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Skin Discoloration

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101. Brodalumab (Kyntheum) - plaque psoriasis

the meeting on 18 May 2017, the CHMP, in the light of the overall data submitted and the scientific discussion within the Committee, issued a positive opinion for granting a marketing authorisation to Kyntheum on 18 May 2017. 2. Scientific discussion 2.1. Problem statement 2.1.1. Disease or condition Kyntheum is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy. 2.1.2. Epidemiology Psoriasis is one of the most common human skin (...) inflammation and destruction; the proliferation, maturation, and chemotaxis of neutrophils; and the maturation of dendritic cells. Assessment report EMA/381484/2017 Page 9/135 The IL-17 receptor plays a central role in the pathogenesis of psoriasis. Blocking the IL-17 receptor on keratinocytes and immune cell types has emerged as a critical target for the treatment of psoriasis. IL-17R blocking has been shown to reduce inflammation, hyperproliferation, and skin thickening in a number of experimental models

2017 European Medicines Agency - EPARs

102. Diagnosis and Treatment of Peripheral Arterial Diseases Full Text available with Trip Pro

for Endarterectomy SAPT Single antiplatelet therapy SBP Systolic blood pressure SFA Superficial femoral artery SPACE Stent Protected Angioplasty versus Carotid Endarterectomy STAR Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function TAMARIS Efficacy and Safety of XRP0038/NV1FGF in Critical Limb Ischaemia Patients With Skin Lesions TAVI Transcatheter aortic valve implantation TBI Toe-brachial index TcPO 2 Transcutaneous oxygen pressure TIA Transient ischaemic attack

2017 European Society of Cardiology

103. Niraparib (Zejula) - Fallopian Tube Neoplasms, Ovarian Neoplasms, Peritoneal Neoplasms

(at the muzzle) in the skin with or without red discoloration. Haemorrhage with septic meningeal inflammation in spinal cord, focal necrosis with septic embolus in liver. Cortical hypertrophy in the adrenal, Kupffer cell hypertrophy and hepatocellular vacuolation, ?uterus, ? number of corpus luteum. Recovery: There was treatment-related very slight to slight arterial hypertrophy in the heart of female and male rats and very slight to marked increased amount of trabecula in the bone (femur) of female and male (...) histiocytosis, depletion in red pulp in spleen (M, very slight), ? spermatogenic epithelium in testes (very slight to slight), depletion of the bone marrow (slight to marked). Septicaemia (septic emboli and/or septic necrosis in 1 or more organs/tissues) were confined to the dead males. Septic emboli and/or septic necrosis with or without oedema corresponded to grossly observed adhesion of the heart, grey-white discoloration/foci of the heart, liver, kidney, and spleen, and scab or thickened area

2017 European Medicines Agency - EPARs

104. Adalimumab (Cyltezo) - Juvenile Rheumatoid Arthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Ulcerative Colitis, Crohn Disease, Hidradenitis Suppurativa, Psoriasis, Ankylosing Spondylitis, Uveitis

and a clinical assessment including a risk assessment as well as corrective actions which have been implemented, were presented. The provided information allowed a conclusive and an in-depth assessment, and potential safety issues arising from the presence of particles could be ruled out. In addition the product specification for the visible particles has been revised and the instructions for use (label section 7) include the statement: “Do not use if: Medication is cloudy, discolored, frozen, or contains

2017 European Medicines Agency - EPARs

105. Neonatal jaundice

in: o Impaired parent-baby attachment o Breast feeding interruption § Use fibreoptic or LED blanket or timed interruptions for breast feeding if jaundice is not severe o Baby and parent distress 18 · Very little evidence of clinically significant toxicity · Detailed long-term follow up studies are limited 18 have yet to be validated 11 · Babies with cholestatic jaundice and conjugated hyperbilirubinaemia receiving phototherapy may: o Develop dark grey-brown discoloration of the skin 8,70 § Known (...) ) delivered per unit area (cm 2 ) of exposed skin at a particular wavelength (nm) measured as microW/cm 2 /nm. 11 Standard phototherapy Phototherapy provided by light source(s) with irradiance of 25–30 microW cm -2 nm -1 over the waveband interval 460–490 nm -1 . 4,11 Total serum bilirubin The sum value of conjugated and unconjugated bilirubin. 17 Unconjugated hyperbilirubinaemia Increased levels of unconjugated (lipid soluble) bilirubin usually caused by haemolysis, immature liver or sepsis. 4 Refer

