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A peanut buy lasix line hypertension first aid, because it releases inflammatory mediators purchase 100mg lasix with mastercard pulse pressure below 20, may cause pneumonitis and should also be urgently removed. A greater degree of obstruction can result in a ball-valve phenomenon, leading to gas trapping and hyperinflation. Chronic cough and recurrent pneumonia are often the manifestations of a foreign body when there is no known history of aspiration. Epiglottitis Epiglottitis is an acute, life-threatening infection of the supraglottic area, usually due to H. The patient should be kept calm and comforted by the parents as agitation worsens the ventilatory state. A physician with the ability to perform emergent cricothyrotomy/tracheostomy in children should always be in attendance. Direct laryngoscopy and oral endotracheal intubation are performed using an endotracheal tube one size smaller than normal. Similar presentations include bacterial tracheitis, laryngeal foreign body, retropharyngeal abscess, and diphtheria. Basic guidelines for care include keeping the patient calm and providing oxygen in a cold steam/croup tent/. Racemic epinephrine may temporarily improve symptoms but one should always remember rebound obstruction often occurs 4- 6 hours later. Severe pharyngeal swelling, trismus, distortion of pharyngeal anatomy and airway obstruction can occur. If significant trismus or difficult intubation is anticipated, an inhalation induction with spontaneous ventilation can be performed. Myringotomy with placement of tubes helps to control recurrent otitis media in children and may improve hearing loss. Lacerations, bleeding, edema, and fractures of the maxillofacial area make airway management extremely difficult. Open or closed injuries to the larynx and trachea can occur from direct trauma but are unusual in children. Subcutaneous emphysema, dyspnea, hoarseness, cough, hemoptysis and in particular, voice changes indicate the possibility of laryngeal damage. Anesthesia for ophthalmic surgery The presence of an ocular abnormality always should alert the anesthesiologist to the possibility of other associated anomalies. It is triggered by pressure on the globe or traction of the extraocular muscles, the conjunctiva, or orbital structures. After pretreatment with a nondepolarizing agent, rapid-sequence induction is generally the method of choice. Anesthetic implications of topical ocular drugs Systemic absorption occurs from either the conjunctiva or nasal mucosa. Topical ocular drugs with systemic toxicity to which the anesthesiologist should be alert are found among commonly used mydriatics/atropine, scopolamine, cyclopentolate/as well as antiglaucoma agents/echothiophate iodide,epinephrine, timolol, betaxolol/, and vasoconstictors/cocaine, phenylephrine/. Cocaine should not be administered in combination with epinephrine because of the facilitation of dysrhythmias (especially in the presence of halothane). Cocaine is contraindicated in patients with hypertension or those receiving drugs which modify the adrenergic nervous system. The main anesthetic management concerns are positioning and blood loss, which can be minimized by hyperventilation/vasoconstriction, hemodilution, autologous storage, and controlled hypotension. Both awake intubation and mask inhalation induction with spontaneous ventilation have been used successfully. Juvenile rheumatoid arthritis is an autoimmune disease associated with chronic nonsuppurative inflammation of synovium and connective tissue. Perioperative stress steroid coverage is indicated if the patient is on chronic steroid therapy or if there is a history of recent steroid use. Neuromuscular disorders Von Recklinghausen disease/ neurofibromatosis/: The hallmark of the disease is café-au-lait spots/more than 6 that are greater than 1,5 cm in diameter/ and neurofibromas. Associated conditions are laryngeal and tracheal compression, a high incidence of kyphosis and progressive scoliosis, an increased incidence of neural tumors, compression