Druvith/medqa1 huggingface dataset:
Question:  What is (are) Porphyria ?
Answer: Heme is a red pigment composed of iron linked to a chemical called protoporphyrin. Heme has important functions in the body. The largest amounts of heme are in the form of hemoglobin, found in red blood cells and bone marrow. Hemoglobin carries oxygen from the lungs to all parts of the body. In the liver, heme is a component of proteins that break down hormones, medications, and other chemicals and keep liver cells functioning normally. Heme is an important part of nearly every cell in the body.
Question:  What is (are) Porphyria ?
Answer: Each of the eight types of porphyria corresponds to low levels of a specific enzyme in the heme biosynthetic pathway. Experts often classify porphyrias as acute or cutaneous based on the symptoms a person experiences:
                
- Acute porphyrias affect the nervous system. They occur rapidly and last only a short time.  - Cutaneous porphyrias affect the skin.
                
Two types of acute porphyrias, hereditary coproporphyria and variegate porphyria, can also have cutaneous symptoms.
                
Experts also classify porphyrias as erythropoietic or hepatic:
                
- In erythropoietic porphyrias, the body overproduces porphyrins, mainly in the bone marrow.  - In hepatic porphyrias, the body overproduces porphyrins and porphyrin precursors, mainly in the liver.
                
Table 1 lists each type of porphyria, the deficient enzyme responsible for the disorder, and the main location of porphyrin buildup.
                
Table 1. Types of porphyria
                
Type of Porphyria    Deficient Enzyme    Main Location of Porphyrin Buildup                  delta-aminolevulinate-dehydratase deficiency porphyria    delta-aminolevulinic acid dehydratase    liver        acute intermittent porphyria    porphobilinogen deaminase    liver        hereditary coproporphyria    coproporphyrinogen oxidase    liver        variegate porphyria    protoporphyrinogen oxidase    liver                congenital erythropoietic porphyria    uroporphyrinogen III cosynthase    bone marrow        porphyria cutanea tarda    uroporphyrinogen decarboxylase (~75% deficiency)    liver        hepatoerythropoietic porphyria    uroporphyrinogen decarboxylase (~90% deficiency)    bone marrow        erythropoietic protoporphyria*    ferrochelatase (~75% deficiency)    bone marrow
                
*Protoporphyria XLPP is a variant of erythropoietic protoporphyria.
Question:  How many people are affected by Porphyria ?
Answer: The exact rates of porphyria are unknown and vary around the world. For example, porphyria cutanea tarda is most common in the United States, and variegate porphyria is most common in South America.1
Question:  What causes Porphyria ?
Answer: Most porphyrias are inherited disorders. Scientists have identified genes for all eight enzymes in the heme biosynthetic pathway. Most porphyrias result from inheriting an abnormal gene, also called a gene mutation, from one parent. Some porphyrias, such as congenital erythropoietic porphyria, hepatoerythropoietic porphyria, and erythropoietic protoporphyria, occur when a person inherits two abnormal genes, one from each parent. The likeliness of a person passing the abnormal gene or genes to the next generation depends on the type of porphyria.
                
Porphyria cutanea tarda is usually an acquired disorder, meaning factors other than genes cause the enzyme deficiency. This type of porphyria can be triggered by
                
- too much iron  - use of alcohol or estrogen  - smoking  - chronic hepatitis Ca long-lasting liver disease that causes inflammation, or swelling, of the liver  - HIVthe virus that causes AIDS  - abnormal genes associated with hemochromatosisthe most common form of iron overload disease, which causes the body to absorb too much iron
                
For all types of porphyria, symptoms can be triggered by
                
- use of alcohol  - smoking  - use of certain medications or hormones  - exposure to sunlight  - stress  - dieting and fasting
Question:  What are the symptoms of Porphyria ?
Answer: Some people with porphyria-causing gene mutations have latent porphyria, meaning they have no symptoms of the disorder. Symptoms of cutaneous porphyrias include
                
- oversensitivity to sunlight  - blisters on exposed areas of the skin  - itching and swelling on exposed areas of the skin
                
