Persius/hicric huggingface dataset:
Doripenem adverse reactions

# Adverse Reactions

## Adverse Reactions from Clinical Trial
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be compared directly to rates from clinical trials of another drug and may not reflect rates observed in practice.
During clinical investigations, 1338 adult patients were treated with DORIBAX (1076 patients received doripenem 500 mg administered over 1 hour every 8 hours and 262 patients received doripenem 500 mg administered over 4 hours every 8 hours); in some patients parenteral therapy was followed by a switch to an oral antimicrobial. . The median age of patients treated with DORIBAX was 54 years (range 1890) in the comparative complicated urinary tract infections (cUTI) study, 46 years (range 1894) in the pooled comparative complicated intra-abdominal infections (cIAI) studies, and 56 years (range 1894) in the other Phase 3 trials. There was a female predominance (62%) in the comparative cUTI study and a male predominance (63% and 75%) in the comparative cIAI and other Phase 3 trials, respectively. The patients treated with DORIBAX were predominantly Caucasian (79%) in the five comparator-controlled Phase 3 studies.
The most common adverse drug reactions ( 5%) observed in the five DORIBAX comparator-controlled Phase 3 clinical trials were anemia, headache, nausea, diarrhea, rash, phlebitis, and elevated hepatic enzymes. During clinical trials, adverse events led to discontinuation of DORIBAX in 4.1% (55 of 1338) of patients compared to 4.3% (58 of 1325) of comparator-treated patients.
Adverse reactions due to DORIBAX 500 mg every 8 hours that occurred at a rate  1 % are listed in Table 4. Hypersensitivity reactions related to intravenous study drug occurred at a rate of less than 1%.
In a Phase 1 study of healthy subjects receiving doripenem doses greater than the approved dose of 500 mg every 8 hours for 10 to 14 days, the incidence of rash was higher than that observed in subjects who received 500 mg every 8 hours. The rash resolved within 10 days after doripenem administration was discontinued.

## Postmarketing Experience
The following adverse reactions have been identified during post-approval use of doripenem. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- Anaphylaxis
- Leukopenia
- Neutropenia
- Seizure
- Thrombocytopenia
- Toxic epidermal necrolysis
- Stevens-Johnson Syndrome
- Interstitial pneumonia
Dural arteriovenous fistula
A dural arteriovenous fistula, also called a dural arteriovenous malformation, is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus.
The Borden Classification of Dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage:
- Type I: dural arterial supply drains anterograde into venous sinus.
- Type II: dural arterial supply drains into venous sinus. High pressure in sinus results in both anterograde drainage and retrograde drainage via subarachnoid veins.
- Type III: dural arterial supply drains retrograde into subarachnoid veins.

# Type I
Type I dural arteriovenous fistulas are suppied by meningeal arteries and drain into a meningeal vein or dural venous sinus. The flow within the draining vein or venous sinus is anterograde.
- Type Ia -- simple dural arteriovenous fistulas have a single meningeal arterial supply
- Type Ib -- more complex arteriovenous fistulas are supplied my multiple meningeal arteries
The distinction between Types Ia and Ib is somewhat specious as there is a rich system of meningeal arterial collaterals. Type I dural fistulas are often asymptomatic, do not have a high risk of bleeding and do not necessarily need to be treated.

# Type II
The high pressure within a Type II dural AV fistula causes blood to flow in a retrograde fashion into subarachnoid veins which normally drain into the sinus. Typically this is because the sinus has outflow obstruction. Such draining veins form venous varices or aneuryms which can bleed. Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins.

# Type III
Type III dural AV fistulas drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. If treatment involves embolization, it will only typically be effective if the glue traverses the actual fistula and enters, at least slightly, the draining vein.
Echinococcus multilocularis

# Overview
Echinococcus multilocularis is a cyclophyllid cestode that, like Echinococcus granulosus, produces hydatid disease in many mammals, including rodents and humans.  Unlike E. granulosus, E multilocularis produces many small cysts ("multilocular infection") that spread throughout the infected animal.  When these cysts are ingested by a canid, usually by eating an infected rodent, it produces heavy infection with tapeworm adults.

