Persius/hicric huggingface dataset:
Pampiniform plexus
Steven C. Campbell, M.D., Ph.D.

# Overview
The spermatic veins emerge from the back of the testis, and receive tributaries from the epididymis: they unite and form a convoluted plexus, the plexus pampiniformis, which forms the chief mass of the cord.
In addition to its function in venous return from the testes, the pampiniform plexis also plays a roles in the temperature regulation of the testes.  It acts as a heat exchanger, cooling blood in adjacent arteries.
The vessels composing this plexus are very numerous, and ascend along the cord in front of the ductus deferens; below the subcutaneous inguinal ring they unite to form three or four veins, which pass along the inguinal canal, and, entering the abdomen through the abdominal inguinal ring, coalesce to form two veins.
These again unite to form a single vein, the testicular vein, which opens on the right side into the inferior vena cava, at an acute angle, and on the left side into the left renal vein, at a right angle.
Pancreatic hormone
Pancreatic hormones (PP) are peptides synthesized in pancreatic islets of Langherhans, which acts as a regulator of pancreatic and gastrointestinal functions.
The hormone is produced as a larger propeptide, which is enzymatically cleaved to yield the mature active peptide: this is 36 amino acids in length and has an amidated C terminus. The hormone has a globular structure, residues 2-8 forming a left-handed poly-proline-II-like helix, residues 9-13 a beta turn, and 14-32 an alpha-helix,held close to the first helix by hydrophobic interactions. Unlike glucagon, another peptide hormone, the structure of pancreatic peptide is preserved in aqueous solution. Both N and C termini are required for activity: receptor binding and activation functions may reside in the N and C termini respectively.

# Subfamilies
- Pancreatic hormone subtype InterPro: IPR015480
- Peptide YY InterPro: IPR015481

# Human proteins containing this domain
NPY;       PPY;       PYY;
Parafluorofentanyl
Para-fluorofentanyl is an opioid analgesic that is an analogue of fentanyl.
Para-fluorofentanyl was sold briefly on the black market in the early 1980s, before the introduction of the Federal Analog Act which for the first time attempted to control entire families of drugs based on their structural similarity rather than scheduling each drug individually as they appeared.  Para-fluorofentanyl is made with the same synthetic route as fentanyl, but by substituting para-fluoroaniline for aniline in the synthesis.
Para-fluorofentanyl has similar effects to fentanyl. Side effects of fentanyl analogues are similar to those of fentanyl itself, which include itching, nausea and potentially serious respiratory depression which can be life-threatening.
Parietal operculum
The parietal operculum, forming the superior bank of the sylvian fissure, as studied in the cat, contains the secondary somatosensory representation, 'S-II', and a second somatotopic representation (parietal ventral, or PV). Anatomically, primate S-II receives inputs from area 3 and area 1, and projects to PV and area 7. PV has projections to area 5 and premotor areas.

# Function
Single cell recording in primates show neurons with larger receptive fields than primary somatosensory cortex, responding to bilateral tactile stimuli, and showing attentional modulation.
In humans, PO is activated during somatosensory stimulation, texture discrimination tasks, and in motor tasks involving sensory feedback. It is also involved in tactile learning and memory, and may also perform co-ordinate transformations from the somatotopic to other spatial frames.
Patient Care Teams
In patient care management, Patient Care Teams are defined as "Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient."

# Rational for patient care teams
The need for multidisciplinary teams in diabetes is demonstrated by the diversity of markers of quality care for diabetics, which at a minimum, include glycemic control, blood pressure control, and lipid control.
Additional markers of quality of care include cessation of tobacco use, serial eye and dental examinations, foot examination, and vaccinations, as well as renal monitoring for albuminuria.
Achieving these goals is difficult with typical rates of success:
- 21.2% of American adults in 2015-2018 achieved all three goals per NHANES data (individualized HbA1c targets , blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL)
- 22.2% of American adults in 2015-2018 achieved all three goals per NHANES data in a second study (HbA1c <7%, non-high-density lipoprotein cholesterol level, <130 mg per deciliter, blood-pressure control <140/90 mm Hg)

