Persius/hicric huggingface dataset:
Nutcracker esophagus overview

# Overview
Nutcracker esophagus (diffuse esophageal spasm or corkscrew esophagus) is a disorder of the movement of the esophagus, and is one of many motility disorders of the esophagus, including achalasia and diffuse esophageal spasm.  It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause chest pain; it may also have no symptoms.  Nutcracker esophagus can affect people of any age, but is more common in the 6th and 7th decades of life.  The diagnosis is made by an esophageal motility study, which evaluates the pressure of the esophagus at various points along its length.  The term "nutcracker esophagus" comes from the finding of increased pressures during peristalsis, with a diagnosis made when pressures exceed 180 mmHg; this has been linked to the pressure of a mechanical nutcracker.  The disorder does not progress, and is not associated with any complications; as a result, treatment of nutcracker esophagus targets control of symptoms only.

# Historical Perspective

# Classification

# Pathophysiology

# Causes
The cause of diffuse esophageal spasm is unknown. Very hot or very cold foods may trigger an episode in some people.

# Differentiating Nutcracker esophagus overview from Other Diseases

# Epidemiology and Demographics

# Risk Factors

# Screening

# Natural History, Complications, and Prognosis

## Natural History

## Complications

## Prognosis

# Diagnosis

## Diagnostic Criteria

## History and Symptoms

## Physical Examination

## Laboratory Findings

## Imaging Findings

### Endoscopy
Endoscopy is typically normal in patients with nutcracker esophagus; however, abnormalities associated with gastroesophageal reflux disease, or GERD, which associates with nutcracker esophagus, may be seen. Studies on endoscopic ultrasound show a slight trend towards thickening of the muscularis propria of the esophagus in nutcracker esophagus, but this is not useful in making the diagnosis.

## Other Diagnostic Studies

# Treatment

## Medical Therapy

## Surgery
Pneumatic dilatation of the esophagus, which is an endoscopic technique where a high-pressure balloon is used to stretch the muscles of the LES, can be performed to improve symptoms.
In patients who have no response to medical or endoscopic therapy, surgery can be performed.  A Heller myotomy involves an incision to disrupt the LES and the myenteric plexus that innervates it.  It is used as a final treatment option in patients who do not respond to other therapies.

## Prevention
Osteo-Odonto-Keratoprosthesis

# Overview
Osteo-Odonto-Keratoprosthesis (OOKP) is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor. After this, a lamina of tissue cut from the tooth is drilled and the hole is fitted with optics. The lamina is grown in the patients' cheek for a period of months and then is implanted upon the eye.

# Indications and prognosis
An operation to graft the OOKP is undertaken in severe pemphigoid, chemical burns, Stevens-Johnson syndrome, trachoma, Lyell syndrome and multiple corneal graft failure.
There is a significant risk of anatomical failure of lamina in the long term, estimated at about 19% in a small study, with the main risks being laminar resorption, particularly in allografts, and glaucoma. Another, bigger study comparing OOKP with the lesser known Osteo-Keratoprosthesis (OKP) in 145 and 82 patients and follow-up terms up to 10 years yielded following statistics:
- 10-year anatomical survival: 66% for OOKP and 47% for OKP,
- 2-year functional survival: 63% for OOKP and 49% for OKP,
- 10-year functional survival: 38% for OOKP and 17% for OKP,
with functional survival defined as best corrected visual acuity above 0.05. A long-term study of 181 patients puts the chances of retaining an intact OOKP after 18 years at 85%.

