Persius/hicric huggingface dataset:
Naratriptan use in specific populations

# Special Populations

### Age
A small decrease in clearance (approximately 26%) was observed in healthy elderly subjects (65 to 77 years) compared to younger patients, resulting in slightly higher exposure (see PRECAUTIONS).

### Race
The effect of race on the pharmacokinetics of naratriptan has not been examined.

### Renal Impairment
Clearance of naratriptan was reduced by 50% in patients with moderate renal impairment (creatinine clearance, 18 to 39 mL/min) compared to the normal group. Decrease in clearances resulted in an increase of mean half-life from 6 hours (healthy) to 11 hours (range: 7 to 20 hours). The mean Cmax increased by approximately 40%. The effects of severe renal impairment (creatinine clearance: 15 mL/min) on the pharmacokinetics of naratriptan has not been assessed (see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION).

### Hepatic Impairment
Clearance of naratriptan was decreased by 30% in patients with moderate hepatic impairment (Child-Pugh grade A or B). This resulted in an approximately 40% increase in the half-life (range: 8 to 16 hours). The effects of severe hepatic impairment (Child-Pugh grade C) on the pharmacokinetics of naratriptan have not been assessed (see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION).
Nephrolithiasis resident survival guide

# Overview
Nephrolithiasis is the presence of stones, in the kidneys or the ureters, formed by different substances.  The common presentation is a severe colic type pain in the abdomen flanks, sometimes including nausea, vomits or even fever.

# Causes

## Life Threatening Causes
- Renal Obstruction
- Renal Isquaemia
- Renal Impairment

## Common Causes
- Hypercalciuria
- Hyperoxaluria
- Hypernatruria
- Hypocitraturia
- Hyperuricosuria
- Cystinuria
- Gout
- Metabolic acidosis
- Previous chemotherapy for Lymphoma and Leukemia
- Urine Infection
- Drug related stones
Allopurinol
Triamterene
Indinavir
- Allopurinol
- Triamterene
- Indinavir

# Management

## Diagnostic Approach
Shown below is an algorithm depicting the diagnostic approach to Nephrolithiasis  based on the 2014 Review of the Cleveland Clinic, urological and kidney institute.

## Therapeutic Approach
Shown below is an algorithm depicting the therapeutic approach to Nephrolithiasis:
Spontaneous passage
Intervention

# Do s
- Perform a metabolic evaluation in patients with risk factors for stone recurrence
Family history of nephrolithiasis
Presence of biliary stone disease
Nephrocalcinosis
Stones are formed from cysteine, uric acid or calcium phosphate
The patient is a child
- Family history of nephrolithiasis
- Presence of biliary stone disease
- Nephrocalcinosis
- Stones are formed from cysteine, uric acid or calcium phosphate
- The patient is a child
- Administer tamsulosin and corticosteroids to help stones pass quicker and with less analgesics.
- Proceed intravenously in patients who are unable to take oral fluids or oral medications and with hypotension.
- Perform

# Don ts
- Do not recommend calcium restrictions, as the may increase the urinary oxalate excretion.
- Do not administer NSAIDs when extracorporeal shock lithotripsy is planned, as it may increase the risk of perinephric bleeding.
- Do not perform extracorporeal shock lithotripsy in women who want to have children, percutaneous nephrolithotomy is a safer option.
Off-pump coronary artery bypass surgery
, Cafer Zorkun, M.D., Ph.D. 

# Overview
Off-pump coronary artery bypass is a form of coronary artery bypass surgery (CABG) performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease.
Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery.  The medical community believed cardiopulmonary bypass caused a post-operative cognitive decline known as postperfusion syndrome (informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass.
Off-pump surgery is associated with less blood transfusions, but is more technically challenging. The technique has a steep learning curve, and the quality of the anastomoses is lower, at least until a surgeon has gained much experience.  Off-pump surgery remains a useful technique for some more complicated cases, such as people whose aorta is calcified.
PCI in the left internal mammary artery

# Overview
Percutaneous coronary intervention in the left internal mammary artery poses several challenges for the interventional cardiologist. A short guide catheter must be used because the distance to the lesion may be quite long, and all efforts must be made to preserve the workable length of the balloon. There is often poor guide catheter support to engage the internal mammary artery. Finally, the internal mammary artery is susceptible to spasm confusing the the diagnosis and treatment of the disease.

