Dermoscopy or epiluminescence microscopy
A simple, noninvasive method to examine the subsurface features of the skin.
Structures seen
Epidermis
Dermoepidermal junction
Superficial dermis
3 types of dermoscope
1.Nonpolarized devices
2.Polarized devices
3.Hybrid devices
Dermoscopy is used in:
1.Evaluating pigmented skin lesions
2.Evaluating nonpigment skin lesions
3.Entomodermoscopy
4.Trichoscopy
5.Onychoscopy
different dermoscopic patterns are used to diagnose the dermatological diseases are
1. melanocytic patterns:
Pigmentary patterns: typical pigment pattern, atypical pigment patter, pseudonetwork
dots and globules
Blue white veil
star brust pattern
2, Non melanocytic pattern:
milia like cyst
comedo like opening
3. vascular patterns:
lacunae
arborizing vessels
comma like vessels
corkscrew vessel
red dots
glomerular vessels
linear vessels
etc
Dermoscopy or epiluminescence microscopy
A simple, noninvasive method to examine the subsurface features of the skin.
Structures seen
Epidermis
Dermoepidermal junction
Superficial dermis
3 types of dermoscope
1.Nonpolarized devices
2.Polarized devices
3.Hybrid devices
Dermoscopy is used in:
1.Evaluating pigmented skin lesions
2.Evaluating nonpigment skin lesions
3.Entomodermoscopy
4.Trichoscopy
5.Onychoscopy
different dermoscopic patterns are used to diagnose the dermatological diseases are
1. melanocytic patterns:
Pigmentary patterns: typical pigment pattern, atypical pigment patter, pseudonetwork
dots and globules
Blue white veil
star brust pattern
2, Non melanocytic pattern:
milia like cyst
comedo like opening
3. vascular patterns:
lacunae
arborizing vessels
comma like vessels
corkscrew vessel
red dots
glomerular vessels
linear vessels
etc
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
Subspecialty of dermatology and pathology focused on performing and interpreting tests on human tissue samples to provide scientific data and consultative opinions to referring clinicians
This is a powerpoint presentation on the epidermal keratinization and its associated disorders, presented by Dr. Jerriton, Dermatology resident of SVMCH, Pondicherry.
Subspecialty of dermatology and pathology focused on performing and interpreting tests on human tissue samples to provide scientific data and consultative opinions to referring clinicians
CONCENTRATIONS TECHNIQUES IN PARASITOLOGY PRESENTATION.pptxShreyayadav91
INTRODUCTION
Concentration procedure separate parasites from fecal debris and increase the chances of detecting parasitic organisms when these are in small numbers.
If number of organisms in stool specimen is low, examination of a direct wet mount may not detect parasites.
Thus, whenever possible, the stool should be concentrated.
Advantages
Maximizes the numbers of organisms detected which may be too scanty to be seen by direct microscopy alone. Worm eggs, larvae, and protozoan cysts may be recovered.
Disadvantages
Destroys trophozoite stages. Most concentration methods destroy trophozoites stages.
Concentration techniques can be classified as the floatation or sedimentation methods.
Floatation technique
Here solutions with higher specific gravity than the organisms to be floated so that the organisms rise to the top and debris sink to the bottom.
Principle
This technique involves suspending the specimen in a medium of greater density than that of the helminthic eggs and protozoan cysts.
Eggs and cysts float to the top and are collected by placing a glass slides on the surface of the meniscus at the top of the tube.
Floatation Methods includes:
Saturated salt solution technique
Zinc sulfate centrifugal floatation
Sugar floatation technique
Saturated salt solution technique
Procedure:
About half tea spoon (about 4 gm) of fresh stool or preserved stool in a flat bottomed container with 20 ml capacity.
Now, few drops of saturated salt solution (specific gravity 1.20) is added and stirred to make a fine emulsion.
More salt solution is added with stirring throughout to fill the container up to the brim, until a convex meniscus is formed.
A glass slide (3”*2”) is carefully laid on the top of the container so that the center is in contact with the fluid.
This preparation is allowed to stand for 20 minutes after which the glass slide is quickly lifted and examined under microscope after putting coverslip.
Zinc sulfate centrifugal floatation
Procedure
Make a fine suspension of about 1 g of feces in 10 m L of water and strain through gauze to remove coarse particles.
Collect the liquid in a small test tube and centrifuge for 1 minute at 2,500 revolutions per minute. Pour off the supernatant, add water, resuspend, and centrifuge in the same manner, repeating the process, till the supernatant is clear.
