Persius/hicric huggingface dataset:
Sandbox/00036

# Overview
Clinical presentations with immunohistochemical profile from flow cytometry and immunostaining may be utilized to differentiate plasma cell neoplasms from other diseases.

# Differentiating Plasma Cell Neoplasms from Other Diseases
- For a patient with marrow plasmacytosis, based upon the kappa () and lambda () expression on immunostaining or flow cytometry, the differential dignoses include:
- Monoclonal plasma cell disorders is suggested by a markedly abnormal  :  ratio (>4 : 1 or <1 : 2) since plasma cells express either  or .
- Polyclonal reactive plasmacytosis is suggested by the presence of both -staining plasma cells and -staining plasma cells, usually in a  :  ratio of 2 : 1.
- Autoimmune diseases
- Metastatic carcinoma
- Chronic liver disease
- Acquired immunodeficiency syndrome (AIDS)
- Chronic infection
- For a patient with monoclonal (M) proteins, the differential dignoses include: (click here for detailed criteria)
- Monoclonal gammopathy of undetermined significance (MGUS)
- Smoldering multiple myeloma
- Multiple myeloma
- IgM monoclonal gammopathy of undetermined significance (IgM MGUS)
- Smoldering Waldenstrom macroglobulinemia
- Waldenstrom macroglobulinemia
- Systemic AL amyloidosis
- For an osteolytic lesion, multiple myeloma may be distinguished from metastatic carcinoma with an unrelated MGUS by the following findings:
- Multiple myeloma is suggested by the presence of serum and/or urinary M protein with 10% clonal bone marrow plasma cells.
- Metastatic carcinoma with an unrelated MGUS is suggested by a small M protein with <10% clonal bone marrow plasma cells.
- For plasmacytoma, the differential diagnoses include:
- Plasma cell granuloma is suggested by a balanced proliferation of  and reacting plasma cells on immunohistochemical studies.
- Plasmacytoid lymphoma is suggested by a mixture of lymphocytes and plasma cells.
- Large cell lymphoma of immunoblastic type is suggested by the predominat lymph node involvement with expression of cytoplasmic IgM heavy chain and panB-cell surface antigens, whereas plasmacytoma typically has IgA or IgG heavy chain and is negative for panB-cell surface antigens.
Sandbox/00038

# Overview
The Durie-Salmon staging system has been widely adopted to stratify patients with multiple myeloma since 1975. It provides a fair estimate on the tumor burden but has limitations in the categorization of bone lesions. The International Staging System overcomes the limitations of Durie-Salmon system by dividing patients based on the serum levels of 2-microglobulin and albumin. Both Durie-Salmon Staging System and International Staging System are useful for assessing the prognosis of a patient with multiple myeloma. However, neither of them are favorable in making therapeutic options.

# Staging

## Durie-Salmon Staging System
This system is based on 4 factors:
- The amount of abnormal monoclonal immunoglobulin in the blood or urine. Large amounts of monoclonal immunoglobulin indicate that significant malignant plasma cells are present and are producing that abnormal protein.
- The amount of calcium in the blood. High blood calcium levels can be related to advanced bone resorption.
- The severity of bone damage based on X-rays. Multiple areas of bone damage seen on X-rays indicate an advanced stage of multiple myeloma.
- The amount of hemoglobin in the blood. Low hemoglobin levels indicate that the myeloma cells occupy much of the bone marrow and that not enough space is left for the normal marrow cells to make enough red blood cells.
This system uses these factors to divide myeloma into 3 stages. Stage I indicates the smallest amount of tumor, and stage III indicates the largest amount of tumor. The table below describes the criteria for the Durie-Salmon staging system:

## International Staging System
This system divides myeloma into 3 stages based only on the serum beta-2 microglobulin and serum albumin levels. The table below describes the criteria for the International Staging System:
Sandbox/table
The following table contains the main risk factors for CDI:

# table

# table
 There is a reported prevalence of 15% in the Northeast of the US.

# table
-  Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ (2012). "Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics". J Antimicrob Chemother. 67 (3): 7428. doi:10.1093/jac/dkr508. PMID 22146873.CS1 maint: Multiple names: authors list (link) .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}
-  Jump up to: 2.0 2.1 2.2 Knight, Christopher L.; Surawicz, Christina M. (2013). "Clostridium difficile Infection". Medical Clinics of North America. 97 (4): 523536. doi:10.1016/j.mcna.2013.02.003. ISSN 0025-7125.
-  Planche, Tim (2013). "Clostridium difficile". Medicine. 41 (11): 654657. doi:10.1016/j.mpmed.2013.08.003. ISSN 1357-3039.
Sandbox:Dami2

# Natural History
HHV-6 infection is usually acquired early in life, between 6 months and 2 years of age, following the loss of protective maternal antibodies. Primary infection can also happen in adults.
HHV 6 infection has 3 phases: first is represented by acute primary infection in infants. The second occurs in healthy children and adults; the virus replicates in the salivary glands and is secreted in saliva (for HHV-6B) without inducing any obvious pathology, remains latent at least in lymphocytes and monocytes, and persists in various tissues, possibly with a low-level replication. The third stage occurs infrequently, typically in immunocompromised persons, and is linked to reactivation of virus from latency or reinfection.

