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aspirin and Reye syndrome


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161. Funtabulously Frivolous Friday Five 208

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 (...) 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

2017 Life in the Fast Lane Blog

162. 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

163. Herpes simplex - oral

— an immune-complex-mediated hypersensitivity disorder that affects the skin and mucous membranes. Syphilis — typically causes a single non-tender ulcer. For more information, see the CKS topic on . Behçet syndrome — produces oral and genital ulcerative disease, and may have associated uveitis. Herpes simplex gingivostomatitis: Aphthous ulcers or stomatitis. For more information, see the CKS topic on . Herpangina — small ulcers typically on the soft palate in children, caused by Coxsackie virus. Oral (...) (such as Bonjela ® ) are no longer licensed for use in children under 16 years of age because of the theoretical risk of Reye's syndrome if they are overused. The prescriptions have been updated accordingly. Issued in May 2009. April 2008 — minor update to text following late comments from an external reviewer. September to December 2007 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked

2016 NICE Clinical Knowledge Summaries

164. Analgesia - mild-to-moderate pain

— 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 (...) 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

2015 NICE Clinical Knowledge Summaries

165. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly

Medical Therapy Diminish Cardiopulmonary Comorbidities and Anesthesia-Related Risks of Surgical Treatment? As discussed in section 5.5, cardiovascular disease, pulmonary dysfunction, and metabolic disorders, including hyperglycemia, are prevalent in acromegaly. In addition to the morbidity caused by these complications themselves, these conditions place patients at increased anesthesia- related and operative risk. Thus, control of these comorbid conditions may reduce surgical risk and improve post (...) hypertension, cardiac disease including biventricular hypertrophy and dia- stolic or systolic dysfunction, fatigue, headaches, carpal tunnel syndrome, sleep apnea syndrome, diaphoresis, loss of vision, colon polyps, and progressive jaw maloc- clusion (Grade A; BEL 1). • R13. A serum IGF-I level, if accompanied by a large number of results from age- and sex-matched normal subjects, is a good tool to assess integrated GH secre- tion and is excellent for diagnosis, monitoring, and especially screening

2011 American Association of Clinical Endocrinologists

166. Oral anticoagulation with warfarin - 4th edition

. Recent evidence for use of aspirin as primary prophylaxis in patients at high risk of CVD suggests negligible net benefit ( ; ). Combinations of warfarin and an antiplatelet agent, compared to warfarin alone, do not have superior antithrombotic efficacy in patients with AF or stable CVD ( ; ). Patients with peripheral arterial disease or ischaemic stroke will derive equivalent secondary antithrombotic efficacy from warfarin alone, compared to aspirin alone, or indeed aspirin and dipyridamole (...) in ischaemic stroke ( ; ; . In contrast, in patients with ACS undergoing percutaneous coronary intervention (PCI) with stent implantation, combination antiplatelet therapy has superior antithrombotic efficacy to warfarin + aspirin ( ). Recommendations • Patients receiving an anti‐platelet agent as primary prophylaxis for CVD on developing an indication for warfarin should stop their antiplatelet agent ( 1B ). • Patients with peripheral artery disease or previous ischaemic stroke on antiplatelet therapy

2011 British Committee for Standards in Haematology

167. A Trial on the Efficacy, Safety and Immunogenicity of Live-Attenuated Influenza Vaccine (LAIV)

to any component of the LAIV, including egg or egg products. Severe allergic reactions after vaccination (including anaphylactic shock, allergic laryngeal edema, allergic purpura, local allergic necrosis). Acute diseases , infections or febrile diseases (axillary temperature ≥37.1℃) on the day of vaccination. Obvious coagulation dysfunction or History of anticoagulant therapy Aspirin is being used(Salicylates are a potential risk factor for Reye syndrome) Known or suspected immune deficiency diseases (...) ): Changchun BCHT Biotechnology Co. Study Details Study Description Go to Brief Summary: This study is a Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase Ⅲ Trial to evaluate the efficacy, safety and immunogenicity of a single dose of Live-Attenuated influenza Vaccine(LAIV) among healthy children and adolescents aged 3-17 years. Condition or disease Intervention/treatment Phase Influenza Biological: Live-Attenuated influenza Vaccine(LAIV) Biological: Placebo Phase 3 Detailed Description

