Persius/hicric huggingface dataset:
Valproic acid capsule/solution patient counseling information

# Patient Counseling Information
See FDA-Approved Medication Guide

### 17.1 Hepatotoxicity
Warn patients and guardians that nausea, vomiting, abdominal pain, anorexia, diarrhea, asthenia, and/or jaundice can be symptoms of hepatotoxicity and, therefore, require further medical evaluation promptly .

### 17.2 Pancreatitis
Warn patients and guardians that abdominal pain, nausea, vomiting, and/or anorexia can be symptoms of pancreatitis and, therefore, require further medical evaluation promptly .

### 17.3 Birth Defects and Decreased IQ
Inform pregnant women and women of childbearing potential that use of valproate during pregnancy increases the risk of birth defects and decreased IQ in children who were exposed. Advise women to use effective contraception while using valproate. When appropriate, counsel these patients about alternative therapeutic options. This is particularly important when valproate use is considered for a condition not usually associated with permanent injury or death. Advise patients to read the Medication Guide, which appears as the last section of the labeling .
Advise women of childbearing potential to discuss pregnancy planning with their doctor and to contact their doctor immediately if they think they are pregnant.
Encourage patients to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if they become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. To enroll, patients can call the toll free number 1-888-233-2334 .

### 17.4 Suicidal Thinking and Behavior
Counsel patients, their caregivers, and families that AEDs, including Depakene, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Instruct patients, caregivers, and families to report behaviors of concern immediately to the healthcare providers .

### 17.5 Hyperammonemia
Inform patients of the signs and symptoms associated with hyperammonemic encephalopathy and be told to inform the prescriber if any of these symptoms occur .

### 17.6 CNS Depression
Since valproate products may produce CNS depression, especially when combined with another CNS depressant (e.g., alcohol), advise patients not to engage in hazardous activities, such as driving an automobile or operating dangerous machinery, until it is known that they do not become drowsy from the drug.

### 17.7 Multi-Organ Hypersensitivity Reactions
Instruct patients that a fever associated with other organ system involvement (rash, lymphadenopathy, etc.) may be drug-related and should be reported to the physician immediately .
ATRIA score for predicting bleeding associated with warfarin

# Overview

# ATRIA score
Low-risk = (0 to 3 points) patients have hemorrhage rates of 1% per year
Intermediate risk = patients have hemorrhage rates of less than 5% per year
High-risk = (5 to 10 points) patients have hemorrhage rates of more than 5% per year
Amphotericin B cholesteryl sulfate dosage and administration

# Dosage And Administration
The recommended dose for adults and pediatric patients is 3 - 4 mg/kg as required, once a day.
AMPHOTEC, reconstituted in Sterile Water for Injection, is administered diluted in 5% Dextrose for Injection by intravenous infusion at a rate of 1 mg/kg/hour. A test dose immediately preceding the first dose is advisable when commencing all new courses of treatment. A small amount of drug (e.g., 10 mL of the final preparation containing between 1.6 to 8.3 mg) should be infused over 15 to 30 minutes and the patient carefully observed for the next 30 minutes.
The infusion time may be shortened to a minimum of 2 hours for patients who show no evidence of intolerance or infusion-related reactions. If the patient experiences acute reactions or cannot tolerate the infusion volume, the infusion time may be extended.
Cardiac allograft vasculopathy epidemiology and demographics

# Overview
As per the data from the Registry of the International Society of Heart and Lung transplantation, the number of reported heart transplants has increased slowly in the recent years, especially in North America. The overall prevalence of CAV in post-cardiac transplant patients at 1, 5 and 10 years is 8, 30 and 50% respectively.

# Epidemiology and Demographics
As per the ISHLT, the prevalence of CAV in post- cardiac transplant patients at 1, 5 and 10 years is 8, 30 and 50% respectively. The actual incidence of CAV has decreased slightly over time. Moreover, CAV as a cause of death in patients post- transplantation has decreased over the last decade. However, the Kaplan-Meier curves demonstrates a steady increase in the incidence of CAV post-transplant, such that only 46% of patients are free from angiographic evidence of CAV at the end of 10 years. Moreover, the survival after development of CAV appears to have minimal improvement in recent years in comparison to immediately preceding years. Donor age, donor history of hypertension, hyperlipidemia, number of HLA mismatches and recipient diagnosis of ischemic heart disease were important predictors for development of CAV.  Similar results were derived from the review of the United Network of Organ Sharing (UNOS) heart transplant database was performed by Nagji and colleagues in 2010 .
The Cardiac Transplant Research Database revealed a higher incidence of CAV in post-transplant patients of 42% at the end of 5 years, whereas only 7% of patients were found to have severe CAV on coronary angiogram over the same period of time. The presence of severe CAV was highly predictive of subsequent events or re-transplantation. Similar to the ISHLT and UNOS, older donor age, male donor or recipient, donor hypertension, diabetes were predictive of development of CAV .
Another prospective cross sectional study done by Torres and colleagues showed almost doubled prevalence of CAV when measured by intravascular ultrasound (IVUS) in contrast to conventional coronary angiography, which suggests that the incidence of CAV may in reality be more than predicted.

