This document discusses several vesiculobullous diseases including pemphigus vulgaris, pemphigoid, erythema multiforme, and epidermolysis bullosa. Pemphigus vulgaris is an autoimmune disease causing fluid-filled blisters and ulcers in the mouth and skin. Pemphigoid includes bullous pemphigoid and cicatricial pemphigoid, which are autoimmune diseases affecting the elderly that cause subepithelial blistering. Erythema multiforme is often triggered by infection and causes red macules and mouth sores. Epidermolysis bullosa is a group of genetic disorders that results in easy blist
Vesiculobullous Lesions - Pemphigus and Pemphigoid
Classification, Terminologies, Subsets of Pemphigus, Difference between pemphigus and pemphigoid, oral manifestations, differential diagnosis, Histopathology, Investigations and Management given in detail.
Vesiculobullous Lesions - Pemphigus and Pemphigoid
Classification, Terminologies, Subsets of Pemphigus, Difference between pemphigus and pemphigoid, oral manifestations, differential diagnosis, Histopathology, Investigations and Management given in detail.
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.
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
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.
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
For more free medical powerpoints, visit www. medicaldump.com, Free updates everyday on all specialties including cardiology, nephrology, neurology, pulmonology, etc.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This is an overview about parasites infest or affect the human eyes & principles of the diseases thay cause
A medical-student-made presentation for Ain Shams University - Faculty of Medicine - Department of Parasitology
Hope it help you
The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands.
Enchancing adoption of Open Source Libraries. A case study on Albumentations.AIVladimir Iglovikov, Ph.D.
Presented by Vladimir Iglovikov:
- https://www.linkedin.com/in/iglovikov/
- https://x.com/viglovikov
- https://www.instagram.com/ternaus/
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Created out of a necessity for superior performance in Kaggle competitions, Albumentations has grown to become a widely used tool among data scientists and machine learning practitioners.
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Mental Health: Maintaining balance and not feeling pressured by user demands.
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Vladimir Iglovikov brings his extensive experience as a Kaggle Grandmaster, ex-Staff ML Engineer at Lyft, sharing valuable lessons and practical advice for anyone looking to enhance the adoption of their open-source projects.
Explore more about Albumentations and join the community at:
GitHub: https://github.com/albumentations-team/albumentations
Website: https://albumentations.ai/
LinkedIn: https://www.linkedin.com/company/100504475
Twitter: https://x.com/albumentations
In the rapidly evolving landscape of technologies, XML continues to play a vital role in structuring, storing, and transporting data across diverse systems. The recent advancements in artificial intelligence (AI) present new methodologies for enhancing XML development workflows, introducing efficiency, automation, and intelligent capabilities. This presentation will outline the scope and perspective of utilizing AI in XML development. The potential benefits and the possible pitfalls will be highlighted, providing a balanced view of the subject.
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The presentation aims to deliver a comprehensive overview of AI usage in XML development, providing attendees with the necessary knowledge to make informed decisions. Whether you’re at the early stages of adopting AI or considering integrating it in advanced XML development, this presentation will cover all levels of expertise.
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Sudheer Mechineni, Head of Application Frameworks, Standard Chartered Bank
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Monitoring and observability aren’t traditionally found in software curriculums and many of us cobble this knowledge together from whatever vendor or ecosystem we were first introduced to and whatever is a part of your current company’s observability stack.
While the dev and ops silo continues to crumble….many organizations still relegate monitoring & observability as the purview of ops, infra and SRE teams. This is a mistake - achieving a highly observable system requires collaboration up and down the stack.
I, a former op, would like to extend an invitation to all application developers to join the observability party will share these foundational concepts to build on:
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Threats to mobile devices are more prevalent and increasing in scope and complexity. Users of mobile devices desire to take full advantage of the features
available on those devices, but many of the features provide convenience and capability but sacrifice security. This best practices guide outlines steps the users can take to better protect personal devices and information.
