This document provides an overview of various skin infections. It discusses bacterial infections like cellulitis, erysipelas, folliculitis, impetigo and furunculosis. It also covers fungal infections such as tinea, candidiasis, pityriasis versicolor and deeper fungal infections. Viral infections including warts and herpes are mentioned. Finally, it summarizes parasitic infestations like scabies, larva migrans and head lice. For each condition, it provides details on pathogenesis, clinical features, diagnosis and treatment.
Fungal infection of the skin, most common on the exposed surfaces of the body, namely the face, arms and shoulders.
Most common fungal diseases ; Ringworm. A common fungal skin infection that often looks like a circular rash.
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Fungal infection of the skin, most common on the exposed surfaces of the body, namely the face, arms and shoulders.
Most common fungal diseases ; Ringworm. A common fungal skin infection that often looks like a circular rash.
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
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.
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.
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
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
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.
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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
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
2. Introduction
• Skin infections are dermatological conditions caused by bacteria,
viruses, fungi and parasites. They are numerous and tend to increase
in humid areas and can be associated with poor hygiene and
underdevelopment.
• It is important for us to know how to diagnose and treat some of
these skin infections because they would present commonly in our
clinics.
4. Cellulitis
• Are soft tissue infections characterized by an acute, diffuse,
spreading edematous, suppurative inflammation of the dermis and
subcutaneous tissues often associated with systemic symptoms of
malaise, fever and chills.
• Differentiated from erysipelas by
1) Lesions of cellulitis are not raised and demarcation from uninvolved
skin is indistinct.
2) Skin is hard on palpation and is extremely painful.
5. • Staph Aureus and GAS are by far the most common aetiologic agents.
• Other bacteria are GBS, Pneumococcus and a variety of gram negative
bacilli.
Risk Factors: Drug and alcohol abuse, cancer and cancer chemotherapy,
DM, cirrhosis, nephritic syndrome, malnutrition, renal failure.
I.P- Few days
Prodrome: Malaise, anorexia, fever, chills can develop rapidly before
cellulitis is apparent clinically. Higher fever (38.5%) and chills usually
associated with GAS.
6. Distribution: Lower leg following interdigital tinea, arm in young male
consider i.v drug use, face following rhinitis and conjunctivitis.
Treatment: B-lactam antibiotics with activity against penicillinase
producing S.aureus are the usual drugs of choice.
Indications for i.v use- rapidly spreading lesions
- Systemic symptoms eg fever, chills
- Immune compromise
- Oral therapy- Healthy individuals with early symptoms in the absence of
systemic symptoms.
7.
8. Erysipelas
• Distinct type of superficial cutaneous cellulitis with marked dermal
lymphatic vessel involvement presenting as a painful, bright red, raised,
oedematous, indurated plaque with advancing raised borders sharply
marginated from the surrounding normal skin.
- Caused by GAS, very uncommonly group C or G streptococcus and
rarely due to Staph aureus
- Sites: Face, lower legs, areas of preexisting lymphedema, umbilical
stump.
- Rx is like cellulitis
10. Folliculitis
• Infectious folliculitis occurs in the upper hair follicle, characterized by
a follicular papule, pustule, erosion, or crust at the follicular
infundibulum; infection can extend deeper into the entire length of the
follicle.
Variants- S.Aureus Folliculitis: Can be superficial(infundibular) or deep
(sycosis) extension beneath infundibulum with abscess formation.
Gram-Negative Folliculitis: Occurs in individuals with acne vulgaris
treated with oral antibiotics. Characterized by small follicular pustules
and /or larger abscesses on the cheeks and by the nostrils.
11. • Hot tub folliculitis: Occurs in the trunk after immersion in spa water.
Caused by P.aeroginosa. Multiple follicular pustules occur few days
after bathing in hot tub.
Investigations: Direct microscopy for S.aureus gram positive.
KOH Preparation: To rule out dermatophytes.
Prophylaxis: Correct underlying predisposing condition. Washing with
antibacterial soap or benzoyl peroxide preparation.
