Lichen planus is a chronic autoimmune disease that affects the skin and mucous membranes. It is characterized by pruritic polygonal papules and plaques that are flat topped and violaceous. The disease commonly affects middle aged women more than men. Oral lichen planus presents as white lacy lesions inside the mouth, while skin lesions typically occur on the wrists and legs. Treatment focuses on reducing symptoms through topical corticosteroids and immunosuppressants. While usually self-limiting, oral lichen planus poses a small risk of malignant transformation over the long term.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
Lichen planus (LP) is a chronic mucocutaneous disorder
of the stratified squamous epithelium that affects oral
and genital mucous membranes, skin, nails, and scalp
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A well pictured presentation on Endodontic Instrumentation for UG students. Best for getting a good grip on the topic as a whole. Meant to supplement not substitute standard texts.
A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.
A comprehensive slideshow covering all the basics relating to dental materials and their physical properties. Based on standard text books - Phillips Science of Dental Materials (11th Edition).
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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.
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
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.
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
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.
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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.
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!
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2. Lichen Planus
Lichen planus (LP) is a disease of
the skin and/or mucous
membranes that
resembles lichens.
It is thought to be the result of
an autoimmune process with an
unknown initial trigger.
Where the trigger is known, a
lesion is known as a lichenoid
lesion.
INTRODUCTION
3. Epidemiology :
EPIDEMIOLOGY
Risks for the condition include:
Exposure to medicines, dyes, and other chemicals
(including gold, antibiotics, arsenic, iodides, chloroquine,
quinacrine, quinide, phenothiazines, and diuretics)
Diseases such as hepatitis C
Race: No racial predispositions.
Sex: Lichen Planus effects women more compared to
men (3:2) ratio.
Age: More than two thirds of lichen planus patients are
aged 30-60 years; however, lichen planus can occur at
any age
4. Time Period:
TIME PERIOD
It is a chronic disease.
It has a sub-acute presentation i.e lesions appear
usually 1-2 weeks after being exposed to stimulus.
The condition often clears up within 18 months
but may come and go for years.
Removal of stimulus could result in a quick
resolution, eg if lichen planus is caused by a
medicine, the rash should resolve once medicine
is stopped.
6. Oral Lesions:
ORAL LESIONS
May be tender or painful (mild cases may not
cause plain)
Are located on the sides of the tongue, inside of
the cheek, or gums
Look like blue-white spots
Form lines in a lacy network
Gradual increase in size of the affected area
Sometimes form painful ulcers
7. Skin Lesions:
SKIN LESIONS
Are usually found on the inner wrist, legs, torso, or
genitals
Are itchy
Have even sides (symmetrical) and sharp borders
Occur in single lesion or clusters, often at the site
of skin injury
May be covered with thin white streaks or scratch
marks (called Wickham's striae)
Are shiny or scaly looking
Have a dark, reddish-purple color on the skin or
are gray-white in the mouth
May develop blisters or ulcers
9. The goal of treatment is to reduce
symptoms and speed healing.
If symptoms are mild, it may not
need treatment.
MANAGMENT
Treatment Goal
10. Treatments may include:
Antihistamines
Medicines that calm down the immune system, such as
cyclosporine (in severe cases)
Lidocaine mouthwashes to numb the area and make eating
more comfortable (for mouth sores)
Topical corticosteroids (such as clobetasol) or oral
corticosteroids (such as prednisone) to reduce swelling and
lower immune responses
Corticosteroids shots into a sore
Vitamin A as a cream (topical retinoic acid) or taken mouth
(acitretin)
Dressings placed over skin medicines to protect from
scratching
Ultraviolet light therapy for some cases
MANAGMENT
Treatments and Rationale
12. Lichen Planus :
Lichen planus is a cell-mediated
immune response of unknown
origin.
It may be found with other
diseases of altered immunity, such
as ulcerative colitis, lichen
sclerosis, myasthenia gravis etc.
Lichen planus has been found to
be associated with hepatitis C
virus infection, chronic active
hepatitis, and primary biliary
cirrhosis
It is most likely an immunologically
mediated reaction, though the
pathophysiology in unclear.
LICHEN PLANUS
14. Signs and Symptoms:
The following may be noted in the patient history:
Lesions initially developing on flexural surfaces of the
limbs, with a generalized eruption developing after a
week or more and maximal spreading within 2-16 weeks
Pruritus of varying severity, depending on the type of
lesion and the extent of involvement
Oral lesions that may be asymptomatic, burning, or even
painful
In cutaneous disease, lesions typically resolving within 6
months (>50%) to 18 months (85%); chronic disease is
more likely oral lichen planus or with large, annular,
hypertrophic lesions and mucous membrane involvement
SYNDROME STATEMENT
15. Signs and Symptoms:
In addition to the cutaneous eruption, lichen
planus can involve the following structures:
Mucous membranes
Genitalia
Nails
Scalp
SYNDROME STATEMENT
Interestingly, this disease is
Interestingly, this disease is
seldom seen in carefree
seldom seen in carefree
people, the nervous, high
people, the nervous, high
strung person is almost
strung person is almost
invariably the one in which
invariably the one in which
this condition develops.
this condition develops.
