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Dysuria in Children

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101. Chlamydia - uncomplicated genital

, purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, inflamed or friable cervix. In men: dysuria, urethral discharge, urethral discomfort. Samples are taken by the following methods: In women: endocervical or vulvovaginal swab, or first-void urine sample. In men: first-void urine sample or urethral swab. Treatment should be initiated promptly in all people who test positive for chlamydia, or have symptoms or signs strongly suggestive (...) or intermenstrual bleeding. Purulent vaginal discharge. Mucopurulent cervical discharge. Deep dyspareunia. Dysuria. Pelvic pain and tenderness. Cervical motion tenderness. Inflamed or friable cervix (which may bleed on contact). Suspect chlamydia in sexually active men with: Dysuria. Mucoid or mucopurulent urethral discharge. Urethral discomfort/urethritis. Epididymo-orchitis. Reactive arthritis. Symptoms of rectal chlamydia include anal discharge and anorectal discomfort, although rectal infection is usually

2019 NICE Clinical Knowledge Summaries

102. Neutropenic sepsis

the right topic? Have I got the right topic? From age 1 month onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients [ ]. This CKS topic covers when to suspect and refer cases of suspected neutropenic sepsis in children over one month of age and adults in primary care. This CKS topic does not cover the recognition and referral of pregnant (...) , and notes that epidemiology data from non-specialised centres is lacking [ ]. The European Society for Medical Oncology (ESMO) guidelines state that febrile neutropenia is observed in about 8 cases per 1000 people receiving cancer chemotherapy [ ]. A prospective observational study of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after haemopoietic stem cell transplantation (n = 1792 neutropenic periods) found a rate of 0.76 episodes of febrile neutropenia per 30

2019 NICE Clinical Knowledge Summaries

103. Pyelonephritis - acute

in pregnancy. Emphysematous pyelonephritis. Acute pyelonephritis should be diagnosed by taking a detailed medical history and conducting a physical examination. Acute pyelonephritis should be suspected in people with signs or symptoms of a urinary tract infection (for example, dysuria, frequency, urgency) accompanied by any new signs or symptoms of pyelonephritis (including fever, nausea, vomiting, or flank pain). A midstream or catheter specimen of urine should be sent for culture and sensitivity. A urine (...) acute pyelonephritis in people with signs or symptoms of a urinary tract infection (for example, dysuria, frequency, urgency) accompanied by any of pyelonephritis (including fever, nausea, vomiting, or flank pain). For information on the signs and symptoms of UTI, see the CKS topics on , and . In all people suspected of having acute pyelonephritis, arrange collection of a mid-steam urine (MSU) or catheter specimen of urine (CSU), to determine the infecting micro-organism. Obtain a urine sample

2019 NICE Clinical Knowledge Summaries

104. Urinary tract infection (lower) - women

infecting organisms. Co-morbidities such as immunosuppression. Complications of lower UTI include pyelonephritis, impaired renal function, urosepsis and in pregnancy pre-term delivery and low-birthweight. Clinical features of lower UTI include dysuria, frequency, urgency, change in urine appearance, nocturia and suprapubic discomfort. Typical features may be absent (in particular in those with underlying cognitive impairment) — UTI may present with delirium and reduced functional ability. Urinary (...) Diagnosis of UTI (lower) - women When to suspect UTI When should I suspect lower urinary tract infection? Suspect urinary tract infection (UTI) in a woman presenting with typical features of UTI (in the absence of vaginal discharge or irritation) such as : Dysuria — discomfort, pain, burning, tingling or stinging associated with urination. Frequency — passing urine more often than usual. Urgency — a strong desire to empty the bladder, which may lead to urinary incontinence. Changes in urine appearance

2019 NICE Clinical Knowledge Summaries

105. Sepsis

of severe illness or death, and appropriately. Ask the person/carers about: Any recent fever or rigors. Any symptoms suggesting specific infection, such as dysuria or productive cough. Clinical features suggesting dehydration, such as reduced urine output in the past 18 hours. Any altered behaviour, mental state, or cognition, such as not responding normally to social cues or waking only with prolonged stimulation, or new irritability (in children); new-onset confusion (in adults). See the CKS topic (...) recovery, and sources of information and support. Assessing and managing any complications following sepsis, such as anxiety and/or post-traumatic stress disorder; persistent fatigue; or chronic pain. Have I got the right topic? Have I got the right topic? From age 1 month onwards. This CKS topic covers when to suspect and refer cases of suspected sepsis in children over one month of age and adults in primary care. This CKS topic does not cover the detailed diagnosis or specialist management of sepsis

