শাহাজালাল স্যারের প্রশ্ন ও উত্তর

এখন পর্যন্ত যে প্রশ্নগুলো স্যার জিজ্ঞাসা করেছেন?

Fluoroquinolone এর ড্রাগসগুলোর নাম।

ciprofloxacin, levofloxacin, lomefloxacin, 

sparfloxacin, gatifloxacin, ofloxacin etc.

Diabetics এর symptoms

 Increased thirst (Polydipsia)

 Feeling tired (Lethargy)
 Frequent urination (Polyuria)
 Constant hunger, even after eating (Polyphagia)
 High level of glucose in urine and in fasting blood
 Blurred vision 

Antibiotics resistance কিভাবে করে?

1. Inhibition of cell wall synthesis 

2. Inhibition of protein synthesis 
3. Inhibition of nucleic acid synthesis
4. Disruption of membrane structure
5. Blocking of cell metabolism

Macrolide drug এর নাম।
erythromycin, clarithromycin, azithromycin.

কিভাবে টেস্ট ছাড়াই বোঝা যাবে কারো ডায়াবেটিস আছে কি না?
ডায়াবেটিসের সাধারণ কিছু লক্ষণ হল, ক্লান্তি, ওজন কমে যাওয়া, অনেক বেশি তেষ্টা, ঘন ঘন প্রস্রাবের প্রবণতা, কাটা স্থান বা ক্ষত শুকোতে সময় লাগা এবং ঝাপসা দৃষ্টি।

Diabetes হলে বেশি ক্ষুদা লাগে কেনো?
ডায়াবেটিসের ফলে শরীর পর্যাপ্ত গ্লুকোজ পায় না। শরীরে প্রয়োজনীয় শক্তির ঘাটতি দেখা দেয়। আর সেই ঘাটতি পূরণের জন্য শরীর তার ফ্যাট ব্যবহার করা শুরু করে। তাই বেশি বেশি ক্ষুদা লাগে। 

সুস্থ মানুষের মুত্রে গ্লুকোজ পাওয়া যায় নাকি?
না। 

Obesity কি?

Obesity is a medical condition in which excess body fat has accumulated to

the extent that it may have negative effects on health, leading to reduced life expectancy and/or increased health problems.

Antibiotic resistance কি?
অণুজীব-বিরোধী প্রতিরোধ্যতা বা অ্যান্টিমাইক্রোবিয়াল রেজিস্ট্যান্স (ইংরেজি: antimicrobial resistance) বা এএমআর হচ্ছে শরীরে কোনো অনুজীবের (প্রচলিত অর্থে ব্যাক্টেরিয়া) নির্মূলে প্রয়োগকৃত নির্দিষ্ট ওষুধের বিপক্ষে যুদ্ধ করে ঐ অনুজীবের টিকে থাকার বা প্রতিরোধক্ষমতা অর্জন করা, যদিও পূর্বে ঐ নির্দিষ্ট ওষুধের মাধ্যমেই সেই অণুজীবটিকে নির্মূল করা সম্ভব হয়েছে।

Penicillin এবং cephalosporin এর পার্থক্য কি ?

Endogenous pyrogen কি?
Endogenous pyrogens are cytokines released from monocytes (which are part of the immune system). In general, they stimulate chemical responses, often in the presence of an antigen, leading to a fever. Whilst they can be a product of external factors like exogenous pyrogens, they can also be induced by internal factors like damage associated with molecular patterns such as cases like rheumatoid arthritis or lupus. Major endogenous pyrogens are interleukin 1 (α and β) and interleukin 6 (IL-6).

Diabetes টেস্টগুলোর নাম?

1. Fasting Blood Sugar (FBS) 

2. Oral Glucose Tolerance Test (OGTT) 
3. Hemoglobin A1c (HbA1c) Test

Oral glucose tolerance test কিভাবে করে?

