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aspirin and Reye syndrome

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81. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes mellitus, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †For comparative-effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments

2014 Society for Cardiovascular Angiography and Interventions

83. Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury

are the more common causes of DILI in children. Infants and children appear susceptible to liver injury caused by valproate and are at an increased risk of Reye ’ s syndrome caused by aspirin. Although propylthiouracil may cause DILI in all age groups, children are more susceptible to severe and fatal hepa- totoxicity due to propylthiouracil ( 13,14 ). With increasing age, there is an increasing risk of liver injury because of many medica- tions such as isoniazid, amoxicillin – clavulanate, and nitrofuran (...) of this diagnosis, but ceruloplasmin is an acute-phase reactant and may be falsely normal or elevated during an acute hepatitis. When suspicion remains or ceruloplasmin level is low, other tests such as 24-h urine collection for copper, slit-lamp eye examina- tion for Kayser – Fleischer rings, serum copper levels, and genetic testing of the ABC B7 gene are indicated as outlined in diagnos- tic guidelines for diagnosing Wilson ’ s disease ( 27 ). Budd – Chiari syndrome may sometimes mimic DILI, and thus

2014 American College of Gastroenterology

84. Clinical practice guideline for care in pregnancy and puerperium

Health, Social Inclusion and Quality of Life, Consejería de Igualdad, Salud y Políticas Sociales, Seville. Reyes Sanz-Amores. Physician, Servicio de Calidad y Procesos. Dirección General de Calidad, Investigación y Gestión del Conocimiento. Department of Equality, Health and Social Policies, Seville. Cooperating Societies Spanish Society for Family and Community Medicine (SEMFyC) Spanish Society of Gynaecology and Obstetrics (SEGO) Spanish Society of Neonatology (SEN) Federation of Spanish Midwives (...) and the puerperium period, but does not provide information on situations that require extra care such as: Previous pathology • Heart disease, including high blood pressure • Kidney disease • Diabetes mellitus and other endocrine disorders • Chronic respiratory disease: severe asthma • Hematologic diseases, including thalassemia, sickle cell anaemia and thrombophilia • Autoimmune diseases with systemic involvement: antiphospholipid antibody syndrome • Epilepsy and other neurological diseases • Psychiatric

2014 GuiaSalud

85. Kawasaki disease. The importance of prompt recognition and early referral

, there is a small risk that salicylates are associated with an increased risk of Reye syndrome in the setting of active viral infection, although only two cases of Reye syndrome in patients with previous Kawasaki disease have been reported in the literature. Varicella and annual influenza immunisation should be considered in children on long term aspirin therapy; expert advice should be sought. In addition, anti-viral IgG in IVIG may interfere with the efficacy of live vaccines (measles, mumps, rubella [MMR (...) lymph node syndrome. 1 Kawasaki disease is relatively common, with an annual incidence in the United Kingdom and United States of approximately 9–12 per 100 000 children aged less than 5 years, compared to an age-matched incidence of meningococcal disease of approximately 1 per 100 000. 2 Kawasaki disease mainly affects children aged 6 months to 4 years and has surpassed acute rheumatic fever as the most common cause of paediatric acquired heart disease in the industrialised world, causing cardiac

2014 Clinical Practice Guidelines Portal

86. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

, resulting in a platelet-fibrinogen plug at the site of injury. Thrombin production then results in clot formation through alteration of fibrinogen into fibrin. Mechanisms of antiplatelet agents: Aspirin inhibits cyclooxygenase-1 (COX-1). Prostacyclin increases cAMP-dependent protein kinase A (PKA). Dipyridamole increases cGMP-dependent protein kinase G (PKG). Direct thrombin inhibitors inhibit thrombin, which activates protease-activated receptor 1 (PAR 1). Abciximab inhibits the glycoprotein IIb-IIIa (...) : individualized dosing titrated to INR. Target INR range, 2–3.Mechanical mitral valves, 2.5–3.5. INR daily until therapeutic, then decreased frequency when stable with minimum monthly testing.Test INR with illness, medication, or diet change. Hemorrhage, 0.5% per patient-y.Increases with INR >8.Prosthetic valves0.4% per patient-y. , Tracheal calcification, hair loss, decreased bone mineral density. , Antiplatelet therapy ( ) Aspirin , Inhibition of COX-1 and COX-2 activity Oralt½ is dose dependent. 15–20 min

