Persius/hicric huggingface dataset:
Cholesteatoma (patient information)
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# Overview
Cholesteatoma is a type of skin cyst located in the middle ear.

# What are the symptoms of Cholesteatoma?
- Dizziness
- Drainage from the ear
- Hearing loss in one ear

# What causes Cholesteatoma?
Poor function in the eustachian tube leads to negative pressure in the middle ear. This pulls a part of the eardrum (tympanic membrane) into the middle ear, creating a pocket or cyst that fills with old skin cells and other waste material. The cyst can become infected. The cyst may get bigger and break down some of the middle ear bones or other structures of the ear, affecting hearing, balance, and possibly function of the facial muscles.

# Who is at highest risk?
Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infection.

# Diagnosis
An ear exam may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with a microscope or an otoscope, a special instrument to view the ear. Sometimes a mass of blood vessels may be seen in the ear.
The following tests may be performed to rule out other causes of dizziness.
- CT scan
- Electronystagmography

# When to seek urgent medical care?
Call your health care provider if ear pain, drainage from the ear, or other symptoms occur or worsen, or if hearing loss occurs.

# Treatment options
Surgery is needed to remove the cyst.

# Where to find medical care for Cholesteatoma?
Directions to Hospitals Treating Cholesteatoma

# What to expect (Outlook/Prognosis)?
Cholesteatomas usually continue to grow if not removed. Surgery usually works, but you may occasionally need the ear cleaned by a health care provider. Additional surgery may be needed if the cholesteatoma comes back.

# Possible complications
- Brain abscess
- Deafness in one ear
- Dizziness (vertigo)
- Erosion into the facial nerve (causing facial paralysis)
- Labyrinthitis
- Meningitis
- Persistent ear drainage
- Spread of the cyst into the brain

# Prevention of Cholesteatoma
Prompt and complete treatment of chronic ear infection may help to prevent some cases of cholesteatoma.

# Sources
Otospondylomegaepiphyseal dysplasia
Synonyms and keywords: Nance-Insley syndrome, Nance-Sweeney chondrodysplasia, OSMED

# Overview
Otospondylomegaepiphyseal dysplasia (OSMED) is an autosomal recessive disorder of bone growth that results in skeletal abnormalities, severe hearing loss, and distinctive facial features. The name of the condition indicates that it affects hearing (oto-) and the bones of the spine (spondylo-), and enlarges the ends of bones (megaepiphyses).

# Pathophysiology
File:Autorecessive.svg
Otospondylomegaepiphyseal dysplasia is a subtype of collagenopathy, types II and XI.  OSMED is inherited in an autosomal recessive pattern, which means the defective gene is located on an autosome, and two copies of the defective gene - one from each parent - must be inherited for a person to be affected by the disorder. The parents of a child with an autosomal recessive disorder are usually not affected but are carriers of one copy of the altered gene. A recessive pattern of inheritance makes OSMED unique among the type II and type XI collagenopathies.
Mutations in the COL11A2 gene cause otospondylomegaepiphyseal dysplasia. The protein made by the COL11A2 gene is involved in the production of type XI collagen. This type of collagen is important for the normal development of bone and other connective tissues. Mutations in the COL11A2 gene lead to a loss of function of this type of collagen, resulting in the signs and symptoms of OSMED.
This disorder affects the epiphyses, the parts of the bone where growth occurs.

# Differentiating from other diseases
The features of OSMED are similar to those of another skeletal disorder, Weissenbacher-Zweymuller syndrome.

# Epidemiology
The frequency of this disorder is unknown, but it is very rare. Only a few families with the condition have been reported.

# Diagnosis

## Symptoms
- Severe bone and joint problems
- Very severe hearing loss
- Back and joint pain
- Limited joint movement

## Physical examination

### Appearance of the patient
- Short statured because the bones in their arms and legs are unusually short.

### Head
- Small lower jaw.

### Eye
- Protruding eyes

### Nose
- Sunken nasal bridge
- Upturned nose with a large, rounded tip

### Throat
- Some affected infants are born with an opening in the roof of the mouth, which is called a cleft palate.

### Extremities
- Short hands and fingers

## Imaging
- Enlarged joints
- Flat bones of the spine (vertebrae)
- Arthritis features
Chromosome 1 open reading frame 162
Chromosome 1 open reading frame 162 is a protein that in humans is encoded by the C1orf162 gene. It has been found to be hypomethylated in instances of gastric cancer. 

