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Subacute Lymphocytic Thyroiditis

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61. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen ultraviolet A (PUVA) therapy

lymphoma PUVA remains a major therapeutic modality in the treatment of cutaneous T-cell lymphoma (CTCL). Its use is in the treat- ment of the most common form of CTCL, MF, where it remains the major therapy for plaque-stage disease. PUVA phototoxicity has been shown to target selectively neoplastic T lymphocytes in the skin. 44–48 9.3.1 How does psoralen–ultraviolet A therapy compare with other types of phototherapy in cytotoxic T-cell lymphoma? Narrowband ultraviolet B (TL-01) compared with psoralen (...) with early stage MF. 51 Almost com- plete remission occurred in 70% of participants with either treatment. Remission durations with NB-UVB were assessed in one study which showed that relapse occurred in a mean of 6 months. 52 NB-UVB appears to be as effective as PUVA in patch stage CTCL; remission durations with NB-UVB and PUVA have not been directly compared. PUVA has long been the ?rst-line phototherapy for plaque- stage MF. PUVA and NB-UVB may work in MF through direct effects on abnormal lymphocytes

2016 British Association of Dermatologists

65. Irritable Bowel Syndrome (IBS)

. • Thyroid function. • Tissue transglutaminase (TTG) antibody to screen for celiac disease. • Esophagogastroduodenoscopy (EGD) and distal duodenal biopsy in patients with diarrhea, to rule out celiac disease, tropical sprue, giardiasis, and in patients in whom abdominal pain and discomfort is located more in the upper abdomen. • Colonoscopy and biopsy.* • Fecal inflammation marker (e.g., calprotectin or lactoferrin) to distinguish IBS from inflammatory bowel disease where the latter is prevalent. © World (...) Gastroenterology Organization, 2015 WGO Global Guidelines IBS 4 • Hydrogen breath test for lactose intolerance and small-intestinal bacterial overgrowth (SIBO). Medium resource levels • History, physical examination, exclusion of alarm symptoms, consideration of psychological factors • FBC, ESR or CRP, stool studies, thyroid function • Sigmoidoscopy* Low resource levels • History, physical examination, exclusion of alarm symptoms, consideration of psychological factors • FBC, ESR, and stool examination * N.B

2015 World Gastroenterology Organisation

66. Management of Multiple Sclerosis

Demyelinating Encephalomyelitis (ADEM) 47, level III; 63, level III • An acute autoimmune demyelinating disease of CNS • Triggered by viral infections and immunisations • Usually a monophasic course • Characterised by: ? subacute encephalopathy evolving over one week to three months, disturbance of consciousness and/or behavioural abnormality ? seizures or coma ? multifocal symptoms and signs: cerebellar or cerebral ? ON or TM ? MRI brain shows symmetrical multifocal or diffuse brain lesions - supra

2015 Ministry of Health, Malaysia

67. Erivedge - vismodegib

/atrophy of odontoblasts and ameloblasts, degradation of dentin with scattered sequestrae, formation of fluid-filled cysts in the dental pulp, hyperplasia of the periodontal ligament, ossification of the root canal, regeneration of the dental organ, occasional fibrometaplasia, and scattered haemorrhage and subacute inflammation. The majority of these changes persisted in recovery animals. 07-1224 GLP Rat 10M/10F 26 weeks + 10M/10F 8 weeks recovery, 10M/10F 0 15 50 100 BID A dose-related, reversible

2013 European Medicines Agency - EPARs

68. Opsumit - macitentan

, the haemostatic system, thyroid, kidney, uterus, ovary and nasal cavity. Arterial intimal thickening characterized by proliferation of the intimal layer was found in dogs treated with macitentan at doses =30 mg/kg/day, independently of the treatment duration. The right and, less often, the left coronary arteries were the preferred target. These findings were often associated with breaks of the internal elastic lamina. After subacute (4-week) treatment with doses higher than 50 mg/kg/day, atrial fibrosis (...) toxicity studies. The changes were minimal, found at doses that indicate acceptable safety margins for humans (8.2 in rats, 5.8 in male dogs and 17 in female dogs) and reversible. A prolonged aPTT was observed in male rats treated with 250 mg/kg/day during 13 or 26 weeks. The finding is considered to have limited relevance to humans as it was observed only at high dose levels that provide safety margins higher than 7, in only one species and only in males. The observed increased thyroid weight

2013 European Medicines Agency - EPARs

69. Lemtrada - alemtuzumab

to high-dose, high-frequency IFNB-1a, nor was it formally studied in patients experiencing disease activity on another MS treatment. The active substance, alemtuzumab, is a humanized monoclonal antibody directed against CD52, one of several specific surface antigens acquired by cells of the hematopoietic system during leukocyte differentiation. Alemtuzumab binds to CD52 which is present at high levels on the surface of T and B lymphocytes and at lower levels on natural killer cells, monocytes (...) and macrophages. There is little or no CD52 detected on neutrophils, plasma cells or bone marrow stem cells. Alemtuzumab was approved until recently as MabCampath for the treatment of B-cell chronic lymphocytic leukemia. The posology, however, is considerably different for MS as compared to B- CLL: the cumulative dose in B-CLL was around 1100 mg, administered in a dose escalation scheme within 12 weeks, while in MS the cumulative dose is much lower: a maximum cumulative dose of 96 mg, administered in two

