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141. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Full Text available with Trip Pro

antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines. Introduction Each year in the United States, >690 000 adults experience an ischemic stroke. The enormous morbidity of ischemic stroke is the result of interplay between the resulting neurological impairment, the emotional and social consequences of that impairment (...) Heart Association (AHA) and American College of Chest Physicians (ACCP) guidelines. – Sections on pregnancy and intracranial atherosclerosis have also been rewritten substantially. One section was removed (Fabry disease) in recognition of the rarity and specialized nature of this condition. Table 1. New or Substantially Revised Recommendations for 2014* Section 2014 Recommendation Description of Change From 2011 Hypertension Initiation of BP therapy is indicated for previously untreated patients

2014 American Heart Association

142. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

with multiple conditions, compared with managing patients with a single disease, and the challenge is compounded when CPGs for evaluation or treatment of several coexisting illnesses are discordant or interacting. CPGs attempt to define practices that meet the needs of patients in most, but not all, circumstances and do not replace clinical judgment. Clinical Implementation —Management in accordance with CPG recommendations is effective only when followed; therefore, to enhance the patient’s commitment (...) . Cardiomyopathy e286 2.4. Valvular Heart Disease: Recommendations e286 2.4.1. Aortic Stenosis: Recommendation e287 2.4.2. Mitral Stenosis: Recommendation e287 2.4.3. Aortic and Mitral Regurgitation: Recommendations e287 2.5. Arrhythmias and Conduction Disorders e288 2.5.1. Cardiovascular Implantable Electronic Devices: Recommendation e288 2.6. Pulmonary Vascular Disease: Recommendations e289 2.7. Adult Congenital Heart Disease e289 Calculation of Risk to Predict Perioperative Cardiac Morbidity e289 3.1

2014 American Heart Association

143. 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

144. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

the team of authors and reviewers for their time and valuable contribu- tions. I believe this CPG will be an invaluable document for healthcare providers involved in the management of STEMI and subsequently to im- prove health outcomes associated with this deadly condition. (Datuk Dr. Noor Hisham bin Abdullah) The Director General of Health, Ministry of Health Malaysia ST segment myocardial infarction (STEMI) is the most deadly among the clinical presentations of acute coro- nary syndrome (ACS). Unlike (...) many of medical conditions, STEMI is associated with high mortality and morbidity in its early stages, including sudden death. The National Cardiovascular Disease (NCVD) ACS Registry revealed that there was a 10% mortality rate for patients who were admitted to hospital with STEMI in 2006-2008. iChairperson: Dr. Robaayah Zambahari Senior Consultant Cardiologist Institute Jantung Negara, Kuala Lumpur Secretary: Dr. Jeyamalar Rajadurai Consultant Cardiologist Subang Jaya Medical Centre, Selangor

2014 Ministry of Health, Malaysia

145. Quality Improvement Guidelines for Pediatric Gastrostomy and Gastrojejunostomy Tube Placement

techniques are similar to techniques in adults, radiation protection is a particular concern, and small body size and different sedation requirements call for particular skill sets compared with adult practice; in addition, G tubes and GJ tubes need to be placed in children with conditions that are rarely, if ever, encountered in adult practice, such as esophageal atresia and microgastria (1). In addition to required informed consent of the parent or guardian to G tube or GJ tube placement, which covers (...) ). The threshold for these indications is 95%. Wheno 90% of procedures are for these indications, the department will review the process of patient selection. Gastric Feeding Many studies have shown that children with chronic diseases have decreased caloric intake or increased nutritional requirements (9,10). Althoughtemporaryaccesstothegastrointestinaltractcanbeobtained via a natural ori?ce such as with a nasogastric or nasojejunal feeding tube, such tubes are notoriously prone to occlusion and dislodgment

2014 Society of Interventional Radiology

146. Acromegaly Full Text available with Trip Pro

measurement of IGF-1 levels in patients with typical clinical manifestations of acromegaly, especially those with acral and facial features. (1|⊕⊕⊕○) 1.2 We suggest the measurement of IGF-1 in patients without the typical manifestations of acromegaly, but who have several of these associated conditions: sleep apnea syndrome, type 2 diabetes mellitus, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, and hypertension. (2|⊕⊕○○) 1.3 We recommend measuring serum IGF-1 to rule out acromegaly (...) factors underlie the pathogenesis of these benign monoclonal somatotroph adenomas ( ). Hereditary conditions include multiple endocrine neoplasia 1, Carney complex, and McCune-Albright syndrome. Germline aryl hydrocarbon receptor interacting protein mutations have been described in familial acromegaly with more aggressive tumors ( ). 1.0 Diagnosis 1.1 We recommend measurement of IGF-1 levels in patients with typical clinical manifestations of acromegaly, especially those with acral and facial features

