Persius/hicric huggingface dataset:
Positive pressure ventilation
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# Overview
Positive pressure ventilation is a technique which utilizes a mechanism such as a mechanical ventilator to force air into the lungs, to assist breathing in patients with temporary, or chronic respiratory problems and disease.
High pressure air at the opening of the airway mobilizes oxygen flow down the pressure gradient, and into the patient's lungs. Spontaneous respiration usually happens, as a negative pressure is created inside the lungs and air enters quickly to fill this lower pressure.
The ventilation mechanism generates a positive pressure outside the patient. An intubation canula of some type is usually implemented to achieve this.
Positive pressure ventilation is also used in fire fighting to blow the smoke away and out of a burning room or structure. See Ventilation (firefighting).
Posterior circulation infarct
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A Posterior Circulation Infarct (POCI) is a type of ischemic stroke affecting the posterior circulation supplying one side of the brain.
Posterior Circulation Stroke Syndrome (POCS) refers to the symptoms of a patient who clinically appears to have suffered from a posterior circulation infarct, but who has not yet had any diagnostic imaging (e.g. CT Scan) to confirm the diagnosis.
It can cause the following symptoms:
- Cranial nerve palsy AND contralateral motor/sensory defect
- Bilateral motor or sensory defect
- Eye movement problems
- Cerebellar dysfunction
- Isolated homonymous hemianopia
For more information, see stroke.
Prasugrel approved by the FDA
July 10 by C. Michael Gibson, M.S., M.D. (click here for Dr. Gibson's disclosures)
The Food and Drug Administration announced today that Prasugrel (which will be sold under the name Effient) is now approved for clinical use.  The drug's label indicates that the drug is effective in reducing the risk of stroke and heart attack in patients undergoing percutaneous coronary intervention and will carry a black label warning regarding an increased risk of potentially fatal bleeding. A panel convened by the FDA had previously voted 9-0 in a recommendation for approval on February 3rd, 2009.
The FDA's Director of New Drugs, John Jenkins, stated in a press release that "Effient offers physicians an alternative treatment for preventing dangerous blood clots from forming and causing a heart attack or stroke during or after an angioplasty procedure," and that "physicians must carefully weigh the potential benefits and risks of Effient as they decide which patients should receive the drug." Click here to download a pdf of Prasugrel's package insert.
FDA statement also indicated that Prasugrel should be avoided in patients with ongoing, a history of stroke or transient ischemic attacks (TIAs or small temporary-strokes), or an urgent need for surgery, including CABG (coronary artery bypass graft surgery).  A press release from Eli Lilly and Daiichi-Sankyo stated that "Effient is contraindicated in patients with a history of prior TIA/stroke. It is generally not recommended in patients 75 years of age or older, except for patients in high-risk situations, such as those with diabetes or a history of prior heart attack."
Given the potential risk of bleeding, it is notable that there are two approved maintenance doses of Prasugrel: 10 mg which was studied in the Triton TIMI 38 trial, and a reduced dose of 5 mg that may be more suitable in patients at an increased risk of bleeding including those patients who weigh less than 60 Kg (132 pounds).
The manufacturese of the drug also stated the following in the press release:
Although concerns had been expressed regarding an excess risk of cancer in the Prasugrel arm, Deputy Director of the Cardiovascular & Renal Products division, Ellis Unger, stated that there is no increase in the relative risk of cancer for prasugrel over clopidogrel if those patients with gastrointestinal bleeding are excluded from the analysis.
The drug is marketed by both Eli Lilly and Daiichi-Sankyo.
Pre Medical Student Resources
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Medical school selector. Select a medical school based upon your GPA, MCAT score and other relevant variables.
Premarin detailed information
Premarin is the commercial name for compound drug consisting primarily of conjugated estrogens. Isolated from mare's urine (PREgnant MARes' urINe), it is manufactured by Wyeth Pharmaceuticals and has been marketed since 1942. It is available in oral (0.3/ 0.45/ 0.625/ 1.25mg), IV, and topical form.

