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Dyspepsia in Pregnancy

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121. Attention deficit hyperactivity disorder

factors most strongly associated with ADHD are low birth weight and maternal smoking during pregnancy. Other risk factors include preterm delivery, epilepsy, acquired brain injury, lead exposure, iron deficiency, alcohol exposure during pregnancy, psychosocial adversity, and adverse maternal mental health. Overall, ADHD can be viewed as a heterogeneous disorder with different resulting from differing combinations of risk factors. [ ; ] Prevalence How common is it? There are three different subtypes (...) . Adverse effects What adverse effects are associated with methylphenidate? The most common adverse effects of methylphenidate include: Gastrointestinal effects such as abdominal pain, nausea, vomiting, diarrhoea, dyspepsia, dry mouth, and anorexia. Cardiovascular effects such as tachycardia, palpitation, arrhythmias, and changes in blood pressure. Central nervous system effects such as insomnia, nervousness, asthenia, depression, irritability, aggression, headache, drowsiness, dizziness, and movement

2018 NICE Clinical Knowledge Summaries

122. Smoking cessation

with, a number of health problems, including: Cancer — it is estimated that smoking is responsible for almost one-fifth of new cancer diagnosis in the UK every year, and 7% of all cancer deaths [ ]. Smoking is the most common cause of lung cancer in the UK [ ]. More than a quarter of all cancer deaths can be attributed to smoking (including lung, oral, throat, bladder, kidney, pancreatic, stomach, liver and cervical cancers) [ ]. Complications in pregnancy and labour — smoking increases the risk (...) of [ ; ; ; ]: Maternal deep vein thrombosis and pre-eclampsia. Preterm birth. Premature rupture of membranes. Placental abruption. Placenta praevia. Ectopic pregnancy. Miscarriage. Fetal complications — fetal exposure to maternal smoking increases the risk of [ ; ; ; ; ]: The child having behavioural problems (such as attention and hyperactivity problems), learning difficulties, reduced educational performance and childhood respiratory problems. The child developing diabetes or obesity in later life. Infant

2018 NICE Clinical Knowledge Summaries

124. Hypertension - not diabetic

during pregnancy, or hypertension caused by other conditions such as renal or hormonal disease. There are separate CKS topics on , , , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary health care. How up-to-date is this topic? How up-to-date is this topic? Changes Changes January 2018 — minor update. Revised SPC for Istin (amlodipine) 5 and 10mg tablets. Drug interactions updated as per (...) salt. Issued May 2008. January 2008 — updated. The Medicines and Healthcare products Regulatory Agency (MHRA) has recently advised that ACE inhibitors and angiotensin II receptor antagonists should not be used at any stage of pregnancy. Issued in January 2008. July to September 2006 — reviewed. Validated in December 2006 and issued in January 2007. October 2005 — minor update. Reference made to the CKS topic on Antiplatelet treatment which outlines gastrointestinal issues that need to be considered

2018 NICE Clinical Knowledge Summaries

125. Urticaria

— the early lesions are pruritic and have a similar appearance to an urticarial rash. Polymorphic eruption of pregnancy — urticarial itchy papules mainly occur in the third trimester of pregnancy, often starting on abdominal stretch marks. Urticaria pigmentosa (a form of mastocytosis) — the skin becomes inflamed and red when stroked (Derier's sign) and has hyperpigmented macules and papules. Urticarial vasculitis — lesions remain for longer than 24 hours and are painful, non-blanching, and palpable (...) tolerate other treatments, because they do not confer any additional benefit [ ]. During pregnancy, oral antihistamines should be avoided where possible, especially during the first trimester. However, if a non-sedating antihistamine is required, loratadine is recommended as there is considerable clinical experience with its use in pregnancy, with no increase in the rate of congenital abnormalities [ ]. Cetirizine, desloratadine (an active metabolite of loratadine), or levocetirizine (an isomer

