Persius/hicric huggingface dataset:
Idiopathic short stature

# Overview
Idiopathic short stature (ISS) refers to extreme short stature that does not have a diagnostic explanation (idiopathic designates a condition that is unexplained or not understood) after an ordinary growth evaluation. The term has been in use since at least 1975 without a precise percentile or statistical definition of "extreme".
In 2003 Eli Lilly and Company offered a more precise definition of ISS when the pharmaceutical company submitted clinical trial data to the U.S. Food and Drug Administration (FDA) requesting approval to advertise their brand of growth hormone for the treatment of ISS. They proposed a definition of a height more than 2.25 standard deviations below mean, roughly equal to the shortest 1.2% of the population.
Other researchers have described a cutoff of 2.0 standard deviations.

# Controversies
Since 2003 this diagnosis has become controversial.
- Does it make sense to define a disease solely as a certain percentage of the population if there is little perceptible difference between a person just above the cutoff and another person just below the cutoff?
- How many of the people in the lowest 2% of the population are not simply "idiopathic" but rather have subtler disorders of growth hormone or IGF1 production or responsiveness or any of hundreds of other known or unknown conditions not readily detected by an "ordinary" growth evaluation?
- Should insurance or government (the other 99% of the population) pay US$100,000 or more (which is the estimated cost) to treat someone to move them from the first percentile to perhaps the 10th? Would that just transfer the disadvantages to those in what was previously the "2nd" percentile?
- Even if treatment successfully changes height to the 5th or 10th percentile, does it actually improve the person's life in any measurable way? There is some evidence that hormone treatment may not result in a significant improvement in psychosocial functioning.

# Treatment

## Medical Therapy
The use of insulin-like growth factor 1 or aromatase inhibitors have been proposed as an alternative to growth hormone.

# Related Chapters
- growth hormone treatment
Illness anxiety disorder

# Overview
Illness anxiety disorder is characterized by excessive health-related concerns, but unlike somatic symptom disorder, somatic symptoms are either absent or mild. Illness anxiety disorder results in an individual mistaking some sort of discomfort as a serious illness.

# Historical Perspective
- During Greek times, people believed that the viscera of the hypochondria were the seat of melancholy. Hypochondria literally converts to "beneath the cartilage between the ribs and navel".

# Classification
- Illness anxiety disorder falls under the category of anxiety disorders.

# Pathophysiology
- There is limited information regarding pathophysiology in anxiety disorders.

# Differential Illness anxiety disorder from other diseases
- Illness anxiety disorder must be differentiate from the following conditions:
- Persistent health-related anxiety
Anxiety disorder
Obsessive-compulsive disorder
Major depressive disorder
Schizophrenia
Delusional disorder
Major depressive disorder
- Persistent health-related anxiety
- Anxiety disorder
- Obsessive-compulsive disorder
- Major depressive disorder
- Schizophrenia
- Delusional disorder
- Major depressive disorder

# Epidemiology and Demographics

## Prevalence
- The prevalence of illness anxiety disorder is 1,300 to 10,000 per 100,000 (1.3% to 10%) of the overall population.

# Risk Factors
Risk factors for the development of illness anxiety disorder include:
- History of childhood abuse
- Serious childhood illness

# Natural History, Complications and Prognosis

## Natural History
If left untreated, illness anxiety disorder may lead to depression, panic disorder, and anxiety.

## Complications
- Pain reliever/ Sedative dependency
- Depression
- Panic Disorder
- Anxiety Disorder
- Complications can arise as a result of invasive testing

## Prognosis
Poor prognostic factors include:
- Decrement in physical function
- Damage to occupational performance
- History of sexual abuse

# Diagnostic Criteria

# History and Symptoms

## History
History includes:
- Checking your body multiple times in search of illness or other issues
- Going to the doctor very often to make sure that they are healthy
- Checking different medical sites and references frequently to see if they have an illness

# Laboratory Findings
The laboratory test of patients with illness anxiety disorder are usually normal.

# Imaging
The imaging studies of patients with illness anxiety disorder are usually normal.

# Treatment

## Psychotherapy
- The most effective treatment for illness anxiety disorder is cognitive behavioral therapy.

## Medical Therapy
- Selective serotonin reuptake inhibitors are a possible treatment option for illness anxiety disorder, but not enough is known about this form of treatment yet.

