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Tongue Carcinoma

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1561. CRACKCast E122 – Disorders of Hemostasis

to: Thrombocytopenia = too few Thrombocytosis = too many Thrombocytopathy = too broken [1] List 10 causes of Thrombocytopenia Here’s the approach: Decreased production: Decreased megakaryocytes secondary to drugs, toxins, or infection Chemo drugs, thiazides, alcohol, digoxin, septra, phenytoin, ASA Normal megakaryocytes with megaloblastic hematopoiesis or hereditary origin Malignant infiltration of bone marrow Increased destruction Immunologic Related to collagen vascular disease, lymphoma, leukemia Drug related (...) are helpful). Portal HTN [2] List 6 causes of thrombocytosis This is a platelet count > 600,000 / mm3. Most common causes = infection or iron deficiency (platelets still work normally) Autonomous (primary thrombocythemia) Reactive (secondary thrombocythemia) Iron deficiency Infection or inflammation Kawasaki’s disease Trauma Nonhematologic malignant disease Postsplenectomy Rebound from alcohol, cytotoxic drug therapy, folate or vitamin B12 deficiency [3] Describe the presentation and treatment of HIT, ITP

2017 CandiEM

1562. Spot the Diagnosis! The case of the Man with the Red Hat

have? Although it is unknown if this is true, Giamberti the temporal artery in this portrait is suspiciously torturous and inflamed – findings in keeping with temporal arteritis, also known as Giant Cell Arteritis (GCA). 2 Temporal arteritis encompasses many signs and symptoms, but the key feature of the disease depicted here is the tortuous temporal artery. The tortuous arteries of giant cell arteritis 3 What are the clinical manifestations of this disease? Temporal arteritis is a form (...) of autoimmune vasculitis which primarily impacts the medium and large vessels. It may present in various ways (cranial arteritis, extracranial arteritis, or polymyalgia); however, the most common symptoms typically include unilateral temporal headache, jaw/tongue claudication, scalp tenderness, proximal muscle weakness and constitutional symptoms such as fever, unintentional weight loss, anorexia, and malaise. 4 If left untreated, it can lead to blindness due to optic ischemic neuropathy in up to 15

2017 CandiEM

1563. Guideline for the management of adults with Systemic Lupus Erythematosus Full Text available with Trip Pro

Foundation Trust, Birmingham, Search for other works by this author on: Sue Brown Royal National Hospital for Rheumatic Diseases, Bath, Search for other works by this author on: Ian N. Bruce Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University (...) . Accreditation is valid for 5 years from 10 June 2013. More information on accreditation can be viewed at . For full details on our accreditation visit: . SLE (or lupus for short) is a multisystem, autoimmune disease, involving complex pathogenetic mechanisms that can present at any age. It most commonly presents in women in the reproductive age group, although lupus is increasingly recognized after the age of 40 years, particularly in Europeans [ ]. Lupus affected nearly 1 in 1000 of the population

2017 British Society for Rheumatology

1564. CRACKCast E119 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis

patients presenting to the ED. With proper management, however, these patients can be efficiently managed and discharged with relative ease. Shownotes – Also check out EMCases Rapid Review video on Rosen’s in Perspective This chapter covers disease states in which the immune system overreacts against typically harmless agents. These hypersensitivity reactions are manifested in clinical symptoms ranging from mildly inconvenient to fatal. For practical purposes, let’s define some terms: Allergy Used (...) in this chapter to refer to mast cell–mediated hypersensitivity reactions. For most allergic diseases to occur, predisposed individuals need to be exposed to allergens through a process called sensitization. Substances that elicit an allergic reaction are referred to as allergens, and those that elicit an antibody response (activated by B- and T-cell receptors) are called antigens. Urticaria A common allergic reaction to foods, drugs, or physical stimuli and is clinically characterized by an erythematous

2017 CandiEM

1565. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

the review to English- language references was a pragmatic decision, but the authors recognize this may exclude some important information pub- lished in other languages. 5.0 Plans for guideline revision The proposed revision for this set of recommendations is scheduled for 2022; where necessary, important interim changes will be updated on the BAD website. 6.0 Background PV is an acquired autoimmune disease in which immunoglob- ulin G (IgG) antibodies target desmosomal proteins to pro- duce (...) to the lack of diagnostic criteria, and inclusion of all subtypes of pemphigus and of other blistering disorders such as bullous pemphigoid, which have a better prognosis. However, not all cases of PV have such a dismal prognosis. Studies differentiating the clinical phenotypes have shown a lower mortality in patients with predominantly mucosal PV (1–17%) compared with those with mucocuta- neous PV (8–42%). 10–12 Mucocutaneous PV tends to be a more severe disease, proving slower to respond to treatment

