Persius/hicric huggingface dataset:
Cefpirome warnings and precautions

# Warnings and Precautions
The Ocurrence of any allergic reaction necessitates discontinuation of treatment. The prescription of cephalosporins requires prior interview, as cross-allergy between penicillins and cephalosporins is present in 5 to 10% of cases. Cephalosporins must be used with extreme caution in penicillin sensiti~ patients.
The use of cephalosporins is strictly prohibited in subjects wilh a history of immediate allergy to cephalosporins. In case of doubt, the presence of the doctor is essential at the time of first administration in order to treat a possible anaphylactic (sudden and severe allergic) reactton which may progress to life-threatening shock and require emergency treatment.
It is advisable to monitor renal funclton during treatment with combinations of cefpirome and diuretics of lhe furosemide or ethacrynic acid type and potenlially nephrotoxic drugs such as certain antibtotics (aminogtyrosides in partirular). In cases of impaired renal function, adjust the dosage according to the creatinine clearance (see under "Dosage and administration").
As with other beta lactam antibiotic granulocytopenia and, more rarely, agranulocylosis ( a potentially lifethreateoing depletion of certain white blood cells) may develop, parlicularly if Cefrom is given over longer periods.
The blood cell count should therefore be monitored for courses of treatment lasting for more than 10 days.
Severe and petsistent diarrhea may occur with broad spectrum antibiotics during treatment or in the weeks following discontinuation. These episodes may be symptomatic of pseudomembranous colitis (in most cases, due to Clostridium difficile). This event, which is rare wilh cephalosporins, may be life threatening.
Even if pseudomembranous colitis is only suspected, administration of Cefrom must be halted immediately. This type of colitis requires immediate and appropriate treatment by a physician.
Drugs that inihibit intestinal mobility must not be taken in such cases.
Insufficient clinical experience has been gained with Cefrom in children.
The safety of cefpirome has not yet been established in pregnant women. Cefrom musl not be administered during pregnancy. Studies in several animal species have shown no teratogenic or fetotoxic action.
The safety of cefpirome has not yet been established in lactating women. Therefore, breast-feeding should be discontinued during treatment with Cefrom.
Chicago 1885 cholera epidemic myth
The Chicago 1885 cholera epidemic myth is a persistent urban legend, stating that 90,000 people in Chicago died of typhoid fever and cholera in 1885. Although the story is widely reported, these deaths did not occur.
Lake Michigan was the source of Chicago's drinking water. During a tremendous storm in 1885, the rainfall washed refuse from the Chicago River far out into the lake and locals feared the sewage would reach the city's water intake cribs, two miles offshore.
According to the legend, typhoid, cholera and other waterborne diseases from the contaminated drinking water killed up to 90,000 people. The Chicago Sanitary District (now The Metropolitan Water Reclamation District) was said to have been created by the Illinois legislature in 1889 in response to a terrible epidemic which killed thousands of residents of this fledgling city.
However, analysis of the deaths in Chicago shows no deaths from cholera and only a slight rise in typhoid deaths. In fact, no cholera outbreaks had occurred in Chicago since the 1860s. Typhoid deaths never exceeded 1,000 in any year in the 1880s. The supposed 90,000 deaths would have represented 12% of the city's entire population and would have left numerous public records as well as newspaper accounts. Libby Hill, researching her book The Chicago River: A Natural and Unnatural History, found no newspaper or mortality records and, at her prompting, the Chicago Tribune issued a retraction (on September 29, 2005) of the three recent instances where they had mentioned the epidemic.

# Actual deaths
One of the most famous people to die from typhoid fever in Chicago was Stephen A. Douglas, a Democrat contender in the 1860 presidential election, who died on June 3, 1861.
Children's Hospital of New Orleans
Children's Hospital of New Orleans is a non-profit children's hospital in New Orleans, Louisiana.
Children's Hospital offers a wide range of inpatient and outpatient pediatric care, including a Pediatric intensive care unit, Neonatal intensive care unit, and a parenting education center.  As of 2002, it has 201 beds and over 380 pediatricians and pediatric specialists.  The hospital admits over 7,000 inpatient and 170,000 outpatient visits each year.  The hospital services the entire state of Louisiana and Gulf Coast region.
Children's Hospital is operated as a non-profit organization, run by an independent board of trustees.  It was originally opened as a rehabilitation center for physically handicapped children in 1955 under the name Crippled Children's Hospital.  The facility was expanded into a full service hospital and given its current name in 1976.
The main hospital is located in the University District of Uptown New Orleans.  The address is 200 Henry Clay Avenue, New Orleans, Louisiana  70118.  Phone:  (504) 899.9511.  This facility is located along the levee next to the Mississippi River, near the Audubon Zoo and Audubon Park, New Orleans.  There is also satellite clinic in the nearby suburb of Metairie.
Children's Hospital is located near the Mississippi River levee, on the city's old high ground or "sliver by the river" which escaped the flooding of most of the city in the Levee failures in Greater New Orleans, 2005 in the aftermath of Hurricane Katrina.  The hospital has its own power generator and remained operational throughout Hurricane Katrina.  It was evacuated on 2005 Sep. 1 when the hospital lost water pressure from the city.  The hospital suffered no flood damage and negligible wind damage during the storm.  It was fully reopened over a month later on 2005 Oct. 10.  