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Alt. GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using ...James Anderson
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The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
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Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
Gopinath Rebala
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My slides at Nordic Testing Days 6.6.2024
Climate impact / sustainability of software testing discussed on the talk. ICT and testing must carry their part of global responsibility to help with the climat warming. We can minimize the carbon footprint but we can also have a carbon handprint, a positive impact on the climate. Quality characteristics can be added with sustainability, and then measured continuously. Test environments can be used less, and in smaller scale and on demand. Test techniques can be used in optimizing or minimizing number of tests. Test automation can be used to speed up testing.
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Epistemic Interaction - tuning interfaces to provide information for AI supportAlan Dix
Paper presented at SYNERGY workshop at AVI 2024, Genoa, Italy. 3rd June 2024
https://alandix.com/academic/papers/synergy2024-epistemic/
As machine learning integrates deeper into human-computer interactions, the concept of epistemic interaction emerges, aiming to refine these interactions to enhance system adaptability. This approach encourages minor, intentional adjustments in user behaviour to enrich the data available for system learning. This paper introduces epistemic interaction within the context of human-system communication, illustrating how deliberate interaction design can improve system understanding and adaptation. Through concrete examples, we demonstrate the potential of epistemic interaction to significantly advance human-computer interaction by leveraging intuitive human communication strategies to inform system design and functionality, offering a novel pathway for enriching user-system engagements.
2. CLASSIFICATION OF VESICULOBULLOUSCLASSIFICATION OF VESICULOBULLOUS
DISEASESDISEASES
VESICLE&BULLAVESICLE&BULLA
A clear fluid lesion just below theA clear fluid lesion just below the
epithelium which ruptures to form an ulcer,epithelium which ruptures to form an ulcer,
if this is smaller than 5mm then it is aif this is smaller than 5mm then it is a
vesicle ,if larger than 5mm than it is a bullavesicle ,if larger than 5mm than it is a bulla
3. CLASSIFICATION OF VESICULOBULLOUSCLASSIFICATION OF VESICULOBULLOUS
DISEASESDISEASES
CLASSIFICATIONCLASSIFICATION
INTRA EPITHELIAL VESICLESINTRA EPITHELIAL VESICLES: The lesion is formed: The lesion is formed
within the epitheliumwithin the epithelium
Acantholytic vesicles :Acantholytic vesicles : This is because of the breakThis is because of the break
down of specialized attachments called thedown of specialized attachments called the
desmosomesdesmosomes
Nonacantholytic vesiclesNonacantholytic vesicles: It is usually in the viral: It is usually in the viral
infections because of the death or the rupture of theinfections because of the death or the rupture of the
group of cells.group of cells.
SUB EPITHELIAL VESICLESSUB EPITHELIAL VESICLES: Lesions formed between the: Lesions formed between the
epithelium and the lamina propria eg:epithelium and the lamina propria eg:
Erthyma multifomeErthyma multifome
PhempegoidPhempegoid
Dermatitis herpetiformisDermatitis herpetiformis
Epidermolysis bullosaEpidermolysis bullosa
4. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
Autoimmune disease.Autoimmune disease.
Common in Ashkenazi and Mediterranean jews .Common in Ashkenazi and Mediterranean jews .
Middle aged females.Middle aged females.
Other variants are:Other variants are:
Pemphius VegitansPemphius Vegitans
Pemphigus Foliaceus & ErthematosusPemphigus Foliaceus & Erthematosus
Paraneoplastic pemphigus.Paraneoplastic pemphigus.
5. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
CLINICAL FEATURES:CLINICAL FEATURES:
Painful ulcers or bulla are formed which are fluidPainful ulcers or bulla are formed which are fluid
filled.filled.
They can be formed any where in the oral cavity .They can be formed any where in the oral cavity .
The bulla is rapidly ruptured leaving a collapsed roofThe bulla is rapidly ruptured leaving a collapsed roof
of grayish membrane with a red ulcerated base.Theof grayish membrane with a red ulcerated base.The
ulcer may look like an apthous ulcer or may be largeulcer may look like an apthous ulcer or may be large
map shaped.map shaped.
Nikolsky sign is positive.Nikolsky sign is positive.
