This document discusses herpes zoster (shingles) and postherpetic neuralgia (PHN). It begins by introducing herpes zoster as a viral infection caused by reactivation of the varicella zoster virus. It then covers the etiopathogenesis, phases, clinical variants, diagnosis, differential diagnosis, treatment of acute herpes zoster including antiviral therapy and interventions, prevention of herpes zoster, and treatment of PHN including conservative management with medications and interventional treatments.
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.
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.
Viral infections of the skin
DIRECT INFECTIONS ON THE SKIN
→Molluscum Contagiosum
→Wart
SKIN MANIFESTATIONS OF SYSTEMIC DISEASES
Vesicular:Hand foot mouth disease,chicken pox,HSV 1,2
Non vesicular:Measles,Rubella and other exanthematous
rashes.
Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. This is an update information about herpes infection from The New England Journal of Medicine.
A concised information regarding use of photo therapy in dermatology. made by me as a part of MD dermatology residency. includes additional information about sunscreens.
Oldest disease known to mankind
First described in ancient Indian
texts as “Kustha roga” attributed ]
to curse from God
Leper : Greek “scaly”
Hansen’s Disease – 1873 Norwegian Armauer Hansen discovered that leprosy is caused by bacterium - Mycobacterium leprae
Albert Neisser (1879) – stained the organism with fuchsin & gentian violet ( AFB )
Viral infections of the skin
DIRECT INFECTIONS ON THE SKIN
→Molluscum Contagiosum
→Wart
SKIN MANIFESTATIONS OF SYSTEMIC DISEASES
Vesicular:Hand foot mouth disease,chicken pox,HSV 1,2
Non vesicular:Measles,Rubella and other exanthematous
rashes.
Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. This is an update information about herpes infection from The New England Journal of Medicine.
A concised information regarding use of photo therapy in dermatology. made by me as a part of MD dermatology residency. includes additional information about sunscreens.
Oldest disease known to mankind
First described in ancient Indian
texts as “Kustha roga” attributed ]
to curse from God
Leper : Greek “scaly”
Hansen’s Disease – 1873 Norwegian Armauer Hansen discovered that leprosy is caused by bacterium - Mycobacterium leprae
Albert Neisser (1879) – stained the organism with fuchsin & gentian violet ( AFB )
Skin Manifestations of Scleroderma, by Dr. Lorinda Chung MD maushard
Keynote presentation by Dr. Lorinda Chung MD at March 9, 2013 Cheri Woo Scleroderma Education Seminar in Tualatin, OR hosted by Oregon Chapter of the Scleroderma Foundation.
Fluoroscopy ,Radiation safety and contrast agents including adverse effect an...Dr Ravi Shankar Sharma
IT includes everything related to fluoroscopy, radiation exposure, it,s effects, contrast agents , and it,s newer variants including gadolinium, anaphylaxis reactions and it,s management, images for epidural,intrathecal,subdural, intrarterial and intravenous contrast picture.
comparative evaluation of effects of different doses of intrathecal clonidine...Dr Ravi Shankar Sharma
this was the winning paper as best free paper in MPISACON14 GWAlOR,which demonstrates comparative evaluation of effects of different doses of intrathecal clonidine with bupivacaine on post operative pain releif
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
6. Anti dromic conduction of virus to dermo
epidermal junction via cutaneous nerves
•Demyelination
•Increase in the electrical
activity of peripheral
nociceptors
Inflammation and tissue
necrosis leading to rash
PERIPHERAL NERVES
SKIN
9. PRODROME
• Precedes the appearance of rash by 3 – 7
days
• Result of viral replication and inflammation
• Flu like symptoms malaise, fatigue,
headache, fever, neck stiffness
• U/L dermatomal pain / altered sensation /
pruritis
11. PAIN
• It can precede or accompany the rash
• Burning / throbbing / stabbing / electric shock
like pain which may be constant or intermitent
• Associated with hyperaesthesia and allodynia
• Interfere with sleep, physical and emotional
functioning
16. TREATMENT
Objectives :
• Reduction of severity and duration of the pain.
• To limit viral replication.
• Recovery of epidermal defects and prevention
of secondary infections.
• Reduction or prevention of PHN.