2016 Clinical Trials

168. Safety of Nasal Influenza Immunisation in Children With Asthma

. Children and 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 ≥38.0 degrees C in last 72 hours *Acute wheeze in last 72 hours requiring treatment beyond that normally prescribed for regular use by the child's treating healthcare professional *Recent admission to hospital in last (...) have demonstrated it to be safe in children over 2 years with mild-moderate asthma. The objective of this multicentre study is to further assess the safety of intranasal LAIV in children with asthma and recurrent wheeze, including those with severe symptoms. Condition or disease Intervention/treatment Phase Asthma Drug: Administration of Live attenuated influenza vaccine (LAIV) Phase 4 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual

2016 Clinical Trials

169. Teething

, lethargy, and photophobia following excessive use of choline salicylate 8.7% gel (one 15 g tube over 24 hours, equivalent to 930 mg aspirin) [ ]. A diagnosis of suspected Reye's syndrome was made by the authors of the case report after exclusion of metabolic disorders and because the systemic salicylate concentration was just above the therapeutic range. However, a review by the MHRA and CHM concluded that a diagnosis of salicylate toxicity was more likely, given the high dose of salicylate (...) and the fact that the diagnostic criteria for Reye's syndrome were not fully met [ ]. In line with advice for aspirin, they recommended that topical oral salicylate preparations should be contraindicated in children younger than 16 years of age, because: Although the threshold salicylate concentration to precipitate Reye's syndrome is unknown, there is a theoretical risk that the excessive use of choline salicylate gels could increase the risk of Reye's syndrome. There are alternative treatment options

2014 NICE Clinical Knowledge Summaries

170. Serratus Anterior Muscle Plane Block vsThoracic Paravertebral Block For Unilateral Mastectomies

. Condition or disease Intervention/treatment Phase Breast Cancer Mastectomy Regional Anesthesia Post Operative Pain Drug: Lidocaine Drug: Bupivacaine Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 100 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single (Outcomes Assessor) Primary Purpose: Treatment Official Title: Effectiveness of Serratus Anterior Muscle Plane Block (...) at the area of injection Coagulation disorder Patients on anticoagulation Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its identifier (NCT number): NCT02822196 Contacts Layout table for location contacts Contact: Sara Guzman-Reyes, MD 713-500-6200 Contact: Tariq A Syed, MS 713-500

2016 Clinical Trials

171. CPAP Effect on Albuminuria in Patients With Diabetic Nephropathy and Obstructive Sleep Apnea

syndrome, or hospitalization for heart failure worsening, within the previous 30 days. Professional drivers, risk profession or respiratory failure. Severe daytime sleepiness (Epworth sleepiness scale >18) Concomitant treatment with high doses of acetylsalicylic acid (> 500 mg/day) or continuous treatment with non-steroidal anti-inflammatory drugs Previous treatment with CPAP Participation in another clinical trial within the 30 days prior to randomization. Contacts and Locations Go to Information from (...) Last Update Posted: September 11, 2018 Last Verified: September 2018 Individual Participant Data (IPD) Sharing Statement: Plan to Share IPD: No Keywords provided by Francisco Garcia-Rio, Hospital Universitario La Paz: CPAP Sleep apnea Diabetes Nephropathy Albuminuria Additional relevant MeSH terms: Layout table for MeSH terms Apnea Sleep Apnea Syndromes Sleep Apnea, Obstructive Kidney Diseases Diabetic Nephropathies Albuminuria Respiration Disorders Respiratory Tract Diseases Signs and Symptoms

2016 Clinical Trials

172. Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) Full Text available with Trip Pro

of Buenos Aires, Institute of Biochemistry and Biophysics, School of Pharmacy and Biochemistry , Buenos Aires , Argentina. Alvarez-Erviti Lydia L baq University College London , Department of Clinical Neurosciences , London , UK. Alves Sandro S dc CEA/DSV/12;BM, INSERM U1169, Gene Therapy for Neurodegenerative Diseases , Fontenay-aux-Roses Cedex , France. Amadoro Giuseppina G agb National Research Council (CNR), Institute of Translational Pharmacology (IFT) , Rome , Italy. Amano Atsuo A ait Osaka (...) , Columbus , OH , USA. Amessou Mohamed M cbi Wayne State University, School of Medicine , Department of Pathology , Karmanos Cancer Institute , Detroit , MI , USA. Amon Angelika A aax Massachusetts Institute of Technology, Koch Institute for Integrative Cancer Research , Cambridge , MA , USA. An Zhenyi Z bgd University of California San Francisco , Department of Neurology , San Francisco , CA , USA. Anania Frank A FA ke Emory University, School of Medicine, Division of Digestive Diseases , Atlanta , GA

