Persius/hicric huggingface dataset:
Solitary pulmonary nodule secondary prevention

# Overview
The American College of Chest Physicians (ACCP) and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule.

# Secondary Prevention

## CT Surveillance
The American College of Chest Physicians (ACCP) recommends the following:
- If less than 8 mm in size, use guidelines by the Fleischner society (see table below).
- For nodules greater than 8 mm in diameter, assess the patient's risk of complications from thoracic surgery:
In low - moderate risk, assess the probability of cancer by a validated calculator and follow up with CT scan surveillance. A model developed at the Mayo Clinic has been the most extensively validated. An open-source version is available online.
In high risk, assess the probability of cancer by a validated calculator and obtain non-surgical biopsy.
- In low - moderate risk, assess the probability of cancer by a validated calculator and follow up with CT scan surveillance. A model developed at the Mayo Clinic has been the most extensively validated. An open-source version is available online.
- In high risk, assess the probability of cancer by a validated calculator and obtain non-surgical biopsy.
- The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society guideline:
Southern tick-associated rash illness overview

# Overview
A rash similar to the rash of Lyme disease has been described in humans following bites of the lone star tick, Amblyomma americanum. The rash may be accompanied by fatigue, fever, headache, muscle and joint pains. This condition has been named southern tick-associated rash illness (STARI). The cause of STARI is not known.

# Causes
The cause of STARI is unknown. Studies have shown that is not caused by Borrelia burgdorferi, the bacterium that causes Lyme disease. Another spirochete, Borrelia lonestari, was detected in the skin of one patient and the lone star tick that bit him. However, subsequent study of over two dozen STARI patients has found no evidence of B. lonestari infection.
STARI is specifically associated with bites of Amblyomma americanum, known commonly as the lone star tick.

# Diagnosis

## Laboratory Findings
STARI is diagnosed on the basis of symptoms, geographic location, and possibility of tick bite. Because the  cause of STARI is unknown, no diagnostic blood tests have been developed.

# Treatment

## Medical Therapy
It is not known whether antibiotic treatment is necessary or beneficial for patients with STARI. Nevertheless, because STARI resembles early Lyme disease, physicians will often treat patients with oral antibiotics.
Sudden infant death syndrome electrocardiogram

# Overview
There are no specific ECG findings associated with sudden infant death syndrome (SIDS). An ECG may be helpful in the diagnosis of long QT syndrome which is associated with SIDS.

# Electrocardiogram
- There are no specific ECG findings associated with sudden infant death syndrome (SIDS).
- An ECG may be helpful in the diagnosis of long QT syndrome which in some cases associated with the SIDS.
Transporter associated with antigen processing
Transporter associated with antigen processing (TAP) protein complex belongs to the ATP-binding-cassette transporter family. It delivers cytosolic peptides into the endoplasmic reticulum (ER), where they bind to nascent MHC class I molecules.
The TAP structure is formed of two proteins: TAP-1 and TAP-2, which have one hydrophobic region and one ATP-binding region each. They assemble into a heterodimer, which results in a four-domain transporter.

# Function
The TAP transporter is found in the ER lumen associated with the peptide-loading complex (PLC). This complex of 2 microglobulin, calreticulin, ERp57, TAP, tapasin, and MHC class I acts to keep hold of MHC molecules until they have been fully loaded with peptides.

## Peptide transport
TAP-mediated peptide transport is a multistep process. The peptide-binding pocket is formed by TAP-1 and TAP-2. Association with TAP is an ATP-independent event, in a fast bimolecular association step, peptide binds to TAP, followed by a slow isomerisation of the TAP complex. It is suggested that the conformational change in structure triggers ATP hydrolysis and so initiates peptide transport.
Both nucleotide-binding domains (NBDs) are required for peptide translocation, as each NBD cannot hydrolyse ATP alone. The exact mechanism of transport is not known; however, findings indicate that ATP binding to TAP-1 is the initial step in the transport process, and that ATP bound to TAP-1 induces ATP binding in TAP-2. It has also been shown that undocking of the loaded MHC class I is linked to the transport cycle of TAP caused by signals from the TAP-1 subunit.

