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Yellow Nail Syndrome

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121. Healthcare-associated infections

with E.coli BSI who are not admitted to hospital. E. coli bacteraemia that is not susceptible to ciprofloxacin. Winter onset. Male gender. Risk factors associated with acquiring infection include: Age — incidence is much higher in people aged over 65 years. Underlying disease — people with chronic renal disease, underlying gastrointestinal conditions or cancer. Antibiotic therapy — people who have recently received or who are receiving antibiotic therapy (especially broad-spectrum antibiotics (...) illness). Detergent hand wipes can be used when it is not possible to perform handwashing. Ensure hands can be decontaminated throughout the duration of clinical work: Keep arms bare below the elbow when delivering direct care. Remove wrist and hand jewellery. Make sure that fingernails are short, clean and free of nail polish. Cover cuts and abrasions with waterproof dressings. Use wall mounted liquid soap dispensers with disposable soap cartridges. Use a good quality liquid soap. Do not use

2019 NICE Clinical Knowledge Summaries

122. Anaemia - B12 and folate deficiency

(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 (...) ). Pernicious anaemia (an autoimmune disorder which results in reduced production of intrinsic factor) is the most common cause of severe vitamin B12 deficiency in the UK. Other causes of vitamin B12 deficiency are rare, but include: Drugs — colchicine, metformin, nitrous oxide, protein pump inhibitors, H2-receptor antagonists. Gastric causes — total or partial gastrectomy, congenital intrinsic factor deficiency or abnormality, Zollinger-Ellison syndrome. Inherited — intrinsic factor receptor deficiency

2019 NICE Clinical Knowledge Summaries

123. Seborrhoeic dermatitis

dermatitis has not been identified. Treatment with antifungals decreases the number of Malassezia yeasts and leads to clinical improvement — recolonization precedes relapse. Seborrhoeic dermatitis typically occurs in healthy people but can also be associated with certain underlying conditions including: Immunodeficiency (for example HIV). Neurological disorders (for example Parkinson’s disease and stroke). Some genetic disorders (for example Down’s syndrome). [ ; ; ; ; ; ; ] Prevalence How common (...) Seborrhoeic dermatitis Seborrhoeic dermatitis - NICE CKS Share Seborrhoeic dermatitis: Summary Seborrhoeic dermatitis is a common inflammatory skin condition occurring in areas rich in sebaceous glands (such as the scalp, nasolabial folds, eyebrows, and chest). In infants the scalp is most commonly affected ('cradle cap'). It typically presents as erythematous patches with scale which may be white or yellow, oily or dry. The exact cause of seborrhoeic dermatitis is not fully understood; many

2019 NICE Clinical Knowledge Summaries

124. Cellulitis - acute

, maceration or fungal infection between the toes, or a concomitant skin disorder (such as atopic eczema). Other risk factors for cellulitis include [ ; ; ; ; ; ]: Lymphoedema. Leg oedema. Venous insufficiency and history of venous surgery. Obesity. Pregnancy [ ]. R isk factors for either rapid progression of cellulitis or delayed response to treatment include [ ; ; ; ; ] : Conditions that predispose to infection, including diabetes mellitus, chronic liver or renal disease, immunocompromise (...) and monitor the person (check local guidelines). Has symptoms or signs suggesting a more serious illness or condition (such as osteomyelitis, or septic arthritis). Consider referring people to hospital, or seek specialist advice, if they: Are severely unwell. Have infection near the eyes or nose (including periorbital cellulitis). Could have uncommon pathogens, for example, after a penetrating injury, exposure to water-borne organisms, or an infection acquired outside the UK. Have spreading infection

