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In adults usually infected (fungal or bacterial) dermatitis, often with offensive discharge.
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Precautions: consider umbilical fistula, carcinoma, umbilical calculus.
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Swab for micro and culture
Toilet—remove all debris and clean
Keep dry and clean—daily dressings
Consider Kenacomb ointment
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UMBILICAL GRANULOMA IN INFANTS
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Apply a caustic pencil gently daily for about 5 d.
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A testis that is not in the scrotum may be ectopic, absent, retractile or truly undescended.
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The problem of non-descent
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Optimal time for assessment
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Between 3 and 6 mths (before development of cremasteric reflex and thus confusion with a retractile testis)
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Review 2½–3 yrs—?acquired maldescent
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Optimal time for surgery
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The optimal time for orchidopexy is 6–12 mths. Production of spermatozoa is adversely affected in undescended testes from 2 yrs onwards. Exploration for the uncommon impalpable testis is worthwhile.
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Injections of chorionic gonadotrophic hormones are generally not recommended. They are ineffective except for borderline retractile testes.
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Leads to increased cardiovascular disease, death rate and psychiatric illness.
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Objective is to prevent resignation, hopelessness and deterioration of health.
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Encourage positive outlook with readiness to re-enter labour force.
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School leavers, esp. non-achievers (beware of impulsive overdoses)
History of psychosomatic or physical disability
Children of the unemployed
Previous problematic marriages
Men with many dependants
Those >50 yrs with good job records
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Can be classified as gonococcal or non-gonococcal urethritis (NGU). NGU is caused most commonly by Chlamydia trachomatis and Mycoplasma genitalium; however, it is common to not find any cause.
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First-pass urine (FPU) for Chlamydia and Gonorrhoea NAAT
If discharge, urethral swab for microscopy and culture
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Treat with doxycycline 100 mg (o) bd for 7 d while waiting for results
If N.Gonorrhoea detected, treat with ceftriaxone 500 mg IM and azithromycin 1 g (o) as a single dose
If tests are negative and symptoms persist, consider referral (depending on access) for first-pass urine NAAT testing for Mycoplasma genitalium, HSV and adenovirus
Female ...