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Dysuria in Children

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81. CRACKCast E095 – Large Intestine

: Bloating Crampy pain Excessive gas Change in bowel habits 10-30% of people progress to diverticulitis (West = left side, Japan = right side) ITIS presentation: LLQ pain (referred to groin or suprapubic) RLQ pain in some! Peritonitis (if perforation) Dysuria / pneumaturia (colovesical fistula) Vomiting / distension (if obstructed) Feces / gas from vagina (colovaginal fistula) A tentative diagnosis can be made clinically, but a CT scan is routinely performed to exclude alternative dx, or complicated (...) types: Organo-axial volvulus is more common in adults, responsible for 60% of presentations Mesentero-axial volvulus is more common in children Organo-axial volvulus more common of the two types in adults (60% of cases) RF: trauma or para-oesophageal hernia Pathophys: stomach rotates around long axis w/ antrum rotates anterosuperiorly fundus rotates posteroinferiorly Mesentero-axial volvulus More common is peds Pathophys: rotation around short axis from the lesser to greater curvature displacement

2017 CandiEM

82. CRACKCast E093 – Appendicitis

of urinary frequency and dysuria or rectal symptoms, such as tenesmus and diarrhea. Children “ Appendicitis is uncommon in neonates, infants and preschool children . Mortality from neonatal appendicitis approaches 28 percent and reflects the difficulty in establishing the diagnosis prior to advanced disease with bowel perforation and sepsis. Case reports indicate that abdominal distension, vomiting, and decreased feeding are the most commonly reported findings in neonates with appendicitis ….. Fever (...) , the average ionizing radiation dose associated with an abdominal x-ray is 0.7 mSv, and the average dose associated with coronary angioplasty is 15 mSv. An abdominal CT carries an excess risk of fatal cancer of 1 in 2000, a value that is even greater in children. However, this value must be tempered by the fact that the general population has a lifetime risk of being diagnosed with cancer of 1 in 3. The risk of radiation increases conversely with age, with children and fetuses having the greatest risk

2017 CandiEM

83. CRACKCast E099 – Urological Disorders

Hematuria UTIs in Adults – Rosens in Perspective Most frequent bacterial infection in adults, one of the most common causes of sepsis Diagnosis is made by: Urinary specific symptoms (dysuria, frequency, urgency, hematuria, suprapubic/CVA discomfort) Bacteriuria (note this alone does not equal UTI! – unless patient Is pregnant or immunocompromised) No other source of infection Classified as: Lower (bladder only) vs. upper (ureters and kidney) Uncomplicated or complicated How is UTI diagnosed? What (...) , unless you have a low pretest probability Urine microscopy helps identify pyuria = > 10 WBC WBC/mm3 or bacteria in the urine IDSA says a positive urine culture is: > 10 5 CFUs/ml = 95% likelihood of infection assuming the patient is symptomatic [1] Differentiate between the three major causes of dysuria? (ddx of dysuria) Cause Urethritis / UTI Vaginitis STIs Gonorrhea, chalmydia, trichomonas, HSV, NGU Mechanical trauma Irritation Clinical features Presence of pyuria Presence of hematuria (50

2017 CandiEM

84. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

-producing C. difficile organisms in stool. ? SYS-CSEP: no change in the definition, but change of the name from ‘clinical sepsis’ to ‘treated unidentified severe infection’ in adults and children, to differentiate this last-resort HAI case definition from the modern concept of sepsis based on organ dysfunction. TECHNICAL DOCUMENT PPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3 3 Objectives The objectives of the ECDC point prevalence survey of healthcare

2016 European Centre for Disease Prevention and Control - Technical Guidance

85. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) ? Patients planning to bear children ? Diabetes ? Obesity ? Geriatric OUTCOMES ASSESSMENT 23. Physicians or their designees should communicate with patients within the early postoperative period to assess if patients are having any significant voiding problems, pain, or other unanticipated events. If patients are experiencing any of these outcomes, they should be seen and examined. (Expert (...) , and severity of incontinence episodes ? Patient’s expectations of treatment (patient- centered goals) ? Pad or protection use ? Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) ? Concomitant pelvic symptoms (e.g., pelvic pain, pressure, bulging, dyspareunia) ? Concomitant gastrointestinal symptoms (e.g., constipation, diarrhea, splinting to defecate) ? Obstetric history (e.g., gravity, parity, method of delivery

