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Alcohol Tremor

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121. 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

122. 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

123. 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

124. 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

125. 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

127. 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

128. Plitidepsin (Aplidin) - Multiple Myeloma

. Solubility studies were undertaken, where it was found that an alcoholic solvent/water mixture combined with a surfactant offers the required properties. A mixture of water for injections (WFI), ethanol and macrogolglycerol ricinoleate was found to afford suitable dissolution characteristics and the relative amounts of each component were optimised. It was found that this solution can be terminally sterilised although re-homogenisation is required afterwards as it become biphasic at high temperature

2018 European Medicines Agency - EPARs

130. Pregabalin

doses of pregabalin (150 mg per day to 600 mg per day; 34 participants) or matching placebo (30 2016 4. Randomised controlled trial: Pregabalin similar to lorazepam for alcohol withdrawal symptoms Pregabalin similar to lorazepam for alcohol withdrawal symptoms | Evidence-Based Medicine This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password (...) * your user name or password? Search for this keyword Search for this keyword Main menu Log (...) in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Pregabalin similar to lorazepam for alcohol withdrawal symptoms Article Text Therapeutics Randomised controlled trial Pregabalin similar to lorazepam for alcohol withdrawal symptoms Giovanni Addolorato 1 , Lorenzo Leggio 1 , 2 Statistics from

2018 Trip Latest and Greatest

131. NARCAN Nasal Spray

, Taylor D, Forbes B. Nalox- one without the needle — Systematic review of candidate routes for non- injectable naloxone for opioid overdose reversal. Drug & Alcohol Dependence. 2016;163:16–23. NARCAN® Nasal Spray efficacy for emergency treatment of opioid overdose Key Take-Home Messages • The administration of ready-to-use, needle-free concentrated NARCAN® Nasal Spray (containing 4mg of naloxone hydrochloride in low volume of 0.1 mL) results in pharmacokinetic parameters that either equal or exceed (...) development or regulatory approval. 18. Dowling J, Isbister GK, Kirkpatrick CM, Naidoo D, Graudins A. Popula- tion pharmacokinetics of intravenous, intramuscular, and intranasal naloxone in human volunteers. Therapeutic Drug Monitoring. 2008;30(4):490–6. 19. McDonald R, Danielsson Glende O, Dale O, Strang J. International patent applications for non-injectable naloxone for opioid overdose reversal: Explor- atory search and retrieve analysis of the PatentScope database. Drug & Alcohol Review. 2018;37(2

2018 Ontario HIV Treatment Network

132. Opioid Use Disorder - Diagnosis and Management in Primary Care

depression. Commonly observed side effects include headaches, pain, nausea, vomiting, hyperhidrosis, constipation, insomnia, vasodilation and over-sedation. These side effects are similar to but lower in intensity than side effects of full opioid receptor agonists (e.g., methadone). Buprenorphine can act synergistically with benzodiazepines, alcohol and/or other sedating medications to significantly increase risk of respiratory depression, overdose or death. Concurrent use of buprenorphine (...) supply), at the discretion of the treating clinician. Assessment for buprenorphine/naloxone induction It is imperative to establish the following prior to induction : Assess for common contraindications to buprenorphine/naloxone induction: allergy to components of buprenorphine/naloxone; severe respiratory distress; delirium tremens ; acute alcohol intoxication; and severe liver insufficiency. Note: Liver enzyme tests are recommended (see below) but not required to start treatment due

2018 Clinical Practice Guidelines and Protocols in British Columbia

133. Treating Opioid Use Disorder During Pregnancy: Guideline Supplement

patients.10 Summary of Clinical recommendations Table 1- Summary of recommendations Also refer to the Summary of Recommendations of the Guideline for contextualizing information. Prenatal screening and assessment 1. All individuals who are or may become pregnant should be offered regular screening for alcohol, tobacco, and non-medical drug use, and informed about relevant risks and available risk reduction strategies. Screenings should be accompanied by brief support. (See Screening and Assessment (...) .) 8. Breastfeeding should be encouraged in mothers who are stable on OAT. (See Rooming-in and Breastfeeding.)11 Introduction Obtaining accurate prevalence data on substance use during pregnancy is particularly difficult primarily due to the stigma and prejudice against pregnant women who use substances. While non-medical opioid use during pregnancy is less frequently self-reported than alcohol and tobacco use, it is recognized by the Public Health Agency of Canada as a significant concern across

