Persius/hicric huggingface dataset:
Chronic aortic regurgitation medical therapy

# Overview
In the management of chronic aortic regurgitation, the left ventricular size and function should be monitored closely along with the exercise tolerance of the patient. If the patient develops heart failure symptoms and the disease starts to be symptomatic, then aortic valve replacement or valve repair is indicated. Annual echocardiographic studies are indicated in all patients with significant AR. Vasodilators such as ACE inhibitors, nifedipine, sodium nitroprusside, and hydralazine may slow the rate of progression of AR. The greatest benefit of medical therapy is among symptomatic patients and those with heart failure symptoms due to advanced disease, but in general, medical therapy has a limited role in AR because symptomatic cases should be treated with valve replacement if the patient is a good candidate for surgery. Warfarin and long-term anticoagulation is not recommended in AR if there are no other indications for anticoagulation.

# Medical Therapy
Medical therapy of chronic AR involves the use of vasodilators. Small trials have demonstrated a benefit from the administration of ACE inhibitors, nifedipine, sodium nitroprusside, and hydralazine in improving left ventricular wall stress, ejection fraction, and left ventricular mass. The use of these vasodilators is indicated only in those individuals who suffer from hypertension in addition to AR. The goal in using these pharmacologic agents is to decrease the afterload so that the left ventricle is unloaded. This results in reduction in left ventricular end diastolic pressure thereby preserving the left ventricular systolic function and also benefits the patients in left ventricular failure secondary to AR.
Long term therapy with nifedipine and hydralazine have shown to increase left ventricular ejection fraction, reduce left ventricular end diastolic volume, and reduction in left ventricular mass thereby delaying the need for valve surgery. While ACE inhibitors such as enalapril and quinapril have shown to decrease left ventricular mass and end diastolic volume but with no influence on ejection fraction.
Patients with severe AR with normal left ventricular function are recommended to undergo surgery though there are no sufficient evidences against medical management.
Use of drugs other than vasodilators, such as digoxin, diuretics, and other positive inotropic drugs for long term treatment have no supporting data. Beta blockers are relatively contraindicated since they decrease heart rate and prolong diastolic phase. There by increasing the back flow of blood from aorta. However, beta blockers can be considered in patients with bicuspid aortic valve with mild AR and aortic root diameter of more than 40mm.

# 2020 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases 

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

## Vasodilator Therapy (DO NOT EDIT)
Clindamycin palmitate hydrochloride warnings

# WARNINGS
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin palmitate hydrochloride for oral solution (Pediatric), and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C.difficile.
C.difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C.difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C.difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C.difficile, and surgical evaluation should be instituted as clinically indicated.
A careful inquiry should be made concerning previous sensitivities to drugs and other allergens.
Usage in Meningitis: Since clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis.
Cloxacillin Sodium dosage and administration

# Dosage and Administration
The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use.
Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillinsshould always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient, therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with penicillinase-resistant penicillins should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer term of therapy.
Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Penicillin-probenecid therapy is generally limited to those infections where very high serum levels of penicillin are necessary.
Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious, life-threatening infections (see PRECAUTIONS  General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
Dicloxacillin is best absorbed when taken on an empty stomach, and should be administered at least 1 hour before or 2 hours after meals. Dicloxacillin should be taken with at least 4 fluid ounces (120 mL) of water and should not be taken in the supine position or immediately before going to bed (see PRECAUTIONS).
Common palmar digital nerves of median nerve
In the palm of the hand the median nerve is covered by the skin and the palmar aponeurosis, and rests on the tendons of the Flexor muscles. Immediately after emerging from under the transverse carpal ligament the median nerve becomes enlarged and flattened and splits into a smaller, lateral, and a larger, medial portion.
The medial portion of the nerve divides into two Common palmar digital nerves (common volar digital nerves).
- The first of these gives a twig to the second Lumbricalis and runs toward the cleft between the index and middle fingers, where it divides into two proper digital nerves for the adjoining sides of these digits;
- the second runs toward the cleft between the middle and ring fingers, and splits into two proper digital nerves for the adjoining sides of these digits; it communicates with a branch from the ulnar nerve and sometimes sends a twig to the third Lumbricalis.
Diagnostic Testing Guidelines Recommendation

# Diagnostic Testing Guidelines

## 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease (DO NOT EDIT)

### Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease (DO NOT EDIT)