2017 British Association of Dermatologists

1566. Primary & Secondary Prevention of CVD

FACTORS 5.2. MODIFIABLE CV RISK FACTORS 34 34 35 6. OTHER CONDITIONS ASSOCIATED WITH INCREASED CV RISK 40 6.1. CHRONIC KIDNEY DISEASE 6.2. INFECTIONS AND THE HEART 40 41 7. OTHER RISK MARKERS OF CVD 53 7.1. ELECTROCARDIOGRAM (ECG) 7.3. BIOCHEMICAL – HS-CRP 7.4. SUBCLINICAL VASCULAR DAMAGE 53 54 54 8. INTERVENTIONS TO PREVENT CVD 57 8.1. NUTRITION 57 8.2. PHYSICAL ACTIVITY 70 6.3. CANCER AND THE HEART 6.4. CONNECTIVE TISSUE DISEASE 43 44 6.5. SLEEP DISORDERS 6.6. PSYCHOSOCIAL FACTORS/DEPRESSION 45 47 (...) Primary & Secondary Prevention of CVD 2016 1 STATEMENT OF INTENT This guideline was developed to be a guide for best clinical practice in the prevention of cardiovascular disease, based on the best available evidence at the time of development. Specific attempts were made to use local data and publications to ensure local relevance. Adherence to this guideline does not necessarily lead to the best clinical outcome in individual patient care as this depends on other clinical factors like co

2017 Ministry of Health, Malaysia

1567. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards Full Text available with Trip Pro

. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 9th ed. Philadelphia, PA : Elsevier Health Sciences ; 2011 :1468–529. Loeys BL, Dietz HC, Braverman AC, et al. . The revised Ghent nosology for the Marfan syndrome. J Med Genet . 2010 ; 47 :476–85. National Cancer Institute Enterprise Vocabulary Server. Available at: . Accessed May 15, 2016. LOINC Test. Available at: . Accessed December 12, 2014. CDISC Glossary. Available at: . Accessed December 12, 2014. National Institute of Child Health (...) Hospital Association (www.childrenshospitals.org). †International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. ‡Child Health Corporation of America Representative. §Association of European Pediatric Cardiologists Representative. ‖The Society of Thoracic Surgeons Representative. ¶ ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee. #Congenital Heart Surgeons’ Society Representative. **National Association of Children’s Hospitals

2017 American Heart Association

1568. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Full Text available with Trip Pro

of the interleukin (IL) 1, IL-6, and tumor necrosis factor (TNF) signaling pathways. Study of the adaptive immune response demonstrated that both proinflammatory and regulatory T cells can be found in the circulation in the first week after fever onset. Expansion of the regulatory T-cell population after IVIG administration is associated with cessation of fever and clinical improvement. The self-limited nature of the disease coupled with a low rate of recurrence suggests emergence of T- and B-cell memory (...) Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search March 2019 March 2019 March 2019 March 2019 March 2019 February 2019 February 2019 February 2019

2017 American Heart Association

1569. Prevention, Diagnosis & Management of infective endocarditis

Prosthetic valve endocarditis 106 5.4 Principles of surgery 107 5.4.1 Aortic valve 109 5.4.2 Mitral valve 109 5.4.3 Tricuspid valve 109 5.4.4 Periannular extension 109 5.5 Surgery for infective endocarditis in congenital heart disease 110 5.5.1 Indications for surgery 110 5.5.2 Timing of surgery 111 5.5.3 Surgical techniques 113 6.0 OUTCOME AND FOLLOW-UP 114 7.0 SPECIFIC SITUATIONS 117 7.1 Infective endocarditis in congenital heart disease 117 7.1.1 Epidemiology 117 7.1.2 Mortality 118 7.1.3 Lesion (...) specific incidence of infective endocarditis in congenital heart disease 118 7.1.4 Management of infective endocarditis in congenital heart disease 120 7.2 Infective endocarditis in paediatric patients 121 7.2.1 Infective endocarditis in neonates with normal heart structures 121 7.2.2 Clinical presentation 122 7.2.3 Management of paediatric infective endocarditis 123 7.3 Infective endocarditis in transcatheter valve implantations 124 7.3.1 Transcatheter pulmonary valve implantation 124 7.3.2

2017 Ministry of Health, Malaysia

1570. Probiotics and Prebiotics

Gastroenterology Organisation, 2017 3.11 Nonalcoholic fatty liver disease ? The usefulness of certain probiotics as a treatment option to mitigate steatohepatitis has been proven through a number of randomized clinical trials in adults and children. Probiotics provided improvements in the outcomes of homeostasis model of assessment (HOMA) scores, blood cholesterol, tumor necrosis factor-a (TNF-a), and liver function tests—alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Further studies (...) claims, and commerce 9 2.1 Understanding the marketplace 9 2.2 Products: dosages and quality 11 2.3 Product safety 11 3 Clinical applications 11 3.1 Colorectal cancer prevention 11 3.2 Diarrhea treatment and prevention 12 3.2.1 Treatment of acute diarrhea 12 3.2.2 Prevention of acute diarrhea 12 3.2.3 Prevention of antibiotic-associated diarrhea 12 3.2.4 Prevention of Clostridium difficile diarrhea 12 3.2.5 Prevention of radiation-induced diarrhea 12 3.3 Helicobacter pylori eradication 12 3.4 Hepatic