# Gene
The gene is located at p13.2 on chromosome 1 in humans and contains 8 exons. It is 11,026 bases long and is oriented on the plus strand.

# mRNA
Three transcript variants have been identified. Isoform 1 is the longest transcript and encodes the longest isoform. Isoform 2 uses an alternate in-frame splice site and is shorter than isoform 1. Isoform 3 lacks an alternate in-frame exon and is shorter compared to isoform 1.
There are six stem loops in the 5' untranslated region and five stem loops in the 3' untranslated region.

# Protein
The predicted molecular weight of the protein C1orf162 is 16.9 kdal. Its isoelectric point is approximately 9.2 in mammals. A single transmembrane region is conserved across species. The protein is predicted to localize mainly in the nucleus. The protein is predicted to be myristoylated.

# Expression
C1orf162 is not ubiquitously expressed in humans. According to microarray-assessed tissue expression patterns, C1orf162 is most highly expressed in bone marrow, lung, fetal liver, lymph node, spleen, and thymus in normal human tissues.  Staining of normal tissues has found high levels of RNA expression in bone marrow, lymph node, spleen, and lung tissue, which coincides with microarray-assessed expression patterns.

# Clinical Significance
One study found the protein to be one of three hypomethylated proteins in instances of gastric cancer. 

# Homology
The gene has no known paralogs. Orthologs have been noted in many mammal species in addition to a few birds and reptiles. The transmembrane region of the protein is highly conserved across species. No orthologs have been identified in fish, insects, or prokaryotes.
Ciclopirox warnings and precautions

# Warnings
Ciclodan Cream is not for ophthalmic use.
Keep out of reach of children.

# Precautions
If a reaction suggesting sensitivity or chemical irritation should occur with the use of Ciclodan Cream treatment should be discontinued and appropriate therapy instituted.
Information for Patients

### General recommendations for the patients:
Use the medication for the full treatment time even though symptoms may have improved and notify the physician if there is no improvement after four weeks.
Inform the physician if the area of application shows signs of increased irritation (redness, itching, burning, blistering, swelling, or oozing) indicative of possible sensitization.
Avoid the use of occlusive wrappings or dressings.

### Carcinogenesis, Mutagenesis, Impairment of Fertility
A carcinogenicity study in female mice dosed cutaneously twice per week for 50 weeks followed by a 6-month drug-free observation period prior to necropsy revealed no evidence of tumors at the application site.
The following in vitro and in vivo genotoxicity tests have been conducted with ciclopirox olamine: studies to evaluate gene mutation in the AmesSalmonella/Mammalian Microsome Assay (negative) and Yeast Saccharomyces Cerevisiae Assay (negative) and studies to evaluate chromosome aberrations in vivo in the Mouse Dominant Lethal Assay and in the Mouse Micronucleus Assay at 500 mg/kg (negative).
The following battery of in vitro genotoxicity tests were conducted with ciclopirox: a chromosome aberration assay in V79 Chinese Hamster Cells, with and without metabolic activation (positive); a gene mutation assay in the HGPRT - test with V79 Chinese Hamster Cells (negative); and a primary DNA damage assay (i.e., unscheduled DNA Synthesis Assay in A549 Human Cells (negative)). An in vitro Cell Transformation Assay in BALB/C3T3 Cells was negative for cell transformation. In an in vivo Chinese Hamster Bone Marrow Cytogenetic Assay, ciclopirox was negative for chromosome aberrations at 5,000 mg/kg.

### Pregnancy Category B
Reproduction studies have been performed in the mouse, rat, rabbit, and monkey (via various routes of administration) at doses 10 times or more the topical human dose and have revealed no significant evidence of impaired fertility or harm to the fetus due to ciclopirox. There are, however, no adequate or well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

### Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Ciclodan Cream is administered to a nursing woman.

### Pediatric Use
Safety and effectiveness in pediatric patients below the age of 10 years have not been established.
Clinical event adjudication: Stroke
For the list of clinical event adjudication definitions, click here
This chapter presents stroke definitions used in the Clinical Event Committee adjudication processes. These definitions are current as of 3/26/10.