## Brain Stimulation Therapy
- Information regarding brain stimulation therapy as a treatment option for illness anxiety disorder is not yet known.
Impulse control disorder

# Overview
Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder (hot-headedness), kleptomania (stealing), pathological gambling, pyromania (fire-starting) and trichotillomania (pulling one's hair out). The onset of these disorders usually occurs between the ages of 7 and 15.
Impulsivity, the key feature of these disorders, can be thought of as seeking a small, short term gain at the expense of a large, long term loss.
Impulse-control disorders are considered to be part of the Obsessive-Compulsive Disorder spectrum.  They include:
- Intermittent explosive disorder
- Kleptomania
- Pyromania
- Pathological gambling
- Trichotillomania
Infantile refsum disease

# Overview
Infantile Refsum disease (IRD) is one of a small group of genetic diseases called peroxisome biogenesis disorders (PBD), which are part of a larger group of diseases called the leukodystrophies.
These are inherited conditions that damage the white matter of the brain and affect motor movements. IRD is the mildest of the PBDs; Zellweger syndrome, neonatal adrenoleukodystrophy, and rhizomelic chondrodysplasia have similar, but more severe symptoms.

# Historical Perspective

# Classification

# Pathophysiology

## Etiology
The PBDs are caused by defects in the genes that are associated with the breakdown of phytanic acid, a substance commonly found in foods. As a result, toxic levels of phytanic acid build up in the brain, blood, and other tissues.

# Causes

# Differentiating Infantile refsum disease from Other Diseases

# Epidemiology and Demographics

# Risk Factors

# Screening

# Natural History, Complications, and Prognosis

## Natural History

## Complications

## Prognosis
IRD is a fatal disease, but some children will survive into their teens and twenties, and possibly even beyond.

# Diagnosis

## Diagnostic Criteria

## History and Symptoms
Symptoms of IRD begin in infancy with a visual impairment called retinitis pigmentosa, which often leads to blindness, and hearing problems that usually progress to deafness by early childhood.
Other symptoms may include rapid, jerky eye movements (nystagmus); floppy muscle tone (hypotonia) and lack of muscle coordination (ataxia); mental and growth retardation; mild abnormalities in the form and structure of the face (dysmorphia); enlargement of the liver (hepatomegaly); and low cholesterol (hypocholesterolemia).
Although Adult Refsum disease and IRD have similar names, they are separate disorders caused by different biomechanisms involved in the breakdown of phytanic acid.

## Physical Examination

## Laboratory Findings

## Imaging Findings

## Other Diagnostic Studies

# Treatment
The primary treatment for IRD is to avoid foods that contain phytanic acid, including dairy products; beef and lamb; and fatty fish such as tuna, cod, and haddock.  Some infants and children may also require plasma exchange (plasmapheresis) in which blood is drawn, filtered, and reinfused back into the body, to control the buildup of phytanic acid.

## Medical Therapy

## Surgery

## Prevention
Inferior mesenteric vein
In human anatomy, the inferior mesenteric vein (IMV) is a blood vessel that drains blood from the large intestine.  It usually terminates when reaching the splenic vein, which goes on to form the portal vein with the superior mesenteric vein (SMV).  Anatomical variations include the IMV draining into the confluence of the SMV and splenic vein and the IMV draining in the SMV.
The IMV lies to the right of the similarly name artery, the inferior mesenteric artery, which originates from the abdominal aorta.

