Homemade Skin Care Recipes

The Beauty of Food Turning Back The Clock

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Diagnostics Of Botulism And C Botulinum

The diagnosis of botulism is primarily based on the history of eating suspected foods, as well as detecting BoNT in patients and in suspected food samples. 10 The detection of C. botulinum cells in clinical and food specimens strongly supports the diagnosis. Electroneur-omyography may be used to distinguish botulism from similar neurological diseases. 10 The culture method for the detection and isolation of C. botulinum includes broth culturing in anaerobic media, such as tryptone-peptone-glucose-yeast extract medium or cooked meat medium, and subsequent culturing on plating media. Typical colonies on egg yolk agar plates show a positive lipase reaction, and a weak p-hemolysis is seen on blood agar. Proper selective media allowing the growth of all strains of C. botulinum are not available. Commercial biochemical reaction series have been developed for the identification of anaerobic bacteria, but these tests have been shown to be unreliable in the diagnosis of C. botulinum. 16

Molecular Detection of C botulinum

PCR and DNA probes provide a sensitive tool for the detection of C. botulinum. The greatest sensitivities of PCR protocols for C. botulinum in various sample materials vary from 2.5 pg of DNA 20 to 0.1 cfu (or spore) g food 21 and 10 cfu g feces. 21,22 A multiplex PCR assay that enables the simultaneous detection of all human pathogenic serotypes A, B, E, and F has provided a marked improvement in the PCR detection of C. botulinum. 21 Nested PCR involves several subsequent amplifications and provides an increased sensitivity in the detection of C. botulinum, for example, in feces. 22 The disadvantage of PCR detection directly from a sample is the possible detection of dead cells because of intact DNA after cell lysis. This problem is overcome by combining enrichment procedures with PCR. 4 Alternatively, reverse transcription polymerase chain reaction (RT-PCR) may be

Molecular Characterization of C botulinum

Molecular characterization of C. botulinum may be used to study the genetic diversity of the organism, 4,5 and in tracing the causative agents of botulism outbreaks. 9,25 Pulsed field gel electrophoresis (PFGE) provides excellent discriminatory power and reproducibility, whereas the PCR-based method (randomly amplified polymorphic DNA assay, or RAPD) is less reproducible but can be quickly performed. The application of rRNA gene restriction pattern analysis (ribotyping) has been used to identify bacterial species yielding distinct patterns for groups I and II C. botulinum. 4 The entire genome sequence of C. botulinum type A strain ATCC 3502 has been established,1-26-1 which enables the development of DNA microarrays containing the whole genome of the organism. The arrays are anticipated to provide more efficient tools for the genomic analysis of C. botulinum.

Botulinum

Classification and the Microbial Ecology of C. botulinum C. botulinum is an anaerobic gram-positive rod-shaped bacterium that forms heat-resistant spores. 1 The taxo-nomic denominator is the production of botulinum neurotoxin (BoNT). Based on the serological properties of the BoNT they produce, C. botulinum strains are divided into types A-F, with types A, B, E, and F being human pathogens, and types C and D being animal pathogens. Based on their metabolic properties, C. botulinum strains are divided into groups I-III. 2 Groups I and II include strains that are pathogenic to humans, whereas group III includes strains causing botulism in animals. Various characteristics of the organisms belonging to different groups are presented in Table 1. Prevalence of C. botulinum C. botulinum is widely spread in the environment, with group I organisms predominating in the temperate regions of the world, and group II organisms prevailing in aquatic environments in the Northern hemisphere. C....

Discharge And Home Healthcare Guidelines

Botulism is a serious neurotoxic disorder that is caused by the gram-positive, spore-forming bacterium Clostridium botulinum, which is found in soil and in the gastrointestinal (GI) tract of birds, fish, and mammals. Although it is usually harmless in the spore state, the organism flourishes in warm anaerobic environments, causing germination with bacterial multiplication and toxin production. Botulism occurs when the bacterium is ingested into the GI tract or enters through an open wound. Once ingested or embedded, the bacterium enters the vascular system. Toxins act at the neuromuscular junction by impairing the release of the neurotransmitter acetylcholine from the presynaptic membrane. Loss of acetylcholine causes paralysis of voluntary and involuntary muscles.

And Animal Models Of Human Cancer

Recent SAGE studies were performed using a p53 null mouse model of mammary epithelial in vivo preneoplastic progression. This led to the identification of several new and unsuspected targets directly or indirectly dysregulated by the absence of p53 in normal mammary epithelium in vivo. These studies also allowed us to analyze the dramatic physiologic effects of hormonal treatment in mammary gland differentiation (45) (database available at In other studies using a mouse model of skin carcinogenesis, the gene expression profile of squamous cell carcinomas induced by UV-light has been compared with that of normal skin (46).

Stigma and Quality of Life

A community-based research programme 11 explored the feelings of exclusion secondary to FI. This study ran over the course of 5 years and involved a group of women suffering from multiple sclerosis (MS). Some of the main concerns in this group were in managing double incontinence, the effects of MS on sexuality and sexual relationships, and trying to live well despite their chronic illness. The shared group experience gave them the freedom to talk openly about sex and incontinence, subjects about which they had previously felt compelled to be silent. Norton and Chelvanayagam 12 ran two focus groups at St. Mark's Hospital in the UK to develop a research questionnaire titled Effects of Bowel Leakage. For many participants, this was the first time they had ever spoken openly about their FI, and it was found to be mutually supportive to be able to speak openly to peers about the ever-present stress and risk of potential humiliation. As with Australian women 11 , access to...

