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Tongue Carcinoma

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1601. Bipolar disorder

and abuse with quetiapine [ ]. October 2015 — minor update. Muscle weakness and rhabdomyolysis have been included as possible adverse effects of lithium [ ]. May 2015 — minor update. Three updates based on updates to manufacturers' Summaries of Product Characteristics (SPCs): Mitochondrial disorders added as a contraindication to the use of valproate [ ]. Renal tumours (microcysts, oncocytomas, and collecting duct renal carcinoma) added as possible adverse effects of prolonged use (over 10 years (...) have also been associated with schizophrenia. Environmental factors/triggers that have been associated with the onset, or with relapses of bipolar disorder include: Early life stress, maternal death before a child reaches five years of age, childhood trauma, childhood abuse, emotional neglect/abuse. Toxoplasma gondii exposure. Cannabis use, cocaine exposure. [ ; ; ; ] Incidence and prevalence How common is it? Data collected between 1990 and 2010 for the Global Burden of Disease study suggests

2019 NICE Clinical Knowledge Summaries

1602. Sepsis

in children and young people. Capillary refill time and oxygen saturation (abnormal results may indicate poor peripheral perfusion). Mottled or ashen skin; pallor or cyanosis of the skin, lips or tongue; cold peripheries. A non-blanching rash which may suggest meningococcal disease. See the CKS topic on for more information on assessment and emergency management. Weak high-pitched or continuous cry (in children under 5 years of age). Any breach of skin integrity (for example cuts, burns, or skin (...) (under one year of age) and older people (over 75 years of age). People who are very frail. People who are immunocompromised due to a co-morbid condition (such as diabetes mellitus, HIV, cirrhosis, sickle cell disease, or asplenia). See the CKS topics on , , , , and for more information. People who are immunosuppressed due to drug treatment (such as anticancer treatment, oral corticosteroids, or other immunosuppressive drugs). See the CKS topics on , , and for more information. People who have had

2019 NICE Clinical Knowledge Summaries

1603. Meningitis - bacterial meningitis and meningococcal disease

Meningitis - bacterial meningitis and meningococcal disease Meningitis - bacterial meningitis and meningococcal disease - NICE CKS Share Meningitis - bacterial meningitis and meningococcal disease: Summary Bacterial meningitis is a life-threatening condition that can affect all ages, but is most common in babies and children. Transmission occurs through close contact, droplets, or direct contact with respiratory secretions. The annual incidence of acute bacterial meningitis in developed (...) mental state (confusion, delirium and drowsiness, impaired consciousness), non-blanching rash, back rigidity, bulging fontanelle (in children younger than 2 years of age), photophobia, Kernig's sign, Brudzinski's sign, coma, paresis, focal neurological deficit, and seizures. All suspected cases of meningitis are medical emergencies requiring immediate hospital admission by telephoning 999. For suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia

2019 NICE Clinical Knowledge Summaries

1604. Hypertension in pregnancy

in their first pregnancy and 1.7% of women in their second pregnancy have pre-eclampsia [ ]. Haemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome occurs in 0.5–0.9% of all pregnancies overall, and in 10–20% of women with severe pre-eclampsia [ ]. Eclampsia complicates 2.7 per 10,000 births [ ]. Risk factors What are the risk factors? Women are at high risk of pre-eclampsia if they have: One of the following high risk factors: A history of hypertensive disease during a previous pregnancy (...) . Chronic kidney disease. Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome. Type 1 or type 2 diabetes. Chronic hypertension. Thrombophilia. Two or more of the following moderate risk factors: First pregnancy. Aged 40 years or older. Pregnancy interval of more than 10 years. Body mass index (BMI) of 35 kg/m 2 or greater at the first visit. Family history of pre-eclampsia. Multiple pregnancy. [ ] Prognosis What is the prognosis? Prognosis for current pregnancy Chronic

2019 NICE Clinical Knowledge Summaries

1605. Epilepsy

for epilepsy vary by age group, but include: Premature birth. Complicated febrile seizures. A genetic condition that is known to be associated with epilepsy, such as tuberous sclerosis or neurofibromatosis. Brain development malformations – usually associated with epilepsy developing before adulthood. A family history of epilepsy or neurologic illness. Head trauma, infections (for example meningitis, encephalitis), or tumours — can occur at any age. Comorbid conditions such as cerebrovascular disease (...) Epilepsy Epilepsy - NICE CKS Share Epilepsy - Summary A seizure is the transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is a disease of the brain defined by any of the following: At least two unprovoked seizures occurring more than 24 hours apart. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years. Diagnosis