2016 Autophagy

173. Efficacy & Safety of Nasal Influenza Immunisation in Children

deficiencies; and high-dose corticosteroids**. **High-dose steroids is defined as a treatment course for at least one month, equivalent to a dose of prednisolone at 20mg or more per day (any age); or for children under 20kg, a dose of 1mg/kg/day or more. Children and 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 Febrile ≥ 38.0 'C in last 72 hours Acute wheeze in last 72 hours (...) . This study will enrol 200 children (and at least 200 unvaccinated household sibling controls), many with a history of asthma or recurrent wheezing, and allow an assessment of efficacy, safety and immune correlates in these children, and how this varies with prior administration of pandemic influenza vaccine and/or LAIV. Condition or disease Intervention/treatment Phase Influenza Vaccines Efficacy and Safety Drug: Live attenuated influenza vaccine Procedure: Surveillance (nasal swabbing) during influenza

2015 Clinical Trials

174. J K Aronson – The Hitchhiker’s Guide to Clinical Pharmacology Part 2

Etomidate 1983 Adrenal suppression Uses restricted Zimeldine 1983 Hypersensitivity Withdrawn Zomepirac 1983 Anaphylaxis Withdrawn Fenclofenac 1984 Lyell’s syndrome Withdrawn Indoprofen 1984 Gastrointestinal bleeding/perforation Withdrawn Osmosin ® 1984 Gastrointestinal ulceration/perforation Withdrawn Phenylbutazone 1984 Blood dyscrasias Uses restricted; later withdrawn Aspirin 1986 Reye’s syndrome (children) Uses restricted Bupropion 1986 Seizures Withdrawn; later reintroduced Nomifensine 1986 (...) for typhoid fever led to the development of the structurally related sulfonylureas as oral hypoglycaemic drugs. Sometimes faulty reasoning leads to a lucky discovery. In the early 1940s Nana Svartz in Sweden reasoned that rheumatoid arthritis, which was thought to be an infective disease, would respond to a molecule containing a sulfonamide to combat the infection and a salicylate as an anti-inflammatory agent. She therefore synthesized a new molecule, sulfasalazine (salicylazosulfapyridine), from

2016 CEBM blog

175. Guidelines on Diagnosis and Treatment of Pulmonary Hypertension

in PAH patients with a personal or family history of hereditary haemorrhagic telangiectasia (Osler– Weber–Rendu syndrome). 31 A number of risk factors for the development of PAH have been identi?ed and are de?ned as any factor or condition that is suspected to play a predisposing or facil- itating role in the development of the disease. Risk factors were classi?ed as de?nite, likely, possible, or unlikely based on the strength of their association with PH and their probable causal role. 1 A de?nite (...) - egory but which have not been studied yet, such as drugs used to treat attention de?cit disorder. Lastly, an unlikely association is de?ned as one in which a suspected factor has been studied in epi- demiological studies and an association with PAH has not been demonstrated. De?nite clinical associations are listed among APAH conditions (Table 4) while the risk level of different drugs and toxins are listed in Table 8. † Group 2, PH due to left heart disease: even if constitutional factors may play

2009 European Society of Cardiology

176. Vaccine safety and adverse events following immunisation

drugs around the time of vaccination may lower antibody responses to some vaccines (Prymula et al., 2009). Aspirin, or medicines that contain aspirin should never be given to children under 16 years old because of the risk of developing Reye’s syndrome. Thiomersal Thiomersal is a mercury based compound has been used as a preservative in the manufacture of some vaccines for many years. In the UK, none of the routine childhood vaccines contain thiomersal. Two vaccines (Anthrax and the Green Cross (...) are described in Chapter 9. Adverse events following immunisation AEFIs may be true adverse reactions that are intrinsic to the vaccine, or may be caused by the way it is administered or be related to an underlying condition in the recipient. Other AEFIs may be coincidental and would have occurred regardless of vaccination. WHO classifies AEFIs according to four main categories: ? programme-related ? vaccine-induced ? coincidental ? unknown. Vaccine safety and the management of adverse events following

