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Yellow Nail Syndrome

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101. The Irish Maternity Early Warning System (IMEWS) National Clinical Guideline

are increased, renal clearance is increased and metabolism is altered (Soma-Pillay et al., 2016; Tan and Tan, 2013). Critical illness in pregnancy may be due to conditions specific to or exacerbated by pregnancy, or coincidental conditions. The conditions specific to pregnancy include (but not limited to) obstetric haemorrhage, pre-eclampsia/eclampsia, pulmonary embolism (venous and amniotic fluid), chorioamnionitis/endometritis, uterine rupture, placenta accreta and acute fatty liver (Neligan and Laffey (...) – – 1 1 Haemorrhage 1 1 – 2 Anaesthesia – – – – Psychiatric causes-suicides 2 3 – 5 Indirect Maternal Deaths 11 10 9 25 Cardiac Disease 4 7 6 14 Other Indirect causes† 4 1 – 5 Indirect neurological conditions** 3 2 3 6 Coincidental Maternal Deaths 6 2 2 9 *Genital tract sepsis deaths only, including early pregnancy deaths as the result of genital tract sepsis. Other deaths from infectious causes are classified under other indirect causes †Includes 2 deaths attributed to HINI influenza ** Includes 2

2019 HIQA Guidelines

102. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update Full Text available with Trip Pro

ulceration due to poor arterial blood flow to the hand Check nail beds, fingers and hand for unusual skin changes Aneurysm Abnormal areas of dilatation with overlying skin thinning Listen with a stethoscope Low-pitch continuous diastolic and systolic Low-pitch continuous diastolic and systolic High-pitch discontinuous systolic only Steal syndrome AVF may have a very strong bruit Feel with your fingers Thrill at the arterial anastomosis and throughout the entire outflow vein that is easy to compress (...) , and vascular access coordinator (VAC). Chronic Kidney Disease Nomenclature Used by KDOQI Prognosis of Chronic Kidney Disease by Glomerular Filtration Rate and Albuminuria Categories Green: low risk (if no other markers of kidney disease, no chronic kidney disease [CKD]); Yellow: moderately increased risk; Orange: high risk; Red, very high risk. Figure reproduced from Inker et al Inker L.A. Astor B.C. Fox C.H. et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation

2019 National Kidney Foundation

103. Onychomycosis

in shape of nail 2. Up to 7% of OM cases More common in children than adults Chalky, white patches on top surface of nail plate Entire nail plate may become roughened and crumbly 3. Up to 6% of cases White discoloration at proximal nail fold beneath nail bed Infection spreads from bottom of nail up towards the tip. Often a marker of immunosuppression disorders Onychomycosis is responsible for only 50–60% of cases of abnormal-appearing nails. Other conditions which can resemble OM must be ruled out (...) . - Vertical pigmented bands in the nail bed Systemic disorders such as iron deficiency (brittle, spoon shaped nails) , hypothyroidism (brittle nails) or hyperthyroidism (onycholysis) – usually most or all nails are involved. Trauma to nails – Single nail, deformed shape, history of injury. – Yellow-green thick, curved slow-growing nails. Associated with defective lymphatic drainage in lungs and pulmonary infection. If the patient has not been previously diagnosed. Guidelines recommend microscopy (KOH

2018 medSask

104. Approaches to promote handwashing and sanitation behaviour change in low? and middle?income countries: a mixed method systematic review Full Text available with Trip Pro

, CONDITION OR ISSUE Diarrhoeal diseases are the second highest cause of death in low income countries and the fifth highest cause of death in the world (WHO, 2011). In an update of the Global Burden of Disease study it was shown that unsafe water, sanitation and handwashing caused nearly 5% of DALYs (Disability‐Adjusted Life Years) for males and females in poor communities (GBD Risk Factor Collaborators, 2015). Water, Sanitation and Hygiene (WASH) interventions consist of (1) water supply (water quantity (...) Citations: Linked article: . Give access Share full text access Please review our and check box below to share full-text version of article. I have read and accept the Wiley Online Library Terms and Conditions of Use. Shareable Link Use the link below to share a full-text version of this article with your friends and colleagues. Copy URL Share a link Share on What are the main findings of this review? Community‐based approaches which include a sanitation component can increase handwashing with soap

2017 Campbell Collaboration

105. Guidelines of care for the management of cutaneous squamous cell carcinoma Full Text available with Trip Pro

, x Kristi Schmitt-Burr Affiliations Basal Cell Carcinoma Nevus Syndrome Life Support Network, Burton, Ohio r x Kristi Schmitt-Burr Affiliations Basal Cell Carcinoma Nevus Syndrome Life Support Network, Burton, Ohio , x Aleksandar Sekulic Affiliations Mayo Clinic, Phoenix, Arizona , MD, PhD s x Aleksandar Sekulic Affiliations Mayo Clinic, Phoenix, Arizona , x Paul Storrs Affiliations Private practice, Chicago, Illinois , MD h x Paul Storrs Affiliations Private practice, Chicago, Illinois , x Joyce (...) techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease. Key words: , , , , , , , , , Abbreviations used

