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Pulmonary Hypertension in Sickle Cell Anemia

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281. Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection

for alcohol use and counselling to reduce moderate and high levels of alcohol intake 50 6.2 Assessing the degree of liver fibrosis and cirrhosis 54 CONTENTS4 7. RECOMMENDATIONS ON TREATMENT 59 7.1 Assessment for HCV treatment 59 7.2 Treatment with direct-acting antiviral agents 62 7.3 Removal of recommendation for treatment with telaprevir or boceprevir 69 7.4 Preferred and alternative regimens for the treatment of persons with chronic hepatitis C virus infection 71 7.5 Treatment with pegylated interferon (...) drug–drug interaction EASL European Association for the Study of the Liver EIA enzyme immunoassay eGFR estimated glomerular filtration rate EMA European Medicines Agency FBC full blood count FDA United States Food and Drug Administration gGT gamma glutamyl transpeptidase gp glycoprotein GRADE Grading of Recommendations Assessment, Development, and Evaluation Hb haemoglobin HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus INR international normalized ratio LMIC low

2016 World Health Organisation Guidelines

282. Lower Extremity Peripheral Artery Disease: Guideline on the Management of Patients With

and liver transplantation candidates AHA/ACC 2012 (28) Intensive glycemic control and the prevention of cardiovascular events ADA/ACC/AHA 2009 (29) In?uenza vaccination as secondary prevention for cardiovascular disease AHA/ACC 2006 (30) Indications for renal arteriography at the time of coronary arteriography AHA/CLCD/ CVRI/KCVD 2006 (31) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)* NHLBI 2003 (32) *A revision (...) to the current document is being prepared, with publication expected in 2017. The new title is expected to be “ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/ PCNA Guideline for the Detection, Evaluation, Prevention and Management of High Blood Pressure.” AAPA indicates American Academy of Physician Assistants; ABC, Association of Black Cardiologists; ACC, American College of Cardiology; ACPM, American College of Preventive Medicine;ADA,AmericanDiabetesAssociation;AGS,AmericanGeriatricsSociety;AHA

2016 American College of Cardiology

283. Depression

(Effexor XR) desvenlafaxine extended release (Pristiq) [No benefit over venlafaxine but significantly higher cost] duloxetine (Cymbalta) Side effects and other attributes used in patient selection Similar to those common to all SSRIs with more nausea. BP increases, including sustained hypertension, are dose- dependent, with a linear dose- response. Primarily functions as an SSRI at doses below 225 mg. Should not be combined with other SSRIs. High rates of withdrawal. Side effect profile similar (...) to immediate release. Major metabolite of venlafaxine with similar side effect profile. Side effects are similar to those common to all SSRIs with more nausea. Can increase blood pressure as well as triglycerides and LDL cholesterol. Similar to SSRIs and venlafaxine; nausea (dose-dependent) and constipation most troublesome, but, unlike venlafaxine, does not appear to produce sustained hypertension. NOT TO BE PRESCRIBED if concurrent heavy alcohol use and/or evidence of chronic liver disease. Sexual

2016 University of Michigan Health System

284. Prevention of stroke in patients with silent cerebrovascular disease Full Text available with Trip Pro

or perfusion-weighted MRI), magnetization transfer, blood-brain barrier permeability, vascular reactivity, metabolites, microatheroma in perforating arterioles, and microinfarcts, all of which may be clinically silent but may show lesional abnormalities on high-resolution MRI. Consensus Terms and Definitions for MRI and CT Manifestations of Silent Cerebrovascular Disease Most silent cerebrovascular findings on MRI are related to cerebral small vessel disease. The first neuroimaging consensus document (...) cause of cardioembolism is atrial fibrillation (AF). The risk of stroke in patients with AF can be estimated with the CHADS 2 -VASC scheme, which incorporates congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA, female sex, and vascular disease (including peripheral artery disease, myocardial infarction, or aortic plaque) into a composite score. A score of 0 is considered low risk; a score of 1 is considered moderate risk; and scores of ≥2 are considered high risk

