text
stringlengths 3
11.6k
| option_0
stringlengths 2
124
| option_1
stringlengths 3
101
| option_2
stringlengths 3
124
| option_3
stringlengths 3
124
| option_4
stringlengths 3
87
| option_5
stringlengths 3
124
| option_6
stringlengths 3
124
| option_7
stringlengths 2
124
| label
class label 1
class | idx
int32 0
75.1k
|
|---|---|---|---|---|---|---|---|---|---|---|
In the United States,<unk> is indicated for the treatment of adults and children ages one year and older with x-linked hypophosphatemia (XLH), a rare, inherited form of rickets, and for the treatment of people age two and older with tumor-induced osteomalacia (TIO), a rare disease that is characterized by the development of tumors that cause weakened and softened bones. The tumors associated with TIO release a peptide hormone-like substance known as fibroblast growth factor 23 (FGF23) that lowers phosphate levels. In the European Union,<unk> is indicated for the treatment of X-linked hypophosphataemia with radiographic evidence of bone disease in children one year of age and older and adolescents with growing skeletons. XLH is genetic disorder affecting phosphate metabolism within the body, which results in hypophosphatemia. The disease is characterized by overproduction of the FGF23 hormone in bone cells. The FGF23 hormone is responsible for blocking phosphate re-absorption by the kidney and the suppression of the vitamin D dependent phosphate absorption by the intestine. Due to the excess activity of FGF23, phosphate levels in the blood are abnormally low, which affects the constitution of bone. Thus,<unk> is designed to bind to the FGF23 receptor and inhibit the excess activity of the FGF23 hormone within the body. While<unk> is effective for the treatment of X-linked hypophosphatemia, the National Institute for Health and Care Excellence in England and Wales initially raised concerns regarding the incremental cost-effectiveness of the new treatment but the drug is available through a simple discount scheme. | Burosumab | Olaratumab | Alirocumab | Emapalumab | Sarilumab | Evolocumab | Lanadelumab | Dupilumab | 00
| 69,102 |
Critical<unk><unk> is diagnosed by the presence of<unk> rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcPo2 ), or skin perfusion pressure (SPP). Other factors which may point to a diagnosis of critical<unk><unk> are a Buerger's angle of less than 20 degrees during Buerger's test, a capillary refill of more than 15 seconds or diminished or absent pulses. Critical<unk><unk> is different from acute<unk><unk> . Acute<unk><unk> is a sudden lack of blood flow to the<unk> , for example caused by an embolus whereas critical<unk><unk> is a late sign of a progressive chronic disease. | Chronic limb threatening ischemia | Arterial insufficiency ulcer | Diabetic foot ulcer | Acute limb ischaemia | Chronic venous insufficiency | Vein graft failure | Chronic wound | Diabetic foot | 00
| 66,729 |
The mechanism of<unk> indicates that platelets in affected individuals accumulate abnormally with thrombin, epinephrine, and adenosine diphosphate, furthermore platelets in these individuals have a lower amount of dense bodies | Hermansky–Pudlak syndrome | Keppen–Lubinsky syndrome | Sakati–Nyhan–Tisdale syndrome | Fox–Fordyce disease | Conradi–Hünermann syndrome | Kandinsky–Clérambault syndrome | Hallermann–Streiff syndrome | Shprintzen–Goldberg syndrome | 00
| 32,813 |
<unk> is inherited in an autosomal dominant fashion. The mutation responsible for the syndrome occurs in the KAT6B gene. This gene is located on the long arm of chromosome 10 (10q22.2). The KAT6B gene gene product is an enzyme called histone acetyltransferase which functions in regulating and making of histone which are proteins that attach to DNA and give the chromosomes their shape. The function of histone acetyltransferase produced from KAT6B is unknown but it is considered as a regulator of early development. There is little known about how the mutation in the KAT6B causes the syndrome but researchers suspects that the mutations occur near the end of the KAT6B gene and causes it to produce shortened acetyltransferase enzyme. The shortened enzyme alters the regulation of other genes. On the other hand, the mutation of KAT6B leading to the specific features of<unk> is still not surely proven. | Genitopatellar syndrome | Rectovestibular fistula | Ischiopatellar dysplasia | Oculoauricular syndrome | Superior canal dehiscence syndrome | Jugular foramen syndrome | Trigeminal trophic syndrome | Orbital apex syndrome | 00
| 62,403 |
<unk> or<unk> <unk> MRI is a type of medical<unk> in which MRI is used in conjunction with a<unk> placed into the rectum in order to obtain high quality images of the area surrounding the rectum. The technique has demonstrated higher accuracy than other modalities in assessing seminal vesicle invasion and extra-capsular extension (ECE) of prostate cancer (96% and 81% respectively).<unk> <unk> MRI is useful for determining the extent of spread and local invasion of cancers of the prostate, rectum, and anus. The<unk> consists of a probe with an inflatable balloon which helps maintain appropriate positioning. Similar<unk> s may be used vaginally for evaluating cervical cancer. | Endorectal coil magnetic resonance imaging | Anorectal manometry | Endoanal ultrasound | Rectal examination | Transrectal ultrasonography | Virtual colonoscopy | Transrectal biopsy | Anal Pap smear | 00
| 32,305 |
Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not associated with pathology include nervous blushes. | symptom of Abscess | symptom of Fever | symptom of Pancreatitis | symptom of Dysentery | symptom of Cholecystitis | symptoms of Neoplasm | symptom of Vaginitis | medical cause of Infection | 00
| 13,866 |
<unk> machine on display at Glenside Museum in Bristol, England<unk> device produced by Siemens and used for example at the Asyl psychiatric hospital in Kristiansand, Norway from the 1960s to the 1980s The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis. In unilateral<unk> , both electrodes are placed on the same side of the patient's head. Unilateral<unk> may be used first to minimize side effects such as memory loss. In bilateral<unk> , the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye. Unilateral<unk> is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK receive bilateral<unk> . The electrodes deliver an electrical stimulus. The stimulus levels recommended for<unk> are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral<unk> and up to 12 times for unilateral<unk> . Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral<unk> , expose patients to the risk of more severe cognitive impairment without additional<unk> utic gains. Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, etomidate, or thiopental, a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation. In a minority of countries such as Japan, India, and Nigeria,<unk> may be used without anesthesia. The Union Health Ministry of India recommended a ban on<unk> without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013. The practice was abolished in Turkey's largest psychiatric hospital in 2008. The patient's EEG, ECG, and blood oxygen levels are monitored during treatment.<unk> is usually administered three times a week, on alternate days, over a course of two to four weeks. An illustration depicting<unk> Neuroimaging prior to<unk> Neuroimaging prior to<unk> may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless it is not indicated due to high cost and low prevalence of these conditions in patients needing<unk> . Concurrent pharmacotherapy Whether psychiatric medications are terminated prior to treatment or maintained, varies. However, drugs that are known to cause toxicity in combination with<unk> , such as lithium, are discontinued, and benzodiazepines, which increase the seizure threshold, are either discontinued, a benzodiazepine antagonist is administered at each<unk> session, or the<unk> treatment is adjusted accordingly. A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves<unk> efficacy. Course<unk> is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds. It is also recommended to not do<unk> more than 3 times per week. Treatment team In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an<unk> treatment nurse or qualified assistant, and one or more recovery nurses. Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff. Devices<unk> machine from before 1960. Most modern<unk> devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in<unk> . A small minority of psychiatrists in the US still use sine-wave stimuli. Sine-wave is no longer used in the UK or Ireland. Typically, the electrical stimulus used in<unk> is about 800 milliamps and has up to several hundred watts, and the current flows for between one and six seconds. In the US,<unk> devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. In the UK, the market for<unk> devices was long monopolized by<unk> ron Ltd, which was set up by psychiatrist Robert Russell. | Electroconvulsive therapy | Brief psychotherapy | Psychotherapy | Cognitive therapy | Suicide intervention | Institutional psychotherapy | Insight-oriented psychotherapy | MDMA-assisted psychotherapy | 00
| 2,963 |
Due to the non-invasive nature of<unk> , clinical examination may or may not reveal a new murmur. An embolic stroke may be the first feature to suggest diagnosis of<unk> . An echocardiograph may be used to further assess for valvular lesions. | Nonbacterial thrombotic endocarditis | Subacute bacterial endocarditis | Libman–Sacks endocarditis | Infective endocarditis | Loeffler endocarditis | Tuberculous pericarditis | Isolated atrial amyloidosis | Viral cardiomyopathy | 00
| 22,076 |
<unk> <unk> is a disease in which the proportion of blood volume that is occupied by red blood cells increases (polycythaemia) and there is an abnormally low level of oxygen in the blood (hypoxemia).<unk> typically develops after extended time living at high altitude (over ). It is most common amongst native populations of high altitude nations. The most frequent symptoms of<unk> are headache, dizziness, tinnitus, breathlessness, palpitations, sleep disturbance, fatigue, loss of appetite, confusion, cyanosis, and dilation of veins.<unk> was first described in 1925 by Carlos Monge Medrano, a Peruvian doctor who specialised in diseases of high altitude. While acute<unk> sickness is experienced shortly after ascent to high altitude,<unk> may develop only after many years of living at high altitude. In medicine, high altitude is defined as over , but most cases of<unk> occur at over . It has recently been correlated with increased expression of the genes ANP32D and SENP1. | Chronic mountain sickness | Decompression sickness | Ski sickness | Motion sickness | Simulator sickness | Altitude sickness | Morning sickness | Sweating sickness | 00
| 34,743 |
A<unk> is a shunt from the right ventricle to the pulmonary circulation. In contrast to a Blalock–Taussig shunt, circulation is primarily in systole. It is sometimes used as the first step in a Norwood procedure. Diagram of a<unk> (orange) in hypoplastic left heart syndrom after Norwood Procedure. In the<unk> (or Right Ventricle-to-Pulmonary Artery shunt) the blood flows from the right ventricle to the pulmonary artery. This procedure was pioneered by the Japanese Cardiothoracic Surgeon, Shunji<unk> (b.1953) in 2003. | Sano shunt | Cerebral shunt | Cardiac shunt | Atriocaval shunt | Pulmonary shunt | Ventriculotomy | Ventriculostomy | Lumbar–peritoneal shunt | 00
| 61,256 |
A<unk> is a sweat gland carcinoma of the hand, which may recur locally in 50% of patients after excision, with distant metastases occurring in 60% of patients. | Malignant acrospiroma | Papillary hidradenoma | Chondroid syringoma | Ganglion cyst | Trichofolliculoma | Dentigerous cyst | Acral fibrokeratoma | Tornwaldt cyst | 00
| 54,273 |
Muscle atrophy occurs due to an imbalance between the normal balance between protein synthesis and protein degradation. This involves complex cell signalling that is incompletely understood and muscle atrophy is likely the result of multiple contributing mechanisms. Mitochondrial function is crucial to skeletal muscle health and detrimental changes at the level of the mitochondria may contribute to muscle atrophy. A decline in mitochondrial density as well as quality is consistently seen in muscle atrophy due to disuse. The ATP-dependent ubiquitin/proteasome pathway is one mechanism by which proteins are degraded in muscle. This involves specific proteins being tagged for destruction by a small peptide called ubiquitin which allows recognition by the proteasome to degrade the protein. | symptom of Bulbar palsy | symptom of Myopia | symptom of Glaucoma | symptom of Vertigo | symptom of Oculopharyngeal muscular dystrophy | symptom of Brain tumor | symptom of Stroke | symptom of Snakebite | 00
| 37,297 |
Diagnosis of<unk> can be made by<unk> biopsy, which is done in the office setting or through curettage of the uterine cavity to obtain<unk> tissue for histopathologic analysis. A workup for<unk> disease may be prompted by abnormal uterine bleeding, or the presence of atypical glandular cells on a pap smear. | Endometrial hyperplasia | Uterine hyperplasia | Endometrial polyp | Adenomyosis | Cervical pregnancy | Chronic deciduitis | Obstetric transition | Strawberry cervix | 00
| 45,371 |
Estimates of frequency range from 0.2 per 100,000 in Israel to 600 per 100,000 in Japan. These differences may be due to how the studies were conducted or the populations themselves. In the United States,<unk> is estimated to affect as many as 200,000 Americans, but fewer than 50,000 are diagnosed. The prevalence of<unk> is about 1 per 2,000 persons.<unk> is often mistaken for depression, epilepsy, the side effects of medications, poor sleeping habits or recreational drug use, making misdiagnosis likely. While<unk> symptoms are often confused with depression, there is a link between the two disorders. Research studies have mixed results on co-occurrence of depression in people with<unk> , as the numbers quoted by different studies are anywhere between 6% and 50%.<unk> can occur in both men and women at any age, although typical symptom onset occurs in adolescence and young adulthood. There is about a ten-year delay in diagnosing<unk> in adults. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of<unk> have been documented. For these to occur in the crucial teen years when education, development of self-image, and development of occupational choice are taking place is especially devastating. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence. | Narcolepsy | Heart failure | Erotolepsy | Major depressive disorder | Nicotine withdrawal | Anemia | Dancing mania | Sleep apnea | 00
| 51,248 |
It is estimated that 7% of women in the western world develop palpable<unk> s. In males, the occurrence of<unk> s is rare and may (but need not) be an indication of malignancy. | Breast cyst | Breast hematoma | Ovarian fibroma | Breast eczema | Trichoadenoma | Hidradenoma | Duct ectasia of breast | Luteoma | 00
| 44,674 |
<unk> (also called hypomastia, breast aplasia, breast hypoplasia, or mammary hypoplasia) is a medical term describing the postpubertal underdevelopment of a woman's breast tissue. Just as it is impossible to define 'normal' breast size, there is no objective definition of<unk> . Breast development is commonly asymmetric and one or both breasts may be small. This condition may be a congenital defect associated with underlying abnormalities of the pectoral muscle (as in Poland's syndrome), related to trauma (typically surgery or radiotherapy) or it may be a more subjective aesthetic description. Self perceived<unk> involves a discrepancy between a person's body image, and her internalized images of appropriate or desirable breast size and shape. Societal ideals over breast size vary over time, but there exist many conceived ideas involving breasts and sexual attractiveness and identity across different cultures. | Micromastia | Synechia | Microtia | Michel aplasia | Macrotia | Microdontia | Amastia | Cartilage–hair hypoplasia | 00
| 33,257 |
<unk> is the third most common cause of end stage kidney failure among African Americans, and commonly seen in African-American patients with<unk> compared to other ethnic groups. In the USA 12% of patients dying with AIDS have histologically proven<unk> , the worldwide incidence amongst AIDS patients appears to be similar. A South African study at Tygerberg Hospital, Stellenbosch University, has shown<unk> histology in 33/61(54%) biopsies performed in<unk> positive patients. | HIV-associated nephropathy | Malarial nephropathy | Lupus nephritis | Mesoamerican nephropathy | IgA nephropathy | Sickle cell nephropathy | Balkan endemic nephropathy | Trench nephritis | 00
| 33,439 |
<unk> also known as the diaphragm phenomenon, is a paralyzed hemidiaphragm, the portion of the diaphragm in contact with the parietal pleura during respiration in the base of the pleural cavity. It's when the zone of apposition ( the portion of the diaphragm in contact with the parietal pleura during expiration in the base of the pleural cavity') is reduced by the flattening of the diaphragm during inspiration and the pressure in the last intercostal spaces changes from intra-abdominal to intra-thoracic pressure. This partially contributes to the expansion of the rib cages during ventilation. This can be recognized by a slight change of sound when the percussion technique is used during expiration and inspiration in the last intercostal spaces. It is caused by a hyperinflation of the lungs associated with chronic obstructive pulmonary diseases, specially to emphysema. Related findings to emphysema Hoover's sign (lung). . . | Litten's sign | Fothergill's sign | Lockwood's sign | Destot's sign | Hegar's sign | Dance's sign | Adson's sign | Louvel's sign | 00
| 67,473 |