ডায়াবেটিস শনাক্ত করার জন্য সবচেয়ে সঠিক ও বহুল ব্যবহৃত পদ্ধতি হলো ওরাল গ্লুকোজ টলারেন্স টেস্ট বা ওজিটিটি। এই পদ্ধতিতে রোগীকে সকালে খালি পেটে একবার রক্তে গ্লুকোজ পরীক্ষা করতে হয়, তারপর ৭৫ গ্রাম গ্লুকোজ শরবত পানের দুই ঘণ্টা পর আরেকবার রক্তে গ্লুকোজ পরীক্ষা করা হয়। এই পদ্ধতিতে নির্ভুলভাবে ডায়াবেটিস ও প্রি-ডায়াবেটিস নির্ণয় করা যায়। 

Cephalosporin এর জেনারেশন গুলা কি কি?

The first-generation cephalosporins:

 The first generation includes cephalothin, cefazolin, cephaloridine, cephradine, cephalexin, cefadroxil.

 They possess excellent coverage against most gram (+)ve bacteria and variable to poor coverage against most gram (-)ve bacteria. 

The second-generation cephalosporins:

 The second generation includes cefprozil, cefaclor, cefamandole, cefuroxime, cefonicid, ceforanide.

 They have a greater gram (-)ve spectrum while retaining a similar gram (+)ve spectrum of the first-generation cephalosporins. They are more resistant to beta-lactamase.

The third-generation cephalosporins:

 The third generation includes cefcapene, cefdinir, cefditoren, cefetamet, cefixime, cefmenoxime, cefoperazone, cefotaxime, cefpodoxime, ceftibuten, cefsulodin, ceftizoxime, ceftriaxone.

 They have much-expanded gram (-)ve activity due to enhanced β-lactamase stability and the ability to penetrate the gram (-)ve cell wall. However, some members of this group have decreased activity against gram (+)ve bacteria. 

The fourth-generation cephalosporins:

 The fourth generation includes: cefepime, cefluprenam, cefozopran, cefpirome, cefquinome.

 They have the broadest spectrum of activity, with similar activity against gram (+)ve bacteria as first-generation cephalosporins.

 They have a greater resistance to beta-lactamases than the third-generation cephalosporins. Many fourth-generation cephalosporins can cross the blood-brain barrier and are effective in meningitis.

 Cefepime and cefpirome are highly active against many resistant bacteria that traditionally have been difficult to treat.

Type 2 Diabetes এর কারণ কি?
Relative deficiency of insulin in The blood due to the inability of β-cells to produce and secrete adequate quantities of insulin. 

Type 2 হলে early স্টেজে কি মেডিকেশন দিতে হবে ?

Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.

কোন Drug glucose uptake বাড়ায় আর কোনটা secretion বাড়ায়?

Difference between bacteriostatic and bactericidal antibiotics.

২য় দিনের প্রশ্ন 

Which class belongs to the painkiller?

NSAIDs classification with example

Metabolites of paracetamol.

Paracetamol has two actions:

Antipyretic action: The COX family of enzymes is responsible for the metabolism of arachidonic acid, which gives rise to numerous pro-inflammatory compounds. Anti-inflammatories such as NSAIDs block the COX enzyme in an inflammatory environment where the concentration of peroxide is high. In contrast, paracetamol blocks the COX enzyme in the CNS where the environment is not oxidative. This leads to a reduced amount of prostaglandin E2 in the CNS, thus lowering the hypothalamic set-point in the thermoregulatory center (i.e. reduce the temperature).

Analgesic action: NAPQI is the metabolite of paracetamol. This reactive compound reacts not only with the thiol in TRPA1 receptors but also with any other available nucleophile that it encounters. Thiol groups in the cysteine proteases, e.g. the proteases that take part in the processing of pro cytokines, such as those generating IL-1β and IL-6, might be the targets of NAPQI giving rise to overall analgesic effects.

Causes of Type 2 diabetes

Type 2 diabetes is primarily the result of two interrelated problems:

• Cells in muscle, fat, and the liver become resistant to insulin. Because these cells don't interact in a normal way with insulin, they don't take in enough sugar. 
• The pancreas is unable to produce enough insulin to manage blood sugar levels. 

