This document discusses keloids and hypertrophic scars. It begins by defining each condition and providing an introduction. It then covers risk factors, pathogenesis, clinical features, diagnosis, management, prevention, complications, prognosis, and local experience. Keloids extend beyond the original wound site, while hypertrophic scars do not but are still raised and thickened. Risk factors include skin injury, genetics, and skin pigmentation. Management involves a variety of options depending on the case, often combining excision, steroid injection, and pressure therapy. Recurrence is a challenge, and further research is still needed for effective keloid treatment.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
This PPT is mainly oriented towards Bailey & Love - Topic on Skin & Sub-cutaneous tissue. Few common diseases has been added. Very useful to Final yr. MBBS Students
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
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.
It is a presentation given at the American university of Beirut Lebanon in Dermatology rotation elective as an introduction for the pathology, pathophysiology, physiology of the different skin lesions in dermatology classified between the different morphology of the lesions supported with images from different atlas and real live image taken from patients after, of course, taking permission to share it publically.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
This PPT is mainly oriented towards Bailey & Love - Topic on Skin & Sub-cutaneous tissue. Few common diseases has been added. Very useful to Final yr. MBBS Students
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
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.
It is a presentation given at the American university of Beirut Lebanon in Dermatology rotation elective as an introduction for the pathology, pathophysiology, physiology of the different skin lesions in dermatology classified between the different morphology of the lesions supported with images from different atlas and real live image taken from patients after, of course, taking permission to share it publically.
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
Discoid lupus is an unpredictable and highly variable disorder. While the condition is benign, it can cause devastating complications, often leading to high morbidity and a poor quality of life. The disorder frequently waxes and wanes. The outcome is much improved for patients with only skin and musculoskeletal involvement.
DLE is more common in skin of colour. For example, in New Zealand, Māori, and Pacific people have a significantly higher relative risk of discoid lupus erythematosus compared to the European population. This ethnic disparity has also been observed in the USA with those with skin of colour having an increased incidence of DLE.
The skin is not only the largest organ of the body, but it also forms a living biological barrier with several functions.
Pyodermas are any pyogenic skin disease (has pus). Skin infections can be caused by bacteria (often Staphylococcal or Streptococcal) either invading normal skin, or affecting a compromised skin barrier
Some bacterial skin infections resolve without serious morbidity. However, skin infections can be severe and result in sepsis or death, particularly in vulnerable patient groups.
Presentations and Management of Intracranial Abscess.pptxCHIZOWA EZEAKU
summary on intracranial abscess with emphasis on aetiology, pathogenesis, pathology, forms of presentations , investigations and treatment options of brain abscess.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- 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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
3. INTRODUCTUON
• Keloid is defined as an abnormal scar that grows beyond the
boundaries of the original site of skin injury.
• Alibert in 1806 called it “cheloide” which is derived from
Greek word “chele” or “crab’s claw.”
• Hypertrophic scar is defined as a widened or unsightly scar
that does not extend beyond the original boundaries of the
wound.
• They are inflammatory disorders of the reticular dermis due
to aberrant wound healing process.
3
5. Scar classification
• Immature Scar
• Mature Scar
• Linear hypertrophic Scar
• Widespread hypertrophic scar
• Minor keloid
• Major keloid
5
6. Epidemiology
• Only humans are affected.
• Occur in 5-15% of wounds.
• All ethnic background can form hypertrophic scar and keloid-
which has greater frequency in pigmented races (16%).
• Young F>M ; other age groups , equal.
• More in the 10- 30 years, less at extreme of age.
• No racial or familial preponderance for hypertrophic scar.
6
12. Phases of wound healing
• There are 3 phases of wound healing and can take months to
complete
• Inflammatory Phase: Platelet degranulation---release &
activation of numerous cytokines--chemotactic agents for
inflammatory cells, epithelial cells & fibroblasts
• Proliferative Phase: Stage of granulation tissue formation
• Remodeling Phase : Conversion of Collagen III → Collagen I
14. AETIOPATHOGENESIS(Hypertrophic scar)
14
• Scar remains in the remodeling phase more than normal scar.
• There is increased deposition of collagen.
• Commonly occurs in situations when wound is sutured under
tension or healing has been delayed
15. AETIOPATHOGENESIS(keloid)
• Imbalance in anabolic and catabolic phases of wound healing.
• Abnormal keratinocyte-fibroblast signaling .
• Increased level of fibronectin and adiponectin.
• Role of melanocyte stimulating hormone.
• Genetics – DeHaNp63, p53 underexpression.