Pour off the clear supernatant, add a small quantity of zinc sulfate solution (specific gravity 1.18- 1.2) and resuspend the sediment well.
Add zinc sulfate solution to a little below the brim and centrifuge at 2,500 revolution per minute for 1 minute.
Take samples care fully from the surface, using a wire loop, transfer to slide and examine under the microscope. A drop of dilute iodine helps to bring out the protozoan cysts in a better way.
This technique is useful for protozoan cysts and eggs of nematodes and small tapeworms, but it does not detect unfertilized roundworm eggs, nematode larvae, and eggs of most trematodes and large tapeworms.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
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Health Education on prevention of hypertensionRadhika kulvi
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Letter to MREC - application to conduct studyAzreen Aj
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Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
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- The role of FDG PET in NET.
2. 1. DARK FIELD MICROSCOPY
2. GRAM STAINING
3. GIEMSA STAINING
4. WET MOUNT
5. KOH WET MOUNT
6. ACETIC ACID TEST
7. WHIFF OR SNIFF TEST
8. TWO AND THREE GLASS TEST
9. BUBO ASPIRATION
CONTENT
3. DFM
1. DARK FIELD MICROSCOPY
• It is the only method to demonstrate Treponema pallidum.
• In this , the light rays hitting the organism in an oblique angle, enter the microscope
objective, to give a luminous appearance against a black background.
REQUIREMENTS
• Dark Field Microscope
• Thin glass slides.
4. DFM
Collection & Preparation
• T. pallidum can be identified in serous fluids from the lesions of Primary, Secondary and
Early Congenital Syphilis.
• Steps :
• Gently abrade the lesion with dry gauze,wipe off any blood stained serum and squeeze
the lesion to produce clear exudate.
• It is then transferred to slide either by pressing the cover slip directly on to exudate or by
pasteur pipette.
• Cover the slip and seal the edges of cover slip with petroleum jelly.
• Examine immediately.
5. DFM
Setting the microscope
• Bring down the condenser of the dark field microscope.
• Put a drop of liquid paraffin on the condenser.
• Place the slide on the microscope stage.
• Raise the condenser until there is good contact between oil and bottom of the slide.
• Avoid trapping of air bubbles in oil.
6. DFM
Reading
• T. pallidum appear white, illuminated on a dark background.
• It is identified by its typical morphology, size and movements
• Shape - Thin spiral organism - 6 - 14micron long.
• 8 -14 spirals which are regular & pronounced.
• They rotate relatively slowly on longitudinal axis ( cock screw ) accompanied by
sudden bending at acute angle.
• Ideally,
• Test should be done on three consecutive days or
• 2 DF smears should be collected , since DFM has sensitivity of 50% only.
7. 2. GRAM STAINING
Gram Stain
Gonococcol & Non Gonococcol Urethritis.
Mucopurulant Cervicitis,
Chancroid,
Bacterial Vaginosis,
Candidal Infections.
Used to detect -
9. Gram Stain
Collection of Specimens
a. Sterile cotton or
b. Calcium alginate or
c. PET ( polyethylene terephthalate )
In India , Sterile cotton is commonly used.
10. Gram Stain
GS - GONORRHOEA
SITES :
The site depends on age , sex, sex practices and clinical symptoms.
Men:
Heterosexual Men - Uretha
Homosexual Men - Urethra, Rectum, Oropharynx
Women -
Primarily from - Endocervical Canal.
Secondary sites from - Urethra, Vagina, Rectum & Oropharynx
11. Gram Stain
Collection - Gonorrhoea
METHODS :
Urethra- Time - 1hr before urination.
In Men :
Retract the prepuce , clean the tip with NS, Collect the pus directly into swab.
If No discharge is seen, milk the urethra from root of the penis towards glans to express pus.
If No pus is obtained even after milking, insert a thin sterile swab 2-3cm into the urethra and
gently scarpe the mucosa by rotating the swab for 5-10secs.
In Females :
Massage the urethra against the pubic symphysis and use the same technique as for men.
12. Gram Stain
Collection - Gonorrhoea
In Females :
Endocervical Specimen -
Insert Vaginal Speculum
Clean the exocervix with sterile cotton swab,
Insert another sterile swab 2 cm into the cervical canal, rotate and move from side to
side for 5 -10 secs and withdraw.
Vagina - Swab from Posterior Cervix .
From prepubertal girls
From women who had hysterectomy.
