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<s>[INST]Answer this question truthfully: What is Doppler imaging of an atrial septal defect?[/INST] The doppler is an effective imaging modality to show an ASD, as well as other details such as the defect size, the direction of flow, the speed of the flow, and what therapies might be of best use. There are some disadvantages to the use of doppler.</s>

<s>[INST]Answer this question truthfully: What is methemoglobinemia and what information is currently available on this medical condition?[/INST] A medicine called methylene blue is used to treat severe methemoglobinemia. Methylene blue may be dangerous in patients who have or may be at risk for a blood disease called G6PD deficiency, and should not be used. If you or your child has G6PD deficiency, always tell your health care provider before receiving treatment. Ascorbic acid may also be used to reduce the level of methemoglobin. Alternative treatments include hyperbaric oxygen therapy and exchange transfusions. In most cases of mild acquired methemoglobinemia, no treatment is needed. But you should avoid the medicine or chemical that caused the problem. Severe cases may need treatment, which may include a blood transfusion.</s>

<s>[INST]Answer this question truthfully: What information is accessible regarding asthma?[/INST] The complications of asthma can be severe. Some include: Death Decreased ability to exercise and take part in other activities Lack of sleep due to nighttime symptoms Permanent changes in the function of the lungs Persistent cough Trouble breathing that requires breathing assistance (ventilator)</s>

<s>[INST]Answer this question truthfully: What exactly is swimmer's itch?[/INST] The non- human schistosomes use two hosts in their life cycles. One is a snail, the other is a bird or mammal. Schistosomes are gonochoristic and sexual reproduction takes place in the vertebrate host. In genera that infect birds, adult worms occur in tissues and veins of the hosts gastrointestinal tract, where they produce eggs that are shed into water with host feces. One European species, Trichobilharzia regenti, instead infects the bird hosts nasal tissues, where its eggs are shed with lachrymal secretions. Once a schistosome egg is immersed in water, a short-lived, non-feeding, free-living stage known as the miracidium emerges. The miracidium uses cilia to follow chemical and physical cues thought to increase its chances of finding the first intermediate host in its life cycle, a snail. After infecting a snail, it develops into a mother sporocyst, which in turn undergoes asexual reproduction, yielding large numbers of daughter sporocysts, which asexually produce another short-lived, free-living stage, the cercaria. Cercariae use a tail-like appendage (often forked in genera causing swimmers itch) to swim to the surface of the water, as well as other physical and chemical cues, in order to locate the next and final (definitive) host in the life cycle, a bird. After infecting a bird, the parasite develops into a schistosomulum and migrates through the hosts circulatory system (or nervous system in case of T. regenti) to the final location within the host body where it matures and, if it encounters a mate, sheds eggs to begin the cycle.</s>

<s>[INST]Answer this question truthfully: Can you provide any information about Simvastatin?[/INST] Simvastatin comes as a tablet to take by mouth. It usually is taken one to three times a day. Take simvastatin at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take simvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of simvastatin and gradually increase your dose, not more than once every 4 weeks. Continue to take simvastatin even if you feel well. Do not stop taking simvastatin without talking to your doctor.</s>

<s>[INST]Answer this question truthfully: Can you give an example of ATLAS that is provided by JC?[/INST] All comparisons are rivaroxaban 2.5mg vs. rivaroxaban 5mg vs. placebo (2.5mg vs. placebo | 5mg vs. placebo). Composite of CV mortality, MI, or stroke (efficacy) 9.1% vs. 8.8% vs. 10.7% (HR 0.84; P=0.02 | HR 0.85; P=0.03) TIMI major bleeding not associated with CABG (safety) 1.8% vs. 2.4% vs. 0.6% (HR 3.46; P<0.001 | HR 4.47; P<0.001) Composite of all-cause mortality, MI or stroke 9.3% vs. 9.1% vs. 11.0% (HR 0.83; P=0.02 | HR 0.84; P=0.02) CV mortality 2.7% vs. 4.0% vs. 4.1% (HR 0.66; P=0.002 | HR 0.94; P=0.63) All-cause mortality 2.9% vs. 4.4% vs. 4.5% (HR 0.68; P=0.002 | HR 0.95; P=0.66) MI 6.1% vs. 4.9% vs. 6.6% (HR 0.90; P=0.27 | HR 0.79; P=0.02) Any stroke 1.4% vs. 1.7% vs. 1.2% (HR 1.13; P=0.56 | HR 1.34; P=0.15) Ischemic stroke 1.4% vs. 1.7% vs. 1.2% (HR 0.89; P=0.64 | HR 1.05; P=0.84) Stent thrombosis 2.2% vs. 2.3% vs. 2.9% (HR 0.65; P=0.02 | HR 0.73; P=0.08) "Good" follow-up Complete: 85% vs. 84% vs. 85% Death: 3% vs. 4% vs. 4% Total: 88% vs. 87% vs. 89% "Bad" follow-up Consent withdrawn: 9% vs. 9% vs. 8% Lost: 0.2% vs. 0.3% vs. 0.3% Other: 3% vs. 4% vs. 3% Total: 11% vs. 12% vs. 13% TIMI minor bleeding 0.9% vs. 1.6% vs. 0.5% (HR 1.62; P=0.09 | HR 2.52; P<0.001) TIMI bleeding requiring medical attention 12.9% vs. 16.2% vs. 7.5% (HR 1.79; P<0.001 | HR 2.39; P<0.001) ICH 0.4% vs. 0.7% vs. 0.2% (HR 2.83; P=0.04 | HR 3.74; P=0.005) Fatal bleeding 0.1% vs. 0.4% vs. 0.2% (HR 0.67; P=0.45 | HR 1.72; P=0.20) Reduction in primary efficacy outcome with rivaroxaban was consistent among subgroups except for patients with history of stroke or TIA.</s>

<s>[INST]Answer this question truthfully: Can individuals with end-stage renal disease undergo coronary artery bypass surgery?[/INST] Class IIb " 1. In patients with preoperative renal dysfunction (creatinine clearance <60 mL/min), off-pump CABG may be reasonable to reduce the risk of acute kidney injury (AKI). (Level of Evidence: B) " " 2. In patients with preexisting renal dysfunction undergoing on-pump CABG, maintenance of a perioperative hematocrit greater than 19% and mean arterial pressure greater than 60 mm Hg may be reasonable. (Level of Evidence: C) " " 3. In patients with preexisting renal dysfunction, a delay of surgery after coronary angiography may be reasonable until the effect of radiographic contrast material on renal function is assessed. (Level of Evidence: B) " " 4. The effectiveness of pharmacological agents to provide renal protection during cardiac surgery is uncertain. (Level of Evidence: B) "</s>

<s>[INST]Answer this question truthfully: What are the additional diagnostic tests for Medulloblastoma?[/INST] Bromodeoxyuridine labeling study may be helpful in the diagnosis of medullblastoma. An elevated bromodeoxyuridine labeling index is suggestive of a rapid growth rate of medulloblastoma. The bromodeoxyuridine labeling index of medulloblastoma is measured between: 6.8 to 26.9% on dilute hydrochloric acid hydrolysis in vitro technique 7.5 to 28.8% on microwave heating in vitro technique</s>

<s>[INST]Answer this question truthfully: What does the Angioplasty Revascularization Investigation for Bypass entail?[/INST] The two U.S. trials of PTCA versus CABG are the multicenter Bypass Angioplasty Revascularization Investigation (BARI) trial and the single-center Emory Angioplasty Surgery Trial (EAST) . In both trials, a majority of patients had two- rather than three-vessel disease and normal LV function. In the BARI trial, 37% of patients had a proximal LAD lesion. The results of BARI trial at seven year follow-up interval has shown that early and late survival rates have been equivalent for the PTCA and CABG groups. The subgroup of patients with treated diabetes had a significantly better survival rate with CABG. That survival advantage for CABG was focused in the group of diabetic patients with multiple severe lesions. The biggest difference in late outcomes was the need for repeat revascularization procedures and symptom status. 54% of PTCA patients underwent subsequent revascularization procedures during the five-year follow-up versus 8% of the CABG group. In addition, the rate of freedom from angina was better in the CABG group and fewer patients in the CABG groups needed to take anti-anginal medications.</s>

<s>[INST]Answer this question truthfully: What interventions exist for urinary incontinence?[/INST] Non-pharmacological interventions include: Behavioral therapy: Behavioral therapy has been found to be more effective than pharmacological therapies for stress and urgency urinary incontinence. lifestyle change weight loss stop smoking treating and preventing constipation Exercises Bladder training Kegel exercises yoga Biofeedback Education Heat therapy MBSR (mindfulness-based stress reduction) PFMT (pelvic floor muscle therapy) Intravesical pressure release device Neuromodulation Electroacupuncture Periurethral bulking</s>

