Persius/hicric huggingface dataset:
Amphotericin B liposomal microbiology

# Microbiology

## Mechanism of Action
Amphotericin B, the active ingredient of AmBisome, acts by binding to the sterol component, ergosterol, of the cell membrane of susceptible fungi. It forms transmembrane channels leading to alterations in cell permeability through which monovalent ions (Na+, K+, H+, and Cl-) leak out of the cell resulting in cell death. While amphotericin B has a higher affinity for the ergosterol component of the fungal cell membrane, it can also bind to the cholesterol component of the mammalian cell leading to cytotoxicity. AmBisome, the liposomal preparation of amphotericin B, has been shown to penetrate the cell wall of both extracellular and intracellular forms of susceptible fungi.
Activity In Vitro and In Vivo
AmBisome has shown in vitro activity comparable to amphotericin B against the following organisms: Aspergillus fumigatus, Aspergillus flavus, Candida albicans, Candida krusei, Candida lusitaniae, Candida parapsilosis, Candida tropicalis), Cryptococcus neoformans, and Blastomyces dermatitidis.

## Drug Resistance
Mutants with decreased susceptibility to amphotericin B have been isolated from several fungal species after serial passage in culture media containing the drug, and from some patients receiving prolonged therapy. Drug combination studies in vitro and in vivo suggest that imidazoles may induce resistance to amphotericin B. However, the clinical relevance of drug resistance has not been established.

## Susceptibility Testing
Standardized methods of in vitro antifungal susceptibility testing have been developed for testing yeasts (1, 2, 3) and filamentous fungi (4, 5). The clinical relevance of the test results is not always clear.
Ampicillin sulbactam clinical studies

# Clinical Studies
Data from a controlled clinical trial conducted in pediatric patients provided evidence supporting the safety and efficacy of UNASYN for the treatment of skin and skin structure infections. Of 99 pediatric patients evaluable for clinical efficacy, 60 patients received a regimen containing intravenous UNASYN, and 39 patients received a regimen containing intravenous cefuroxime. This trial demonstrated similar outcomes (assessed at an appropriate interval after discontinuation of all antimicrobial therapy) for UNASYN- and cefuroxime-treated patients:
Most patients received a course of oral antimicrobials following initial treatment with intravenous administration of parenteral antimicrobials. The study protocol required that the following three criteria be met prior to transition from intravenous to oral antimicrobial therapy: (1) receipt of a minimum of 72 hours of intravenous therapy; (2) no documented fever for prior 24 hours; and (3) improvement or resolution of the signs and symptoms of infection.
The choice of oral antimicrobial agent used in this trial was determined by susceptibility testing of the original pathogen, if isolated, to oral agents available. The course of oral antimicrobial therapy should not routinely exceed 14 days.
Aortic regurgitation surgery overview
For the WikiPatient page for this topic, click here; For the main page of aortic insufficiency, click here
Related Key Words and Synonyms: Aortic valve replacement.

# Overview
Aortic valve replacement is indicated in patients with severe aortic insufficiency who are either symptomatic or those who have a left ventricular end-diastolic diameter >55 mm or 25 mm/m2 or an left ventricular ejection fraction <55%.
The majority of patients with severe aortic regurgitation requiring surgery undergo aortic valve replacement instead of aortic valve repair which is sometimes preformed at highly specialized surgical centers which have appropriate technical expertise and experience in selecting potential patients.

# Advanatges of A Mechanical Valve
Mechanical valves are made of man-made (synthetic) materials, such as a metal like titanium.  Mechanical heart valves do not fail often. They last from 12 to 20 years.  However, blood clots develop on them. If a blood clot forms, the patient may have a stroke. Anticoagulation with warfarin will be required which can be associated with bleeding.

# Advantages of A Bioprosthetic Valve
Bioprosthetic valves are made of human or animal tissue. Biological valves do not require anticoagulation, but they tend to fail over time.Patients with a biological valve may need to have the valve replaced in 10 to 15 years.