2018 NICE Clinical Knowledge Summaries

126. Bacterial vaginosis

of the vagina and vestibule. In women with characteristic symptoms of BV, examination and further tests may be omitted and empirical treatment started if all the following apply: The woman is at low risk of an STI. The woman does not have symptoms of other conditions. Symptoms have not developed pre or post a gynaecological procedure. The woman is not postnatal or post miscarriage. The woman is not pre or post termination of pregnancy. This is a first episode of suspected BV, or if recurrent, a previous (...) of child-bearing age, but may also be encountered in perimenopausal women . Reported prevalence rates include 5% in a group of asymptomatic college students, 12% in pregnant women attending an antenatal clinic in the UK, and 30% in women undergoing termination of pregnancy [ ]. It is more prevalent in Black women (45–55%) than in Caucasian women (5–15%) [ ]. Women who have sex with women are at increased risk for BV because they share similar lactobacillary types and are more likely to have concordant

2018 NICE Clinical Knowledge Summaries

127. Learning disabilities

to be due to a combination of factors, including: Increased rates of obesity and of being underweight due to dietary factors, lack of physical exercise, and difficulties accessing healthy lifestyle advice and support. A 20-fold increased risk of epilepsy compared to background population rates. Increased risk of dysphagia leading to eating and drinking problems and aspiration pneumonia. Increased rates of visual and hearing impairment. Increased rates of constipation, dyspepsia, thyroid disorders (...) check the person's understanding. Ask the person or their parent/carer about: The person's past or current behaviour and difficulties with daily living such as budgeting, planning, time management, understanding complex information, and time taken to learn new skills. Family and social history. Developmental history (birth, pregnancy, developmental milestones). Health problems as a child. Input from other professionals, both as a child and as an adult. Educational history (types of schools, level

2018 NICE Clinical Knowledge Summaries

128. Vitamin D deficiency in adults - treatment and prevention

and transparently linked to the supporting evidence. Update Update New evidence New evidence Evidence-based guidelines NOS (2018) Vitamin D and bone health in adults. National Osteoporosis Society. [ ] Specialist Pharmacy Service (2019) Which oral vitamin D dosing regimens correct deficiency in pregnancy? Specialist Pharmacy Service. [ ] HTAs (Health Technology Assessments) No new HTAs since 1 October 2016. Economic Appraisals No new economic appraisals relevant to England since 1 October 2016. Systematic (...) containing ultraviolet B (UVB) radiation (or by artificial UVB light). Both vitamin D 3 and D 2 can be obtained from natural foods, fortified foods, and food supplements. There are few natural rich food sources of vitamin D and most contain vitamin D 3 . Rich sources include cod liver oil (this also contains vitamin A which can be harmful in high doses and should be avoided in pregnancy) and oily fish (such as salmon, mackerel, and sardines). Egg yolk, meat, offal, milk, and mushrooms contain small

2018 NICE Clinical Knowledge Summaries

129. Antiplatelet treatment

Changes in product availability No changes in product availability since 1 June 2018. Goals and outcome measures Goals and outcome measures Goals Goals To support primary healthcare professionals to: Prescribe appropriate antiplatelet treatment for the primary and secondary prevention of cardiovascular disease. Assess and to reduce the risk of gastrointestinal bleeding associated with antiplatelet treatment. Manage antiplatelet-associated dyspepsia. Outcome measures Outcome measures No outcome (...) and there is a risk of harm. If aspirin is being considered, discuss the likely benefits (reduced CVD risk) and risks (such as gastrointestinal bleeding) with the person. For people at risk of developing dyspepsia, or who have developed dyspepsia after starting treatment, see the sections on , and , in the scenario . Basis for recommendation Basis for recommendation These recommendations are based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline Risk estimation and the prevention

2018 NICE Clinical Knowledge Summaries

130. Impetigo

on the concurrent use of clarithromycin or erythromycin with statins has been clarified. July 2014 — minor update. Text changed in prescribing information to reflect the manufacturer's recommendation that topical fucidic acid can be used during pregnancy. It can also be used during breastfeeding but should not be applied to the breast. July 2013 — reviewed. A literature search was conducted in June 2013 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last (...) if impetigo is known to be caused by MRSA – for more information, see the CKS topic on . If impetigo is more widespread or bullous treat with an oral antibiotic: Oral flucloxicillin (four times a day for 7 days) is recommended first line — for more information (including on prescribing in pregnancy and breastfeeding), see the section on . Oral clarithromycin (twice a day for 7 days) can be considered as an alternative if the person is allergic to penicillin or unable to tolerate it — for more information

