Persius/hicric huggingface dataset:
Sandbox: differentialdx maria
CIN is classified in grades:

# Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT
Note: Newly detected indeterminate nodule in persons 35 years of age or older.
- Low risk patients: Minimal or absent history of smoking and of other known risk factors.
- High risk patients: History of smoking or of other known risk factors.
-  Jump up to: 1.0 1.1 1.2  Solitary Pulmonary Nodule: Morphological Evaluation.  Accessed on March 15, 2016
-  Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 237: 395-400.
-  Jump up to: 3.0 3.1  Lung Cancer Epidemiology. Wikipedia.   Accessed on February 17, 2016
-  Jump up to: 4.0 4.1 4.2   Mucoepidermoid carcinoma. Radiopedia. Dr Frank Gailliard.  Accessed on February 17, 2016
-  AJCC System for Staging of Benign and Malignant Salivary Gland Tumors. AJCC  Accessed on February 18, 2016
Scanning laser ophthalmoscopy
Scanning laser ophthalmoscopy is a method of examination of the eye. It uses the technique of confocal laser scanning microscopy for diagnostic imaging of retina or cornea of the human eye.
It is helpful in the diagnosis of glaucoma, macular degeneration, and other retinal disorders.
It has been combined with adaptive optics technology to provide sharper images of the retina.
Serious Emotional Disturbance

# Background
In U.S. healthcare, SED is an acronym for serious emotional disturbance.

# Definition
Emotional Disturbance is one of thirteen disabilities outlined in the Individuals with Disabilities Education Act (IDEA). 
Section 1912(c) of the Public Health Service Act, as amended by Public Law 102-321 defines children with a serious emotional disturbance as those who are from birth to age of majority who have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the individual to be deemed emotionally disturbed, it must be determined that the child's condition results in functional impairment, substantially interfering with one or more major life activities, such as the abilities to eat, bathe, and dress oneself, or the abilities to function effectively in social, familial, and educational contexts.

# Characteristics
The National Dissemination Center for Children with Disabilities (NICHCY) has identified the following characteristics and behaviors as typical of children with emotional disturbances:
- Inappropriate types of behavior under normal circumstances, such as aggression or self-injurious behavior
- Hyperactivity (short attention span, impulsiveness)
- Withdrawal or a general pervasive mood of unhappiness or depression (failure to initiate interaction with others, retreat from exchanges or social interaction, excessive fear or anxiety)
- Development of physical symptoms or fears associated with personal or school problems
- Immaturity (inappropriate crying, temper tantrums, poor coping skills)
- An inability to build and maintain relationships with peers and teachers
- Learning difficulties that cannot be explained by intellectual, sensory, or health factors (academically performing below grade level) 

# SED diagnoses
- Schizophrenia
- Other Psychotic Disorders
- Bipolar Disorder
- Depressive Disorder Not Otherwise Specified
- Anxiety Disorders
- Dissociative Identity Disorder
- Personality Disorder

