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161. Common Pregnancy Complaints and Questions (Diagnosis)

Common Pregnancy Complaints and Questions (Diagnosis) Common Pregnancy Complaints and Questions: First Trimester, Second Trimester, Third Trimester Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjU5NzI0LW92ZXJ2aWV3 processing > Common Pregnancy Complaints and Questions Updated: May 31, 2016 Author: Fidelma B Rigby, MD; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Common Pregnancy Complaints and Questions First Trimester What are the first symptoms of pregnancy? Missing a period is usually the first signal of a new pregnancy, although women with irregular periods may not initially recognize a missed period as pregnancy. During this time, many women experience

2014 eMedicine.com

162. Psychosocial and Environmental Pregnancy Risks (Treatment)

, especially congenital anomalies. The rate of congenital anomalies in the general population is 3% for defects that are detectable at birth in live-born infants and 6% for defects detected by the end of the first year of life. Because the baseline risk is small, if an exposure conveys a modestly increased risk, a large population of infants is required to detect an increase in anomalies. In addition, the gestational window is critical because exposures outside certain gestational periods may be nontoxic (...) the second and third trimester of pregnancy (eg, Chernobyl, maternal thyroid ablation) is associated with an increased risk of onset of childhood thyroid cancer, but with a less than 5-year lag time; these cancers are also associated with increased morbidity and aggressiveness. Intervention Clearly, preventing exposure during the first trimester is advisable. Informed counseling is needed for patients with conditions that require diagnostic imaging, and it is even more necessary for patients who must

2014 eMedicine.com

163. Schistosomiasis (Overview)

Effects on Women. Reviews in Obstetrics & Gynecology . 2010. 3:28-32. Corachan M. Schistosomiasis and international travel. Clin Infect Dis . 2002 Aug 15. 35(4):446-50. . Houston S, Kowalewska-Grochowska K, Naik S, McKean J, Johnson ES, and Warren K. First Report of Schistosoma mekongi Infection with Brain Involvement. Clinical Infectious Diseases . 2004. 38:e1-6. Mohammed AZ, Edino ST, Samaila AA. Surgical pathology of schistosomiasis. J Natl Med Assoc . 2007 May. 99(5):570-4. . . Leder K, Weller P (...) . [ ] (See Etiology and Epidemiology.) Sometimes referred to as bilharzias, bilharziasis, or snail fever, schistosomiasis was discovered by Theodore Bilharz, a German surgeon working in Cairo, who first identified the etiological agent Schistosoma hematobium in 1851. [ ] A Schistosoma egg is seen below. Egg of Schistosoma hematobium, with its typical terminal spine. Most human schistosomiasis is caused by S haematobium, S mansoni , and S japonicum . Less prevalent species, such as S mekongi and S

2014 eMedicine.com

164. Amebiasis (Treatment)

, and diloxanide furoate) are best suited for such therapy. [ , ] This recommendation is based on 2 arguments: first, that invasive disease may develop, and second, that shedding of E histolytica cysts in the environment is a public health concern. [ ] Asymptomatic E dispar infections should not be treated, but because this organism is a marker of fecal-oral contamination, educational efforts should be initiated. [ ] Metronidazole is the mainstay of therapy for invasive amebiasis. [ , , ] Tinidazole has been (...) agent (eg, paromomycin or diloxanide furoate) to prevent a relapse. [ ] Amebic liver abscess of up to 10 cm can be cured with metronidazole without drainage. [ ] Clinical defervescence should occur during the first 3-4 days of treatment. Failure of metronidazole therapy may be an indication for surgical intervention. Treatment with a luminal agent should also follow. [ ] Chloroquine has also been used for patients with hepatic amebiasis. Dehydroemetine (available from the Centers for Disease Control

2014 eMedicine.com

165. Common Pregnancy Complaints and Questions (Treatment)

Common Pregnancy Complaints and Questions (Treatment) Common Pregnancy Complaints and Questions: First Trimester, Second Trimester, Third Trimester Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjU5NzI0LW92ZXJ2aWV3 processing > Common Pregnancy Complaints and Questions Updated: May 31, 2016 Author: Fidelma B Rigby, MD; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Common Pregnancy Complaints and Questions First Trimester What are the first symptoms of pregnancy? Missing a period is usually the first signal of a new pregnancy, although women with irregular periods may not initially recognize a missed period as pregnancy. During this time, many women experience