# PCI in The Left Internal Mammary Artery

## Pathophysiology
The left internal mammary artery can develop disease at 4 separate sites:
- At the ostium. This should not be confused for spasm. The ostium of the IMA is prone to spasm and aggressive therapy with nitrates is recommended to minimize the possibility that the lesion is due to spasm rather than fixed obstructive disease.
- At the site of a kink in the IMA.
- In the body of the IMA (somewhat rare)
- At the anastomosis of the IMA with the LAD
- An intervention is sometimes performed in the native LAD distal to the anastomosis

## Technical Considerations
- A short guiding catheter should be used (a 100 cm guide). Otherwise the balloon will not reach distal parts of the left internal mammary artery.
- Coronary spasm may develop at the ostium during the procedure which can be confused with a dissection. Nitrates and repositioning of the wire to minimize wire bias should be performed before stenting the ostium.
- The approach to kinks in an artery such as the IMA is discussed elsewhere.
Particular values of the Gamma function
The Gamma function is an important special function in mathematics. Its particular values can be expressed in closed form for integer and half-integer arguments, but no simple expressions are known for the values at rational points in general.

# Integers and half-integers
For non-negative integer arguments, the Gamma function coincides with the factorial, that is,
and hence
For positive half-integers, the function values are given exactly by
-r equivalently,
where n!! denotes the double factorial. In particular,
and by means of the reflection formula,

# General rational arguments
In analogy with the half-integer formula,
where n!^{(k)} denotes the k:th multifactorial of n. By exploiting such functional relations, the Gamma function of any rational argument p/q can be expressed in closed algebraic form in terms of \Gamma(1/q). However, no closed expressions are known for the numbers \Gamma(1/q) where q > 2. Numerically,
It is unknown whether these constants are transcendental in general, but \Gamma(1/3) was shown to be transcendental by Le Lionnais in 1983 and Chudnovsky showed the transcendence of \Gamma(1/4) in 1984. \Gamma(1/4) / \pi^{-1/4} has also long been known to be transcendental, and Yuri Nesterenko proved in 1996 that \Gamma(1/4), \pi and e^{\pi} are algebraically independent.
The number \Gamma(1/4) is related to the lemniscate constant S by
and it has been conjectured that
where  is the Masser-Gramain constant.
Borwein and Zucker have found that \Gamma(n/24) can be expressed algebraically in terms of , K(k(1)), K(k(2)), K(k(3)) and K(k(6)) where K(k(N)) is a complete elliptic integral of the first kind. This permits efficiently approximating the Gamma function of rational arguments to high precision using quadratically convergent arithmetic-geometric mean iterations. No similar relations are known for \Gamma(1/5) or other denominators.
In particular, \Gamma(1/4) is given by
Other formulas include the infinite products
and
where A is the Glaisher-Kinkelin constant and G is Catalan's constant.

# Other constants
The Gamma function has a local minimum on the positive real axis
with the value
Integrating the reciprocal Gamma function along the positive real axis also gives the Fransen-Robinson constant.
Penciclovir cream (patient information)

# Why is this medication prescribed
Penciclovir is used on the lips and faces of adults to treat cold sores caused by herpes simplex virus. Penciclovir does not cure herpes infections but decreases pain and itching if applied when the earliest symptoms first appear.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How should this medicine be used
Penciclovir comes as a cream. It is usually used externally every 2 hours while you are awake for 4 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist or doctor to explain any part you do not understand. Use penciclovir exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Use this medication as soon as possible after symptoms appear.
Clean and dry the area before applying the cream to avoid spreading the infection. Rub the cream in gently, using enough cream to cover all sores completely.
Continue to use penciclovir even if you feel well. Do not stop using penciclovir without talking to your doctor.

# What special precautions should I follow
Before using penciclovir:
- tell your doctor and pharmacist if you are allergic to penciclovir, acyclovir (Zovirax), or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking penciclovir, call your doctor.

# What should I do if I forget a dose
Apply the missed dose as soon as you remember it and apply any remaining doses for that day at evenly spaced intervals. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.

# Side effects
Penciclovir may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- irritation at the site of application

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# What other information should I know
Keep all appointments with your doctor. Penciclovir should only be used on the lips and face. Avoid getting it in your eyes. Keep the infected area clean and dry.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. If you still have symptoms of infection after you finish the penciclovir, call your doctor.

# Brand names
- Denavir
Pericardial effusion treatment overview

# Overview
Treatment of pericardial effusion depends on the underlying cause and the severity of the problem. Some pericardial effusions remain small and never require treatment. Patients with acute inflammatory signs may get symptomatic relief with anti-inflammatory drugs. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space.