# Selecting A Mechanical Verssus a Bioprosthetic Valve
The 2006 American College of Cardiology/American Heart Association (ACC/AHA) recommendations for the choice of aortic valve :
- If the patient is under 65 years of age and does not have a contraindication to anticoagulation then a mechanical valve is preferred.
- If the patient is 65 years of age and does not have risk factors for thromboembolism, then a bioprosthetic valve is reasonable
- If the patient already has a mechanical valve in the mitral or tricuspid position and already requires anticoagulation, then a mechical valve is preferred
- If the patient has active prosthetic valve endocarditis, then the valve should be replaced
- If the patient has contraindications to anticoagulation therapy regardless his or her age, then a bioprosthetic valve is indicated

# Operative Mortality
The risk of death or serious complications from isolated aortic valve replacement is typically between 1-3%, depending on the health and age of the patient, as well as the skill of the surgeon and the health care institute. The patient's past history of heart surgery affects the mortality rate as well.
Interphalangeal articulations of hand

# Overview
The interphalangeal articulations of hand are hinge-joints of the phalanges of the hand. There are two sets (except in the thumb):
- "proximal interphalangeal joints" (PIP), those between the first (also called proximal) and second (intermediate) phalanges
- "distal interphalangeal joints" (DIP), those between the second and third (distal) phalanges
A similar group of articulations also function in the toes.

# Ligaments
Each joint has a volar ligament and two collateral ligaments.
The arrangement of these ligaments is similar to those in the metacarpophalangeal joints (also known as MCP joints).
The extensor tendons supply the place of posterior ligaments.

# Movements
The only movements permitted in the interphalangeal joints are flexion and extension.
- Flexion is more extensive, about 100, in the PIP joints and slightly more restricted, about 80, in the DIP joints.
- Extension is limited by the volar and collateral ligaments.
The muscles generating these movements are:
Azithromycin (ophthalmic) description

# Description
AzaSite (azithromycin ophthalmic solution) is a 1% sterile aqueous topical ophthalmic solution of azithromycin formulated in DuraSite (polycarbophil, edetate disodium, sodium chloride). AzaSite is an off-white, viscous liquid with an osmolality of approximately 290 mOsm/kg.
Preservative: 0.003% benzalkonium chloride. Inactives: mannitol, citric acid, sodium citrate, poloxamer 407, polycarbophil, edetate disodium (EDTA), sodium chloride, water for injection, and sodium hydroxide to adjust pH to 6.3.
Azithromycin is a macrolide antibiotic with a 15-membered ring. Its chemical name is (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-13--2-ethyl-3,4,10-trihydroxy-3,5,6,8,10,12,14-heptamethyl-11-oxy]-1-oxa-6-aza-cyclopentadecan-15-one, and the structural formula is:Azithromycin has a molecular weight of 749, and its empirical formula is C38H72N2O12.
Bedaquiline dosage and administration

# Dosage and Administration
SIRTURO should only be used in combination with at least 3 other drugs to which the patient's MDR-TB isolate has been shown to be susceptible in vitro. If in vitro testing results are unavailable, treatment may be initiated with SIRTURO in combination with at least 4 other drugs to which the patient's MDR-TB isolate is likely to be susceptible.
Throughout treatment with, and following the last intake of SIRTURO, patients should continue to take their companion drugs as directed.
The recommended dosage of SIRTURO is:
- Weeks 12: 400 mg (4 tablets of 100 mg) once daily with food
- Weeks 324: 200 mg (2 tablets of 100 mg) 3 times per week with food (with at least 48 hours between doses) for a total dose of 600 mg per week.
The total duration of treatment with SIRTURO is 24 weeks. The SIRTURO tablet should be swallowed whole with water. Patients should avoid alcohol use while on treatment.