2014 eMedicine.com

166. Infertility (Treatment)

courtesy of Jairo E. Garcia, MD. Infertility. Clear preovulatory cervical mucus. Image courtesy of Jairo E. Garcia, MD. Infertility. Fern pattern of preovulatory mucus. Image courtesy of Jairo E. Garcia, MD. At this point, the mucus organizes itself, forming multiple microchannels so the spermatozoa can travel through. During this journey, the spermatozoa simultaneously undergo activation and capacitation. [ ] In addition, the mucus acts as a filter for abnormal spermatozoa and cellular debris present (...) . The relationship between müllerian anomalies and infertility is not entirely clear except when absolute absence of the uterus, cervix, vagina, or a combination of these occurs. Premature delivery has been associated with cervical incompetence, unicornuate uterus associated with a blind horn, and septate uterus. Septate uterus may also be responsible for implantation problems and first-trimester miscarriages. Acquired defects associated with a traumatic delivery, dilatation and curettage, intrauterine device

2014 eMedicine.com

167. Pneumonia, Fungal (Overview)

suspected. Many classes of antifungal agents are now available, including the classic antibiotics; first-, second-, and third-generation triazoles; and the echinocandins. Amphotericin B is less frequently used and, when used, is often given as a liposomal formulation to decrease toxicity. [ ] Next: Risk Factors Workers or farmers with heavy exposure to bird, bat, or rodent droppings or other animal excreta in endemic areas are predisposed to any of the endemic fungal pneumonias, such as , in which (...) are ubiquitous, are usually found worldwide, and tend to cause disease in hosts with abnormal immune defenses. For instance, C neoformans can affect people with intact immune systems at a rate of 0.2 cases per million population per year. Prior to the advent of highly active antiretroviral therapy (HAART), approximately 80-90% of patients with acquired immunodeficiency syndrome (AIDS) developed . [ ] Morbidity and mortality in fungal infection and pneumonia The endemic fungal pneumonias are generally self

2014 eMedicine.com

168. Pneumonia, Fungal (Treatment)

suspected. Many classes of antifungal agents are now available, including the classic antibiotics; first-, second-, and third-generation triazoles; and the echinocandins. Amphotericin B is less frequently used and, when used, is often given as a liposomal formulation to decrease toxicity. [ ] Next: Risk Factors Workers or farmers with heavy exposure to bird, bat, or rodent droppings or other animal excreta in endemic areas are predisposed to any of the endemic fungal pneumonias, such as , in which (...) are ubiquitous, are usually found worldwide, and tend to cause disease in hosts with abnormal immune defenses. For instance, C neoformans can affect people with intact immune systems at a rate of 0.2 cases per million population per year. Prior to the advent of highly active antiretroviral therapy (HAART), approximately 80-90% of patients with acquired immunodeficiency syndrome (AIDS) developed . [ ] Morbidity and mortality in fungal infection and pneumonia The endemic fungal pneumonias are generally self

2014 eMedicine.com

169. Psychosocial and Environmental Pregnancy Risks (Overview)

, especially congenital anomalies. The rate of congenital anomalies in the general population is 3% for defects that are detectable at birth in live-born infants and 6% for defects detected by the end of the first year of life. Because the baseline risk is small, if an exposure conveys a modestly increased risk, a large population of infants is required to detect an increase in anomalies. In addition, the gestational window is critical because exposures outside certain gestational periods may be nontoxic (...) the second and third trimester of pregnancy (eg, Chernobyl, maternal thyroid ablation) is associated with an increased risk of onset of childhood thyroid cancer, but with a less than 5-year lag time; these cancers are also associated with increased morbidity and aggressiveness. Intervention Clearly, preventing exposure during the first trimester is advisable. Informed counseling is needed for patients with conditions that require diagnostic imaging, and it is even more necessary for patients who must

2014 eMedicine.com

170. Tinea Pedis (Overview)

with accompanying mass movements of troops and refugees, the general increase in available means of travel, and the rise in the use of occlusive footwear have all combined to make T rubrum the world's most prevalent dermatophyte. [ ] The first reported case of tinea pedis in the United States was noted in Birmingham, Alabama, in the 1920s. World War I troops returning from battle may have transported T rubrum to the United States. Other Medscape tinea articles include , , , , , , and . Next: Pathophysiology T (...) M Robbins, MD; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Tinea Pedis Overview Background Tinea pedis has afflicted humanity for centuries, so it is perhaps surprising that the condition was not described until Pellizzari did so in 1888. [ ] The first report of tinea pedis was in 1908 by Whitfield, who, with Sabouraud, believed that tinea pedis was a very rare infection caused by the same organisms that produce . Tinea pedis is the term used

