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PubMed2026

Histoplasmosis in children: emerging insights and evolving guidelines.

PURPOSE OF REVIEW: This review provides an update on the epidemiology, risk factors, clinical presentation, diagnosis, and management recommendations incorporating recommendations from recent publications including the Infectious Disease Society of America guidelines for the management of pulmonary and disseminated histoplasmosis. RECENT FINDINGS: Updates to the epidemiology of histoplasmosis indicate a broader geographic range than historically defined. Updated guidelines do not recommend routine treatment for asymptomatic, mild and moderate pulmonary histoplasmosis although itraconazole can be offered for immunocompromised children or for prolonged or worsening symptoms. Liposomal amphotericin B is recommended as initial treatment for severe histoplasmosis syndromes (severe pulmonary and disseminated histoplasmosis). Fibrosing mediastinitis, a late complication of histoplasmosis is treated with stenting of vessels and bronchi. Recent studies demonstrate that rituximab (anti-CD20 monoclonal antibody) may stop progression or lead to regression of progressive fibrosis. SUMMARY: Histoplasmosis has manifold manifestations, many of which are self-limited and do not require treatment. Severe histoplasmosis and its complications should be treated with liposomal amphotericin B followed by itraconazole. Clinical trials are needed to assess the efficacy of rituximab for the treatment of fibrosing mediastinitis.

Humans↗

PubMed2025

Guidelines for T cell nomenclature.

Advances in T cell biology have revealed heterogeneity among T cell populations that is not captured by existing general nomenclature. This issue has caused an ad hoc broadening of core T cell subset definitions and the invention of new subset designations that have not been uniformly delineated. To address this issue, in this Consensus Statement, we propose guidelines that serve three goals. First, they advocate that primary research reports define the experimental basis by which relevant subsets are designated in the methods section of each study. Second, they provide standardized definitions for existing subset designations in popular use, and common experimental criteria for defining each subset are noted. Last, they present an alternative 'modular nomenclature' paradigm. The newly proposed modular nomenclature eschews conceptualization of antigen-experienced T cells as belonging to a few idealized subsets, and the nomenclature instead simply indicates individual biological properties present in a T cell population with brief descriptors. Collectively, these guidelines intend to enhance transparency in the literature while facilitating clearer communication of findings and concepts to researchers, students and clinicians.

Terminology as Topic↗

PubMed2025

Guidelines From the French-Speaking Society for Histocompatibility and Immunogenetics (SFHI) for Harmonisation of HLA Genotyping in Autoimmune Diseases, Drug Hypersensitivity and Pharmacogenetics.

HLA molecules play a central role in the adaptive immune response. Their high polymorphism influences individual susceptibility to various autoimmune diseases and certain drug-induced hypersensitivities. In France, HLA genotyping is classified as a medical genetics procedure and is strictly regulated. The Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI) has established national guidelines outlining clinically validated indications, required resolution levels and interpretation criteria based on robust data. These guidelines are particularly relevant for common clinical contexts, including autoimmune diseases and pharmacogenetic testing. Well-established associations include HLA-DQB1*02/DQA1*05 (DQ2) and HLA-DQB1*03:02/DQA1*05 (DQ8) with celiac disease, HLA-B*27 with spondyloarthritis, HLA-DQB1*06:02 with type 1 narcolepsy, HLA-A*29 with Birdshot chorioretinopathy and several pharmacogenetic risk alleles such as HLA-B*57:01 (abacavir), HLA-B*15:02 and HLA-A*31:01 (carbamazepine) and HLA-B*58:01 (allopurinol). In immunotherapy, the efficacy of tebentafusp has been shown to depend on HLA-A*02:01 positivity. HLA alleles must be interpreted as relative risk factors, not absolute predictors. Critical analysis of HLA-related scientific literature requires consideration of the genotyping technique, typing resolution, allele frequencies within the studied population and environmental factors. High-resolution typing is essential in pharmacogenetics and recommended in selected autoimmune disorders. Interpretation should be conducted by qualified medical biologists, integrating clinical context, allelic diversity and recent technological advances, particularly next-generation sequencing. HLA genotyping represents a valuable tool in diagnosis and risk assessment, with increasing importance in the era of personalised medicine.

Humans↗

PubMed2026

Systematic Review of Pharmacologic Treatment for Migraine Prevention in Adults: Report of the AAN Guidelines Subcommittee and the American Headache Society.

