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Successful completion of the literature review courses and other program related course work discount 20mg esomeprazole overnight delivery gastritis diet 4 believers. Examples of teaching affiliations order esomeprazole 20mg amex gastritis vs ulcer, study clubs buy esomeprazole 20 mg cheap gastritis diet ñêà÷àòü, publications generic 40mg esomeprazole with visa gastritis diet 2015, research, etc, from previous program graduates. Goal #7 To foster an interest on the part of our residents in community health care, community service and dental education. Measured using: Graduate Program in Prosthodontics Resident Faculty Evaluation Form. Measured using: Resident Year End Evaluation of the Graduate Program in Prosthodontics Form Meetings with all residents on a continuous basis – every Monday, Wednesday, and Friday morning Written student complaints C. Measured using: Outcome Assessment by Program Alumni Form Exit Interview Form 9 Tab D D. Measured using: Individual faculty input to program director as well as from scheduled faculty meetings E. Measured using: Monitoring of resident performance Resident evaluation forms Advanced Dental Education Committee meetings 10 Tab D 2. Outcomes Measurements Refer to Standard 2: Appendix K1 Resident Evaluation of Faculty Refer to Standard 5: Appendix U Resident Exit Interview Outcome Assessment by Program Alumni Resident Year End Evaluation of Program 11 Tab D 3. Outcomes Assessment Results Goal #1 To develop the diagnostic and treatment planning skills necessary for successful provision of complex prosthodontic treatment. All residents have successfully completed this clinical course which runs continuously throughout the program. Residents have clinical requirements that provide them with repeated experiences in diagnosis and treatment planning of complex patient cases. All residents have successfully completed this prosthodontics seminar course by presenting numerous formal treatment planning and completed treatment presentations. All residents successfully completed this course in its initial offering of fall 2012. This course has offered the residents additional experience in treatment planning implant placement with the prosthetic goal in mind. At the end of each semester, the program director completes a patient electronic health record chart audit during which completed treatment plans are reviewed and patient, resident, and faculty electronic signatures are verified. Completed exit interviews and alumni surveys (Outcome Assessment by Program Alumni form) indicate that graduates from this program received information regarding treatment planning that was appropriate and sufficient for the successful practice of prosthodontics as a specialty. All residents have successfully completed all prosthodontic related coursework associated with the Prosthodontics residency program. All residents have successfully completed the basic science coursework associated with the Prosthodontics residency program. Alumni outcome assessment forms and exit interviews indicate that graduates from this program are generally satisfied with the knowledge of Prosthodontics and basic science that they receive and that it is appropriate for the successful practice of Prosthodontics as a specialty. Goal #3 To provide advanced clinical instruction in all phases of prosthodontics so that a graduating resident will have the clinical skills necessary to successfully practice prosthodontics as a specialty. All residents have been successful in completing clinical coursework associated with the program. All residents who have graduated from this program have met the clinical requirements as described in the program manual. These clinical requirements provide a measurement standard that assures each resident will have a sufficient number of patients with differing treatment needs such that they will be able to develop a satisfactory level of proficiency in all aspects of Prosthodontics. Outcome assessment questionnaires received from program alumni indicate that they felt the program offered them a level of instruction sufficient to allow them to practice Prosthodontics successfully as a specialty. Successful completion of a written research protocol by Prosthodontics residents at the end of their research course. Over the last seven years (2006-2012), 15/21 individuals completed our program receiving both their Master’s Degree and their Certificate in Prosthodontics. Three of the six who have not defended their thesis graduated a year ago and are currently preparing their thesis. One of the other six residents plans to defend her thesis but has been delayed due to personal reasons. The outcome assessments from program alumni indicated they are a particular strength of the program. With the advent of new Guidelines for the Board, residents are mentored and encouraged to complete patient requirements for the Section B Examination. Residents are strongly encouraged to participate in the Board certification process during and after program completion. Both of these requirements are funded by the Advanced Education Program in Prosthodontics. While treatment planning patients with residents, the Program Director is always considering if the patient could be a board examination patient and encourages the resident to treat the case as it could be. I am proud to have encouraged and supported the recent alumni in their board certification pursuit. Outcome assessment surveys from program alumni indicated that respondents are involved in one or more activities associated with life-long learning. All residents completing the program have successfully completed the literature review courses and other program related course work associated with the Prosthodontics residency program. Outcome assessments from program alumni indicate that ten of our recent graduates are actively involved in dental education. Outcome assessments from program alumni indicate that all of them are actively involved in the practice of Prosthodontics and nearly all are full time. Resident evaluations of faculty generally indicate a satisfaction with faculty teaching and participation in the educational process.

