Persius/hicric huggingface dataset:
Osgood-Schlatter disease
Synonyms and keywords: Tibial tubercle traumatic apophysitis; Louise's knees disease; tibial tubercle osteochondrosis

# Overview
Osgood-Schlatter disease (also known as tibial tubercle traumatic apophysitis or Louise's knees disease) is an inflammation of the growth plate at the tibial tuberosity. It is one of a group of conditions called Osteochondritis.
The disease is most common in active boys aged 10-15. It most commonly occurs in just one leg but can occur in both at the same time. It is named after the American surgeon Robert Bayley Osgood (18731956) and the Swiss surgeon Carl Schlatter (18641934), the two people who first described it.
It usually self resolves.

# Causes
The condition is caused by stress on the tendon that attaches the muscle at the front of the thigh to the tibia.  It occurs when, following an adolescent growth spurt, stress from contraction of the quadriceps is transmitted through the patellar tendon to the not yet fully-developed tibial tuberosity. This can cause inflammation and avulsion fracture, and eventually results in bone growth in the tendon, producing a visible lump.

# History and Symptoms
A visible bump around 2cm in diameter will appear at the tibial tubercle and will cause pain during and after high impact activities, and sometimes after lesser activities such as climbing stairs.  The disease is generally a benign condition which in most cases will eventually disappear on its own. Symptoms may last for 2-3 years, but will nearly always resolve at the end of the growth spurt, or at the latest when the tibial epiphysis fuses. However, many adults will continue to experience pain when kneeling throughout the rest of their lives.

# Treatment
Treatment includes rest, icing and stretching. Analgesics can also help reduce pain. Doctors encourage patients to take a break from any more physical activity that could induce more pain until the pain subsides.  Immobilization of the knee by a cast may be required if the problem persists. As a last resort surgery, consisting of the drilling (under anaesthetic) of multiple holes through the epiphyseal plate promotes fusion and relieves the condition.
Osteitis fibrosa cystica
Osteitis fibrosa cystica, also known as Von Recklinghausen's disease of bone, is characterized by increased osteoclastic resorption of calcified bone with replacement by fibrous tissue. It may be caused by primary hyperparathyroidism or other causes of the rapid mobilization of mineral salts.
The bone problems associated with the disorder osteitis fibrosa are usually reversible with surgery, except in the case of fluid filled cysts, which require non-surgical attention.

# Causes
- Hyperparathyroidism

# Symptoms
Osteitis fibrosa cystica can lead to bone pain or tenderness, pathological fractures in the arms, legs, or spine, and deformities (bowing of the bones). Being a precursor to the disorder, hyperparathyroidism itself may cause kidney stones, nausea, constipation, fatigue and weakness. Blood tests show a high level of serum calcium and alkaline phosphatase, and low serum phosphorus.  X-rays may indicate thin bones, fractures, bowing, and cysts. The cysts may be lined by osteoclasts, filled with fibrous stroma and sometimes blood ("brown tumors"). The skull may look like "ground glass" or "salt and pepper." The outer part of bones may be eroded; the most sensitive area to check is the fingers. Teeth X-rays may also be abnormal.

# Differential Diagnosis of Osteitis fibrosa cystica

# Treatment
The main treatment for hyperparathyroidism is surgery to remove the abnormal parathyroid gland(s). Newer techniques use radioactive tracers and rapid parathyroid hormone blood tests to make the surgery quicker and easier. If surgery is not possible, drugs can sometimes be used to lower calcium levels.
Osteochondrosis overview

# Overview
The Osteochondroses are a family of orthopedic diseases that occur in children and in rapidly growing animals, particularly pigs, horses, and large breed dogs. They are characterized by interruption of the blood supply of a bone, in particular to the epiphysis, followed by localized bony necrosis and later, regrowth of the bone.

# Causes
The ultimate cause for these conditions is unknown, although several of the human osteochrondroses are more common in very active individuals. This leads some researchers to speculate that cumulative microtrauma may be the primary event. Osteochondrosis in swine has been shown to be a condition responsive to supplementation with the essential trace element boron and may be a manifestation of boron deficiency.

