Persius/hicric huggingface dataset:
Ritonavir dosage and administration

# Dosage And Administration
NORVIR is administered orally in combination with other antiretroviral agents. It is recommended that NORVIR be taken with meals if possible.

## General Dosing Guidelines
Patients should be aware that frequently observed adverse events, such as mild to moderate gastrointestinal disturbances and paraesthesias, may diminish as therapy is continued.

## Dose modification for NORVIR
Dose reduction of NORVIR is necessary when used with other protease inhibitors: atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir.
Prescribers should consult the full prescribing information and clinical study information of these protease inhibitors if they are co-administered with a reduced dose of ritonavir .

## Adult Patients

### Recommended Dosage for treatment of HIV-1
The recommended dosage of ritonavir is 600 mg twice daily by mouth. Use of a dose titration schedule may help to reduce treatment-emergent adverse events while maintaining appropriate ritonavir plasma levels. Ritonavir should be started at no less than 300 mg twice daily and increased at 2 to 3 day intervals by 100 mg twice daily. The maximum dose of 600 mg twice daily should not be exceeded upon completion of the titration.

## Pediatric Patients
The recommended dosage of ritonavir in children greater than 1 month is 350 to 400 mg per m2 twice daily by mouth and should not exceed 600 mg twice daily. Ritonavir should be started at 250 mg per m2 twice daily and increased at 2 to 3 day intervals by 50 mg per m2 twice daily. If patients do not tolerate 400 mg per m2 twice daily due to adverse events, the highest tolerated dose may be used for maintenance therapy in combination with other antiretroviral agents, however, alternative therapy should be considered. The use of NORVIR oral solution is recommended for children greater than 1 month who cannot swallow capsules. Please refer to the NORVIR oral solution full prescribing information for pediatric dosage and administration.
Sandbox:Otitis externa risk factors

# Overview
Risk factors for acute otitis externa include activities and conditions that predispose an individual to ear canal inflammation. They also include being a female between 65 and 74 years old. Risk factors for malignant necrotizing otitis externa include conditions predisposing an individual to immunocompromise, including undergoing chemotherapy or suffering from diabetes mellitus.

# Risk Factors
- Risk factors for acute otitis externa include activities and conditions that predispose an individual to ear canal inflammation:
Swimming in public pools or other unclean bodies of water, heightening the chance of bacterial or fungal infection.
Living in a humid or tropical climate.
Developing dermatoses such as eczema, seborrhea, and psoriasis.
Loss of cerumen in the ear canal, lowering the amount of ear canal protective coating.
Experiencing foreign objects that can cause irritation and inflammation, such as hearing aids or ear plugs.
Having ear canal obstructions, such as sebaceous cysts.
Experiencing suppuration from other ear diseases such as otitis media
Undergoing prolonged treatment with topical antibiotics.
Raises risk of otomycosis.
Experiencing physical trauma in the ear canal.
Repeating exposure to irritants, such as soaps, shampoos, or related cosmetic chemicals.
Having a narrow ear canal more prone to retaining water.
- Swimming in public pools or other unclean bodies of water, heightening the chance of bacterial or fungal infection.
- Living in a humid or tropical climate.
- Developing dermatoses such as eczema, seborrhea, and psoriasis.
- Loss of cerumen in the ear canal, lowering the amount of ear canal protective coating.
- Experiencing foreign objects that can cause irritation and inflammation, such as hearing aids or ear plugs.
- Having ear canal obstructions, such as sebaceous cysts.
- Experiencing suppuration from other ear diseases such as otitis media
- Undergoing prolonged treatment with topical antibiotics.
Raises risk of otomycosis.
- Raises risk of otomycosis.
- Experiencing physical trauma in the ear canal.
- Repeating exposure to irritants, such as soaps, shampoos, or related cosmetic chemicals.
- Having a narrow ear canal more prone to retaining water.
- Being a female between age 65 and 74.
- For malignant necrotizing otitis externa, contributors to immunocompromise, including the following:
Chemotherapy
Diabetes mellitus
- Chemotherapy
- Diabetes mellitus
Sandbox:Otitis media classification

# Overview
Otitis media may be classified according to the etiology, duration, physical examination findings, and degree of severity into 3 subtypes: acute, otitis media with effusion, and chronic suppurative otitis media.

# Classification
Otitis media can be classified into many variants on the basis of etiology, duration, symptomatology, physical findings, and degree of severity. The terminology is sometimes confusing because of multiple terms being used to describe the same condition. A common misconception with ear infection is that sufferers think that a symptom is itchy ear. Although sufferers may feel discomfort, an itchy ear is not a symptom of ear infection.