# Complications
central nervous system (CNS) with seizures, hyperpyrexia, vomiting, diarrhea, cough, emophagocytic syndrome, fulminant hepatitis, disseminated infection, and hepatosplenomegaly.
Sandbox:Mahda
Natural history and management of refractory benign esophageal strictures.
Natural history and management of refractory benign esophageal strictures
Peptic esophageal stricture: is surgery still necessary?
Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study
Complications of esophageal stricture dilation
Over time, the damage caused by stomach acid can scar the lining of the esophagus.When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight lossand dehydration. medscape
Refractory Esophageal Strictures: What To Do When Dilation Fails
- +stricture&selectedTitle=4%7E137    for patient inforamtion
medscape:
- Reinforce the need for patients with esophageal stricture to comply with the usual antireflux precautions and lifestyle modifications.
- Encourage weight loss.
- Patients are told to eat smaller meals, avoid eating in a hurried fashion, and chew their food well.
- Ill-fitting dentures or poor dentition should be corrected if possible.
- Educate all patients with esophageal stricture about avoiding medications known to cause esophagitis, including over-the-counter medications such as aspirin and nonsteroidal anti-inflammatory drugs.
- Inform all patients that the stricture recurrence rate for esophageal stricture is higher if they are noncompliant with PPI therapy.
- For patient education resources, see  Heartburn and GERD Center and Digestive Disorders Center, as well as  Acid Reflux (GERD) and  Heartburn.
Sandbox:Zahir

# Vaginal/Vulvar mass differential diagnosis

# Differentiating  from other Diseases
 must be differentiated from other diseases that cause , , and , such as , , and .
OR
 must be differentiated from , , and .
OR
As  manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype.  must be differentiated from other diseases that cause , such as  and . In contrast,  must be differentiated from other diseases that cause , such as  and .

## Differentiating  from other diseases on the basis of , , and 
On the basis , , and ,  must be differentiated from , , , , , and .
Sandbox: diff

# Overview
Intra-abdominal neuroblastoma must be differentiated from other diseases that cause abdominal swelling and constipation such as Wilms tumor and ganglioneuroma. Intra-thoracic neuroblastoma must be differentiated from other diseases that cause shortness of breath and chronic cough such as intrathoracic lymphoma and extra lobar pulmonary sequestration.

# Differentiationg Neuroblastoma from other Diseases
- Intra-abdominal neuroblastoma must be differentiated from other diseases that cause abdominal swelling and constipation such as:
- Wilms tumor
- Rhabdomyosarcoma
- Ganglioneuroma
- Ganglioneuroblastoma
- Intra-thoracic neuroblastoma must be differentiated from other diseases that cause shortness of breath and chronic cough such as:
- Intrathoracic lymphoma
- Extra lobar pulmonary sequestration
- Round pneumonia
- Ganglioneuroma
- Ganglioneuroblastoma
-  Jump up to: 1.0 1.1 Neuroblastoma. Radiopaedia(2015)  Accessed on October, 5 2015
-  Jump up to: 2.0 2.1 Neuroblastoma. Wikipedia(2015)  Accessed on October, 5 2015
Sandbox: nima

# Overview
The hallmark of hepatic encephalopathy is accumulation of ammonia and toxic substances in the blood that are normally detoxified in the liver. A positive history of cirrhosis and acute viral hepatitis is suggestive of hepatic encephalopathy. The most common symptoms of hepatic encephalopathy include cognitive impairment, personality changes, and even coma. 

# History and Symptoms
Hepatic encephalopathy or portosystemic encephalopathy is a syndrome of largely reversible impairment of brain function occurring in patients with acute or chronic liver failure or when the liver is bypassed by portosystemic shunts.Hepatic encephalopathy (HE) is a common problem in liver cirrhosis and is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance spectroscopy (MRS).
A positive history of alcohol use and viral hepatitis is suggestive of HE. The most common symptoms of hepatic encephalopathy include:
- cognitive impairment
- personality changes
- change in consciousness. 
- Coma

## History
Patients with hepatic encephalopathy may have a positive history of:
- Viral hepatitis
- Chronic alcohol use
- History of drug and toxin use
Halothane
Acetaminophen
Aflatoxin
- Halothane
- Acetaminophen
- Aflatoxin

## Common Symptoms
Common symptoms of hepatic encephalopathy include: 
- Memory impairment
- Personality changes
- Coma
- Jaundice
- Abdominal pain
Hepatic encephalopathy (HE) is a common problem in liver cirrhosis and is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance spectroscopy (MRS).

