Persius/hicric huggingface dataset:
Nafcillin sodium dosage and administration

# Dosage and Administration
Nafcillin for injection Pharmacy Bulk Package is available for intravenous use only. The usual I.V. dosage for adults is 500 mg every 4 hours. For severe infections, 1 gram every 4 hours is recommended. Administer slowly over at least 30 to 60 minutes to minimize the risk of vein irritation and extravasation.
Bacteriologic studies to determine the causative organisms and their susceptibility to nafcillin should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with nafcillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer duration of therapy.
Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Nafcillin-probenecid therapy is generally limited to those infections where very high serum levels of nafcillin are necessary.
No dosage alterations are necessary of patients with renal dysfunction, including those on hemodialysis. Hemodialysis does not accelerate nafcillin clearance from the blood.
For patients with hepatic insufficiency and renal failure, measurement of nafcillin serum levels should be performed and dosage adjusted accordingly.
With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Do not add supplementary medication to nafcillin.
Oral preparation of the penicillinase-resistant penicillins should not be used as initial therapy in serious life-threatening infections (see PRECAUTIONS, General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
Novel human coronavirus infection overview

# Overview
Novel human coronavirus is a new strain of coronavirus that has not been previously identified in humans. A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. A novel coronavirus (human betacoronavirus 2c EMC/2012) has caused a handful of infections in three countries in the Middle East. Although it does not seem to be transmitted between humans, it can cause severe disease and death, and scientists are watching closely for new cases.

# Historical Perspective
The virus first emerged in the Middle East, and was discovered on September 2012 in a Qatari patient who had recently traveled to Saudi Arabia. Virologist Ron Fouchier has speculated that the virus might originate from bats.

# Causes
Novel human coronavirus is a ssRNA positive-strand viruses with no DNA stage. It belongs to order Nidovirales and family Coronaviridae.

# Differentiating Novel Human Coronavirus Infection from other Diseases
WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily between people, unlike the SARS virus.

# Diagnosis

## History and Symptoms
In confirmed cases of illness in humans, common symptoms have been acute, serious respiratory illness with fever, cough, shortness of breath, and breathing difficulties. Based on current clinical experience, the infection generally presents as pneumonia. It is important to note that the current understanding of the illness caused by this infection is based on a limited number of cases and may change as more information becomes available.

## Laboratory Findings
Lab  tests (polymerase chain reaction or PCR) for the novel coronavirus are  available at CDC and other international labs. Otherwise, these tests are not routinely  available.

## Other Diagnostic Studies
The United Kingdom's Health Protection Agency is working on the genetic sequence of the virus, based on the sequence obtained from the Qatari case.

# Treatment

## Medical Therapy
There  are no specific treatments for illnesses caused by the novel coronavirus.  Many of the symptoms caused by this virus can be treated and therefore treatment should be based on the symptoms of the patient. Medical care is supportive and highly effective.
PCI complications: peri procedure bleeding
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# Overview
Peri-procedure bleeding is one of the most frequent complications of percutaneous coronary interventions, and independent predictor of mortality.. Although periprocedural bleeding is almost unavoidable clinical complication in coagulopathies,  manipulation after a careful evaluation of the patient may help to reduce its frequency. 

# Peri-procedure Bleeding

# 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)

## Bleeding Risk (DO NOT EDIT)
Papular purpuric gloves and socks syndrome
Synonyms and keywords: PPGSS

# Overview
Papular purpuric gloves and socks syndrome (PPGSS) is an uncommon cutaneous condition with a typical purpuric exanthem limited to hands and feet.

# Causes
- An association with parvovirus B19 has been described.
- The syndrome has also been associated with several viruses such as HHV6, measles and coxsackie B6

# Epidemiology and Demographics
- PPGSS occurs primarily in teenagers and young adults.

# Natural History, Complications and Prognosis
- Rash and fever completely resolved in less than 3 days.
- The disease has a short course and a benign prognosis.

