Persius/hicric huggingface dataset:
Activated clotting time
Synonyms and keywords: ACT

# Overview
The activated clotting time (ACT) was introduced during the 1970s as a test to monitor the administration and subsequent reversal of unfractionated heparin (UFH) during coronary artery bypass graft surgery.  Currently the test is widely used in the cardiac catheterization laboratory to monitor the adequacy of UFH dosing.  The unit of measure is in seconds.

# Titration of UFH dosing based upon the ACT
While practice patterns in Europe are such that a large single dose of UFH is often administered for a percutaneous coronary intervention (PCI) (150 Units/per Kg), in the United States, lower doses of UFH (35 to 70U/kg depending upon the operator) are administered, and subsequent doses of UFH are titrated based upon the ACT.  In the absence of a glycoprotein 2b3a inhbitor, the target ACT is usually 250 to 300 seconds. If a glycoprotein 2b3a inhibitor has been administered, the target ACT is lower, at 200 to 250 seconds.

# Relationship of the ACT to clinical outcomes
Despite the aggressive use of ACT monitoring, there is scant data to relate the peak ACT to efficacy or bleeding outcomes in the setting of PCI.
CME Category::Cardiology
Absolute risk reduction

# Overview
The absolute risk reduction is the decrease in risk of a given activity or treatment in relation to a control activity or treatment. It is the inverse of the number needed to treat.
In general, absolute risk reduction is usually computed with respect to two treatments A and B, with A typically a drug and B a placebo (in our example above, A is a 5-year treatment with the hypothetical drug, and B is treatment with placebo, i.e. no treatment). A defined endpoint has to be specified (in our example: the appearance of colon cancer in the 5 year period). If the probabilities pA and pB of this endpoint under treatments A and B, respectively, are known, then the absolute risk reduction is computed as pB-pA.
The inverse of the absolute risk reduction, NNT, is an important measure in pharmacoeconomics. If a clinical endpoint is devastating enough (e.g. death, heart attack), drugs with a low absolute risk reduction may still be indicated in particular situations. If the endpoint is minor, health insurers may decline to reimburse drugs with a low absolute risk reduction.

# Worked example
For example, consider a hypothetical drug which reduces the risk of colon cancer by 50%. Even without the drug, colon cancer is fairly rare, maybe 1 in 3,000 in every 5 year period. The absolute risk reduction for a 5-year treatment with the drug is therefore 1/6,000, as by treating 6,000 people with the drug, one can expect to reduce the number of colon cancer cases from 2 to 1.
Anti-thymocyte globulin
Synonyms and keywords: ATG

# Overview
Anti-thymocyte globulin (ATG) is an infusion of rabbit-derived antibodies against human T cells which is used in the prevention and treatment of acute rejection in organ transplantation and therapy of aplastic anemia.
In the United States it is frequently given at the time of the transplant to prevent rejection, although many European centres prefer to reserve its use for the treatment of steroid-resistant acute rejection, as European centres generally serve more homogeneous populations and rejection tends to be less of a problem.
ATG is associated with cytokine release syndrome when it is used, and in the longer term may increase the risk of post-transplant lymphoproliferative disorder as well as (theoretically) impairing the development of immunological tolerance. Temporary depletion of the T cell population at the time of the transplant also risks delayed acute rejection, which may be missed and cause severe damage to the graft.
Anti-IL-2R receptor antibodies such as basiliximab and daclizumab are increasingly being used in place of ATG as an induction therapy, as they do not cause cytokine release syndrome and (theoretically) improving the development of tolerance.
Frequently associated with high grade fevers over 39C, chills, and possibly rigors during administration. These can often be reduced by slowing the infusion rate.
Abdominal mass overview

# Overview
An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, a retroperitoneal mass (a mass in the posterior  of the peritoneum), an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis and omental metastasis. The treatments depend on the cause, and may range from watchful waiting to radical surgery.

# Diagnosis

## History and Symptoms
The first steps in diagnosis are a medical history and physical examination. Important clues during history include weight loss, diarrhea and abdominal pain.