Candidate Genes In Tumor Progression And Metastasis

Cancer epigenetics studies cannot be fully understood if we do not appreciate the relevance of the silencing of tumor-suppressor genes associated with CpG island hypermethylation and their histone modifications and chromatin-linked changes. In such a context, the multistage mouse skin progression model is also demonstrably useful for defining the chronological inactivation pattern of tumor-suppressor genes with methylation-associated silencing that are known to be hypermethylated in human cancer (17, 18). Of these, there is information available about the DNA repair genes MLH1, BRCA1 and adhesion-related genes E-cadherin (CDH1), the transcriptional repressor Snail and the Snail Gfi-1 repressor family member (MLT1). The DNA methylation patterns of these genes during tumor progression are characterized by bisulfite genomic sequencing and by methylation-specific PCR (MSP). Four of these genes (MGMT, Snail, E-cadherin and MLT1) are methylated in the mouse skin carcinogenesis model (Figure...

Direct Nonhealth Care Costs

Fecal incontinence compared with other disorders does not appear to have a heavy overall impact on the NHS. Indeed, as already pointed out, the costs related to the disorder are almost entirely borne by the patients themselves or their families. In addition to the cost of pads, other costs have to be borne entirely by the patient. The above-mentioned Dutch study 5 estimated expenditure for antidiarrheal drugs (used by 26 of the patients interviewed), skin care products (11 ), special articles of clothing (10 ), cleaning products (9 ), and special foods (6 ).

Primary Nursing Diagnosis

To prevent trauma that may precipitate bleeding episodes, avoid intramuscular injections and minimize the number of venipuncture attempts. Alert other health team members about the patient's high risk for bleeding. Avoid sources of mucosal irritation such as rectal temperatures, urinary catheters, and suppositories. Use only sponge sticks and nonalcoholic rinses for oral care. Assure that tourniquets or blood pressure cuffs are applied no longer than necessary. Perform nasopharyngeal or oropharyngeal suctioning very gently and only when needed. Prevent skin breakdown through the use of frequent turning and preventive skin care.

Microbial Colonization Of Humans

Your body is the mobile, warm-blooded equivalent of an ocean's coral reef, supporting a vast and highly divergent range of life. These microbes stretch from head to toe, spread across your skin, hide in the crevices of your mouth and nose, and follow your food from start to finish. Their presence is not just normal, but helpful or even necessary.

Quaternary Ammonium Compounds

Of this large group of compounds, alkyl benzalkonium chlorides are the most widely used antiseptics. Other compounds that have been used as antiseptics include benzethonium chloride, cetrimide, and cetylpyridium chloride. As discussed above, QACs are primarily bacteriostatic and fungi-static, although they are microbicidal against certain organisms at high concentrations they are more active against gram-positive than against gram-negative bacilli. QACs have relatively weak activity against mycobac-teria and fungi and have greater activity against lipophilic viruses. Initially, they were used as an adjunct in surgery, such as preoperative patient skin treatment, cleaning of surgeon's hands, and disinfection of surgical instruments. During 1980-2000, in the United States, they are seldom used alone for skin and hand disinfection, but rather in combination with alcohols to produce sustained residual activity 49 . Weak activity against gram-negative bacilli influenced the occurrence of...

Impact of technologies that reduce competitive microflora

An example of a new food preservation technology that presents a potential concern is the use of vacuum packaging and modified atmosphere packaging of foods to extend shelf-life. This would seem to be a very useful technology for packaging fresh fish, which is highly perishable. Greater shelf-life could increase consumption of what has become recognized as a very healthy food. However, a natural concern would be to question whether this technology would create conditions that would allow neurotoxin to be produced by non-proteolytic C. botulinum sooner than in fish stored in non-oxygen-reduced environments. In one study, not only was neurotoxin produced faster in modified atmospheres, it was produced before the fish was considered spoiled (Post et al., 1985). Therefore, a technology that provides a longer shelf-life for this very perishable food may suppress the natural warning system for consumers by suppressing the growth of the natural spoilage microorganisms.

Controlled And Modified Atmospheres For Fruits And Vegetables

In considering the above described benefits, a number of potential problems associated with CA or MA storage must be recognized. Above all is the potential health hazard associated with these technologies, especially modified atmosphere packaging or MAP.317 It has been pointed out that the same principles of atmosphere modification responsible for all the benefits of CA or MA are also the main cause of controversy surrounding the potential health hazards associated with these technologies.31819 Modification of the atmosphere and, in particular, the reduction or elimination of O2 from the package head space will in many cases disturb the equilibrium of the atmosphere in favor of anaerobic microorganisms. The aerobic bacteria that normally spoil the product, and in so doing warn consumers of any potential health hazard, may find themselves at an atmospheric disadvantage and their growth inhibited. In the absence of competing aerobic organisms, anaerobic nonproteolytic toxin producers,...

Evaluation of Eyelid Lesions

Lesions Definition

The epidermis responds to chronic trauma with increased cell proliferation and increased keratin production (Fig. 9). The characteristic morphologic features of lichenification include palpable thickness of the skin compared to nearby normal skin accentuation of the normal cross-hatched skin markings and the presence of lichen-type scale. Lichenification is especially characteristic in the chronic lesions of atopic dermatitis and neuro-dermatitis. It is particularly marked in the variant of these two diseases known as lichen simplex chronicus. Color is surprisingly hard to describe accurately. This is partly due to the lack of absolute color standards and partly due to the confounding effect that the patient's normal skin color has on lesional color. One must also discount the color contributed by secondary characteristics such as scale or crust. This can usually be accomplished by looking at the peripheral edge of a lesion, since both scale and crust are often less prominent in this...

