American family physician
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Mastitis represents a spectrum of inflammatory conditions. Lactational mastitis is the most common, with an approximate incidence of 10% in the United States, and it usually occurs in the first 3 months postpartum. Diagnosis is made clinically based on the presence of symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging. ⋯ Use of probiotics for treatment or prevention is not supported by good evidence. Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition. The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible.
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Conjunctivitis caused by viruses, bacteria, or allergies is one of the most common eye conditions in primary care. There is no single sign or symptom that accurately differentiates viral from bacterial conjunctivitis. A comprehensive history and physical examination can guide diagnosis. ⋯ Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut. Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing. Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state.
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Chronic cough is a cough lasting longer than 8 weeks in adults and 4 weeks in children. In the United States, more than 12.3 million individuals are estimated to have chronic cough. The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and laryngopharyngeal reflux. ⋯ When initial test findings are unremarkable, further diagnostic tests, such as bronchoscopy and nasendoscopy, are often warranted through referral to a pulmonologist and otolaryngologist. Common etiologies in children include protracted bacterial bronchitis, asthma, bronchiectasis, upper airway cough syndrome, and gastroesophageal reflux disease. Because of the high likelihood of spontaneous resolution, children with a dry cough without wheezing or exertional dyspnea may be observed for 2 weeks.