SARCOIDOSIS. Sarcoidosis is a multi system inflammatory disorder of unknown etiology that predominantly affects the lungs and intra thoracic lymph nodes. Sarcoidosis is manifested by the presence of non caseating granulomas ( NCG's ) in affected organs. It is characterised by a seemingly exaggerated immune response against a difficult - to - discern antigen. SIGNS AND SYMPTOMS. The presentation of sarcoidosis depends on the extent and severity of organ involvement. *Asymptomatic. *Systematic complaints like fever and anorexia. *PULMONARY MANIFESTATION Dyspnea on exertion. Cough. Chest pain Hemoptysis. Pulmonary findings on physical examination can be Usually normal. Crepitus. External oxygen desaturation. LOFGREN SYNDROME. Fever,bilateral hilarious lymphadenopathy and polyarthralgias. DERMATOLOGICAL MANIFESTATION. *-Erythema nodosum. *A lower extremity panniculitis with painful erythematous nodules. *Lupus permit ( the most specific associated cutaneous lesion ) *Violaceous rash on cheeks and nose ( common ) *Maculopapular plaques ( uncommon ) OCULAR MANIFESTATION. *Anterior or posterior granulomatous uveitis. *Conjunctival lesions and scleral plaques. If untreated can lead to blindness. OTHER POSSIBLE MANIFESTATION. *Osseous involvement. *Heart failure from cardiomyopathy. *Heart block and sudden death. *Lymphocytic meningitis. *Cranial nerve palsies and hypothalamic / pituitary dysfunction. DIAGNOSIS. *Chest X-RAY central to the evaluation. *High resolution CT identifies active alveolitis versus fibrosis. *Gallium scans. *Pulmonary function tests and carbon monoxide diffusion capacity test of the lungs( DLCO ) for carbon monoxide is used routinely in evaluation and follow up. An isolated decrease in DLCO is the most common abnormality. *Cardiopulmonary exercise testing is a sensitive test for identifying and quantifying the extent of pulmonary involvement.I t also suggests cardiac involvement that otherwise is not evident. IMPAIRED HEART RATE RECOVERY DURING THE FIRST MINUTE FOLLOWING EXERCISE HAS BEEN SHOWN TO BE AN INDEPENDENT PREDICTOR FOR CARDIOVASCULAR AND ALL CAUSE MORTALITY. DIAGNOSIS REQUIRES BIOPSY IN MOST CASES.ENDOBRONCHIAL BIOPSY VIA BRONCHOSCOPY IS OFTEN DONE.THE CENTRAL HISTOLOGICAL FINDING IS THE PRESENCE OF NON CASEATING GRANULOMAS WITH SPECIAL STAINS NEGATIVE FOR FUNGUS AND MYCOBACTERIA. *Hypercalcemia. *Hypercalcuria. *Elevated alkaline phosphatase level. *Elevated angiotensin converting enzyme level. STAGING OF SARCOIDOSIS. STAGE O : Normal chest radiographic findings. STAGE I. : Bilateral hilar lymphadenopathy. STAGE II : Bilateral hilar lymphadenopathy and infiltrates. STAGE III : Infiltrates alone. STAGE IV : fibrosis. TREATMENT. Most patients do not require therapy and their condition improves spontaneously. Markers for poor prognosis are Advanced chest radiography stage. Extra pulmonary disease Evidence of pulmonary hypertension. Most patients require symptomatic treatment with NSAID 's for treatment of arthralgias. Treatment for patients with pulmonary involvement. *Asymptomatic patients do not require treatment. *In patients with minimal symptoms,serial re evaluation is prudent *Treatment is indicated for patients with severe symptoms. *Corticosteroid are helpful. *For extra pulmonary sarcoidosis involving heart,liver,eyes,kidney and central nervous system , corticosteroid therapy is indicated. *Topical steroids are useful for ocular disease. Common indications for non - corticosteroid are *Steroid resistant disease. *Intolerable adverse effects of steroids. Non corticosteroid agents are METHOTREXATE CHLOROQUINE and HYDROCHLOROQUINE used for cutaneous lesion,hypercalcemia,neurologic sarcoidosis and bone lesions. CHLOROQUINE is useful for Acute and maintenance treatment of chronic pulmonary sarcoidosis. CYCLOPHOSPHAMIDE is used in refractory sarcoidosis. AZATHIOPRINE is best used as a steroid sparing agent. CHLORAMBUCIL is beneficial in patients with progressive disease unresponsive to steroids. CYCLOSPORINE is of limited benefit in skin sarcoidosis or in progressive sarcoidosis resistant to conventional therapy. INFLIXIMAB & THALIDOMIDE are used for refractory sarcoidosis. FOR PATIENTS WITH ADVANCED PULMONARY FIBROSIS FROM SARCOIDOSIS,LUNG TRANSPLANTATION REMAINS THE ONLY HOPE FOR LONG TERM SURVIVAL. LONG TERM MONITORING. *Monitor pulmonary function and chest radiography every 6 months. *Assess for progression or resolution. *Determine if previously uninvolved organs have become affected. *Annual slit lamp examination and ECG are recommended.

Middle aged male pt came with the complaints of fever and cough with sputum...15 days.. X ray findings? differential diagnosis?

