Persius/hicric huggingface dataset:
Quinupristin dalfopristin description

# Description
Synercid (quinupristin and dalfopristin powder for injection) I.V., a streptogramin antibacterial agent for intravenous administration, is a sterile lyophilized formulation of two semisynthetic pristinamycin derivatives, quinupristin (derived from pristinamycin I) and dalfopristin (derived from pristinamycin IIA) in the ratio of 30:70 (w/w).
Quinupristin is a white to very slightly yellow, hygroscopic powder. It is a combination of three peptide macrolactones. The main component of quinupristin (>88.0%) has the following chemical name: N--6-ethyldocosahydro-10,23-dimethyl-5,8,12,15,17,21,24-heptaoxo-13-phenyl-18- methyl]-12H-pyridopyrrolo- oxapentaazacyclononadecin-9-yl]-3-hydroxypicolinamide.
The main component of quinupristin has an empirical formula of C53H67N9O10S, a molecular weight of 1022.24 and the following structural formula:
Dalfopristin is a slightly yellow to yellow, hygroscopic, powder. The chemical name for dalfopristin is: (3R,4R,5E,10E,12E,14S,26R,26aS )-26-sulfonyl]-8,9,14,15,24,25,26,26a-octahydro-14-hydroxy-3-isopropyl-4,12-dimethyl-3H-21,18-nitrilo-1H,22H-pyrrolo-dioxadiazacyclotetracosine-1,7,16,22(4H,17H )-tetrone.
Dalfopristin has an empirical formula of C34H50N4O9S, a molecular weight of 690.85 and the following structural formula:
RNA-induced transcriptional silencing
RNA-induced transcriptional silencing (RITS) is a form of RNA interference by which short RNA molecules - microRNA (miRNA) or small interfering RNA (siRNA) - trigger the downregulation of transcription of a particular gene or genomic region. This is usually accomplished by modification of histones, often by methylation, or by the induction of heterochromatin formation. The protein complex that binds the miRNA and interacts with histones and DNA is known as the RITS complex.
RITS has been studied extensively in the fission yeast S. pombe, particularly the induction and spreading of heterochromatin in the mating-type region and in centromere formation. The RITS complex in S. pombe contains at least a piwi domain-containing RNase H-like argonaute, a chromodomain protein Chp1, and a protein called Tas3 of unknown function, while heterochromatin formation has been shown to require at least argonaute and an RNA-dependent RNA polymerase. Loss of these genes in S. pombe results in abnormal heterochromatin organization and formation of the chromosome centromeres, resulting in slow or stalled anaphase during cell division.
The maintenance of heterochromatin regions by RITS complexes has been described as a self-reinforcing feedback loop, in which RITS complexes stably bind the methylated histones of a heterochromatin region and induce co-transcriptional degradation of any nascent messenger RNA (mRNA) transcripts, which are then used as RNA-dependent RNA polymerase substrates to replenish the complement of siRNA molecules. Heterochromatin formation, but possibly not maintenance, is dependent on the ribonuclease protein dicer, which is used to generate the initial complement of siRNAs.
The relevance of observations from fission yeast mating-type regions and centromeres to mammals is not clear, as some evidence suggests that heterochromatin maintenance in mammalian cells is independent of the components of the RNAi pathway.
Raltegravir dosage and administration

# Dosage And Administration

## General Dosing Recommendations
ISENTRESS Film-Coated Tablets and Chewable Tablets can be administered with or without food .
Maximum dose of chewable tablets is 300 mg twice daily.
ISENTRESS Chewable Tablets may be chewed or swallowed whole.
ISENTRESS Film-Coated Tablets must be swallowed whole.
Because the formulations are not bioequivalent, do not substitute chewable tablets for the 400 mg film-coated tablet.
During coadministration of ISENTRESS 400 mg film-coated tablets with rifampin, the recommended dosage of ISENTRESS is 800 mg twice daily in adults. There are no data to guide co-administration of ISENTRESS with rifampin in patients below 18 years of age .

### Adults
For the treatment of adult patients with HIV-1 infection, the dosage of ISENTRESS is one 400 mg film-coated tablet administered orally, twice daily.