2016 American Academy of Neurology

285. Manual exchange blood transfusion protocol

. Hypotension due to other causes such as hypovolaemia, or underlying sepsis. Hypertension (if the diastolic rises by >20mmHg, slow down transfusion and stop if diastolic continues to rise or >100mmHg). In children with sickle cell disease, check full blood count (FBC) to ensure that haemoglobin (Hb) is <120g/L and Hct <0.40. Hyperviscosity especially in those with sickle cell disease or hyperleucocytosis. Fitting (rare, but can occur as a result of hyperviscocity) in patients with sickle cell disease if Hb (...) ) in sickle cell patients, urea and electrolytes (U&Es), liver function tests (LFTs), calcium (Ca2+), arterial blood gas (ABG), clotting studies. Procedure Isovolumetric method (preferred method) Equipment: Syringes (5ml, 10ml, 20ml, 50ml), needles and three-way tap. 0.9% saline or 4.5% human albumin solution, heparinised saline and Hepsal flushes. High flow infusion pump, IVAC and IV giving sets. Blood giving set, with a warming coil for neonates ( ). Paediatric venesection bag(s), available from Blood

2014 Publication 1593

286. Manual exchange blood transfusion protocol

. Hypotension due to other causes such as hypovolaemia, or underlying sepsis. Hypertension (if the diastolic rises by >20mmHg, slow down transfusion and stop if diastolic continues to rise or >100mmHg). In children with sickle cell disease, check full blood count (FBC) to ensure that haemoglobin (Hb) is <120g/L and Hct <0.40. Hyperviscosity especially in those with sickle cell disease or hyperleucocytosis. Fitting (rare, but can occur as a result of hyperviscocity) in patients with sickle cell disease if Hb (...) ) in sickle cell patients, urea and electrolytes (U&Es), liver function tests (LFTs), calcium (Ca2+), arterial blood gas (ABG), clotting studies. Procedure Isovolumetric method (preferred method) Equipment: Syringes (5ml, 10ml, 20ml, 50ml), needles and three-way tap. 0.9% saline or 4.5% human albumin solution, heparinised saline and Hepsal flushes. High flow infusion pump, IVAC and IV giving sets. Blood giving set, with a warming coil for neonates ( ). Paediatric venesection bag(s), available from Blood

2014 Publication 1593

287. SMFM State of Pregnancy Monograph

. Pregnancy after liver transplantation g. Pancreatitis h. Wilson’s disease7. Hematologic diseases a. Maternal anemia and hemoglobinopathies b. Sickle cell disease c. von Willebrand disease d. Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome e. Care of the Jehovah’s Witness pregnant woman 8. Renal disease (includes renal transplantation) 9. Neurologic diseases: a. Seizure disorders b. Headache c. AV malformation/ berry aneurysm d. Multiple sclerosis e. Pseudotumor cerebri f. Myasthenia gravis (...) with a premature fetus (24 to 31 weeks of gestation) would result in a reduction in cerebral palsy. The MFMU Network also provided the first conclusive evidence that treating pregnant women who have even the mildest form of gestational diabetes can reduce the risk of common birth complications among infants, as well as blood pressure disorders among mothers. These findings have changed clinical practice and are leading to better outcomes for both mothers and babies. In 2011, SMFM joined the National Quality

2015 Society for Maternal-Fetal Medicine

288. Medical eligibility criteria for contraceptive use

with superficial venous disorders Varicose veins Women with varicose veins can use CHCs without restriction (MEC Category 1). Very low Superficial venous thrombosis (SVT) Women with SVT can generally use CHCs (MEC Category 2). a GRADE assessment includes the quality categories of very low, low, moderate and high. When a range is presented, the range reflects the GRADE quality assessment across important outcomes and/or across contraceptive methods. See the specific GRADE table in Part I, section 1.4: Reviewed (...) contraceptives among breastfeeding women 28 Recommendations for combined hormonal contraceptives among postpartum women 34 Recommendations for combined hormonal contraceptives among women with superficial venous disorders 38 Recommendations for combined hormonal contraceptives among women with dyslipidaemias 42 Recommendations for progestogen-only contraceptives and levonorgestrel-releasing intrauterine devices among breastfeeding women 47 Recommendations for safety of depot medroxyprogesterone acetate