Nothing is known about the use of<unk> during pregnancy or lactation, or in patients under 18 years of age. The package leaflet recommends against using it under these circumstances. | Alfatradiol | Estradiol acetate | Estradiol valerate | Estradiol furoate | Estradiol | Estradiol | Estradiol diundecylate | Estradiol sulfate | 00
| 60,184 |
<unk> (CL-43) is a<unk> protein that acts as an antigen recognition protein. When an agent, zymosan, was injected into the tunicate Styela plicata (causing inflammation), secretion of this<unk> was tripled within 96 hours. | Collectin of 43 kDa | Glycoprotein IX | M protein | Polysulfated glycosaminoglycan | Type V collagen | Tumor-associated glycoprotein 72 | Peripheral myelin protein 22 | Collagen, type VI, alpha 2 | 00
| 56,768 |
<unk> is a form of hemolytic<unk> . In some cases, a<unk> can cause the immune system to mistakenly think the body's own red blood cells are dangerous, foreign substances. Antibodies then develop against the red blood cells. The antibodies attach to red blood cells and cause them to break down too early. It is known that more than 150<unk> s can cause this type of hemolytic<unk> . The list includes : * Cephalosporins (a class of antibiotics) * Dapsone * Levodopa * Levofloxacin * Methyldopa * Nitrofurantoin * Nonsteroidal anti-inflammatory<unk> s (NSAIDs) - among them, the commonly used Diclofenac and Ibuprofen * Phenazopyridine (pyridium) * Quinidine Penicillin in high doses can induce immune mediated hemolysis via the hapten mechanism in which antibodies are targeted against the combination of penicillin in association with red blood cells. Complement is activated by the attached antibody leading to the removal of red blood cells by the spleen. The<unk> itself can be targeted by the immune system, e.g. by IgE in a Type I hypersensitivity reaction to penicillin, rarely leading to anaphylaxis. | Drug-induced autoimmune hemolytic anemia | Drug-induced nonautoimmune hemolytic anemia | Cold autoimmune hemolytic anemia | Acquired hemolytic anemia | Mixed autoimmune hemolytic anemia | Refractory anemia with excess of blasts | Thiamine responsive megaloblastic anemia syndrome | Warm antibody autoimmune hemolytic anemia | 00
| 54,149 |
<unk> is resistant to amphotericin B and nearly all other antifungal drugs. Consequently, there is currently no consistently effective antifungal therapy for this agent. Miconazole has shown the best in vivo activity; however, itraconazole, fluconazole, ketoconazole and voriconazole have also been used in treatment, albeit with less success. In an in vitro environment, terbinafine has been found to work in synergy with azoles against P.<unk> . Echinocandins, such as caspofungin and sordarins, have shown promise in in vitro assays. CMT-3, a chemically modified tetracycline, has also shown to be active in vitro against P.<unk> . | Pseudallescheria boydii | Helicobacter bizzozeronii | Bacteroides caccae | Prevotella bivia | Helicobacter heilmannii s.s | Pasteurella | Madurella grisea | Hortaea werneckii | 00
| 50,903 |
Some steps suggested to lower the risk include: not douching, avoiding sex, or limiting the number of sex partners. One review concluded that probiotics may help prevent re-occurrence. Another review found that, while there is tentative evidence, it is not strong enough to recommend their use for this purpose. Early evidence suggested that antibiotic treatment of male partners could re-establish the normal microbiota of the male urogenital tract and prevent the recurrence of infection. However, a 2016 Cochrane review found high-quality evidence that treating the sexual partners of women with<unk> had no effect on symptoms, clinical outcomes, or recurrence in the affected women. It also found that such treatment may lead treated sexual partners to report increased adverse events. | Bacterial vaginosis | Trichomoniasis | Atrophic vaginitis | Vaginal yeast infection | Aerobic vaginitis | Prelabor rupture of membranes | Cryptomenorrhea | Leukorrhea | 00
| 432 |
Disability-adjusted life year for<unk> per 100,000 inhabitants in 2004 As of 2010, there were 44.7 million people in the world with open angle<unk> . The same year, there were 2.8 million people in the United States with open angle<unk> . By 2020, the prevalence is projected to increase to 58.6 million worldwide and 3.4 million in the United States. Both internationally and in the United States,<unk> is the second-leading cause of blindness. Globally, cataracts are a more common cause.<unk> is also the leading cause of blindness in African Americans, who have higher rates of primary open-angle<unk> . Bilateral vision loss can negatively affect mobility and interfere with driving. A meta-analysis published in 2009 found that people with primary open angle<unk> do not have increased mortality rates, or increased risk of cardiovascular death. | Glaucoma | Keratitis | Normal tension glaucoma | Conjunctivitis | Cat eye syndrome | Uveitis | Phacolytic glaucoma | Ocular hypertension | 00
| 5,167 |
As a beverage The plant yields an abundance of a mildly<unk> ous milky juice, and travellers like nomadic cowherds suck its tender shoots to allay thirst. Traditional accounts hold that<unk> is the Soma plant of the Vedas. The Rig Veda, ix. says, the purifying Soma, like the sea rolling its waves, has poured forth songs, hymns and thoughts. Medicinal The plant is bitter, acrid, cooling, alterant, narcotic, emetic, antiviral, and rejuvenating. India In classical Indian medicine it is considered useful in vitiated conditions of pitta, dipsia, viral infection, hydrophobia, psychopathy and general debility. | Cynanchum acidum | Arcanum joviale | Cynanchum viminale | Mitragyna speciosa | Gongylonema pulchrum | Antihecticum poterii | Peganum harmala | Gnathostoma spinigerum | 00
| 70,534 |
There are several ongoing efforts by scientists, governments, international organisations, and others to determine the<unk> of SARS-CoV-2, the virus responsible for the<unk> -19 pandemic. Most scientists say that as with other pandemics in human history, the virus is likely of zoonotic<unk> in a natural setting, and ultimately<unk> ated from a bat-borne virus. Several other explanations, including many conspiracy theories, have been proposed about the<unk> s of the virus. SARS-CoV-2 has close genetic similarity to multiple previously identified bat coronaviruses, suggesting it crossed over into humans from bats. Research is ongoing as to whether SARS-CoV-2 came directly from bats or indirectly through any intermediate hosts. Initial genome sequences of the virus showed little genetic diversity, although subsequently a number of stable variants emerged (some spreading more vigorously), indicating that the spillover event introducing SARS-CoV-2 to humans is likely to have occurred in late 2019. Health authorities and scientists internationally state that as with the 2002–2004 outbreak of SARS-1, efforts to trace the specific geographic and taxonomic<unk> s of SARS-CoV-2 could take years, and the results could be inconclusive. In January 2021, the World Health Assembly (decision-making body of the World Health Organization, WHO) commissioned a study on the<unk> s of the virus, to be conducted jointly between WHO experts and Chinese scientists. In March 2021, the findings of this study were published online in a report to the WHO Commissioner-General. Echoing the assessment of most virologists, the report determined that the virus most likely had a zoonotic<unk> in bats, possibly transmitted through an intermediate host. It also stated that a laboratory<unk> for the virus was "extremely unlikely." Scientists found the conclusions of the WHO report to be helpful but noted that more work was needed. In the United States, the European Union, and other countries, some criticised the lack of transparency and data access in the report's formulation. The WHO issued its 30 March report alongside a statement of the WHO director-general Tedros Adhanom Ghebreyesus saying that the matter "requires further<unk> . The U.S. government and 13 other countries and the EU issued statements on the same day, echoing Tedros's critique of the report for lacking transparency and data access in its formulation. In a later press conference, the WHO director-general said it was "premature" for the WHO's report to rule out a potential link between a laboratory leak and called on China to provide 'raw data' and lab audits in a second phase of<unk> . On 12 October 2021, WHO announced a new team to study the<unk> s of the<unk> -19 pandemic. Earlier, on 22 July 2021, the Chinese government had held a press conference in which Zeng Yixin, Vice Health Minister of the National Health Commission (NHC), said that China would not participate in a second phase of the WHO's<unk> denouncing it as "shocking" and "arrogant". | Investigations into the origin of COVID-19 | Treatment and management of COVID-19 | Discovery of disease-causing pathogens | Chinese government response to COVID-19 | Vaccine storage | Coordinated diagnostics | Wastebasket diagnosis | Connecting Organizations for Regional Disease Surveillance | 00
| 74,072 |
<unk> <unk> or simply toxic syndrome (Spanish: síndrome del aceite tóxico or síndrome tóxico) is a musculoskeletal disease. A 1981 outbreak in Spain which affected about 20,000 people, with over 300 dying within a few months and a few thousand remaining disabled, is thought to have been caused by contaminated colza (rapeseed)<unk> . It was unique because of its size, the novelty of the clinical condition, and the complexity of its aetiology. Its first appearance was as a lung disease, with unusual features, though the symptoms initially resembled a lung infection. The disease appeared to be restricted to certain geographical localities, and several members of a family could be affected, even while their neighbours had no symptoms. Following the acute phase, a range of other chronic symptoms was apparent. Alternative mechanisms == The conclusion of the Joint WHO/CISAT Scientific Committee for the<unk> from 2002, that<unk> was the cause for<unk> , is based only on epidemiological evidence, since up to now, experimental studies performed in a variety of laboratory animals have failed to reproduce the symptoms of human<unk> . None of the in vivo or in vitro studies performed with toxic-oil-specific components, such as fatty acid anilides, and esters of 3-(N-phenylamino)-1,2-propanediol (abbreviated as PAP), have provided evidence that these markers are causally involved in the pathogenesis of<unk> . Specifically, three possible causative agents of<unk> are PAP (3-(N-phenylamino)-1,2-propanediol), the 1,2-dioleoyl ester of PAP (abbreviated OOPAP), and the 3-oleoyl ester of PAP (abbreviated OPAP). These three compounds are formed by means of similar chemical processes, and<unk> that contains one of the three substances is likely to contain the other two.<unk> samples that are suspected to have been ingested by people who later developed<unk> often contain all three of these contaminants (among other substances), but are most likely to contain OOPAP. However, when these three substances were given to laboratory animals, OOPAP was not acutely toxic, PAP was toxic only after injection, but not after oral administration, and OPAP was toxic only after injection of high doses. Therefore, none of these three substances is thought to cause<unk> . Similar results were obtained after administration of fatty acid anilides. Data discrepancies combined with both a high level of secrecy surrounding the huge investigation and the fact that the first cases of the syndrome were located in Madrid (near the U.S. military base in Torrejón de Ardoz) spread the idea of a conspiracy. Several of those affected by<unk> claim they never consumed any of the tainted<unk> products. Furthermore, the tainted<unk> was primarily sold in low-cost street markets; yet, a considerable percentage of the patients were wealthy. Another theory suggests the toxic reaction was triggered by organophosphate poisoning (e. g., from pesticide residues in tomatoes) and covered up by the Spanish government and the WHO. | Toxic oil syndrome | Hashitoxicosis | Ciguatera fish poisoning | Aerotoxic syndrome | Polymer fume fever | Ski sickness | Chlorine gas poisoning | Theobromine poisoning | 00
| 34,600 |
The most common side effect of<unk> is skin irritation. | Crotamiton | Dosulepin | Itruvone | Aquamid | Brodifacoum | Co-codaprin | Chlordecone | Crofelemer | 00
| 41,420 |
Like other<unk> diseases, MNGIE is a multisystem disorder. MNGIE primarily affects the gastrointestinal and neurological systems. Gastrointestinal symptoms may include gastrointestinal dysmotility, due to inefficient peristalsis, which may result in pseudo-obstruction and cause malabsorption of nutrients. Additionally, gastrointestinal symptoms such as borborygmi, early satiety, diarrhea, constipation, gastroparesis, nausea, vomiting, weight loss, and diverticulitis may be present in MNGIE patients. Neurological symptoms may include diffuse leukoencephalopathy, peripheral neuropathy, and myopathy. Ocular symptoms may include retinal degeneration, ophthalmoplegia, and ptosis. Those with MNGIE are often thin and experience continuous weight loss. The characteristic thinness of MNGIE patients is caused by multiple factors including inadequate caloric intake due to gastrointestinal symptoms and discomfort, malabsorption of food from bacterial overgrowth due to decreased motility, as well as an increased metabolic demand due to inefficient production of ATP by the<unk> | Mitochondrial neurogastrointestinal encephalopathy syndrome | Okamoto syndrome | Yushō disease | Morquio syndrome | Sandhoff disease | Sanjad-Sakati syndrome | Stratton Parker syndrome | Wilson's temperature syndrome | 00
| 43,032 |
Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety. Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems with anxiety. Anxiety may cause psychiatric and physiological symptoms. The risk of anxiety leading to depression could possibly even lead to an individual harming themselves, which is why there are many 24-hour suicide prevention hotlines. The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past. Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping). The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank" as well as "nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary." It may include a vague experience and feeling of helplessness. The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying: "You may ... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can't get it out of your mind." The physiological symptoms of anxiety may include: *Neurological, as headache, paresthesias, fasciculations, vertigo, or presyncope. *Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry mouth, or bolus. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS. *Respiratory, as shortness of breath or sighing breathing. *Cardiac, as palpitations, tachycardia, or chest pain. *Muscular, as fatigue, tremors, or tetany. *Cutaneous, as perspiration, or itchy skin. *Uro-genital, as frequent urination, urinary urgency, dyspareunia, or impotence, chronic pelvic pain syndrome. | symptom of Multiple sclerosis | symptom of Dermatomyositis | symptom of Myasthenia gravis | symptom of Amyotrophic lateral sclerosis | symptom of Japanese encephalitis | symptom of Polyneuropathy | symptom of Brain tumor | symptom of Myotonic dystrophy | 00
| 37 |
A<unk> <unk><unk> is a type of medication which affects gonadotropins and sex hormones. They are used for a variety of indications including in fertility medicine and to lower sex hormone levels in the treatment of hormone-sensitive cancers such as prostate cancer and breast cancer, certain gynecological disorders like heavy periods and endometriosis, high testosterone levels in women, early puberty in children, as a part of transgender hormone therapy, and to delay puberty in transgender youth among other uses.<unk><unk> s are given by injections into fat, as implants placed into fat, and as nasal sprays. Side effects of<unk><unk> s are related to sex hormone deficiency and include symptoms of low testosterone levels and low estrogen levels such as hot flashes, sexual dysfunction, vaginal atrophy, penile atrophy, osteoporosis, infertility, and diminished sex-specific physical characteristics. They are<unk> s of the<unk> receptor and work by increasing or decreasing the release of gonadotropins and the production of sex hormones by the gonads. When used to suppress gonadotropin release,<unk><unk> s can lower sex hormone levels by 95% in both sexes.<unk> was discovered in 1971, and<unk> analogues were introduced for medical use in the 1980s. Their nonproprietary names usually end in -relin. The most well-known and widely used<unk> analogues are leuprorelin (brand name Lupron) and triptorelin (brand name Decapeptyl).<unk> analogues are available as generic medications. Despite this, they continue to be very expensive. | Gonadotropin-releasing hormone agonist | Gonadotropin-releasing hormone antagonist | Gonadotropin-releasing hormone modulator | Prolactin modulator | Antiandrogen | Thyroid blocker | 17α-Alkylated anabolic steroid | Steroidal antiandrogen | 00
| 32,544 |
Types The 2005 Oxford Textbook of Medicine distinguishes type 1<unk> by "persistent daily chaotic variability in peak flow (usually greater than 40 per cent diurnal variation in PEFR more than 50 per cent of the time)", while type 2 is identified by "sporadic sudden falls in PEFR against a background of usually well-controlled asthma with normal or near normal lung function". In both types, patients are subject to recurrent, severe attacks. The cardinal symptoms of an asthma attack are shortness of breath (dyspnea), wheezing, and chest tightness. Individuals with type 1 suffer chronic attacks in spite of ongoing medical therapy, while those with type 2 experience sudden, acute and even potentially life-threatening attacks even though otherwise their asthma seems well managed. When first defined by Margaret Turner-Warwick in 1977, the term<unk> was used specifically to describe type 1, but as studies into the phenotype were conducted the second type was also distinguished. | Brittle asthma | Thunderstorm asthma | Yokkaichi asthma | Reactive airway disease | Cardiac asthma | Asthma | Mineral dust airway disease | Occupational asthma | 00
