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101. Delayed onset toxic reaction from bee sting

further Neurologic work-up. I hope this information is helpful. Eric Macy, MD, MS, FAAAAI Utility navigation Support the AAAAI Foundation 555 East Wells Street Suite 1100, Milwaukee , WI 53202-3823 Medical content developed and reviewed by the leading experts in allergy, asthma and immunology. © 2020 American Academy of Allergy, Asthma & Immunology. All Rights Reserved. | | Social navigation Mobile navigation Search navigation

2020 American Academy of Allergy, Asthma & Immunology - Ask the Expert

102. Acute idiopathic urticaria and exposure to vitamin D

navigation Support the AAAAI Foundation 555 East Wells Street Suite 1100, Milwaukee , WI 53202-3823 Medical content developed and reviewed by the leading experts in allergy, asthma and immunology. © 2020 American Academy of Allergy, Asthma & Immunology. All Rights Reserved. | | Social navigation Mobile navigation Search navigation

2020 American Academy of Allergy, Asthma & Immunology - Ask the Expert

103. Preparing for a challenging winter 2020/21

of Medical Sciences 9 2. Health and wellbeing in winter The need for health and social care undergoes large seasonal fluctuations, peaking in the winter. The winter burden on the healthcare system is not only affected by increased incidence of infectious diseases, but also non-infectious conditions that increase in prevalence or are exacerbated during the winter months, such as asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, myocardial infarction and stroke. Every winter (...) winter; led to over 17,000 excess respiratory deaths; 8,9,10,11 and caused NHS Trusts to cancel all elective surgery in January 2018, resulting in 22,800 fewer elective hospital admissions when compared to the previous year. 12 A generalised increase in respiratory infections over the winter could also rapidly overwhelm test and trace capacity. Priorities for prevention and mitigation There is a need for urgent preparation to mitigate the risks of a particularly challenging winter 2020/21, including

2020 Academy of Medical Sciences

104. COVID-19 (SARS-CoV-2) Infection in Pregnancy: A Systematic Review Full Text available with Trip Pro

George's, University of London, London, United Kingdom. 2 Faculty of Medicine, Imperial College London, London, United Kingdom. 3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, aaharky@gmail.com. 4 Department of Integrative Biology, Faculty of Life Science, University of Liverpool, Liverpool, United Kingdom, aaharky@gmail.com. PMID: 32728006 DOI: Free article Item in Clipboard COVID-19 (SARS-CoV-2) Infection in Pregnancy: A Systematic Review Hubba (...) Akhtar et al. Gynecol Obstet Invest . 2020 . Free article Show details Display options Display options Format Gynecol Obstet Invest Actions . 2020 Jul 30;1-12. doi: 10.1159/000509290. Online ahead of print. Authors , , , Affiliations 1 Department of Medicine, St George's, University of London, London, United Kingdom. 2 Faculty of Medicine, Imperial College London, London, United Kingdom. 3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, aaharky

2020 EvidenceUpdates

105. Role of extracorporeal membrane oxygenation in COVID-19: A systematic review Full Text available with Trip Pro

1 Medical School, St George's, University of London, London, UK. 2 School of Public Health, Imperial College London, London, UK. 3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. 4 Faculty of Life Sciences, University of Liverpool, Liverpool, UK. PMID: 32717771 DOI: Item in Clipboard Role of extracorporeal membrane oxygenation in COVID-19: A systematic review Ana Alina Haiduc et al. J Card Surg . 2020 . Show details Display options Display options Format (...) J Card Surg Actions . 2020 Jul 27. doi: 10.1111/jocs.14879. Online ahead of print. Authors , , , Affiliations 1 Medical School, St George's, University of London, London, UK. 2 School of Public Health, Imperial College London, London, UK. 3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. 4 Faculty of Life Sciences, University of Liverpool, Liverpool, UK. PMID: 32717771 DOI: Item in Clipboard Full-text links Cite Display options Display options Format

2020 EvidenceUpdates

106. Randomized trials of invasive cardiovascular interventions that include a placebo control: a systematic review and meta-analysis Full Text available with Trip Pro