13. Gram Stain
Collection :
NGU , Mucopurulant Cervicitis
Same as Gonorrhoea,
Samples are collected after holding urine for 3 - 4 hrs , since the collection is scanty in
these diseases.
Bacterial Vaginosis
Specimen is collected from Posterior or Lateral wall of vagina with a sterile saline saoked
swab
Chancroid
From the edges of the ulcer.
Clean the ulcer with saline soaked gauze, then roll a sterile swab in one direction on
the edge of undermined ulcer , then reroll the swab in reverse direction on a glass slide
and stain it. Organism can also be showed from intact bubo aspirate.
14. Gram Stain
Procedure
Preparation of smear
a. Take a galss slide , pass it through flame twice or thrice and wipe it to clean.
b. Draw 2 vertical lines 2.5cm apart with marker on the central part of slide.
c. Roll the swab with specimen over the marked area.
d. Label the smear.
Fixing the smear - done to kill the organism, prevent changes and make it permeable to dye.
a. Hold the slide with smear facing upwards.
b. Pass the slide over the flame of a Bunsen's burner or spirit lamp twice or thrice.
c. Allow the fixed smear to cool.
15. Gram Stain
Procedure
Staining
a. Cover the fixed smear with crystal violet for 1 minute and then rinse it with tap water.
b. Flood the slide with Gram's Iodine solution for 1 min. Drain off the solution and gently rinse
with running water.
c. Decolourize with acetone-ethanol until the drops falling off the slide are no longer blue. It
usually takes 10 - 20secs. Rinse quickly uner running water to stop decolourisation.
d. Counter stain with safranin or fuschsin for 1 min. Gently wash in running water and blot the
slide with absorbent paper.
16. Gram Stain
Smear Reading
Examine under light microscope.
Scan and focus on a good field.
Put a drop of Liquid paraffin without air trapping and examine under 100x oil immersion
objective.
Push the condenser up and open the iris diaphgram to allow max light to pass through.
17. Gram Stain
Smear Reading
Intracellular kidney or coffee Bean shaped diplococci - Gonorrhoea
Bipolar stained gram neg bacilli - Acinetobacter.
5 or more Polymorphonuclear leucocytes ( PMN ) in abscence of diplococci - Non gonococcal
urethriris.
Cervical Gram stain - with 30 PMN/hpf in women of menstrauating age - Mucopurulent cervicitis.
“School of fish” or “rail road track” or gram neg bacilli in chains - Hemophilus ducreyi -
Chancroid.
“Clue cells” - Gardenerella vaginalis - Bacterial vaginosis.
Gram positive budding yeast looking like “fig of 8” and yeast hyphae - Vulvovaginal candidiasis /
Balanoposthitis.
18.
19. Giemsa Stain
3. GIEMSA STAIN
Used to detect -
Genital Herpes
Molluscum contagiosum
Donovanosis
Chancroid.
T. vaginalis and Chlamydia species can also be seen, but not used routinely.
20. Giemsa Stain
Requirments
Giemsa Stock
• It is prepared by dissolving 4g Giemsa powder in 250ml glycerol at 60℃ and then adding
250ml methanol.
• 4ml of stock solution is added to 96ml of distilled water or buffered water at pH 7.0 -7.2.
21. Giemsa Stain
COLLECTION OF SPECIMEN
Herpes Progenitalis
• The intact roof of the vesicle is opened along one side and folded back.
• scrape the under surface of the roof of vesicle and the floor of ulcer with a curette or scalpel
and smear the obtained material on a glass slide.
Donovanosis
• A small piece of tissue is removed from the edge of the granlomatous ulcer after cleaning
the area with sterile saline soaked gauze or sraped tissue by a scalpel.
• Place it in a slide,then crush it with another slide from above , spread and allow it to dry.
Molluscum Contagiosum
The central semisolid core is removed and stained.
22. Giemsa Stain
Procedure
Smear is fixed in methanol - dip the slide for 5 mins in coplin jar containing methanol.
Allow the smear to dry
Dilute the giemsa stain 10 times or 1ml Giemsa stain is mixed with 9ml of distilled water.
Cover the slide with diluted Giemsa stain and leave it to stand for 20-30 mins.
Wash the slide with distlled water.
Allow the smear to dry.
23. Giemsa Stain
Smear Reading
Smear is first examined under a low power objective and then under oil immersion objective.
Herpes progenitalis - shows multinucleated giant keratinocytes, nuclei will show blurring of
chromatin pattern and loss of staining.
Donovanosis - Intracellular donovan bodies, Bluish purple colour and resemble safety pin.