### Pediatrics
For the treatment of children and adolescents with HIV-1 infection, the dosage of ISENTRESS is as follows:
12 years of age and older: One 400 mg film-coated tablet orally, twice daily
6 to less than 12 years of age:
If at least 25 kg in weight:
One 400 mg film-coated tablet orally, twice daily OR
Chewable tablets: weight based to maximum dose 300 mg, twice daily as specified in Table 1
If less than 25 kg in weight:
Chewable tablets: weight based to maximum dose 300 mg, twice daily as specified in Table 1
2 to less than 6 years of age:
If at least 10 kg in weight:
Chewable tablets: weight based to maximum dose 300 mg, twice daily as specified in Table 1

## Dosage Forms And Strengths
Film-coated Tablets
400 mg pink, oval-shaped, film-coated tablets with "227" on one side.
Chewable Tablets
100 mg pale orange, oval-shaped, orange-banana flavored, chewable tablets scored on both sides and imprinted on one face with the Merck logo and "477" on opposite sides of the score.
25 mg pale yellow, round, orange-banana flavored, chewable tablets with the Merck logo on one side and "473" on the other side.
Retroperitoneal Lymph Node Dissection

# Overview
Retroperitoneal Lymph Node Dissection, commonly referred to as RPLND, is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type.  It is usually performed using an incision that extends from the sternum to several inches below the navel. While laparoscopic methods may be used, they have been considered less effective by some surgeons.
Testicular cancer spreads in a well-known pattern, and the lymph nodes in the retroperitoneum are a primary landing site during spread of the disease. Examining the removed lymphatic tissue will determine the extent of spread of any malignant disease and if no malignant tissue is found, the cancer may be more accurately considered as a stage I cancer, limited to the testis.
The procedure is becoming standard treatment for clinical stage I and II non-seminomatous germ cell tumors (NSGCTT) because of the low mortality and relapse rate with this procedure, as compared with the alternative, which is observation. Also, NSGCTT is considered more aggressive than seminomas, the "other" kind of testicular cancer.  Seminomas are also much more sensitive to radiation than NSGCTT's, so the noninvasive radiation treatment is often preferred over RPLND.
The potential problems in RPLND have mostly to do with nerves: sympathetic nerves running parallel to the spinal cord may be damaged or severed during the procedure, which can result in infertility, an inability to ejaculate, or the inability to have an erection. This is why most often, a nerve-sparing technique is used where possible. A less invasive form using laparoscopic techniques (L-RPLND) exists, which is more costly, time-consuming, and requires special equipment that not every hospital may have. Open RPLND (O-RPLND), which is performed by opening the abdomen to get inside, has more room for problems, but is an equally effective way to remove the lymph nodes. Disadvantages of an open RPLND include longer recovery time, sometimes with physiotherapy required to help the patient regain the ability to walk after being bed-bound.  As with any major surgery, infection is a possibility, and bowel obstructions and adhesions are another possible side effect.
There are different schools of thought about the need to perform RPLND after orchiectomy, and it depends on the type of tumour, and what stage it is in. Most American Doctors recommend surgery, whereas in Europe, chemotherapy is more often used. An RPLND may be performed to remove non-malignant tumour remnants which persist after chemotherapy; without further treatment these may once more become malignant, and may be resistant to the combination of chemotherapy previously used.
Chemotherapy before RPLND is considered an effective approach, because it is possible that it suffices and no relapse occurs. However, in the event that the cancer does recur, chemotherapy can complicate surgery.
Rifapentine dosage and administration

# Dosage And Administration

## Dosage
Rifapentine has been studied for the treatment of tuberculosis caused by drug-susceptible organisms as part of regimens consisting of an initial 2 month phase followed by a 4 month continuation phase.
These recommendations apply only to the treatment of patients with drug-susceptible organisms.

### Initial Phase (2 Months) of short course treatment for pulmonary tuberculosis
Rifapentine should be administered at a dose of 600 mg (4  150 mg tablets) twice weekly for two months by direct observation of therapy, with an interval of no less than 3 consecutive days (72 hours) between doses, in combination with other antituberculosis drugs as part of an appropriate regimen which includes daily companion drugs such as ethambutol, pyrazinamide, and streptomycin.
The determination of the companion drugs to be used should be made by the treating physician and depends on the results of susceptibility testing as well as the phase of treatment. Rifapentine has been studied as part of the initial regimen with isoniazid, pyrazinamide and ethambutol .

