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The exact incidence of<unk> is unknown. It is one of the more common conditions in a group known as mitochondrial diseases. Together, mitochondrial diseases occur in about 1 in 4,000 people. | MELAS syndrome | Bannayan–Riley–Ruvalcaba syndrome | Pashayan syndrome | Fitzsimmons–Guilbert syndrome | Teunissen–Cremers syndrome | Fryns-Aftimos syndrome | Abruzzo–Erickson syndrome | Berk–Tabatznik syndrome | 00
| 33,579 |
<unk> <unk> is a brain<unk> in which scattered lesions occur over a widespread area in white matter tracts as well as grey matter.<unk> is one of the most common and devastating types of traumatic brain<unk> and is a major cause of unconsciousness and persistent vegetative state after severe head trauma. It occurs in about half of all cases of severe head trauma and may be the primary damage that occurs in concussion. The outcome is frequently coma, with over 90% of patients with severe<unk> never regaining consciousness. Those who do wake up often remain significantly impaired.<unk> can occur across the spectrum of traumatic brain<unk> (TBI) severity, wherein the burden of<unk> increases from mild to severe. Concussion may be a milder type of<unk> . | Diffuse axonal injury | Wallerian degeneration | Central chromatolysis | Synaptopathy | Hemorrhagic infarct | Acute motor axonal neuropathy | Posterior circulation infarct | Subacute combined degeneration of spinal cord | 00
| 21,564 |
<unk> risk<unk> ng system attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding.<unk> et al. identified independent risk factors in 1996 which were later shown to predict mortality accurately. The<unk> ng system uses clinical criteria (increasing age, co-morbidity, shock) as well as endoscopic finding (diagnosis, stigmata of acute bleeding). It is named for Professor Tim<unk> , who was the main investigator and first author of the studies that led to its formulation. A convenient mnemonic is ABCDE - i.e. Age, Blood pressure fall (shock), Co-morbidity, Diagnosis and Evidence of bleeding. Variable<unk> 0<unk> 1<unk> 2<unk> 3 Age 80 Shock No shock Pulse >100BP >100 Systolic SBP <100 Co-morbidity Nil major CHF, IHD, major morbidity kidney failure, liver failure, metastatic cancer Diagnosis Mallory-Weiss All other diagnoses GI malignancy Evidence of bleeding None Blood, adherent clot, spurting vessel | Rockall score | Manchester score | Baux score | FOUR score | Kapandji score | Eagle score | Krenning score | Alvarado score | 00
| 47,597 |
The symptoms and signs associated with<unk> are related to prolonged, visually demanding, near-centered tasks. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others. In some cases, difficulty with making eye contact have been noted as a complaint amongst sufferers. Note that some Internet resources confuse<unk> and divergence dysfunction, reversing them. | Convergence insufficiency | Strabismus | Vertebrobasilar insufficiency | Papillary stenosis | Monotropism | Ecotropism | Vitreomacular adhesion | Solvent drag | 00
| 32,839 |
<unk> is a dihydrofolate reductase inhibitor. | Pralatrexate | Trimetrexate | Abemaciclib | Afamelanotide | Cemiplimab | Mannomustine | Trifluridine | Lenalidomide | 00
| 22,379 |
Estimates of the numbers of people suffering from<unk> s and major depressive disorder (MDD) vary significantly. Overall, 13-20% of people will experience significant depressive symptoms at some point in their life. The overall prevalence of MDD is slightly lower ranging from 3.7-6.7% of people. In their lifetime, 20% to 25% of women, and 7% to 12% of men will suffer a<unk> . The peak period of development is between the ages of 25 and 44 years. Onset of<unk> s or MDD often occurs to people in their mid-20s, and less often to those over 65. The prevalence of depressive symptoms in the elderly is around 1-2%. Elderly persons in nursing homes may have increased rates, up to 15-25%. African-Americans have higher rates of depressive symptoms compared to other races. Prepubescent girls are affected at a slightly higher rate than prepubescent boys. In a National Institute of Mental Health study, researchers found that more than 40% of people with post-traumatic stress disorder suffered from depression four months after the traumatic event they experienced. Women who have recently given birth may be at increased risk for having a<unk> . This is referred to as postpartum depression and is a different health condition than the baby blues, a low mood that resolves within 10 days after delivery. | Major depressive episode | Major depressive disorder | Outline of bipolar disorder | Depression | Late life depression | Atypical depression | Postpartum psychosis | Postpartum depression | 00
| 34,618 |
Symptoms of<unk> can be caused by or be associated with: *Sleep breathing disorders, such as sleep apnea or upper airway resistance syndrome *Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake *Use of or withdrawal from alcohol and other sedatives, such as anti-anxiety and sleep drugs like benzodiazepines *Use of or withdrawal from pain-relievers such as opioids *Heart disease *Restless legs syndrome, which can cause sleep onset<unk> due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations *Periodic limb movement disorder (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware *Pain: an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can also cause awakening. *Hormone shifts such as those that precede menstruation and those during menopause *Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child, and bereavement *Gastrointestinal issues such as heartburn or constipation *Mental, neurobehavioral, or neurodevelopmental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, autism, dementia, ADHD, Asperger syndrome, and FASD *Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic circadian rhythm disorders are characterized by similar symptoms. * Certain neurological disorders such as brain lesions, or a history of traumatic brain injury *Medical conditions such as hyperthyroidism *Abuse of over-the-counter or prescription sleep aids (sedative or depressant drugs) can produce rebound<unk> *Poor sleep hygiene, e.g., noise or over-consumption of caffeine *A rare genetic condition can cause a prion-based, permanent and eventually fatal form of<unk> called fatal familial<unk> *Physical exercise: exercise-induced<unk> is common in athletes in the form of prolonged sleep onset latency *Increased exposure to the blue light from artificial sources, such as phones or computers *Chronic pain *Lower back pain *Asthma Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone. They also have an elevated metabolic rate, which does not occur in people who do not have<unk> but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with<unk> have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term<unk> . Genetics Heritability estimates of<unk> vary between 38% in males to 59% in females. A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence the risk of<unk> , and showed that<unk> is highly polygenic. In particular, a strong positive association was observed for the MEIS1 gene in both males and females. This study showed that the genetic architecture of<unk> strongly overlaps with psychiatric disorders and metabolic traits. It has been hypothesised that the epigenetics might also influence<unk> through a controlling process of both sleep regulation and brain-stress response having an impact as well on the brain plasticity. Substance-induced Alcohol-induced Alcohol is often used as a form of self-treatment of<unk> to induce sleep. However, alcohol use to induce sleep can be a cause of<unk> . Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep. Stopping chronic alcohol use can also lead to severe<unk> with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect. Benzodiazepine-induced Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam, and diazepam, are commonly used to treat<unk> in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood). Opioid-induced Opioid medications such as hydrocodone, oxycodone, and morphine are used for<unk> that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated<unk> . However, dependence on opioids can lead to long-term sleep disturbances. Risk factors<unk> affects people of all age groups but people in the following groups have a higher chance of acquiring<unk> : *Individuals older than 60 *History of mental health disorder including depression, etc. *Emotional stress *Working late night shifts *Traveling through different time zones *Having chronic diseases such as diabetes, kidney disease, lung disease, Alzheimer's, or heart disease *Alcohol or drug use disorders *Gastrointestinal reflux disease *Heavy smoking *Work stress | Insomnia | Delayed sleep phase disorder | Parasomnia | Restless legs syndrome | Hypersomnia | Mental disorder | Dyssomnia | Sleep apnea | 00
| 3,451 |
Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is however the healthy state of a human child or other young offspring, for they have not yet undergone puberty, the body's start of reproductive capacity. In humans, infertility is the inability to become pregnant after one year of unprotected and regular sexual intercourse involving a male and female partner. There are many causes of infertility, including some that medical intervention can treat. Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%. Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts. In 10–20% of cases, no cause is found. The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods. The most frequent cause of infertility today in occidental population is the delay of maternity, because the quality of oocytes decreases dramatically with age, especially after 35 years. Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature. | complications of Testicular torsion | complications of Epididymitis | medical cause of Epididymitis | complications of Cystocele | complications of Ovarian cyst | symptom of Epididymitis | complications of Baker's cyst | complications of Pelvic inflammatory disease | 00
| 7,110 |
An<unk> (OMP) is a<unk><unk> . In the UK they are registered with a qualification in ophthalmology who is employed to carry out<unk> eye examinations and prescribe glasses, contact lenses, eyepatches and other orthoptic treatment. In order to work as an<unk> a doctor must be on the Central List of the Ophthalmic Qualifications Committee at the Royal College of Ophthalmologists. This is a statutory list that is administered by the British<unk> Association. OMPs are often trainee ophthalmologists who work to supplement their income. "MPs are ophthalmologists who undertake NHS sight tests under the General Ophthalmic Services contract. Like optometrists, they examine eyes, test sight, diagnose abnormalities and prescribe suitable corrective lenses. OMPs are registered with and regulated by the General<unk> Council. There are currently around 400 registered<unk> s in the UK. "The responsibilities of OMPs in conducting NHS sight tests are the same as those of optometrists and both have an important role in the primary detection of eye disease. In the course of sight testing, symptoms and signs of eye disease may become evident and the OMP has the additional role of taking a history, conducting an ophthalmic examination as appropriate, and referring patients for further investigation and treatment where indicated. Some OMPs also work in the Hospital Eye Service or as General<unk> s or in other health care settings." | Ophthalmic medical practitioner | Ophthalmic technician | Eye care professional | Dental therapist | Phlebologist | Psychologist | Psychiatrist | Barefoot doctor | 00
| 40,708 |
<unk> , also known as genetic<unk> , is the belief that human behaviour is directly controlled by an individual's genes or some component of their physiology, generally at the expense of the role of the environment, whether in embryonic development or in learning. Genetic reductionism is a similar concept, but it is distinct from genetic<unk> in that the former refers to the level of understanding, while the latter refers to the supposedly causal role of genes.<unk> has been associated with movements in science and society including eugenics, scientific racism, and the debates around the heritability of IQ, the basis of sexual orientation, and sociobiology. In 1892, the German evolutionary biologist August Weismann proposed in his germ plasm theory that heritable information is transmitted only via germ cells, which he thought contained determinants (genes). The English polymath Francis Galton, supposing that undesirable traits such as club foot and criminality were inherited, advocated eugenics, aiming to prevent supposedly defective people from breeding. American physician Samuel George Morton and the French physician Paul Broca attempted to relate the cranial capacity (internal skull volume) to skin colour, intending to show that white people were superior. Other workers such as the American psychologists H. H. Goddard and Robert Yerkes attempted to measure people's intelligence and to show that the resulting scores were heritable, again to demonstrate the supposed superiority of people with white skin. Galton popularized the phrase nature and nurture, later often used to characterize the heated debate over whether genes or the environment determined human behavior. Scientists such as ecologists and behavioural geneticists now see it as obvious that both factors are essential, and that they are intertwined, especially through the mechanisms of epigenetics. The American biologist E. O. Wilson founded the discipline of sociobiology, founded on observations of animals such as social insects, controversially suggesting that its explanations of social behaviour might apply to humans. | Biological determinism | Diagnostic greed | Biological inequity | Genetic heterogeneity | Biosecurity | Biological globalization | Therapeutic privilege | Dynamic mutation | 00
| 3,308 |
A<unk> is a health professional such as a doctor of medicine, pharmacist, chemist or<unk> that is specialized in<unk> biology, a medical specialty derived from<unk> pathology. The concept includes interventional biology, including assisted reproductive technology. These professionals follow a medical residency whose duration varies between countries (from 3 to 5 years). This term is frequently used in France, Belgium and other countries in Western Europe, Africa or Asia. | Clinical biologist | Biological pharmacist | Pharmacist | Radiographer | Biomedical scientist | Pulmonary scientist | Proceduralist | Psychologist | 00
| 51,338 |
<unk> is an extremely rare genetic disorder and there is a limited amount of information related to it. Similar or related medical conditions are arachnodactyly, aminoaciduria, congenital cataracts, cerebellar ataxia, and delayed developmental milestones. | Bhaskar–Jagannathan syndrome | McGillivray syndrome | Senior–Løken syndrome | Lown–Ganong–Levine syndrome | Andersen–Tawil syndrome | Kearns–Sayre syndrome | Smith–Fineman–Myers syndrome | Juberg-Hayward syndrome | 00
| 35,267 |
