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Hornor G. Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners. J Pediatr Health Care 2022; 36:489-499. [PMID: 35987556 DOI: 10.1016/j.pedhc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Gail Hornor
- Gail Hornor, Forensic Nurse Specialist, International Association of Forensic Nurses, Hilliard, OH.
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Emulsion-Based Multicompartment Vaginal Drug Carriers: From Nanoemulsions to Nanoemulgels. Int J Mol Sci 2021; 22:ijms22126455. [PMID: 34208652 PMCID: PMC8233730 DOI: 10.3390/ijms22126455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/05/2023] Open
Abstract
In order to overcome the limitations associated with vaginal administration of drugs, e.g., the short contact time of the drug form with the mucosa or continuous carrier wash-out, the development of new carriers for gynecological use is necessary. Furthermore, high individual anatomical and physiological variability resulting in unsatisfactory therapeutic efficacy of lipophilic active substances requires application of multicompartment drug delivery systems. This manuscript provides an up-to-date comprehensive review of the literature on emulsion-based vaginal dosage forms (EVDF) including macroemulsions, microemulsions, nanoemulsions, multiple emulsions and self-emulsifying drug delivery systems. The first part of the paper discusses (i) the influence of anatomical-physiological conditions on therapeutic efficacy of drug forms after local and systemic administration, (ii) characterization of EVDF components and the manufacturing techniques of these dosage forms and (iii) methods used to evaluate the physicochemical and pharmaceutical properties of emulsion-based vaginal dosage forms. The second part of the paper presents (iv) the results of biological and in vivo studies as well as (v) clinical evaluation of EVDF safety and therapeutic efficacy across different indications.
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Septic gonococcal arthritis in a pediatric patient: Rare case report. Int J Surg Case Rep 2021; 80:105701. [PMID: 33667910 PMCID: PMC7937740 DOI: 10.1016/j.ijscr.2021.105701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Septic arthritis is an orthopedic emergency that requires rapid diagnosis and treatment due to the rapid destruction to cartilage. The responsible organism and etiology differs depending on patient age, especially in children. Gonococcal Arthritis in toddlers is a rare occurrence with few documented cases in the literature. An orthopedic surgeon is likely not to come across this either in training or through their careers. Consequently, its presentation and subsequent treatment algorithms leave several gray areas. PRESENTATION OF CASE In this case report, we present a rare and not so straightforward presentation of a toddler with septic gonococcal arthritis along with a summary of treatment considerations described in the current literature and the course of treatment for this patient. Our patient is a toddler who originally presented to the emergency department with shoulder and knee pain for several days after an unwitnessed fall. He was subsequently discharged and presented again the next day with a knee effusion and elevated inflammatory markers. An MRI showed a large joint effusion without any underlying abscess or osteomyelitis to explain his elevated inflammatory markers. A knee aspiration was subsequently preformed which eventually grew out Neisseria Gonorrhea on hospital day 3 after the patient had been on antibiotics. He was taken back for an arthroscopic irrigation and debridement for definitive treatment. CLINICAL DISCUSSION/CONCLUSION Disseminated gonococcal infection in toddlers is a rare occurrence without much information in the literature and should not be dismissed as a differential. We recommend a high index of suspicion with thorough work up. We also recommend surgical management of a septic joint due to DGI diagnosed via arthrocentesis (gross purulence, symptoms not improving on medical therapy, positive aspiration cultures, elevated synovial cell counts, and medically unstable patients) given the sequelae of medical management alone. The importance of interdisciplinary team collaboration that include pediatrician, infectious disease specialist, social worker, and government child safety associations is pivotal.
