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# 1
Describe dermatitis, diagnostic criteria, and treatment modalities.

There are two types of dermatitis: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ACD occurs after exposure to an antigen that triggers the immune response, and ICD can occur after any skin exposure to a toxic substance. Both types of dermatitis appear as pruritic streaks of papules, vesicles, and blisters that are in a linear formation. Treatment modalities include topical corticosteroids, systemic corticosteroids, topical immunosuppressants, and antihistamines (Arcangelo et al., 2017).

2. Describe the drug therapy for Conjunctivitis and Otitis Media.

Conjunctivitis

There are two common types of conjunctivitis: bacterial and viral. For mild bacterial conjunctivitis, older generation antibiotic ointments or drops are recommended and are applied every 2 to 6 hours for 5 to 7 days. For moderate to severe conjunctivitis the latest generation antibiotics such as fluoroquinolones are used because they provide strong gram-negative and some gram-positive coverage. Liquid solutions used are polymyxin B/trimethoprim, ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, gatifloxacin, and azithromycin. Ointments are also available such as Bacitracin, erythromycin, and ciprofloxacin. For gonococcal conjunctivitis the recommended drug therapy is ceftriaxone 1 gm intramuscular injection. For concurrent chlamydial infection the treatment is 1 gm azithromycin by mouth.

Viral conjunctivitis due to adenoviruses is self-limiting and does not require treatment with medications. If the viral conjunctivitis is due to herpes simplex infection, patients should receive antiviral therapy. Mild infections can be treated with trifluridine 1% drops or topical ganciclovir 0.15% gel. Conjunctivitis due to herpes zoster can be treated with a combination of oral antivirals and topical steroids. Antivirals used can be acyclovir, famciclovir, or valacyclovir (Hashmi et al., 2024).
Otitis Media
Non-steroidal anti-inflammatory drugs or acetaminophen can be used to control the pain associated with otitis media. Oral antibiotics such as a high dose of amoxicillin or a second-generation cephalosporin are the first-choice treatments especially if there is any suppuration present. If there is a TM perforation, ototopical antibiotics, such as ofloxacin, should be used first because they are safe for the middle ear. High dose amoxicillin-clavulanate can be used for patients whose symptoms do not improve after using amoxicillin alone (Danishyar & Ashurst, 2023).

3. Discuss Herpes Virus infections, patient presentation, and treatment.

There are seven types of herpes viruses: herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), varicella-zoster virus (VSV), Epstein-Barr virus, cytomegalovirus, human herpes virus type 6 (HHV-6), and human herpes virus type 8 (HHV-8). Herpes simplex virus type 1 usually involves the skin above the waist while herpes simplex virus type 2 involves the skin below the waist. Herpes zoster is shingles, and varicella is chicken pox, and both are the result of the varicella-zoster virus. Hhv-6 causes roseola, HHV-8 causes Kaposi sarcoma, and Ebstein-Barr virus causes mononucleosis.

Patients with HSV-1 and HSV-2 present with painful recurrent vesicular eruptions. With primary varicella infections patients present with fever and malaise and later get itchy vesicular lesions on a reddened base. A reactivation of the VSV virus causes shingles, which presents as vesicular lesions on one side of the body. Treatment of herpes viruses can either be with an oral or systemic antiviral drug such as acyclovir, famciclovir, or valacyclovir (Arcangelo et al., 2017).

4. Describe the most common primary bacterial skin infections and the treatment of choice.

The most common primary bacterial skin infections are impetigo, felons, paronychias, cellulitis, and folliculitis. Impetigo is primarily caused by S. aureus alone or in combination with group A Streptococcus (GAS). Impetigo is communicable and is transmitted through person-to-person contact. Cellulitis is an infection involving the skin and subcutaneous layers that can develop in any type of wound. It can possibly spread systemically as well and is most often caused by GAS or S. aureus. Folliculitis is a pustular infection of the hair follicles caused by S. aureus. Lesions are usually found on the cheek, under the nose, the chin, or in the areas of the mid face. Paronychia is an infection of the nailbed tissue caused by nail biting or hangnails. A felon is an infection the involves the pulp space in the finger. Treatments may include broad-spectrum penicillin, first to third generation cephalosporins, fluoroquinolones, and miscellaneous antibiotics such as clindamycin, linezolid, and tigecycline (Arcangelo et al., 2017).

