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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Antibiotics for the treatment of leptospirosis: systematic review and meta-analysis of controlled trials

Leptospirosis is a zoonotic disease prevalent mainly in developing countries and is associated with high case fatality. Antibiotics especially penicillin are the mainstay of treatment for a suspected or confirm case of leptospirosis but role of Penicillin has not been evaluated systematically in the light of current evidence. The present systematic review and meta-analysis is done to evaluate the role of antibiotics in the treatment of leptospirosis. Parallel group clinical trials involving use of penicillin in treatment of leptospirosis were searched from all available sources. Ten clinical trials were found suitable as per laid inclusion criteria eligible for present systematic review and five clinical trials were included in meta-analysis. Clinical trials included for meta-analysis were compared on the basis of mortality, fever days, numbers of patients presenting with oliguria, and number of patients undergoing need-based dialysis. Analysis was done by comprehensive meta-analysis software 2. Qualitative outcomes are summarized as odds ratio and quantitative outcomes are summarized as standard mean difference with 95% confidence interval. Random and fixed models are used for analysis. There was no significant difference between penicillin group and controlled group for mortality (Odds ratio 1.59 (95% CI 0.59-4.29), P = 0.35), fever days (std difference in mean = -0.223 (95% CI 0.394-0.995), P = 0.358), number of patients presenting with oliguria (Odds ratio 1.795 (95% CI 0.325-9.929), P = 0.502), and number of patients who underwent need based dialysis (Odds ratio 1.587 (95% CI 0.919-2.731), P = 0.098). Role of various antibiotics in treatment of leptospirosis is uncertain, and can be attributed to nonavailability of adequate clinical trials. Role of penicillin in the treatment of leptospirosis can be debated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Low‐dose dopamine for women with severe pre‐eclampsia

No data on the use of low‐dose dopamine in women with severe pre‐eclampsia who have very low urine output.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

[Ibuprofen versus indomethacin in the preterm persistent patent ductus arteriosus therapy: review and meta-analysis]

INTRODUCTION: Persistent patent ductus arteriosus (PDA) is a common pathology in the preterm whose traditional treatment has been indomethacin. Recently, ibuprofen has shown its effectiveness in closing the PDA with less hemodynamic effects. The objective of this paper is to review the current literature in order to determine if there is any benefit of ibuprofen versus indomethacin in the PDA therapy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Dopamine versus no treatment to prevent renal dysfunction in indomethacin‐treated preterm newborn infants

Dopamine has not been shown to prevent adverse effects of indomethacin on the kidneys of preterm babies. Indomethacin is a drug used in preterm babies to prevent brain hemorrhage or to help close off PDA (patent ductus arteriosus ‐ when a channel between the lungs and heart does not close off after birth as it should). Indomethacin often causes fluid retention and reduced flow of urine, which can sometimes cause deterioration in kidney (renal) function. The drug dopamine is sometimes used along with indomethacin to try and prevent negative impact on the kidneys. The review found there is not enough evidence from trials to show there is any value in giving dopamine to babies being treated with indomethacin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Severe adverse events from the treatment of advanced melanoma: a systematic review of severe side effects associated with ipilimumab, vemurafenib, interferon alfa-2b, dacarbazine and interleukin-2

BACKGROUND: Current immunomodulatory agents for stage III and IV melanoma exert different mechanisms of action that manifest in distinct adverse events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study

The review concluded that surgical patients who received perioperative haemodynamic optimisation were at decreased risk of renal impairment. As there was no description of the control treatments used, the reliability of the authors' conclusions is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Meta-analysis of frusemide to prevent or treat acute renal failure

This review investigated the effects of frusemide intake to prevent or treat acute renal failure. The authors' conclusion that frusemide is not effective in the prevention or treatment of acute renal failure in adults, and that high doses may be associated with an increased risk of ototoxicity, may be overstated given the small existing evidence base.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis

This review compared the effects of hydralazine with other antihypertensives for the treatment of severe hypertension in pregnancy. The authors concluded that the findings are not robust enough to guide clinical practice, though they do not support the use of hydralazine. The conclusions follow from the evidence presented, although there were some weaknesses in the conduct of the review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Is continuous renal replacement therapy beneficial for people with rhabdomyolysis?

