Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidi...Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition.The purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of SSSS.Data sources A PubMed search was completed in Clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus aureus.Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation.The diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal involvement.Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide therapy.Clarithromycin or cefuroxime may be used should the patient have penicillin allergy.If the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant S.aureus is high,vancomycin should be used.Conclusion A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.展开更多
Patients with locally advanced oropharyngeal cancer are at risk for poor outcomes due to the multi-modal nature of treatment and the potential for treatmentrelated toxicity.Although treatment with concurrent chemother...Patients with locally advanced oropharyngeal cancer are at risk for poor outcomes due to the multi-modal nature of treatment and the potential for treatmentrelated toxicity.Although treatment with concurrent chemotherapy and radiotherapy has drastically reduced the need for a debilitating and disfiguring surgery,treatment related toxicities are often difficult to control.Acute toxicities include mucositis,skin desquamation,depression,cachexia,fatigue and nausea and vomiting.Failure to control these symptoms can adversely affect the patient's ability to complete their treatment regimen.Although there are many promising new treatments in the area of symptom management for this patient population,a review of the literature reflects the need for more research.展开更多
Background and Justification: Paraquat is one of the easily available household poisons and has become an easy source of committing suicide, especially in rural India including in West Bengal where it is used as a “w...Background and Justification: Paraquat is one of the easily available household poisons and has become an easy source of committing suicide, especially in rural India including in West Bengal where it is used as a “weedkiller.” Out of the fatal 272 poisoning cases where autopsies were done at NRSMCH Morgue in the year 2019, 56.6% of cases died due to transoral paraquat poisoning. Though adequate literature is available showing gross and microscopic changes in lungs, liver, and kidneys following transoral paraquat poisoning, data showing the effect of the poison in the gastrointestinal (GI) tract is limited though its detrimental effects on the GI tract are associated with increased morbidity. Objectives: The objectives of the study were to assess the gross and histopathological changes in different parts of the GI Tract involving lips, tongue, esophagus, and stomach in paraquat death cases brought for autopsy in NRSMCH Morgue, Kolkata, to fill the gap in the existing literature to a certain extent. Methods: The study was a descriptive, cross-sectional study that was done over 5 months and during which we got 38 cases based on inclusion and exclusion criteria. Results: Macroscopically Congestion with erosion and hemorrhage was seen mostly in the stomach followed by the esophagus. Histopathologically desquamation was the consistent finding in all organs attributed to the corrosive property of the paraquat solution. Chronic inflammatory cell infiltrations are predominantly seen in the tongue followed by the esophagus and lips. Hyperplasia of the surface epithelium was noticeable mostly in the esophagus followed by the tongue and lips but not in the stomach. Involvement of Distortion of glandular architecture in the stomach outnumbers the other organs, followed by the tongue. Necrotic changes were limited to the stomach and esophagus only. Both ulceration and necrotic changes were predominantly limited to the lowermost part of the esophagus than its rest portion, mainly at the junction of the esophagus and stomac展开更多
Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes including psoriasis vulgaris, pustular psoriasis, guttate psoriasis and erythrodermic psoriasis, in which psoriasis vulgar...Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes including psoriasis vulgaris, pustular psoriasis, guttate psoriasis and erythrodermic psoriasis, in which psoriasis vulgaris is most common. In recent years, Traditional Chinese Medicine(TCM) has attracted widespread attention in the treatment of psoriasis because of better efficacy and a lower incidence of adverse reactions. In TCM, psoriasis is considered to be caused by blood heat and the stagnation of Qi and blood. This article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of psoriasis vulgaris, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.展开更多
文摘Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition.The purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of SSSS.Data sources A PubMed search was completed in Clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus aureus.Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation.The diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal involvement.Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide therapy.Clarithromycin or cefuroxime may be used should the patient have penicillin allergy.If the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant S.aureus is high,vancomycin should be used.Conclusion A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.
文摘Patients with locally advanced oropharyngeal cancer are at risk for poor outcomes due to the multi-modal nature of treatment and the potential for treatmentrelated toxicity.Although treatment with concurrent chemotherapy and radiotherapy has drastically reduced the need for a debilitating and disfiguring surgery,treatment related toxicities are often difficult to control.Acute toxicities include mucositis,skin desquamation,depression,cachexia,fatigue and nausea and vomiting.Failure to control these symptoms can adversely affect the patient's ability to complete their treatment regimen.Although there are many promising new treatments in the area of symptom management for this patient population,a review of the literature reflects the need for more research.
文摘Background and Justification: Paraquat is one of the easily available household poisons and has become an easy source of committing suicide, especially in rural India including in West Bengal where it is used as a “weedkiller.” Out of the fatal 272 poisoning cases where autopsies were done at NRSMCH Morgue in the year 2019, 56.6% of cases died due to transoral paraquat poisoning. Though adequate literature is available showing gross and microscopic changes in lungs, liver, and kidneys following transoral paraquat poisoning, data showing the effect of the poison in the gastrointestinal (GI) tract is limited though its detrimental effects on the GI tract are associated with increased morbidity. Objectives: The objectives of the study were to assess the gross and histopathological changes in different parts of the GI Tract involving lips, tongue, esophagus, and stomach in paraquat death cases brought for autopsy in NRSMCH Morgue, Kolkata, to fill the gap in the existing literature to a certain extent. Methods: The study was a descriptive, cross-sectional study that was done over 5 months and during which we got 38 cases based on inclusion and exclusion criteria. Results: Macroscopically Congestion with erosion and hemorrhage was seen mostly in the stomach followed by the esophagus. Histopathologically desquamation was the consistent finding in all organs attributed to the corrosive property of the paraquat solution. Chronic inflammatory cell infiltrations are predominantly seen in the tongue followed by the esophagus and lips. Hyperplasia of the surface epithelium was noticeable mostly in the esophagus followed by the tongue and lips but not in the stomach. Involvement of Distortion of glandular architecture in the stomach outnumbers the other organs, followed by the tongue. Necrotic changes were limited to the stomach and esophagus only. Both ulceration and necrotic changes were predominantly limited to the lowermost part of the esophagus than its rest portion, mainly at the junction of the esophagus and stomac
文摘Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes including psoriasis vulgaris, pustular psoriasis, guttate psoriasis and erythrodermic psoriasis, in which psoriasis vulgaris is most common. In recent years, Traditional Chinese Medicine(TCM) has attracted widespread attention in the treatment of psoriasis because of better efficacy and a lower incidence of adverse reactions. In TCM, psoriasis is considered to be caused by blood heat and the stagnation of Qi and blood. This article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of psoriasis vulgaris, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.