2017 World Gastroenterology Organisation

1571. Supplementary Feedings in the Healthy Term Breastfed Neonate Full Text available with Trip Pro

infant's feeding requirements and supplementation is required, donor human milk is preferable to other supplements. 3. When donor human milk is not available or appropriate, protein hydrolysate formulas may be preferable to standard infant formula as they avoid exposure to intact cow's milk proteins and reduce bilirubin levels more rapidly, (II-2) although recent data are less supportive of its role in preventing allergic disease. (I) The use of this type of formula may also convey the psychological (...) commonly used method of supplementation in more affluent regions of the world, but concerns have been raised because of distinct differences in tongue and jaw movements, and faster flow may result in higher (and unnecessary) volumes of feeds. Some experts have recommended a teat/nipple with a wide base and slow flow to try to mimic breastfeeding and to avoid nipple confusion or preference, , (II-2), but little research has been done evaluating outcomes with different teats/nipples. Research Needs

2017 Academy of Breastfeeding Medicine

1572. Evaluation of the Neck Mass in Adults Full Text available with Trip Pro

Arbor, MI 48109-5312, USA. Email: Abstract Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC (...) and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. - Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. - Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Forty years ago

2017 American Academy of Otolaryngology - Head and Neck Surgery

1573. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock Full Text available with Trip Pro

, Stollery Children’s Hospital/University of Alberta, Edmonton, AB, Canada. 15 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s, Durham, NC. 16 Departments of Pediatrics and Critical Care, Clinical Epidemiology and Biostatistics, McMaster University, Pediatric Intensive Care Unit, McMaster Children’s Hospital, Hamilton, ON, Canada. 17 Beth Israel Medical Center, Hartsdale, NY. 18 Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor (...) a supranormal MAP above this point is likely not of benefit ( ) and may actually decrease CO by increasing afterload above the capacity of the myocardium to compensate. In addition, reduction in perfusion pressure below the critical point necessary for adequate splanchnic organ perfusion can also occur in disease states with increased intra-abdominal pressure (IAP) such as bowel wall edema, ascites, or abdominal compartment syndrome. If this increased IAP is not compensated for by an increase in MAP

2017 Society of Critical Care Medicine

1574. Cranial Neuropathy

that predicting the prognosis is difficult [95]. CT CT provides useful information regarding temporal bone fractures and trauma, presurgical osseous anatomy, nerve involvement with inflammatory middle ear disease, foraminal expansion, patterns of bone erosion, and intrinsic bone tumor matrices [83,84,96-98]. In patients with risk for contrast allergy and contrast-induced nephropathy, noncontrast CT may be sufficient if patients cannot undergo MRI. A dedicated temporal bone CT with thin sections should (...) infiltration of the tongue may be noted on imaging. Lesions of the posterior fossa, skull base, upper neck, and floor of the mouth may affect the hypoglossal nerve. They include infarctions, meningiomas, schwannomas, paragangliomas, carcinomas, metastases, subarachnoid hemorrhage, Chiari malformations, basilar invagination, and fractures [99]. MRI and CT As with the other lower cranial nerves, MRI is the preferred modality for CN XII, and CT provides complementary information on the integrity of the bony

2017 American College of Radiology

1575. ASCIA Position Paper - Hereditary Angioedema (HAE)

abnormalities. This subtype will not be discussed in this document. Acquired C1-INH deficiency (AAE) may cause angioedema in adults and must be distinguished from HAE (section 4.3). 1.2 Historical facts The first description of HAE has been attributed to Robert Graves, who in 1843 described a patient with “a tumor rising on the forehead in the space of half an hour” and then later “sometimes the lips, inside of the mouth, palate, and uvula are attacked giving rise to a very considerable inconvenience” 1 (...) swelling, which was reported in older cohort studies to result in fatal asphyxiation in up to a third of patients 12 . Attacks may be preceded by a prodrome of tingling, or a non-itchy rash (erythema marginatum 13 ) anywhere on the body. Affected patients also have higher than expected rates of autoimmune disease 14 15 . 3.1 The acute attack HAE is characterised by episodic swelling of subcutaneous tissues, gut and upper respiratory tract 16 . Clinical episodes may occur frequently or may be years

