Prepubertal Vulvovaginitis

2019 ◽  
Author(s):  
Kimberly Huhmann ◽  
Hong-Thao Thieu
Keyword(s):  
Streptococcus Pyogenes ◽  
Foreign Bodies ◽  
Voiding Dysfunction ◽  
Signs And Symptoms ◽  
Vaginal Infection ◽  
Hygiene Measures ◽  
Assessment And Treatment ◽  
Staphylococcal Aureus ◽  
Surgical Separation ◽  
Infectious Etiology

Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms. This review contains 1 table and 28 references.  Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction

Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis

2016 ◽  
Author(s):  
Frederick W. Foley
Keyword(s):  
Multiple Sclerosis ◽  
Sexual Dysfunction ◽  
Patient Population ◽  
Behavioral Interventions ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Assessment And Treatment ◽  
Pharmacologic Agents

This chapter discusses the signs and symptoms of sexual dysfunction that are common in persons with multiple sclerosis. The epidemiology of sexual dysfunction in this patient population is presented, along with techniques and instruments for screening for sexual dysfunction. Definitions of primary, secondary, and tertiary sexual dysfunction are reviewed, and a detailed discussion of treatment strategies is presented, including pharmacologic agents, devices, and behavioral interventions.

scholarly journals Iatrogenic delirium on symptom-triggered alcohol withdrawal protocol

2020 ◽  
Vol 12 (1) ◽  
pp. 23-25 ◽  
Author(s):  
Andrew Chunkil Park ◽  
Leigh Goodrich ◽  
Bobak Hedayati ◽  
Ralph Albert ◽  
Kyle Dornhofer ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Treatment Duration ◽  
Treatment Options ◽  
Alcohol Withdrawal Syndrome ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Content Type ◽  
Assessment And Treatment ◽  
Antiepileptic Medications ◽  
Confusional States

Purpose The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal. Design/methodology/approach The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol. Findings While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium. Originality/value This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

scholarly journals A Case of Mysterious Impacted Duodenal Foreign Body Presenting with Halitosis

2017 ◽  
Vol 10 (3) ◽  
pp. 800-807 ◽  
Author(s):  
Bhavtosh Dedania ◽  
Dipen Khanapara ◽  
Amruta Panwala ◽  
Murali Dharan
Keyword(s):  
Foreign Bodies ◽  
Similar Case ◽  
Oral Care ◽  
Adverse Outcomes ◽  
Potential Hazard ◽  
First Case ◽  
Intentional Ingestion ◽  
Hygiene Measures ◽  
Substance Abuse Disorders ◽  
Flexible Wire

The majority of gastrointestinal (GI) foreign bodies (FBs) discovered in adults are the result of intentional ingestion, most of which are found in patients with a preexisting psychiatric illness, with substance abuse disorders, or in people seeking secondary gain. No similar case of internal injuries following unintentional ingestion of a barbecue grill cleaning brush bristle has been reported. A 58-year-old Caucasian male with no significant history presented with complaint of halitosis, not improving after oral care and dental hygiene measures. He denied any other symptoms. After ruling out oral causes of halitosis, an esophagogastroduodenoscopy was performed, which revealed a black wire-shaped metallic FB embedded in the duodenum. The FB was identified as a silver metallic flexible wire resembling the bristle of a barbecue grill cleaning brush. The halitosis resolved completely within 3 weeks of the removal of the FB. To the best of our knowledge, this is the first case of duodenal impaction of a barbecue grill cleaning brush bristle atypically presenting with halitosis. Physicians’ awareness of this potential injury from grill cleaning brush bristles would lead to a quick diagnosis after a focused history. Also avid grillers must be made aware of this potential hazard and should be encouraged to carefully examine the barbecue grill surface for any remnant bristle of the grill cleaning brush. Appropriate history taking, considering GI causes as potentially inducing halitosis, and an awareness of this entity among providers are important to facilitate prompt diagnoses and prevent major adverse outcomes.

