Persius/hicric huggingface dataset:
McCune-Albright syndrome (patient information)
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# Overview
McCune-Albright syndrome is a genetic disease that affects the bones and color (pigmentation) of the skin.

# What are the symptoms of McCune-Albright syndrome?
The hallmark symptom of McCune-Albright syndrome is premature puberty in girls. Menstrual periods may begin in early childhood, long before the breasts or pubic hair develop (which normally occur first). Puberty and menstrual bleeding may begin as early as 4 - 6 months in girls.
Early sexual development may also occur in boys, but it is not as common as it is in girls.
Other symptoms include:
- Bone fractures
- Deformities of the bones in the face
- Gigantism
- Irregular, large patchy cafe-au-lait spots, especially on the back

# What causes McCune-Albright syndrome?
McCune-Albright syndrome is caused by mutations in the GNAS1 gene. The abnormal gene is present in a fraction, but not all, of the patient's cells (mosaicism).

# Who is at highest risk?
This disease is not inherited. It is caused by a new change (mutation) to the DNA that occurs in the womb while the baby is developing. This mutation is not passed on to any of the person's children.

# Diagnosis
A physical examination may show signs of:
- Abnormal bone growth in the skull
- Abnormal heart rhythms (arrhythmias)
- Acromegaly
- Adrenal abnormalities
- Gigantism
- Hyperparathyroidism
- Hyperthyroidism
- Hypophosphatemia
- Large cafe-au-lait spots on the skin
- Liver disease, jaundice, fatty liver
- Ovarian cysts
- Pituitary or thyroid tumors
- Scar-like tissue in the bone (fibrous dysplasia)
Tests may show too much:
- Adrenal hormones
- Blood prolactin
- Growth hormone
Other tests that may be done include:
- MRI of the head
- X-rays of the bones
Genetic testing is available for the GNAS1 gene.

# When to seek urgent medical care?
Call your health care provider if your child starts puberty early, or has other symptoms of McCune-Albright syndrome. Genetic counseling, and possibly genetic testing, may be recommended if the disease is diagnosed.

# Treatment options
There is no specific treatment for McCune-Albright syndrome. Drugs that block estrogen production, such as testolactone, have been tried with some success.
Adrenal abnormalities (such as Cushing's syndrome) may be treated with surgery to remove the adrenal glands. Gigantism and pituitary adenoma will need treatment with hormone inhibitors or surgery.

# Where to find medical care for McCune-Albright syndrome?
Directions to Hospitals Treating McCune-Albright syndrome

# What to expect (Outlook/Prognosis)?
Lifespan is relatively normal.

# Possible complications
- Blindness
- Cosmetic problems from bone abnormalities
- Deafness
- Osteitis fibrosa cystica
- Premature puberty
- Repeated broken bones
- Tumors of the bone (rare)

# Sources
Meglumine antimoniate warnings and precautions

# Warnings and Precautions
A protein-rich diet should be provided throughout treatment and, where possible, iron depletion and other specific deficiencies should be corrected beforehand.
When possible, both the electrocardiogram and renal and hepatic function should be monitored throughout treatment. Dosage must be reduced should abnormalities occur.

### Use in pregnancy
Safe use in pregnancy has not been established. However, because it is potentially fatal, visceral leishmaniasis should always be treated without delay.
Methenamine hippurate warnings and precautions

# WARNINGS
Large doses of methenamine (8 grams daily for 3 to 4 weeks) have caused bladder irritation, painful and frequent micturition, albuminuria, and gross hematuria.

# PRECAUTIONS
Prescribing methenamine hippurate tablets USP 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.
1.Care should be taken to maintain an acid pH of the urine, especially when treating infections due to urea-splitting organisms such as Proteus and strains of Pseudomonas.
2.In a few instances in one study, the serum transaminase levels were slightly elevated during treatment but returned to normal while the patients were still taking methenamine hippurate tablets USP. Because of this report, it is recommended that liver function studies be performed periodically on patients taking the drug, especially those with liver dysfunction.
3.Use in Pregnancy: In early pregnancy the safe use of methenamine hippurate tablets USP is not established. In the last trimester, safety is suggested, but not definitely proved. No adverse effects on the fetus were seen in studies in pregnant rats and rabbits.
Methenamine hippurate tablets USP taken during pregnancy can interfere with laboratory tests of urine estriol (resulting in unmeasurably low values) when acid hydrolysis is used in the laboratory procedure. This interference is due to the presence in the urine of methenamine and/or formaldehyde. Enzymatic hydrolysis, in place of acid hydrolysis, will circumvent this problem.

## Information for Patients
Patients should be counseled that antibacterial drugs including methenamine hippurate tablets USP should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When methenamine hippurate tablets USP are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by methenamine hippurate tablets USP or other antibacterial drugs in the future.

