Persius/hicric huggingface dataset:
Heavy metal ingestion overview

# Overview
Heavy metal poisoning is the toxic accumulation of heavy metals in the soft tissues of the body. Heavy metals are chemical elements that have a specific gravity (a measure of density) at least five times that of water. The heavy metals most often implicated in accidental human poisoning are lead, mercury, arsenic, and cadmium. More recently, thallium has gained some attention in the media as the poison used in several murder cases in the 1990s. Some heavy metals, such as zinc, copper, chromium, iron, and manganese, are required by the body in small amounts, but these same elements can be toxic in larger quantities.

# Natural History, Complications and Prognosis
The chelation process can only halt further effects of the poisoning; it cannot reverse neurological damage already sustained.

# Diagnosis

## Physical Examination
Depending on the metal, there may be blue-black lines in the gum tissues. In severe cases, patients exhibit obvious impairment of cognitive, motor, and language skills. The expression "mad as a hatter" comes from the mercury poisoning prevalent in 17th-century France among hatmakers who soaked animal hides in a solution of mercuric nitrate to soften the hair.
Henderson-Hasselbalch equation

# Overview
In chemistry, the Henderson-Hasselbalch (frequently misspelled Henderson-Hasselbach) equation describes the derivation of pH as a measure of acidity (using pKa, the acid dissociation constant) in biological and chemical systems. The equation is also useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid-base reactions (it is widely used to calculate isoelectric point of the proteins).

# Historical Perspective
Lawrence Joseph Henderson wrote an equation, in 1908, describing the use of carbonic acid as a buffer solution. Hasselbalch was using the formula to study metabolic acidosis, which results from carbonic acid in the blood.

# Henderson-Hasselbalch equation
Two equivalent forms of the equation are
and
Here, pKa is -log Ka where Ka is the acid dissociation constant, that is:
for the non-specific Brnsted acid-base reaction:
In these equations, A- denotes the ionic form of the relevant acid. Bracketed quantities such as  and  denote the molar concentration of the quantity enclosed.
In analogy to the above equations, the following equation is valid:
where B+ denotes the salt of the corresponding base B.

# Derivation
The HendersonHasselbalch equation can be applied to relate the pH of blood to constituents of the bicarbonate buffering system:
Taken together, the following equation can be used to relate the pH of blood to the concentration of bicarbonate and the partial pressure of carbon dioxide:
where pH is the acidity in the blood,  is the concentration of bicarbonate in the blood, and pCO2 is the partial pressure of carbon dioxide in the blood. For clinical application, the equation can be simplified as:

# Limitations
There are some significant approximations implicit in the Henderson-Hasselbalch equation. The most significant is the assumption that the concentration of the acid and its conjugate base at equilibrium will remain the same as the formal concentration. This neglects the dissociation of the acid and the hydrolysis of the base. The dissociation of water itself is neglected as well. These approximations will fail when dealing with relatively strong acids or bases (pKa more than a couple units away from 7), dilute or very concentrated solutions (less than 1 mM or greater than 1M), or heavily skewed acid/base ratios (more than 100 to 1).
Hennepin County Medical Center
Hennepin County Medical Center (HCMC) is a Level I trauma center based in Minneapolis, Minnesota, the county seat of Hennepin County.  The primary 422-bed facility is located on five city blocks across the street from the Hubert H. Humphrey Metrodome, with satellite clinics in Minneapolis, Brooklyn Center, and Richfield.  HCMC has been listed among America's Best Hospitals by US News & World Report magazine every year since 1999. Some patients come a long distance to be treated at HCMC because of the recognized trauma surgery specialists, transplant services, advanced endoscopy/hepatobilliary center, and the region's only hyperbaric oxygen chamber.

# History
The hospital was created in 1887 as the Minneapolis City Hospital, then referred to as "General Hospital" or "City Hospital", a block from its current main building.  Ownership was transferred to the county in 1964, when it was renamed Hennepin County General Hospital.  The hospital took its current name in 1974.  By the early 1970s, the hospital was a disorganized patchwork of buildings, leading to the decision to clear and rebuild the facility.  The current hospital facility was completed in 1976, following a $25 million bond passed by voters in 1969.  The hospital expanded in 1991 when the adjacent Metropolitan-Mount Sinai Medical Center closed.  It gained Level I trauma center status in 1989, the first such site in the state.
The hospital underwent a governance change in January 2007, which created a new governing entity with greater autonomy from the county government.  The public mission of the hospital did not change, but this transition was made in an attempt to ensure the long-term viability of the hospital.

