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Pruritus in Pregnancy

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222. Padeliporfin (Tookad) - prostate cancer / Prostatic Neoplasms

to the intravenous administration procedure (see SmPC section 5.3). Prostate fluid is a component of the ejaculate. It is not known if the results of Tookad activation in the prostate will affect sperm. To avoid any paternally transmitted damage to the offspring it is recommended as a precautionary measure to avoid pregnancy until any hypothetically damaged cells are removed through spermatogenic cycling. If the patient is sexually active with women who are capable of getting pregnant, he and/or his partner (...) should use an effective form of birth control to prevent getting pregnant during a period of 90 days after the VTP procedure (see SmPC section 4.6). Regarding blood compatibility, due to the colour of padeliporfin solution, the evaluation of the haemolytic potential of padeliporfin was not possible in rat, monkey, or human blood. The clinical evidence available at the moment is sufficient to rule out an haemolytic cause of concern for padeliporfin. The submitted ERA was updated with the calculation

2017 European Medicines Agency - EPARs

224. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management Full Text available with Trip Pro

, such as elevated intraocular and intracranial pressure, both of which are controversial. Several RCTs have been conducted with ketamine in the perioperative setting. One excluded patients with elevated intracranial pressure, intraocular pressure, uncontrolled hypertension, history of psychosis, and pregnancy ; a second excluded psychosis, pregnancy, or altered mental status ; and another excluded severe cardiopulmonary disease, uncontrolled hypertension, raised intracranial pressure, glaucoma, hepatorenal (...) dysfunction, pregnancy, and psychosis. For acute pain, poorly controlled cardiovascular disease, pregnancy, and hepatic dysfunction seem to be commonly agreed-upon relative contraindications. None of the studies, however, reported any patients who experienced major adverse cardiovascular events or hepatic dysfunction as a result of ketamine, so the clinical significance of these relative contraindications is uncertain. When comparing randomized trials for acute pain to those evaluating its use for chronic

2018 American Society of Regional Anesthesia and Pain Medicine

225. Flowchart: Stillbirth care, PSANZ investigations

autopsy • Needle biopsies, laparoscopic autopsy or access to tissue from small incisions Findings Selective investigations **APS tests–Antiphospholipid syndrome tests • Anticardiolipin antibodies • Lupus anticoagulant • Anti-B2 glycoprotein-1 antibodies Placental abruption/infarction Pruritus (without rash) in pregnancy and/or Risk factors for obstetric cholestasis LFTs Bile acids Personal/family history of VTE APS** tests LGA HbA1c SGA HbA1c CMV APS** tests Hydropic Anaemic Jaundiced Infections

2018 Queensland Health

228. Management of specific situations in polycythaemia vera and secondary erythrocytosis Full Text available with Trip Pro

, thrombosis, haemorrhage, pregnancy, pruritus surgery and management. The search covered the period from 2005, the date of last version of the guideline (McMullin et al , ), to February week 3 2017. Exclusions included articles not in English, studies not in humans, single case reports and small case series. A total of 6062 articles were identified which, with exclusions and duplications, resulted in 1215 articles which were reviewed. Review of manuscript Review of the manuscript was performed by the BSH (...) of acute thrombotic events and secondary prevention of thrombosis in PV. The unusual thrombotic events, splanchnic vein and cerebral vein thromboses are discussed and haemorrhage. The specific situations of surgery and pregnancy and guidance on management of pruritus are included. The evidence for the management of other causes of erythrocytosis, including idiopathic erythrocytosis, congenital erythrocytosis, hypoxic pulmonary disease and post‐transplant erythrocytosis, is reviewed and recommendations

2018 British Committee for Standards in Haematology

229. Diagnosis and management of polycythaemia vera Full Text available with Trip Pro

, mutation, JAK 2, MPL , CALR , bone marrow, red cell mass, erythropoietin, risk, management, treatment, cytoreduction, venesection, hydroxyurea, interferon, busulfan, pipobroman, radioactive phosphorus, aspirin, anagrelide, ruxolitinib, thrombosis, haemorrhage, pregnancy, pruritus, surgery and management. The search covered the period from 2005, the date of last version of the guideline (McMullin et al , ), to February week 3 2017. Exclusions included articles not in English, studies not in humans (...) disturbances or, occasionally, haemorrhage. Splenic pain and/or enlargement, pruritus, gout and constitutional symptoms, such as fatigue, may be present. Alternatively, asymptomatic patients may be identified incidentally following a full blood count. All patients who are newly diagnosed with PV should be discussed in a multidisciplinary team setting. The recommended diagnostic criteria for JAK 2‐positive and the very rare JAK 2‐negative PV are given in full in Table . Role of the bone marrow biopsy in JAK

