Persius/hicric huggingface dataset:
Piperacillin tazobactam sodium indications and usage

# Indications and Usage
ZOSYN is a combination product consisting of a penicillin-class antibacterial, piperacillin, and a -lactamase inhibitor, tazobactam, indicated for the treatment of patients with moderate to severe infections caused by susceptible isolates of the designated bacteria in the conditions listed below.
- Intra-abdominal Infections
Appendicitis (complicated by rupture or abscess) and peritonitis caused by -lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus. The individual members of this group were studied in fewer than 10 cases.
- Skin and Skin Structure Infections
Uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by -lactamase producing isolates of Staphylococcus aureus.
- Female Pelvic Infections
Postpartum endometritis or pelvic inflammatory disease caused by -lactamase producing isolates of Escherichia coli.
- Community-acquired Pneumonia
Community-acquired pneumonia (moderate severity only) caused by -lactamase producing isolates of Haemophilus influenzae.
- Nosocomial Pneumonia
Nosocomial pneumonia (moderate to severe) caused by -lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused byP. aeruginosa should be treated in combination with an aminoglycoside) .
To reduce the development of drug-resistant bacteria and maintain the effectiveness of ZOSYN and other antibacterial drugs, ZOSYN should be used only to treat infections that are proven or strongly suspected to be caused by bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Pre-natal dextro-transposition of the great arteries

# Overview
Diagnosis can be done after 18 weeks gestation using an ultrasound. However, if it is not diagnosed in utero, cyanosis of the newborn (blue baby) should immediately indicate that there is a problem with the cardiovascular system.

# Pre-natal d-TGA
- Most of the time, diagnosis can be done after 18 weeks gestation using an ultrasound. However, if it is not diagnosed in utero, cyanosis of the newborn (blue baby) should immediately indicate that there is a problem with the cardiovascular system.
- Prenatally, a baby with d-TGA experiences no symptoms as the lungs will not be used until after childbirth, and oxygen is provided by the mother via the placenta and umbilical cord; in order for the red blood to bypass the lungs in utero, the fetal heart has two shunts that begin to close when the newborn starts breathing; these are the foramen ovale and the ductus arteriosus. The foramen ovale is a hole in the atrial septum which allows blood from the right atrium to flow into the left atrium; after birth, the left atrium will be filled with blood returning from the lungs and the foramen ovale will close. The ductus arteriosus is a small, artery-like structure which allows blood to flow from the trunk of the pulmonary artery into the aorta; after birth, the blood in the pulmonary artery will flow into the lungs and the ductus arteriosus will close. Sometimes these shunts will fail to close after birth; these defects are called patent foramen ovale and patent ductus arteriosus, and either may occur independently, or in combination with one another, or with d-TGA or other heart and/or general defects.
- In the presence of a d-TGA, the fetus will be asymptomatic due to the presence of shunts during the intrauterine period until after birth when several changes are produced in the circulation:
The following Fetal structures become the following  Infant and adult structures :
- The foramen ovale becomes the fossa ovalis
- The ductus arteriosus becomes the ligamentum arteriousus
- The ductus venosus becomes the ligamentum venosus
- The umbilical vein becomes the ligamentum teres
- The umbilical arteries becomes the medial umbilical ligaments
Right ventricular outflow tract obstruction overview