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Zhang H, Kunadia A, Lin Y, Fondell JD, Seidel D, Fan H. Identification of a strong and specific antichlamydial N-acylhydrazone. PLoS One 2017; 12:e0185783. [PMID: 28973037 PMCID: PMC5626472 DOI: 10.1371/journal.pone.0185783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/19/2017] [Indexed: 12/02/2022] Open
Abstract
Sexually transmitted Chlamydia trachomatis is an extremely common infection and often leads to serious complications including infertility and pelvic inflammatory syndrome. Several broad-spectrum antibiotics are currently used to treat C. trachomatis. Although effective, they also kill beneficial vaginal lactobacilli. Two N-acylhydrazones, CF0001 and CF0002, have been shown previously to inhibit chlamydial growth without toxicity to human cells and Lactobacillus spp. Of particular significance, the rate of random mutation leading to resistance of these inhibitors appears to be extremely low. Here, we report three analogs of CF0001 and CF0002 with significantly stronger inhibitory effects on chlamydiae. Even though the new compounds (termed SF1, SF2 and SF3) displayed slightly decreased inhibition efficiencies for a rare Chlamydia variant selected for CF0001 resistance (Chlamydia muridarum MCR), they completely overcame the resistance when used at concentrations of 75–100 μM. Importantly, SF1, SF2 and SF3 did not shown any toxic effect on lactobacilli, whereas SF3 was also well tolerated by human host cells. An effort to isolate SF3-resistant variants was unsuccessful. By comparison, variants resistant to rifampin or spectinomycin were obtained from smaller numbers of chlamydiae. Our findings suggest that SF3 utilizes an antichlamydial mechanism similar to that of CF0001 and CF0002, and will be more difficult for chlamydiae to develop resistance to, potentially making it a more effective antichlamydial agent.
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Affiliation(s)
- Huirong Zhang
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
| | - Anuj Kunadia
- Department of Chemistry and Chemical Biology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
| | - Yingfu Lin
- Department of Chemistry and Chemical Biology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
| | - Joseph D. Fondell
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
| | - Daniel Seidel
- Department of Chemistry and Chemical Biology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
- * E-mail: (DS); (HF)
| | - Huizhou Fan
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey, United States of America
- * E-mail: (DS); (HF)
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Clinical and microbiologic characteristics of vulvovaginitis in Korean prepubertal girls, 2009-2014: a single center experience. Obstet Gynecol Sci 2016; 59:130-6. [PMID: 27004204 PMCID: PMC4796083 DOI: 10.5468/ogs.2016.59.2.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/25/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls. METHODS A total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded. RESULTS Girls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05). CONCLUSION Specific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.
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Hertweck P, Yoost J. Common problems in pediatric and adolescent gynecology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Labbé J. Vulvovaginite à gonocoque chez l’enfant prépubère : infection sexuellement transmissible ou contamination accidentelle ? Arch Pediatr 2013; 20:904-5. [DOI: 10.1016/j.arcped.2013.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
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Daval-Cote M, Liberas S, Tristan A, Vandenesch F, Gillet Y. [Gonococcal vulvovaginitis in prepubertal girls: sexual abuse or accidental transmission?]. Arch Pediatr 2012; 20:37-40. [PMID: 23219271 DOI: 10.1016/j.arcped.2012.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/22/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
Vulvovaginitis is the most frequent gynecologic pathology among prepubertal females. An infectious cause is found in 30% of cases and is highly associated with the presence of vaginal discharge upon examination. Neisseria gonorrhoeae may be one of the causative agents. Since N. gonorrhoeae is a common sexually transmitted disease, sexual abuse should be considered in the pediatric setting. We report the case of a 5-year-old girl with N. gonorrhoeae vulvovaginitis. Her previous history, multiple interviews with the patient and her parents, and clinical examination showed no evidence or signs of sexual abuse. Both parents presented gonorrhea, urethritis for the father and vaginitis for the mother. The discrepancy between pediatric evaluation and the presence of a bacterium associated with sexually transmitted disease led us to consider other means of contamination. Previous studies have shown that other routes of transmission are possible but are often neglected. Hence, contamination can be transmitted by the hands or mostly through passive means (towels, rectal thermometer, etc.). Many epidemics have been noted in group settings with young girls with no evidence of sexual transmission. Therefore, we concluded that this patient's infection was likely an accidental transmission within her family. The acknowledgement of these transmission routes is very important in order to avoid misguided suspicion of sexual abuse and the possible traumatic family and psychosocial consequences.
