Persius/hicric huggingface dataset:
Palivizumab clinical pharmacology

# Clinical Pharmacology

## Pharmacokinetics
In children less than or equal to 24 months of age without congenital heart disease (CHD), the mean half-life of palivizumab was 20 days and monthly intramuscular doses of 15 mg per kg achieved mean  SD 30 day trough serum drug concentrations of 37  21 mcg per mL after the first injection, 57  41 mcg per mL after the second injection, 68  51 mcg per mL after the third injection, and 72  50 mcg per mL after the fourth injection. Trough concentrations following the first and fourth Synagis dose were similar in children with CHD and in non-cardiac patients. In children given Synagis for a second season, the mean  SD serum concentrations following the first and fourth injections were 61  17 mcg per mL and 86  31 mcg per mL, respectively.
In 139 children less than or equal to 24 months of age with hemodynamically significant CHD who received Synagis and underwent cardio-pulmonary bypass for open-heart surgery, the mean  SD serum palivizumab concentration was 98  52 mcg per mL before bypass and declined to 41  33 mcg per mL after bypass, a reduction of 58% . The clinical significance of this reduction is unknown.
Specific studies were not conducted to evaluate the effects of demographic parameters on palivizumab systemic exposure. However, no effects of gender, age, body weight, or race on palivizumab serum trough concentrations were observed in a clinical study with 639 children with CHD (less than or equal to 24 months of age) receiving five monthly intramuscular injections of 15 mg per kg of Synagis.
The pharmacokinetics and safety of Synagis liquid solution and Synagis lyophilized formulation administered via intramuscular injection at 15 mg per kg were studied in a cross-over trial of 153 infants less than or equal to 6 months of age with a history of prematurity. The results of this trial indicated that the trough serum concentrations of palivizumab were comparable between the liquid solution and the lyophilized formulation, which was the formulation used in the clinical studies.
Palmar branch of the median nerve
The palmar branch of the median nerve arises at the lower part of the forearm.
It pierces the volar carpal ligament, and divides into a lateral and a medial branch;
- The lateral branch supplies the skin over the ball of the thumb, and communicates with the volar branch of the lateral antibrachial cutaneous nerve.
- The medial branch supplies the skin of the palm and communicates with the palmar cutaneous branch of the ulnar.
Papillary carcinoma of the breast

# Overview
Papillary carcinoma is an rare ductal malignancy, accounting for 1%2% of breast carcinomas. Papillary carcinomas may be solitary or multiple. When the epithelium of a papillary carcinoma has features diagnostic of intraductal carcinoma, the lesion is classified as papillary ductal carcinoma in situ. If a cystic component is present, the tumor is described as an intracystic papillary carcinoma. In the absence of an appreciable cyst, a diagnosis of solid papillary carcinoma is appropriate. Invasive elements arising in a papillary carcinoma are almost always detected at the periphery of the lesion. Papillary carcinomas are usually well circumscribed and often contain hemorrhagic and cystic areas. The mean patient age at diagnosis of papillary carcinoma is 6367 years. Approximately 50% of papillary carcinomas arise in the retroareolar region of the breast. Papillary carcinoma may manifest clinically as a palpable mass or nipple discharge, with the latter present in 22%34% of patients.

# Imaging Findings for Papillary carcinoma
- The most common mammographic pattern of invasive papillary carcinoma is a round, oval, or lobulated mass.
- The mass margins are usually circumscribed but may be obscured or indistinct
- US evaluation of invasive papillary carcinomas may reveal a hypoechoic and solid mass, often with posterior acoustic enhancement; alternatively, complex cystic and solid masses may be evident.
- There is overlap in the imaging patterns of invasive papillary carcinoma and papillary ductal carcinoma in situ.
- For patients presenting with nipple discharge, galactography may be helpful.
- Like papillomas, papillary carcinomas may be evident as ductal obstruction, filling defects, or focal or diffuse ductal wall irregularity.
Intracystic papillary carcinoma
Penciclovir indications and usage

# Indications And Usage
DENAVIR is a nucleoside analog HSV DNA polymerase inhibitor indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age or older.USE IN SPECIFIC POPULATIONS

## Pregnancy
Category B
There are no adequate and well-controlled studies in pregnant women.
Animal Data
No adverse effects on the course and outcome of pregnancy or on fetal development were noted in rats and rabbits following the intravenous administration of penciclovir at doses of 80 and 60 mg/kg/day, respectively (estimated human equivalent doses of 13 and 18 mg/kg/day for the rat and rabbit, respectively, based on body surface area conversion; the body surface area doses being 260 and 355x the maximum recommended dose following topical application of the penciclovir cream).  Because animal reproduction studies are not always predictive of human response, penciclovir should be used during pregnancy only if clearly needed.

