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Nikolskys Sign

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23. Review of Autoimmune Blistering Diseases: the Pemphigoid diseases. (PubMed)

and bullous lupus. This is in contrast to pemphigus and related disorders, which demonstrate intraepidermal acantholysis and a positive Nikolsky sign. The classification and management is based on clinical, histological and direct and indirect immunofluorescence findings. There are, however, overlapping clinical and histological features between the conditions and clinical heterogeneity within each disease.© 2019 European Academy of Dermatology and Venereology.

2019 Journal of the European Academy of Dermatology and Venereology

24. Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation - a retrospective chart review. (PubMed)

(6.2%). Nikolsky sign, atypical targets, fever and lymphopenia were included in a model for predicting the probability of SJS/TEN.All cases were obtained from academic centers which may limit the generalization of findings to community-based settings. Exploratory study with a small number of cases and need for external validation of the model performance.Early dermatologic evaluation of patients with concern for SJS/TEN is key to separate patients with this condition from those ultimately diagnosed

2019 Journal of American Academy of Dermatology

26. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome (Full text)

. There was no interaction between the GP IIb/IIIa receptor antagonist used, CrCl, and ischemic or bleeding outcomes. In patients with CrCl 114 mL/min). Although the rates of both ischemic and bleeding events were higher among patients with lower creatinine clear- ances, there was no interaction between the assigned GP IIb/IIIa receptor antagonist, CrCl, and clinical outcome. An analysis of the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS (...) failure signs or symptoms) and baseline SCr =2.5 mg/dL and serum potassium <5.0 mmol/L. Serum potassium should be monitored closely. Statin Available data suggest statin therapy should be considered in CKD patients presenting with ACS. ACE indicates angiotensin-converting enzyme; ACS, acute coronary syndrome; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; ICH, intracranial hemorrhage; LV, left ventricular; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCT

2015 American Heart Association PubMed

27. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes

Patients with suspected ACS should be risk stratified based on the likelihood of ACS and adverse outcome(s) to decide on the need for hospitalization and assist in the selection of treatment options. 42–44 (Level of Evidence: B ) Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition. The goal of the initial evaluation focuses on answering 2 questions: What is the likelihood that the symptoms and signs (...) as in patients with diabetes mellitus, impaired renal function, and dementia. , Atypical symptoms, including epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain should raise concern for NSTE-ACS. Psychiatric disorders (eg, somatoform disorders, panic attack, anxiety disorders) are noncardiac causes of chest pain that can mimic ACS. 3.2.2. Physical Examination The physical examination in NSTE-ACS can be normal, but signs of HF should expedite

2014 American Heart Association

28. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack (Full text)

, looking for signs of overnutrition or undernutrition (Class IIa; Level of Evidence C ). New recommendation Patients with a history of ischemic stroke or TIA and signs of undernutrition should be referred for individualized nutritional counseling (Class I; Level of Evidence B ). New recommendation Routine supplementation with a single vitamin or combination of vitamins is not recommended (Class III; Level of Evidence A ). New recommendation It is reasonable to recommend that patients with a history (...) . These seemingly silent infarctions are associated with typical risk factors for ischemic stroke, increased risk for future ischemic stroke, and unrecognized neurological signs in the absence of symptoms. Clinicians who diagnose silent infarction routinely ask whether this diagnosis warrants implementation of secondary prevention measures. The writing committee, therefore, identified silent infarction as an important and emerging issue in secondary stroke prevention. Although data to guide management

2014 American Heart Association PubMed

29. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

) to decide on the need for hospitalization and assist in the selection of treatment options (42-44). (Level of Evidence: B) Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition. The goal of the initial evaluation focuses on answering 2 questions: 1. What is the likelihood that the symptoms and signs represent ACS? 2. What is the likelihood of adverse clinical outcome(s)? Risk assessment scores and clinical (...) (54, 55). Atypical symptoms, including epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain should raise concern for NSTE- ACS (56). Psychiatric disorders (e.g., somatoform disorders, panic attack, anxiety disorders) are noncardiac causes of chest pain that can mimic ACS (57). 3.2.2. Physical Examination The physical examination in NSTE-ACS can be normal, but signs of HF should expedite the diagnosis and treatment of this condition. Acute

