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Dysuria in Children

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541. Shock, Septic (Overview)

. (See , , , and .) This article does not cover sepsis of the neonate or infant. Special consideration must be given to neonates, infants, and small children with regard to fluid resuscitation, appropriate antibiotic coverage, intravenous (IV) access, and vasopressor therapy. (See , , , , and .) Shock Classification, Terminology, and Staging Shock is identified in most patients by hypotension and inadequate organ perfusion, which may be caused by either low cardiac output or low systemic vascular (...) and gastrointestinal (GI) infections – Diarrhea, abdominal pain, abdominal distention, guarding or rebound tenderness, rectal tenderness or swelling Pelvic and genitourinary (GU) infections – Pelvic or flank pain, adnexal tenderness or masses, vaginal or urethral discharge, dysuria, frequency, urgency Bone and soft-tissue infections – Localized limb pain or tenderness, focal erythema, edema, swollen joint, crepitus in necrotizing infections, joint effusions Skin infections – Petechiae, purpura, erythema

2014 eMedicine Emergency Medicine

542. Renal Calculi (Overview)

at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon. Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however, the incidence of nephrolithiasis in children has increased (...) , Laing FC, Wing VW, Hoddick W. Sensitivity of sonography in pyonephrosis: a reevaluation. AJR Am J Roentgenol . 1985 Jan. 144(1):71-3. . Schneider K, Helmig FJ, Eife R, Belohradsky BH, Kohn MM, Devens K, et al. Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?. Pediatr Radiol . 1989. 19(5):302-7. . Fultz PJ, Hampton WR, Totterman SM. Computed tomography of pyonephrosis. Abdom Imaging . 1993. 18(1):82-7. . Wu TT, Lee YH, Tzeng WS, Chen WC, Yu CC, Huang JK. The role of C-reactive

2014 eMedicine Emergency Medicine

543. Epididymitis (Overview)

a selective approach to antibiotic therapy in pediatric epididymitis. They suggest treating all young infants, regardless of urinalysis results, and older boys who have a positive urinalysis or culture. It is also recommended to presumptively treat sexually active adolescents with epididymitis for sexually transmitted infections. This study excluded boys with recent urologic surgery and known lower urinary tract anomalies. [ ] Antibiotics Empiric coverage varies with the patient's age and sexual history (...) between older and younger patients with epididymitis?. Investig Clin Urol . 2017 May. 58 (3):205-209. . Cristoforo TA. Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis. Pediatr Emerg Care . 2017 Jan 17. . Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children

2014 eMedicine Emergency Medicine

544. Encephalitis (Overview)

, children, and adults are much more likely to have localizing CNS infection almost exclusively due to type 1, in a bimodal distribution of patients aged 5-30 years or older than 50 years. St Louis encephalitis and WNE are more common and are most severe in patients older than 60 years; conversely, LAC is more common and is most severe in children younger than 16 years. EEE and WEE disproportionately affect infants while EEE disproportionately affects children and elderly persons. Previous Next (...) those in children, are treated with antimicrobials) and of the 2 most common causes of encephalitis—the arboviruses and the potentially curable HSV. † Wait 4 hours after glucose load. AFB—acid-fast bacillus; CSF—cerebrospinal fluid; EEE-eastern equine encephalitis; HSV—herpes simplex virus; RBC—red blood cell; TB—tuberculosis; WBC—white blood cell. Contributor Information and Disclosures Author David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section

2014 eMedicine Emergency Medicine

545. Epididymitis (Treatment)

a selective approach to antibiotic therapy in pediatric epididymitis. They suggest treating all young infants, regardless of urinalysis results, and older boys who have a positive urinalysis or culture. It is also recommended to presumptively treat sexually active adolescents with epididymitis for sexually transmitted infections. This study excluded boys with recent urologic surgery and known lower urinary tract anomalies. [ ] Antibiotics Empiric coverage varies with the patient's age and sexual history (...) between older and younger patients with epididymitis?. Investig Clin Urol . 2017 May. 58 (3):205-209. . Cristoforo TA. Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis. Pediatr Emerg Care . 2017 Jan 17. . Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children