2017 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

86. Point-of-care testing for urinary tract infections

by Anacleto et al., 26 the authors compared the accuracy of the Uricult Trio device against conventional urine microscopy and culture. They tested 198 mid-stream clean-catch, randomly voided (i.e. urine collected at any point in the stream) or catheterized urine samples from children aged 0-7 if the sample had been screened positive for nitrites or leukocyte esterase with a urine dipstick test. A urine sample was obtained from children 2 years of age if they presented with dysuria, urgency, flank pain (...) results in pyelonephritis. UTIs are categorised as either uncomplicated or complicated. Uncomplicated UTIs can be further sub- classified into cystitis (lower urinary tract) and pyelonephritis (upper urinary tract). Patients with cystitis typically present with dysuria, frequency, urgency, haematuria and/or suprapubic pain; pyelonephritis classically manifests with flank pain, costovertebral angle tenderness, fever, nausea and vomiting in addition Point-of-care testing for urinary tract infections

2016 NIHR DEC Oxford

87. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

incontinence and concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder) surgical treatment of stress urinary incontinence after appropriate evaluation and counseling have been performed. (Expert Opinion) Physicians may offer synthetic midurethral slings, in addition to other sling types, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) Patients planning to bear children Diabetes Obesity Geriatric (...) from the history, bladder diary, questionnaires, and/or pad testing. Characterization of incontinence (stress, urgency, mixed, continuous, without sensory awareness) Chronicity of symptoms Frequency, bother, and severity of incontinence episodes Patient’s expectations of treatment (patient-centered goals) Pad or protection use Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) Concomitant pelvic symptoms (e.g

2017 American Urological Association

88. Suspected cancer: recognition and referral

Introduction 6 Safeguarding children 7 Patient-centred care 8 T erms used in this guideline 9 1 Recommendations organised by site of cancer 11 1.1 Lung and pleural cancers 11 1.2 Upper gastrointestinal tract cancers 13 1.3 Lower gastrointestinal tract cancers 16 1.4 Breast cancer 17 1.5 Gynaecological cancers 18 1.6 Urological cancers 20 1.7 Skin cancers 22 1.8 Head and neck cancers 24 1.9 Brain and central nervous system cancers 25 1.10 Haematological cancers 25 1.11 Sarcomas 28 1.12 Childhood cancers 29 (...) ). Page 3 of 79Gynaecological symptoms 44 Lumps or masses 45 Neurological symptoms in adults 48 Pain 48 Respiratory symptoms 49 Skeletal symptoms 52 Skin or surface symptoms 53 Urological symptoms 55 Non-specific features of cancer 57 Primary care investigations 64 Symptoms in children and young people 68 More information 74 2 Research recommendations 75 2.1 Age thresholds in cancer 75 2.2 Primary care testing 75 2.3 Cancers insufficiently researched in primary care 75 2.4 Patient experience 76 Update

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

89. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review

Crescenzo , Samuele Cortese , , Nicoletta Adamo , Luigi Janiri Statistics from Altmetric.com Introduction Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric conditions, with a pooled worldwide prevalence estimated at about 5% in school-aged children and persistence of impairing symptoms in adulthood in up to 65% of cases. The pooled estimated prevalence of ADHD (as categorical diagnosis) in adults is around 2.5%. ADHD is characterised by a persistent and impairing (...) for the diagnosis in adults (at least five symptoms of inattention and/or hyperactivity/impulsivity, rather than six as in children) and the inclusion of specific age-appropriate examples of ADHD symptoms in adults. The International Classification of Diseases (ICD-10) describes a syndrome, namely, hyperkinetic disorder (HKD), which overlaps with the predominantly combined ADHD subtype in the DSM-IV. Specifically, the diagnosis of HKD requires symptoms of inattention and hyperactivity/impulsivity ( ). View

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2017 Evidence-Based Mental Health

