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X-Ray showing<unk> MPR) There is no single test for confirming that breathlessness is caused by<unk> – there are many causes of shortness of breath. Low oxygen saturation and disturbed arterial blood gas readings support the proposed diagnosis by suggesting a<unk> shunt. A chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing<unk> ri-hilum pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), and possibly pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated with noncardiogenic<unk> Lung ultrasound, employed by a healthcare provider at the point of care, is also a useful tool to diagnose<unk> ; not only is it accurate, but it may quantify the degree of lung water, track changes over time, and differentiate between cardiogenic and non-cardiogenic<unk> . Especially in the case of cardiogenic<unk> , urgent echocardiography may strengthen the diagnosis by demonstrating impaired left ventricular function, high central venous pressures and high<unk> artery pressures. Blood tests are<unk> rformed for electrolytes (sodium, potassium) and markers of renal function (creatinine, urea). Liver enzymes, inflammatory markers (usually C-reactive protein) and a complete blood count as well as coagulation studies (PT, aPTT) are also typically requested. B-type natriuretic<unk> ptide (BNP) is available in many hospitals, sometimes even as a point-of-care test. Low levels of BNP (<100 pg/ml) suggest a cardiac cause is unlikely. | Pulmonary edema | Pneumonia | Pleurisy | Emphysema | Hydrothorax | Pleural effusion | Pulmonary infiltrate | Atelectasis | 00
| 12,409 |
<unk> is a type of treatment that uses a substance or group of substances to stimulate the immune system to destroy a tumor or infectious microorganisms such as bacteria or viruses. | Vaccine therapy | Pulse vaccination strategy | Therapeutic vaccines | Destination therapy | Targeted immunization strategies | Vaccine bundling | Pre-exposure prophylaxis | Dendritic cell-based cancer vaccine | 00
| 49,266 |
Operation<unk> (currently known as<unk> New Millennium) is a multi-national immunization program launched in 1995 by the World Health Organization to coordinate polio vaccination efforts (currently it is also used to coordinated measles and rubella vaccination efforts). The name of the operation was derived from the names of the regions participating in the operation: Eastern Mediterranean, Caucasus, Central Asian Republics and Russia. Currently, 18 countries are participating and more than 60 million children have been vaccinated. | MECACAR | AEMT-CC | MCN | HERG | HAMLET | OHVIRA | CAPOX | PATH | 00
| 45,473 |
A<unk> effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to:<unk> pain<unk> disease<unk> amnesia<unk> cough, i.e. a habit cough *Mass<unk> illness | Psychogenic | Malignant | Toxicant | Neuroskeptic | Carcinoid | Infodemic | Endemic | Carcinogenesis | 00
| 37,662 |
<unk> is a rare cancer, occurring in up to 10% of primary vaginal malignancies. It is all but confirmed if maternal use of DES is established. Even though it was once thought to no longer occur past the age of 30, it is still seen into the 40s and 50s. Some of the main signs and symptoms for<unk> are spotting between menstrual cycles, bleeding post-menopause, abnormal bleeding, and malignant pericardial effusion or cardiac tamponade. | Clear-cell adenocarcinoma of the vagina | Squamous-cell carcinoma of the vagina | Glassy cell carcinoma of the cervix | Neuroendocrine carcinoma of the cervix | Villoglandular adenocarcinoma of the cervix | Endometrial stromal sarcoma | Endometrial stromal tumour | Microcystic adnexal carcinoma | 00
| 48,072 |
<unk> A<unk> <unk> is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases. The medication in a<unk> is most commonly a bronchodilator, corticosteroid or a combination of both for the treatment of asthma and COPD. Other medications less commonly used but also administered by<unk> are mast cell stabilizers, such as cromoglicate or nedocromil. | Metered-dose inhaler | Nasal spray | Transdermal spray | Nebulizer | Throat lozenge | Dental aerosol | Caphosol | Liquid ventilator | 00
| 30,634 |
Seizures * Tonic-clonic seizures: Mainly used in the prophylactic management of tonic-clonic seizures with complex symptomatology (psychomotor seizures). A period of 5–10 days of dosing may be required to achieve anticonvulsant effects. * Focal seizures: Mainly used to protect against the development of focal seizures with complex symptomatology (psychomotor and temporal lobe seizures). Also effective in controlling focal seizures with autonomic symptoms. * Absence seizures: Not used in treatment of pure absence seizures due to risk for increasing frequency of seizures. However, can be used in combination with other anticonvulsants during combined absence and tonic-clonic seizures. * Seizures during surgery: A 2018 meta-analysis found that early antiepileptic treatment with either<unk> or<unk> obarbital reduced the risk of seizure in the first week after neurosurgery for brain tumors. * Status epilepticus: Considered after failed treatment using a benzodiazepine due to slow onset of action. Other * Abnormal heart rhythms: may be used in the treatment of ventricular tachycardia and sudden episodes of atrial tachycardia after other antiarrhythmic medications or cardioversion has failed. It is a class 1b antiarrhythmic. * Digoxin toxicity: Intravenous formulation is drug of choice for arrhythmias caused by cardiac glycoside toxicity. * Trigeminal neuralgia: Second choice drug to carbamazepine. Special considerations *<unk> has a narrow therapeutic index. Its therapeutic range for an anticonvulsant effect is 10–20 μg/mL and for an antiarrhythmic effect 10–20 μg/mL. *The most common cause of<unk> intoxication is self‑medication, which accounts for more than thirty percent of the cases. * Avoid giving intramuscular formulation unless necessary due to skin cell death and local tissue destruction. * Elderly patients may show earlier signs of toxicity. * In the obese, ideal body weight should be used for dosing calculations. * Pregnancy: Pregnancy category D due to risk of fetal hydantoin syndrome and fetal bleeding. However, optimal seizure control is very important during pregnancy so drug may be continued if benefits outweigh the risks. Due to decreased drug concentrations as a result of plasma volume expansion during pregnancy, dose of<unk> may need to be increased if only option for seizure control. * Breastfeeding: The manufacturer does not recommend breastfeeding since low concentrations of<unk> are excreted in breast milk. * Liver disease: Do not use oral loading dose. Consider using decreased maintenance dose. * Kidney disease: Do not use oral loading dose. Can begin with standard maintenance dose and adjust as needed. * Intravenous use is contraindicated in patients with sinus bradycardia, sinoatrial block, second- or third-degree atrioventricular block, Stokes-Adams syndrome, or hypersensitivity to<unk> , other hydantoins or any ingredient in the respective formulation. | Phenytoin | Mephenytoin | Carbamazepine | Mesuximide | Propazepine | Levetiracetam | Phenobarbital | Oxcarbazepine | 00
| 3,259 |
The diagnosis is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue. In contrast to syphilitic ulcers,<unk> lymphadenopathy is generally mild or absent. Tissue biopsy and Wright-Giemsa stain are used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis. Donovan bodies are rod-shaped, oval organisms that can be seen in the cytoplasm of mononuclear phagocytes or histiocytes in tissue samples from patients with<unk> . They appear deep purple when stained with Wright's stain. These intracellular inclusions are the encapsulated Gram-negative rods of the causative organisms. They were discovered by Charles Donovan. Classification The first known name for this condition was "serpiginous ulcer", which dates to 1882. The proper clinical designation for donovanosis is<unk> ". A<unk> is a nodular type of inflammatory reaction, and<unk> refers to the<unk> region, which is commonly involved in this infection. The disease is commonly known as donovanosis, after the Donovan bodies seen on microscopy, which are a diagnostic sign. The causative organism, Klebsiella<unk> tis, was called Calymmatobacterium<unk> tis, and some sources still use this classification, from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this, it was called Donovania<unk> tis, named after the Donovan bodies. The specific name<unk> tis refers to the<unk> tous lesions. The organism was recently reclassified under the genus Klebsiella, a drastic taxonomic change since it involved changing the organism's phylum. However, polymerase chain reaction techniques using a colorimetric detection system showed a 99% similarity with other species in the genus Klebsiella. The clinical appearances of this lesion orally are classified into three types: Ulcerative, exuberant, cicatricial. | Granuloma inguinale | Lichen myxedematosus | Trichostasis spinulosa | Epidermolysis bullosa | Pseudofolliculitis barbae | Tinea imbricata | Hydroa vacciniforme | Cold abscess | 00
| 12,088 |
Normally, human<unk><unk> is straw-yellow.<unk><unk> other than straw-yellow sometimes reflects an<unk> ity—an underlying pathological condition—in human beings. | Abnormal urine color | Pyuria | Proteinuria | Polyuria | Anuria | Crystalluria | Bacteriuria | Oliguria | 00
| 72,039 |
<unk> , short for<unk> <unk> renal artery<unk> and autotransplantation, is a technique mainly used for complex disease involving multiple segmental branches in patients with fibromuscular dysplasia. In<unk> , temporary nephrectomy and<unk> <unk> repair with microvascular techniques followed by autotransplantation allows the precise repair of such lesions. | Ex vivo reconstruction | Multifocal technique | Skin window technique | Computational anatomy | Anatomical model | Preclinical imaging | Computer-assisted surgery | Ultrasound research interface | 00
| 66,738 |
* Eyes: People taking<unk> are prone to a complication known as floppy iris syndrome during cataract surgery. Adverse outcomes of the surgery are greatly reduced by the surgeon's prior knowledge of the person's history with this drug, and thus having the option of alternative techniques. * Severe hypotension. * Persons with cardiac conditions including hypotension, mechanical heart failure (valvular, pulmonary embolism, pericarditis), and congestive heart failure should be monitored carefully while taking<unk> . * Alpha blockers, including prazosin, terazosin, doxazosin, or<unk> , do not appear to affect all-cause mortality in heart failure re-hospitalization in those also receiving β-blockers.<unk> can also cause retrograde ejaculation, which occurs when semen is redirected to the urinary bladder instead of being ejaculated normally. This is because<unk> relaxes the muscles of the urethral sphincters, which are normally closed during ejaculation. This side effect can be mitigated by regular pelvic floor (Kegel) exercise and contracting the pelvic floor during ejaculation. | Tamsulosin | Terazosin | Doxazosin | Silodosin | Oxybutynin | Erythrocrine | Oxymetazoline | Finasteride | 00
| 30,307 |
H&E-LFB stain. The<unk> is a structure in the forebrain. Along with the caudate nucleus it forms the dorsal striatum. The caudate and<unk> contain the same types of neurons and circuits – many neuroanatomists consider the dorsal striatum to be a single structure, divided into two parts by a large fiber tract, the internal capsule, passing through the middle. The<unk> , together with the globus pallidus, makes up the lentiform nucleus. The<unk> is the outermost portion of the basal ganglia. These are a group of nuclei in the brain that are interconnected with the cerebral cortex, thalamus, and brainstem. Basal ganglia include the dorsal striatum, substantia nigra, nucleus accumbens, and the subthalamic nucleus. In mammals, the basal ganglia are associated with motor control, cognition, emotions, learning, and domain-general functions important for executive functioning as well as support for domain-specific languages. The basal ganglia are located bilaterally, and have rostral and caudal divisions. The<unk> is located in the rostral division as part of the striatum. The basal ganglia receive input from the cerebral cortex, via the striatum. The<unk> is interconnected with the following structures: alt=This is a transverse section of the striatum from a structural MR image. The striatum includes the caudate nucleus (top) and<unk> (right) and the globus pallidus (left).|This is a transverse section of the striatum from a structural MR image. The striatum includes the caudate nucleus (top) and<unk> (right) and the globus pallidus (left). This description is rudimentary and does not nearly exhaust even the basic established circuitry of the<unk> . The cortico-subcortico-cortical circuits with<unk> al involvement are dense and complicated, consisting of a wide range of axonal, dendritic, chemical, afferent, and efferent substrates. The<unk> 's outputs are highly arborized across output structures, and cortical efferents arise from layers III-VI of the cortex, dependent on gyri and location within the<unk> . Topographical organization of the<unk> combines the following elements: anterior-to-posterior functional and somatotopic gradients, lateral-to-medial functional and somatotopic gradients, diffuse terminal output, patchy localized terminal output, segregated terminals from adjacent regions, finely interdigitated terminals from distal cortical regions in a seemingly overlapping fashion. Caudate nucleus The caudate works with the<unk> to receive the input from cerebral cortex. Collectively, they can be considered the "entrance" to the basal ganglia. Projections from the<unk> reach the caudate directly via the caudolenticular grey bridges. The<unk> and caudate are jointly connected with the substantia nigra, however the caudate outputs more densely to the substantia nigra pars reticulata while the<unk> sends more afferents to the internal globus pallidus. Substantia nigra The substantia nigra contains two parts: the substantia nigra pars compacta (SNpc) and the substantia nigra pars reticulata (SNpr). The SNpc obtains input from the<unk> and caudate, and sends information back. The SNpr also obtains input from the<unk> and caudate. However, it sends the input outside the basal ganglia to control head and eye movements. The SNpc produces dopamine, which is crucial for movements. The SNpc is the part that degenerates during Parkinson's disease. Globus pallidus The globus pallidus contains two parts: the globus pallidus pars externa (GPe) and the globus pallidus pars interna (GPi). Both regions acquire input from the<unk> and caudate and communicate with the subthalamic nucleus. However, mostly the GPi sends GABAergic inhibitory output to the thalamus. The GPi also sends projections to parts of the midbrain, which have been assumed to affect posture control. | Putamen | Inferior colliculus | Arcuate nucleus | Periventricular nucleus | Barrel cortex | Medulla | Medulla | Piriform cortex | 00
| 2,592 |
alt=See caption. The first sign of<unk> is a painless swollen<unk> mp on the arm or leg, often similar in appearance to an insect bite. Sometimes the swollen area instead appears as a patch of firm, raised skin about three centimeters across called a "plaque"; or a more widespread swelling under the skin. Over the course of a few weeks, the original swollen area expands to form an irregularly shaped patch of raised skin. After about four weeks, the affected skin sloughs off leaving a painless ulcer.<unk> s typically have "undermined edges", the ulcer being a few centimeters wider underneath the skin than the wound itself. In some people, the ulcer may heal on its own or remain small<unk> t linger unhealed for years. In others, it continues to grow wider and sometimes deeper, with skin at the margin dying and sloughing off. Large ulcers may extend deep into underlying tissue, causing bone infection and exposing muscle, tendon, and bone to the air. When ulcers extend into muscles and tendons, parts of these tissues can be replaced by scar tissue, immobilizing the body part and resulting in permanent disability. Exposed ulcers can be infected by other bacteria, causing the wound to become red, painful, and foul smelling. Symptoms are typically limited to those caused by the wound; the disease rarely affects other parts of the body.<unk> s can appear anywhere on the body,<unk> t are typically on the limbs. Ulcers are most common on the lower limbs (roughly 62% of ulcers globally) and upper limbs (24%),<unk> t can also be found on the trunk (9%), head or neck (3%), or genitals (less than 1%). The World Health Organization classifies<unk> into three categories depending on the severity of its symptoms. Category I describes a single small ulcer that is less than . Category II describes a larger ulcer, up to , as well as plaques and broader swollen areas that have not yet opened into ulcers. Category III is for an ulcer larger than 15 centimeters, multiple ulcers, or ulcers that have spread to include particularly sensitive sites such as the eyes, bones, joints, or genitals. | Buruli ulcer | Lichen planus | Callous ulcer | Lichen sclerosus | Kangri ulcer | Lipschütz ulcer | Stercoral ulcer | Melanosis coli | 00
| 20,363 |
There is no medical treatment for either syndrome but there are some recommendations that can help with prevention or early identification of some of the problems. Children with either syndrome should have their hearing tested, and adults should be aware that the hearing loss may not develop until the adult years. Yearly visits to an ophthalmologist or other eye care professional who has been informed of the diagnosis of Stickler or<unk> is important for all affected individuals. Children should have the opportunity to have myopia corrected as early as possible, and treatment for cataracts or detached retinas may be more effective with early identification. Support for the joints is especially important during sports, and some recommend that contact sports should be avoided by those who have very loose joints. | Marshall syndrome | TORCH syndrome | Christianson syndrome | Avellis syndrome | Noonan syndrome | Hanhart syndrome | Laron syndrome | Goldenhar syndrome | 00
| 54,065 |
The<unk> is a disposable self-use home test for Sleep Bruxism. Its indications correlate well with comparable indications from formal sleep lab studies. The device is a miniature but complete sleep EMG (electromyography) monitor, including two pre-gelled EMG electrodes, an amplifier, a micro-processor-based real time data acquisition and analysis hardware and software, and a permanent chemical display unit. The entire system is integrated on a small piece of lightweight plastic film attached to the user's cheek. By analyzing the jaw muscles’ EMG waveforms in real time during the night and presenting the result on the built-in display, the device doesn't need a large data memory, and the downloading and analysis phases, common to all current sleep recorders, are eliminated. Test results indicate the number of bruxing events detected per hour of sleep (bruxing index or BI). This indication appears as permanent numbers encoded onto the electro-chemical display for easy reading. The device itself can serve as the medical record of the test. Self-test letters indicate technical and clinical validity of the study. Sleep Bruxism (SB) is a serious medical disorder, characterized by involuntary grinding and clenching of teeth during sleep. It is often accompanied by unpleasant grinding sounds heard by the bed-partner or roommate. Symptoms include wearing of teeth, temporomandibular joint (TMJ) dysfunction or pain, chewing difficulties, headaches and daytime sleepiness. The prevalence of SB is estimated at 14–20% in children and 8% in adults. Diagnosis of SB is usually based on clinical examination and patient history. However, none of the signs and symptoms may be considered conclusive. Another alternative has been to send the patient to a sleep lab for an overnight test. | BiteStrip | Souvenaid | Crusaid | CareFlite | Alloplant | Clinistrip | Paper cut | Protomap | 00
| 29,391 |
Pallor is a pale color of the skin that can be caused by illness, emotional shock or stress, stimulant use, or anemia, and is the result of a reduced amount of oxyhaemoglobin and may also be visible as pallor of the conjunctivae of the eyes on physical examination. Pallor is more evident on the face and palms. It can develop suddenly or gradually, depending on the cause. It is not usually clinically significant unless it is accompanied by a general pallor (pale lips, tongue, palms, mouth and other regions with mucous membranes). It is distinguished from similar presentations such as hypopigmentation (lack or loss of skin pigment) or simply a fair complexion. | symptom of Iron-deficiency anemia | symptom of Vitamin B12 deficiency anemia | symptoms of Peptic ulcer disease | symptom of Peptic ulcer disease | symptom of Coronary artery disease | symptom of Cardiovascular disease | symptom of Leukemia | symptom of Gastroenteritis | 00
