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Dysuria in Children

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561. Efficacy and Safety Of Spil's Estradiol Vaginal Tablet

. Drug: Estradiol one tablet will be inserted daily for 14 days Other Name: Vagifem Outcome Measures Go to Primary Outcome Measures : Vaginal pH [ Time Frame: 14 days ] Secondary Outcome Measures : Symptoms of vulvar and vaginal atrophy [ Time Frame: 14 days ] Each subject will specify identified most bothersome symptoms vaginal dryness, vaginal and/or vulvar irritation/ itching, dysuria, vaginal pain associated with sexual activity, vaginal bleeding associated with sexual activity) and self-evaluate (...) the symptom on a pre-defined scale 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

2012 Clinical Trials

562. What’s the diagnosis and what’s the gold standard for POCUS??

What’s the diagnosis and what’s the gold standard for POCUS?? What’s the diagnosis and what’s the gold standard for POCUS?? : EDE Blog • March 2, 2015 • A man in his late 50s presented to an ED a while back during the summers months with a 3 day H/O multiple complaints including rhinorhea, sore throat, dry cough, vomiting, loose stool, right frontal headaches, dyspnea, dysuria, and dark urine. So, a mixed picture. Fever of 100.9 was measured at home. No contacts or travel. Pretty healthy (...) standard if done 2 days later or the elective test is not done with a keen eye to look for the findings we’re interested in. Leave a Reply Name ( required ) Email ( required; will not be published ) Website « » Recent Posts April 1st, 2019 I don't have many heroes. Most of mine were accumulated in childhood, a time when that designation p March 25th, 2019 We've talked about this before, but it's time for a reminder. POCUS improves the speed and success March 18th, 2019 Here is another case from Dr

2015 EDE Blog

563. Kidney Stones 01: Presentation

Kidney Stones 01: Presentation Kidney Stones 01: Presentation – PEMBlog Search for: Search for: Kidney Stones 01: Presentation This is part of the four part PEMBlog series on kidney stones. Throughout you’ll learn about diagnosis and management of an increasingly recognized problem in the Pediatric Emergency Department. History Family history is suggestive in about 1/7 children with stones. Metabolic disorders (intestinal malabsorption) are risk factors. In children with metabolic disorders (...) likely to be seen upon presentation in adolescents than school-aged children ( ). Ureteral stones are more painful, as the spasm is intense, and older children and adolescents have them two thirds of the time. Hematuria Gross hematuria is less frequent than the microscopic version in one-third to one-half of patients. Note that some voids may be bloody, others not for the individual patient. noted that the absence of gross hematuria had a 100% NPV – but it was only 24 patients. Dysuria Only one

2015 PEM Blog

564. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

use RCTs 76 Figure 22. RR Number of Children With Adverse Events 82 Figure 23. RR Number of Adults With Adverse Events 83 Figure 24. RR Number of Elderly Participants With Adverse Events 85 Figure 25. RR Number of Critically Ill or High-Risk Participants With Adverse Events 88 Figure 26. Number of Participants With Serious Adverse Events 94 Appendixes Appendix A. Exact Search Strings and List of Manufacturers Appendix B. Sample Data Abstraction Forms Appendix C. Evidence Tables Appendix D (...) no evidence that a particular mechanism or route of administration of probiotic organisms was associated with an increased risk of an adverse event in intervention participants relative to control group participants. Stratified analyses and meta-regressions showed no increased risk of adverse events for children (RR 0.96; 95% CI: 0.88, 1.04; p=0.296, 35 RCTs), adults (RR 0.97; 95% CI: 0.79, 1.19; p=0.745, 40 RCTs), or elderly (RR 0.94; 95% CI: 0.82, 1.08; p=0.367, 4 RCTs) participants compared

