Persius/hicric huggingface dataset:
Aortic insufficiency cardiac catheterization

# Overview
Although echocardiography is now the primary imaging modality used to evaluate aortic insufficiency, cardiac catheterization is often performed in patients with aortic insufficiency primarily to assess for the presence of epicardial coronary artery disease prior to surgical aortic valve replacement. Aortography can also be performed to assess the severity of aortic insufficiency. The presence or absence of an aortic dissection can be evaluated. Left ventricular function (hemodynamics), size, and systolic function (ejection fraction) can also be evaluated.

# Cardiac Catheterization
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Coronary catheterization is a subset of this technique, involving the catheterization of the coronary arteries.

## Aortography Procedure
A 4-6 F pigtail catheter is generally used to perform aortography. The pigtail catheter is placed a few centimeters above the aortic root. For aortic insufficiency quantification, the catheter is placed in the aortic root approximately 2 cm above the aortic valve. The image intensifier is placed in the 45 degree left anterior oblique view with no cranial or caudal angulation. Usually a total of 40 to 50 cc of dye is injected with approximately 20 cc administered every second. The patients should be informed that they can have a warm feeling throughout their body.

### Grading Aortic Insufficiency
Grading the severity of aortic insufficiency is based on the amount of opacification of the left ventricle, two complete cardiac cycles after injection compared to that of the aortic root.
- Grade 1
- Grade 2
- Grade 3
- Grade 4

## Coronary Angiography
As a result of the regurgitant flow into the left ventricle, there is greater than normal flow in the coronary arteries that tends to dilute the contrast. It can be quite difficult to fill the coronary arteries during a standard injection.
Abbreviations:
CAD: Coronary artery disease;
CABG: Coronary artery bypass grafting;
PCI: Percutaneous coronary intervention;
TAVI:Transcatheter aortic valve implantation;
 VHD:Valvular heart disease

# 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Only when a diagnosis cannot be made with noninvasive imaging or when an acute coronary syndrome is a differential diagnosis should an angiography be explored.

# 2008 Focused Update Incorporated into the 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)

## Cardiac Catheterization Indications (DO NOT EDIT)

# Sources
- 2008 focused update incorporated into the 2006 ACC/AHA guidelines for the management of patients with valvular heart disease
Arteritic anterior ischemic optic neuropathy
Arteritic anterior ischemic optic neuropathy (AAION or arteritic AION) is the cause of vision loss that occurs in temporal arteritis (aka giant cell arteritis). Temporal arteritis is an inflammatory disease of medium-sized blood vessels that happens especially with advancing age. AAION occurs in about 15-20 percent of patients with temporal arteritis. Damage to the blood vessels supplying the optic nerves leads to insufficient blood supply (ischemia) to the nerve and subsequent optic nerve fiber death. Most cases of AAION result in nearly complete vision loss first to one eye. If the temporal arteritis is left untreated, the fellow eye will likely suffer vision loss as well within 1-2 weeks. Arteritic AION falls under the general category of anterior ischemic optic neuropathy, which also includes non-arteritic AION.

# Symptoms and diagnosis
There are several constitutional symptoms of temporal arteritis that may aid in diagnosis of AAION such as jaw claudication (spasms of the jaw muscle), scalp tenderness, unintentional weight loss, fatigue, myalgias and loss of appetite. However, many cases are asymptomatic.  There are also elevations in three blood tests that help identify AAION: erythrocyte sedimentation rate (ESR), C  reactive protein (CRP) and platelet count (thrombocytosis). A related rheumatic disease  called polymyalgia rheumatica has a 15 percent incidence of giant cell arteritis.
Prompt diagnosis is critical, since the sudden blindness in the one eye is often followed, within days, by similar sudden blindness in the second eye.  Treatment may prevent further damage (see below). Any patient diagnosed with non-arteritic AION over the age of 50 must be asked about the constitutional symptoms mentioned above.  Furthermore, AION patients over the age of 75 should often be blood tested regardless.

# Treatment
AAION requires urgent and critical intervention with a very long course of corticosteroids to prevent further damage. While this treatment is in itself problematic, non-treatment leads to bilateral blindness and strokes.
There is much research currently underway looking at ways to protect the nerve (neuroprotection) or even regenerate new fibers within the optic nerve.
Association of Gay and Lesbian Psychiatrists
The Association of Gay and Lesbian Psychiatrists (AGLP) is an organization that educates and advocates on lesbian, gay, bisexual, and transgender (LGBT) mental health issues.  Their stated purposes include publishing a quarterly newsletter and the Journal of Gay and Lesbian Psychotherapy; conducting seminars and discussion groups concurrent with the annual meeting of the American Psychiatric Association (APA); working within the APA to advocate for policies relevant to the LGBT community; collaborating with other organizations of LGBT physicians and other minority and advocacy groups; providing referral services for LGBT patients; assisting medical students and residents in their professional development; and encouraging and facilitating the presentation of programs and publications relevant to LGBT concerns at professional meetings.

