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Dyspepsia in Pregnancy

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122. Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Risks

. Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, and advance work to resolve any methodological issues that could impede new reviews. DRIs are a set of reference values that provide guidance on adequate and safe intakes of nutrients across the life span, by sex, and during pregnancy and lactation in apparently healthy individuals. They are based on an expert consensus process in which ad hoc committees convened by the Food and Nutrition (...) /?pageaction=displayproduct&productid=2428). In addition, the protocol was registered in PROSPERO (CRD42017056126). Key Questions The Key Questions (KQs) for sodium and potassium are as follows. Sodium KQ1. Among adults and children of all age groups (including both sexes and pregnant and lactating women), what is the effect (benefits and harms) of interventions to reduce dietary sodium intake on blood pressure at the time of the study and in later life? a. Do other minerals (e.g., potassium, calcium

2018 Effective Health Care Program (AHRQ)

123. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

framework Abbreviations: AF=atrial fibrillation; DVT=deep vein thrombosis; KQ=Key Question; ICH=intracranial hemorrhage; PE=pulmonary embolism Thromboembolic outcomes: • Cerebrovascular infarction • Transient ischemic attack • Systemic embolism (excludes PE and DVT) Bleeding outcomes: • Hemorrhagic stroke • Intracranial hemorrhage • Major bleed • Minor bleed Other clinical outcomes: • Mortality • Myocardial infarction • Infection • Heart block • Esophageal fistula • Tamponade • Dyspepsia • Health (...) -related quality of life • Functional capacity • Health services utilization • Long-term adherence to therapy • Cognitive function Adults with nonvalvular AF Individual characteristics: • Age • Sex • Race/ethnicity • Presence of heart disease • Type of AF • Previous thromboembolic event • Previous bleed • Comorbid conditions • In therapeutic range • Pregnant • Noncompliant Anticoagulation therapy Procedural interventions Antiplatelet therapies KQ 2 KQ 3b KQ 3a/b Diagnostic accuracy efficacy Diagnostic

2018 Effective Health Care Program (AHRQ)

124. Gastroesophageal Reflux Disease (GERD)

daily. The National Ambulatory Medical Care Survey (NAMCS) found that 38.53 million annual adult outpatient visits were related to GERD. For patients presenting with GERD symptoms, 40-60% or more have reflux esophagitis. Up to 10% of these patients will have erosive esophagitis on upper endoscopy. GERD is more prevalent in pregnant women, and a higher complication rate exists among the elderly. Patients with GERD generally report decreases in productivity, quality of life and overall well-being (...) no endoscopic evidence of disease. Although these diagnostic limitations occur less often when patients present with the classic symptoms of heartburn and acid regurgitation, diagnosis may be difficult in patients with recalcitrant courses and extraesophageal manifestations of this disease. Diagnostic Problems The lack of a gold standard in the diagnosis of GERD presents a clinical dilemma in treating patients with reflux symptomatology. Many related syndromes including dyspepsia, atypical GERD, H. pylori

2018 University of Michigan Health System

126. Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks

. Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, and advance work to resolve any methodological issues that could impede new reviews. DRIs are a set of reference values that provide guidance on adequate and safe intakes of nutrients across the life span, by sex, and during pregnancy and lactation in apparently healthy individuals. They are based on an expert consensus process in which ad hoc committees convened by the Food and Nutrition (...) /?pageaction=displayproduct&productid=2428). In addition, the protocol was registered in PROSPERO (CRD42017056126). Key Questions The Key Questions (KQs) for sodium and potassium are as follows. Sodium KQ1. Among adults and children of all age groups (including both sexes and pregnant and lactating women), what is the effect (benefits and harms) of interventions to reduce dietary sodium intake on blood pressure at the time of the study and in later life? a. Do other minerals (e.g., potassium, calcium

2018 Effective Health Care Program (AHRQ)

130. Prevention of chemotherapy induced nausea and vomiting in adults: netupitant/palonosetron

that netupitant/palonosetron was well tolerated with many adverse reactions likely to be associated with either the underlying condition or associated cytotoxic treatments. Netupitant/palonosetron is contraindicated in pregnancy. Severe constipation and complications due to constipation may also occur (summary of product characteristics [SPC]). In-line with the other 5-HT 3 receptor antagonists the SPC also includes warnings and precautions on the risk of serotonin syndrome and QT prolongation. The SPC lists (...) with many adverse reactions likely to be associated with either the underlying condition or associated cytotoxic treatments. Similarly serious adverse events and deaths reflect the patient population and current treatment. In Aapro et al. (2014) and Gralla et al. (2014) the most common treatment-related adverse events were constipation, dyspepsia, eructation and headache. As stated in the EPAR cases of severe constipation and complications due to constipation were seen during the clinical trial

