Persius/hicric huggingface dataset:
Venlafaxine use in specific populations

# Use In Specific Populations

## Age and Gender
A population pharmacokinetic analysis of 404 venlafaxine-treated patients from two studies involving both b.i.d. and t.i.d. regimens showed that dose-normalized trough plasma levels of either venlafaxine or ODV were unaltered by age or gender differences. Dosage adjustment based on the age or gender of a patient is generally not necessary (see DOSAGE AND ADMINISTRATION).

## Extensive/Poor Metabolizers
Plasma concentrations of venlafaxine were higher in CYP2D6 poor metabolizers than extensive metabolizers. Because the total exposure (AUC) of venlafaxine and ODV was similar in poor and extensive metabolizer groups, however, there is no need for different venlafaxine dosing regimens for these two groups.

## Liver Disease
In 9 subjects with hepatic cirrhosis, the pharmacokinetic disposition of both venlafaxine and ODV was significantly altered after oral administration of venlafaxine. Venlafaxine elimination half-life was prolonged by about 30%, and clearance decreased by about 50% in cirrhotic subjects compared to normal subjects. ODV elimination half-life was prolonged by about 60%, and clearance decreased by about 30% in cirrhotic subjects compared to normal subjects. A large degree of intersubject variability was noted. Three patients with more severe cirrhosis had a more substantial decrease in venlafaxine clearance (about 90%) compared to normal subjects.
In a second study, venlafaxine was administered orally and intravenously in normal (n = 21) subjects, and in Child-Pugh A (n = 8) and Child-Pugh B (n = 11) subjects (mildly and moderately impaired, respectively). Venlafaxine oral bioavailability was increased 23 fold, oral elimination half-life was approximately twice as long and oral clearance was reduced by more than half, compared to normal subjects. In hepatically impaired subjects, ODV oral elimination half-life was prolonged by about 40%, while oral clearance for ODV was similar to that for normal subjects. A large degree of intersubject variability was noted.
Dosage adjustment is necessary in these hepatically impaired patients (see DOSAGE AND ADMINISTRATION).

## Renal Disease
In a renal impairment study, venlafaxine elimination half-life after oral administration was prolonged by about 50% and clearance was reduced by about 24% in renally impaired patients (GFR=10 to 70 mL/min), compared to normal subjects. In dialysis patients, venlafaxine elimination half-life was prolonged by about 180% and clearance was reduced by about 57% compared to normal subjects. Similarly, ODV elimination half-life was prolonged by about 40% although clearance was unchanged in patients with renal impairment (GFR=10 to 70 mL/min) compared to normal subjects. In dialysis patients, ODV elimination half-life was prolonged by about 142% and clearance was reduced by about 56% compared to normal subjects. A large degree of intersubject variability was noted. Dosage adjustment is necessary in these patients (seeDOSAGE AND ADMINISTRATION).
Very low density lipoprotein physiology

# Overview
Very Low-Density Lipoprotein (VLDL) is a lipoprotein subclass. It is assembled in the liver from cholesterol and apolipoproteins. It is converted in the bloodstream to low-density lipoprotein (LDL). VLDL particles have a diameter of 30-80 nm. VLDL transports endogenous products where chylomicrons transport exogenous (dietary) products.

# Function
VLDL transports endogenous triglycerides, phospholipids, cholesterol and cholesteryl esters.  It functions as the body's internal transport mechanism for lipids.