## Additional SED Diagnoses
- Attention-Deficit Hyperactivity Disorder
- Eating Disorders
- Pervasive Developmental Disorders
- Oppositional Defiant Disorder
- Impulse control disorder
- Phobia
- Elimination Disorders
Simian immunodeficiency virus
Simian immunodeficiency virus (SIV) is a retrovirus that is found, in numerous strains, in primates; the specific strains infecting humans are HIV-1 and HIV-2, the viruses that cause AIDS.
The origin of HIV is now generally attributed to SIV from African primates. HIV-2 is most closely related to SIVsm, the SIV strain that primarily infects Sooty Mangabeys, while HIV-1 is closely related to the chimpanzee strain of SIV, designated SIVcpz.  The most likely route of transmission of HIV-1 to humans involves contact with the blood of chimps that are often hunted for bushmeat in Africa.
SIV monkey strains are transmitted sexually and usually do not cause AIDS in their natural hosts, Sooty mangabeys and African Green Monkeys, even when the infected hosts carry large viral loads. SIV strains may cause an AIDS-like immune deficiency known as SAIDS (simian acquired immunodeficiency syndrome) if they cross species boundaries.  For example, SIVagm, the SIV strain from African Green Monkeys causes SAIDS in Pig-Tailed Macaques. Unlike African Green Monkeys, macques are native to Asia and do not carry their own strain of SIV. Interestingly, yellow and chacma baboons, African monkeys, do not develop SAIDS when they contract SIVagm.
SIV was first discovered in 1985, in captive Rhesus macaques suffering from SAIDS. This observation was made shortly after HIV-1 had been isolated as the cause of AIDS and led to the discovery of the HIV-2 strains in West Africa that same year. HIV-2 was more similar to the then-known SIV strains than to HIV-1, suggesting for the first time the simian origin of HIV.  Further studies indicated that HIV-2 is derived from the SIVsm strain found in sooty mangabeys whereas HIV-1, the predominant virus found in humans, is derived from SIV strains infecting chimpanzees (SIVcpz).
The monkey SIV strains do not infect humans and HIV-1 does not infect monkeys. In 2004, this tropism was partly explained by different variants of the protein TRIM5 in humans and monkeys. This intracellular protein recognizes the capsid of various retroviruses and blocks their reproduction. Other proteins such as APOBEC3G/3F may be important in restricting cross-species transmission.
To better study HIV/AIDS in animal models, researchers have created various HIV-SIV chimeras, viruses whose genome partly comes from HIV and partly from SIV. These are often referred to as SHIV.
The ICTVdB code of SIV is 61.0.6.5.003.
Small nucleolar RNA snR55/Z10
Small nucleolar RNA snR55/Z10 is a non-coding RNA (ncRNA) molecule which functions in the biogenesis of other small nuclear RNAs (snRNAs). These small nucleolar RNAs (snoRNAs) are modifiying RNAs and usually located in the nucleolus of the eukaryotic cell which is a major site of snRNA biogenesis.
snoRNA snR55 was identified in (Schizosaccharomyces pombe) and has also been called snoRNA Z10 . This snoRNA belongs to the C/D box class of snoRNAs which contain the conserved sequence motifs known as the C box (UGAUGA) and the D box (CUGA). Most of the members of the box C/D family function in directing site-specific 2'-O-methylation of substrate RNAs.
This predicted snoRNA does not appear to have the C/D box snoRNA terminal stem structure.
Sore mouth infection overview

# Overview
Sore mouth is a viral infection caused by a member of the poxvirus group and is an infection primarily of sheep and goats.

# Differentiating Sore mouth infection from other Diseases
Foot-and-mouth disease (FMD) is a serious disease that does resemble sore mouth and can affect sheep, goats, cattle, swine, and other "cloven-hoofed" animals.  Although FMD has not occurred in the United States since 1929, if there are symptoms you observe in your animals that appear more serious than sore mouth, immediately report it to your veterinarian, to State or Federal animal disease control officials, or to your county agricultural agent.

# Epidemiology and Demographics
Geographically, sore mouth infection is commonly found throughout the world. According to the United States Department of Agriculture Animal and Plant Health Inspection Service's National Animal Health Monitoring System (USDA APHIS NAHMS) 2001 sheep survey, 40 percent of U.S. operations reported sore mouth infecting their flocks in the previous three years.
Sore mouth is generally found only in sheep and goats. Other ruminants that are occasionally infected include musk oxen and gazelles.

# Natural History, Complications and Prognosis
The sore may be painful and can last for 2 months. People do not infect other people.  Sores usually heal without scarring.
Animals may become infected more than once in their lifetime but repeat infections usually occur after a year's time and are usually less severe.

# Treatment

## Medical Therapy
Currently there is no approved treatment for sore mouth. However, the sores may be painful and may become infected with bacteria if not properly managed. If you are experiencing pain, fever, or notice that the sore is becoming rapidly larger or spreading, you should see your primary care provider.
Specific inhalation challenge

# Overview
The Specific Inhalation Challenge (SIC) is defined as a diagnosis tool 
to assess airway responsiveness to "sensitizing" substances as opposed to
nonspecific stimuli such as pharmacological agents (i.e. histamine, methacholine),
cold air and exercise.
Subjects are exposed to a suspected occupational agent in a controlled way under close supervision
in a hospital laboratory. The specific inhalation challenges has been considered as the
gold standard in confirming the diagnosis of occupational asthma.

