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Pruritus in Pregnancy

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122. 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

123. 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

124. Gonorrhoea infection

for uncomplicated gonorrhoea is dual therapy with single-dose intramuscular ceftriaxone plus single-dose oral azithromycin. The treatment of N gonorrhoeae is important in the prevention of infertility, chronic pelvic pain, and ectopic pregnancy in women. If acquired congenitally from an infected mother, the neonate can present with ophthalmia neonatorum, which left untreated can cause blindness. Definition Neisseria gonorrhoeae is a gram-negative diplococcus bacterium that is closely related to other human (...) pelvic pain in women tenderness and/or swelling of the epididymis mucopurulent or purulent exudate at the endocervix urethral irritation in men dysuria in men tenderness and/or swelling of testis tenderness and/or swelling of prostate anal pruritus mucopurulent discharge from the rectum rectal pain tenesmus rectal bleeding vaginal discharge cervical friability uterine, adnexal, or cervical motion tenderness uterine mass anterior cervical lymphadenopathy conjunctivitis fever skin lesions (papules

2018 BMJ Best Practice

125. Haemorrhoids

protrude outside the anal canal causing symptoms. [Figure caption and citation for the preceding image starts]: Rubber band on redundant haemorrhoidal tissue Kurt G. Davis, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Bands placed above the dentate line Kurt G. Davis, MD [Citation ends]. History and exam presence of risk factors rectal bleeding perianal pain/discomfort anal pruritus tender palpable perianal lesion anal mass age between 45 and 65 years constipation (...) pregnancy or space-occupying pelvic lesion hepatic insufficiency ascites Diagnostic investigations anoscopic examination colonoscopy/flexible sigmoidoscopy FBC stool for occult haem Treatment algorithm ACUTE ONGOING Contributors Authors Senior Lecturer and Consultant in Colorectal Surgery National Bowel Research Centre (NBRC) Blizard Institute Barts and The London School of Medicine & Dentistry Queen Mary University of London London UK Disclosures MAT held a clinical research training fellowship (2000

2018 BMJ Best Practice

126. 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

127. 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

128. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae

twice daily 4.4 Pregnancy and breastfeeding 85-87 Pregnant and breastfeeding individuals should not be treated with quinolone or tetracycline antimicrobials. Pregnancy does not diminish treatment efficacy. Ceftriaxone 1g intramuscularly as a single dose (Grade 1A) or Spectinomycin 2g intramuscularly as a single dose (Grade 1A) o Spectinomycin is in the FDA pregnancy category B and therefore not expected to be harmful and can be used if no suitable alternatives. It is not known if it is excreted (...) Sluis WB, Bouman MB, Gijs L, et al. Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. Int J STD AIDS 2015;26(8):595-8. doi: 10.1177/0956462414544725 41. Bodsworth NJ, Price R, Davies SC. Gonococcal infection of the neovagina in a male-to-female transsexual. Sex Transm Dis 1994;21(4):211-2. 42. Haustein UF. [Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection]. Hautarzt 1995;46(12):858-9. 43. Public Health England. Key findings from

2019 British Association for Sexual Health and HIV

129. 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

131. 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

2019 European Association of Urology

132. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

of antifungal susceptibility testing should take into account the acid pH of the vagina compared with the neutral pH at which testing is usually performed; the activity of azole antifungals is reduced in acidic environment and clinical resistance may occur despite the isolate being microbiologically susceptible. Treatment: • Oral azoles – continue to avoid in pregnancy, at risk of pregnancy and whilst breastfeeding • Ketoconazole is no longer recommended for the treatment of VVC • Non-azole therapies (...) strains or reintroduction of the organism to the genital tract. The majority are usually due to C. albicans. 15 For many women an identifiable host factor is not found but can include: • persistence of Candida sp (as detected by PCR although culture-negative between attacks) 16 • poorly controlled diabetes mellitus • immunosuppression • endogenous and exogenous oestrogen (including pregnancy, HRT and possibly the combined oral contraceptive pill) 17-20 • recent (up to three months before the episodes

2019 British Association for Sexual Health and HIV

133. Management of Atopic Eczema

). Prevalence of schizophrenia and affective disorders are also higher in AE compared with control (1.2% vs 0.5% and 7.7% vs 4.5% respectively). 23, level II-2 Prevalence of AE is increased with exposure to active and passive smoking. However, it is not associated with maternal smoking during pregnancy. 24, level II-2 • Co-morbidities e.g. skin infection, atopic disease, food allergy, cardiovascular disease, psychological and psychosocial dysfunction may co-exist in AE.7 Management of Atopic Eczema 5 (...) . AGGRAVATING/TRIGGERING FACTORS There are many potential aggravating factors which can worsen flares in AE, either independently or in combination. Potential aggravating/ triggering factors include the following: • aeroallergen • physical irritants • environmental factors • food • microbial colonisation/infection • patient factors (e.g. pregnancy) 5.1 Aeroallergen House dust worsens itch in AE. 25, level III Severity of skin symptoms is associated with indoor house dust mites levels (p 50% deteriorate

2019 Ministry of Health, Malaysia

134. AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

, B In HCV-infected pregnant women with pruritus or jaundice, there should be a high index of suspicion for intrahepatic cholestasis of pregnancy with subsequent assessment of alanine aminotransferase ALT , aspartate aminotransferase AST , and serum bile acids. I, B HCV-infected women with cirrhosis should be counseled about the increased risk of adverse maternal and perinatal outcomes. Antenatal and perinatal care should be coordinated with a maternal–fetal medicine (ie, high-risk pregnancy (...) November) • AASLD-IDSA HCV Guidance Panel and transmission and prevention counseling recommendations. See the Supplementary Materials for recommendations regard- ing monitoring and medical management of HCV-infected children. Pregnancy As risk factor–based screening has not been shown to be effect- ive [101–103], screening with an HCV antibody assay (with confirmatory nucleic acid testing for a positive result) is newly recommended for pregnant women. Without increased testing of pregnant women