# Changes during circulation
Nascent VLDL circulates in blood and picks up apolipoprotein C-II and apolipoprotein E donated from High-Density Lipoprotein (HDL).  At this point, the nascent VLDL becomes a mature VLDL.  Once in circulation, the VLDL will come in contact with Lipoprotein lipase (LPL) in the capillary beds in the body (adipose, cardiac, and skeletal muscle).  The LPL will remove triglycerides from the VLDL for storage or energy production.
The VLDL now meets back up with HDL where apoC-II is transferred back to the HDL (but keeps apoE).  In addition to this, the HDL transfers cholesteryl esters to the VLDL in exchange for phospholipids and triglycerides (via cholesteryl ester transfer protein).
As more and more triglycerides are removed from the VLDL because of the action of the LPL enzyme, the composition of the molecule changes, and it becomes intermediate density lipoprotein (IDL).
50% of IDL are recognized by receptors in the liver cells (because of the apoB-100 and apoE they contain) and are endocytosed.
The other 50% of IDL lose their apoE. When their cholesterol content becomes greater than the triglyceride content, they become low-density lipoprotein (LDL), with the primary apolipoprotein being apoB-100.  The LDL is taken into a cell via the LDL receptor (endocytosis) where the contents are either stored, used for cell membrane structure, or converted into other products (steroid hormones or bile acids).

# VLDL and disease
VLDL levels have been correlated with accelerated rates of atherosclerosis, and are elevated in a number of diseases and metabolic states.
The uniqueness of this correlation is disputed by Harchaoui and Boekholdt
A1BG response element negative results
Def. nucleotide "sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents",  "may be found in both promoter and enhancer regions" are called response elements.

# Hypotheses
- A1BG has no response elements in either promoter.
- A1BG is not transcribed by a response element.
- Each response element does not participate in the transcription of A1BG.

# Response element negative results

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
A1BG response element positive results
Def. nucleotide "sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents",  "may be found in both promoter and enhancer regions" are called response elements.

# Hypotheses
- A1BG has all known response elements in both promoters.
- A1BG is transcribed by all known response elements.
- Each known response element participates in the transcription of A1BG.

# Response element positive results

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
AASLD guidelines classification scheme

# Overview
AASLD (American Association of Study of Liver Disease) provides recommendations for various liver diseases. It develops clinical practice guidelines which are  supported by a high level of scientific evidence. They assist in appropriate health care to patients. The clinical practice guidelines should not be looked at as "standards of care". They are provided to aid in the diagnosis and management of liver diseases.

# Classification of Recommendations
AASLD recommendations are classified into five grades based on quality of evidence.

# Adapted Classification
AASLD has adapted the recommendations classification from American Heart Association recommendations classification. The adapated classification is as follows:

## Class of recommendation

## Level of evidence

# GRADE Classification
The AASLD Practice Guidelines Committee has adopted the classification used by the Grading of Recommendation Assessment,Development, and Evaluation (GRADE) workgroup with minor modifications. The classification is as follows

## Class of Recommendation

## Level of Evidence
Therapeutic response to statin therapy

# 2013 ACC AHA guidelin Recommendations for Monitoring, Optimizing, and Addressing Insufficient Response to Statin Therapy

## Monitoring Statin Therapy

## Optimizing Statin Therapy
"*Several RCTs found that low and low-moderate intensity statin therapy reduced ASCVD events. In addition, the CTT meta-analyses found each 39 mg/dL reduction in LDLC reduces ASCVD risk by 22%. Therefore, the Panel considered that submaximal statin therapy should be used to reduce ASCVD risk in those unable to tolerate moderate-or high-intensity statin therapy."

## Insufficient Response to Statin Therapy
"In those already on a statin, in whom baseline LDLC is unknown, an LDLC <100 mg/dL was observed in most individuals receiving high-intensity statin therapy. 
Clinical ASCVD includes acute coronary syndromes, or a history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin."
Congenital Absence of the Vas Deferens
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# Overview
Congenital absence of the vas deferens (CAVD) is a condition in which the two vas deferens, male reproductive organs, fail to form properly prior to birth. The vas deferens helps connect the sperm-producing testicles to the penis. Therefore, men who are missing both vas deferens are typically able to create sperm but are unable to transport them appropriately. Their semen does not contain sperm, a condition known as azoospermia. CAVD is associated with cystic fibrosis and occurs because of a mutation in the CFTR gene. Individuals with CAVD can reproduce with the assistance of modern technology in a procedure known as intracytoplasmic sperm injection.
Absorption (electromagnetic radiation)
In physics, absorption of electromagnetic radiation is the process by which the energy of a photon is taken up by matter, typically the electrons of an atom. Thus, the electromagnetic energy is transformed to other form of energy, for example, to heat. The absorption of light during wave propagation is often called attenuation.

