Persius/hicric huggingface dataset:
Sandbox:ivbalaraman

# INTRODUCTION
Lambert Eaton Myasthenic syndrome is a rare disorder causing muscle weakness targeting the Neuromuscular junction.This disorder is usually seen with Small cell Lung cancer, which may be an indication to investigate for SCLC.

# PATHOPHYSIOLOGY
Understanding the concept of Neuromuscular junction,Presynaptic Acetylecholine (ACh) concentration,end plate potential, post-synpatic ACh receptors, role of Calcium and Voltage gated Calcium channel(VGCC) and role of potassium is essential to understand the pathophysiology of Lambert Eaton Myasthenic syndrome.
Briefly, The disease is of autoimmune origin, that is, it is caused by antibodies that are directed against the antigens of the neuromuscular junction.  In 1989, the previously anticipated antibodies were demonstrated to be directed against presynaptic calcium channels, which are located in neuromuscular junction (see synapse) and are responsible for the efficient release of acetylcholine
In cases with both LEMS and lung cancer (usually small cell type), the antibodies are suggested to be aimed at cancer cells and to bind and affect the antigens in neuromuscular junction accidentally.
====Voltage Gated Calcium Channel==== ]
- Potassium channels and the concentration of potassium ions does not contribute to the ACh release.
The mechanism by which the ACh is released is by increasing the concentration of calcium ions and their influx into the nerve terminal viz Voltage gated calcium channel (VGCC)
VGCC is a transmembrane protein with many subunits that is the main target in LEMS.
The commonly associated subtypes are L-type,N-type,P/Q-Type of alpha-1 subunit of VGCC, of which the P/Q subtype is the most important target in the disorder.
N-Type is usually associated with the paraneoplastic LEMS.
VGCC is responsible for releasing the accumulated ACh in nerve terminal. Thereafter ACh binds to its receptor that depolarizes the muscle fibre end plate leading to a muscle contraction by generating a action potential. IgG antibodies of LEMS acts on the VGCC leading to the disorder of the above mechanism resulting in muscle weakness.
In paraneoplastic LEMS, Small cell lung cancer expresses the VGCC on the sufrace of the tumor cells that acts as the antigen to trigger the antibody production causing profound clinical symptoms.No genetic predisposition seen.
In Non-paraneoplastic syndrome,the autoimmunity against the P/Q type VGCC are seen usually in HLA-B8(HLA-Class I) and HLA- DR3 & HLA- DQ2 (HLA -class II) genes.
There are also some patients who do not carry these antibodies in their serum samples and the exact cause of disease in these cases still remains to be determined.
Sandbox:pharyngitis

# Infectious Mononucleosis(IM)
After a prodromal period of chills, sweats, feverishness, and malaise, IM presents with the classic triad of severe sore throat, fever (a temperature as high as 38C to 40C), and lymphadenopathy.
Children with viral pharyngitis also can present with atypical symptoms, such as mouth-breathing, vomiting, abdominal pain, and diarrhea. If Infectious mononucleosis patients are treated with amoxicillin or ampicillin, 90 percent will develop a classic maculopapular rash.

# GABHS Infection
Symptoms of strep throat may include pharyngeal erythema and swelling, tonsillar exudate, edematous uvula, palatine petechiae, and anterior cervical lymphadenopathy.

# Diphtheria
Characterized by sore throat, low-grade fever, and an adherent grayish membrane with surrounding inflammation of the tonsils, pharynx, or nasal passages.
- Fever
- Headache
- Joint pain and muscle aches
- Skin rashes
- Swollen lymph nodes in the neck

# Neisseria gonorrhoeae
Neisseria gonorrhoeae is usually asymptomatic, clinically apparent pharyngitis sometimes develops, and pharyngeal colonization may be associated with disseminated disease. Gonococcal pharyngitis should be suspected, particularly in women and homosexual men.
-  Jump up to: 1.0 1.1 Bisno AL (2001) Acute pharyngitis. N Engl J Med 344 (3):205-11. DOI:10.1056/NEJM200101183440308 PMID: 11172144
-  Jump up to: 2.0 2.1 2.2 Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
Sandbox colesevelam
Synonyms / Brand Names: Welchol tablet

# Overview
Sandbox colesevelam is a anti-anginal, antiarrhythmic, beta-adrenergic blocker drug that is FDA approved for the treatment of acute myocardial infarction, angina, and hypertension. There is a Black Box Warning for this drug as shown here. Common adverse reactions include bradyarrhythmia, heart block, heart failure, hypotension, pruritus, rash, constipation, diarrhea, indigestion, nausea, dizziness, fatigue, headache, depression, dyspnea, and wheezing.