# Treatment
- Pericardial effusion due to a viral infection usually resolves within a few weeks without treatment.
- Some pericardial effusions remain small and never require treatment.
- If the pericardial effusion is due to a condition such as lupus, treatment with aspirin or non-steroid anti-inflammatory drugs may provide benefit.
- If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space.
- A drainage tube is often left in place for several days.  In some cases, surgical drainage may be required by pericardiocentesis, in which a needle, and sometimes a catheter are used to drain excess fluid.  Pericardial window is made surgically in patients with recurrent pericardial effusion which drains the fluid into peritonial cavity
Portal hypertensive gastropathy surgery
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# Overview

# Surgery

## Transcutaneous Intrahepatic Portosystemic Shunt
Transcutaneous intrahepatic portosystemic shunt procedures, or TIPS involve decompressing the portal vein by shunting a portal venule to a lower pressure systemic venule, under guidance with fluoroscopy.  Since it treats the root cause of portal hypertension gastropathy, it has been putatively used for the condition.  The literature reports suggest both regression of portal hypertensive gastropathy on endoscopic images and improvement in bleeding after TIPS.

## Cryotherapy
Finally, cryotherapy involves the use of pressurized carbon dioxide administered through the endoscope to freeze and destroy tissue in a focal area.  It is being studied for the treatment of portal hypertensive gastropathy.
Post traumatic stress disorder overview
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# Overview
Post traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death or a threat to the patient's or someone else's life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping.
It is important to make a distinction between PTSD and traumatic stress, which is a similar condition, but of less intensity and duration. The condition has also been known historically or colloquially as shell shock, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).
Presumed ocular histoplasmosis syndrome

# Overview
Presumed ocular histoplasmosis syndrome (POHS) is a syndrome affecting the eye, which is characterized by peripheral atrophic chorioretinal scars, atrophy or scarring adjacent to the optic disc and maculopathy.
The loss of vision in POHS is caused by choroidal neovascularization.

# Causes
Despite its name, the "presumed" relationship of POHS to Histoplasma capsulatum is controversial. The fungus has rarely been isolated from cases with POHS, the condition has also been found in locations where histoplasmosis is rare, and there appears to be a relationship with tobacco smoking.

# Presentation
The diagnosis of POHS is based on the clinical triad of multiple white, atrophic choroidal
scars, peripapillary pigment changes (dark spots around optic disc of the eye), and a maculopathy caused by choroidal neovascularization.
Completely distinct from POHS, acute ocular histoplasmosis may rarely occur in immunodeficiency.

# Diagnosis
Fluorescein angiography is usually performed for diagnosis and follow-up of patients with POHS.

# Treatment
Treatment requires careful consideration of angiographic findings when a choroidal neovascular membrane is suspected which is a condition that responds to treatment. A vitreo-retinal specialist (an ophthalmologist specialized in treatment of retinal diseases) should be consulted for proper management of the case.
Presumed ocular histoplasmosis syndrome and age-related macular degeneration (AMD) have been successfully treated  with laser, anti-vascular endothelial growth factors and photodynamic therapy. Ophthalmologists are using anti-vascular endothelial growth factors to treat AMD and similar conditions since research indicates that vascular endothelial growth factor (VEGF) is one of the causes for the growth of the abnormal vessels that cause these conditions.
Protein Misfolding Cyclic Amplification
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"PMCA" redirects here.  For the transport protein, see Plasma membrane Ca2+ ATPase.
Protein Misfolding Cyclic Amplification (PMCA) is an amplification technique (like PCR) to multiply misfolded prions. It is a test for spongiform encephalopathies like BSE. 
The technique initially incubates a small amount of abnormal prion with an excess of normal protein, so that some conversion takes place. The growing chain of misfolded protein is then blasted with ultrasound, breaking it down into smaller chains and so rapidly increasing the amount of abnormal protein available to cause conversions. By repeating the cycle, the mass of normal protein is rapidly changed into misfolded prion.
Pyrimethamine dosage and administration

# Dosage And Administration

## For Treatment of Toxoplasmosis
The dosage of DARAPRIM for the treatment of toxoplasmosis must be carefully adjusted so as to provide maximum therapeutic effect and a minimum of side effects. At the dosage required, there is a marked variation in the tolerance to the drug. Young patients may tolerate higher doses than older individuals. Concurrent administration of folinic acid is strongly recommended in all patients.
The adult starting dose is 50 to 75 mg of the drug daily, together with 1 to 4 g daily of a sulfonamide of the sulfapyrimidine type, e.g. sulfadoxine. This dosage is ordinarily continued for 1 to 3 weeks, depending on the response of the patient and tolerance to therapy. The dosage may then be reduced to about one half that previously given for each drug and continued for an additional 4 to 5 weeks.
The pediatric dosage of DARAPRIM is 1 mg/kg/day divided into 2 equal daily doses; after 2 to 4 days this dose may be reduced to one half and continued for approximately 1 month. The usual pediatric sulfonamide dosage is used in conjunction with DARAPRIM.

