Persius/hicric huggingface dataset:
Itraconazole indications and usage
INDICATIONS AND USAGE
SPORANOX (itraconazole) Capsules are indicated for the treatment of the following fungal infections in immunocompromised and non-immunocompromised patients:
Blastomycosis, pulmonary and extrapulmonary
Histoplasmosis, including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis, and
Aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy.
Specimens for fungal cultures and other relevant laboratory studies (wet mount, histopathology, serology) should be obtained before therapy to isolate and identify causative organisms. Therapy may be instituted before the results of the cultures and other laboratory studies are known; however, once these results become available, antiinfective therapy should be adjusted accordingly.
SPORANOX Capsules are also indicated for the treatment of the following fungal infections in non-immunocompromised patients:
Onychomycosis of the toenail, with or without fingernail involvement, due to dermatophytes (tinea unguium), and
Onychomycosis of the fingernail due to dermatophytes (tinea unguium).
Prior to initiating treatment, appropriate nail specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis of onychomycosis.
(See CLINICAL PHARMACOLOGY: Special Populations, CONTRAINDICATIONS, WARNINGS, and ADVERSE REACTIONS: Post-marketing Experience for more information.)
Juvenile primary lateral sclerosis
Juvenile Primary Lateral Sclerosis is a rare disorder characterized by progressive weakness and stiffness of muscles in the arms, legs and face. The disorder damages motor neurons, which are the specialized nerve cells in the brain and spinal cord that control movement.

# Symptoms
Early symptoms of the disorder begin in early childhood. They include clumsiness, muscle spasms, weakness and stiffness in legs, and difficulty with balance. As these symptoms progress over a period of 15 to 20 years, they become more serious. These later symptoms include weakness and stiffness in the arms and hands, slurred speech, drooling, difficulty swallowing, and an inability to walk.

# Genetics
Juvenile Primary Lateral Sclerosis is inherited in an autosomal recessive pattern, and most often, parents of affected individuals do not show any signs or symptoms. Mutations in the ALS2 gene, found on Chromosome 2, are responsible for causing Juvenile Primary Lateral Sclerosis. Mutations in the ALS2 gene in this disorder disrupt the instructions for producing alsin. As a result, alsin is unstable and decays rapidly, or it is disabled and cannot function properly. It is currently unknown how the loss of functional alsin protein causes the death of motor neurons and the symptoms of juvenile primary lateral sclerosis.
Mutations in the ALS2 gene cause juvenile primary lateral sclerosis.
The ALS2 gene provides instrutions for making a protien called aslin.Alsin is abundant in moter neurons,but its function is not fully understood.Mutations in the ASL2 gene alter the instructions for producing aslin.
File:Autorecessive.svg
Joint pain resident survival guide

# Overview
Joint pain,  also known as Arthralgia (from Greek arthro-, joint + -algos, pain), occurs due to a wide spectrum of causes such as trauma, infection, inflammation, bone and/or cartilage degeneration, allergic reaction to medication, and crystal deposition. Meanwhile, its been recommended that the words arthralgia and arthritis should be used when the underlying cause of the joint pain is non-inflammatory and inflammatory, respectively.
As an orthopedic resident you have to evaluate the patients in order to localize the joint pain finding the underlying pathophysiologic cause/causes responsible for this problem for your patients which you have to evaluate a wide spectrum of differential diagnosis in order to find the main related cause. for this purpose you have to have a complete past medical history from your patient.

# Causes
The Arthralgia occurs due to a wide spectrum of problems including the degenerative and destructive processes ( arthritis and sports injuries) inflammation of tissues around the joint (bursitis) or even it might be due to the other problems such as infections or vaccinations. In other words the joint pain can be found due to the thee main causes:

## Inflammatory arthritis:
Which resulting primarily from inflammation affecting joint structures like synovium, synovial cavity, and entheses.

## Noninflammatory arthritis:
Which resulting primarily from change in the structure or mechanics of the joint.

## Arthralgia
Which resulting primarily from joint tenderness without joint abnormalities.

## Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Life threatening cause 1
- Life threatening cause 2
- Life threatening cause 3

## Common Causes
- Common cause 1
- Common cause 2
- Common cause 3
- Common cause 4
- Common cause 5

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of ] according the the  guidelines.

