Persius/hicric huggingface dataset:
Divalproex sodium patient counseling information

# Patient Counseling Information
See FDA-Approved Medication Guide.

### 17.1 Hepatotoxicity
Warn patients and guardians that nausea, vomiting, abdominal pain, anorexia, diarrhea, asthenia, and/or jaundice can be symptoms of hepatotoxicity and, therefore, require further medical evaluation promptly .

### 17.2 Pancreatitis
Warn patients and guardians that abdominal pain, nausea, vomiting, and/or anorexia can be symptoms of pancreatitis and, therefore, require further medical evaluation promptly .

### 17.3 Birth Defects and Decreased IQ
Inform pregnant women and women of childbearing potential that use of valproate during pregnancy increases the risk of birth defects and decreased IQ in children who were exposed. Advise women to use effective contraception while using valproate. When appropriate, counsel these patients about alternative therapeutic options. This is particularly important when valproate use is considered for a condition not usually associated with permanent injury or death. Advise patients to read the Medication Guide, which appears as the last section of the labeling .
Advise women of childbearing potential to discuss pregnancy planning with their doctor and to contact their doctor immediately if they think they are pregnant.
Encourage patients to enroll in the NAAED Pregnancy Registry if they become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. To enroll, patients can call the toll free number 1-888-233-2334 .

### 17.4 Suicidal Thinking and Behavior
Counsel patients, their caregivers, and families that AEDs, including Depakote, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Instruct patients, caregivers, and families to report behaviors of concern immediately to the healthcare providers .

### 17.5 Hyperammonemia
Inform patients of the signs and symptoms associated with hyperammonemic encephalopathy and be told to inform the prescriber if any of these symptoms occur .

### 17.6 CNS Depression
Since valproate products may produce CNS depression, especially when combined with another CNS depressant (e.g., alcohol), advise patients not to engage in hazardous activities, such as driving an automobile or operating dangerous machinery, until it is known that they do not become drowsy from the drug.
17.7 Multi-Organ Hypersensitivity Reactions
Instruct patients that a fever associated with other organ system involvement (rash, lymphadenopathy, etc.) may be drug-related and should be reported to the physician immediately .
17.8 Medication Residue in the Stool
Instruct patients to notify their healthcare provider if they notice a medication residue in the stool .
Mfd. by AbbVie LTD, Barceloneta, PR 00617
For AbbVie Inc., North Chicago, IL 60064, U.S.A.
Ebstein's anomaly of the tricuspid valve history

# History
- Presentation depends greatly on the degree of  apical displacement of the tricuspid valve leaflet as well as the degree of dysfunction of the tricuspid valve. If the tricuspid valve is severely deformed, fetal hydrops may occur. If the valve is functioning, patients may remain symptom free for many years.
- The majority of patients have dyspnea and cyanosis (40%) but some may be asymptomatic.
- Palpitations may occur secondary to SVTs (supraventricular tachycardia) and WPW (Wolff-Parkinson-White syndrome) (8%).
- Growth and development are normal.
Echo in Ebstein's anomaly of the tricuspid valve

# Ebstein's Anomaly of the Tricuspid Valve
Ebstein's Anomaly is the apical displacement of the tricuspid valve into the right ventricle.  
For more see: Ebstein's Anomaly of the Tricuspid Valve
- Graphical represntation of Ebstein's Anomaly from the Mayo Clinic website (note there is also an ASD on this diagram)

### Echo functions in Ebstein's Anomaly
Echocardiographic evaluation of Ebstein's must include evaluation of:
- extent of apical displacement and attachment location of the leaflets
- degree of tricuspid regurgitation
- morphology of the anterior leaflet
- presence or absence of right ventricular outflow tract obstruction
- degree of atrialization
- surgical options
- presence of mitral valve prolapse
- associated anomalities including Atrial Septal Defect and less commonly Ventricular Septal Defect

### Special Echo techniques in Ebstein's Anomaly
- Measurement of the distance between the insertion sites of the tricuspid leaflets
- Doppler should be used to determine the degree of tricuspid regurgitation
Ebstein's Anomaly is best seen in the apical four chamber view

