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141. CRACKCast E130 – Viruses

, FACE, and FEET Primary varicella: Chickenpox is a febrile illness characterized by malaise and rash. The rash begins first on the scalp and face and then spreads to the trunk and extremities. (rarely involves the hands and feet) The lesions start as maculopapular, and progress to fluid filled vesicles that eventually crust over and form scabs. The lesions occur as crops at various stages of development. Patients are contagious until all lesions are scabbed over, which can typically take 1 to 2

2017 CandiEM

142. CRACKCast E137 – Skin Infections

that extends through the epidermis into the dermis. It is manifested as ulcers with a punched-out appearance, with raised reddened margins covered with thick crust. It has a predilection for the lower extremities. Unlike impetigo, ecthyma can result in cutaneous scarring. Treatment: Mild-moderate non-bullous impetigo = topical mupirocin TID for 5 days Severe impetigo, bullous impetigo, ulcerative impetigo = Staph and MRSA coverage: Clindamycin AND Septra Cephalexin AND Septra [2] What is the eagle effect

2017 CandiEM

143. CRACKCast E120 – Dermatologic presentations

Thickened area of keratinised epithelium Crust Dried area of plasma proteins, resulting from inflammation Fissure Deep cracks in skin surfaces, extending into dermis Erosion Disruption of surface epithelium, usually linear, traumatic Ulcer Deep erosion extending into dermis Scar Dense collection of collage, a result of healing after trauma or procedures Excoriation Linear erosions typically secondary to scratching or rubbing Infections Bacterial, viral, fungal or protozoal infection, caused by breaks (...) Folliculitis [7] Describe treatment of poison ivy “Allergic contact dermatitis is a form of delayed hypersensitivity mediated by lymphocytes sensitized by the contact of the allergen to the skin.The common Toxicodendron species, including poison ivy, oak, and sumac can produce a severe reaction. Toxicodendron species often result in vesicular or bullous eruptions. Oozing, crusting, scaling, and fissuring may be found along with lichenification in chronic lesions. The distribution of the eruption depends

2017 CandiEM

146. Guidelines for care of patients with actinic keratosis

/amenability; ??? very ?exible/amenable. First hospital clinic attendance NHS tariff 2014–15: £104. 178 Hospital follow-up attendance: £68. GP visit: £44. 179 © 2017 British Association of Dermatologists British Journal of Dermatology (2017) 176, pp20–43 28 Guidelines for actinic keratosis 2017, D. de Berker et al.8.2 Active treatments All topical therapies for AK may result in side-effects of irrita- tion. Some AKs proceed to ooze, crusting and soreness with local swelling. Details are cited (...) and low-cost treatment. 63 It can be used either as lesional treatment or as part of ?eld treat- ment. The side-effects with the latter can be substantial, and it is important that the patient is counselled about them, includ- ing soreness, redness and possible crusting. All of these can be minimized through reduction in the frequency of application or short breaks in a course of therapy. It is permitted to wash the area and apply thin emollient. If the reaction is excessive, weak steroid can

2017 British Association of Dermatologists

147. CRACKCast E071 – Ophthalmology Part A

SYSTEMIC extension of the infections require IV abx 4) Describe typical features of conjunctivitis and management options Conjunctivitis #1 cause of a red eye Symptoms: Redness, FB sensation, lid swelling, eye crusting, drainage NO photophobia, NO visual loss Caseus: Viral, bacterial, mechanical, allergic, toxic Called KERATOconjunctivitis when the cornea is involved as well Most commonly viral Bacterial causes: Pneumoniae, H. influenzae, Staph, Moraxella, Neisseria gonorrhoeae, Klebsiella, Pseudomonas (...) eyelid margins with pronounced blood vessels NOT an infection., just an inflammation VERY common! Symptoms: Eye burning, itching, tearing, FB sensation, morning crusting Treatment: Rubbing eyelid margins with mild shampoo + cloth Warm compresses QID Severe: topical abx 9) Compare periorbital and orbital cellulitis PEX and treatment — See — Orbital Cellulitis Etiology Symptoms Important differences to periorbital cellulitis Maxillary/ethmoid sinusitis Orbital trauma Dental Infection Need CT to rule