# Treatment
Shown below is an algorithm summarizing the treatment of ] according the the  guidelines.

# Do's
- The content in this section is in bullet points.

# Don'ts
- The content in this section is in bullet points.
Left ventriculogram quality grades
Synonyms and keywords: Left ventriculogram quality; LV gram quality; LV gram quality grades

# Left Ventriculogram Quality Grades
Following are the explanations for the different grades of LV gram quality:

## Uninterpretable
LV gram quality is uninterpretable, if it is impossible to analyze heart-beat type, ventricular wall motion, mitral valve regurgitation, and left ventricular ejection fraction because of insufficient filling of the LV cavity, poor panning, and short film duration.  So all the fields for analysis are marked as CNA (can not assess).

## Poor
LV gram quality is poor, if it is difficult to analyze heart-beat type, ventricular wall motion, and mitral valve regurgitation and impossible to analyze left ventricular ejection fraction because of poor panning and short film duration.  So only ejection fraction is marked as CNA (can not assess).

## Fair
LV gram quality is fair, if it is difficult to analyze heart-beat type, ventricular wall motion, mitral valve regurgitation, and left ventricular ejection fraction with proper panning and enough film duration which covers at least three heart-beats.  So nothing is marked as CNA (can not assess).

## Good
LV gram quality is good, if it is easy to analyze heart-beat type, ventricular wall motion, mitral valve regurgitation, and left ventricular ejection fraction with good filling of the LV cavity, proper panning, and enough film duration which covers at least three heart-beats.  So nothing is marked as CNA (can not assess).

## Excellent
LV gram quality is excellent, if it is very easy to analyze heart-beat type, ventricular wall motion, mitral valve regurgitation, and left ventricular ejection fraction with perfect filling of the LV cavity, proper panning, and enough film duration which covers at least three heart-beats.  So nothing is marked as CNA (can not assess).
Lateral cutaneous nerve of forearm
The lateral antebrachial cutaneous nerve (or lateral cutaneous nerve of forearm) (branch of musculocutaneous nerve, also sometimes spelled "antebrachial") passes behind the cephalic vein, and divides, opposite the elbow-joint, into a volar and a dorsal branch.

# Volar branch
The volar branch (ramus volaris; anterior branch) descends along the radial border of the forearm to the wrist, and supplies the skin over the lateral half of its volar surface.
At the wrist-joint it is placed in front of the radial artery, and some filaments, piercing the deep fascia, accompany that vessel to the dorsal surface of the carpus.
The nerve then passes downward to the ball of the thumb, where it ends in cutaneous filaments.
It communicates with the superficial branch of the radial nerve, and with the palmar cutaneous branch of the median nerve.

# Dorsal branch
The dorsal branch (ramus dorsalis; posterior branch) descends, along the dorsal surface of the radial side of the forearm to the wrist.
It supplies the skin of the lower two-thirds of the dorso-lateral surface of the forearm, communicating with the superficial branch of the radial nerve and the dorsal antebrachial cutaneous branch of the radial.
Persistent left superior vena cava

# Overview
A persistent left superior vena cava (PLSVC) is the most common variation of the thoracic venous system, is  prevalent in 0.3% of the population, and an embryologic reminant that results from a failure to involute.
In PLSVC, the left brachiocephalic vein does not develop fully and the left upper limb and head & neck drain into the right atrium via the coronary sinus.  The variation, in insolation, is considered benign, but is very frequently associated with cardiac abnormalities (e.g. ventricular septal defect, atrioventricular septal defect) that have a significant mortality and morbidity. It is more frequent in patients with congenital heart defects.

# Diagnosis

## Chest x-ray
- Chest x-ray of a patient with persistent SVC (Courtesy of RadsWiki and copylefted)
- The atrial and ventricular pacemaker leads passing through a persistent left  SVC.
- The atrial and ventricular pacemaker leads passing through a persistent left SVC.

