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Thanks. Three I was gonna say, uh, my screen now, um, cover and see. Yep. Okay. Uh, first one, they just said My pointer A swell, uh, you never and see that. Yeah, we can see if I can. Cool. So, hi, everyone. Hope everyone's okay and found this case. Um, okay, so far. So we're gonna be covering case all which is reproductive. And ask me physiology. We're gonna be looking at UT Eyes latest today as well with Becky on some pharmacology, too. But I'm going to be starting off the session with some reproductive anatomy. We'll look into histology as well on with the computer t the menstrual cycle. We'll be looking at some sex hormones and how they interact with each other on will quickly go over some kidney physiology to help you with. Well, Becky, we'll talk about later on. I'll cover the Gillick and phrase the guidelines to, um so I'm gonna just start now. So if everyone could just type into the chat, what do you think the difference between these two pelvis is is so you can just describe it. And if anyone wants deidentify, um, which gender? Each one is just say left and right on. But we'll start off with this. So, um, don't be shy. Just, like, just describe what you see. So let me just have a look at the chart. So someone says the right is mail on the left is female. That's right. Connect you one. Um, like, identify some anatomical difference is so not just gender. Like, um, yes. So someone said the actual in and then it gynecoid pelvis. Does anyone know what the the one is called and you can describe. So can you noticed any differences in wit or anything is? Well, yeah, under a port. Or you could under it. But yet Yeah. So I'm gonna, um, tell you guys now, So, um, you can see Can you see the next slide? Oh, okay. So you can see that the female pelvis is wider on down here. You can see a last prominent school, Scott spine compared to the male pelvis on in the mail pelvis. You can see a longer sacrum here is well on. It's quite narrow. And this is in the females. It's wider. Just the child birth. So that's why I often women have why the hips and have the gynecologist on an interpreter. Um, pelvis is well, so I'm going to go into some more anatomy. So the first part of this is this going to be a few questions in the chart? So can anyone label the's labels that just shot them out into the chart? Don't be shy. Um, and then we can move on to the next part. So can I. Don't tell me what this label ist. Um, don't be shy. It's just fine to get it wrong. Yeah. And can anyone tell me what the rest are you going to show any out? Doesn't matter which one you say. And I was kind of hard to see, but, um, I think we have a few ounces coming in a swell. So yeah, I'm just gonna move onto the answers. So here we have, um, the urethra, the epididymis, um, in there, you can see the nutritious and right below it right what's right next to the uterus, the bladder. And, you know, in pregnant women where they have to have polyuria because a baby will be in here so this will expand on. Often it will compress onto the bladder and That's why I often pregnant women will use the toilet a lot. So that's why it's really important to understand the anatomy, especially in this sagittal car section, because it really illustrates why some symptoms may occur when there might be very variations in this. So, um, you can also see here there's the ureter. Um, if anyone's ever heard of the phrase water under the bridge So you the ureter has obviously the urine or we'll call it the water. Um, on the bridge Is this you tried arteries to the you try an artery runs until area to the your eat a here never, and see that on. But so you can remember that by remembering water under the bridge and in men, you can see the vast difference being labeled as well. So here, um, in that in vast difference, that runs anterior to the ureters. Well, so just remember, it's water under the bridge in both cases. So I've just got another labeling exercise here. A swell. So, um, what's the missing part of that? You're trying to be here? Yeah, the ampulla Andi, what's the missing part of the you trying world yet on what's missing. Ah, what have I labeled here, Um, under the side next to the ovary and then even say that. So I've got a damn polar, the myometrium and the broad ligament. So I was gonna go into what the broad ligament is Onda about all the the ligaments. So you can see here the ovarian ligament here That's a five breast band that basically just connects our ovaries to the rest of the uterus on here. There's no vasculature running through that. You also have this suspensory ligament here and that contains the ovarian on the over an artery and the ovarian vein. And I'm just going to go in a bit more detail about the broad ligament. So the broad ligament, there's three parts to it that we have to know. So the broad ligament is just folds of the perineum, and it has three parts. You have the may, so salpingo never parents may. So cell pinks was connects to the you trying to be here. So if you have, if you think of this is a cross section, um that connects the rest of the broad ligament to the and then you have the May Savarin um, here is well, so that attach is to the ovaries. So if you think behind here does attach just this broad ligament to the ovaries, I'll show you another cross section. That might be easier. But there's another, um, layer to listen to the part of the broad ligament, too. So there's the ms, um, atrium. So that's this big green bit on that just covers the whole uterus as a broad sheet. So if you think of it as a cross section, this is the ovary. On this top section is the Masons of May. So salpingo above here. Connecting that, um, is the makes a very, um, and then they have the mid me symmetry. Um, here does that make sense to everyone on one mark? Got to mention was the round ligament that can also be seen here and passes through here on all these just folds. Um, they're like a big blanket over the whole entire uterus. Basically, um, I'm going to go into a bit more detail about each part of the female anatomy. So let's look at the you trying to So you have fimbriated? Yeah. So they just February. You can remember that as finger in Latin so you can see that just kind of like silly shapes, very kind of washed on. Pick up the new site from the ovary said, This will release in your sight. And this was picked up by the, um, February here, and it travels along the you trying to be so most fertilization will occur in the you trying to be and the widest part. So here you have the ampulla. The sample is wide and it's convoluted, and it has a very thin wall on. This is where, because the widest part of the uterine to this is where, UM, first is a shin is most likely Turker on. It's highly complicated with me cause of hold on, and that's just increased the surface area on control. The movement off the side along um, you also have the infundibulum here on it's Ms. So it's Ms um, you know, if anyone knows, Latin just means bridge, so it's narrow and it's great, and it has a really thick walls, and you can just remember that another thing to remember is there's two types of epithelium in the uterine tubes. You have simple Colombia actually um on you have. There's two types of the security. There's security, really watery secretions off gammy nourishment as well. And then you also have silly, silly ated wants to. So that's just the length of the PSA level. Change with hormone release. So when when females my whole, have their menstrual cycle, when there's an increase in eastern GYN that increases the length of the cilia, and that basically just means this'll ear well washed, the egg fastest of the beat right will increase. That's just a little fact to remember. So now we'll move on to the wall of the uterus. Eso The uterine wall is made up of three parts the endometrium, the myometrium in the parametrium. So the endometrium is just apathy, apathy, Leah layer on that increases in thickness according to the menstrual cycle, which will go into later. But this is where this I go is embedded after fertilization. Then you have the myometrium. If you remember my oh, as muscle. So this is the thickest layer, and it's made of smooth muscle. You can have hypertropia hyperplasia here, so hypertrophy just means a zit increase in cell size or hyperplasia, which means an increase in cell number during pregnancy is well on. Then you finally have the parametrium. So the parametrium if I kind of remember as, like perimeter so permitted that out to most, like, edge off a circle. A parrot parametrium is the outermost layer on. This is the