Persius/hicric huggingface dataset:
Azygous continuation of the inferior vena cava

# Overview
- Azygos continuation of the IVC is AKA absence of the hepatic segment of the IVC with azygos continuation.
- The renal portion of the IVC receives blood return from both kidneys and passes posterior to the diaphragmatic crura to enter the thorax as the azygos vein.
- The azygos vein joins the superior vena cava at the normal location in the right paratracheal space.
- The hepatic segment (often termed the posthepatic segment) is ordinarily not truly absent; rather, it drains directly into the right atrium.
- Each gonadal vein drains to the ipsilateral renal vein.
- Formerly thought to be predominantly associated with severe congenital heart disease and asplenia or polysplenia syndromes, azygos continuation of the IVC has become increasingly recognized in otherwise asymptomatic patients since the advent of cross-sectional imaging.
- It is important to recognize the enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided paratracheal mass or retrocrural adenopathy.
- Preoperative knowledge of the anatomy may be important in planning cardiopulmonary bypass and to avoid difficulties in catheterizing the heart.

# Diagnosis
- The renal portion of the IVC receives blood return from both kidneys and passes posterior to the diaphragmatic crura to enter the thorax as the azygos vein.
- The azygos vein joins the superior vena cava at the normal location in the right paratracheal space.

## Chest x-ray
Image shown below is courtesy of RadsWiki and copylefted

## CT
Images shown below are courtesy of RadsWiki and copylefted

# See Also
- Double inferior vena cava
- Left inferior vena cava
- Persistent left superior vena cava
Gallstone pancreatitis resident survival guide
Synonyms and keywords: Biliary pancreatitis

# Overview
Gallstone pancreatitis is an acute pancreatitis caused by gallstones.  Gallstone pancreatitis is suspected when an acute pancreatitis patient with or without previous history of biliary colic or gallbladder related symptoms presents with elevated serum alanine aminotransferase (ALT) levels and evidence of gallstones or common bile duct stones on abdominal ultrasound.

# Causes

## Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.  Gallstone pancreatitis may be a life-threatening condition, especially if it presents with suppurative cholangitis and progresses to necrotizing pancreatitis, and it should be treated as such irrespective of the causes.

## Common Causes
- Cholelithiasis
- Choledecholithiasis
- Biliary sludge

# Management
Shown below is an algorithm depicting the management of gallstone pancreatitis according to the American College of Gastroenterology (ACG) and the Society for Surgery of the Alimentary Tract (SSAT).
ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; CBC: Complete blood count; ERCP: Endoscopic retrograde cholangiopancreatography; GB: Gallbladder; GGT: Gamma-glutamyl transpeptidase; H/o History of; ICU: Intensive care unit; IOC: Intraoperative cholangiography; IV: Intravenous; Sx: Symptom

# Modified Marshall Scoring System
 A score of 2 or more in any system defines the presence of organ failure. 
 A score for patients with pre-existing chronic renal failure depends on the extent of further deterioration of baseline renal function. No formal correction exists for a baseline creatinine 134 mol/l or 1.4 mg/dl.
 For non-ventilated patients, the FiO2 can be estimated from below:

# Grades of Severity
The definitions of severity in acute pancreatitis according to the revised Atlanta classification is as follows.
- Mild acute pancreatitis
- Moderately severe acute pancreatitis
- Severe acute pancreatitis

# Do's
- Refer the patient for prompt cholecystectomy once gallstones are identified as the etiology for pancreatitis in order to prevent recurrent attacks and potential biliary sepsis.
- Perform cholecystectomy before discharging the patient with mild acute pancreatitis due to gallstones in order to prevent the recurrence (strong recommendation, moderate quality of evidence).
- Perform cholecystectomy in mild acute pancreatitis after resolution of abdominal pain and normalization of laboratory values.
- Consider serum triglyceride as the etiology if its >1000 mg/dl in the absence of gallstones and/or history of significant history of alcohol use (conditional recommendation, moderate quality of evidence).