Symptoms of acute porphyrias include
                
- pain in the abdomenthe area between the chest and hips  - pain in the chest, limbs, or back  - nausea and vomiting  - constipationa condition in which an adult has fewer than three bowel movements a week or a child has fewer than two bowel movements a week, depending on the person  - urinary retentionthe inability to empty the bladder completely  - confusion  - hallucinations  - seizures and muscle weakness
                
Symptoms of acute porphyrias can develop over hours or days and last for days or weeks. These symptoms can come and go over time, while symptoms of cutaneous porphyrias tend to be more continuous. Porphyria symptoms can vary widely in severity.
Question:  How to diagnose Porphyria ?
Answer: A health care provider diagnoses porphyria with blood, urine, and stool tests. These tests take place at a health care providers office or a commercial facility. A blood test involves drawing blood and sending the sample to a lab for analysis. For urine and stool tests, the patient collects a sample of urine or stool in a special container. A health care provider tests the samples in the office or sends them to a lab for analysis. High levels of porphyrins or porphyrin precursors in blood, urine, or stool indicate porphyria. A health care provider may also recommend DNA testing of a blood sample to look for known gene mutations that cause porphyrias.
Question:  What to do for Porphyria ?
Answer: People with an acute porphyria should eat a diet with an average-to-high level of carbohydrates. The recommended dietary allowance for carbohydrates is 130 g per day for adults and children 1 year of age or older; pregnant and breastfeeding women need higher intakes.2 People should avoid limiting intake of carbohydrates and calories, even for short periods of time, as this type of dieting or fasting can trigger symptoms. People with an acute porphyria who want to lose weight should talk with their health care providers about diets they can follow to lose weight gradually.
                
People undergoing therapeutic phlebotomies should drink plenty of milk, water, or juice before and after each procedure.
                
A health care provider may recommend vitamin and mineral supplements for people with a cutaneous porphyria.
Question:  What to do for Porphyria ?
Answer: - Porphyrias are rare disorders that affect mainly the skin or nervous system and may cause abdominal pain.  - Each of the eight types of porphyria corresponds to low levels of a specific enzyme in the heme biosynthetic pathway.  - The exact rates of porphyria are unknown and vary around the world. For example, porphyria cutanea tarda is most common in the United States, and variegate porphyria is most common in South America.  - Most porphyrias result from inheriting an abnormal gene, also called a gene mutation, from one parent.  - Porphyria cutanea tarda is usually an acquired disorder, meaning factors other than genes cause the enzyme deficiency.  - Symptoms of cutaneous porphyrias include      - oversensitivity to sunlight    - blisters on exposed areas of the skin    - itching and swelling on exposed areas of the skin    - Symptoms of acute porphyrias include      - pain in the abdomen    - pain in the chest, limbs, or back    - nausea and vomiting    - constipation    - urinary retention    - confusion    - hallucinations    - seizures and muscle weakness    - A health care provider diagnoses porphyria with blood, urine, and stool tests.  - Treatment for porphyria depends on the type of porphyria the person has and the severity of the symptoms.
Question:  What is (are) Diabetes, Heart Disease, and Stroke ?
Answer: Diabetes is a disorder of metabolismthe way our bodies use digested food for energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the body's main source of fuel.
                
After digestion, glucose enters the bloodstream. Then glucose goes to cells throughout the body where it is used for energy. However, a hormone called insulin must be present to allow glucose to enter the cells. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.
                
In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, diabetes develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy.
                
Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other health problems as well, such as vision loss, kidney failure, and amputations.
Question:  What is (are) Diabetes, Heart Disease, and Stroke ?
Answer: Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes is also called impaired fasting glucose or impaired glucose tolerance. Many people with prediabetes develop type 2 diabetes within 10 years. In addition, they are at risk for heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes and lower their risk of heart disease and stroke.
Question:  What is (are) Diabetes, Heart Disease, and Stroke ?
Answer: If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.
                
People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).
Question:  Who is at risk for Diabetes, Heart Disease, and Stroke? ?
Answer: Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.
                