# Residency programs
HCMC has independent residency programs in Emergency Medicine, Surgery, Family Medicine and Internal Medicine.  In addition, it is a rotating site for many programs from the University of Minnesota, including otolaryngology, obstetrics/gynecology, orthopedics, neurosurgery, neurology, ophthalmology, and many medical subspecialty fellowships.  It has independent fellowships in geriatrics, critical care medicine and sleep medicine.

# Internship opportunity
Students from UCIMED, a medical school located at Costa Rica are given the opportunity to do internship at the hospital. The initiative started thanks to an agreement signed on February 2006. Many of the students from UCIMED end up as residents at HCMC.

# EMS
HCMC also provides emergency medical services to parts of the Cities of Minneapolis, Minnetonka, Golden Valley, and Shorewood, as well as being the EMS provider for Eden Prairie, St. Louis Park, Hopkins, St. Anthony, Woodland, Excelsior, Deephaven, Tonka Bay, Richfield, and most of Minnetonka (South of 394).
There are 19 Ambulances, 3 Medical Director vehicles, and 2 Supervisor Units utilized in its fleet (as of January 05). A MCI trailer is on hand for MCI incidents in its coverage area. It is estimated that HCMC is on track for over 60,000 911 calls for 2007.
High pressure nervous syndrome
High pressure nervous syndrome (HPNS)  is a neurological and physiological diving disorder that results when a diver spends too much time breathing a high-pressure mixture of helium and oxygen (heliox). HPNS is a limiting factor in future deep diving.
"Helium tremors" were first described in 1965 by Royal Navy physiologist Peter B. Bennett, who also founded the Divers Alert Network. Zal'tsman also reported on helium tremors in his experiments from 1961. Unfortunately these reports were not available in the west until 1967.
The term high pressure nervous syndrome was first used by Brauer to describe the combined symptoms of tremor, electroencephalography (EEG) changes, and somnolence that appeared during a 1,189 foot chamber dive in Marseilles.

# Symptoms
Symptoms of HPNS include tremors, myoclonic jerking, somnolence, EEG changes, visual disturbance, nausea, dizziness, and decreased mental performance.
The susceptibility of divers and animals to HPNS does depend on the individual.

# Suppressive Measures
It is not likely that HPNS can be prevented entirely but there are effective methods to delay or change the development of the symptoms.

## Rate of Compression
Utilizing slow rates of compression or adding stops to the compression have been found to prevent large initial decrements in performance.

## Breathing Mixture
It can be avoided by including small amounts of other gases in the mix, such as nitrogen (creating trimix) or hydrogen (hydreliox).

## Drugs
Alcohol, anesthetics and anticonvulsant drugs have had varying results in suppressing HPNS with animals. None are currently in use for humans.
History of the present illness

# Overview
In a medical encounter, a history of the present illness (HPI) (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).

# Questions to include
Different sources include different questions to be asked while conducting a HPI, but in general they include the following:
- onset
- location and radiation
- severity and character/quality
- duration and timing
- precipitating and palliating factors
- progression

# Acronyms
Several acronyms have been developed to categorize the appropriate questions to include:
- "OPQRST". Alternatively, "PQRST". See also Opqrst.
- "CLEARAST"
- "LIQOR AAA"
- "FAR COLDER"
- "OLD CART"

# Medicare definitions
The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable HPI. A "brief HPI" constitutes one to three of the following elements:
- location
- quality
- severity
- duration
- timing
- context
- modifying factors
- associated signs & symptoms
A "extended HPI" includes four or more of these elements.
Hymenolepis infection overview

# Overview
Hymenolepis infection (hymenolepiasis) is infestation by one of two species of tapeworm, Hymenolepis nana or Hymenolepis diminuta.

# Causes
Hymenolepis infection (hymenolepiasis) is caused by one of the two species of tapeworm, Hymenolepis nana or Hymenolepis diminuta. Hymenolepis nana infections are much more common than Hymenolepis diminuta infections in humans, because in addition to being spread by insects, the disease can be spread directly from person to person by eggs in feces. Humans and other animals become infected when they intentionally or unintentionally eat material contaminated by insects. In an infected person, it is possible for the worm's entire life-cycle to be completed in the bowel, so infection can persist for years.