## Age
Gao et al. demonstrated that older donor age has a strong co-relation with development of CAV within 3 years following transplant. However, no significant difference was noted in long term mortality in patients receiving heart transplants from older age group donors. Similar results were obtained from the ISHTL registry and UNOS database.

## Gender
The UNOS database found significant improvement in short and long term mortality in males who received transplants from same sex donors. However, no survivial advantage was found in females receiving transplants from female donors. A study done by Al-Khaldi et al. showed worse graft outcomes especially in men above 45 years of age who received female allografts.
Differentiating Henoch-Schonlein purpura from other diseases

# Overview
Henoch-Schonlein purpura should be differentiated from other immune complex mediated small vessel vasculitis such as Anti-glomerular basement membrane disease, Cryoglobulinemic vasculitis, Hepatitis C virus-associated cryoglobulinemic vasculitis, Hypocomplementemic urticarial vasculitis (anti-C1q vasculitis).

# Differentiating Henoch-Schonlein Purpura from other Diseases
Henoch-Schonlein purpura should be differentiated from other immune complex mediated small vessel vasculitis such as Anti-glomerular basement membrane disease, Cryoglobulinemic vasculitis, Hepatitis C virus-associated cryoglobulinemic vasculitis, Hypocomplementemic urticarial vasculitis (anti-C1q vasculitis).

# Differential Diagnosis
Abbreviations:
ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.
Differentiating dermatitis herpetiformis from other diseases

# Overview
Dermatitis Herpetiformis (also called Duhring's disease), is a chronic itchy rash which is frequently associated with Celiac Disease. The rash is made of papules and vesicles which are present on different parts of the body mostly commonly on neck, trunk, buttocks and knees. It is an autoimmune mediated skin condition, which is IgA mediated reaction and is associated with gluten sensitivity of small bowel. There is presence of antibodies which leads to positive serology test results.
Dermatitis herpetiformis is associated with high prevalence of other autoimmune diseases.

# Differentiating Dermatitis Herpetiformis from Other Diseases
Dermatitis herpetiformis is an intensely itching, blistering rash which might present with excoriations (see Dermatitis herpetiformis physical examination). It should be differentiated from all those skin conditions which presents with itching, blisters and excoriations.
Ebstein's anomaly of the tricuspid valve laboratory findings

# Laboratory Findings

### Electrocardiogram
The EKG is abnormal in 50 to 67%.
About 50% of individuals with Ebstein's anomaly have evidence of Wolff-Parkinson-White Syndrome (syndrome of pre-excitation of the ventricles due to an accessory pathway known as the Bundle of Kent), secondary to the the apical displacement of the septal tricuspid valve leaflet resulting in discontinuity of the central fibrous body.
Other abnormalities that can be seen on the ECG include:
(1) signs of right atrial enlargement or tall and broad 'Himalayan' P waves,
(2) first degree atrioventricular block manifesting as a prolonged PR-interval,
(3) low amplitude QRS complexes in the right precordial leads,
(4) atypical right bundle branch block,
(5) T wave inversion in V1-V4 and Q waves in V1-V4 and II, III and aVF.
(6) a short PR interval and a delta wave and low voltages.

### Chest X Ray
The Chest X-ray shows a balloon shaped heart that looks a lot like a pericardial effusion. The RA is dilated. The heart looks globular.

### Echocardiogram
See Echo in Ebstein's anomaly of the tricuspid valve for more info/images
a) Can be used to assess the severity of dilatation of the right atrium, and the functional status of the tricuspid valve as well as the right ventricle.
b) Normally the tricuspid valve closes within 30 msec of the mitral valve. In Ebstein's, the tricuspid valve closes 50 to 60 msec after the mitral valve.
c) The delayed tricuspid closure is not due to RBBB because it also occurs with preexcitation.
d) 2D ECHO allows you to assess whether the repair can be accomplished without a prosthetic valve, and detects whether an interatrial shunt is present.
Below is an apical 4-chamber transthoracic view, showing apically-displaced leaflets of the tricuspid valve. Note substantial tricuspid regurgitation, which originates close to the apex, where the abnormal leaflets actually coapt:

## 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
Elvitegravir cobicistat emtricitabine tenofovir how supplied

# How Supplied
STRIBILD tablets are green, capsule-shaped, film-coated, debossed with "GSI" on one side and the number "1" surrounded by a square box ( 1 ) on the other side. Each bottle contains 30 tablets (NDC 61958-1201-1), a silica gel desiccant and closed with a child-resistant closure.
Store at 25 C (77 F), excursions permitted to 1530 C (5986 F) (see USP Controlled Room Temperature).
- Keep container tightly closed.
- Dispense only in original container.
- Do not use if seal over bottle opening is broken or missing.
Familial Mediterranean fever echocardiography and ultrasound

# Overview
There are no echocardiography/ultrasound findings associated with familial Mediterranean fever. However, echocardiography/ultrasound may be helpful in the diagnosis of complications, including pericardial effusion, pleural effusion, and hepatosplenomegaly.

# Echocardiography/Ultrasound
- There are no echocardiography/ultrasound findings associated with familial Mediterranean fever. However, echocardiography/ultrasound  may be helpful in the diagnosis of complications of  familial Mediterranean fever, which include:
Pericardial effusion
Pleural effusion
Hepatosplenomegaly
- Pericardial effusion
- Pleural effusion
- Hepatosplenomegaly
- A recent study comparing the cardiac functions in FMF patients and healthy controls using tissue Doppler imaging has observed impaired left ventricular diastolic function indices in FMF patients.
- Other non-specific findings which have been found on the ultrasound imaging of patients with FMF include:
Peritoneal fluid
Enlarged kidneys
Hyperechoic kidneys
Lymphadenopathy
Peritoneal cysts
Dilated bowel loops
cholelithiasis
Cholecystitis
Cavernous malformation of the portal vein
Terminal ileitis
Segmental infarct of the kidney
Bleeding from a ruptured renal cyst
Incidental ovarian dermoid cyst.
- Peritoneal fluid
- Enlarged kidneys
- Hyperechoic kidneys
- Lymphadenopathy
- Peritoneal cysts
- Dilated bowel loops
- cholelithiasis
- Cholecystitis
- Cavernous malformation of the portal vein
- Terminal ileitis
- Segmental infarct of the kidney
- Bleeding from a ruptured renal cyst
- Incidental ovarian dermoid cyst.
International Day against Drug Abuse and Illicit Trafficking
The International Day against Drug Abuse and Illicit Trafficking is a United Nations International Day against drug abuse and the illegal drug trade. It has been held annually since 1988 on 26 June, a date chosen to commemorate Lin Zexu's dismantling of the opium trade in Humen, Guangdong, just before the Opium War (zh:)
The observance was instituted by General Assembly resolution 42/117 of 7 December 1987.
The UN's 2007 World Drug Report
puts the value of the illegal drug trade at US$322 billion a year.
-  World Drug Report 2007
-  UN Report: Global Drug Abuse Under Control
Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency

# Overview
Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency, often shortened to LCHAD deficiency is a rare genetic disorder that prevents the body from converting certain fats to energy, particularly during periods of fasting. This condition is inherited in an autosomal recessive pattern.
Mutations in the HADHA gene lead to inadequate levels of an enzyme called long-chain 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase, which is part of a protein complex known as mitochondrial trifunctional protein. Long-chain fatty acids from food and body fat cannot be metabolized and processed without sufficient levels of this enzyme. As a result, these fatty acids are not converted to energy, which can lead to characteristic features of this disorder, such as lethargy and hypoglycemia. Long-chain fatty acids or partially metabolized fatty acids may build up in tissues and damage the liver, heart, retina, and muscles, causing more serious complications.
Typically, initial signs and symptoms of this disorder occur during infancy or early childhood and can include feeding difficulties, lethargy, hypoglycemia,hypotonia, liver problems, and abnormalities in the retina. Muscle pain, a breakdown of muscle tissue, and abnormalities in the nervous system that affect arms and legs (peripheral neuropathy) may occur later in childhood. There is also a risk for complications such as life-threatening heart and breathing problems, coma, and sudden unexpected death. Episodes of LCHAD deficiency can be triggered by periods of fasting or by illnesses such as viral infections.

# Related Chapters
- Medium chain acyl dehydrogenase deficiency
Nutritional screening and assessment resident survival guide
Synonyms and keywords:

# Overview
Nutrition plays a pivotal role in life and in medicine. Acute and chronic diseases in most organ systems have pronounced effects on food intake and metabolism with increased catabolism, which lead to nutrition-related conditions associated with increased morbidity and eventually death. At the other end of the spectrum, diet is a major determinant of future health, i.e. the absence or postponement of disorders like cardio-vascular disease, diabetes, cancer and cognitive disease. Malnutrition can be defined as a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease .

# Causes

## Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Life threatening cause 1
- Life threatening cause 2
- Life threatening cause 3

## Common Causes
- Common cause 1
- Common cause 2
- Common cause 3
- Common cause 4
- Common cause 5

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of ] according the the  guidelines.

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

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

# Don'ts
- The content in this section is in bullet points.
Sudden infant death syndrome echocardiography and ultrasound

# Overview
There are no echocardiography/ultrasound findings associated with .
OR
Echocardiography/ultrasound may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include , , and .
OR
There are no echocardiography/ultrasound  findings associated with . However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include , , and .

# Ultrasound
There are no echocardiography/ultrasound findings associated with .
OR
Echocardiography/ultrasound may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include:
OR
There are no echocardiography/ultrasound findings associated with . However, echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include:
T-cell leukemia natural history, complications and prognosis

# Overview
The natural history of adult T-cell leukemia varies between the different subtypes of the disease. Common complications of adult T-cell leukemia include cardiac arrhythmias, opportunistic infections , and bone fractures. The prognosis varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor prognosis, where as chronic and smouldering subtypes have a good prognosis.

# Natural History
- The natural history of adult T-cell leukemia varies between the different subtypes of the disease.
- Usually patients with acute adult T-cell leukemia have an aggressive clinical course with a median survival period of less than 12 months. If left untreated, most of the patients with acute adult T-cell leukemia will develop constitutional symptoms, lymphadenopathy, and organomegaly within a few weeks of diagnosis.
- Usually patients with chronic adult T-cell leukemia will have an stable clinical course. If left untreated, most of the patients with chronic adult T-cell leukemia will develop lymphocytosis for months, or even years, before presenting with the typical cutaneous manifestations.
- Most patients with smoldering adult T cell leukemia are initially asymptomatic. If left untreated, most of the patients with smoldering adult T cell leukemia will develop steroid-responsive skin rash and multiple lung infiltrates.

# Complications
- Common complications of adult T-cell leukemia include:
- Cardiac arrhythmias (due to hypercalcaemia)
- Opportunistic infections (Strongyloides stercoralis infection is a frequent cause of death among adult T-cell leukemia patients)
- Bone fractures (due to lytic bone lesions)
- Anemia
- Recurrent bleeding

# Prognosis
- The prognosis varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor prognosis, where as chronic and smoldering subtypes have a good prognosis.
- The 4-year overall survival rate of patients with acute adult T-cell leukemia is approximately 11%.
- The 4-year overall survival rate of patients with adult T-cell lumphoma is approximately 16%.
- The 4-year overall survival rate of patients with chronic adult T-cell leukemia is approximately 36%.
- The 4-year overall survival rate of patients with smouldering adult T-cell leukemia is approximately 52%.
- The table below lists prognostic factors for adult T-cell leukemia patients:
The EKG in the patient treated with calcium channel blockers

# Electrocardiographic Findings
- In patients with sinus node disease, verapamil and diltiazem may cause severe bradycardia and even sinus arrest.
- Effect on rate depends on the balance between the effect on the conduction system and a reflex increase in the heart rate due to vasodilation.
- Diltiazem and verapamil may prolong the PR interval, nifedipine has no effect.
- No effect on the QRS or the QTc
Valproic acid capsule delayed release nonclinical toxicology

# Nonclinical Toxicology

### 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Valproate was administered orally to rats and mice at doses of 80 and 170 mg/kg/day (less than the maximum human dose on a mg/m2 basis) for 2 years. The primary findings were an increase in the incidence of subcutaneous fibrosarcomas in high-dose male rats receiving valproate and a dose-related trend for benign pulmonary adenomas in male mice receiving valproate. The significance of these findings for humans is unknown.
Valproate was not mutagenic in an in vitro bacterial assay (Ames test), did not produce dominant lethal effects in mice, and did not increase chromosome aberration frequency in an in vivo cytogenetic study in rats. Increased frequencies of sister chromatid exchange (SCE) have been reported in a study of epileptic children taking valproate, but this association was not observed in another study conducted in adults. There is some evidence that increased SCE frequencies may be associated with epilepsy. The biological significance of an increase in SCE frequency is not known.
Chronic toxicity studies of valproate in juvenile and adult rats and dogs demonstrated reduced spermatogenesis and testicular atrophy at oral doses of 400 mg/kg/day or greater in rats (approximately equivalent to or greater than the maximum recommended human dose (MRHD) on a mg/m2 basis) and 150 mg/kg/day or greater in dogs (approximately 1.4 times the MRHD or greater on a mg/m2 basis). Fertility studies in rats have shown no effect on fertility at oral doses of valproate up to 350 mg/kg/day (approximately equal to the MRHD on a mg/m2 basis) for 60 days.The effect of valproate on testicular development and on sperm production and fertility in humans is unknown.