Exactly why this happens is unknown, but being overweight and inactive are key contributing factors.

Diagnostic test of diabetes

1. Fasting Blood Sugar (FBS) 

2. Oral Glucose Tolerance Test (OGTT) 

3. Hemoglobin A1c (HbA1c) Test

What should you prescribe when a person has normal insulin secretion but has insulin resistance?

Healthy lifestyle choices can help prevent type 2 diabetes, and that's true even if you have biological relatives living with diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

• Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables, and whole grains.
• Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running, or swimming.
• Losing weight. Losing a modest amount of weight and keeping it off can delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight can reduce the risk of diabetes.
• Avoiding inactivity for long periods. Sitting still for long periods can increase your risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), an oral diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

Mechanism of insulin resistance.

Similarity and dissimilarity between Penicillin and cephalosporin

Similarities

Both are antibiotics & act against Bacterial infections.

Diismilarities:

Penicillin has low cure rate than Cephalosporin.

A common cause for obesity in Bangladeshi people.

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have negative effects on health, leading to reduced life expectancy and/or increased health problems. Common cause for obesity in Bangladeshi people is Diet & Sedentary lifestyle.

Which receptor mutation occurs in obesity?

Various genetic conditions that feature obesity have been identified (e.g. leptin receptor mutations, melanocortin receptor mutations).

Main management for obesity.

• Dieting and exercise
• Anti-obesity drugs: With a suitable diet, anti-obesity drugs may be taken to reduce appetite or decrease fat absorption. Examples: Orlistat, lorcaserin, phentermine, and a combination of phentermine and topiramate.
• Bariatric surgery

What is the difference between type1 and type 2 diabetes?

• Type 1 diabetes is an autoimmune disease. It occurs when the insulin-producing islet cells in the pancreas are completely destroyed, so the body can’t produce any insulin.
• In type 2 diabetes, the islet cells are still working. However, the body is resistant to insulin. In other words, the body no longer uses insulin efficiently.
• Type 1 diabetes is far less common than type 2. It used to be called juvenile diabetes because the condition is typically diagnosed in early childhood.
• Type 2 diabetes is more commonly diagnosed in adults, though we’re now seeing more and more children being diagnosed with this disease. It’s more commonly seen in those who are overweight or obese.

Cephalosporine  mechanisms

Cephalosporins are bactericidal agents and have the same mode of action as other beta-lactam antibiotics (such as penicillins). All bacterial cells have a cell wall that protects them. Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell wall, which  causes the wall to break down and eventually the bacteria die. Peptidoglycan is a heteropolymeric component of the cell wall that provides rigid mechanical stability. The final transpeptidation step in the synthesis of peptidoglycan is facilitated by transpeptidases known as penicillin binding proteins (PBPs). PBPs bind to the D-Ala-D-Ala at the end of peptidoglycan precursors to crosslink the peptidoglycan.Cephalosporins mimic the structure of the D-Ala-D-Ala link and bind to the active site of PBPs, disrupting the cross-linking process. If the peptidoglycan fails to cross-link, the cell wall will lose its strength which results in cell lysis.

Cephalosporin কি ধরনের ড্রাগ?

Cephalosporins have a β-lactam ring structure like that of penicillins. They are the largest and most diverse family of β-lactam antibiotics.

fluoroquinolone কোন টাইপের ইনফেকশনে ব্যাবহার করা হয়?

They are used to treat urinary tract infections, respiratory infections (such as sinusitis, pneumonia, bronchitis), and skin infections.

Antidiabetic drug এর Classification

• Biguanides
• Thiazolidinediones
• Alpha-glucosidase inhibitors
• Sulfonylureas
• Meglitinide analogs

NSAIDs এর কোন প্রকারটা ভালো?

Based on mechanism of action, NSAIDs are divided into two broad classes.

