Persius/hicric huggingface dataset:
Norovirus diagnostic study of choice

# Overview

# Diagnostic Study of Choice

## Study of choice
 is the gold standard test for the diagnosis of .
OR
The following result of  is confirmatory of :
OR
 must be performed when:
- The patient presents with , , and .
- A  is positive for , , and  in the patient.
OR
 is the gold standard test for the diagnosis of .
OR
The diagnostic study of choice for  is .
OR
There is no single diagnostic study of choice for the diagnosis of .
OR
There is no single diagnostic study of choice for the diagnosis of , but  can be diagnosed based on  and .
OR
 is primarily diagnosed based on the clinical presentation.
OR
Investigations:
- Among the patients who present with clinical signs of , the  is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of , the  is the most sensitive test for diagnosis.
- Among the patients who present with clinical signs of , the  is the most efficient test for diagnosis.

### The comparison of various diagnostic studies for 
 is the preferred investigation based on the sensitivity and specificity
The following finding(s) on performing  is(are) confirmatory for :
The  must be performed when:
- The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
- A positive  is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:

## Name of Diagnostic Criteria
It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
 is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of .
OR
There is no single diagnostic study of choice for , though  may be diagnosed based on  established by .
OR
The diagnosis of  is made when at least  of the following  diagnostic criteria are met: , , , and .
OR
The diagnosis of  is based on the  criteria, which includes , , and .
OR
 may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
OR
IF there are clear, established diagnostic criteria
The diagnosis of  is made when at least  of the following  diagnostic criteria are met: , , , and .
OR
The diagnosis of  is based on the  criteria, which include , , and .
OR
The diagnosis of  is based on the  definition, which includes , , and .
OR
IF there are no established diagnostic criteria
There are no established criteria for the diagnosis of .
Nucleic acid amplification technique

# Overview
Nucleic acid amplification techniques (NAAT) are biochemistry and molecular biology methods that involve the in-vitro synthesis of many copies of DNA or RNA from one original template.

# Types of Nucleic Acid Amplification Techniques (NAAT)

## Ligase chain reaction
A ligase chain reaction is a DNA amplification technique based upon the ligation of oligonucleotide probes. The probes are designed to exactly match two adjacent sequences of a specific target DNA. The chain reaction is repeated in three steps in the presence of excess probe:
- Heat denaturation of double-stranded DNA
- Annealing of probes to target DNA
- Joining of the probes by thermostable DNA ligase
After the reaction is repeated for 20-30 cycles, the production of ligated probe is measured.

## Polymerase chain reaction
Polymerase chain reaction (PCR) is an in vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include:
- Thermal denaturation of the double-stranded target molecules
- Annealing of the primers to their complementary sequences
- Extension of the annealed primers by enzymatic synthesis with DNA polymerase
The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships.

## Self-sustained sequence replication
Self-sustained sequence replication is an isothermal in-vitro nucleotide amplification process. The process involves the concomitant action of an RNA-directed DNA polymerase, ribonuclease(s), and DNA-directed RNA polymerases to synthesize large quantities of sequence-specific RNA and DNA molecules.
Ondine's curse (patient information)
For the WikiDoc page for this topic, click here
Synonyms and Keywords: Congenital central hypoventilation syndrome; CCHS; Primary alveolar hypoventilation

# Overview
Primary alveolar hypoventilation is a rare disorder of unknown cause in which a person does not take enough breaths per minute. The lungs and airways are normal.

# What are the symptoms of Ondine's curse?
- Symptoms are usually worse during sleep, and periods of apnea (episodes of stopped breathing) are usually present.
- Often patients themselves do not complain of shortness of breath during the day.
- Symptoms include:
- Bluish coloration of the skin caused by lack of oxygen
- Daytime drowsiness
- Fatigue
- Lethargy
- Morning headaches
- Swelling of the ankles
- Waking up from sleep unrested
- Waking up many times at night
- Persons with this disease are extremely sensitive to even small doses of sedatives or narcotics, which can make their already inadequate breathing much worse.

# What causes Ondine's curse?
- Normally, when the oxygen levels in the blood are low or the carbon dioxide levels are high, there is a signal from the brain to breathe more deeply or more quickly. In people with primary alveolar hypoventilation, this change in breathing does not happen.
- The cause of primary alveolar hypoventilation is unknown. Some patients have a specific genetic defect.
- The disease mainly affects men 20 to 50 years old, although it may also occur in young boys.

# When to seek urgent medical care?
- Call for an appointment with your health care provider if symptoms of this disorder develop.
- Seek urgent medical care if bluish skin (cyanosis) occurs.