same as the visceral party. Um um, as well. So aqui path ology that you guys might want to remember is you could have you try And fibroids are also called lion maney mia on that. Just basically growths made up of connect connective tissue, Um, in the uterine wall. So lots of women have them, and most of them are completely fine to have. But you can have sub mucosal ones that are between the endometrium on the myometrium so that just a thick, fibrous kind of, um, like connective balls, connective tissue ball that can grow here you can have intramural, which is within the myometrium itself. So interest, it could be embedded in here on their actually the most common type. And you can also have Perry me trim. So, um, so that could be done. Kelated I mean, and that's at the head of nutrition here. Um, if that makes sense. So now we're going to move onto the Squamocolumnar junction. So you see here there's two types of epithelium, Hera's well, and there's a transformation zone where it goes from Columbia to squamous epithelium. I hope this diagram makes a bit more easy to see, but in the transformation zone, this is just a junction where cells can undergo dysplasia. So that's just when there's change from one type of cell type to another on because there's loads of dysplasia happening here. Wherever there's dysplasia, there's usually a likelihood off abnormalities to occur. For example, they can be pre cancerous on We can monitor. Um, we can monitor that with the Pap smear, which I'll go into in a second. Um, one thing I'd like to highlight as well is the's kind of corners here, if you can see the art shapes, these are vaginal fornices, so these are kind of like gutters surrounding the vaginal cervix on this condition be used to drain any access fluid from the pelvic cavity. I'll go into like the pouches later, but if if say, there's some excess fluid, we'd use colder centesis, which is just I'm like a draining off the fluid and you'd go in and drain it from this for next. Here. Um, you also have these rugae. Well, I thought going to them last were here, but these are basically just folds any regain. The body is usually just to help with surface area expansion. So in the stomach as well, it's when it kind of expand during sexual intercourse on also in childbirth. Um, you also have the internal and the external. Us So So, basically, on the end of cervical canal is just through here. You might hear that phrase. So the Actos service cervix is stratified squamous here. I already mentioned that on this area is called Actos, and this this area is called the Endo. And the reason that you have squamous here is to protect the cervix from abrasion. Basically, um, I was going to move on, so I mentioned pap smears. So in a pap smear you insert of for next, uh, this is an animation that just shows a fornix in setting into the vagina and just before the uterus at the service. And it will basically you. After that opens up the canal, you'll take a sample off um, cells from that. And then you can look at it under a microscope, basically, and you'll see the transformation cells, the transformation zone. So here you can see, um, you have squamous on, um, Colombia. So it papsmear in. Women are taken every three years after the age of 21. Because Rambo, I said, because there's lots of displays you're here. You want to check if there's any pre cancerous precursors. So if say, they look under a microscope on the nucleus, looks reduce. This is a really significant shrinkage. So then you'd call it a high grade lesion, and that would indicate cervical cancer. So here I've just revealed what's underneath there, and you can see the squamous on the Columbia or cells quite clearly. So I'm going to move on to an SBA if we could just launch the polls. So it's just about what the function of the lady exiles are. So can I don't tell? Well, put in the poll what the function off lady excels are, So I'll give you a few seconds. Eso remember, Guys, the polls are completely anonymous, so we can't see who said What's that? Just have a go Onda. Yeah, It'll be better if you're learning as well, because you can remember it better. I'll give it a few more, um, several. And just even gas is. Well, um, no one can see what you put. So, um, I went to just half At least half of everyone replies, Okay, I'm I and the polled the I think Yeah. So, um, the correct answer was actually, um de so I'll go into Why? So once I could not going to buy a second. So the current tense was actually D. So the answer is not a because late excels lie in the interest issue. So that's just the gaps between the seminar first tubules on. But that's not actually within the walls of the two bills. So, um likes it'll say, totally cells juice. And it's not be because they synthesize testosterone. It's not, see because they they do respond to LH. But that is for testosterone androgen, binding release and ears credit. Because there is no release of LH system like the Lady XL's so they can regress. Basically, um, he is wrong because basically have p e prime ordeal. Primordial germ cells on they trigger the formation of genital bridge. So I'm just going to go into another question in the chat. So can you tell me what this cross section is showing of highlights? You see this, um, these two labels, What do you think I've highlighted here? I might have hinted at it earlier, but can you tell me what these gaps show? Yes. So everyone's got it. So, um, I was going to real the answer. So you have the vesicouterine print the rectal, you try and patch, and they cost one thing. You can also be called the parts of Douglas a swell so fluid here because they're just basically gaps between, um, the two parts of the section. But fluid can build up in these gaps. So during an infection. So the rectal you tried patch that's between the anus and the rectum so it could be fluid can build up here. And like I said earlier, you can do cold. This anti cysts from the fornix off the vagina here on that can remove this excess fluid from this posterior. For next. You can see here the anatomy is really important to see because look how close that for Nexus to the gap. So if there is fluid feeling this, you can easily remove it from the posterior fluid from the posterior aspect. So I've just said that here a swell, um, some more. And that's me. So can you in label this in the chat on this have ago is okay, I'm I just, um labelled them myself, but this the time. But yeah, these labels is that a lot of big next in a shin is your is also this is the bladder. This is the seminal vesicle. This was the doctor's difference. And that was the urethra. So in the testes. So this is the testes. You have the head, the body and the tail of the epididymis. And then you also have these seminal first two rules that I mentioned earlier. And you have the typical Virginia as well. So he s the matter. Gona they produce sperm on the PSA totally cells. That car isn't here, they'll nourish them. So both are found in the seminal for seven efforts. Tubules right on the Tunica. Albuginea is surrounded by the corpus cavernosum on D on. This basically is to contain this cough is kind of lotion just contains blood, and that's just to maintain an erection during sexual intercourse. So this is quite a heavy slide, but basically it just covers what puberty is. Puberty is basically a period of time in which an adolescent convenience, sexual maturity and it generally in females it's between the ages 8 to 14 and in males it's between the ages of 9 to 15 on puberty is controlled by a hate BG access to hate PG I'm just stands for hypothalamic pituitary gonadal access. So FSH, um, can cause estrogen production, and LH can cause progesterone and testosterone production. So estrogen and testosterone, then Kenly need to these sexual secondary sexual characteristics characteristics. So in females you have hair growth breast development Monash, which is just in the way of saying menstrual cycles. On In males, you could have excess hair growth, penile testers and larynx growth. So, um, you might also experience a growth spurt. And that's just because I'll go into this a bit later about how this is for um, But growth spurts occurred. Do, too. Easter Dial's on testosterone causing pulsing, released off growth hormone right on this growth home and causes insulin like growth factor one. So you might have heard I g f one released and that basically, um, causes, um, the trabecular. So you know, the bone has trabecular parts that this causes trabecular of modeling in bone on decrease and a decrease in blood sugar. So that basically also causes a growth in most of our body cells. So