# Tributaries
Tributaries of the inferior mesenteric vein drain the large intestine, sigmoid colon and rectum and include the
- left colic vein
- sigmoid veins
- superior rectal vein

# Additional images
- The pancreas and duodenum from behind.
Intercostobrachial nerve
The lateral cutaneous branch of the second intercostal nerve does not divide, like the others, into an anterior and a posterior branch; it is named the intercostobrachial nerve.
It pierces the Intercostalis externus and the Serratus anterior, crosses the axilla to the medial side of the arm, and joins with a filament from the medial brachial cutaneous nerve.
It then pierces the fascia, and supplies the skin of the upper half of the medial and posterior part of the arm, communicating with the posterior brachial cutaneous branch of the radial nerve.
The size of the intercostobrachial nerve is in inverse proportion to that of the medial brachial cutaneous nerve.
A second intercostobrachial nerve is frequently given off from the lateral cutaneous branch of the third intercostal; it supplies filaments to the axilla and medial side of the arm.
Internal laryngeal nerve
The internal laryngeal nerve is the internal branch (ramus internus) of the superior laryngeal nerve. It descends to the hyothyroid membrane, pierces it in company with the superior laryngeal artery, and is distributed to the mucous membrane of the larynx.
Of these (sensory) branches some are distributed to the epiglottis, the base of the tongue, and the epiglottic glands; others pass backward, in the aryepiglottic fold, to supply the mucous membrane surrounding the entrance of the larynx, and that lining the cavity of the larynx as low down as the vocal folds.
A filament descends beneath the mucous membrane on the inner surface of the thyroid cartilage and joins the recurrent nerve.
Above the vocal folds the sensory innervation of the larynx is via the internal laryngeal nerve. Below the vocal folds it is by way of branches of the recurrent laryngeal nerve.

# Pathology
Irritation of the internal laryngeal nerve results in uncontrolled coughing - usually as a result of food or water in the laryngopharynx.

# Additional images
- The ligaments of the larynx. Antero-lateral view.
Internal pudendal artery
The internal pudendal artery is an artery that branches off the internal iliac artery, providing blood to the external genitalia.
The internal pudendal artery is the terminal branch of the anterior trunk of the internal iliac artery.  It is smaller in the female than in the male.

# Path
It exits the pelvic cavity through the greater sciatic foramen to enter the gluteal region.
It then curves around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen.
It travels through the pudendal canal with the internal pudendal veins and the pudendal nerve.

# Branches
The internal pudendal artery gives off the following branches:
Some sources consider the urethral artery a direct branch of the internal pudendal artery, while others consider it a branch of the perineal artery.
In males, the internal pudendal artery also gives rise to the perforating arteries of the penis.

# Additional images
- Right hip bone. Internal surface.
- The arteries of the pelvis.
- Dissection of side wall of pelvis showing sacral and pudendal plexuses.
- The deeper branches of the internal pudendal artery.
- Diagram of the arteries of the penis.
- The penis in transverse section, showing the bloodvessels.
International Nurses Day
Assistant Editor-In-Chief: Michelle Lew

# Overview
International Nurses Day (IND) is celebrated around the world every May 12. This day is celebrated to remember all of the valuable contributions nurses make to society.

## Background
The International Council of Nurses (ICN) has celebrated this day since 1965. In 1953 Dorothy Sutherland, an official with the U.S. Department of Health, Education and Welfare, had proposed that then-President Eisenhower proclaim a "Nurses Day," but he did not approve it.
In January 1974, the decision was made to celebrate the day on May 12 as it is the anniversary of the birth of Florence Nightingale, who is widely considered the founder of modern nursing. Each year, ICN prepares and distributes the International Nurses' Day  Kit. The kit contains educational and public information materials, for use by nurses everywhere.
As Florence Nightingale is no longer seen as a role model in some parts of the world, demands have arisen, for example by the British public sector union UNISON, to transfer this day on another date.  21 May, the birthday of Elizabeth Fry (1780-1845), has been suggested. Elizabeth Fry founded the Institution of Nursing Sisters and is also known for her work with prisoners. 
As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually. And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week (May 6-12) each year.

