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Bacterial, Mycobacterial, and Spirochetal (Nonvenereal) Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Scarlet fever is caused by toxins produced by streptococcal organisms. It is characterized by an exudative pharyngitis, fever, and bright erythematous eruption. The characteristic eruption usually appears 12 to 48 hours after the onset of fever. Patients present with tiny pink-red spots usually starting cranially and descending to the chest, axillae, and groin and then spreading to the rest of the body. As the eruption progresses, it becomes more widespread and resembles a sunburn with a bright red eruption. The tongue can be red and bumpy and is described as a strawberry tongue. Antimicrobials, usually penicillin for 10 days, is the mainstay of treatment.
Case 18
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Pleural fluid is considered to be exudative if it meets any of the following criteria:Pleural fluid protein/serum protein ratio >0.5Pleural fluid LDH/serum LDH ratio >0.6Pleural fluid LDH >2/3 of the upper limit of normal for serum LDH
Aids and Hepatitis
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Staff. High risk body fluids are blood, amniotic fluid, vaginal secretions, semen, breast milk, CSF, peritoneal, pleural, pericardial and synovial fluid. Saliva in association with dentistry, and unfixed organs and tissues also are classified as high risk and may transmit the virus. It is presently considered unethical to test all patients for evidence of HIV infection prior to surgery. ‘Universal precautions’ which assume that all patients maybe infected are recommended. Identical precautions are taken with other bloodborne infective agents, e.g. hepatitis B, and their success suggests that they are likely to be equally effective against the less infective HIV virus. Other precautions include the use of gloves when there is any risk of contact with infective body fluids, the wearing of masks and protective glasses when infective fluids may become airborne and gowns if there is any chance of being splashed. If contact with body fluids occurs the affected part should be washed immediately. Open or exudative wounds should be covered and contact with potentially infective fluids avoided. To reduce the risk of needle stick injuries, needles are immediately disposed of in a suitable container. They are not resheathed, or passed from one person to another. The risk of seroconversion following a needle stick injury is 0.3%. Post-exposure prophylaxis with zidovudine, lamivudine and indinavir is given as soon as possible (within 1-2 hours) after exposure and continued for 4 weeks.
How can we optimize the development of drugs for wound healing?
Published in Expert Opinion on Drug Discovery, 2022
Evelina Vågesjö, Patricia Grigoleit, Andreas Fasth, Mia Phillipson
The currently available treatments for non-healing wounds are limited, and based on a set of principles that include wound cleaning, control of excess exudation, and maintaining a moist wound environment. This is achieved by changing dressings, evaluating, and treating wound infections, wound debridement, and offloading, as well as treating underlying diseases to restore tissue perfusion and metabolic control [8,9]. These labor-intensive treatments multiply with the duration of the wounds. A range of products with fewer regulatory requirements for documented efficacy compared to pharmaceuticals are available, and most often classified as advanced dressings or medical devices. New pharmaceutical treatment alternatives for wound care have in recent decades been scarce, with Regranex (PDGF-BB) the most recent biologic pharmaceutical for treatment of Diabetic Foot Ulcers (DFUs) (approved by the FDA, the U.S. Food and Drug administration, 1997, by EMA, European Medicines Agency, 1999, and withdrawn 2012), together with Episalvan for treatment of partial thickness wounds (approved by EMA, 2016). A number of pharmaceutical drug candidates, including growth factors, intended for healing of non-healing wounds of different etiology, have been discontinued following phase 2 studies as they often did not meet the primary endpoints addressing efficacy in a sufficiently rigorous way.
Treat and extend paradigm in management of neovascular age-related macular degeneration: current practice and future directions
Published in Expert Review of Ophthalmology, 2021
Ellie Bowditch, Eugenia Chu, Thomas Hong, Andrew A. Chang
Neovascular AMD is a chronic, degenerative condition manifested by a progressive disturbance of central sight, leading to irreversible central scotoma [27]. Recurrence of exudation is an issue in treatment that impacts on patient compliance. Continuation of therapy which may be life-long carries substantial treatment burden and disease-associated morbidity for patients and their caregivers [28,29]. Understanding treatment burden and factors that adversely affect a patients’ quality of life are important considerations when devising a management approach to nAMD [28]. With current treatment methods for nAMD aimed at preserving central vision and slowing the natural progression of the disease, the current focus in management of nAMD is aimed at reducing the treatment burden in the lives of patients, their carers, and healthcare resources. As nAMD requires continuing intravitreal therapy over several years, and perhaps indefinitely, an understanding of optimizing approaches to treatment is an important strategy for ophthalmologists in the real-world setting to achieve the best possible outcomes for patients.
Prospects for the application of growth factors in wound healing
Published in Growth Factors, 2020
Sanam Dolati, Mehdi Yousefi, Alireza Pishgahi, Salman Nourbakhsh, Behzad Pourabbas, Seyed Kazem Shakouri
Topical application of exogenous GFs suffers inadequate efficacy since stratum corneum acts as a barrier against hydrophilic macromolecules. Similarly limiting in this regard are low in vivo stability and removal by exudation prior to arriving at the wound site (Adeli-Sardou et al. 2019; Park, Hwang, and Yoon 2017). Therefore, GF-loaded drug delivery systems (DDSs) are required to overcome these limitations and improve wound healing (Laiva, O'Brien, and Keogh 2018). There exist various DDSs in this respect, including scaffolds, hydrogels, polymeric particles, micro- and nano-particulate systems, and stem cells (Rippon, Ousey, and Cutting 2016). The structure of hydrogels could be modified easily and is akin to that of the natural ECM, facilitating differentiation and proliferation of the cells as well as in situ cell recruitment (Lei et al. 2018; Xu et al. 2018). Cellular scaffolds including fibroblasts, keratinocytes, or stem cells have illustrated promising outcomes for prompting wound healing and decreasing scar formation (Liu et al. 2014; Mascré et al. 2012). Additionally, stem cell-based approaches display higher capacity for wound healing through their paracrine effects, immune modulation, and differentiation into epidermal and dermal cells (Balaji, Keswani, and Crombleholme 2012).