Persius/hicric huggingface dataset:
Cetirizine precautions

# List of precautions
General
Cardiovascular problems
Renal impairment
Elderly patients
Inhibition of Mental Awareness

## General
Due to its pseudoephedrine component, Cetirizine  should be used with caution in patients with hypertension, diabetes mellitus, ischemic heart disease, increased intraocular pressure, hyperthyroidism, renal impairment, or prostatic hypertrophy. Patients with decreased renal function should be given a lower initial dose (one tablet per day) because they have reduced elimination of cetirizine and pseudoephedrine.Return to top

## Cardiovascular problems
Care should be taken in the administration of Cetirizine concomitantly with other sympathomimetic amines because combined effects on the cardiovascular system may be harmful to the patient.Return to top

## Renal impairment
The cetirizine and pseudoephedrine components of Cetirizine are known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.Return to top

## Elderly patients
In general, dosing in an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.Return to top

## Inhibition of Mental Awareness
Due caution should be exercised when driving a car or operating potentially dangerous machinery. Concurrent use of ZYRTEC with alcohol or other CNS depressants should be avoided because additional reductions in alertness and additional impairment of CNS performance may occur.Return to top
Adapted from the FDA Package Insert.
Chemical burn overview

# Overview
A chemical burn occurs when living tissue is exposed to a reactive chemical substance such as a strong acid or base. The main types of irritant and/or corrosive products are acids, bases, oxidizers, solvents, and reducing agents.
Chemicals that touch skin can lead to a reaction on the skin, throughout the body, or both.
Chemical exposure is not always obvious. One should suspect chemical exposure if an otherwise healthy person becomes ill for no apparent reason, particularly if an empty chemical container is found nearby.
Exposure to chemicals at work over a long period of time can cause changing symptoms as the chemical builds up in the person's body.

# Classification
Chemical burns follow standard burn classification and may cause extensive tissue damage.

# Causes
Sparklers and other fireworks that give off sparks or flames can give chemical burns as well as heat-induced burns. Other common sources of chemical burns include silver nitrate (AgNO3), hydrochloric acid (HCl), lye (NaOH), and lime (CaO). Chemical burns may occur through direct contact on body surfaces including skin and eyes, inhalation, and ingestion.

# Risk Factors
Chemical fabrication, mining, medicine, and related professional fields are examples of occupations where chemical burns may occur.
Group (periodic table)
A group, also known as a family, is a vertical column in the periodic table of the chemical elements. There are 18 groups in the standard periodic table.
The modern explanation of the pattern of the periodic table is that the elements in a group have similar configurations of the outermost electron shells of their atoms: as most chemical properties are dominated by the orbital location of the outermost electron. There are three ways of numbering the groups of the periodic table, one using Hindu-Arabic numerals and the other two using Roman numerals. The Roman numeral names are the original traditional names of the groups; the Arabic numeral names are those recommended by the International Union of Pure and Applied Chemistry (IUPAC) to replace the old names in an attempt to reduce the confusion generated by the two older, but mutually confusing, schemes.
There is considerable confusion surrounding the two old systems in use (old IUPAC and CAS) that combined the use of Roman numerals with letters. In the old IUPAC system the letters A and B were designated to the left (A) and right (B) part of the table, while in the CAS system the letters A and B were designated to main group elements (A) and transition elements (B). The former system was frequently used in Europe while the latter was most common in America. The new IUPAC scheme was developed to replace both systems as they confusingly used the same names to mean different things.
The periodic table groups are as follows (in the brackets are shown the old systems: European and American):
- Group 1 (IA,IA): the alkali metals or hydrogen family/lithium family
- Group 2 (IIA,IIA): the alkaline earth metals or beryllium family
- Group 3 (IIIA,IIIB): the scandium family
- Group 4 (IVA,IVB): the titanium family
- Group 5 (VA,VB): the vanadium family
- Group 6 (VIA,VIB): the chromium family
- Group 7 (VIIA,VIIB): the manganese family
- Group 8 (VIII, VIIIB): the iron family
- Group 9 (VIII, VIIIB): the cobalt family
- Group 10 (VIII, VIIIB): the nickel family
- Group 11 (IB,IB): the coinage metals (not an IUPAC-recommended name) or copper family
- Group 12 (IIB,IIB): the zinc family
- Group 13 (IIIB,IIIA): the boron family
- Group 14 (IVB,IVA): the carbon family
- Group 15 (VB,VA): the pnictogens (not an IUPAC-recommended name) or nitrogen family
- Group 16 (VIB,VIA): the chalcogens or oxygen family
- Group 17 (VIIB,VIIA): the halogens or fluorine family
- Group 18 (Group 0): the noble gases or helium family/neon family
Chromosome abnormality
A chromosome anomaly (chromosome abnormality) reflects an atypical number of chromosomes (karyotype) or a structural abnormality in one or more chromosomes. Chromosome anomalies usually occur when there is an error in cell division following meiosis or mitosis. There are many types of chromosome anomalies. They can be organized into two basic groups, numerical and structural anomalies.