2014 Society for Cardiovascular Angiography and Interventions

31. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

. These seemingly silent infarctions are associ- ated with typical risk factors for ischemic stroke, increased risk for future ischemic stroke, and unrecognized neurological signs in the absence of symptoms. Clinicians who diagnose silent infarction routinely ask whether this diagnosis war- rants implementation of secondary prevention measures. The writing committee, therefore, identified silent infarction as an important and emerging issue in secondary stroke prevention. Although data to guide management (...) patients are at high risk of having sleep apnea, 272 a sleep study should be considered to identify the presence of sleep apnea among patients with stroke or TIA even in the absence of sleep apnea signs or symptoms. The American Academy of Sleep Medicine recommends the use of polysomnography, either conducted in a sleep laboratory or unattended polysomnography conducted in patients’ homes for the detection of sleep apnea 270 ; however several studies have evaluated the use of autotitrating continuous

2014 Congress of Neurological Surgeons

32. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

Prevention of constipation with stool softeners is encouraged. 4.3.2 Monitoring The general condition of the patient, vital signs, pulse oximetry and the cardiac rhythm should be continuously monitored following STEMI. 4.3 Cardiac Care Unit (CCU) management 4.3.1 General measures All STEMI patients should be admitted to a CCU or equivalent unit equipped with adequate monitoring facilities. Following successful reperfusion, uncomplicated cases may be kept for a minimum of 24 hours before transfer (...) Prevention of constipation with stool softeners is encouraged. 4.3.2 Monitoring The general condition of the patient, vital signs, pulse oximetry and the cardiac rhythm should be continuously monitored following STEMI. 4.3.3 Concomitant therapy 4.3.3.1 Oxygen I, C x Oxygen is indicated in the presence of hypoxaemia (SpO 2 75 years old, 75 years of age and with renal impairment (serum creatinine (Scr) > 200 µmol/L in women and > 250 µmol/L in men), UFH is preferable to LMWH. 128 • Anti Xa inhibitor

2014 Ministry of Health, Malaysia

33. A Rare Case of Pediatric Bullous Spontaneous Acute Urticaria (Full text)

A Rare Case of Pediatric Bullous Spontaneous Acute Urticaria Acute spontaneous bullous urticaria is an extremely rare entity, and there are few reports with blister formation in acute urticaria patients.We present a 2-year-old girl who was admitted for bullous spontaneous acute urticaria; the underlying reason for this was not detected. Nikolsky's sign and Darier's sign were negative. Lesions were not compatible with erythema multiforme. However, biopsy was not allowed to be performed. Because

2018 Medical Principles and Practice PubMed

34. Association Between Severe Acute Contact Dermatitis Due to Nigella sativa Oil and Epidermal Apoptosis. (PubMed)

lesions spreading beyond the area of NSO application: typical and atypical targets, patches with central blisters, erythematous or purpuric plaques with a positive Nikolsky sign mimicking Stevens-Johnson syndrome, or toxic epidermal necrolysis. Two patients had pustules. They had severe impairment, with more than 15% skin detachment and fever. The results of skin biopsies showed epidermal apoptosis characterized by vacuolar alteration of the basal layer, keratinocyte apoptosis, and a moderate

2018 JAMA dermatology (Chicago, Ill.)

35. Acute Myocardial Infarction in patients presenting with ST-segment elevation

- ticular value for the diagnosis of other causes of chest pain, such as pericardial effusion, massive pulmonary embolism or dissection of the ascending aorta (Table 4). The absence of wall-motion ab- normalities excludes major myocardial infarction. In the emergency setting, the role of computed tomography (CT) scan should be Table 5 Atypical ECG presentations that deserve prompt management in patients with signs and symptoms of ongoing myocardial ischaemia • LBBB • Ventricular paced rhythm • Patients (...) Titrated i.v. opioids are indicated to relieve pain. I C Oxygen is indicated in patients with hypoxia (SaO 2 12 h beforehand or if pain and ECG changes have been stuttering. I C 67 Reperfusion therapy with primary PCI may be considered in stable patients presenting 12–24 h after symptom onset. IIb B 60, 61 Routine PCI of a totally occluded artery >24 h after symptom onset in stable patients without signs of ischaemia (regardless of whether ?brinolysis was given or not) is not recommended. III A 62–64

