By K. Hamid. Southern Polytechnic State Univerisity. 2019.
Failure of the dermal papilla to reach the hair follicle “bulge” during catagen stage will lead to cessation of follicular cycling as seen in patients with congenital papular atrichia order cheap toradol online back pain treatment kolkata. These patients carry a mutation in the hairless gene or vitamin D receptor gene cheap 10mg toradol otc pain treatment goals, resulting in permanent disconnection of the der- mal papilla from the hair bulge buy 10mg toradol overnight delivery natural pain treatment for dogs, leading to hair loss (25). In horizontal sections, the catagen hair is generally round or oval and is surrounded by a thickened hyaline membrane, often concertinaed by compression from the ascending hair bulb. The catagen hair usually contains apoptotic cells, which stain reddish with hematoxylin and eosin. The level of this section shows only a shrinking outer root sheath (trichilemma) which is surrounded by a thickened hyaline membrane, indicating catagen (hematoxylin and eosin stain, original magniﬁcation 200x). Terminal Telogen Hair After catagen, the hair follicle enters telogen, where the hair follicle matures into a club hair. The hair follicle retracts to the level of the “bulge” at the site of insertion of the arector pili mus- cle into the follicle (Fig. Here the resting hair comprises a telogen germinal unit situated below the telogen club. The telogen germinal unit consists of trichilemma, which is somewhat convoluted and surrounded by palisading basaloid cells. The telogen germinal unit has a char- acteristic appearance and shows no obvious apoptosis (Fig. A telogen club comprises a central mass of trichilemmal keratin, star-shaped in horizontal section, surrounded by trichil- emmal and ﬁbrous sheaths, connecting telogen germinal units and hair shafts (Fig. The rec- ognition of terminal, anagen, catagen and telogen hairs is only possible from the examination of the lower follicle below the “bulge” level for the presence of inner root sheath, apoptosis, or trichilemmal club, respectively. In the upper follicle, only a keratinized hair shaft can be seen with no internal root sheath, so discrimination between anagen, catagen, or telogen hairs is not possible at this level. After 2 to 4 months of telogen, the telogen germinal cells envelops the dermal papilla and grows down the existing follicular tract or stela to form an anagen hair (Fig. Subsequent hair cycling will continue throughout life for as long as the hair follicle is viable. A certain proportion of the hair follicles undergo growth, regression, and rest, continuously and independently. This process involves orchestration of a complex yet delicate interplay of molecular signals. A thorough knowledge of the gross and microscopic follicular anatomy in vertical and horizontal sections is essential for the accurate interpretation of the biopsy, leading to the successful evaluation of the patient with hair disorder. Note that total ﬁbrosis without a vascular supply indicates cicatricial alopecia and a lack of ability for further cycling. The Structure of the Human Hair Follicle: Light Microscopy of Vertical and Horizontal Sections of Scalp Biopsies. Transverse microscopic anatomy of the human scalp: a basis for morphometric approach to disorders of the hair follicle. Label-retaining cells reside in the “bulge” area of pilosebaceous unit: implications for follicular stem cells, hair cycle and skin carcinogenesis. A comparison of vertical versus transverse sections in the evaluation of alopecia biopsy specimens. Vertical and Transverse sections of alopecia biopsy specimens: Combining the two to maximize diagnostic yield. Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. Morphology and properties of Asian and Caucasian hair J Cosm Sic 2006; 57:327–338. Difference is hair follicle dermal papilla volume are due to extracellular matrix volume and cell number: implications for the control of hair follicle size and androgen responses. Atrichia caused by mutations in the Vitamin D receptor gene is a phenocopy of generalized atrichia caused by mutations in the hairless gene. Hair cosmetics can be helpful in camouﬂaging hair loss by optimizing the appearance of exist- ing hair; however, hair cosmetics may also be the cause of hair loss when improperly used or used to excess. The primary goal of this chapter is to help the reader understand how shampoos and conditioners can be incorporated into a treatment algorithm for patients undergoing hair disease treatment. The secondary goal of this chapter is to understand hair loss precipitated by hair coloring, permanent waving, and hair straightening. While these procedures can beautify the hair or appeal to fashion concerns, they can also permanently damage the hair protein and produce premature hair breakage and loss. Haircare is important because damage to the non- living ﬁber is permanent until replaced by new growth, which is a time-consuming activity. Shampoo is designed to remove sebum, eccrine sweat, apocrine sweat, fungal elements, desquamated corneocytes, styling products, and