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Cushing Response

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201. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

to get better instantly. Their most acute need is appropriate reas- surance that their disorder has been recognised and that help will be forthcoming. Initial treatment should be selected in collaboration with the patient, based on the severity of the disorder, previous response to treatment, availability and the person’s preference. It will usually take 4–6 weeks to see improvement, whether cognitive–behavioural therapy (CBT) or an antide- pressant is used, and most people can tolerate this. Only (...) . Overview of the management of anxiety disorders. CBT: cognitive–behavioural therapy. CBT can be delivered face-to-face by an experienced clinician or as guided digital CBT. dCBT: guided digital CBT (CBT accessed by computer, tablet or smartphone application). §Watchful waiting includes monitoring response to psychoeducation and lifestyle measures. *For the purpose of initial treatment choice, mild, moderate and severe are defined pragmatically, according to effect on function, as inability to perform

2018 Royal Australian and New Zealand College of Psychiatrists

202. Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

, with further evaluation in patients with amenorrhea and more severe clinical features including consideration of hypogonadotropic hypogonadism, Cushing disease or androgen-producing tumours. The guideline recognises that PCOS is an insulin-resistant and metabolic disorder; tests for insulin resistance, however, lack accuracy and should not be incorporated into the diagnostic criteria for PCOS at this time. Anti-Müllerian hormone is likewise not recommended for diagnosis at this time. Complication screening (...) . Ngaanyatjarra Health Service, Dec 2006. (viewed Aug 2018). Kildea S, Bowden FJ. Reproductive health, infertility and sexually transmitted infections in Indigenous women in a remote community in the Northern Territory. Aust N Z J Public Health 2000; 24: 382-386. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted. Author Salutation First Name Middle Name Last Name

2018 MJA Clinical Guidelines

203. ESC/ESH Management of Arterial Hypertension Full Text available with Trip Pro

Vascular endothelial growth factor WUCH White-coat uncontrolled hypertension 1 Preamble Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health (...) and coordinates the preparation of new Guidelines. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts, and in this case by ESH -appointed experts. After appropriate revisions the Guidelines are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG and ESH for publication in the European Heart Journal and in the Journal of Hypertension as well as Blood

2018 European Society of Cardiology

204. International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

pharmacological agents 97 4.7 Inositol 99 Chapter Five Assessment and treatment of infertility 100 5.1a Assessment of factors that may affect fertility, treatment response or pregnancy outcomes 101 5.1b Tubal patency testing 103 5.2 Ovulation induction principles 104 5.3 Letrozole 105 5.4 Clomiphene citrate and/or metformin 107 5.5 Gonadotrophins 110 5.6 Anti-obesity agents 112 5.7 Laparoscopic ovarian surgery 113 5.8 Bariatric surgery 115 5.9a In-vitro fertilisation 117 5.9b Gonadotropin releasing hormone (...) with amenorrhea and more severe clinical features including consideration of hypogonadotropic hypogonadism, Cushing’s disease, or androgen producing tumours. We acknowledge the challenges in defining specific diagnostic features, including around menarche and menopause, where diagnostic features naturally evolve. The guideline aims to facilitate timely and appropriate diagnosis for women with PCOS, whilst avoiding over diagnosis, especially in adolescents. Specific recommendations of relevance here include

2018 European Society of Human Reproduction and Embryology

205. Budesonide (Jorveza) - to treat adults with eosinophilic oesophagitis

38 2.4.5. Conclusions on clinical pharmacology 40 2.5. Clinical efficacy 40 2.5.1. Dose response study 40 2.5.2. Main study(ies) 42 2.5.3. Discussion on clinical efficacy 59 2.5.4. Conclusions on the clinical efficacy 63 2.6. Clinical safety 64 2.6.1. Discussion on clinical safety 70 2.6.2. Conclusions on the clinical safety 72 2.7. Risk Management Plan 73 2.8. Pharmacovigilance 75 Assessment report EMA/774645/2017 Page 4/83 2.9. Product information 75 2.9.1. User consultation 75 3. Benefit-Risk (...) -double blind PPI Proton pump inhibitor PPI-REE Proton pump inhibitor-responsive oesophageal eosinophilia PRA Patient’s Response Assessment PRO Patient reported outcome PT Preferred term QoL Quality of life R Reference dose RCI Repeated confidence interval RH Relative Humidity SAE Serious adverse event SAF Safety set Scr 2 Screening visit 2 SD Standard deviation SmPC Summary of Product Characteristics SOC System Organ Class TAMC Total Aerobic Microbial Count TEAE Treatment-emergent adverse event TLC

