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Alcohol Tremor

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121. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Full Text available with Trip Pro

nutrition may have a role in the malnourished patient postoperatively Low Weak Smoking cessation Smoking should be stopped at least 4 weeks before surgery High Strong Alcohol dependency management Alcohol consumption (in alcohol abusers) should be avoided for at least 4 weeks before surgery Moderate Strong Anaemia management Anaemia should be identified, investigated and corrected preoperatively High Strong Pulmonary rehabilitation and prehabilitation Prehabilitation should be considered for patients (...) Strong Chlorhexidine–alcohol is preferred to povidone-iodine solution for skin preparation High Strong Preventing intraoperative hypothermia Maintenance of normothermia with convective active warming devices should be used perioperatively High Strong Continuous measurement of core temperature for efficacy and compliance is recommended High Strong Standard anaesthetic protocol Lung-protective strategies should be used during one-lung ventilation Moderate Strong A combination of regional and general

2020 ERAS Society

122. Staff and associate specialist (SAS) grade handbook

that addiction is multifactorial and can be regarded as having genetic, psychological, social and environmental components. There is frequently an alcoholic parent or history of child abuse. Addiction becomes an active and serious problem when those individuals with predisposing factors discover which drug or drink (or behaviour such as gambling) fixes the way they feel. Access then often dictates which substances someone will try until they find ‘the one’. Since the early 1990s, it has been recognised (...) as an actual disease, and is classified accordingly with other chronic illnesses. It therefore often involves cycles of relapse and remission. Unfortunately, society’s attitude has not changed significantly and addiction is still a rather taboo subject. Definitions [1] The simplest definition of alcoholism is from the American Society of Addiction Medicine (ASAM): ‘(Alcoholism) is characterised by continuous or periodic impaired control over drinking, preoccupation with alcohol, use of alcohol despite

2020 Association of Anaesthetists of GB and Ireland

123. Hyperthyroidism: Beta-blockers

, thrombocytopenia. [ ] Drug interactions Drug interactions with beta-blockers include: Angio-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists (AIIRAs) — enhanced hypotensive effect. Alcohol — enhanced hypotensive effect. Alpha-blockers — enhanced hypotensive effect; also increased risk of first-dose hypotension when given with alpha-blockers such as prazosin. Amiodarone — increased risk of bradycardia, atro-ventricular (AV) block, and myocardial depression. Anti-arrhythmics — increased (...) risk of myocardial depression. Antidiabetic drugs — beta-blockers may mask warning signs of hypoglycaemia, such as tremor. Calcium-channel blockers — enhanced hypotensive effect. Clonidine — increased risk of withdrawal hypertension. Corticosteroids — hypotensive effect of beta-blockers antagonized by beta-blockers. Diltiazem — increased risk of AV block and bradycardia. Diuretics — enhanced hypotensive effect. Insulin — beta-blockers enhance hypoglycaemic effect of insulin. Methyldopa — enhanced

2020 NICE Clinical Knowledge Summaries

124. Hypothyroidism: Levothyroxine

. Cardiovascular — such as angina, arrhythmias, palpitations, and tachycardia. Immunological — such as hypersensitivity reactions (including rash, pruritus, urticaria, and oedema). Metabolic — such as weight loss. Musculoskeletal — such as arthralgia and muscle weakness. Neurological — such as anxiety, tremor, restlessness, excitability, insomnia. Psychiatric — may induce mania. Reproductive — menstrual irregularities. General — such as headache, flushing, sweating, fever, heat intolerance. [ ; ] Drug (...) and vegetables) and in alcohol consumption may also affect anticoagulant control. Adjust the warfarin dose accordingly. Antidepressants — the effects of levothyroxine may be decreased by concomitant treatment with sertraline. Antidepressant response to tricyclics can be accelerated, concomitant administration may precipitate cardiac arrhythmias. Antidiabetic drugs — treatment with levothyroxine may increase blood glucose levels; therefore the requirements for insulin or oral antidiabetic drugs may