# Implementations of patient care teams
18.2% (vs. 8.1%% in usual care) of patients achieved control of glycemic, blood pressure ("HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL"), and LDL goals in a randomized controlled trial of patient care teams in an international study of patients with "poor cardiometabolic profiles (glycated hemoglobin  level 8% plus systolic blood pressure  140 mm Hg and/or low-density lipoprotein cholesterol  level 130 mg/dL).". These rates were lower than in a prior study of Kaiser.
The impact of patient care team and many other quality improvement efforts to improve the care of diabetes patients have been systematically reviewed.
Pediculus corporis

# Overview
The body louse (Pediculus humanus humanus, sometimes called Pediculus humanus corporis) is a louse that infests humans. The condition of being infested with head lice, body lice, or pubic lice is known as pediculosis.  The body louse genome sequence analysis was published in 2010.

# Life cycle and morphology
Pediculus humanus humanus (the body louse) is indistinguishable in appearance from Pediculus humanus capitis (the head louse) but will interbreed only under laboratory conditions. In their natural state, they occupy different habitats. In particular, body lice have evolved to attach their eggs to clothes, whereas head lice attach their eggs to the base of hairs.
The life cycle of the body louse consists of three stages: egg (also called a nit), nymph, and adult.
- Nits are louse eggs. They are generally easy to see in the seams of an infested person's clothing, particularly around the waistline, under armpits or even in body hair. They are oval and usually yellow to white in color. Body lice nits may take 12 weeks to hatch.
- A nymph is an immature louse that hatches from the nit (egg). A nymph looks like an adult body louse, but is smaller. Nymphs mature into adults about 912 days after hatching. To live, it must feed on blood.
- The adult body louse is about the size of a sesame seed (2.53.5 mm), has six legs, and is tan to greyish-white. Females lay eggs. To live, lice must feed on blood. If separated from their hosts, lice die at room temperature.

# Origins
The body louse diverged from the head louse at around 100,000 years ago, hinting at the time of the origin of clothing. Body Lice were first described by Carl Linnaeus in the 10th edition of Systema Naturae.
Pelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.
Broadly, it can be divided into the external examination and internal examination.
A chaperone is appropriate under some circumstances.

# External examination
- examination of anatomy
- skin lesions

# Internal examination
Use of speculum to locate external cervical os.  
Examination for foreign bodies.

## Manoeuvres
- test for cervical motion tenderness, as classically seen in pelvic inflammatory disease
- palpation of adnexal structures
- cervical swabs
- vaginal swabs
- pap smear
Pemphigus vegetans

# Overview
Pemphigus vegetans is a localized form of pemphigus vulgaris.
in which there is a localized vegetating papillomatous response. The eroded areas do not heal like usual but form papillomatous growth and vegetation.
Accounts for 1-2% of pemphigus cases and is a relatively benign variant of Pemphigus Vulgaris. 
Two forms are recognized:
- Pemphigus vegetans of Neumann is a localized disease of pemphigus vulgaris slightly more extensive than pemphigus vegetans of Hallopeau. :568 This type is more common and characterized by early lesions similar to Pemphigus Vulgaris with large bullae and erosive areas.  Healing is through formation of granulation tissue.
- Pemphigus vegetans of Hallopeau is a disease of localized pemphigus vulgaris. :568 It is named for Francois Henri Hallopeau. This type is less aggressive and has pustules not bullae. These pustules heal by verrucios hyperkeratotic vegetations.

# Diagnosis

## Physical Examination

### Skin
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
- Pemphigus vegetans. With permission from Dermatology Atlas.
Penetrating trauma

# Overview
Penetrating trauma is an injury that occurs primarily by an object piercing the skin or entering a tissue of the body.

# Pathophysiology
The severity of the injury is determined largely by the velocity of the object that enters the body. High-velocity objects are usually projectiles such as bullets from high-powered or assault rifles.  Bullets from handguns and shotguns are classed as medium-velocity projectiles.  Low-velocity items, such as knives, are usually propelled by a person's hand, and usually do damage only to the area that is directly contacted by the object.