2019 NICE Clinical Knowledge Summaries

1606. Pelvic inflammatory disease

Pelvic inflammatory disease Pelvic inflammatory disease - NICE CKS Share Pelvic inflammatory disease: Summary Pelvic inflammatory disease (PID) is a general term for infection of the upper genital tract. PID is almost always due to a sexually transmitted infection (STI). Chlamydia trachomatis is the most common causative organism, accounting for 14–35% of cases. Other causative organisms include Neisseria gonorrhoeae (2–3% of cases) , Mycoplasma genitalium, and organisms in normal vaginal flora (...) for the management of pelvic inflammatory disease [ ] and the European guideline for the management of pelvic inflammatory disease [ ]. This CKS topic covers the management of acute pelvic inflammatory disease (PID) in primary care. This CKS topic does not cover the management of chronic PID, chronic pelvic pain, postpartum endometritis, or PID following childbirth. There are separate CKS topics on , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK

2019 NICE Clinical Knowledge Summaries

1607. Crohn's disease

emboli, arterial or venous thrombosis, or vasculitis. Acute appendicitis — acute terminal ileum disease can mimic acute appendicitis. See the CKS topic on for more information. Diverticulitis — see the CKS topic on for more information. Coeliac disease — see the CKS topic on for more information. Irritable bowel syndrome — see the CKS topic on for more information. Anal fissure — see the CKS topic on for more information. Malignancy (such as colorectal cancer, small bowel cancer, and lymphoma) — see (...) , or if the corticosteroid dose cannot be tapered as planned. These drugs are are also effective at maintaining remission. Thiopurines may increase the person's risk of non-melanoma skin cancer, and people should be monitored for skin cancer and given appropriate sun protection advice. Biologic therapy — the anti-tumour necrosis factor alpha monoclonal antibody agents infliximab and adalimumab are effective at inducing remission in people with severe active disease which has not responded to conventional therapy

2019 NICE Clinical Knowledge Summaries

1608. Diarrhoea - prevention and advice for travellers

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 are common adverse effects. Advise the person not to use loperamide or bismuth subsalicylate (for example Pepto-Bismol ® ) if they have blood or mucous in the stool and/or high (...) 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 disease, stroke, congestive heart failure, or sickle cell disease) in whom

2019 NICE Clinical Knowledge Summaries

1609. Anaemia - B12 and folate deficiency

, for example, due to: Pregnancy and lactation, prematurity. Malignancy (for example leukaemia, carcinoma, or lymphoma). Blood disorders (for example haemolytic anaemias, sickle cell anaemia, myelofibrosis). Inflammatory diseases (for example tuberculosis, Crohn's disease, or malaria). Exfoliative skin diseases. Excessive urinary excretion (for example due to congestive heart failure, acute liver damage, or chronic dialysis). Liver disease. Malabsorption — due to coeliac disease, tropical sprue, congenital (...) (Imerslund Gräsback syndrome). Intestinal causes — malabsorption, ileal resection, Crohn's disease. Nutritional — malnutrition, vegan diet. Folate deficiency is often caused by problems with dietary intake alone, or in a combination with increased folate usage, or malabsorption. For example: Drugs — alcohol, anticonvulsants, nitrofurantoin, sulfasalazine, methotrexate, trimethoprim. Excessive requirements in pregnancy, malignancy, blood disorders, or malabsorption. Excessive urinary excretion. Liver

2019 NICE Clinical Knowledge Summaries

1610. Polymyalgia rheumatica

and butterfly rash), cardiopulmonary, and neurological features. Cancer , including: Multiple myeloma — weakness, fatigue, bone pain. Less commonly renal failure, hypercalcaemia, and acute infection. Acute leukaemia — pallor, petichiae, bruising, and fever. Lymphoma — palpable non-tender lymphadenopathy. Less commonly fever, night sweats, and weight loss. Lung carcinoma — apical (Pancoast) tumour may cause progressive, constant pain in the shoulder, upper chest or interscapular region. There may also (...) , 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

2019 NICE Clinical Knowledge Summaries

1611. Urethritis - male

on expert opinion in a guideline published by the British Association for Sexual Health and HIV UK national guideline on the management of non-gonococcal urethritis [ ], European Urology guidelines Guidelines on urological infections [ ], and a Canadian guideline Non-gonococcal urethritis - public health notifiable disease management guidelines [ ]. Diagnosis How should I make a working diagnosis of urethritis in primary care? Refer all men with suspected urethritis to a genito-urinary medicine (GUM (...) and central nervous system disease, as there is a risk of neurological aggravation. Severe liver disease or hepatic encephalopathy, due to substantial impairment of metronidazole clearance, which may contribute to symptoms of encephalopathy. Prescribe one-third of the daily dosage once daily. Alcohol dependency — there may be a disulfiram-like reaction (flushing, increased respiratory rate, increased pulse rate, nausea, headache, and dizziness) if taken with alcohol. [ ; ] Drug interactions What

