Persius/hicric huggingface dataset:
Major histocompatibility complex, class II, DQ alpha 1
Major histocompatibility complex, class II, DQ alpha 1, also known as HLA-DQA1, is a human gene present on short arm of chromosome 6 (6p21.3) and also denotes the genetic locus which contains this gene. The protein encoded by this gene is one of two proteins that are required to form the DQ heterodimer, a cell surface receptor essential to the function of the immune system.

# Function
HLA-DQA1 belongs to the HLA class II alpha chain paralogues. This class II molecule is a heterodimer consisting of an alpha (DQA) and a beta chain (DQB), both anchored in the membrane. It plays a central role in the immune system by presenting peptides derived from extracellular proteins. Class II molecules are expressed in antigen-presenting cells (APC: B lymphocytes, dendritic cells, macrophages).

# Gene structure and polymorphisms
The alpha chain contains 5 exons. Exon one encodes the leader peptide, exons 2 and 3 encode the two extracellular protein domains, exon 4 encodes the transmembrane domain and the cytoplasmic tail. Within the DQ molecule both the alpha chain and the beta chain contain the polymorphisms specifying the peptide binding specificities, resulting in up to 4 different molecules. Typing for these polymorphisms is routinely done for bone marrow transplantation.

# Alleles

## DQ1
There are four commonly encountered DQA1 alleles: DQA1*0101, *0102, *0103, *0104. These alleles are always found in haplotypes with HLA-DQB1*05 (DQ5) and HLA-DQB1*06 (DQ6).  DQ1 is a serotype, rare among serotypes for human class II antigens, in that the antibodies to DQ1 react to the alpha chain of HLA DQ, these DQA1 allele gene products.

## Other
The other DQA1 alleles have no defined serotype. There are 5 groups, DQA1*02, *03, *04, *05, *06. DQA1 within these groups are either invariant or produce the same -chain subunit. DQA1*02 and DQA1*06 contain only one allele. DQA1*03 has three alleles which each produce nearly identical 3. For DQA1*05, the DQA1*0501 and DQA1*0505 produce identical 5.  Other DQA1*05 exist that produce variant  5var, but these are rare.
Nausea, vomiting, diarrhea, fatigue and abdominal pain

# Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain
Gastric dumping syndrome should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following:
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
Oxytetracycline hydrochloride warnings and precautions

# Warnings and Precautions

## Warnings
If renal impairment exists, even usual oral or parenteral doses may lead to excessive systemic accumulation of the drug and possible liver toxicity. Under such conditions, lower than usual doses are indicated and if therapy is prolonged, tetracycline serum level determinations may be advisable.
Oxytetracycline HCl, which is one of the ingredients of Urobiotic-250, may form a stable calcium complex in any bone-forming tissue with no serious harmful effects reported thus far in humans. However, use of oxytetracycline during tooth development (last trimester of pregnancy, neonatal period and early childhood) may cause discoloration of the teeth (yellow-grey-brownish). This effect occurs mostly during long term use of the drug but it also has been observed in usual short treatment courses.
Because of its sulfonamide content, this drug should be used only after critical appraisal in patients with liver damage, renal damage, urinary obstruction, or blood dyscrasias. Deaths have been reported from hypersensitivity reactions, agranulocytosis, aplastic anemia, and other blood dyscrasias associated with sulfonamide administration. When used intermittently, or for a prolonged period, blood counts and liver and kidney function tests should be performed.
Certain hypersensitive individuals may develop a photodynamic reaction precipitated by exposure to direct sunlight during the use of this drug. This reaction is usually of the photoallergic type which may also be produced by other tetracycline derivatives. Individuals with a history of photosensitivity reactions should be instructed to avoid exposure to direct sunlight while under treatment with this or other tetracycline drugs, and treatment should be discontinued at first evidence of skin discomfort.
NOTE: Reactions of a photoallergic nature are exceedingly rare with Terramycin (oxytetracycline HCl). Phototoxic reactions are not believed to occur with Terramycin.

## Precautions
As with all antibiotic preparations, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, the antibiotic should be discontinued and appropriate specific therapy should be instituted. This drug should be used with caution in persons having histories of significant allergies and/or asthma.
PCI complications: Hemodynamic Support for Complex PCI

# Hemodynamic Support for Complex PC

## Overview

## Pathophysiology
Rapid hemodynamic deterioration and death during PCI can occur due to hypotension, decompensated heart failure, shock, or arrhythmias.

## Prevention
Usage of hemodynamic support devices can be helpful in specific circumstances nevertheless, its routine usage is not recommended to reduce cardiovascular events.