# History
The organization informally began in the late 1960s, when lesbian and gay members of the APA met during its annual conferences.  In the mid-1970s, following the APA's declassification of homosexuality as a mental disorder in 1973, the Caucus of Gay, Lesbian, and Bisexual Members of the American Psychiatric Association (CGLBM-APA) was officially founded.  A primary function of the organization was to advocate to the APA on LGBT mental health issues.  The Caucus changed its name to the Association of Gay and Lesbian Psychiatrists in 1985.

# Achievements
- In 1978, the Caucus successfully petitioned the APA to create a task force on lesbian and gay issues.  That task force has since been elevated to a full standing committee in the APA.
- Since 1982, the organization has been recognized as a representative in the Assembly of the APA which speaks directly on matters of special concern to lesbian and gay members of the APA.
- In 1983, the Caucus successfully petitioned the APA to create a task force on psychiatric aspects of AIDS, which ultimately led to the 1984 publication of two important APA volumes: Innovations in Psychotherapy with Homosexuals and Psychiatric Implications of Acquired Immune Deficiency Syndrome.  In 1988, that task force was elevated to a full standing committee in the APA.
- The AGLP was influential in the APA's removal of "Ego-Dystonic Homosexuality" from the revised DSM-III.
Avoidant or restrictive food intake disorder
Synonyms and keywords: Avoidant food intake disorder; restrictive food intake disorder

# Overview
This disorder is characterized by the abnormal feeding habits.  This may lead to critical weight loss, nutritional deficiency and decrease in psychosocial functioning. In this instance, the causes are not attributed to a physical condition.

# Differential Diagnosis
- Gastrointestinal disease
- Food allergies and intolerances
- Occult malignancies
- Specific neurological/neuromuscular
- Structural, or congenital disorders
- Conditions associated with feeding difficulties
- Reactive attachment disorder
- Autism spectrum disorder
- Specific phobia
- Social anxiety disorder (social phobia)
- Anorexia nervosa
- Obsessive-compulsive disorder
- Major depressive disorder
- Schizophrenia spectrum disorders
- Factitious disorder

# Risk Factors
- Anxiety disorders
- Autism spectrum disorder
- Attention-deficit/hyperactivity disorder
- Obsessive-compulsive disorder
- Family history of familial anxiety
- Gastroesophageal reflux disease
- History of gastrointestinal conditions
- Vomiting

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Avoidant or Restrictive Food Intake Disorder
Bactericidal/permeability-increasing protein
Bactericidal/permeability-increasing protein (BPI) is a 456-residue (~50kDa) protein that is part of the innate immune system. It belongs to family of lipid-binding serum glycoproteins.

# Distribution and function
BPI was initially identified in neutrophils, but is found in other tissues including the epithelial lining of mucous membranes.
It is an endogenous antibiotic protein with potent killing activity against Gram-negative bacteria.  It binds to compounds called lipopolysaccharides produced by Gram-negative bacteria.  Lipolysaccharides are potent activators of the immune system; however, BPI at certain concentrations can prevent this activation.
BPI was discovered by Jerrold Weiss and Peter Elsbach at New York University Medical School.