# Dont's
- Do not request an ERCP in patients with gallstone pancreatitis who lack laboratory or clinical evidence of ongoing biliary obstruction (strong  recommendation, low quality of evidence).
Idiopathic inflammatory demyelinating diseases

# Overview
Idiopathic Inflammatory Demyelinating Diseases (IIDDs), sometimes known as Borderline forms of multiple sclerosis, is a collection of multiple sclerosis variants, sometimes considered different diseases.

# Historical Perspective

# Classification

# Pathophysiology

# Causes

# Differentiating Idiopathic inflammatory Demyelinating Diseases from other Diseases
The list of these diseases depends of the author, but usually are included:
- Optic-spinal MS and neuromyelitis optica (NMO or Devic's disease), which are currently considered variants of the same condition.
- Acute disseminated encephalomyelitis or ADEM, a closely related disorder in which a known virus or vaccine triggers autoimmunity against myelin.
- Balo concentric sclerosis, a pathological form.
- Schilder disease or diffuse myelinoclastic sclerosis: is an infrequent disease that presents clinically as a pseudotumoural demyelinating lesion; and is more common in children.
- Marburg multiple sclerosis, pathological form, also known as malignant, fulminant or acute MS.
As MS is an active field for research, the list is not closed or definitive. For example, some diseases like Susac's syndrome (MS has an important vascular component ) or autoimmune variants of peripheral neuropathies like Guillain-Barre syndrome could be included.
Some authors also think that primary progressive multiple sclerosis should be considered a different entity from standard MS
. Others maintain the opposite.
Finally, also a dual classification of these diseases has been proposed, according to the shape of edges of the scars, in MS-like and ADEM-like

# Epidemiology and Demographics

## Age

## Gender

## Race

# Risk Factors

# Natural History, Complications and Prognosis

# Diagnosis

## Diagnostic Criteria

## Symptoms

## Physical Examination

## Laboratory Findings

## Imaging Findings

## Other Diagnostic Studies

# Treatment

## Medical Therapy

## Surgery

## Prevention
Brief reactive psychosis (patient information)
For the WikiDoc page for this topic, click here

# Overview
Brief reactive psychosis is a sudden, short-term display of psychotic behavior, such as hallucinations or delusions, that occurs with a stressful event.

# What are the symptoms of Brief reactive psychosis?
- Symptoms of brief reactive psychosis may include the following:
- Disorganized behavior
- False ideas about what is taking place (delusions)
- Hearing or seeing things that aren't real (hallucinations)
- Strange speech or language
- The symptoms are not due to alcohol or other drug abuse and they last longer than a day, but less than a month.

# What causes Brief reactive psychosis?
- Brief reactive psychosis is triggered by extreme stress (such as a traumatic accident or loss of a loved one), and is followed by a return to the previous level of function. The person may or may not be aware of the strange behavior.
- This condition most often affects people in their 20s, 30s, and 40s. People who have personality disorders are at greater risk for having a brief reactive psychosis.

# When to seek urgent medical care?
Call for an appointment with a mental health professional if you have symptoms of this disorder. If you are concerned for your safety or for the safety of someone else, call the local emergency number (such as 911) or go immediately to the nearest emergency room.

# Diagnosis
- A psychiatric evaluation can confirm the diagnosis.
- A physical exam and laboratory testing can rule out medical illness as the cause of the symptoms.

# Treatment options
- By definition, psychotic symptoms go away on their own in less than 1 month.
- In some cases, however, brief reactive psychosis can be the beginning of a more chronic psychotic condition, such as schizophrenia or schizoaffective disorder.
- Antipsychotic drugs can help decrease or stop the psychotic symptoms.
- Talk therapy may also help you cope with the emotional stress that triggered the problem.

# Where to find medical care for Brief reactive psychosis?
Directions to Hospitals Treating Brief reactive psychosis

# What to expect (Outlook/Prognosis)?
Most people with this disorder have a good outcome. Repeat episodes may occur in response to stress.

# Possible complications
As with all psychotic illnesses, this condition can severely disrupt your life and possibly lead to violence and suicide.