2018 American Academy of Dermatology

106. Antiocoagulation - oral

. Rivaroxaban has also been approved as an option for prophylaxis of atherothrombotic events (with aspirin alone, or with aspirin and clopidogrel, or ticlodipine) for people with coronary heart disease and after an acute coronary syndrome in people with elevated cardiac biomarkers. It is also indicated for people with symptomatic peripheral artery disease at high risk of ischaemic events. Unlike warfarin, apixaban, dabigatran, edoxaban and rivaroxaban do not require regular international normalized ratio (...) Antiocoagulation - oral Prodigy Toggle navigation Topics Specialities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Allergies Cancer Cardiovascular Child health Drugs and devices Ear, nose and throat Endocrine and metabolic Eyes Gastroenterology Gastrointestinal Haematology Immunizations Infections and infestations Injuries Kidney disease and urology Men's health Mental health Musculoskeletal Neurological Oral health Palliative care Poisoning Pregnancy Preventative medicine Respiratory

2017 Prodigy

107. Bruising

, or exacerbated by, an underlying bleeding disorder or medical condition, including: Vascular disorders (for example senile or simple purpura). Platelet disorders (for example idiopathic thrombocytopenic purpura, leukaemia, or liver disease). Coagulation disorders (for example haemophilia, vitamin K deficiency, or von Willebrand disease). Drugs (such as corticosteroids, warfarin, and alcohol). The presence of a bleeding disorder or underlying medical condition does not rule out non-accidental injury (...) and abdominal pain). [ ; ; ] Vascular disorders Senile purpura A common and benign condition, resulting from impaired collagen production and capillary fragility in elderly people. Manifests as bruises which are usually bilateral on the extensor surfaces of the hands, forearms, face, and neck, which fade to a brownish colour over several months. Simple purpura ('easy bruising syndrome') A benign disorder typically occurring in otherwise healthy women, usually in their twenties or thirties. Manifests

2017 Prodigy

108. CRACKCast E196 – Monitoring the Emergency Patient

for an arterial line. Persistent or recurrent hemodynamic instability Monitoring of conditions or treatments that result in large fluid or blood pressure shifts Frequent arterial blood sampling Expected inaccuracies in noninvasive blood pressure management (e.g. because of obesity or dysrhythmias) [4] What is the Beer-Lambert Law and how does it allow us to measure pulse oximetry? Rosen’s trivia at its finest. The concentration of an absorbing substance can be determined if the characteristic wavelength (...) who is mechanically ventilated, potentially indicating the presence of hypoxia, hypercarbia, or insufficient anesthesia. Phase 4-5: Diminishing CO2 due to inspiration. If there is an ETT cuff leak, you can see this area blending in with the expiratory phase (Phase 1-2). [7] List 5 uses for ETCO2. Uses for ETCO2 monitoring include, but are not limited to: Rapid assessment of critically-ill patients Just like you learned in medical school, every critically ill patient needs to have their ABC’s

2018 CandiEM

109. Primary Biliary Cholangitis

wellastheNationalInstitutesofHealthwebsite(https://livertox. 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 (...) contain at least 11 portal ?elds. Biopsy ?ndings can be classi?ed under: (i) Disorders involving the bile ducts such as chronic non- suppurative cholangitis or ?brosing obliterative cholangi- tis, as well as less frequent cholangiopathies (Table 3). (ii) Disordersnotinvolvingbileducts,suchasavarietyofstor- age,in?ltrativeorin?ammatoryliverdiseases,granuloma- tous diseases, nodular regenerative hyperplasia, peliosis, sinusoidal dilatation and cirrhosis of different cause. (iii) Hepatocellular

2017 European Association for the Study of the Liver

110. Nappy rash: What else might it be?

Nappy rash: What else might it be? Differential diagnosis | Diagnosis | Nappy rash | CKS | NICE Search CKS… Menu Differential diagnosis Nappy rash: What else might it be? Last revised in July 2018 What else might it be? Alternative conditions that may present similarly to nappy rash include: Allergic contact dermatitis This occurs when the skin is sensitized to a specific irritant or allergen following exposure, and it has a characteristic pattern of distribution affecting skin areas exposed (...) yellow, greasy scale seen in other sites may not be seen in the nappy area or flexures. It most commonly starts between the second week and sixth month of life. See the CKS topic on for more information. Psoriasis Infantile psoriasis is uncommon, and when it occurs it most typically affects the inguinal folds and gluteal cleft. The rash presents as bright red, well-defined symmetrical plaques which are typically without the silvery white scale which may be seen at other sites, such as the scalp