# Pharmacology
The major forms of estrogen in Premarin are estrone (>50%), equilin (15-25%) and equilenin. The estrogens in Premarin are often called "conjugated equine estrogens" (CEE) because the estrogen molecules are generally present with hydrophilic side-groups attached such as sulfate. Thus, estrone sulfate is actually the major molecule in Premarin.  Estrone sulfate is easily absorbed into the blood after Premarin pills are taken by women. Estrone sulfate is converted to estradiol, an active estrogen normally found in women. It is not clear if estrogens such as equilin that are foreign to the human body have effects in women that are significantly different from the estrogens like estradiol that are normally made in the human body.

# Indications
Premarin is indicated for the treatment of mild to severe vasomotor symptoms of the menopause, prevention of osteoporosis, and treatment of vaginal and vulvar atrophy. Premarin has been one of the most widely used drugs in the United States. Premarin became the form of estrogen most commonly used for hormone replacement therapy.

# Controversy
Premarin is the subject of some contention. Animal rights activists claim that animal husbandry and urine collection methods used in Premarin's production cause undue stress and suffering to the mares involved. Additionally, it is proposed that there is an overabundance of poorly bred foals produced by Pregnant Mare Urine (PMU) farms each year.  However, PMU horses only represent 0.01% of equines in North America . There has been an increase in the number of registered horses on PMU ranches with almost all horses now being registered stock.    The vast majority of these purebred foals are sold for pleasure riding and driving.
Primary cutaneous amyloidosis

# Overview
Primary cutaneous amyloidosis is a form of amyloidosis associated with oncostatin M receptor.  This type of amyloidosis has been divided into the following types::520
- Macular amyloidosis is a cutaneous condition characterized by itchy, brown, rippled macules usually located on the interscapular region of the back.:521 Combined cases of lichen and macular amyloidosis are termed biphasic amyloidosis, and provide support to the theory that these two variants of amyloidosis exist on the same disease spectrum. 
- Lichen amyloidosis is a cutaneous condition characterized by the appearance of occasionally itchy lichenoid papules, typically appearing bilaterally on the shins.:521
- Nodular amyloidosis is a rare cutaneous condition characterized by nodules that involve the acral areas.:521

# Diagnosis

## Physical Examination

### Skin
- Macular amyloidosis. Adapted from Dermatology Atlas.{{Cite
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- .Lichen amyloidosus Adapted from Dermatology Atlas.
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Progressive nonfluent aphasia

# Overview
Progressive nonfluent aphasia is one of three clinical syndromes associated with frontotemporal lobar degeneration.

# Clinical Features
The main clinical features are progressive difficulties with speech production. There can be problems in different parts of the speech production system, hence patients can present with articulatory breakdown (hesitant, effortful speech or speech 'apraxia'), agrammatism (difficulties with syntax e.g. use of the wrong tense or word order), anomia or phonemic breakdown (difficulties with sounds). However, it is rare for patients to have just one of these problems and most people will present with more than one problem.
Features therefore include:
- Hesitant, effortful speech
- Stutter (including return of a childhood stutter)
- Anomia
- Phonemic paraphasias (sound errors in speech e.g. 'gat' for 'cat')
- Agrammatism
- As the disease develops speech quantity decreases and many patients will become mute.
Cognitive domains other than language are rarely affected early on. However, as the disease progresses other domains can be affected. Problems with writing, reading and speech comprehension can occur as can behavioural features similar to frontotemporal dementia.

# Nosology
There is some confusion in the terminology used by different neurologists. Mesulam's original description in 1982 of progressive language problems caused by neurodegenerative disease (which he called primary progressive aphasia - PPA) included patients with both progressive non-fluent aphasia (PNFA) and semantic dementia (SD). The Neary criteria for PNFA and SD are therefore different to the Mesulam criteria for PPA. This is further confused by some doctors using the term primary progressive aphasia to mean patients with progressive non-fluent aphasia only. (See Knibb and Hodges recent paper for a good discussion of this ongoing problem - "Semantic dementia and primary progressive aphasia: a problem of categorization?"
Alzheimer Dis Assoc Disord. 2005 Oct-Dec;19 Suppl 1:S7-14.)