because of this, I GF you have increased bone modeling less, um, less blood sugar on. Do you have a growth in most ourselves? So that's what leads to this growths. But spurs well, So how so? How the hate BG access or puberty begins is cause of these kiss kiss pectin that stimulate the gun out the trophies. And these basically initiate puberty. So the activation of the hate BG act access, um, is basically when puberty begins. So when the access fluctuate So with differences in what hormones are producing itch gland, they convey sickly lead to both local and systemic changes. Um, on Then it can also said, Hey, three axis, consistent, relate, obviously testosterone of stuff to put cause the secondary sexual characteristics that we talked about earlier. A swell. So I'm going to talk about delayed and precautious people. He's a precautious, just means early surfaced, and they're saying It's so let's talk about precautious or early puberty first. So, um, this is when there's an absence off off the start off sexual maturation at the expected time. So the uh so your appearance can be your sexual. Basically, your sexual characteristics can be developed at an earlier age. On this is considered precautious puberty. So, um, this can be gone on a trove and independent dependent. So, um, basically, what it means there's an individual would displayed Start Ristic before they're expected. Age. Um, so in dependent. So dependent would be there's a central precautious puberty, so that's under HPI. GI Axis is activated early on. The majority is usually idiopathic, so that means there's not really an underlying cause, and we don't really know why. But it's usually it can also, because of organic CNS disruption up, it could be meningitis or other head injury or even hydrocephalus, which you will go into in the head case. But, um, save this postcranial surgery that can all affect the hate PGA access hate BG access on this convenience activated too early so these individuals would display these characteristics are younger age. You can also have an independent 12 in an independent one this condition peripheral, precautious people t so you could have stacks sex, steroids or androgens that are secreted without the activation of the hasty GI axis. So basically, these are producing excess on earlier on stage without even being told by the hates BG access. So, um, this could be from an adrenal tumor. It could be due to a congenital adrenal hyperplasia off from ovarian tumor or the go or ovarian damage or cysts or other Go. Now, true tumors is well, so the difference between the dependent on the independent one is in in the dependent one. It's to do with the HPD axis being activated early on the in the independent one. It's because the peripheral, um, systems like the, um, adrenal secretions or go nuts produce are homelands and Xs on. This is without Dex activation off the HPD access. Um, before I go into the Sorry, I forgot to talk about the delayed Puberty is also in delayed puberty. So this is when an individual would not display the characterised sexual characteristics until a later age. So you they display it later than you would expect. So there's two types you can have. Um, it's to do with the underactive NoSalt the go nuts. So this is when you can have a hypo gonadotropic hypogonadism or hyper going out of tropic hypogonadism. So in hypogonadal gonna try to pick. So that's hate Waipio. The gonads don't produce efficient sex hormones. So this is a defect in or not switching on of the hates PG access. Um, and you can have a constitutional delay in growth or you can have hypopituitarism so that's congenital or acquired on. This is this's you could have chronic illnesses like testicular ovarian damage as well in hyper going out of trophic her hypogonadism. This is when you don't respond to the gun out of trophies like LH and FSH. So this is associated with primary gonad failure on this Condoleeza to an absence in the negative feedback control of the Hbg access and you can have abnormal gonad development. Artistically damage in that case is well, so both of these are just pathologies to remember in terms of puberty. So, um, can anyone answer this SPS So in a typical 28 day human female reproductive cycle. On which day after the beginning of the menstrual period is the level of LH most likely to be the highest. So I think most people have got it. But I'll just wait till a few more people answer. Remember, it's completely anonymous. A swell. See, I think I'll close it. That, um Okay, so I'm just going to say the answer Waas 14 days. So those have you got that right? Well, don't sell. Show you. Why in a second also pleased Annotate the slides as well. It's just the helpers go through the sides a lot smoother, but I've got another SPS Well, and I'm going twice. So, which is the following is the dominant hormonal influence on the endometrium during the proliferative phase of the menstrual cycle. So if you could just have the pole being launched. So which of these hormones affects the endometrium in the proliferative phase, so I'll just wait. So yeah, I think I've been ended that. So, um so it was I think most people got that right with estrogen, so I'll go into why now? So as you can see here, we have quite a big graph I'll try and break it down for everyone. So but this is just going through the menstrual cycle. So if you think of the menstrual cycle, um, I know it's not usually told towards like this, but it's best to think about, too, as a number of a term that encompasses both the you try and cycles. So do you try and just basically, is about the uterus or the you try and well, so focuses on the uterine walls structure on, um, the ovarian cycle. So if you think about the ovaries so it encompasses that you tried under over in cycle and it's made of the proliferative on the secretary on the menses phase. So menses portraits A creature, um, menciuslesson. Also, you have the follicular on the luteal phase in the ovarian cycle, so let's focus on the ovarian cycle first. So here you have the follicular phase. Um, so it begins on the first day of menstruation, where the FSH causes 32 three to about 30 follicles to grow in the ovary, and they basically stimulate the production off Easter agents. If you just follow the graph East region, it kind of stimulates the productive restriction here. Um, basically this eastern into grades. All the follicles, apart from the graph e and folic you'll so only one focal is left on the graph. Ian Follicle then would produce more Easter gyn um, which would inhibit FSH but causes the LH to surged so FSH less. And that triggers this green LH to go up. So you can see at the end off the follicular phase, you have a peak LH, and that's a day 14. And that's just because the FSH is lowered by the graph e and follicle. So now let's go down down here to the U trying cycle. So whilst this particular phase is happening, you have this proliferative face the second stage. There's a gradual increase in that you try and wall thickness. So this is between the proliferate to face would be between about day six to day 14. So as this is happening, the eastern produced by the's follicles increases the thickness off the endometrium. So I've just highlighted that in pink here, so that wall is now getting thicker, right? Um, this, um, basically is the proliferation of the strikes and Vasilis so does you can see here there's more vascular vascular ization, and there's a large expansion as well of the structure and function. Our list as well on this is later on shed when it gets to menses. But for now, we're assuming we're going to be fertile. I so here it's still building up on, um, he can also see these viral arteries that this straight endometrial glands on spiral arteries that the circles a glance and these the spiral arteries on, baby the spiral arteries whilst the proliferation face happens, the kind of spiral up and the long gate higher. And this is in a vascular storm. So I kind of think this guy vascular strong competitors looks like a hurricane. So if you just imagine this almost is happening or growing, Um, so here you have progesterone receptors on, do they more than doubled? This here is more than double than before Ovulation occurs. So now we've got this LH peek FSH dip on now are endometrium is built up. So now it basically peak times full, um, her egg to release. And that's exactly what happens. So here you can see it's ovulation. So from this allergy search, the second that you cite is basically swept up by the fimbria here, um, and into the you trying to be. So the follicle basically becomes that's left behind in the ovary becomes