Persius/hicric huggingface dataset:
Narrative Review: Major Bleeding

# Diagnosis
Addmission date: MM/DD/YYYY

# Major Bleeding
An episode of suspected internal or external bleeding that results in one or more of the following:
O Death
O Re-operation
O Hospitalization
O Transfusion of red blood cells as follows:

### During first 7 days post implant
- Adults ( 50 kg):   4U packed red blood cells (PRBC) within any 24 hour period during first 7 days post implant.

### After 7 days post implant
- Any transfusion of packed red blood cells (PRBC) after 7 days following implant with the investigator recording the number of units given. (record number of units given per 24 hour period).
Note: Hemorrhagic stroke is considered a neurological event and not as a separate bleeding event.

# Event
Demographic:  year old 
Site Reported Event Onset Date: MM/DD/YYYY
Event summary:
- Symptoms and sign:
Subject presented with  on MM/DD/YYYY.
Important characteristics of the chief complaint such as severity, site, and duration.
Other important symptoms related to the chief complaint.
- Subject presented with  on MM/DD/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Past Medical History: 
- Past Surgical History: 
- Medications: 
- Physical assessment:
Vital signs
Positive physical examinations or related negative examinations.
- Vital signs
- Positive physical examinations or related negative examinations.
Event (2): 

# Procedure
- Index Procedure Date/Time:
mm/dd/YYYY at xx:xx  
- mm/dd/YYYY at xx:xx  
- Index Procedure Detail:
On mm/dd/YYYY at xx:xx  the subject underwent a  for .
Access site details
The site reported that there were/were not procedural complication(s).
- On mm/dd/YYYY at xx:xx  the subject underwent a  for .
- Access site details
- The site reported that there were/were not procedural complication(s).

# Laboratory data and Imaging
- Lab studies:
CBC, INR, and PT/PTT:
Other relevant laboratory tests:
Date/ name/ value
- CBC, INR, and PT/PTT:
- Other relevant laboratory tests:
Date/ name/ value
- Date/ name/ value
- ECG / date:
- ECHO / date:
- CXR / date:
- Other imaging and diagnostic tests / date:

# Consults
- Date and time of consult
- Suggested treatments

# Clinical course
- Date and time of events,
- Patient condition got worse or better.

# Treatment and outcome
- List of relevant medical treatments
- Outcome
National Cancer Research Network
The National Cancer Research Network (NCRN) is a UK based government funding utility created to provide infrastructure to the UK's National Health Service (NHS) and increase funding for clinical trials.

# History
NCRN was created in April of 2001 by the UK's Department of Health.

# Stated Goal
The stated goal of NCRN:
To improve the speed, quality and integration of research with the ultimate aim of improving patient care. NCRN was established by the Department of Health in April 2001 and has already succeeded in doubling patient accrual into cancer clinical trials.
Neuron-derived orphan receptor 1
The neuron-derived orphan receptor 1 (NOR1) also known as NR4A3 (nuclear receptor subfamily 4, group A, member 3) is a protein that in humans is encoded by the NR4A3 gene. NOR1 is a member of the nuclear receptor family of intracellular transcription factors.
NOR1 plays a central regulatory role in cell proliferation, differentiation, metabolism and apoptosis

# Interactions
Neuron-derived orphan receptor 1 has been shown to interact with SIX3.
Rehabilitation (neuropsychology)

# Overview
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury.

# Methods
Speech therapy, occupational therapy, and many other methods that "exercise" specific brain functions are used.  For example eye-hand coordination exercises may rehabilitate certain motor deficits, or well structured planning and organizing exercises might help rehabilitate certain frontal lobe "executive functions" of the brain following a traumatic blow to the head.
Brain functions that are impaired because of traumatic brain injuries are often the most challenging and difficult to rehabilitate.  Much work is being done in nerve regeneration for the most severely damaged neural pathways.

# Common Examples
three common neuropsychological problems treatable with rehabilitation are Attention Deficit/Hyperactivity Disorder (ADHD), concussion,  and spinal cord injury.