### Echocardiographic representation from in various views
Below in a video clip is an apical 4-chamber transthoracic view, showing apically-displaced leaflets of the tricuspid valve. Note substantial tricuspid regurgitation, which originates close to the apex, where the abnormal leaflets actually coapt:
Ellis-van Creveld syndrome (patient information)
For the WikiDoc page for this topic, click here

# Overview
Ellis-van Creveld syndrome is a rare genetic disorder that affects bone growth.

# What are the symptoms of Ellis-van Creveld syndrome?
- Cleft lip or palate
- Epispadias or undescended testicle (cryptorchidism)
- Extra fingers (polydactyly)
- Limited range of motion
- Nail problems, including missing or deformed nails
- Short arms and legs, especially forearm and lower leg
- Short height (between 3 1/2 and 5 feet tall)
- Sparse, absent, or fine textured hair
- Tooth abnormalities:
- Peg teeth
- Widely spaced teeth
- Teeth present at birth (natal teeth)
- Delayed or missing teeth

# What causes Ellis-van Creveld syndrome?
Ellis-van Creveld is passed down through families (inherited). It is caused by defects in one of two Ellis van Creveld syndrome genes (EVC and EVC2) that are next to each other.
The severity of the disease varies from person to person. The highest rate of the condition is seen among the Old Order Amish population of Lancaster County, Pennsylvania. It is fairly rare in the general population.

# Who is at highest risk?
Ellis-van Creveld is passed down through families (inherited).

# Diagnosis
Signs of this condition include:
- Growth hormone deficiency
- Heart defects, such as a hole in the heart (atrial septal defect) occur in about half of all cases
Tests include:
- Chest x-ray
- Echocardiogram
- Genetic testing may be available for mutations in the EVC gene
- Skeletal x-ray
- Ultrasound
- Urinalysis

# When to seek urgent medical care?
Call your health care provider if your child has symptoms of this syndrome. If you have a family history of Ellis-van Creveld syndrome and your child has any symptoms, visit your health care provider.
Genetic counseling can help families understand the condition and how to care for the patient.

# Treatment options
Treatment depends on which body system is affected and the severity of the problem. The condition itself is not treatable, but many of the complications can be treated.

# Where to find medical care for Ellis-van Creveld syndrome?
Directions to Hospitals Treating Ellis-van Creveld syndrome

# What to expect (Outlook/Prognosis)?
Many babies with this condition die in early infancy, usually due to a small chest or heart defect. Stillbirth is common.
The outcome depends on which body system is involved and to what extent that body system is involved. Like most genetic conditions involving bones or the physical structure, intelligence is normal.

# Possible complications
- Bone abnormalities
- Breathing difficulty
- Congenital heart disease (CHD) especially atrial septal defect (ASD)
- Kidney disease

# Prevention of Ellis-van Creveld syndrome
Genetic counseling is recommended for prospective parents from a high-risk group, or who have a family history of Ellis-van Creveld syndrome.

# Sources
Emtricitabine rilpivirine tenofovir how supplied

# How Supplied
COMPLERA tablets are purplish-pink, capsule-shaped, film-coated, debossed with "GSI" on one side and plain-faced on the other side. Each bottle contains 30 tablets (NDC 61958-1101-1), a silica gel desiccant, polyester fiber coil, and is closed with a child-resistant closure.
Store at 25 C (77 F), excursions permitted to 15 C30 C (59 F86 F) (see USP Controlled Room Temperature).
Keep container tightly closed
Dispense only in original container
Do not use if seal over bottle opening is broken or missing.
European Working Group for Legionella Infections
The European Working Group for Legionella Infections (EWGLI) was formed in 1986. Its members are scientists with an interest in improving knowledge and information on the epidemiological and microbiological (clinical and environmental) aspects of legionnaires' disease. This is achieved through international surveillance of the disease, as well as developments in diagnosis, management and treatment methods.
EWGLI is based at the Health Protection Agency - Centre for Infections, Department of Respiratory Diseases (Legionella Section), 61 Colindale Avenue, London NW9 5EQ, United Kingdom

# External quality assessment schemes
External Quality Assessment (EQA) schemes are an important component in the operation of EWGLI. The following schemes are available:
- Typing and Identification Schemes
- Urinary Antigen Scheme
- Water Scheme
- Sequencing Proficiency Panels
Ezetimibe/Simvastatin dosage forms and strengths

