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Femoral Neck Stress Fracture

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222. Code of practice and performance standards for forensic pathologists dealing with suspicious deaths in Scotland

any explanations in relation to their own findings in order to come to properly reasoned conclusions. It is important that pathologists record any briefing given to them in sufficient detail, including the date and time, to enable the practitioner themselves (or some other individual) to recall and understand any matter that they may have had in mind when conducting the examination. The absolute importance of proper notes is stressed throughout this code. PUB 110116 8 V7 Final 5 Scene (...) there is a possibility of sex-related crime, swabs will be taken from those areas considered most likely to be productive of semen or saliva (face, neck, nipples and hands) i) a swab or swabs from the perianal skin, taken before a swab or swabs from the anus j) a swab or swabs from vulva and high and low vagina, taking care to avoid contamination of the latter from the initial swabbing of the former. These swabs must be taken after swabbing of the perianal skin and anus (to avoid leakage during the course

2016 Royal College of Pathologists

223. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting Full Text available with Trip Pro

in Turner syndrome R 4.1. We recommend that an infant or child is examined with transthoracic echocardiography (TTE) at the time of diagnosis, even if the fetal echocardiogram or postnatal cardiac examination was normal (⨁⨁◯◯). R 4.2. We recommend that girls or women with aortic dilatation and/or bicuspid aortic valve be counseled to seek prompt evaluation if they are experiencing acute symptoms consistent with AoD, such as chest, neck, shoulder, back or flank discomfort, particularly if it is sudden (...) care delivery system, the pediatric and adult health care teams establish a workflow to support a coordinated transition process (⨁⨁◯◯). R 5.4. We suggest that pediatric endocrinologists and their care teams encourage peer-to-peer (and parent-to-parent) contact with TS support and advocacy organizations to enhance knowledge and confidence, reduce stress and distress and promote the reciprocal sharing of experiences (⨁⨁◯◯). 6. Health surveillance for comorbidities throughout the lifespan R 6.1. We

2016 European Society of Human Reproduction and Embryology

224. Odomzo - sonidegib

particularly on the face, head, and neck, causing severe disfigurement 4 . The incidence of mBCC is extremely rare, with frequencies ranging from 0.0028% to 0.55% of all BCC cases 5 , often involving regional lymph nodes (40-83%), lung (35-53%), bone (20- 28%), skin (10-17%), and liver 6 . Based on a recent review of 100 mBCC cases, median survival after mBCC diagnosis was 54 months, with shorter survival in patients with distant metastases versus those with regional metastases (24 vs 87 months) 7 . BCC (...) the observation that the colour of an aqueous solution intensified, there were no changes to any of the parameters. Page 13/123 Stress tests were carried out in the solid state at high temperatures at different humidities, and in the presence of oxygen. Studies were also carried out in hot aqueous solution without additive, with acid or with base and at ambient temperature with oxidant. Small amounts of degradation were observed at high temperature. Some degradation was observed in base and with oxidant

2015 European Medicines Agency - EPARs

225. 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

227. Newborn Nursing Care Pathway

understanding of newborn physiology and capacity to identify variances that may require further assessments Refer to: • Behavior • Postpartum Nursing Care Pathway: Bonding & Attachment Norm and Normal Variations • Head round, symmetrical • May have moulding, some overlapping of sutures • Anterior & posterior fontanelles flat and soft • Neck short and thick • Full range of motion Parent education / Anticipatory Guidance • Place baby skin-to-skin • Discuss variances and when they should resolve (caput (...) Norm and Normal Variations • Refer to POS Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Norm and Normal Variations • Refer to POS • Moulding resolves ~ 3 days • Average head circumference 33 – 35 cm once moulding disappears (ensure consistent way of measuring) 14 Parent education / Anticipatory Guidance • Refer to >12 – 24 hr • Prevent plagiocephaly (flat spots on head) and strengthen neck muscles by placing baby on abdomen when awake (tummy time) for several short periods each day

