Persius/hicric huggingface dataset:
Delavirdine indications and usage

# Indications and Usage
RESCRIPTOR Tablets are indicated for the treatment of HIV-1 infection in combination with at least 2 other active antiretroviral agents when therapy is warranted.
The following should be considered before initiating therapy with RESCRIPTOR in treatment-naive patients. There are insufficient data directly comparing antiretroviral regimens containing RESCRIPTOR with currently preferred 3-drug regimens for initial treatment of HIV. In studies comparing regimens consisting of 2 nucleoside reverse transcriptase inhibitors (NRTIs) (currently considered suboptimal) to RESCRIPTOR plus 2 NRTIs, the proportion of patients receiving the regimen containing RESCRIPTOR who achieved and sustained an HIV-1 RNA level <400 copies/mL over 1 year of therapy was relatively low (see DESCRIPTION OF CLINICAL STUDIES).
Resistant virus emerges rapidly when RESCRIPTOR is administered as monotherapy. Therefore, RESCRIPTOR should always be administered in combination with other antiretroviral agents.
Dermatitis herpetiformis overview

# Overview
Dermatitis Herpetiformis (also called Duhring's disease), is a chronic itchy rash which is frequently associated with Celiac Disease. The rash is made of papules and vesicles which are present on different parts of the body mostly commonly on neck, trunk, buttocks and knees. It is an autoimmune mediated skin condition, which is IgA mediated reaction and is associated with gluten sensitivity of small bowel. There is presence of antibodies which leads to positive serology test results.
Dermatitis herpetiformis is associated with high prevalence of other autoimmune diseases.

# Historical Perspective

# Classification

# Pathophysiology

# Causes

# Differentiating Dermatitis Herpetiformis from Other Diseases

# Epidemiology and Demographics

# Risk Factors
Dermatitis herpetiformis usually begins in people age 20 and older, although children may sometimes be affected. It is seen in both men and women.

# Natural History, Complications and Prognosis

# Diagnosis

## History and Symptoms
Dermatitis herpetiformis breakouts are usually extremely itchy.  In many people the vesicles or papules appear on the elbows, knees, back, and buttocks (pressure points).   It may also present as a patch of red skin with little water blisters scattered about.   It is a systemic condition; the unpredictable skin rash may appear or be exacerbated by any irritation such as dry skin, scratching or clothing that is rough or scratchy.   The fact that the rash is most prevalent at pressure points (where clothing rubs the most) may be why the symptoms sometimes appear to be symmetrical.

## Physical Examination

## Laboratory Findings
A skin biopsy and direct immunofluorescence test of the skin are performed in most cases; doctors may additionally recommend a biopsy of the intestines.

## CT Findings

## MRI Findings

## Other Imaging Findings

# Treatment

## Medical Therapy
Dapsone, an antibiotic, may help the majority of patients. A strict gluten-free diet will also be recommended to help control the disease. Adherence to this diet may eliminate the need for medications and prevent later complications.

## Surgery

## Prevention
Diseases of the parathyroid gland

# Hyperparathyroidism and related conditions
The single major disease of parathyroid glands is overactivity of one or more of the parathyroid lobes, which make too much parathyroid hormone causing a potentially serious calcium imbalance. This is called hyperparathyroidism; it leads to hypercalcemia and osteitis fibrosa cystica. Since hyperparathyroidism was first described in 1925, the symptoms have become known as "moans, groans, stones, and bones."  The primary treatment for this disease is the surgical removal of the faulty gland.
Modern high frequency ultrasound can see parathyroid masses, even before they cause high calcium. They are called parathyroid incidentalomas. If a patient has elevated calcium, the ultrasound can be used to locate the abnormal glands. The use of ultrasound guided FNA, and parathyroid hormone washings can confirm the abnormal glands. A blood calcium 15-30 minutes after the biopsy can help determine if the disease is caused by a single abnormal gland or multiple glands.
A drop in serum calcium suggests a single source, and no drop suggests multiple glands. This, with a non-localizing Sestamibi scan would point toward a neck exploration, rather than a minimally invasive method aimed a single gland disease.
A Sestamibi scan is often used to determine which parathyroid gland(s) are responsible for overproduction of parathyroid hormone.
Another related condition is called secondary hyperparathyroidism, or secondary HPT - common in patients with chronic kidney disease on dialysis. In secondary HPT, the parathyroid glands make too much parathyroid hormone (PTH), and the kidneys do not produce enough vitamin D, and calcium and phosphorus are out of balance. Even though one may not have any symptoms, treating secondary HPT is important. Cinacalcet (Sensipar) is a medicine that can help treat such dialysis patients and is available by prescription only.