Friction blisters Friction blisters, caused by rubbing against the skin, can be prevented by reducing the friction to a level where blisters will not form. This can be accomplished in a variety of ways. Blisters on the feet can be prevented by wearing comfortable, well-fitting shoes and clean socks. Inherently ill-fitting or stiffer shoes, such as high heels and dress shoes, present a larger risk of blistering. Blisters are more likely to develop on skin that is moist, so socks that manage moisture or frequent sock changes will aid those with particularly sweaty feet. While exercising or playing sports, special sports socks can help keep feet drier and reduce the chance of blisters. Before going for a long walk, it is also important to ensure that shoes or hiking boots have been properly broken in. Even before a "hot" or irritated area on the foot is felt, taping a protective layer of padding or a friction-reducing interface between the affected area and the footwear can prevent the formation of a blister. Bandages, moleskin and tapes generally must be applied to the foot daily, and most have a very high coefficient of friction (COF), but a friction-management patch applied to the shoe will remain in place much longer, throughout many changes of socks and insoles. This type of intervention may be used with footwear that is worn daily, with specialty shoes and boots like hockey skates, ice skates, inline skates, ski boots and cleats, or even with orthotic braces and splints. For periods of sustained use such as hiking and trail running, especially where water ingress or moisture build up in the shoe or boot can occur, moisture wicking liner socks can provide the required friction protection. To avoid friction blisters on the hands, gloves should be worn when using tools such as a shovel or pickaxe, doing manual work such as gardening, or using sports equipment like golf clubs or baseball bats. Oars used for competitive rowing are known for causing frequent blisters on the hands of oarsmen. Weightlifters are also prone to blisters as are gymnasts from the friction developed by the rubbing against the bars. To further reduce the occurrence one can tape the hands, and there are also a number of products on the market that claim to reduce the occurrence of blisters. These are all intended to be worn as a liner underneath a glove. The majority of these offerings simply add padding, and create a layer that reduces the coefficient of friction between the skin and the glove. A lubricant, typically talcum powder, can be used to reduce friction between skin and apparel in the short term. People put talcum powder inside gloves or shoes for this purpose, although this type of lubricant can actually increase the friction in the long term as it absorbs moisture. Increased friction makes blisters more likely. Other Sunscreen and protective clothing should also be used during the hottest part of the day to avoid blisters from sunburn. Avoiding sunlight during midday is the best way to avoid blisters from sunburn. Protective gloves should be worn when handling detergents, cleaning products, solvents and other chemicals. | symptom of Herpes labialis | symptom of Tularemia | symptom of Buruli ulcer | symptom of Rosacea | symptom of Syphilis | symptoms of Tularemia | symptom of Angular cheilitis | symptom of Stevens–Johnson syndrome | 00
| 9,237 |
The<unk> (ICM) supports, represents and works to strengthen professional associations of<unk> on a global basis. At present, ICM has over 100 members, representing midwifery associations in around 100 countries. The ICM works with<unk> and midwifery associations globally to secure women’s rights and access to midwifery care before, during and after childbirth. The ICM has worked alongside UN agencies and other partners for decades in global initiatives to help reduce the numbers of mothers and babies who die in and around childbirth, and evidence is growing that shows expanding midwifery care is one of the best ways to combat maternal mortality. The drive for safer motherhood continues to gain strength as more women worldwide achieve access to midwifery care. | International Confederation of Midwives | Surgeon General of the United States Navy | Assistant doctor | Foundation doctor | Surgeon's assistant | World Federation of Associations of Pediatric Surgeons | Victorian Order of Nurses | Red Cross of the Democratic Republic of the Congo | 00
| 41,647 |
In those in whom the cause is known and prompt treatment is available, the prognosis is good. Even if the cause is unknown, if appropriate preventive medication is available, the prognosis is generally good. If death occurs, it is usually due to either respiratory (typically asphyxia) or cardiovascular causes (shock), with 0.7–20% of cases causing death. There have been cases of death occurring within minutes. Outcomes in those with exercise-induced<unk> are typically good, with fewer and less severe episodes as people get older. | Anaphylaxis | Asthma | Heat urticaria | Allergy | Cholinergic urticaria | Carcinoid syndrome | Tachyphylaxis | Angioedema | 00
| 5,118 |
While no single test is reliable to distinguish iron deficiency anemia from the anemia of<unk> inflammation, there are sometimes some suggestive data: * In anemia of<unk> inflammation without iron deficiency, ferritin is normal or high, reflecting the fact that iron is sequestered within cells, and ferritin is being produced as an acute phase reactant. In iron deficiency anemia ferritin is low. * Total iron-binding capacity (TIBC) is high in iron deficiency, reflecting production of more transferrin to increase iron binding; TIBC is low or normal in anemia of<unk> inflammation. | Anemia of chronic disease | Anemia in pregnancy | Transfusion-dependent anemia | Acquired hemolytic anemia | Heparin-induced thrombocytopenia | Hemoglobinemia | Sideroblastic anemia | EEM syndrome | 00
| 27,983 |
<unk> is a toxin found in the venom of the King Cobra (Ophiophagus hannah), which lives throughout South East Asia. This toxin belongs to the cysteine-rich secretory protein (CRISP) family.<unk> weakly blocks the contraction of smooth muscles elicited by high potassium-induced depolarization, suggesting that it inhibits voltage-dependent calcium channels. | Ophanin | Melanin | Cellulite | Ceruloplasmin | Hematoporphyrin | Respiratory pigment | Canthaxanthin | Kerion | 00
| 29,221 |
In mammals, each Bartonella species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of Carrion's disease. Bartonella species also have a tropism for endothelial cells, observed in the chronic phase of Carrion's disease (also known as verruga Peruana) and bacillary angiomatosis. Pathological response can vary with the immune status of the host. Infection with B. henselae can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis in immunocompromised patients), endocarditis, or meningitis. | Bartonellosis | Brucellosis | Shigellosis | Salmonellosis | Leptospirosis | Bacillary dysentery | Listeriosis | Rhinosporidiosis | 00
| 30,510 |
A typical<unk> An<unk> is a simple piece of equipment for determining urine specific gravity. A typical<unk> is composed of a float, a weight, and a stem. The float is an air-filled glass tube, ending in the weight on the left and the stem on the right. The weight is a bulb filled with ball bearings embedded in a red solid, probably a glue of some sort. The glass stem extends to the right, and has calibrated graduations and numbers marked off to indicate specific gravity measurements. It is placed in a tube of urine, and where the meniscus of the urine reaches displays the specific gravity of the urine. An<unk> is typically used in medical diagnostic labs. | Urinometer | Exophthalmometer | Vernier acuity | Dosimetry | Corneal topography | String galvanometer | Pupilometer | Ocular tilt reaction | 00
| 59,435 |
Motor neglect can occur in isolation from, or in association with hemispatial neglect, making the pathological state more complicated in at least 30% of patients with brain damage. Motor neglect has been described in different terms: disorders and intentional neglect; motor hemi neglect; thalamic, nonsensory neglect; and callosal neglect. Laplane and Degos coined the term motor neglect, giving this definition:"Absent or low use of spontaneous contralesional limb (lower and/or higher), despite preserved motor skills...not explained by weakness or lack of sensitivity, it improves with the verbal suggestion". Clinical features Motor neglect concerns all proximal and distal movements, involving both the upper and lower limb in automatic gestures. Taxonomy of motor neglect symptoms is diverse: poor use of the affected limb, difficulty in bimanual activities (such as opening a bottle), spontaneous gestures reduced especially while speaking and, lack of "swing" of the arm while walking. The gait is unbalanced, and the lower limb is often dragged with the consequent risk of falls. Movements of the neglected limb, when executed, are initiated with delay hypokinesia, reduced in their amplitude, and accompanied by bradykinesia One of the most distinctive features of motor neglect is the verbal prompt. Specifically, patients that are encouraged to use the limb with motor neglect have relatively normal movement, but do not perform the same movement spontaneously. Two forms of motor deficits are associated with, but different from, motor neglect: directional hypokinesia and, motor neglect component Directional hypokinesia refers to a deficit of startup of movements of ipsilesional limbs in contralesional space. Patients are slowed down when they have to perform an action with the non-neglected limb in space account side, despite preservation of control and motor coordination. Motor neglect component is similar to motor neglect but, unlike the latter, doesn't improve through direct verbal command, only through vestibular caloric stimulation. | Hemimotor neglect | Dissociated sensory loss | Pallesthesia | Finger agnosia | Abnormal posturing | Terminal digit preference | Hemispatial neglect | Spastic hemiplegia | 00
| 65,111 |
The most common adverse reactions encountered in Phase II and Phase III trials were nausea (5.5%), headache (4.7%), and diarrhea (4.4%), as well as rash (2.7%) and itchiness (2.1%). Other less frequent but serious adverse reactions included hematologic disorders, hepatotoxicity, Clostridium difficile colitis, bronchospasm, infusion-related reactions including Red Man Syndrome, and anaphylactic shock. In trials,<unk> was associated with higher rates of hemorrhagic events compared to comparator groups and should be a precaution in patients undergoing surgery or taking anticoagulants. Patients on<unk> also had post-baseline alanine aminotransferase (ALT) levels that were 3 times the upper normal limit, some even having elevations 10 times the upper normal limit; however, eight of the twelve<unk> -treated patients had comorbid conditions that could affect their ALT, compared to only one patient in the comparator group. There is no evidence of ototoxicity associated with<unk> . Drug interactions Clinical drug-drug interactions with<unk> have not been studied, and<unk> does not appear to interact with cytochrome P450 substrates, inhibitors, or inducers. It was found to have an in vitro synergistic interaction with the antimicrobial oxacillin, but the clinical significance of this interaction has yet to be established. Pregnancy and lactation Use of<unk> in pregnant women has not been studied sufficiently and should only occur when the potential benefit outweighs the potential risk to the fetus. Animal studies did not show embryo or fetal toxicity at doses that were 1.2 and 0.7 times the human dose. However, delayed fetal maturation was observed at a dose that was 3.5 times the human dose. While<unk> is excreted in rat milk, it is unknown if it is excreted in human milk. It should be used in nursing mothers only when the potential benefit exceeds the potential risk. There is no evidence in animals of teratogenicity. | Dalbavancin | Rifampicin | Meropenem | Imipenem | Amikacin | Doripenem | Imipenem/cilastatin/relebactam | Avibactam | 00
| 48,475 |
It is often impossible to distinguish<unk> from<unk> respiratory distress syndrome (ARDS). The typical presentation of<unk> is the sudden development of shortness of breath, severe hypoxemia (O2 saturation <90% in room air), low blood pressure, and fever that develop within 6 hours after<unk> and usually resolve with supportive care within 48 to 96 hours. Although low blood pressure is considered one of the important signs for diagnosing<unk> , in some cases high blood pressure can occur. Delayed<unk> occurs 6 to 72 hours after<unk> completion. It is associated with a higher rate of mortality. | Transfusion-related acute lung injury | Transfusion associated circulatory overload | Culture-bound syndrome | Macrophage activation syndrome | Transfusion-related immunomodulation | Systemic inflammatory response syndrome | Transfusion transmitted infection | Transfusion-associated graft-versus-host disease | 00
| 35,434 |
<unk> is a multi-systemic condition characterized by repeated episodes of inflammation and deterioration of cartilage. The often painful disease can cause joint deformity and be life-threatening if the respiratory tract, heart valves, or blood vessels are affected. The exact mechanism is poorly understood, but it is thought to be related to an immune-mediated attack on particular proteins that are abundant in cartilage. The diagnosis is reached on the basis of the symptoms and supported by investigations such as blood tests and sometimes other investigations. Treatment may involve symptomatic treatment with painkillers or anti-inflammatory medications, and more severe cases may require suppression of the immune system. | Relapsing polychondritis | Rheumatoid nodulosis | Reactive arthritis | Juvenile idiopathic arthritis | Psoriatic arthritis | Discoid lupus erythematosus | Polymyalgia rheumatica | Rheumatoid arthritis | 00
| 29,399 |
Functional assessment of brain activity can be assessed for<unk> using imaging techniques such as fMRI, PET and EEG, in accordance with clinical data. Some research has suggested that organic and<unk> to some extent share the involvement of the same structures of the temporo-frontal region in the brain. It has been suggested that deficits in episodic memory may be attributable to dysfunction in the limbic system, while self-identity deficits have been suggested as attributable to functional changes related to the posterior parietal cortex. To reiterate however, care must be taken when attempting to define causation as only ad hoc reasoning about the aetiology of<unk> is possible, which means cause and consequence can be infeasible to untangle. | Psychogenic amnesia | Drug-induced amnesia | Excited delirium | Post-traumatic amnesia | Emergence delirium | Posthypnotic amnesia | Transient global amnesia | Memory distrust syndrome | 00
| 33,029 |
<unk> refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric<unk> procedures (GBP). Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food. The operation is prescribed to treat morbid obesity (defined as a body mass index greater than 40), type 2 diabetes, hypertension, sleep apnea, and other comorbid conditions. Bariatric<unk> is the term encompassing all of the surgical treatments for morbid obesity, not just gastric<unk> es, which make up only one class of such operations. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric<unk> patients has been shown to be reduced by up to 40%. As with all<unk> , complications may occur. A study from 2005 to 2006 revealed that 15% of patients experience complications as a result of gastric<unk> , and 0.5% of patients died within six months of<unk> due to complications. A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric<unk> was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric<unk> as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes. | Gastric bypass surgery | Endoscopic sleeve gastroplasty | Vertical banded gastroplasty surgery | Sleeve gastrectomy | Adjustable gastric band | Collis gastroplasty | SILS gastric banding | Bariatric surgery | 00
| 17,444 |