## Specificity
The ATPase activity of TAP is highly dependent on the presence of the correct substrate, and peptide binding is prerequisite for ATP hydrolysis. This prevents waste of ATP via peptide-independent hydrolysis.
The specificity of TAP proteins was first investigated by trapping peptides in the ER using glycosylation. TAP binds to 8- to 16-residue peptides with equal affinity, while translocation is most efficient for peptides that are 8 to 12 residues long. Efficiency reduces for peptides longer than 12 residues. However, peptides with more than 40 residues were translocated, albeit with low efficiency.  Peptides with low affinity for the MHC class I molecule are transported out of the ER by an efficient ATP-dependent export protein. These outlined mechanisms may represent a mechanism for ensuring that only high-affinity peptides are bound to MHC class I.
Zolmitriptan how supplied storage and handling

# How Supplied/Storage and Handling
2.5 mg Orally Disintegrating Tablets - White to off white, round tablets debossed F7 on one side and plain on the other side are supplied in cartons containing a blister pack of 6 unit-dose tablets (NDC 68462-499-76)
5 mg Orally Disintegrating Tablets - White to off-white, round tablets debossed F11on one side and plain on the other side are supplied in cartons containing a blister pack of 3 unit-dose tablets (NDC 68462-500-33)
Store zolmitriptan orally disintegrating tablets at 20 to 25C (68 to 77F); . Protect from light and moisture.
Abacavir lamivudine dosage and administration

# Dosage And Administration
- A Medication Guide and Warning Card that provide information about recognition of hypersensitivity reactions should be dispensed with each new prescription and refill.
- EPZICOM can be taken with or without food.

## Adult Patients
The recommended oral dose of EPZICOM for adults is one tablet daily, in combination with other antiretroviral agents.

## Dosage Adjustment
Because it is a fixed-dose combination, EPZICOM should not be prescribed for:
- patients requiring dosage adjustment such as those with creatinine clearance <50 mL/min,
- patients with hepatic impairment.
Use of EPIVIR (lamivudine) Oral Solution or Tablets and ZIAGEN (abacavir sulfate) Oral Solution may be considered.
Abrupt closure and distal embolization case 1

# Abrupt Closure and Distal Embolization
Shown below is a pre-intervention angiogram with significant lesion in the mid LAD. The small circle indicates the presence of thrombus in the proximal LAD.
Shown below is a post-intervention angiogram with occlusion at the mid LAD depicting abrupt closure.
Shown below is a post-intervention angiogram with occlusion at the distal LAD depicting distal embolization.
Abrupt closure and loss of side branch case 1

# Abrupt Closure and Loss of Side Branch
Shown below is a pre-intervention angiogram with significant lesion in the mid RCA.
Shown below is a post-intervention angiogram with occlusion at the mid RCA depicting abrupt closure.
Shown below is a post-intervention angiogram with occlusion of the acute marginal branch after intervention on the RCA depicting loss of side branch.
Abrupt closure and loss of side branch case 2

# Abrupt Closure and Loss of Side Branch
Shown below is a pre-intervention angiogram with significant lesion in the mid LCX with continuation into the proximal part of obtuse marginal branch.
Shown below is an angiogram with ongoing intervention on the significant lesion described above.
Shown below is a post-intervention angiogram with occlusion at the mid LCX depicting abrupt closure. It can also be considered as a loss of side branch, as the occluded mid LCX looks like a side branch after the origin of obtuse marginal branch.
Abrupt closure and loss of side branch case 3

# Abrupt Closure and Loss of Side Branch
Shown below is a pre-intervention angiogram with significant lesion in the mid RCA.
Shown below is a post-intervention angiogram without any lesion in the RCA.
Shown below is a post-intervention angiogram with occlusion at the mid RCA depicting abrupt closure.
Shown below is a post-intervention angiogram with occlusion of the acute marginal branch after intervention on the RCA depicting loss of side branch.
Abrupt closure and loss of side branch case 4