# Hypoparathyroidism and related conditions
- Hypoparathyroidism
- Pseudohypoparathyroidism
- Pseudopseudohypoparathyroidism
- Disorders of the parathyroid hormone receptor have been associated with Jansen's metaphyseal chondroplasia and Blomstrand's chondroplasia.
Drug effectiveness review project
The Drug Effectiveness Review Project (DERP) is an Oregon-based collaboration of public and private organizations, including fifteen states, that have joined together to provide systematic evidence-based reviews of the comparative effectiveness and safety of drugs in many widely used drug classes and to apply the findings to inform public policy and related activities.
The purpose of the DERP reports is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes.
DERP reports are not usage guidelines, nor should they be read as an endorsement of or recommendation for any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.
Dyscalculia (patient information)
For the WikiDoc page for this topic, click here
Synonyms and Keywords: Mathematics disorder

# Overview
Mathematics disorder is a condition in which a child's math ability is far below normal for their age, intelligence, and education.

# What are the symptoms of Dyscalculia?
- Early difficulties with arithmetic are noticed, as well as low scores in math classes and tests
- Some of the problems seen include:
- Trouble with reading, writing, and copying numbers
- Problems counting and adding numbers, often making simple mistakes
- Difficulty telling the difference between addition and subtraction
- Problems understanding math symbols and word problems
- Unable to line up numbers properly to add, subtract, or multiply
- Unable to arrange numbers from smallest to largest, or the opposite
- Unable to understand graphs

# What causes Dyscalculia?
- Children who have mathematics disorder may have trouble performing simple mathematical equations, such as counting and adding.
- Mathematical disorder may appear with:
- Developmental coordination disorder
- Mixed receptive-expressive language disorder
- Reading disorder

# When to seek urgent medical care?
Call for an appointment with your health care provider if you have any concerns about your child's development.

# Diagnosis
- Standardized tests can assess the child's math ability.
- Grades and class performance can also help.

# Treatment options
- The best treatment is remedial education.
- Other programs that have been successful include Project Math and teaching computer skills.

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

# What to expect (Outlook/Prognosis)?
Early intervention improves the chances of a better outcome.

# Possible complications
- The child may have problems in school, including behavior problems and loss of self-esteem.
- Some children with mathematics disorder become anxious or afraid when given math problems, making the problem even worse.

# Prevention
- Affected families should make every effort to recognize existing problems early.
- Intervention may begin as early as kindergarten or elementary school.

# Source
Echo in ventricular septal defect

## Ventricular Septal Defect
A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). The ventricular septum consists of a muscular (inferior) and membranous portion (superior). The membranous portion (which is close to the atrioventricular node) is most commonly affected.
Congenital VSDs are collectively the most common congenital heart defect.

# Echo functions in VSD
- location and number of defects
- direction of shunting
- PA and RV pressures
- LV thickness, presence of hypertrophy/overload
- associated anomalies

# Special Echo techniques in VSD
Size of the defect determines on the plane in which it is visualized as the defect is usually not symmetric.  MUST take maximum diameter.

# Perimembranous VSD
- best seen on parasternal long, short or 5 chamber views
Yale University School of Medicine Congenital Heart Disease: Membranous VSD

# Muscular VSD

## Inlet VSD
- best seen on apical 4 chamber view
unusual VSD:

## Outlet VSD
- best seen on parasternal long/short views

# Other VSD types
Trabecular defects are best seen on parasternal long and apical 4 chamber views
Echo in cardiac tumors and masses

# Overview of Cardiac Tumors

# Benign Tumors

## Cardiac myxomas
Frequency: 30% of benign tumors
Location: left atrium (75%), right atrium (23%), ventricles (2%)
presentation: intracardic obstruction, embolization, constitutional symptoms (fever, weight loss, fatigue, arthralgias, rash)
Preferred imaging modality: 2D echo- TTE is adequate

## Lipomas
Frequency: 10% of benign tumors
Location: Left ventricle, right atrium, interarterial septum
size: 1-15cm
Preferred imaging modality: MRI

## Rhabdomyomas
Frequency: 6% of benign cardiac tumors
Location: ventricles and atria (pedunculated mass), within septal myocardium
presentation: heart block, SVT, ventricular tachycardia, sudden death
demographic: 75% occur in children (<1 yo)

## Fibromas
Location: usually within the myocardium of the left ventricle, anterior free wall, interventricular septum
size: 3-10cm
presentation:
demographic: rarely in adults, mostly in children