2014 eMedicine.com

171. Common Pregnancy Complaints and Questions (Overview)

Common Pregnancy Complaints and Questions (Overview) Common Pregnancy Complaints and Questions: First Trimester, Second Trimester, Third Trimester Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjU5NzI0LW92ZXJ2aWV3 processing > Common Pregnancy Complaints and Questions Updated: May 31, 2016 Author: Fidelma B Rigby, MD; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Common Pregnancy Complaints and Questions First Trimester What are the first symptoms of pregnancy? Missing a period is usually the first signal of a new pregnancy, although women with irregular periods may not initially recognize a missed period as pregnancy. During this time, many women experience

2014 eMedicine.com

172. Infertility (Overview)

courtesy of Jairo E. Garcia, MD. Infertility. Clear preovulatory cervical mucus. Image courtesy of Jairo E. Garcia, MD. Infertility. Fern pattern of preovulatory mucus. Image courtesy of Jairo E. Garcia, MD. At this point, the mucus organizes itself, forming multiple microchannels so the spermatozoa can travel through. During this journey, the spermatozoa simultaneously undergo activation and capacitation. [ ] In addition, the mucus acts as a filter for abnormal spermatozoa and cellular debris present (...) . The relationship between müllerian anomalies and infertility is not entirely clear except when absolute absence of the uterus, cervix, vagina, or a combination of these occurs. Premature delivery has been associated with cervical incompetence, unicornuate uterus associated with a blind horn, and septate uterus. Septate uterus may also be responsible for implantation problems and first-trimester miscarriages. Acquired defects associated with a traumatic delivery, dilatation and curettage, intrauterine device

2014 eMedicine.com

173. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview)

a premalignant or malignant lesion. Biopsy is necessary to rule out primary and secondary malignancies that involve the penis. One case report describes the presentation of acute promyelocytic leukemia as an ulcerating balanoposthitis. [ ] Plasma Cell Balanitis Plasma cell balanitis, also known as Zoon balanitis and balanitis circumscripta plasmacellularis (see ), was first described by Zoon in 1952. This variant of balanitis almost exclusively affects uncircumcised males and is characterized microscopically (...) response rate to the first treatment is approximately 90%. A particular crusted variant (hyperkeratotic or Norwegian scabies) exists, characterized by more keratotic lesions, is seen in patients with HIV or other immunocompromised states. This form is highly contagious, even to individuals who are not immunocompromised, because of the high total mite burden and may lead to localized epidemic outbreaks. Bacterial superinfection, usually by staphylococcal or streptococcal species, may occur. Previous

2014 eMedicine.com

174. Cysticercosis (Overview)

with seizures and their families should know proper seizure first-aid. Patients who have had seizures should know about possible driving restrictions, which, in the United States, vary from state to state. Patients who have received a VP shunt should be educated about the signs and symptoms of elevated ICP (possible shunt failure) and meningitis (secondary infection of indwelling hardware). For excellent patient education resources, please see eMedicineHealth's . Previous References Schantz PM, Moore AC (...) : Mossammat M Mansur, MD, MBBS; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD Share Email Print Feedback Close Sections Sections Cysticercosis Overview Background Cysticercosis (ie, infection caused by eggs of the pork tapeworm) is an increasingly common medical problem in the United States, especially in the Southwest and other areas where large populations migrated from endemic areas and among populations that often travel to these areas. Cysticercosis is caused by the metacestode, or larval

2014 eMedicine.com

175. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Treatment)

treatment suggests a premalignant or malignant lesion. Biopsy is necessary to rule out primary and secondary malignancies that involve the penis. One case report describes the presentation of acute promyelocytic leukemia as an ulcerating balanoposthitis. [ ] Plasma Cell Balanitis Plasma cell balanitis, also known as Zoon balanitis and balanitis circumscripta plasmacellularis (see ), was first described by Zoon in 1952. This variant of balanitis almost exclusively affects uncircumcised males (...) subsequent use. The overall response rate to the first treatment is approximately 90%. A particular crusted variant (hyperkeratotic or Norwegian scabies) exists, characterized by more keratotic lesions, is seen in patients with HIV or other immunocompromised states. This form is highly contagious, even to individuals who are not immunocompromised, because of the high total mite burden and may lead to localized epidemic outbreaks. Bacterial superinfection, usually by staphylococcal or streptococcal

