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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Burns can be very painful and a number of different options may be used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and opioids such as morphine. Benzodiazepines may be used in addition to analgesics to help with anxiety. During the healing process, antihistamines, massage, or transcutaneous nerve stimulation may be used to aid with itching. Antihistamines, however, are only effective for this purpose in 20% of people. There is tentative evidence supporting the use of gabapentin and its use may be reasonable in those who do not improve with antihistamines. Intravenous lidocaine requires more study before it can be recommended for pain.
Intravenous antibiotics are recommended before surgery for those with extensive burns (>60% TBSA). , guidelines do not recommend their general use due to concerns regarding antibiotic resistance and the increased risk of fungal infections. Tentative evidence, however, shows that they may improve survival rates in those with large and severe burns. Erythropoietin has not been found effective to prevent or treat anemia in burn cases. In burns caused by hydrofluoric acid, calcium gluconate is a specific antidote and may be used intravenously and/or topically. Recombinant human growth hormone (rhGH) in those with burns that involve more than 40% of their body appears to speed healing without affecting the risk of death.
Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt with as early as possible. Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as an escharotomy. This is done to treat or prevent problems with distal circulation, or ventilation. It is uncertain if it is useful for neck or digit burns. Fasciotomies may be required for electrical burns.
Various methods of treatment are used, depending greatly on the length of exposure and other factors. There are documented cases using both conservative and invasive treatments, including skin grafting and/or the application of nonadhesive dressing alongside topical corticosteroids to reduce inflammation. In some patients postinflammatory hypopigmentation or hyperpigmentation may result in the months after initial injury, and ultraviolet protection such as sunscreen is essential to prevent an elevated risk of skin cancer in the damaged tissues. The pain caused by these burns is often intense and can be prolonged, making a pain management plan important. This often includes short term prescriptions of painkillers.
In the case of self-harm induced injury the underlying mental health aspects should be treated as with all self-inflicted injuries.
Corns and calluses are easier to prevent than to treat. When it is usually not desirable to form a callus, minimizing rubbing and pressure will prevent callus formation. Footwear should be properly fitted, gloves may be worn, and protective pads, rings or skin dressings may be used. People with poor circulation or sensation should check their skin often for signs of rubbing and irritation so they can minimize any damage.
Radiation burns should be covered by a clean, dry dressing as soon as possible to prevent infection. Wet dressings are not recommended. The presence of combined injury (exposure to radiation plus trauma or radiation burn) increases the likelihood of generalized sepsis. This requires administration of systemic antimicrobial therapy.
Calluses and corns may go away by themselves eventually, once the irritation is consistently avoided. They may also be dissolved with keratolytic agents containing salicylic acid, sanded down with a pumice stone or silicon carbide sandpaper or filed down with a callus shaver, or pared down by a professional such as a podiatrist or a foot health practitioner.
The most simple treatment for PFB is to let the beard grow. Existing razor bumps can often be treated by removal of the ingrown hair. Extrafollicular hairs can usually be pulled gently from under the skin with tweezers. Using the fingernails to "break" razor bumps can lead to infection and scarring, and should be avoided. Complete removal of the hair from its follicle is not recommended. Severe or transfollicular hairs may require removal by a dermatologist.
Medications are also prescribed to speed healing of the skin. Clinical trials have shown glycolic acid-based peels to be an effective and well-tolerated therapy which resulted in significantly fewer PFB lesions on the face and neck. The mechanism of action of glycolic acid is unknown, but it is hypothesized that straighter hair growth is caused by the reduction of sulfhydrylbonds in the hair shaft by glycolic acid, which results in reduced re-entry of the hair shaft into the follicular wall or epidermis. Salicylic acid peels are also effective. Prescription antibiotic gels (Benzamycin, Cleocin-T) or oral antibiotics are also used. Retin-A is a potent treatment that helps even out any scarring after a few months. It is added as a nightly application of Retin-A Cream 0.05 - 0.1% to the beard skin while beard is growing out. Tea tree oil, Witch Hazel, and Hydrocortisone are also noted as possible treatments and remedies for razor bumps.
In Belgium, the Conseil Supérieur de la Santé gives a scientific advisory report on public health policy, the Superior Health Council of Belgium provides an overview of products that are authorized in Belgium for consumer use and that contain caustic substances, as well as of the risks linked to exposure to these products. This report aims at suggesting protection measures for the consumers, and formulates recommendations that apply to the different stages of the chain, which begins with the formulation of the product, followed by its regulation / marketing / application and post-application and ends with its monitoring.