# Diagnosis
- The health care provider will perform a physical exam.
- Tests will be done to rule out other causes. For example, muscular dystrophy can make the rib muscles weak, and emphysema damages the lung tissue itself.
- A small stroke can affect the breathing center in the brain.
- Tests that may be done include:
- Blood gases
- Chest x-ray
- Hematocrit and hemoglobin blood tests
- Lung function tests
- Overnight oxygen level measurements (oximetry)
- Serum bicarbonate
- Sleep study (polysomnography)

# Treatment options
- Medications that stimulate the respiratory system may be used but do not always work.
- Mechanical devices that assist breathing, particularly at night, may be helpful in some patients.
- Oxygen therapy may be helpful in a few patients, but may cause worse night symptoms in others.

# Where to find medical care for Ondine's curse?
Directions to Hospitals Treating Ondine's curse

# What to expect (Outlook/Prognosis)?
Response to treatment varies.

# Possible complications
The low blood oxygen level can cause high blood pressure in the lung blood vessels. This can lead to cor pulmonale (right-sided heart failure).

# Prevention
- There is no known prevention.
- Patients should avoid using sleeping medications or other medications that may cause drowsiness.

# Source
Oseltamivir warnings and precautions

# Warnings And Precautions

## Serious Skin/Hypersensitivity Reactions
Cases of anaphylaxis and serious skin reactions including toxic epidermal necrolysis, Stevens-Johnson Syndrome, and erythema multiforme have been reported in postmarketing experience with TAMIFLU. TAMIFLU should be stopped and appropriate treatment instituted if an allergic-like reaction occurs or is suspected.

## Neuropsychiatric Events
influenza can be associated with a variety of neurologic and behavioral symptoms that can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease.
There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving TAMIFLU. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on TAMIFLU usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution. The contribution of TAMIFLU to these events has not been established. Closely monitor patients with influenza for signs of abnor d mal behavior. If neuropsychiatric symptoms occur, evaluate the risks and benefits of continuing treatment for each patient.

## Bacterial Infections
Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. TAMIFLU has not been shown to prevent such complications.

## Limitations of Populations Studied
Efficacy of TAMIFLU in the treatment of influenza in patients with chronic cardiac disease and/or respiratory disease has not been established. No difference in the incidence of complications was observed between the treatment and placebo groups in this population. No information is available regarding treatment of influenza in patients with any medical condition sufficiently severe or unstable to be considered at imminent risk of requiring hospitalization.
Efficacy of TAMIFLU for treatment or prophylaxis of influenza has not been established in immunocompromised patients.
Safety and efficacy of TAMIFLU for treatment of influenza in pediatric patients less than 2 weeks of age have not been established. Safety and efficacy of TAMIFLU for prophylaxis of influenza have not been established for pediatric patients less than 1 year of age.
Posterior inferior cerebellar artery

# Overview
The posterior inferior cerebellar artery (PICA), the largest branch of the vertebral, is one of the three main  arterial blood supplies for the cerebellum.

# Course
It winds backward around the upper part of the medulla oblongata, passing between the origins of the vagus and accessory nerves, over the inferior peduncle to the under surface of the cerebellum, where it divides into two branches.
The medial branch is continued backward to the notch between the two hemispheres of the cerebellum; while the lateral supplies the under surface of the cerebellum, as far as its lateral border, where it anastomoses with the anterior inferior cerebellar and the superior cerebellar branches of the basilar artery.
Branches from this artery supply the choroid plexus of the fourth ventricle.

# Diseases
Infarction of this artery due to thrombosis or stroke leads to PICA syndrome, a  neurological disease with characteristic, stereotyped symptoms.

# Additional images
Plaque reduction neutralization test

# Overview
The Plaque reduction neutralization test is used to quantify the titre of neutralising antibody for a virus.
The serum sample or solution of antibody to be tested is diluted and mixed with a viral suspension. This is incubated to allow the antibody to react with the virus. This is poured over a confluent monolayer of host cells. The surface of the cell layer is covered in a layer of agar or carboxymethyl cellulose to prevent the virus from spreading indiscriminately. The concentration of plaque forming units can be estimated by the number of plaques  (regions of infected cells) formed after a few days. Depending on the virus, the plaque forming units are measured by microscopic observation, fluorescent antibodies or specific dyes that react with infected cells.
The concentration of serum to reduce the number of plaques by 50% compared to the serum free virus gives the measure of how much antibody is present or how effective it is. This measurement is denoted as the PRNT50 value.
Currently it is considered to be the "gold standard" for detecting and measuring antibodies that can neutralise the viruses that cause many diseases. It has a higher sensitivity than other tests like hemagglutination and many commercial Enzyme immunoassay without compromising specificity.
However, the test is relatively cumbersome and time intensive (few days) relative to EIA kits that give quick results (usually several minutes to a
few hours).
An issue with this assay that has recently been identified is that the neutralization ability of the antibodies is dependent on the virion maturation state and the cell-type used in the assay . Therefore, if the wrong cell line is used for the assay it may seem that the antibodies have neutralization ability when they actually do not, or vice versa they may seem ineffective when they actually possess neutralization ability.