2013 American Heart Association

88. Quality Improvement Guidelines for Percutaneous Management of Acute Lower Extremity Ischemia

. Several independent variables have been identi?ed, including (i) acute versus chronic limb ischemia; (ii) target site treated, ie, native vessel or graft; (iii) dosing regimen of the thrombolytic drug and duration of therapy; (iv) method of infusion, ie, continuous infusion versus bolus infusion or other methods; (v) postthrombolytic anticoagulation therapy, eg, heparin or aspirin; and (vi) clinical endpoints, eg, technically successful thrombolysis versus clinically useful thrombolysis versus (...) and ischemic changesmaybecomeirreversibleoverthecourseoftreatment.Inaddition, revascularization of category III ischemia carries the added risk of toxic shock syndrome. Intravenous heparin at full anticoagulation doses should be initiated as soon as possible and continued until thrombolysis is started. Prompt initiation of anticoagulation reduces or prevents clot propagation and reduces the chances of further embolization. In one study (61), the time from establishing diagnosis to initiation of therapy

2013 Society of Interventional Radiology

89. Richard Lehman’s journal review—16 July 2018

”. Back then there was something called “children’s aspirin” which was fixed at a dose of 75mg in the UK and 82.5mg in the USA. When aspirin was found to kill children through Reye’s syndrome, these doses persisted as the standard doses for cardiovascular protection. with a magnificent individual participant data analysis of the preventive effect of aspirin 75-100mg according to body weight and other individual characteristics. “ Low doses of aspirin (75–100 mg) were only effective in preventing (...) is currently being evaluated in a phase 2b clinical efficacy study in sub-Saharan Africa.” That’s it folks. Worth a couple of sentences in a trade journal at this point, perhaps. The Lancet ? Weighing the effects of aspirin But now for something truly mighty. The debate about the right dose of aspirin for primary prevention started in the 1980s, when I remember a cardiology professor saying “if you just keep an aspirin tablet on the bathroom shelf and lick it every day, you’ll probably be about right

2018 The BMJ Blog

90. Jeffrey Aronson: When I use a word . . . Must and should

”; the semi-modal (or marginal modal) verbs are “ought to”, “used to”, “dare [to]”, and “need [to]”. Modal verbs have three uses. • Epistemic modal verbs (Greek ἐπιστήμη, knowledge) express the truth or likelihood of a proposition, i.e. whether it is possible, probable, or necessarily true. For example: “Aspirin may cause Reye’s syndrome” [in general, with a particular probability]; “Aspirin might cause Reye’s syndrome” [with a particular probability, in this case]; “The aspirin must have caused Reye’s (...) syndrome” [for certain, in this case]. • Dynamic modal verbs (Greek δύναμις power or strength) ascribe ability or volition. For example: “Aspirin can cause Reye’s syndrome” [it has the ability in general to do so, even if it didn’t do so in a particular case]. • Deontic modal verbs (Greek δέον, binding) express directives or permission. For example: “You must prescribe aspirin” [an imperative]; “You should or ought to prescribe aspirin” [preferably, unless something dictates otherwise]; “You may

2018 The BMJ Blog

91. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis

Therapy With Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Acetaminophen, Aspirin, or Corticosteroids Be Given to Patients Diagnosed With GAS Pharyngitis? Recommendation 10. Adjunctive therapy may be useful in the management of GAS pharyngitis. If warranted, use of an analgesic/antipyretic agent such as acetaminophen or an NSAID for treatment of moderate to severe symptoms or control of high fever associated with GAS pharyngitis should be considered as an adjunct to an appropriate antibiotic (strong (...) , high). Aspirin should be avoided in children (strong, moderate). Adjunctive therapy with a corticosteroid is not recommended (weak, moderate). V. Is the Patient With Frequent Recurrent Episodes of Apparent GAS Pharyngitis Likely to Be a Chronic Pharyngeal Carrier of GAS? Recommendations 11. We recommend that clinicians caring for patients with recurrent episodes of pharyngitis associated with laboratory evidence of GAS pharyngitis consider that they may be experiencing >1 episode of bona fide