| 18,893 |
AV nodal blocking can be achieved in at least three ways: Physical maneuvers A number of physical maneuvers increase the resistance of the AV node to transmit impulses (AV nodal block), principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are collectively referred to as vagal maneuvers. The Valsalva maneuver should be the first vagal maneuver tried and works by increasing intra-thoracic pressure and affecting baroreceptors (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold his/her breath while trying to exhale forcibly as if straining during a bowel movement. Holding the nose and exhaling against the obstruction has a similar effect. Pressing down gently on the top of closed eyes may also bring heartbeat back to normal rhythm for some people with atrial or<unk> tachycardia (SVT). This is known as the oculocardiac reflex. Medications Termination of<unk> following adenosine administration asprin immediately Adenosine, an ultra-short-acting AV nodal blocking agent, is indicated if vagal maneuvers are not effective. If unsuccessful or the<unk> recurs diltiazem or verapamil are recommended. Adenosine may be safely used during pregnancy. SVT that does not involve the AV node may respond to other anti-arrhythmic drugs such as sotalol or amiodarone. Cardioversion If the person is hemodynamically unstable or other treatments have not been effective, synchronized electrical cardioversion may be used. In children this is often done with a dose of 0.5 to 1 J/Kg. | Paroxysmal supraventricular tachycardia | Wandering atrial pacemaker | Inappropriate sinus tachycardia | Ventricular escape beat | Junctional ectopic tachycardia | AV nodal reentrant tachycardia | Atrioventricular reentrant tachycardia | Accelerated idioventricular rhythm | 00
| 31,596 |
Clinical assessment Caricature of a man with depression A diagnostic assessment may be conducted by a suitably trained general practitioner, or by a psychiatrist or psychologist, who records the person's current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination, which is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism, self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression, the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised. Primary-care physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression. In addition, there may also be barriers related to the person, provider, and/or the medical system. Non-psychiatrist physicians have been shown to miss about two-thirds of cases, although there is some evidence of improvement in the number of missed cases. Before diagnosing major depressive disorder, a doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse may be ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men. Vitamin D levels might be evaluated, as low levels of vitamin D have been associated with greater<unk> for depression. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a dementing disorder, such as Alzheimer's disease. Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. No biological tests confirm major depression. In general, investigations are not repeated for a subsequent episode unless there is a medical indication. DSM and ICD criteria The most widely used criteria for diagnosing depressive conditions are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems. The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with the other. Both DSM-5 and ICD-10 mark out typical (main) depressive symptoms. ICD-10 defines three typical depressive symptoms (depressed mood, anhedonia, and reduced energy), two of which should be present to determine the depressive disorder diagnosis. According to DSM-5, there are two main depressive symptoms: a depressed mood, and loss of interest/pleasure in activities (anhedonia). These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to the extent in which it impairs functioning) for the diagnosis. Major depressive disorder is classified as a mood disorder in DSM-5. The diagnosis hinges on the presence of single or recurrent major depressive episodes. Further qualifiers are used to classify both the episode itself and the course of the disorder. The category Unspecified Depressive Disorder is diagnosed if the depressive episode's manifestation does not meet the criteria for a major depressive episode. The ICD-10 system does not use the term major depressive disorder but lists very similar criteria for the diagnosis of a depressive episode (mild, moderate or severe); the term recurrent may be added if there have been multiple episodes without mania. Major depressive episode A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features—commonly referred to as psychotic depression—is automatically rated as severe. If the person has had an episode of mania or markedly elevated mood, a diagnosis of bipolar disorder is made instead. Depression without mania is sometimes referred to as unipolar because the mood remains at one emotional state or "pole". Bereavement is not an exclusion criterion in DSM-5, and it is up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are a range of related diagnoses, including dysthymia, which involves a chronic but milder mood disturbance; recurrent brief depression, consisting of briefer depressive episodes; minor depressive disorder, whereby only some symptoms of major depression are present; and adjustment disorder with depressed mood, which denotes low mood resulting from a psychological response to an identifiable event or stressor. Subtypes The DSM-5 recognizes six further subtypes of MDD, called specifiers, in addition to noting the length, severity and presence of psychotic features: * "Melancholic depression" is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt. * "Atypical depression" is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant long-term social impairment as a consequence of hypersensitivity to perceived interpersonal rejection. * "Catatonic depression" is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here, the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia or in manic episodes, or may be caused by neuroleptic malignant syndrome. *"Depression with anxious distress" was added into the DSM-5 as a means to emphasize the common co-occurrence between depression or mania and anxiety, as well as the<unk> of suicide of depressed individuals with anxiety. Specifying in such a way can also help with the prognosis of those diagnosed with a depressive or bipolar disorder. *"Depression with peri-partum onset" refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth or while a woman is pregnant. DSM-IV-TR used the classification "postpartum depression," but this was changed to not exclude cases of depressed woman during pregnancy. Depression with peripartum onset has an incidence rate of 3–6% among new mothers. The DSM-V mandates that to qualify as depression with peripartum onset, onset occurs during pregnancy or within one month of delivery. * "Seasonal affective disorder" (SAD) is a form of depression in which depressive episodes come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer. Differential diagnoses To confirm major depressive disorder as the most likely diagnosis, other potential diagnoses must be considered, including dysthymia, adjustment disorder with depressed mood, or bipolar disorder. Dysthymia is a chronic, milder mood disturbance in which a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression). Adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode. Bipolar disorder, previously known as manic–depressive disorder, is a condition in which depressive phases alternate with periods of mania or hypomania. Although depression is currently categorized as a separate disorder, there is ongoing debate because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a mood disorder continuum. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, medications, and substance use disorders. Depression due to physical illness is diagnosed as a mood disorder due to a general medical condition. This condition is determined based on history, laboratory findings, or physical examination. When the depression is caused by a medication, non-medical use of a psychoactive substance, or exposure | risks of Somatization disorder | risks of Delusional disorder | risks of Obsessive–compulsive disorder | complications of Major depressive disorder | treatment of Gender dysphoria | complications of Obsessive–compulsive disorder | complications of Bipolar disorder | complications of Agoraphobia | 00
| 831 |
Treatments include topical steroids such as clobetasol, and halobetasol which in some studies have proven to be equally effective as systemic, or pill, therapy and somewhat safer. However, in difficult-to-manage or widespread cases, systemic prednisone and powerful steroid-free immunosuppressant medications, such as methotrexate, azathioprine or mycophenolate mofetil, may be appropriate. Some of these medications have the potential for severe adverse effects such as kidney and liver damage, increased susceptibility to infections, and bone marrow suppression. Antibiotics such as tetracycline or erythromycin may also control the disease, particularly in patients who cannot use corticosteroids. The anti-CD20 monoclonal antibody rituximab has been found to be effective in treating some otherwise refractory cases of pemphigoid. A 2010 meta-analysis of 10 randomized controlled trials showed that oral steroids and potent topical steroids are effective treatments, although their use may be limited by side-effects, while lower doses of topical steroids are safe and effective for treatment of moderate<unk> . IgA-mediated pemphigoid can often be difficult to treat even with usually effective medications such as rituximab. | Bullous pemphigoid | Epidermolysis bullosa | Mucous membrane pemphigoid | Vesicular pemphigoid | IgA pemphigus | Paraneoplastic pemphigus | Pemphigoid nodularis | Giant cell lichenoid dermatitis | 00
| 29,563 |
Anti-Ro/SSA can target Ro52 and Ro60 proteins. Most Anti-Ro/SSA activity occurs on the cell surface, wherein Ro proteins are expressed on the cell membrane and extracellular Anti-Ro/SSAs bind to Ro. There is some evidence that the IgG isotype of anti-Ro/SSA antibody can enter the cell. * Anti-Ro<unk> are typically IgA, IgM, and IgG isotypes, though most is known about the five IgG subclasses. The antibody is inducible via immunization using Ro peptide. The mechanism that induces Anti-Ro/SSA production in autoimmune disorders remains under study. Some proposed factors that may stimulate production are viral infection, treatment of cells with TNF-α, cellular apoptosis, and exposure to UV irradiation. * Anti-Ro/SSA is produced in the cytoplasm of cells in the epidermal layer of the skin following UV irradiation. Ro antigens are simultaneously upregulated on the cell surface, resulting in the Anti-Ro/SSA antibody marking cells for destruction. Anti-Ro52 antibodies in particular have been tied to elevated photosensitivity. Certain alleles of the human major histocompatibility complex (MHC II, called HLA II in humans) have been associated with the presence of Anti-Ro antibodies and the spread of the immune response. Anti-Ro/SSA associates with the HLA II alleles HLA-DR3 and HLA-DR2, as well as some HLA-DQ alleles. The T-cell response plays a role in the formation of Anti-Ro/SSA antibodies due to T-cell affinity for MHC class II. | Anti-SSA/Ro autoantibodies | Anti-LKM antibody | Anti-histone antibodies | Anti-dsDNA antibodies | Anti-nuclear antibody | Antisperm antibodies | Anti-mitochondrial antibody | Anti-neutrophil cytoplasmic antibody | 00
| 60,819 |
The prognosis has improved for<unk> es. The mortality rate in-hospital is about 2.5-19%. The elderly, ICU admissions, shock, cancer, fungal infections, cirrhosis, chronic kidney disease, acute respiratory failure, severe disease, or disease of biliary origin have a worse prognosis. | Liver abscess | Pyogenic liver abscess | Amoebic liver abscess | Hepatolithiasis | Cholangitis | Pancreatic abscess | Ascending cholangitis | Pancreatic cyst | 00
| 44,457 |
Bochdalek<unk> The Bochdalek<unk> , also known as a postero-lateral<unk><unk> , is the most common manifestation of<unk> , accounting for more than 95% of cases. In this instance the diaphragm abnormality is characterized by a hole in the postero-lateral corner of the diaphragm which allows passage of the abdominal viscera into the chest cavity. The majority of Bochdalek<unk> s (80–85%) occur on the left side of the diaphragm, a large proportion of the remaining cases occur on the right side. To date, it carries a high mortality and is an active area of clinical research. Morgagni<unk> CT of the chest demonstrates a Morgagni<unk> (red arrow) This rare anterior defect of the diaphragm is variably referred to as a Morgagni, retrosternal, or parasternal<unk> . Accounting for approximately 2% of all<unk> cases, it is characterized by<unk> tion through the foramina of Morgagni which are located immediately adjacent and posterior to the xiphoid process of the sternum. Diaphragm eventration The diagnosis of<unk><unk> eventration is used when there is abnormal displacement (i.e. elevation) of part or all of an otherwise intact diaphragm into the chest cavity. This rare type of<unk> occurs because in the region of eventration the diaphragm is thinner, allowing the abdominal viscera to protrude upwards. | Congenital diaphragmatic hernia | Tracheal agenesis | Pulmonary atresia | Pulmonary agenesis | Asphyxiating thoracic dysplasia | Pulmonary artery sling | Pulmonary hypoplasia | First arch syndrome | 00
| 26,001 |
The<unk> or<unk> (pl.) (), is the crescent-shaped whitish area of the bed of a fingernail or toenail. In humans, it appears by week 14 of gestation, and has a primary structural role in defining the free edge of the distal nail plate (the part of the nail that grows outward). | Lunula | Microgyrus | Syrinx | Tophus | Gyrus | Ranula | Collateral eminence | Oral torus | 00
| 24,179 |
<unk> , also known as<unk> abnormalities, are a set of clinical conditions due to chromosomal, gonadal and/or genitalia variation. Individuals with congenital (inborn) discrepancy between sex chromosome, gonadal, and their internal and external genitalia are categorised as individuals with a disorder of sex development (DSD). Afterwards, if the family or individual wishes, they can partake in different management and treatment options for their conditions (e.g. hormone therapy). Infants born with atypical genitalia often cause confusion and distress for the family. Psychosexual development is influenced by numerous factors that include, but are not limited to, gender differences in brain structure, genes associated with<unk> development, prenatal androgen exposure, interactions with family, and cultural and societal factors. Because of the complex and multifaceted factors involved, communication and psychosexual support are all important. A team of experts, or patient support groups, are usually recommended for cases related to<unk> . This team of experts are usually derived from a variety of disciplines including pediatricians, neonatologists, pediatric urologists, pediatric general surgeons, endocrinologists, geneticists, radiologists, psychologists and social workers. These professionals are capable of providing first line (prenatal) and second line diagnostic (postnatal) tests to examine and diagnose<unk> . | Sexual anomalies | Anorectal anomalies | Sex chromosome anomalies | Growth attenuation | Congenital limb deformities | Trichomegaly | Color anomaly | Breastfeeding difficulties | 00
| 74,318 |
Diagnosis typically occurs during the first 6 months of life due to characteristic neurological symptoms. These symptoms include muscle spasms, tetany, and seizures. Laboratory testing indicates<unk> (decreased serum magnesium levels),<unk> (decreased serum calcium levels), and little to no measurable parathyroid hormone levels. Diagnosis is confirmed with these symptoms and can be further solidified with genetic sequencing of the TRPM6 gene. | Hypomagnesemia with secondary hypocalcemia | Exercise-associated hyponatremia | Chronic recurrent multifocal osteomyelitis | Hypotonic hyponatremia | Normophosphatemic familial tumoral calcinosis | Secondary hyperparathyroidism | Familial hypocalciuric hypercalcemia | Isotonic hyponatremia | 00
| 40,628 |
Patients will present with a sudden onset of cramps/abdominal pain or a 'stitch'. The pain localises in the area of the umbilicus and can radiate to the lumbar and surrounding regions. | Omental infarction | Romanus lesion | Subgaleal hemorrhage | Stercoral perforation | Skull fracture | Labyrinthine fistula | Orbital emphysema | Orbital blowout fracture | 00
| 66,397 |
The pathogenesis of<unk> is complicated, but involves two main routes – an immunological route, and a mechanical route. Immunologically, disease is caused primarily through the activity of lung macrophages, which phagocytose dust particles after their deposition. These macrophages seek to eliminate the dust particle through either the mucociliary mechanism, or through lymphatic vessels which drain the lungs. Macrophages also produce an inflammatory mediator known as interleukin-1 (IL-1), which is part of the immune systems first line defenses against infecting particles. IL-1 is responsible for 'activation' of local vasculature, causing endothelial cells to express certain cell adhesion molecules, which help the cells of the body's immune system to migrate into tissues. Macrophages exposed to dust have been shown to have markedly decreased chemotaxis. Production of inflammatory mediators – and the tissue damage that ensues as an effect of this, as well as reduced motility of cells, is fundamental to the pathogenesis of pneumoconiosis and the accompanying inflammation,<unk> , and emphysema. There are also some mechanical factors involved in the pathogenesis of Complex Pneumoconiosis that should be considered. The most notable indications are the fact that the disease tends to develop in the upper lobe of the lung – especially on the right, and its common occurrence in taller individuals. | Progressive massive fibrosis | Progressive disease | Localized disease | Malignant edema | Biphasic disease | Chronic toxicity | Tumor progression | Malignant | 00
| 35,532 |
+MRC breathlessness scale Grade Degree of dyspnea 1 no dyspnea except with strenuous exercise 2 dyspnea when walking up an incline or hurrying on the level 3 walks slower than most on the level, or stops after 15 minutes of walking on the level 4 stops after a few minutes of walking on the level 5 with minimal activity such as getting dressed, too dyspneic to leave the house The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination. Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, tripod positioning, pronounced use of accessory muscles (sternocleidomastoid, scalenes) and absent breath sounds. A number of scales may be used to quantify the degree of<unk> . It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale). The MRC breathlessness scale suggests five grades of dyspnea based on the circumstances in which it arises. Blood tests A number of labs may be helpful in determining the cause of<unk> . D-dimer, while useful to rule out a pulmonary embolism in those who are at low risk, is not of much value if it is positive, as it may be positive in a number of conditions that lead to<unk> . A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level, while supportive of the diagnosis, could also be due to advanced age, kidney failure, acute coronary syndrome, or a large pulmonary embolism. Imaging A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism. | Shortness of breath | Bad breath | Cough | Voice change | Labored breathing | Alertness | Personality changes | Sore throat | 00
| 7,972 |
It is characterized by ulcers. Diagnosis of<unk> cutis calls for high degree of clinical suspicion. This needs to be backed with demonstration of trophozoites from lesions. Unless an early diagnosis can be made such patients can suffer from significant morbidity. | Cutaneous amoebiasis | Granulosis rubra nasi | Malassezia folliculitis | Herpetic whitlow | Sycosis vulgaris | Cutaneous lupus mucinosis | Onychomycosis | Tinea capitis | 00
| 53,764 |