| 57,920 |
<unk> is usually diagnosed by an eye doctor who examines the eye using a microscope. The method is termed slit lamp examination and it is done with an "85% sensitivity rate and a 100% specificity rate." Since the symptom of increased pressure within the eye is generally painless until the condition becomes rather advanced, it is possible for people afflicted with glaucoma to be in danger yet not be aware of it. As a result, it is recommended that persons have regular eye examinations to have their levels of intraocular pressure measured, so that treatments can be prescribed before there is any serious damage to the optic nerve and subsequent loss of vision. | Pseudoexfoliation syndrome | Trench nephritis | Shunt nephritis | Focal proliferative nephritis | Lupus nephritis | Malarial nephropathy | HIV-associated nephropathy | Diffuse proliferative nephritis | 00
| 55,355 |
A variety of<unk> , and more specifically vegan, foods<unk> is the set of health-related challenges and advantages of<unk> diets. Appropriately planned<unk> diets are healthful and nutritionally adequate for all stages of the human life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. However,<unk> diets deficient in vitamin B12 or calories may compromise children's health and development. The UK National Health Service recommends that<unk> diets should also follow the general recommendations for healthy diets, such as low fat, salt and sugar intakes and 5 fruits or vegetables a day. Qatar's public health ministry states, "One cannot be a healthy<unk> by going to a fast food restaurant and ordering french fries and soda!". Evidence suggests that<unk> s generally have lower rates of coronary heart disease, obesity, hypertension, type 2 diabetes, and osteoporosis.<unk> diets tend to be rich in carbohydrates, omega-6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E, potassium and magnesium. They are possibly low in saturated fat, cholesterol, and animal protein. | Vegetarian nutrition | Sports nutrition | Preventive nutrition | Feingold diet | Plant-based diet | Protein supplement | Low-FODMAP diet | Management of obesity | 00
| 20,372 |
Given the disease burden of strokes, prevention is an important public health concern. Primary prevention is less effective than secondary prevention (as judged by the number needed to treat to prevent one stroke per year). Recent guidelines detail the evidence for primary prevention in stroke. In those who are otherwise healthy, aspirin does not appear beneficial and thus is not recommended. In people who have had a myocardial infarction or those with a high cardiovascular risk, it provides some protection against a first stroke. In those who have previously had a stroke, treatment with medications such as aspirin, clopidogrel, and dipyridamole may be beneficial. The U.S. Preventive Services Task Force (USPSTF) recommends against screening for carotid artery stenosis in those without symptoms. Risk factors The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation although the size of the effect is small; 833 people have to be treated for 1 year to prevent one stroke. Other modifiable risk factors include high blood cholesterol levels, diabetes mellitus, end-stage kidney disease, cigarette smoking (active and passive), heavy alcohol use, drug use, lack of physical activity, obesity, processed red meat consumption, and unhealthy diet. Smoking just one cigarette per day increases the risk more than 30%. Alcohol use could predispose to ischemic stroke, as well as intracerebral and subarachnoid hemorrhage via multiple mechanisms (for example, via hypertension, atrial fibrillation, rebound thrombocytosis and platelet aggregation and clotting disturbances). Drugs, most commonly amphetamines and cocaine, can induce stroke through damage to the blood vessels in the brain and acute hypertension. Migraine with aura doubles a person's risk for ischemic stroke. Untreated, celiac disease regardless of the presence of symptoms can be an underlying cause of stroke, both in children and adults. High levels of physical activity reduce the risk of stroke by about 26%. There is a lack of high quality studies looking at promotional efforts to improve lifestyle factors. Nonetheless, given the large body of circumstantial evidence, best medical management for stroke includes advice on diet, exercise, smoking and alcohol use. Medication is the most common method of stroke prevention; carotid endarterectomy can be a useful surgical method of preventing stroke. Blood pressure High blood pressure accounts for 35–50% of stroke risk. Blood pressure reduction of 10 mmHg systolic or 5 mmHg diastolic reduces the risk of stroke by ~40%. Lowering blood pressure has been conclusively shown to prevent both ischemic and hemorrhagic strokes. It is equally important in secondary prevention. Even people older than 80 years and those with isolated systolic hypertension benefit from antihypertensive therapy. The available evidence does not show large differences in stroke prevention between antihypertensive drugs—therefore, other factors such as protection against other forms of cardiovascular disease and cost should be considered. The routine use of beta-blockers following a stroke or TIA has not been shown to result in benefits. Blood lipids High cholesterol levels have been inconsistently associated with (ischemic) stroke. Statins have been shown to reduce the risk of stroke by about 15%. Since earlier meta-analyses of other lipid-lowering drugs did not show a decreased risk, statins might exert their effect through mechanisms other than their lipid-lowering effects. Diabetes mellitus Diabetes mellitus increases the risk of stroke by 2 to 3 times. While intensive blood sugar control has been shown to reduce small blood vessel complications such as kidney damage and damage to the retina of the eye it has not been shown to reduce large blood vessel complications such as stroke. Anticoagulation drugs Oral anticoagulants such as warfarin have been the mainstay of stroke prevention for over 50 years. However, several studies have shown that aspirin and other antiplatelets are highly effective in secondary prevention after a stroke or transient ischemic attack. Low doses of aspirin (for example 75–150 mg) are as effective as high doses but have fewer side effects; the lowest effective dose remains unknown. Thienopyridines (clopidogrel, ticlopidine) might be slightly more effective than aspirin and have a decreased risk of gastrointestinal bleeding, but are more expensive. Both aspirin and clopidogrel may be useful in the first few weeks after a minor stroke or high risk TIA. Clopidogrel has less side effects than ticlopidine. Dipyridamole can be added to aspirin therapy to provide a small additional benefit, even though headache is a common side effect. Low-dose aspirin is also effective for stroke prevention after having a myocardial infarction. Those with atrial fibrillation have a 5% a year risk of stroke, and this risk is higher in those with valvular atrial fibrillation. Depending on the stroke risk, anticoagulation with medications such as warfarin or aspirin is useful for prevention. Except in people with atrial fibrillation, oral anticoagulants are not advised for stroke prevention—any benefit is offset by bleeding risk. In primary prevention, however, antiplatelet drugs did not reduce the risk of ischemic stroke but increased the risk of major bleeding. Further studies are needed to investigate a possible protective effect of aspirin against ischemic stroke in women. Surgery Carotid endarterectomy or carotid angioplasty can be used to remove atherosclerotic narrowing of the carotid artery. There is evidence supporting this procedure in selected cases. Endarterectomy for a significant stenosis has been shown to be useful in preventing further strokes in those who have already had one. Carotid artery stenting has not been shown to be equally useful. People are selected for surgery based on age, gender, degree of stenosis, time since symptoms and the person's preferences. Surgery is most efficient when not delayed too long—the risk of recurrent stroke in a person who has a 50% or greater stenosis is up to 20% after 5 years, but endarterectomy reduces this risk to around 5%. The number of procedures needed to cure one person was 5 for early surgery (within two weeks after the initial stroke), but 125 if delayed longer than 12 weeks. Screening for carotid artery narrowing has not been shown to be a useful test in the general population. Studies of surgical intervention for carotid artery stenosis without symptoms have shown only a small decrease in the risk of stroke. To be beneficial, the complication rate of the surgery should be kept below 4%. Even then, for 100 surgeries, 5 people will benefit by avoiding stroke, 3 will develop stroke despite surgery, 3 will develop stroke or die due to the surgery itself, and 89 will remain stroke-free but would also have done so without intervention. Diet Nutrition, specifically the Mediterranean-style diet, has the potential for decreasing the risk of having a stroke by more than half. It does not appear that lowering levels of homocysteine with folic acid affects the risk of stroke. A Centers for Disease Control and Prevention public service announcement about a woman having a stroke after pregnancy. Women A number of specific recommendations have been made for women including taking aspirin after the 11th week of pregnancy if there is a history of previous chronic high blood pressure and taking blood pressure medications during pregnancy if the blood pressure is greater than 150 mmHg systolic or greater than 100 mmHg diastolic. In those who have previously had preeclampsia other risk factors should be treated more aggressively. Previous stroke or TIA Keeping blood pressure below 140/90 mmHg is recommended. Anticoagulation can prevent recurrent ischemic strokes. Among people with nonvalvular atrial fibrillation, anticoagulation can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. However, a recent meta-analysis suggests harm from anticoagulation started early after an embolic stroke. Stroke prevention treatment for atrial fibrillation is determined according to the CHA2DS2–VASc score. The most widely used anticoagulant to prevent thromboembolic stroke in people with nonvalvular atrial fibrillation is the oral agent warfarin while a number of newer agents including dabigatran are alternatives which do not require prothrombin time monitoring. Anticoagulants, when used following stroke, should not be stopped for dental procedures. If studies show carotid artery stenosis, and the person has a degree of residual function on the affected side, carotid endarterectomy (surgical removal of the stenosis) may decrease the risk of recurrence if performed rapidly after stroke. | symptom of Glioblastoma | symptom of Meningioma | symptom of Brain tumor | symptom of Neurofibromatosis | symptom of Intracerebral hemorrhage | symptom of Posterior reversible encephalopathy syndrome | symptom of Epidural hematoma | medical cause of Epidural hematoma | 00
| 15,261 |
<unk> sometimes causes soreness of the tongue. Hypersensitivity reactions are very rare and show symptoms such as nausea or dyspepsia, although it is not entirely clear which side effects are caused by AMC and which by dichlorobenzyl alcohol or other ingredients of the lozenges. AMC has a low toxicity with an LD50 of 1500 mg/kg body weight (in rats). | Amylmetacresol | Silver diammine fluoride | Sodium hypochlorite | Silver nitrate | Perchloryl fluoride | Tetramethyl bisphenol F | Tetrachlorodecaoxide | Sodium hydroxide | 00
| 37,361 |
Diagnosis is made by imaging/sonography and thyroid hormone tests. | Van Wyk and Grumbach syndrome | Helsmoortel-Van der Aa syndrome | Van Den Bosch syndrome | Beare–Stevenson cutis gyrata syndrome | Jeavons syndrome | Gougerot–Blum syndrome | McGillivray syndrome | Cruveilhier–Baumgarten disease | 00
| 66,249 |
Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of plaque (atherosclerosis) in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others. Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk. In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries. The number of cases of CAD for a given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among men than women of a given age. Clogged artery | causes of Ventricular tachycardia | causes of Cardiac tamponade | types of Supraventricular tachycardia | risks of Atrial fibrillation | causes of Mitral valve stenosis | causes of Libman–Sacks endocarditis | symptom of Brugada syndrome | complications of Atrial fibrillation | 00
| 559 |
A<unk> is a sign seen on a radiograph that indicates localized ileus from nearby inflammation. Simply put, it is the dilation of a segment of small intestine to be differentiated from colonic cutoff sign which is a dilation of a segment of large bowel. An isolated distended<unk> of bowel is seen near the site of injured viscus or inflamed organ. This<unk> is called a<unk> ." It arises from the body's efforts to localize traumatic or inflammatory lesions. The local distention of that intestinal<unk> is due to local paralysis and accumulation of gas in the intestinal<unk> . In acute pancreatitis, the<unk> is usually seen in left hypochondrium, while in acute cholecystitis, it is seen in the right hypochondrium. In acute appendicitis, the<unk> is seen in right right lower quadrant. | Sentinel loop | Pulvermacher's chain | Gartland classification | Pipkin classification | Siewert classification | Herscovici classification | Gray's Anatomy | Engel classification | 00
| 52,137 |
The pain is sharp and sudden, in response to an external stimulus. The most common trigger is cold, with 75% of people with<unk> reporting pain upon application of a cold stimulus. Other types of stimuli may also trigger pain in<unk> , including: * Thermal – hot and cold drinks and foods, cold air, coolant water jet from a dental instrument. * Electrical – electric pulp testers. * Mechanical–tactile – dental probe during dental examination, periodontal scaling and root planing, toothbrushing. * Osmotic – hypertonic solutions such as sugars. * Evaporation – air blast from a dental instrument. * Chemical – acids, e.g. dietary, gastric, acid etch during dental treatments. The frequency and severity with which the pain occurs are variable. | Dentin hypersensitivity | Dentin dysplasia | Tooth ankylosis | Ligamentous laxity | Zaspopathy | Radiosensitivity | Accessory nerve disorder | Enthesopathy | 00
| 37,089 |
Untreated<unk> is almost always fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 percent. Death is almost inevitable if treatment is delayed more than about 24 hours, and some people may even die on the same day they present with the disease. | Septicemic plague | Urban plague | Bubonic plague | Hittite plague | Metal fume fever | Sylvatic plague | Tomato fever | Pneumonic plague | 00
| 12,612 |
Bas-LCLC are considered to have a particularly poor prognosis, even compared to other forms of lung cancer. However, not all studies have confirmed this. | Basaloid large cell carcinoma of the lung | Epithelial-myoepithelial carcinoma of the lung | Mucinous cystadenocarcinoma of the lung | Salivary gland–like carcinoma of the lung | Large cell neuroendocrine carcinoma of the lung | Basaloid squamous cell lung carcinoma | Sarcomatoid carcinoma of the lung | Giant-cell carcinoma of the lung | 00
| 61,305 |
Common side effects include increased phosphate level, mouth sores, feeling tired, change in kidney function, diarrhea, dry mouth, nails separating from the bed or poor formation of the nail, change in liver function, low salt (sodium) levels, decreased appetite, change in sense of taste, low red blood cells (anemia), dry skin, dry eyes and hair loss. Other side effects include redness, swelling, peeling or tenderness on the hands or feet (hand foot syndrome), constipation, stomach pain, nausea and muscle pain.<unk> may cause serious eye problems, including inflamed eyes, inflamed cornea (front part of the eye) and disorders of the retina, an internal part of the eye. Patients are advised to have eye examinations intermittently and to tell their health care professional right away if they develop blurred vision, loss of vision or other visual changes. | Erdafitinib | Abrocitinib | Baricitinib | Upadacitinib | Tucatinib | Oclacitinib | Ceritinib | Neratinib | 00
| 69,841 |
Before surgical intervention in adolescents, symptoms can be relieved by the combined oral contraceptive pill taken continuously to suppress the menstrual cycle or NSAIDs to relieve pain. Surgical treatment of the<unk> by<unk> otomy typically involves making cruciate incisions of the<unk> , excising segments of<unk> from their bases, and draining the vaginal canal and uterus. For affected girls who wish (or whose parents wish) to have their<unk> s preserved, surgical techniques to excise of a central flange of the<unk> can be used. The timing of surgical<unk> repair is controversial: some doctors believe it is best to intervene immediately after the neonatal period, while others believe that surgical repair should be delayed until puberty, when estrogenization is complete. | Imperforate hymen | Cervical ectropion | Megarectum | Retroverted uterus | Sperm granuloma | Hydrocolpos | Bifid penis | Spermatocele | 00
| 25,457 |