of spinal roots, and an increased incidence of cancer. Patients may have increased intracranial pressure or a prolonged response to nondepolarizing muscle relaxants. Anesthetic considerations include respiratory compromise in the presence of scoliosis, antiepileptic medications, and considerations for patients with seizure disorders. Clinical features include poor sucking and swallowing, muscle atrophy, facial weakness, ptosis, cataracts, frontal baldness, gonadal atrophy, endocrine failure, and mental retardation. These patients are predisposed to aspiration, atelectasis, and pneumonia, bradycardia and intraventricular conduction delays, and hypoxemia and hypercapnia. Nondepolarizing agents can be used safely but reversal with neostigmine and an antimuscarinic can precipitate contracture. Muscular dystrophy, Duchenne is an X-linked recessive trait that usually presents with waddling gait in a child between the ages of 3 and 5 years. As the disease progresses patients are unable to protect their airways from secretions, pneumonias occur, kyphoscoliosis occurs, and cardiac muscle degenerates. There was report about propofol infusion causing rhabdomyolisis in patient with Duchenne muscular dystrophy. Myasthenia gravis is an autoimmune disorder that results in a decrease in the number of acetylcholine receptors at the neuromuscular junction. If nondepolarizing agents are needed they should be used in 1/20 of the usual dose and titrated to effect. Anesthesia for children with congenital heart disease Congenital lesions of the heart are generally classified according to the physiologic problems: left-to-right shunt: single connection between the venous and arterial systems; children display right-sided failure because of increased pulmonary blood flow; right-to-left shunt: a connection between the venous and arterial systems with obstruction to outflow on the right side will shunt blood right to left; venous blood is ejected systemically by the left ventricle and these children are 20 cyanotic; complex: complex shunts or mixing lesions are cardiac defects where all venous and arterial blood is mixed before being ejected from the heart; obstructive: obstructive lesions such as valvular stenosis or coarction of the aorta, can prevent ventricular outflow from either side of the heart, diminishing cardiac output and causing ventricular failure. Left-to-Right Shunts Simple left-to-right shunts include the defects which connect the arterial and venous circulation resulting in increased pulmonary blood flow: atrial septal defect; ventricular septal defect; patent ductus arteriosus; atrioventricular canal;aortopulmonic window. Right-to-Left Shunts Lesions that produce a right-to-left shunt contain not only a connection between the right and left heart, but also must offer increased resistance to blood flow through the pulmonary vasculature. Patients have marked hypoxemia and cyanosis: tetralogy of Fallot; tricuspid atresia; pulmonary atresia; Ebstein’s anomaly. Right-to-Left shunts usually slow inhalation induction; Left-to-Right shunts do not affect induction significantly, may attenuate Right-to-Left shunts. Treatment of hypercyanotic spells: high FiO2; hydration; morphine; ketamine; phenylephrine; propranolol; halothane; thiopenthal; squatting, abdominal compression. It is important to remember that postoperative pain can increase catecholamines and will affect vascular resistance and shunt direction. Cardiomyopathies Cardiomyopathies in children – primary/idiopathic and secondary, when they occur in association with an underlying disorder. The functional profile includes decreased ejection fraction and stroke volume, increased ventricular volume and filling pressures and normal or decreased ventricular compliance. Another important cause of dilated cardiomyopathy in children is the anthracycline anticancer agents, such as doxorubicin, adriamycin. Goals of anesthetic management: preserving ventricular filling and intravascular volume status, minimizing drug-induced myocardial depression, and avoiding significant increases in afterload.