RALD patients show normal to modestly decreased total lymphocytes, mild to no elevation in αβ-double negative T cells, a relative expansion of B cells, and elevated granulocytes and monocytes. The absolute or relative monocytosis in particular is an important characteristic of this<unk> and help differentiate it from ALPS. Autoantibodies are also common. | RAS-associated autoimmune leukoproliferative disorder | Thymoma-associated multiorgan autoimmunity | Fibrin-associated diffuse large B-cell lymphoma | ALK+ large B-cell lymphoma | Autoimmune lymphoproliferative syndrome | Epstein–Barr virus–associated lymphoproliferative diseases | X-linked lymphoproliferative disease | Nodal marginal zone B cell lymphoma | 00
| 65,893 |
A female doctor takes the pulse of a male patient<unk> -biased<unk> g is the idea that<unk> and psychological<unk> are influenced by the<unk> of the patient. Several studies have found evidence of differential<unk> for patients with similar ailments but of different sexes. Female patients face discrimination through the denial of treatment or misclassification of<unk> as a result of not being taken seriously due to stereotypes and<unk> <unk> . According to traditional<unk> studies, most of these<unk> studies were done on men thus overlooking many issues that were related to women's health. This topic alone sparked controversy and brought about question to the<unk> standard of our time. Popular media has illuminated the issue of<unk> <unk> in recent years. Research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally. | Gender bias in medical diagnosis | Rare disease assumption | Sex differences in medicine | Sex differences in stroke care | Psychological impact of climate change | Sex differences in psychology | Violence against healthcare professionals by country | Self-experimentation in medicine | 00
| 61,524 |
<unk> (military code Q, also known as One-and-one-half mustard) is a vesicant chemical weapon, a type of mustard gas. In its pure form it is more toxic and has up to five times the potency as a vesicant compared to standard mustard gas, though it is a solid at room temperature and so was only ever deployed as mixtures with the original mustard, with phosgene, or as a solution. Since 1997, it has been listed under Schedule I of the Chemical Weapons Convention, as a substance with few uses outside of chemical warfare (although since then, it has been found to be useful in chemotherapy). | Sesquimustard | Enarodustat | Truenat | Erteberel | Veristrat | Patiromer | Androvax | Lazaretto | 00
| 36,646 |
<unk> , or dermanyssosis, is a frequently unrecognized ectoparasitosis and source of growing concern in human medicine, occurring after contact with avian mites which infest canaries, sparrows, starlings, pigeons and poultry and caused by two genera of mites, Ornithonyssus and Dermanyssus. Avian mite species implicated include the red mite (Dermanyssus gallinae), tropical fowl mite (Ornithonyssus bursa) and northern fowl mite (Ornithonyssus sylviarum). Mite dermatitis is also associated with rodents infested with the tropical rat mite (Ornithonyssus bacoti), spiny rat mite (Laelaps echidnina) and house-mouse mite (Liponyssoides sanguineus), where the condition is known as rodent mite dermatitis. Urban<unk> is associated with window-sills, ventilation and air-conditioning intakes, roofs and eaves, which serve as shelters for nesting birds. Humans bitten by these mites experience a non-specific dermatitis with intense itching. | Gamasoidosis | Amyloidosis | Sarcoidosis | Melioidosis | Neurosarcoidosis | Acrokeratoelastoidosis of Costa | Extrapulmonary tuberculosis | Chronic multifocal Langerhans cell histiocytosis | 00
| 55,640 |
At the early stage, a<unk> may not show any symptom at all. Some symptoms may include: * Seeing floaters in the vision * Seeing cobwebs in the vision *Seeing haze or shadows * Distorted vision *Rapid flashes of light in peripheral vision *Red tint to vision * Blurriness *Sudden blindness *Headache | Retinal haemorrhage | Vitreous hemorrhage | Intraocular hemorrhage | Retinal vasculitis | Retinal detachment | Vitreoretinopathy | Ischemic optic neuropathy | Branch retinal vein occlusion | 00
| 23,920 |
This condition has been associated with mutations in the POLR3A gene. This gene is located on the long arm of chromosome 10 (10q22.3). This gene encodes the largest subunit (A) of the DNA directed RNA polymerase III. This subunit includes the catalytic site of RNA polymerase III. Mutations in this gene have been associated with hypogonadotropic hypogonadism and hypomyelinating leukodystrophy with or without oligodontia. | Wiedemann–Rautenstrauch syndrome | Progeria | Beckwith–Wiedemann syndrome | Weismann-Netter–Stuhl syndrome | Daentl Townsend Siegel syndrome | Wiedemann–Steiner syndrome | Prader–Willi syndrome | Bardet–Biedl syndrome | 00
| 64,326 |
According to recent studies structure of the bones and skin could be the answer to stopping it. This can probably be achieved by a certain surgery. A change in posture could also help heal the deformed bones.--> | Deviated gaze | Facial toning | Auditory exclusion | Audio-visual entrainment | Conjugate eye movement | Stuttering | Binocular dysphoria | Hypernasal speech | 00
| 43,343 |
<unk> is a cardiac arrhythmia in which there is a single ectopic beat, or irregular heartbeat, following each regular heartbeat. Most often this is due to ectopic beats occurring so frequently that there is one after each sinus beat, or normal heartbeat. The two beats are figuratively similar to two twins (hence bi- + gemini). For example, in ventricular<unk> , a sinus beat is shortly followed by a premature ventricular contraction (PVC), a pause, another normal beat, and then another PVC. In atrial<unk> , the other "twin" is a premature atrial contraction (PAC). | Bigeminy | Gallop rhythm | Picardy sweat | Stuttering | Dichotic pitch | Atopy | Bendopnea | Growing Pains | 00
| 60,574 |
Similar to many other cancers, lung cancer is initiated by either the activation of oncogenes or the inactivation of tumor suppressor genes. Carcinogens cause mutations in these genes that induce the development of cancer. Mutations in the K-ras proto-oncogene contribute to roughly 10–30% of lung adenocarcinomas. Nearly 4% of non-small-cell lung carcinomas involve an EML4-ALK tyrosine kinase fusion gene. Epigenetic changes such as alteration of DNA methylation, histone tail modification, or microRNA regulation may result in the inactivation of tumor suppressor genes. Importantly, cancer cells develop resistance to oxidative stress, which enables them to withstand and exacerbate inflammatory conditions that inhibit the activity of the immune system against the tumor. The epidermal growth factor receptor (EGFR) regulates cell proliferation, apoptosis, angiogenesis, and tumor invasion. Mutations and amplification of EGFR are common in NSCLC, and they provide the basis for treatment with EGFR inhibitors. Her2/neu is affected less frequently. Other genes that are often mutated or amplified include c-MET, NKX2-1, LKB1, PIK3CA, and BRAF. The cell lines of origin are not fully understood. The mechanism may involve the abnormal activation of stem cells. In the proximal airways, stem cells that express keratin 5 are more likely to be affected, typically leading to squamous-cell lung carcinoma. In the middle airways, implicated stem cells include club cells and neuroepithelial cells that express club-cell secretory protein. SCLC may originate from these cell lines or neuroendocrine cells, and it may express CD44. Metastasis of lung cancer requires transition from epithelial to mesenchymal cell type. This may occur through the activation of signaling pathways such as Akt/GSK3Beta, MEK-ERK, Fas, and Par6. | medical cause of Hemoptysis | symptom of Lung cancer | types of Lung cancer | medical cause of Hemothorax | medical cause of Bronchiectasis | medical cause of Chylothorax | medical cause of Bronchiolitis | symptom of Bronchiectasis | 00
| 1,278 |
Diagnosis is made on the appearance; the virus cannot routinely be cultured. The diagnosis can be confirmed by excisional biopsy. Histologically,<unk> is characterized by<unk> bodies (also known as Henderson-Patersen bodies) in the epidermis, above the stratum basale, which consist of cells with abundant large granular eosinophilic cytoplasmic inclusion bodies (accumulated virions) and a small nucleus that has been pushed to the periphery. File:Low magnification micrograph of a<unk> lesion.Low magnification micrograph of a<unk> lesion Image:molluscum<unk> low mag.Low-magnification micrograph of<unk> , H&E stain Image:molluscum<unk> high mag.High-magnification micrograph of<unk> , showing the characteristic<unk> bodies, H&E stain | Molluscum contagiosum | Wart | Tinea manuum | Chickenpox | Lentigo simplex | Folliculitis | Lichen myxedematosus | Herpes simplex | 00
| 12,081 |
Micrograph of Alzheimer type II astrocytes, as may be seen in hepatic encephalopathy Investigations The diagnosis of hepatic encephalopathy can only be made in the presence of confirmed liver disease (types A and C) or a portosystemic shunt (type B), as its symptoms are similar to those encountered in other encephalopathies. To make the distinction, abnormal liver function tests and/or ultrasound suggesting liver disease are required, and ideally a liver biopsy. The symptoms of hepatic encephalopathy may also arise from other conditions, such as bleeding in the brain and seizures (both of which are more common in chronic liver disease). A CT scan of the brain may be required to exclude bleeding in the brain, and if seizure activity is suspected an electroencephalograph (EEG) study may be performed. Rarer mimics of encephalopathy are meningitis, encephalitis, Wernicke's encephalopathy and Wilson's disease; these may be suspected on clinical grounds and confirmed with investigations. The diagnosis of hepatic encephalopathy is a clinical one, once other causes for confusion or coma have been excluded; no test fully diagnoses or excludes it. Serum ammonia levels are elevated in 90% of people, but not all hyperammonaemia (high ammonia levels in the blood) is associated with encephalopathy. A CT scan of the brain usually shows no abnormality except in stage IV encephalopathy, when brain swelling (cerebral oedema) may be visible. Other neuroimaging modalities, such as magnetic resonance imaging (MRI), are not currently regarded as useful, although they may show abnormalities. Electroencephalography shows no clear abnormalities in stage 0, even if minimal HE is present; in stages I, II and III there are triphasic waves over the frontal lobes that oscillate at 5 Hz, and in stage IV there is slow delta wave activity. However, the changes in EEG are not typical enough to be useful in distinguishing hepatic encephalopathy from other conditions. Once the diagnosis of encephalopathy has been made, efforts are made to exclude underlying causes (such as listed above in "causes"). This requires blood tests (urea and electrolytes, full blood count, liver function tests), usually a chest X-ray, and urinalysis. If there is ascites, a diagnostic paracentesis (removal of a fluid sample with a needle) may be required to identify spontaneous bacterial peritonitis (SBP). Classification West Haven criteria The severity of hepatic encephalopathy is graded with the West Haven Criteria; this is based on the level of impairment of autonomy, changes in consciousness, intellectual function, behavior, and dependence on therapy. * Grade 0 - No obvious changes other than a potentially mild decrease in intellectual ability and coordination * Grade 1 - Trivial lack of awareness; euphoria or anxiety; shortened attention span; impaired performance of addition or subtraction * Grade 2 - Lethargy or apathy; minimal disorientation for time or place; subtle personality change; inappropriate behaviour * Grade 3 - Somnolence to semistupor, but responsive to verbal stimuli; confusion; gross disorientation * Grade 4 - Coma Types Micrograph showing liver cirrhosis, a condition that often precedes hepatic encephalopathy. Trichrome stain. A classification of hepatic encephalopathy was introduced at the World Congress of Gastroenterology 1998 in Vienna. According to this classification, hepatic encephalopathy is subdivided in type A, B and C depending on the underlying cause. * Type A (=acute) describes hepatic encephalopathy associated with acute liver failure, typically associated with cerebral oedema * Type B (=bypass) is caused by portal-systemic shunting without associated intrinsic liver disease * Type C (=cirrhosis) occurs in people with cirrhosis - this type is subdivided in episodic, persistent and minimal encephalopathy The term minimal encephalopathy (MHE) is defined as encephalopathy that does not lead to clinically overt cognitive dysfunction, but can be demonstrated with neuropsychological studies. This is still an important finding, as minimal encephalopathy has been demonstrated to impair quality of life and increase the risk of involvement in road traffic accidents. Minimal HE The diagnosis of minimal hepatic encephalopathy requires neuropsychological testing by definition. Older tests include the "numbers connecting test" A and B (measuring the speed at which one could connect randomly dispersed numbers 1–20), the "block design test" and the "digit-symbol test". In 2009 an expert panel concluded that neuropsychological test batteries aimed at measuring multiple domains of cognitive function are generally more reliable than single tests, and tend to be more strongly correlated with functional status. Both the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and PSE-Syndrom-Test may be used for this purpose. The PSE-Syndrom-Test, developed in Germany and validated in several other European countries, incorporates older assessment tools such as the number connection test. | complications of Cirrhosis | complications of Hepatitis | complications of Acute liver failure | complications of Hepatitis B | complications of Hepatitis A | medical cause of Liver cancer | medical cause of Cirrhosis | complications of Hepatitis E | 00
| 20,619 |
A distinct feature of the<unk> is its prolonged clinical evolution, with relapsing episodes and autoimmune dysfunction. If diagnosed in its early stages, the symptoms respond well to antibiotics. If the disease evolves to a chronic phase, it can potentially cause oligoarthritis, cognitive impairment, meningoencephalitis and erythema nodosum, with the patient risking to develop both articular and neurological sequelae. The neurological manifestations of BYS were first described by<unk> et al. including patients with peripheral neuritis, meningitis and cranial neuritis (facial nerve palsy, diplopia and deafness). Likely transmission vectors of BYS belong to the Amblyomma and Rhipicephalus genera, which could help to explain all the particularities observed in BYS versus LD. Some features of BYS also resemble those found in the Southern tick-associated rash illness (STARI, also known as Masters' disease), which is found in the Southern USA. | Baggio–Yoshinari syndrome | DeSanto-Shinawi syndrome | Keppen–Lubinsky syndrome | Barakat-Perenthaler syndrome | Pelger–Huët anomaly | Aagenaes syndrome | Koolen–De Vries syndrome | GRACILE syndrome | 00
| 67,648 |