## Nursing Mothers
There is no information on whether penciclovir is excreted in human milk after topical administration. However, following oral administration of famciclovir (the oral prodrug of penciclovir) to lactating rats, penciclovir was excreted in breast milk at concentrations higher than those seen in the plasma. Therefore, a decision should be made whether to discontinue the drug, taking into account the importance of the drug to the mother.
There are no data on the safety of penciclovir in newborns.

## Pediatric Use
An open-label, uncontrolled trial with penciclovir cream 1% was conducted in 102 patients, ages 12-17 years, with recurrent herpes labialis. The frequency of adverse events was generally similar to the frequency previously reported for adult patients. Safety and effectiveness in pediatric patients less than 12 years of age have not been established.

## Geriatric Use
In 74 patients  65 years of age, the adverse events profile was comparable to that observed in younger patients.
Penicillin G procaine description

# Description
Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) contains equal amounts of the benzathine and procaine salts of penicillin G. It is available for deep intramuscular injection.
Penicillin G benzathine is prepared by the reaction of dibenzylethylene diamine with two molecules of penicillin G. It is chemically designated as (2S,5R,6R)-3,3-Dimethyl-7-oxo-6-(2-phenylacetamido)-4-thia-1-azabicycloheptane-2-carboxylic acid compound with N,N'-dibenzylethylenediamine (2:1), tetrahydrate. It occurs as a white, crystalline powder and is very slightly soluble in water and sparingly soluble in alcohol. Its chemical structure is as follows:
Penicillin G procaine, (2S,5R,6R)-3,3-Dimethyl-7-oxo-6-(2-phenylacetamido)-4-thia-1-azabicycloheptane-2-carboxylic acid compound with 2-(diethylamino)ethyl p-aminobenzoate (1:1) monohydrate, is an equimolar salt of procaine and penicillin G. It occurs as white crystals or a white, microcrystalline powder and is slightly soluble in water. Its chemical structure is as follows:
Each disposable syringe (2 mL size) contains the equivalent of 1,200,000 units of penicillin G comprising: the equivalent of 600,000 units of penicillin G as the benzathine salt and the equivalent of 600,000 units of penicillin G as the procaine salt in a stabilized aqueous suspension with sodium citrate buffer; and as w/v, approximately 0.5% lecithin, 0.55% carboxymethylcellulose, 0.55% povidone, 0.1% methylparaben, and 0.01% propylparaben.
Bicillin C-R injectable suspension in the disposable-syringe formulation is viscous and opaque. Read CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, and DOSAGE AND ADMINISTRATION sections prior to use.
Pennsylvania College of Optometry
The Pennsylvania College of Optometry (PCO) is one of the oldest optometry schools and throughout most of the 20th century has been a leader in both training and research.  It was the first school in the United States to confer the Doctor of Optometry degree after a four-year educational program.  It was the first of all the optometry schools to receive regional accreditation and the first to offer courses in contact lenses.  PCO was the first to offer inter-disciplinary clinical training and have off-campus externship programs.  It was also the first independent college of optometry to develop graduate programs in vision rehabilitation and affiliate with a medical school.  It was also the first to revise its curriculum to integrate basic and clinical courses using a module approach; introducing clinical concepts, skills, and students presence early in the educational program rather than as an additional training after completion of basic studies.
The Eye Institute (TEI) is the main clinical facility of PCO.  TEI, from its inception to the present day, is a world renowned clinical facility that includes adult primary care, pediatric, vision rehabilitation, laser procedures, sub-specialty optometry services, and sub-specialty ophthalmology services.  This premier training facility is open on a 24 hour basis and all graduates spend time in this facility beginning early in their studies.
Within the Eye Institute is the William Feinbloom Vision Rehabilitation Center.  The center is concerned with low vision and receives patients from around the world.  It remains today the leading low vision research center in the world.
Besides two other clinical facilities in the Philadelphia area, PCO administers one of the countrys largest extern program, where doctors-in-training rotate through private practices, clinics, government facilities; veterans hospitals, Department of the Interior Indian reservation clinics, and other clinical settings to afford their graduates the widest range of experience.

# Cheltenham Township site
In 1929, Henry W. Breyer, Jr., purchased the abandoned Lindenhurst property once owned by John Wanamaker in Cheltenham on York Road, below Washington Lane. Breyer donated the former Wanamaker land to the Boy Scouts of America for use as a wildlife preserve. Camp Henry W. Breyer was sold by the Philadelphia Council in 1990 and is now the site of the Pennsylvania College of Optometry.
The Elkins Park Campus is situated on 11 acres of land in Cheltenham Township, and is three miles from The Eye Institute, the College's "clinical classroom" located in West Oak Lane. The Elkins Park Campus offers first class amenities as well as a man-made pond, often treated to resemble a 2000 Flushes Blue toilet bowl.