Survey data about how many cancer patients use<unk> or complementary therapies vary from nation to nation as well as from region to region. A 2000 study published by the European Journal of Cancer evaluated a sample of 1023 women from a British cancer registry suffering from breast cancer and found that 22.4% had consulted with a practitioner of complementary therapies in the previous twelve months. The study concluded that the patients had spent many thousands of pounds on such measures and that use "of practitioners of complementary therapies following diagnosis is a significant and possibly growing phenomenon". In Australia, one study reported that 46% of children suffering from cancer have been treated with at least one non-traditional therapy. Further 40% of those of any age receiving palliative care had tried at least one such therapy. Some of the most popular<unk> were found to be dietary therapies, antioxidants, high dose vitamins, and herbal therapies. Use of unconventional cancer<unk> in the United States has been influenced by the U.S. federal government's National Center for Complementary and<unk> Medicine (NCCAM), initially known as the Office of<unk> Medicine (OAM), which was established in 1992 as a National Institutes of Health (NIH) adjunct by the U.S. Congress. More specifically, the NIC's Office of Cancer Complementary and<unk> Medicine sponsors over $105 million a year in grants for pseudoscientific cancer research. Over thirty American medical schools have offered general courses in<unk> medicine, including the Georgetown, Columbia, and Harvard university systems, among others. | Alternative cancer treatments | Experimental cancer treatment | Longevity medicine | Tobacco harm reduction | Cancer immunoprevention | Cancer rehabilitation | Toxics use reduction | Suicide prevention | 00
| 39,770 |
Acute respiratory distress syndrome is usually treated with mechanical ventilation in the intensive care unit (ICU). Mechanical ventilation is usually delivered through a rigid tube which enters the oral cavity and is secured in the airway (endotracheal intubation), or by tracheostomy when prolonged ventilation (≥2 weeks) is necessary. The role of non-invasive ventilation is limited to the very early period of the disease or to prevent worsening respiratory distress in individuals with atypical pneumonias, lung bruising, or major surgery patients, who are at risk of developing ARDS. Treatment of the underlying cause is crucial. Appropriate antibiotic therapy is started as soon as culture results are available, or if infection is suspected (whichever is earlier). Empirical therapy may be appropriate if local microbiological surveillance is efficient. Where possible the origin of the infection is removed. When sepsis is diagnosed, appropriate local protocols are followed. Mechanical ventilation The overall goal of mechanical ventilation is to maintain acceptable gas exchange to meet the body's metabolic demands and to minimize adverse effects in its application. The parameters PEEP (positive end-expiratory pressure, to keep alveoli open), mean airway pressure (to promote recruitment (opening) of easily collapsible alveoli and predictor of hemodynamic effects), and plateau pressure (best predictor of alveolar overdistention) are used. Previously, mechanical ventilation aimed to achieve tidal volumes (Vt) of 12–15 ml/kg (where the weight is ideal body weight rather than actual weight). Recent studies have shown that high tidal volumes can overstretch alveoli resulting in volutrauma (secondary lung injury). The ARDS Clinical Network, or ARDSNet, completed a clinical trial that showed improved mortality when people with ARDS were ventilated with a tidal volume of 6 ml/kg compared to the traditional 12 ml/kg. Low tidal volumes (Vt) may cause a permitted rise in blood carbon dioxide levels and collapse of alveoli because of their inherent tendency to increase shunting within the lung. Physiologic dead space cannot change as it is ventilation without perfusion. A shunt is a perfusion without ventilation within a lung region. Low tidal volume ventilation was the primary independent variable associated with reduced mortality in the NIH-sponsored ARDSNet trial of tidal volume in ARDS. Plateau pressure less than 30 cm was a secondary goal, and subsequent analyses of the data from the ARDSNet trial and other experimental data demonstrate that there appears to be no safe upper limit to plateau pressure; regardless of plateau pressure, individuals with ARDS fare better with low tidal volumes. Airway pressure release ventilation No particular ventilator mode is known to improve mortality in acute respiratory distress syndrome (ARDS). Some practitioners favor airway pressure release ventilation when treating ARDS. Well documented advantages to APRV ventilation include decreased airway pressures, decreased minute ventilation, decreased dead-space ventilation, promotion of spontaneous breathing, almost 24-hour-a-day alveolar recruitment, decreased use of sedation, near elimination of neuromuscular blockade, optimized arterial blood gas results, mechanical restoration of FRC (functional residual capacity), a positive effect on cardiac output (due to the negative inflection from the elevated baseline with each spontaneous breath), increased organ and tissue perfusion and potential for increased urine output secondary to increased kidney perfusion. A patient with ARDS, on average, spends between 8 and 11 days on a mechanical ventilator; APRV may reduce this time significantly and thus may conserve valuable resources. Positive end-expiratory pressure Positive end-expiratory pressure (PEEP) is used in mechanically ventilated people with ARDS to improve oxygenation. In ARDS, three populations of alveoli can be distinguished. There are normal alveoli that are always inflated and engaging in gas exchange, flooded alveoli which can never, under any ventilatory regime, be used for gas exchange, and atelectatic or partially flooded alveoli that can be "recruited" to participate in gas exchange under certain ventilatory regimens. The recruitable alveoli represent a continuous population, some of which can be recruited with minimal PEEP, and others can only be recruited with high levels of PEEP. An additional<unk> is that some alveoli can only be opened with higher airway pressures than are needed to keep them open, hence the justification for maneuvers where PEEP is increased to very high levels for seconds to minutes before dropping the PEEP to a lower level. PEEP can be harmful; high PEEP necessarily increases mean airway pressure and alveolar pressure, which can damage normal alveoli by overdistension resulting in DAD. A compromise between the beneficial and adverse effects of PEEP is inevitable. The 'best PEEP' used to be defined as 'some' cm above the lower inflection point (LIP) in the sigmoidal pressure-volume relationship curve of the lung. Recent research has shown that the LIP-point pressure is no better than any pressure above it, as recruitment of collapsed alveoliand, more importantly, the overdistension of aerated unitsoccur throughout the whole inflation. Despite the awkwardness of most procedures used to trace the pressure-volume curve, it is still used by some to define the minimum PEEP to be applied to their patients. Some new ventilators can automatically plot a pressure-volume curve. PEEP may also be set empirically. Some authors suggest performing a 'recruiting maneuver'a short time at a very high continuous positive airway pressure, such as 50 cm (4.9 kPa)to recruit or open collapsed units with a high distending pressure before restoring previous ventilation. The final PEEP level should be the one just before the drop in Pa or peripheral blood oxygen saturation during a step-down trial. A large randomized controlled trial of patients with ARDS found that lung recruitment maneuvers and PEEP titration was associated with high rates of barotrauma and pneumothorax and increased mortality. Intrinsic PEEP (iPEEP) or auto-PEEPfirst described by John Marini of St. Paul Regions Hospitalis a potentially unrecognized contributor to PEEP in intubated individuals. When ventilating at high frequencies, its contribution can be substantial, particularly in people with obstructive lung disease such as asthma or chronic obstructive pulmonary disease (COPD). iPEEP has been measured in very few formal studies on ventilation in ARDS, and its contribution is largely unknown. Its measurement is recommended in the treatment of people who have ARDS, especially when using high-frequency (oscillatory/jet) ventilation. Prone position The position of lung infiltrates in acute respiratory distress syndrome is non-uniform. Repositioning into the prone position (face down) might improve oxygenation by relieving atelectasis and improving perfusion. If this is done early in the treatment of severe ARDS, it confers a mortality benefit of 26% compared to supine ventilation. However, attention should be paid to avoid the SIDS in the management of the respiratory distressed infants by continuous careful monitoring of their cardiovascular system. Fluid management Several studies have shown that pulmonary function and outcome are better in people with ARDS who lost weight or whose pulmonary wedge pressure was lowered by diuresis or fluid restriction. Medications As of 2019, it is uncertain whether or not treatment with corticosteroids improves overall survival. Corticosteroids may increase the number of ventilator-free days during the first 28 days of hospitalization. One study found that dexamethasone may help. The combination of hydrocortisone, ascorbic acid, and thiamine also requires further study as of 2018. Inhaled nitric oxide (NO) selectively widens the lung's arteries which allows for more blood flow to open alveoli for gas exchange. Despite evidence of increased oxygenation status, there is no evidence that inhaled nitric oxide decreases morbidity and mortality in people with ARDS. Furthermore, nitric oxide may cause kidney damage and is not recommended as therapy for ARDS regardless of severity. Alvelestat (AZD 9668) had been quoted according to one review article. Extracorporeal membrane oxygenation Extracorporeal membrane oxygenation (ECMO) is mechanically applied prolonged cardiopulmonary support. There are two types of ECMO: Venovenous which provides respiratory support and venoarterial which provides respiratory and hemodynamic support. People with ARDS who do not require cardiac support typically undergo venovenous ECMO. Multiple studies have shown the effectiveness of ECMO in acute respiratory failure. Specifically, the CESAR (Conventional ventilatory support versus Extracorporeal membrane oxygenation for Severe Acute Respiratory failure) trial demonstrated that a group referred to an ECMO center demonstrated significantly increased survival compared to conventional management (63% to 47%). Ineffective treatments As of 2019, there is no evidence showing that treatments with exogenous surfactants, statins, beta-blockers or n-acetylcysteine decreases early mortality, late all-cause mortality, duration of mechanical ventilation, or number of ventilator-free days. | complications of Peritonitis | complications of Ascites | medical cause of Peritonitis | complications of Gallstone | complications of Acute liver failure | medical cause of Abdominal pain | complications of Diverticulitis | complications of Typhus | 00
| 13,092 |
Treatment of symmetrical drug related intertriginous and flexural exanthema involves identifying and stopping the causative agent. Topical steroids can help to reduce the redness. | Baboon syndrome | Kindler syndrome | GRACILE syndrome | Hurler syndrome | GAPO syndrome | Down syndrome | Rotor syndrome | Birk-Barel syndrome | 00
| 57,911 |
* A physical examination including, Wood's lamp examination and a detailed history, usually sufficient for diagnosis. * Skin examination. * Viewing medical history. | Hyperpigmentation | Hypopigmentation | Xanthosis | Dyschromia | Hypertrichosis | Sclerosis | Hyperkeratinization | Parakeratosis | 00
| 20,684 |
A<unk> is a substance that causes another substance to be secreted. One example is gastrin, which stimulates the H/K ATPase in the parietal cells (increased gastric acid production by the stomach). Pentagastrin, a synthetic gastrin, histamine, and acetylcholine are also gastric<unk> s. Insulin<unk> s, such as sulfonylureas, trigger insulin release by direct action on the KATP channel of the pancreatic beta cells. Blockage of this channel leads to depolarization and secretion of vesicles. Angiotensin II is a<unk> for aldosterone from the adrenal gland. | Secretagogue | Cholagogue | Immunostimulant | Depressogen | Chaotropic agent | Antifungal | Antiparasitic | Antisialagogue | 00
| 43,205 |
<unk> is an acronym for Prostate Imaging Reporting and Data System, defining standards of high quality clinical service for multi-parametric Magnetic Resonance Imaging (mpMRI), including image creation and reporting. | PI-RADS | BI-RADS | LI-RADS | TNM staging system | Pipkin classification | Ann Arbor staging | Microstaging | AfterImage | 00
| 67,477 |
Health care associated Sometimes dental treatment or surgical procedures in the mouth appear to precede the onset of<unk> , or sometimes persons with<unk> will blame clinicians for their<unk> . Organic disease Diagram of the divisions of the trigeminal nerve, the nerve which supplies sensation to the face. Dermatomes of the head (paired on either side). Green- ophthalmic division, red- maxillary division, yellow- mandibular division. Many persons with<unk> blame organic disease for their<unk> . Research in individuals with<unk> showed that there is increased cerebral activity (demonstrated during positron emission tomography), possibly suggesting that there is an overactive alerting mechanism to peripheral stimuli. It has been theorized that this can trigger neuropeptides to be released, and the formation of free radicals (capable of damaging cells), the release of eicosanoids (e.g. prostaglandins). There is some suggestion that<unk> is an early form of trigeminal neuralgia.<unk> may be referred from other parts of the head or other parts of the body to cause facial<unk> . Nowhere in the body is referred<unk> more well illustrated than in the face, and this is due to the richly and complexly innervated nature of the head and neck. "Neuralgia-inducing cavitational osteonecrosis" Neuralgia-inducing cavitational osteonecrosis (NICO) is a controversial term, and it is questioned to exist by many. Osteonecrosis of the jaws refers to the death of bone marrow in the maxilla or the mandible due to inadequate blood supply. It is not necessarily a<unk> ful condition,<unk> ly there will be no<unk> at all unless bone necrotic bone becomes exposed to the mouth or through the facial skin, and even then this continues to be<unk> less in some cases. When<unk> does occur, it is variable in severity, and may be neuralgiform or neuropathic in nature. The term NICO is used to describe<unk> caused by ischemic osteonecrosis of the jaws, where degenerative extracellular cystic spaces (cavitations inside the bone) are said to develop as a result of ischemia and infarctions in the bone marrow, possibly in relation to other factors such as a hereditary predisposition for thrombus formation within blood vessels, chronic low-grade dental infections and the use of vasoconstrictors in local anesthetics during dental procedures. This proposed phenomenon has been postulated to be the cause of<unk> in some patients with<unk> or trigeminal neuralgia, but this is controversial. NICO is said to be significantly more common in females, and the lesions may or may not be visible on radiographs. When they are visible, the appearance is very variable. About 60% of the lesions appear as a "hot spot" on an technetium 99 bone scan. Proponents of NICO recommend decortication (surgical removal of a section of the cortical plate, originally described as a treatment for osteomyelitis of the jaws) and curettage of the necrotic bone from the cavitation, and in some reported cases, this has relieved the chronic<unk> . However, NICO appears to show a tendency to recur and develop elsewhere in the jaws. The American Association of Endodontists Research and Scientific Affairs Committee published a position statement on NICO in 1996, stating: "Most affected sites with a postoperative NICO diagnosis have been in edentulous areas where the teeth have been lost. However, some patients with long, frustrating histories of<unk> associated with endodontically treated teeth have been presented the treatment option of tooth extraction followed by periapical curettage in an attempt to alleviate<unk> . The American Association of Endodontists cannot condone this practice when NICO is suspected. Because of the lack of clear etiological data, a NICO diagnosis should be considered only as a last resort when all possible local odontogenic causes for facial<unk> have been eliminated. If a NICO lesion is suspected in relation to an endodontically treated tooth, if possible, periradicular surgery and curettage should be attempted, not extraction. In addition, the practice of recommending the extraction of endodontically treated teeth for the prevention of NICO, or any other disease, is unethical and should be reported immediately to the appropriate state board of dentistry."<unk> trigeminal neuralgia Some suggest that<unk> is an early form of trigeminal neuralgia. Psychologic Sometimes stressful life events appear to precede the onset of<unk> , such as bereavement or illness in a family member. Hypochondriasis, especially cancerophobia, is also often cited as being involved. Most people with<unk> are "normal" people who have been under extreme stress, however other persons with<unk> have neuroses or personality disorders, and a small minority have psychoses. Some have been separated from their parents as children. Depression, anxiety and altered behavior are strongly correlated with<unk> . It is argued whether this is a sole or contributing cause of<unk> , or the emotional consequences of suffering with chronic, unrelieved<unk> . It has been suggested that over 50% of people with<unk> have concomitant depression or hypochondria. Furthermore, about 80% of persons with psychogenic facial<unk> report other chronic<unk> conditions such as listed in the table. | Atypical facial pain | Nablus mask-like facial syndrome | Necrospermia | Symmastia | Dogger Bank itch | Pellagra | Trypophobia | Focal hyperhidrosis | 00
