Persius/hicric huggingface dataset:
Neomycin dosage and administration

# Dosage and Administration
To minimize the risk of toxicity use the lowest possible dose and the shortest possible treatment period to control the condition. Treatment for periods longer than two weeks is not recommended.

### Hepatic Coma
For use as an adjunct in the management of hepatic coma, the recommended dose is 4 to 12 grams per day given in the following regimen:
- Withdraw protein from diet. Avoid use of diuretic agents.
- Give supportive therapy including blood products, as indicated.
- Give NEO-FRADIN Oral Solution in doses of four to twelve grams of neomycin sulfate per day in divided doses.
- Treatment should be continued over a period of five to six days during which time protein should be returned incrementally to the diet.
- If less potentially toxic drugs cannot be used for chronic hepatic insufficiency, neomycin sulfate in doses of up to four grams daily may be necessary. The risks for the development of neomycin induced toxicity progressively increase when the treatment must be extended to preserve the life of a patient with hepatic encephalopathy who has failed to fully respond. Frequent periodic monitoring of these patients to ascertain the presence of drug toxicity is mandatory (see PRECAUTIONS). Also, neomycin serum concentrations should be monitored to avoid potentially toxic levels. The benefits to the patient should be weighed against the risks of nephrotoxicity, permanent ototoxicity and neuromuscular blockade following the accumulation of neomycin in the tissues.
Niacin/lovastatin clinical studies

# Clinical Studies
In a multi-center, randomized, double-blind, parallel, 28-week, active-comparator study in patients with Type IIa and IIb hyperlipidemia, ADVICOR was compared to each of its components (NIASPAN and lovastatin). Using a forced dose-escalation study design, patients received each dose for at least 4 weeks. Patients randomized to treatment with ADVICOR initially received 500 mg/20 mg. The dose was increased at 4-week intervals to a maximum of 1000 mg/20 mg in one-half of the patients and 2000 mg/40 mg in the other half. The NIASPAN monotherapy group underwent a similar titration from 500 mg to 2000 mg. The patients randomized to lovastatin monotherapy received 20 mg for 12 weeks titrated to 40 mg for up to 16 weeks. Up to a third of the patients randomized to ADVICOR or NIASPAN discontinued prior to Week 28. In this study, ADVICOR decreased LDL-C, TG and Lp(a), and increased HDL-C in a dose-dependent fashion (Tables 3, 4, 5 and 6 below). Results from this study for LDL-C mean percent change from baseline (the primary efficacy variable) showed that:
LDL-lowering with ADVICOR was significantly greater than that achieved with lovastatin 40 mg only after 28 weeks of titration to a dose of 2000 mg/40 mg (p<.0001)
ADVICOR at doses of 1000 mg/20 mg or higher achieved greater LDL-lowering than NIASPAN (p<.0001) The LDL-C results are summarized in Table 3.
ADVICOR achieved significantly greater HDL-raising compared to lovastatin and NIASPAN monotherapy at all doses (Table 4).
In addition, ADVICOR achieved significantly greater TG-lowering at doses of 1000 mg/20 mg or greater compared to lovastatin and NIASPAN monotherapy (Table 5).
The Lp(a) lowering effects of ADVICOR and NIASPAN were similar, and both were superior to lovastatin (Table 6). The independent effect of lowering Lp(a) with NIASPAN or ADVICOR on the risk of coronary and cardiovascular morbidity and mortality has not been determined.

## ADVICOR Long-Term Study
A total of 814 patients were enrolled in a long-term (52-week), open-label, single-arm study of ADVICOR. Patients were force dose-titrated to 2000 mg/40 mg over 16 weeks. After titration, patients were maintained on the maximum tolerated dose of ADVICOR for a total of 52 weeks. Five hundred-fifty (550) patients (68%) completed the study, and fifty-six percent (56%) of all patients were able to maintain a dose of 2000 mg/40 mg for the 52 weeks of treatment. The lipid-altering effects of ADVICOR peaked after 4 weeks on the maximum tolerated dose, and were maintained for the duration of treatment. These effects were comparable to what was observed in the double-blind study of ADVICOR (Tables 3-5).
Night terror (patient information)
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Phone:617-632-7753; Associate Editor-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

# Overview
Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state.

# What are the symptoms of Night terror?
- Night terrors are most common during the first third of the night, often between midnight and 2 a.m.
- Children often scream and are very frightened and confused. They thrash around violently and are often not aware of their surroundings.
- You may be unable to talk to, comfort, or fully wake up a child who is having a night terror.
- The child may be sweating, breathing very fast (hyperventilating), have a fast heart rate (palpitations), and widened (dilated) pupils.
- The spell may last 10 - 20 minutes, then the child goes back to sleep.
- Most children are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.
- Children with night terrors may also sleep walk.
- In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream when he or she wakes up, and will not be disoriented after the episode.