# rBPI21
Because lipopolysaccharides are potent inflammatory agents, and the action of antibiotics can result in the release of these compounds, the binding capacity of BPI was explored as a possible means of reducing injury.  Xoma Ltd. developed a recombinant 21kDa portion of the BPI molecule called rBPI21, NEUPREX, or opebecan.  In a trial, it was found to decrease the mortality of Gram-negative bacterial-induced sepsis.  Studies suggest that its binding activity is not the means by which it mediates its protective effect.  Studies show biological effects with Gram-positive bacteria and even in infection by the protozoan, Toxoplasma gondii.
Barriers to Implementing Clinical Guidelines
Multiple factors have been linked to poor adherence to applications of clinical statements and treatment guidelines. Non teaching or for profit hospitals tend to score lower than academic or not for profit hospitals. This translates into a survival advantage for teaching over non teaching hospitals, which is attenuated but not eliminated by controlling for baseline patient characteristics. It appears that hospital therapy tradition and structure of care play significant roles in the different outcome among hospitals.
In fact, in a study of Medicare patients who had acute myocardial infarction (AMI) treated in 1994 and 1995, admission to a hospital ranked high on the Americas Best Hospitals list published annually by the US News & World Report was associated with a lower 30 day mortality, linked to a higher rate of use of aspirin and beta blockers by these hospitals.
It is interesting that most studies looking at outcome by treating physician found that the outcome of AMI patients is better when the care is assumed by a cardiologist. Although specialists may be treating patients with less comorbid conditions, attempts to adjust for baseline patient characteristics did not eliminate the difference in in-hospital or one year mortality. It is the better implementation of recommended medical therapy and the higher use of reperfusion therapy by cardiologists that could account for most of the observed difference in outcome. Although this finding calls for better implementation of the guidelines by all treating physicians, it does not justify a universal call on all AMI patients to be cared for by cardiologists only.
The factors that may prevent a physician from applying the guidelines are complex and poorly understood.
1. The physician may simply be unaware of the presence of the guidelines,
2. The physician may be unfamiliar with contents of guidelines.
3. The physician aware of the recommendations, clinical statements and guidelines, but may disagree with the guidelines,
4. The physician believe that guidelines and clinical statements are overwhelming and confusing, and have poor outcome expectancy,
5. The physician may find it hard to change practices she/he already used to.
Reference:
1. Singh M., Holmes D. R., Acute Myocardial Infarction, Med Clin N Am 91 (2007)
(-)-2-Carbomethoxy-3-(4-iodophenyl)tropane
(-)-2-Carbomethoxy-3-(4-iodophenyl)tropane (-CIT or RTI-55) is a stimulant drug used in scientific research and with some medical uses, which was developed in the early 1990s. -CIT is a phenyltropane based dopamine reuptake inhibitor and is derived from methylecgonidine. -CIT is one of the most potent phenyltropane stimulants that is commercially available, which limits its use in humans, as it might have significant abuse potential if used outside of a strictly controlled medical setting.  When radiolabeled with iodine-123, it is known as iometopane.

# Uses
-CIT is mainly used in scientific research into the dopamine reuptake transporter. Various radiolabelled forms of -CIT (with different radioactive isotopes of iodine used depending on the application) are used in both humans and animals to map the distribution of dopamine transporters and serotonin transporters in the brain.
The main practical application for this drug in medicine is to assess the rate of dopamine neuron degradation in the brains of sufferers of Parkinson's disease and some other conditions such as progressive supranuclear palsy.

# Legal Status
-CIT is legal in all countries throughout the world as of 2007. Some jurisdictions such as the USA, Canada, Australia and New Zealand might however consider -CIT to be a controlled substance analogue of cocaine on the grounds of its related chemical structure.
International Bureau of Weights and Measures
The International Bureau of Weights and Measures (Bureau international des poids et mesures, in French), is an international standards organisation, one of three such organisations established to maintain the International System of Units (SI) under the terms of the Convention du Metre (Metre Convention). The organization is usually referred to by its French abbreviation, BIPM.
It is based at the Pavillon de Breteuil in Sevres, France, where it enjoys extraterritorial status. As such, it escaped German occupation during World War II.
The BIPM helps to ensure uniformity of SI weights and measures around the world. It does this with the authority of the Convention du Metre, a diplomatic treaty between fifty-one nations (as of 2005), and it operates through a series of Consultative Committees, whose members are the national metrology laboratories of the Member States of the Convention, and through its own laboratory work.
The BIPM carries out measurement-related research. It takes part in, and organises, international comparisons of national measurement standards, and it carries out calibrations for member states.
The BIPM has an important role in maintaining accurate worldwide time of day. It combines, analyzes, and averages the official atomic time standards of member nations around the world to create a single, official Coordinated Universal Time (UTC).
The other organisations which maintain the SI system are the General Conference on Weights and Measures (CGPM, Conference generale des poids et mesures) and the International Committee for Weights and Measures (CIPM, Comite international des poids et mesures)
Cordarone tablet use in specific populations

# Use in Specific Populations

## Pregnancy: Pregnancy Category D
See "WARNINGS, Neonatal Hypo- or Hyperthyroidism".

## Labor and Delivery
It is not known whether the use of Cordarone during labor or delivery has any immediate or delayed adverse effects. Preclinical studies in rodents have not shown any effect of Cordarone on the duration of gestation or on parturition.