## Missed doses
Patients should be advised of the need to take SIRTURO as prescribed. Compliance with the full course of therapy must be emphasized.
If a dose is missed during the first 2 weeks of treatment, patients should not make up the missed dose but should continue the usual dosing schedule. From Week 3 onwards, if a 200 mg dose is missed, patients should take the missed dose as soon as possible, and then resume the 3 times a week regimen.
Brachydactyly - arterial hypertension

# Overview
Brachydactyly - arterial hypertension syndrome is characterised by the association of brachydactyly and hypertension.

# Pathophysiology
Magnetic resonance imaging (MRI) in 15 patients with this syndrome demonstrated loops in the posterior and inferior cerebellar arteries in all affected individuals (but not in the unaffected members of the kindred) that may lead to neurovascular compression and be responsible for the hypertension.

## Genetics
The causative gene is dominantly inherited and has been mapped to chromosome 12p (region 12p12.2-p11.2). The hypertension is severe but responds to antihypertensive drugs. Without treatment, affected individuals often die of a stroke before the age of 50.

# Differentiating Brachydactyly - arterial hypertension from other Diseases
The condition resembles an essential hypertension as the activity of the renin-angiotensin system and sympathetic nervous system is normal and the hypertension is salt-insensitive. Hypertensive retinopathy is rarely found.

# Epidemiology and Demographics
It is a rare disease that has been described in less than 100 patients belonging to less than 10 families. Most of the reported patients were Turkish, from a small area on the North-eastern Black Sea coast, but the syndrome has also been described in Japanese, US and Canadian families.

# Diagnosis
- Hypertension
- Brachydactyly is of the type E form, mainly affecting the metacarpals.
- Phalanges might be normal or shortened.
- The syndrome usually is associated with short proportionate stature.
CMV esophagitis (patient information)
For the WikiDoc page for this topic, click here

# Overview
Cytomegalovirus (CMV) esophagitis is a viral infection of the esophagus, the muscular tube through which food travels from the mouth to the stomach.

# What are the symptoms of CMV esophagitis?
Symptoms include:
- Difficult and painful swallowing
- Low-grade fever
- Mouth sores (oral lesions)

# What causes CMV esophagitis?
CMV esophagitis is caused by the cytomegalovirus (CMV).

# Who is at highest risk?
The condition is often a sign of a weakened immune system. The following conditions raise your risk for CMV infections:
- HIV/AIDS
- Chemotherapy
- Diabetes
- Leukemia or lymphoma
- Organ transplants
- Other conditions that suppress or weaken your immune system

# Diagnosis
- Blood and urine culture
- CMV antigenemia
- Cold agglutinins
- Culture of cells obtained from an esophageal brushing
- Esophagogastroduodenoscopy (EGD) with or without a biopsy

# When to seek urgent medical care?
Call your health care provider if you develop symptoms of CMV esophagitis, especially if you have a suppressed immune system.

# Treatment options
Treatment involves antiviral medications that are given through a vein (intravenously), such as ganciclovir or foscarnet. In some cases, patients are given an antiviral medicine called valganciclovir, which is taken by mouth.
Some people with this condition also need pain medicine.
Many people who are treated for an episode of CMV esophagitis take medicine to suppress the CMV for a long time.

# Where to find medical care for CMV esophagitis?
Directions to Hospitals Treating CMV esophagitis

# What to expect (Outlook/Prognosis)?
Esophagitis can usually be treated effectively. The outcome depends on the immune system problem that makes the person more likely to get the infection.

# Possible complications
- Infection at other sites
- Holes in your esophagus (perforations)
- Recurrent infection

# Prevention of CMV esophagitis
Preventing AIDS can help avoid opportunistic infections, such as those caused by CMV. Opportunistic infections are caused by organisms that do not usually lead to disease, but that take advantage of a damaged immune system. People with AIDS who are effectively treated with antiretroviral therapy are much less likely to get CMV infection.

