BIOSOFT HELP FILES

Sacrospinal anomalies are suggested by hairy patches, vascular malformations, asymmetry, pits, lipomata, epispadias, hypospadias, asymmetric gluteal cleft, 

The Centers for Disease Control and Prevention advises that immune-competent adults are not infectious more than 10 days after symptom onset.7 RT-PCR testing detects noninfectious viral RNA up to 12 weeks after infection.7 To distinguish infectious from noninfectious viruses, cycle thresholds may be used. The cycle threshold is the number of cycles a sample must be amplified in the laboratory before the virus can be detected. A low cycle threshold value correlates with higher viral load and contagiousness because fewer cycles are required to detect the virus. Cycle threshold values are also affected by collection technique and vary by assay, reducing their reliability.8
FACTORS AFFECTING CLINICAL SENSITIVITY AND SPECIFICITY OF PCR/RAT
Days from symptom onset - Sn greatest at days 1 - 5 after symptom onset (> 90%), lower Sn earlier before symptoms or more than 5 days after symptoms
Sampling site - Lower Sn for sampling sites other than nasopharynx
RAT compared with rt-PCR testing - Sn - overall 62%-64% lower if asymptomatic, greater if pesymptomatic, to detect like contagious patients 87%-90% Sn lower if asymptomatic, specificity > 99%

SBAR is a reliable and validated communication tool that can be easily implemented in hospital-based practice for sharing information among healthcare providers; however, there are limitations to use in patients with complex medical histories and care plans, especially in the critical care setting. The SBAR tool requires training of all clinical staff so that communication is well understood. It requires a culture change to adopt and sustain structured communication formats by all healthcare providers
Shahid, S., Thomas, S. Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review. Saf Health 4, 7 (2018). https://doi.org/10.1186/s40886-018-0073-1

EMR-SBAR_TOOLS_CLINICAL_HANDOFFS.pdf in MY-LIBRARY(D/LIBRARY
Shahid, S., Thomas, S. Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review. Saf Health 4, 7 (2018). https://doi.org/10.1186/s40886-018-0073-1

OBJECTIVE
To optimize the permethrin-based therapies for scabies infestations in infants and young children, the efficacies of 3 different regimens were evaluated.

STUDY DESIGN
The retrospective analysis encompassed 85 infants and children aged <4 years with scabies. The children had received either topical permethrin 5% on the entire body on days 1/8, on days 1/8/15, on days 1/8/15 plus interim applications restricted to hands and feet on days 2/3/4//9/10/11, or alternative treatments.

RESULTS
The intensified regimen, consisting of full-body permethrin applied on days 1/8/15 and hands/feet on days 2/3/4//9/10/11, resulted in the cure of scabies in 73.5% of the cases. The cure rates were significantly greater compared with full-body permethrin given on days 1/8, which led to eradication in 44%, and were greater compared with the clearance in children who had received full-body permethrin on days 1/8/15 (53.8%) or alternative treatments (60%). For patients in whom permethrin had previously been applied, the intensified regimen resulted in the eradication of scabies in 71.4% of the cases, compared with 30% and 55.6% after full-body permethrin on days 1/8 and 1/8/15, respectively.

CONCLUSIONS
The intensified regimen of full-body permethrin plus interim applications on hands/feet, which aims at reducing the number of mites present on the frequently heavily infested palmoplantar sites in addition to the standard entire body application, appears efficacious in curing scabies in young children.