# Imaging
Imaging studies have shown differing results which probably represents the heterogeneity of language problems than can occur in PNFA. However, classically atrophy of left perisylvian areas is seen.

# Management
There is no curative treatment for this condition. Supportive management is helpful.
Protease-activated receptor 2
Protease activated receptor 2 (PAR2) also known as  coagulation factor II (thrombin) receptor-like 1 (F2RL1) or G-protein coupled receptor 11 (GPR11) is a protein that in humans is encoded by the F2RL1 gene. PAR2 modulates inflammatory responses, obesity, metabolism, and acts as a sensor for proteolytic enzymes generated during infection.

# Gene
The F2RL1 gene contains two exons and is widely expressed in human tissues. The predicted protein sequence is 83% identical to the mouse receptor sequence.

# Mechanism of activation
PAR2 is a member of the large family of 7-transmembrane receptors that couple to guanosine-nucleotide-binding proteins. PAR2 is also a member of the protease-activated receptor family. It is activated by trypsin, but not by thrombin. It is activated by proteolytic cleavage of its extracellular amino terminus. The new amino terminus functions as a tethered ligand and activates the receptor. Additionally, these receptors can be activated by exogenous proteases, such as house dust mite protein Der P9. These receptors can also be activated non-protealytically, by exogenous peptide sequences that mimic the final amino acids of the tethered ligand.

# Agonists and antagonists
Potent and selective small molecule agonists and antagonists for PAR2 have been discovered.
Functional selectivity occurs with PAR2, several proteases cleave PAR2 at distinct sites leading to biased signalling. Synthetic small ligands also modulate biased signalling leading to different functional responses.
So far, PAR2 has been co-crystallized with two different antagonist ligands, while an agonist-bound state model of PAR2 (with the endogenous ligand SLIGKV) has been determined through mutagenesis and structure-based drug design.
Pseudo gray platelet syndrome
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# Overview
Pseudo gray platelet syndrome was described by Cockbill, Burmester, and Heptinstall (1988) who reported a 25-year-old woman with a history of mild bruising and bleeding. Bleeding time, activated partial thromboplastin time, prothrombin time, and euglobulin lysis time were within normal limits. There were no platelet antibodies detected. The patient's mother and two sisters had histories of easy bruising and heavy menstrual periods. A brother had no reported bleeding tendencies. Platelets from the mother, sisters, and a daughter were normal in number and appearance under the light microscope. Platelets in blood collected into EDTA tubes appeared gray and agranular compared with platelets from blood in citrate or heparin. The key finding is under electron microscopy, EDTA-exposed platelets showed extensive activation, with loss of storage granule contents and pseudopod formation. Platelet aggregation studies were normal.
The abnormal platelet reaction following EDTA exposure is thought to be caused by a plasma factor, although not an immunoglobulin. The mechanism by which platelet activation occurs remains unknown. Few cases have been reported in the literature.
Pseudo-gray platelet syndrome differs from gray platelet syndrome (GPS), one of the giant platelet syndromes. GPS is characterized by thrombocytopenia, abnormally large agranular platelets in peripheral blood smears, and almost total absence of platelet alpha-granules and their constituents. The defect in GPS is the failure of megakaryocytes to package secretory proteins into alpha-granules. Patients with the GPS are affected by mild to moderate bleeding tendencies.
Pulmonary aspiration overview

# Overview
In medicine, aspiration is the entry of secretions or foreign material into the trachea and lungs. The patient may either inhale the material, or it may be blown into the lungs during positive pressure ventilation or CPR. As the right main bronchus is more vertical and of slightly wider lumen than the left, aspirated material is more likely to end up in this branch or one of its subsequent bifurcations.

# Pathophysiology
The lungs are normally protected against aspiration by a series of "protective reflexes" such as coughing and swallowing. Significant aspiration can only occur if the protective reflexes are absent (in neurological disease, coma, drug overdose, sedation or general anesthesia). In intensive care, sitting patients up reduces the risk of pulmonary aspiration and ventilator associated pneumonia.