2018 British Committee for Standards in Haematology

230. Obeticholic acid (Ocaliva) - Liver Cirrhosis, Biliary

progression, levels of total and HDLc are reduced, while levels of lipoprotein X increase (Loria 2014). There is no consensus that these lipid abnormalities in PBC patients correlate with an increased risk for developing cardiovascular disease (Crippin 1992, Longo 2002, Allocca 2006, Ungprasert 2014). Pruritus and fatigue are the most commonly reported symptoms in PBC (Mayo 2008, Crosignani 2008). Neither the exact pruritogen nor the underlying mechanisms for the cause of cholestatic pruritus have been (...) completely elucidated, although the autotaxin pathway has been implicated (Bolier 2012, Beuers 2014). Pruritus may subside spontaneously when patients decompensate and develop hepatic failure, suggesting the pruritogen is synthetized in the liver (Jones 2012, Jones 1999). Fatigue is reported in up to 78% of PBC patients. Although fatigue is not well understood, it known that it is not specific to PBC, and it does not correlate with disease severity (Crosignani 2008). Fatigue is related to autonomic

2017 European Medicines Agency - EPARs

232. Chlormethine (Ledaga) - mycosis fungoides-type cutaneous T-cell lymphoma

been reported in the literature. Chlormethine caused foetal malformations in mice and rats when given as single injections of 1–2.5 mg/kg. Other findings in animals included embryo-lethality and growth retardation when administered as a single injection. Chlormethine is not recommended during pregnancy and in women of child bearing potential not using contraception. There was no information on pharmacodynamic drug interaction, repeated-dose toxicity, toxicokinetic data, and in pre-and postnatal (...) means of contraception. Females must have a negative pregnancy test. Main exclusion criteria • Newly diagnosed MF with no prior therapy. • A prior history of treatment with topical NM within the last two years or topical carmustine (BCNU). • Use of topical or systemic therapies, including corticosteroids, for MF within 4 weeks of entry in the study. • Patients with a diagnosis of stage IIB – IV MF. • Patients who had a history of a higher T score than T2 or a higher N score than N1. • Patients who

2017 European Medicines Agency - EPARs

234. Primary Biliary Cholangitis

on QoL, and include: cholestatic pruritus, sicca complex, abdom- inal discomfort and fatigue [29,30]. Patient surveys have also reported restless legs, sleeplessness, depression and cognitive dysfunction. Increased understanding of PBC has led to the dis- tinctionofhigh-andlow-riskdisease,recognisedafterevaluation of response to the ?rst-line agent, ursodeoxycholic acid (UDCA). Age at onset, sex (male), stage at presentation, and selected bio- chemical/serologic indices pre- and post-therapy (...) be interpreted in a context speci?c manner. The diagnostic approach to cholestasis Effectivebiliarysecretionisessentialforadequatehepaticdetox- i?cation and an intestinal digestive function. Cholestasis is the impairment of bile formation and/or bile ?ow which can be asymptomatic, or manifest with fatigue, pruritus, right upper quadrant abdominal discomfort and jaundice [37]. Early bio- chemical markers include increased serum ALP and gamma- glutamyltranspeptidase (GGT), followed by conjugated hyper

2017 European Association for the Study of the Liver

235. Guidance on Primary Biliary Cholangitis

on quality of life. (95-96) Severe fatigue may be associated with decreased over- all survival. (97) The etiology of the fatigue in PBC is unknown, but in some it may be associated with orthostatic hypotension, daytime sleepiness, cognitive defects, or impaired recovery of muscle from acidosis. (98) Fatigue from PBC is relatively constant or slowly pro- gressive over time. (99) pruritus Early studies reported that pruritus (itching) occurs in 20% to 70% of patients with PBC. It is now less common because (...) of the growing number of patients with PBC who are diagnosed in the early, asymptom- atic phase. (100-102) Patients report itching as local or l i Ndor et al. Hepatology , Month 2018 8 diffuse and often exacerbated by contact with cloth- ing, heat, or pregnancy. It has a circadian rhythm and is worse in the evenings. The clinical course of itch- ing in PBC often fluctuates, with periods of relative exacerbation and improvement. Paradoxically, pruri- tus has been reported to wane in very advanced liver