# Diagnosis

## History and Symptoms
Most people who are infected do not have any symptoms. Those who have symptoms may experience nausea, weakness, loss of appetite, diarrhea, and abdominal pain. Young children, especially those with a heavy infection, may develop a headache, itchy bottom, or have difficulty sleeping. Sometimes infection is misdiagnosed as a pinworm infection. Contrary to popular belief, a tapeworm infection does not generally cause weight loss. You cannot feel the tapeworm inside your body.

## Laboratory Findings
Examination of the stool for eggs and parasites confirms the diagnosis. Concentration techniques and repeated examinations will increase the likelihood of detecting light infections. The eggs and proglottids of H. nana are smaller than H. diminuta. Proglottids of both are relatively wide and have three testes.

# Treatment

## Medical Therapy
A prescription drug called praziquantel is given. The medication causes the tapeworm to dissolve within the intestines. Praziquantel is generally well tolerated. Sometimes more than one treatment is necessary.
Hypocretin (orexin) receptor 2
Orexin receptor type 2 (Ox2R or OX2), also known as  hypocretin receptor type 2 (HcrtR2), is a protein that in humans is encoded by the HCRTR2 gene.

# Structure
The structure of the receptor has been solved to 2.5 A resolution as a fusion protein bound to suvorexant using lipid-mediated crystallization.

# Function
OX2 is a G-protein coupled receptor expressed exclusively in the brain.  It has 64% identity with OX1.  OX2 binds both orexin A and orexin B neuropeptides.  OX2 is involved in the central feedback mechanism that regulates feeding behaviour.

# Ligands

## Agonists
- Orexin-A
- Orexin-B
- SB-668,875

## Antagonists
- Almorexant - Dual OX1 and OX2 antagonist
- EMPA - Selective OX2 antagonist
- Filorexant - Dual OX1 and OX2 antagonist
- JNJ-10397049 (600x selective for OX2 over OX1)
- Lemborexant - Dual OX1 and OX2 antagonist
- MIN-202 - Selective OX2 antagonist
- MK-1064 - Selective OX2 antagonist
- MK-8133 - Selective OX2 antagonist
- Nemorexant - Dual OX1 and OX2 antagonist
- SB-649,868 - Dual OX1 and OX2 antagonist
- Suvorexant - Dual OX1 and OX2 antagonist
- TCS-OX2-29 - Selective OX2 antagonist
- (3,4-dimethoxyphenoxy)alkylamino acetamides
- Compound 1m - Selective OX2 antagonist
Interleukin 1 receptor, type I
Interleukin 1 receptor, type I (IL1R1) also known as CD121a (Cluster of Differentiation 121a), is an interleukin receptor. IL1R1 also denotes its human gene.
The protein encoded by this gene is a cytokine receptor that belongs to the interleukin-1 receptor family. This protein is a receptor for interleukin 1 alpha (IL1A), interleukin 1 beta (IL1B), and interleukin 1 receptor antagonist (IL1RA). It is an important mediator involved in many cytokine induced immune and inflammatory responses. This gene along with interleukin 1 receptor, type II (IL1R2), interleukin 1 receptor-like 2 (IL1RL2), and interleukin 1 receptor-like 1 (IL1RL1) form a cytokine receptor gene cluster in a region mapped to chromosome 2q12.

# Interactions
Interleukin 1 receptor, type I has been shown to interact with PIK3R1, Myd88 and IL1RAP.
Imipenem cilastatin overdosage