Radiation burns are caused by exposure to high levels of radiation. Levels high enough to cause burn are generally lethal if received as a whole-body dose, whereas they may be treatable if received as a shallow or local dose.
The most effective prevention is to grow a beard. For men who are required to; or simply prefer to shave, studies show the optimal length to be about 0.5 mm to 1 mm to prevent their hair growing back into the skin. Using a beard trimmer at the lowest setting (0.5mm or 1mm) instead of shaving is an effective alternative. The resulting faint stubble can be shaped using a standard electric razor on non-problematic areas (cheeks, lower neck).
For most cases, completely avoiding shaving for three to four weeks allows all lesions to subside, and most extrafollicular hairs will resolve themselves in about ten days.
Permanent removal of the hair follicle is the only definitive treatment for PFB. Electrolysis is effective but limited by its slow pace, pain and expense. Laser-assisted hair removal is effective. There is a risk of skin discoloration and a very small risk of scarring.
Exfoliation with various tools such as brushes and loofahs also helps prevent bumps.
Some men use electric razors to control PFB. Those who use a razor, should use a single blade or special wire-wrapped blade to avoid shaving too closely, with a new blade each shave. Shaving in the direction of hair growth every other day, rather than daily, may improve pseudofolliculitis barbae. If one must use a blade, softening the beard first with a hot, wet washcloth for five minutes or shave while showering in hot water can be helpful. Some use shaving powders (a kind of chemical depilatory) to avoid the irritation of using a blade. Barium sulfide-based depilatories are most effective, but produce an unpleasant smell.
For every form of contagious infection, there is a readily available form of medication that can be purchased at any pharmacy. It is a commonly held belief among wrestlers, however, that these ointments do not treat symptoms Sometimes wrestlers who don’t want to report an infection to their coach will resort to unusual and unhealthy treatments. Included among these ‘home remedies’ are nail polish remover, bleach, salt, and vinegar solutions, which are used to either suffocate or burn the infection, often leaving extensive scars. The remedies, while sometimes successful, are not guaranteed to actually kill the infection, often only eliminating visible symptoms temporarily. Even though the infection may no longer be symptomatic, it can still be easily transmitted to other individuals. Because of this, it is recommended that wrestlers attempting to treat skin infections use conventional medicine, as prescribed by a physician.
Both cryosurgery and electrosurgery are effective choices for small areas of actinic cheilitis. Cryosurgery is accomplished by applying liquid nitrogen in an open spraying technique. Local anesthesia is not required, but treatment of the entire lip can be quite painful. Cure rates in excess of 96% have been reported. Cryosurgery is the treatment of choice for focal areas of actinic cheilitis. Electrosurgery is an alternate treatment, but local anesthesia is required, making it less practical than cryosurgery. With both techniques, adjacent tissue damage can delay healing and promote scar formation.
More extensive or recurring areas of actinic cheilitis may be treated with either a shave vermillionectomy or a carbon dioxide laser. The shave vemillionectomy removes a portion of the vermillion border but leaves the underlying muscle intact. Considerable bleeding can occur during the procedure due to the vascular nature of the lip. A linear scar may also form after treatment, but this can usually be minimized with massage and steroids. Healing time is short, and effectiveness is very high.
A newer procedure uses a carbon dioxide laser to ablate the vermillion border. This treatment is relatively quick and easy to perform, but it requires a skilled operator. Anesthesia is usually required. Secondary infection and scarring can occur with laser ablation. In most cases, the scar is minimal, and responds well to steroids. Pain can be a progressive problem during the healing phase, which can last three weeks or more. However, the carbon dioxide laser also offers a very high success rate, with very few recurrences.
Chemical peeling with 50% trichloroacetic acid has also been evaluated, but results have been poor. Healing usually takes 7–10 days with very few side effects. However, limited studies show that the success rate may be lower than 30%.
Topical 5-fluorouracil (5-FU, Efudex, Carac) has been shown to be an effective therapy for diffuse, but minor actinic cheilitis. 5-fluorouracil works by blocking DNA synthesis. Cells that are rapidly growing need more DNA, so they accumulate more 5-fluorouracil, resulting in their death. Normal skin is much less affected. The treatment usually takes 2–4 weeks depending on the response. The typical response includes an inflammatory phase, followed by redness, burning, oozing, and finally erosion. Treatment is stopped when ulceration and crusting appear. There is minimal scarring. Complete clearance has been reported in about 50% of patients.