2017 CandiEM

149. Colonization of subsurface microbial observatories deployed in young ocean crust Full Text available with Trip Pro

Colonization of subsurface microbial observatories deployed in young ocean crust Oceanic crust comprises the largest hydrogeologic reservoir on Earth, containing fluids in thermodynamic disequilibrium with the basaltic crust. Little is known about microbial ecosystems that inhabit this vast realm and exploit chemically favorable conditions for metabolic activities. Crustal samples recovered from ocean drilling operations are often compromised for microbiological assays, hampering efforts (...) to resolve the extent and functioning of a subsurface biosphere. We report results from the first in situ experimental observatory systems that have been used to study subseafloor life. Experiments deployed for 4 years in young (3.5 Ma) basaltic crust on the eastern flank of the Juan de Fuca Ridge record a dynamic, post-drilling response of crustal microbial ecosystems to changing physical and chemical conditions. Twisted stalks exhibiting a biogenic iron oxyhydroxide signature coated the surface

2010 The ISME journal

150. First Investigation of the Microbiology of the Deepest Layer of Ocean Crust Full Text available with Trip Pro

First Investigation of the Microbiology of the Deepest Layer of Ocean Crust The gabbroic layer comprises the majority of ocean crust. Opportunities to sample this expansive crustal environment are rare because of the technological demands of deep ocean drilling; thus, gabbroic microbial communities have not yet been studied. During the Integrated Ocean Drilling Program Expeditions 304 and 305, igneous rock samples were collected from 0.45-1391.01 meters below seafloor at Hole 1309D, located (...) results suggest that the gabbroic layer hosts a microbial community that can degrade hydrocarbons and fix carbon and nitrogen, and has the potential to employ a diversity of non-oxygen electron acceptors. This rare glimpse of the gabbroic ecosystem provides further support for the recent finding of hydrocarbons in deep ocean gabbro from Hole 1309D. It has been hypothesized that these hydrocarbons might originate abiotically from serpentinization reactions that are occurring deep in the Earth's crust

2010 PloS one


GALENICALS IN THE TREATMENT OF CRUSTED SCABIES Crusted scabies is rare. It is a therapeutic challenge, as the common drugs used against scabies are unsatisfactory. The successful use of galenicals in a 10-year-old girl with crusted scabies is reported.

2010 Indian journal of dermatology

152. Do biotic interactions modulate ecosystem functioning along stress gradients? Insights from semi-arid plant and biological soil crust communities Full Text available with Trip Pro

Do biotic interactions modulate ecosystem functioning along stress gradients? Insights from semi-arid plant and biological soil crust communities Climate change will exacerbate the degree of abiotic stress experienced by semi-arid ecosystems. While abiotic stress profoundly affects biotic interactions, their potential role as modulators of ecosystem responses to climate change is largely unknown. Using plants and biological soil crusts, we tested the relative importance of facilitative (...) that reductions in the cover of plant and biological soil crust communities will negatively impact ecosystems under future climatic conditions.

2010 Philosophical Transactions of the Royal Society B: Biological Sciences

153. 12 minute consultation: a patient with nasal crusting. (Abstract)

12 minute consultation: a patient with nasal crusting. Nasal crusting is frequently encountered by the otorhinolaryngologist and often requires no specific treatment. It is, however, important to carry out a full history and examination, followed by appropriate investigations, in order to detect the small number of cases in which crusting is caused by systemic or malignant disease.This review was based on a literature search last performed on 30th July 2009. The MEDLINE, EMBASE and Cochrane (...) databases were searched using the subject headings (nasal crusting OR crusts) and in combination with diagnosis, therapy and surgery. Similar searches were performed for relevant diseases, e.g. Wegener's granulomatosis, sarcoidosis. Results were limited to English language articles including clinical trials, meta-analyses, systematic reviews and review articles. Relevant references from selected articles were reviewed.Knowledge of the causes of nasal crusting will help to target the history, examination