Psychological The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women "fake good" in order to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism prior to initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons. Fertility does not seem to increase when the women takes antioxidants to reduce the oxidative stress brought by the situation. Infertility may have psychological effects. Parenthood is one of the major transitions in adult life for both men and women. The stress of the non-fulfilment of a wish for a child has been associated with emotional squeal such as anger, depression, anxiety, marital problems and feelings of worthlessness. Partners may become more anxious to conceive, increasing sexual dysfunction. Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer. Emotional stress and marital difficulties are greater in couples where the infertility lies with the man. Male and female partner respond differently to infertility problem. In general, women show higher depression levels than their male partners when dealing with infertility. A possible explanation may be that women feel more responsible and guilty than men during the process of trying to concieve. On the other hand, infertile men experience a psychosomatic distress. Social Having a child is considered to be important in general society. Infertile couples may be exposed to social and family pressure which lead to their social isolation. This event has a negative effect on the way in which the couple could experience an infertility treatment. Moreover the socioeconomic status influences the psychology of the infertile couples: low socioeconomic status is associated with increased chances of developing depression. In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. Some respond by actively avoiding the issue altogether; middle-class men are the most likely to respond in this way. In the United States some treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for Family and Medical Leave Act leave. It has been suggested that infertility be classified as a form of disability. | complications of Uterine fibroid | complications of Ovarian cyst | complications of Pelvic inflammatory disease | symptoms of Endometriosis | complications of Mastitis | medical cause of Abnormal uterine bleeding | medical cause of Endometritis | complications of Epididymitis | 00
| 7,117 |
Has a higher incidence of extrapyramidal side effects than the other atypical antipsychotics, but still less than that seen with typical antipsychotics. A trend was observed in a clinical trial comparing mosapramine with<unk> that favoured<unk> for producing less prominent extrapyramidal side effects than mosapramine although statistical significant was not reached. It may produce less QT interval prolongation than zotepine, as in one patient who had previously been on zotepine switching to<unk> corrected their prolonged QT interval. It also tended to produce less severe extrapyramidal side effects than haloperidol in a clinical trial comparing the two (although statistical significance was not reached). Discontinuation The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a felling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time. There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped. | Perospirone | Tiospirone | Tetherin | Survivin | Neurofilament light polypeptide | Tetraspanin | Alpha-neurotoxin | Precipitin | 00
| 51,013 |
Micrograph showing a<unk> (Eosinophilic granulomatosis with polyangiitis). H&E stain. FDG-PET/CT * Laboratory tests of blood or body fluids are performed for patients with active<unk> . Their results will generally show signs of inflammation in the body, such as increased erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), anemia, increased white blood cell count and eosinophilia. Other possible findings are elevated antineutrophil cytoplasmic antibody (ANCA) levels and hematuria. * Other organ functional tests may be abnormal. Specific abnormalities depend on the degree of various organs involvement. A Brain SPECT can show decreased blood flow to the brain and brain damage. * The definite diagnosis of<unk> is established after a biopsy of involved organ or tissue, such as skin, sinuses, lung, nerve, brain, and kidney. The biopsy elucidates the pattern of blood vessel inflammation. :*Some types of<unk> display leukocytoclasis, which is vascular damage caused by nuclear debris from infiltrating neutrophils. It typically presents as palpable purpura. Conditions with leucocytoclasis mainly include hypersensitivity<unk> (also called leukocytoclastic<unk> and cutaneous small-vessel<unk> (also called cutaneous leukocytoclastic angiitis). * An alternative to biopsy can be an angiogram (x-ray test of the blood vessels). It can demonstrate characteristic patterns of inflammation in affected blood vessels. * 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)has become a widely used imaging tool in patients with suspected Large Vessel<unk> , due to the enhanced glucose metabolism of inflamed vessel walls. The combined evaluation of the intensity and the extension of FDG vessel uptake at diagnosis can predict the clinical course of the disease, separating patients with favourable or complicated progress. * Acute onset of<unk> -like symptoms in small children or babies may instead be the life-threatening purpura fulminans, usually associated with severe infection. + Laboratory Investigation of<unk> Syndromes Disease Serologic test Antigen Associated laboratory features Systemic lupus erythematosus ANA including antibodies to dsDNA and ENA including SM, Ro (SSA), La (SSB), and RNP Nuclear antigens Leukopenia, thrombocytopenia, Coombs' test, complement activation: low serum concentrations of C3 and C4, positive immunofluorescence using Crithidia luciliae as substrate, antiphospholipid antibodies (i.e. anticardiolipin, lupus anticoagulant, false-positive VDRL) Goodpasture's disease Anti-glomerular basement membrane antibody Epitope on noncollagen domain of type IV collagen Small vessel<unk> Microscopic polyangiitis Perinuclear antineutrophil cytoplasmic antibody Myeloperoxidase Elevated CRP Granulomatosis with polyangiiitis Cytoplasmic antineutrophil cytoplasmic antibody Proteinase 3 (PR3) Elevated CRP Eosinophilic granulomatosis with polyangiitis perinuclear antineutrophil cytoplasmic antibody in some cases Myeloperoxidase Elevated CRP and eosinophilia IgA<unk> (Henoch-Schönlein purpura) None Cryoglobulinemia Cryoglobulins, rheumatoid factor, complement components, hepatitis C Medium vessel<unk> Classical polyarteritis nodosa None Elevated CRP and eosinophilia Kawasaki's Disease None Elevated CRP and ESR In this table: ANA = Antinuclear antibodies, CRP = C-reactive protein, ESR = Erythrocyte Sedimentation Rate, dsDNA = double-stranded DNA, ENA = extractable nuclear antigens, RNP = ribonucleoproteins; VDRL = Venereal Disease Research Laboratory | Vasculitis | Eosinophilic cellulitis | Venous thrombosis | Neuritis | Atherosclerosis | Coronary thrombosis | Lymphangitis | Microvasculitis | 00
| 15,897 |
Gastroenteritis can be caused by viral, bacterial, or parasitic infections. Common routes of infection include: * Food * Contaminated water * Contact with an infected person * Unwashed hands Fifty to seventy percent of cases of gastroenteritis in adults are caused by noroviruses (genus Norovirus, family Caliciviridae). This virus is highly contagious and spreads rapidly. Norovirus is the most common cause of gastroenteritis in the United States. | Gastroenterocolitis | Enterocolitis | Proctocolitis | Gastroenteritis | Ischemic colitis | Ileitis | Colitis | Enteritis | 00
| 49,953 |
No treatment is generally required, as bone demineralisation and kidney stones are relatively uncommon in the condition. | Familial hypocalciuric hypercalcemia | Primary hyperparathyroidism | Secondary hyperparathyroidism | Tertiary hyperparathyroidism | Normophosphatemic familial tumoral calcinosis | Pseudohypoparathyroidism | Pseudopseudohypoparathyroidism | Hyperphosphatasia with mental retardation syndrome | 00
| 55,058 |
Most children with<unk> have mild symptoms and supportive care at home is effective. For children with moderate to severe<unk> , treatment with corticosteroids and nebulized epinephrine may be suggested. Steroids are given routinely, with epinephrine used in severe cases. Children with oxygen saturation less than 92% should receive oxygen, and those with severe<unk> may be hospitalized for observation. In very rare severe cases of<unk> that result in respiratory failure, emergency intubation and ventilation may be required. With treatment, less than 0.2% of children require endotracheal intubation. Since<unk> is usually a viral disease, antibiotics are not used unless secondary bacterial infection is suspected. The use of cough medicines, which usually contain dextromethorphan or guaifenesin, are also discouraged. Supportive care Supportive care for children with<unk> includes resting and keeping the child hydrated. Infections that are mild are suggested to be treated at home.<unk> is contagious so washing hands is important. Children with<unk> should generally be kept as calm as possible. Over the counter medications for pain and fever may be helpful to keep the child comfortable. There is some evidence that cool or warm mist may be helpful, however, the effectiveness of this approach is not clear. If the child is showing signs is distress while breathing (inspiratory stridor, working hard to breath, blue (or blue-ish) coloured lips, or decrease in the level of alertness), immediate medical evaluation by a doctor is required. Steroids Corticosteroids, such as dexamethasone and budesonide, have been shown to improve outcomes in children with all severities of<unk> , however, the benefits may be delayed. Significant relief may be obtained as early as two hours after administration. While effective when given by injection, or by inhalation, giving the medication by mouth is preferred. A single dose is usually all that is required, and is generally considered to be quite safe. Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally effective. Epinephrine Moderate to severe<unk> (for example, in the case of severe stridor) may be improved temporarily with nebulized epinephrine. While epinephrine typically produces a reduction in<unk> severity within 10–30 minutes, the benefits are short-lived and last for only about 2 hours. If the condition remains improved for 2–4 hours after treatment and no other complications arise, the child is typically discharged from the hospital. Epinephrine treatment is associated with potential adverse effects (usually related to the dose of epinephrine) including tachycardia, arrhythmias, and hypertension. Oxygen More severe cases of<unk> may require treatment with oxygen. If oxygen is needed, "blow-by" administration (holding an oxygen source near the child's face) is recommended, as it causes less agitation than use of a mask. Other While other treatments for<unk> have been studied, none has sufficient evidence to support its use. There is tentative evidence that breathing heliox (a mixture of helium and oxygen) to decrease the work of breathing is useful in those with severe disease, however, there is uncertainty in the effectiveness and the potential adverse effects and/or side effects are not well known. In cases of possible secondary bacterial infection, the antibiotics vancomycin and cefotaxime are recommended. In severe cases associated with influenza A or B infections, the antiviral neuraminidase inhibitors may be administered. | Croup | Foreign body | Bronchorrhea | Epiglottitis | Tonsillitis | Tracheitis | Laryngitis | Post-nasal drip | 00
| 10,610 |
The CFTR protein is a channel protein that controls the flow of H2O and Cl− ions in and out of cells inside the lungs. When the CFTR protein is working correctly, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning, these ions cannot flow out of the cell due to a blocked channel. This causes cystic fibrosis, characterized by the buildup of thick mucus in the lungs. Several mutations in the CFTR gene can occur, and different mutations cause different defects in the CFTR protein, sometimes causing a milder or more severe disease. These protein defects are also targets for drugs which can sometimes restore their function. ΔF508-CFTR gene mutation, which occurs in >90% of patients in the U.S., creates a protein that does not fold normally and is not appropriately transported to the cell membrane, resulting in its degradation. Other mutations result in proteins that are too short (truncated) because production is ended prematurely. Other mutations produce proteins that do not use energy (in the form of ATP) normally, do not allow chloride, iodide, and thiocyanate to cross the membrane appropriately, and degrade at a faster rate than normal. Mutations may also lead to fewer copies of the CFTR protein being produced. The protein created by this gene is anchored to the outer membrane of cells in the sweat glands, lungs, pancreas, and all other remaining exocrine glands in the body. The protein spans this membrane and acts as a channel connecting the inner part of the cell (cytoplasm) to the surrounding fluid. This channel is primarily responsible for controlling the movement of halide anions from inside to outside of the cell; however, in the sweat ducts, it facilitates the movement of chloride from the sweat duct into the cytoplasm. When the CFTR protein does not resorb ions in sweat ducts, chloride and thiocyanate released from sweat glands are trapped inside the ducts and pumped to the skin. Additionally hypothiocyanite, OSCN, cannot be produced by the immune defense system. Because chloride is negatively charged, this modifies the electrical potential inside and outside the cell that normally causes cations to cross into the cell. Sodium is the most common cation in the extracellular space. The excess chloride within sweat ducts prevents sodium resorption by epithelial sodium channels and the combination of sodium and chloride creates the salt, which is lost in high amounts in the sweat of individuals with CF. This lost salt forms the basis for the sweat test. Most of the damage in CF is due to blockage of the narrow passages of affected organs with thickened secretions. These blockages lead to remodeling and infection in the lung, damage by accumulated digestive enzymes in the pancreas, blockage of the intestines by thick feces, etc. Several theories have been posited on how the defects in the protein and cellular function cause the clinical effects. The most current theory suggests that defective ion transport leads to dehydration in the airway epithelia, thickening mucus. In airway epithelial cells, the cilia exist in between the cell's apical surface and mucus in a layer known as airway surface liquid (ASL). The flow of ions from the cell and into this layer is determined by ion channels such as CFTR. CFTR not only allows chloride ions to be drawn from the cell and into the ASL, but it also regulates another channel called ENac, which allows sodium ions to leave the ASL and enter the respiratory epithelium. CFTR normally inhibits this channel, but if the CFTR is defective, then sodium flows freely from the ASL and into the cell. As water follows sodium, the depth of ASL will be depleted and the cilia will be left in the mucous layer. As cilia cannot effectively move in a thick, viscous environment, mucociliary clearance is deficient and a buildup of mucus occurs, clogging small airways. The accumulation of more viscous, nutrient-rich mucus in the lungs allows bacteria to hide from the body's immune system, causing repeated respiratory infections. The presence of the same CFTR proteins in the pancreatic duct and sweat glands in the skin also cause symptoms in these systems. Chronic infections The lungs of individuals with cystic fibrosis are colonized and infected by bacteria from an early age. These bacteria, which often spread among individuals with CF, thrive in the altered mucus, which collects in the small airways of the lungs. This mucus leads to the formation of bacterial microenvironments known as biofilms that are difficult for immune cells and antibiotics to penetrate. Viscous secretions and persistent respiratory infections repeatedly damage the lung by gradually remodeling the airways, which makes infection even more difficult to eradicate. The natural history of CF lung infections and airway remodeling is poorly understood, largely due to the immense spatial and temporal heterogeneity both within and between the microbiomes of CF patients. Over time, both the types of bacteria and their individual characteristics change in individuals with CF. In the initial stage, common bacteria such as S. aureus and H. influenzae colonize and infect the lungs. Eventually, Pseudomonas aeruginosa (and sometimes Burkholderia cepacia) dominates. By 18 years of age, 80% of patients with classic CF harbor P. aeruginosa, and 3.5% harbor B. cepacia. Once within the lungs, these bacteria adapt to the environment and develop resistance to commonly used antibiotics. Pseudomonas can develop special characteristics that allow the formation of large colonies, known as "mucoid" Pseudomonas, which are rarely seen in people who do not have CF. Scientific evidence suggests the interleukin 17 pathway plays a key role in resistance and modulation of the inflammatory response during P. aeruginosa infection in CF. In particular, interleukin 17-mediated immunity plays a double-edged activity during chronic airways infection; on one side, it contributes to the control of P. aeruginosa burden, while on the other, it propagates exacerbated pulmonary neutrophilia and tissue remodeling. Infection can spread by passing between different individuals with CF. In the past, people with CF often participated in summer "CF camps" and other recreational gatherings. Hospitals grouped patients with CF into common areas and routine equipment (such as nebulizers) was not sterilized between individual patients. This led to transmission of more dangerous strains of bacteria among groups of patients. As a result, individuals with CF are now routinely isolated from one another in the healthcare setting, and healthcare providers are encouraged to wear gowns and gloves when examining patients with CF to limit the spread of virulent bacterial strains. CF patients may also have their airways chronically colonized by filamentous fungi (such as Aspergillus fumigatus, Scedosporium apiospermum, Aspergillus terreus) and/or yeasts (such as Candida albicans); other filamentous fungi less commonly isolated include Aspergillus flavus and Aspergillus nidulans (occur transiently in CF respiratory secretions) and Exophiala dermatitidis and Scedosporium prolificans (chronic airway-colonizers); some filamentous fungi such as Penicillium emersonii and Acrophialophora fusispora are encountered in patients almost exclusively in the context of CF. Defective mucociliary clearance characterizing CF is associated with local immunological disorders. In addition, the prolonged therapy with antibiotics and the use of corticosteroid treatments may also facilitate fungal growth. Although the clinical relevance of the fungal airway colonization is still a matter of debate, filamentous fungi may contribute to the local inflammatory response and therefore to the progressive deterioration of the lung function, as often happens with allergic bronchopulmonary aspergillosis – the most common fungal disease in the context of CF, involving a Th2-driven immune response to Aspergillus species. | medical cause of Bronchiectasis | medical cause of Bronchiolitis | medical cause of Hemoptysis | medical cause of Acute bronchitis | symptom of Idiopathic pulmonary fibrosis | symptom of Bronchiectasis | complications of Bronchiolitis | medical cause of Bronchiolitis obliterans | 00
| 3,403 |
