Monday, September 22, 2014

Tinea Cruris: Causes, Signs and Symptoms, Diagnosis, Treatment and Prevention



Tinea Cruris
Tinea cruris or jock itch or ring worm of groin is an itchy superficial fungal infection of the skin of groin and adjacent parts of the body. It is an opportunistic fungal infection (dermatophyte fungal infection), affecting both male and female. Opportunistic fungal infection refers to the illness caused by fungus when the immune system of the patient is depressed. Jock itch is more often seen in males. It is also called tinea inguinalis, where inguin means ‘groin’.

Signs and Symptoms

Signs and symptoms of tinea cruris include erythematous itchy rash (pruritus) or burning sensation in the groin and adjacent areas of the body like thighs and perineum. The lesions of tinea cruris are seen as large erythematous patches of skin with peeling (scales) and cracking.

Causes

Tinea cruris is an opportunistic fungal infection, most often with trichophyton rubrum followed by trichophyton tonsurans and trichophyton mentagrophytes.

Risk factors

Tinea crusis may spread from fungal infection of other body parts like foot (athlete’s foot). Other risk factors include tight clothing as it offers ideal environment (heat and moist) for the growth of fungus. It may also come from the other affected persons during swimming and cloth handling and sharing.

Diagnosis

Most often, tinea cruris is diagnosed clinically as it presents with pruritic erythematous patches (maybe with raised border) on the groin region. Microscopic examination of wet scales from the affected area is diagnostic.  

Differential diagnosis

Differential diagnosis (DD) of tinea cruris includes cutaneous candidiasis, contact dermatitis, acanthosis nigricans, psoriasis and seborrheic dermatitis.

Treatment

Treatment of tinea cruris comprises of topical anti-fungal agents, applied to the affected skin areas. Azole (e.g. ketoconazole, miconazole, etc.) and allylamine (e.g. terbinafine, butenafine, etc.) drug families of antifungal agents are effective and usually used to treat tinea cruris.

  • Terbinafine topical cream 1% (Lamisil, Cutis, Terbiderm) is applied to the affected area of the skin once or twice daily for one to two weeks.
  • Ketoconazole topical cream 2% (Nizoral, Conaz, Spike, Tezole) twice daily for four weeks is often effective.
  • Whitfield's ointment (3% of salicylic acid and 6% of benzoic acid) is an often used antifungal preparation for the treatment of tinea cruris.
  • Topical steroid and anti-fungal combination is not recommended, currently.

Prevention

In order to prevent the spread of tinea cruris, keep your groin clean and dry, especially after taking bath, swimming or perspiration (sweating). Do not share your clothing or towel with others. Do not wear tight undergarments and use antifungal powders.

Alternative Names

Many a time, in different areas, different names are used for the same condition. Similarly, tinea cruris is also known as ringworm of groin, jock itch, crotch rot (itch), eczema marginatum, Dhobie itch, gym itch, and more.

Reference


  • El-Gohary M, van Zuuren EJ, Fedorowicz Z, Burgess H, Doney L, Stuart B, et al. Topical antifungal treatments for tinea cruris and tinea corporis. Cochrane Database Syst Rev 2014; 8:CD009992. [PubMed]

  • Thaker SJ, Mehta DS, Shah HA, Dave JN, Kikani KM. A comparative study to evaluate efficacy, safety and cost-effectiveness between Whitfield's ointment + oral fluconazole versus topical 1% butenafine in tinea infections of skin. Indian J Pharmacol. 2013 Nov-Dec; 45(6): 622-4. [PubMed]

Keywords: Tinea cruris, Groin itch, Fungus groin, Itchy groin, Jock itch, Dhobie’s itch, Sign and symptoms, Causes, Itch treatment, Tinea cruris treatment, Prevetion, Lamisil cream, Cutis cream

Saturday, September 20, 2014

Total Parenteral Nutrition (TPN): A Patient with 35 to 40 Kilograms of Body Weight