# Organism
Echinococcus multilocularis is a cyclophyllid cestode that, like Echinococcus granulosus, produces hydatid disease in many mammals, including rodents and humans.  Unlike E. granulosus, E multilocularis produces many small cysts ("multilocular infection") that spread throughout the infected animal.  When these cysts are ingested by a canid, usually by eating an infected rodent, it produces heavy infection with tapeworm adults.
These adults produce eggs and proglottids that are passed with feces.  Small rodents serve as the most common intermediate hosts, but humans that ingest eggs or proglottids may also become infected.
A study by Purdue veterinary parasitologists indicated that the disease is spreading throughout the American Midwest, where it was previously rare or nonexistent.  Additionally, the disease has extended its range in Europe in the last few decades.

# Treatment

## Antimicrobial therapy
- Echinococcus multilocularis (alveolar cyst disease) treatment
- Preferred regimen: If  60 kg Albendazole 400 mg PO bid or if < 60 kg Albendazole 15 mg/kg/day PO bid with meals for at least 2 years.
- Note (1): Wide surgical resection only reliable treatment; technique evolving.
- Note (2): Long-term follow up needed to evaluate progression of the lesions.

# See Also
- Alveolar hydatid disease
ELISA (patient information)
For the WikiDoc page for this topic, click here

# Overview
ELISA stands for enzyme-linked immunoassay. It is a commonly used laboratory test to detect antibodies in the blood.

# How is the ELISA done?
Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
The sample is sent to a laboratory where the targeted antibody (or antigen) is linked to an enzyme. If the target substance is in the sample, the test solution turns a different color.
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

# Who needs ELISA?
This test is often used to see if you have been exposed to viruses or other substances that cause infection. It is often used to screen for current or past infections.

# Where to find centers that perform ELISA?
Directions to Hospitals Performing ELISA

# Possible complications
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
- Excessive bleeding.
- Fainting or feeling light-headed.
- Hematoma (blood accumulating under the skin).
- Infection (a slight risk any time the skin is broken).

# What to expect (Outlook/Prognosis)?
Normal Results
Normal values depend on the type of substance being identified. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results
Abnormal Results
Abnormal values depend on the type of substance being identified. In some people, a positive result may be normal.

# Sources
Echo in tetralogy of fallot

# Tetralogy of Fallot
Tetralogy of fallot is a congenital heart disease comprised of four anatomic features stemming from the malalignment of the infundibular septum:
- Right ventrifular outflow obstruction (pulmonic stenosis)
- Ventricular Septal Defect
- Overriding aorta
- Right ventricular hypertrophy
- Clinically, it is a cyanotic heart defect and generally is diagnosed in infancy or early childhood.

## Echo functions in Tetralogy of Fallot
- Characterization of defects
- Options for surgical intervention
- Post-operative repair function

## Best evaluated by:
- parasternal long-axis view
- short-axis view (to evaluate size of septal defect)

## Post surgical evaluation should include:
- Evaluation of VSD repair
- Residual shunting
- Right ventricular size and contractility
- Right ventricular outflow tract for residual stenosis
- Severity of pulmonary regurgitation

# Additional Resource
Yale University School of Medicine Congenital Heart Disease: Tetralogy of Fallot
Editing delusional disorder

# Overview

# Historical Perspective

# Classification

# Pathophysiology

# Causes

# Differentiating Tongue cancer from other Diseases

# Epidemiology and Demographics

# Risk Factors

# Natural History, Complications and Prognosis

# Diagnosis
Staging |  History and Symptoms |  Physical Examination | Laboratory Findings | CT |  MRI | Other Imaging Findings | Other Diagnostic Studies

