Persius/hicric huggingface dataset:
Selective mutism (patient information)
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# Overview
Selective mutism is a condition in which a child who can speak well stops speaking, usually in school or social settings.

# What are the symptoms of Selective mutism?
- Ability to speak at home with family
- Failure to speak in certain social situations
- Fear of people
- Shyness
This pattern of mutism must be observed for at least 1 month. (The first month of school does not count, because shyness is common during this period.)

# What causes Selective mutism?
- The cause of selective mutism is unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with this condition have some form of extreme social phobia.
- Parents often think that the child is refusing to speak, but usually the child is truly unable to speak in certain settings.
- Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems. This condition is most common in children under age 5.
- This syndrome is not the same as mutism. In selective mutism, the child has the ability to both understand and speak, but fails to speak in certain settings or environments. Children with mutism never speak.

# When to seek urgent medical care?
Call your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.

# Diagnosis
- Teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language.
- Children who are uncomfortable with a new language may not want to use it outside of a familiar setting. This is not necessarily selective mutism.

# Treatment options
- Current treatment involves behavior changes, family participation, and the child's school.
- Certain medications that treat anxiety and social phobia have been used safely and successfully.

# Where to find medical care for Selective mutism?
Directions to Hospitals Treating Selective mutism

# What to expect (Outlook/Prognosis)?
Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

# Possible complications
Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

# Support groups
- American Speech-Language-Hearing Association
- Selective Mutism and Childhood Anxiety Disorders

# Source
Slurred speech resident survival guide
Synonyms and Keywords: Approach to dysarthria, Approach to slurred speech, Approach to difficulty in speaking,Approach to motor speech disorders.

# Overview
Slurred Speech or Dysarthria is usually defined as difficulty in speech and is a motor speech disorder caused by a neurological deficit resulting in weakening or paralysis of the muscles responsible for speech formation. The causes of dysarthria are vast and depend upon the location of the lesion. The treatment of dysarthria depends upon the etiology. Treatment usually focuses on achieving independent daily living for the patients. These include Augmentative and alternative communication, Lee Silverman voice treatment and Pitch Limiting Voice Treatment.

# Causes
The causes of slurred speech and dysarthria are vast and can be classified as follows. 

# Diagnosis

# Treatment

# Do's
- Communication strategies should employed by the patient with dysarthria.
- Eye contact should be maintained with the communication partner.
- Repair strategies such as restating message in different words and using gestures to help convey messages should be used.
- Environmental modification such as reducing background noise and ensuring that good lighting is present.
- Face to face seating for conversations should be employed.

# Don'ts
- Don't speak too fast. Speak slowly so that listeners may understand you better.
- Don't go for long topics. Ask the patient to  start small  and introduce the topic of conversation with one word or short phrase.
- Fatigue can make it difficult for patients to speak clearly.
- Background noise should be reduced.
Subacute cutaneous lupus erythematosus

# Overview
Subacute cutaneous lupus erythematosus (SCLE) is a clinically distinct subset of cases of lupus erythematosus that is most often present in white women aged 15 to 40, consisting of skin lesions that are scaly and evolve as polycyclic annular lesions or psoriasiform plaques.
Characteristically the lesions appear in sun-exposed areas such as the vee of the neckline or the forearms, but not the face. It may be brought on by sun-sensitizing medications, but is usually associated with autoimmune disorders such as rheumatoid arthritis and Sjogren's syndrome.
Treatment generally involves sun avoidance/protection and topical corticosteroids. Sometimes systemic drug treatment is necessary. Besides corticosteroids other immunosuppressants such as methotrexate are also used.
Lesions of SCLE may have an annular configuration, with raised red borders and central clearing.
Suicidal ideation physical examination

# Overview
There are no physical findings specific to suicidal ideation. Findings might be specific to secondary causes responsible for suicidal ideation which may be medical, psychiatric, substance abuse etc....
Doing a mental status examination is mandatory for the diagnosis of any patient endorsing suicidal ideation. However, complete medical evaluation should be done to rule out organic conditions that might be causing suicidal ideation.

