This document defines and compares cellulitis and erysipelas, two types of skin infections caused by bacteria entering through breaks in the skin. Cellulitis affects deeper skin layers and fat, while erysipelas is more superficial. Diagnosis is clinical based on symptoms of redness, swelling and warmth. Treatment involves antibiotics, either orally or intravenously depending on severity. Factors like fever, rapid progression and underlying health issues determine need for intravenous antibiotics. Incision and drainage is sufficient for small skin abscesses without systemic involvement.
Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue. It is most commonly caused by S. pyogenes and S. aureus.5 Bacteria may gain access to the dermis via a break in the skin barrier in healthy adults, whereas the hematogenous route is more common in immunocompromised patients.
The affected skin is usually erythematous, swollen, painful, and warm to the touch. Severe cellulitis can be complicated by bullae, pustules, or necrotic tissue. Damage to lymphatic vessels can lead to recurrent episodes of cellulitis.6 In areas of the world endemic for lymphatic filariasis, it is important to rule out this disease in cases of recurrent bouts of lower-extremity cellulitis and lymphangitis.
Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue. It is most commonly caused by S. pyogenes and S. aureus.5 Bacteria may gain access to the dermis via a break in the skin barrier in healthy adults, whereas the hematogenous route is more common in immunocompromised patients.
The affected skin is usually erythematous, swollen, painful, and warm to the touch. Severe cellulitis can be complicated by bullae, pustules, or necrotic tissue. Damage to lymphatic vessels can lead to recurrent episodes of cellulitis.6 In areas of the world endemic for lymphatic filariasis, it is important to rule out this disease in cases of recurrent bouts of lower-extremity cellulitis and lymphangitis.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Skin, Soft Tissue, & Bone Infections Symposia - The CRUDEM FoundationThe CRUDEM Foundation
This is the Skin, Soft Tissue, & Bone Infections Symposia presented in Milot, Haiti at Hôpital Sacré Coeur in 2011. CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Skin, Soft Tissue, & Bone Infections Symposia - The CRUDEM FoundationThe CRUDEM Foundation
This is the Skin, Soft Tissue, & Bone Infections Symposia presented in Milot, Haiti at Hôpital Sacré Coeur in 2011. CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Announcement about my previous presentations - Thank youAreej Abu Hanieh
ANNOUNCEMENT Thank you for all of you, my followers who sent me messages with a lot of love and appreciations, I finally graduated after 6 years of studying in Birzeit University , In doctor of Pharmacy department I hope all of you benefited from all the presentations posted before Thank you a new PharmD GraduatedAreej ^^
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
Follow us on: Pinterest
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Definition:
• Cellulitis (which includes erysipelas): skin infection that manifests
as an area of skin erythema, edema, and warmth; it develops as a
result of bacterial entry via breaches in the skin barrier.
• A skin abscess is a collection of pus within the dermis or
subcutaneous space.
3. Cellulitis Vs. Erysipelas
Similarities:
• Both manifest as areas of skin erythema, edema, and warmth; they develop as a result
of bacterial entry via breaches in the skin barrier
• Nearly always unilateral
• The lower extremities are the most common site of involvement
4. Differences:
*Purulent: Pus Discharge.
Cellulitis Erysipelas
Affects deeper dermis and SQ fats Affects the upper dermis and superficial
lymphatics
Purulent or non-purulent Non-purulent
Indolent course (few days) Acute onset
More localized symptoms Systemic symptoms (ex: fever and chills)
S.aureus (more w/ purulent) or β-hemolytic
strep (esp. GAS)
β-hemolytic strep
5. Non-purulent Cellulitis Vs. Erysipelas
• Erysipelas opposite to Non-purulent cellulitis, characterized by
raised lesions above the level of surrounding skin with clear
demarcation between involved and non-involved tissue.
6. Purulent Cellulitis Vs. Skin Abscess
• The discharges of skin abscess are drainable opposite to that of
Purulent cellulitis.
7. Cellulitis Risk Factors
1. Skin barrier disruption (abrasion, penetrating wound, pressure
ulcer, venous leg ulcer, insect bite, injection drug use)
2. Skin inflammation (eczema, radiation therapy)
3. Edema due to impaired lymphatic drainage or venous insufficiency
4. Obesity
5. Immunosuppression (diabetes, HIV infection…)
6. Preexisting skin infection (tinea pedis, impetigo)
9. Diagnosis and culture
• No specific lab test ( ↑inflammatory markers and WBCs)
• The diagnosis depends on clinical presentation.
• Skin abscess manifests as a painful, fluctuant, erythematous nodule, with or without
surrounding cellulitis.
• Lab testing is not required for patients with uncomplicated infection in the absence of
comorbidities or complications.
• Drainable abscess -----> incision & drainage -----> Cx and susceptibility test.
• Radiographic examination: US (skin abscess), MRI (osteomyelitis), CT (necrotizing faciatious)
• A skin biopsy if the diagnosis is uncertain
• Cultures of swabs from intact skin are not helpful.
