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161. International Consolidated Venous Ulcer Guideline

. >1.985 mm as measured using high frequency ultrasound or other clinically documented technique. A (Choh et al., 2010; Vesic et al., 2008; Volikova et al., 2009; Xia et al., 2004), CVI= 0.667, Moderate SOR A.2.b.iii. Stasis dermatitis including tan or red-brown skin color (hemosiderin deposits) usually at medial ankle, or small erosions that may be open or crusted. A (Alguire et al., 1997; Burton, 1993; Pappas et al., 1997) CVI= 0.952, High SOR A.2.b.iv. Lipodermatosclerosis, (fibrosis of dermis

2015 Association for the Advancement of Wound Care

162. Public health guidance on varicella vaccination in the European Union

to vesicular lesions before crusting. Successive crops (usually two to four) appear over several days. The rash tends to have central distribution, with the highest concentration of lesions on the trunk [31]. Lesions can also occur on mucous membranes and cornea [5]. Humans are the only VZV reservoir which can be transmitted person-to-person by direct contact with respiratory secretions or inhalation of vesicle fluid (airborne spread) [31]. The period of communicability goes from one to two days before (...) the onset of the rash to when the lesions are crusted over, usually four to five days after the appearance of the rash. The incubation period goes from 10 to 21 days, commonly 14 to 16 days [31]. Although most people with varicella make full recoveries, complications can occur, especially in older age groups, pregnant women (including congenital varicella syndrome and neonatal varicella) and immunocompromised patients. Varicella is responsible for a substantial burden of hospitalisations

2015 European Centre for Disease Prevention and Control - Public Health Guidance

163. Varicose veins

) are intradermal veins that are less than 1 mm in diameter. Reticular veins are permanently dilated intradermal veins that range between 1–3 mm in diameter. They may be tortuous but are usually asymptomatic. Assess for any , including: Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin), and atrophie

2019 NICE Clinical Knowledge Summaries

164. Cholesteatoma

retraction pocket, with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro (...) , with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro-suctioning of the ear

2019 NICE Clinical Knowledge Summaries

165. Seborrhoeic dermatitis

to surrounding skin. Symmetrically distributed lesions — usually one or two body areas are affected but signs may be more widespread. Mild itching (in particular where the scalp is affected). The most commonly affected areas are the: Scalp — lesions can range from mild desquamation (dandruff) to thick brownish crusts adherent to skin and hair. Face (in particular the nasolabial folds, glabellar area, eyebrows, and behind the ears). The eyelids may be red, swollen and flaky (seborrhoeic blepharitis (...) are associated with seborrhoeic dermatitis including chlorpromazine, cimetidine, gold, haloperidol, interferon‐alpha, lithium, and methyldopa. Examine the person looking for: of seborrhoeic dermatitis such as erythematous scaly patches in areas rich in sebaceous glands — severity can vary from mild flaking to widespread, oily, dense scaling or crusting. Consider the need for further investigations: Diagnosis is usually clinical — investigations (such as blood tests, skin scrapings, or skin biopsy) may

2019 NICE Clinical Knowledge Summaries

166. Cellulitis - acute

, red, swollen and painful swelling, which may need incision and drainage. Erysipelas — a form of cellulitis involving more superficial dermal structures distinguished clinically by raised and well demarcated borders. Chronic conditions (these are usually bilateral but if worse on one side, it may be difficult to exclude superimposed cellulitis): Varicose eczema/venous insufficiency — crusting, scaling, and itching. Contact allergic dermatitis — can present acutely as erythematous, sore and tender (...) lymphoedema who develop cellulitis but do not require : Prescribe amoxicillin 500 mg three times daily. If there is any evidence of Staphylococcus aureus infection, for example, folliculitis, pus formation, or crusted dermatitis, prescribe flucloxacillin 500 mg four times a day in addition to amoxicillin, or as an alternative. If the person has a penicillin allergy, prescribe clarithromycin 500 mg twice daily. Continue antibiotic treatment until all signs of acute inflammation have resolved. The course

2019 NICE Clinical Knowledge Summaries

167. Meibomian cyst (chalazion)

the lacrimal puncta. The person may report history of a watery eye. Blepharitis — suggested by redness of lid margins and crusting on the eyelids, with a history of bilateral ocular burning, itching, foreign body sensation, and photophobia. For more information on recognition and management, see the CKS topic on . Malignant eyelid tumours: Basal cell carcinoma (most common, about 80% to 95% of malignant eyelid tumours) — suggested by a nodule with a pearly edge and surface telangiectasia, and in some cases

2019 NICE Clinical Knowledge Summaries

168. Blepharitis

prevent complications, periodic relapses and exacerbations are typical. Characteristic clinical features include burning, itching, erythema and crusting of the eyelids, worse in the mornings. Conditions commonly associated with blepharitis include dry eye syndrome, seborrhoeic dermatitis and rosacea. The differential diagnosis of chronic blepharitis includes malignant tumours of the eyelid (such as squamous cell, basal cell, or sebaceous cell carcinoma), eczema, infection, infestation (such as pubic (...) — incidence of these complications is greater in children. See the CKS topic on for more information. [ ; ; ] Diagnosis Diagnosis of blepharitis Clinical features When should I suspect blepharitis? Suspect blepharitis if the person has: Characteristic symptoms (often intermittent, with exacerbations and remissions occurring over long periods): Burning, itching and/or crusting of the eyelids. Symptoms are worse in the mornings. Both eyes are affected. Recurrent hordeolum. Contact lens intolerance