2019 NICE Clinical Knowledge Summaries

125. Leg ulcer - venous

be relied on to guide clinical decisions [ ]. Expert opinion in the Wound UK document is that referral to a vascular service or tissue viability team should be considered for all people with ABPI greater than 1.3 as further assessments are required to determine the person’s suitability for compression therapy [ ]. Differential diagnosis What else might it be? Exclude the following conditions in the initial assessment of a person with a suspected venous leg ulcer: Peripheral arterial disease — ulcers due (...) to arterial disease often appear well demarcated and have a 'punched out' appearance. There may be signs of arterial compromise, such as pallor, loss of hair, nail dystrophy, coldness, and diminished capillary refill. A history of intermittent claudication, cardiovascular disease, or stroke may indicate the presence of arterial disease. See the CKS topic on for more information. Rheumatoid arthritis — rheumatoid ulcers may be venous, arterial, or vasculitic. Vasculitic ulcers can occur on the calf

2019 NICE Clinical Knowledge Summaries

126. Antiretroviral / HIV Drug Dosing for Paediatrics

/effective if >25kg; Reduce in renal failure With or without food. Can be crushed and mixed with small amount of water or food. Nausea, diarrhoea, headache, fatigue. Abacavir (ABC) Ziagen ® (ViiV) Child: (=3months) 8mg/kg BD or 16mg/kg OD. Well tolerated round up doses. Max dose: 600mg per day Paed dosing for 300mg tab: (14-19kg) ? ½ tab BD or 1tab OD, (>20-24kg) ½ tab AM + 1 tab PM or 1½ tab OD, (>25kg) ? 1 tab BD or 2 tabs OD Adult: (=12 yrs): 300mg BD or 600mg OD Tab: 300mg (yellow) scored Liq: 20mg (...) /20ml vial) Do not give with stavudine. With or without food. Capsules can be opened and dissolved in water. Granulocytopenia and/or anaemia, nausea, headache, myopathy, hepatitis, nail pigmentation, neuropathy. Emtricitabine (FTC) Emtriva ® (Gilead) Child: (= 4months) 6mg/kg OD of the oral solution. (max. dose 240mg OD) Adult: Capsule (=33kg) 200mg OD; oral solution: 240mg OD Cap: 200mg (blue/white)=240mg liq Liq: 10mg/ml - Fridge (Discard 45 days after opening) - not bioequivalent to caps

2015 The Children's HIV Association

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

A, von Stackelberg A, Schrappe M, et al.: Allogeneic hematopoietic SCT in children with ALL: current concepts of ongoing prospective SCT trials. Bone Marrow Transplant 41 (Suppl 2): S71-4, 2008. [ ] Bertaina A, Merli P, Rutella S, et al.: HLA-haploidentical stem cell transplantation after removal of αβ+ T and B cells in children with nonmalignant disorders. Blood 124 (5): 822-6, 2014. [ ] Handgretinger R, Chen X, Pfeiffer M, et al.: Feasibility and outcome of reduced-intensity conditioning (...) Risk of graft rejection Low Low–moderate Moderate–high Moderate–high Moderate–high Time to immune reconstitution a Rapid (6–12 mo) Moderate (6–18 mo) Slow (6–24 mo) Slow (6–24 mo) Slow (9–24 mo) b Risk of acute GVHD Moderate Moderate Moderate Low Low Risk of chronic GVHD High Moderate Low Low Low BM = bone marrow; EBV-LPD = Epstein-Barr virus–associated lymphoproliferative disorder; GVHD = graft-versus-host disease; HCT = hematopoietic cell transplantation; PBSCs = peripheral blood stem cells

2018 PDQ - NCI's Comprehensive Cancer Database

128. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

and symptoms may be caused by lesions in the CNS or by CNS . Liver and spleen Signs or symptoms of LCH that affects the or may include: Swelling in the abdomen caused by a buildup of extra . Trouble breathing. Yellowing of the skin and whites of the eyes. Itching. Easy bruising or bleeding. Feeling very tired. Lung Signs or symptoms of LCH that affects the may include: Collapsed lung. This condition can cause chest pain or tightness, trouble breathing, feeling tired, and a bluish color to the skin. Trouble (...) of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. : A series of questions and tests to check the brain, , and function. The exam checks a person's mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. : A procedure in which a sample of is drawn and checked for the following