Pyrogenic Exotoxins of Streptococcus Pyogenes and Staphylococcus Aureus

Botulinum Toxins Botulinum toxins are produced primarily by C. botulinum and cause the paralytic symptoms of botulism. Seven serologically different neurotoxins, designated A, B, CI, D, E, F and G, have been identified, and all appear to be structurally and functionally similar. Types A, B, E and F cause botulism in humans. Types CI and D are the primary causes of animal botulism. Type G is produced by an environmental isolate of C. botulinum. C. botulinum is a Gram-positive, spore-forming, anaerobe that is classified into groups I-IV based on biochemical, physiological and serological characteristics. Spores of C. botulinum are highly resistant to heating and boiling and can persist in the environment for years. Production of toxin requires germination of spores and anaerobic growth of the bacteria. Some strains of C. botulinum produce more than one type of botulinum toxin. Some isolates of C. butyricum and C. baratii have also been shown to produce botulinum toxin. Three forms of...

Nitrates nitrites and nitrosamines

Nitrates and nitrites in preserved meats (bacon, cold cuts) can prevent growth of Clostridium botulinum, the organism that can produce the potent botulinum toxin. However, nitrates and nitrites have been shown to have adverse effects, such as methemoglobinemia and carcinogenesis, the latter resulting from the formation of nitrosamines. Coincidentally, reduction of nitrate to nitrite is a common reaction for bacteria in the GI tract. Usually, the GI effect on nitrite is preceded by nitrate being reduced to nitrite by microflora of mouth saliva. The minimum nitrate intake for a person is estimated at 75 mg d. The resulting nitrite can oxidize hemoglobin to methemoglobin, which results in the loss of oxygen-binding ability. Consequently, dietary or water sources of nitrate and nitrite can have life-threatening effects (methemoglobinemia), particularly in young children. NADH reductase is the major enzyme responsible for the reduction of methemoglobin. Because of a transient deficiency of...

Phylum Firmicutes The low GC Grampositive bacteria

Several species of Clostridium are serious human pathogens including C. botulinum (botulism) and C. tetani (tetanus). C. perfringens causes gas gangrene, and if ingested, can also result in gastroenteritis. All these conditions are due to the production of bacterial exotoxins. The resistance of spores to heating is thus highly relevant both in medicine and in the food industry. Related to Clostridium are the heliobacteria, two genera of anaerobic photoheterotrophic rods, some of which produce endospores. They are the only known photo-synthetic Gram-positive bacteria. So-called 'Botox' injections, much in vogue in certain circles as a cosmetic treatment, involve low doses of C. botulinum exotoxin. By acting as a muscle relaxant, they are intended to reduce the facial wrinkles that develop with the passing of time The toxin is also used to treat medical conditions in which abnormal muscle contractions make it impossible for patients to open their eyes properly.

History of food irradiation

Permanent Magnet Motor

The microbiological standard for irradiation-sterilized foods was to use a radiation dose sufficient to reduce a theoretical population of spores of Clostridium botulinum. This standard, recommended by the National Academy of Sciences and the National Research Council Advisory Committee to the army's program on food irradiation, was adopted. In the ensuing years, there was no record of any problem with possible C. botulinum survivors, although this has continued to be one of the antinuclear arguments against food irradiation.

Chordates Including the Vertebrates

Reptiles show numerous evolutionary developments. Many of these developments freed reptiles from dependence on moist conditions. Their dry skin limits evaporative loss. Internal fertilization and shelled, waterproof eggs eliminates the need for water for reproduction. In turtles and crocodilians the temperature of incubation of the eggs determines the sex ratio. More efficient respiration allows greater size, up to the 115-kg Komodo dragon. Reptile jaws are capable of applying crushing force. They have higher blood pressure and more efficient circulation. Their lungs are more efficient. Whereas amphibians force air into their lungs with mouth muscles, reptiles developed the ability

Hypothyroidism in Infancy Childhood and Adolescence

Deceleration of linear growth is an important sign that is helpful in the early recognition of this disease. Affected children are relatively overweight for their height, although they are rarely obese. If hypothyroidism is severe and longstanding, immature facies and immature body proportion (increased upper lower body ratio) may be noted with delay in dental and skeletal maturation. The children have cold intolerance, dry skin and dry hair texture. In patients with severe long-standing hypothyroidism, muscular pseudohypertrophy gives a Herculean appearance called Kocher-Debre-Semelaign syndrome 23 .

Risk For Deficient Fluid Volume

Defining Characteristics (Specify vomiting, diarrhea, excessive renal excretion, dry skin and mucous membranes, weight loss, decreased urinary output, altered intake, sunken fontanels in infant, decrease of tears and saliva, sunken soft eyeballs, nasogastric suction, fistula.)

Dermatologic Physical Exam

Nonsolar lentigines These are macules of medium to dark-brown pigmentation that retain normal skin markings over their surface. Even when confluent, their size rarely exceeds 5 mm. They may be clinically indistinguishable from a junctional nevus. They are generally darker, sharper, and more regular than ephelides (see Photo 5). Solar lentigines These are macules of light- to medium-brown pigmentation tht retain normal skin markings over their surface. Color is often uneven, and the margins are irregular and fuzzy. Size varies from 0.5 to 1 cm or more (see Photo 6).

Effect Of Processing Treatments On Oxidation

Accessibility of tissues to oxygen is considered one of the most important factors contributing to oxidative instability. While filleting of fish is a common practice, it has been shown that the skin protects underlying areas from oxidation 34 . If the skin has to be removed early in the processing chain, deep skinning is an alternative to normal skinning and has been shown to improve the cold storage stability of saithe fillets 288 . Improvement is warranted since the highest rate of oxidation is observed in the under skin layer lipids 34 . Meat preservation by means of curing is typically obtained by application of mixtures containing nitrite as the key ingredient. Other ingredients in the curing mixture include sodium chloride, sugars, ascorbate, polyphosphates, and spices. Nitrite imparts multiple functional roles to cured products, inhibiting spore germination of Clostridium botulinum when added in combination with sodium chloride, producing the characteristic cured meat color,...

