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Tongue Carcinoma

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1561. Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste

is expert advice [ ; ]. The authors of a standard textbook on oral care in palliative disease recommend that it is appropriate to offer people with taste disturbance a trial of an oral zinc salt [ ]. However: There is limited and conflicting evidence from small trials of 30 or less people with radiotherapy-related taste problems that use of an oral zinc salt may be effective, but this may not apply to people with other cancer-related taste problems. No zinc salt is licensed for this use in the UK (...) problem Encourage: Regular oral hygiene, including tongue cleaning and good care of dentures. Fluid intake. Modification of diet (for example exclude garlic and onions). Smoking cessation. Regular use of a gargle or mouthwash containing an antimicrobial agent (for example chlorhexidine) may reduce breath odour. Consider artificial saliva if the mouth is very dry. Treat any underlying cause. For more information, see the CKS topic on . Also and in the . Oral hygiene Oral hygiene should include tooth

2019 NICE Clinical Knowledge Summaries

1562. Diarrhoea - prevention and advice for travellers: Scenario: Diarrhoea - prevention and advice for travellers

amenities are limited or unavailable. Bismuth subsalicylate is more suitable for mild diarrhoea; loperamide has a faster onset of action and is more effective than bismuth subsalicylate for controlling diarrhoea and cramping. Bismuth subsalicylate is not suitable for people with aspirin allergy, renal insufficiency, gout, severe enteric disease or HIV (risk of bismuth absorption), or people who are taking an anticoagulant such as warfarin, or pregnant or breastfeeding women. Darkened tongue and stools (...) needs. For more information, see the NaTHNaC website ( ). Groups who may benefit from prophylactic treatment include those who: Have increased susceptibility to infection or are immunocompromised. Have a high risk of complications if they were to develop travellers' diarrhoea, for example: People with chronic gastrointestinal disease (such as Crohn's disease, or ulcerative colitis). People with an ileostomy or colostomy. People with other diseases (such as malignancy, type 1 diabetes mellitus, renal

2019 NICE Clinical Knowledge Summaries

1563. Candida - oral: What else might it be?

and does not usually require further investigation. Erosive lichen planus manifests as zones of tender erythema and painful ulcers surrounded by white, radiating striae, and may require biopsy to rule out serious causes. Oral cancers, including: Squamous cell carcinoma — early lesions are often asymptomatic, appear as areas of erythroplakia (red patch) or leukoplakia (white patch), and may be ulcerated or exophytic (growing outwards). As the lesion grows, it becomes more symptomatic. Melanoma (...) Candida - oral: What else might it be? Differential diagnosis | Diagnosis | Candida - oral | CKS | NICE Search CKS… Menu Differential diagnosis Candida - oral: What else might it be? Last revised in August 2017 What else might it be? Differential diagnoses of oral candidiasis include: Erythema migrans (also known as geographic tongue or benign migratory glossitis) — an inflammatory disorder affecting 1–3% of the population. It is associated with atopic conditions and psoriasis

2019 NICE Clinical Knowledge Summaries

1564. Bruising: How should I assess a person with bruising?

— suggests corticosteroid use, hypothyroidism, ageing, self-inflicted injury, a collagen defect, or factor XIII deficiency. Laxity — may suggest . Pallor — suggests anaemia, which may be associated with malignancy. Jaundice — suggests liver disease. Petechiae (tiny, round, non-blanching, pinpoint flat spots less than 3 mm in diameter) — for example at clothing line pressure sites may indicate a platelet disorder; or if in the distribution of the superior vena cava they may follow coughing, vomiting (...) , suggesting . Tenderness — may be seen in acute leukaemia or neuroblastoma. Examine the abdomen for: Splenomegaly — suggests malignancy or (rare). Hepatomegaly — suggests malignancy or liver disease. Ascites, caput medusa, and spider telangiectasia — suggest chronic liver disease. Examine the head and neck. The oropharynx — for signs of bleeding, trauma, or healing injury to the frenulae (may suggest other non-accidental injury); gum hypertrophy may occur in monocytic leukaemia; wet purpura on the buccal

