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Saturday 31 October 2020
DM DE
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DR
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Democratic Party was founded around 1828 by supporters of Andrew Jackson, making it the world's oldest active political party
The GOP was founded in 1854 by opponents of the Kansas–Nebraska Act, which allowed for the potential expansion of slavery into the western territories.
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RHINO
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P KZN AHEI REC X TRAPS
Autoinflammatory disease mimicking acute hemorrhagic edema of infancy
Abstract
The autoinflammatory diseases are a heterogeneous group of disorders characterized by early appearance of symptoms and characteristic flares of fever plus signs of internal inflammation, including various skin manifestations. We describe a 2.5‐year‐old boy who presented with fever, purpuric skin lesions, and edema, the classic clinical triad of acute hemorrhagic edema of infancy (AHEI). Although AHEI was our initial leading diagnosis, additional history revealed that these episodes were recurrent, and further investigation lead to a diagnosis of tumor necrosis factor receptor–associated periodic syndrome (TRAPS). This case report affirms the broad clinical spectrum of the autoinflammatory diseases and reinforces the importance of obtaining a thorough history of previous episodes of skin and extracutaneous inflammation in patients with a clinical diagnosis of AHEI.
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P KZN RR OVER 30 SECS
STORM OF OUR CIRCUMSTANCES
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Accuracy of shorter respiratory rate measurement times in the pediatric population
First published: 18 October 2020
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ped.14513
Abstract
Background
As one of the vital signs, the respiratory rate is an important index of general health in an initial examination. The duration of respiratory rate measurements is known to influence the results obtained in adults. We examined herein the difference in respiratory rate measurements between two measurement durations in a pediatric population.
Methods
The present, prospective, cross‐sectional study conducted from November 2017 through March 2018 at Tokyo Metropolitan Children’s Medical Center analyzed the differences in the respiratory rate in a 1‐minute group and 30‐second group using the Bland Altman plot.
Results
Ninety‐five patients were enrolled. The median age was 0.99 years, and 50 patients were male. The correlation between the results of the 30‐second and 1‐minute measurement durations was good (r2=0.970, p<0.001; Spearman’s rank correlation). The mean difference between the 30‐second and 1‐minute measurement results was 0.86 (95% confidence interval: 0.27‐1.45)
Conclusion
The shorter measurement duration may result in overestimation of the respiratory rate, especially in young children or children with tachypnea. Nonetheless, the shorter measurement times correlated well with the 1‐minute measurement, and the difference was less than one per minute compared with the 1‐minute measurement. Thus, this method may be able to detect life‐threatening conditions earlier than longer measurement times.
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ADHD MEDS
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TRKY EQUAKE
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—Lama Tsony, “Facing Fear”
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IQBL
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RADNER-
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PSYD Being a non-conformist is a sign of high IQ, research finds.
It means that people with higher intelligence are less likely to follow others.
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Most of the time, we think we are our thoughts. We forget, or have never noticed, that there's an aspect of our mind that's watching these thoughts arise and pass away... Sometimes I ask my student to imagine each thought as a visitor knocking at the door of their house. The thoughts don't live there; you greet them, acknowledge them, and watch them go.~ Sharon Salzberg ################# “All modern music owes everything to Bach.” Nikolai Rimsky-Korsakov #############  |
TOMLIN I personally think we developed language because of our deep need to complain."X WACOD BBTBR NOT BXM WHY SUFFR -JUST WORK WIN
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WACOD
Never underestimate the importance of removing stuff you don’t need.
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I personally think we developed language because of our deep need to complain."
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BOUDELAIRE I personally think we developed language because of our deep need to complain."
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BG 18.55: Only by loving devotion to me does one come to know who I am in truth. Then, having come to know me, my devotee enters into full consciousness of me.
HRHRRRHH- HKHKKKHH
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Thursday 29 October 2020
CULGRIA
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COVID RED
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TEN BASIC SMELLS
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FAR FUTURE TIMELINE X WE ARE STAR SPIT
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PhD STUDENTS WITH SUPR EYE-BRAIN COMBN
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SHAPE UP OR WILL BE PASSED UP
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Christie Tate: “For Me, Breaking a Bad Habit Requires the Help of Other People Who Act as Loving Witnesses.”
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TRICK OR TRACTATE IE WRITE A TREATISE
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LIVERPOOL TIER3 EFFECTIVITY -COVIDITY -VK NATNL LCKDWN
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BBTBR APPROX 14+22=36 BN YRS
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LACTOSE INTOLERANT MILKY WAY GALAXY
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Wednesday 28 October 2020
MIFU X WORLD STROKE DAY DNBAM X DONT BELV A M
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PSYDMost people reported that they found better ways to cope with their pain after the programme.
Mindfulness-based stress reduction benefits 89% of patients with chronic pain and depression, new research finds.
Participants in the study did mindful hatha yoga and took a course in mindfulness meditation for eight weeks.
Both approaches encourage non-judgmental awareness of the present moment.
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WACOD
DWM-Having sufficient vitamin D levels is linked to a lower risk of COVID-19 infection, new research finds.
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"Everything is light, everything is warmth,
everything is electricity, everything is a
magnetic field, everything is you."
~ L.H.