Inhibitors based on the Snare Motif

Botulinus neurotoxins are zinc proteases which cleave the SNARE proteins of synaptic vesicles thereby preventing neurotransmitter release. The SNARE complex is a four helix bundle made up of three proteins which each contain the repeating SNARE motif AAxxA, where A is Asp or Glu and x is any amino acid. In the present report 'hinge' peptide libraries were constructed based on the SNARE motif and shown to inhibit Botulinum neurotoxin. Botulinum neurotoxin A (Botox A) is one of several protein toxins from Clostridium botulinum which cause paralytic syndromes resulting from blockade of neurotransmitter release. These toxins are all zinc endopeptidases acting in the neuronal cytosol Botox B, D, F and G as well as tetanus toxin attack specifically VAMP (also called synaptobrevin) - a protein of synaptic vesicles, whereas Botox A and E cleave SNAP-25 and Botox C acts on syntaxin - both proteins of the presynaptic membrane SNAP-25 is one component of the so-called SNARE complex which is...

Dermatologie Physical Exam

The histology of a keratoacanthoma is very similar to that of a well-differentiated squamous cell carcinoma of the skin. KAs commonly contain squamous cells with atypical mitosis, individual cell keratinization, and other histologic signs of malignancy. The microscopic differentiation is dependent on both the cellular detail and the low-power configuration of the lesion. At each margin, a narrow spur of dermal connective tissue separates the normal epidermis from the lesion at the transitional junction between the normal and proliferating cells. For this reason, marginal punch biopsy is not adequate to distinguish between the two. Excisional biopsy or an incisional biopsy that contains a cross-section of the lesion into the adjacent normal skin is needed.

Clinical Features of Infection

Matic breaks due to burns or abrasions in the normal skin of a susceptible child). Herpetic whitlow is an occupational hazard (dentists, hospital personnel, wrestlers) resulting from infection of broken skin (often on fingers) in contact with virus on another individual. Erythema multiforme is a severe recurrent skin disease that follows HSV episodes. It is initiated by expression of the HSV DNA polymerase gene in the epidermis and has a T cell immunopathology involving, primarily, CD4+ V i2 T cells.

Oromandibular Dystonia

Oromandibular Dystonia

TREATMENT Botulinum toxin has become the primary treatment of choice for oromandibular dystonia and essential blepharospasm. More than 90 of patients obtain some relieve of spasms that can last for an average of three months. One to two unit injections of botulinum toxin type A (Botox or Dysport ) are placed into the involved facial muscles. For patients who become refractory to type A, toxin type B (Myobloc ) can offer some benefit. Complications of botulinum toxin when used in the mid and lower face include bruising, mouth droop, chewing and speaking problems, and dry mouth. Pharmacologic therapy may be useful as an adjunct but is rarely useful as a primary treatment modality. About 20 to 30 of patients will report some benefit from one drug or another. The most important drugs are Clonazepam (Klonopin), trihexyphenidyl (Artane), and baclofen (Lioresal). Unlike blepharospasm, there is no good surgical procedure for oromandibular dystonia.

Primary and Secondary Sites of Infection

After initial replication in the pharynx, or in the skin if the virus has entered directly through damaged integument, virus is spread through regional lymph nodes (Henderson 1948) and into the circulation (Burrows 1968a McVicar and Sutmoller 1976 Burrows et al. 1981 Alexandersen et al. 2002b and c Zhang and Alexandersen, unpublished data Garland, unpublished data). This can be detected as a plasma serum-associated viraemia usually lasting for 4-5 days (Cottral and Bachrach 1968 Alexandersen et al. 2002c Alexandersen et al. 2003b Garland, unpublished data), resulting in seeding of secondary sites and multiple cycles of viral replication and spread, in particular in the cornified epithe-lia of skin, tongue and mouth where the main viral amplification occurs (Oleksiewicz et al. 2001 Alexandersen et al. 2001 Hess et al. 1967 Burrows et al. 1981 Zhang and Alexandersen, unpublished data). Although vesicular epithelia clearly contain the highest concentration of virus, apparently normal...

Ultraviolet Radiation and Skin

Both UVB and UVA are now regarded complete carcinogens, i.e. triggering both initiation and promotion of carcinogenesis 2 . Furthermore, UVB is associated with erythema (sunburn) and immunosuppression, while UVA is made responsible for pigmentation changes as well as skin aging.

Animal Toxins and Plant Toxicants

Blighted, solanine levels can increase sevenfold, sufficient to harm a small child. Cooked potatoes with high concentrations of solanine have a bitter taste and can cause a burning sensation in the throat. Solanine has been shown to exhibit terato-genic effects in animals. It is likely that solanine serves as a natural pesticide to the beetle and leaf hopper. Another noxious chemical, tomatine, also an alkaloid, is found in tomato and may also serve as a natural plant pesticide. Psoralen, found in parsnip, carrots, and celery, is a chemical produced by a plant under stress. Psoralen is a skin irritant, causing rash and skin problems.

Clinical Examination And Screening Techniques To Identify The Patient At Risk Of Foot Ulceration

Apligraf is considered a composite graft, containing both epidermal and dermal components. The outer layer consists of allogenic human keratinocytes constructed with an inner dermal layer consisting of human fibroblasts on type 1 collagen dispersed in a protein matrix. Apligraf histologically resembles human skin, but it does not contain structures, such as blood vessels, hair follicles, or sweat glands. Interestingly, Apligraf acts like human skin, producing all the cytokines and growth factors produced by normal skin during the wound healing process (101). In diabetic foot ulcers, Apligraf was shown to significantly increase the wound healing rate as well as decreasing the median time to complete wound closure (102,103). Ulcer recurrence rate was similar in both Apligraf-treated ulcers and standard treatment groups (103).