# Source
Bromodomain and WD repeat-containing protein 3
Bromodomain and WD repeat-containing protein 3 is a protein that in humans is encoded by the BRWD3 gene.

# Function
The protein encoded by this gene contains a bromodomain and several WD repeats. It is thought to have a chromatin-modifying function, and may thus play a role in transcription.

# Clinical significance
Mutations in this gene can cause mental retardation or permanent paralysis X-linked type 93, which is also referred to as mental retardation X-linked with macrocephaly. This gene is also associated with translocations in patients with B-cell chronic lymphocytic leukemia.
Carbenicillin indanyl sodium adverse reactions

# Adverse Reactions
The following adverse reactions have been reported as possibly related to Geocillin administration in controlled studies which include 344 patients receiving Geocillin.

## Gastrointestinal
The most frequent adverse reactions associated with Geocillin therapy are related to the gastrointestinal tract. Nausea, bad taste, diarrhea, vomiting, flatulence, and glossitis were reported. Abdominal cramps, dry mouth, furry tongue, rectal bleeding, anorexia, and unspecified epigastric distress were rarely reported.

## Dermatologic
Hypersensitivity reactions such as skin rash, urticaria, and less frequently pruritus.

## Hematologic
As with other penicillins, anemia, thrombocytopenia, leukopenia, neutropenia, and eosinophilia have infrequently been observed. The clinical significance of these abnormalities is not known.

## Miscellaneous
Other reactions rarely reported were hyperthermia, headache, itchy eyes, vaginitis, and loose stools.

## Abnormalities of Hepatic Function Tests
Mild SGOT elevations have been observed following Geocillin administration.
Cardiac allograft vasculopathy medical therapy

# Overview
Once CAV has developed, pharmacologic options to halt progression are limited. Moreover, outcomes resulting from available treatment have been disappointing. Retransplantation is the only definitive treatment of established CAV. Ideal regimen should not affect the lipid profile, blood pressures and renal function, and should have a positive impact on hemodynamics.

# Medical Therapy
Treatment option for established CAV include:

## Pharmacologic Management

### High Dose Immunosuppressive Therapy
- Lamich and colleagues  studied the effects of augmented immunosuppressive therapy on progression of established CAV in a prospective trial of 76 cardiac allograft recipients. They concluded that the likelihood of CAV regression is higher when treatment was instituted within one year of transplant (92%) compared to after one year (40%) (P=0.033).
- However, this is not routinely practiced as the risks of high dose immunosuppressive therapy outweighs the benefits.
Carnitine-acylcarnitine translocase deficiency
Carnitine-acylcarnitine translocase deficiency is a rare condition that prevents the body from converting long-chain fatty acids into energy, particularly during periods without food. Carnitine, a natural substance acquired mostly through the diet, is used by cells to process fats and produce energy. People with this disorder have a faulty enzyme that prevents long-chain fatty acids from being transported into the innermost part of the mitochondria for processing.

# Presentation
The signs of carnitine-acylcarnitine translocase deficiency usually begin within the first few hours of life. Seizures, an irregular heartbeat, and breathing problems are often the first signs of this disorder. This disorder may also cause extremely low levels of ketones (products of fat breakdown that are used for energy) and low blood sugar (hypoglycemia). Together, these two signs are called hypoketotic hypoglycemia. Other signs that are often present include ammonia in the blood (hyperammonemia), an enlarged liver (hepatomegaly), heart abnormalities (cardiomyopathy), and muscle weakness. This disorder can cause sudden infant death.

# Pathiophysiology
Mutations in the SLC25A20 gene lead to the production of a defective version of an enzyme called carnitine-acylcarnitine translocase.
Without this enzyme, long-chain fatty acids from food and fats stored in the body cannot be broken down and processed. As a result, these fatty acids are not converted into energy, which can lead to characteristic signs and symptoms of this disorder, such as weakness, hypoglycemia, and an irregular heartbeat. Free long-chain fatty acids or those that are joined with carnitine can affect the electrical properties of cardiac cells causing an irregular heart beat (arrhythmia, which can lead to cardiac arrest). Fatty acids may also build up in tissues and can damage the heart, liver, and muscles, and cause more serious complications.
Chediak-Higashi syndrome (patient information)
For the WikiDoc page for this topic, click here

# Overview
Chediak-Higashi syndrome is rare disease of the immune and nervous systems that involves by pale-colored hair, eyes, and skin.