### Continuation Phase (4 Months) of short course treatment for pulmonary tuberculosis
Following the Initial Phase (2 months), Continuation Phase (4 months) treatment may consist of Rifapentine 600 mg once weekly for 4 months in combination with isoniazid or an appropriate antituberculosis agent for susceptible organisms by direct observation therapy.
Rifapentine was studied as a component of a 4 month continuation phase in conjunction with INH 900 mg once a week in two clinical studies .
The prescribing physician is directed to current guidelines for further direction on other possible components of the Continuation Phase regimen as well as for directions on extending this phase.

# Administration
Take Rifapentine with meals. Administration of rifapentine with a meal increases oral bioavailability and may reduce the incidence of gastrointestinal upset, nausea, and/or vomiting. .
In patients with conditions which predispose them to neuropathy (e.g., nutritional deficiency, HIV infection, renal failure, alcoholism, as well as pregnant and breastfeeding women), concomitant administration of pyridoxine (Vitamin B6) is recommended in order to avoid INH-associated peripheral neuropathy (see American Thoracic Society/Centers for Disease Control/Infectious Disease Society of America Guideline for the Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children).

# Dosage Forms And Strengths
Rifapentine is supplied as 150 mg round normal convex dark-pink film-coated tablets debossed "Rifapentine" on top and "150" on the bottom.
Rimantadine dosage and administration

# Dosage And Administration

## FOR PROPHYLAXIS IN ADULTS AND CHILDREN
Adults: The recommended adult dose of Flumadine is 100 mg twice a day. In patients with severe hepatic dysfunction, renal failure (CrCI 10 mL/min.) and elderly nursing home patients, a dose reduction to 100 mg daily is recommended. There are currently no data available regarding the safety of rimantadine during multiple dosing in subjects with renal or hepatic impairment. Because of the potential for accumulation of rimantadine metabolites during multiple dosing, patients with any degree of renal insufficiency should be monitored for adverse effects, with dosage adjustments being made as necessary.

## Children
In children less than 10 years of age, Flumadine should be administered once a day, at a dose of 5 mg/kg but not exceeding 150 mg. For children 10 years of age or older, use the adult dose.

## FOR TREATMENT IN ADULTS
The recommended adult dose of Flumadine is 100 mg twice a day. In patients with severe hepatic dysfunction, renal failure (CrCI 10 mL/min) and elderly nursing home patients, a dose reduction to 100 mg daily is recommended. There are currently no data available regarding the safety of rimantadine during multiple dosing in subjects with renal or hepatic impairment. Because of the potential for accumulation of rimantadine metabolites during multiple dosing, patients with any degree of renal insufficiency should be monitored for adverse effects, with dosage adjustments being made as necessary. Flumadine therapy should be initiated as soon as possible, preferably within 48 hours after onset of signs and symptoms of influenza A infection. Therapy should be continued for approximately seven days from the initial onset of symptoms.
Rizatriptan dosage and administration

# Dosage and Administration

### 2.1	Dosing Information in Adults
The recommended starting dose of MAXALT is either 5 mg or 10 mg for the acute treatment of migraines in adults. The 10-mg dose may provide a greater effect than the 5-mg dose, but may have a greater risk of adverse reactions .

### Redosing in Adults
Although the effectiveness of a second dose or subsequent doses has not been established in placebo-controlled trials, if the migraine headache returns, a second dose may be administered 2 hours after the first dose. The maximum daily dose should not exceed 30 mg in any 24-hour period. The safety of treating, on average, more than four headaches in a 30-day period has not been established.

### 2.2 Dosing Information in Pediatric Patients (Age 6 to 17 Years)
Dosing in pediatric patients is based on the patient's body weight. The recommended dose of MAXALT is 5 mg in patients weighing less than 40 kg (88 lb), and 10 mg in patients weighing 40 kg (88 lb) or more.
The efficacy and safety of treatment with more than one dose of MAXALT within 24 hours in pediatric patients 6 to 17 years of age have not been established.

### 2.3 Administration of MAXALT-MLT Orally Disintegrating Tablets
For MAXALT-MLT Orally Disintegrating Tablets, administration with liquid is not necessary. Orally disintegrating tablets are packaged in a blister within an outer aluminum pouch and patients should not remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with the saliva.

### 2.4 Dosage Adjustment for Patients on Propranolol

### Adult Patients
In adult patients taking propranolol, only the 5-mg dose of MAXALT is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg) .