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Comparison of a conventional antimicrobial suscepti- bility assay to an oligonucleotide chip system for detection of drug resistance in Myco- bacterium tuberculosis isolates buy lasix 100mg online blood pressure medication and hair loss. Current perspectives on drug sus- ceptibility testing of Mycobacterium tuberculosis complex: the automated nonradiometric systems purchase cheap lasix on line arteria mammaria. Comparison between molecular epidemiology, geographical regions and drug resistance in Mycobacterium tuberculosis strains isolated from Iranian and Afghan patients. The W-Beijing lineage of Mycobacterium tuberculosis overproduces triglycerides and has the DosR dormancy regulon constitutively upregulated. Mixed infection and clonal representative- ness of a single sputum sample in tuberculosis patients from a penitentiary hospital in Georgia. Sputum processing methods to improve the sensi- tivity of smear microscopy for tuberculosis: a systematic review. Proposal for standardization of optimized mycobacte- rial interspersed repetitive unit-variable-number tandem repeat typing of Mycobacterium tuberculosis. Impact of drug resistance on fitness of Mycobacterium tuberculosis strains of the W-Beijing geno- type. Public health impact of isoniazid-resistant Mycobacterium tuberculosis strains with a mutation at amino-acid position 315 of katG: a decade of experience in The Netherlands. Molecular epidemiology of tuberculosis and other mycobacterial infec- tions: main methodologies and achievements. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. A small number of African countries have The fndings in the World Malaria Report 2010 further been able to rapidly scale up malaria diagnostic testing strengthen the business case for investing in malaria control. Only by knowing where our enemy lurks, been delivered to sub-Saharan Africa between 2008 and identifying the places where we still have malaria, can we 2010, enough to protect 578 million people. Resurgences of malaria were observed in parts of at least three African These prevention eforts are producing a measurable countries. The annual number of malaria cases not known, but likely refect some combination of natural and deaths continues to decline, especially in Africa. These programme number of countries that have successfully cut their malaria failures are a pointed reminder of what could happen if burden in half over the past decade continues to rise. For we reduce our vigilance and do not follow through on the frst time, not a single case of falciparum malaria was our collective commitments. One by one, high coverage rates with malaria prevention and control we are counting down the number of countries endemic measures may prove even more challenging than having for malaria. Morocco and Turkmenistan as being free from malaria, and was able to add the names of these countries to the Ofcial We cannot let this momentum slip. The international community needs to ensure sufcient and predictable Major changes in the way we tackle malaria are global funding to meet ambitious targets set for malaria occurring quickly. This is the year when we fnally declared control as part of the drive to reach the health-related that everyone with suspected malaria has a right to a Millennium Development Goals by 2015. For too long in too many places, fever has been The will to sustain the gains that we have made in malaria equated with malaria. Our eforts at prevention must come not only from global health leaders and from have produced real changes in malaria transmission, politicians, but from afected communities. If communities and most cases of fever, even in Africa, are no longer due can know the true burden of malaria, and can see the results to malaria. This is another clear marker of progress, and of prevention and control eforts, then the will to eliminate another sign of the way control strategies are constantly and ultimately eradicate malaria will never fade. We have inexpensive, quality-assured rapid diagnostic tests that can be used all the way down to the community level. Staff from the (Iran (Islamic Republic of)); Muthana Ibrahim (Iraq); National Malaria Control Global Fund assisted in the conduct of rapid impact assessments presented Programme (Kenya); Nurbolot Usenbayev (Kyrgyzstan); Kongxay Luang- in Chapter 6 on the impact of malaria control. Madeleine Thomson, Pietro phengsouk (Lao Peoples Democratic Republic) Tolbert Geewleh Nyenswah Ceccato, and Michael Bell at International Research Institute for Climate and (Liberia); Andry Joeliarijaona