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What surprised us was its colour cheap esomeprazole 40mg otc gastritis doctor, that of rhubarb and magnesia generic 20 mg esomeprazole mastercard gastritis bile reflux diet, nothing at all like the sand we had hitherto seen buy esomeprazole 20 mg with amex gastritis or ulcer, and nothing at all like what we had expected purchase 20 mg esomeprazole otc gastritis diet þòóþ. Her attempt to domesticate the chaos of the wilderness (note the reference to rhubarb and magnesia used in domestic medicine) and to make it meaningful, is characteristic of the belated explorers. They represent their journeys as spiritual, often structuring them in accordance with the pilgrim age, while reversing this model as well as transforming that of the traveller pilgrim. The Hajj (every Muslim’s obligatory pilgrimage to the holy shrines in Mecca, and the fth of Islam’s seven pillars) marks the believer’s iden tity and her or his membership of the community of Muslims. Travellers like the Blunts and Doughty locate the Christian and universalist quest in the quintessential Muslim and anti-Christian site. They apply the notion of the Hajj to the whole of Arabia, which they regard as the locus genii of an authentic Islam. The Blunts focus on Nadj, the centre of the religious re vival known as Wahhabism, originating in the mid eighteenth century and becoming a unifying force in the twentieth century mobilised by the Sau’di dynasty to build up Saudi Arabia. Moreover, after the journey Anne Blunt un derwent a religious experience which resulted in her subsequent conversion to Roman Catholicism. Lawrence’s interpretation of redemption is unique in that he resorts to a particular version of the pilgrimage paradigm: the Crusade. An expert on the Crusades’ military architecture (the basis for the entire design of the Seven Pillars of Wisdom), Lawrence medievalised Arabia and applied chivalric ideas to the Arab Revolt of 1916–18 which he helped organise. It was precisely the epic and chivalric dimension of the ‘war in the desert’ that instantaneously made the book a myth and Lawrence an international cult gure, for during the 1920s and 1930s it represented an opposite kind of war to the great upheaval which had 115 billie melman just devastated Europe. The moving front of the Arabian campaign, and the tribesmen who carried it forth, formed a desirable contrast to the Western Front and static and impersonal artillery trench warfare. Though bloody, as a number of episodes in Lawrence’s account make clear, the violence in the revolt was depicted by him and seen by readers averse to the industrial carnage in Europe as ‘clean’. Late travellers’ treatment of nomad life and culture departs, albeit not entirely, from the ethnocentric idiom and epistemology of Orientalist discourse. More speci cally, they differ from earlier writers like Burton and Palgrave who had had little rst-hand knowledge of Bedouin life. One important such departure is the ethnographic search for an understand ing of nomad culture on its own terms, stressing the need to make the authentic Arab voice audible. The word ‘authentic’ has different meanings: historical (denoting the descendants of the inhabitants of the peninsula be fore Islamisation), biological and even racial (indicating Arab racial purity), or socio-cultural (de ning a nomadic and pastoral life and economy). The Bedouin was deemed superior to the Ottoman, the Levantine, and even to the Arab city dweller of the Hijaz who had been exposed to outside in u ences, including Western material culture and ideas. Even writers who had only passed through the peninsula picked up this juxtaposition of the town and the desert and made it the pivot of their writing. The purity of the Bedouin, they argued, was the result of the hardship of his life and his isolation from the outside world. Thus Mark Sykes, known less as a traveller than as one of the architects of the 1916 Anglo French Sykes-Picot agreement which divided the Middle East into areas of direct British and French rule, spheres of in uence, and independent Arab states, transposes the notion onto Arabist policy. But what is common to writers as different as Sykes, the Blunts, Henry St John Philby, and Wilfred Thesiger is their notion that the traveller/ethnographer should be the preserver and keeper of the pristine Arab way of life and of the true and pure Arabia. Hence the insistence not only on documentation but on what may be described as dialogical writing that would ‘present the case on the seldom heard voice from within before it shall have been sti ed by the growing pressure from without, as might 116 the Middle East / Arabia: ‘the cradle of Islam’ well happen even as a more or less