# 2
Question 1:
Dermatitis is a common dermatologic problem which causes an inflammatory reaction after a single or multiple exposure to an agent or in response to an allergen. There are two types, irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ICD results from exposure to any agent that has a toxic effect on the skin, and ACD results from the exposure to an antigen that causes an immunologic response. (Arcangelo et al., 2017).
The pathophysiology of dermatitis involves a complex interplay of genetic, immunological, and environmental factors. Genetics, skin barrier dysfunction, immune system dysregulation, inflammatory cascade, microbial factors, environmental triggers, chronicity and exacerbations are some of the factors involved in the development of irritant or allergic dermatitis.
The two types of dermatitis have similar presentation, both appear as linear streaks of papules, vesicles, and blisters that are very pruritic, the difference between them is that in ICD the lesions are found only in the area of exposure to the irritant and in ACD the lesions are more diffuse and may present over an underlying area of edema. Papules, erythema, excoriation and lichenification due to constant scratching may be present, thus maintaining a normal epidermal barrier is key. (Arcangelo et al., 2017).
Prevention is essential for contact dermatitis. Once the patient becomes aware of the triggers, avoiding them is a must. Before starting the treatment, an assessment is performed to determine the severity of the problem. For mild symptoms, cool compresses and colloidal oatmeal baths may offer relief from pruritus. If it does not improve, pharmacological treatment is needed. The mainstays of therapy are topical corticosteroids and topical immunosuppressives, systemic corticosteroids are recommended for widespread symptoms and antihistamines for pruritus relief, emollients or occlusive dressings may improve barrier repair in dry, lichenified skin, and menthol lotion improves pruritus.
The recommended order for contact dermatitis treatment is:
First line: apply low-potency topical corticosteroid two timer per day. Take oral antihistamine for relief of symptoms. Apply to moist skin surface. Use only 14 days in adult and 7 days in child.
Second line: increase potency of topical corticosteroid. Avoid using moderate-high potency topical corticosteroid on face or intertriginous areas.
Third line: prescribe oral corticosteroid on tapered-dosage regimen. 1mg/kg decreased by 5mg every 2 days, continue therapy for at least 2 weeks. Increase dose if dermatitis flares up, then taper as above.
Complementary and alternative medicine include some supplements like Gingko biloba, Zinc 50 mg daily, fish oils, Vitamin A 50.000 IU daily, Vitamin E 400 IU daily, evening primrose 3.000 mg daily. (Arcangelo et al., 2017).
Question 2:
Conjunctivitis drug therapy
There are three types of conjunctivitis, bacterial, viral and allergic and the treatments vary depending on the cause. To begin with, is important to keep in mind that the infection is highly contagious, thus hand hashing and instrument-cleansing techniques are imperative.
Bacterial Conjunctivitis (nongonococcal, nonchlamidial)
– First line: erythromycin ointment or bacitracin-polymyxin B ointment or solution. Ointment causes a greater degree of blurry vision than solution.
– Second line: ophthalmic fluoroquinolones (besifloxacin, gatifloxacin, levofloxacin, or moxifloxacin.
Seasonal Conjunctivitis (Hay Fever)
– First line: topical antihistamine (alcaftadine or emedastine). Minimize the triggers, cool compresses, artificial tears may help.
– Second line: addition of a low-potency topical corticosteroid or a product with antihistamine/mast cell stabilizer properties. Corticosteroids not more than 2 weeks.
– Third line: ophthalmic ketorolac.
Vernal/Atopic Conjunctivitis
– First line: topical or oral antihistamine or mast cell stabilizer. Minimize the triggers, cool compresses, artificial tears may help.
– Second line: for acute exacerbations addition of a brief course of low-potency topical corticosteroid.
Viral Conjunctivitis
– First line: Topical antihistamines or artificial tears or cold compresses.
– Second line: in several cases a low-potency corticosteroid for no more than 2 weeks.
Giant papillary Conjunctivitis
– Mild disease: one or more of the following, replace contact lenses more frequently, decrease contact lens wearing time, increase the frequency of enzyme treatment, use preservative-free lenses care system, switch to disposable lenses, administer mast cell stabilizer, change the contact lest polymer.
– Moderate to severe disease: same as mild and discontinuation of contact lens wear for several weeks or a brief course of topical corticosteroids.
Otitis Media drug therapy
The main goals are pain relief, prevention of complications and prevention of future antimicrobia .,l resistance. Acetaminophen and Ibuprofen (NSAID) are used to relief pain regardless of antibiotic use. The management of antibiotic use depends on the patient-specific characteristics such as age, bilateral involvement, presence of otorrhea, and severity of illness (Lieberthal et al., 20130.
The first-line therapy includes Amoxicillin as the antibiotic treatment in patients with severe symptoms and who have not had a course of amoxicillin in the past 30 days. If the patient received amoxicillin in the past 30 days, the indication is a combination of amoxicillin-clavulanate. If allergy to penicillin is present, a cephalosporine is indicated as the first-line treatment.
Patients who received antibiotics for more than 72 hours and severe symptoms persist are deemed treatment failure and can be due to the presence of a resistant organism, a viral infection which is not responding to antibiotic therapy, inadequate concentration of antibiotic in the middle ear or noncompliance with the prescribed regimen. The escalation of the drug depends on the initial therapy. If the first drug given was Amoxicillin, the escalation is to Amoxicillin-clavulanate, if fails amoxicillin-clavulanate, an oral cephalosporine (i.e., cefpodoxime, cefuroxime, cefdinir) or 1-dose ceftriaxone IM injection, the patient should receive a 3-day course of IV ceftriaxone (Leibovitz et al., 2000). Tympanocentesis is an option for patient who had failed repeatedly to antibiotic treatment. (Arcangelo et al., 2017).