2016 National Institute for Health and Clinical Excellence - Advice

131. CUA guideline on adult overactive bladder

, hepatic Dry mouth, headache, accommodation disorder, visual impairment, constipation, abdominal pain, dyspepsia, and fatigue Beta-3 adrenoceptor agonist Mirabegron Myrbetriq ® A 25 or 50 mg OD Renal, hepatic Nausea, headache, hypertension, UTI, nasopharyngitis Severe uncontrolled hypertension, pregnancy BID: twice a day; CNS AE: central nervous system adverse effects; ER: extended release; GI: gastrointestinal; GU: genitourinary; IR: immediate release; OD: once a day; QID: four times a day; TID: three (...) management of overactive bladder Category Drug Brand name Grade Recommended doses Considerations in medically complex elderly Dose adjustment Adverse events Contraindications Antimuscarinics Oxybutynin Ditropan Ditropan XL A IR: 5 mg BID, TID, or QID ER: 5 or 10 mg OD Data show efficacy of 2.5mg bid. 235,272 Doses of 20 mg daily consistently associated with cognitive impairment, unreported by patients 252 Elderly Dry mouth, constipation, CNS AE Pregnancy or breast- feeding; drug hypersensitivity

2017 Canadian Urological Association

133. Stretta System for gastro-oesophageal reflux disease

is contraindicated in people under 18 years and in pregnancy. Symptoms of GORD are common in pregnant women. Age and pregnancy are protected characteristics under the Equality Act 2010. Clinical and technical e Clinical and technical evidence vidence A literature search was carried out for this briefing in accordance with the published process and methods statement. This briefing includes the most relevant/best publicly-available evidence relating to the clinical and cost effectiveness of the technology (...) ://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 15Current NHS options The NICE guideline on gastro-oesophageal reflux disease and dyspepsia in adults recommends lifestyle modifications such as weight reduction or smoking cessation, and gastric acidity-lowering medication to improve symptoms. People whose symptoms do not respond to medication or lifestyle changes, who develop complications despite medication, or who develop intolerance to medication may be considered for anti-reflux surgery

2016 National Institute for Health and Clinical Excellence - Advice

134. Peptest for diagnosing gastro-oesophageal reflux

. In the larynx it can cause sore throat and voice disorders. The severity of the symptoms depends on the degree of sphincter dysfunction, the type and amount of fluid brought up from the stomach, and the neutralising effect of saliva. According to NICE guidance on dyspepsia, GORD is a common condition. About 1 in 5 people are thought to experience at least 1 episode of GORD per week, with 1 in 10 people experiencing symptoms of GORD daily. People of all ages can be affected, including children (...) , and a report is sent to the patient and doctor. Current NHS options Current NHS options NICE guidance on dyspepsia makes recommendations on the diagnosis, management and treatment of GORD. The aims are to control symptoms, heal oesophagitis and prevent recurrent oesophagitis or other complications. The guideline recommends referral for endoscopy if there are any red-flag symptoms, which include: gastrointestinal bleeding persistent vomiting progressive unintentional weight loss aged 55 years or older

2015 National Institute for Health and Clinical Excellence - Advice

135. Musculoskeletal Strains and Sprains - Guidelines for Prescribing NSAIDs

ASA ( < 325 mg) co-therapy is associated with fewer GI ulcers and serious upper GI disorders. Regular use of NSAIDs, in particular ibuprofen, might interfere with the antiplatelet effect of ASA. ASA should be taken an hour before the NSAID Pregnancy : NSAIDs are not recommended during the first and third trimesters of pregnancy due to risk of miscarriage in the first trimester and interference with closure of the ductus arteriosis in the third trimester. Lactation: Ibuprofen is a preferred drug (...) . NSAIDs should be taken with a full glass of water to facilitate dissolution. Encourage patients on NSAIDs to drink fluids to maintain adequate hydration (to prevent kidney dysfunction). Taking NSAIDs with food is often recommended to prevent GI symptoms, although there is no evidence this reduces the incidence of dyspepsia or ulceration. Expect onset of pain relief with analgesics in 30 - 60 minutes. Patients with a sprain or strain should be advised to seek further medical advice

