Types of Vaccines and Their Definitions

Live Attenuated Vaccine:
This type of vaccine involves injecting a small sample of the virus into the body, allowing the immune system to fight it and create an immune response against it for future attacks. The MMR vaccine is an example of a live attenuated vaccine.

Conjugate Vaccine:
Conjugate vaccines are created by combining a weak antigen with a strong antigen to produce a stronger immune response. Typically, a polysaccharide is joined with a strong protein to create this type of vaccine.

Inactivated Vaccine:
Inactivated vaccines, such as the pertussis and hepatitis A vaccines, contain dead pathogens that cannot cause disease but still stimulate an immune response.

Subunit Vaccine:
Subunit vaccines only contain the antigenic component of the pathogen. However, there is no guarantee that immunological memory will be achieved appropriately. The pneumococcal vaccine is an example of a subunit vaccine.

Toxoid Vaccine:
Toxoid vaccines are toxins that have been deactivated but still stimulate an immune response from the immune system. Examples include the diphtheria and tetanus vaccines.

Understanding the Different Types of Vaccines

Management of Dyspepsia and Referral for Possible Cancer

Dyspepsia is a common symptom that can be caused by various factors, including medication and lifestyle choices. However, it can also be a sign of underlying conditions such as stomach or oesophageal cancer. The 2015 NICE guidelines provide updated advice on when urgent referral for endoscopy is necessary. Patients with dysphagia or an upper abdominal mass consistent with stomach cancer should be referred urgently. Patients aged 55 years or older with weight loss and upper abdominal pain, reflux, or dyspepsia should also be referred urgently. Non-urgent referrals include patients with haematemesis or those with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with other symptoms.

For patients with undiagnosed dyspepsia, a step-wise approach is recommended. First, medications should be reviewed for possible causes. Lifestyle advice should also be given. If symptoms persist, a trial of full-dose proton pump inhibitor for one month or a ‘test and treat’ approach for H. pylori can be tried. If symptoms persist after either approach, the alternative should be attempted. Testing for H. pylori infection can be done using a carbon-13 urea breath test, stool antigen test, or laboratory-based serology. If symptoms resolve following test and treat, there is no need to check for H. pylori eradication. However, if repeat testing is required, a carbon-13 urea breath test should be used.

Managing the Risk of Osteoporosis in Patients Taking Corticosteroids

Osteoporosis is a significant risk for patients taking corticosteroids, which are commonly used in clinical practice. To manage this risk appropriately, the 2002 Royal College of Physicians (RCP) guidelines provide a concise guide to prevention and treatment. According to these guidelines, the risk of osteoporosis increases significantly when a patient takes the equivalent of prednisolone 7.5mg a day for three or more months. Therefore, it is important to manage patients in an anticipatory manner, starting bone protection immediately if it is likely that the patient will need to take steroids for at least three months.

The RCP guidelines divide patients into two groups based on age and fragility fracture history. Patients over the age of 65 years or those who have previously had a fragility fracture should be offered bone protection. For patients under the age of 65 years, a bone density scan should be offered, with further management dependent on the T score. If the T score is greater than 0, patients can be reassured. If the T score is between 0 and -1.5, a repeat bone density scan should be done in 1-3 years. If the T score is less than -1.5, bone protection should be offered.

The first-line treatment for corticosteroid-induced osteoporosis is alendronate. Patients should also be replete in calcium and vitamin D. By following these guidelines, healthcare professionals can effectively manage the risk of osteoporosis in patients taking corticosteroids.

The use of ethambutol has been linked to optic neuropathy and the onset of color blindness. If these symptoms occur, the medication should be stopped. To prevent these adverse effects, pyridoxine (vitamin B6) is often administered alongside ethambutol in medical settings.

Side-Effects and Mechanism of Action of Tuberculosis Drugs

Rifampicin is a drug that inhibits bacterial DNA dependent RNA polymerase, which prevents the transcription of DNA into mRNA. However, it is a potent liver enzyme inducer and can cause hepatitis, orange secretions, and flu-like symptoms.

Isoniazid, on the other hand, inhibits mycolic acid synthesis. It can cause peripheral neuropathy, which can be prevented with pyridoxine (Vitamin B6). It can also cause hepatitis and agranulocytosis. Additionally, it is a liver enzyme inhibitor.

Pyrazinamide is converted by pyrazinamidase into pyrazinoic acid, which in turn inhibits fatty acid synthase (FAS) I. However, it can cause hyperuricaemia, leading to gout, as well as arthralgia, myalgia, and hepatitis.

Lastly, Ethambutol inhibits the enzyme arabinosyl transferase, which polymerizes arabinose into arabinan. It can cause optic neuritis, so it is important to check visual acuity before and during treatment. Additionally, the dose needs adjusting in patients with renal impairment.

In summary, these tuberculosis drugs have different mechanisms of action and can cause various side-effects. It is important to monitor patients closely and adjust treatment accordingly to ensure the best possible outcomes.

