Deep vein thrombosis: update on diagnosis and management.

Deep vein thrombosis: update on diagnosis and management. Med J Aust. 2019 Jun 02;: Authors: Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ Abstract Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre-test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre-test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into "unlikely" or "likely". If DVT is "unlikely", refer for D-dimer test. If the D-dimer level is normal, DVT can be excluded; if the D-dimer level is increased, refer for compression ultrasound. If DVT is "likely", refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post-thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence show...
Source: Med J Aust - Category: General Medicine Authors: Tags: Med J Aust Source Type: research

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Publication date: Available online 24 September 2020Source: Sexual &Reproductive HealthcareAuthor(s): Karolina Linden, Rikke Damkjær Maimburg
Source: Sexual and Reproductive Healthcare - Category: Reproduction Medicine Source Type: research
Authors: Podda GM, Fiorelli EM, Birocchi S, Rambaldi B, Di Chio MC, Casazza G, Cattaneo M Abstract Immune thrombocytopenia (ITP) can be associated with lymphoproliferative diseases (LPD) or solid tumors. A systematic review of published literature was conducted to evaluate response to treatment of ITP secondary to malignancy. Primary outcome was overall response (complete response+response) to first-line treatments [steroids alone or in combination with intravenous immunoglobulins (IVIg)]. Among secondary outcomes, overall response to second-line treatments [splenectomy, rituximab or thrombopoietin receptor agonist...
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
Publication date: Available online 24 September 2020Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Fang He, Shenghua Liu, Dunjin Chen
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Objective: The menopausal transition has a negative effect on peripheral dilation in response to various stimuli including shear stress and exercise. Whether the presence of elevated traditional cardiovascular disease (CVD) risk factors in women going through menopause exacerbates the adverse effect on peripheral vasodilation is unclear. Methods: Forty-four perimenopausal women with relatively low CVD risk were divided into tertiles based on atherosclerotic CVD (ASCVD) 10-year risk scores (lowest: 0.1%-0.5%, middle: 0.6%-0.9%, higher:>1%). Comparisons were made across tertile groups for the femoral artery vascular ...
Source: Menopause - Category: OBGYN Tags: Brief Report Source Type: research
Selective estrogen receptor modulators (SERMs) are an increasingly important therapeutic modality that are used by clinicians on a daily basis. Unfortunately, clinicians have a limited understanding regarding the underlying mechanism(s) of how SERMs function and their increasingly useful role in the treatment of estrogen-responsive target tissues such as the breast, bone, vagina, uterine endometrium, and brain. This review will provide a basic understanding of our current knowledge of SERM pharmacodynamics and will highlight the clinical applications of Food and Drug Administration–approved SERMs in the treatment of ...
Source: Menopause - Category: OBGYN Tags: Clinical Corner: Invited Review Source Type: research
Conclusions and Relevance: Lacking strong evidence indicating significant patient risk for vaginal laser treatment of GSM, the FDA safety communication appears unsubstantiated and implies gender bias. Identified complications suggest most reported “adverse events” represent lack of treatment effect. The well-documented benefits and low risk of adverse event suggest laser therapy for GSM is reasonable with appropriate pretreatment counseling. Additional randomized, well-controlled clinical trials are needed to further elucidate both the safety and efficacy of this nonhormone therapy.
Source: Menopause - Category: OBGYN Tags: Review Articles Source Type: research
This study aimed to assess the symptom burden in the last 6 months of life in a real-world cohort. METHODS: Patients diagnosed with metastatic gynaecologic malignancies from 2016 to 2019 who completed the revised Edmonton Symptom Assessment System (ESASr) questionnaire within 6 months of death in a large Canadian province were identified. Patient-reported symptom scores were categorized as none to mild (0-3) and moderate to severe (4-10). Individual symptoms were subsequently grouped into physical, psychological, and total subscores. The severity of symptoms was further analyzed for any associations with age, time to d...
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
Publication date: 26 September–2 October 2020Source: The Lancet, Volume 396, Issue 10255Author(s): Andrew W Horne, Katy Vincent, Catherine A Hewitt, Lee J Middleton, Magda Koscielniak, Wojciech Szubert, Ann M Doust, Jane P Daniels, Suraiya Abdi, Santanu Acharya, Shamma Al-Inizi, Elizabeth Ball, Andrew Baranowski, Nadia Bhal, Kalsang Bhatia, Siladitya Bhattacharya, Judy V. Birch, Tyrone Carpenter, Tony Chalhoub, Ying C. Cheong
Source: The Lancet - Category: General Medicine Source Type: research
Publication date: 26 September–2 October 2020Source: The Lancet, Volume 396, Issue 10255Author(s): Hasan Tahsin Özpolat, Bulent Baran, Filiz Akyuz
Source: The Lancet - Category: General Medicine Source Type: research
oavida LE Abstract Humans are exposed to methylmercury (MeHg), a bioaccumulative neurotoxin, mainly through the consumption of marine fish. Several studies showed that high MeHg exposure can lead to neurological damage. This is particularly relevant for pregnant women, because MeHg exposure negatively impacts foetal development. Populations living near the sea are generally at increased exposure risk due to higher consumption of fish and seafood. Here, we present the first study of MeHg exposure levels of the population living at the French Riviera, using mercury (Hg) concentrations in hair as a proxy for MeHg exp...
Source: Chemosphere - Category: Chemistry Authors: Tags: Chemosphere Source Type: research
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