# Sources
-    Child Health Corporation of America.  New Orleans Update.
Chloroquine phosphate how supplied

# How Supplied
- Chloroquine Phosphate Tablets USP 250 mg: White, Round, Scored Compressed Tablet; Debossed "West-ward 195".
Bottles of 50 tablets.
Bottles of 100 tablets.
Bottles of 500 tablets.
Bottles of 1000 tablets.
Unit Dose Boxes of 100 tablets.
- Chloroquine Phosphate Tablets USP 500 mg: Pink Color, Round Tablets Debossed "WW 125".
Bottles of 25 tablets.
Bottles of 100 tablets.
Bottles of 500 tablets.
Bottles of 1000 tablets.
Unit Dose Boxes of 100 tablets.
Store at 20-25C (68-77F). .
Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
Chloroquine phosphate microbiology

# Microbiology

## Mechanism of Action
Chloroquine is an antimalarial agent. While the drug can inhibit certain enzymes, its effect is believed to result, at least in part from its interaction with DNA. However, the mechanism of plasmodicidal action of chloroquine is not completely certain.

## Activity in vitro and in vivo
Chloroquine is active against the erthyrocytic forms of Plasmodium vivax, Plasmodium malariae, and susceptible strains of Plasmodium falciparum (but not the gametocytes of P. falciparum). It is not effective against exoerythrocytic forms of the parasite.
In vitro studies with trophozoites of Entamoeba histolytica have demonstrated that chloroquine also possesses amebicidal activity comparable to that of emetine.

## Drug Resistance
Resistance of Plasmodium falciparum to chloroquine is widespread and cases of Plasmodium vivax have been reported.
Clarithromycin labels and packages

# Labels And Packages
Filmtab - Film-sealed tablets, AbbVie Inc.
Biaxin Filmtab 250 mg and 500 mg and Biaxin XL 500 mg
Mfd. by AbbVie LTD, Barceloneta, PR 00617
Biaxin Granules for Oral Suspension, 125 mg/5 mL and 250 mg/5 mL
Mfd. by AbbVie Inc., North Chicago, IL  60064
For AbbVie Inc., North Chicago, IL  60064, U.S.A.
03-A879 September, 2013
NDC 0074-3368-60
Biaxin
Filmtab
Clarithromycin
Tablets, USP
250 mg
60 Tablets
Rx only abbvie
NDC 0074-2586-60
Biaxin
Filmtab
Clarithromycin
Tablets, USP
500 mg
60 Tablets
Rx only abbvie
NDC 0074-3165-60
Biaxin XL
Filmtab
Clarithromycin
Extended-Release
Tablets
500 mg
60 Tablets
Rx only abbvie
NDC 0074-2586-11
Biaxin
Filmtab
Clarithromycin Tablets, USP
500 mg
100 Tablets
THIS PACKAGE FOR HOUSEHOLDS WITHOUT YOUNG CHILDREN
Rx only abbvie
NDC 0074-3165-41
14 Tablets Unit-of-Use
BIAXINXL
FILMTAB
clarithromycin
extended-release tablets
500 mg
BIAXINXL Pac
Contains one 7day course of antibiotic treatment. Usual dose: Two tablets once daily with food. Do not accept if blister seal has been broken.
Rx only abbvie
NDC 0074-3165-11
BiaxinXL
Filmtab
Clarithromycin Extended-Release Tablets
500 mg
100 Tablets
THIS PACKAGE FOR HOUSEHOLDS WITHOUT YOUNG CHILDREN
Rx only abbvie
biaxin xl 500 mg 100ct hud
NDC 0074-3163-13
Biaxin 
Granules
Clarithromycin for Oral Suspension, USP
125 mg per 5 mL
100 mL (when mixed)
Rx only abbvie
NDC 0074318813
Biaxin Granules
Clarithromycin for Oral Suspension, USP
250 mg per 5 mL
100 mL (when mixed)
Rx only abbvie
Clindamycin hydrochloride warnings
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including CLEOCIN HCl, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile.
C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
A careful inquiry should be made concerning previous sensitivities to drugs and other allergens.