2018 Queensland Health

106. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction

swelling.—Assessment of swelling by ultrasound (US) examination may be useful. A range of equipment, skill, and technique exists. Recommendations for use of US in TCVO are pre- sented in Appendix B (available online at www.jvir.org). Skin and soft-tissue ?ndings: Skin discoloration (red, purple, or blue discoloration; chronic pigmen- tation changes) Lymphatic blistering or weeping Stasis ulcers Infection (cellulitis, abscess) Nonhealing wounds or incisions Venous ?ndings: Venous collateral (...) ” such as the ability of the patient to wear watchbands, rings, bracelets, or necklaces, dif?culty buttoning their top collar button, or tightness of shirts or brassieres/ blouses. Loss of normal skin folds, restricted ability to make a ?st or ?ex the elbow, or other limitations caused by swelling are useful ?ndings to report as well. Bilateral or symmetric swelling should be measured as follows: Absolute circumference of each arm (mm) Absolute circumference of neck and/or head (mm) Use of ultrasound to assess

2018 Society of Interventional Radiology

107. SGLT2 inhibitors: information on potential risk of toe amputation to be included in prescribing information

) is informing about a potential increased risk of lower limb amputation (mostly affecting the toes) in patients taking the SGLT2 inhibitors canagliflozin, dapagliflozin and empagliflozin used for type 2 diabetes. Patients taking these medicines are reminded to check their feet regularly and follow their doctor's advice on routine preventative foot care. They should also tell their doctor if they notice any wounds or discoloration, or if their feet are tender or painful. The review of SGLT2 inhibitors (...) in the prescribing information for these medicines. For canagliflozin, the prescribing information will also list lower limb amputation as an uncommon side effect (occurring in between 1 and 10 patients in 1,000). Doctors may consider stopping treatment with canagliflozin if patients develop significant foot complications such as infection or skin ulcers. The review of SGLT2 inhibitors was carried out by EMA's ( ). The recommendations have now been endorsed by the ( ), and will be sent to the European Commission

2017 European Medicines Agency - EPARs

108. Primary Biliary Cholangitis

- bilirubinemia at more advanced stages. Cholestasis is considered chronic if it lasts[6months [37], is classi?ed as intrahepatic or extrahepatic, and includes hepatocellular and cholangiocellular forms of impaired bile formation. Jaundice (icterus) is the yellow discoloration of skin, sclera and mucous membranes due to hyperbilirubinemia, which can be a sign of severe cholestasis, but also has a broader diagnosis including pre-, intra- and post- hepatic causes (see Tables 2 and 3 (...) wellastheNationalInstitutesofHealthwebsite(https://livertox. nih.gov) can be helpful for assessing a patient’s risk pro?le for DILI. Previous surgery and blood transfusions should be listed. Physical examination should include screening for hepato- and splenomegaly as well as extrahepatic signs of advanced liver disease, such as icterus of sclera, skin and mucous membranes, xanthelasma, palmar and plantar erythema, nail abnormalities, or scratch lesions particularly on the arms and legs. Abdominal ultrasound is the ?rst recommended

2017 European Association for the Study of the Liver

109. Endovenous mechanochemical ablation for varicose veins

guidance 435). 2 2 Indications and current treatments Indications and current treatments 2.1 Varicose veins are a sign of underlying venous insufficiency and affect 20–30% of adults. Most people with varicose veins have no symptoms but venous insufficiency may cause fatigue, heaviness, aching, throbbing, itching and cramps in the legs. Chronic venous insufficiency can lead to skin discoloration, inflammatory dermatitis and ulceration. Great saphenous vein insufficiency is the most common form of venous (...) insufficiency in people presenting with symptoms. 2.2 A NICE guideline describes recommendations for the diagnosis and management of varicose veins. Many people have varicose veins that do not cause any symptoms or need treatment on medical grounds. However, some people will need treatment for the relief of symptoms or if there is evidence of skin discolouration, inflammation or ulceration. Treatment options include endothermal ablation, ultrasound-guided foam sclerotherapy and surgery (usually stripping

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

110. Chronic wounds: advanced wound dressings and antimicrobial dressings

of the surrounding skin patient preference. In primary care in England, prescription costs of advanced wound dressings and antimicrobial dressings are over £110 million each year, and other procurement routes add to the total NHS expenditure on these products. The wide range of wound dressings and their associated costs present a challenge for healthcare professionals who are managing wounds. Choice requires knowledge of the safety and clinical and cost effectiveness of a wide range of dressings. However (...) -and- conditions#notice-of-rights). Page 5 of 43with the hydrocolloid dressings group. However, although the authors stated that the methodological quality of the included studies was assessed using the Cochrane Collaboration tool and the risk of bias is reported, the quality of the evidence is not graded. They noted that the included trials have many limitations and stressed that dressings do not replace best practices, such as turning and repositioning, skin care, good nutrition and continence management