2019 NICE Clinical Knowledge Summaries

107. Child maltreatment - recognition and management

, hitting, throwing, burning, or suffocating. Sexual abuse involves forcing or tempting a child to take part in sexual activities. Emotional abuse includes conveying to children/young people that they are worthless, unloved, or a burden. Neglect includes the persistent failure to meet the child’s basic physical and/or psychological needs. Fabricated or induced illness involves the misrepresentation of the child as ill by the caregiver by fabricating or inducing symptoms. Healthcare professionals should (...) , children's social care should be contacted to discuss the need for a referral. If the child is thought to be in immediate danger, the police should be informed. If hospital admission is needed, the admitting paediatrician should be made aware of any safeguarding concerns. If maltreatment is considered one possible explanation for a report or clinical feature: Other alerting features of child maltreatment should be sought. Information should be obtained from other agencies and colleagues

2019 NICE Clinical Knowledge Summaries

108. Gonorrhoea

arthralgia, tenosynovitis, or septic arthritis. In men, if left untreated, complications include epididymitis, infertility and prostatitis. In women, complications include pelvic inflammatory disease (PID). Gonorrhoea in pregnancy is associated with spontaneous abortion and other complications. A diagnosis of gonorrhoea may be suspected on the basis of history, symptoms, and examination. In men, symptoms (such as urethral discharge and dysuria) usually develop 2–5 days after exposure. Examination (...) commonly reveals a mucopurulent or purulent urethral discharge, and less commonly epididymal tenderness or swelling. Uncomplicated urogenital infection is asymptomatic in up to 50% of women. Where present, symptoms (such as dysuria and increased or altered vaginal discharge) usually develop within 10 days. No abnormal findings are usually present on examination. Ideally, all people with suspected gonorrhoea should be referred to a genito-urinary (GUM) clinic or other local specialist sexual health

2019 NICE Clinical Knowledge Summaries

109. Avibactam sodium / ceftazidime (Avycaz)

in children 3 months to less than 18 years with a suspected or confirmed bacterial infection and receiving other systemic antibacterial therapy was recently completed. Pending determination of appropriate doses for each age group, a multiple-dose, active-controlled trial will be recommended to evaluate safety, tolerability and efficacy of CAZ-AVI in children with cUTI and cIAI from 3 months to less than 18 years of age. An additional PK and safety study to include neonates from birth to 3 months

2015 FDA - Drug Approval Package

110. Ebymect - dapagliflozin / metformin

makes reference to module 5 of the marketing authorisation application of Xigduo. The most common side effects are hypoglycaemia, nausea, vomiting, diarrhoea, abdominal pain, loss of appetite, vulvovaginitis, balanitis and related genital infections, urinary tract infection, dysuria and polyuria. Specific safety issues regarding a tumour imbalance in dapagliflozin treated patients, the limited data available in patients > 75 years old, the use in patients at risk of volume depletion, hypotension (...) : Warnings and precautions If you are 75 years old or older, you should not start taking this medicine. This is because you may be more prone to some side effects. If you are taking another medicine for diabetes that contains “pioglitazone”, you should not start taking this medicine. Not applicable Pediatric population Product labeling: Posology and method of administration: Paediatric population The safety and efficacy of Xigduo in children aged 0 to < 18 years have not yet been established. No data

2015 European Medicines Agency - EPARs

111. Zerbaxa - ceftolozane / tazobactam

in children and adolescents below 18 years of age have not yet been established. No data are available. Method of administration Zerbaxa is for intravenous infusion. The infusion time is 1 hour for 1 g / 0.5 g of Zerbaxa. Precautions to be taken before handling or administering the product See section 6.2 for incompatibilities. See section 6.6 for instructions on reconstitution and dilution of the medicinal product before administration. 2.2. Quality aspects 2.2.1. Introduction The finished product