<s>[INST]Answer this question truthfully: What information is available on cerebral arteriovenous malformation?[/INST] Brain damage Intracerebral hemorrhage Language difficulties Numbness of any part of the face or body Persistent headache Seizures Subarachnoid hemorrhage Vision changes Water on the brain (hydrocephalus) Weakness in part of the body Possible complications of open brain surgery include: Brain swelling Hemorrhage Seizure Stroke</s>

<s>[INST]Answer this question truthfully: Can you provide a general summary of hereditary elliptocytosis?[/INST] Hereditary elliptocytosis is one of the most common RBC membrane disorders worldwide,and the incidence of HE is 25-50 per 100,000 individuals. The prevalence of Hereditary elliptocytosis is 50 out of 100,000 affected cases in Northern European countries and North America. In endemic areas for malaria,the incidence of HE is notably higher, this incidence ranges from a low of 600 per 100,000 persons in equatorial Africa to a high of 30,000 per 100,000 persons in Malayan aborigines. This large number of prevalence is because of relative resistance of elliptocytes against malaria in the endemic areas. As many patients with HE are asymptomatic, the true incidence is not known.</s>

<s>[INST]Answer this question truthfully: What is the editing history for Archive016 and Category pages?[/INST] Hi Cyde. Would you have time to have a look at the thread here ? Any input there, or at the bugzilla thread would be much appreciated. Thanks. Carcharoth 21:01, 22 April 2007 (UTC)</s>

<s>[INST]Answer this question truthfully: Can you show me what the football sign looks like?[/INST] The football sign refers to a large oval radiolucency in the shape of an American football, which is seen on supine abdominal X-ray films. The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum.</s>

<s>[INST]Answer this question truthfully: What is the epidemiological and demographic explanation for Yaws?[/INST] Yaws mainly affects children in rural, warm, tropical areas, such as the Caribbean Islands, Latin America, West Africa, India, and Southeast Asia.</s>

<s>[INST]Answer this question truthfully: What are the epidemiological and demographic factors associated with Peutz-Jeghers Syndrome?[/INST] The epidemiology and demographics are as follows: The prevalence of Peutz-Jeghers syndrome is estimated to be 0.8 to 2.8 in 100000. Peutz-Jeghers syndrome affects individuals between the ages of 10 to 30 years. Average age of diagnosis of Peutz-Jeghers syndrome is 23 years for males and 26 years for females. There is no racial predilection to Peutz-Jeghers syndrome. Peutz-Jeghers syndrome affects men and women equally. Average age of diagnosis of Peutz-Jeghers syndrome is 23 years for males and 26 years for females.</s>

<s>[INST]Answer this question truthfully: What are the symptoms and history of acrodermatitis chronica atrophicans?[/INST] The following are some of the common findings in patients' history: Tick bite Since there could be several years between the tick bite and development of skin lesions, absence of tick bite in patients' history never exclude the diagnosis. Based on a study done on 693 patients with acrodermatitis chronica atrophicans approximately 85% remembered a tick bite. Erythema migrans Some of the patients in a study experienced erythema migrans 6 months to 8 years before acrodermatitis chronica atrophicansis development. Neurological symptoms Rheumatological symptoms Symptoms and different forms of skin involvement in acrodermatitis chronica atrophicans are dependent to duration of the disease. It usually involves extensor surfaces of the acral regions of limbs beginning with an inflammatory stage (bluish red discoloration and edema followed by an atrophic phase). Sclerotic skin plaques may also develop. Acrodermatitis chronica atrophicans can progress and cause wrinkle. The following are symptoms have been observed in acrodermatitis chronica atrophicans: Sclerotic skin lesions Pain and burning Edema Wrinkles Peripheral neuropathy (develop in half of patients) Such as paresthesia and hypesthesia Some patients develop symptoms related to peripheral neuropathy at the exact site of acrodermatitis chronica atrophicans's lesion, nevertheless there are other patients that experienced these symptoms at other sites. Most of the times it presents as asymmetric distal sensory disturbance, which could be painful or painless. Arthropathy Constitutional symptoms (such as fever and fatigue) Joint deformities Band-like induration on extremities Based on a study done on 693 patients suffering from acrodermatitis chronica atrophicans: Involvement of lower limb (70%) has been more common compared to upper limb (45.2%). In 42.4% of cases acral involvement occurred bilaterally. Only 2 among 693 patients had skin involvement on areas other than extremities. Less than 3% of studied patients had symptoms such as nodule, arthritis, itching, muscle atrophy, joint deformities and paresis. Small fraction of patients didn't experience any skin discoloration and their main presentations were edema and atrophic changes. In some cases episodic knee joint effusion has been observed. In some cases symptoms such as personality changes have been reported due to involvement of central nervous system.</s>

<s>[INST]Answer this question truthfully: What is the reason for conducting screening for albinism?[/INST] There is insufficient evidence to recommend routine screening for albinism Individuals with familial history of albinism can undergo genetic sequence analysis</s>

<s>[INST]Answer this question truthfully: What does abrupt closure during coronary intervention mean?[/INST] Clinical: unstable angina, female, AMI, chronic renal failure Angiographic: Intraluminal thrombus, ACC/AHA score, multivessel disease, long lesions, >45 degree angulation, branch points, proximal tortuosity, ostial RCA, degenerated SVGs, pre stenosis >90%, intimal dissections</s>

<s>[INST]Answer this question truthfully: What does syphilitic aortitis mean?[/INST] Syphilitic aortitis can cause de Musset's sign, a bobbing of the head that de Musset first noted in Parisian prostitutes. Aortic dilatation Linear calcification of the ascending aorta Helps to distinguish syphilitic aortitis from abdominal aortic aneurysm</s>

<s>[INST]Answer this question truthfully: What does atrial septal defect mean?[/INST] Atrial septal defect is associated with complications such as migraine headache with aura, atrial fibrillation, pulmonary hypertension, heart failure, and stroke.</s>

<s>[INST]Answer this question truthfully: Would you be able to provide an explanation of Archive016 and Wikimediaplayer.js?[/INST] I added a line to bail out when document.getElementById('file') doesn't exist, which is the case when a user is editing the image description page (and probably the same for history, delete, and protect tabs as well). Regards, howcheng { chat } 18:14, 14 May 2007 (UTC)</s>

<s>[INST]Answer this question truthfully: Could you please provide me the current phrasing so I can rephrase it accordingly?[/INST] A protein kinase inhibitor is a type of enzyme inhibitor which specifically blocks the action of protein kinase. Kinase inhibitors such as dasatinib are sometimes used in the treatment of cancer. Many of the kinase inhibitors used in treating cancer are inhibitors of tyrosine kinase.</s>

<s>[INST]Answer this question truthfully: What are the functions and characteristics of the ileum, and could you offer some supplementary visuals to facilitate comprehension?[/INST] Inferior ileocecal fossa. Arteries of cecum and vermiform process. Goblet cell in ileum</s>

<s>[INST]Answer this question truthfully: What is the history and what are the symptoms of Molluscum contagiosum?[/INST] Oral mucosal involvement with the presentation of: Dysphagia Pain Wide spread, large (>6 mm) lesions Characteristic of immunocompromised patients</s>

<s>[INST]Answer this question truthfully: Can you provide a summary of laryngeal papillomatosis?[/INST] Adjuvant therapies (therapies that are used in addition to surgery) have been used to treat more severe cases of laryngeal papillomatosis. Drug treatments may include antivirals such as interferon and cidofovir, which block the virus from making copies of itself, and indole-3-carbinol, a cancer -fighting compound found in cruciferous vegetables, such as broccoli and Brussels sprouts. To date, the results of these and other adjuvant therapies have been mixed or not yet fully proven. Some side effects of antivirals include dizziness, headaches, and body aches. Scientists and clinicians are working to discover more about laryngeal papillomatosis. While HPV 6 and HPV 11 are known causes, millions of people are exposed to these two viruses without developing the disease. It is not known why some people are more at risk than others or why some cases are much more serious than others. Researchers funded by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring how our genes and immune system may contribute to our risk for contracting the disease as well as the severity of its symptoms. Researchers are also studying other possible therapies for laryngeal papillomatosis. In one clinical trial, researchers are investigating whether a common anti-inflammatory drug can inhibit an enzyme that promotes tumor growth in laryngeal papillomatosis, thus reducing the recurrence of tumors in children and adults with laryngeal papillomatosis. Researchers are also investigating the effectiveness of a pulsed dye laser, a laser that delivers short intense pulses of light, to determine if it is more effective at preserving the surrounding tissue while removing tumors from vocal folds. In one NIDCD- sponsored clinical investigation, researchers are studying whether a certain dietary supplement can work with the pulsed dye laser to decrease the rate of recurrence of tumors in children with laryngeal papillomatosis. To read about these and other clinical trials, go to Pulsed Dye Laser for Juvenile Onset Recurrent Respiratory Papillomatosis.</s>