# Physical process
When a material is illuminated, photons can make the valence electrons of an atom transition to a higher electronic energy levels. The photon is destroyed in the process and the absorbed radiant energy is transformed to electric potential energy. Several things can happen then to the absorbed energy, as it may be re-emitted by the electron as radiant energy (in this case the overall effect is in fact a scattering of light), dissipated to the rest of the material (i.e. transformed into heat), or even the electron can be freed from the atom (as in the photoelectric and Compton effects).
For most substances, the amount of absorption varies with the wavelength of the light, since the energy of the incident photon must be similar to an allowed electronic transition. This leads to the appearance of colour in pigments that absorb some wavelengths but not others. For example, an object that absorbs blue, green and yellow light will appear red when viewed under white light.

# Quantitative measurements
The absorbance of an object quantifies how much of the incident light is absorbed by it (not all photons get absorbed, some are reflected or refracted instead). This may be related to other properties of the object through the Beer-Lambert law.
Precise measurements of the absorbance at many wavelengths allow the identification of a substance via absorption spectroscopy, where a sample is illuminated from one side, and the intensity of the light that exits from the sample in every direction is measured.

# Earth surface
The specific phenomena involving absorption of electromagnetic radiation at the Earth's surface have several important aspects.  These phenomena include regulating the temperature of the Earth's crust, surface waters and lower atmosphere.  Changes in the Earth's crust such as glaciation, deforestation, polar ice melting, will necessarily alter the quantity and wavelength selectivity of electromagnetic absorption at the Earth's surface; correspondingly, changes in climate such as global warming may accompany changes in electromagnetic absorption or its inverse, the albedo.  Regulation of the temperature of surface waters has been analyzed with respect to the influence of electromagnetic radiation absorption, indicating the effects of total solar insolation and the local albedo.
Acute leukemia resident survival guide
Synonyms and keywords: Acute lymphocytic leukemia, Acute myeloid leukemia, ALL, AML

# Overview
Acute Leukemia is a malignancy of bone marrow myeloid and lymphoblastic precursor cells, in which these poorly differentiated hematopoietic cells proliferate rapidly. Hence, their accumulation would disrupt the performance of bone marrow to produce normal blood cells

# Causes
AML and ALL are life-threatening diseases, which would result in death if left untreated. In the majority of cases, etiology is not apparent.

## Common Causes of AML
- Gene mutations: FLT3, IDHI, IDH2, KRAS, DNMT3A, NPM1
- Chromosomal translocations, deletions, and inversions
- Benzene or radiation exposure chronically 

## Common Causes of ALL
- Radiation exposure
- Genetic disorders; e.g., Down syndrome, ataxia-telangiectasia, Fanconi anemia
- Certain infections: e.g., HTLV-1  

# FIRE
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
- Focused Initial Rapid Evaluation (FIRE) in AML :
- Focused Initial Rapid Evaluation (FIRE) in ALL:  

# Diagnosis
Diagnostic criteria of acute myeloid leukemia and acute lymphoblastic leukemia are similar to one another.
- According to the 2016 WHO criteria observing 20% blasts in the bone marrow biopsy or peripheral blood smear is diagnostic for AML. These genetic abnormalities in AML are diagnostic even with less than 20% marrow blasts: inv(16), t(16;16), t(8;21), and t(15;17).
- Presenting 20% of leukemic lymphoblasts in bone marrow aspirate and biopsy would prove ALL.