Bacterial folliculitis- Penicillins, cephalosporins,macrolides,tetracyclines
12. • Gram negative folliculitis- Discontinue current antibiotics. Wash with
benzoyl peroxide. Use ampicillin, trimethoprim-sulfamethoxazole qid,
• Isotretinoin.
13. Impetigo
• S.aureus and GAS (S.pyogenes) can cause superficial infection of the
epidermis (impetigo) which may extend into the dermis (ecthyma)
xterized by crusted erosions or ulcers.
They may arise as primary infections in minor superficial breaks in the
skin or as secondary infections of preexisting
dermatoses.(impetiginiztion or secondary infection).
Lab invs- Gram stain, culture, dermatopathology.
Rx-Prevention-daily bath, benzyl peroxide wash
Topical-mupirocin 3x dly for7-10days, cephalosporin,erythromycin
16. Superficial fungal infections
• They are the most common of all mucocutaneous infections. Often
caused by overgrowth of transient or resident flora associated with a
change in the microenvironment of the skin.
The fungi causing these are dermatophytes, candida spp and
malassezia furfur.
Dermatophytes are made up of Epidermophyton, Trichophyton and
Microsporon. They are a unique grp of fungi capable of infecting
nonviable keratinized cutaneous structures including statum corneum,
nails and hair.
17. • Dermatophytoses of keratinized epidermis: Tinea facialis, corporis,
cruris, manus and pedis.
• Dermatophytoses of nail apparatus: Tinea unguim (toenails,
fingernails)
• Dermatophytoses of hair and hair follicle: Tinea capitis and tinea
barbae.
• Pathogenesis: Dermatophytes synthesize keratinases that digest
keratin and sustain existence of fungi in keratinized structures.
18. • Clinical features: Tinea Pedis
• Interdigital-1) Dry scaling
• 2)Maceration, peeling and fissuring of toe webs.
• Moccasin type- Well demarcated erythema with minute papules on
margin, fine white scaling and hyperkeratosis. (Confined to heels,
soles, lateral borders of feet.)
• Inflammatory/Bullous type- Vesicles or bullae filled with clear fluid
• -sole,instep, webspaces
19. • Tinea Manuum- Well demarcated scaling patches, hyperkeratosis and
scaling confined to palmar creases, fissures on palmar hand. Borders
well demarcated, central clearing.
• Tinea Cruris- Large scaling, well demarcated dull red/tan/brown
plaques. Central clearing. Papules, pustules may present at margins.
• Tinea corporis- Sharply marginated plaque with central clearing.
• Tinea capitis- A large round hyperkeratotic plaque of alopecia due to
breaking off of hair shafts close to the surface. Circular in shape.
20. • Host factors that facilitate dermatophyte infections: atopy, topical and
systemic glucocorticoids, ichthyosis, collagen vascular dx.
Local factors favoring dermatophyte infection: sweating, occlusion,
occupational exposure, geographic location, high humidity (tropical or
semitropical climates.
Investigations: KOH 5 to 20% ,Wood’s lamp, Fungal Cultures
21. Treatment
Topical antifungals- may be effective for treatment of dermatophytosis
of the skin but not for hair or nails.
Examples are Terbinafine, miconazole,ketoconazole.
Systemic antifungal- infection of keratinized skin: use if lesions are
extensive or if infection has failed to respond to topical preparations.
Required for treatment of tinea capitis and unguim.
1) Terbinafine 250mg dly
2) Azole/imidazoles- itraconazole-100mg, fluconazole
100,150,200mg,ketoconazole- 200mg
3) Griseofulvin-250-500mg
22.
23. Pityriasis Versicolor
• Characterized by well dermacated scaling patches with variable
pigmentation.
• Occurring most commonly on the trunk.
• Most common in young adults.
• Predisposing factors - High temp, relative humidity, oily skin,
hyperhydrosis, steroid Rx.
• No symptoms most of the time, rarely mild pruritus. Mainly a
cosmetic concern
24.
25. • Lesions present as sharply marginated macules, off white or brown of
varying intensities.
• 0ccurs mostly on the upper trunk, upper arms, neck, abdomen,
axillae, groins, thighs and genitalia.
