Triggered Skin Sensitivity: Understanding Contact Dermatitis.

Dermatitis, the incendiary reaction of the skin to various components, can manifest in various types, including atopic dermatitis, contact dermatitis, nummular eczema, seborrhoea, and stasis dermatitis. Atopic dermatitis is the most common skin disease in children and has a growing prevalence in recent years. It is characterized by extreme tingling, eczemous skin injuries, dryness of the skin, and a family history of atopic illnesses. Contact dermatitis (CD) is a common, irritating skin disorder caused by allergens and aggravating elements in the environment. It is the most common cause of work-related dermatitis and plays a substantial role in hand and face dermatitis. A complete restorative history is essential for establishing CD and identifying the allergies that cause it. Fix testing, skin tests for fast contact reactions, serum allergen-specific IgE testing, subjective and quantitative evaluation of allergens inside probable items patients were exposed to, and challenge testing are among the other diagnostic techniques. To avoid a breakdown and the continuation of the skin illness, early and suitable therapy is critical. Allergic dermatitis to contact (ACD) develops during the normal, delayed incendiary reaction and has a perplexing etiology. Accurate identification of the allergen that is causing the reaction allows for adequate individual avoidance. The major treatment alternatives continue to be corticosteroids. Nickel-contact dermatitis is an allergic reaction that affects both children and adults. Adverse contact dermatitis (ACD) is a frequent skin reaction to a common allergen that can affect both children and adults. Less than 10% of all diagnostic procedures in pediatric patients involve checking for ACD symptoms. To answer the clinical question, a thorough history is gathered based on appearance, age group, and dermatitis type. According to pediatricians in the US, metals, perfumes, topical antimicrobials, excessive chemicals, and fabric softeners are the most typical allergens.

Dexmedetomidine as an Adjunct in a Fluoroscopically Guided Stellate Ganglion Block for Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by pain that is disproportionate to the inciting event. Autonomic and inflammatory responses predominate, and treatment plans that explicitly target these responses reduce symptoms for longer periods of time, are typically better tolerated, and have more favorable outcomes. Our patient was a young male who presented with a four-month history of a road traffic accident (RTA) that resulted in a fractured left distal radius and scaphoid. His main complaint was pain and discomfort, even after surgical forearm stabilization, as well as hyperesthesia, restricted range of motion, and new-onset tremors. The patient was provisionally diagnosed with complex regional pain syndrome (CRPS) and booked for a fluoroscopically guided stellate ganglion block when the oral medication regime provided minimal relief. A stellate ganglion block was administered using a combination of ropivacaine, methylprednisolone, and dexmedetomidine under fluoroscopic guidance. During our routine outpatient follow-ups, our patient's pain score on the visual analog scale (VAS) fell to zero, the burning, vasomotor, and temperature abnormalities subsided, and he gradually regained the use of his left forearm and hand. The etiology of complex regional pain syndrome is multifaceted. Early identification and therapy typically halt the progression. Long-term outcomes are improved by treatment strategies that target inflammatory and autonomic responses. Dexmedetomidine has a mild anti-nociceptive action when used as an adjuvant in peripheral nerve blocks and ganglion blocks, blocking pain transmission in Aδ and C fibers. We feel that by combining dexmedetomidine and a stellate ganglion block, we could provide immediate and long-term relief to our patient. More research is needed to monitor and analyze the efficacy of dexmedetomidine as a treatment for chronic pain syndromes such as CRPS.

Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report.

Cardiovascular diseases during pregnancy are rare but account for complications that pose risks to the mother as well as the child. In patients with fixed cardiac output due to stenotic valvular lesion(s), the physiological changes during pregnancy carry high risk of morbidity and mortality. Case Presentation: Our patient was diagnosed with severe mitral and aortic stenosis at her first antenatal visit at 24 weeks of gestation. She was also diagnosed with intrauterine growth restriction and was therefore planned to be operated on at a gestational age of 34 weeks. After careful selection of monitoring and anesthetic regime, the patient was managed without any intraoperative or postoperative complications. Clinical Discussion: This case reports how the anesthetists, obstetricians, and cardiac surgeons devised a well-designed plan to operate on a patient with a relatively rare disease manifestation. Our patient had coexisting severe stenotic lesions of both mitral and aortic valves and posed a clinical dilemma regarding the choice of anesthesia and perioperative management. Regardless of the anesthetic technique, goals for a patient with the combined valvular disease include maintenance of adequate preload, systemic vascular resistance, cardiac contractility, sinus rhythm and avoidance of tachycardia, bradycardia, aortocaval compression, and anesthetic or surgery-induced hemodynamic changes. Conclusion: The course of management would give clinicians an idea of how to manage a patient with combined stenotic valvular lesions for cesarean section, ensuring a smooth course and a safe postoperative period.

Successful Resuscitation and Management of Cardiac Arrest in Pregnancy Due to Undiagnosed Severe Mitral Stenosis: A Case Report.