The FDA indication for<unk> is reduction of the rate of cardiovascular death, myocardial infarction (MI), and stroke in people with acute coronary syndrome or history of myocardial infarction.<unk> is used for the prevention of thrombotic events (for example stroke or heart attack) in different categories of patients. The drug is combined with acetylsalicylic acid unless the latter is contraindicated. The PLATO trial concluded superiority of<unk> compared to clopidogrel in reducing the rate of death from vascular causes, MI, and stroke in patients presenting with acute coronary syndromes. A post-hoc subgroup analysis of the PLATO trial suggested a reduction in total mortality with<unk> compared to clopidogrel in patients with non-ST elevation acute coronary syndrome. However, this finding should only be considered exploratory as it was not a primary endpoint of the PLATO trial. Subsequent studies have also been underpowered in evaluating total mortality benefits with<unk> . Further studies are required to provide statistically significant outcomes for total mortality with<unk> before this can be applied convincingly to clinical practice. According to ESC 2017 guidelines, dual antiplatelet therapy (DAPT) with<unk> in combination with acetylsalicylic acid (Aspirin) is the preferred treatment in patients with acute coronary syndrome with or without ST segment elevation, irrespective of the initial treatment strategy – invasive or non-invasive (IB level of evidence) however if there is a plan for percutaneous coronary intervention (PCI), administration of thrombolysis or the presence of some other patient factors (e.g. high bleeding risk) other antiplatelet agents are recommended. The 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy provides similar recommendations, although with a lower level of evidence (IIaB). Furthermore, the 2017 ESC Focused Update on Duration of Dual Antiplatelet Therapy allows physicians to administer<unk> to patients with stable coronary artery disease undergoing percutaneous coronary intervention after taking thrombotic and haemorrhagic risk into consideration. In people with non-cardioembolic minor ischaemic stroke or high-risk TIA,<unk> monotherapy did not reach statistical significance in reducing the composite of stoke, myocardial infarction or death compared to aspirin despite numerical reduction.<unk> plus aspirin was superior to aspirin alone in reducing the composite of stroke or death at 30 days in the large THALES randomised controlled trial; however, at an increased risk of severe bleeding. Although supporting the role of short-term dual antiplatelet therapy post minor ischaemic stroke or high-risk TIA, there are currently no published head-to-head comparisons of<unk> plus aspirin versus the current standard-of-care in this cohort of clopidogrel plus aspirin. Further studies addressing this (including the results of the currently ongoing CHANCE-2 trial) are required to clarify the role of<unk> in clinical practice post stroke. In trials of both<unk> monotherapy and<unk> plus aspirin versus aspirin alone for minor ischaemic stroke or high-risk TIA, the subgroup of patients with ipsilateral stenosis of intracranial or extracranial arteries had a higher absolute risk of recurrent stroke and greater magnitude of absolute benefit than the subgroup without ipsilateral stenosis. However, these subgroup analyses were hypothesis-generating only. A study compared<unk> and clopidogrel in participants with acute coronary syndrome (PLATO Trial) showed that participants treated with<unk> had a lower risk of infection-related deaths. The Targeting Platelet-Leukocyte Aggregates in Pneumonia With<unk> (XANTHIPPE) study showed improvement in lung function in participants hospitalized for pneumonia using<unk> . | Ticagrelor | Clopidogrel | Ticlopidine | Prokarin | Rivaroxaban | Eptifibatide | Apixaban | Palladin | 00
| 51,584 |
Histopathology of<unk> , showing plenty of spindle shaped cells with eosinophilic cytoplasm i.e. mast cells infiltrating the dermis and the appendiceal structures (black arrows). The basal cells show more pigmentation (blue arrows). The disease is most often diagnosed as an infant, when parents take their baby in for what appears to be bug bites. The bug bites are actually the clumps of mast cells. Doctors can confirm the presence of mast cells by rubbing the baby's skin. If hives appear, it most likely signifies the presence of<unk> . | Urticaria pigmentosa | Ichthyosis acquisita | Lamellar ichthyosis | Phytophotodermatitis | Ichthyosis bullosa of Siemens | Striate keratoderma | Dermatopathia pigmentosa reticularis | Ichthyosis vulgaris | 00
| 29,573 |
The major side effect of using<unk> is addiction, and it becomes difficult to get rid of it. It is also increasingly known that<unk> often causes oral and throat cancer. It is also heavily recommended to restrict use of<unk> due to major side effects. | Naswar | Latah | Tzaraath | Tabun | Lint | Gurah | Dokha | Dollond | 00
| 56,159 |
The<unk> is an oculoplastic procedure which is performed to reconstruct a lower eyelid defect. It is usually performed as a 2-stage procedure. The most common use for the<unk> is reconstruction after the removal of a lower eyelid skin cancer. The result aims to recreate the normal appearance and function of the lid. | Hughes procedure | Mumford procedure | Eden-Lange procedure | Blalock–Hanlon procedure | Kawashima procedure | Mustard procedure | Macewen's operation | Damus–Kaye–Stansel procedure | 00
| 67,500 |
The<unk><unk><unk> planning<unk> consists of four planning phases, one implementation phase, and 3 evaluation phases.<unk> phases<unk> phases Phase 1<unk> Social Diagnosis Phase 5<unk> Implementation Phase 2<unk> Epidemiological, Behavioral & Environmental Diagnosis Phase 6<unk> Process Evaluation Phase 3<unk> Educational & Ecological Diagnosis Phase 7<unk> Impact Evaluation Phase 4<unk> Administrative & Policy Diagnosis Phase 8<unk> Outcome Evaluation Phase 1<unk> Social Diagnosis The first stage in the program planning phase deals with identifying and evaluating the social problems that affect the quality of life of a population of interest. Social assessment is the "application, through broad participation, of multiple sources of information, both objective and subjective, designed to expand the mutual understanding of people regarding their aspirations for the common good". During this stage, the program planners try to gain an understanding of the social problems that affect the quality of life of the community and its members, their strengths, weaknesses, and resources; and their readiness to change. This is done through various activities such as developing a planning committee, holding community forums, and conducting focus groups, surveys, and/or interviews. These activities will engage the beneficiaries in the planning process and planners will be able to see the issues just as the community sees them. Phase 2<unk> Epidemiological, Behavioral, and Environmental Diagnosis Epidemiological diagnosis deals with determining and focusing on specific health issue(s) of the community, and the behavioral and environmental factors related to prioritized health needs of the community. Based on these priorities, achievable program goals and objectives for the program being developed are established. Epidemiological assessment may include secondary data analysis or original data collection — examples of epidemiological data include vital statistics, state and national health surveys, medical and administrative records, etc. Genetic factors, although not directly changeable through a health promotion program, are becoming increasingly important in understanding health problems and counseling people with genetic risks, or may be useful in identifying high-risk groups for intervention. Behavioral diagnosis — This is the analysis of behavioral links to the goals or problems that are identified in the social or epidemiological diagnosis. The behavioral ascertainment of a health issue is understood, firstly, through those behaviors that exemplify the severity of the disease (e.g tobacco use among teenagers); secondly, through the behavior of the individuals who directly affect the individual at risk (e.g. parents of teenagers who keep cigarettes at home); and thirdly, through the actions of the decision-makers that affects the environment of the individuals at risk (e.g. law enforcement actions that restrict teens' access to cigarettes). Once behavioral diagnosis is completed for each health problem identified, the planner is able to develop more specific and effective interventions. Environmental diagnosis — This is a parallel analysis of social and physical environmental factors other than specific actions that could be linked to behaviors. In this assessment, environmental factors beyond the control of the individual are modified to influence the health outcome. For example, poor nutritional status among children may be due to the availability of unhealthful foods in school. This may require not only educational interventions, but also additional strategies such as influencing the behaviors of a school's food service managers Phase 3<unk> Educational and Ecological Diagnosis Once the behavioral and environmental factors are identified and interventions selected, planners can start to work on selecting factors that, if modified, will most likely result in behavior change, as well as sustain it. These factors are classified as 1) predisposing, 2) enabling, and 3) reinforcing factors. Predisposing factors are any characteristics of a person or population that motivate behavior prior to or during the occurrence of that behavior. They include an individual's knowledge, beliefs, values, and attitudes. Enabling factors are those characteristics of the environment that facilitate action and any skill or resource required to attain specific behavior. They include programs, services, availability and accessibility of resources, or new skills required to enable behavior change. Reinforcing factors are rewards or punishments following or anticipated as a consequence of a behavior. They serve to strengthen the motivation for a behavior. Some of the reinforcing factors include social support, peer support, etc. Phase 4<unk> Administrative and Policy Diagnosis This phase focuses on the administrative and organizational concerns that must be addressed prior to program implementation. This includes assessment of resources, development and allocation of budgets, looking at organizational barriers, and coordination of the program with other departments, including external organizations and the community. Administrative diagnosis assesses policies, resources, circumstances and prevailing organizational situations that could hinder or facilitate the development of the health program. Policy diagnosis assesses the compatibility of program goals and objectives with those of the organization and its administration. This evaluates whether program goals fit into the mission statements, rules and regulations that are needed for the implementation and sustainability of the program. Phase 5<unk> Implementation of the Program Phase 6<unk> Process Evaluation=== This phase is used to evaluate the process by which the program is being implemented. This phase determines whether the program is being implemented according to the protocol, and determines whether the objectives of the program are being met. It also helps identify modifications that may be needed to improve the program. Phase 7<unk> Impact Evaluation=== This phase measures the effectiveness of the program with regards to the intermediate objectives as well as the changes in predisposing, enabling, and reinforcing factors. Often this phase is used to evaluate the performance of educators. Phase 8<unk> Outcome Evaluation=== This phase measures change in terms of overall objectives as well as changes in health and social benefits or quality of life. That is, it determines the effect of the program in the health and quality of life of the community. | PRECEDE–PROCEED model | Zelen's design | Consensus error grid | CHIVA method | Wiley protocol | NDR Method | Solidarity trial | Mixing study | 00
| 60,662 |
<unk> is used to treat idiopathic Parkinson's disease as add-on for people taking a stable dose of levodopa (L-dopa) alone or in combination with other Parkinson drugs, to help with "off" episodes when levodopa stops working. | Safinamide | Pyrazinamide | Ethambutol | Isoniazid | Oxepanoprolinamide | Rifampicin | Plazomicin | Rifabutin | 00
| 51,353 |
Although sometimes neglected, many healthcare professionals glean information on<unk> morbidity of particular diseases (e.g. cardiovascular diseases, autoimmune disorders, mental disorders, diabetes, cancer) to assess whether a person is at risk of developing similar problems.<unk> histories may be imprecise because of various possible reasons: * Adoption, fostering, illegitimacy, and adultery * Lack of contact between close relatives * Uncertainty about the relative's exact diagnosis * In complex situations, a<unk> tree or genogram may be used to organize the resulting information. Some medical conditions are carried only by the female line such as X-linked conditions and some Mitochondrial diseases. Tracing female ancestors can be difficult in societies that change the woman's<unk> name when she marries. Death records often give the maiden name of the deceased, and possibly also the deceased's mother’s maiden name. Some of the most useful records for tracing women are wills and probate records. Other medical conditions are carried only by the male line, though these Y-linked conditions are rare owing to the small size of the Y Chromosome. Tracing male ancestors may be impossible if the conception is due to rape or sexual activity outside of marriage. Attaining the age when<unk> members are diagnosed with a certain disease can also be helpful for screening purposes, like colon and breast cancer. | Family history | Psychiatric history | SAMPLE history | Past medical history | History of medical diagnosis | History of pathology | History of birth control | History of wound care | 00
| 23,222 |
A fever, when combined with profound neutropenia (febrile neutropenia), is considered a medical emergency and requires broad spectrum antibiotics. An absolute neutrophil count less than 200 is also considered a medical emergency and almost always requires hospital admission and initiation of broad spectrum antibiotics with selection of specific antibiotics based on local resistance patterns. Precautions to avoid opportunistic infections in those with chronic neutropenia include maintaining proper soap and water hand hygiene, good dental hygiene and avoiding highly contaminated sources that may contain a large fungal reservoirs such as mulch, construction sites and bird or other animal waste. Neutropenia can be treated with the hematopoietic growth factor granulocyte-colony stimulating factor (G-CSF). These are cytokines that are present naturally in the body. The factors promote neutrophil recovery following anticancer therapy or in chronic neutropenia. Recombinant G-CSF factor preparations, such as filgrastim can be effective in people with congenital forms of neutropenia including severe congenital neutropenia and cyclic neutropenia; the amount needed (dosage) to stabilize the neutrophil count varies considerably (depending on the individual's condition). Guidelines for neutropenia regarding diet are currently being studied. Those who have chronic neutropenia and fail to respond to G-CSF or who have an increased risk of developing MDS or AML (due to increased dosage requirements of G-CSF or having abnormal precursor cells in the bone marrow) often require hematopoietic stem cell transplantation as a treatment. Most cases of neonatal neutropenia are temporary. Antibiotic prophylaxis is not recommended because of the possibility of encouraging the development of multidrug-resistant bacterial strains. These are cytokines that are present naturally in the body. The factors promote neutrophil recovery following anticancer therapy. The administration of intravenous immunoglobulins (IVIGs) has had some success in treating neutropenias of alloimmune and autoimmune origins with a response rate of about 50%. Blood transfusions have not been effective. Patients with neutropenia caused by cancer treatment can be given antifungal drugs. A Cochrane review found that lipid formulations of amphotericin B had fewer side effects than conventional amphotericin B, though it is not clear whether there are particular advantages over conventional amphotericin B if given under optimal circumstances. Another Cochrane review was not able to detect a difference in effect between amphotericin B and fluconazole because available trial data analysed results in a way that disfavoured amphotericin B. Trilaciclib, a CDK4/6 inhibitor, administered approximately thirty minutes before chemotherapy, has been shown in three clinical trials to significantly reduce the occurrence of chemotherapy-induced neutropenia and the associated need for interventions such as the administration of G-CSF’s. The drug is currently under review by the FDA for use in small cell lung cancer with a decision expected by February 15, 2021. | symptom of Cartilage–hair hypoplasia | symptom of Laron syndrome | symptom of Kallmann syndrome | symptom of XYY syndrome | symptom of Keratoconus | symptom of Achondroplasia | symptom of Prader–Willi syndrome | types of Hair loss | 00
| 8,865 |
<unk> , sold under the brand name Avodart among others, is a medication primarily used to treat the symptoms of an enlarged prostate. A few months may be required before benefits occur. It is also used for scalp hair loss in men and as a part of hormone therapy in transgender women. It is taken orally. The most commonly reported side effects of<unk> , although statistically rare, include sexual dysfunction, breast tenderness and depression. Exposure during pregnancy is specifically contraindicated because<unk> , being a form of antiandrogen, may interfere with the sexual differentiation of the male foetus.<unk> was patented in 1993 by GlaxoSmithKline and was approved for medical use in 2001. It is available as a generic medication. In 2017, it was the 276th most commonly prescribed medication in the United States, with more than one million prescriptions. | Dutasteride | Finasteride | Tadalafil | Ingenol mebutate | Tamsulosin | Cyproterone acetate | Alclometasone | Vardenafil | 00
| 26,698 |
<unk> is a surgical transplant procedure in which a<unk> is transplanted to a patient. The<unk> may be an allograft from a human donor, or it may be grown artificially, though the latter has not yet been transplanted onto a human. | Penis transplantation | Penile implant | Uterus transplantation | Meniscus transplant | Preputioplasty | Penoscrotal transposition | Laser hair removal | Penectomy | 00
| 41,955 |
Onset of symptoms usually occur in early adulthood and is characterized by intention tremor, progressive ataxia, convulsions, and myoclonic epileptic jerks. Tremors usually affect one extremity, primarily the upper limb, and eventually involve the entire voluntary motor system. Overall, the lower extremity is usually disturbed less often than the upper extremity. Additional features of the syndrome include: an unsteady gait, seizures, muscular hypotonia, reduced muscular coordination, asthenia, adiadochokinesia and errors with estimating range, direction, and force of voluntary movements. Mental deterioration can, rarely, occur. | Ramsay Hunt syndrome type 1 | Ramsay Hunt syndrome type 2 | Tolosa–Hunt syndrome | Robinow syndrome | Dandy–Walker malformation | Autosomal dominant porencephaly type I | Seaver Cassidy syndrome | Lateral meningocele syndrome | 00
| 46,867 |
Brain Tumor Segmentation under<unk> . Aortic Dissection Inpainting under<unk> .<unk> is a free, non-commercial open science client/server-based medical imaging processing online framework. It offers capabilities, like viewing medical data (computed tomography, magnetic resonance imaging, etc.) in two- and three-dimensional space directly in standard web browsers, like Google Chrome, Mozilla Firefox, Safari, and Microsoft Edge. Other functionalities are the calculation of medical metrics (dice score and Hausdorff distance), manual slice-by-slice outlining of structures in medical images (segmentation), manual placing of (anatomical) landmarks in medical image data, viewing medical data in virtual reality and a facial reconstruction and registration of medical data for augmented reality. Other features of<unk> are the automatic cranial implant design with a neural network, the inpainting of aortic dissections with a generative adversarial network and an automatic aortic landmark detection with deep learning in computed tomography angiography scans.<unk> is currently hosted on an server at the Graz University of Technology in Austria, and expanded jointly with the Institute for Artificial Intelligence in Medicine (IKIM) in Essen, Germany. | Studierfenster | Mittelschmerz | Ärzte-Zeitung | Ugeskrift for Læger | Wiener klinische Wochenschrift | Medgadget | Pendelluft | Schmutzdecke | 00
| 73,335 |