## ADHD
There are many therapists and interventions for rehabilitation of children and adults who suffer ADHD, many of whom are parents of children with this problem.  The most frequently used treatment method involves drugs such as Ritalin, and many argue that drugs do not rehabilitate but only relieve ADHD sufferers (and those around them) from the social and behavioral disruptiveness caused by attention deficiencies and hyperactive behavior.
However, many others argue that such symptom relief enables the sufferer and those around him or her to improve cognitive and motor functioning and controls through standard educational and social training that would otherwise be impossible.
The next most common rehabilitation approach for ADHD uses various and specific cognitive/behavioral methods to help establish new brain-behavior relationships or functioning that is impaired in sufferers of ADHD.

## Concussion
Much research and focus has been given to concussion suffered frequently by athletes.  While the severity of brain trauma has been standardized for immediate "side-line" assessment, much work needs to be done to understand how to rehabilitate or accelerate the rehabilitation of athletes' brain function following serious concussion -- where consciousness is lost for a few moments or more.  Currently, rehabilitation of concussive brain injury is based on "quiet" time without jarring motions that enables the brain to "heal" on its own.
Rehabilitation research and practices are a fertile area for clinical neuropsychologists and others.
Nevirapine indications and usage

# Indications And Usage
VIRAMUNE XR is indicated for use in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and in children 6 to less than 18 years of age .
Additional important information regarding the use of VIRAMUNE XR for the treatment of HIV-1 infection:
- Based on serious and life-threatening hepatotoxicity observed in controlled and uncontrolled trials, nevirapine should not be initiated in adult females with CD4+ cell counts greater than 250 cells/mm3 or in adult males with CD4+ cell counts greater than 400 cells/mm3 unless the benefit outweighs the risk .
- The 14-day lead-in period with immediate-release VIRAMUNE dosing must be strictly followed; it has been demonstrated to reduce the frequency of rash .
- If rash persists beyond the 14-day lead-in period with immediate-release VIRAMUNE, do not begin dosing with VIRAMUNE XR. The lead-in dosing with 200 mg once-daily immediate-release VIRAMUNE should not be continued beyond 28 days, at which point an alternative regimen should be sought.
Nitrofurantoin contraindications

# Contraindications
Anuria, oliguria, or significant impairment of renal function (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine) are contraindications. Treatment of this type of patient carries an increased risk of toxicity because of impaired excretion of the drug.
Because of the possibility of hemolytic anemia due to immature erythrocyte enzyme systems (glutathione instability), the drug is contraindicated in pregnant patients at term (38-42 weeks gestation), during labor and delivery, or when the onset of labor is imminent. For the same reason, the drug is contraindicated in neonates under one month of age.
Macrobid is contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin.
Macrobid is also contraindicated in those patients with known hypersensitivity to nitrofurantoin.
Nocturia resident survival guide

# Overview
Waking up multiple times during night to urinate is termed as Nocturia. It can be caused by simple increased fluid intake, as consequence of other medical illness or intrinsically overactive bladder. If a patients presents with night time increase urine frequency ask him about his intake of fluids, cardiovascular factors (like hypertension, diabetes, obesity, heart failure) , sleep ( restless leg, OSA ), and patient is an old women menopause can be a contributing factor. It isn't a medical emergency but by simple life style changes and treatment of comorbidities patient can feel better. But if not treated properly it can result in fatigue, memory deficits, depression, increased risk of heart disease, gastrointestinal disorders, and, at times, traumatic injury through falls. Waking up multiple times disturb sleep and healthy sleep is important for a healthy body and active life.Nocturia without underlying medical conditions is called as Nocturnal Polyuria syndrome and is thought be the result of impaired circadian release of endogenous arginine vasopressin. The synthetic form of vasopressin like desmopressin is used for the treatment of Nocturia.

# Causes

## Common Causes
- Hormonal imbalance which may leads to:
Global polyuria
Nocturnal polyuria
- Global polyuria
- Nocturnal polyuria
- Vesical problems which includes bladder storage disorders:
Benign prostatic hyperplasia (BPH)
Neurogenic bladder dysfunction
Learned voiding dysfunction
Anxiety disorders
- Benign prostatic hyperplasia (BPH)
- Neurogenic bladder dysfunction
- Learned voiding dysfunction
- Anxiety disorders

# Diagnosis

# Treatment
Shown below is an algorithm summarizing the treatment of Nocturia according the guidelines.

# Do's
- Take afternoon naps.
- Maintain a healthy weight, as excess weight can put pressure on the bladder.
- Avoid beverages and stimulants with caffeine and alcohol after the evening.
- Do perform voiding diary inpatient complaining of Nocturia.
- To find the underlying etiology of disease, a frequency volume chart is helpful in diagnoses.
- Drink fewer liquids during the evening and before bed.
- Make a food diary to manage what must change in the patient's diet.