| 61,824 |
<unk> s are found in a variety of different consumer products, agricultural products, and chemicals. Common sources of<unk> s include: * Contraceptives and Hormone Therapies<unk> s and xenoestrogens are commonly used in oral contraceptives such as birth control pills and hormone replacement therapies due to their similarities to natural hormones. * Agriculture Synthetic estrogenic drugs such as the bovine growth hormone (BVG) are commonly used to increase the size of cattle and maximize the amount of meat and dairy product that can come from them.<unk> s are also found in certain pesticides, herbicides, and fungicides. * Plastics<unk> s are found in almost all plastics, and they appear in many consumer products that use plastic elements or plastic packaging. Common<unk> s in plastics and other industrial compounds include BPA, Phthalates, PVC, and PCBs. These can be found in several household items, including plastic dishes and utensils, Styrofoam, cling wrap, flooring, toys, and other items containing plastic or plasticizers. In 2000, the FDA banned the use of phthalates in baby toys due to health concerns. * Cleaning and Cosmetic Products Many household products can contain certain<unk> s, including laundry detergent, fabric softeners, soap, shampoo, toothpaste, makeup and cosmetic products, feminine hygiene products. | Xenohormone | Neurohormone | Hormone | Local hormone | Prohormone | Gastrointestinal hormone | Sex hormone | Neurotransmitter | 00
| 61,509 |
<unk> is an angiotensin II receptor antagonist used for the treatment of high blood pressure. It is marketed in the United States as Teveten by Abbvie, the spin-off of the pharmaceutical discovery division of Abbott Laboratories; it is marketed as Eprozar by Intas Pharmaceuticals in India, and by Abbott Laboratories elsewhere. The compound came into the Abbott Laboratories cardiovascular pipeline with its acquisition of Kos Pharmaceuticals in 2006, which had licensed it, along with "a range of hypertensive treatments", from the Biovail Corporation.<unk> is sometimes paired with hydrochlorothiazide, whereupon it is marketed in the US as Teveten HCT and elsewhere as Teveten Plus. The drug acts on the renin–angiotensin system to decrease total peripheral resistance in two ways. First, it blocks the binding of angiotensin II to AT1 receptors in vascular smooth muscle, causing vascular dilatation. Second, it inhibits sympathetic norepinephrine production, further reducing blood pressure. As with other angiotensin II receptor antagonists,<unk> is generally better tolerated than enalapril (an ACE inhibitor), especially among the elderly. | Eprosartan | Telmisartan | Olmesartan | Irbesartan | Losartan | Azilsartan | Valsartan | Candesartan | 00
| 18,890 |
<unk> <unk> (the term developmental language disorder is preferred by some) is diagnosed when a child's language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. Twin studies have shown that it is under genetic influence. Although language<unk> can result from a single-gene mutation, this is unusual. More commonly<unk> results from the combined influence of multiple genetic variants, each of which is found in the general population, as well as environmental influences. | Specific language impairment | Nonverbal learning disorder | Language delay | Mixed receptive-expressive language disorder | Global perceptions of autism | Speech and language impairment | Language disorder | Global developmental delay | 00
| 24,714 |
5 minute segment of a polysomnogram, demonstrating 7 PLMs with arousals People with<unk> often do not know the cause of their excessive daytime sleepiness and their<unk><unk> s are reported by a spouse or sleep partner.<unk> cannot be diagnosed by polysomnogram (PSG) alone, it is necessary to obtain a full medical history and taking into account all available information. Polysomnography is recognized as the assessment method which brings most precise information on sleep quality, sleep structure and physiological parameters during sleep (respiration, heart rate,<unk> s). Therefore, diagnostic of<unk> can usually be established only in laboratory settings. As people usually ignore the cause of their daytime impairments, PLMS during sleep are mostly found through laboratory examination rather than clinical complaints. Video-Polysomnography may be recommended to distinguish PLMS from other leg<unk> s during sleep time which may be similar to PLMS when it comes to duration and pattern. Measures from PSG allocated to the diagnostic of<unk> are essentially based on electromyography (EMG) measuring muscle activity. EMG electrodes are usually placed on anterior tibialis muscle. Recent studies showed actigraphy may be combined to PSG as a screening tool for<unk> diagnosis. Actigraphs are watch-shaped device - usually worn by adult population on the wrist - used to record sleep and wake periods for at least a week. Recent actigraphy devices allow more precise recordings which helps evaluating if actual<unk> s meet diagnostic criteria for<unk> . Recent studies showed actigraph records reflect quite accurately PLMI criterion. Crucial for the diagnosis are the inter-movement intervals and the frequency of PLMS - each<unk> must happen within a 4 to 90 second interval from the previous<unk> . The periodic<unk><unk> index (PLMI), which corresponds to the number of periodic<unk><unk> s per hour, must be more than 15<unk> s per hour in adults and 5<unk> s or more per hour in children. The diagnosis of<unk> requires a visible cause-effect relationship between PLMS and an observed sleep disturbance or daytime impairment (both disturbance and impairment have to be clinically significant). Other relevant causes of Insomnia and Hypersomnia have to be ruled out before diagnosing<unk> (most importantly anxiety, obstructive sleep apnea, and narcolepsy). Furthermore, symptoms can not be better explained by any other conditions. For the differential diagnosis it is important to differentiate<unk> from other leg<unk> s during sleep, which are high-frequency: * alternating leg<unk> activity (ALMA) are very similar events and could be mistaken for PLMS * hypnagogic foot tremor (HFT) events are also very similar to PLMS and could be misdiagnosed * excessive fragmentary myoclonus (EFM) events are shorter than PLMS Classification<unk> is classified in the third edition of the International Classification of Sleep<unk> s (ICSD-3) which presents current sleep<unk> s nosology. ICSD-3 is divided in 7 sections and<unk> is classified in the Sleep-Related<unk><unk> s' section. There are some updates from ICSD-2. The diagnosis is more strict. A simple complaint is no longer enough: a significant clinical impairment is needed. Sleep impairments need to be clearly caused by PLMS and the symptoms also need to be explained solely by the PLMS. | Periodic limb movement disorder | Periodic paralysis | Cramp fasciculation syndrome | Essential tremor | Holmes tremor | Torsion dystonia | Lonomia | Oromandibular dystonia | 00
| 24,815 |
The word diarrhea is from the Ancient Greek from "through" and "flow". Diarrhea is the spelling in American English, whereas diarrhoea is the spelling in British English. Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain) and "the trots". | symptom of Arsenic poisoning | symptom of Lead poisoning | symptom of Carbon monoxide poisoning | symptom of Alcohol intoxication | symptom of Shigellosis | symptom of Sulfhemoglobinemia | symptoms of Toxic shock syndrome | symptom of Tuberculosis | 00
| 3,747 |
<unk> is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature as its own body temperature, thus avoiding the need for internal<unk> . The internal<unk> process is one aspect of homeostasis: a state of dynamic stability in an organism's internal conditions, maintained far from thermal equilibrium with its environment (the study of such processes in zoology has been called physiological ecology). If the body is unable to maintain a normal temperature and it increases significantly above normal, a condition known as hyperthermia occurs. Humans may also experience lethal hyperthermia when the wet bulb temperature is sustained above for six hours. The opposite condition, when body temperature decreases below normal levels, is known as hypothermia. It results when the homeostatic control mechanisms of heat within the body malfunction, causing the body to lose heat faster than producing it. Normal body temperature is around , and hypothermia sets in when the core body temperature gets lower than . Usually caused by prolonged exposure to cold temperatures, hypothermia is usually treated by methods that attempt to raise the body temperature back to a normal range. It was not until the introduction of thermometers that any exact data on the temperature of animals could be obtained. It was then found that local differences were present, since heat production and heat loss vary considerably in different parts of the body, although the circulation of the blood tends to bring about a mean temperature of the internal parts. Hence it is important to identify the parts of the body that most closely reflect the temperature of the internal organs. Also, for such results to be comparable, the measurements must be conducted under comparable conditions. The rectum has traditionally been considered to reflect most accurately the temperature of internal parts, or in some cases of sex or species, the vagina, uterus or bladder. Some animals undergo one of various forms of dormancy where the<unk> process temporarily allows the body temperature to drop, thereby conserving energy. Examples include hibernating bears and torpor in bats. | Thermoregulation | Neurosecretion | Hemostasis | Vasoactivity | Cardiac cycle | Cardiovascular physiology | Bone conduction | Coagulation | 00
| 11,600 |
Lifestyle Weight-bearing endurance exercise and/or exercises to strengthen muscles improve bone strength in those with osteoporosis. Aerobics, weight bearing, and resistance exercises all maintain or increase BMD in postmenopausal women. Fall prevention can help prevent osteoporosis complications. There is some evidence for hip protectors specifically among those who are in care homes. Pharmacologic Therapy The US National Osteoporosis Foundation recommends pharmacologic treatment for patients with hip of spine fracture thought to be related to osteoporosis, those with BMD 2.5 SD or more below the young normal mean (T-score -2.5 or below), and those with BMD between 1 and 2.5 SD below normal mean whose 10-year risk, using FRAX, for hip fracture is equal or more than 3%. Bisphosphonates are useful in decreasing the risk of future fractures in those who have already sustained a fracture due to osteoporosis. This benefit is present when taken for three to four years. They do not appear to change the overall risk of death. Tentative evidence does not support the use of bisphosphonates as a standard treatment for secondary osteoporosis in children. Different bisphosphonates have not been directly compared, therefore it is unknown if one is better than another. Fracture risk reduction is between 25 and 70% depending on the bone involved. There are concerns of atypical femoral fractures and osteonecrosis of the jaw with long-term use, but these risks are low. With evidence of little benefit when used for more than three to five years and in light of the potential adverse events, it may be appropriate to stop treatment after this time. One medical organization recommends that after five years of medications by mouth or three years of intravenous medication among those at low risk, bisphosphonate treatment can be stopped. In those at higher risk they recommend up to ten years of medication by mouth or six years of intravenous treatment. The goal of osteoporosis management is to prevent osteoporotic fractures, but for those who have sustained one already it is more urgent to prevent a secondary fracture. That is because patients with a fracture are more likely to experience a recurrent fracture, with marker increase in morbidity and mortality compared. Among the five bisphosphonates, no significant differences were found for a secondary fracture for all fracture endpoints combined. That being said, alendronate was identified as the most efficacious for secondary prevention of vertebral and hip fractures while zoledronate showed better performance for nonvertebral non-hip fracture prevention. For those with osteoporosis but who have not had a fracture, evidence does not support a reduction in fracture risk with risedronate or etidronate. Alendronate decreases fractures of the spine but does not have any effect on other types of fractures. Half stop their medications within a year. When on treatment with bisphosphonates rechecking bone mineral density is not needed. There is tentative evidence of benefit in males with osteoporosis. Fluoride supplementation does not appear to be effective in postmenopausal osteoporosis, as even though it increases bone density, it does not decrease the risk of fractures. Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women with postmenopausal osteoporosis. Some evidence also indicates strontium ranelate is effective in decreasing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Hormone replacement therapy, while effective for osteoporosis, is only recommended in women who also have menopausal symptoms. It is not recommended for osteoporosis by itself. Raloxifene, while effective in decreasing vertebral fractures, does not affect the risk of nonvertebral fracture. And while it reduces the risk of breast cancer, it increases the risk of blood clots and strokes. While denosumab is effective at preventing fractures in women, there is not clear evidence of benefit in males. In hypogonadal men, testosterone has been shown to improve bone quantity and quality, but, as of 2008, no studies evaluated its effect on fracture risk or in men with a normal testosterone levels. Calcitonin while once recommended is no longer due to the associated risk of cancer and questionable effect on fracture risk. Alendronic acid/colecalciferol can be taken to treat this condition in post-menopausal women. Certain medications like alendronate, etidronate, risedronate, raloxifene, and strontium ranelate can help to prevent osteoporotic fragility fractures in postmenopausal women with osteoporosis. Tentative evidence suggests that Chinese herbal medicines may have potential benefits on bone mineral density. | complications of Kallmann syndrome | onset of Kallmann syndrome | complications of Klinefelter syndrome | medical cause of Hyperdontia | medical cause of Precocious puberty | complications of Growth hormone deficiency | symptom of Kallmann syndrome | complications of Prader–Willi syndrome | 00
| 1,597 |
They present over a wide age range (birth to about 65 years), but within the head and neck region, about 50% of cases develop in patients younger than 15 years of age. Within the head and neck, males are affected about 2–3 times more often than females. | Fetal rhabdomyoma | Fetal adenocarcinoma | Uremic fetor | Fetal trimethadione syndrome | Gestational choriocarcinoma | Mixed Müllerian tumor | Heterotopic pregnancy | Embryoma | 00
| 62,537 |
<unk> , sold under the brand name Gocovri among others, is a medication used to treat dyskinesia associated with parkinsonism and influenza caused by type A influenzavirus, though its use for the latter is no longer recommended due to widespread drug resistance. It acts as a nicotinic antagonist, dopamine agonist, and noncompetitive NMDA antagonist. The antiviral mechanism of action is antagonism of the influenzavirus A M2 proton channel, which prevents endosomal escape (i.e. the release of viral genetic material into the host cytoplasm).<unk> was first used for the treatment of influenza A. After antiviral properties were initially reported in 1963,<unk> received approval for prophylaxis against the influenza virus A in 1976. However,<unk> -resistant influenza viruses were first reported during the 1980 influenza A epidemic and resistance frequency continued to rise into the early 2000s. Currently,<unk> is no longer recommended for the treatment of influenza A due to a high level of<unk> resistance among circulating influenza A viruses. In 1973, the Food and Drug Administration (FDA) approved<unk> for use in the treatment of Parkinson's disease. In 2017, the extended release formulation was approved for use in the treatment of levodopa-induced dyskinesia. Off-label uses include improvement of fatigue in multiple sclerosis and accelerating the rate of functional recovery and arousal following a brain injury.<unk> has a mild side effect profile. Common neurological side effects include drowsiness, light headedness, dizziness, and confusion. Due to its effects on the central nervous system, it should not be combined with additional CNS stimulants or anticholinergic drugs.<unk> is contraindicated in persons with end stage kidney disease, given that the drug is cleared by the kidneys. It should also be taken with caution in those with enlarged prostates or glaucoma, due to its anticholinergic effects. Live attenuated vaccines are contraindicated while taking<unk> , as it may limit the efficacy of the administered vaccine. | Amantadine | Rimantadine | Quifenadine | Alcaftadine | Umifenovir | Tecovirimat | Rupatadine | Inadine | 00
| 20,874 |
