Persius/hicric huggingface dataset:
Cholest-5-ene-3beta,7alpha-diol 3beta-dehydrogenase
In enzymology, a cholest-5-ene-3,7-diol 3-dehydrogenase (EC 1.1.1.181) is an enzyme that catalyzes the chemical reaction
Thus, the two substrates of this enzyme are cholest-5-ene-3,7-diol and NAD+, whereas its 3 products are 7-hydroxycholest-4-en-3-one, NADH, and H+.
The systematic name of this enzyme class is cholest-5-ene-3,7-diol:NAD+ 3-oxidoreductase. This enzyme is also called 3-hydroxy-5-C27-steroid oxidoreductase. The human version of this enzyme is known as hydroxy--5-steroid dehydrogenase, 3 - and steroid delta-isomerase 7 or HSD3B7 which is encoded by the HSD3B7 gene.

# Function
This enzyme belongs to the family of oxidoreductases, specifically those acting on the CH-OH group of donor with NAD+ or NADP+ as acceptor. This enzyme is involved in the initial stages of the synthesis of bile acids from cholesterol and a member of the short-chain dehydrogenase/reductase superfamily. This enzyme is a membrane-associated endoplasmic reticulum protein which is active against 7-alpha hydrosylated sterol substrates.

# Clinical significance
Mutations in the HSD3B7 gene are associated with a congenital bile acid synthesis defect which leads to neonatal cholestasis, a form of progressive liver disease.
Clindamycin hydrochloride dosage and administration

# DOSAGE AND ADMINISTRATION
If significant diarrhea occurs during therapy, this antibiotic should be discontinued (see WARNING box).
Adults: Serious infections  150 to 300 mg every 6 hours. More severe infections  300 to 450 mg every 6 hours. Pediatric Patients:Serious infections  8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. More severe infections  16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses.
To avoid the possibility of esophageal irritation, CLEOCIN HCl Capsules should be taken with a full glass of water.
Serious infections due to anaerobic bacteria are usually treated with CLEOCIN PHOSPHATE Sterile Solution. However, in clinically appropriate circumstances, the physician may elect to initiate treatment or continue treatment with CLEOCIN HCl Capsules.
In cases of -hemolytic streptococcal infections, treatment should continue for at least 10 days.
Combined internal medicine and psychiatry residency
A combined internal medicine and psychiatry residency program is a graduate medical education program in the United States, which leads to board eligibility in both internal medicine and psychiatry i.e. a graduate of the residency is both an internist as well as a psychiatrist. The program takes five years. There are only 16 such programs in the country. They are represented by the Association of Medicine Psychiatry.
Graduates of such programs can follow a variety of career paths as Dual Internist/Psychiatrists:
1. Integrated Med-Psych Practice: Where they provide both medical and psychiatric care to patients who need both and in whom the individual problems cannot be separated.
2. Working with subspecialties of psychiatry that require or are enhanced by an in-depth understanding of Internal Medicine:
a. Consultation Psychiatry/Psychosomatic medicine: treating the psychiatric problems of medically ill patients that are being cared for by other medical practitioners
b. Geriatric Psychiatry:  Elderly patients often have multiple medical problems that make them more susceptible to side effects of medicines and may play a role in the development of their psychiatric symptoms. 
c. Chronic Pain management: Patients with chronic pain frequently have depression and other psychiatric syndromes that make their pain worse and harder to treat. Also several psychological therapies have been found to be effective for most patients with chronic pain.
3. Working in a subspecialty of Internal Medicine that requires or is enhanced by an in-depth knowledge of psychiatry:
a. Hematology-Oncology: Treating cancer
b. HIV care
c. Pain management: see above
DNA replication-related element gene transcriptions
"The promoters of Drosophila genes encoding DNA replication-related proteins contain transcription regulatory elements consisting of an 8-bp palindromic DNA replication-related element (DRE) sequence (5-TATCGATA)."