# Mental status examination
A detailed mental status examination is necessary for a patient endorsing suicidal ideation, there may be slight variation in the findings of mental status examination depending on the underlying psychiatric condition that might be the cause of suicidal ideation. Assessing appearance, behavior, ability to cooperate with the exam, level of activity, speech, mood and affect, thought process and content, insight and judgement. Check the patient's orientation, mood, affect, cognition( memory, speech, language). Ask the patient about any suicidal or homicidal ideation.
Sulfadiazine dosage and administration

# Dosage and Administration
SYSTEMIC SULFONAMIDES ARE CONTRAINDICATED IN INFANTS UNDER 2 MONTHS OF AGE except as adjunctive therapy with pyrimethamine in the treatment of congenital toxoplasmosis.
Usual Dosage for Infants over 2 Months of Age and Children
Initially, one-half the 24-hour dose. Maintenance, 150 mg/kg or 4 g/m2, divided into 4 to 6 doses, every 24 hours, with a maximum of 6 g every 24 hours. Rheumatic fever prophylaxis, under 30 kg (66 pounds), 500 mg every 24 hours; over 30 kg (66 pounds), 1 g every 24 hours.
Usual Adult Dosage
Initially, 2 g to 4 g. Maintenance, 2 g to 4 g, divided into 3 to 6 doses, every 24 hours.
Sulfamethoxazole indications and usage

# Indications and Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bactrim (sulfamethoxazole and trimethoprim) tablets and other antibacterial drugs, Bactrim (sulfamethoxazole and trimethoprim) tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy.
Urinary Tract Infections: For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris. It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination.
Acute Otitis Media: For the treatment of acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when in the judgment of the physician sulfamethoxazole and trimethoprim offers some advantage over the use of other antimicrobial agents. To date, there are limited data on the safety of repeated use of BACTRIM in pediatric patients under two years of age. BACTRIM is not indicated for prophylactic or prolonged administration in otitis media at any age.
Acute Exacerbations of Chronic Bronchitis in Adults: For the treatment of acute exacerbations of chronic bronchitis due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when a physician deems that BACTRIM could offer some advantage over the use of a single antimicrobial agent.
Shigellosis: For the treatment of enteritis caused by susceptible strains of Shigella flexneri and Shigella sonnei when antibacterial therapy is indicated.
Pneumocystis jiroveci Pneumonia: For the treatment of documented Pneumocystis jiroveci pneumonia and for prophylaxis against P. jiroveci pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing P. jiroveci pneumonia.
Traveler's Diarrhea in Adults: For the treatment of traveler's diarrhea due to susceptible strains of enterotoxigenic E. coli.
Sulfanilamide warnings and precautions

# Warnings and Precautions

## Precautions
General
Because sulfonamides are absorbed from the vaginal mucosa, the usual precautions for oral sulfonamides apply. Patients should be observed for skin rash or evidence of systemic toxicity, and if these develop, the medications should be discontinued.
Deaths associated with administration of oral sulfonamides have reportedly occurred from hypersensitivity reactions, agranulocytosis, aplastic anemia, and other blood dyscrasias.
Goiter production, diuresis, and hypoglycemia have reportedly occurred rarely in patients receiving oral sulfonamides. Cross-sensitivity may exist with these agents. Rats appear to be especially susceptible to the goitrogenic effects of sulfonamides, and long-term administration has reportedly produced thyroid malignancies in this species.
Vaginal applicators or inserters should be used with caution after the seventh month of pregnancy.
Information For Patients
The doctor should advise the patient that in the event unusual local itching and burning occur, or other unusual symptoms develop, medication should be discontinued and not restarted without further consultation.
Drug Interactions
Drug interactions have not been documented with AVC.
Carcinogenesis, Mutagenesis, Impairment of Fertility
No data are available on long-term potential of AVC for carcinogenicity, mutagenicity, or impairment of fertility in animals or humans.
Pregnancy
Teratogenic Effects. Pregnancy Category C: Animal reproductive studies have been conducted with sulfonamides, including sulfanilamide (see below). It is not known whether AVC can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. AVC should be given to a pregnant woman only if clearly needed.
Sulfonamides, including sulfanilamide, readily pass through the placenta and reach fetal circulation. The concentration in the fetus is from 50-90% of that in the maternal blood and if high enough, can cause toxic effects. The safe use of sulfonamides, including sulfanilamide, in pregnancy has not been established. The teratogenic potential of most sulfonamides has not been thoroughly investigated in either animals or humans. However, a significant increase in the incidence of cleft palate and other bony abnormalities of offspring has been observed with certain sulfonamides of the short-, intermediate- and long-acting types (including sulfanilamide) when given to pregnant rats and mice at high oral doses (seven to 25 times the human therapeutic oral dose.)
Nursing Mothers
Sulfanilamide should be avoided in nursing mothers because absorbed sulfonamides will appear in maternal milk and have caused kernicterus in the newborn. Because of the potential for serious adverse reactions in nursing infants from sulfonamides, a decision should be made whether to discontinue nursing or to discontinue the drug.
Pediatric Use
Safety and effectiveness of AVC in pediatric patients have not been established.
Superficial branch of the radial nerve
The superficial branch of the radial nerve  passes along the front of the radial side of the forearm to the commencement of its lower third.
It lies at first slightly lateral to the radial artery, concealed beneath the Brachioradialis. In the middle third of the forearm, it lies behind the same muscle, close to the lateral side of the artery.
It quits the artery about 7 cm. above the wrist, passes beneath the tendon of the Brachioradialis, and, piercing the deep fascia, divides into two branches: lateral and medial.