# Sources
Capreomycin sulfate adverse reactions

# Adverse Reactions

## Nephrotoxicity
In 36% of 722 patients treated with Capastat Sulfate, elevation of the BUN above 20 mg/100 mL has been observed. In many instances, there was also depression of PSP excretion and abnormal urine sediment. In 10% of this series, the BUN elevation exceeded 30 mg/100 mL.
Toxic nephritis was reported in 1 patient with tuberculosis and portal cirrhosis who was treated with Capastat Sulfate (1 g) and aminosalicylic acid daily for 1 month. This patient developed renal insufficiency and oliguria and died. Autopsy showed subsiding acute tubular necrosis.
Electrolyte disturbances including hypokalemia, hypomagnesemia and hypocalcemia, sometimes serious in nature, have been reported.

## Ototoxicity
Subclinical auditory loss was noted in approximately 11% of 722 patients undergoing treatment with Capastat Sulfate. This was a 5- to 10-decibel loss in the 4000- to 8000-CPS range. Clinically apparent hearing loss occurred in 3% of the 722 subjects. Some audiometric changes were reversible. Other cases with permanent loss were not progressive following withdrawal of Capastat Sulfate.
Tinnitus and vertigo have occurred.

## Liver
Serial tests of liver function have demonstrated a decrease in BSP excretion without change in AST (SGOT) or ALT (SGPT) in the presence of preexisting liver disease. Abnormal results in liver function tests have occurred in many persons receiving Capastat Sulfate in combination with other antituberculosis agents that also are known to cause changes in hepatic function. The role of Capastat Sulfate in producing these abnormalities is not clear; however, periodic determinations of liver function are recommended.

## Blood
Leukocytosis and leukopenia have been observed. The majority of patients treated have had eosinophilia exceeding 5% while receiving daily injections of Capastat Sulfate. This has subsided with reduction of the Capastat Sulfate dosage to 2 or 3 g weekly.
Pain and induration at the injection site have been observed. Excessive bleeding at the injection site has been reported. Sterile abscesses have been noted. Rare cases of thrombocytopenia have been reported.

## Hypersensitivity
Urticaria and maculopapular skin rashes associated in some cases with febrile reactions have been reported when Capastat Sulfate and other antituberculosis drugs were given concomitantly.
Cefotetan Compatibility and Stability

# Compatibility and Stability of CEFOTAN Products
Frozen samples should be thawed at room temperature before use. After the periods mentioned below, any unused solutions or frozen material should be discarded. DO NOT REFREEZE.
NOTE: Solutions of CEFOTAN must not be admixed-with solutions containing aminoglycosides. If CEFOTAN and aminoglycosides are to be administered to the same patient, they must be administered separately and not as a mixed injection. DO NOT ADD SUPPLEMENTARY MEDICATION.
CEFOTEAN DISODIUM FOR INJECTION
CEFOTAN (cefotetan disodium for injection) reconstituted as described above (PREPARATION OF SOLUTION) maintains satisfactory potency for 24 hours at room temperature (25C/77F), for 96 hours under refrigeration (5C/41F), and for at least 1 week in the frozen state (-20C/-4F). After reconstitution and subsequent storage in disposable glass or plastic syringes, CEFOTAN (cefotetan disodium for injection) is stable for 24 hours at room temperature and 96 hours under refrigeration.
ADD-Vantage Vials
Ordinarily, ADD-Vantage Vials should be reconstituted only when it is certain that the patient is ready to receive the drug. However, ADD-Vantage Vials of CEFOTAN reconstituted as described in Preparation of Solution, for ADD-Vantage Vials, maintains satisfactory potency for 24 hours at room temperature (25C/77F).
(DO NOT REFRIGERATE OR FREEZE CEFOTAN IN ADD-VANTAGE VIALS.)
CEFOTETAN INJECTION
The thawed solution in Galaxy plastic container (PL 2040) remains chemically stable for 48 hours at room temperature (25C/77F) or for 21 days under refrigeration (5C/41F).
NOTE: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Cefpodoxime dosage and administration
FILM-COATED TABLETS
VANTIN Tablets should be administered orally with food to enhance absorption. (See CLINICAL PHARMACOLOGY.)
The recommended dosages, durations of treatment, and applicable patient population are as described in the following chart:
Adults and Adolescents (age 12 years and older)
GRANULES FOR ORAL SUSPENSION
VANTIN Oral Suspension may be given without regard to food. The recommended dosages, durations of treatment, and applicable patient populations are as described in the following chart:
Adults and Adolescents (age 12 years and older)
Infants and Pediatric Patients (age 2 months through 12 years)
Patients with Renal Dysfunction
For patients with severe renal impairment (<30 mL/min creatinine clearance), the dosing intervals should be increased to Q 24 hours. In patients maintained on hemodialysis, the dose frequency should be 3 times/week after hemodialysis.
When only the serum creatinine level is available, the following formula (based on sex, weight, and age of the patient) may be used to estimate creatinine clearance (mL/min). For this estimate to be valid, the serum creatinine level should represent a steady state of renal function.
Patients with Cirrhosis
Cefpodoxime pharmacokinetics in cirrhotic patients (with or without ascites) are similar to those in healthy subjects. Dose adjustment is not necessary in this population.
Preparation of Suspension
After mixing, the suspension should be stored in a refrigerator, 2 to 8C (36 to 46F). Shake well before using. Keep container tightly closed. The mixture may be used for 14 days. Discard unused portion after 14 days.
Ceftaroline dosage and administration