# UK celebrations
Each year on May 12th a service is held in Westminster Abbey in London. During the Service, a symbolic Lamp is taken from the Nurses' Chapel in the Abbey and handed from one nurse to another, thence to the Dean, who places it on the High Altar. This signifies the passing of knowledge from one nurse to another. At St Margaret's Church at East Wellow in Hampshire, where Florence Nightingale is buried, a service is also held on the Sunday after her birthday.

# Themes
ICN themes for International Nurses Day:
- 1988 - Safe Motherhood
- 1989 - School Health
- 1990 - Nurses and Environment
- 1991 - Mental Health - Nurses in Action
- 1992 - Healthy Ageing
- 1993 - Quality, costs and Nursing
- 1994 - Healthy Families for Healthy Nation
- 1995 - Women's Health: Nurses Pave the Way
- 1996 - Better Health through Nursing Research
- 1997 - Healthy Young People = A Brighter Future
- 1998 - Partnership for Community Health
- 1999 - Celebrating Nursing's Past, claiming the future
- 2000 - Nurses - Always there for you
- 2001 - Nurses, Always There for You: United Against Violence
- 2002 - Nurses Always There for You: Caring for Families
- 2003 - Nurses: Fighting AIDS stigma, working for all
- 2004 - Nurses: Working with the Poor; Against Poverty
- 2005 - Nurses for Patients Safety: Targeting counterfeit medicines and substandard medication
- 2006 - Safe staffing saves lives
- 2007 - Positive practice environments: Quality workplaces = quality patient care

# Nursing week
The U.S. and Canada celebrate their National Nursing Week each year from May 9 to May 15 each year. It was established in the U.S. by President Richard Nixon in 1974.
Intestinal capillariasis

# Overview
Capillariasis is a disease in the group of helminthiasis diseases caused by the nematode Capillaria philippinensis.

# Symptoms
Symptoms in infested humans include watery diarrhea, abdominal pain, edema, weight loss, borborygmus (stomach growling), and depressed levels of potassium and albumin in the blood.  In humans, the parasites damage the cells of the intestinal wall.  This damage interferes with the absorption of nutrients and the maintenance of a proper electrolyte balance.  Untreated C. philippinensis infestations are often fatal.

# Diagnosis
Diagnosis usually involves finding the eggs and/or adults of C. philippinensis in stool samples.

# Treatment and prevention
Anthelmintics such as mebendazole and albendazole have been reported to eliminate infestation of humans more effectively than thiabendazole.
Prevention is as simple as avoiding eating small, whole, uncooked fish.  However, in C. philippinensis endemic areas, such dietary habits are common and have been practiced for many generations.

## Antimicrobial Regimen
- 1. Intestinal capillariasis
- Preferred regimen: Albendazole 400 mg/day PO for 10 days
- Alternative regimen: Mebendazole 200 mg PO bid for 20 days
Intracranial hypotension

# Overview
Intracranial hypotension refers to a decreased pressure (hypotension) of the intracranial pressure.
It may be generated during the treatment of hydrocephalus.
"Spontaneous intracranial hypotension" (SIH), also known as a spontaneous low CSF (Cerebrospinal fluid) pressure headache, usually presents without any preexisting trauma or known violation of the epidural or thecal space.

# Symptoms
The headache is usually orthostatic and related to traction on pain-sensitive intracranial and meningeal structures.  The condition is benign and self limited.  It may be associated with nausea, vomiting, horizontal diplopia, unsteadiness, vertigo, altered hearing, neck pain/stiffness, interscapular pain, and occasionally visual field cuts.

# Diagnosis
The diagnosis is made based on history, exclusion of competing differential diagnoses, and the following studies:
MRIs with gadolinium may display diffuse patchy meningeal enhancement, "sagging" of the brain, tonsilar descent, and posterior fossa crowding.  This condition is associated with low CSF opening pressure on lumbar puncture (normal CSF pressure is at least 60 mmH2O or 590 Pa).
MR imaging is relatively sensitive and specific in the detection of benign or spontaneous intracranial hypotension.
The classic imaging features include:
- Thick linear enhancement of the pachymeninges, no enhancement of the sulci or brain surface, enhancement above and below the tentorium
- Enlargement of the pituitary gland
- Descent of the brain (low cerebellar tonsils)
- Subdural effusions (or hemorrhage in some patients)
- Subdural effusions
- Descent of the brain
- Enhancement of the pachymeninges
- Enhancement of the pachymeninges

# Treatment
Although conservative management should by attempted, an epidural blood patch should be attempted, as it is the treatment of choice.