2017 Australasian Society of Clinical Immunology and Allergy

1576. The UK guidelines for management and surveillance of Tuberous Sclerosis Complex Full Text available with Trip Pro

, UK Search for other works by this author on: , C Harland Epsom & St Helier Hospital, Wrythe Lane, Carshalton, Surrey, UK Search for other works by this author on: , S R Johnson Division of Respiratory Medicine, Faculty of Medicine & Health Sciences, Nottingham University, Nottingham, UK Search for other works by this author on: , A Parker Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, UK Search for other works by this author on: , J R Sampson Division of Cancer and Genetics (...) were neurologists, nephrologists, psychiatrist, psychologists, oncologists, general paediatricians, dermatologist, urologists, radiologists, clinical geneticists, neurosurgeons, respiratory and neurodisability clinicians. Conclusions These new UK guidelines for the management and surveillance of TSC patients provide consensus guidance for delivery of best clinical care to individuals with TSC in the UK. Introduction Tuberous Sclerosis Complex (TSC) is a genetic disease caused by mutations

2018 Tuberous Sclerosis Association

1577. Midostaurin for the indication of Acute Myeloid Leukaemia

MACE amsacrine, cytarabine, and etoposide MAH marketing-authorisation holder MDS myelodysplastic syndrome PTJA01 - Midostaurin with standard chemotherapy in FLT3 positive acute myeloid leukaemia Version 1.3, Novermber 2017 EUnetHTA Joint Action 3 WP4 10 MEC mitoxantrone + etoposide + cytarabine MeSH Medical Subject Headings MidAC mitoxantrone and cytarabine MRD minimal residual disease NCCN National Comprehensive Cancer Network NCT National Clinical Trial NE not estimable NICE National Institute (...) assessment is newly diagnosed FLT3 mutation- positive AML. AML is a haematological malignancy characterised by abnormal growth of haema- topoietic cells of myeloid lineage in the bone marrow, blood and other tissues. Overall, the 5-year survival rate for AML is 20%–30%. Younger patients have better outcomes compared with older patients. Patients with FLT3 mutation-positive AML have worse outcomes for overall survival (OS), time to relapse and disease-free survival (DFS) compared with patients without

2017 EUnetHTA

1578. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

, Doernbecher Children’s Hospital, Portland, Oregon, USA 16 Väestöliitto Fertility Clinics, Helsinki, Finland 17 Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark 18 Department of Pediatric Endocrinology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands 19 Department of Pediatric Endocrinology, Children’s Hospital, University of Bonn, Bonn, Germany 20 Cincinnati Children’s Hospital Medical Center, University of Cincinnati (...) areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review

2017 European Society of Endocrinology

1579. CRACKCast E089 – Esophagus, Stomach & Duodenum

, stridor, rhonchi, poor feeding Causes of esophageal obstruction: Mechanical obstruction: Internal Foreign body Adults – meat/bones; dentures; pen caps, etc. Kids – coins/batteries Strictures / rings ( Schatzki’s ring ) / webs Eosinophilic esophagitis Malignancy External factors Large Left atrium / ventricle Goiter Mediastinal tumour Motor factors (remember than the distal 2/3rds are innervated by involuntary smooth muscle) Achalasia Infectious (botulism, tetanus, etc.) Food bolus therapies: (from Ep (...) Pregnancy Obesity Coughing / bending / Supine position Gastroparesis / neuromuscular disease leading to gastric outlet obstruction Decreased esophageal motility Achalasia DM Scleroderma GEeRD = “gastric emptying; esophageal relaxation drugs” mnemonic Complications of GERD Esophagitis Progressing to Barrett’s metaplasia, erosion, ulcerations, scarring Stricture formation due to persistent scarring and inflammation Reflux induced asthma Microaspiration of Adenocarcinoma of the esophagus Esophageal

2017 CandiEM

1580. Portable neuromodulation stimulator for multiple sclerosis

of the brain by spreading from brain cell to brain cell leading to their damage. Over time, PSP gets progressively worse, with people becoming severely disabled within three to five years of onset. Currently, there is no cure for PSP and no treatment to slow down the disease. January 2019 Selumetinib is in clinical development for children with neurofibromatosis type 1 (NF1), also called von Recklinghausen’s disease. NF1 is a rare genetic disorder characterized by the development of multiple benign tumours (...) * Anaesthetics Pain Relief and ITU Cancer and Palliative Care Cardiovascular Disease and Vascular Surgery Dental and Oral Health and Maxillo-facial Surgery Ear Nose and Throat Emergency Care Endocrine Nutritional and Metabolic Eye Disease Gastrointestinal Pancreatic and Liver Disease Gynaecology Womens Sexual Health and Benign Breast Disease Haematology and Blood Products Health Promotion and Protection including Screening Immunology and Allergy Infectious Disease and Immunisation Mens Health and Sexual

2017 NIHR Innovation Observatory

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