2019 NICE Clinical Knowledge Summaries

1612. Cellulitis - acute

subcutaneous tissues, fascia, and occasionally muscles. The presenting signs are usually non-specific (redness, swelling, and pyrexia). The person is usually systemically very unwell and has disproportionate pain. Metastatic cancer (carcinoma erysipeloides) — a fixed, red patch often with a raised edge and oedema due to lymphatic obstruction. A metastasis from breast cancer is the most common cause, but rarely it may be caused by lung, ovarian, colonic, or pancreatic metastases, or malignant melanoma. Wet (...) , and other co‐existing diseases (for example people who are immunocompromised, have diabetes, cancer, or malnutrition). [ ; ; ; ; ; ] Prevalence How common is it? Epidemiological surveys report that the incidence of cellulitis ranges from 0.2 per 1000 person-years to 24.6 per 1000 person-years in different populations [ ]. Recurrence of cellulitis is common, and each episode increases the likelihood of subsequent recurrence: In a longitudinal cohort study of 36,276 people presenting with a first episode

2019 NICE Clinical Knowledge Summaries

1613. Migraine

disorder. Background information Background information Definition What is it? Migraine is a common primary headache disorder. Primary headaches are headaches which are not associated with another underlying condition. Secondary headaches are headaches which occur as a result of underlying local or systemic pathology such as intracerebral haemorrhage, malignancy or infection. Migraine is characterized by: Attacks of moderate or severe headache (commonly, but not always unilateral, and often described (...) Migraine with typical aura can include: Visual and/or sensory and/or speech/language symptoms — visual aura is the most common type of aura and occurs in over 90% of people who have migraine with aura [ ]. Sensory aura often presents with unilateral pins and needles and or numbness which gradually moves away from the point of origin on the body, face and/or tongue [ ]. The ICHD diagnostic criteria for migraine with typical aura does not include motor, brainstem or retinal symptoms [ ]: Motor symptoms

2019 NICE Clinical Knowledge Summaries

1614. Diverticular disease

, vomiting, reduced flatus. Colorectal cancer — see the CKS topic on for more information. Frequent small or continual rectal bleeds are unlikely to be caused by diverticular disease and require further investigation, even in a person known to have diverticula. In addition, the diverticulitis complication of bowel obstruction may mimic symptoms of colorectal cancer. Gynaecological Pelvic inflammatory disease — see the CKS topic on for more information. Ovarian cyst or torsion — suggested by sharp (...) . Is dehydrated or at risk of dehydration and is unable to take or tolerate oral fluids at home. Is unable to take or tolerate oral antibiotics (if needed) at home. Is frail and/or has significant co-morbidities and/or is immunocompromised (for example has diabetes mellitus, end-stage chronic kidney disease, malignancy, cirrhosis, or is taking immunosuppressive drugs). Manage the person in primary care if there is suspected mild, uncomplicated diverticulitis, depending on clinical judgement: Consider

2019 NICE Clinical Knowledge Summaries

1615. Diarrhoea - antibiotic associated

of a proton pump inhibitor or other acid-suppressive drugs (such as H 2 -receptor antagonists) [ ; ; ; ]. Underlying morbidity such as abdominal surgery, chronic renal disease, inflammatory bowel disease, immunosuppression (such as solid organ or haematopoietic stem cell transplant recipients, people with HIV infection, people undergoing cancer chemotherapy) [ ; ; ; ]. Prolonged hospitalization or residence in a nursing home [ ; ]. Complications What are the complications? The complications of Clostridium (...) and fourth generation), fluoroquinolones, and broad-spectrum penicillins. Factors that increase the risk of C. difficile infection include increased age, history of C. difficile infection, exposure to other cases, concomitant use of a proton pump inhibitor or other acid-suppressing drug, and underlying morbidity (such as abdominal surgery, chronic renal disease, inflammatory bowel disease, and immunosuppression). The complications of C. difficile infection can be severe and include pseudomembranous