immediate consequence of the appalling upheaval of 1914’. During the long and arduous journeys, all trav ellers, regardless of their religion and nationality, but Westerners especially, depended entirely on the tribes’ protection of life and limb, and protection of caravans became an important source of living throughout the Nafud and Empty Quarter. With a few exceptions, travellers describe their guides and, by extension the guides’ tribes, as companions, in familial terms which do not necessarily denote a parental lial bond (this would be entirely within the paternalist Orientalist framework), but rather a bond between siblings. This is a distinctly masculine bond and indeed the travel epic purports to be a masculine genre. Male travellers celebrate a physical prowess and admire the Bedouin for his manliness. They also appreciate his being an asil, that is of pure Arab blood and therefore apparently the upper-class Englishman’s equal. Occasionally the male bond has a homoerotic streak to it (Lawrence is a case in point). Although at least three of the major explorers of the greater Arabia, Anne Blunt, Bell, and Stark, were women and one of them, Anne Blunt, practically de ned the terms of the discussion on nomad Arabs, they were marginalised by contemporary and following travellers and excluded from the Arabist succession. Put slightly differently, the discovery of the Arab means his loss to the traveller and, one may add, to a nostalgic Western reading public. This is so because the related processes of im perialism, Westernisation, and modernisation were irreversible. The sense of loss is most apparent in Thesiger’s Arabian Sands (1959), which revolves around his crossings of the Empty Quarter in 1946, from south to north then back and from south-west (Manwwaki in Yemen) to north-east (the Trucial Coast on the Gulf). The siger’s is a collective conquest of the desert, achieved with the Bait Kathir 117 billie melman and Rashid Bedouins he lives and travels with and whose company he val ues as the most signi cant bond of his life. Throughout he avoids ‘criticizing their standards and ways of life different from my own’, and adopts these ways. His tone is elegiac: ‘I realized that the Bedu with whom I had lived and travelled, and in whose company I had found contentment, were doomed. I shall al ways remember how often I was humbled by those illiterate herdsmen who possessed, in so much greater measure than I, generosity and courage, en durance, patience and light-hearted gallantry. However, the lament for the transformation of the peninsula denies the Arabs the ability to take an active part in processes of change. Thesiger predicted that the nomad would become a passive lumpenproletariat in shanty towns (p.

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The asynchronous rise and fall of different cognitive abilities across the life span order 40mg esomeprazole chronic gastritis juice. In the present work buy esomeprazole 40mg without a prescription gastritis diet vi, each of these categories is discussed largely in the context of the aging brain trusted 20mg esomeprazole gastritis antibiotics. The previous work should be consulted for a more complete discussion of anti aging methods applied more broadly to generic 40 mg esomeprazole visa gastritis mercola the entire human body, not just the brain. The methods described here would repair existing cellular damage, though new damage would slowly re-accumulate because the basic biological processes have not been altered. But the continuing arrest of brain degradation, neuron mass loss, and aging in pre-clinical Alzheimer’s patients, using medical nanorobots with periodic re-treatment perhaps every decade or so, should constitute a complete preventative treatment against the development of clinically observable Alzheimer’s disease in most individuals. These biomaterials are biochemical byproducts with no further useful physiological or structural function that have proven resistant to natural biological degradation and disposal. If we conservatively assume that the mass of the non-A protein exceeds the mass of all forms of A in an amyloid plaque by 9-fold. The amyloid cascade hypothesis for Alzheimer’s disease: an appraisal for the development of therapeutics. Proteomic characterization of postmortem amyloid plaques isolated by laser capture microdissection. Plaque binding sites can be installed on the external recognition modules of tissue-mobile microbivore-class (Section 4. The only significant material effluent from these synthetic digestive processes would be harmless free amino acids. Amphoterin includes a sequence motif which is homologous to the Alzheimer’s beta-amyloid peptide (Abeta), forms amyloid fibrils in