2015 British Columbia Perinatal Health Program

228. Acute pain management: scientific evidence (3rd Edition)

anaesthetics 204 7.5.5 Safety 205 References 208 8. NON-PHARMACOLOGICAL TECHNIQUES 225 8.1 Psychological interventions 225 8.1.1 Provision of information 225 8.1.2 Stress and tension reduction 226 8.1.3 Attentional techniques 227 8.1.4 Cognitiv e-behavioural interventions 228 8.2 Transcutaneous electrical nerve stimulation 230 8.3 Acupuncture 231 8.4 Other physical therapies 232 8.4.1 Manual and massage therapies 232 8.4.2 Heat and cold 232 8.4.3 Other therapies 232 References 233 Acute Pain Management

2015 National Health and Medical Research Council

229. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

behaviors on cancer-related health risks is also emphasized. Health-promoting behaviors are stressed for survivors of childhood cancer. Targeted educational efforts appear to be worthwhile in the following areas:[ ] Abstinence from smoking, excess alcohol use, and illicit drug use to reduce the risk of organ toxicity and, potentially, subsequent neoplasms. Healthy dietary practices and active lifestyle to reduce treatment-related metabolic and cardiovascular complications. Proactively addressing

2018 PDQ - NCI's Comprehensive Cancer Database

230. Childhood Vascular Tumors Treatment (PDQ®): Health Professional Version

on the right depict the hemangioma after proliferation (slightly raised with a brighter central color). Credit: Israel Fernandez-Pineda, M.D. Infantile hemangiomas can be superficial in the dermis, deep in the subcutaneous tissue, combined, or in the viscera. Combined lesions are common. They are most common in the head and neck but can be anywhere on the body. They can be localized, segmental, or multiple in nature. The cutaneous appearance of infantile hemangiomas is usually red to crimson, firm (...) with minimal or arrested growth (IH-MAG) is a variant of hemangioma that can be confused with capillary malformation because of their unusual characteristics. These hemangiomas are mostly fully formed at birth and are characterized by telangiectasia and venules with light and dark areas of skin coloration (refer to ). They resolve spontaneously and are pathologically GLUT1 positive.[ ] They are mainly located on the lower body but can be present in the head and neck area; if they are segmental, they can

2018 PDQ - NCI's Comprehensive Cancer Database

231. Patellofemoral Pain

The patellofemoral joint (PFJ) comprises the articulation be- tween the patella and the trochlear groove of the femur. The patella is a large sesamoid bone embedded in the quadriceps extensor mechanism. The roles of the patella are to increase the moment arm of the quadriceps muscles, provide bony protection to the distal joint surfaces of the femoral condyles when the knee is flexed, and prevent damaging compressive forces on the quadriceps tendon with resisted knee extension. Clinical Presentation (...) that nearly 50% of their cohort had bilateral PFP . People with PFP demonstrate some common clinical char- acteristics. Often, patients report pain with palpation of the distal pole or medial aspect of the patella, the medial plica, and the medial femoral condyle. 113,210 There may be pain with grinding or compressing of the patella. Anthropometrics Patient characteristics, anthropometrics, and patellofemoral alignment are often postulated as important factors in the development of PFP. However, a recent

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

232. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis

) or a T-score of –2.5 or lower in the lumbar spine (anteroposterior), femoral neck, total hip, and/or 33% (one-third) radius even in the absence of a prevalent fracture (Grade B; BEL 2). • R5b. Osteoporosis may also be diagnosed in patients with osteopenia and increased fracture risk using FRAX ® country-specific thresholds (Grade B; BEL 2). 3.Q2. When Osteoporosis Is Diagnosed, What Is an Appropriate Evaluation? • R6. Evaluate for causes of secondary osteoporosis (Grade B; BEL 2). • R7. Evaluate (...) fracture of the hip or spine (Grade A; BEL 1). • R21. Strongly recommend pharmacologic therapy for patients with a T-score of –2.5 or lower in the spine, femoral neck, total hip or 33% radius (Grade A; BEL 1). • R22. Strongly recommend pharmacologic therapy for patients with a T-score between –1.0 and –2.5 if the FRAX ® 10-year probability for major osteoporotic fracture is =20% or the 10-year probability of hip frac- ture is =3% in the U.S. or above the country-specific threshold in other countries