# Don'ts
- Don't confuse Nocturia with overactive bladder. People with Overactive Bladder also experience frequent urination at night and day, but people with Nocturia tend to experience frequent urination at night only.
- Don't drink water at night or before bed.
- Don't take stimulant drinks like coffee, tea before bed, they increase urination.
- Don't start medicine based on your symptoms without consultation. Always consult your doctor before taking any medicine.
Tangential and normal components
In mathematics, given a vector at a point on a surface, that vector can be decomposed uniquely as a sum of two vectors, one tangent to the surface, called the tangential component of the vector, and another one 
perpendicular to the surface, called the normal component of the vector.
More generally, given a submanifold N of a manifold M, and a vector in the tangent space to M at a point of N, it can be decomposed into the component tangent to N and the component normal to N.

# Formal definition

## Surface
More formally, let S be a surface, and x be a point on the surface. Let \mathbf{v} be a vector at x. Then one can write uniquely \mathbf{v} as a sum
where the first vector in the sum is the tangential component and the second one is the normal component. It follows immediately that these two vectors are perpendicular to each other.
To calculate the tangential and normal components, consider a unit normal to the surface, that is, a unit vector \hat{n} perpendicular to S at x. Then,
and thus
where "\cdot" denotes the dot product. Another formula for the tangential component is
where "\times" denotes the cross product.
Note that these formulas do not depend on the particular unit normal \hat{n} used (there exist two unit normals to any surface at a given point, pointing in opposite directions, so one of the unit normals is the negative of the other one).

## Submanifold
More generally, given a submanifold N of a manifold M and
a point p \in N, we get a short exact sequence
involving the tangent spaces:
The quotient space T_p M / T_p N is a generalized space of normal vectors.
If M is a Riemannian manifold, the above sequence splits, and the tangent space of M at p decomposes as a direct sum of the component tangent to N and the component normal to N:
Thus every tangent vector v \in T_p M splits as
v = v_\parallel + v_\perp,
where v_\parallel \in T_p N and v_\perp \in N_p N := (T_p N)^\perp.

# Computations
Suppose N is given by non-degenerate equations.
If N is given explicitly, via parametric equations (such as a parametric curve), then the derivative gives a spanning set for the tangent bundle (it's a basis if and only if the parametrization is an immersion).
If N is given implicitly (as in the above description of a surface, or more generally as a hypersurface) as a level set or intersection of level surfaces for g_i, then the gradients of g_i span the normal space.
In both cases, we can again compute using the dot product; the cross product is special to 3 dimensions though.

# Applications
- Lagrange multipliers : constrained critical points are where the tangential component of the total derivative vanish.
- Surface normal
Oral ulcer (patient information)
For the WikiDoc page for this topic, click here

# Overview
Mouth ulcers are sores or open lesions in the mouth.

# What are the symptoms of Oral ulcer?
Symptoms vary and depend on the specific cause of the mouth ulcer. In general, symptoms may include:
- Open sores in the mouth
- Pain or discomfort in the mouth

# What causes Oral ulcer?
Mouth ulcers are caused by many disorders. These include:
- Canker sores
- Gingivostomatitis
- Herpes simplex (fever blister)
- Leukoplakia
- Oral cancer
- Oral lichen planus
- Oral thrush
The skin lesion of histoplasmosis may also appear as a mouth ulcer.

# Who is at highest risk?
People with decreased immunity are at higher risk of getting oral ulcer

# When to seek urgent medical care?
Call for an appointment with your health care provider if your mouth ulcers don't go away after 3 weeks. Call for an appointment with your health care provider if mouth ulcers return frequently, or if new symptoms develop.

# Diagnosis
A health care provider or dentist usually diagnoses the type of mouth ulcer, based on its appearance and location. Blood tests or a biopsy of the ulcer may be needed to confirm the cause.