# Overview
Right ventricular outflow tract (RVOT) and/or pulmonary artery obstruction are present in some form in 25 % of all congenital heart defects. The right ventricular outflow tract obstruction includes stenosis or narrowing of the pulmonary valve, the tissue above the valve (supravalvar obstruction) and below it(subvalvar obstruction). Congenital subvalvar and supravalvar right ventricular outflow tract stenosis usually occurs with other congenital heart defects such as Ventricular Septal Defect (VSD) or Tetralogy of Fallot. The timing and type of surgery will vary from patient to patient depending upon the severity of the obstruction and the associated congenital defect.
If right ventricular outflow tract obstruction is present and the ventricular septum is intact, usually the right ventricle will adapt better given that no right to left shunting is present. This absence of shunting may result in sufficient pulmonary blood flow to allow the patient to remain asymptomatic longer.
Usually therapy is directed to increase pulmonary blood flow and decompressing the right ventricle (RV) and it will depend on the severity and location of the defect. According to the anatomic features of the pulmonary valve stenosis, the physician may use balloon dilatation (a minimally invasive transvenous procedure) to dilate the obstruction during cardiac catheterization, but if the pulmonary artery is the structure involved, stenting (insertion of a small tube) within the narrowed region can be done following balloon angioplasty. Standard treatment of right ventricular outflow tract or pulmonary artery obstruction involves open chest surgery.
Solitary pulmonary nodule diagnostic study of choice

# Overview
Lung biopsy is the study of choice to diagnose pulmonary nodule. Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor histology. Common types of lung tissue biopsy for solitary pulmonary nodule include conventional bronchoscopic-guided transbronchial biopsy, bronchoscopic-transbronchial needle aspiration, endobronchial ultrasound-guided sheath transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration. Common indications for biopsy in pulmonary nodule include: high risk nodule (> 65%), intermediate risk nodule with a high risk patient profile, intermediate risk nodule with a positive positron emission tomography scan.

# Diagnostic Study of Choice

## Study of Choice
- Lung biopsy is the study of choice to diagnose pulmonary nodule.

## Biopsy
- Biopsy for pulmonary nodule may be classified into 2 categories:

### 1. Non-surgical Biopsy
- Bronchoscopy
- Transthoracic needle aspiration
- Needle core biopsy

### 2. Surgical
- Wedge resection
- Indications for biopsy in pulmonary nodule include:
- High risk nodule (> 65%)
- Intermediate risk nodule, with a high risk patient profile
- Intermediate risk nodule, with a positive positron emission tomography (PET) scan
- Determination of tumor histologic sub-type
- Characterization of genetic mutations
- Contraindications for biopsy in pulmonary nodule include:
- Emphysema
- Bullous disease
- Chronic respiratory failure
- Complications of taking biopsy in pulmonary nodule include:
- Pneumothorax
- Hemothorax  For more information about surgical biopsy of pulmonary nodule, click here.

## Non-surgical Procedures for Taking Biopsy
Bronchoscopy
- Common bronchoscopy biopsy techniques for pulmonary nodule include:
- Conventional bronchoscopic-guided transbronchial biopsy
- Bronchoscopic-transbronchial needle aspiration (preferred technique)
- Endobronchial ultrasound-guided sheath transbronchial biopsy
- Endobronchial ultrasound-guided transbronchial needle aspiration
- Indications for bronchoscopy in pulmonary nodule include:
- Central nodules
- Large lesions
- No fitness for surgery
- Nodules close to the patent airways
- When patients are at risk of complications from any other procedures of taking biopsy
Transthoracic Needle Biopsy
- Usually followed by CT guidance
- Indications for transthoracic needle biopsy in pulmonary nodule include:
- Peripheral nodules
- Nodules close to the chest wall
- No fitness for surgery
Tetracycline hydrochloride dosage and administration