Imiquimod (Aldara) is an immune response modifier that has been studied for the treatment of actinic cheilitis. It promotes an immune response in the skin leading to apoptosis (death) of the tumor cells. It causes the epidermis to be invaded by macrophages, which leads to epidermal erosion. T-cells are also activated as a result of imiquimod treatment. Imiquimod appears to promote an “immune memory” that reduces the recurrence of lesions. There is minimal scarring. Complete clearance has been demonstrated in up to 45% of patients with actinic keratoses. However, the dose and duration of therapy, as well as the long-term efficacy, still need to be established in the treatment of actinic cheilitis.
The exact symptoms of a chemical burn depend on the chemical involved. Symptoms include itching, bleaching or darkening of skin, burning sensations, trouble breathing, coughing blood and/or tissue necrosis. Common sources of chemical burns include sulfuric acid (HSO), hydrochloric acid (HCl), sodium hydroxide (NaOH), lime (CaO), silver nitrate (AgNO), and hydrogen peroxide (HO). Effects depend on the substance; hydrogen peroxide removes a bleached layer of skin, while nitric acid causes a characteristic color change to yellow in the skin, and silver nitrate produces noticeable black stains. Chemical burns may occur through direct contact on body surfaces, including skin and eyes, via inhalation, and/or by ingestion. Lipophilic substances that diffuse efficiently in human tissue, e.g., hydrofluoric acid, sulfur mustard, and dimethyl sulfate, may not react immediately, but instead produce the burns and inflammation hours after the contact. Chemical fabrication, mining, medicine, and related professional fields are examples of occupations where chemical burns may occur. Hydrofluoric acid leaches into the bloodstream and reacts with calcium and magnesium, and the resulting salts can cause cardiac arrest after eating through skin.
An escharotic is a substance that causes tissue to die and slough off. Examples include acids, alkalis, carbon dioxide, metallic salts and sanguinarine, as well as certain medicines like imiquimod. Escharotics known as black salves, containing ingredients such as zinc chloride and sanguinarine containing bloodroot extracts, were traditionally used in herbal medicine as topical treatments for localised skin cancers, but often cause scarring and can potentially cause serious injury and disfigurement. Consequently, escharotic salves are very strictly regulated in most western countries and while some prescription medicines are available with this effect, unauthorized sales are illegal. Some prosecutions have been pursued over unlicensed sales of escharotic products such as Cansema.
Calcium deficiency can sometimes be rectified by adding agricultural lime to acid soils, aiming at a pH of 6.5, unless the subject plants specifically prefer acidic soil. Organic matter should be added to the soil to improve its moisture-retaining capacity. However, because of the nature of the disorder (i.e. poor transport of calcium to low transpiring tissues), the problem cannot generally be cured by the addition of calcium to the roots. In some species, the problem can be reduced by prophylactic spraying with calcium chloride of tissues at risk.
Plant damage is difficult to reverse, so corrective action should be taken immediately, supplemental applications of calcium nitrate at 200 ppm nitrogen, for example. Soil pH should be tested, and corrected if needed, because calcium deficiency is often associated with low pH.
Early fruit will generally have the worst systems, with them typically lessening as the season progresses. Preventative measures, such as irrigating prior to especially high temperatures and stable irrigation will minimize the occurrence.
Depending on the duration of exposure aerosol-induced frostbite can vary in depth. Most injuries of this type only affect the epidermis, the outermost layer of skin. However, if contact with the aerosol is prolonged the skin will freeze further and deeper layers of tissue will be affected, causing a more serious burn that reaches the dermis, destroys nerves, and increases the risk of infection and scarring . When the skin thaws, pain and severe discomfort can occur in the affected area. There may be a smell of aerosol products such as deodorant around the affected area, the injury may itch or be painful, the skin may freeze and become hardened, blisters may form on the area, and the flesh can become red and swollen.
When choosing a site for plantation establishment, it is typically good practice to ensure it exhibits good drainage and is non shaded. It should not be next to old Scotch pine stands, which could still hold the "Cyclaneusma". The trees in the plantation should have adequate spacing to allow for proper air circulation. Additionally, the owner should invest in tree stock which displays resistance or tolerance to "Cyclaneusma." After planting, attentive tree care must be undertaken, including nutrient management and water and weed control, to ensure robust, healthy trees. To scout for the disease, the threshold level is 20% of sampled trees showing signs. At this point, the owner should consider treating the entire plantation. In some areas, it is possible to control the disease through the silvicultural practice of thinning, selecting for trees with resistance to "Cyclaneusma".
