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Pruritus is a disagreeable sensation that provokes a desire to scratch It is modulated by central factors, including cortical ones Not all cases of pruritus are mediated by histamine Although many cases of generalized pruritus can be attributed to dry skin, there are many other causes: scabies, dermatitis herpetiformis, atopic dermatitis, genital pruritus, pruritus vulvae et ani, miliaria, insect bites, pediculosis, contact dermatitis, drug reactions, urticaria, psoriasis, lichen planus, lichen simplex chronicus, folliculitis, bullous pemphigoid, and fiberglass dermatitis Persistent pruritus not explained by cutaneous disease should prompt a staged workup for systemic causes Perhaps the most common cause of pruritus associated with systemic disease is uremia in conjunction with hemodialysis Both this condition and the pruritus of liver disease may be helped by phototherapy with ultraviolet B or PUVA Naltrexone and nalmefene have been shown to relieve the pruritus of liver disease Naltrexone is not effective in pruritus associated with renal failure, but gabapentin may be effective Endocrine disorders such as hypothyroidism or hyperthyroidism, psychiatric disturbances, lymphoma, leukemia, and other internal malignant disorders, iron deficiency anemia, and certain neurologic disorders may also cause pruritus Antihistamines reduce pruritus only by their sedating effect (except in urticaria) Nonsedating, second generation antihistamines are of no value in nonurticarial pruritus

The only symptom is itching, which is chiefly nocturnal Physical findings are usually not present, but there may be erythema, fissuring, maceration, lichenification, excoriations, or changes suggestive of candidiasis or tinea

Object-oriented programming is built on three pillars: encapsulation, specialization, and polymorphism. Each class should be fully encapsulated; that is, it should fully define the state and responsibilities of that type. Specialization allows you to establish hierarchical relationships among your classes. Polymorphism allows you to treat a group of hierarchically related objects in a similar way and have the objects sort out how to implement the programming instructions.

KDE 28, 51 kernel 14, 313 kernel environment 15 16 kernel extension 78, 80 building 144 Kernel Extensions (KEXT) 19, 61 kernel initialization 36 kextd 36 keyboard navigation 12 keyboard options 12 kill 45, 307

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Urinalysis and blood glucose testing may lead to a diagnosis of diabetes mellitus Microscopic examination or culture of tissue scrapings may reveal yeasts or fungi Stool examination may show pinworms Radiologic studies may demonstrate spinal cord disease

Elimination of external factors and irritating agents may give complete relief from pruritus Pruritus accompanying specific skin disease will subside when the disease is controlled Pruritus accompanying serious internal disease may not respond to any type of therapy

Greaves MW Itch in systemic disease: therapeutic options Dermatol Ther 2005 Jul Aug;18(4):323 7 [PMID: 16297004] Heymann WR Itch J Am Acad Dermatol 2006 Apr;54(4):705 6 [PMID: 16546594]

The first pillar of object-oriented programming is encapsulation. The idea behind encapsulation is that you want to keep each type or class discrete and self-contained so that you can change the implementation of one class without affecting any other class. A class that provides a method that other classes can use is called a server. A class that uses that method is called a client. Encapsulation allows you to change the details of how a server does its work without breaking anything in the implementation of the client.

The etiologic differential diagnosis consists of Candida infection, parasitosis, local irritation from contact with drugs and irritants, nerve impingement and other primary skin disorders of the genital area such as psoriasis, seborrhea, intertrigo, or lichen sclerosus et atrophicus

Itching, chiefly nocturnal, of the anogenital area Examination is highly variable, ranging from no skin findings to excoriations and inflammation of any degree, including lichenification

Available prophylactic measures include control of mosquitoes by screening and insect repellents, particularly during early morning and late afternoon exposures A screening program at an airport for persons with fever facilitated the diagnosis of dengue and the implementation of public health measures in Taipei, Taiwan A variety of vaccines, involving attenuated or genetically modified virus, are under study including combinations of attenuated dengue strains

Treatment entails the appropriate use of volume support (with Ringer s lactate the preferred agent in moderately severe shock), blood products, and pressor agents, and acetaminophen rather than nonsteroidal anti-inflammatory drugs for analgesia Activities are gradually restored during prolonged convalescences Endoscopic therapy is useful in evaluating and managing gastrointestinal hemorrhage although injection therapy with sclerosing agents is not beneficial in most dengue hemorrhagic states Monitoring platelet counts does not usefully predict clinically significant bleeding Monitoring for hemoconcentration, however, may help in anticipating the complications of dengue hemorrhagic fever or shock syndrome

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Fatalities are rare but do occur, especially during epidemic outbreaks, with occasional patients dying from fulminant hepatitis Convalescence for most patients is slow

Centers for Disease Control and Prevention (CDC): Travelassociated dengue infections United States, 2005 MMWR Morb Mortal Wkly Rep 2006 Jun 30;55(25):700 2 [PMID: 16810147] Wilder-Smith A et al Dengue in Travelers N Engl J Med 2005 Sep 1;353(9):924 32 [PMID: 16135837] Wills BA et al Comparison of three fluid solutions for resuscitation in dengue shock syndrome N Engl J Med 2005 Sep 1;353(9):877 89 [PMID: 16135832]

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