# Complications
In addition to causing damage to the tissues they contact, medium and high velocity projectiles cause a cavitation injury: as the object enters the body, it creates a pressure wave which forces tissue out of the way, creating a cavity that can be much larger than the object itself.  The tissues soon move back into place, eliminating the cavity, but the cavitation frequently does considerable damage first.  Cavitation can be especially damaging when it affects delicate tissues such as the brain, as occurs in penetrating head trauma.

# Related Chapters
- Blunt trauma
- Penetrating head injury
Performance status

# Overview
In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients' general wellbeing. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care. It is also used in oncological randomized controlled trials as a measure of quality of life.

# Scoring systems
There are various scoring systems. The most generally used are the Karnofsky score and the Zubrod score, the latter being used in publications by the WHO. For children, the Lansky score is used.
Parallel scoring systems include the Global Assessment of Functioning (GAF) score, which has been incorporated as the fifth axis of the Diagnostic and Statistical Manual (DSM) of psychiatry.

# Karnofsky scoring
The Karnofsky score runs from 100 to 0, where 100 is "perfect" health and 0 is death. Although the score has been described with intervals of 10, a practitioner may choose decimals if he or she feels a patient's situation holds somewhere between two marks. It is named after Dr David A. Karnofsky, who described the scale with Dr Joseph H. Burchenal in 1949.
- 100% - normal, no complaints, no signs of disease
- 90% - capable of normal activity, few symptoms or signs of disease
- 80% - normal activity with some difficulty, some symptoms or signs
- 70% - caring for self, not capable of normal activity or work
- 60% - requiring some help, can take care of most personal requirements
- 50% - requires help often, requires frequent medical care
- 40% - disabled, requires special care and help
- 30% - severely disabled, hospital admission indicated but no risk of death
- 20% - very ill, urgently requiring admission, requires supportive measures or treatment
- 10% - moribund, rapidly progressive fatal disease processes
- 0% - death.

# ECOG/WHO/Zubrod score
The ECOG score (published by Oken et al in 1982), also called the WHO or Zubrod score (after C. Gordon Zubrod), runs from 0 to 5, with 0 denoting perfect health and 5 death:
- 0 - Asymptomatic
- 1 - Symptomatic but completely ambulant
- 2 - Symptomatic, <50% in bed during the day
- 3 - Symptomatic, >50% in bed, but not bedbound
- 4 - Bedbound
- 5 - Death

# Lansky score
Children, who might have more trouble expressing their experienced quality of life, require a somewhat more observational scoring system suggested and validated by Lansky et al in 1987:
- 100 - fully active, normal
- 90 - minor restrictions in strenuous physical activity
- 80 - active, but tired more quickly
- 70 - greater restriction of play and less time spent in play activity
- 60 - up and around, but active play minimal; keeps busy by being involved in quieter activities
- 50 - lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities
- 40 - mainly in bed; participates in quiet activities
- 30 - bedbound; needing assistance even for quiet play
- 20 - sleeping often; play entirely limited to very passive activities
- 10 - doesn't play; does not get out of bed
- 0 - unresponsive
Periodontal scaler

# Overview
Periodontal scalers are dental instruments used primarily in the prophylactic and periodontal care of human teeth.  The working ends come in a variety of shapes and sizes, but they are always sharp at the tip, so as to allow for access to narrow embrasure spaces between teeth.  They differ from curettes, which possess a rounded tip to access subgingival calculus below the gum line.  Subgingival use of a scaler would prove too traumatic to the gingiva for subgingival cleaning.
Scalers are universal and have cutting surfaces on both sides of their blades, and are thus fit for both mesial and distal surfaces of any tooth in the area in which they are being used.
Scalers are best used when their terminal shanks, namely, the last portions of the handle attached to the blades, are held parallel to the long axis of the tooth.  To facilitate proper usage, instruments often come with posterior analogs which possess angled terminal shanks.
Petiveria alliacea
Petiveria alliacea is a deeply rooted herbacious perennial shrub growing in tropical areas of Africa, South and Central America and the Caribbean. It grows up to 1 metre in height and has small greenish piccate flowers. The roots and leaves have a strong acrid, garlic-like odour which taints the milk and meat of animals that graze on it.