• Infection can persist for years if predisposing conditions persist.
26. • Dyspigmentation persist for mths after infection has been cleared.
• Management- Topical
• Selenium sulphide shampoo
• Ketoconazole shampoo
• Systemic therapy , Fluconazole,
• Itraconazole
28. Subcutaneous mycoses
Are a heterogenous group of fungal infections that develop at the site
off transcutaneous trauma. Infection slowly evolves as the aetiologic
agent survives and adapts to adverse host environment. The diagnosis
rests on clinical presentation, histopathology and culture of the
aetiologic agents. Eg Mycetoma,Chromomycosis and sporotrichosis.
Mycetoma is a chronic suppurative infection originating in
subcutaneous tissue characterized by the presence of grains, which are
are tightly clumped colonies of the causative agent. Painless swelling,
woody induration and sinus tracts that discharge pus intermittently are
characteristic.
29. • Pathogenesis- Pathogens live in soil and enter through breaks in the
skin. Only organisms that can survive at body temperature can
produce mycetoma.
• Lab investigations- Smear of pus from lesion granules show medlar
bodies visualized on KOH preparations as microbial colonies.
• Dermatopathology- Pseudoepitheliomatous hyperplasia of epidermis.
Grains are found in purulent foci surrounded by fibrosis and
mononuclear cell inflammatory cell response.
Culture- Isolate organism. Imaging: CTscan and echosonography define
30. • the extent of involvement. Xray of bone shows multiple osteolytic
lesions (cavities) periosteal bone formation.
• Mgt- Surgery
• Medicosurgical Approach- bulk reduction with effective antimicrobial
agent given.
Systemic Antimicrobial therapy: Usually continued for 10months
32. • Chromomycosis: Is a chronic localized invasive fungal infection of skin
and subcutaneous tissues caused by pigmented (dematiaceous or
dark-walled) fungi. Verrucous plaques usually occur on the leg or
foot. Fonsecaea pedrosoi, F.compacta.
• Lab investigations- Smear of Pus from lesion. Medlar bodies visualized
in 10 to 20% KOH preparation as black dots. Hyphal forms can be seen
in crusts, pus and exudate.
• Dermatopathology-Warty granuloma, medlar bodies
• Culture- Organism in sabouraud’s agar show velvety green to black,
restricted, slow growing colonies.
33. • Treatment- Rx is continued for at least 1year.
• Sporotrichosis- commonly follows accidental inoculation of the skin
and is characterized by ulceronodule formation at the inoculation
site.
• Aetiology- Sporothrix schenckii, a dimorphic fungus, living as a
saprophyte on plants in many areas of the world.
• Touch Preparation- KOH solution added to smear from lesional skin
biopsy helps visualize multiple yeast forms.
38. Scabies
• Is an infestation by the mite sarcoptes scabiei, usually spread by skin
to skin contact, characterized by generalized intractable pruritus,
papules, nodules and post inflammatory hyperpigmentation.
• Pathogenesis: Hypersensitivity of both immediate and delayed types
occurs in the development of lesions other than burrows.
• For pruritus to occur sensitization of S.scabiei, must take place.
• Clinical Features: pruritus intense widespread, interferes with sleep.
• Often present in family members
• Intraepidermal burrows,scabetic nodules-penis,scrotum,axilla,waist.
39. • buttocks, areola
• Investigations- Microscopy- Scabetic mites,eggs and faecal pellet
• Dermoscopy- Jet with contrail sign
• Dermatopathology- Scabietic burrow
• Treatment- Permethrin cream from neck downwards leave for 8hrs
then wash off. Repeat in 1wk
• Benzyl benzoate 10% and 25%- several regimen recommended.
• Systemic ivermectin: 200ug/kg PO ,2 doses I week apart.
• Washing of beddings and underwears 2x, 1 week apart
40. • Treatment of close contacts.
• Treatment of secondary bacterial infection.
• Treatment of pruritus.
41. Pediculosis capitis (Head Lice)
• Is an infestation of the scalp by head louse, which feeds on the scalp
and neck and deposits its eggs in the hair.