### Duplex Ultrasonography to Evaluate Asymptomatic Patients With Known or Suspected Carotid Stenosis (DO NOT EDIT)

### In revascularization candidates

### Carotid Artery Evaluation and Revascularization Before Cardiac Surgery (DO NOT EDIT)
Diethylcarbamazine dosage and administration

# Dosage and Administration
It is widely accepted that total cumulative dosages of 72 mg/kg are necessary to eliminate W. bancrofti infections. Lower dosages are recommended by some authorities for treating B. malayi and B. timori infections. Controlled studies are now ongoing to evaluate these recommendations. Children under 10 years of age should receive half the total adult dose.
The following dosage schedules are intended only as a guide since many countries have developed their own specific treatment regimens. The doses given are suitable for both adults and children aged over 10 years.
In all cases treatment is best initiated with smaller doses for 2-3 days in order to avoid the danger of immunological reactions.

### Lymphatic filariasis
Individual treatment: 6 mg/kg daily for 12 days administered orally, preferably in divided doses after meals.
Mass administration: 6 mg/kg in 24 hours administered, as above, 12 times at weekly or monthly intervals, or as a single annual dose.
Individual treatment: 3-6 mg/kg daily for 6-12 days administered orally, preferably in divided doses after meals.
Mass treatment: 3-6 mg/kg in 24 hours administered, as above, 6 times at weekly or monthly intervals.
In both China and India several trials have shown that, used consistently over a period of at least 6 months, table salt medicated with diethylcarbamazine at a concentration of 0.1% can eliminate W. bancrofti lymphatic filariasis. A concentration of 0.3% for 3-4 months may be necessary where B. malayi is endemic.

### Occult filariasis
A dose of 8 mg/kg daily for 14 days repeated, as necessary, if symptoms return.
Dilation and curettage (patient information)
For the WikiDoc page for this topic, click here

# Overview
D and C is a procedure to scrape and collect the tissue (endometrium) from inside the uterus.
- Dilation (D) is a widening of the cervix to allow instruments into the uterus.
- Curettage (C) is the scraping of the walls of the uterus.

# How is the Dilation and curettage done?
D and C, also called uterine scraping, may be performed in the hospital or in a clinic while you are under general or local anesthesia.
The health care provider will insert an instrument called a speculum into the vagina. This holds open the vaginal canal. Numbing medicine may be applied to the opening to the uterus (cervix).
The cervical canal is widened using a metal rod, and a curette (a metal loop on the end of a long, thin handle) is passed through the opening into the uterus cavity. The doctor gently scrapes the inner layer of tissue, called the endometrium. The tissue is collected for examination.

# Who needs Dilation and curettage?
This procedure may be done to:
- Diagnose conditions such as uterine cancer
- Remove tissue after a miscarriage
- Treat heavy menstrual bleeding or irregular periods
- Perform a therapeutic or elective abortion
Your doctor may also recommend a D and C if you have:
- Abnormal bleeding while on hormone replacement therapy
- An embedded intrauterine device (IUD)
- Bleeding after menopause
- Endometrial polyps
- Thickening of the uterus
This list may not be all-inclusive.

# Where to find centers that perform Dilation and curettage?
Directions to Hospitals Performing Dilation and curettage

# What to expect (Outlook/Prognosis)?
You may return to normal activities as soon as you feel better, possibly even the same day. There may be vaginal bleeding, as well as pelvic cramps and back pain for a few days after the procedure.
You can usually manage pain well with medications. Tampon use and sexual intercourse are not recommended for 1 - 2 weeks after this procedure.

# Possible complications
Complications related to D and C include:
- Puncture of the uterus
- Scarring of the uterine lining (Asherman syndrome, may lead to infertility later)
- Tear of the cervix
Complications due to anesthesia include:
- Reactions to medications
- Problems breathing
Complications of any surgery include:
- Bleeding
- Infection

# Results
D and C has few risks. It can provide relief from bleeding, and can help diagnose infection, cancer, and other diseases.