2018 PDQ - NCI's Comprehensive Cancer Database

129. Fungal skin infection - foot

mildly-potent topical corticosteroid such as hydrocortisone cream in addition, if there is associated marked inflammation. Considering prescribing an oral antifungal such as terbinafine first-line if an adult has severe or extensive disease, depending on fungal microscopy or culture results and/or clinical judgement. Alternative options are oral itraconazole or oral griseofulvin, if terbinafine is not tolerated or is contraindicated. Managing concomitant fungal nail, hand, or groin infection (...) detailed information on drug doses, contraindications and cautions, adverse effects, and drug interactions. If a child has severe or extensive disease, arrange to a paediatric dermatologist. If there is concomitant suspected fungal nail, hand, or groin infection, arrange appropriate management. See the CKS topics on and for more information. Advise the person to arrange for if there is an inadequate response to initial treatment. Basis for recommendation Basis for recommendation The recommendations

2018 NICE Clinical Knowledge Summaries

130. Malaria prophylaxis

. knowlesi — a malaria parasite of monkeys in South-East Asia which can cause severe and sometimes fatal illness in humans. Assessment of a person intending to travel to a malaria endemic area involves: Taking a thorough history to identify travel itinerary, factors that may put the person at high risk of developing severe/fatal malaria (such as pregnancy, extremes of age and immunosuppression), past medical history (including psychiatric and seizure conditions) and drug and vaccine history. Checking (...) line of defence against vector-borne diseases is effective bite prevention. Chemoprophylaxis (if appropriate for the area to be visited) taking into account contra-indications and co-morbid conditions. Provision of emergency standby treatment — this is not required for most travellers but should be considered if taking chemoprophylaxis and visiting remote areas not within 24 hours of medical facilities Chemoprophylaxis and measures to prevent mosquito bites do not eliminate the risk of contracting

2018 NICE Clinical Knowledge Summaries

131. Otitis externa

) reaction — id reactions can result from an infection or inflammatory skin condition. A fungal infection elsewhere in the body (for example skin, nails, vagina) can cause a secondary inflammatory process in the external ear canal (presents as an itchy rash with blisters or vesicles). Basis for recommendation Basis for recommendation These recommendations are pragmatic, and are based on expert opinion in review articles [ ; ]. When to investigate When to investigate For information on when to investigate (...) into the bone surrounding the ear canal (the mastoid and temporal bones). Malignant otitis, without treatment, is a fatal condition. Otitis externa is common and more than 1% of people will be diagnosed with the condition each year. It affects people of all ages, but incidence peaks at age 7–12 years. Diagnosis of otitis externa is based on characteristic signs and symptoms, which include: Ear pain, itch, discharge, and hearing loss. Swollen, red, or eczematous ear canal and/or external ear. The most common

2018 NICE Clinical Knowledge Summaries

132. Nappy rash

does not resolve with standard treatments, the child must be evaluated for underlying disease or an alternative condition [ ; ]. The recommendation to consider seeking advice from a medical microbiologist if nappy rash does not respond to appropriate imidazole or antibiotic treatment in primary care is pragmatic, based on what CKS considers to be good clinical practice. Further investigations such as patch testing may be helpful if there is refractory nappy rash, to exclude conditions (...) including increased liver enzymes and cholestatic hepatitis (with or without jaundice) has been reported rarely. Conditions which predispose to QT interval prolongation — such as electrolyte disturbances and people taking drugs that prolong the QT interval, for example amiodarone, sotalol, terfenadine, and amisulpride. Chronic kidney disease (CKD) stages 4 and 5 — if the estimated glomerular filtration rate (eGFR) is less than 30 mL/minute/1.73 m 2 , prescribe half the normal dose, and avoid Klaricid XL

