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<unk> <unk> is a mood disorder subset in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year, most commonly in winter. Common symptoms include sleeping too much, having little to no energy, and overeating. The condition in the summer can include heightened anxiety. In the Diagnostic and Statistical Manual of Mental Disorders DSM-IV and DSM-5, its status was changed. It is no longer classified as a unique mood disorder but is now a specifier, called "with<unk> pattern", for recurrent major depressive disorder that occurs at a specific time of the year and fully remits otherwise. Although experts were initially skeptical, this condition is now recognized as a common disorder. However, the validity of<unk> has been questioned by a 2016 analysis by the Center for Disease Control, in which no links were detected between depression and<unk> ity or sunlight exposure. Video explanation In the United States, the percentage of the population affected by<unk> ranges from 1.4% of the population in Florida, to 9.9% in Alaska.<unk> was formally described and named in 1984 by Norman E. Rosenthal and colleagues at the National Institute of Mental Health. | Seasonal affective disorder | Major depressive episode | Major depressive disorder | Depression | Late life depression | Premenstrual syndrome | Secondary mania | Postpartum depression | 00
| 4,833 |
It can present with the following: * severe burning pain * lacrimation * photophobia * blepharospasm * swelling of palpebral conjunctiva * retrotarsal folds Usually the effect of UV exposure is felt after 6-8 hours from exposure. With severe irritation, the eyes become blood red. In minor cases, avoid rubbing and wash the eyes thoroughly with water until the irritation subdues. Always consult an eye specialist as soon as possible. Medications (for minor erosion of cornea) usually involve eye drop such as Hydroxypropyl Methycellulose Ophthalmic solution USP sold under the trade name GenTeal®. (February 2019) | Photophthalmia | Enophthalmia | Xerophthalmia | Enophthalmos | Periorbital hyperpigmentation | Anophthalmia | Exophthalmos | Corneal opacity | 00
| 67,192 |
Some kinds of exercise recommended in OA. Lifestyle modification (such as weight loss and exercise) and pain medications are the mainstays of treatment. Acetaminophen (also known as paracetamol) is recommended first line with NSAIDs being used as add on therapy only if pain relief is not sufficient. Medications that alter the course of the disease have not been found as of 2018. Recommendations include modification of risk factors through targeted interventions including 1) obesity and overweight, 2) physical activity, 3) dietary exposures, 4) comorbidity, 5) biomechanical factors, 6) occupational factors. Lifestyle changes For overweight people, weight loss may be an important factor. Weight loss and exercise provides long-term treatment and advocated in patients with OA. As an adjunct to these lifestyle changes, use of analgesia, intra-articular cortisone injection and consideration of hyaluronic acids and platelet-rich plasma are recommended for pain relief in patients with knee osteoarthritis. Patient education has been shown to be helpful in the self-management of arthritis. It decreases pain, improves function, reduces stiffness and fatigue, and reduces medical usage. Patient education can provide on average 20% more pain relief when compared to NSAIDs alone. Physical measures Moderate exercise may be beneficial with respect to pain and function in those with osteoarthritis of the knee and hip. These exercises should occur at least three times per week. While some evidence supports certain physical therapies, evidence for a combined program is limited. Providing clear advice, making exercises enjoyable, and reassuring people about the importance of doing exercises may lead to greater benefit and more participation. Limited evidence suggests that supervised exercise therapy may improve exercise adherence. There is not enough evidence to determine the effectiveness of massage therapy. The evidence for manual therapy is inconclusive. A 2015 review indicated that aquatic therapy is safe, effective, and can be an adjunct therapy for knee osteoarthritis. Functional, gait, and balance training have been recommended to address impairments of position sense, balance, and strength in individuals with lower extremity arthritis, as these can contribute to a higher rate of falls in older individuals. For people with hand osteoarthritis, exercises may provide small benefits for improving hand function, reducing pain, and relieving finger joint stiffness. Lateral wedge insoles and neutral insoles do not appear to be useful in osteoarthritis of the knee. Knee braces may help but their usefulness has also been disputed. For pain management heat can be used to relieve stiffness, and cold can relieve muscle spasms and pain. Among people with hip and knee osteoarthritis, exercise in water may reduce pain and disability, and increase quality of life in the short term. Also therapeutic exercise programs such as aerobics and walking reduce pain and improve physical functioning for up to 6 months after the end of the program for people with knee osteoarthritis. Hydrotherapy might also be an advantage on the management of pain, disability and quality of life reported by people suffering from osteoarthritis. Medication Treatment recommendations by risk factors GI risk CVD risk Option Low Low NSAID, or paracetamol Moderate Low Paracetamol, or low dose NSAID with antacid Low Moderate Paracetamol, or low dose aspirin with an antacid Moderate Moderate Low dose paracetamol, aspirin, and antacid. Monitoring for abdominal pain or black stool. By mouth The pain medication paracetamol (acetaminophen) is the first line treatment for osteoarthritis. Pain relief does not differ according to dosage. However, a 2015 review found acetaminophen to have only a small short-term benefit with some laboratory concerns of liver inflammation. For mild to moderate symptoms effectiveness of acetaminophen is similar to non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, though for more severe symptoms NSAIDs may be more effective. NSAIDs are associated with greater side effects such as gastrointestinal bleeding. Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) are equally effective when compared to nonselective NSAIDs, and have lower rates of adverse gastrointestinal effects, but higher rates of cardiovascular disease such as myocardial infarction. They are also more expensive than non-specific NSAIDs. Benefits and risks vary in individuals and need consideration when making treatment decisions, and further unbiased research comparing NSAIDS and COX-2 selective inhibitors is needed. NSAIDS applied topically are effective for a small number of people. The COX-2 selective inhibitor rofecoxib was removed from the market in 2004, as cardiovascular events were associated with long term use. Failure to achieve desired pain relief in osteoarthritis after 2 weeks should trigger reassessment of dosage and pain medication. Opioids by mouth, including both weak opioids such as tramadol and stronger opioids, are also often prescribed. Their appropriateness is uncertain, and opioids are often recommended only when first line therapies have failed or are contraindicated. This is due to their small benefit and relatively large risk of side effects. The use of tramadol likely does not improve pain or physical function and likely increases the incidence of adverse side effects. Oral steroids are not recommended in the treatment of osteoarthritis. Use of the antibiotic doxycycline orally for treating osteoarthritis is not associated with clinical improvements in function or joint pain. Any small benefit related to the potential for doxycycline therapy to address the narrowing of the joint space is not clear, and any benefit is outweighed by the potential harm from side effects. Topical There are several NSAIDs available for topical use, including diclofenac. A Cochrane review from 2016 concluded that reasonably reliable evidence is available only for use of topical diclofenac and ketoprofen in people aged over 40 years with painful knee arthritis. Transdermal opioid pain medications are not typically recommended in the treatment of osteoarthritis. The use of topical capsaicin to treat osteoarthritis is controversial, as some reviews found benefit while others did not. Joint injections Ultrasound-guided hip joint injection: A skin mark is made to mark the optimal point of entry for the needle. Steroids Joint injection of glucocorticoids (such as hydrocortisone) leads to short-term pain relief that may last between a few weeks and a few months. A 2015 Cochrane review found that intra-articular corticosteroid injections of the knee did not benefit quality of life and had no effect on knee joint space; clinical effects one to six weeks after injection could not be determined clearly due to poor study quality. Another 2015 study reported negative effects of intra-articular corticosteroid injections at higher doses, and a 2017 trial showed reduction in cartilage thickness with intra-articular triamcinolone every 12 weeks for 2 years compared to placebo. A 2018 study found that intra-articular triamcinolone is associated with an increase in intraocular pressure. Hyaluronic acid Injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis, but did increase risk of further pain. In ankle osteoarthritis, evidence is unclear. Platelet rich plasma The effectiveness of injections of platelet-rich plasma is unclear; there are suggestions that such injections improve function but not pain, and are associated with increased risk. A Cochrane review of studies involving PRP found the evidence to be insufficient. Surgery Bone fusion Arthrodesis (fusion) of the bones may be an option in some types of osteoarthritis. An example is ankle osteoarthritis, in which ankle fusion is considered to be the gold standard treatment in end-stage cases. Joint replacement If the impact of symptoms of osteoarthritis on quality of life is significant and more conservative management is ineffective, joint replacement surgery or resurfacing may be recommended. Evidence supports joint replacement for both knees and hips as it is both clinically effective and cost-effective. People who underwent total knee replacement had improved SF-12 quality of life scores, were feeling better compared to those who did not have surgery, and may have short- and long-term benefits for quality of life in terms of pain and function. The beneficial effects of these surgeries may be time-limited due to various environmental factors, comorbidities, and pain in other regions of the body. For people who have shoulder osteoarthritis and do not respond to medications, surgical options include a shoulder hemiarthroplasty (replacing a part of the joint), and total shoulder arthroplasty (replacing the joint). Biological joint replacement involves replacing the diseased tissues with new ones. This can either be from the person (autograft) or from a donor (allograft). People undergoing a joint transplant (osteochondral allograft) do not need to take immunosuppressants as bone and cartilage tissues have limited immune responses. Autologous articular cartilage transfer from a non-weight-bearing area to the damaged area, called osteochondral autograft transfer system, is one possible procedure that is being studied. When the missing cartilage is a focal defect, autologous chondrocyte implantation is also an option. Shoulder replacement For those with osteoarthritis in the shoulder, a complete shoulder replacement is sometimes suggested to improve pain and function. Demand for this treatment is expected to increase by 750% by the year 2030. There are different options for shoulder replacement surgeries, however, there is a lack of evidence in the form of high-quality randomized controlled trials, to determine which type of shoulder replacement surgery is most effective in different situations, what are the risks involved with different approaches, or how the procedure | complications of Ehlers–Danlos syndromes | complications of Cat-scratch disease | complications of Raynaud syndrome | complications of Xeroderma pigmentosum | complications of Gangrene | complications of Vasculitis | complications of Epidermolysis bullosa | complications of Avascular necrosis | 00
| 13,418 |
<unk> (PEN) is a rare, benign cutaneous condition characterized by small, firm, non-pigmented nodules or papules. They typically occur as a solitary (single) lesion near the mucocutaneous junction of the skin of the face, although they can occur elsewhere on the body. | Palisaded encapsulated neuroma | Basal-cell carcinoma | Solitary cutaneous leiomyoma | Melanocytic nevus | Bizarre parosteal osteochondromatous proliferation | Skin appendage | Malignant chondroid syringoma | Neurofibroma | 00
| 58,241 |
<unk> is a diagnosis used to describe a specific type of cortical scarring in the deep regions of the sulcus that leads to distortion of the gyri.<unk> is identified by its characteristic "mushroom-shaped" gyri, in which scarring causes shrinkage and atrophy in the deep sulcal regions while the surface gyri are spared. This condition is most often caused by hypoxic-ischemic brain injury in the perinatal period. The effects of<unk> can range in severity, although it is most commonly associated with cerebral palsy, mental retardation and epilepsy. N.C. Bresler was the first to view<unk> in 1899 and described this abnormal morphology in the brain as “mushroom-gyri." Although<unk> was first identified in 1899, there is still limited information known or reported about the condition. Gyrus vs. sulcus | Ulegyria | Rhinitis medicamentosa | Dermatophagia | Polymeal | Intertrigo | Burning mouth syndrome | Foot-and-mouth disease | Churna | 00
| 63,355 |
Early detection and treatment of<unk> is known to reduce rates of morbidity and the chance of long-term pulmonary complications. Evidence shows that there is an association between achieving higher IgG levels and reduced infection frequency. If<unk> remains undetected and untreated, outcomes are generally poor, especially if chronic lung damage or bronchiectasis has occurred. Unfortunately, the diagnosis of<unk> is often significantly delayed. | Hypogammaglobulinemia | Hypergammaglobulinemia | Dysgammaglobulinemia | Monocytopenia | Thymic hypoplasia | Monoclonal B-cell lymphocytosis | Lymphocytopenia | Splenomegaly | 00
| 29,754 |
<unk> is a non-proteinogenic α-amino acid. It is a homologue of the amino acid cysteine, differing by an additional methylene bridge (-CH2-). It is biosynthesized from methionine by the removal of its terminal Cε methyl group. In the body,<unk> can be recycled into methionine or converted into cysteine with the aid of certain B-vitamins. High levels of<unk> in the blood (hyperhomocysteinemia) is regarded as a marker of cardiovascular disease, likely working through atherogenesis, which can result in ischemic injury. Therefore, hyperhomocysteinemia is a possible risk factor for coronary artery disease. Coronary artery disease occurs when an atherosclerotic plaque blocks blood flow to the coronary arteries, which supply the heart with oxygenated blood. Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks, and strokes, although it is unclear whether hyperhomocysteinemia is an independent risk factor for these conditions. Hyperhomocysteinemia also has been associated with early-term spontaneous abortions and with neural tube defects. | Homocysteine | Cysteamine | 3-Methylhistidine | Carnitine | Inositol | Inosine | Nicotinamide | Glutamine | 00
| 5,947 |
The<unk> is an award presented by the British Society for Antimicrobial Chemotherapy. It was established in 1982 and named for L. P.<unk> . The<unk> is made of silver by the Birmingham Mint. The recipient of the award is considered by the society as having international authority in the field of antimicrobial chemotherapy. They are invited to deliver an accompanying<unk> and receive honorary membership of the Society. | Garrod Lecture and Medal | Arris and Gale Lecture | King v. Burwell | Beauty Mark | Dollond | Souvenaid | LeRoy Carhart | Dreamlab | 00
| 74,876 |
The phase-I trials began in February 2021 after receiving permission from Drugs Controller General of India (DGCI), to evaluate the safety and immunogenicity of the vaccine candidate in about 120 participants consisting of age group (18-70) years. The phase-II trials is planned to conduct with 500 participants from the age group (18-75) years. On 24 August 2021, the Drugs Controller General of India gave a go ahead for phase II/III trials after it was found to safe, tolerable, and immunogenic in the phase I trial results. | HGC019 | IEC 62304 | EPI-001 | SmeT | MVA-B | Southern Cross group | ESKAPE | ID2020 | 00
| 74,358 |
Tinea corpora (body), tinea manus (hands), tinea cruris (groin), tinea pedis (foot) and tinea facie (face) can be treated topically. Tinea unguum (nails) usually will require oral treatment with terbinafine, itraconizole, or griseofulvin. Griseofulvin is usually not as effective as terbinafine or itraconizole. A lacquer (Penlac) can be used daily, but is ineffective unless combined with aggressive debridement of the affected nail. Tinea capitis (scalp) must be treated orally, as the medication must be present deep in the hair follicles to eradicate the fungus. Usually griseofulvin is given orally for 2 to 3 months. Clinically dosage up to twice the recommended dose might be used due to relative resistance of some strains of<unk> s. Tinea pedis is usually treated with topical medicines, like ketoconazole or terbinafine, and pills, or with medicines that contains miconazole, clotrimazole, or tolnaftate. Antibiotics may be necessary to treat secondary bacterial infections that occur in addition to the fungus (for example, from scratching). Tinea cruris (groin) should be kept dry as much as possible. | Dermatophyte | Speculum | Diatragacanth | Papule | Schistocyte | Leper colony | Emerods | Microgenia | 00
| 21,346 |
The key symptoms of<unk> are those in its name:<unk> high<unk> at intervals of about 3–5 weeks, as well as<unk> ulcers,<unk> and/or<unk> . In between episodes, and even during the episodes, the children appear healthy. At least 6 months of episodes. Diagnosis requires recurrent negative throat cultures and that other causes (such as EBV, CMV, FMF) be excluded. | Periodic fever, aphthous stomatitis, pharyngitis and adenitis | Pruritic urticarial papules and plaques of pregnancy | Vesiculopustular eruption and leukemoid reaction in Down syndrome | Asymmetric periflexural exanthem of childhood | Photosensitivity with HIV infection | Chronic mucocutaneous candidiasis | Tubulointerstitial nephritis and uveitis | Multifocal choroiditis and panuveitis | 00
| 49,306 |
Drug-interaction studies and post hoc analyses of Phase III studies showed no clinically relevant interaction of<unk> with the systemic exposures to losartan, furosemide, omeprazole, digoxin, and warfarin, the lipid-lowering effects of statins, and oral vitamin D receptor agonists. According to the European label (Summary of Product Characteristics), medicinal products that are known to interact with iron (e.g. doxycycline) or have the potential to interact with Velphoro should be administered at least one hour before or two hours after Velphoro. This allows<unk> to bind phosphate as intended and be excreted without coming into contact with medications in the gut that it might interact with. According to the US prescribing information, Velphoro should not be prescribed with oral levothyroxine. The combination of<unk> and levothyroxine is contraindicated because<unk> contains iron, which may cause levothyroxine to become insoluble in the gut, thereby preventing the intestinal absorption of levothyroxine. | Sucroferric oxyhydroxide | Disufenton sodium | Sodium thiosulfate | Fermagate | Iron sucrose | Aluminum chloride hexahydrate | Zinc pyrithione | Sodium ferric gluconate complex | 00
| 66,333 |
The<unk> receptors are 7-transmembrane domains and are members of the G protein-coupled receptors (GPCR) superfamily.<unk> receptors have five subtypes, D1 through D5, the subtypes can be divided into two subclasses due to their mechanism of action on adenylate cyclase enzyme, D1-like receptors (D1 and D5) and D2-like receptors (D2, D3 and D4). D1-like receptors are primarily coupled to Gαs/olf proteins and activates adenylate cyclase which increases intracellular levels of cAMP, they also activate the Gβγ complex and the N-type Ca2+ channel. D2-like receptors decrease intracellular levels of the second messenger cAMP by inhibiting adenylate cyclase. Bromocriptine Bromocriptine is an ergot derivative, semi-synthetic. Bromocriptine is a D2 receptor agonist and D1 receptor antagonist with a binding affinity to D2 receptors of anterior pituitary cells, exclusively on lactotrophs. Bromocriptine stimulates Na+, K+-ATPase activity and/or cytosolic Ca2+ elevation and therefore reduction of prolactin which leads to no production of cAMP. Pramipexol Pramipexol is a highly active non-ergot D2-like receptor agonist with a higher binding affinity to D3 receptors rather than D2 or D4 receptors. The mechanism of action of pramipexole is mostly unknown, it is thought to be involved in the activation of<unk> receptors in the area of the brain where the striatum and the substantia nigra is located. This stimulation of<unk> receptors in the striatum may lead to the better movement performance. | Dopamine agonist | Dopamine antagonist | Alpha-adrenergic agonist | Norepinephrine–dopamine disinhibitor | Muscarinic antagonist | Beta-adrenergic agonist | Serotonin receptor agonist | Orexin antagonist | 00
| 34,651 |
<unk> may be found in isolation or in conjunction with myriad functional and anatomic abnormalities of the central<unk> us system. Nearly 80% of those affected with<unk> will experience hypothalamic dysfunction and/or impaired development of the brain, regardless of MRI findings or severity of<unk> . Vision<unk> can be unilateral (in one eye) or bilateral (in both eyes), although it presents most often bilaterally (80%). Because the unilateral cases tend to have better vision, they are typically diagnosed at a later age than those with bilateral<unk> . Visual acuity can range from no light perception to near-normal vision. Children diagnosed with<unk> generally present with vision problems which include nystagmus (involuntary movement of the eyes), which tends to develop at 1 to 3 months and/or strabismus (inability to align both eyes simultaneously), manifested during the first year of life. The majority of children affected experience improvement in vision during the first few years of life, though the reason for this occurrence is unknown. There have been no reported cases of decline in vision due to<unk> . Neuroradiographic abnormalities Estimates of cerebral malformations vary from 39% to 90% of children with<unk> . Abnormalities evident via neuroradiography can include agenesis (absence) or<unk> of the corpus callosum, absence or incomplete development of the septum pellucidum, malformations of the pituitary gland, schizencephaly, cortical heterotopia, white matter<unk> , pachygyria, and holoprosencephaly.<unk> of the corpus callosum, often in conjunction with other major malformations, is significantly associated with poor and delayed developmental outcome.<unk> is often referred to as septo-optic dysplasia, a term that refers to agenesis of the septum pellucidum. It is now clear that the absence of the septum pellucidum does not correlate with the associated symptoms of<unk> . Hypothalamic dysfunction Dysfunction of the hypothalamus results in loss of regulation over behavior and function of the pituitary gland (master gland). Hypopituitarism is present in 75% to 80% of patients with<unk> . The anterior pituitary gland contributes to growth, metabolism, and sexual development. The most common pituitary endocrinopathies are growth hormone (GH) deficiency (70%), hypothyroidism (43%), adrenal insufficiency (27%), and diabetes insipidus (5%). Absence of GH may often be indicated by short stature, although this is not always the case. Other indicators of GH deficiency may include hypoglycemic events (including seizures), prolonged jaundice, micropenis in boys, and delayed dentition. Testing for GH may involve blood tests (IGF-1 and IGFBP-3), growth hormone stimulation test, or bone age x-ray of the hand or wrist (or body for children younger than 2 years). A poorly functioning pituitary gland may also cause a lack of thyroid hormone, leading to central hypothyroidism. Thyroid hormone is critical for growth and brain development, especially during the first few weeks to months of life. Children with untreated hypothyroidism are at high risk of mental retardation; thus, early detection is crucial. Central hypothyroidism can be diagnosed by a low or normal thyroid-stimulating hormone (TSH) in the presence of a low level of free T4. Free T-4 should be checked annually for at least four years. Cortisol is made in times of stress. Approximately one-quarter of patients with<unk> have adrenal insufficiency, meaning they do not produce enough cortisol on a daily basis or in stressful situations. Imbalances in sex hormone may result in a delay in sexual development (puberty) or precocious puberty. Sex hormones may be tested from birth to 6 months of age (during a mini-puberty). Hyperprolactinemia (an excess of prolactin) often occurs in conjunction with<unk> and indicates either dysfunction of the hypothalamus or a disconnect between the hypothalamus and pituitary gland. Hyperprolactinemia often correlates with development of obesity in children with<unk> . The posterior pituitary gland produces anti-diuretic hormone (ADH), which controls outflow of water from the body by urine. ADH deficiency, also known as diabetes insipidus (DI), results in dehydration and high sodium levels in the body from excessive urination. Testing for DI involves blood and urine testing, including water deprivation tests, to determine ADH creation levels by the body. DI may be treated with a medication called desmopressin acetate (DDAVP). Oxytocin is also produced in the posterior pituitary gland. Though best known for its role in childbirth and lactation, oxytocin has also been found to have a role in human bonding, increase in trust, and decrease in fear. Hypothalamic dysfunction may also result in problems with feeding, sleep, and body temperature regulation. Feeding behaviors in children with<unk> often include hyperphagia (overeating), resulting in obesity; or hypophagia (reduced food intake) with or without weight loss. Children also frequently experience aversion to specific textures of food. Disturbance of circadian sleep rhythm, resulting in abnormal sleep-wake cycles, is noted in one-third of children with<unk> . This disturbance could result in behavioral problems and disruption of family life. Development More than 70% of children with<unk> experience developmental delay, ranging from isolated focal defects to delay in all areas of development (global delay). Motor delay is most common (75%) and communication delay is least common (44%). Predictors of significantly delayed development include<unk> or agenesis of the corpus callosum and hypothyroidism. The absence of the septum pellucidum does not predict developmental delay. Delays may occur in unilateral (39%) as well as bilateral (78%) cases. | Optic nerve hypoplasia | Septo-optic dysplasia | Macular hypoplasia | Cystic eyeball | Retinal dysplasia | Congenital cataract | Vitreous bulge | Post-lingual deafness | 00
| 18,756 |
<unk> in a ventilated person with a central line and nasogastric tube Evaluation of aspiration is generally performed with a video fluoroscopic swallowing study involving radiologic evaluation of the swallowing mechanism via challenges with liquid and solid food consistencies. These studies allow for evaluation of penetration to the vocal folds and below but are not a sensitive and specific marker for aspiration. Additionally, it is difficult to distinguish between<unk> and<unk> is.<unk> is typically diagnosed by a combination of clinical circumstances (people with risk factors for aspiration) and radiologic findings (an infiltrate in the proper location). A chest x-ray is typically performed in cases where any<unk> is suspected, including<unk> . Findings on chest x-ray supportive of<unk> include localized consolidation depending on the patient's position when the aspiration occurred. For example, people that are supine when they aspirate often develop consolidation in the right lower lobe of the lung. Sputum cultures are not used for diagnosing<unk> because of the high risk of contamination. Clinical symptoms may also increase suspicion of<unk> , including new difficulty breathing and fever after an aspiration event. Likewise, physical exam findings such as altered breath sounds heard in the affected lung fields may also be suggestive of<unk> . Some cases of<unk> are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens. While<unk> and chemical<unk> is may<unk> pear similar, it is important to differentiate between the two due to major differences in management of these conditions. Chemical<unk> is is caused by damage to the inner layer of lung tissue, which triggers an influx of fluid. The inflammation caused by this reaction can rapidly cause similar findings seen in<unk> , such as an elevated WBC (white blood cell) count, radiologic findings, and fever. However, it is important to note that the findings of chemical<unk> is are triggered by inflammation not caused by infection, as seen in<unk> . Inflammation is the body's immune response to any perceived threat to the body. Thus, treatment of chemical<unk> is typically involves removal of the inflammatory fluid and supportive measures, notably excluding antibiotics. The use of antimicrobials is reserved for chemical<unk> is complicated by secondary bacterial infection. | Aspiration pneumonia | Chemical pneumonitis | Bacterial pneumonia | Tuberculosis | Viral pneumonia | Pulmonary aspiration | Occult pneumonia | Pleural empyema | 00
| 24,395 |
The primary aim of treatment of a newly formed<unk> communication is to prevent the development of an<unk> as well as chronic sinusitis. The decision on how to treat OAC/OAF depends on various factors. Small size communications between 1 and 2 mm in diameter, if uninfected, are likely to form a clot and heal by itself later. Communications larger than this require treatments to close the defect and these interventions can be categorised into 3 types: surgical, non-surgical and pharmacological. Surgery Surgical methods are required if a large defect is present or if a defect persists. Surgery involves creating a flap utilising local tissue to close the communication. There are a number of different flaps that can be used such as the buccal advancement flap, the buccal fat pad flap, a combination of the two and a palatal flap. The flap used is dependent on the size and position of the defect. Buccal advancement flap The buccal advancement flap is the most commonly used due to its simplicity, reliability and versatility. It involves cutting a broad based trapezoid shaped mucoperiosteal flap with two vertical incisions. The flap is cut buccally, is three sided and extends to the full depth of the sulcus. Buccal fat pad flap The buccal fat pad flap is also a popular option due to its high success rate. It is a simple procedure where the buccal extension of the anatomical fat pad is used for closure. These two flaps can be used in combination where the buccal fat pad covers the communication followed by a further covering via the buccal mucosal flap described above. This double layer flap has advantages over a single layer as it provides stable soft tissue covering, reduces the incidences of wound breakdown and defect recurrence as well as reducing the risk of postoperative infection. Sutures, either non-resorbing or slowly resorbing, are generally used in the surgical repairs of OAC. Non-surgical interventions Ultimately, surgery is usually required to close an OAC/OAF. However, if surgery is not immediately available then non-surgical methods can be used to encourage the growth of oral mucosa between the oral cavity and the antrum. The aim of these methods is to protect the blood clot within the socket and help to prevent infection. One option is construction of a denture with an acrylic base plate or extension of the patient’s existing denture to protect the socket and support the clot. These options are particularly helpful in patients who smoke as it provides protection from smoke inhalation. The socket can also be sutured over with mattress sutures if there is adequate soft tissue available. Medication Medications may be needed as an adjunct to assist the closure of the defect. Antibiotics can help control or prevent any sinus infections. Preoperative nasal decongestants usage can reduce any existing sinus inflammation which will aid surgical manipulation of the mucosa over the bone. Postoperative care Following all methods of OAC/OAF closure, the patients are instructed to avoid activities that could produce pressure changes between the nasal passages and oral cavity for at least 2 weeks due to risk of disruption to the healing process. Nose blowing and sneezing with a closed mouth are prohibited. A soft diet is also often advocated during this period. Following surgery, nasal decongestants and prophylactic antibiotics are often prescribed to prevent postoperative infection. | Oroantral fistula | Liber pantegni | Omphalocele | Urachal fistula | Cimino fistula | Midline cervical cleft | Hypospadias | Iatrosophia | 00
| 69,423 |
The<unk> was founded by Jerome H. Stone with the help of several family members in Chicago, Illinois, and incorporated on April 10, 1980, as the Alzheimer's Disease and Related Disorders<unk> , Inc. is a non-profit American volunteer health organization which focuses on care, support and research for Alzheimer's disease. The<unk> is the largest non-profit funder of Alzheimer's disease research. The organization has chapters and communities across the nation, with its national office located in Chicago and the public policy office in Washington, D.C. Its mission is "to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health." | Alzheimer's Association | Parkinson's UK | Alzheimer's Research UK | Parkinson's disease dementia | NINCDS-ADRDA Alzheimer's Criteria | Dementia with Lewy Bodies Consortium | Olive quick decline syndrome | medical cause of Dementia | 00
| 35,561 |
The following outline is provided as an overview of and topical guide to<unk> , the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in<unk> are called<unk> sts. | Outline of cardiology | Operating theater | Catheterization laboratory | Endoscopy unit | Cardiothoracic anesthesiology | Outline of emergency medicine | Transfer board | Monitor unit | 00
| 48,068 |
Acute Acute<unk> occurs when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, Guillain–Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation. Chronic Chronic<unk> may be secondary to many disorders, including COPD. Hypoventilation in COPD involves multiple mechanisms, including decreased responsiveness to hypoxia and hypercapnia, increased ventilation-perfusion mismatch leading to increased dead space ventilation, and decreased diaphragm function secondary to fatigue and hyperinflation. Chronic<unk> also may be secondary to obesity hypoventilation syndrome (i.e., Pickwickian syndrome), neuromuscular disorders such as amyotrophic lateral sclerosis, and severe restrictive ventilatory defects as observed in interstitial lung disease and thoracic deformities. Lung diseases that primarily cause abnormality in alveolar gas exchange usually do not cause hypoventilation but tend to cause stimulation of ventilation and hypocapnia secondary to hypoxia. Hypercapnia only occurs if severe disease or respiratory muscle fatigue occurs. | Respiratory acidosis | Respiratory alkalosis | Metabolic acidosis | Metabolic alkalosis | Acidosis | Hypercapnia | Contraction alkalosis | Normal anion gap acidosis | 00
| 22,551 |
The most striking sign of<unk> is the co-occurrence of both syndactyly (about 0.03% of births) and long QT syndrome (1% per year) in a single patient. Other common symptoms include cardiac arrhythmia (94%), heart malformations (59%), and autism or an autism spectrum disorder (80% who survive long enough for evaluation). Facial dysmorphologies such as flattened noses also occur in about half of patients. Children with this disorder have small teeth, which due to poor enamel coating, are prone to dental cavities and often require removal. The average age of death due to complications of these symptoms is 2.5 years. Atypical<unk> has largely the same symptoms as the classical form. Differences in the atypical form are the lack of syndactyly, the presence of musculoskeletal problems (particularly hyperflexible joints), and atrial fibrillation. Patients with atypical<unk> also have more facial deformities, including protruding foreheads and tongues. Finally, one patient with atypical<unk> had a body development discrepancy wherein her upper body was normally developed (that of a 6-year-old) while her lower half resembled a 2- or 3-year-old. Children with<unk> tend to be born via caesarean section due to fetal distress. | Timothy syndrome | Goldenhar syndrome | Joubert syndrome | Wolfram syndrome | Christianson syndrome | Cohen syndrome | Kaufman oculocerebrofacial syndrome | Karak syndrome | 00
| 20,478 |
Earlier onset of symptoms is linked to a worse prognosis. For children who exhibit symptoms between the ages of 2 and 4, death usually occurs by the age of 15 to 20 years. The cause of death is usually due to neurological complications, obstructive airway disease, and cardiac failure. If patients have minimal neurologic involvement, they may survive into their 50s or beyond. | Hunter syndrome | Mucopolysaccharidosis type I | Laron syndrome | Mucopolysaccharidosis | Sabinas brittle hair syndrome | Malouf syndrome | Hurler syndrome | TORCH syndrome | 00
| 38,031 |
Functional magnetic resonance imaging <unk> of the<unk> cord<unk> is an adaptation of the<unk> method that has been developed for use in the brain (1). Although the basic principles underlying the methods are the same,<unk> requires a number of specific adaptations to accommodate the periodic motion of the<unk> cord, the small cross-sectional dimensions (roughly 8 mm x 15 mm at the largest region), the length (~45 cm in adult humans), and the fact that the magnetic field that is used for MRI varies with position in the<unk> cord because of magnetic susceptibility differences between bone and tissues.<unk> has been used to produce maps of neuronal activity at most levels of the<unk> cord in response to various stimuli, such as touch, vibration, and thermal changes, and with motor tasks. Research applications of<unk> to date include studies of normal sensory and motor function, and studies of the effects of trauma to the<unk> cord (1-3) and multiple sclerosis (4). Two different data acquisition methods have been applied, one based on the established BOLD (blood-oxygen-level dependent)<unk> methods used in the brain, and the other based on SEEP (signal enhancement by extravascular water protons) contrast with essentially proton-density weighted spin-echo imaging (see MRI). The majority of the studies published to date are based on the SEEP contrast method. Methods demonstrated to overcome the challenges listed above include using a recording of the heart-beat to account for the related time course of<unk> cord motion, acquiring image data with relatively high (~ 1-2 mm) spatial resolution to detect fine structural details, and acquiring images in thin contiguous sagittal slices to span a large extent of the<unk> cord. Methods based on BOLD contrast have employed parallel imaging techniques to accelerate data acquisition, and imaging slices transverse to the<unk> cord, in order to reduce the effects of spatial magnetic field distortions (5). Methods based on SEEP contrast have been developed specifically because they have low sensitivity to magnetic field distortions while maintaining sensitivity to changes in neuronal activity. | Spinal fMRI | Magnetic resonance myelography | Myelography | Cervicography | Magnetic resonance neurography | Brain mapping | Electromagnetic source imaging | Clinical neurophysiology | 00
| 49,632 |
<unk> (Smart, Positive, Active, Realistic, X-factor thoughts) is a not a video game. It is educational software intended to help young people with mild to moderate depression, stress or anxiety. Through the game, this e-therapy will teach them how to resolve their issues on their own, according to a talking psychotherapeutic approach called cognitive behavioural therapy. Before taking part in this game, a personality test is required to determine if<unk> will be suited and helpful for the future user. | Sparx | BGR-34 | Latisemin | SCALPEL | OHVIRA | MCN | KHAT | COVAX-19 | 00
| 65,277 |
<unk> , sold under the brand name Doptelet, is a medication that used for certain conditions that lead to thrombocytopenia (low platelets) such as thrombocytopenia associated with chronic liver disease in adults who are to undergo a planned medical or dental procedure. It was approved for medical use in the United States in 2018, and in the European Union in 2019. It acts as a thrombopoietin receptor agonist. | Avatrombopag | Lusutrombopag | Eltrombopag | Ximelagatran | Anistreplase | Desmoteplase | Argatroban | Apixaban | 00
| 71,350 |
gadolinium MRI in a patient with<unk> kayasu arteritis showing thickened, enhancing aortic wall, consistent with large vessel vasculitis Although the cause of<unk> kayasu arteritis is unknown, the condition is characterized by segmental and patchy granulomatous inflammation of the aorta and its major derivative branches. This inflammation leads to arterial stenosis, thrombosis, and aneurysms. There is irregular fibrosis of the blood vessels due to chronic vasculitis, leading to sometimes massive intimal fibrosis (fibrosis of the inner section of the blood vessels). Prominent narrowing due to inflammation, granuloma, and fibrosis is often seen in arterial studies such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), or arterial angiography (DSA). Genetics The genetic contribution to the pathogenesis of<unk> is supported by the genetic association with HLA-B∗52. A 2013 large collaborative study uncovered multiple additional susceptibility loci for this disease, increasing its number of genetic loci to five risk loci across the genome. About 200,000 genetic variants were genotyped in two ethnically divergent<unk> cohorts from Turkey and North America by using a custom-designed genotyping platform (Immunochip). Additional genetic variants and the classical HLA alleles were imputed and analyzed. The study identified and confirmed two independent susceptibility loci within the HLA region (r2 < 0.2): HLA-B/MICA (rs12524487, OR = 3.29, p = 5.57 × 10-16) and HLA-DQB1/HLA-DRB1 (rs113452171, OR = 2.34, p = 3.74 × 10-9; and rs189754752, OR = 2.47, p = 4.22 × 10-9). In addition, a genetic association was identified and confirmed between<unk> and the FCGR2A/FCGR3A locus on chromosome 1 (rs10919543, OR = 1.81, p = 5.89 × 10-12). The risk allele at this locus results in increased mRNA expression of FCGR2A. In addition, a genetic association between IL12B and<unk> kayasu arteritis was established (rs56167332, OR = 1.54, p = 2.18 × 10-8). A fifth genetic locus for the disease in an intergenic region on chromosome 21q22 downstream of PSMG1 was revealed (P=4.39X10-7). A recent genome-wide association study (GWAS) identified genetic susceptibility loci for<unk> kayasu arteritis with a genome-wide level of significance in IL6 (rs2069837) (odds ratio OR 2.07, P = 6.70 × 10(-9)), RPS9/LILRB3 (rs11666543) (OR 1.65, P = 2.34 × 10(-8)), and the intergenic locus on chromosome 21q22 (rs2836878) (OR 1.79, P = 3.62 × 10(-10)). The genetic susceptibility locus in RPS9/LILRB3 lies within the leukocyte receptor complex gene cluster on chromosome 19q13.4, and the disease risk variant in this locus correlates with reduced expression of multiple genes including the inhibitory leukocyte immunoglobulin-like receptor gene LILRB3 (P = 2.29 × 10(-8)). In addition, this study identified additional candidate susceptibility genes with suggestive levels of association (P < 1 × 10(-5)) including PCSK5, LILRA3, PPM1G/NRBP1, and PTK2B. Another gene associated with this condition is MLX (Max-like protein X) | Takayasu's arteritis | Giant cell arteritis | Monckeberg's arteriosclerosis | Charcot–Bouchard aneurysm | Lupus vasculitis | Syphilitic aortitis | Arterial tortuosity syndrome | Polyarteritis nodosa | 00
| 21,942 |
Disease Disease is any condition that impairs the normal physical or mental (or both) function of an organism. (Though this definition includes injuries, it will not be discussed here). Diseases can arise from infection, environmental conditions, accidents, and inherited diseases. It is not always easy to classify the source of a health problem. For instance, people can develop gout, which is known to cause permanent or near permanent changes to the human body, because of diet, inherited genetic predisposition, as a secondary condition from other diseases, or as an unintended side effect of certain medications. Infectious diseases can be caused by pathogens and microorganisms such as viruses, prions, bacteria, parasites, and fungi. For infectious, environmental, and genetically predisposed conditions, lifestyle choices such as exercise, nutrition, stress level, hygiene, home and work environments, use or abuse of legal and illegal drugs, and access to healthcare (including an individual's financial ability and personal willingness to seek medical attention) especially in the early stages of an illness all combine to determine a person's risk factors for developing a disease or condition. Precancerous condition Progressive disease localized disease to spread to other area of the body. Diet Injury Trauma is "a body wound or shock produced by sudden physical injury, as from violence or accident," or, more simply put, is "a physical wound or injury, such as a fracture or blow." Accidental injuries, most of which can be predicted and thus prevented, are the unintentional negative outcomes of unforeseen or unplanned events or circumstances which may have been avoided or prevented if reasonable measures had been taken or if the risks involving the circumstances leading up to the accident been recognized and acted upon (minimized). Battery is a criminal offense involving the use of force against another that results in harmful or offensive contact. (Assault is fear/belief of impending battery.) Violence is defined by the WHO as the intentional use of physical force or power, threatened or actual, against oneself or others that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. Head trauma Head trauma in the form of a traumatic brain injury, stroke, drug or alcohol abuse, and infection have been known in some cases to cause changes to a person's mental processes, the most common being amnesia, ability to deal with stress and changes in aggression. There have also been documented cases of a person's personality changing more drastically, the best-known case being Phineas Gage, who in 1848 who survived a 1.1 meter long tamping iron being driven through his skull (though almost all presentations of Gage's subsequent personality changes are grossly exaggerated). There is also the rare condition called Foreign Accent Syndrome in which someone who has suffered a brain injury will appear to speak in a new language or dialect. This is typically thought to be due to an injury to the linguistic center of the brain causing speech impairment that just happens to sound like a persons non-native language. This is thought to be the reasoning behind the urban legend where someone wakes from a coma or surgery and suddenly speaks a new language. Body modification Body modification is the deliberate altering of the human body for any non-medical reason, such as aesthetics, sexual enhancement, a rite of passage, religious reasons, to display group membership or affiliation, to create body art, shock value, or self-expression. | Acquired characteristic | Biosimilar | Human biology | Permanent makeup | Surrogacy laws by country | Heterogeneous condition | Human genetic enhancement | Learned intermediary | 00
| 56,091 |
<unk> is a term denoted for the phenomenon of an upset stomach that comes from the use of filthy keyboards and in more recent times, from the use of mobile phones' keypads. | QWERTY Tummy | LeShawndra Price | QTY Code | Beauty Mark | UW Med Flight | Khodadoust line | Ganfyd | Therapy cap | 00
| 64,226 |
As of 2014, physicians were reported as generally not culturing to identify the<unk> g bacterial pathogen during diagnosis of<unk> s | Skin and skin structure infection | Waterborne diseases | Autoimmune/inflammatory syndrome induced by adjuvants | Mouth infection | Skin infection | Multidrug-resistant bacteria | Infectious diseases | Intestinal infectious diseases | 00
| 57,320 |
MWS is a heterogeneous, initially described as a<unk> . But this condition is more on the lines of a phenotypic expression of various heterogeneous diseases and belongs to the second group in the classification of arthrogryposis. Unknown congenital myopathy has been suspected to underlie MWS due to muscular involvement, but extension of the neuromuscular systems failed to identify a primary myopathy in patients with MWS. Secondary muscle involvement from a CNS lesion may occur. This could lead to congenital weakness with hypoatonia deep tendon reflex. Genetics MWS is inherited in an autosomal recessive manner. This means the defective gene responsible for the disorder is located on an autosome, and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder. | Marden–Walker syndrome | Roberts syndrome | Norman–Roberts syndrome | Uhl anomaly | Down syndrome | Renal dysplasia-limb defects syndrome | Birk-Barel syndrome | Spina bifida | 00
| 50,690 |
<unk> is an inherited autosomal recessive disease characterized by high concentrations of the amino acid cystine in the urine, leading to the formation of cystine stones in the kidneys, ureters, and bladder. It is a type of aminoaciduria. "Cystine", not "cysteine," is implicated in this disease; the former is a dimer of the latter. | Cystinuria | Xanthinuria | Aminoaciduria | Uricosuria | Iminoglycinuria | Hyperuricosuria | Renal glycosuria | Lipiduria | 00
| 19,689 |
<unk> <unk> , also known as ophthalmic<unk> , is shingles involving the eye or the surrounding area. Common signs include a rash of the forehead with swelling of the eyelid. There may also be eye pain and redness, inflammation of the conjunctiva, cornea or uvea, and sensitivity to light. Fever and tingling of the skin and allodynia near the eye may precede the rash. Complications may include visual impairment, increased pressure within the eye, chronic pain, and stroke. The underlying mechanism involves a reactivation of the latent varicella<unk> virus (VZV) within the trigeminal ganglion supplying the ophthalmic nerve (the first division of the trigeminal nerve). Diagnosis is generally based on signs and symptoms. Alternatively, fluid collected from the rash may be analyzed for VZV DNA using real-time PCR. This test is rapid, easy to perform, and is highly sensitive and specific method for diagnosing this condition. Treatment is generally with antiviral pills such as acyclovir. Steroid eye drops and drops to dilate the pupil may also be used. The herpes<unk> vaccine is recommended for prevention in those over the age of 50.<unk> is the second most common manifestation of shingles, the first being involvement of skin of the thorax. Shingles affects up to one half million people in the United States per year, of which 10% to 25% is<unk> . | Herpes zoster ophthalmicus | Sympathetic ophthalmia | Ocular larva migrans | Vertigo | Oropouche fever | Adenoviral keratoconjunctivitis | Ocular rosacea | Herpes simplex keratitis | 00
| 66,851 |
If<unk> is inhaled, side effects resembling those of other anticholinergics are minimal. However, dry mouth and sedation have been reported. Also, effects such as skin flushing, tachycardia, acute angle-closure glaucoma, nausea, palpitations and headache have been observed. Inhaled<unk> does not decrease mucociliary clearance. The inhalation itself can cause headache and irritation of the throat in a few percent of patients. Urinary retention has been reported in patients receiving doses by nebulizer. As a result, caution may be warranted, especially by men with prostatic hypertrophy. | Ipratropium bromide | Levosalbutamol | Salbutamol | Zafirlukast | Formoterol | Pranlukast | Seratrodast | Glycopyrronium bromide | 00
| 17,152 |
A drawing showing the sensation of vertigo Vertigo is a sensation of spinning while stationary. It is commonly associated with nausea or vomiting, unsteadiness (postural instability), falls, changes to a person's thoughts, and difficulties in walking. Recurrent episodes in those with vertigo are common and frequently impair the quality of life. Blurred vision, difficulty in speaking, a lowered level of consciousness, and hearing loss may also occur. The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset. Persistent onset vertigo is characterized by symptoms lasting for longer than one day and is caused by degenerative changes that affect balance as people age. Naturally, the nerve conduction slows with aging and a decreased vibratory sensation is common. Additionally, there is a degeneration of the ampulla and otolith organs with an increase in age. Persistent onset is commonly paired with central vertigo signs and symptoms. The characteristics of an episodic onset vertigo are indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes. | symptom of Benign paroxysmal positional vertigo | medical cause of Tinnitus | symptom of Bulbar palsy | symptom of Vertigo | symptom of Glaucoma | symptom of Oculopharyngeal muscular dystrophy | symptoms of Sympathetic ophthalmia | symptom of Giant cell arteritis | 00
| 29,204 |
Vaginal discharge is a mixture of liquid, cells, and<unk> that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections,<unk><unk> , and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse. | symptom of Bacterial vaginosis | symptom of Vaginal yeast infection | symptom of Chlamydia | symptom of Gonorrhea | symptom of Trichinosis | symptom of Vaginitis | symptom of Tularemia | symptom of Taeniasis | 00
| 31,996 |
The key was heated and pressed to the area where a person had been bitten by a dog believed to have rabies. If performed soon after the bite had occurred, the heat had the potential to cauterize and sterilize the wound, eradicating the rabies virus. The practice was endorsed by the Catholic Church (the practice was seldom seen in Orthodox lands), and such keys were used by priests at places with which St.<unk> was associated, where the skin of humans and animals was branded as a protection against the bites of rabid dogs. This practice is recorded in the 1870s in the Ardennes region of France, where dogs were branded with St.<unk> 's Key, as "a sure preventative of madness". | Saint Hubert's Key | Denis Browne bar | Stimson line | Saint Valentine's Key | LeRoy Carhart | Hippocratic bench | Beevor's axiom | Talairach coordinates | 00
| 57,645 |
<unk> is a law formulated by Dr. William<unk> when he made the observation that epidemic events rise and fall in a roughly symmetrical pattern. The time-evolution behavior could be captured by a single mathematical formula that could be approximated by a bell-shaped curve. | Farr's laws | Listing's law | Courvoisier's law | Davis's law | Hy's law | Laura's Law | Baumgarten–Tangl law | Sutton's law | 00
| 73,276 |
<unk> is believed to be inherited through autosomal recessive inheritance. It believed that this disease is caused by a nonlysosomal connective-tissue disturbance. The protein inactivation mutation is found on the matrix metalloproteinase 2 gene (MMP2). MM2 is responsible for bone remodeling. Bone remodeling is the process in which old bone is destroyed so that new bone can be created to replace it. This mutation causes a multicentric osteolysis and arthritis syndrome. It is hypothesized that the loss of an upstream MMP-2 protein activator MT1-MMP, results in decreased MMP-2 activity without affecting MMP2. The inactivating homoallelic mutation of MT1-MMP can be seen at the surface of fibroblasts. It was determined that fibroblasts lacking MT1-MMP lack the ability to degrade type I collagen which leads to anomalous function. | Winchester syndrome | Erdheim–Chester disease | POEMS syndrome | CREST syndrome | AL amyloidosis | OSLAM syndrome | Systemic-onset juvenile idiopathic arthritis | Secondary systemic amyloidosis | 00
| 49,582 |
Primary Most<unk> tumors begin with myxomas, fibromas, rhabdomyomas, and hamartomas, although malignant sarcomas (such as angiosarcoma or cardiac sarcoma) have been known to occur. In a study of 12,487 autopsies performed in Hong Kong seven cardiac tumors were found, most of which were benign. According to Mayo Clinic: "At Mayo Clinic, on average only one case of<unk> is seen each year." In a study conducted in the Hospital of the Medical University of Vienna 113 primary cardiac tumour cases were identified in a time period of 15 years with 11 being malignant. The mean survival in the latter group of patients was found to be . Primary malignant cardiac tumors (PMCTs) are even rarer. The most recent published study about PMCTs used the Surveillance, Epidemiology and End-Results (SEER)<unk> Registry to study 497 patients with PMCTs who were diagnosed during 2000–2001 in the United States. Most cases were angiosarcomas (27.3%) with an incidence of 0.107 per 1,000,000 person-years and Non- Hodgkin's lymphomas NHL (26.9%), with an incidence of 0.108 per 1,000,000 person-years. The incidence rate of NHL increased significantly over the study period, but the incidence of cardiac angiosarcomas did not. The overall survival of NHL was found to be significantly better than angiosarcomas. Another previous study using the Surveillance, Epidemiology and End-Results (SEER)<unk> Registry from 1973–2011 found 551 cases of PMCTs, with an incidence of 34 cases per million persons. The study also found that the incidence has doubled over the past four decades. The associated mortality was very high, with only 46% of patients alive after one year. Sarcomas and mesotheliomas had the worst survival, while lymphomas had better survival. When compared with extracardiac tumors, PMCTs had worse survival. Secondary Secondary or metastatic<unk> tumours are much more common than primary<unk> tumours, occurring even 100 times more often. Every tumour in theory can metastasize to the<unk> with the only exception being tumours of the central nervous system. Malignant melanomas frequently metastasize to the<unk> , and represent the tumour with the highest rate of cardiac metastases (in more than half of cases). | Heart cancer | Lung cancer | Skin cancer | Liver cancer | Cancer | Myocardial infarction complications | Kidney cancer | Gastrointestinal cancer | 00
| 41,787 |
The FDA label for<unk> carries a boxed warning for cytokine release syndrome (CRS), neurologic toxicity, hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS), and prolonged cytopenia. CRS and HLH/MAS are systemic responses to the activation and proliferation of CAR-T cells causing high fever and flu-like symptoms, and prolonged cytopenia is a drop in the number of a certain blood cell type for an extended period of time. | Idecabtagene vicleucel | Ciltacabtagene autoleucel | Lisocabtagene maraleucel | Brexucabtagene autoleucel | Ibrexafungerp | Titermax | Sabizabulin | Clinatec | 00
| 74,292 |
Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine. NAAT has been estimated to have a sensitivity of approximately 90% and a specificity of approximately 99%, regardless of sampling from a cervical swab or by urine specimen. In women seeking an sexually transmitted infection (STI) clinic and a urine test is negative, a subsequent cervical swab has been estimated to be positive in approximately 2% of the time. At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens. Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely-positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Other methods also exist including: ligase chain reaction (LCR), direct fluorescent antibody resting, enzyme immunoassay, and cell culture. Rapid point-of-care tests are, as of 2020, not thought to be effective for diagnosing chlamydia in men of reproductive age and nonpregnant women because of high false-negative rates. | medical cause of Epididymitis | symptom of Epididymitis | complications of Epididymitis | medical cause of Endometritis | complications of Testicular torsion | medical cause of Dysmenorrhea | symptom of Testicular cancer | medical cause of Vaginitis | 00
| 684 |
As of 2015 the worldwide incidence was about 2 to 5 per 10 000 live births, and this number seemed to be increasing. As of 2017 the CDC estimates that about 1,871 babies are born each year in the United States with<unk> . | Gastroschisis | Prune belly syndrome | Omphalocele | Rachischisis | Diaschisis | Cranioschisis | Intestinal atresia | Encephalocele | 00
| 21,604 |
<unk> is a spectrum of congenital abnormalities of the<unk> varying from small defects to complete absence of the<unk> . It can be isolated, when only the<unk> is affected, and in 60% of the cases it is associated with radial dysplasia (or radial club, radius dysplasia, longitudinal radial deficiency). Radial dysplasia is the condition in which the forearm bone and the soft tissues on the<unk> side are underdeveloped or absent. In an embryo the upper extremities develop from week four of the gestation. During the fifth to eighth week the<unk> will further develop. In this period something goes wrong with the growth of the<unk> but the exact cause of<unk> is unknown. One out of every 100,000 live births shows<unk> . In more than 50% of the cases both hands are affected, otherwise mainly the right hand is affected. About 86% of the children with hypoplastic<unk> have associated abnormalities. Embryological hand development occurs simultaneously with growth and development of the cardiovascular, neurologic and hematopoietic systems.<unk> has been described in 30 syndromes wherein those abnormalities have been seen. A syndrome is a combination of three or more abnormalities. Examples of syndromes with an hypoplastic<unk> are Holt-Oram syndrome, VACTERL association and thrombocytopenia absent radius (TAR syndrome). | Thumb hypoplasia | Maxillary hypoplasia | Renal hypoplasia | Condylar hypoplasia | Radial aplasia | Hemifacial microsomia | Webbed neck | Ape hand deformity | 00
| 59,858 |
A person's presentation in context of trauma or non-traumatic background determines suspicion for a spinal cord injury. The features are namely paralysis, sensory loss, or both at any level. Other symptoms may include incontinence. A radiographic evaluation using an X-ray, CT scan, or MRI can determine if there is damage to the spinal column and where it is located. X-rays are commonly available and can detect instability or misalignment of the spinal column, but do not give very detailed images and can miss injuries to the spinal cord or displacement of ligaments or disks that do not have accompanying spinal column damage. Thus when X-ray findings are normal but SCI is still suspected due to pain or SCI symptoms, CT or MRI scans are used. CT gives greater detail than X-rays, but exposes the patient to more radiation, and it still does not give images of the spinal cord or ligaments; MRI shows body structures in the greatest detail. Thus it is the standard for anyone who has neurological deficits found in SCI or is thought to have an unstable spinal column injury. Neurological evaluations to help determine the degree of impairment are performed initially and repeatedly in the early stages of treatment; this determines the rate of improvement or deterioration and informs treatment and prognosis. The ASIA Impairment Scale outlined above is used to determine the level and severity of injury. | medical cause of Paraplegia | medical cause of Hemiparesis | symptom of Cerebral palsy | symptom of Amyotrophic lateral sclerosis | medical cause of Dystonia | medical cause of Parkinsonism | picture of Acrocallosal syndrome | medical cause of Polyneuropathy | 00
| 20,169 |
The afflicted may have relatively small amounts of pain that will quickly increase in severity over a time period of 6–12 weeks. The skin temperature around the bone may increase, a bony swelling may be evident, and movement may be restricted in adjacent joints. Spinal lesions may cause quadriplegia and patients with skull lesions may have headaches. Sites Commonly affected sites are metaphyses of vertebra, flat bones, femur and tibia. Approximate percentages by sites are as shown: * Skull and mandible (4%) * Spine (16%) * Clavicle and ribs (5%) * Upper extremity (21%) * Pelvis and sacrum (12%) * Femur (13%) * Lower leg (24%) * Foot (3%) | Aneurysmal bone cyst | Bone cyst | Osteoid osteoma | Unicameral bone cyst | Juvenile active ossifying fibroma | Osteoma | Osteochondroma | Peripheral ossifying fibroma | 00
| 38,562 |
A displaced supracondylar fracture in a child<unk> s are a group of humerus fracture which includes supracondylar fractures, single condyle fractures, bi-column fractures and coronal shear fractures. | Distal humeral fracture | Humerus fracture | Jefferson fracture | Proximal humerus fracture | Radial head fracture | Trimalleolar fracture | Bosworth fracture | Tibial plateau fracture | 00
| 70,619 |
<unk> can occur in any person with diabetes who takes any medicine to lower their blood glucose, but severe hypoglycemia occurs most often in people with type 1 diabetes who must take insulin for survival. In type 1 diabetes, iatrogenic hypoglycemia is more appropriately viewed as the result of the interplay of insulin excess and compromised glucose counterregulation rather than as absolute or relative insulin excess alone. Hypoglycemia can also be caused by sulfonylureas in people with type 2 diabetes, although it is far less common because glucose counterregulation generally remains intact in people with type 2 diabetes. Severe hypoglycemia rarely, if ever, occurs in people with diabetes treated only with diet, exercise, or insulin sensitizers. For people with insulin-requiring diabetes, hypoglycemia is one of the recurrent hazards of treatment. It limits the achievability of normal glucoses with current treatment methods. Hypoglycemia is a true medical emergency, which requires prompt recognition and treatment to prevent organ and brain damage. | Diabetic hypoglycemia | Reactive hypoglycemia | Idiopathic hypoglycemia | Ketotic hypoglycemia | Hyperinsulinemic hypoglycemia | Ketosis-prone diabetes | Stress hyperglycemia | Non-islet cell tumor hypoglycemia | 00
| 25,135 |
An<unk> , also known as exclusion diet, is a diagnostic procedure used to identify foods that an individual cannot consume without adverse effects. Adverse effects may be due to food allergy, food intolerance, other physiological mechanisms (such as metabolic or toxins), or a combination of these.<unk> s typically involve entirely removing a suspected food from the diet for a period of time from two weeks to two months, and waiting to determine whether symptoms resolve during that time period. In rare cases, a health professional may wish to use an<unk> , also referred to as an oligoantigenic diet, to relieve a patient of symptoms they are experiencing. Common reasons for undertaking an<unk> include suspected food allergies and suspected food intolerances. An<unk> might remove one or more common foods, such as eggs or milk, or it might remove one or more minor or non-nutritive substances, such as artificial food colorings. An<unk> relies on trial and error to identify specific allergies and intolerances. Typically, if symptoms resolve after the removal of a food from the diet, then the food is reintroduced to see whether the symptoms reappear. This challenge–dechallenge–rechallenge approach has been claimed to be particularly useful in cases with intermittent or vague symptoms. The exclusion diet can be a diagnostic tool or method used temporarily to determine whether a patient's symptoms are food-related. The term<unk> is also used to describe a "treatment diet", which eliminates certain foods for a patient. Adverse reactions to food can be due to several mechanisms. Correct identification of the type of reaction in an individual is important, as different approaches to management may be required. The area of food allergies and intolerances has been controversial and is currently a topic that is heavily researched. It has been characterised in the past by lack of universal acceptance of definitions, diagnosis and treatment. | Elimination diet | Low-FODMAP diet | Low-fiber/low-residue diet | Cotton ball diet | Feingold diet | Gluten-free diet | Plant-based diet | Stillman diet | 00
| 49,984 |
<unk> is a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank. People can first notice they suffer with the condition when looking at mini-blinds in their home. The Amsler Grid showing the visual perception of the left eye of a person experiencing<unk> (straight lines appear bent or curved) Initially characterized in the 1800s,<unk> was described as one of the primary and most notable indications of myopic and senile maculopathies.<unk> can present itself as unbalanced vision, resulting from small unintentional movements of the eye as it tries to stabilize the field of vision.<unk> can also lead to the misrepresentation of an object’s size or shape. It is mainly associated with macular degeneration, particularly age-related macular degeneration with choroidal neovascularization. Other conditions that can present with complaints of<unk> include: pathological myopia, presumed ocular histoplasmosis syndrome, choroidal rupture and multifocal choroiditis. | Metamorphopsia | Integrative agnosia | Agraphesthesia | Misophonia | Hemispatial neglect | Apperceptive agnosia | Dysmorphopsia | Phonagnosia | 00
| 29,717 |
In neuroscience,<unk> s provide a method of measuring the electro-physiological responses of a<unk> neuron using a microelectrode system. When a neuron generates an action potential, the signal propagates down the neuron as a current which flows in and out of the cell through excitable membrane regions in the soma and axon. A microelectrode is inserted into the brain, where it can record the rate of change in voltage with respect to time. These microelectrodes must be fine-tipped, high-impedance conductors; they are primarily glass micro-pipettes, metal microelectrodes made of platinum, tungsten, iridium or even iridium oxide. Microelectrodes can be carefully placed close to the cell membrane, allowing the ability to record extracellularly.<unk> s are widely used in cognitive science, where it permits the analysis of human cognition and cortical mapping. This information can then be applied to brain machine interface (BMI) technologies for brain control of external devices. | Single-unit recording | Stent-electrode recording array | Evoked potential | Evoked field | Cortical stimulation mapping | Viral neuronal tracing | Compound muscle action potential | End-plate potential | 00
| 33,205 |
<unk> (also known as "tricholemmoma") is a benign cutaneous neoplasm that shows differentiation toward cells of the outer root sheath. The lesion is often seen in the face and neck region. Multifocal occurrence is associated with Cowden syndrome, in which hamartomatous intestinal polyposis is seen in conjunction with multiple<unk> lesions. | Trichilemmoma | Trichodiscoma | Trichilemmal cyst | Trichofolliculoma | Trichilemmal carcinoma | Hidradenoma | Nevus sebaceous | Giant condyloma acuminatum | 00
| 56,125 |
Due to how rare this disorder is, evidence on prognosis is not yet identified. However, based on what is known, a woman who is diagnosed with<unk> may have the potential to live a long life. However, this diagnosis does lead to infertility, difficulty engaging in intercourse, the reoccurrence of kidney stones, etc. which may mean preserving a good quality of life may be difficult. Therefore, difficulty accepting this diagnosis may require extensive counseling and group therapy in order to accept and adapt to a different lifestyle. | WNT4 deficiency | Janus kinase 3 deficiency | MECP2 duplication syndrome | GATA2 deficiency | ZC4H2 deficiency | DOCK8 deficiency | NGLY1 deficiency | 8p23.1 duplication syndrome | 00
| 70,925 |
<unk> , also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors agree to provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient. The practice has been referred to as<unk> , retainer medicine, membership medicine, cash-only practice, and direct care. While all<unk> " medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the fee charged. Estimates of U.S. doctors practicing<unk> range from fewer than 800 to 5,000. | Concierge medicine | Cold medicine | Bush medicine | Venoms in medicine | Anthroposophic medicine | Topological drugs | Byzantine medicine | Chiral drugs | 00
| 44,472 |
<unk> patients often report pain as dominant in their lives. It is recommended that healthcare providers handle the pain related to<unk> s as one of the main priorities in<unk> management (together with addressing the cause). Six out of ten venous leg ulcer patients experience pain with their ulcer, and similar trends are observed for other<unk> s. Persistent pain (at night, at rest, and with activity) is the main problem for patients with<unk> ulcers. Frustrations regarding ineffective analgesics and plans of care that they were unable to adhere to were also identified. | Chronic wound | Burn scar contracture | Wound contracture | Implant failure | Cancer cluster | Postoperative wounds | Stab wound | Chronic limb threatening ischemia | 00
| 31,218 |
Symptoms of<unk> progress at a rapid, steady rate. Patients suffering from the disease can survive for 2–20 years. Eventually patients will need 24-hour care for daily function. CSF leaks are a known cause of reversible<unk> . | Frontotemporal dementia | Fatal insomnia | Dementia with Lewy bodies | Lewy body dementias | Vascular dementia | Subcortical dementia | Semantic dementia | Early-onset Alzheimer's disease | 00
| 15,926 |
<unk> (formerly marketed as Alloferin) is a neuromuscular blocking (NMB) agent, alternatively referred to as a skeletal muscle relaxant. It is a semi-synthetic substance prepared from C-toxiferine I, a bis-quaternary alkaloid obtained from Strychnos toxifera. C-toxiferine I itself has been tested for its pharmacological action and noted to be a very long acting neuromuscular blocking agent For a formal definition of the durations of actions associated with NMB agents, see page for gantacurium. The replacement of both the N-methyl groups with N-allyl moieties yielded N,N-diallyl-bis-nortoxiferine, now recognized as<unk> . Inclusion of the allylic functions presented an enhanced potential area of biotransformation, and thus<unk> is observed to have a much shorter duration of neuromuscular blocking action than its parent C-toxiferine I. It also has a more rapid onset of action, and is ~1.5 times as potent as tubocurarine. The pharmacological action of<unk> is readily reversed by neostigmine, and it produces little histamine release. The major disadvantage of<unk> is that it elicits a vagolytic effect produced by a selective atropine-like blockade of cardiac muscarinic receptors. | Alcuronium chloride | Rocuronium bromide | Pancuronium bromide | Suxamethonium chloride | Vecuronium bromide | Rapacuronium bromide | Gantacurium chloride | Mivacurium chloride | 00
| 39,199 |
The most accurate method of diagnosis is prenatal screening through real-time fetal images. However, since maternal body habitus leads to diagnostic difficulties using this method, MRI and sonography are the most commonly used technique since there is no exposure to ionizing radiation. At the beginning of the second trimester, the central nervous system (CNS) and anatomic structures of the fetus can be clearly visualized and the characteristic malformations of<unk> , such as a shortened trunk, marked lordosis in the cervicothoracic vertebrae, absence or partial absence of the occipital squama, abnormal fusion of vertebrae, closed vertebral arches, formation of an encephalocele (for<unk> apertus), and dorsiflexion of the head in respect to the spine, can be precisely diagnosed as well as the severity and location established. Once established, further decisions can be made with regard to terminating the pregnancy or providing a plan of adequate postnatal care. Differential diagnosis Since many of the characteristics of<unk> , such as congenital retroflexion of the spine and fusion of the cervical vertebrae, are shared with other disorders, key differences are important to note. While anencephaly experiences a partial to total lack of the neurocranium,<unk> does not. In anencephaly, the retroflexed head is not covered with skin while in<unk> , the retroflexed head is covered with skin entirely. Cervical vertebrae are malformed and reduced in<unk> while they are almost normal in anencephaly. Even though KFS does experience malformed cervical vertebra due to failure of segmentation during early fetal development, there is not retroflexion of the head as seen in<unk> . While<unk> clausus is fatal, KFS is not and can be surgically corrected. Therefore, it is crucial to correctly diagnose KFS and not mistake it for<unk> clausus. | Iniencephaly | Klippel–Feil syndrome | Brachyphalangy | Microhydranencephaly | Oxycephaly | Hemihydranencephaly | Anencephaly | Hydranencephaly | 00
| 8,625 |
The prognosis of<unk> is extremely variable and depends on the condition leading to<unk> , whether one (unilateral) or both (bilateral) kidneys are affected, the pre-existing kidney function, the duration of<unk> (acute or chronic), and whether<unk> occurred in developing or mature kidneys. Permanent kidney damage can occur from prolonged<unk> secondary to compression of kidney tissue and ischemia. For example, unilateral<unk> caused by an obstructing stone will likely resolve when the stone passes, and the likelihood of recovery is excellent. Alternately, severe bilateral prenatal<unk> (such as occurs with posterior urethral valves) will likely carry a poor long-term prognosis, because obstruction while the kidneys are developing causes permanent kidney damage even if the obstruction is relieved postnatal.<unk> can be a cause of pyonephrosis, which is a urological emergency. | Hydronephrosis | Pyonephrosis | Glomerulonephrosis | Pyelonephritis | Ureteric stricture | Ureteral cancer | Salpingitis | Obstructive uropathy | 00
| 25,104 |
It is semisynthetic and in the same class as penicillin.<unk> is used against staphylococci that produce beta-lactamase, due to its large R chain, which does not allow the beta-lactamases to bind. This drug has a weaker antibacterial activity than benzylpenicillin, and is devoid of serious toxicity except for allergic reactions. | Cloxacillin | Piperacillin | Dicloxacillin | Flucloxacillin | Cefazolin | Resistin | Ampicillin | Vancomycin | 00
| 19,142 |
A lumbar puncture in progress. A large area on the back has been washed with an iodine-based disinfectant leaving brown coloration As only 10 percent of people admitted to the emergency department with a thunderclap headache are having an SAH, other possible causes are usually considered simultaneously, such as meningitis, migraine, and cerebral venous sinus thrombosis. Intracerebral hemorrhage, in which bleeding occurs within the brain itself, is twice as common as SAH and is often misdiagnosed as the latter. It is not unusual for SAH to be initially misdiagnosed as a migraine or tension headache, which can lead to a delay in obtaining a CT scan. In a 2004 study, this occurred in 12 percent of all cases and was more likely in people who had smaller hemorrhages and no impairment in their mental status. The delay in diagnosis led to a worse outcome. In some people, the headache resolves by itself, and no other symptoms are present. This type of headache is referred to as "sentinel headache", because it is presumed to result from a small leak (a "warning leak") from an aneurysm. A sentinel headache still warrants investigations with CT scan and lumbar puncture, as further bleeding may occur in the subsequent three weeks. The initial steps for evaluating a person with a suspected subarachnoid hemorrhage are obtaining a medical history and performing a physical examination. The diagnosis cannot be made on clinical grounds alone and in general medical imaging and possibly a lumbar puncture is required to confirm or exclude bleeding. Imaging The modality of choice is computed tomography (CT scan), without contrast, of the brain. This has a high sensitivity and will correctly identify 98.7% of cases within six hours of the onset of symptoms. A CT scan can rule out the diagnosis in someone with a normal neurological exam if done within six hours. Its efficacy declines thereafter, and magnetic resonance imaging (MRI) is more sensitive than CT after several days. Angiography After a subarachnoid hemorrhage is confirmed, its origin needs to be determined. If the bleeding is likely to have originated from an aneurysm (as determined by the CT scan appearance), the choice is between cerebral angiography (injecting radiocontrast through a catheter to the brain arteries) and CT angiography (visualizing blood vessels with radiocontrast on a CT scan) to identify aneurysms. Catheter angiography also offers the possibility of coiling an aneurysm (see below). In emergency department patients complaining of acute-onset headache without significant risk factors for SAH, evidence suggests that CT scanning of the head followed by CT angiography can reliably exclude SAH without the need for a lumbar puncture. The risk of missing an aneurysmal bleed as the cause of SAH with this approach is less than 1%. Lumbar puncture Xanthochromia versus normal CSF. Lumbar puncture, in which cerebrospinal fluid (CSF) is removed from the subarachnoid space of the spinal canal using a hypodermic needle, shows evidence of bleeding in three percent of people in whom a non-contrast CT was found normal. A lumbar puncture or CT scan with contrast is therefore regarded as mandatory in people with suspected SAH when imaging is delayed to after six hours from the onset of symptoms and is negative. At least three tubes of CSF are collected. If an elevated number of red blood cells is present equally in all bottles, this indicates a subarachnoid hemorrhage. If the number of cells decreases per bottle, it is more likely that it is due to damage to a small blood vessel during the procedure (known as a "traumatic tap"). While there is no official cutoff for red blood cells in the CSF no documented cases have occurred at less than "a few hundred cells" per high-powered field. The CSF sample is also examined for xanthochromia—the yellow appearance of centrifugated fluid. This can be determined by spectrophotometry (measuring the absorption of particular wavelengths of light) or visual examination. It is unclear which method is superior. Xanthochromia remains a reliable ways to detect SAH several days after the onset of headache. An interval of at least 12 hours between the onset of the headache and lumbar puncture is required, as it takes several hours for the hemoglobin from the red blood cells to be metabolized into bilirubin. ECG ECG changes resembling those of an STEMI in a woman who had an acute CNS injury from a subarachnoid hemorrhage. Electrocardiographic changes are relatively common in subarachnoid hemorrhage, occurring in 40–70 percent of cases. They may include QT prolongation, Q waves, cardiac dysrhythmias, and ST elevation that mimics a heart attack. Classification There are several grading scales available for SAH. The Glasgow Coma Scale (GCS) is ubiquitously used for assessing consciousness. Its three specialized scores are used to evaluate SAH; in each, a higher number is associated with a worse outcome. These scales have been derived by retrospectively matching characteristics of people with their outcomes. The first widely used scale for neurological condition following SAH was published by Botterell and Cannell in 1956 and referred to as the Botterell Grading Scale. This was modified by Hunt and Hess in 1968: Grade Signs and symptoms Survival 1 Asymptomatic or minimal headache and slight neck stiffness 70% 2 Moderate to severe headache; neck stiffness; no neurologic deficit except cranial nerve palsy 60% 3 Drowsy; minimal neurologic deficit 50% 4 Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances 20% 5 Deep coma; decerebrate rigidity; moribund 10% The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan. Grade Appearance of hemorrhage 1 None evident 2 Less than 1 mm thick 3 More than 1 mm thick 4 Diffuse or none with intraventricular hemorrhage or parenchymal extension This scale has been modified by Claassen and coworkers, reflecting the additive risk from SAH size and accompanying intraventricular hemorrhage (0 – none; 1 – minimal SAH w/o IVH; 2 – minimal SAH with IVH; 3 – thick SAH w/o IVH; 4 – thick SAH with IVH);. The World Federation of Neurosurgeons (WFNS) classification uses Glasgow coma score and focal neurological deficit to gauge severity of symptoms. Grade GCS Focal neurological deficit 1 15 Absent 2 13–14 Absent 3 13–14 Present 4 7–12 Present or absent 5 <7 Present or absent A comprehensive classification scheme has been suggested by Ogilvy and Carter to predict outcome and gauge therapy. The system consists of five grades and it assigns one point for the presence or absence of each of five factors: age greater than 50; Hunt and Hess grade 4 or 5; Fisher scale 3 or 4; aneurysm size greater than 10 mm; and posterior circulation aneurysm 25 mm or more. | complications of Vertebral artery dissection | medical cause of Vertebral artery dissection | symptoms of Vertebral artery dissection | symptom of Vertebral artery dissection | complications of Giant cell arteritis | symptom of Idiopathic intracranial hypertension | complications of Trigeminal neuralgia | symptom of Giant cell arteritis | 00
| 16,571 |
<unk> mellitus (DM) is a type of metabolic disease characterized by hyperglycemia. It is caused by either defected insulin secretion or damaged biological function, or both. The high-level blood glucose for a long time will lead to dysfunction of a variety of tissues. Type 2<unk> is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. Pre-diabetes means that the blood sugar level is higher than normal but not yet high enough to be type 2<unk> . Gestational<unk> is a condition in which a woman without<unk> develops high blood sugar levels during pregnancy. Type 2<unk> mellitus and prediabetes are associated with changes in levels of metabolic markers, these markers could serve as potential prognostic or therapeutic targets for patients with prediabetes or Type 2<unk> mellitus. | Biomarkers of diabetes | Glycemic index | Alzheimer's disease biomarkers | Insulin index | Quantitative insulin sensitivity check index | Homeostatic model assessment | Epidemiology of diabetes | FACE risk profile | 00
| 71,922 |
The most common symptom is unusual interaction with strangers. A child with DSED shows no sign of fear or discomfort when talking to, touching, or accompanying an adult stranger. They can be categorized by the following: * Overly familiar verbal or physical behavior that is not consistent with culturally sanctioned and appropriate<unk> boundaries or seems out of character for their current age * Lack of reservation when it comes to approaching and interacting with unfamiliar adults * Diminished or absent checking back with an adult caregiver after venturing away, even in unfamiliar settings * Willingness to go off with an unfamiliar adult with minimal or no hesitation The attachment style associated with DSED is disorganized attachment. This attachment style is a combination of anxious and avoidant attachment and participants often have a need for closeness, fear of rejection, and contradictory mental states and behaviors. Disorganized Attachment is common amongst children living in institutions such as foster care. Children living in these institutions have an increased risk of suffering from DSED. Which is common in those who experience neglect from caregivers at an early age making it a common occurrence in children suffering from DSED. DSED can cause symptoms commonly associated with attention deficit hyperactivity disorder (ADHD) It can be comorbid with cognitive, language and speech delay. Additionally, children who are<unk> ly<unk> despite not undergoing the trauma to become so should not be diagnosed with DSED. The child’s behavior can be explained with other disorders such as Williams syndrome which often has similar symptoms to DSED. | Disinhibited social engagement disorder | Autism's False Prophets | Multiple complex developmental disorder | Autism spectrum | Personality development disorder | Childhood disintegrative disorder | Frontal lobe disorder | Tourette syndrome | 00
| 66,062 |
Penicillin is used to treat<unk> . Two examples of penicillin therapies include: * Aqueous penicillin G 3–4 million units every four hours for 10 to 14 days. * One daily intramuscular injection and oral probenecid four times daily, both for 10 to 14 days. Follow-up blood tests are generally performed at 3, 6, 12, 24, and 36 months to make sure the infection is gone. Lumbar punctures for CSF fluid analysis are generally performed every 6 months until cell counts normalize. All patients with syphilis should be tested for HIV infection. All cases of syphilis should be reported to public health authorities and public health departments can aid in partner notification, testing, and determining need for treatment. The treatment success is measured with a 4-fold drop in the nontreponemal antibody test. In early-stage syphilis drop should occur in 6–12 months. in late syphilis drop can take 12–24 months. Titers may decline more slowly in persons who have previously had syphilis. In people who cannot take penicillin it is uncertain if other antibiotic therapy is effective for treating<unk> . | Neurosyphilis | Syphilis | Mumps | Chickenpox | Leprosy | Smallpox | Rubella | Rickettsialpox | 00
| 33,359 |
<unk> (often abbreviated as<unk> in literature) is a rare autosomal recessive genetic disorder characterized by short stature, predisposition to the development of cancer, and genomic instability.<unk> is caused by mutations in the BLM gene which is a member of the RecQ DNA helicase family. Mutations in other members of this family, namely WRN and RECQL4, are associated with the clinical entities Werner syndrome and Rothmund–Thomson syndrome, respectively. More broadly,<unk> is a member of a class of clinical entities that are characterized by chromosomal instability, genomic instability, or both and by cancer predisposition. Cells from a person with<unk> exhibit a striking genomic instability that includes excessive crossovers between homologous chromosomes and sister chromatid exchanges (SCEs). The condition was discovered and first described by New York dermatologist Dr. David<unk> in 1954.<unk> has also appeared in the older literature as<unk> –Torre–Machacek syndrome. | Bloom syndrome | Plummer–Vinson syndrome | Schnitzler syndrome | Secretan's syndrome | Galloway Mowat syndrome | Mucus fishing syndrome | Naegeli–Franceschetti–Jadassohn syndrome | König's syndrome | 00
| 21,573 |
WHO The World Health Organization (WHO) classification scheme places<unk> s into three main categories, which emphasize the<unk> grade rather than the anatomical origin: * well-differentiated<unk> rs, further subdivided into<unk> s with benign and those with uncertain behavior * well-differentiated (low grade)<unk> carcinomas with low-grade malignant behavior * poorly differentiated (high grade)<unk> carcinomas, which are the large cell<unk> and small cell carcinomas. Additionally, the WHO scheme recognizes mixed<unk> s with both<unk> and epithelial carcinoma features, such as goblet cell cancer, a rare gastrointestinal tract<unk> . Placing a given<unk> into one of these categories depends on well-defined histological features: size, lymphovascular invasion, mitotic count, Ki-67 labelling index, invasion of adjacent organs, presence of metastases and whether they produce hormones. Anatomic distribution Traditionally,<unk> s have been classified by their anatomic site of origin.<unk> s can arise in many different areas of the body, and are most often located in the intestine, pancreas or the lungs. The various kinds of cells that can give rise to<unk> s are present in endocrine glands and are also diffusely distributed throughout the body, most commonly Kulchitsky cells or similar enterochromaffin-like cells, that are relatively more common in the gastrointestinal and pulmonary systems.<unk> s include certain<unk> s of the gastrointestinal tract and of the pancreatic islet cells, certain thymus and lung<unk> s, and medullary carcinoma of the parafollicular cells of the thyroid.<unk> s with similar cellular characteristics in the pituitary, parathyroid, and adrenomedullary glands are sometimes included or excluded. Within the broad category of<unk> s there are many different<unk> types, representing only a small proportion of the<unk> s or cancers in most of these tissues: * Pituitary gland:<unk> of the anterior pituitary * Thyroid gland:<unk> thyroid<unk> s, particularly medullary carcinoma * Parathyroid<unk> s * Thymus and mediastinal carcinoid<unk> s * Pulmonary<unk> s * bronchus * pulmonary carcinoid<unk> s: typical carcinoid (TC; low-grade); atypical carcinoid (AC; intermediate-grade) * small-cell lung cancer (SCLC) * large cell<unk> carcinoma of the lung (LCNEC) * Extrapulmonary small cell carcinomas (ESCC or EPSCC) * Gastroenteropancreatic<unk> s (GEP-NET) * Foregut GEP-NET (foregut<unk> s can conceptually encompasses not only<unk> s of the stomach and proximal duodenum, but also the pancreas, and even thymus, lung and bronchus) * Pancreatic endocrine<unk> s (if considered separately from foregut GEP-NET) * Midgut GEP-NET (from distal half of 2nd part of the duodenum to the proximal two-thirds of the transverse colon) * appendix, including well differentiated<unk> s (benign); well differentiated<unk> s (uncertain malignant potential); well differentiated<unk> carcinoma (with low malignant potential); mixed exocrine-neuroendocrine carcinoma (goblet cell carcinoma, also called adenocarcinoid and mucous adenocarcinoid) * Hindgut GEP-NET * Liver and gallbladder * Adrenal<unk> s, particularly adrenomedullary<unk> s * Pheochromocytoma * Peripheral nervous system<unk> s, such as: * Schwannoma * paraganglioma * neuroblastoma * Breast * Genitourinary tract * urinary tract carcinoid<unk> and<unk> carcinoma * ovary *<unk> of the cervix * Prostate<unk> with<unk> differentiation * testes * Merkel cell carcinoma of skin (trabecular cancer) * Inherited conditions: * multiple endocrine neoplasia type 1 (MEN1) * multiple endocrine neoplasia type 2 (MEN2) * von Hippel-Lindau (VHL) disease * neurofibromatosis type 1 * tuberous sclerosis * Carney complex Grading<unk> lesions are graded histologically according to markers of cellular proliferation, rather than cellular polymorphism. The following grading scheme is currently recommended for all gastroenteropancreatic<unk> neoplasms by the World Health Organization: Mitoses in a<unk> . G Mitotic count (per 10 HPF) Ki-67 index (%) GX Grade cannot be assessed G1 20 > 20% If mitotic count and Ki-67 are discordant, the figure which gives the highest grade is used. G1 and G2<unk> neoplasms are called<unk> s <unk> s) – formerly called carcinoid<unk> rs. G3 neoplasms are called<unk> carcinomas (NECs). It has been proposed that the current G3 category be further separated into histologically well-differentiated and poorly-differentiated neoplasms to better reflect prognosis. Staging Lymph node metastasis of a<unk> . Currently there is no one staging system for all<unk> neoplasms. Well-differentiated lesions generally have their own staging system based on anatomical location, whereas poorly differentiated and mixed lesions are staged as carcinomas of that location. For example, gastric NEC and mixed adenoneuroendocrine cancers are staged as primary carcinoma of the stomach. TNM staging of gastroenteropancreatic Grade 1 and Grade 2<unk> s are as follows: Stomach Primary<unk> (T) T Category<unk> Criteria TX Primary<unk> r cannot be assessed T0 No evidence of primary<unk> r T1 Invades the lamina propria or submucosa, and less than or equal to 1 cm in size T2 Invades the muscularis propria, or greater than 1 cm in size T3 Invades through the muscularis propria into subserosal tissue without penetration of overlying serosa T4 Invades visceral peritoneum (serosal) or other organs or adjacent structures Regional Lymph Node (N) N Category N Criteria NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis Distant Metastasis (M) M Category M Criteria M0 No distant metastasis M1 Distant metastasis M1a Metastasis confined to liver M1b Metastasis in at least one extra-hepatic site M1c Both hepatic and extra-hepatic metastases AJCC Prognostic Stage Groups Stage Criteria I T1, N0, M0 II T2 or T3, N0, M0 III Any T, N1, M0; T4, N0, M0 IV Any T, any N, M1 Duodenum / Ampulla of Vater Primary<unk> (T) T Category<unk> Criteria TX Primary<unk> r cannot be assessed T1 Invades the mucosa or submucosa only, and less than or equal to 1 cm in size (duodenal<unk> s)Confined within the sphincter of Oddi, and less than or equal to 1 cm in size (ampullary<unk> s) T2 Invades the muscularis propria, or is > 1 cm (duodenal)Invades through sphincter into duodenal submucosa or muscularis propria, or is > 1 cm (ampullary) T3 Invades the pancreas or peripancreatic adipose tissue T4 Invades visceral peritoneum (serosal) or other organs Regional Lymph Node (N) N Category N Criteria NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis Distant Metastasis (M) M Category M Criteria M0 No distant metastasis M1 Distant metastasis M1a Metastasis confined to liver M1b Metastasis in at least one extra-hepatic site M1c Both hepatic and extra-hepatic metastases AJCC Prognostic Stage Groups Stage Criteria I T1, N0, M0 II T2 or T3, N0, M0 III T4, N0, M0; Any T, N1, M0 IV Any T, any N, M1 Jejunum and Ileum Primary<unk> (T) T Category<unk> Criteria TX Primary<unk> r cannot be assessed T0 No evidence of primary<unk> r T1 Invades the lamina propria or submucosa, and less than or equal to 1 cm in size T2 Invades the muscularis propria, or greater than 1 cm in size T3 Invades through the muscularis propria into subserosal tissue without penetration of overlying serosa T4 Invades visceral peritoneum (serosal) or other organs or adjacent structures Regional Lymph Node (N) N Category N Criteria NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis less than 12 nodes N2 Large mesenteric masses (> 2 cm) and / or extensive nodal deposits (12 or greater), especially those that encase the superior mesenteric vessels Distant Metastasis (M) M Category M Criteria M0 No distant metastasis M1 Distant metastasis M1a Metastasis confined to liver M1b Metastasis in at least one extra-hepatic site M1c Both hepatic and extra-hepatic metastases AJCC Prognostic Stage Groups Stage Criteria I T1, N0, M0 II T2 or T3, N0, M0 III Any T, N1 or N2, M0; T4, N0, M0; IV Any T, any N, M1 Appendix Primary<unk> (T) T Category<unk> Criteria TX Primary<unk> r cannot be assessed T0 No evidence of primary<unk> r T1 2 cm or less in greatest dimension T2<unk> more than 2 cm but less than or equal to 4 cm T3<unk> more than 4 cm or with subserosal invasion or involvement of the mesoappendix T4 Perforates the peritoneum or directly invades other organs or structures (excluding direct mural extension to adjacent subserosa of adjacent bowel) Regional Lymph Node (N) N Category N Criteria NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis Distant Metastasis (M) M Category M Criteria M0 No distant metastasis M1 Distant metastasis M1a Metastasis confined to liver M1b Metastasis in at least one extra-hepatic site M1c Both hepatic and extra-hepatic metastases AJCC Prognostic Stage Groups Stage Criteria I T1, N0, M0 II T2 or T3, N0, M0 III Any T, N1, M0; T4, N1, M0 IV Any T, any N, M1 Colon and Rectum Primary<unk> (T) T Category<unk> Criteria TX Primary<unk> r cannot be assessed T0 No evidence of primary<unk> r T1 Invades the lamina propria or submucosa, and less than or equal to 2 cm T1a Less than 1 cm in greatest dimension T1b 1–2 cm in greatest dimension T2 Invades the muscularis propria, or greater than 2 cm in size with | Neuroendocrine tumor | Pituitary adenoma | Metastatic insulinoma | Insulinoma | Glucagonoma | Granular cell tumor | Endocrine gland neoplasm | Glial tumor | 00
| 37,905 |
The management of abdominal pain depends on many factors, including the etiology of the pain. In the emergency department, a person presenting with abdominal pain may initially require IV fluids due to decreased intake secondary to abdominal pain and possible emesis or vomiting. Treatment for abdominal pain includes analgesia, such as non-opioid (ketorolac) and opioid medications (morphine, fentanyl). Choice of analgesia is dependent on the cause of the pain, as ketorolac can worsen some intra-abdominal processes. Patients presenting to the emergency department with abdominal pain may receive a "GI cocktail" that includes an antacid (examples include omeprazole, ranitidine, magnesium hydroxide, and calcium chloride) and lidocaine. After addressing pain, there may be a role for antimicrobial treatment in some cases of abdominal pain. Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success. Surgical management for causes of abdominal pain includes but is not limited to cholecystectomy, appendectomy, and exploratory laparotomy. Emergencies Below is a brief overview of abdominal pain emergencies. + Condition Presentation Diagnosis Management Appendicitis Abdominal pain, nausea, vomiting, fever Periumbilical pain, migrates to RLQ Clinical (history & physical exam) Abdominal CT Patient made NPO (nothing by mouth) IV fluids as needed General surgery consultation, possible appendectomy Antibiotics Pain control Cholecystitis Abdominal pain (RUQ, radiates epigastric), nausea, vomiting, fever, Murphy's sign Clinical (history & physical exam) Imaging (RUQ ultrasound) Labs (leukocytosis, transamintis, hyperbilirubinemia) Patient made NPO (nothing by mouth) IV fluids as needed General surgery consultation, possible cholecystectomy Antibiotics Pain, nausea control Acute pancreatitis Abdominal pain (sharp epigastric, shooting to back), nausea, vomiting Clinical (history & physical exam) Labs (elevated lipase) Imaging (abdominal CT, ultrasound) Patient made NPO (nothing by mouth) IV fluids as needed Pain, nausea control Possibly consultation of general surgery or interventional radiology Bowel obstruction Abdominal pain (diffuse, crampy), bilious emesis, constipation Clinical (history & physical exam) Imaging (abdominal X-ray, abdominal CT) Patient made NPO (nothing by mouth) IV fluids as needed Nasogastric tube placement General surgery consultation Pain control Upper GI bleed Abdominal pain (epigastric), hematochezia, melena, hematemesis, hypovolemia Clinical (history & physical exam, including digital rectal exam) Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Aggressive IV fluid resuscitation Blood transfusion as needed Medications: proton pump inhibitor, octreotide Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Lower GI Bleed Abdominal pain, hematochezia, melena, hypovolemia Clinical (history & physical exam, including digital rectal exam) Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Aggressive IV fluid resuscitation Blood transfusion as needed Medications: proton pump inhibitor Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Perforated Viscous Abdominal pain (sudden onset of localized pain), abdominal distension, rigid abdomen Clinical (history & physical exam) Imaging (abdominal X-ray or CT showing free air) Labs (complete blood count) Aggressive IV fluid resuscitation General surgery consultation Antibiotics Volvulus Sigmoid colon volvulus: Abdominal pain (>2 days, distention, constipation) Cecal volvulus: Abdominal pain (acute onset), nausea, vomiting Clinical (history & physical exam) Imaging (abdominal X-ray or CT) Sigmoid: Gastroenterology consultation (flexibile sigmoidoscopy) Cecal: General surgery consultation (right hemicolectomy) Ectopic pregnancy Abdominal and pelvic pain, bleeding If ruptured ectopic pregnancy, the patient may present with peritoneal irritation and hypovolemic shock Clinical (history & physical exam) Labs: complete blood count, urine pregnancy test followed with quantitative blood beta-hCG Imaging: transvaginal ultrasound If patient is unstable: IV fluid resuscitation, urgent obstetrics and gynecology consultation If patient is stable: continue diagnostic workup, establish OBGYN follow-up Abdominal aortic aneurysm Abdominal pain, flank pain, back pain, hypotension, pulsatile abdominal mass Clinical (history & physical exam) Imaging: Ultrasound, CT angiography, MRA/magnetic resonance angiography If patient is unstable: IV fluid resuscitation, urgent surgical consultation If patient is stable: admit for observation Aortic dissection Abdominal pain (sudden onset of epigastric or back pain), hypertension, new aortic murmur Clinical (history & physical exam) Imaging: Chest X-Ray (showing widened mediastinum), CT angiography, MRA, transthoracic echocardiogram/TTE, transesophageal echocardiogram/TEE IV fluid resuscitation Blood transfusion as needed (obtain type and cross) Medications: reduce blood pressure (sodium nitroprusside plus beta blocker or calcium channel blocker) Surgery consultation Liver injury After trauma (blunt or penetrating), abdominal pain (RUQ), right rib pain, right flank pain, right shoulder pain Clinical (history & physical exam) Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage Resuscitation (Advanced Trauma Life Support) with IV fluids (crystalloid) and blood transfusion If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy Splenic injury After trauma (blunt or penetrating), abdominal pain (LUQ), left rib pain, left flank pain Clinical (history & physical exam) Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage Resuscitation (Advanced Trauma Life Support) with IV fluids (crystalloid) and blood transfusion If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy and possible splenectomy If patient is stable: medical management, consultation of interventional radiology for possible arterial embolization | symptom of Diverticulitis | symptoms of Diverticulitis | symptom of Giardiasis | symptom of Ulcerative colitis | symptom of Campylobacteriosis | symptom of Gastroenteritis | symptom of Cholecystitis | symptom of Upper gastrointestinal bleeding | 00
| 14,780 |
A<unk> <unk> is a measure of how far an individual test result deviates from the<unk> .<unk> is commonly used to report the results of medical screening tests, particularly where the results of the individual tests are highly variable.<unk> was originally used as a method to normalize data from participating laboratories of Alpha-fetoprotein (AFP) so that individual test results could be compared. 35 years later, it is the established standard for reporting maternal serum screening results. An<unk> for a test result for a patient can be determined by the following: : As an example, Alpha-fetoprotein (AFP) testing is used to screen for a neural tube defect (NTD) during the second trimester of pregnancy. If the<unk> AFP result at 16 weeks of gestation is 30 ng/mL and a pregnant woman's AFP result at that same gestational age is 60 ng/mL, then her<unk> is equal to 60/30 = 2.0. In other words, her AFP result is 2 times higher than<unk> . | Multiple of the median | Relative value unit | Absolute threshold | Equivalent dose | Form constant | Threshold limit value | Indicative limit value | Minimal important difference | 00
| 47,573 |
<unk> is rare; misdiagnosis may lead to increased medical expenses, family stress, and the chance of using incorrect forms of treatment, which may exacerbate the patient's condition. Nevertheless,<unk> can be diagnosed if properly detected. Vision impairment is the most common observable symptom of the<unk> . Occurrences in children are more prevalent than occurrences in adolescents or adults. Children or adults suspected of having<unk> should initially see an optometrist or ophthalmologist. A fundus eye examination that aids in the detection of common vision impairment abnormalities, such as granularity of the retinal pigment epithelium in the central macula will be performed. Though it is also seen in a variety of other<unk> s, a loss of ocular cells is a warning sign of<unk> . If<unk> is the suspected diagnosis, a variety of tests is conducted to help accurately confirm the diagnosis, including: * Blood or urine tests can help detect abnormalities that may indicate<unk> . For example, elevated levels of Dolichol in urine have been found in many individuals with NCL. The presence of vacuolated lymphocytes—white blood cells that contain holes or cavities (observed by microscopic analysis of blood smears)—when combined with other findings that indicate NCL, is suggestive for the juvenile form caused by CLN3 mutations. * Skin or tissue sampling is performed by extracting a small piece of tissue, which then is examined under an electron microscope. This can allow physicians to detect typical NCL deposits. These deposits are common in tissues such as skin, muscle, conjunctiva, and rectum. This diagnostic technique is useful, but other invasive tests are more reliable for diagnosing<unk> . * Electroencephalogram (EEG) is a technique that uses special probes attached on to the individual's scalp. It records electrical currents/signals, which allow medical experts to analyze electrical pattern activity in the brain. EEG assists in observing if the patient has seizures. * Electrical studies of the eyes are used, because as mentioned, vision loss is the most common characteristic of<unk> . Visual-evoked responses and electroretinograms are effective tests for detecting various eye conditions common in childhood NCLs. * Computed tomography (CT) or magnetic resonance imaging (MRI) are diagnostic imaging tests that allow physicians to better visualize the appearance of the brain. MRI imaging test uses magnetic fields and radio waves to help create images of the brain. CT scan uses x-rays and computers to create a detailed image of the brain's tissues and structures. Both diagnostic imaging tests can help reveal brain areas that are decaying, or atrophic, in persons with NCL. * Measurement of enzyme activity specific to<unk> may help confirm certain diagnoses caused by different mutations. Elevated levels of palmitoyl-protein thioesterase is involved in CLN1. Acid protease is involved in CLN2. Cathepsin D is involved in CLN10. * DNA analysis can be used to help confirm the diagnosis of<unk> . When the mutation is known, DNA analysis can also be used to detect unaffected carriers of this condition for genetic counseling. If a family mutation has not previously been identified or if the common mutations are not present, recent molecular advances have made it possible to sequence all of the known NCL genes, increasing the chances of finding the responsible mutation(s). | Batten disease | Keshan disease | Akureyri disease | Krabbe disease | Farber disease | Karak syndrome | Sandhoff disease | Menkes disease | 00
| 26,797 |
The<unk> is a medical device previously used to determine the location and aid the removal of bullets and shrapnel in a patient's body. The device would be used by a surgeon who would, with the help of x-ray photographs, precisely remove the foreign object. The device would usually give a location within 1 or 2 millimeters of the foreign object. At its peak, the average rate of projectile removal when the device was used by local surgeons reached approximately 90%. The device was extensively used during World War I. | Hirtz compass | Ocular tilt reaction | Haller index | Cup-to-disc ratio | Krogh length | Stenger test | Mentzer index | Acoustic reflex | 00
| 58,784 |
A<unk> is a small lesion that appears on the surface of the skin and typically resembles a cauliflower, with tiny black petechiae (tiny hemorrhages under the skin) in the center. Pinpoint bleeding may occur when these are scratched.<unk> s occur on the soles of feet and toes. They may be painful when standing or walking.<unk> s are often similar to calluses or corns, but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to fingerprints of the feet. Friction ridges are disrupted by<unk> s; if the lesion is not a<unk> , the striations continue across the top layer of the skin.<unk> s tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike calluses (which tend to be painful on direct pressure, instead). | Plantar wart | Callus | Veinoplus | Molluscum contagiosum | Broken toe | Squamous cell carcinoma | Freckle | Broken finger | 00
| 10,715 |
Virology The<unk> virus is a typical flavivirus measuring about 40-60 nm in diameter. The genome of<unk> V consists of 10,774 nucleotides of single-stranded, positive-sense RNAencoding a single polyprotein that is cleaved post-translationally into three structural (C, prM/M and E) and seven non-structural (NS1, NS2a, NS2b, NS3, NS4a, NS4b and NS5) proteins. The genome of<unk> V is very similar (>92% homologous) to that of Alkhurma Hemorrhagic Fever Virus which is primarily found in Saudi Arabia. These two species both belong to the family Flaviviridae and diverged over 700 years ago and have thus remained geographically separated. Transmission A variety of animals are thought to be reservoir hosts for the<unk> , including porcupines, rats, squirrels, mice, and shrews. Monkeys are the main amplifying hosts for<unk> virus and they are also sufferers. The surili Presbytis entellus and the bonnet macaque are very susceptible to the<unk> virus. They develop tremendous viremia and infect the ticks. The vector for<unk> transmission is Haemaphysalis spinigera, a<unk> tick. Humans contract infection from the bite of nymphs of the tick. Man is a terminal host and there no human-to-human transmission because the human domestic environment does not sustain the ticks. | Kyasanur Forest disease | Hittite plague | Cholera belt | Scabies | Psittacosis | Babesiosis | Leishmaniasis | Caragea's plague | 00
| 25,854 |
<unk> s are drugs used to alleviate the symptoms of diarrhea. These include loperamide (Imodium), diphenoxylate with atropine (Lomotil), and opiates such as paregoric, tincture of opium, codeine, and morphine. In diarrhea caused by invasive pathogens such as Salmonella, Shigella, and Campylobacter, the use of such<unk> s has generally been strongly discouraged, though evidence is lacking that they are harmful when administered in combination with antibiotics in Clostridium difficile cases. Use of<unk> s in children and the elderly has also been discouraged in treatment of EHEC (Shiga-like toxin producing Escherichia coli) due to an increased rate of hemolytic uremic syndrome. | Antimotility agent | Proton-pump inhibitor | Cholagogue | Antiemetic | Decongestant | Antipyretic | Chaotropic agent | Prokinetic agent | 00
| 61,160 |
Some of the advantages resulting from adopting<unk> may include improved communication in integrated healthcare delivery networks, improved community wide electronic health records, the automatic transfer to public health authorities of case reports for reportable diseases (e.g. for disease control or detection of epidemics), improved transfer of payment information for services rendered and a significant improvement in the overall quality of health care by reducing errors in the system. The fact that universal standards are being promoted (if not adopted by national organizations and agencies) is an indication that the dialogue will continue regarding the development, structure, financing, monitoring, enforcement, and integration of standards within the broader health care system. International interest in<unk> continues to grow. A number of efforts have been undertaken to translate the<unk> documents and terms into various languages, such as Simplified Chinese, German, Spanish. As of January, 2009, the software RELMA (Regenstrief<unk> Mapping Assistant) is available in separate downloads that contain an additional word index in Spanish, Simplified Chinese, or Korean, which allows searching in these languages in addition to English. Harmonization efforts between<unk> and SNOMED CT were initiated in 2012. | LOINC | NLM | PATH | KHAT | SFHAM | TOFI | CAPOX | DRACO | 00
| 31,368 |
Females The diagnostic workup begins with a careful history and examination, followed by a pregnancy test. Some Fillipine or Vietnum women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation. The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain. Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction. Some of the mechanisms by which the limbic system impacts on pain, and in particular myofascial pain, have been clarified by research findings in neurology and psychophysiology. Males In chronic<unk> , there are no standard diagnostic tests in males; diagnosis is by exclusion of other disease entities. | Pelvic pain | Dysmenorrhea | Testicular pain | Penile pain | Pelvic girdle pain | Hematospermia | Vaginal discharge | Penile discharge | 00
| 36,427 |
<unk> (previously known as the<unk> Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers. It includes 53 review groups that are based at research institutions worldwide.<unk> has approximately 30,000 volunteer experts from around the world. The group conducts systematic reviews of health-care interventions and diagnostic tests and publishes them in the<unk> Library. According to the Library, articles are available via one-click access, but some require paid subscription or registration before reading. A few reviews, in occupational health for example, incorporate results from non-randomised observational studies as well as controlled before–after (CBA) studies and interrupted time-series studies. | Cochrane | Serenic | Anol | Wart | Lime | Theranos | Nice | Aidoc | 00
| 9,001 |
Synthesis 2-chlorobenzonitrile is reacted with the Grignard reagent cyclopentylmagnesium bromide to give (2-chlorophenyl)(cyclopentyl)methanone. This is then brominated using bromine to form the corresponding bromoketone, which is then reacted with methylamine in an aqueous solution to form the methylimino derivative, 1-(2-Chloro-N-methylbenzimidoyl)cyclopentanol, with hydrolysis of the tertiary bromine atom. This final intermediate is then heated in decalin or another suitable high-boiling solvent, upon which a ring-expansion rearrangement occurs, forming<unk> . Preparation of<unk> . Structure In chemical structure,<unk> is an arylcyclohexylamine derivative.<unk> is a chiral compound. The more active enantiomer, esketamine (S-ketamine), is also available for medical use under the brand name<unk> anest S, while the less active enantiomer, arketamine (R-ketamine), has never been marketed as an enantiopure drug for clinical use. While S-ketamine is more effective as an analgesic and anesthetic through NMDA receptor antagonism, R-ketamine produces longer-lasting effects as an antidepressant. The optical rotation of a given enantiomer of<unk> can vary between its salts and free base form. The free base form of (S)‑ketamine exhibits dextrorotation and is therefore labelled (S)‑(+)‑ketamine. However, its hydrochloride salt shows levorotation and is thus labelled (S)‑(−)‑ketamine hydrochloride. Detection<unk> may be quantitated in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients, provide evidence in an impaired driving arrest, or to assist in a medicolegal death investigation. Blood or plasma<unk> concentrations are usually in a range of 0.5–5.0 mg/L in persons receiving the drug therapeutically (during general anesthesia), 1–2 mg/L in those arrested for impaired driving and 3–20 mg/L in victims of acute fatal overdosage. Urine is often the preferred specimen for routine drug use monitoring purposes. The presence of norketamine, a pharmacologically active metabolite, is useful for confirmation of<unk> ingestion. | Ketamine | Propofol | Remifentanil | Alfentanil | Fentanyl | Etomidate | Esketamine | Sevoflurane | 00
| 1,212 |
* History and physical exam - relief of symptoms with compression of the fistula on exam is highly suggestive of<unk> * Arteriography * Duplex ultrasound | Vascular access steal syndrome | Acute limb ischaemia | Vein graft failure | Intubation granuloma | Diabetic foot infection | Gas gangrene | Burn scar contracture | Subclavian steal syndrome | 00
| 37,656 |
Simple cholecystectomy is suitable for type I patients. For types II–IV, subtotal cholecystectomy can be performed to avoid damage to the main bile ducts. Cholecystectomy and bilioenteric anastomosis may be required. Roux-en-Y hepaticojejunostomy has shown good outcome in some studies. | Mirizzi's syndrome | Hartnup disease | Ascher's syndrome | Meckel's diverticulum | Cord colitis syndrome | Bloom syndrome | Löffler's syndrome | Schnitzler syndrome | 00
| 18,344 |
The best option for diagnosis is using PCR. Diagnosis with Microsporidia can be done through gram-positive, acid-fast spores in stool and biopsy material with morphologic demonstration of the organism. Initial detection through light microscopic examination of tissue sections, stools, duodenal aspirates, nasal discharges, bronchoalveolar lavage fluids, and conjunctival smears. Definitive diagnosis can also be achieved through fluorescein-tagged antibody immunofluorescence or electron microscopy, and species identification can be done through PCR. Classification Although it is classified as a protozoal disease in ICD-10, their phylogenetic placement has been resolved to be within the Fungi, and some sources classify<unk> as a mycosis, however, they are highly divergent and rapidly evolving. | Microsporidiosis | Bertielliasis | Isosporiasis | Tungiasis | Mansonelliasis | Trichinosis | Otomycosis | Helminthiasis | 00
| 31,153 |
<unk> is a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments. Its proponents claim that it focuses on the "root causes" of diseases based on interactions between the environment and the gastrointestinal, endocrine, and immune systems to develop "individualized treatment plans." It has been described as pseudoscience, quackery, and at its essence a rebranding of complementary and alternative medicine. In the United States,<unk> practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful.<unk> was created by Jeffrey Bland. Bland founded The Institute for<unk> (IFM) in the early 1990s as part of one of his companies HealthComm. IFM, which promotes<unk> , became a registered non-profit in 2001. Today Mark Hyman is one of the leading proponents. | Functional medicine | Allopathic medicine | Exercise medicine | Graphic medicine | Narrative medicine | Herbal medicine | Anthroposophic medicine | Conservation medicine | 00
| 51,999 |
Countries aim to prevent<unk> by ensuring that the work of their national TB control programmes, and of all practitioners working with people with TB, is carried out according to the International Standards for TB Care. These emphasize providing proper diagnosis and treatment to all TB patients, including those with<unk> -resistant TB; assuring regular, timely supplies of all anti-TB<unk> s; proper management of anti-TB<unk> s and providing support to patients to maximize adherence to prescribed regimens; caring for<unk> cases in a centre with proper ventilation, and minimizing contact with other patients, particularly those with HIV, especially in the early stages before treatment has had a chance to reduce the infectiousness. Also an effective disease control infrastructure is necessary for the prevention of<unk> berculosis. Increased funding for research, and strengthened laboratory facilities are much required. Immediate detection through<unk> susceptibility testing's are vital, when trying to stop the spread of<unk> berculosis. | Extensively drug-resistant tuberculosis | Totally drug-resistant tuberculosis | Multidrug-resistant tuberculosis | Primary inoculation tuberculosis | Latent tuberculosis | Extrapulmonary tuberculosis | Tuberculosis | Miliary tuberculosis | 00
| 45,278 |
Sodium<unk> saline is one of the most effective osmotic laxatives (secondary in action only to magnesium<unk> . Its laxative action is the result of osmotic imbalance that extracts bound water from stool and pulls it back into the large bowel. The increased water content softens the stool and stimulates the bowel to contract (move its contents to the rectum). Sodium<unk><unk> improves the wetting and penetrating abilities of the solution, sorbitol enhances the water-releasing effect of sodium<unk> and<unk> helps to lubricate the stool. The combined action helps to soften hard stools and relieve constipation without straining in a very short period of time ~ 15 min. The ingredients are not absorbed, distributed or metabolised by the human body, all of the composition is being excreted in faeces. | Sodium citrate/sodium lauryl sulfoacetate/glycerol | Potassium citrate/potassium hydrogen carbonate | Sodium phenylacetate/sodium benzoate | Lactic acid/citric acid/potassium bitartrate | Acid-citrate-dextrose | Sodium nitrite/sodium thiosulfate | Turk's solution | Ringer's lactate solution | 00
| 66,615 |
Nutritional<unk> responds well to administration of 2,000-10,000 IU of vitamin D3 by mouth daily. Vitamin D3 (cholecalciferol) is typically absorbed more readily than vitamin D2 (ergocalciferol).<unk> due to malabsorption may require treatment by injection or daily oral dosing of significant amounts of vitamin D3. | Osteomalacia | Rickets | Hypophosphatasia | Osteopoikilosis | Osteopenia | Osteodystrophy | Blue nails | Green nails | 00
| 14,123 |
Hemiplegia (Greek 'hemi' = Half), is condition that affects one side of the body. Signs of a<unk> attack are similar to what would be presented in a stroke that typically includes sudden severe headache on one side of the brain, weakness of half the body, ataxia and aphasia which can last for hours, days or weeks. | Hemiplegic migraine | Acephalgic migraine | Mixed tension migraine | External compression headache | Cluster headache | Sporadic hemiplegic migraine | Thunderclap headache | Familial hemiplegic migraine | 00
| 40,983 |
In the United States<unk> affects about 1.2% of the population. About half of these cases have obvious symptoms while the other half do not. It occurs between two and ten times more often in women. The disease is more common in those over the age of 60 years. Subclinical<unk> modestly increases the risk of cognitive impairment and dementia. | Hyperthyroidism | Anorexia nervosa | Acromegaly | Panic disorder | Micromegaly | Anxiety disorder | Hypothyroidism | Panic attack | 00
| 1,095 |
* Erythema ab igne * Erythema chronicum migrans * Erythema induratum * Erythema infectiosum (or fifth disease) * Erythema marginatum * Erythema migrans * Erythema multiforme (EM) * Erythema nodosum * Erythema toxicum * Erythema elevatum diutinum * Erythema gyratum repens * Keratolytic winter erythema * Palmar erythema | symptom of Dermatitis | symptom of Arthritis | symptom of Fever | symptom of Allergy | symptom of Acne | symptom of Scabies | symptom of Chalazion | symptom of Abscess | 00
| 13,882 |
A three unit porcelain fused to metal<unk> (PFM) made by a dental technician. lingual buttons extending, in the photo, upward on #2 (on the left) and downward on #4. These are used to grasp the crowns with a hemostat and make them easier to handle. They can also be used to aid in removal of the crown in case there is an excessive amount of retention during the try-in. They are cut off prior to final cementation. The proximal surfaces of the pre-solder index abutment and pontic, showing lab-processed grooves for added retention of the acrylic resin The abutment and pontic joined with acrylic resin in a solder index and reinforced with an old bur (lying horizontally across the occlusal surface of the copings). A<unk> is a fixed dental restoration (a fixed dental prosthesis) used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants. | Bridge | Caul | Crown | Wart | Veneer | Flap | Xilloc | Boil | 00
| 19,924 |
<unk> s are biomarkers of net<unk> of<unk> and fibrinolysis. Examples include prothrombin fragment 1+2 (F1+2), thrombin–antithrombin complex (TAT), fibrinopeptide A (FpA), fibrin monomers (FMs), plasmin-α2-antiplasmin complex (PAP), and D-dimer (DD). These compounds are<unk> s of thrombin generation (F1+2, TAT), fibrin generation (FpA, FMs), and fibrinolysis (DD, PAP).<unk> s, particularly D-dimer, are useful in the diagnosis of acute venous thromboembolism. They may also be useful in the assessment of hypercoagulability and venous thromboembolism risk. Levels of<unk> s are increased with pregnancy, with estrogen-containing birth control pills, with menopausal hormone therapy, and with high-dose parenteral estradiol therapy for prostate cancer. Transdermal estradiol appears to have less influence on<unk> s than oral estrogens in menopausal hormone therapy. Birth control pills containing estradiol or estetrol also appear to have less influence on<unk> s than ethinylestradiol-containing birth control pills.<unk> s of platelet<unk> (primary hemostasis) include platelet factor 4 (PF4), β-thromboglobulin (β-TG), and P-selectin. | Coagulation activation marker | Fibrin degradation product | Acute-phase protein | Thrombin time | Reptilase time | Bleeding time | Activated clotting time | Prothrombin time | 00
| 75,076 |
<unk> is characterized by the regular or repeated inability to achieve or maintain an erection of sufficient rigidity to accomplish sexual activity. It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months." Psychological impact<unk> often has an impact on the emotional well-being of both men and their partners. Many men do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of<unk> go untreated. | Erectile dysfunction | Metabolic syndrome | Urinary incontinence | Sexual dysfunction | Anorgasmia | Dysosmia | Prognathism | Ectopia | 00
| 1,160 |
<unk> is a clinical sign in which there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards. It occurs in patients with exophthalmos in Graves disease. The sign is named after Alexis<unk> . | Joffroy's sign | Dance's sign | Hegar's sign | Lockwood's sign | Litten's sign | Litten's sign | Winterbottom's sign | Adson's sign | 00
| 55,107 |
<unk> mesylate (Corlopam) is a drug and synthetic benzazepine derivative which acts as a selective D1 receptor partial agonist.<unk> is used as an antihypertensive agent. It was approved by the Food and Drug Administration (FDA) in September 1997. | Fenoldopam | Alvimopan | Nefopam | Bethanechol | Tofisopam | Ethylnorepinephrine | Avacopan | Noribogaine | 00
| 33,979 |
<unk> , also known as IIBR-100, is a replication-competent recombinant VSV viral vectored COVID-19 vaccine candidate. It was developed by the Israel Institute for Biological Research (IIBR). The IIBR partnered with the US-based NRx Pharmaceuticals to complete clinical trials and commercialize the vaccine. A study conducted in hamsters suggested that one dose of the vaccine was safe and effective at protecting against COVID-19. | BriLife | Medgadget | ClinLife | MindMed | GeroScience | Methodic school | Gynopedia | TennCare | 00
| 74,335 |
Formula and pumped breastmilk side by side. Note that the formula is of uniform consistency and color, while the expressed breast milk exhibits properties of an organic solution by separating into a layer of fat at the top (the "creamline"), followed by the milk, and then a watery blue-colored layer at the bottom. Expressed milk Manual breast pump A mother may express her milk (remove milk from breasts) for storage and later use. Expression may occur manually with hand expression, or by using a breast pump. Mothers express milk for multiple reasons. Expressing breast milk can maintain a mother's milk supply when she and her child are apart. A sick baby who is unable to nurse can take expressed milk through a nasogastric tube. Some babies are unable or unwilling to nurse. Maternal breastmilk is the food of choice for premature babies; these infants may be fed maternal milk through tubes, supplemental nursing systems, bottles, spoons or cups until they develop satisfactory ability to suck and swallow breast milk. Some women donate expressed breast milk (EBM) to others, either directly or through a milk bank. This allows mothers who cannot breastfeed to give their baby the benefits of breast milk. While informally-shared breastmilk does carry the nutritional benefits of breastmilk, this breastmilk is most often not pasteurized or screened, and thus carries with it the risk of transmitting diseases or medications that are unsafe for infants. Parents considering directed or informal milk sharing should discuss this option with their doctor, and they should be familiar with the donors medical history and milk handling practices. use of informally-shared (unscreened, not pasteurized) milk from an anonymous donor is discouraged by the academy of<unk> Medicine. Babies feed differently with artificial nipples than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth. Drinking from a bottle takes less effort and the milk may come more rapidly, potentially causing the baby to lose desire for the breast. This is often referred to as nipple confusion or nipple preference. While some infants do experience this preference for the bottle, many infants do not and will be able to alternate between bottle and breast without issue. "Exclusively expressing" and "exclusively pumping" are terms for a mother who exclusively feeds her baby expressed milk. Exclusively pumping is poorly studied in the literature, especially in recent years. However, from available evidence, it appears to be fairly uncommon, with only approximately 7% of study participants reporting exclusive pumping. Storage of Expressed Breastmilk Breastmilk may be stored for various amounts of time depending on storage temperature and conditions. The content and quality of expressed milk changes over time as it is stored, particularly when frozen. For example, there is a decrease in the ability of breastmilk to kill bacteria when it is stored in the refrigerator for more than 48 hours. Additionally, the quantity of fat, protein, and calories in breastmilk decreases when the milk is frozen for more than 3 months. While several components of breastmilk change over time, inflammatory factors (cytokines) and maternal antibodies, and growth factors are thought to be stable for at least 6 months when the breastmilk is frozen. Storage guidelines, according to the CDC, La Leche League International and the Academy of<unk> Medicine, are noted in the table below. +Storage of Expressed Breastmilk Storage Location Optimal Storage Time Acceptable Storage Time Source Countertop 4 hours 8 hours Insulated bag with icepack 24 hours Refrigerator 4 days 5 days Freezer compartment of minifridge 2 weeks Standard Freezer 6 months 12 months Deep Freezer (usually separate from refrigerator) 6–12 months Breastmilk Storage Containers Expressed breastmilk can be stored in freezer storage bags, containers made specifically for breastmilk, a supplemental nursing system, or a bottle ready for use. Parents should avoid using storage containers which contain bisphenol A (BPA). Additionally, use of polyethylene containers have been shown to decrease the immune benefits of breastmilk, including its ability to kill bacteria and the maternal antibodies it contains, by up to 60%. Shared nursing It is not only the mother who may breastfeed her child. She may hire another woman to do so (a wet nurse), or she may share childcare with another mother (cross-nursing). Both of these were common throughout history. It remains popular in some developing nations, including those in Africa, for more than one woman to breastfeed a child. Shared<unk> is a risk factor for HIV infection in infants. Shared nursing can sometimes provoke negative social reactions in the English-speaking world. Tandem nursing It is possible for a mother to continue<unk> an older sibling while also<unk> a new baby; this is called tandem nursing. During the late stages of pregnancy, the milk changes to colostrum. While some children continue to breastfeed even with this change, others may wean. Most mothers can produce enough milk for tandem nursing, but the new baby should be nursed first for at least the first few days after delivery to ensure that it receives enough colostrum.<unk> triplets or larger broods is a challenge given babies' varying appetites. Breasts can respond to the demand and produce larger milk quantities; mothers have breastfed triplets successfully. File:Breastfeeding newborn twins.Newborn twins being breastfed File:Breastfeeding 2 year old twins.Woman breastfeeds 2 year old twins whilst reading them a book. File:Tandem<unk> toddler and baby.Woman tandem nurses an infant and a toddler. Re-lactation and induced lactation Re-lactation is the process of restarting<unk> . In developing countries, mothers may restart<unk> after a weaning as part of an oral rehydration treatment for diarrhea. In developed countries, re-lactation is common after early medical problems are resolved, or because a mother changes her mind about<unk> . Re-lactation is most easily accomplished with a newborn or with a baby that was previously<unk> ; if the baby was initially bottle-fed, the baby may refuse to suckle. If the mother has recently stopped<unk> , she is more likely to be able to re-establish her milk supply, and more likely to have an adequate supply. Although some women successfully re-lactate after months-long interruptions, success is higher for shorter interruptions. Techniques to promote lactation use frequent attempts to breastfeed, extensive skin-to-skin contact with the baby, and frequent, long pumping sessions. Suckling may be encouraged with a tube filled with infant formula, so that the baby associates suckling at the breast with food. A dropper or syringe without the needle may be used to place milk onto the breast while the baby suckles. The mother should allow the infant to suckle at least ten times during 24 hours, and more times if he or she is interested. These times can include every two hours, whenever the baby seems interested, longer at each breast, and when the baby is sleepy when he or she might suckle more readily. In keeping with increasing contact between mother and child, including increasing skin-to-skin contact, grandmothers should pull back and help in other ways. Later on, grandmothers can again provide more direct care for the infant. These techniques require the mother's commitment over a period of weeks or months. However, even when lactation is established, the supply may not be large enough to breastfeed exclusively. A supportive social environment improves the likelihood of success. As the mother's milk production increases, other feeding can decrease. Parents and other family members should watch the baby's weight gain and urine output to assess nutritional adequacy. A WHO manual for physicians and senior health workers citing a 1992 source states: "If a baby has been<unk> sometimes, the breastmilk supply increases in a few days. If a baby has stopped<unk> , it may take 1-2 weeks or more before much breastmilk comes." Induced lactation, also called adoptive lactation, is the process of starting<unk> in a woman who did not give birth. This usually requires the adoptive mother to take hormones and other drugs to stimulate breast development and promote milk production. In some cultures,<unk> an adoptive child creates milk kinship that builds community bonds across class and other hierarchal bonds. | Breastfeeding | Human–animal breastfeeding | Infant formula | Breast milk | Home birth | Parenteral nutrition | Dieting | Infant bathing | 00
| 51,786 |
Most<unk> s are removed with surgery. A few selected cases are treated with topical medication. Surgical excision with a free margin of healthy tissue is a frequent treatment modality. Radiotherapy, given as external beam radiotherapy or as brachytherapy (internal radiotherapy), can also be used to treat<unk> <unk><unk> s. | Conjunctival squamous cell carcinoma | Pseudolymphoma | Rhinoscleroma | Odontogenic keratocyst | Fundic gland polyp | Aquarium granuloma | Idiopathic facial aseptic granuloma | Chorangioma | 00
| 64,182 |
The name<unk> " is misleading, as it is neither<unk> or a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype, which is why such a lesion is prone to bleeding. It is also not truly<unk> (pus-producing), as the cause is hormonal or traumatic and has no association with infection or pus production. | Pyogenic granuloma | Kaposi's sarcoma | Actinic granuloma | Infantile hemangioma Infantile hemangioma 1 | Angiokeratoma | Aquarium granuloma | Silicone granuloma | Acral fibrokeratoma | 00
| 34,341 |
One common side effect that is experienced by babies who are receiving phototherapy treatment is more frequent and loose stools. The color of these stools are usually a greenish color; however, this is normal because that is the way bilirubin is removed from the body. As bilirubin levels return to normal and phototherapy is no longer needed, the frequency of bowel movements and the color of the stools will return to normal. Short-term * Skin lesions * Diarrhea due to thermal and hydroelectrolytic abnormalities * Bronze baby syndrome (grey and brown pigmentation of the skin in infants with cholestasis) * Hematological changes * Paralytic ileus Long-term * Neoplasms * Skin lesions * Café au lait spots * Allergic diseases (allergic asthma, rhinitis, and conjunctivitis) Other side effects of phototherapy include effects on circadian cycle genes, patent ductus arteriosus, and possible retinal damage if the eyes are exposed to constant phototherapy. | Biliblanket | COVIran Barekat | Souvenaid | Billy's Bootcamp | Hobcart | Alloplant | BiteStrip | Clinistrip | 00
| 47,655 |
2-chlorobenzalmalononitrile is the active agent in CS<unk> .<unk> generally consists of aerosolized solid or liquid compounds (bromoacetone or xylyl bromide), not<unk> .<unk> works by irritating mucous membranes in the eyes, nose, mouth and lungs. It causes crying, sneezing, coughing, difficulty breathing, pain in the eyes, and temporary blindness. With CS<unk> , symptoms of irritation typically appear after 20 to 60 seconds of exposure and commonly resolve within 30 minutes of leaving (or being removed from) the area. Risks As with all non-lethal or less-lethal weapons, there is a risk of serious permanent injury or death when<unk> is used. This includes risks from being hit by<unk> cartridges that may cause severe bruising, loss of eyesight, or skull fracture, resulting in immediate death. A case of serious vascular injury from<unk> shells has also been reported from Iran, with high rates of associated nerve injury (44%) and amputation (17%), as well as instances of head injuries in young people. Novel findings suggest that menstrual changes are one of the most commonly reported health issues in women. While the medical consequences of the<unk> es themselves are typically limited to minor skin inflammation, delayed complications are also possible. People with pre-existing respiratory conditions such as asthma are particularly at risk. They are likely to need medical attention and may sometimes require hospitalization or even ventilation support. Skin exposure to CS may cause chemical burns or induce allergic contact dermatitis. When people are hit at close range or are severely exposed, eye injuries involving scarring of the cornea can lead to a permanent loss in visual acuity. Frequent or high levels of exposure carry increased risks of respiratory illness. In the 2019–20 Chilean protests various people have suffered complete and permanent loss of vision in one or both eyes as result of the impact of<unk> grenades. The majority (2116; 93.8%) of protestors who reported exposure to<unk> during the 2020 protests in Portland, Oregon (USA) reported physical (2114; 93.7%) or psychological (1635; 72.4%) health issues experienced immediately after (2105; 93.3%) or days following (1944; 86.1%) the exposure. The majority (1233; 54.6%) of respondents who reported exposure to<unk> during the 2020 protests in Portland, Oregon (USA) have also reported receiving or planning to seek medical or mental healthcare for their<unk> -related health issues. It has been shown that health issues associated with the exposure to<unk> are often require medical attention. Site of Action TRPA1 ion channels expressed on nociceptors have been implicated as the site of action for CS<unk> , CR<unk> , CN<unk> (phenacyl chloride) and bromoacetone in rodent models. | Tear gas | Mustard gas | Bottled gas | Air bronchogram | Mydicar | Pustular bacterid | Wheeze | Transudate | 00
| 21,468 |
Medications Antimanic drugs are used to control acute attacks and prevent recurring episodes of<unk> combined with a range of psychological therapies. The recommended length of treatment ranges from 2 years to 5 years. Anti-depressants may also be required for existing treatments but are avoided in patients who have had a recent history with<unk> . Sertraline has often been debated to have side effects that can trigger<unk> . These include antipsychotics such as: * Aripiprazole * Clozapine * Haloperidol * Olanzapine *Paliperidone * Quetiapine * Risperidone *Ziprasidone Other anti-manic drugs that are not antipsychotics include: * Carbamazepine * Lithium *Oxcarbazepine * Valproate Benzodiazepines such as clonazepam or lorazepam may be used to control agitation and excitement in the short-term. Other drugs used to treat symptoms of mania/hypomania but considered less effective include: * Gabapentin * Lamotrigine * Levetiracetam * Topiramate | Hypomania | Klazomania | Potomania | Alexithymia | Amenomania | Mania | Acholia | Dyssomnia | 00
| 67,911 |
<unk> A<unk> :These are longer (at least 2cm and up to 6cm) unbranching<unk> coursing diagonally from the hila out to the periphery of the lungs. They are caused by distension of anastomotic channels between peripheral and central lymphatics of the lungs.<unk> A<unk> are less commonly seen than<unk> B<unk> .<unk> A<unk> are never seen without<unk> B or C<unk> .<unk> B<unk> in a patient with congestive heart failure.<unk> B<unk> :These are short parallel<unk> at the lung periphery. These<unk> represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. Causes of<unk> B<unk> include pulmonary edema, lymphangitis carcinomatosa and malignant lymphoma, viral and mycoplasmal pneumonia, interstitial pulmonary fibrosis, pneumoconiosis, and sarcoidosis. They can be an evanescent sign on the chest x-ray of a patient in and out of heart failure.<unk> C<unk> :These are the least commonly seen of the<unk> . They are short, fine<unk> throughout the lungs, with a reticular appearance. They may represent thickening of anastomotic lymphatics or superimposition of many<unk> B<unk> . | Kerley lines | Mees' lines | Stenvers projection | Loop mark | Cramp-ring | Gilula's lines | Surfer's knots | Beau's lines | 00
| 36,135 |
<unk> is a condition whereby the blood supply from the<unk> cerebral artery (ACA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the medial aspects of the frontal and parietal lobes, basal ganglia,<unk> fornix and<unk> corpus callosum. Depending upon the area and severity of the occlusion, signs and symptoms may vary within the population affected with ACA syndrome. Blockages to the proximal (A1) segment of the vessel produce only minor deficits due to the collateral blood flow from the opposite hemisphere via the<unk> communicating artery. Occlusions distal to this segment will result in more severe presentation of ACA syndrome. Contralateral hemiparesis and hemisensory loss of the lower extremity is the most common symptom associated with ACA syndrome. | Anterior cerebral artery syndrome | Middle cerebral artery syndrome | ROSAH syndrome | Posterior cerebral artery syndrome | Vertebral artery dissection | Watershed stroke | Cervical artery dissection | Carotid artery dissection | 00
| 46,336 |
<unk> can occur in various forms. The clinical presentation of each form is different and depends to a large extent on the underlying enzyme defect, its precursor retention, and deficient products. Classical forms appear in infancy, and nonclassical forms appear in late childhood. The presentation in patients with classic<unk> can be further subdivided into two forms: salt-wasting and simple-virilizing, depending on whether mineralocorticoid deficiency presents or absents, respectively. This subtyping is often not clinically meaningful, though, because all patients lose salt to some degree, and clinical presentations may overlap. Classic Salt-wasting In 75% of cases of severe enzyme deficiency, insufficient aldosterone production can lead to salt wasting, failure to thrive, and potentially fatal hypovolemia and shock. A missed diagnosis of salt-loss<unk> is related to the increased risk of early neonatal morbidity and death. Simple-virilizing The main feature of<unk> in newborn females is the abnormal development of the external genitalia, which has varying degrees of virilization. According to clinical practice guidelines, for newborns found to have bilateral inaccessible gonads,<unk> evaluation should be considered. If virilizing<unk> cannot be identified and treated, both boys and girls may undergo rapid postnatal growth and virilization. Nonclassic In addition to the salt-wasting and simple-virilizing forms of<unk> diagnosed in infancy, a mild or "nonclassic" form exists, which is characterized by varying degrees of postnatal androgen excess, but is sometimes asymptomatic. The nonclassic form may be noticed in late childhood and may lead to accelerated growth, premature sexual maturation, acne, and secondary polycystic ovary syndrome. In adult males, early balding and infertility may suggest the diagnosis. The nonclassic form is characterized by mild subclinical impairment of cortisol synthesis; serum cortisol concentration is usually normal. | Congenital adrenal hyperplasia | Polycystic ovary syndrome | Lipoid congenital adrenal hyperplasia | Late onset congenital adrenal hyperplasia | Persistent adrenarche syndrome | Congenital iodine deficiency syndrome | Congenital hypothyroidism | Congenital hyperinsulinism | 00
| 13,435 |