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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

NIMS DRUGS DIRECTORY

NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Friday, October 31, 2014



Unusually large dermal and subcutaneous rheumatoid nodules in a patient with severe rheumatoid arthritis.

Where do rheumatoid nodules typically occur?
These are typically present as asymptomatic, firm, fixed, or mobile subcutaneous nodules adjacent to bony structures. The most common site is the elbow . Other common locations include the extensor aspects of the fingers, flexor sheath tendons in the palms, Achilles tendons, ischial tuberosities, and sacrum. Rheumatoid nodules occur in approximately 25% of patients with rheumatoid arthritis.

What causes rheumatoid nodules?
The pathogenesis is not understood, but the evidence suggests that rheumatoid arthritis occurs in genetically susceptible patients after an arthritogenic microbial antigen exposure. The identity of the microbial trigger has not been established, although considerable attention has been placed on the Epstein-Barr virus. Once the process is initiated, a complex autoimmune disease develops characterized by increased numbers of CD41 T cells in the joint, which also
activate B cells that produce autoantibodies (primarily IgM) to the Fc portion of autologous IgG. The antigen that provokes the autoimmune response has not been fully established, but research is focusing on type 2 collagen, human cartilage glycoprotein-39, human stress protein BiP, and several different heat shock proteins. How this autoimmune response produces rheumatoid nodules is not clear.

Thursday, October 30, 2014

The diffuse, reticulated erythema disappeared with warming of this newborn.

Cutis marmorata telangiectatica congenita 

 a rare congenital vascular disorder that usually manifests in affecting the blood vessels of the skin. The condition was first recognised and described in 1922 by Cato van Lohuizen, a Dutch pediatrician whose name was later adopted in the other common name used to describe the condition - 

Cutis marmorata telangiectatica congenita is described to occur in association with other discrete syndromes such as Sturge-Weber syndrome and Klippel-Trenaunay syndrome. 

Some have suggestedthat Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and cutis marmorata telangiectatica congenita may be included in a group of vascular diseases that are associated with other developmental defects of the mesodermal system during embryonic life.

An otherwise healthy infant with extensive CMTC affecting the right arm, trunk and leg with sharp midline cutoff.



Pathophysiology

The pathogenesis of cutis marmorata telangiectatica congenita (CMTC) remains unclear. Its cause may be multifactorial. Most cases occur sporadically, although rare cases occur in families.

Cases of cutis marmorata telangiectatica congenita are reported in association with fetal ascites and an elevated maternal beta-human chorionic gonadotropin (beta-hCG) level, although a direct relationship has not been established.

Some authors suggest that the Happle lethal gene hypothesis (ie, the lethal dominant gene survives by means of mosaicism) best explains the patchy distribution of the lesions and sporadic occurrence of the disease. Other authors suggest that a possible teratogen is the cause, and yet others consider cutis marmorata telangiectatica congenita to be an autosomal dominant genetic disorder with incomplete penetrance.



Treatment and complications

In general, there is no treatment available for CMTC, although associated abnormalities can be treated. In the case of limb asymmetry, when no functional problems are noted, treatment is not warranted, except for an elevation device for the shorter leg.


Laser therapy has not been successful in the treatment of CMTC, possibly due to the presence of many large and deep capillaries and dilated veins. Pulsed-dye laser and long-pulsed-dye laser have not yet been evaluated in CMTC, but neither argon laser therapy nor YAG laser therapy has been helpful.

When ulcers develop secondary to the congenital disease, antibiotic treatment such as oxacillin and gentamicin administered for 10 days has been prescribed. In one study, the wound grew Escherichia coli while blood cultures were negative.

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