## For Treatment of Acute Malaria
DARAPRIM is NOT recommended alone in the treatment of acute malaria. Fast-acting schizonticides, such as chloroquine or quinine, are indicated for treatment of acute malaria. However, DARAPRIM at a dosage of 25 mg daily for 2 days with a sulfonamide will initiate transmission control and suppression of non-falciparum malaria. DARAPRIM is only recommended for patients infected in areas where susceptible plasmodia exist. Should circumstances arise wherein DARAPRIM must be used alone in semi-immune persons, the adult dosage for acute malaria is 50 mg for 2 days; children 4 through 10 years old may be given 25 mg daily for 2 days. In any event, clinical cure should be followed by the once-weekly regimen described below for chemoprophylaxis. Regimens which include suppression should be extended through any characteristic periods of early recrudescence and late relapse, i.e., for at least 10 weeks in each case.

## For Chemoprophylaxis of Malaria
Adults and pediatric patients over 10 years  25 mg (1 tablet) once weekly
Children 4 through 10 years  12.5 mg (1/2 tablet) once weekly
Infants and children under 4 years  6.25 mg (1/4 tablet) once weekly.
Radial catheterization contraindication

# Relative Contraindications
- Absence of palpable radial artery pulse
- Abnormal Allen test (oximetry/ plethysmography), indicating that only one artery supplies the hand
- Presence of upper extremity peripheral vascular disease such as Buerger's disease and severe Raynaud's disease
- Presence of arteriovenous shunt for dialysis
- Potential use of the radial artery as a conduit for aortocoronary bypass
- Cellulitis or other infections over the radial artery
- Coagulation defects
- Patients who may require intra-aortic balloon pump counterpulsation (IABP)
- Devices that are not compatible in 7F or smaller sheaths such as TEC, larger Rotoblator burrs, certain stents
- Congenital abnormalities of upper limb vasculature such as extreme tortuosity, anomalous take off of the radial artery, or severe atherosclerosis
Recessive multiple epiphyseal dysplasia
Recessive multiple epiphyseal dysplasia is a disorder of cartilage and bone development. This condition has relatively mild signs and symptoms, including joint pain, scoliosis, and malformations of the hands, feet, and knees. 
Some affected individuals are born with an inward- and downward-turning foot (a clubfoot). An abnormality of the kneecap called a double-layered patella is also relatively common. Although some people with recessive multiple epiphyseal dysplasia have short stature as adults, most are of normal height.

# Genetic prevalence
This condition is inherited in an autosomal recessive pattern, the incidence is unknown as many cases are not diagnosed due to mild symptoms.
Mutations in the SLC26A2 gene cause recessive multiple epiphyseal dysplasia. Recessive multiple epiphyseal dysplasia is the mildest condition in a spectrum of skeletal disorders caused by mutations in the SLC26A2 gene. This gene provides instructions for making a protein that is essential for the normal development of cartilage and for its conversion to bone. Mutations in the SLC26A2 gene alter the structure of developing cartilage, preventing bones from forming properly and resulting in the skeletal problems characteristic of recessive multiple epiphyseal dysplasia.
Reference ranges for common blood tests
A reference range is a set of values used by a health professional to interpret a set of medical test results. The range is usually defined as the set of values 95% of the normal population falls within.
The reference range will vary, depending on the age, sex and  race of a population, and even the instruments the laboratory uses to perform the tests. Furthermore, by definition, 5% of the normal population will fall outside the reference range.

# Clinical biochemistry
- Items marked with a  are part of "CHEM-7" and CHEM-20
- Items marked with a - are part of "CHEM-20", but not CHEM-7
- Not listed:  chloride,  carbon dioxide, - uric acid,

# Hematology

# Immunology
Systemic inflammatory response syndrome
For more information about sepsis spectrum syndromes, click here.
Synonyms and keywords: SIRS

# Overview
In medicine, systemic inflammatory response syndrome (SIRS) is an inflammatory state of the whole body (the "system") without a proven source of infection. It is a serious medical condition.

# Definition of SIRS , 
Criteria for SIRS were agreed in 1992. SIRS can be diagnosed when two or more of the following are present:
- Heart rate > 90 beats per minute
- Temperature  38 C (100.4 F)
- Tachypnea > 20 breaths per minute or, on blood gas, a PaCO2 < 32 mm Hg
- White blood cell count  12000 cells/mm3 ( 12 x 109 cells/L), or > 10% band forms (immature white blood cells / bandemia).

# Difference between SIRS and sepsis
SIRS with a suspected or proven infection is called sepsis.
Simply stated:

# Complications of SIRS
SIRS can result in the multiple organ dysfunction syndrome.

# Causes of SIRS
- Severe trauma
- Postoperative complication
- Burns
- Acute pancreatitis
- Immunodeficiency (such as AIDS)

# Relation to cytokine storm
SIRS can be considered to be a subset of cytokine storm, a general term (not commonly used in clinical medicine) for cytokine dysregulation.