# Procedure
OOKP is a complex two stage Operation which was pioneered in Italy in the 1963 by professor Strampelli.
Stage 1 of the surgery involves 5 separate procedures:
- The eye is opened up and the entire inner surface of the eyelids, corneal surface and all scar tissue is removed
- Inner mucosal lining of the cheek is transplanted onto the new surface of the eye
- A canine or premolar tooth and part of the adjacent bone and ligaments are removed
- A bolt-shaped structure is fashioned from the tooth-bone complex which is fitted with a plastic optical cylinder
- The tooth-bone-cylinder complex is implanted into the patient's cheek to grow a new blood supply
Stage 2 (about 4 months later) involves 2 separate procedures:
- The cheek mucosal lining over the eye is opened and the inner contents of the eye are removed
- The tooth-bone-cylinder complex is removed from the cheek and inserted into the eye, the mucosal cheek lining is replaced over the implant.
At the end of the procedure, light can now enter through the plastic cylinder, and the patient is able to see through this cylinder with good vision.
Optic nerve sheath meningioma

# Overview
Optic nerve sheath meningiomas (ONSM) are rare benign tumors of the optic nerve. 60-70% of cases occur in middle age females, and is more common in older adults (mean age 44.7 years). It is also seen in children, but this is rare. The tumors grow from cells that surround the optic nerve, and as the tumor grows, it compresses the optic nerve. This causes loss of vision in the affected eye. 
It is typically a slow growing tumor, and has never been reported to cause death. However, there is concern that the tumor can grow into the brain and cause other types of neurological damage. In some patients, the tumor grows so slowly that treatment is not necessary. Standard treatments are observation, surgery, radiation therapy, and combinations of the above. 

# Incidence
About 1-2% of all meningiomas are optic nerve sheath meningiomas. Meningiomas have an incidence of ~4.18/100,000 persons each year. Thus, ~10,000 meningiomas are diagnosed in the US each year; corresponding to ~100 cases of ONSM each year in the US. The actual number of meningiomas is likely much higher as it is very common in elederly women. ONSM comprises about 2% of orbital tumors, and about 10% of optic nerve lesions.
Neurofibromatosis type II (NF-2) affects around 9% of ONSM patients, where the incidence in the general population is around 0.03-0.05%. Thus NF-2 is felt to be a risk factor for the development of ONSM.

# Diagnosis
Usually diagnosis can be achieved by an MRI of the brain or orbits when the patient presents with chronic visual loss, optic disc atrophy, and retinocilliary shunt vessels (the so called Hoyt-Spencer triad).

# Treatment
Most ophthalmologists will not advocate any treatment unless visual loss is present and ongoing. Reports of patients with ONSM having no change in their vision for multiple years are not uncommon. If loss of vision occurs, radiation therapy will improve vision in about 1/3rd of cases, and preserve vision in about 1/3rd of cases. Surgery has traditionally been associated with rapid deteroriation of vision.  However, newer surgical techniques may prove better for the treatment of ONSM.
Oseltamivir drug interactions

# Drug Interactions

## Influenza Vaccines
The concurrent use of TAMIFLU with live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. However, because of the potential for interference between these products, LAIV should not be administered within 2 weeks before or 48 hours after administration of TAMIFLU, unless medically indicated. The concern about possible interference arises from the potential for antiviral drugs to inhibit replication of live vaccine virus. Trivalent inactivated influenza vaccine can be administered at any time relative to use of TAMIFLU.

## Overall Drug Interaction Profile for Oseltamivir
Information derived from pharmacology and pharmacokinetic studies of oseltamivir suggests that clinically significant drug interactions are unlikely.
Oseltamivir is extensively converted to oseltamivir carboxylate by esterases, located predominantly in the liver. Drug interactions involving competition for esterases have not been extensively reported in literature. Low protein binding of oseltamivir and oseltamivir carboxylate suggests that the probability of drug displacement interactions is low.
In vitro studies demonstrate that neither oseltamivir nor oseltamivir carboxylate is a good substrate for P450 mixed-function oxidases or for glucuronyl transferases.
Clinically important drug interactions involving competition for renal tubular secretion are unlikely due to the known safety margin for most of these drugs, the elimination characteristics of oseltamivir carboxylate (glomerular filtration and anionic tubular secretion) and the excretion capacity of these pathways. Coadministration of probenecid results in an approximate two-fold increase in exposure to oseltamivir carboxylate due to a decrease in active anionic tubular secretion in the kidney. However, due to the safety margin of oseltamivir carboxylate, no dose adjustments are required when coadministering with probenecid.
No pharmacokinetic interactions have been observed when coadministering oseltamivir with amoxicillin, acetaminophen, aspirin, cimetidine, antacids (magnesium and aluminum hydroxides and calcium carbonates), or warfarin.
Oxacillin sodium how supplied

