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Nikolskys Sign

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21. 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

to consider testing for Turner syndrome (TS) in a female with typical signs ( ) (⨁⨁⨁⨁). R 1.5. We recommend gonadectomy in all female individuals with Y chromosome material identified on standard karyotyping (⨁⨁◯◯). 2. Growth and puberty R 2.1. We recommend initiating growth hormone (GH) treatment early (around 4–6 years of age, and preferably before 12–13 years) in the following circumstances: the child already has evidence of growth failure (e.g., below 50th percentile height velocity (HV) observed over (...) a more evidence-based analysis of the genotype–phenotype associations. 1.1.3. Indications for testing R 1.4. We recommend to consider testing for TS in a female with typical signs ( ) (⨁⨁⨁⨁). Table 2 Detailed list of more common abnormalities associated with Turner syndrome and their approximate prevalence (see also ). Feature Frequency (%) Growth failure and reduced adult height 95–100 Failure to thrive during first year of life 50 Endocrinopathies Glucose intolerance 15–50 Type 2 diabetes 10 Type 1

2016 European Society of Human Reproduction and Embryology

22. Acute Coronary Syndromes Guidelines

]. Additional guidance around the timing and use of therapies is detailed in the accompanying practice advice. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand 897Key Evidence-Based Recommendations Recommendation GRADE strength of recommendation NHMRC Level of Evidence (LOE) Initial assessment of chest pain It is recommended that a patient with acute chest pain or other symptoms suggestive of an ACS receives a 12-lead ECG and this ECG is assessed for signs of myocardial (...) group. The ques- tions proposed for literature review are provided in the appendix. The literature reviewer was appointed through an open tender process. The literature review sought published studies from 2010 to 2015. The process of literature review was commenced in the second quarter of 2015 and com- pleted in the fourth quarter of 2015. Evidence summaries were reviewed and signed off by the work groups and, where deemed appropriate, were supplemented with additional studies published after

2016 Cardiac Society of Australia and New Zealand

24. SCAI Expert Consensus Statement: 2016 Best Practices in the Cardiac Catheterization Laboratory

into the electronic health record. All of these items must be documented in the medical record prior to the proce- dure or as part of the checklist mentioned above. Non- invasive hemodynamic and oximetric monitoring of patient vital signs should be routine. Defibrillation pads should be attached to all STEMI patients. Access related risks should be considered with the goal of choosing the optimal access site to reduce complica- tions. CCL staff should ensure that at least one work- ing IV is in place prior (...) must be recorded in a procedure log or electronic re- cord and signed by the attending physician, and such records should be easily accessible, particularly when the patient leaves the CCL. Infection Control in the Catheterization Laboratory Infectious complications resulting from cardiac cathe- terization are exceedingly rare; however, best practices for sterile technique are essential. Electric clippers should be used to prepare the femoral access site. A variety of antimicrobial agents

2016 Society for Cardiovascular Angiography and Interventions

26. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome Full Text available with Trip Pro

. There was no interaction between the GP IIb/IIIa receptor antagonist used, CrCl, and ischemic or bleeding outcomes. In patients with CrCl 114 mL/min). Although the rates of both ischemic and bleeding events were higher among patients with lower creatinine clear- ances, there was no interaction between the assigned GP IIb/IIIa receptor antagonist, CrCl, and clinical outcome. An analysis of the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS (...) failure signs or symptoms) and baseline SCr =2.5 mg/dL and serum potassium <5.0 mmol/L. Serum potassium should be monitored closely. Statin Available data suggest statin therapy should be considered in CKD patients presenting with ACS. ACE indicates angiotensin-converting enzyme; ACS, acute coronary syndrome; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; ICH, intracranial hemorrhage; LV, left ventricular; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCT

2015 American Heart Association

29. Review of Autoimmune Blistering Diseases: the Pemphigoid diseases. (Abstract)

and bullous lupus. This is in contrast to pemphigus and related disorders, which demonstrate intraepidermal acantholysis and a positive Nikolsky sign. The classification and management is based on clinical, histological and direct and indirect immunofluorescence findings. There are, however, overlapping clinical and histological features between the conditions and clinical heterogeneity within each disease.© 2019 European Academy of Dermatology and Venereology.