# Common Names
It is known by a wide number of common names including: guinea henweed, anamu in the Dominican Republic and Brazil (where it is also known as tipi), apacin in Guatemala, mucura in Peru, and guine in many other parts of Latin America, feuilles ave, herbe aux poules, petevere a odeur ail, and, in Trinidad, as mapiurite (pronounced Ma-po-wheete) and gully root, and many others.

# Medicinal uses
Petiveria alliacea has been widely used to treat an astounding range of medical conditions both in humans and in animals including: venereal diseases, an antiseptic, arthritis, pain, cancer, womb inflammation, diuretic, decoagulant, cold, snake bite, flu, cods, hysteria, paralysis, fever, rabies, to treat arrow poison in Brazil and as a bat and insect repellent and as an abortifacient.

# Chemical Ingredients
Petiveria alliacea has been found to contain a large number of biologically active chemicals including benzaldehyde, benzoic acid, benzyl-2-hydroxyethyl-trisulphide, coumarin, isoarborinol, isoarborinol acetate, isoarborinol cinnamate, isothiocyanates, polyphenols, senfol, tannins, trithiolaniacine. For details on these and medicinal uses of the plant, see the "External links".
Phenytoin overdose

# Overdosage topics
Pediatric patients
Adults
Manifestations
Plasma levels
Treatment

## Pediatric patients
The lethal dose in pediatric patients is not known. Return to top

## Adults
The lethal dose in adults is estimated to be 2 to 5 grams. Return to top

## Manifestations
The initial symptoms are nystagmus, ataxia, and dysarthria. Other signs are tremor, hyperreflexia, lethargy, slurred speech, nausea, vomiting. The patient may become comatose and hypotensive. Death is due to respiratory and circulatory depression. Return to top

## Plasma levels
There are marked variations among individuals with respect to phenytoin plasma levels where toxicity may occur. Nystagmus, on lateral gaze, usually appears at 20 mcg/mL, ataxia at 30 mcg/mL; dysarthria and lethargy appear when the plasma concentration is over 40 mcg/mL, but as high a concentration as 50 mcg/mL has been reported without evidence of toxicity. As much as 25 times the therapeutic dose has been taken to result in a serum concentration over 100 mcg/mL with complete recovery. Return to top

## Treatment
Treatment is nonspecific since there is no known antidote.
The adequacy of the respiratory and circulatory systems should be carefully observed and appropriate supportive measures employed. Hemodialysis can be considered since phenytoin is not completely bound to plasma proteins. Total exchange transfusion has been used in the treatment of severe intoxication in pediatric patients.
In acute overdosage the possibility of other CNS depressants, including alcohol, should be borne in mind. Return to top
Adapted from the FDA Package Insert.
Phosphate minerals
Phosphate minerals are those minerals that contain the tetrahedrally coordinated phosphate (PO43-) anion along with the freely substituting arsenate (AsO43-) and vanadate (VO43-). Chlorine (Cl-), fluorine (F-), and hydroxide (OH-) anions also fit into the crystal structure.
The phosphate class of minerals is a large and diverse group, however, only a few species are relatively common.
Examples include:
- triphylite Li(Fe,Mn)PO4
- monazite (Ce,La,Y,Th)PO4
- Apatite group Ca5(PO4)3(F,Cl,OH)
hydroxylapatite Ca5(PO4)3OH
fluorapatite Ca5(PO4)3F
chlorapatite Ca5(PO4)3Cl
- hydroxylapatite Ca5(PO4)3OH
- fluorapatite Ca5(PO4)3F
- chlorapatite Ca5(PO4)3Cl
- pyromorphite Pb5(PO4)3Cl
- vanadinite Pb5(VO4)3Cl
- erythrite Co3(AsO4)28H2O
- amblygonite LiAlPO4F
- lazulite (Mg,Fe)Al2(PO4)2(OH)2
- wavellite Al3(PO4)2(OH)35H2O
- turquoise CuAl6(PO4)4(OH)85H2O
- autunite Ca(UO2)2(PO4)210-12H2O
- carnotite K2(UO2)2(VO4)23H2O
- phosphophyllite Zn2(Fe,Mn)(PO4)24H2O