17. Clinical Presentation
The clinical presentation of lichen planus has
several variations, as follows:
Hypertrophic lichen planus
Atrophic lichen planus
Erosive/ulcerative lichen planus
Follicular lichen planus (lichen planopilaris)
Annular lichen planus
Linear lichen planus
Vesicular and bullous lichen planus
Actinic lichen planus
Lichen planus pigmentosus
Lichen planus pemphigoides
CLINICAL PRESENTATION
18. Clinical Forms: Oral Lichen Planus
Reticular, the most common presentation of oral lichen planus,
characterised by the net-like appearance of lacy white lines, oral
variants of Wickham's straiae. This is usually asymptomatic.
Erosive/ulcerative, the second most common form of oral lichen
planus, characterised by oral ulcers presenting with persistent,
irregular areas of redness, ulcerations and erosions covered with a
yellow slough. This can occur in one or more areas of the mouth. In
25% of people with erosive oral lichen planus, the gums are
involved, described as desquamative gingivitis (a condition not
unique to lichen planus). It may be the initial or only sign of the
condition.
Papular, with white papules.
Plaque-like appearing as a white patch which may
resemble leukoplakia
Atrophic, appearing as areas. Atrophic oral lichen planus may also
manifest as desquamative gingivitis.
Bullous, appearing as fluid-filled vesicles which project from the
surface.
CLINICAL PRESENTATION
20. Direct immunofluorescence study reveals
globular deposits of immunoglobulin M (IgM)
and complement mixed with apoptotic
keratinocytes.
No imaging studies are necessary.
Microscopy confirms OLP.
DIAGNOSIS
Diagnosis:
21. Histopathology:
Distinguishing histopathologic features of lichen planus
include the following:
Hyperkeratotic epidermis with irregular acanthosis and focal
thickening in the granular layer
Degenerative keratinocytes (colloid or Civatte bodies) in the
lower epidermis; in addition to apoptotic keratinocytes, colloid
bodies are composed of globular deposits of IgM (occasionally
immunoglobulin G [IgG] or immunoglobulin A [IgA]) and
complement
Linear or shaggy deposits of fibrin and fibrinogen in the
basement membrane zone
In the upper dermis, a bandlike infiltrate of lymphocytic
(primarily helper T) and histiocytic cells with many Langerhans
cells
HISTOPATHOLOGY
24. Lichen planus is a self-limited disease that usually resolves
within 8-12 months.
Mild cases can be treated with fluorinated topical steroids.
More severe cases, especially those with scalp, nail, and
mucous membrane involvement, may necessitate more
intensive therapy.
MANAGEMENT
Management
25. Pharmacologic therapies include the following:
Cutaneous lichen planus: Topical steroids,
particularly class I or II ointments (first-line
treatment); systemic steroids; oral metronidazole
;
oral acitretin; other treatments of unproven
efficacy (eg, mycophenolate mofetil and
sulfasalazine)
Lichen planus of the oral mucosa: Topical
steroids; topical calcineurin inhibitors; oral or
topical retinoids (with close monitoring of lipid
levels)
MANAGEMENT
Pharmacological Management
26. Patients with widespread lichen planus may
respond to the following:
Narrow-band or broadband UV-B therapy.
Psoralen with UV-A (PUVA) therapy; use of topical
ointment at the time of UV-A treatment may
decrease the effectiveness of PUVA; precautions
should be taken for persons with a history of skin
cancers or hepatic insufficiency
MANAGEMENT
Pharmacological Management
27. Morbidity:
In lichen planus, atrophy and scarring are seen
in hypertrophic lesions and in lesions on the
scalp.
Cutaneous lichen planus does not carry a risk
of skin cancer, but ulcerative lesions in the
mouth, particularly in men, do have a higher
incidence of malignant transformation.
However, the malignant transformation rate of
oral lichen planus is low (< 2% in one
report).
Vulvar lesions in women may also be
associated with squamous cell carcinoma.
MANAGEMENT
31. In summary:
Lichen Planus effects women more compared
to men (3:2) ratio, etiology of Lichen Planus is
not known, it is characterised by nine P’s
Papulosquamous disorder
Pruritic
Polyangular with
Plain Topped
Pigmented
Purple coloured
Papules and Plaques
Pterygium Unguium present in nails
Penile annular lesions
SUMMARY