# Natural History, Complications and Prognosis
The prognosis for these conditions is very variable, and depends both on the anatomic site and on the time at which it is detected. In some osteochondroses, such as Sever's disease and Freiberg's infraction, the involved bone may heal in a relatively normal shape and leave the patient asymptomatic. On the contrary, Legg-Calve-Perthes disease frequently results in a deformed femoral head that leads to arthritis and the need for joint replacement.
Surgery to correct this problem is long, and can be very painful.

# Diagnosis

## History and Symptoms
These conditions nearly all present with an insidious onset of pain referred to the location of the bony damage. Some, notably Kienbock's disease of the wrist, may involve considerable swelling, and Legg-Calve-Perthes disease of the hip causes the victim to limp. The spinal form, Scheuermann's disease, may cause bending, orkyphosis of the upper spine.
Ovarian torsion overview

# Overview
Ovarian torsion refers to a twisting of the ovary. If the torsion involves the ovary and the oviduct it is called adnexal torsion. Ovarian torsion is in the differential diagnosis of unilateral abdominal pain in a woman. Approximately 60% of the time it occurs on the right side of the abdomen.

# Epidemiology and Demographics
Obviously ovarian torsion only occurs in women. Ovarian torsion is the fifth most common gynecologic emergency. 83% of cases occur in women of reproductive age, with a median age at presentation of 28 years.

# Diagnosis

## History and Symptoms
Patients with ovarian torsion often present with sudden onset of sharp and usually unilateral lower abdominal pain. 70% of the cases are accompanied by nausea and vomiting. In case of necrosis, fever occurs.

## Ultrasound
Abdominal ultrasound is helpful in establishing the diagnosis in patients with suspected torsion.

# Treatment

## Medical Therapy
Associated symptoms of nausea and vomiting can be treated with antiemetics. Dehydration secondary to vomiting can be treated with intravenous fluids.

## Surgery
Conservative treatment of ovarian torsion includes laparoscopy to uncoil the torsed ovary and possibly oophoropexy to fixate the ovary which is likely to torse again. In severe cases, where blood flow is cut off to the ovary for an extended period of time, necrosis of the ovary can occur.  In these cases the ovary must be surgically removed.
Oxiconazole microbiology

# Microbiology
Oxiconazole nitrate is an imidazole derivative whose antifungal activity is derived primarily from the inhibition of ergosterol biosynthesis, which is critical for cellular membrane integrity. It has in vitro activity against a wide range of pathogenic fungi.
Oxiconazole has been shown to be active against most strains of the following organisms both in vitro and in clinical infections at indicated body sites:
Epidermophyton floccosum
- Trichophyton mentagrophytes
- Trichophyton rubrum
- Malassezia furfur
The following in vitro data are available; however, their clinical significance is unknown. Oxiconazole exhibits satisfactory in vitro minimum inhibitory concentrations (MICs) against most strains of the following organisms; however, the safety and efficacy of oxiconazole in treating clinical infections due to these organisms have not been established in adequate and well-controlled clinical trials:
- Candidaalbicans
- Microsporum audouini
- Microsporum canis
- Microsporum gypseum
- Trichophyton tonsurans
- Trichophyton violaceum
Oxygen Enhancement Ratio

# Overview
The Oxygen Enhancement Ratio (OER) in radiobiology refers to the enhancement of therapeutic or detrimental effect of ionizing radiation due to the presence of oxygen. The effect is most notable in ionizing radiation dose.

# Uses in medicine
The effect is used in medical physics to increase the effect of radiation therapy in oncology treatments. Additional oxygen abundance creates additional free radicals and increases the damage to the target tissue.
In solid tumors the inner parts become less oxygenated than normal tissue and up to three times higher dose is needed to achieve the same tumor control probability as in tissue with normal oxygenation.
PARTNER (Cohort A) Trial

# Objective
To compare the outcomes with transcatheter aortic valve implantation (TAVI) versus surgical valve replacement among high-risk patients with severe symptomatic aortic stenosis