Rakotorahalahy (Madagascar); Misheck Luhanga Society, The Earth Institute at Columbia University, New York, and Hannah (Malawi); Christina Rundi (Malaysia); Klenon Traoré (Mali); Ba Mamadou Gould and Steve Yoon at Centers for Disease Control and Prevention, Atlanta Dit Dialaw (Mauritania); Héctor Olguín Bernal (Mexico); Samuel Jose Alves prepared analysis of the relationship between climate and disease trends Mabunda (Mozambique); Khin Mon Mon (Myanmar); P. Baquilod (Philippines); Division Of Communicable Disease Control (Republic Erin Eckert (Macro International Inc. Rompão (Sao Tome and Principe); Mohammed Alzahrani (Saudi Korenromp, Estifanos Shargie (Global Fund) reviewed drafts of chapters and Arabia); Mame Birame Diouf (Senegal); Musa Sillah-Kanu (Sierra Leone); made suggestions for their improvement. Deniyage (Sri Lanka); Abd The World Malaria Report 2010 was produced by Maru Aregawi, Alla Ahmed Ibrahim Mohd (Sudan (North)); Robert Gama Hassan (Sudan Richard Cibulskis, Yosuke Kita, Mac Otten, and Ryan Williams on behalf (South)); Simon P. Other colleagues in the Global Saowanit Vijaykadga (Thailand); Liyè Ayo (Togo); Seher Topluoglu (Turkey); Malaria Programme also contributed to the production of chapters: Amy Sofia Aliyeva (Turkmenistan); Ebony Quinto (Uganda); Frank Chacky (United Barrette, David Bell, Andrea Bosman, Jo Lines, Kamini Mendis, Jose Nkuni, Republic of Tanzania (Mainland)); Abdullah Ali, Abdul-Wahid Al-Mafazy Sivakumaran Murugasampillay, Robert Newman, Peter Olumese, Aafje (United Republic of Tanzania (Zanzibar)); Tyo Inna, Lebedeva Natalya, Rietveld, Pascal Ringwald, Silvia Schwarte. It highlights of malaria decreases through much of sub-Saharan Africa, the need continued progress made towards meeting international targets for to diferentiate malaria from non-malarial fevers becomes more malaria control to be achieved by 2010 and 2015. A small number of countries have shown that it is possible to scale up rapidly the availability of malaria diag- International funding for malaria control has risen steeply in the nostic testing on a national scale, provided that attention is given to past decade. These fgures represent a substantial increase have been delivered to sub-Saharan Africa, enough to cover 76% of since 2005, when only 5 countries were providing sufcient courses the 765 million persons at risk of malaria. Nets delivered in 2006 and 2007 are therefore already few decades has led to an intensifcation of efcacy monitoring to due for replacement, and those delivered between 2008 and 2010 allow early detection of resistance. Failure to replace these nets could lead to a resurgence in parasite sensitivity to artemisinins, the clinical and parasitological of malaria cases and deaths. The widespread use of a single class of insecticides 2000 and 2009 was found in 31 of the 56 malaria-endemic countries increases the risk that mosquitoes will develop resistance, which outside Africa, while downward trends of 25%–50% were seen in 8 could rapidly lead to a major public health problem. It is estimated that the number of cases of malaria rose from 233 million in 2000 to 244 million in 2005 but decreased to 225 million in 2009. The number of deaths due to malaria is estimated to have decreased from 985000 in 2000 to 781000 in 2009. While progress in reducing the malaria burden has been remark- able, there was evidence of an increase in malaria cases in 3 countries in 2009 (Rwanda, Sao Tome and Principe, and Zambia). The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes even if numbers of cases have been reduced substantially. The experiences in Rwanda and Zambia also indicate that monthly monitoring of disease surveillance data, both nationally and subnationally, is essential. Since many countries in sub-Saharan Africa had inadequate data to monitor disease trends, it is apparent that greater eforts need to be made to strengthen routine surveillance systems. Major epidemiological events could be occurring in additional countries without being detected and inves- tigated. On World Malaria Day 2008, the United Nations Secretary-Gen- countries in other Regions reported having a policy of parasito- eral called for eforts to ensure universal coverage with malaria logical testing of suspected malaria cases in persons of all ages, prevention and treatment programmes by the end of 2010. By November 2010, 25 countries were still allowing the marketing of z Policies and strategies for malaria control these products (down from 37 in 2009) and 39 pharmaceutical To attain the 2010 and 2015 targets, countries must reach all companies were manufacturing them.

