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Pruritus in Pregnancy

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161. Diagnosis and management of polycythaemia vera

, 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

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2018 British Committee for Standards in Haematology

162. Management of specific situations in polycythaemia vera and secondary erythrocytosis

, 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

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2018 British Committee for Standards in Haematology

163. 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

164. 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

165. 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

2018 European Association of Urology

166. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management

, 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

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2018 American Society of Regional Anesthesia and Pain Medicine

167. Care of Adults with Neurofibromatosis Type 1

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 (...) the skin. cNFs are histologically similar to PN but do not appear to undergo malignant transformation. 79 Although cNFs are not life-threatening, they can lead to significant morbidity. A population-based survey in Wales found cNFs in > 99% of adults with NF1, 80 making this the most common tumor manifestation in adults. This study described an increase in the number of cNFs with increasing age and revealed that 10 of 30 (33%) women underwent an increase in size and number of cNFs during pregnancy

2018 American College of Medical Genetics and Genomics

168. Ursodeoxycholic Acid And Cholestasis Of Pregnancy

to Primary Outcome Measures : Number of participants with preterm delivery (before week 37) [ Time Frame: at the time of delivery ] Secondary Outcome Measures : Pruritus on the Visual Analogue Scale [ Time Frame: from enrollment until delivery ] Transaminases [ Time Frame: from enrolment until delivery ] Bile Acids [ Time Frame: from enrolment until delivery ] Fetal movement count [ Time Frame: from enrolment until delivery ] mother evaluation Number of pregnancies with cardiotocography suggestive (...) Ursodeoxycholic Acid And Cholestasis Of Pregnancy Ursodeoxycholic Acid And Cholestasis Of Pregnancy - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Ursodeoxycholic Acid And Cholestasis Of Pregnancy (CERTO

2010 Clinical Trials

169. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

investigations The following additional investigations should be considered prior to commencing treatment: full blood count and differen- tial, urea and electrolytes, liver function tests, fasting glucose and glycated haemoglobin (HbA1c), fasting lipids, antinuclear antibody (differential of pemphigus erythematosus), urinaly- sis, blood pressure, weight, height (children) and a pregnancy test in female patients at risk of pregnancy. Current guidelines on prevention of osteoporosis 30 should be followed, so

2017 British Association of Dermatologists

170. Guidelines on the management of abnormal liver blood tests

destruction of platelets occurs owing to antiplatelet immunoglobulin. Alkaline phosphatase (ALP) is produced mainly in the liver (from the biliary epithelium) but is also found in abundance in bone and in smaller quantities in the intestines, kidneys and white blood cells. Levels are physiologically higher in child- hood, associated with bone growth, and in pregnancy due to placental production. Pathologically increased levels occur mainly in bone disease (eg, metastatic bone disease and bone fractures (...) liver disease Autoimmune liver disease is more common in patients with pre-existing autoimmune diseases, and liver blood tests may be appropriate if clinical symptoms change to suggest development of liver disease—for example, pruritus in primary biliary chol- angitis. Patients with inflammatory bowel disease (including ulcerative colitis and Crohn’s disease) have a particular notable risk of developing the autoimmune cholestatic liver disease, primary sclerosing cholangitis; disease prevalence

2017 British Society of Gastroenterology

171. CRACKCast E120 – Dermatologic presentations

are a useful alternative to older sedating ones to control pruritus and histamine-mediated rashes while allowing the patient to remain active. Scabies infestations should be diagnosed clinically and treated expeditiously even without definitive proof of the infestation. Medication reactions are common and may results from any medication, typically within 4 to 21 days after taking the medication. Rashes that are associated with mucosal lesions, blisters, or desquamating skin are often caused by significant (...) soft tissue infections, drug eruptions, or immune disorders. Patients with Stevens-Johnson syndrome (<10% TBSA) and toxic epidermal necrolysis require inpatient treatment, preferably in a burn unit. Cutaneous signs of systemic disease may include pruritus, urticaria, erythema multiforme, erythema nodosum, pyoderma gangrenosum, and others. Physicians should be familiar with one or two topical steroid preparations of low, medium, and high potency and their appropriate therapeutic use. Hydrocortisone