# Overdosage
The acute intravenous toxicity of imipenem-cilastatin sodium in a ratio of 1:1 was studied in mice at doses of 751 to 1359 mg/kg. Following drug administration, ataxia was rapidly produced and clonic convulsions were noted in about 45 minutes. Deaths occurred within 4-56 minutes at all doses.
The acute intravenous toxicity of imipenem-cilastatin sodium was produced within 5-10 minutes in rats at doses of 771 to 1583 mg/kg. In all dosage groups, females had decreased activity, bradypnea, and ptosis with clonic convulsions preceding death; in males, ptosis was seen at all dose levels while tremors and clonic convulsions were seen at all but the lowest dose (771 mg/kg). In another rat study, female rats showed ataxia, bradypnea, and decreased activity in all but the lowest dose (550 mg/kg); deaths were preceded by clonic convulsions. Male rats showed tremors at all doses and clonic convulsions and ptosis were seen at the two highest doses (1130 and 1734 mg/kg). Deaths occurred between 6 and 88 minutes with doses of 771 to 1734 mg/kg.
In the case of overdosage, discontinue PRIMAXIN I.V., treat symptomatically, and institute supportive measures as required. Imipenem-cilastatin sodium is hemodialyzable. However, usefulness of this procedure in the overdosage setting is questionable.
Insulin-induced gene 1 protein
Insulin induced gene 1, also known as INSIG1, is a protein which in humans is encoded by the INSIG1 gene.
INSIG1 is short for insulin-induced gene 1; it is located on chromosome 7 (7q36). This human gene encodes for a transmembrane protein of 277 amino acids with probably 6 transmembrane domains. It is localized in the endoplasmic reticulum (ER) and seems to be expressed in all tissues, especially in liver. This gene is called an insulin-induced gene because the molecule insulin can regulate it. Importantly, the protein encoded by this gene plays a critical role in regulating cholesterol concentrations in cells.

# Function
- INSIG1 plays an important role in the SREBP-mediated regulation of cholesterol biosynthesis: by binding to the sterol-sensing domain of SCAP (SREBP cleavage activating protein) it makes the SCAP/SREBP complex stay longer in the ER, thus prohibiting SCAP from carrying activated SREBP to the golgi complex. This ultimately blocks SREBP from acting as a transcription factor for the SRE in the promoter region of the HMG-CoA-reductase gene and results in a decreased expression of HMG-CoA-reductase.
- INSIG1 also binds to the sterol-sensing domain of HMG-CoA-reductase, resulting in the enzyme's increased degradation.
Both functions require the binding of INSIG1 protein via the same site.
There are two other proteins whose sterol-binding sites show a great similarity to the ones of SCAP and HMG-CoA-reductase and who might thus be regulated by INSIG1 as well:
- Niemann-Pick disease type C1 protein, which participates in the intracellular movement of cholesterol
- Patched, the receptor for Hedgehog, a protein that contains covalently bound cholesterol
Oxysterols regulate cholesterol homeostasis through liver X receptor (LXR) and sterol regulatory element-binding protein (SREBP) mediated signaling pathway. This protein binds to the sterol-sensing domains of SREBP cleavage-activating protein (SCAP) and HMG CoA reductase, and is essential for the sterol-mediated trafficking of the two proteins. Alternatively spliced transcript variants encoding distinct isoforms have been observed.

# Regulation
INSIG1 is regulated by insulin and highly expressed in liver.

# Sequence (277 AA)

# Synonyms
CL-6, INSIG-1, Insulin-induced gene 1 protein, MGC1405 (source: iHOP)

# Interactions
INSIG1 has been shown to interact with SREBF2.
Interferon alfa-2b description

# description
INTRON A (Interferon alfa-2b) for intramuscular, subcutaneous, intralesional, or intravenous Injection is a purified sterile recombinant interferon product.
INTRON A recombinant for Injection has been classified as an alpha interferon and is a water-soluble protein with a molecular weight of 19,271 daltons produced by recombinant DNA techniques. It is obtained from the bacterial fermentation of a strain of Escherichia coli bearing a genetically engineered plasmid containing an interferon alfa-2b gene from human leukocytes. The fermentation is carried out in a defined nutrient medium containing the antibiotic tetracycline hydrochloride at a concentration of 5 to 10 mg/L; the presence of this antibiotic is not detectable in the final product. The specific activity of interferon alfa-2b, recombinant is approximately 2.6  108 IU/mg protein as measured by the HPLC assay.
Prior to administration, the INTRON A Powder for Injection is to be reconstituted with the provided Diluent for INTRON A (Sterile Water for Injection USP) (see DOSAGE AND ADMINISTRATION). INTRON A Powder for Injection is a white to cream-colored powder.
These packages do not require reconstitution prior to administration (see DOSAGE AND ADMINISTRATION). INTRON A Solution for Injection is a clear, colorless solution.
International Headache Society
The International Headache Society (IHS) is a charity organisation founded in 1981 for people from all professions that are working to treat headache disorders.
It has over 1,000 ordinary members (including national society members).The society publishes an international journal Cephalalgia.
The society was incorporated in 1994 in England and Wales as a Company Limited by Guarantee and registered in 1995 as a charity.

