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HIV and the SKIN • Sudden Acute Exacerbations • Treatment Failure DR
2018/08/13 KEY FEATURES • Atypical presentation of common disorders • Severe or exaggerated presentations HIV AND THE SKIN • Sudden acute exacerbations • Treatment failure DR. FREDAH MALEKA DERMATOLOGY UNIVERSITY OF PRETORIA:KALAFONG VIRAL INFECTIONS EXANTHEM OF PRIMARY HIV INFECTION • Exanthem of primary HIV infection • Acute retroviral syndrome • Herpes simplex virus (HSV) • Morbilliform rash (exanthem) : 2-4 weeks after HIV exposure • Varicella Zoster virus (VZV) • Typically generalised • Molluscum contagiosum (Poxvirus) • Pronounced on face and trunk, sparing distal extremities • Human papillomavirus (HPV) • Associated : fever, lymphadenopathy, pharyngitis • Epstein Barr virus (EBV) • DDX: drug reaction • Cytomegalovirus (CMV) • other viral infections – EBV, Enteroviruses, Hepatitis B virus 1 2018/08/13 HERPES SIMPLEX VIRUS(HSV) • Vesicular eruption due to HSV 1&2 • Primary lesion: painful, grouped vesicles on an erythematous base • HIV: attacks are more frequent and severe • : chronic, non-healing, deep ulcers, with scarring and tissue destruction • CLUE: severe pain and recurrences • DDX: syphilis, chancroid, lymphogranuloma venereum • Tzanck smear, Histology, Viral culture HSV • Treatment: Acyclovir 400mg tds 7-10 days • Alternatives: Valacyclovir and Famciclovir • In setting of treatment failure, viral isolates tested for resistance against acyclovir • Alternative drugs: Foscarnet, Cidofovir • Chronic suppressive therapy ( >8 attacks per year) 2 2018/08/13 VARICELLA • Chickenpox • Presents with erythematous papules and umbilicated -
Experience with Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice the Bump That Rashes
STUDY ONLINE FIRST Experience With Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice The Bump That Rashes Emily M. Berger, MD; Seth J. Orlow, MD, PhD; Rishi R. Patel, MD; Julie V. Schaffer, MD Objective: To investigate the frequency, epidemiol- (50.6% vs 31.8%; PϽ.001). In patients with molluscum ogy, clinical features, and prognostic significance of in- dermatitis, numbers of MC lesions increased during the flamed molluscum contagiosum (MC) lesions, mollus- next 3 months in 23.4% of those treated with a topical cum dermatitis, reactive papular eruptions resembling corticosteroid and 33.3% of those not treated with a topi- Gianotti-Crosti syndrome, and atopic dermatitis in pa- cal corticosteroid, compared with 16.8% of patients with- tients with MC. out dermatitis. Patients with inflamed MC lesions were less likely to have an increased number of MC lesions Design: Retrospective medical chart review. over the next 3 months than patients without inflamed MC lesions or dermatitis (5.2% vs 18.4%; PϽ.03). The Setting: University-based pediatric dermatology practice. GCLRs were associated with inflamed MC lesion (PϽ.001), favored the elbows and knees, tended to be Patients: A total of 696 patients (mean age, 5.5 years) pruritic, and often heralded resolution of MC. Two pa- with molluscum. tients developed unilateral laterothoracic exanthem– like eruptions. Main Outcome Measures: Frequencies, characteris- tics, and associated features of inflammatory reactions Conclusions: Inflammatory reactions to MC, including to MC in patients with and without atopic dermatitis. the previously underrecognized GCLR, are common. Treat- ment of molluscum dermatitis can reduce spread of MC Results: Molluscum dermatitis, inflamed MC lesions, and via autoinoculation from scratching, whereas inflamed MC Gianotti-Crosti syndrome–like reactions (GCLRs) oc- lesions and GCLRs reflect cell-mediated immune re- curred in 270 (38.8%), 155 (22.3%), and 34 (4.9%) of sponses that may lead to viral clearance. -
Bronchiolitis Obliterans • Mycoplasma Induced Asthma/Wheezing • Resistant Mycoplasma Infection
CROSS CANADA ROUNDS - Long Case Mandeep Walia Clinical Fellow BC Children’s Hospital 21 June, 2018 Long Case History • 10 Y, Boy Feb 8th • Fever- low-moderate grade, rhinorrhea, cough (dry), mild sore throat • Nausea, non bilious vomiting Day 5- worsening cough -dry, sleep disturbance. • Walk in clinic- no wheeze. Prescribed ventolin. Minimal improvement Day 8- redness eyes, purulent discharge, blisters on lips, ulcers on tongue & buccal mucosa. Difficulty to swallow solids. History- cont • No headache, abnormal movements, visual or hearing loss • No chest pain/stridor/ • No diarrhoea. Vomiting stopped after D3 • No hematuria/dysuria. Feb 17 (D10)- BCCH ED : • concerns for extensive oral mucositis, new onset skin rash. Past Hx • Healthy pregnancy. No complications. • Born by SVD, no neonatal resuscitation/NICU stay. • Recurrent OM- evaluated by ENT-not required myringotomy tubes. • Mild eczema. Development - milestones normal Immunization- upto date Allergies- no