# What causes Night terror?
- The cause is unknown, but night terrors may be triggered by:
- Fever
- Lack of sleep
- Periods of emotional tension, stress, or conflict
- Night terrors are most common in boys ages 5 - 7, although they also can occur in girls. They are fairly common in children ages 3 - 7, and much less common after that.
- Night terrors may run in families. They can occur in adults, especially when there is emotional tension or the use of alcohol.

# When to seek urgent medical care?
Call for an appointment with your health care provider if:
- The night terrors occur often
- They disrupt sleep on a regular basis
- Other symptoms occur with the night terror
- The night terror causes, or almost causes, injuries

# Diagnosis
- In many cases, no further examination or testing is needed.
- If the night terror is severe or prolonged, the child may need a psychological evaluation.

# Treatment options
- In many cases, a child who has a night terror only needs to be comforted.
- Reducing stress or using coping mechanisms may reduce night terrors.
- Talk therapy or counseling may be needed in some cases.
- Benzodiazepine medicines (such as diazepam) used at bedtime will often reduce night terrors, but are rarely used to treat this disorder.

# Where to find medical care for Night terror?
Directions to Hospitals Treating Night terror

# What to expect (Outlook/Prognosis)?
- Most children outgrow night terrors in a short period of time.
- The number of episodes usually decreases after age 10.
- Rarely, children will have problems falling asleep or staying asleep.

# Prevention
Minimizing stress or using coping mechanisms may reduce night terrors. The number of episodes usually decreases after age 10.

# Source
Nitazoxanide clinical pharmacology

# Clinical Pharmacology
Absorption: Following oral administration of Alinia Tablets or Oral Suspension, maximum plasma concentrations of the active metabolites tizoxanide and tizoxanide glucuronide are observed within 1-4 hours. The parent nitazoxanide is not detected in plasma. Pharmacokinetic parameters of tizoxanide and tizoxanide glucuronide are shown in Tables 1 and 2below.
Alinia for Oral Suspension is not bioequivalent to Alinia Tablets. The relative bioavailability of the suspension compared to the tablet was 70%.
Effect of Food: When Alinia Tablets are administered with food, the AUCt of tizoxanide and tizoxanide glucuronide in plasma is increased almost two-fold and the Cmax is increased by almost 50%.
When Alinia for Oral Suspension was administered with food, the AUCt of tizoxanide and tizoxanide glucuronide increased by about 45-50% and the Cmax increased by 10%.
Alinia Tablets and for Oral Suspension were administered with food in clinical trials and hence they are recommended to be administered with food.
Multiple dosing: Following oral administration of a single Alinia Tablet every 12 hours for 7 consecutive days, there was no significant accumulation of nitazoxanide metabolites tizoxanide or tizoxanide glucuronide detected in plasma.
Distribution: In plasma, more than 99% of tizoxanide is bound to proteins.
Metabolism: Following oral administration in humans, nitazoxanide is rapidly hydrolyzed to an active metabolite, tizoxanide (desacetyl-nitazoxanide). Tizoxanide then undergoes conjugation, primarily by glucuronidation. In vitrometabolism studies have demonstrated that tizoxanide has no significant inhibitory effect on cytochrome P450 enzymes.
Elimination: Tizoxanide is excreted in the urine, bile and feces, and tizoxanide glucuronide is excreted in urine and bile. Approximately two-thirds of the oral dose of nitazoxanide is excreted in the feces and one-third in the urine.

## Special Populations
Patients with Impaired Hepatic and/or Renal Function: The pharmacokinetics of nitazoxanide in patients with impaired hepatic and/or renal function has not been studied.
Geriatric Patients: The pharmacokinetics of nitazoxanide in geriatric patients has not been studied.
Pediatric Patients: The pharmacokinetics of nitazoxanide following administration of Alinia Tablets in pediatric patients less than 12 years of age has not been studied. The pharmacokinetics of nitazoxanide following administration of Alinia for Oral Suspension in pediatric patients less than 1 year of age has not been studied.
Nocturnal angina pectoris overview
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# Overview
Nocturnal angina is the occurrence of anginal discomfort either during the initial few hours of sleep or during the early morning hours. It is speculated that discomfort caused during the first hour of sleep is due to increased venous return, whereas the discomfort caused during the early morning hours is due to increased vascular tone.