# SIC methods
One of the steps of SIC is to perform a challenge with the suspected asthmagen.
Then, FEV1 is subsequently measured using another device and compared to a baseline.
A positive response is usually a decrease in baseline FEV1 of 15 to 20 percent.

### Realistic Method
The Realistic Method was developped in the 1970's.
The patient enters a sealed chamber and is exposed to the suspected agent in a controlled,
non-work, test environment. The asthmagen can be water-soluble and nebulized.
If the agent is non-soluble, the patient tips the agent from one tray to another in an attempt
to mimic the work environment. This method has the advantage of being able to assess,
albeit highly subjectively,	ocular and nasal symptoms as well as a reduction
in FEV1.
There are, however, disadvantages to the method. First, SIC is currently only conducted
in specialty facilities because the facilities and equipment are rare and expensive.
Second, the realistic method may exposed the patient to huge concentrations of particles,
resulting in unduly severe asthma attacks.
Alternately, the agent can be delivered using the recently developped closed-circuit technique.

### Closed-Circuit Method
This test requires the patient to breathe aerosols of the suspected agent (asthmagen)
through an oro-facial mask or mouth piece.
These asthmagens are aerosolized using closed-circuit chambers,
and the quantities and concentrations administered being minute
and extremely stable minimize the risk of exaggerated responses.
Stent thrombosis introduction

# Overview
Stent thrombosis (ST) is a rare but devastating complication of coronary artery stenting that is associated with a high rate of morbidity and mortality     This process should not be confused with restenosis, a fibro-proliferative disorder which is associated with recurrent angina and ischemia but uncommonly with myocardial infarction or death.

# The Risk of Stent Thrombosis Associated with Bare Metal and Drug Eluting Stents
- Over the years stent thrombosis of bare metal stents (BMS) has been minimized by refining stent design, adopting optimal stenting strategies and improved antiplatelet medication usage from early rates of 24%  to a rare and acceptable 0.5-1.5% in the current environment.
- Following the approval by the FDA, the drug eluting stents (DES) largely replaced BMS, driven solely by the reduced revascularization with relatively little attention paid to the issue of stent thrombosis.
- Increased usage of DES and continued presentation of patients with ST beyond the first few months of implantation, coupled with the widespread awareness of ST, have led to a steady and increased stream of reporting of ST in DES.
- Recent description of frequent subclinical insitu thrombus formation within DES in the coronaries by Katani et al, not only took the medical community by surprise but afforded a first hand in-vivo glimpse at the stent site itself.

# Treatment
- It should be noted that the term coronary stent thrombosis (ST) is commonly used for clinically significant episodes. 
- In this context, clinically significant ST appears to be a rare complication with devastating consequences if left untreated emergently, though the mileu for such probably exists in a much larger population.
Stochastic universal sampling
Stochastic universal sampling (SUS) is a genetic operator used in genetic algorithms for selecting potentially useful solutions for recombination.
First introduced into the literature by Baker, SUS is a development of Fitness proportionate selection which exhibits no bias and minimal spread. Where fitness proportionate selection chooses several solutions from the population by repeated random sampling, SUS uses a single random value to sample all of the solutions by choosing them at evenly spaced intervals. Described as an algorithm SUS looks something like:
Here RWS describes the bulk of fitness proportionate selection (also known as Roulette Wheel Selection) - in true fitness proportional selection the parameter f is always a random number from 0 to F. The algorithm above is very inefficient both for fitness proportionate and stochastic universal sampling, and is intended to be illustrative rather than canonical.
Stroke historical perspective

# Overview
The history of stroke goes back to the 5th century B.C. as apoplexy. In 17th century it was discovered that the cause is sudden disruption of blood supply to the brain.