## Geriatric Use
Clinical studies of methenamine hippurate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
Methenamine Hippurate is contraindicated in patients with renal insufficiency
Methenamine mandelate warnings and precautions

# Warnings and Precautions
General: Dysuria may occur (usually at higher than recommended dosage). This can be controlled by reducing the dosage and the acidification. When urine acidification is contraindicated or unattainable (as with some urea-splitting bacteria), the drug is not recommended.
Drug Interactions: Formaldehyde and sulfamethizole form an insoluble precipitate in acid urine; therefore, methenamine mandelate, USP should not be administered concurrently with sulfamethizole.
Drug/Laboratory Test Interactions: Formaldehyde interferes with fluorometric procedures for determination of urinary catecholamines and vanillylmandelic acid (VMA), causing erroneously high results. Formaldehyde also causes falsely decreased urine estriol levels by reacting with estriol when acid hydrolysis techniques are used; estriol determinations which use enzymatic hydrolysis are unaffected by formaldehyde. Formaldehyde causes falsely elevated 17-hydroxycorticosteroid levels when the Porter-Silber method is used and falsely decreased 5-hydroxyindoleacetic acid (5HIAA) levels by inhibiting color development when nitrosonaphthol methods are used.
Pregnancy Category C: Animal reproduction studies have not been conducted with methenamine mandelate, USP. It is also not known whether methenamine mandelate, USP can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Methenamine mandelate, USP should be given to a pregnant woman only if clearly needed. Since introduction, published reports on the use of methenamine mandelate, USP in pregnant women have not shown an increased risk of fetal abnormalities from use during pregnancy.
PCI in the patient with sole remaining conduit

# PCI in the Patient with Sole Remaining Conduit
Sole remaining conduit (SRC) refers to the only remaining artery (native artery or bypass graft) with occlusion of the native and bypass supplies to the remaining two coronary arteries. There are insufficient data on percutaneous coronary intervention to a sole remaining conduit.
When patients with SRC present with severe anginal symptoms, there are three options to deal with these patients. First, perform PCI through and to the SRC. Second, to perform PCI to one or more chronic total occlusions and finally, to optimize patients with medical therapy. Other adjunct devices such as intra-aortic balloon pump may be beneficial in this setting.
Tavano et al studied 16 patients who underwent percutaneous coronary intervention in their sole remaining vessel. All patients were symptomatic with unstable angina or minimal effort angina refractory to maximal medical therapy. In-hospital, one-month and 6-month major adverse cardiac events (defined as the composite of death, myocardial infarction, and target vessel revascularization) and angina status according to the Canadian Cardiovascular Society (CCS) score were assessed. During hospital stay one patient died 10 hours after the procedure secondary to acute pulmonary edema, urgent coronary angiography showed a patent target vessel. At one month 75% of patients were asymptomatic, the other 3 patients experienced symptom improvement from CCS III to I. After 6 months, a second patient died after an out-of-hospital cardiac arrest that occurred 4 months after the procedure. At one year, there were no additional deaths, one patient developed non-Q wave myocardial infarction and one patient underwent repeat PCI of the target vessel.

# Conclusion
There is limited data on PCI to the sole remaining conduit. Small retrospective analysis support PCI as a treatment strategy for highly symptomatic and difficult-to-treat patient cohort.
Paroxysmal Atrial Tachycardia (PAT) with Block
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# Diagnosis

## Electrocardiographic Findings
- The P wave morphology is different than that of a normal sinus rhythm (NSR).
- The atrial rate is between 150 and 250 beats per minute (BPM).
It is less than 200 in most cases.
In atrial flutter the rate is > 250 BPM in most cases.
- It is less than 200 in most cases.
- In atrial flutter the rate is > 250 BPM in most cases.
- There is an isoelectric baseline between P waves in all leads.
In atrial flutter there is a sawtooth appearance to the P waves.
- In atrial flutter there is a sawtooth appearance to the P waves.
- AV block
Usually 2:1, but can be 3:1, and can even be variable and resemble atrial fibrillation.
- Usually 2:1, but can be 3:1, and can even be variable and resemble atrial fibrillation.
- Digoxin toxicity caused 73% of cases in the Lown series. Other reports put the number at 40 to 82%.