2019 Journal of the European Academy of Dermatology and Venereology

30. Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation - a retrospective chart review. (Abstract)

(6.2%). Nikolsky sign, atypical targets, fever and lymphopenia were included in a model for predicting the probability of SJS/TEN.All cases were obtained from academic centers which may limit the generalization of findings to community-based settings. Exploratory study with a small number of cases and need for external validation of the model performance.Early dermatologic evaluation of patients with concern for SJS/TEN is key to separate patients with this condition from those ultimately diagnosed

2019 Journal of American Academy of Dermatology

31. Acute Myocardial Infarction in patients presenting with ST-segment elevation

- ticular value for the diagnosis of other causes of chest pain, such as pericardial effusion, massive pulmonary embolism or dissection of the ascending aorta (Table 4). The absence of wall-motion ab- normalities excludes major myocardial infarction. In the emergency setting, the role of computed tomography (CT) scan should be Table 5 Atypical ECG presentations that deserve prompt management in patients with signs and symptoms of ongoing myocardial ischaemia • LBBB • Ventricular paced rhythm • Patients (...) Titrated i.v. opioids are indicated to relieve pain. I C Oxygen is indicated in patients with hypoxia (SaO 2 12 h beforehand or if pain and ECG changes have been stuttering. I C 67 Reperfusion therapy with primary PCI may be considered in stable patients presenting 12–24 h after symptom onset. IIb B 60, 61 Routine PCI of a totally occluded artery >24 h after symptom onset in stable patients without signs of ischaemia (regardless of whether ?brinolysis was given or not) is not recommended. III A 62–64

2012 European Society of Cardiology

32. Third Universal Definition of Myocardial Infarction

ischae- mia and a worse prognosis. Other ECG signs associated with acute myocardial ischaemia include cardiac arrhythmias, intraven- tricular and atrioventricular conduction delays, and loss of pre- cordial R wave amplitude. Coronary artery size and distribution of arterial segments, collateral vessels, location, extent and sever- ity of coronary stenosis, and prior myocardial necrosis can all impact ECG manifestations of myocardial ischaemia. 36 Therefore the ECG at presentation should always (...) may be inscribed in the PR segment, the QRS complex, the ST-segment or the T wave. The earliest manifestations of myocardial ischaemia are typically T wave and ST-segment changes. Increased hyperacute T wave amplitude, with prominent symmetrical T waves in at least two contiguous leads, is an early sign that may precede the eleva- tion of the ST-segment. Transient Q waves may be observed during an episode of acute ischaemia or (rarely) during acute MI with successful reperfusion. Table 3 lists ST

2012 European Society of Cardiology

33. Valvular Heart Disease

vascularization on the chest X-ray is essential when interpreting dyspnoea or clinical signs of HF. 13 3.1.2 Echocardiography Echocardiography isthe key techniqueused to con?rmthe diagno- sis of VHD, as well as to assess its severity and prognosis. It should beperformedandinterpretedbyproperlytrainedpersonnel. 14 Itis indicatedinanypatientwithamurmur,unlessnosuspicionofvalve disease is raised after the clinical evaluation. The evaluation of the severity of stenotic VHD should combine the assessment of valve (...) , particularly when valve repair is considered. 4.1 Evaluation Initial examination should include a detailed clinical evaluation. AR is diagnosed by the presence of a diastolic murmur with the appro- priate characteristics. Exaggerated arterial pulsations and low diastolic pressure represent the ?rst and main clinical signs for quantifying AR. In acute AR, peripheral signs are attenuated, which contrasts with a poor clinical status. 12 The general principles for the use of non-invasive and invasive

2012 European Society of Cardiology

34. Association Between Severe Acute Contact Dermatitis Due to Nigella sativa Oil and Epidermal Apoptosis. Full Text available with Trip Pro

lesions spreading beyond the area of NSO application: typical and atypical targets, patches with central blisters, erythematous or purpuric plaques with a positive Nikolsky sign mimicking Stevens-Johnson syndrome, or toxic epidermal necrolysis. Two patients had pustules. They had severe impairment, with more than 15% skin detachment and fever. The results of skin biopsies showed epidermal apoptosis characterized by vacuolar alteration of the basal layer, keratinocyte apoptosis, and a moderate