# Sources
Echocardiography in congenital heart disease
Edited by: Bradley Crotty, M.D. 

# Introduction
Congenital heart disease occurs in approximately 6 /1000 live births, and has advanced tremendously from the early descriptions and operations of the 1930s-1950s. Advances in diagnosis and treatment, including detection and in utero therapy, continue to push this field, making it more complex and specialized. An increasing number of patients are entering adulthood, and leaving the realm of the pediatric cardiologist. In academic medical centers, subspecialization of cardiologists into adult congenital disease is the norm.
Echocardiography is a tool that is used in both diagnosis as well as crucial follow-up for these congenital problems. Patients who are required surgery in the past, as well as patients with mild congenital malformations.  Not yet surgically corrected require vigilant follow-up from their cardiologist.  Long-term follow-up data from the most recent surgical procedures is still being accumulated, and the natural history of disease is still being modified accordingly.
Transthoracic echocardiography is a very useful tool for the follow-up and surveillance of these patients.  It allows for a noninvasive and radiation free imaging of heart valves, cardiac chambers, and estimations of pulmonary artery pressures. Many lesions require echocardiographic vigilance to ensure stability of repair.  These can include changes in artificial valves, or patch repair of septal defects, as patients grow.
Echocardiography findings by lesions will be discussed in this section, a company by echocardiography loops.  A brief discussion of postoperative changes by leash and will also be discussed.

# Lesions by category

# Heart Valves

## Congenital bicuspid valve
Congenital bicuspid valves are found in approximately 1-2% of adults.

## Aortic Stenosis

## Pulmonic Stenosis

# Septal Defects and Shunts

## ASD - primum

## ASD - secundum

## VSD

## Patent Ductus Arteriosis

# Aortic Arch Defects

## Coarctation

## Interrupted Aortic Arch

## Marfan's Syndrome

# Complex Lesions

## Tetrology of Fallot

## Transposition of Great Vessels

## Ebstein's Abnormality

## Double - outlet RV

## Atioventricular canal defects

## Hypoplastic Left Heart
> ==== Modified Fontan ====

# Other Lesions

## total anomolous pulmonary vein connection
--Bcrotty 17:19, 24 September 2007 (MST)
Endodermal sinus tumor (patient information)
For the WikiDoc page on this topic, click here

# Overview
The symptoms of endodermal sinus tumor include abdominal distention, acute/sub acute abdominal pain. Endodermal sinus tumor may be diagnosed using biopsy and measurement of  GATA-4, a transcription factor. The mainstay of therapy for endodermal sinus tumor is chemotherapy. Prognosis is good with treatment.

# What are the symptoms of Endodermal sinus tumor?
The symptoms of endodermal sinus tumor include abdominal distention, acute/sub acute abdominal pain.

# Diagnosis
Endodermal sinus tumor may be diagnosed using biopsy and measurement of  GATA-4, a transcription factor.

# Treatment options
The mainstay of therapy for endodermal sinus tumor is chemotherapy.

# Where to find medical care for Endodermal sinus tumor?
Directions to Hospitals Treating Endodermal sinus tumor

# What to expect (Outlook/Prognosis)?
- Prognosis is good with treatment.

# Sources
Eosinophilic fasciitis (patient information)
For the WikiDoc page for this topic, click here

# Overview
Eosinophilic fasciitis is a very rare syndrome in which muscle tissue underneath the skin, called fascia, becomes swollen and thick. Rapid swelling can occur in the hands, arms, legs, and feet.
The disease is similar in appearance to scleroderma but is not related.

# What are the symptoms of Eosinophilic fasciitis?
- Bone pain or tenderness
- Carpal tunnel syndrome
- Numbness or tingling in one or both hands
- Pain in one or both hands
- Weakness in one or both hands
- Muscle weakness
- Tenderness and swelling of the arms and legs (occasionally including joints)
- Thickened skin with puckered appearance

# What causes Eosinophilic fasciitis?
The cause of eosinophilic fasciitis is unknown. Fewer than 300 cases have been reported in the past 35 years.
People with this condition have a buildup of eosinophils, a type of white blood cell, in the affected fascia and muscles. Eosinophils are related to allergic reactions, but their exact function is unknown.

# Who is at highest risk?
The syndrome affects people of any age, but is more common in people ages 30 to 60.

# When to seek urgent medical care?
Call your health care provider for an appointment if you have symptoms of this disorder.

# Diagnosis
Tests that may be done include:
- Gamma globulins (a type of immune system cell)
- Erythrocyte sedimentation rate (ESR)
- MRI
- Muscle biopsy
- Skin biopsy

# Treatment options
Treatment with corticosteroids and other immune-suppressing medications relieves symptoms, especially when started early in the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help relieve symptoms.
If blood diseases develop, they are treated based on their type.

# Where to find medical care for Eosinophilic fasciitis?
Directions to Hospitals Treating Eosinophilic fasciitis

# What to expect (Outlook/Prognosis)?
In most cases, the condition goes away within 3 to 5 years. However, symptoms may return (recur) or persist. The outlook is much worse if blood diseases occur.