C/F con…dC/F con…d
6. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
Some time the ulcers are joined together to make aSome time the ulcers are joined together to make a
confluence this condition is very painful.confluence this condition is very painful.
It has a variable course might involve skin,It has a variable course might involve skin,
oesophagus, cervix.oesophagus, cervix.
Protein/fluid,electrolyte and weight loss /secondaryProtein/fluid,electrolyte and weight loss /secondary
infections.infections.
Fatal if untreated.Fatal if untreated.
8. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
PATHOGENESIS:PATHOGENESIS:
It is an autoimmune diseaseIt is an autoimmune disease
There are circulating antibodies of type IgG.There are circulating antibodies of type IgG.
These antibodies are reactive against theThese antibodies are reactive against the
desmosomes or the tonofilament complex.desmosomes or the tonofilament complex.
There destruction or disruption of theseThere destruction or disruption of these
tonofilament complex ,resulting in the loss oftonofilament complex ,resulting in the loss of
attachment from cell to cellattachment from cell to cell
path.cont…dpath.cont…d
9. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
The epithelial damage is directly proportion toThe epithelial damage is directly proportion to
the number of the circulating antibobies.the number of the circulating antibobies.
The tonofilament or desmosomes are disruptedThe tonofilament or desmosomes are disrupted
by a proteolytic enzyme which is released byby a proteolytic enzyme which is released by
these antibodies .these antibodies .
The cell to cell break down also takes placeThe cell to cell break down also takes place
through a complement system but this processthrough a complement system but this process
is not clearly understood .is not clearly understood .
11. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
HISTOPATHOLOGY:HISTOPATHOLOGY:
Intra epithelial vesicles or bulla and cleft like spacesIntra epithelial vesicles or bulla and cleft like spaces
are produced by acantolysisare produced by acantolysis
These changes are in the stratum spinosum or theThese changes are in the stratum spinosum or the
prickle cell layerprickle cell layer
The basal cell remain attach to the lamina propriaThe basal cell remain attach to the lamina propria
and project into the bulla like tombstones.and project into the bulla like tombstones.
Inflammatory cells are very scanty howeverInflammatory cells are very scanty however
eosinophils may be seen.eosinophils may be seen.
Acantholytic statum spinosum cells occur singly orAcantholytic statum spinosum cells occur singly or
are in the forms of clumps lying freely within theare in the forms of clumps lying freely within the
blister fluid. These cell loose there polyhedralblister fluid. These cell loose there polyhedral
morphology rather they are small rounded andmorphology rather they are small rounded and
contain hyper chromatic nuclei called the TAZANKcontain hyper chromatic nuclei called the TAZANK
CELLS.CELLS.
17. PEMPHIGUS VULGARISPEMPHIGUS VULGARIS
TREATMENT:TREATMENT:
High mortality rates previouslyHigh mortality rates previously
Introduction of systemic corticosteroidsIntroduction of systemic corticosteroids
like prednisolone in stable cases.like prednisolone in stable cases.
Prednisolone plus azathioprinePrednisolone plus azathioprine
methotrexate and cyclophospamide inmethotrexate and cyclophospamide in
progressed or advance cases.progressed or advance cases.
20. PEMPHGOIDPEMPHGOID
PATHOLOGYPATHOLOGY
Autoimmune diseaseAutoimmune disease
Not life threateningNot life threatening
Elderly females above 60 yrs of ageElderly females above 60 yrs of age
Loss of attachment and separation of full thicknessLoss of attachment and separation of full thickness
epithelium from the lamina propria.epithelium from the lamina propria.
Alteration of rete pegsAlteration of rete pegs
Epithelium forms the roof of the blistersEpithelium forms the roof of the blisters
Auto antibodies are formed against theAuto antibodies are formed against the
hemidesmosomes (BPAG-1,230kd;BPAG-2; 180kd.hemidesmosomes (BPAG-1,230kd;BPAG-2; 180kd.
