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Failure to Thrive in the Elderly

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121. Heart Failure, Congestive (Follow-up)

tachyarrhythmias (usually supraventricular tachyarrhythmia [SVT]) and complete heart block. Prompt pharmacologic or electrical cardioversion is warranted in any patient with a tachyarrhythmia who presents with congestive heart failure. Primary cardiomyopathy or myopathic disease secondary to inborn errors of metabolism should be considered in the absence of structural cardiac disease or arrhythmia when cardiac dysfunction is present. Previous Next: Managing Acute Congestive Heart Failure in the Older Child (...) Long-standing but unrecognized congestive heart failure may present acutely; similarly, an acute presentation may represent an acute onset of acquired cardiac disease (myocarditis or arrhythmia). Management of acute decompensation involves treatment of presenting symptoms and adjustment or initiation of long-term therapy. In older children with acute congestive heart failure, admit to the ICU for diuresis with IV furosemide. For patients with significant hypotension, IV dopamine (5-10 mcg/kg/min

2014 eMedicine Pediatrics

122. Heart Failure, Congestive (Treatment)

tachyarrhythmias (usually supraventricular tachyarrhythmia [SVT]) and complete heart block. Prompt pharmacologic or electrical cardioversion is warranted in any patient with a tachyarrhythmia who presents with congestive heart failure. Primary cardiomyopathy or myopathic disease secondary to inborn errors of metabolism should be considered in the absence of structural cardiac disease or arrhythmia when cardiac dysfunction is present. Previous Next: Managing Acute Congestive Heart Failure in the Older Child (...) Long-standing but unrecognized congestive heart failure may present acutely; similarly, an acute presentation may represent an acute onset of acquired cardiac disease (myocarditis or arrhythmia). Management of acute decompensation involves treatment of presenting symptoms and adjustment or initiation of long-term therapy. In older children with acute congestive heart failure, admit to the ICU for diuresis with IV furosemide. For patients with significant hypotension, IV dopamine (5-10 mcg/kg/min

2014 eMedicine Pediatrics

123. Therapeutic guidelines for antiretroviral (ARV) treatment of adult HIV infection

HIV Study (WIHS) showed that those who started treatment early (at CD4 cell count >350/µL) were less likely to die of AIDS-related causes and more likely to die at an older age than those who started treatment late (at CD4 cell count 500 cells/µL. 3. More recently, the large, international INSIGHT START trial demonstrated the benefit of initiating ART immediately in patients with CD4 cell count >500 cells/µL as compared to deferring ART initiation until the CD4 cell count had declined to 350 cells (...) OF EVIDENCE 27 i. Laboratory Assessments 28 ii. Monitoring During ART 30 C. REFERENCES 36 IV CHANGING THE ARV REGIMEN 39 A. RECOMMENDATIONS 39 THERAPEUTIC GUIDELINES FOR ANTIRETROVIRAL TREATMENT OF ADULT HIV INFECTION VERSION: DEC 2019 i. In the setting of viral suppression: 39 ii. Antiretroviral switches in the setting of virologic failure 39 B. DISCUSSION OF EVIDENCE 40 i. Viral Suppression 40 ii. Virologic failure 44 C. REFERENCES 48 V ADVERSE DRUG REACTIONS 53 A. RECOMMENDATIONS 53 i. Sensitivity

2020 CPG Infobase

124. Covid-19: Providing virtual care during a pandemic, a guide to telemedicine in the paediatric office

the COVID19 pandemic should be considered: See every newborn and baby up to 3 months of age. See babies > 3 months of age if there is a concern for failure to thrive. See patients with infectious symptoms only if they have a recent COVID-19 negative swab result. In clinics with PPE, the same patients as above can be seen, as well as symptomatic infectious patients. In these cases: Make sure to give sick patients a mask. Don PPE when seeing patients. If possible, schedule sick patients at a separate time (...) have any hair?”), and so appreciative when you make them feel better. I love going to work every day, never knowing what the day will bring, what type of problem or story I will get to hear. But in the midst of this pandemic, we are “social distancing” (or “physical distancing with social engagement”), and we want to keep people home as much as we can. We are asking people to self-isolate after travel and when they are sick—which is odd for doctors since it’s our duty to see patients who are ill

2020 Canadian Paediatric Society

125. Child and Adolescent Asthma Guidelines

of the growing impact of asthma in New Zealand, especially among children, the inequities suffered by Maori, Paci? c peoples and low-income families, and the intersectorial and holistic approaches needed to tackle the issues. Other guidelines consulted This guide is a complete update of the outdated Paediatric Society of New Zealand 2005 Management of Asthma in Children aged 1–15 years. The following guidelines were reviewed in the preparation of this document: the National Asthma Council of Australia 2015 (...) ) C. Red flags suggesting alternate diagnoses* • Daily symptoms from birth • Frequent or daily wet, moist-sounding or productive cough • Digital clubbing • Chest wall deformity • Failure to thrive • Heart murmur • Spilling, vomiting or choking • Asymmetrical chest findings • Stridor as well as wheeze • Persistent ear, nose or sinus infection • Family history of unusual chest disease • Symptoms much worse than objective signs or spirometry *Consider aspiration, bronchiectasis, ciliary dyskinesia