# Numerical abnormalities
When an individual is missing either a chromosome from a pair (monosomy) or has more than two chromosomes of a pair (trisomy). An example of a condition caused by a numerical anomaly is Down Syndrome, also known as Trisomy 21 (an individual with Down Syndrome has three copies of chromosome 21, rather than two). Turner Syndrome is an example of a monosomy where the individual is born with only one sex chromosome, an X.

# Structural abnormalities
When the chromosome's structure is altered. This can take several forms:
- Deletions: A portion of the chromosome is missing or deleted. Known disorders include Wolf-Hirschhorn syndrome, which is caused by partial deletion of the short arm of chromosome 4; and Jacobsen syndrome, also called the terminal 11q deletion disorder.
- Duplications: A portion of the chromosome is duplicated, resulting in extra genetic material. Known disorders include Charcot-Marie-Tooth disease type 1A which may be caused by duplication of the gene encoding peripheral myelin protein 22 (PMP22) on chromosome 17.
- Translocations: When a portion of one chromosome is transferred to another chromosome. There are two main types of translocations. In a reciprocal translocation, segments from two different chromosomes have been exchanged. In a Robertsonian translocation, an entire chromosome has attached to another at the centromere; these only occur with chromosomes 13, 14, 15, 21 and 22.
- Inversions: A portion of the chromosome has broken off, turned upside down and reattached, therefore the genetic material is inverted.
- Rings: A portion of a chromosome has broken off and formed a circle or ring. This can happen with or without loss of genetic material.
- Isochromosome: Formed by the mirror image copy of a chromosome segment including the centromere.
Chromosome instability syndromes are a group of disorders characterized by chromosomal instability and breakage. They often lead to an increased tendency to develop certain types of malignancies.

# Inheritance
Most chromosome anomalies occur as an accident in the egg or sperm, and are therefore not inherited. Therefore, the anomaly is present in every cell of the body. Some anomalies, however, can happen after conception, resulting in mosaicism (where some cells have the anomaly and some do not). Chromosome anomalies can be inherited from a parent or be "de novo". This is why chromosome studies are often performed on parents when a child is found to have an anomaly.
Chronic cold urticaria
For the WikiPatient page for this topic, click here

# Overview
Cold Urticaria (essentially meaning "cold hives") is a disease where hives, or large red welts form on the skin. The welts are usually itchy and often the hands and feet will become itchy and swollen as well. Hives vary in size from about the size of a pencil eraser to as big as a quarter or larger. The disease is classified as chronic when hives appear for longer than 6 weeks; they can last for life, though their course is often unpredictable. They are most likely to occur between ages 18-25.

# Symptoms
Red welts, wheals, or hives that vary in size on the skin or mucus membranes. They may or may not itch. Hives can last for a few minutes or a few days, and vary from person to person. Also a burning sensation occurs. During a severe reaction, hypotension, which can be life-threatening, can occur. A serious reaction is most likely to occur if the hives occur with less than 3 minutes of exposure (during a cold test).

# Cause
The hives are a histamine reaction in response to cold stimuli, including a drastic drop in temperature, cold air, and cold water. There are many causes for cold hives, most are idiopathic (meaning they have no known cause). Some rare conditions can cause cold hives, and it can be useful to test for these conditions if the cold hives are in any way unusual.

