hiv aids approach to the patient with diarrhea and or wasting

... erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient ... (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than would hemorrhagic papules, ... irregularity, color variegation (black, blue, brown, pink, and white), a diameter >6 mm, and a history of change (e.g., an increase in size or development of associated symptoms such as pruritus or pain)...

Ngày tải lên: 06/07/2014, 20:20

... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing ... Violaceous to purple, polygonal lesions that resemble those seen in lichen planus Milia: Small, firm, white papules filled with keratin Morbilliform: Generalized, small erythematous macules and/ or papules ... epidermis without an associated loss of dermis Ulcer: Loss of epidermis and at least a portion of the underlying dermis Excoriation: Linear, angular erosions that may be covered by crust and are...

Ngày tải lên: 06/07/2014, 20:20

... hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to the sun-exposed portions of the face Once the distribution ... to assess the patient before taking an extensive history This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated with relevant historic data Four ... distribution is psoriasis or dermatitis herpetiformis (Figs 52-7 and 52-8, respectively) The primary lesion in psoriasis is a scaly papule that soon forms erythematous plaques covered with a white...

Ngày tải lên: 06/07/2014, 20:20

... The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with...

Ngày tải lên: 06/07/2014, 20:20

... multiple erythematous plaques with a target or iris morphology It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's ... contact (Fig 52-10) or primary irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption ... (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... Ongoing or previous illnesses History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) ... areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed ... the latter technique, a punch is pressed against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted with...

Ngày tải lên: 06/07/2014, 20:20

... allergens is applied to the patient' s back under occlusive dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of delayed ... characteristic coral pink color, and wounds colonized by Pseudomonas to appear pale blue Tinea capitis caused by certain dermatophytes such as Microsporum canis or M audouini exhibits a yellow fluorescence ... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled Urticaria (Fig 52-11) will blanch with...

Ngày tải lên: 06/07/2014, 20:20

... an exception to the coordinated interaction among cells and organs In general, the cells of a multicellular organism are programmed for collaboration Many diseases occur because the specialized ... traitorous behavior of cancer cells is that the patient feels betrayed by his or her body The cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem ... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease...

Ngày tải lên: 07/07/2014, 01:20

... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past ... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease or a...

Ngày tải lên: 07/07/2014, 01:20

... solid tumors For these tumors, other prognostic factors have been identified (Chaps 104, 105, and 106) In addition to tumor burden, a second major determinant of treatment outcome is the physiologic ... used, such as the patient' s age or Karnofsky performance status (Table 77-4) Older patients and those with a Karnofsky performance status

Ngày tải lên: 07/07/2014, 01:20

... may precede or follow other treatment approaches It is best for the treatment plan either to follow a standard protocol precisely or else to be part of an ongoing clinical research protocol evaluating ... physician also has much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and the pressure of a ... possible to gain access electronically to standard treatment protocols and to every approved clinical research study in North America through a personal computer interface with the Internet.2 The...

Ngày tải lên: 07/07/2014, 01:20

... Table 77-5 Tumor Markers Tumor Markers Cancer NonNeoplastic Conditions Hormones Human chorionic gonadotropin Gestational trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary ... Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate...

Ngày tải lên: 07/07/2014, 01:20

... most patients who are cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms ... the history and physical examination are the major investigations performed As time passes, the likelihood of recurrence of the primary cancer diminishes For many types of cancer, survival for ... practice has been to follow the patient monthly for 6–12 months, then every other month for a year, every months for a year, every months for a year, every months for a year, and then annually At each...

Ngày tải lên: 07/07/2014, 01:20

... temporal features, provocative and palliative factors, and intensity (Chap 12); a review of the oncologic history and past medical history as well as personal and social history; and a thorough ... the best understood form Stimuli that activate signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the ... vomiting center in the medulla, the motor center responsible for coordinating the secretory and muscle contraction activity that leads to emesis Diverse receptor types participate in the process, including...

Ngày tải lên: 07/07/2014, 01:20

... bombesin, adrenocorticotropic hormone) and host-derived factors (e.g., tumor necrosis factor, interleukins and 6, growth hormone) contribute to the altered metabolism, and a vicious cycle is established ... contribute to the sense of vulnerability Juggling the demands of work and family with the demands of treatment may create enormous stresses Sexual dysfunction is highly prevalent and needs to be discussed ... losses and handicaps, real and perceived Patients may be preoccupied with minor physical problems They perceive a decline in their job mobility and view themselves as less desirable workers They...

Ngày tải lên: 07/07/2014, 01:20

... difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything that can be done to provide comfort ... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions ... hope Of course, patients not all progress through all the stages or proceed through them in the same order or at the same rate Nevertheless, developing an understanding of how the patient has been...

Ngày tải lên: 07/07/2014, 01:20

... in their published work and were not able to overcome the emerging division of labor between religious and theological studies, on the one hand, and the anthropology of religion, on the other ... wrestled with the question of whether religion is unique among human behaviors or can be accounted for using the research methods and/ or explanatory principles that are applied to human behavior more ... understand more about religious or mystical things To understand how and why people deem things religious and allow researchers to explore the making and unmaking of religion How they relate to other...

Ngày tải lên: 11/06/2014, 12:43

... Peter C Sandvik and the team at MARINTEK who guided me for the work on hydrodynamics completed while I was in Norway Many thanks also to all the staff in the Structures Laboratory for their assistance ... velocity and acceleration of the oscillator caused by the excitation force F The least squares method can be used to solve for the mass m, stiffness k and damping c of the oscillator by minimising the ... measurements For the first scenario there is no choice but to identify the structural properties of the structure and compare these to some theoretical values in order to identify the magnitude and location...

Ngày tải lên: 14/09/2015, 22:16

... among women  living with HIV Prevention of  transmission of  HIV from  mothers living  with HIV to their  infants Treatment, care  and support for  mothers living  with HIV and their children  and families ... age worldwide and is a major contributor to maternal, infant and child morbidity and mortality (WHO 2009; UNAIDS 2009) Without treatment, one third of children living with HIV die before they ... Leadership and Governance; and 7) Collaboration and Coordination, in order to demonstrate the multisectoral approach needed to develop successful PMTCT programs, and to highlight the ways in...

Ngày tải lên: 16/03/2014, 05:20

... Approach to the Patient: Acute Febrile Illness A physician must have a consistent approach to acutely ill patients Even before the history is elicited and a physical examination performed, ... examination, and the neurologic evaluation are of particular importance The patient may appear either anxious and agitated or lethargic and apathetic Fever is usually present, although elderly patients and ... and about changes in severity or rate of progression over time Host factors and comorbid conditions may enhance the risk of infection with certain organisms or of a more fulminant course than is...

Ngày tải lên: 07/07/2014, 04:20