# Usage in Meningitis
Since clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis.
Clindamycin phosphate how supplied

# HOW SUPPLIED
CLEOCIN T Topical Solution containing clindamycin phosphate equivalent to 10 mg clindamycin per milliliter is available in the following sizes:
30 mL applicator bottle  NDC 0009-3116-01
60 mL applicator bottle  NDC 0009-3116-02
Carton of 60 single-use pledget applicators  NDC 0009-3116-14
CLEOCIN T Topical Gel containing clindamycin phosphate equivalent to 10 mg clindamycin per gram is available in the following sizes:
60 gram tube  NDC 0009-3331-01
30 gram tube  NDC 0009-3331-02
CLEOCIN T Topical Lotion containing clindamycin phosphate equivalent to 10 mg clindamycin per milliliter is available in the following size:
60 mL plastic squeeze bottle  NDC 0009-3329-01
Store at controlled room temperature 20 to 25 C (68 to 77 F) .
Protect from freezing.
Colistimethate sodium how supplied

# How Supplied
Coly-Mycin M Parenteral is supplied in vials containing colistimethate sodium (equivalent to 150 mg colistin base activity per vial) as a white to slightly yellow Iyophilized cake.
NDC 42023-107-01: one individual vial.
NDC 42023-107-06: six vials per carton.
Store between 20 to 25C (68 to 77F). (See USP controlled room temperature.)
Store reconstituted solution in refrigerator 2 to 8C (36 to 46F) or between 20 to 25C (68 to 77F) and use within 7 days.
Colistimethate sodium microbiology

# Microbiology
Colistimethate sodium is a surface active agent which penetrates into and disrupts the bacterial cell membrane. It has been shown to have bactericidal activity against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section:
Aerobic gram-negative microorganisms: Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.
Susceptibility Tests
Colistimethate sodium is no longer listed as an antimicrobial for routine testing and reporting by clinical microbiology laboratories.
Consortium for the Barcode of Life
Consortium for the Barcode of Life is an international collaborative effort which aims to develop a mechanism capable of generating a unique genetic barcode for every species of life on earth.
The science behind the Consortium's initiative has met with considerable controversy, with responses ranging from enthusiastic endorsement to strident rejection. More work needs to be done to determine to what extent barcoding can complement existing taxonomic methods in cataloguing the planet's biodiversity.

# Telephone directory of earth's species
On September 14, 2007, a team of scientists (50 countries) initiated a global database project for  Earth's 1.8 million known species (from tiny genetic material). David Schindel, a Smithsonian Institution paleontologist, executive secretary of the Consortium for the Barcode of Life stated that it will create a global reference library: "a kind of telephone directory for all species."  30,000 species had been put in the database to reach 500,000, 5 years. The consortium is sponsored by the Smithsonian Institution's Museum of Natural History. The 2003 research paper of geneticist Paul Hebert of University of Guelph, Ontario proposed a database of DNA barcodes identifying all species.
DURACLON dosage and administration

# Dosage and Administration
The recommended starting dose of Duraclon for continuous epidural infusion is 30 mcg/hr. Although dosage may be titrated up or down depending on pain relief and occurrence of adverse events, experience with dosage rates above 40 mcg/hr is limited.
Familiarization with the continuous epidural infusion device is essential. Patients receiving epidural clonidine from a continuous infusion device should be closely monitored for the first few days to assess their response.
The 500 mcg/mL (0.5 mg/mL) strength product must be diluted prior to use in 0.9% Sodium Chloride for Injection, U.S.P., to a final concentration of 100 mcg/mL:

## Renal Impairment
Dosage should be adjusted according to the degree of renal impairment, and patients should be carefully monitored. Since only a minimal amount of clonidine is removed during routine hemodialysis, there is no need to give supplemental clonidine following dialysis.
Duraclon must not be used with a preservative.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Displaced point of maximal impulse

# Overview
During a cardiac examination, the normal point of maximal impulse (PMI) should be routinely palpated in the left midclavicular line between the fourth and fifth ribs (normally 2-3 cm in diameter). The normal PMI represents the apical impulse of the left ventricle. A displaced PMI sheds light on abnormalities of the heart, and therefore allows for a correct diagnosis

