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In diagnostic pathology, a<unk> , or LE body, is a dense, homogeneous, basophilic particle, easily stainable with<unk> . It consists of degraded nuclear material from an injured cell, along with autoantibodies and a limited amount of cytoplasm.<unk> es occur in systemic lupus erythematosus. The<unk> may be green, blue, or purple with the Papanicolaou stain and magenta with Romanowsky stains. The material has a positive Feulgen stain reaction, which is typical of DNA. The material may be extracellular or may be ingested by leukocytes, which are then known as LE cells. | Hematoxylin body | Howell–Jolly body | Contour threads | Ferruginous body | Micronucleus | Cowdry bodies | Emerods | Smegma | 00
| 67,704 |
<unk> is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries. | Penile fracture | Testicular torsion | Urethrocele | Varicocele | Hematocele | Buried penis | Cervical ectropion | Penile torsion | 00
| 12,296 |
The diagnosis is made either by testing of the fumarate hydratase activity in cultured skin fibroblasts or lymphoblastoid<unk> s and demonstrating reduced activity (≤60%) or by molecular genetic testing. Special histologic features of fibroids may allow an early diagnosis in absence of other symptoms. Histology The skin lesions may be difficult to diagnose clinically but a punch biopsy will usually reveal a Grenz zone separating the tumour from the overlying skin. Histological examination shows dense dermal nodules composed of elongated<unk> s with abundant eosinophilic cytoplasm arranged in fascicles (spindle<unk> s). The nuclei are uniform, blunt-ended and cigar-shaped with only occasional mitoses. Special stains that may be of use in the diagnosis include Masson's trichrome, Van Gieson's stain and phosphotungstic acid–haematoxylin. The renal<unk> carcinomas have prominent eosinophilic nucleoli surrounded by a clear halo. Differential diagnosis Differential diagnosis of this condition includes the Birt-Hogg-Dubé syndrome and tuberous sclerosis. As the skin lesions are typically painful, it is also often necessary to exclude other painful tumors of the skin (including blue rubber bleb nevus, leiomyoma, eccrine spiradenoma, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomus tumor and granular<unk> tumor; the mnemonic "BLEND-AN-EGG" may be helpful). Other skin lesions that may need to be considered include cylindroma, lipoma, poroma and trichoepithelioma; these tend to be painless and have other useful distinguishing features. | Hereditary leiomyomatosis and renal cell cancer syndrome | Menke-Hennekam syndrome | Hereditary leiomyomatosis and renal cell carcinoma | Fryns syndrome | Heerfordt syndrome | Serrated polyposis syndrome | Hereditary breast–ovarian cancer syndrome | Ehlers–Danlos syndromes | 00
| 62,787 |
Throughout southeast Asia, estimates are that more than half of children under the age of six years have subclinical vitamin A deficiency and night blindness, with progression to<unk> being the leading cause of preventable childhood blindness. Estimates are that each year there are 350,000 cases of childhood blindness due to vitamin A deficiency. The causes are vitamin A deficiency during pregnancy, followed by low transfer of vitamin A during lactation and infant/child diets low in vitamin A or beta-carotene. The prevalence of pre-school age children who are blind due to vitamin A deficiency is lower than expected from incidence of new cases only because childhood vitamin A deficiency significantly increases all-cause mortality. | Xerophthalmia | Enophthalmia | Corneal opacity | Enophthalmos | Exophthalmos | Hypertrichosis | Raccoon eyes | Photophthalmia | 00
| 23,166 |
<unk> (original brand name Agenerase, GlaxoSmithKline) is a protease inhibitor used to treat HIV infection. It was approved by the Food and Drug Administration on April 15, 1999, for twice-a-day dosing instead of needing to be taken every eight hours. The convenient dosing came at a price, as the dose required is 1,200 mg, delivered in 8 (eight) very large 150 mg gel capsules or 24 (twenty-four) 50 mg gel capsules twice daily. It was patented in 1992 and approved for medical use in 1999. Production of<unk> was discontinued by the manufacturer on December 31, 2004; a prodrug version (fosamprenavir), is available. | Amprenavir | Ritonavir | Fosamprenavir | Saquinavir | Nelfinavir | Indinavir | Entecavir | Coronavir | 00
| 35,992 |
Hysterosalpingography, a common technique in the work-up of infertility, is reliable in the diagnosis of<unk> , which is seen as small globular collections within the tubal wall, either discontinuous or in continuity with the tubal lumen. Tubal obstruction and hydrosalpinx are commonly seen as well. Other techniques include laparoscopic chromopertubation, salpingoscopy, and transvaginal hydrolaparoscopy (the latter allows visualization of the tubal mucosa) | Salpingitis isthmica nodosa | Postpartum thyroiditis | Cystitis glandularis | Ovarian apoplexy | Cystitis cystica | Ovarian torsion | Male infertility crisis | Autoimmune oophoritis | 00
| 57,268 |
<unk> is the administration of therapeutic agents before a main treatment. One example is<unk> hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate.<unk> aims to reduce the size or extent of the cancer before using radical treatment intervention, thus both making procedures easier and more likely to succeed and reducing the consequences of a more extensive treatment technique, which would be required if the tumor were not reduced in size or extent. Another related concept is that<unk> acts on micrometastatic disease. The downstaging is then a surrogate marker of efficacy on undetected dissemination, resulting in improved longtime survival compared to the surgery-alone strategy. This systemic therapy (chemotherapy, immunotherapy or hormone therapy) or radiation therapy is commonly used in cancers that are locally advanced, and clinicians plan an operation at a later stage, such as pancreatic cancer. The use of such therapy can effectively reduce the difficulty and morbidity of more extensive procedures. The use of therapy can turn a tumor from untreatable to treatable by shrinking the volume. Often, it is unclear which surrounding structures are directly involved in the disease and which are just showing signs of inflammation. By administering therapy, a distinction can often be made. Some doctors give the therapy in the hope that a response is seen, and they can then decide what is the best course of action. In some cases, magnetic resonance imaging can predict the response of a patient to<unk> , for example in ovarian cancer. Not everyone is suitable for<unk> because it can be extremely toxic. Some patients react so severely that further treatments, especially surgery, are precluded, and the patient is rendered unfit for anesthetic. | Neoadjuvant therapy | Adjuvant therapy | Hormone therapy | Estrogen deprivation therapy | Carboxytherapy | Androgen deprivation therapy | Intraoperative radiation therapy | Chemoradiotherapy | 00
| 45,385 |
The<unk> <unk> name abbreviated<unk> ; gene name abbreviated<unk> ,<unk> or<unk> 1) is a tumor suppressor<unk> that is dysfunctional in several major cancers. One function of<unk> is to prevent excessive cell growth by inhibiting cell cycle progression until a cell is ready to divide. When the cell is ready to divide,<unk> is phosphorylated, inactivating it, and the cell cycle is allowed to progress. It is also a recruiter of several chromatin remodeling enzymes such as methylases and acetylases.<unk> belongs to the pocket<unk> family, whose members have a pocket for the functional binding of other<unk> s. Should an oncogenic<unk> , such as those produced by cells infected by high-risk types of human papillomavirus, bind and inactivate<unk> , this can lead to cancer. The<unk> gene may have been responsible for the evolution of multicellularity in several lineages of life including animals. | Retinoblastoma protein | Myeloma protein | Promyelocytic leukemia protein | Peripheral myelin protein 22 | Tumor-associated glycoprotein 72 | Retinol-binding protein | Heart-type fatty acid binding protein | Adenovirus E1B protein | 00
| 60,466 |
<unk> is as active against influenza as ribavirin in animal models, with slightly less toxicity, so it may also eventually replace ribavirin as an anti-influenza agent. | Taribavirin | Telaprevir | Ribavirin | Coronavir | Paritaprevir | Saquinavir | Abacavir | Indinavir | 00
| 32,361 |
<unk> is most commonly caused by a bacterial infection. Bacteria can enter the joint by: * The bloodstream from an infection elsewhere (most common) * Direct penetration into the joint (arthrocentesis, arthroscopy, trauma) * A surrounding infection in the bone or tissue (uncommon, from osteomyelitis,<unk> bursitis, abscess). Microorganisms in the blood may come from infections elsewhere in the body such as wound infections, urinary tract infections, meningitis or endocarditis. Sometimes, the infection comes from an unknown location. Joints with preexisting arthritis, such as rheumatoid arthritis, are especially prone to bacterial arthritis spread through the blood. In addition, some treatments for rheumatoid arthritis can also increase a person's risk by causing an immunocompromised state. Intravenous drug use can cause endocarditis that spreads bacteria in the bloodstream and subsequently causes<unk> . Bacteria can enter the joint directly from prior surgery, intraarticular injection, trauma or joint prosthesis. Risk factors In children, although<unk> occurs in healthy children and adolescents with no co-occurring health issues, there are certain risk factors that may increase the likelihood of acquiring<unk> . For example, children with renal osteodystrophy or renal bone disease, certain hematological disorders and diseases causing immune suppression are risk factors for childhood<unk> . The rate of<unk> varies from 4 to 29 cases per 100,000 person-years, depending on the underlying medical condition and the joint characteristics. For those with a<unk> joint, 85% of the cases have an underlying medical condition while 59% of them had a previous joint disorder. Having more than one risk factor greatly increases risk of<unk> . * Age over 80 years * Diabetes mellitus * Osteoarthritis * Rheumatoid arthritis. Risk of<unk> increases with anti-tumor necrosis factor alpha treatment. * Immunosuppressive medication * Intravenous drug abuse * Recent joint surgery * Hip or knee prosthesis and skin infection * HIV infection * Other causes of sepsis Organisms Most cases of<unk> involve only one organism; however, polymicrobial infections can occur, especially after large open injuries to the joint.<unk> is usually caused by bacteria, but may be caused by viral, mycobacterial, and fungal pathogens as well. It can be broadly classified into three groups: non-gonococcal arthritis, gonococcal arthritis, and others. *Non-gonococcal arthritis – These bacteria account for over 80% of<unk> cases and are usually staphylococci or streptococci. Such infections most commonly come from drug abuse, cellulitis, abscesses, endocarditis, and chronic osteomyelitis. Methicillin-resistant Staphylococcus aureus (MRSA) may affect 5 to 25% of the cases while gram negative bacilli affects 14 to 19% of the<unk> cases. Gram negative infections are usually acquired through urinary tract infections, drug abuse, and skin infections. Older people who are immunocompromised are also prone to get gram negative infections. Common gram negative organisms are: Pseudomonas aeruginosa and Escherichia coli. Both gram positive and gram negative infections are commonly spread through the blood from an infective source; but can be introduced directly into the joint or from surrounding tissue. It often affects older people, and often happens suddenly, involving only one joint. Joint aspiration cultures are positive in 90% of cases, while only 50% of blood cultures yield any organisms. *Gonococcal arthritis – Neisseria gonorrhoeae is a common cause of<unk> in people who are sexually active and under 40 years old. The bacteria is spread through the blood to the joint following sexual transmission. Other symptoms of disseminated gonococcal infection can include migration of joint pain, tenosynovitis and dermatitis. Synovial fluid cultures are positive in 25 to 70% of the cases while blood cultures are seldom positive. Apart from blood and joint cultures, swabs from urethra, rectum, pharynx, and cervix should also be taken. Polymerase chain reaction (PCR) is another useful way of identifying gonococcal infections if diagnosis is difficult and clinical presentation is similar to reactive arthritis. *Others – Fungal and mycobacterial infections are rare causes of<unk> and usually have a slow onset of joint symptoms. Mycobacterial joint infection most commonly affects hip and knee joints, caused by reactivation of past mycobacterial infections, with or without signs and symptoms of tuberculosis in lungs. Synovial fluid cultures will be positive in 80% of the cases. However, acid fast smears are not useful. Histology is not specific to myocobacterial infection as there are other granulomatous diseases that can show similar histology. Borrelia burgdorferi, a bacterium that causes lyme disease, can affect multiple large joints such as the knee. Confirmation of Lyme disease is done through enzyme-linked immunosorbent assay (ELISA) followed by confirmation using Western Blot test. It cannot be cultured from synovial fluid. However, PCR testing yields 85% positive result from synovial fluid. Viruses such as rubella, parvovirus B19, chikungunya, and HIV infection can also cause<unk> . *Prosthetic joint infection – Artificial joint infection are usually caused by coagulase negative Staphylococci, Staphylococcus aureus, and gram negative bacilli. Concurrent infections by multiple organisms is also reported in 20% of the cases. The risk factors of prosthetic joint infections are: previous fracture, seropositive rheumatoid arthritis, obesity, revision arthroplasty, and surgical site infections. List of organisms * Staphylococci (40%) *Staphylococcus aureus – the most common cause in most age groups. Can be caused by skin infection, previously damaged joint, prosthetic joint or intravenous drug use. * coagulase-negative staphylococci – usually due to prosthetic joint * Streptococci – the second-most common cause (28%) *Streptococcus pyogenes – a common cause in children under 5 * Streptococcus pneumoniae * Group B streptococci – a common cause in infants * Haemophilus influenzae * Neisseria gonorrhoeae – the most common cause of<unk> in young, sexually active adults. Multiple macules or vesicles seen over the trunk are a pathognomonic feature. * Neisseria meningitidis * Escherichia coli – in the elderly, IV drug users and the seriously ill * Pseudomonas aeruginosa – IV drug users or penetrating trauma through the shoe * M. tuberculosis,<unk> lmonella spp. and Brucella spp. – cause<unk> spinal arthritis * Eikenella corrodens – human bites * Pasteurella multocida, bartonella henselae, capnocytophaga – animal bites or scratches * Fungal species – immunocompromised state * Borrelia burgdorferi – ticks, causes lyme disease * Spirillum minus, Streptobacillus moniliformis– rat bites | Septic arthritis | Osteoarthritis | Knee arthritis | Gout | Compression arthralgia | Rheumatoid arthritis | Inflammatory arthritis | Reactive arthritis | 00
| 14,148 |
A variety of mutations in the TYMP gene have been discovered that lead to the onset of<unk> . The TYMP gene is a nuclear gene, however, mutations in the TYMP gene affect<unk> DNA and function. Mutations in this gene result in a loss of thymidine phosphorylase activity. Thymidine phosphorylase is the enzymatic product of the TYMP gene and is responsible for breaking down thymidine nucleosides into thymine and 2-deoxyribose 1-phosphate. Without normal thymidine phosphorylase activity, thymidine nucleosides begin to build up in cells. High nucleoside levels are toxic to<unk> DNA and cause mutations that lead to dysfunction of the respiratory chain, and thus, inadequate energy production in the cells. These<unk> effects are responsible for the symptomatology associated with the disease. | Mitochondrial neurogastrointestinal encephalopathy syndrome | Okamoto syndrome | Yushō disease | Morquio syndrome | Sandhoff disease | Sanjad-Sakati syndrome | Stratton Parker syndrome | Wilson's temperature syndrome | 00
| 43,033 |
Erythromelalgia is a rare symptom of<unk> , here present in a patient with longstanding<unk> . Note reddish limbs and swelling. People with<unk> can be asymptomatic. A classic symptom of<unk> is pruritus or itching, particularly after exposure to warm water (such as when taking a bath), which may be due to abnormal histamine release or prostaglandin production. Such itching is present in approximately 40% of patients with<unk> . Gouty arthritis may be present in up to 20% of patients. Peptic ulcer disease is also common in patients with<unk> ; most likely due to increased histamine from mast cells, but may be related to an increased susceptibility to infection with the ulcer-causing bacterium H. pylori. Another possible mechanism for the development for peptic ulcer is increased histamine release and gastric hyperacidity related with<unk> . A classic symptom of<unk> (and the related myeloproliferative disease essential thrombocythemia) is erythromelalgia. This is a burning pain in the hands or feet, usually accompanied by a reddish or bluish coloration of the skin. Erythromelalgia is caused by an increased platelet count or increased platelet "stickiness" (aggregation), resulting in the formation of tiny blood clots in the vessels of the extremity; it responds rapidly to treatment with aspirin. Patients with<unk> are prone to the development of blood clots (thrombosis). A major thrombotic complication (e.g. heart attack, stroke, deep venous thrombosis, or Budd-Chiari syndrome) may sometimes be the first symptom or indication that a person has<unk> . Headaches, lack of concentration and fatigue are common symptoms that occur in patients with<unk> as well. | Polycythemia vera | Capillary leak syndrome | Essential thrombocythemia | Aplastic anemia | Primary myelofibrosis | Myomatous erythrocytosis syndrome | Immune thrombocytopenic purpura | Chronic myelogenous leukemia | 00
| 13,022 |
<unk> has a mortality rate of less than 20% in areas with access to antibiotics. Before antibiotics were available, the mortality was 80–100%. Morbidity rates also dropped from 70% to 22% due to earlier diagnosis and treatment. | Cavernous sinus thrombosis | Mucormycosis | Labyrinthine fistula | Labyrinthitis | Vitreous hemorrhage | Orbital cellulitis | Orbital apex syndrome | Retinal migraine | 00
| 37,552 |
In 2006 the terms "objective test" and<unk> " came under criticism in the Journal of Personality Assessment. The more descriptive "rating scale or self-report measures" and "free response measures" are suggested, rather than the terms "objective tests" and<unk> s," respectively. Additionally, there are inherent biases implied in the terminology itself. For example, when individuals use the term "objective" to describe a test, it is assumed that the test possess accuracy and precision. Conversely, when the term<unk> " is used to describe a test, it is assumed that these measures are less accurate. Neither of these assumptions are fully accurate, and have led researchers to develop alternative terminology to describe various<unk> measures. For example, it has been proposed that the Rorschach be labeled as a "behavioral task" due to its ability to provide an in vivo or real life sample of human behavior. It is easy to forget that both objective and<unk> s are capable of producing objective data, and both require some form of subjective interpretation from the examiner. Objective testing, such as self-report measures, like the MMPI-2, require objective responses from the examinee and subjective interpretations from the examiner.<unk> ing, such as the Rorschach, requires subjective responses from the examinee, and can in theory involve objective (actuarial) interpretation. | Projective test | Minor test | Rosenhan experiment | Sereny test | Harrington–Hollingsworth experiment | ISET Test | Resonance frequency analysis | CHIVA method | 00
| 18,427 |