## Physical Examination
During physical examination, the clinician must identify the location of the mass, as well as characterize its location (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile. It should also be characterized for pulse or peristalsis, as these would help in further identifying the mass.

## Laboratory Findings
Routine blood tests are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a full blood count, blood urea nitrogen (BUN), creatinine, and liver function tests such as albumin, international normalized ratio (INR), partial thromboplastin time (PTT), serum amylase and total bilirubin (TBIL). If late-stage liver disease is suspected, then a serum glucose may be appropriate.

## X Ray
KUB (kidneys, ureters, bladder) x-rays could possibly reveal free intraperitoneal air, constipation or obstruction.

## CT
Abdominal CT with oral IV contrast will evaluate for bowel pathology, abscess, and hepatosplenomegaly.
Abdominal pain overview

# Overview
Abdominal pain can be one of the symptoms associated with many transient disorders or serious diseases. Making a definitive diagnosis of the cause of abdominal pain can be difficult because many diseases present with this symptom, abdominal pain is a common problem. Most frequently the cause of the pain is benign and/or self-limited, but in cases of serious causes urgent intervention may be required.

# Classification
Abdominal pain can be classified into three categories: acute abdomen, recurrent, and chronic functional. Abdominal pain is traditionally described by its chronicity (acute or chronic), progression over time, nature (sharp, dull, colicky), characterization of the factors that worsen or alleviate pain, and distribution of the pain.

# Causes
The causes of abdominal pain vary with the distribution of the pain. The distribution can be determined by various methods, such as abdominal quadrants. Other methods exist that divide the abdomen into nine sections.

# Differentiating Abdominal pain from other Diseases
Chronic functional abdominal pain is quite similar to, but less common than, irritable bowel syndrome (IBS), and many of the same treatments for IBS can also be of benefit to those with CFAP. The fundamental difference between IBS and CFAP is that in CFAP, unlike in IBS, there is no change in bowel habits such as constipation or diarrhea. Bowel dysfunction is a necessary diagnostic criteria of IBS.

# Diagnosis

## Physical Examination
When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain, the patient's history of the presenting complaint and their physical examination should derive a diagnosis in over 90% of cases. It is important also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as abdominal pain.

## Electrocardiogram
An electrocardiograph is needed to rule out a heart attack, which can occasionally present as abdominal pain.

## X Ray
Imaging including an erect chest X-ray and plain films of the abdomen can aid in the diagnosis of the disorder causing the abdominal pain.
Acanthocytosis overview

# Overview
Acanthocytosis is a digestive disorder that is characterized by the absence of very low density lipoproteins (VLDL) and chylomicrons in the plasma. Acanthocyte is a general term meaning 'spiny cell'. AKA "spur cell" in more severe cases
In human biology and medicine, the term refers to pathological red blood cells, which are coarse and irregularly crenelated  resembling many-pointed stars. They are seen on blood films in, among others, lipid abnormalities, liver disease, chorea acanthocytosis, McLeod syndrome and several inherited neurological disorders, such as neuroacanthocytosis.

# Pathophysiology
The imbalance in membrane lipids due to various abnormalities mainly in the liver, cause cells to stiffen, wrinkle and form spicules.

# Diagnosis

## History and Symptoms
Patients with acanthocytosis may have a history of chronic diarrhea with pale, foul-smelling, and bulky stools; loss of appetite and vomiting; and slow weight gain and decreased growth, possibly including a bleeding tendency. Patients may report symptoms of ataxia, tremors, and visual abnormalities or jaundice, abdominal pain, pallor, dark urine, and recurrent infections. Adolescents and adults may report dyskinesias, specifically orolingual, and cognitive deterioration.
Accessory cephalic vein
The accessory cephalic vein arises either from a small tributory plexus on the back of the forearm or from the ulnar side of the dorsal venous net-work; it joins the cephalic below the elbow.
In some cases the accessory cephalic springs from the cephalic above the wrist and joins it again higher up.
A large oblique branch frequently connects the basilic and cephalic veins on the back of the forearm.
Rumack-Matthew nomogram
Synonyms and keywords: Rumack-Matthews nomogram, acetaminophen nomogram

# Overview
The Rumack-Matthew nomogram is an acetaminophen toxicity nomogram plotting serum concentration of acetaminophen against the time since ingestion in an attempt to prognosticate possible liver toxicity as well as allowing a clinician to decide whether to proceed with N-Acetylcysteine (NAC) treatment or not. It is a logarithmic graph starting not directly from ingestion, but from 4 hours post ingestion after absorption is considered likely to be complete.

