No bacterial resistance has been reported from BPO usage and in fact it can help limit resistance to antibiotics. Common side effects include burning, stinging, scaling and dryness at the sight of application and can be managed by reducing quantity applied, frequency of application, using a less potent product and use of non-comedogenic moisturizers. Retinoids
Topical retinoids both alone and in combination are also first line for treating mild to moderate cases of acne. Safety and efficacy has been demonstrated in individuals 12–18 years of age. Retinoids prevent formation of comedones and promote comedolysis by binding to retinoic receptors and normalizing growth of keratinocytes. Tretinoin and adapalene have demonstrated efficacy in reducing inflammation. Adapalene as a newer retinoid is thought to be more effective and better tolerated than others in this class. As a topical product, it has similar side effects to topical BPO of burning, stinging, drying and scaling which can be managed much the same way. Reducing the potency of initial treatment, using a non-comedogenic moisturizers, and applying a small amount on the whole face rather than spot-treating may reduce severity of side effects.In severe cases, oral isotretinoin may be recommended to prevent scarring. Dosing ranges from 0.2 mg/kg/day to 2 mg/kg/day for several months to over a year with careful monitoring. Monitoring may include complete blood count with differential and baseline liver function and lipids tests followed by routine liver function and lipid tests while on treatment.
A pelvic fracture is a break of the bony structure of the pelvis. This includes any break of the sacrum, hip bones (ischium, pubis, ilium), or tailbone. Symptoms include pain, particularly with movement. Complications may include internal bleeding, injury to the bladder, or vaginal trauma.Common causes include falls, motor vehicle collisions, a vehicle hitting a pedestrian, or a direct crush injury. In younger people significant trauma is typically required while in older people less significant trauma can result in a fracture. They are divided into two types: stable and unstable. Unstable fractures are further divided into anterior posterior compression, lateral compression, vertical shear, and combined mechanism fractures. Diagnosis is suspected based on symptoms and examination with confirmation by X-rays or CT scan. If a person is fully awake and has no pain of the pelvis medical imaging is not needed.Emergency treatment generally follows advanced trauma life support. This begins with efforts to stop bleeding and replace fluids. Bleeding control may be achieved by using a pelvic binder or bed-sheet to support the pelvis. Other efforts may include angiographic embolization or preperitoneal packing. After stabilization, the pelvis may require surgical reconstruction.Pelvic fractures make up around 3% of adult fractures. Stable fractures generally have a good outcome. The risk of death with an unstable fracture is about 15%, while those who also have low blood pressure have a risk of death approaching 50%. Unstable fractures are often associated with injuries to other parts of the body. Signs and symptoms
Symptoms include pain, particularly with movement.