2015 World Health Organisation Guidelines

289. Priapism

saline with a concentration of 100-500 µg/mL and given in 200 µg doses every 3-5 minutes directly into the corpus cavernosum. Maximum dosage is 1 mg within 1 hour. Patients at high cardiovascular risk should be given lower doses. Patient monitoring is highly recommended. B In cases that persist despite aspiration and intracavernous injection of a sympathomimetic drug, these steps should be repeated several times before considering surgical intervention. C Ischaemic priapism due to sickle cell anaemia (...) . Outpatient penile aspiration and epinephrine irrigation for young patients with sickle cell anemia and prolonged priapism. Blood 2000 95(1): p. 78-82. http://www.ncbi.nlm.nih.gov/pubmed/10607688 36. Miller

2015 European Association of Urology

290. Practice Guidelines for Perioperative Blood Management

. Observational studies and case reports indicate that certain congenital or acquired conditions ( e.g. , sickle-cell anemia, clotting factor deficiency, hemophilia, and liver disease) may be associated with blood transfusion complications (Category B3/B4-H evidence ) In addition, observational studies indicate that findings from pertinent preoperative laboratory tests ( e.g. , hemoglobin, hematocrit, coagulation tests) may be predictive of perioperative blood loss, the risk of transfusion, or other adverse (...) circumstances at high risk for excessive bleeding. Acute Normovolemic Hemodilution (ANH). Consider ANH to reduce allogeneic blood transfusion in patients at high risk for excessive bleeding ( e.g. , major cardiac, orthopedic, thoracic, or liver surgery), if possible. Intraoperative and Postoperative Management of Blood Loss Intraoperative and postoperative interventions include (1) allogeneic red blood cell transfusion, (2) reinfusion of recovered red blood cells, (3) intraoperative and postoperative

2015 American Society of Anesthesiologists

291. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke

Arterial puncture at noncompressible site in previous 7 d History of previous intracranial hemorrhage Intracranial neoplasm, AVM, or aneurysm Recent intracranial or intraspinal surgery Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg) Active internal bleeding Acute bleeding diathesis, including but not limited to Platelet count <100 000/mm 3 Heparin received within 48 h resulting in abnormally elevated aPTT above the upper limit of normal Current use of anticoagulant with INR >1.7 (...) ), a National Institutes of Health–funded acute stroke treatment trial network, found that there was a broad variation among these experts in which criteria they would or would not consider treating, as shown in the . Figure. Survey of US stroke clinicians on their willingness to treat with recombinant tissue-type plasminogen activator (rtPA) in the setting of each individual rtPA exclusion criteria. aPTT indicates activated partial thromboplastin time; AVM, arteriovenous malformation; BP, blood pressure

2015 American Academy of Neurology

292. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography Full Text available with Trip Pro

Choreoathetoid cerebral palsy Lyme disease Congenital mitral valve disease Encephalitis Sickle cell anemia Congenital aortic valve disease Familial chorea (including Huntington disease) Infective endocarditis Infective endocarditis Intracranial tumor Leukemia or lymphoma Cardiomyopathy Lyme disease Gout and pseudo gout Myocarditis, viral or idiopathic Hormonal Poststreptococcal reactive arthritis Kawasaki disease Metabolic (eg, Lesch-Nyhan, hyperalaninemia, ataxia telangiectasia) Henoch-Schonlein purpura (...) length, velocity, and completeness of the Doppler envelope) are influenced by the systemic blood pressure. Because blood pressure may change rapidly in a febrile or agitated patient, it is reasonable whenever circumstances allow to measure blood pressure at the time of the echocardiogram to recognize the presence of an abnormal circulatory load (high or low) and to include blood pressure data when serial echocardiograms are performed to assist in the appropriate comparison. Other nonrheumatic mitral