## CT
Images shown below are courtesy of RadsWiki and copylefted
- Image 1 - Duplication of inferior vena cava. This is a not uncommon variation. The left sided IVC (black arrow) most commonly ends in the normal left renal vein. Image 2 - Duplication of superior vena cava. This is a rare variation of the SVC. The left sided SVC (white arrow) is draining into the left atrium, thereby bypassing the pulmonary circulation. The right SVC is normal.   (Image courtesy of Dr Abhijit Datir)

## Cardiac Catheterization
Images shown below are courtesy of RadsWiki and copylefted
-1621953796774001204&hl=en
-6286747543454457354&hl=en

# Pathologic Findings
Image shown below is courtesy of Professor Peter Anderson DVM PhD and Published with permission.  PEIR, University of Alabama at Birmingham, Department of Pathology
- Persistent Left Superior Vena Cava: Gross natural color heart in situ dissected to show persistent left superior vena cava
Leukocyte receptor tyrosine kinase
Leukocyte receptor tyrosine kinase is an enzyme that in humans is encoded by the LTK gene.

# Function
The protein encoded by this gene is a member of the ALK/LTK receptor family of receptor tyrosine kinases (RTKs) whose ligand is unknown. Closely related to the insulin receptor family of RTKs. Tyrosine-specific phosphorylation of proteins is a key to the control of diverse pathways leading to cell growth and differentiation. Two alternatively spliced transcript variants encoding different isoforms have been described for this gene.

# Interactions
LTK has been shown to interact with IRS-1, Shc, and PIK3R1.
Levothyroxine detailed information
Levothyroxine, also known as L-thyroxine, synthetic T4 or 3,5,3',5'-tetraiodo-L-thyronine, is a synthetic form of thyroxine (thyroid hormone). The natural hormone is chemically in the L-form, as is the pharmaceutical agent.  Dextrothyroxine (D-thyroxine) briefly saw research as an anticholesterol agent but was pulled due to cardiac side-effects.
The EU has recently standardized the use of the name "levothyroxine" for the drug.  Common brand names include ""Thyrax"", "Euthyrox", "Levaxin" and "Eltroxin" in Europe, and "Levoxyl" and "Synthroid" in the U.S. There are also numerous generic versions approved by the Food and Drug Administration.

# Uses
This medicine is a hormone replacement usually given to patients with thyroid problems, specifically, hypothyroidism. It is also given to people who have Goitre or an enlarged thyroid gland.

# Administration
It is recommended that levothyroxine be taken half an hour to an hour before meals to maximize its absorption. It is also recommended that the patient take the tablet with one glass of water to ease swallowing as well as to help the tablet dissolve for absorption.

# Precautions and side effects
There are also foods and other substances that can interfere with absorption of thyroxine replacement. Avoid taking calcium and iron supplements within 4 hours of the medication and avoid taking soy products within 3 hours of the medication as these can reduce absorption of the medication.
Synthetic levothyroxine may have adverse side effects like:  palpitations, nervousness, headache, difficulty sleeping, insomnia, swelling of the legs and ankles, weight loss and/or increased appetite. Some may be allergic to the medicine. If the patient develops a severe reaction to this drug like difficulty breathing, shortness of breath or swelling of the face and tongue it is imperative that the patient immediately seek medical attention.

# Marketing and approvals
Synthroid is the most prescribed brand of T4 in United States. Synthroid was marketed in 1955, but was not FDA approved at that time as it was considered "generally regarded safe". In the 1990s, in response to debate as to whether Synthroid was more effective than other levothyroxine preparations, (which ended up concluding that there was little difference between Synthroid and generic brands all levothyroxine preparations were required to undergo the formal FDA approval process. Synthroid was approved by the FDA on 2002-07-24.
Lipopolysaccharide binding protein
Lipopolysaccharide binding protein is a protein that in humans is encoded by the LBP gene.
LBP is a soluble acute-phase protein that binds to bacterial lipopolysaccharide (or LPS) to elicit immune responses by presenting the LPS to important cell surface pattern recognition receptors called CD14 and TLR4.
The protein encoded by this gene is involved in the acute-phase immunologic response to gram-negative bacterial infections. Gram-negative bacteria contain a glycolipid, lipopolysaccharide (LPS), on their outer cell wall. Together with bactericidal permeability-increasing protein (BPI), the encoded protein binds LPS and interacts with the CD14 receptor, probably playing a role in regulating LPS-dependent monocyte responses. Studies in mice suggest that the encoded protein is necessary for the rapid acute-phase response to LPS but not for the clearance of LPS from circulation. This protein is part of a family of structurally and functionally related proteins, including BPI, plasma cholesteryl ester transfer protein (CETP), and phospholipid transfer protein (PLTP). Finally, this gene is found on chromosome 20, immediately downstream of the BPI gene.