# Methods
The Placement of Aortic Transcatheter Valves (PARTNER) trial Cohort A was a prospective, multicenter, randomized, active-treatment-controlled clinical trial comparing transcatheter aortic-valve replacement with surgical aortic valve replacement in high-risk patients with severe aortic stenosis.
High-risk patient: defined by a Society of Thoracic Surgeons (STS) risk score of 10% or higher or by the presence of coexisting conditions that would be associated with a predicted risk of death by 30 days after surgery of 15% or higher.
Patients were randomly assigned to two groups:
- Surgical aortic valve replacement
- Transcatheter aortic valve implantation (either a transfemoral or a transapical approach)
Study device: The Edwards SAPIEN heart-valve system (Edwards Lifesciences)
The primary endpoint: the rate of death from any cause at 1 year

# Results
A total of 699 patients were enrolled at 25 centers. At 30 days, the rates of death from any cause were 3.4% in the transcatheter group compared with 6.5% in the surgical group (P=0.07). At 1 year, the rates of death from any cause were 24.2% in the transcatheter group compared with 26.8% in the surgical group (P=0.44), a reduction of 2.6 percentage point in the transcatheter group (two-sided 95% confidence interval , -9.3 to 4.1; upper limit of the one-sided 95% CI, 3.0 percentage points) was within the prespecified noninferiority margin of 7.5 percentage points (P=0.001 for noninferiority).
Rates of all neurologic events (i.e., all strokes and transient ischemic attacks) were higher in the transcatheter group than in the surgical group at 30 days (5.5% vs. 2.4%, P=0.04) and at 1 year (8.3% vs. 4.3%, P=0.04). At 30 days, the rates of major stroke were 3.8% in the transcatheter group and 2.1% in the surgical group P=0.20)
At 1 year, the rates of major strokes were 5.1% in the transcatheter group and 2.4% in the surgical group (P=0.07). At 30 days, the transcatheter group had a significantly higher rate of major vascular complications than did the surgical group (11.0% vs. 3.2%, P<0.001) but had lower rates of major bleeding events (9.3% vs. 19.5%, P<0.001) and new-onset atrial fibrillation (8.6% vs. 16.0%), P=0.006). At 30 days, more patients in the transcatheter group had an improvement in cardiac symptoms, but at 1 year there was no significant difference between the two groups.

# Conclusion
In high-risk patients with severe aortic stenosis, transcatheter and surgical procedures for aortic valve replacement were associated with similar rates of survival at 1 year and resulted in similar improvements in cardiac symptoms (noninferiority of the transcatheter group, as compared with the surgical group).
PARTNER (Cohort B) Trial

# Objective
To assess the outcomes with transcatheter aortic valve implantation (TAVI) compared with standard therapy among patients with severe symptomatic aortic stenosis who were poor surgical candidates for surgical aortic valve replacement

# Methods
The Placement of Aortic Transcatheter Valves (PARTNER) trial Cohort B was a prospective, multicenter, randomized, active-treatment-controlled clinical trial comparing TAVI with standard therapy in high-risk patients with severe aortic stenosis who were not suitable candidates for surgery.
High-risk patient: defined by a Society of Thoracic Surgeons (STS) risk score of 10% or higher or by the presence of coexisting conditions that would be associated with a predicted risk of death by 30 days after surgery of 15% or higher.
Patient not suitable for surgery: defined as having coexisting conditions that would be associated with a predicted probability of 50% or more of either death by 30 days after surgery or a serious irreversible condition.
Patients were randomly assigned to two groups:
- Standard therapy (including balloon aortic valvuloplasty)
- Transfemoral transcatheter aortic valve implantation
Study device: The Edwards SAPIEN heart-valve system (Edwards Lifesciences) consisting of a trileaflet bovine pericardial valve and a balloon-expandable, stainless-steel support frame
The primary endpoint: the rate of death from any cause over the duration of the trial

# Results
A total of 358 patients were enrolled at 21 centers. 
At 1 year, the rate of death from any cause was 30.7% in TAVI group, as compared with 50.7% in standard therapy group(hazard ratio with TAVI, 0.55; 95% confidence interval , 0.40 to 0.74; P<0.001).
The rate of the composite endpoint of death from any cause or repeat hospitalization was 42.5% with TAVI as compared with 71.6% with standard therapy (hazard ratio, 0.46; 95% CI, 0.35 to 0.59; P<0.001). 
Among survivors at 1 year, the rate of cardiac symptoms (New York Heart Association class III or IV) was lower among TAVI patients (25.2% vs. 58.0%, P<0.001). 
At 30 days, TAVI, as compared with standard therapy, was associated with a higher incidence of major strokes (5.0% vs. 1.1%, P=0.06) and major vascular complications (16.2% vs. 1.1%, P<0.001).