2018 NICE Clinical Knowledge Summaries

111. Tinea Cruris Skin Infection - Guidelines for Prescribing Topical Antifungals

Reddened areas can extend down inner leg or upwards to stomach or buttocks Edges are bumpy or scaling Burning and itching are common Often co-morbid with tinea pedis and tinea unguium (toe-nail infection) Rule out the following conditions which can resemble tinea cruris: (candida intertrigo) - yeast infection which covers penis and scrotum as well as groin area with diffuse, red papular lesions. This may be treated with OTC antifungals - appears as yellow, greasy, scales on scalp and may extend down (...) resolve despite appropriate treatment. Refer for evaluation and possible systemic treatment No improvement after 1 week of pharmacologic treatment. Refer for an evaluation Patient has diabetes or is immunocompromised due to disease or drug treatment Patient has symptoms of systemic illness (e.g. fever, fatigue, swollen lymph glands) Unable to confirm patient's diagnosis of tinea cruris. Further evaluation and /or supervised is required. (See Differential Diagnosis above) 1 . Non-pharmacological

2017 medSask

112. Tinea Pedis Infection - Guidelines for Prescribing Topical Antifungals

of pharmacologic treatment. Refer for an evaluation Previous tinea infection which did not fully resolve, despite appropriate treatment. Refer for evaluation and possible systemic treatment Patient has diabetes or is immunocompromised due to disease or drug treatment Patient has symptoms of systemic illness (e.g. fever, fatigue, swollen lymph glands) Unable to confirm patient self-diagnosis of tinea pedis - requires further evaluation and /or supervised treatment (see Differential Diagnosis above) (fungal nail (...) . Children under 12 years of age rarely develop the condition Superficial fungal infections of the skin are caused by three dermatophytes; Trichophyton, Epidermophyton and Microsporum , which use the keratin layer of the epidermis as their source of nutrition The type of tinea infection is classified by where it is located on the body, not by the causative organism Tinea infections are contagious. Athlete's foot can be spread from person to person through contaminated towels, clothing or surfaces. Tinea

2017 medSask

113. Scabies

to excoriation or secondary bacterial infection; -other lesions: vesicles (usually at the start of a burrow), nodules (firm, 0.5 cm in diameter, usually on the male genitalia, groin, buttocks), wheals; -poor hygienic conditions may result in secondary bacterial infection; -irritant or allergic contact eczema can be induced following topical treatment. 2. Crusted scabies (the term “Norwegian scabies” should no longer be used) [1], [4], [13] -occurs in patients with severe immune deficiency due to disease (e.g (...) a yellow-to-brown, thick, verrucous aspect; -diffuse non-crusted scabies with involvement of the back may also occur [12]; -bacterial secondary infection can result in malodorous skin lesions. Diagnosis Diagnosis is suspected on the characteristics of itch (generalised, intense at night), clinical findings and suggestive history (e.g. positive context for contamination, disease observed in close contacts). Definitive diagnosis is supported by a positive microscopic examination of skin scrapings which

2017 European Dermatology Forum

114. Androgenetic Alopecia

, Belgium 9 Department of Dermatology, University of Bologna, Italy 10 Department of Dermatology and Allergy, Division of Evidence based Medicine, Charité – Universitätsmedizin, Berlin, Germany ABSTRACT Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian (...) follicle in predisposed men and women. Its aetiology is multifactorial and polygenic (13). Men Androgenetic alopecia in men is an androgen-dependent trait (14). Evidence from genetic disorders and from clinical trials of 5a-reductase inhibitors has shown that dihydrotestosterone (DHT) is the androgen chiefly responsible for the follicular pathology although the molecular and cellular events are only partially understood. DHT probably acts primarily on dermal papilla, the predominant site of androgen

2017 European Dermatology Forum

115. Biologic therapy for psoriasis

at localised sites and associated with significant functional impairment and/or high levels of distress (for example nail disease or involvement of high-impact and difficult-to-treat sites such as the face, scalp, palms, soles, flexures and genitals) áá R5 Consider biologic therapy earlier in the treatment pathway (for example, if methotrexate has failed, is not tolerated or is contra-indicated) in people with psoriasis that fulfils the disease severity criteria and who also have active psoriatic arthritis (...) the presence of psoriatic arthritis (in consultation with an adult or paediatric rheumatologist) outcomes to previous treatments for psoriasis Other factors person's age past or current co-morbid conditions (for example, inflammatory bowel disease, cardiovascular disease) conception plans body weight the person's views and any stated preference on administration route or frequency adherence áá R15 Be aware that the recommended first-line choice of biologic therapy will not be appropriate for every