# Consensus sequences
DNA replication-related element (DRE) sequence is 5-TATCGATA-3'.

# Samplings
Copying the consensus of the DRE: 5'-TATCGATA-3' and putting the sequence in "F" finds no locations for this sequence in any A1BG direction as can be found by the computer programs.
For the Basic programs testing consensus sequence 5'-TATCGATA-3' (starting with SuccessablesDRRE.bas) written to compare nucleotide sequences with the sequences on either the template strand (-), or coding strand (+), of the DNA, in the negative direction (-), or the positive direction (+), the programs are, are looking for, and found:
- negative strand, negative direction, looking for 5'-TATCGATA-3', 0.
- negative strand, positive direction, looking for 5'-TATCGATA-3', 0.
- positive strand, negative direction, looking for 5'-TATCGATA-3', 0.
- positive strand, positive direction, looking for 5'-TATCGATA-3', 0.
- complement, negative strand, negative direction, looking for 5'-ATAGCTAT-3', 0.
- complement, negative strand, positive direction, looking for 5'-ATAGCTAT-3', 0.
- complement, positive strand, negative direction, looking for 5'-ATAGCTAT-3', 0.
- complement, positive strand, positive direction, looking for 5'-ATAGCTAT-3', 0.
- inverse complement, negative strand, negative direction, looking for 5'-TATCGATA-3', 0.
- inverse complement, negative strand, positive direction, looking for 5'-TATCGATA-3', 0.
- inverse complement, positive strand, negative direction, looking for 5'-TATCGATA-3', 0.
- inverse complement, positive strand, positive direction, looking for 5'-TATCGATA-3', 0.
- inverse negative strand, negative direction, looking for 5'-ATAGCTAT-3', 0.
- inverse negative strand, positive direction, looking for 5'-ATAGCTAT-3', 0.
- inverse positive strand, negative direction, looking for 5'-ATAGCTAT-3', 0.
- inverse positive strand, positive direction, looking for 5'-ATAGCTAT-3', 0.

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
Differentiating Thyroid adenoma from other Diseases

# Overview
Thyroid adenoma must be differentiated from other thyroid disorders such as multinodular goiter, grave's disease, Hashimoto's disease, medullary thyroid carcinoma, De Quervain's thyroiditis, thyroid lymphoma, and acute suppurative thyroiditis.

# Differentiating Thyroid adenoma from other Diseases
- The table below summarizes the findings that differentiate thyroid adenoma from other conditions that cause neck swelling.
- Thyroid adenoma must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter.
Differentiating crohn's disease from other diseases

# Overview
The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.

# Differentiating Crohn's Disease from other Diseases
The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
Oral lesioins of Crohn's disease must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer
The following table differentiates all the diseases presenting with abdominal pain, fever and lower gastrointestinal bleeding.
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

## Differentiating Crohn's disease from other causes of abdominal pain and diarrhea
Crohn's disease must be differentiated from other causes of abdominal pain and diarrhea.
Differentiating dermatomyositis from other diseases

# Overview
Dermatomyositis must be differentiated from other common, lymphocyte predominant inflammatory myopathies. Hypothyroidism and sarcoidosis have some symptoms in common with dermatomyositis, and therefore need to be ruled out.

# Differentiating Dermatomyositis from other Diseases
Dermatomyositis must be differentiated from other common, lymphocyte predominant inflammatory myopathies.  If present, the characteristic perifascicular atrophy makes this distinction trivial.
There is some overlap in the microscopic appearances of different inflammatory myopathies, but some helpful differences are often present.  The rimmed vacuoles of inclusion body myositis (IBM) are absent in dermatomyositis.  Polymyositis is characterised by diffuse or patchy inflammation of the muscle fascicles, a random pattern of muscle atrophy, and T-cell predominance with T-cells seen invading otherwise viable appearing muscle fibers.
Diseases that can present with similar symptoms as those of dermatomyositis are-
- Hypothyroidism
- Sarcoidosis

## Differentiating dermatomyositis from other diseases with chronic pain and fatigue
Differentiating lupus nephritis from other diseases