# Conclusion
In patients with severe aortic stenosis who were poor surgical candidates, TAVI (compared with standard therapy) significantly decreased the rates of all-cause mortality, rehospitalizations, and cardiac symptoms at the expense of higher incidence of major strokes and major vascular complications.
Palisades Medical Center
Palisades Medical Center is a regional hospital in North Bergen, New Jersey.  The hospital has approximately 202 beds and serves approximately 350,000 people in Southern Bergen and Hudson counties.  It has been a member of the NewYork-Presbyterian Hospital network since 1999, and is affiliated with the Columbia University College of Physicians & Surgeons.

# History
Palisades was formerly known as North Hudson Hospital in Weehawken, New Jersey.  In 1978, the hospital was relocated to the North Bergen waterfront and renamed Palisades Medical Center.
1915 Postcard image of North Hudson Hospital

# Medical Record Controversy
On September 21, 2007, the actor George Clooney and a companion were taken to Palisades Medical Center for treatment after a motorcycle accident.  Information that Clooney was a patient at the hospital was disseminated to the media before any official hospital statement, leading officials to suspect an internal leak.  The hospital conducted an audit and announced that 27 employees had accessed Clooney's information without prior authorization.  All 27 employees were suspended for one month without pay.  The employees included nurses, support staff, and security guards, but no physicians.  A union representing some staff is challenging 7 of the suspensions.
Palivizumab how supplied

# How Supplied
Synagis is supplied in single-dose vials as a preservative-free, sterile liquid solution at 100 mg per mL for intramuscular injection.
50 mg vial NDC 60574-4114-1
The 50 mg vial contains 50 mg Synagis in 0.5 mL.
100 mg vial NDC 60574-4113-1
The 100 mg vial contains 100 mg Synagis in 1 mL.
There is no latex in the rubber stopper used for sealing vials of Synagis.

## Storage
Upon receipt and until use, Synagis should be stored between 2C and 8C (36F and 46F) in its original container. DO NOT freeze. DO NOT use beyond the expiration date.
Pancreas transplantation

# Overview
A pancreas transplant is an organ transplant that involves implanting a healthy  pancreas (one that can produce insulin) into a person who has diabetes. Because the pancreas performs functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas attached in a different location.  In the event of rejection of the new pancreas, the recipient could not survive without the native pancreas still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor.  Whole pancreas transplants from living donors are not possible, again because the pancreas is a necessary organ for digestion. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes who have severe complications.

# Types
There are three main types of pancreas transplantation:
- Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor.
- Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.
- Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function.
CT image demonstrates a right lower quadrant pancreas transplant

# Indications
In most cases, pancreas transplantation is performed on individuals with type 1 diabetes with end-stage renal disease The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantions.

# Preservation until implantation
The donor's blood in the pancreatic tissue will be replaced by an ice-cold organ storage solution, such as UW (Viaspan) or  HTK until the allograft pancreatic tissue is implanted.

# Complications
Complications immediately after surgery include rejection, thrombosis, pancreatitis and infection.

# Prognosis
The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection and cancer.

# History
The first pancreas transplantation was performed in 1966, three years after the first kidney transplantation. A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.
Parasympathetic ganglion
Parasympathetic ganglia are the autonomic ganglia of the parasympathetic nervous system. Most are small terminal ganglia or intramural ganglia, so named because they lie near or within (respectively) the organs they innervate. The exceptions are the four paired parasympathetic ganglia of the head and neck.