2018 NICE Clinical Knowledge Summaries

133. Fungal skin infection - body and groin

cream in addition, if there is associated marked inflammation. Considering prescribing an oral antifungal such as terbinafine first-line if an adult has severe or extensive disease, depending on fungal microscopy or culture results and/or clinical judgement. Alternative options are oral itraconazole or oral griseofulvin, if terbinafine is not tolerated or is contraindicated. Managing concomitant fungal nail, foot, or hand infection, if present, to reduce the risk of reinfection (...) a fine scale. May be more noticeable in the summer months if patches fail to tan. Lesions may fluoresce a bright yellow-green or gold colour on Wood lamp examination. See the CKS topic on for more information. Psoriasis — chronic plaque psoriasis typically presents as monomorphic, erythematous plaques covered by adherent silvery-white scale, usually on the scalp, trunk, buttocks, periumbilical area, and extensor surfaces (such as forearms, shins, elbows, and knees). May be associated with nail

2018 NICE Clinical Knowledge Summaries

134. Psoriasis

conditions such as psoriatic arthritis, metabolic syndrome, inflammatory bowel disease (particularly Crohn's disease), anxiety and depression. The diagnosis of psoriasis is usually based on clinical findings. Features suggesting psoriasis include: Distribution — psoriasis often occurs on extensor surfaces (elbows and knees), trunk, flexures, sacral and natal cleft, scalp and behind the ears, and umbilicus. Size and shape of lesions — there is usually a clear delineation between normal and affected skin (...) Psoriasis Psoriasis - NICE CKS Share Psoriasis: Summary Psoriasis is a systemic, immune-mediated, inflammatory skin disease which typically has a chronic relapsing-remitting course, and may have nail and joint (psoriatic arthritis) involvement. Chronic plaque psoriasis (including scalp psoriasis, flexural psoriasis, and facial psoriasis) is the most common form, affecting 80–90% of people with psoriasis. The second most common form is localized pustular psoriasis of the palms and soles. Other

2018 NICE Clinical Knowledge Summaries

135. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition

. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear G . The tolerance of soft tissue for pressure and shear may also be affected by microclimate G , nutrition, perfusion, co-morbidities and condition of the soft tissue. ” (National Pressure Ulcer Advisory Panel [NPUAP], 2016, para 3). Within the context of this Guideline, the interprofessional team refers to a team consisting of regulated health-care providers who provide wound care (i.e., pressure (...) in this Guideline overlap with wound care best practices in specialized populations (e.g., pediatric, spinal cord injury, bariatric, critically ill, older adults, individuals in the operating room, and individuals in palliative care settings), they do not fully encompass the comprehensive care required by these sub-groups. Th us, these specialized populations are considered to be outside the scope of this Guideline. For additional information on pressure injury management in these populations, please refer

2016 Registered Nurses' Association of Ontario

136. CRACKCast E005 – Patient Monitoring

CRACKCast E005 – Patient Monitoring CRACKCast E005 - Patient Monitoring - CanadiEM CRACKCast E005 – Patient Monitoring In , by Adam Thomas September 15, 2016 This episode of CRACKCast covers Rosen’s Chapter 005, Patient Monitoring. Proper management of any acutely ill patient requires accurate monitoring. This involves understanding of the strengths and limitations to the monitoring modalities at the emergency physician’s disposal. Shownotes – Link 1) List 6 situations when pulse oximetry (...) will falsely read as high So when is pulse oximetry not useful? Three settings: 1) Methemoglobinemia cyanide poisoning antimalarials benzocaine post methylene blue infusion 2) Carboxyhemoglobinemia CO poisoning 3) Poor light penetration dark nail polish low perfusion states dark skinned patients 2) List 10 situations when capnography is useful Capnography can be qualitative or quantitative: End-tidal CO2 measurement Colorimetry (qualitative) Uses a breath by breath assessment purple = <4 mmhg CO2 tan = 4