2011 EvidenceUpdates

565. Autosomal Dominant Polycystic Kidney Disease (ADPKD)

are not yet sufficient to confirm a favorable benefit/harm balance. In children with autosomal dominant polycystic kidney disease, early use of pravastatin may slow the progression of structural kidney disease . Treatment reference Effect of pravastatin on total kidney volume, left ventricular mass index, and microalbuminuria in pediatric autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 9(5):889-896, 2014. Key Points Autosomal dominant polycystic kidney disease occurs in about 1/1000 (...) , but penetrance is essentially complete; all patients ≥ 80 yr have some signs. In contrast, is rare; incidence is 1/10,000. It frequently causes renal failure during childhood. In 86 to 96% of cases, ADPKD is caused by mutations in the PKD1 gene on chromosome 16, which codes for the protein polycystin 1; most other cases are caused by mutations in the PKD2 gene on chromosome 4, which codes for polycystin 2. A few familial cases are unrelated to either locus. Pathophysiology Polycystin 1 may regulate tubular

2013 Merck Manual (19th Edition)

566. Urinary Frequency

Clinical evaluation Urgency, dysuria, nocturia, purulent urethral discharge with fever, chills, low back pain, myalgia, arthralgia, and perineal fullness Prostate tender to palpation Rectal examination Culture of secretions after prostatic massage Radiation cystitis History of radiation therapy of the lower abdomen, prostate, or perineum for treatment of cancer Clinical evaluation and Asymmetric arthritis of knees, ankles, and metatarsophalangeal joints Unilateral or bilateral conjunctivitis Small (...) Ultrasonography or CT of the kidneys, ureters, and bladder and foul-smelling urine, sometimes fever, confusion, and flank pain, particularly in women and girls Dysuria and frequency in young sexually active men (which suggests an STD) Urinalysis and culture STD testing Bladder detrusor overactivity Nocturia, urge incontinence, weak urinary stream, and sometimes urinary retention Cystometry STD = sexually transmitted disease. Evaluation History History of present illness should first ask about the amounts

2013 Merck Manual (19th Edition)

567. Scrotal Pain

in older men with diabetes, peripheral vascular disease, or both Clinical evaluation Evaluation Expeditious evaluation, diagnosis, and treatment are required because untreated may cause loss of a testis. History History of present illness should determine location (unilateral or bilateral), onset (acute or subacute), and duration of pain. Important associated symptoms include fever, dysuria, penile discharge, and presence of scrotal mass. Patients should be asked about preceding events, including (...) with positive urinalysis, discharge, or dysuria) Color Doppler ultrasonography to rule out torsion (no clear-cut alternate cause) Other testing as suggested by findings (see Table: ) Urinalysis and culture are always required. Findings of UTI (eg, pyuria, bacteriuria) suggest epididymitis. Patients with findings that suggest UTI and patients with urethral discharge or should be tested for STDs as well as other bacterial causes of UTI. Timely diagnosis of testicular torsion is critical. If findings

2013 Merck Manual (19th Edition)

568. Isolated Hematuria

and ureters, prostate, bladder, and urethra. Etiology Most cases involve transient microscopic hematuria that is self-limited and idiopathic. Transient microscopic hematuria is particularly common in children, present in up to 5% of their urine samples. There are numerous specific causes (see Table: ). The most common specific causes differ somewhat by age, but overall the most common are (in adults) Vigorous exercise may cause transient hematuria. Cancer and prostate disease are a concern mainly (...) in patients > 50, although younger patients with risk factors may develop cancer. Glomerular disorders can be a cause at all ages. may represent a primary renal disorder (acquired or hereditary) or be secondary to many causes, including infections (eg, group A beta-hemolytic streptococcal infection), connective tissue disorders and (eg, at all ages, [Henoch-Schönlein purpura] in children), and blood disorders (eg, mixed cryoglobulinemia, serum sickness). Worldwide, is the most common form