# Overview
Lupus nephritis must be differentiated from other glomerular diseases that may cause hematuria, proteinuria, or renal failure. The various types of glomerular diseases should be differentiated from each other based on associations, presence of pitting edema, hemeturia, hypertension, hemoptysis, oliguria, peri-orbital edema, hyperlipidemia, type of antibodies, light and electron microscopic features. The following table differentiates between various types of glumerular diseases:

# Differentiating lupus nephritis from other Diseases
Lupus nephritis must be differentiated from other glomerular diseases that may cause hematuria, proteinuria, or renal failure. The various types of glomerular diseases should be differentiated from each other based on associations, presence of pitting edema, hemeturia, hypertension, hemoptysis, oliguria, peri-orbital edema, hyperlipidemia, type of antibodies, light and electron microscopic features. The following table differentiates between various types of glumerular diseases:
Some infectious diseases such as HIV, HBV, HCV, syphilis, leprosy, malaria, and schistosomiasis may cause glomerular diseases.
Drug induced hemolytic anemia (patient information)
For the WikiDoc page for this topic, click here

# Overview
Drug-induced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the body's defense (immune) system to attack its own red blood cells. This causes red blood cells to break down earlier than normal, a process called hemolysis.

# What are the symptoms of Drug induced hemolytic anemia?
- Dark urine
- Fatigue
- Pale skin color
- Rapid heart rate
- Shortness of breath
- Yellow skin color (jaundice)

# What causes Drug induced hemolytic anemia?
- In some cases, a drug can cause the immune system to mistakenly think your own red blood cells are dangerous, foreign substances. Antibodies then develop against the red blood cells. The antibodies attach to red blood cells and cause them to break down too early.
- Drugs that can cause this type of hemolytic anemia include:
- Cephalosporins (a class of antibiotics) is the most common cause
- Dapsone
- Levodopa
- Levofloxacin
- Methyldopa
- Nitrofurantoin
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Penicillin and its derivatives
- Phenazopyridine (pyridium)
- Quinidine
- There are other, rarer causes of drug-induced hemolytic anemia. This includes hemolytic anemia associated with glucose-6 phosphate dehydrogenase (G6PD) deficiency. In this case, the breakdown of red blood cells is due to a certain type of stress in the cell, rather than the body's immune system.
- Drug-induced hemolytic anemia is rare in children.

# When to seek urgent medical care?
See your health care provider if you have symptoms of this condition.

# Diagnosis
- A physical examination may show an enlarged spleen. A number of blood and urine tests may be done to help diagnose this condition.
- Tests may include:
- Absolute reticulocyte count
- Direct or indirect Coombs' test
- Indirect bilirubin levels
- Red blood cell count
- Serum haptoglobin
- Urine hemoglobin

# Treatment options
- Stopping the drug that is causing the problem may relieve or control the symptoms.
- Some persons may be given a medicine called prednisone to reduce the immune response against the red blood cells.
- Special blood transfusions may be needed to treat severe symptoms.

# Where to find medical care for Drug induced hemolytic anemia?
Directions to Hospitals Treating Drug induced hemolytic anemia

# Prevention
You should continue to avoid the drug that caused this condition.

# What to expect (Outlook/Prognosis)?
Most patients have a good outcome if they stop taking the drug that is causing the problem.

# Possible complications
Death caused by severe anemia is rare.
EKG abnormalities in central nervous system disease

# Overview
Classic manifestations on EKG of the so-called cerebrovascular accidents, (most commonly associated with subarachnoid hemorrhage or other intracranial bleeds) are symmetrically and deeply inverted giant T waves.

# Pathophysiology
The mechanisms are not fully delineated but may relate to excessive catecholamine stimulation causing direct myocardial injury (myocytolysis).