# Natural History, Complications and Prognosis
If enough material enters the lungs, the patient may simply drown. However, small volumes of gastric acid contents can fatally damage the delicate lung tissue. Even small volumes of aspirated food may lead to bronchopneumonia infection. Chronic aspiration may lead to bronchiectasis and may cause some cases of asthma.

# Diagnosis

## Chest X Ray
The location of abscesses caused by aspiration depends on the position one is in. If one is sitting or standing up, the aspirate ends up in the posterior basal segment of the right lower lobe. If one is on one's back, it goes to the superior segment of the right lower lobe. If one is lying on the right side, it goes to the superior segment of the right middle lobe, or the posterior basal segment of the right upper lobe. If one is lying on the left, it goes to the lingula.

# Treatment

## Primary Prevention
Measures to prevent aspiration depend on the situation and the patient. In patients at imminent risk of aspiration, endotracheal intubation by a trained health professional provides the best protection. A simpler intervention that can be implemented is to lay the patient on their side in the rescue position (as taught in first aid and CPR classes), so that any vomitus produced by the patient will drain out their mouth instead of back down their pharynx.
People with chronic neurological disorders, for example, after a stroke, are less likely to aspirate thickened fluids.
Wells score for PE (original)

# Overview

# Wells Score Calculator for PE
This handy calculator computes the pre-test probability of pulmonary embolism using Wells criteria.
Check all boxes that apply to your patient:
function calcScore(){
var score = 0;
if(document.forms.checked == 1){score += 3;}
if(document.forms.checked == 1){score += 3;}
if(document.forms.checked == 1){score += 1.5;}
if(document.forms.checked == 1){score += 1.5;}
if(document.forms.checked == 1){score += 1.5;}
if(document.forms.checked == 1){score += 1;}
if(document.forms.checked == 1){score += 1;}
document.forms.value = score;
if(score < 2){document.forms.value = "Low probability of PE: Consider checking D-dimer";}
if(score >= 2 && score <= 6){document.forms.value = "Moderate probability of PE: Consider checking D-dimer";}
if(score > 6){document.forms.value = "High probability of PE: Consider imaging of the pulmonary arteries";}

# Interpretation
Shown below is the pretest probability of PE according to Wells criteria:
- Score >6: High probability (Rate of PE: ~66.7%)
- Score 2-6: Moderate probability (Rate of PE: ~20.5%)
- Score <2: Low probability (Rate of PE: ~3.6%)
Pulmonary laceration overview

# Overview
A pulmonary laceration is a chest injury in which lung tissue is torn or cut. An injury that is potentially more serious than pulmonary contusion, pulmonary laceration involves disruption of the architecture of the lung.

# Causes
Pulmonary laceration is a common result of penetrating trauma but may also be caused by blunt trauma; broken ribs may perforate the lung, or the tissue may be torn due to shearing forces that result from different rates of acceleration or deceleration of different tissues of the lung. Pulmonary laceration may result from blunt and penetrating forces that occur in the same injury and may be associated with pulmonary contusion.  As with contusions, pulmonary lacerations usually occur near solid structures in the chest such as ribs. Pulmonary laceration is suspected when rib fractures are present.

# Diagnosis

## CT
CT scanning is more sensitive and better at detecting pulmonary laceration than X-rays are,  and often reveals multiple lacerations in cases where chest X-ray showed only a contusion. Before CT scanning was widely available, pulmonary laceration was considered unusual because it was not common to find with X-ray alone. On a CT scan, pulmonary lacerations show up in a contused area of the lung, typically appearing as cavities filled with air or fluid that usually have an elliptical or ovoid shape. The roundness of the cavity is due to the elasticity of the lung.

## Other Diagnostic Studies
Pulmonary laceration is usually accompanied by hemoptysis (coughing up blood or of blood-stained sputum).Tracheobronchial injury can be ruled out using bronchoscopy. Thoracoscopy may be used in both diagnosis and treatment of pulmonary laceration.