## Less Common Symptoms
Less common symptoms of  include
- Abdominal pain
- Jaundice
Sandbox:milan

# Overview
Dyspnea is the uncomfortable awareness of one's own breathing. It is a common symptom of numerous medical disorders.

# Causes

## Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Acute heart failure
- Acute coronary syndrome
- Acute papillary muscle rupture
- Acute respiratory distress syndrome
- Aortic dissection
- Bronchospasm
- Cardiac tamponade
- Foreign body aspiration
- Glottic edema
- Pneumothorax
- Pulmonary embolism
- Pulmonary edema

## Common Causes
- Acute heart failure
- Acute coronary syndrome
- Asthma
- Anemia
- COPD
- Pulmonary embolism
- Pneumonia
- Respiratory tract infection

# FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

# Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention

# Do's

# Don'ts
Sandbox:patho
- Neuroblastic tumors may be grouped according to International Neuroblastoma Pathology Classification (Shimada classification) into two groups: schwannian stroma rich group and a schwannian stroma poor group as illustrated below:
- Based on the degree of the cellular maturity and composition, neuroblastoma may be further classified into three subtypes according to the International Neuroblastoma Pathology Classification which include:
- Undifferentiated neruoblastoma
- Poorly differentiated neuroblastoma
- Differentiating neuroblastoma
- The table below summarizes the differnces between the three histological subtypes of neurublastoma:
-  Jump up to: 1.0 1.1 Neuroblastoma, Ganglioneuroblastoma and Ganglioneuroma. Stanford Medicine Surgical Pathology Criteria(2015) / Accessed on October, 5 2015
-  Shimada H, Umehara S, Monobe Y, Hachitanda Y, Nakagawa A, Goto S;  et al. (2001). "International neuroblastoma pathology classification for prognostic evaluation of patients with peripheral neuroblastic tumors: a report from the Children's Cancer Group". Cancer. 92 (9): 245161. PMID 11745303.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) .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}
Sandbox:x-ray

# Overview
- There are no x-ray findings associated with .
OR
- An x-ray may be helpful in the diagnosis of . Findings on an x-ray suggestive of/diagnostic of  include , , and .
OR
- There are no x-ray findings associated with . However, an x-ray may be helpful in the diagnosis of complications of , which include , , and .

# X Ray
- There are no x-ray findings associated with .
OR
- An x-ray may be helpful in the diagnosis of . Findings on an x-ray suggestive of/diagnostic of  include:
OR
- There are no x-ray findings associated with . However, an x-ray may be helpful in the diagnosis of complications of , which include:
Sandbox skin2

# Acne vulgaris

# Acne rosacea

# Anthrax, cutaneous

# Bacillary angiomatosis

# Bite wounds

# Carbuncle

# Cat scratch disease

# Cellulitis

# Ecthyma

# Erysipelas

# Erysipeloid

# Erythrasma

# Furuncle

# Gas gangrene

# Glanders

# Impetigo
- Impetigo, adult
- Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and -hemolytic streptococci)
- Limited number of lesions
- Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days
- Numerous lesions or outbreaks of post streptococcal glomerulonephritis
- Preferred regimen: Dicloxacillin 250 mg PO qid for 7 days OR Amoxicillin-Clavulanate 875/125 mg PO bid for 7 days OR Cephalexin 250 mg PO qid for 7 days
- Alternative regimen (for penicillin-allergic patients): Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300400 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 12 double-strength tablets PO bid for 7 days
- Culture-directed antimicrobial therapy
- Streptococcus alone
- Preferred regimen: Penicillin V 250500 mg PO qid for 7 days
- Alternative regimen (for penicillin-allergic patients): Erythromycin 250 mg PO qid for 7 days OR Clindamycin 300400 mg PO qid for 7 days
- Methicillin-resistant Staphylococcus aureus
- Preferred regimen: Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300450 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 12 double-strength tablets PO bid for 7 days
- Impetigo, pediatric
- Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and -hemolytic streptococci)
- Limited number of lesions
- Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days
- Numerous lesions or outbreaks of post streptococcal glomerulonephritis
- Preferred regimen: Amoxicillin-Clavulanate 25 mg/kg/day of amoxicillin component PO bid for 7 days OR Cephalexin 2550 mg/kg/day PO tidqid for 7 days
- Alternative regimen (for penicillin-allergic patients): Clindamycin 2530 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 812 mg/kg/day PO bid for 7 days
- Culture-directed antimicrobial therapy
- Streptococcus alone
- Preferred regimen: Penicillin V 60,000100,000 U/kg PO qid for 7 days
- Alternative regimen (for penicillin-allergic patients): Erythromycin 40 mg/kg/day PO tidqid for 7 days OR Clindamycin 20 mg/kg/day PO tid for 7 days
- Methicillin-resistant Staphylococcus aureus
- Preferred regimen: Clindamycin 2530 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 812 mg/kg/day PO bid for 7 days