2013 Merck Manual (19th Edition)

569. Cervicitis

of cervicitis include gynecologic procedures, foreign bodies (eg, pessaries, barrier contraceptive devices), chemicals (eg, in douches or contraceptive creams), and allergens (eg, latex). Symptoms and Signs Cervicitis may not cause symptoms. The most common symptoms are vaginal discharge and vaginal bleeding between menstrual periods or after coitus. Some women have dyspareunia, vulvar and/or vaginal irritation, and/or dysuria. Mucopurulent Cervicitis By permission of the publisher. From Goldfarb (...) A. In Atlas of Clinical Gynecology: Pediatric and Adolescent Gynecology . Edited by M Stenchever (series editor) and AF Goldfarb. Philadelphia, Current Medicine, 1998. Examination findings can include purulent or mucopurulent discharge, cervical friability (eg, bleeding after touching the cervix with a swab), and cervical erythema and edema. Diagnosis Clinical findings Testing for vaginitis and STDs Cervicitis is diagnosed if women have cervical exudate (purulent or mucopurulent) or cervical friability

2013 Merck Manual (19th Edition)

570. Overview of Vaginitis

is directed at the cause and at any severe symptoms. Etiology The most common causes vary by patient age. Vulvitis and vulvovaginitis have some of the same causes. Children In children, vaginitis usually involves infection with GI tract flora (nonspecific vulvovaginitis). A common contributing factor in girls aged 2 to 6 yr is poor perineal hygiene (eg, wiping from back to front after bowel movements; not washing hands after bowel movements; fingering, particularly in response to pruritus). Chemicals (...) in bubble baths or soaps may cause inflammation. Foreign bodies (eg, tissue paper) may cause nonspecific vaginitis with a bloody discharge. Sometimes childhood vulvovaginitis is due to infection with a specific pathogen (eg, streptococci, staphylococci, Candida sp; occasionally, pinworm). Women of reproductive age In these women, vaginitis is usually infectious. The most common types are , which is sexually transmitted Normally in women of reproductive age, Lactobacillus sp is the predominant

2013 Merck Manual (19th Edition)

571. Genital Herpes

that are caused by genital herpes. This photo shows vesicles and ulcers in the vulva of a woman with recurrent genital herpes. This photo shows a cluster of vesicles on the penile shaft in a man with genital herpes. This photo shows groups and clusters of vesicles and ulcers in a man with primary genital herpes. This photo shows widespread ulceration of the penis and scrotum due to coalescence of smaller lesions in a man with severe genital herpes infection. Urinary hesitancy, dysuria, urinary retention (...) acyclovir starting at 36 wk gestation to reduce the risk of a recurrence and thus the need for cesarean delivery. Fetal scalp monitors should not be used during labor on infants whose mothers have suspected active genital herpes. Key Points After the initial infection, HSV remains dormant in nerve ganglia, from which it can periodically emerge. Transmission may occur through contact with the lesions, but viral shedding and transmission can also occur when lesions are not apparent (asymptomatic shedding

2013 Merck Manual (19th Edition)

572. Typhoid Fever

people, infants, and the elderly. Stupor, coma, or shock reflects severe disease and a poor prognosis. Complications occur mainly in patients who are untreated or in whom treatment is delayed. Treatment Ceftriaxone Sometimes a fluoroquinolone or azithromycin Antibiotic resistance is common and increasing, particularly in endemic areas, so susceptibility testing should guide drug selection. In general, preferred antibiotics include Ceftriaxone 1 g IM or IV q 12 h (25 to 37.5 mg/kg in children) for 14 (...) vaccination, the current threat of a smallpox outbreak is most likely to come from which of the following? Bioterrorism Immunodeficiency Travel abroad Vaccination refusal NEWS & VIDEOS MMR Not Linked to Autism in Danish Cohort Study MONDAY, March 4, 2019 (HealthDay News) -- Measles, mumps, rubella (MMR) vaccination is not associated with an increased risk for autism, including in children with autism risk factors, according... Video Overview of Tuberculosis (TB) SOCIAL MEDIA Add to Any Platform Loading