2014 The Endocrine Society

147. Kawasaki disease Full Text available with Trip Pro

as , , and . are thought to be caused by localised , can include attention deficits, learning deficits, emotional disorders ( , fear of night, and ), and internalization problems ( , or ). Causes [ ] As the cause(s) of Kawasaki disease remain unknown, the illness is more accurately referred to as Kawasaki syndrome. Its cause is widely hypothesized to involve the interaction of genetic and environmental factors, possibly including an infection in combination with to an mechanism. The specific cause is unknown (...) other indications, aspirin is otherwise normally not recommended for children due to its association with . Because children with Kawasaki disease will be taking aspirin for up to several months, vaccination against and is required, as these infections are most likely to cause Reye's syndrome. High-dose aspirin is associated with anemia and does not confer benefit to disease outcomes. have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial

2012 Wikipedia

148. Coping with Common GI Symptoms in the Community: A Global Perspective on Heartburn, Constipation, Bloating, and Abdominal Pain/Discomfort

countries, due to H. pylori infection and use of acetylsalicylic acid (ASA) and NSAIDs. • Unrecognized constipation. • Celiac disease. • Hepatic congestion/swelling of any cause—e.g., right-sided heart failure, steatosis, hepatitis. • IBD, especially Crohn’s disease. • Chronic mesenteric ischemia (older patients): pain is exacerbated by eating (intestinal angina) and is out of proportion to the physical examination; new onset in older patients, history of vascular disease, symptoms of nausea, vomiting (...) developed in a multinational consensus in accordance with predefined symptom criteria [1]. Relatively few data are available on the epidemiology of individual symptoms (with the exception of constipation), although there are considerable data on FGID syndromes. The latter are frequently used as a surrogate for the former throughout this guideline—e.g., gastroesophageal reflux disease (GERD) for heartburn, irritable bowel syndrome (IBS) for abdominal pain/bloating. In addressing any disorder

2013 World Gastroenterology Organisation

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

limb ischemia (ALI), de?ned as any sudden decrease in, or worsening of, limb perfusion causing a threat to extremity mobility and viability that has been present for less than 14 days, is one sequela of peripheral arterial disease (PAD). It is one of the most common vascular emergencies interventional radiologists and vascular surgeons are asked to evaluate and treat. The treatment options for ALI fall into three broad categories: (i) medical management, (ii) surgical management, and (iii) image (...) be addressed. There are diverse etiologies for ALI, with the two most common etiologies being embolus and thrombosis in situ secondary to underlying disease such as atherosclerosis (43). Differentiation between the two can & SIR, 2013 J Vasc Interv Radiol 2013; 24:3–15 http://dx.doi.org/10.1016/j.jvir.2012.09.026 N.H.P.isapaidconsultantfor DFineInc, Stryker,andPromexTechnologyand has a royalty agreement with Promex Technology. None of the other authors have identi?ed a con?ict of interest. This article

2013 Society of Interventional Radiology

150. Definition, Evaluation, and Treatment of Severe Asthma:

recommendations. Results: When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled“ despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count (...) on Definition, Evaluation, and Treatment of Severe Asthma • 2013 Page 7 of 112 very low quality evidence indicates that the estimated effects of interventions are very uncertain and further research is very likely to have an important impact on resulting recommendations. The strength of recommendations is expressed as either strong (We recommend…) or conditional (We suggest…) and has explicit implications (Table 1). Understanding the interpretation of these two grades is essential for sagacious clinical

2013 American Thoracic Society

151. 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

152. 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 (...) prevention so far. But it has enormous repercussions for all preventive uses of aspirin. When Bayer first made its fortune by selling acetylsalicylic acid as an analgesic in 1899, little could anyone have foreseen that dose-finding studies for the prevention of stroke, heart attacks and cancer would still be going on well into the twenty-first century. The BMJ 14 Jul 2018 Gestational dimeric inhibin-A and later CVD Another cardiovascular risk factor! Doesn’t your heart leap! And actually there are stacks

2018 The BMJ Blog

153. Management of suspected viral encephalitis in children Full Text available with Trip Pro

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 (...) cerebrovascular accidents Neoplastic Paraneoplastic encephalitis Primary brain tumour Metastases Metabolic encephalopathy Hepatic encephalopathy Renal encephalopathy Hypoglycaemia Toxins (alcohol, drugs) Hashimoto's disease Septic encephalopathy Mitochondrial diseases Other Antibody-mediated encephalitis: VGKC complex or NMDA receptor Drug reactions Encephalitis lethargica Haemophagocytic Lymphohistiocytosis (HLH) syndrome (usually children) Epilepsy Functional disorder In this table some of the important

2012 British Infection Association

154. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis Full Text available with Trip Pro

Parainfluenza Cold, croup EBV Infectious mononucleosis Cytomegalovirus CMV mononucleosis HIV Primary acute HIV Infection Mycoplasma Mycoplasma pneumoniae Pneumonitis, bronchitis Chlamydia Chlamydophila pneumoniae Bronchitis, pneumonia Chlamydophila psittaci Psittacosis Abbreviations: CMV, cytomegalovirus; EBV, Epstein-Barr virus; HIV, human immunodeficiency virus. In addition to acute disease, streptococcal pharyngitis is important because it can lead to the nonsuppurative postinfectious disorders of acute (...) ). Evidence Summary Acute GAS pharyngitis has certain characteristic epidemiological and clinical features [ , ] (Table ). The disorder is primarily a disease of children 5–15 years of age, and, in temperate climates, it usually occurs in the winter and early spring. Patients with GAS pharyngitis commonly present with sore throat (generally of sudden onset), pain on swallowing, and fever. Headache, nausea, vomiting, and abdominal pain may also be present, especially in children. On examination, patients