2016 American Association of Clinical Endocrinologists

233. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

? 37 Q3.1. Diabetes risk, metabolic syndrome, and prediabetes (IFG, IGT) 37 Q3.2. Type 2 diabetes 39 Q3.3. Dyslipidemia 40 Q3.4. Hypertension 41 Q3.5. Cardiovascular disease and cardiovascular disease mortality 42 Q3.6. Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 44 Q3.7. Polycystic ovary syndrome (PCOS) 46 Q3.8. Female infertility 47 Q3.9. Male hypogonadism 48 Q3.10. Obstructive sleep apnea 50 Q3.11. Asthma/reactive airway disease 50 Q3.12. Osteoarthritis 51 Q3.13. Urinary stress (...) osteoarthritis? How much weight loss would be required? 81 Q5.13. Is weight loss effective to treat urinary stress incontinence? How much weight loss would be required? 82 Q5.14. Is weight loss effective to treat gastroesophageal reflux disease (GERD)? How much weight loss would be required? 83 Q5.15. Is weight loss effective to improve symptoms of depression? How much weight loss would be required? 89 Q6. Is lifestyle/behavioral therapy effective to treat overweight and obesity, and what components

2016 American Association of Clinical Endocrinologists

234. Osteoporosis and Bone Mineral Density

with contraindications to MR, CT is useful for discerning the presence of lucency in incomplete fractures [88,89]. Such lucency has been suggested as an indication for intramedullary nailing [80]. CT is also useful in excluding the presence of a neoplastic-related pathologic fracture. The use of intravenous contrast has not been shown to demonstrate utility in the evaluation for proximal femoral fracture. MRI The primary utility of MRI is to determine both the presence of radio-occult stress-related changes common (...) . 2014;29(3):518-530. 29. Del Rio LM, Winzenrieth R, Cormier C, Di Gregorio S. Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case-control study. Osteoporos Int. 2013;24(3):991-998. 30. Krueger D, Fidler E, Libber J, Aubry-Rozier B, Hans D, Binkley N. Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women. J Clin Densitom. 2014;17(1):60-65. 31. Lamy O, Krieg MA, Stoll D, Aubry-Rozier B

2016 American College of Radiology

235. Chronic Hip Pain

, Koo KH, Yoon KS, Kim YM, Kim HJ. Subchondral fatigue fracture of the femoral head in military recruits. J Bone Joint Surg Am. 2004;86-A(9):1917-1924. 34. Vande Berg BC, Malghem J, Goffin EJ, Duprez TP, Maldague BE. Transient epiphyseal lesions in renal transplant recipients: presumed insufficiency stress fractures. Radiology. 1994;191(2):403-407. 35. Yamamoto T, Schneider R, Bullough PG. Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skeletal Radiol (...) . Suspect impingement. Osseous abnormalities are often evident on radiographs (incidence unverified), but cross-sectional imaging is more sensitive for many abnormalities. Intrinsic bony abnormalities include fracture, ON, and tumor. MRI is sensitive and specific. Further specific discussions about metastatic disease and stress fractures are presented in other American College of Radiology (ACR) Appropriateness Criteria ® documents (see below). Scintigraphy is sensitive but not specific. Image-guided

2016 American College of Radiology

236. CRACKCast E038 – Pediatric Trauma

to be there for the resuscitation keep them informed utilize social work and child life specialists if available Investigations: Labs: initial hemoglobin is unreliable – serial labs are necessary don’t forget to get a blood glucose Radiology: Chest x-ray Pelvic x-ray Unless: age >3 and no complaint of injury no impaired LOC no major distracting injury no complaint of pelvic pain no signs of fracture on inspection no pain on pelvic stressing no pain on hip rotation or flexion more complete skeletal survey in young children (...) bony fractures Plain radiographic clearing requires: imaging the C7-T1 interface three views of the c spine predental space < 6mm in kids less than 6 years prevertebral space < 1/2-1/3 the vertebral body width the four cervical radiographic lines: patients with persistent neck pain despite negative radiographs and CT should get an MRI flex / ext. views are rarely helpful Management: Two phases of SCI Direct injury : irreversible injury due to ischemia, hypoxia, tissue death Spinal shock Injury