Transmission Clinical Features Pathology and Pathogenicity

PV-associated disease ranges from clinically inapparent infections, through a variety of benign warts, to malignant carcinoma. These differences in pathology are due to different viral types, different epithelial host cells, and the immune response of the host. The complete viral life cycle requires a stratified, differentiating epithelium (see Figure 2). In normal skin, only the basal cells can divide after each division, one daughter cell remains in the basal layer and the other is pushed upward to begin the differentiation process. The latter cells withdraw from the cell cycle and begin to synthesize proteins that provide strength and barrier function to the epithelium.

Reconstructive Surgery

Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple settings. Skin defects on the penile shaft should be liberally grafted so as to prevent fibrotic scar formation with future erectile problems.

Host Range and Virus Propagation

Another method for the extension of the inherent host range of PVs is through the use of transgenic animals. Recently, both transgenic rabbits and mice have been described harboring CRPV and BPV-1, respectively. These systems provide additional tools to examine a myriad of specific issues regarding tissue-specific expression, cellular transformation, cytogenetic abnormalities associated with carcinogenic progression, and immune recognition and tumor immunity. BPV-1 transgenic mice will develop nonproductive epidermal fibropapillomas after a delay of 8-9 months. The warts occasionally become malignant and are locally invasive. Extrachromoso-mal BPV-1 DNA is found exclusively in the wart tissue in contrast to the normal skin and tissues that harbor only integrated, transcriptionally silent BPV DNA. CRPV transgenic rabbits develop an extensive population of cutaneous papillomas within 1-3 months, and viral mRNAs are only expressed in skin tumors, not in normal tissues.

Gender Ethnicracial And Life Span Considerations

Elicit a history of skin problems, the length of time skin disorders have existed, daily routine skin care, and current medications. Ask the patient about exposure to sunlight in particular, establish long-term patterns of exposure to sunlight, either at work or in recreational activities, and determine what form of sun protection the patient has customarily used. Record the patient's history of scars, vaccination sites, and burns. Establish a patient history of exposure to radiation or arsenic be sure to ask about the patient's occupational history to discover if he or she has been at risk of ingesting arsenic at an industrial site. PHYSICAL EXAMINATION. Observe the color, texture, turgor, and pigmentation of the patient's skin for deviations from normal skin parameters. Note in detail any lesions, nodules, or plaques.

Pharmacologic Highlights

The most common problem for patients with liver failure is fluid volume excess. Measure the patient's abdominal girth at the same location daily, and mark the location as a reference point for future measurements. Notify the physician if the girth increases by 2 inches in 24 hours. Provide the required fluid allotment over the three meals and at night. If the patient desires, reserve some fluids to be used as ice chips. Provide mouth care every 2 hours. Because areas of edema are likely to be fragile and prone to skin breakdown, provide skin care.

Essential Blepharospasm

TREATMENT The most affective treatment currently available is chemodenervation with botulinum toxin. The latter blocks neuromuscular transmission by inhibiting release of acetyl choline at peripheral nerve endings. Onset is usually within three to five days, and the duration of effect is typically about three months. For the 4 to 5 of patients who do not respond to botulinum toxin type A (Botox ) or who develop resistance to it, botulinum toxin type B (Myobloc ) is also available, and generally works well in most cases. When chemodenervation fails to give adequate results pharmacological agents such as benzodiazepines or anticholinergic agents can be added. For those who do not obtain satisfactory control of spasms on these regimens, surgical myectomy with removal of orbicularis muscle from the upper eyelids combined with brow fixation, will usually produce acceptable results.

Reduction of preservatives

As a result of concerns about the potential for formation of carcinogenic nitrosamines in products containing nitrite, there have been numerous studies, reports, and debates about safe levels. However, nitrite serves as a means of preventing growth of Clostridium botulinum and is thus an important safety component of these products restricting its use presents an increased risk of botulism from cured products (Marriott et al., 1981 Tompkin, 1980). The residual level of nitrite in today's cured meats is five times lower than in the 1970s (CAST, 1997), as a result in part of introducing other compounds such as ascorbates in the curing system to allow reduction of nitrites while maintaining the ability to inhibit C. botulinum (Marriott et al., 1981). Similarly, salt plays a key role in the safety of many products. Salt levels decreased considerably during the twentieth century, from levels greater than 6 in the first half of the century to around 2 today (CAST, 1997). Much emphasis has...

Historical perspective on food processing Roman sausage to canning to space food

Early humans were hunters and gatherers. Getting food was a daily process, and food spoilage and foodborne illnesses must have been common. Agricultural production of grains and animal husbandry followed the hunting gathering stage, although hunting and gathering remained common means of obtaining food. Early forms of preservation such as salting, drying, smoking and fermenting were practiced long before people understood why they worked, and were likely discovered by accident. Although food safety was probably not at the forefront of early man's concern when they were just trying to get enough food to survive, these food preservation techniques that inhibited food spoilage microorganisms had the added benefit of inhibiting many pathogenic organisms. Early attempts at fermentation were probably especially fraught with dangers. Clostridium botulinum is derived from the Latin term botulus, meaning sausage. The 'controlled spoilage' under the specific conditions of fermentation allows...

Concerns about refrigerated foods

While consumers focus on the convenience of prepared foods, they still want 'fresh' foods. And while they want 'fresh' foods, they want to keep the foods longer. The consumer demand for high-quality convenient meals that require minimal preparation has resulted in an increase in refrigerated foods that are lightly processed to preserve flavor, texture, nutrients, and other quality factors. This has often been combined with packaging in a vacuum or modified atmosphere to help extend shelf-life. One such process is known as 'sous vide ' a food is vacuum packaged, given a minimal heat treatment, quickly chilled and then reheated just before serving. The process retains many of the flavor, nutritional and texture aspects of fresh product. Concerns have been raised about the potential for growth of psychrotrophic strains of C. botulinum, since the packaging provides an anaerobic environment, competing microflora have been destroyed by the heat treatment, and the shelf-life might provide...