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Affiliation(s)
- M Daval-Cote
- Service d'urgences pédiatriques, hôpital Femme-Mère-Enfant, Bron, France
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Affiliation(s)
- Naomi F Sugar
- Department of Pediatrics, Division of General Pediatrics, University of Washington, Seattle, Wash, USA
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Abstract
Gonorrhea has been recognized since antiquity, and more than 60 million new cases occur yearly worldwide. Much has been learned about the molecular pathogenesis of infection by Neisseria gonorrhoeae, but immunity from natural infection does not protect against reinfection with the same strain, and the goal of a protective vaccine remains elusive. Gonococcal ophthalmia neonatorum is the most common manifestation in infants born to mothers with gonococcal genital tract infections. Genital and pharyngeal gonococcal infections in young children almost always are acquired from sexual abuse by an infected adult. Invasive disease can occur at any age but is uncommon. Nonculture diagnostic tests are widely used in adults, but culture is required in children for medicolegal purposes. N. gonorrhoeae strains have developed resistance to many antibiotic classes, and resistance profiles vary among geographic regions and within regions over time. Current guidelines for treatment of gonococcal infections in children in the United States are reviewed.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Woods CR. Sexually transmitted diseases in prepubertal children: mechanisms of transmission, evaluation of sexually abused children, and exclusion of chronic perinatal viral infections. ACTA ACUST UNITED AC 2005; 16:317-25. [PMID: 16210111 DOI: 10.1053/j.spid.2005.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Charles R Woods
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Evans H. Vaginal discharge in the prepubertal child. ACTA ACUST UNITED AC 2003; 3:194-202. [PMID: 14520081 DOI: 10.1097/01.pca.0000085282.60628.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hughes Evans
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, 35294, USA.
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Abstract
BACKGROUND The medical diagnosis of child sexual abuse is based on a combination of factors, including disclosures by the child, specific physical examination findings and sexually transmitted infections. Genital infections with Neisseria gonorrhoeae (GC) are regarded as definitive evidence of sexual contact in children, but current microbiologic culture methods have low sensitivity for detecting vulvovaginal GC infections in prepubertal girls. METHODS To compare the three strategies of culture alone, nonculture alone (Gen-Probe PACE 2) and sequential testing for genital GC (nonculture followed by culture of nonculture positives), we conducted a decision analysis to identify optimal testing strategies using published test sensitivities, specificities and pretest probabilities of genital GC. We surveyed community child welfare professionals to determine values for each potential health outcome. RESULTS Sequential testing yielded a higher overall health outcome value (0.855) than culture (0.834) or nonculture methods (0.838). These results were insensitive to changes in GC prevalence, test characteristics and individual health outcome values over clinically important ranges. With a baseline prevalence of 10%, more children (4 per 100) with GC infection were missed by culture than were inaccurately labeled as having GC infection (0.5 per 100) by nonculture methods. Sequential testing yielded fewer false negative results (0.8 per 100) than culture and had no false positives. CONCLUSIONS With the use of clinical decision analysis, sequential testing using nonculture methods followed by culture was preferred to culture or nonculture methods alone in the evaluation of GC in prepubertal girls with genital discharge. Current recommendations for GC testing should be reassessed with clinical decision analysis as new test methods or strategies become available.
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Affiliation(s)
- Vincent J Palusci
- DeVos Children's Hospital Child Protection Team, Michigan State University, Grand Rapids, USA.
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Moon TD, Kennedy AA, Knight KM. Vaginal discharge due to undiagnosed bilateral duplicated collecting system with ectopic ureters in a three-year-old female: an initial high index of suspicion for sexual abuse. J Pediatr Adolesc Gynecol 2002; 15:213-6. [PMID: 12459227 DOI: 10.1016/s1083-3188(02)00158-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In prepubertal girls with vaginal discharge, consideration of the etiology must be given to respiratory pathogens (Streptococcus pyogenes, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Neisseria meningitidis), enteric pathogens (Escherichia coli, Shigella, and Yersinia), poor hygiene, foreign body, nonabsorbent undergarments, irritants, vulvar skin disease, anatomic abnormalities (double vagina with fistula, pelvic abscess, and ectopic ureter), and sexual abuse. Prepubertal girls, outside the newborn period, with suspected gonococcal infection should be strongly considered to be victims of sexual abuse, once congenital and other newborn acquired forms of gonorrhea are excluded. We present a case of a three-year-old female with vaginal discharge and fever with a clouded social history, disproportionate distress on physical exam, and initial laboratory gram stain suggestive of gonococcus.
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Affiliation(s)
- Troy D Moon
- Department of Pediatrics, Tulane Hospital for Children and Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
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Rawlins S. Nonviral Sexually Transmitted Infections. J Obstet Gynecol Neonatal Nurs 2001. [DOI: 10.1111/j.1552-6909.2001.tb01551.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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