<s>[INST]Answer this question truthfully: Could you give me some information on Williams syndrome?[/INST] Common complications of Williams syndrome include: Cardiovascular disease Failure to thrive Connective tissue changes Endocrine abnormalities There is no significant reduction in life expectancy in children diagnosed with Williams syndrome unless there is any significant heart condition or problems in the kidney.</s>

<s>[INST]Answer this question truthfully: What information is available about abdominal masses?[/INST] An abdominal mass is a swelling in any one part of the abdomen.</s>

<s>[INST]Answer this question truthfully: What does chronic hypertension mean?[/INST] ABCD, ACCORD, AIRE, ALLHAT, ANBP2, BHAT, Captopril Trial, CIBIS, COPERNICUS, CONVINCE, EPHESUS, HOPE, HYVET, IDNT, INVEST, LIFE, MERIT-HF, MRFIT, NAVIGATOR, PROGRESS, ONTARGET, RALES, REIN, REIN-2, RENAAL, SAVE, SOLVD, TRACE, UKPDS, ValHEFT, VALUE</s>

<s>[INST]Answer this question truthfully: What is the primary prevention method for ileus?[/INST] Effective measures for the primary prevention of ileus include early mobilization, avoidance of Ryle's tube (nasogastric tube), prior oral feeding with high carbohydrate solid or liquid solution, limiting parenteral fluids, avoidance of pain medications such as opiates, utilizing a minimally invasive surgical method and use of epidural anesthesia for post operative analgesia.</s>

<s>[INST]Answer this question truthfully: What is Erythema and could you give me an overview of it, please?[/INST] Erythema is redness of the skin caused by capillary congestion. It can be caused by infection, massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn), and waxing and plucking of the hairs any of which can cause the capillaries to dilate, resulting in redness. Erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation.</s>

<s>[INST]Answer this question truthfully: What are the laboratory results for Adrenoleukodystrophy?[/INST] The diagnosis is established by clinical findings and the detection of serum long chain fatty acid levels. Chromosome study to look for changes (mutations) in the ABCD1 gene. It is particularly reliable in carriers and recommended as the diagnostic assay in women. {{#ev:youtube|bv_Ra5pxPRI}}</s>

<s>[INST]Answer this question truthfully: What surgical procedure is performed for cardiac tumors?[/INST] Surgery may be an option in specific cases of malignant tumors. Patients with solitary heart illness and a managed primary tumor are optimal. The tumor must be amenable to resection while maintaining adequate heart function to support life.</s>

<s>[INST]Answer this question truthfully: In what way are non-ST elevation myocardial infarction and substance abuse connected?[/INST] Cocaine usage can produce myocardial ischemia leading to UA / NSTEMI. Cocaine blocks the presynaptic reuptake of neurotransmitters such as norepinephrine and dopamine, which produces excess concentrations at the postsynaptic receptors that lead to sympathetic activation with consequent vasoconstriction, an acute rise in arterial pressure, tachycardia, and a predisposition to ventricular arrhythmias and seizures. There may also be a direct contractile effect on vascular smooth muscle. Cocaine usage can also predispose to coronary thrombosis as a consequence of coronary spasm. Moreover, cocaine increases the response of platelets to arachidonic acid, thus increasing thromboxane A2 production and platelet aggregation and thus predisposing to cocaine related arterial thrombosis. Cocaine also causes sinus tachycardia, as well as an increase in blood pressure and myocardial contractility, thereby increasing myocardial oxygen demand. These increases can precipitate myocardial ischemia and UA / NSTEMI in both the presence and absence of obstructive coronary atherosclerosis and coronary spasm. The typical patient with cocaine related chest pain, unstable angina or MI is: Young (usually less than 40 yrs) Male gender Cigarette smoker Has symptom onset minutes or even several hours after cocaine use. It can occur with all routes of administration and with small or large doses. Treatment includes nitroglycerin and calcium channel blockers. If patients have STEMI and show no response to sublingual NTG and calcium channel blockers, immediate coronary angiography should be performed, if possible. PCI has been successfully performed in these patients but can problematic in subjects with cocaine-related MI since those in whom stents are deployed are at substantial risk of subsequent in- stent thrombosis unless double-antiplatelet therapy (ASA and clopidogrel) is ingested regularly and predictably for several months afterward, and those who partake in substance abuse often are unreliable in adhering to such a regimen. Beta blockers should not be used in patients with cocaine induced MI as it can augment cocaine induced coronary arterial vasoconstriction. In order to control sinus tachycardia and hypertension (after initial NTG and calcium channel blockers), labetalol, an alpha blocker and beta blocker, has been advocated, because it has been shown not to induce coronary artery vasoconstriction.</s>

<s>[INST]Answer this question truthfully: What is Carcinoma and what are the different types of lung carcinoma?[/INST] Adenocarcinoma is a malignant tumor originating in the epithelial cells of glandular tissue and forming glandular structures. This is common in the lung (forming 30-40% of all lung carcinomas). It is found peripherally, arising from goblet cells or type II pneumocytes. Squamous cell carcinoma due to squamous metaplasia. This accounts for 20-30% of lung tumors and is usually hilar in origin. Small cell carcinoma is almost certainly due to smoking. These metastasise early, and may secrete ADH (lowering patient sodium concentration). Large cell undifferentiated carcinomas account for 10-15% of lung neoplasms. These are aggressive and difficult to recognise due to the undifferentiated nature. These are most commonly central in the lung. Sinonasal undifferentiated carcinoma</s>

<s>[INST]Answer this question truthfully: What is the meaning of urocanic aciduria?[/INST] The amino acid histidine, when catalyzed by the enzyme histidase, forms urocanic acid. Disruptions in this pathway, caused by a deficiency of histidase, is the underlying cause of histidinemia. This results in reduced levels of skin and serum urocanic acid, the primary indicator of insufficient histidase activity. In urocanic aciduria, increased urocanic acid in the urine indicates a deficiency of the enzyme urocanase. This enzyme breaks down urocanic acid, forming formininoglutamic acid, and also forms imidazolonepropionic acid from trans-urocanic acid. With normal to only slightly elevated levels of histidine present in the liver during urocanic aciduria, the only true metabolic indicator of the disorder can be found in the urine.</s>

<s>[INST]Answer this question truthfully: What is Fifth Disease?[/INST] Fifth disease is also referred to as erythema infectiosum (meaning infectious redness) and as Human Parvovirus B19 Infection, Slapped cheek syndrome, Slapcheek, Slap face or Slapped face. It is a mild rash illness that occurs most commonly in children. The name "fifth disease" derives from its historical classification as the fifth of the classical childhood skin rashes or exanthems. In 1975, the cause of Fifth disease was discovered to be parvovirus B19.</s>

<s>[INST]Answer this question truthfully: What is the mechanism behind the development and progression of smallpox?[/INST] Smallpox pathogenicity is due to its ability to evade the host's immune system. Most proteins responsible for the pathogenesis of the virus are located at the terminal DNA regions of the virus. Genetic comparisons of the smallpox virus with the vaccinia virus allowed to observe certain genetic changes that may be responsible for the virulence of the smallpox virus. However, without studying the gene transcripts, it is not possible to draw objective conclusions.</s>

<s>[INST]Answer this question truthfully: Could you tell me what Pacemaker syndrome is?[/INST] Since the implantation of artificial pacemaker in 1958, cases of decreased cardiac output due to ventricular pacing have been reported. The majority of the patients had increased total peripheral resistance due to aortic and carotid reflexes activity resulting from the reduced cardiac output.</s>

<s>[INST]Answer this question truthfully: What is an infection caused by Mycoplasma genitalium?[/INST] The cause of Mycoplasma genitalium infection is Mycoplasma genitalium.</s>