2016 National Institute for Health and Clinical Excellence - Advice

111. Oral and Dental Aspects of Child Abuse and Neglect

and discolored. 11,12 Gags applied to the mouth may result in bruises, lichenification, or scarring at the corners of the mouth. 13 Some serious injuries of the oral cavity, including posterior pharyngeal injuries and retropharyngeal abscesses, may be inflicted by caregivers who fabricate illness in a child 14 ABBREVIATIONS AAP: American Academy of Pediatrics. ABFO: American Board of Forensic Odontology. To cite: Fisher-Owens SA, Lukefahr JL, Tate AR, American Academy of Pediatric Den- tistry, Council (...) is suspicious for an adult human bite. 37 Bite marks found on human skin are challenging to inter- pret because of the distortion presented and the time elapsed between the injury and the analysis. 36 Recent investigations have led to questions about the scientific validity of forensic patterned evidence (bite mark analysis in particular) and its role in legal proceedings. 38 The pattern, size, contour, and color of a bite mark ideally can be evaluated by a forensic odon- tologist; a forensic pathologist

2017 American Academy of Pediatric Dentistry

112. Recommendation for Record-Keeping

size/body mass index (BMI) Vital signs—pulse, blood pressure Extraoral examination Facial features Nasal breathing Lip posture Symmetry Pathologies Skin health TMJ / TMD 16 Signs of clenching/bruxism Headaches from TMD Pain Joint sounds Limitations or disturbance of movement or function Intra-oral soft tissue examination Tongue Roof of mouth Frenulae Floor of mouth Tonsils/pharynx Lips Pathologies noted Oral hygiene and periodontal assessment 29,30 Oral hygiene, including an index or score Gingival (...) tissue examination Teeth present Supernumerary/missing teeth Dental development status Over-retained primary teeth Ankylosed teeth Ectopic eruption Anomalies/pathologies noted Tooth size, shape discrepancies Tooth discoloration Enamel hypoplasia/fluorosis Congenital defects Existing restorations Defective restorations Caries Pulpal pathology 31,32 Traumatic injuries Third molars Radiographic examination 33 Developmental anomalies Eruptive patterns/tooth positions/root resorption Crestal alveolar bone

2017 American Academy of Pediatric Dentistry

113. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs

and was below EPA oral reference dose in adults. 39 The following adverse effects have been noted in the literature: • Metallic/bitter taste. 24 • Temporary staining to skin which resolves in 2-14 days. 24 • Mucosal irritation/lesions resulting from inadvertent con- tact with SDF , resolved within 48 hours. 7 Esthetics The hallmark of SDF is a visible dark staining that is a sign of caries arrest on treated dentin lesions. This dark discoloration is permanent unless restored. A recent study that assessed pa (...) percent (i.e., higher than other comparable interventions), SDF pre- sents as an advantageous modality. Besides its efficacy, SDF is favored by its less invasive (clinically and in terms of behavior guidance requirements) nature and its inex- pensiveness. 5. The undesirable effects of SDF (mainly esthetic concerns due to dark discoloration of carious SDF-treated dentin) are outweighed by its desirable properties in most cases, while no toxicity or adverse events associated with its use have been

2017 American Academy of Pediatric Dentistry

114. Androgenetic Alopecia

(Germany) Expiry date: 06/2020 1/59 EVIDENCE BASED (S3) GUIDELINES FOR THE TREATMENT OF ANDROGENETIC ALOPECIA IN WOMEN AND IN MEN Varvara Kanti 1 , Andrew Messenger 2 , Gabor Dobos 1 , Pascal Reygagne 3 , Andreas Finner 4 , Anja Blumeyer 5 , Myrto Trakatelli 6 , Antonella Tosti 7 , Veronique del Marmol 8 , Bianca Maria Piraccini 9 , Alexander Nast 10 , Ulrike Blume-Peytavi 1 1 Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité – Universitätsmedizin (...) receptor and Type II 5a-reductase expression within the hair follicle. A number of signaling molecules have been implicated in the inhibition of hair growth in AGA including TGF-ß1 and TGF-ß2(14), dickopf 1 (a member of the WNT-signaling family)(15) and IL-6(16). There is also evidence for involvement of prostaglandins in AGA. The enzyme PGD(2)-synthase and its product PGD(2) are elevated in balding scalp skin; PGD(2) has an inhibitory effect on hair growth in animal and in in vitro experiments (17). 6