Melanomas are usually caused by DNA damage resulting from exposure to UV light from the sun. Genetics also play a role. Melanoma can also occur in skin areas with little sun exposure (i.e. mouth, soles of feet, palms of hands, genital areas). People with dysplastic nevus syndrome, also known as familial atypical multiple mole melanoma, are at increased risk for the development of melanoma. Having more than 50 moles indicates an increased risk melanoma might arise. A weakened immune system makes cancer development easier due to the body's weakened ability to fight cancer cells. UV radiation The UV radiation from tanning beds increases the risk of melanoma. The International Agency for Research on Cancer finds that tanning beds are "carcinogenic to humans" and that people who begin using tanning devices before the age of thirty years are 75% more likely to develop melanoma. Those who work in airplanes also appear to have an increased risk, believed to be due to greater exposure to UV. UVB light (wavelengths between 315 and 280 nm) from the sun is absorbed by skin cell DNA and results in a<unk> of direct DNA damage called cyclobutane pyrimidine dimers. Thymine-thymine, cytosine-cytosine, or cytosine-thymine dimers are formed by the joining of two adjacent pyrimidine bases within a DNA strand. Somewhat similarly to UVB, UVA light (longer wavelengths between 400 and 315 nm) from the sun or from tanning beds can also be directly absorbed by skin DNA (at about 1/100 to 1/1000 of the efficiency of UVB). Exposure to radiation (UVA and UVB) is one of the major contributors to the development of melanoma. Occasional extreme sun exposure (resulting in "sunburn") is causally related to melanoma. Melanoma is most common on the back in men and on legs in women (areas of intermittent sun exposure). The risk appears to be strongly influenced by socioeconomic conditions rather than indoor versus outdoor occupations; it is more common in professional and administrative workers than unskilled workers. Other factors are mutations in or total loss of tumor suppressor genes. Use of sunbeds (with deeply penetrating UVA rays) has been linked to the development of skin cancers, including melanoma. Possible significant elements in determining risk include the intensity and duration of sun exposure, the age at which sun exposure occurs, and the degree of skin pigmentation. Melanoma rates tend to be highest in countries settled by migrants from Northern Europe who have a large amount of direct, intense sunlight to which the skin of the settlers is not adapted, most notably Australia. Exposure during childhood is a more important risk factor than exposure in adulthood. This is seen in migration studies in Australia. Having multiple severe sunburns increases the likelihood that future sunburns develop into melanoma due to cumulative damage. The sun and tanning beds are the main sources of UV radiation that increase the risk for melanoma and living close to the equator increases exposure to UV radiation. Genetics A number of rare mutations, which often run in families, greatly increase melanoma susceptibility. Several genes increase risks. Some rare genes have a relatively high risk of causing melanoma; some more common genes, such as a gene called MC1R that causes red hair, have a relatively lower elevated risk. Genetic testing can be used to search for the mutations. One class of mutations affects the gene CDKN2A. An alternative reading frame mutation in this gene leads to the destabilization of p53, a transcription factor involved in apoptosis and in 50% of human cancers. Another mutation in the same gene results in a nonfunctional inhibitor of CDK4, a cyclin-dependent kinase that promotes cell division. Mutations that cause the skin condition xeroderma pigmentosum (XP) also increase melanoma susceptibility. Scattered throughout the genome, these mutations reduce a cell's ability to repair DNA. Both CDKN2A and XP mutations are highly penetrant (the chances of a carrier to express the phenotype is high). Familial melanoma is genetically heterogeneous, and loci for familial melanoma appear on the chromosome arms 1p, 9p and 12q. Multiple genetic events have been related to melanoma's pathogenesis (disease development). The multiple tumor suppressor 1 (CDKN2A/MTS1) gene encodes p16INK4a – a low-molecular weight protein inhibitor of cyclin-dependent protein kinases (CDKs) – which has been localised to the p21 region of human chromosome 9. FAMMM is typically characterized by having 50 or more combined moles in addition to a family history of melanoma. It is transmitted autosomal dominantly and mostly associated with the CDKN2A mutations. People who have CDKN2A mutation associated FAMMM have a 38 fold increased risk of pancreatic cancer. Other mutations confer lower risk, but are more common in the population. People with mutations in the MC1R gene are two to four times more likely to develop melanoma than those with two wild-type (typical unaffected<unk> copies. MC1R mutations are very common, and all red-haired people have a mutated copy. Mutation of the MDM2 SNP309 gene is associated with increased risks for younger women. Fair- and red-haired people, persons with multiple atypical nevi or dysplastic nevi and persons born with giant congenital melanocytic nevi are at increased risk. A family history of melanoma greatly increases a person's risk, because mutations in several genes have been found in melanoma-prone families. People with a history of one melanoma are at increased risk of developing a second primary tumor. Fair skin is the result of having less melanin in the skin, which means less protection from UV radiation exists. A family history could indicate a genetic predisposition to melanoma. | types of Anal cancer | types of Bladder cancer | types of Gastrointestinal bleeding | types of Skin cancer | medical cause of Stomach cancer | medical cause of Cervical cancer | symptom of Appendix cancer | medical cause of Mucosal melanoma | 00
| 16,528 |
Within fMRI methodology, there are two different ways that are typically employed to present stimuli. One method is a block<unk> design, in which two or more different conditions are alternated in order to determine the differences between the two conditions, or a control may be included in the presentation occurring between the two conditions. By contrast,<unk><unk> designs are not presented in a set sequence; the presentation is randomized and the time in between stimuli can vary.<unk> attempts to model the change in fMRI signal in response to neural<unk> s associated with behavioral trials. According to D'Esposito,<unk><unk> fMRI has the potential to address a number of cognitive psychology questions with a degree of inferential and statistical power not previously available." Each trial can be composed of one experimentally controlled (such as the presentation of a word or picture) or a participant mediated<unk> " (such as a motor response). Within each trial, there are a number of<unk> s such as the presentation of a stimulus, delay period, and response. If the experiment is properly set up and the different<unk> s are timed correctly,<unk> allows a person to observe the differences in neural activity associated with each<unk> . | Event-related functional magnetic resonance imaging | Amplitude integrated electroencephalography | Event-related potential | Psychomotor vigilance task | Quantitative electroencephalography | Integrated cognitive assessment | Steady state visually evoked potential | Luria-Nebraska neuropsychological battery | 00
| 47,021 |
It is classified as a xanthine alkaloid (more specifically, a methylxanthine), others of which include theophylline and caffeine. Caffeine differs from these compounds in that it has an extra methyl group (see under Pharmacology section).<unk> is a slightly water-soluble (330 mg/L), crystalline, bitter powder.<unk> is white or colourless, but commercial samples can be yellowish. It has an effect similar to, but lesser than, that of caffeine in the human nervous system, making it a lesser homologue.<unk> is an isomer of theophylline, as well as paraxanthine.<unk> is categorized as a dimethyl xanthine. | Theobromine | Phosphene | Benzoctamine | Cromoglicic acid | Chlorotrianisene | Magnetophosphene | Adapromine | Lepromin | 00
| 2,255 |
Radiologic findings * Anterior chest wall (most common site, 65–90% of patients): Hyperostosis, sclerosis and bone hypertrophy especially involving the sternoclavicular joint, often with a soft tissue component. * Spine (33% of patients): Segmental, usually involving the thoracic spine. The four main presentations include spondylodiscitis, osteosclerosis, paravertebral ossifications, and sacroiliac joint involvement. * Long bones (30% of patients): usually metadiaphyseal and located in the distal femur and proximal tibia. It looks like chronic osteomyelitis but will not have a sequestrum or abscess. * Flat bones (10% of patients): mandible and ilium. Peripheral arthritis has been reported in 92% of cases of<unk> as well. In children, the<unk> is most likely to affect the metaphysis of long bones in the legs (tibia, femur, fibula), followed by clavicles and spine. | SAPHO syndrome | Pustulosis palmaris et plantaris | Ataxia–telangiectasia | Kabuki syndrome | Wiskott–Aldrich syndrome | HUPRA syndrome | Chédiak–Higashi syndrome | Chronic granulomatous disease | 00
| 28,319 |
Fractures in children generally heal relatively fast but may take several weeks to heal. Most growth plate fractures heal without any lasting effects. Rarely, bridging bone may form across the fracture, causing stunted growth and/or curving. In such cases, the bridging bone may need to be surgically removed. A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side. Therefore, the American Academy of Orthopaedic Surgeons recommends regular follow-up for at least a year after a growth plate fracture. | Salter–Harris fracture | Jefferson fracture | Essex-Lopresti fracture | Holdsworth fracture | Smith's fracture | Holstein–Lewis fracture | Malgaigne's fracture | Pott's fracture | 00
| 40,439 |
A simple division of the<unk> s is made into low-flow and high-flow types. Low-flow<unk> s involve a single type of blood or lymph vessel, and are known as simple<unk> s; high-flow<unk> s involve an artery. There are also<unk> s that are of mixed-flow involving more than one type of vessel, such as an arteriovenous<unk> . Low-flow<unk> s include capillary<unk> s, venous<unk> s, and lymphatic<unk> s. Capillary<unk> Port-wine stain on leg. Capillary<unk> s involve the capillaries, and are the most common type. They used to refer only to port-wine stains but now include others. Capillary<unk> s are limited to the superficial layers of the skin but they can thicken, become nodular, and sometimes become disfiguring. It has been proposed that the category of capillary<unk> s, also called vascular stains, be classified into seven major clinical types including nevus flammeus nuchae also known as nevus simplex, commonly known as stork bite or salmon patch. A capillary<unk> is also a feature of the disorder macrocephaly-capillary<unk> . Venous<unk> Venous<unk> s are typically ill-defined masses, coloured from pale to dark blue. They can affect any tissue in the body. The mass is soft, and easily compressed, and their blue colouring is due to the dilated anomalous involved veins. They are most commonly found in the head and neck. Venous<unk> s can often extend deeper from their surface appearance, reaching underlying muscle or bone. In the neck they may extend into the lining of the mouth cavity or into the salivary glands. A severe venous<unk> can involve the lymph vessels as a lymphaticovenous<unk> . Lymphatic<unk> Drawing of a microcystic lymphangioma on the left side of a boy's tongue. Lymphatic<unk> s are congenital, developing from badly-formed lymphatic vessels in early embryonic development. Abnormal development of the lymph vessels results in their failure to connect and drain into the venous system. These lymph vessels can become blocked due to the collection of lymph which forms a cyst as a mass, and are known as lymphangiomas. They can be macrocystic, microcystic, or a combination of the two. Macrocystic have cysts greater than , and microcystic lymphangiomas have cysts that are smaller than . A macrocystic lymphangioma is also known as a cystic hygroma. Cystic hygromas most often occur in the neck where they are known as nuchal hygromas. A severe venous<unk> is known as a lymphaticovenous<unk> that also involves the lymph vessels. Arteriovenous<unk> 3D image of an arteriovenous<unk> shown in purple on the ring finger of a hand. Arteriovenous<unk> s occur between an artery and a vein. In the brain a cerebral arteriovenous<unk> causes arterial blood to be directly shunted into the veins as there is an absence of a capillary bed. This carries a high risk of an intracranial hemorrhage. | Vascular malformation | Infantile hemangioma Infantile hemangioma 1 | Vascular anomaly | Developmental venous anomaly | Vascular tumor | Vascular occlusion | Congenital vertebral anomaly | Vascular ring | 00
| 50,353 |
The exact cause for the varied collection of symptoms found in the different<unk> phenotypes is not clear. The white matter of the brain, the Leydig cells of the testes and the adrenal cortex are the most severely affected systems. The excess VLCFA can be detected in almost all tissues of the body, despite the localization of symptoms. The lack of Coenzyme A does not permit the disintegration of the VLCFA, accumulating the same in the white matter, adrenal glands, and the testes more specifically in the Leydig cells not allowing the proper function of these organs. Successful treatment of the demyelination process that affects the brain with either stem cell transplant or gene therapy does not immediately normalize the VLCFA levels in body tissues. The levels of VLCFA can be normalized by treatment with Lorenzo's oil, but this does not alter the progression of the disease. It is unclear whether the accumulation of VLCFA is associated with the pathogenesis of the disease in a specific way, or if it is a biochemical phenotype, useful for identification. | Adrenoleukodystrophy | Hereditary inclusion body myopathy | Inclusion body myositis | Mitochondrial myopathy | Familial amyloid neuropathy | Familial amyloid polyneuropathy | Charcot–Marie–Tooth disease | Lambert–Eaton myasthenic syndrome | 00
| 3,620 |
Flying foxes experimentally infected with the<unk> develop a viraemia and shed the virus in their urine, faeces and saliva for approximately one week. There is no other indication of an illness in them. Symptoms of<unk> infection of humans may be respiratory, including hemorrhage and edema of the lungs, or in some cases viral meningitis. In horses, infection usually causes one or more of pulmonary oedema, congestion and neurological signs. Ephrin B2 has been identified as the main receptor for the henipaviruses. | Hendra virus | Limestone Canyon virus | Cricket paralysis virus | Sepik virus | Western equine encephalitis virus | Human bocavirus | Slow virus | B virus | 00
| 23,976 |
<unk> (brand names Parstelin, Parmodalin, Jatrosom N, Stelapar) is a combination formulation of the monoamine oxidase inhibitor antidepressant drug<unk> and the typical antipsychotic drug<unk> that has been used in the treatment of major depressive disorder. It contains 10 mg<unk> and 1 mg<unk> . The drug has been in clinical use since at least 1961. It is still available in Italy with the name of Parmodalin. | Tranylcypromine/trifluoperazine | Cinnarizine/dimenhydrinate | Buprenorphine/naltrexone | Chloracyzine | Chlorcyclizine | Triflupromazine | Dezocine | Naltrexone/bupropion | 00
| 68,257 |
<unk> 's<unk> is a rare rheumatic condition. It was first described by the French physician<unk> in 1921. | Leri pleonosteosis | Radial dysplasia | Multiple epiphyseal dysplasia | Unicameral bone cyst | Myositis ossificans | Osteopetrosis | Osteochondrosis | Bone cyst | 00
| 65,549 |
When observing a person with strabismus, the misalignment of the eyes may be quite apparent. A person with a constant eye turn of significant magnitude is very easy to notice. However, a small magnitude or intermittent strabismus can easily be missed upon casual observation. In any<unk> , an eye care professional can conduct various tests, such as cover testing, to determine the full extent of the strabismus. Symptoms of strabismus include double vision and eye strain. To avoid double vision, the brain may adapt by ignoring one eye. In this<unk> , often no noticeable symptoms are seen other than a minor loss of depth perception. This deficit may not be noticeable in someone who has had strabismus since birth or early childhood, as they have likely learned to judge depth and distances using monocular cues. However, a constant unilateral strabismus<unk> ng constant suppression is a risk for<unk> in children. Small-angle and intermittent strabismus are more likely to<unk> disruptive visual symptoms. In addition to headaches and eye strain, symptoms may include an inability to read comfortably, fatigue when reading, and unstable or "jittery" vision. Psychosocial effects Tommaso Inghirami Norma Shearer Jean-Paul Sartre Marty Feldman People of all ages who have noticeable strabismus may experience psychosocial difficulties. Attention has also been drawn to potential socioeconomic impact resulting from<unk> s of detectable strabismus. A socioeconomic consideration exists as well in the context of decisions regarding strabismus treatment, including efforts to re-establish binocular vision and the possibility of stereopsis recovery. One study has shown that strabismic children commonly exhibit behaviors marked by higher degrees of inhibition, anxiety, and emotional distress, often leading to outright emotional disorders. These disorders are often related to a negative perception of the child by peers. This is due not only to an altered aesthetic appearance, but also because of the inherent symbolic nature of the eye and gaze, and the vitally important role they play in an individual's life as social components. For some, these issues improved dramatically following strabismus surgery. Notably, strabismus interferes with normal eye contact, often<unk> ng embarrassment, anger, and feelings of awkwardness, thereby affecting social communication in a fundamental way, with a possible negative effect on self esteem. Children with strabismus, particularly those with exotropia, an outward turn, may be more likely to develop a mental health disorder than normal-sighted children. Researchers have theorized that esotropia (an inward turn) was not found to be linked to a higher propensity for mental illness due to the age range of the participants, as well as the shorter follow-up time period; esotropic children were monitored to a mean age of 15.8 years, compared with 20.3 years for the exotropic group. A subsequent study with participants from the same area monitored people with congenital esotropia for a longer time period; results indicated that people who are esotropic were also more likely to develop mental illness of some sort upon reaching early adulthood, similar to those with constant exotropia, intermittent exotropia, or convergence insufficiency. The likelihood was 2.6 times that of controls. No apparent association with premature birth was observed, and no evidence was found linking later onset of mental illness to psychosocial stressors frequently encountered by those with strabismus. Investigations have highlighted the impact that strabismus may typically have on quality of life. Studies in which subjects were shown images of strabismic and non-strabismic persons showed a strong negative bias towards those visibly displaying the condition, clearly demonstrating the potential for future socioeconomic implications with regard to employability, as well as other psychosocial effects related to an individual's overall happiness. Adult and child observers perceived a right heterotropia as more disturbing than a left heterotropia, and child observers perceived an esotropia as "worse" than an exotropia. Successful surgical correction of strabismus, for adult as well as children, has been shown to have a significantly positive effect on psychological well-being. Very little research exists regarding coping strategies employed by adult strabismics. One study categorized coping methods into three subcategories: avoidance (refraining from participation in an activity), distraction (deflecting attention from the condition), and adjustment (approaching an activity differently). The authors of the study suggested that individuals with strabismus may benefit from psychosocial support such as interpersonal skills training. No studies have evaluated whether psychosocial interventions have had any benefits on individuals undergoing strabismus surgery. | medical cause of Amblyopia | symptom of Meesmann corneal dystrophy | medical cause of Dry eye syndrome | picture of Graves' ophthalmopathy | symptom of Scintillating scotoma | symptom of Reye syndrome | complications of Sympathetic ophthalmia | complications of Reye syndrome | 00
