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Pruritus in Pregnancy

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201. Conjunctivitis: Bacterial, Viral and Allergic

eyelashes A) Bacterial Warm compresses to unstick eyelids in morning Irrigate with sterile saline or eye wash to remove secretions and provide relief B) Viral Cold compresses to relieve irritation, redness C) Allergic Allergen avoidance if possible Avoid rubbing eyes Sunglasses reduce exposure outdoors Cold compresses over eye to relieve pruritus, swelling 2) Pharmacologic – OTC options Lubricating drops or ointments for all types A) Acute Bacterial Polymyxin B-gramicidin eye drops, 4-6 times per day (...) in patients ≥ 4 years old Slow onset: 5 to 14 days; option for prophylaxis for seasonal allergies – begin therapy 2 to 4 weeks before allergen season Adverse effects – well tolerated, < 1% of patients report adverse effects. 4) Pregnancy Preferred therapy: non-pharmacologic measures, artificial tears Second line: Lack of data on use of pharmacologic agents during pregnancy Antihistamines not expected to cause toxicity Short-term use of decongestants (avoid in 1 st trimester) Mast cell stabilizers

2018 medSask

202. Guidelines for the Management of Genital Herpes in New Zealand

Episode Genital Herpes: Third Trimester Acquisition 23 Management of Pregnant Women with Recurrent Genital Herpes 24 Treatment algorithm – Management of Women with History of Genital Gerpes Prior to Pregnancy and Women with First Clinical Episode Greater than 6 Weeks Prior to Delivery 25 NEONATAL HSV INFECTION 25 Transmission to the Fetus and Newborn 26 Disease Classification 26 Table 2: Classification of Neonatal HSV Infection46 27 Management of Neonatal HSV Infection 29 Guidelines for Talking (...) 2017 Only available online at 2. Sexually Transmitted Infections – Summary of Guidelines 2017 Patient information pamphlets 1. The Facts: A guide for people with Herpes Simplex Includes – Genital Herpes – The Facts Herpes and Relationships Herpes and Pregnancy Facial Herpes 2. Herpes: Myth vs Facts Helpline Website Resources New Zealand Sexual Health Society (NZSHS) resources Comprehensive STI Management Guidelines and Patient Information handouts are available on

2017 New Zealand Sexual Health Society

204. Lichen Sclerosus

? • This guideline was developed by an international, multidisciplinary panel of experts in LS • It aims to highlight potential triggers for LS • Advice on initial management • Advice on current treatment options with best long-term outcome for females and males • Future research strategies. What is the goal of the treatment in Lichen sclerosus? Females: • Currently, treatment mainly aims for suppression of symptoms like pruritus and signs such as pallor, erythema and fissures in vulval LS. • Ideally treatment (...) or calcineurin inhibitors (Virgili 2012)to suppress symptoms like pruritus and invisible/not symptomatic inflammation at any time • What is the risk of long-term treatment? ? There is an intrinsic risk in LS to develop anogenital malignancies. ? There is no evidence from the literature that there is an increased risk of anogenital malignancies after long-term treatment (either with steroids nor for calcineurin inhibitors, however very long term follow up studies are not available). • Is there a good

2018 European Dermatology Forum

205. Atopic Eczema

includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is 19 targeted with the majority of the recommended therapies, but some patients may need additional 20 antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, 21 immunotherapy, complementary medicine and educational intervention will be addressed in part 22 II of the guideline. 23 24 Key words: Atopic eczema, atopic dermatitis, pruritus, immunomodulation, emollients 25 26 EDF Guideline AE part I and II (...) After establishing the diagnosis of AE, the overall disease severity must be determined by 30 evaluating both objective signs and subjective symptoms. As signs-only scores are lacking 31 the subjective part of pruritus and sleep disturbance, composite scores assessing signs and 32 symptoms must be used to assess overall disease severity (3). The classical composite 33 score is the “Scoring of Atopic Dermatitis” (SCORAD) developed by the European Task 34 Force of Atopic Dermatitis (ETFAD) (4). AE

2018 European Dermatology Forum

206. Care of Adults with Neurofibromatosis Type 1

to a high-risk obstetrician should be considered for pregnant women with NF1. Preanesthesia neuraxial imaging to evaluate for spinal or paraspinal neurofibromas is probably not needed. If there are concerns, spinal anesthesia may be considered. Educate adults with NF1 that, as an autosomal dominant disorder, the offspring recurrence risk is 50% for each pregnancy. PGD and prenatal diagnosis of NF1 are available. Individuals with de novo mutations, somatic mosaicism, and large genomic rearrangements (...) an issue for adults. A limited number of NF1 genotype–phenotype correlations are known 8–11 and can be clinically useful in some cases. In general, however, the spectrum of severity of the NF1 phenotype, even within a family, can be striking. There are many reasons why adults may present for care. These include: 1) assistance with a specific problem in a person with known NF1; 2) diagnostic evaluation of a parent with a child newly diagnosed with NF1; 3) guidance during pregnancy; 4) diagnostic