# Applications
Phosphate minerals are often used for control of rust and prevention of corrosion on ferrous materials, applied with electrochemical conversion coatings.
Phosphatidylserine
Phosphatidylserine (PS) is a phospholipid nutrient found in fish, green leafy vegetables, soybeans and rice, and is essential for the normal functioning of neuronal cell membranes and activates Protein kinase C (PKC) which has been shown to be involved in memory function. 
In apoptosis, phosphatidylserine is transferred to the outer leaflet of the plasma membrane.  This is part of the process by which the cell is targeted for phagocytosis. PS has been shown to slow cognitive decline in animal models. .
PS has been investigated in a small number of double-blind placebo trials and has been shown to increase memory performance in the elderly. Because of the potentail cognitive benefits of phosphatidylserine, the substance is sold as a dietary supplement to people who believe they can benefit from an increased intake.
The dietary supplement was originally processed from bovine sources however Prion disease scares in the 1990s outlawed this process, and a soy-based alternative was adopted. .
Phosphoglucomutase

# Overview
Phosphoglucomutase (EC 5.4.2.2) is an enzyme that transfers a phosphoryl group on a glucose monomer from the 1' to the 6' position in the forward direction or the 6' to the 1' position in the reverse.
More specifically, it facilitates the interconversion of glucose 1-phosphate and glucose 6-phosphate.

# Pathophysiology

## Function in Glycogenolysis
After glycogen phosphorylase has broken off a single glucose molecule from the greater glycogen structure, the free glucose has a phosphate group on its 1-carbon. This glucose-1-phosphate isomer cannot be metabolized easily. The enzyme phosphoglucomutase phosphorylates the 6-carbon, while subsequently dephosphorylating the 1-carbon. The result is glucose-6-phosphate, which can now theoretically travel down the glycolysis or pentose phosphate pathway.

## Function in Glycogenesis
Phosphoglucomutase also acts in the opposite fashion when a large concentration of glucose-6-phosphate is present. In this case, it is the 1-carbon that is phosphorylated and the 6-carbon that is dephosphorylated. The resulting glucose-1-phosphate is then changed into UDP-glucose in a number of intermediate steps. If activated by insulin, glycogen synthase will proceed to clip the glucose from the UDP-glucose complex and on to the glycogen molecule.

## Disease Relevance
Human muscle contains two phosphoglucomutases with nearly identical catalytic properties, PGM I and PGM II. One or the other of these forms is missing in some humans congenitally.
Phosphoglucomutase deficiency is an extremely rare condition that does not have a set of well-characterized physiological symptoms. This condition can be detected by an in vitro study of anaerobic glycolysis which reveals a block in the pathway toward lactic acid production after glucose 1-phosphate but before glucose 6-phosphate.

## Genes
- PGM1, PGM2, PGM3, PGM5

# Related Chapter
- Mutase
Phyllanthus niruri
The annual herb Phyllanthus niruri is best known by the common names stone-breaker, chanca piedra and quebra pedra, but has many other common names in assorted languages, including dukong anak, dukong-dukong anak, amin buah, rami buah, turi hutan, and bhuiaonla. It is a widespread tropical plant commonly found in coastal areas. It is a relative of the spurges, belonging to the leafflower genus of Family Phyllanthaceae.
It grows 50 to 70 centimeters tall and bears ascending herbaceous branches. The bark is smooth and light green. It bears numerous pale green flowers which are often flushed with red. The fruits are tiny, smooth capsules containing seeds.
The plant has long been used as an herbal remedy for urinary calculi, and has been shown in modern medical research studies to reduce the risks of stones in individuals prone to the condition. Research on the plant continues to determine if it has any other beneficial effects. It may have antiviral activity.