# Abrupt Closure and Loss of Side Branch
Shown below is a pre-intervention angiogram with multiple significant lesions in the mid RCA.
Shown below is an angiogram with ongoing intervention on the significant lesion in the mid RCA.
Shown below is a post-intervention angiogram with occlusion at the mid RCA depicting abrupt closure.
Shown below is an angiogram with ongoing intervention on the significant lesion in the mid RCA.
Shown below is a post-intervention angiogram with occlusion of the acute marginal branch after intervention on the RCA depicting loss of side branch.
Acute Coronary Syndrome (Assessment and Plan)
Author: William J Gibson MD, PhD
Patient presents with XX hour history of  chest pain that radiates to , associated with . EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 2 MI given high concern for supply-demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy, myocarditis),  non-plaque associated thromboembolism (Afib, cardioversion, PFO), coronary dissection, vascular steal, vasculitis.
Dx:
- Serial EKG (Q30 mins initially), if STEMI
- Serial troponins (admission, 2H and 6H) if concern ACS rapidly evolving, 3x Q6H for rule-out (if 5th generation hsTn: Serial troponins Q3H sufficient)
Risk stratification:
- TIMI Risk Score (NSTEMI): 
- If GRACE Score > 140, early invasive strategy may be preferred (cath <72h ) 
- HbA1c, lipid panel
- Consider further risk stratification (stress test vs CT angio vs coronary angiography)
- TTE to rule out new wall motion abnormality
Tx:
- Treat any secondary causes of myocardial ischemia (eg AF w RVR, anemia, hypoxemia (only if O2sat <92%), infection)
Initial therapy:
- Anticoagulation/Anti-platelet: ASA (325), Heparin drip (goal PTTT 60-80), defer clopidogrel on admission given unclear if patient will need CABG
- Rate: Metoprolol 25mg PO Q6H, titrate to HR 50-60 (will hold if evidence of shock, AV-block)
- Pain: sublingual nitro PRN (caution if inferior MI), defer morphine given interference with P2Y12 inhibitors and retrospective analyses suggesting increased adverse events.
- Defer oxygen given randomized evidence of increased infarct size in STEMI without hypoxia 
- Lipids: Atorvastatin 80mg 
Long term: Plan for ASA 81mg QD, P2Y12 (preference: ticagrelor>prasugrel>clopidogrel), Beta blocker, Statin, ACE (esp if EF<40%)/ARB, consider spironolactone (RALES), ezetimibe (IMPROVE-IT), low-dose rivaroxaban (ATLAS-2), empagliflozin if DM (EMPA-REG).
Post-stenting:
- if stented will give clopidogrel 75mg PO QD (30 days of BMS, 1 year for DES)
References:
- Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-75.
- Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015;131(24):2143-50.
- Cannon CP, Braunwald E, Mccabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495-504.
Amelogenesis imperfecta (patient information)
For the WikiDoc page for this topic, click here

# Overview
Amelogenesis imperfecta is a tooth development disorder in which the teeth are covered with thin, abnormally formed enamel.

# What are the symptoms of Amelogenesis imperfecta?
The enamel of the tooth is soft and thin. The teeth appear yellow and are easily damaged. Both baby teeth and permanent teeth are affected.

# What causes Amelogenesis imperfecta?
Amelogenesis imperfecta is passed down through families as a dominant trait. That means you only need to get the abnormal gene from one parent in order for you to get the disease.

# Diagnosis
A dentist can identify and diagnose the condition.

# When to seek urgent medical care?
Call your dentist if you have symptoms of this condition.

# Treatment options
The treatment depends on the severity of the problem. Full crowns will improve the appearance of the teeth and protect them from damage.

# Where to find medical care for Amelogenesis imperfecta?
Directions to Hospitals Treating Amelogenesis imperfecta

# What to expect (Outlook/Prognosis)?
Treatment is often successful in protecting the teeth.

# Possible complications
The enamel is easily fractured and damaged, which affects the appearance of the teeth, especially if left untreated.