known Treatment Hx- Tylenol/benadryl/Ventolin. No antibiotics/NSAIDS FHx- Caucasian descent. unremarkable. Social Hx- active in sports. No exposure to pets/smoke Physical exam • Weight- 37.9kg(77centile) Skin- • HR-96/min, RR-30/min , • pink papules, 2-3mm, central • SPO2 94% RA, T-39.2ᵒc, BP115/64 erosion, about 15-20 on trunk, • HEENT- upper & lower extremities. Sparing palms & soles. • B/L conjunctival injection, • purulent discharge MSK-no arthritis • • Lips, buccal mucosa , soft & hard Perianal skin, glans- normal palate-scattered vesicles & superficial erosions. No crusting (serous/hemorrhagic) • B/L ears-normal • No clubbing/lymphadenopathy Systemic Examination • Respiratory - tachyapnea. No retractions/indrawing. B/L air entry decreased. No wheeze/crackles. • CVS-S1 S2 normal. no murmur • PA- no HSM • Neurological - conscious. -
Vertical Perspective Medical Assistance Program
Kansas Vertical Perspective Medical Assistance Program December 2006 Provider Bulletin Number 688 General Providers Emergent and Nonemergent Diagnosis Code List Attached is a list of diagnosis codes and whether the Kansas Medical Assistance Program (KMAP) considers the code to be emergent or nonemergent. Providers are responsible for validating whether a particular diagnosis code is covered by KMAP under the beneficiary’s benefit plan and that all program requirements are met. This list does not imply or guarantee payment for listed diagnosis codes. Information about the Kansas Medical Assistance Program as well as provider manuals and other publications are on the KMAP Web site at https://www.kmap-state-ks.us. If you have any questions, please contact the KMAP Customer Service Center at 1-800-933-6593 (in-state providers) or (785) 274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday. EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 1 of 347 Emergency Indicators as noted by KMAP: N – Never considered emergent S – Sometimes considered emergent (through supporting medical documentation) Y – Always considered emergent Diagnosis Emergency Diagnosis Code Description Code Indicator 0010 Cholera due to Vibrio Cholerae S 0011 Cholera due to Vibrio Cholerae El Tor S 0019 Unspecified Cholera S 019 Late Effects of Tuberculosis N 0020 Typhoid Fever S 0021 Paratyphoid Fever A S 0022 Paratyphoid Fever B S 0023 Paratyphoid Fever C S 024 Glanders Y 025 Melioidosis -
MICHIGAN BIRTH DEFECTS REGISTRY Cytogenetics Laboratory Reporting Instructions 2002
MICHIGAN BIRTH DEFECTS REGISTRY Cytogenetics Laboratory Reporting Instructions 2002 Michigan Department of Community Health Community Public Health Agency and Center for Health Statistics 3423 N. Martin Luther King Jr. Blvd. P. O. Box 30691 Lansing, Michigan 48909 Michigan Department of Community Health James K. Haveman, Jr., Director B-274a (March, 2002) Authority: P.A. 236 of 1988 BIRTH DEFECTS REGISTRY MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BIRTH DEFECTS REGISTRY STAFF The Michigan Birth Defects Registry staff prepared this manual to provide the information needed to submit reports. The manual contains copies of the legislation mandating the Registry, the Rules for reporting birth defects, information about reportable and non reportable birth defects, and methods of reporting. Changes in the manual will be sent to each hospital contact to assist in complete and accurate reporting. We are interested in your comments about the manual and any suggestions about information you would like to receive. The Michigan Birth Defects Registry is located in the Office of the State Registrar and Division of Health Statistics. Registry staff can be reached at the following address: Michigan Birth Defects Registry 3423 N. Martin Luther King Jr. Blvd. P.O. Box 30691 Lansing MI 48909 Telephone number (517) 335-8678 FAX (517) 335-9513 FOR ASSISTANCE WITH SPECIFIC QUESTIONS PLEASE CONTACT Glenn E. Copeland (517) 335-8677 Cytogenetics Laboratory Reporting Instructions I. INTRODUCTION This manual provides detailed instructions on the proper reporting of diagnosed birth defects by cytogenetics laboratories. A report is required from cytogenetics laboratories whenever a reportable condition is diagnosed for patients under the age of two years. -
Fundamentals of Dermatology Describing Rashes and Lesions