# What are the symptoms of Chediak-Higashi syndrome ?
Children with this condition may have:
- Silver hair, light-colored eyes (albinism)
- Increased infections in the lungs, skin, and mucous membranes
- Jerky eye movements (nystagmus)
Infection of affected children with certain viruses, such as Epstein-Barr virus (EBV), can cause a deadly illness resembling the blood cancer lymphoma.
Other symptoms may include:
- Decreased vision
- Intellectual disability (mental retardation)
- Muscle weakness
- Nerve problems in the limbs (peripheral neuropathy)
- Nosebleeds or easy bruising
- Numbness
- Tremor
- Seizures
- Sensitivity to bright light (photophobia)
- Unsteady walking (ataxia)

# What causes Chediak-Higashi syndrome ?
Chediak-Higashi syndrome is passed down through families (inherited). It is an autosomal recessive disease. This means that both parents must pass the faulty gene to the child to show symptoms of the disease.
Defects have been found in the CHS1 (also called LYST) gene. The primary defect in this disease is found in certain substances normally present in skin cells and certain white blood cells.

# Diagnosis
The doctor will perform a physical exam. This may show signs of a swollen spleen or liver or jaundice.
Tests that may be done include:
- Complete blood count, including white blood cell count
- Blood platelet count
- Blood culture and smear
- Brain MRI or CT
- EEG
- EMG
- Nerve conduction tests

# When to Contact a Medical Professional ?
Call your health care provider if you have a family history of this disorder and you are planning to have children.
Call for an appointment with your health care provider if your child shows symptoms of Chediak-Higashi syndrome.

# Treatment
There is no specific treatment for Chediak-Higashi syndrome. Bone marrow transplants appear to have been successful in several patients, especially when performed early in the disease.
Antibiotics are used to treat infections. Antiviral drugs such as acyclovir and chemotherapy drugs are often used in the accelerated phase of the disease. Surgery may be needed to drain abscesses in some cases.

# Prevention of Chediak-Higashi syndrome
Genetic counseling is recommended before becoming pregnant if you have a family history of Chediak-Higashi.

# What to expect (Outlook/Prognosis)?
Death often occurs in the first 10 years of life, from chronic infections or accelerated disease that results in lymphoma-like illness. However, some affected children have survived longer.

# Possible complications
- Frequent infections especially with Epstein-Barr virus
- Lymphoma-like cancer
- Early death

# Sources
Demeclocycline hydrochloride adverse reactions

# Adverse Reactions
The following reactions have been reported in patients receiving tetracyclines:
Gastrointestinal: Anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, pancreatitis, and inflammatory lesions (with monilial overgrowth) in the anogenital region, increases in liver enzymes, and hepatic toxicity has been reported rarely.
Rarely, hepatitis and liver failure have been reported. These reactions have been caused by both the oral and parenteral administration of tetracyclines.
Instances of esophageal ulcerations have been reported in patients receiving oral tetracyclines. Most of the patients were reported to have taken the medication immediately before lying down. (See DOSAGE AND ADMINISTRATION.)
Skin: Maculopapular and erythematous rashes, erythema multiforme. Exfoliative dermatitis has been reported but is uncommon. Fixed drug eruptions and Stevens-Johnson syndrome have been reported rarely. Lesions occurring on the glans penis have caused balanitis. Pigmentation of the skin and mucous membranes has also been reported. Photosensitivity is discussed above. (See WARNINGS.)
Renal toxicity: Acute renal failure. Rise in BUN has been reported and is apparently dose related. Nephrogenic diabetes insipidus (see WARNINGS).
Hypersensitivity reactions: Urticaria, angioneurotic edema, polyarthralgia, anaphylaxis, anaphylactoid purpura, pericarditis, exacerbation of systemic lupus erythematosus, lupus-like syndrome, pulmonary infiltrates with eosinophilia.
Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia and eosinophilia have been reported.
CNS: Pseudotumor cerebri (benign intracranial hypertension) in adults and bulging fontanels in infants (see PRECAUTIONS - General). Dizziness, headache, tinnitus, and visual disturbances have been reported. Myasthenic syndrome has been reported rarely.
Other: When given over prolonged periods, tetracyclines have been reported to produce brown-black microscopic discoloration of thyroid glands. No abnormalities of thyroid function studies are known to occur. Very rare cases of abnormal thyroid function have been reported.
Tooth discoloration has occurred in pediatric patients less than 8 years of age (see WARNINGS), and also has been reported rarely in adults.
Demeclocycline hydrochloride drug interactions