2015 American Heart Association

293. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke Full Text available with Trip Pro

partial thromboplastin time; AVM, arteriovenous malformation; BP, blood pressure; CT, computed tomography; GI, gastrointestinal; ICH, intracerebral hemorrhage; INR, international normalized ratio; LOC, loss of consciousness; NSTEMI, non–ST-segment–elevation myocardial infarction; SAH, subarachnoid hemorrhage; and STEMI, ST-segment–elevation myocardial infarction. Reproduced from De Los Rios et al with permission from Elsevier. Copyright © 2014, National Stroke Association. Another example of varying (...) stroke in the previous 3 mo Symptoms suggest SAH Arterial puncture at noncompressible site in previous 7 d History of previous intracranial hemorrhage Intracranial neoplasm, AVM, or aneurysm Recent intracranial or intraspinal surgery Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg) Active internal bleeding Acute bleeding diathesis, including but not limited to Platelet count <100 000/mm 3 Heparin received within 48 h resulting in abnormally elevated aPTT above the upper limit

2015 American Heart Association

294. Diffuse ST depression, and ST elevation in aVR. Left main, right?

Diffuse ST depression, and ST elevation in aVR. Left main, right? Dr. Smith's ECG Blog: Diffuse ST depression, and ST elevation in aVR. Left main, right? Saturday, March 2, 2019 This ECG was recorded on a middle-aged male with sickle cell disease and diffuse pain. Sinus rhythm Left ventricular hypertrophy (LVH) Diffuse significant ST depression with ST Elevation in aVR Computerized QT = 494 ms, QTc = 538 ms What else? What do you think? Here is a Previous ECG for comparison: Baseline LVH Only (...) +threatening+hypokalemia tom fiero hmmm. all quite interesting. and finally, perhaps, one needs to remember the possibility(?) that this is ischemia? in a person, middle aged, sickling. 1. probably anemic. 2. RBC's malformed, and possibly not flowing well through the coronary circulation. ischemia is mentioned by you both as on the list... I always fear that I'll miss acute chest syndrome or ACS, in that unfortunate SS patient who comes in for he eighth time this month, requiring narcotics. cool

2019 Dr Smith's ECG Blog

295. Guidelines for the treatment of malaria. Third edition

red cells per unit volume of blood, the number of parasites seen in one field on high power microscopy examination of a thick blood film, or the number of parasites seen per 200–1000 white blood cells on high-power examination of a thick blood film. Asymptomatic parasitaemia. The presence of asexual parasites in the blood without symptoms of illness. Cerebral malaria. Severe P. falciparum malaria with coma (Glasgow coma scale 30 min after a seizure. Combination treatment. A combination of two (...) , the greater is the selection pressure. Severe anaemia. Haemoglobin concentration of 10/year), partial immunity to clinical disease and a reduced risk of developing severe malaria are acquired in early childhood. The pattern of acquired immunity is similar across the sub-Sahel region, where malaria transmission is intense only during the 3- or 4-month rainy season and relatively low at other times. In both these situations, clinical disease is confined mainly to 4 High transmission area: hyperendemic

2015 World Health Organisation Guidelines

296. Management of Multiple Sclerosis

demyelinating nature of the underlying condition, rule out alternative differential diagnosis and in the diagnosis of PPMS. 20, level III a. Oligoclonal Bands IgG OCBs represent IgG unique to the CSF and they are indicative of plasma cell immune response in the CNS. 75, level III The finding of OCBs in CSF but not in the serum and/elevated IgG index supports the diagnosis of MS. 76, level III In Caucasians, OCBs were positive in about 68% of CIS and 84 - 88% of patients with MS. 77, level II-2 A hospital (...) a. Inclusion Criteria Adult patients (=18 years old) with MS b. Exclusion criteria • Patients with other relapsing remitting central nervous system disorders not fulfilling diagnostic criteria for MS • Paediatric groups with demyelinating disorders TARGET GROUP/USER This CPG is intended to guide those involved in the management of MS particularly healthcare professionals in primary and secondary/tertiary care namely:- a. Physicians and specialists from related disciplines b. Family Medicine Specialists c

