Other Antidepressants

Serotonin-norepinephrine reuptake inhibitors(SNRIs)

e.g. venlafaxine and duloxetine
- Inhibit the reuptake of both 5-HT and norepinephrine 
- Has a more favourable adverse effect profile than TCAs

Norepinephrine reuptake inhibitor

e.g. bupropion, reboxetine

Monoamine receptor antagonists

e.g. mirtazapine, trazodone, mianserin



RABIES (Hydrophobia)

An acute infectious disease of mammals, especially carnivores, characterized by CNS pathology leading to paralysis and death.

Etiology and Epidemiology

Rabies is caused by a neurotropic virus often present in the saliva of rabid animals


The virus travels from the site of entry via peripheral nerves to the spinal cord and the brain, where it multiplies; it continues through efferent nerves to the salivary glands and into the saliva.

microscopic examination shows perivascular collections of lymphocytes but little destruction of nerve cells. Intracytoplasmic inclusion bodies (Negri bodies), usually in the cornu Ammonis, are pathognomonic of rabies, but these bodies are not always found.


In humans, the incubation period varies from 10 days to > 1 yr and averages 30 to 50 days.

Rabies commonly begins with a short period of depression, restlessness, malaise, and fever. Restlessness increases to uncontrollable excitement, with excessive salivation and excruciatingly painful spasms of the laryngeal and pharyngeal muscles. The spasms, which result from reflex irritability of the deglutition and respiration centers, are easily precipitated Hysteria due to fright

Prognosis and Treatment

Death from asphyxia, exhaustion, or general paralysis usually occurs within 3 to 10 days after onset of symptoms

Rheumatic fever

Rheumatic fever

Before antibiotic therapy, this was the most common cause of valvular disease.
1. Usually preceded by a group A streptococci respiratory infection; for example, strep throat.
2. All three layers of the heart may be affected. The pathologic findings include Aschoff bodies, which are areas of focal necrosis surrounded by a dense inflammatory infiltration.

3. Most commonly affects the mitral valve, resulting in mitral valve stenosis, regurgitation, or both.


The periodontium consists of tissues supporting and investing the tooth and includes cementum, the periodontal ligament (PDL), and alveolar bone.

Parts of the gingiva adjacent to the tooth also give minor support, although the gingiva is Not considered to be part of the periodontium in many texts. For our purposes here, the groups Of gingival fibers related to tooth investment are discussed in this section.




Special visceral afferent (SVA) fibers of cranial nerves VII, IX, and X conduct signals into the solitary tract of the brainstem, ultimately terminating in the nucleus of the solitary tract on the ipsilateral side.

Second-order neurons cross over and ascend through the brainstem in the medial lemniscus to the VPM of the thalamus.

Thalamic projections to area 43 (the primary taste area) of the postcentral gyrus complete the relay.

SVA VII fibers conduct from the chemoreceptors of taste buds on the anterior twothirds of the tongue, while SVA IX fibers conduct taste information from buds on the posterior one-third of the tongue.

SVA X fibers conduct taste signals from those taste cells located throughout the fauces.


The smell-sensitive cells (olfactory cells) of the olfactory epithelium project their central processes through the cribiform plate of the ethmoid bone, where they synapse with mitral cells. The central processes of the mitral cells pass from the olfactory bulb through the olfactory tract, which divides into a medial and lateral portion The lateral olfactory tract terminates in the prepyriform cortex and parts of the amygdala of the temporal lobe.

These areas represent the primary olfactory cortex. Fibers then project from here to area 28, the secondary olfactory area, for sensory evaluation. The medial olfactory tract projects to the anterior perforated sub­stance, the septum pellucidum, the subcallosal area, and even the contralateral olfactory tract.

Both the medial and lateral olfactory tracts contribute to the visceral reflex pathways, causing the viscerosomatic and viscerovisceral responses.

The Tongue

The Tongue

  • The tongue (L. lingua; G. glossa) is a highly mobile muscular organ that can vary greatly in shape.
  • It consists of three parts, a root, body, and tip.
  • The tongue is concerned with mastication, taste, deglutition (swallowing), articulation (speech), and oral cleansing.
  • Its main functions are squeezing food into the pharynx when swallowing, and forming words during speech.