2013 Merck Manual (19th Edition)

573. Fever

, the current threat of a smallpox outbreak is most likely to come from which of the following? Bioterrorism Immunodeficiency Travel abroad Vaccination refusal NEWS & VIDEOS MMR Not Linked to Autism in Danish Cohort Study MONDAY, March 4, 2019 (HealthDay News) -- Measles, mumps, rubella (MMR) vaccination is not associated with an increased risk for autism, including in children with autism risk factors, according... Video Overview of Tuberculosis (TB) SOCIAL MEDIA Add to Any Platform Loading Topic Resources (...) and ultimately failure of most organs; the coagulation cascade is also activated, leading to (DIC). Because fever can increase the basal metabolic rate by about 10 to 12% for every 1 ° C increase over 37 ° C, fever may physiologically stress adults with preexisting cardiac or pulmonary insufficiency. Fever can also worsen mental status in patients with dementia. Fever in healthy children can cause . Etiology Many disorders can cause fever. They are broadly categorized as Infectious (most common) Neoplastic

2013 Merck Manual (19th Edition)

574. Acute Liver Failure

, malaise, anorexia) or result from the causative disorder. Fetor hepaticus (a musty or sweet breath odor) and motor dysfunction are common. Tachycardia, tachypnea, and hypotension may occur with or without sepsis. Signs of cerebral edema can include obtundation, coma, bradycardia, and hypertension. Patients with infection sometimes have localizing symptoms (eg, cough, dysuria), but these symptoms may be absent. Diagnosis Prolongation of PT and/or clinical manifestations of encephalopathy in patients (...) [anti-HCV]) Autoimmune markers (eg, antinuclear antibodies [ANA], anti–smooth muscle antibodies, immunoglobulin levels) Other testing is done based on findings and clinical suspicion, as for the following: Recent travel to developing countries: Tests for A, B, D, and E Females of child-bearing age: Pregnancy testing Age < 40 and relatively normal aminotransferase levels: Ceruloplasmin level to check for Suspicion of a disorder with structural abnormalities (eg, , , ): Ultrasonography and sometimes

2013 Merck Manual (19th Edition)

575. Urinary Incontinence in Adults

urethritis Atrophic vaginitis Thinning of urethral and vaginal epithelium and submucosa may cause local irritation and decrease urethral resistance, length, and maximum closure pressure with loss of the mucosal seal. These disorders are usually characterized by urgency and occasionally by scalding dysuria. Foreign bodies Bladder irritation precipitates spasm. Only symptomatic UTIs cause incontinence. Dysuria and urgency can prevent patients from reaching the toilet before voiding. Neuropsychiatric (...) micturition center Voiding dysfunction of childhood (poor relaxation of the sphincter with bladder contraction can result from the fear of bed wetting or soiling of clothes) *Other prostate surgical procedures rarely cause established incontinence. Outlet incompetence is a common cause of stress incontinence. In women, it is usually due to weakness of the pelvic floor or of the endopelvic fascia. Such weakness commonly results from multiple vaginal deliveries, pelvic surgery (including hysterectomy), age

2013 Merck Manual (19th Edition)

576. Obstructive Uropathy

occasionally cause a palpable flank mass, particularly in massive hydronephrosis of infancy and childhood. Urine volume does not diminish in unilateral obstruction unless it occurs in the only functioning kidney (solitary kidney). Absolute anuria occurs with complete obstruction at the level of the bladder or urethra. Partial obstruction at that level may cause difficulty voiding or abnormalities of the urine stream. In partial obstruction, urine output is often normal and is rarely increased. Increased (...) of bladder catheterization, cystourethroscopy, and imaging (eg, ultrasonography, CT, pyelography), depending on the level of obstruction. Treatment, depending on cause, may require prompt drainage, instrumentation, surgery (eg, endoscopy, lithotripsy), hormonal therapy, or a combination of these modalities. The prevalence of obstructive uropathy, depending on the cause, ranges from five in 10,000 to five in 1,000. The condition has a bimodal distribution. In childhood, it is due mainly to congenital

