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121. Meningitis - bacterial meningitis and meningococcal disease

or meningococcal disease? Provide information and support for the person and their family from patient support organisations such as: NHS A-Z ( ). Meningitis Research Foundation ( ). Free 24-hour UK helpline: 080 8800 3344. The Meningitis Now (Trust) ( ). Offers free services, providing emotional, practical, and financial support for people who have been affected by meningitis. Free 24-hour UK helpline: 080 8801 0388. Brain and Spine Foundation ( ). Free telephone number: 0808 808 1000. The National Deaf

2019 NICE Clinical Knowledge Summaries

126. Leg cramps

(such as arrythmias, convulsions, respiratory depression, and renal failure) and irreversible loss of vision. Cinchonism can occur in overdose, but has also been reported after normal doses of quinine — symptoms include nausea, vomiting, convulsions, headache, tinnitus, deafness, vasodilation, and visual disturbance. In high doses, quinine can be teratogenic and may cause miscarriage. Other reported adverse effects include: Haematological: thrombocytopenia, intravascular coagulation, pancytopenia. Neurological

2018 NICE Clinical Knowledge Summaries

127. Trigeminal neuralgia

, and gradually withdrawn. Referral to a neurologist or a specialist in pain management should be considered if the person has severe pain that limits their daily acitivities. Specialist referral, with the urgency determine by clinical judgment, is advised if there are atypical clinical features, or features suggestive of a serious underlying cause (e.g. sensory changes, deafness or other ear problems, history of skin or oral lesions that could spread perineurally, pain only in the ophthalmic division (...) : Tumours, such as posterior fossa tumours, extracranial masses along the trigeminal nerve, perineural spread of existing malignancy, cavernous sinus masses. Multiple sclerosis. Epidermoid, dermoid, or arachnoid cysts. Aneurysm, or arteriovenous malformation. Assess for the presence of red flag symptoms and signs that may suggest a serious underlying cause, including: Sensory changes. Deafness or other ear problems. History of skin or oral lesions that could spread perineurally. Pain only

2018 NICE Clinical Knowledge Summaries

128. Immunizations - childhood

presents with unilateral or bilateral parotid swelling, but may be asymptomatic. Complications include pancreatitis, oophoritis, orchitis (rarely, it may cause male infertility), aseptic meningitis, and encephalitis. Very rarely, mumps may cause permanent unilateral or bilateral sensorineural deafness (estimates vary from 1 in 3400 to 1 in 20,000 infections). For more information, see the CKS topic on . Morbidity from mumps has decreased significantly since the introduction of the measles, mumps (...) conjunctivitis. An erythematous rash, usually seen on the face and neck and behind the ears, is usually transitory. Maternal infection in the first 8–10 weeks of pregnancy may have serious consequences: fetal damage occurs in up to 90% of infants, resulting in multiple defects including cataracts; deafness; cardiac abnormalities; microcephaly; intrauterine growth retardation; and inflammatory lesions of the brain, liver, lungs, and bone marrow. For more information, see the CKS topic on . Since universal

2018 NICE Clinical Knowledge Summaries

129. Lyme disease

: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens Johnson syndrome, toxic epidermal necrolysis, erythema multiforme. Other adverse effects reported rarely, or very rarely, include: Anaphylaxis. Arrhythmias. Arthralgia. Deafness. Hepatitis, cholestatic jaundice. Pancreatitis. QT interval prolongation. Jarisch–Herxheimer reaction — this has been observed in about 15% of people with Lyme disease. It is a systemic reaction thought to be caused by the release of cytokines when

2019 NICE Clinical Knowledge Summaries

132. Impetigo

, depression, mania, hallucination. Skin — rash, hyperhidrosis (common), pruritus, urticaria (uncommon). Rarely, or very rarely: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens Johnson syndrome, toxic epidermal necrolysis. Other adverse effects reported rarely, or very rarely, include: Anaphylaxis. Arrhythmias. Deafness. Pancreatitis. QT interval prolongation. [ ; ; ] Drug interactions What key interactions are associated with clarithromycin? Calcium channel blockers (CCBs