# Diagnosis

## Symptoms
PPGSS is characterized by
- Pruritus
- Fever

## Physical Examination

### Extremities
- Edema
- Erythema of the hands and feet, 

## Laboratory Findings
- All laboratory tests are normal.
- Positive serology for Parvovirus B19. IgM is positive but not IgG.
- Viral DNA test to detect the virus.
Paroxysmal AV Block Historical Perspective

# Overview
One of the first reported cases of paroxysmal AV block was secondary to mitral valvulitis, indicating an intrinsic conduction defect. A similar block was later seen in the Bundle of His, wherein during a hypothesized zone of opportunity, a spontaneous depolarization of conducting fibres was seen. Idiopathic paroxysmal AV block may be diagnosed by a positive response to adenosine triphosphate.

# Famous Cases
- In 1931, Adolph Sachs et al reported one of the first cases on paroxysmal AV block. The patient had presented with multiple spells of palpitations, hot flashes, dizziness, ringing in the ears, weakness and diaphoresis accompanied by convulsions. During an acute episode, he noticed an irregular ventricular rhythm, irregular complexes and given a time interval of 30 seconds, the ventricle would beat once in the first 15 second window and 4-5 times in the succeeding window.  It was noticed that the duration of the block progressively increased until it was present all the time. Mitral valvulitis was put down as the cause of the attack and the fact that a response to atropine does not rule out an intrinsic conduction defect was emphasized. "Paroxysmal complete auriculo-ventricular heart-block: A case report - ScienceDirect"..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}
- In 1972, Philippe Coumel et al hypothesized that the cause of bradycardia/pause dependent AV block was the spontaneous depolarization of specialized conducting fibers in the late stages of diastole. It was during this zone of opportunity that they noticed this AV dissociation. In this case, they found that the block occurred to be proximal to the division of the His bundle. 
- In 1997. Brignole et al first described EI AVB in a group of 15 syncope patients with an initial negative work up. They fortuitously stumbled upon ECG findings indicating a paroxysmal AV block and reconfirmed this by performing an adenosine triphosphate test in each patient.
Paroxysmal AV Block other imaging findings

# Overview
Cardiac nuclear imaging techniques can be useful to detect and/or discriminate amongst infiltrative cardiomyopathies.

# Other Imaging Studies

## 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay
- Cardiac nuclear imaging techniques help diagnose infiltrative cardiomyopathies,  most notably in distinguishing between wild-type transthyretin and light chain cardiac amyloidosis and sarcoidosis.
Pediatric Basic Life Support(BLS) overview

# Overview
Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).
- Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all  found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)
- Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
- Good Prognostic Factor upon arrival at the emergency department-
The short interval between arrest and arrival at the hospital.
Less than 20 minutes of resuscitation in the emergency department.
Less than 2 doses of epinephrine.
- The short interval between arrest and arrival at the hospital.
- Less than 20 minutes of resuscitation in the emergency department.
- Less than 2 doses of epinephrine.
Piperacillin tazobactam sodium description

# Description
ZOSYN (piperacillin and tazobactam) for Injection and ZOSYN (piperacillin and tazobactam) Injection are injectable antibacterial combination products consisting of the semisynthetic antibacterial piperacillin sodium and the -lactamase inhibitor tazobactam sodium for intravenous administration.
Piperacillin sodium is derived from D(-)--aminobenzyl-penicillin. The chemical name of piperacillin sodium is sodium (2S,5R,6R)-6--3,3-dimethyl-7-oxo-4-thia-1-azabicycloheptane-2-carboxylate. The chemical formula is C23H26N5NaO7S and the molecular weight is 539.5. The chemical structure of piperacillin sodium is:
Tazobactam sodium, a derivative of the penicillin nucleus, is a penicillanic acid sulfone. Its chemical name is sodium (2S,3S,5R)-3-methyl-7-oxo-3-(1H-1,2,3-triazol-1-ylmethyl)-4-thia-1-azabicycloheptane-2-carboxylate-4,4-dioxide. The chemical formula is C10H11N4NaO5S and the molecular weight is 322.3. The chemical structure of tazobactam sodium is:
ZOSYN (piperacillin and tazobactam) for Injection, is a white to off-white sterile, cryodesiccated powder consisting of piperacillin and tazobactam as their sodium salts packaged in glass vials. The formulation also contains edetate disodium dihydrate (EDTA) and sodium citrate.
Each ZOSYN 2.25 g single dose vial contains an amount of drug sufficient for withdrawal of piperacillin sodium equivalent to 2 grams of piperacillin and tazobactam sodium equivalent to 0.25 g of tazobactam. The product also contains 0.5 mg of EDTA per vial.
Each ZOSYN 3.375 g single dose vial contains an amount of drug sufficient for withdrawal of piperacillin sodium equivalent to 3 grams of piperacillin and tazobactam sodium equivalent to 0.375 g of tazobactam. The product also contains 0.75 mg of EDTA per vial.
Each ZOSYN 4.5 g single dose vial contains an amount of drug sufficient for withdrawal of piperacillin sodium equivalent to 4 grams of piperacillin and tazobactam sodium equivalent to 0.5 g of tazobactam. The product also contains 1 mg of EDTA per vial.
Each Zosyn 40.5 g pharmacy bulk vial contains piperacillin sodium equivalent to 36 grams of piperacillin and tazobactam sodium equivalent to 4.5 g of tazobactam sufficient for delivery of multiple doses.
ZOSYN Injection in the Galaxy Container is a frozen iso-osmotic sterile non-pyrogenic premixed solution. The components and dosage formulations are given in the table below:
ZOSYN contains a total of 2.79 mEq (64 mg) of sodium (Na+) per gram of piperacillin in the combination product.
Prednisone instructions for administration