Question 3:
There are seven different types of herpes viruses associated with human illness. HSV-1, HSV-2, VZV, Epstein-Barr virus, Cytomegalovirus, HHV-6, HHV-8. Herpes viruses replicate their own polymerase along with several of their own enzymes. HSV is highly contagious and is spread by contact with skin or mucous membrane. After the primary infection the virus remains latent until a trigger such as stress, viral infection or sunlight reactivates it.
The infection with HSV-1 and HSV-2 causes painful and recurrent vesicular eruptions with a common incubation period of 4-10 days followed by the eruption of clustered vesicles on an erythematous base. HSV-1 causes oral or facial infections, the primary occurrences usually have intense symptoms, prodromal signs are burning, tingling or itching and then a single or group of vesicles are developed. The VZV (varicella-zoster virus) cause two types of disease, chickenpox and shingles, both with similar symptoms like fever, malaise, itchy vesicular lesions, myalgia, pain.
The goal of the treatment is to reduce the duration of the symptoms and suppress pain by stopping the reproduction of the virus. Topical antiviral agents are used, they work by inhibiting viral DNA synthesis. Acyclovir 5% every 3 hours for 7 days or Penciclovir 1% every 2 hours for 4 days. Systemic antivirals decrease the duration of the rash, and the acute pain associated to herpes zoster. The antivirals used are Acyclovir, Famciclovir, Valacyclovir. Caution in renal disease patients, excretion is by the renal system, contraindication in heart failure and lactation. (Arcangelo et al., 2017).
Herpesvirus infections present with a range of symptoms depending on the specific virus and the patient’s immune status. Early diagnosis and appropriate antiviral treatment are crucial for managing symptoms, preventing complications, and improving patient outcomes. Vaccination plays a key role in preventing certain herpesvirus-related diseases.