2017 British Association of Dermatologists

116. CRACKCast E139 – Frostbite

and associated conditions Quantity of exposed surface area Heat loss—conductive, evaporative Aerosol propellants Cardiovascular Hypotension Atherosclerosis Arteritis Raynaud’s syndrome Cold-induced vasodilation Anemia Sickle cell disease Diabetes Vasoconstrictors, vasodilators [5] Describe the pre-hospital and ED management of frostbite Priorities Prevent re-freeze injury & thaw Analgesia Wound care Tetanus prophylaxis Consider if there is a role for thrombolytic therapy (IV or IA) Post-thaw wound care (...) and progresses to pain and edema Can last days 3. Hyperemia: Hot, red and prolonged cap refill Vasomotor paralysis Severe pain, hyperalgesia Edema and bullae formation Can last weeks to months 4. Post-hyperemia Normal appearance unless tissue lost May have chronic pain [4] Chilblains (Perino) Due to repetitive exposure to cold conditions or in someone with underlying disease Look like cold sores that appear within 24 hrs after exposure to cold Face, hands, feet, tibia Risk groups: Young women, Raynaud’s

2017 CandiEM

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

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 (...) become frontrunners are the Pemphigus Disease Area Index (PDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), 31–34 each taking 2–5 min to complete. 32,34 These have also been validated for use in oral PV but are inferior to another system, the Oral Disease Severity Score, which may be combined with ABSIS or PDAI in patients with skin or extraoral mucosal sites. 35 It is recommended that disease severity is scored in routine clinical practice. It is essential in clinical trials

2017 British Association of Dermatologists

118. Prevention, Diagnosis & Management of infective endocarditis

emboli despite adequate antimicrobial therapy Semi-elective (after 2 weeks of antimicrobials) PVE and relapsing infection Elective (after 6 weeks of antimicrobials) Well-tolerated chronic severe valvular regurgitation with controlled infection SUMMARY OF THE CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS20 IE in specific conditions There are important considerations for IE in congenital heart disease (CHD), CIED and transcatheter valve implants (...) > Immunocompromised patients • Fever is usually very high in acute IE • Anaemia • In subacute cases this may be anaemia of chronic disease or microcytic anaemia Peripheral • Splinter haemorrhages • Nail beds of the fingers or toes • Examine all digits of upper and lower limbs • Exclude workplace trauma • Osler’s nodes > Painful subcutaneous nodules (red-purple, slightly raised, tender lumps and with a pale centre) • Pulps of the fingers or toes • Pain precedes the development of the visible lesion by up to 24

2017 Ministry of Health, Malaysia

119. Effect of nail polish and henna on oxygen saturation determined by pulse oximetry in healthy young adult females. (Abstract)

Effect of nail polish and henna on oxygen saturation determined by pulse oximetry in healthy young adult females. The purpose of this study was to determine the effect of different colour nail polishes and henna on the measurement of oxygen saturation and the differences among the measurements of three pulse oximetry devices.33 healthy females with a mean age of 19±1.0 years and no complaints or known disease were included into the study. All the participants applied henna to one (...) of their fingers a day before the study. Just before the study, one finger was left empty as control and the other fingers were dyed using various colours of nail polish (red, blue, beige, purple, brown, white, pink, green, colourless polish, light blue, light green and yellow). There were more than eight colour nail polishes and some fingers were used for the other colours after being completely cleaned. The same brand nail polishes were used for the study. Oxygen saturation measurements were done using three

2010 Emergency Medicine Journal

120. Otezla - apremilast

implicated in psoriasis and psoriatic arthritis (PsA) (Schafer, 2010). The proinflammatory mediators that are upregulated in PsA include the cytokines TNF-a, IL-1,IL-6, and IL-8, and the chemokines monocyte chemotactic protein-1 (MCP-1) and macrophageinflammatory protein-1 beta (MIP-1ß) (CC-10004-PSA-002-PD). Based on these effects, apremilast is being developed for use in the treatment of various immune-mediated inflammatory conditions such as psoriasis, PsA, rheumatoid arthritis (RA), Behçet disease (...) arthritis Otezla, alone or in combination with Disease Modifying Antirheumatic Drugs (DMARDs), is indicated for the treatment of active psoriatic arthritis (PsA) in adult patients who have had an inadequate response or who have been intolerant to a prior DMARD therapy (see section 5.1). Psoriasis Otezla is indicated for the treatment of moderate to severe chronic plaque psoriasis in adult patients who failed to respond to or who have a contraindication to, or are intolerant to other systemic therapy

2015 European Medicines Agency - EPARs

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