# Diagnosis
Diagnosis is typically obtained by an allergist or other licensed practitioner performing a cold test. During the cold test, a piece of ice is held against the forearm, typically for 3-5 minutes. A positive result is a specific looking mark of raised red hives. The hives maybe the shape of the ice, or it may radiate from the contact area of the ice.

# Treatment
Obviously, the most important thing is to stay warm. Some air conditioned rooms and pools may be too cold for the skin. Warming up immediately usually aids in the relief of the itching.
Allergy medications such as Benadryl, Zyrtec, and Allegra may be taken to prevent and get rid of hives. Cold hives can result in a potentially serious, or even fatal, systemic reaction. People with cold hives may have to carry an injectable form of epinephrine (like Epi-pen or Twinject) for use in the event of a serious reaction.
A reaction may even occur on a warm day when there is sweat on the skin. If there is a breeze it will rapidly cool the skin and create hives. Getting warm quickly by drying the skin and covering up will help to control the hives before they get too bad.
Swimming can be especially dangerous as the rapid heart rate combined with the onset of hives can lead to hypotension. Taking an allergy medication before entering the water and conserving energy until your body adjusts to the temperature may help to prevent the hypotension.
Contrary to popular belief, immersing the affected area in hot water or a warmer environment does not improve conditions.
Cidofovir how supplied

# How Supplied
VISTIDE (cidofovir injection) 75 mg/mL for intravenous infusion, is supplied as a non-preserved solution in single-use clear glass vials as follows:
NDC 61958-0101-1                              375 mg in a 5 mL vial in a single-unit carton
VISTIDE should be stored at controlled room temperature 2025 C (6877 F).
VISTIDE (cidofovir injection) is covered by U.S. Patent No. 5,142,051 and its foreign counterparts. Other patents pending.
Cidofovir microbiology

# Microbiology

## In Vitro Susceptibility
Cidofovir is active in vitro against a variety of laboratory and clinical isolates of cmv and other herpesviruses (Table 1). Controlled clinical studies of efficacy have been limited to patients with AIDS and cmv retinitis.

## Resistance
cmv isolates with reduced susceptibility to cidofovir have been selected in vitro in the presence of high concentrations of cidofovir4. IC50 values for selected resistant isolates ranged from 715 M.
There are insufficient data at this time to assess the frequency or the clinical significance of the development of resistant isolates following VISTIDE administration to patients.
The possibility of viral resistance should be considered for patients who show a poor clinical response or experience recurrent retinitis progression during therapy.

## Cross Resistance
Cidofovir-resistant isolates selected in vitro following exposure to increasing concentrations of cidofovir were assessed for susceptibility to Ganciclovir and foscarnet4. All were cross resistant to Ganciclovir, but remained susceptible to foscarnet. ]- or Ganciclovir/foscarnet-resistant isolates that are cross resistant to cidofovir have been obtained from drug naive patients and from patients following Ganciclovir or Ganciclovir/ foscarnet therapy. To date, the majority of Ganciclovir-resistant isolates are UL97 gene product (phosphokinase) mutants and remain susceptible to cidofovir5. Reduced susceptibility to cidofovir, however, has been reported for DNA polymerase mutants of cmv which are resistant to Ganciclovir69. To date, all clinical isolates which exhibit high level resistance to Ganciclovir, due to mutations in both the DNA polymerase and UL97 genes, have been shown to be cross resistant to cidofovir. Cidofovir is active against some, but not all, cmv isolates which are resistant to foscarnet1012. The incidence of foscarnet-resistant isolates that are resistant to cidofovir is not known.
A few triple-drug resistant isolates have been described. Genotypic analysis of two of these triple-resistant isolates revealed several point mutations in the cmv DNA polymerase gene. The clinical significance of the development of these cross-resistant isolates is not known.
Ciprofloxacin overdose