2019 NICE Clinical Knowledge Summaries

1565. Blackouts: How do I diagnose the underlying cause of a blackout?

, pleuritic chest pain, thromboembolic (TE) risk factors, such as previous TE disease, prolonged immobilisation (e.g. flight > 4 hours), smoking, contraceptive pill or HRT use, known malignancy, or family history of thromboembolism. Be aware that syncope is a relatively common finding in older people with a PE (24% of people aged over 65 years). For more information, see the CKS topic on . Occult haemorrhage — suggested by recent tissue trauma or signs/symptoms of GI bleeding (haematemesis, and melaena (...) levels, if hypoglycaemia is suspected. Full blood count to check haemoglobin levels, if anaemia or bleeding is suspected. Assess for the presence of a life-threatening cause for blackout, such as: Myocardial infarction and ischaemia — suggested by a history of coronary artery disease (CAD) and preceding chest pain. ECG may show signs of infarction such as ST-segment elevation, new left bundle branch block, and/or arrhythmia. Note that a normal ECG does not exclude CAD. If there is any suggestion

2019 NICE Clinical Knowledge Summaries

1566. What is the evidence on availability and integration of refugee and migrant health data in health information systems in the WHO European Region?

States, but differences existed in the availability, data types and main sources of data collection. Except for countries with population registers, the predominant data sources were medical records, disease-specific records and notification data. Data integration was often limited, and health monitoring surveys and data linkage approaches were underused. Policy considerations include harmonizing migrant definitions, promoting the coordination/governance of data collection, performance monitoring (...) and Examination Survey for Adults EEA European Economic Area EU European Union KiGGS German Health Interview and Examination Survey for Children and Adolescents NCD noncommunicable disease MeSH Medical Subject Headings TB tuberculosis TropNetEurop European Network for Tropical Medicine and Travel Health tw textwordsv ACKNOWLEDGEMENTS Technical development, review and publication coordination Technical conceptualization, financial support for the preparation and evidence synthesis, and coordination

2019 WHO Health Evidence Network

1567. Antipsychotics for the Prevention and Treatment of Delirium

not find statistically significant differences for haloperidol or second-generation antipsychotics in neurological harms, including extrapyramidal side effects and neuroleptic malignant syndrome. However, cardiac harms tended to occur more frequently with antipsychotics, specifically prolongation of QT interval with second-generation antipsychotics. ix Conclusions. Haloperidol or second-generation antipsychotics, compared to placebo, used for the prevention or treatment of delirium did not improve

2019 Effective Health Care Program (AHRQ)

1568. Guidelines for crises in anaesthesia - Quick Reference Handbook

and associated with laryngospasm (although it can have other causes). Box A: DRUG DOSES FOR TREATMENT OF LARYNGOSPASM 0.25-0.5 -1 i.v.: • Propofol • Rocuronium • Atracurium • Suxamethonium (also i.m. including tongue 4.0 -1 ) Box B: ALTERNATIVES and MIMICS Foreign body Infection of larynx/upper respiratory tract Anaphylaxis Airway tumour Vocal cord paralysis Intrinsic laryngeal or tracheal obstruction Extrinsic laryngeal or tracheal compression Sub-glottic stenosis Laryngo/tracheomalacia Box C (...) Laryngospasm and stridor (v.1) 3-7 Patient fire (v.1) 3-8 Malignant hyperthermia crisis (v.1) 3-9 Cardiac tamponade (v.1) 3-10 Local anaesthetic toxicity (v.1) 3-11 High central neuraxial block (v.1) 3-12 Cardiac ischaemia (v.2) 3-13 Neuroprotection following cardiac arrest (v.1) 3-14 Sepsis (v.1) Section 4: ‘Other’ Guidelines for crises external to, but posing risk to the patient 4-1 Mains oxygen failure (v.1) 4-2 Mains electricity failure (v.1) 4-3 Emergency evacuation (v.1) The Association