## Papillary fibroelastoma
Frequency: 8% of benign tumors
Size: 0.5 - 2.0 cm
Location: mitral valve (most commonly), aortic valce, endocardial surfaces
Demographic: 60 yo (average age)
Presentation: embolization

## Hemangiomas

# Malignant Tumors

## Angiosarcoma
Frequency: 30% of malignant cardiac tumors

## Leiomyosarcoma

## Rhabdomycosarcoma
Frequency: 10% of primary cardiac sarcoma. Most common cardiac tumor in children

## Lymphoma
Fequency: 5% of primary malignant cardiac tumors

## Metastasis
Eletriptan nonclinical toxicology

# Nonclinical Toxicology

### 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

### Carcinogenesis
Eletriptan was administered to rats and mice in the diet for 104 weeks. In rats, the incidence of testicular interstitial cell adenomas was increased at the high dose of 75 mg/kg/day, but not at 15 mg/kg/day, a dose associated with plasma exposures (AUC) approximately 2 times that in humans at the MRHD of 80 mg/day. In mice, the incidence of hepatocellular adenomas was increased at the high dose of 400 mg/kg/day, but not a dose of 90 mg/kg/day, associated with plasma AUC approximately 7 times that in humans at the MRHD.

### Mutagenesis
Eletriptan was negative in in vitro (bacteria reverse mutation (Ames), mammalian cell gene mutation (CHO/ HGPRT), chromosomal aberration assay in human lymphocytes) and in vivo (mouse micronucleus) assays.

### Impairment of Fertility
In a fertility and early embryonic development study, eletriptan (50, 100, or 200 mg/kg/day) was orally administered to male and female rats prior to and throughout mating and continuing in females to implantation. Plasma exposures (AUC) were 4, 8 and 16 times in males and 7, 14 and 28 times in females, respectively, that in humans at the MRHD. Dose-related decreases in the number of corpora lutea, implants, and viable fetuses per dam were observed at all doses. Prolongation of the estrus cycle was observed at the highest dose tested. Male fertility parameters were not affected.
Epoprostenol detailed information
Epoprostenol is a synthetic form of prostacyclin, and is used to treat pulmonary hypertension. It is sold under the trade name Flolan.

# Clinical pharmacology
As an analogue of prostacyclin PGI2, epoprostenol effects vasodilation, which in turn lowers the blood pressure. Epoprotstenol also inhibits platelet aggregation, though the role this phenomenon may play in relation to pulmonary hypertension has yet to be determined.

# Administration
Epoprostenol is given via continuous infusion that requires a semi-permanent central venous catheter. This means that the patient must be attached to an infusion pump at all times. This delivery system can cause sepsis and thrombosis. Because epoprostenol is unstable, it must be kept cold, even during administration. Since it has a half-life of 3 to 5 minutes, the infusion has to be continuous (24/7), and an interruption can lead to a potentially fatal rebound of symptoms.

# History
Epoprostenol was developed by GlaxoSmithKline and approved in the USA as a medicine in 1995.

# Marketing
It was licensed to Myogen, which was subsequently acquired by Gilead Sciences. Flolan is marketed in the United States by Gilead Sciences and elsewhere by GlaxoSmithKline.
Ethionamide clinical pharmacology

# Clinical Pharmacology

## Absorption
Ethionamide is essentially completely absorbed following oral administration and is not subjected to any appreciable first pass metabolism. Ethionamide tablets may be administered without regard to the timing of meals.
The pharmacokinetic parameters of ethionamide following single oral-dose administration of 250 mg of Trecator film-coated tablets under fasted conditions to 40 healthy adult volunteers are provided in Table 1.
Trecator tablets have been reformulated from a sugar-coated tablet to a film-coated tablet. The Cmax for the film-coated tablets (2.16 g/mL) was significantly higher than that of sugar-coated tablets (1.48 g/mL) (see DOSAGE AND ADMINISTRATION).

## Distribution
Ethionamide is rapidly and widely distributed into body tissues and fluids following administration of a sugar-coated tablet, with concentrations in plasma and various organs being approximately equal. Significant concentrations are also present in cerebrospinal fluid following administration of a sugar-coated tablet. Distribution of ethionamide into the same body tissues and fluids, including cerebrospinal fluid following administration of the film-coated tablet, has not been studied, but is not expected to differ significantly from that of the sugar-coated tablet. The drug is approximately 30% bound to proteins. The mean (SD) apparent oral volume of distribution observed in 40 healthy volunteers following a 250 mg oral dose of film-coated tablets was 93.5 (19.2) L.