## Acute Otitis Media
Acute otitis media (AOM) is most often purely viral and self-limited, as is its usual accompanying viral URI.  There is congestion of the ears and perhaps mild discomfort and popping, but the symptoms resolve with the underlying URI.  If the middle ear, which is normally sterile, becomes contaminated with bacteria,  pus and pressure in the middle ear can result, and this is called acute bacterial otitis media.  Viral acute otitis media can lead to bacterial otitis media in a very short time, especially in children, but it usually does not.  The individual with bacterial acute otitis media has the classic "earache", pain that is more severe and continuous and is often accompanied by fever of 102oF or more. Bacterial cases may result in perforation of the ear drum, infection of the mastoid space (mastoiditis) and in very rare cases further spread to causemeningitis.

## Otitis Media with Effusion
Otitis media with effusion (OME), also called serous or secretory otitis media (SOM), is simply a collection of fluid that occurs within the middle ear space as a result of the negative pressure produced by altered Eustachian tube function. This can occur purely from a viral URI, with no pain or bacterial infection, or it can precede and/or follow acute bacterial otitis media. Fluid in the middle ear sometimes causes conductive hearing impairment, but only when it interferes with the normal vibration of the eardrum by sound waves.  Over weeks and months, middle ear fluid can become very thick and glue-like (thus the name glue ear), which increases the likelihood of its causing conductive hearing impairment.  Early-onset OME is associated with feeding while lying down and early entry into group child care, while parental smoking, a short period of breastfeeding and greater amounts of time spent in group child care increased the duration of OME in the first two years of life.

## Chronic Suppurative Otitis Media
Chronic suppurative otitis media involves a perforation (hole) in the eardrum and active bacterial infection within the middle ear space for several weeks or more. There may be enough pus that it drains to the outside of the ear (otorrhea), or the purulence may be minimal enough to only be seen on examination using a binocular microscope.  This disease is much more common in persons with poor Eustachian tube function.  Hearing impairment often accompanies this disease.
Sandbox Listeriosis medical therapy

# Overview
Ampicillin, with or without gentamicin, is considered the drug of choice for listeriosis. Patients intolerant of penicillins may be managed with trimethoprim-sulfamethoxazole alternatively. Suggested minimum duration of therapy depends on clinical manifestations: bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 to 6 weeks, and brain abscess or rhomboencephalitis for at least 6 weeks.

# Principles of Therapy
- Ampicillin, amoxicillin, and penicillin G have been considered effective for listeriosis. For patients unable to tolerate beta-lactams, trimethoprim-sulfamethoxazole may be used alternatively. Chloramphenicol is not regarded as an acceptable option due to high treatment failure and relapse rates.
- Addition of an aminoglycoside, which provides synergistic bactericidal effects to ampicillin, is generally recommended for the treatment of listerial bacteremia, endocarditis, brain abscess, meningitis, or rhomboencephalitis.
- Bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 to 6 weeks, and brain abscess or rhomboencephalitis for at least 6 weeks.
- Meningitis is the most common clinical manifestation, and antibiotics that penetrate well into the CSF should be chosen.
- Gastroenteritis caused by Listeria monocytogenes is usually self-limited and complete recovery typically occurs within 2 days. Patients who have ingested food implicated in outbreaks and who have a high risk of invasive illness may consider oral herapy with ampicillin or trimethoprim-sulfamethoxazole for several days.

# Medical Therapy for Listeria monocytogenes Adapted from Clin Infect Dis. 1997;24(1):1-9., Clin Infect Dis. 2005;40(9):1327-32., and Clin Infect Dis. 2004;39(9):1267-84.
 Click on the following categories to expand treatment regimens.
Self-defeating personality disorder

# Overview
Self-defeating personality disorder (also known as masochistic personality disorder) is a personality disorder that was never formally admitted into the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was discussed in an appendix of the manual's revised third edition (DSM-III-R). Nevertheless, some researchers and theorists continue to use its criteria.

# DSM research criteria
Self-defeating personality disorder is a pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following:
- Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
- Rejects or renders ineffective the attempts of others to help him or her
- Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain ( e.g., an accident)
- Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
- Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure)
- Fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, e.g., helps fellow students write papers, but is unable to write his or her own
- Is uninterested in or rejects people who consistently treat him or her well, e.g., is unattracted to caring sexual partners
- Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
The behaviors do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused. Also, the behaviors do not occur only when the person is depressed.
Spectinomycin indications and usage

# Indications and Usage
TROBICIN Sterile Powder is indicated in the treatment of acute gonorrheal urethritis and proctitis in the male and acute gonorrheal cervicitis and proctitis in the female when due to susceptible strains of Neisseria gonorrhoeae. Men and women with known recent exposure to gonorrhea should be treated as those known to have gonorrhea.
The in vitro susceptibility of Neisseria gonorrhoeae to spectinomycin hydrochloride can be tested by agar diluted methods. TROBICIN Susceptibility Powder is available for this purpose and its package insert should be consulted for details.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of TROBICIN Sterile Powder and other antibacterial drugs, TROBICIN Sterile Powder 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 the empiric selection of therapy.
Spinal cord stenosis classification

# Overview
Spinal cord stenosis may be classified according to where on the spine the condition occurs, into three groups: Cervical spinal cord stenosis, thoracic spinal cord stenosis and lumbar spinal cord stenosis. Spinal cord stenosis occurs most often in the lower back and in the neck.

