Directory of health resources for healthcare professionals.

Laboratory Tests
In men, urine cultures should always be performed. Midstream urine collection is unnecessary in men. Even in uncircumcised men, the likelihood of contamination is low. Culture is considered positive with a CFU exceeding 103/ml of one organism.
Based on history and physical examination findings, acute uncomplicated cystitis is difficult to differentiate from prostatitis. Three-glass or four-glass testing can help to localize the infection.21 First-void (urethral), midstream (bladder), and end-stream (bladder) urine samples are collected and cultured. A fourth sample is obtained by expressing secretions through prostatic massage. Infection is localized to the prostate if the prostatic samples (end-void or prostatic secretions) yield a 10-fold greater colony count than the first-void sample. Most clinicians do not routinely perform these tests because they are cumbersome, expensive, and not well standardized. Some clinicians opt to perform simple urinalysis on three- or four-glass specimens. In men whose culture findings are negative, testing for gonorrhea and chlamydia should be performed. Other possible pathogens include Ureaplasma, Trichomonas, and herpes simplex virus.

Treatment
Antibiotic choice in men is similar to that in women. However, beta-lactams and nitrofurantoin tend to be less effective, since they do not achieve high concentrations within the prostate gland. Fluoroquinolones are generally favored, and men are typically treated for 7 to 14 days. Recurrent infection likely represents residual prostatic infection, in which case retreatment for 4 to 6 weeks is prudent.

Follow-Up
About one third of young men with one UTI have demonstrable (on renal ultrasonogram, intravenous pyelogram, or voiding cystourethrogram) urinary tract defects. However, these numbers may not differ much from women’s and usually do not affect treatment. Isolated infections are treated with 7 to 10 days of antibiotics, and frequent infections (more than two per year) are treated with prophylaxis. Most experts do not recommend urologic evaluation for men with a single UTI.
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S. Jain was infatuated with Miss Sheila, a co-worker in a factory. S. Jain was a married man with 3 children.  Their unusual closeness was spotted by other workers, eyes were raised, and Mr. Jain felt very embarrassed. Although they averred they had only brother-sister relations, but nobody believed them. Due to an uneasy conscience, he doubted everybody. When other workers were talking about themselves or discussing something, Jain felt they were talking about him or Miss. Shiela, and found some excuses to pick up a quarrel with them. On the roadside if a boy passed some remark against the girl, Mr. Jain was ready to start a fight. Ultimately the management warned Mr. Jain to desist from quarrelling with other workers in the factory on the plea of “protecting the girl” as that was none of his responsibility. When this warning proved ineffective and he again picked up a quarrel in the factory because of that girl, he was issued a show cause notice for termination of his services. Under these circumstances, he came to us for help. He confessed to us that he felt so possessive of the girl that he could not tolerate any body raising a finger against her.
Chicory given three times a day for 3 weeks loosened his mental shackles and he felt freed from any bondage to “protect the girl”. Thence forward his relations with fellow workers became normal.
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Pain in the back is among the most frequent of all symptoms affecting human beings. A woman was once defined as “a two-legged animal with a pain in the back.” Man has been declared by mechanical experts “a mechanical misfit.” The backbone is shaped like a spring curved like the letter “S”. The spinal column is composed of small bones between which are cushions of cartilage known as disks. The bones are bound together by strong tissues called ligaments. The nerves come out in little notches between the bones. Any inflammation or infection of any of these tissues may cause a pain in the back. A sudden stress or a long-continued strain may throw any of the joints into a wrong position. Diseases may injure the cartilage or bone and result in pain. People who do heavy lifting or who stand long on their feet are especially likely to have pains in the back.
The common name for backache is lumbago; scientifically doctors speak of it as low back-pain, since it is the lower portion of the spine that is most frequently affected. In determining the cause of the pain in the back, X-ray pictures are a necessity. The use of such pictures and of other tests will reveal whether or not damage has been done to a disk, or whether or not it has slipped out of position. Sometimes an inequality in the length of the legs, even of a tiny amount, may throw a strain on some portion of the back and bring about pain. Tumors also affect the back, as they do any other portion of the body.
Sometimes backache is incidental to gout, gall bladder disease, ulcer of’ the stomach, or childbirth. The pain in the back which women often have after childbirth is sometimes related to the organs of childbirth, but at other times to disturbances of the intestines and kidneys. Sometimes the stress comes from sleeping in a bed which does not properly support the spine. For this reason, the doctor who handles such cases will want to know about the bed. He may consider the patient’s obtaining relief by wearing proper braces or supports. He will treat any detectable infection. He will measure the length of the legs, examine the patient for overweight or flat feet, and of course prescribe drugs, to relieve the pain while he is making his studies. He will also recommend the application of heat and sometimes of massage or manipulation to bring about relief.
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“Circe’s teacher called us this week because she is daydreaming in class. We had told her to watch for seizures in the beginning of the year, and now she thinks that Circe is having absence seizures again. Should we increase her medicine?”
Circe could be having more absence seizures. Perhaps this alert teacher has identified the problem early. Have you seen any at home? Is Circe aware of missing things? Is it possible that the teacher is just watching too closely and misinterpreting things? Perhaps we should first check the blood level to be certain that she is taking the medication and taking enough. Perhaps we should see Circe and hyperventilate her to see if we can produce one of her spells. If we can’t be sure in the office, we might want to have another EEG to see if she is still having electrical spells. In this way we can sort out if Circe has a problem and the best approach to correcting it.
Learning problems are more common in children who have epilepsy. Early identification of a problem, if it exists, can lead to strategies for compensation and a far more successful school learning experience. However, learning problems can also be secondary to the medication, to psychological stress, and to the school’s and the teacher’s reaction to the child and to epilepsy. Changes in school performance are best identified by the teacher, who, together with your physician, can also be your and your child’s best ally in finding the cause and the best approach to a solution.
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The normal body temperature in children varies, but the average is about 37° Celsius (98.4°F). During the course of each day, the body temperature will vary by a degree or two. It is usually lowest in the early hours of the morning, and highest in the late afternoon and early evening.

