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Pruritus in Pregnancy

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181. Vaginitis

include discharge, pruritus, and dyspareunia. It is recommended to screen for sexually transmitted infections (STIs; also known as sexually transmitted diseases [STDs]) in all patients with infective vaginitis. Sexual partners of patients with Trichomonas vaginalis should be treated and offered screening for other STIs. Definition Vaginitis is inflammation of the vagina due to changes in the composition of the vaginal micro-environment from infection, irritants, or from hormonal deficiency (e.g (...) ., atrophic vaginitis). Bacterial vaginosis, trichomoniasis, and candidiasis are types of infections that cause vaginitis. History and exam presence of risk factors vaginal discharge dysuria discharge adherent to vaginal mucosa prior episodes pruritus vulvodynia vaginal dryness dyspareunia erythema pale epithelium shiny epithelium decreased elasticity friable epithelium fever vaginal bleeding abdominal pain strawberry cervix douching poor or excessive hygiene antibiotic use change in feminine hygiene

2018 BMJ Best Practice

182. Transfusion reaction

), and transfusion-related acute lung injury (TRALI). Delayed immune-mediated transfusion reactions occur within days to weeks of transfusion and include delayed haemolytic transfusion reaction, graft-versus-host disease, and post-transfusion purpura. History and exam presence of risk factors chills flushing dyspnoea fever chest, abdominal, flank, and back pain hypotension bleeding from mucous membranes, GI tract, or urinary tract headache nausea and vomiting anxiety pain along the infused extremity pruritus (...) urticaria angio-oedema jaundice rales red urine stridor or bronchospasm pallor maculopapular rash diarrhoea disseminated purpura exfoliative dermatitis with mucocutaneous involvement prior pregnancy previous transfusion hx of transplantation IgA deficiency immunocompromise hx of transfusion reaction Diagnostic investigations direct antiglobulin test visual inspection of post-transfusion blood sample repeat ABO testing on post-transfusion blood sample post-transfusion urinalysis serum IgA levels anti-IgA

2018 BMJ Best Practice

183. Dubin-Johnson syndrome

associated with lipochrome-like pigment in liver cells: report of 4 cases. Ann Intern Med. 1954 Nov;41(5):952-62. History and exam presence of risk factors intermittent jaundice lack of pruritus illness, infection, or stress pregnancy-triggered jaundice medication-triggered jaundice abdominal pain fatigue hepatomegaly family history age 10 to 30 years Iranian Jewish or Moroccan Jewish ethnicity male sex Diagnostic investigations serum (...) in the liver, giving it a characteristic black colour. Primary defect is a mutation in an apical canalicular membrane protein responsible for excretion of bilirubin. Jaundice is worsened by an intercurrent illness, pregnancy, and oral contraceptives. A unique pattern of urinary excretion of coproporphyrins (by-products of haem synthesis) aids in the diagnosis. It is a benign condition with a normal life expectancy and no specific treatment required. Definition Dubin-Johnson syndrome (DJS) is an autosomal

2018 BMJ Best Practice

184. Acute cystitis

suprapubic pain prior history of urinary tract infections (UTIs) and treatment history recent urinary tract instrumentation flank pain abdominal pain fever vaginal discharge vaginal pruritus dyspareunia structurally or functionally abnormal bladder frequent sexual intercourse history of urinary tract infection (UTI) congenital abnormality spermicidal jelly urinary catheter asymptomatic bacteriuria diabetes spinal cord injuries pregnancy immunodeficiency older age lack of circumcision age <15 years (...) of trimethoprim/sulfamethoxazole or trimethoprim, or 5 days of nitrofurantoin. For complicated cases of cystitis, first line is empirical therapy with a fluoroquinolone antibiotic for 7 to 14 days; treatment should be adjusted based on the results of the urine culture. Complicating characteristics include pregnancy; recent instrumentation, including catheterisation or indwelling catheter; male patient; diabetes, immunosuppression; structurally or functionally abnormal urinary bladder; history of recurrent