2017 medSask

136. Psoriasis

. There is no evidence that secukinumab has any negative effect on diabetes control. 24 Kidney failure/Renal impairment In the pivotal clinical trials there was no evidence for treatment emergent adverse events related to renal function 27, 28 . Wish for pregnancy in near future Pregnancy “Women of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment. There are no adequate data from the use of secukinumab in pregnant women. Animal studies (...) of active and chronic infection o Check for contraception and breastfeeding o Check for need for vaccines (see “vaccination”) o Check for hypersensitivity, metabolic, gastrointestinal and renal disorders/dysfunction, underweight, o Check for depression, anxiety o Check for co-medication: CYP3A4 enzyme inducers • Laboratory controls including pregnancy test (see Table 1) During-treatment • Objective assessment of the disease (such as PASI/BSA/PGA; arthritis) • HRQoL (such as DLQI/ Skindex-29 or -17

2017 European Dermatology Forum

137. Diagnosis and treatment of osteoporosis.

with CrCl ≤35 mL/min. Contraindications to denosumab include hypersensitivity to any component of the product, hypocalcemia prior to beginning therapy, and pregnancy. Contraindications to teriparatide include Paget's disease, any prior therapeutic radiation involving the skeleton, bone metastases or history of skeletal malignancies, metabolic bone disease (other than osteoporosis), hypercalcemia, pregnant and nursing women, unexplained elevated alkaline phosphatase, hypersensitivity, pediatric (...) populations, or young adults with open epiphyses. Contraindications to raloxifene include pregnancy, history of venous thromboembolism, women who are pregnant or may become pregnant, and nursing women. For both anabolic agents, teriparatide and abaloparatide, use is approved for only two years. Cumulative use of abaloparatide and parathyroid hormone analogs (e.g., teriparatide) for more than two years during a patient's lifetime is not recommended. Contraindications to estrogens include history of venous

2017 National Guideline Clearinghouse (partial archive)

138. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

of intercurrent disease and medication rather than loss of secretory ability [ ]. The guideline The guideline covers management of the eye and mouth manifestations, systemic dryness and systemic disease in general with comments on the management of pregnancy and lymphoma in patients with SS. For each section we have reviewed and summarized the available evidence and then listed the recommendations that achieved a mean SOA score of ⩾7 plus 75% of respondents scoring ⩾ 7 after the second round of the Delphi (...) limit its use in some. The recommended starting dose is 5 mg once daily, escalating at weekly intervals as tolerated to 5 mg qds (with meals and at bedtime) but if response is insufficient, the dose can be increased to 30 mg daily, if tolerated well; discontinue if no improvement after 2–3 months. Contra-indications include uncontrolled asthma and chronic obstructive pulmonary disease, uncontrolled cardiorenal disease and acute iritis. Common side effects include dyspepsia, diarrhoea, abdominal pain

2017 British Society for Rheumatology

139. CRACKCast E095 – Large Intestine

, or electrolyte disturbances” — Quotation from Uptodate 2017 ● Nocturnal diarrhea, anorexia, onset > 50 yrs of age However, here are features that are typical for IBS: One out of three days of: Bloating Abdominal pain (relieved with defecation) Constipation OR diarrhea OR both Upper GI symptoms (dyspepsia / nausea) Mild abdominal tenderness The strict definition is made by the ROME IV criteria – check out the show notes! Check out Box 85.2 – ddx for IBS based on symptoms – diarrhea, constipation, pain (...) % of population have this anatomic variant RF: Usually needs coexisting trauma, adhesions, lymph nodes or malignancy, Pregnancy 20% risk for gangrene Sigmoid Needs Long redundant section of sigmoid w/ narrow mesentery attachment to abdo wall The narrow attachment allows mesentery to twist on itself = luminal obstruction After obstruction, the proximal colon continues to force gas and liquid into the obstructed segment = sometimes massive dilation of the distal colon RF: A high fiber diet / Chronic

2017 CandiEM

140. CRACKCast E093 – Appendicitis

) coverage is not typically needed to treat appendicitis but may be considered if the patient has previously known MRSA colonization “ – rosen’s 9th Ed. Wisecracks 1) Which patient groups present atypically? Children, pregnant women, the elderly! Pregnancy “Acute appendicitis is the most common general surgical problem encountered during pregnancy. Clinical manifestations are generally similar as other adults. •Right lower quadrant pain is the most common symptom and occurs within a few centimeters (...) of McBurney’s point in most pregnant women, regardless of the stage of pregnancy. In late pregnancy, pain may be the right mid or upper quadrant . Rebound tenderness and guarding are less prominent in pregnant women, especially in the third trimester. Be aware of that sneaky retrocecal appendix or pelvic appendix. Mild leukocytosis can be a normal finding in pregnant women: the total leukocyte count may be as high as 16,900 cell/microL in the third trimester and 29,000 cells/microL during labor, so

2017 CandiEM

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