2016 CandiEM

137. Masican - masitinib

Performance Liquid Chromatograph HR Hazard ratio MTD Maximum tolerated dose OS Overall Survival PD Progressive disease PDGFR Platelet-derived growth factor receptor PFS Progression Free Survival P-gp Permeability glycoprotein PR Partial Response SAE Serious adverse events SD Stable Disease / Standard Deviation TKI Tyrosine Kinase Inhibitor t max Time to maximum concentration Vd Volume of distribution WT Wild Type Assessment report EMA/303044/2014 Page 6/77 1. Background information on the procedure 1.1 (...) Similarity Pursuant to Article 8 of Regulation (EC) No. 141/2000 and Article 3 of Commission Regulation (EC) No 847/2000, the applicant did not submit a critical report addressing the possible similarity with authorised orphan medicinal products because there is no authorised orphan medicinal product for a condition related to the proposed indication. Applicant’s requests for consideration Conditional Marketing Authorisation The applicant requested consideration of its application for a Conditional

2014 European Medicines Agency - EPARs

138. Masiviera - masitinib

ECOG Eastern Cooperative Oncology Group EGFR Human epidermal growth factor EMA European medicine agency F Bioavailability FGFR3 fibroblast growth factor receptor 3 HR Hazard ratio KPS Karnofsky Performance Status M+G Masitinib + gemcitabine mITT modified Intent To Treat M-RECIST Modified Response Evaluation Criteria In Solid Tumours NA Not applicable or not assessable NOAEL No observable adverse effect level OS Overall Survival PD Progressive disease PDGF Platelet-derived growth factor PDAC (...) Serious adverse events SD Stable Disease t1/2 half life TKI Tyrosine Kinase Inhibitor Tmax Time to maximum concentration TTP Time to progression ULN Upper limit of normal VAS Visual analogue scale Vd Volume of distribution WT Wild Type EMA/CHMP/327108/2014 Page 7/71 1. Background information on the procedure 1.1. Submission of the dossier The applicant AB Science submitted on 30 August 2012 an application for Marketing Authorisation to the European Medicines Agency (EMA) for Masiviera, through

2014 European Medicines Agency - EPARs

139. Nonimmune hydrops fetalis

of these are disorders associated with lymphatic dysfunction, such as Noonan and multiple pterygium syndrome, both of which frequently present with cystic hygroma; idiopathic chylothorax, in which a local pleuromediastinal lymph vessel disturbance occurs as the possible pathogenic mechanism; yellow nail syn- drome, a dominantly inherited congen- ital lymphedema syndrome; and congenitalpulmonary lymphangiectasia. Familial recurrence in some of these cases suggests a hereditary maldevelop- ment of lymphatic vessels (...) an- tigen A, also called anti-Ro, or the combinationantiSSA/RoorantiRo/SSA antibodies associated with maternal autoimmune disease. It may also result from structural abnormalities affecting cardiac conduction, as with endocardial cushion defects in the setting of a het- erotaxy syndrome. Once third-degree atrioventricular block has developed, treatment with corticosteroid therapy hasnotbeenshowntobebene?cial,and inthesettingofhydropstheprognosisis poor. 22 For thisreason, in-uterotherapy for fetal

2015 Society for Maternal-Fetal Medicine

140. Diagnosis and Management of Aplastic Anaemia

and exclude clonal evolution to myelodysplastic syndrome (MDS) or paroxysmal nocturnal haemoglobinuria (PNH), as this will influence the choice of conditioning. It is also vital not to miss constitutional AA so as to avoid (i) serious (and potentially lethal) toxicity from the transplant and (ii) inappropriate selection of a sibling donor. Grade 1C The Haematopoietic Cell Transplant Co‐morbidity Index or equivalent assessment should be documented. Grade 2B Alternatives to HSCT, including IST, should (...) putative drugs should be discontinued and the patient should not be re‐challenged. If a possible drug association is suspected, this must be reported to the Medicines and MHRA using the Yellow Card Scheme ( ). There is usually no hepatosplenomegaly or lymphadenopathy (except in infection). In young adults the presence of short stature, skin hyper/hypo pigmented areas and skeletal abnormalities, particularly affecting the thumb is suggestive of FA (Shimamura & Alter, ). The triad of nail dystrophy

2015 British Committee for Standards in Haematology

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