Global distribution of<unk> <unk> virus (2006)<unk> V was first isolated from a<unk> ish 37-year-old woman at Omogo in the<unk> <unk> District of Uganda in 1937 during research on yellow<unk> virus. A series of serosurveys in 1939 in central Africa found anti-WNV positive results ranging from 1.4% (Congo) to 46.4% (White<unk> region, Sudan). It was subsequently identified in Egypt (1942) and India (1953), a 1950 serosurvey in Egypt found 90% of those over 40 years in age had<unk> V antibodies. The ecology was characterized in 1953 with studies in Egypt and Israel. The virus became recognized as a cause of<unk> e human meningoencephalitis in elderly patients during an outbreak in Israel in 1957. The disease was first noted in horses in Egypt and France in the early 1960s and found to be widespread in southern Europe, southwest Asia and Australia. The first appearance of<unk> V in the<unk> ern Hemisphere was in 1999 with encephalitis reported in humans, dogs, cats, and horses, and the subsequent spread in the United States may be an important milestone in the evolving history of this virus. The American outbreak began in College Point, Queens in New York City and was later spread to the neighboring states of New Jersey and Connecticut. The virus is believed to have entered in an infected bird or mosquito, although there is no clear evidence.<unk> <unk> virus is now endemic in Africa, Europe, the Middle East,<unk> and central Asia, Oceania (subtype Kunjin), and most recently, North America and is spreading into Central and South America. Outbreaks of<unk> <unk> virus encephalitis in humans have occurred in Algeria (1994), Romania (1996 to 1997), the Czech Republic (1997), Congo (1998), Russia (1999), the United States (1999 to 2009), Canada (1999–2007), Israel (2000) and Greece (2010). Epizootics of disease in horses occurred in Morocco (1996), Italy (1998), the United States (1999 to 2001), and France (2000), Mexico (2003) and Sardinia (2011). Outdoor workers (including biological fieldworkers, construction workers, farmers, landscapers, and painters), healthcare personnel, and laboratory personnel who perform necropsies on animals are at risk of contracting<unk> V. In 2012, the US experienced one of its worst epidemics in which 286 people died, with the state of Texas being hard hit by this virus. Weather Drought has been associated with a higher number of<unk> <unk> virus cases in the following year. As drought can decrease fish and other populations that eat mosquito eggs, higher numbers of mosquitoes can result. Higher temperatures are linked to decreased time for replication and increased viral load in birds and mosquitoes. | West Nile fever | Chikungunya | Brain fever | Zika fever | Dengue fever | Malaria | Blackwater fever | Argentine hemorrhagic fever | 00
| 2,691 |
Indications for<unk> include: * Corneal dystrophy involving the corneal<unk> layer, e.g.: * Fuchs'<unk> dystrophy * Posterior polymorphous corneal dystrophy *Pseudophakic bullous keratopathy *Iridocorneal<unk> syndrome | Descemet membrane endothelial keratoplasty | Conductive keratoplasty | Laser thermal keratoplasty | Boston keratoprosthesis | Corneal transplantation | Automated lamellar keratoplasty | Minimally invasive glaucoma surgery | Excimer laser trabeculostomy | 00
| 72,639 |
<unk> is diagnosed based on signs and symptoms as described above, and by patient history. Other conditions that can have a similar appearance or occur at the same time include: * Frostnip is similar to<unk> , but without ice crystal formation in the skin. Whitening of the skin and numbness reverse quickly after rewarming. * Trench foot is damage to nerves and blood vessels that results exposure to wet, cold (non-freezing) conditions. This is reversible if treated early. * Pernio or chilblains are inflammation of the skin from exposure to wet, cold (non-freezing) conditions. They can appear as various types of ulcers and blisters. * Bullous pemphigoid is a condition that causes itchy blisters over the body that can mimic<unk> . It does not require exposure to cold to develop. * Levamisole toxicity is a vasculitis that can appear similar to<unk> . It is caused by contamination of cocaine by levamisole. Skin lesions can look similar those of<unk> , but do not require cold exposure to occur. People who have hypothermia often have<unk> as well. Since hypothermia is life-threatening this should be treated first. Technetium-99 or MR scans are not required for diagnosis, but might be useful for prognostic purposes. | Frostbite | Chilblains | Crossbite | Trench foot | Overbite | Snakebite | Abrasion | Nasal fracture | 00
| 11,540 |
heart conduction system showing<unk> The AV node receives two inputs from the right atrium: posteriorly, via the crista terminalis, and anteriorly, via the interatrial septum. Contraction of heart muscle cells requires depolarization and repolarization of their cell membranes. Movement of ions across cell membranes causes these events. The cardiac conduction system (and AV node part of it) coordinates myocyte mechanical activity. A wave of excitation spreads out from the sinoatrial node through the atria along specialized conduction channels. This activates the AV node. The<unk> delays impulses by approximately 0.09s. This delay in the cardiac pulse is extremely important: It ensures that the atria have ejected their blood into the ventricles first before the ventricles contract. This also protects the ventricles from excessively fast rate response to atrial arrhythmias (see below). AV conduction during normal cardiac rhythm occurs through two different pathways: *the first “pathway” has a slow conduction velocity but shorter refractory period *the second “pathway” has a faster conduction velocity but longer refractory period. An important property that is unique to the AV node is decremental conduction, in which the more frequently the node is stimulated the slower it conducts. This is the property of the AV node that prevents rapid conduction to the ventricle in cases of rapid atrial rhythms, such as atrial fibrillation or atrial flutter. The AV node's normal intrinsic firing rate without stimulation (such as that from the SA node) is 40-60 times/minute. This property is important because loss of the conduction system before the AV node should still result in pacing of the ventricles by the — slower — pacemaking ability of the AV node. | Atrioventricular node | Node of Ranvier | Heart valve | Cardiopulmonary nerves | Vasa vasorum | Endobronchial valve | Coronary | Sternal saw | 00
| 14,818 |
It is unknown as to what causes<unk> . While a causal relationship between seizure activity and the GI symptoms has not been proven, the GI symptoms cannot be explained by other pathophysiological mechanisms, and are seen to improve upon anticonvulsant treatment. Because the condition is so rare, no high-quality studies exist. There have been too few reported cases to identify risk factors, genetic factors, or other potential causes. | Abdominal epilepsy | Epilepsy in children | Sudden unexpected death in epilepsy | Epilepsy syndromes | Photosensitive epilepsy | Epilepsy | Generalized epilepsy | Temporal lobe epilepsy | 00
| 40,447 |
A vial of<unk> , manufactured and sold in Russia<unk> and other third-generation antibiotics are used to treat organisms that tend to be resistant to many other antibiotics. Due to emergent resistance,<unk> should not be used for the treatment of Enterobacter infections. Before using<unk> , it is important to determine the susceptibility of the bacteria. If sepsis is being considered, empiric therapy may be initiated prior to susceptibility testing. Medical uses include: * lower respiratory tract infections * acute bacterial otitis media * skin and skin structure infections * urinary tract infections * uncomplicated gonorrhea * pelvic inflammatory disease * bacterial sepsis * intra-abdominal infections * meningitis * surgical prophylaxis * Lyme disease<unk> is also a choice drug for treatment of bacterial meningitis caused by pneumococci, meningococci, Haemophilus influenzae, and "susceptible enteric Gram-negative rods, but not Listeria monocytogenes." In combination with doxycycline or azithromycin,<unk> used to be recommended by the United States Centers for Disease Control and Prevention (CDC) for the treatment of uncomplicated gonorrhea. Due to increased risk of developing azithromycin resistant strains and the high efficacy of higher doses of<unk> the guidance has been updated to mono-antibiotic therapy with a higher dose of<unk> . Spectrum of activity Like other third-generation cephalosporins,<unk> is active against Citrobacter spp., Serratia marcescens, and beta-lactamase-producing strains of Haemophilus and Neisseria. However, unlike ceftazidime and cefoperazone,<unk> does not have useful activity against Pseudomonas aeruginosa. It is generally not active against Enterobacter species, and its use should be avoided in the treatment of Enterobacter infections, even if the isolate appears susceptible, because of the emergence of resistance. Some organisms, such as Citrobacter, Providencia, and Serratia, have the ability to become resistant through the development of cephalosporinases (enzymes that hydrolyze cephalosporins and render them inactive). Available forms<unk> is available for administration via the intramuscular or the intravenous routes. Diluents containing calcium should not be used to reconstitute<unk> , and it must not be administered in intravenous lines containing other calcium-containing solutions, as a<unk> -calcium precipitate could form. Specific populations Pregnancy<unk> is pregnancy category B. It has not been observed to cause birth defects in animal studies, but a lack of well-controlled studies done in pregnant women exists. Breastfeeding Low concentrations of<unk> are excreted in breast milk that are "not expected to cause adverse effects in breastfed infants." The manufacturer recommends that caution be exercised when administering<unk> to women who breastfeed. Newborns Hyperbilirubinemic neonates are contraindicated for the use of<unk> . It can compete with bilirubin and displace it from binding to albumin, increasing the risk of bilirubin encephalopathy. Elderly According to the package insert, clinical studies did not show differences in efficacy and safety of<unk> in geriatrics compared to younger patients but "greater sensitivity of some older individuals cannot be ruled out." | Ceftriaxone | Meropenem | Levofloxacin | Cefotaxime | Azithromycin | Cefepime | Vancomycin | Ampicillin | 00
| 19,312 |
In people who experience recurrent urinary tract infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to reduce the likelihood of recurrence. If no abnormality is identified, some studies suggest long-term preventive treatment with antibiotics, either daily or after sexual activity. In children at risk for recurrent urinary tract infections, not enough studies have been performed to conclude prescription of long-term antibiotics have a net positive benefit. Drinking cranberry juice does not appear to provide much if any benefit in decreasing urinary tract infections. | complications of Melioidosis | complications of Bronchiolitis | complications of Asbestosis | complications of Tonsillitis | complications of Chagas disease | symptom of Cryptococcosis | complications of Idiopathic pulmonary fibrosis | complications of Diphtheria | 00
| 23,020 |
<unk> refers to congenital maldevelopments that are linked to maternal diabetes. Prenatal exposure to hyperglycemia can result in spontaneous abortions, perinatal mortality, and malformations. Type 1 and Type 2<unk> pregnancies both increase the risk of diabetes induced teratogenicity. The rate of congenital malformations is similar in Type 1 and 2 mothers because of increased adiposity and the age of women with type 2 diabetes. Genetic predisposition and different environmental factors both play a significant role in the development of<unk> . Metabolic dysfunction in pregnant mothers also increases the risk of fetal malformations. | Diabetic embryopathy | Uremic fetor | Fetus in fetu | Toxic abortion | Fetal hydantoin syndrome | Abortion in Brunei | Fetal warfarin syndrome | Heterotopic pregnancy | 00
| 73,378 |
<unk> is a parasite responsible for the disease<unk> sis. This species has been known to spread by using sandflies as its vector and a vertebrate as its primary host, just like other species of<unk> . They have also been known to spread throughout the Brazilian Amazon region due to their ecological niches needed for survival and reproduction. However, when the host is infected, the<unk> can cause 3 different forms of<unk> sis. For this species, it has been known to cause cutaneous<unk> sis and mucocutaneous<unk> sis. Cutaneous<unk> sis is commonly characterized with skin lesions, which can appear localized, or throughout the body. While mucocutaneous<unk> sis is characterized with ulcers around the skin, mouth, and nose. This form of<unk> sis has also been known to can spread by metastasis and can be deadly. | Leishmania amazonensis | Leishmania major | Leishmania braziliensis | Leishmania mexicana | Leishmania donovani | Trichobacteriosis axillaris | Leishmania infantum | Brugia malayi | 00
| 70,054 |
<unk> (EU), also known as estradiol undecanoate and formerly sold under the brand names Delestrec and Progynon Depot 100 among others, is an estrogen medication which has been used in the treatment of prostate cancer in men. It has also been used as a part of hormone therapy for transgender women. Although<unk> has been used in the past, it was discontinued and hence is no longer available. The medication has been given by injection into muscle usually once a month. Side effects of<unk> in men may include breast tenderness, breast development, feminization, sexual dysfunction, infertility, fluid retention, and cardiovascular issues.<unk> is a synthetic estrogen and hence is an agonist of the estrogen receptor, the biological target of estrogens like estradiol. It is an estrogen ester and a very long-lasting prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen. An injection of<unk> has a duration of about 1 to 4 months.<unk> was first described in 1953 and was introduced for medical use by 1956. It has been used in Europe as a parenteral estrogen to treat prostate cancer in men, although not as often as polyestradiol phosphate. | Estradiol undecylate | Estradiol dienantate | Estradiol enantate | Estradiol furoate | Estradiol valerate | Estradiol hemisuccinate | Estradiol diundecylenate | Estradiol dipropionate | 00
| 63,003 |
<unk> can occur on the hair of the scalp; Trichosporon ovoides is likely the cause in this case.<unk> on scalp hair is rarely caused by Trichosporon inkin; pubic hair with<unk> is what T. inkin is mainly associated with.<unk> can occur on pubic hair; T. inkin likely causes this. Trichosporon beigelii | White piedra | Grisi siknis | Paraphrenia | Cebocephaly | Oneirophrenia | Incontinentia pigmenti achromians | Ethmocephaly | Commotio cordis | 00
| 45,707 |
Cubicles for drug<unk> at a<unk> in Strasbourg.<unk> s (SIS) are medically<unk> facilities designed to provide a hygienic environment in which people are able to consume illicit recreational drugs intravenously and prevent deaths due to drug overdoses. The legality of such a facility is dependent by location and political jurisdiction.<unk> s are part of a harm reduction approach towards drug problems. The facilities provide sterile<unk> equipment, information about drugs and basic health care, treatment referrals, access to medical staff, and, at some facilities, counseling. Most programs prohibit the sale or purchase of recreational drugs at the facility. | Supervised injection site | Dressed to Kill | Alternate care site | Deep clean | Vaccine cooler | Water for injection | Injection | Subcutaneous implant | 00
| 10,852 |