Impact of injury and stress

Archer (1996) stated that traditional food preservation systems work well to inhibit the growth of toxin-producing bacteria such as S. aureus or C. botulinum that require relatively high numbers for the toxin to cause disease. However, he expressed concern that infectious bacteria such as E. coli O157 H7 and strains of Salmonella may increase in virulence during stressful conditions of food preservation. Stresses such as starvation and extremes of temperature, pH, and osmolarity cause adaptive responses, one of which may be to potentiate expression of virulence genes or, even worse, create unpredictable mutations in the virulence genes. To date there is little evidence that this occurs in food production, but it warrants vigilance.

Clinical manifestation

Skin lesions fragile, flaccid vesicle or bulla filled with clear fluid, arising on normal skin or on an erythematous base large erosions with lateral spread of blisters Vegetating (vegetans) variant lesions in skin folds form vegetating plaques with excessive granulation tissue and crusting occur more frequently in intertriginous areas and on scalp and face

Supplementation of Carotenoids for Prevention and Treatment

Sume carotenoid containing supplements every day. The aim of such supplementation should be to use the protective functions of carotenoids against the development of macular degeneration, cardiovascular diseases, irradiation induced skin aging, and cancer. Even many people followed the change from the principle An apple a day keeps the doctor away in Five servings a day keep the doctor away and use at least five servings of fruit and vegetables, billions of other people and also of those using lots of fruits and vegetables additionally take supplements with p-carotene or retinol or lycopene or other carote-noids 1 . The supplements as nutraceuticals are combinations of different compounds or single compounds. It is always written on the packages how many percentages of the recommended daily amount (RDA) the intake of one tablet or capsule will cover. With high probability billion of people take in supplements with beneficial effects for their health conditions. Nevertheless,...

Native Americans Early Uses of Animals

Products in medical treatment has not received the same attention. Animal products were used in a number of medical remedies in many Native American nations. Moose and bear fat were used by the Ojibwa to treat skin wounds and to ensure healthy skin in the extreme temperatures. Deer tendons were used as suture material by numerous tribes. The Yukon treated scurvy by ingestion of the animal adrenal glands. Fish oil, because of its high iodine content, was used to treat goiters in Eskimo and Aleut nations. Some South American nations treated epilepsy through shock treatment'' with electric eels. A type of injection device was used by some Native American nations well before the invention of the syringe in 1904. Such devices were constructed from the bladder of a deer or duck connected to a reed or quill of the porcupine. These syringes were used to clean wounds or to inject herbal medicine into the wound.

Refrigeration and freezing

Modern freezing technology began with Clarence Birdseye, who, based on his experience with frozen seafood, developed rapid freezing technology that better preserved the quality of foods. A significant percentage of foods sold today are frozen (Lund, 2000). Although it was long held that refrigeration prevented growth of pathogens, we now recognize there are a number of pathogens capable of growth at refrigeration temperatures, including Listeria monocytogenes and some strains of Clostridium botulinum. Nevertheless, refrigeration significantly slows the growth even of those pathogens that can grow at low temperatures. Freezing, on the other hand, prevents growth of bacterial pathogens and sometimes kills them (Archer, 2004). Refrigeration and freezing are of key importance in the safety of foods, and are thus commonly used by the processing industry.

Sodium Hypochlorite

Frequent use causes a yellow discoloration to skin, catheter, and clothes Soaking for 5 min with the disinfectant is required during transfer set replacement May cause skin irritation and reaction Very dry skin results from exposure to povidone-iodine Growth of Pseudomonas sp. was observed in an opened multi-dispensed bottle of povidone-iodine 31 Povidone-iodine does not kill viruses such as HIV or Hepatitis May cause sclerosing encapsulating peritonitis 28 More costly

Defining the terms and scope of food and nutritional toxicology

In essence, toxicology is the science of poisons, toxicants, or toxins. A poison, toxicant, or toxin is a substance capable of causing harm when administered to an organism. Harm can be defined as seriously injuring or, ultimately, causing the death of an organism. This is a rather simplistic definition, because virtually every known chemical or substance has the potential for causing harm. The term toxicant can be a synonym for poison, or the term poison might be more appropriate for the most potent substances, i.e., substances that induce adverse effects at exposure levels of a few milligrams per kilogram of body weight (see later discussion). The term toxin usually refers to a poison derived from a protein or conjugated protein produced by some higher plant, animal, or pathogenic bacteria that is highly poisonous for other living organisms, e.g., botulinum toxins. Toxicologists study the noxious or adverse effects of substances on living organisms or on in vitro surrogate models,...

Conditions That May Simulate Verruca Vulgaris

The distinction between warts and plantar calluses is sometimes difficult and is important because the latter can be treated with keratolytics and debridement alone and do not require the more destructive therapies used on verrucae. The difference can be determined by paring the lesion down with a scalpel blade. Warts will show a single or sometimes multiple cores that interrupt normal skin lines. They also exhibit dark red or black speckles, which are the thrombosed ends of the feeder vessels. Calloses show neither of these changes.

Specific History

Establish accurately the time of onset of the problem. If it is a chronic disorder, document the frequency and duration of individual attacks, exacerbations, or recurrent episodes. Many skin problems have a fairly characteristic age of onset, gender preference, and duration. Recurrences may follow recognizable fixed patterns, which will aid in diagnosis.

Assessment

Assess the patient for signs of dehydration such as tachycardia, altered level of consciousness, dry skin with poor turgor, dry mucous membranes, weight loss, and weak peripheral pulses. Check for postural hypotension that is, a drop in systolic blood pressure greater than 15 mm Hg when the patient is moved from a lying to a sitting or standing position.