2018 JAMA dermatology (Chicago, Ill.)

35. A Rare Case of Pediatric Bullous Spontaneous Acute Urticaria Full Text available with Trip Pro

A Rare Case of Pediatric Bullous Spontaneous Acute Urticaria Acute spontaneous bullous urticaria is an extremely rare entity, and there are few reports with blister formation in acute urticaria patients.We present a 2-year-old girl who was admitted for bullous spontaneous acute urticaria; the underlying reason for this was not detected. Nikolsky's sign and Darier's sign were negative. Lesions were not compatible with erythema multiforme. However, biopsy was not allowed to be performed. Because

2018 Medical Principles and Practice

36. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

) to decide on the need for hospitalization and assist in the selection of treatment options (42-44). (Level of Evidence: B) Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition. The goal of the initial evaluation focuses on answering 2 questions: 1. What is the likelihood that the symptoms and signs represent ACS? 2. What is the likelihood of adverse clinical outcome(s)? Risk assessment scores and clinical (...) (54, 55). Atypical symptoms, including epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain should raise concern for NSTE- ACS (56). Psychiatric disorders (e.g., somatoform disorders, panic attack, anxiety disorders) are noncardiac causes of chest pain that can mimic ACS (57). 3.2.2. Physical Examination The physical examination in NSTE-ACS can be normal, but signs of HF should expedite the diagnosis and treatment of this condition. Acute

2014 Society for Cardiovascular Angiography and Interventions

38. Non-ST-Elevation Acute Coronary Syndromes: Guideline For the Management of Patients With

?ed based onthelikelihoodofACSandadverseoutcome(s)todecideon the need for hospitalization and assist in the selection of treatment options (42–44). (Level of Evidence: B) Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition. The goal of the initial evaluation focuses on answering 2 questions: 1. What is the likelihood that the symptoms and signs represent ACS? 2. What is the likelihood of adverse (...) mellitus, impaired renal function, and dementia(54,55).Atypicalsymptoms,includingepigastric pain,indigestion,stabbingorpleuriticpain,andincreasing dyspneaintheabsenceofchestpainshouldraiseconcern forNSTE-ACS(56).Psychiatricdisorders(e.g.,somatoform disorders, panic attack, anxiety disorders) are noncardiac causesofchestpainthatcanmimicACS(57). 3.2.2. Physical Examination ThephysicalexaminationinNSTE-ACScanbenormal,but signs of HF should expedite the diagnosis and treatment Amsterdam et al. JACC VOL. 64

2014 American College of Cardiology

39. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Full Text available with Trip Pro

, looking for signs of overnutrition or undernutrition (Class IIa; Level of Evidence C ). New recommendation Patients with a history of ischemic stroke or TIA and signs of undernutrition should be referred for individualized nutritional counseling (Class I; Level of Evidence B ). New recommendation Routine supplementation with a single vitamin or combination of vitamins is not recommended (Class III; Level of Evidence A ). New recommendation It is reasonable to recommend that patients with a history (...) . These seemingly silent infarctions are associated with typical risk factors for ischemic stroke, increased risk for future ischemic stroke, and unrecognized neurological signs in the absence of symptoms. Clinicians who diagnose silent infarction routinely ask whether this diagnosis warrants implementation of secondary prevention measures. The writing committee, therefore, identified silent infarction as an important and emerging issue in secondary stroke prevention. Although data to guide management

2014 American Heart Association

40. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Full Text available with Trip Pro

Patients with suspected ACS should be risk stratified based on the likelihood of ACS and adverse outcome(s) to decide on the need for hospitalization and assist in the selection of treatment options. 42–44 (Level of Evidence: B ) Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition. The goal of the initial evaluation focuses on answering 2 questions: What is the likelihood that the symptoms and signs (...) as in patients with diabetes mellitus, impaired renal function, and dementia. , Atypical symptoms, including epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain should raise concern for NSTE-ACS. Psychiatric disorders (eg, somatoform disorders, panic attack, anxiety disorders) are noncardiac causes of chest pain that can mimic ACS. 3.2.2. Physical Examination The physical examination in NSTE-ACS can be normal, but signs of HF should expedite

2014 American Heart Association

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