2015 Ministry of Health, Malaysia

297. Acute Pain Management: Scientific Evidence

evidence included in this fourth edition has been published from August 2009 onwards, which was the cut-off date for literature inclusion in the third edition. Literature was considered when published between this date and the cut-off date for this fourth edition (August 2014). However, in rare circumstances, references published after this cut-off were considered but only if of high relevance and encountered in the editorial process. Moreover, evidence-based guidelines had been published independently (...) 19 1.4.5 Prevention of chronic postsurgical pain 20 1.5 Pre-emptive and preventive analgesia 23 1.5.1 Pre-emptive analgesia 24 1.5.2 Preventive analgesia 24 1.6 Adverse physiological and psychological effects of acute pain 25 1.6.1 Acute pain and the injury response 25 1.6.2 Adverse physiological effects 27 1.6.3 Pain and analgesia: effects on injury-induced organ dysfunction 27 1.6.4 Adverse psychological effects 28 1.7 Genetics and acute pain 28 1.7.1 Single gene pain disorders 29 1.7.2 Genetic

2015 Clinical Practice Guidelines Portal

298. Dalbavancin hydrochloride (HCl) (Dalvance)

-301 and -302 Trials 93 Table 62: Infusion site reactions in all Phase 2 and 3 Dalbavancin Trials 94 Table 63: Subjects with AEs reported for the SOC “Nervous System Disorders” in DUR001-301 and 302 trials 95 Table 64: Adverse Events Related to Decrease in White Blood Cell and Platelet Count 96 Table 65: Subjects with Post-Baseline Decrease in WBC and Platelet Counts 97 Table 66: Adverse Events Related to Renal Toxicity 97 Table 67: Subjects with Post-baseline Creatinine Elevation 98 Table 68 (...) currently breastfeeding an infant. 3. Patients with sustained shock, defined as systolic blood pressure 8 µg/mL). 7. Patients with evidence of meningitis, necrotizing fasciitis, gas gangrene, gangrene, septic arthritis, osteomyelitis; endovascular infection, such as clinical and/or echocardiographic evidence of endocarditis or septic thrombophlebitis. 8. Infections caused exclusively by Gram-negative bacteria (without Gram-positive bacteria present) and infections caused by fungi, whether alone

2013 FDA - Drug Approval Package

299. Injectafer (VIT-45, ferric carboxymaltose injection; FCM)

global heart failure, chronic heart disease, hypertension and hyperthyroidism received 500 mg of Ferinject diluted in 250 mL administered over 30 minutes for iron deficiency anemia. She presented 6 hrs later with left hemiparesis and was confirmed as having a partial middle cerebral artery stroke. She died approximately later. Event was considered possibly related to Ferinject. The other fatal events (not considered drug-related) were: myocardial infarction (3 patients); increasing respiratory (...) deaths. One patient died as described above and one recovered with unspecified sequelae. There were 18 cases of hypersensitivity that had some unlisted event term among the listed events. These are shown in the table below. Reference ID: 3344953NDA 203565 Page 4 of 6 No increases in frequency of certain identified events, including hypersensitivity, hemosiderosis, cardiotoxicity, hyperphosphatemia, overdose or hypertension were identified. The data in the safety updates did not raise new safety

2013 FDA - Drug Approval Package

300. Abusive Head Trauma and the Eye in Infancy

and external forces on the blood vessel walls probably contribute to the occurrence of RHs in AHT, there are pointers towards the dominant factor in particular situations. For instance, the widespread, severe RHs occasionally seen in severe crush injuries of the head (24);(49) are likely to be due to transient very high intravascular pressure effects. In contrast, sustained periods of raised intracranial pressure and intrathoracic pressure have not been associated with the severity of RHs (29). In most (...) associated with numerous, bilateral RHs; Shaking may indicate potential vitreous traction with external forces, and additional internal forces. In accidental impact trauma RHs are only associated with severe, high velocity injuries. Head crush injury (abrupt severe elevation intravascular pressure) can produce severe RHs, however the severity of RHs does not correlate with periods of raised intracranial or intrathoracic pressure. References (5) Green MA, Lieberman G, Milroy CM, Parsons MA. Ocular

2013 Royal College of Ophthalmologists

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