# Treatment
Treatment of acute lymphoblastic leukemia includes three phases:
- Induction therapy, i.e., prednisolone, vincristine, cytarabine
- Administrating Central Nervous System prophylaxis, i.e., methotrexate
- Chemotherapy as a maintenance treatment for two years
- Stem cell transplantation in adults who are eligible while there is a suitable donor

# Do's
- Before starting the therapy, taking a precise history and physical examination have to be done to diagnose any kind of comorbidities ,i.e. heart failure or renal diseases that affect the prognosis and treatment choices.
- HLA-typing evaluation have to be done for all of the AML cases In the pretreatment assessment.
- Seven days after the induction phase of chemotherapy ended, bone marrow biopsy must be done in order to assess the remission situation.
- In the induction chemotherapy process of AML for most of the cases, cytarabine IV infusion should be administrated for seven days consecutively + anthracycline on days one to three.(known as "7+3" regimens) 

# Don'ts
- If the patient with acute leukemia has a coagulopathy disorder and is susceptible to bleeding, do not have to undergo lumbar puncture in the workup process before correcting that.
- Without the assessment of cardiac symptoms and echocardiogram, chemotherapy medicines which are cardiotoxic should not be administrated.
Ampicillin sulbactam adverse reactions

# Adverse Reactions

## Adult Patients
Ampicillin/sulbactam is generally well tolerated. The following adverse reactions have been reported:
- Pain at IM injection site  16%
- Pain at IV injection site  3%
- Thrombophlebitis  3%
The most frequently reported adverse reactions were diarrhea in 3% of the patients and rash in less than 2% of the patients.
Additional systemic reactions reported in less than 1% of the patients were: itching, nausea, vomiting, candidiasis, fatigue, malaise, headache, chest pain, flatulence, abdominal distension, glossitis, urine retention, dysuria, edema, facial swelling, erythema, chills, tightness in throat, substernal pain, epistaxis and mucosal bleeding.

## Pediatric Patients
Available safety data for pediatric patients treated with ampicillin/sulbactam demonstrate a similar adverse events profile to those observed in adult patients. Additionally, atypical lymphocytosis has been observed in one pediatric patient receiving ampicillin/sulbactam.
- Hepatic: Increased AST, ALT, alkaline phosphatase, and LDH.
- Hematologic: Decreased hemoglobin, hematocrit, RBC, WBC, neutrophils, lymphocytes, platelets and increased lymphocytes, monocytes,basophils, eosinophils, and platelets.
- Blood Chemistry: Decreased serum albumin and total proteins.
- Renal: Increased BUN and creatinine.
- Urinalysis: Presence of RBCs and hyaline casts in urine.
The following adverse reactions have been reported with ampicillin-class antibiotics and can also occur with ampicillin/sulbactam.
Gastritis, stomatitis, black hairy tongue and enterocolitis. Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.
Urticaria, erythema multiforme, and an occasional case of exfoliative dermatitis have been reported. These reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids. Whenever such reactions occur, the drug should be discontinued, unless the opinion of the physician dictates otherwise. Serious and occasional fatal hypersensitivity (anaphylactic) reactions can occur with a penicillin.
In addition to the adverse laboratory changes listed above for ampicillin/sulbactam, agranulocytosis has been reported during therapy with penicillins. All of these reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Some individuals have developed positive direct Coombs Tests during treatment with ampicillin/sulbactam, as with other beta-lactam antibiotics.
Anadenanthera colubrina var. colubrina
Anadenanthera colubrina var. colubrina is a tree native to Argentina and Brazil.  Common names for it include Angico, Angico-brabo-liso, Angico-cambui, Angico-coco, Angico-escuro, Angico-liso, Angico-vermelho, Aperta-ruao and Cambui-angico.
Anadenanthera colubrina var. colubrina normally grows to a height of about 10-20m, but occasionally it will be seen up to 30m tall. It can be found growing at an altitude of 100-1200 m in areas with 1200-2000 mm/year annual rainfall.
The tree's bark has a thickness of about 4-10 mm.  The outside surface is nearly smooth.  It is gray, black speckled and resembles snake skin, after which it was once given a scientific designation. This tree has recoreded medicinal uses and the bark contains 16.4% tannin. The wood is hard to very hard and it has a density of 0.80-1.10 g/cm3. It is used for firewood, charcoal, floors, beams, posts, stakes, boat construction and general construction.
Aneurysm of sinus of valsalva overview