2010 Clinical Otolaryngology

155. Difficult-to-treat scabies: oral ivermectin

information. Summary Oral ivermectin appears to be effective for treating people with classical or crusted scabies. However, differences in treatment regimens and the length of follow-up make interpreting comparisons with topical treatments difficult. Transient exacerbation of pruritus may occur at the beginning of treatment. Regulatory status: Regulatory status: unlicensed The topic was prioritised because there was a high volume of requests from the NHS for information on this topic (...) ) and inferior in 1 RCT (n=162). Ivermectin was inferior to permethrin in 3 RCTs (total n=339) and not statistically significantly different in 3 RCTs (4 comparisons: total n=479). Treatment failure rates with ivermectin varied widely from 7% to 70% (see tables 1, 2 and 3 for details). In crusted scabies, uncontrolled trials and case series used multiple doses of oral ivermectin and/or ivermectin in combination with topical therapy (see table 4). Safety Safety The European summary of product characteristics

2014 National Institute for Health and Clinical Excellence - Advice

157. Is There an Association Between Hyperbaric Oxygen Therapy and Improved Outcome of Deep Chemical Peeling? A Randomized Pilot Clinical Study. Full Text available with Trip Pro

PCP underwent 5 consecutive daily HBOT sessions, compared with PCP alone. Pain, pruritus, erythema, crusting, scaling, and edema were daily evaluated up to 28 days following PCP. Photographs taken on days 14 and 35 following PCP were assessed. Confidence to appear in public was assessed 14 days following PCP.Eight participants equally assigned to HBOT and control groups. Lower severity scores for erythema, scaling, and pruritus were documented in the HBOT group (mean difference 1.19, P = .006; .84 (...) , P = .04; and 2.19, P = .001, respectively). Photographic assessment severity score was higher for skin tightness, edema, erythema, crusting, and scaling in the control group on day 14 post PCP (P < .05) and for erythema on day 35 post PCP (P < .05). Epithelialization percentage was higher in the HBOT group on day 14 post PCP compared with controls (98.5% ± 1% vs 94.2% ± 1%; P = .021). The HBOT group scored higher in confidence to appear in public (20.8 ± 1.7 vs 14.5 ± 1.3; P = .029).Hyperbaric

2018 Plastic surgery (Oakville, Ont.) Controlled trial quality: uncertain

159. Actinic keratosis: ingenol mebutate gel (ESNM14)

in the target treatment area at day 57. An additional secondary outcome that was not specified in the initial study protocol was the median percentage reduction in the number of actinic keratosis lesions. Safety outcomes included skin response at the site of treatment application assessed by a local-skin-response scale. This scale graded 6 different responses (erythema, flaking or scaling, crusting, swelling, vesiculation or pustulation, and erosion or ulceration) on a scale of 0 to 4, giving a maximum (...) , the most common treatment-related adverse events were at the administration site (pain, pruritus and irritation). Local skin responses (erythema, flaking or scaling, crusting, swelling, vesiculation or pustulation, and erosion or ulceration) at the application site, which the authors suggest are an expected effect of topical Actinic keratosis: ingenol mebutate gel (ESNM14) © NICE 2018. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights

2013 National Institute for Health and Clinical Excellence - Advice

160. Breastfeeding Healthy Term Infants

• Mothers with active herpes simplex lesions on or near the nipple should interrupt breastfeeding on the breast and nipple affected until lesions are crusted or resolved 2,26,45 • Mothers receiving a high-dose of the antibiotic Metroridazole: discontinue breastfeeding for 12 – 24 hours to allow excretion of the dose 45 • Mothers with active tuberculosis who are not receiving adequate therapy are considered infectious. 2 Following 2-weeks of appropriate TB drug therapy breastfeeding is recommended

2015 British Columbia Perinatal Health Program

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