2014 eMedicine.com

176. Amebiasis (Overview)

migrants from and travelers to endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals. E histolytica is transmitted via ingestion of the cystic form (infective stage) of the protozoa. Viable in the environment for weeks to months, cysts can be found in fecally contaminated soil, fertilizer, or water or on the contaminated hands of food handlers. Fecal-oral transmission can also occur in the setting of anal sexual practices or direct rectal inoculation through (...) scenarios may favor inpatient care. See , a Critical Images slideshow, to help make an accurate diagnosis. Next: Pathophysiology E histolytica is a pseudopod-forming, nonflagellated protozoal parasite that causes proteolysis and tissue lysis (hence the species name) and can induce host-cell apoptosis (see the image below). Humans and perhaps nonhuman primates are the only natural hosts. Life cycle of Entamoeba histolytica. Ingestion of E histolytica cysts (see the first image below) from the environment

2014 eMedicine.com

177. Pneumonia, Fungal (Follow-up)

suspected. Many classes of antifungal agents are now available, including the classic antibiotics; first-, second-, and third-generation triazoles; and the echinocandins. Amphotericin B is less frequently used and, when used, is often given as a liposomal formulation to decrease toxicity. [ ] Next: Risk Factors Workers or farmers with heavy exposure to bird, bat, or rodent droppings or other animal excreta in endemic areas are predisposed to any of the endemic fungal pneumonias, such as , in which (...) are ubiquitous, are usually found worldwide, and tend to cause disease in hosts with abnormal immune defenses. For instance, C neoformans can affect people with intact immune systems at a rate of 0.2 cases per million population per year. Prior to the advent of highly active antiretroviral therapy (HAART), approximately 80-90% of patients with acquired immunodeficiency syndrome (AIDS) developed . [ ] Morbidity and mortality in fungal infection and pneumonia The endemic fungal pneumonias are generally self

2014 eMedicine.com

178. Psychosocial and Environmental Pregnancy Risks (Follow-up)

, especially congenital anomalies. The rate of congenital anomalies in the general population is 3% for defects that are detectable at birth in live-born infants and 6% for defects detected by the end of the first year of life. Because the baseline risk is small, if an exposure conveys a modestly increased risk, a large population of infants is required to detect an increase in anomalies. In addition, the gestational window is critical because exposures outside certain gestational periods may be nontoxic (...) the second and third trimester of pregnancy (eg, Chernobyl, maternal thyroid ablation) is associated with an increased risk of onset of childhood thyroid cancer, but with a less than 5-year lag time; these cancers are also associated with increased morbidity and aggressiveness. Intervention Clearly, preventing exposure during the first trimester is advisable. Informed counseling is needed for patients with conditions that require diagnostic imaging, and it is even more necessary for patients who must

2014 eMedicine.com

179. Infertility (Follow-up)

courtesy of Jairo E. Garcia, MD. Infertility. Clear preovulatory cervical mucus. Image courtesy of Jairo E. Garcia, MD. Infertility. Fern pattern of preovulatory mucus. Image courtesy of Jairo E. Garcia, MD. At this point, the mucus organizes itself, forming multiple microchannels so the spermatozoa can travel through. During this journey, the spermatozoa simultaneously undergo activation and capacitation. [ ] In addition, the mucus acts as a filter for abnormal spermatozoa and cellular debris present (...) . The relationship between müllerian anomalies and infertility is not entirely clear except when absolute absence of the uterus, cervix, vagina, or a combination of these occurs. Premature delivery has been associated with cervical incompetence, unicornuate uterus associated with a blind horn, and septate uterus. Septate uterus may also be responsible for implantation problems and first-trimester miscarriages. Acquired defects associated with a traumatic delivery, dilatation and curettage, intrauterine device

2014 eMedicine.com

180. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Follow-up)

treatment suggests a premalignant or malignant lesion. Biopsy is necessary to rule out primary and secondary malignancies that involve the penis. One case report describes the presentation of acute promyelocytic leukemia as an ulcerating balanoposthitis. [ ] Plasma Cell Balanitis Plasma cell balanitis, also known as Zoon balanitis and balanitis circumscripta plasmacellularis (see ), was first described by Zoon in 1952. This variant of balanitis almost exclusively affects uncircumcised males (...) subsequent use. The overall response rate to the first treatment is approximately 90%. A particular crusted variant (hyperkeratotic or Norwegian scabies) exists, characterized by more keratotic lesions, is seen in patients with HIV or other immunocompromised states. This form is highly contagious, even to individuals who are not immunocompromised, because of the high total mite burden and may lead to localized epidemic outbreaks. Bacterial superinfection, usually by staphylococcal or streptococcal

2014 eMedicine.com

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