# How Supplied
Each vial of Oxacillin for Injection, USP contains oxacillin sodium monohydrate equivalent to 1 gram or 2 grams of oxacillin.
- Oxacillin for Injection USP, 1 g vials in a Box of 10           NDC 55150-127-15
- Oxacillin for Injection USP, 2 g vials in a Box of 10           NDC 55150-128-24
Oxacillin for Injection, USP is a sterile, white to off-white powder and after reconstitution it becomes light yellow colored clear liquid.
Store dry powder at 20 to 25C (68 to 77F). 
This container closure is not made with natural rubber latex.
Oxytetracycline hydrochloride

# Overview
Oxytetracycline was the second of the broad-spectrum  tetracycline group of antibiotics to be discovered.
Oxytetracycline works by interfering with the ability of bacteria to produce essential proteins. Without these proteins, the bacteria cannot grow, multiply and increase in numbers. Oxytetracycline therefore stops the spread of the infection and the remaining bacteria are killed by the immune system or eventually die.
Oxytetracycline is a broad-spectrum antibiotic, active against a wide variety of bacteria. However, some strains of bacteria have developed resistance to this antibiotic, which has reduced its effectiveness for treating some types of infections.
Oxytetracycline is still used to treat infections caused by Chlamydia (e.g. the chest infection psittacosis, the eye infection trachoma, and the genital infection urethritis) and infections caused by Mycoplasma organisms (e.g. pneumonia).
Oxytetracycline is also used to treat acne, due to its activity against the bacteria on the skin that cause acne (Propionibacterium acnes). It is used to treat flare-ups of chronic bronchitis, due to its activity against the bacteria usually responsible, Haemophilus influenzae.
Oxytetracycline may also be used to treat other rarer infections, such as those caused by a group of micro-organisms called rickettsiae (e.g. Q fever). To make sure the bacteria causing an infection are susceptible to it, a tissue sample is usually taken, for example a swab from the infected area, or a urine or blood sample.

# Category
Tetracycline

# US Brand Names
UROBIOTIC

# FDA Package Insert

# Mechanism of Action
The tetracyclines are primarily bacteriostatic and are thought to exert their antimicrobial effect by the inhibition of protein synthesis. The tetracyclines, including minocycline, have a similar antimicrobial spectrum of activity against a wide range of gram-positive and gram-negative organisms. Cross-resistance of these organisms to tetracyclines is common.
Pediatric intensive care unit

# Overview
A pediatric intensive care unit, usually abbreviated to PICUis an area within a hospital specializing in the care of critically ill infants, children, and teenagers.
A PICU is typically directed by one or more pediatric intensivists or PICU consultants  and staffed by doctors and nurses who are specially trained and experienced in pediatric intensive care.  The unit may also have nurse practitioners, respiratory therapists, physician assistants, physiotherapists, social workers and clerks on staff although this varies widely depending on geographic location.
The ratio of professionals to patients is generally higher than in other areas of the hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications.  Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems.  Consequently, PICUs have a larger operating budget than many other departments within the hospital.

# History
Goran Haglund established the first pediatric intensive care unit, which he called a "pediatric emergency ward", in 1955.
Infants were first kept intubated for long periods in the early 1960s. Breathing tubes made out of polyvinyl chloride (PVC) allowed clinicians to avoid performing tracheostomy (surgically inserting a tube into the windpipe) in more children who required prolonged mechanical ventilation.
Paroxysmal AV Block Prognosis

# Overview
Prognosis of intrinsic paroxysmal AV block is more dire than extrinsic idiopathic paroxysmal AV block or extrinsic vagal paroxysmal AV block.