vitro, and binds avidly to Abeta. Bone marrow-derived microglia play a critical role in restricting senile plaque formation in Alzheimer’s disease. Nanorobot activities at a particular plaque may need to be accompanied by the emission of small aliquots of an engineered enzyme designed to separate the plaque body from any neurites, synapses, neuronal processes, elements of brain extracellular matrix,1170 or other vital extracellular structures around which the plaque body might be wrapped or weakly bonded. These enzymes can later be retrieved using sorting rotors equipped with binding sites having high affinity for the engineered enzyme. Alternatively, the nanorobot can incorporate mechanisms and mechanical procedures designed to avoid damage to key extracellular structures while the plaque is being extracted and digested. Nanorobots can also use available binding sites to extract free A, tau (Section 5. Inflammation around the senile amyloid plaques upregulates the production of prostaglandins and leads to the increase in the extracellular concentration of glutamate which contributes to the ultimate death of neurons. Extracting pro-inflammatory cytokines may also help to downregulate the production of excess glutamate. Metabotropic glutamate receptors: a review on prospectives and therapeutic aspects. Intracellular aggregates often accumulate inside lysosomes, organelles that contain the most powerful degradation machinery in the cell. But if the lysosomes become congested and engorged, the cell will stop working properly – crudely analogous to a house whose toilets have all backed up. Intracellular aggregates that accumulate elsewhere than in the lysosome are also a contributing factor in several types of neurodegeneration. Selective molecular binding activity to phosphorylated tau protein has been found in phosphorylated pSmad2 and pSmad3 proteins1180 and curcumin,1181 but numerous phosphorylation-dependent anti-tau antibodies. Phosphorylated Smad 2/3 colocalizes with phospho-tau inclusions in Pick disease, progressive supranuclear palsy, and corticobasal degeneration but not with alpha-synuclein inclusions in multiple system atrophy or dementia with Lewy bodies. Binding of curcumin to senile plaques and cerebral amyloid angiopathy in the aged brain of various animals and to neurofibrillary tangles in Alzheimer’s brain. An ultra-specific avian antibody to phosphorylated tau protein reveals a unique mechanism for phosphoepitope recognition. Tau monoclonal antibody generation based on humanized yeast models: impact on Tau oligomerization and diagnostics. Assuming an injected dose of Nbot = 86 billion nanorobots (~1 cm3 dose, assuming 12. Complementary dimerization of microtubule-associated tau protein: Implications for microtubule bundling and tau-mediated pathogenesis. Nanorobot activities near a particular tangle may need to be accompanied by the emission of small aliquots of an engineered enzyme designed to separate the neurofibrillary material from any cytoskeletal elements or other vital intracellular structures around which it might be wrapped or weakly bonded. Alternatively, the nanorobot can incorporate mechanisms and procedures designed to avoid damage to key intracellular structures while the tangles are being extracted and digested. Free-floating toxic tau oligomers are also extracted and safely digested by the nanorobots, possibly using binding sites derived from known molecular receptors that are specific to phosphorylated tau oligomers as described above, further reducing the rate of formation of new neurofibrillary tangles. A quantitative study of lipofuscin accumulation with age in normals and individuals with Down’s syndrome, phenylketonuria, progeria and transneuronal atrophy. The lipofuscin content of nerve cells of the inferior olivary nucleus in Alzheimer’s disease. Immunohistochemical localization of advanced glycation end products, pentosidine, and carboxymethyllysine in lipofuscin pigments of Alzheimer’s disease and aged neurons. Another study1212 of progeric, phenylketonuric, and Down’s syndrome brains over a 14-92 year age range found no significant difference in the amount of lipofuscin accumulated with age compared to normal brains, so these values seem likely to be approximately correct for Alzheimer’s brains as well. How to create binding sites for such a heterogeneous material consisting of lipids, proteins, carbohydrates and a small amount of metals. One approach is to find or create receptors for specific molecules found in lipofuscin membranes. For example, 186 different proteins1213 were identified in the coatings of retinal epithelium lipofuscin granules, none of which were found in the purified lipofuscin when the coatings were chemically removed.