# Differential Diagnosis of a Displaced PMI
In alphabetical order  
- Aortic aneurysm
- Dilated pulmonary artery
- Left ventricular aneurysm
- Left ventricular enlargement
- Left ventricular hypertrophy
- Massive pleural effusion
- Right-sided tension pneumothorax
- Right ventricular dilation
- Right ventricular hypertrophy

## Chest X Ray
- Chest X-ray is useful for the diagnosis of congestive heart failure, pneumothorax and pleural effusions

## MRI and CT
- MRI and CT scan for patients with aortic dissections or aortic aneurysms

## Echocardiography or Ultrasound
- Echocardiogram assesses the presence/absence of apical aneurysm, wall thickness, ventricular function, chamber size, measurement of pulmonary artery (PA) pressure (indirectly)
- Transesophageal echocardiogram (aortic dissections or aortic aneurysms)

# Treatment
- Blood pressure control (left ventricular hypertrophy)
- Observation and diuretics (tension pneumothorax)
- Treatment of underlying etiology and diuretics (right heart failure)

# Surgery and Device Based Therapy
- Needle decompression and chest tube (pleural effusions)
- Surgical correction (aortic aneurysm)
Differential diagnosis of jaundice

# Overview
Jaundice is yellowish discoloration of the skin, conjunctiva (a clear covering over the sclera, or whites of the eyes) and mucous membranes caused by hyperbilirubinemia. Usually, the concentration of bilirubin in the blood must exceed 23 mg/dL for the coloration to be easily visible. This page contains different causes of jaundice.

# Differential diagnosis of jaundice
Differential diagnosis of jaundice are: 
The differential diagnosis for jaundice and pruritis are:
The differential diagnosis for jaundice, pruritis and RUQ pain are:
The differential diagnosis for jaundice, pruritis and RUQ pain are:
The differential diagnosis for jaundice, fever and RUQ pain are:
The differential diagnosis for jaundice and fever are:
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
-  Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164168. PMID 28145671..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}
Distal splenorenal shunt procedure

# Overview
In medicine, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt, is a surgical procedure in which the distal splenic vein (a part of the portal venous system) is attached to the left renal vein (a part of the systemic venous system).  It is used to treat portal hypertension and its main complication (esophageal varices).

# Splenopancreatic and gastric disconnection (SPGD)
DSRS is typically done with splenopancreatic and gastric disconnection (ligation of the gastric veins and pancreatic veins (that drain into the portal vein) and complete detachment of the splenic vein from the portal venous system), as it improves the outcome.

# Comparison to TIPS
Survival with a transjugular intrahepatic portosystemic shunt (TIPS) versus a DSRS is thought to be approximately similar, but still an area of intensive research.
Both TIPS and DSRS lead to decreased rates of variceal bleeding at the expense of hepatic encephalopathy; however, TIPS appears to have more shunt dysfunction and lead to more encephalopathy and bleeds. DSRS appears to be more cost effective than TIPS.
Ductus arteriosus abnormal closure
Assistant Editor-In-Chief: Kristin Feeney, B.S. ]

# Abormal closure of ductus arteriosus
The abnormal closure of the ductus arteriosus results in patent ductus arteriosus. Patent ductus arteriosus, or PDA, is a heart condition that is normal but reverses soon after birth. In a persistent PDA, there is an irregular transmission of blood between two of the most important arteries in close proximity to the heart. Although the ductus arteriosus  normally seals off within a few days, in PDA, the newborn's ductus arteriosus does not close, but remains patent. PDA is common in infants with persistent respiratory problems such as hypoxia, and has a high occurrence in premature children. In hypoxic newborns, too little oxygen reaches the lungs to produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children are more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.In some babies, on the other hand, the ductus arteriosus remains open. This opening permits blood to surge unswervingly starting from the aorta into the pulmonary artery.
A patent ductus arteriosus allows oxygenated blood to flow down its pressure gradient from the aorta to the pulmonary arteries. Thus, some of the infant's oxygenated blood does not reach the body, and the infant becomes short of breath. The heart rate hastens, thereby increasing the speed with which blood is oxygenated and delivered to the body. Left untreated, the infant will likely suffer from congestive heart failure, as his heart is unable to meet the metabolic demands of his body.
In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), a PDA may need to remain open. In this cardiovascular condition, the PDA is the only way that oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins are used to keep the patent ductus arteriosus open.