<s>[INST]Answer this question truthfully: What are antibodies, and how are they used in medicine?[/INST] Detection of particular antibodies is a very common form of medical diagnostics, and applications such as serology depend on these methods. For example, in biochemical assays for disease diagnosis, a titer of antibodies directed against Epstein-Barr virus or Lyme disease is estimated from the blood. If those antibodies are not present, either the person is not infected, or the infection occurred a very long time ago, and the B cells generating these specific antibodies have naturally decayed. In clinical immunology, levels of individual classes of immunoglobulins are measured by nephelometry (or turbidimetry) to characterize the antibody profile of patient. Elevations in different classes of immunoglobulins are sometimes useful in determining the cause of liver damage in patients whom the diagnosis is unclear. For example, elevated IgA indicates alcoholic cirrhosis, elevated IgM indicates viral hepatitis and primary biliary cirrhosis, while IgG is elevated in viral hepatitis, autoimmune hepatitis and cirrhosis. Autoimmune disorders can often be traced to antibodies that bind the body's own epitopes; many can be detected through blood tests. Antibodies directed against red blood cell surface antigens in immune mediated hemolytic anemia are detected with the Coombs test. The Coombs test is also used for antibody screening in blood transfusion preparation and also for antibody screening in antenatal women. Practically, several immunodiagnostic methods based on detection of complex antigen-antibody are used to diagnose infectious diseases, for example ELISA, immunofluorescence, Western blot, immunodiffusion, and immunoelectrophoresis. "Targeted" monoclonal antibody therapy is employed to treat diseases such as rheumatoid arthritis, multiple sclerosis, psoriasis, and many forms of cancer including non-Hodgkin's lymphoma, colorectal cancer, head and neck cancer and breast cancer. Some immune deficiencies, such as X-linked agammaglobulinemia and hypogammaglobulinemia, result in partial or complete lack of antibodies. These diseases are often treated by inducing a short term form of immunity called passive immunity. Passive immunity is achieved through the transfer of ready-made antibodies in the form of human or animal serum, pooled immunoglobulin or monoclonal antibodies, into the affected individual. Rho(D) Immune Globulin antibodies are specific for human Rhesus D antigen, also known as Rhesus factor. These antibodies are known under several brand names, including RhoGAM. Rhesus factor is an antigen found on red blood cells; individuals that are Rhesus-positive (Rh+) have this antigen on their red blood cells and individuals that are Rhesus-negative (Rh-) do not. During normal childbirth, delivery trauma or complications during pregnancy, blood from a fetus can enter the mother's system. In the case of an Rh-incompatible mother and child, consequential blood mixing may sensitize an Rh- mother to the Rh antigen on the blood cells of the Rh+ child, putting the remainder of the pregnancy, and any subsequent pregnancies, at risk for hemolytic disease of the newborn. RhoGAM is administered as part of a prenatal treatment regimen to prevent sensitization that may occur when a Rhesus-negative mother has a Rhesus-positive fetus. Treatment of a mother with RhoGAM antibodies prior to and immediately after trauma and delivery destroys Rh antigen in the mother's system from the fetus. Importantly, this occurs before the antigen can stimulate maternal B cells to "remember" Rh antigen by generating memory B cells. Therefore, her humoral immune system will not make anti-Rh antibodies, and will not attack the Rhesus antigens of the current or subsequent baby. RhoGAM treatment prevents sensitization that can lead to Rh disease, but does not prevent or treat the underlying disease itself.</s>

<s>[INST]Answer this question truthfully: What are the other diagnostic tests for hand-foot-and-mouth disease?[/INST] Hand foot mouth disease is a clinical diagnosis, there is no need for performing diagnostic tests.</s>

<s>[INST]Answer this question truthfully: What is the meaning of clitoromegaly and what are the factors that lead to it?[/INST] Clitoromegaly is otherwise a rare condition and can be either present by birth or acquired later in life. If present at birth, congenital adrenal hyperplasia can be one of the causes, since in this condition the adrenal gland of the female fetus produces additional androgens and the newborn baby has ambiguous genitalia which are not clearly male or female. In acquired clitoromegaly, the main cause is due to hormonal imbalance affecting the adult women, as in polycystic ovarian syndrome (PCOS), arrhenoblastoma and Fraser syndrome. Clitoromegaly may be acquired through use of anabolic steroids or testosterone supplements, both of which can cause enlargement of the clitoris. This occurs in Female to Male Transsexuals (FtM) after a period of hormone replacement therapy. Like FtM transsexuals, female body-builders who use androgens may also experience enlargement of the clitoris and increases in libido. Women who use testosterone for therapeutic reasons (treating low libido, averting osteoporosis, as part of an anti-depressant regimen, etc) may also experience some enlargement of the clitoris although the dosages warranted for these conditions is much lower. Deliberately induced clitoris enlargement, as form of female genital body modification, is reported to be achieved through testosterone injections directly in the clitoris shaft.</s>

<s>[INST]Answer this question truthfully: What is the MRI result for a glomus tumor?[/INST] MRI may be helpful in the diagnosis of glomus tumor. Findings on MRI suggestive of glomus tumor include: T1 images Slightly hypointense or hyperintense T2 images Hyperintense Depending on the histologic subtype, diagnosis of glomus tumor may be more difficult and the signal can sometimes appear similar to the nail bed. The T1 image appears much more intense following gadolinium injection, allowing the lesion to be visualized more clearly. The technique can be particularly useful for the detection of early lesions, which are very small (even 2 mm lesions) and difficult to diagnose either by physical examination or using other imaging techniques. It can also be useful for assessment of patients with recurrence or incomplete resolution of symptoms following surgery.</s>

<s>[INST]Answer this question truthfully: Could you provide me with a list of neurological disorders, please?[/INST] Dandy-Walker syndrome Dawson disease De Morsier's syndrome Dejerine-Klumpke palsy Dejerine-Sottas disease Dementia Dermatomyositis Developmental Dyspraxia Diabetic neuropathy Diffuse sclerosis Dysautonomia Dyscalculia Dysgraphia Dyslexia Dystonia</s>

<s>[INST]Answer this question truthfully: What are the laboratory results for lung sarcomatoid carcinoma?[/INST] There are no specific laboratory findings associated with sarcomatoid carcinoma of the lung.</s>

<s>[INST]Answer this question truthfully: What is the Holt-Oram Syndrome?[/INST] Holt-Oram syndrome is estimated to affect 1 in 100,000 individuals.</s>

<s>[INST]Answer this question truthfully: What is the reason for volunteering at WikiDoc?[/INST] By including your email address as an editor, you can connect with the thousands of students, physicians and patients around the world who view your contributions each year.</s>

<s>[INST]Answer this question truthfully: Could you explain what Upper Airway Resistance Syndrome (UARS) is?[/INST] It is difficult to confirm diagnosis, as few sleep testing centers have the proper test equipment to recognize the illness. Polysomnography (sleep study) with the use of a probe to measure Pes (esophageal pressure) is the gold standard diagnostic test for UARS. Apneas and hypopneas are absent or present in low numbers. Multiple snore arousals may be seen, and if an esophageal probe is used, progressive elevation of esophageal pressure fluctuations terminating in arousals is noted.</s>

<s>[INST]Answer this question truthfully: What is the explanation for Blepharitis and its natural history, complications, and prognosis?[/INST] Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, eyelid crusting, itching and irritation of the eyelids. If left untreated, severe blepharitis may cause alterations in the eyelid margin, loss of eyelashes, scarring of the eyelids, conjunctivitis, corneal involvement, superficial keratopathy, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum or stye, chalazion, corneal ulcer, and conjunctivitis. Blepharitis is generally associated with a favorable long-term prognosis.</s>

<s>[INST]Answer this question truthfully: What is the classification of ovarian germ cell tumors?[/INST] Ovarian germ cell tumor may be classified into two subtypes of benign and malignant tumors. Benign tumors are comprised of only teratoma, however, the malignant germ cell tumors may be classified to different types according to the histologic features. Teratoma Mature cystic teratomas (dermoid cysts) Immature teratoma Monodermal teratoma Struma ovarii Carcinoid tumors Neural tumors Dysgerminoma Yolk sac tumor Mixed germ cell tumors Pure embryonal carcinoma Non- gestational choriocarcinoma Pure embryoma WHO classifies ovarian germ cell tumors as follows: Teratoma Immature Mature Solid Cystic (dermoid cyst) Dysgerminoma Endometrial Sinus tumors Embryonal carcinoma Polyembryoma Choriocarcinoma Mixed germ cell tumors</s>

<s>[INST]Answer this question truthfully: What is the explanation behind psoriasis when considering its natural history, potential complications, and prognosis?[/INST] If left untreated, patients with psoriasis may progress to develop psoriatic arthritis, joint erosions, and conjunctivitis. Common complications of psoriasis include depression, psoriatic arthritis, chronic inflammatory bowel disease, non-alcoholic fatty liver disease, celiac disease, sensorineural hearing loss, osteopenia, and osteoarthritis. Psoriasis is a life-long disease that involves multiple relapses and remissions, though symptoms can be controlled with proper medication.</s>

<s>[INST]Answer this question truthfully: What is the resident survival guide for the Norovirus outbreak?[/INST] Shown below is an algorithm summarizing the approach to prevention and control of a norovirus infection outbreak according to recommendations by CDC. Hand Hygiene Wash hands with soap and running water for 20 seconds. Hand sanitizers (with at least 60% alcohol) can be used as an adjunct to soap. Wash your hands: Before eating, drinking and smoking After visiting bathroom After changing diapers After touching things that other people might have touched Avoid touching your face. Do not touch any ready to eat foods with bare hands. Food and water precautions Avoid eating raw fruits and vegetables unless they are washed and peeled by yourself. Avoid eating improperly cooked shellfish, oysters and clams. Prefer food which is cooked properly and served hot. Avoid ice. Safe beverages include: Bottled or canned water Bottled carbonated soda Hot tea, coffee, beer and wine Boiled water, or water which has been treated appropriately with chlorine Beverages from sealed containers Isolation of infected people If you see someone getting sick, move away from the area and report to the cruise staff. Infected patients should be isolated during period of illness and up to 48-72 hours following recovery. Asymptomatic but norovirus positive food handlers should also be isolated. Disinfection of the environment Clean contaminated surfaces to remove organic loads. Use freshly prepared 5000 ppm chlorine bleach solution. Apply disinfecting agent for up to 4 min on fecally soiled surfaces. Other disinfecting agents include: Ozone Hydrozen peroxide PPM: Parts Per Million</s>