# Stroke
Stroke is an acute symptomatic episode of neurological dysfunction attributed to a vascular cause.

## Classification

## Stroke Disability
Stroke disability should be measured by a reliable and valid scale in all cases.  For example, the modified Rankin Scale may be used to address this requirement:
Clostridium perfringens alpha toxin
Clostridium perfringens alpha toxin is a toxin produced by the bacterium Clostridium perfringens (C. perfringens) and is responsible for gas gangrene and myonecrosis in infected tissues. The toxin also possesses hemolytic activity.
This toxin has been shown to be the key virulence factor in infection with C. perfringens; the bacterium is unable to cause disease without this toxin. Further, vaccination against the alpha toxin toxoid protects mice against C. perfringens gas gangrene. As a result, knowledge about the function of this particular protein greatly aids understanding of myonecrosis. The alpha toxin has remarkable similarity to toxins produced by other bacteria as well as natural enzymes. There is significant homology with phospholipase C enzymes from Bacillus cereus, C. bifermentans, and Listeria monocytogenes. The C terminal domain shows similarity with non-bacterial enzymes such as pancreatic lipase, soybean lipoxygenase, and synaptotagmin I.
The alpha toxin is a zinc metallophospholipase requiring zinc for activation. First, the toxin binds to a binding site on the cell surface. The C-terminal C2 domain binds calcium and allows the toxin to bind to the phospholipid head-groups on the cell surface. The C-terminal domain enters the phospholipid bilayer. The N-terminal domain has phospholipase activity. This property allows hydrolysis of phospholipids such as phosphatidyl choline, mimicking endogenous phospholipase C. The hydrolysis of phosphatidyl choline produces diacylglycerol which activates a variety of second messenger pathways. The end result includes activation of arachidonic acid pathway and production of thromboxane A2, production of IL-8, platelet-activating factor, and several intercellular adhesion molecules. These actions combine to cause edema due to increased vascular permeability.
Cloudy cornea (patient information)
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# Overview
A cloudy cornea is a loss of transparency of the cornea.

# What causes Cloudy cornea?
The cornea is normally a nearly invisible, clear structure covering the iris of the eye. Its two purposes are to transmit and focus the light entering the eye.
Causes of cloudy cornea include:
- Chemical burns to the cornea
- Herpetic keratoconjunctivitis (a form of conjunctivitis caused by herpes simplex)
- Infectious diseases
- Poor nutrition
- River blindness (onchocerciasis -- an infection common in parts of Africa)
- Several rare inherited diseases involving abnormal metabolism
- Sjogren syndrome
- Trachoma
- Trauma
- Vitamin A deficiency
Clouding leads to varying degrees of vision loss.

# When to seek urgent medical care?
Contact your health care provider if:
- The outer surface of the eye appears cloudy
- You have trouble with your vision
Note: It is appropriate to see an ophthalmologist for vision or eye problems. However, your primary health care provider may also be involved if a whole-body (systemic) disease is suspected.

# Treatment options
Consult your health care provider. There is no appropriate home care.

# Where to find medical care for Cloudy cornea?
Directions to Hospitals Treating Cloudy cornea

# What to expect (Outlook/Prognosis)?
The health care provider will examine your eyes and ask questions about your medical history.
Questions may include:
- Did the cornea become cloudy quickly, or did it develop slowly?
- When did you first notice this?
- Does it affect both eyes?
- Is there any history of injury to the eye?
- What other symptoms do you have?
- Do you have any trouble with your vision?
- If so, what type (blurring, reduced vision, or other) and how much?
Tests may include:
- Biopsy of lid tissue
- Ophthalmoscopy
- Special photographs to measure the cells of the cornea
- Standard eye exam
- Ultrasound to measure corneal thickness