# Interactions
Lipopolysaccharide-binding protein has been shown to interact with CD14, TLR2, TLR4 and the co-receptor MD-2.
Loop electrical excision procedure

# Overview
The loop electrosurgical excision procedure (LEEP) is one of the most commonly used approaches to treat high grade cervical dysplasia (CIN II/III, HGSIL) discovered on colposcopic examination. In the UK it is known as large loop excision of the transformation zone (LLETZ).  The procedure has many advantages including low cost, high success rate, and ease of use.  The procedure can be done in an office setting and usually only requires a local anesthetic, though sometimes IV sedation or a general anesthetic is used.

# Process
When performing a LEEP, the physician uses a wire loop through which an electric current is passed at variable power settings.  Various shapes and sizes of loop can be used depending on the size and orientation of the lesion.  The cervical transformation zone and lesion are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an endocervical specimen for further histologic evaluation.
The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with pathological interpretation.

# Complications
Complications are less frequent in comparison to a cold knife conization, but can include infection and hemorrhage. 
A survey study has indicated that the LEEP procedure does not appear to affect fertility. On the other hand, a case-control study has found an association between surgical treatment of CIN lesions and risk of infertility or subfertility, with an odds ratio of approximately 2. Scarring of the cervix is a theoretical mechanism of causing trouble conceiving. This scar tissue can be massaged or broken up in a number of ways, thus allowing the cervical opening to dilate back to normal size. 
A cohort study came to the result that women with a time interval from LEEP to pregnancy of less than 12 months compared with 12 months or more were at significantly increased risk for spontaneous abortion, with risk of  miscarriage of 18% compared with 4.6%, respectively. On the other hand, no increased risk was identified for preterm birth after LEEP.
Luliconazole clinical pharmacology

# Clinical Pharmacology

## Mechanism of Action
LUZU Cream, 1% is an azole antifungal .

## Pharmacodynamics
At therapeutic doses, LUZU Cream, 1% is not expected to prolong QTc to any clinically relevant extent.

## Pharmacokinetics
Luliconazole is the R enantiomer of a chiral molecule. The potential for inter-conversion between R and S enantiomers in humans has not been assessed. Information on the pharmacokinetics of luliconazole presented below refers to both R enantiomer and S enantiomer, if any, combined.
Luliconazole is >99% protein bound in plasma.
In a pharmacokinetic trial, 12 subjects with moderate to severe tinea pedis and 8 subjects with moderate to severe tinea cruris applied a mean daily amount of approximately 3.5 grams of LUZU Cream, 1% to the affected and surrounding areas once daily for 15 days. Plasma concentrations of luliconazole on Day 15 were measurable in all subjects and fluctuated little during the 24 hour interval. In subjects with tinea pedis, the mean  SD of the maximum concentration (Cmax) was 0.40  0.76 ng/mL after the first dose and 0.93  1.23 ng/mL after the final dose. The mean time to reach Cmax (Tmax) was 16.9  9.39 hours after the first dose and 5.8  7.61 hours after the final dose. Exposure to luliconazole, as expressed by area under the concentration time curve (AUC024 was 6.88  14.50 ng*hr/mL after the first dose and 18.74  27.05 ng*hr/mL after the final dose. In subjects with tinea cruris, the mean  SD Cmax was 4.91  2.51 ng/mL after the first dose and 7.36  2.66 ng/mL after the final dose. The mean Tmax was 21.0  5.55 hours after the first dose and 6.5  8.25 hours after the final dose. Exposure to luliconazole, as expressed by AUC024 was 85.1  43.69 ng*hr/mL after the first dose and 121.74  53.36 ng*hr/mL after the final dose.
Lymphoid enhancer-binding factor 1
Lymphoid enhancer-binding factor 1 (LEF1) is a protein that in humans is encoded by the LEF1 gene.