Molluscum contagiosum - Handerson - Patterson bodies / Molluscum bodies - appear as ovoid ,
deeply basophilic bodies with hyaline homogenous structure surrounded by a membrane.
24.
25. Wet Mount
4. WET MOUNT
( DIRECT MICROSCOPY WITHOUT STAINING )
Used for diagnosis of -
Trichomoniasis
Bacterial vaginosis
Candidiasis
26. Wet Mount
WET MOUNT
Collection of specimen
Vaginal discharge is obtained with cotton tipped swab from the posterior fornix.
In Men , the sample is collected by inserting a sterile swab into the urethra 2-3 cm deep.
Procedure
Sample is placed in a galss slide,
Diluted with a drop of saline then cover slip is placed.
Examined under a light microscope immediaty under 40x lens with reduced illumination.
27. Wet Mount
WET MOUNT
Slide Reading :
Trichomoniasis -
Clear pear shaped organism about a size of pus cell with 4 anterior flagellae and an
axostyle that traverse through body end to end.
They show typical jerky movements.
Bacterial vaginosis - Clue cells may be seen.
Candiasis - Yeast cells can also be seen.
28. KOH Mount
5. KOH WET MOUNT
Used for diagnosis of -
Candidal infection in genital tract.
Requirements:
10% or 20% KOH.
Collection of specimen:
Females - discharge is collected from posterior fornix.
Males - a swab moistened in saline is rubbed against the glans penis.
29. KOH Mount
Procedure
Take a clean microscope slide.
Place the specimen on the slide.
Add 2 drops of 10% KOH .
Put a coverslip over the specimen, ensuring no air bubbles is trapped under the coverslip.
Then examined under light microscope under 10x then using 40x.
30. KOH Mount
Reading
Identification of yeast confirms the candidiasis.
Yeast are round to ovoid cells ,showing typical budding (blastoconidia) and pseudohyphae
31. AA Test
6. Acetic Acid Test
It is used to detect subclinical Genital Human Papilloma Virus ( HPV ) - associated infections.
Requirments:
Acetic Acid - 3 to 5 %
Swab sticks.
32. AA Test
Procedure
Clean the area with gauze soaked in saline and then with dry gauze.
Apply acetic acid with the swab.
Wait for 2 to 3 mins for lesions of vulva and penis.
In Uterine cervix , the reaction appears in 1 min.
33. AA Test
Reading
In Men - Affected area looks Red because of hypervascularization.
In Females - Affected area became whitish, distinctle demrcated and thickened, sometimes
with elevated borders and centrally located epithelial fissures.
The whtish appearance is due to over expression of cytokeratin 10 in HPV infected suprabasal
cells.
The epithelial cells of HPV infected cells contain large nuclei and their protein content is very
high. Acetic acid application causes denaturation of these proteins, which results in whitish
appearance.
34. Whiff test
7. WHIFF TEST OR SNIFF TEST
Used to diagnose - Bacterial vaginosis
Procedure -
Addition of 1 or 2 drops of 10% KOH solution to the specimen of vaginal discharge on a
glass slide causes enhancement of typical Fishy smell.
35. Two glass test
8. TWO AND THREE GLASS TEST
TWO GLASS TEST
It is used to differentiate anterior urethritis from posterior urethritis or infection of bladder.
Procedure -
Pt is asked to pass urine in two seperate glasses.
Reading -
In Ant. Urethritis - 1st specimen if cloudy or hazy with pus / mucus thread. 2nd glass is
clear.
In Post. Urethritis - 2nd glass will be hazy.
In Bacterial Cystitis - Both glasess will be hazy.
36. Three Glass Test
Three Glass Test
In this , anterior urethre is irrigated with colourless antiseptic solution until washing contained in
the first glass seem to be clear.
the pt is then asked to pass urine in two glass containers.
If the 1st glass contain pus - Post Urethra is infected.
If the 2nd glass contain pus - Bladder is also is infected.
37. Asp of Bubo
9. ASPIRATION OF BUBO
Used to detect -
Chancroid
LGV
in a fluctuating bubo.
38. Asp of Bubo
Procedure
The pt is made to lie on a couch in supine position.
Skin is sterilized with iodine and bubo is aspirated using 16 - 18G needle with 10 or 20 ml
syringe.
Aspiration is done from non dependent fluctuant part of the bubo and continued till all parts of
the swelling are reduced.
The material is sent for H.ducreyi, chlamydia and anaerobe cultures; smear for gram stain and
direct uorescene for chlamydia.