# Related Chapters
- cerebrospinal fluid leak
Involutional melancholia

# Background
Involutional melancholia or involutional depression is a traditional name for a psychiatric disorder affecting mainly elderly or late middle-aged people, usually accompanied with paranoia. It is classically defined as 'depression of gradual onset occurring during the involutional years (40-55 in women and 50-65 in men), with symptoms of marked anxiety, agitation, restlessness, somatic concerns, hypochondriasis, occasional somatic or nihilistic delusions, insomnia, anorexia, and weight loss.

# Literature review
Emil Kraepelin (1907) was the first to describe Involutional melancholia as a distinct clinical entity separate from the manic-depressive psychosis. Dreyfus (1907) challenged his concepts of origin and he thought it to be endogenous in origin. Kirby (1909) described it as a distinctive syndrome, as did Hoch and MacCurdy in 1922. Titley (1936) described the premorbid personality and narrow range of interests, etc., Kallman (1959) found incidence of schizophrenia in the families of such patients.

# Characteristic symptoms
- Previous illness of depressive conditions
- Symptoms of fear
- Despondency and hypochondriacal delusions
- Late onset of the disorder
- Prolonged course with poor prognosis and/or deterioration

# Etiology
It was first thought to be of acquired conditions till as early as 1907, when Dreyfus challenged it to be of endogenous origin after studying 85 of Kraepelin's original patients.

# Treatments
Involutional melancholia is classically treated with antidepressants and mood elevators.
Ligand-gated ion channel
The Ligand-gated ion channels, also referred to as LGICs, or ionotropic receptors, are a group of intrinsic transmembrane ion channels that are opened or closed in response to binding of a chemical messenger, as opposed to voltage-gated ion channels or stretch-activated ion channels.

# Regulation
The ion channel is regulated by a ligand and is usually very selective to one or more ions like Na+, K+, Ca2+, or Cl-. Such receptors located at synapses convert the chemical signal of presynaptically released neurotransmitter directly and very quickly into a postsynaptic electrical signal.
Many LGICs are additionally modulated by allosteric ligands, by channel blockers, ions, or the membrane potential.

# Example: nicotinic acetylcholine receptor
The prototypic ligand-gated ion channel is the nicotinic acetylcholine receptor. It consists of a pentamer of protein subunits, with two binding sites for acetylcholine, which, when bound, alter the receptor's configuration and cause an internal pore to open.  This pore, permeable to Na+, allows Na+ ions to flow down their electrochemical gradient into the cell. With a sufficient number of channels opening at once, the intracellular Na+ concentration rises to the point at which the positive charge within the cell is enough to depolarize the membrane, and an action potential is initiated.

# Classification and examples
Many important ion channels are ligand-gated, and they show a great degree of homology at the genetic level. The Ligand-gated ion channels are classified into three superfamilies:

## The Cys-loop receptors
- anionic
GABAA
GABAC
Glycine
- GABAA
- GABAC
- Glycine
- cationic
5-HT3 serotonin receptor
nicotinic acetylcholine receptor
- 5-HT3 serotonin receptor
- nicotinic acetylcholine receptor

## The ionotropic glutamate receptors
- NMDA
- Kainate
- AMPA

## The ATP-gated channels
- P2X

# Clinical relevance
Ligand-gated ion channels are likely to be the major site at which anaesthetic agents have their effects, although unequivocal evidence of this is yet to be established. In particular, the GABA and NMDA receptors are affected by anaesthetic agents at concentrations similar to those used in clinical anaesthesia.