2019 Association of Anaesthetists of GB and Ireland

1569. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19

regularly with a standardized questionnaire for symptoms and known exposures in between visits. Although case reports of disease in patients with malignancies or transplants recipients are accumulating, more information is needed. Research on viral detection, longitudinal follow-up of viral shedding, and clinical outcomes in immunocompromised patients due to multiple underlying conditions are necessary. Definition of the impact of antiviral therapy in this high- risk population is also needed (...) Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19 Last updated May 6, 2020 and posted online at Please check website for most updated version of these guidelines. Supplementary materials are available here. Version 1.0.1 Infectious Diseases Society of America G8uidelines on the Diagnosis of COVID-19 Kimberly E. Hanson 1 , Angela M. Caliendo 2 , Cesar A. Arias 3 , Janet A. Englund 4 , Mark J. Lee 5 , Mark Loeb 6 , Robin Patel 7

2020 Infectious Diseases Society of America

1570. Tracheostomy Care

of this document was delayed by the global COVID-19 pandemic. The pandemic resulted in a surge of patients requiring relatively prolonged intubation and ventilation, with around 10% of this patient group requiring a tracheostomy. The highly infectious nature of the SARS-CoV-2 virus meant that usual considerations for tracheostomy and usual care for patients with a tracheostomy were adjusted. As the community learns more about how best to manage this disease, some of the guidance will evolve. Detailed (...) these strategies did not increase harm for patients and they seemed to have protected staff. However, as we learn more about this disease, considering when the risk of infection becomes low enough in a given patient to adopt more ‘usual’ care and interventions will be important in engagement and rehabilitation. At the time of publication, the guidance for tracheostomy management in the COVID-19 era is limited to expert consensus statements and opinion. The changes in practice were supported by an NHS England

2020 Faculty of Intensive Care Medicine

1571. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19 Last updated December 2, 2020 and posted online at Please check website for most updated version of these guidelines. Version 3.5.1 Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19 Authors Adarsh Bhimraj 1 , Rebecca L. Morgan 2 , Amy Hirsch Shumaker 3 , Valery Lavergne 4 , Lindsey Baden 5 (...) , Vincent Chi-Chung Cheng 6 , Kathryn M. Edwards 7 , Rajesh Gandhi 8 , Jason Gallagher 9 , William J. Muller 10 , John C. O’Horo 11 , Shmuel Shoham 12 , M. Hassan Murad 13 , Reem A. Mustafa 14 , Shahnaz Sultan 15 , Yngve Falck-Ytter 3 Affiliations 1 Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio 2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario 3 VA Northeast Ohio Healthcare System, Case Western Reserve University School

2020 Infectious Diseases Society of America

1572. Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation Therapy

-Hodgkin lymphoma. – Wilms tumor. • malignant disorders treated with allogenic HCT – acute lymphocytic leukemia. – acute myeloid leukemia. – high-risk solid tumors. – juvenile myelomonocytic leukemia. – myelodysplastic syndrome. • non-malignant disorders treated with allogenic HCT – bone marrow failure syndromes. – chronic granulomatous disease. – Fanconi anemia. – metabolic storage disorders. – osteopetrosis. – severe aplastic anemia. – sickle cell anemia. – thalessemia. – Wiskott-Aldrich syndrome (...) Patients Receiving Immunosuppressive Therapy and/or Radiation Therapy ABBREVIATIONS AAPD: American Academy Pediatric Dentistry. ANC: Absolute neutrophil count. BRONJ: Bisphosphonate-related osteonecrosis of the jaw. CBC: Complete blood count. GVHD: Graft versus host disease. HCT: Hematopoietic cell transplantation. ISOO: International Society of Oral Oncology. LLLT: Low-level laser therapy. MASCC: The Multinational Association of Supportive Care in Cancer. AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