# Overview
Aneurysm of the aortic sinus, also known as the sinus of Valsalva, is comparatively rare, occurring in about one person in every thousand.
When present, it is usually in either the right (65-85%) or in the noncoronary (10-30%) sinus, rarely in the left (< 5%) sinus. This type of aneurysm is typically congenital and may be associated with heart defects. It is sometimes associated with Marfan syndrome or Loeys-Dietz syndrome, but may also result from Ehlers-Danlos syndrome, atherosclerosis, syphilis, cystic medial necrosis, chest injury, or infective endocarditis.
If unruptured, this type aneurysm may be asymptomatic and therefore go undetected until symptoms appear or medical imaging is performed for other reasons.
Aortic insufficiency surgery prognosis
For the WikiPatient page for this topic, click here; For the main page of aortic insufficiency, click here
Related Key Words and Synonyms: Aortic valve replacement.

# Overview
Most valve surgery operations are successful, but in some rare cases, an aortic valve repair may fail and another operation may be needed.

# Operative Mortality
The risk of death or serious complications from isolated aortic valve replacement is typically between 1-3%, depending on the health and age of the patient, as well as the skill of the surgeon and the health care institute. The patient's past history of heart surgery affects the mortality rate as well. Complications like myocardial Injury and acute kidney injury may negatively effect the prognosis.
Atovaquone proguanil drug interactions

# Drug Interactions

## Rifampin/Rifabutin
Concomitant administration of rifampin or rifabutin is known to reduce atovaquone concentrations . The concomitant administration of Atovaquone proguaniland rifampin or rifabutin is not recommended.

## Anticoagulants
Proguanil may potentiate the anticoagulant effect of warfarin and other coumarin-based anticoagulants. The mechanism of this potential drug interaction has not been established. Caution is advised when initiating or withdrawing malaria prophylaxis or treatment with Atovaquone proguanilin patients on continuous treatment with coumarin-based anticoagulants. When these products are administered concomitantly, coagulation tests should be closely monitored.

## Tetracycline
Concomitant treatment with tetracycline has been associated with a reduction in plasma concentrations of atovaquone . Parasitemia should be closely monitored in patients receiving tetracycline.

## Metoclopramide
While antiemetics may be indicated for patients receiving MALARONE, metoclopramide may reduce the bioavailability of atovaquone and should be used only if other antiemetics are not available .

## Indinavir
Concomitant administration of atovaquone and indinavir did not result in any change in the steadystate AUC and Cmax of indinavir but resulted in a decrease in the Ctrough of indinavir . Caution should be exercised when prescribing atovaquone with indinavir due to the decrease in trough concentrations of indinavir.
Azithromycin (ophthalmic) how supplied

# How Supplied
AzaSite is a sterile aqueous topical ophthalmic formulation of 1% azithromycin.
- NDC 31357-040-25: 2.5 mL in 5 mL bottle containing a total of 25 mg of azithromycin in a white, round, low-density polyethylene (LDPE) bottle, with a clear LDPE dropper tip, and a tan colored high density polyethylene (HDPE) eyedropper cap. A white tamper evident over-cap is provided.
- NDC 31357-040-03: 2.5 mL in 4 mL bottle containing a total of 25 mg of azithromycin in a white, round, low-density polyethylene (LDPE) bottle, with a clear LDPE dropper tip, and a tan colored high density polyethylene (HDPE) eyedropper cap. A white tamper evident over-cap is provided.

### Storage and Handling
Store unopened bottle under refrigeration at 2C to 8C (36F to 46F). Once the bottle is opened, store at 2C to 25C (36F to 77F) for up to 14 days. Discard after the 14 days.