the corpus luteum save you imagine the left behind is the corpse. So the corpus luteum, um, on, But, um, in the luteal phase. So now we've entered the luteal phase on, but, um, basically, the mature follicle now protrudes into the surface of the ovary and forms a stigma. So this is the stigma on the l A stimulates basically protein letting activity and the thicker external on the tunic albuginea of the the follicle on down the over Ms expelled. So just gets out of here. They're this stigma into the entrance of the you try and tube, aided by the February wafting up. So, um so what? Nicest. Go on to the secretary phase now. So now you have the progesterone, which is, um, here. So the progesterone is the green relations to creation from the corpus luteum Dickens' the endometrium for implantations. You can see it. It's a good peak high on the stoma. Um, it's most vascular today. The you try and glands become way more tortuous and sore tooth on their more coiled a swell on these lands, basically produced thick like a crow. Teens that are rich with products like there have been emptied by these glands on. They basically nourish this developing blastocyst is ready to nourish this possible glasses. So basically Easter gyn then triggers the proliferation off the endometrium on the dilation of the lactic ducks in the back breasts as well. Um, Progesterone maintains the endometrium here on the endometrium basically would triggered secretion of you. Try milk and decreases the ascites bility of the uterus. So after days 8 to 10, you can see that the Corpus Luteum then would degenerate into the corpus out the cans on. That's because of the loss in LH taken. See here there's a decrease in LH on that basically is luteal isis. So off the corpus luteum. So this is called a luteal isis of the Corpus Luteum, and that's also there's decreased progesterone here and now as well. Because of that, decreased a gesture and this is no longer maintained, and you shed that you try and wall as menses. So that's when you have menstruation or a period, Um, so you have this fibroid corpus Albuquerque's neck and stay in your uterus for years before it's degraded later. So if a egg say is fertilized so the blastocystis fertilized and produces hey, see GI, this endometrium is basically maintained. Well, this corpus luteum is maintained, so the production of progesterone remains high. But if that egg so you would come here and it's not fertilized, then you have nothing producing hate. C g on. There's nothing to maintain the corpus luteum. And so it will stop producing this progesterone. And so this endometrium just degrades. And then you have it go out of your China as your period, basically. And also after that you have the contraction of the spiral arteries on. Become smaller on you. Have you did? Basically, period is basically the degeneration off the stratum function, Alice under shedding of it. So that's basically what happens. It does that make sense to hope that does. We can ask questions at the end if anyone, once we do go over that again. But I just have that again here. So this is really important concept to remember. But if you just remember, the endometrium is made out of the outer on the outer strikes and function honest and that's just said during menstruation. Been under in a stroke and bustle is which is always present. So the Miami trim is the muscle off. The uterus is well, so, so really quickly. You're sites are premature excels these roles produced before the birth of female. Hence, the females have a limited number of eggs, and so when you're a genesis occurs, you have the sides that undergo my OSIs and you have the secondary your sights on. Then you have fertilization, possibly here on the over on secondary over, um after it's released, could be fertilized in the you're trying to on. Then it would travel down here on it would implant here, and it would be producing hasty G. So you're corpus. Lutein would be maintained, and then progesterone would be maintain. So this wall still a stick. But if there is no say, there is no egg being fertilized, it would just leave on. There's no hate CG here, so your corpus luteum dies into the corpus. I'll becomes on because of there's no progesterone, your starting functionality shed as blood in your period. Basically, if that makes sense. Um, another SBA. So which statement is true about Jenna? Each? Oh, good. And, um, g on our it. So if anyone could just put the SBN Okay, I'm gonna wait. So just everyone just have ago. So I was doing a half of everyone. So if if I don't want to clue, it's been a terrific release in home own if that triggers anyone's memories of what it does. But, um, I was going to go into the answer Nell and closed the pole. So basically, this is a hard one. Basically, is released during Ali in puberty. Cell going to the production now, Um, the next light. So, um, so you can see I'm just gonna go through how the hormones interact with each other in females first, and then I'll go on two males after, So this is just going to be the female hormone attraction, so you can see the hypothalamus, um, would release acts on the anterior pituitary by the gonadotropin releasing hormone is released from the hypothalamus in a pulsating manner, and it basically acts on the anterior pituitary, causing the release off FSH and Elledge and the FSH and LH acts on the granulosus cells on the cheek. A cells. Um, so the LH accident weaker and FSH acts on the granulosa on these cells basically released androgens that stimulate the the granulosa cells to convert androgens to Easter gyn. Basically, um, um And then granulosa cells would then also release inhibit as well. Um, it's a totally cells which inhibits, um, FSH here on. They also have negative feedback cycles of androgens also could have stopped literally stand. Her act on the hypothalamus is well in a negative feedback loop. Eso in males. It's, um it's quite similar as well. So you have hep Thomas. Listen, going out of traffic releasing hormone in a coastal minor acting on the anterior pituitary. But instead of the thicker and granulosa cells, you have the lady on the PSA totally cells. Um so on the so totally cells basically nourished the sperm, um, increased tomato genesis, and they also release inhibits. Inhibin is released when a sperm count is too high, so subtly systole cells will nourish any sperm that are created on. If that's too high, they'll release inhibits in have been axis a negative feedback onto the hepatologists and anterior pituitary to stop any more sperm being really, he says. So late cells basically are activated by, um, LH basically and produce testosterone on that is causes any sex secondary sexual characteristics like peanut Penis growth that we've mentioned earlier, or larynx growth Or also, um, things like hair growth. So, um, assessment, Um, so that it's just those two tables that quite similar. So if you just look, the only difference really is there's these to swap, and you have so totally and and Leydig cells instead. So I just remember that first part is always the same, and it's just the last part. Varies. So I'm sort of talk about androgen so and urgency, basically just a type of sex hormone on there, often labeled as male sex hormones. But females do produce them in small amounts, too. So many androgens are basically converted into other androgens, so I'll go into that later on here. But, um, testosterone DHEA a d e gs on Androgel just I own are all converted into testosterone on. Basically, just all go back and forth from each other on their production, and the conversion basically occur in the adrenal cortex of their dreams. will gland on the go nuts. Um, so I'm going to go into the flow chart now, so you have androgens being produced in their group. Will cortex controlled by adrenal cortical perfect releasing hormone. See, I have it here. So a CT age on ACTH is produced in the anterior pituitary gland, and it's produced because of Crohn's. See how it's just means cortico trophic releasing hormone so that stimulates a C T H a C T J. It's also increases our cortisol or glucocorticoids. So that's going to It's So cholesterol is convention a depression alone and that triggers on that computer. Get into DHEA and progesterone Pedestrian could be converted into aldosterone and cortisol. But going back into our main cycle, both of these condemned become, um I understand. Understand? Uh, I am and then becomes the interest. Interesting parts. So now you've got to and dress Did I own? You can produce testosterone. Onda Testosterone convict basically converted into its more active form called DHT by five alpha reductase. So