Comparison of Permethrin-Based Treatment Strategies against Scabies in Infants and Young Children
J Pediatr 2022 Jun 01;245(1)184-189, K Riebenbauer, PB Weber, A Haitel, J Walochnik, J Valencak, D Meyersburg, T Kinaciyan, A Handisurya

Scapular movements are abduction and adduction in the coronal plane, forward titling and rerotilting in the sagittal plane, internal and external rotation in the axial plane, scapular elevation and depression, scapular retraction and protraction.  Scapular dyskinesis means abnormal movements or positioning of the scapula.  The commonest is the scapular protraction.  In an excessively protracted scapula the chance for the contact between the acromion and the supraspinatus tendon is high and thus the impingement symptoms.  This is why scapular retraction exercises are helpful in impingement syndrome of the shoulder.  Abnormally places scapula does not provide a stable platform for shoulder movements (all shoulder muscles start o inser to scapula) and thus shoulder pain due to shoulder muscle fatigue and weakness can be traced to scapular dyskinesis

These are basic assumptions people hold about the self and the environment developed over the course of a life-time.  Some examples are “Unless I do everything perfectly I am a failure”, “Unless I have money I can’t be happy”, and “Unless I am totally without symptoms I am not healthy”

1)      Hydrocele

2)      Hernias

3)      Acute epididymal-orchitis – exclude gonococcal infections (See under genital discharge)

4)      Testicular Torsion – thunderclap scrotal pain, early pubertal, diffuse scrotal tenderness, teste located high in the scrotum, swollen diffusely tender testes, transverse rotation of the testes, anterior epididymis, thickened spermatic cord, past recurrent mild similar episodes, cremasteric reflex negative (retraction of scrotum and testicle with ipsilateral stroking of the inner proximal thigh), Tx – Surgical exploration

5)      Appendiceal Torsion – moderate pain developing over a few days, prepubertal, point tenderness at the upper pole of the testis, cremasteric reflex positive, Mx – bed rest an scrotal elevation

6)      Epididymitis - moderate pain developing over a few days,  adolescence, point tenderness over the epididymis., cremasteric reflex positive, Prehn’s sign positive (scrotal elevation relieves the testicular pain), Mx - Antibiotics

1)      Acute epididymitis – painful swelling of epididymis, tender swelling of epididymis, unilateral testicular pain, tender testes, hydrocele, palpable eoididymis, tendere swollen spermatic cord, in sexually active males associated with asymptomatic urethritis,  but laboratory evidence of urethritis seen, non-STD epididymitis is associated with UT instrumentation, surgery, systemic disease, immunosuppression, Gram stain of urethral secretions show more than 5 WBC  per oil immersion field, WBC with gram negative intracellular diplococci in case of gonococcal infection, first void urine leucocyte esterase test positive, first void urine sediment microscopy shows more than 10 WBC high power field, urethral swab specimens for culture of N. gonorrhoeae and C. trachomatis positive if acute epidicymits is of STD origin, color duplex doppler ultrasonography sensitivity 70% specificity 88%, Tx – for gonococcal or chlamydial infections Ceftriaxone 250 mg IM single dose AND Doxycycline 100 mg PO bid for 10 days, bed rest, scrotal elevation, analgesics, for epididymitis due to enteric organisms Ofloxacin 300 mg PO bid for 10 days OR Levofloxacin 500 mg PO once daily for 10 days, partner evaluation and treatment if sexual contact with the patient within 60 days of symptom onset.  Failure to improve within 3 days requires a re-evaluation of diagnosis and treatment.

2)      Chronic epididymitis

1)      Torsion of testis – surgical emergency

2)      Torsion of appendices of testis – small, painful, tender, firm, para testicular nodule felt at the superior pole of the testis,  managed conservatively with rest, testicular elevation, and NSAIDS

1)      Neonate with an inconsolable crying episode, similar to past recurrent episodes with spontaneous resolution (testicular torsion needs exclusion)

2)      Postpubertal child with acute scrotum, past similar recurrent episodes with spontaneous resolution (needs exclusion of testicular torsion)

3)      Early adolescence with acute scrotum (torsion of appendices of testes and epididymis)

4)      Epididymitis of childhood – exclude sexually transmitted diseases

5)      Acute scrotal pain with absent cremasteric reflex – a pinch or light upstrokes in the superior medial aspect of thighs elicit elevation of the ipsilateral testicle.  This reflex is absent in the  testicular torsion