2012 European Society of Cardiology

36. Third Universal Definition of Myocardial Infarction

ischae- mia and a worse prognosis. Other ECG signs associated with acute myocardial ischaemia include cardiac arrhythmias, intraven- tricular and atrioventricular conduction delays, and loss of pre- cordial R wave amplitude. Coronary artery size and distribution of arterial segments, collateral vessels, location, extent and sever- ity of coronary stenosis, and prior myocardial necrosis can all impact ECG manifestations of myocardial ischaemia. 36 Therefore the ECG at presentation should always (...) may be inscribed in the PR segment, the QRS complex, the ST-segment or the T wave. The earliest manifestations of myocardial ischaemia are typically T wave and ST-segment changes. Increased hyperacute T wave amplitude, with prominent symmetrical T waves in at least two contiguous leads, is an early sign that may precede the eleva- tion of the ST-segment. Transient Q waves may be observed during an episode of acute ischaemia or (rarely) during acute MI with successful reperfusion. Table 3 lists ST

2012 European Society of Cardiology

37. Valvular Heart Disease

vascularization on the chest X-ray is essential when interpreting dyspnoea or clinical signs of HF. 13 3.1.2 Echocardiography Echocardiography isthe key techniqueused to con?rmthe diagno- sis of VHD, as well as to assess its severity and prognosis. It should beperformedandinterpretedbyproperlytrainedpersonnel. 14 Itis indicatedinanypatientwithamurmur,unlessnosuspicionofvalve disease is raised after the clinical evaluation. The evaluation of the severity of stenotic VHD should combine the assessment of valve (...) , particularly when valve repair is considered. 4.1 Evaluation Initial examination should include a detailed clinical evaluation. AR is diagnosed by the presence of a diastolic murmur with the appro- priate characteristics. Exaggerated arterial pulsations and low diastolic pressure represent the ?rst and main clinical signs for quantifying AR. In acute AR, peripheral signs are attenuated, which contrasts with a poor clinical status. 12 The general principles for the use of non-invasive and invasive

2012 European Society of Cardiology

38. Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation

), or coronary bypass graft (CABG) surgery], also raises the likelihood of NSTE-ACS. 3.2 Diagnostic tools 3.2.1 Physical examination The physical examination is frequently normal. Signs of heart failure or haemodynamic instability must prompt the physician to expe- dite diagnosis and treatment. An important goal of the physical examination is to exclude non-cardiac causes of chest pain and non-ischaemic cardiac disorders (e.g. pulmonary embolism, aortic dissection, pericarditis, valvular heart disease

2011 European Society of Cardiology

39. Linear Immunoglobulin A dermatosis mimicking Toxic Epidermal Necrolysis: a case report of etanercept treatment. (PubMed)

Linear Immunoglobulin A dermatosis mimicking Toxic Epidermal Necrolysis: a case report of etanercept treatment. A 65-year-old pluripathological woman attended our hospital with a cutaneous eruption of sudden appearance after vancomycin treatment. She presented targetoid lesions affecting approximately 25-30% of her body surface, large erosions with mucosal lesions and positive Nikolsky sign. Under the initial clinical suspicion of toxic epidermal necrolysis (TEN), and considering the recent

2017 British Journal of Dermatology

40. Funtabulously Frivolous Friday Five 132

sign (also known as “indirect Nikolsky sign”or “Nikolsky II sign”) refers to the extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla. [ ] Nikolsky commonly occurs with Steven’s Johnson Syndrome, Staphylococcal Scolded Skin Syndrome, TEN and Pemphigus vulgarise. Question 2 Why do germs seem to spread in winter? Drier air. Lab experiments have looked at the way flu spreads among groups of guinea pigs. In moister air, the epidemic struggles to build (...) Funtabulously Frivolous Friday Five 132 Funtabulously Frivolous Friday Five 132 Emergency medicine and critical care medical education blog Search LITFL ... | | Funtabulously Frivolous Friday Five 132 , Last updated June 2, 2016 Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old-fashioned medical trivia…introducing 132 Question 1 What is the Asboe-Hansen sign, seen in toxic epidermal necrolysis (TEN)? The Asboe-Hansen

2016 Life in the Fast Lane Blog

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