# Category
Bile Acid Sequestrant

# Adult Indications and Dosage of Tablet
- Initial dose (not receiving a diuretic): Lotensin 10 mg PO qd
- Initial dose (concurrent diuretic use): the diuretic should be discontinued 2 to 3 days prior to beginning therapy with Lotensin, if blood pressure is not controlled with Lotensin alone, diuretic therapy should be resumed. If the diuretic cannot be discontinued, an initial dose of 5 mg Lotensin should be used.
- Maintenance dose: Lotensin 2040 mg PO qd or Lotensin 1020 mg PO bid (MAX 80 mg/day)

## Adult Indications and Dosage of Tablet, film coated
- Initial dose (not receiving a diuretic): Lotensin 10 mg PO qd
- Initial dose (concurrent diuretic use): the diuretic should be discontinued 2 to 3 days prior to beginning therapy with Lotensin, if blood pressure is not controlled with Lotensin alone, diuretic therapy should be resumed. If the diuretic cannot be discontinued, an initial dose of 5 mg Lotensin should be used.
- Maintenance dose: Lotensin 2040 mg PO qd or Lotensin 1020 mg PO bid (MAX 80 mg/day)
Sandbox restrictive
-  Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ (1998). "Idiopathic pulmonary fibrosis: predicting response to therapy and survival". Am. J. Respir. Crit. Care Med. 157 (4 Pt 1): 106372. doi:10.1164/ajrccm.157.4.9703022. PMID 9563720..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}
-  du Bois RM (2006). "Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis". Clin. Chest Med. 27 (1 Suppl 1): S1725, vvi. doi:10.1016/j.ccm.2005.08.001. PMID 16545629.
-  Neghab M, Mohraz MH, Hassanzadeh J (2011). "Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust". J Occup Health. 53 (6): 4328. PMID 21996929.
Sandbox sepsis rsg2

# Empiric Antibiotic Therapy

## Unclear infection source
Doripenem 500 mg IV q8h OR Ertapenem 1 gm IV q24h OR Imipenem 0.5 gm IV q6h OR Meropenem 1 gm IV q8h AND Vancomycin 1 gm IV q12h
Piperacillin-Tazobactam 3.375 gm IV q4h  AND Vancomycin 1 gm IV q12h
Colistin 2.5 mg/kg then 1.5 mg/kg IV q12h  AND Meropenem 1 gm IV q8h  AND Vancomycin 1 gm IV q12h

## Biliary source
Ampicillin-Sulbactam 3 gm IV q6h OR Piperacillin-Tazobactam 3.375 gm IV q4h OR Ticarcillin-Clavulanate 3.1 gm IV q4h

## Community-acquired pneumonia
Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h  AND Piperacillin-Tazobactam 3.375 gm IV q4h  AND Vancomycin 1 gm IV q12h

## History of intravenous drug use with high prevalence of MRSA
Vancomycin 1 gm IV q12h

## Sepsis associated with petechiae
Ceftriaxone 2 gm IV q12h
User:Sandeep Basnet

# Education
M.B.B.S. from B.P.Koirala Institute of Health Sciences, Dharan, Nepal

# Contact
- sandeepbasnet2@yahoo.com
- sandeepbasnet2@gmail.com

# Research and Publication
- "Presentation and outcomes of patients with acute coronary syndrome in eastern Nepal" in Swiss Medical Weekly (PMID: 21491212) (/)
- "Patterns of valvular involvement in Rheumatic Heart Disease" in the annual meeting of the american society of tropical medicine and health, 2008 ()