2013 Merck Manual (19th Edition)

577. Evaluation of the Elderly Patient

, constipation, drugs (eg, antihistamines, opioids), prostate cancer, urinary retention, UTI Dysuria with or without fever Prostatitis, UTI Polyuria Diabetes insipidus (decrease in ADH action), diabetes mellitus, diuretics Incontinence Cystitis, functional decline, normal-pressure hydrocephalus, spinal cord dysfunction, stroke, urinary retention or overflow, UTI Musculoskeletal Back pain Abdominal aortic aneurysm, compression fractures, infection, metastatic cancer, multiple myeloma, osteoarthritis, Paget (...) the number of tablets in each vial during the first and subsequent visits may be necessary. If someone other than a patient administers the drugs, that person is interviewed. Patients should be asked to demonstrate their ability to read labels (often printed in small type), open containers (especially the child-resistant type), and recognize drugs. Patients should be advised not to put their drugs into one container. Alcohol, tobacco, and recreational drug use history Patients who smoke should

2013 Merck Manual (19th Edition)

578. Vesicoureteral Reflux

with a history of fetal hydronephrosis or with a UTI or appear as part of a sibling screening. Rarely, children present with hypertension, which is more commonly a long-term consequence of renal scarring. Children with UTI may have fever, abdominal or flank pain, dysuria, frequency, urgency, wetting accidents, or rarely hematuria. Diagnosis Ultrasonography Voiding cystourethrography (VCUG) Sometimes radioisotope scan Urinalysis and culture are done to detect infection. In infants and young children (...) with an increased risk for being diagnosed with depression, according to a study... 3D Model Cystic Fibrosis: Defective Chloride Transport Video How to Catheterize the Urethra of a Male Infant or Small Child SOCIAL MEDIA Add to Any Platform Loading , MD, University of Rochester Medical Center; , MD, University of Rochester School of Medicine and Dentistry Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Vesicoureteral reflux is retrograde passage of urine from

2013 Merck Manual (19th Edition)

579. Gonorrhea

intercourse, likelihood of transmission from women to men is about 20%, but from men to women, it may be higher. Neonates can acquire during passage through the birth canal, and children may acquire gonorrhea as a result of sexual abuse. In 10 to 20% of women, cervical infection ascends via the endometrium to the fallopian tubes (salpingitis) and pelvic peritoneum, causing (PID). Chlamydiae or intestinal bacteria may also cause PID. Gonorrheal cervicitis is commonly accompanied by dysuria or inflammation (...) and very few infected men are asymptomatic. About 25% of men have minimal symptoms. Male urethritis has an incubation period from 2 to 14 days. Onset is usually marked by mild discomfort in the urethra, followed by more severe penile tenderness and pain, dysuria, and a purulent discharge. Urinary frequency and urgency may develop as the infection spreads to the posterior urethra. Examination detects a purulent, yellow-green urethral discharge, and the meatus may be inflamed. Gonorrhea (Urethritis) ©

2013 Merck Manual (19th Edition)

580. Chlamydial, Mycoplasmal, and Ureaplasmal Mucosal Infections

conjunctivitis, and infant pneumonia. Untreated chlamydial salpingitis can become chronic, causing minimal symptoms but having serious consequences. Diagnosis is by culture, immunoassay for antigens, or nucleic acid–based tests. Treatment is with single-dose azithromycin or a week of ofloxacin , levofloxacin , erythromycin , or a tetracycline . (See also .) Several organisms can cause nongonococcal sexually transmitted cervicitis in women and urethritis, proctitis, and pharyngitis in both sexes (...) transmitted, including and (chlamydiae) and pneumonia (chlamydiae and mycoplasmas). Symptoms and Signs Men develop symptomatic urethritis after a 7- to 28-day incubation period, usually beginning with mild dysuria, discomfort in the urethra, and a clear to mucopurulent discharge. Discharge may be slight, and symptoms may be mild but are frequently more marked early in the morning; then, the urethral meatus is often red and blocked with dried secretions, which may also stain underclothes. Occasionally

2013 Merck Manual (19th Edition)

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