2018 European Medicines Agency - EPARs

206. Sudden Hearing Loss Full Text available with Trip Pro

obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of sudden sensorineural hearing loss. (KAS 6) Clinicians should evaluate patients with sudden sensorineural hearing loss for retrocochlear pathology by obtaining magnetic resonance imaging or auditory brainstem response. (KAS 10) Clinicians should offer, or refer to a clinician who can offer, intratympanic steroid therapy when patients have incomplete recovery from (...) is emphasized. KAS 5—New studies were added to confirm the lack of benefit of nontargeted laboratory testing in sudden sensorineural hearing loss. KAS 6—Audiometric follow-up is excluded as a reasonable workup for retrocochlear pathology. Magnetic resonance imaging, computerized tomography scan if magnetic resonance imaging cannot be done, and, secondarily, auditory brainstem response evaluation are the modalities recommended. A time frame for such testing is not specified, nor is it specified which

2019 American Academy of Otolaryngology - Head and Neck Surgery

207. Management of Cardiac Disease in Cancer Patients Throughout Oncological Treatment: ESMO Consensus Recommendations

therapy needs to be individualised with multidisciplinary discussion considering the cancer sta- tus, response to prior therapy, severity of cardiotoxicity, regression of toxicity with immunosuppressive therapy and patientpreferenceafterweighingtherisksandbene?ts.IfICI therapy needs to be restarted, monotherapy with an anti- Annals of Oncology G. Curigliano et al. 184 Volume 31 - Issue 2 - 2020programmedcell death protein 1(anti-PD-1) agent might

2020 European Society for Medical Oncology

208. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence Full Text available with Trip Pro

increase in androgen production are hypothesized to contribute to IR and hyperinsulinemia. The association between IR and androgen excess in women has long been recognized because of the association of hyperandrogenic features with the rare syndromes of extreme IR due to mutations of the insulin receptor or autoantibodies targeting the insulin receptor [ - ]. Insulin may also potentiate the steroidogenic response to gonadotropins indirectly, by acting at the pituitary to increase gonadotrope (...) levels, and greater IR among women with PCOS [ - ]. Endothelial dysfunction has been described and may promote chronic inflammation [ ]. Although the mechanisms responsible for obesity-related IR are not completely clear, ectopic accumulation of fatty acids in organs and tissue that are not meant to store large amounts of fat appears to play a role [ ]. Ectopic fat accumulation can also occur in the absence of obesity, i.e., when there has been reduced prenatal growth and thus a reduction

2019 Pediatric Endocrine Society

209. Overweight, Obesity and Contraception

who were at risk for diabetes due to being overweight. There were few data available for progestogen-only injectables, and one study showed a higher mean fasting glucose, glucose 2-hour response, and fasting insulin level amongst DMPA users compared to those using NET-EN. Overall the review suggested that there was little evidence on which to base conclusions about the impact of hormonal contraceptives in women with diabetes. Among women without diabetes, there did not appear to be any major (...) to COC users, 167,168 other studies have reported a significant two-fold greater VTE risk among patch and ring users compared to COC users. 61,169 Evidence level 2+ A recent systematic review 170 investigated whether CHC use modifies the risk of VTE in obese women, and also evaluated evidence for a dose–response relationship between BMI and VTE. No studies regarding the contraceptive patch or vaginal ring met the inclusion criteria in this review. Data from one pooled analysis, 171 one cohort study

2019 Faculty of Sexual & Reproductive Healthcare

210. Management of Atopic Eczema

. Adherence to these guidelines may not necessarily guarantee the best outcome in every case. Every healthcare provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally. Management of Atopic Eczema UPDATING THE CPG These guidelines were issued in 2018 and will be reviewed in a minimum period of four years (2022) or sooner if new evidence becomes available. When it is due for updating (...) . MANAGEMENT OF ATOPIC ECZEMA IN PRIMARY CARE Investigator’s Global Assessment IGA : Investigators’ Global Assessment QoL : Quality of life DLQI : Dermatology Life Quality Index CDLQI: Children’s Dermatology Life Quality Index SEVERITY ASSESSMENT CLEAR TO MILD IGA score: 0 to 2 ATOPIC ECZEMA PATIENT PRESENTING TO PRIMARY CARE MODERATE IGA score: 3 SEVERE TO VERY SEVERE IGA score: 4 to 5 REFER DERMATOLOGY SERVICE DLQI/CDLQI >10 DLQI/CDLQI =10 NO YES TREATMENT Refer Algorithm 2 RESPONSE QoL CONTINUE