Adult human testicle with epididymis: A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens Those aged 15 to 35 are most commonly affected. The acute form usually develops over the course of several days, with pain and swelling frequently in only one testis, which will hang low in the scrotum. There will often be a recent history of dysuria or urethral discharge. Fever is also a common symptom. In the chronic version, the patient may have painful point tenderness but may or may not have an irregular epididymis upon palpation, though palpation may reveal an indurated epididymis. A scrotal ultrasound may reveal problems with the epididymis, but such an ultrasound may also show nothing unusual. The majority of patients who present with chronic<unk> have had symptoms for over five years. Complications Untreated, acute<unk> 's major complications are abscess formation and testicular infarction. Chronic<unk> can lead to permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body. Chronic pain is also an associated complication for untreated chronic<unk> . | Epididymitis | Testicular cancer | Oophoritis | Orchitis | Salpingitis | Testicular torsion | Inguinal hernia | Spermatocele | 00
| 13,238 |
The<unk> is a clinical sign of early measles in which thin, whitish patches are seen on the gums and buccal mucosa due to desquamation of epithelial cells. The sign is named after Jules<unk> . | Comby sign | Claybrook sign | Boas' sign | Bing's sign | Halo sign | Battle's sign | Markle sign | Lincoln sign | 00
| 54,981 |
<unk> may present as a primary mental disorder, or as a symptom of another psychiatric illness. With secondary<unk> , the<unk> delusions are due to other mental disorders such as bipolar I disorder or schizophrenia. Symptoms may also be precipitated by alcoholism and the use of antidepressants. There may be a potential genetic component involved as family histories of first degree relatives with histories of psychiatric disorders are common. Sigmund Freud explained<unk> as a defense mechanism to ward off homosexual impulses which can lead to strong feelings of paranoia, denial, displacement and projection. Similarly, it has been explained as a way to cope with severe loneliness or ego deficit following a major loss.<unk> may also be linked to unsatiated urges dealing with homosexuality or narcissism. Some research shows brain abnormalities occurring in patients with<unk> such as heightened temporal lobe asymmetry and greater volumes of lateral ventricles than those with no mental disorders. | Erotomania | Dipsomania | Anotia | Dysmelia | Onychotillomania | Melanonychia | Coccydynia | Amaurosis fugax | 00
| 6,006 |
Diagram of a<unk> A<unk> <unk> is a<unk> used in<unk> of victims of traffic collisions from motor vehicles. Commonly carried on ambulances, a<unk> is typically used by an emergency medical technician, paramedic, or another first responder. It was originally designed for<unk> of race car drivers. Typically used in conjunction with a cervical collar, a<unk> is a semi-rigid brace that secures the head, neck and torso in an anatomically neutral position. Its use is claimed to reduce the possibility of additional injuries to these regions during<unk> , although its value has been questioned, as there is a lack of evidence to support its use. The original<unk> was designed by Richard<unk> in 1978. | Kendrick extrication device | Anomaloscope | Bogota bag | Ilizarov apparatus | Fetoscope | Bonanno catheter | Euthanasia device | Videoscope | 00
| 21,010 |
There are two primary types of<unk> : squamous-cell carcinoma and adenocarcinoma. * Squamous-cell carcinoma of the vagina arises from the squamous cells (epithelium) that line the vagina. This is the most common type of<unk> . It is found most often in women aged 60 or older. * Vaginal adenocarcinoma arises from the glandular (secretory) cells in the lining of the vagina. Adenocarcinoma is more likely to spread to the lungs and lymph nodes. * Clear cell adenocarcinoma occurs in a small percentage of women (termed "DES-Daughters") born between 1938 and 1973 (later outside the United States) that were exposed to the drug diethylstilbestrol (DES) in utero. DES was prescribed to 5 to 10 million mothers period to prevent possible miscarriages and premature births. Typically, women develop DES-related adenocarcinoma before age 30, but increasing evidence suggests possible effects or cancers (including other forms of vaginal glandular tumors) at a later age. DES-exposure in women is also linked to various infertility and pregnancy complications. Daughters exposed to DES in utero may also have an increased risk of moderate/severe cervical squamous cell dysplasia and an increased risk of breast cancer. Approximately one in 1,000 (0.1%) DES daughters will be diagnosed with clear cell adenocarcinoma. The risk is virtually non-existent among premenopausal women not exposed to DES. * Vaginal germ cell tumors (primarily teratoma and endodermal sinus tumor) are rare. They are found most often in infants and children. * Sarcoma botryoides, a rhabdomyosarcoma also is found most often in infants and children. * Vaginal melanoma, a melanoma that appears in the vagina. File:Diagram showing stage 1<unk> CRUK 194.Stage 1<unk> File:Diagram showing stage 2<unk> CRUK 210.Stage 2<unk> File:Diagram showing stage 3<unk> CRUK 223.Stage 3<unk> File:Diagram showing stage 4A<unk> CRUK 237.Stage 4A<unk> File:Diagram showing stage 4B<unk> CRUK 240.Stage 4B<unk> | Vaginal cancer | Uterine prolapse | Cervical cancer | Uterine cancer | Pyometra | Vaginal melanoma | Endometrial cancer | Vaginal disease | 00
| 43,669 |
No specific cure is known. Treatment is largely supportive. Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for tender lymph nodes and fever, and corticosteroids are useful in severe extranodal or generalized disease. Symptomatic measures aimed at relieving the distressing local and systemic complaints have been described as the main line of management of KFD. Analgesics, antipyretics, NSAIDs, and corticosteroids have been used. If the clinical course is more severe, with multiple flares of bulky enlarged cervical lymph nodes and fever, then a low-dose corticosteroid treatment has been suggested. | Kikuchi disease | Yushō disease | Oguchi disease | Farber disease | Keshan disease | Akureyri disease | Viliuisk encephalomyelitis | Crouzon syndrome | 00
| 11,118 |
A noticeable lump in relation to an<unk> remity may be the first presenting symptom.<unk> deformities can arise, namely coronal plane deformities around the knees, ankles, shoulders, elbows, and wrists. For example, genu valgum (knock knees), ankle valgus, ulnar bowing and shortening, and radial head subluxation are encountered. The majority of affected individuals have clinically manifest osteochondromas around the knee. Forearm involvement in HMO is considerable. Furthermore, short stature may occur and is generally disproportionate. Such manifestations usually result from disruption of physeal growth especially that osteochondromas typically arise at the metaphyseal ends of long bones in close proximity to the physis. Intra-articular osteochondromas of the hip can induce limitation of range of motion, joint pain and acetabular dysplasia. Likewise joint pain at other locations and neurovascular compression can occur. Furthermore, functional disability in regard to activities of daily living can be a presenting feature. Spinal deformity pain or neurological compromise should arouse suspicion of involvement of the vertebrae. Possible connection to autism Some parents of children with<unk> have observed autism-like social problems in their children. To explore those observations more deeply, a 2012 study by the Sanford-Burnham Medical Research Institute used a mouse model of<unk> to observe cognitive function. The findings indicated that the mutant mice endorsed three autistic characteristics: social impairment, impairments in ultrasonic vocalization, and repetitive behavior. | Hereditary multiple exostoses | Inherited patterned lentiginosis | Diffuse idiopathic skeletal hyperostosis | Pycnodysostosis | Familial myxovascular fibromas | Nevoid basal-cell carcinoma syndrome | Gerodermia osteodysplastica | Acrofrontofacionasal dysostosis | 00
| 19,474 |
<unk> s are pigmented<unk> s in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin. They are usually yellowish to dark-brown, and may be complete or broken. The<unk> s are best seen using slit lamp under cobalt blue filter. They are named for Bruno<unk> .<unk> s are indicative of keratoconus, a degenerative corneal condition that causes the cornea to thin and change to a conic shape. | Fleischer ring | Rey–Osterrieth complex figure | Hutchinson's pupil | Forchheimer spots | Optic disc drusen | Sorsby's fundus dystrophy | Brushfield spots | Fuchs spot | 00
| 31,350 |
The<unk> . A rotation of the head is detected, which triggers an inhibitory signal to the extraocular muscles on one side and an excitatory signal to the muscles on the other side. The result is a compensatory movement of the eyes. The<unk> (VOR) is a reflex acting to stabilize gaze during head movement, with eye movement due to activation of the<unk> r system. The reflex acts to stabilize images on the retinas of the eye during head movement. Gaze is held steadily on a location by producing eye movements in the direction opposite that of head movement. For example, when the head moves to the right, the eyes move to the left, meaning the image a person sees stays the same even though the head has turned. Since slight head movement is present all the time, VOR is necessary for stabilizing vision: people with an impaired reflex find it difficult to read using print, because the eyes do not stabilise during small head tremors, and also because damage to reflex can cause nystagmus. The VOR does not depend on what is seen. It can also be activated by hot or cold stimulation of the inner ear, where the<unk> r system sits, and works even in total darkness or when the eyes are closed. However, in the presence of light, the fixation reflex is also added to the movement. In lower animals, the organs that coordinate balance and movement are not independent from eye movement. A fish, for instance, moves its eyes by reflex when its tail is moved. Humans have semicircular canals, neck muscle "stretch" receptors, and the utricle (gravity organ). Though the semicircular canals cause most of the reflexes which are responsive to acceleration, the maintaining of balance is mediated by the stretch of neck muscles and the pull of gravity on the utricle (otolith organ) of the inner ear. The VOR has both rotational and translational aspects. When the head rotates about any axis (horizontal, vertical, or torsional) distant visual images are stabilized by rotating the eyes about the same axis, but in the opposite direction. When the head translates, for example during walking, the visual fixation point is maintained by rotating gaze direction in the opposite direction, by an amount that depends on distance. | Vestibulo–ocular reflex | Oculocardiac reflex | Acoustic reflex | Axon reflex | Moro reflex | Corneal reflex | Pupillary light reflex | Tonic labyrinthine reflex | 00
| 13,143 |
PEN tumours are always painless, solid masses felt on the skin that, due to their slow-growing nature, typically take many years to grow to a size where they are noticeable. There are never any symptoms associated with systemic disease. | Palisaded encapsulated neuroma | Basal-cell carcinoma | Solitary cutaneous leiomyoma | Melanocytic nevus | Bizarre parosteal osteochondromatous proliferation | Skin appendage | Malignant chondroid syringoma | Neurofibroma | 00
| 58,242 |
The common isoforms of<unk> . Top: γA/γ' contains the common γ chain (also known as γA) and the rare γ' chain, which has an extended C-terminal. Bottom: variant containing the AαE isoforms in the place of more common Aα. This AαE/AαE combination has an extended C-terminals (αEC) and a mass of 420 kDa, which is heavier than typical<unk> . Click to see the extended description. Human<unk> . Aα chains (cyan), Bβ chains (red), γA chains (pink), calcium (green), carbohydrated (orange). FpA:<unk> rinopeptides A. FpB:<unk> rinopeptides B. αC: Aα chain C-terminal domain. D: D domain. E: E domain. Human<unk> (PDB: 3GHG). Colors are the same as in the other picture. Disulfide bonds are also shown (highlighted with yellow). Parts of the actual structure are unresolved: e.g., the C-terminals of Aα chains are too short. The Aα, Bβ, and γ chains are transcribed and translated coordinately on the endoplasmic reticulum (ER), with their peptide chains being passed into the ER while their signal peptide portions are removed. Inside the ER, the three chains are assembled initially into Aαγ and Bβγ dimers, then to AαBβγ trimers, and finally to (AαBβγ)2 heximers, i.e. two AαBβγ trimers joined together by numerous disulfide bonds. The heximer is transferred to the Golgi where it is glycosylated, hydroxylated, sulfated, and phosphorylated to form the mature<unk> glycoprotein that is secreted into the blood. Mature<unk> is arranged as a long flexible protein array of three nodules held together by a very thin thread which is estimated to have a diameter between 8 and 15 Ångstrom (Å). The two end nodules (termed D regions or domains) are alike in consisting of Bβ and γ chains, while the center slightly smaller nodule (termed the E region or domain) consists of two intertwined Aα alpha chains. Measurements of shadow lengths indicate that nodule diameters are in the range 50 to 70 Å. The length of the dried molecule is 475 ± 25 Å. The<unk> molecule circulates as a soluble plasma glycoprotein with a typical molecular weight of ~340-~420 kDa (kilo-daltons) (depending on its content of Aα verses AαE, γ versus γ' chains, and carbohydrate ~4-~10%w/w). It has a rod-like shape with dimensions of 9 × 47.5 × 6 nm and has a negative net charge at physiological pH (its isoelectric point ~5.5-~6.5, e.g. pH 5.8). The normal concentration of<unk> in blood plasma is 150–400 mg/dl, with levels appreciably below or above this range associated with pathological bleeding and/or thrombosis.<unk> has a circulating half-life of ~4 days. | Fibrinogen | Factor VIII | Factor VIII | Β-Thromboglobulin | Von Willebrand factor | Platelet-activating factor | Factor IX | Thrombin | 00
| 9,083 |
<unk> is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of<unk> .<unk> is primarily caused by leukocyte migration and resultant damage. Although both occur in<unk> , inflammation of veins (phlebitis) or arteries (arteritis) on their own are separate entities. | Vasculitis | Eosinophilic cellulitis | Venous thrombosis | Neuritis | Atherosclerosis | Coronary thrombosis | Lymphangitis | Microvasculitis | 00
| 15,894 |
A skin biopsy is the most common test used to diagnose<unk> . The biopsy will detect growth of new or abnormal tissue. Another test that can be performed is using immunohistochemistry, but it is inconsistent. Markers used to detect<unk> consist of carcinoembryonic antigen, progesterone receptors, estrogen receptors, epithelial membrane antigen, pancytokeratins, and cytokeratin 7. | Eccrine carcinoma | Apocrine gland carcinoma | Microcystic adnexal carcinoma | Cylindroma | Ductal carcinoma | Hidradenocarcinoma | Trichoblastoma | Adenoacanthoma | 00
| 56,102 |
<unk> s are safe in all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site, and 5 to 15 percent of people may experience fever, headaches, or nausea. Because of the certain fatality of the virus, receiving the vaccine is always advisable. Vaccines made from nerve tissue are used in a few countries, mainly in Asia and Latin America, but are less effective and have greater side effects. Their use is thus not recommended by the World Health Organization. | Rabies vaccine | Malaria vaccine | Dengue vaccine | Yellow fever vaccine | Brucellosis vaccine | Hantavirus vaccine | Ebola vaccine | Typhus vaccine | 00
| 49,312 |
