Persius/hicric huggingface dataset:
Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)
For the WikiPatient page for this topic, click here
Synonyms and keywords: Natural orifice translumenal endoscopic surgery, Single incision laparoscopic surgery, Minimally invasive surgery, Transanal endoscopic microsurgery, Natural orifice surgery consortium for assessment and research, Society of american gastrointestinal and endoscopic surgeons.

# Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)
Senior leadership from the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal Endoscopic Suregons (SAGES) organized a working group of surgeons and gastroenterologists who met in New York City on July 22 and 23, 2005 to develop standards for the practice of this emerging technique. This group is known as the Natural Orifice Surgery Consortion for Assessment and Research (NOSCAR). A White Paper on NOTES was released by NOSCAR simultaneously in two medical journals in May 2006 . This paper identified the major areas of research that need to be addressed before NOTES can become a viable clinical application for patients. These areas include development of a reliable closure technique for the internal incision, prevention of infection, and creation of advanced endoscopic surgical tools .
Some of NOSCAR tasks include:
- Producing White Papers which focus on the challenges that need thought and research.
- Tracking the groups of similar research projects that address the previous challenges.
- Organizing the research projects, enhance collaboration and attract funding to key areas of study.
- Building a robust outcomes database by collecting submission of data.
- Fostering collaborative clinical trials.
The White Paper on NOTES and the guidlines for participation in NOSCAR can be found in this external link ().
NOSCARTM - What is it and why does it matter? (By Dr. David Rattner, NOSCARTM co-founder, in SAGES 2008 Meeting) {{#ev:youtube|cnHUYpvqzHE&feature=relmfu}}
Polyethylene glycol-electrolyte solution (PEG-ES) (patient information)

# Why is this medication prescribed
Polyethylene glycol-electrolyte solution (PEG-ES) is used to cleanse the bowel before a gastrointestinal examination or surgery. It works by causing diarrhea.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How should this medicine be used
Polyethylene glycol-electrolyte solution (PEG-ES) comes as a powder to take by mouth. You should prepare the solution in the container; follow the instructions on the label carefully. An 8-ounce glass of solution should be rapidly swallowed every 10 minutes until the prescribed amount of liquid has been taken or your stool is watery, clear, and free of solid matter. Your doctor will tell you at what time you should begin drinking PEG-ES. You should not eat for at least 3-4 hours before you are told to begin drinking PEG-ES. You should not take any oral medications within 1 hour of starting PEG-ES. You should begin having bowel movements within 1 hour of beginning PEG-ES. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take PEG-ES exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

# What special precautions should I follow
Before taking PEG-ES:
- tell your doctor and pharmacist if you are allergic to PEG-ES or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins or herbal products.
- tell your doctor if you have or have ever had a gastrointestinal disease or obstruction.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

# Side effects

## Mild side effects
PEG-ES may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- upset stomach
- stomach pain
- bloating
- vomiting
- rectal irritation