Maternal collapse is a rare, potentially fatal event with associated feto-maternal morbidity and mortality. We report a case of severe mitral stenosis without any prior symptoms, that presented as acute cardiac decompensation leading to maternal collapse and cardiac arrest. A 35-year-old female in her 28th week of gestation presented to the emergency room with a four-hour history of per-vaginal discharge and leaking of amniotic fluid. Her past history, physical examination, and laboratory workup were unremarkable. An initial diagnosis of pre-term premature rupture of membranes (PPROM) was made and she was managed conservatively. Within four hours of the presentation, she developed shortness of breath, which gradually worsened, and the anesthesia team was requested to assess the patient. Upon arrival, the patient was in severe respiratory distress. She collapsed soon after and started frothing copiously from the mouth. Pulse was absent and cardio-pulmonary resuscitation (CPR) commenced. Endotracheal intubation was performed and the obstetric team was asked to prepare for a perimortem cesarean section, which was completed four minutes after the commencement of CPR and the baby was delivered alive and well with an APGAR score of 7 and 8 at one minute and five minutes of birth, respectively, and birth weight of 1.1 kg. CPR continued for 16 minutes after which a return of spontaneous circulation was achieved. Due to the unavailability of an ICU bed, the patient was shifted to OR where she stayed for the next five hours for further resuscitation. After a two-month-long ICU course, the patient was discharged in stable condition; her baby was discharged after a month of hospital stay. The expertise of anesthesiologists as resuscitators and peri-operative physicians helped in successful resuscitation, saving not just one but two lives in the process.

Strength through defects: A novel Bayesian approach for the optimization of architected materials.

We use a previously unexplored Bayesian optimization framework, "evolutionary Monte Carlo sampling," to systematically design the arrangement of defects in an architected microlattice to maximize its strain energy density before undergoing catastrophic failure. Our algorithm searches a design space with billions of 4 × 4 × 5 3D lattices, yet it finds the global optimum with only 250 cost function evaluations. Our optimum has a normalized strain energy density 12,464 times greater than its commonly studied defect-free counterpart. Traditional optimization is inefficient for this microlattice because (i) the design space has discrete, qualitative parameter states as input variables, (ii) the cost function is computationally expensive, and (iii) the design space is large. Our proposed framework is useful for architected materials and for many optimization problems in science and elucidates how defects can enhance the mechanical performance of architected materials.

Telogen Effluvium: A Review of the Literature.

Telogen effluvium is one of the most common causes of alopecia. It is a scalp disorder characterized by excessive shedding of hair. Several factors such as drugs, trauma, and emotional and physiological stress can lead to the development of telogen effluvium. Multiple alterations in the hair cycle have been proposed as the underlying mechanism. Telogen effluvium can present as acute or chronic hair fall with symptoms such as trichodynia. Diagnostic tests that can be used include hair wash test, trichogram, phototrichogram, and scalp biopsy. In the treatment of telogen effluvium, it is essential to identify and remove the causative factors and to use drugs such as corticosteroids, minoxidil, and novel treatments such as CNPDA (caffeine, niacinamide, panthenol, dimethicone, and an acrylate polymer). Herein, we discuss the presentation, diagnostic approaches, and effective treatment options available for telogen effluvium.

Potential Barriers amongst Health Care Professionals of Pakistan in managing COVID-19 patients.

OBJECTIVES: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients. METHODS: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media. RESULTS: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the knowledge about basic infection control measure like donning/doffing and understanding about high-risk procedures. On job training, professional and administrative support is compromising. Many of HCPs are anxious nowadays, having symptoms related to burn out with logical reasons behind. Even with all those hurdles they are committed and ready to volunteer themselves. CONCLUSION: The HCPs of Pakistan needs urgent attention for providing them Formal training regarding infection control measure. Administrative and professional support is required from institutions and scientific societies. Online teaching modules and webinar is a suitable option. The symptoms of burn out are significant and would increase with passage of time. This needs to be supported by occupational health committees.

The Clinicopathological Profile of Eosinophilic Myocarditis.

Eosinophilic myocarditis (EM) is a rare form of myocarditis. As there is extreme diversity in its manifestations, the true incidence is difficult to assess and no proper epidemiological criteria are present. It generally presents with a wide array of clinical manifestations. Clinical presentation tends to differ in cases and not all the patients show the same signs and symptoms. The etiology of EM often remains obscure but potential causes have been identified which may include hypersensitivity to drugs, exposure to certain viruses and parasites, and hyper-eosinophilic syndromes. Endomyocardial biopsy is considered to be a gold standard for the diagnosis of EM. Echocardiography, cardiac magnetic resonance, and bio markers particularly serum eosinophilic cationic protein concentrations are also known to aid in diagnosis. EM may lead to progressive, irreversible, and fatal myocardial damage if prompt diagnosis is not made and therapy is not initiated. The current treatment regimens include corticosteroids, cytotoxic agents, and immunosuppressive therapy. However, a proper treatment criterion is yet to be established.