# Historical Perspective
The original line starting at 200 microgram/mL at 4 hours was published in 1975 by Rumack BH. and Matthew H. When the NAC study was begun in 1976, the FDA required a line that was 25% below the original line now called the treatment line. The study line which is now referred to as the treatment line was created starting at 150 microgram/mL at 4 hours and is the usual line used in the United States to determine treatment of acetaminophen overdose. This was published in 1981.

# Clinical Use
In hands of skilled clinicians this nomogram allows for timely management of acetaminophen overdose. Generally, a serum plasma concentration (APAP) of 140-150 microgram/mL (or milligrams/L) at 4 hours post ingestion, indicates the need for NAC treatment. This nomogram is not used alone if the patient has altered mental status or if the history is not reliable.  Rather, a second level should be drawn and plotted to see if the slope of the line remains at or above the nomogram.  A formal half life may also be determined.  Measure at time (t=0) upon admission of the patient to the emergency room, and a blood value at time (t=4 hrs) should be obtained and half-life calculated.  If the half-life is more than 4 hours, then treatment is necessary to prevent hepatotoxicity and liver failure.
Shown below is an image depicting the Rumack-Matthew nomogram.
Achilles tendon rupture

# Overview
Achilles tendon rupture is the most common injury involving a break in a tendon.  It commonly occurs as a sports injury during explosive acceleration e.g. pushing off or jumping up.

# History and Symptoms

## Symptoms
- Acute pain
- Difficulty walking
- Referred stabbing pain in the posterior leg and ankle from muscle spasm

# Diagnosis
Diagnosis is made by clinical history; typically people say it feels like being kicked or shot behind the ankle.  Upon examination a gap may be felt just above the heel unless swelling has filled the gap and the Simmonds' test (aka Thompson test) will be positive; squeezing the calf muscles of the affected side while the patient lies prone, face down, with his feet hanging loose results in no movement (no passive planter flexion) of the foot, while movement is expected with an intact Achilles tendon and should be observable upon manipulation of the uninvolved calf.
An O'Brien test can also be performed which entails placing a sterile needle through the skin and into the tendon. If the needle hub moves in the opposite direction of the tendon and the same direction as the toes when the foot is moved up and down then the tendon is at least partially intact.

## MRI
Images courtesy of RadsWiki
- STIR: MRI; Achilles tendon rupture
- Proton density: MRI; Achilles tendon rupture
- Proton density: MRI; Achilles tendon rupture
- Proton density: MRI; Achilles tendon rupture
- Proton density: MRI; Achilles tendon rupture
Sometimes an ultrasound scan may be required to clarify or confirm the diagnosis. MRI can also be used to confirm the diagnosis.

# Risk factors
Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 30-40 years with a male-to-female ratio of nearly 20:1. Fluoroquinolone antibiotics, such as ciprofloxacin, and glucocorticoids have been linked with an increased risk of Achilles tendon rupture. Direct steroid injections into the tendon have also been linked to rupture.

# Treatment
Treatment remains divided between operative and non-operative management. Non-operative management traditionally consisted of restriction in an "equinus" plaster cast for six to eight weeks with the foot pointed downwards (to oppose the ends of the ruptured tendon).
Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option offers a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%).  However surgery imposes much higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.
Vestibulocochlear nerve

# Overview
The vestibulocochlear nerve (also known as the auditory or acoustic nerve) is the eighth of twelve cranial nerves, and is responsible for transmitting sound and equilibrium (balance) information from the inner ear to the brain.