2020 NICE Clinical Knowledge Summaries

127. Diarrhoea - adult's assessment: Scenario: Chronic diarrhoea ( 4weeks)

insufficiency) or fat malabsorption (for example coeliac disease). Previous abdominal surgery — suspect bile acid diarrhoea if the person has a history of cholecystectomy or ileal resection. Family history of coeliac disease or inflammatory bowel disease. Diet and relationship of symptoms to eating — lactose intolerance is suggested if symptoms are worsened by dairy products; diarrhoea may be due to consumption of caffeine or food additives, such as sorbitol. Excessive alcohol intake — can cause a toxic (...) effect on intestinal epithelium or rapid gut transit. Abdominal pain — may indicate coeliac disease, Crohn's disease, or malignancy. Weight loss, anxiety, palpitations, tremor — consider hyperthyroidism. Lifelong history of constipation — consider impaction with overflow diarrhoea. Immunocompromised person — consider opportunistic infection with parasites (for example Giardia, Cryptosporidium, Cyclospora). Features of systemic disease (such as thyrotoxicosis, diabetes, adrenal insufficiency

2020 NICE Clinical Knowledge Summaries

128. Psychosis and schizophrenia: Adverse effects

or switching drugs should be referred to specialist mental health services, or that advice should be sought. Adverse effects include [ ; ] : Extrapyramidal symptoms — more common with first-generation antipsychotics. They include: Dystonic reactions (abnormal movements of the face and body), and pseudoparkinsonism (tremor, bradykinesia, and rigidity) — these can be alleviated by antimuscarinic drugs, such as procyclidine (should not be prescribed routinely). Akathisia (motor restlessness) — can often (...) of alcohol are enhanced. Tolerance to sedation usually develops. Sleep apnoea syndrome — reported in patients using quetiapine. Quetiapine should be used with caution in people receiving concomitant central nervous system depressants and who have a history of, or are at risk for, sleep apnoea, such as those who are overweight/obese or are male [ ]. Anticholinergic effects (such as dry mouth, blurred vision, urinary retention, constipation, and cutaneous flushing) — chlorpromazine and clozapine have

2020 NICE Clinical Knowledge Summaries

129. Adult liver transplantation: UK clinical guideline – part 2: surgery and post-operation

immunosuppression immunosuppressant Side effects Calcineurin inhibitors Renal impairment Infections (viral, bacterial and fungal) increased risk Hyperuricaemia Gout Hypertension Hypercholesterolaemia Glucose intolerance Hypomagnesaemia Hyperkalaemia Headaches/migraines Insomnia Tremor Hirsuitism Gum hypertrophy Mycophenolate Diarrhoea Leucopenia Teratogenic (should be avoided by mother prior to and during pregnancy and male patients planning to father children. Men should use condoms during treatment (...) the associated catabolic state. The cardiovas- cular mortality and morbidity rise, along with renal disease and non alcoholic fatty liver disease (NAFLD), in the recipient’s graft. 38 post-transplant smoking Up to a quarter of patients in centres around the world will be regularly smoking tobacco at the time of their LT. 39 While the European Association for the Study of the Liver (EASL) recommends abstinence before listing, UK transplant centres do not take an ‘absolutist’ view. 40 Cigarette smoking

2020 British Society of Gastroenterology

130. Obstetric Management of Patients with Spinal Cord Injuries

transections. Afferent stimuli come from distention of a hollow viscus (eg, the bladder, bowel, or uterus) and from the skin below the level of the lesion or of the genital areas. Signs and Symptoms The inhibitory response from cerebral vasomotor centers causes vasodilation above the level of injury, with symptoms including pounding headache, flushing, nasal congestion, nausea, anxiety, malaise, and a prickling sensation in the skull; signs include sweating, blushing, skin blotching, piloerection, tremor (...) distension and fundal massage, which may increase the risk of autonomic dysreflexia. Although breastfeeding may be possible, data suggest that SCI, particularly at or above T6, can disrupt lactation and is associated with shorter breastfeeding duration . Additional support may be needed to facilitate breastfeeding in women with SCIs who desire to breastfeed and are physiologically capable of doing so. Depression, suicide, alcoholism, and a wide variety of other mental health problems all occur at higher