SPD is uncommon in clinical settings (about 2.2%) and occurs more commonly in males. It is rare compared with other personality disorders, with a prevalence estimated at less than 1% of the general population. Philip Manfield suggests that the<unk> condition", which roughly includes the DSM<unk> , avoidant and schizotypal personality disorders, is represented by "as many as forty percent of all personality disorders." Manfield adds "This huge discrepancy from the ten percent reported by therapists for the condition is probably largely because someone with a<unk> disorder is less likely to seek treatment than someone with other axis-II disorders." A 2008 study assessing personality and mood disorder prevalence among homeless people at New York City drop-in centres reported an SPD rate of 65% among this sample. The study did not assess homeless people who did not show up at drop-in centres, and the rates of most other personality and mood disorders within the drop-in centres was lower than that of SPD. The authors noted the limitations of the study, including the higher male-to-female ratio in the sample and the absence of subjects outside the support system or receiving other support (e.g., shelters) as well as the absence of subjects in geographical settings outside New York City, a large city often considered a magnet for disenfranchised people. A University of Colorado Colorado Springs study comparing personality disorders and Myers–Briggs Type Indicator types found that the disorder had a significant correlation with the Introverted (I) and Thinking (T) preferences. | Schizoid personality disorder | Avoidant personality disorder | Histrionic personality disorder | Organic personality disorder | Haltlose personality disorder | Dependent personality disorder | Depressive personality disorder | Obsessive–compulsive personality disorder | 00
| 8,529 |
Onset of first symptom has been reported between 1–12 years, with a mean age of onset at 8 years. Clinical course can be divided into early (< 6 yrs age, predominance of respiratory symptoms) and late course (6–20 years of age, predominance of motor symptoms on superior limbs). Progression to involve other cranial nerve muscles occurs over a period of months or years. In the Gomez review facial nerve was affected in all cases while hypoglossal nerve was involved in all except one case. Other cranial nerves involved were vagus, trigeminal, spinal accessory nerve, abducent, occulomotor and glossopharyngeal in this order. Corticospinal tract signs were found in 2 of the 14 patients. The disease may progress to patient's death in a period as short as 9 months or may have a slow evolution or may show plateaus. Post mortem examination of cases have found depletion of nerve cells in the nuclei of cranial nerves. The histologic alterations found in patient with<unk> were identical to those seen in infantile-onset spinal muscular atrophy. Strength may improve with administration of cholinesterase inhibitors. | Fazio–Londe disease | XMEN disease | Hajdu–Cheney syndrome | Crigler–Najjar syndrome | Baggio–Yoshinari syndrome | Klüver–Bucy syndrome | DeSanto-Shinawi syndrome | Treacher Collins syndrome | 00
| 38,446 |
<unk> is a biopsy technique in which a<unk> lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists.<unk> es are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a<unk> can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery. There are four main types of<unk> es: shave biopsy, punch biopsy, excisional biopsy, and incisional biopsy. The choice of the different<unk> es is dependent on the suspected diagnosis of the<unk> lesion. Like most biopsies, patient consent and anesthesia (usually lidocaine injected into the<unk> are prerequisites. | Skin biopsy | Dermatoscopy | Polar body biopsy | Bone biopsy | Serum protein electrophoresis | Open biopsy | Muscle biopsy | Retinoscopy | 00
| 47,441 |
Although the etiology is unconfirmed, transient<unk> is known to be caused by increased levels of ammonia in the blood stream, as well as a failure of the urea cycle to convert enough of the ammonia into urea. Since transamination of proteins is a leading producer of ammonia, protein restriction may be recommended as a therapy to reduce the symptoms of the episode. THAN can also be treated by avoiding amino acids in TPN or total parenteral nutrition or by giving a high caloric diet to limit catabolism of the tissues and therefore to minimize the breakdown of endogenous protein. The most common treatments are dialysis (both peritoneal and hemodialysis), sodium benzoate, and arginine. Sodium Benzoate combines with glycine to be excreted in the form of hippuric acid. The goal of these treatments is to convert nitrogen to a compound that can be excreted more easily. | Transient hyperammonemia of the newborn | Permanent neonatal diabetes | Neonatal hepatitis | Hemolytic disease of the newborn | Hemolytic disease of the newborn | Transient neonatal diabetes | Neonatal diabetes | Neonatal hypoglycemia | 00
| 63,036 |
Mechanism of action In the setting of HLH, over-secretion of IFN-γ is thought to contribute to the pathogenesis of the disease.<unk> binds and neutralizes IFN-γ, preventing it from inducing pathological effects. Pharmacokinetics Like other antibody-based medications, which are made of amino acid chains called polypeptides,<unk> is broken down into smaller peptides via the body's normal catabolism. | Emapalumab | Olaratumab | Ustekinumab | Evolocumab | Anifrolumab | Dupilumab | Sarilumab | Burosumab | 00
| 69,727 |
<unk> , sold under the brand name Anthim, is a monoclonal antibody medication designed for the treatment of exposure to Bacillus anthracis spores (etiologic agent of anthrax). The medication was developed by Elusys Therapeutics, Inc. | Obiltoxaximab | Atoltivimab | Regdanvimab | Sotrovimab | Odesivimab | Nirsevimab | Bebtelovimab | Lirentelimab | 00
| 67,272 |
Treatment may involve surgery, which is currently the only recommended intervention. Surgery should include the removal of even small nodules, to prevent the recurrence of the<unk><unk> . | Idiopathic scrotal calcinosis | Infantile digital fibromatosis | Cutaneous endometriosis | Superficial acral fibromyxoma | Baker's cyst | Chemotherapy-induced acral erythema | Granuloma inguinale | Juvenile hyaline fibromatosis | 00
| 55,879 |
Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling<unk> . This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the waters break the amniotic sac, it is possible for the umbilical cord to drop down and become compressed. This complication severely diminishes oxygen flow to the baby, so the baby must be delivered immediately (usually by Caesarean section) so that he or she can breathe. If there is a delay in delivery, the brain can be damaged. Among full-term, head-down babies, cord prolapse is quite rare, occurring in 0.4 percent. Among frank<unk> babies the incidence is 0.5 percent, among complete<unk> es 5 percent, and among footling<unk> es 15 percent. Head entrapment is caused by the failure of the fetal head to negotiate the maternal midpelvis. At full term, the fetal bitrochanteric diameter (the distance between the outer points of the hips) is about the same as the biparietal diameter (the transverse diameter of the skull)—simply put the size of the hips are the same as the size of the head. The relatively larger buttocks dilate the cervix as effectively as the head does in the typical head-down presentation. In contrast, the relative head size of a preterm baby is greater than the fetal buttocks. If the baby is preterm, it may be possible for the baby's body to emerge while the cervix has not dilated enough for the head to emerge. Because the umbilical cord—the baby's oxygen supply—is significantly compressed while the head is in the pelvis during a<unk> , it is important that the delivery of the aftercoming fetal head not be delayed. If the arm is extended alongside the head, delivery will not occur. If this occurs, the Løvset manoeuvre may be employed, or the arm may be manually brought to a position in front of the chest. The Løvset manoeuvre involves rotating the fetal body by holding the fetal pelvis. Twisting the body such that an arm trails behind the shoulder, it will tend to cross down over the face to a position where it can be reached by the obstetrician's finger, and brought to a position below the head. A similar rotation in the opposite direction is made to deliver the other arm. In order to present the smallest diameter (9.5 cm) to the pelvis, the baby's head must be flexed (chin to chest). If the head is in a deflexed position, the risk of entrapment is increased. Uterine contractions and maternal muscle tone encourage the head to flex. Oxygen deprivation may occur from either cord prolapse or prolonged compression of the cord during birth, as in head entrapment. If oxygen deprivation is prolonged, it may cause permanent neurological damage (for instance, cerebral palsy) or death. It has been suggested that a fast vaginal delivery would mean the risk of stopping baby's oxygen supply is reduced. However, there is not enough research to show this and a quick delivery might cause more harm to the baby than a conservative approach to the birth. Injury to the brain and skull may occur due to the rapid passage of the baby's head through the mother's pelvis. This causes rapid decompression of the baby's head. In contrast, a baby going through labor in the head-down position usually experiences gradual molding (temporary reshaping of the skull) over the course of a few hours. This sudden compression and decompression in<unk> may cause no problems at all, but it can injure the brain. This injury is more likely in preterm babies. The fetal head may be controlled by a special two-handed grip call the Mauriceau–Smellie–Veit maneuver or the elective application of forceps. This will be of value in controlling the rate of delivery of the head and reduce decompression. Related to potential head trauma, researchers have identified a relationship between<unk> and autism. Squeezing the baby's abdomen can damage internal organs. Positioning the baby incorrectly while using forceps to deliver the after coming head can damage the spine or spinal cord. It is important for the birth attendant to be knowledgeable, skilled, and experienced with all variations of<unk> . Factors influencing safety * Birth attendant's skill (and experience with<unk> – The skill of the doctor or midwife and the number of<unk> s previously assisted is of crucial importance. Many of the dangers in vaginal birth for<unk> babies come from mistakes made by birth attendants. With the majority of<unk> babies being delivered by cesarean section there is more risk that birth attendants will lose their skills in delivering<unk> babies and therefore increase the risk of harm to the baby during a vaginal delivery. * Type of<unk> presentation – the frank<unk> has the most favorable outcomes in vaginal birth, with many studies suggesting no difference in outcome compared to head down babies. (Some studies, however, find that planned caesarean sections for all<unk> babies improve outcome. The difference may rest in part on the skill of the doctors who delivered babies in different studies.) Complete<unk> presentation is the next most favorable position, but these babies sometimes shift and become footling<unk> es during labour. Footling and kneeling<unk> es have a higher risk of cord prolapse and head entrapment. * Parity – Parity refers to the number of times a woman has given birth before. If a woman has given birth vaginally, her pelvis has "proven" it is big enough to allow a baby of that baby's size to pass through it. However, a head-down baby's head often molds (shifts its shape to fit the maternal pelvis) and so may present a smaller diameter than the same-size baby born<unk> . * Fetal size in relation to maternal pelvic size – If the mother's pelvis is roomy and the baby is not large, this is favorable for vaginal<unk> delivery. However, prenatal estimates of the size of the baby and the size of the pelvis are unreliable. * Hyperextension of the fetal head – this can be evaluated with ultrasound. Less than 5% of<unk> babies have their heads in the "star-gazing" position, face looking straight upwards and the back of the head resting against the back of the neck. Caesarean delivery is absolutely necessary, because vaginal birth with the baby's head in this position confers a high risk of spinal cord trauma and death. * Maturity of the baby – Premature babies appear to be at higher risk of complications if delivered vaginally than if delivered by caesarean section. * Progress of labor – A spontaneous, normally progressing, straightforward labor requiring no intervention is a favorable sign. * Second twins – If a first twin is born head down and the second twin is<unk> , the chances are good that the second twin can have a safe<unk> . | Breech birth | Preterm birth | Stillbirth | Coffin birth | Low birth weight | Multiple birth | Asynclitic birth | Water birth | 00
| 13,858 |
Scanning electron micrograph showing a mixture of red blood<unk> s, some with round normal morphology, some with mild<unk> ng showing elongation and bending The loss of red blood<unk> elasticity is central to the pathophysiology of<unk> . Normal red blood<unk> s are quite elastic and have a biconcave disc shape, which allows the<unk> s to deform to pass through capillaries. In<unk> , low oxygen tension promotes red blood<unk> <unk> ng and repeated episodes of<unk> ng damage the<unk> membrane and decrease the<unk> 's elasticity. These<unk> s fail to return to normal shape when normal oxygen tension is restored. As a consequence, these rigid blood<unk> s are unable to deform as they pass through narrow capillaries, leading to vessel occlusion and ischaemia. The actual anaemia of the illness is caused by haemolysis, the destruction of the red<unk> s, because of their shape. Although the bone marrow attempts to compensate by creating new red<unk> s, it does not match the rate of destruction. Healthy red blood<unk> s typically function for 90–120 days, but<unk> d<unk> s only last 10–20 days. | Sickle cell disease | Glucose-6-phosphate dehydrogenase deficiency | Sickle cell trait | Avascular necrosis | Primary hyperoxaluria | Sick cell syndrome | Thalassemia | Hawkinsinuria | 00
| 53,558 |
Affected organ Common signs and symptoms Nose Swelling of the nasal mucosa (allergic rhinitis) runny nose, sneezing Sinuses Allergic<unk> Eyes Redness and itching of the conjunctiva (allergic conjunctivitis, watery) Airways Sneezing, coughing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe<unk> s the airway constricts due to swelling known as laryngeal edema Ears Feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage. Skin Rashes, such as eczema and hives (urticaria) Gastrointestinal tract Abdominal pain, bloating, vomiting, diarrhea Many allergens such as dust or pollen are airborne particles. In these<unk> s, symptoms arise in areas in contact with air, such as eyes, nose, and lungs. For instance, allergic rhinitis, also known as hay fever,<unk> s irritation of the nose, sneezing, itching, and redness of the eyes. Inhaled allergens can also lead to increased production of mucus in the lungs, shortness of breath, coughing, and wheezing. Aside from these ambient allergens, allergic reactions can result from foods, insect stings, and reactions to medications like aspirin and antibiotics such as penicillin. Symptoms of food allergy include abdominal pain, bloating, vomiting, diarrhea, itchy skin, and swelling of the skin during hives. Food allergies rarely<unk> respiratory (asthmatic) reactions, or rhinitis. Insect stings, food, antibiotics, and certain medicines may produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system. Depending on the rate of severity, anaphylaxis can include skin reactions, bronchoconstriction, swelling, low blood pressure, coma, and death. This type of reaction can be triggered suddenly, or the onset can be delayed. The nature of anaphylaxis is such that the reaction can seem to be subsiding, but may recur throughout a period of time. Skin Substances that come into contact with the skin, such as latex, are also common<unk> s of allergic reactions, known as contact dermatitis or eczema. Skin allergies frequently<unk> rashes, or swelling and inflammation within the skin, in what is known as a "weal and flare" reaction characteristic of hives and angioedema. With insect stings a large local reaction may occur (an area of skin redness greater than 10 cm in size). It can last one to two days. This reaction may also occur after immunotherapy. | medical cause of Sinusitis | medical cause of Tonsillitis | medical cause of Epiglottitis | medical cause of Conjunctivitis | complications of Pharyngitis | complications of Tonsillitis | symptom of Sinusitis | symptom of Otitis media | 00