2015 European Medicines Agency - EPARs

112. Edistride - dapagliflozin

/EC. 2.4.2. Conclusions on the clinical efficacy The CHMP considers that the clinical data are acceptable to support the marketing authorisation. Assessment report EMA/679678/2015 Page 6/27 2.5. Clinical safety The applicant makes reference to module 5 of the marketing authorisation application of Edistride The most common side effects are hypoglycaemia (when used with a sulphonylurea or insulin), urinary tract infection, genital tract infection, dyslipidaemia, dysuria and polyuria. Specific (...) this medicine. Pediatric population Product labeling: Posology and method of administration: Paediatric population The safety and efficacy of dapagliflozin in children aged 0 to < 18 years have not yet been established. No data are available. Patient information Children and adolescents Forxiga is not recommended for children and adolescents under 18 years of age, because it has not been studied in these patients. Not applicable Pregnancy / Nursing mothers Product labeling: Fertility, pregnancy

2015 European Medicines Agency - EPARs

113. Complications after bladder augmentation or substitution in children: a prospective study of 86 patients. (PubMed)

Complications after bladder augmentation or substitution in children: a prospective study of 86 patients. • To evaluate complications after urinary bladder augmentation or substitution in a prospective study in children.• Data of 86 patients who underwent urinary bladder augmentation (80 patients) or substitution (6 patients) between 1988 and 2008 at the authors' institute were analysed. • Ileocystoplasty occurred in 32, colocystoplasty in 30 and gastrocystoplasty in 18. Urinary bladder (...) , there were a total of 105 complications (39 bladder stones, 16 stoma complications, 11 bowel obstructions, 5 reservoir perforations, 7 VUR recurrences, 1 ureteral obstruction, 4 vesico-urethral fistulae, 4 orchido-epididymitis, 4 haematuria-dysuria syndrome, 3 decreased bladder capacity/compliance, 3 pre-malignant histological changes, 1 small bowel bacterial overgrowth and 7 miscellaneous). • In 25 patients, more than one complication occurred and required 91 subsequent surgical interventions. Patients

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2011 BJU international

114. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

for Childhood Cancer During the past five decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for more than 80% of children with access to contemporary therapies for pediatric malignancies.[ , ] The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as late effects , which manifest months to years after completion of cancer treatment (...) to Support Survivor Care Risk-based screening The need for long-term follow-up for childhood cancer survivors is supported by the American Society of Pediatric Hematology/Oncology, the International Society of Pediatric Oncology, the American Academy of Pediatrics, the Children’s Oncology Group (COG), and the Institute of Medicine. A risk-based medical follow-up is recommended, which includes a systematic plan for lifelong screening, surveillance, and prevention that incorporates risk estimates based

2018 PDQ - NCI's Comprehensive Cancer Database

115. Trichomoniasis

pain, dysuria, and dyspareunia. Of men with trichomoniasis, 15–50% are asymptomatic and usually present as sexual partners of infected women. The commonest symptoms are urethral discharge and/or dysuria. Other clinical features include balanitis, urethral irritation, and increased urinary frequency. The diagnosis of trichomoniasis should ideally be confirmed by a sexual health specialist. If referral is declined or not possible, the person can be tested in primary care, but results may (...) thin and scanty to profuse and thick. The classic discharge is frothy and yellow-green, and occurs in 10-30% of infected women. For other causes of vaginal discharge, see the CKS topic on . Other symptoms include: Vulval itch/vulvovaginal soreness. Offensive odour. Lower abdominal pain and dysuria. Dyspareunia. Inflammation of the vulva and vagina, or more rarely a strawberry appearance of the cervix (cervicitis) may be observed on pelvic examination. No abnormalities are found on pelvic

2018 NICE Clinical Knowledge Summaries

116. Bacterial vaginosis

— characterized by a fishy-smelling, yellow/green frothy discharge that may be associated with itching, soreness, and dysuria. See the CKS topic on for more information. Chlamydia — can cause vaginal discharge and dysuria and does not usually present with itch. See the CKS topic on for more information. Gonorrhoea — rarely presents with itch and is associated with pain and a purulent cervical discharge. See the CKS topic on for more information. Genital herpes — may present with redness, itch, and ulceration

