This document discusses the approach to erythema nodosum, a panniculitis condition presenting as subcutaneous nodules. It is most commonly caused by infections such as streptococcal infections or tuberculosis. The nodules typically appear on the shins and resolve within a few weeks. For chronic or recurrent cases, thorough investigation is needed to rule out underlying causes like sarcoidosis or inflammatory bowel disease. Treatment involves managing the triggering infection or condition with medications like NSAIDs, potassium iodide, or steroids. Biopsy may be needed to confirm the diagnosis. Prognosis is generally good if an underlying cause is identified and treated.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
history of TB,epidemiology, clinical features, lab diagnosis, treatment, MDR TB, XDR TB, TDR TB, and mechanism of drug resistant, methods of identification of resistant drugs
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
history of TB,epidemiology, clinical features, lab diagnosis, treatment, MDR TB, XDR TB, TDR TB, and mechanism of drug resistant, methods of identification of resistant drugs
Cutaneous involvement is very common in the different types of vasculitis. Skin lesions may be the only manifestation or may occur in the context of systemic disease
Rheumatic fever is an acute inflammatory disease, due to cross reaction of antibodies against GAS M protein, which resembles the proteins of heart, joints, brain and other connective tissues
Cutaneous involvement is very common in the different types of vasculitis. Skin lesions may be the only manifestation or may occur in the context of systemic disease
Rheumatic fever is an acute inflammatory disease, due to cross reaction of antibodies against GAS M protein, which resembles the proteins of heart, joints, brain and other connective tissues
For infectious diseases module as part of medical school studies.
By Robert Ferris and Krystyna Gelinski.
Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
Systemic Lupus-erythmatosus a detailed review.pdfUsamaSaleem91
Systemic lupus erythmatosus is an autoimmune disease affecting multiple organ systems. This presentation almost describes everything you need to know about this disease. A proper knowledge of this disease is necessary for healthcare professionals specially those related to medicine and rheumatology.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
4. PATHOPHYSIOLOGY
Delayed hypersensitivity reaction to a variety of
antigens
CIC have not been found in idiopathic or
uncomplicated cases
IBD – may show immune complexes
5. HISTOLOGIC FINDINGS
Septal panniculitis -septal
edema and lymphohistiocytic
infiltrate
Miescher’s microgranulomas -
clusters of macrophages
around small vessels or a slit-
like space
Lymphohistiocytic infiltrate
Granuloma and lipogranuloma
formation
6. CLINICAL FEATURES
Erythema nodosum usually starts
with flu-like symptoms of fever and
bodyaches
Arthralgia may precede the
eruptive phase
Red tender nodules usually on the
anterior surface of legs-shins
Other areas- arms, trunk and face
Lesions borders are poorly
defined and vary from
2 cm to 10 cm
1 st week - tense, hard,
red and painful
7. 2nd week - fluctuate and attain a
yellowish hue, resembling a bruise
Do not suppurate or ulcerate
Individual lesions usually last for 2
weeks but occasionally new lesions
appear up to 3–6 weeks
Lesions disappear as the overlying
skin desquamates
Joint tenderness and morning stiffness
may occur.
No destructive changes occur.
Synovial fluid is acellular and
rheumatoid factor (RF) negative
12. STREPTOCOCCAL PHARYNGITIS
Beta-hemolytic streptococcal infections- most common
44% - adults and 48% - in children
EN eruptions-2–3 weeks after an episode of streptococcal
pharyngitis
Should have throat culture evaluation for group A strep.,
as well as strep. antistreptolysin O (ASO) titers or
polymerase chain reaction (PCR) assays, or both
ASO titers should be taken at the time of diagnosis and
then again within 4 weeks to assess for strep. infection
13.
14. TUBERCULOSIS AND
MYCOBACTERIAL INFECTIONS
Erythema nodosum may occur with primary TB
All patients with EN should be stratified by risk for TB
exposure
Antitubercular therapy (ATT) should be initiated for EN in
patients with positive Mantoux skin test reactions
Culture identification from primary sites identifying an
atypical nontuberculous mycobacterium as a cause of EN.