Gross Features of the Tongue

  • The dorsum of the tongue is divided by a V-shaped sulcus terminalis into anterior oral (presulcal) and posterior pharyngeal (postsulcal) parts.
  • The apex of the V is posterior and the two limbs diverge anteriorly.
  • The oral part forms about 2/3 of the tongue and the pharyngeal part forms about 1/3.


Oral Part of the Tongue

  • This part is freely movable, but it is loosely attached to the floor of the mouth by the lingual frenulum.
  • On each side of the frenulum is a deep lingual vein, visible as a blue line.
  • It begins at the tip of the tongue and runs posteriorly.
  • All the veins on one side of the tongue unite at the posterior border of the hyoglossus muscle to form the lingual vein, which joins the facial vein or the internal jugular vein.
  • On the dorsum of the oral part of the tongue is a median groove.
  • This groove represents the site of fusion of the distal tongue buds during embryonic development.


The Lingual Papillae and Taste Buds

  • The filiform papillae (L. filum, thread) are numerous, rough, and thread-like.
  • They are arranged in rows parallel to the sulcus terminalis.
  • The fungiform papillae are small and mushroom-shaped.
  • They usually appear are pink or red spots.
  • The vallate (circumvallate) papillae are surrounded by a deep, circular trench (trough), the walls of which are studded with taste buds.
  • The foliate papillae are small lateral folds of lingual mucosa that are poorly formed in humans.
  • The vallate, foliate and most of the fungiform papillae contain taste receptors, which are located in the taste buds.


The Pharyngeal Part of the Tongue

  • This part lies posterior to the sulcus terminalis and palatoglossal arches.
  • Its mucous membrane has no papillae.
  • The underlying nodules of lymphoid tissue give this part of the tongue a cobblestone appearance.
  • The lymphoid nodules (lingual follicles) are collectively known as the lingual tonsil.

German measles

German measles (rubella)
 - sometimes called "three day measles".
 - incubation 14-21 days; infectious 7 days before the rash and 14 days after the onset of the rash.
 - in adults, rubella present with fever, headache, and painful postauricular Lymphadenopathy 1 to 2 days prior to the onset of rash, while in children, the rash is usually the first sign.
 - rash (vasculitis) consists of tiny red to pink macules (not raised) that begins on the head and spreads downwards and disappears over the ensuing 1-3 days; rash tends to become confluent.
 - 1/3rd of young women develop arthritis due to immune-complexes.
 - splenomegaly (50%) 



A hormone is a chemical that acts as a messenger transmitting a signal from one cell to another. When it binds to another cell which is the target of the message, the hormone can alter several aspects of cell function, including cell growth, metabolism, or other function.

Hormones can be classified on three primary ways as following:

1.  Autocrine: An autocrine hormone is one that acts on the same cell that released it.

2.  Paracrine: A paracrine hormone is one that acts on cells which are nearby relative to the cell which released it. An example of paracrine hormones includes growth factors, which are proteins that stimulate cellular proliferation and differentiation.

3. Endocrine: An endocrine hormone is one that is released into the bloodstream by endocrine glands. The receptor cells are distant from the source. An example of an endocrine hormone is insulin, which is released by the pancreas into the bloodstream where it regulates glucose uptake by liver and muscle cells.

Fulminant hepatitis

Fulminant hepatitis

Fulminant hepatitis leads to submassive and massive hepatic necrosis. 
a. Etiology. HAV, HBV, HCV, delta virus (HDV) superinfection, HEV, chloroform, carbon tetrachloride, isoniazid, halothane, and other drugs (acetaminophen overdose) all may cause fulminant hepatitis.
b. Clinical features include progressive hepatic dysfunction with a mortality of 25%-90%.
c. Pathology

(1) Grossly, one sees progressive shrinkage of the liver as the parenchyma is destroyed. 



Distortion is dependant on temperature & time interval before investing .
To avoid any distortion ,
Invest the pattern as soon as possible .
Proper handling of the pattern .

Wax pattern should be evaluated for smoothness , finish & contour .
Pattern is inspected under magnification & residual flash is removed .