Ecthyma Gangrenosum

Ecthyma Gangrenosum Histology

May closely resemble ecthyma gangrenosum. As in bacterial ecthyma gangrenosum, cutaneous lesions due to opportunistic fungi may be a manifestation of hematogenous dissemination with secondary seeding of the skin. Alternatively, they may represent primary invasive infection, which may then disseminate. Gastrointestinal and respiratory tracts and skin are common portals of entry for disseminated infections. Invasive infections of the skin may occur in previously normal skin, but are more likely to occur in areas that have had a disrupted barrier, such as sites of vascular access, venipuncture, burns, or surgical procedures.

Eccrine Hidrocystoma

Eccrine Hidrocystoma Eyelid

TREATMENT When removal is desired, complete surgical excision including the cyst wall is the treatment of choice. Pulsed dye laser ablation has been reported to give good results after multiple treatment sessions. Botulinum toxin has been suggested as an alternative therapeutic option because of its effect on reducing sweat production. Alfadley A, Al Aboud KA, Tulba A, Mourad MM. Multiple eccrine hidrocystomas of the face. Int J Dermatol 2002 40 125-129. Blugerman G, Schavelzon D, D'Angelo S. Multiple eccrine hidrocystomas a new therapeutic option with botulinum toxin. Dermatol Surg 2003 29 557-559.

Mycosis Fungoides

Mycosis Fungoides Bilder

CLINICAL PRESENTATION The disease begins as a chronic, pruritic, scaling dermatitis. This premycotic stage is represented by an erythematous, eczematous, or psoriasiform dermatitis that slowly progresses into the second, or plaque, stage. In this stage discrete plaques with bizarre configurations and a variable degree of scaling arise on a background of otherwise normal skin. Pruritius and excoriation are common. The third, or tumor, stage is characterized by eyelid tumors and plaques that are indistinguishable from lesions that occur on other body areas. Full-thickness eyelid ulceration with cicatricial ectropion is the most common sequel affecting 40 of patients with ophthalmic involvement. In addition conjunctival and lacrimal tumors, keratitis, corneal ulceration, uveitis, secondary glaucoma, optic atrophy, and papilledema have been reported. Nonspecific findings include cataracts, dry eyes, glaucoma, and ectropion.

Gustatory Sweating

The symptom can be troublesome and embarrassing. Occasionally it affects food intake to the degree that it could make glycemic control difficult. As sweating is controlled by sympathetic cholinergic pathways, treatment has traditionally involved oral anticholinergic drugs, but the acceptability of these to patients is low because of systemic side effects. Topical antimuscarinic agents, such as glycopyrrolate, have been demonstrated to be effective in controlling gustatory sweating caused by parotid surgery and in diabetic gustatory sweating (79,80). Gustatory sweating and flushing within and surrounding the cutaneous distribution of the auriculotemporal nerve (Frey's syndrome), can develop after surgery or trauma to parotid gland. Surgery as resection of the glos-sopharyngeal nerve (which supplies the otic ganglion and hence the auriculotemporal and buccal nerves with parasympathetic fibers) abolishes the syndrome (81,82). A better approach is the injection of botulinum toxin into the...

Atopic Dermatitis

Clogged Tear Photos

Pruritis aggravated by heat, sweat, or wool often leads to chronic rubbing and as a result, the eyelid skin becomes violaceous early on and hyperpigmented with time. Coalescent papules, fissures, and fine scaling may occur. If the condition becomes chronic, thickening and accentuation of normal skin lines (lichenification) can occur on the periocular skin, and scaling plaques occur predominantly on the upper eyelids. With time eversion or stenosis of the lacrimal puncta may occur and frank ectropion may be seen in severe cases. Loss of eyelashes can occur. Darkening of periorbital skin suggests the diagnosis of atopy and is frequently of cosmetic concern to patients. Secondary staphylococcal infection or colonization of the eczematous skin is common leading to chronic anterior blepharitis. Associated ocular changes include keratoconjunctivitis, chemosis, sympblepharon, corneal pannus, Tranta's dots, anterior and posterior subcapsular cataracts, and keratoconus.

Madarosis

Lupus Eyelid

Lash loss is also associated with infiltrative lesions such as sarcoidosis, lymphoma, and cutaneous neoplasms. Inflammatory processes including severe blepharitis can cause lashes to fall out, and chronic infections with the mite Demodex folliculorum, found in 10 to 15 of normal individuals, can also be associated with madarosis. Loss of lashes and facial hair has been reported as a complication of botulinum toxin for oromandibular dystonia, but this is exceedingly uncommon. Iodine plaque brachytherapy and external beam irradiation for choroidal tumors is a known cause of madarosis. Loss of lashes is a common finding in leprosy and ichthyosis. In some cases the loss of lashes can be factitious or idiopathic.

Keloid

Hypertrophic Scar Pathology

INTRODUCTION Keloids represent exuberant scar formation resulting from proliferation of dermal tissue following skin injury. Mechanisms for keloid formation represent abnormal wound healing and include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Keloids differ from hypertrophic scars in that they spread beyond the initial site of injury. Because they tend to be invasive into the surrounding normal skin both clinically and histologically, with prolongation of the proliferative phase of wound repair they have been described as incomplete tumors. Although any body area can be affected, keloids commonly develop on the face, neck, chest, shoulders, and back. Keloids on the eyelid skin are relatively rare, even in patients who are prone to keloid formation. These scars tend to occur with greater frequency in patients with darker skin tones, but patients of any skin type can develop this exuberant clinical response.

St Johns Wort

Was gathered on St John's Eve and put in oil. The consequent balm was considered infallible for the cure of wounds (Gubernatis). Gerard also speaks of an oil made of the plant, a most precious remedie for deep wounds. Another interpretation by Coles of the perforations was that they resembled the pores of the skin. So they could be used to treat skin problems (Vickery. 1981).