# Drug Interactions
Because the tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage.
Since bacteriostatic drugs may interfere with the bactericidal action of penicillins, it is advisable to avoid giving tetracycline-class drugs in conjunction with penicillin.
Concurrent use of tetracyclines with oral contraceptives may render oral contraceptives less effective.
The concurrent use of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity.
Absorption of tetracyclines is impaired by antacids containing aluminum, calcium or magnesium, and by iron-containing preparations.
Differentiating erysipelas from other diseases

# Overview
Erysipelas must be differentiated from other inflammatory dermatological conditions that present with pain, erythema, edema, and blisters of the skin, as well as other systemic conditions such as fever, chills, fatigue, headache, and vomiting.

# Differentiating Erysipelas from other Diseases
- Erysipelas must be differentiated from other causes of lower limb edema like chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, lymphatic filariasis and causes of generalized edema.
- Erysipelas must be differentiated from other inflammatory dermatological conditions that present with pain, erythema, edema, and blisters of the skin, as well as other systemic conditions such as fever, chills, fatigue, headache, and vomiting.
Differentiating tonsillits from other diseases

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

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

## Differentiating between Common Misdiagnosis

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

### Epstein-Barr
- Differentiated based on clinical manifestations.
- May be responsible for prolonged fatigue.
- Tonsillectomy may lead to further complications including an increased risk of hemorrhaging.
Emtricitabine rilpivirine tenofovir overdosage

# Overdosage
If overdose occurs the patient must be monitored for evidence of toxicity. Treatment of overdose with COMPLERA consists of general supportive measures including monitoring of vital signs and ECG (QT interval) as well as observation of the clinical status of the patient.
Emtricitabine: Limited clinical experience is available at doses higher than the therapeutic dose of EMTRIVA. In one clinical pharmacology study, single doses of emtricitabine 1200 mg were administered to 11 subjects. No severe adverse reactions were reported. The effects of higher doses are not known.
Hemodialysis treatment removes approximately 30% of the emtricitabine dose over a 3-hour dialysis period starting within 1.5 hours of emtricitabine dosing (blood flow rate of 400 mL per minute and a dialysate flow rate of 600 mL per minute). It is not known whether emtricitabine can be removed by peritoneal dialysis.
Rilpivirine: There is no specific antidote for overdose with rilpivirine. Human experience of overdose with rilpivirine is limited. Since rilpivirine is highly bound to plasma protein, dialysis is unlikely to result in significant removal of rilpivirine.
If indicated, elimination of unabsorbed active substance may be achieved by gastric lavage. Administration of activated charcoal may also be used to aid in removal of unabsorbed active substance.
Tenofovir Disoproxil Fumarate: Limited clinical experience at doses higher than the therapeutic dose of VIREAD 300 mg is available. In one study, 600 mg tenofovir DF was administered to 8 subjects orally for 28 days, and no severe adverse reactions were reported. The effects of higher doses are not known.
Tenofovir is efficiently removed by hemodialysis with an extraction coefficient of approximately 54%. Following a single 300 mg dose of VIREAD, a four-hour hemodialysis session removed approximately 10% of the administered tenofovir dose.