Individuals with<unk> , particularly those without symptoms, often require no treatment. Those with<unk> and symptoms of dysautonomia (palpitations, chest pain) may benefit from beta-blockers (e.g., propranolol, metoprolol, bisoprolol). People with prior stroke or atrial fibrillation may require blood thinners, such as aspirin or warfarin. In rare instances when<unk> is associated with severe mitral regurgitation, surgical repair or replacement of the mitral valve may be necessary. Mitral valve repair is generally considered preferable to replacement. Current ACC/AHA guidelines promote repair of mitral valve in people before symptoms of heart failure develop. Symptomatic people, those with evidence of diminished left ventricular function, or those with left ventricular dilatation need urgent attention. Prevention of infective endocarditis Individuals with<unk> are at higher risk of bacterial infection of the heart, called infective endocarditis. This risk is approximately three-to eightfold the risk of infective endocarditis in the general population. Until 2007, the American Heart Association recommended prescribing antibiotics before invasive procedures, including those in dental surgery. Thereafter, they concluded that "prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis." Many organisms responsible for endocarditis are slow-growing and may not be easily identified on routine blood cultures (these fastidious organisms require special culture media to grow). These include the HACEK organisms, which are part of the normal oropharyngeal flora and are responsible for perhaps 5 to 10% of infective endocarditis affecting native valves. It is important when considering endocarditis to keep these organisms in mind. | Mitral valve prolapse | Da Costa's syndrome Da Costa's syndrome 1 | Mitral regurgitation | Aortic regurgitation | Mitral stenosis | Tricuspid regurgitation | Tricuspid valve stenosis | Pulmonary valve stenosis | 00
| 14,080 |
<unk> is typically used to treat hypothyroidism, and is the treatment of choice for people with hypothyroidism, who often require lifelong thyroid hormone therapy. It may also be used to treat goiter via its ability to lower thyroid-stimulating hormone (TSH), which is considered goiter-inducing.<unk> is also used as interventional therapy in people with nodular thyroid disease or thyroid cancer to suppress TSH secretion. A subset of people with hypothyroidism treated with an appropriate dose of<unk> will describe continuing symptoms despite TSH levels in the normal range. In these people, further laboratory and clinical evaluation is warranted, as they may have another cause for their symptoms. Furthermore, reviewing their medications and possible dietary supplements is important, as several medications can affect thyroid hormone levels.<unk> is also used to treat subclinical hypothyroidism, which is defined by an elevated TSH level and a normal-range free<unk> level without symptoms. Such people may be asymptomatic and whether they should be treated is controversial. One benefit of treating this population with<unk> therapy is preventing development of hypothyroidism. As such, treatment should be taken into account for patients with initial TSH levels above 10 mIU/l, people with elevated thyroid peroxidase antibody titers, people with symptoms of hypothyroidism and TSH levels of 5–10 mIU/l, and women who are pregnant or want to become pregnant. Oral dosing for patients with subclinical hypothyroidism is 1 μg/kg/day. It is also used to treat myxedema coma, which is a severe form of hypothyroidism characterized by mental status changes and hypothermia. As it is a medical emergency with a high mortality rate, it should be treated in the intensive-care unit with thyroid hormone replacement and aggressive management of individual organ system complications. Generic<unk> , 25-μg oral tablet Dosages vary according to the age groups and the individual condition of the person, body weight, and compliance to the medication and diet. Other predictors of the required dosage are sex, body mass index, deiodinase activity (SPINA-GD), and etiology of hypothyroidism. Annual or semiannual clinical evaluations and TSH monitoring are appropriate after dosing has been established.<unk> is taken on an empty stomach about half an hour to an hour before meals. As such, thyroid replacement therapy is usually taken 30 minutes prior to eating in the morning. For patients with trouble taking<unk> in the morning, bedtime dosing is effective, as well. A study in 2015 showed greater efficacy of<unk> when taken at bedtime. Doses of<unk> that normalize serum TSH may not normalize abnormal levels of LDL cholesterol and total cholesterol. Poor compliance in taking the medicine is the most common cause of elevated TSH levels in people receiving appropriate doses of<unk> . 50 and older For older people (over 50 years old) and people with known or suspected ischemic heart disease,<unk> therapy should not be initiated at the full replacement dose. Since thyroid hormone increases the heart's oxygen demand by increasing heart rate and contractility, starting at higher doses may cause an acute coronary syndrome or an abnormal heart rhythm. Pregnancy and breastfeeding Hypothyroidism is common among pregnant women. A nationwide cohort study showed that 1.39% of all pregnant women in 2010 in Denmark received a prescription of<unk> during pregnancy. According to the U.S. Food and Drug Administration pregnancy categories,<unk> has been assigned category A. Given that no increased risk of congenital abnormalities has been demonstrated in pregnant women taking<unk> , therapy should be continued during pregnancy. Furthermore, therapy should be immediately administered to women diagnosed with hypothyroidism during pregnancy, as hypothyroidism is associated with a higher rate of complications, such as spontaneous abortion, preeclampsia, and premature birth. Thyroid hormone requirements increase during and last throughout pregnancy. As such, pregnant women are recommended to increase to nine doses of<unk> each week, rather than the usual seven, as soon as their pregnancy is confirmed. Repeat thyroid function tests should be done five weeks after the dosage is increased. While a minimal amount of thyroid hormones is found in breast milk, the amount does not influence infant plasma thyroid levels. Furthermore,<unk> was not found to cause any adverse events to the infant or mother during breastfeeding. As adequate concentrations of thyroid hormone are required to maintain normal lactation, appropriate<unk> doses should be administered during breastfeeding. Children<unk> is safe and effective for children with hypothyroidism; the goal of treatment for children with hypothyroidism is to reach and preserve normal intellectual and physical development. | Levothyroxine | Cortisone acetate | Cortisone | Fludrocortisone | Calcipotriol | Potassium iodide | Liothyronine | Hypophysectomy | 00
| 24,312 |
The exact pathogenesis is dependent upon the cause. Ulcers and erosions can be the result of a spectrum of conditions including those causing auto-immune epithelial damage, damage because of an immune defect (e.g., HIV, leukemia, infections e.g. herpes viruses) or nutritional disorders (e.g., vitamin deficiencies). Simple mechanisms which predispose the<unk> to trauma and ulceration are xerostomia (dry<unk> – as saliva usually lubricates the mucous membrane and controls bacterial levels) and epithelial atrophy (thinning, e.g., after radiotherapy), making the lining more fragile and easily breached. Stomatitis is a general term meaning inflammation within the<unk> , and often may be associated with ulceration. Pathologically, the<unk> represents a transition between the gastrointestinal tract and the skin, meaning that many gastrointestinal and cutaneous conditions can involve the<unk> . Some conditions usually associated with the whole gastrointestinal tract may present only in the<unk> , e.g., orofacial granulomatosis/oral Crohn's disease. Similarly, cutaneous (skin) conditions can also involve the<unk> and sometimes only the<unk> , sparing the skin. The different environmental conditions (saliva, thinner mucosa, trauma from teeth and food), mean that some cutaneous disorders which produce characteristic lesions on the skin produce only non specific lesions in the<unk> . The vesicles and bullae of blistering mucocutaneous disorders progress quickly to ulceration in the<unk> , because of moisture and trauma from food and teeth. The high bacterial load in the<unk> means that ulcers may become secondarily infected. Cytotoxic drugs administered during chemotherapy target cells with fast turnovers such as malignant cells. However, the epithelia of the<unk> also has a high turnover rate and makes oral ulceration (mucositis) a common side effect of chemotherapy. Erosions, which involve the epithelial layer, are red in appearance since the underlying lamina propria shows through. When the full thickness of the epithelium is penetrated (ulceration), the lesion becomes covered with a fibrinous exudate and takes on a yellow-grey color. Because an ulcer is a breach of the normal lining, when seen in cross section, the lesion is a crater. A "halo" may be present, which is a reddening of the surrounding mucosa and is caused by inflammation. There may also be edema (swelling) around the ulcer. Chronic trauma may produce an ulcer with a keratotic (white, thickened mucosa) margin. Malignant lesions may ulcerate either because the tumor infiltrates the mucosa from adjacent tissues, or because the lesion originates within the mucosa itself, and the disorganized growth leads to a break in the normal architecture of the lining tissues. Repeat episodes of<unk> s can be indicative of an immunodeficiency, signaling low levels of immunoglobulin in the oral mucous membranes. Chemotherapy, HIV, and mononucleosis are all causes of immunodeficiency/immunosuppression with which oral ulcers may become a common manifestation. Autoimmunity is also a cause of oral ulceration. Mucous membrane pemphigoid, an autoimmune reaction to the epithelial basement membrane, causes desquamation/ulceration of the oral mucosa. Numerous aphthous ulcers could be indicative of an inflammatory autoimmune disease called Behçet's disease. This can later involve skin lesions and uveitis in the eyes. Vitamin C deficiency may lead to scurvy which impairs wound healing, which can contribute to ulcer formation. For a detailed discussion of the pathophysiology of aphthous stomatitis, see Aphthous stomatitis#Causes. | Mouth ulcer | Geographic tongue | Stercoral ulcer | Dental abscess | Callous ulcer | Pouchitis | Skin fissure | Tropical ulcer | 00
| 9,372 |
<unk> s have been reported in the English literature to develop in children and young adults aged from 2 to 38 years (median age ~17 years). However, a recent study in the Chinese literature reported on three cases in infants <1 year old. LPF-NTs have almost always been superficially situated and occurring primarily in the legs and arms with fewer cases in the head, neck, and trunk areas. Three cases of primary and one case of recurrent LPF-NT<unk> s presented with infiltration into the adjacent skeletal muscles and one recently reported case presented with the<unk> situated in, and limited to, the lumbar spine. The<unk> s have ranged from 1.3 cm to 8.7 cm in maximum diameter; may be tender but usually are painless (although the lumbar spine<unk> presented with intermittent abdominal pain); and may be pigmented. In as high as 30% of cases, patients treated with surgical removal of the LPF-NT have presented with recurrent<unk> s at the site of surgery. The recurrent<unk> s have, in general, showed similar features to the primary<unk> s. In particular, they almost always continue to act in a non-malignant manner. | Lipofibromatosis-like neural tumor | Neural fibrolipoma | Eccrine angiomatous hamartoma | Embryonal tumour with multilayered rosettes | Folliculosebaceous cystic hamartoma | Intranodal palisaded myofibroblastoma | Perivascular epithelioid cell tumour | Aggressive angiomyxoma | 00
| 74,727 |
Most affected people have a stable clinical course but are often transfusion dependent. | Chromosome 5q deletion syndrome | Chromosomal deletion syndrome | 13q deletion syndrome | 22q11.2 distal deletion syndrome | 22q11.2 duplication syndrome | 22q13 deletion syndrome | 1q21.1 deletion syndrome | 2q37 deletion syndrome | 00
| 22,391 |
No prevention mechanism exists for Sjögren's<unk> (SS) because of its complexity as an autoimmune disorder, but lifestyle changes can reduce the risk factors related to developing SS or reduce the severity of the condition for patients who have already been diagnosed. Diet is strongly associated with the inflammation seen in many autoimmune related diseases, including SS. An experimental study concluded that SS patients often show high sensitivity to gluten that directly relates to inflammation. Moderate exercise is also helpful in SS patients, mainly reducing the effect of lung inflammation. | medical cause of Dry eye syndrome | medical cause of Stye | symptom of Meesmann corneal dystrophy | complications of Sympathetic ophthalmia | medical cause of Vertigo | picture of Graves' ophthalmopathy | medical cause of Conjunctivitis | symptom of Reye syndrome | 00
| 4,302 |
Antihistamine agents are the typically prescribed drug for the treatment of<unk> . They block the effect of histamine, a compound produced by the body which forms a part of the local immune response consequently causing inflammation. Some research has suggested that the use antihistamines and antagonist in synergy are better for the treatment of<unk> s. The cascade of events that link the autoantibody-antigen reaction with the production and release of histamine is not well characterized. Therefore, the focus of treatment for<unk> has been on characterizing the effectiveness of antihistamines rather than analysis of receptor binding or the pathomechanisms. | Physical urticaria | Cold urticaria | Pressure urticaria | Solar urticaria | Cholinergic urticaria | Delayed pressure urticaria | Heat urticaria | Dermatographic urticaria | 00
| 35,774 |
<unk> is a heterocyclic organic compound with the chemical structure shown at right. It is an aromatic compound that has two benzene rings fused to a central furan ring. All the numbered carbon atoms have a hydrogen atom bonded to each of them. It is a volatile white solid that is soluble in nonpolar organic solvents. It is obtained from coal tar, where it exists as a 1% component. | Dibenzofuran | Triphenylbromoethylene | Desmethylchlorotrianisene | Triphenylchloroethylene | Paraquat | Vinyl chloride | Chlorotrianisene | Diiodohydroxyquinoline | 00
| 22,694 |
Similar to many general anesthetics, the exact mechanism of the action has not been clearly delineated.<unk> reduces pain sensitivity (analgesia) and relaxes muscles.<unk> likely binds to GABA, glutamate and glycine receptors, but has different effects on each receptor.<unk> acts as a positive allosteric modulator of the GABAA receptor in electrophysiology studies of neurons and recombinant receptors. It potentiates glycine receptor activity, which decreases motor function. It inhibits receptor activity in the NMDA glutamate receptor subtypes.<unk> inhibits conduction in activated potassium channels.<unk> also affects intracellular molecules. It inhibits plasma membrane calcium ATPases (PMCAs) which affects membrane fluidity by hindering the flow of Ca2+ (calcium ions) out across the membrane, this in turn affects neuron depolarization. It binds to the D subunit of ATP synthase and NADH dehydrogenase. General anaesthesia with<unk> reduces plasma endocannabinoid AEA concentrations, and this could be a consequence of stress reduction after loss of consciousness. | Isoflurane | Methoxyflurane | Desflurane | Halothane | Sevoflurane | Etomidate | Ketamine | Remifentanil | 00
| 10,973 |
Carbon dioxide is a normal metabolic product but it accumulates in the body if it is produced faster than it is cleared. During strenuous exercise the production rate of carbon dioxide can increase more than tenfold over the production rate during rest. Carbon dioxide is dissolved in the blood and elimination is by gas exchange in the lungs during breathing.<unk> is generally caused by hypoventilation, lung disease, or diminished consciousness. It may also be caused by exposure to environments containing abnormally high concentrations of carbon dioxide, such as from volcanic or geothermal activity, or by rebreathing exhaled carbon dioxide. In this situation the<unk> can also be accompanied by respiratory acidosis. Acute<unk> respiratory failure may occur in acute illness caused by chronic obstructive pulmonary disease (COPD), chest wall deformity, some forms of neuromuscular disease (such as myasthenia gravis, and obesity hypoventilation syndrome. AHRF may also develop in any form of respiratory failure where the breathing muscles become exhausted, such as severe pneumonia and acute severe asthma. It can also be a consequence of profound suppression of consciousness such as opioid overdose. During diving Normal respiration in divers results in alveolar hypoventilation resulting in inadequate CO2 elimination or<unk> . Lanphier's work at the US Navy Experimental Diving Unit answered the question, "Why don't divers breathe enough?": * Higher inspired oxygen () at accounted for not more than 25% of the elevation in end tidal CO2 (ETCO2) above values found at the same work rate when breathing air just below the surface. * Increased work of breathing accounted for most of the elevation of (alveolar gas equation) in exposures above , as indicated by the results when helium was substituted for nitrogen at . * Inadequate ventilatory response to exertion was indicated by the fact that, despite resting values in the normal range, rose markedly with exertion even when the divers breathed air at a depth of only a few feet. A variety of reasons exists for carbon dioxide not being expelled completely when the diver exhales: * The diver is exhaling into a vessel that does not allow all the CO2 to escape to the environment, such as a long snorkel, full-face diving mask, or diving helmet, and the diver then reinhales from that vessel, causing increased dead space. * The carbon dioxide scrubber in the diver's rebreather is failing to remove sufficient carbon dioxide from the loop (higher inspired CO2), or the breathing gas is contaminated with CO2. * The diver is overexercising, producing excess carbon dioxide due to elevated metabolic activity and respiratory gas exchange cannot keep up with the metabolic production of carbon dioxide. * Gas density limits ventilation at high ambient pressures. The density of the breathing gas is higher at depth, so the effort required to fully inhale and exhale increases, making breathing more difficult and less efficient (high work of breathing). Higher gas density also causes gas mixing within the lung to be less efficient, thus increasing the effective dead space. * The diver is deliberately hypoventilating, known as "skip breathing". Skip breathing Skip breathing is a controversial technique to conserve breathing gas when using open-circuit scuba, which consists of briefly holding one's breath between inhalation and exhalation (i.e., "skipping" a breath). It can lead to CO2 not being exhaled efficiently. The risk of burst lung (pulmonary barotrauma of ascent) is increased if the breath is held while ascending. It is particularly counterproductive with a rebreather, where the act of breathing pumps the gas around the "loop", pushing carbon dioxide through the scrubber and mixing freshly injected oxygen. In closed-circuit rebreather diving, exhaled carbon dioxide must be removed from the breathing system, usually by a scrubber containing a solid chemical compound with a high affinity for CO2, such as soda lime. If not removed from the system, it may be reinhaled, causing an increase in the inhaled concentration. Under hyperbaric conditions,<unk> contributes to nitrogen narcosis and oxygen toxicity by causing cerebral vasodilation which increases the dosage of oxygen to the brain. | Hypercapnia | Hypocapnia | Acidosis | Alkalosis | Metabolic alkalosis | Hypoxemia | Metabolic acidosis | Hypoventilation | 00
