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Pruritus in Pregnancy

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141. Disorders of the Hepatic and Mesenteric Circulation Full Text available with Trip Pro

bile duct obstruction. This results in a secondary form of cholangiopathy, termed portal hypertensive cholangiopathy or portal cavernoma cholangiopathy ( ). This complication has been reported in about 0.5%–1% of patients with chronic PVT. Patients may present with symptoms of cholestasis including pruritus. These patients are also at risk of developing bacterial cholangitis and intraductal stones ( ). Diagnosis requires presence of a cholestatic liver chemistry profile, portal cavernoma

2020 American College of Gastroenterology

142. Evidence Map - Aromatherapy and Essential Oils

orange OPCC&CT Office of Patient Centered Care and Cultural Transformation P P-value PBO Placebo PICOTS Population, interventions, comparators, outcomes, timing, setting, and study design pts Participants PUQE Pregnancy-Unique Quantification of Emesis/Nausea QOL Quality of Life RCSQ Richards-Campbell Sleep Questionnaire RCT Randomized controlled trial REEDA Redness, Edema, Ecchymosis, Discharge, Approximation ROB Risk of bias RR Risk ratio Aromatherapy and Essential Oils Evidence Synthesis Program 8 (...) volunteers or those with various health conditions (eg, cancer, pregnancy, postpartum, mothers of children with ADHD) Psychological Depressive symptoms measured by various scales Dysmenorrhea 23 --- Physical Pain Nausea/vomiting, postoperative 26 Studies of patients undergoing a variety of surgical procedures Nausea/vomiting Nausea severity Nausea/vomiting, early pregnancy 28 --- Psychological Satisfaction with treatment Nausea/vomiting Nausea and vomiting severity; vomiting intensity Onychomycosis 40

2019 Veterans Affairs Evidence-based Synthesis Program Reports

143. Perioperative

urine tests for pregnancy. However, patients of childbearing age should be asked if there is a possibility they might be pregnant. Pregnancy testing is indicated in: 1. Patients planning to undergo surgeries involving the uterus (e.g., hysterectomy, myomectomy), 2. Uterine cavity surgery (e.g., dilation and curettage, endometrial ablation), or 3. Surgery that impacts blood flow to the uterus (e.g., endovascular surgeries that disrupt aortic blood flow, procedures involving the uterine arteries (...) Perioperative Index Table 1. General Preoperative Management Preoperative Health Screening and Assessment Preoperative Testing Electrocardiogram Chest X-ray Hemoglobin/Hematocrit Testing Potassium/Sodium Testing Renal Function (Creatinine) Testing Pregnancy Testing Hemostasis (Coagulation) Testing Glucose Testing in Nondiabetic Patients Sleep Apnea Nicotine Cessation Preparation for Surgery 2. Perioperative Management of Select Conditions Cardiovascular Considerations Prevention of Endocarditis

2020 Institute for Clinical Systems Improvement

144. Management of Cancer Medication-Related Infusion Reactions

mg/kg doses can be safely administered as a rapid infusion (i.e. over 10 minutes). 93,94 For all other medications, please refer to Appendix 1. Management of Cancer Medication-Related Infusion Reactions 14 Acute Management of Infusion Reactions 2,10,35,95–101 GRADE 1-2 GRADE 3-4 Any one of the following symptoms: Any one of the following symptoms: Transient flushing or rash (covering 30% BSA) Dizziness (not interfering with activity) Lightheadedness/ dizziness (interferes with activity) Pruritus (...) • For high-risk patients (e.g. patients who experienced severe anaphylaxis during the initial infusion, as well as patients with severe respiratory or cardiac disease and patients who are pregnant), a four-bag 16 step protocol can be used. 112,118,119,127 Management of Cancer Medication-Related Infusion Reactions 19 RECOMMENDATIONS FOR INFUSION REACTION PROPHYLAXIS [Return to Table 1.1] Risk Factors Given the potential for life-threatening injury when an IR occurs, it is important to consider all

2019 Cancer Care Ontario

145. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA

] of the UN Convention on the Elimination of all Forms of Discrimination against Women provides similar healthcare rights to pregnant women (51). At the EU level, the Charter of Fundamental Rights of the European Union (the Charter) includes the right to healthcare under Article 35, which states that ‘everyone has the right of access to preventive healthcare and the right to benefit from medical treatment under the conditions established by national laws and practices’ (52). The Charter’s application

2019 European Centre for Disease Prevention and Control - Public Health Guidance

146. Crizanlizumab, Voxelotor, and L-Glutamine for Sickle Cell Disease: Effectiveness and Value

transfusion methods. For pregnant patients with SCD, the panel suggests either standard care or prophylactic transfusion at regular intervals. More broadly, for patients with SCD undergoing surgery

2020 California Technology Assessment Forum

147. Drug-Induced Liver Injury

, this study found no evidence for alcohol consumption being a risk factor for DILI attributed to isoniazid. 87 Limited evidence is available to support that pregnant women are more susceptible to DILI, despite the inclusion of pregnancy as a risk factor for cholestatic/mixed type of DILI in the CIOMS/RUCAM causality assessment scale. 63 Furthermore, it is important to distinguish DILI during pregnancy from intra- hepatic cholestasis of pregnancy, which can have a similar clin- ical picture. Information (...) - hypertensive agents involve non-pregnant patients, in particu- lar for methyldopa. 88–90 The hepatotoxic potential of propylthiouracil has been recognised in the form of a black box warning issued by the US Food and Drug Administration (FDA) in 2010 and soon thereafter by the European Medicines Agency (EMA). 91 While paediatric patients appear to be at higher risk of propylth- iouracil hepatotoxicity, little evidence supports that pregnancy would be a risk factor for this type of DILI. 92 Nevertheless