ABC OF : NAIL DISORDERS. ( I ). MAY BE USEFUL. *** ANONYCHIA is the absence of nails, an anomaly, which may be the result of a congenital ectodermal defect, ichthyosis, severe infection, severe allergic contact dermatitis, self-inflicted trauma, Raynaud phenomenon, lichen planus, epidermolysis bullosa, or severe exfoliative diseases....... *** PSORIASIS can also affect the fingernails and toenails, leading to thick fingernails with pitting, ridges in the nails, nail lifting away from the nail bed, and irregular contour of the nail....... *** LICHEN PLANUS of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise....... *** FUNGAL nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.....by some dermatophytes, Candida (Monilia) species, etc....... The technical name for a fungal nail infection is “ONYCHOMYCOSIS.”....... *** SPOON-SHAPED or spooning fingernails refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. This growth disturbance in the nail is known as KOILONYCHIA....... In particular, koilonychias is associated with IRON DEFICIENCY. *** Fingernails are made by living skin cells....... So a skin condition such as eczema may lead to fingernail ridges. Skin dryness can also cause these ridges. If the body is low in protein, calcium, zinc.......or vitamin A, a deficiency can sometimes be revealed by ridges in the fingernails. ** HORIZONTAL RIDGES run from side to side on nails and are often referred to as BEAU'S LINES may be a sign of previous injury, underlying health conditions, or in rare cases, arsenic poisoning....... Horizontal ridges can be caused by trauma to the nail and may be deep or discolored. The can also indicate malnutrition, psoriasis or a thyroid problem....... ** VERTICAL RIDGES are usually harmless and a consequence of ageing.......nail injury, or trauma, or underlying medical conditions....... *** The ECTODERMAL DYSPLASIAS (EDs) are genetic disorders affecting the development or function of the teeth, hair, nails and sweat glands....... ** ED is not a single disorder, but a group of closely related conditions of which more than 150 different syndromes have been identified....... *** Nail CLUBBING, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. ... Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called "Hippocratic fingers"..... ** Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. ... Heart defects that are present at birth (congenital) Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess....... *** While the NAIL BITING and picking seems to be such a common problem, the psychological and medical research does not agree on the exact motivation for the action. However, it suggests that nail biting can be the result of STRESS, VARIOUS MEDICAL DISORDERS, LEARNED BEHAVIORS, OR JUST PLAIN HABIT....... *** SPLINTER HEMORRHAGES : They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails. Splinter hemorrhages can occur with infection of the heart valves (endocarditis)....... *** YELLOW TOENAILS in an infection by a fungus that attacks the nails..... or, in some cases, they may be a sign of skin cancer. The fungal infection is caused most often by dermatophytes, which eat keratin to grow....... One of the MOST COMMON CAUSES of YELLOW NAILS is a FUNGAL INFECTION. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as SEVERE THYROID DISEASE, LUNG DISEASE, DIABETES or PSORIASIS....... *** WHILE NAILS ( LEUKONYCHIA ) : CAUSES : Iron deficiency anemia. Cirrhosis of liver. Kidney disease. Heart failure. Diabetes. Problems with the digestion of proteins. An excessive loss of proteins in the intestines. zinc deficiency........etc....... *** RED NAILS :- CAUSES : LUPUS patients get quirky, angular blood vessels in their nail folds. PSORIASIS starts in the nails up to 10 percent of the time and CAUSES SPLITTING and PITTING of the nail bed. HEART DISEASE can turn the nail beds red....... ** If the NAIL BED is RED, it could be caused by a high content of fatty acids and cholesterol, due to an excess of dairy products, sugar and salt in the diet. This can lead to an underactive liver and blocked arteries....... To keep the system healthy by replacing refined foods with wholegrain rice and bread, and flush out the system with plenty of fresh vegetables and at least five glasses of water a day....... *** HALF PINK and HALF WHITE nails can be a sign of kidney disease....... *** BRITTLE NAILS :- CAUSES : AGING. CHEMICAL/TOXIN EXPOSURE. LONG-TERM USE OF NAIL POLISH AND POLISH REMOVE. LOW HUMIDITY ENVIRONMENT. MALNUTRITION. NAIL-PATELLA SYNDROME. PROLONGED EXPOSURE TO WATER. TRAUMA. ** B complex vitamins (especially biotin), calcium, and zinc have all been implicated. There are other medical conditions which can cause brittle nails such as ANEMIA (low blood count), THYROID DISORDERS, and skin disorders such as LICHEN PLANUS and PSORIASIS. ** ONYCHOSCHIZIA includes splitting, brittle, soft or thin nails. Onychoschizia is MORE COMMON IN WOMEN. Only VERY RARELY are INTERNAL DISEASE or VITAMIN DEFICIENCIES the reason (IRON DEFICIENCY is the MOST COMMON).......

A 65 years old female admitted to the ICU with Urosepsis. Past history of anemia and Interstitial Lung Disease. Please describe is there are any pathological changes in the nails ?

30/F ,,,C/o high grade fever 10 days, cough nd chest pain 15 days, ,, Rx taken levoflox500 1od, after dat moxclav625 bid for 5 days, no relief,, H/o old tuberculosis 2 year back, taken DOTS from civil hospital for 6 months, after dat Afb negative,, ,, kindly suggest Rx nd Dx,,