## Metabolism
Ethionamide is extensively metabolized to active and inactive metabolites. Metabolism is presumed to occur in the liver and thus far 6 metabolites have been isolated: 2-ethylisonicotinamide, carbonyl-dihydropyridine, thiocarbonyl-dihydropyridine, S-oxocarbamoyl dihydropyridine, 2-ethylthioiso-nicotinamide, and ethionamide sulphoxide. The sulphoxide metabolite has been demonstrated to have antimicrobial activity against Mycobacterium tuberculosis.

## Elimination
The mean (SD) half-life observed in 40 healthy volunteers following a 250 mg oral dose of film-coated tablets was 1.92 (0.27) hours. Less than 1% of the oral dose is excreted as ethionamide in urine.

## Mechanism of Action
Ethionamide may be bacteriostatic or bactericidal in action, depending on the concentration of the drug attained at the site of infection and the susceptibility of the infecting organism. The exact mechanism of action of ethionamide has not been fully elucidated, but the drug appears to inhibit peptide synthesis in susceptible organisms.
Ezetimibe/Simvastatin description

# Description
VYTORIN contains ezetimibe, a selective inhibitor of intestinal cholesterol and related phytosterol absorption, and simvastatin, an HMG-CoA reductase inhibitor.
The chemical name of ezetimibe is 1-(4-fluorophenyl)-3(R)--4(S)-(4-hydroxyphenyl)-2-azetidinone. The empirical formula is C24H21F2NO3 and its molecular weight is 409.4.
Ezetimibe is a white, crystalline powder that is freely to very soluble in ethanol, methanol, and acetone and practically insoluble in water. Its structural formula is:
Simvastatin, an inactive lactone, is hydrolyzed to the corresponding -hydroxyacid form, which is an inhibitor of HMG-CoA reductase. Simvastatin is butanoic acid, 2,2-dimethyl-,1,2,3,7,8,8a-hexahydro-3,7-dimethyl-8--1-naphthalenyl ester, ]. The empirical formula of simvastatin is C25H38O5 and its molecular weight is 418.57.
Simvastatin is a white to off-white, nonhygroscopic, crystalline powder that is practically insoluble in water and freely soluble in chloroform, methanol and ethanol. Its structural formula is:
VYTORIN is available for oral use as tablets containing 10 mg of ezetimibe, and 10 mg of simvastatin (VYTORIN 10/10), 20 mg of simvastatin (VYTORIN 10/20), 40 mg of simvastatin(VYTORIN 10/40), or 80 mg of simvastatin (VYTORIN 10/80). Each tablet contains the following inactive ingredients: butylated hydroxyanisole NF, citric acid monohydrate USP, croscarmellose sodium NF, hypromellose USP, lactose monohydrate NF, magnesium stearate NF, microcrystalline cellulose NF, and propyl gallate NF.
Fractional excretion of uric acid
In water-electrolyte imbalance, Fractional excretion of uric acid (FEUA) is defined as fraction of uric acid filtered by the kidneys that is then excreted by the kidneys.
The normal values are:
- 6 to 12%
- 4 to 11%

# Diagnosis of causes of hyponatremia
In the diagnosis of hyponatremia:
- A value of 4% for less suggests prerenal causes.
- A normal value (4 to 11%) suggests psychogenic polydipsia or reset osmostat.
- If the FEUA is high (higher than 11%), this suggests SIADH, thiazide-induced hyponatremia, or renal salt wasting.
Fibroblast growth factor receptor

# Overview
The fibroblast growth factor receptors are, as their name implies, receptors which bind to members of the fibroblast growth factor family of proteins.

# Structure
The fibroblast growth factor receptors consist of an extracellular ligand domain comprised of three immunoglobulin-like domains, a single transmembrane helix domain, and an intracellular domain with tyrosine kinase activity. 
The fibroblast growth factors are the largest family of growth factor ligands, comprising 22 members.
The natural alternate splicing of four fibroblast growth factor receptor (FGFR) genes results in the production of over 48 different isoforms of FGFR.
These isoforms vary in their ligand binding properties and kinase domains, however all share the common extracellular region composed of three immunoglobulin (Ig) like domains (D1-D3), and thus belong to the immunoglobulin superfamily.
The three immunoglobin(Ig)-like domains, D1, D2 and D3, present a stretch of acidic amino acids ("the acidic box") between D1 and D2. This "acidic box" can participate in the regulation of FGF binding to the FGFR. Immunoglobulin-like domains D2 and D3 are sufficient for FGF binding. Each receptor can be activated by several FGFs. In many cases the FGFs themselves can also activate more than one receptor, this is not the case with FGF-7 however which can only activate FGFR2b.
A gene for a fifth FGFR protein, FGFR5, has also been identified. In contrast to FGFRs 1-4 it lacks a cytoplasmic tyrosine kinase domain and one isoform, FGFR5, only contains the extracellular domains D1 and D2.
The FGFRs are known to dimerize as heterodimers and homodimers.