2018 British Columbia Perinatal Health Program

135. Hereditary Hemochromatosis

be elevated among patients with nonalcoholic fatty liver disease and in those with alcoholic liver disease. These diagnoses are more common than HH among patients with elevated serum ferritin who are not C282Y homozygotes or C282Y/H63D compound heterozygotes. A secondary cause for liver disease should be excluded among patients with suspected iron overload who are not C282Y homozygotes. Phlebotomy remains the mainstay of therapy, but emerging novel therapies such as new chelating agents may have a role (...) with either abnormally low levels of hepcidin ( ) or decreased binding of hepcidin to ferroportin (FPN), the transmembrane protein that exports iron outside the cell ( ). Secondary iron overload may be considered as any condition of acquired hepcidin deficiency from disorders of erythropoiesis or increased red blood cell (RBC) turnover or due to other chronic liver disease or excess alcohol intake ( ). Over time, iron deposition can lead to dysfunction and failure in multiple organs including the liver

2019 American College of Gastroenterology

136. Assessment and Management of Patients at Risk for Suicide

both drug and non-drug poisoning.[8] Other means include, but are not limited to, overdose of licit or illicit drugs, alcohol or combinations thereof, hanging, poisoning (with chemical compounds such as industrial cleaners or pesticides), carbon monoxide inhalation, suffocation (with plastic hoods or inert gasses), electric shock, immolation, drowning, exsanguination, and evisceration. Hanging deaths have increased in the past decade, with evidence of suicide contagion stemming from the deaths

2019 VA/DoD Clinical Practice Guidelines

139. Management of Major Depressive Disorder (2nd Ediiton)

• chronic diseases • obesity • chronic pain (e.g. backache, headache) • impoverished home environment • financial constraint • experiencing major life changes • pregnant or postpartum period • socially-isolated • multiple vague symptoms • sleep disturbance • substance abuse (e.g. alcohol, illicit drugs) • loss of interest in sexual activity • old age • There is insufficient evidence to perform screening for depression in the general population. The common tools used in Malaysia for screening (...) measurement to evaluate future suicide risk among patients who self-harm. 25, level II-2 Hence, measurement of this risk should be included during the risk assessment and can be done using specific tools (e.g. Beck Suicide Intent Scale). The suicide risk factors are: 21 • loss of relationship • financial or occupational difficulties • poor social support • past suicide attempt • family history of suicide • alcohol abuse/dependence • other medical co-mordibities • suicidal ideations • severity

2019 Ministry of Health, Malaysia

140. Clearing the Smoke on Cannabis: Regular Use and Cognitive Functioning

psychoactive substance in Canada, led only by alcohol. According to the 2018 National Cannabis Survey (second quarter), 16% of Canadians aged 15 years and older reported using cannabis in the past three months. The use of cannabis is generally more prevalent among young people, with 33% of individuals between the age of 15 to 24 reporting use in the past three months compared to 13% of those aged 25 or older (Statistics Canada, 2018). Given the proportion of Canadians using cannabis and in light (...) , time distortion, deficits in attention span and memory, body tremors, increased heart rate and blood pressure, and impaired motor functioning. Over the past few decades, there has been an increase in the concentrations of THC (and decrease in CBD levels) in illicit cannabis, increasing from 4% in 1995 to 12% in 2014 (ElSohly et al., 2016). Canada legalized the use of cannabis for non- medical purposes for individuals over 18 years of age (19 in some provinces) on October 17, 2018. A review

2019 Canadian Centre on Substance Abuse

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