The National Lung and Heart Institute, Imperial College London, Dovehouse St, Chelsea, London SW3 6LY, UK. 8 Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. 9 Institute for Medical Engineering and Science, MIT, 77 Massachusetts Ave., Cambridge, MA 02139, USA. 10 Division of Cardiology, C.A.S.T., P.O. "G. Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Via S (...) Institute of Primary Health Care (BIHAM), University of Bern, Mittelstraße 43, 3012 Bern, Switzerland. 4 The Lambe Institute for Translational Medicine and CURAM, National University of Ireland, University Road, Galway H91 TK33, Ireland. 5 Center for Molecular Cardiology, Schlieren Campus, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland. 6 Royal Brompton and Harefield Hospital Trust, Imperial College London, Sydney Street, London SW3 6NP, UK. 7 The National Lung and Heart Institute

2020 EvidenceUpdates

107. Effectiveness of prothrombin complex concentrate for the treatment of bleeding: A systematic review and meta-analysis Full Text available with Trip Pro

K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127-1130. Maegele M, Lefering R, Yucel N, et al. Early coagulopathy in multiple injury: an analysis from the German trauma registry on 8724 patients. Injury. 2007;38:298-304. Bassin L, Stone M, Krol M, Reich DL. Risk factors for intraoperative coagulopathy in cardiac surgery. Heart Lung Circ. 2010;19:506. Singh SA, Vivekananthan P, Sharma A, Sharma S, Bharathy KG. Retrospective analysis of post-operative coagulopathy

2020 EvidenceUpdates

108. Adult Sinusitis

(ABRS) should be distinguished from acute rhinosinusitis due to viral respiratory infections and noninfectious conditions. ABRS should be diagnosed when signs and symptoms of acute rhinosinusitis (ARS) (purulent nasal drainage plus nasal obstruction, facial pain-pressure or both) persist without improvement for at least 10 days or if signs and symptoms worsen within 10 days after initial improvement. Radiographic imaging should not be performed in patients with ARS unless a complication (...) clavulanate should be prescribed as first-line therapy for 5-10 days. Amoxicillin with clavulanate should be prescribed for patients at high risk of being infected by an organism resistant to amoxicillin. Patients with an allergy to penicillin should be prescribed doxycycline or a respiratory quinolone as first-line therapy. For patients who fail to improve or worsen by 7 days following initial treatment, they should be reassessed to confirm the diagnosis and to detect complications. If initial treatment

2020 American Academy of Family Physicians

109. Allergic Rhinitis

with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Individuals with AR should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. Specific IgE testing (blood or skin) should be performed for patients with a clinical diagnosis of AR who do

2020 American Academy of Family Physicians

110. Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

for complete drug information Queensland Clinical Guideline: VTE prophylaxis in pregnancy and the puerperium Refer to online version, destroy printed copies after use Page 9 of 25 1.5 Signs and symptoms of VTE Table 2. Signs and symptoms of VTE Type Clinical presentation Pulmonary embolism 11 • Dyspnoea (most common symptom of PE) • Palpitations • Chest pain • Haemoptysis • Hypoxia/Cyanosis • Tachycardia • Tachypnoea • Hypotension • Collapse Deep Vein Thrombosis • DVT in pregnancy is often proximal and may (...) if hospitalised • Consider # LMWH prophylaxis Pre-pregnancy therapeutic anticoagulation Antenatal therapeutic anticoagulation Socio-demographic • Age = 35 years • BMI = 30 kg/m 2 • Cigarette smoker (>10/day) Medical history • Systemic lupus erythematosus • Cardiac or lung disease • Sickle cell disease • Gross varicose veins • Inflammatory conditions • Nephrotic syndrome • Cancer • Pre-existing diabetes • Ovarian hyperstimulation Pregnancy related • Immobility (e.g. bed rest, long distance travel