# Dosage Forms and Strengths
- VYTORIN 10/10, (ezetimibe 10 mg/simvastatin 10 mg tablets) are white to off-white capsule-shaped tablets with code "311" on one side.
- VYTORIN 10/20, (ezetimibe 10 mg/simvastatin 20 mg tablets) are white to off-white capsule-shaped tablets with code "312" on one side.
- VYTORIN 10/40, (ezetimibe 10 mg/simvastatin 40 mg tablets) are white to off-white capsule-shaped tablets with code "313" on one side.
- VYTORIN 10/80, (ezetimibe 10 mg/simvastatin 80 mg tablets) are white to off-white capsule-shaped tablets with code "315" on one side.
Granulocyte macrophage colony stimulating factor

# Overview
Granulocyte-macrophage colony-stimulating factor, often abbreviated to GM-CSF, is a protein secreted by macrophages, T cells, mast cells, endothelial cells and fibroblasts.

# Functions
GM-CSF is a cytokine that functions as a white blood cell growth factor. GM-CSF stimulates stem cells to produce granulocytes (neutrophils, eosinophils, and basophils) and monocytes. Monocytes exit the circulation and migrate into tissue, whereupon they mature into macrophages. It is thus part of the immune/inflammatory cascade, by which activation of a small number of macrophages can rapidly lead to an increase in their numbers, a process crucial for fighting infection. The active form of the protein is found extracellularly as a homodimer.

# Genetics
The gene has been localized to a cluster of related genes at chromosome region 5q31, which is known to be associated with interstitial deletions in the 5q- syndrome and acute myelogenous leukemia. Other genes in the cluster include those encoding interleukins 4, 5, and 13.

# Glycosylation
Human granulocyte macrophage colony-stimulating factor is glycosylated in its mature form.  The glycosylation sites are reported to be at amino acid residues 23 (leucine), 27 (asparagine), and 39 (glutamic acid) (see US Patent No. 5,073,627).

# Clinical significance
GM-CSF is also known as molgramostim or, when the protein is expressed in yeast cells, sargramostim (Leukine).
GM-CSF is used as a medication to stimulate the production of white blood cells following chemotherapy. It has also recently been evaluated in clinical trials for its potential as a vaccine adjuvant in HIV-infected patients. The preliminary results have been promising but GM-CSF is not presently FDA-approved for this purpose.

## Leukine
Leukine is the trade name of sargramostim manufactured by Berlex Laboratories, a subsidiary of Schering AG. Its use was approved by U.S. Food and Drug Administration for acceleration of white blood cell recovery following autologous bone marrow transplantation in patients with non-Hodgkin's lymphoma, acute lymphocytic leukemia, or Hodgkin's disease in March 1991. In November 1996, the FDA also approved sargramostim for treatment of fungal infections and replenishment of  white blood cells following chemotherapy.

## Controversy
Berlex funded a study that ran in the May 26 2005 issue of the New England Journal of Medicine which concluded that,  GM-CSF did  produce significantly more remissions in Crohn's disease than those who received a placebo in the study, and it also decreased disease severity and improved quality of life.
The study's lead author, Joshua Korzenik of Harvard Medical School and Massachusetts General Hospital, is a paid consultant for Berlex , and co-inventor of the patent which is owned by Washington University. Korzenik created a "firewall" to protect the integrity of the study, consisting of two committees to review the study results and process as well and sending trial data to outside clinicians for review.
Gamma-aminobutyric acid receptor subunit alpha-1
Gamma-aminobutyric acid receptor subunit alpha-1 is a protein that in humans is encoded by the GABRA1 gene.
GABA is the major inhibitory neurotransmitter in the mammalian brain where it acts at GABA-A receptors, which are ligand-gated chloride channels. Chloride conductance of these channels can be modulated by agents such as benzodiazepines that bind to the GABA-A receptor. At least 16 distinct subunits of GABA-A receptors have been identified.
The GABRA1 receptor is the specific target of the z-drug class of nonbenzodiazepine hypnotic agents and is responsible for their hypnotic and hallucinogenic effects.
General transcription factor gene transcriptions
General transcription factors (GTFs), also known as basal transcriptional factors, are a class of protein transcription factors that bind to specific sites on DNA to activate transcription. GTFs, RNA polymerase, and the mediator multiple protein complex constitute the basic transcriptional apparatus.