You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:
                
- Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.  - Having abnormal blood fat (cholesterol) levels.      - LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteriesthe blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.    - Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.    - HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.    - Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.  - Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.
Question:  What is (are) Diabetes, Heart Disease, and Stroke ?
Answer: Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:
                
Traits and Medical Conditions    Definition        Elevated waist circumference    Waist measurement of          - 40 inches or more in men      - 35 inches or more in women             Elevated levels of triglycerides             - 150 mg/dL or higher or Taking medication for elevated triglyceride levels             Low levels of HDL (good) cholesterol             - Below 40 mg/dL in men      - Below 50 mg/dL in women or Taking medication for low HDL cholesterol levels            Elevated blood pressure levels             - 130 mm Hg or higher for systolic blood pressure or      - 85 mm Hg or higher for diastolic blood pressure  or Taking medication for elevated blood pressure levels            Elevated fasting blood glucose levels             - 100 mg/dL or higher or Taking medication for elevated blood glucose levels
Question:  How to prevent Diabetes, Heart Disease, and Stroke ?
Answer: Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:
                
- Make sure that your diet is "heart-healthy." Meet with a registered dietitian to plan a diet that meets these goals:      - Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.    - Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.    - Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.    - Keep the amount of trans fat in your diet to a minimum. It's a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.    - If you smoke, quit. Your doctor can help you find ways to quit smoking.  - Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.  - Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.
Question:  What are the treatments for Diabetes, Heart Disease, and Stroke ?
Answer: You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you.
                
A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it.
                
A1C target        Below 7 percent, unless your doctor sets a different target
                

                
Blood glucose targets        Before meals    90 to 130 mg/dL        1 to 2 hours after the start of a meal    Less than 180 mg/dL
                
B is for blood pressure. Have it checked at every office visit.
                
Blood pressure target        Below 140/80 mm Hg, unless your doctor sets a different target
                
C is for cholesterol. Have it checked at least once a year.
                
Blood fat (cholesterol) targets        LDL (bad) cholesterol    Under 100 mg/dL        Triglycerides    Under 150 mg/dL        HDL (good) cholesterol For men: above 40 mg/dL For women: above 50 mg/dL
                
Control of the ABCs of diabetes can reduce your risk for heart disease and stroke. If your blood glucose, blood pressure, and cholesterol levels aren't on target, ask your doctor what changes in diet, activity, and medications can help you reach these goals.
Question:  What are the treatments for Diabetes, Heart Disease, and Stroke ?
Answer: Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure.
                
For additional information about heart and blood vessel disease, high blood pressure, and high cholesterol, call the National Heart, Lung, and Blood Institute Health Information Center at 3015928573 or see  www.nhlbi.nih.gov on the Internet.
Question:  What are the treatments for Diabetes, Heart Disease, and Stroke ?
Answer: At the first sign of a stroke, you should get medical care right away. If blood vessels to your brain are blocked by blood clots, the doctor can give you a "clot-busting" drug. The drug must be given soon after a stroke to be effective. Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage. Meal planning and physical activity may be part of your ongoing care. In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots.
                
For additional information about strokes, call the National Institute of Neurological Disorders and Stroke at 18003529424 or see  www.ninds.nih.gov on the Internet.
Question:  What to do for Diabetes, Heart Disease, and Stroke ?
Answer: - If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke.  - Controlling the ABCs of diabetesA1C (blood glucose), blood pressure, and cholesterol-can cut your risk of heart disease and stroke.  - Choosing foods wisely, quitting smoking, and taking medications (if needed) can all help lower your risk of heart disease and stroke.  - If you have any warning signs of a heart attack or a stroke, get medical care immediatelydon't delay. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain.
Question:  What is (are) Diarrhea ?
Answer: Diarrhea is loose, watery stools. Having diarrhea means passing loose stools three or more times a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own.
                
Diarrhea lasting more than 2 days may be a sign of a more serious problem. Chronic diarrheadiarrhea that lasts at least 4 weeksmay be a symptom of a chronic disease. Chronic diarrhea symptoms may be continual or they may come and go.
                
Diarrhea of any duration may cause dehydration, which means the body lacks enough fluid and electrolyteschemicals in salts, including sodium, potassium, and chlorideto function properly. Loose stools contain more fluid and electrolytes and weigh more than solid stools.
                
People of all ages can get diarrhea. In the United States, adults average one bout of acute diarrhea each year,1 and young children have an average of two episodes of acute diarrhea each year.2