<s>[INST]Answer this question truthfully: What exactly is pure red cell aplasia?[/INST] Complete blood count, peripheral smear, reticulocyte count Hepatic function test Renal function test Bone marrow aspiration and biopsy Common symptoms of pure red cell aplasia include fatigue and lethargy. Common physical examination findings of pure red cell aplasia include fast heart beat and pale apperance. Laboratory findings consistent with the diagnosis of pure red cell aplasia include: Normocytic, normochromic anemia; rarely, macrocytic anemia may be seen Very low or zero reticulocyte percentage and an absolute reticulocyte count <10,000/microL Normal white blood cell Normal platelet counts Bone marrow biopsy: normal myelopoiesis, lymphopoiesis, and megakaryocytopoiesis, but few erythroid precursors There are no ECG findings associated with pure red cell aplasia. An x-ray may be helpful in the diagnosis of thymoma and other neoplasms. There are no echocardiography/ultrasound findings associated with pure red cell aplasia. Chest CT scan may be helpful in the diagnosis of thymoma and other neoplasms. Chest MRI may be helpful in the diagnosis of thymoma and other neoplasms. There are no other imaging findings associated with pure red cell aplasia. Viral studies for hepatitis C and parvovirus B19 Autoimmune antibody studies Karyotype T cell receptor clonality studies Peripheral blood immunophenotyping</s>

<s>[INST]Answer this question truthfully: What other imaging findings are associated with osteosarcoma?[/INST] A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. Bone scan in osteosarcoma is used to: Observe abnormal areas of bone. Many bone tumors will light up on a bone scan. Observe if cancer has spread to other bones (metastasis). Delayed images of a bone scan demonstrate the femoral lesion to have increased activity. No other lesions evident.</s>

<s>[INST]Answer this question truthfully: Can you provide a summary of parotitis?[/INST] Parotitis must be differentiated from other diseases that present edematous swelling in the throat and neck. Diseases include retropharyngeal abscess, angioneurotic edema, salivary gland neoplasia, Sjgren's syndrome, and sialolithiasis and sialadenitis of the submandibular glands.</s>

<s>[INST]Answer this question truthfully: What is the importance of a chest x-ray for detecting aortic stenosis?[/INST] Chest X-ray may be used as a diagnostic tool in the evaluation of aortic stenosis. Findings associated with aortic stenosis include left ventricular enlargement and calcification of the aortic valve.</s>

<s>[INST]Answer this question truthfully: What information can be obtained from a chest x-ray of an individual with sporotrichosis?[/INST] Findings suggestive of sporotrichosis on chest x-ray include the presence of cavitations, tracheobronchial lymph node enlargement, and presence of nodular lesions.</s>

<s>[INST]Answer this question truthfully: What does the physical examination for hypocalcemia involve?[/INST] The clinical manifestations of hypocalcemia depend on the degree of hypocalcemia. Common physical examination findings of hypocalcemia include Chvostek's sign, Trousseau's sign, and circumoral numbness.</s>

<s>[INST]Answer this question truthfully: Is it possible for a chest x-ray to diagnose croup?[/INST] X Ray findings in croup patients include evidence of steeple sign: narrowing of the subglottic lumen in the neck. It also includes a visibly distended hypopharynx in some cases.</s>

<s>[INST]Answer this question truthfully: What are the historical and symptomatic characteristics of metanephric adenoma?[/INST] Metanephric adenoma are often asymptomatic. Possible symptoms of metanephric adenoma include: Hematuria Abdominal distension Abdominal pain Polycythaemia is a characteristic finding seen in approximately 10% of patients with metanephric adenoma.</s>

<s>[INST]Answer this question truthfully: Could you please provide the original sentence or context for me to rephrase it?[/INST] Risk factors for histoplasmosis infection include living in or traveling to the Central or Eastern United States. Patients with immunosupression, hematological malignancies, immunosuppressive therapy and infants are at a higher risk of developing disseminated histoplasmosis infection.</s>

<s>[INST]Answer this question truthfully: What medical therapy is used for treating squamous cell carcinoma of the lung?[/INST] The optimal treatment management of squamous cell carcinoma of the lung will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate staging. Common medical treatment options for the management of squamous cell carcinoma of the lung, include: Chemotherapy Adjuvant chemotherapy Neoadjuvant chemotherapy Radiation therapy To see chemotherapy for squamous cell carcinoma of the lung, click here To see radiation therapy for squamous cell carcinoma of the lung, click here Initial chemotherapy for patients with squamous cell carcinoma of the lung will depend on molecular testing, the presence of particular genetic mutations, and staging. Chemotherapy for patients with squamous cell carcinoma of the lung, is divided into 2 main types: specific-inhibitor therapy (usually indicated with the presence of a genetic mutation) and platinum-based chemotherapy (usually indicated with the absence of a genetic mutation) Combination chemotherapy regimens using platinum-based chemotherapy and specific-inhibitors is the treatment of choice for the management of patients with squamous cell carcinoma of the lung Erlotinib is the first-line treatment for patients with squamous cell carcinoma of the lung whose cancer has spread to other parts of the body and that has certain types of epidermal growth factor receptor (EGFR) mutations. Chemotherapy treatments for squamous cell carcinoma of the lung, include: Paclitaxel 175 mg/m2 over 3 hours every 3 weeks (as a single agent) for up to 5 cycles 80 mg/m2 over 1 hour weekly for 6 weeks of an 8-week treatment cycle (as a single agent) until disease progression or unacceptable toxicity. Cisplatin 100 mg/m2 on day 1 every 4 weeks (in combination with etoposide) for 3 to 4 cycles; 100 mg/m2 on day 1 every 4 weeks (in combination with vinorelbine) 100 mg/m2 on day 1 every 4 weeks (in combination with gemcitabine) 80 mg/m2 on day 1 every 3 weeks (in combination with gemcitabine) 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed) for up to 6 cycles or until disease progression or unacceptable toxicity Erlotinib Oral: 150 mg once daily until disease progression or unacceptable toxicity Afatinib Oral: 40 mg once daily until disease progression or unacceptable toxicity Missed doses:Do not take a missed dose within 12 hours of next dose Gefitinib Oral: 250 mg once daily until disease progression or unacceptable toxicity Missed doses:Do not take a missed dose if it is within 12 hours of the next scheduled dose Crizotinib Oral:250 mg twice daily, continue treatment until disease progression or unacceptable toxicity Missed doses:If a dose is missed, take as soon as remembered unless it is <6 hours prior to the next scheduled dose (skip the dose if <6 hours before the next dose); do not take 2 doses at the same time to make up for a missed dose. If vomiting occurs after dose, administer the next dose at the regularly scheduled time Vinorelbine Gemcitabine Carboplatin IV:Target AUC 6 every 3 to 4 weeks (in combination with paclitaxel) Target AUC 6 every 3 weeks (in combination with bevacizumab and paclitaxel) Target AUC 5 every 3 weeks (in combination with pemetrexed) Target AUC 6 every 3 weeks (in combination with pemetrexed and bevacizumab) for up to 4 cycles followed by maintenance therapy or in combination with radiation therapy and paclitaxel Target AUC 6 every 3 weeks for 2 cycles Target AUC 6 every 3 weeks for 2 cycles Target AUC 2 weekly for 7 weeks Target AUC 2 every week for 7 weeks; then target AUC 6 every 3 weeks for 2 cycles Etoposide IV: 35 mg/m2/day for 4 days, up to 50 mg/m2/day for 5 days every 3 to 4 weeks Oral: Due to poor bioavailability, oral doses should be twice the IV dose (and rounded to the nearest 50 mg) Docetaxel IV: 75 mg/m2 every 3 weeks (as a single agent or in combination with cisplatin) Pemetrexed IV:Initial treatment of locally advanced or metastatic NSCLC: 500 mg/m2 on day 1 of each 21-day cycle (in combination with cisplatin) for up to 6 cycles or until disease progression or unacceptable toxicity Maintenance treatment of locally advanced or metastatic NSCLC (after 4 cycles of initial platinum-based therapy): 500 mg/m2 on day 1 of each 21-day cycle (as a single-agent); continue until disease progression or unacceptable toxicity Second-line treatment of recurrent/metastatic disease (after prior chemotherapy): 500 mg/m2 on day 1 of each 21-day cycle (as a single-agent); continue until disease progression or unacceptable toxicity Platinum-based chemotherapy (cisplatin, carboplatin,, irinotecan) are the mainstay of squamous cell carcinoma of the lung Platinum-based chemotherapy consists of four to six cycles Cisplatin is the preferred platinum based agent of choice when the therapy is used with curative intent To see more information about mangnagment approach for non-small cell lung cancer click here To see more information about the chemotherapeutic regimens in non-small cell lung cancer click here Medical therapy complications for squamous cell carcinoma of the lung will depend on the chemotherapeutic agent. Common chemotherapy complications, include: Platinum-based chemotherapy, the main dose-limiting side effect of cancer treatment with platinum compounds, include: Neurotoxicity Nephrotoxicity Peripheral neuropathies Other chemotherapeutic agent complications, include: Extravasation Cardiotoxicity Side effects symptoms of chemotherapeutic agents, include: Hair loss Loss of appetite Nausea Vomiting Diarrheaor constipation Easy bruising Fatigue Radiation therapy for squamous cell carcinoma of the lung, includes: Curative intent radiation therapy Palliative radiation therapy Indications for radiation therapy in squamous cell carcinoma of the lung, include: Sufficient pulmonary reserve Stage I Stage II without fitness for surgery Stage IIIA or IIIB squamous cell carcinoma of the lung and are not fit for chemoradiation Common types of external beam radiation therapy for the treatment of squamous cell carcinoma of the lung, include: Three-dimensional conformal radiation therapy Intensity modulated radiation therapy Stereotactic body radiation therapy Stereotactic radiosurgery</s>