EKB SCA BBTBR GON
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GOLDEN CALF X MOSES X OT X GOMATA
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KEAS OF NZ - PARROT LIKE BIRDS-MOUNTAIN PARROTS
V KAKAS- FOREST PARROTS OF NZ
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GON X P KZN STRIA DISTENSAE X CARRY ON SUNRISE WALK ON DAYS OFF AMAP
SG- 60 MN BUFFALOES IN 8 YRS -325 BISONS IN VS
ANMLS SUFFER - SLF HOPE THEY CURSE
CAN U IMAGINE THE SLAUGHTER
FROM 1970- 68% VERTEBRATE ANIMALS KILLED FOR HUMAN HAPPINESS
OBLITERATING EVERY OTHER ANIMAL
HUMANS ARE THE COVID OF THE NATURE
BIRD ANT TREE DONT WANT TO SERVE MAN - WE ARE A BULLY TO THEM
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P KZN STRIA DISTENSAE
Bruise-like marks on a healthy teenage male’s back
October 9, 2020
A 15-year-old male first noticed the marks on his back during a recent vertical growth spurt. On exam there are multiple horizontal violaceous linear striae on his back. He is otherwise healthy and denies any history of back injury or exposure to topical or systemic steroids. What's the diagnosis?
The case
You are asked to evaluate a healthy 15-year-old boy with transverse bruise-like marks on his back (Figure 1).
Figure 1
A 15-year-old male first noticed the marks on his back during a recent vertical growth spurt. On exam there are multiple horizontal violaceous linear striae on his back. He is otherwise healthy and denies any history of back injury or exposure to topical or systemic steroids.
Differential diagnosis for bruises on lower back
The differential diagnosis includes striae distensae in addition to bruising from skin injury. There are various triggers for striae distensae including both topical and oral steroid usage, obesity, excessive marijuana use, and rapid weight gain or loss.1 Another less common cause of striae in adolescents is Cushing syndrome, which is often associated with metabolic weight gain, high blood pressure, and Cushingoid facies.2
Diagnosis: Transverse striae distensae (also known as stretch marks)
Differential diagnosis
Discussion
Striae distensae during adolescence are a common physiological change associated with rapid pubertal growth spurts. These pink-silver thin streaks are seen in up to 35% of girls and 15% of boys between 9–16 years of age.6 In females, the marks commonly occur on the breasts, thighs, shoulders, and buttocks.7 In males, the marks tend to be on the back, thighs, and calves.7 Recent studies on patient demographics have found that striae distensae in adolescents are often associated with tall stature, childhood obesity, and a family history of striae distensae.7,8 These striae initially appear as violaceous, flat plaques called striae rubra that progress over the course of months into permanent pink and hypopigmented scar-like depressions called striae alba.7
Although the exact pathogenesis remains unknown, striae distensae of adolescence result from dermal breaks in connective tissue following physical stress and skin stretching.9 Pubertal growth spurts are a common time for physiologic skin stretching in teenage boys. It is also thought that reduced levels of the genes encoding collagen and fibronectin result in a thinning of the connective tissue and atrophic appearing striae.2 Histological analysis of striae reveals collagen fibers stacked horizontally in straight bundles whereas in normal skin, collagen is arranged randomly into wavy and thick collagen fibers.9
Management
In general, treatment of striae distensae is not necessary in otherwise healthy adolescent males. Lesions often stop progressing at the end of pubertal growth spurts in healthy teenagers who have normal body surface area. Lesions also tend to pale in color and shrink once the growth spurt is complete. Thus, management typically begins with reassurance and patient education of the benign nature of the course. In patients with risk factors for striae distensae, such as obesity with high body mass index (BMI), a healthy diet and exercise regimen is a good place to start for further management.
Although not a necessity in adolescent males with striae likely to improve after puberty, patients interested in improving the cosmetic appearance of striae can opt for initial therapy with 0.1% topical retinoic acid. Laser therapy, more specifically pulse-dye laser, has also been shown to work as initial therapy for inflammatory marks in the striae rubra stage.9 Other interventions including phototherapy, chemical peels, cocoa butter, and vitamin supplements are of limited evidence in the current literature.
Of note, striae located on the lower back are commonly mistaken for bruises from child abuse, as mentioned in the differential diagnosis. Patients are often referred to social services due to this misdiagnosis. This highlights the importance of raising awareness among providers regarding the appearance of these benign striae.
Patient Outcome
This patient was diagnosed with striae distensae based on clinical and physical exam findings. No further lab workup was necessary. We suggested observation of the patient’s back and regular sunscreen use. The patient felt that no further treatment was needed at this time.
References
1. Salter SA, Kimball AB. Striae gravidarum. Clin Dermatol. 2006; 24(2), 97-100. doi:10.1016./j.clindermatol.2005.10.008
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SG- IF 2 CONSECUTIVE MONSOONS FAIL IN JINDE, MNS WILL DTH, CIVIL WAR ETC
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THIS PANDEMIC IS A SOFT CALAMITY, WW2 FAMINES ASTEROID HIT -THEY WERE HARD CALAMITY
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ECO-MINIMALISM -Minimalism provides greater financial flexibility to those who choose it. When we remove ourselves from the constant pursuit and accumulation of material possessions, greater financial flexibility is one of the benefits experienced quickly and recognized easily.
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ONE CHILD POLICY , SMALL HOUSE, WALKBILITY TO TOWN CENTREOF ECO-MINIMALISM- IE SELF
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"I was entirely happy. Perhaps we feel like that when we die and become a part of something entire, whether it is sun and air, or goodness and knowledge. At any rate, that is happiness; to be dissolved into something complete and great."
-- Willa Cather, My Antonia
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