| 13,285 |
alt<unk> is a common encapsulated, Gram-negative, strict aerobic (although can grow anaerobically in the presence of nitrate), Rod-shaped bacterium that can cause disease in plants and animals, including humans. A species of considerable medical importance,<unk> is a multidrug resistant<unk> thogen recognized for its ubiquity, its intrinsically advanced antibiotic resistance mechanisms, and its association with serious illnesses – hospital-acquired infections such as ventilator-associated pneumonia and various sepsis syndromes. The organism is considered opportunistic insofar as serious infection often occurs during existing diseases or conditions – most notably cystic fibrosis and traumatic burns. It generally affects the immunocompromised but can also infect the immunocompetent as in hot tub folliculitis. Treatment of<unk> infections can be difficult due to its natural resistance to antibiotics. When more advanced antibiotic drug regimens are needed adverse effects may result. It is citrate, catalase, and oxidase positive. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also in low-oxygen atmospheres, thus has colonized many natural and artificial environments. It uses a wide range of organic material for food; in animals, its versatility enables the organism to infect damaged tissues or those with reduced immunity. The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs, such as the lungs, the urinary tract, and kidneys, the results can be fatal. Because it thrives on moist surfaces, this bacterium is also found on and in medical equipment, including catheters, causing cross-infections in hospitals and clinics. It is also able to decompose hydrocarbons and has been used to break down tarballs and oil from oil spills.<unk> is not extremely virulent in comparison with other major<unk> thogenic bacterial species – for example the Gram-positive Staphylococcus aureus and Streptococcus pyogenes – though<unk> is capable of extensive colonization, and can aggregate into enduring biofilms. | Pseudomonas aeruginosa | Acinetobacter baumannii | Staphylococcus aureus | Streptococcus bovis | Enterobacter cloacae | Bacillus cereus | Bacillus anthracis | Pasteurella | 00
| 28,439 |
The<unk> <unk> r lobe), or anterior end of the inferior<unk> , abuts against the roof of the fourth ventricle, and can only be distinctly seen after the cerebellum has been separated from the medulla oblongata and pons. On either side of the<unk> is a thin layer of white substance, named the posterior medullary velum. It is semilunar in form, its convex border being continuous with the white substance of the cerebellum; it extends on either side as far as the flocculus. | Nodule of vermis | Epicles | Tapetum lucidum | Pretectal area | Genu valgum | Infundibulum | Cutaneous horn | Stratum granulosum | 00
| 49,777 |
The key elements of the HPA axis are: * The paraventricular nucleus of the hypothalamus, which contains neuroendocrine neurons which synthesize and secrete vasopressin and corticotropin-releasing hormone (CRH). These two peptides regulate: * The anterior lobe of the<unk> gland. In particular, CRH and vasopressin stimulate the secretion of adrenocorticotropic hormone (ACTH), once known as corticotropin. ACTH in turn acts on: * the<unk> cortex, which produces glucocorticoid hormones (mainly cortisol in humans) in response to stimulation by ACTH. Glucocorticoids in turn act back on the hypothalamus and<unk> (to suppress CRH and ACTH production) in a negative feedback cycle. CRH and vasopressin are released from neurosecretory nerve terminals at the median eminence. CRH is transported to the anterior<unk> through the portal blood vessel system of the hypophyseal stalk and vasopressin is transported by axonal transport to the posterior<unk> gland. There, CRH and vasopressin act synergistically to stimulate the secretion of stored ACTH from corticotrope cells. ACTH is transported by the blood to the<unk> cortex of the<unk> gland, where it rapidly stimulates biosynthesis of corticosteroids such as cortisol from cholesterol. Cortisol is a major stress hormone and has effects on many tissues in the body, including the brain. In the brain, cortisol acts on two types of receptor – mineralocorticoid receptors and glucocorticoid receptors, and these are expressed by many different types of neurons. One important target of glucocorticoids is the hypothalamus, which is a major controlling centre of the HPA axis. Vasopressin can be thought of as "water conservation hormone" and is also known as "antidiuretic hormone." It is released when the body is dehydrated and has potent water-conserving effects on the kidney. It is also a potent vasoconstrictor. Important to the function of the HPA axis are some of the feedback loops: * Cortisol produced in the<unk> cortex will negatively feedback to inhibit both the hypothalamus and the<unk> gland. This reduces the secretion of CRH and vasopressin, and also directly reduces the cleavage of proopiomelanocortin (POMC) into ACTH and β-endorphins. * Epinephrine and norepinephrine (E/NE) are produced by the<unk> medulla through sympathetic stimulation and the local effects of cortisol (upregulation enzymes to make E/NE). E/NE will positively feedback to the<unk> and increase the breakdown of POMCs into ACTH and β-endorphins. | Hypothalamic–pituitary–adrenal axis | Hypothalamic–pituitary–somatotropic axis | Hypothalamic–pituitary–thyroid axis | Sympathoadrenal system | Hypothalamic–pituitary–gonadal axis | Hypothalamic–pituitary–prolactin axis | Parasympathetic nervous system | Autonomic nervous system | 00
| 7,523 |
<unk> is a tricyclic compound, specifically a dibenzazepine, and possesses three rings fused together with a side chain attached in its chemical structure. Other dibenzazepine TCAs include imipramine, desipramine, clomipramine, and trimipramine.<unk> is a tertiary amine TCA, with its side chain-demethylated metabolite desipramine being a secondary amine. Unlike other tertiary amine TCAs,<unk> has a bulky 4-chlorobenzoylmethyl substituent on its amine instead of a methyl group. Although<unk> is technically a tertiary amine, it acts in large part as a prodrug of desipramine, and is more similar to secondary amine TCAs in its effects. Other secondary amine TCAs besides desipramine include nortriptyline and protriptyline. The chemical name of<unk> is N-(4-chlorobenzoylmethyl)-3-(10,11-dihydro-5H-dibenzob,fazepin-5-yl)-N-methylpropan-1-amine and its free base form has a chemical formula of C26H27ClN2O with a molecular weight of 418.958 g/mol. The drug is used commercially mostly as the hydrochloride salt; the free base form is not used. The CAS Registry Number of the free base is 23047-25-8 and of the hydrochloride is 26786-32-3. | Lofepramine | Diphenhydramine | Sibutramine | Dezocine | Palonosetron | Zotepine | Avacopan | Quinupramine | 00
| 38,598 |
R-groups determine the chemical properties of the drug, and distinguishes individual types of<unk> s. This chemical structure affords a high affinity for calcium hydroxyapatite, allowing for rapid and specific skeletal targeting.<unk> s are a class of drugs that prevent the loss of bone density, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called<unk> s because they have two phosphonate () groups. They are thus also called diphosphonates (bis- or di- + phosphonate). Evidence shows that they reduce the risk of fracture in post-menopausal women with osteoporosis. Bone tissue undergoes constant remodeling and is kept in balance (homeostasis) by osteoblasts creating bone and osteoclasts destroying bone.<unk> s inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss. The uses of<unk> s include the prevention and treatment of osteoporosis, Paget's disease of bone, bone metastasis (with or without hypercalcemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, fibrous dysplasia, and other conditions that exhibit bone fragility. | Bisphosphonate | Phosphate binder | Pamidronic acid | Etidronic acid | Sulfonylurea | Allopurinol | Risedronic acid | Alendronic acid | 00
| 15,167 |
<unk> (NMZL) is an uncommon form of marginal-zone lymphoma that can produce colonization of the follicles in the lymph node. It is a form of low grade lymphoma with similar incidence in men and women and a mean age of 61 years (range 26–92 years). It is often associated with Sjogren syndrome. It shows interfollicular infiltrate of monocytoid, centrocyte-like B cells that are 2–3× larger than small lymphocytes with partial/total effacement of lymph node architecture. | Nodal marginal zone B cell lymphoma | Marginal zone B-cell lymphoma | Splenic marginal zone lymphoma | Pediatric-type follicular lymphoma | Fibrin-associated diffuse large B-cell lymphoma | Diffuse large B-cell lymphoma | Primary mediastinal B-cell lymphoma | Follicular lymphoma | 00
| 50,893 |
History and physical examination are central to the diagnostic workup in<unk> . The history typically includes the present illness, family history, general medical history, diet, medication use, drug use and occupation. The physical examination typically includes an assessment of volume state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and flank. A rash may be relevant too, especially as an indicator of autoimmune disease. Examination of the urine (urinalysis) allows a direct assessment for possible kidney problems, which may be suggested by appearance of blood in the urine (hematuria), protein in the urine (proteinuria), pus cells in the urine (pyuria) or cancer cells in the urine. A 24-hour urine collection used to be used to quantify daily protein loss (see proteinuria), urine output, creatinine clearance or electrolyte handling by the renal tubules. It is now more common to measure protein loss from a small random sample of urine. Basic blood tests can be used to check the concentration of hemoglobin, white count, platelets, sodium, potassium, chloride, bicarbonate, urea, creatinine, albumin, calcium, magnesium, phosphate, alkaline phosphatase and parathyroid hormone (PTH) in the blood. All of these may be affected by kidney problems. The serum creatinine concentration is the most important blood test as it is used to estimate the function of the kidney, called the creatinine clearance or estimated glomerular filtration rate (GFR). It is a good idea for patients with longterm kidney disease to know an up-to-date list of medications, and their latest blood tests, especially the blood creatinine level. In the United Kingdom, blood tests can monitored online by the patient, through a website called RenalPatientView. More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as infections (hepatitis B, hepatitis C), autoimmune conditions (systemic lupus erythematosus, ANCA vasculitis), paraproteinemias (amyloidosis, multiple myeloma) and metabolic diseases (diabetes, cystinosis). Structural abnormalities of the kidneys are identified with imaging tests. These may include Medical ultrasonography/ultrasound, computed axial tomography (CT), scintigraphy (nuclear medicine), angiography or magnetic resonance imaging (MRI). In certain circumstances, less invasive testing may not provide a certain diagnosis. Where definitive diagnosis is required, a biopsy of the kidney (renal biopsy) may be performed. This typically involves the insertion, under local anaesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. The kidney tissue is then examined under a microscope, allowing direct visualization of the changes occurring within the kidney. Additionally, the pathology may also stage a problem affecting the kidney, allowing some degree of prognostication. In some circumstances, kidney biopsy will also be used to monitor response to treatment and identify early relapse. A transplant kidney biopsy may also be performed to look for rejection of the kidney. | Nephrology | Urology | Andrology | Sophrology | Neurology | Haematologica | Hematology | Rheum | 00
| 1,559 |
The primary symptoms of hypotension are lightheadedness or dizziness. If the blood pressure is sufficiently low, fainting (syncope) may occur. Low blood pressure is sometimes associated with certain symptoms, many of which are related to causes rather than effects of hypotension: * chest pain * shortness of breath * irregular heartbeat * fever higher than 38.3 °C (101 °F) * headache * stiff neck * severe upper back pain * cough with sputum * prolonged diarrhea or vomiting * shakiness (shivering) * loss of appetite * dyspepsia (indigestion) * dysuria (painful urination) * acute, life-threatening allergic reaction * seizures * loss of consciousness * profound fatigue * temporary blurring or loss of vision * black tarry stools | symptom of Cardiogenic shock | symptoms of Cardiogenic shock | symptom of Myocardial infarction | symptom of Arrhythmia | symptom of Cardiac tamponade | symptom of Sepsis | symptom of Ventricular fibrillation | symptom of Malignant hyperthermia | 00
| 13,313 |
The<unk> is a rare delusional misidentification syndrome in which a person experiences the delusion that they have a<unk> or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own. The syndrome is also called the syndrome of<unk> of the self, delusion of<unk><unk> , or simply<unk><unk> . Sometimes, the patient is under the impression that there is more than one<unk> A<unk> may be projected onto any person, from a stranger to a family member. This syndrome is often diagnosed during or after the onset of another mental disorder, such as schizophrenia or other disorders involving psychotic hallucinations. There is no widely accepted method of treatment, as most patients require individualized therapy. The prevalence of this disease is relatively low, as few cases have been reported since the disease was defined in 1978 by George Nikolaos Christodoulou (b.1935), a Greek-American Psychiatrist. However,<unk><unk> is not clearly defined in literature, and therefore may be under-reported. | Syndrome of subjective doubles | Postorgasmic illness syndrome | Functional somatic syndrome | Paroxysmal extreme pain disorder | Vitreous touch syndrome | Nociplastic pain | Pseudobulbar affect | Feline hyperesthesia syndrome | 00
| 25,017 |
Electroencephalogram (EEG) displaying burst suppression patterns. Onset of bursts are indicated by solid arrows; offset, by open arrows. In both A and B, the interval between each vertical dotted line is one second The diagnosis is based on the clinical presentation and on typical electroencephalographic patterns based on time of onset. Typically, onset of seizures and spasms have been indicative of OS diagnosis, while MRI and Abormal EEG "burst suppression" pattern can confirm. Genetic testing with chromosomal microarray analysis followed by an epilepsy gene panel or whole exome sequencing may be considered after MRI imaging has been exhausted. Differential diagnoses between other epileptic encephalopathies such as West syndrome or Lennox-Gastaut syndrome are distinguished by myoclonic seizures and differences in spike-and-wave patterns on EEG. | Ohtahara syndrome | Pallister–Killian syndrome | Cohen syndrome | Cohen-Gibson syndrome | Berdon syndrome | Scheie syndrome | Gleich's syndrome | Christianson syndrome | 00
| 48,002 |