2014 eMedicine Emergency Medicine

546. Urinary Incontinence (Diagnosis)

lesions make up the next category of pediatric incontinence disorders. These include spinal dysraphism, tethered spinal cord, and spinal cord tumors. Nonstructural causes account for most cases of pediatric incontinence. [ ] Infection and inflammation may be the source. Dysfunctional voiding habits can develop even at a young age. Some children may become so preoccupied with activities that voiding is delayed until capacity is reached and accidents result. Some believe that certain children develop (...) . The impeded flow of urine may fill the vagina. The vagina empties when the child stands. Nocturnal enuresis is the most common pediatric incontinence disorder. For discussion of this topic, see . Previous Next: Etiology Even in an individual patient, urinary incontinence may have multiple etiologies, with varying degrees of contribution to the overall disorder. Structural and functional disorders involving the bladder, urethra, ureters, and surrounding connective tissue can contribute. In addition

2014 eMedicine Emergency Medicine

547. Urethritis, Male (Diagnosis)

intermittent catheterization suffer urethritis; however, use of latex instead of silicone catheters significantly increases this risk. Symptoms of urethritis ( ) can also be due to sensitivity to chemicals in spermicidal or contraceptive jellies or foams. Idiopathic urethritis of childhood is of uncertain cause, perhaps related to dysfunctional elimination syndrome, [ ] and presents as blood-stained urethral discharge, bleeding between micturition, or dysuria in the 5- to 15-year-old male, and can result (...) characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis . 2011 Mar. 38(3):180-6. . Herz D, Weiser A, Collette T, Reda E, Levitt S, Franco I. Dysfunctional elimination syndrome as an etiology of idiopathic urethritis in childhood. J Urol . 2005 Jun. 173(6):2132-7. . Eradi B, Ninan GK. Intravesical steroid instillation--a novel therapeutic intervention for idiopathic urethritis of childhood. Eur J Pediatr Surg . 2009 Apr. 19(2):105-7. . Henderson L

2014 eMedicine Emergency Medicine

548. Urinary Tract Infection, Female (Diagnosis)

of estrogen with attendant changes in vaginal flora (notably, loss of lactobacilli), which allows periurethral colonization with gram-negative aerobes, such as E coli; and higher likelihood of concomitant medical illness, such as diabetes. Of neonates, boys are slightly more likely than girls to present with UTI as part of a gram-negative sepsis syndrome. The incidence in preschool-aged children is approximately 2% and is 10 times more common in girls. UTI occurs in 5% of school-aged girls, but it is rare (...) infection) represents the majority of these infections (see the image below). Related terms include pyelonephritis, which refers to upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine. Plain radiograph in a 63-year-old patient with poorly controlled type 2 diabetes mellitus shows emphysematous cystitis. Signs and symptoms Symptoms and signs of UTI in the adult are as follows: Dysuria Urinary urgency and frequency

2014 eMedicine Emergency Medicine

549. Urinary Tract Infection, Male (Diagnosis)

to the normal male urinary tract’s many natural defenses to infection, many experts consider UTIs in males, by definition, to be complicated (ie, more likely to be associated with anatomic abnormalities, requiring surgical intervention to prevent sequelae). Signs and symptoms Dysuria is the most frequent chief complaint in men with UTI. The combination of dysuria, urinary frequency, and urinary urgency is about 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream (...) organisms can retard ureteral peristalsis. E coli is responsible for approximately 25% of cases in males, with and causing many remaining infections; , Pseudomonas , , and are less frequent. Bacterial cystitis Bacterial cystitis without concomitant infection in other portions of the genitourinary tract is believed to be a rare event in males. The abrupt onset of irritative voiding symptoms (eg, frequency, urgency, nocturia, dysuria) and suprapubic pain are clinically diagnostic. Most cases of bacterial