90. WHO guidelines for the treatment of Genital Herpes Simplex Virus

HSV herpes simplex virus HSV-1 herpes simplex virus type 1 HSV-2 herpes simplex virus type 2 MSH Management Sciences for Health MSM men who have sex with men NAAT nucleic acid amplification test PICO population, intervention, comparator, outcome POCT point-of-care diagnostic test STI sexually transmitted infection UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WHO World Health (...) and reproductive health services that are needed to attain the related targets under Sustainable Development Goal (SDG) No. 3 (Ensure healthy lives and promote well-being for all at all ages), including: target 3.2 – to end preventable deaths of newborns and children under 5 years of age; target 3.3 – to end the epidemics of AIDS and other communicable diseases; target 3.4 – to reduce premature mortality from noncommunicable diseases and promote mental health and well-being; target 3.7 – to ensure universal

2016 World Health Organisation Guidelines

92. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

, Canada Tyler Hughes, M.D. McPherson Hospital McPherson, KS Douglas Katz, M.D., FACR Vice Chairman of Research and Education Winthrop Radiology Associates Winthrop-University Hospital, Department of Radiology Director of Body CT, Winthrop-University Hospital Mineola, NY Anupam Kharbanda, M.D., M.Sc. Director of Research, Emergency Services Associate PEM Fellowship Director Department of Pediatric Emergency Medicine Children’s Hospitals and Clinics of Minnesota Minneapolis, MN Susan Promes, M.D (...) , KS Douglas Katz, M.D., FACR Vice Chairman of Research and Education Winthrop Radiology Associates Winthrop-University Hospital, Department of Radiology Director of Body CT, Winthrop-University Hospital Mineola, NY Anupam Kharbanda, M.D., M.Sc. Director of Research, Emergency Services Associate PEM Fellowship Director Department of Pediatric Emergency Medicine Children’s Hospitals and Clinics of Minnesota Minneapolis, MN Susan Promes, M.D. University of California San Francisco School of Medicine

2016 Effective Health Care Program (AHRQ)

93. WHO guidelines for the treatment of Neisseria gonorrhoeae

Training in Human Reproduction HSV-2 herpes simplex virus type 2 IM intramuscular MSH Management Sciences for Health MSM men who have sex with men NAATs nucleic acid amplification tests PICO population, intervention, comparator, outcome POCT point-of-care test STI sexually transmitted infection UNAIDS Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WHO World Health Organization1 WHO GUIDELINES FOR THE TREATMENT OF NEISSERIA (...) lives and promote well-being for all at all ages), including: target 3.2 – to end preventable deaths of newborns and children under 5 years of age; target 3.3 – to end the epidemics of AIDS and other communicable diseases; target 3.4 – to reduce premature mortality from noncommunicable diseases and promote mental health and well-being; target 3.7 – to ensure universal access to sexual and reproductive health-care services; and target 3.8 – to achieve universal health coverage. Worldwide, more than

2016 World Health Organisation Guidelines

94. WHO guidelines for the treatment of Chlamydia trachomatis

FOR THE TREATMENT OF CHLAMYDIA TRACHOMATIS STI Guideline Development Group (GDG): Chairpersons: Judith Wasserheit, Holger Schünemann and Patricia Garcia Members: * 8 ' @W K D WD ? H F W VO \ P S K R L G W L VVX H D Q GW U D F K R P D H \ HL Q I H F W L R Q CLINICAL PRESENTATION Genital infections due to C. trachomatis are DV \ P SW R P DW L FL QD S S U R [ L P DWH O \ RIZR P H QD Q G RIP H Q (2). Symptoms of uncomplicated chlamydial infection in women include abnormal vaginal discharge, dysuria, and post (...) -coital and intermenstrual bleeding. Common clinical signs on speculum examination include cervical friability and discharge. Symptomatic men usually present with urethral discharge and dysuria, sometimes accompanied by testicular pain. If left untreated, most genital infections will resolve spontaneously with no sequelae but they may result in severe complications, mainly in young women. Infection can ascend to the upper reproductive tract and can F D X V HS H O Y L FL Q A D P P D W R U \G LVH D VHH