# Lateral branch
The lateral branch, the smaller, supplies the radial side of the thumb (by a digital nerve), the skin of the radial side and ball of the thumb, joining with the volar branch of the lateral antibrachial cutaneous nerve.

# Medial branch
The medial branch communicates, above the wrist, with the dorsal branch of the lateral antibrachial cutaneous, and, on the back of the hand, with the dorsal branch of the ulnar nerve.
It then divides into four digital nerves, which are distributed as follows: the first supplies the ulnar side of the thumb; the second, the radial side of the index finger; the third, the adjoining sides of the index and middle fingers; the fourth communicates with a filament from the dorsal branch of the ulnar nerve, and supplies the adjacent sides of the middle and ring fingers.

# Additional images
- Ulnar and radial arteries. Deep view.
- Diagram of segmental distribution of the cutaneous nerves of the right upper extremity. Posterior view.
- Superficial palmar nerves.
- Deep palmar nerves.
- Front of right upper extremity, showing surface markings for bones, arteries, and nerves.
Tetracycline hydrochloride description

# Description
Tetracycline is a yellow, odorless, crystalline powder. Tetracycline is stable in air but exposure to strong sunlight causes it to darken. Its potency is affected in solutions of pH below 2 and is rapidly destroyed by alkali hydroxide solutions. Tetracycline is very slightly soluble in water, freely soluble in dilute acid and in alkali hydroxide solutions, sparingly soluble in alcohol, and practically insoluble in chloroform and in ether. The chemical name for tetracycline hydrochloride is 4-(Dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,6,10,12,-12a-pentahydroxy-6-methyl-1,11-dioxo-2-naphthacenecar-boxamide monohydrochloride. Its structural formula is as follows:
Each capsule, for oral administration, contains 250 mg or 500 mg tetracycline hydrochloride.
Inactive Ingredients: Lactose, light mineral oil, and magnesium stearate.
The 250 mg and 500 mg capsule shells contain D&C yellow no. 10, FD&C blue no. 1, FD&C yellow no. 6, gelatin, and titanium dioxide.
The imprinting ink for the 250 mg and 500 mg capsules contains D&C yellow #10, FD&C blue no. 1, FD&C blue no. 2, FD&C red no. 40, iron oxide black, pharmaceutical shellac glaze, propylene glycol and n-butyl alcohol.
The heart in primary myocardial tumors

# CT

# Histopathological Findings
Images courtesy of Professor Peter Anderson DVM PhD and published with permission  PEIR, University of Alabama at Birmingham, Department of Pathology
- The right side of the heart has been opened to demonstrate a large right atrial mass overlying the septal leaflet of the tricuspid valve. No metastases were demonstrated at autopsy.
- Myxosarcoma. This tumor was excised from a 27-year-old woman with a left atrial mass (clinically diagnosed as myxoma). She died of widespread metastases at postoperative 48th month.
- A 64-year-old man with back pain had surgical excision of a right atrial mass. There was a pleomorphic sarcoma with vacuolated cells. The patient died with bony metastases.
Tinea versicolor (patient information)
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# Overview
Tinea versicolor is a long-term (chronic) fungal infection of the skin.

# What are the symptoms of Tinea versicolor?
The main symptom is patches of discolored skin with sharp borders (edges) and fine scales. The patches are often dark reddish-tan in color. The most common sites are the back, underarms, upper arms, chest, and neck. Affected areas do not darken in the sun (skin may appear lighter than surrounding healthy skin)
In African Americans, there may be loss of skin color (hypopigmentation) or an increase in skin color (hyperpigmentation).
Other symptoms include:
- Increased sweating
- Itching

# What causes Tinea versicolor?
Tinea versicolor is relatively common. It is caused by the fungus Pityrosporum ovale,  a type of yeast that is normally found on human skin. It only causes problems under certain circumstances.

# Who is at highest risk?
The condition is most common in adolescent and young adult males. It typically occurs in hot climates.

# Diagnosis
A skin scraping that is examined under a microscope should show the yeast.

# When to seek urgent medical care?
Call for an appointment with your health care provider if you develop symptoms of tinea versicolor.