| 14,552 |
+Grading of edema Grade Definition Absent Absent + Mild: Both feet / ankles ++ Moderate: Both feet, plus lower legs, hands or lower arms +++ Severe: Generalised bilateral pitting edema, including both feet, legs, arms and face Cutaneous edema is referred to as "pitting" when, after pressure is applied to a small area, the indentation persists after the release of the pressure. Peripheral pitting edema, as shown in the illustration, is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis. Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipedema, and myxedema. Edema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. | symptom of Allergy | symptom of Influenza | symptom of Sinusitis | symptom of Dermatitis | symptom of Arthritis | symptom of Pneumonia | symptom of Croup | symptom of Acne | 00
| 5,011 |
The<unk> <unk> measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity. Scoring (taken from Bohannon and Smith, 1987): * 0: No increase in muscle tone * 1: Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension * 1+: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM * 2: More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved * 3: Considerable increase in muscle tone, passive movement difficult * 4: Affected part(s) rigid in flexion or extension | Modified Ashworth scale | Hamilton–Norwood scale | Kastle–Meyer test | ALS Functional Rating Scale - Revised | Jadad scale | Tinetti test | Barthel scale | Prader scale | 00
| 66,904 |
<unk> is wiki-based medical website and point-of-care phone application for emergency medicine clinicians.<unk> is owned by OpenEM Foundation, a 501(c)(3) nonprofit organization.<unk> initially started as a database created from notes and checklists passed from resident class to subsequent resident class at the Harbor-UCLA emergency medicine residency program. In 2009,<unk> was launched as a free wiki-based website and phone application that was universally available to all residency programs and global practitioners. As of October 2019,<unk> has about 4,050 content pages. Emergency medicine practitioners have been quick to adopt smart phone applications, including<unk> , for use as point-of-care medical references.<unk> has been listed as a key reference for emergency medicine physicians, residents, medical students, nurses, and paramedics. | WikEM | ICECI | BHIE | MedChi | ICE | ICES | E-med | SCoRS | 00
| 65,694 |
Anticholinergic side effects such as dry mouth and constipation are either greatly reduced in comparison to imipramine and most other TCAs or fully lacking with<unk> . However, it still has significant antihistamine effects and therefore can produce sedation, though this is diminished relative to other TCAs similarly.<unk> also lacks significant alpha-blocking properties, and hence does not pose a risk of orthostatic hypotension. | Iprindole | Sertindole | Pirlindole | Butriptyline | Selegiline | Bromocriptine | Iobitridol | Rimonabant | 00
| 38,610 |
Treatment is directed at the underlying condition and is usually surgical. | Hematosalpinx | Hydrosalpinx | Spermatocele | Hydrocolpos | Pinard horn | Couvelaire uterus | Hematometra | Cystocele | 00
| 48,258 |
Mechanism of action<unk> is known to cause reversible reduction of dopamine release by selectively inhibiting pre-synaptic human vesicular monoamine transporter type 2 (VMAT2). In vitro,<unk> shows great selectivity for VMAT2 and little to no affinity for VMAT1 or other monoamine receptors. Although the exact cause of tardive dyskinesia is unknown, it is hypothesized that it may result from neuroleptic-induced dopamine hypersensitivity because it is exclusively associated with the use of neuroleptic drugs. By selectively reducing the ability of VMAT2 to load dopamine into synaptic vesicles, the drug reduces overall levels of available dopamine in the synaptic cleft, ideally alleviating the symptoms associated with dopamine hypersensitivity. The importance of<unk> selectivity inhibiting VMAT2 over other monoamine transporters is that VMAT2 is mainly involved with the transport of dopamine, and to a much lesser extent other monoamines such as norepinephrine, serotonin, and histamine. This selectivity is likely to reduce the likelihood of "off-target" adverse effects which may result from the upstream inhibition of these other monoamines. Pharmacokinetics<unk> is a prodrug which is an ester of +-α-dihydrotetrabenazine (DTBZ) with the amino acid L-valine. It is extensively hydrolyzed to the active metabolite DTBZ. Plasma protein binding of<unk> is over 99%, and that of DTBZ is about 64%. The biological half-life of both<unk> and DTBZ is 15 to 22 hours. Liver enzymes involved in inactivation are CYP3A4, CYP3A5 and CYP2D6. The drug is excreted, mostly in form of inactive metabolites, via the urine (60%) and the feces (30%). | Valbenazine | Brinzolamide | Nitroxazepine | Ranolazine | Brotizolam | Benazepril | Methyldopa | Propranolol | 00
| 69,320 |
Diagnosis is usually performed by submitting multiple stool samples for examination by a parasitologist in a procedure known as an ova and parasite examination. About 30% of children with D. fragilis infection exhibit peripheral blood eosinophilia. A minimum of three stool specimens having been immediately fixed in polyvinyl alcohol fixative, sodium acetate-acetic acid-formalin fixative, or Schaudinn's fixative should be submitted, as the protozoan does not remain morphologically identifiable for long. All specimens, regardless of consistency, are permanently stained prior to microscopic examination with an oil immersion lens. The disease may remain cryptic due to the lack of a cyst stage if these recommendations are not followed. The trophozoite forms have been recovered from formed stool, thus the need to perform the ova and parasite examination on specimens other than liquid or soft stools. DNA fragment analysis provides excellent sensitivity and specificity when compared to microscopy for the detection of D. fragilis and both methods should be employed in laboratories with PCR capability. The most sensitive detection method is parasite culture, and the culture medium requires the addition of rice starch. An indirect fluorescent antibody (IFA) for fixed stool specimens has been developed. # One researcher investigated the phenomenon of symptomatic relapse following treatment of infection with D. fragilis in association with its apparent disappearance from stool samples. The organism could still be detected in patients through colonoscopy or by examining stool samples taken in conjunction with a saline laxative. # A study found that trichrome staining, a traditional method for identification, had a sensitivity of 36% (9/25) when compared to stool culture. # An additional study found that the sensitivity of staining was 50% (2/4), and that the organism could be successfully cultured in stool specimens up to 12-hours old that were kept at room temperature. | Dientamoebiasis | Thelaziasis | Paragonimiasis | Isosporiasis | Metagonimiasis | Loa loa filariasis | Cyclosporiasis | Toxocariasis | 00
| 37,027 |
<unk> should always be considered in infants and children presenting with hypertension, cardiac failure, or sudden death. Plain radiography, sonography and MRI can aid in the diagnosis. Postnatal gray-scale and color Doppler echocardiographic and sonographic examinations allowed noninvasive diagnosis, assessment of severity, and monitoring of progression. Contrast-enhanced MR angiography with breath-hold and cardiac gating techniques can allow evaluation of the extent of the disease. *Dilated and hypertrophied ventricles *Extramedullary hematopoiesis of liver *Hypertrophy of myocardium *Bright and hyper-reflective myocardium *Periarticular calcifications in the wrists, ears, shoulders, ankles and hip *Heart usually looks structurally normal *Cardiomegaly and pulmonary plethora *Diffuse<unk> calcification involving aorta, carotid, cerebral, renal, mesenteric and cardiac arteries *Echo-dense aortic annulus, ascending aorta, transverse arch, descending aorta, main pulmonary artery, and coronary arteries unusually. *Abdominal ultrasound can reveal hepatosplenomegaly, ascites, renal echogenicity and diffused<unk> calcifications involving the aorta, common iliac, splenic, and renal arteries, as well as peritoneal calcifications involving the visceral peritoneum overlying the liver and intestine *Brain ultrasound can show dilated lateral ventricles, poorly developed corpus callosum, and leukomalacia *Echocardiogram can reveal a structurally normal heart, normal ventricular function, however mild concentric ventricular hypertrophy and multiple intracardiac as well as vascular calcifications<unk> should be suspected when there is hyperechogenicity of vessel walls, evidence of polyhydramnios or a past history of early neonatal deaths. *DNA testing can identify one of the mutations responsible for the condition | Generalized arterial calcification of infancy | Primary familial brain calcification | Hypertension and brachydactyly syndrome | Multifocal fibrosclerosis | Calcinosis cutis | Lipodermatosclerosis | Normolipoproteinemic xanthomatosis | Universal angiomatosis | 00
| 57,691 |
Early diagnosis is necessary to properly manage sepsis, as the initiation of rapid therapy is key to reducing deaths from severe sepsis. Some hospitals use alerts generated from electronic health records to bring attention to potential cases as early as possible. Blood culture bottles: orange cap for anaerobes, green cap for aerobes, and yellow cap for blood samples from children Within the first three hours of suspected sepsis, diagnostic studies should include white blood cell counts, measuring serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes. To identify the causative organism(s), at least two sets of blood cultures using bottles with media for aerobic and anaerobic organisms are necessary. At least one should be drawn through the skin and one through each vascular access device (such as an IV catheter) that has been in place more than 48 hours. Bacteria are present in the blood in only about 30% of cases. Another possible method of detection is by polymerase chain reaction. If other sources of infection are suspected, cultures of these sources, such as urine, cerebrospinal fluid, wounds, or respiratory secretions, also should be obtained, as long as this does not delay the use of antibiotics. Within six hours, if blood pressure remains low despite initial fluid resuscitation of 30 ml/kg, or if initial lactate is ≥ four mmol/l (36 mg/dl), central venous pressure and central venous oxygen saturation should be measured. Lactate should be re-measured if the initial lactate was elevated. Evidence for point of care lactate measurement over usual methods of measurement, however, is poor. Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such as a necrotizing soft tissue infection, an infection causing inflammation of the abdominal cavity lining, an infection of the bile duct, or an intestinal infarction. A pierced internal organ (free air on an abdominal X-ray or CT scan), an abnormal chest X-ray consistent with pneumonia (with focal opacification), or petechiae, purpura, or purpura fulminans may indicate the presence of an infection. Definitions Sepsis Steps. Training tool for teaching the progression of sepsis stages Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, there is just a moderate probability that the person has sepsis. According to SIRS, there were different levels of sepsis: sepsis, severe sepsis, and septic shock. The definition of SIRS is shown below: * SIRS is the presence of two or more of the following: abnormal body temperature, heart rate, respiratory rate, or blood gas, and white blood cell count. * Sepsis is defined as SIRS in response to an infectious process. * Severe sepsis is defined as sepsis with sepsis-induced organ dysfunction or tissue hypoperfusion (manifesting as hypotension, elevated lactate, or decreased urine output). Severe sepsis is an infectious disease state associated with multiple organ dysfunction syndrome (MODS) * Septic shock is severe sepsis plus persistently low blood pressure, despite the administration of intravenous fluids. In 2016 a new consensus was reached to replace screening by systemic inflammatory response syndrome (SIRS) with the sequential organ failure assessment (SOFA score) and the abbreviated version (qSOFA). The three criteria for the qSOFA score include a respiratory rate greater than or equal to 22 breaths per minute, systolic blood pressure 100 mmHg or less and altered mental status. Sepsis is suspected when 2 of the qSOFA criteria are met. The SOFA score was intended to be used in the intensive care unit (ICU) where it is administered upon admission to the ICU and then repeated every 48 hours, whereas the qSOFA could be used outside the ICU. Some advantages of the qSOFA score are that it can be administered quickly and does not require labs. However, the American College of Chest Physicians (CHEST) raised concerns that qSOFA and SOFA criteria may lead to delayed diagnosis of serious infection, leading to delayed treatment. Although SIRS criteria can be too sensitive and not specific enough in identifying sepsis, SOFA also has its limitations and is not intended to replace the SIRS definition. qSOFA has also been found to be poorly sensitive though decently specific for the risk of death with SIRS possibly better for screening. NOTE - Surviving Sepsis Campaign 2021 Guidelines recommends "against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock". End-organ dysfunction Examples of end-organ dysfunction include the following: * Lungs: acute respiratory distress syndrome (ARDS) (PaO2/FiO2 ratio 5 mEq/l * lactic acidosis: serum lactate 2 times the upper limit of normal * oliguria (urine output ) * prolonged capillary refill > 5 seconds * core to peripheral temperature difference * Respiratory dysfunction (in the absence of a cyanotic heart defect or a known chronic respiratory disease) * the ratio of the arterial partial-pressure of oxygen to the fraction of oxygen in the gases inspired (PaO2/FiO2) 2) > 65 torr (20 mmHg) over baseline PaCO2 (evidence of hypercapnic respiratory failure), or * supplemental oxygen requirement of greater than FiO2 0.5 to maintain oxygen saturation ≥ 92% * Neurologic dysfunction * Glasgow Coma Score (GCS) ≤ 11, or * altered mental status with drop in GCS of 3 or more points in a person with developmental delay/intellectual disability * Hematologic dysfunction * platelet count or 50% drop from maximum in chronically thrombocytopenic, or * international normalized ratio (INR) > 2 * Disseminated intravascular coagulation * Kidney dysfunction * serum creatinine ≥ 2 times the upper limit of normal for age or 2-fold increase in baseline creatinine in people with chronic kidney disease * Liver dysfunction (only applicable to infants > 1 month) * total serum bilirubin ≥ 4 mg/dl, or * alanine aminotransferase (ALT) ≥ 2 times the upper limit of normal Consensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience. Biomarkers Biomarkers can help diagnosis because they can point to the presence or severity of sepsis, although their exact role in the management of sepsis remains undefined. A 2013 review concluded moderate-quality evidence exists to support the use of the procalcitonin level as a method to distinguish sepsis from non-infectious causes of SIRS. The same review found the sensitivity of the test to be 77% and the specificity to be 79%. The authors suggested that procalcitonin may serve as a helpful diagnostic marker for sepsis, but cautioned that its level alone does not definitively make the diagnosis. A 2012 systematic review found that soluble urokinase-type plasminogen activator receptor (SuPAR) is a nonspecific marker of inflammation and does not accurately diagnose sepsis. This same review concluded, however, that SuPAR has prognostic value, as higher SuPAR levels are associated with an increased rate of death in those with sepsis. Serial measurement of lactate levels (approximately every 4 to 6 hours) may guide treatment and is associated with lower mortality in sepsis. Differential diagnosis The differential diagnosis for sepsis is broad and has to examine (to exclude) the non-infectious conditions that may cause the systemic signs of SIRS: alcohol withdrawal, acute pancreatitis, burns, pulmonary embolism, thyrotoxicosis, anaphylaxis, adrenal insufficiency, and neurogenic shock. Hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH) may have similar symptoms and are on the differential diagnosis. Neonatal sepsis In common clinical usage, neonatal sepsis refers to a bacterial blood stream infection in the first month of life, such as meningitis, pneumonia, pyelonephritis, or gastroenteritis, but neonatal sepsis also may be due to infection with fungi, viruses, or parasites. Criteria with regard to hemodynamic compromise or respiratory failure are not useful because they present too late for intervention. | complications of Gangrene | complications of Avascular necrosis | complications of Sunburn | complications of Burn | complications of Raynaud syndrome | complications of Epidermolysis bullosa | complications of Cat-scratch disease | complications of Frostbite | 00
| 6,651 |
<unk> is the most commonly seen water–electrolyte imbalance. The disorder is more frequent in females, the elderly, and in people who are hospitalized. The number of cases of<unk> depends largely on the population. In hospital it affects about 15–20% of people; however, only 3–5% of people who are hospitalized have a sodium level less than 130 mmol/L.<unk> has been reported in up to 30% of the elderly in nursing homes and is also present in approximately 30% of people who are depressed on selective serotonin reuptake inhibitors. People who have<unk> who require hospitalisation have a longer length of stay (with associated increased costs) and also have a higher likelihood of requiring readmission. This is particularly the case in men and in the elderly. | Hyponatremia | Hyperproteinemia | Hypernatremia | Hyperglycemia | Alkalosis | Hyperlipidemia | Hypotonic hyponatremia | Hepatic encephalopathy | 00
| 7,519 |
The symptoms generally resolve during decompression and require no further treatment. | Compression arthralgia | Palindromic rheumatism | Arthus reaction | Ankle flare | Enthesitis | Glossitis | Bursitis | Neuropathic arthropathy | 00
| 65,388 |
The<unk> test is a method indicated when other more reliable and less invasive tests for determining coagulation are not available. However, it remains the most reliable way of assessing clinical<unk> in patients with uremia. Historically it was indicated whenever physicians needed information about platelet activation. | Bleeding time | Clotting time | Thrombin time | Coagulation activation marker | Activated clotting time | Prothrombin time | Kaolin clotting time | Partial thromboplastin time | 00
| 8,404 |
Symptoms include epigastric pain, early satiety, fatigue and weight loss. Most people affected by primary<unk> are over 60 years old. | Gastric lymphoma | Poorly cohesive gastric carcinoma | Atrophic gastritis | Lymphocytic esophagitis | Oesophagogastric junctional adenocarcinoma | Hereditary diffuse gastric cancer | Tropical ulcer | Herpes esophagitis | 00
| 35,204 |
Fever is a common symptom of many medical conditions: * Infectious disease, e.g., COVID-19, Dengue, Ebola, gastroenteritis, HIV, influenza, Lyme disease, rocky mountain spotted fever, secondary syphilis, malaria, mononucleosis, as well as infections of the skin, e.g., abscesses and boils. * Immunological diseases, e.g., relapsing polychondritis, autoimmune hepatitis, granulomatosis with polyangiitis, Horton disease, inflammatory bowel diseases, Kawasaki disease, lupus erythematosus, sarcoidosis, and Still's disease; * Tissue destruction, as a result of cerebral bleeding, crush syndrome, hemolysis, infarction, rhabdomyolysis, surgery, etc.; * Cancers, particularly blood cancers such as leukemia and lymphomas; * Metabolic disorders, e.g., gout, and porphyria; and * Inherited metabolic disorder, e.g., Fabry disease. Adult and pediatric manifestations for the same disease may differ; for instance, in COVID-19, one metastudy describes 92.8% of adults versus 43.9% of children presenting with fever. In addition, fever can result from a reaction to an incompatible blood product. Teething is not a cause of fever. | symptom of Osteomyelitis | symptom of Osteoarthritis | symptom of Arthritis | symptom of Osteoporosis | symptom of Sprain | symptom of Bone tumor | symptom of Tendinopathy | symptom of Peripheral artery disease | 00
| 3,181 |