2014 eMedicine Emergency Medicine

550. Tuberculosis (Diagnosis)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin

2014 eMedicine Emergency Medicine

551. Optimal Duration of Indwelling Urinary Catheter Following Pelvic Surgery

as catheter discontinuation with inability to void 6 hours post-removal, or void with post-void residual greater than 200 cc of urine. Secondary Outcome Measures : Number of Participants With a Symptomatic Urinary Tract Infection [ Time Frame: During 1 week of hospitalization (prior to discharge) ] Urinary tract infection defined as symptomatic urinary complaints such as dysuria, with urinalysis consistent with infection. Eligibility Criteria Go to Information from the National Library of Medicine (...) to freely give written informed consent to participate in the study and have signed the Informed Consent Form; Males or females, >18 years of age inclusive at the time of study screening; American Society of Anesthesiologists (ASA) Class I-III; Infraperitoneal colorectal surgery (open and/or laparoscopic); Elective Surgery Exclusion Criteria: Mentally incompetent or unable or unwilling to provide informed consent or comply with study procedures; Children <18; No perioperative antibiotics; Past

2013 Clinical Trials

552. Cranberry on Urinary Tract Infections

containing control formulation Drug: Placebo Outcome Measures Go to Primary Outcome Measures : Number of urinary tract infections [ Time Frame: 12 months ] The number of symptomatic UTIs over 12 months (defined by self-report as having one or more of the following symptoms: dysuria, frequency, urgency, hematuria, supra-pubic pressure or fever), the proportion of participants with at least 1 symptomatic UTI, the median time to the first UTI Secondary Outcome Measures : Side effects [ Time Frame: 12 months (...) ] Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: Child, Adult, Older Adult Sexes Eligible for Study: Female

2013 Clinical Trials

553. Ibuprofen Versus Mecillinam for Uncomplicated Cystitis

Criteria Inclusion Criteria: woman between 18 and 60 years of age dysuria and pollakiuria and/or urinary urgency ability to give written consent Exclusion Criteria: pregnancy/breastfeeding child under one month of age diabetes kidney disease organic aciduria clinical suspicion of pyelonephritis; fever, reduced general condition, upper back pain vaginal symptoms such as discharge or irritation severe abdominal pain symptoms that have lasted for more than seven days one or more urinary tract infections (...) symptom load with regard to specific symptoms and when feeling completely symptom free will be registered in the patient diary. Secondary Outcome Measures : The patients' symptom load with regard to specific symptoms. [ Time Frame: Seven days ] Specific symptoms, such as dysuria, urgency and pollakiuria, will be given a number from 0-6 in the patient diary, 0 = no problem and 6= as bad as it can get. Other Outcome Measures: Proportion of patients who were in need of a secondary medical consult within

2013 Clinical Trials

554. Severity of Overactive Bladder Symptoms in Patients After Synergo Treatment

schedule. In the first days following C-HT, storage LUTS (frequency, dysuria, urgency, nocturia) (25.6%) and hematuria (6.0%) are the most common adverse events. Most studies mention that these symptoms were mild and transient, resolving spontaneously within a few days of treatment. One study described severe cystitis complaints in three patients (16%), but other studies have not confirmed these adverse events. Two studies report the development of a contracted bladder and severe urinary incontinence (...) and no evidence of disease at cystoscopic evaluation Criteria Inclusion Criteria: both genders age above 18 bladder cancer patients after completion of Synergo treatment no evidence of disease at cystoscopic evaluation after completion of Synergo treatment Exclusion Criteria: children pregnant women failure to complete Synergo treatment evidence of bladder cancer at cystoscopic evaluation after Synergo treatment Contacts and Locations Go to Information from the National Library of Medicine To learn more about

2013 Clinical Trials

555. Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia. Full Text available with Trip Pro

was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.We found complicated patterns of contraceptive use. The predictors of contraception switching