2013 European Medicines Agency - EPARs

70. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Health Professional Version

and Other Myeloid Malignancies in Children Approximately 20% of childhood leukemias are of myeloid origin and they represent a spectrum of hematopoietic malignancies.[ ] The majority of myeloid leukemias are acute, and the remainder include chronic and/or subacute myeloproliferative disorders such as chronic myelogenous leukemia and juvenile myelomonocytic leukemia. Myelodysplastic syndromes occur much less frequently in children than in adults and almost invariably represent clonal, preleukemic (...) are inhibited by fluoride. Immunophenotypic Evaluation The use of monoclonal antibodies to determine cell-surface antigens of AML cells is helpful to reinforce the histologic diagnosis. Various lineage-specific monoclonal antibodies that detect antigens on AML cells should be used at the time of initial diagnostic workup, along with a battery of lineage-specific T-lymphocyte and B-lymphocyte markers to help distinguish AML from ALL and acute leukemias of ambiguous lineage. The expression of various cluster

2017 PDQ - NCI's Comprehensive Cancer Database

71. Alogliptin and alogliptin/pioglitazone

which describes an increase in common infections, such as nasopharyngitis, UTI, and URI. • Malignancy (including bladder, thyroid, and pancreatic cancer): The incidence of these AEs was similar in the three treatment groups (0.6-0.7%). The incidence of AEs of malignancy which led to discontinuation was also similar between the treatment groups (0.1-0.2%). Therefore, in the population and for the duration studied, alogliptin does not appear to increase the risk of malignancy. Although pioglitazone

2012 FDA - Drug Approval Package

72. 2013 ACCF/AHA Guideline for the Management of Heart Failure Full Text available with Trip Pro

and Metabolic Causes of Cardiomyopathy e250 5.3.1. Obesity e250 5.3.2. Diabetic Cardiomyopathy e250 5.3.3. Thyroid Disease e250 5.3.4. Acromegaly and Growth Hormone Deficiency e250 5.4. Toxic Cardiomyopathy e251 5.4.1. Alcoholic Cardiomyopathy e251 5.4.2. Cocaine Cardiomyopathy e251 5.4.3. Cardiotoxicity Related to Cancer Therapies e251 5.4.4. Other Myocardial Toxins and Nutritional Causes of Cardiomyopathy e251 5.5. Tachycardia-Induced Cardiomyopathy e251 5.6. Myocarditis and Cardiomyopathies Due

2013 American Heart Association

73. Heart Failure: Guideline For the Management of

Factors for HF (Hypertension, Diabetes Mellitus, Metabolic Syndrome, and Atherosclerotic Disease) e157 5. Cardiac Structural Abnormalities and Other Causes of HF e157 5.1. Dilated Cardiomyopathies e157 5.1.1. De?nition and Classi?cation of Dilated Cardiomyopathies e157 5.1.2. Epidemiology and Natural History of DCM e157 5.2. Familial Cardiomyopathies e158 5.3. Endocrine and Metabolic Causes of Cardiomyopathy e158 5.3.1. Obesity e158 5.3.2. Diabetic Cardiomyopathy e158 5.3.3. Thyroid Disease e158 5.3.4

2013 American College of Cardiology

74. Cutaneous Lupus Erythematosus (CLE), Diagnosis and Monitoring

by Gilliam et al into LE-specific and LE-non-specific skin manifestations [4]. The LE-specific skin manifestations encompass the subtypes of CLE: (i) acute cutaneous lupus erythematosus (ACLE), (ii) subacute cutaneous lupus erythematosus (SCLE), (iii) chronic cutaneous lupus erythematosus (CCLE), which consists of discoid LE (DLE), LE panniculitis/profundus (LEP) and chilblain LE (CHLE), and (iv) intermittent cutaneous LE (ICLE), synonymously LE tumidus (LET) (Table 1) [5, 6]. The possibility (...) and is a non-scarring subtype, but diffuse thinning of the hair (“lupus hair”) can occur along the hairline. In general, ACLE often coincides with exacerbation of systemic organ involvement and prolonged disease activity. Subacute cutaneous lupus erythematosus (SCLE) Skin lesions of SCLE characteristically appear in a symmetric distribution on sun- exposed areas (head, upper body). Two forms of SCLE can be distinguished: i) the annular variant, which occurs as ring-shaped erythema with peripheral

