rajpurkar/squad huggingface dataset:
Title: Tuberculosis

Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, T lymphocytes, B lymphocytes, and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis.

Question: What specific type of disease is TB?
Answer: granulomatous inflammatory

Question: What type of cells gather around infected macrophages in a person infected with TB?
Answer: lymphocytes

Question: What type of cell forms when macrophages clump together trying to kill off the TB infection?
Answer: multinucleated

Question: What natural defensive response is hindered by cells in granulomas that can't send antigen to lymphocytes?
Answer: immune response

Question: What's the technical term for abnormal cell death?
Answer: necrosis
Title: Tuberculosis

In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up. It contains living bacteria, so can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.

Question: What process replaces tissue damaged by TB?
Answer: scarring

Question: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
Answer: caseous necrotic material

Question: What type of bacteria-attacking medicine will treat tuberculosis?
Answer: antibiotics

Question: Are the bacteria in caseous necrotic material living or dead?
Answer: living
Title: Tuberculosis

Diagnosing active tuberculosis based only on signs and symptoms is difficult, as is diagnosing the disease in those who are immunosuppressed. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation. Interferon-γ release assays and tuberculin skin tests are of little use in the developing world. IGRA have similar limitations in those with HIV.

Question: Is active TB difficult or easy to diagnose by patients' symptoms alone?
Answer: difficult

Question: If a patient has some symptoms associated with TB, after what time period should tuberculosis be diagnostically considered?
Answer: two weeks

Question: What part of the body would be X-rayed to check for TB?
Answer: chest

Question: What sign of TB infection would a lab be looking for in a sputum culture?
Answer: acid-fast bacilli

Question: Along with interferon-y release essays, what other tests aren't useful in TB diagnosis in developing countries?
Answer: tuberculin skin tests
Title: Tuberculosis

The Mantoux tuberculin skin test is often used to screen people at high risk for TB. Those who have been previously immunized may have a false-positive test result. The test may be falsely negative in those with sarcoidosis, Hodgkin's lymphoma, malnutrition, and most notably, active tuberculosis. Interferon gamma release assays (IGRAs), on a blood sample, are recommended in those who are positive to the Mantoux test. These are not affected by immunization or most environmental mycobacteria, so they generate fewer false-positive results. However, they are affected by M. szulgai, M. marinum, and M. kansasii. IGRAs may increase sensitivity when used in addition to the skin test, but may be less sensitive than the skin test when used alone.

Question: What result might someone who has received a TB vaccination get from the Mantoux test?
Answer: false-positive

Question: What liquid would you need from a patient to perform IGRAs?
Answer: blood

Question: In combination with skin tests, are IGRAs associated with an increase or decrease in sensitivity?
Answer: increase

Question: Which test has fewer false positives: IGRAs or the Mantoux skin test?
Answer: IGRAs

Question: What does "IGRAs" stand for?
Answer: Interferon gamma release assays
Title: Tuberculosis

It is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of Canada, the United Kingdom, and the United States, BCG is administered only to those people at high risk. Part of the reasoning against the use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing the test's use in screening. A number of new vaccines are currently in development.

Question: For about how long does full immunity from the TB vaccine last?
Answer: ten years

Question: What percentage of kids in the whole world get the BCG vaccine?
Answer: 90%

Question: Is TB common or uncommon in the United States?
Answer: uncommon

Question: In addition to the U.S. and Canada, what European country sees very few tuberculosis infections?
Answer: the United Kingdom

Question: What segment of the population gets the TB vaccine in countries like Canada with a very low incidence of infection?
Answer: high risk
Title: Tuberculosis

The World Health Organization declared TB a "global health emergency" in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between its launch and 2015. A number of targets they have set are not likely to be achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multiple drug-resistant tuberculosis. A tuberculosis classification system developed by the American Thoracic Society is used primarily in public health programs.

Question: What group heads up the Global Plan to Stop Tuberculosis?
Answer: Stop TB Partnership

Question: In what year did the WHO say tuberculosis was a "global health emergency"?
Answer: 1993

Question: How many lives did the Stop TB Partnership vow to save in the nine years between its start and 2015?
Answer: 14 million

Question: Drug-resistant TB is one of the barriers to success of the Stop TB Partnership's initiative; what's the other other?
Answer: HIV-associated tuberculosis

Question: What organization created a system to classify various types of TB?
Answer: American Thoracic Society
Title: Tuberculosis

Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective. The two antibiotics most commonly used are isoniazid and rifampicin, and treatments can be prolonged, taking several months. Latent TB treatment usually employs a single antibiotic, while active TB disease is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance. People with latent infections are also treated to prevent them from progressing to active TB disease later in life. Directly observed therapy, i.e., having a health care provider watch the person take their medications, is recommended by the WHO in an effort to reduce the number of people not appropriately taking antibiotics. The evidence to support this practice over people simply taking their medications independently is poor. Methods to remind people of the importance of treatment do, however, appear effective.