# Genetics
Genetics involves the expression, transmission, and variation of inherited characteristics.
Def. 
a "branch of biology that deals with the transmission and variation of inherited characteristics, in particular chromosomes and DNA" is called genetics.

# Gene transcriptions
DNA is a double helix of interlinked nucleotides surrounded by an epigenome. On the basis of biochemical signals, an enzyme, specifically a ribonucleic acid (RNA) polymerase, is chemically bonded to one of the strands (the template strand) of this double helix. The polymerase, once phosphorylated, begins to catalyze the formation of RNA using the template strand. Although the catalysis may have more than one beginning nucleotide (a start site) and more than one ending nucleotide (a stop site) along the DNA, each nucleotide sequence catalyzed that ultimately produces approximately the same RNA is part of a gene. The catalysis of each RNA representation from the template DNA is a transcription, specifically a gene transcription. The overall process is also referred to as gene transcription.

# General factors
Def. "something that actively contributes to the production of a result" is called a factor.
Here's a theoretical definition:
Def. a factor that actively or passively contributes to the production of any result is called a general factor.
Gene ID: 2959 GTF2B general transcription factor IIB "encodes the general transcription factor IIB, one of the ubiquitous factors required for transcription initiation by RNA polymerase II. The protein localizes to the nucleus where it forms a complex (the DAB complex) with transcription factors IID and IIA. Transcription factor IIB serves as a bridge between IID, the factor which initially recognizes the promoter sequence, and RNA polymerase II."

# Theoretical general transcription factors
Here's a theoretical definition:
Def. a transcription factor that binds to any site or to a specific site on DNA to activate, moderate, regulate, or modulate transcription is called a general transcription factor (GTF).

# Hypotheses
- GTFs contribute to the transcription of A1BG.
Historical Rates of Saphenous Vein Graft Failure

# Definition of SVG Failure
Saphenous vein graft occlusion is defined as a complete, 100% occlusion of a saphenous vein graft. 
Saphenous vein failure is defined as an occlusion of the vein graft or a 75% or greater stenosis.

# Per Patient and Per Lesion Analyses of SVG Failure
The rate of occlusion or failure of saphenous vein grafts is calculated  on a per graft basis and a per patient basis. The per patient basis is  higher, because only one vein graft out of several must fail for the  patient to be characterized as a failure. Analyses should be presented  on both a per patient basis (the unit of  randomization) and a per SVG  basis (the unit that is associated with  clinical events).  Because the  behavior of multiple SVGs may be  correlated, and this within patient  correlation may reduce the estimate  of the variance in the population,  an adjustment for the within patient  correlation must be provided when  presenting the results on a per SVG  basis.  The within patient conocrdance can be adjusted for using a General Linear Model of Intraclass Correlation (GLIMIC) .

# Historical Rates of SVG Failure and Occlusion
Current rates of graft occlusion and failure are as follows:
The rate of per patient vein graft occlusion at 12-18 months is about 42%
The rate of per patient vein graft failure at 12-18 months is about 46%
The rate of per graft vein graft occlusion at 12-18 months is about 26%
The rate of per graft vein graft failure at 12-18 months is about 29%
As a comparison, the rate of internal mammary artery failure at 12-18 months was only 8%.

# Underestimation of SVG Failure in Earlier Studies
These carefully ascertained current rates of occlusion are higher than what are often quoted in the literature which were :
- 15% rate of SVG occlusion at 1 year
- 25% rate of SVG occlusion at 6 years
- 40% rate of SVG occlusion at 10 years

# Potential for Pre-Operative SVG Failure
It should be noted that studies of SVGs that are not implanted show that about 1% of veins are already stenosed by > 50% before implantation.
Hydroxychloroquine sulfate Clinical Pharmacology