environmental dirt from the scalp and hair (1). Cleansing the hair is actually a complex task, since the average woman has 4 to 8 square meters of hair surface area to clean (2). It is very easy to formulate a shampoo that will remove dirt, but hair that has had all the sebum removed is dull in appearance, coarse to the touch, subject to static electricity, and more difﬁcult to style (3). Thus, the goal of a shampoo is to maintain scalp hygiene while beautify- ing the hair. A shampoo that has high detergent properties can remove the outer cuticle of the hair shaft rendering it frizzy and dull, while a well-designed conditioning shampoo can impart shine and improve manageability. Proper shampoo selection can be the difference between attractive and unattractive hair. Shampoo Formulation Shampoos cleanse by utilizing synthetic detergents, also known as surfactants, which are amphiphilic. This means that the detergent molecule possesses both lipophilic, or oil-attracting, and hydrophilic, or water-attracting, sites. The lipophilic site binds to sebum and oil-soluble dirt while the hydrophilic site binds to water allowing removal of the sebum with water rins- ing (4). There are four basic categories of shampoo detergents: anionics, cationics, amphoterics, and nonionics (5). Usually, a shampoo is a combination of two to four detergents with various abilities to remove sebum, produce foam, and condition the hair. Creating the perfect balance between hygiene and beautiﬁcation is the goal of a successful shampoo. Anionic detergents are the most popular cleanser in general purpose shampoos and are named for their negatively charged hydrophilic polar group. Anionic detergents are adept at removing sebum from the scalp, but leave the hair harsh, rough, subject to static electricity, dull, and difﬁcult to detangle. Common anionic detergents include the lauryl sulfates, laureth sulfates, sarcosines, and sulfosuccinates. The second most popular detergents are the amphoter- ics, which contain both an anionic and a cationic group. This allows them to behave as cationic 60 Draelos detergents at low pH and as anionic detergents at high pH. Within the amphoteric detergent category, there are several subgroups, which include the betaines, sultaines, and imidazo- linium derivatives. Amphoteric detergents such as cocamidopropyl betaine and sodium lau- raminopropionate are found in baby shampoos.
The dosage should be high enough to ensure efficacy and minimise the risk of resistance selection and low enough to minimise the risk of dose-related toxicity discount toradol 10mg with amex treatment guidelines for chronic pain. Antibiotic combinations should only be used when it has been proven that such combinations are necessary to achieve efficacy or to prevent the emergence of resistant organisms cheap 10 mg toradol fast delivery unifour pain treatment center. Empirical antimicrobial therapy should be based on local epidemiological data on potential pathogens and their patterns of susceptibility toradol 10 mg line aan neuropathic pain treatment guidelines. Duration of therapy should be as short as possible and should not exceed 7 days unless there is proof that this duration is inadequate. Prophylactic antibiotics should be restricted to a limited range of drugs of proven efficacy in situations where they have been proven to be effective or where the consequences of infection are disastrous. Surgical prophylaxis should be such as to achieve high plasma and tissue levels during, and immediately following, the operation. This will usually be best achieved by parenteral dosing commencing just before the operation. A single dose should be used unless it has been demonstrated that the benefits of longer-term prophylaxis outweigh the risk of resistance selection or propagation. Because of their potent capacity for selecting resistant organisms and the risk of patient sensitisation, topical antibiotics should be restricted to proven indications and topical antiseptics substituted wherever possible. Appropriate specimens for microscopy, culture and susceptibility testing should be obtained before commencing antibacterial therapy. A Gram stain or direct antigen detection may allow specific therapy before the pathogen has been cultured. Indications: chronic mastitis and breast abscess (organisms in which resistance to ampicillin is due to enzyme which sulbactam can inhibit); mixed Gram positive and anaerobic infections such as community acquired aspiration pneumonia, diabetic foot infections, decubitus infections, mild to moderate intraabdominal infections; i. Aspergillus; also active against Diagnosis and Management of Infectious Diseases Page 391 Antifungals Ajellomyces dermatitidis, Candida albicans, Candida tropicalis, Issatchenkia orientalis, Cryptococcus, Histoplasma, Paracoccoidoides, Sporothrix schenckii, Trichosporon,? Expectorated sputum is an unreliable source of specimens; the frequency of confusing Gram negative bacteria has been reported at 31%. Specimens with < 10 squamous epithelial cells/100X field may be of satisfactory quality, especially if containing > 25 