Question: What part of the mycobacterial cell makes tuberculosis more difficult to treat?
Answer: wall

Question: Isoniazid is one of the two most popular drugs for TB treatment; what's the other one?
Answer: rifampicin

Question: What complication does the use of combinations of antibiotics for active TB prevent?
Answer: antibiotic resistance

Question: What's the three-word name for the method where a health care worker watches their patient take their medication?
Answer: Directly observed therapy

Question: What organization recommends directly observed therapy to make sure people take their antibiotics correctly?
Answer: WHO
Title: Tuberculosis

Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication. Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs. Totally drug-resistant TB is resistant to all currently used drugs. It was first observed in 2003 in Italy, but not widely reported until 2012, and has also been found in Iran and India. Bedaquiline is tentatively supported for use in multiple drug-resistant TB.

Question: If a person has TB that's resistant to rifampicin and isoniazid, which type of the disease do they have?
Answer: MDR-TB

Question: What's the minimum number of second-line medication classes your TB would have to resist to make it count as "extensively drug-resistant"?
Answer: three

Question: In what country was the first case of totally drug-resistant tuberculosis?
Answer: Italy

Question: What's the only antibiotic that might be effective against totally drug-resistant TB?
Answer: Bedaquiline

Question: Cases of totally drug-resistant TB have been found in what country in addition to Italy and India?
Answer: Iran
Title: Tuberculosis

The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year. Studies using DNA fingerprinting of M. tuberculosis strains have shown reinfection contributes more substantially to recurrent TB than previously thought, with estimates that it might account for more than 50% of reactivated cases in areas where TB is common. The chance of death from a case of tuberculosis is about 4% as of 2008, down from 8% in 1995.

Question: As immunosuppression goes up in tuberculosis cases, what risk rises with it? 
Answer: reactivation

Question: What disease has a similar relationship as TB does between reactivation and immunosuppression?
Answer: HIV

Question: If you'd been diagnosed with tuberculosis in 1995, how great a chance would you have faced of dying from it?
Answer: 8%

Question: In what year did the risk of dying from TB reach half what it was in 1995?
Answer: 2008

Question: New studies have found that half of reactivation cases of tuberculosis might actually be due to what other "re-" word?
Answer: reinfection
Title: Tuberculosis

Roughly one-third of the world's population has been infected with M. tuberculosis, with new infections occurring in about 1% of the population each year. However, most infections with M. tuberculosis do not cause TB disease, and 90–95% of infections remain asymptomatic. In 2012, an estimated 8.6 million chronic cases were active. In 2010, 8.8 million new cases of TB were diagnosed, and 1.20–1.45 million deaths occurred, most of these occurring in developing countries. Of these 1.45 million deaths, about 0.35 million occur in those also infected with HIV.

Question: At any given time, about how much of all the people in the world has M. tuberculosis?
Answer: one-third

Question: Approximately how many active TB cases were there in 2012?
Answer: 8.6 million

Question: How many patients were diagnosed with tuberculosis in 2010?
Answer: 8.8 million

Question: About how many people died in 2010 carrying both HIV and TB?
Answer: 0.35 million

Question: What percentage of the world's total population gets infected with tuberculosis every year?
Answer: 1%
Title: Tuberculosis

Tuberculosis is the second-most common cause of death from infectious disease (after those due to HIV/AIDS). The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002. China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010. The number of new cases has declined by 17% between 2004–2014. Tuberculosis is more common in developing countries; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the US population test positive. Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.

Question: What infectious disease causes more deaths than tuberculosis?
Answer: HIV/AIDS

Question: When did new cases of TB infection start going down?
Answer: 2002

Question: What country has had the most success reducing the TB mortality rate?
Answer: China

Question: In what decade did some strains of drug-resistant TB start showing up?
Answer: 1980s

Question: How much did China reduce its rate of death from TB in the 20 years leading up to 2010?
Answer: 80%
Title: Tuberculosis

In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1,200 cases per 100,000 people. India had the largest total incidence, with an estimated 2.0 million new cases. In developed countries, tuberculosis is less common and is found mainly in urban areas. Rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139 in 2010. In Canada and Australia, tuberculosis is many times more common among the aboriginal peoples, especially in remote areas. In the United States Native Americans have a fivefold greater mortality from TB, and racial and ethnic minorities accounted for 84% of all reported TB cases.