2018 American College of Medical Genetics and Genomics

207. Paediatric Urology

of erythropoietin during testicular torsion of the rats. World J Urol, 2007. 25: 531. 185. Lian, B.S., et al. Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion. Eur J Pediatr Surg, 2016. 26: 17. 186. Philip, J., et al. Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility? BJU Int, 2006. 97: 138. 187. Gielchinsky, I., et al. Pregnancy Rates after Testicular Torsion. J Urol, 2016. 196: 852. 188. Bergman, J.E., et al. Epidemiology of hypospadias

2018 European Association of Urology

208. Urological Infections

. Antimicrob Agents Chemother (Bethesda), 1966. 6: 142. 36. Gold, E.M., et al. Asymptomatic bacteriuria during pregnancy. Obstet Gynecol, 1966. 27: 206. 37. Kass, E.H. Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med, 1962. 56: 46. 38. Kincaid-Smith, P., et al. Bacteriuria in Pregnancy. Lancet, 1965. 1: 395. 39. Little, P.J. The incidence of urinary infection in 5000 pregnant women. Lancet, 1966. 2: 925. 40. Mulla, N. Bacteriuria in pregnancy. Obstet Gynecol, 1960. 16 (...) in pregnancy: a single dose of 3 g amoxicillin versus a 4-day course of 3 doses 750 mg amoxicillin. Gynecol Obstet Invest, 1989. 27: 84. 58. Olsen, L., et al. Single-dose versus six-day therapy with sulfamethizole for asymptomatic bacteriuria during pregnancy. A prospective randomised study. Dan Med Bull, 1989. 36: 486. 59. Thoumsin, H., et al. Single dose fosfomycin trometamol versus multiple dose nitrofurantoin in pregnant women with bacteriuria: preliminary results. Infection, 1990. 18 Suppl 2: S94. 60

2018 European Association of Urology

209. Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update

or congenital anomaly, or jeopardizes the patient in any serious way d Rash, upper respiratory tract infection, nausea, pruritus, headache, diarrhea, dizziness, abdominal pain, bronchitis, leukopenia, injection site reactions ACR 20/50/70 = American College of Rheumatology 20/50/70% improvement from baseline; AE = adverse event; csDMARD = conventional synthetic disease-modifying antirheumatic drug; DAS = Disease Activity Score; DMARD = disease-modifying antirheumatic drug; ETN = etanercept; FDA = U.S. Food

2018 Effective Health Care Program (AHRQ)

210. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

, and treatable ( e.g. , pregnancy, nonclassic congenital adrenal hyperplasia, ovarian or adrenal neoplasm, or other endocrinopathies). The most common of these is nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (as noted in Section 1, Etiology and Section 5, Androgen Testing Remarks). This is particularly important to detect because of its genetic implications for those women desiring fertility ( ). We suggest screening hyperandrogenemic women for nonclassic congenital adrenal (...) in detail ( ). Different subspecialists use different strategies for evaluating the patient with hirsutism ( , ). The evaluation of hyperandrogenemic women may include the following: pregnancy tests in patients with amenorrhea; measuring dehydroepiandrosterone (DHEA) sulfate (DHEAS) to screen for adrenal hyperandrogenism; assessing for Cushing syndrome, thyroid dysfunction, acromegaly, and hyperprolactinemia if features of these conditions are present (however, all are uncommon causes of hirsutism

2018 The Endocrine Society

211. Pembrolizumab (Keytruda) (urothelial carcinoma) - As monotherapy for the treatment of locally advanced or metastatic or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy (first line)

, confirmed pregnancy, non-compliance with trial procedures, loss to follow up, or completion of 24 months of treatment. Clinically stable patients with progressive disease who were judged by the investigator to be benefiting from pembrolizumab could remain on treatment until subsequent progression. Patients receiving pembrolizumab who attained a complete response and had been on treatment for at least 24 weeks could discontinue treatment. Patients who stopped study treatment after 24 months, for reasons (...) . In the overall KEYNOTE-052 study population, treatment-related adverse events (AEs) were reported in 66% of patientsand were at least grade 3 in severity in 19% of patients. Discontinuation due to treatment-related AEs occurred in 7% of patients. 7 The most commonly reported treatment-related AEs were fatigue (18%), pruritus (17%), rash (12%), decreased appetite (10%), hypothyroidism (10%), diarrhoea (8.6%), and nausea (8.4%). Individual treatment-related AEs of at least grade 3 in severity occurred in less

