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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Pallor, or abnormally pale skin color, is commonly associated with anemia and may indicate an iron, folate or vitamin B12 deficiency.4,10 Possible non-nutrient causes include a low perfusion state, shock, stress, sickle cell anemia, cancer, and genetic conditions which affect pigmentation, such as albinism and vitiligo.4 An in-depth patient interview is recommended to differentiate between pallor and naturally pale skin. Pallor may be more challenging to identify in darker-skinned individuals; the appearance of the conjunctiva of the eye (see Figure 7.1), nail beds, and the oral mucosa can provide additional evidence of deficiency.
Vitiligo
Published in Charles Theisler, Adjuvant Medical Care, 2023
Vitiligo is a cosmetic problem caused by the loss of cells (melanocytes) that produce skin color (melanin) resulting in white blotches on the skin. Often the patches begin on areas of skin that are exposed to the sun and effect both sides of the body. Vitiligo tends to expand over time, causing larger areas of skin to lose pigment. It may begin at any age, but the average age of onset is in the mid-twenties.1 Vitiligo is more common in people with autoim mune diseases. There is no cure for vitiligo, but available treatments may stop its progression and induce varying degrees of re-pigmentation. A combination of therapies is usually more effective than any single therapy.1
Premalignant Neoplasms
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Clinical Presentation: AKs most commonly present on sun-exposed skin as erythematous and scaly macules, papules, or plaques with poorly defined borders (Figure 20.1). They are often better felt than seen due to their rough texture. Colors may vary from skin-colored to erythematous, pink, or brown. Although lesions are often asymptomatic, they can be tender or pruritic. Several clinical variants exist, including hyperkeratotic, atrophic, and pigmented (Figure 20.2).
Comparison of the efficacy of focused ultrasound at different focal depths in treating vulvar lichen sclerosus
Published in International Journal of Hyperthermia, 2023
Ru Jia, Can Wu, Xiaoxu Tang, Miaomiao He, Xinglin Liu, Chang Su, Chengzhi Li
At 12 months after treatment, symptoms recurred in 3 patients (7.0%) in the experimental group. Among which, one patient had milder symptoms than before treatment, and two patients complained of the same symptoms as before with thin skin, white color and no changes. In the control group, 10 patients (24.4%) had recurrent pruritus, of which 5 cases were milder than before treatment and 5 cases were the same as before. The skin became thinner and lighter in color compared with before treatment. No significant difference in curative rate was found between the two groups, but the recurrence rate of the experimental group was lower than that of the control group (p = 0.027). Figures 3 and 4 showed the changes of the clinical manifestation after FU treatment at 2.5 and 4.0 mm focal depths.
Moringa oleifera seed ethanol extract and its active component kaempferol potentiate pentobarbital-induced sleeping behaviours in mice via a GABAergic mechanism
Published in Pharmaceutical Biology, 2022
Wei-Liang Liu, Bai-Fen Wu, Jian-Hua Shang, Xue-Feng Wang, Yun-Li Zhao, Ai-Xiang Huang
Recently, some studies have reported that using MO seeds (MOS) powder in bread, biscuit, noodles, cake and dairy products can improve nutritional values (Aluko et al. 2013; Alam et al. 2014). MO leaf has some resemblance of nutrient substance with that of seeds, and after fermentation, the levels of essential amino acids, polyunsaturated fatty acids and phytochemical concentration of MOS powder are increased, especially when applied in fermented dairy products, without affecting the colour of the foods (Ijarotimi et al. 2013). Additionally, MO seeds have been consumed in daily foods by the Malaysian population. Besides its applications in foods as mentioned above, MOS is highly effective on the treatments of flocculation, diabetes (Bao et al. 2020), cancer (Elsayed et al. 2015), hepatic injury (Saini et al. 2016), immune dysregulation (Anudeep et al. 2016), oxidative stress and convulsions (González-Trujano et al. 2018).
The Clinical Respiratory Score: investigating the reliability of an asthma scoring tool across a multidisciplinary team
Published in Journal of Asthma, 2022
Patrick McLaughlin, Rosa C. Banuelos, Elizabeth A. Camp, Venkatesh Kancharla, Esther Maria Sampayo
By calculating the ICC for not only the total CRS but also for each individual component of the score, we were able to determine if each component held comparative weight. The component with the greatest inter-rater reliability was the room air SpO2. This result was expected since oxygen saturation is an objective value. This component did not have an ICC > 0.80, possibly due to the variability in oxygen saturations that occur over time, especially if the first rater initiated supplemental oxygen requiring the second rater to turn off the oxygen to assess a room air SpO2. The components with the lowest inter-rater reliability were mental status and color. Color or cyanosis has previously been reported in other studies to have poor inter-observer reliability (6). This may be attributed to color and mental status rarely being abnormal. Color assessment is subjective, and the categories are not mutually exclusive, with a “normal” characteristic having a possible score of 0 or 1. Based on the low ICC for color and mental status, we recalculated the ICC for the CRS. We found that the CRS could be simplified to four components without affecting the inter-rater reliability. Conducting a sensitivity analysis by removing the components of the score that had poor inter-rater reliability, we determined that the CRS is a robust score that is not dependent on subjective factors and could be simplified while maintaining its overall reliability (15).