Question: Out of every 100,000 people in Swaziland in 2007, how many were infected with tuberculosis?
Answer: 1,200

Question: What country had a record-setting 2 million new cases of TB in 2007?
Answer: India

Question: What people in Australia and Canada have a much higher risk of TB infection than other residents?
Answer: aboriginal

Question: What indigenous people in the U.S. are five times more likely to die from TB?
Answer: Native Americans

Question: What percentage of TB cases in America are diagnosed in minority groups?
Answer: 84%
Title: Tuberculosis

Tuberculosis has been present in humans since antiquity. The earliest unambiguous detection of M. tuberculosis involves evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then was transferred to humans, or whether it diverged from a common ancestor, is currently unclear. A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as was previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans as early as the Neolithic Revolution.

Question: What animal was found with 17,000-year-old damage from tuberculosis?
Answer: bison

Question: What does MTBC stand for?
Answer: M. tuberculosis complex

Question: During what time period do some scientist believe the first human could have contracted TB from an ancestor they shared with animals?
Answer: Neolithic Revolution

Question: In which U.S. state was the oldest definitive evidence of TB found?
Answer: Wyoming
Title: Tuberculosis

The bacillus causing tuberculosis, M. tuberculosis, was identified and described on 24 March 1882 by Robert Koch. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Koch did not believe the bovine (cattle) and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. Later, the risk of transmission from this source was dramatically reduced by the invention of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". While it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. The World Tuberculosis Day was established on 24 March for this reason.

Question: Who discovered M. tuberculosis?
Answer: Robert Koch

Question: What year was Koch awarded a Nobel Prize?
Answer: 1905

Question: Koch's conviction that human and bovine strains of TB were unrelated meant more people were exposed by drinking what?
Answer: milk

Question: What did Koch call the ineffective treatment for TB he came up with in 1890?
Answer: tuberculin

Question: What event is celebrated on March 24th to recognize the test for latent TB?
Answer: World Tuberculosis Day
Title: Tuberculosis

Tuberculosis caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, one in six deaths in France was still caused by TB. After TB was determined to be contagious, in the 1880s, it was put on a notifiable disease list in Britain; campaigns were started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons (the sanatoria for the middle and upper classes offered excellent care and constant medical attention). Whatever the (purported) benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years (circa 1916).

Question: What was tuberculosis called in 19th-century England?
Answer: consumption

Question: How many deaths out of every six in France during 1918 were attributed to tuberculosis?
Answer: one

Question: In what decade was TB's communicability finally realized?
Answer: 1880s

Question: What did Britain try to get people to stop doing to reduce the spread of TB in public?
Answer: spitting

Question: What were the "treatment" facilities for poor people with TB in the early 1900s called?
Answer: sanatoria
Title: Tuberculosis

In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. By the 1950s, mortality had decreased nearly 90%. Improvements in public health began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat to public health such that when the Medical Research Council was formed in Britain in 1913, its initial focus was tuberculosis research.

Question: When did the incidence of TB in Europe reach its highest point?
Answer: 1800s

Question: When tuberculosis was at its worst in Europe, what percentage of deaths was TB-related?
Answer: 25%

Question: What British health organization made tuberculosis its top priority at its start?
Answer: Medical Research Council

Question: What year was the Medical Research Council created?
Answer: 1913

Question: About how much had the death rate from TB been reduced in Europe by the midpoint of the 20th century?
Answer: 90%
Title: Tuberculosis

Slow progress has led to frustration, expressed by executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government, although adherence is often sketchy. Commercial treatment-providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations. The government of Brazil provides universal TB-care, which reduces this problem. Conversely, falling rates of TB-infection may not relate to the number of programs directed at reducing infection rates, but may be tied to increased level of education, income and health of the population. Costs of the disease, as calculated by the World Bank in 2009 may exceed 150 billion USD per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250M rural migrants in China.

Question: What member of leadership at the Global Fund to Fight AIDS, Tuberculosis and Malaria called TB a "pandemic"?
Answer: Mark Dybul

Question: What country covers treatment for tuberculosis for its citizens?
Answer: Brazil

Question: What organization said some countries might be spending as much as $150 billion each year on TB?
Answer: World Bank

Question: What population segment in China struggles to get follow-up care for TB infection?
Answer: rural migrants

Question: What do some people think we need more of to prevent for-profit providers of TB treatment from over-prescribing?
Answer: regulations
Title: Tuberculosis

One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on relationship between reduced stigma and mortality are lacking as of 2010, and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.

Question: What groups might help tuberculosis patients share with and support each other?
Answer: TB clubs

Question: Education about TB seems to decrease the stigma of the disease and lead to what other positive effect?
Answer: increasing treatment adherence

Question: What do some people say is even worse than the effects of tuberculosis itself?
Answer: the stigma

Question: What group of people can add to the TB stigma by treating patients as troublesome or unwanted?
Answer: healthcare providers

Question: As recently as what year were there no studies on how TB mortality is connected to stigma?
Answer: 2010