## Nursing Mothers
Cordarone and one of its major metabolites, desethylamiodarone (DEA), are excreted in human milk, suggesting that breast-feeding could expose the nursing infant to a significant dose of the drug. Nursing offspring of lactating rats administered Cordarone have been shown to be less viable and have reduced body-weight gains. Therefore, when Cordarone therapy is indicated, the mother should be advised to discontinue nursing.

## Pediatric Use
The safety and effectiveness of Cordarone Tablets in pediatric patients have not been established.

## Geriatric Use
Clinical studies of Cordarone Tablets did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Cardiac rehabilitation (patient information)

# Overview
A cardiac rehabilitation program may help you with:
- Understanding risk factors for heart disease and how to reduce them
- Improving the ability to cope with stress (anger management)
- Lowering blood pressure
- Understanding mechanism, effects and side effects of medications and possible drug interactions.
- Strengthening the heart and cardiovascular system
- Gaining a great sense of well-being and self confidence
- Improving daily physical activity

# What to eat at the restaurant?
- Ask about low-fat or fat-free choices.
- Ask the server to make substitutions like steamed vegetables instead of French fries.
- Use the basic guidelines of your healthy eating plan when choosing a main dish. Pick lean meat, fish or skinless chicken.
- Make sure your entree is broiled, baked, grilled, steamed or poached instead of fried.
- Order vegetable side dishes and ask that any sauces or butter be left off.
- Ask for low-calorie salad dressing or a lemon to squeeze on your salad instead of dressing.
- Ask for baked, boiled or roasted potatoes instead of fried. And ask for them without the butter and sour cream.
- Order fresh fruit or fruit sorbet in place of cake, pie or ice cream.
- When it seems that everything on the menu is off limits, ask if the chef will make you a fruit or vegetable platter. Most chefs are happy to do so.

# What to avoid at the restaurant?
- Push the butter out of your way or ask that it be removed. Ask for soft margarine instead.
- Order your dressings and sauces on the side so you can control how much you use.
- Stay away from fried appetizers and creamy soups. Begin your meal with broth-based soup like minestrone or gazpacho.
- At salad bars, stay away from high-fat items like cheese, cream dressings, chopped eggs, croutons, olives and bacon bits.
- Ask that your food be made without butter or cream sauces. Youll be surprised at how delicious meat, fish and chicken can be when broiled dry.
- Take the skin off poultry when it arrives, and remove visible fat from meat. 

# Additional Resources
- American Heart Association Recommendations for Lifestyle Modifications and Risk Reductions]
Carnitine palmitoyltransferase II deficiency

# Overview
Carnitine palmitoyltransferase II deficiency is a condition that prevents the body from converting certain fats called long-chain fatty acids into energy, particularly during periods without food. Carnitine, a natural substance acquired mostly through the diet, is used by cells to process fats and produce energy. People with this disorder have a faulty enzyme that prevents these fats from being processed in the mitochondria.

# Classification

## Types
There are three main types of carnitine palmitoyltransferase II deficiency:
- a lethal neonatal form
- a severe infantile hepatocardiomuscular form,
- a myopathic form

### Neonatal form
Infants with the lethal neonatal form of this disorder usually experience respiratory failure, liver failure, seizures, and an irregular heart beat leading to cardiac arrest. In many cases, patients have malformed features and an abnormally developed brain and kidneys.

### Hepatocardiomuscular type
Signs and symptoms of the infantile hepatocardiomuscular type usually appear between 6 and 24 months of age. This condition involves recurring attacks of abnormally low levels of fat breakdown products and blood sugar (hypoketotic hypoglycemia) causing a loss of consciousness and seizures. Liver failure and an enlarged liver (hepatomegaly) are also sometimes seen. In many cases, there is also heart involvement. Episodes are often triggered by infections, fever, or fasting.

### Myopathic form
The myopathic form is the most frequently seen and least severe form of carnitine palmitoyltransferase II deficiency. It has a variable age of onset and is characterized by muscle pain (myalgia) and weakness. This condition is sometimes associated with the abnormal breakdown of an oxygen-binding muscle protein called myoglobin (myoglobinuria). Myoglobinuria can cause kidney failure and death.

# Causes
Mutations in the CPT2 gene cause carnitine palmitoyltransferase II deficiency, leading to the production of a defective version of an enzyme called carnitine palmitoyltransferase II.
Without this enzyme, long-chain fatty acids from food and fats stored in the body cannot be broken down and processed.
Excessive levels of long-chain fatty acids may build up in tissues, damaging the heart, liver, and muscles and causing more serious complications.
This condition is inherited in an autosomal recessive pattern.