2018 American Academy of Pediatric Dentistry

1573. Polymorphous low-grade adenocarcinoma: the university of pittsburgh experience. Full Text available with Trip Pro

node metastases, 3 with carcinomas of the base of the tongue. One PLGA metastasized to the subcutaneous tissue of the face, orbit, and lungs at 19.6 years. An extrapalatal site was the only significant determinant of disease-free survival (P = .03).Diagnosis of PLGA remains a challenge. Extrapalatal carcinomas appear to behave in a more aggressive fashion than those of the palate, and cancer arising from the base of the tongue frequently metastasizes to the cervical lymph nodes, suggesting a role (...) as such. However, 8 non-PLGAs (thus excluded) were incorrectly diagnosed as PLGA. Most carcinomas (14 of 24 [58%]) were palatal. Recurrent carcinomas had a significantly higher mitotic rate (2.7 mitoses per 10 high-power fields) compared with primary tumors (1.2 mitoses per high-power fields, P = .046), and 3 of 7 (43%) recurrences showed progression to an intermediate-grade histologic type. No patient died of disease. Median disease-free survival was 12.8 years. Four of 24 patients (17%) had regional lymph

2010 Archives of Otolaryngology Head and Neck Surgery

1574. Guidelines for the Management of Genital, Anal and Throat HPV Infection in New Zealand

. A lesion may be small and discrete or may be an extensive plaque covering most of the vulval or perianal skin. It may be clinically indistinguishable from the papular form of external genital warts, but appears more disorganised. 53,54 Histological examination of these lesions shows high-grade intraepithelial neoplasia. HSIL is usually associated with HPV type 16 infection. • Vulval cancer. This may arise from HSIL as a tumour or ulcer. A number of clinical variants of PIN are recognised; many (...) Human Papillomavirus LSIL Low-grade Squamous Intraepithelial Lesion MSM Men who have Sex with Men NCSP National Cervical Screening Programme PCR Polymerase Chain Reaction amplification PIN Penile Intraepithelial Neoplasia RRP Recurrent Respiratory Papillomatosis SCC Squamous Cell Carcinoma SIL Squamous Intraepithelial Lesion STI Sexually Transmitted Infection TCA Trichlorocetic Acid VaIN Vaginal Intraepithelial Neoplasia VIN Vulvar Intraepithelial Neoplasia VLP Virus-Like Particle2 WHAT’S NEW

2017 New Zealand Sexual Health Society

1575. Nausea/vomiting in pregnancy: Prochlorperazine

symptoms These depend on the dose and the susceptibility of the individual person: Parkinsonian symptoms (including tremor) may occur more commonly in adults or the elderly and may appear gradually. Dystonia (abnormal face and body movements) and dyskinesia are more common in young people and can occur after only a few doses. Akathisia (restlessness) characteristically occurs after large initial doses. Tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw) usually develops (...) disorders Cardiac arrhythmias, including atrial arrhythmia, atrioventricular block, ventricular fibrillation, and ventricular tachycardia (rare), have been reported. QT prolongation, sudden death, cardiac arrest, and Torsades de points have also occurred following treatment with prochlorperazine. Pre-existing cardiac disease, family history of QT prolongation, increasing age, hypokalaemia, and concurrent use of other drugs known to prolong the QT interval may predispose people to these effects. Blood

2018 NICE Clinical Knowledge Summaries

1576. Screening of fetal aneuploidies whereby non-invasive prenatal test (NIPT)

chromosomal aneuploidies in the scope of this assessment? A0003 What are the known risk factors for fetal chromosomal aneuploidies? A0004 What is the natural course of fetal chromosomal aneuploidies? A0005 What are the symptoms and the burden of disease of chromosomal aneuploidies? A0006 What are the consequences of chromosomal aneuploidies for society? A0007 Who is the target population for prenatal aneuploidy screening? A0011 How much is NIPT used? A0023 How many people belong to the target population (...) for prenatal aneuploidy screening? A0024 How are chromosomal aneuploidies currently screened and diagnosed according to published guidelines and practice? A0025 How are chromosomal aneuploidy pregnancies currently managed according to published guidelines and in practice? 4.2 Results Overview of the disease or health condition [A0002] – What are the fetal chromosomal aneuploidies in the scope of this assessment? Noninvasive prenatal tests are validated for use in pregnant women and are currently applied