The most effective treatment is autologous bone marrow transplants with stem cell rescues. However many patients are too weak to tolerate this approach. Other treatments can involve application of chemotherapy similar to that used in multiple myeloma. A combination of melphalan and dexamethasone has been found effective in those who are ineligible for stem cell transplantation, and a combination of bortezomib and dexamethasone is now in widespread clinical use. | AL amyloidosis | Giant cell arteritis | AA amyloidosis | Secondary systemic amyloidosis | Monoclonal gammopathy of undetermined significance | Familial renal amyloidosis | POEMS syndrome | Monoclonal gammopathy of renal significance | 00
| 50,329 |
<unk> The<unk> is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive a fertilized egg. These cycles are concurrent and coordinated, normally last between 21 and 35 days in adult women, with a median length of 28 days, and continue for about 30–45 years. Naturally occurring hormones drive the cycles; the cyclical rise and fall of the follicle stimulating hormone prompts the production and growth of oocytes (immature egg cells). The hormone estrogen stimulates the uterus lining to thicken to accommodate an embryo should fertilization occur. The blood supply of the thickened lining (endometrium) provides nutrients to a successfully implanted embryo. If implantation does not occur, the lining breaks down and blood is released. Triggered by falling progesterone levels, menstruation (a "period", in common parlance) is the cyclical shedding of the lining, and is a sign that pregnancy has not occurred. Each cycle occurs in phases based on events in the ovary (ovarian cycle) or the uterus (uterine cycle). The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase; the uterine cycle consists of the menstrual, proliferative and secretory phases. Day one of the<unk> is the first day of the period, which lasts for about five days. Around day fourteen, an egg is usually released from the ovary. Menarche (the onset of the first period) usually occurs around the age of twelve years. The<unk> can cause some women to experience problems that disrupt daily lives. These can include cramps, tender breasts, tiredness, and premenstrual syndrome. More severe problems such as premenstrual dysphoric disorder are experienced by 3–8% of women. The<unk> can be modified by hormonal birth control. | Menstrual cycle | Metabolic age | Sex after pregnancy | Bone age | Sleep sex | Anovulatory cycle | Menstruation | Menstrual leave | 00
| 5,540 |
As an ACE inhibitor,<unk> causes a decrease in ACE. This blocks the conversion of angiotensin I to angiotensin II. Blockage of angiotensin II limits hypertension within the vasculature. Additionally,<unk> has been found to possess cardioprotective properties. Rats given<unk> one week prior to induction of myocardial infarction, displayed decreased infarct size. The cardioprotective effects of ACE inhibitors are mediated through a combination of angiotensin II inhibition and bradykinin proliferation. Increased levels of bradykinin stimulate in the production of prostaglandin E2 and nitric oxide, which cause vasodilation and continue to exert antiproliferative effects. Inhibition of angiotensin II by<unk> decreases remodeling effects on the cardiovascular system. Indirectly, angiotensin II stimulates of the production of endothelin 1 and 3 (ET1, ET3) and the transforming growth factor beta-1 (TGF-β1), all of which have tissue proliferative effects that are blocked by the actions of<unk> . The antiproliferative effects of<unk> have also been demonstrated by in vitro studies where<unk> inhibits the estrogen-stimulated growth of neonatal cardiac fibroblasts in rats. Other ACE inhibitors have also been found to produce these actions, as well. | Moexipril | Racecadotril | Spirapril | Ramipril | Pravastatin | Lovastatin | Rosuvastatin | Ganirelix | 00
| 49,705 |
<unk> <unk> syndrome is a form of chorio-retinitis, an infection in the retina, the back of the eye. The disease is most commonly caused by the Varicella zoster virus and is found almost exclusively in patients with HIV/AIDS (acquired immunodeficiency syndrome).<unk> is the second most common opportunistic retinal infection in North America among people with AIDS. The reason this disease process is considered opportunistic is precisely because it only presents in patients with AIDS, a disease that attacks and weakens the immune system, making space for other infections, like Varicella zoster virus (VZV) and Herpes simplex virus (HSV), to attack the body. The syndrome,<unk> , falls under the umbrella of Necrotizing Herpetic Retinopathy, along with Acute Retinal<unk> (ARN). Although fairly similar processes, the two forms of retinopathy have different presenting symptoms. Acute Retinal<unk> , or ARN, is damage more central in the retinal portion of the eye with dead or necrotic areas well defined. ARN also presents with inflammation within the eye and is often painful.<unk> <unk> is a chorioretinitis presenting with multiple lesions in the peripheral retina. Unlike ARN, this disease process has no signs of intraocular inflammation, the hallmark feature, or vascular involvement. | Progressive outer retinal necrosis | Chronic relapsing inflammatory optic neuropathy | Intraretinal microvascular abnormalities | Punctate inner choroiditis | Arteritic anterior ischemic optic neuropathy | Choroidal neovascularization | Progressive retinal atrophy | Acute retinal necrosis | 00
| 35,681 |
Werther and Lotte, from The Sorrows of Young Werther A<unk> is defined as an emulation of another suicide that the person attempting suicide knows about either from local knowledge or due to accounts or depictions of the original suicide on television and in other media. The publicized suicide serves as a trigger, in the absence of protective factors, for the next suicide by a susceptible or suggestible person. This is referred to as suicide contagion. A spike of emulation suicides after a widely publicized suicide is known as the Werther effect, following Goethe's novel The Sorrows of Young Werther. Suicides occasionally spread through a school system, through a community, or in terms of a celebrity suicide wave, nationally. This is called a suicide cluster. Suicide clusters are caused by the social learning of suicide-related behaviors, or<unk> s". Point clusters are clusters of suicides in both time and space, and have been linked to direct social learning from nearby individuals. Mass clusters are clusters of suicides in time but not space, and have been linked to the broadcasting of information concerning celebrity suicides via the mass media. | Copycat suicide | Youth suicide | Night terror | Suicide by jumping from height | Poison ivy | Mozambique funeral beer poisoning | Mushroom poisoning | Suicide | 00
| 3,235 |
This infection is caused by the fungus formerly classified as Cladosporium werneckii, but more recently classified as Hortaea werneckii. The causative organism has also been described as Phaeoannellomyces werneckii.<unk> is extremely superficial and can be removed from the skin by forceful scraping. It tends to appear in areas where eccrine sweat glands are highly concentrated. Infections generally start to appear on the skin around 2–7 weeks post inoculation. The ability of H. werneckii to tolerate high salt concentrations and acidic conditions allows it to flourish inside the stratum corneum. H. wernickii tends remain localized in one spot or region, and produces darkly-colored, brown macules on the skin due to the production of a melanin-like substance. | Tinea nigra | Lichen striatus | Cutis marmorata | Linea alba | Xanthelasma | Ellipta | Onychophosis | Tinea imbricata | 00
| 42,515 |
Family/medical history An autosomal dominant pattern<unk> is an autosomal dominant condition. This means that the person only needs to have one copy of the mutated gene in order to have the condition. People with a family history are at a higher risk of having the disease than people with no family history. A random mutation in the gene can cause a person with no family history to also have the condition. Diagnostic techniques A combination of medical tests are used to diagnosis<unk> . These tests can include: * Computer Tomography Scan (CT scan) - This test uses multiple images taken at different angles to produce a cross-sectional image of the body. * Magnetic Resonance Imaging (MRI) - This technique proves detailed images of the body by using magnetic fields and radio waves. * EOS Imaging - EOS imaging provides information on how musculoskeletal system interacts with the joints. The 3D image is scanned while the patient is standing and allows the physician to view the natural, weight-bearing posture. * X-rays - X-ray images will allow the physician to have a closer look on whether or not the bones are growing abnormally. The images taken will help to identify any bone anomalies. Two key features to look for in a patient with<unk> is the presence of dumb-bell shaped femur bones and coronal clefts in the vertebrae. Other features to look for include: * Platyspondyly (flat vertebral bodies) * Kyphoscoliosis (abnormal rounding of the back and lateral curvature of the spine) * Abnormal growth of epiphyses, metaphyses, and diaphysis * Short tubular bones * Narrowed joint spaces Genetic Testing - A genetic sample may be taken in order to closely look at the patient's DNA. Finding an error in the COL2A1 gene will help identify the condition as a type II chondroldysplasia. | Kniest dysplasia | Atypia | Stener lesion | Field cancerization | Nuclear atypia | Epithelial dysplasia | Mammoplasia | Zoobiquity | 00
| 28,971 |
<unk> s (SA) are rare, benign cutaneous adnexal tumors that may progress to become their malignant counterparts, i.e.<unk> rcinomas (SAC). Cutaneous adnexal tumors are a group of skin tumors consisting of tissues that have differentiated (i.e. matured from stem cells) towards one of the four primary adnexal structures found in normal skin: hair follicles, sebaceous sweat glands, apocrine sweat glands, and eccrine sweat glands. SA and SAC tumors were regarded as eccrine gland tumors and termed eccrine<unk> s and eccrine<unk> s, respectively. However, more recent studies have found them to be hair follicle tumors and commonly term them<unk> s and<unk> rcinomas, respectively. Further confusing the situation, SA-like and SAC-like tumors are also 1) manifestations of the inherited disorder, CYLD cutaneous syndrome (CCS), and 2) have repeatedly been confused with an entirely different tumor, adenoid cystic carcinomas of the salivary gland. Here, SA and SAC are strictly defined as sporadic hair follicle tumors that do not include the hereditary CCS<unk> s and heridtary<unk> rcinoms of CCS or the adenoid cystic carcinomas. SA tumors usually occur as slow-growing, single, small, nodular lesions located in the skin of the head, neck, or trunk. SAC tumors develop from benign SA tumors or in very rare cases begin as malignant tumors. SA and SAC tumors must be distinguished from the<unk> and<unk> ricnoma tumors that develop in individuals afflicted with the CYLD cutaneous syndrome. CCS is an inherited disorder that commonly involves the development of multiple but on occasion a single or few tumors that closely resemble, and may be confused with, the sporadic SA and SAC tumors described here. CCS<unk> and CCS<unk> rcinoma tumors must be distinguished form the sporadic SA and SAC tumors reviewed here in order to afford genetic counseling to individuals with CCS as well as to the close family members of these individuals. Currently, SA and SAC are usually treated by complete excision making sure that no tumor cells are left behind at the surgical site. This is particularly important in SAC where the incomplete surgical removal of all tumor cells may result in recurrence of the tumor at the surgical site and/or its metastasis to the local lymph nodes draining the surgical site and/or to distant tissues. In addition to surgical resection, some cases of SAC tumors have been treated with adjuvant therapy that includes radiotherapy and/or chemotherapy. It is not clear that these adjuvant treatments improve patient prognoses. Further studies are needed to determine the best treatment(s) for localize SA, localized SAC, and, in particular, metastatic SAC tumors. | Spiradenoma | Dentigerous cyst | Hidrocystoma | Syringoma | Ganglion cyst | Paradental cyst | Mantleoma | Acrospiroma | 00
| 56,028 |
Approaches to the treatment of<unk> include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for<unk> are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents. Children with<unk> tend to exhibit problematic behavior that can be very difficult to control. An occupational therapist can recommend family based education referred to as Parent Management Training (PMT) in order to encourage positive parents and child relationships and reduce the child's tantrums and other disruptive behaviors. Since<unk> is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy. Psychopharmacological treatment Psychopharmacological treatment is the use of prescribed medication in managing<unk> . Prescribed medications to control<unk> include mood stabilizers, anti-psychotics, and stimulants. In two controlled randomized trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. However, a third study found the treatment of lithium over a period of two weeks invalid. Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity. The effectiveness of drug and medication treatment is not well established. Effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. Psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention. In one case, a 16-year-old boy was given estrogen at an L. A. juvenile jail due to allegedly having<unk> due to somewhat elevated testosterone levels, developing gynecomastia and requiring breast reduction surgery as a result. Individual interventions Individual interventions are focused on child-specific individualized plans. These interventions include anger control/stress inoculation, assertiveness training, a child-focused problem-solving skills training program, and self-monitoring skills. Anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. They include a process of steps the child may go through. Assertiveness training educates individuals in keeping a balance between passivity and aggression. It aims to help the child respond in a controlled and fair manner. A child-focused problem-solving skills training program aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions. Parent and family treatment According to randomized trials, evidence shows that parent management training is most effective. It has strong influences over a long period of time and in various environments. Parent-child interaction training is intended to coach the parents while involving the child. This training has two phases; the first phase is child-directed interaction, where the focus is to teach the child non-directive play skills. The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. The parent-child interaction training is best suited for elementary-aged children. Parent and family treatment has a low financial cost, which can yield an increase in beneficial results. Multimodal intervention Multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighborhood. It is an intervention that concentrates on multiple risk factors. The focus is on parent training, classroom social skills, and playground behavior programs. The intervention is intensive and addresses barriers to individuals' improvement such as parental substance use or parental marital conflict. An impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or stuck with for adequate periods of time. | Oppositional defiant disorder | Attention deficit hyperactivity disorder | Conduct disorder | Tourette syndrome | Personality development disorder | Motivational deficiency disorder | Obsessive–compulsive personality disorder | Obsessive–compulsive disorder | 00
| 29,919 |
<unk> is an Australian company that creates wound-care treatment systems for people in humanitarian emergencies using maggot therapy. | MedMagLabs | TennCare | VirtaMed | CareFlite | Pharmasave | BiteStrip | Drusen | MindMed | 00
| 74,830 |
Clinical presentation Clinical features include: *<unk> scoloured teeth - teeth may be amber, brown, blue or opalescent * Bulbous shape to the tooth crown due to cervical constriction * Tooth wear/Non-carious tooth surface loss (NCTSL) - due to the poorly mineralised dentine, the enamel of the tooth is unsupported and subsequently shears or chips off as it is subjected to biting forces. This exposes the underlying poorly mineralised dentine which is less resistant to wear. Therefore, features of abrasion and attrition may become apparent. * Reduction in occlusal vertical<unk> mension (OVD) - this is secondary to the tooth wear/NCTSL. A reduced OVD can lead to craniofacial dysgnathia, poor tooth aesthetics, and<unk> sorders during chewing, swallowing, speaking and eating. The baby (primary) teeth are usually more severely affected than adult (permanent) teeth. Enamel is usually lost early because it is further inclined to attrition due to loss of scalloping at the dentinoenamel junction (DEJ). It was suggested that the scalloping is beneficial for the mechanical properties of teeth as it reinforces the anchor between enamel and dentine. However, the teeth are not more susceptible to dental caries than normal ones. Periodontal<unk> sease, or gum<unk> sease, is a common finding amongst individuals with<unk> despite no clinical findings of tooth decay (dental caries). The reason for this is currently not well understood. Certain patients with<unk> will suffer from multiple periapical abscesses apparently resulting from pulpal strangulation secondary to pulpal obliteration or from pulp exposure due to extensive coronal wear. They may need apical surgery to save the involved teeth. Note that, although dentine exposure is a common clinical finding, individuals with<unk> usually do not experience tooth sensitivity as the exposed dentine is typically sclerosed (hardened), thereby appearing glassy/shiny. Radiographic presentation Radiographic features include: * Bulbous shape of tooth crown with pronounced cervical constriction * Small pulp, or total pulp obliteration * Small or obliterated root canal * Presence of pulp stones * Narrow and small roots * Periapical radiolucency without any evidence of clinical pathology such as tooth decay (dental caries) Presentation by sub-type of<unk> Clinical and radiographic features can be categorised by the sub-type of<unk> (see Shield's Classification in the Classification section): Type I Clinically, both the baby (primary) and adult (permanent) teeth often appear amber coloured and translucent, and show signs of severe attrition. Primary teeth have a more obvious appearance as they have a thinner layer of enamel overlying dentine, hence the abnormal color of dentine is more noticeable. Radiographically, affected teeth have short and narrow roots, and obliterated pulps due to dentine hypertrophy before or shortly after tooth eruption. The severity of these features is variable, with some teeth presenting with total obliteration of the pulp, while other teeth appear to have normal, healthy dentine. Some type I cases present with no clinical findings, with only radiographic abnormalities. Type II Type II has a similar clinical and radiographic appearance to type I with some<unk> stinguishing features: * Bulbous crowns are common with pronounced cervical constriction * All teeth in the mouth are affected, with severe abnormalities present in both the baby (primary) and adult (permanent) teeth. This is in contrast to type I where the presentation is more variable *Rarely, individuals exhibit sensorineural hearing loss. It is proposed this hearing loss is a secondary feature to attrition; this type of tooth wear can cause jaw overclosure with subsequent changes to the shape of the inner ear, thus causing hearing loss. However, the true cause remains unknown. Type III Similar clinical and radiographic features to that of type I and II are apparent for the adult (permanent) teeth. The main<unk> stinguishing feature is "shell teeth", a term used to describe the unique appearance of the baby (primary) teeth; the primary teeth have multiple pulp exposures and radiographically appear hollow as the dentine layer is thin (dentine hypotrophy) and the pulp chamber is very large. | Dentinogenesis imperfecta | Kyrle disease | Osteogenesis imperfecta | Rhizomelic chondrodysplasia punctata | Chondrodysplasia punctata | Fuchs' dystrophy | Thiel–Behnke dystrophy | Iododerma | 00
| 33,460 |
