Tingginya insiden keganasan kulit yang ditemukan pada stadium lanjut membutuhkan kemampuan lebih baik untuk mengenali tanda dan gejala awal. Pengenalan dini gejala klinis kanker kulit berpigmen, terutama melanoma maligna, dapat dengan pemeriksaan lesi menggunakan kriteria ABCDE. Kriteria ini sederhana dan mudah digunakan, baik oleh tenaga medis maupun masyarakat awam. Makin banyak kriteria ABCDE yang terpenuhi, makin tinggi kemungkinan suatu lesi adalah kanker kulit. High incidence of skin malignancy found in advanced stages calls for a better clinical judgment to detect early signs and symptoms. Screening for early clinical findings of pigmented skin cancer, especially malignant melanoma, can use ABCDE criteria. The criteria are simple and easy to apply, either by medical professionals or general public. The more ABCDE criteria were met, the higher chance that a lesion is a skin cancer.
Mucoid degeneration of the ACL is largely an underdiagnosed condition. These are often misjudged as partial tears of ACL on routine MRI evaluation. Here we histologically analyse the incidence of mucoid degeneration of the cruciate ligaments in 32 patients who underwent primary total knee arthroplasty in our institute. 10 among them had bilateral total knee replacements making the total sample size 42 knees. ACL samples were sent for histopathological evaluation from 41 knees (one knee was an ACL deficient knee), and PCL samples were sent from patients who underwent total knee replacements with posterior stabilising implants. out of these 41 samples of ACL, 60.9 % turned out to be positive for mucoid degeneration. 9 out of 13 PCL samples (69.5%) turned out to be having mucoid degeneration. This study shows that the real incidence of mucoid degeneration of cruciate ligaments is much more than what is reported in literature. This emphasises the role of preoperative MRI to look for coexisting painful mucoid degeneration even in elderly patients with early osteoarthritis, which is an arthroscopically treatable condition thus delaying the total knee replacements in these patients. The higher incidence of mucoid degeneration in cruciate ligaments associated with advanced arthritis raises the question of functional integrity of PCL in these patients, making the use of posterior stabilising implants more advisable in patients with advanced stages of osteoarthritis.
Nekrolisis epidermal (NE) yang terbagi atas Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan reaksi simpang obat berat dengan mortalitas tinggi. Penyebab kematian terbanyak pada NE adalah sepsis, namun gejala sepsis tidak spesifik pada NE dan hasil kultur darah membutuhkan waktu lama. Oleh karena itu penting mengetahui prediktor yang berpengaruh terhadap peningkatan risiko bakteremia pada pasien dengan NE. Evidence-based case report ini bertujuan mengetahui faktor prediktor terjadinya bakteremia pada pasien NE berdasarkan literatur. Pencarian artikel menggunakan basis data PubMed, Cochrane, dan Scopus yang relevan dengan pertanyaan klinis untuk kemudian ditelaah. Didapatkan dua artikel kohort yang sesuai. Studi Koh dkk. mendapatkan tiga prediktor yang berpengaruh terhadap kejadian bakteremia pada pasien NE; yaitu hemoglobin ≤ 10 g/dL (odds ratio [OR] 2,4; interval kepercayaan [IK] 95% 2,2-2,6), luas epidermolisis ≥ 10% (OR 14,3; IK 95% 13,4-15,2) dan penyakit komorbid kardiovaskular (OR 2,1; IK 95% 2,0-2,3). Studi De Prost dkk. mendapatkan tiga prediktor yaitu usia > 40 tahun (hazard ratio [HR] 2,5; IK 95% 1,35-4,63), leukosit > 10.000/mm3 (HR 1,9; IK 95% 0,96-3,61), serta LPB ≥ 30% (HR 2,5; IK 95% 1,13-5,47). Epidermolisis yang lebih luas merupakan faktor prediktor terjadinya bakteremia pada NE di kedua studi. Faktor risiko lainnya memerlukan penelitian lebih lanjut.
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