five alcohol alpha reductase basically converts this testosterone to DHT on. Um, say if someone's deficient in five alpha reductase, you have, um, big US genitalia so you can have high post baby s. So that's when you have the urethra opening on the inside of the Penis. Um, or people with conditions that, um where they still undergo puberty. Um, Ato, uh, later age, because that has her levels are high. You might have an elongated Penis, um, elongation to make your Penis look more normal or, um, well, not normal, but it to make it. I don't know more. Um, use usable, but yeah, people that have ah deficiency and that often need treatments for fertility. Um, undressed the diet can also from Easter dial, which can that on also eastern. So that's just by aromatase. So just remember aromatase for the eastern eastern iol that will produced, um, the female Oh, um, phenotype. So so testosterone as well. Just remember, is bound to a s. Hey, Hbg So sex hormone binding globulin on. Then testosterone concentration is tapped at a high level in the testes by binding to androgen binding hormones as well. So Anderson production is also, um they can basically is regulated by the brain as well. So remember that so they can be converted into each other but needs to be triggered by the brain. Um, you can also have Cushing's syndrome. So I'm I'm mentioning that right now because it's basically affects the brain. So that's when you have an overproduction of ACTH on that results in high cortisol on diet and weight. Because of this, a swell. So this is the summary. So, um, this is just a summary, um, aids to cover what happened. So and so you have cholesterol because of my in the mattress by cytochrome see 45 convinced into pregnant alone and that becomes progesterone by a D hydrogenation on, then becomes undressed did iron. This is spelling error here, but I said in the last slide, but aromatase to east region or our testosterone dehydrogenase is so I've got some kidney and after me here, um, I'm going to skip through the night to be just for time, but the diagram is that. But I'm going to go into kidney function. So you have, um, the four folks to the kidney. Filtration absorption, secretion and metabolism on the other kidney is really important part in our body. So it's involved in fluid and osmotic balance. Excretion of waste products, blood manufacturer of IEP oh, synthesis. Control of blood glucose pressure. I mean BP, a c acid base, metabolism and electrolyte metabolism and also gluconeogenesis These things you just have to remember is the function's off the kidney, unfortunately, but, um yeah, that's all on the slide and then wants to look at it. But this is just a creation for the G fro, so it tends to be around 125 mL per minute, usually so it's just your inflow multiplied by the urine concentration over the plasma concentration. So the G f R is increased via the the raw systems of the Renan under tension and aldosterone system. And this is activated by the macular density cells in the D. C T regions of the joke stomach lemon glomerular apparatus. So aldosterone basically acts on the d. C T to increase our sodium reabsorption whilst also excreting more protons. And this basically raises up blood. PH because of the excess pertains on also has, um, serum. Potassium is well, um, so you also have indolent. So if we want to measure an individual's G fro rate for saving, inspecting, say, kidney disease of some kind, and we could measure that inland to give an estimate are accurate estimate off create of g fro. But instead we tend to use creatinine because that test would take less time and obviously in the hospital environment, um, time is precious. But on issue with Curtain is that it could create an overestimation as creating can be produced, um, in the proximal convoluted to bill as well. Um, so men also tend to have, ah, highest year and creatinine as well as muscles. Also released creatinine. Um, so they'll have a higher creatinine, but their muscles release creating. Remember that on G F. Ours as well as gender is also affected by age and ethnicity. So I'm just going to go over really quickly. Some, um, kidney disease is that you might come across. You have PKD. PKD is just polycystic kidney disease. I put an image here, so it's a genetic condition. That's where these normal normal tissues basically replaced by this fluid filled cyst. So this is an image of someone's kidneys with a lot of cysts, you know, have renal calculi of renal stones and that can lead to hydronephrotic or urine retention in the kidneys, and that would lead to line two groin pain. Or this is also called renal colic as well. Um, really quickly going to go also with these guidelines. So with any sexual health cases or, um, contraception cases in young people, we have to look at the guidelines that you might let come across in university. So you have the Gillick competence. So this is for contruction, for our any medical treatment under 16 so much they must be intelligent and mature enough to understand the medical treatment and any of the implications that you, as a medical professional, tell them on early, then made they actually consent to treatment. Otherwise, a parent or guardian must make that decision for them in their best interest. And we can have a say if we don't believe it's in them at best interest for, um, it's mainly down to their parents if they don't understand the treatment. Um, you also have the phrase the guidelines, and they mainly cover contraception. So the individual of the child under 16 must understand the professionals advice so about contraception, and they can't be persuaded Teo on their patient parents. They're likely to begin up, continue having sexual intercourse without contraceptive treatment. Even if so, say you say no, they'll still have sex. And that's putting them at risk. So you would still give it to them. In that case, unless they receive this contraceptive treatment, their physical or mental health is likely to suffer. Because, remember, we always have to work in the patient's best interest. And that's the last one is the best interest requires them to receive this contraception. Um, advice or treatment. So the key to all of this is you have to look in the patient's best interest. Are they're competent? Do they have capacity on? Is it in their best interest to, um so that's the end of my presentation. I think we're gonna have a short break on then. Bekir will, um, take over from here. I think the, um, we're gonna have to say five minute break. Picky. Yeah. No, that that was Thank you, Bob. So I'll just show my screen now. Very good. Okay. Yeah. Um, hopefully you can all see that, And I'm just gonna get the point is well, so it's clear, but yeah. Mornings back A on today. I'm gonna be presenting these topics hair. So to start us off. I'm gonna look a contraception. So the first type of contraception, I'm gonna talk about this barrier methods. And these are kind of physically stopping any semen getting into your uterus and causing a pregnancy. So there's two main types on the left hand side. You can see condoms. Onda Perfect use of condoms would be 98% effective. But in the real world, that's not gonna happen. So typically it's around 82% effective. Another type of barrier method you can have is die from and to Vicryl caps on. These are kind of silicon cups that fit over your cervix. Um, and you want to use them with something called like a span aside gel on. When he used the cup on the gel perfectly, you get 95% efficacy. Um, although ari methods are the only method that helps protect against STD eyes, condoms are better for protecting protecting against ST I see. But the caps provide kind of little protection. If you are with the capsules. Well, women conflict them before they have sexual intercourse, but they need to keep them in for six hours after the sexual intercourse to make sure that they work on. If the woman has previously had Children before the caps on, I'm gonna work as well. Um, so I've got a nice little S p. A few here. Sorry. Go out to you. A 19 year old woman presents to the GP wanting to start contraception. The GP recommends the combined or a contraceptive mill. What is the main role of Easter gyn and the combined or contraceptive pills? So the PO has launched? Yeah, I just had to go. We can't see who's sending him. What? So just have a random guess if you're not sure, it's well, but I'm so close that in five seconds, three to one doubly. So if we just close it there, ask right so well done to those of you who put the correct answer, which was okay, So I'll explain that in this life, but kind of in the