Describing disorder: The importance and advancement of compositional explanations in psychopathology

2021 ◽  
pp. 095935432110211
Author(s):  
Hannah Hawkins-Elder ◽  
Tony Ward
Keyword(s):  
Mental Disorder ◽  
Scientific Inquiry ◽  
Network Models ◽  
Signs And Symptoms ◽  
Research Domain Criteria ◽  
Classification Schemes ◽  
Research And Practice ◽  
Assessment And Treatment ◽  
Historical Accounts ◽  
Research Domain

Understanding the makeup of mental disorders has great value for both research and practice in psychopathology. The richer and more detailed our compositional explanations of mental disorder—that is, comprehensive accounts of client signs and symptoms—the more information we have to inform etiological explanations, classification schemes, clinical assessment, and treatment. However, at present, no explicit compositional explanations of psychopathology have been developed and the existing descriptive accounts that could conceivably fill this role—DSM/ICD syndromes, transdiagnostic and dimensional approaches, symptom network models, historical accounts, case narratives, and the Research Domain Criteria (RDoC)—fall short in critical ways. In this article, we discuss what compositional explanations are, their role in scientific inquiry, and their importance for psychopathology research and practice. We then explain why current descriptive accounts of mental disorder fall short of providing such an explanation and demonstrate how effective compositional explanations could be constructed.

scholarly journals Common Radiological Findings in Children with Suspected Foreign Body Inhalation

2020 ◽  
Vol 9 (4) ◽  
pp. 280-284
Author(s):  
Muhammad Junaid ◽  
Mansoor Alam ◽  
Fawad Sahibzada ◽  
Sajid Ali ◽  
Khalid Saeed ◽  
...  
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Emergency Situation ◽  
Signs And Symptoms ◽  
Radiological Findings ◽  
Air Trapping ◽  
Cross Sectional ◽  
Complete Obstruction ◽  
Delayed Extraction ◽  
Foreign Body Inhalation

BACKGROUND: Foreign body inhalation is an emergency situation, affecting children mostly in first decade of life. An aspirated solid or semisolid object may lodge in the larynx or trachea may cause complete obstruction. Lesser degrees of obstruction or passage of the obstructive object beyond the carina can result in less severe signs and symptoms. Chronic debilitating symptoms with recurrent infections might occur with delayed extraction, or the patient may remain asymptomatic. Many aspirated foreign bodies are unexpectedly discovered, go undetected, or are misdiagnosed. In many cases with suspected foreign body radiological findings may reveal other findings e.g. emphysema, atelectasis, air trapping. OBJECTIVE: To determine the frequency of common radiological findings among children with suspected foreign body inhalation. MATERIAL AND METHODS: This cross-sectional descriptive study was conducted at Department of ENT, Khyber Teaching Hospital, Peshawar, from April 2017 to October 2017. In this study a total of 141 patients were observed. All patients were subjected to detailed history and clinical examination. X ray chest (AP and lateral views) of all the patients was performed to detect common radiological findings (Radio-opaque Foreign Body (FB), Pneumonia, Emphysema, atelectasis and Air Trapping). The demographic details like name, age, gender, address and contacts were recorded on a pre-designed proforma. RESULTS: In this study mean age was 8 years with SD ± 3.563.  Sixty percent children were male while 40% children were female. Sixteen percent children had Radio opaque FB, 13% children had pneumonia, 28% had emphysema, 18% children had atelectasis while 25% had Air trapping. CONCLUSION: Our study concludes that the frequency of Radio opaque was 16%, pneumonia 13%, emphysema 28%, atelectasis 18%, Air trapping 25% among children with suspected foreign body inhalation. KEY WORDS: radiological findings, suspected foreign body inhalation, Pneumonia, Emphysema, atelectasis and Air Trapping

scholarly journals A Rare Case of Foreign Body Ingestion, Mimicking as Mesenteric Cyst. "Case Report"

2020 ◽  
Vol 1 (1) ◽  
pp. 56-59
Author(s):  
Saleem Ullah Khan ◽  
Muhammad Kamran ◽  
Asim Ur Rehman ◽  
Muhammad Ramzan ◽  
Imran Hashim ◽  
...  
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Foreign Bodies ◽  
Pediatric Population ◽  
Signs And Symptoms ◽  
Foreign Body Ingestion ◽  
Mesenteric Cyst ◽  
Radiological Investigation ◽  
Diagnostic Dilemma ◽  
Operative Recovery

Background: Foreign body ingestion by children is a commonly encountered problem and accounts for a significant emergency visits among pediatric population. Although these ingested foreign bodies pass spontaneously and uneventfully, a subset of such bodies may become trapped in the digestive tract, eventually leading to significant injury. Most of these bodies are radio-opaque and detectable radiologically, but some radio-lucent may become a diagnostic dilemma and subtle management issue. Case Report: We report a case of a one-year girl who presented after accidental ingestion of foreign body with signs and symptoms of acute intestinal obstruction. Initially we were unable to diagnose the cause, but later the radiological investigation suspected a mesenteric cyst. After failure to respond to conservative measures she underwent exploratory laparotomy, and a jelly ball was removed from the gut. The patient had uneventful post-operative recovery and was kept on follow-up for three months without any complication. Conclusion: These patients do not respond to conservative measures and need surgery on an emergency basis. It is likely that if left untreated may have caused Intestinal perforation and irreversible shock. Radiolucent foreign bodies are difficult to diagnose and need high level of suspicion. Need of the hour is to educate the parents to be extra vigilant as “prevention is better than cure”.