# International Headache Congress
The International Headache Congress (IHC) is held every second year, organised and hosted on behalf of IHS by a member national society.
International Prognostic Index

# Overview
The International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the IPI was developed, the primary consideration in assessing prognosis was the Ann Arbor stage alone, but this was increasingly found to be an inadequate means of predicting survival outcomes, and so other factors were studied.
A retrospective analysis was performed on 2031 patients with aggressive non-Hodgkin's lymphoma, of all ages, treated with a doxorubicin-based chemotherapy regimen such as CHOP between 1982 and 1987. Several patient characteristics were analyzed to determine whether they were associated with differences in survival, and the factors that emerged as significant were, in addition to the Ann Arbor stage: age, elevated serum lactate dehydrogenase (LDH), performance status, and number of extranodal sites of disease.

## International Prognostic Index
One point is assigned for each of the following risk factors:
- Age greater than 60 years
- Stage III or IV disease
- Elevated serum LDH
- ECOG/Zubrod performance status of 2, 3, or 4
- More than 1 extranodal site
The sum of the points allotted correlates with the following risk groups:
- Low risk (0-1 points) - 5-year survival of 73%
- Low-intermediate risk (2 points) - 5-year survival of 51%
- High-intermediate risk (3 points) - 5-year survival of 43%
- High risk (4-5 points) - 5-year survival of 26%
Although the IPI has shown itself to be a useful clinical tool, widely used by oncologists and a mainstay of risk stratification in clinical trials for lymphoma, it should be kept in mind that it was developed prior to the use of rituximab, which is now included with anthracycline-based combination chemotherapy as of the standard of care in B-cell lymphomas (the majority of non-Hodgkin's lymphomas). Rituximab has dramatically improved the outcomes of lymphoma patients, and its effect on the prognostic value of the IPI is uncertain.

# Follicular Lymphoma International Prognostic Index (FLIPI)
Given the success of the IPI for intermediate grade lymphomas, an effort was undertaken to develop a similar prognostic index for the most common low-grade lymphoma, follicular lymphoma. The prognostic factors that emerged from this were: age, stage, number of lymph node areas involved, serum hemoglobin level, and serum LDH.
One point is assigned for each of the following adverse prognostic factors:
- Age greater than 60 years
- Stage III or IV disease
- Greater than 4 lymph node groups involved
- Serum hemoglobin less than 12 g/dL
- Elevated serum LDH
The sum of the points allotted correlates with the following risk groups:
- Low risk (0-1 points) - 5 and 10-year survivals of 91% and 71%, respectively
- Intermediate risk (2 points) - 5 and 10-year survivals of 78% and 51%, respectively
- High risk (3-5 points) - 5 and 10-year survivals of 53% and 36%, respectively
International medical graduate
An International Medical Graduate or "IMG", earlier known as a Foreign Medical Graduate or "FMG", is a term used to describe a physician who has graduated from a medical school outside of the country in which he or she intends to practise. Generally, the medical school of graduation is one listed in the International Medical Education Directory (or IMED) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.
Medical schools around the world vary in educational standards, curriculum, and evaluation methods. The purpose of ECFMG Certification is to assess the readiness of international medical graduates to enter specialty training and fellowship programs.

# Licence requirements by country
The requirements to obtain a licence to practise varies by country (and often by state or province).

## Australia
IMGs who wish to be licensed in Australia must obtain certification from the Australian Medical Council (AMC). To do so, an IMG must obtain an ECFMG certificate and sit a series of exams.
Those IMGs who have successfully passed the necessary exams and obtained AMC certification can then apply to an Australian specialty training positions.

## Canada
In addition to undergoing the regular licencing process as required of all Canadian medical school graduates, IMG's must also achieve a pass mark on the LMCC Evaluating Examination. IMGs in Canada also have harder to get into residency programs compared to Canada graduates - only ten percent of IMG applicants get a position. 

## United States
Many IMGs who wish to be licensed as a physician in the United States begin by completing a U.S. residency hospital program. To do so, an IMG must obtain an ECFMG certificate.
Those IMGs who have successfully passed the necessary USMLE exams and obtained the ECFMG certification can then apply to U.S. residency positions via the NRMP and ERAS.

# Sources
The Educational Commission for Foreign Medical Graduates