2017 CandiEM

173. National minimum retesting intervals in pathology: A final report detailing consensus recommendations for minimum retesting intervals for use in pathology

interval? 4 1.2 Establishing MRIs 4 1.3 Using minimum retesting intervals in practice 5 1.4 Terms and conditions for use 6 1.5 References 6 2 Abbreviations 7 3 Biochemistry recommendations 9 3.1 Renal 9 3.2 Bone 11 3.3 Liver 12 3.4 Lipids 13 3.5 Endocrine related 13 3.6 Cardiac 20 3.7 Gastrointestinal 21 3.8 Specific proteins 23 3.9 Tumour markers 24 3.10 Therapeutic drug monitoring 26 3.11 Occupational/toxicology 28 3.12 Pregnancy related 29 3.13 Paediatric related 32 4 Haematology recommendations 33 (...) in the same acute episode Consensus opinion of the relevant expert working group B-O7 Opiate toxicity including morphine, codeine and heroin Retesting is not indicated in the same acute episode Consensus opinion of the relevant expert working group B-O8 Opioid toxicity including methadone Retesting is not indicated in the same acute episode Consensus opinion of the relevant expert working group 3.12 Pregnancy related Ref Clinical situation Recommendation Source B-P1 Urine ßHCG (pregnancy) Urine pregnancy

2016 Royal College of Pathologists

174. CrackCAST E129 – Bacteria

dose. The most common side effects of tetanus vaccine are minor: local swelling, pain, erythema, pruritus, fever, nausea, vomiting, malaise, and nonspecific rash. Local reactions do not preclude future use of toxoid. No evidence exists that tetanus and diphtheria toxoids are teratogenic. HTIG is not contraindicated in pregnancy. [12] What is the mechanism of action of botulinum toxin? And describe the 5 types of botulism. Botulism is a rare life-threatening paralytic illness caused by neurotoxins (...) ) in four divided doses for 14 days. Standard cough suppressants and antihistamines are ineffective. [4] Who needs post-exposure prophylaxis for pertussis and diphtheria? What is the regimen? Pertussis: Exposed people / vulnerable people = get a macrolide For those at high risk for developing severe pertussis: Including household contacts of a pertussis case, Infants and women in their third trimester of pregnancy (risk of transmitting the infection to the unborn) Persons with preexisting health

2017 CandiEM

175. Injectable Extended-Release Naltrexone to Treat Opioid Use Disorder

, blood-borne infections, and fatal overdose. 4 In addition, babies born to mothers who used opioids during pregnancy are at increased risk for neonatal abstinence syndrome, a condition that can be life-threatening if not promptly recognized and treated. 5 While heroin has historically been the most commonly misused opioid, non-medical use of prescription opioid analgesics (such as morphine, oxycodone, hydromorphone, and fentanyl) is now the dominant form of opioid misuse. 6 “Misuse” has been defined (...) , marijuana, or nicotine Current alcohol dependence Positive urine test for cocaine or amphetamines Naltrexone use within past 6 months Pregnancy or breastfeeding Design: Multi-centre, randomized, placebo-controlled, double-blind Intervention: 380 mg Vivitrol every 4 weeks Comparator: Placebo injection every 4 weeks Setting: 13 clinical sites in Russia Duration: 24 weeks Mean age, years: 29.4 to 29.7 Caucasian, N (%): 248 (99.2) Male, N (%): 220 (88.0%) HIV serology positive, N (%): 103 (41.2) Hepatitis C

2017 CADTH - Issues in Emerging Health Technologies

176. CRACKCast E090 – Liver and Biliary Tract

) Empiric ceftriaxone ? 6) List 6 stigmata of chronic liver disease and list 3 complications. This stuff is all due to loss of hepatic metabolic or synthetic function → decreased portal vein blood flow → portal hypertension. Stigmata Scleral / cutaneous icterus +/- pruritus Hepatomegaly Spider angiomata Caput medusa Patchy ecchymosis with thin skin Splenomegaly Gray / acholic stools Gynecomastia Muscle wasting Palmar erythema Dupuytren’s contractures Testicular atrophy Complications: Hepatocellular (...) gradient > 1.1 g/dL (>11 g/L) can be an early indicator of SBP. (subtract the albumin in the ascitic fluid, from the serum albumin level) This can also be used to determine whether the ascites is from portal hypertension or not 10) List 3 types of drug-induced liver disease. Cytotoxic (“ALT”) Acetaminophen Lovastatin Tetracycline Cholestatic (“ALP”) Azathioprine haLdoL Phenobarbital Veno-occlusive (“AAA”) Anabolic steroids Azathioprine Anti-pregnancy (OCP’s) 11) What are two types of hepatic abscesses