## Severe side effects
If you experience any of the following symptoms, call your doctor immediately:
- rash
- hives
- skin irritation
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the mixed solution in the refrigerator and use it within 48 hours. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# What other information should I know
Keep all appointments with your doctor and the laboratory.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- CoLyte
- GoLYTELY
TRANSCEND Study suggests that telmisartan reduces cardiovascular events
August 31, 2008 by Scott P. Williams 
ESC Congress 2008- Munich, DE:  Researchers from McMaster University reported that the angiotensin-receptor blocker (ARB), telmisartan, while well tolerated by patients and associated with a modest reduction in the secondary outcome of cardiovascular death, myocardial infarction, and stroke, failed to meet its primary endpoint. These results were presented by Dr. Koon Teo, on behalf of the TRANSCEND (Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease) Study investigators, as part of the Hot Line at the ESC 2008 Congress. The full results were published online today in The Lancet.
The TRANSCEND Study was composed of 5926 patients who are unable to tolerate angiotensin-converting enzyme (ACE) inhibitors. Following a three-week run-in period patients were randomized to either 80 mg/day of telmisartan (n=2954) or placebo (n=2972). Patients were recruited at 630 centers located in 40 countries. The duration of follow up was a median of 56 months, with a maximum and minimum of 64 and 51 months, respectively.
Telmisartan was well tolerated by patients. 23.8% (n=705) of patients in the placebo group permanently discontinued study drug compared to 21.6% (n=639) of patients who received telmisartan (p=0.055). The most frequent reason for study drug discontinuation was hypotensive symptoms, which was more frequent in patients who received telmisartan (0.54%  vs. 0.98% ). Patients who received telmisartan had a lower mean blood pressure than patients who received placebo in this study.
The trials primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. 17.0% (n=504) of patients who received placebo sustained this composite outcome compared to 15.7% (n=465) of patients who received telmisartan (hazard ratio 0.92, 95% CI 0.811.05, p=0.216). 14.8% (n=440) of patients in the placebo group and 13.0% (n=384) of patients in the telmisartan group suffered a secondary efficacy outcome, a composite of cardiovascular death, myocardial infarction, and stroke (0.87, 0.761.00, p=0.048 unadjusted; p=0.068 after adjustment for multiplicity of comparisons and overlap with primary endpoint).
The TRANSCEND Study investigators call telmisartans lack of effect on hospitalization for heart failure unexpected and puzzling and consider this an area in need of further research.
The statistically significant 13% reduction in the composite occurrence of cardiovascular death, myocardial infarction, and stroke suggests thattelmisartan could prove valuable in reducing the occurrence of major cardiovascular events among patients who are unable to tolerate the standard therapy of ACE inhibitors.
The TRANSCEND Study was supported by a grant from Boehringer Ingelheim. Additionally, Dr. S. Yusuf was supported by the Heart and Stroke Foundation of Ontario, and a Senior Scientist Award from the Canadian Institutes of Health Research.
Reviewed by C. Michael Gibson, M.S., M.D.
Acute mesenteric ischemia natural history, complications and prognosis

# Overview
Acute mesenteric ischemia is an emergency that is associated with high rate of mortality as the treatment id delayed. The early initiation of treatment is associated with low mortality rate ranging from 0 to 10%; whereas delayed treatment beyond 24 hours from the onset of symptoms carries an elevated mortality rate that reaches 80 to 100%. Bad prognostic factors are increased age, presence of comorbidities, non occlusive mesenteric ischemia and a delay initiation in the initiation of treatment.

# Natural History, Complications and Prognosis

## Mortality
- The mortality associated with acute mesenteric ischemia ranges in general from 50 to 70%, which makes this disease an emergency requiring prompt diagnosis and initiation of treatment.
- Acute mesenteric ischemia is associated with such an elevated mortality rate because of:
The pathophysiology of the disease itself and effects of hypoxia on the survival of cells of the mesentery
Delay in diagnosis
Delay in treatment
- The pathophysiology of the disease itself and effects of hypoxia on the survival of cells of the mesentery
- Delay in diagnosis
- Delay in treatment

## Prognosis
The prognostic factors in acute mesenteric ischemia includes the following:

### Delay in diagnosis and treatment:
The early initiation of treatment is associated with low mortality rate ranging from 0 to 10%; whereas delayed treatment beyond 24 hours from the onset of symptoms carries an elevated mortality rate that reaches 80 to 100%.

### Location of ischemia:
Ischemia in the peripheral portion of the mesentery are associated with worse prognosis compared to ischemia in the central parts of the small intestine due to the presence of collateral vessels.

### Underlying cause and pathophysiology:
Non occlusive mesenteric ischemia is associated with worse prognosis compared to occlusive mesenteric ischemia because nonocclusive mesenteric ischemia usually has a non typical presentation causing a delay in diagnosis and treatment.
Mesenteric thrombosis is associated with less mortality compared to superior mesenteric artery ischemia.