# Diagnosis

## Electrocardiographic Findings
The ECG may be notable for marked QT-U prolongation (sometimes a giant U wave appears to be embeded in the T wave, creating a slight discontinuity in the waveform morphology). The long QT-U may predispose to torsade(s) de pointes. Takostubo syndrome may occur in some cases. Apical hypertrophic cardiomyopathy (Yamaguchis syndrome) is associated with deep narrow (spade-like) T wave inversions, most marked in the mid-precordial leads.
- EKG changes seen in 71.5% of patients with subarachnoid hemorrhage, and 57.1% of those with cerebral hemorrhage.
- Most common abnormalities are
Large, upright, or deeply inverted T waves
Prolongation of the QTc interval
Prominent U waves
- Large, upright, or deeply inverted T waves
- Prolongation of the QTc interval
- Prominent U waves
- Can persist for 11 days
- Rarely can ST segment elevation or depression
- Rhythm disturbances
Sinus bradycardia
Sinus tachycardia
Wandering atrial pacemaker
AV junctional rhythm
Premature ventricular contractions PVCs
Ventricular tachycardia (VT)
- Sinus bradycardia
- Sinus tachycardia
- Wandering atrial pacemaker
- AV junctional rhythm
- Premature ventricular contractions PVCs
- Ventricular tachycardia (VT)
- Reason for changes is thought to be altered autonomic tone

## Examples
- Patient with subaracnoidal hemorrhage
- EKG of a patients with CNS Disorders
- Inverted and deep T waves in the precordal leads due to subaracnoidal aneurysm [Image courtesy of Dr Jose Ganseman Dr Ganseman's webpage: An ultimate source of EKG

# Refrences
Ebstein's anomaly of the tricuspid valve CT and MRI

# CT and MRI
Inferior displacement of tricuspid valve leaflets with enlargement of the right atrium and enlargement and dysfunction of the right ventricle.

## Cardiac catheterization and hemodynamics
a) RA pressure usually not increased due to the fact that the RA is enlarged and compliant.
b) Normal RV pressures unless significant TR is present.
c) PA pressures are normal or slightly decreased due to TR and a large right-to-left shunt.
d) An ASD may be present
Growth hormone response element gene transcriptions

# Human genes
Gene ID: 2688 is GH1 growth hormone 1: "The protein encoded by this gene is a member of the somatotropin/prolactin family of hormones which play an important role in growth control. The gene, along with four other related genes, is located at the growth hormone locus on chromosome 17 where they are interspersed in the same transcriptional orientation; an arrangement which is thought to have evolved by a series of gene duplications. The five genes share a remarkably high degree of sequence identity. Alternative splicing generates additional isoforms of each of the five growth hormones, leading to further diversity and potential for specialization. This particular family member is expressed in the pituitary but not in placental tissue as is the case for the other four genes in the growth hormone locus. Mutations in or deletions of the gene lead to growth hormone deficiency and short stature."

# Consensus sequences
"Computer analysis of the nt 653 to nt 483 region identified two sites that resemble the  GAS consensus sequence, TTNCNNNAA (19). Similar GAS-like sites have been shown to mediate the effects of various cytokines, including  GH, on the transcription of other genes (19, 20). The first site, TTCCTAGAA (ALS-GAS1), is located between nt 633 and nt 625; the second site, TTAGACAAA (ALS-GAS2), is located between nt 553 and nt 545."
"To ascertain whether one or both of these two ALS-GAS sites were functionally important for GH stimulation of ALS promoter activity, plasmids containing block mutations of either ALS-GAS1  or ALS-GAS2  were prepared in the context of the luciferase construct retaining full responsiveness to GH , and transfected into H4-II-E cells . Mutation of the ALS-GAS1 element abolished the ability of the promoter to respond to GH ; mutation of the ALS-GAS2 element was without effect. Thus, an intact ALS-GAS1 element is necessary for GH stimulation of ALS promoter activity."
High anion gap metabolic acidosis critical pathways

# Approach

# Definition
- Delta-Delta value is used to determine whether there is an additional metabolic acid-base disturbance or not.
- Delta-Delta () = Delta anion gap (AG) / Delta bicarbonate (HCO3)
Delta anion gap (AG) = Calculated anion gap - Expected anion gap
Calculated anion gap =  -  - 
Expected anion gap = 2.5 x serum albumin level
Delta bicarbonate (HCO3) = 24 - serum bicarbonate level
- Delta anion gap (AG) = Calculated anion gap - Expected anion gap
Calculated anion gap =  -  - 
Expected anion gap = 2.5 x serum albumin level
- Calculated anion gap =  -  - 
- Expected anion gap = 2.5 x serum albumin level
- Delta bicarbonate (HCO3) = 24 - serum bicarbonate level
Hydroxychloroquine sulfate Warnings And Precautions