2017 CandiEM

177. CRACKCast E098 – Sexually Transmitted Infections

. Penicillin remains drug of choice in pregnancy, neurosyphilis, and congenital syphilis, even in the presence of penicillin allergy. Admission for desensitization and treatment. Question 7) What is the causes of chancroid? How is it managed? Chancroid – Ulcerating infection caused by gram-negative organism Haemophilus ducreyi . Common in developing world but extremely uncommon in Western world. Incubation of less than a week preceded by tender erythematous papule that rapidly ulcerates to form multiple (...) , pharyngitis) Ceftriaxone 250 mg IM single dose plus Azithromycin 1 g PO single dose. What makes an STI “complicated”: list three conditions (table 88.4) Disseminated gonorrhea Gonococcal conjunctivitis Epididymitis/orchitis Question 9) Compare differences in presentation and treatment between Trichomoniasis, Bacterial Vaginosis, and Candidiasis, and Non-gonococcal urethritis. See Table 88.3 Presentation Physical exam Treatment Trichomonas Females – vaginal discharge, pruritus, dysuria, urinary frequency

2017 CandiEM

178. Injectable Extended-Release Naltrexone to Treat Opioid Use Disorder

, blood-borne infections, and fatal overdose. 4 In addition, babies born to mothers who used opioids during pregnancy are at increased risk for neonatal abstinence syndrome, a condition that can be life-threatening if not promptly recognized and treated. 5 While heroin has historically been the most commonly misused opioid, non-medical use of prescription opioid analgesics (such as morphine, oxycodone, hydromorphone, and fentanyl) is now the dominant form of opioid misuse. 6 “Misuse” has been defined (...) , marijuana, or nicotine Current alcohol dependence Positive urine test for cocaine or amphetamines Naltrexone use within past 6 months Pregnancy or breastfeeding Design: Multi-centre, randomized, placebo-controlled, double-blind Intervention: 380 mg Vivitrol every 4 weeks Comparator: Placebo injection every 4 weeks Setting: 13 clinical sites in Russia Duration: 24 weeks Mean age, years: 29.4 to 29.7 Caucasian, N (%): 248 (99.2) Male, N (%): 220 (88.0%) HIV serology positive, N (%): 103 (41.2) Hepatitis C

2017 CADTH - Issues in Emerging Health Technologies

179. CRACKCast E099 – Urological Disorders

% of patients) Vaginal discharge Vaginal odor Pruritus Men with urinary complaints Vaginal discharge Med Hx Internal dysuria Frequency, urgency, voiding small volumes Abrupt onset Suprapubic pain Often associated with diaphragm use External dysuria Gradual onset Internal dysuria Occasional history of frequency, urgency, voiding small volumes Gradual onset Multiple partners Recent change in partners Partner with discharge or dysuria Calculi Chemical or radiation Psychogenic / sexual instrumentation Neoplasm (...) instrumentation or organ transplant Systemic disease (diabetes, renal insufficiency, immunodeficiency) Men ( due to high risk for urologic abnormality) Lippism: “Anatomy, instrumentation, transplant S, P, E, C, I , A , L Systemic disease Pregnancy Elderly Compromised renal function or immune function Instrumentation Anatomy Long urethra (males) These require a longer course of abx (similar to uncomplicated pyelonephritis) Patients with complicated cystitis who can tolerate oral therapy: oral fluoroquinolone

2017 CandiEM

180. CRACKCast E096 – Anorectal Disorders

(bright red, painful, blood on toilet paper) vs. internal (bright red, painless, drips in the toilet bowl or is streaked in with the stool). The external ones originate distal to the dentate line and are covered in anoderm (MSE). The Internal ones originate proximal to the dentate line and are covered in mucosa. HOWEVER, people can have mixed type hemorrhoids too! Risk fx: Family hx of hemorrhoids Straining and constipation Pregnancy & traumatic deliveries Prolonged sitting Heavy lifting Portal (...) Hirschsprung’s disease Spinal cord lesions (cancer, ischemia, infection) Mass effects Anorectal cancer Foreign body / fecal impaction / hemorrhoids Medical Diarrhea / laxative abuse Dementia Pediatric patients Congenital, meningocele, spina bifida Other causes Post-corrective surgery for an imperforate anus Sexual abuse Encopresis (young children experiencing emotional stress). [10] List 8 causes of pruritus ani An uncontrollable urge to scratch the anal area, usually caused by perianal irritation. More

2017 CandiEM

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