# Sources
Amoxicillin-clavulanate potassium description

# Description
AUGMENTIN is an oral antibacterial combination consisting of amoxicillin and the betalactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid).
Amoxicillin is an analog of ampicillin, derived from the basic penicillin nucleus, 6aminopenicillanic acid. The amoxicillin molecular formula is C16H19N3O5S3H2O, and the molecular weight is 419.46. Chemically, amoxicillin is (2S,5R,6R)-6--3,3-dimethyl-7-oxo-4-thia-1-azabicycloheptane-2-carboxylic acid trihydrate and may be represented structurally as:
Clavulanic acid is produced by the fermentation of Streptomyces clavuligerus. It is a beta-lactam structurally related to the penicillins and possesses the ability to inactivate some betalactamases by blocking the active sites of these enzymes. The clavulanate potassium molecular formula is C8H8KNO5, and the molecular weight is 237.25. Chemically, clavulanate potassium is potassium (Z)(2R,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-1-azabicyclo-heptane-2-carboxylate and may be represented structurally as:
- Inactive Ingredients:
- Each 125-mg chewable tablet and each 5 mL of reconstituted 125/5 mL oral suspension of AUGMENTIN contains 0.16 mEq potassium
- Each 250-mg chewable tablet and each 5 mL of reconstituted 250/5 mL oral suspension of AUGMENTIN contains 0.32 mEq potassium
- Each 200-mg chewable tablet and each 5 mL of reconstituted 200/5 mL oral suspension of AUGMENTIN contains 0.14 mEq potassium
- Each 400-mg chewable tablet and each 5 mL of reconstituted 400/5 mL oral suspension of AUGMENTIN contains 0.29 mEq potassium
Association for International Cancer Research

# Overview
Association for International Cancer Research (AICR) is a cancer research association based in the United Kingdom.
Originally founded in 1979 as the UK branch of the National Foundation for Cancer Research, an American cancer charity, the Association for International Cancer Research was registered as an independent charity in early 1980.     The AICR Head Office is based in St Andrews, Scotland and in 1995 it moved its charitable registration from the Charity Commission to the Office of the Scottish Charity Regulator.  The fact that it does not appear in the Charity Commission Register sometimes leads people to assume - incorrectly - that it is not a proper charity.  However, the Charity Commission only regulates charities in England and Wales.
AICR makes grants to recognised researchers to support fundamental research into the causes, mechanisms, diagnosis, treatment and prevention of cancer.  Uniquely amongst UK cancer research charities, AICR awards grants anywhere in world, not just in the United Kingdom.  In the year ending September 2005, AICR awarded approximately 10 million in cancer research grants of which about half were outside the UK.
Atovaquone proguanil warnings and precautions

# Warnings And Precautions

## Vomiting and Diarrhea
Absorption of atovaquone may be reduced in patients with diarrhea or vomiting. If Atovaquone proguanil is used in patients who are vomiting, parasitemia should be closely monitored and the use of an antiemetic considered.  Vomiting occurred in up to 19% of pediatric patients given treatment doses of Atovaquone proguanil. In the controlled clinical trials, 15.3% of adults received an antiemetic when they received atovaquone/proguanil and 98.3% of these patients were successfully treated. In patients with severe or persistent diarrhea or vomiting, alternative antimalarial therapy may be required.

## Relapse of Infection
In mixed P. falciparum and Plasmodium vivax infections, P. vivax parasite relapse occurred commonly when patients were treated with Atovaquone proguanil alone.
In the event of recrudescent P. falciparum infections after treatment with Atovaquone proguanil or failure of chemoprophylaxis with Atovaquone proguanil, patients should be treated with a different blood schizonticide.

## Hepatotoxicity
Elevated liver laboratory tests and cases of hepatitis and hepatic failure requiring liver transplantation have been reported with prophylactic use of Atovaquone proguanil.

## Severe or Complicated Malaria
Atovaquone proguanil has not been evaluated for the treatment of cerebral malaria or other severe manifestations of complicated malaria, including hyperparasitemia, pulmonary edema, or renal failure. Patients with severe malaria are not candidates for oral therapy.
Behavioral and psychotic symptoms of dementia
Synonyms and keywords: BPSD

# Overriew
BPSD is defined as "symptoms of disturbed perception, thought content, mood or behavior that frequently occur in
patients with dementia".

# Pathophysiology
The cause of BPSD is not clear. It has been hypothesized to be due to abnormalities in the way information is processed, integrated, and retrieved.