# Dosage and Administration
Adults
Usual daily dose, 1 gram as 500 mg b.i.d. or 250 mg q.i.d. Higher doses such as 500 mg q.i.d. may be required for severe infections or for those infections which do not respond to the smaller doses.
Children above eight years of age
Usual daily dose, 10 to 20 mg/lb (25 to 50 mg/kg) body weight divided in four equal doses.
Therapy should be continued for at least 24 to 48 hours after symptoms and fever have subsided.
For treatment of brucellosis, 500 mg tetracycline q.i.d. for three weeks should be accompanied by streptomycin, 1 gram intramuscularly twice daily the first week and once daily the second week.
For the treatment of syphilis in patients allergic to penicillin, the following dosage of tetracycline is recommended: early syphilis (less than one years duration), 500 mg q.i.d. for 15 days. Syphilis of more than one years duration (except neurosyphilis), 500 mg q.i.d. for 30 days.
For treatment of gonorrhea, the recommended dose is 500 mg by mouth four times a day for seven days.
In cases of moderate to severe acne which, in the judgement of the clinician, require long-term treatment, the recommended initial dosage is 1 gram daily in divided doses. When improvement is noted, dosage should be gradually reduced to maintenance levels ranging from 125 mg to 500 mg daily. In some patients it may be possible to maintain adequate remission of lesions with alternate day or intermittent therapy. Tetracycline therapy of acne should augment the other standard measures known to be of value. Duration of long-term treatment which can safely be recommended has not been established (see WARNINGS and Carcinogenesis, Mutagenesis, Impairment of Fertility).
Concomitant Therapy
Absorption of tetracycline is impaired by antacids containing aluminum, calcium or magnesium and preparations containing iron, zinc or sodium bicarbonate.
Food and some dairy products also interfere with absorption.
In the treatment of streptococcal infections, a therapeutic dose of tetracycline should be administered for at least ten days.
In patients with renal impairment (see WARNINGS): total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses.
Uncomplicated urethral, endocervical or rectal infections in adults caused by Chlamydiatrachomatis: 500 mg, by mouth, four times a day for at least seven days.
Administration of adequate amounts of fluid with the capsule formulation of tetracycline is recommended to wash down the drug and reduce the risk of esophageal irritation and ulceration (see ADVERSE REACTIONS).
Valproic acid capsule/solution indications and usage

# Indications and Usage

### 1.1 Epilepsy
Depakene (valproic acid) is indicated as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures. Depakene (valproic acid) is indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types which include absence seizures.
Simple absence is defined as very brief clouding of the sensorium or loss of consciousness accompanied by certain generalized epileptic discharges without other detectable clinical signs. Complex absence is the term used when other signs are also present.
See Warnings and Precaution (5.1) for statement regarding fatal hepatic dysfunction.

### 1.2 Important Limitations
Because of the risk to the fetus of decreased IQ, neural tube defects, and other major congenital malformations, which may occur very early in pregnancy, valproate should not be administered to a woman of childbearing potential unless the drug is essential to the management of her medical condition .
Vitamin D deficiency echocardiography and ultrasound

# Overview
There are no echocardiography/ultrasound findings associated with .
OR
Echocardiography/ultrasound  may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include , , and .
OR
There are no echocardiography/ultrasound  findings associated with . However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include , , and .

# Echocardiography/Ultrasound
- There are no echocardiography/ultrasound findings associated with .
OR
- Echocardiography/ultrasound may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include:
OR
- There are no echocardiography/ultrasound findings associated with . However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include:
2-methylbutyryl-coenzyme a dehydrogenase deficiency
2-Methylbutyryl-CoA dehydrogenase deficiency, also called 2-Methylbutyryl glycinuria or short/branched-chain acyl-CoA dehydrogenase deficiency (SBCADD), is an autosomal recessive metabolic disorder. It causes the body to be unable to process the amino acid isoleucine properly.  Initial case reports identified individuals with developmental delay and epilepsy, however most cases identified through newborn screening have been asymptomatic.

# Signs and symptoms
SBCADD is included as a secondary target condition in most newborn screening programs, as the key analyte is the same as is used to identify isovaleric acidemia.   Most cases have been Hmong individuals, who are asymptomatic.  There are isolated case reports where individuals have been identified with SBCADD in addition to developmental delay and epilepsy.  It is currently unclear what the complete clinical presentation of SBCADD looks like.  There is some concern that these cases with additional symptoms may reflect an ascertainment bias rather than being a true representation of the clinical spectrum of the disease.  Currently, there is no accepted treatment, as most affected individuals do not require any.  Some recommend avoidance of valproic acid, as it can be a substrate for 2-methylbutyryl-CoA dehydrogenase.