# See Also
- ELISA
Palivizumab warnings and precautions

# Warnings And Precautions

## Hypersensitivity Reactions
Cases of anaphylaxis and anaphylactic shock, including fatal cases, have been reported following initial exposure or re-exposure to Synagis. Other acute hypersensitivity reactions, which may be severe, have also been reported on initial exposure or re-exposure to Synagis. Signs and symptoms may include urticaria, pruritus, angioedema, dyspnea, respiratory failure, cyanosis, hypotonia, hypotension, and unresponsiveness. The relationship between these reactions and the development of antibodies to Synagis is unknown. If a significant hypersensitivity reaction occurs with Synagis, its use should be permanently discontinued. If anaphylaxis or other significant hypersensitivity reaction occurs, administer appropriate medications (e.g., epinephrine) and provide supportive care as required. If a mild hypersensitivity reaction occurs, clinical judgment should be used regarding cautious readministration of Synagis.

## Coagulation Disorders
Synagis is for intramuscular use only. As with any intramuscular injection, Synagis should be given with caution to children with thrombocytopenia or any coagulation disorder.

## ] Diagnostic Test Interference
Palivizumab may interfere with immunological-based ] diagnostic tests such as some antigen detection-based assays. In addition, palivizumab inhibits virus replication in cell culture, and therefore may also interfere with viral culture assays. Palivizumab does not interfere with reverse transcriptase-polymerase chain reaction based assays. Assay interference could lead to false-negative ] diagnostic test results. Therefore, diagnostic test results, when obtained, should be used in conjunction with clinical findings to guide medical decisions .

## Treatment of ] Disease
The safety and efficacy of Synagis have not been established for treatment of ] disease.

## Proper Administration
The single-dose vial of Synagis does not contain a preservative. Administration of Synagis should occur immediately after dose withdrawal from the vial. The vial should not be re-entered. Discard any unused portion.
Pancytopenia resident survival guide
Synonyms and keywords: Approach to pancytopenia, Pancytopenia management, Pancytopenia work-up

# Overview
Pancytopenia is described as a decrease in the 3 cell lines which are red blood cells, white blood cells, and platelets. Clinically, pancytopenia is defined as hemoglobin< 9gm, white blood cell count< 4,000/cm and platelets < 100,000/cmm.  It can be due to decreased production in the bone marrow or increased destruction of cells in the periphery. Pancytopenia can also be caused due to drugs such as chemotherapy agents. Treatment involves identifying the underlying cause and appropriate therapy.

# Causes

## Decreased production of cells
- Aplastic anemia
- Myelodysplasia
- Myelofibrosis
- Diamond-Blackfan syndrome
- Fanconi's anemia
- Leukemia

## Increased peripheral destruction
- Splenomegaly
- Hypersplenism

## Other causes
- Chemotherapy
- Parvovirus B-19 infection
- Autoimmune conditions
- Human immunodeficiency virus infection
- Tuberculosis
- Lymphoma
For a full list of pancytopenia causes, click here.

# Diagnosis
Diagnosis of pancytopenia is outlined in the algorithm below in accordance with the approach to pancytopenia: Diagnostic algorithm for clinical hematologists published in Blood Reviews,2018 and Pancytopenia: A Clinico Hematological study published in the Journal of Laboratory Physicians in 2011. 
Abbreviations:  RBC- Red blood cell, WBC-White blood cell,  HIV- Human Immunodeficiency Virus, LD body- Leishman-Donovan body, PCR- Polymerase chain reaction

# Treatment
Treatment of pancytopenia is outlined in the algorithm below.
Abbreviations: LDH- Lactate dehydrogenase, RBC- Red blood cell, G-CSF - Granulocyte colony stimulating factor, CNS- Central nervous system, ATG- Anti-thymocyte globulin, HIV- Human Immunodeficiency Virus, ART- Anti Retroviral Therapy

# Dos
- Screen for infections like hepatitis, HIV, Parvovirus-B19, Epstein Barr virus, etc.
- Periodic, regular blood tests must be done for patients on methotrexate or other marrow suppressing drugs.
- Patients with malignancies such as leukemia, lymphoma, myelodysplastic syndrome, etc. should be informed about the risk of pancytopenia.

# Dont's
- Don't prescribe aspirin or NSAIDs, or any other drugs that may precipitate bleeding in patients with pancytopenia.
- Don't wait for culture and sensitivity reports in case of neutropenic fever or sepsis in pancytopenic patients. Prompt treatment with broad-spectrum antibiotics is key.
- Don't progress to treatment without correcting underlying nutritional deficiencies such as Vitamin B12 or folate deficiency.
Paroxysmal AV Block echocardiography

# Overview
Echocardiography has a highler yield where diagnosing syncope and presyncope is concerned, in patients with structural heart disease.