2018 BMJ Best Practice

185. Sexually Transmitted Infections in primary care consultations: development of an online tool to guide healthcare practitioners

anatomical site? Which diagnostic tests are to be performed for a pre-defined risk group? Population Included: Symptomatic or asymptomatic sexually active men and women (pregnant and non-pregnant), including adolescents Excluded: Children aged 2/multiple partners past 12/6 months (including swingers) 3, 8, 18, 19 • Inconsistent condom use 3, 17 • STI 1 year), including HIV positive patients: • First choice: BPG 2.4 million units IM weekly for 3 consecutive weeks (day 1, day 8 and day 15) • Second choice (...) : Doxycycline 100 mg orally twice daily for 28 days (be aware of photosensitisation) Pregnant women Referral to 2 nd line for treatment and follow-up In case of penicillin allergy • When in doubt, first assess the risk of anaphylaxis. If patients have a history compatible with an IgE mediated allergy then alternative therapies (such as doxycycline) should be used. • Patients should also be referred for skin testing to confirm allergy and for consideration of penicillin desensitisation. Table 12 – Hepatitis

2019 Belgian Health Care Knowledge Centre

186. Care around stillbirth and neonatal death

in Queensland, Australia: A population-based study. Aust N Z J Obstet Gynaecol 2017; 57(1): 33-9. 4. Kerber K, Mathai M, Lewis G, et al. Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby. BMC Pregnancy and Childbirth 2015; 15 (Suppl 2). 5. Perinatal and Maternal Mortality Review Committee. Tenth annual report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality: Reporting mortality 2014. Wellington (...) investigated or classified in terms of their cause, with around 50% at term classified as “unexplained” 3 . The lack of a diagnosis adds to parents’ distress, as they struggle to understand “what went wrong” and “will it happen again” in a subsequent pregnancy. In 20-30% of stillbirths, deficiencies in the quality of care are implicated. National perinatal mortality audit programs can help to reduce these deaths 4,5 . This update of the guideline has been undertaken through a partnership between PSANZ

2019 Centre of Research Excellence in Stillbirth

187. Oxycodone

for post-caesarean section analgesia: A randomised controlled trial. 187-93 10.4103/0019-5049.177877 Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural (...) oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined (...) section and to compare the incidence and severity of pruritus. Secondary objectives are to compare other side effects of epidural administered oxycodone and morphine (nausea 2014 11. RCT Comparing the Analgesic Efficacy of 4 Therapeutic Strategies Based on 4 Different Major Opioids (Fentanyl, Oxycodone , Buprenorphine vs Morphine) in Cancer Patients With Moderate/Severe Pain, at the Moment of Starting 3rd Step of WHO Analgesic Ladder. RCT Comparing the Analgesic Efficacy of 4 Therapeutic Strategies

2018 Trip Latest and Greatest

188. Headache

) strengthens measures to avoid use of valproate medicines in pregnancy In March 2018, the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate medicines (...) migraine the reduction was either 1.3 or 1.8 days, depending on the dose taken. The most common side effects were injection site reactions, constipation, muscle spasms and pruritus. The Food and Drug Administration in the US approved erenumab in May 2018 for the preventive treatment of migraine in adults. Summary (...) Medicines Agency (EMA) strengthens measures to avoid use of valproate medicines in pregnancy In March 2018, the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate (...) not getting through to women, despite earlier steps aimed at ensuring this. Summary Migraine has a high prevalence in children (10%) and is a significant source of morbidity. Careful consideration of the broad differential diagnosis is important when evaluating a child with headache . The expectations

2018 Trip Latest and Greatest

191. Ciclosporin (Verkazia) - Conjunctivitis, Keratitis

conjunctivitis, infectious conjunctivitis or ocular rosacea in children. Clinically, VKC is characterised by both conjunctival (hyperaemia, oedema, discharge) and corneal signs (superficial keratitis, corneal ulcerations, plaques, scars). Patients have a characteristic ropey, stringy mucous and/or serous discharge. Typical symptoms include photophobia, burning, pruritus, and blepharospasm. Intense ocular itching, followed by tearing and ropey, stringy mucous and/or serous discharge, and foreign body (...) in pregnant or breast-feeding women were available with either oral CsA or ophthalmic dosage forms, however Ryffel (1983) reported no teratogenic effects of CsA in rats and rabbits up to maternal toxic doses of 30mg/kg, but there was some evidence for reproductive toxicity at high (>maternal toxic) doses, at which foetal death and growth retardation of the off-spring occurred. Local tolerance Local tolerance was investigated in four 28-day studies in rabbits with instillations in the eyes four times a day