2016 World Health Organisation Guidelines

95. Male Urethral Stricture

statements of Strong, Moderate, or Conditional Recommendation based on risks and benefits were developed. Additional information is provided as Clinical Principles and Expert Opinions when insufficient evidence existed. Guideline Statements Diagnosis/Initial Management 1. Clinicians should include urethral stricture in the differential diagnosis of men who present with decreased urinary stream, incomplete emptying, dysuria, urinary tract infection (UTI), and after rising post void residual. (Moderate (...) tend to be located in the bulbar and posterior urethra. Preoperative Assessment Presentation Patients with urethral stricture most commonly present with decreased urinary stream and incomplete bladder emptying but may also demonstrate UTI, epididymitis, rising post-void residual urine volume or decreased force of ejaculation. Additionally, patients may present with urinary spraying or dysuria. 10 Patient Reported Outcomes Measures Patient reported measures (PRMs) help elucidate the presence

2016 American Urological Association

97. Surgical Management of Stones: AUA/Endourology Society Guideline

(s). Index Patients 13 and 14 are children (<18 years if age) with similar characteristics to Index Patients 1-10. Index Patient 15 is a pregnant female with symptomatic renal or ureteral stone(s) with normal renal function without urinary tract infection (UTI). The proximal ureter is defined as the segment distal to the ureteropelvic junction (UPJ) and above the upper border of the sacroiliac joint. The middle ureter is that which overlies the sacroiliac joint and the distal ureter that lies (...) number of studies were available to provide comparative effectiveness inferences in children. Imaging, Pre-operative Testing Guideline Statement 1 Clinicians should obtain a non-contrast CT scan on patients prior to performing PCNL. Strong Recommendation; Evidence Level Grade C × Discussion Neither randomized trials nor comparative studies have specifically addressed the role of preoperative CT prior to PCNL. Nevertheless, the use of CT for preoperative assessment in those with nephrolithiasis has

2016 American Urological Association

98. Management of Chronic Pain in Survivors of Adult Cancers

Dyspareunia, vaginal pain Dysuria Eye pain Oral pain and reduced jaw motion Paresthesias Scleroderma-like skin changes Surgical pain syndromes Lymphedema Postamputation phantom pain Postmastectomy pain Postradical neck dissection pain Postsurgery pelvic floor pain Post-thoractomy pain/frozen shoulder Postsurgery extremity pain (eg, sarcoma) Recommendation 1.4. Clinicians should evaluate and monitor for recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new

2016 American Society of Clinical Oncology Guidelines

99. Urinary Tract Infection?Child

, and the second peak of UTI occurs between the ages of 2 to 4 years during toilet training. After the age of 6 years, UTIs are infrequent and often associated with dysfunctional elimination [8]. Cystitis is a UTI limited to the bladder. Cystitis typically presents with localizing symptoms of frequency, urgency, and dysuria. Acute pyelonephritis is infection of the kidneys. Pyelonephritis typically presents with systemic symptoms such as high fever, malaise, vomiting, abdominal or flank pain, and tenderness [3 (...) -6]. Pyelonephritis can cause renal scarring, which is the most severe long-term sequela of UTI and can lead to hypertension and chronic renal failure [3-6]. With the increased use of prenatal ultrasound (US), it was realized that many of the scars that were attributed to pyelonephritis actually occur in utero and represent renal dysplasia [3-6]. Contrary to earlier studies suggesting that renal scarring secondary to pyelonephritis is the most common cause of chronic renal disease in children

2016 American College of Radiology

100. Clinical Practice Guidelines on Prevention, Diagnosis and Management of Tuberculosis

laboratory diagnosis 41 7 Treatment of tuberculosis 48 8 Public health screening and infection control 70 9 Tuberculosis contact investigations and screening 78 10 Tuberculosis in children - specific considerations 85 11 Cost-effectiveness issues 89 12 Clinical quality improvement 90 Appendix 1 Recommendations for sputum collection 91 Annex 1 MD 532 Notification of Tuberculosis 93 Annex 2 MD 117 Treatment Progress Report 95 References 97 Self-assessment (MCQs) 112 Workgroup members 114 ContentsD Foreword (...) to the Tuberculosis Control Unit or specialists with experience in tuberculosis management. GPP 262 No. Recommendation Grade, Level of evidence CPG Page No. 6 Two sputum samples – including one early morning sample – should be obtained for both microscopy and mycobacterial cultures for patients with suspected pulmonary tuberculosis. Recommendations for sputum collection are in Appendix 1 (page 91). Grade D Level 4 27 7 In patients in whom it is difficult to obtain sputum specimens, e.g. children and stroke

2016 Ministry of Health, Singapore

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