# Treatment
Medical Therapy |  Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

# Case Studies
Case#1

# Diagnosis

## Physical Examination
Shown below are images of tongue cancer to assist in the identification of the disease.

# Acknowledgements:
Images of tongue cancer from Bechara Y. Ghorayeb, MD.
Effective renal plasma flow

# Overview
Effective renal plasma flow (eRPF) is a measure used in renal physiology to calculate renal plasma flow (RPF) and hence estimate renal function.
Where extraction ratio is the amount of compound entering the kidney that got excreted into the final urine. 
When using a compound with an extraction ratio near 1, such as para-aminohippurate (PAH), then eRPF is almost equal to RPF. Therefore, PAH clearance is a method to estimate renal plasma flow.
Emergency care practitioner
An Emergency Care Practitioner or ECP may come from either a Paramedical, Nursing or Allied Health Professional background and has developed additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a 'standard' paramedic/qualified nurse or other ambulance crew such as technicians. It has been recommended by the British Paramedic Association that ECPs be trained to PgDip or MSc Level.
Additional skills which they may be able to perform include:
- Administration of certain medications under patient group directives (PGD's)such as antibiotics
- Suturing, steri-stripping and glueing of wounds
- Minor surgical procedures in the field (removal of skin flaps)
- Catheterisation
- System based assessment & otoscopy/opthalmoscopy/urinalysis
- Neurological assessment - e.g. Tendon reflexes, CNII-XII, MMSE
The Emergency Care Practitioner (ECP) may be employed in any area of care such as Primary Care Centres (GP Practices), Hospitals, Prisons, Walk in centres, or Out of Hours Medical Centres. The majority of ECP's work autonomously. Many are employed by Primary Care Trusts or Ambulance Services. The work of the ECP appears to be recognised as a valuable asset in many care arenas with the current trend of employment within GP practices becoming more prevalant
Emergency medical responder

# Overview
Emergency medical responders are people who are specially trained to provide out-of-hospital care in medical emergencies.  There are many different types of emergency medical responders, each with different levels of training, ranging from first aid and basic life support to advanced life support.  Terms may have different meanings with different training requirements in different countries.

# General terms
Medic is a term that may be used to denote a wide range of trained medical responders, from people who provide basic first aid to physicians.  Usage of medic does not imply that the individual provides any specific level of care.  In some areas, paramedic is also used as a general term for medical responders.  However, paramedic may also be a specific level of training.
A first responder is the first medically trained personnel who come in to contact with a patient.  Additionally, there are several levels of training that are referred to as first responders.

# Levels of training
First responders, as a level of training, perform basic first aid skills and CPR.  Healthcare providers who are certified first responders (known as community first responders in the UK) have some additional training in basic life support.  These responders may either be lay people or associated with an ambulance service.
Emergency medical technicians (EMT) are the next level of providers.  Within the United States, there are three common levels of EMTs, each with an increased scope of practice: EMT-Basic, EMT-Intermediate, and EMT-Paramedic (also known as a paramedic).
Paramedics have the most training of the emergency medical responders.  Paramedics perform advanced life support.
Emergency physicians may also respond to serious medical emergencies.  Depending on the location, physicians may work on an ambulance, an air ambulance, or use a fly-car.

# Additional types of responders
In the field of wilderness first aid, medical providers receive additional training relating to wilderness medicine.  There are several levels of certification that parallel the aforementioned levels, which include Wilderness First Responder and Wilderness Emergency Medical Technician.
Street medics provide medical care at protests and demonstrations.  They have varying degrees of medical training and are usually are volunteers.
Flight medics are usually trained paramedics who may receive an additional certification (FP-C) to function in an aeromedical environment.  Flight medics work out of an air ambulance.
A combat medic is a trained soldier who is responsible for providing first aid and front-line trauma care on the battlefield.  In the Royal Army Medical Corps of the British Army, these medics are known as Combat Medical Technician.  In the United States Army, these healthcare specialists are known as 68W (the Military Occupational Specialty classification).
Emotions in Decision Making

# Overview
One of the most common theories in the field of decision making is the expected utility theory (EU). According to this theory, people usually make their decisions by weighing the severity and likelihood of the possible outcomes of different alternatives. The integration of this information is made through some type of expectation, based calculus (cognitive activity) which enables us to make a decision. In this theory, psychological processes and the decision makers emotional state were ignored and not taken into account as inputs to the expectation based calculus.