"Cyclaneusma" presents somewhat of a challenge to manage, as infected needles remain part of the tree throughout the winter and spring months. The creation of spores as well as infection can occur in freezing temperatures with wet needles. Inoculated needles may not develop symptoms for up to a year from the infection date, proving difficult for the effectiveness of pesticides applied in the first season to be judged. Infected needles on or under the tree retain the ability to release spores any time during the growing season, so they should be removed as soon as possible. It is typically recommended to apply five treatments of fungicide, such as chlorothalonil or dodine, when the threshold level is met, beginning in March and continuing roughly every 5–6 weeks through October. If the infection level of a Christmas tree plantation is not yet too high, the aesthetics of the tree can be saved by using a leaf blower to remove infected needles from the tree.
The second strategy of management is the sanitization control in order to reduce the primary inoculum. Remove and destroy (burn) all plants debris after the harvest, scout for disease and rogue infected plants as soon as detected and steam sanitization the greenhouse between crops.
The first strategy of management is the cultural practices for reducing the disease. It includes adequating row and plant spacing that promote better air circulation through the canopy reducing the humidity; preventing excessive nitrogen on fertilization since nitrogen out of balance enhances foliage disease development; keeping the relatively humidity below 85% (suitable on greenhouse), promote air circulation inside the greenhouse, early planting might to reduce the disease severity and seed treatment with hot water (25 minutes at 122 °F or 50 °C).
There is no cure for IBS but in the future gene therapy may offer a cure.
Treatments for IBS generally attempt to improve the appearance of the skin and the comfort of the sufferer. This is done by exfoliating and increasing the moisture of the skin. Common treatments include:
- Emollients: moisturisers, petroleum jelly or other emolients are used, often several times a day, to increase the moisture of the skin.
- Baths: long baths (possibly including salt) several times a week are used to soften the skin and allow exfoliation.
- Exfoliating creams: creams containing keratolytics such as urea, salicylic acid and lactic acid may be useful.
- Antiseptic washes: antiseptics may be used to kill bacteria in the skin and prevent odour.
- Retenoids: very severe cases may use oral retinoids to control symptoms but these have many serious side effects including, in the case of IBS, increased blistering.
Treatment is cause-related, but also symptomatic if the underlying cause is unknown or not correctable. It is also important to note that most ulcers will heal completely without any intervention. Treatment can range from simply smoothing or removing a local cause of trauma, to addressing underlying factors such as dry mouth or substituting a problem medication. Maintaining good oral hygiene and use of an antiseptic mouthwash or spray (e.g. chlorhexidine) can prevent secondary infection and therefore hasten healing. A topical analgesic (e.g. benzydamine mouthwash) may reduce pain. Topical (gels, creams or inhalers) or systemic steroids may be used to reduce inflammation. An antifungal drug may be used to prevent oral candidiasis developing in those who use prolonged steroids. People with mouth ulcers may prefer to avoid hot or spicy foods, which can increase the pain. Self-inflicted ulceration can be difficult to manage, and psychiatric input may be required in some people.
Surgical debridement (cutting away affected tissue) is the mainstay of treatment for necrotizing fasciitis. Early medical treatment is often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Given the dangerous nature of the disease, a high index of suspicion is needed. Initial treatment often includes a combination of intravenous antibiotics including piperacillin/tazobactam, vancomycin, and clindamycin. Cultures are taken to determine appropriate antibiotic coverage, and antibiotics may be changed when culture results are obtained.
Treatment for necrotizing fasciitis may involve an interdisciplinary care team. For example, in the case of a necrotizing fasciitis involving the head and neck, the team could include otolaryngologists, speech pathologists, intensivists, infectious disease specialists, and plastic surgeons or oral and maxillofacial surgeons. Maintaining strict asepsis during any surgical procedure and regional anaesthesia techniques is vital in preventing the occurrence of the disease.
The most common treatment is the acne medication isotretinoin. It may be combined with prednisone. Dapsone, which is normally used to treat leprosy, is a riskier medication but is sometimes prescribed in cases where the normal therapy is ineffectual. Antibiotics such as tetracycline or erythromycin may also be prescribed. An alternative option is to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy.
Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with corticosteroids such as triamcinolone.
Treatments for CCCA remain investigational. Altering hair care practices has not been proven to assist in hair rejuvenation. High-dose topical steroids, antibiotics, immunomodulators such as tacrolimus (Protopic) and pimecrolimus (Elidel), and anti-androgen/5alpha Reductase inhibitors have been used with unknown efficacy.