2012 Infectious Diseases Society of America

155. Management of suspected viral encephalitis in adults

Hypoglycaemia Toxins (alcohol, drugs) Hashimoto's disease Septic encephalopathy Mitochondrial diseases Other Antibody-mediated encephalitis: VGKC complex or NMDA receptor Drug reactions Encephalitis lethargica Haemophagocytic Lymphohistiocytosis (HLH) syndrome (usually children) Epilepsy Functional disorder Almost every infectious and non-infectious condition can occasionally present with an encephalitis-like illness. In this table some of the important aetiologies are classified into whether they cause (...) 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 cerebrovascular accidents Neoplastic Paraneoplastic encephalitis Primary brain tumour Metastases Metabolic encephalopathy Hepatic encephalopathy Renal encephalopathy

2012 British Infection Association

156. 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 (...) of this study is to assess the reactogenicity, safety and immunogenicity of different formulations of GlaxoSmithKline (GSK) Biologicals' investigational supra-seasonal universal influenza vaccines (SUIVs) (unadjuvanted or adjuvanted) in 18 to 39 year-old healthy subjects. Subjects will be enrolled and vaccinated with one or 2 primary dose(s) followed by a booster dose one year later. Condition or disease Intervention/treatment Phase Influenza, Human Biological: D-SUIV Formulation 1 Biological: D-SUIV

2017 Clinical Trials

157. Assessment of Viral Shedding in Children Previously in Receipt of Multiple Doses of Live Attenuated Influenza Vaccine (LAIV) Compared to Influenza Vaccine-naïve Controls

; or individuals who are receiving topical/inhaled/low-dose oral systemic corticosteroids or those receiving corticosteroids as replacement therapy, e.g. for adrenal insufficiency. Children / adolescents younger than 18 years of age receiving salicylate therapy because of the association of Reye's syndrome with salicylates and wild-type influenza infection. Pregnancy Contraindications to vaccination on that occasion, e.g. due to child being acutely unwell: Febrile ≥38.0oC in last 72 hours **Acute wheeze (...) ); day 21 oral fluid collection (by nurse or parent at home or at GP surgery). Condition or disease Intervention/treatment Phase Influenza Vaccination Influenza Vaccination Biological: Fluenz Tetra (The two groups are defined by immunisation history, all receive the same intervention in the study) Phase 4 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 373 participants Allocation: Non-Randomized Intervention Model: Parallel

2017 Clinical Trials

158. 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 (...) hospitalized for influenza. Note the the AAP’s official recommendations regarding antiviral treatment are: Children <5 years and especially those <2 years, regardless of the presence of underlying medical conditions Adults ≥50 years and especially those ≥65 years Children and adults with chronic pulmonary (including asthma and cystic fibrosis), hemodynamically significant cardiovascular disease (except hypertension alone), or renal, hepatic, hematologic (including sickle cell disease and other

2019 PEM Blog

159. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg (...) (such as with viral infections). Given the difficulty separating the contributions of deep structure to signs and symptoms, the term rhinosinusitis is frequently used to describe this simultaneous involvement, and will be used in this text. Rhinosinusitis refers to inflammation of the nasal cavities and sinuses. When the inflammation is due to bacterial infection, it is called bacterial rhinosinusitis. Rhinosinusitis is a frequently occurring disease, with significant impact on quality of life and health care

2011 CPG Infobase

160. Dengue

(grades III and IV), it is called dengue shock syndrome. Definition (NCI) A serious condition caused by Dengue virus infection. Patients present with an acute febrile illness followed by restlessness, irritability, and bleeding. It may lead to hemorrhagic shock and death. Concepts Disease or Syndrome ( T047 ) MSH ICD10 SnomedCT 186599009 , 186598001 , 20927009 English Hemorrhagic Fever, Dengue , DHF - Dengue haemorrhag fever , Dengue hemorrhagic fever (diagnosis) , Thai Hemorrhagic Fever , Fever (...) Sindrome da shock da dengue Spanish Síndrome de Choque por Dengue , síndrome de shock por Dengue (trastorno) , síndrome de shock por Dengue Norwegian Dengue sjokksyndrom French Syndrome de choc de la dengue , Syndrome de choc dû à la dengue , Dengue avec syndrome de choc English Dengue shock syndrome (disorder) , Dengue shock syndrome , Dengue Shock Syndrome Dutch Dengue-shocksyndroom Derived from the NIH UMLS ( ) Ontology: seven-day; fever, dengue (C1401762) Concepts Disease or Syndrome ( T047

2018 FP Notebook

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