### Hemodynamic Support Devices
- Intra-aortic balloon pump
Can provide minimal hemodynamic support for PCI but is capable of improving coronary and cerebral blood flow.
But its usage is limited in patients with severe peripheral artery or aortic disease.
One of the advantages of this device is the small catheter size which reduces the risk of vascular access site complications. Moreover, ease of use is another advantage of intra-aortic balloon pump.
- Can provide minimal hemodynamic support for PCI but is capable of improving coronary and cerebral blood flow.
- But its usage is limited in patients with severe peripheral artery or aortic disease.
- One of the advantages of this device is the small catheter size which reduces the risk of vascular access site complications. Moreover, ease of use is another advantage of intra-aortic balloon pump.
- The Impella Percutaneous Left Ventricularassist Devices
This device provides greater left ventricular support.
Impella device provides better hemodynamic support compared with balloon counterpulsation.
Nevertheless, usage of this device is limited in patients with left ventricular thrombus, aortic stenosis, peripheral artery disease, or aortic disease.
- This device provides greater left ventricular support.
- Impella device provides better hemodynamic support compared with balloon counterpulsation.
- Nevertheless, usage of this device is limited in patients with left ventricular thrombus, aortic stenosis, peripheral artery disease, or aortic disease.
- Extracorporeal membrane oxygenation and the Tandem-Heart devices
These devices are rarely used in order to support complex PCI
- These devices are rarely used in order to support complex PCI

### 2021 ACA Revascularization Guideline
Risks associated with patent ductus arteriosus surgery

# Overview
The decision to operate a patent ductus arteriosus should be made based on the risk to benefits ratio

### Small and Medium-Sized Ductus
Three risks exist:
- Endocarditis
- Deposition of calcium in the walls of the ductus which can compromise surgical results
- Heart failure with a medium-sized ductus.
Because of these risks, the mere presence of a ductus in childhood is an indication for operation at age 1 to 2 years.

### Large PDAs with Severe Pulmonary Vascular Obstructive Disease
If the pulmonary vascular resistance is > 10 units/m2 then this contraindicates closure. The risk of death from repair at all ages is < 2%, and is under 1% when patients with pulmonary hypertension and small infants are excluded. LVH regresses, but if there is pulmonary hypertension, RVH does not regress. The risk of endocarditis disappears. The lesion can also be closed using a Rashkind device. There may be a 1 in 5 times risk of embolization of the occluder.
Sandbox:Differentiating tonsillits from other diseases

# Overview
Tonsillitis is a bacterial or viral infection that causes inflammation and swelling of the tonsils. Most often, this infection is characterized by two distinct traits; sore throat and difficulty swallowing. However, other infections such as Scarlet fever and Epstein-Barr virus may present in a similar fashion. Thus prior to any treatment of the infection, it is important to perform diagnostic testing to identify the correct infection.

# Differentiating Tonsillitis from other Diseases
- There are two diseases that are distinguished to present similarly to tonsillitis; they are Scarlet fever and Epstein Barr Virus.

## Differentiating between Common Misdiagnosis

### Scarlet Fever
- Scarlet fever may be ruled out in testing for specific bacteria that produce the erythrogenic toxin.
- This toxin is ultimately the underlying cause of Scarlet fever.
- In its absence, Scarlet fever would only present as purulent tonsillitis.

### Epstein-Barr
- Differentiated based on clinical manifestations.
- May be responsible for prolonged fatigue.
- Tonsillectomy may lead to further complications including an increased risk of hemorrhaging.
Sandbox: Differentiating Pertussis from other diseases

# Overview
Pertussis should be differentiated from other infectious and non infectious causes of prolonged cough.

# Differential Diagnosis
- Pertussis' symptoms are similar to, and can be misdiagnosed as, the following diseases:
Asthma
Atypical pneumonia
Bronchiolitis
Chlamydial infections
Common cold
Foreign body aspiration
Gastroesophageal reflux disease
Sinusitis
Tuberculosis
- Asthma
- Atypical pneumonia
- Bronchiolitis
- Chlamydial infections
- Common cold
- Foreign body aspiration
- Gastroesophageal reflux disease
- Sinusitis
- Tuberculosis
- Pertussis is differentiated from the common cold by the persistence and worsening of respiratory symptoms 1-2 weeks
Schizotypal personality disorder (patient information)
For the WikiDoc page for this topic, click here

# Overview
Schizotypal personality disorder is a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior.

# What are the symptoms of Schizotypal personality disorder?
- People with schizotypal personality disorder may be very disturbed. Their odd behavior may look like that of people with schizophrenia. For example, they may also have unusual preoccupations and fears, such as fears of being monitored by government agencies.
- More commonly, however, people with schizotypal personality disorder behave oddly and have unusual beliefs (such as aliens). They cling to these beliefs so strongly that it prevents them from having relationships.
- People with schizotypal personality disorder feel upset by their difficulty in forming and keeping close relationships. This is different from people with schizoid personality disorder, who do not want to form relationships.