# Possible complications
Arthritis is a rare complication of eosinophilic fasciitis. Some patients may develop very serious blood disorders or blood-related cancers, such as aplastic anemia or leukemia.

# Prevention
There is no known prevention.
Generalized weakness resident survival guide
Synonyms and Keywords: generalized weakness, muscle weakness, approach to generalized weakness, generalized weakness workup, generalized weakness management, generalized weakness workup

# Overview
Generalized weakness or lack of strength is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individual's general physical fitness. The weakness may be caused due to affection in the muscle, nerve, or neuromuscular plate. Causes of generalized weakness may be as varied as cardiovascular, chemical, dermatologic, drugs side effects, endocrine, environmental, gastroenterologic, genetic, hematologic, iatrogenic, infectious, musculoskeletal, neurologic, nutritional, oncologic,  overdose, psychiatric, and renal. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Many times, the cause of weakness may be identified with the history and physical examination; emg may guide into the type of weakness, but other times biopsy or other laboratory test may be necessary.

# Causes

## Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Cadmium poisoning
- Dicamba poisoning
- Fluoride poisoning
- Hexane-2,5-dione poisoning
- Temik poisoning
- Benztropine Mesylate overdose
- Hypercalcemia
- Hyperkalaemic periodic paralysis
- Hypermagnesemia
- Hypermethioninemia
- Hypokalemic periodic paralysis
- Hypomagnesemia
- Hypophosphatemia
- Uremia

## Common Causes
- Guillian-Barre syndrome
- Myasthenia Gravis
- Polymyositis
- Lambert-Eaton syndrome
- Botulism

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of Generalized weakness according to the American Academy of Neurology guidelines:

# Treatment
Treat the underlying cause.
- To view the treatment of Guillian-Barre syndrome click here.
- To view the treatment of Myasthenia Gravis click here.
- To view the treatment of Polymyositis click here.
- To view the treatment of Lambert-Eaton syndrome click here.
- To view the treatment of Botulism click here.

# Do's
- Verify true weakness in the examination and rule-out muscle pain or fatigue.
- Inquiere about social history and family history for genetic disorders.
- Review medications list.
- Look for upper motor and lower motor neuron signs.
- Evaluate if weakness is symmetrical or asymmetrical, as well as for exacerbating factors.
- Order TSH testing.
- Order glucose and vitamin B12 when deficiency is suspected.
- Order serum and urine testing for drug and toxins exposure.
- Perform electromyogram and nerve conduction test if lab results are inconclusive.

# Don'ts
- Do not use a muscle biopsy as first testing modality; this should usually be reserved after all other diagnostic workup has failed to reveal a cause.
H.pylori gastritis guideline recommendations

# Overview
Evidence-based guidelines for H. pylori infection in children and adolescents in North America and Europe.

# Guideline
Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children.
Grades of evidence
1. High: Further research is unlikely to change confidence in the estimate of effect.
2. Moderate:  Further research is likely to have an important influence on confidence in the estimate of effect and may change the estimate.
3. Low:  Further research is very likely to have an important influence on confidence in the estimate of effect and may change the estimate.
4: Very low: Any estimate of effect is uncertain.
5: Not applicable: The grades of evidence were not relevant for a particular statement.
Haemophilus b conjugate vaccine how supplied

# How Supplied/Storage And Handling
HIBERIX is available in single-dose vials (contains no latex)of lyophilized vaccine, accompanied by disposable prefilled TIP-LOK syringes (may contain latex) (packaged without needles) containing 0.7 mL of saline diluent. The tip caps of the needleless prefilled syringes may contain natural rubber latex.

## Supplied as
NDC 58160-806-01 Vial of lyophilized vaccine in Package of 10: NDC 58160-806-05
NDC 58160-951-02 Syringe containing diluent in Package of 10: NDC 58160-951-11

## Storage Before Reconstitution
Lyophilized vaccine vials: Store refrigerated between 2 and 8C (36 and 46F). Protect vials from light.
Diluent: Store refrigerated between 2 and 8C (36 and 46F) or at a controlled room temperature between 20 and 25C (68 and 77F). Do not freeze. Discard if the diluent has been frozen.

## Storage After Reconstitution
HIBERIX should be administered within 24 hours of reconstitution. After reconstitution, store refrigerated between 2 and 8C (36 and 46F). Discard the reconstituted vaccine if not used within 24 hours. Do not freeze. Discard if the vaccine has been frozen.