2019 Ministry of Health, Malaysia

211. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings

, it is difficult to identify a threshold dose for all ICS that will cause HPA axis suppression. 18 Therefore, it is important to recog- nize chronic ICS therapy as a risk factor for AI. A study of infants with hemangiomas treated with high-dose glucocor- ticoid therapy for 12–26 weeks demonstrated the return of normal circadian response in salivary cortisol levels within 6 weeks and normal response to administration of low-dose ACTH stimulation by 12 weeks after stopping treatment. 14 During the process (...) of recovery from HPA suppression, physiological circadian secretion of cortisol may recover before return of the ability of the hypothalamus to respond to stress. 19 Therefore, a patient may have a normal 8:00 AM cortisol, but still be unable to show an appropriate serum cortisol response to stress. 20 21 The wide variability in box 1 Acquired causes of adrenal insufficiency PrimaryPrimary ? Autoimmune adrenalitis (Addison disease) – Isolated. – Autoimmune polyendocrinopathy type 1. – Autoimmune

2019 Pediatric Endocrine Society

212. Spine imaging

circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based on unique aspects of the patient’s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient (...) of disease ? Diagnosis – testing based on a reasonable suspicion of a particular condition or disorder, usually due to the presence of signs or symptoms ? Management – testing to direct therapy of an established condition, which may include preoperative or postoperative imaging, or imaging performed to evaluate the response to nonsurgical intervention ? Surveillance – periodic assessment following completion of therapy, or for monitoring known disease that is stable or asymptomatic Imaging of the Spine

2019 AIM Specialty Health

213. Clinical Practice Guideline for the Management of Infantile Hemangiomas

proliferative growth and involution phases within the expected time frame. , Noninvasive imaging may be used to monitor response to treatment but typically is not required. Occasionally, differentiating an IH from a highly vascularized malignant tumor may be difficult. Clinical history, response to therapy, and imaging characteristics considered together are extremely important in this differentiation. In rare cases, a tissue biopsy may be needed to confirm the diagnosis. Clinicians should use imaging (...) vascular characteristics and no arteriovenous shunting (an exception to the latter is that hepatic IHs may exhibit arteriovenous shunting). This may change as the IH involutes and has a more fatty appearance with decreased vascularity. , Doppler ultrasonography is also the modality of choice when screening for hepatic IHs and can be used to monitor progression of disease and response to treatment. Key Action Statement 2C ( ) View this table: TABLE 10 Key Action Statement 2C: Clinicians should perform

2019 American Academy of Pediatrics

214. CRACKCast E198 – Brain Resuscitation

] What are Lundberg A waves? On ICP monitoring devices, Lundberg A waves represent periods of refractory ICP elevation. These appear as increases in ICP from baseline, plateauing ICP for several minutes, and then spontaneous return of ICP to near-baseline levels. These are generally the result of increasing ICP that leads to increased cerebral vasodilation that further increased ICP and diminished CPP. The return to baseline is the result of the Cushing Response. [2] What is the relationship between

2019 CandiEM

216. Screening and Management of the Hyperandrogenic Adolescent

before menarche. Once initiated, patients should be coun- seled that it may take 6 months before they see the benefits of treatment. c Any estrogen-containing therapy should be effective at reducing acne, and oral contraceptive pills (OCPs)particularlyareeffectiveforadolescentswho report premenstrual acne flare-ups. c Patients should be assessed at routine intervals (every 3–6 months) for adverse effects and response to treatment until their condition is stable; they then should be monitored annually (...) hyperandrogenism of puberty, idiopathic hyperandrogenism, and PCOS. Other lesscommonpotentialcausesofhyperandrogenisminclude nonclassic congenital adrenal hyperplasia, androgen- secreting tumors, hypothyroidism, Cushing disease, and severe hyperprolactinemia. The diagnosis of hyperandrogenism can be based on clinical symptoms or measurement of serum androgens. In females, androgens originate from three primary sources: (1) the ovarian theca, (2) the adrenal cortex, and (3) within end organs by peripheral