# What causes Schizotypal personality disorder?
- The exact cause is unknown. Genes are thought to be involved, because this condition is more common in relatives of schizophrenics.
- Schizotypal personality disorder should not be confused with schizophrenia. People with schizotypal personality disorder can have odd beliefs and behaviors, but they are not disconnected from reality and usually do not hallucinate.
- Hallucinations, delusions (fixed, false beliefs), and loss of touch with reality are hallmarks of psychosis. People with schizotypal personality disorder do not usually have psychotic symptoms.
- Between 30% and 50% of people with schizotypal personality disorder also have a major depressive disorder. A second personality disorder, such as paranoid personality disorder, is also common with this condition.

# When to seek urgent medical care?
Talk to your health care provider or mental health professional if:
- You have trouble forming and keeping relationships due to unusual beliefs
- You suspect that your child may have this problem

# Diagnosis
Some of the common signs of schizotypal personality disorder include the following:
- Discomfort in social situations
- Inappropriate displays of feelings
- No close friends
8Odd behavior or appearance
- Odd beliefs, fantasies, or preoccupations
- Odd speech

# Treatment options
- Some people may be helped by antipsychotic medications.
- Talk therapy (psychotherapy) is a big part of treatment.
- Social skills training can help some people cope with social situations.

# Where to find medical care for Schizotypal personality disorder?
Directions to Hospitals Treating Schizotypal personality disorder

# Prevention
There is no known prevention. Awareness of risk, such as a family history of schizophrenia, may allow early diagnosis.

# What to expect (Outlook/Prognosis)?
Schizotypal personality disorder is usually a long-term (chronic) illness. The outcome of treatment varies based on the severity of the disorder.

# Possible complications
- Poor social skills
- Lack of interpersonal relationships

# Source
The heart in temporal arteritis / giant cell arteritis
Assistant Editor-in-Chief: Brian Blank

# Overview
Extracranial vascular involvement is clinically detectable in 10-15% of patients with giant cell arteritis(GCA) or temporal arteritis. It often presents dramatically as an unsuspected cause ofaortic dissection or ruptured aortic aneurysm in the elderly  Cardiac involvement with Giant-cell arteritis (GCA) or temporal arteritis is rare.  Patients with GCA may experience chest pain if they have either aortic root involvement or myocardial infarction.

# Diagnosis

## Pathology
The use of tissue analysis to find granulomatous giant cell coronary arteritis is rare, as are proven cases leading to fatal . Giant cells can be found along the degenerative internal elastic membrane of the arterial wall.  The intima thickens to the point it becomes a fibrous cord. Harrison may have also noticed luminal thrombosis in 16 cases of temporal arteritis, though only one involved the epicardial coronary arteries. Giant-cell arteritis of intramural coronary arteries is also possible. 

# Imaging studies
CT scans and MRI with T2-weighted images are enough for diagnosis.
The patient has back pain physician extender algorithm

# Do's*
1. Obatin a history to fully characterize the nature back pain (onset, sti lml'f;,'fa;k;'ask.
2. Obtain a relevant ROS focusing on systemic diseases, cancer, infection, neurologic symptoms and character of the back pain.
2. Perform a focused physical examination
- sign of local tenderness
- range of motion
- sign of radiculopathy
- spurling sign
- straight leg raise
- While this algorithm provides steps to perform a focused history and physical examination, it is no replacement for a detailed history and physical examination.
Transformation/transcription domain-associated protein
Transformation/transcription domain-associated protein, also known asTRRAP, is a protein that in humans is encoded by the TRRAP gene. TRRAP belongs to the phosphatidylinositol 3-kinase-related kinase protein family.