2020 Queensland Health

111. Primary postpartum haemorrhage

haemodynamic state whilst simultaneously identifying and treating the cause of bleeding. As soon as PPH identified, notify (and request the immediate attendance of) an experienced/senior obstetrician. Table 15. Resuscitation Aspect Consideration DRS ABC · Follow standard procedures for emergency resuscitation · Danger, Response, Send for help, Airway, Breathing, Circulation Initial assessment · Assess rate and volume of bleeding—caution with underestimation 11 · Lie woman flat 11 or if hypotensive (...) when determining optimal route) · Repeated doses not recommended Prescribing considerations · Not LAM approved as first line medication 41 · Increases pyrexia greater than 38 O C (misoprostol versus controls RR 3.97, 95% CI 3.13 to 5.04) 60 o Greater than 40 O C reported in 1–14% 61 Evidence summary · No strong evidence that misoprostol is more effective than other uterotonics 60,62,63 · Most useful where injectable uterotonics are unavailable 52 or contraindicated (e.g. asthma, hypertension

2020 Queensland Health

112. Perineal care

the perineum while flexed middle finger takes a grip on the baby’s chin. § When a good grip is achieved, the woman is asked to stop pushing and to breathe rapidly, while the accoucheur slowly assists the head through the introitus. The perineal ring is pushed under baby’s chin when most of head is out · Theoretical arguments for hands on: o Pressure against perineum may protect fragile tissue o Pressure against fetal head before crowing may aid presentation of the smallest diameter and prevent rapid

2020 Queensland Health

113. 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease

arteries 26 5.1.5.1 Background 26 5.1.5.2 Eligibility for sports 26 5.1.6 Myocardial bridging 28 5.1.6.1 Background 28 5.1.6.2 Eligibility 28 5.2 Exercise recommendations in individuals with chronic heart failure 28 5.2.1 Background: rationale for exercise in chronic heart failure 28 5.2.2 Risk stratification and preliminary evaluation 28 5.2.3 Exercise modalities and sports participation in heart failure 29 5.2.3.1 Aerobic/endurance exercise 29 5.2.3.2 Resistance exercise 29 5.2.3.3 Respiratory (...) cardiomyopathy HDL High-density lipoprotein HF Heart failure HIIT High-intensity interval training HR Heart rate HFmrEF Heart failure with mid-range ejection fraction HFpEF Heart failure with preserved ejection fraction HFrEF Heart failure with reduced ejection fraction HRmax Maximal heart rate HRR Heart rate reserve HTAD Hereditary thoracic aortic disease HTx Heart transplant ICD Implantable cardioverter defibrillator IMT Intima–media thickness INOCA Ischaemic and non-obstructive coronary artery disease

2020 European Society of Cardiology

114. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline Full Text available with Trip Pro

in both forms of the disease. Owing to the widespread distribution of lung changes in HP, a third acquisition in the prone position is usually not necessary. The optimal chest HRCT scan for characterizing HP should be a noncontrast examination, except in the context of acute respiratory decline, in which case CT angiography may be justified to detect acute pulmonary embolisms. CT angiography should be preceded by a noncontrast chest HRCT scan to detect new ground-glass changes that raise (...) pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax. Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: The guideline

2020 American Thoracic Society

115. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update Full Text available with Trip Pro

for postexposure prophylaxis in VZ‐susceptible individuals taking biologics, with VZ immunoglobulin or oral aciclovir/valaciclovir. Use of biologic therapy and tuberculosis R45 (↑) Consider screening for latent tuberculosis (TB) with an interferon‐gamma release assay (IGRA) alone, or with an IGRA and concurrent Mantoux test; be aware of the individual's risk factors for TB when interpreting results. R46 (↑↑) Apply local policy on the use of a plain chest radiograph for screening for TB to rule out (...) abnormalities at baseline including granulomas indicative of prior infection and other confounding lung diseases. If positive, assess for active TB and/or management of latent TB in consultation with a TB specialist (see NICE tuberculosis guideline). R47 (GPP) In people who require treatment for latent TB [3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)], aim to complete 2 months of treatment before commencing biologic therapy. R48 (GPP) Any symptoms

2020 British Association of Dermatologists

116. United Kingdom BASHH national guideline for the management of epididymo-orchitis

obstruction by a urologist (1C): Indicated in all patients with urinary tract pathogen confirmed epididymo-orchitis [21,22]. Investigation will usually include an ultrasound and CT scan of the renal tract and flexible cystoscopy. 10 Investigations for suspected tuberculous epididymitis (1D): ? Three early morning urines for acid and alcohol- fast bacilli (AAFB) ? Intravenous urography ? Renal tract ultrasound scan ? Biopsy ? Chest x-ray: to look for co-existing respiratory disease [75] May be positive