2018 NICE Clinical Knowledge Summaries

133. Hypothyroidism

to symptoms such as fatigue, depression, and cold intolerance. Cardiovascular complications including dyslipidaemia, coronary heart disease, and heart failure. Reproductive complications such as impaired fertility, and serious obstetric and neonatal complications such as miscarriage, stillbirth, and congenital abnormalities. Neurological and cognitive complications including deafness, impaired concentration and memory. Myxoedema coma. Symptoms are often non-specific and may go unrecognized. They include (...) distress, congenital abnormalities, congenital hypothyroidism, and impaired fetal neurocognitive development [ ; ; ; ; ]. Neurological and cognitive complications In OH, these include: Deafness. Impaired attention, concentration, memory, perceptual function, language, executive function, and psychomotor speed [ ]. Data on the association between SCH and cognitive impairment are inconsistent. One systematic review and meta-analysis of 15 studies (n = 19,944) found no evidence of an association between

2018 NICE Clinical Knowledge Summaries

134. Neck pain - whiplash injury

. The impact may result in bony or soft-tissue injuries, which may lead to a variety of clinical manifestations called whiplash-associated disorders (WAD). The most common symptoms of whiplash are: Neck pain that may refer to the shoulder or arm. Headache. Other signs and symptoms of whiplash may include: A reduced range of neck movements. Muscular spasm. Stiffness. Deafness. Tinnitus. Dysphagia and nausea. Fatigue, dizziness, and paraesthesiae. Memory loss. Temporomandibular joint pain (...) accuracy of the Canadian C-Spine Rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria found that the Canadian C-Spine Rule was more accurate. Signs and symptoms What are the signs and symptoms of whiplash? The most common symptoms of whiplash are: Neck pain which may be referred to the shoulder or arm (88-100% of people). Headache (54-66% of people). Other signs and symptoms of whiplash may include: A reduced range of neck movements. Muscular spasm. Stiffness. Deafness

2018 NICE Clinical Knowledge Summaries

135. Otitis externa

by the Medicines and Healthcare products Regulatory Agency (MHRA). Prescriptions have been updated to reflect the revised dosing. Issued in July 2011. June 2011 — topic structure revised to ensure consistency across CKS topics — no changes to clinical recommendations have been made. August to October 2010 — updated. Topical acetic acid 2% is now recommended for first-line use in cases of mild acute diffuse otitis externa (discomfort and/or itch; no pain, deafness, or discharge). Topical antibiotics (...) irrigation with tap water, especially in people with other risk factors. [ ; ] Complications What are the complications of otitis externa? The complications of otitis externa include: Abscess. Chronic otitis externa. Regional dissemination of infection with: auricular cellulitis, chondritis, parotitis, spreading cellulitis. Fibrosis, leading to stenosis of the ear canal and conductive deafness. Myringitis (inflammation of the tympanic membrane). Tympanic membrane perforation. Malignant otitis

2018 NICE Clinical Knowledge Summaries

136. Mumps

is rare. Oophoritis — reported in about 7% of women with mumps, but rarely causes infertility or premature menopause. Aseptic meningitis — occurs in up to 25% of people with mumps, and is three times more common in males. Mumps meningitis is usually benign, and almost all patients have a complete recovery with no residual neurological deficits and no risk of mortality. Transient hearing loss — affects about 4% of people, but permanent deafness is much less common (about 1 in 20,000 people). Bilateral (...) peaking after 2 days, and then resolving over the course of about 1 week. Deafness — this is rarely permanent. Pancreatitis — causes upper abdominal discomfort, but is nearly always mild and transient in nature. Assess the likelihood of mumps, by considering: Immunization history. Mumps is unlikely in people who have been fully immunized. Younger people who have not received two doses of the combined measles, mumps, and rubella (MMR) vaccine are most at risk. History of mumps — mumps is unlikely

2018 NICE Clinical Knowledge Summaries

137. Rubella

-assessment and counselling. Risk to the fetus is dependent on stage of pregnancy: Beyond 20 weeks' gestation there have been no published case reports of (CRS). Between 16–20 weeks' gestation there is a low chance of deafness occurring. Between 11–16 weeks' gestation there is a 10–20% risk of CRS, with single defects being most common. Before 8–10 weeks' gestation there is a 90% risk of CRS and a high likelihood of multiple defects. There are no effective treatments to prevent CRS but Human Normal

2018 NICE Clinical Knowledge Summaries

139. Carbon monoxide poisoning

air vents. Have all gas appliances correctly installed and serviced regularly by a registered engineer. By law, engineers fitting or servicing gas appliances must be Gas Safe registered engineers. People aged over 60 years of age, chronically sick, disabled, deaf or hearing-impaired, blind or visually impaired could be entitled to a free annual gas safety check (unless they live in a rented accommodation, where it is the landlord's responsibility to ensure that the check is done

2018 NICE Clinical Knowledge Summaries

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