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Evaluation of the chloride and bromide salts of cetylpy- ridium for the transportation of sputum in tuberculosis bacteriology buy lasix 100 mg amex blood pressure medication uk names. A novel pathogenic taxon of the Mycobacterium tuberculosis complex discount lasix online american express blood pressure meter, Canetti: characterization of an exceptional isolate from Africa. Proposed minimal standards for the genus Mycobac- terium and for the description of new slowly growing Mycobacterium Species. Impact of new technologies on Mycobacterium tuberculo- sis genomics A new wave in the analysis of the physiological secrets of microorganisms started more than a decade ago with the reading of the first complete genome sequence, corresponding to the bacterium Haemophilus influenzae (Fleishman 1995). Nowa- days, the accessibility to hundreds of bacterial genome sequences has changed our way of studying the bacterial world, including bacterial pathogens such as M. A quick search in PubMed, limiting results to the last 10 years, showed more than 27,000 papers devoted to “omics” issues: more than three thousand concerning bacteria, and almost three hundred concerning Mycobacterium tuberculosis. Up to five different “omics” methodologies have been described so far, all concerning the global study of the target organism, analyzing all its genes, transcriptional products, proteins, etc. Integration of data derived from the several “omics” by bioinformatics will probably allow a rational insight into M. The sequence of the genome, and its comparison to sequences of other microorganisms reported in several databases, allowed the as- signation of precise functions to 40 % of the predicted proteins and the identifica- tion of 44 % of orthologues (genes with very similar functions in a different spe- cies), leaving 16 % as unique unknown proteins. The elucidation of complete genome sequences and the development of microar- ray-based comparative genomics have been powerful tools in the progress of new areas by the application of robotics to basic molecular biology. Comparative ge- nomics and genomic tools have also been used to identify factors associated with the pathogenicity of M. Moreover, these tools allowed a de- scription of the evolutionary scenario of the genus (see Chapter 2). A major barrier for genomic studies has been the great number of genes with unknown function that have been identified. The elucidation of protein function was possible with the global analysis of bacterial proteins, giving insights into the functional role of several so far unknown proteins. Thanks to the joint contributions of biochemical techniques and mass spectrometry, up to 1,044 non- redundant proteins were reported in different cellular fractions (Mawuenyega 2005). Genomics and other molecular tools allowed studies on gene expression and regu- lation, which were unthinkable years ago. Understanding how the bacillus regulates its different genes according to environmental changes will probably lead to the comprehension of many interesting aspects of M. This chapter will address the general basics, as well as the state-of-the-art ge- nomics, transcriptomics and proteomics in relation to M. Finally, a general overview will be made on lipids, the most peculiar metabolites of this bac- terium. Expectations were generated on the elucidation of some unique characteristics of the biology of the tubercle bacillus, such as its characteristic slow growth, the nature of its complex cell wall, certain genes related to its virulence and persistence, and the apparent stability of its genome. In turn, the few genes with particularly low (< 50 %) G+C content are those coding for transmembrane proteins or polyketide synthases. This deviation to low G+C content is believed to be a consequence of the required hydrophobic amino acids, essential in any trans- membrane domain, that are coded by low G+C content codons. The posses- sion of a single rrn operon in a position relatively distant from oriC has been pos- tulated to be a factor contributing to the slow growth phenotype of the tubercle bacillus (Brosch 2000a). Another 32 different insertion sequences were found, of which seven belonged to the 13E12 family of repetitive sequences; the other insertion sequences had not been described in other organisms (Cole 1998b). Two prophages were detected in the genome sequence; both are similar in length and also similarly organized. The second prophage, PhiRv2 has proven to be much more stable, with less variability among strains (Cole 1999). A bias in the overall orientation of genes with respect to the direction of replication was also found. It was also found that the number of genes that arose by duplication is similar to the number seen in E. The lack of divergence of duplicated genes is consistent with the hypothesis of a recent evolutionary descent or a recent bottleneck in my- cobacterial evolution (Brosch 2002, Sreevatsan 1997, see chapter 2). This flexibility is useful for survival in the changing environments within the human host that range from high oxygen tension in the lung alveolus to microaerophilic/anaerobic condi- tions within the tuberculous granuloma. In total, there are genes encoding for 250 distinct enzymes involved in fatty acid metabolism, compared to only 50 in the genome of E. These proteins are believed to play an important role in survival and multiplication of mycobacteria in different