Follow the following points for total parenteral nutrition (TPN) or TPN feeding for a patient with weight of 35-40 kilograms:
  1. Pass CVP line (Use it only for parenteral feeding; don’t infuse other medicines through this line) 
  2. Injection 10% Dextrose Water (D/W) 1000ml + 2KCL + 1Multibionta (Round the clock = @ 11 drops/minute). Note: Monitor random blood sugar level thrice a day; if high- Add 10-12 units insulin R in 10% D/W; if low- Add 25% D/W ampoules in 10% D/W accordingly. Recommended dose of 10% D/W is 30-40ml/kg/day. 
  3. Injection B. Braun Aminoplasmal 10% (Round the clock = @ 6 drops/minute. Recommended dose is 10-20ml/kg/day. 
  4. Injection Lipofundin MCT/LCT 10% + 5000 units of Heparin (Round the clock = @ 6 drops/minute). Recommended dose is 10-20ml/kg/day. 
  5. Control complications! Catheter-related sepsis occurs in 50% of the patients while glucose abnormalities and liver dysfunction occur in > 90% of the patients.
  6. Monitoring: RBS thrice a day, Serum electrolytes daily, LFTs daily, Urea/Creatinine daily, Record input/output daily (monitor fluid overload or dehydration).
Keywords: Parenteral nutrition, Parenetral feeding, Central line, TPN feeding, CVP line, Dextrose water, Lipofundin, Aminoplasmal, Complications, Monitoring

Thursday, September 18, 2014

Absolute Contraindications of Breastfeeding



Source: www.commons.wikimedia.org
In the following conditions, breastfeeding is absolutely contraindicated:
1. The mother is having AIDS (Acquired Immunodeficiency Deficiency Syndrome) caused by HIV (human immunodeficiency virus) infection.

2. The mother is having HTLV (human T-cell lymphotrophic virus) type I or II.
3. The mother is suffering from herpes simplex of breast e.g. Chicken pox or Shingles.
4. The mother is using illegal drugs e.g. Heroin, Cocaine, Marijuana, Amphetamines, Phencyclidine.

5. The mother is receiving diagnostic or therapeutic radioisotopes (radiotherapy) or exposed to radioactive substances e.g. Copper 64, Indium 111, Iodine 123, 125, 131, Gallium 67, Radioactive sodium, Technetium 99m.
6. The mother is on one or more of the following drugs: chemotherapeutic agents (e.g. Cyclophosphamide, Cyclosporine, Doxorubicin, Methotrexate), radioisotopes.
7. The baby is suffering from a condition called glactosemia.
8. The mother has untreated tuberculosis.
Note: Do not stop breast-feeding if you have cesarean delivery, received vaccination, breast surgery, pierced nipples and hepatitis C. If you have active hepatitis A or hepatitis B, breast-feed your baby after the baby has received immune globulins.

References

The transfer of drugs and other chemicals into human milk. Pediatr 108(3):776-89.

Question and Answers

1. I am suffering from AIDS. Can I breastfeed my baby?
Answer: No, you cannot breastfeed your baby if you have AIDS as the virus (HIV) can transmitted from your body to your baby through milk. [Reference]
2. I am cocaine user. Can I breastfeed my baby?
Answer: No, you cannot breastfeed your baby if you use illegal drugs like Heroin, Cocaine, Marijuana, Amphetamines and Phencyclidine. [Reference]
3. I am having breast cancer and taking radiotherapy. Can I breastfeed my baby?
Answer: No, you cannot breastfeed your baby if you are under radiotherapy (isotopes) as it delays neurocognitive development. [Reference]
4. I am suffering from Graves' disease and on radioactive iodine therapy. Can I breastfeed my baby?
Answer: No, you cannot breastfeed your baby/infant as radioactive iodine therapy is an absolute contraindication for breastfeeding as it delays neurocognitive development. [Reference]
5. Hi, I am suffering from herpes simplex virus. Can I feed my baby?
Answer: No, you cannot breastfeed your baby as herpes virus will be transmitted to your baby and your baby will suffer from the same illness. [Reference]
 