Conventional NSAIDs: Examples - Diclofenac, Naproxen, Ibuprofen, Aspirin, Ketoprofen, Indometacin.

Selective Cox-2 inhibitors: Examples - Celecoxib, Rofecoxib, valdecoxib.

Selective COX-2 inhibitors better than conventional NSAIDs.

Paracetamol এর toxicity কি?

Paracetamol is remarkably safe in recommended doses, but because of its wide availability, deliberate or accidental overdoses are common.  

An overdose of paracetamol causes liver damage (hepatotoxicity). Single doses of paracetamol above 10 g, chronic doses over 6 g per day, or chronic doses over 4 g per day in patients with conditions which may increase susceptibility to paracetamol toxicity (e.g. alcoholism), can potentially cause liver damage. More rarely, paracetamol overdose can also cause severe kidney damage. The diagnosis of paracetamol overdose/toxicity include serum bilirubin, ALT, AST, and prothrombin time assay.

Examples of Beta-lactam antibiotics.

β-lactam antibiotics, including penicillins and cephalosporins, inhibit platelet aggregation responses, and some can induce a bleeding diathesis when given in high doses. These include carbenicillin, penicillin G, ticarcillin, ampicillin, nafcillin, cloxacillin, mezlocillin, oxacillin, and piperacillin.

Antidiabetic drugs

• Sulfonylureas
• Pioglitazone
• Rosiglitazone
• Acarbose miglitol
• Ripaglinide

Why fever occurs? 

Fever occurs when the body temperature is increased over 100°F (37.8°C). Fever is not by itself an illness. It's usually a symptom of an underlying condition, most often an infection. Many experts believe that fever is a natural bodily defense against infection.

Mechanism of fluoroquinolone?

Fluoroquinolones inhibit bacterial growth by blocking their DNA replication pathway. During protein synthesis and DNA replication, double-stranded DNA needs to unwind into a single stranded structure, which allows for complementary base pairing to occur and synthesis of mRNA to proceed. DNA gyrase (DNA topoisomerase II) in the bacteria unwinds the bacterial DNA during DNA replication. Topoisomerase IV, on the other hand, is involved in the relaxation of the supercoiled circular DNA and separation of the inter-linked daughter chromosomes. In gram (+)ve bacteria, the main target for fluoroquinolones is DNA gyrase (topoisomerase II); in gram (-)ve bacteria, the primary target is 

topoisomerase IV. Fluoroquinolones inhibit these enzymes by binding to them, due to which the bacteria are unable to replicate or even synthesize proteins and eventually die.

NSAID'S vs Paracetamol

Comparison of Paracetamol with NSAIDs 

1. Unlike aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol has no appreciable anti-inflammatory action. 

2. Paracetamol has analgesic properties comparable to those of aspirin. 

3. Aspirin and other NSAIDs commonly have detrimental effects on the stomach lining where prostaglandins serve a protective role, but paracetamol is safe. 

4. In recommended doses, paracetamol does not affect blood coagulation, or function of the kidneys. 

5. Paracetamol is safe in pregnancy, and does not affect the closure of the fetal ductus arteriosus as NSAIDs can. 

6. Like NSAIDs and unlike opioid analgesics, paracetamol has not been found to cause euphoria or alter mood in anyway. Both paracetamol and NSAIDs have the benefit of bearing a very low risk of addiction, dependence, tolerance and withdrawal.

COX1 vs COX2
Mechanisms of NSAIDs
Antibiotics classification
b lactam ki ki...tadeer majhe similarities
first invention করা penicillin এর নাম কি?
ay penicillin এখন কাজ করে না...ayat re ki bole
Steroid drugs er mechanism
Antidiabetic drugs
Kon anti-diabetic drugs er mechanism same
Sulfonylurea drugs er mechanism
Mammalian cell এ antibiotics এর ইফেক্ট আছে কিনা
Complications of obesity
Antidiabetic drug এর classification
Orlistat drug কেনো ব্যাবহার করা হয়?