# Lyme disease, cutaneous

# Mastitis

# Necrotizing fasciitis

# Pilonidal cyst

# Pyomyositis

# Seborrheic dermatitis

# Surgical site infections

# Vascular insufficieny ulcer

# Vibrio infection

# Wound infection

# Yaws
Sandndox moco

# Pelvic MRI
A dedicated pelvic MRI protocol is recommended for optimal assessment.
MRI is considered superior to CT for local staging. Contrast enhanced MRI imaging improves accuracy in detecting myometrial invasion.
- T1: hypo- to isointense to normal endometrium
- T1 C+(Gd): carcinomatous tissue will enhance less than normal endometrium
- T2: hyperintense or heterogeneous relative to normal endometrium
MR Imaging findings according to FIGO stage
- stage 1: tumour confined to uterus
- stage 1a: tumour confined to the uterine endometrium
- normal or widened endometrium
- normal low T2 signal junctional zone
- complete subendometrial enhancement on T1 contrast imaging
- stage 1b: invasion of less than half of the myometrium
- disruption or irregularity of the low T2 signal junctional zone
- disruption of subendometrial early enhancement
- stage 1c: invasion of outer half of myometrium
- disruption or irregularity of the low T2 signal junctional zone
- disruption of subendometrial early enhancement
- preservation of band of outer myometrium
- stage 2: tumour extends to cervix
- stage 2a
- widening of internal os and endocervical canal by high/isointense T2W signal tumour mass.
- intact low T2W signal of normal cervical stroma
- stage 2b
- widening of internal os and endocervical canal by high/isointense T2W signal tumour mass
- disruption of low T2 signal cervical stroma
- stage 3: tumour extension beyond the uterus
- stage 3a
- irregularity to the uterine contour
- disruption of low T2 signal uterine serosa
- stage 3b
- thickening of vaginal wall
- high T2 signal tumour infiltrating low signal vaginal wall
- stage 3c
- pelvic/para aortic lymph node involvement
- short axis >/= 8 mm in pelvic nodes
- stage 4: bladder/rectal or distant metastasis
- stage 4a
- disruption of low T2 signal bladder or rectal wall
- intraluminal bladder mass
-  "endometrial cancer MRI"..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}
Savory (herb)
Satureja is a genus of aromatic plants of the family Lamiaceae, related to rosemary and thyme. There are about 30 species called savories, of which Summer Savory and Winter Savory are the most important in cultivation.

# Description
Satureja species are native to warm temperate regions and may be annual or perennial. They are low-growing herbs and subshrubs, reaching heights of 15-50 cm.
The leaves are 1 to 3 cm long, with flowers forming in whorls on the stem, white to pale pink-violet.

# Ecology and cultivation
Satureja species are food plants for the larva of some Lepidoptera (butterflies and moths). Caterpillars of the moth Coleophora bifrondella feed exclusively on Winter Savory (S. montana).
Savory may be grown purely for ornamental purposes; members of the genus need sun and well-drained soil.

# Uses
Both summer savory and winter savory are used to flavor food. The former is preferred by cooks but as an annual is only available in summer; winter savory is an evergreen perennial.
Savory plays an important part in Italian cuisine, particularly when cooking beans. It is also used to season the traditional Acadian stew known as fricot.
Yerba Buena (Spanish: "good herb"; S. douglasii) is used to make a herbal tea in the western United States.
Winter savory is reputed to help ease flatulence.

# Selected species
- Satureja acinos
- Satureja alpina
- Satureja coerulea
- Satureja cuneifolia
- Satureja douglasii  Yerba Buena (syn. S. chamissonis)
- Satureja hortensis  Summer Savory
- Satureja mexicana
- Satureja montana  Winter Savory
- Satureja multiflora  Chilean Shrub Mint
- Satureja palmeri (believed extinct; rediscovered 2001)
- Satureja rumelica
- Satureja spicigera
- Satureja thymbra
- Satureja viminea  Serpentine Savory

## Formerly in Satureja
- Browne's Savory, Clinopodium brownei (as Satureja brownei)
- Large-flowered Calamint, Calamintha grandiflora (as Satureja grandiflora)
- Stone Mint, Cunila mariana (as Satureja origanoides)