# Overdosage topics
Manifestations
Treatment

## Manifestations
In the event of acute overdosage, reversible renal toxicity has been reported in some cases.
Single doses of Ciprofloxacin were relatively non-toxic via the oral route of administration in mice, rats, and dogs. No deaths occurred within a 14-day post treatment observation period at the highest oral doses tested; up to 5000 mg/kg in either rodent species, or up to 2500 mg/kg in the dog. Clinical signs observed included hypoactivity and cyanosis in both rodent species and severe vomiting in dogs. In rabbits, significant mortality was seen at doses of Ciprofloxacin > 2500 mg/kg. Mortality was delayed in these animals, occurring 10-14 days after dosing.
In mice, rats, rabbits and dogs, significant toxicity including tonic/clonic convulsions was observed at intravenous doses of Ciprofloxacin between 125 and 300 mg/kg. Return to top

## Treatment
The stomach should be emptied by inducing vomiting or by gastric lavage. The patient should be carefully observed and given supportive treatment, including monitoring of renal function and administration of magnesium, aluminum, or calcium containing antacids which can reduce the absorption of Ciprofloxacin. Adequate hydration must be maintained. Only a small amount of Ciprofloxacin (< 10%) is removed from the body after hemodialysis or peritoneal dialysis. Return to top
Adapted from the FDA Package Insert.
Clinical Skills Online
Clinical Skills Online (CSO) is a project, developed by the Educational Technology Unit at St George's, University of London, UK, aimed at providing online videos demonstrating core Clinical Skills common to a wide range of medical and health-based courses in Higher Education.
These videos are freely available to anyone using them for educational, personal and non-commercial purposes only. All content on the CSO website (including text, images, videos, and any other original works), unless otherwise stated, is licensed under the Creative Commons.
It is worth mentioning that the clinical skills videos on the CSO site have been created at the 'lowest common denominator' level for a host of medical and healthcare related disciplines with a view to share with the wider community. Please also be aware that there maybe slight variations in the procedures, shown in the videos, from institution to institution depending on policies and equipment used.
Coactivator (genetics)
A coactivator is a protein that increases gene expression by binding to an activator (or transcription factor) which contains a DNA binding domain.  The coactivator is unable to bind DNA by itself.
The coactivator can enhance transcription initiation by stabilizing the formation of the RNA polymerase holoenzyme enabling faster clearance of the promoter. Coactivators may control many other substeps of transcription, including elongation, RNA splicing, and termination and degradation of the coactivator-activator complex.
Some coactivators possess intrinsic histone acetyltransferase (HAT) activity, which acetylates histones and causes chromatin to relax in a limited region allowing increased access to the DNA.  CBP and p300 are examples of coactivators with HAT activity.Numerous other enzyme activities have been reported among the 300 known coactivators for nuclear receptors. The most well known of these are SRC-1, SRC-2, and SRC-3. Coactivators work in high molecular weight complexes of 6-10 coactivator and coactivator-associated proteins (termed co-coactivators).
The same coactivator will likely be used to increase transcription of many different genes, since it is the activator that provides the specificity to a particular sequence. Recent evidence indicates that coactivators may have diverse roles outside of transcription and that they may act as 'master genes' for regulating major cellular and metabolic growth processes.
Cocamidopropyl betaine
Cocamidopropyl betaine (CAPB) is a zwitterionic surfactant with a quaternary ammonium cation in its molecule. It is a viscous pale yellow transparent liquid and is used as a surfactant in bath products like shampoos and hand soaps, and in cosmetics as an emulsifying agent and thickener, and to reduce irritation purely ionic surfactants would cause. It also serves as an antistatic agent in hair conditioners.
Cocamidopropyl betaine is a derivate of cocamide and betaine. See cocamide for the discussion of the length of carbon chain in the molecule.
Cocamidopropyl betaine is a medium strength surfactant which most often does not irritate skin or mucous membranes. That said, some studies indicate it is an allergen. It also has antiseptic properties, making it suitable for personal sanitary products. It is compatible with other cationic, anionic, and nonionic surfactants.
Cocamidopropyl betaine to a significant degree has replaced cocamide DEA.