# External link
- Official site
Protease inhibitor (pharmacology)
Protease inhibitors (PIs) are a class of medication used to treat or prevent infection by viruses, including HIV and Hepatitis C. PIs prevent viral replication by inhibiting the activity of HIV-1 protease, an enzyme used by the viruses to cleave nascent proteins for final assembly of new virons.
Protease inhibitors have been developed or are presently undergoing testing for treating various viruses:
- HIV/AIDS: antiretroviral protease inhibitors (saquinavir, ritonavir, indinavir, nelfinavir etc.)
- Hepatitis C: experimental agents: BILN 2061, VX 950.
Given the specificity of the target of these drugs there is the risk, as in antibiotics, of the development of drug-resistant mutated viruses. To reduce this risk it is common to use together different drugs aimed at different targets.

# Antiretrovirals
Protease inhibitors were the second class of antiretroviral drugs developed. In all cases, patents remain in force until 2010 or beyond.

# Antiprotozoal Activity
Researchers are investigating the use of protease inhibitors developed for HIV treatment as anti-protozoals for use against malaria and gastrointestinal protozoal infections:
- A combination of ritonavir and lopinavir was found to have some effectiveness against Giardia infection. 
- The drugs saquinavir, ritonavir, and lopinavir have been found to have anti-malarial properties.  
- A cysteine protease inhibitor drug was found to cure Chagas disease in mice.
Photophobia (patient information)
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# Overview
Photophobia is eye discomfort in bright light.
Photophobia is a fairly common symptom. For many people, photophobia is not due to any disease. Severe photophobia may occur with eye problems and can cause severe eye pain even in relatively low light.

# What are the symptoms?
- Blurred vision
- Changes in hearing
- Dizziness
- Headache
- Itching
- Nausea
- Neck stiffness
- Numbness or tingling elsewhere in the body
- Pain in the eye
- Redness
- Sore or wound in eye
- Swelling

# What are the causes?
- Acute iritis or uveitis (inflammation inside eye)
- Burns to the eye
- Corneal abrasion
- Corneal ulcer
- Drugs such as amphetamines, atropine, cocaine, cyclopentolate, idoxuridine, phenylephrine, scopolamine, trifluridine, tropicamide, and vidarabine
- Excessive wearing of contact lenses, or wearing badly fitted contact lenses
- Eye disease, injury, or infection (such as chalazion, episcleritis, glaucoma)
- Eye testing when the eyes have been dilated
- Meningitis
- Migraine headache

# Diagnosis
The doctor will perform a physical examination, including an eye exam. You may be asked the following questions:
- When did the light sensitivity begin?
- Does it hurt all the time or just sometimes?
- How bad is it?
- Do you need to wear dark glasses or stay in dark rooms?
- Did a doctor recently dilate your pupils?
- Have you used any eye drops?
- Do you use contact lenses?
- Have you used soaps, lotions, cosmetics, or other chemicals around your eyes?
- Have you been around dust, wind, sun, pollen, or chemicals?
- Does anything make the sensitivity better or worse?
- Have you been injured?
- What medicines do you take?
- What other symptoms do you have?
The following tests may be done:
- Corneal scraping
- Lumbar puncture
- Pupil dilation
- Slit-lamp examination

# When to seek urgent medical care?
If eye pain is severe, see your health care provider to determine the cause of light sensitivity. Proper treatment may cure the problem. Seek urgent medical attention if your pain is moderate to severe, even in low-light conditions.
Call your doctor if light sensitivity is severe or painful -- for example, if you need to wear sunglasses indoors.
Also call if the sensitivity occurs with headaches, red eye or blurred vision or does not go away in a day or two.

# Treatment options

### Home care
You can reduce the discomfort of light sensitivity by:
- Avoiding sunlight
- Closing your eyes
- Wearing dark glasses
- Darkening the room

# Sources
Poly(tetramethylene ether) glycol
Poly(tetramethylene ether) glycol ia a polyether polyol. It is also known as PTMEG or  polytetrahydrofuran and various tradenames such as "Terathane" and "PolyTHF". One of its CAS Registry Numbers is .
It is prepared by acid-catalyzed polymerization of tetrahydrofuran.. The polymers are of moderate size, usually having number average molecular weights of between 250 and 3000 da, for example see the "Terathane" series of PTMEG from Invista.
The main use for PTMEG polymers is to make elastomeric fibers such as Spandex. These elastomers are either polyurethanes made by reacting PTMEG with diisocyanates, or polyesters made by reacting PTMEG with diacids or their derivatives.
Polyzene-F (patient information)
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# Overview
Although the debate over stent usage has until now centered on the merits of bare-metal versus drug-eluting stents, new research shows that there may be a novel alternative approach to stenting which offers all the benefits of a drug-eluting device with none of the drawbacks: stents treated with a nanothin layer of Polyzene-F.
Polyzene-F, patented by CeloNova BioSciences, Inc., is an inert surface treatment which prevents inflammation and platelet adhesion while promoting rapid, healthy endothelial cell growth and vessel healing. As a result, a stent treated with Polyzene-F inhibits both restenosis and thrombus formation without the need to resort to an anti-proliferative drug and potentially indefinite dual antiplatelet therapy.
Posterior tibial recurrent artery
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The posterior tibial recurrent artery, an inconstant branch, is given off from the anterior tibial before that vessel passes through the interosseous space.
It ascends in front of the Popliteus, which it supplies, and anastomoses with the inferior genicular branches of the popliteal artery, giving an offset to the tibiofibular joint.
Proximal isovelocity surface area
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Synonyms and related keywords: PISA