# Treatment

## Medical Therapy
The treatment of nocturnal angina pectoris is same as the chronic stable angina. If increased coronary vascular tone is felt to be the underlying mechanism, the calcium channel blockade may be of benefit.
Oncology Project Mission Statement

# WikiDoc Oncology Project  Mission Statement
- Thank you for your interest in the WikiDoc Oncology Project.
- The project aims to integrate current body of medical literature into treatment strategies for malignant diseases, in conformity with practice guidelines, consensus statements, systematic reviews, and expert opinions.
- Educational content provided herein is not intended to supplant but supplement clinical judgment.
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Opisthotonus (patient information)
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# Overview
Opisthotonos is a condition in which the body is held in an abnormal position. The person is usually rigid and arches the back, with the head thrown backward. If a person with opisthotonos lies on his or her back, only the back of the head and the heels touch the supporting surface.

# What causes Opisthotonus?
Opisthotonos may occur in infants with meningitis. It may also occur as a sign of reduced brain function or injury to the nervous system.
Other causes may include:
- Arnold-Chiari syndrome (a problem with the structure of the brain)
- Brain tumor
- Gaucher disease
- Growth hormone deficiency (occasionally)
- Glutaric aciduria and organic acidemias (forms of chemical poisoning)
- Krabbe Disease
- Seizures
- Severe electrolyte imbalance
- Severe head injury
- Stiff-person syndrome (a condition that makes a person rigid and have spasms)
- Subarachnoid hemorrhage (bleeding in the brain)
- Tetanus
Drugs such as phenothiazines and other antipsychotic medications, can cause a side effect called acute dystonic reaction. Opisthotonos may be part of this reaction.
In rare cases, infants born to women who drink large amounts of alcohol during pregnancy may have opisthotonus due to alcohol withdrawal.

# Who is at highest risk?
Opisthotonos is much more common in infants and children than in adults. It is also more exaggerated in infants and children because of their less mature nervous systems.

# When to seek urgent medical care?
Go to the emergency room or call your local emergency number (such as 911) if this symptom occurs. Typically opisthotonos is a symptom of other conditions that are serious enough for a person to seek medical attention.

# Diagnosis
This condition will be evaluated in a hospital, and emergency measures may be taken.
The health care provider will take a medical history and perform a physical examination to look for the cause of opisthotonos
Medical history questions may include:
- When did this behavior start?
- Is it always the same type of posturing?
- What other symptoms came before or with the abnormal posturing (such as fever, stiff neck, or headache)?
- Is there any recent history of illness?
The physical examination will include a complete check of the nervous system.
Tests may include:
- Blood and urine tests
- Cerebrospinal fluid (CSF) culture and cell counts
- CT scan of the head
- Electrolyte analysis
- Lumbar puncture (spinal tap)
- MRI of the brain

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

# Sources
Oxacillin sodium adverse reactions

# Adverse Reactions

### Body as a Whole
The reported incidence of allergic reactions to penicillin ranges from 0.7 to 10 percent (see WARNINGS). Sensitization is usually the result of treatment but some individuals have had immediate reactions when first treated. In such cases, it is thought that the patients may have had prior exposure to the drug via trace amounts present in milk and vaccines.  Two types of allergic reactions to penicillins are noted clinically, immediate and delayed.
Immediate reactions usually occur within 20 minutes of administration and range in severity from urticaria and pruritus to angioneurotic edema, laryngospasm, bronchospasm, hypotension, vascular collapse and death.  Such immediate anaphylactic reactions are very rare (see WARNINGS) and usually occur after parenteral therapy but have occurred in patients receiving oral therapy. Another type of immediate reaction, an accelerated reaction, may occur between 20 minutes and 48 hours after administration and may include urticaria, pruritus, and fever.  Although laryngeal edema, laryngospasm, and hypotension occasionally occur, fatality is uncommon.  Delayed allergic reactions to penicillin therapy usually occur after 48 hours and sometimes as late as 2 to 4 weeks after initiation of therapy.  Manifestations of this type of reaction include serum sickness-like symptoms (i.e., fever, malaise, urticaria, myalgia, arthralgia, abdominal pain) and various skin rashes. Nausea, vomiting, diarrhea, stomatitis, black or hairy tongue, and other symptoms of gastrointestinal irritation may occur, especially during oral penicillin therapy.

### Nervous System Reactions
Neurotoxic reactions similar to those observed with penicillin G may occur with large intravenous doses of oxacillin, especially with patients with renal insufficiency.

### Urogenital Reactions=
Renal tubular damage and interstitial nephritis have been associated infrequently with the administration of oxacillin.  Manifestations of this reaction may include rash, fever, eosinophilia, hematuria, proteinuria, and renal insufficiency.

### Gastrointestinal Reactions
Pseudomembranous colitis has been reported with the use of oxacillin.  The onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment (see WARNINGS).