BACKGROUND AND OBJECTIVES: This systematic review (SR) provides updated evidence-based conclusions regarding the use of pharmacologic migraine prevention in adults to inform a new joint American Academy of Neurology (AAN) and American Headache Society practice guideline. METHODS: A multidisciplinary panel conducted an SR following the 2017 AAN Clinical Practice Guideline Process Manual. Randomized controlled trials evaluating pharmacologic preventive treatments for adults with episodic or chronic migraine were included. Searches encompassed MEDLINE, Embase, and ClinicalTrials.gov from database inception through June 6, 2024. Studies were screened in duplicate, with dual independent risk-of-bias assessment. Outcomes included change in monthly headache days, ≥50% responder rate, and validated patient-reported quality of life (QOL) measures. Raw mean differences, standardized mean differences, and risk ratios were calculated. A modified Grading of Recommendations Assessment, Development, and Evaluation process was used to classify certainty of evidence. RESULTS: A total of 217 studies met inclusion criteria. For episodic migraine, high-confidence evidence showed that galcanezumab and erenumab are more effective than placebo in reducing headache frequency. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, fremanezumab, propranolol, topiramate, and valproate. Several additional oral agents including amitriptyline, bisoprolol, flunarizine, fluoxetine, levetiracetam, metoprolol, nifedipine, pizotifen, and telmisartan had low-confidence evidence suggesting possible benefit. For chronic migraine, high-confidence evidence supported reductions in headache frequency with fremanezumab, galcanezumab, and onabotulinumtoxinA. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, erenumab, topiramate and valproate. Across both episodic and chronic migraine populations, erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, atogepant, topiramate and onabotulinumtoxinA demonstrated improvements in patient-reported QOL outcomes on validated instruments. Evidence comparing active treatments was limited and generally of low or very low confidence, restricting conclusions about comparative effectiveness. DISCUSSION: This SR provides a comprehensive synthesis of evidence on pharmacologic migraine prevention in adults. High- and moderate-confidence findings confirm the efficacy of several established and newer preventive therapies and demonstrate improvements in patient-reported outcomes across multiple validated measures. These conclusions informed the development of evidence-based recommendations, presented in a companion publication, to guide clinicians in selecting preventive medications for adults with episodic and chronic migraine.

Humans↗

PubMed2026

ACG Clinical Guideline: Diagnosis and Management of Adenomatous Colorectal Polyposis Syndromes.

The hereditary adenomatous colorectal polyposis syndromes are incurable, systemic, cancer risk predisposition syndromes with substantial morbidity and mortality. They differ in their mode of inheritance, age at disease onset, phenotypic expression, and cancer risk. The most common cancer risks involve the gastrointestinal tract including the colon, rectum, duodenum, ampulla, and stomach. Identifying these syndromes through personal and family history risk assessment and germline genetic testing, along with timely surgical and endoscopic management, can reduce cancer incidence and mortality. These guidelines use the Grading of Recommendations, Assessment, Development, and Evaluation methodology to provide clinical guidance on the selection of individuals who should undergo a risk assessment for a hereditary adenomatous colorectal polyposis syndrome, modality and timing of germline genetic testing, cancer risk mitigation through endoscopic and surgical interventions, and the role of chemoprevention. This document reviews the approach to genetic testing in patients with phenotypic colorectal polyposis and the impact of presymptomatic diagnosis in families with a known familial germline pathogenic variant or clinical features suggestive of a hereditary adenomatous polyposis syndrome. Management strategies for patients based on genetic test results or without genetic testing are provided. We also review colorectal and extracolonic phenotypic benign and malignant manifestations of the known hereditary syndromes with a focus on the 2 most common hereditary colorectal polyposis syndromes: familial adenomatous polyposis and MUTYH-associated polyposis. The document concludes with recommendations on polyposis and cancer risk mitigation strategies and highlights updates to management since the previous guideline was published.

Humans↗

PubMed1978

Guidelines for protocol studies in chronic lymphocytic leukemia.

The treatment of any malignant disease requires appropriate criteria for diagnosis of the disease, appropriate methods for study, and techniques for evaluating response to treatment. In the past five years, there have been a number of proposed guidelines for studies in chronic lymphocytic leukemia (CLL). These submitted guidelines represent a further re-evaluation of concepts in CLL, and are currently in use by Cancer and Leukemia Group B for protocol studies. It is clear that revisions will continue to be make as new knowledge accumulates. In the meantime, these are submitted for publication for use by other investigators.

Drug Therapy↗

PubMed1976

Applying the guidelines of Beyond the Best Interests of the Child.

Although the wisdom of the guidelines advocated in Beyond the Best Interests of the Child for making custody and visitation decisions is widely proclaimed, the realities of existing statutes and procedural systems preclude their simple application to present-day custody cases. It is the purpose of this paper to join the efforts of others in attempting to delineate how the theoretical policies and abstract strategies comprising these guidelines can be implemented under the constraints of present realities. This effort takes the form of three disguised cases to which is added the author's commentary on his interventions and recommendations.