2018 NICE Clinical Knowledge Summaries

131. Ovarian cancer

with ovarian cancer is about 1 in 52. The risk of ovarian cancer is increased by factors such as increasing age, family history of ovarian or breast cancer, gene mutation, and endometriosis. The risk of ovarian cancer is reduced by factors such as an increasing number of pregnancies, breastfeeding, and the use of the combined oral contraceptive pill. Ovarian cancer should be suspected and tests carried out in any woman (particularly if over 50 years of age) if any of the following symptoms are persistent (...) reports any of the following unexplained symptoms: Weight loss. Malaise or fatigue. Change in bowel habit. Other symptoms of ovarian cancer that may be present include: Abnormal or postmenopausal bleeding. Gastrointestinal symptoms, such as dyspepsia, nausea, and bowel obstruction. Shortness of breath (due to pleural effusion). If ovarian cancer is suspected, examination of the abdomen and pelvis should be carried out. If the woman has ascites or a pelvic or abdominal mass (which is not caused

2018 NICE Clinical Knowledge Summaries

132. Chickenpox

, usually about 5 days after the onset of the rash. The virus persists in sensory nerve ganglia of the dorsal root. Years later, it can reactivate and cause herpes zoster (shingles). Chickenpox is usually a self-limiting disease in healthy children. Complications include: Bacterial skin infection, most common in young children. Lung involvement, more common in adults. In pregnancy, severe maternal chickenpox and fetal varicella syndrome. In later pregnancy, varicella can result in neonatal chickenpox (...) or older) who presents within 24 hours of rash onset, particularly for people with severe chickenpox or those at risk of complications. Advice should be given about contact with other people and when to seek medical advice. Have I got the right topic? Have I got the right topic? From birth onwards. This CKS topic covers the primary care management of chickenpox in healthy children and adults, during pregnancy, in neonates, and in people who are immunocompromised. It also offers advice on the management

2018 NICE Clinical Knowledge Summaries

134. Obsessive-compulsive disorder

? Risk factors for the development of obsessive-compulsive disorder (OCD) include: Family history: First-degree relatives of people with OCD are at increased risk of developing the disorder. Age: A bimodal onset has been observed, with peak mean ages of onset at approximately 10 years and 21 years. Onset over the age of 30 years is rare. Developmental factors Emotional, physical, and sexual abuse, neglect, social isolation, bullying. Pregnancy and the postnatal period In one study of 59 female OCD (...) patients, 39% of participants described onset of OCD symptoms during pregnancy. Common obsessions in these periods are worries about harming or abusing the baby and/or not being careful enough e.g. with sterilizing feeding equipment. Compulsions include avoidance behaviour, repeatedly seeking approval, checking the baby is still breathing. [ ; ; ] Prevalence How common is it? Obsessive compulsive disorder (OCD) is thought to be the fourth most common psychiatric illness after depression, alcohol

2018 NICE Clinical Knowledge Summaries

135. Allergic rhinitis

in November 2005. July 2005 — updated to include sodium cromoglicate eye drops for use in pregnancy. Issued in July 2005. December 2004 — rewritten. Validated in March 2005 and issued in April 2005. December 2001 — rewritten, replacing the previous topic Allergic rhinitis/hay fever . Validated in March 2002 and issued in April 2002. September 1998 — written. Update Update New evidence New evidence Evidence-based guidelines No new guidelines published since 1 July 2018. HTAs (Health Technology Assessments (...) with pregnancy, starting the oral contraceptive pill, hormone replacement therapy (HRT), or hypothyroidism. See the CKS topics on and for more information. Food and drink Alcohol, sulphites, and spicy foods may cause rhinorrhoea and facial flushing. Non-allergic rhinitis with eosinophilia syndrome (NARES) This rare condition is a diagnosis of exclusion characterized by nasal eosinophils in people with perennial symptoms, and occasionally reduced sense of smell. 50% of people develop aspirin-sensitive disease