# Historical Perspective
Stroke is documented in the Hippocrates notes in the 5th century B.C. as apoplexy, meaning struck down by violence, which refers to a person who suddenly falls and becomes unconscious. In 1658, Dr. Johann Jacob Wepfer, pathologist and pharmacologist, discovered that the apoplexy is caused by sudden disruption of blood supply to the brain. He identified that the blood supply to the brain was disrupted either due to bleeding in the brain or blocking of the arteries by blood clots.
At this time, physicians also believed that excessive food consumption would cause a person to strain with a bowel movement. This straining was thought to have a possible connection with the occurrence of apoplexy, so purging with enemas and stimulants was used frequently. Exercising and proper body position with the neck and head extension were encouraged to ensure proper blood flow to the brain.
Finally, bloodletting had become a common practice, but at this point, restrictions were now being discussed. New guidelines recommended the use of bloodletting judiciously when physicians believed that congestion was the cause of apoplexy in a patient.

## Famous Cases
It is believed that actors Luke Perry, Cary Grant and Bill Paxton; actresses Debbie Reynolds, Della Reese and Grace Kelly; former presidents Franklin Roosevelt, Richard Nixon and Gerald Ford; director John Singleton; baseball player Kirby Puckett; former British prime minister Winston Churchill; former Russian dictator Josef Stalin were all the victims of a fatal stroke.
In addition, singers Loretta Lynn and Randy Travis; actresses Sharon Stone ("Basic Instinct") and Marla Gibbs (TV's "The Jeffersons"); former NFL New England Patriots player Tedy Bruschi; sprinter Michael Johnson; actors Tim Curry ("Rocky Horror Picture Show") and Frankie Muniz (TV's "Malcolm In The Middle"); rock singer Bret Michaels have also had the experience of a stroke but have survived from.
Strychnine poisoning overview

# Overview
Strychnine poisoning can be fatal to humans and can be introduced to the body by inhalation, swallowing or absorption through eyes or mouth. It produces some of the most dramatic and painful symptoms of any known toxic reaction. For this reason, strychnine poisoning is often used in literature and film.

# Diagnosis

## History and Symptoms
Ten to twenty minutes after exposure,  the body's muscles begin to spasm, starting with the head and neck. The spasms then spread to every muscle in the body, with nearly continuous convulsions, and get worse at the slightest stimulus. The convulsions progress, increasing in intensity and frequency until the backbone arches continually. Death comes from asphyxiation caused by paralysis of the neural pathways that control breathing, or by exhaustion from the convulsions. The subject will die within 23 hours after exposure. At the point of death, the body "freezes" immediately, even in the middle of a convulsion, resulting in instantaneous rigor mortis.

# Treatment

## Medical Therapy
There is no specific antidote for strychnine. Treatment of strychnine poisoning involves an oral application of an activated charcoal infusion which serves to absorb any poison within the digestive tract that has not yet been absorbed into the blood. Anticonvulsants such as phenobarbital or diazepam are administered to control convulsions, along with muscle relaxants such as dantrolene to combat muscle rigidity. If the patient survives past 24 hours, recovery is probable.
The treatment for strychnine poisoning in the late 19th and early 20th centuries was to administer tannic acid which precipitates the strychnine as an insoluble tannate salt, and then to anaesthetise the patient with chloroform until the effects of the strychnine had worn off.
Subgaleal hemorrhage overview

# Overview
Subgaleal hemorrhage  is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.

# Causes
A majority (90%) results from vacuum being applied to the head at delivery (Ventouse assisted delivery). Subgaleal hematoma has a high frequency of occurrence of associated head trauma (40%), such as intracranial hemorrhage or skull fracture. The occurrence of these features does not correlate significantly with the severity of subgaleal hemorrhage.

# Diagnosis

## History and Symptoms
The diagnosis is generally a clinical one, with a fluctuant boggy mass developing over the scalp (especially over the occiput) with superficial skin bruising. The swelling develops gradually 12-72 hours after delivery, although it may be noted immediately after delivery in severe cases. The hematoma spreads across the whole calvaria as its growth is insidious and may not be recognized for hours. Patients with subgaleal hematoma may present with hemorrhagic shock. The swelling may obscure the fontanel and cross suture lines (distinguishing it from cephalohematoma).