# Presentation
- Oral presentation in "Patterns of valvular involvement in Rheumatic Heart Disease" in ANMECON, 2008
- Poster presentation in "Patterns of valvular involvement in Rheumatic Heart Disease"  in the 16th World Congress on Heart Disease in Vancouver, B.C, Canada, 2011 (  - Board No. 19)
Sarracenia purpurea
Sarracenia purpurea, commonly known as the Purple pitcher plant or Side-saddle flower,  is a carnivorous plant in the family Sarraceniaceae. Its range includes almost the entire eastern seaboard of the United States, the Great Lakes, and south eastern Canada, making it the most common and broadly distributed pitcher plant, as well as the only member of the genus that inhabits cold temperate climates.
The species is the floral emblem of the Canadian province of Newfoundland and Labrador.
Like other species of Sarracenia, S. purpurea obtains most of its nutrients through prey capture. However, prey acquisition is said to be inefficient, with less than 1% of the visiting prey captured within the pitcher. Even so, anecdotal evidence by growers often shows that pitchers quickly fill up with prey during the warm summer months. Prey fall into the pitcher and drown in the rainwater that collects in the base of each leaf.  Prey items such as flies, ants, spiders, and even moths, are then digested by an invertebrate community (made up mostly by the mosquito Wyeomyia smithii and the midge Metriocnemus knabii), protists, and rotifers, which form the base of a food web that shreds and mineralizes available prey, making nutrients available to the plant.

# Taxonomy
The species is further divided into two subspecies, S. purpurea subsp. purpurea and S. purpurea subsp. venosa. The former is found from New Jersey north and requires a winter dormancy, while the latter is found from New Jersey south and tolerates warmer temperatures.
In 1999, Sarracenia purpurea subsp. venosa var. burkii was described as a species of its own: Sarracenia rosea. This re-ranking has been widely disclaimed since then. The following species and infraspecific taxa are usually recognized:
- Sarracenia purpurea subsp. purpurea
Sarracenia purpurea subsp. purpurea f. heterophylla
Sarracenia purpurea subsp. purpurea f. ruplicola
- Sarracenia purpurea subsp. purpurea f. heterophylla
- Sarracenia purpurea subsp. purpurea f. ruplicola
- Sarracenia purpurea subsp. venosa
Sarracenia purpurea subsp. venosa var. burkii
Sarracenia purpurea subsp. venosa var. burkii f. luteola
Sarracenia purpurea subsp. venosa var. montana
- Sarracenia purpurea subsp. venosa var. burkii
Sarracenia purpurea subsp. venosa var. burkii f. luteola
- Sarracenia purpurea subsp. venosa var. burkii f. luteola
- Sarracenia purpurea subsp. venosa var. montana
- Flower of Sarracenia purpurea subsp. purpurea
Flower of Sarracenia purpurea subsp. purpurea
- Oldest known illustration of Sarracenia purpurea, from Clusius's Rariorum plantarum historia, cf. 18, 1601
Oldest known illustration of Sarracenia purpurea, from Clusius's Rariorum plantarum historia, cf. 18, 1601
Sceletium tortuosum
Sceletium tortuosum is a succulent herb commonly found in South Africa, which is also known as Kanna, Channa, Kougoed (Kauwgoed) - which literally means, 'chew(able) things/goodies' or 'something to chew'. The plant has been used by South African pastoralists and hunter-gatherers as a mood-altering substance from prehistoric times. The first known written account of the plant's use was in 1662 by van Riebeeck. The traditionally prepared dried sceletium was often chewed and the saliva swallowed, but it has also been made into gel caps, teas and tinctures. It has also been used as a snuff and smoked.

# Effects
Sceletium is known to elevate mood and decrease anxiety, stress and tension. It has also been used as an appetite suppressant by shepherds walking long distances in arid areas. In intoxicating doses it can cause euphoria, initially with stimulation and later with sedation. Users also report increased personal insight, interpersonal ease and a meditative, grounded feeling without any perceptual dulling. Others have noted enhanced tactile and sexual response. High doses produce distinct inebriation and stimulation often followed by sedation. The plant is not considered hallucinogenic, contrary to some literature on the subject, and no severe adverse effects have been documented.