InflammatoryInflammatory
cells(lymphocytes,neutrophils,eosinophils)are seencells(lymphocytes,neutrophils,eosinophils)are seen
in the later stagesin the later stages
22. PEMPHGOIDPEMPHGOID
CLINICAL FEATURES(MMP)CLINICAL FEATURES(MMP)
Oral mucosa is the first site- lesions are rarelyOral mucosa is the first site- lesions are rarely
wide spreadwide spread
Subepithelial bullae, ruptured in the later stages.Subepithelial bullae, ruptured in the later stages.
Bleeding in the bullae – bleeding blistersBleeding in the bullae – bleeding blisters
Slow progress, skin involvement absent or rareSlow progress, skin involvement absent or rare
Involvement of eyes, nose larynx, pharynx andInvolvement of eyes, nose larynx, pharynx and
osephaghusosephaghus
Nikolsky sign is positiveNikolsky sign is positive
29. ERYTEMA MULTIFORMEERYTEMA MULTIFORME
AETIOLOGY /PATHOLOGYAETIOLOGY /PATHOLOGY
Unclear aetiology and pathogenesisUnclear aetiology and pathogenesis
Infections like HSV can trigger thisInfections like HSV can trigger this
diseasedisease
Drugs like Sulphonamides ,barbituratesDrugs like Sulphonamides ,barbiturates
Suggested cause is also given as to aSuggested cause is also given as to a
type III hypersensitivity reactiontype III hypersensitivity reaction
30. ERYTEMA MULTIFORMEERYTEMA MULTIFORME
CLINICAL FEATURESCLINICAL FEATURES
Prodomal signs:Prodomal signs:
Upper respiratory infectionUpper respiratory infection
Headache and malaiseHeadache and malaise
Nausea and arthralgiaNausea and arthralgia
C/Fcont…dC/Fcont…d
31. ERYTEMA MULTIFORMEERYTEMA MULTIFORME
Signs during the disease:Signs during the disease:
Red macules – 1cm or more in diameter withRed macules – 1cm or more in diameter with
cyanotic centercyanotic center
Lips grossly swollen ,split crusted bleedingLips grossly swollen ,split crusted bleeding
Widespread fibrin covered erosions andWidespread fibrin covered erosions and
erythema in the mouth.erythema in the mouth.
Mild feverMild fever
Conjunctivitis may be associatedConjunctivitis may be associated
Attacks recur at the intervals of several monthsAttacks recur at the intervals of several months
Usually self limiting.Usually self limiting.
33. ERYTEMA MULTIFORMEERYTEMA MULTIFORME
HISTOPATHOLOGYHISTOPATHOLOGY
Necrosis of the kertinocytesNecrosis of the kertinocytes
Inter & intra cellular odema.Inter & intra cellular odema.
Subepithelial blisters are commonSubepithelial blisters are common
Infiltration of inflammatory cells.Infiltration of inflammatory cells.
35. ERYTEMA MULTIFORMEERYTEMA MULTIFORME
MANAGEMENTMANAGEMENT
No specific treatment required , if HSV inf..No specific treatment required , if HSV inf..
acycoviracycovir
Systemic steroids may give relief to theSystemic steroids may give relief to the
fever.fever.
In severe cases antibiotics are used toIn severe cases antibiotics are used to
prevent ant secondary infections.prevent ant secondary infections.
Symptomatic –analgesics, antipyretics,Symptomatic –analgesics, antipyretics,
antihistamines.antihistamines.
37. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
Definition:Definition:
A large group of clinically similarA large group of clinically similar
desquamating disease processes of thedesquamating disease processes of the
skin and mucosa that have in common theskin and mucosa that have in common the
separation of the epithelium from theseparation of the epithelium from the
underlying connective tissue and theunderlying connective tissue and the
formation of large blisters that frequentlyformation of large blisters that frequently
result in extensive and often immobilizingresult in extensive and often immobilizing
scar formation.scar formation.
38. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
MAJOR CATEGORIES OF EPIDERMOLYSIS BULLOSAMAJOR CATEGORIES OF EPIDERMOLYSIS BULLOSA
TypeType Genetic PatternGenetic Pattern Separation LevelSeparation LevelDefec. StructureDefec. Structure
HereditaryHereditary
SimplexSimplex Autosomal dominant IntraepithelialAutosomal dominant Intraepithelial linking proteinslinking proteins
JunctionalJunctional autosomal recessive lamina lucidaautosomal recessive lamina lucida anchoring filamentsanchoring filaments
DystrophicDystrophic autosomal dominant sublamina densaautosomal dominant sublamina densa type VII collagentype VII collagen
AcquiredAcquired
AcquisitaAcquisita None/autoimmune sublamina densaNone/autoimmune sublamina densa type VII collagentype VII collagen
39. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
HEREDITARY TYPES:HEREDITARY TYPES:
Congenital absence of componentsCongenital absence of components
ACQUIRED TYPES:ACQUIRED TYPES:
Autoantibodies (IgG; sometimes IgA) toAutoantibodies (IgG; sometimes IgA) to
type VII collagen.type VII collagen.
43. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
2.2. Junctional Epidermolysis BullosaJunctional Epidermolysis Bullosa
Severe form; autosomal recessiveSevere form; autosomal recessive
Haemorrhagic blisters; loss of nails, largeHaemorrhagic blisters; loss of nails, large
blisters of face, trunk and extremitiesblisters of face, trunk and extremities
Generalized scarring and atrophyGeneralized scarring and atrophy
Intraorally-haemorrhagic blisters of palate,Intraorally-haemorrhagic blisters of palate,
perioral and perinasal areasperioral and perinasal areas
Erupted teeth exhibit hypoplastic and severelyErupted teeth exhibit hypoplastic and severely
pitted enamel prone to cariespitted enamel prone to caries
44. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
3.3. Dystrophic Epidermolysis BullosaDystrophic Epidermolysis Bullosa
Both autosomal dominant and recessive; recessive isBoth autosomal dominant and recessive; recessive is
severesevere
Lesions are birth; arise at pressure sitesLesions are birth; arise at pressure sites
Blisters rupture leaving painful ulcers which heal withBlisters rupture leaving painful ulcers which heal with
large scars that undergo contractures, leading to loss oflarge scars that undergo contractures, leading to loss of
motility and claw-like hands (Mitten Deformity)motility and claw-like hands (Mitten Deformity)
Teeth exhibit delayed eruption and enamel hypoplasiaTeeth exhibit delayed eruption and enamel hypoplasia
with rapid caries developmentwith rapid caries development
Scarring around mouth leads to diminished opening,Scarring around mouth leads to diminished opening,
ankyloglossiaankyloglossia
45. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
Epidermolysis Bullosa AcquisitaEpidermolysis Bullosa Acquisita
Non-hereditary form; appears in adulthoodNon-hereditary form; appears in adulthood
Clinically resembles autosomal dominantClinically resembles autosomal dominant
type of JEB-type VII collagentype of JEB-type VII collagen
Trauma/friction induced blisters of knees,Trauma/friction induced blisters of knees,
elbows, hands and feet- heal with scarselbows, hands and feet- heal with scars
Intraoral blisters rare- when present sameIntraoral blisters rare- when present same
picture same picture as JEBpicture same picture as JEB
46. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
HISTOPATHOLOGYHISTOPATHOLOGY
Simplex type exhibits zone of cleavageSimplex type exhibits zone of cleavage
(intra-epithelial) above basal cell layer.(intra-epithelial) above basal cell layer.
Remaining types have sub-epithelialRemaining types have sub-epithelial
separationseparation
48. EPIDERMOLYSIS BULLOSAEPIDERMOLYSIS BULLOSA
MANAGEMENTMANAGEMENT
No specific treatment available for hereditaryNo specific treatment available for hereditary
typestypes
Acquired form maybe treated withAcquired form maybe treated with
corticosteroids and immuno-suppressantscorticosteroids and immuno-suppressants
Maintenance of pt’s nutritional and oral hygieneMaintenance of pt’s nutritional and oral hygiene
statusstatus
Wound healing techniquesWound healing techniques
Prevention of infectionsPrevention of infections
Systemic use of Phenytoin (also acts as aSystemic use of Phenytoin (also acts as a
collagenase inhibitor)collagenase inhibitor)