<s>[INST]Answer this question truthfully: What is the available information on immune hemolytic anemia?[/INST] Treatment with a steroid medication such as prednisone is usually the first therapy tried. If a steroid medication does not improve the condition, removal of the spleen (splenectomy) may be considered. Treatments with drugs that suppress the immune system (immunosuppressants) may also be given if you do not respond to steroids. Blood transfusions, if needed for severe anemia, are given with caution because the blood may not be compatible and it may cause further hemolysis.</s>

<s>[INST]Answer this question truthfully: What are the epidemiology and demographics regarding human papillomavirus?[/INST] Following demographic factors may affect the incidence and prevalence of HPV infection: Cutaneous warts More common in children aged 12-16 yrs of age 10% of children and 3.5% of adults are affected, worldwide Genital warts Incidence of genital HPV infection increases at the age when individuals begin to engage in sexual activity. Highest incidence of genital warts is seen in females aged 20-24 yrs and males aged 25-29 yrs of age (CDC) Prevalence of cervical HPV in females may decline after age 30 HPV associated cancer Incidence is more common in younger age group(sexually active) (2196503) Recurrent respiratory papillomatosis Increased incidence is seen in children as compared to adults Human Papillomavirus Cervicovaginal Prevalence of Types 6, 11, 16 and 18 Among Women Aged 1459 Years by Age Group and Time Period, National Health and Nutrition Examination Survey, 20032006 and 20072010 Data from CDC Genital warts Prevalence per 1000 person-years Among participants in private health plans aged 1039 years by sex, age group, and year, 20032010 is shown in the graph below: Data from CDC HPV associated cancers Out of total 38,793 HPV -associated cancers that occur in the United States each year, 23,000 occur among women, and about 15,793 among men Three fold increased prevalence of HPV associated anal and oropharyngeal cancer in men as compared to women. Increased incidence of oropharngeal and anal cancer among men who have sex with men (MSM) Worldwide, the point prevalence of HPV in females is 10%, with highest prevalence among African females There may be increased incidence of high risk HPV infections in African American females as compared to Caucasian</s>

<s>[INST]Answer this question truthfully: Could you please provide me with the context for this sentence? Is there anything specific that you would like me to consider while rephrasing it?[/INST] The syndrome was first identified in 1961 by Dr. J. C. P. Williams of New Zealand.</s>

<s>[INST]Answer this question truthfully: What other imaging findings are related to seizures?[/INST] 3-T MRI may be helpful in patients with epilepsy and negative 1.5-T MRI.</s>

<s>[INST]Answer this question truthfully: Could you please provide me with the original text to paraphrase?[/INST] The vast majority of chronic wounds can be classified into three categories: venous ulcers, diabetic, and pressure ulcers. A small number of wounds that do not fall into these categories may be due to causes such as radiation poisoning or ischemia. Venous ulcers, which usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly. They are thought to be due to venous hypertension caused by improper function of valves that exist in the veins to prevent blood from flowing backward. Ischemia results from the dysfunction and, combined with reperfusion injury, causes the tissue damage that leads to the wounds. Another major cause of chronic wounds, diabetes, is increasing in prevalence. Diabetics have a 15% higher risk for amputation than the general population due to chronic ulcers. Diabetes causes neuropathy, which inhibits the perception of pain. Thus patients may not initially notice small wounds to legs and feet, and may therefore fail to prevent infection or repeated injury. Further, diabetes causes immune compromise and damage to small blood vessels, preventing adequate oxygenation of tissue, which can cause chronic wounds. Pressure also plays a role in the formation of diabetic ulcers. Another leading type of chronic wounds is pressure ulcers, which usually occur in people with conditions such as paralysis that inhibit movement of body parts that are commonly subjected to pressure such as the heels, shoulder blades, and sacrum. Pressure ulcers are caused by ischemia that occurs when pressure on the tissue is greater than the pressure in capillaries, and thus restricts blood flow into the area. Muscle tissue, which needs more oxygen and nutrients than skin does, shows the worst effects from prolonged pressure. As in other chronic ulcers, reperfusion injury damages tissue.</s>

<s>[INST]Answer this question truthfully: What is mediastinitis and what causes it?[/INST] Common causes of mediastinitis include bacterial and fungal infections.</s>

<s>[INST]Answer this question truthfully: Can you provide an explanation of psychosis, including its natural history, potential complications, and prognosis?[/INST] Psychosis can prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others.</s>

<s>[INST]Answer this question truthfully: Could you provide an overview of histoplasmosis, please?[/INST] Histoplasmosis can be classified with respect to the involved organ system. This can include pulmonary, nervous system, cardiovascular system and mediastinum. Histoplasmosis can also be classified according to the severity in to mild, moderate and severe, according to disease duration into acute, sub-acute, chronic and recurrent and according to the progression of the disease into localized or disseminated histoplasmosis.</s>

<s>[INST]Answer this question truthfully: What is information about Pap smear?[/INST] A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. It is a screening test for cervical cancer.</s>

<s>[INST]Answer this question truthfully: What is the importance of Ureaplasma urealyticum?[/INST] Ureaplasma species can be distinguished from other bacteria via culture on specific media for Mycoplasma and/or PCR -based techniques.</s>

<s>[INST]Answer this question truthfully: What is Enterobiasis, and what factors are associated with its risks?[/INST] Common risk factors in the development of enterobiasis include young age, unhygienic practices, and close contact with an infected person.</s>

<s>[INST]Answer this question truthfully: What is brachial neuritis, and what are the acute symptoms associated with it?[/INST] Deformity of the hand or arm, mild to severe, which can lead to contractures Partial or complete arm paralysis Partial or complete loss of sensation in the arm, hand, or fingers Recurrent or unnoticed injury to the hand or arm due to diminished sensation</s>

<s>[INST]Answer this question truthfully: What are the factors that increase the risk of developing hypoplastic left heart syndrome?[/INST] Hypoplastic left heart is more common in males than in females.</s>

<s>[INST]Answer this question truthfully: What are the adverse effects of fibrate?[/INST] Mild stomach upset Myopathy (muscle pain with CPK elevations). In combination with statin drugs, fibrates cause an increased risk of rhabdomyolysis (idiosyncratic destruction of muscle tissue, leading to renal failure). A powerful statin drug, cerivastatin (Lipobay), was withdrawn because of this complication. The less lipophilic statins are less prone to cause this reaction, and are probably safer when combined with fibrates. Clofibrate are no longer used because they were found to increase morbidity and mortality rates. Also, increased rates of malignancy in rodents have been found. Fibrates are excreted via kidney. It can cause reversible increases in serum creatinine levels. Thus, reduction in doses are indicated in cases with increased serum creatinine levels. Gemfibrozil's excretion is independent of renal function, and can be used in patients with chronic kidney disease.</s>

<s>[INST]Answer this question truthfully: Could you provide me with an overview of graft-versus-host disease?[/INST] Medical therapy focuses on immunosuppressive medications, since GvHD is an abnormal and intense immunological phenomenon. Steroids are the first line of therapy. Other treatment options include alternative immunosuppressive medications like tacrolimus or mycophenolate. There is no role for surgery in the management of GvHD. However, if GvHD becomes very severe to the point of organ dysfunction requiring surgery, surgery may be indicated in the correct clinical context. Prevention of GvHD is based on primary preventive strategies, including use of donor stem cells that are closely HLA -matched to the recepient, the use of methotrexate in the first 11 days immediately post-transplant, and the use of anti-microbial agents to prevent GI inflammation and infection. There is no role for secondary prevention.</s>