# Instructions for administration
instructions for administration#Determining dosage| Determining dosage]
instructions for administration#Spontaneous remission|Spontaneous remission]
instructions for administration#Prolonged therapy|Prolonged therapy]
instructions for administration#Initial dosage|Initial  dosage]
instructions for administration#Maintenance dosage| Maintenance dosage]

## Determining dosage
The severity, prognosis, expected duration of the disease, and the reaction of the patient to medication are primary factors in determining dosage. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT.  instructions for administration#Instructions for administration|Return to top]

## Spontaneous remission
If a period of spontaneous remission occurs in a chronic condition, treatment should be discontinued.   instructions for administration#Instructions for administration|Return to top]

## Prolonged therapy
Blood pressure, body weight, routine laboratory studies, including two-hour postprandial blood glucose and serum potassium, and a chest X-ray should be obtained at regular intervals during prolonged therapy. Upper GI X-rays are desirable in patients with known or suspected peptic ulcer disease.  instructions for administration#Instructions for administration|Return to top]

## Initial dosage
The initial dosage of Prednisone may vary from 5 mg to 60 mg per day depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, Prednisone should be discontinued and the patient transferred to other appropriate therapy.  instructions for administration#Instructions for administration|Return to top]

### Maintenance dosage
After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patientas individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation, it may be necessary to increase the dosage of Prednisone for a period of time consistent with the patientas condition. If after long-term therapy the drug is to be stopped, it recommended that it be withdrawn gradually rather than abruptly.  instructions for administration#Instructions for administration|Return to top]
Adapted from the FDA Package Insert.
Purine nucleoside phosphorylase deficiency
Synonyms and keywords: PNP-deficiency

# Overview
Purine nucleoside phosphorylase deficiency, often called PNP-deficiency, is a rare congenital immunodeficiency of purine nucleoside phosphorylase. This enzyme is important in the purine degradation pathway. A deficiency of it causes T-cell immunodeficiency. It is also often associated with neurological disorders such as mental retardation. This autosomal recessive metabolic disorder results in severe combined immunodeficiency.

# Historical Perspective

# Classification

# Pathophysiology
The disorder is caused by a disruption of the purine nucleoside phosphorylase, a key enzyme in the purine salvage pathway.
This enzyme is required for purine degradation. Specifically, it catalyzes the conversion of inosine and guanosine to hypoxanthine. A deficiency of it leads to build up of elevated deoxy-GTP (dGTP) levels resulting in T-cell toxicity and deficiency.
In contrast to adenosine deaminase deficiency (another deficiency of purine metabolism), there is minimal disruption to B cells.

# Causes

# Differentiating Purine nucleoside phosphorylase deficiency from Other Diseases

# Epidemiology and Demographics

## Prevalence
File:Autorecessive.svg
PNP-deficiency is extremely rare. Only 33 patients with the disorder in the United States have been documented. In the United Kingdom only one child has been diagnosed with this disorder.