# Classification
- Spinal cord stenosis may be classified according to where on the spine the condition occurs, into three groups:
Cervical spinal cord stenosis
Thoracic spinal cord stenosis
Lumbar spinal cord stenosis
- Cervical spinal cord stenosis
- Thoracic spinal cord stenosis
- Lumbar spinal cord stenosis
- Spinal cord stenosis occurs most often in the lower back and in the neck.
Stavudine dosage and administration

# Dosage and Administration
The interval between doses of ZERIT (stavudine) should be 12 hours. ZERIT may be taken with or without food.
Recommended Adult Dosage
The recommended adult dosage is based on body weight as follows:
For patients weighing less than 60 kg: 30 mg every 12 hours.
For patients weighing at least 60 kg: 40 mg every 12 hours.
Recommended Pediatric Dosage
For newborns from birth to 13 days old: 0.5 mg/kg given every 12 hours.
For pediatric patients at least 14 days old and weighing less than 30 kg: 1 mg/kg given every 12 hours.
For pediatric patients weighing at least 30 kg: use the recommended adult dosage.

## Dosage Adjustment

## Renal Impairment
Adult Patients: ZERIT may be administered to adult patients with impaired renal function with an adjustment in dosage as shown in Table 1.
Pediatric Patients: Since urinary excretion is also a major route of elimination of stavudine in pediatric patients, the clearance of stavudine may be altered in children with renal impairment. There are insufficient data to recommend a specific dose adjustment of ZERIT in this patient population.

## Method of Preparation for Oral Solution
Prior to dispensing, the pharmacist must constitute the dry powder with purified water to a concentration of 1 mg stavudine per mL of solution, as follows:
Add 202 mL of purified water to the container.
Shake container vigorously until the powder dissolves completely. Constitution in this way produces 200 mL (deliverable volume) of 1 mg/mL stavudine solution. The solution may appear slightly hazy.
Dispense solution in original container with measuring cup provided. Instruct patient to shake the container vigorously prior to measuring each dose and to store the tightly closed container in a refrigerator, 2C to 8C (36F to 46F). Discard any unused portion after 30 days.
Sulfanilamide clinical pharmacology

# Clinical Pharmacology
Sulfanilamide has been a useful ingredient of vaginal formulations for about four decades. It blocks certain metabolic processes essential for the growth of susceptible bacteria. In AVC, the sulfanilamide is in a specially compounded base buffered to the pH (about 4.3) of the normal vagina to encourage the presence of the normally occurring Doderleins bacilli of the vagina.
The use of AVC for the treatment of vulvovaginitis caused by Candida albicans is supported by three clinical investigations. The three studies show AVC with sulfanilamide to be significantly more effective (p  0.01) than placebo as follows:
In Study I, the ratio of effectiveness was 71% for the AVC with sulfanilamide versus 49% for placebo with 30 days of treatment;
In Study II, the percentages were 48% and 24%, respectively, with 15 days of treatment;
In Study III, the percentages were 66% versus 33%, respectively, with 30 days of treatment.
Superior branch of oculomotor nerve
The superior branch of the oculomotor nerve or the superior division, the smaller, passes medialward over the optic nerve.
It supplies the Superior rectus and Levator palpebrae superioris.

# Additional images
- Nerves of the orbit. Seen from above.
- Nerves of the orbit, and the ciliary ganglion. Side view.
- Dissection showing origins of right ocular muscles, and nerves entering by the superior orbital fissure.
- Pathways in the Ciliary Ganglion.
Superior pancreaticoduodenal artery
The superior pancreaticoduodenal artery descends between the contiguous margins of the duodenum and pancreas.
It is a branch of the gastroduodenal artery, which eventually comes from the celiac trunk.
It supplies both these organs, and anastomoses with the inferior pancreaticoduodenal branch of the superior mesenteric artery, and with the pancreatic branches of the splenic artery.
Syringomyelia (patient information)
For the WikiDoc page for this topic, click here

