scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

scholarly journals A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice

2020 ◽  
Vol 36 (4) ◽  
pp. 249-255 ◽  
Author(s):  
Carlos Walter Sobrado Júnior ◽  
Carlos de Almeida Obregon ◽  
Afonso Henrique da Silva e Sousa Júnior ◽  
Lucas Faraco Sobrado ◽  
Sérgio Carlos Nahas ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Strong Association ◽  
Management Strategies ◽  
Hemorrhoidal Disease ◽  
New Classification ◽  
The Past ◽  
Internal Hemorrhoids ◽  
New Treatment ◽  
Treatment Alternatives

Purpose: Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years.Methods: Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification.Results: Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed.Conclusion: Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.

Interleukin-23 Blockers: Born to be First-line Biologic Agents in Inflammatory Bowel Disease?

2019 ◽  
Vol 25 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Marjorie C. Argollo ◽  
Mariangela Allocca ◽  
Federica Furfaro ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Clinical Practice ◽  
Treatment Options ◽  
Biologic Agents ◽  
First Line ◽  
Treatment Algorithms ◽  
Loss Of Response ◽  
The Past ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
Interleukin 23

Over the past decades, the advent of anti-TNF agents has dramatically changed the treatment algorithms for IBD. However, primarily and more importantly, secondary loss of response to anti-TNF agents, is often observed. Thus, new treatment options have been actively explored and some have already been incorporated in the current clinical practice. Among the class of anti-cytokine agents, the anti-IL12/IL23 monoclonal antibodies (mAbs) have been first presented, in clinical practice, by the anti-p40 mAb ustekinumab in Crohn’s disease (CD). More selective anti-IL23 agents (anti-p19) have shown efficacy and are being further developed, in contrast to agents inhibiting IL-17 downstream, which have failed in IBD clinical trials despite their clear efficacy in psoriasis.

Emergencies

2012 ◽  
Author(s):  
Rob Forsyth ◽  
Richard Newton
Keyword(s):  
Status Epilepticus ◽  
Emergency Management ◽  
Visual Loss ◽  
Sudden Onset ◽  
Pharmacological Management ◽  
Status Dystonicus ◽  
Acute Agitation ◽  
Traumatic Coma

Acute agitation 534Emergency management of coma 536Traumatic coma 541Status epilepticus 544Status dystonicus 551Sudden onset visual loss 558The child who suddenly stops walking 559Acute ataxia 572In nearly all situations, environmental, rather than pharmacological, management of acute agitation or psychosis is to be preferred....

scholarly journals 2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint

2021 ◽  
Vol 33 (5) ◽  
pp. 1149-1156
Author(s):  
Swan Sim Yeap ◽  
Aree Tanavalee ◽  
Emmanuel C. Perez ◽  
Maw Pin Tan ◽  
Bernadette Heizel M. Reyes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Musculoskeletal Diseases ◽  
Treatment Algorithm ◽  
Southeast Asian ◽  
Practical Implementation ◽  
Local Health ◽  
Asian Countries ◽  
Pharmacological Management ◽  
Southeast Asian Countries

Abstract Background Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide. Aim Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice. Methods A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts. Results Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm. Conclusion This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.

scholarly journals Advances in the management of generalized convulsive status epilepticus: what have we learned?

Brain ◽  
2021 ◽  
Author(s):  
Aidan Neligan ◽  
Sanjeev Rajakulendran ◽  
Matthew C. Walker
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
The Past ◽  
Class A ◽  
Adults And Children

Abstract Convulsive status epilepticus is the most serious manifestation of an epileptic diathesis. In the early stages (5–30 min), there exists class A evidence to support the efficacy of benzodiazepines as first-line treatment. As status epilepticus progresses into the later stages, the evidence for treatment becomes less robust until we are depending upon short case series and case reports for the treatment of refractory status epilepticus. However, the past year saw the publication of three randomized controlled trials in the setting of benzodiazepine-resistant established convulsive status epilepticus: the EcLiPSE and ConSEPT studies, compared levetiracetam to phenytoin in children; and the ESETT study compared fosphenytoin, levetiracetam and sodium valproate in adults and children. In addition, the emergence of data from the SENSE study, a multicentre multinational prospective cohort study and the publication of a systematic review and meta-analysis of the mortality of status epilepticus over the past 30 years, has brought the treatment of status epilepticus into sharp focus. In this update we provide a detailed analysis of these studies and their impact on clinical practice. We review contentious areas of management in status epilepticus where a consensus is lacking and advance the case for more research on existing and alternative treatment strategies.

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