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Cellulitis of the perirectal area buy generic esomeprazole 40 mg online symptoms of gastritis back pain, sites of iatrogenic puncture (central venous catheter insertion esomeprazole 40 mg without prescription gastritis diet kits, venipuncture generic esomeprazole 40mg free shipping gastritis no appetite, lumbar puncture generic 40mg esomeprazole with visa gastritis not healing, and bone marrow biopsy), or abrasions is a setup for gram negative dissemination. In the context of vaginitis, beta-hemolytic streptococcus is Page 203 a common cause in prepubertal girls and may present with perianal cellulitis with local itching, pain, blood-streaked stools, erythema, and proctitis (3). Rarely, cellulitis or skin discoloration overlying a fluctuant mass might be the presenting finding in tuberculosis of the superficial lymph nodes, often referred to as scrofula, the most common form of extrapulmonary tuberculosis in children. The tonsillar, anterior cervical, submandibular, and supraclavicular nodes become involved secondary to extension of a primary lesion of the upper lung fields or abdomen. Disease is most often unilateral, but bilateral involvement may occur because of the crossover drainage patterns of lymphatic vessels in the chest and lower neck. Cellulitis of the sublingual and submandibular spaces (Ludwig angina) tends to spread rapidly without lymph node involvement or abscess formation. It is an acute, life-threatening entity that may require tracheostomy in the event of respiratory obstruction. Cellulitis can be a complication of hidradenitis suppurativa, a chronic, inflammatory, suppurative disorder of the apocrine glands in the axillae or anogenital area, and occasionally, the scalp, posterior aspect of the ears, female breasts, and around the umbilicus. Cellulitis of the lateral nail fold can occur as spicules that have separated from the nail plate, penetrate the soft tissue. Predisposing factors include compression of the side of the toe from poorly fitting shoes, particularly if the great toes are abnormally long and the lateral nail folds are prominent, and improper cutting of the nail in a curvilinear manner rather than straight across. A gram stain of a leading edge aspirate is done by injecting a small amount of non bacteristatic saline into the leading edge of the cellulitis, then aspirating back the saline. Since introduction of the Hib vaccine, the most common organisms are streptococci. In a series of 243 children admitted with cellulitis, Sadow and Chamberlain (1998) contend that, given a treatment threshold based on a band-to-neutrophil ratio of 0. Most cases of early or mild cellulitis, especially those without fever, do not require laboratory testing. Antibiotic treatment is targeted mainly against the usual pathogen, group A strep. Staph aureus is uncommon (unless an abscess is present), but difficult to exclude without a leading edge aspirate culture. Staph aureus used to be sensitive to anti-Staph aureus penicillins (cloxacillin, dicloxacillin, methicillin, oxacillin, nafcillin) and cephalosporins. However, if Staph aureus is suspected, then there is a 25% failure rate for cephalosporins and anti-Staph aureus penicillins. Vancomycin and aminoglycosides are parenteral and can only be used for inpatient treatment of staph aureus. If a satisfactory clinical response is not achieved within 7 days, a culture and sensitivity should be taken of a leading edge aspirate. If a resistant organism is detected, an appropriate antibiotic should be given for an additional 7 days. Young children (<36 months of age) with pneumococcal facial lesions cellulitis are at risk for pneumococcal bacteremia, and usually present with fever and leukocytosis. With regard to prevention, a recent study noted that 96% of the pneumococcal serotypes causing facial cellulitis are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States (8). Impetiginous crusts should be softened with warm compresses and removed with an antibacterial soap. A three-phase bone scan is being used to determine if osteomyelitis is coexisting in a cellulitis patient. Focal increased uptake in the initial phase, with subsequent decline in the bone phase. You are managing a serious pediatric burn victim who has developed cellulitis after repeated procedures for debridement of necrotic tissue. Gangrenous cellulitis associated with gram-negative bacilli in pancytopenic patients: Dilemma with respect to effective therapy. Once-daily administration of ceftriaxone for the treatment of selected serious bacterial infections in children. Bacterial meningitis occurs more frequently between the ages of 2 months and two years. Rarely, the infection is due to spread from a contiguous focus such as the sinuses, the middle ear, or the mastoids. Bacterial meningitis secondary to otitis media is an uncommon phenomenon, but when it does occur, it is usually septicemic in origin, rather than due to direct extension. In young infants, evidence of meningeal inflammation may be minimal and only irritability and poor feeding may be present. Such paradoxical irritability (which worsens when the child is carried, rocked or gently bounced), is highly suggestive of meningitis. The older child will present with more clinical findings, such as nuchal rigidity, vomiting, lethargy and photophobia. Common bacterial causes in this age group include Streptococcus pneumonia Page 205 (pneumococcus) and Neisseria meningitidis (meningococcus). Antibiotics must still be given immediately once bacterial meningitis is suspected. The treatment of meningitis is directed at reducing the damage produced by the inflammatory response by maintaining adequate cerebral perfusion with the use of adequate amounts of intravenous fluids and agents that reduce intracranial pressure and by treating the infection.