2019 American College of Obstetricians and Gynecologists

217. AACE/ACE Guidelines for Management of Growth Hormone Deficiency in Adults and Patients Transitioning from Pediatric to Adult Care

) provided by the laboratory utilized. This decision should consider the pretreatment IGF-1 SDS and the circumstances and tolerability of each individ- ual patient. Because some patients may only tolerate lower rhGH doses frequently limited by side effects, whereas others may require higher rhGH doses to achieve desired clinical effects, the goals of treatment should be the clinical response, avoidance of side effects, and targeting serum IGF-1 levels to fall within the age-adjusted reference range (IGF (...) -1 SDS between –2 and + 2) (Grade D; based on expert opinion of the committee). R37. It is recommended to initiate rhGH therapy using low GH dosages (0.1 to 0.2 mg/day) in GH-deficient patients with concurrent DM, obesity, older age, and previous gestational DM to avoid impairment of glu- cose metabolism. Higher rhGH starting doses (0.3 to 0.4 mg/day) are advised in nondiabetic young adults 2 SDS). The dose should be modified based on the clinical response, serum IGF-1 levels, side effects

2019 American Association of Clinical Endocrinologists

218. Male Sexual Dysfunction

-being in men with erectile dysfunction in a randomized, placebo-controlled trial. Andrology, 2013. 1: 475. 217. Spitzer, M., et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med, 2012. 157: 681. 218. Mulhall, J., et al. Impact of Baseline Total Testosterone Level on Successful Treatment of Sexual Dysfunction in Men Taking Once-Daily Tadalafil 5 mg for Lower Urinary Tract Symptoms and Benign (...) phentolamine versus prostaglandin E1 in erectile dysfunction. J Urol, 1997. 157: 2132. 254. McMahon CG, et al. A comparison of the response to the intracavernosal injection of papaverine and phentolamine, prostaglandin E1 and a combination of all three agents in the management of impotence J Urol, 1999. 162. [No abstract available]. 255. Dinsmore, W.W., et al. Vasoactive intestinal polypeptide/phentolamine for intracavernosal injection in erectile dysfunction. BJU Int, 2008. 102: 933. 256. McMahon, C.G

2019 European Association of Urology

219. Immune Modulating Therapies in Pregnancy and Lactation

a variety of immunomodulating drugs, defined in this document as agents that inhibit or modulate the immune response. Because autoimmune conditions occur more often among women of childbearing age ( ), continuation of these medications during pregnancy is often considered to optimize disease management in the woman and pregnancy outcomes ( ), without placing the fetus at undue risk ( ). Emerging safety and efficacy data regarding the use of these medications during pregnancy and lactation can be used (...) the VACTERL association among tumor necrosis factor antagonist-exposed pregnancies is similar to the general population. EUROCAT Working Group. J Rheumatol 2011;38:1871–4. Gisbert JP, Chaparro M. Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol 2013;108:1426–38. Clowse ME, Scheuerle AE, Chambers C, Afzali A, Kimball AB, Cush JJ, et al. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance

2019 American College of Obstetricians and Gynecologists

220. Gastroenteropancreatic Neuroendocrine Neoplasms

[51]. A second placebo- controlled trial (TELECAST) including patients with less frequent bowel movements supports the efficacy and good tolerability of telotristat ethyl. Adverse effects include mild elevations of liver enzymes. Depression-related events and nausea were observed at higher doses [52]. Patients with durable response showed significant and/or meaningful improvements in global quality of life (QoL), as well as nausea, pain, diarrhoea and GI symptoms [53]. Telotristat ethyl (250 mg (...) on different prognostic factors including grade, tumour extent and slope of progression. Somatostatin analogues SSAs are an established antiproliferative therapy in metastatic GEP-NETs, based on two placebo-controlled trials. Most frequently, they are used in first-line treatment, based on their modest activity and the settings in which they have been studied. 16 Overall response rates (ORRs) are low ( 25%), and NET G2 with a Ki-67 of =10%. Most patients (96%) had stable disease at study onset. The median

2020 European Society for Medical Oncology

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