# Pharmacology
S. tortuosum can cause significant mood-elevation and anxiolytic (anti-anxiety) action. In doses as low as 50 mg users have reported improvements in mood, decreased anxiety, relaxation and a sense of well-being. At higher dosages near 100 mg, kanna acts as a calming euphoriant and empathogen.
The alkaloids contained in S. tortuosum believed to possess psychoactivity include: mesembrine, mesembrenone, mesembrenol and tortuosamine. Mesembrine is a major alkaloid present in Sceletium tortuosum, which has been shown to be a potent serotonin reuptake inhibitor (more so than imipramine), and a PDE4-inhibitor (less so than rolipram).
Sceletium tortuosum contains about 1-1.5% total alkaloids.  There is about 0.3% mesembrine in the leaves and 0.86% in the stems of the plant.

# Interactions
Little is known about the interactions of S. tortuosum, although it should not be combined with SSRIs, MAOIs, cardiac or psychiatric medications. Headaches in conjunction with alcohol have been noted with kanna use. Some reports suggest a synergy with cannabis.
Schlenk equilibrium
The Schlenk equilibrium is a chemical equilibrium named after its discoverer Wilhelm Schlenk taking place in solutions of Grignard reagents.
The process described is an equilibrium between two equivalents of an alkyl or aryl magnesium halide on the left of the equation and on the right side, one equivalent of the dialkyl or diaryl magnesium compound and magnesium halide salt.
The position of the equilibrium is influenced by solvent and temperature, the nature of the various substituents and the presence of impurities. It is known that magnesium atom in Grignard solutions, either RMgX, R2Mg or MgX2, can coordinate two molecules of ether (i.e. diethyl ether or tetrahydrofuran, THF).  In the presence of ethereal solvent, the equilibrium tends to lie in favor of the alkyl or aryl magnesium halide.  However, the addition of dioxane to an etheral Grignard precipitates out all of the magnesium halide species, driving the equilibrium completely to the right side of the equation.
Complexity is added to this equilibrium because the organomagnesium halide species in solution are capable of forming dimers and trimers etc. for instance when concentration is increased. Alkyl magnesium chlorides in ether are present as dimers.
Scrophularia nodosa
Scrophularia nodosa (also called figwort, woodland figwort, and common figwort) is a perennial herbaceous plant from temperate regions of the Northern hemisphere except western North America  . It grows in moist and cultivated waste ground.
It grows upright, with thick, sharply square, succulent stems up to 150cm tall from a horizontal rootstock. Its leaves are opposite, ovate at the base and lanceolate at the tip, all having toothed margins. The flowers are in loose cymes in oblong or pyramidal panicles. The individual flowers are globular, with five green sepals encircling green or purple petals, giving way to an egg-shaped seed capsule.

# Folklore
The plant was thought, by the doctrine of signatures to be able to cure the throat disease scrofula because of the throat-like shape of its flowers.
Spinothalamic tract

# Overview
The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information about pain, temperature, itch and crude touch to the thalamus. The pathway decussates at the level of the spinal cord, rather than in the brainstem like the posterior column-medial lemniscus pathway and corticospinal tract.
The cell bodies of neurons that make up the spinothalamic tract are located principally within the dorsal horn of the spinal cord. These neurons receive input from sensory fibers that innervate the skin and internal organs.

# Tracts
There are two main parts of the spinothalamic tract (STT):
- The lateral spinothalamic tract transmits pain and temperature.
- The anterior spinothalamic tract (or ventral spinothalamic tract) transmits touch.

# Information transmitted
The types of sensory information transmitted via the spinothalamic tract are described as affective sensation. This means that the sensation is accompanied by a compulsion to act. For instance, an itch is accompanied by a need to scratch, and a painful stimulus makes us want to withdraw from the pain.

# Sub-systems
There are two sub-systems identified:
- Direct (for direct conscious appreciation of pain)
- Indirect (for affective and arousal impact of pain). Indirect projections include
Spino-Reticulo-Thalamo-Cortical (part of the ascending reticular arousal system, aka ARAS)
Spino-Mesencephalo-Limbic (for affective impact of pain).
- Spino-Reticulo-Thalamo-Cortical (part of the ascending reticular arousal system, aka ARAS)
- Spino-Mesencephalo-Limbic (for affective impact of pain).