# Structure
This nerve, along which the sensory cells (the hair cells) of the inner ear transmit information to the brain. It consists of the cochlear nerve, carrying information about hearing, and the vestibular nerve, carrying information about balance. 
It emerges from the medulla oblongata and enters the inner skull via the internal acoustic meatus (or internal auditory meatus) in the temporal bone, along with the facial nerve.

# Functions
The eighth cranial nerve has two prime roles. It is needed to convey information of vestibular sensation - that is, the position and movement of the head. Secondly, it is used for hearing.

# Innervations
The nerve splits into two large divisions - the cochlear nerve and the vestibular nerve. Broadly speaking, the cochlear nerve innervates the cochlea, while the vestibular nerve goes to the vestibular apparatus.

# Physiology
How hearing information is coded on the nerve has long been a matter of scientific debate between two competing theories, a place theory and a rate theory.

# Symptoms of damage
vertigo, false sense of motion, loss of equilibrium (dark places), nystagmus, motion sickness

# Name
Some older texts call the nerve the acoustic or auditory nerve , but these terms have fallen out of widespread use because they fail to recognize the nerve's role in the vestibular system. Vestibulocochlear nerve is therefore preferred by most.

# Additional images
- Superficial dissection of brain-stem. Ventral view.
- Dissection showing the projection fibers of the cerebellum.
- Hind- and mid-brains; postero-lateral view.
- Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ.
- Position of the right bony labyrinth of the ear in the skull, viewed from above.
- Vestibulo-ocular reflex
Adrenomedullin receptor
Adrenomedullin receptor is a receptor. Studies of the rat counterpart suggest that the encoded protein may function as a receptor for adrenomedullin. adrenomedullin. It is encoded by the human gene ADMR.

# Structure
The structure of the adrenomedullin receptor is a calcitonin receptor-like receptor (CL) linked to the second of three single transmembrane domain receptor activity-modifying proteins (RAMPs), i.e. RAMP2, which is essential for functional activity. It is worth noting that unlike the classical one ligand-one receptor notion of receptor signalling, the interaction of both CL and RAMP at the membrane, is required for AM to mediate its action.

# Mechanism
The outcome of AM stimulatation of its receptor is activation of the G protein Gs, resulting in cellular production of both cyclic AMP (cAMP). The activated adrenomedullin receptor also produces nitric oxide production. Some may find the production of these inside the cell to be at odds, since often they have opposing effects, but as yet, the timing of these effects remains to be studied.
Emotional dysregulation

# Overview
Emotional dysregulation (or affect dysregulation) is a term used in the mental health community to refer to an emotional response that is not well modulated. This means that an individual does not respond to a person, place, thing, or event in a manner that would generally be considered within the normal range of emotions. Emotional dysregulation is seen across both positive and negative affect. It is characterized by difficulty regulating one's emotions; examples of this might be rage over a broken plate, or hysterics over a missed appointment. In contrast, emotional regulation is defined as the relative ability to tolerate painful affect (referred to as affect tolerance), along with the ability to internally reduce distress.
Emotional dysregulation is a broad phenomenon that is a component of many mental health disorders. It is often caused by early exposure to psychological trauma or chronic maltreatment (such as child abuse, child neglect, or institutional neglect/abuse), and is strongly associated with Complex Post Traumatic Stress Disorder. The term is also used with reference to Borderline Personality Disorder (BPD), Reactive Attachment Disorder and other conditions. There is an effort within some sectors of the mental health community to rename Borderline Personality Disorder as either "Emotional Dysregulation Disorder" or "Emotional Dysregulatory Disorder" in the DSM and ICD-10.
Treatment for emotional dysregulation must address the underlying cause. For example, attachment-based treatment interventions may be appropriate for children or adolescents suffering from emotional dysregulation such as is found in Reactive Attachment Disorder or Complex Post-Traumatic Stress Disorder.
Albendazole description