# Related Chapters
- Atrial flutter
- Atrial tachycardia
- Atrial fibrillation
- Multifocal atrial tachycardia
Pegylated interferon alfa-2a contraindications

# Contraindications
PEGASYS is contraindicated in patients with:
- Known hypersensitivity reactions such as urticaria, angioedema, bronchoconstriction, anaphylaxis, or Stevens-Johnson syndrome to alpha interferons, including PEGASYS, or any of its components.
- Autoimmune hepatitis
- Hepatic decompensation (Child-Pugh score greater than 6 ) in cirrhotic patients before treatment
- Hepatic decompensation with Child-Pugh score greater than or equal to 6 in cirrhotic CHC patients coinfected with HIV before treatment
PEGASYS is contraindicated in neonates and infants because it contains benzyl alcohol. Benzyl alcohol is associated with an increased incidence of neurologic and other complications which are sometimes fatal in neonates and infants.
PEGASYS/COPEGUS combination therapy is additionally contraindicated in:
- Women who are pregnant
- Men whose female partners are pregnant
- Patients with known hypersensitivity (urticaria, angioedema, bronchoconstriction, and anaphylaxis) to COPEGUS or to any component of the tablet
- Patients with hemoglobinopathies (e.g., thalassemia major, sickle-cell anemia)
- Combination with didanosine. Reports of fatal hepatic failure, as well as peripheral neuropathy, pancreatitis, and symptomatic hyperlactatemia/lactic acidosis have been reported in clinical trials .
Petrous portion of the internal carotid artery
Petrous portion of the internal carotid artery (or petrous segment).When the internal carotid artery enters the canal in the petrous portion of the temporal bone, it first ascends a short distance, then curves forward and medialward, and again ascends as it leaves the canal to enter the cavity of the skull between the lingula and petrosal process of the sphenoid.
The artery lies at first in front of the cochlea and tympanic cavity; from the latter cavity it is separated by a thin, bony lamella, which is cribriform in the young subject, and often partly absorbed in old age.
Farther forward it is separated from the semilunar ganglion by a thin plate of bone, which forms the floor of the fossa for the ganglion and the roof of the horizontal portion of the canal.
Frequently this bony plate is more or less deficient, and then the ganglion is separated from the artery by fibrous membrane.
The artery is separated from the bony wall of the carotid canal by a prolongation of dura mater, and is surrounded by a number of small veins and by filaments of the carotid plexus, derived from the ascending branch of the superior cervical ganglion of the sympathetic trunk.
Pituitary adenylate cyclase-activating peptide
Pituitary adenylate cyclase-activating polypeptide also known as PACAP is a protein that in humans is encoded by the ADCYAP1 gene. PACAP is similar to vasoactive intestinal peptide. One of its effects is to stimulate enterochromaffin-like cells. It binds to vasoactive intestinal peptide receptor and to the PACAP receptor.

# Function
This gene encodes adenylate cyclase-activating polypeptide 1. Mediated by adenylate cyclase-activating polypeptide 1 receptors, this polypeptide stimulates adenylate cyclase and subsequently increases the cAMP level in target cells. Adenylate cyclase-activating polypeptide 1 not only is a hypophysiotropic hormone (i.e. a substance that induces activity in the hypophysis) but also functions as a neurotransmitter and neuromodulator. In addition, it plays a role in paracrine and autocrine regulation of certain types of cells. This gene is composed of five exons. Exons 1 and 2 encode the 5' UTR and signal peptide, respectively; exon 4 encodes an adenylate cyclase-activating polypeptide 1-related peptide; and exon 5 encodes the mature peptide and 3' UTR. This gene encodes three different mature peptides, including two isotypes: a shorter form and a longer form.
Recently a version of this gene has been associated with post-traumatic stress disorder (PTSD) in women (but not men). This disorder involves a maladaptive psychological response to traumatic, i.e. existence-threatening, events. Ressler et al. identified an association of a SNP in the gene coding for pituitary adenylate cyclase-activating polypeptide (PACAP), implicating this peptide and its receptor (PAC1) in PTSD.

# Interactions
Pituitary adenylate cyclase-activating peptide has been shown to interact with secretin receptor.
Premature Ventricular Contraction EKG Examples
For the main page on premature ventricular contraction, click here.

