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Most are brownish-red, and they are especially dense on the periphery of the feet.

Forest carbon credits ‘worse than nothing’? There’s more to this story

Looking elsewhere, similar lesions are noted on the penile corona and glans. These findings prompt a more directed and thorough history, which reveals that the patient is exclusively homosexual and recently engaged in high-risk sexual activity. At this point, the patient admits to consulting a urologist two weeks ago.

Accordingly, laboratory tests, including a rapid plasma reagin RPR , are obtained. The RPR results are positive The case is reported to the county health department. It would be hard to imagine a more classic example of secondary syphilis than was seen in this case, occurring in a patient so obviously at risk. Being a surgical expert on the structural maladies of the foot and ankle in no way imparts expertise in skin diseases of the same areas.

The point is: Skin diseases belong with the experts in skin disease ie, dermatology providers. They are uniquely qualified, not only in terms of recognizing what is being seen, but in being able to see those findings in the context of other physical and historical data. This case is the perfect example.

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But when the rash is composed of round, slightly scaly lesions concentrated on the peripheral feet and hands, the differential narrows significantly. Pointed questions regarding sexual history become necessary. Homosexuality, by itself, is not a risk factor, but engaging in high-risk behaviors performed with exclusively homosexual partners is. These facts, combined with the discovery of the widespread truncal rash, mandated specific blood tests; once those tests confirmed the suspected diagnosis, the law mandated reporting of the case to the health department.

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Representatives of said entity will likely confirm the diagnosis with more specific testing, treat the patient probably with penicillin injection , then take a detailed history of sexual exposure in order to stop the spread of the disease in the community. Physically, this patient will be fine. Krajewski left a calling card for the power company workers who inevitably came to investigate, explaining that he took full responsibility for the action. That, at any rate, is a rough and ready rehearsal of the barest bones on which the stories as told and debated in the worldwide press were based.

There always is.

Spin Time also claim to operate an osteria a Roman tavern , as well as a craft brewery, a carpentry shop, and other activities. Cardinal Krajewski says his only concern was to alleviate an immediate and pressing danger to the health and safety of suffering people. His behaviour and characterisation of his actions after the fact both bespeak unwillingness to be turned into the poster boy for antinomian revolutionaries and fashionable radicals. News Analysis. Christopher Altieri.

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