2019 European Association for the Study of the Liver

148. Opioid Treatments for Chronic Pain

with acute exacerbations of chronic pain (for specific questions or subquestions), pregnant or breastfeeding women, and persons with opioid use disorder related to use of prescription opioids. Details regarding the populations, interventions, comparators, and outcomes are summarized in Table 1 and described in detail by Key Question in Appendix B. For this review, opioids includes pure opioid agonists, partial agonists (e.g., buprenorphine), and dual mechanism agents. The dual mechanism agents were (...) , serious adverse events, overdose, substance misuse, substance use disorder related outcomes, other harms (gastrointestinal, somnolence, pruritus, dizziness, headache, fracture, motor vehicle accidents, cardiovascular events, endocrinological effects) KQ 4a: Measures of diagnostic accuracy • Intermediate outcomes (e.g., pharmacokinetics/pharmacodynamics, drug-drug interactions, dose conversions) Timing Short- (1 to 2 point improvement on a 0 to 10 scale), or pain relief rated as moderate, good

2020 Effective Health Care Program (AHRQ)

149. Nonopioid Pharmacologic Treatments for Chronic Pain

+ None + SAE None ++ None + None + None + None + No evidence Application site erythema Moderate ++ NA NA NA NA NA Application site pain Large ++ NA NA NA NA NA Application site pruritus None ++ NA NA NA NA NA Cognitive effects NA No evidence No evidence NA NA NA Hyperemesis NA No evidence No evidence NA NA NA Nausea NA None + Large + NA NA NA Sedation NA No evidence Insufficient NA NA Insufficient Dizziness NA Large + Large + NA NA Insufficient CBD = cannabidiol; NA = not applicable; THC (...) exacerbations of chronic pain, pregnant/breastfeeding women, and patients treated with opioids for opioid use disorder 5 Methods This Comparative Effectiveness Review follows the methods suggested in the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Effectiveness and Comparative Effectiveness Reviews (hereafter “AHRQ Methods Guide”). 21 All methods were determined a priori, and a protocol was published on the AHRQ website (

2020 Effective Health Care Program (AHRQ)

150. Methotrexate use in paediatric and adolescent rheumatology

but widely used: Methotrexate is a useful DMARD for many paediatric and adolescent rheumatological conditions including juvenile idiopathic arthritis; juvenile dermatomyositis; vasculitis; uveitis; systemic lupus erythematosus; localised scleroderma; sarcoidosis as well as having a variety of non-rheumatological indications. Contraindications: • Active infection (in non-malignant conditions) • ascites; • immunodeficiency syndromes (in non-malignant conditions); • significant pleural effusion • pregnancy (...) injection can help. • Giving on Friday or Saturday night may reduce school absence. • Psychological support may be beneficial. Skin rash/sun sensitivity: • high sunscreen factor is important. Mouth ulcers and sore throat • possible improvement with folic acid (see dose above). Injection site erythema/pruritus is usually mild. Safety: The National Patient Safety Association (NPSA) highlighted errors with incorrect methotrexate dosing for patients and overdose of methotrexate for non-cancer indications

2020 British Society for Rheumatology

151. Adult liver transplantation: A UK clinical guideline – part 1: pre-operation

. Malignancy (primary or secondary), pregnancy (AFLP/HELLP), vascular (including Budd- Chiari Syndrome) and metabolic disor- ders are rarer causes. Alcoholic hepatitis is considered in the CLD section, as is acute on chronic liver failure (AoCLF). When to consider referral/discussion with the LTU in ALF Once diagnosed, the ALF patient should be managed in an HDU environment and discussed with a LTU (see table 1). Important details include any history of paracetamol ingestion (timing, frequency, ‘staggered (...) ’), pregnancy , other drugs (prescribed, herbal or proscribed), comorbidity (mental and physical health), laboratory results (including PT, pH, arterial lactate, glucose, renal function, viral screen, autoantibodies and immunoglob- ulins) and liver imaging. Ideally, patients are safer trans- ferred before encephalopathy appears, although there is little published guidance covering this important issue. Table 1 outlines clinical features in paracetamol and non- paracetamol ALF that correlate with poor

2020 British Society of Gastroenterology

152. 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

153. 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

154. Acute varicella-zoster

. Varicella-zoster virus (VZV) is an exclusively human virus. The incubation period is about 14 days (range 9 to 21 days). Varicella is characterised by fever, malaise, and a generalised pruritic, vesicular rash. The disease normally presents in childhood and is usually self-limiting. Adverse outcomes are more common in immunocompromised people, adolescents, adults, and pregnant women. History and exam presence of risk factors fever vesicular rash vesicles on mucous membranes pruritus headache fatigue (...) Acute varicella-zoster Acute varicella-zoster - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Acute varicella-zoster Last reviewed: February 2019 Last updated: March 2019 Summary Adults, pregnant women, immunosuppressed patients, and neonates are at high risk of complications, including pneumonia, neurological sequelae, hepatitis, secondary bacterial infection, and death. Patients in high-risk categories should

2018 BMJ Best Practice

155. 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

156. 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

157. 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

158. 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

159. Vestronidase alfa (Mepsevii) - Mucopolysaccharidosis VII

(47.8%), vomiting (47.8%), upper respiratory tract infection (43.5%), infusion site extravasation (34.8%), rash (30.4%), diarrhoea (30.4%) and pyrexia (30.4%). The most common adverse reactions from 4 clinical trials in patients treated with Mepsevii were anaphylactoid reaction (13%), urticaria (13%), infusion site swelling (13%), infusion site extravasation (8.7%), pruritus (8.7%), diarrhoea (8.7%) and rash (8.7%). Serious adverse event/deaths/other significant events No deaths were reported in any

2018 European Medicines Agency - EPARs

160. 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

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