2020 Asthma and Respiratory Foundation NZ

126. Ankyloglossia, Exclusive Breastfeeding, and Failure to Thrive. Full Text available with Trip Pro

Ankyloglossia, Exclusive Breastfeeding, and Failure to Thrive. A 6-month-old term boy was hospitalized to evaluate the cause of his failure to thrive, mandated as part of an investigation by the Department of Children and Families after an allegation of medical neglect was made. On admission the patient was below birth weight, and a medical workup for failure to thrive was pursued; however, he was noted to have severe ankyloglossia and was an exclusively breastfed infant. The only interventions

2010 Pediatrics

127. Potocki-Lupski Syndrome: A Microduplication Syndrome Associated with Oropharyngeal Dysphagia and Failure to Thrive. Full Text available with Trip Pro

Potocki-Lupski Syndrome: A Microduplication Syndrome Associated with Oropharyngeal Dysphagia and Failure to Thrive. Failure to thrive (FTT) is a feature of children with Potocki-Lupski syndrome (PTLS) [duplication 17p11.2]. This study was designed to describe the growth characteristics of 24 subjects with PTLS from birth through age 5 years in conjunction with relevant physical features and swallow function studies.We evaluated 24 individuals with PTLS who were ascertained by chromosome (...) analysis and/or array comparative genome hybridization. Clinical assessments included review of medical records, physical examination, otolaryngological examination, and swallow function studies. Measures of height and weight were converted to Z-scores.The mean weight-for-age and weight-for-length Z-scores at birth were lower (P < .01) than the reference standard and did not change with age. A history of poor feeding, hypotonia, and FTT were reported in 92%, 88%, and 71%, respectively. Individuals

2010 Journal of Pediatrics

128. Bovine colostrum in the management of nonorganic failure to thrive: a randomized clinical trial. (Abstract)

Bovine colostrum in the management of nonorganic failure to thrive: a randomized clinical trial. The objective of the study was to evaluate the clinical efficacy of oral bovine colostrum in the management of nonorganic failure to thrive (FTT).In a randomized clinical trial, 120 children (1-10 years of age) of either sex with mild or moderate nonorganic FTT were divided into 2 groups. Both groups were matched with regard to age, sex, weight, and height. One group (control) received routine (...) treatments for FTT and the other group (case), besides routine treatments, received supplementary bovine colostrum at the dose of 40 mg . kg . day for a 3-month period. Following the initial visit, subsequent visits were completed following 1, 2, and 3 months of supplementation. For quantitative measurements, Waterlow I (height for age) and Gomez (weight for age) indices were used.The mean value of Gomez index in the case group (81.72) was significantly higher than the control group (77.12) at the end

2010 Journal of pediatric gastroenterology and nutrition Controlled trial quality: uncertain

129. Cobalamin F Disease Detected by Newborn Screening and Follow-up on a 14-Year-Old Patient. (Abstract)

was small for gestational age, exhibited dysmorphic features and mild developmental delay, and had trigonocephaly and ventricular septal defect. There was biochemical normalization and clinical improvement within 3 weeks of parenteral cobalamin treatment. The other patient presented at 4 weeks of life with failure to thrive and feeding difficulties. She was treated only with monthly cyanocobalamin shots. The patient has never experienced metabolic decompensation. She had short stature and was an average (...) student with no behavioral concerns. Her metabolic derangements normalized after switching to weekly hydroxycobalamin. The available data on 14 patients with confirmed cblF disease suggest variability in age of onset, presenting symptoms, response to treatment, and long-term complications. Common clinical findings include small for gestational age, feeding difficulties, growth failure, and developmental delays. Some patients have congenital heart defects, dysmorphic features, and other congenital

2011 Pediatrics

130. British guideline on the management of asthma

, respectively, and in section 4.3 on predicting future risk of asthma attacks, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5–12 years, and children under 5 years. Further information on managing asthma in adolescents (10–19 years of age as defined by the World Health Organization) 3 is given in section 11.2 British guideline on the management of asthma The guideline considers diagnosis of asthma and management in all (...) patients with a diagnosis of asthma, although there is less evidence available for people at either age extreme. The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease (COPD) or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms. 1.2.2 Target users of the guideline