| 3,840 |
<unk> syndrome was originally thought to involve a rapidly conducting accessory pathway (bundle of James) that connects the atria directly to the bundle of His, bypassing the slowly conducting atrioventricular node. However, the majority of those with<unk> in whom electrophysiological studies have been performed do not have any evidence of an accessory pathway or structural abnormality. Whilst in a minority of cases some form of intranodal or paranodal fibers that bypass all or part of the atrioventricular node can be found with subsequent conduction down the normal His-Purkinje system, in most cases the short PR interval is caused by accelerated conduction through the atrioventricular node.<unk> syndrome is therefore felt to represent a clinical syndrome with multiple different underlying causes. | Lown–Ganong–Levine syndrome | Wolff–Parkinson–White syndrome | Lucey–Driscoll syndrome | Morgagni Stewart Morel syndrome | Bhaskar–Jagannathan syndrome | Claude's syndrome | Witteveen–Kolk syndrome | Townes–Brocks syndrome | 00
| 33,657 |
Most people do not experience adverse symptoms, but the opening of intercellular tight junctions (increased<unk> can act as a trigger for diseases that can affect any organ or tissue depending on genetic predisposition. Increased<unk> is a factor in several diseases, such as Crohn's disease, celiac disease, type 1 diabetes, type 2 diabetes, rheumatoid arthritis, spondyloarthropathies, inflammatory bowel disease, irritable bowel syndrome, schizophrenia, certain types of cancer, obesity, fatty liver, atopy and allergic diseases, among others. In the majority of cases, increased permeability develops prior to disease, but the cause–effect relationship between increased<unk> in most of these diseases is not clear. A relationship with autism has been hypothesized but the data supporting this theory are limited and contradictory, since both increased<unk> and normal permeability have been documented in people with autism. It is important to note that almost all studies use cohorts of children who have already developed autism, beyond the age of onset (it is not determined if increased permeability could be a cause that resolves itself later in childhood). Studies with mice provide some support to this hypothesis. A well studied model is celiac disease, in which increased<unk> appears secondary to the abnormal immune reaction induced by gluten and allows fragments of gliadin protein to get past the<unk> epithelium, triggering an immune response at the<unk> submucosa level that leads to diverse gastrointestinal or extra-gastrointestinal symptoms. Other environmental triggers may contribute to alter permeability in celiac disease, including<unk> infections and iron deficiency. Once established, this increase of permeability might self-sustain the inflammatory immune responses and perpetuate a vicious circle. Eliminating gluten from the diet leads to normalization of<unk> and the autoimmune process shuts off. | Intestinal permeability | Vascular permeability | Digestion | Vasoactivity | Enterohepatic circulation | Muscle tone | Enteroenteric circulation | Indigestion | 00
| 35,856 |
Rose spots on abdomen of a person with typhoid fever<unk> resembles typhoid fever. Infection is characterized by a sustained fever, headache, abdominal pain, malaise, anorexia, a nonproductive cough (in early stage of illness), a relative bradycardia (slow heart rate), and hepatosplenomegaly (an enlargement of the liver and spleen). About 30% of Caucasians develop rosy spots on the central body. In adults, constipation is more common than diarrhea. Only 20 to 40% of people initially have abdominal pain. Nonspecific symptoms such as chills, sweating, headache, loss of appetite, cough, weakness, sore throat, dizziness, and muscle pains are frequently present before the onset of fever. Some very rare symptoms are psychosis (mental disorder), confusion, and seizures. | Paratyphoid fever | Typhoid fever | Yellow fever | Haverhill fever | Tomato fever | Blackwater fever | Trench fever | Cotton fever | 00
| 34,779 |
<unk> <unk> or energy<unk> is a dietary regimen that reduces food intake without incurring malnutrition. "Reduce" can be defined relative to the subject's previous intake before intentionally<unk> g food or beverage consumption, or relative to an average person of similar body type.<unk> is typically adopted intentionally to reduce body weight. It is recommended as a possible regimen by US dietary guidelines and scientific societies for body weight control. | Calorie restriction | Alkaline diet | Intermittent fasting | Rosedale diet | Low-FODMAP diet | Low-carbohydrate diet | Low-protein diet | Very-low-calorie diet | 00
| 21,945 |
The disease presents with an eosinophilic granulomatous mass, most commonly in the posterior pole of the retina. The granulomatous mass develops around the entrapped<unk> , in an attempt to contain the spread of the<unk> . ELISA testing of intraocular fluids has been demonstrated to be of great value in diagnosing<unk> toxocariasis. Differential diagnosis The retinal lesion can mimic retinoblastoma in appearance, and mistaken diagnosis of the latter condition can lead to unnecessary enucleation. | Ocular larva migrans | Sympathetic ophthalmia | Ligneous conjunctivitis | Actinic conjunctivitis | Acute hemorrhagic conjunctivitis | Ocular rosacea | Phlyctenular keratoconjunctivitis | Allergic conjunctivitis | 00
| 41,433 |
Elderly man at a nursing home in Norway<unk> <unk> is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for<unk> periods.<unk> is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time. It is common for<unk> to provide custodial and non-skilled care, such as assisting with activities of daily living like dressing, feeding, using the bathroom, meal preparation, functional transfers and safe restroom use. Increasingly,<unk> involves providing a level of medical care that requires the expertise of skilled practitioners to address the multiple chronic conditions associated with older populations.<unk> can be provided at home, in the community, in assisted living facilities or in nursing homes.<unk> may be needed by people of any age, although it is a more common need for senior citizens. | Long-term care | Chronic care | Elderly care | Hospice | Cancer rehabilitation | Chronic care management | Assisted living | Acorns Children's Hospice | 00
| 31,197 |
While listening to the lungs with a stethoscope, the patient is asked to pronounce the modern English (more generally, post-Great Vowel Shift) long-E vowel sound. | Egophony | Acropachy | Paragraphia | Macrodontia | Amastia | Emmasofia | Aphallia | Hamartia | 00
| 34,377 |
In the United States<unk> is indicated for the treatment of people with complicated urinary tract infections and complicated intra-abdominal infections who have limited or no alternative treatment options. It is also indicated to treat HABP/VABP in adults 18 years of age and older. In the European Union it is indicated for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. | Imipenem/cilastatin/relebactam | Meropenem/vaborbactam | Ceftazidime/avibactam | Teicoplanin | Resistin | Neomycin/polymyxin B/bacitracin | Fosfomycin/tobramycin | Meropenem | 00
| 72,527 |
<unk> (pronounced ) is an X-linked recessive genetic disorder that may affect the blood, brain, peripheral nerves, muscle, and heart. It is caused by a variety of recessively inherited mutations in the XK gene on the X chromosome. The gene is responsible for producing the Kx protein, a secondary supportive protein for the Kell antigen on the red blood cell surface. | McLeod syndrome | McKittrick-Wheelock syndrome | Flynn–Aird syndrome | CAMFAK syndrome | Fryns-Aftimos syndrome | Danon disease | Rotor syndrome | Dennie–Marfan syndrome | 00
| 38,144 |
<unk> , also called<unk> aciduria, is an autosomal recessive metabolic disorder that disrupts normal amino acid metabolism. It is a classical type of organic acidemia. The result of this condition is the inability to properly digest specific fats and proteins, which in turn leads to a buildup of a toxic level of<unk> acid in the blood.<unk> stems from several genotypes, all forms of the disorder usually diagnosed in the early neonatal period, presenting progressive encephalopathy, and secondary hyperammonemia. The disorder can result in death if undiagnosed or left untreated. It is estimated that this disorder has a frequency of 1 in 48,000 births, though the high mortality rate in diagnosed cases make exact determination difficult.<unk> s are found with an equal frequency across ethnic boundaries. | Methylmalonic acidemia | Hawkinsinuria | Phenylketonuria | Alkaptonuria | Glutaric acidemia type 2 | Orotic aciduria | 3-Methylglutaconic aciduria | Urocanic aciduria | 00
| 14,181 |
After return of heart function, there has been a moderately higher risk of death in the hospital when compared to MI patients without<unk> . Whether this still holds true with the recent changes in treatment strategies of earlier hospital admission and immediate angioplasty with thrombus removal is unknown.<unk> does not affect the long-term prognosis. Survival The survival of<unk> largely depends on the promptness of defibrillation. The success rate of prompt defibrillation during monitoring is currently higher than 95%. It is estimated that the success rate decreases by 10% for each additional minute of delay. | Primary ventricular fibrillation | Re-entry ventricular arrhythmia | Pre-excitation syndrome | AV nodal reentrant tachycardia | Sudden arrhythmic death syndrome | Unstable angina | Ventricular flutter | Familial atrial fibrillation | 00
| 56,763 |
Tetany or tetanic seizure is a medical sign consisting of the involuntary contraction of muscles, which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them. Muscle cramps caused by the disease tetanus are not classified as tetany; rather, they are due to a lack of inhibition to the neurons that supply muscles. Tetanic contractions (physiologic tetanus) are a broad range of muscle contraction types, of which tetany is only one. | symptom of Respiratory alkalosis | symptom of Mouth breathing | symptom of Hypoxia | symptom of Hypotension | symptom of Hyperthermia | symptom of Hyponatremia | symptom of Hyperkalemia | symptom of Acute respiratory distress syndrome | 00
| 43,720 |
The<unk> <unk> also known as the calcitriol receptor) is a member of the nuclear receptor family of transcription factors. Calcitriol (the active form of<unk> D, 1,25-(OH)2vitamin D3) binds to<unk> , which then forms a heterodimer with the retinoid-X receptor. The<unk> heterodimer then enters the nucleus and binds to<unk> D responsive elements <unk> E) in genomic DNA.<unk> binding results in expression or transrepression of many specific gene products.<unk> is also involved in microRNA-directed post transcriptional mechanisms. In humans, the<unk> is encoded by the<unk> gene located on chromosome 12q13.11.<unk> is expressed in most tissues of the body, and regulates transcription of genes involved in intestinal and renal transport of calcium and other minerals. Glucocorticoids decrease<unk> expression. Many types of immune cells also express<unk> . | Vitamin D receptor | Androgen-binding protein | Growth hormone secretagogue receptor | Thyroid peroxidase | Androgen prohormone | Calcitonin gene-related peptide | Retinoblastoma protein | Parathyroid hormone-related protein | 00
| 38,460 |
<unk> is used in the treatment of HIV-1 infection, but is not a cure. It is not normally recommended as initial treatment.<unk> can also reduce the risk of developing HIV-1 infection after coming into contact with the virus either at work (e.g., needlestick) or through exposure to infected blood or other bodily fluids. It is always used in combination with other HIV medications for the better control of the infection and a reduction in HIV complications. The World Health Organization (WHO) recommends<unk> to be phased out to due to its high toxicity levels. If the drug must be used, it is recommended to use low dosages to reduce the occurrence of side effects; however, a 2015 Cochrane review found no clear advantage between high and low dosage regimens. Pregnancy and breastfeeding<unk> has been demonstrated to affect the fetus in animal studies but no data are available from human studies. Pregnant women should therefore be given<unk> only if the potential benefits outweigh the potential harm to the fetus. Additionally, there have been case reports of fatal lactic acidosis in pregnant women receiving combination therapy of<unk> and didanosine with other antiviral agents. The Centers for Disease Control and Prevention recommend that HIV-infected mothers not breastfeed their infants, in order to avoid the risk of HIV transmission through breast milk. There is also evidence that<unk> gets into animal breast milk, although no data are available for human breast milk. Children<unk> is safe for use in children infected with HIV from birth through adolescence. Adverse effects and safety profile are the same as adults. Elderly There is no data available for<unk> use in HIV-infected adults aged 65 years or older. However, among 12,000 people over the age of 65, 30% developed peripheral neuropathy. Additionally, since the elderly are more likely to have decreased renal function, they are more likely to develop toxic side effects. | Stavudine | Lamivudine | Censavudine | Saquinavir | Telbivudine | Sorivudine | Fostemsavir | Brivudine | 00
| 17,315 |
<unk> is used to treat dyspareunia. In the US it is indicated for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy (VVA), due to menopause. In the EU it is indicated for the treatment of moderate to severe symptomatic VVA in post-menopausal women who are not candidates for local vaginal oestrogen therapy. It is available as a 60 mg tablet that is taken by mouth once a day. The fact that<unk> can be taken orally is advertised as an advantage over other products that are topically applied in the vaginal canal.<unk> has not demonstrated any effects on libido, arousal, duration of intercourse or quality of orgasm in controlled clinical trials. | Ospemifene | Veristrat | Sesquimustard | Acolbifene | Toremifene | Tiotixene | Patiromer | Mitapivat | 00
| 64,267 |