2012 Infectious Diseases Society of America

92. Management of suspected viral encephalitis in children

Coccidioidomycosis Cryptococcosis Histoplasmosis North American blastomycosis Para/post-infectious causes Inflammatory Acute disseminated encephalomyelitis (ADEM) Acute haemorrhagic leukoencephalopathy (AHLE) Acute necrotising encephalitis (ANE) in children Bickerstaff's encephalitis Toxic/Metabolic Reye's syndrome Systemic infection Septic encephalopathy Shigellosis Non-infectious causes Vascular Vasculitis Systemic lupus erythematosis Behçet's disease Subarachnoid & subdural haemorrhage Ischaemic (...) of management guidelines. In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a similar simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis. Keywords: , , , , , , Introduction Encephalitis is defined as a syndrome of neurological dysfunction caused by inflammation of the brain parenchyma. Encephalitis has many causes and some

2012 British Infection Association

93. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

. Diagnosis and management of acute rheumatic fever 30 The importance of accurate diagnosis 30 Diffi culties with diagnosis 30 Current approaches to diagnosis: Jones criteria, WHO criteria and Australian guidelines 30 Clinical features of acute rheumatic fever: major manifestations 33 Clinical features of acute rheumatic fever: minor manifestations 36 Evidence of group A streptococcal infection 38 Differential diagnosis 39 Syndromes that may be confused with acute rheumatic fever 39 Echocardiography (...) and timing of discharge • Addition of ibuprofen as an alternative to aspirin for treatment of ARF • Recommended aspirin dose changed from 80- 100 mg/kg/day to Begin with 50-60 mg/kg/day, increasing, if needed, up to 80–100 mg/kg/day Chapter 4 - Secondary prevention and RHD control programs Individual approaches to secondary prevention • New recommendations for duration of secondary prophylaxis for Probable ARF • Revised discussion of Australian/regional studies/ evidence • Recommended 23 g needle changed

2012 Clinical Practice Guidelines Portal

94. A Study to Evaluate the Reactogenicity, Safety and Immunogenicity of GlaxoSmithKline (GSK) Biologicals' Investigational Supra-seasonal Universal Influenza Vaccines

or by HIV infection); Adolescents (through 18 years) who are receiving aspirin- or salicylate-containing medications and who might be at risk for experiencing Reye syndrome after influenza virus infection; Residents of nursing homes and other long-term care facilities; American Indians/Alaska Natives; and Persons who are extremely obese (Body Mass Index ≥ 40). Additional criterion applicable for Phase I subjects: Hematological and/or biochemical parameters outside the laboratory normal ranges, unless (...) with excessive daytime sleepiness or narcolepsy; or history of narcolepsy in a subject's parent or sibling. History of Guillain-Barré syndrome. History of any reaction or hypersensitivity likely to be exacerbated by any component of the vaccines; a history of anaphylactic-type reaction to consumption of eggs; or a history of severe adverse reaction to a previous influenza vaccine. Hypersensitivity to latex. Acute disease and/or fever at the time of enrolment. Fever is defined as temperature ≥ 38.0°C / 100.4

2017 Clinical Trials

95. The flu is coming. I repeat, The flu is coming!

with conditions that compromise respiratory function or handling of secretions (including tracheostomy and mechanical ventilation) 12 Women who are pregnant or postpartum during the influenza season Children and adolescents <19 years who are receiving long-term aspirin therapy or salicylate-containing medications (including those with Kawasaki disease and rheumatologic conditions) because of increased risk of Reye syndrome American Indian and Alaskan native people Children and adults with extreme obesity (ie

