Interpretation of management guidelines for Graves Ophthalmopathy in 2019 / 国际眼科杂志(Guoji Yanke Zazhi)

@#Graves ophthalmopathy(GO)is an autoimmune disease, mostly accompanied by orbital tissue inflammation. The practical guideline was produced by a research team of members from different scientific disciplines. The article provided a thorough interpretation of the management guidelines in GO and intended to provide direction for diagnosis of GO in daily clinical practice and improved the curative effect and medical service quantity of GO patients.

Trastorno de alimentación: identificación y primeras intervenciones para los profesionales de salud / Eating disorders early identification and management: guidelines for health practitioners

Introducción: los trastornos de la alimentación e ingesta (TAI) son un complejo conjunto interdimensional de enfermedades mentales que afectan el rendimiento corporal, mental y social. El núcleo de la enfermedad es el miedo a ganar peso. Las estrategias de control de ingesta varían entre: restricción, selección y purga alimentaria. Afectan diferentes sexos, razas, etnias y edades. Con mayor frecuencia en adolescentes y mujeres jóvenes (9: 1). Presentan alta mortalidad, comorbilidad mental y conflictos familiares asociados. Método: integrar información disponible y útil según criterio de experto, orientada al manejo clínico de los TAI. Resultado: debido a que los profesionales de salud de diferentes áreas podrían ser el único contacto que el/la paciente busca para aliviar alguna dolencia aparentemente no relacionada con TAI, es necesario lograr identificar y diagnosticar los estadios patológicos e indicar las primeras conductas, así como hacer una referencia exitosa. El retraso en el diagnóstico causa alteraciones severas y crónicas en la fisiología, el comportamiento, la cognición y el funcionamiento psicosocial. Los objetivos de este estudio son: a. Presentar, en forma integrada, la información disponible de modo de facilitar a los profesionales de la salud la detección precoz de los TAI; b. Ofrecer un conjunto de acciones útiles que faciliten el diagnóstico TAI; c. Organizar la comprensión del riesgo TAI en un diagrama que facilite la construcción de la derivación utilizando las dimensiones: cuerpo, mente, relaciones; d. Mostrar las alternativas psicoterapéuticas en uso e. Proveer información para realizar las primeras intervenciones. Conclusión: reconocer tempranamente el cuadro TAI puede detener el curso patológico y los potenciales daños.(AU)

Introduction: eating disorders (ED) are a complex interdimensional set of mental disorders that affect social, bodily and mental performance. The core issue of the illness is the fear of weight gain. Food intake control strategies are displayed among eating restriction,selection and purging foods. ED affect people despite their sex, ethnicity or age often in adolescents and young women (9:1). EDhave been associated with high mortality, mental disorders comorbidity, and family conflicts. Method: to integrate expert selectedrelevant information to improve ED clinical management by health practitioners. Results: because health practitioners from differentareas may be the only contact the patient is looking for to alleviate an ailment apparently not related to ED, it is necessary to identifyand diagnose the pathological stages and indicate the first behaviors, as well as make a successful reference. Diagnosis delay causes severe and chronic alterations in physiology, behavior, cognition and psychosocial functioning. The objectives of this study are: a.To present integrated information about ED I order to facilitate early detection and diagnosis to health practitioners; b. To offer a setof useful actions that facilitate early ED detection; c. To organize the understanding of ED risk in a diagram that facilitates derivationusing the dimensions: body, mind, relationships; d. To show the current psychotherapies e. To provide information to perform the first interventions. Conclusion: early ED recognition can stop the pathological course and potential damage of the disease.(AU)

Interpretation of European Consensus Guidelines on the Management of Respiratory Distress Syndrome-2019 Update / 中国实用儿科杂志

The 2019 European Guideline on Respiratory Distress Syndrome(RDS)updated and supplemented the 2016 version according to newly-published evidence and literature,in order to optimize the management of RDS. The updates includes risk factors of preterm births,the standardized use of prenatal glucocorticoids protocol,the evidence-based delivery room management and the early application of protective pulmonary ventilation after birth;pulmonary surfactant administration as the crucial treatment for RDS;the incidence chronic lung disease can be reduced by non-invasive respiratory support. Prenatal glucocorticoids use and caffeine administration can significantly shorten the duration of mechanical ventilation. In addition,good temperature control,precise fluid and nutrition management,perfusion maintenance and cautious antibiotic use can help improve the outcome of preterm births.

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis

Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the "Associação Brasileira de Alergia e Imunologia (ASBAI)" and the "Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)" has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective.

Background: Stevens–Johnson syndrome and toxic epidermal necrolysis are severe, life‑threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor‑α inhibitors. Aim: The ideal therapy of Stevens– Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective. Methods: The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens–Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as “guidelines,” “Stevens–Johnson syndrome,” “toxic epidermal necrolysis,” “corticosteroids,” “intravenous immunoglobulin,” “cyclosporine” and “management.” The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three‑point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. Results: A total of 104 articles (meta‑analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these guidelines. Recommendations: This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1‑2 mg/kg/day or equivalent), tapered rapidly within 7‑10 days. Cyclosporine (3‑5 mg/kg/day) for 10‑14 days may also be used either alone, or in combination with corticosteroids. Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful.

Cumplimiento de guías en pacientes hospitalizados con falla cardiaca ¿Cómo estamos? / Compliance with guidelines in inpatients with heart failure ¿Where are we?