• Allergic immunoglobin E mediated response.
• Role of TGF-b, PDGF, IGF 1, IL-6 in the invasive activity of
keloid.
• Spontaneous keloids.
15
17. • Hypertrophic scar contains islands composed of aggregates of
fibroblasts, small vessels and well organised type 3 collagen
throughout the dermis.
• Keloids contains disorganised type 1 and 3 hyalinized collagen
bundles that form acellular node like structures in the deep
dermis with paucity of cells centrally.
17
19. Typical histopathological findings
• Presence of keloid hyalinized collagen
• Tongue-like advancing edge underneath normal-
appearing epidermis and papillary dermis
• Horizontal cellular fibrosis bands in the upper
reticular dermis
• Prominent fascia-like fibrous bands
• Collagen bundles are thicker and more abundant in
keloids; and there is the presence of large, broad &
closely arranged collagen fibres composed of
numerous fibrils
19
22. CLINICAL FEATURES
Cinical features Hypertrophic scar Keloid
Always preceded by injury yes no
Anatomical association no yes
Extent of growth limited to wound Extends beyond the wound
Resolves Spontaneously Yes No
Recurs after surgery No Yes
Physical examination Raised erythematous
lesions
Raised erythematous
lesions
Physical examination Soft , doughy, rubbery and
hard
Soft , doughy, rubbery and
hard
22
Adapted from Dr Achebe U lecture note
33. Diagnosis
• Diagnosis is usually based on the clinical findings.
• Biopsy may confirm the diagnosis in equivocal cases.
33
34. MANAGEMENT OF HYPERTROPHIC SCAR
• Patience and counseling.
• Massage, Pressure, Silicon sheet or gel will accelerate
maturation.
• Wide spread large hypertrophic scar may require serial
excision, intralesional therapy and tissue expansion.
• Surgical intervention, if hypertrophic scar is interfering with
function.
• Surgery involves, scar release or revision, z-plasty, skin flap or
grafting.
34
37. Prevention of Keloids
• First rule in keloid therapy.
• Avoid nonessential surgery in keloid formers.
• Close all surgical wounds with minimal tension.
• Incisions should not cross joint space.
• Avoid making midchest incisions.
• Incisions follow skin crease where possible.
• Control of inflammatory acne.
• Prophylactic pressure garment.
37
38. MANAGEMENT OF KELOID
• No single modality is best.
• Depends on age, location, size & response to previous
treatment.
• Combination therapy is advocated.
• Mainstay is triple keloidal therapy .
• Marginal excision, steroid injection and silicone gel sheeting.
• Steroid injection, pressure dressing & silicone gel.
• Excision, postop radiation & steroid injection.
• Regular followup,
– FBC+ DIFF, SEUCR, RBS, BP monitoring following high dose steroids
38
45. PROGNOSIS
• The bane of keloid is reoccurrence.
• Hypertrophic scars usually regress with time or with
treatment.
• However, both may result in significant disfigurement and loss
of function.
45
46. LOCAL EXPERIENCE (1yr)
• 64 new cases
• M: F= 1:2
• Ear lobe (65%), upper arm(25%), others (10%)
• Marginal excision + intralesional kenalog+ silicon gel
46
47. FUTURE TRENDS
• Use of vesmeter
• Stem cell therapy
• Electrochemotherapy
• Fat grafting / lipofilling
• Role of decapentaplegic homolog(Smad)3, high mobility group
boxprotein-1, and calcimycin.
47
48. CONCLUSION
• Both hypertrophic scars and keloids are aberrant proliferative
scars.
• Hypertrophic scars usually regress , with better treatment
outcome.
• At present , no single best therapy for keloid management,
and the large number of treatment options reflects this.
• Combination therapy is thus advocated.
48
49. References
• Rei Ogawa: Keloid and Hypertrophic Scars Are the Result of
Chronic Inflammation in the Reticular Dermis. Int J Mol Sci.
2017 Mar; 18(3): 606.
• Ahmad S.E, Etal:Keloid Scarring: Understanding the Genetic
Basis, Advances, and Prospects. Arch Plast Surg. 2012 May;
39(3): 184–189.
• Townsend M Etal :Wound healing. Sabiston textbook of
Surgery, 20 edition,2017:pg 141-144.
• Keloid and hypertrophic scar. A lecture note delivered by Dr
Uche Achebe.
• Sriram Bhat M: Keloids. Wounds and wound healing. SRB
manual of surgery, 4th edition, 2013: pg12- 13
• emedicine.medscape.com/article/Keloids and hypertrophic
scar
49