# Prognosis
- Given the presence of an innate structural defect, there is an increase risk of progression to complete AV Block in patients with intrinsic AV block. Sparse literature suggest some correlation between length of asystole and increased severity.
- Given that extrinsic vagally mediated AV block is not associated with an innate conduction defect (seen in intrinsic paroxysmal AV block) and is at the level of the AV node, it is considered benign. 
- Given the absence of structural heart disease, the paroxysmal nature of the episodes and the low probability of progression into more severe forms of AV block, extrinsic idiopathic paroxysmal AV block has a good prognosis.
Pathological demand avoidance

# Overview
Pathological demand avoidance is a pervasive developmental disorder identified by Elizabeth Newson. She conducted her research at the Child Development Research Unit, University of Nottingham, England, and later at the Early Years Diagnostic Centre, Nottingham.

# Diagnostic Criteria
In contrast to most individuals with autism spectrum disorders, individuals with PDA possess superficial social skills and seem to have a theory of mind. They often engage in manipulative, domineering behavior. The defining criteria are:
- Passive early history in the first year, resisting ordinary demands and missing milestones
- Continuing to resist demands, resorting to tantrums, distraction techniques
- Surface sociability, but apparent lack of sense of social identity, pride or shame
- Lability of mood and impulsivity
- Comfortable in role play and pretending
- Language delay, seemingly the result of passivity
- Obsessive behavior
- Neurological signs (awkwardness, similar to autism spectrum disorders

# Controversies
Many autism advocates and researchers view PDA as simply an expression of an autism spectrum disorder. The National Autistic Society states, "We do not agree that this is a separate syndrome. Each of the behaviours Professor Newson describes can be found in some individuals with any form of autistic spectrum disorder. They can be found on their own or in any number in any combination. It is when all or almost all appear in an individual that Professor Newson would apply the label of PDA."
Penciclovir adverse reactions

# Adverse Reactions

## Clinical Studies
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
In two double-blind, placebo-controlled trials, 1516 patients were treated with DENAVIR (penciclovir cream) and 1541 with placebo. One or more local adverse reactions were reported by 3% of the patients treated with DENAVIR and 4% of placebo-treated patients. The rates of reported local adverse reactions are shown in Table 1.
Two studies, enrolling 108 healthy subjects, were conducted to evaluate the dermal tolerance of 5% penciclovir cream (a 5-fold higher concentration than the commercial formulation) compared to vehicle using repeated occluded patch testing methodology. The 5% penciclovir cream induced mild erythema in approximately one-half of the subjects exposed, an irritancy profile similar to the vehicle control in terms of severity and proportion of subjects with a response. No evidence of sensitization was observed.

## Post-Marketing Experience
The following adverse reactions have been identified during post-approval use of DENAVIR.  Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
The following events have been identified from worldwide post-marketing use of DENAVIR in treatment of recurrent herpes labialis (cold sores) in adults.  These events have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal connection to DENAVIR.
General:  Headache, oral/pharyngeal edema, parosmia.
Skin: Aggravated condition, decreased therapeutic response, local edema, pain, paresthesia, pruritus, skin discoloration, and urticaria.
Persistent pupillary membrane