# Function
TRRAP is an adapter protein, which is found in various multiprotein chromatin complexes with histone acetyltransferase activity (HAT), which in turn is responsible for epigenetic transcription activation. TRRAP has a central role in MYC (c-Myc) transcription activation, and also participates in cell transformation by MYC. It is required for p53/TP53-, E2F1-, and E2F4-mediated transcription activation. It is also involved in transcription activation mediated by the adenovirus E1A, a viral oncoprotein that deregulates transcription of key genes.
TRRAP is also required for the mitotic checkpoint and normal cell cycle progression. The MRN complex (composed of MRE11, RAD50, and NBS1) is involved in the detection and repair of DNA double-strand breaks (DSBs). TRRAP associates with the MRN complex and when TRRAP is removed, the complex shows reduced cDNA end-joining activity. Hence, TRRAP may function as a link between DSB repair and chromatin remodeling.

## Model organisms
Model organisms have been used in the study of TRRAP function. A conditional knockout mouse line, called Trraptm1a(EUCOMM)Wtsi was generated as part of the International Knockout Mouse Consortium program  a high-throughput mutagenesis project to generate and distribute animal models of disease to interested scientists.
Male and female animals underwent a standardized phenotypic screen to determine the effects of deletion. Twenty four tests were carried out on mutant mice and two significant abnormalities were observed. No homozygous mutant embryos were identified during gestation, and therefore none survived until weaning. The remaining tests were carried out on heterozygous mutant adult mice; no significant abnormalities were observed in these animals.

# Interactions
Transformation/transcription domain-associated protein has been shown to interact with:
- ACTL6A,
- EP400,
- MAX,
- Myc,
- PCAF,
- SUPT3H, and
- TAF9.  and
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Anatomical Therapeutic Chemical Classification System

# Overview
The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. It is controlled by the WHO Collaborating Centre for Drug Statistics Methodology, and was first published in 1976.
The classification system divides drugs into different groups according to the organ or system on which they act and/or their therapeutic and chemical characteristics.

# Classification
In this system, drugs are classified into groups at 5 different levels:

## First level
The first level of the code is based on a letter for the anatomical group and consists of one letter; there are 14 main groups:

## Second level
The second level of the code is based on the therapeutic main group and consists of two digits.

## Third level
The third level of the code is based on the therapeutic/pharmacological subgroup and consists of one letter.

## Fourth level
The fourth level of the code is based on the chemical/therapeutic/pharmacological subgroup and consists of one letter.

## Fifth level
The fifth level of the code is based on the chemical substance subgroup and consists of two digits.
Amitriptyline hydrochloride dosage and administration

# Dosage and Administration

### Oral Dosage
Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance.

### Initial Dosage for Adults
For outpatients 75 mg of amitriptyline HCl a day in divided doses is usually satisfactory. If necessary, this may be increased to a total of 150 mg per day. Increases are made preferably in the late afternoon and/or bedtime doses. A sedative effect may be apparent before the antidepressant effect is noted, but an adequate therapeutic effect may take as long as 30 days to develop.
An alternate method of initiating therapy in outpatients is to begin with 50 mg to 100 mg amitriptyline HCl at bedtime. This may be increased by 25 mg or 50 mg as necessary in the bedtime dose to a total of 150 mg per day.
Hospitalized patients may require 100 mg a day initially. This can be increased gradually to 200 mg a day if necessary. A small number of hospitalized patients may need as much as 300 mg a day.

### Adolescent and Elderly Patients
In general, lower dosages are recommended for these patients. 10 mg three times a day with 20 mg at bedtime may be satisfactory in adolescent and elderly patients who do not tolerate higher dosages.

### Maintenance
The usual maintenance dosage of amitriptyline HCl is 50 mg to 100 mg per day. In some patients 40 mg per day is sufficient. For maintenance therapy the total daily dosage may be given in a single dose preferably at bedtime. When satisfactory improvement has been reached, dosage should be reduced to the lowest amount that will maintain a relief of symptoms. It is appropriate to continue maintenance therapy 3 months or longer, to lessen the possibility of relapse.

### Pediatric Use
In view of the lack of experience with the use of this drug in pediatric patients, it is not recommended at the present time for patients under 12 years of age.

### Plasma Levels
Because of the wide variation in the absorption and distribution of tricyclic antidepressants in body fluids, it is difficult to directly correlate plasma levels and therapeutic effect. However, determination of plasma levels may be useful in identifying patients who appear to have toxic effects and may have excessively high levels, or those in whom lack of absorption or noncompliance is suspected. Because of increased intestinal transit time and decreased hepatic metabolism in elderly patients, plasma levels are generally higher for a given oral dose of amitriptyline hydrochloride than in younger patients. Elderly patients should be monitored carefully and quantitative serum levels obtained as clinically appropriate. Adjustments in dosage should be made according to the patients clinical response and not on the basis of plasma levels.