2020 American College of Obstetricians and Gynecologists

132. Treatment of Patients with Schizophrenia

) and attempts that were aborted or interrupted o Intentional self-injury in which there was no suicide intent Substance Use History • Use of tobacco, alcohol, and other substances (e.g., vaping, marijuana, cocaine, heroin, hallucinogens) and any misuse of prescribed or over-the-counter medications or supplements • Current or recent substance use disorder or change in use of alcohol or other substances Medical History • Whether or not the patient has an ongoing relationship with a primary care health (...) or emergency circumstances. Examples of such circumstances are not limited to unconsciousness but may also include circumstances such as temporary psychosis or intoxication with alcohol or other substances (U.S. Department of Health and Human Services; Office for Civil Rights 2017b). Although it is beyond the scope of this guideline to discuss the differential diagnosis of psychotic disorders and their evaluation, many features and aspects of clinical course will enter into such a determination in addition

2020 American Psychiatric Association

133. Clearing the Smoke on Cannabis: Respiratory and Cardiovascular Effects of Cannabis Smoking

for COPD. Because of this uncertainty, caution should be exercised until the link between chronic regular use and COPD is better understood. • It is essential for healthcare professionals to be aware of the impact of cannabis smoking on respiratory health so that they can inform and advise their patients, as well as develop strategies to promote further awareness and general respiratory health. Background After alcohol, cannabis (also referred to as marijuana) is the most widely used psychoactive (...) substance in Canada. According to the 2013 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 10.6% of Canadians aged 15 years and older reported using cannabis at least once in the past year (Statistics Canada, 2015), virtually unchanged from 10.2% in 2012. The use of cannabis is generally more prevalent among young people, with 22.4% of youth aged 15 to 19 and 26.2% of young adults aged 20 to 24 reporting past- Clearing the Smoke on Cannabis Respiratory Effects of Cannabis Smoking – An Update Opal

2020 Canadian Centre on Substance Abuse

134. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

test 18 3.1.5.6 Invasive testing 19 3.1.6 Step 6: assess event risk 21 3.1.6.1 Definition of levels of risk 22 3.2 Lifestyle management 23 3.2.1 General management of patients with coronary artery disease 23 3.2.2 Lifestyle modification and control of risk factors 23 3.2.2.1 Smoking 23 3.2.2.2 Diet and alcohol 24 3.2.2.3 Weight management 24 3.2.2.4 Physical activity 24 3.2.2.5 Cardiac rehabilitation 24 3.2.2.6 Psychosocial factors 24 3.2.2.7 Environmental factors 25 3.2.2.8 Sexual activity 25

2019 European Society of Cardiology

135. Assessment of ataxia

in the prevalence of many mutations. Schöls L, Bauer P, Schmidt T, et al. Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis. Lancet Neurol. 2004 May;3(5):291-304. http://www.ncbi.nlm.nih.gov/pubmed/15099544?tool=bestpractice.com Differentials Alcoholic cerebellar degeneration Ischaemic stroke (cerebellum) Ischaemic stroke (brain stem) Haemorrhage in the cerebellum Multiple sclerosis (MS) Wernicke-Korsakoff syndrome Drug-induced ataxia Toxic neuropathies Von Hippel-Lindau (...) ) Spinocerebellar ataxia 37 (SCA 37) Spinocerebellar ataxia 38 (SCA 38) Spinocerebellar ataxia 40 (SCA 40) Dentatorubral-pallido-luysian atrophy (DRPLA) Episodic ataxia type 1 Episodic ataxia type 2 Fragile-X tremor-ataxia syndrome (FXTAS) Mitochondrial cytopathy Niemann-Pick disease type C (NP-C) Contributors Authors Assistant Professor of Neurology The Ohio State University Columbus OH Disclosures BKC declares that she has no competing interests. Dr Barbara Kelly Changizi would like to gratefully acknowledge