2018 American Association for the Study of Liver Diseases

236. BSG and UKPBC primary biliary cholangitis treatment and management guidelines

auto- immune liver disease. It continues to have a burden of morbidity and mortality that spans both the consequences of a sometimes progressive biliary injury, alongside a symptom profile notably encom- passing pruritus, sicca complex, fatigue, abdominal discomfort and arthralgias/bone pain. UK-PBC and the British Society of Gastroenterology (BSG) have partnered to develop a comprehensive guideline document to provide detailed advice and recom- mendations on the best approaches to the manage- ment (...) in isolation is not a highly predictive surrogate marker for risk of death in PBC. A detailed review of liver histology suggests that the presence of a lymphoplasmacytic interface hepatitis is a marker of more rapidly progressive disease 14 96 and, in another report of four cases, rapidly progressive bile duct loss, even in the absence of cirrhosis, led to liver failure; this is the so-called ‘pre-cirrhotic ductopenic’ variant of PBC, characteristic of early onset symptomatic (pruritus) disease. 127

2018 British Society of Gastroenterology

238. A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda Full Text available with Trip Pro

. There was a statistically significant shorter length of stay for the ERAS arm compared to SOC, with a difference of -18.5 hours (P < .001, 95% confidence interval [CI], -23.67, -13.34). The incidence of complications of severe pain and headache was lower in the ERAS arm compared to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm compared to SOC (P = .023). Conclusions: Use of an ERAS protocol for women undergoing emergency cesarean delivery in a low-income setting is feasible (...) * Actions Device Removal / standards Actions Early Ambulation / standards Actions Eating Actions Emergencies Actions Feasibility Studies Actions Female Actions Hospitals / standards* Actions Humans Actions Length of Stay* Actions Patient Discharge / standards* Actions Patient Readmission / standards Actions Postoperative Complications / therapy Actions Pregnancy Actions Prospective Studies Actions Recovery of Function Actions Single-Blind Method Actions Time Factors Actions Treatment Outcome Actions

2020 EvidenceUpdates

239. Superficial Bacterial Skin Infections - Guidelines for Prescribing Topical Antibiotics for impetigo and folliculitis

dermatitis: Did the patient have any recent contact with an unknown plant, chemical, or topical medicine? Lesions would be limited to exposed area Distinguished by: Sudden onset of severe pruritus Asymmetric distribution Location Allergy history : An ulcerative, deeper form of impetigo usually found on the lower leg area following a trauma to the skin such as a scratch or cut. Punched out ulcers covered with a yellow crust; raised purple margins Commonly on buttocks, thighs, legs, ankles or feet Diabetes (...) to patient's primary care provider Pregnancy: Animal studies have not reported any safety issues but human data is limited. Only small amounts of mupirocin are absorbed after topical use and there are no reports of teratogenicity—risk appears minimal. However, consider avoiding unless benefit outweighs risk. Systemic agents [penicillins, cephalosporins, clindamycin and erythromycin (except estolate)] are indicated for impetigo and are safe in pregnancy, so may be an appropriate alternative Lactation

2017 medSask

240. Hemorrhoids - Guidelines for Prescribing Rectal Hydrocortisone Combination Products

movement. Create a permanent bulge at the anus. This stage is quite painful. Fourth-degree hemorrhoids are at risk of thrombosis and gangrene. External hemorrhoids originate and are located below the dentate line and can be painful. Mixed hemorrhoids - combination of internal and external hemorrhoids Contributing Causes: Chronic constipation Straining Diarrhea (due to frequent bowel movements) Pregnancy Old age Certain physical exertion (lifting heavy objects with poor technique) Prolonged sitting (...) of fullness and incomplete evacuation after defecation Protruding hemorrhoids present as a mass with more prominent bleeding If 4th degree internal hemorrhoid, increased risk of strangulation and/or thrombosis with acute pain Individuals often have fecal soiling --> pruritus and irritation Hemorrhoids are diagnosed based on the presence of the typical signs and symptoms listed above. Rule out the following conditions that may present with similar signs and symptoms: Colorectal Cancer - Symptoms: Large

2017 medSask

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