12. When to give IV not PO?
• Patients with mild infection ------> oral antibiotics.
• IV if:
1. Systemic signs of toxicity (eg, fever >100.5°F/38°C, hypotension, or sustained
tachycardia)
2. Rapid progression of erythema
3. Progression of clinical findings after 48 hours of oral antibiotic therapy
4. Inability to tolerate oral therapy
5. Proximity of the lesion to an indwelling medical device (ex: prosthetic joint or
vascular graft)
13. When To Cover MRSA:
1. Systemic signs of toxicity (eg, fever >100.5°F/38°C, hypotension, or sustained
tachycardia)
2. Prior episode of MRSA infection or known MRSA colonization
3. Lack of clinical response to antibiotic regimen that does not include activity against
MRSA
4. Presence of risk factor(s) for MRSA infection (including recent hospitalization,
residence in a long-term care facility, recent facility, recent surgery, hemodialysis, and
HIV infection)
5. Proximity of the lesion to an indwelling medical device (eg, prosthetic joint or
vascular graft)
14. • Symptoms of infection resolve within 24-48 h
• Visible skin manifestation takes up to 72 h
15. Non-purulent Cellulitis:
PO options IV options
MRSA & β-hemolytic strep 1. Clindamycin
2. Amoxicillin PLUS TMP/SULF
3. Amoxicillin PLUS doxycycline
4. Amoxicillin PLUS minocycline
Vancomycin (preferred),
daptomycin
MSSA & β-hemolytic strep Cephalexin, dicloxacillin,
Cefadroxil, clindamycin
Cefazolin, clindamycin,
nafcillin, oxacillin.
16. Erysipelas
PO options IV options
β-hemolytic strep Penicillin, amoxicillin Cefazolin, ceftriaxone,
flucloxacillin
17. Purulent cellulitis and Skin Abscess
• Always cover MRSA
• When to cover gm-ve , gm+ve & anaerobes:
1. Pressure ulcer.
2. Peri-oral peri-rectal site of infection.
3. Prominent skin necrosis.
• Start IV Tx, Switch to PO once signs of infection resolved.
18. IV options PO options
MRSA Vancomycin (preferred) or
daptomycin
PLUS one of the following:
1. ampicillin/sulbactam
2. Piperacillin/tazobactam
3. Ticarcillin/clavulanate
4. Ceftriaxone + metronidazole
5. Ciprofloxacin +
metronidazole
6. Levofloxacin +
metronidazole
Clindamycin, TMP/SULF,
doxycycline, minocycline,
linezolid.
MRSA & GM+ve, GM-ve
bacilli and anaerobes.
Vancomycin (preferred) or
daptomycin
19. • PO options after s/s resolution:
• clindamycin, trimethoprim-sulfamethoxazole, or tetracyclines (doxycycline
or minocycline)
20. Skin abscess
Role of antibiotic therapy — The role of antibiotic therapy for patients with abscess
depends on individual clinical circumstances. In general, antibiotic therapy is
warranted in the following circumstances:
• Single abscess ≥2 cm
• Multiple lesions
• Extensive surrounding cellulitis
• Associated immunosuppression or other comorbidities
• Systemic signs of toxicity (eg, fever >100.5°F/38°C, hypotension, or sustained tachycardia)
• Inadequate clinical response to incision and drainage alone
• Presence of an indwelling medical device (such as prosthetic joint, vascular graft, or
pacemaker)
• High risk for transmission of S. aureus to others (such as in athletes, military personnel)
Management with incision and drainage alone (in the absence of antimicrobial
therapy) is generally sufficient for otherwise healthy adults with skin abscess <2 cm
in the absence of the above factors.
21. Duration of treatment:
• In general ----> 5 days
• Up to 14 days if:
1. Severe infection
2. Slow response to therapy
3. Immunosuppression.
22. Recurrent infection
• Usually in the same location
• Predisposing factors:
• Edema due to impaired lymphatic drainage, Venous insufficiency, Obesity,
Immunosuppression, Fissuring or maceration of the interdigital toe spaces and Tinea
pedis.
• treatment should be directed at both the infection and the predisposing condition if
modifiable
• Manage same as the initial episode.
23. Suppressive antibiotic therapy
• Used for patients with three to four episodes of cellulitis per year in the setting of predisposing
factors that cannot be alleviated.
• For patients with known or presumed beta-hemolytic streptococcal infection:
• Penicillin V
• Erythromycin
• Penicillin G benzathine IM
• For patients with known or presumed staphylococcal infection:
• Clindamycin
• Trimethoprim-sulfamethoxazole
• Suppressive therapy may be continued for several months with interval assessments for
efficacy and tolerance.
Editor's Notes
bilateral involvement should prompt consideration of alternative causes
patients with edema may benefit from treatment with compressive stockings and diuretic therapy.