# Parasympathetic ganglia of the head and neck
These paired ganglia supply all parasympathetic innervation to the head and neck.
- ciliary ganglion (spincter pupillae, ciliary muscle)
- pterygopalatine ganglion (lacrimal gland, glands of nasal cavity)
- submandibular ganglion (submandibular and sublingual glands)
- otic ganglion (parotid gland)

# Roots
Each has three roots entering the ganglion and a variable number of exiting branches.
- The motor root carries presynaptic parasympathetic nerve fibers (GVE) that terminate in the ganglion by synapsing the postsynaptic fibers traveling to target organs.
- The sympathetic root carries postsynaptic sympathetic fibers (GVE) that traverse the ganglion without synapsing.
- The sensory root carries general sensory fibers (GSA) that also do not synapse in the ganglion.
Some ganglia also carry special sensory fibers (SVA) for taste sensation.

# Nerves supplying parasympathetic fibers
- oculomotor nerve (ciliary ganglion)
- facial nerve (pterygopalatine ganglion, submandibular ganglion)
- glossopharyngeal nerve (otic ganglion)
- vagus nerve (no named ganglion)
- Pelvic splanchnic nerves (no named ganglion)
Penciclovir microbiology
Antiviral Activity:  In cell culture studies, penciclovir has antiviral activity against the following herpes viruses:  HSV-1 and HSV-2. The antiviral activity of penciclovir against wild type strains grown on human foreskin fibroblasts was assessed with a plaque reduction assay and staining with crystal violet 3 days postinfection for HSV. The median EC50 values of penciclovir against laboratory and clinical isolates of HSV-1 andHSV-2 were 2 M (range 1.2 to 2.4 M, n=7) and 2.6 M (range 1.6 to 11 M, n=6), respectively.
Resistance:  Penciclovir-resistant mutants of HSV can result from mutations in viral thymidine kinase (TK) and DNA polymerase genes.  Mutations in the viral TK gene may lead to complete loss of TK activity (TK negative), reduced levels of TK activity (TK partial), or alteration in the ability of viral TK to phosphorylate the drug without an equivalent loss in the ability to phosphorylate thymidine (TK altered).  The median EC50 values observed in a plaque reduction assays with penciclovir resistant HSV-1 and HSV-2 were 69 M (range 14 to 115 M, n=6) and 46 M (range 4 to > 395 M, n=9), respectively.  The possibility of viral resistance to penciclovir should be considered in patients who fail to respond or experience recurrent viral shedding during therapy.
Cross-resistance:  Cross-resistance has been observed among HSV DNA polymerase inhibitors. The most commonly encountered acyclovir-resistant mutants that are deficient in viral thymidine kinase (TK negative) are also resistant to penciclovir.
Pharmaceutical diversion
Pharmaceutical diversion is the "illegal diversion of prescription drugs...."   It is, simply put, "the diversion of licit drugs for illicit purposes." 

# Examples of how, when and why it occurs
This activity can occur in many venues; and it:
-ccurs in a variety of ways, by all segments of our population, in all neighborhoods, and in all workplaces. Its abuse is often overlooked by the thinking that if a doctor prescribes the drug, and a pharmacist dispenses the medication, it cant be abused. Understanding that the top prescription drugs of abuse are every bit as addictive, abused, and valuable as illicit drugs, is sometimes difficult to comprehend.
A leading web site claims that:
Prescription drug abuse accounts for almost 30% of the overall drug problem in the United States, representing a close challenge to cocaine addiction. It is estimated that millions of Americans are addicted to prescription drugs. A large majority of these addicts are average citizens, with no prior history of drug abuse, who became addicted after first using prescription drugs for legitimate medical reasons. Often times however, these diverted prescription drugs end up on our streets where illegal drug abuse is an evergrowing problem.
The Cincinnati Post has reported on its frequency. John Burke, a leading expert on the issue, was quoted as saying, "Pharmaceutical diversion is kind of funny because it's going on in every community, but it appears not to exist unless you go after it purposely," 
According to the United States Department of Justice (DOJ), "Most pharmaceuticals abused in the United States are diverted by doctor shopping, forged prescriptions, theft and, increasingly, via the Internet." 
"To reduce the occurrence of pharmaceutical diversion by doctor shopping and prescription fraud," the DOJ and "21 states have established prescription monitoring programs (PMPs) that facilitate the collection, analysis, and reporting of information regarding pharmaceutical drug prescriptions."