Contraceptives – Time to become effective (if not used on the first day of period):
Immediate: IUD
2 days: Progestin-only pill (POP)
7 days: Combined oral contraceptive (COC), injection, implant, intrauterine system (IUS)

Intrauterine contraceptive devices include copper IUDs and levonorgestrel-releasing IUS. Both are over 99% effective. The IUD prevents fertilization by decreasing sperm motility, while the IUS prevents endometrial proliferation and thickens cervical mucus. Potential problems include heavier periods with IUDs and initial bleeding with the IUS. There is a small risk of uterine perforation, ectopic pregnancy, and infection. New IUS systems, such as Jaydess® and Kyleena®, have smaller frames and less levonorgestrel, resulting in lower serum levels and different rates of amenorrhea.

Dyspepsia, abdominal pain, nausea, and anorexia are among the early signs of stomach cancer. This type of cancer is uncommon and is more likely to occur in individuals over the age of 50, particularly those with pernicious anemia. Pancreatic cancer is linked to the onset of diabetes. Bone pain is a typical symptom of myeloma. Recurrent infections, bleeding, and bruising are common symptoms of acute leukemia.

Management of Dyspepsia and Referral for Possible Cancer

Dyspepsia is a common symptom that can be caused by various factors, including medication and lifestyle choices. However, it can also be a sign of underlying conditions such as stomach or oesophageal cancer. The 2015 NICE guidelines provide updated advice on when urgent referral for endoscopy is necessary. Patients with dysphagia or an upper abdominal mass consistent with stomach cancer should be referred urgently. Patients aged 55 years or older with weight loss and upper abdominal pain, reflux, or dyspepsia should also be referred urgently. Non-urgent referrals include patients with haematemesis or those with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with other symptoms.

For patients with undiagnosed dyspepsia, a step-wise approach is recommended. First, medications should be reviewed for possible causes. Lifestyle advice should also be given. If symptoms persist, a trial of full-dose proton pump inhibitor for one month or a ‘test and treat’ approach for H. pylori can be tried. If symptoms persist after either approach, the alternative should be attempted. Testing for H. pylori infection can be done using a carbon-13 urea breath test, stool antigen test, or laboratory-based serology. If symptoms resolve following test and treat, there is no need to check for H. pylori eradication. However, if repeat testing is required, a carbon-13 urea breath test should be used.

Common Eye Conditions and Their Symptoms

Blepharitis: This condition presents with crusting of both eyelids, redness, swelling, and itching. It can be treated with eyelid hygiene and warm compress. If necessary, chloramphenicol ointment can be used.

Conjunctivitis: Patients with conjunctivitis have watery/discharging eyes, a gritty sensation, and conjunctival erythema. Most cases resolve on their own, but some may require topical antibiotics.

Chalazion: A painless swelling or lump on the eyelid caused by a blocked gland. Patients report a red, swollen, and painless area on the eyelid that settles within a few days but leaves behind a firm, painless swelling. Warm compresses and gentle massaging can help with drainage.

Entropion: The margin of the eyelid turns inwards towards the surface of the eye, causing irritation. It is more common in elderly patients and requires surgical treatment.

Hordeolum: An acute-onset localised swelling of the eyelid margin that is painful. It is usually localised around an eyelash follicle, and plucking the affected eyelash can aid drainage. Styes are usually self-limiting, but eyelid hygiene and warm compress can help with resolution.

Understanding Common Eye Conditions and Their Symptoms

Immediate CT scan is necessary to evaluate for raised intracranial pressure and tentorial herniation in a patient with a sluggishly responsive unilaterally dilated pupil. This is the most pressing concern, given the patient’s reduced GCS. Although other investigations will be necessary, the CT brain is the most critical test, as the patient may require urgent neurosurgical intervention to save their life.

Patients with head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. There are different types of traumatic brain injuries, including extradural hematoma, subdural hematoma, and subarachnoid hemorrhage. Primary brain injury may be focal or diffuse, and secondary brain injury can occur due to cerebral edema, ischemia, infection, or herniation. Management may include IV mannitol/frusemide, decompressive craniotomy, and ICP monitoring. Pupillary findings can provide information on the location and severity of the injury.

Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.

Epstein’s pearl, a type of congenital cyst found in the mouth, typically does not require any treatment. These cysts are commonly found on the hard palate, but can also be mistaken for a tooth eruption when located on the gums. They usually resolve on their own within a few weeks. Neonatal teeth, on the other hand, are rare and not typically found on the hard palate. Bohn’s nodules are mucous gland cysts that are usually located on the buccal or lingual aspects of the alveolar ridges, and rarely on the palate. A congenital ranula is a papule or nodule that is firm and translucent, and is typically found on the anterior floor of the mouth, lateral to the lingual frenulum.

Understanding Epstein’s Pearl

Epstein’s pearl is a type of cyst that is present in the mouth from birth. It is commonly found on the hard palate, but can also be seen on the gums, which may be mistaken for a tooth eruption. The good news is that no treatment is usually required as these cysts tend to disappear on their own within a few weeks.