polymorphonuclears/100X field. Gram stain should always be done; 97% of Streptococcus pneumoniae and Haemophilus influenzae infections are detected by Gram stain-directed culture versus 51% by routine culture; overall specificity is 90% but sensitivity is 60-85%. Streptococcus pneumoniae isolation may improve if plating occurs within 1 h of collection. A combination of coagglutination and semiquantitative, microscopy-directed culture of homogenised sputum is optimal. A culture of > 100,000-1M/mL of bacteria preliminarily identified in the Gram should be regarded as significant. If an adequate specimen of sputum cannot be obtained, if there is no clear diagnosis from expectorated sputum, or if there is poor response to antibiotics chosen on the basis of an expectorated sample, bronchoalveolar lavage is the safest, most reliable method of obtaining authentic specimens. Gram stain and culture should be performed, with > 10,000- 100,000 bacteria/mL of fluid being regarded as significant. For paediatric patients, a specimen may be collected by a respiratory therapist via suction. Gram stain and culture of a bronchoscopy protected specimen brush (with 10,000 bacteria/mL significant) and viral antigen detection in cells may be useful, as may Gram stain, viral culture, pneumococcal antigen detection on pleural fluid. Urinary tract specimens for anaerobes should be suprapubic percutaneous bladder aspirates. Catheter specimens do not distinguish between colonisation and infection and procedure may introduce urethral flora into bladder. Suprapubic aspiration is the best way to obtain an uncontaminated specimen when this is not possible by normal means. Urine from urinary tract diversion specimens has a rich mixed aerobic and anaerobic flora (uterosigmoidostomy > ileal conduit > colon loop). Foley catheters are not acceptable for culture, since growth represents distal urethral flora. Urine specimens should be refrigerated immediately upon receipt in the laboratory unless they are processed at once. The use of a dip slide at the time of collection to establish the true count is good practice. As the time a specimen is left unrefrigerated increases, so does the percentage of mixed cultures. Less than 5% of urines which are properly collected and transported contain multiple organisms. Exceptions to this rule are urine specimens from patients with neurogenic bladders or chronic indwelling catheters, in which polymicrobic bacteriuria may be detected in 30-80% of cultures. The Becton-Dickinson Urine Culture Tube is useful where there is considerable delay between collection and processing (up to 24 h), though a possibly better system is provided by using a lyophilised preservative containing boric acid, sorbitol and sodium formate; this provides 94% agreement with fresh specimens in microscopy and 96% agreement in culture after 48 h. Of the many rapid methods for detecting bacteriuria available, acridine orange staining is the most sensitive (98% at 10,000 cfu/mL, 99% at 100,000 cfu/mL), requires only 2 minutes and costs only 50 cents per test. Gram stain for the presence of bacteria in an uncentrifuged urine specimen has a sensitivity of 80% and specificity of 90%. The urine dipstick leucocyte esterase and nitrite tests have sensitivity of 79-88% and specificity of 80-96%. Both take 2 minutes per test and have 93-94% sensitivity at detecting pyuria (lower in leucopenic patients). The Bac-T-Screen is more sensitive at detecting bacteriuria (93% at 10,000 cfu/mL and 97% at 100,000 cfu/mL versus 79% and 92%) but costs nearly 3 times as much per test. The Lumac system has the highest sensitivity (98%) and predictive value of negative (99. The most effective method appears to be screening of urines at the point of collection with Boehringer Mannheim Combur-9 dipsticks, eliminating all urines which do not show any abnormality; this gives a virtually 100% correlation with full laboratory testing. The presence of leucocytes and/or hematuria and/or bacteria on microscopy suggests, but does not prove, urinary tract infection. Many patients with increased numbers of white cells in the urine do not have urinary tract infection. The most common cause is probably vaginal contamination, but inflammatory processes anywhere in the body may result in the presence of increased numbers of leucocytes in the urine. Again, many patients with urinary tract infection do not have increased numbers of white cells in the urine. Such patients should be investigated with renal function assessments and possibly a renal biopsy. If standard culture methods are used, results can be speeded up by realising that 85% of urines with 100,000 organisms/mL will, after 4-6 h incubation, produce recognisable colonies which can be presumptively identified by a combination of colonial morphology and spot tests with an accuracy of > 90%. Specimens from patients with urinary tract infection usually produce counts of > 100,000. At the 10,000-100,000 level, there is a 5% chance of infection, and cultures should be repeated. Two specimens yielding a titre of 100,000 or more make the probability of infection about 95%.