2018 NICE Clinical Knowledge Summaries

117. Chilblains

in children, pregnant or breastfeeding women. If no underlying cause can be identified and there are no contraindications, consider prescribing modified-release nifedipine 20-60mg daily (off-label indication). Titrate slowly up to a maximum dose of 60 mg daily depending on response and tolerability. Monitor the person's blood pressure as nifedipine may be associated with hypotension. Discontinue treatment if not tolerated or response is inadequate. Continue treatment until the lesions have healed (...) , or for the rest of the cold season if prophylaxis is indicated. Seek specialist advice if nifedipine is unsuitable or not tolerated. Do not prescribe nifedipine to children under the age of 18 years or pregnant or breastfeeding women. Advise continuation of self-care and preventative measures in addition to drug treatment. Basis for recommendations Basis for recommendation The recommendations on the management of chilblains are based on the clinical guideline Perniosis (syn. Chilblains) [ ] and expert opinion

2018 NICE Clinical Knowledge Summaries

118. Balanitis

be suspected if there is: Penile soreness and itch, odour, and possible dysuria, difficulty passing urine, and/or dyspareunia. Redness and swelling of the glans penis (and often the foreskin) with exudate; tightening of the foreskin or meatal stenosis; phimosis. Assessment of a person with suspected balanitis should include: Asking about hygiene practices; exposure to potential irritants, allergens and new drugs; trauma, skin conditions, sexual history, and history of immunosuppression. Examining (...) with pain and burning (irritant) or itch (allergic contact dermatitis) with a persistent or recurrent red, scaly rash on the glans penis with localized swelling. Allergic contact dermatitis requires prior sensitization to chemicals such as preservatives, and is uncommon in children. See the CKS topic on for more information. Seborrhoeic dermatitis — this may present with mild itch or redness, with typical scaly lesions elsewhere on the body, such as the nasolabial folds, scalp, ears, eyebrows. See

2018 NICE Clinical Knowledge Summaries

119. Chronic prostatitis and chronic pelvic pain syndrome

, inguinal or rectal regions. 17,22 In addition, they may report dysuria, or pain during or after ejaculation. 17 Findings from a retrospective analysis of clinical records (n=1,563) indicate that the most prevalent localisation for pain is the perineal region (63% of patients), followed by the testicular, pubic and penile areas. 10 Tenderness in the abdominal/pelvic region is also reported by patients with CP/CPPS, with the most common sites including the prostate and pelvic floor muscles. 23,24 (...) symptoms experienced by CBP and CP/CPPS patients. 25-27 Neuropathic pain is also a feature of CP/CPPS and is described in more detail in Box 1. LUTS are also a common clinical presentation, 4,22,28 with cohort studies reporting at least one such symptom in 39– 68% of patients. 4,29 LUTS include voiding symptoms (for example, weak stream, straining and hesitancy) or storage symptoms (for example, urgency with or without urgency incontinence, increased urinary frequency, nocturia and dysuria). 17,30

2015 Prostate Cancer UK

120. Dietary interventions for preventing complications in idiopathic hypercalciuria. (PubMed)

life stages; people with the condition are prone to developing oxalate and calcium phosphate kidney stones. In some cases, crystallised calcium can be deposited in the renal interstitium, causing increased calcium levels in the kidneys. In children, idiopathic hypercalciuria can cause a range of comorbidities including recurrent macroscopic or microscopic haematuria, frequency dysuria syndrome, urinary tract infections and abdominal and lumbar pain. Various dietary interventions have been described (...) that aim to decrease urinary calcium levels or urinary crystallisation.Our objectives were to assess the efficacy, effectiveness and safety of dietary interventions for preventing complications in idiopathic hypercalciuria (urolithiasis and osteopenia) in adults and children, and to assess the benefits of dietary interventions in decreasing urological symptomatology in children with idiopathic hypercalciuria.We searched the Cochrane Renal Group's Specialised Register (23 April 2013) through contact

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2014 Cochrane

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