2017 European Dermatology Forum

115. CrackCAST E129 – Bacteria

rapidly. Antimicrobial therapy should be initiated promptly, before identification of an organism. [1] Describe the clinical features, diagnostic tests and management of Diphtheria. Humans are the only known reservoir for Corynebacterium diphtheriae . Spread is by person-to-person through respiratory droplets or by direct contact with secretions, skin lesion exudates, or rarely fomites or food . Transmission is associated with crowded living conditions. Individuals may spread the disease when (...) for the primary location of infection. Cutaneous diphtheria can occur as a primary skin infection or as a secondary infection of a preexisting wound. Circulating exotoxin causes the systemic symptoms of diphtheria, most profoundly affecting the nervous system, heart, and kidneys. Progression of symptoms/signs: Generic URTI symptoms Low grade fever and sore throat are the most frequent presenting complaints. Weakness, dysphagia, headache, voice changes, and loss of appetite ⅓ develop cervical lymphadenopathy

2017 CandiEM

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

and less likely to achieve remission off-treatment than purely mucosal PV. 13 6.1 Clinical presentation The diagnosis of PV should be suspected in any patient with mucocutaneous erosions or blisters. The oral mucosa is the ?rst site of involvement in the majority of cases, and PV may remain con?ned to the mucosal surfaces or extend to involve the skin (average lag period of 4 months). 14–16 Diagnostic delay is very common when PV is con?ned to the oral mucosa. 17 A minority of patients will present (...) with cutaneous erosions, but oral erosions will, eventually, occur in most cases. PV presents across a wide age range with peak fre- quency in the third to sixth decades. 7.0 Laboratory diagnosis Perilesional skin biopsies should be taken for histology and direct immuno?uorescence (DIF). In patients with isolated oral disease, a histology specimen should be taken from per- ilesional mucosa and a DIF sample taken from an uninvolved area, ideally from the buccal mucosa. 18 Suprabasal acantholysis with blister

2017 British Association of Dermatologists

119. Prevention, Diagnosis & Management of infective endocarditis

have also shown that early surgical interventions in these patients decrease embolic complications and improve outcomes. There have also been changes with regards to antimicrobial prophylaxis. The evidence currently shows that routine antimicrobial prophylaxis prior to dental procedures is not indicated for all cardiac patients and should be limited to high- risk cardiac patients only. Maintaining a good oral and skin hygiene routine is highly recommended in the prevention of IE. With these recent (...) medical procedures and should be limited only for cardiac patients associated with the highest risk of adverse outcomes from IE (refer Chapter 8.0). • Those with high predisposing risk for developing IE should be advised to maintain good oral and skin hygiene. SUMMARY OF THE CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS21 SUMMARY OF THE CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS Summary

2017 Ministry of Health, Malaysia

120. AIUM Practice Parameter for the Performance of Physiologic Evaluation of Extremity Arteries

E. Preprocedure ? ?assessment ? ?of ? ?patients ? ?with ? ?chronic ? ?kidney ? ?disease ? ?requiring ? ?dialysis. ? 4,5 F. Evaluation ? ?of ? ?cold ? ?sensitivity ? ?or ? ?discoloration ? ?of ? ?extremities ? ?or ? ?digits. ? 6 G. Evaluation ? ?of ? ?suspected ? ?thoracic ? ?outlet ? ?syndrome. ? 6 H. Evaluation ? ?of ? ?a ? ?suspected ? ?steal ? ?distal ? ?to ? ?an ? ?arteriovenous ? ?fistula ? ?or ? ?graft. ? 7,8 I. Preoperative ? ?assessment ? ?for ? ?arterial ? ?harvesting. ? 9,10 J (...) ? ?to ? ?the ? ?skin ? ?in ? ?an ? ?area ? ?of ? ?questionable ? ?viability. ? 17 ? ? ?The ? ?usual ? ?locations ? ?on ? ?the ? ?lower extremities ? ?are ? ?on ? ?the ? ?foot, ? ?ankle, ? ?and ? ?calf, ? ?with ? ?a ? ?reference ? ?point ? ?on ? ?the ? ?chest. ? ? ??After ? ?the desquamated ? ?cells ? ?are ? ?cleaned ? ?from ? ?the ? ?skin, ? ?a ? ?coupling ? ?solution ? ?such ? ?as ? ?distilled ? ?water ? ?is applied ? ?to ? ?the ? ?skin, ? ?and ? ?the ? ?tcP ?O ?2 ? ??sensor ? ?is ? ?affixed

2017 American Institute of Ultrasound in Medicine

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