# Sources
College of Family Physicians Canada
The College of Family Physicians of Canada (CFPC) is the voice of family medicine in Canada. Representing over 18,000 members across the country, it is the professional organization responsible for establishing standards for the training, certification, and lifelong education of family physicians and for advocating on behalf of family medicine, family physicians and their patients. The CFPC accredits postgraduate family medicine training in Canadas 17 medical schools.
Prince Philip, Duke of Edinburgh, as a member of the Canadian Royal Family, is an Honorary Member of the College.
Canadian Family Physician is the official journal of the CFPC. A peer-reviewed research and clinical journal, it is published monthly. Canadian Family Physician is the only peer-reviewed family medicine journal in Canada that is indexed in PubMed Central, MEDLINE, EMBASE/Excerpta Medica, CINAHL, and Current Contents/Clinical Practice. All research and clinical review articles are reviewed by at least 2 external readers, in addition to the editorial staff, to ensure that content is accurate and relevant. The circulation of Canadian Family Physician is 35000. Canadian Family Physician is an open access journal. The full contents are available online at www.cfp.ca.
The CFPC is not to be mistaken with regulatory and by-law setting Colleges, such as the College of Physicians and Surgeons of Ontario.
Complement copy gene transcriptions
Def. a "nucleotide sequence in which each base is replaced by the complementary base of the given sequence: adenine (A) by thymine (T) or uracil (U), cytosine (C) by guanine (G), and vice versa."
"A DNA molecule is formed from two strands, each of which is the complement of the other."

# Inverse copies

# Complement-inverse copies

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
Complementarity (molecular biology)
In molecular biology, complementarity is a property of double-stranded nucleic acids such as DNA and RNA as well as DNA:RNA duplexes. Each strand is complementary to the other in that the base pairs between them are non-covalently connected via two or three hydrogen bonds.
Since there is only one complementary base for any of the bases found in DNA and in RNA, one can reconstruct a complementary strand for any single strand. This is essential for DNA replication.
For example, the complementary strand of the DNA sequence
is
a trick to remember this is
tRNAs exhibit wobble, in which the third base of their anticodon does not follow the strict complementarity rules.
Creighton University Medical Center
Saint Joseph Hospital at Creighton University Medical Center (CUMC) is a hospital located in north Omaha, Nebraska, USA.  It is currently operated by Tenet Healthcare but owned by Creighton University.

# History
The hospital was founded on September 25, 1870 by the Sisters of Mercy.  In 1880, the Sisters of St. Francis took over management of the hospital. The Hospital has gone through several name changes beginning as Creighton Memorial, Saint Joseph Hospital, Saint Joseph Hospital at Creighton University Medical Center then now called Creighton University Medical Center.
The hospital is the teaching hospital for the College of Pharmacy, College of Nursing, College of Dentistry and the College of Health Careers.

# Pop Culture
In 2007 the Marvel Comics superhero Iron Man was treated at the Creighton University Medical Center following a fight.  This part of an ongoing storyline in the comic.
Disease Name differential diagnosis

# Overview
Adhesive capsulitis is one of the most common disease in primary care settings. It can be occurred primarily or secondarily. Careful clinical examination and diagnosis is need to differentiate it from other disease.

# Differential Diagnosis
Adhesive capsulitis is one of the most common disease in primary care settings. It can be occurred primarily or secondarily. Careful clinical examination and diagnosis is need to differentiate it from other disease. Differentials are:
- Rotator cuff injury or tendinopathy +/- supraspinatus impingement: History of overuse or repetitive use with focal tenderness and preservation of passive range of motion helps to aid diagnosis of rotator cuff tendinopathy. hawkin and neer test positive in impingement.
- Rotator cuff tear: Severe lateral arm pain with limited active and passive range of motion with drop arm test positive. MRI help to diagnose it.
- Acromioclavicular arthropathy: Pain at superior location of shoulder joint with history of heay weight lifting or overuse with preservation of range of motion. It can be diagnose clinically with positive result of cross arm test and compression test.
- Subacromion Bursitis: Local injection of lidocaine and MRI aid the diagnosis.
- Cervical Radiculopathy or Cervical disc degeneration: Weakness and numbness impaired light touch in upper extremity with reduced active range of motion with neck movement.
- Subdeltoid Bursitis: History of overuse injury and MRI aid in diagnose this.
- Tendinopathy of biceps at bicipital groove: anterior upper arm pain with positive test result of speed and yergason test, MRI rule out the adhesive capsulitis.
- Malignancy: Constitutional symptoms and compressional symptoms from pancoast tumor  with imaging technique rule out frozen shoulder.
- Polymyalgia Rheumatica: Proximal muscle weakness of upper and lower extremity and increased ESR rule out adhesive capsulitis.
- Autoimmune disease: SLE or Rheumatoid Arthritis or other autoimmune disease may mimic frozen shoulder.
Divalproex sodium contraindications