### Age of the patient:
Elderly patients have higher risk of mortality compared to younger patients.

### Comorbidities
Clinical event adjudication: Unstable angina requiring hospitalization
For the list of clinical event adjudication definitions, click here
This chapter presents unstable angina requiring hospitalization definitions used in the Clinical Event Committee adjudication processes. These definitions are current as of 3/26/10.

# Unstable angina requiring hospitalization
Unstable angina requiring hospitalization is defined as:
- Symptoms of myocardial ischemia at rest (chest pain or equivalent) or an accelerating pattern of angina with frequent episodes associated with progressively decreased exercise capacityAND
- Prompting an unscheduled visit to a healthcare facility and hospitalization (including chest pain observation units) within 24 hours of the most recent symptomsAND
- At least one of the following:
- ST elevationNew ST elevation at the J point in two anatomically contiguous leads with the cut-off points:   0.2 mV in men (> 0.25 mV in men < 40 years) or  0.15 mV in women in leads V2-V3 and/or  0.1 mV in other leads.
- ST depression and T-wave changesNew horizontal or down-sloping ST depression  0.05 mV in two contiguous leads; and/or new T inversion  0.1 mV in two contiguous leads.

# General Considerations
- Escalation of pharmacotherapy for ischemia, such as intravenous nitrates or increasing dosages of -blockers, should be considered supportive of the diagnosis of unstable angina.  However, a typical presentation and admission to the hospital with escalation of pharmacotherapy, without any of the additional findings listed under category 3, would be insufficient alone to support classification as hospitalization for unstable angina.
- If subjects are admitted with suspected unstable angina, and subsequent testing reveals a non-cardiac or non-ischemic etiology, this event should not be recorded as hospitalization for unstable angina.  Potential ischemic events meeting the criteria for myocardial infarction should not be adjudicated as unstable angina.
- Planned rehospitalization for performance of an elective revascularization in the absence of symptoms at rest prompting admission should not be considered a hospitalization for unstable angina.  For example, a patient with stable exertional angina whose admission for coronary angiography and PCI is prompted by a positive outpatient stress test should not be considered a hospitalization for unstable angina.
- A patient who undergoes an elective catheterization where incidental coronary artery disease is found and who subsequently undergoes coronary revascularization will not be considered as meeting the hospitalization for unstable angina endpoint.
Family with sequence similarity 19 member A4, C-C motif chemokine like
Family with sequence similarity 19 member A4, C-C motif chemokine like is a protein that in humans is encoded by the FAM19A4 gene.

# Function
This gene is a member of the TAFA family which is composed of five highly homologous genes that encode small secreted proteins. These proteins contain conserved cysteine residues at fixed positions, and are distantly related to MIP-1alpha, a member of the CC-chemokine family. The TAFA proteins are predominantly expressed in specific regions of the brain, and are postulated to function as brain-specific chemokines or neurokines, that act as regulators of immune and nervous cells. Alternatively spliced transcript variants have been observed for this gene. .
Hyperlipidemia statins in children and adolescents with hyperlipidemia

# Overview
Children and adolescents with high-risk hyperlipidemia require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia, despite compliance with lifestyle recommendations.