Dermatology for the Non-Dermatologist May 30 – June 3, 2018 - 1 - Fundamentals of Dermatology Describing Rashes and Lesions History remains ESSENTIAL to establish diagnosis – duration, treatments, prior history of skin conditions, drug use, systemic illness, etc., etc. Historical characteristics of lesions and rashes are also key elements of the description. Painful vs. painless? Pruritic? Burning sensation? Key descriptive elements – 1- definition and morphology of the lesion, 2- location and the extent of the disease. DEFINITIONS: Atrophy: Thinning of the epidermis and/or dermis causing a shiny appearance or fine wrinkling and/or depression of the skin (common causes: steroids, sudden weight gain, “stretch marks”) Bulla: Circumscribed superficial collection of fluid below or within the epidermis > 5mm (if <5mm vesicle), may be formed by the coalescence of vesicles (blister) Burrow: A linear, “threadlike” elevation of the skin, typically a few millimeters long. (scabies) Comedo: A plugged sebaceous follicle, such as closed (whitehead) & open comedones (blackhead) in acne Crust: Dried residue of serum, blood or pus (scab) Cyst: A circumscribed, usually slightly compressible, round, walled lesion, below the epidermis, may be filled with fluid or semi-solid material (sebaceous cyst, cystic acne) Dermatitis: nonspecific term for inflammation of the skin (many possible causes); may be a specific condition, e.g. atopic dermatitis Eczema: a generic term for acute or chronic inflammatory conditions of the skin. Typically appears erythematous, -
Viral Exanthem
Robert E. Kalb, M.D. Buffalo Medical Group, P.C. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 Viral Exanthem What is a viral exanthem? An exanthem is a doctor’s word for a rash caused by an infectious organism. In this case, a viral exanthem is a rash caused by a virus. You may be familiar with some viral exanthems and you undoubtedly have had some yourself. One familiar viral exanthem is chickenpox. Other viral exanthems include measles and rubella, for which most people have been immunized against. While measles and rubella may sound unpleasant, the vast majority of the hundreds of other viral exanthems are harmless, yet they may cause short-term discomfort. Just as adults may get colds and experience uncomfortable, yet tolerable symptoms like a runny nose, sore throat, and coughing, viral exanthem’s symptoms include itching and redness and are also uncomfortable, but usually short-lived. They very rarely have emotional, developmental, or physical aftereffects. What are the symptoms of a viral exanthem? The most obvious symptom is the widespread rash, which may be anywhere over the body’s surface. Some viral exanthems have particular patterns that help us with diagnosing their cause. Other rashes may appear random. The rash may itch or it may not. Other symptoms may occur prior to or with the rash; fever, a tired achy feeling, irritability, loss of appetite, headache, and abdominal pain. What is the treatment for a viral exanthem? The treatment is symptom control and patience. You may benefit from an oral or topical antihistamine, or another topical anti-itch medication, as determined by the nature and extent of your problem. -
Chin and Malar Augmentation
CHIN AND MALAR AUGMENTATION SOROUSH ZAGHI, MD INTRODUCTION EVALUATION OF CHIN PROJECTION Chin projection should approach a line perpendicular to the Frankfurt horizontal at vermilion border of lower lip. ZERO MERIDIAN OF GONZALES-ULLOA A line perpendicular to the Frankfort horizontal line is projected through the nasion. Legan’s angle Contained by lines from the glabella to the subnasale and the subnasale to the soft-tissue pogonion. This should be 12 ± 4 degrees for appropriate chin projection. MERRIFIELD Z ANGLE Contained by the Frankfort horizontal line and a line connecting the soft-tissue pogonion to the most anterior part of the lip. The Z angle should be 80 ± 5 degrees. PRE-OPERATIVE CONSIDERATIONS • Skin texture • Anatomic proportions • Prior facial trauma • Emotional stability • Aging face: Soft tissue ptosis, jowls, Marionette lines • Occlusal relationship: Microgenia, Micrognathia, Retrognathia. PATIENT WITH JOWLS • 35 F – Before and 4 months after chin implant with liposuction from jowls and submental area. PATIENT WITH RETROGNATHIA • Patient with retrognathia, voluntary protrusion of jaw (better candidate for mandibular advancement) • Patient with retrognathia and chin implant (deepened labiomental fold). Lower lip analysis- Labiomental fold • Position of the labiomental fold determines the chin pad percentage of the lower facial height. • High labiomental fold Poor candidate. Augmentation will enlarge the entire lower face. • Low labiomental fold Good candidate. Augmentation will accentuate the chin only. LOW LABIOMENTAL FOLD • Patient with low labiomental fold • Before and after chin augmentation. CHIN PAD THICKNESS • Soft tissue thickness: normal= 8 to 11 mm. • Cephalogram demonstrating a very thick chin pad. • Avoid setting back jaws with thick pads; leads to bony irregularities, soft tissue pad ptosis and an unsupported chin pad. -
Wisconsin Childhood Communicable Diseases Wall Chart