The "late effects" include conditions reported as such best buy toradol myofascial pain treatment center watertown ma, or occurring as sequelae one year or more after accidental injury cheap 10 mg toradol mastercard pain treatment for rheumatoid arthritis. E929 Late effects of accidental injury Excludes: late effects of: surgical and medical procedures (E870-E879) therapeutic use of drugs and medicaments (E930-E949) E929 toradol 10 mg line pain treatment for carpal tunnel. The "late effects" include conditions reported as such, or occurring as sequelae one year or more after attempted suicide or self-inflicted injury. The "late effects" include conditions reported as such, or occurring as sequelae one year or more after injury purposely inflicted by another person. The "late effects" include conditions reported as such, or occurring as sequelae one year or more after injury due to legal intervention. They include self-inflicted injuries, but not poisoning, when not specified whether accidental or with intent to harm. E980 Poisoning by solid or liquid substances, undetermined whether accidentally or purposely inflicted E980. The "late effects" include conditions reported as such, or occurring as sequelae one year or more after injury undetermined whether accidentally or purposely inflicted. The "late effects" include conditions reported as such, or occurring as sequelae one year or more after injury resulting from operations of war. Based on what I learned in this unit, I plan to take the following steps to make sure my knowledge about infectious diseases stays up-to-date. January 2007 2-29 International Association Infectious Diseases of Fire Fighters Unit 2 – Pathogens Page left blank intentionally. Bollon General President General Secretary-Treasurer Unit 3 – Prevention • After this unit, you will be able to: – Explain the concept of standard precautions. Observing standard precautions is critical since people with infectious diseases may have no symptoms and may be unaware that they have a disease. This section discusses engineering controls, work practice controls, and the appropriate use of personal protective equipment. Under the Bloodborne Pathogen Standard, employers are required to implement engineering and work practice controls. Don’t try to guess whether or not an individual has an infectious disease based on the way he or she looks or acts; you must treat everyone as though he or she were potentially infectious. January 2007 3-3 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. Examples of engineering controls include: • Self-sheathing needles • Puncture-resistant sharps containers • Disposable airway equipment resuscitation bags and mechanical respiratory assist devices (e. Proper handling of needles and sharps and handwashing are also work practice controls. Needles and Sharps Improper handling or disposal of needles and other sharp instruments pose the greatest exposure risk to emergency responders. Your department should have its own standard operating procedure detailing the use and disposal of needles and other sharps. January 2007 3-5 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. Also, remember to flush mucous membranes and/or eyes with water immediately (or as soon as feasible) following contact with blood or other potentially infectious materials or after removing personal protective equipment. Your department must make available an antiseptic hand cleanser or towelette if a handwashing facility is not available. Equipment should be readily available; at a minimum, equipment should be carried in your vehicle. Ideally, your department will provide you with a small cloth pack to wear around your waist to carry equipment. January 2007 3-7 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. Gloves must be used whenever there is a potential for contact with any body fluid. Respirators are used to block the splatter of blood or other potentially infectious materials from entering the mouth, nose, and in some instances, the eyes. Respiratory assistive devices prevent the emergency responder from coming in direct contact with saliva, respiratory secretions, or patient vomitus. Examples of respiratory assistive devices are pocket mouth-to-mouth resuscitation masks, bag-valve masks, and oxygen-demand valve resuscitators. Emergency responders within close proximity of a suspected infectious patient should immediately don a fit-tested respirator. January 2007 3-11 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. Remember to always wear gloves and appropriate protective clothing when handling any contaminated equipment or clothing. Extra plastic bags should be kept in your emergency vehicle for storage of contaminated materials. Your department must provide separate facilities for disinfecting contaminated medical equipment and cleaning personal protective clothing. These facilities must be separate from each other and from the fire station kitchen, living, sleeping or personal hygiene areas. Bleach is harmful to metal surfaces and to structural firefighting gear and equipment. After all visible blood or other body fluid is removed, decontaminate the area with an appropriate germicide. January 2007 3-13 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. January 2007 3-15 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. Incident with spurting blood, trauma, • Don masks, splash-resistance eyewear, childbirth or other situations where gloves and other fluid-resistant clothing. Situation where sharp or rough • Structural firefighting gear including gloves surfaces or a potentially high-heat shall be worn. During cleaning or disinfecting of • Cleaning gloves, splash-resistant eyewear clothing or equipment potentially and fluid-resistant clothing shall be worn. Handling sharp objects • Following use, all sharp objects shall be placed immediately in sharps containers. January 2007 3-17 International Association Infectious Diseases of Fire Fighters Unit 3 – Prevention Page left blank intentionally. The amount of protection needed for any given emergency will vary depending on the circumstances of the response. Improper handling of needles poses significant exposure risk to emergency responders.