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Molluscum contagiosum - In immunocompromized patient 10mg paxil visa, it is multiple buy discount paxil 10 mg on line, large size, bilateral, recurrent and resistant to treatment. Sign ¾ single or multiple ¾ Pale, waxy ¾ umblicated nodules ¾ If the nodule is located on the lid margin it may give rise to ipsilateral chronic follicular conjunctivitis and occasionally a superficial keratitis 74 Treatment ¾ Expression ¾ shaving and excision ¾ destruction of the lesion by cauterization, cryotherapy 3. Squamous Cell Carcinoma - a malignant neoplasm of keratinizing cells of the epidermis. Kaposi’s Sarcoma a malignant vascular tumor that develops on the skin, mucous membrane, lymph node and visceral organs. It appears like flat or raised non tender , purple red -dark reddish lesion over the eye lid or conjunctiva. Cranial nerve palsy If the third, fourth, or sixth nerves are affected, there will be diplopia. These forms are more effective for the front of the eye, the conjunctiva, cornea, anterior chamber and iris. Drops are the most convenient and common way of giving topical treatment to the eye. If high levels of the drug need to be maintained, the drops must be applied frequently. Predispose to infection by reducing local immunity Contra indication of steroids 1. Equipment and supplies - Snellen’s E- chart -Reading chart - Occluder - Pinhole - Torch -2. How to apply eye medication - explain to the patient what is to be done - read the instruction on the eye drop/ointment carefully and sit the patient with the head tilted back. Making and Applying an Eye Pad - Cut the cotton and gauze rolls - Place layers of gauze on the working bench or table - Place a thick cotton layer on top of the gauze - Further place another layer of gauze on top of the cotton - This makes a three layered patch: gauze-cotton wool-gauze - Cut the patch in to smaller patches and trim it with scissor to make it oval. Making and Applying a Protective shield - Trace the edge of a drinking cup or gally pot on card board or x-ray film - Cut a circle of thin card from the card board or used x- ray film from the traced and make a cut to the center of the circle or tip of the fold using one of the radius. We hope that you will find this to be a pleasurable and challenging introduction to diseases of the nervous system. During this phase of your medical school experience, you are expected to become familiar with the vocabulary, basic pathologic concepts and morphologic aspects of neurologic diseases. Traditionally, diseases of the nervous system have been classified or divided etiologically into vascular, metabolic, neoplastic, infectious, degenerative, demyelinative, traumatic and developmental categories. Diseases of the neuromuscular system have been segregated somewhat, but can be divided similarly. This approach is still considered to be the most effective and understandable way to present this myriad of afflictions, but it often seems disjointed to the novice. So, be patient and we believe that things will fall into place by the end of the course. We shall try to emphasize common entities in the lectures, the small groups and images reviews, but prototypes of rare diseases also will be presented to provide you with an overview and perspective. The main purpose of the formal lectures is the presentation of conceptual, nosological, or pathogenetic aspects of neuropathology. In the small groups, we will reinforce material from lectures largely through review of images. Additionally, we will illustrate the application of basic neuropathologic principles to problem solving and analysis in the clinical setting. We will enlist your help in generating differential diagnoses to give you a feel for how we approach neurological diseases. We have included a lecture on Neuroimaging since this area is currently expanding tremendously and a basic appreciation of techniques and the value, and limitations, of those techniques will assist you in many areas of your clinical training. We have intentionally listed somewhat extensive chapters, too much to be used in a short course. This will lead you to the site that contains images for all pathology courses (topic bar will say ‘General Pathology’). A large number of additional websites are available that may enhance your learning, if you wish to investigate them. If you want to review some normal neurohistology, there is an interesting “virtual slide box of histology” at www. Finally, constructive criticism and comments are welcome and should be referred to the course director.