2013 AIDS Controlled trial quality: uncertain

556. Parental evaluation of postoperative outcome of circumcision with Plastibell or conventional dissection by dorsal slit technique: A randomized controlled trial. (Abstract)

children (p < 0.0001). Postoperatively, children in the PD group required 2.79 fold more analgesic than those in the CDS group. 97.9% of parents in the PD group and 80.2% of parents in the CDS group claimed satisfactory aesthetic results. The PD group parents were statistically significantly more concerned about swelling.Plastibell use has comparable outcomes to the conventional dissection technique for paediatric circumcision and has an obvious advantage of shorter surgical duration. However (...) Parental evaluation of postoperative outcome of circumcision with Plastibell or conventional dissection by dorsal slit technique: A randomized controlled trial. To evaluate and compare parental satisfaction after Plastibell and conventional dissection circumcision.198 children were randomly and equally allocated to two groups (PD: Plastibell and CDS: dissection) for circumcision. Follow-up was done at 7th, 15th and 90th day after surgery. Written questionnaires were given to parents at the time

2013 Journal of pediatric urology Controlled trial quality: uncertain

557. Articles of the month (February 2016)

of disease in childhood. 98(1):27-9. 2013. PMID: Here is a contribution from Dr. Kate Bingham. You probably know how I feel about getting urines in pediatric patients. ( ) However, for newborns, a urine culture is going to get done. This paper describes a technique to get the urine without a foley. Basically, feed kid, wait 25 min, clean genitals, hold baby under armpits (standing position), tap suprapubic area at 100/min for 30 seconds, then massage low back for 30 seconds. Repeat until pee is produced (...) outcome. There weren’t any differences in the secondary outcomes, such as admission to hospital, length of stay, or return visits. Bottom line: Once again, dex is great for asthma Sticking with obvious pediatric topics: ondansetron works Danewa AS, Shah D, Batra P, Bhattacharya SK, Gupta P. Oral Ondansetron in Management of Dehydrating Diarrhea with Vomiting in Children Aged 3 Months to 5 Years: A Randomized Controlled Trial. The Journal of pediatrics. 169:105-109.e3. 2016. PMID: This is another paper

2016 First10EM

558. How to create a modern superhero

How to create a modern superhero How to create a modern superhero How to create a modern superhero | | September 23, 2016 168 Shares You start out by working in a busy emergency department. You see patients with all sorts of complaints: abdominal pain, headaches, and chest pain. Vomiting, diarrhea, and dysuria. Ankle sprains, bug bites, and allergic reactions. Domestic violence, rape, and child abuse. You don’t ever let the stress of the job take away your humanity. You treat your patients (...) have him treat abused patients during the day, and then go after the psychopaths who hurt them at night: the wife beaters, rapists, and child molesters. You make him cunning enough to be able to gather information during his shift, and use that information at night to target the psychopaths. You add depth to this character, place him in a city where you used to work, and add a love story. Soon you realize that one page has led to two hundred. You send it to friends for review, find a professional

2016 KevinMD blog

559. Postrenal Failure

Postrenal Failure Postrenal Failure Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Postrenal Failure Postrenal Failure Aka: Postrenal (...) that results in dilatation of the renal pelvis and calyces. It is caused by obstruction of urine flow, nephrolithiasis, or vesicoureteral reflux. Signs and symptoms include flank pain, nausea, vomiting, fever, and dysuria. Definition (NCI_NCI-GLOSS) Abnormal enlargement of a kidney, which may be caused by blockage of the ureter (such as by a kidney stone) or chronic kidney disease that prevents urine from draining into the bladder. Definition (CSP) distention of the pelvis and calices of the kidney

2015 FP Notebook

560. Vulvar Lichen Sclerosus

Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Vulvar Lichen Sclerosus Vulvar Lichen (...) subepithelial fibrosis. Clinical manifestations include pruritus, dysuria, and dyspareunia. Definition (MSH) Atrophy and shriveling of the SKIN of the VULVA that is characterized by the whitish LICHEN SCLEROSUS appearance, inflammation, and PRURITUS. Concepts Disease or Syndrome ( T047 ) MSH ICD10 SnomedCT 73057003 , 156019006 , 198379009 , 266666006 , 26348009 , 198380007 English Vulvae, Kraurosis , Leukoplakic vulvitis , VULVAL LEUKOPLAKIA , kraurosis of vulva (diagnosis) , kraurosis of vulva

2015 FP Notebook

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