# Echocardiography

## 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Cardiac Imaging
- Echocardiography has a highler yield where diagnosing syncope and presyncope in patients with structural heart disease.
- Thransthroacic/ Transesophagal echocardiography may highlight endocarditis with or without perivalvular complications, aortic dissection, or unruptured sinus of Valsalva aneurysm which have all been occasionally associated with bradycardia or conduction block.
Penicillin G benzathine how supplied

# How Supplied
Bicillin  L-A (penicillin G benzathine injectable suspension) is supplied in packages of 10 disposable syringes as follows:
1 mL size, containing 600,000 units per syringe, (21 gauge, thin-wall 1 inch needle for pediatric use), NDC 60793-700-10.
2 mL size, containing 1,200,000 units per syringe, (21 gauge, thin-wall 1-1/2 inch needle), NDC 60793-701-10.
4 mL size, containing 2,400,000 units per syringe (18 gauge x 11/2 inch needle), NDC 60793-702-10.
Store in a refrigerator, 2 to 8C (36 to 46F).
Keep from freezing.
Penicillin G benzathine microbiology

# Microbiology

### Mechanism of Action
Penicillin G exerts a bactericidal action against penicillin-susceptible microorganisms during the stage of active multiplication.  It acts through the inhibition of biosynthesis of cell-wall peptidoglycan, rendering the cell wall osmotically unstable.

### Mechanism of Resistance
Penicillin is not active against penicillinase-producing bacteria or against organisms resistant to beta-lactams because of alterations in the penicillin-binding proteins.  Resistance to penicillin G has not been reported in Streptococcus pyogenes.
Penicillin has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section.
Gram-positive bacteria
Beta-hemolytic streptococci (groups A, B, C, G, H, L and M)
Other microorganisms
Treponema pallidum
Treponema carateum

### Susceptibility Test Methods
When available, the clinical microbiology laboratory should provide the results of in vitro susceptibility test results for antimicrobial drug products used in resident hospitals to the physician as periodic reports that describe the susceptibility profile of nosocomial and community-acquired pathogens.  These reports should aid the physician in selecting an antibacterial drug product for treatment.

### Dilution Techniques
Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs).  These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized procedure.

### Diffusion techniques
Quantitative methods that require the measurement of zone diameters can also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds.  The zone size provides an estimate of the susceptibility of bacteria to antimicrobial compounds. The zone size should be determined using a standardized test method.  This procedure uses paper discs impregnated with 10 units penicillin to test the susceptibility of microorganisms to penicillin G benzathine injectable solution.  The disc diffusion interpretive criteria are provided in the table below.
Streptococcus pyogenes (Group A)

### Quality Control
Standardized susceptibility test procedure require the use of laboratory controls to monitor and ensure the accuracy and precision of the supplies and reagents used in the assay, and the techniques of the individuals performing the test. Standard penicillin powder should provide the range of MIC values noted in the following table.  For the diffusion technique using the 10 unit penicillin disc, the criteria in the following table should be achieved.
Permanent neonatal diabetes mellitus
A newly identified and potentially treatable form of monogenic diabetes is the neonatal diabetes caused by activating mutations of the KCNJ11 gene, which codes for the Kir6.2 subunit of the beta cell KATP channel. This disease is considered to be a type of maturity onset diabetes of the young (MODY).
It can be associated with GCK, KCNJ11, INS, and ABCC8.

# Presentation and diagnosis
This results in congenital impairment of insulin release, although in the past, this was always being thought to be unusually early type 1 diabetes mellitus. The insulin deficiency results in intrauterine growth retardation with birth weight small for gestational age. The diabetes is usually diagnosed in the first 3 months of life due to continuing poor weight gain, polyuria, or diabetic ketoacidosis. Rare cases have been recognized as late as 6 months of age.

# Treatment
Remarkably, this type of diabetes often responds well to sulfonylureas and insulin may not be necessary. More severe mutations in the KCNJ11 gene can cause early-onset diabetes which does not respond to the sulfonylurea drugs, as well as a syndrome of developmental delay and neurological features called the DEND syndrome. These forms of diabetes are very rare conditions, appearing in about 1/100,000 to 1/200,000 live births, and accounting for about 1/1000 of type 1 diabetes cases. Fewer than 5% of the cases assumed to exist have been diagnosed, and most diabetes clinics around the world are checking for KCNJ11 mutations in any persons who developed apparent insulin-dependent diabetes without the typical type 1 antibodies before 6 months of age. At least some of these people have been able to change from insulin to sulfonylurea pills after decades of injections.