2018 European Medicines Agency - EPARs

194. Nitisinone (Nityr) - Tyrosinemias

(Reference Product: 5 AEs; Test Product 1: 1 AE; Test Product 2: 3 AEs). The adverse events were mild in intensity. There was no clinically significant and/or consistent drug-related change in vital signs, physical findings or safety laboratory values after administration of a total dose of 10 mg nitisinone per treatment period. Generally the safety data is in line with that of the reference product although an extra patient experienced pruritus with test product 2 versus Test product 1 or reference (...) , Date for submission of interim or final reports (planned or actual) Post-approval surveillance study (PASS)/ Nitisinone Tablets for Hereditary Tyrosinemia type 1 (HT-1) in Canada Category 3 To evaluate the long-term safety of Nitisinone tablets in the treatment of HT-1 and monitor its safety profile during pregnancy Long-term safety of Nitisinone tablets and to monitor its safety profile during pregnancy. Planned Planned Interim update (if the study is started) to be included in ASR to Health

2018 European Medicines Agency - EPARs

195. Varicella Zoster Virus glycoprotein E antigen (Shingrix) - Herpes Zoster

70 years having a four times increased risk of PHN than those younger than 60 years. Besides increase in age, immunosuppression from any cause, including hematologic malignancies, HIV and immunosuppressive medications, is an important risk factor for herpes zoster, increasing the risk of HZ by at least 10-fold. An increased risk of HZ has been reported in infants whose mothers had had varicella in pregnancy. Prompt antiviral therapy, if available, is recommended for herpes zoster in healthy (...) immunodeficiency viruses; those receiving immunosuppressive therapy, including high-dose corticosteroids; or those who are or may be pregnant. Unmet medical need Shingrix was developed to address the medical need to prevent HZ and HZ-related complications such as post-herpetic neuralgia (PHN) in older adults (=50 YOA) and to address the unmet medical need to prevent HZ and HZ complications in IC adults =18 YOA. The term HZ/su indicates the herpes zoster subunit candidate vaccine (50 µg gE/AS01 B) during

2018 European Medicines Agency - EPARs

198. Emicizumab (Hemlibra) - Hemophilia A

(ISRs) were reported very commonly from clinical trials. All ISRs observed in the Hemlibra clinical trials were reported as being non serious and generally mild to moderate in intensity. Most ISRs resolved without treatment. The most commonly reported ISR symptoms were injection site erythema (7.4 %), injection site pruritus (5.3%) and injection site pain (5.3%) (SmPC section 4.8). Safety data below patients age 1 are not available. In order to address the question to which extent the quantitatively

2018 European Medicines Agency - EPARs

199. Efavirenz/Emtricitabine/Tenofovir disoproxil - HIV

. •Statement that malformations have been observed in foetuses from efavirenz-treated monkeys. •Statement that a moderate amount of data on pregnant women (between 300-1,000 pregnancy outcomes) indicates oo malformations or foetaJJneonatal toxicity associated with emtricitabine and tenofovir disoproxil. Prominent wording io Efavirenz/Emtricitabine/Tenofovir disoproxil PIL: •Warning that women should not get pregnant during treatment with Efavirenz/Emtricitabine/Tenofovir disoproxil and for 12 weeks (...) sometimes characterized by a fulminant course has been reported post-marketing in patients with no pre-existing hepatic disease or other identifiable risk factors. • The following hepatobiliary disorders: ADRs are listed in the tabulated summary of adverse reactions for the efavirenz component: hepatitis acute, hepatic failure. None proposed Neural tube developmental Content in SmPC: None Assessment report EMA/846772/2017 Page 28/38 abnormalities Section 4.6 in SmPC: •Advisory statement that pregnancy

2018 European Medicines Agency - EPARs

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