17. TREATMENT – ACUTE HERPES ZOSTER
CONSERVATIVE MANAGEMENT
• Patient education
- avoid contact with individuals who are sero
negative for VZV
- keep rash clean and free of adhesive
dressings to prevent secondary infections
18. ANTI VIRAL THERAPY:
- Inhibit viral DNA polymerase and hence its
replication
- must be given to all herpes zoster patients
- beneficial when given within 72 hrs of onset of
rash
Those who benefit even > 72 hrs :
- ophthalmic zoster
- immunocompromised
- neurological damage
19. Benefits of antiviral therapy
• Inhibition of viral replication
• Reduce duration of viral shedding
• Hastens rash healing
• Decrease the degree of neural damage
• Decrease the severity and duration of acute pain
• Decrease duration of PHN
• Decrease incidence of PHN
20.
21. CONSERVATIVE MANAGEMENT contd
• ANALGESICS:
- mild pain – NSAIDS / acetaminophen / weak
opioids
- moderate pain – strong opioids ( effective in
reducing pain )
• CO ANALGESICS: gabapentin , pregabalin , TCA’S may
be used
22. CONSERVATIVE MANAGEMENT contd
• CORTICOSTEROIDS:
- reduce inflammatory features of acute zoster
- possibly prevent injury to affected neurons
- effective when used in combination with antivirals
- no effect on the healing of rash
- no effect on the occurrence of PHN
23. INTERVENTIONS
• Single shot epidural with local anaesthetic + STEROID
(level B evidence)
• Continuous epidural with LA
• Paravertebral blocks
• Sympathetic blocks
• SCS
24.
25. PREVENTION
• VZV vaccination for children
• VZIG – for immunocompromised seronegative
patients who are exposed to chicken pox /
herpes zoster
• Herpes zoster vaccination for adults
27. INTRODUCTION
• POST HERPETIC NEURALGIA : dermatomal
pain persistent > 120 days after the onset of
rash
• PHN risk factors:
- age > 50 yrs
- painful prodrome
- severe acute pain / rash
28. PATHOPHYSIOLOGY
VIRAL REPLICATION
NEURAL DAMAGE AND
INFLAMMATION
(GANGLIONITIS)
SENSITIZATION
PERIPHERAL C FIBRES
burning,
hyperalgesia, allodynia
CENTRAL involves
NMDA R & Glutamate
R / EPHAPTIC
conduction
DEAFFERENTIATION
Loss of large and small
diameter fibers
Ectopic discharges
Collateral sproutings
29. CLINICAL FEATURES
• sharp shooting, electric shock like pain
- continuous burning / throbbing pain
• tactile allodynia ( most deblitating )
- hyperalgesia
• Musculoskeletal pain
• Sensory abnormalities :
- hypoaesthesia, altered temperature sensation,
paraesthesia, dysaesthesia, chronic pruritis
33. CONSERVATIVE MANAGEMENT
• ANTICONVULSANTS:
- Gabapentin : alpha 2 delta L type voltage gated
Ca++ channel blocker
- start with 300mg / day (max dose upto 3600mg /
day )
- Pregabalin : alpha 2 delta L type voltage gated
Ca++ channel blocker
- start with 150 mg / day ( max upto 600 mg/day)
- better tolerated
34. CONSERVATIVE MANAGEMENT contd
• ANTI DEPRESSANTS:
- TCA’s : amitryptyline / nortryptyline
• Provides moderate to excellent pain relief .
(used esp in those suffering with insomnia)
desipramine – less sedating
- SNRI’s : not FDA approved
duloxetine is still used
35. CONSERVATIVE MANAGEMENT contd
• OPIOIDS: Tramadol & Oxycodone useful
CLINICAL RECOMMENDATIONS:
• Use lowest effective dose
• Initiate with short acting opioids
• Convert to long acting
• Proactively combat nausea and constipation
36.
37. INTERVENTIONAL MANAGEMENT
• SYMPATHETIC NERVE BLOCKS :
- Good evidence
- it reduces sympathetically mediated neuronalinflammation
• SPINAL CORD STIMULATION : good evidence
• POOR EVIDENCE :
- Continuous epidural for one week
- intercostal N block
- transforaminal DRG
- intra thecal opioids
• PRF leisoning
• Narrow band UVB
38. PREVENTION OF PHN
• Vaccination
• Anti viral therapy
• Pharmacotherapy – alleviate pain
• Sympathetic blocks
39. PREVENTION OF PHN
• Vaccination
• Early antiviral therapy
• Early treatment of neuropathic pain