2018 NICE Clinical Knowledge Summaries

136. Dysmenorrhoea

symptoms. Menstrual history, including length of menstrual cycle, regularity, and duration, and the volume of menstrual flow. for primary dysmenorrhoea, such as family history of dysmenorrhoea. Medical history, past and present. Several conditions (for example, irritable bowel syndrome and lactose intolerance) can mimic pain similar to dysmenorrhoea. See the CKS topic on for more information. Obstetric history, including plans for pregnancy. Drug history, including treatment(s) tried and the effect (...) and endocervical swabs — if the woman is at risk of a sexually transmitted infection, especially if pain is associated with vaginal discharge and abnormal vaginal bleeding. See the CKS topic on for more information. Pregnancy test — to exclude an ectopic pregnancy. See the CKS topic on for more information. Primary dysmenorrhoea is the most likely diagnosis when: Menstrual pain starts 6–12 months after the menarche, once cycles are regular. Pain, usually cramping in nature, occurs in the lower abdomen but may

2018 NICE Clinical Knowledge Summaries

137. Dental abscess

. Detailed information on dental service provision and dental treatments. Previous changes Previous changes July 2015 — minor update. The information on the concurrent use of clarithromycin with statins has been clarified. April 2015 — minor update. The prescribing information on the use of analgesics in pregnancy and breastfeeding has been removed and replaced with a link to the CKS topic on . July 2014 — minor update. Update to prescribing information to reflect the fact that there are reports (...) disturbances and people taking drugs that prolong the QT interval — macrolides can also prolong the QT interval, increasing the risk of Torsades de Pointes arrhythmia. Myasthenia gravis — macrolide antibiotics may aggravate weakness symptoms of people with myasthenia gravis. [ ; ; ; ] Adverse effects What are the adverse effects of clarithromycin? The most common adverse effects are gastrointestinal — such as nausea, vomiting, dyspepsia, and diarrhoea. Consider pseudomembranous colitis if a person develops

2018 NICE Clinical Knowledge Summaries

139. What drugs are considered first line for dyspepsia in a pregnant woman?

Service (NTIS) for the very latest information on drug and chemical safety during pregnancy or breast feeding. Their phone number is 0191 232 1525. They are a dedicated service and have better and more up-to-date information resources at their disposal. CKS have recently updated their guidance on pregnancy-associated dyspepsia [1], this states: “ What drug treatment should I prescribe? Antacids or alginates are recommended as first-line treatments if symptoms are relatively mild and are not controlled (...) What drugs are considered first line for dyspepsia in a pregnant woman? What drugs are considered first line for dyspepsia in a pregnant woman? - Trip Database or use your Google+ account Turning Research Into Practice ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search

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140. The frequency, clinical course, and health related quality of life in adults with Gilbert's syndrome: a longitudinal study. (PubMed)

subjects and jaundice was associated with abdominal pain, dyspepsia or loss of appetite in 54 (53.465%) subjects. A significant difference in 25-Hydroxyvitamin D3 levels was detected between GS patients and control subjects (P <  00001). Twelve subjects with GS developed significant unconjugated bilirubinemia during direct antiviral therapy (DAAs) therapy for HCV despite achieving sustained virologic response. Pregnancy was associated with significant exacerbation of unconjugated bilirubin which (...) persisted through pregnancy. Risk factors for clinical jaundice included general anesthesia, pregnancy, fasting > 12 h, pregnancy, and low calorie weight losing plans, systemic infections, and intensive physical effort. During jaundice attacks, subjects with GS had significant differences in vitality, role emotional, social functioning, worry and general health domains of the SF-36v2 and CLDQ compared to controls. The homozygous polymorphism A(TA)7TAA was the most frequent polymorphism in Egyptians

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2019 BMC Gastroenterology

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