# Clinical Pharmacology
The drug possesses antimalarial actions and also exerts a beneficial effect in lupus erythematosus (chronic discoid or systemic) and acute or chronic rheumatoid arthritis. The precise mechanism of action is not known.
Like chloroquine phosphate, USP, hydroxychloroquine sulfate is highly active against the erythrocytic forms of P. vivax and malariae and most strains of P. falciparum (but not the gametocytes of P. falciparum).
Hydroxychloroquine sulfate does not prevent relapses in patients with vivax or malariae malaria because it is not effective against exo-erythrocytic forms of the parasite, nor will it prevent vivax or malariae infection when administered as a prophylactic. It is highly effective as a suppressive agent in patients with vivax or malariae malaria, in terminating acute attacks, and significantly lengthening the interval between treatment and relapse. In patients with falciparum malaria, it abolishes the acute attack and effects complete cure of the infection, unless due to a resistant strain of P. falciparum.
IMITREX injection patient counseling information

# Patient Counseling Information
See FDA-approved patient labeling (Patient Information and Instructions for Use).

### Risk of Myocardial Ischemia and/or Infarction, Prinzmetals Angina, Other Vasospasm-Related Events, Arrhythmias, and Cerebrovascular Events
Inform patients that IMITREX Injection may cause serious cardiovascular side effects such as myocardial infarction or stroke. Although serious cardiovascular events can occur without warning symptoms, patients should be alert for the signs and symptoms of chest pain, shortness of breath, irregular heartbeat, significant rise in blood pressure, weakness, and slurring of speech and should ask for medical advice when observing any indicative sign or symptoms. Patients should be apprised of the importance of this follow-up .

### Anaphylactic/Anaphylactoid Reactions
Inform patients that anaphylactic/anaphylactoid reactions have occurred in patients receiving IMITREX Injection. Such reactions can be life threatening or fatal. In general, anaphylactic reactions to drugs are more likely to occur in individuals with a history of sensitivity to multiple allergens .

### Medication Overuse Headache
Inform patients that use of acute migraine drugs for 10 or more days per month may lead to an exacerbation of headache and encourage patients to record headache frequency and drug use (e.g., by keeping a headache diary) .

### Pregnancy
Inform patients that IMITREX Injection should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus .

### Nursing Mothers
Advise patients to notify their healthcare provider if they are breastfeeding or plan to breastfeed .

### Ability To Perform Complex Tasks
Since migraines or treatment with IMITREX Injection may cause somnolence and dizziness, instruct patients to evaluate their ability to perform complex tasks during migraine attacks and after administration of IMITREX Injection.

### Serotonin Syndrome
Patients should be cautioned about the risk of serotonin syndrome with the use of IMITREX Injection or other triptans, particularly during combined use with SSRIs, SNRIs, TCAs, and MAO inhibitors .
IMITREX tablet how supplied storage and handling

# How Supplied/Storage and Handling
IMITREX Tablets, 25 mg, 50 mg, and 100 mg of sumatriptan (base) as the succinate.
IMITREX Tablets, 25 mg, are white, triangular	shaped, film	coated tablets debossed with I on one side and 25 on the other in blister packs of 9 tablets (NDC 0173-0735-00).
IMITREX Tablets, 50 mg, are white, triangular	shaped, film	coated tablets debossed with IMITREX 50 on one side and a chevron shape (^	) on the other in blister packs of 9 tablets (NDC 0173-0736-01).
IMITREX Tablets, 100 mg, are pink, triangular	shaped, film	coated tablets debossed with IMITREX 100 on one side and a chevron shape (^	) on the other in blister packs of 9 tablets (NDC 0173-0737-01).
Store between 2C and 30C (36F and 86F).
International Committee for Weights and Measures
The International Committee for Weights and Measures is the English name of the Comite international des poids et mesures (CIPM, sometimes written in English Comite International des Poids et Mesures). It consists of eighteen persons from Member States of the Convention du Metre (Metre Convention). Its principal task is to ensure world-wide uniformity in units of measurement and it does this by direct action or by submitting proposals to the General Conference on Weights and Measures (CGPM, Conference generale des poids et mesures). Note that the abbreviation ICWM does not exist.
A recent focus area of the CIPM has been the establishment of the CIPM Arrangement de reconnaissance mutuelle (Mutual Recognition Arrangement, MRA) which serves as the framework for the mutual acceptance of measurements performed in the Member States of the Metre Convention.
The CIPM meets annually at the International Bureau of Weights and Measures (BIPM, Bureau international des poids et mesures), and discusses reports presented to it by its Consultative Committees. It issues an Annual Report on the administrative and financial position of the BIPM to the governments of the Member States of the Metre Convention.