# Overview
The proximal isovelocity surface area (PISA) technique can be used to estimate the flow across the regurgitant valve together with the Effective Regurgitant Orifice Area (EROA).
The technique is an application of the continuity principle with the underlying assumption being that the flow at the hemispheric first alias proximal surface is equal to the orificial flow at the same time in the cardiac cycle.
In order to measure these indices of regurgitation it is necessary to perform both continuous wave Doppler (CWD)  and colour Doppler analyses of representative cardiac cycles.
Vmax (the peak velocity of the regurgitant flow signal) is measured with CWD.
Colour Doppler is then used to measure the radius (RA1) of the first aliased hemispheric shell at a Nyquist limit (Scale Value) typically in the range 30 - 40 cm/sec (VN).  

## Typical values of PISA radius (at VN of 38 cm/sec) for mitral regurgitation of differing severity are:
- Grade              PISA Radius(mm)
- Mild:              < 3.5
- Moderate:          3.5 - 7.5
- Moderately Severe: 7.5 - 14.5
- Severe:            > 14.5

## Typical values of PISA Flow for mitral regurgitation of differing severity are:
- Grade              PISA Q
- Mild:              < 30 ml/sec
- Moderate:          30 - 130 ml/sec
- Moderately Severe: 130 - 500 ml/sec
- Severe:            > 500 ml/sec

## Typical values of EROA for mitral regurgitation of differing severity are:
- Grade              EROA(mm2)
- Mild:              < 20
- Moderate:          20 - 29
- Moderately Severe: 30 - 39
- Severe:            > 40
According to Kolev et al, the PISA technique may be particularly appropriate for the estimation of the severity of mitral regurgitation in the patient with an eccentric regurgitant jet.

# How to Calculate PISA?
- Shift Aliasing velocity to 40 cm/sec
- Cine to mid systole
- Measure radius (cm)
- Calculate r2/ 2 to get ERO
- To Calculate Volume (cc) ERO x TVI of mitral valve
Pseudomembranous colitis overview

# Overview
Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression "C. diff colitis" is used almost interchangeably with the more proper term of pseudomembranous colitis. The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can be severe, causing toxic megacolon, or even fatal.

# Pathophysiology
The use of broad-spectrum antibiotics such as clindamycin and cephalosporins causes the normal bacterial flora of the bowel to be altered. In particular, when the antibiotic kills off other, competing bacteria in the intestine, any bacteria remaining will have less competition for space and nutrients there. The net effect is to permit much more extensive growth than normal of certain bacteria. Clostridium difficile is one such type of bacteria. In addition to proliferating in the bowel, the C. diff also elaborates a toxin. It is this toxin that is responsible for the diarrhea which characterizes pseudomembranous colitis.

# Causes
The Clostridium difficile bacteria is normally seen in the intestine. However, it may overgrow when you take antibiotics. The bacteria release a powerful toxin that causes the lining of the colon to become inflammed and bleed.
The most common antibiotics associated with this condition are ampicillin, clindamycin, fluoroquinolones, cephalosporins, rabeprazole
Pseudomembranous colitis is rare in infants younger than 12 months old and uncommon in children.  It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and who are not in the hospital.

# Risk Factors
In most cases a patient presenting with pseudomembranous colitis has recently been on antibiotics.  Antibiotics disturb the normal bowel bacterial flora. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition.  Even though they are not particularly likely to cause pseudomembranous colitis, but, rather, due to their very frequent use, cephalosporin antibiotics (such as cefazolin and cephalexin) account for a large percentage of cases. Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors.

# Treatment

## Surgery
In rare cases, surgery is needed to treat infections that get worse or do not respond to antibiotics.

## Prevention
A randomized controlled trial using a probiotic drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus was reported to have some efficacy. This study was sponsored by the company that produces the drink studied . Although intriguing, several other studies have been unable to demonstrate any benefit of oral supplements of similar bacteria at preventing CDAD.