# Treatment options
Treatment consists of applying antifungal medicines to the skin. These medications include clotrimazole, ketoconazole, and miconazole.
Over-the-counter dandruff shampoos applied to the skin for 10 minutes each day in the shower may also help treat the skin.

# Where to find medical care for Tinea versicolor?
Directions to Hospitals Treating Tinea versicolor

# What to expect (Outlook/Prognosis)?
Though tinea versicolor is easily treated, pigment changes may last for months after treatment. The condition may come back during the warm months.

# Prevention of Tinea versicolor
People with a history of tinea versicolor should try to avoid excessive heat or sweating.

# Sources
Treatment of coronary stent thrombosis
Stents are usually placed in the proximal segments of major epicardial vessels, hence in-stent thrombotic occlusion clinically present as severe ischemia or infarction.

# Management
Emergent target lesion or target vessel revascularization is the treatment of choice in stent thrombosis to restore vessel patency.
- Revascularization may be carried out by PCI or in some instances, thrombolytics .
- If revascularization is not successful, urgent CABG should be considered.
- The probable cause for stent thrombosis should be evaluated as the treatment varies with etiology. The probable contributing factors are:
suboptimal stent apposition,
Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis.
premature discontinuation of dual antiplatelet therapy,
clopidogrel resistance.
- suboptimal stent apposition,
- Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis.
- premature discontinuation of dual antiplatelet therapy,
- clopidogrel resistance.
- If the patient develops stent thrombosis while on clopidogrel, it may suggest that the patient was not responsive to clopidrogrel therapy. TRITON TIMI 38 trial demonstrated that newer antiplatelet agents such as prasugrel may be used after weighing the risks of bleeding against benefits of decreased recurrence of stent thrombosis/coronary events.
- Patients who present with stent thrombosis after completing the recommended duration of treatment with clopidogrel restarting clopidogrel 75 mg daily along with aspirin and continuing for a minimum of one year should be considered.

# Sources
The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI
Trichotillomania (patient information)
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Synonyms and Keywords: Trichotillosis; Compulsive hair pulling

# Overview
Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner.

# What are the symptoms of Trichotillomania?
- Symptoms usually begin before age 17.
- The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.
- These symptoms are usually seen in children:
- An uneven appearance to the hair
- Bare patches or all around (diffuse) loss of hair
- Bowel blockage (obstruction) if people eat the hair they pull out
- Constant tugging, pulling, or twisting of hair
- Denying the hair pulling
- Hair regrowth that feels like stubble in the bare spots
- Increasing sense of tension before the hair pulling
- Other self-injury behaviors
- Sense of relief, pleasure, or gratification after the hair pulling
- Most people with this disorder also have problems with:
- Feeling sad or depressed
- Anxiety
- Poor self image

# What causes Trichotillomania?
- Trichotillomania is a type of impulsive control disorder.
- Its causes are not clearly understood.
- It may affect as much as 4% of the population. Women are four times more likely to be affected than men.

# Diagnosis
- People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).
- A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.

# Treatment options
- Experts don't agree on the use of medication for treatment. However, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown effective in reducing some symptoms.
- Behavioral therapy and habit reversal may also be effective.

# Where to find medical care for Trichotillomania?
Directions to Hospitals Treating Trichotillomania

# What to expect (Outlook/Prognosis)?
- Trichotillomania that begins in younger children (fewer than 6 years old) may go away without treatment. For most, the hair pulling ends within 12 months.
- For others, trichotillomania is a lifelong disorder.
- Treatment often improves the hair pulling and the feelings of depression, anxiety, or poor self image.

# Possible complications
People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.

# Prevention
- Early detection is the best form of prevention because it leads to early treatment.
- Decreasing stress can help, because stress may increase compulsive behavior.

# Source
Trimethoprim dosage and administration

# Dosage And Administration

## Acute Otitis Media in Pediatric Patients
The recommended dose for pediatric patients with acute otitis media is 10 mg/kg trimethoprim per 24 hours, given in divided doses every 12 hours for 10 days. The following table is a guideline for the attainment of this dosage:

## Uncomplicated Urinary Tract Infections
The usual oral adult dosage is 100 mg (10 mL) every 12 hours or 200 mg (20 mL) every 24 hours, each for 10 days.

## Patients with Impaired Renal Function
The use of trimethoprim in patients with a creatinine clearance of less than 15 mL/min is not recommended. Patients with a creatinine clearance of 15 to 30 mL/min should receive half the dose recommended for patients of the same age with normal renal function.