# Contraindications
Depakote should not be administered to patients with hepatic disease or significant hepatic dysfunction .
Depakote is contraindicated in patients known to have mitochondrial disorders caused by mutations in mitochondrial DNA polymerase  (POLG; e.g., Alpers-Huttenlocher Syndrome) and children under two years of age who are suspected of having a POLG-related disorder.
Depakote is contraindicated in patients with known hypersensitivity to the drug .
Depakote is contraindicated in patients with known urea cycle disorders .
Depakote is contraindicated for use in prophylaxis of migraine headaches in pregnant women .
Doxycycline monohydrate description

# Description
Doxycycline is a broad-spectrum antibiotic synthetically derived from oxytetracycline. Doxycycline Monohydrate Capsules 100 mg, 75 mg, and 50 mg contain doxycycline monohydrate equivalent to 100 mg, 75 mg, or 50 mg of doxycycline for oral administration. The chemical designation of the light-yellow crystalline powder is alpha-6-deoxy-5-oxytetracycline.
Structural formula:
C22H24N2O8 - H2, M.W. = 462.45
Doxycycline has a high degree of lipid solubility and a low affinity for calcium binding. It is highly stable in normal human serum. Doxycycline will not degrade into an epianhydro form.
Inert ingredients: colloidal silicon dioxide; magnesium stearate; microcrystalline cellulose; sodium starch glycolate; and a hard gelatin capsule which contains black iron oxide, red iron oxide, titanium dioxide, and yellow iron oxide for the 100 mg and 75 mg strengths, titanium dioxide and yellow iron oxide for the 50 mg strength. The capsules are printed with edible ink containing black iron oxide, red iron oxide, and yellow iron oxide for the 50 mg and 100 mg strengths and black iron oxide, FD&C Blue No. 2, FD&C Red No. 40, FD&C Blue No. 1, and D&C Yellow No. 10 for the 75 mg strength.
Econazole dosage and administration

# DOSAGE AND ADMINISTRATION
Ecoza topical foam, 1% is for topical use only. Ecoza topical foam, 1% is not for oral, ophthalmic, or intravaginal use.
Ecoza topical foam, 1% should be applied to cover affected areas once daily for 4 weeks.

## DOSAGE FORMS AND STRENGTHS
Foam, 1%. Each gram of Ecoza topical foam, 1%, contains 10 mg of econazole nitrate in a white to off-white foam.
Efavirenz dosage and administration

# Dosage and Administration

## Adults
The recommended dosage of SUSTIVA (efavirenz) is 600 mg orally, once daily, in combination with a protease inhibitor and/or nucleoside analogue reverse transcriptase inhibitors (NRTIs). It is recommended that SUSTIVA be taken on an empty stomach, preferably at bedtime. The increased efavirenz concentrations observed following administration of SUSTIVA with food may lead to an increase in frequency of adverse reactions. Dosing at bedtime may improve the tolerability of nervous system symptoms. SUSTIVA capsules or tablets should be swallowed intact with liquid. For patients who cannot swallow capsules or tablets, the capsule sprinkle method of administration is recommended.

## Concomitant Antiretroviral Therapy
SUSTIVA must be given in combination with other antiretroviral medications.

## Dosage Adjustment
If SUSTIVA is coadministered with voriconazole, the voriconazole maintenance dose should be increased to 400 mg every 12 hours and the SUSTIVA dose should be decreased to 300 mg once daily using the capsule formulation (one 200 mg and two 50 mg capsules or six 50 mg capsules). SUSTIVA tablets should not be broken.
If SUSTIVA is coadministered with rifampin to patients weighing 50 kg or more, an increase in the dose of SUSTIVA to 800 mg once daily is recommended.

## Pediatric Patients
It is recommended that SUSTIVA be taken on an empty stomach, preferably at bedtime. Table 1 describes the recommended dose of SUSTIVA for pediatric patients 3 months of age or older and weighing between 3.5 kg and 40 kg. The recommended dosage of SUSTIVA for pediatric patients weighing 40 kg or greater is 600 mg once daily. For pediatric patients who cannot swallow capsules, the capsule contents can be administered with a small amount of food or infant formula using the capsule sprinkle method of administration.