2018 EUnetHTA

1577. Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children

Tongue Assessment Tool CASP Critical Appraisal Skills Program CIHI Canadian Institute for Health Information CPNP Canadian Prenatal Nutrition Program EBM expressed breast milk FDA Food and Drug Administration HATLFF Hazelbaker Assessment Tool for Lingual Frenulum Function GDM gestational diabetes mellitus HSV herpes simplex virus IBCLC ® International Board Certified Lactation Consultant ® IBLCE ® International Board of Lactation Consultant Examiners ® ILCA ® International Lactation Consultant (...) and institutionalize the baby-friendly hospital initiative in health systems Empower women to exclusively breastfeed 38% 800,000 Globally, only Suboptimal breastfeeding contributes to infant deaths of infants are exclusively breastfed BENEFITS OF BREASTFEEDING LIMIT FORMULA MARKETING STRENGTHEN HEALTH SYSTEMS SUPPORT MOTHERS SUPPORT PAID LEAVE WHY IT MATTERS RECOMMENDED ACTIONS SCOPE OF THE PROBLEM 5 BREASTFEEDING | Folasin Niacin B6 E A D K C B1 B2 B12 the nutrition from respiratory infections, diarrhoeal disease

2018 Registered Nurses' Association of Ontario

1578. Neck lump: Examination

to be removed). Use a tongue depressor to examine the lateral borders of the tongue. The chest for signs of lung disease. The abdomen for hepatosplenomegaly, and the axillae and groin for lymphadenopathy (if haematological malignancy is suspected). Pulse and blood pressure — abnormalities may indicate thyroid disease. Specific areas from which a suspected lymph node metastasis (a firm lump) may have originated. In general, if the suspected lymph node metastasis is in the upper or mid neck, the primary (...) is likely to be a head and neck tumour (including thyroid). Lateral lymph nodes may be enlarged because of metastasis from squamous cell cancer of mouth, pharynx, and upper oesophagus. If the suspected lymph node metastasis is in the lower neck (supraclavicular lymph nodes), the primary may be from the thyroid, pyriform sinuses, upper oesophagus, or from below the clavicle (for example breast, lung, or intra-abdominal malignancy). An enlarged lymph node in the left supraclavicular fossa may indicate

2018 NICE Clinical Knowledge Summaries

1579. Polymyalgia rheumatica: How should I diagnose polymyalgia rheumatica?

to reduce the risk of serious complications, such as vision loss. Features include abrupt onset headache (usually temporal) and temporal tenderness; visual disturbance, including diplopia; jaw or tongue claudication; prominence, beading, or diminished pulse on examination of the temporal artery; upper cranial nerve palsies; and limb claudication or other evidence of large vessel involvement. For more information on diagnosis and management, see the CKS topic on . Active infection or cancer because (...) treatment with corticosteroids may mask these conditions. Other conditions that can cause similar symptoms to PMR, such as arthritis, thyroid disease, and statin-induced myalgia or myositis. For more information on other conditions to consider, see the section on . Arrange the following tests in all people with suspected PMR to rule out other conditions before starting corticosteroids: full blood count, urea and electrolytes, liver function tests, calcium, alkaline phosphatase, protein electrophoresis

2018 NICE Clinical Knowledge Summaries

1580. Bipolar disorder: Antipsychotics

be used with caution in people with: Blood dyscrasias. Cardiovascular disease. Conditions predisposing to seizures; epilepsy. Depression. Diabetes (may raise blood glucose). History of jaundice. Myasthenia gravis. Parkinson’s disease (may be exacerbated). Photosensitisation (may occur with higher dosages). Prostatic hypertrophy. Severe respiratory disease. Susceptibility to angle-closure glaucoma. [ ] What adverse effects of antipsychotics should I be aware of? Antipsychotics can cause a wide range (...) ) - can often be relieved by reducing the dose of the antipsychotic. Tardive dyskinesia - late-onset movement disorder that can occur with prolonged use of antipsychotics. It is characterized by rhythmical, involuntary movements, usually lip-smacking and tongue rotating, although it can affect the limbs and trunk. It may be persistent and can sometimes worsen on treatment withdrawal. The drug should be discontinued on appearance of early signs. Oculogyric crisis has been reported as an adverse effect

2018 NICE Clinical Knowledge Summaries

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