2019 American Association for the Study of Liver Diseases

135. ASCIA Guide - Aeroallergen Immunotherapy

in atopic dermatitis is of limited benefit. • Oral allergy syndrome (OAS), also known a pollen food syndrome: AIT is not currently recommended. • Nasal polyposis: there is no evidence that inhalant AIT alters the natural history of nasal polyposis, although co-existing allergic rhinitis may benefit. CONTRAINDICATIONS AND PRECAUTIONS Absolute contraindications • Inability for patient or child’s parent/guardian to give informed consent. • Current or planned pregnancy (contraindication to initiation of AIT (...) only). ­ The major reason for not initiating AIT is the risk of anaphylaxis, which could be dangerous to the foetus (hypotension with reduced placental perfusion, uterine contractions). ­ SCIT is considered to pose a higher risk than SLIT. One trial reported that initiation of SLIT in pregnancy was safe, but this is not yet considered standard of care. ­ Enquiries should be made in all female patients of child-bearing age regarding their plans for pregnancy prior to initiation of AIT. ­ Pregnancy

2019 Australasian Society of Clinical Immunology and Allergy

136. ASCIA Guidelines: Chronic Spontaneous Urticaria (CSU)

- Leukotriene receptor antagonists (LTRAs) 10 - Omalizumab 10 - Ciclosporin 13 - Dapsone 14 - Hydroxychloroquine 14 - Corticosteroids 14 - Anticoagulants 14 - Thyroxine 14 - Other treatments 14 • Drug treatment in paediatric populations 15 • Drug availability in New Zealand • PBS requirements in Australia • Non-drug management • Management of CSU in pregnancy and lactation 16 16 17 18 3. Treatment algorithms 19 • Australia • New Zealand 4. References 21 ASCIA INFORMATION FOR HEALTH PROFESSIONALS 3 1 (...) of Urticaria: The 2017 Revision and Update (Zuberbier et al, 2018). Urticaria is characterized by: 1. wheals of variable size, surrounded by erythema. 2. pruritus of variable severity, or sometimes a burning sensation. 3. a transient nature with the skin returning to normal, usually within 30 minutes to 24 hours. Angioedema is characterised by: 1. a sudden, pronounced swelling of the deeper dermis or mucus membranes. 2. painful or uncomfortable, rather than pruritic. 3. resolution slower than for urticaria

2019 Australasian Society of Clinical Immunology and Allergy

137. Urological Infections

bacteriuria--a long-term study. Scand J Urol Nephrol, 1988. 22: 31. 33. Asscher, A.W., et al. The clinical significance of asymptomatic bacteriuria in the nonpregnant woman. J Infect Dis, 1969. 120: 17. 34. Elder, H.A., et al. The natural history of asymptomatic bacteriuria during pregnancy: the effect of tetracycline on the clinical course and the outcome of pregnancy. Am J Obstet Gynecol, 1971. 111: 441. 35. Elder, H.A., et al. Use of sulfasymazine in the treatment of bacteriuria of pregnancy (...) . 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

2019 European Association of Urology

138. BSG and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis

be actively sought and treated (strength of recommendation: STRONG; quality of evidence: LOW). 22. We suggest that cholestyramine (or similar) is first-line medical treatment for pruritus. Rifampicin and naltrexone are second-line treatments (strength of recommendation: WEAK; quality of evidence: LOW). 23. We suggest that an elevated CA19.9 may support a diag- nosis of suspected cholangiocarcinoma but has a low diag- nostic accuracy. Routine measurement of serum CA19.9 is not recommended for surveillance (...) ). We suggest that those without IBD may benefit from less frequent 5-year colonoscopy or earlier in the advent of new symptoms (strength of recom- mendation: WEAK; quality of evidence: VERY LOW). 28. We suggest that in the presence of cirrhosis, hepatocellular carcinoma surveillance should be carried out in accordance with international guidelines (strength of recommendation: WEAK; quality of evidence: LOW). 29. We recommend that because pregnancy in cirrhotic patients carries a higher risk

2019 British Society of Gastroenterology

140. Guideline regarding treatment of haemorrhoids

, prolapse (swelling), itching and soiling (stool and/or mucus discharge) [3, 4]. Further the healthcare providers should ask about risk factors: hard stools (constipation), the use of opioids or other medication causing constipation, increased intra-abdominal pressure (obesity, prolonged sitting on the toilet and pregnancy), low fiber diets and fluid intake [5-8]. In addition, a surgical history of previous anorectal procedures must be obtained. A detailed physical examination must include external (...) beneficial effect for the outcomes of pruritus (OR 0.23; 95% CI 0.07 to 0.79), bleeding (OR 0.12; 95% CI 0.04 to 0.37), bleeding post- haemorrhoidectomy (OR 0.18; 95% 0.06 to 0.58)(P=0.004), discharge and leakage (OR 0.12; 95% CI 0.04 to 0.42) and overall symptom improvement (OR 15.99 95% CI 5.97 to 42.84). The number of adverse events which took place as a result of taking phlebotonics were few and often consisted of mild gastro-intestinal side- effects. The systematic review demonstrated

2019 Palliative Care Evidence Review Service (PaCERS)

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