2019 NICE Clinical Knowledge Summaries

169. Leg ulcer - venous

of ulceration, malodour, and increased exudate. Examine both legs for signs of venous insufficiency, including: Pitting oedema — rule out non-venous causes of oedema, such as heart failure and chronic kidney disease. See the CKS topics on and . Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin

2019 NICE Clinical Knowledge Summaries

170. Chickenpox in Pregnancy

a chickenpox rash should immediately contact their general practitioner. Women should avoid contact with potentially susceptible individuals, e.g. other pregnant women and neonates, until the lesions have crusted over. This is usually about 5 days after the onset of the rash. Symptomatic treatment and hygiene is advised to prevent secondary bacterial infection of the lesions. Oral aciclovir should be prescribed for pregnant women with chickenpox if they present within 24 hours of the onset of the rash (...) , clothing and bedding). The primary infection is characterised by fever, malaise and a pruritic rash that develops into crops of maculopapules, which become vesicular and crust over before healing. The incubation C C P P P P P DRCOG Green-top Guideline No. 13 © Royal College of Obstetricians and Gynaecologists 5 of 17 period is between 1 and 3 weeks and the disease is infectious 48 hours before the rash appears and continues to be infectious until the vesicles crust over. The vesicles usually crust over

2015 Royal College of Obstetricians and Gynaecologists

171. Does lowering a fever >101F in children improve clinical outcomes?

? View/ Open Date 2010-06 Format Metadata Abstract Treating fever significantly increases comfort, activity, feeding, and fluid intake and decreases the patient's temperature compared with placebo (strength of recommendation (SOR): A, multiple randomized controlled trials [RCTs]). It doesn't shorten or prolong the overall duration of illness or reduce the recurrence of febrile seizures (SOR: A, multiple RCTs). In patients with varicella, reducing fever prolongs the time it takes for lesions to crust

2015 Clinical Inquiries

172. Scabies

: Crusted scabies; Indigenous communities; Infestations; Norwegian scabies; Poverty; Pruritus

2015 Canadian Paediatric Society

173. Geological significance of new zircon U-Pb geochronology and geochemistry: Niuxinshan intrusive complex, northern North China Craton. Full Text available with Trip Pro

into two groups. One group's geochemical signature exhibits steep rare earth element (REE) patterns with negligible Eu anomalies, lower Yb, higher Sr, and negative Nb-Ta-Ti (NTT) anomalies, which indicate a volcanic-arc environment with a thickened crust in a convergent setting. The other group exhibits flat REE patterns with obvious negative Eu anomalies, higher Yb, lower Sr, and weak NTT anomalies, which indicate an intra-plate extensional environment with a thinning crust. Combining geochronologic

2019 PLoS ONE

174. Protein fortification with mealworm (Tenebrio molitor L.) powder: Effect on textural, microbiological, nutritional and sensory features of bread. Full Text available with Trip Pro

, no differences in nutritional quality of lipids were seen between fortified and control breads. Results of sensory analyses revealed that protein fortification of bread with MP significantly affected bread texture and overall liking, as well as crust colour, depending on the substitution level. Overall, proof of concept was provided for the inclusion of MP into bread doughs started with different leavening agents (sourdough and/or baker's yeast), at 5 or 10% substitution level of soft wheat flour. Based

2019 PLoS ONE

175. Giant pyoderma gangrenosum in a patient with ulcerative colitis: A case report. Full Text available with Trip Pro

is extremely rare.A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar

2020 Medicine

176. Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant). Full Text available with Trip Pro

Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant). Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes (...) the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2

2020 Medicine

177. Herpes reactivation after the injection of hyaluronic acid dermal filler: A case report and review of literature. Full Text available with Trip Pro

presented with erythema, crusted papules, pain and swelling on the nose after receiving the injection of hyaluronic acid. A swab of the discharge fluid was obtained for bacterial and viral culture, showing positive for herpes simplex virus.The patient was diagnosed as herpes reactivation after the injection of hyaluronic acid.The patient underwent antiviral therapy with acyclovir 400 mg, 3 times daily for seven days.After a week of antiviral treatment, the clinical signs improved.Herpes reactivation

2020 Medicine

178. Jet Ventilation in the Pregnant Patient with Airway Stenosis: Surgical Safety and Outcomes. (Abstract)

pregnancy outcomes.Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One

2020 Rhinology and Laryngology

179. Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study. (Abstract)

Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events.All of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS (...) subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups.BHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.Copyright © 2020 Elsevier Inc. All rights reserved.

2020 American Journal of Otolaryngology

180. Laser ablation of posterior nasal nerves for rhinitis. (Abstract)

and endoscopically advanced toward the posterior middle meatus. Patients were followed up for the first 90 days after treatment.ELA was successfully completed in 97% of patients. No crusting, epistaxis, or other complications were observed. One patient could not be treated in the office due to limited endoscopic access. TNSS was reduced significantly after30 and 90 days (mean ± SD: 6.0 ± 0.7 prior to ablation, 2.3 ± 0.4 at 90 days, p < .001). Rhinitis and congestion scores decreased at 30 and 90 days after

2020 American Journal of Otolaryngology

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