• Few symptoms but is a major cause of concern.
• Transmission is by shared hats, caps, brushes, combs, head to head
contact.
• Symptoms are pruritus of the back and sides of scalp. Scratching and
secondary infection associated with occipital and /or cervical
lymphadenopathy.
42. • Microscopy- Louse or nit on a hair shaft can be examined to confirm
the gross examination of the scalp and hair
• Fomite/environmental control: Avoid contact with possibly
contaminated items such as hats, headsets, bedding. They should be
washed and dried on the hot cycle of a drier.
• Combs and brushes should be soaked in rubbing alcohol for 1hr.
• Rx- Permethrin 1% over the counter, 5% prescription. Apply to
infected areas then wash off after 10mins. Repeat 7 to 14days.
• Malathion 0.5% in 78% isopropyl alcohol
44. Warts
• 3 clinical manifestations of cutaneous Human papilloma virus
infection.
• Common Warts ( Verruca vulgaris)
• Plantar warts
• Flat warts
• Human papillomavirus are double-stranded DNA, some types
commonly infect keratinized skin. Warts are a discrete benign
epithelial hyperplasia with varying degrees of surface hyperkeratosis
45. • Manifested as minute papules to large plaques. Lesions may become
confluent forming a mosaic. The extent of lesions is determined by the
immune status of the host.
Verruca vulgaris (common warts): Firm papules, 1-10mm or rarely
larger, hyperkeratotic, clefted surface with vegetations. Palmar lesions
disrupt the normal line of fingerprints. Xteristic red or brown dots are
better seen with hand lens and are pathognomonic, representing
thrombosed capillary loops.
46. • Verruca plantaris (Plantar Warts) : Early small shiny sharply
marginated papule---plaque with rough hyperkeratotic surface
studded with brown black dots.
• Verruca Plana (Flat warts): Sharply defined flat papules, flat surface.
The thickness of the lesion is 1 to 2mm skin colored or light brown.
• Epidermodysplasia verriciformis: Flat topped papules. Pityriasis
versicolor like lesions, particularly on the trunk. Skin colored, light
brown, pink, hypopigmented.
• Dermatopathology: Acanthosis, papillomatosis, hyperkeratosis.
Characteristic feature is foci of vacuolated cells.
47. • Treatment: Aggressive therapies which are often quite painful and
may be followed by scarring are usually to be avoided because the
natural hx of cutaneous HPV infection is spontaneous resolution in
months or years.
• Patient initiated therapy: 10-20% salicylic acid and lactic acid in
collodion. 40% salicylic acid plaster for 1wk.
• Cryosurgery
• Electrosurgery
• Co2 laser
48. Genital warts
• When clinically symptomatic, lesions are barely visible papules to
nodules to confluent masses occurring on the anogenital area caused
by a mucosal HPV type.
• Aetiology- HPV is a DNA papovavirus that multiplies in the nuclei of
infected epithelial cells. More than 20 types of HPV can infect the
genital tract: types 6 and 11 most commonly.
Transmission: Through sexual contact: genital-genital, oral-genital,
genital-anal
50. • Serology
• Rx- Imiquimod 5% cream, applied 3x a week usually at bedtime
• Podofilox- podophyllin
• Podophyllin 10-20%
• Electrodessication
• Carbon dioxide laser and electrodessication
51.
52.
53. Herpes virus 1 and 2
• Genital herpes is a chronic sexually transmitted viral infection,
characterized by symptomatic and asymptomatic viral shedding.
• In most cases both primary infection and recurrences are
asymptomatic.
• When symptomatic primary GH may present with grouped vesicles at
the site of inoculation associated with significant pain and regional
lymphadenopathy.
• Recurring outbreak of vesicles at the same site
• Shedding rate is higher from HSV-2 than HSV-1.
54. • Risk Factors- increases with no of sexual partners.
• Most clinical lesions are minor breaks in the mucocutaneous
epithelium presenting as erosions, abrasions, fissures.
• Management: First clinical episode- Acyclovir 400mg tid or 200mg 5x
a day for 7-10days.
• Recurrent episodes 400mg 5x a day for10days.