2019 SIGN

131. Giardiasis

. 2010 Jun;8(6):413-22. http://www.ncbi.nlm.nih.gov/pubmed/20400969?tool=bestpractice.com Escobedo AA, Almirall P, Robertson LJ, et al. Giardiasis: the ever-present threat of a neglected disease. Infect Disord Drug Targets. 2010 Oct;10(5):329-48. http://www.ncbi.nlm.nih.gov/pubmed/20701575?tool=bestpractice.com Children may present with weight loss and failure to thrive due to malabsorption. History and exam diarrhoea frequent belching abdominal bloating and discomfort malaise weight loss nausea (...) and vomiting contaminated water/food domestic animals living in or around the house hypogammaglobulinaemia young age male sex day-care use men having sex with men Diagnostic investigations FBC stool microscopy stool antigen detection; enzyme-linked immunosorbent assay and direct fluorescence antibody (DFA) ImmunoCard STAT! string test (EnteroTest) duodenal aspirates and biopsies polymerase chain reaction of stool sample Treatment algorithm ACUTE ONGOING Contributors Authors Chief Hospitalist Sound

2019 BMJ Best Practice

132. Strimvelis for treating adenosine deaminase deficiency?severe combined immunodeficiency

recurrent infections. The systemic metabolic defect also causes non-immunological manifestations, including insufficient weight and height gain, cognitive and behavioural problems, and deafness. ADA–SCID has a profound effect on health-related quality of life and, if left untreated, infants die before school age. Quality of life is affected by developmental delay, chronic diarrhoea, failure to thrive, recurrent infections and neurological impairments. People whose condition is untreated must be isolated (...) dysfunction of the immune system because of a lack of lymphocytes, and the resulting recurrent infections and failure to thrive. The committee understood this severely affects the quality of life of people with the condition. It heard that, because of the systemic metabolic defect, people can also have non-immunological manifestations of the condition, most commonly cognitive, behavioural and neurosensory deficits. Current treatment options do not improve these abnormalities, so people who have successful

2018 National Institute for Health and Clinical Excellence - Highly specialised technology

133. Child abuse and neglect

) for this group is not. This is because the principal focus of this guideline is on supporting children and young people, including through supporting their parents and carers. It also does not cover adults (aged 18 or older) who experienced abuse or neglect as children. What is the status of this guidance? The application of the recommendations in this guideline is not mandatory. While there is no legal obligation to implement our guidance, health and social care practitioners are actively encouraged (...) been abused or neglected 57 Update information 58 Child abuse and neglect (NG76) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 58This guideline is the basis of QS179. Ov Overview erview This guideline covers recognising and responding to abuse and neglect in children and young people aged under 18. It covers physical, sexual and emotional abuse, and neglect. The guideline aims to help anyone whose work

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

134. Faltering growth: recognition and management of faltering growth in children

of 23Conte Context xt The term 'faltering growth' (previously called 'failure to thrive') is widely used to refer to a slower rate of weight gain in childhood than expected for age and sex. The term faltering growth is preferred as periods of slow growth may represent temporary variation from the expected pattern and the word 'failure' may be seen as pejorative. Various definitions of faltering growth have been used in the past, meaning estimates of prevalence in the UK vary widely. The World Health (...) weight by 3 weeks of age, consider: referral to paediatric services if there is evidence of illness, marked weight loss, or failure to respond to feeding support (see recommendations in NICE's guideline on postnatal care up to 8 weeks after birth) when to reassess if not referred to paediatric services. 1.1.5 If an infant loses more than 10% of their birth weight in the early days of life, measure their weight again at appropriate intervals depending on the level of concern, but no more frequently

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

135. Supporting Rapid Learning and Improvement Across Ontario’s Health System

of our time, based on the best available research evidence and systematically elicited citizen values and stakeholder insights. We aim to strengthen health systems – locally, nationally, and internationally – and get the right programs, services and drugs to the people who need them. Authors Kerry Waddell, M.Sc., Lead, Evidence Synthesis, McMaster Health Forum Francois-Pierre Gauvin, PhD, Senior Scientific Lead, Citizen Engagement and Evidence Curation, McMaster Health Forum John N. Lavis, MD PhD (...) to a growing aging population.(6) To contend with these challenges, the government recently introduced The People’s Health Care Act, which will enact the Connecting Care Act and amend and repeal a number of existing acts and regulations.(7) These acts will trigger substantial system redesign, including: • the consolidation of the province’s six arm’s-length agencies (i.e., Cancer Care Ontario, eHealth Ontario, Health Quality Ontario, Health Shared Services Ontario, HealthForce Ontario Marketing