Resumen La insuficiencia cardiaca es una patología de alta prevalencia, con una morbimortalidad importante, la cual genera grandes costos para el sistema de salud. Un tratamiento adecuado es fundamental para obtener buenos resultados clínicos. El objetivo del estudio es evaluar el cumplimiento de las guías de manejo farmacológico de falla cardiaca, por parte del médico, al momento del alta hospitalaria. Métodos: estudio descriptivo, prospectivo que incluyó pacientes con insuficiencia cardiaca descompensada que ingresaron a urgencias entre diciembre 2011 y febrero 2012. Se recolectaron datos de la hospitalización y de la fórmula médica de egreso. Dos evaluadores calificaron el cumplimiento de formulación de betabloqueadores (BB), Inhibidores de la enzima convertidora de angiotensina (IECA) o antagonistas de los receptores de angiotensina II (ARAII) y espironolactona según recomendaciones de la guía para falla cardiaca AHA 2005 ≤ actualización 2009. Se consideraron las indicaciones y contraindicaciones de cada fármaco. Para los BB, se tuvo en cuenta el tipo de BB formulado. Resultados: ingresaron 47 pacientes, edad promedio 71 años (DE 14.3), con predominio de mujeres 55.3%. Fallecieron cinco pacientes, por lo tanto se evaluó la formulación en 42 pacientes. Entre éstos 80.9% (34/42) recibieron BB, 76.1% (32/42) IECA o ARAII y 38% (16/42) espironolactona. 19 pacientes tuvieron FEVI ≤ 40%. El cumplimiento de la guía fue adecuado en 52.6% para BB, 77.7% para IECA o ARAII y 78.5% para espironolactona. Conclusiones: en este estudio encontramos un cumplimiento de las recomendaciones de las guías para falla cardiaca por debajo de lo que se espera para la atención de los pacientes. El menor cumplimiento se observó en la prescripción del betabloqueador al egreso, por una alta formulación de metoprolol tartrato. Estos datos concuerdan con estudios realizados en otros países y obligan a implementar estrategias de cumplimiento de guías para asegurar que los pacientes reciban el tratamiento adecuado. (Acta Med Colomb 2014; 39: 40-45).

Abstract Heart failure is a highly prevalent disease with significant morbidity and mortality that generates large costs to the health system. Proper treatment is essential in order to obtain good clinical outcomes. The objective of this study is to assess the compliance with the pharmacological management of heart failure guidelines by the physician at hospital discharge. Methods: a descriptive , prospective study that included patients with decompensated heart failure admitted to the emergency department between December 2011 and February 2012. Data hospitalization and prescription at hospital discharge were collected. Two reviewers rated the prescription compliance of beta blockers (BB), angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blocker (ARB II) and spironolactone as recommended by the 2005 AHA guideline for heart failure - Update 2009. Indications and contraindications of each drug were considered. For BB, the type of BB prescribed was taken into account. Results: 47 patients were admitted. Mean age was 71 years (SD 14.3), with 55.3% female predominance. Five patients died, so the prescription was evaluated in 42 patients. Among these , 80.9% (34 /42) received BB, 76.1% (32 /42) ACE inhibitors or ARBs and 38% (16 /42) spironolactone. 19 patients had LVEF ≤ 40%. Compliance with the guidelines was adequate in 52.6% for BB, 77.7% for ACE inhibitors or ARBs and 78.5% for spironolactone. Conclusions: in this study, a compliance in guidelines recommendations for heart failure below of what is expected for the care of patients was found. The lower compliance was observed in prescribing beta blocker at discharge by a high metoprolol tartrate formulation. These data are consistent with studies realized in other countries and force to implement strategies of guidelines compliance to ensure that patients receive the appropriate treatment. (Acta Med Colomb 2014; 39: 40-45).

Management of Acute Liver Failure in Infants and Children: Consensus Statement of the Pediatric Gastroenterology Chapter, Indian Academy of Pediatrics.

Process: Selected members were requested to prepare guidelines on specific issues, which were reviewed by two other members. These guidelines were then incorporated into a draft statement, which was circulated to all members. On 17th December 2011, Kunwar Viren Oswal round table conference was organized by the Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi and the Sub-specialty Chapter of Pediatric Gastroenterology, Indian Academy of Pediatrics. Presentations, ensuing discussions, and opinions expressed by the participants were incorporated into the final draft. Objectives: To formulate comprehensive evidence based guidelines for management of acute liver failure in India, Recommendations: Viral hepatitis is the leading cause of acute liver failure (ALF) in India. Search for metabolic etiology, particularly in infants and neonates, and in apparently idiopathic cases needs to be done. Planning for early transfer is important as the risks involved with patient transport may increase or even preclude transfer at later stages. Management should be in an intensive care setting in select situations. There is currently insufficient evidence to routinely prescribe branched-chain amino acids, non-absorbable antibiotics or lactulose. Group recommends use of N-acetyl cysteine routinely in patients with ALF. Administration of antibiotics is recommended where infection is present or the likelihood of impending sepsis is high. Enteral nutrition is preferred to parenteral nutrition. Protein restriction is not recommended. An international normalized ratio >4 or Factor V concentration of <25% are the best available criteria for listing for liver transplantation. Overall 40-50% of ALF patients survive without transplantation. Survival in patients fulfilling criteria for liver transplantation and not transplanted is 10-20%. Liver transplantation is a definite treatment for ALF with high one-and five-year survival rates.