### Metabolic Reactions
Hepatotoxicity, characterized by fever, nausea, and vomiting associated with abnormal liver function tests, mainly elevated SGOT levels, has been associated with the use of oxacillin.
PCI in patients with previous CABG

# Overview
Incidence of major adverse cardiovascular events is significantly higher among patients with previous history of CABG undergoing PCI of a saphenous vein graft compared to those with native coronary artery PCI. PCI of an saphenous vein graft is associated with a higher rate of distal debris embolization during PCI. Embolic protection devices are a group of devices designed and used to prevent distal embolization.

# 2021 ACA Revascularization Guideline
- Incidence of major adverse cardiovascular events is significantly higher among patients with previous history of CABG undergoing PCI of a saphenous vein graft compared to those with native coronary artery PCI. This significant difference is caused by a higher risk of procedural complications, including the no-reflow phenomenon and periprocedural MI.
- The risk of distal debris embolization during PCI is high in PCI of an saphenous vein graft Compared with PCI of native coronary arteries since atherosclerotic plaques in saphenous vein graft are more diffuse, with thinner, and more friable fibrous caps.

## Embolic Protection Devices
- Embolic protection devices are a group of devices designed and used to prevent distal embolization.
- Usage of these devices showed capability of significantly reducing the rate of major adverse cardiovascular events (such as cardiac death, stent thrombosis, and ischemia-driven target-vessel revascularization) in patients undergoing PCI of a saphenous vein graft.
- A study that compared different embolic protection devices showed that the FilterWire EX device is not inferior to the GuardWire.
TIMI thrombus grade 6 case studies

# Case Study 1
Shown below are an animated image and a static image depicting PERFUSE grade 6 thrombus in the RCA.  Encircled in yellow in the image on the right is the thrombus area where you can notice an abrupt blunt cut-off appearance beyond which no dye is penetrating the artery.
Shown below are an animated image and a static image of the same case depicting a collateral artery arising from the left system and supplying the right side of the heart.  The presence of a collateral artery is a sign that the previously noted thrombus in the RCA is a chronic thrombus.
Shown below are an animated image and a static image of the same previous case of PERFUSE grade 6 thrombus in the RCA following PCI.  Outlined in yellow in the image on the right is the path of the dye in the patent RCA following PCI.
Paroxysmal AV Block Based on Cause

# Overview
Based on the cause, paroxysmal AV block maybe classified into Intrinsic paroxysmal AV Block, Extrinsic Vagal paroxysmal AV block and Extrinsic Idiopathic paroxysmal AV Block.

# Classification
- Paroxysmal AV Block may be classified according to the cause into three types :
- Intrinsic AV Block (I-AVB)
- Extrinsic Vagal AV Block (EV- AVB)
- Extrinsic Idiopathic AV Block (EI- AVB) "Syncope and paroxysmal atrioventricular block - Aste - 2017 - Journal of Arrhythmia - Wiley Online Library"..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}
Penicillin G procaine how supplied

# How Supplied
Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) is supplied in packages of 10 disposable syringes as follows:
2 mL size, containing 1,200,000 units per syringe (21 gauge, thin-wall 1 inch needle for pediatric use), NDC 60793-601-10.
2 mL size, containing 1,200,000 units per syringe (21 gauge, thin-wall 1-1/2 inch needle), NDC 60793-600-10.
Store in a refrigerator, 2o to 8o (36o to 46oF).
Keep from freezing.
Persistent left inferior vena cava

# Overview
- A left inferior vena cava results from regression of the right supracardinal vein with persistence of the left supracardinal vein.
- The prevalence is 0.2%0.5%
- The major clinical significance of this anomaly is the potential for misdiagnoses as left sided paraaortic lymphadenopathy.
- Spontaneous rupture of an abdominal aortic aneurysm into a left inferior vena cava has been reported.
- Transjugular access to the infrarenal inferior vena cava for placement of an inferior vena cava filter may be difficult.
- Typically, the left inferior vena cava joins the left renal vein, which crosses anterior to the aorta in the normal fashion, uniting with the right renal vein to form a normal right sided prerenal inferior vena cava.  
- Image 1 - Duplication of inferior vena cava. This is a not uncommon variation. The left sided IVC (black arrow) most commonly ends in the normal left renal vein. Image 2 - Duplication of superior vena cava. This is a rare variation of the SVC. The left sided SVC (white arrow) is draining into the left atrium, thereby bypassing the pulmonary circulation. The right SVC is normal.   (Image courtesy of Dr Abhijit Datir)

# See Also
- Azygous continuation of the inferior vena cava
- Double inferior vena cava
- Persistent left superior vena cava