Malignancies

SCF has been shown to be expressed on stromal cells as a membrane-bound protein, and its expression can be induced by fibrogenic growth factors such as PDGF (Hiragun et al., 1998). It has also been shown to be expressed on keratinocytes as a membrane-bound protein in normal skin. However, in the skin of patients with mastocytosis, an increased amount of soluble SCF

Pathology

Very early lesions are only detectable by microscopical examination (Gailiunas 1968 Yilma 1980), and it is characteristic that even apparently normal skin with no macroscopical or histopathological changes may contain significant amounts of virus (Alexandersen et al. 2001). The first histopathological changes can be observed in the cornified, stratified squamous epithelium and are characterised by ballooning degeneration and increased cytoplasmic, eosinophilic staining of the cells in the stratum spinosum and the onset of intercellular oedema within the dermis (Fig. 4). This is followed by necrosis and subsequent mononuclear cell and granulocyte infiltration the lesions, now macroscopically visible, develop into vesicles by separation of the epithelium from the underlying tissue and filling of the cavity with vesicular fluid (Fig. 4). In some cases vesicular fluid production may be high and the vesicles large in other cases the amount of fluid may be limited and the epithelium...

Antiseptic Agents

Normal human skin is colonized with microorganisms, which Price, an American surgeon, divided into two types resident and transient flora 47 . Resident flora live and grow on normal skin. Predominant flora is normally harmless and consists of coagulase-negative staphylococci, mainly Staphylo-coccus epidermidis, micrococci, and a smaller number of diphtheroids. In some areas of the body, such as moist areas (e.g., axillae), gram-negative bacteria are more common (e.g., Acinetobacter, Klebsiella) 48 . However, composition of skin flora depends on location, sex, age, health condition, hospitalization, season of the year, and frequency of hand washing 49 . Resident flora are protective to skin because they prevent invasion by other harmful species. They are difficult to remove, because they are attached to deeper layers of the skin. These microorganisms can cause infections during surgery and other invasive procedures. Also, skin bacteria can create problems when transferred from...

Outcome Criteria

Reveals presence of secretions and excretions that lead to skin impairment especially in infants and young children who have thinner, more sensitive skin. ability to maintain healthy skin and mucous membranes with proper nutrition and circulation to tissues and the preservation of muscle mass and strength needed to pad bony prominences and allow movement and position change.

Metabolism

Bacteria that use oxygen are called aerobes. Those that do not are called anaerobes. This distinction is not absolute, however, since many organisms can switch between the two modes of metabolism, and others can tolerate the presence of oxygen even if they do not use it. Some bacteria die in oxygen, however, including members of the Gram positive Clostridium genus. Clostridium botulinum produces botulinum toxin, the deadliest substance known. C. tetani produces tetanus toxin, responsible for tetanus and lockjaw, while other Clostridium species cause gangrene.

Drug therapy

The effectiveness of oxybutynin in the management of patients with detrusor overactivity is well documented. A double-blind placebo controlled trial found oxybu-tynin to be significantly better than placebo in improving lower urinary tract symptoms although 80 of patients complained of significant adverse effects, principally dry mouth or dry skin 180 . Similar results have also been demonstrated in further placebo-controlled trials 181,182 . Botulinum toxin In 1817 an illness caused by Clostridium botulinum toxin was first recorded, when Justinus Kerner described a link between a sausage, and a paralytic illness that affected 230 people. He was a district health officer and made botulism (Latin 'botulus' meaning sausage) a notifiable disease 225 . In 1897, the microbiologist Emile-Pierre van Ermengen identified a gram-positive, spore-forming, anaerobic bacterium in a ham that caused 23 cases of botulism in a Belgian nightclub. He termed the bacterium Bacillus botulinus it was later...

Canning

Early canning processes were arbitrary - canning was more of an art than a science - and there were frequent losses due to spoilage. Food safety scares were abundant in the United States at the beginning of the twentieth century, including numerous cases of botulism from canned foods. This resulted in passage of the Pure Food and Drugs Act (and the Meat Inspection Act) and led to the establishment of the Food and Drug Administration from the Bureau of Chemistry of the US Department of Agriculture. It was the formation of the National Canners Association in 1907 and the establishment of its first laboratory in 1913 that led to science-based thermal processes for canned foods. NCA scientists developed the use of thermocouples for heat penetration studies to set processes for canned foods (NCA, 1920) and the thermal death time (TDT) techniques for determining the heat resistance of spores (Esty and Williams, 1924). Using this technique, Esty and Meyers (1922) established the 'classic'...

Resorcinol

Resorcinol is used in hairdressing as a modifier (or a coupler) of the PPD group of dyes. It is the least frequent sensitizer in hairdressers. It is also used in resins, in skin treatment mixtures, and for tanning. Severe cases of dermatitis due to resorcinol contained in wart preparations have been reported.

Chicken and Turkey

Radiation treatment of poultry products as low as 1 kGy is currently allowed in several countries. In the U.S., fresh or frozen poultry and further processed poultry products including mechanically separated meat can be radiated to an absorbed dose between 1.5 and 3 kGy.53 54 If the products are intended for packaging, the film must be permeable to oxygen in order to reduce possible growth and subsequent toxin production by Clostridium botulinum. In the Netherlands the maximum dose approved for poultry is 3 kGy, while in Israel and South Africa treatment doses as high as 7 kGy may be used.55 The latter dose is sufficiently high to eliminate salmonellae in fresh poultry however, flavor problems invariably arise.55 Threshold doses of 2.5 and 1.5 kGy have been reported for chicken and turkey, respectively, following radiation at temperatures of 5 to 10 C in plastic bags.956 57 For this reason, doses higher than 2.5 kGy are normally reserved for application to frozen poultry products...

Mental Retardation

Learning, employment, health and safety, social interaction, and protection and advocacy (e.g., protecting self from exploitation, exercising legal responsibilities). Additional information is also gathered on exceptional medical (e.g., respiratory care, skin care) and behavioral needs (e.g., self-directed destructive -ness, sexual). The composite score from the scale is used to determine the need for supports and the level of intensity.

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