# Description
ALBENZA (albendazole) is an orally administered broad-spectrum anthelmintic. Chemically, it is methyl 5-(propylthio)-2-benzimidazolecarbamate. Its molecular formula is C12H15N3O2S. Its molecular weight is 265.34. It has the following chemical structure:
Albendazole is a white to off-white powder. It is soluble in dimethylsulfoxide, strong acids, and strong bases. It is slightly soluble in methanol, chloroform, ethyl acetate, and acetonitrile. Albendazole is practically insoluble in water. Each white to off-white, film-coated tablet contains 200 mg of albendazole.
Inactive ingredients consist of: carnauba wax, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, sodium lauryl sulfate, sodium saccharin, sodium starch glycolate, and starch.
Alchornea castaneifolia
Alchornea castaneifolia (Iporuru, Iporoni, Iporuro, Ipururo, Ipurosa, Macochihua, Niando, Pajaro; syn. Hermesia castaneifolia Humb. & Bonpl. ex Willd.) is a medicinal plant native to Amazon Rainforest vegetation in Brazil.

# Traditional medicine
For centuries the indigenous peoples of the Amazon have used the bark and leaves of iporuru (Alchornea castaneifolia) for many different purposes and prepared it in many different ways. The Alchornea castaneifolia plant commonly is used with other plants during shamanistic training and, sometimes is an ingredient in ayahuasca (a hallucinogenic, multi-herb decoction used by South American shamans). Throughout the Amazon the bark or leaves of iporuro are tinctured (generally with the local rum, called aguardiente) as a local remedy for rheumatism, arthritis, colds, and muscle pains. Iporuro (Alchornea castaneifolia) is well known to the indigenous peoples of Peru for relieving the symptoms of osteoarthritis, and in aiding flexibility and range of motion. The Candochi-Shapra and the Shipibo Indian tribes use both the bark and roots of iporuro for treating rheumatism. To prevent diarrhea, members of the Tikuna tribe take 1 tbsp. of Alchornea castaneifolia bark decoction before meals. The pain-relieving properties of iporuru appear in topical treatments; crushed leaves are rubbed on painful joints and are beaten into a paste to apply to painful stingray wounds.
It is sometimes sold as "Iporuro 10x Extract."
"Little research has been done to catalog completely the phytochemicals in iporuru. Initial screening has revealed it to contain steroids, saponins, phenols, flavonols, flavones, tannins, xanthones, and alkaloids. The anti-inflammatory properties of iporuru are attributed to a group of alkaloids, including one called alchorneine, which are found in the bark of iporuru as well as several other species of Alchornea."
All Children's Hospital
All Children's Hospital is a children's hospital located in St. Petersburg, Florida.
It is the only freestanding childrens hospital on the state's Gulf coast and is a leader in pediatric treatment, education, research and advocacy.  It has consistently ranked among Americas top 25 childrens hospitals in comparative studies done by Child Magazine, which rated All Children's Hospital as the best in Florida in 2007.  All Children's has also garnered Most Outstanding Business awards from the Tampa Bay Business Journal and the Greater St. Petersburg Chamber of Commerce.
The mission of this private, not-for-profit hospital is rooted in its beginnings as Floridas first Crippled Childrens Hospital for polio victims. All Childrens understands that its not enough to treat disease -- that true progress comes from teaching and research to cure disease. All Childrens shares its pediatric expertise through research and education affiliations with the University of South Florida (USF Health) as well as the H. Lee Moffitt Cancer Center & Research Institute.
As a regional referral center for children with some of the most challenging medical problems, All Childrens draws patients from throughout Florida, all 50 states and 36 foreign countries. Growing regional demand is such that construction is now underway on a new hospital and outpatient center to replace the current 40-year old facility. When this $300-million project is completed in 2009, it will represent nearly a million square feet of space dedicated to state-of-the-art pediatric healthcare.
On September 1, 2007, 5 boys and 1 girl were born to Karoline and Ben Byler of Wesley Chapel (2 and 3 pounds each). Ryan Patrick was in critical condition, while one brother, Jackson Robert, was upgraded from critical to serious condition, according to All Children's Hospital in St. Petersburg. Charlie Craig and MacKenzie Margaret were in serious condition, while, Brady Christopher and Eli Benjamin, were in stable condition. Currently, all but one baby is listed in fair condition.  The Bylers used fertility drugs.