Symptoms vary widely between sources of<unk> ity, dosage, length of time patient was exposed to the<unk> substance, patient history, and patient genetics. Especially in the case of leukoencephalopathy developing due to substance use or environmental<unk> s, symptoms typically do not develop until several days to months after exposure to the pharmacological agent. Clinical features range from inattention, forgetfulness, and changes in personality to dementia, coma, and even death. Obvious signs of the condition are difficulty with cognitive function and equilibrioception. Common initial symptoms include confusion, somnolence, generalized seizures, headaches, and vision impairment. Young acute lymphoblastic leukemia patients with methotrexate-induced leukoencephalopathy appear asymptomatic. However,<unk> induced by substance use or environmental<unk> s have had more damaging side effects. Heroin-induced leukoencephalopathy has had three stages described. The first stage features soft (pseudobulbar) speech, cerebellar ataxia, motor restlessness, and apathy/bradyphrenia. The intermediate stage includes pyramidal tract and pseudobulbar signs, spastic paresis, myoclonic jerks, and choreoathetoid movements. The final or terminal stage is characterized by stretching spasms, akinetic mutism, hypotonic paresis, central pyrexia, and death. Similarly, leukoencephalopathy induced by orally administered methotrexate for arthritis patients presents similar symptoms including ataxia, dysarthria, and seizures; however, long-term cognitive effects remain unknown. Symptoms of leukoencephalopathy caused by overdose of metronidazole medication include dysarthria, gait disturbance, weakness of extremities, and mental confusion. Despite the pharmacological agent or source of<unk> ity, some patients completely recover from<unk> . Related disorders Posterior reversible encephalopathy syndrome (PRES) can also result from medication<unk> ity. Symptoms similar to those of leukoencephalopathy patients have been seen in PRES patients. However, the prognosis of<unk> is typically slightly worse than that of PRES because<unk> is more likely to lead to ataxia, dementia, or coma. Hypoglycemic encephalopathy is often seen in diabetics as a result to accidental overdose with the long-acting sulfonylurea drug group. Brain regions affected by<unk> have been seen to be affected by this disease as well; however, hypoglycaemic encephalopathy has been known to involve both white and grey matter abnormalities. | Toxic leukoencephalopathy | Powassan encephalitis | Progressive multifocal leukoencephalopathy | Viral encephalitis | Herpesviral encephalitis | Autoimmune encephalitis | Tuberculous meningitis | Polioencephalitis | 00
| 42,785 |
Ultrasound showing an abscess of the skin thumb An abscess is a localized collection of pus (purulent inflammatory tissue) caused by suppuration buried in a tissue, an organ, or a confined space, lined by the pyogenic membrane. Ultrasound imaging can help in a diagnosis. Classification Abscesses may be classified as either skin abscesses or internal abscesses. Skin abscesses are common; internal abscesses tend to be harder to diagnose, and more serious. Skin abscesses are also called cutaneous or subcutaneous abscesses. IV drug use For those with a history of intravenous drug use, an X-ray is recommended before treatment to verify that no needle fragments are present. If there is also a fever present in this population, infectious endocarditis should be considered. Differential Abscesses should be differentiated from empyemas, which are accumulations of pus in a preexisting, rather than a newly formed, anatomical cavity. Other conditions that can cause similar symptoms include: cellulitis, a sebaceous cyst, and necrotising fasciitis. Cellulitis typically also has an erythematous reaction, but does not confer any purulent drainage. | complications of Diverticulitis | complications of Crohn's disease | medical cause of Bowel obstruction | medical cause of Gastritis | complications of Campylobacteriosis | complications of Peptic ulcer disease | complications of Gallstone | medical cause of Abdominal pain | 00
| 127 |
<unk> is a metabolic disturbance characterised by an excess of ammonia in the blood. It is a dangerous condition that may lead to brain injury and death. It may be primary or secondary. Ammonia is a substance that contains nitrogen. It is a product of the catabolism of protein. It is converted to the less toxic substance urea prior to excretion in urine by the kidneys. The metabolic pathways that synthesize urea involve reactions that start in the mitochondria and then move into the cytosol. The process is known as the urea cycle, which comprises several enzymes acting in sequence. It is greatly exacerbated by common zinc deficiency, which raises ammonia levels further. | Hyperammonemia | Lactic acidosis | Organic acidemia | Hypermethioninemia | Hyperaemia | Hypouricemia | Isovaleric acidemia | Ketosis | 00
| 14,194 |
<unk> are associated with aging and macular degeneration are distinct from another clinical entity, optic disc<unk> , which is present on the optic nerve head. Both age-related<unk> and optic disc<unk> can be observed by ophthalmoscopy. Optical coherence tomography scans of the orbits or head, calcification at the head of the optic nerve without change in size of globe strongly suggests<unk> in a middle-age or elderly patient. Whether<unk> promote AMD or are symptomatic of an underlying process that causes both<unk> and AMD is not known, but they are indicators of increased risk of the complications of AMD. 'Hard<unk> ' may coalesce into 'soft<unk> ' which is a manifestation of macular degeneration. | Drusen | Crusaid | Aneugen | Keldur | Lipotuck | Splinter | Otenaproxesul | Earwax | 00
| 35,379 |
Risk factors for developing<unk> include: * Genetic Markers: HLA-DR4, HLA-DR7, and HLA-DRw53 * Race: Blacks, Hispanics, Asians, and Native Americans | Antiphospholipid syndrome | Protein C deficiency | Protein S deficiency | Catastrophic antiphospholipid syndrome | Acquired haemophilia | Antithrombin III deficiency | Sticky platelet syndrome | Congenital hypofibrinogenemia | 00
| 9,067 |
A diagnosis of<unk> in adults is based on a heart rate less than 60 BPM, although some studies use a heart rate of less than 50 BPM. This is determined usually either by palpation or ECG. If symptoms occur, a determination of electrolytes may be helpful in determining the underlying cause. | Bradycardia | Hypopyon | Tachycardia | Sinus bradycardia | Apnea | Reflex bradycardia | Cardiovascular drift | Bradypnea | 00
| 549 |
<unk> <unk> is present in the basolateral face of the α-intercalated cells of the collecting ducts of the nephron, which are the main acid-secreting cells of the kidney. They generate hydrogen ions and bicarbonate ions from carbon dioxide and water – a reaction catalysed by carbonic anhydrase. The hydrogen ions are pumped into the collecting duct tubule by vacuolar H+ ATPase, the apical proton pump, which thus excretes acid into the urine. kAE1 exchanges bicarbonate for chloride on the basolateral surface, essentially returning bicarbonate to the blood. Here it performs two functions: * Electroneutral chloride and bicarbonate exchange across the plasma membrane on a one-for-one basis. This is crucial for CO2 uptake by the red blood cell and conversion (by hydration catalysed by carbonic anhydrase) into a proton and a bicarbonate ion. The bicarbonate is then excreted (in exchange for a chloride) from the cell by<unk> <unk> . * Physical linkage of the plasma membrane to the underlying membrane skeleton (via binding with ankyrin and<unk> 4.2). This appears to be to prevent membrane surface loss, rather than having to do with membrane skeleton assembly. | Band 3 anion transport protein | Sodium-chloride symporter | Cysteine-rich secretory protein | Cystic fibrosis transmembrane conductance regulator | Thiamine transporter 1 | Carboxylate transporter | Sulfate transporter | Zinc transporter 8 | 00
| 31,032 |
VHF symptoms appear similar to other viruses of the same family, such as Lassa fever. The known symptoms include swelling in the neck and face, sore throat, diarrhea, and a rash resembling measles on the face and body. Blood tests of those infected revealed elevated liver values, white blood cell counts that were first low and then elevated over time, and low platelet counts. | Lujo mammarenavirus | Caño Delgadito orthohantavirus | Chapare mammarenavirus | Limestone Canyon virus | Dobrava-Belgrade orthohantavirus | Prospect Hill orthohantavirus | Bayou orthohantavirus | Seoul orthohantavirus | 00
| 55,687 |
Features that may result from a high level of GH or expanding tumor include: * Headaches – often severe and prolonged * Soft tissue swelling visibly resulting in enlargement of the hands, feet, nose, lips, and ears, and a general thickening of the skin * Soft tissue swelling of internal organs, notably the heart with the attendant weakening of its muscularity, and the kidneys, also the vocal cords resulting in a characteristic thick, deep voice and slowing of speech * Generalized expansion of the skull at the fontanelle * Pronounced brow protrusion, often with ocular distension (frontal bossing) * Pronounced lower jaw protrusion (prognathism) with attendant macroglossia (enlargement of the tongue) and teeth spacing * Hypertrichosis, hyperpigmentation and hyperhidrosis may occur in these people. * Skin tags * Carpal tunnel syndrome Complications * Problems with bones and joints, including osteoarthritis, nerve compression syndrome due to bony overgrowth, and carpal tunnel syndrome * Hypertension * Diabetes mellitus * Cardiomyopathy, potentially leading to heart failure * Colorectal cancer * Sleep Apnea * Thyroid nodules and thyroid cancer * Hypogonadism * Compression of the optic chiasm by the growth of pituitary adenoma leading to visual problems | Acromegaly | Pachydermoperiostosis | Micromegaly | Hyperaldosteronism | Cinchonism | Pheochromocytoma | Hypoaldosteronism | Primary polydipsia | 00
| 53,446 |
Infant undergoing<unk> therapy in a United States maternity ward. A<unk> is a<unk> therapy tool to treat newborn jaundice (hyperbilirubinemia). High levels of<unk> rubin can cause brain damage (kernicterus), leading to cerebral palsy, auditory neuropathy, gaze abnormalities and dental enamel hypoplasia. The therapy uses a blue<unk> (420–470 nm) that converts<unk> rubin into a form that can be excreted in the urine and feces. Soft goggles are put on the child to reduce eye damage from the high intensity<unk> . | Bili light | MedFlight | Blacklight | Ultraviolet index | ZMapp | CareFlight | DrawMD | LifeFlight | 00
| 25,096 |
Diagnosis is typically post-mortem. Classification There are five known subgroups of MGA; MGA type I, II, III, IV & V. Type OMIM Gene Locus Also known as/Description Genetics Type I AUH Chr.9<unk> type I,<unk><unk> acidemia or<unk> -Methylglutaconyl-CoA Hydratase Deficiency Mutations in the AUH gene cause<unk> type I. This gene provides instructions for producing<unk> -methylglutaconyl-CoA hydratase, an enzyme that is involved in processing the amino acid leucine. This amino acid is broken down in the mitochondria during the process of energy production. A deficiency of this enzyme leads to a buildup of<unk><unk> acid, which is eliminated in the urine. Researchers believe that other genes or environmental factors also contribute to the development of this disorder. Type II TAZ Xq28 Barth syndrome (BTHS),<unk> type II or Cardiomyopathy-neutropenia syndrome Mutations in the TAZ gene cause<unk> type II (Barth syndrome). This gene provides instructions for making a protein called tafazzin. This protein plays a critical role in maintaining the levels of a particular lipid, called cardiolipin, located in the inner membrane of the mitochondria. A lack of tafazzin results in abnormalities in the structure and function of mitochondria, leading to the heart defects and other problems seen in this disorder. Type III OPA3 19q13.2-q13.3<unk> type III or Costeff syndrome Mutations in the OPA3 gene cause<unk> type III. This gene carries instructions for making a protein that is also found in mitochondria, but whose function is unknown. Researchers have suggested that cells with a defective OPA3 protein are more susceptible to a process that eliminates damaged or unneeded cells (so-called apoptosis). Type IV ? ?<unk> type IV Type V DNAJC19<unk> q26.3<unk> type V The characteristic features of<unk> type I include speech delay, delayed development of both mental and motor skills (psychomotor delay), elevated levels of acid in the blood and tissues (metabolic acidosis), abnormal muscle tone (dystonia), and spasms and weakness affecting the arms and legs (spastic quadriparesis). Fewer than 20 cases of<unk> type I have been reported. Barth syndrome is a common name for<unk> type II. The main features of Barth syndrome include a weakened and enlarged heart (dilated cardiomyopathy), recurrent infections due to low numbers of white blood cells (neutropenia), skeletal problems, and delayed growth. The incidence of<unk> type II is approximately 1 in 200,000 male infants. Costeff syndrome is another name for<unk> type III. This disorder is characterized mainly by the degeneration of the optic nerves, which carry information from the eyes to the brain. Sometimes other nervous system problems occur, such as an inability to maintain posture, poor muscle tone, the development of certain involuntary movements (extrapyramidal dysfunction), and a general decrease in brain function (cognitive deficit). The incidence of<unk> type III is about 1 in 10,000 newborns in the Iraqi Jewish population. This disorder is extremely rare in all other populations. The signs and symptoms of<unk> type IV are variable and overlap with types I-III. The incidence of<unk> type IV is unknown. | 3-Methylglutaconic aciduria | Urocanic aciduria | Hawkinsinuria | Alpha-aminoadipic and alpha-ketoadipic aciduria | Homocystinuria | 2-Hydroxyglutaric aciduria | Cystathioninuria | Phenylketonuria | 00
| 34,200 |
The most distinctive feature of PEPD is episodic burning pain of the rectum, ocular, and mandibular regions. It should be stressed that while pain often originates or is centered in these areas it can also spread or be diffuse in nature. Pain experienced by patients with this<unk> should not be underestimated as women with the<unk> who have also given birth describe PEPD pain as worse than labor pain. Concomitant with this pain is typically flushing, often in an area associated with the pain. During attacks in infants, the child often looks startled or terrified and can scream inconsolably. These attacks can be precipitated by injections, defecation, wiping of the perineum, eating, or the consumption of oral medication. When attacks occur due to such precipitation, pain and flushing are often present in the area of attack precipitation, though symptoms may also be diffuse in nature. Other symptoms may include hypersalivation when attacks are localized in the mandibular region, or leg weakness after foot trauma. A prominent non-physical symptom are tonic non-epileptic seizures. Such seizures are more common in infancy and childhood than during adulthood. In older children, inconsolable screaming usually precedes such attack, followed by apnea, paleness, and stiffness. Such stiffness can last from seconds to a few minutes. Attack precipitants are usually physical in nature, such as defecation, eating, or taking medicine. Some less common precipitants are micturition, coitus, and painful stimuli. There are also non-physical precipitants, such as the thought or sight of food. In general attacks tend to occur in the precipitated area, though this is not always the case. While some individuals have described a build-up to attacks, in general they tend to be abrupt. The duration of these attacks can be from a few seconds to two hours. Patients are largely normal between attacks. The only notable interictal problem is constipation, likely due to apprehension of precipitating an attack. This symptom often decreases with age, likely due to coping mechanisms such as the use of stool softeners. | Paroxysmal extreme pain disorder | Nociplastic pain | Functional somatic syndrome | Psychogenic pain | Mass psychogenic illness | Syndrome of subjective doubles | Cephalalgiaphobia | Postorgasmic illness syndrome | 00
| 46,906 |
Subsets and Splits