2013 European Dermatology Forum

75. Effectiveness of biological drugs for non NICE indications (licensed and unlicensed).

lymphocytic leukaemia for whom fluorabine combination chemotherapy is not appropriate Application of license for multiple sclerosis - - EMA withdrew the licence (15/08/2012) for EU In agreement with MHRA, Genzyme will Intravenous infusion SMC recommends restricted use http://www.scottishmedicines.org.uk /SMC_Advice/Advice/494_08_alemtu zumab__MabCampath_/alemtuzuma b__MabCampath_ http://www.ema.europa.eu/docs/en _GB/document_library/EPAR_- 4 Drug name Drug type Licensed indication Outcome NICE appraisal (...) ) Not recommended for use by SMC Rituximab (Mabthera) Monoclonal antibody For the treatment of non-Hodgkin’s lymphoma in adults, chronic lymphocytic leukaemia, and rheumatoid arthritis Follicular lymphoma patients receiving rituximab+ CVP chemotherapy lived 25.9 months without disease coming back. Patients who failed other treatments responded to rituximab In CLL patients, outcomes were better when they received rituximab In patients with RA, rituximab was more effective than placebo, rituximab had

2013 West Midlands Clinical Support Unit

76. Management of suspected viral encephalitis in children Full Text available with Trip Pro

-infectious encephalitis, sub-acute encephalitis and sub-acute sclerosing panencephalitis Mumps virus Parotitis, orchitis or pancreatitis may occur before, during or after meningoencephalitis Others (rarer causes) Influenza viruses, adenovirus, Erythrovirus B19, lymphocytic choreomeningitis virus, rubella virus, Arthropod-borne and zoonotic viruses Flaviviruses (family Flaviviridae) West Nile virus North America, Southern Europe, Africa, Middle East, West and Central Asia associated with flaccid paralysis

2012 British Infection Association

77. Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

demyelination. 40,62 Other possible toxicities include diabetic ketoacidosis, 63 hyperthyroidism, 64 thyroiditis, 65 GI dysfunction (vom- iting, abdominal pain, and cholecystitis), 40,66 blood dyscra- sias (ane mia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, hemophagocytic syndrome), 40,66,67 septic arthritis, 68 optic neuritis, 69 cough, 40,70 viral pneu- monia, 71 and lymphoma. 40 In general, most of these toxicities are associations based on case reports or reports to the FDA Adverse Event

2012 American College of Chest Physicians

78. Hypothyroidism investigation and management

caused by autoimmune chronic lymphocytic thyroiditis. The initial screening for suspected hypothyroidism is thyroid stimulating hormone (TSH). A thyroid peroxidase antibody assay is the only test required to confirm the diagnosis of autoimmune thyroiditis. Thyroid ultrasonography is only indicated if there is a concern regarding structural thyroid abnormalities. Thyroid radionucleotide scanning has no role in the work-up for hypothyroidism. Treatment is with thyroxine replacement (1.6 µg/kg lean body (...) worldwide. 4 however, in Australia and other iodine replete countries, autoimmune chronic lymphocytic thyroiditis is the most common aetiology. 5 the main causes of hypothyroidism and associated clinical features are shown in Table 1. When to suspect hypothyroidism symptoms are influenced by the severity of the hypothyroidism, as well as its rapidity of onset. slow failure of thyroid function caused by autoimmune thyroiditis typically presents insidiously over years. 6 Where the diagnosis is suspected

2012 Clinical Practice Guidelines Portal

79. Management of suspected viral encephalitis in adults

conjunctivitis, with CNS involvement Enterovirus 71 Epidemic hand foot and mouth disease, with aseptic meningitis, brainstem encephalitis, myelitis Poliovirus Myelitis Coxsackieviruses, Echoviruses, Parechovirus Mostly aseptic meningitis Paramyxoviruses (family Paramyxoviridae ) Measles virus Causes acute post-infectious encephalitis, subacute encephalitis and subacute sclerosing panencephalitis Mumps virus Parotitis, orchitis or pancreatitis may occur before, during or after meningoencephalitis Others (...) (rarer causes) Influenza viruses, adenovirus, Erythrovirus B19, lymphocytic choreomeningitis virus, rubella virus, Arthropod-borne and zoonotic viruses a Most are zoonotic – ie animals rather than humans are the main natural hosts, the exceptions being dengue and chikungunya viruses. Flaviviruses (family Flaviviridae ) West Nile virus North America, Southern Europe, Africa, Middle East, West and Central Asia associated with flaccid paralysis and Parkinsonian movement disorders Japanese encephalitis

2012 British Infection Association

80. Childhood Hematopoietic Cell Transplantation (PDQ®): Health Professional Version

information). This approach to transplantation relies on GVL because, in most cases, the intensity of the preparative regimen is not sufficient for cure. Although studies have shown benefit for patients pursuing this approach when they are ineligible for standard transplantation,[ ] this approach has not been used for most children with cancer who require HCT because pediatric cancer patients can generally undergo myeloablative approaches safely. Using donor lymphocyte infusions (DLI) or early withdrawal (...) of immune suppression to enhance GVL GVL can be delivered therapeutically through the infusion of cells after transplant that either specifically or nonspecifically target the tumor. The most common approach is the use of DLI. This approach relies on the persistence of donor T-cell engraftment after transplant to prevent rejection of donor lymphocytes infused to induce the GVL. Therapeutic DLI results in potent responses in patients with CML who relapse after transplant (60%–80% enter into long-term

2016 PDQ - NCI's Comprehensive Cancer Database

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