# Treatment options
The goal of treatment is to relieve symptoms. The cause, if known, should be treated. Gentle, thorough oral hygiene may relieve some of the symptoms. Topical (rubbed on) antihistamines, antacids, corticosteroids, or other soothing preparations may be recommended for applying directly to the ulcer. Avoid hot or spicy foods, which often increase the pain of mouth ulcers.

# Where to find medical care for Oral ulcer?
Directions to Hospitals Treating Oral ulcer

# What to expect (Outlook/Prognosis)?
The outcome varies depending on the cause of the ulcer. Many mouth ulcers are harmless and heal without treatment. There are types of cancer, however, that may first appear as a mouth ulcer that does not heal.

# Possible complications
- Cellulitis of the mouth, from secondary bacterial infection of ulcers
- Dental infections (tooth abscesses)
- Oral cancer
- Spread of contagious disorders to other people

# Prevention
Good oral hygiene may help prevent some types of mouth ulcers, as well as some complications from mouth ulcers. Good oral hygiene includes brushing the teeth at least twice per day, flossing at least daily, and getting regular professional dental cleanings and examinations.

# Sources
P-selectin glycoprotein ligand-1
Selectin P ligand, also known as SELPLG or CD162 (cluster of differentiation 162), is a human gene.
SELPLG codes for PSGL-1, the high affinity counter-receptor for P-selectin on myeloid cells and stimulated T lymphocytes. As such, it plays a critical role in the tethering of these cells to activated platelets or endothelia expressing P-selectin.
The organization of the SELPLG gene closely resembles that of CD43 and the human platelet glycoprotein GpIb-alpha both of which have an intron in the 5-prime-noncoding region, a long second exon containing the complete coding region, and TATA-less promoters.
P-selectin glycoprotein ligand-1 (PSGL-1) is a glycoprotein found on white blood cells and endothelial cells that binds to P-selectin (P stands for platelet), which is one of a family of selectins that includes E-selectin (endothelial) and L-selectin (leukocyte). Selectins are part of the broader family of cell adhesion molecules. PSGL-1 can bind to all three members of the family but binds best (with the highest affinity) to P-selectin.

# Posttranslational modification
PSGL-1 protein requires two distinct posttranslational modifications to gain its selectin binding activity:
- sulfation of tyrosines
- the addition of the sialyl Lewis x tetrasaccharide (sLex) to its O-linked glycans

# Function
PSGL-1 is expressed on all white blood cells and plays an important role in the recruitment of white blood cells into inflamed tissue: White blood cells normally do not interact with the endothelium of blood vessels. However, inflammation causes the expression of cell adhesion molecules (CAM) such as P-selectin on the surface of the blood vessel wall. White blood cells present in flowing blood can interact with CAM. The first step in this interaction process is carried out by PSGL-1 interacting with P-selectin and/or E-selectin on endothelial cells and adherent platelets.  This interaction results in "rolling" of the white blood cell on the endothelial cell surface followed by stable adhesion and transmigration of the white blood cell into the inflamed tissue.
In mice it seems to be an immune factor regulating T-cell checkpoints, and it could be a target for future checkpoint inhibitor anti-cancer drugs.
PCI in The Patient with Diabetes

# Diagnostic Cardiac Catheterization in the Patient with Diabetes

# PCI in the patient with Diabetes
The DIABETES trial was the first randomized multicenter trial examining the efficacy of SES in preventing restenosis in diabetic patients. The trial randomized 160 diabetic patients with de novo coronary stenoses to either SES or BMS. One year dual antiplatelet therapy of aspirin and clopidogrel was routinely prescribed for one year in both arms.
The DIABETES (DIABETes and sirolimus Eluting Stent) trial showed a marked reduction in target lesion revascularization (TLR) with the sirolimus-eluting stent (SES) compared with the bare metal stent (BMS) at 2 year follow-up. However, there was also a significant cumulative rate of revascularization due to atherosclerosis progression in both groups as well as an increase in late stent thrombosis after clopidogrel discontinuation.
The overall MACE rate, defined as death, MI, TLR, or stent thrombosis, was significantly lower in the SES group at the two year follow-up, though this was driven by the considerable reduction in the TLR rate after SES implantation. At the two year follow-up, the rate of TLR was 7.7% in the SES group compared with 35.0% in the BMS group (p<0.001).  There were no significant differences in the rates of death or MI between the groups.
The total revascularization rate at two years increased in both the SES and BMS groups (7.7%and 10% respectively; p=0.7) due to progression of atherosclerosis in segments remote from the target lesion.
The beneficial effect of SES implantation in clinical restenosis was independent of diabetes treatment, gender, vessel location, the use of IIb/IIIa inhibitors, stent size, and reference vessel diameter.
Read the news brief of this trial in the WikiDoc News section