2016 CandiEM

237. CRACKCast E049 – General Principles to Orthopedic Injuries

of a fragment into the bone – vertebral, humeral head Pathologic: a fracture through abnormal bone. Primary or metastatic cancer, Cysts, Osteogenesis imperfecta Scurvy Rickets Paget’s disease Osteoporotic bone – due to a disease (polio) Stress fracture: repeated low intensity forces leading to the resorption of bone: running, sports, dancing. Due to intrinsic and extrinsic causes: training regimen, equipment, nutrition, hormones. Tibia, fibula, metatarsals, navicular, cuneiform, calcaneus, femoral neck (...) , meniscus, disks, Ultrasound Can very accurately dx disruptions of bony cortices: Long bones Orbital floor Ankle/foot Rib fractures 1) List 10 complications of fractures Complication Info Key points Hemorrhage Blood loss, shock, and death! Pelvic, femur, tib-fib Vascular injury See chapter 48! Knee – popliteal artery Femoral neck – AVN of femoral head 10-20% of injuries may have normal palpable pulses These injuries can lead to late complications Nerve injury Neuropraxia – contusion to a nerve leading

2016 CandiEM

238. Vokanamet - canagliflozin / metformin

for 24 months under long term conditions at 25°C/60% RH ‘for 9 months at 30°C /75% RH and up to 6 months under accelerated conditions at 40°C/75% RH according to the ICH guidelines in the intended container closure system representative of that intended for the market. Photostability testing following the ICH guideline Q1B was performed. Results on stress conditions (including high temperature, acid, alkaline, oxidising) were also provided. The active substance is stable at high temperature (...) and microbiological purity. The analytical procedures used are stability indicating. Assessment report EMA/179391/2014 Page 20/130 In addition, the same batches were exposed to light as defined in the ICH Guideline on photostability testing of new drug substances and products and also were put under stress conditions at 50 ºC. Based on available stability data, the shelf-life and storage conditions as stated in the SmPC are acceptable. 2.2.4. Discussion on chemical, pharmaceutical and biological aspects

2014 European Medicines Agency - EPARs

239. Jardiance - empagliflozin

stressed conditions in the solid state (1 commercial scale batch) and in solution (1 development batch). Solid state photostability testing following the ICH guideline Q1B was performed on 1 commercial scale batch. Solid state material was also exposed to high temperature (80 o C) and to open storage conditions (40 o C / 75% RH). Empagliflozin was tested in solution at low (2.5), intrinsic, and high (13) pH, each under heat stress conditions (80 o C), in the presence of strong (H 2 O 2 ), or mild (AIBN (...) indicating. In addition, stressed stability studies were carried out on 1 commercial scale batch. The finished product was exposed for 6 months to heat (60 o C, closed amber bottle) and various open storage Assessment report EMA/CHMP/137741/2014 Page 13/99 conditions (25 o C / 60% RH, 30 o C / 75% RH, 40 o C / 75% RH). It was also exposed to light as defined in the ICH Guideline on Photostability Testing of New Drug Substances and Products. No relevant change or trend to any of the measured parameters

2014 European Medicines Agency - EPARs

240. Dapagliflozin (Farxiga)

, and renal impairment — especially in elderly patients with renal dysfunction and perhaps in individuals receiving loop diuretics. Other safety concerns include the potential to increase low-density lipoprotein cholesterol (LDL-C), and the unknown risk for fractures with long-term use in vulnerable patient populations. These potential adverse effects are known for this pharmacologic class and can be mitigated with adequate patient monitoring and careful management of adverse effects as described (...) . The primary safety objective will be to determine whether the upper bound of the two-sided 95% confidence interval (CI) for the estimated hazard ratio (HR) for the MACE composite endpoint observed with dapagliflozin is less than 1.3 when compared to placebo. In this study, the Applicant also plans to assess AEs of special interest (i.e., serious urinary tract infections [UTIs], serious genital infections, hepatic events, renal events, fractures, events related to volume depletion, and malignancies

2014 FDA - Drug Approval Package

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