Granulomatous inflammation is characterized primarily by the accumulation of macrophages and activated T-lymphocytes, with increased production of key inflammatory mediators, Tumor necrosis factor alpha (TNF), Interferon gamma, Interleukin 2 (IL-2), IL-8, IL-10, IL-12, IL-18, IL-23 and transforming growth factor beta (TGF-β), indicative of a T helper cell-mediated immune response. Sarcoidosis has paradoxical effects on inflammatory processes; it is characterized by increased macrophage and CD4 helper T-cell activation, resulting in accelerated inflammation, but immune response to antigen challenges such as tuberculin is suppressed. This paradoxic state of simultaneous hyper- and hypoactivity is suggestive of a state of anergy. The anergy may also be responsible for the increased risk of infections and cancer. The regulatory T-lymphocytes in the periphery of sarcoid granulomas appear to suppress IL-2 secretion, which is hypothesized to cause the state of anergy by preventing antigen-specific memory responses. Schaumann bodies seen in sarcoidosis are calcium and protein inclusions inside of Langhans giant cells as part of a granuloma. Sarcoidosis is characterized by the formation of non-caseous epithelioid cell granulomas in various organs and tissues. While TNF is widely believed to play an important role in the formation of granulomas (this is further supported by the finding that in animal models of mycobacterial granuloma formation inhibition of either TNF or IFN-γ production inhibits granuloma formation), sarcoidosis can and does still develop in those being treated with TNF antagonists like etanercept. B cells also likely play a role in the pathophysiology of sarcoidosis. Serum levels of soluble human leukocyte antigen (HLA) class I antigens and angiotensin converting enzyme (ACE) are higher in people with sarcoidosis. Likewise the ratio of CD4/CD8 T cells in bronchoalveolar lavage is usually higher in people with pulmonary sarcoidosis (usually >3.5), although it can be normal or even abnormally low in some cases. Serum ACE levels have been found to usually correlate with total granuloma load. Cases of sarcoidosis have also been reported as part of the immune reconstitution syndrome of HIV, that is, when people receive treatment for HIV, their immune system rebounds and the result is that it starts to attack the antigens of opportunistic infections caught prior to said rebound and the resulting immune response starts to damage healthy tissue. Image:Sarcoidosis_(1)_lymph_node_biopsy.Sarcoidosis in a lymph node Image:Asteroid Body in Sarcoidosis.Asteroid body in sarcoidosis Image:Asteroid body intermed mag.Micrograph showing pulmonary sarcoidosis with granulomas with asteroid bodies, H&E stain | causes of Hypercalcaemia | causes of Hyperphosphatemia | complications of Hypercalcaemia | causes of Chronic kidney disease | medical cause of Hypercalcaemia | causes of Hyperthermia | causes of Peritonitis | causes of Rib fracture | 00
| 10,118 |
<unk> <unk> is a 37 amino acid neurotoxin from the venom of the scorpion Leiurus quinquestriatus hebraeus (deathstalker) that blocks calcium-activated potassium channels. This blockade causes hyperexcitability of the nervous system. It is a close homologue of agitoxin and both toxins come from Leiurus quinquestriatus hebraeus. It is named after Charybdis, a sea monster from Greek myth. | Charybdotoxin | Bungarotoxin | Α-Bungarotoxin | Muscarinic toxin 7 | Batrachotoxin | Kaliotoxin | Β-Bungarotoxin | Alpha-neurotoxin | 00
| 17,362 |
There are two main classes of hormonal contraceptives: combined contraceptives contain both an estrogen and a progestin. Progestogen-only contraceptives contain only progesterone or a synthetic analogue (progestin). There is also a non-hormonal contraceptive called ormeloxifene which acts on the hormonal system to prevent pregnancy. Combined The most popular form of<unk> , the combined oral contraceptive pill is known colloquially as the pill. It is taken once a day, most commonly for 21 days followed by a seven-day break, although other regimens are also used. For women not using ongoing<unk> , COCPs may be taken after intercourse as emergency contraception: this is known as the Yuzpe regimen. COCPs are available in a variety of formulations. The contraceptive patch is applied to the skin and worn continuously. A series of three patches are worn for one week each, and then the user takes a one-week break. NuvaRing is worn inside the vagina. A ring is worn for three weeks. After removal, the user takes a one-week break before inserting a new ring. As with COCPs, other regimens may be used with the contraceptive patch or NuvaRing to provide extended cycle combined<unk> . Some combined injectable contraceptives can be administered as one injection per month. Progestogen-only The progestogen only pill (POP) is taken once per day within the same three-hour window. Several different formulations of POP are marketed. A low-dose formulation is known as the minipill. Unlike COCPs, progestogen-only pills are taken every day with no breaks or placebos. For women not using ongoing<unk> , progestogen-only pills may be taken after intercourse as emergency contraception. There are a number of dedicated products sold for this purpose. Hormonal intrauterine contraceptives are known as intrauterine systems (IUS) or Intrauterine Devices (IUD). An IUS/IUD must be inserted by a health professional. The copper IUD does not contain hormones. While a copper-containing IUD may be used as emergency contraception, the IUS has not been studied for this purpose. Depo Provera is an injection that provides three months of contraceptive protection. Noristerat is another injection; it is given every two months. Contraceptive implants are inserted under the skin of the upper arm, and contain progesterone only. Jadelle (Norplant 2) consists of two rods that release a low dose of hormones. It is effective for five years. Nexplanon has replaced the former Implanon and is also a single rod that releases etonogestrel (similar to the body's natural progesterone). The only difference between Implanon and Nexplanon is Nexplanon is radio opaque and can be detected by x-ray. This is needed for cases of implant migration. It is effective for three years and is usually done in office. It is over 99% effective. It works in 3 ways: 1. Prevents ovulation- usually an egg does not mature 2. thickens cervical mucus so to prevent sperm from reaching the egg 3. If those 2 fail, the last is the progesterone causes the lining of the uterus to be too thin for implantation. Ormeloxifene Ormeloxifene is a selective estrogen receptor modulator (SERM). Marketed as Centchroman, Centron, or Saheli, it is pill that is taken once per week. Ormeloxifene is legally available only in India. | Hormonal contraception | Combined hormonal contraception | Fertility medication | Hormonal therapy | Bodybuilding supplement | Abortifacient | Sex-hormonal agent | Vas-occlusive contraception | 00
| 35,617 |
<unk> (Hernia-in-W) is a rare type of hernia and may be lethal if undiagnosed. The hernial sac contains two loops of bowel with another loop of bowel being intra-abdominal. A loop of bowel in the form of 'W lies in the hernial sac and the centre portion of the 'W loop may become strangulated, either alone or in combination with the bowel in the hernial sac. It is more often seen in men, and predominantly on the right side.<unk> should be suspected in patients with large incarcerated herniae and in patients with evidence of intra-abdominal strangulation or peritonitis. Postural or manual reduction of the hernia is contra-indicated as it may result in non-viable bowel being missed. It is named after Czech surgeon Karel<unk> . | Maydl's hernia | De Garengeot's hernia | Amyand's hernia | Petit's hernia | Richter's hernia | Grynfeltt–Lesshaft hernia | Fascial hernia | Internal hernia | 00
| 61,217 |
As seen on axial CT Ultrasonography showing a trabeculated wall, seen as small irregularities mainly at left (superior part). This is strongly associated with<unk> . Analysis of urine flow may aid in establishing the type of micturition (urination) abnormality. Common findings, determined by ultrasound of the bladder, include a slow rate of flow, intermittent flow, and a large amount of urine retained in the bladder after urination. A normal test result should be 20-25 mL/s peak flow rate. A post-void residual urine greater than 50 ml is a significant amount of urine and increases the potential for recurring<unk> tract infections. In adults older than 60 years, 50-100 ml of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. In chronic<unk> , ultrasound of the bladder may show massive increase in bladder capacity (normal capacity is 400-600 ml). Non-neurogenic chronic<unk> does not have a standardized definition; however, urine volumes >300mL can be used as an informal indicator. Diagnosis of<unk> is conducted over a period of 6 months, with 2 separate measurements of urine volume 6 months apart. Measurements should have a PVR (post-void residual) volume of >300mL. Determining the serum prostate-specific antigen (PSA) may help diagnose or rule out prostate cancer, though this is also raised in BPH and prostatitis. A TRUS biopsy of the prostate (trans-rectal ultra-sound guided) can distinguish between these prostate conditions. Serum urea and creatinine determinations may be necessary to rule out backflow kidney damage. Cystoscopy may be needed to explore the<unk> passage and rule out blockages. In acute cases of<unk> where associated symptoms in the lumbar spine are present such as pain, numbness (saddle anesthesia), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess cauda equina syndrome. | Urinary retention | Oliguria | Dysuria | Anuria | Cyclospasm | Polyuria | Urinary incontinence | Perfume intolerance | 00
| 20,537 |
<unk> is a reflex of the abdominal muscles to contract upon mechanical force to the abdomen, and serves as protection. It is a visceromotor reflex, since the parietal peritoneum and viscera are involved in generating the reflex. | Muscular defense | Coagulation | Neurosecretion | Drug metabolism | Bone conduction | Immune response | Thermoregulation | Sensation | 00
| 48,759 |
Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration. Hypovolemia is caused by a variety of events, but these can be simplified into two categories: those that are associated with kidney function and those that are not. The signs and symptoms of hypovolemia worsen as the amount of fluid lost increases. Immediately or shortly after mild fluid loss, one may experience headache, fatigue, weakness, dizziness or thirst (as in blood transfusion, diarrhea, vomiting). Untreated hypovolemia or excessive and rapid losses of volume may lead to hypovolemic shock. Signs and symptoms of hypovolemic shock include increased heart rate, low blood pressure, pale or cold skin, and altered mental status. When these signs are seen, immediate action should be taken to restore the lost volume. | symptom of Placental abruption | symptom of Postpartum infections | symptom of Mastitis | symptom of Obstetric fistula | symptom of Postpartum bleeding | symptom of Stillbirth | symptom of Eclampsia | symptom of Ectopic pregnancy | 00
| 13,342 |
Woodring et al. (1991) suggested the following diagnostic criteria for tracheomegaly in adults based on chest radiography: * Adult Males: Tracheal transverse diameter > 25 mm and sagittal diameter > 27 mm. * Adult Females: Tracheal transverse diameter > 21 mm and sagittal diameter > 23 mm. | Tracheobronchomegaly | Subcutaneous emphysema | Tracheal deviation | Bronchophony | Tracheomalacia | Laryngotracheal stenosis | Tracheal agenesis | Pachygyria | 00
| 49,172 |
Chlorhexidine for treating Periodontitis To reduce the tightness and dehydration of the skin, Lubricant ointment has been used. When the skin becomes less tense, it doesn't pull at the lips as much causing a reduction in the<unk> . Once the skin is loose enough the<unk> subsides.<unk> can be a life long disorder But drug treatment for the causing disease would heal the lips as well. For example for harlequin ichthyosis drugs such as Tazarotene and isotretinoin have been used to help the skin heal and loosen up which helps the<unk> heal. But sometimes surgery might become necessary to correct the disorder. Lateral columella base-labrum transposition flap results in soft linear scars without hyperplasia. It is an easy, minimally invasive and nearly no secondary malformation method. a type of flap used is the Limberg/Rhomboid flap. The flap is made up of Cutaneous tissue to close defects anywhere on the body. If the<unk> is caused by periodontitis, treatment includes removal of plaque and calculus from the teeth, antimicrobial mouth rinse such as chlorhexidine, antiseptic chips/gels. When the swelling in the gums reduces it will no longer push on lips making them turn outwards. | Eclabium | Nalmefene | Mazindol | Dimethazan | Tebentafusp | Sesquimustard | Loratadine | Cloroqualone | 00
| 52,451 |
<unk> occurs when a<unk> loses someone of importance in their life. There is substantial research regarding grief in adults, but there is less focus in literature about grief among<unk> ren.<unk> ren will experience instances in their life that could involve losing a parent, sibling, or friend through suicide, unintentional injury, homicide, or natural causes. The levels of grief and<unk> differ among<unk> ren, including uncomplicated and complicated<unk> . Unlike adults,<unk> ren may experience and express their grief and<unk> through behaviors, and are less likely to outwardly express their emotions. The<unk> ren who experience<unk> and grief can receive treatment involving group intervention, play therapy, and cognitive behavioral therapy. Different forms of treatment for<unk> ren experiencing<unk> and or grief can help to reduce symptoms of anxiety, depression, social adjustment, and posttraumatic stress. Research has shown that it is important to be aware of the difficulties in predicting how losing a closed one can impact a<unk> ’s emotionality and how their coping abilities will differ across ages and cultures. | Child bereavement | Child psychopathology | Computer-induced medical problems | Childhood trauma | Suboptimal health | Post-traumatic growth | Jurosomatic illness | Childhood chronic illness | 00
| 70,514 |
<unk> , pseudophakic cystoid macular edema or postcataract CME is one of the most common causes of visual loss after cataract surgery. The syndrome is named in honor of S. Rodman<unk> and J. Donald M.<unk> . The incidence is more common in older types of cataract surgery, where postcataract CME could occur in 20–60% of patients, but with modern cataract surgery, incidence of<unk> have reduced significantly. Replacement of the lens as treatment for cataract can cause pseudophakic macular edema. (‘pseudophakia’ means ‘replacement lens’) this could occur as the surgery involved sometimes irritates the retina (and other parts of the eye) causing the capillaries in the retina to dilate and leak fluid into the retina. This is less common today with modern lens replacement techniques. | Irvine–Gass syndrome | Gianotti–Crosti syndrome | Gitelman syndrome | Young–Madders syndrome | Coffin–Lowry syndrome | Fowler's syndrome | FG syndrome | Wilson–Turner syndrome | 00
| 66,876 |
For diagnosis, measures of liver biochemistry and pancreatic enzymes are performed. Along with ruling out structural abnormalities, normally by performing an abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). Measurements of bile transit when performing ERCP are taken to help evaluate different treatment options.<unk> is best diagnosed using manometry-an internal test done to measure the pressures within surrounding ducts to determine whether or not the muscle is functioning normally. | Sphincter of Oddi dysfunction | Sphincter paralysis | Neurogenic bowel dysfunction | Retained antrum syndrome | Anorectal anomalies | Rectal foreign body | Functional constipation | Anal dysplasia | 00
| 57,151 |
While a transverse lie prior to labor can be manually versed to a longitudinal lie, once the uterus starts contracting the uterus normally will not allow any version procedure. A<unk> is an indication for a caesarean section. Generally, as it is diagnosed early, the baby is not damaged by the time of delivery. With the rupture of the membranes, there is an increased risk of a cord prolapse as the<unk> may not completely block the birth canal. Thus the caesarean section is ideally performed before the membranes break. Delivery of the second twin The delivery of the second twin in a transverse lie with a<unk> represents a special situation that may be amenable to a vaginal delivery. As the first twin has just been delivered and the cervix is fully dilated the obstetrician may perform an internal version, that is inserting one hand into the uterus, find the baby’s feet, and then bring the baby into a breech position and deliver the baby as such. Impaction During labor the<unk> will be wedged into the pelvis and the head lie in one iliac fossa, the breech in the other. With further uterine contractions the baby suffocates. The uterus continues to try to expel the impacted fetus and as its retraction ring rises, the musculature in the lower segments thins out leading eventually to a uterine rupture and the death of the mother. Impacted<unk> s contribute to maternal mortality. Obviously a cesarean section should be performed before the baby has died, but even when the baby has died or impaction has occurred, C/S is the method of choice of delivery, as alternative methods of delivery are potentially too traumatic for the mother. If the baby is preterm or macerated and very small a spontaneous delivery has been observed. | Shoulder presentation | Cephalic presentation | Non-lifting sign | Dichoptic presentation | B symptoms | Joint locking | Baricity | Tennis injuries | 00
| 53,123 |
<unk> , common name raccoon roundworm, is a roundworm nematode, found ubiquitously in raccoons, the definitive hosts. It is named after H. A. Baylis, who studied them in the 1920s–30s, and Greek askaris (intestinal worm).<unk> larvae in paratenic hosts can migrate, causing visceral larva migrans (VLM).<unk> sis as the zoonotic infection of humans is rare, though extremely dangerous due to the ability of the parasite's larvae to migrate into brain tissue and cause damage. Concern for human infection has been increasing over the years due to urbanization of rural areas resulting in the increase in proximity and potential human interaction with raccoons. | Baylisascaris procyonis | Gongylonema pulchrum | Toxocara cati | Dipylidium caninum | Echinostoma revolutum | Myriodontium keratinophilum | Trichobacteriosis axillaris | Basidiobolus ranarum | 00
| 57,455 |
<unk> (also called Toxicodendron<unk> or Rhus<unk> is a type of allergic contact<unk> caused by the oil<unk> found in various plants, most notably species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. The name is derived from the Japanese word for the sap of the Chinese lacquer tree, urushi. Other plants in the sumac family (including mango, pistachio, the Burmese lacquer tree, the India marking nut tree, and the shell of the cashew) also contain<unk> , as do unrelated plants such as Ginkgo biloba. As is the case with all contact<unk> ,<unk><unk> allergic rashes are a Type IV hypersensitivity reaction, also known as delayed-type hypersensitivity. Symptoms include itching, inflammation, oozing, and, in severe cases, a burning sensation. The American Academy of Dermatology estimates that there are up to 50 million cases of<unk><unk><unk> annually in the United States alone, accounting for 10% of all lost-time injuries in the United States Forest Service. Poison oak is a significant problem in the rural Western and Southern United States, while poison ivy is most rampant in the Eastern United States.<unk> from poison sumac is less common. | Urushiol-induced contact dermatitis | Phototoxic tar dermatitis | Allergic contact dermatitis | Blister beetle dermatitis | Autosensitization dermatitis | Rodent mite dermatitis | Contact dermatitis | Irritant contact dermatitis | 00
| 28,473 |
Several large studies have suggested that the incidence of<unk> s has increased since the 1960s. The incidence is highest in elderly women over the age of 65, but importantly<unk> s are not considered as fragility fractures. In terms of fracture type, isolated malleolar fractures are most common (two-thirds of fractures); bimalleolar fractures occur in roughly 25% of patients while trimalleolar fractures occur in 5-10%. Open fractures are rare, compromising 2% of all<unk> s. In children,<unk> s occur in about 1 per 1000 per year. | Ankle fracture | Elbow fracture | Humerus fracture | Ulna fracture | Hip fracture | Femoral fracture | Hume fracture | Jefferson fracture | 00
| 31,732 |
Subsets and Splits