2019 NICE Clinical Knowledge Summaries

1616. Gastroenteritis

; and laxative abuse (the condition normally reverses on withdrawal of the drug). Endocrinopathy, for example diabetes, hyperthyroidism, congenital adrenal hyperplasia, Addison's disease, and hypoparathyroidism. Non-enteral infections, for example HIV/AIDS. Secretory tumours, for example carcinoid tumours, medullary tumour of the thyroid, and vasoactive intestinal peptide-secreting adenomas. Basis for recommendation Basis for recommendation This information is from a National Institute for Health and Care (...) Gastroenteritis Gastroenteritis - NICE CKS Share Gastroenteritis: Summary Gastroenteritis is a transient disorder due to enteric infection with viruses, bacteria, or protozoa. About 20% of the UK population develop gastroenteritis each year. The risk of complications (such as dehydration and electrolyte disturbance, haemolytic uraemic syndrome, and malnutrition) is greatest at the extremities of life, in people with concurrent chronic disease, and in those who are immunocompromised

2019 NICE Clinical Knowledge Summaries

1617. Leg ulcer - venous

. There is a suspected of ulceration, such as: Arterial or mixed venous/arterial disease — refer people with an ankle brachial pressure index (ABPI) of less than 0.8 to a specialist vascular clinic for further assessment; if the ABPI is less than 0.5, refer urgently. Also consider referring people with ABPI greater than 1.3 as further assessments may be required to determine their suitability for compression therapy. See the section for more information. Malignancy — refer to dermatology using the suspected cancer (...) arthritis, vasculitis, sickle cell disease, malignancy, and drugs (such as nicorandil, corticosteroids, and nonsteroidal anti-inflammatory drugs). Venous leg ulceration is caused by sustained venous hypertension, which results from chronic venous insufficiency due to venous valve incompetence or an impaired calf muscle pump. Risk factors include obesity, immobility, increasing age, varicose veins, and a history of deep vein thrombosis (DVT). The estimated prevalence of venous leg ulcers in the UK

2019 NICE Clinical Knowledge Summaries

1618. Neutropenic sepsis

with haematological malignancy was 37.8% [ ]. Expert opinion in a review article notes that people with haematological malignancies such as leukaemia have higher rates of mortality from febrile neutropenia than people with solid tumours [ ]. In a US retrospective analysis of paediatric cancer patients on an intensive care unit (n = 359), the overall mortality from sepsis was 17%. This rate increased to 30% in children who had undergone haematopoietic stem cell transplants. Mortality varied by causative pathogen (...) — causes additional immunosuppression [ ]. Antibiotics — antibiotics at the time of onset of febrile neutropenia increases the risk of serious complications by disrupting the normal body flora [ ; ; ]. Advanced malignancy [ ; ]. History of previous febrile neutropenia [ ]. Prolonged hospital admission [ ; ]. Previous surgery [ ]. Co-morbidities such as diabetes mellitus, liver disease, renal disease; poor nutritional status — the risk of complications increases in people with more than one significant

2019 NICE Clinical Knowledge Summaries

1619. Drugs to avoid in 2015

. Citalopram and escitalopram, which can cause QT prolongation, are not included in our list (Rev Prescrire n° 369). We are planning to review this adverse effect with the various SSRI antidepressants. Oncology – Catumaxomab, used in malignant ascites, has serious adverse effects (pos- sibly fatal) in more than three-quarters of patients (Prescrire Int n° 109). It is more prudent to drain ascites, at intervals guided by symptoms. – Panitumumab does not prolong sur- vival in metastatic colorectal cancer (...) assess- ment of a drug’s harm-benefit balance based on individual experience can help to guide further research but is subject to major bias and represents only weak evidence (3,4). For example, it can be dif- ficult to attribute a specific outcome to a particular drug, as other factors must be taken into account, including the nat ural history of the disease, the placebo effect, the effect of another treatment the patient may not have mentioned, or a change in lifestyle or diet. Similarly

2015 Prescrire

1620. Transoral Robotic Surgery

of TORS include lack of tactile feedback, difficult hemostasis and initial investment costs. 5 Malignant lesions of the oral or oropharyngeal cavity are relatively uncommon. The estimated annual incidence worldwide is approximately 123,000, with 79,000 deaths annually. 6 Cancers of the oral and oropharyngeal mucosa are most often squamous cell carcinomas and arise from the palate, tonsils, base of tongue, vellecula and aryepiglottic folds. 3,6 Several risk factors are known to be associated (...) total cost for TORS partial pharyngectomy and partial glossectomy (tongue base) in mild to moderate disease compared to open surgery. There was no significant difference between treatment group for partial glossectomy of the anterior tongue. Richmon 7 demonstrated that compared to non-TORS surgery, TORS was associated with a cost savings of $4,285 in patients with malignant oropharyngeal neoplasm. In 2014, Hammoudi 15 showed that TORS was associated with a significantly higher cost of surgery ($7781

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

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