# Overview
Persistent pupillary membrane (PPM) is a condition of the eye involving remnants of a fetal membrane that persist as strands of tissue crossing the pupil.  The pupillary membrane in mammals exists in the fetus as a source of blood supply for the lens.  It normally atrophies from the time of birth to the age of four to eight weeks.
PPM occurs when this atrophy is incomplete. It generally does not cause any symptoms. The strands can connect to the cornea or lens, but most commonly to other parts of the iris.  Attachment to the cornea can cause small corneal opacities, while attachment to the lens can cause small cataracts.  Using topical atropine to dilate the pupil may help break down PPMs.
In dogs, PPM is inherited in the Basenji but can occur in other breeds such as the Pembroke Welsh Corgi, Chow Chow, Mastiff, and English Cocker Spaniel.
It is also rarely seen in cats, horses, and cattle.
Phosphate-transporting ATPase
In enzymology, a phosphate-transporting ATPase (EC 3.6.3.27) is an enzyme that catalyzes the chemical reaction
The 3 substrates of this enzyme are ATP, H2O, and phosphate, whereas its two products are ADP and phosphate.
This enzyme belongs to the family of hydrolases, specifically those acting on acid anhydrides to catalyse transmembrane movement of substances.  The systematic name of this enzyme class is ATP phosphohydrolase (phosphate-importing). This enzyme is also called ABC phosphate transporter.  This enzyme participates in abc transporters - general.
Phospholipid transfer protein
Phospholipid transfer protein is a protein that in humans is encoded by the PLTP gene.

# Function
The protein encoded by this gene is one of at least two lipid transfer proteins found in human plasma. The encoded protein transfers phospholipids from triglyceride-rich lipoproteins to high density lipoprotein (HDL). In addition to regulating the size of HDL particles, this protein may be involved in cholesterol metabolism. At least two transcript variants encoding different isoforms have been found for this gene.

# Interactions
PLTP has been shown to interact with Apolipoprotein A1 and APOA2.

# Interactive pathway map
Click on genes, proteins and metabolites below to link to respective articles. 
-  The interactive pathway map can be edited at WikiPathways: "Statin_Pathway_WP430"..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
Phosphorylase kinase, alpha 1
Phosphorylase b kinase regulatory subunit alpha, skeletal muscle isoform is an enzyme that in humans is encoded by the PHKA1 gene. It is the muscle isoform of Phosphorylase kinase (PhK).
The PHKA1 gene encodes the alpha subunit of muscle phosphorylase kinase (EC 2.7.1.38), a key regulatory enzyme of glycogen metabolism. Phosphorylase kinase consists of 4 copies of an alpha-beta-gamma-delta tetramer. The alpha, beta (PHKB; MIM 172490), and gamma (PHKG1; MIM 172470 and PHKG2; MIM 172471) subunits have several isoforms; the delta subunit is calmodulin (CALM1; MIM 114180). PHKA2 (MIM 306000) encodes the alpha subunit of liver-specific phosphorylase kinase and is also located on the X chromosome.
A deficiency of this enzyme causes glycogen storage disease type IXd (GSD 9D).
Platinum-based antineoplastic

# Overview
Platinum-based antineoplastic drugs (informally called platins) are chemotherapeutic agents to treat cancer. They are coordination complexes of platinum.
The main dose-limiting side effect of cancer treatment with platinum compounds is neurotoxicity, which causes peripheral neuropathies including polyneuropathy.

# Mechanism of action
As studied mainly on cisplatin, but presumably for other members as well, platinum-based antineoplastic agents cause crosslinking of DNA as monoadduct, interstrand crosslinks, intrastrand crosslinks or DNA protein crosslinks. Mostly they act on the adjacent N-7 position of guanine, forming 1, 2 intrastrand crosslink.
The resultant crosslinking inhibit DNA repair and/or DNA synthesis in cancer cells.
Platinum-based antineoplastic agents are sometimes described as "alkylating-like" due to similar effects as alkylating antineoplastic agents, although they do not have an alkyl group.

# Examples
- cisplatin, the first to be developed. Cisplatin is particularly effective against testicular cancer; the cure rate was improved from 10% to 85%.
- carboplatin, a second-generation platinum-based antineoplastic agent
- oxaliplatin
- satraplatin
- picoplatin
- Nedaplatin
- Triplatin
- Lipoplatin, a liposomal version of cisplatin