environments (Marri 2006). Pro- teins in this class contain multiple tandem repetitions of the motif Gly-Gly-Ala, hence, their glycine concentration is superior to 50 %. This gene encodes the enzyme in charge of removing oxidized guanines whose incorporation during repli- cation causes base-pair mismatching (Mizrahi 1998, Cole 1999). With the aim of making the information publicly available and the search and analysis of information easier, the Pasteur Institute (http://www. This database is freely available for use on the Internet and is known as the Tuberculist Web Server http://genolist. As more information was generated, databases grew bigger, more experimental information became available, and better and more accurate algorithms for gene identification and prediction were released. The letter C was not included since it usually stands for “comple- mentary”, which means that the gene is located in the complementary strand. As expected, the classes that exhibited the greatest numbers of changes were the un- known category and the conserved hypothetical category (Table 4-1). The re- annotation of the genome sequence allowed the identification of four sequencing errors making the current sequence size change from 4,411,529 to 4,411,532 bp (Camus 2002). Comparative genomics In recent times, new technologies have been developed at an overwhelming pace, in particular those related to sequencing and tools for genome sequence data man- agement, storage and analysis. As of April 2007, 484 microbial genomes have been finished and projects are underway aimed at the sequencing of other 1,155 micro- organisms (http://www. Mycobacteria are not an exception in this titanic genome-sequencing race; since 1998, when the first myco- bacterial genome sequence was published (Cole 1998a); many genome projects have been initiated. Until April 2007, 34 projects on the genome sequencing of different mycobacterial species are finished or in-process. For this reason, these are the strains that have been used as reference strains for comparative genomics both in vitro and in silico. The next step in comparative genomics was the use of genomic subtractive hybridi- zation or bacteria artificial chromosome hybridization for the identification of re- gions of difference among the strains under analysis (Mahairas 1996, Gordon 1999). As a result, they identified 10 regions of difference, including the three previously described (Mahairas 1996). Until 2002, most studies concerning comparative genomics were based on differ- ences among the strain type M. Some excellent reviews are available on comparative genomics, made before the publication of the second M. This strain was considered to be highly transmissible and virulent for human beings (Fleischmann 2002). With the sequence of this second strain, a first approach to the bioinformatic analysis of intraspecies variability became possible. Dark gray filled cells indicate the presence in all strains tested, light gray indicate the presence in some strains, white is absence from all strains tested.

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The module can be used in the basic training of health center teams in the training institutions and training of health center teams who are already working in the community order line lasix pulse pressure of 20, health workers and care givers buy cheap lasix 40mg hypertension 20 year old male. All of the following are primary skin lesions except a) papule b) Vesicle c) macule d) pustule e) ulcer 3. Bullous impetigo is most commonly seen in: a) Adults b) Adolescents c) Neonates and Infants d) Pre school children e) Elderly 4. An acute, deep-seated, red, hot, tender nodule or abscess that evolves from a staphylococcal folliculitis is a) Ichthyma b) Cellulitis c) Furuncle d) Erysipelas e) Necrotizing fascitis 3 5. The factors associated with increased colonization rate of Candida include/s a) Usage of broad spectrum antibiotics for long periods b) Diabetes mellitus c) Depressed cell mediated immunity d) Pregnancy e) All of the above 6. In some areas discoid lupus erythematosus is common and lichen planus is seen far more frequently than in temperate countries. Then there are the more chronic infections: Leprosy, Leishmaniasis, scabies and onchocericiasis– which affect the skin so distinctively; the whole range of ulcers of the skin; and the serious effects on the skin of protein malnutrition. Skin diseases affect all segments of the population with out ethnic variability but are more prevalent among children and in low socioeconomic groups, essentially due to poor hygienic practices. Different studies also suggest that skin infections are more prevalent in extreme climatic conditions. Another study carried out in 1996 to determine the prevalence of skin diseases among school children in rural Ethiopia, showed that 80. It is formed by an ordered arrangement of cells called keratinocytes, the basic function of which is to synthesize keratin, a filamentous protein that serves a protective function. The dermis is the middle layer, composed of collagen, tough and resilient part of the skin lies on the subcutaneous tissue which is principally composed of lobules of fat cells. Although there is a considerable regional variation in their relative thickness: the epidermis is thickest on the palms and soles and very thin on the eyelids. Cells of the epidermis Keratinocyte - produces keratin which forms the outer most skin layer covered by thin lipids to give the skin