Most doctors would define a fever as a temperature greater than 38.5° Celsius, which is present for 24 hours or more. A child may have a slightly raised temperature for a brief period of time for many reasons, including increased physical activity.

It is often inaccurate to try to determine the child’s temperature without a thermometer. Feeling a child’s skin temperature (for example, by putting lips to the forehead) is not a reliable way of diagnosing a fever. Sometimes a child may appear flushed, and his skin may feel warm, but the child’s core temperature will in fact be quite normal. This is seen especially when he has a cold or has engaged in vigorous physical exercise. It can also occur on a very hot day.

All parents should have a reliable thermometer and be able to take their child’s temperature. If you are not sure how to do this, ask your local doctor or maternal and child health or community nurse to show you. A child’s temperature can be taken orally (putting a thermometer in the mouth under the tongue), rectally (putting the thermometer a little way into the baby’s rectum), or under the armpit. Under the armpit is usually the safest way, especially in young children.

Often taking the temperature of a baby or young child is more difficult than it seems. Generally, temperatures can only be taken orally in children over the age of 6 years. Below this age they are usually unable to co-operate and may bite the thermometer which contains mercury which is dangerous if swallowed. Children who have a blocked nose due to a cold may find it hard to breathe keeping their mouth closed, so that a reading obtained from the armpit is often easier. Rectal temperatures are best reserved for babies and young children under the age of 12 months. Taking a rectal temperature is often difficult, especially when the baby is very active — there is a risk of the thermometer sliding out of the rectum, or of the tip of the thermometer damaging the lining of the rectum.

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Bag urine

This test is used for babies and children who are not yet toilet trained. It is less reliable than an MSU (see opposite), but is useful to exclude the presence of a urinary tract infection.

Procedure

If you are at a clinic, the staff will help you with this procedure. Clean your child’s genital area with warm water and pat dry with a clean towel. Apply the adhesive plastic bag provided by your doctor or nurse. You should ideally try to give the child a lot to drink before applying the bag, because if it is left on for more than 15-20 minutes, contamination can occur. Be very careful when removing the bag and transferring the urine to a sterile jar, because contamination with non-sterile surfaces can easily occur. If you are at a clinic, the staff will do this for you.

‘Dipstick’ test

This test can be performed on ordinary specimens of urine. It is a general test which indicates whether the urine contains protein, blood, sugar or other substances which should not be present in normal circumstances. The sticks are a commercially available kit and are simple to use. Your doctor will always have some dipsticks in the surgery to do on-the-spot tests if needed.

Micturating cystourethrogram (MCU)

This is a special X-ray, in which dye is injected into the bladder via a catheter, and shows the bladder and urinary system both before and during the process of your child emptying his bladder. It can be used to detect cases of vesico-ureteric reflux.

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