2018 Scottish Medicines Consortium

213. Antiocoagulation - oral

Antiocoagulation - oral Prodigy Toggle navigation Topics Specialities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Allergies Cancer Cardiovascular Child health Drugs and devices Ear, nose and throat Endocrine and metabolic Eyes Gastroenterology Gastrointestinal Haematology Immunizations Infections and infestations Injuries Kidney disease and urology Men's health Mental health Musculoskeletal Neurological Oral health Palliative care Poisoning Pregnancy Preventative medicine Respiratory (...) and clinically relevant bleeding risk. A prosthetic heart valve. Apixaban is also contraindicated in: People who are taking any other anticoagulants, except when switching to or from warfarin treatment. People who are taking strong inhibitors of cytochrome P3A4 enzyme and P-glycoprotein, such as ketoconazole, or HIV protease inhibitors such as ritonavir. For more information, see . Women who are pregnant or breastfeeding. The safety of apixaban has not been established in pregnant or breastfeeding women

2017 Prodigy

217. Sarilumab (Kevzara) - for treating adults with moderate to severe rheumatoid arthritis

study with sarilumab in cynomolgus. These studies have not revealed adverse effects on fertility and pregnancy outcome. In surviving neonates, no developmental defects were noted. To support the use of sarilumab in paediatric patients, toxicity was evaluated with the surrogate mAb in juvenile mice, although such study was not considered necessary in the agreed PIP. The study, with a focus on the effect of IL-6Ra blockade on the immune system, did not raise concerns for use of sarilumab in young

2017 European Medicines Agency - EPARs

218. CRACKCast E143 – Diving Injuries and Dysbarism

of small bubbles of nitrogen gas in the blood and tissues on ASCENT! LOCATION, location, location of the bubbles – determines the type of symptoms that arise Fetal circulation anatomy explains why pregnant women should not dive. Multiple small bubbles normally occur on ascent, but if they become persistent, large or too numerous for the lungs to filter → inflammatory cascades ensue, cytokines, thrombosis, ischemia, obstruction etc. can occur. These bubbles can cause ischemia and hypoxia if large (...) marmorata – patchy cyanotic marbling of the skin (trunk and torso) – may first show up as pruritus, then erythema, then mottling. This is due to venous stasis. Lymphatic obstruction presents with edema. Spinal cord at high risk – lumbar region: ● Limb weakness/paralysis ● Paresthesias – distal to proximal migration ● Numbness ● Low back/abdominal pain ● Bladder symptoms, fecal incontinence, priapism ● Patchy symptoms Cerebral symptoms: ● Headache, blurred vision, diplopia, dysarthria, fatigue, behaviour

2018 CandiEM

219. Dupilumab (Dupixent) - Atopic Dermatitis

observation carried forward MedDRA Medical Dictionary for Regulatory Activities MI Multiple imputation MMRM Mixed-effect model with repeated measures NRS Numerical Rating Scale OLE Open-label extension PCS Pruritus Categorical Scale PCSV Potentially clinically significant value PK Pharmacokinetic POEM Patient Oriented Eczema Measure PPS Per protocol set PT Preferred term QoL Quality of life QW Weekly Q2W Every 2 weeks Q4W Every 4 weeks RBC Red blood cell Regeneron Regeneron Pharmaceuticals, Inc. SAE (...) is characterized by pruritus, xerosis, and eczematous lesions. Especially pruritus and skin infections which are a major complication in AD compromise health and lower the quality of life and can result in sleep disturbance, pain and psychiatric comorbidities such as anxiety, depression, and suicidal ideation. 2.1.5. Management Limited treatment options are available. Local therapies often relieve typical symptoms for the duration of their application. Atopic dermatitis is treated primarily with topical

2017 European Medicines Agency - EPARs

220. Trientine tetrahydrochloride (Cuprior) - Hepatolenticular Degeneration

and kidney than plasma concentrations, with the highest concentration occurring at 1hr post-dose. Placental transfer of trientine has not been investigated. However, the low molecular weight suggests that exposure of the embryo can be expected. As studies in animals have shown reproductive toxicity, which was probably a result of trientine-induced copper deficiency (see section chapter on reproductive toxicity below) Cuprior should only be used in pregnancy after careful consideration of the benefits (...) increased in a dose-related manner. In follow-up experiments copper supplementation reduced the teratogenicity of trientine, supporting the role of copper-deficiency in the trientine-induced teratogenicity. The need for careful monitoring of maternal serum copper levels throughout pregnancy and the potential need for dose adjustments has been identified in the SmPC (section 4.6). On this basis, the reproductive and developmental toxicity risks associated with trientine-induced alterations of copper

2017 European Medicines Agency - EPARs

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