# Overview
Syringomyelia is damage to the spinal cord due to the formation of a fluid-filled area within the cord.

# What are the symptoms of Syringomyelia?
- Gradual loss of muscle mass (wasting, atrophy)
- Headache
- Muscle function loss, loss of ability to use arms or legs
- Numbness or decreased sensation
Decreased sense of pain or temperature
Lessened ability to sense that the skin is being touched
Neck, shoulders, upper arms, trunk -- in a cape-like pattern
Slowly, but progressively, gets worse
- Decreased sense of pain or temperature
- Lessened ability to sense that the skin is being touched
- Neck, shoulders, upper arms, trunk -- in a cape-like pattern
- Slowly, but progressively, gets worse
- Pain down the arms, neck, or into the upper back
- Weakness (decreased muscle strength, independent of exercise) in the arms or legs
Additional symptoms that may be associated with this disease:
- Muscle contractions
- Rashes
- Spasms in or tightness of the leg muscles
- Uncoordinated movement

# What causes Syringomyelia?
The fluid buildup seen in syringomyelia may be a result of spinal cord trauma, tumors of the spinal cord, or birth defects (specifically, "chiari malformation," in which part of the brain pushes down onto the spinal cord at the base of the skull).
The fluid-filled cavity usually begins in the neck area. It expands slowly, putting pressure on the spinal cord and slowly causing damage.

# When to seek urgent medical care?
Call your health care provider if you have symptoms of syringomyelia.

# Diagnosis
A neurologic examination may show loss of sensation or movement caused by compression of the spinal cord.
A spinal CT with myelogram or an MRI of the spine confirms syringomyelia and determines the exact location and extent. Often, an MRI of the head will be done to look for associated conditions including hydrocephalus (water on the brain).

# Treatment options
The goals of treatment are to stop the spinal cord damage from getting worse and to maximize functioning. Surgery to relieve pressure in the spinal cord may be appropriate. Physical therapy may be needed to maximize muscular function.

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

# What to expect (Outlook/Prognosis)?
Untreated, the disorder gets worse very slowly, but it eventually causes severe disability. Surgical decompression usually stops the progression of the disorder, with about 50% of people showing significant improvement in neurologic function after surgical decompression.

# Possible complications
Without treatment, the condition will lead to:
- Continued or progressive loss of neurologic function
- Permanent disability
Possible complications of surgery include:
- Postoperative infection and other complications common to all surgeries

# Prevention
There is no known prevention, other than avoiding trauma to the spinal cord. Prompt treatment reduces progression of the disorder.

# Sources
Thiabendazole clinical pharmacology

# Clinical Pharmacology
In man, thiabendazole is rapidly absorbed and peak plasma concentration is reached within 1 to 2 hours after the oral administration of a suspension. It is metabolized almost completely to the 5-hydroxy form which appears in the urine as glucuronide or sulfate conjugates. In 48 hours, about 5% of the administered dose is recovered from the feces and about 90% from the urine. Most is excreted in the first 24 hours.

### Mechanism of Action
The precise mode of action of thiabendazole on the parasite is unknown, but it may inhibit the helminth- specific enzyme fumarate reductase.
Thiabendazole is vermicidal and/or vermifugal against Ascaris lumbricoides (common roundworm), Strongyloides stercoralis (threadworm), Necator americanus, and Ancylostoma duodenale (hookworm), Trichuris trichiura (whipworm), Ancylostoma braziliense (dog and cat hookworm), Toxocara canis and Toxocara cati (ascarids), and Enterobius vermicularis (pinworm).
Its effect on larvae of Trichinella spiralis that have migrated to muscle is questionable.
Thiabendazole also suppresses egg and/or larval production and may inhibit the subsequent development of those eggs or larvae which are passed in the feces.
Thiabendazole indications and usage

# Indications and Usage
MINTEZOL is indicated for the treatment of:
- Strongyloidiasis (threadworm)
- Cutaneous larva migrans (creeping eruption)
- Visceral larva migrans
- Trichinosis: Relief of symptoms and fever and a reduction of eosinophilia have followed the use of MINTEZOL during the invasion stage of the disease.
Thiabendazole is usually inappropriate as first line therapy for enterobiasis (pinworm). However, when enterobiasis occurs with any of the conditions listed above, additional therapy is not required for most patients.
MINTEZOL should be used only in the following infestations when more specific therapy is not available or cannot be used or when further therapy with a second agent is desirable:
- Uncinariasis (hookworm: Necator americanus and Ancylostoma duodenale)
- Trichuriasis (whipworm)
- Ascariasis (large roundworm)
Tinidazole warnings and precautions

# Warnings and Precautions

## Neurological Adverse Reactions
Convulsive seizures and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity, have been reported in patients treated with tinidazole. The appearance of abnormal neurologic signs demands the prompt discontinuation of tinidazole therapy.

## Vaginal Candidiasis
The use of tinidazole may result in Candida vaginitis. In a clinical study of 235 women who received tinidazole for bacterial vaginosis, a vaginal fungal infection developed in 11 (4.7%) of all study subjects .

## Blood Dyscrasia
Tinidazole should be used with caution in patients with evidence of or history of blood dyscrasia .

## Drug Resistance
Prescribing Tindamax in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.