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Cough fracture

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181. Cystic fibrosis: diagnosis and management.

changes Chronic wet or productive cough Chronic sinus disease Obstructive azoospermia (in young people and adults) Acute or chronic pancreatitis Malabsorption Rectal prolapse (in children) Pseudo-Bartter syndrome. Refer people with suspected cystic fibrosis to a specialist cystic fibrosis centre if: They have a positive or equivocal sweat test result Their assessment suggests they have cystic fibrosis but their test results are normal Gene testing reveals 1 or more cystic fibrosis mutations (...) for microbiological investigations, using sputum samples if possible, or a cough swab or nasal pharyngeal aspirate (NPA) Lung function testing with spirometry (including forced expiratory volume in 1 second [FEV 1 ], forced vital capacity [FVC], and forced expiratory flow [FEF] 25%–75%) in adults, and in children and young people who can do this. If spirometry is normal at a routine review, consider measuring lung clearance index. Include the following at each annual review in relation to pulmonary assessment

2017 National Guideline Clearinghouse (partial archive)

182. Diagnosis and treatment of osteoporosis.

fracture of femur and vertebral column, cancer. Recombinant parathyroid hormone (teriparatide) is shown to cause an increase in the incidence of osteosarcoma in male and female rats, dependent on dose and duration of treatment, hypotension, syncope, rash, sweating symptoms, hyperuricemia, constipation, diarrhea, indigestion, nausea, vomiting, arthralgia, spasm, asthenia, dizziness, rhinitis, increasing frequency of cough, pharyngitis, angina pectoris. Raloxifene (Evista) carries the risk of deep vein (...) on pharmacologic therapy utilized DXA as the diagnostic tool for osteoporosis. Harm : There is radiation exposure for DXA, which, although small, is still present. Benefit-Harm Assessment : The benefits of DXA as a diagnostic tool outweigh the small risk of radiation that is involved. Relevant Resource : Hailey et al., 1998 Pharmacologic Treatment Recommendation : Bisphosphonates should be considered (unless contraindicated) for reduction of fracture risk (both vertebral and non-vertebral) in: Postmenopausal

2017 National Guideline Clearinghouse (partial archive)

183. Diagnosis and management of epilepsy in adults

count should not be monitored routinely. Diagnosis and management of epilepsy in adults 2 + 4 2 + 2+ 4 4 1 ++ 2 + 4| 19 4.6.4 BONE HEALTH Antiepileptic drug use is associated with a higher risk of clinical fracture, 145-149 with one systematic review reporting that AEDs increased the odds of fracture by 1.2 to 2.4 times. 148 The evidence is strongest for an association with phenobarbital, carbamazepine, clonazepam and sodium valproate. 148, 149 Bone mineral density is also lower in these patients (...) and many fractures are related to seizures. 148, 149 Postmenopausal women who use AEDs are at increased risk of fracture (hazard ratio (HR) 1.44, 95% CI 1.30 to 1.61) 145 and most AEDs were associated with an increased risk of non-traumatic factures in individuals aged 50 or over. 146 A systematic review found no RCTs investigating therapeutic agents to prevent fracture in people with epilepsy although one RCT included in the review suggested that supplementation with high dose vitamin D may

2015 SIGN

184. Partial seizures in children and young people with epilepsy: zonisamide as adjunctive therapy

). The most commonly reported adverse events were nasopharyngitis, weight loss and headache. Serious treatment-emergent adverse events were reported in 10 (6.9%) children and were considered to be treatment related in 3 cases (renal colic, foot fracture, and abdominal pain). Decreases in bicarbonate level of more than 3.5 mmol/L were observed in 64 (44.4%) children, but there were no reports of metabolic acidosis. These changes in bicarbonate levels were considered to be similar to those described (...) received placebo. The most common treatment-emergent adverse events in children aged 6–11 years were pyrexia (21.9%), headache (21.2%), upper respiratory tract infection (21.1%), decreased appetite (20.5%), rash (12.3%), somnolence (18.5%), vomiting (14.4%), fatigue (13.7%), nasopharyngitis (13.7%), sinusitis (11.0%), viral infection (11.0%), upper abdominal pain (10.3%), cough (10.3%), insomnia (10.3%) and nasal congestion (10.3%). In children and young people aged Partial seizures in children

2014 National Institute for Health and Clinical Excellence - Advice

185. National minimum retesting intervals in pathology: A final report detailing consensus recommendations for minimum retesting intervals for use in pathology

fracture or pain located in bone, suppression of other immune- globulin classes, renal impairment) and a band of 3 days for hCG) is a reliable indicator of residual tumour and a sig-nificant predictor of survival B- TM13 Serum ß-HCG (tumour marker) If rate of change in tumour marker concentration changes velocity, an urgent repeat to confirm the result is reasonable Sturgeon CM, Hoffman BR, Chan DW, Ch'ng SL, Hammond E, Hayes DF et al. National Academy of Clinical Biochemistry Laboratory Medicine