# NCEP Recommendations for Statins in Children and Adolescents With Hyperlipidemia

## NCEP Recommendations for the Use of 3-hydroxy-3-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors (Statins) in Children and Adolescents With Hyperlipidemia (DO NOT EDIT)
Special Supplemental Nutrition Program for Women, Infants and Children
The Special Supplemental Nutrition Program for Women, Infants and Children (known as WIC) is a Federal assistance program of the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) for healthcare and nutrition of low-income pregnant women, breastfeeding women, and infants and children under the age of five. The eligibility requirement is a family income  below 185% of the U.S. Poverty Income Guidelines.  If a person who participates in other benefit programs, or has family members participate in the Food Stamp Program, Medicaid, or Temporary Assistance for Needy Families, they automatically meet the eligibility requirements. This program is unrelated to the USDA's "Food Stamp" program.
The Special Supplemental Nutrition Program for Women, Infants, and Children was created by a 1972 bill that Senator Humphrey (D) of Minnesota introduced. It was made permanent in 1975.
WIC participants often receive a monthly check or voucher.  In many poor areas, "WIC stores" exist that only sell food for vouchers issued by the state WIC program, and do not accept any other form of payment. These stores charge the maximum permitted under the program, charging up to 16% more than regular stores for the same food. 
In 2006, the Federal Government decided to cut costs and initiated a ruling that started the end of WIC stores.  The WIC store association initiated a class action suit, but lost the case.  Within the last 2 years, over 80% of WIC stores have closed down due to the cost cutting measures dictated by the Government.  These measures including insisting WIC stores to sell at below cost price, which for over 90% of products is even less than the cost at Walmart and similar stores.
CDC Classification System for HIV Infection in Adults and Adolescents

# Overview
This classification system is how the United States agency, the Centers for Disease Control and Prevention (CDC) classifies HIV disease and infection. This is to allow the government to handle epidemic statistics and define who receives US government assistance. In 1993, the CDC added pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer to the list of clinical conditions in the AIDS surveillance case definition published in 1987 and expanded the AIDS surveillance case definition to include all HIV-infected persons with CD4+ T-lymphocyte counts of less than 200 cells/uL or a CD4+ percentage of less than 14. Considerable variation exists in the relative risk of death following different AIDS defining clinical conditions.

# CDC Classification System for HIV Infection in Adults and Adolescents
According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:
A CD4+ T-cell count below 200 cells/l (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).
-r he/she has one of the following defining illnesses:
- Candidiasis of bronchi, trachea, or lungs
- Candidiasis esophageal
- Cervical cancer (invasive)
- Coccidioidomycosis, disseminated or extrapulmonary
- Cryptococcosis, extrapulmonary
- Cryptosporidiosis, chronic intestinal for longer than 1 month
- Cytomegalovirus disease (other than liver, spleen or lymph nodes)
- Encephalopathy (HIV-related)
- Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
- Histoplasmosis, disseminated or extrapulmonary
- Isosporiasis, chronic intestinal (for more than 1 month)
- Kaposi's sarcoma
- Lymphoma Burkitt's, immunoblastic or primary brain
- Mycobacterium avium complex
- Mycobacterium, other species, disseminated or extrapulmonary
- Pneumocystis carinii pneumonia
- Pneumonia (recurrent)
- Progressive multifocal leukoencephalopathy
- Salmonella septicemia (recurrent)
- Toxoplasmosis of the brain
- Tuberculosis
- Wasting syndrome due to HIV
People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:
- undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
- OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
- OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia
AND
- the individual has had Pneumocystis carinii pneumonia
- OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/l (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).
Class III A recommendations in guidelines for cardiovascular medicine

# Overview
LOE A is defined as evidence obtained from either multiple populations, multiple randomized clinical trials, or meta-analyses of randomized clinical trials. The total number of class III-LOE A recommendations in guidelines published by American cardiology societies is 57.

# Class III A Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III A recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.

# Class III A Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III A recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.
Class III B recommendations in guidelines for cardiovascular medicine

# Overview
LOE B is defined as evidence obtained from either a limited number of populations, a single randomized clinical trial, or meta-analyses of non-randomized studies. The total number of class III-LOE B recommendations in guidelines published by American cardiology societies is 229.

# Class III B Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III B recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.

# Class III B Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III B recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.
Class III C recommendations in guidelines for cardiovascular medicine

# Overview
LOE C is defined as evidence obtained from either a very limited number of populations, consensus opinion of experts, case studies, or standard of care. The total number of class III-LOE C recommendations in guidelines published by American cardiology societies is 277.

# Class III C Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III C recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.

# Class III C Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III C recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.