# Recommended Dosage
The recommended dosage of Teflaro is 600 mg administered every 12 hours by intravenous (IV) infusion over 1 hour in patients  18 years of age. The duration of therapy should be guided by the severity and site of infection and the patient's clinical and bacteriological progress.
The recommended dosage and administration by infection is described inTable 1.
Patients with Renal Impairment
Preparation of Solutions
Aseptic technique must be followed in preparing the infusion solution. The contents of Teflaro vial should be constituted with 20 mL Sterile Water for Injection, USP; or 0.9% of sodium chloride injection (normal saline); or 5% of dextrose injection; or lactated ringer's injection. The preparation of Teflaro solutions is summarized inTable 3.
The constituted solution must be further diluted in range between 50 mL to 250 mL before infusion into patients. Use the same diluent for this further dilution, unless sterile water for injection was used earlier. If sterile water for injection was used earlier, then appropriate infusion solutions include: 0.9% Sodium Chloride Injection, USP (normal saline); 5% Dextrose Injection, USP; 2.5% Dextrose Injection, USP, and 0.45% Sodium Chloride Injection, USP; or Lactated Ringer's Injection, USP. The resulting solution should be administered over approximately 1 hour.
Constitution time is less than 2 minutes. Mix gently to constitute and check to see that the contents have dissolved completely. Parenteral drug products should be inspected visually for particulate matter prior to administration.
The color of Teflaro infusion solutions ranges from clear, light to dark yellow depending on the concentration and storage conditions. When stored as recommended, the product potency is not affected.
Studies have shown that the constituted solution in the infusion bag should be used within 6 hours when stored at room temperature or within 24 hours when stored under refrigeration at 2 to 8o C (36 to 46o F).
The compatibility of Teflaro with other drugs has not been established. Teflaro should not be mixed with or physically added to solutions containing other drugs.
Preparation of 600 mg of Teflaro dose in 50 mL
Withdraw 20 mL of diluent from the infusion bag. Proceed to inject entire content of the Teflaro vial into the bag to provide a total volume of 50 mL. The resultant concentration is approximately 12 mg/mL.
Preparation of 400 mg of Teflaro dose in 50 mL
Withdraw 20 mL of diluent from the infusion bag. Proceed to inject entire content of the Teflaro vial into the bag to provide a total volume of 50 mL. The resultant concentration is approximately 8 mg/mL.