2016 Royal College of Pathologists

186. Chronic Opioid Therapy for Chronic Non-Cancer Pain

of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain. 2014;30:557-564. Food and Drug Administration. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. Silver Spring, MD: U.S. Food and Drug Administration; August 31, 2016. Food and Drug Administration. FDA announces safety labeling (...) screening of the patient for potential comorbidities and risk factors using an appropriate screening tool. The screening should address: (i) History of addiction; (ii) Abuse or aberrant behavior regarding opioid use; (iii) Psychiatric conditions; (iv) Regular concomitant use of benzodiazepines, alcohol, or other central nervous system medications; (v) Poorly controlled depression or anxiety; (vi) Evidence or risk of significant adverse events, including falls or fractures; (vii) Receipt of opioids from

2016 Kaiser Permanente Clinical Guidelines

192. Lessons from research for doctors in training: recognition and early management of meningococcal disease in children and young people

output monitored. Diagnosis: Very little evidence to support a diagnosis of viral URTI. Child was feverish and lethargic, but chest was clear, and no record of mucus, cough, sore throat, otitis media. Section 2 Clinical case histories Case 2 Outcome The child re-presented 12 hours later in uncompensated shock, with a widespread rash and died despite full resuscitation. Learning points n Children with sepsis often have rigors. n Children in early stages of sepsis may look reasonably well and remain

2018 Meningitis Research Foundation

193. Drugs to avoid in 2015

disorders, hyperoxaluria, and bone fractures in adolescents. Orlistat alters the gastroin- testinal absorption of many nutrients (fat-soluble vitamins A, D, E and K), leading to a risk of deficiency, and also reduces the efficacy of some drugs (thy- roid hormones, some antiepileptics). Oral contraceptive efficacy can be reduced if orlistat provokes severe diarrhoea (Prescrire Int n° 57, 71, 107, 110, Rev Prescrire n° 374). There are currently no drugs capable of inducing permanent weight loss (...) efficacy in the prevention of osteoporotic fractures and no efficacy for “bone loss” during prostate cancer, and carries a disproportionate risk of adverse effects, including back pain, mus- culoskeletal pain, and serious infections (including endocarditis) due to the immunosuppressive effects of this monoclonal antibody (Prescrire Int n° 117 and 130)(a). – Strontium ranelate has only modest effi- cacy in preventing recurrent vertebral fractures. Yet its adverse effects include neuropsychiatric

2015 Prescrire

194. Principles of Control of Bleeding for First Aiders

or chest, as well as fractures. Severe bleeding may also occur from complications of pregnancy. Symptoms and signs may include: • pain, tenderness or swelling over or around the affected area • the appearance of blood from a body opening, e.g.: o bright red and/or frothy blood coughed up from the lungs o vomited blood which may appear bright red or as dark brown "coffee grounds" o blood-stained urine o vaginal bleeding or bleeding from the penis o rectal bleeding which may be bright red or black

2016 Australian Resuscitation Council

195. Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol

exacerbations, but not exacerbations requiring admission to hospital, compared with vilanterol 25 micrograms alone. Fluticasone furoate/vilanterol 100/ 25 micrograms improved trough FEV 1 after 24 weeks' treatment compared with placebo but not compared with vilanterol alone. Safety Safety No statistical analysis of safety data from studies is available. Local corticosteroid effects, pneumonia (including requiring admission to hospital) and non-traumatic fractures were seen more frequently with fluticasone (...) . An additional study (Martinez et al. 2013) had the same design as that by Kerwin et al. (2013), but for methodological reasons, statistical analysis of the results for fluticasone furoate/vilanterol 100/ 25 micrograms could not be performed. Statistical analysis of safety data was not presented in any of the studies included in this review, which limits the conclusions that can be drawn. Local corticosteroid effects, pneumonia (including pneumonia requiring admission to hospital) and non-traumatic fractures

2013 National Institute for Health and Clinical Excellence - Advice

196. Duavive - oestrogens conjugated / bazedoxifene

of fracture. Duavive is indicated in postmenopausal women with a uterus (with 12 months since the last menses). When determining whether to use DUAVIVE or other therapies, including oestrogens, for an individual postmenopausal woman, consideration should be given to menopausal symptoms, effects on uterine and breast tissues, and cardiovascular risks and benefits (see sections 4.4 and 5.1). The legal basis for this application refers to: Article 10(b) of Directive 2001/83/EC – relating to applications (...) postmenopausal symptoms in women with a uterus is progestin containing HRT which has been associated with vaginal bleeding, breast pain / tenderness, and increases in breast density. The combination of BZA with CE is considered by the Applicant to provide an alternative treatment option to progestin containing HRT. BZA has been approved in the EU as Conbriza ® and in Japan as Viviant ® for the treatment of postmenopausal osteoporosis in women at increased risk of fracture, and has also been approved

2015 European Medicines Agency - EPARs

198. Cerdelga - eliglustat

, discomfort, pain, and early satiety; fatigue; easy bruising/bleeding; splenic rupture; chronic bone pain and acute bone crises; osteonecrosis; marrow infarction; and pathological fractures. Three main clinical types of GD have been described, all of which are inherited in an autosomal recessive manner and caused by mutations in the GBA gene located at chromosome 1q22. The most common form, Gaucher disease type 1 (GD1), has historically been characterised as lacking central nervous system (CNS

2015 European Medicines Agency - EPARs

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