# CAPB Specification
CAPB is obtained as an aqueous solution in concentrations of about 30%.
- Active ingredient		29.5  32.5 %
- Water				62  66 %
- NaCl			        4.6  5.6 %
Typical impurities of leading manufacturers today:
- Sodium monochloroacetate	< 5 ppm
- Amidoamine (AA)		        < 0.3 %
- DMAPA 			        < 15 ppm
- Glycerol			< 3%
However, there are qualities in the market with up to 3% AA.
The impurities AA and DMAPA are most critical, as they have been shown to be responsible for skin sensitation reactions. These by-products can be avoided by a moderate excess chloroacetate and the exact adjustment of pH value during betainization reaction accompanied by regular analytical control.

# Safety concerns relating to CAPB
CAPB has been claimed to cause allergic reactions in some users, but a controlled pilot study has found that these cases may represent irritant reactions rather than true allergic reactions.  Furthermore, results of human studies have shown that CAPB has a low sensitizing potential if impurities with amidoamine (AA) and dimethylaminopropylamine (DMAPA) are low and tightly controlled. Other studies have concluded that most apparent allergic reactions to CAPB are more likely due to amidoamine.
Coffee ground vomiting

# Overview
Coffee ground vomiting refers to a particular appearance of vomit.  Blood contains iron within heme molecules in red blood cells. When this iron has been exposed to gastric acid for some time, it becomes oxidized. This reaction causes the vomitus to look like ground coffee. Coffee-ground vomitus is a classic sign of upper gastrointestinal bleeding.  A peptic ulcer, for example, may bleed into the stomach and produce coffee-ground vomitus. When bright red blood is vomited, this is termed hematemesis.
Hematemesis, in contrast to coffee ground vomitus, suggests that upper gastrointestinal bleeding is more acute or more severe, or originates more proximal to the stomach: for example, in the esophagus due to a Mallory-Weiss tear.
Oxidized blood from an upper gastrointestinal bleeding can also be excreted in stool. It produces tarry, blackened stools known as melena.
Collecting duct system
The collecting duct system of the kidney consists of a series of tubules and ducts that connect the nephrons to the ureter. It participates in electrolyte and fluid balance through reabsorption and excretion, processes regulated by the hormones aldosterone and antidiuretic hormone.
Anatomically, there are several components of the collecting duct system, including the connecting tubules, cortical collecting ducts, and medullary collecting ducts.

# Function
The collecting duct system is the last component of the kidney to influence the body's electrolyte and fluid balance. In humans, the system accounts for 4-5% of the kidney's reabsorption of sodium and 5% of the kidney's reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.
The wide variation in water reabsorption levels for the collecting duct system reflects its dependence on hormonal activation. The collecting ducts, particularly the outer medullary and cortical collecting ducts, are largely impermeable to water without the presence of antidiuretic hormone (ADH, or vasopressin).
- In the absence of ADH, water in the renal filtrate is left alone to enter the urine, promoting diuresis.
- When ADH is present, aquaporins allow for the reabsorption of this water, thereby inhibiting diuresis.
The collecting duct system participates in the regulation of other electrolytes, including chloride, potassium, hydrogen ions, and bicarbonate.

# Anatomy
The parts of the system are as follows:
The connecting tubule derives from the metanephric blastema, but the rest of the system derives from the ureteric bud. Because of this, some sources group the connecting tubule as part of the nephron, rather than grouping it with the collecting duct system.

# Cell types
Each component of the collecting duct system contains two cell types, intercalated cells and a segment-specific cell type:
- For the connecting tubules, this specific cell type is the connecting tubule cell
- For the collecting ducts, it is the principal cell. The inner medullary collecting ducts contain an additional cell type, called the inner medullary collecting duct cell.

## Principal cells
The principal cell mediates the collecting duct's influence on sodium and potassium balance via sodium channels and potassium channels located on the cell's apical membrane. Aldosterone determines if the sodium channels transport ions.

## Intercalated cells
Intercalated cells come in  and  varieties and participate in acid-base homeostasis.
For their contribution to acid-base homeostasis, the intercalated cells play important roles in the kidney's response to acidosis and alkalosis. Damage to the -intercalated cell's ability to secrete acid can result in distal renal tubular acidosis (RTA type I, classical RTA).

# Additional images
- Transverse section of pyramidal substance of kidney of pig, the bloodvessels of which are injected.
- Alpha intercalated cell cartoon