<s>[INST]Answer this question truthfully: What is the method for secondary prevention of pneumomediastinum?[/INST] Secondary modes of preventing pneumomediastinum include: In case of spontaneous pneumomediastinum without any complications, patients are required to be hospitalized for 24 hours for observational purposes. Regular follow-ups are required to avoid recurrence or development of malignant pneumomediastinum. Keep medical condition, which may progress to pneumomediastinum such as asthma, COPD, mediastinitis or pneumonia under control with proper medical therapy.</s>

<s>[INST]Answer this question truthfully: What is corrective surgery for dextro-transposition of the great arteries?[/INST] Arterial switch or Jatene Operation The successful anatomical correction of TGA was first described in 1975 by Jatene et al. It has become the preferred procedure for most of the D-TGA (see above for the conditions) An arterial switch operation involves the following steps- The baby will be placed under general anesthesia. The heart and vessels are accessed via median sternotomy. The heart/lung machine (cardiopulmonary bypass machine) is connected. Since, the heart/lung machine needs its "circulation" to be filled with blood, a child will require a blood transfusion for this surgery. The patient is cooled for 20 minutes to 20 Celsius degree rectal temperature. Once the heart is stopped and emptied, the aorta and the pulmonary artery are divided. The site of the aortic transection is marked before the cross clamp is applied. The aorta and pulmonary artery are transected at a level above the valve sinuses. The ostium of the coronary arteries are excised along with a large segment of surrounding aortic wall and sutured into place in the neo-aorta (basal part of the pulmonary artery). The pulmonary trunk is moved forward into its new position anterior to the aorta. Finally, the switched great arteries are sutured into place. The heart is then allowed to fill and take over its normal function. Temporary pacemaker wires and drainage tubes are then placed and the chest is closed. Some arterial switch recipients may present with post-operative pulmonary stenosis, which would then be repaired with angioplasty, pulmonary stenting via heart cath or median sternotomy, and/or xenograft. Lecompte maneuver - During this surgery the bifurcation of the pulmonary arteries are placed anterior to the aorta. This helps in straddling the ascending aorta to the left and right pulmonary arteries. This reduces the tension that could be there due to anterio translocation of the pulmonary arterial root. This has helped to decrease the pulmonary artery stenosis that may occur as an complication of ASO.</s>

<s>[INST]Answer this question truthfully: What steps can be taken to prevent ascending cholangitis?[/INST] Cholangitis may also complicate medical procedures involving the bile duct, especially ERCP. To prevent this, it is recommended that those undergoing ERCP for any indication receive prophylactic (preventative) antibiotics.</s>

<s>[INST]Answer this question truthfully: What is the definition and pathophysiology of mediastinitis?[/INST] Mediastinitis is the inflammation or infection of the mediastinum. The anterior and upper regions of the mediastinum are the most often affected. Although the pathogenesis of the infection remains unknown, radiographic, serologic, or histopathologic evidence of prior Histoplasma capsulatum infection, histoplasmosis, or chronic granulomatous disease is always observed. Additionally, mediastinitis may also present as the result of Staphylococcus aureus or Staphylococcus epidermidis infection following chest surgery. On gross pathology, a white, fibrotic mass and a distinct gap with adipose tissue are characteristic findings of mediastinitis. On microscopic histopathological analysis, inflammation with granulated tissue and avascular and paucicellular fibrohyaline tissue are characteristic findings of mediastinitis.</s>

<s>[INST]Answer this question truthfully: What are the symptoms and the medical background associated with urethral cancer?[/INST] Symptoms of urethral cancer include hematuria, trouble with urination, swelling in the groin, and a lump or thickness in the perineum or penis.</s>

<s>[INST]Answer this question truthfully: What is an overview of the levo-transposition of the great arteries?[/INST] levo-Transposition of the great arteries, also commonly referred to as congenitally corrected transposition of the great arteries It is an acyanotic heart defect congenital heart defect in which the primary arteries, the aorta and the pulmonary artery are transposed, with the aorta anterior and to the left of the pulmonary artery; and the morphological left and right ventricles are also transposed. Use of the term "corrected" has been disputed by many due to the frequent occurrence of other abnormalities and or acquired disorders in l-TGA patients. In segmental analysis, this condition is described as atrioventricular discordance ventricular inversion with ventriculoarterial discordance. l-TGA is often referred to simply as transposition of the great arteries (TGA); however, TGA is a more general term which may also refer to dextro-transposition of the great arteries (d-TGA). Another term commonly used to refer to both l-TGA and d-TGA is transposition of the great vessels (TGV), although this term can have an even broader meaning than TGA. The letter L in the terms l-TGA or L-TGA refers to the a leftward or Levo aorta, versus the normal dextro or rightward aorta.</s>

<s>[INST]Answer this question truthfully: What is the explanation behind the Archive016 and Johnny the Vandal sockpuppets?[/INST] We had some of these on wikibooks today, using a different IP than the one you identified... your bot created Category:Wikipedia sockpuppets of Johnny the Vandal, so are you "in charge" of this case? The IP in question has a history of vandalizing "according to pattern" here on wikipedia. -- SB_Johnny | talk | books 20:13, 12 April 2007 (UTC) I think you're really confusing something here. Cydebot modified over a hundred sockpuppet categories. It was the result of a huge blanket WP:CFD. I am in no way, shape, or form maintaining these things. If you'd like to do so, by my guest. -- Cyde Weys 22:27, 12 April 2007 (UTC) Heh, no thanks:). We just have another IP for him... I'll talk to one of the local CUs about it. -- SB_Johnny | talk | books 09:27, 13 April 2007 (UTC)</s>

<s>[INST]Answer this question truthfully: What are the risk factors that can make encephalitis viral?[/INST] Age - In general, young children and older adults are at greater risk of most types of viral encephalitis Weakened Immune system Certain geographical locations are more prone for ticks and mosquitoes bite Outdoor activities - It can increase the risk of insects bites Season of the year - it is commoner in summer and fall</s>

<s>[INST]Answer this question truthfully: What information is available regarding cholestasis?[/INST] The underlying cause of cholestasis must be treated.</s>

<s>[INST]Answer this question truthfully: Could you explain the meaning of coronary artery bifurcation?[/INST] Bifurcation lesions occur when the atherosclerotic plaque involves the origin of two separate arteries. A bifurcation is defined as a division of a main, parent branch into two daughter branches of at least 2.0 mm. Bifurcation lesions in coronary artery disease (CAD) are common, encompassing 15-18% of lesions treated with percutaneous coronary intervention (PCI). The optimal treatment for these lesions is subject to intense debate; current practice includes a variety of approaches. There is no data to suggest that stenting of a side branch improves outcomes over conventional balloon dilation of the side branch origin. In fact, sidebranch stenting may be associated with a higher risk of stent thrombosis. The consensus view at this time is that if there is adequate flow in the side branch and no evidence of ischemia at the end of the procedure, then further dilations of the side branch are not warranted.</s>

<s>[INST]Answer this question truthfully: Can you provide a brief summary or explanation of inflammatory bowel disease?[/INST] While patients of IBD do have an increased risk of colorectal cancer this is usually caught much earlier than the general population in routine surveillance of the colon by colonoscopy, and therefore patients are much more likely to survive.</s>

<s>[INST]Answer this question truthfully: What is the historical background of Diabetes Insipidus?[/INST] Thomas Willis was first noted the difference diabetes mellitus from diabetes insipidus in 1670. Johann Peter Frank was first introduced the term " diabetes insipidus "; described polyuric patients excreting nonsaccharine urine in 1794. In 1913, a historical milestone was achieved when Farini successfully used posterior pituitary extracts to treat diabetes insipidus. In the early 1920s the available evidence indicated that diabetes insipidus was a disorder of the pituitary gland. In 1928, De Lange first observed that some patients with diabetes insipidus did not respond to posterior pituitary extracts. In 1945, Forssman and Waring established that the kidney played a critical role in the forms of diabetes insipidus that were resistant to this treatment. In 1947, Williams and Henry introduced the term nephrogenic diabetes insipidus for the congenital syndrome characterized by polyuria and renal concentrating defect resistant to vasopressin. In 1955, du Vigneaud received the 1955 Nobel Prize in chemistry for the first synthesis of the hormone vasopressin, which represented a milestone in the development of treatment for central diabetes insipidus.</s>

<s>[INST]Answer this question truthfully: What is the surgical procedure for traumatic brain injury?[/INST] Surgery is not a first-line treatment option for patients with traumatic brain injury. Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions. Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery. Sometimes when the brain is injured swelling occurs and fluids accumulate within the brain space. When an injury occurs inside the skull-encased brain, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This leads to an increase in the pressure within the skull, called intracranial pressure (ICP). High ICP can cause delicate brain tissue to be crushed, or parts of the brain to herniate across structures within the skull, potentially leading to severe damage. Medical personnel measure a patient's ICP using a probe or catheter. The instrument is inserted through the skull to the subarachnoid level and is connected to a monitor that registers ICP. If a patient has high ICP, he or she may undergo a ventriculostomy, a procedure that drains cerebrospinal fluid (CSF) from the ventricles to bring the pressure down by way of an external ventricular drain. Decompressive craniectomy is a last-resort surgical procedure in which part of the skull is removed in an attempt to reduce severely high ICP.</s>