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Erythema toxicum presents as papules discount 20 mg esomeprazole with amex gastritis diet ñåêñóàëüíûå, macules cheap esomeprazole 20mg online gastritis diet zucchini, and sometimes pustules surrounded by an irregular halo of erythema discount esomeprazole 40 mg line diet during gastritis attack. A Wright stain of a smear (by pricking the skin and doing a touch prep on a slide) reveals eosinophils with no organisms present (3) 20 mg esomeprazole with visa gastritis diet for diabetics. Page 667 Nevi (moles) are clusters of melanocytes that appear at the epidermal-dermal junction. The number of acquired nevi increases with age, reaching a plateau in the 30s or 40s (1). The amount of nevi that develop is related to the amount of sun exposure sustained in childhood. Although most nevi are benign, a small percentage may undergo malignant transformation into melanoma. Risk of melanoma increases as the number of nevi increases and as the amount of sun exposure increases. Malignant change may be suspected if the nevi display irregular borders, large size (5-15mm), multiple colors, or become ulcerated, scaled, or indurated. If any of these suspicious characteristics are observed, the nevus can easily be excised. Acute paronychia may occur spontaneously, or after trauma, removal of a hangnail, or nail-biting (6). Staphylococci or streptococci infections are often responsible for acute paronychia. The patient presents with warmth, edema, erythema and proximal nail fold tenderness. Treatment includes warm soaks (to soften the skin), oral antibiotics, and drainage of an abscess if one is present. The chronic form is more commonly seen in children and is often caused by finger sucking, which creates a desirable environment for yeast, such as Candida, and bacteria to thrive (7). In chronic paronychia, the nail fold (eponychium) will swell and then separate from the underlying nail plate. Treatment includes reducing predisposing factors, careful attention to hand drying, incision and drainage of the pus, and topical anti inflammatory agents. Antibiotics may be employed empirically or until the cultures come back (most likely Staph aureus) (7). Varicella zoster (chickenpox) is spread via respiratory secretions and direct contact with cutaneous lesions. Routine varicella immunization has drastically reduced the incidence of this infection. Subsequently, a pruritic, vesicular rash originates on the scalp or trunk and spreads to the rest of the body. The lesions of varicella zoster are sometimes described as "dew drops on a rose petal" (8). The vesicles then dry up and become crusts, which persist for three weeks before disappearing. Children are contagious from two days before to five days after the onset of the rash. A Tzanck smear may be helpful in confirming the diagnosis (reveals multinucleated giant cells) (6), but this is usually unnecessary. Varicella encephalitis may occur shortly after the appearance of the rash, most commonly presenting with mild ataxia. However, the prognosis is usually good, unlike the encephalitis caused by herpes simplex virus. Immunocompromised patients with varicella zoster infections may experience persistent vesicular eruptions that may become hemorrhagic or they may experience disseminated varicella. Acyclovir may be administered in cases of severe varicella, but some advocate routine use of acyclovir for varicella or zoster, especially for adolescents due to their propensity to develop severe disease. Herpes zoster, or shingles, is characterized by groups of vesicles distributed along a cutaneous nerve (a dermatome). As in chickenpox, the vesicles dry up into crusts and disappear within three weeks. They are often compressed against the surface of the foot due to continual weight bearing pressure and may be painful. They are slightly raised, typically less than 3mm in diameter, and appear in crops of 10-30 or more. Their color ranges from pink to brown, and may occur on the forehead and dorsum of the hand. In a young child, these warts may have been transmitted through the birth canal, through spread from cutaneous warts, or they may signify child abuse. Condyloma acuminata are moist, soft, papillomatous lesions that may occur as single or multiple lesions. When treating warts, it is imperative to protect the surrounding skin from irritation. Prior to treatment, plantar, palmar, and common warts should be pared down until the capillaries are revealed. Liquid nitrogen or cantharidin may be used to treat common warts as well as light electrodesiccation and curettage. Common warts and plantar warts may respond to lactic acid or salicylic acid treatments (over the counter topical wart medication). The lesions are small, firm, skin colored papules that are centrally umbilicated.

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