net and combined. Use those two things you're thinking there's Easter gyn on this progesterone. So the eastern part, as was in the corner SBA inhibits FSH, so there's no follicular development. But the progesterone part inhibits the LH on that kind of acts on three different kind of parts of the female and after me, if you are so, it acts on the mucus, the fallopian tubes on the endometrium so the mucus gets a bit more thicker, a bit more sedating the fallopian tubes, reducing that celery action on the endometrium reduce and proliferation so those you're too kind of components of the combined pill. Um, good things about the pill is that it's it's quite effective if you stop taking it in rapidly, return your fertility back on it improves kind of PMS symptoms and any pain with your periods as well, and also reduces your risk off three types of cancers and Amitril, ovarian and colon cancer. About us with anything, there are kind of negatives. So with the combined or contraceptive pill, you kind of get more unscheduled bleeding, breast pain and tenderness. Hypertension VT. Of venous thromboembolism on a small increase in breast and survival cancer, I'm coming back to the Bt's. This is why, if females gonna go into surgery, she has to stop taking the combined or contraceptive pill four weeks before her kind of like elective surgery on she could only started two weeks after the surgery because there's kind of increase. Rest off those kind of embolisms forming. So next slide. Yep. So the next one is the progesterone only pill on. Once again, you kind of get these kind of negative aspects taking the progesterone. But when you are taking it, you want to take at the same time every day and you're not gonna take a pill free brake, I forgot to say, in the combine or contraceptive pill, you take it for 21 days on Stop taking it for seven, but with the progesterone, and you kind of take it every single day with no kind of break until your period comes on. So you don't really know when your period's going to start, which can be quite challenging for a lot of females on. If you forget to take it less than three hours when you normally take it, you can just continue is normal. But if you take it three hours later, then you have to do additional methods just for extra protection. So that would be maybe kind of stop having sex for the next 48 hours or using a condom just to give that added protection on when you're starting this pill. If you start it within the first five days of your cycle or you've switched from the combine like directly at day 21 your immediately protected. But if you're not within those kind of to kind of brackets, you have to use kind of the condom use condoms or kind of stop hum, um, avoid sex for the next 48 hours until the the it kind of starts working effectively. So now the SBA fuel are read it to you. And if you just want to, the poll is well, a 32 year old women with recently diagnosed pelvic inflammatory disease presents to her GP requesting emergency contraception after having unprotected sexual intercourse 98 hours ago. What is the most appropriate choice of emergency contraceptive for this patient? So this is quite a hard one, So just give it a go. Just think about if you remember any kind of key our figures. There's kind of like a timescale. Just think, trying to think if you remember. So, please. And three seconds to one lovely. If we just closed out there. Thank you. Yes. Oh, this is quite a hard one. Um I think most of the highest was, but the actual answer was be on. I'll explain in the next light. But why don't they? Do you put a baby? So this is the kind of time scale I was talking about on on the left hand side. There in bread is, um, kind of unprotected sexual intercourse on the preceding like timescale afterwards. So if it's within 72 hours off that event, you want to prescribe somebody on this drug called 11 now, and it contains levonorgestrel. I'm sorry if I say some stuff wrong, that that's how I think it's pronounced, and it's just a high days off progesterone on. It's going to delay the ovulation on because it's delaying ovulation. You need to think, What if somebody's ovulation is already a card you can't really delay anymore, so it's only really effective if they take it before they've had ovulation. So there is some kind of like discrepancies within, um, the next key kind of figure to remember is 120 hours. So if somebody comes to kind of the pharmacy or the GP after 72 hours, but before 120 would want to give them this pill called a one, and it contains you live Prestol acetate on. If they come in kind of after 120 hours, or on within five days off the event or within five days of their estimated ovulation, you can give them this into you turn device, which looks like this, and it's also known as kind of the copper coils. You can see the kind of math metal, copper on the wire hair on. This is the most effective contraception we have, Um, but it's not really affected by a women's be, um, my butt is affected by the uterus kind of situation. So a lot of women as they get older, they can get fibroids, I think, which have talked about if the uterus is kind of really significantly affected. With that, it's quite difficult to put the IUD in successfully. Do you need to take that into consideration? Um, and if the women's period is the lady, often Sassoon. If she needs to take a pregnancy test, a swell so another SPF. You have been putting lots in to keep you awake that I'm already getting out. 18 year old woman visits had GP to discuss starting a form of contraception. She tells a GP that she suffers from migraines which of the following to the GP not prescribe. So if we could launch the power like be great. Okay. See, I just have have a good guess. Think about which one might be the old one out that house not giving too much away if you're ever not sure with SPF just kind of do elimination a swell Cozaar stuff and three seconds to one lovely if we stop it there. Thank you. See a world on today's of you Put um, say this was quite a hard SBA. I think it would have been more obvious if I put see is like combined or a contraceptive pill. It's because the hormonal patches of the only ones that contain eastern well on with migraines You never want to give the patient Easter gyn kind of contraception because it massively increases the risk of stroke. Um, but I'll explain that father and he slides. So these are some other ones I thought I mentioned. So we'll start with until you turn system. It looks very similar to our into uterine devices are Coppell coil that we kind of showed, but previously. But in this case it releases hormones. It releases progesterone. So it's gonna thicken that mucus. They're not endometrium and stop that over and release. But it does take around seven days to provide that kind of protection. But it is effective for five years. So are are you DS and are you s are very effective up to like 99%. So these are very good side the contraceptive impound have shown in that kind of image that looks like a rod, it's about four centimeters. Also kind of flexible plastic. And it goes in somebody's nondominant dominant arm, kind of on the inside on the inside. It's subdermally on the I think they've designed special kind of insight is to make sure just a subdermal because you don't want it to go any deeper than that. Um, but like our previous kind of contraceptions, if it's within the first I days off your period, it's immediate protection. But any other days avoid sex and he's condoms as well. So two down here is your contraceptive. Bring and patch the's both release Easter gyn on progesterone on the ring here is on the right hand side. Both of these kind of in, um, a four week kind of cycle. So for three weeks, you kind of keep the patch on for three weeks. You can keep the ring inside, but for the last week, you kind of remained them both. Um, but with the ring every week, you want to be changed? Um, kind of cleaning it, Um, and no story with the ring. You keep them for the three weeks, but with a patch, you want to put on a new patch every every week? Um, but yeah. As I said in the SBA, they both kind of release Easter gyn on Easter Jin's. You never kind of put with my grandson. Don't give the combined or contraceptive pill either. On the last one is your contraceptive injection. This releases progesterone on the's. You need injections every three months. Um, but the negatives with this contraception is it that it can cause weight gain on. There's delay in fertility returns up to 12 months. So you don't want to give it to somebody who's kind of considering starting a family or