WISCONSIN CHILDHOOD COMMUNICABLE DISEASES Disease Name Incubation Period Time Period When Person is Spread by Signs and Symptoms Criteria for Exclusion from School or Group Onsite Control and Prevention Measures Time from exposure to Contagious (AKA, causative agent) symptoms Cold sores Direct contact with open sores Fever, irritability, blisters in mouth, on gums, lips, 2-7 weeks after symptoms appear, virus Exclude until fever-free, child able to control drooling, (Herpes simplex virus) or saliva 2 days to 2 weeks conjunctivitis, keratitis shedding possible without symptoms blisters resolved Mononucleosis Person to person contact with Many months after infection; excretion None, unless illness prevents participation; no contact saliva 30-50 days Fever, sore throat, swollen lymph nodes, fatigue of virus can occur intermittently for life sports until spleen no longer enlarged (Mono, Epstein-Barr virus) For all diseases: Good handwashing and hygiene; avoid Mumps R/V Inhalation of respiratory Fever, swelling and tenderness of parotid glands, Exclude for 5 days after swelling onset (day of swelling kissing, sharing drinks, or utensils, use proper disinfection droplets, direct contact with 12-25 days; headache, earache, painful swollen testicles, From 2 days before to 5 days after onset is day zero); exclude susceptible* contacts from of surfaces and toys (Mumps virus) saliva of infected person usually 16-18 days abdominal pain with swollen ovaries swelling day 12 through day 25 after exposure Mumps: Provide immunization records for exposed -
Seminarium: Podstawy Dysmorfologii
The seminar: DYSMORPHOLOGY Tutor: Marzena Wisniewska, M.D., Ph.D. Dysmorphology – is the recognition and study of birth defects and syndromes. The term “dysmorphic” is used to describe children whose physical features are not usually found in a child of the same age or ethnic background. Some features are abnormal in all circumstances, e.g. premature fusion of the cranial sutures, whereas other features may be a non-significant familial trait, e.g. 2/3 toe syndactyly. Dysmorphology examination checklist: Growth parameters – according to centile charts: height, weight, upper limbs, lower limbs short stature gigantism – proportionate or disproportionate Anomalies: Macrosomia – too big stature Microsomia – too small stature Hemihypertrophy – asymmetric half of the body or a single limb Cranium OFC – occipital – frontal circumference symmetry cranial sutures fontanelle Anomalies: Microcephaly – abnormally small head, OFC < 3 SD Macrocephaly – abnormally large head Hydrocephalus – impared circulation and absorption of cerebrospinal fluid Craniostenosis – premature fusion of all sutures Craniosynostosis – premature fusion of one suture – change of skull shape: Scaphocephaly (dolicocephaly) – increased lenght compared to width of skull (saggital synostosis) Brachycephaly – flattening of the occiput with increased width compared to lenght of the skull (bilateral coronal synostosis) Plagiocephaly – asymmetry of the head shape (unilateral coronal or lambdoid synostosis) Trigonocephaly – the forehead assumes a triangular shape (metopic synostosis) -
Statistical Analysis Plan
Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This -
Oral Manifestations of Systemic Diseases: Overview, Gastrointestinal Diseases, Nutritional Disease 12/09/16, 11:27
Oral Manifestations of Systemic Diseases: Overview, Gastrointestinal Diseases, Nutritional Disease 12/09/16, 11:27 Oral Manifestations of Systemic Diseases Author: Heather C Rosengard, MPH; Chief Editor: Dirk M Elston, MD more... Updated: Jul 27, 2016 Overview The oral cavity plays a critical role in numerous physiologic processes, including digestion, respiration, and speech. It is also unique for the presence of teeth and mucosa. The mouth is frequently involved in conditions that affect the skin, but it is also affected by many systemic diseases. Oral involvement may precede or follow the appearance of findings at other locations. This article is intended as a general overview of conditions with oral manifestations of systemic diseases. It is not intended to provide details about the diagnosis and management of these conditions. Many of these conditions have excellent full- length Medscape Drugs & Diseases articles, which are linked herein. Gastrointestinal Diseases The oral cavity is the portal of entry to the GI tract and is lined with stratified squamous epithelium. The oral cavity is often involved in conditions that affect the GI tract. Both ulcerative colitis (UC) and Crohn disease are classified as inflammatory bowel disease (IBD). While Crohn disease can affect any part of the GI tract (from the oral cavity to the anus), inflammation in UC is generally restricted to the colon and is specifically limited to the mucosa and submucosa. Ulcerative colitis UC is characterized by periods of exacerbation and remission, and, generally, oral lesions coincide with exacerbations of the colonic disease. Lesions in the colon consist of areas of hemorrhage and ulceration, along with abscesses.