# EKG Examples
Shown below is an EKG showing premature ventricular contractions.
Copyleft image obtained courtesy of ECGpedia, :De-KJcasu17-1.jpg
Shown below is an EKG showing a Premature Ventricular Contractions.
Copyleft image obtained courtesy of ECGpedia, 
Shown below is an EKG showing a Premature Ventricular Contractions triggering ventricular flutter.
Copyleft image obtained courtesy of ECGpedia, 
Shown below is an EKG showing a sinus rhythm with ventricular bigemini.
Copyleft image obtained courtesy of ECGpedia, :E284.jpg
Shown below is an EKG showing a sinus rhythm with ventricular bigemini. Every sinus beat is followed by a ventricular extrasystoles.
Copyleft image obtained courtesy of ECGpedia, :Rhythm_bigemini.png
Shown below is an EKG image of premature ventricular contraction. The arrow indicates a ventricular extrasystole (VES).
Copyleft image obtained courtesy of ECGpedia, :Rhythm_ventricular_premature.png
Shown below is an EKG showing a trigeminal rhythm where wide complex beats are interpolated between normal QRS complexes. Note that there is PR prolongation after the wide complex beat. The wide complex beats are probably ventricular beats. As a rule interpolated wide beats are usually ventricular. In most cases the P wave after the PVC is not conducted and a compensatory pause is created instead of an interpolated beat.
Copyleft image obtained courtesy of ECGpedia, :E282.jpg
Shown below is an EKG showing a sinus rhythm with interpolated ventricular premature complexes. Wide complex beats interpolated between sinus complexes suggests strongly that they are ventricular in origin.
Copyleft image obtained courtesy of ECGpedia, :E000783.jpg
Sodium-hydrogen exchange regulatory cofactor 2
Sodium-hydrogen exchange regulatory cofactor NHE-RF2 (NHERF-2) also known as tyrosine kinase activator protein 1 (TKA-1) or SRY-interacting protein 1 (SIP-1) is a protein that in humans is encoded by the SLC9A3R2 (solute carrier family 9 isoform A3 regulatory factor 2) gene.
NHERF-2) is a scaffold protein that connects plasma membrane proteins with members of the ezrin/moesin/radixin family and thereby helps to link them to the actin cytoskeleton and to regulate their surface expression. It is necessary for cAMP-mediated phosphorylation and inhibition of SLC9A3. In addition, it may also act as scaffold protein in the nucleus.

# Function
This regulatory protein (factor) interacts with a sodium/hydrogen exchanger NHE3 (SLC9A3) in the brush border membrane of the proximal tubule, small intestine, and colon that plays a major role in transepithelial sodium absorption. SLC9A3R2, as well as SLC9A3R1 and protein kinase A phosphorylation, may play a role in NHE3 regulation.

# Interactions
Sodium-hydrogen exchange regulatory cofactor 2 has been shown to interact with SGK, Actinin alpha 4, Parathyroid hormone receptor 1, Phosphoinositide-dependent kinase-1, EZR, PODXL, Cystic fibrosis transmembrane conductance regulator and PLCB3.
Sandbox-ID-Gastrointestinal and Intraabdominal

# Gastrointestinal and Intraabdominal
- Tropical sprue
- Preferred regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND (Tetracycline 250 mg PO qid OR Doxycycline 100 mg PO qd for 46 weeks, up to 6 months in residents of the tropics who have had long-term disease)
- Alternative regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Ampicillin 500 mg bid for  4 weeks
-  Guerra, R.; Wheby, M. S.; Bayless, T. M. (1965-10). "Long-term antibiotic therapy in tropical sprue". Annals of Internal Medicine. 63 (4): 619634. ISSN 0003-4819. PMID 5838328. Check date values in: |date= (help).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}
-  Ferri, Fred (2015). Ferri's Clinical Advisor 2016 5 Books in 1. City: Elsevier Science Health Science. ISBN 978-0323280471.
Sinusitis resident survival guide (pediatrics)
Synonyms and keywords:

# Overview
Since inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa, the term "rhinosinusitis" is preferred to "sinusitis" which is defined as inflammation of the nasal cavity and paranasal sinuses. Infections in the respiratory tract  most commonly colds  can inflame and thicken in sinus membranes and block mucus drainage. These infections can be viral, bacterial, or fungal. Acute rhinosinusitis (ARS) is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks. Acute viral rhinosinusitis (AVRS) focuses on symptomatic management as it typically resolves within 7 to 10 days. Acute bacterial sinusitis is a complication of viral upper respiratory infection (URI) or allergic inflammation.  Acute sinusitis has been observed that between 6% and 7% of children seeking care for respiratory symptoms have an illness. The sinuses in the forehead don't start developing until kids are 9 or 12 years old and aren't formed enough to get infected until the early teen years for that, cold-related headaches in young kids usually aren't sinus infections. The most common bacteria that cause acute sinusitis include; Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis.

# Causes

## Common Causes
- A viral infection
- Bacterial infection
- Fungal infection
- Allergic sinusitis
- Nasal polyps
- Deviated nasal septum
- Immune system-related diseases can lead to nasal blockage
- A dental infection
- Aspirin sensitivity
- Prolonged intubation lead to nosocomial bacterial sinusitis
- Nose injury
- Foreign object in the nose
- Birth defect with an abnormality of the roof of the mouth (cleft palate)
- Problem with stomach acids (gastroesophageal reflux disease, or GERD)
- Cystic fibrosis and immunodeficiency syndromes
Immune problems or antibody deficiencies are risks for chronic sinus conditions

# Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of ] according the the  guidelines.

# Treatment
Shown below is an algorithm summarizing the treatment of ] according the the  guidelines.

# Do's
- The content in this section is in bullet points.

# Don'ts
- The content in this section is in bullet points.