### Pediatric Patients
For pediatric patients weighing 40 kg (88 lb) or more, taking propranolol, only a single 5-mg dose of MAXALT is recommended (maximum dose of 5 mg in a 24-hour period). MAXALT should not be prescribed to propranolol-treated pediatric patients who weigh less than 40 kg (88 lb) .
Sandbox:epidemiology and demographics

# Overview

# Epidemiology and Demographics

## Incidence
- The incidence/prevalence of  is approximately  per 100,000 individuals worldwide.
- In , the incidence/prevalence of  was estimated to be  cases per 100,000 individuals worldwide.

## Prevalence
- The incidence/prevalence of  is approximately  per 100,000 individuals worldwide.
- In , the incidence/prevalence of  was estimated to be  cases per 100,000 individuals worldwide.
- The prevalence of  is estimated to be  cases annually.

## Case-fatality rate
- In , the incidence of  is approximately  per 100,000 individuals with a case-fatality rate of %.
- The case-fatality rate of  is approximately .

## Age
- Age:
Patients of all age groups may develop .
The incidence of  increases with age; the median age at diagnosis is  years.
 commonly affects individuals younger than/older than  years of age.
 is usually first diagnosed among .
 commonly affects .
- Patients of all age groups may develop .
- The incidence of  increases with age; the median age at diagnosis is  years.
-  commonly affects individuals younger than/older than  years of age.
-  is usually first diagnosed among .
-  commonly affects .

## Race
- Race:
There is no racial predilection to .
 usually affects individuals of the  race.  individuals are less likely to develop .
- There is no racial predilection to .
-  usually affects individuals of the  race.  individuals are less likely to develop .

## Gender
- Gender:
 affects men and women equally.
 are more commonly affected by  than . The  to  ratio is approximately  to 1.
-  affects men and women equally.
-  are more commonly affected by  than . The  to  ratio is approximately  to 1.

## Region
- The majority of  cases are reported in .
-  is a common/rare disease that tends to affect  and .

## Developed Countries

## Developing Countries
Sandbox:septic arthritis pathogenesis

# Pathophysiology
Presence of extreme vasularity and absence of limiting of basement membrane, promotes the easy access of infections into the synovial space.
Hematogenous spread: Septic arthritis most commonly develop as a result of hematogenous spreading bacteria into the vascular synovial membrane. Hematogenous spread is commonly associate with injection drug use, presence of indwelling catheters, and an underlying immunocompromised state such as HIV infection.
Direct inoculation: Direct inoculation of microorganisms may occur during deep penetrating injuries, intra-articular steroid injection, arthroscopy or prosthetic joint surgery, particularly in association with knee and hip arthroplasties and contiguous osteomyelitis rupturing into the joint.
Bone infection such as osteomyelitis can spread by breaking through its outer cortex and then into the intracapsular region that lead to joint infection. This kind of spread is more common in children as the small capillaries can cross the epiphyseal growth plate and permit extension of infection into the epiphysis and joint space.
Pathogenesis of septic arthritis depends on multiple factors and it mainly depends on the balance between virulence of the microbial pathogen and the host immune response against the pathogen.

## Non-gonococcal arthritis
Staph. aureus is the most common pathogen non gonococcal pathogen that causes septic arthritis. The pathogenesis of septic arthritis by staphylococcus can be a better representation for pathogenesis of most non gonococcal arthritis.
Bacterial colonization and adherence into the synovium
Mechanism of infection transmission
Hematogenous spread: Septic arthritis most commonly develop as a result of hematogenous spreading bacteria into the vascular synovial membrane. Hematogenous spread is commonly associate with injection drug use, presence of indwelling catheters, and an underlying immunocompromised state such as HIV infection.
Determinants of hematognous seeding:
- Well vascularized synovium
- Absence of limiting basement membrne
- Recent joint surgery, induces the production of host-derived extracellular matrix proteins( e.g. collagen)  that aids in post surgical healing process, can assist bacterial attachment and progression to infection
- Virulence of microorganism
- Susceptibility of synovial membrane for microorganism
Direct inoculation: Direct inoculation of microorganisms may occur during deep penetrating injuries, intra-articular steroid injection, arthroscopy or prosthetic joint surgery, particularly in association with knee and hip arthroplasties.
Contiguous spread: Bone infection such as osteomyelitis can spread by breaking through its outer cortex and then into the intracapsular region that lead to joint infection.
Role of bacterial products in pathogenesis