# Path of sensation
The Spinothalamic Tract, like the Dorsal Column-Medial Lemniscus Tract, use three neurons to convey sensory information from the periphery to conscious level at the cerebral cortex.
Pseudounipolar neurons (those with only one long process) in the dorsal root ganglion have axons that lead from the skin into the dorsal spinal cord where they synapse with secondary neurons in the marginal nucleus. These secondary neurons are called tract cells.
The axons of the tract cells cross over to the other side of the spinal cord via the anterior white commissure, and to the anterolateral corner of the spinal cord (hence the spinothalamic tract being part of the anterolateral system). The axons travel up the length of the spinal cord into the brainstem. Pain travels through spinothalamic tracts, and crosses over in the spinal cord at the point it enters, and then travels up contralaterally.
Traveling up the brainstem, the tract moves dorsally. The neurons ultimately synapse with third-order neurons in several nuclei of the thalamus -- including the medial dorsal, ventral posterior lateral, and ventral medial posterior nuclei. From there, signals go to the cingulate cortex, the primary somatosensory cortex, and insular cortex respectively.

# Lesions
Unilateral lesion usually causes contralateral anaesthesia (loss of pain) and temperature.  Anaesthesia will normally begin 1-2 segments below the level of lesion, affecting all caudal body areas.  This is clinically tested by using pin pricks.
Sedentary lifestyle

# Overview
Sedentary lifestyle is a type of lifestyle most commonly found in modern (particularly Western) cultures.  It is characterized by sitting or remaining inactive for most of the day  (for example, in an office without any (or little) exercise.
It is believed to be a factor in obesity, and, in doing so, may contribute to other diseases, such as type II diabetes, heart disease, and even hemorrhoids.
The term sedentary in biology applies to organisms and species that are not migratory but rather remain at a single location (permanently fixed or otherwise).
Examples in zoology include such sessile orgasms as barnacles, corals and mussels.
Examples can include the change in telephones. Previously they were connected to cords forcing individuals to get up, but now with cell phones and cordless phones, inactivity and remaining seated occur more regularly.
Selective reduction
Selective reduction (or fetal reduction) is the practice of reducing the number of fetuses in a multifetal pregnancy (i.e. those involving more than one fetus).  With selective reduction, a specific fetus or fetuses are "selected" for termination, usually after a congenital defect has been identified. Prenatal diagnostic testing may be used to determine which of the fetuses has a greater chance of chromosomal defect or genetic disease.  Those fetuses are then targeted in selective reduction because of the probability of their health being inferior to that of the others.
The term multifetal reduction describes a procedure to reduce a higher-order multiple pregnancy (one with three or more fetuses) to a twin or singleton pregnancy, without targeting a specific fetus for reduction.  It can also be used to reduce a twin pregnancy to a singleton one, but this is less common as the risks in twin pregnancies, while existent, are much lower than in higher-order multiple ones. The aim of multifetal reduction is to avoid the medical issues generally related to multiple births (including premature births, low birth weights and associated medical problems).
It is reasoned that if some of the fetuses will be terminated to preserve the well-being of the others and the mother, the ones that are terminated might as well be the ones that would, if born, face more health issues in addition to the ones inherent to all multiple births.  This adds a new dimension of controversy; beyond the already controversial nature of abortion, critics charge that reduction is a form of eugenics.
The reduction procedure is generally carried out during the first trimester. The most common method is to inject a chemical solution or feticide into the fetus or fetuses selected for either genetic reasons or for ease of accessibility. Generally, the fetal material is reabsorbed into the woman's body.  While the procedure generally reduces the over-all risk level for the remaining fetus or fetuses, reduction does have its own risks, including the possibility that one or more of the remaining fetuses will also die.
Selective or multifetal reduction can be a very difficult decision for those who choose to make it; in many cases it is a decision faced by couples who used fertility treatments that resulted in a multifetal pregnancy.