# Risk Factors

# Screening

# Natural History, Complications, and Prognosis

## Natural History

## Complications

## Prognosis

# Diagnosis

## Diagnostic Criteria

## History and Symptoms
In addition to the symptoms associated with immunodeficiency, such as depletion of T-cells, decline of lymphocyte activity, and an abrupt proliferation of both benign and opportunistic infections, PNP-deficiency is often characterized by the development of autoimmune disorders. Lupus-erythematosis, autoimmune hemolytic anemia, and idiopathic thrombocytopenic purpura have been reported with PNP-deficiency.
Neurological symptoms, such as developmental decline, hypotonia, and mental retardation have also been reported.

## Physical Examination

## Laboratory Findings

## Imaging Findings

## Other Diagnostic Studies

# Treatment

## Medical Therapy

## Surgery

## Prevention
Respiratory distress assessment instrument
Synonyms and keywords: RDAI

# Overview
The respiratory distress assessment instrument (RDAI) is an assessment scale to evaluate the severity of illness in infants.

# Historical Perspective
The RDAI was developed in 1987 to measure response to treatment of bronchiolitis.

# Data Source for Derivation and Validation
The RDAI was tested for reliability by two of the original investigators. They reported weighted kappa of 0.9.

# Usage and Application of the Instrument
Recently, the construct validity of the RDAI has been challenged due to low correlation with subsequent admission to the hospital or length of stay (LOS). In a study of 65 children, the intraclass correlation coefficient was 0.39 (95% CI: 0.170.58 ) as measured by respiratory therapists. This suggests 'poor' agreement. The Children's Hospital of Wisconsin Respiratory Score (CHWRS) may better predict the need for admission.
Additional alternative scales are:
- Court's scale which includes respiratory rate and assessments of retractions, adventitial sounds, skin color, and general condition.
- Bronchiolitis severity score (BSS) which includes respiratory rate and assessments of wheezing, retractions and general condition.
- Respiratory distress observation scale (RDOS). This rates four findings on a scale ranging from 0 to 3 so that total scores range from 0 to 12.
- Tal and modified-Tal scoring systems

# The Instrument
Rizatriptan patient counseling information

# Patient Counseling Information
See FDA-Approved Patient Labeling (Patient Information).
Risk of Myocardial Ischemia and/or Infarction, Prinzmetal's Angina, Other Vasospasm-Related Events, and Cerebrovascular Events
Inform patients that MAXALT may cause serious cardiovascular side effects such as myocardial infarction or stroke. Although serious cardiovascular events can occur without warning symptoms, patients should be alert for the signs and symptoms of chest pain, shortness of breath, weakness, slurring of speech, and should ask for medical advice when observing any indicative sign or symptoms. Patients should be apprised of the importance of this follow-up .

### Serotonin Syndrome
Patients should be cautioned about the risk of serotonin syndrome with the use of MAXALT or other triptans, particularly during combined use with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) .

### Pregnancy
Inform patients that MAXALT should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus .

### Nursing Mothers
Advise patients to notify their healthcare provider if they are breastfeeding or plan to breastfeed .

### Ability to Perform Complex Tasks
Since migraines or treatment with MAXALT may cause somnolence and dizziness, instruct patients to evaluate their ability to perform complex tasks during migraine attacks and after administration of MAXALT.

### Medication Overuse Headache
Inform patients that use of acute migraine drugs for 10 or more days per month may lead to an exacerbation of headache, and encourage patients to record headache frequency and drug use (e.g., by keeping a headache diary) .

### Handling of Orally Disintegrating Tablets Packages
Instruct patients not to remove the blister from the outer aluminum pouch until ready to use the orally disintegrating tablet inside .

### Patients with Phenylketonuria
Inform phenylketonuric patients that MAXALT-MLT Orally Disintegrating Tablets contain phenylalanine (a component of aspartame). Each 5-mg orally disintegrating tablet contains 1.1 mg phenylalanine, and each 10-mg orally disintegrating tablet contains 2.1 mg phenylalanine .