2009 The Green Book

177. A Phase III/IV Open-label Study of the Immunogenicity and Safety of a Single Dose of a Live Attenuated Influenza Vaccine (LAIV) (FluenzTM) for Each of Three Successive Years in Children naïve to, or in Previous Receipt of the AS03B Adjuvanted H1N1 (2009)

; symptomatic HIV infection; cellular immune deficiencies; and highdose corticosteroids. FLUENZ is not contraindicated for use in individuals with asymptomatic HIV infection; or individuals who are receiving topical/inhaled corticosteroids or lowdose systemic corticosteroids or those receiving corticosteroids as replacement therapy, e.g. for adrenal insufficiency. Children and adolescents younger than 18 years of age receiving salicylate therapy because of the association of Reye's syndrome with salicylates (...) to measure antibody responses to the LAIV vaccination over three subsequent years and will involve six blood samples, six dried blood spots (taken from the end of the blood sample needle) and six oral fluid samples - before and three weeks after each vaccination each year. These samples will allow us to assess how the immune system responds to the vaccinations in terms of the antibodies that are present. Condition or disease Intervention/treatment Phase Live Attenuated Influenza Vaccine Drug: Fluenz

2014 Clinical Trials

178. Safety of Nasal Influenza Immunisation in Egg Allergic Children

infection; cellular immune deficiencies; and high-dose corticosteroids. NB: LAIV is not contraindicated for use in individuals with asymptomatic HIV infection; or individuals who are receiving topical/inhaled corticosteroids or low-dose systemic corticosteroids or those receiving corticosteroids as replacement therapy, e.g. for adrenal insufficiency. Children and adolescents younger than 18 years of age receiving salicylate therapy because of the association of Reye's syndrome with salicylates and wild (...) on the safety of LAIV in egg-allergic children. In SNIFFLE 1 Study, 433 doses were given to 282 egg-allergic children; data is currently being analysed. The objective of this multicentre study is to further assess the safety of intranasal LAIV in egg-allergic children, in order to demonstrate that these children can safely be given the new LAIV within a primary care health environment. Condition or disease Intervention/treatment Phase Egg Hypersensitivity Drug: Administration of Live attenuated influenza

2014 Clinical Trials

179. Viral Infections of the Mouth (Follow-up)

that is clinically similar to that of HHV-1 infection. HHV-3, also known as varicella-zoster virus (VZV), causes the primary infection chickenpox and the secondary reactivation disease herpes zoster. HHV-4, also known as Epstein-Barr virus (EBV), causes the primary infection , and it is implicated in various diseases, such as , other immunoproliferative disorders, and nasopharyngeal carcinoma. HHV-4 causes oral hairy leukoplakia in patients who are immunosuppressed. [ ] HHV-5, also known as cytomegalovirus (CMV (...) ), causes a primary infection of the salivary glands and other tissues, and it is believed to have a chronic form. HHV-6, which can produce acute infection in CD4 + T lymphocytes, causes , a febrile illness that affects young children. It is believed to chronically persist in salivary gland tissue in some hosts, and oral shedding is the probable route of disease transmission. Although it has been linked to apical periodontitis in some studies, the evidence so far is mixed, so such an association remains


180. Upper Respiratory Tract Infection (Diagnosis)

syndrome (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). Hemoptysis suggests the possibility of tuberculosis. A tuberculin skin test, chest radiography, or both are appropriate in these patients. Complications of specific conditions Complications of group A streptococcal disease Group A streptococcal pharyngitis is of special concern because its complications include streptococcal toxic shock syndrome, acute rheumatic fever (ARF), acute glomerulonephritis (...) . Lymphadenitis may follow or accompany URI. Guillain-Barré syndrome may manifest as an ascending polyneuropathy a few days or weeks after a URI. In children or adolescents, the use of aspirin during a viral infection may rarely cause Reye syndrome. Aspirin is contraindicated for the management of fevers in children or adolescents. URI, especially with fever, may increase the work of the heart, adding strain to persons with suboptimal cardiovascular status, and can lead to cardiovascular decompensation


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