 

Keywords: Breastfeeding, Contraindications, Absolute contraindication, AIDS, HIV, Chemotherapy, Radiotherapy, Glactosemia, Untreated TB

Tuesday, September 16, 2014

Date Fruit Benefits



Date fruit (Phoenix dactylifera) is one of the most popular and well-known fruit in the world. Date fruit is an edible, sweet, small and highly nutritious fruit which grows on medium-sized trees. Eating dates benefits the human body in many ways. Date fruits can be eaten alone or in combination of other herbs or in the form of date shake. Some of the date fruit benefits are:

  1. Fructose content of the date fruit treats constipation [1].
  2. Zinc [2] content contained in the fruits of date avoids allergies (e.g. Asthma).
  3. Several vitamins, minerals and phosphorus play an important role in stimulating reproductive system functioning [3].
  4. Dates are useful in the treatment of heart diseases [4] due to its iron content.
  5. Vitamin B complex and sugar content of the date fruits are useful in the prophylaxis in renal failure [5].
  6. Tannine [6] and vitamin K present in the date fruit help stop bleeding during pregnancy.
  7. It is helpful in the treatment of anemia [7], especially iron deficiency anemia in women.
  8. Dates play an important role to stop the multiplication and reproduction of cancerous cell [8] as they contain magnesium, calcium and sulfur. It is one of the important benefits of eating dates.
  9. Alkaline salts contained in the fruit of date treats acidity and heart burn [7].
  10. Some agents like carotene in date fruits helps improve dizziness.
  11. Flour of dried date fruit is helpful to treat asthma [2] and pertussis.
  12. Date fruits alleviate stress of pregnancy and childbirth [9].

References

  1. Wisten, A. and Messner, T., 2005. Fruit and fibre (Pajala porridge) in the prevention of constipation. Scandinavian journal of caring science , 19(1), 71-76.
  2. Morgan, C.L. et al. 2011. Zinc supplementation alters airway inflammation and airway hyperresponsiveness to a common allergen. Journal of inflammation (London, England) , 8(1), 36.
  3. Al-Kuran, O. et al. 2011. The effect of late pregnancy consumption of date fruit on labour and delivery. Journal of obstetrics and gynecology: the journal of the Institute of Obstetrics and Gynecology, 31(1), 29-31.
  4. Kansagara, D. et al. 2011. Treatment of anemia in patients with heart disease: a systemic review. . PubMed Health,   A Systematic Review. VA ESP Project # 05-225.
  5. Saafi-Ben Salah, EB. Et al. 2012. Antioxidant-rich date palm fruit extract inhibits oxidative stress and nephrotoxicity induced by dimethoate in rat. Journal of physiology and biochemistry. 68(1), 47-58.
  6. Livdans-Forret, A.B., Harvey, P.J. and Larkin-Their, S.M., 2007. Menorrhagia: A synopsis of management focusing on herbal and nutritional supplements, and chiropractic. The journal of the Canadian chiropractic association , 51(4), 235-246.
  7. Vyawahare, N. et al. 2009. Phoenix dactylifera: An update of its indegenous uses, phytochemistry and pharmacology. The Internet Journal of Pharmacology, [online] 7(1) Available at: http://www.ispub.com/journal/the-internet-journal-of-pharmacology/volume-7-number-1/phoenix-dactylifera-an-update-of-its-indegenous-uses-phytochemistry-and-pharmacology.html [Accessed on 17 September 2012].
  8. Al-Shahib, W. and Marshall, R.J., 2003. The fruit of the date palm: its possible use as the best food for the future? International journal of food sciences and nutrition , 54(4), 247-259.
  9. Koffour, G.A., Amoateng, P. and Andey, T.A., 2011. Immunomodulatory and erythropoietic effects of aqueous extract of the fruits of Solanum torvum Swartz (Solanaceae). Pharmacognosy research, 3(2), 130-134.

Keywords: Date fruit, Benefits of date fruit, Health benefits, Phoenix dactylifera,

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