2020 British Association for Sexual Health and HIV

117. A living WHO guideline on drugs for covid-19 Full Text available with Trip Pro

-Dourado , respiratory medicine physician , Yae-Jean Kim , paediatric infectious disease physician , Niranjan Kissoon , paediatric intensive care physician , Arthur Kwizera , critical care physician , Jon Henrik Laake , intensive care physician , Flavia R Machado , intensive care physician , Nida Qadir , critical care physician , Rohit Sarin , chest physician , Yinzhong Shen , infectious disease physician , Linan Zeng , methodologist , Romina Brignardello-Petersen , methodologist , Lyubov Lytvyn (...) ) Critical covid-19— Defined by the criteria for acute respiratory distress syndrome (ARDS), sepsis, septic shock, or other conditions that would normally require the provision of life sustaining therapies such as mechanical ventilation (invasive or non-invasive) or vasopressor therapy. Severe covid-19— Defined by any of: Oxygen saturation <90% on room air* Respiratory rate >30 breaths per minute in adults and children >5 years old, ≥60 breaths/min in children <2 months old, ≥50 in children 2-11 months

2020 BMJ Rapid Recommendations

118. Hypertension - Diagnosis and Management

Contraindications Precautions Angiotensin converting enzyme inhibitors Angiotensin II receptor blocker Pregnancy History of angioedema Bilateral renal artery stenosis Electrolyte imbalances Severe renal impairment Beta-blockers Second- or third-degree AV block Sick sinus syndrome or SA block Bradycardia Decompensated HF Severe peripheral arterial circulatory disorders Athletes and physically active patients Asthma (non-selective BBs) Calcium Channel Blockers – Dihydropyridine (e.g., amlodipine) Heart Failure

2020 Clinical Practice Guidelines and Protocols in British Columbia

119. Prostate Cancer Part 1: Diagnosis and Referral in Primary Care

prostate cancer in asymptomatic men independent of PSA level (e.g., a secondary study of the screening arm of the PLCO (Prostate Lung Colorectal Ovarian) trial found that only 15% of suspicious DRE screening results were also abnormal for age-based PSA levels). However, it is uncertain that the harms of overdiagnosis and overtreatment outweigh the benefits, and a recent systematic review highlighted the lack of evidence supporting the effectiveness of the DRE as a screening tool in primary care (...) , Ballman KV, Hershman DL, et al. Prognostic Significance of Digital Rectal Examination and Prostate Specific Antigen in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Arm. J Urol. 2017 Feb;197(2):363–8. BC Cancer. Prostate – Chapter 3 Diagnosis. Vancouver; Revised March 2001 [Internet]. [cited 2018 Oct 22]. Available from: http://www.bccancer.bc.ca/ health-professionals/clinical-resources/cancer-management-guidelines/genitourinary/prostate Haider MA, Yao X, Loblaw A, Finelli

2020 Clinical Practice Guidelines and Protocols in British Columbia

120. When is Covid, Covid?

, cough and sometimes a range of other symptoms. The clinical features of the 41 patients infected with 2019 novel coronavirus in Wuhan included pneumonia with abnormal findings on chest CT. The agent was identified as SARS-CoV-2. Testing by RT-PCR has been globally implemented to identify RNA sequences thought to be unique to SARS-CoV-2. Worldwide case numbers are based on the reporting of the presence or absence of small RNA sequences of the SARS-CoV-2 genome. Some diseases can be diagnosed based (...) for the 2019-nCoV by the real-time PCR test for nucleic acid in respiratory or blood samples. Disease control agencies and the World Health Organisation have produced guidance for diagnosing Covid-19. We looked up case definitions*, and copied them into a table ( .) to compare them. WHO A suspect case has clinical symptoms of respiratory disease, perhaps with other associated presentations. A probable case is a suspect case for whom laboratory testing was inconclusive or not possible. A confirmed case

2020 CEBM Covid-19 Open Evidence Reviews

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