2019 PEM Blog

97. Dengue

to risk of (as well as Reye Syndrome risk) Daily monitoring of and Hospitalization indications Infants, elderly and pregnant women Serious comorbidity ( , unreliable social situation) Findings suggestive of impending severe Dengue Severe Dengue management Aggressive supportive care initial protocol NS or LR 5-7 cc/kg/h for 1-2 hours then 3-5 ml/kg/h for 2-4 hours then 2-3 ml/kg/h X. Course Incubation: 3-15 days (typically 4-8 days) Usually benign and self-limited course lasting <7 days XI. Prevention (...) hemorrhagic fever, which causes bleeding from your nose, gums, or under your skin. It can also become dengue shock syndrome, which causes massive bleeding and shock. These forms of dengue are life-threatening. There is no specific treatment. Most people with dengue recover within 2 weeks. Until then, drinking lots of fluids, resting and taking non-aspirin fever-reducing medicines might help. People with the more severe forms of dengue usually need to go to the hospital and get fluids. To lower your risk

2018 FP Notebook

98. Jeffrey Aronson: When I use a word . . . Modes of speech: can and may, must and should

Jeffrey Aronson: When I use a word . . . Modes of speech: can and may, must and should Jeffrey Aronson: When I use a word . . . Modes of speech: can and may, must and should - The BMJ ---> Which is better: “Aspirin can cause Reye’s syndrome” or “Aspirin may cause Reye’s syndrome”? The answer lies in a consideration of modal verbs, also called modal auxiliaries. Modal verbs are used to express modality, in other words, they modify the meaning of a verb, indicating how to interpret it. The main (...) (or central) modal verbs are “can”, “could”, “shall”, “should”, “will”, “would”, “may”, “might”, and “must”; the semi-modal (or marginal modal) verbs are “ought to”, “used to”, “dare [to]”, and “need [to]”. They have three uses. Epistemic modal verbs (Greek ἐπιστήμη, knowledge) express the truth or likelihood of a proposition, i.e. whether it is possible, probable, or necessarily true. For example: “Aspirin may cause Reye’s syndrome” [in general, with a particular probability]; “Aspirin might cause Reye’s

2017 The BMJ Blog

99. Funtabulously Frivolous Friday Five 208

got fed some diet tablets out of her handbag by the mischievous 3 year old brother. What might they be? Phentermine . Any of the sympathomimetic diet agents would give a similar presentation. The child was admitted given the potential risk of seizures and choreiform movements. Unsurprisingly her lack of appetite necessitated an NG for hydration support! Question 4 Why don’t we give aspirin to children? Risk of Reye’s Syndrome . First described by Dr Douglas Reye in a report published in the Lancet (...) of Reye’s syndrome has decreased since the 1970s and 80s. Whether this is due to a reduction in the use of aspirin to treat fever in children with viral illnesses, or to an increase in earlier diagnosis of other inborn errors of metabolism is uncertain. However, now the only disease whereby aspirin is given to children is Kawasaki’s. [ ] Question 5 Tall, obese, adolescent boys with small external genitalia are most commonly affect by what orthopaedic condition? Slipped upper femoral epiphyses. [ ] Share

2017 Life in the Fast Lane Blog

100. Analgesia - mild-to-moderate pain

rheumatoid arthritis [ ]. Aspirin is not licensed for use in people younger than 16 years of age because of the risk of Reye's syndrome in this group. Reye's syndrome is a very rare but often fatal disease. It is characterized by encephalopathy and fatty degeneration of the liver [ ]. Codeine and dihydrocodeine are licensed for use in children. However, following a review by the European Medicines Agency (EMA) codeine is now restricted for use as an analgesic for children and adolescents [ ]. The EMA has (...) — at analgesic doses, aspirin increases the level of uric acid. Severe hepatic impairment — due to the increased risk of gastrointestinal bleeding. Severe chronic kidney disease (CKD) stage 4 or estimated Glomerular Filtration Rate (eGFR) of 15-29 – due to the increased risk of deterioration of renal function and GI bleeding. Children younger than 16 years of age (unless specifically indicated by a specialist, for example for Kawasaki disease) – due to the risk of Reye's syndrome. Women who are in the third

2015 NICE Clinical Knowledge Summaries

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