2018 BMJ Best Practice

136. Amfetamine overdose

drug interaction hypertension hyperreflexia and clonus chest pain cardiac arrhythmia hx of hepatitis B or C, HIV tremor, repetitive movements disorientation, confusion, delirium malnutrition superficial venous abnormalities rapid speech, pacing, trismus hallucinations or delusions tremor, hypertonicity, or muscle rigidity paranoia, hypervigilance, or psychosis mydriasis hx of heart disease tachypnoea dyspnoea lack of thirst abdominal pain positive Babinski focal neurological signs, papilloedema (...) high ambient temperature volume depletion exercise and sweating excessive alcohol intake polydrug usage anxiety and depression hx of behavioural disturbance hx of delinquency or crime ADHD attendance at dance club or rave party hx of drug misuse for more than 1 year genetic predilection Diagnostic investigations serum glucose serum electrolytes serum creatinine, urea ABG serum AST, ALT, gamma-GT serum PT, PTT, INR urinalysis urine toxicology screen serum alcohol level serum creatine kinase serum

2018 BMJ Best Practice

137. Zinc deficiency

presence of risk factors increased susceptibility to infection stomatitis delayed wound healing acrodermatitis enteropathica fertility issues/adverse pregnancy outcomes fatigue gastrointestinal symptoms short stature bone fracture impaired glucose tolerance dermatitis weight loss alopecia paronychia fever intention tremor depression impaired concentration nystagmus dysarthria night blindness hypogeusia anosmia blepharitis dementia living in a developing region age >65 years chronic gastrointestinal (GI (...) ) and liver disease renal disease sickle cell disease diabetes mellitus chronic treatment with hydrochlorothiazide, penicillamine, ethambutol, certain antibiotics HIV infection alcoholism long-term vegetarian/vegan diets specialised weight-loss diets infants with nutrient-poor diets FHx of zinc deficiency anorexia nervosa Diagnostic investigations serum or plasma zinc levels serum iron level serum 25-OH vitamin D level serum folate serum vitamin B12 cell zinc content analysis of zinc levels in hair

2018 BMJ Best Practice

138. Alcohol in essential tremor and other movement disorders. (Abstract)

Alcohol in essential tremor and other movement disorders. Many patients with essential tremor (ET) report transient improvement of symptoms after drinking alcohol. However, the brief duration of action, subsequent rebound, and the risk of developing alcohol addiction make the use of alcohol as a treatment for ET inappropriate. Whether excessive alcohol consumption is a risk for or a consequence of ET has been a subject of some controversy. In this review, we critically examine the mechanism (...) of action of alcohol and its role in ET and other movement disorders.

2010 Movement Disorders

139. Caffeinated energy drinks and effects in UK young people

drinks, and between 10% and 36% report mixing these with alcohol. Consumption varies by age group and country. Some evidence suggests males consume more energy drinks than females, who may start to consume CEDs at a slightly younger age. There is conflicting evidence of consumption by ethnicity. The two UK studies found that 11% of surveyed young people consume CEDs on a daily basis, and link higher use in males and those with lower socioeconomic status. We found consistent findings across reviews (...) for: physical symptoms (e.g. headaches, sleep-related issues); behavioural effects such as alcohol, smoking and substance use; behaviour disorders; and poorer psychological well-being (e.g. irritation, anger). Contradictory evidence was reported for anxiety and depression; and limited evidence suggested associations with self- harming and suicide-related behaviour. Mixing alcohol with energy drinks was linked to engaging in risky lifestyle behaviours and self-injury. Little evidence described educational

2019 EPPI Centre

140. Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness

the presence of (pre- )diabetes, hypertension, a low HDL-cholesterol, high triglycerides, and/or a high waist-circumference might indicate a higher associated risk, as is also the presence of non-alcoholic steato-hepatitis. Insulin resistance and metabolic syndrome are more prevalent in people with visceral adiposity. Obesity clearly does imply risks, may lead to physical and psychological symptoms, can cause functional limitation, the development of co- morbidities and complications, and cause psycho (...) arterial disease, nephropathy, neuropathy, retinopathy Hypertension Chronic kidney disease Hyperlipidaemia Peripheral artery disease Other diabetes complications Gastrointestinal Gastro-oesophagal reflux Gallstones Liver fat accumulation and Non- alcoholic steatohepatitis KCE Report 316 Bariatric Surgery 23 Cirrhosis – hepatocellular carcinoma Restricted ventilation Exertional dyspnoe; asthma Obstructive sleep apnoe Obesity hypoventilation syndrome (Pickwick syndrome) Mechanical effects of weight

2019 Belgian Health Care Knowledge Centre

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