<s>[INST]Answer this question truthfully: What exactly is Zenker's diverticulum?[/INST] Zenker's diverticulum (ZD) also known as pharyngosophageal diverticulum. It is an acquired sac-like outpouching of the mucosa and submucosa layers originating from the pharyngoesophageal junction. Killian's dehiscence a pulsion of false diverticulum occurring dorsally at the pharyngoesophageal wall surrounded by the oblique inferior pharyngeal constrictor muscle and the transversal fibers of the cricopharyngeal muscle. ZD occurs due to increased intraluminal pressure in the oropharynx during swallowing, against an inadequate relaxation of the cricopharyngeal muscle. An incomplete opening of the Upper Esophageal Sphincter (UES) causing the protrusion of the mucosa through an area of relative weakness at the dorsal pharyngoesophageal wall. The pharyngoesophageal phase of swallowing is affected in ZD resulting in hindering the neuromuscular functions such as chewing, initiating the swallowing, and propulsion of the food from the oropharynx into the cervical esophagus.</s>

<s>[INST]Answer this question truthfully: What treatment is recommended for individuals with chronic mitral regurgitation?[/INST] Shown below is an algorithm depicting the indications for mitral valve surgery or period monitoring among patients with chronic primary MR according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Note that when mitral valve surgery is indicated, mitral valve repair is preferred over mitral valve replacement whenever feasible. Abbreviations: LVEF: left ventricular ejection fraction; LVESD: left ventricular end systolic diameter; MR: mitral regurgitation; PASP: Pulmonary artery systolic pressure Primary MR What is the severity of MR ? Severe MR Severe MVP with loss of coaptation RHD with loss of central coaptation Left ventricular dilation Regurgitation fraction 50% Regurgitation volume 60ml Effective regurgitation orifice 0.4cm Vena contracta 0.7cm Progressive MR (Stage B) Severe MVP with normal coaptation RHD with normal coaptation No Left ventricular dilation Regurgitation fraction < 50% Regurgitation volume < 60ml Effective regurgitation orifice < 0.4cm Vena contracta < 0.7cm Is the patient symptomatic? Yes (Stage D) No (Stage C) Is the LVEF >30%? LVEF 30-60% OR LVESD40 mm (Stage C2) LVEF >60% AND LVESD<40 mm (Stage C1) New onset atrial fibrillation OR PASP>50 mmHg (Stage C1) Is the likelihood of success for the valve repair >95% and the expected mortality <1%? No Yes Yes No Mitral valve surgery (Class IIb) Mitral valve surgery (Class I) Mitral valve repair (Class IIa) Periodic monitoring Periodic monitoring Shown below is an algorithm depicting the indications for mitral valve surgery or period monitoring among patients with chronic secondary MR according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Note that when mitral valve surgery is indicated, mitral valve repair is preferred over mitral valve replacement whenever feasible. Abbreviations: MR: mitral regurgitation Mitral regurgitation is a syndrome of pure volume overload whereas aortic regurgitation is a combination of both volume and pressure overload. Both syndromes are associated with an increase in preload. In mitral regurgitation, the afterload is reduced whereas in aortic regurgitation the afterload is increased. This is very important because when the mitral valve is repaired, there is no longer a reduction afterload and the left ventricle may fail due to an abrupt rise in the afterload. In aortic regurgitation, because the afterload is already increased chronically, replacement of the valve is not as likely to precipitate acute left ventricular failure due to an abrupt rise in afterload. By the time symptoms develop, there is already left ventricular dysfunction. Because of the low pressure system into which the blood is ejected into through the mitral valve, the ejection fraction is always high in mitral regurgitation. If the ejection fraction appears to be "normal", there is already decline in left ventricular function. There is no indication for vasodilator therapy in the absence of systemic hypertension in asymptomatic patients with preserved left ventricular function. There are two surgical options for the treatment of mitral regurgitation: mitral valve replacement and mitral valve repair. In general, mitral valve repair is preferred to mitral valve replacement as it carries a lower risk of subsequent prosthetic valve endocarditis and results in better preservation of left ventricular function. The ACC/AHA 2008 guidelines recommend mitral valve repair rather than mitral valve replacement if the anatomy is appropriate, including patients with rheumatic mitral valve disease and mitral valve prolapse (Grade 1C). The procedure should be performed at experienced surgical centers. Limited damage to certain areas of the mitral valve leaflets or chordae tendineae Limited calcification of the leaflets or annulus Prolapse of less than one-third of either leaflet Pure annular dilatation Valvular perforations Incomplete papillary muscle rupture Extensive calcification or degeneration of a leaflet or annulus Prolapse of more than one-third of the leaflet tissue Extensive chordal fusion, calcification, or papillary muscle rupture Extensive damage of mitral valve secondary to endocarditis</s>

<s>[INST]Answer this question truthfully: Could you please explain what pelvic inflammatory disease is?[/INST] Pelvic inflammatory disease is a generic term for the infection of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis (with or without abscess formation). Pus can be released into the peritoneum. Two-thirds of patients with laparoscopic evidence of previous PID were not aware they had ever had PID. PID is often associated with sexually transmitted diseases, as it is a common result of such infections. PID is a vague term and can refer to viral, fungal, or parasitic infections, though it most often refers to bacterial infections. PID should be classified by affected organs, the stage of the infection, and the causative organism(s). Although an STD is often the cause, other routes are possible, including lymphatic, postpartum, post-abortal (either miscarriage or abortion) or intrauterine device (IUD) -related and hematogenous spread.</s>

<s>[INST]Answer this question truthfully: Could you explain what anemia of chronic disease means?[/INST] Approximately 30-60% of patients with rheumatoid arthritis also have anemia. More than 30% of cancer patients have anemia. In elderly patients, about one third of the cases of anemia are ACD.</s>

<s>[INST]Answer this question truthfully: What are the natural history, complications, and prognosis associated with cellulitis?[/INST] Cuts and wounds on the skin are the most common means of contracting cellulitis. Other conditions may also lead to the condition. Staphylococcus aureus and Group A Streptococci are the most common causative agents of infection. When the bacteria invades the skin, they release toxins which cause local erythema, pain, and induration. With a course of oral antibiotic treatment, cellulitis can be cured. Cellulitis spreads fairly fast, and if the disease is not treated it can lead to multiple serious complications. Cellulitis can be complicated by the development of: Blood infection (sepsis) Bone infection (osteomyelitis) Inflammation of the lymph vessels (lymphangitis) Inflammation of the heart (endocarditis) Meningitis Shock Tissue death (gangrene) Cellulitis usually subsides within 7-10 days of antibiotic use. Longer treatment may be needed if the cellulitis is more severe. This may occur if the patient has a chronic disease or their immune system is not working properly. People with fungal infections of the feet may have cellulitis that keeps recurring. The cracks in the skin from the fungal infection allow bacterial entry into the skin.</s>

<s>[INST]Answer this question truthfully: Can you provide an overview of secondary adrenal insufficiency?[/INST] The prevalence of secondary adrenal insufficiency is approximately 15-28 per 100,000 individuals worldwide more common than Addison disease. The incidence increases with age; the median age at diagnosis is 60 years. There is no racial predilection.Women are more commonly affected by secondary adrenal insufficiency than male.</s>

<s>[INST]Answer this question truthfully: Could you provide the text that you want me to rephrase into proper English? As "What is spinal muscular atrophy?" is already in proper English.[/INST] Carrier testing , , - Carrier testing helps to identify carriers of the mutated genes (SMN, survival motor neuron gene). This can help to predict the risk of SMA in future pregnancies in the carriers. PCR-based dosage assay Detect carriers with homozygous deletions or compound heterozygosity. Sequencing of the SMN gene - Detect point mutations. Other methods - family linkage analysis to identify the Parents genotype. New Born screening may help to identify pre-symptomatic individuals and institution of early treatment (once it becomes available). This can prevent the occurrence of severe disease forms in future.</s>

<s>[INST]Answer this question truthfully: What is the relationship between spontaneous coronary artery dissection and percutaneous coronary intervention?[/INST] Conservative management should be the first choice if emergent revascularization is not necessary. However, optimal management is in question due to insufficient clinical experience. There are some treatment options including conservative management, emergency revascularization (PCI or CABG), fibrinolytic therapy, mechanical hemodynamic support, and even cardiac transplantation.The preference of the approach should be tailored to the patients clinical status.</s>

<s>[INST]Answer this question truthfully: What is Empyema, and what details do we possess regarding it?[/INST] The health care provider may note decreased breath sounds or an abnormal sound (friction rub) when listening to the chest with a stethoscope (auscultation). Tests may include the following: Chest x-ray CT scan of chest Pleural fluid Gram stain and culture Thoracentesis</s>