2019 McMaster Health Forum

136. Guidelines on Supraventricular Tachycardia (for the management of patients with) Full Text available with Trip Pro

-entrant tachycardia AVRT Atrioventricular re-entrant tachycardia BBB Bundle branch block b.p.m. Beats per minute CHA2DS2- VASc Cardiac failure, Hypertension, Age ≥75 (Doubled), Diabetes, Stroke (Doubled) – Vascular disease, Age 65–74 and Sex category (Female) CL Cycle length CMR Cardiac magnetic resonance CT Computed tomography CTI Cavotricuspid isthmus CV Conduction velocity CYP Cytochrome P450 DAD Delayed after-depolarization DC Direct current DCS Distal coronary sinus EA Enhanced automaticity EAD (...) %. The overall incidence of atrial flutter is 88/100 000 person-years in the US population annually. Adjusted for age, the incidence of atrial flutter in men (125/100 000) is >2.5 times that of women (59/100 000) and increases exponentially with age. Patients with atrial flutter are more likely to have been smokers, have a longer PR interval, history of myocardial infarction (MI), and history of heart failure (HF). Catheter ablation is now used extensively for most varieties of SVT, and patient-reported

2019 European Society of Cardiology

137. Management of Dyslipidaemias Full Text available with Trip Pro

of illustrating risk than as a guide to treatment, because therapeutic trials have been based on a fixed follow-up period and not on lifetime risk. Another problem relates to older people. In some age categories, the majority of people, especially males, will have estimated 10 year cumulative CV death risks exceeding the 5–10% level, based on age only, even when other CV risk factor levels are relatively low. Therefore, before initiating treatment in the elderly, clinicians should evaluate patients carefully (...) for low-density lipoprotein cholesterol 22 Recommendations for pharmacological low-density lipoprotein cholesterol lowering 35 Recommendations for drug treatment of patients with hypertriglyceridaemia 38 Recommendations for the detection and treatment of patients with heterozygous familial hypercholesterolaemia 40 Recommendations for the treatment of dyslipidaemias in older people (aged >65 years) 43 Recommendations for the treatment of dyslipidaemias in diabetes mellitus 45 Recommendations for lipid

2019 European Society of Cardiology

138. A palliative approach to care in the last 12 months of life

for people, communities and the health system as a whole. The purpose of this BPG is to provide evidence-based recommendations to nurses and the interprofessional health team who support adults (18 years and older) experiencing the last 12 months of a progressive life-limiting illness, their families and their caregivers. The goals of the recommendations are to: (a) improve delivery of psychosocial, spiritual and culturally safe care; (b) enhance coordination of care; and (c) facilitate supportive work (...) or “how-to” guide; rather, it supports best practices and decision making for nurses G , the interprofessional health team G and health-service organizations. This BPG should be reviewed and applied in accordance with the needs and preferences G of adults (18 years and older) who are experiencing the last 12 months of a progressive life-limiting illness and their families G . This document provides evidence-based recommendation G statements and descriptions of (a) practice, education G

2020 Registered Nurses' Association of Ontario

139. Delivering novel therapies in the 21st century

-tumour activity and the efficacy of PD-L1 therapies. CASE STUDY 2 CASE STUDY 3 Novel treatments for chronic heart failure Modified mRNA therapies can help tissue to regenerate after injury. mRNA expressing the VEGF protein is injected directly into damaged cardiac muscle tissue where it is taken up by cells to make new proteins. A single administration improves cardiac function, repairs heart damage, and regenerates blood vessels including arteries two months after myocardial infarction in animal (...) with neurodegenerative disease. Intrathecal treatment has introduced a new avenue for drug delivery to the brain. ASO technology has the potential to benefit patients with other neurodegenerative diseases including amyotrophic lateral sclerosis, Alzheimer’s disease, spinal muscular atrophy, and Parkinson’s disease. Image: Professor Sarah J Tabrizi FMedSci, UCL Institute of Neurology. “Huntington’s disease is genetic and I look after families. Eventually I want to do a clinical trial in 18 year olds, decades away

2019 Academy of Medical Sciences

140. Iron Deficiency – Diagnosis and Management

ages: tiredness, restless legs, inattention, poor school performance, irritability/depression, growth retardation, unexplained cognitive and intellectual impairment, breath-holding spells, developmental delay, pica/pagophagia Infants: poor feeding, lethargy, failure to thrive, cardiomegaly, tachypnea Adolescents: presyncope, syncope, headache, irritability, fatigue, exercise intolerance, restless legs Diagnosis Serum ferritin is the diagnostic test of choice for iron deficiency. The ferritin cut (...) to the potentially severe consequences of delayed identification of colorectal cancer. Age-specific risk for colon and rectal cancer is elevated among those born circa 1990 compared to older cohorts. Overt GU bleeding Consider referral to urologist for further work-up, especially for gross painless hematuria. Unexplained iron deficiency/IDA Adult males, post-menopausal females and pre-menopausal females with unexplained iron deficiency/IDA should receive: referral for GI investigations (upper/lower endoscopy

2019 Clinical Practice Guidelines and Protocols in British Columbia

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