Question 4:
The most common bacterial skin infections are impetigo, bullous impetigo, folliculitis, felons, paronychias and cellulitis. The typical bacterial responsible are Staphylococcus aureus, Streptococcus pyogenes and Streptococcus agalactiae.
Impetigo/Bullous impetigo/Ecthyma: they are characterized by scattered vesicular lesions caused by S. Aureus or GAS, in some cases Pseudomonas aeruginosa or fungal organisms are present. It is highly contagious, normally found on the face, scalp or extremities, and begins with scattered, discrete and itchy macules which are spread by scratching and then develop into vesicles and pustules on an erythematous base that eventually rupture, oozing a purulent liquid. Once dried, lesions are thick and honey-colored crusted. The drug therapy includes topical mupirocin ointment three times daily for 7-10 days (Fitzpatrick et al., 1997). In Bullous impetigo mupirocin is less effective, in that case an oral antibiotic is prescribed for 7-10 days. A broad-spectrum penicillin (amoxicillin-clavulanate or dicloxacillin) or a first-generation cephalosporin (cephalexin) is a good first choice. If there is allergy to penicillin, clindamycin is a good alternative. Second line is the use of IV antibiotics like nafcillin. (Swartz, 2000).
Cellulitis and Erysipelas: cellulitis is an infection which involve the skin and subcutaneous layer and has the potential to spread systemically, causing serious illness. It can develop from any type of wound and in the most cases is caused by GAS or S. aureus. Erysipelas is a superficial form of cellulitis and is seen more often in children and the elderly. It can spread rapidly through the skin and lymphatics, causing significant mortality if not treated. The first-line treatment for mild cellulitis starts with oral antibiotic therapy, for more serious illness it requires parenteral treatment and possibly hospitalization. Patients without presence of systemic symptoms or purulence should receive antibiotic therapy directed against GAS such as Penicillin, Amoxicillin-clavulanate or Dicloxacillin. On the other hand, purulent infections should be managed with incision and drainage procedures often in combination with empiric antibiotic against S. aureus. Erysipelas is treated aggressively due to its potential to spread fast, the first choice is oral penicillin or amoxicillin-clavulanate, if serious illness is present, IV therapy is necessary and hospitalization. (Arcangelo et al., 2017).
Pustular infections: Folliculitis, furunculosis and carbunculosis are pustular infections. Folliculitis is a superficial infection of the hair follicle commonly caused by S. aureus, the lesions are found on the cheek or chin, under the nose or on the central facial areas (Trent et al., 2001). Furunculosis and carbunculosis are also caused by S. aureus but both conditions involve deeper areas of the skin and can develop from unresolved causes of folliculitis. (Arcangelo et al., 2017). Erythematous itchy papules that turn into small pustules which rupture and form crusts. A furuncle, which develops from folliculitis, is a painful, pus-filled nodule that encircles a hair follicle. A carbuncle is a confluence of several furuncles that form deep within the dermis frequently accompanied by systemic signs such as fever, malaise, and headache. Warm compresses can be used to facilitate drainage, topical treatments may help, mupirocin, gentamicin or bacitracin. If the infection is too deep, systemic therapy may be started empirically with penicillin, a cephalosporin or fluoroquinolone if it is severe or persistent. The second line is to apply mupirocin to the nostrils, axillae or perineum to eradicate the organism and prevent recurrence. (Arcangelo et al., 2017).

# 3
Qualitative data can be either nominal or ordinal. Nominal data is when you use it to classify, label or categorize a certain variable. An example of this would mean you have a collection of data that is geared toward an audience, and you want to see where all the individuals live. There are people in UK, USA, Asia, and Australia. This is considered nominal data because you are geographically classifying these people. Another way would be classifying these people by hair color. You describe them as brown, blonde, or red head (Quantitative vs Qualitative Data: What’s the Difference?, 2021).
Ordinal data is classifying all of the qualitative data into its natural hierarchy. This is like when you are at the grocery store and at the end, they have you share your experience via a survey. You can either choose poor, outstanding, or above and beyond. While you cannot have a definitive measurement of whether poor and above and beyond, you know that there is a qualifying measure between each category (Streefkerk, 2019).

A chart from Career Foundry breaks down and explains both qualitative and quantitative perfectly (Streefkerk, 2019). This is a great break down to see how both sides are shown:
Quantitative data
my best friend is 5 feet 6 inches
They have size 6 feet
They weigh 63 kilograms
My best friend has one older sibling and two younger siblings
They have two cats
My best friend lives twenty miles away from me
They go swimming four times a week