# Genes
So far, five distinct membrane FGFR have been identified in vertebrates and all of them belong to the tyrosine kinase superfamily (FGFR1 to FGFR4).
- FGFR1 (see also Fibroblast growth factor receptor 1)
- FGFR2 (see also Fibroblast growth factor receptor 2)
- FGFR3 (see also Fibroblast growth factor receptor 3)
- FGFR4
- FGFR6
Famciclovir indications and usage

# Indications And Usage

## Immunocompetent Adult Patients

### herpes labialis (cold sores)
FAMVIR is indicated for the treatment of recurrent herpes labialis.

### Genital herpes
Recurrent episodes: FAMVIR is indicated for the treatment of recurrent episodes of Genital herpes. The efficacy of FAMVIR when initiated more than 6 hours after onset of symptoms or lesions has not been established.
Suppressive therapy: FAMVIR is indicated for chronic suppressive therapy of recurrent episodes of Genital herpes. The efficacy and safety of FAMVIR for the suppression of recurrent Genital herpes beyond 1 year have not been established.
Herpes zoster (shingles): FAMVIR is indicated for the treatment of herpes zoster. The efficacy of FAMVIR when initiated more than 72 hours after onset of rash has not been established.

## HIV-Infected Adult Patients
Recurrent orolabial or Genital herpes: FAMVIR is indicated for the treatment of recurrent episodes of orolabial or Genital herpes in HIV-infected adults. The efficacy of FAMVIR when initiated more than 48 hours after onset of symptoms or lesions has not been established.

## Limitation of Use
The efficacy and safety of FAMVIR have not been established for:
- Patients <18 years of age
- Patients with first episode of Genital herpes
- Patients with ophthalmic zoster
- Immunocompromised patients other than for the treatment of recurrent orolabial or Genital herpes in HIV-infected patients
- Black and African American patients with recurrent Genital herpes
Inborn errors of lipid metabolism

# Overview
Numerous genetic disorders are caused by errors in fatty acid metabolism. These disorders may be described as fatty oxidation disorders or as a lipid storage disorders, and are any one of several inborn errors of metabolism that result from enzyme defects affecting the ability of the body to oxidize fatty acids in order to produce energy within muscles, liver, and other cell types.
Some of the more common fatty acid metabolism disorders are:

# Coenzyme A dehydrogenase deficiencies
- Very long-chain acyl-coenzyme A dehydrogenase deficiency (VLCAD) - Very long-chain acyl-coenzyme A dehydrogenase
- Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency (LCHAD) - Long-chain 3-hydroxyacyl-coenzyme A
- Medium-chain acyl-coenzyme A dehydrogenase deficiency (MCAD) - Medium-chain acyl-coenzyme A dehydrogenase
- Short-chain acyl-coenzyme A dehydrogenase deficiency (SCAD) - Short-chain acyl-coenzyme A dehydrogenase
- 3-hydroxyacyl-coenzyme A dehydrogenase deficiency (HADH) - 3-hydroxyacyl-coenzyme A dehydrogenase

# Other Coenzyme A enzyme deficiencies
- 2,4 Dienoyl-CoA reductase deficiency - 2,4 Dienoyl-CoA reductase
- 3-hydroxy-3-methylglutaryl-CoA lyase deficiency - 3-hydroxy-3-methylglutaryl-CoA lyase
- Malonyl-CoA decarboxylase deficiency - Malonyl-CoA decarboxylase

# Carnitine related
- Primary carnitine deficiency - SLC22A5 (carnitine transporter)
- Carnitine-acylcarnitine translocase deficiency - Carnitine-acylcarnitine translocase
- Carnitine palmitoyltransferase I deficiency (CPT) - Carnitine palmitoyltransferase I
- Carnitine palmitoyltransferase II deficiency (CPT) - Carnitine palmitoyltransferase II

# Lipid storage
- Acid lipase diseases
Wolman disease
Cholesteryl ester storage disease
- Wolman disease
- Cholesteryl ester storage disease
- Gaucher disease
- Niemann-Pick disease
- Fabry disease
- Farbers disease
- Gangliosidoses
- Krabbe disease
- Metachromatic leukodystrophy

# Other
- Mitochondrial trifunctional protein deficiency
- Electron transfer flavoprotein (ETF) dehydrogenase deficiency (GAII & MADD)
- Tangier disease
- Acute fatty liver of pregnancy