A signifcant loss of 10 per cent of body weight over 18 months has shown long-lasting benefts for blood pressure in Type 2 diabetes purchase paxil 30mg mastercard; despite some weight regain [171] discount 20 mg paxil amex. Physical activity Increased physical activity is associated with reductions in cardiovascular risk in both Type 1 and Type 2 diabetes [88, 106, 173]. The most recent recommendation from the American Dietetic Association [174] suggests that maximum beneft is obtained from undertaking moderate aerobic activity at least three times weekly (a total of 150 minutes per week) together with resistance training at least twice weekly. The goal of treatment is to relieve hypoglycaemic symptoms and limit the risk of injury, while avoiding over-treating. Glucose is the preferred treatment for hypoglycaemia with a 10g and 20g dose of oral glucose increasing blood glucose levels by approximately 2mmol/l and 5mmol/l respectively. The glycaemic response of a food used to treat hypoglycaemia is directly related to its glucose content, and as fruit juice and sucrose only contain half the amount of carbohydrate as glucose, a larger portion would be needed to produce the same effect [178]. Glucose levels often begin to fall approximately 60 minutes after glucose ingestion hence the practice of introducing a follow-on carbohydrate snack despite the lack of robust supporting evidence. One small study has shown that a follow-on snack providing a more sustained glucose release may be useful to prevent the re-occurrence of the hypoglycaemic episode [179]. Treatment regimens and individual circumstances vary, and although glucose is recommended as a frst-line treatment for any hypoglycaemic episode, taking extra starchy carbohydrate may be necessary for prolonged hypoglycaemia. Where lifestyle factors, such as exercise or alcohol consumption, may contribute to hypoglycaemia, proactive steps can often be taken to minimise any risks. However, the role of specifc nutrition management in the prevention and management of diabetes related complications is not supported by evidence from randomised controlled trials. As nutritional management is part of the package of care used to improve glycaemic control, good practice would be to offer dietetic advice and support to those with diabetes related complications. One systematic review of the effect of dietary protein restriction in diabetic nephropathy concluded that the evidence was not strong enough to justify the use of protein restriction in the management of diabetic nephropathy [180]. However, this review does recommend that some people may respond to low protein diets and suggests that a six month trial may be initiated, and continued in those that respond. Evidence-based nutrition guidelines for the prevention and management of diabetes 23 Nutrition recommendations for managing diabetes related complications 6. If an individual needs an amputation, their nutritional status should be assessed and reviewed appropriately, as with all surgical procedures, nutritional support should be offered to those in a poor nutritional state. Although the evidence is weak, a recent review highlighted that dietary recommendations should rely on measures that promote gastric emptying or at a minimum do not retard emptying. Artifcial (post-pyloric) feeding should be offered when nutritional status continues to decline because of gastroparesis [184]. However, as the management of glycaemic control is important, dietary review and counselling should again be offered as part of the package of care. There is very little published evidence for nutrition support in people with diabetes either in hospital or in the community and the same applies to end of life care. Nutrition management should be in partnership with the patient and the multi-disciplinary diabetes team with the aim of improving care and optimising glucose control. Hyperglycaemia is common in hospitalised patients and an important marker of poor clinical outcome and mortality in patients. Optimising glucose control is paramount and is associated with better outcomes in conditions including accidental injury, stroke and critical illness, where hyperglycaemia predicts worse outcomes. When feeding enterally, either standard or diabetes specifc formula may be used but care should be taken not to over-feed as it may exacerbate hyperglycaemia [184]. There is no evidence for the most effective mode of long-term nutritional support for people with diabetes [184], but a systematic review of 23 short-term studies have shown that diabetes specifc formulae (containing high proportions of monounsaturated fatty acids, fructose and fbre) signifcantly reduce postprandial blood glucose levels and reduced insulin requirements with no deleterious effect on lipid levels [184]. Patients requiring parenteral nutrition should be treated with standard protocols and covered with adequate insulin to maintain normoglycaemia. Evidence-based nutrition guidelines for the prevention and management of diabetes 25 Additional considerations End of life care is an important consideration. The aims of nutrition advice for these individuals are different as the risk of macro- and microvascular complications are no longer relevant. The main emphasis should be on the avoidance of symptoms due to hyper and hypoglycaemia, providing short-term symptomatic relief, while respecting the wishes of the individual. There is some evidence that the older person with diabetes may have poorer nutritional status than those without diabetes, both in the community [186] and in hospital [187].