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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Purpura, also called blood spots, are purple-colored spots and patches that are most recognizable on the skin but can also appear in mucous membranes, including the lining of the mouth. Potential micronutrient deficiencies include vitamin C and vitamin K. Purpura may also be caused by vitamin E toxicity, which has an anticoagulant effect on the blood. Possible non-nutrient causes include anticoagulation therapy, injury or thrombocytopenia.7
Granulomatous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Albert Alhatem, Robert A. Schwartz, Muriel W. Lambert, W. Clark Lambert
Overview: Purpuric eruptions are subdivided into two types: non-thrombocytopenic (normal platelet) and thrombocytopenic (low platelet). Purpura may result from compromising the vessel walls (trauma, infection, vasculitis, collagen disorders) or due to hemostatic pathology (thrombocytopenia, abnormal platelet function, clotting factor deficiency, or abnormal clotting factor function). Other conditions may be associated with petechiae, including septicemia, immune thrombocytopenia (ITP), hemolytic uremic syndrome, leukemia, and coagulopathies (e.g., hemophilia). Non-thrombocytopenic purpura may result from coagulation disorders, connective tissue disorders, scurvy, or vasculitis. Thrombocytopenic purpura may be due to medications, immune disorders, septicemia, Rocky Mountain spotted fever, or systemic lupus erythematous.
Monographs of fragrance chemicals and extracts that have caused contact allergy / allergic contact dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A woman, with a previous history of dermatitis from adhesive tape, was hospitalized for an operation. Three days later, an itchy purpuric dermatitis appeared over the anterior trunk, its distribution suggesting production by a cologne profusely applied the previous day. The cologne had run over her breasts and abdomen, sparing the submammary folds, and had accumulated in her right groin due to her semi-lateral decubitus. The lesions became brownish and disappeared in 2 weeks. A series of 20 perfumes and cosmetic substances were patch tested with negative results. A patch test with the cologne (as is) gave a positive reaction at days 2 and 3. No purpura was seen. Two months later, 18 components of the cologne from the manufacturer were tested at the same concentration as in the cologne; ‘methylionantheme’ (0.0437% in alcohol) elicited a positive reaction. Other ionones were later tested and the patient now had positive patch test reactions to ionone and alpha-isomethyl ionone (test concentrations not specified) (39). alpha-Isomethyl ionone is part of Methylionantheme ®.
Sinonasal and respiratory outcomes of eosinophilic granulomatosis with polyangiitis patients receiving 100 mg mepolizumab in real-life clinical practice: 1-year follow up study
Published in Journal of Asthma, 2023
Ozge Can Bostan, Emine Duran, Gulseren Tuncay, Melek Cihanbeylerden, Omer Karadag, Ebru Damadoglu, Gul Karakaya, Ali F. Kalyoncu
The determination of migrating pulmonary infiltrates or pleural effusion on computed tomography (CT) scan or chest x-ray was considered pulmonary involvement. Due to recent studies demonstrating the association of severe asthma and EGPA with bronchiectasis, the presence of bronchiectasis on CT was also noted and classified (19–24). Palpable purpura on the skin that could not be explained by other reasons or confirmed by skin biopsy was considered skin involvement. Chronic rhinosinusitis, nasal polyps, paranasal sinus involvement supported by imaging studies were evaluated as upper respiratory tract involvement, and mononeuritis multiplex or polyneuropathy supported by EMG as peripheral nerve involvement. Intestinal vasculitis, eosinophilic esophagitis or gastroenteritis were evaluated as gastrointestinal involvement. Myocarditis, pericardial effusion, myopericarditis, endomyocardial fibrosis, or ischemic heart disease due to vasculitis demonstrated on echocardiography were accepted as cardiac involvement. Proteinuria >500 mg/24 h, and hematuria (>5-10 red blood cells per high power field (hpf) in urine), supporting biopsy or renal failure due to renal vasculitis were evaluated as renal involvement. Arthralgia, arthritis, myalgia, or myositis were evaluated as musculoskeletal involvement (25).
Clinical spectrum of immunoglobulin A vasculitis in children and determining the best timing of urine examination to predict renal involvement
Published in Postgraduate Medicine, 2022
Fatma Yazılıtaş, Evrim Kargın Çakıcı, Eda Didem Kurt Şükür, Semanur Özdel, Tülin Güngör, Esra Bağlan, Evra Çelikkaya, Deniz Karakaya, Diclehan Orhan, Mehmet Bülbül
Among our 178 patients with IgA vasculitis, whose median age was 6.5 years (mean age 7.1 ± 3.0 years; range 2.2 to 17.8 years) at presentation, boys constituted 51.1% of (n: 91). Purpura was present in all patients. All patients had vasculitic purpuric rash at the time of diagnosis. The season of the diagnosis with the highest number of IgA vasculitis patients was autumn (n = 65, 36.5%), followed by winter (n = 42, 23.6%), and spring (n = 49, 27.5), whereas the smallest number of patients were observed in summer (n = 22, 12.3%). A total of 24 (13.5%) patients had renal involvement. There were no significant sex differences in patients with or without renal involvement (p = 0.46). The median age was significantly higher in patients with abnormal urine analysis compared with those with normal urine analysis [6.9 ± 2.8 years vs. 8.2 ± 2.9 years, p = 0.040]. The largest proportion of renal involvement occurred among patients who presented during the spring season (p = 0.009). The clinical and demographic characteristics and laboratory values of patients are summarized in Table 1.
Primary immune thrombocytopenia in adults: Belgian recommendations for diagnosis and treatment anno 2021 made by the Belgian Hematology Society
Published in Acta Clinica Belgica, 2022
A. Janssens, D. Selleslag, J. Depaus, Y. Beguin, C. Lambert
Many patients remain asymptomatic with the diagnosis of ITP made only after a routine blood test. Others may have bleeding symptoms ranging from skin bleeding (petechiae, purpura, bruises) (dry purpura) to mucosal bleeding (gingival bleeding, mouth blisters, epistaxis, blood in stool or urine, heavy menstrual bleeding) or intracranial bleeding (wet purpura) appearing spontaneously or after trauma. Bleeding symptoms have mostly been reported in patients with a platelet count of less than 30 x 109/L while life-threatening bleedings are rare in patients with platelets higher than 10 x 109/L. Other factors influencing the bleeding risk are age, comorbidities, lifestyle, need for invasive procedures, need of treatment with anticoagulant or antiplatelet agents, …