18. LABORATORY DIAGNOSIS
Careful history, physical examination and drug history
Prior diarrheal illness, URTI and any endemic infections
Throat culture—rules out streptococcal infection
CBC and ESR
Antistreptolysin O (ASO)/DNase titer at 2 weeks and 4 weeks interval
Stool examination.
Chest X-ray (CXR)— purified protein derivative (PPD) to rule out
Koch’s, unilateral hilar lymph nodes—Infections and malignancy
CXR to rule out sarcoid—bilateral hilar lymph nodes
Biopsy the lesion to rule out vasculitis—Collagen vascular disease.
19. DIFFERENTIAL DIAGNOSIS
Lupus panniculitis—present in fatty areas such as
buttocks, posterior arms and leave scars
Tuberculous erythema induratum—usually ulcerate
Erythema nodosum leprosum
Acute urticaria—itching is intense
Nodular vasculitis-PAN—look for fixed livedo reticularis
Sarcoidosis
Superficial thrombophlebitis—linear tender streaks
Erysipelas
Filarial lymphadenitis
Insect bites.
25. CHRONIC ERYTHEMA NODOSUM
Chronic EN is a condition in which the lesions pop up
elsewhere for a period of weeks to months
In most of the cases a cause is elusive
TB should be considered in our settings and a trial ATT may
be given
Intense investigations to rule out sarcoid, IBD and collagen
vascular disease (CVD) should be done
Rare association- Takayasu arteritis, vitamin B12 deficiency
and Ehlers Danlos has been reported.
27. THERAPEUTIC LADDER FOR EN
Discontinue possible causative medications
Treatment of underlying infectious diseases mainly
streptococcal and TB
Bed rest and leg elevation and nonsteroidal anti-
inflammatory drugs (NSAIDs) (aspirin, ibuprofen,
indomethacin, naproxen)
Potassium iodide—saturated solution of potassium
iodide-5–15 drops three times a day. Mechanism of
action is exactly not known
Colchicine in the setting of Behçet’s disease
28. Various treatments for IBD like systemic steroids, HCQS, MMF,
cyclosporine, thalidomide, infliximab and etanercept are effective in
managing the underlying EN
Paradoxically both infliximab and etanercept have been reported to
produce EN as a cutaneous side effect.
NSAID are to be avoided in IBD as they aggravate the disease
Systemic steroids - relatively safe therapeutic option if underlying
infection, risk of bacterial dissemination or sepsis and malignancy has
been excluded by a thorough evaluation
A general rule is 1 mg/kg (body weight)/day.
29. USE OF POTASSIUM IODIDE
Saturated solution of potassium iodide 1,000 mg/mL
Droppers - for calibrations: 0.3 mL (300 mg),0.6 mL ( 600 mg)
In adults and older children, common dose = 300 mg TDS with starting
dose = 150–300 mg TDS
Saturated solution of potassium iodide (SSKI)- bitter taste – water or
fruit juice
Crystallization in cold - rewarming and shaking
Discard if solution turns yellow-brown
Side effects: Acute—nausea, eructations, excessive salivation,
urticaria, angioedema, small vessel vasculitis
Chronic—enlargement of salivary and lacrimal glands, acneiform
eruptions, iododerma, hypothyroidism, hyperkalemia and occasionally
hyperthyroidism
30. PROGNOSIS
Erythema nodosum prognosis is excellent
The lesions resolve without any adverse reactions
in most cases
Few cases are recurrent and refractory for which
an underlying cause is to be ascertained and
treated accordingly
Some of the idiopathic cases respond to
colchicine/dapsone on prolonged treatment.
31. CONCLUSIONS
Erythema nodosum is an acute panniculitis
presenting as subcutaneous nodules most
commonly due to infections and responds well to
treatment
Chronic nodules need to be investigated
thoroughly and treated accordingly.
32. ACKNOWLEDGEMENTS
Dr Mala Saranathan ,Dermatologist
Dr G Srihari , Dermatologist
Dr M Srinivas , Pathologist
Dr M Santipriya , Pathologist