# PCI in Diabetic Ketoacidosis
Vaccine mediated polio infection
Synonyms and keywords: Vaccine derived paralytic polio; Vaccine derived polio; Paralytic polio due to vaccination; Vaccine related polio infection; Vaccine associated polio; Vaccine related polio.

# Overview
Oral polio vaccine (OPV) is one of the safest and most effective vaccines that prevents millions of cases of polio, not only through direct immunization, but also through herd immunity. On rare occasions, the vaccine is associated with paralytic polio. 
There are two subtypes of paralytic polio that are related to OPV, vaccine associated paralytic polio and vaccine derived paralytic polio.

# Vaccine associated paralytic polio
- Vaccine associated paralytic polio (VAPP) occurs when the attenuated strain used in the vaccine reverts into more virulent form inside the intestine.
- The more virulent form is capable of causing the disease only in the vaccinated child or any close susceptible contact. Therefore, no outbreaks are associated with VAPP.
- The prevalence of VAPP is 1 in every 2.7 million vaccine doses.
- In developed countries, the risk of VAPP is highest with the first dose; while in developing countries, it is increased with subsequent doses of vaccine.

# Vaccine derived paralytic polio
- Vaccine derived paralytic polio (VDPP) is caused by a very rare mutation of the original strain of polio in the vaccine.
- VDPP has the ability to cause the disease in any person who is not immune; therefore, it is able to cause outbreaks or even epidemics, especially in communities that do not have a routine vaccination program.
- When it causes outbreaks, VDPP is called circulating vaccine derived paralytic polio (cVDPP).
- In the last 10 years, 24 VDPP reported outbreaks occurred and unfortunately led to 750 cases of paralytic polio.
- Management of VDPP involves conducting extensive vaccination campaigns in the affected communities and aiming to vaccinate every child, thus preventing the spread of the infection.
Paroxysmal AV Block EKG examples

# Overview
- Intrinsic paroxysmal AV block is characterized by atrial premature beats/ventricular premature beats prior to and during the period of asystole.
- Extrinsic vagal paroxysmal AV block is characterized by sinus rate slowing, increasing PP interval/PR interval prior to the period or asystole.
- Extrinsic idiopathic paroxysmal AV block is characterized by narrowing of QRS complexes and sinus rate increase prior to the period of asystole.

# ECG examples
Classic ECG Findings seen in the different types of paroxysmal AV Block are as follows :
Paroxysmal AV Block Epidemiology

# Overview
Exact data reflecting the epidemiology of paroxysmal AV block is unavailable. However certain studies have shown an increased incidence in the elderly, no gender predisposition and an association with bundle branch blocks.

# Epidemiology
- Given the difficulty in diagnosis, sporadic presentation and sparse literature available, the exact incidence and prevalence of paroxysmal AV block is unknown.
- An unpublished study done at Beth Israel Deaconess Medical Centre in collaboration with a cardiology department in the Netherlands found that paroxysmal AV block was most associated with RBBBs followed by LBBBs, intraventricular conduction delays and normal QRS complexes.
An age presentation of 26-99 years of age, an equal incidence in both men and women and an increased prevalence in older individuals were also seen.
However, the association between paroxysmal AV block and RBBB is a matter of much debate, as it is not sure whether RBBB causes a direct effect or is a sign seen in an aging population.
- An age presentation of 26-99 years of age, an equal incidence in both men and women and an increased prevalence in older individuals were also seen.
- However, the association between paroxysmal AV block and RBBB is a matter of much debate, as it is not sure whether RBBB causes a direct effect or is a sign seen in an aging population.
- The ISSUE 2 study was characterised by a population of individuals with a high mean age, a history of recurrent syncope beginning in middle or older ages, and frequent injuries probably due to presentation without warning.