduced, produced antibodies prevent or therapeutic uses against that disease here cancer causing constituents of carcinogens, pro onchogens , proto onchogens, mutagens, onchogens are inserted into chromosomes by using reverse transcriptase complementary DNA is made from their RNA , further process may require cancer suppressor Gene's, growth inhibitors factors, apoptosis inhibitors and tumour markers have been used to manufacture ANTI CANCER VACCINES recently Russia claimed, have developed m - RNA based personalized cancer vaccines in early December 2024 freely available by early 2025 ....

30/05/2025

BENIGN PROSTATE OR CARCINOMA
PROSTATE .. .
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Male Prostate gland lies in pelvic cavity at base of the urinary bladder surrounds prostatic urethra, Ejaculatory ducts ( deferent duct + seminal vesicles) composed of smooth muscles ,glands of columnar epithelial cells secretes lubricating fluids through tiny ducts into urethra
Prostatic secretions a thin milky fluid contains enzymes prostatic specific antigens thinning the semen, enhance Male fertility , nourishing s***m cells a product of germinal epithelial cells , sertoli cells of semniferous tubules in te**es lubricate ej*******on , help urination, activate hormones metabolism ie. Conversion of testosterone,( androgen ) secretions of interstitial cells of leydig in between tubules into more active forms dihydrotestosterone but
But due pathological change process ie. Hypertrophy( cell size increase ) and hyperplasia ( excess cells multiply) of prostate with due narrowed urethra resulting frequent urge to urinate ,, haematuria ,, pain and burning urination ,,painful ej*******on ,,retention or dribbling urine, stiff lower back thus enlargement of prostate starts with aging after 50 -- 60 , hormonal changes testosterone to dihydrotestosterone, obesity, metabolic syndromes, sedentary lifestyle, WHEN THERE IS LESS SPERMATOGENESIS & TESTOSTERONE SECRETION RESULTING FROM ADVANCED DEGENERATIVE AGE FREQUENTLY EMPHASISE IN SEXUAL ACTIVITIES RE - ENFORCED TE**ES AND PROSTATIC GLANDS TO ACTIVATE ITS FUNCTIONS BY FEED BACK MECHANISMS CAUSING HYPERPLASIA AND HYPERTROPHY OF PROSTATE GLAND MANIFESTATIONS OF BENIGN OR CARCINOMA PROSTATE
Mgmt ---'
Stop old age coitus , invite brain attacks and heart attack

27/07/2024

( Mysterious female )
Genetic in below punnet square define the different alleles ( different version of gene = genotype ) and trait ( observable character in female offspring = phenotype ) present globally are female having X,X' allele or X',X' allele Trait present in condition 1st generation XX' trait and in condition 2nd generation X'X' traits are courageous and beautiful whereas in condition 1 XX and condition 2 XX' are coward or ugly may be with mixed observable characteristics.
Female traits X'X' and XX' are strongly dominant courageous beautiful may not be obedient to parents or husbands possessing highly sexual behaviour need multi partners stay pre and post marital relationship, destroying self, home, family, social and nations.
This type of female may represent dacoits , violence, terrorists behavior in the community but
But such females sometimes may be proved highly indigenous, courageous and heroism for all season to the nation

Mgmt
1 Such females needs moral education from their parents or husband
2 They should be emotionally induced by sensable movie that is kind and charatable in their heart.
3 Should be punished early on her bad activities since childhood
4 Enriched her with law legal and justice lessons
5 Learn her how to emotionally controlled over their bad will power ( sexy )
---- Reduce divorce diversity, increase love to offspring

07/11/2021

RICE (CARBOHYDRATES ) EATING AFTER 40 IS HARMFUL ?
Cell degeneration start just after 35 to 40 and stomach has no gastric amylase to digest carbohydrates but food remains in stomach atleast for 4 to 6 hrs allowing food to break down by acidification action
and small jet of chyme when entered Duodenum less secretion of pancreatic amylase due to degeneration of tissues
Thus indigested food , cause Gastric upset, diarrhoea etc., when absorbed in circulation very hard to modify glucose to glycogen and energy production by inefficient insulin so please consume less carbohydrates in elderly ......

Dr Ram Bechan Shah

31/05/2025

30/05/2025

30/05/2025

27/07/2024

07/11/2021

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