## Non-gonococcal arthritis
Sebaceous cysts (patient information)
For the WikiDoc page for this topic, click here

# Overview
A sebaceous cyst is a closed sac under the skin filled with a cheese-like or oily material.
See also:
- Carbuncle
- Cyst
- Furuncle

# What are the symptoms of Sebaceous cysts?
The main symptom is usually a small, non-painful lump beneath the skin.
If the lump becomes infected or inflammed, other symptoms may include:
- Skin redness
- Tender or sore skin
- Warm skin in the affected area
Grayish-white, cheesy, foul-smelling material may drain from the cyst.

# What causes Sebaceous cysts?
Sebaceous cysts most often arise from swollen hair follicles.  Skin trauma can also induce a cyst to form.  A sac of cells is created into which a protein called keratin is secreted.
These cysts are usually found on the face, neck, and trunk.  They are usually slow- growing, painless, freely movable lumps beneath the skin.  Occasionally, however, a cyst will become inflamed and tender.

# Diagnosis
In most cases, your doctor can diagnose this type of cyst by simply examining your skin. Occasionally, a biopsy may be needed to rule out other conditions.

# When to seek urgent medical care?
Call your health care provider if you notice any new growths on your body. Although cysts are not dangerous, your doctor should examine you for signs of skin cancer.

# Treatment options
Sebaceous cysts are not dangerous and can usually be ignored. Placing a warm moist cloth (compress) over the area may help the cyst drain and heal.
- If you have a small inflamed cyst, your doctor may inject it with a steroid medicine that reduces swelling.
- If the cyst becomes swollen, tender, or large, your doctor may drain it or perform surgery to remove it.

# Where to find medical care for Sebaceous cysts?
Directions to Hospitals Treating Sebaceous cysts

# What to expect (Outlook/Prognosis)?
Large, painful cysts may interfere with day-to-day life.

# Possible complications
- These cysts may occasionally become infected and form painful abscesses.
- The cysts may return after they are surgically removed.

# Sources
Serrate RNA effector molecule homolog
Serrate RNA effector molecule homolog (SRRT) also known as arsenite-resistance protein 2 (ARS2) is a protein that in humans is encoded by the SRRT gene.
The SRRT gene product plays a role in RNA-mediated gene silencing (RNAi) by miRNAs. Independently of its activity on miRNAs, it is necessary and sufficient to promote neural stem cell self-renewal, by directly binding the SOX2 promoter and positively regulating its transcription.
It does not directly confer arsenite resistance but rather modulates arsenic sensitivity. Diseases associated with SRRT include spondylocostal dysostosis.
Silver sulfadiazine adverse reactions

# Adverse Reactions
Several cases of transient leucopenia have been reported in patients receiving silver sulfadiazine therapy. Leucopenia associated with silver sulfadiazine administration is primarily characterized by decreased neutrophil count.  Maximal white blood cell depression occurs within two to four days of initiation of therapy.  Rebound to normal leukocyte levels follows onset within two to three days.  Recovery is not influenced by continuation of silver sulfadiazine therapy.  The incidence of leucopenia in various reports averages about 20%.  A higher incidence has been seen in patients treated concurrently with cimetidine.
Other infrequently occurring events include skin necrosis, erythema multiforme, skin discoloration, burning sensation, rashes, and interstitial nephritis.  Reduction in bacterial growth after application of topical antibacterial agents has been reported to permit spontaneous healing of deep partial-thickness burns by preventing conversion of the partial thickness to full thickness by sepsis.  However, reduction in bacterial colonization has caused delayed separation, in some cases necessitating escharotomy in order to prevent contracture.
Absorption of silver sulfadiazine varies depending upon the percent of body surface area and the extent of the tissue damage.  Although few have been reported, it is possible that any adverse reaction associated with sulfonamides may occur.  Some of the reactions which have been associated with sulfonamides are as follows: blood dyscrasias, including agranulocytosis, aplastic anemia, thrombocytopenia, leucopenia, hemolytic anemia; dermatologic and allergic reactions, Stevens-Johnson syndrome and exfoliative dermatitis; gastrointestinal reactions; hepatitis and hepatocellular necrosis; CNS reactions; and toxic nephrosis.