Child↗

PubMedDate not supplied

Guidelines for use of flexible fiberoptic colonoscopy in management of patients with colorectal neoplasia.

Flexible fiberoptic colonoscopy, to have the maximum effect upon the management of patients having, suspected of, or at risk of having colorectal neoplastic disease, must be applied in accordance with substantial guidelines. Schemes for the application of colonoscopy have been designed for the early and accurate diagnosis of benign and malignant polypoid lesions. Colonoscopy has proven effective in confirming radiographic findings and the removal of pre-malignant and superficially malignant lesions. When applied in accordance with appropriate guidelines, flexible fiberoptic colonoscopy should provide not only secure surveillance in those individuals at high risk, but also should reduce appreciably the morbidity and mortality of colorectal neoplasia.

Colonic Neoplasms↗

PubMed2025

HCSeeker: A classification tool for human genetic variant hot and cold spots designed for PM1 and benign criteria in the ACMG-AMP guideline.

PURPOSE: The PM1 criterion, which states that a variant is located in a mutational hot spot and/or critical and well-established functional domain without benign variation (such as the active site of an enzyme), is considered moderate evidence for assessing its pathogenicity. Although guidelines from the American College of Medical Genetics and Genomics and the Association for Molecular Pathology are widely adopted, the PM1 criterion remains limited from lacking a reliable database of variant hot spots. Compared with hot spots, cold spots are neglected by the guidelines. To improve variant classification, we suggest including cold spots for supporting benign classifications. Consequently, we have developed the HCSeeker to provide data support for PM1 and the "Benign" criteria. METHODS: HCSeeker uses the Kernel Density Estimation and the Expectation-Maximization algorithm to identify hot- and cold-spot regions. RESULTS: Through HCSeeker, we identified 988 hot spots and 682 cold spots across 889 genes and provided a public database (http://www.genemed.tech/hcseeker/) for researchers and clinicians to query variant locations, facilitating the application of American College of Medical Genetics and Genomics and the Association for Molecular Pathology PM1 or "Benign" criteria. CONCLUSION: We developed the HCSeeker tool, which can effectively identify variant hot and cold spots within genes to enhance the interpretability of gene variants.

Humans↗

PubMed1977

Cardiac arrest in the Emergency Medical Service System: guidelines for resuscitation.

A two-year study of 198 consecutive patients treated for cardiac arrest in the emergency department at Stanford University Medical Center was undertaken. The relatively poor overall survival rate of 3% and the complexity of deciding how to treat cardiac arrest victims suggest the need for guidelines to assist the emergency physician when resuscitating cardiac arrest patients. From the above study and a survey of the literature, the authors formulated the following guidelines of when resuscitation should be discontinued or not attempted: Cases of apnea and pulselessness known to have exceeded 10 minutes, no response after more than 30 minutes of advanced cardiac life support (ACLS), no ventricular EKG activity after more than 10 minutes of ACLS, and preexisting terminal illness.

Adult↗

PubMed1976

Guidelines for evaluating sex therapy.

Clinical advances in the treatment of human sexual dysfunctions must be documented by objective and scientific assessments of changes in patients as a result of the therapy. The principle guidelines for evaluating such changes include (1) the use of standard methods of interviewing patients and recording information obtained, both before and after treatment, (2) careful specification of treatment technique(s) used, standardized when applied to any group of patients, (3) assessment of patients' psychosocial as well as sexual functioning, (4) clearly defined criteria for diagnosis and outcome, (5) use of control or comparison groups, and (6) methodical in-person follow-up contacts. The procedures can be applied by clinicians in their individual practice as well as by independent evaluation programs. These guidelines, presented in this paper, provide a framework for reliable investigations to determine which treatments work best for which patients with which sexual dysfunctions.

Evaluation Studies as Topic↗

PubMedDate not supplied

Antihistamines. Guidelines and implications.

Antihistamines may be used to maximum benefit for the allergic patient if the physician adheres to four guidelines. These guidelines are based upon 1) an appreciation of certain structural and pharmacologic differences among antihistamines, and 2) an understanding of their mechanism of action. Around the clock administration is advisable, the dosage should be titrated for the individual patient, substitutions to another antihistamine should be to a different class of antihistamine, and the efficacy of any single antihistamine usually will diminish with prolonged use, either on the basis of true tolerance or because of psychic factors. There is good theoretical evidence when alpha-adrenergic sympathomimetics, employed as decongestants in combination with antihistamines, should not be given to allergic patients. Two newer drugs, disodium cromoglycate and beclomethasone, may provide symptomatic relief for allergic rhinitis patients. They may benefit the patient who does not obtain full symptomatic relief from antihistamines.