# Causes
- Alzheimer's disease
- Multi-infarct dementia
- Lewy body dementia

# Natural History, Complications and Prognosis

## Natural History
The symptoms may progress or certain symptoms occur during certain phases of the illness.

## Complications
- Premature institutionalization
- Increased cost
- Reduced quality of life for both caregiver and patient
- Caregive stress
- Nursing staff stress

# Diagnosis

## Symptoms
In the original description of Alzheimer's disease by Alois Alzheimer in 1906, the following symptos figured prominently:
- Aggression and hostility in 20% of patients
- Agitation
- Cursing
- Delusions of sexual abuse in 20%-73% of patients
- Depressive mood
- Hallucinations in 15% to 49% of patients
- Hoarding
- Misidentifications in 23% to 50% of patients
- Paranoia
- Screaming
- Sexual disinhibition
- Shadowing
- Wandering

# Treatment

# Guidelines
The Alzheimer's Association recommends training and education for both professional and family caregivers on psychosocial interventions that might include :
Breast self-examination (patient information)
For the WikiDoc page for this topic, click here

# Overview
Many women feel that doing a breast self exam is an important part of their health care. It helps them learn how their breasts normally feel, so that if they find a lump they will know whether it is something to discuss with their health care provider.
However, there is not a unanimous agreement among experts about recommending breast self exams. It is not known for sure what role breast self exams play in finding breast cancer or saving lives.
Talk to your health care provider about whether you should do breast self exams.

# How is self-examination of breast done?
If you do decide to perform breast self exams, be sure to do the exam about 3 - 5 days after your period starts, when your breasts are not as tender or lumpy. If you have gone through menopause, do your exam on the same day every month.
First, lie on your back.
- Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast.
- Then, while sitting or standing, examine your armpit, because breast tissue extends to that area.
- Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast.
- Use one of the patterns shown in the diagram to make sure that you are covering all of the breast tissue.
Most women have some lumps, so don't be concerned about figuring out what a lump or abnormal area is. Your goal is to find anything new or different and then see your health care provider for an evaluation.
Although some women find it easiest to do the exam in the shower, when the skin is soft and wet, you are more likely to examine all of the breast tissue if you are lying down.
Next, stand in front of a mirror with your arms by your side. Look at your breasts directly and in the mirror for changes in skin texture (such as dimpling, puckering, indentations, or skin that looks like an orange peel), shape, contour, or the nipple turning inward. Do the same with your arms raised above your head.
Discuss any changes you find with your health care provider right away.

# Sources
Capreomycin sulfate dosage and administration

# Dosage and Administration
Capastat Sulfate may be administered intramuscularly or intravenously following reconstitution. Reconstitution is achieved by dissolving the vial contents (1 g) in 2 mL of 0.9% Sodium Chloride Injection or Sterile Water for Injection. Two to 3 minutes should be allowed for complete dissolution.
Intravenously  For intravenous infusion, reconstituted Capastat Sulfate should be diluted in 100 mL of 0.9% Sodium Chloride Injection and administered over 60 minutes.
Intramuscularly  Reconstituted Capastat Sulfate should be given by deep intramuscular injection into a large muscle mass, since superficial injection may be associated with increased pain and the development of sterile abscesses.
For administration of a 1-g dose, the entire contents of the vial should be given. For doses lower than 1 g, the following dilution table may be used.
The solution may acquire a pale straw color and darken with time, but this is not associated with loss of potency or the development of toxicity. After reconstitution, all solutions of Capastat Sulfate may be stored for up to 24 hours under refrigeration.
Capreomycin is always administered in combination with at least 1 other antituberculosis agent to which the patient's strain of tubercle bacilli is susceptible. The usual dose is 1 g daily (not to exceed 20 mg/kg/day) given intramuscularly or intravenously for 60 to 120 days, followed by 1 g by either route 2 or 3 times weekly. (Note  Therapy for tuberculosis should be maintained for 12 to 24 months. If facilities for administering injectable medication are not available, a change to appropriate oral therapy is indicated on the patient's release from the hospital.)
Patients with reduced renal function should have dosage reduction based on creatinine clearance using the guidelines included in Table 1. These dosages are designed to achieve a mean steady-state capreomycin level of 10 g/mL.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.