such. So this slide is quite a sensitive topic. Um, so, yeah, please do contact us. If kind of anything comes up that upsets you just go through it now. So yeah, it's abortions on these illegal until 24 weeks on this kind of two different pathways I'm going to discuss here. So on the left hand side is Mr Presto on This is a progesterone receptor antagonist on it makes the endometrium inhospitable on relaxes your cervix. On sensitize is your uterus tah prostaglandins on on the right hand side is gym across. So this is a PG one analog on it softens on your cervix and stimulates your uterine contractions. Um, and these two can kind of be used a condom on combination as well. Um, in surgery, um, upset. Like hopes and gynie. You can use the the gym across to kind of reduce the obstetric bleeding because it can act as a visit. Constructor. Course I'm gonna move onto UTI is now. Look at kind of community and hospital acquired ones. So nice SPF you. What is the most likely cause it of organism of a gram? Positive community acquired UTI. So have a good This is quite a hard one because It's just like a fucked recall one. So I'll give you three more seconds to one K if we stopped that cop. Thank you. Yeah, this was a really hard while on a few. If you put the correct answer, which was he on? I'll explain it in this side's s. So you're you're in. You're tract infections. You can get in your community, or they can be healthcare associated. So when somebody is in the hospital on healthcare associative ones, they're bit more severe. Um, obviously, ground positive and gram negative. Your two different types of bacteria get so yeah, this was our FDA answer Stuff separate fisticuffs. You can also get this bacteria and trick August figure less, but it's a bit less comment. Uh, ground negatives always think of Colyte the most common. Whether it's in community and healthcare. I've listed some other ones down below gram positive healthcare. Once again, staff supper, phytic, assists and trick. Okay, Faecalis. This is a bit more common in healthcare and stuff alert caucus aureus, a swell and then your EKG. Today, as I said before, coarser, if somebody are stable and uncomplicated, UTI is this would be the definition So it's an infection in a healthy, non pregnant, pre menopausal female with kind of goods of functionally, anatomically working your new tracks. So it's kind of your ideal patient that you would see the least amount of kind of health issues. But if it's a complicated UTI, it would be an infection with increased colonization off the bacteria on your therapy like your therapeutic intervention isn't working as well. Cool. So s T I Z now, these are the ones that gonna be covering, So starting off with chlamydia my arm again. So yeah, so chlamydia is gram negative, normal tile, and it needs to live inside of south to survive. Um, within males and females, you see a lot of conditions ending an itis. So your arthritis proctitis epitomize this onda females. And again, your arthritis serving Titus on the main thing here with chlamydia is you would see pelvic inflammatory disease on what it would result in kind of your fallopian tubes. It would reduce the motor movement off that cilia and make them a bit more club shape. So you're more likely to have a topic Pregnancies Azarias ult of this is well on Dinuba ones you'd see conductive itis and pneumonias well, and that's because during the kind of labored process, they're exposed to the kind of mothers in the secretions and environment. So that kind of at risk of getting comedia if the mother has a nest ei during kind of labor time. So the next one is gonorrhea on an exams. Whenever you see grand negative, difficult guy, you always think gonorrhea. Um, it's a capsulated bacteria, meaning that it's quite resistant to a lot of things, especially your complement system on it can affect the kind of, um, reproductive system. So in the males, you'd see kind of prostate infections, kind of green greenish discharge on some pain. We're going to the toilet on the females, you see, pelvic inflammatory disease is while fertility built bleeding between periods on discharge under Syria. But going to re can also affect your kind of firings. Annual rectum, if it does, and factual racktim you'd see some discharge, some anal itching, some soreness on painful bowel movements, a swell, um, but in newborns, you'd also see kind of conjunctivitis, a swell if they contract going around. So the next one is, um, syphilis, and then This is the organism that is kind of responsible for syphilis. It's quite a difficult organism to culture because it has quite a symbol, but it does need oxygen to survive. It's very motels is highly invasive on I've got a nice little diagram here for you, so it's quite like a spiral shape as well. On this three stages bacillus, the first stage is the end stage on. They'll be source at your infection site on They won't be painful. The next stage are you t some rashes on your mucous membranes, Maybe some swollen lymph nodes, A sore throat, patchy hair loss, weight loss amputee Um, but in the late stage, this is very severe. UTI That's what 10 to 30 years after contracting syphilis on do you might see some kind of paralysis. Numbness, blindness. Um, dementia listed a couple there, but yeah, it's it's quite debilitating. So I've got another SP a few here. What marry into of hate TV cause genital warts. So if we could launch the pole, thank you. So I just have a ridge of them trying to some exclusion world on lots of you in the correct answer. Keep them bring keep them coming in. Yeah, course I close the end. Five seconds. Three to one. Carefree crazy out there. Thank you. Yeah, it was kind of between, um, being day and these are the numbers you kind of always get. Talk about. The correct answer is D. I switched the numbers around to confuse you a little bit. Be me. Yeah, it's six and 11 is the correct answer. So six and 11 cause your genital warts, but 16 and 18 cause cervical cancer. And I think HPV strains are associated but, like, 99 0.7% of cervical cancer is it's highly correlated together, Which is why they've got the Gardasil vaccination now for a year. A boys and girls now, which is really good. Um, but your HPV unknown and the double stranded DNA viruses on do this kind of condition here. Trichomoniasis vaginalis is caused by a protease era on. I've got a nice little image here. You can see that there's a lot of flagellar making them highly motel on. What it causes is a lot of itching burning after urination. But the key kind of phrase here is a strawberry cervix on an offensive discharge, so you often see kind of like a fishy odor. Um, so that should be kind of bringing along bowels in your head if you see that on an exam. But yet on the last one is hate ST. On this is an envelope to double stranded DNA virus on. It stays late in, and you're kind of Neurontin is for lifelong, so we'll kind of climb up to your ganglion on due to any reason. Typically, like stress, lack of sleep. Maybe it just kind of comes down and presents itself in the epithelial tissues. So if it's the hate, just be one time it will present in your kind of or or cavity, so you'll get you'll see like cold sores. But if it's a HSV two type, you'll see it has genital genital sores on. Previously, researchers didn't think that was like a link between the tube and now the kind of two different types of quite highly linked together. So another SPF you, a 20 year old women, visits her GP with frothy white discharge on complaining of discomfort during urination. Um, on closer inspection, a strawberry serve it on a fishy odor, unnoted what is the most likely cause it'd organism in this case. So this is one to just make sure you're still paying attention, and you're you haven't fallen asleep, so keep moving a guy. That's really good. Lots of you putting in the answers. I'll give you five more seconds. Fab. Okay, I'll stop it there. Okay? Yeah. If we could not drawn us, um, slides, that would be get. Um yeah, well done. Two days of you who put on a which was the correct answer. I have a gay. I kind of highlighted that on my side. I just said, if he strawberry cervix and fishy odor just notice that kind of organism on the last one. I thought just put in is Hetch IV. This is just kind of one you could look back on if you get the slides. Just know that it's a retro virus with a single stranded. Our energy? No. It causes kind of four stages, with four being the most severe bleeding onto aids here. Other high risk group categories. That's the structure. Yeah, this looks a bit confusing, but the main take away is that this kind of four