Qualitative data
My best friend has curly brown hair
They have green eyes
My best friend is funny, loud, and
a good listener
They can also be quite impatient and impulsive at times
My best friend drives a red car
They have a very friendly face and a contagious laugh
Overall, quantitative research is research is expressed in numbers and through graphs. These numbers and graphs are used to test and or confirm theories. Using numbers, surveys, and surveys with close-ended questions. However, this does put the risk of biases. These biases can include information bias, selection bias, sampling bias, and plotted variable bias (Streefkerk, 2019). Whereas qualitative research is used to be expressed in words. This is used to get a better understanding of concepts, experiences and even thoughts. This makes sure there is an in-depth insight in those specific topics that may be hard to simply understand in simple terms. This qualitative research designs can be used with personal interviews that use open-ended questions, reviews and theories. The biases they can be at risk for are observer bias, recall bias, and social desirability bias (Streefkerk, 2019). One last difference between qualitative and quantitative research is that there are advantages and limitations with both. Both of them in research have benefits and downfalls, just like any other thing. However, the research has to take into consideration all of their hypotheses and then see what forms the data collections and analysis’ to produce the most informative and relative findings (Grand Canyon University, 2023).
# 4
There are a multitude of approaches to choose from when it comes to analyzing qualitative and quantitative data, each of which possesses its own particular area of expertise. However, when it comes to combined results that comprise both quantitative and qualitative data, there is a lack of well-defined techniques in these approaches, which would make it possible to evaluate the overall quality of the evidence. We provide a methodical methodology to critically analyzing empirical data that is produced from qualitative and quantitative research by means of the meta-aggregation of findings from implementation and process assessments.For the purpose of standardizing evaluations of the overall rigor of evidence in mixed-method systematic reviews or evidence synthesis, this methodology makes use of a set of criteria. First and foremost, it is necessary to ascertain the credibility of the findings obtained from each individual study. (Olagher, 2023).
On the basis of these individual evaluations, an aggregate score is assigned to each synthesised discovery that was obtained via the meta-aggregation system. Our argument is that this methodology provides a form of critical review that is both fair and inclusive. This is accomplished by first evaluating individual findings rather than studies, and then generating an overall evaluation of the findings that have been synthesized. Alterations can be made to the criteria in order to accommodate a variety of primary research approaches, and they are also adjustable. The objective of qualitative research is to gain an understanding of phenomena by analyzing a significant amount of narrative material. Through the use of approaches such as content analysis, interviews, and observations, it provides an insight into the processes and reasons that come into play when human behavior is seen. However, quantitative research is characterized by its numerical and objective nature; its primary purpose is to measure variables and evaluate statistical relationships. In order to collect and analyze numerical data, a number of different methods are utilized. Some of these methods include conducting experiments, conducting surveys, and using statistical models. In the process, both the geographical and temporal factors are taken into consideration. The separation of data into qualitative and quantitative components, with the latter containing a wide variety of research methods, is made possible by a comprehensive categorization system that allows for the separation of data.
The purpose of both methodologies is to improve our understanding of the world; yet, quantitative research stands out owing to the fact that it is numerical and objective. It seeks to solve questions such as “when” and “where” by providing answers that are specific. One example of a subjective phenomenon that is at the core of qualitative research is the fact that different people express their feelings of melancholy in a variety of different ways.When you begin working on the dissertation or thesis for your academic degree, it is absolutely necessary for you to have a solid understanding of both quantitative and qualitative research theories and techniques. In the event that you reach that point, it is of the utmost importance that you select the strategy that is most suitable for the circumstance that you are examining. It is absolutely necessary for you and the chair of your dissertation to work together in order for this strategy to be successful. As you continue reading, the differences between qualitative and quantitative research will become more apparent to you.
From the research methodologies that were utilized to the strategy for data processing, as well as the advantages and disadvantages of each technique, these observations will cover a wide variety of topics. In addition, we will present a concise summary of mixed-method research, which is a research methodology that integrates the two approaches into a single study. When contrasted with quantitative research, qualitative research is characterized by distinct objectives, methodologies, and styles. When mathematical methods are unable to produce objective measurements or conclusions that can be quantified, qualitative research steps in to fill the hole that such methods leave behind. Comparatively, qualitative research is more inquisitive and makes use of data sources such as images, diary entries, video recordings, and interviews. Quantitative research, on the other hand, seeks precise answers or statistics in a controlled environment.Quantitative research is distinct from qualitative research in that these two types of research employ distinct methods for analyzing data. In contrast to qualitative research, which seeks to discover meaning through the use of exploratory “how?” and “why?” questions, quantitative research provides precise explanations of causal relationships that can be measured and expressed in a scientific manner. While qualitative research may involve visiting individuals in their homes or other locations, quantitative research is typically conducted in a controlled environment. This is in contrast to qualitative research, which may involve visitation. As opposed to qualitative research, which seeks to learn about a subject that is dependent on the context that is being examined, the objective of this study is to collect information that is objective, such as the optimal time to provide a particular medical therapy.
What are the primary distinctions between strategies that are quantitative and those that are qualitative? Researchers who are doing qualitative studies may visit participants at their homes or other locations in order to collect information from smaller samples that were acquired in the field. After the research has been completed, the findings need to be examined and comprehended in the context of the situation. This involves identifying patterns or trends that might serve as a foundation for coming up with new ideas, theories, stories, or hypotheses in the future.When conducting quantitative research, it is common practice to employ instruments (like surveys) rather than people (like interviewers) as the primary methodology. In qualitative research, researchers are expected to draw inferences from the data in order to build theories. This is another significant difference between researchers in quantitative and qualitative research. Researchers have the objective of putting theories to the test through the use of quantitative analyses. There are a variety of approaches that may be taken to analyze quantitative data. Gap analysis, trend analyses, cross-tabulation analyses, and SWOT analyses (which stands for strengths, weaknesses, opportunities, and threats) are some examples of the types of analyses that fall under this category. When it comes to organizing and evaluating your data, there is a specific method that may be utilized, regardless of the system(s) that you employ. (University N, 2023).

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