# Emotions as an information source
In Risk as Feelings, Loewenstein, Weber and Hsee  argue that these processes of decision making include anticipatory emotions and anticipated emotions:
anticipatory emotions are immediate visceral reactions (fear, anxiety, dread) to risk and uncertainties; anticipated emotions are typically not experienced in the immediate present but are expected to be experienced in the future (disappointment or regret). Both types of emotions serve as additional source of information. For example, research shows that happy decision-makers are reluctant to gamble. The fact that a person is happy would make him or her decide against gambling, since he or she would not want to undermine his or her happy feeling. This can be looked upon as "mood maintenance" .
According to the information hypothesis, feelings during the decision process affects people's choices, in cases where feelings are experienced as reactions to the imminent decision. If feelings are attributed to an irrelevant source to the decision at hand, their impact is reduced or eliminated.
Zajonc  argues that emotions are meant to help people take or avoid taking a stand, versus cognitive calculus that helps people make a true/false decision.

# Anticipated Pleasure
Mellers and McGraw (2001)  proposed that anticipated pleasure is an emotion that is generated during the decision making process and is taken into account as an additional information source. They argued that the decision maker estimates how he or she will feel when he or she is right or wrong as a result of choosing one of the alternatives. These estimated feelings are averaged and compared between the different alternatives. It seems that this theory is the same as the expected utility theory (EU) but both can result in different choices.

# Implications to decision making processes
In a research from 2001, Isen suggests that tasks which are meaningful, interesting, or important to the decision maker; and if he or she is in a good mood, the decision making process will be more efficient and thorough.
People will usually integrate material for decision making and be less confused by a large set of variables, if the conditions are of positive affect. This allows the decision makers to work faster and they will either finish the task at hand quicker, or will turn attention to other important tasks. Positive affect generally leads people to be gracious, generous, and kind to others; to be socially responsible and to take others perspective better in interaction.
Ethylene glycol (data page)
This page provides supplementary chemical data on ethylene glycol.

# Material Safety Data Sheet
The handling of this chemical may incur notable safety precautions. It is highly recommend that you seek the Material Safety Datasheet (MSDS) for this chemical from a reliable source  such as SIRI, and follow its directions. MSDS for ethylene glycol is available at Mallinckrodt Baker.

# Structure and properties

# Thermodynamic properties

# Vapor pressure of liquid
Table data obtained from CRC Handbook of Chemistry and Physics, 44th ed.

# Freezing point of aqueous solutions
Table obtained from Lange's Handbook of Chemistry, 10th ed. Specific gravity is referenced to water at 15.6C.
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# Distillation data

# Spectral data
Ethylmalonic encephalopathy
Ethylmalonic encephalopathy is an inherited disorder that affects several body systems, particularly the nervous system.

# Symptoms
Neurologic signs and symptoms include progressively delayed development, weak muscle tone (hypotonia), seizures, and abnormal movements. The body's network of blood vessels is also affected. Children with this disorder may experience rashes of tiny red spots (petechiae) caused by bleeding under the skin and blue discoloration in the hands and feet due to reduced oxygen in the blood (acrocyanosis). Chronic diarrhea is another common feature of ethylmalonic encephalopathy.
The signs and symptoms of ethylmalonic encephalopathy are apparent at birth or begin in the first few months of life. Problems with the nervous system typically worsen over time, and most affected individuals survive only into early childhood. A few children with a milder, chronic form of this disorder have been reported.

# Pathophysiology
Mutations in the ETHE1 gene cause ethylmalonic encephalopathy. The ETHE1 gene provides instructions for making an enzyme that plays an important role in energy production. It is active in mitochondria, which are the energy-producing centers within cells. Little is known about the enzyme's exact function, however.
Mutations in the ETHE1 gene lead to the production of a nonfunctional version of the enzyme or prevent any enzyme from being made. A lack of the ETHE1 enzyme impairs the body's ability to make energy in mitochondria. Additionally, a loss of this enzyme allows potentially toxic compounds, including ethylmalonic acid and lactic acid, to build up in the body. Excess amounts of these compounds can be detected in urine. It remains unclear how a loss of the ETHE1 enzyme leads to progressive brain dysfunction and the other features of ethylmalonic encephalopathy.
This condition is inherited in an autosomal recessive pattern, which means two copies of the gene in each cell are altered.