Psychiatric Assessment and Treatment Planning

2014 ◽  
Author(s):  
Janis L. Cutler
Keyword(s):  
Treatment Options ◽  
Signs And Symptoms ◽  
Cultural Perspective ◽  
Psychiatric Assessment ◽  
Appropriate Treatment ◽  
Assessment And Treatment ◽  
History Of ◽  
Psychosocial History ◽  
Patient’S History ◽  
Objective Description

This chapter presents the elements of a psychiatric assessment. After hearing the patient’s chief complaint, the physician elicits the patient’s history of the present illness (a chronological, systematic description of the patient’s signs and symptoms) past psychiatric history, medical history, psychosocial history, family history, and review of systems. The physician also obtains the patient’s mental status examination, which is an objective description of his or her current mental state. Integration of the patient’s history and objective findings results in a comprehensive descriptive and diagnostic impression, which summarizes patterns of data, predicts prognosis, and suggests appropriate treatment options. Use of a biopsychosocial and cultural perspective produces a psychiatric assessment that considers the patient’s strengths and vulnerabilities in relation to his or her cultural group.

scholarly journals Assessment and treatment of individuals at high risk for psychosis

2019 ◽  
Vol 25 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Christina Andreou ◽  
Barbara Bailey ◽  
Stefan Borgwardt
Keyword(s):  
High Risk ◽  
Psychotic Disorders ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Psychotic Symptoms ◽  
List Type ◽  
Evidence Based Treatment ◽  
The Past ◽  
Psychosis Risk ◽  
Assessment And Treatment

SUMMARYEarly detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.LEARNING OBJECTIVESAfter reading this article you will be able to: •recognise signs and symptoms indicating increased psychosis risk•understand uses and limitations of screening for high psychosis risk, and interpretation of results•recognise evidence-based treatment options for patients at clinical high risk for psychosis.DECLARATION OF INTERESTC.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.

scholarly journals EPIDEMOLOGICAL STUDY OF FOREIGN BODIES IN UPPER AERODIGESTIVE TRACT

2020 ◽  
pp. 1-4
Author(s):  
Alokendu Bose ◽  
Indranil Khatua ◽  
Badal Kumar Sahu ◽  
Debarshi Jana
Keyword(s):  
Socioeconomic Status ◽  
Foreign Bodies ◽  
Signs And Symptoms ◽  
P Value ◽  
Upper Aerodigestive Tract ◽  
Significant Difference ◽  
High Incidence ◽  
Risk Patients ◽  
The Common ◽  
Written Informed Consent

Background: Foreign body aspiration may occur at any age, however most of these accidents occur in the children below age three years. The high incidence in young children reflects their tendency to explore their world using their mouths. Furthermore, these children have not yet developed a full posterior dentition, and neuromuscular mechanisms for swallowing and airway protection may not be fully mature. Aim: To describe the common presenting signs and symptoms of foreign bodies among patients attending ENT department at TMH. Material and methods: The present study was carried out in the Department of Otorhinolaryngology, R. G. Kar Hospital, Kolkata, West Bengal. Approval by the ethics committee of Hospital, Jamshedpur is taken and written informed consent of patients is obtained to conduct the study. The study was conducted from August 2014 to December 2015 for a period of 1 and half years. Result: In our study, there was equal incidence of FB among the various socioeconomic statuses. We have clustered 1 and 2 socioeconomic status as upper status, and 3,4 and 5 as lower status. There were statistically no significant difference in the incidence of FB was seen according to their SES, with p – value = 0.7721 { p > 0.05 }. Conclusion: Proper history and examination are the key components to diagnose foreign bodies. Otolaryngologists should categorise high risk patients on the basis of parity of mother, socioeconomic status and education of care giver, and they should be examined thoroughly.

Pain and fatigue

2013 ◽  
pp. 93-99
Author(s):  
Candy McCabe ◽  
Richard Haigh ◽  
Helen Cohen ◽  
Sarah Hewlett
Keyword(s):  
Quality Of Life ◽  
Management Strategies ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Self Management ◽  
Management Support ◽  
Charitable Organizations ◽  
Assessment And Treatment ◽  
Clinical Signs And Symptoms

Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.

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