# Function
Lymphoid enhancer-binding factor-1 (LEF1) is a 48-kD nuclear protein that is expressed in pre-B and T cells. It binds to a functionally important site in the T-cell receptor-alpha (TCRA) enhancer and confers maximal enhancer activity. LEF1 belongs to a family of regulatory proteins that share homology with high mobility group protein-1 (HMG1).

# Clinical significance
LEF1 is highly overexpressed and associated with disease progression and poor prognosis in B-cell chronic lymphocytic leukemia and other kinds of malignancies like colorectal cancer. It is also a promising potential drug target.

# Interactions
Lymphoid enhancer-binding factor 1 has been shown to interact with:
- ALX4,
- AML-1,
- CTNNB1,
- EP300,
- MITF
- PIAS4,
- SMAD2, and
- SMAD3.
Mycobacterium avium intracellulare
Synonyms and key words: MAI

# Overview
Mycobacterium avium intracellulare is an atypical mycobacterial infection which can occur in the later stages of AIDS. It can also affect women who do not have AIDS and usually first presents as a persistent cough.

# Pathophysiology
MAI is a saprotrophic organism that is present in soil and water, entry is usually via the GI tract but also can be via the lungs.

# Clinical manifestations
It causes fevers, diarrhoea, malabsorption and anorexia and it can disseminate to the bone marrow.

# Treatment
Therapy for MAI presents a challenge as it is typically resistant to standard mycobacterial therapies. It is normally treated with a series of 3 antibiotics for a period of at least 6 months.
Macrocephaly (patient information)
For the WikiDoc page for this topic, click here

# Overview
Increased head circumference is when the measured distance around the widest part of the skull is larger than expected for the child's age and background.

# What are the symptoms of Macrocephaly?
Increased pressure in the head (increased intracranial pressure) often occurs with increased head circumference. Symptoms of this condition include:
- Eyes moving downward
- Irritability
- Vomiting

# What causes Macrocephaly?
Benign familial macrocephaly (family tendency toward large head size)
- Canavan disease
- Hurler syndrome
- Hydrocephalus (congenital, post-traumatic, or obstructive)
- Intracranial bleeding
- Morquio syndrome

# When to seek urgent medical care?
- The health care provider usually finds macrocephaly during a routine well-baby exam.
- The health care provider will take a medical history and will perform a physical examination.
- Medical history questions may include:
Time pattern
When did you first notice that the baby's head seemed large?
Does the baby's head size seem to be increasing faster compared to the growth of the body?
Location
Does the head seem larger all over?
Is the head growing more in a front-to-back pattern or in a side-to-side pattern?
Other
What other symptoms are present (especially changes in brain or nervous system functions)?
- Time pattern
When did you first notice that the baby's head seemed large?
Does the baby's head size seem to be increasing faster compared to the growth of the body?
- When did you first notice that the baby's head seemed large?
- Does the baby's head size seem to be increasing faster compared to the growth of the body?
- Location
Does the head seem larger all over?
Is the head growing more in a front-to-back pattern or in a side-to-side pattern?
- Does the head seem larger all over?
- Is the head growing more in a front-to-back pattern or in a side-to-side pattern?
- Other
What other symptoms are present (especially changes in brain or nervous system functions)?
- What other symptoms are present (especially changes in brain or nervous system functions)?
- The distance is measured in centimeters or inches and compared with:
Past measurments of a child's head circumference
Normal ranges for a child's sex and age (weeks, months) -- based on normal growth rates of infants' and children's heads
- Past measurments of a child's head circumference
- Normal ranges for a child's sex and age (weeks, months) -- based on normal growth rates of infants' and children's heads
- A careful physical exam will be done. Other milestones for growth and development will be checked.
- In some cases, a single measurement is enough to confirm that there is a size increase that needs to be tested further. More often, repeated measurements of the head circumference over a period of time are needed to confirm that the head circumference is increased and the problem is getting worse.
- Diagnostic tests vary depending on the cause, but often include:
Head CT scan
MRI of the head
- Head CT scan
- MRI of the head

# Where to find medical care for Macrocephaly?
Directions to Hospitals Treating Macrocephaly

# Sources