# Cause and genetics
The disorder is caused by a mutation in the ACADSB gene, located on the long arm of human chromosome 10 (10q25-q26). It is inherited in an autosomal recessive manner, which means an affected individual must inherit one copy of the mutation from each parent.

# Diagnosis
Most individuals with SBCADD are identified through newborn screening, where they present with an elevation of a five carbon acylcarnitine species.  Confirmatory testing includes plasma and urine analysis to identify the carnitine and glycine conjugates of 2-methylbutyryl-CoA.
American College of Obstetricians and Gynecologists

# Background
The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000 and represents 90 percent of U.S. board-certified obstetrician-gynecologists.
Members are referred to as fellows and use the post-nominal letters FACOG to indicate their status. To become a fellow, candidates must pass a two-part exam given yearly. The first part is a written exam, which must be taken the first year the candidate is eligible. The second part is the oral exam, taken the year after the written exam is passed. The oral boards are based on a collection of a year's worth of cases known as the "case list". Many doctors feel an incredible level of stress associated with this period of time; some put their practices on hold to allow enough time to prepare adequately. Some aspects of each section of the exam change from year to year, requiring candidates to be in touch with ACOG and one another for advice and guidance.
An entire industry has arisen from the desire of candidates to receive coaching and review materials before testing.
Amoxicillin-clavulanate potassium drug interactions

# Drug Interactions
- Probenecid
Probenecid decreases the renal tubular secretion of amoxicillin but does not delay renal excretion of clavulanic acid. Concurrent use with AUGMENTIN may result in increased and prolonged blood concentrations of amoxicillin. Coadministration of probenecid is not recommended.
- Oral Anticoagulants
Abnormal prolongation of prothrombin time (increased international normalized ratio ) has been reported in patients receiving amoxicillin and oral anticoagulants. Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently with AUGMENTIN. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation.
- Allopurinol
The concurrent administration of allopurinol and amoxicillin increases the incidence of rashes in patients receiving both drugs as compared to patients receiving amoxicillin alone. It is not known whether this potentiation of amoxicillin rashes is due to allopurinol or the hyperuricemia present in these patients.
- Oral Contraceptives
AUGMENTIN may affect intestinal flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives.
- Effects on Laboratory Tests
High urine concentrations of amoxicillin may result in false-positive reactions when testing for the presence of glucose in urine using CLINITEST, Benedicts Solution, or Fehlings Solution. Since this effect may also occur with AUGMENTIN, it is recommended that glucose tests based on enzymatic glucose oxidase reactions be used.
Following administration of amoxicillin to pregnant women, a transient decrease in plasma concentration of total conjugated estriol, estriol-glucuronide, conjugated estrone, and estradiol has been noted.
Avoidant personality disorder (patient information)
For the WikiDoc page for this topic, click here

# Overview
Avoidant personality disorder is a mental health condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection.

# What are the symptoms of Avoidant personality disorder?
- People with avoidant personality disorder can't stop thinking about their own shortcomings. They form relationships with other people only if they believe they will not be rejected.
- Loss and rejection are so painful that these people will choose to be lonely rather than risk trying to connect with others.

# What causes Avoidant personality disorder?
- Personality disorders are lifelong patterns of behavior that cause problems with work and relationships.
- About 1% of the population has avoidant personality disorder. Both males and females have the condition equally.
- The cause is unknown.

# When to seek urgent medical care?
See your health care provider or a psychiatrist if shyness or fear of rejection overwhelms your ability to function in life and relationships.