Adrenergic alpha-Agonists↗

PubMed1977

Why no guidelines for behavior modification?

This paper reviews the guidelines for behavioral programs published by the National Association of Retarded Children. The review discusses a number of reasons why guidelines should not be enunciated for behavior modification, e.g., the procedures of behavior modification appear to be no more or less subject to abuse and no more or less in need of ethical regulation than intervention procedures derived from any other set of principles and called by other terms. The review recommends alternative methods for protecting the rights of clients who participate in behavioral programs. Specifically, behavioral clinicians, like other therapists, should be governed by the ethics codes of their professions; also, the ethics of all intervention programs should be evaluated in terms of a number of critical issues.

Behavior Control↗

PubMed1977

Intravenous theophylline therapy: nomogram guidelines.

We evolved a nomogram for guiding and standardizing intravenous theophylline therapy in hospitalized patients. It provides rapid calculation of a loading dose based on body weight and previous therapy and a maintenance infusion rate related to three categories of expected metabolic activity. The guidelines were prospectively used in the treatment of 72 patients, mainly in a respiratory care unit. The nomogram was successfully used to attain near-steady-state serum concentrations in the therapeutic range of 8 to 20 mg/litre in 72% of patients, with only two patients outside of the range of 5 to 25 mg/litre. These guidelines facilitate initial theophylline dosage in older patients with liver and cardiac disease and provide a rational basis for interpreting serum concentration measurements and adjustment of drug therapy.

Adult↗

PubMed1978

Guidelines of the Food and Drug Administration for study of new drugs in human subjects.

The Food and Drug Administration recently has published general guidelines for the clinical evaluation of drugs used in adults and in infants and children. Specific guidelines for a number of drug classes, including anti-infective drugs, are also available. Marketing approval of a new drug requires that its benefits be judged to exceed its risks, that it be accurately and truthfully labeled, and that it be manufactured properly. Foreign studies are commonly accepted in support of new drugs, but approval requires at least one domestic trial unless the disease does not occur in the United States (for examply, tropical diseases).

Adult↗

PubMed1976

School psychological emergency interventions proposal for guidelines based on recent Israeli experience.

The Yom Kippur War and its stressful aftermath created a number of special psychological effects in Israeli schools. During that period mental health and counseling services were available and made use of in the educational system. Extensive experiences permit an attempt to delineate guidelines for future school psychological emergency interventions. These guidelines rest on the supposition that the planning and delivery of professional emergency interventions resemble those governing routine mental health services in a number of crucial aspects. Firstly, the need for an educated anticipation of problems, their kinds, their ecology and other characteristics. Schematically, three categories of emergency reactions could be expected in schools: shock and grief, and other acute disturbances; fear and its psychological concomitants; confusion, perplexity, and their attitudinal accompaniments. It is noted that the stressful event can also generate positive effects. Secondly, the necessity for a preliminary, on the spot, assessment of psychological affliction in any specific emergency case. Such examination should be done against the background of the total emergency situation (locally and country-wide), as well as the chronic characteristics of the particular school or system. Third, the requirement for deliberate planning of the intervention program. In this phase, judgements have to be made about the recipients of the aid, the methods of help and the levels at which professional services will be extended. Fourth, the consideration of important clinical and community psychological principles during the execution of the program.

Adaptation, Psychological↗

PubMed1977

Guidelines for peer review. Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Drug Usage.

Eigteen guideline-audits of antimicrobial usage have been prepared for use by hospital staffs for peer review. They may also be used as a national standard to assess the appropriate use of antimicrobial agents in hospitals. It is hoped that the guidelines will stimulate wide discussion and national peer review and will ultimately result in improved care of patients with infectious disease.

Anti-Bacterial Agents↗

PubMedDate not supplied

Guidelines for supervised wound care by emergency nurse practitioners.

Nearly 10 million patients with traumatic lacerations are treated annually in Emergency Departments in the United States. Since these wounds do not usually pose a threat to the patient's life, they assume a lower level of priority than emergent conditions. Consequently, treatment of patients with lacerations is often delayed until the emergent patient is resuscitated. In the event that wound care is inadvertently delayed, bacteria may proliferate to levels that result in infection. In selected patients, supervised wound care by an emergency nurse practitioner (ENP) can safely eliminate this delay in treatment. During their graduate training in the University of Virginia Nursing School, the ENPs are instructed to treat traumatic wounds with physician supervision. The criteria for patient selection and care are outlined in comprehensive guidelines reported herein. The bases for these treatment guidelines were clinical and experimental studies conducted at our medical center which examined the influence of various therapeutic decisions on the ultimate fate of the wound.

Asepsis↗