different stages the last one is AIDS on. Do you can see here you're in blue. Your T helper cells have massively gone down when my HIV RNA has gone up. Um, see, I just don't midges your marine system on. There's two different types of hatred be. I thought I mentioned there's HIV one which is kind of world wide, but hatred be too. I believe in is kind of more in West Africa but is actually last severe than a church IV, one C. I thought I just met, you know, course of this is the last topic off the evening. Um, this is antibiotics on. There's a few definitions to go. Three are the first is to explain the difference between a static and sidle antibiotics. So if, um, I want to consider bacteria static antibiotic, I need to know that it just stops the growth of the bacteria. I can only really use this if my patient has a proper functioning immune system. Where is that? Want to use a bacterial sidle antibiotic, which would just kill off all of my bacteria if my patient is, I mean a compromised s so that I will give their immune system or what's left of the immune system. Time to clear the infection itself. Yes, you can see that on this graph. I've added antibiotic here. I'm bacteria side. All kind of goes down straight away. So that's really good for people with kind of immunocompromised systems bacteria started. You're kind of just fatto because I'm stopping the ground and then I mean, I healthy immune system will come in on and kind of decrease the levels. Who's the That's three definitions here. The first is selective toxicity on. This is just kind of finding out if I take an antibiotic will only target the bacteria in my body, or will it start attacking the cells in my body? The second definition is the therapeutic index on this has shown in this diagram here. So the left hand side is the kind of minimum dose needed to show a positive effect of the drug. On the right hand side is the kind of, uh, minimum dose to get the side effect that I don't want to see. So this is the kind of Goldilocks region. This is the good region that I want to be in on an ideal drug would have a wide therapeutic index because it allows the kind of room of error or any kind of external factors. But if I have a kind of narrow therapeutic index, I need to kind of more monitor at the drug itself a bit more. Working regularly on the last definition is therapeutic spectrum on this is just looking at how many varieties of bacteria is my antibiotic for effective against so another s v a. Which of the following is a sour, simple cyst inhibitor. So if we could launch power Thank you. Just have a redid options on. Yeah, just have a good guess. Yeah, that's if you get in this one, right? Yes. Okay. Fops all close and three seconds to one. Okay. Replace the polar. Thank you. See, you are lots of you got the correct answer, which is C amoxiclav on. I'll explain that in this slide. So, in a bacteria cell wall, you have two components. You have proteins and you have carbohydrates on. To link the two together. You need something called pbp, which stands of penicillin binding protein on This allows kind of cross links between those two components. But antibiotics can come in on inhibit that kind of joining molecule on stop those cross linkages together on that antibiotic are Beetle Acton's. So these are cephalosporins on penicillin on because you are creating those cross things you get bacteria cell weakening on that result in cell isis. So ultimately killing off the bacteria. Yeah, Beetle At times, penicillins, cephalosporins. I've also mentioned vancomycin. This also targets your cell wall, but just a bit differently, because it does it differently. It can actually target MRSA kind of variants is well, but only targets gram positive bacteria, which is a bit limiting. So another topic to discuss is that with these beetle act, I'm antibiotics and penicillins cephalosporins often in their structure. You see this kind of ring shape which is known as the beetle act? Uh, MRI. However, um, some bacteria able to produce this enzyme could be tylactin maze, which just snips the ring here. It just makes it really unstable on just stops the effectiveness off those penicillins and cephalosporins. But luckily, results have been able to use a club Vanek acid, which stops this beetle act amazed coming along and breaking, making it structurally in ST unstable. So it kind of maintains the penicillins and stuff. It's pourin still work and they've also combined amoxicillin and chronic acid together. That is, while SBA What's so co amoxiclav? Cool. So another SBA Here you are GP and suspect that your current patient has a bacterial infection. You decide to prescribe it Antibiotic which inhibits protein synthesis. Which drug to use prescribe? Yeah, just have a guy, um, read the options trying to eliminate any Oh, see, I'll give you five more seconds very to one fops. So if we end up old, uh, lovely, so well done to those of you you put a day which was most of you on. I'll explain on this month. This is, um, a very simplified diagram off a ribosome. Eso bacterial ribosome are comprised 50 s and 30 s, but human ones or 60 and 40. But yeah, the ones that target your 50 sub unit. This too and the first is macrolide on. This includes things that ended moisten so like azithromycin for sprue myson on it just ultimately prevents protein synthesis Continuation Where is chloramphenicol? Prevents peptide born information's but also acts on 50 s on the 30 s tetracyclines kind of work on the block TNF t n r and a attachment to the, um you know, a cell kind of group on the last one is aminoglycoside. Add black asides on this includes gentamicin on it. Just blocks. Translation initiation. So hopefully this is just a clear diagram you can back on when you were revising, but yeah, second to last concept is new click acid synthesis on. Um, we want to target kind of pathways used and not kind of synthesis. And we've managed to come up with two main ones. So flora quinolones inhibit DNA. Top him or is eight to pin memorization to on it stops. Deanna, I'm winding during replication, so I've listed some examples down below on. We're from prison. This's inhibits are in a pill. Emirates, unjust. Ultimately stops MRI synthesis. Okay. On metabolism, the main metabolic pathway we focus on with antibiotics. This folate synthesis. I'm because it's ultimately these tow time in Guangnan and add in in a nuclear tights, which of really important um so it's good to kind of talk this pathway on do with reset while scientists have come up with co-trimoxazole marks is all on. This is comprised of two types of antibiotics, the first being cellphone name. Arts on this targets has sent these ends on here in the pathways and trimethoprim target a reductase pathway here on together. These are really good for infections that really quite serious, resistant to a lot of things on. We don't really know what's caused them, or if we do know what's caused them. There's more than one organism causing it, but it's not very good in the presence of Pass On. That is because the bacteria can take building blocks from dead. Neutrophils would basically make up the past on the bacteria can then use that for for like, synthesis. So this pathway goes into overdrive, so it's no very good to target it. Okay, on this is my last lights that this is an overview or the antibiotics here, and I just thought I'd mentioned quite difficult targets to get antibiotics. Two. Is your blood brain barrier prostate I an interest of cellular bacteria, however, having said that, chloramphenicol can penetrate the blood blame brain barrier under normal conditions, but it should only be used in serious cases because it's quite toxic. Um, your blood brain barrier is quite hard to penetrate because often shunts think shunts things out on There's a lot of tight junctions, a swell. But if you kind of have an inflamed meninges like meningitis or any kind of inflammation in your body, that is a way that antibiotics can enter in those difficult targets more easily on Also, macrolides can penetrate those kind of interesting that bacteria, which is why they used in a gonna bring a treatment. Um, so I mentioned about the tetracyclines can cause kind of toxicity to your kind of conventional flora on can ultimately cause or a candidate sis on clindamycin also come mc um, you more from herbal to see difficile infection as well. On D gentamicin is toxic to your kidneys as well, which is quite a high your point. But, yes, that completes my presentation. Um, please, do you fill out the feedback form to get the slides on the recording? Because I thank you very much for listening