Rhabdomyolysis is a potentially life‐threatening condition where damaged muscle tissue breaks down quickly, and products of damaged muscle cells are released into the bloodstream. Of these products, a protein called myoglobin is harmful to kidney health and can lead to acute kidney injury. There is some evidence to suggest that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review

Patient-controlled analgesia (PCA) is a mainstay in the control of pain after major surgery. The drug most commonly used with PCA is morphine, but its administration can result in adverse effects, most commonly nausea and vomiting. Paracetamol (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase 2 (COX-2) inhibitors are commonly used in conjunction with morphine following major surgery with the aim of reducing morphine consumption and the associated adverse effects. These non-opioids also have their own adverse effects. NSAIDs are associated with prolonged bleeding time and adverse gastrointestinal effects amongst other outcomes. The use of COX-2 inhibitors has been associated with increased thromboembolic events such as myocardial infarction and stroke, although these associations tend to be seen only with long-term use.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Evaluation, Trials and Studies Coordinating Centre (UK).

Version: 2010

Gastrointestinal Complications (PDQ®): Health Professional Version

Expert-reviewed information summary about constipation, impaction, bowel obstruction, and diarrhea as complications of cancer or its treatment. The management of these problems is discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 28, 2014

Drug Class Review: Constipation Drugs: Final Report [Internet]

Chronic constipation is a disorder characterized by unsatisfactory defecation that results from infrequent stools, difficult stool passage, or both over a time period of at least 12 weeks. In this report, we review the general and comparative effectiveness, safety, and tolerability of drugs for chronic constipation. Our review covers the use of the following in adults and children with chronic constipation and Irritable Bowel Syndrome, constipation-predominant (IBS-C): docusate calcium, docusate sodium, lactulose, lubiprostone, polyethylene glycol 3350, psyllium, and tegaserod.

Drug Class Reviews - Oregon Health & Science University.

Version: September 2007
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Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period

This guideline contains recommendations specific to twin and triplet pregnancies and covers the following clinical areas: optimal methods to determine gestational age and chorionicity; maternal and fetal screening programmes to identify structural abnormalities, chromosomal abnormalities and feto-fetal transfusion syndrome (FFTS), and to detect intrauterine growth restriction (IUGR); the effectiveness of interventions to prevent spontaneous preterm birth; and routine (elective) antenatal corticosteroid prophylaxis for reducing perinatal morbidity. The guideline also advises how to give accurate, relevant and useful information to women with twin and triplet pregnancies and their families, and how best to support them.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2011
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The Effectiveness of Interventions to Treat Severe Acute Malnutrition in Young Children: A Systematic Review

Severe acute malnutrition (SAM) arises as a consequence of a sudden period of food shortage and is associated with loss of a person's body fat and wasting of their skeletal muscle. Many of those affected are already undernourished and are often susceptible to disease. Infants and young children are the most vulnerable as they require extra nutrition for growth and development, have comparatively limited energy reserves and depend on others. Undernutrition can have drastic and wide-ranging consequences for the child's development and survival in the short and long term. Despite efforts made to treat SAM through different interventions and programmes, it continues to cause unacceptably high levels of mortality and morbidity. Uncertainty remains as to the most effective methods to treat severe acute malnutrition in young children.

Health Technology Assessment - NIHR Evaluation, Trials and Studies Coordinating Centre (UK).

Version: April 2012
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Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection

Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken by the NHS needs to: prioritise the treatment of sick babies, minimise the impact of management pathways on healthy women and babies, use antibiotics wisely to avoid the development of resistance to antibiotics. These drivers have not always been addressed consistently in the NHS, and this guideline was commissioned to ensure they would be addressed in future.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2012
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Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: April 2009
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Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet]

This guideline has been written within a conceptual framework which places the woman and her baby at the centre of care, appreciating that all postnatal care should be delivered in partnership with the woman and should be individualised to meet the needs of each mother-infant dyad. The guideline aims to identify the essential ‘core care’ which every woman and her baby should receive, as appropriate to their needs, during the first 6–8 weeks after birth, based upon the best evidence available.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: July 2006
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Low-Dose Aspirin for the Prevention of Morbidity and Mortality From Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

We conducted a systematic review of the evidence on the use of low-dose aspirin for the prevention of morbidity and mortality from preeclampsia to support the U.S. Preventive Services Task Force (USPSTF) in updating its previous recommendation. Prior reviews have established that benefits of aspirin prophylaxis are not obtained in populations of healthy or unselected pregnant women not at high risk of preeclampsia. In this review we considered the evidence on benefits and harms of low-dose aspirin for women at elevated risk of developing preeclampsia and consequent maternal and fetal health outcomes. Three key questions (KQs) were systematically reviewed: 1) Is there evidence that aspirin reduces adverse maternal or fetal health outcomes? 2) Is there evidence that aspirin reduces incidence of preeclampsia? and 3) What are the harms of low-dose aspirin use during pregnancy?

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: April 2014
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Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]

NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2011
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Medical Encyclopedia

  • Urine output - decreased
    Decreased urine output means that you produce less urine than normal. Most adults make at least 500 ml of urine in 24 hours (a little over 2 cups).
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