protective capacity from water and heat loss, penetration of microbial agents, and other trauma by physical mechanisms. The number of melanocytes in the epidermis is the same, regardless of the person’s race or skin color; it is the number , shape and size of melanosomes (melanin containing granules) and the type of melanin that determine difference in skin color. They are found in the epidermis but they constantly move as a result, they transport antigens to the regional lymph nodes and present them to naïve T lymphocytes in the regional lymph nodes and consequently the naive T lymphocytes become recruited to the specific antigen and the resultant immunologic response occurs. In this way, the skin is very crucial part of the immune system because of the large surface area that it spans. Protection: it protects the body from many environmentally unfavorable factors; such as, thermal, chemical, ultra violet radiation and different disease-causing microorganisms. Immunologic: the skin is an end organ for many immunologically mediated disorders as well as a tool for immunologic research. The skin can be viewed as a peripheral arm of the immune system involved in normal homeostasis and host defense. Synthetic function: the skin synthesizes vitamin D, different hormones, melanin, and other substances. While describing skin lesions, the following features should be identified: Sites involved and distribution: - if lesions are affecting both sides of the body symmetrically, it probably could have an endogenous origin (e. Primary lesions Macule: flat lesion due to a localized color change only; the surface is normal (size <1cm) Patch: similar to a macule but the size (> 1cm) Nodule: any elevated lesion (> 1cm diameter) which has a round surface (i. Fissure: linear split in the epidermis or dermis at an orifice (angle of the mouth or anus), over a joint or along a skin crease. Surface features Normal/ smooth: the surface is not different from the surrounding skin and feels smooth Scaly: dry/flaky surface due to abnormal stratum corneum with accumulation of or increased shedding of keratinocytes. Friable: surface bleeds easily after minor trauma Crust: dried serum, pus or blood Excoriation: localized damage to the skin due to scratching. Lichenification: thickening of the epidermis with increased skin markings due to persistent scratching. Umblicated; surface contains a round depression in the centre, characteristics of molluscum contagiosum or herpes simplex. Purpose of the Module The ultimate purpose of this training module is to produce competent Health Officers who can correctly identify and effectively manage common dermatologic problems both in clinical and community settings. Direction for Using the Satellite Module This satellite module can be used in the basic training of Health Center team particularly health officers who are in the training and service programs. In order to make maximum use of the satellite module, the health officer should follow the following directions. Use listed references and suggested reading materials to supplement your understanding of the problem. For total and comprehensive understanding of the causes (etiology/pathogenesis) and prevention of common skin diseases, the Health Officer Students are advised to refer to the core module. Discuss the functions of skin in terms of a) Protection b) Thermoregulation c) Immunologic function d) Synthesis e) Others 2. A two year old child presented with itchy, faintly papular eczematous lesions on both cheeks, forehead and neck. Skin colored papules and nodules with shining surfaces and umblicated top were noted on a four year old child. A six year old child presented with high fever, pain, and diffusely swollen left leg of two day duration. On examination of the limb; erythematous, grossly swollen, hot, and tenderness elicited with left side inguinal lymphadenopathy which was also tender. Bacterial infection of the skin (pyodermas) Bacterial skin infection is one of the commonly encountered problems in the tropics. When the normal protective functions of the skin are altered by trauma (scratching and excoriation ), pre existing and/or coexisting skin diseases like, eczema, scabies or venous or lymphatic insufficiency, pathogenic organisms get access to the skin to establish infection. Two main clinical forms are recognized: non-bullous impetigo (or impetigo contagiosa) and bullous impetigo. Impetigo presents as either a primary pyodermal of intact skin or a secondary infection due to preexisting skin disease or traumatized skin. Impetigo rarely progresses to systemic infection, although post streptococcal glomerulonephritis may occur as a rare systemic complication. Bullous impetigo is most common in neonates and infants Causative agents It is caused by Staphylococcus aureus. The non-bullous form is usually caused by group Aβ streptococcus, in some geographical areas Staphylococcus aureus or by both organisms together. Clinical features Non-bullous impetigo: The characteristic lesion is a fragile vesicle or pustule that readily ruptures and becomes a honey-yellow, adherent, crusted papule or plaque and with minimal or no surrounding redness and usually occurs on hands and face. Bullous impetigo: The characteristic lesion is a vesicle that develops into a superficial flaccid bulla on intact skin, with minimal or no surrounding redness. The roof of the bulla ruptures, often leaving a peripheral collarette of scale if removed; it reveals a moist red base.