# WARNINGS

## General
Hydroxychloroquine sulfate is not effective against chloroquine-resistant strains of P. falciparum.
Children are especially sensitive to the 4-aminoquinoline compounds. A number of fatalities have been reported following the accidental ingestion of chloroquine, sometimes in relatively small doses (0.75 g or 1 g in one 3-year-old child). Patients should be strongly warned to keep these drugs out of the reach of children.
Use of hydroxychloroquine sulfate in patients with psoriasis may precipitate a severe attack of psoriasis. When used in patients with porphyria the condition may be exacerbated. The preparation should not be used in these conditions unless in the judgment of the physician the benefit to the patient outweighs the possible hazard.

## Usage in Pregnancy
Usage of this drug during pregnancy should be avoided except in the suppression or treatment of malaria when in the judgment of the physician the benefit outweighs the possible hazard. It should be noted that radioactively-tagged chloroquine administered intravenously to pregnant, pigmented CBA mice passed rapidly across the placenta. It accumulated selectively in the melanin structures of the fetal eyes and was retained in the ocular tissues for five months after the drug had been eliminated from the rest of the body.

# Precautions

## General
Antimalarial compounds should be used with caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs.
Periodic blood cell counts should be made if patients are given prolonged therapy. If any severe blood disorder appears which is not attributable to the disease under treatment, discontinuation of the drug should be considered. The drug should be administered with caution in patients having G-6-PD (glucose-6-phosphate dehydrogenase) deficiency.
IMITREX injection how supplied storage and handling

# How Supplied/Storage and Handling
IMITREX Injection contains sumatriptan (base) as the succinate salt and is supplied as a clear, colorless to pale yellow, sterile, nonpyrogenic solution as follows:
Prefilled Syringe and/or Autoinjector Pen:
Each pack contains a Patient Information and Patients Instructions for Use leaflet.
- IMITREX STATdose System, 4 mg, containing 1 IMITREX STATdose Pen, 2 prefilled single-dose syringe cartridges, and 1 carrying case (NDC 0173-0739-00).
- IMITREX STATdose System, 6 mg, containing 1 IMITREX STATdose Pen, 2 prefilled single-dose syringe cartridges, and 1 carrying case (NDC 0173-0479-00).
- Two 4-mg single-dose prefilled syringe cartridges for use with IMITREX STATdose System (NDC 0173-0739-02).
- Two 6-mg single-dose prefilled syringe cartridges for use with IMITREX STATdose System (NDC 0173-0478-00).
Single-Dose Vial:
- IMITREX Injection single-dose vial (6 mg/0.5 mL) in cartons containing 5 vials (NDC 0173-0449-02).
Store between 2 and 30C (36 and 86F). Protect from light.
Indications for surgery in patent ductus arteriosus

# Overview
The decision to operate a patent ductus arteriosus should be made based on the risk to benefits ratio

# Indications for Surgery 
- Symptomatic patients with left-to-right shunt (left sided volume overload).
- Reversible pulmonary arterial hypertension
- If medical therapy fails (fluid restriction and prostaglandin inhibitors such as indomethacin)
- If a child is more than 6 to 8 months old, surgical correction of PDA is warranted.
There is some lack on consensus on the management strategies of silent and small patent ductus arteriosus

### Small PDA
- Small PDA may present with audible murmur with or without symptoms of left volume overload. The American College of Cardiology/American Heart Association (ACC/AHA)recommends closure of small PDA, even without evident left sided volume overload. In case the PDA is left untreated, a follow-up every 3-5 year is recommended.

### Silent PDA
- No audible murmur
- Detected incidentally on diagnostic procedures done for other conditions.
- Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention.