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When ambient temperature is excessive, humans and many other animals cool themselves below ambient by evaporative cooling of sweat (or other aqueous liquid; saliva in dogs, for example); this helps prevent potentially fatal hyperthermia. The effectiveness of evaporative cooling depends upon humidity. Wet-bulb temperature, which takes humidity into account, or more complex calculated quantities such as wet-bulb globe temperature (WBGT), which also takes solar radiation into account, give useful indications of the degree of heat stress and are used by several agencies as the basis for heat-stress prevention guidelines. (Wet-bulb temperature is essentially the lowest skin temperature attainable by evaporative cooling at a given ambient temperature and humidity.) A sustained wet-bulb temperature exceeding is likely to be fatal even to fit and healthy people unclothed in the shade next to a fan; at this temperature, environmental heat gain instead of loss occurs. , wet-bulb temperatures only very rarely exceeded anywhere, although significant global warming may change this. In<unk> of heat stress<unk> by physical exertion, hot environments, or protective equipment, prevention or mitigation by frequent rest breaks, careful hydration, and monitoring body temperature should be attempted. However, in situations demanding one is exposed to a hot environment for a prolonged period or must wear protective equipment, a personal cooling system is required as a matter of health and safety. There are a variety of active or passive personal cooling systems; these can be categorized by their power sources and whether they are person- or vehicle-mounted. Because of the broad variety of operating conditions, these devices must meet specific requirements concerning their rate and duration of cooling, their power source, and their adherence to health and safety regulations. Among other criteria are the user's need for physical mobility and autonomy. For example, active-liquid systems operate by chilling water and circulating it through a garment; the skin surface area is thereby cooled through conduction. This type of system has proven successful in certain military, law enforcement, and industrial applications. Bomb-disposal technicians wearing special suits to protect against improvised explosive devices (IEDs) use a small, ice-based chiller unit that is strapped to one leg; a liquid-circulating garment, usually a vest, is worn over the torso to maintain a safe core body temperature. By contrast, soldiers traveling in combat vehicles can face microclimate temperatures in excess of and require a multiple-user, vehicle-powered cooling system with rapid connection capabilities. Requirements for hazmat teams, the medical community, and workers in heavy industry vary further.

causes of Perspiration

medical cause of Perspiration

causes of Infection

causes of Pleurisy

Classification of pneumonia

symptom of Bronchitis

symptom of Croup

symptom of Hypoxia

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Both high- and low-force trauma can cause bone fracture injuries. Preventive efforts to reduce motor vehicle crashes, the most common cause of high-force trauma, include reducing distractions while driving. Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate 6-fold increase in crashes. Wearing a seatbelt can also reduce the likelihood of injury in a collision. 30 km/h or 20 mph speed limits (as opposed to the more common intracity 50 km/h / 30 mph) also drastically reduce the risk of accident, serious injury and even death in crashes between motor vehicles and humans. Vision Zero aims to reduce traffic deaths to zero through better traffic design and other measures and to drastically reduce traffic injuries which would prevent many bone fractures. A common cause of low-force trauma is an at-home fall. When considering preventative efforts, the National Institute of Health (NIH) examines ways to reduce the likelihood of falling, the force of the fall, and bone fragility. To prevent at-home falls they suggest keeping cords out of high-traffic areas where someone could trip, installing handrails and keeping stairways well-lit, and installing an assistive bar near the bathtub in the washroom for support. To reduce the impact of a fall the NIH recommends to try falling straight down on your buttocks or onto your hands. Some sports have a relatively high risk of bone fractures as a common sports injury. Preventive measures depend to some extent on the specific sport, but learning proper technique, wearing protective gear and having a realistic estimation of one's own capabilities and limitations can all help reduce the risk of bone fracture. In contact sports rules have been put in place to protect athlete health, such as the prohibition of unnecessary roughness in American football. Taking calcium vitamin D supplements can help strengthen your bones. Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults; however, vitamin D supplementation alone did not reduce the risk of fractures.

symptom of Osteoporosis

symptom of Osteoarthritis

symptom of Osteomyelitis

symptom of Arthritis

symptom of Peripheral artery disease

symptom of Cardiovascular disease

symptom of Prostate cancer

symptom of Coronary artery disease

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Graphic from the World Health Organization describing the main<unk> typically in vaccines. A vaccine dose contains many<unk> , very little of which is the active<unk> the immunogen. A single dose may have merely nanograms of virus particles, or micrograms of bacterial polysaccharides. A vaccine injection, oral drops or nasal spray is mostly water. Other<unk> are added to boost the immune response, to ensure safety or help with storage, and a tiny amount of material is left-over from the manufacturing process. Very rarely, these materials can cause an allergic reaction in people who are very sensitive to them.

Vaccine ingredients

Animal vaccination

Vaccine cooler

Cancer vaccine

Autogenous vaccines

Vaccine storage

Specific-pathogen-free

Animal products in pharmaceuticals

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Epilepsy can have both genetic and acquired causes, with the interaction of these factors in many cases. Established acquired causes include serious brain trauma, stroke, tumours, and brain problems resulting from a previous infection. In about 60% of cases, the cause is unknown. Epilepsies caused by genetic, congenital, or developmental conditions are more common among younger people, while brain tumors and strokes are more likely in older people. Seizures may also occur as a consequence of other health problems; if they occur right around a specific cause, such as a stroke, head injury, toxic ingestion, or metabolic problem, they are known as acute symptomatic seizures and are in the broader classification of seizure-related disorders rather than epilepsy itself. Genetics Genetics is believed to be involved in the majority of cases, either directly or indirectly. Some epilepsies are due to a single gene defect (1–2%); most are due to the interaction of multiple genes and environmental factors. Each of the single gene defects is rare, with more than 200 in all described. Most genes involved affect ion channels, either directly or indirectly. These include genes for ion channels themselves, enzymes, GABA, and G protein-coupled receptors. In identical twins, if one is affected, there is a 50–60% chance that the other will also be affected. In non-identical twins, the<unk> is 15%. These<unk> are greater in those with generalized rather than focal seizures. If both twins are affected, most of the time they have the same epileptic syndrome (70–90%). Other close relatives of a person with epilepsy have a<unk> five times that of the general population. Between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy. Acquired Epilepsy may occur as a result of several other conditions, including tumors, strokes, head trauma, previous infections of the central nervous system, genetic abnormalities, and as a result of brain damage around the time of birth. Of those with brain tumors, almost 30% have epilepsy, making them the cause of about 4% of cases. The<unk> is greatest for tumors in the temporal lobe and those that grow slowly. Other mass lesions such as cerebral cavernous malformations and arteriovenous malformations have<unk> as high as 4060%. Of those who have had a stroke, 2–4% develop epilepsy. In the United Kingdom, strokes account for 15% of cases and they are believed to be the cause in 30% of the elderly. Between 6 and 20% of epilepsy is believed to be due to head trauma. Mild brain injury increases the<unk> about two-fold while severe brain injury increases the<unk> seven-fold. In those who have experienced a high-powered gunshot wound to the head, the<unk> is about 50%. Some evidence links epilepsy and celiac disease and non-celiac gluten sensitivity, while other evidence does not. There appears to be a specific syndrome that includes coeliac disease, epilepsy, and calcifications in the brain. A 2012 review estimates that between 1% and 6% of people with epilepsy have coeliac disease while 1% of the general population has the condition. The<unk> of epilepsy following meningitis is less than 10%; it more commonly causes seizures during the infection itself. In herpes simplex encephalitis the<unk> of a seizure is around 50% with a high<unk> of epilepsy following (up to 25%). A form of an infection with the pork tapeworm (cysticercosis), in the brain, is known as neurocysticercosis, and is the cause of up to half of epilepsy cases in areas of the world where the parasite is common. Epilepsy may also occur after other brain infections such as cerebral malaria, toxoplasmosis, and toxocariasis. Chronic alcohol use increases the<unk> of epilepsy: those who drink six units of alcohol per day have a 2.5-fold increase in<unk> Other<unk> include Alzheimer's disease, multiple sclerosis, tuberous sclerosis, and autoimmune encephalitis. Getting vaccinated does not increase the<unk> of epilepsy. Malnutrition is a<unk> factor seen mostly in the developing world, although it is unclear however if it is a direct cause or an association. People with cerebral palsy have an increased<unk> of epilepsy, with half of people with spastic quadriplegia and spastic hemiplegia having the disease.

risks of Dupuytren's contracture

risks of Peripheral artery disease

causes of Peripheral artery disease

symptom of Athlete's foot

causes of Sciatica

symptom of Sciatica

symptom of Legius syndrome

symptom of Carpal tunnel syndrome

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Precortistatin is a protein that in humans is encoded by the CORT gene. The 105 amino acid residue human precortistatin in turn is cleaved into<unk> 17 and<unk> 29.<unk> 17 is the only active peptide derived from the precursor.<unk> (or more specifically<unk> 17) is a neuropeptide that is expressed in inhibitory neurons of the cerebral cortex, and which has a strong structural similarity to somatostatin. Unlike somatostatin, when infused into the brain, it enhances slow-wave sleep. It binds to sites in the cortex, hippocampus and the amygdala.

Cortistatin

Urodilatin

Griseofulvin

Ajulemic acid

Ketoconazole

Dapsone

Terbinafine

Anisatin

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The symptoms associated with this syndrome are variable, but common features include: low birthweight, low muscle tone at birth, poor feeding in infancy (often requiring feeding by tube for a period) and oromotor dyspraxia together with moderate developmental delays and learning disabilities but amiable behaviour. Other clinically important features include epilepsy, heart defects (atrial septal defect, ventricular septal defect) and kidney/urological anomalies. Silvery depigmentation of strands of hair have been noted in several patients. With age, there is an apparent coarsening of facial features. 17q21.3 was reported simultaneously in 2006 by three independent groups, with each group reporting several patients, and is now recognised to be one of the more common recurrent microdeletion syndromes. In 2007, a patient with a small duplication in same segment of DNA was described. An overview of the clinical features of the syndrome, by reviewing 22 individuals with a 17q21.31 microdeletion, estimated the disorder is present in 1 in every 16,000 people.

Koolen–De Vries syndrome

Urbach–Wiethe disease

Van Den Bosch syndrome

Van der Woude syndrome

Van Gogh syndrome

Baggio–Yoshinari syndrome

Barakat-Perenthaler syndrome

Aagenaes syndrome

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<unk> , like other omega-3 fatty<unk> based drugs, appears to reduce production of triglycerides in the liver and to enhance clearance of triglycerides from circulating very low-density lipoprotein (VLDL) particles. The way it does that is not clear, but potential mechanisms include increased breakdown of fatty<unk> ; inhibition of diglyceride acyltransferase, which is involved in biosynthesis of triglycerides in the liver; and increased activity of lipoprotein lipase in blood.

Omega-3 carboxylic acids

Omega-3 fatty acid

Omega-3 acid ethyl esters

Fish oil

Fish oil

Omega-6 fatty acid

Dietary fiber

Cholic acid

00

<unk> is a type of surgical skin planing, generally with the goal of removing acne, scarring, and other skin or tissue irregularities, typically performed in a professional medical setting by a dermatologist or plastic surgeon trained specifically in this procedure.<unk> has been practiced for many years (before the advent of lasers) and involves the controlled deeper abrasion (wearing away) of the upper to mid layers of the skin with any variety of strong abrasive devices including a wire brush, diamond wheel or fraise, sterilized sandpaper, salt crystals, or other mechanical means.<unk> should not be confused with microdermabrasion which is a newer and non-surgical cosmetic procedure performed by non-physician personnel, nurses, estheticians, medical assistants, and most recently untrained individuals in their homes.<unk> procedures are surgical, invasive procedures that typically require a local anaesthetic. Often, they are performed in surgical suites or in professional medical centers. Since the procedure can typically remove the top to deeper layers of the epidermis, and extend into the reticular dermis, there is always minor skin bleeding. The procedure carries risks of scarring, skin discoloration, infections, and facial herpes virus (cold sore) reactivation. In aggressive<unk> cases, there is often tremendous skin bleeding and spray during the procedure that has to be controlled with pressure. Afterward, the skin is normally very red and raw-looking. Depending on the level of skin removal with<unk> , it takes an average of 7–30 days for the skin to fully heal (re-epithelialize). Often, this procedure was performed for deeper acne scarring and deep surgical scars.<unk> is rarely practiced currently and there are very few doctors who are trained and still perform this surgery.<unk> has largely been replaced all over the world by newer and somewhat simpler technologies including lasers, CO2 or Erbium:YAG laser. Laser technologies carry the advantage of little to no bleeding and are often less operator dependent than<unk> . The purpose of surgical<unk> is to help diminish the appearance of deeper scars and skin imperfections. Often, the goal is to smooth the skin and, in the process, remove small scars (as from acne), uneven skin tone from scars or birthmarks, sun damage, tattoos, age spots, Stretch marks or fine wrinkles.<unk> is a mechanical surgical skin planing method which has remained popular partially because it may afford an overall lower cost (affordable) and may provide similar superior results as newer laser method for certain skin conditions.

Dermabrasion

Hydradermabrasion

Barrier cream

Laser coagulation

Comedo extraction

Natural skin care

Topical steroid withdrawal

Topical steroid

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Initial screening tests for GTN include: * Internal pelvic exam: to check for lumps or anything unusual changes. *Ultrasound exam of the pelvis: Also called a sonogram, an ultrasound creates a picture of the internal organ. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and directed at the uterus to take the pictures. * Blood chemistry studies: It can be done to check the levels of certain hormones and other substances that may be impacted by the presence of GTN. * Serum tumor marker test: For GTN, the blood is checked for the level of β-hCG, a hormone that is made by the body during pregnancy. β-hCG in the blood of a woman who is not pregnant may be a sign of GTN and also helpful tests to monitor a woman’s recovery during and after treatment. Placental side<unk> tumor (PSTT) is differentiated by low β-hCG levels because it is a<unk> ic proliferation of intermediate<unk> cells. * Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, bacteria, and the level of β-hCG. *Spinal tap: Cerebrospinal fluid is tested for high amounts of the hormone β-hCG if the GTN has spread to the brain or spinal cord. *Computed tomography (CT): A CT scan can be used to measure the tumor's size. *Chest x-ray: It may be done if the tumor has spread outside of the uterus. Tumor staging FIGO (International Federation of Gynecology and Obstetrics) 2000 Anatomical staging is commonly used to evaluate stage of GTN. Stage I - Disease confined to the uterus Stage II - GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament) Stage III - GTN extends to the lungs, with or without known genital tract involvement Stage IV - All other metastatic sites

Trophoblastic neoplasm

Embryonal carcinoma

Embryoma

Germ cell tumor

Gastroblastoma

Mixed Müllerian tumor

Gestational choriocarcinoma

Embryonal rhabdomyosarcoma

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Based on information given on the consent forms, it seems<unk> is a substrate of CYP2D6 and CYP3A4, like its predecessor aripiprazole. Participants in the clinical trials are advised to avoid grapefruit, Seville oranges and related citruses.

Brexpiprazole

Lorpiprazole

Mepiprazole

Aripiprazole

Pirlindole

Risperidone

Electroconvulsive therapy

Edivoxetine

00

<unk> is a parasitic disease caused by an infection with roundworms of the Filarioidea type. These are spread by blood-feeding insects such as black flies and mosquitoes. They belong to the group of diseases called helminthiases. These parasites exist in the wild in subtropical parts of southern Asia, Africa, the South Pacific, and parts of South America. One does not acquire them in the Northern Hemisphere like Europe or the US. Eight known filarial worms have humans as a definitive host. These are divided into three groups according to the part of the body they affect: * Lymphatic<unk> is caused by the worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms occupy the lymphatic system, including the lymph nodes; in chronic cases, these worms lead to the syndrome of elephantiasis. * Subcutaneous<unk> is caused by Loa loa (the eye worm), Mansonella streptocerca, and Onchocerca volvulus. These worms occupy the layer just under the skin. L. loa causes Loa loa<unk> , while O. volvulus causes river blindness. * Serous cavity<unk> is caused by the worms Mansonella perstans and Mansonella ozzardi, which occupy the serous cavity of the abdomen. Dirofilaria immitis, the dog heartworm, rarely infects humans. The adult worms, which usually stay in one tissue, release early larval forms known as microfilariae into the person's blood. These circulating microfilariae can be taken up during a blood meal by an insect vector; in the vector, they develop into infective larvae that can be spread to another person. Individuals infected by filarial worms may be described as either "microfilaraemic" or "amicrofilaraemic", depending on whether microfilariae can be found in their peripheral blood.<unk> is diagnosed in microfilaraemic cases primarily through direct observation of microfilariae in the peripheral blood. Occult<unk> is diagnosed in amicrofilaraemic cases based on clinical observations and, in some cases, by finding a circulating antigen in the blood.

Filariasis

Toxocariasis

Acariasis

Helminthiasis

Leishmaniasis

Trypanosomiasis

Onchocerciasis

Isosporiasis

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+MRC breathlessness scale Grade Degree of dyspnea 1 no dyspnea except with strenuous exercise 2 dyspnea when walking up an incline or hurrying on the level 3 walks slower than most on the level, or stops after 15 minutes of walking on the level 4 stops after a few minutes of walking on the level 5 with minimal activity such as getting dressed, too dyspneic to leave the house The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination. Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, tripod positioning, pronounced use of accessory muscles (sternocleidomastoid, scalenes) and absent breath sounds. A number of scales may be used to quantify the degree of shortness of breath. It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale). The MRC breathlessness scale suggests five grades of dyspnea based on the circumstances in which it arises. Blood tests A number of labs may be helpful in determining the cause of shortness of breath. D-dimer, while useful to rule out a pulmonary embolism in those who are at low risk, is not of much value if it is positive, as it may be positive in a number of conditions that lead to shortness of breath. A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level, while supportive of the diagnosis, could also be due to advanced age, kidney failure, acute coronary syndrome, or a large pulmonary embolism. Imaging A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.

symptom of Chilaiditi syndrome

symptom of Buruli ulcer

symptom of Rheumatic fever

symptom of Syphilis

symptom of Stevens–Johnson syndrome

symptom of Behçet's disease

symptom of Legionnaires' disease

symptom of Leishmaniasis

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<unk> (INN), also known as benoxinate or BNX, is an ester-type local anesthetic, which is used especially in ophthalmology and otolaryngology.<unk> is sold by Novartis under the brand names Novesine or Novesin. Safety for use in pregnancy and lactation has not been established.

Oxybuprocaine

Proxymetacaine

Noribogaine

Ibogaine

Procaine

Tetracaine

Levobupivacaine

Trospium chloride

00

The use of X-rays, a form of ionizing radiation, requires the potential risks from a procedure to be carefully balanced with the benefits of the procedure to the patient. Because the patient must be exposed to a continuous source of X-rays instead of a momentary pulse, a<unk> procedure generally subjects a patient to a higher absorbed dose of radiation than an ordinary (still) radiograph. Only important applications such as health care, bodily safety, food safety, nondestructive testing, and scientific research meet the risk-benefit threshold for use. In the first half of the 20th century, shoe-fitting<unk> s were used in shoe stores, but their use was discontinued because it is no longer considered acceptable to use radiation exposure, however small the dose, for nonessential purposes. Much research has been directed toward reducing radiation exposure, and recent advances in<unk> technology such as digital image processing and flat panel detectors, have resulted in much lower radiation doses than former procedures.<unk> burn from long exposure Because<unk> involves the use of X-rays, a form of ionizing radiation,<unk> c procedures pose a potential for increasing the patient's risk of radiation-induced cancer,in addition to the cancer risk and other stochastic radiation effects, deterministic radiation effects have also been observed ranging from mild erythema, equivalent of a sun burn, to more serious burns. Radiation doses to the patient depend greatly both on the size of the patient and length of the procedure, with typical skin dose rates quoted as 20–50 mGy/min. Exposure times vary depending on the procedure being performed, ranging from minutes to hours. A study of radiation-induced skin injuries was performed in 1994 by the U.S. Food and Drug Administration (FDA) followed by an advisory to minimize further<unk> -induced injuries. The problem of radiation injuries due to<unk> has been further addressed in review articles in 2000 and 2010. While deterministic radiation effects are a possibility, radiation burns are not typical of standard<unk> c procedures. Most procedures sufficiently long in duration to produce radiation burns are part of necessary life-saving operations. X-ray image intensifiers generally have radiation-reducing systems such as pulsed rather than constant radiation, along with "last image hold", which "freezes" the screen and makes it available for examination without exposing the patient to unnecessary radiation. Image intensifiers have been introduced that increase the brightness of the screen, so that the patient can be exposed to a lower dose of X-rays. Whilst this reduces the risk of ionisation occurring, it does not remove it entirely.

Fluoroscopy

Frozen pelvis

Radiography

Scintigraphy

Palpation

Exploratory surgery

Contrast CT

Volume CT

00

DKA most frequently occurs in those who know they have diabetes, but it may also be the first presentation in someone who had not previously been known to be diabetic. There is often a particular underlying problem that has led to the DKA episode; this may be intercurrent illness (pneumonia, influenza, gastroenteritis, a urinary tract infection), pregnancy, inadequate insulin administration (e.g. defective insulin pen device), myocardial infarction (heart attack), stroke or the use of cocaine. Young people with recurrent episodes of DKA may have an underlying eating disorder, or may be using insufficient insulin for fear that it will cause weight gain. Diabetic ketoacidosis may occur in those previously known to have diabetes mellitus type 2 or in those who on further investigations turn out to have features of type 2 diabetes (e.g. obesity, strong family history); this is more common in African, African-American and Hispanic people. Their condition is then labeled "ketosis-prone type 2 diabetes". Drugs in the gliflozin class (SGLT2 inhibitors), which are generally used for type 2 diabetes, have been associated with cases of diabetic ketoacidosis where the blood sugars may not be significantly elevated ("euglycemic DKA"). While this is a relatively uncommon adverse event, it is thought to be more common if someone receiving an SGLT2 inhibitor who is also receiving insulin has reduced or missed insulin doses. Furthermore it can be triggered by severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake. SGLT2 inhibitors should be stopped before surgery and only recommenced when it is safe to do so. SGLT2 inhibitors may be used in people with type 1 diabetes, but the possibility of ketoacidosis requires specific risk management. Specifically, they should not be used if someone is also using a low carbohydrate or ketogenic diet.

medical cause of Hypophosphatemia

medical cause of Hyperphosphatemia

medical cause of Hyperparathyroidism

medical cause of Hypercalcaemia

medical diagnosis of Hyperparathyroidism

complications of Hypophosphatemia

medical cause of Hyperkalemia

complications of Hyperparathyroidism

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<unk> , sold as under the brand names Radicava and Radicut among others, is an intravenous medication used to help with recovery following a stroke and to treat amyotrophic lateral sclerosis (ALS). The label carries a warning about the potential for hypersensitivity reactions to<unk> , and adverse effects include bruising, gait disturbances, headache, skin inflammation, eczema, problems breathing, excess sugar in urine, and fungal skin infections. The mechanism by which<unk> might be effective is unknown. The drug is known to be an antioxidant, and oxidative stress has been hypothesized to be part of the process that kills neurons in people with ALS. The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication.

Edaravone

Molindone

Delavirdine

Nintedanib

Ablomin

Vatalanib

Bexarotene

Triazoledione

00

After taking a thorough history, the diagnosis of colonic<unk> is usually easily included in the differential diagnosis. Abdominal plain x-rays are commonly confirmatory for a<unk> , especially if a "bent inner tube" sign or a "coffee bean" sign are seen. These refer to the shape of the air-filled closed loop of colon which forms the<unk> . Should the diagnosis be in doubt, a barium enema may be used to demonstrate a "bird's beak" at the point where the segment of proximal bowel and distal bowel rotate to form the<unk> . This area shows an acute and sharp tapering and looks like a bird's beak. If a perforation is suspected, barium should not be used due to its potentially lethal effects when distributed throughout the free intraperitoneal cavity. Gastrografin, which is safer, can be substituted for barium. The differential diagnosis includes the much more common constricting or obstructing carcinoma. In approximately 80 percent of colonic obstructions, invasive carcinoma is found to be the cause of the obstruction. This is usually easily diagnosed with endoscopic biopsies. Diverticulitis is a common condition with different presentations. Although diverticulitis may be the source of a colonic obstruction, it more commonly causes an ileus, which appears to be a colonic obstruction. Endoscopic means can be used to secure a diagnosis although this may cause a perforation of the inflamed diverticular area. CT scanning is the more common method to diagnose diverticulitis. The scan will show mesenteric stranding in the involved segment of edematous colon which is usually in the sigmoid region. Micro perforations with free air may be seen. Ulcerative colitis or Crohn's disease may cause colonic obstruction. The obstruction may be acute or chronic after years of uncontrolled disease leads to the formation of strictures and fistulas. The medical history is helpful in that most cases of inflammatory bowel disease are well known to both patient and doctor. Other rare syndromes, including Ogilvie's syndrome, chronic constipation and impaction may cause a pseudo obstruction. * Abdominal x-ray – tire-like shadow arising from right iliac fossa and passing to left * Upper GI series File:Sigmavolvulus - Coffee-bean-sign - LSL.Coffee bean sign in a person with sigmoid<unk> File:CT of small bowel<unk> (annotated).CT scan of a small bowel<unk> . It shows two juxtaposed segments of narrowing, which is the spot of mesentery rotation. The other signs indicate strangulation. File:Voluculus.An x-ray of a person with a small bowel<unk> . File:CecalVolvulusXray.Plain X ray of a cecal<unk> File:CecalVolvulus.CT scan of a cecal<unk>

Volvulus

Diverticulum

Rectal foreign body

Anal fissure

Rectitis

Fecal impaction

Vesicointestinal fistula

Proctocolitis

00

<unk> (BNS) is an extremely rare neurologic complication of Waldenström macroglobulinemia (WM), which is a chronic lymphoproliferative disorder. There's no clear definition of BNS but what is known so far is that unlike WM, It involves the central nervous system (CNS), infiltrated by differentiated malignant B cells and by having hyperglobulinemia. This infiltration increases blood viscosity, which impairs blood circulation through small blood vessels of the brain and the eye. Some scientists proposed that a person diagnosed with BNS is typically classified into Group A and Group B depending on whether or not plasma cells are present within the brain parenchyma, leptomeninges, dura, and/or the cerebral spinal fluid (CSF). Symptoms are diverse and nonspecific, and they can vary depending on which aspect of the CNS is being affected. Symptoms can include a range of severity of nausea and seizures. Since the symptoms vary, there are multiple treatment options to treat the symptoms for this non-curable disease. Although there is no specific set of diagnosis for BNS, different combinations of diagnostic tools are used to narrow down and conclude the presence of BNS.

Bing–Neel syndrome

Hagemoser–Weinstein–Bresnick syndrome

SACRAL syndrome

VEXAS syndrome

Costeff syndrome

Melnick–Needles syndrome

POEMS syndrome

OSLAM syndrome

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<unk> or collection of clinical trial data can be achieved through various methods that may include, but are not limited to, any of the following: paper or electronic medical records, paper forms completed at a site, interactive voice response systems, local electronic data capture systems, or central web based systems. There is arguably no more important document than the instrument that is used to acquire the data from the clinical trial with the exception of the protocol, which specifies the conduct of that clinical trial. The quality of the data collected relies first and foremost on the quality of that instrument. No matter how much time and effort go into conducting the clinical trial, if the correct data points were not collected, a meaningful analysis may not be possible. It follows, therefore, that the design, development and quality assurance of such an instrument must be given the utmost attention. The ICH guidelines on good clinical practice (GCP) use the term ‘case report form’ (CRF) to refer to these systems. No matter what CRF is utilized, the quality and integrity of the data is of primary importance.

Clinical data acquisition

Patient tracking system

Clinical data management system

Toxicity category rating

Hospital information system

Clinical decision support system

Personal health record

Patient registration

00

Tanner Scale of female breast development<unk> , also known as breast budding, is the onset of secondary breast development, which often represents the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; however, some males have a condition in which they develop breasts, termed gynecomastia.<unk> typically occurs between the ages of 8 and 13 years with significant variation between individuals. However, the initial growth of breast tissue occurs during fetal development regardless of sex. Usually, females experience menarche about 2 years after<unk> has begun, with complete breast development from<unk> to adult breasts, taking between 2 and 4 years. Moreover, puberty is considered delayed if breast development does not start before age 13 or if a female has not had her first period (menarche) within 3 years of<unk> . Additionally, secondary breast development occurring before the age of 7 or 8 years could be a sign of premature<unk> or precocious puberty. Of note, for some girls<unk> will occur, with subsequent regression of breast development, and then months or years later, normal breast growth will commence again accompanied by normal pubertal changes; this is termed transient<unk> . Pubertal changes, including breast development, are assessed using the Tanner Scale (Sexual Maturity Rating Scale) where stage 1 represents the lack of breast development, stage 2 is the breast budding or<unk> stage, stages 3 and 4 are continual breast growth and areolar development, and stage 5 signifies completion of development. This system does not use breast size, but instead examines the shape of breasts, nipples, and areolae to determine the progression of growth. Various hormones interact and result in the changes seen during<unk> . The growth and accumulation of adipose tissue in the breasts are induced by estrogen, while the development of mammary glands and areolae are caused by progesterone; both estrogen and progesterone are produced by ovaries. Due to change in hormone levels, young breasts are likely to develop asymmetrically and in many cases, adult breasts will remain unequal in size or shape.

Thelarche

Pubarche

Menarche

Adrenarche

Gonadarche

Spermarche

Sunovion

Abulia

00

<unk> has been used in estrogen replacement therapy, for the treatment of breast cancer in women and prostate cancer in men, and for the treatment of certain gynecological disorders.

Hexestrol

Gestodene

Fosfestrol

Moxestrol

Dimestrol

Benzestrol

Dienestrol

Allenestrol

00

Most commonly affects women aged 13–35 years, approximately puberty through their prime. Some reports show affected women to men at 9:1. Rare cases have been shown to affect post-menopausal women, children, and men. Incident report is currently unknown. Although rare, men and children have been shown to be affected. Heat, humidity, stress, and exercise have been shown to worsen symptoms. Rate of incidence is currently unknown.<unk><unk> has also been shown to be severe during menstruation and spontaneously disappear during pregnancy.

Fox–Fordyce disease

Degos disease

Pott disease

Ollier disease

Letterer–Siwe disease

Cruveilhier–Baumgarten disease

Brill–Zinsser disease

Salla disease

00

<unk> (ACHP) is an autosomal-recessive disorder that results in hemimelia, a lack of formation of the distal extremities. This is a congenital defect that consists of bilateral amputations of the distal upper and lower extremities, as well as aplasia of the hands and feet. It was first discovered and is prevalent almost exclusively in Brazil.

Acheiropodia

Boswellia

Aegyptiacum

Camptocormia

Veronaea

Leishmania

Curatella

Aedes epactius

00

<unk> (also known as Shabbir syndrome) is a rare epithelial disorder inherited in an autosomal recessive fashion. It is characterized by abnormalities in the larynx, nails <unk> -"), and skin <unk> "). The disorder is only found in Punjabi Muslims and only a few cases have been reported. It was characterized by Pakistani dermotologist Syed Ghulam Shabbir (1923–2002) in 1986. It may be associated with LAMA3.

Laryngo-onycho-cutaneous syndrome

Ablepharon macrostomia syndrome

Odontoma dysphagia syndrome

Scalp–ear–nipple syndrome

Branchio-oculo-facial syndrome

Achalasia microcephaly

Galloway Mowat syndrome

Saal Greenstein syndrome

00

<unk> is often classified according to the underlying cause. Non-occlusive<unk> develops because of low blood pressure or constriction of the vessels feeding the colon; occlusive<unk> indicates that a blood clot or other blockage has cut off blood flow to the colon. Non-occlusive<unk> In hemodynamically unstable patients (i.e. shock) the mesenteric perfusion may be compromised. This condition is commonly asymptomatic, and usually only apparent through a systemic inflammatory response. Occlusive<unk> Mostly the result of a thromboembolism. Commonly the embolism is caused by atrial fibrillation, valvular disease, myocardial infarction, or cardiomyopathy. In addition,<unk> is a well-recognized complication of abdominal aortic aneurysm repair, when the origin of the inferior mesenteric artery is covered by the aortic graft. In a 1991 review concerning 2137 patients the accidental inferior mesenteric artery ligation was the most common cause (74%) of<unk> . Thus, patients without adequate collateralization are at risk for<unk> of the descending and sigmoid colon. Bloody diarrhea and leukocytosis in the postoperative period are essentially diagnostic of<unk> . The complication can be prevented through careful selection of subjects that may require replanting inferior mesenteric artery (IMA) and completing the pre surgical procedure information with an instrumental evaluation during surgical treatment.

Ischemic colitis

Ulcerative colitis

Diversion colitis

Chemical colitis

Collagenous colitis

Cytomegalovirus colitis

Microscopic colitis

Diverticulitis

00

Problematic<unk> use or pathological<unk> use, is generally defined as problematic, compulsive use of the<unk> , that results in significant impairment in an individual's function in various life domains over a prolonged period of time. Young people are at particular risk of developing<unk> , with case studies highlighting students whose academic performance plummets as they spend more and more time online. Some also suffer health consequences from loss of sleep, as they stay up later and later to chat online, check for social network status updates or to reach the next game levels. Excessive<unk> use has not been recognised as a disorder by the World Health Organization, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the<unk> ional Classification of Diseases (ICD-11). However, the diagnosis of gaming disorder has been included in the ICD-11. Controversy around the diagnosis includes whether the disorder is a separate clinical entity, or a manifestation of underlying psychiatric disorders. Research has approached the question from a variety of viewpoints, with no universally standardised or agreed definitions, leading to difficulties in developing evidence based recommendations. As adolescents (12–19 years) and emerging adults (20–29 years) access the<unk> more than any other age groups and undertake a higher risk of overuse of the<unk> , the problem of<unk> behavior disorder is most relevant to young people.

Internet addiction disorder

Cannabis use disorder

Benzodiazepine use disorder

Pornography addiction

Benzodiazepine dependence

Polysubstance dependence

Amphetamine dependence

Stimulant use disorder

00

<unk> refers to the regrowth or repair of nervous tissues, cells or cell products. Such mechanisms may include generation of new neurons, glia, axons, myelin, or synapses.<unk> differs between the peripheral nervous system (PNS) and the central nervous system (CNS) by the functional mechanisms involved, especially in the extent and speed of repair. When an axon is damaged, the distal segment undergoes Wallerian degeneration, losing its myelin sheath. The proximal segment can either die by apoptosis or undergo the chromatolytic reaction, which is an attempt at repair. In the CNS, synaptic stripping occurs as glial foot processes invade the dead synapse. Nervous system injuries affect over 90,000 people every year. It is estimated that spinal cord injuries alone affect 10,000 each year. As a result of this high incidence of neurological injuries, nerve regeneration and repair, a subfield of neural tissue engineering, is becoming a rapidly growing field dedicated to the discovery of new ways to recover nerve functionality after injury. The nervous system is divided into two parts: the central nervous system, which consists of the brain and spinal cord, and the peripheral nervous system, which consists of cranial and spinal nerves along with their associated ganglia. While the peripheral nervous system has an intrinsic ability for repair and regeneration, the central nervous system is, for the most part, incapable of self-repair and regeneration. There is currently no treatment for recovering human nerve function after injury to the central nervous system. In addition, multiple attempts at nerve re-growth across the PNS-CNS transition have not been successful. There is simply not enough knowledge about regeneration in the central nervous system. In addition, although the peripheral nervous system has the capability for regeneration, much research still needs to be done to optimize the environment for maximum regrowth potential.<unk> is important clinically, as it is part of the pathogenesis of many diseases, including multiple sclerosis.

Neuroregeneration

Remyelination

Demineralization

Necrosis

Degeneration

Neuroinflammation

Neuroenhancement

Tissue expansion

00

Unlike narcolepsy with cataplexy, which has a known cause (autoimmune destruction of hypocretin-producing neurons), the cause of IH is largely unknown. , researchers have identified a few abnormalities associated with IH, which with further study may help to clarify the etiology. Destruction of noradrenergic neurons has produced<unk> in experimental animal studies, and injury to adrenergic neurons has also been shown to lead to<unk> . IH has also been associated with a malfunction of the norepinephrine system and decreased cerebrospinal fluid (CSF) histamine levels. Researchers have recently found an abnormal hypersensitivity to GABA (the major brain chemical responsible for sedation) in a subset of patients with central<unk> i.e.: IH, narcolepsy without cataplexy and long sleepers. They have identified a small (500 to 3000 daltons) naturally occurring bioactive substance (most likely a peptide as it is trypsin-sensitive) in the CSF of afflicted patients. Although this substance requires further identification of its chemical structure, it is currently referred to as a "somnogen" because it has been shown to cause hyper-reactivity of GABAA receptors, which leads to increased sedation or somnolence. In essence, it is as though these patients are chronically sedated with a benzodiazepine (medication which acts through the GABA system) such as Versed or Xanax, even though they do not take these medications.

Idiopathic hypersomnia

Strephosymbolia

Psychoorganic syndrome

Nightmare disorder

Erotolepsy

Interictal dysphoric disorder

Narcolepsy

Klazomania

00

Currently there is no curative treatment.

GFER Syndrome

GRACILE syndrome

RAPADILINO syndrome

CLOVES syndrome

Crigler–Najjar syndrome

Van Gogh syndrome

Diogenes syndrome

Van der Woude syndrome

00

<unk> es have been used since 1999 for correcting larger errors in near-sighted, far-sighted, and astigmatic eyes. This type of<unk> is also called phakic<unk> (PIOL), as it is implanted without removing the patient's natural crystalline<unk> . Phakic<unk> appear to be less dangerous than excimer laser surgery (LASIK) in those with significant nearsightedness. More commonly<unk> s are implanted via Clear<unk> Extraction And Replacement (CLEAR) surgery. During CLEAR, the crystalline<unk> is extracted and an<unk> replaces it in a process that is very similar to cataract surgery: both involve<unk> replacement, local anesthesia, last approximately 30 minutes, and require making a small incision in the eye for<unk> insertion. People recover from CLEAR surgery 1–7 days after the operation. During this time, they should avoid strenuous exercise or anything else that significantly raises blood pressure. They should visit their ophthalmologists regularly for several weeks to monitor the<unk> implants. CLEAR has a 90% success rate (risks include wound leakage, infection, inflammation, and astigmatism). CLEAR can be performed only on patients ages 40 and older. This is to ensure that eye growth, which disrupts<unk> <unk> es, will not occur post-surgery. Once implanted,<unk> <unk> es have three major benefits. First, they are an alternative to the excimer laser procedure (LASIK), a form of eye surgery that does not work for people with serious vision problems. Effective<unk> implants also eliminate the need for glasses or contact<unk> es post-surgery for most patients. The cataract will not return, as the<unk> has been removed. The disadvantage is that the eye's ability to change focus (accommodate) has generally been reduced or eliminated, depending on the kind of<unk> implanted. Some of the risks that FDA have been found so far during a three-year study of the Artisan are: * a yearly loss of 1.8% of the endothelial cells, * 0.6% risk of retinal detachment, * 0.6% risk of cataract (other studies have shown a risk of 0.5–1.0%), and * 0.4% risk of corneal swelling. Other risks include: * 0.03–0.05% eye infection risk, which in worst case can lead to blindness. (This risk exists in all eye surgery procedures and is not unique to<unk> s.) * glaucoma, * astigmatism, * remaining near or far sightedness, * rotation of the<unk> inside the eye one or two days after surgery. One of the causes of the risks above is that the<unk> can rotate inside the eye if the PIOL is too short, if the eye was incorrectly measured, or because the sulcus has a slightly oval shape (the height is slightly smaller than the width). Toric<unk> s must be powered and aligned inside the eye on a meridian that corrects the patient's preexisting astigmatism. Again, these<unk> es can rotate inside the eye postoperatively or be placed incorrectly by the operating surgeon. Either way, the patient's preexisting astigmatism may not be corrected completely or may even increase. When standard<unk> s are implanted with a CLEAR procedure, in substitution of the patient's crystalline, astigmatism is typically not corrected, as astigmatism is mainly attributable to a deformation of the cornea. Toric<unk> s may be used during the CLEAR procedure to correct astigmatism. The surgeon can ascertain the astigmatic, or steepest, meridian in a number of ways, including manifest refraction or corneal topography. Manifest refraction is the familiar test where the eye doctor rotates<unk> es in front of the eye, asking the patient, "Which is better (or clearer), this one or this one?" Corneal topography is considered a more quantitative test, and for purposes of aligning a toric<unk> , most surgeons use a measurement called simulated keratometry (SimK), which is calculated by the internal programming of the corneal topography machine, to determine the astigmatic meridian on the surface of the cornea. The astigmatic meridian can also be identified using corneal wavefront technology or paraxial curvature matching.

Intraocular lens

Scleral lens

Corneal button

Eye dropper

Optic cup

Intrastromal corneal ring segment

Lacrimal sac

Fundus

00

The primary feature of<unk> is bone marrow fibrosis, but it is often accompanied by: * Abdominal fullness related to an enlarged spleen (splenomegaly). * Bone pain * Bruising and easy bleeding due to inadequate numbers of platelets * Cachexia (loss of appetite, weight loss, and fatigue) * Enlargement of both the liver and spleen * Fatigue * Gout and high uric acid levels * Increased susceptibility to infection, such as pneumonia * Pallor and shortness of breath due to anemia * In rarer cases, a raised red blood cell volume * Cutaneous myelofibrosis is a rare skin condition characterized by dermal and subcutaneous nodules.

Primary myelofibrosis

Prefibrotic primary myelofibrosis

Acute panmyelosis with myelofibrosis

Chronic neutrophilic leukemia

Acute myeloid leukemia

Leukemoid reaction

Myelodysplastic syndrome

Chronic lymphocytic leukemia

00

Classification The most frequent types of cleft palates are overt, submucous, and occult submucous.

Velopharyngeal inadequacy

Velopharyngeal insufficiency

Congenital cartilaginous rest of the neck

Patulous Eustachian tube

Nasal septum deviation

Salivary gland hypoplasia

Persistent thyroglossal duct

Esophageal motility disorder

00

A specific cause for the separation of the<unk><unk> during pregnancy and delivery has not been identified by researchers as of date. Thoughts surrounding the hormone relaxin and its effect on the laxity of ligaments during pregnancy have been investigated, but no direct cause of this hormone to<unk> has been identified. Relaxin, in conjunction with progesterone, can cause a physiological separation of the<unk><unk> during pregnancy that typically measures 3-5mm and is most pronounced in the first trimester and returns to normal size within 5 months postpartum. Risk factors associated with the condition have been identified and include cephalopelvic disproportion, large fetuses, epidural anesthesia, the use of forceps, primigravida, multiple gestations, previous of difficult delivery such as shoulder dystocia, and previous pre-existing pelvic injury or pathology. Risk factors can further be stratified by causes including enzymatic causes such as disturbances in collage synthesis, endocrine causes related to hormones produced in pregnancy such as progesterone, estrogen and relaxin, inflammatory processes, metabolic disturbances in the production of vitamin D and calcium and pelvic instability such as congenital malformations and excessive lumbar lordosis. In addition, outside of pregnancy and post-partum states, separation of the<unk><unk> can be seen in the setting of trauma. These cases are related to injuries sustained from high velocity injuries such as motor vehicle accidents, falls from large heights, falling from a horse and crush injuries.

Pubic Symphysis Diastasis

Vertebral hemangioma

Spinal epidural hematoma

Epidural abscess

Cervical spinal stenosis

Vertebral osteomyelitis

Diastematomyelia

Spinal fracture

00

<unk> <unk> is an inherited genetic syndrome most often caused by an inactivating mutation in the E-cadherin gene (CDH1) located on chromosome 16. Individuals who inherit an inactive copy of the CDH1 gene are at significantly elevated risk for developing stomach cancer. For this reason, individuals with these mutations will often elect to under go prophylactic<unk> tomy, or a complete removal of the stomach to prevent this cancer. Mutations in CDH1 are also associated with high risk of lobular breast cancers, and may be associated with a mildly elevated risk of colon cancer. The most common form of stomach cancer associated with CDH1 mutations is<unk> type adenocarcinoma. An estimated 70% of males and 56% of females who inherit an inactivating CDH1 mutation will develop this form of cancer by age 80. Female patients are also estimated to have a 42% lifetime risk of developing lobular breast cancer. The median age of<unk> cancer diagnosis in individuals with a CDH1 inactivating mutation is 38 years of age, but cases have been reported as young as 14 years of age.

Hereditary diffuse gastric cancer

Hereditary nonpolyposis colorectal cancer

Juvenile polyposis syndrome

Coeliac disease

Tropical sprue

Attenuated familial adenomatous polyposis

Familial adenomatous polyposis

Serrated polyposis syndrome

00

<unk> <unk> is a form of echinococcosis, or a<unk> that originates from a parasitic flatworm.<unk> is caused by an infection of the flatworm species Echinococcus multilocularis. Although<unk> echinococcosis is rarely diagnosed in humans and is not as widespread as cystic echinococcosis (caused by Echinococcus granulosus), it is also still a serious<unk> that has a significantly high fatality rate. It is considered one of the most life-threatening helminthic infections humans can have. It is mostly popular in China, Eastern France, Switzerland, Austria, Bulgaria, Turkey, Iran, Japan, Afghanistan, and Russia, and is mostly confined to the Northern hemisphere, south to around the 40th or 45th degree of Northern latitude, save some cases reported in Northern Africa.

Alveolar hydatid disease

Echinococcosis

Pneumocystosis

Cryptococcosis

Amoebic liver abscess

Pyogenic liver abscess

Cholangiosarcoma

Liver abscess

00

<unk> acts in a host after their immunological components are withdrawn, their immunological activity is modified extracorporeally, and then reinfused into the same host. This process in its former part is analogous to adoption: a child is once adopted out from their home, grown up, and then returned to their home of birth. Transferred immunological components include immune cells such as T lymphocytes or tumour-infiltrating lymphocytes, NK cells, macrophages, or B cells. There seems to be some variation in usage of this term. # Transferred components are immune cells and autologous as above. # Transfer of immune cells is made between different individuals of monozygotic twins in human or of the same pure line in experimental animals from immunologically sensitized to naive host, where transferred cells are engrafted without rejection or GVHD in the new host. # Transfer of cells are made between allogeneic hosts but the new host is irradiated for preventing rejection or GVHD. # Transfer of cells are made between allogeneic hosts. # Transferred components include cells as well as immune molecules such as immunoglobulins between allogeneic hosts. The term is used almost synonymously for "passive immunity" in some situations, however, passive immunity acts among xenogeneic hosts; for example, in snake venom immunotherapy, antivenom IgG is obtained from sensitized horse and inoculated to humans.

Adoptive immunity

Herd immunity

Contact immunity

Trained immunity

Passive immunity

Host adaptation

Seroconversion

Immune tolerance

00

<unk> (trade name Paremyd) is a combination drug used as an ophthalmic solution to induce mydriasis. It consists of:<unk> (0.25%), an anticholinergic drug<unk> (norpholedrine, 1%), a sympathomimetic drug

Tropicamide/hydroxyamfetamine

Dextropropoxyphene

Buprenorphine/naltrexone

Nandrolone hexyloxyphenylpropionate

Testosterone propionate/testosterone ketolaurate

Hydrocortisone buteprate

Drostanolone propionate

Tranylcypromine/trifluoperazine

00

There is no cure for<unk> 's. There is no single most effective medication, and no one medication effectively treats all symptoms. Most medications prescribed for tics have not been approved for that use, and no medication is without the risk of significant adverse effects. Treatment is focused on identifying the most troubling or impairing symptoms and helping the individual manage them. Because comorbid conditions are often a larger source of impairment than tics, they are a priority in treatment. The management of<unk> 's is individualized and involves shared decision-making between the clinician, patient, family and caregivers. Practice guidelines for the treatment of tics were published by the American Academy of Neurology in 2019. Education, reassurance and psychobehavioral therapy are often sufficient for the majority of cases. In particular, psychoeducation targeting the patient and their family and surrounding community is a key management strategy. Watchful waiting "is an acceptable approach" for those who are not functionally impaired. Symptom management may include behavioral, psychological and pharmacological therapies. Pharmacological intervention is reserved for more severe symptoms, while psychotherapy or cognitive behavioral therapy (CBT) may ameliorate depression and social isolation, and improve family support. The decision to use behavioral or pharmacological treatment is "usually made after the educational and supportive interventions have been in place for a period of months, and it is clear that the tic symptoms are persistently severe and are themselves a source of impairment in terms of self-esteem, relationships with the family or peers, or school performance". Psychoeducation and social support Knowledge, education and understanding are uppermost in management plans for tic disorders, and psychoeducation is the first step. A child's parents are typically the first to notice their tics; they may feel worried, imagine that they are somehow responsible, or feel burdened by misinformation about<unk> 's. Effectively educating parents about the diagnosis and providing social support can ease their anxiety. This support can also lower the chance that their child will be unnecessarily medicated or experience an exacerbation of tics due to their parents' emotional state. People with<unk> 's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful. Even children with milder tics may be angry, depressed or have low self-esteem as a result of increased teasing, bullying, rejection by peers or social stigmatization, and this can lead to social withdrawal. Some children feel empowered by presenting a peer awareness program to their classmates. It can be helpful to educate teachers and school staff about typical tics, how they fluctuate during the day, how they impact the child, and how to distinguish tics from naughty behavior. By learning to identify tics, adults can refrain from asking or expecting a child to stop ticcing, because "tic suppression can be exhausting, unpleasant, and attention-demanding and can result in a subsequent rebound bout of tics". Adults with<unk> may withdraw socially to avoid stigmatization and discrimination because of their tics. Depending on their country's healthcare system, they may receive social services or help from support groups. Behavioral Behavioral therapies using habit reversal training (HRT) and exposure and response prevention (ERP) are first-line interventions in the management of<unk> , and have been shown to be effective. Because tics are somewhat suppressible, when people with<unk> are aware of the premonitory urge that precedes a tic, they can be trained to develop a response to the urge that competes with the tic. Comprehensive behavioral intervention for tics (CBIT) is based on HRT, the best researched behavioral therapy for tics.<unk> experts debate whether increasing a child's awareness of tics with HRT/CBIT (as opposed to ignoring tics) can lead to more tics later in life. When disruptive behaviors related to comorbid conditions exist, anger control training and parent management training can be effective. CBT is a useful treatment when OCD is present. Relaxation techniques, such as exercise, yoga and meditation may be useful in relieving the stress that can aggravate tics. Beyond HRT, the majority of behavioral interventions for<unk> 's (for example, relaxation training and biofeedback) have not been systematically evaluated and are not empirically supported. Medication Clonidine is one of the medications typically tried first when medication is needed for<unk> 's. It is available as a pill or a transdermal (skin) patch. Children with tics typically present when their tics are most severe, but because the condition waxes and wanes, medication is not started immediately or changed often. Tics may subside with education, reassurance and a supportive environment. When medication is used, the goal is not to eliminate symptoms. Instead, the lowest dose that manages symptoms without adverse effects is used, because adverse effects may be more disturbing than the symptoms being treated with medication. The classes of medication with proven efficacy in treating tics—typical and atypical neuroleptics—can have long-term and short-term adverse effects. Some antihypertensive agents are also used to treat tics; studies show variable efficacy but a lower side effect profile than the neuroleptics. The antihypertensives clonidine and guanfacine are typically tried first in children; they can also help with ADHD symptoms, but there is less evidence that they are effective for adults. The neuroleptics risperidone and aripiprazole are tried when antihypertensives are not effective, and are generally tried first for adults. Because of lower side effects, aripiprazole is preferred over other antipsychotics. The most effective medication for tics is haloperidol, but it has a higher risk of side effects. Methylphenidate can be used to treat ADHD that co-occurs with tics, and can be used in combination with clonidine. Selective serotonin reuptake inhibitors are used to manage anxiety and OCD. Other Complementary and alternative medicine approaches, such as dietary modification, neurofeedback and allergy testing and control have popular appeal, but they have no proven benefit in the management of<unk> . Despite this lack of evidence, up to two-thirds of parents, caregivers and individuals with<unk> use dietary approaches and alternative treatments and do not always inform their physicians. There is low confidence that tics are reduced with tetrahydrocannabinol, and insufficient evidence for other cannabis-based medications in the treatment of<unk> 's. There is no good evidence supporting the use of acupuncture or transcranial magnetic stimulation; neither is there evidence supporting intravenous immunoglobulin, plasma exchange, or antibiotics for the treatment of PANDAS. Deep brain stimulation (DBS) has become a valid option for individuals with severe symptoms that do not respond to conventional therapy and management, although it is an experimental treatment. Selecting candidates who may benefit from DBS is challenging, and the appropriate lower age range for surgery is unclear; it is potentially useful in less than 3% of individuals. The ideal brain location to target has not been identified as of 2019. Pregnancy A quarter of women report that their tics increase before menstruation; however, studies have not shown consistent evidence of a change in frequency or severity of tics related to pregnancy or hormonal levels. Overall, symptoms in women respond better to haloperidol than they do for men. Most women find they can withdraw from medication during pregnancy without much trouble. When needed, medications are used at the lowest doses possible. During pregnancy, neuroleptic medications are avoided when possible because of the risk of pregnancy complications. When needed, olanzapine, risperidone and quetiapine are most often used as they have not been shown to cause fetal abnormalities. One report found that haloperidol could be used during pregnancy, to minimize the side effects in the mother, including low blood pressure, and anticholinergic effects, although it may cross the placenta. If severe tics might interfere with administration of local anesthesia, other anesthesia options are considered. Neuroleptics in low doses may not affect the breastfed infant, but most medications are avoided. Clonidine and amphetamines may be present in breast milk.

Tourette syndrome

Lesch–Nyhan syndrome

Conduct disorder

Tardive dyskinesia Tardive dyskinesia 1

Autism spectrum

High-functioning autism

Oppositional defiant disorder

Klismaphilia

00

<unk> is similar to anticonvulsant<unk> syndrome, but the onset is often sooner in the treatment course, generally after 7–14 days of therapy. It is considered immune-mediated.

Sulfonamide hypersensitivity syndrome

Levamisole induced necrosis syndrome

Side effects of penicillin

Group A streptococcal infection

Staphylococcal scalded skin syndrome

Papular purpuric gloves and socks syndrome

Group B streptococcal infection

Serum sickness-like reaction

00

alt=Pathobiology of<unk> Despite extensive investigation, the cause of<unk> remains unknown. The<unk> in<unk> has been linked to cigarette smoking, environmental factors (e.g. occupational exposure to gases, smoke, chemicals or dusts), other medical conditions including gastroesophageal reflux disease (GERD), or to genetic predisposition (familial<unk> . However, none of these is present in all people with<unk> and therefore do not provide a completely satisfactory explanation for the disease.<unk> is believed to be the result of an aberrant wound healing process including/involving abnormal and excessive deposition of collagen<unk> in the pulmonary interstitium with minimal associated inflammation. Cellular senescence is suspected to be a central contributing cause, a belief which is supported by benefits seen in patients given senolytic therapy. It is hypothesized that the initial or repetitive injury in<unk> occurs to the lung cells, called alveolar epithelial cells (AECs, pneumocytes), which line the majority of the alveolar surface. When type I AECs are damaged or lost, it is thought that type II AECs undergo proliferation to cover the exposed basement membranes. In normal repair, the hyperplastic type II AECs die and the remaining cells spread and undergo a differentiation process to become type I AECs. Under pathologic conditions and in the presence of transforming growth factor beta (TGF-β), fibroblasts accumulate in these areas of damage and differentiate into myofibroblasts that secrete collagen and other proteins. In the current classification of the pathogenesis of<unk> , it is believed that it occurs by way of the formation of a UIP (usual interstitial pneumonia) lesion, which then undergoes the aforementioned pathological condition characteristic of<unk> . Other proposed repeated injury mechanisms indicate that<unk> may result not just from a UIP lesion, but also from NSIP and DAD (nonspecific interstitial pneumonia and diffuse alveolar damage) lesions, or a combination of several. In the past, it was thought that inflammation was the first event in initiating lung tissue scarring. Later findings showed that the development of fibroblastic foci precedes the accumulation of inflammatory cells and the consequent deposition of collagen. This pathogenetic model is indirectly supported by the clinical features of<unk> , including an insidious onset over several years, relatively infrequent acute exacerbations, and failure to respond to immunosuppressive therapy. However, it is the belief of some researchers that the disease is a multi-mechanistic one, wherein the trigger for the disease may stem from abnormalities in any number of wound healing pathways, including the inflammatory response. Such abnormalities could occur in any number of the nine implicated pathways (clotting cascade, antioxidant pathways, apoptosis, inflammatory cytokines, angiogenesis and vascular remodelling, growth factors, surfactant and matrix regulatory factors), and that through further investigation into all nine, novel therapies and approaches could be proposed on a unique or case by case basis should attempts at treating or circumventing complications in any one pathway prove unsuccessful. A number of therapies that target fibroblast activation or the synthesis of extracellular matrix are currently in early testing or are being considered for development. Familial<unk> accounts for less than 5% of the total of patients with<unk> and is clinically and histologically indistinguishable from sporadic<unk> . Genetic associations include mutations in pulmonary surfactant proteins A1, A2, C (SFTPA1, SFTPA2B) and mucin (MUC5B). A remarkable aspect of the MUC5B variant is its high frequency of detection, as it is found in approximately 20% of individuals with Northern and Western European ancestry and in 19% of the Framingham Heart Study population. Mutations in human telomerase genes are also associated with familial pulmonary<unk> and in some patients with sporadic<unk> (e.g. the TERT, TERC genes). Recently an X-linked mutation in a third telomerase-associated gene, dyskerin (DKC1), has been described in a family with<unk> .

Idiopathic pulmonary fibrosis

Sarcoidosis

Mineral dust airway disease

Hypersensitivity pneumonitis

Allergic bronchopulmonary aspergillosis

Interstitial lung disease

Rheumatoid lung disease

Idiopathic interstitial pneumonia

00

Not everyone with<unk> has<unk> <unk> es <unk> , nor does everyone with<unk> an cysts have<unk> ; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms. File:Polycystic_ovary.Transvaginal ultrasound scan of<unk><unk> File:PCO<unk><unk> .Polycystic<unk> as seen on sonography Differential diagnosis Other causes of irregular or absent menstruation and hirsutism, such as hypothyroidism, congenital adrenal hyperplasia (21-hydroxylase deficiency), Cushing's syndrome, hyperprolactinemia, androgen secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. Assessment and testing Standard assessment * History-taking, specifically for menstrual pattern, obesity, hirsutism and acne. A clinical prediction rule found that these four questions can diagnose<unk> with a sensitivity of 77.1% (95% confidence interval CI 62.7%–88.0%) and a specificity of 93.8% (95% CI 82.8%–98.7%). * Gynecologic ultrasonography, specifically looking for small<unk> an follicles. These are believed to be the result of disturbed<unk> an function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In a normal menstrual cycle, one egg is released from a dominant follicle – in essence, a cyst that bursts to release the egg. After ovulation, the follicle remnant is transformed into a progesterone-producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In<unk> , there is a so-called "follicular arrest"; i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more). According to the Rotterdam criteria, which are widely used for diagnosis, 12 or more small follicles should be seen in an<unk> on ultrasound examination. More recent research suggests that there should be at least 25 follicles in an<unk> to designate it as having<unk> <unk> an morphology <unk> M) in women aged 18–35 years. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. If a high resolution transvaginal ultrasonography machine is not available, an<unk> an volume of at least 10 ml is regarded as an acceptable definition of having<unk> <unk> an morphology instead of follicle count. * Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the<unk> . (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the<unk> es in this way to confirm a diagnosis of<unk> .) * Serum (blood) levels of androgens (hormones associated with male development), including androstenedione and testosterone may be elevated. Dehydroepiandrosterone sulfate levels above 700–800 µg/dL are highly suggestive of adrenal dysfunction because DHEA-S is made exclusively by the adrenal glands. The free testosterone level is thought to be the best measure, with ~60% of<unk> patients demonstrating supranormal levels. The Free androgen index (FAI) of the ratio of testosterone to sex hormone-binding globulin (SHBG) is high and is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for<unk> ,<unk> sibly because FAI is correlated with the degree of obesity. Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle-stimulating hormone), when measured in international units, is elevated in women with<unk> . Common cut-offs to designate abnormally high LH/FSH ratios are 2:1 or 3:1 as tested on Day 3 of the menstrual cycle. The pattern is not very sensitive; a ratio of 2:1 or higher was present in less than 50% of women with<unk> in one study. There are often low levels of sex hormone-binding globulin, in particular among obese or overweight women. Anti-Müllerian hormone (AMH) is increased in<unk> , and may become part of its diagnostic criteria. Glucose tolerance testing * 2-hour oral glucose tolerance test (GTT) in women with risk factors (obesity, family history, history of gestational diabetes) may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with<unk> . Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight people, although it is more common in the latter (and in those matching the stricter NIH criteria for diagnosis); 50–80% of people with<unk> may have insulin resistance at some level. * Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women needing higher dosages of metformin or the use of a second medication to significantly lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5). * Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of impaired glucose tolerance and frank diabetes among women with<unk> according to a prospective controlled trial. While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with<unk> (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines.

Polycystic ovary syndrome

Hypothyroidism

Gonadotropin-resistant ovary syndrome

Hyperprolactinaemia

Functional hypothalamic amenorrhea

Congenital adrenal hyperplasia

Lactational amenorrhea

Metabolic syndrome

00

The<unk> (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin trial) was a clinical trial aimed at evaluating whether statins reduce heart attacks and strokes in people with normal cholesterol levels.

JUPITER trial

STEPS trial

PARAMOUNT trial

MOMS Trial

AURORA trial

ASTEROID trial

Solidarity trial

RECOVERY Trial

00

<unk> , sold under the brand names Dolophine and<unk> among others, is a synthetic opioid agonist used for chronic pain and also for opioid dependence. It is used to treat chronic pain, and it is also used to treat addiction to heroin or other opioids. Prescribed for daily use, the medicine relieves cravings and removes withdrawal symptoms. Detoxification using<unk> can be accomplished in less than a month, or it may be done gradually over as long as six months. While a single dose has a rapid effect, maximum effect can take up to five days of use. The pain-relieving effects last about six hours after a single dose. After long-term use, in people with normal liver function, effects last 8 to 36 hours.<unk> is usually taken by mouth and rarely by injection into a muscle or vein. Side effects are similar to those of other opioids. These frequently include dizziness, sleepiness, vomiting, and sweating. Serious risks include opioid abuse and respiratory depression. Abnormal heart rhythms may also occur due to a prolonged QT interval. The number of deaths in the United States involving<unk> poisoning declined from 4,418 in 2011 to 3,300 in 2015. Risks are greater with higher doses.<unk> is made by chemical synthesis and acts on opioid receptors.<unk> was developed in Germany around 1937 to 1939 by Gustav Ehrhart and Max Bockmühl. It was approved for use as an analgesic in the United States in 1947, and has been used in the treatment of addiction since the 1960s. It is on the World Health Organization's List of Essential Medicines.

Methadone

Isomethadone

Normethadone

Levomethadone

Morphine

Buprenorphine

Codeine

Naltrexone

00

<unk> (DPP; sold as Allergen, Arbid, Belfene, Diafen, Hispril, Histyn, Lergobine, Lyssipol, Mepiben, Neargal) is a first-generation antihistamine with anticholinergic effects of the diphenylpiperidine class. It is marketed in Europe for the treatment of allergies. DPP has also been found to act as a dopamine reuptake inhibitor and produces hyperactivity in rodents. It has been shown to be useful in the treatment of Parkinsonism.

Diphenylpyraline

Aceclidine

Piperoxan

Papaverine

Ropivacaine

Triprolidine

Ibogaine

Levorphanol

00

Due to the disorders rare occurrence there is no standardized treatment or protocol. There were no clinical trials conducted on patients that suffer from<unk> , therefore, we are unaware of the safety or potential treatment for such a condition. At this moment we can find a series of single case reports of patients. Physicians treat specific syndromes of the disorder in order to improve the lives of patients. Treatment usually involves a collaboration of many medical professionals. These medical professionals include, but are not limited to: dermatologists, doctors who have specialized in diagnosing and treating skin disorder; ophthalmologists, specialists of the eyes; cardiologist, doctors of the heart; endocrinologists, specialists of the endocrine system; neurologists and or neurosurgeons, specialist in treating and diagnosing conditions of the brain; otolaryngologists, specialists of the ear, nose, and throat; dentists, who are specialized in treating conditions of the teeth, speech pathologists; psychiatrists, and many others. Management<unk> needs to be managed by a multidisciplinary team of experts. Additional specialties such as cardiology, ophthalmology, neurology, and neurosurgery may need to be involved. The team of experts pay close attention to how these children develop throughout the school age period.<unk> Handbook - Dr. Beth Drolet In 2013, the<unk> Community was formed. The non-profit entity was developed to raise awareness about the condition, support patients and families of those with the condition and raise money for research into causes and treatment.

PHACE syndrome

Char syndrome

MASS syndrome

Flammer syndrome

TAN syndrome

Dressler syndrome

HAIR-AN syndrome

Wunderlich syndrome

00

Heart during ventricular diastole. In cardiac physiology,<unk> is the amount of sarcomere stretch experienced by cardiac muscle cells, called cardiomyocytes, at the end of ventricular filling during diastole.<unk> is directly related to ventricular filling. As the relaxed ventricle fills during diastole, the walls are stretched and the length of sarcomeres increases. Sarcomere length can be approximated by the volume of the ventricle because each shape has a conserved surface-area-to-volume ratio. This is useful clinically because measuring the sarcomere length is destructive to heart tissue. It requires cutting out a piece of cardiac muscle to look at the sarcomeres under a microscope. It is currently not possible to directly measure<unk> in the beating heart of a living animal.<unk> is estimated from end-diastolic ventricular pressure and is measured in millimeters of mercury (mmHg).

Preload

Regimen

Bandage

Sham rage

VACTERL association

Dose profile

Test to Release

Gain-field encoding

00

<unk> is a benzodiazepine derivative. It is a partial agonist of benzodiazepine receptors and was shown in 1984 to possess both anxiolytic and sedative properties in humans but was never marketed.

Premazepam

Halazepam

Medazepam

Oxazepam

Diclazepam

Camazepam

Cinolazepam

Temazepam

00

<unk> is contraindicated in sick sinus syndrome. It should also not be used concomitantly with potent inhibitors of CYP3A4, including azole antifungals (such as ketoconazole), macrolide antibiotics, nefazodone and the antiretroviral drugs nelfinavir and ritonavir. Use of<unk> with verapamil or diltiazem is contraindicated.

Ivabradine

Lofexidine

Setiptiline

Maprotiline

Verapamil

Nortilidine

Veratridine

Procainamide

00

A<unk> is a scientific<unk> devoted to the field of<unk><unk> , including epidemiology, biostatistics, and<unk> care (including medicine, nursing and related fields).<unk> s, like most scientific<unk> s, are peer-reviewed.<unk> s are commonly<unk> hed by<unk> organizations and societies, such as the Bulletin of the World<unk> Organization or the<unk> of Epidemiology and Community<unk> <unk> hed by the British Medical Association). Many others are<unk> hed by a handful of large<unk> hing corporations that includes Elsevier, Wolters Kluwer, Wiley-Blackwell, Springer Science+Business Media, and Informa, each of which has many imprints (which are brands named after former independent<unk> hers that were merged or acquired). Many societies partner with such corporations to handle the work of producing their<unk> s. The increase in<unk><unk> research in recent decades has seen a rapid increase in the number of articles and<unk> s. As such, many<unk> s have emerged with a specialized focus, such as in the area of policy (e.g.<unk> of<unk><unk> Policy), a specific region or country of the world (e.g. Asia-Pacific<unk> of<unk><unk> , Pan American<unk> of<unk><unk> or Eastern Mediterranean<unk><unk> , a specific intervention/practice area (e.g. Cancer Epidemiology, Biomarkers & Prevention), or other particular focus (e.g. Human Resources for<unk> .

Public health journal

General medical journal

Air quality guideline

International health

Hospital medicine

Clinical research associate

Biomedical scientist

Regulatory science

00

Normal adult hemoglobin A molecule comprises two α and two β globin chains associated with a heme ring. Mutation at the 6th position of the beta chain is the cause of<unk> <unk> disease. Due to<unk> <unk> disease, vascular occlusion may occur in the conjunctiva, iris, retina, or choroid. Retinal changes occur due to blockage of retinal blood vessels by abnormal RBCs.

Sickle cell retinopathy

Autoimmune retinopathy

Diabetic retinopathy

Hypertensive retinopathy

Radiation retinopathy

Chloroquine retinopathy

Photic retinopathy

Autoimmune optic neuropathy

00

CT scan of the lungs showing findings diagnostic of<unk> . White and black arrows point to dilated bronchi characteristic of the disease. The goals of a diagnostic evaluation for<unk> are radiographic confirmation of the diagnosis, identification of potential treatable causes, and functional assessment of the patient. A comprehensive evaluation consists of radiographic imaging, laboratory testing, and lung function testing. Laboratory tests that are commonly part of the initial evaluation include a complete blood count, sputum cultures for bacteria, mycobacteria, and fungi, testing for cystic fibrosis, and immunoglobulin levels. Additional tests that are sometimes indicated include testing for specific genetic disorders. Lung function testing is used for the assessment and monitoring of functional impairment due to<unk> . These tests may include spirometry and walking tests. Obstructive lung impairment is the most common finding but restrictive lung impairment can be seen in advanced disease. Flexible bronchoscopy may be performed when sputum studies are negative and a focal obstructing lesion is suspected. A chest x-ray is abnormal in most patients with<unk> . Computed tomography is recommended to confirm the diagnosis and is also used to describe the distribution and grade the severity of the disease. Radiographic findings include airway dilation, bronchial wall thickening, and atelectasis. There are three types<unk> that can be seen on CT scan, namely cylindrical, varicose, and cystic<unk> . File:Bronchiectasis (3705143327).Bronchiectasis primarily in the middle lobe of the right lung. File:Bronchiectasis<unk> secondary to a large carcinoid tumor (not shown) that was completely obstructing the bronchus proximally. Dilation of the airways is present.

Bronchiectasis

Chronic obstructive pulmonary disease

Plastic bronchitis

Tracheobronchomalacia

Bronchitis kettle

Asbestosis

Acute bronchitis

Dust pneumonia

00

In lactation<unk> , frequent emptying of both breasts by breastfeeding is essential. Also essential is adequate fluid supply for the mother and baby. For breastfeeding women with light<unk> , massage and application of heat prior to feeding can help as this may aid unblocking the ducts. However, in more severe cases of<unk> heat or massage could make the symptoms worse and cold compresses are better suited to contain the inflammation. Nonpuerperal<unk> is treated by medication and possibly aspiration or drainage (see in particular treatment of subareolar abscess and treatment of granulomatous<unk> . According to a BMJ best practice report, antibiotics are generally to be used in all nonpuerperal<unk> cases, with replacement of the antibiotics by an antifungal agent such as fluconazole in cases of deep fungal infections, and corticosteroids are to be used in case of granulomatous<unk> (with differential diagnosis to tuberculosis infection of the breast). In idiopathic granulomatous<unk> , successful treatment includes invasive surgical procedures or less invasive treatment with steroid medications. Antibiotics In lactational<unk> , antibiotics are not needed in the overwhelming majority of cases and should be used only for bacterial infections. For people with nonsevere infections, dicloxacillin or cephalexin are recommended. For people with severe infections, vancomycin is recommended. The length of antibiotic treatment ranges anywhere from 5–14 days. The effects of antibiotics has not been well studied as of 2013. Breast abscess An abscess (or suspected abscess) in the breast may be treated by ultrasound-guided fine-needle aspiration (percutaneous aspiration) or by surgical incision and drainage; each of these approaches is performed under antibiotic coverage. In case of puerperal breast abscess, breastfeeding from the affected breast should be continued where possible. For small breast abscesses, ultrasound-guided fine needle aspiration such as to completely drain the abscess is widely recognized as a preferred initial management. One recommended treatment includes antibiotics, ultrasound evaluation and, if fluid is present, ultrasound-guided fine needle aspiration of the abscess with an 18 gauge needle, under saline lavage until clear. The exudate is then sent for microbiological analysis for identification of the pathogen and determination of its antibiotic sensitivity profile, which may in turn give an indication for changing the antibiotics. At follow-up, a mammography is performed if the condition has resolved; otherwise the ultrasound-guided fine-needle aspiration with lavage and microbiological analysis is repeated. If three to five aspirations still do not resolve the condition, percutaneous drainage in combination with placement of an indwelling catheter is indicated, and only if several attempts at ultrasound-guided drainage fail, surgical resection of the inflamed lactiferous ducts (preferably performed after the acute episode is over). It is noted, however, that even the excision of the affected ducts does not necessarily prevent recurrence. Nonpuerperal breast abscesses have a higher rate of recurrence compared to puerperal breast abscesses. There is a high statistical correlation of nonpuerperal breast abscess with diabetes mellitus (DM). On this basis, it has recently been suggested that diabetes screening should be performed on patients with such abscess. Although there are a number of recommendations regarding the treatment of breast abscesses, a 2015 review found insufficient evidence of whether needle aspiration is comparable to incision and drainage, or whether antibiotics should generally be given to women undergoing incision and drainage.

Mastitis

Breast cancer

Amurca

Breast engorgement

Pyometra

Hidradenoma

Trichodiscoma

Hydrocolpos

00

A one gram ampoule of<unk> <unk> is frequently used following major trauma.<unk> is used to prevent and treat blood loss in a variety of situations, such as dental procedures, heavy menstrual bleeding, and surgeries with high risk of blood loss. Trauma<unk> has been found to decrease the risk of death in people who have significant bleeding due to trauma. Its main benefit is if<unk> ken within the first three hours. It has been shown to reduce death due to any cause and death due to bleeding. Further studies are assessing the effect of<unk> in isolated brain injury. Given within three hours of a head injury it also decreases the risk of death. Menstrual bleeding<unk> is sometimes used to treat heavy menstrual bleeding. When<unk> ken by mouth it both safely and effectively treats regularly occurring heavy menstrual bleeding and improves quality of life. Another study demonstrated that the dose does not need to be adjusted in females who are between ages 12 and 16. Childbirth<unk> is sometimes used (often in conjunction with oxytocin) to reduce bleeding after childbirth. Death due to postpartum bleeding was reduced in women receiving<unk> . Surgery *<unk> is sometimes used in orthopedic surgery to reduce blood loss, to the extent of reducing or altogether abolishing the need for perioperative blood transfusion. It is of proven value in clearing the field of surgery and reducing blood loss when given before or after surgery. Drain and number of transfusions are reduced. * In surgical corrections of craniosynostosis in children it reduces the need for blood transfusions. * In spinal surgery (e.g., scoliosis), correction with posterior spinal fusion using instrumentation, to prevent excessive blood loss. * In cardiac surgery, both with and without cardiopulmonary bypass (e.g., coronary artery bypass surgery), it is used to prevent excessive blood loss. Dentistry In the United States,<unk> is FDA approved for short-term use in people with severe bleeding disorders who are about to have dental surgery.<unk> is used for a short period of time before and after the surgery to prevent major blood loss and decrease the need for blood transfusions.<unk> is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time; e.g., from acquired or inherited disorders. Hematology There is not enough evidence to support the routine use of<unk> to prevent bleeding in people with blood cancers. However, there are several trials that are currently assessing this use of<unk> . For people with inherited bleeding disorders (e.g. von Willebrand's disease),<unk> is often given. It has also been recommended for people with acquired bleeding disorders (e.g., directly acting oral anticoagulants (DOACs)) to treat serious bleeding. Nosebleeds The use of<unk> , applied directly to the area that is bleeding or<unk> ken by mouth, appears useful to treat nose bleeding compared to packing the nose with cotton pledgets alone. It decreases the risk of rebleeding within 10 days. Other uses * Tentative evidence supports the use of<unk> in hemoptysis. * In hereditary angioedema * In hereditary hemorrhagic telangiectasia -<unk> has been shown to reduce frequency of epistaxis in patients suffering severe and frequent nosebleed episodes from hereditary hemorrhagic telangiectasia. * In melasma -<unk> is sometimes used in skin whitening as a topical agent, injected into a lesion, or<unk> ken by mouth, both alone and as an adjunct to laser therapy; as of 2017 its safety seemed reasonable but its efficacy for this purpose was uncertain because there had been no large scale randomized controlled studies nor long term follow-up studies. * In hyphema -<unk> has been shown to be effective in reducing risk of secondary hemorrhage outcomes in people with traumatic hyphema. Experimental uses<unk> might alleviate neuroinflammation in some experimental settings.<unk> can be used in case of postpartum hemorrhage; it can decrease the risk of death due to bleeding by one third according to the WHO.

Tranexamic acid

Platelet-rich plasma

Flufenamic acid

Heparin

Hirudin

Palladin

Celadrin

Tinzaparin sodium

00

Mechanism of action<unk> inhibits the sodium-potassium ATPase in heart muscle cells, resulting in increased force of contractions (positive inotropic), reduced speed of electric conduction (negative dromotropic), increased excitability (positive bathmotropic), and reduced frequency of heartbeat (negative chronotropic). Pharmacokinetics The drug is almost completely absorbed from the gut. When in the bloodstream, 90 to 97% are bound to plasma proteins.<unk> undergoes enterohepatic circulation. It is metabolized in part by CYP3A4; metabolites include<unk> enin, digoxin (>2%), and conjugate esters. In healthy people, 60% are eliminated via the kidneys and 40% via the faeces. In people with impaired kidney function, elimination via the faeces is increased. The biological half-life is 7 to 8 days except when kidney and liver functions are impaired, in which case it is usually longer.

Digitoxin

Digoxin

Amiodarone

Carvedilol

Metoprolol

Sotalol

Colestilan

Bisoprolol

00

1842 Versailles—Bellevue line disaster. News about events like this one contributed to<unk> anxiety The<unk> is anxiety and fear associated with<unk> , railways, and railway travel.

Fear of trains

Fear of flying

Fear of needles

Fear of falling

Fear of Falling

Sense of impending doom

Automatism

Listener fatigue

00

The<unk> is used for congenital heart disease with a single effective ventricle and an interrupted inferior vena cava (IVC). It was first performed in 1978 and reported in 1984. __TOC__

Kawashima procedure

Yasui procedure

Krukenberg procedure

Broström procedure

Mumford procedure

Hughes procedure

Sugiura procedure

Mustard procedure

00

The initial diagnosis of<unk> porphyria is confirmed by urinalysis, including the common method, the Watson-Schwartz test. Elevated urine porphobilinogen confirms diagnosis of<unk> , hereditary coproporphyria (HCP), or variegate porphyria (VP). A positive test should be indicated with an increase of five times normal, not just a slight increase which can occur with dehydration. To distinguish between<unk> from HCP and VP, fecal porphyrin levels are normal in<unk> but elevated in HCP and VP. Rapid, accurate diagnosis is important. Delays in diagnosis may result in permanent neurological damage or death.

Acute intermittent porphyria

Hepatic porphyria

Variegate porphyria

Erythropoietic porphyria

Hepatoerythropoietic porphyria

Woodhouse–Sakati syndrome

Diarrhetic shellfish poisoning

Porphyria

00

<unk> is an infection<unk> that can be caused by various species of Candida yeast. Unlike Candida infections of the mouth and throat (oral<unk> or vagina (Candidal vulvovaginitis),<unk> is a serious, progressive, and potentially fatal infection that can affect the blood (fungemia), heart, brain, eyes, bones, and other parts of the body.

Invasive candidiasis

Otomycosis

Byssinosis

Shiitake mushroom dermatitis

Protothecosis

Phycomycosis

Onychomycosis

Dermatomycosis

00

<unk> in an infant without<unk> <unk> supplementation with elevated prothrombin time (PT) that is corrected by<unk> <unk> administration is typically sufficient to make the diagnosis. Confirmation, or investigation of minor<unk> , can be performed by testing proteins produced in the absence of<unk> <unk> , the most established assay being for PIVKA-II.

Vitamin K deficiency bleeding

Contaminated haemophilia blood products

Venom-induced consumption coagulopathy

Cold autoimmune hemolytic anemia

Quebec platelet disorder

Acquired haemophilia

Postcoital bleeding

Thrombophilia

00

When a mosquito carrying<unk> virus bites a person, the virus enters the skin together with the mosquito's saliva. It binds to and enters white blood cells, and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing several signaling proteins, such as cytokines and interferons, which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to capillary permeability. As a result, less blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone marrow due to infection of the stromal cells leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of<unk> . Viral replication Once inside the skin,<unk> virus binds to Langerhans cells (a population of dendritic cells in the skin that identifies pathogens). The virus enters the cells through binding between viral proteins and membrane proteins on the Langerhans cell, specifically, the C-type lectins called DC-SIGN, mannose receptor and CLEC5A. DC-SIGN, a non-specific receptor for foreign material on dendritic cells, seems to be the main point of entry. The dendritic cell moves to the nearest lymph node. Meanwhile, the virus genome is translated in membrane-bound vesicles on the cell's endoplasmic reticulum, where the cell's protein synthesis apparatus produces new viral proteins that replicate the viral RNA and begin to form viral particles. Immature virus particles are transported to the Golgi apparatus, the part of the cell where some of the proteins receive necessary sugar chains (glycoproteins). The now mature new viruses are released by exocytosis. They are then able to enter other white blood cells, such as monocytes and macrophages. The initial reaction of infected cells is to produce interferon, a cytokine that raises many defenses against viral infection through the innate immune system by augmenting the production of a large group of proteins mediated by the JAK-STAT pathway. Some serotypes of the<unk> virus appear to have mechanisms to slow down this process. Interferon also activates the adaptive immune system, which leads to the generation of antibodies against the virus as well as T cells that directly attack any cell infected with the virus. Various antibodies are generated; some bind closely to the viral proteins and target them for phagocytosis (ingestion by specialized cells and destruction), but some bind the virus less well and appear instead to deliver the virus into a part of the phagocytes where it is not destroyed but can replicate further. Severe disease In antibody-dependent enhancement (ADE), antibodies bind to both viral particles and Fc gamma receptors expressed on immune cells, increasing the likelihood that the viruses will infect those cells. It is not entirely clear why secondary infection with a different strain of<unk> virus places people at risk of<unk> hemorrhagic fever and<unk> shock syndrome. The most widely accepted hypothesis is that of antibody-dependent enhancement (ADE). The exact mechanism behind ADE is unclear. It may be caused by poor binding of non-neutralizing antibodies and delivery into the wrong compartment of white blood cells that have ingested the virus for destruction. There is a suspicion that ADE is not the only mechanism underlying severe<unk> -related complications, and various lines of research have implied a role for T cells and soluble factors such as cytokines and the complement system. Severe disease is marked by the problems of capillary permeability (an allowance of fluid and protein normally contained within the blood to pass) and disordered blood clotting. These changes appear associated with a disordered state of the endothelial glycocalyx, which acts as a molecular filter of blood components. Leaky capillaries (and the critical phase) are thought to be caused by an immune system response. Other processes of interest include infected cells that become necrotic—which affect both coagulation and fibrinolysis (the opposing systems of blood clotting and clot degradation)—and low platelets in the blood, also a factor in normal clotting.

Dengue fever

Leptospirosis

Chikungunya

Malaria

Blackwater fever

Yellow fever

Ross River fever

Viral hepatitis

00

The<unk> of medicine<unk> s, or<unk> i, ) was an ancient school of medicine in ancient Greece and Rome. They were founded in Rome by Athenaeus of Cilicia, in the 1st century AD. The Roman era was a time when the Methodic school had enjoyed its greatest reputation, from which the<unk> differed principally in that, instead of the mixture of primitive atoms, they adopted an active principle of immaterial nature, pneuma, or spirit. This principle was the cause of health and disease. It is from Galen that we learn the doctrines of the founder of the<unk> .

Pneumatic school

Foundation school

Eclectic school

Psychical school

Empiric school

Methodic school

Child life specialist

Speech–language pathology

00

Recurrence is common: 40% of patients with XP had recurrence after primary surgical excision, 60% after secondary excision, and 80% when all four eyelids were involved. A possible cause might be insufficiently deep excisions.

Xanthelasma

Onychophosis

Melasma

Hypertrichosis cubiti

Woolly hair nevus

Koilonychia

Onychogryphosis

Halo nevus

00

According to both the American Association on Intellectual and Developmental Disabilities(Intellectual Disability: Definition, Classification, and Systems of Supports (11th Edition) and the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), three criteria must be met for a diagnosis of intellectual disability: significant limitation in general mental abilities (intellectual functioning), significant limitations in one or more areas of adaptive behavior across multiple environments (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and evidence that the limitations became apparent in childhood or adolescence. In general, people with intellectual disabilities have an IQ below 70, but clinical discretion may be necessary for individuals who have a somewhat higher IQ but severe impairment in adaptive functioning. It is formally diagnosed by an assessment of IQ and adaptive behavior. A third condition requiring onset during the developmental period is used to distinguish intellectual disability from other conditions, such as traumatic brain injuries and dementias (including Alzheimer's disease). Intelligence quotient The first English-language IQ test, the Stanford–Binet Intelligence Scales, was adapted from a test battery designed for school placement by Alfred Binet in France. Lewis Terman adapted Binet's test and promoted it as a test measuring "general intelligence". Terman's test was the first widely used mental test to report scores in "intelligence quotient" form ("mental age" divided by chronological age, multiplied by 100). Current tests are scored in "deviation IQ" form, with a performance level by a test-taker two standard deviations below the median score for the test-takers age group defined as IQ 70. Until the most recent revision of diagnostic standards, an IQ of 70 or below was a primary factor for intellectual disability diagnosis, and IQ scores were used to categorize degrees of intellectual disability. Since the current diagnosis of intellectual disability is not based on IQ scores alone, but must also take into consideration a person's adaptive functioning, the diagnosis is not made rigidly. It encompasses intellectual scores, adaptive functioning scores from an adaptive behavior rating scale based on descriptions of known abilities provided by someone familiar with the person, and also the observations of the assessment examiner who is able to find out directly from the person what he or she can understand, communicate, and such like. IQ assessment must be based on a current test. This enables a diagnosis to avoid the pitfall of the Flynn effect, which is a consequence of changes in population IQ test performance changing IQ test norms over time. Distinction from other disabilities Clinically, intellectual disability is a subtype of cognitive deficit or disabilities affecting intellectual abilities, which is a broader concept and includes intellectual deficits that are too mild to properly qualify as intellectual disability, or too specific (as in specific learning disability), or acquired later in life through acquired brain injuries or neurodegenerative diseases like dementia. Cognitive deficits may appear at any age. Developmental disability is any disability that is due to problems with growth and development. This term encompasses many congenital medical conditions that have no mental or intellectual components, although it, too, is sometimes used as a euphemism for intellectual disability. Limitations in more than one area Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age). To assess adaptive behavior, professionals compare the functional abilities of a child to those of other children of similar age. To measure adaptive behavior, professionals use structured interviews, with which they systematically elicit information about persons' functioning in the community from people who know them well. There are many adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior requires clinical judgment as well. Certain skills are important to adaptive behavior, such as: * Daily living skills, such as getting dressed, using the bathroom, and feeding oneself * Communication skills, such as understanding what is said and being able to answer * Social skills with peers, family members, spouses, adults, and others Other specific skills can be critical to an individual's inclusion in the community and to develop appropriate social behaviors, as for example being aware of the different social expectations linked to the principal lifespan stages (i.e., childhood, adulthood, old age). The results of a Swiss study suggest that the performance of adults with ID in recognizing different lifespan stages is related to specific cognitive abilities and to the type of material used to test this performance.

complications of Myotonic dystrophy

symptom of Myotonic dystrophy

complications of Lesch–Nyhan syndrome

symptom of Tay–Sachs disease

medical cause of Parkinsonism

symptom of Buschke–Ollendorff syndrome

symptom of Lesch–Nyhan syndrome

symptom of Duchenne muscular dystrophy

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<unk> becomes important clinically when it loses stiffness, becomes too stiff or has decreased shearing ability. When inflammatory<unk> tis or trauma causes<unk> ibrosis and adhesions,<unk> l tissue<unk> ails to differentiate the adjacent structures effectively. This can happen after surgery where the<unk> has been incised and healing includes a scar that traverses the surrounding structures. Anatomical compartments A<unk> l compartment is a section within the body that contains muscles and nerves and is surrounded by<unk> . In the human body, the limbs can each be divided into two segments – the upper limb can be divided into the arm and the<unk> orearm and the sectional compartments of both of these – the<unk> l compartments of the arm and the<unk> l compartments of the<unk> orearm contain an anterior and a posterior compartment. Likewise, the lower limbs can be divided into two segments – the leg and the thigh and these contain the<unk> l compartments of the leg and the<unk> l compartments of the thigh. A<unk> tomy may be used to relieve compartment syndrome as a result of high pressure within a<unk> l compartment.

Fascia

Fasciculation

Dystrophy

Kindling

Pallesthesia

Contracture

Synesthesia

Spasticity

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Diagram of the hypothalamic–pituitary–thyroid axis. The hypothalamus secretes TRH (green), which stimulates the production of TSH (red) by the pituitary gland. This, in turn, stimulates the production of thyroxine by the thyroid (blue). Thyroxine levels decrease TRH and TSH production by a negative feedback process. Thyroid hormone is required for the normal functioning of numerous tissues in the body. In healthy individuals, the thyroid gland predominantly secretes thyroxine (T4), which is converted into triiodothyronine (T3) in other organs by the selenium-dependent enzyme iodothyronine deiodinase. Triiodothyronine binds to the thyroid hormone receptor in the nucleus of cells, where it stimulates the turning on of particular genes and the production of specific proteins. Additionally, the hormone binds to integrin αvβ3 on the cell membrane, thereby stimulating the sodium–hydrogen antiporter and processes such as formation of blood vessels and cell growth. In blood, almost all thyroid hormone (99.97%) are bound to plasma proteins such as thyroxine-binding globulin; only the free unbound thyroid hormone is biologically active. The thyroid gland is the only source of thyroid hormone in the body; the process requires iodine and the amino acid tyrosine. Iodine in the bloodstream is taken up by the gland and incorporated into thyroglobulin molecules. The process is controlled by the thyroid-stimulating hormone (TSH, thyrotropin), which is secreted by the pituitary. Not enough iodine, or not enough TSH, can result in decreased production of thyroid hormones. The hypothalamic–pituitary–thyroid axis plays a key role in maintaining thyroid hormone levels within normal limits. Production of TSH by the anterior pituitary gland is stimulated in turn by thyrotropin-releasing hormone (TRH), released from the hypothalamus. Production of TSH and TRH is decreased by thyroxine by a negative feedback process. Not enough TRH, which is uncommon, can lead to not enough TSH and thereby to not enough thyroid hormone production. Pregnancy leads to marked changes in thyroid hormone physiology. The gland is increased in size by 10%, thyroxine production is increased by 50%, and iodine requirements are increased. Many women have normal thyroid function but have immunological evidence of thyroid autoimmunity (as evidenced by autoantibodies) or are iodine deficient, and develop evidence of hypothyroidism before or after giving birth.

complications of Turner syndrome

complications of XYY syndrome

complications of Kallmann syndrome

complications of Klinefelter syndrome

onset of Kallmann syndrome

medical cause of Precocious puberty

medical cause of Hyperdontia

complications of Growth hormone deficiency

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<unk> is often considered a familial condition.<unk> has been identified on region 5.6 cM on chromosome 17q22. Mutations in the TBX4 (T-box protein 4) gene have been found to cause<unk> due to the essential role TBX4 plays in lower limb development since TBX4 is a transcription factor.

Ischiopatellar dysplasia

Canalicular adenoma

Genitopatellar syndrome

Choroid plexus papilloma

Craniopharyngioma

Choroidal fissure cyst

Nasolabial cyst

Choroid plexus cyst

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Determinants of mean arterial pressure Illustration depicting the effects of<unk> igh blood pressure In most people with established essential<unk> , increased resistance to blood flow (total peripheral resistance) accounts for the<unk> igh pressure while cardiac output remains normal. There is evidence that some younger people with prehypertension or 'borderline<unk> '<unk> ave<unk> igh cardiac output, an elevated<unk> eart rate and normal peripheral resistance, termed<unk> yperkinetic borderline<unk> . These individuals develop the typical features of established essential<unk> in later life as their cardiac output falls and peripheral resistance rises with age. Whether this pattern is typical of all people who ultimately develop<unk> is disputed. The increased peripheral resistance in established<unk> is mainly attributable to structural narrowing of small arteries and arterioles, although a reduction in the number or density of capillaries may also contribute. It is not clear whether or not vasoconstriction of arteriolar blood vessels plays a role in<unk> .<unk> is also associated with decreased peripheral venous compliance which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction. Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently increased in older people with<unk> . This can mean that systolic pressure is abnormally<unk> igh, but diastolic pressure may be normal or low, a condition termed isolated systolic<unk> . The<unk> igh pulse pressure in elderly people with<unk> or isolated systolic<unk> is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by<unk> igh blood pressure. Many mechanisms<unk> ave been proposed to account for the rise in peripheral resistance in<unk> . Most evidence implicates either disturbances in the kidneys' salt and water<unk> andling (particularly abnormalities in the intrarenal renin–angiotensin system) or abnormalities of the sympathetic nervous system. These mechanisms are not mutually exclusive and it is likely that both contribute to some extent in most cases of essential<unk> . It<unk> as also been suggested that endothelial dysfunction and vascular inflammation may also contribute to increased peripheral resistance and vascular damage in<unk> . Interleukin 17<unk> as garnered interest for its role in increasing the production of several other immune system chemical signals thought to be involved in<unk> such as tumor necrosis factor alpha, interleukin 1, interleukin 6, and interleukin 8. Excessive sodium or insufficient potassium in the diet leads to excessive intracellular sodium, which contracts vascular smooth muscle, restricting blood flow and so increases blood pressure.

Hypertension

Obesity

Prehypertension

Diabetes

Body mass index

Abdominal obesity

Smoking

Exercise

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Odontogenic<unk> Dental panoramic radiograph showing dentigerous<unk> associated with an impacted lower right wisdom tooth in the right mandible (arrowed, appears on the lower left of the image). Relative incidence of odontogenic<unk> . Odontogenic<unk> have histologic origins in the cells of the dental structures. Some are inflammatory while others are developmental. * Radicular<unk> is the most common (up to two thirds of all<unk> . This inflammatory<unk> originated from a reaction to dental pulp necrosis. * Dentigerous<unk> the second most prevalent<unk> is associated with the crown of non-erupted tooth. * Odontogenic keratocyst This lesion may be associated with the Nevoid basal cell carcinoma syndrome. * Buccal bifurcation<unk> which appears in the buccal bifurcation region of the mandibular first molars in the second half of the first decade of life. *Eruption<unk> a small<unk> in the gingiva as a tooth erupts, forming from the degenerating dental follicle *Primordial<unk> previous thought to be a unique entity. Most primordial<unk> have proven to be Keratocystic odontogenic tumors *Orthokeratinized odontogenic<unk> a variant of the Keratocystic odontogenic tumor *Gingival<unk> of the newborn; an inclusion<unk> from remnants of the dental lamina on a newborn gingiva *Gingival<unk> of the adult; a soft tissue variant of the lateral periodontal<unk> *Lateral periodontal<unk> a non-inflammatory<unk> (vs a radicular<unk> on the side of a tooth derived from remanents of the dental lamina *Calcifying odontogenic<unk> a rare lesion with<unk> c and neoplastic features and significant diversity in presentation, histology and prognosis *Glandular odontogenic<unk> <unk> with respiratory like epithelial lining and the potential for recurrence with characteristics similar to a central variant of low-grade mucoepidermoid carcinoma Developmental/ Non-odontogenic<unk> There are several development<unk> of the head and neck most of which form in the soft tissues rather than the bone. There are also several<unk> , previously thought to arise from epithelial remanents trapped in embryonic lines of fusion, most of which are now believed to be odontogenic in origin or have an unknown cause. Their names are included for the sake of completeness. Developmental<unk> *Nasopalatine duct<unk> the most common development jaw<unk> appears only in the mid-line of the maxilla. Developmental<unk> of the soft tissues around the jaws *Palatal<unk> of the newborn (Epstein's pearls) *Nasolabial<unk> (nasoalveolar<unk> *Epidermoid<unk> of the skin *Dermoid<unk> *Thyroglossal duct<unk> *Branchial cleft<unk> (Cervical lymphoepitelial<unk> *Oral lymphoepithelial<unk> Developmental<unk> of questionable cause *Globulomaxillary<unk> *Median palatal<unk> *Median mandibular<unk>

Cysts of the jaws

Osteomyelitis of the jaws

Omphalolith

Hemifacial hypertrophy

Black hairy tongue

Chattering teeth

Blue nails

Enamel hypoplasia

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Individuals with frostbite or potential frostbite should go to a protected environment and get warm fluids. If there is no risk of re-freezing, the extremity can be exposed and warmed in the groin or underarm of a companion. If the area is allowed to refreeze, there can be worse tissue damage. If the area cannot be reliably kept warm, the person should be brought to a medical facility without rewarming the area. Rubbing the affected area can also increase tissue damage. Aspirin and ibuprofen can be given in the field to prevent clotting and inflammation. Ibuprofen is often preferred to aspirin because aspirin may block a subset of prostaglandins that are important in injury repair. The first priority in people with frostbite should be to assess for hypothermia and other life-threatening complications of cold exposure. Before treating frostbite, the core temperature should be raised above 35 °C. Oral or intravenous (IV) fluids should be given. Other considerations for standard hospital management include: * wound care: blisters can be drained by needle aspiration, unless they are bloody (hemorrhagic). Aloe vera gel can be applied before breathable, protective dressings or bandages are put on. * antibiotics: if there is trauma, skin infection (cellulitis) or severe injury * tetanus toxoid: should be administered according to local guidelines. Uncomplicated frostbite wounds are not known to encourage tetanus. * pain control: NSAIDs or opioids are recommended during the painful rewarming process. Rewarming If the area is still partially or fully frozen, it should be rewarmed in the hospital with a warm bath with povidone iodine or chlorhexidine antiseptic. Active rewarming seeks to warm the injured tissue as quickly as possible without burning. The faster tissue is thawed, the less tissue damage occurs. According to Handford and colleagues, "The Wilderness Medical Society and State of Alaska Cold Injury Guidelines recommend a temperature of 37–39 °C, which decreases the pain experienced by the patient whilst only slightly slowing rewarming time." Warming takes 15 minutes to 1 hour. The faucet should be left running so the water can circulate. Rewarming can be very painful, so pain management is important. Medications People with potential for large amputations and who present within 24 hours of injury can be given TPA with heparin. These medications should be withheld if there are any contraindications. Bone scans or CT angiography can be done to assess damage. Blood vessel dilating medications such as iloprost may prevent blood vessel blockage. This treatment might be appropriate in grades 2–4 frostbite, when people get treatment within 48 hours. In addition to vasodilators, sympatholytic drugs can be used to counteract the detrimental peripheral vasoconstriction that occurs during frostbite. A systematic review and metaanalysis revealed that iloprost alone or iloprost plus recombinant tissue plasminogen activator (rtPA) may decrease amputation rate in<unk> of severe frostbite in comparison to buflomedil alone with no major adverse events reported from iloprost or iloprost plus rtPA in the included studies. Surgery Various types of surgery might be indicated in frostbite injury, depending on the type and extent of damage. Debridement or amputation of necrotic tissue is usually delayed unless there is gangrene or systemic infection (sepsis). This has led to the adage "Frozen in January, amputate in July". If symptoms of compartment syndrome develop, fasciotomy can be done to attempt to preserve blood flow.

medical cause of Disseminated intravascular coagulation

symptom of Thrombotic thrombocytopenic purpura

medical cause of Thrombotic thrombocytopenic purpura

symptom of Platelet storage pool deficiency

symptom of Disseminated intravascular coagulation

medical cause of Hemolytic anemia

medical cause of Protein S deficiency

symptom of Haemophilia

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A variety of over-the-counter and prescription anti-itch drugs are available. Some plant products have been found to be effective anti-pruritics, others not. Non-chemical remedies include cooling, warming, soft stimulation. Topical antipruritics in the form of creams and sprays are often available over-the-counter. Oral anti-itch drugs also exist and are usually prescription drugs. The active ingredients usually belong to the following classes: * Antihistamines, such as diphenhydramine (Benadryl) * Corticosteroids, such as hydrocortisone topical cream; see topical steroid * Counterirritants, such as mint oil, menthol, or camphor * Crotamiton (trade name Eurax) is an antipruritic agent available as a cream or lotion, often used to treat scabies. Its mechanism of action remains unknown. * Local anesthetics, such as benzocaine topical cream (Lanacane) Phototherapy is helpful for severe itching, especially if caused by kidney failure. The common type of light used is UVB. Sometimes scratching relieves isolated itches, hence the existence of devices such as the back scratcher. Often, however, scratching only offers temporary relief and can intensify itching, even causing further damage to the skin, dubbed the "itch-scratch cycle". The mainstay of therapy for dry skin is maintaining adequate skin moisture and topical emollients. No studies have been conducted to investigate the effectiveness of emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy on chronic itchiness of unknown origin. The effectiveness of therapeutic options for people who are terminally ill with malignant cancer is not known.

symptom of Vaginitis

symptom of Gonorrhea

symptom of Volvulus

symptom of Bacterial vaginosis

symptom of Vaginal yeast infection

symptom of Hemorrhoid

symptom of Gastrointestinal bleeding

symptom of Dysentery

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AC almost always affects the lower lip and only rarely the upper lip, probably because the lower lip is more exposed to the sun. In the unusual cases reported where it affects the upper lip, this may be due to upper lip prominence. The commissures (corners of the mouth) are not usually involved. Affected individuals may experience symptoms such as a dry sensation and cracking of the lips. It is usually painless and persistent. The appearance is variable. White lesions indicate hyperkeratosis. Red, erosive or ulcerative lesions indicate atrophy, loss of epithelium and inflammation. Early, acute lesions may be erythematous (red) and edematous (swollen). With months and years of sun exposure, the lesion becomes chronic and may be grey-white in color and appear dry, scaly and wrinkled. There is thickening whitish discoloration of the lip at the border of the lip and skin. There is also a loss of the usually sharp border between the red of the lip and the normal skin, known as the vermillion border. The lip may become scaly and indurated as AC progresses. When palpated, the lip may have a texture similar to rubbing the gloved finger along sandpaper. AC may occur with skin lesions of<unk> keratosis or skin cancer elsewhere, particularly on the head and neck since these are the most sun exposed areas. Rarely it may represent a genetic susceptibility to light damage (e.g. xeroderma pigmentosum or<unk> prurigo).

Actinic cheilitis

Angular cheilitis

Linitis plastica

Tinea capitis

Dermatochalasis

Tinea imbricata

Ankyloblepharon

Capillaritis

00

<unk> (INN), known as<unk> in the United States and Japan, is a medication used to treat a type of movement disorder due to antipsychotics known as dystonia and parkinsonism. It is not useful for tardive dyskinesia. It is taken by mouth or by injection into a vein or muscle. Benefits are seen within two hours and last for up to ten hours. Common side effects include dry mouth, blurry vision, nausea, and constipation. Serious side effect may include urinary retention, hallucinations, hyperthermia, and poor coordination. It is unclear if use during pregnancy or breastfeeding is safe.<unk> is an anticholinergic which works by blocking the activity of the muscarinic acetylcholine receptor.<unk> was approved for medical use in the United States in 1954. It is available as a generic medication. In 2017, it was the 226th most commonly prescribed medication in the United States, with more than two million prescriptions. It is sold under the brand name Cogentin among others.

Benzatropine

Octatropine methylbromide

Atropine

Tripelennamine

Droperidol

Desomorphine

Apomorphine

Tianeptine

00

No curative treatment is available for<unk> at this time, although palliative treatment is possible to some extent. The latter mainly focuses on treating the skin lesions through standard methods and stalling collagen degradation (or boosting<unk> performance, where possible), so as to keep the intracellular dipeptide levels low and give the cells time to resynthesise or absorb what proline they cannot recycle so as to be able to rebuild what collagen does degrade. Patients can be treated orally with ascorbate (a.k.a. vitamin C, a cofactor of prolyl hydroxylase, an enzyme that hydroxylates proline, increasing collagen stability), manganese (a cofactor of<unk> , suppression of collagenase (a collagen degrading enzyme), and local applications of ointments that contain L-glycine and L-proline. The response to the treatment is inconsistent between affected individuals. A therapeutic approach based on enzyme replacement (administering functional<unk> is under consideration. Due to the weakened immune response in<unk> cases, it is also of paramount importance to keep any infections under control, often with heavy antibiotics.

Prolidase deficiency

Dopamine transporter deficiency syndrome

Beta-ketothiolase deficiency

Dopamine beta hydroxylase deficiency

Gerstmann syndrome

Aromatic L-amino acid decarboxylase deficiency

Contiguous gene syndrome

Eruptive hypomelanosis

00

The<unk> is a soft, flexible<unk> (or curette) popularized by Harvey<unk> in the early 1970s. The flexibility of the<unk> was claimed to reduce the risk of perforating the uterus during vacuum aspiration. Both<unk> 's procedure, menstrual extraction, and his<unk> were embraced by activists Carol Downer and Lorraine Rothman, who modified the technique in 1971 and promoted it. The "self-help" abortion movement envisioned by Downer and Rothman never entered the mainstream in the U.S. before or after Roe v. Wade. Physicians sometimes use a<unk> in early induced surgical abortion, in treatment of incomplete abortion, and in endometrial biopsy. In 2010, a Sri Lankan physician named Geeth Silva was the first physician to use the<unk> in the removal of impacted faeces from a patient; this was done in Columbo at the Sri Jayawardenepura General Hospital. Physicians and other health care providers sometimes use a<unk> in "menstrual regulation" vacuum aspiration procedures in developing countries where abortion is illegal (e.g. Bangladesh).

Karman cannula

Surgical mask

Bonanno catheter

Word catheter

Blood lancet

Bloxsom air lock

Laryngeal mask airway

Dental dam

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There is debate as to the benefits of screening. As of 2017, the United States Preventive Services Task Force found insufficient evidence to make a recommendation among those without symptoms. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommend testing for coeliac disease in first-degree relatives of those with the disease already confirmed, in people with persistent fatigue, abdominal or gastrointestinal symptoms, faltering growth, unexplained weight loss or iron, vitamin B12 or folate deficiency, severe mouth ulcers, and with diagnoses of type 1 diabetes, autoimmune thyroid disease, and with newly diagnosed chronic fatigue syndrome and irritable bowel syndrome. Dermatitis herpetiformis is included in other recommendations. The NICE also recommend offering serological testing for coeliac disease in people with metabolic bone disease (reduced bone mineral density or osteomalacia), unexplained neurological disorders (such as peripheral neuropathy and ataxia), fertility problems or recurrent miscarriage, persistently raised liver enzymes with unknown cause, dental enamel defects and with diagnose of Down syndrome or Turner syndrome. Some evidence has found that early detection may decrease the risk of developing health complications, such as osteoporosis, anaemia, and certain types of cancer, neurological disorders, cardiovascular diseases, and reproductive problems. They thus recommend screening in people with certain health problems. Serology has been proposed as a screening measure, because the presence of antibodies would detect some previously undiagnosed cases of coeliac disease and prevent its complications in those people. However, serologic tests have high sensitivity only in people with total villous atrophy and have a very low ability to detect cases with partial villous atrophy or minor intestinal lesions. Testing for coeliac disease may be offered to those with commonly associated conditions.

medical cause of Malabsorption

medical cause of Protein losing enteropathy

medical cause of Bowel obstruction

complications of Malabsorption

medical cause of Malnutrition

medical cause of Abdominal pain

medical cause of Intestinal pseudo-obstruction

medical cause of Constipation

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<unk> (INN) or amdinocillin (USAN) is an extended-spectrum penicillin antibiotic of the amidinopenicillin class that binds specifically to penicillin binding protein 2 (PBP2), and is only considered to be active against Gram-negative bacteria. It is used primarily in the treatment of urinary tract infections, and has also been used to treat typhoid and paratyphoid fever. Because<unk> has very low oral bioavailability, an orally active prodrug was developed: pivmecillinam.

Mecillinam

Cethromycin

Piperacillin

Ampicillin

Methicillin

Carbenicillin

Erythromycin

Bacampicillin

00

<unk> , termed DAPs for short, are a class of disorders characterized by a novel alteration in base unit proteins that results in a structure with pathogenic potential. This functional alteration in a protein in relation to its thermodynamic and kinetic properties enacts an extended chain response among neighboring proteins until an extensive and potentially harmful polymerized structure is formed. Due to this endogenous foreign formation, these diseases are often untreatable and very severe in clinical manifestation. Although DAPs are rare infections, the poor outcome in patients and the need for further understanding makes this class of diseases a pillar for future research.

Diseases of abnormal polymerization

Immune-mediated inflammatory diseases

Chromosome instability

Causes of cancer

Human genetic enhancement

Miscarriage risks

Articular cartilage repair

Viral pathogenesis

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Symptoms of<unk> may include: * Dyspepsia, nausea and vomiting. * Flatulence, bloating and diarrhea. * Persistent pain in the upper right abdomen.

Postcholecystectomy syndrome

Gallstone ileus

Abdominal compartment syndrome

Abdominal aortic aneurysm

Superior mesenteric artery syndrome

Pellegrini–Stieda syndrome

Spontaneous bacterial peritonitis

Nutcracker syndrome

00

Truvada and Descovy are contraindicated for use as<unk> (PrEP) in individuals who have an unknown or positive HIV status. HIV positive or negative status must be determined before someone begins the use of either of these medications as PrEP. Additionally, any hypersensitivity or severe allergy to any ingredient, emtricitabine, tenofovir disoproxil, or tenofovir alafenamide is a contraindication for continued use of these medications.

Pre-exposure prophylaxis

Post-exposure prophylaxis

Transmission-based precautions

Protective isolation

Vaccine storage

Vaccine therapy

Pulse vaccination strategy

Vaccine bundling

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A schematic drawing of a bulla and a bleb, two lung abnormalities that may rupture and lead to<unk> Primary spontaneous Spontaneous<unk> es are divided into two types: primary, which occurs in the absence of known lung disease, and secondary, which occurs in someone with underlying lung disease. The cause of primary spontaneous<unk> is unknown, but established risk factors include being of the male sex, smoking, and a family history of<unk> . Smoking either cannabis or tobacco increases the risk. The various suspected underlying mechanisms are discussed below. Secondary spontaneous Secondary spontaneous<unk> occurs in the setting of a variety of lung diseases. The most common is chronic obstructive pulmonary disease (COPD), which accounts for approximately 70% of cases. Known lung diseases that may significantly increase the risk for<unk> are Type Causes Diseases of the airways COPD (especially when bullous emphysema is present), acute severe asthma, cystic fibrosis Infections of the lung<unk> cystis<unk> nia (PCP), tuberculosis, necrotizing<unk> nia Interstitial lung disease Sarcoidosis, idiopathic pulmonary fibrosis, histiocytosis X, lymphangioleiomyomatosis (LAM) Connective tissue diseases Rheumatoid arthritis, ankylosing spondylitis, polymyositis and dermatomyositis, systemic sclerosis, Marfan's syndrome and Ehlers–Danlos syndrome Cancer Lung cancer, sarcomas involving the lung Miscellaneous Catamenial<unk> (associated with the menstrual cycle and related to endometriosis in the chest) In children, additional causes include measles, echinococcosis, inhalation of a foreign body, and certain congenital malformations (congenital pulmonary airway malformation and congenital lobar emphysema). 11.5% of people with a spontaneous<unk> have a family member who has previously experienced a<unk> . The hereditary conditions – Marfan syndrome, homocystinuria, Ehlers–Danlos syndromes, alpha 1-antitrypsin deficiency (which leads to emphysema), and Birt–Hogg–Dubé syndrome – have all been linked to familial<unk> . Generally, these conditions cause other signs and symptoms as well, and<unk> is not usually the primary finding. Birt–Hogg–Dubé syndrome is caused by mutations in the FLCN gene (located at chromosome 17p11.2), which encodes a protein named folliculin. FLCN mutations and lung lesions have also been identified in familial cases of<unk> where other features of Birt–Hogg–Dubé syndrome are absent. In addition to the genetic associations, the HLA haplotype A2B40 is also a genetic predisposition to PSP. Traumatic A traumatic<unk> may result from either blunt trauma or penetrating injury to the chest wall. The most common mechanism is due to the penetration of sharp bony points at a new rib fracture, which damages lung tissue. Traumatic<unk> may also be observed in those exposed to blasts, even though there is no apparent injury to the chest. They may be classified as "open" or "closed". In an open<unk> , there is a passage from the external environment into the pleural space through the chest wall. When air is drawn into the pleural space through this passageway, it is known as a "sucking chest wound". A closed<unk> is when the chest wall remains intact. Medical procedures, such as the insertion of a central venous catheter into one of the chest veins or the taking of biopsy samples from lung tissue, may lead to<unk> . The administration of positive pressure ventilation, either mechanical ventilation or non-invasive ventilation, can result in barotrauma (pressure-related injury) leading to a<unk> . Divers who breathe from an underwater apparatus are supplied with breathing gas at ambient pressure, which results in their lungs containing gas at higher than atmospheric pressure. Divers breathing compressed air (such as when scuba diving) may suffer a<unk> as a result of barotrauma from ascending just while breath-holding with their lungs fully inflated. An additional problem in these cases is that those with other features of decompression sickness are typically treated in a diving chamber with hyperbaric therapy; this can lead to a small<unk> rapidly enlarging and causing features of tension. Newborn infants Newborn babies between 3–9 days of birth with low birth weight have a higher risk of<unk> .

Pneumothorax

Hemothorax

Pneumatosis

Chylothorax

Costochondritis

Urinothorax

Traumatic cardiac arrest

Hydropneumothorax

00

<unk> <unk> is an eye condition which occurs in association with a squint, typically infantile esotropia. The exact cause is unknown, although it is logical to assume it is from faulty innervation of eye muscles.

Dissociated vertical deviation

Infantile esotropia

Lipoatrophia semicircularis

Cyclotropia

Ecotropism

Ectopia cordis

Exotropia

Pseudostrabismus

00

<unk> (INN, USAN, BAN) (brand names Brantur, Cantor) is a monoamine oxidase inhibitor antidepressant drug that was used in France for the treatment of depression until it was withdrawn from the market in 1996 because it caused convulsions. A study found that it acts as a reversible inhibitor of MAO-A (RIMA) in rats. In a study it has also been found to weakly inhibit acetylcholinesterase in rat brain (striatum) homogenates.

Minaprine

Midodrine

Ritodrine

Erythrocrine

Amixetrine

Methylergometrine

Ergometrine

Drostanolone propionate

00

Using a tailored multi-faceted approach as outlined above can decrease rates of<unk> by 27% among the elderly. At least 30–40% of all cases of<unk> could be prevented, and high rates of<unk> reflect negatively on the quality of care. Episodes of<unk> can be prevented by identifying hospitalized people at risk of the condition. This includes individuals over age 65, with a cognitive impairment, with hip fracture, or with severe illness. Close observation for the early signs is recommended in such populations.<unk> may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing or minimizing problematic medications. Ensuring a therapeutic environment (e.g. individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted sleep hygiene with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization) can also yield benefit toward preventing<unk> . Research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations. Melatonin and other pharmacological agents have been studied for prevention of postoperative<unk> , but evidence is not clear. Avoidance or cautious use of benzodiazepines has been recommended for reducing the risk of<unk> in critically ill individuals. It is unclear if the medication donepezil, a cholinesterase inhibitor, reduces<unk> following surgery. There is also no clear evidence to suggest that citicoline, methylprednisolone, or antipsychotic medications prevent<unk> . A review of intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery showed little or no difference in postoperative<unk> according to the type of anaesthetic maintenance agents in five studies (321 participants). The authors of this review were uncertain whether maintenance of anaesthesia with propofol-based total intravenous anaesthesia (TIVA) or with inhalational agents can affect the incidence rate of postoperative<unk> . Interventions for preventing<unk> in older people in institutional long-term care The current evidence suggests that software-based interventions to identify medications that could contribute to<unk> risk and recommend a pharmacist's medication review probably reduces incidence of<unk> in older adults in long-term care. The benefits of hydration reminders and education on risk factors and care homes' solutions for reducing<unk> is still uncertain.

Delirium

Dementia

Excited delirium

Status epilepticus

Ateliosis

Dancing mania

Oneiroid syndrome

Depression of Alzheimer disease

00

Surgery has been the most common form of treatment for both localized and diffuse<unk> . After surgery, patients may receive physical therapy in order to help rehabilitate affected joints. However, recurrence of<unk> after surgery is common, with a higher rate of recurrence for diffuse<unk> than for localized<unk> . In cases of recurrent or resistant disease, multiple surgeries, total joint arthroplasties, or amputation may be required. A multidisciplinary approach, supplementing surgery with radiotherapy or other treatments, can also improve outcomes in cases of recurrent<unk> . In the late 2010s, treatment with CSF1R inhibitors emerged as an option that may help improve functionality for patients with recurrent<unk> or<unk> that is not easily managed by surgery.

Tenosynovial giant cell tumor

Synovial osteochondromatosis

Synovial chondromatosis

Osteochondroma

Meniscal cyst

Synovial sarcoma

Myositis ossificans

Osteochondritis dissecans

00

<unk> has the following symptoms: * Bilateral shortening of the femur * Post-natal growth problems (deficiency) * Cataracts * Intellectual disability * Possible seizures * Possible infections of respiratory tract

Rhizomelic chondrodysplasia punctata

Chondrodysplasia punctata

X-linked recessive chondrodysplasia punctata

Dentinogenesis imperfecta

Tricho–rhino–phalangeal syndrome type 2

Greig cephalopolysyndactyly syndrome

Meromelia

Degos disease

00

The main adverse drug reaction associated with<unk> therapy is hypercalcemia – early symptoms include: nausea, vomiting, constipation, anorexia, apathy, headache, thirst, pruritus, sweating, and/or polyuria. Compared to other vitamin D compounds in clinical use (cholecalciferol, ergocalciferol),<unk> has a higher risk of inducing hypercalcemia. However, such episodes may be shorter and easier to treat due to its relatively short half-life. High<unk> levels may also be seen in human disease states in patients not on supplementation. In someone with hypercalcaemia and high<unk> levels, low intact parathyroid hormone levels are usually present. The major conditions with hypercalcaemia due to elevated<unk> levels are lymphoma, tuberculosis and sarcoidosis where excess production occurs due to ectopic 25(OH)D-1-hydroxylase (CYP27B1) expressed in macrophages. Other conditions producing similar findings including: * Fungal infections; Pneumocystis jiroveci, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, candidiasis * Other granulomatous conditions; PR3+ vasculitis, Crohn's disease, acute granulomatous pneumonia, talc granuloma, silicone-induced granuloma, BCG-associated, granulomatous hepatitis, paraffin-associated granuloma * Genetic conditions; Williams syndrome, pseudoxanthoma elasticum, CYP24A1 mutation (adult / infantile), SLC34A1 mutation * Miscellaneous; mycobacterium avium, leprosy, lipoid pneumonia, cat scratch fever, berylliosis Some plants contain glycosides of 1,25-dihydroxycholecalciferol. Consumption of these glycosides by grazing animals leads to vitamin D toxicity, resulting in calcinosis, the deposition of excessive calcium in soft tissues. Three rangeland plants, Cestrum diurnum, Solanum malacoxylon, and Trisetum flavescens are known to contain these glycosides. Of these, only Cestrum diurnum is found in the U.S., mainly in Florida.

Calcitriol

Parathyroid hormone

Estriol

Estriol

Parathyroid hormone-related protein

Cholecalciferol

Ergocalciferol

Calcipotriol

00

<unk> is a disorder that causes abnormal resonance in a human's voice due to increased airflow through the nose during<unk> . It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter. In normal<unk> , nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal<unk> is the opening and closing of a velopharyngeal passage way between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.

Hypernasal speech

Stilted speech

Compulsive hoarding

Alaryngeal speech

Speech delay

Nasal voice

Hoarse voice

Receptive aphasia

00

A physical examination of the hand may show discoloration (blanching, mottling, and/ or cyanosis; gangrene may be present in advanced cases), unusual tenderness/ a callous over the<unk> eminence, and fingertip ulcerations and splinter hemorrhages over ulnar digits; if an aneurysm is present, there may also be a pulsatile mass. Allen's test will be positive if an occlusion is present and negative if an aneurysm is present. An angiogram may show a "corkscrew" ulnar artery or an occlusion or aneurysm at the hook of the hamate.

Hypothenar hammer syndrome

Anterior interosseous syndrome

Femur fibula ulna syndrome

Carpal coalition

Dead arm syndrome

Adducted thumb syndrome

Sprengel's deformity

Multicentric carpotarsal osteolysis syndrome

00

The disorder's prevalence is estimated to be below 1 in 1,000,000.

XYYYY syndrome

XYYY syndrome

XYY syndrome

XXYY syndrome

Joubert syndrome

XX male syndrome

Klinefelter syndrome

Ring chromosome 20 syndrome

00

<unk> (also known as recurrent peritonitis) is the inflammation of the peritoneum which persists for 48 hours after a surgery that has been successfully carried out in adequate surgical conditions.<unk> is usually the most delayed and severe consequence of nosocomial intra-abdominal infection. Patients who acquire<unk> are usually admitted to ICU due to the critical, life-threatening nature of the condition which can lead to multi-organ failure despite treatment and has a high mortality rate of 60%. Signs and symptoms of<unk> include fever, hypotension and abdominal pain. Diagnosis of the condition is often difficult and treatment intervention should be as early as possible.

Tertiary peritonitis

Spontaneous bacterial peritonitis

Culture-bound syndrome

Abdominal compartment syndrome

Feline infectious peritonitis

Hemolytic–uremic syndrome

Proteus syndrome

Postcholecystectomy syndrome

00

The endometrium, the tissue that normally lines the female uterus, undergoes changes with each menstrual cycle. At the end of each cycle and after the lining has thickened in preparation for hosting a fertilised ovum, it sloughs off, detaches, and is expelled through the cervix and vagina in the process of menstruation. In<unk> , some endometrial-like tissue is found in other parts of the body; most often the pelvis and abdomen, the central nervous system, the nasal passages, skin and thorax. At these other 'ectopic' sites, endometrium tissue still responds to hormones with normal cyclical changes - bleeding roughly every 28 days. Theories explaining distant ectopic<unk> include: * Vasculogenesis: Up to 37% of the microvascular endothelium of ectopic endometrial tissue originates from endothelial progenitor cells, which result in de novo formation of microvessels by the process of vasculogenesis rather than the conventional process of angiogenesis. * Lymphatic spread: endometrial fragments travel through the<unk> duct and hilar lymph nodes, reaching the chest cavity and causing pulmonary or pleural<unk> . * Coelomic metaplasia theory: the pleura and peritoneum share the same embryological origin, both derived from mesothelium. A pathological stimulus could be responsible for inducing precursor cells (mesothelial stem cells) of the pleura or peritoneum in order to differentiate into endometrial cells. * Vascular embolisation: endometrial fragments are taken into the venous system, travel through the right side of the heart, and are deposited in the pulmonary circulation. The endometrial tissue settles in the lung parenchyma or pleura. A review of autopsy data showed that patients with<unk> have bilateral pulmonary lesions, which supports the vascular embolisation theory. The pleural and/or diaphragmatic lesions were always found on the left side, which supports the theory of coelomic metaplasia.

Thoracic endometriosis

Cervical thymic cyst

Inguinal lymphadenopathy

Cervical lymphadenopathy

Subphrenic abscess

Lung hernia

Paraproctitis

Diaphragmatic hernia

00

The<unk> is the increase in the probability of a person dying a relatively short time after their long-time spouse has died. The pattern indicates a sharp increase in risk of death for the widower, particularly but not exclusively, in the three months closest thereafter the death of the spouse. This process of losing a spouse and dying shortly after has also been called "dying of a broken heart". Becoming a widow is often a very detrimental and life changing time in a spouse's life, that forces them to go through changes that they may not have anticipated to make for a significant amount of time. Responses of grief and bereavement due to the loss of a spouse increases vulnerability to psychological and physical illnesses. Psychologically, losing a long-term spouse can cause symptoms such as depression, anxiety, and feelings of guilt. Physical illness may also occur as the body becomes more vulnerable to emotional and environmental stressors. There are many factors that may be affected when one becomes a widow. A widow tends to have a decline in health regulation. Higher prevalence in mortality rates are noted among bereaved spouses during the first six months of bereavement compared to the last six months of bereavement. In general, however, a study on a large population sample has suggested that the rates of death nearly double during the first three months after the loss of a spouse, and quickly taper thereafter. Grieving spouses are more vulnerable during these few months not only health wise but socially and physically. During this early period of bereavement spouses tend to have less interest in their health as well as physical appearance caring less about continuing with medications or adapting healthy behaviors. Consequently, they are likelier to practice risky behaviors and commit suicide. Women on the other hand, are more likely to look for social support such as friends, family, or support groups regarding the matter. This effect appears to be far more prevalent in older married couples than in younger married couples. Through the many studies that have been conducted over the years, it has been found that the<unk> affects the mortality rates of people with varying levels of severity depending on their genders and religions. It is far more frequent in more seasoned, long-term, elder couples than in recently married couples. One of the main reasons that this would seem to be true is that older married couples have spent the majority of their lives together, and they have spent time working together and growing together as a couple. In most cases, they raised children together and experienced many hardships together that brought them even closer. This would make the death of their spouse much harder. Since the topic has only been recently studied within this last decade, and due to the prevalence of older couples being affected, most widows in similar studies are typically over the age of 50. After analyzing the numerous studies that have been directed throughout the years, it has been found that the<unk> impact influences the death rates of individuals with changing levels of stringencies relying upon their sexual orientations and religions. While it is still unknown exactly what causes this phenomenon to occur, there are many theories that support this notion and its correlation to the<unk> .

Widowhood effect

Weekend effect

Ceiling effect

Outcomes paradox

Construct validity

Lombard effect

Whitten effect

Martha Mitchell effect

00

The adverse effects of<unk> administration are primarily those of the opioids as a class: nausea, vomiting, dizziness, diaphoresis, urinary retention, and constipation. Due to moderate stimulant effects mediated by dopamine and norepinephrine, sedation is less likely compared to other opioids. Unlike other opioids, it does not cause miosis because of its anticholinergic properties. Overdose can cause muscle flaccidity, respiratory depression, obtundation, psychosis, cold and clammy skin, hypotension, and coma. A narcotic antagonist such as naloxone is indicated to reverse respiratory depression and other effects of<unk> . Serotonin syndrome has occurred in patients receiving concurrent antidepressant therapy with selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors, or other medication types (see Interactions below). Convulsive seizures sometimes observed in patients receiving parenteral<unk> on a chronic basis have been attributed to accumulation in plasma of the metabolite norpethidine (normeperidine). Fatalities have occurred following either oral or intravenous<unk> overdose. Interactions<unk> has serious interactions that can be dangerous with monoamine oxidase inhibitors (e.g., furazolidone, isocarboxazid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine). Such patients may suffer agitation, delirium, headache, convulsions, and/or hyperthermia. Fatal interactions have been reported including the death of Libby Zion. Seizures may develop when tramadol is given intravenously following, or with,<unk> . It can interact as well with SSRIs and other antidepressants, antiparkinson agents, migraine therapy, stimulants and other agents causing serotonin syndrome. It is thought to be caused by an increase in cerebral serotonin concentrations. It is probable that<unk> can also interact with a number of other medications, including muscle relaxants, benzodiazepines, and ethanol.

Pethidine

Esketamine

Ketamine

Fentanyl

Aceclidine

Nalorphine

Remifentanil

Procaine

00

Model of a normal heart <unk> ; and a weakened heart, with over-stretched muscle and dilation of<unk> ventricle (right); both during diastole Heart failure is caused by any condition that reduces the efficiency of the heart muscle, through damage or overloading. Over time, these increases in workload, which are mediated by long-term activation of neurohormonal systems such as the renin–angiotensin system, lead to fibrosis, dilation, and structural changes in the shape of the<unk> ventricle from elliptical to spherical. The heart of a person with heart failure may have a reduced force of contraction due to overloading of the ventricle. In a normal heart, increased filling of the ventricle results in increased contraction force by the Frank–Starling law of the heart, and thus a rise in cardiac output. In heart failure, this mechanism fails, as the ventricle is loaded with blood to the point where heart muscle contraction becomes less efficient. This is due to reduced ability to cross-link actin and myosin filaments in over-stretched heart muscle.

complications of Left ventricular hypertrophy

complications of Atrial fibrillation

complications of Dilated cardiomyopathy

complications of Coronary thrombosis

complications of Angina

complications of Ventricular tachycardia

complications of Pericarditis

medical cause of Coronary artery disease

00

A study of the National<unk> Database in the United States assessed cases of primary<unk> from 2004 to 2013, finding that median survival was 49 months with 5- and 10-year survival rates estimated at 46% and 31% respectively. A study of the RARECARE project, aimed at investigating rare<unk> s in Europe, estimated a 5-year relative survival rate of 54% in patients with<unk> of the urethra.

Urethral cancer

Penile cancer

Bladder cancer

Urethral diverticulum

Acute prostatitis

Ureteral cancer

Urinary bladder disease

Hydrocele

00

An insulin pump used to deliver appropriate levels of insulin. Diabetics The prevention of hypoglycemia depends on the cause. In those with diabetes treated by insulin, glinides, or sulfonylurea, the prevention of hypoglycemia has a large focus on patient education and medication adjustments. The foundation of diabetes education is learning how to recognize the signs and symptoms of hypoglycemia, as well as learning how to act quickly to prevent worsening of an episode. Another cornerstone of prevention is strong self-monitoring of blood glucose, with consistnent and frequent measurements. Research has shown that patients with type 1 diabetes who use continuous glucose monitoring systems with insulin pumps significantly improve blood glucose control. Insulin pumps help to prevent high glucose spikes, and help prevent inappropriate insulin dosing. Continuous glucose monitors can sound alarms when blood glucose is too low or too high, especially helping those with nocturnal hypoglycemia or hypoglycemic unawareness. In terms of medication adjustments, medication doses and timing can be adjusted in order to prevent hypoglycemia, or a medication can be stopped altogether. Non-diabetics In those with hypoglycemia who do not have diabetes, there are a number of preventative measures dependent on the cause. Hypoglycemia caused by hormonal dysfunction like lack of cortisol in Addison's disease or lack of growth hormone in hypopituitarism can be prevented with appropriate hormone replacement. The hypoglycemic episodes associated with non-B cell tumors can be decreased following surgical removal of the tumor, as well as following radiotherapy or chemotherapy to reduce the size of the tumor. In some cases, those with non-B cell tumors may have hormone therapy with growth hormone, glucocorticoid, or octreotide to also lessen hypoglycemic episodes. Post-gastric bypass hypoglycemia can be prevented by eating smaller, more frequent meals, avoiding sugar-filled foods, as well as medical treatment with an alpha-glucosidase inhibitor, diazoxide, or octreotide. Some causes of hypoglycemia require treatment of the underlying cause to best prevent hypoglycemia. This is the case for insulinomas which often require surgical removal of the tumor in order for hypoglycemia to remit. In patients who cannot undergo surgery for removal of the insulinoma, diazoxide or octreotide may be used.

medical cause of Lightheadedness

medical cause of Panic attack

symptom of Subarachnoid hemorrhage

symptom of Intracerebral hemorrhage

medical cause of Stroke

symptom of Vertebral artery dissection

symptom of Posterior reversible encephalopathy syndrome

symptoms of Subarachnoid hemorrhage

00

In the European Union<unk> is indicated in adults for the treatment of advanced gastric cancer when given in combination with cisplatin.

Tegafur/gimeracil/oteracil

Trifluridine/tipiracil

Decitabine/cedazuridine

Bicyclomycin

Ethambutol/isoniazid/rifampicin

Trastuzumab/hyaluronidase

Pemetrexed

Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim

00

Clubfeet in the course of correction Treatment is usually with some combination of the Ponseti method and French method. The Ponseti method involves a combination of casting, Achilles tendon release, and bracing. It is widely used and highly effective under the age of two. The French method involves realignment, taping, and long-term home exercises and night splinting. It is also effective but outcomes vary and rely on heavy involvement of caregivers. Generally, the Ponseti method is preferred. Another technique, the Kite method, does not appear to be as effective. In about 20% of cases, additional surgery is required after initial treatment. Ponseti method A foot abduction brace type Denis Browne bar. Various types of foot-abduction braces are used to hold the child's feet in the desired position. The Ponseti method corrects<unk> over the course of several stages. * Serial casting: First, the foot is manually manipulated into an improved position and held in place with a long leg cast which extends from the toes up to the thigh. After a week this cast is removed, the foot is re-manipulated, and placed into a new cast. This process repeats and the foot is gradually reshaped over the course of 4-6 serial casts, although some feet may require additional casts. * The goal of the initial cast is to align the forefoot with the hindfoot. Ponseti describes the forefoot as pronated in relation to the hindfoot, so supinating the forefoot and elevating the first metatarsal improves this alignment. * Subsequent casts are applied after stretching the foot with a focus on abducting the forefoot with lateral pressure at the talus, to bring the navicular laterally and improve the alignment of the talonavicular joint. In contrast to the Kite method of casting, it is important to avoid constraining the calcanocuboid joint. With each additional cast, the abduction is increased and this moves the hindfoot from varus into valgus. It is important to leave the ankle in equinus until the forefoot and hindfoot are corrected. * The final stage of casting is to correct the equinus. After fully abducting the forefoot with spontaneous correction of the hindfoot, an attempt is made to bring the ankle up and into dorsiflexion. The foot must have the ability to dorsiflex to at least 10 degrees past 0 (neutral, or L position), although 15 degrees or more is better and preferred. If the foot can not dorsiflex enough, the brace will not work/be tolerated. If it is determined the foot can not dorsiflex at least 10 degrees, the Achilles Tenotomy surgical procedure is performed. * Achilles tendon release: At the end of the serial casting, most children have corrected cavus, adductus and varus deformities, but continue to have equinus deformity. To correct this, a procedure called an Achilles tendon release (commonly called Achilles tenotomy) is performed. Before the procedure, many centers place the child under sedation or monitored anesthesia care, although Ponseti recommended using local anesthetic alone. Next, the area around the heel is cleansed and numbed, and a small scalpel is used to cut the Achilles tendon. The incision is small so there is minimal bleeding and no need for stitches. The skin is covered with a small dressing, and the foot is placed into a final long leg cast in a fully corrected position. This cast is typically left in place for three weeks. During this time, the Achilles tendon will regrow in a lengthened position. * Bracing: After successful correction is achieved through serial casting and Achilles tenotomy, the foot must be kept in a brace to prevent it from returning to the deformed position over the first few years of a child's life. The brace is made up of two shoes or boots that are connected to each other by a bar that is bent under the shoes at 10-15 degrees, or curved to create 10-15 degrees dorsiflexion. This device is also called a foot abduction brace (FAB) or more generally boots and bar (BnB). At first, the brace is worn full-time (23 hours per day) on both feet, regardless of whether the<unk> affects one or two feet. After 3 months of 23/7 wear, the brace is worn less frequently by gradually reducing hours a couple at a time, every couple months so that hours are down to 12-14 per day at or around a year old. From this point on until at least 4–5 years, or even longer (6–9 years if needed), the brace is worn mostly while sleeping at night and during naps (12–14 hours per day). Bracing is essential in preventing recurrence of the deformity and is a major determinant of a child's long-term outcome. The Ponseti method is highly effective with short-term success rates of 90%. However, anywhere from 14% to 41% of children experience a recurrence of the deformity. The most common reason for this is inadequate adherence to bracing, such as not wearing the brace properly, not keeping it on for the recommended length of time, or not using it every day. Children who do not follow proper bracing protocol have up to seven times higher recurrence rates than those who follow bracing protocol, as the muscles around the foot can pull it back into the abnormal position. Recurrence is more common when there is poor compliance with the bracing, because the muscles around the foot can pull it back into the abnormal position. Low parental education level and failure to understand the importance of bracing is a major contributor to non-adherence. Relapses are managed by repeating the casting process. Relapsed feet may also require additional, more extensive surgeries and have a reduced chance of achieving subsequent correction. Another reason for recurrence is a congenital muscle imbalance between the muscles that invert the ankle (tibialis posterior and tibialis anterior muscles) and the muscles that evert the ankle (peroneal muscles). This imbalance is present in approximately 20% of infants successfully treated with the Ponseti casting method, and makes them more prone to recurrence. This relapse is usually treated with Ponseti casting and can be done multiple times before resorting to surgery. If after all non-surgical casting and bracing options have been exhausted, and when the child is over four years of age (many doctors prefer to wait until after seven years old), this can be addressed with a surgery to transfer the tibialis anterior tendon from its medial attachment (on the navicula) to a more lateral position (on the lateral cuneiform). The surgery requires general anesthesia and subsequent casting while the tendon heals, but it is a relatively minor surgery that re-balances the muscles of the foot without disturbing any joints. French method The French method is a conservative, non-operative method of<unk> treatment that involves daily physical therapy for the first two months followed by thrice-weekly physical therapy for the next four months and continued home exercises following the conclusion of formal physical therapy. During each physical therapy session the feet are manipulated, stretched, then taped to maintain any gains made to the feet's range of motion. Exercises may focus on strengthening the peroneal muscles, which is thought to contribute to long-term correction. After the two month mark, the frequency of physical therapy sessions can be weaned down to three times a week instead of daily, until the child reaches six months. After the conclusion of the physical therapy program, caregivers must continue performing exercises at home and splinting at night in order to maintain long-term correction. Compared to the Ponseti method which uses rigid casts and braces, the French method uses tape which allows for some motion in the feet. Despite its goal to avoid surgery, the success rate varies and surgery may still be necessary. The Ponseti method is generally preferred over the French method. Surgery If non-operative treatments are unsuccessful or achieve incomplete correction of the deformity, surgery is sometimes needed. Surgery was more common prior to the widespread acceptance of the Ponseti method. The extent of surgery depends on the severity of the deformity. Usually, surgery is done at 9 to 12 months of age and the goal is to correct all the components of the<unk> deformity at the time of surgery. For feet with the typical components of deformity (cavus, forefoot adductus, hindfoot varus, and ankle equinus), the typical procedure is a Posteromedial Release (PMR) surgery. This is done through an incision across the medial side of the foot and ankle, that extends posteriorly, and sometimes around to the lateral side of the foot. In this procedure, it is typically necessary to release (cut) or lengthen the plantar fascia, several tendons, and joint capsules/ligaments. Typically, the important structures are exposed and then sequentially released until the foot can be brought to an appropriate plantigrade position. Specifically, it is important to bring the ankle to neutral, the heel into neutral, the midfoot aligned with the hindfoot (navicula aligned with the talus, and the cuboid aligned with the calcaneus). Once these joints can be aligned, thin wires are usually placed across these

Clubfoot

Pigeon toe

Jaipur foot

Barefoot

Trench foot

Elm yellows

Jersey finger

Pegleg

00

A<unk> is a committed precursor of a hormone consisting of peptide hormones synthesized together that has a minimal hormonal effect by itself because of its expression-suppressing structure, often created by protein folding and binding additional peptide chains to certain ends, that makes hormone receptor binding sites located on its peptide hormone chain segments inaccessible.<unk> s can travel the blood stream as a hormone in an inactivated form, ready to be activated later in the cell by post-translational modification. The body naturally produces<unk> s as a way to regulate hormone expression, making them an optimal storage and transportation unit for inactive hormones. Once<unk> s are needed to be expressed,<unk> convertase, a protein, cleaves the<unk> s and separates them into one or more active hormones. Often in nature, this cleaving process happens immediately, and a<unk> is quickly converted to a set of one or more peptide hormones. Examples of natural, human<unk> s include proinsulin and pro-opiomelanocortin, but the most widespread<unk> s in use are synthetic and labeled as anabolic steroid precursors, used as ergogenic or anabolic agents for muscle growth. A commonly consumed example of said precursors are androstenedione and androstenediol, both of which are currently banned substances in the United States. However, several illegal steroids, such as 3β-hydroxy-5α-androst-1-en-17-one, are still being produced legally under different chemical names, and the majority have not undergone clinical studies.

Prohormone

Xenohormone

Neurohormone

Hormone

Local hormone

Gastrointestinal hormone

Sex hormone

Neuropeptide

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<unk> is psychological model which considers how<unk> theory pertains to people’s preferences and expectations for the proximity of others when faced with stress, threat, danger or pain. In 1982 the American Psychiatrist, Lawrence Kolb, noticed that patients with chronic pain displayed behaviours with their healthcare providers akin to what children might display with an<unk> figure, thus marking one of the first applications of<unk> theory to physical health. Development of adult<unk> theory and adult<unk> measures in the 1990s provided researchers with the means to apply<unk> theory to health in a more systematic way. Since that time it has been used to understand variation in stress response, health outcomes and health behaviour. Ultimately, the application of<unk> theory to health care may enable health care practitioners to provide more personalized medicine by creating a deeper understanding of patient distress and allowing clinicians to better meet their needs and expectations.

Attachment and health

Dance and health

Creativity and mental health

Outline of health

Homelessness and mental health

Memory and trauma

Sociology of health and illness

Social

00