Surgical debridement (cutting away affected tissue) is the mainstay of treatment for<unk> . Early medical treatment is often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Tissue cultures (rather than wound swabs) are taken to determine appropriate antibiotic coverage, and antibiotics may be changed in light of results. Besides blood pressure control and hydration, support should be initiated for those with unstable vital signs and low urine output. Surgery Aggressive wound debridement should be performed early, usually as soon as the diagnosis of<unk> soft tissue infection (NSTI) is made. Surgical incisions often extend beyond the areas of induration (the hardened tissue) to remove the damaged blood vessels that are responsible for the induration. However, cellulitic soft tissues are sometimes spared from debridement for later skin coverage of the wound. More than one operation may be used to remove additional necrotic tissue. In some cases when an extremity is affected by a NSTI, amputation may be the surgical treatment of choice. After the wound debridement, adequate dressings should be applied to prevent exposure of bones, tendons, and cartilage so that such structures do not dry out and to promote wound healing. For<unk> infection of the perineal area (Fournier's gangrene), wound debridement and wound care in this area can be difficult because of the excretory products that often render this area dirty and affect the wound-healing process. Therefore, regular dressing changes with a fecal management system can help to keep the wound at the perineal area clean. Sometimes, colostomy may be necessary to divert the excretory products to keep the wound at the perineal area clean. File:Open wound after debridement of<unk> .Wound after aggressive acute debridement of<unk> File:Necrotizing fasciitis left leg debridement.Necrotic tissue from the left leg surgically removed File:Post surgical debridement and skin grafting..Postsurgical debridement and skin grafting File:Knee Disarticulation Amputation.After knee disarticulation amputation Antibiotics Empiric antibiotics are usually initiated as soon as the diagnosis of NSTI has been made, and then later changed to culture-guided antibiotic therapy. In the case of NSTIs, empiric antibiotics are broad-spectrum, covering gram-positive (including MRSA), gram-negative, and anaerobic bacteria. While studies have compared moxifloxacin (a fluoroquinolone) and amoxicillin-clavulanate (a penicillin) and evaluated appropriate duration of treatment (varying from 7 to 21 days), no definitive conclusions on the efficacy of treatment, ideal duration of treatment, or the adverse effects could be made due to poor-quality evidence. Add-on therapy * Hyperbaric oxygen: While human and animal studies have shown that high oxygen tension in tissues helps to reduce edema, stimulate fibroblast growth, increase the killing ability of white blood cells, inhibit bacterial toxin release, and increase antibiotic efficacy, no high-quality trials have been shown to support or refute the use of hyperbaric oxygen therapy in patients with NSTIs. * Intravenous immunoglobulin (IVIG): No clear difference between using IVIG and placebo has been shown in the treatment of NSTIs, and one study showed serious adverse effects with IVIG use, including acute kidney injury, allergic reactions, aseptic meningitis syndrome, haemolytic anaemia, thrombi, and transmissible agents. * AB103: One study assessed the efficacy of a new type of treatment that affects the immune response, called AB103. The study showed no difference in mortality with use of this therapy, but it is difficult to draw definitive conclusions due to low-quality evidence. * Supportive therapy: Supportive therapy, often including intravenous hydration, wound care, anticoagulants to prevent thromboembolic events, pain control, etc. should always be provided to patients when appropriate. | Necrotizing fasciitis | Cellulitis | Ischemic fasciitis | Gas gangrene | Pyomyositis | Plantar fasciitis | Fournier gangrene | Abscess | 00
| 10,141 |
Cerebrospinal fluid leaks are diagnosed by performing different tests. A diagnostic dural puncture is commonly used because its results show the presence of a leak easily. Other types of tests that could be used are cranial CT, cranial MRI, spinal MRI, and CT myelography. A cranial MRI can be diagnostic by showing one of the five main findings, which are subdural fluid collections, enhancement of venous structures, dural enhancement on MRI saggital views, pituitary hyperemia, and sagging of the brain. Another cause of<unk> s is postural<unk> tachycardia syndrome (POTS), a form of dysautonomia, which is diagnosed with autonomic testing instead of the imaging tests that are used to determine a CSF leak. It can be difficult to distinguish if a patient is solely affected by POTS because patients with CSF leaks have similar symptoms and may even develop secondary POTS. | Orthostatic headache | Cold-stimulus headache | External compression headache | Hypnic headache | Sexual headache | Tension headache | Thunderclap headache | Vascular headache | 00
| 53,684 |
The symptoms of<unk> are classically described as beginning in infancy and leading to death within a span of several years; however, as more cases are recognized, it is apparent that symptoms can emerge at any age—including adolescence or adulthood—and patients can survive for many years following diagnosis. Symptoms are often first seen after a triggering event that taxes the body's energy production, such as an infection or surgery. The general course of<unk> is one of episodic developmental regression during times of metabolic stress. Some patients have long periods without disease progression while others develop progressive decline. Infants with the syndrome have symptoms that include diarrhea, vomiting, and dysphagia (trouble swallowing or sucking), leading to a failure to thrive. Children with early<unk> disease also may appear irritable and cry much more than healthy babies. Seizures are often seen. Excess lactate may be seen in the urine, cerebrospinal fluid, and blood of a person with<unk> . As the disease progresses, the muscular system is debilitated throughout the body, as the brain cannot control the contraction of muscles. Hypotonia (low muscle tone and strength), dystonia (involuntary, sustained muscle contraction), and ataxia (lack of control over movement) are often seen in people with<unk> disease. The eyes are particularly affected; the muscles that control the eyes become weak, paralyzed, or uncontrollable in conditions called ophthalmoparesis (weakness or paralysis) and nystagmus (involuntary eye movements). Slow saccades are also sometimes seen. The heart and lungs can also fail as a result of<unk> disease. Hypertrophic cardiomyopathy (thickening of part of the heart muscle) is also sometimes found and can cause death; asymmetric septal hypertrophy has also been associated with<unk> . In children with<unk> associated ventricular septal defects, caused by pyruvate dehydrogenase deficiency, high forehead and large ears are seen; facial abnormalities are not typical of<unk> . However, respiratory failure is the most common cause of death in people with<unk> . Other neurological symptoms include peripheral neuropathy, loss of sensation in extremities caused by damage to the peripheral nervous system. Hypertrichosis is seen in<unk> caused by mutations in the nuclear gene SURF1. | Leigh syndrome | Tay–Sachs disease | Maroteaux–Lamy syndrome | Coffin–Siris syndrome | Ohtahara syndrome | Nathalie syndrome | Laurence–Moon syndrome | Kosaki overgrowth syndrome | 00
| 14,276 |
Efforts to prevent bites include clearing clutter and the use of pesticides. OSHA recommends that workers take following measures to prevent<unk> : * Wear a long-sleeved shirt, hat, gloves, and boots when handling boxes, firewood, lumber, rocks, etc. * Inspect and shake out clothing and shoes before getting dressed. * Use insect repellents, such as DEET or Picaridin, on clothing and footwear. | Spider bite | Dog bite | Cat bite | Animal bite | Centipede bite | Nail biting | Snakebite | Needlestick injury | 00
| 35,750 |
<unk> , also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. The term was coined by William A. Hammond in 1879 when describing a case of obsessive–compulsive disorder (OCD) exhibited in repeatedly washing one's hands.<unk> has long been related to compulsive hand washing. Names pertaining directly to the abnormal fear of dirt and filth include molysmophobia or molysomophobia, rhypophobia, and rupophobia, whereas the terms bacillophobia and bacteriophobia specifically refer to the fear of bacteria and microbes in general. The term<unk> comes from the Greek μύσος (musos), "uncleanness" and φόβος (phobos), "fear". | Mysophobia | Thermophobia | Phonophobia | Neophobia | Pseudophobia | Nosophobia | Arachnophobia | Trypophobia | 00
| 41,827 |
Signs and symptoms usually depend on the size and type of cancer. ; Breast cancer: Lump in breast and axilla associated with or without ulceration or bloody nipple discharge. ; Endometrial cancer: Bleeding per vaginam. ; Cervix cancer: Bleeding after sexual intercourse. ; Ovarian cancer: Nonspecific symptoms such as abdominal distension, dyspepsia. ; Lung cancer: Persistent cough, breathlessness, blood in the sputum, hoarseness of voice. ; Head and neck cancer: Non-healing ulcer or growth, lump in the neck. ; Brain cancer: Persistent headache, vomiting, loss of consciousness, double vision. ; Thyroid cancer: Lump in the neck. ; Oesophageal cancer: Painful swallowing predominantly with solid food, weight loss. ; Stomach cancer: Vomiting, dyspepsia, weight loss. ; Colon & rectal cancer: Bleeding per rectum, alteration of bowel habits. ; Liver cancer: Jaundice, pain and mass in right upper abdomen. ; Pancreatic cancer: Weight loss, jaundice. ; Skin cancer: Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain. ; Kidney cancer: Blood in urine, abdominal lump. ; Bladder cancer: Blood in urine. ; Prostate cancer: Urgency, hesitancy and frequency while passing urine, bony pain. ; Testis cancer: Swelling of testis, back pain, dyspnoea. ; Bone cancer: Pain and swelling of bones. ; Lymphoma: Fever, weight loss more than 10% body weight in preceding 6 months and drenching night sweats which constitutes the B symptoms, lump in neck, axilla or groin. ; Blood cancer: Bleeding manifestations including bleeding gums, bleeding from nose, blood in vomitus, blood in sputum, blood stained urine, black coloured stools, fever, lump in neck, axilla, or groin, lump in upper abdomen. | Oncology | Hematology | Neuro-oncology | Haematologica | Neurology | Osteology | Gynaecology | Nephrology | 00
| 54,158 |
<unk> was approved by the Food and Drug Administration in March 2018, and the European Medicines Agency in September 2018, for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy.<unk> is administered via subcutaneous injection. It is available as a single-dose prefilled syringe containing 100 mg of<unk> in 1 ml of solution. | Tildrakizumab | Brolucizumab | Risankizumab | Mogamulizumab | Etaracizumab | Caplacizumab | Ixekizumab | Crizanlizumab | 00
| 63,540 |
Cholecystectomy with a choledocoplasty is the most frequent treatment of primary<unk> s, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. | Biliary fistula | Biliary pseudolithiasis | Common bile duct stone | Hepatolithiasis | Pancreatic abscess | Pancreatic fistula | Gallstone ileus | Biliary colic | 00
| 36,678 |
A<unk> (also called<unk> ed state, tetanus, or physiologic tetanus, the latter to differentiate from the disease called tetanus) is a sustained muscle contraction evoked when the motor nerve that innervates a skeletal muscle emits action potentials at a very high rate. During this state, a motor unit has been maximally stimulated by its motor neuron and remains that way for some time. This occurs when a muscle's motor unit is stimulated by multiple impulses at a sufficiently high frequency. Each stimulus causes a twitch. If stimuli are delivered slowly enough, the tension in the muscle will relax between successive twitches. If stimuli are delivered at high frequency, the twitches will overlap, resulting in<unk> . A<unk> can be either unfused (incomplete) or fused (complete). An unfused tetanus is when the muscle fibers do not completely relax before the next stimulus because they are being stimulated at a fast rate; however there is a partial relaxation of the muscle fibers between the twitches. Fused tetanus is when there is no relaxation of the muscle fibers between stimuli and it occurs during a high rate of stimulation. A fused<unk> is the strongest single-unit twitch in contraction. When<unk> ed, the contracting tension in the muscle remains constant in a steady state. This is the maximal possible contraction. During<unk> s, muscles can shorten, lengthen or remain constant length.<unk> is usually normal (such as when holding up a heavy box). Muscles often exhibit some level of<unk> activity, leading to muscle tone, in order to maintain posture; for example, in a crouching position, some muscles require sustained contraction to hold the position.<unk> can exist in a variety of states, including isotonic and isometric forms—for example, lifting a heavy box off the floor is isotonic, but holding it at the elevated position is isometric. Isotonic contractions place muscles in a constant tension but the muscle length changes, while isometric contractions hold a constant muscle length. Voluntary sustained contraction is a normal (physiologic) process (as in the crouching or box-holding examples), but involuntary sustained contraction exists on a spectrum from physiologic to disordered (pathologic). Muscle tone is a healthy form of involuntary sustained partial contraction. In comparison with<unk> in an isometric state (such as holding up a heavy box for several minutes), it differs only in the percentage of motor units participating at any moment and the frequency of neural signals; but the low percentage and low frequency in healthy tone are the key factors defining it as healthy (and not<unk> . Involuntary sustained contraction of a hypertonic type, however, is a pathologic process. On the mild part of the spectrum, cramps, spasms, and even tetany are often temporary and nonsevere. On the moderate to severe parts of the spectrum are dystonia, trismus, pathologic tetanus, and other movement disorders featuring involuntary sustained strong contractions of skeletal muscle. | Tetanic contraction | Neutral stimulus | Segmentation contractions | Neural facilitation | Co-stimulation | Neural adaptation | Reinnervation | Exeresis | 00
| 12,440 |
<unk> is inflammation of the aorta associated with the tertiary stage of syphilis infection. SA begins as inflammation of the outermost layer of the blood vessel, including the blood vessels that supply the aorta itself with blood, the vasa vasorum. As SA worsens, the vasa vasorum undergo hyperplastic thickening of their walls thereby restricting blood flow and causing ischemia of the outer two-thirds of the aortic wall. Starved for oxygen and nutrients, elastic fibers become patchy and smooth muscle cells die. If the disease progresses,<unk> leads to an aortic aneurysm. Overall, tertiary syphilis is a rare cause of aortic aneurysms.<unk> has become rare in the developed world with the advent of penicillin treatments after World War II. | Syphilitic aortitis | Takayasu's arteritis | Carotid artery stenosis | Arterial tortuosity syndrome | Arteriolosclerosis | Inflammatory aortic aneurysm | Mycotic aneurysm | Diabetic angiopathy | 00
| 42,329 |
These medications are used in the treatment of many conditions, such as: * Dyspepsia * Peptic ulcer disease including after endoscopic treatment for bleeding * As part of Helicobacter pylori eradication therapy * Gastroesophageal reflux disease (GERD or GORD) including symptomatic endoscopy-negative reflux disease and associated laryngopharyngeal reflux causing laryngitis and chronic cough * Barrett's esophagus * Eosinophilic esophagitis * Stress gastritis and ulcer prevention in critical care * Gastrinomas and other conditions that cause hypersecretion of acid including Zollinger–Ellison syndrome (often 2–3x the regular dose is required) Specialty professional organizations recommend that people take the lowest effective<unk> dose to achieve the desired therapeutic result when used to treat gastroesophageal reflux disease long-term. In the United States, the Food and Drug Administration (FDA) has advised that over-the-counter<unk> s, such as Prilosec OTC, should be used no more than three 14-day treatment courses over one year. Despite their extensive use, the quality of the evidence supporting their use in some of these conditions is variable. The effectiveness of<unk> s has not been demonstrated for every case. For example, although they reduce the incidence of esophageal adenocarcinoma in Barrett's oesophagus, they do not change the length affected. Indications for stopping<unk> s<unk> s are often used longer than necessary. In about half of people who are hospitalized or seen at a primary care clinic there is no documented reason for their long-term use of<unk> s. Some researchers believe that, given the little evidence of long-term effectiveness, the cost of the medication and the potential for harm means that clinicians should consider stopping<unk> s in many people. After four weeks, if symptoms have resolved, the<unk> may be stopped in those who were using them for heartburn, gastroesophageal reflux disease, or inflammation of the esophagus if these last two were not severe. Stopping is not recommended in those with Barrett's esophagus or a bleeding stomach ulcer. Stopping may be carried out by first decreasing the amount of medication taken or having the person take the medication only when symptoms are present. | Proton-pump inhibitor | Antisialagogue | Mucoactive agent | Prokinetic agent | Galactagogue | Cholagogue | Antacid | Caloric restriction mimetic | 00
| 1,805 |
Actively involving veterinarians and pet owners is important for controlling the transmission of Toxocara from pets to humans. A group very actively involved in promoting a reduction of infections in dogs in the United States is the Companion Animal Parasite Council -- CAPC. Since pregnant or lactating dogs and cats and their offspring have the highest, active parasitic load, these animals should be placed on a deworming program. Pet feces should be picked up and disposed of or buried, as they may contain Toxocara eggs. Practicing this measure in public areas, such as parks and beaches, is especially essential for decreasing transmission. Up to 20% of soil samples of U.S. playgrounds have found roundworm eggs. Also, sandboxes should be covered when not in use to prevent cats from using them as litter boxes. Hand washing before eating and after playing with pets, as well as after handling dirt will reduce the chances of ingesting Toxocara eggs. Washing all fruits and vegetables, keeping pets out of gardens and thoroughly cooking meats can also prevent transmission. Finally, teaching children not to place nonfood items, especially dirt, in their mouths will drastically reduce the chances of infection.<unk> has been named one of the neglected diseases of U.S. poverty, because of its prevalence in Appalachia, the southern U.S., inner city settings, and minority populations. Unfortunately, there is currently no vaccine available or under development. However, the mitochondrial genomes of both T. cati and T. canis have recently been sequenced, which could lead to breakthroughs in treatment and prevention. | Toxocariasis | Filariasis | Acariasis | Helminthiasis | Paragonimiasis | Metagonimiasis | Leishmaniasis | Isosporiasis | 00
| 18,314 |
<unk> , also known as recurrent respiratory<unk> (RRP) or glottal<unk> , is a rare medical condition in which benign tumors (papilloma) form along the aerodigestive tract. There are two variants based on the age of onset: juvenile and adult<unk> . The tumors are caused by human papillomavirus (HPV) infection of the throat. The tumors may lead to narrowing of the airway, which may cause vocal changes or airway obstruction.<unk> is initially diagnosed through indirect laryngoscopy upon observation of growths on the larynx and can be confirmed through a biopsy. Treatment for<unk> aims to remove the papillomas and limit their recurrence. Due to the recurrent nature of the virus, repeated treatments usually are needed.<unk> is primarily treated surgically, though supplemental nonsurgical and/or medical treatments may be considered in some cases. The evolution of<unk> is highly variable. Though total recovery may be observed, it is often persistent despite treatment. The number of new cases of<unk> cases is approximately 4.3 cases per 100,000 children and 1.8 cases per 100,000 adults annually. __TOC__ | Laryngeal papillomatosis | Laryngeal cyst | Otic polyp | Oral mucocele | Nasopharyngeal cyst | Epiglottitis | Vulvitis | Tuberculous gumma | 00
| 26,781 |
<unk> (also known as<unk> <unk><unk> is a rare type of non-atherosclerotic peripheral artery<unk> . It can present as claudication, critical limb ischemia or acute limb ischemia. The most commonly affected vessel is the popliteal artery. The cause is unknown. __TOC__ | Adventitial cystic disease | Eustachian tube dysfunction | Patulous Eustachian tube | Cystic fibrosis | Tracheal agenesis | Vocal cord cyst | Tracheobronchopathia osteochondroplastica | Bronchomalacia | 00
| 74,495 |
<unk> is a rare, low-grade benign salivary gland neoplasm. The most common involved site is the parotid gland, however other possible sites include the submandibular gland, minor salivary glands of upper lip, buccal mucosa, palate and<unk> septum. It appears as a slow-growing, firm and mobile mass. Treatment is by surgical excision with a margin of healthy tissue. Although the recurrence rate is high, the prognosis is generally good. | Basal cell adenoma | Ceruminous adenoma | Papillary eccrine adenoma | Sebaceous adenoma | Pilomatricoma | Squamous cell papilloma | Solitary trichoepithelioma | Hydrocarbon keratosis | 00
| 67,428 |
<unk> s present as a unilateral nasal obstruction. Foul-smelling, blood-stained discharge is often present. Nosebleed and pain may occur due to the ulceration of surrounding mucosa. | Rhinolith | Omphalolith | Phlebolith | Vitreous bulge | Enamel pearl | Forchheimer spots | Lethal midline granuloma | Skip lesion | 00
| 36,063 |
<unk> <unk> occurs when a man expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal<unk> nile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax,<unk> climax and (historically) ejaculatio praecox. There is no uniform cut-off defining<unk> ", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after<unk> netration. The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse. Although men with<unk> describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. Men's typical ejaculatory latency is approximately 4–8 minutes. The opposite condition is delayed ejaculation. Men with<unk> often report emotional and relationship distress, and some avoid pursuing sexual relationships because of<unk> -related embarrassment. Compared with men, women consider<unk> less of a problem, but several studies show that the condition also causes female partners distress. | Premature ejaculation | Delayed ejaculation | Dyschronometria | Retrograde ejaculation | Dyspareunia | Pelvic floor dysfunction | Persistent genital arousal disorder | Coital incontinence | 00
| 10,218 |
During and after the harvesting,<unk> s go through a period of ischemia and reperfusion after engraftment, which causes damage to endothelial and smooth muscle cells (SMC). The<unk> ing exposes the<unk> to arterial pressure and flow that causes increased shear stress and wall tension, which further damages the endothelial layer and SMC. The damage causes local release of tissue factors and reduced bioavailability of prostacyclin and nitric oxide (NO), all of which contribute to platelet activation, deposition of fibrin, which promotes thrombosis. Growth factors that released from macrophages and platelets lead to increased proliferation and migration of SMCs to the intima. The migrated SMC release extracellular matrix resulting in reduced intimal cellularity. Low levels of endothelial nitric oxide, adenosine and prostaglandins, further contribute to SMC proliferation. Over time continued SMC migration and proliferation cause extracellular matrix deposition and fibrotic change that lead to development of intimal hyperplasia, which results in luminal loss that makes the<unk> more susceptible to atherosclerosis. Progressive atherosclerosis is the primarily cause of late<unk> .<unk><unk> atherosclerotic lesions are more diffuse and concentric, yet less calcified, compared to native atherosclerotic lesions, and are more susceptible to thrombosis formation and rupture. | Vein graft failure | Arterial insufficiency ulcer | Vascular access steal syndrome | Gas gangrene | Diabetic foot infection | Chronic venous insufficiency | Arteriovenous fistula | Diabetic foot ulcer | 00
| 70,836 |
There are no specific causes of this disease. With this being so rare not enough research has been allocated to pinpoint a specific cause of this disease. The main thing that we know about this disease is that the inflammation of the Tenon capsule may be related to macular retinal edema and intraocular pressure quantitative trait locus. | Tenonitis | Haemolacria | Funisitis | Perichondritis | Dacryocystitis | Orchitis | Superior canal dehiscence syndrome | Trochleitis | 00
| 19,176 |
<unk> occurs in children, including neonates, but is more common in adults, particularly those between the ages 60–80. BPDCN usually (i.e. 61% to 90% of cases) presents with skin lesions, i.e. nodules, tumors, red or purple papules, bruise-like patches, and/or ulcers that most often occur on the head, face, and upper torso. The lesions are due to diffuse infiltrations of the skin by malignant pDC. In one large study, this presentation was accompanied by swollen lymph nodes, usually in the neck, due to malignant pDC infiltrations (~50% of cases); enlarged liver (~16% of cases) and/or spleen (26% of cases), also due to malignant pDC infiltrations; increased levels of malignant pDC in blood (i.e. >2% of nucleated<unk> s) (~40% of cases), bone marrow (~65% of cases) and cerebrospinal fluid (47% of childhood cases but less often detected in adult cases). More advanced or severe cases may present with extreme organ and/or lymph node enlargements, skin lesions in virtually any site, and clinical evidence of malignant pDC infiltrations in the breasts, eyes, kidneys, lungs, gastrointestinal tract, bone, sinuses, ears, or testes. About 10% of individuals with BPDCN present with a leukemia-like disease, i.e. they exhibit circulating malignant pDC, anemia, thrombocytopenia, and/or leukopenia due to extensive malignant pDC infiltrations in the bone marrow. A leukemic phase of the disease is a common feature of end stage and post-therapy relapsing BPDCN. | Blastic plasmacytoid dendritic cell neoplasm | Congenital self-healing reticulohistiocytosis | Nodal marginal zone B cell lymphoma | Angioimmunoblastic T-cell lymphoma | Mature T-cell lymphoma | Peripheral T-cell lymphoma | Precursor T-lymphoblastic lymphoma | Pleomorphic T-cell lymphoma | 00
| 53,883 |
<unk> has an autosomal recessive pattern of inheritance.<unk> has been associated with mutations in the RAB23 gene, which is located on chromosome 6 in humans. Additionally, three key SNPs in the MEGF8 gene, located on chromosome 19 at 19q13.2, have been identified as primary causes of<unk> . | Carpenter syndrome | Larsen syndrome | Irukandji syndrome | McGillivray syndrome | Brunner syndrome | Jeavons syndrome | Jacobsen syndrome | Jalili syndrome | 00
| 29,929 |
<unk> (brand names Androgénol, Enoltestovis, Enoltestovister), or 17α-methyltestosterone<unk><unk> enol<unk> , also known as 17α-methylandrost-3,5-dien-17β-ol-3-one<unk><unk><unk> , is a synthetic anabolic-androgenic steroid and an androgen<unk> – specifically, the<unk><unk><unk> of<unk> . | Methyltestosterone 3-hexyl ether | Chloromethylandrostenediol | Androstenediol dipropionate | Hydroxyprogesterone heptanoate | Ethyltestosterone | Cloxotestosterone acetate | Estradiol dienantate | Estradiol undecylate | 00
| 69,661 |
349x349px Symptoms of achalasia can be detected by fluoroscopy during barium swallow or oesophageal manometry. Achalasia Barium swallow A positive barium swallow will display the narrowing of the distal oesophagus in a ‘bird beak’ or ‘champagne class’ fashion, aperistalsis, minimal LES opening and oesophageal dilation as the main indicator of the disease. Minimal barium will be present in the stomach. However, these diagnostic findings are not always present in the early onset of the disease and so a normal oesophagogram is not an indication of a lack of disease. Oesophageal manometry Patients who suffer from the vigorous achalasia variant of the disease, do not express dilation. Manometry is the best, most sensitive method in these cases as it can diagnose abnormalities related to achalasia based on basal pressure, without the need for the manifestation of dilation. Aperistalsis and a poorly relaxed and hypertensive LES is required for a positive diagnosis.<unk> Prenatal diagnosis of<unk> is difficult due to the variability present in the causes of the disease. Early detection, however, is important for consanguineous parents as an autosomal recessive inheritance is highly implicated for<unk> . Anomaly scans during pregnancy can be used to calculate the ratio between the head/abdominal circumference and head circumference/femur length which are used calculate and diagnose<unk> . Ultrasound scans have also led to the accidental discovery of<unk> , however this occurrence is an anomaly. Women who are at risk of contracting TORCH infections or exposure to Zika virus are recommended to undergo screening as most resultant infections are asymptomatic. This includes testing sera and saliva for viral antigens. Prenatal diagnosis is further complicated when<unk> manifests with achalasia as it is only possible to detect symptoms shortly after the first trimester and early into the second. Consequently,<unk> is usually diagnosed after the onset of achalasia by eighteen months or older. An occipital-frontal head circumference of less than three standard deviations is an indication of<unk> . Radiography and NMR imaging of the skull can also be utilised. A physical examination of height and weight proportions as well as IQ and motor development is implemented for further confirmation as not all children with<unk> have abnormal development A positive test will show normal to abnormal proportions, a low IQ and slow motor development. | Achalasia microcephaly | Laryngo-onycho-cutaneous syndrome | Odontoma dysphagia syndrome | Retained antrum syndrome | complications of Hiatal hernia | Atresia | Ontario Minamata disease | Esophageal achalasia | 00
| 72,332 |
The Netherlands Antilles, where<unk> is more common than anywhere in the world, located off the coast of Venezuela. Population studies from numerous areas in the world have shown that<unk> occurs at roughly the same rate in almost all populations: somewhere around 1 in 5000. In some areas, it is much more common; for instance, in the French region of Haut Jura the rate is 1:2351 - twice as common as in other populations. This has been attributed to a founder effect, in which a population descending from a small number of ancestors has a high rate of a particular genetic trait because one of these ancestors harbored this trait. In Haut Jura, this has been shown to be the result of a particular ACVRL1 mutation (named c.1112dupG or c.1112_1113insG). The highest rate of<unk> is 1:1331, reported in Bonaire and Curaçao, two islands in the Caribbean belonging to the Netherlands Antilles. Most people with<unk> have a normal lifespan. The skin lesions and nosebleeds tend to develop during childhood. AVMs are probably present from birth, but don't necessarily cause any symptoms. Frequent nosebleeds are the most common symptom and can significantly affect quality of life. | Hereditary hemorrhagic telangiectasia | Pedophilia | Patau syndrome | Ehlers–Danlos syndromes | Haemophilia | Bernard–Soulier syndrome | Ogden syndrome | Panayiotopoulos syndrome | 00
| 16,716 |
<unk> is a pre-prepared non-porous plastic reagent strip with a predefined gradient of antibiotic, covering a continuous concentration range. It is applied to the surface of an agar plate inoculated with the<unk> strain, where there is release of the antimicrobial gradient from the plastic carrier to the agar to form a stable and continuous gradient beneath and in nearby to the strip. The time taken for a plate to be ready depends on the bacterium that is being<unk> ed, and the conditions of the agar plate. The predefined<unk> gradient remains stable for at least 18 to 24 hours; that is, a period that covers the critical times of many species of fastidious and non-fastidious organisms. After the<unk> , the bacterial growth becomes visible after incubation and a symmetrical inhibition ellipse centered along the strip is seen. The MIC value is read from the scale in terms of µg/mL where the ellipse edge intersects the strip. After the required incubation period, the minimum inhibitory value is read where the edge of the inhibition ellipse intersects the side of the strip. The plate should not be read if the culture appears mixed or if the lawn of growth is too light or too heavy.<unk> MIC endpoints are usually clear-cut although different growth/inhibition patterns may be seen depending on the antifungal or antibiotic used.<unk> being used to determine the susceptibility of Candida albicans to caspofungin. Selection of agar medium<unk> can be used with many different kinds of AST agar medium as long as the medium supports good growth of the<unk> organism and does not interfere with the activity of the antimicrobial agent. However, to maximise reproducibility, the medium chosen should fulfil the basic requirements for a susceptibility<unk> medium. The following AST media are recommended for use with<unk> : * Aerobes: Mueller Hinton agar such as MHE (bioMérieux) * Anaerobes: Brucella blood agar with appropriate supplements These media may require supplemental nutrients to obtain enhanced growth of nutritionally fastidious organisms such as pneumococci, streptococci, Abiotrophia, Haemophilus, gonococci, meningococci and Campylobacter. In general, media recommendations from the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility<unk> ing (EUCAST) are considered appropriate for<unk> . | Etest | Rape statistics | Minor test | Kick chart | Projective test | E chart | Bioanalysis | Test panel | 00
| 45,698 |
<unk> mood shifts Late adolescence and early adulthood are peak years for the onset of<unk> . The condition is characterized by intermittent episodes of mania and/or depression, with an absence of symptoms in between. During these episodes, people with<unk> exhibit disruptions in normal mood, psychomotor activity (the level of physical activity that is influenced by mood)—e.g. constant fidgeting during mania or slowed movements during depression—circadian rhythm and cognition. Mania can present with varying levels of mood disturbance, ranging from euphoria, which is associated with "classic mania", to dysphoria and irritability. Psychotic symptoms such as delusions or hallucinations may occur in both manic and depressive episodes; their content and nature are consistent with the person's prevailing mood. According to the DSM-5 criteria, mania is distinguished from hypomania by length: hypomania is present if elevated mood symptoms persist for at least four consecutive days, while mania is present if such symptoms persist for more than a week. Unlike mania, hypomania is not always associated with impaired functioning. The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode, or vice versa, remain poorly understood. Manic episodes An 1892 color lithograph depicting a woman diagnosed with hilarious mania Also known as a manic episode, mania is a distinct period of at least one week of elevated or irritable mood, which can range from euphoria to delirium. The core symptom of mania involves an increase in energy of psychomotor activity. Mania can also present with increased self-esteem or grandiosity, racing thoughts, pressured speech that is difficult to interrupt, decreased need for sleep, disinhibited social behavior, increased goal-oriented activities and impaired judgement, which can lead to exhibition of behaviors characterized as impulsive or high-risk, such as hypersexuality or excessive spending. To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated, a manic episode usually lasts three to six months. In severe manic episodes, a person can experience psychotic symptoms, where thought content is affected along with mood. They may feel unstoppable, or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas. This may lead to violent behavior and, sometimes, hospitalization in an inpatient psychiatric hospital. The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale, though questions remain about the reliability of these scales. The onset of a manic or depressive episode is often foreshadowed by sleep disturbance. Manic individuals often have a history of substance abuse developed over years as a form of "self-medication". Hypomanic episodes An 1858 lithograph captioned 'Melancholy passing into mania' Hypomania is the milder form of mania, defined as at least four days of the same criteria as mania, but which does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features such as delusions or hallucinations, and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full-blown manic episodes. Some people who experience hypomania show increased creativity, while others are irritable or demonstrate poor judgment. Hypomania may feel good to some individuals who experience it, though most people who experience hypomania state that the stress of the experience is very painful. People with<unk> who experience hypomania tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, the individual will often deny that anything is wrong. If not accompanied by depressive episodes, hypomanic episodes are often not deemed problematic unless the mood changes are uncontrollable or volatile. Most commonly, symptoms continue for time periods from a few weeks to a few months. Depressive episodes 'Melancholy' by William Bagg, after a photograph by Hugh Welch Diamond Symptoms of the depressive phase of<unk> include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities, excessive or inappropriate guilt, hopelessness, sleeping too much or not enough, changes in appetite and/or weight, fatigue, problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide. Although the DSM-5 criteria for diagnosing unipolar and<unk> episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth. The earlier the age of onset, the more likely the first few episodes are to be depressive. For most people with<unk> types 1 and 2, the depressive episodes are much longer than the manic or hypomanic episodes. Since a diagnosis of<unk> requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and incorrectly treated with prescribed antidepressants. Mixed affective episodes In<unk> , a mixed state is an episode during which symptoms of both mania and depression occur simultaneously. Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control. Anxiety<unk> s occur more frequently as a comorbidity in mixed<unk> episodes than in non-mixed<unk> depression or mania. Substance (including alcohol) abuse also follows this trend, thereby appearing to depict<unk> symptoms as no more than a consequence of substance abuse. Comorbid conditions People with<unk> often have other co-existing psychiatric conditions such as anxiety (present in about 71% of people with<unk> , substance use (56%), personality<unk> s (36%) and attention deficit hyperactivity<unk> (10–20%) which can add to the burden of illness and worsen the prognosis. Certain medical conditions are also more common in people with<unk> as compared to the general population. This includes increased rates of metabolic syndrome (present in 37% of people with<unk> , migraine headaches (35%), obesity (21%) and type 2 diabetes (14%). This contributes to a risk of death that is two times higher in those with<unk> as compared to the general population. Substance abuse is a common comorbidity in<unk> ; the subject has been widely reviewed. | Bipolar disorder | Substance use disorder | Major depressive disorder | Attention deficit hyperactivity disorder | Bipolar I disorder | Schizophrenia | Major depressive episode | Personality disorder | 00
| 410 |
Summary of reasons for<unk> ing patient's characteristic indication rationale under age 21, regardless of sexual history no<unk> more harms than benefits age 20–25 until age 50–60<unk> every 3–5 years if results normal broad recommendation over age 65; history of normal<unk> s no further<unk> ing recommendation of USPSTF, ACOG, ACS and ASCP; had total hysterectomy for non-cancer disease – cervix removed no further<unk> ing harms of screening after hysterectomy outweigh the benefits had partial hysterectomy – cervix remains continue<unk> ing as normal has received HPV vaccine continue<unk> ing as normal vaccine does not cover all cancer-causing types of HPV history of endometrial cancer, with history of hysterectomy discontinue routine<unk> ing<unk> no longer effective and likely to give false positive Screening guidelines vary from country to country. In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or 60. Screening is typically recommended every three to five years, as long as results are normal. American Congress of Obstetricians and Gynecologists (ACOG) and others recommend starting screening at age 21. Many other countries wait until age 25 or later to start screening. For instance, some parts of Great Britain start screening at age 25. ACOG's general recommendation is that people with female reproductive organs age 30–65 have an annual well-woman examination, that they not get annual<unk> s, and that they do get<unk> s at three to five year intervals. HPV is passed through skin to skin contact; sex does not have to occur, although it is a common way for it to spread. It takes an average of a year, but can take up to four years, for a person's immune system to control the initial infection. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the patient stress and result in further<unk> s and possible treatment. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion. For instance, screening people under age 25 does not decrease cancer rates under age 30. HPV can be transmitted in sex between females, so those who have only had sex with other females should be screened, although they are at somewhat lower risk for cervical cancer. Guidelines on frequency of screening vary—typically every three to five years for those who have not had previous abnormal smears. Some older recommendations suggested screening as frequently as every one to two years, however there is little evidence to support such frequent screening; annual screening has little benefit but leads to greatly increased cost and many unnecessary procedures and treatments. It has been acknowledged since before 1980 that most people can be screened less often. In some guidelines, frequency depends on age; for instance in Great Britain, screening is recommended every three years for women under 50, and every five years for those over. Screening should stop at about age 65 unless there is a history of abnormal<unk> result or disease. There is probably no benefit in screening people aged 60 or over whose previous<unk> s have been negative. If a woman's last three<unk> results were normal, she can discontinue<unk> ing at age 65, according to the USPSTF, ACOG, ACS, and ASCP; England's NHS says 64. There is no need to continue screening after a complete hysterectomy for benign disease.<unk> smear screening is still recommended for those who have been vaccinated against HPV since the vaccines do not cover all HPV types that can cause cervical cancer. Also, the vaccine does not protect against HPV exposure before vaccination. Those with a history of endometrial cancer should discontinue routine<unk> s after hysterectomy. Further<unk> s are unlikely to detect recurrence of cancer but do bring the risk of giving false positive results, which would lead to unnecessary further<unk> ing. More frequent<unk> smears may be needed to follow up after an abnormal<unk> smear, after treatment for abnormal<unk> or biopsy results, or after treatment of cancer ( cervical, colon, etc ). Effectiveness The<unk> , when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%. Failure of prevention of cancer by the<unk> can occur for many reasons, including not getting regular screening, lack of appropriate follow-up of abnormal results, and sampling and interpretation errors. In the US, over half of all invasive cancers occur in females who have never had a<unk> smear; an additional 10 to 20% of cancers occur in those who have not had a<unk> smear in the preceding five years. About one-quarter of US cervical cancers were in people who had an abnormal<unk> smear but did not get appropriate follow-up (patient did not return for care, or clinician did not perform recommended<unk> s or treatment). Adenocarcinoma of the cervix has not been shown to be prevented by<unk> s. In the UK, which has a<unk> smear screening program, adenocarcinoma accounts for about 15% of all cervical cancers. Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK. Results In screening a general or low-risk population, most<unk> results are normal. In the United States, about 2–3 million abnormal<unk> smear results are found each year. Most abnormal results are mildly abnormal (ASC-US (typically 2–5% of<unk> results) or low-grade squamous intraepithelial lesion (LSIL) (about 2% of results)), indicating HPV infection. Although most low-grade cervical dysplasias spontaneously regress without ever leading to cervical cancer, dysplasia can serve as an indication that increased vigilance is needed. In a typical scenario, about 0.5% of<unk> results are high-grade SIL (HSIL), and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate Atypical Glandular Cells of Undetermined Significance (AGC-NOS). As liquid-based preparations (LBPs) become a common medium for<unk> ing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.9% compared with a 2003 median rate of 2.1%. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little. Abnormal results are reported according to the Bethesda system. They include: * Squamous cell abnormalities (SIL) * Atypical squamous cells of undetermined significance (ASC-US) * Atypical squamous cells – cannot exclude HSIL (ASC-H) * Low-grade squamous intraepithelial lesion (LGSIL or LSIL) * High-grade squamous intraepithelial lesion (HGSIL or HSIL) * Squamous cell carcinoma * Glandular epithelial cell abnormalities * Atypical glandular cells not otherwise specified (AGC or AGC-NOS) Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast, herpes simplex virus and trichomoniasis. However it is not very sensitive at detecting these infections, so absence of detection on a<unk> does not mean absence of the infection. Image:Normal<unk> (Cervical) Smear.Micrograph of a normal<unk> smear Image:Low-grade sil and endocx.Micrograph of a<unk> showing a low-grade intraepithelial lesion (LSIL) and benign endocervical mucosa.<unk> stain. Image:Trichomonas<unk> .Micrograph of a<unk> showing trichomoniasis. Trichomonas organism seen in the upper right.<unk> stain. Image:Herpes simplex virus<unk> .Micrograph of a<unk> showing changes of herpes simplex virus.<unk> stain. Image:Adenocarcinoma on<unk> 1.Endocervical adenocarcinoma on a<unk> . Image:Candida<unk> 1.Candida organisms on a<unk> . Image:Herpes_simplex_virus_pap_test.Viral cytopathic effect consistent with herpes simplex virus on a<unk> . Image:Pap<unk> normal.Normal squamous epithelial cells in premenopausal women Image:Pap<unk> atropy.Atrophic squamous cells in postmenopausal women Image:Pap<unk> endocervical cells.Normal endocervical cells should be present into the slide, as a proof of a good quality sampling Image:Pap<unk> citolysis.The cytoplasms of squamous epithelial cells melted out; many Döderlein bacilli can be seen. Image:Pap<unk> trichomonas.Infestation by Trichomonas vaginalis Image:Pap<unk> abnormal.An obviously atypical cell can be seen Pregnancy<unk> s can usually be performed during pregnancy up to at least 24 weeks of gestational age.<unk> s during pregnancy have not been associated with increased risk of miscarriage. An inflammatory component is commonly seen on<unk> smears from pregnant women and does not appear to be a risk for subsequent preterm birth. After childbirth, it is recommended to wait 12 weeks before taking a<unk> because inflammation of the cervix caused by the birth interferes with<unk> interpretation. | Pap test | Pregnancy test | Cervical screening | Anal Pap smear | Breast self-examination | Male genital examination | Colposcopy | Trichology | 00
| 2,968 |
In humans<unk> was originally made available for use in humans for the treatment of rheumatoid arthritis and gout in 1949. However, it is no longer approved, and therefore not marketed, for any human use in the United States. In the UK it is used to treat ankylosing spondylitis, but only when other therapies are unsuitable. In horses<unk> is the most commonly used NSAID for horses in the United States. It is used for the following purposes: * Analgesia: It is used for pain relief from infections and musculoskeletal disorders, including sprains, overuse injuries, tendinitis, arthralgias, arthritis, and laminitis. Like other NSAIDs, it acts directly on musculoskeletal tissue to control inflammation, thereby reducing secondary inflammatory damage, alleviating pain, and restoring range of motion. It does not cure musculoskeletal ailments or work well on colic pain. * Antipyresis: It is used for reduction of fevers. Its antipyretic qualities may mask other symptoms. History of<unk> in racing In the 1968 Kentucky Derby, Dancer's Image, the winner of the race, was disqualified after traces of<unk> were allegedly discovered in a post-race urinalysis. Owned by prominent Massachusetts businessman Peter D. Fuller and ridden by jockey Bobby Ussery, Dancer's Image was the first horse to win the Kentucky Derby and then be disqualified.<unk> was legal on most tracks around the United States in 1968, but had not yet been approved by Churchill Downs. Controversy and speculation still surround the incident. In the weeks prior to the race, Fuller had given previous winnings to Coretta Scott King, the widow of slain civil rights activist Martin Luther King Jr., which brought both praise and criticism. The previous year, King held a sit-in against housing discrimination which disrupted Derby week. Forty years later, Fuller still believed Dancer's Image was disqualified due to these events. Although Forward Pass had been named the winner, after many appeals the Kentucky Derby official website lists both Dancer's Image and Forward Pass as the winner. The website's race video commentary states that on the winner's plaque at Churchill Downs, both Dancer's Image and Forward Pass are listed as the 1968 winner of the Kentucky Derby. In dogs<unk> is occasionally used in dogs for the longer-term management of chronic pain, particularly due to osteoarthritis. About 20% of adult dogs are affected with osteoarthritis, which makes the management of musculoskeletal pain a major component of companion animal practice. The margin of safety for all NSAIDs is narrow in the dog, and other NSAIDs are more commonly used (etodolac, and carprofen). Gastrointestinal-protectant drugs, such as misoprostol, cimetidine, omeprazole, ranitidine, or sucralfate, are frequently included as a part of treatment with any NSAID. Dogs receiving chronic<unk> therapy should be followed with regular blood work and renal monitoring. Side effects of<unk> in dogs include gastrointestinal (GI) ulceration, bone marrow depression, rashes, malaise, blood dyscrasias, and diminished renal blood flow. | Phenylbutazone | Metolazone | Flonicamid | Butylone | Tolbutamide | Bromfenac | Acebutolol | Iodixanol | 00
| 17,271 |
Mechanism of action<unk> targets the IL-23 subunit alpha (p19 subunit) preventing it from binding to cell receptors that would otherwise be activated by its presence. Pharmacokinetics * Cmax 8.09 µg/mL * tmax 5.5 days * volume of distribution 13.5 L * apparent clearance 0.516 L/day | Guselkumab | Ustekinumab | Emapalumab | Olaratumab | Evolocumab | Dupilumab | Tralokinumab | Alirocumab | 00
| 64,287 |
For treatment,<unk> heals well in children with rest and restriction of physical activity and sports using the affected arm. The prognosis is also good with treatment and the affected capitellum is remodeled. Irregularities of the capitellum and surrounding elbow area can both be seen by radiograph and MRI. When treatment is effective the flattened and fragmented capitellum is completely remodeled and returns to its normal circular shape, and also the high intensity signal on an MRI T2 series disappears. These results indicate that the capitellum is completely remodeled and the child is able to return to normal physical and sports activities. | Panner disease | Mondor's disease | Ollier disease | Premature thelarche | Minor's disease | Haff disease | Chandler's disease | Adiposogenital dystrophy | 00
| 61,000 |
<unk> is a PEG/lipid conjugate (i.e. PEGylated lipid), specifically, it is the N,N-dimyristylamide of 2-hydroxyacetic acid, O-pegylated to a PEG chain mass of about 2 kilodaltons (corresponding to about 45-46 ethylene oxide units per molecule of N,N-dimyristyl hydroxyacetamide). It is a non-ionic surfactant by its nature. It has been deployed in the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine (0.05 mg per dose) that contains the active ingredient tozinameran. | ALC-0159 | OSU-6162 | HU-308 | ALC-0315 | HPTN 052 | MRK-016 | NHS 24 | VIR-576 | 00
| 74,014 |
There are three types of<unk> : conventional<unk> , daily<unk> , and nocturnal<unk> . Below is an adaptation and summary from a brochure of The Ottawa Hospital. Conventional<unk> Conventional<unk> is usually done three times per week, for about three to four hours for each treatment (Sometimes five hours for larger patients), during which the patient's blood is drawn out through a tube at a rate of 200–400 mL/min. The tube is connected to a 15, 16, or 17 gauge needle inserted in the dialysis fistula or graft, or connected to one port of a dialysis catheter. The blood is then pumped through the dialyzer, and then the processed blood is pumped back into the patient's bloodstream through another tube (connected to a second needle or port). During the procedure, the patient's blood pressure is closely monitored, and if it becomes low, or the patient develops any other signs of low blood volume such as nausea, the dialysis attendant can administer extra fluid through the machine. During the treatment, the patient's entire blood volume (about 5000 cc) circulates through the machine every 15 minutes. During this process, the dialysis patient is exposed to a week's worth of water for the average person. Daily<unk> Daily<unk> is typically used by those patients who do their own dialysis at home. It is less stressful (more gentle) but does require more frequent access. This is simple with catheters, but more problematic with fistulas or grafts. The "buttonhole technique" can be used for fistulas requiring frequent access. Daily<unk> is usually done for 2 hours six days a week. Nocturnal<unk> The procedure of nocturnal<unk> is similar to conventional<unk> except it is performed three to six nights a week and between six and ten hours per session while the patient sleeps. | Hemodialysis | Iridodialysis | Peritoneal dialysis | Dialysis | Hemofiltration | Home hemodialysis | Hemoperfusion | Intravenous sodium bicarbonate | 00
| 14,696 |
Intraocular pressure may be lowered by allowing drainage of aqueous humor from within the eye to the following routes: (1) filtration through the sclerotomy around the margins of the scleral flap into the filtering bleb that forms underneath the conjunctiva, (2) filtration through outlet channels in the scleral flap to underneath the conjunctiva,(3) Filtration through the connective tissue of the scleral flap to underneath the conjunctiva. Into cut ends of Schlemm's canal. (4) aqueous flow into cut ends of Schlemm's canal into collector channels and episcleral veins (5) into a cyclodialysis cleft between the ciliary body and the sclera if tissue is dissected posterior to the scleral spur. | Trabeculectomy | Frontal sinus trephination | Head transplant | Astragalectomy | Eyelid revision | Iridodonesis | Iridectomy | Vibroacoustic therapy | 00
| 38,395 |
A<unk> (Gr., hepato = liver) is a toxic chemical substance that damages the liver. It can be a side-effect, but<unk> s are also found naturally, such as microcystins and pyrrolizidine alkaloids, or in laboratory environments, such as carbon tetrachloride, or far more pevasively in the form of ethanol (drinking alcohol). The effects of<unk> s depend on the amount, point of entry and distribution speed of the toxin, and on the health of the person. Intrinsic<unk> s (type A) have a predictable, dose-dependent effect. Idiosyncratic (type B)<unk> reactions are unpredictable, independent of dose, and appear to be determined by the individual exposed. Compounds that preferentially affect bile ducts are referred to as "cholestatic", one example being chlorpromazine. Those that target mostly the hepatocytes themselves are termed "hepatocellular", one example being paracetamol. "Mixed" toxicity, affecting both the bile ducts and hepatocytes, is not uncommon. Hepatocellular injury is clinically marked by a high ratio of ALT to ALP, and cholestatic injury by a lower ratio. | Hepatotoxin | Dinotoxin | Chlorotoxin | Conotoxin | Hemotoxin | Kaliotoxin | Neurotoxin | Staphylotoxin | 00
| 32,796 |
<unk> 's sign is found in tetany. However, it may also be present in hypomagnesemia. Magnesium is a cofactor for adenylate cyclase, which catalyzes the conversion of ATP to 3',5'-cyclic AMP. The 3',5'-cyclic AMP (cAMP) is required for parathyroid hormone activation. It is frequently seen in alcoholics, persons with diarrhea, patients taking aminoglycosides or diuretics, because hypomagnesemia can cause hypocalcemia. It is also seen in measles, tetanus and myxedema. It can also be found in subjects with respiratory alkalosis, for example as a result of hyperventilation syndrome, which can lead to a drastic reduction of the concentration in serum of calcium ions while at normal levels, for the binding of a significant proportion of ionized calcium (Ca2+) with albumin and globulins. | Chvostek sign | Hegar's sign | Amsler sign | Froment's sign | Lincoln sign | Pemberton's sign | Westermark sign | Bing's sign | 00
| 23,899 |
<unk> is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes (such as seasonal affective disorder) and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.<unk> is a pathological state characterized by a lack of alertness during the waking episodes of the day. It is not to be confused with fatigue, which is a normal physiological state. Daytime sleepiness appears most commonly during situations where little interaction is needed. Since the patients’ attention levels (wakefulness) are impaired, their quality of life may be impacted as well. This is especially true for people whose jobs request high levels of attention, such as in the healthcare field. Indeed, the lack of attention can cause injuries to self or others, which makes this disorder a real public health issue. | Hypersomnia | Orthosomnia | Dyssomnia | Parasomnia | Excessive daytime sleepiness | Insomnia | Snatiation | Sleepwalking | 00
| 17,513 |
Huntington's disease Huntington's disease is a neurodegenerative disease and most common inherited cause of<unk> . The condition was formerly called Huntington's<unk> but was renamed because of the important non-choreic features including cognitive decline and behavioural change. Other genetic causes Other genetic causes of<unk> are rare. They include the classical Huntington's disease 'mimic' or phenocopy syndromes, called Huntington's disease-like syndrome types 1, 2 and 3; inherited prion disease, the spinocerebellar ataxias type 1, 3 and 17, neuroacanthocytosis, dentatorubral-pallidoluysian atrophy (DRPLA), brain iron accumulation disorders, Wilson's disease, benign hereditary<unk> , Friedreich's ataxia, mitochondrial disease and Rett syndrome. Acquired causes The most common acquired causes of<unk> are cerebrovascular disease and, in the developing world, HIV infection—usually through its association with cryptococcal disease. Sydenham's<unk> occurs as a complication of streptococcal infection. Twenty percent (20%) of children and adolescents with rheumatic fever develop Sydenham's<unk> as a complication. It is increasingly rare, which may be partially due to penicillin, improved social conditions, and/or a natural reduction in the bacteria (Streptococcus) it has stemmed from. Psychological symptoms may precede or accompany this acquired<unk> and may be relapsing and remitting. The broader spectrum of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection can cause<unk> and are collectively referred to as PANDAS.<unk> gravidarum refers to<unk> c symptoms that occur during pregnancy. If left untreated, the disease resolves in 30% of patients before delivery but, in the other 70%, it persists. The symptoms then progressively disappear in the next few days following the delivery.<unk> may also be caused by drugs (commonly levodopa, anti-convulsants and anti-psychotics). Other acquired causes include CSF leak, systemic lupus erythematosus, antiphospholipid syndrome, kappa light-chain monoclonal gammopathy of undetermined significance, thyrotoxicosis, polycythaemia rubra vera, transmissible spongiform encephalopathies and coeliac disease. | Chorea | Myoclonus | Dystonia | Opisthotonus | Paratonia | Opsoclonus | Athetosis | Clonus | 00
| 17,652 |
Side effects are similar to those of buprenorphine and other opioids. In addition, naloxone can induce withdrawal symptoms in people who are addicted to opioids. The most common side effects (in order of most common to least common) of sublingual tablets include: headaches, opioid withdrawal syndrome, pain, nausea, increased sweating, and difficulty sleeping. The most common side effects seen in film formulations are tongue pain, decreased sensation and redness in the mouth, headache, nausea, vomiting, excessive sweating, constipation, signs and symptoms of opioid withdrawal, sleeping difficulties, pain, and swelling of the extremities.<unk> has a milder side effect profile than methadone, and has limited respiratory effects, due to both agonist/antagonist effects. However,<unk> may be less safe than methadone in people with stable liver disease, since it can elevate liver enzymes. Dependence and withdrawal<unk> , when taken in excess, can produce dysphoric symptoms for non opioid-dependent/tolerant individuals due to buprenorphine being a partial opioid agonist. The sublingual formulation of the<unk> combination was designed to reduce the potential to inject the medication in comparison to buprenorphine alone. If the combination is taken via the sublingual route, as directed, the addition of naloxone does not diminish the effects of buprenorphine. When the combination sublingual tablet is dissolved and injected by opioid-dependent individuals, a withdrawal effect may be triggered due to the high parenteral bioavailability of naloxone. While this mechanism can potentially act to deter intravenous injection, the Suboxone formulation still has potential to produce an opioid agonist "high" if used sublingually by non-dependent persons, leading to dependence on opioids. | Buprenorphine/naloxone | Oxycodone/naloxone | Buprenorphine/naltrexone | Fentanyl/fluanisone | Buprenorphine/samidorphan | Dextromethorphan/quinidine | Naloxone | Nalorphine dinicotinate | 00
| 66,230 |
It may present as a cardiac arrhythmia or as sudden cardiac death. | Cystic tumour of the atrioventricular nodal region | Anomalous aortic origin of a coronary artery | Anomalous left coronary artery from the pulmonary artery | Wandering atrial pacemaker | Progressive cardiac conduction defect | Isolated atrial amyloidosis | Permanent junctional reciprocating tachycardia | Eosinophilic ulcer of the oral mucosa | 00
| 61,567 |
<unk> yields profound antitumoral activity by acting on several immunological levels synergistically.<unk> stimulates the innate immune system by activating toll-like receptor 7 (TLR7), commonly involved in pathogen recognition. Cells activated by<unk> via TLR-7 secrete cytokines (primarily interferon-α (IFN-α), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)). There is evidence that<unk> , when applied to skin, can lead to the activation of Langerhans cells, which subsequently migrate to local lymph nodes to activate the adaptive immune system. Other cell types activated by<unk> include natural killer cells, macrophages and B-lymphocytes.<unk> exerts its effect by increasing levels of the opioid growth factor receptor (OGFr). In experiments, blocking OGFr function with siRNA technology resulted in loss of any antiproliferative effect of<unk> . | Imiquimod | Clobetasol propionate | Clobetasol | Tretinoin | Cryotherapy | Isotretinoin | Alitretinoin | Elastix | 00
| 32,876 |
In most, if not all<unk> es, a change in the 3-dimensional folding conformation increases the tendency of a specific protein to bind to itself. In this aggregated form, the protein is resistant to clearance and can interfere with the normal capacity of the affected organs. In some cases, misfolding of the protein results in a loss of its usual function. For example, cystic fibrosis is caused by a defective cystic fibrosis transmembrane conductance regulator (CFTR) protein, and in amyotrophic lateral sclerosis / frontotemporal lobar degeneration (FTLD), certain gene-regulating proteins inappropriately aggregate in the cytoplasm, and thus are unable to perform their normal tasks within the nucleus. Because proteins share a common structural feature known as the polypeptide backbone, all proteins have the potential to misfold under some circumstances. However, only a relatively small number of proteins are linked to proteopathic disorders, possibly due to structural idiosyncrasies of the vulnerable proteins. For example, proteins that are normally unfolded or relatively unstable as monomers (that is, as single, unbound protein molecules) are more likely to misfold into an abnormal conformation. In nearly all instances, the disease-causing molecular configuration involves an increase in beta-sheet secondary structure of the protein. The abnormal proteins in some proteopathies have been shown to fold into multiple 3-dimensional shapes; these variant, proteinaceous structures are defined by their different pathogenic, biochemical, and conformational properties. They have been most thoroughly studied with regard to prion disease, and are referred to as protein strains. α-synuclein (brown) in Lewy bodies (large clumps) and Lewy neurites (thread-like structures) in the cerebral cortex of a patient with Lewy body disease, a synucleinopathy. 40X microscope objective. The likelihood that<unk> will develop is increased by certain risk factors that promote the self-assembly of a protein. These include destabilizing changes in the primary amino acid sequence of the protein, post-translational modifications (such as hyperphosphorylation), changes in temperature or pH, an increase in production of a protein, or a decrease in its clearance. Advancing age is a strong risk factor, as is traumatic brain injury. In the aging brain, multiple proteopathies can overlap. For example, in addition to tauopathy and Aβ-amyloidosis (which coexist as key pathologic features of Alzheimer's disease), many Alzheimer patients have concomitant synucleinopathy (Lewy bodies) in the brain. It is hypothesized that chaperones and co-chaperones (proteins that assist protein folding) may antagonize proteotoxicity during aging and in protein misfolding-diseases to maintain proteostasis. | Proteinopathy | Multisystem proteinopathy | Bisalbuminemia | Cryoglobulinemia | Lipiduria | Hemoglobinopathy | Ageing | Proteinuria | 00
| 44,320 |
<unk> is "the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body". It is carried out to normalize – or modulate – nervous tissue function.<unk> is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space (intrathecal drug delivery). Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired. The most clinical experience has been with electrical stimulation.<unk> whether electrical or magnetic, employs the body's natural biological response by stimulating nerve cell activity that can influence populations of nerves by releasing transmitters, such as dopamine, or other chemical messengers such as the peptide Substance P, that can modulate the excitability and firing patterns of neural circuits. There may also be more direct electrophysiological effects on neural membranes as the mechanism of action of electrical interaction with neural elements. The end effect is a "normalization" of a neural network function from its perturbed state. Presumed mechanisms of action for neurostimulation include depolarizing blockade, stochastic normalization of neural firing, axonal blockade, reduction of neural firing keratosis, and suppression of neural network oscillations. Although the exact mechanisms of neurostimulation are not known, the empirical effectiveness has led to considerable application clinically. Existing and emerging<unk> treatments also include application in medication-resistant epilepsy, chronic head pain conditions, and functional therapy ranging from bladder and bowel or respiratory control to improvement of sensory deficits, such as hearing (cochlear implants and auditory brainstem implants) and vision (retinal implants). Technical improvements include a trend toward minimally invasive (or noninvasive) systems; as well as smaller, more sophisticated devices that may have automated feedback control, and conditional compatibility with magnetic resonance imaging.<unk> therapy has been investigated for other chronic conditions, such as Alzheimer's disease, depression, chronic pain, and as an adjunctive treatment in recovery from stroke. | Neuromodulation | Neurosecretion | Remyelination | Vasculogenesis | Reinnervation | Lymphangiogenesis | Neuroregeneration | Arteriogenesis | 00
| 65,081 |
<unk> interferes with alkaline phosphatase measurements. As<unk> is a glycoprotein (as opposed to a small molecule), no relevant interactions via the cytochrome P450 liver enzymes are expected. | Asfotase alfa | Velmanase alfa | Sebelipase alfa | Angiozyme | Desmoteplase | Anistreplase | Lusutrombopag | Celadrin | 00
| 68,751 |
The usual treatment of a standardised<unk> is to prescribe reading glasses to correct for impairment of the eye(s). Pilocarpine drops may be administered as a treatment as well as a diagnostic measure. Thoracic sympathectomy is the definitive treatment of diaphoresis, if the condition is not treatable by drug therapy. | Adie syndrome | Sneddon's syndrome | Meigs's syndrome | Liddle's syndrome | Hamman's syndrome | Gardner's syndrome | Young's syndrome | Meige's syndrome | 00
| 30,407 |
Treatment of<unk> is a multidisciplinary practice involving the use of surgery, chemotherapy, radiation, and possibly immunotherapy. Surgery is generally the first step in a combined therapeutic approach. Resectability varies depending on tumor site, and<unk> often presents in sites that don't allow for full surgical resection without significant morbidity and loss of function. Less than 20% of<unk> tumors are fully resected with negative margins.<unk> s are highly chemosensitive, with approximately 80% of cases responding to chemotherapy. In fact, multi-agent chemotherapy is indicated for all patients with<unk> . Before the use of adjuvant and neoadjuvant therapy involving chemotherapeutic agents, treatment solely by surgical means had a survival rate of <20%. Modern survival rates with adjuvant therapy are approximately 60–70%. There are two main methods of chemotherapy treatment for<unk> . There is the VAC regimen, consisting of vincristine, actinomycin D, and cyclophosphamide, and the IVA regimen, consisting of ifosfamide, vincristine, and actinomycin D. These drugs are administered in 9–15 cycles depending on the staging of the disease and other therapies used. Other drug and therapy combinations may also show additional benefit. Addition of doxorubicin and cisplatin to the VAC regimen was shown to increase survival rates of patients with alveolar-type, early-stage<unk> in IRS study III, and this same addition improved survival rates and doubled bladder salvage rates in patients with stage III<unk> of the bladder. In children and young adults with stage IV metastatic<unk> , a Cochrane review has found no evidence to support the use of high-dose chemotherapy as a standard therapy. Radiation therapy, which kill cancer cells with focused doses of radiation, is often indicated in the treatment of<unk> , and the exclusion of this treatment from disease management has been shown to increase recurrence rates. Radiation therapy is used when resecting the entirety of the tumor would involve disfigurement or loss of important organs (eye, bladder, etc.). Generally, in any case where a lack of complete resection is suspected, radiation therapy is indicated. Administration is usually following 6–12 weeks of chemotherapy if tumor cells are still present. The exception to this schedule is the presence of parameningeal tumors that have invaded the brain, spinal cord, or skull. In these cases radiation treatment is started immediately. In some cases, special radiation treatment may be required. Brachytherapy, or the placement of small, radioactive "seeds" directly inside the tumor or cancer site, is often indicated in children with tumors of sensitive areas such as the testicles, bladder, or vagina. This reduces scattering and the degree of late toxicity following dosing. Radiation therapy is more often indicated in higher stage classifications. Immunotherapy is a more recent treatment modality that is still in development. This method involves recruiting and training the patient's immune system to target the cancer cells. This can be accomplished through administering small molecules designed to pull immune cells towards the tumors, taking immune cells pulled from the patient and training to attack tumors through presentation with tumor antigen, or other experimental methods. A specific example here would be presenting some of the patient's dendritic cells, which direct the immune system to foreign cells, with the PAX3-FKHR fusion protein in order to focus the patient's immune system to the malignant<unk> cells. All cancers, including<unk> , could potentially benefit from this new, immune-based approach. | Rhabdomyosarcoma | Myosarcoma | Pyomyoma | Rhabdomyoma | Hemangiosarcoma | Liposarcoma | Angiosarcoma | Fibrosarcoma | 00
| 14,218 |
In medicine,<unk> refers to the loss of surface layers, such as the epithelium.<unk> coupled with peeling and cracking of skin gives rise to a "crazy pavement dermatosis" pattern seen in Kwashiorkor or Kwashiorkor-Marasmus complex. In occupational asthma, the<unk> of the bronchial mucosa can occur in the setting of nonimmunologic exposures (i.e., chemical spill, chlorine, ammonia), causing irritation. Clostridioides difficile is known to cause formation of pseudomembranes in the intestines that is formed by denuded epithelium, neutrophilic infiltrate, fibrin, and bacteria due to the effects of its toxins: Toxin A (TcdA) and Toxin B (TcdB), which disrupt cellular cytoskeletons and tight junctions leading to cell death. | Denudation | Bookmarking | Couching | Desquamation | Craterization | Emaciation | Lobulation | Organ gifting | 00
| 67,938 |
Disability-adjusted life year for prematurity and low birth weight per 100,000 inhabitants in 2004. Preterm birth complicates the births of infants worldwide affecting 5% to 18% of births. In Europe and many developed countries the preterm birth rate is generally 5–9%, and in the U.S. it has even risen to 12–13% in the last decades. As weight is easier to determine than gestational age, the World Health Organization tracks rates of low birth weight (< 2,500 grams), which occurred in 16.5 percent of births in less developed regions in 2000. It is estimated that one third of these low birth weight deliveries are due to preterm delivery. Weight generally correlates to gestational age; however, infants may be underweight for other reasons than a preterm delivery. Neonates of low birth weight (LBW) have a birth weight of less than and are mostly but not exclusively preterm babies as they also include small for gestational age (SGA) babies. Weight-based classification further recognizes Very Low Birth Weight (VLBW) which is less than 1,500 g, and Extremely Low Birth Weight (ELBW) which is less than 1,000 g. Almost all neonates in these latter two groups are born preterm. About 75% of nearly a million deaths due to preterm deliver would survive if provided warmth, breastfeeding, treatments for infection, and breathing support. Complications from preterm births resulted in 740,000 deaths in 2013, down from 1.57 million in 1990. | risks of Necrotizing enterocolitis | risks of Giardiasis | risks of Short bowel syndrome | risks of Refeeding syndrome | causes of Fecal incontinence | risks of Peritonitis | risks of Postpartum infections | risks of Myocardial infarction | 00
| 12,590 |
<unk> may require surgery and medications. Medications include diuretics, which aid the body in eliminating water, salts, and digoxin for strengthening the contraction of the<unk> . This slows the<unk> beat and removes some fluid from tissues. Some<unk> s require surgical procedures to restore circulation back to normal and in some cases, multiple surgeries are needed. Interventional cardiology now offers patients minimally invasive alternatives to surgery for some patients. The Melody Transcatheter Pulmonary Valve (TPV), approved in Europe in 2006 and in the U.S. in 2010 under a Humanitarian Device Exemption (HDE), is designed to treat<unk><unk> disease patients with a dysfunctional conduit in their right ventricular outflow tract (RVOT). The RVOT is the connection between the<unk> and lungs; once blood reaches the lungs, it is enriched with oxygen before being pumped to the rest of the body. Transcatheter pulmonary valve technology provides a less-invasive means to extend the life of a failed RVOT conduit and is designed to allow physicians to deliver a replacement pulmonary valve via a catheter through the patient's blood vessels. Many people require lifelong specialized cardiac care, first with a pediatric cardiologist and later with an adult<unk> cardiologist. There are more than 1.8 million adults living with<unk> s. | Congenital heart defect | Musculoskeletal abnormality | Neuromuscular disease | Vascular anomaly | Genetic disorder | Brain damage | Neuromuscular junction disease | Musculoskeletal injury | 00
| 18,120 |
Signs and symptoms that may suggest lung cancer include: * Respiratory symptoms: coughing, coughing up blood, wheezing, or shortness of breath * Systemic symptoms: weight loss, weakness, fever, or clubbing of the fingernails * Symptoms due to the cancer mass pressing on adjacent structures: chest pain, bone pain, superior vena cava obstruction, or difficulty swallowing If the cancer grows in the airways, it may obstruct airflow causing breathing difficulties. The obstruction can also lead to accumulation of secretions behind the blockage, and increase the risk of pneumonia. Many of the symptoms of lung cancer (poor appetite, weight loss, fever, fatigue) are not specific. In many people, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Symptoms that suggest the presence of metastatic disease include weight loss, bone pain, and neurological symptoms (headaches, fainting, convulsions, or limb weakness). Common sites of spread include the brain, bone, adrenal glands, opposite lung, liver, pericardium, and kidneys. About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest radiography. Depending on the type of tumor, paraneoplastic phenomena – symptoms not due to the local presence of cancer – may initially attract attention to the disease. In lung cancer, these phenomena may include hypercalcemia, syndrome of inappropriate antidiuretic hormone (abnormally concentrated urine and diluted blood), ectopic ACTH production, or Lambert–Eaton myasthenic syndrome (muscle weakness due to autoantibodies). Tumors in the top of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, resulting in Horner's syndrome (dropping of the eyelid and a small pupil on that side), as well as damage to the brachial plexus. | complications of Asbestosis | complications of Melioidosis | complications of Idiopathic pulmonary fibrosis | complications of Bronchiolitis | complications of Mesothelioma | complications of Alpha-1 antitrypsin deficiency | medical cause of Bronchiolitis obliterans | symptom of Idiopathic pulmonary fibrosis | 00
| 1,272 |
<unk> causes arterial/arteriolar vasodilation leading to a decrease in blood pressure by activating peripheral D1 receptors. It decreases afterload and also promotes sodium excretion via specific dopamine receptors along the nephron. The renal effect of<unk> and dopamine may involve physiological antagonism of the renin-angiotensin system in the kidney. In contrast to dopamine,<unk> is a selective D1 receptor agonist with no effect on beta adrenoceptors, although there is evidence that it may have some alpha-1 and alpha-2 adrenoceptor antagonist activity. D1 receptor stimulation activates adenylyl cyclase and raises intracellular cyclic AMP, resulting in vasodilation of most arterial beds, including renal, mesenteric, and coronary arteries. to cause a reduction in systemic vascular resistance.<unk> has a rapid onset of action (4 minutes) and short duration of action (< 10 minutes) and a linear dose–response relationship at usual clinical doses. | Fenoldopam | Alvimopan | Nefopam | Bethanechol | Tofisopam | Ethylnorepinephrine | Avacopan | Noribogaine | 00
| 33,981 |
<unk> can result in lower back or upper neck pain. The amount of degeneration does not correlate well with the amount of pain patients experience. Many people experience no pain while others, with the same amount of damage have severe, chronic pain. Whether a patient experiences pain or not largely depends on the location of the affected disc and the amount of pressure that is being put on the spinal column and surrounding nerve roots. Nevertheless,<unk> is one of the most common sources of back pain and affects approximately 30 million people every year. With symptomatic<unk> , the pain can vary depending on the location of the affected disc. A degenerated disc in the lower back can result in lower back pain, sometimes radiating to the hips, as well as pain in the buttocks, thighs or legs. If pressure is being placed on the nerves by exposed nucleus pulposus, sporadic tingling or weakness through the knees and legs can also occur. A degenerated disc in the upper neck will often result in pain to the neck, arm, shoulders and hands; tingling in the fingers may also be evident if nerve impingement is occurring. Pain is most commonly felt or worsened by movements such as sitting, bending, lifting and twisting. After an injury, some discs become painful because of inflammation and the pain comes and goes. Some people have nerve endings that penetrate more deeply into the anulus fibrosus (outer layer of the disc) than others, making discs more likely to generate pain. In the alternative, the healing of trauma to the outer anulus fibrosus may result in the innervation of the scar tissue and pain impulses from the disc, as these nerves become inflamed by nucleus pulposus material.<unk> can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life. When pain from<unk> is severe, traditional nonoperative treatment may be ineffective. | Degenerative disc disease | Lumbar disc disease | Spinal disc herniation | Discitis | Spinal disease | Spinal tumor | Spinal stenosis | Lumbar spinal stenosis | 00
| 22,260 |
Ehlers–Danlos syndromes (EDS) are a group of thirteen genetic connective-tissue disorders that are in the current classification, with a fourteenth type discovered in 2018. Symptoms may include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis. EDS occurs due to variations of more than 19 genes that are present at birth. The specific gene affected determines the type of EDS. Some cases result from a new variation occurring during early development, while others are inherited in an autosomal dominant or recessive manner. Typically, these variations result in defects in the structure or processing of the protein collagen. Diagnosis is often based on symptoms and confirmed with genetic testing or skin biopsy, but people may initially be misdiagnosed with hypochondriasis, depression, or chronic fatigue syndrome. No cure is currently known and treatment is supportive in nature. Physical therapy and bracing may help strengthen muscles and support joints. While some forms of EDS result in a normal life expectancy, those that affect blood vessels generally decrease it. The hypermobile type of EDS (hEDS) affects at least one in 5,000 people globally; other types occur at lower frequencies. The prognosis depends on the specific disorder. Excess mobility was first described by Hippocrates in 400 BC. The syndromes are named after two physicians, Edvard Ehlers and Henri-Alexandre Danlos, who described them at the turn of the 20th century. | medical cause of Hyperdontia | onset of Kallmann syndrome | medical cause of Precocious puberty | complications of Kallmann syndrome | symptom of Kallmann syndrome | picture of Congenital hypothyroidism | medical cause of Hypothyroidism | complications of Klinefelter syndrome | 00
| 6,559 |
Normal development The testes begin as an immigration of primordial germ cells into testicular cords along the gonadal ridge in the abdomen of the early embryo. The interaction of several male genes organizes this developing gonad into a testis rather than an ovary by the second month of gestation. During the third to fifth months, the cells in the testes differentiate into testosterone-producing Leydig cells, and anti-Müllerian hormone-producing Sertoli cells. The germ cells in this environment become fetal spermatogonia. Male external genitalia develops during the third and fourth months of gestation and the fetus continues to grow, develop, and differentiate. The testes remain high in the abdomen until the seventh month of gestation when they move from the abdomen through the inguinal canals into the two sides of the scrotum. Movement has been proposed to occur in two phases, under the control of somewhat different factors. The first phase, movement across the abdomen to the entrance of the inguinal canal, appears controlled (or at least greatly influenced) by anti-Müllerian hormone (AMH). The second phase, in which the testes move through the inguinal canal into the scrotum, is dependent on androgens (most importantly testosterone). In rodents, androgens induce the genitofemoral nerve to release calcitonin gene-related peptide, which produces rhythmic contractions of the gubernaculum, a ligament which connects the testis to the scrotum, but a similar mechanism has not been demonstrated in humans. Maldevelopment of the gubernaculum or deficiency or insensitivity to either AMH or androgen can, therefore, prevent the testes from descending into the scrotum. Some evidence suggests an additional paracrine hormone, referred to as descendin, may be secreted by the testes. In many infants with inguinal testes, further descent of the testes into the scrotum occurs in the first six months of life. This is attributed to the postnatal surge of gonadotropins and testosterone that normally occurs between the first and fourth months of life. Spermatogenesis continues after birth. In the third to fifth months of life, some of the fetal spermatogonia residing along the basement membrane become type A spermatogonia. More gradually, other fetal spermatogonia become type B spermatogonia and primary spermatocytes by the fifth year after birth. Spermatogenesis arrests at this stage until puberty. Most normal-appearing undescended testes are also normal by microscopic examination, but reduced spermatogonia can be found. The tissue in undescended testes becomes more markedly abnormal ("degenerates") in microscopic appearance between two and four years after birth. Some evidence indicates early orchiopexy reduces this degeneration. Pathophysiology At least one contributing mechanism for reduced spermatogenesis in cryptorchid testes is temperature. The temperature of testes in the scrotum is at least a few degrees cooler than in the abdomen. Animal experiments in the middle of the 20th century suggested that raising the temperature could damage fertility. Some circumstantial evidence suggests tight underwear and other practices that raise the testicular temperature for prolonged periods can be associated with lower sperm counts. Nevertheless, research in recent decades suggests that the issue of fertility is more complex than a simple matter of temperature. Subtle or transient hormone deficiencies or other factors that lead to a lack of descent also may impair the development of spermatogenic tissue. The inhibition of spermatogenesis by ordinary intra-abdominal temperature is so potent that continual suspension of normal testes tightly against the inguinal ring at the top of the scrotum by means of special "suspensory briefs" has been researched as a method of male contraception, and was referred to as "artificial<unk> " by one report. An additional factor contributing to infertility is the high rate of anomalies of the epididymis in boys with<unk> (over 90% in some studies). Even after orchiopexy, these may also affect sperm maturation and motility at an older age. | Cryptorchidism | Supernumerary kidney | Microorchidism | Hypospadias | Polyorchidism | Loxoscelism | Renal agenesis | Testicular dysgenesis syndrome | 00
| 12,347 |
<unk> develops insidiously, and may not initially cause symptoms significant enough to impact on quality of life. Nevertheless, many people experience significant symptoms. These might include: * Shortness of breath * Syncope (fainting) * Angina, but only in the presence of ischemic heart disease A person suffering from<unk> may have an enlarged heart, with pulmonary edema and an elevated jugular venous pressure and a low pulse pressure. Signs of mitral and tricuspid regurgitation may be present. | Dilated cardiomyopathy | Pulmonary embolism | Amyloid cardiomyopathy | Coronary artery disease | Alcoholic cardiomyopathy | Cardiomyopathy | Ischemic cardiomyopathy | Valvular heart disease | 00
| 14,938 |
A<unk> (CO) is a gazetted<unk> who is qualified and licensed to practice medicine. In her books, "Beyond the State: The Colonial Medical Service in British Africa" and "Indian Doctors in Kenya, 1895 - 1940: The Forgotten History", the author Anna Greenwood notes that before 1923 there were twice as many Indian doctors as there were European doctors working in the Colonial Medical Service. The Indian doctors had migrated to British Africa along with the coolies who came to work on the Uganda Railway. The Indian doctors faced discrimination and were not appointed to nor paid at the same rank as medical<unk> s (European doctors). Instead, they were designated as Assistant or Sub-assistant surgeons despite having attended similar 3 - 4 year Indian medical schools that were recognized by the General Medical Council in the UK and performing<unk> and administrative duties that were largely identical to those of the European doctors. From the mid-1920s the Indians were removed from the colonial service as they were not deemed to be the proper face of the imperial services in Africa. The Indian Assistant and Sub-Assistant Surgeons were thus replaced with similarly qualified Africans who came to be known as<unk> s when the authorizing legislation was passed in 1988 abolishing the Assistant and Sub-Assistant Surgeon and similar positions. In Kenya, the origin of the<unk> can be traced back to around 1888 when Sir William Mackinnon, 1st Baronet founded the Imperial British East Africa Company. The company was granted royal charter by Queen Victoria and was used by the Government of the United Kingdom to establish its influence in the East Africa Protectorate (present day Kenya). As the influence grew a healthcare system developed to meet the medical needs of the colony. In 1901 Kenyatta National Hospital was established as the Native Civil Hospital and later renamed the King George VI Hospital after King George VI of the United Kingdom. In 1958 the European Hospital (present-day Nairobi Hospital) was established in the same area to serve the European settlers. The need for qualified medical staff who would provide preventive, promotive, curative and rehabilitative services in hospitals and communities led to the establishment of the first formal training programme for<unk> s at Kenyatta National Hospital in 1928. The programme initially admitted experienced nurses and took them through a one-year certificate course which prepared them for advanced practice. The nursing track was discontinued and new students had to complete a medical course and sit and pass continuous assessment tests and final qualifying examinations which covered the biomedical sciences, medicine, surgery, paediatrics, obstetrics and gynecology, community health and health service management. The training expanded after Kenya's independence in 1962 through to 1970 when the newly created University of Nairobi started its own medical school and also used Kenyatta National Hospital as its teaching hospital. Legislation to regulate medical practice by<unk> s was passed in 1988 thus creating the<unk> s Council in 1989. In 1990 the Kenya Medical Training College was established by the government with campuses in all major towns and in 1996 the Roman Catholic Diocese of Kakamega established St. Mary's School of<unk> Medicine at St. Mary's Hospital in Mumias which become the second and third institutions to offer the training in Kenya. By this time<unk> s had to complete an accredited four-year programme of study, practicals and internship in<unk> medicine and surgery and have their names entered in the<unk> s register which was cleaned annually and taken to the government printer to be published in the Kenya Gazette. Private practice by<unk> s who had left government service after working for a minimum of 10 years was now allowed. Professional degrees in<unk> medicine and surgery were first offered by Egerton University and other universities as from 2006 and in 2012 the Commission for University Education Act No. 42 of 2012 removed the accreditation role from all regulatory bodies such as the<unk> s Council (COC) and the Kenya Medical Practitioners and Dentists Council (KMPDC) making the Commission for University Education (CUE) the only authorized accrediting body for all university degrees in Kenya including the degree in<unk> medicine. In 2017 the old legislation was repealed and the<unk> s Council reconstituted by the<unk> s (Training, Registration and Licensing) Act No. 20 of 2017 which requires each<unk> , clinic or medical centre to be registered by the council and to maintain a current practice license and a current practising certificate in order to operate legally within the scope of medicine, dentistry, orthopedics or health work. A<unk> may, with respect to patients - examine, diagnose, order laboratory and imaging investigations, prescribe treatment and perform procedures as per their scope of training.<unk> s are members of the Kenya<unk> s Association and the Kenya Union of<unk> s. In June 2020 the Public Service Commission approved the Revised Scheme of Service for<unk> Personnel which was issued by the State Department for Public Service to define the<unk> 's career structure, job description, standards for recruitment, training and advancement, and career planning and succession management within the civil service. The scheme is administered by the Ministry of Health through the Cabinet Secretary and the Principal Secretary in conjunction with the Public Service Commission and the County Chief<unk> for Health in each of the 47 Counties of Kenya.<unk> is a professional designation established by the government through the<unk> s Council (COC) which has jurisdiction and responsibility for the<unk> 's training, registration and licensing and each<unk> must (1) study<unk> medicine and surgery or<unk> medicine and community health for three or four years (2) graduate from a government-accredited medical training college (3) sit and pass a government licensing examination (4) complete an internship year at a teaching hospital (5) be registered as a<unk> (6) have a medical practice licence (7) complete a three-year period of<unk> supervision under a senior<unk> or a senior medical<unk> (8) have a practising certificate if they have a private practice which allows one to provide general medical services on their own directly to the public (9) undergo one or two additional years of specialized training (optional) and (10) become a trainer.<unk> (CO) is a protected professional title and its use by unregistered persons is prohibited by law and punishable by up to five years in jail with or without a fine. Globally, the title may not have legal restrictions and can refer to a job grade rather than a medical qualification such as junior assistive<unk> staff (e.g. in Zambia and Tanzania), licensed medical professionals (e.g. in Kenya and Malawi) or high-level corporate<unk> s, directors, and managers (e.g. Chief<unk> s in Europe and the United States). A<unk> observes, interviews and examines sick and healthy individuals in all specialties to determine and document their health status and applies relevant pathological, radiological, psychiatric and community health techniques, procedures and findings needed to classify diseases and related health problems and to establish a provisional or final diagnosis upon which to prescribe, initiate, carry out or terminate treatment or therapy based on their specialized knowledge, skills and experience in<unk> pharmacology, use of<unk> guidelines, best practices and disease patterns as well as individual patient and community characteristics while being actively pharmacovigilant to prevent, identify, minimize and manage drug reactions, drug errors, side effects and poisoning, overdiagnosis, overscreening, overtreatment and futile care. A<unk> performs general and specialized medical duties such as diagnosis and treatment of disease and injury, ordering and interpreting medical tests, performing routine medical and surgical procedures, referring patients to other practitioners and managing health departments, institutions, projects and systems.<unk> s, medical<unk> s and medical practitioners are the only<unk> s who are gazetted and licensed to practice medicine in Kenya. They work under oath and generate credible health data and information within communities and health institutions and cascade the same to the county and national governments, government agencies and third parties through standard recording and reporting tools from the Ministry of Health which are used to capture data on disease outbreaks, physical injuries and deformities, mental illness, drug resistance, disability, nutritional disorders, births and deaths among others. | Clinical officer | Clinician | Surgical technologist | Clinical biologist | Biomedical scientist | Pharmacist | Biological pharmacist | Proceduralist | 00
| 50,275 |
<unk> hydrochloride is an odorless white crystalline powder that is freely soluble in methanol, ethanol, and chloroform, and slightly soluble in water. | Butenafine | Rupatadine | Olopatadine | Loratadine | Patiromer | Mibolerone | Proxicromil | Ridinilazole | 00
| 39,839 |
The signs and symptoms of an infection depend on the type of disease. Some signs of infection affect the whole body generally, such as fatigue, loss of appetite, weight loss, fevers, night sweats, chills, aches and pains. Others are specific to individual body parts, such as skin rashes, coughing, or a runny nose. In certain<unk> , infectious diseases may be asymptomatic for much or even all of their course in a given host. In the latter case, the disease may only be defined as a "disease" (which by definition means an illness) in hosts who secondarily become ill after contact with an asymptomatic carrier. An infection is not synonymous with an infectious disease, as some infections do not<unk> illness in a host. Bacterial or viral As bacterial and viral infections can both<unk> the same kinds of symptoms, it can be difficult to distinguish which is the<unk> of a specific infection. Distinguishing the two is important, since viral infections cannot be cured by antibiotics whereas bacterial infections can. +Comparison of viral and bacterial infection Characteristic Viral infection Bacterial infection Typical symptoms In general, viral infections are systemic. This means they involve many different parts of the body or more than one body system at the same time; i.e. a runny nose, sinus congestion, cough, body aches etc. They can be local at times as in viral conjunctivitis or "pink eye" and herpes. Only a few viral infections are painful, like herpes. The pain of viral infections is often described as itchy or burning. The classic symptoms of a bacterial infection are localized redness, heat, swelling and pain. One of the hallmarks of a bacterial infection is local pain, pain that is in a specific part of the body. For example, if a cut occurs and is infected with bacteria, pain occurs at the site of the infection. Bacterial throat pain is often characterized by more pain on one side of the throat. An ear infection is more likely to be diagnosed as bacterial if the pain occurs in only one ear. A cut that produces pus and milky-colored liquid is most likely infected.<unk> Pathogenic viruses Pathogenic bacteria | causes of Endometritis | medical cause of Endometritis | risks of Pelvic inflammatory disease | symptom of Epididymitis | complications of Epididymitis | medical cause of Epididymitis | symptom of Endometritis | risks of Appendix cancer | 00
| 2,494 |
Medical personnel checking the carotid pulse of a patient Cardiac arrest is synonymous with clinical death. Historical information and a physical exam can diagnose cardiac arrest and provide information regarding the potential cause and the prognosis. The provider taking taking the person's clinical history should aim to determine if the episode was observed by anyone else, what time the episode took place, what the person was doing (in particular if there was any trauma), and if there were involvement of drugs. The physical examination portion of diagnosing cardiac arrest focuses on the absence of a pulse. In many cases, lack of a carotid pulse is the gold standard for diagnosing cardiac arrest. Lack of a pulse in the periphery (radial/pedal) may also result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Studies have shown that rescuers may often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons. Point-of-care ultrasound (POCUS) is a tool that can be used to examine the movement of the heart and its force of contraction at the person experiencing cardiac arrest's bedside. POCUS can accurately diagnose cardiac arrest in hospital settings, overcoming some of the shortcomings of diagnosis through checking the central pulse (carotid arteries or subclavian arteries), as well as detecting movement and contractions of the heart. Using POCUS, clinicians can have limited, two-dimensional views of different parts of the heart during arrest. These images can help clinicians determine whether electrical activity within the heart is pulseless or pseudo-pulseless, as well as help them diagnose the potentially reversible causes of an arrest. Published guidelines from the American Society of Echocardiography, American College of Emergency Physicians, European Resuscitation Council, and the American Heart Association, as well as the 2018 preoperative Advanced Cardiac Life Support guidelines, have recognized the potential benefits of using POCUS in diagnosing and managing cardiac arrest. Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. Instead, the current guidelines prompt individuals to begin CPR on any unconscious person who has absent or abnormal breathing. The Resuscitation Council in the United Kingdom stand in line with the ERC's recommendations and those of the American Heart Association. They have suggested that the technique to check carotid pulses should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration. Various other methods for detecting circulation, and therefore diagnosing cardiac arrest have been proposed. Guidelines following the 2000 International Liaison Committee on Resuscitation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse. These signs included coughing, gasping, colour, twitching, and movement. However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally, a similar protocol that of which the European Resuscitation Council has adopted. In a non-acute setting where the patient is expired, diagnosis of cardiac arrest can be done via molecular autopsy or postmortem molecular testing which uses a set of molecular techniques to find the ion channels that are cardiac defective. This could help elucidate the cause of death in the patient. Other physical signs or symptoms can help determine the potential cause of the cardiac arrest. Below is a chart of the clinical findings and signs/symptoms a person may have and a potential cause associated with it. +Physical findings related to potential causes Location Findings Possible Causes General Pale skin Hemorrhage Decreased body temperature Hypothermia Airway Presence of secretions, vomit, blood Aspiration Inability to provide positive pressure ventilation Tension pneumothorax Airway obstruction Neck Distension of the neck veins Tension pneumothorax Cardiac tamponade Pulmonary embolism Trachea shifted to one side Tension pneumothorax Chest Scar in the middle of the sternum Cardiac disease Lungs Breath sounds only on one side Tension pneumothorax Right mainstem intubation Aspiration No breath sounds or distant breath sounds Esophageal intubation Airway obstruction Wheezing Aspiration Bronchospasm Pulmonary edema Rales Aspiration Pulmonary edema Pneumonia Heart Decreased heart sounds Hypovolemia Cardiac tamponade Tension pneumothorax Pulmonary embolus Abdomen Distended and dull Ruptured abdominal aortic aneurysm Ruptured ectopic pregnancy Distended and tympanic Esophageal intubation Rectal Blood present Gastrointestinal hemorrhage Extremities Asymmetrical pulses Aortic dissection Skin Needle tracks Drug abuse Classifications Clinicians classify cardiac arrest into "shockable" versus "non-shockable", as determined by the EKG rhythm. This refers to whether a particular class of cardiac dysrhythmia is treatable using defibrillation. The two "shockable" rhythms are ventricular fibrillation and pulseless ventricular tachycardia while the two "non-shockable" rhythms are asystole and pulseless electrical activity. | complications of Cardiovascular disease | symptoms of Cardiovascular disease | complications of Arrhythmia | symptoms of Coronary artery disease | complications of Angina | symptom of Coronary artery disease | complications of Myocardial infarction | symptom of Cardiovascular disease | 00
| 4,346 |
Good hygiene is necessary to avoid reinfection. The Rockefeller Foundation's hookworm campaign in Mexico in the 1920s was extremely effective at eliminating hookworm from humans with the use of anthelmintics. However, preventative measures were not adequately introduced to the people that were treated. Therefore, the rate of reinfection was extremely high and the project evaluated through any sort of scientific method was a marked failure. More education was needed to inform the people of the importance of wearing shoes, using latrines (better access to sanitation), and good hygiene.<unk> parasite prevention methods are not isolated to specific geographical areas; however, many of the research-based interventions have primarily taken place in underdeveloped countries and regions, where sanitation is a large concern for spreading disease.Current best practice behaviors that prevent<unk> parasites include: using proper hand washing practices, using correctly-built latrines with ample ventilation, having a piped water source, and wearing shoes. Currently, in some parts of Ethiopia where disease prevalence is high, up to 80% of people in a population lack access to washing facilities. While this is high, 93% did have access to a latrine, but only 29.2% of those latrines had proper construction to decrease parasitic infections. Behavioral interventions have focused on promoting washing, sometimes with soap, in context of education at schools and child care facilities. In recent studies, the best interventions follow a multidisciplinary approach by: * Increasing environmental sanitation to promote hand washing and shoe wearing habits * Educating children at young ages at school and at home Specific evidence-based interventions that may lower disease prevalence include: * Interventions at schools, focusing on the construction of pit latrines (ventilated and improved), providing clean drinking water and educating the students about hygiene * The SAFE (surgery, antibiotics, facial cleanliness, environmental sanitation) strategy to address trachoma, primarily the facial cleanliness and the environmental sanitation components * Hand-washing with soap at critical times and nail clipping to decrease reinfection rates, although further research is needed to develop and implement similar interventions at scale * Programs combining anthelmintic drug administration with interventions to increase environmental sanitation (such as decreasing fecal contamination) | Intestinal parasite infection | Soil-transmitted helminthiasis | Pinworm infection | Hookworm infection | Intestinal infectious diseases | Behavior-altering parasite | Protozoan infection | Foreign body in alimentary tract | 00
| 8,237 |
Physical examination | Craniotabes | Biorisk | Midaflur | Ulotaront | Draco | Curette | Foltx | Cloforex | 00
| 39,245 |
May-Grünwald-Giemsa The May-Grünwald-Giemsa stain is a two step procedure that includes first staining with May-Grünwald stain, which does not produce the<unk> effect, followed by staining the Giemsa stain which does produce the<unk> effect. Wright's and Wright-Giemsa stains Wright's stain can be used alone or in combination with the Giemsa stain, which is known as the Wright-Giemsa stain. Wright's stain is named after James Homer Wright who in 1902 published a method using heat to produce polychromed methylene blue, which is combined with eosin Y. The polychromed methylene blue is combined with eosin and allowed to precipitate, forming an eosinate which is redissolved in methanol. The addition of Giemsa to Wright's stain increases the brightness of the "reddish-purple" color of the cytoplasmic granules. The Wright's and Wright-Giemsa stains are two of the<unk> -type stains in common use in the United States and are mainly used for the staining of blood and bone marrow films. Leishman stain In 1901 William Leishman developed a stain that was similar to Louis Jenner's but with the replacement of pure methylene blue with polychromed methylene blue. Leishman's stain is prepared from the eosinate of polychromed methylene blue and eosin Y using methanol as the solvent. Giemsa stain Giemsa stain is composed of "Azure II" and eosin Y with methanol and glycerol as the solvent. "Azure II" is thought to be a mixture of azure B (which Giemsa called "azure I") and methylene blue, although the exact composition of "azure I" is considered a trade secret. Comparable formulations using known dyes have been published and are commercially available. Giemsa stain is considered to be the standard stain for detection and identification of the malaria parasite. | Romanowsky stain | Wayson stain | Bielschowsky stain | Auramine phenol stain | Movat's stain | Feulgen stain | Jones' stain | Alcian blue stain | 00
| 9,093 |
As of 2017 the cause of the disease was not understood. | Schnitzler syndrome | Bloom syndrome | Plummer–Vinson syndrome | Senter syndrome | Tropical sprue | Hartnup disease | Food protein-induced enterocolitis syndrome | Juvenile polyposis syndrome | 00
| 52,039 |
Screening ECGs (either at rest or with exercise) are not recommended in those without symptoms who are at low risk. This includes those who are young without risk factors. In those at higher risk the evidence for screening with ECGs is inconclusive. Additionally echocardiography, myocardial perfusion imaging, and cardiac stress testing is not recommended in those at low risk who do not have symptoms. Some biomarkers may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the value of some biomarkers is questionable. Ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP), and coronary artery calcium, are also of unclear benefit in those without symptoms as of 2018. The NIH recommends lipid testing in children beginning at the age of 2 if there is a family history of heart disease or lipid problems. It is hoped that early testing will improve lifestyle factors in those at risk such as diet and exercise. Screening and selection for primary prevention interventions has traditionally been done through absolute risk using a variety of scores (ex. Framingham or Reynolds risk scores). This stratification has separated people who receive the lifestyle interventions (generally lower and intermediate risk) from the medication (higher risk). The number and variety of risk scores available for use has multiplied, but their efficacy according to a 2016 review was unclear due to lack of external validation or impact analysis. Risk stratification models often lack sensitivity for population groups and do not account for the large number of negative events among the intermediate and low risk groups. As a result, future preventative screening appears to shift toward applying prevention according to randomized trial results of each intervention rather than large-scale risk assessment. | risks of Erectile dysfunction | risks of Hypertriglyceridemia | risks of Stevens–Johnson syndrome | risks of Myocardial infarction | risks of Subarachnoid hemorrhage | risks of Pelvic inflammatory disease | risks of Coronary artery disease | risks of Toxic epidermal necrolysis | 00
| 13,534 |
The nerve of the<unk><unk> forms from the junction of the greater petrosal nerve and the deep petrosal nerve within the foreamen lacerum. This combined nerve exits the foramen lacerum and travels to the pterygopalatine fossa through the<unk><unk> in the sphenoid. The nerve of the<unk><unk> contains axons of both sympathetic and parasympathetic axons, specifically; *preganglonic parasympathetic axons from the greater petrosal nerve, a branch of the facial nerve (cell bodies are located in the superior salivatory nucleus) *postganglionic sympathetic axons from the deep petrosal nerve, a branch of the internal carotid plexus (cell bodies are located in the superior cervical ganglion) | Nerve of pterygoid canal | Buccal branches of the facial nerve | Oculomotor nerve | Supratrochlear nerve | Olfactory nerve | Marginal mandibular branch of the facial nerve | Auriculotemporal nerve | Iris sphincter muscle | 00
| 36,349 |
Amyotrophic lateral sclerosis<unk> was approved in the United States for the treatment of ALS by the U.S. Food and Drug Administration (FDA) in 1995. A Cochrane Library review states a 9% gain in the probability of surviving one year. | Riluzole | Glatiramer acetate | Inotersen | Glybuzole | Nusinersen | Fingolimod | Tocilizumab | Glysobuzole | 00
| 21,923 |
Extensive investigation into<unk> has shown that there is no relationship between the two, causal or otherwise, and that<unk> ingredients do not cause autism. Vaccinologist Peter Hotez researched the growth of the false claim and concluded that its spread originated with Andrew Wakefield's fraudulent 1998 paper, with no prior paper supporting a link. Despite the scientific consensus for the absence of a relationship and the retracted paper, the anti-vaccination movement at large continue to promote myths, conspiracy theories, and misinformation linking the two. A developing tactic appears to be the "promotion of irrelevant research as an active aggregation of several questionable or peripherally related research studies in an attempt to justify the science underlying a questionable claim." | Vaccines and autism | MMR vaccine and autism | Diet and cancer | Breastfeeding and HIV | Epilepsy and driving | Religion and HIV/AIDS | Epilepsy and employment | Alcohol and health | 00
| 72,025 |
<unk> is used for the treatment of active duodenal ulcers not related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs), as the mechanism behind these ulcers is due to acid oversecretion. It is not FDA approved for gastric ulcers, but is widely used because of evidence of efficacy. The use for<unk> in peptic ulcer disease has diminished recently, but it is still the preferred agent for stress ulcer prevention.<unk> has also been used for the following conditions: * Active duodenal ulcer not related to NSAID use * Maintenance therapy for resolved duodenal ulcers * Gastric ulcer not related to NSAID use and gastritis due to GERD—Triple combination therapy with lansoprazole + cisapride +<unk> can significantly improve symptoms and quality of life and was more cost-effective than ranitidine combination group. * Aphthous ulcer and stomatitis due to radiation or chemotherapy—The 2013 guidelines of the International Society of Oral Oncology does not recommended<unk> for the prevention of oral mucositis in head and neck cancer patients receiving radiotherapy or chemoradiation due to a lack of efficacy found in a randomized controlled trial. * Gastro-esophageal reflux disease during pregnancy—First-line drug therapy combined with lifestyle and diet modification. * Stress ulcer prophylaxis—The use of<unk> rather than H2 antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as continuous subglottic suctioning, have been shown to reduce the risk of ventilator-associated pneumonia (VAP).<unk> is less effective for prophylaxis against gastrointestinal bleeding than either a PPI or H2-blocker. For that reason, it is not commonly used for stress ulcer prophylaxis. * Prevention of stricture formation—Sucralfate has an inhibitory effect on stricture formation in experimental corrosive burns and can be used in the treatment of corrosive esophageal burns to enhance mucosal healing and suppress stricture formation * Proctitis from ulcerative colitis * Rectal bleeding due to proctitis from radiation to treat cancers of the cervix, prostate, and colon. * Grade 1 bleeding experienced immediate relief with sucrasulfate enema for 1 month. * Grade 2 bleeding, sucrasulfate enema and/or coagulation were effective. * Grade 3 bleeding lasted for 1 year despite frequent transfusions and coagulation. * Grade 2 and 3 rectal bleeding occurred in 8.5% of people. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucrasulfate enema and coagulation is effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture. * Treatment of anastomotic ulcer after gastric bypass surgery *<unk> suspension is recommended by the US-based National Capital Poison Center (Poison Control) as an intervention for known or suspected button battery ingestions to reduce the risk and severity of injury to the esophagus prior to the battery's endoscopic removal. *Protection against ventilator-associated pneumonia - Reductions in gastric acidity and volumes increase bacterial overgrowth and the incidence of ventilator-associated pneumonia.<unk> may be considered to have the advantage over H2-blockers and PPIs in this regard because<unk> does not change the pH of gastric fluid. A majority of meta-analyses found that<unk> therapy decreased the incidence of ventilator-associated pneumonia compared to H2-antagonists. | Sucralfate | Cimetidine | Dexlansoprazole | Lansoprazole | Azacitidine | Ranitidine | Loperamide | Rabeprazole | 00
| 28,861 |
<unk> formerly known as American Well, is a telemedicine company based in Boston, Massachusetts, that connects patients with doctors over secure video.<unk> sells its platform as a subscription service to healthcare providers to put their medical professionals online and its proprietary software development kits, APIs, and system integrations enable clients to embed telehealth into existing workflows utilized by providers and patients.<unk> has roughly 800 employees and has raised more than $500 million from investors, including Anthem, Philips, Allianz and Teva Pharmaceuticals, with the goal of connecting patients to healthcare providers remotely. The company operates in all 50 U.S. states and works with 55 health plans, which support over 36,000 employers and collectively represent more than 80 million covered lives, as well as 240 of the nation's largest health systems, encompassing more than 2,000 hospitals. In 2020, over 40,000 providers were using the<unk> Platform. American Well was rebranded to<unk> on March 9, 2020. | Amwell | Wart | Aidman | Sultiame | Lisp | Lunsers | Ices | Ambe | 00
| 65,934 |
<unk> s are treated with surgery. | Goblet cell carcinoid | Nipple adenoma | Small intestine neuroendocrine tumor | VIPoma | Pulmonary enteric adenocarcinoma | Ceruminous adenocarcinoma | Hibernoma | Sebaceous adenoma | 00
| 60,060 |
<unk> , sold under the brand name Byetta and Bydureon among others, is a medication used to treat diabetes mellitus type 2. It is used together with diet, exercise, and potentially other antidiabetic medication. It is a treatment option after metformin and sulfonylureas. It is given by injection under the skin within an hour before the first and last meal of the day. A once-weekly injection version is also available. Common side effects include low blood sugar, nausea, dizziness, abdominal pain, and pain at the site of injection. Other serious side effects may include medullary thyroid cancer, angioedema, pancreatitis, and kidney injury. Use in pregnancy and breastfeeding is of unclear safety.<unk> is a glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist) also known as incretin mimetics. It works by increasing insulin release from the pancreas and decreases excessive glucagon release.<unk> was approved for medical use in the United States in 2005. In 2017, it was the 260th most commonly prescribed medication in the United States, with more than one million prescriptions. | Exenatide | Liraglutide | Linagliptin | Pioglitazone | Insulin degludec | Rosiglitazone | Canagliflozin | Vildagliptin | 00
| 32,176 |
Aspergillus spores are small (2–3 μm in diameter) and can penetrate deep into the respiratory system to the alveolar level. In healthy people, innate and adaptive immune responses are triggered by various immune cells (notably neutrophils, resident alveolar macrophages and dendritic cells) drawn to the site of infection by numerous inflammatory cytokines and neutrophilic attractants (such as CXCR2 receptor ligands). In this situation, mucociliary clearance is initiated and spores are successfully phagocytosed, clearing the infection from the host. In people with predisposing lung diseases—such as persistent asthma or cystic fibrosis (or rarer diseases such as chronic granulomatous disease or Hyper-IgE syndrome)—several factors lead to an increased risk of<unk> . These include immune factors (such as atopy or immunogenic HLA-restricted phenotypes), as well as genetic factors (such as CFTR gene mutations in both asthmatics and cystic fibrosis patients and a ZNF77 mutation resulting in a premature stop codon in asthmatics and<unk> patients). By allowing Aspergillus spores to persist in pulmonary tissues, it permits successful germination which leads to hyphae growing in mucus plugs. There are hypersensitivity responses, both a type I response (atopic, with formation of immunoglobulin E, or IgE) and a type III hypersensitivity response (with formation of immunoglobulin G, or IgG). The reaction of IgE with Aspergillus antigens results in mast cell degranulation with bronchoconstriction and increased capillary permeability. Immune complexes (a type III reaction) and inflammatory cells are deposited within the mucous membranes of the airways, leading to necrosis (tissue death) and eosinophilic infiltration. Type 2 T helper cells appear to play an important role in<unk> due to an increased sensitivity to interleukin (IL) 4 and IL-5. These cytokines up-regulate mast cell degranulation, exacerbating respiratory decline. Aspergillus also utilises a number of factors to continue evading host responses, notably the use of proteolytic enzymes that interrupt IgG antibodies aimed towards it. Another important feature is its ability to interact and integrate with epithelial surfaces, which results in massive pro-inflammatory counter-response by the immune system involving IL-6, IL-8 and MCP-1 (a CCL2 receptor ligand). Proteases released by both the fungus and neutrophils induce further injury to the respiratory epithelium, leading to initiation of repair mechanisms (such as an influx of serum and extracellular matrix (ECM) proteins) at the site of infection. Aspergillus spores and hyphae can interact with ECM proteins, and it is hypothesised that this process facilitates the binding of spores to damaged respiratory sites. As concentrations of Aspergillus proteases increase, the immunological effect switches from pro-inflammatory to inhibitory, and further reduces phagocytic ability to clear Aspergillus. Ultimately, repeated acute episodes lead to wider scale damage of pulmonary structures (parenchyma) and function via irreversible lung remodelling. Left untreated, this manifests as progressive bronchiectasis and pulmonary fibrosis that is often seen in the upper lobes, and can give rise to a similar radiological appearance to that produced by tuberculosis. | Allergic bronchopulmonary aspergillosis | Chronic pulmonary aspergillosis | Tuberculosis | Miliary tuberculosis | Fungal pneumonia | Primary pulmonary coccidioidomycosis | Cryptogenic organizing pneumonia | Atypical pneumonia | 00
| 36,459 |
A woman with<unk> Characteristic symptoms vary with severity. In general symptoms are internal or external bleeding episodes, which are called "bleeds". People with more severe<unk> suffer more severe and more frequent bleeds, while people with mild<unk> usually suffer more minor symptoms except after surgery or serious trauma. In cases of moderate<unk> symptoms are variable which manifest along a spectrum between severe and mild forms. In both<unk> A and B, there is spontaneous bleeding but a normal bleeding time, normal prothrombin time, normal thrombin time, but prolonged partial thromboplastin time. Internal bleeding is common in people with severe<unk> and some individuals with moderate<unk> . The most characteristic type of internal bleed is a joint bleed where blood enters into the joint spaces. This is most common with severe<unk> cs and can occur spontaneously (without evident trauma). If not treated promptly, joint bleeds can lead to permanent joint damage and disfigurement. Bleeding into soft tissues such as muscles and subcutaneous tissues is less severe but can lead to damage and requires treatment. Children with mild to moderate<unk> may not have any signs or symptoms at birth, especially if they do not undergo circumcision. Their first symptoms are often frequent and large bruises and haematomas from frequent bumps and falls as they learn to walk. Swelling and bruising from bleeding in the joints, soft tissue, and muscles may also occur. Children with mild<unk> may not have noticeable symptoms for many years. Often, the first sign in very mild<unk> cs is heavy bleeding from a dental procedure, an accident, or surgery. Females who are carriers usually have enough clotting factors from their one normal gene to prevent serious bleeding problems, though some may present as mild<unk> cs. Complications Severe complications are much more common in cases of severe and moderate<unk> . Complications may arise from the disease itself or from its treatment: * Deep internal bleeding, e.g. deep-muscle bleeding, leading to swelling, numbness or pain of a limb. * Joint damage from haemarthrosis <unk> arthropathy), potentially with severe pain, disfigurement, and even destruction of the joint and development of debilitating arthritis. * Transfusion transmitted infection from blood transfusions that are given as treatment. * Adverse reactions to clotting factor treatment, including the development of an immune inhibitor which renders factor replacement less effective. * Intracranial haemorrhage is a serious medical emergency caused by the buildup of pressure inside the skull. It can cause disorientation, nausea, loss of consciousness, brain damage, and death.<unk> arthropathy is characterized by chronic proliferative synovitis and cartilage destruction. If an intra-articular bleed is not drained early, it may cause apoptosis of chondrocytes and affect the synthesis of proteoglycans. The hypertrophied and fragile synovial lining while attempting to eliminate excessive blood may be more likely to easily rebleed, leading to a vicious cycle of hemarthrosis-synovitis-hemarthrosis. In addition, iron deposition in the synovium may induce an inflammatory response activating the immune system and stimulating angiogenesis, resulting in cartilage and bone destruction. | Haemophilia | Pedophilia | Acquired haemophilia | Exophilia | Dysfibrinogenemia | Von Willebrand disease | Harris platelet syndrome | Quebec platelet disorder | 00
| 1,118 |
+Occurrence of ARC by disease Disease state ARC Severe burn 65% Sepsis 39.5–56% Subarachnoid hemorrhage 100% Trauma 85.7% Traumatic brain injury 85%<unk> can occur in many critical care instances, but is common when patients are administered large quantities of fluid replacement, as is common in an intensive care unit. It is considered a normal part of the body's response to a severe infection or other traumatic event. Changes in renal function due to trauma or infection may be in part due to changes in hormone release as part of the body's immune and healing responses. | Augmented renal clearance | Enhanced permeability and retention effect | Bioconcentration | Electrolyte exclusion effect | Natriuresis | Renal compensation | Prostatic congestion | Adrenal fatigue | 00
| 73,755 |
Walter Reed Hospital, in Washington, D.C. during the 1918 flu pandemic. An<unk> is an epidemic of an influenza virus that spreads across a large region (either multiple continents or worldwide) and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The most recent, the 2009 swine flu pandemic, resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.<unk> s occur when a new strain of the influenza virus is transmitted to humans from another animal species. Species that are thought to be important in the emergence of new human strains are pigs, chickens and ducks. These novel strains are unaffected by any immunity people may have to older strains of human influenza and can therefore spread extremely rapidly and infect very large numbers of people. Influenza A viruses can occasionally be transmitted from wild birds to other species, causing outbreaks in domestic poultry, and may give rise to human<unk> s. The propagation of influenza viruses throughout the world is thought in part to be by bird migrations, though commercial shipments of live bird products might also be implicated, as well as human travel patterns. The World Health Organization (WHO) has produced a six-stage classification that describes the process by which a novel influenza virus moves from the first few infections in humans through to a pandemic. This starts with the virus mostly infecting animals, with a few cases where animals infect people, then moves through the stage where the virus begins to spread directly between people, and ends with a pandemic when infections from the new virus have spread worldwide. One strain of virus that may produce a pandemic in the future is a highly pathogenic variation of the H5N1 subtype of influenza A virus. On 11 June 2009, a new strain of H1N1 influenza was declared to be a pandemic (Stage 6) by the WHO after evidence of spreading in the southern hemisphere. The 13 November 2009 worldwide update by the WHO stated that "as of 8 November 2009, worldwide more than 206 countries and overseas territories or communities have reported 503,536 laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6,250 deaths." | Influenza pandemic | Third plague pandemic | Second plague pandemic | First plague pandemic | Massachusetts smallpox epidemic | Pandemic | Swine influenza | Flu season | 00
| 30,074 |
<unk> , sold under the brand name Xalatan among others, is a medication used to treat increased pressure inside the eye. This includes ocular hypertension and open angle glaucoma. It is applied as eye drops to the eyes. Onset of effects is usually within four hours, and they last for up to a day. Common side effects include blurry vision, redness of the eye, itchiness, and darkening of the iris.<unk> is in the prostaglandin analogue family of medications. It works by increasing the outflow of aqueous fluid from the eyes through the uveoscleral tract.<unk> was approved for medical use in the United States in 1996. It is on the World Health Organization's List of Essential Medicines.<unk> is available as a generic medication. In 2019, it was the 77th most commonly prescribed medication in the United States with more than 9million prescriptions. | Latanoprost | Travoprost | Carboprost | Iloprost | Bimatoprost | Travoprost/timolol | Bimatoprost/timolol | Bifluranol | 00
| 27,511 |
Histopathologic images of Alzheimer's disease, in the CA3 area of the hippocampus, showing an amyloid plaque (top right), neurofibrillary tangles (bottom left), and granulovacuolar degeneration bodies (bottom center) Neuropathology Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions. This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulate gyrus. Degeneration is also present in brainstem nuclei particularly the locus coeruleus in the pons. Studies using MRI and PET have documented reductions in the size of specific brain regions in people with Alzheimer's disease as they progressed from mild cognitive impairment to Alzheimer's disease, and in comparison with similar images from healthy older adults. Both Aβ plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by Alzheimer's disease, especially in the hippocampus. However, Alzheimer's disease may occur without neurofibrillary tangles in the neocortex. Plaques are dense, mostly insoluble deposits of beta-amyloid peptide and cellular material outside and around neurons. Tangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves. Although many older individuals develop some plaques and tangles as a consequence of aging, the brains of people with Alzheimer's disease have a greater number of them in specific brain regions such as the temporal lobe. Lewy bodies are not rare in the brains of people with Alzheimer's disease. Biochemistry Alzheimer's disease has been identified as a protein misfolding disease, a proteopathy,<unk> d by the accumulation of abnormally folded amyloid beta protein into amyloid plaques, and tau protein into neurofibrillary tangles in the brain. Plaques are made up of small peptides, 39–43 amino acids in length, called amyloid beta (Aβ). Amyloid beta is a fragment from the larger amyloid-beta precursor protein (APP) a transmembrane protein that penetrates the neuron's membrane. APP is critical to neuron growth, survival, and post-injury repair. In Alzheimer's disease, gamma secretase and beta secretase act together in a proteolytic process which<unk> s APP to be divided into smaller fragments. One of these fragments gives rise to fibrils of amyloid beta, which then form clumps that deposit outside neurons in dense formations known as amyloid plaques. Alzheimer's disease is also considered a tauopathy due to abnormal aggregation of the tau protein. Every neuron has a cytoskeleton, an internal support structure partly made up of structures called microtubules. These microtubules act like tracks, guiding nutrients and molecules from the body of the cell to the ends of the axon and back. A protein called tau stabilises the microtubules when phosphorylated, and is therefore called a microtubule-associated protein. In Alzheimer's disease, tau undergoes chemical changes, becoming hyperphosphorylated; it then begins to pair with other threads, creating neurofibrillary tangles and disintegrating the neuron's transport system. Pathogenic tau can also<unk> neuronal death through transposable element dysregulation. Disease mechanism Exactly how disturbances of production and aggregation of the beta-amyloid peptide give rise to the pathology of Alzheimer's disease is not known. The amyloid hypothesis traditionally points to the accumulation of beta-amyloid peptides as the central event triggering neuron degeneration. Accumulation of aggregated amyloid fibrils, which are believed to be the toxic form of the protein responsible for disrupting the cell's calcium ion homeostasis, induces programmed cell death (apoptosis). It is also known that Aβ selectively builds up in the mitochondria in the cells of Alzheimer's-affected brains, and it also inhibits certain enzyme functions and the utilisation of glucose by neurons. Various inflammatory processes and cytokines may also have a role in the pathology of Alzheimer's disease. Inflammation is a general marker of tissue damage in any disease, and may be either secondary to tissue damage in Alzheimer's disease or a marker of an immunological response. There is increasing evidence of a strong interaction between the neurons and the immunological mechanisms in the brain. Obesity and systemic inflammation may interfere with immunological processes which promote disease progression. Alterations in the distribution of different neurotrophic factors and in the expression of their receptors such as the brain-derived neurotrophic factor (BDNF) have been described in Alzheimer's disease. | medical cause of Dementia | medical cause of Frontotemporal dementia | symptom of Alzheimer's disease | medical cause of Parkinsonism | complications of Frontotemporal lobar degeneration | symptom of Amyotrophic lateral sclerosis | symptom of Lesch–Nyhan syndrome | medical cause of Dystonia | 00
| 51,365 |
Individuals with QPD are at risk for experiencing a number of bleeding symptoms, including joint bleeds, hematuria, and large bruising. | Quebec platelet disorder | Harris platelet syndrome | Gray platelet syndrome | Sticky platelet syndrome | Glanzmann's thrombasthenia | Bernard–Soulier syndrome | Pseudo gray platelet syndrome | Von Willebrand disease | 00
| 49,447 |
The diagnosis of<unk> can be done via the following methods and tests: * MRI * Chest radiography * Pulmonary function test * Lymph node test * Laboratory test (to measure CD40) Types Five types of<unk> have been characterized: *<unk> type 1 (X-linked), characterized by mutations of the CD40LG gene. In this type, T cells cannot tell B cells to switch classes. *<unk> type 2 (autosomal recessive), characterized by mutations of the AICDA gene. In this type, B cells cannot recombine genetic material to change heavy chain production *<unk> type 3 characterized by mutations of the CD40 gene. In this type, B cells cannot receive the signal from T cells to switch classes. *<unk> type 4 which is a defect in class switch recombination downstream of the AICDA gene that does not impair Somatic Hypermutation. *<unk> type 5 characterized by mutations of the UNG gene. | Hyper IgM syndrome | Hyper-IgM syndrome type 5 | Hyper-IgM syndrome type 2 | Hyper-IgM syndrome type 3 | Hyper-IgM syndrome type 4 | Hyper-IgM syndrome type 1 | Anti-IgLON5 disease | Common variable immunodeficiency | 00
| 40,366 |
<unk> is recognized as a social determinant of health.<unk> has also been identified as a social vaccine against contracting<unk> . Research suggests a negative linear<unk> between<unk> al attainment (years of<unk> and<unk> infection rate, especially the<unk> al attainment of women and girls. The United Nations<unk> al, Scientific, and Cultural Organization (UNESCO) aims to ensure all individuals, in and out of formal<unk> , have access to comprehensive<unk> <unk> . UNESCO is a founding cosponsor of UNAIDS, and in conjunction with partner agencies UNESCO published the International Technical Guidance on Sexuality<unk> in 2018. This report provides evidence-based guidelines for developing and implementing comprehensive sexuality<unk> curriculum for young people. | Relationship between education and HIV/AIDS | Epidemiology of domestic violence | Impact of health on intelligence | Psychological effects of Internet use | Genetics of post-traumatic stress disorder | Timeline of sexual orientation and medicine | Caregiving by country | Prevalence of mental disorders | 00
| 64,928 |
A<unk> is a break of the<unk> bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.<unk> s are most commonly caused by a fall on an outstretched hand. Diagnosis is generally based on a combination of clinical examination and medical imaging. Some fractures may not be visible on plain X-rays. In such cases the affected area may be immobilised in a splint or cast and reviewed with repeat X-rays in two weeks, or alternatively an MRI or bone scan may be performed. The fracture may be preventable by using wrist guards during certain activities. In those in whom the fracture remains well aligned a cast is generally sufficient. If the fracture is displaced then surgery is generally recommended. Healing may take up to six months. It is the most commonly fractured carpal bone. Males are affected more often than females. | Scaphoid fracture | De Quervain syndrome | Bosworth fracture | Wrist | Hume fracture | Scapholunate ligament | Cuboid fracture | Distal radius fracture | 00
| 43,521 |
Inhaled<unk> works like other β2 agonists, causing bronchodilation by relaxing the smooth muscle in the airway so as to treat the exacerbation of asthma. | Formoterol | Arformoterol | Salmeterol | Fluticasone | Levosalbutamol | Salbutamol | Beclometasone/formoterol | Seratrodast | 00
| 22,130 |
The clinical manifestations of tetanus are caused when tetanus toxin blocks inhibitory impulses, by interfering with the release of neurotransmitters, including glycine and gamma-aminobutyric acid. These inhibitory neurotransmitters inhibit the alpha motor neurons. With diminished inhibition, the resting firing rate of the alpha motor neuron increases, producing rigidity, unopposed muscle contraction and spasm. Characteristic features are risus sardonicus (a rigid smile), trismus (commonly known as "lock-jaw"), and opisthotonus (rigid, arched back). Seizures may occur, and the autonomic nervous system may also be affected.<unk> appears to prevent the release of neurotransmitters by selectively cleaving a component of synaptic vesicles called synaptobrevin II. Loss of inhibition also affects preganglionic sympathetic neurons in the lateral gray matter of the spinal cord and produces sympathetic hyperactivity and high circulating catecholamine levels. Hypertension and tachycardia alternating with hypotension and bradycardia may develop. Tetanic spasms can occur in a distinctive form called opisthotonos and be sufficiently severe to fracture long bones. The shorter nerves are the first to be inhibited, which leads to the characteristic early symptoms in the face and jaw, risus sardonicus and lockjaw. The toxin bind to the neurons is irreversible and nerve function can only be returned by the growth of new terminals and synapses. | Tetanospasmin | Immunoevasin | Pentostatin | Endrin | Anordrin | Thrombin | Fibrinolysin | Cathelicidin | 00
| 8,270 |
William Smellie (1792) Wooden<unk> c.1800, Hunterian Museum, Glasgow James Young Simpson's Caesarian<unk> , Hunterian Museum, Glasgow Obstetric<unk> consist of two branches (blades) that are positioned around the head of the fetus. These branches are defined as left and right depending on which side of the mother's pelvis they will be applied. The branches usually, but not always, cross at a midpoint, which is called the articulation. Most<unk> have a locking mechanism at the articulation, but a few have a sliding mechanism instead that allows the two branches to slide along each other.<unk> with a fixed lock mechanism are used for deliveries where little or no rotation is required, as when the fetal head is in line with the mother's pelvis.<unk> with a sliding lock mechanism are used for deliveries requiring more rotation. The blade of each<unk> branch is the curved portion that is used to grasp the fetal head. The<unk> should surround the fetal head firmly, but not tightly. The blade characteristically has two curves, the cephalic and the pelvic curves. The cephalic curve is shaped to conform to the fetal head. The cephalic curve can be rounded or rather elongated depending on the shape of the fetal head. The pelvic curve is shaped to conform to the birth canal and helps direct the force of the traction under the pubic bone.<unk> used for rotation of the fetal head should have almost no pelvic curve. The handles are connected to the blades by shanks of variable lengths.<unk> with longer shanks are used if rotation is being considered. Anglo-American types All American<unk> are derived from French<unk> (long<unk> or English<unk> (short<unk> . Short<unk> are applied on the fetal head already descended significantly in the maternal pelvis (i.e., proximal to the vagina). Long<unk> are able to reach a fetal head still in the middle or even in the upper part of the maternal pelvis. At present practice, it is uncommon to use<unk> to access a fetal head in the upper pelvis. So, short<unk> are preferred in the UK and USA. Long<unk> are still in use elsewhere. Simpson<unk> (1848) are the most commonly used among the types of<unk> and has an elongated cephalic curve. These are used when there is substantial molding, that is, temporary elongation of the fetal head as it moves through the birth canal. Elliot<unk> (1860) are similar to Simpson<unk> but with an adjustable pin in the end of the handles which can be drawn out as a means of regulating the lateral pressure on the handles when the instrument is positioned for use. They are used most often with women who have had at least one previous vaginal delivery because the muscles and ligaments of the birth canal provide less resistance during second and subsequent deliveries. In these cases the fetal head may thus remain rounder. Kielland<unk> (1915, Norwegian) are distinguished by having no angle between the shanks and the blades and a sliding lock. The pelvic curve of the blades is identical to all other<unk> . The common misperception that there is no pelvic curve has become so entrenched in the<unk> iterature that it may never be able to be overcome, but it can be proved by holding a blade of Kielland's against any other<unk> of one's choice. Kielland<unk> are probably the most common<unk> used for rotation. The sliding mechanism at the articulation can be helpful in asynclitic births (when the fetal head is tilted to the side) since it is no longer in line with the birth canal. Because the handles, shanks, and blades are all in the same plane the<unk> can be applied in any position to affect rotation. Because the shanks and handles are not angled, the<unk> cannot be applied to a high station as readily as those with the angle since the shanks impinge on the perineum. Wrigley's<unk> , named after Arthur Joseph Wrigley, are used in low or outlet deliveries (see explanations below), when the maximum diameter is about above the vulva. Wrigley's<unk> were designed for use by general practitioner obstetricians, having the safety feature of an inability to reach high into the pelvis. Obstetricians now use these<unk> most commonly in cesarean section delivery where manual traction is proving difficult. The short length results in a lower chance of uterine rupture. Piper's<unk> has a perineal curve to allow application to the after-coming head in breech delivery. | Obstetrical forceps | Forceps | Dermacentor | Caesarean section | Natural childbirth | Condom machine | Labor induction | Debakey forceps | 00
| 45,025 |
The consensus is that the use of<unk> should be restricted only to healthy individuals, in situations where it offers specific advantages and even then, only at dosages less than 2.5 MAC hours. The National Institute for Occupational Safety and Health maintains a recommended exposure limit for<unk> as waste anesthetic gas of 2 ppm (13.5 mg/m3) over 60 minutes. Kidney The first report of nephrotoxicity appeared in 1964, when Paddock and colleagues reported three cases of acute kidney injury, two of whom were found to have calcium oxalate crystals in the renal tubules at autopsy. In 1966, Crandell and colleagues reported a series in which 17/95 (18%) of patients developed an unusual type of nephropathy after operations in which<unk> was used as a general anesthetic. This particular type of chronic kidney disease was characterized by vasopressin-resistant high-output kidney failure (production of large volumes of poorly concentrated urine) with a negative fluid balance, pronounced weight loss, elevation of serum sodium, chloride, osmolality and blood urea nitrogen. The urine of these patients was of a relatively fixed specific gravity and an osmolality very similar to that of the serum. Furthermore, the high urine output persisted a challenge test of fluid deprivation. Most cases resolved within 2–3 weeks, but evidence of renal dysfunction persisted for more than one year in 3 of these 17 cases (18%), and more than two years in one case (6%). Compared with halothane,<unk> produces dose-dependent abnormalities in kidney function. The authors showed that subclinical nephrotoxicity occurred following<unk> at minimum alveolar concentration (MAC) for 2.5 to 3 hours (2.5 to 3 MAC hours), while overt toxicity was present in all patients at dosages greater than five MAC hours. This study provided a model that would be used for the assessment of the nephrotoxicity of volatile anesthetics for the next two decades. Furthermore, the concurrent use of tetracyclines and<unk> has been reported to result in fatal renal toxicity. Liver Reports of severe and even fatal hepatotoxicity related to the use of<unk> began to appear in 1966. Mechanism The biodegradation of<unk> begins immediately. The kidney and liver toxicity observed after anesthetic doses is attributable to one or more metabolites produced by O-demethylation of<unk> . Products of this catabolic process include methoxyfluoroacetic acid (MFAA), dichloroacetic acid (DCAA), and inorganic fluoride.<unk> nephrotoxicity is dose dependent and irreversible, resulting from O-demethylation of<unk> to fluoride and DCAA. It is not entirely clear whether the fluoride itself is toxic—it may simply be a surrogate measure for some other toxic metabolite. The concurrent formation of inorganic fluoride and DCAA is unique to<unk> biotransformation compared with other volatile anesthetics, and this combination is more toxic than fluoride alone. This may explain why fluoride formation from<unk> is associated with nephrotoxicity, while fluoride formation from other volatile anesthetics (such as enflurane and sevoflurane) is not. | Methoxyflurane | Isoflurane | Desflurane | Halothane | Sevoflurane | Etomidate | Methitural | Methacholine | 00
| 37,433 |
<unk> is an opportunistic microorganism that infects its host by way of breaks in the skin or epidermis. Inflammation then takes place as the area of infection is inundated with lymphocytes, macrophages, and granulocytes. This pyogenic inflammation causes regional lymphadenitis in the sexually transmitted disease chancroid. | Haemophilus ducreyi | Mycoplasma genitalium | Trichomonas tenax | Chlamydia trachomatis | Mycobacterium ulcerans | Veillonella parvula | Treponema pallidum | Coxa vara | 00
| 12,106 |
Physical appearance Can include: * Periorbital edema "eye puffiness" * Perioral edema * Upper extremity edema * Ascites * Lower extremity edema * Pre-tibial edema * Pedal edema Physical manifestations Can include: * Impaired vision, difficulty opening eyes * Shortness of breath (SOB), dyspnea on exertion (DOE), orthopnea * Chest pain * Extreme discomfort * Debilitation | Anasarca | Edema | Anuria | Myxedema | Arterial stiffness | Peripheral edema | Lipedema | Bisalbuminemia | 00
| 16,765 |