## Laboratory Findings
Laboratory studies consist of a hematocrit and bilirubin evaluation.

# Treatment

## Medical Therapy
Management consists of vigilant observation over days to detect progression.  Fluid bolus may be required if blood loss is significant and patient becomes tachycardic. Transfusion and phototherapy may be necessary. Investigation for coagulopathy may be indicated.
Superficial epigastric artery
The superficial epigastric artery arises from the front of the femoral artery about 1 cm below the inguinal ligament, and, passing through the femoral sheath and the fascia cribrosa, turns upward in front of the inguinal ligament, and ascends between the two layers of the superficial fascia of the abdominal wall nearly as far as the umbilicus.
It distributes branches to the superficial subinguinal lymph glands, the superficial fascia, and the integument; it anastomoses with branches of the inferior epigastric, and with its fellow of the opposite side.

# Additional images
- The subcutaneous inguinal ring.
- The femoral artery.
- The great saphenous vein and its tributaries at the fossa ovalis.
- The great saphenous vein and its tributaries.
- The femoral vein and its tributaries.
Supravalvular aortic stenosis

# Overview
Supravalvular aortic stenosis is the most uncommon cause of left ventricular outflow tract obstruction (LVOT) accounting for 8% of congenital cases of LVOT obstruction. It is seen in 10% patients with aortic stenosis.

# Pathophysiology
- Obstruction occurs just above the coronary ostium at the level of the sinotubular junction:
- Hourglass type: single discrete narrowing or long tubular hypoplasia (the most common)
Hypoplastic type: uniform narrowing of the ascending aorta.
- Hourglass type: single discrete narrowing or long tubular hypoplasia (the most common)
- Hypoplastic type: uniform narrowing of the ascending aorta.
- Associated lesion is peripheral pulmonary arterial stenosis
- Because of high perfusion pressure of the coronary arteries there is premature coronary artery disease.
- Coronary arteries may be obstructed by an adjacent stenotic ring.
- A high concentration of Integrin B3 is thought to be a cause and its inhibition has helped with the treatment.
- ELN mutation can also cause supra valvular aortic stenosis. 

## Associated conditions
The following conditions can be associated with supra valvular aortic stenosis:
- Frequently accompanied by aortic regurgitation, due to jet on aortic valve.
- Associated with elfin facies, high calcium.

## Genetics
- One third of the cases are transmitted as an autosomal dominant trait.

# Diagnosis and Treatment

## Physical Examination
- 50% have a characteristically greater pulse and systolic blood pressure in the right carotid and brachial arteries than in the left.
- The systolic murmur is maximal below the right clavicle and radiates primarily to the right carotid artery.
- No ejection click is present, no diastolic murmur.

## Echocardiography
- 2 Dimensional echo and doppler useful for diagnosis
- Outflow gradient with narowing of aorta is noticed.

# 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

## Diagnostic Recommendations Recommendations for Supravalvular Aortic Stenosis

## Therapeutic Recommendations Recommendations for Supravalvular Aortic Stenosis

# 2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)

## Evaluation of the Unoperated Patient (DO NOT EDIT)

## Interventional and Surgical Therapy (DO NOT EDIT)

## Key Issues to Evaluate and Follow-Up (DO NOT EDIT) 

## Reproduction (DO NOT EDIT)

## Coronary Anomalies Associated With Supravalvular Aortic Stenosis (DO NOT EDIT)
TAsplenia surgical techniques

# Overview
The mainstay of treatment for asplenia is medical therapy and prevention.

# Surgery
The mainstay of treatment for asplenia is medical therapy and prevention.
-  Waghorn DJ (2001). "Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed". J Clin Pathol. 54 (3): 2148. doi:10.1136/jcp.54.3.214. PMC 1731383. PMID 11253134..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}