# Diagnosis
A person with avoidant personality disorder may:
- Be easily hurt when people criticize or disapprove of them
- Hold back too much in intimate relationships
- Be reluctant to become involved with people
- Avoid activities or jobs that involve contact with others
- Be shy in social situations out of fear of doing something wrong
- Make potential difficulties seem worse than they are
- Hold the view they are not good socially, not as good as other people, or unappealing

# Treatment options
- Antidepressant medications can often make people less sensitive to rejection.
- However, talk therapy (psychotherapy) is considered to be the most effective treatment for this condition.
- Psychodynamic psychotherapy, which helps patients understand their thoughts and feelings, and cognitive behavioral therapy (CBT) can help.
- A combination of medication and talk therapy may be more effective than either treatment alone.

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

# What to expect (Outlook/Prognosis)?
People with this disorder may develop some ability to relate to others, and this can be improved with treatment.

# Possible complications
- Without treatment, a person with avoidant personality disorder may become resigned to a life of near or total isolation.
- They may go on to develop a second psychiatric disorder such as substance abuse or a mood disorder such as depression.

# Source
Cardiac allograft vasculopathy history and symptoms

# Overview
Patients with cardiac allograft vasculopathy (CAV) seldom present with typical angina symptoms due to cardiac denervation at the time of heart transplantation.

# History and Symptoms
As mentioned above, patients with cardiac transplants do not typically present with anginal symptoms. About 10-30% of patients regain some renervation to the heart. Hence, they typically present late with the following manifestations.
- Graft failure
- Arrhythmias
- Silent myocardial infarction: Due to denervation at the time of surgery patients with CAV rarely present with typical angina symptoms, especially in the initial years of transplantation. However, studies have demonstrated that re-innervation does occur late after heart transplantation.
- Sudden death
The current practice is to routinely screen cardiac allograft recipients using conventional angiography or intravascular ultrasound (IVUS) as discussed in subsequent sections.
Cefepime compatibility reconstitution and stability
Intravenous: MAXIPIME is compatible at concentrations between 1 mg per mL and 40 mg per mL with the following intravenous infusion fluids: 0.9% Sodium Chloride Injection, 5% and 10% Dextrose Injection, M/6 Sodium Lactate Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, Lactated Ringers and 5% Dextrose Injection, NormosolTM-R, and NormosolTM-M in 5% Dextrose Injection. These solutions may be stored up to 24 hours at controlled room temperature 20C to 25C (68F to 77F) or 7 days in a refrigerator 2C to 8C (36F to 46F). MAXIPIME in ADD-Vantage vials is stable at concentrations of 10 to 40 mg per mL in 5% Dextrose Injection or 0.9% Sodium Chloride Injection for 24 hours at controlled room temperature 20C to 25C or 7 days in a refrigerator 2C to 8C.
MAXIPIME admixture compatibility information is summarized in Table 15.
Solutions of MAXIPIME, like those of most beta-lactam antibiotics, should not be added to solutions of ampicillin at a concentration greater than 40 mg per mL, and should not be added to metronidazole, vancomycin, gentamicin, tobramycin, netilmicin sulfate, or aminophylline because of potential interaction. However, if concurrent therapy with MAXIPIME is indicated, each of these antibiotics can be administered separately.
Intramuscular: MAXIPIME (cefepime hydrochloride) constituted as directed is stable for 24 hours at controlled room temperature 20C to 25C (68F to 77F) or for 7 days in a refrigerator 2C to 8C (36F to 46F) with the following diluents: Sterile Water for Injection, 0.9% Sodium Chloride Injection, 5% Dextrose Injection, Sterile Bacteriostatic Water for Injection with Parabens or Benzyl Alcohol, or 0.5% or 1% Lidocaine Hydrochloride.
NOTE: PARENTERAL DRUGS SHOULD BE INSPECTED VISUALLY FOR PARTICULATE MATTER BEFORE ADMINISTRATION. IF PARTICULATE MATTER IS EVIDENT IN RECONSTITUTED FLUIDS, THE DRUG SOLUTION SHOULD BE DISCARDED.
As with other cephalosporins, the color of MAXIPIME powder, as well as its solutions, tend to darken depending on storage conditions; however, when stored as recommended, the product potency is not adversely affected.