Up to 90% of people infected with H. pylori never experience symptoms or complications. However, individuals infected with H. pylori have a 10% to 20% lifetime risk of developing peptic ulcers. Acute infection may appear as an acute<unk> with abdominal pain (stomach ache) or nausea. Where this develops into chronic<unk> , the symptoms, if present, are often those of non-ulcer dyspepsia: Stomach pains, nausea, bloating, belching, and sometimes vomiting. Pain typically occurs when the stomach is empty, between meals, and in the early morning hours, but it can also occur at other times. Less common ulcer symptoms include nausea, vomiting, and loss of appetite. Bleeding in the stomach can also occur as evidenced by the passage of black stools; prolonged bleeding may cause anemia leading to weakness and fatigue. If bleeding is heavy, hematemesis, hematochezia, or melena may occur. Inflammation of the pyloric antrum, which connects the stomach to the duodenum, is more likely to lead to duodenal ulcers, while inflammation of the corpus (i.e. body of the stomach) is more likely to lead to gastric ulcers. Individuals infected with H. pylori may also develop colorectal or gastric polyps, i.e. non-cancerous growths of tissue projecting from the mucous membranes of these organs. Usually, these polyps are asymptomatic but gastric polyps may be the cause of dyspepsia, heartburn, bleeding from the upper gastrointestinal tract, and, rarely, gastric outlet obstruction while colorectal polyps may be the cause of rectal bleeding, anemia, constipation, diarrhea, weight loss, and abdominal pain. Individuals with chronic H. pylori infection have an increased risk of acquiring a cancer that is directly related to this infection. These cancers are stomach adenocarcinoma, less commonly diffuse large B-cell lymphoma of the stomach, or extranodal marginal zone B-cell lymphomas of the stomach, or, more rarely, of the colon, rectum, esophagus, or ocular adenexa (i.e. orbit, conjunctiva, and/or eyelids). The signs, symptoms, pathophysiology, and diagnoses of these cancers are given in the cited linkages. | medical cause of Gastritis | medical cause of Peptic ulcer disease | symptoms of Helicobacter pylori | complications of Helicobacter pylori | symptom of Helicobacter pylori | symptom of Stomach cancer | symptoms of Small intestine cancer | symptoms of Crohn's disease | 00
| 7,928 |
Myeloblast with an<unk> (to the left of the nucleus).<unk> s (or<unk> ies) are large, crystalline cytoplasmic inclusion bodies sometimes observed in myeloid blast cells during acute myeloid leukemia, acute promyelocytic leukemia, and high-grade myelodysplastic syndromes and myeloproliferative disorders. Composed of fused lysosomes and rich in lysosomal enzymes,<unk> s are azurophilic and can resemble needles, commas, diamonds, rectangles, corkscrews, or (rarely) granules. | Auer rod | Azurophilic granule | Nissl body | Aschoff body | Heinz body | Sebaceous filament | Ferruginous body | Kamino bodies | 00
| 19,642 |
schematic representation of antibody.<unk> (ACA) are antibodies often directed against<unk> and found in several diseases, including syphilis, antiphospholipid syndrome, livedoid vasculitis, vertebrobasilar insufficiency, Behçet's syndrome, idiopathic spontaneous abortion, and systemic lupus erythematosus (SLE). They are a form of anti-mitochondrial antibody. In SLE, anti-DNA antibodies and<unk> may be present individually or together; the two types of antibodies act independently. This is in contrast to rheumatoid arthritis with systemic sclerosis (scleroderma) because<unk> are present in both conditions, and therefore may tie the two conditions together.<unk> can be classified in two ways: * As IgM, IgG or IgA * As β2-glycoprotein dependent or independent * In autoimmune disease, ACA are beta-2 glycoprotein dependent * In syphilis, ACA are beta-2 glycoprotein independent and can be assayed using the Venereal Disease Research Laboratory test | Anti-cardiolipin antibodies | Anti-apolipoprotein antibodies | Anti-mitochondrial antibody | Anti-SSA/Ro autoantibodies | Antisperm antibodies | Anti-LKM antibody | Anti-histone antibodies | Anti-dsDNA antibodies | 00
| 46,940 |
An example of a protein structure from Protein Data Bank.<unk> seeks to describe the 3-dimensional structure of every protein encoded by a given genome. This genome-based approach allows for a high-throughput method of structure determination by a combination of experimental and modeling approaches. The principal difference between<unk> and traditional<unk> prediction is that<unk> attempts to determine the structure of every protein encoded by the genome, rather than focusing on one particular protein. With full-genome sequences available, structure prediction can be done more quickly through a combination of experimental and modeling approaches, especially because the availability of large number of sequenced genomes and previously solved protein structures allows scientists to model protein structure on the structures of previously solved homologs. Because protein structure is closely linked with protein function, the<unk> has the potential to inform knowledge of protein function. In addition to elucidating protein functions,<unk> can be used to identify novel protein folds and potential targets for drug discovery.<unk> involves taking a large number of approaches to structure determination, including experimental methods using genomic sequences or modeling-based approaches based on sequence or<unk> homology to a protein of known structure or based on chemical and physical principles for a protein with no homology to any known structure. As opposed to traditional<unk> biology, the determination of a protein structure through a<unk> effort often (but not always) comes before anything is known regarding the protein function. This raises new challenges in<unk> bioinformatics, i.e. determining protein function from its 3D structure.<unk> emphasizes high throughput determination of protein structures. This is performed in dedicated centers of<unk> . While most<unk> biologists pursue structures of individual proteins or protein groups, specialists in<unk> pursue structures of proteins on a genome wide scale. This implies large-scale cloning, expression and purification. One main advantage of this approach is economy of scale. On the other hand, the scientific value of some resultant structures is at times questioned. A Science article from January 2006 analyzes the<unk> field. One advantage of<unk> , such as the Protein Structure Initiative, is that the scientific community gets immediate access to new structures, as well as to reagents such as clones and protein. A disadvantage is that many of these structures are of proteins of unknown function and do not have corresponding publications. This requires new ways of communicating this<unk> information to the broader research community. The Bioinformatics core of the Joint center for<unk> (JCSG) has recently developed a wiki-based approach namely Open protein structure annotation network (TOPSAN) for annotating protein structures emerging from high-throughput<unk> centers. | Structural genomics | Genomics | Molecular biology | Molecular genetics | Phylogenomics | Genotyping | Toxicogenomics | Virology | 00
| 10,447 |
<unk> under a light microscope: Notice the uterus; this species is monoecious. An adult<unk> is a flattened (dorsoventrally) and leaf-shaped fluke. The body is slightly elongated and slender, measuring 15–20 mm in length and 3–4 mm in width. It narrows at the anterior region into a small opening called the oral sucker, which act as the mouth. From the mouth, two tubes called caeca run the length of body. They are the digestive and excretory tracts. The posterior end is broad and blunt. A poorly developed ventral sucker lies behind the oral sucker, at about one-fourth of the body length from the anterior end. A common genital pore opens just in front of it. As a hermaphrodite, it has both male and female reproductive organs. A single rounded ovary is at the centre of the body, and two testes are towards the posterior end. The uterus from the ovary, and seminal ducts from the testes, meet and open at the genital pore. The testes are highly branched. Other highly branched organs called vitellaria (or vitelline glands) are distributed on either side of the body. The eggs are similar to those of other related flukes such as Opisthorchis viverrini and O. felineus, and are often confused during diagnosis. They small and oval in shape, measuring about 30 x 15 μm in diameter. They are sharply curved and with a clear convex operculum towards the narrower end. At the broader end is a stem-shaped knob. The miracidium can be seen inside the fertilised egg. | Clonorchis sinensis | Echinostoma cinetorchis | Haplorchis taichui | Taenia asiatica | Opisthorchis felineus | Taenia solium | Opisthorchis viverrini | Schistosoma japonicum | 00
| 15,863 |
<unk> can be successfully controlled with early diagnosis and aggressive treatment including albumin infusions, nephrectomy, and medications. Affected children have rapid decline in kidney function resulting in end-stage renal disease within the first years of life, and require treatment with dialysis and kidney transplantation. Most children live fairly normal life post-transplant but will spend significant time hospitalised pre-transplant and have numerous surgeries to facilitate treatment. Kidney transplantation outcomes for children with<unk> are similar to those of other patient groups.<unk><unk> typically does not reoccur following kidney transplantation, however recurrences have been seen in children with NPHS1 mutations who develop anti-nephrin antibodies. Due to the protein (albumin) losses many patients have reduced muscle tone and may experience delays in certain physical milestones such as sitting, crawling and walking. Similarly many patients experience growth delays due to protein loss. Delays vary from mild to significant but most patients experience growth spurts once they receive their transplanted kidney. Physical therapy may be useful for the child to strengthen muscle tone. Children who have a history of stroke from thrombotic complications can have neurologic delays. Undiagnosed cases are often fatal in the first year due to blood clots, infections or other complications. | Congenital nephrotic syndrome | Cystic kidney disease | Medullary cystic kidney disease | Glomerulocystic kidney disease | Juvenile nephronophthisis | Malarial nephropathy | Polycystic kidney disease | Transplant glomerulopathy | 00
| 42,029 |
Due to<unk> ’s role as a major cause of certain diseases (particularly cancers) and its consistently increasing antibiotic resistance, there is a clear need for new therapeutic strategies to prevent or remove the bacterium from colonizing humans. Much work has been done on developing viable vaccines aimed at providing an alternative strategy to control<unk> infection and related diseases. Researchers are studying different adjuvants, antigens, and routes of immunization to ascertain the most appropriate system of immune protection; however, most of the research only recently moved from animal to human trials. An economic evaluation of the use of a potential<unk> vaccine in babies found its introduction could, at least in the Netherlands, prove cost-effective for the prevention of peptic ulcer and stomach adenocarcinoma. A similar approach has also been studied for the United States. Notwithstanding this proof-of-concept (i.e. vaccination protects children from acquisition of infection with<unk> , as of late 2019 there have been no advanced vaccine candidates and only one vaccine in a Phase I clinical trial. Furthermore, development of a vaccine against<unk> has not been a current priority of major pharmaceutical companies. Many investigations have attempted to prevent the development of<unk> -related diseases by eradicating the bacterium during the early stages of its infestation using antibiotic-based drug regimens. Studies find that such treatments, when effectively eradicating<unk> from the stomach, reduce the inflammation and some of the histopathological abnormalities associated with the infestation. However studies disagree on the ability of these treatments to alleviate the more serious histopathological abnormalities in<unk> infections, e.g. gastric atrophy and metaplasia, both of which are precursors to gastric adenocarcinoma. There is similar disagreement on the ability of antibiotic-based regiments to prevent gastric adenocarcinoma. A meta-analysis (i.e. a statistical analysis that combines the results of multiple randomized controlled trials) published in 2014 found that these regimens did not appear to prevent development of this adenocarcinoma. However, two subsequent prospective cohort studies conducted on high-risk individuals in China and Taiwan found that eradication of the bacterium produced a significant decrease in the number of individuals developing the disease. These results agreed with a retrospective cohort study done in Japan and published in 2016 as well as a meta-analysis, also published in 2016, of 24 studies conducted on individuals with varying levels of risk for developing the disease. These more recent studies suggest that the eradication of<unk> infection reduces the incidence of<unk> -related gastric adenocarcinoma in individuals at all levels of baseline risk. Further studies will be required to clarify this issue. In all events, studies agree that antibiotic-based regimens effectively reduce the occurrence of metachronous<unk> -associated gastric adenocarcinoma. (Metachronous cancers are cancers that reoccur 6 months or later after resection of the original cancer.) It is suggested that antibiotic-based drug regimens be used after resecting<unk> -associated gastric adenocarcinoma in order to reduce its metachronus reoccurrence. | Helicobacter pylori | Giardia duodenalis | Entamoeba histolytica | Neisseria mucosa | Cryptosporidium parvum | Entamoeba gingivalis | Campylobacter upsaliensis | Ancylostoma duodenale | 00
| 7,939 |
Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury and, rarely, achalasia. The fundoplication can also come undone over time in about 5–10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection. Postoperative ileus, which is common after abdominal surgery, is possible. In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of<unk> patients, whereas the occurrence is less with patients undergoing partial anterior fundoplication. Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, counseling regarding aerophagia, medications, and correction – either by endoscopic balloon dilatation or repeat surgery to revise the<unk> to a partial fundoplication – may be necessary. Acute dysphagia or short term trouble swallowing is a symptom that most patients will have after having a fundoplication. Patients who have dysphagia prior to surgery are more likely to have some dysphagia post-operatively. Symptoms of dysphagia will often resolve on their own within a few months. Short term dysphagia is controlled by modifying diet to include more easily swallowed food such as liquids and soft foods. Dysphagia that persists longer than 3 months will need further evaluation, typically with a barium swallow study, esophageal manometry, or endoscopy. Structural changes such as movement of the wrap, herniation, development of stenosis or stricture may lead to persistent dysphagia. Previously undiagnosed achalasia or a wrap that is too tight may also lead to persistent dysphagia. Depending on the etiology of persistent dysphagia, a trial of PPI therapy, endoscopic dilation, or surgical revision may be necessary. Vomiting is sometimes impossible or, if not, very painful after a fundoplication, with the likelihood of this complication typically decreasing in the months after surgery. In some cases, the purpose of this operation is to correct excessive vomiting. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely with some amount of pain. | Nissen fundoplication | Transoral incisionless fundoplication | Pyloroplasty | Collis gastroplasty | Endoscopic sleeve gastroplasty | Esophageal stent | Finney strictureplasty | Vertical banded gastroplasty surgery | 00
| 16,105 |
<unk> is a genetic disorder caused by the buildup of glycosaminoglycans (GAGs) in various organ tissues. It is a cutaneous condition, also characterized by mild mental retardation and corneal clouding. Respiratory problems, sleep apnea, and heart disease may develop in adolescence.<unk> is classified as a lysosomal storage disease. Patients with<unk> lack the ability to break down GAGs in their lysosomes due a deficiency of the enzyme iduronidase. All forms of mucopolysaccharidosis type I (MPS I) are a spectrum of the same disease. Hurler-Sheie is the subtype of MPS I with intermediate severity. Hurler syndrome is the most severe form, while<unk> syndrome is the least severe form. Some clinicians consider the differences between Hurler, Hurler-Scheie, and<unk> syndromes to be arbitrary. Instead, they classify these patients as having "severe", "intermediate", or "attenuated" MPS I. | Hurler–Scheie syndrome | Hunter syndrome | Gerstmann–Sträussler–Scheinker syndrome | Mucopolysaccharidosis type I | TORCH syndrome | Mucopolysaccharidosis | Gerstmann syndrome | Hurler syndrome | 00
| 47,176 |
<unk> is a form of fibrous dysplasia where only one bone is involved. It comprises a majority of the cases of fibrous dysplasia (approximately 70–80%). It is a rare bone disease characterized by the replacement of normal elements of the bone by fibrous connective tissue, which can cause very painful swellings and bone deformities, and make bone abnormally fragile and prone to fracture. A congenital, noninherited, benign anomaly of bone development in a single bone, it consists of the replacement of normal marrow and cancellous bone by immature bone with fibrous stroma.<unk> occurs with equal frequency in both sexes and normally develops early in life, with lesions frequently identified late in the first and early second decades. Most patients are asymptomatic, with the diagnosis often established after an incidental finding or with pain, swelling, or fracture. Lesions usually enlarge in proportion to skeletal growth and the abnormal replacement remain active only until skeletal maturity.<unk> does not convert into the polyostotic type. When symptoms are present, they often are nonspecific, including pain, swelling, or pathologic fracture. It most often affects the ribs (28%), proximal femur (23%), tibia, craniofacial bones (10-25%) and humerus (10-25%). | Monostotic fibrous dysplasia | Polyostotic fibrous dysplasia | Peripheral ossifying fibroma | Solitary fibrous tumor | Juvenile active ossifying fibroma | Aggressive fibromatosis | Low-grade fibromyxoid sarcoma | Ameloblastic fibroma | 00
| 46,300 |
<unk> is typically diagnosed in individuals following 5–10 years of consistent exposure to chemicals like xylene, toluene, and styrene, which are generally found in paint, plastic and degreasing products. Patients work and environmental history must be evaluated for exposure to organic chemicals. A traumatic brain injury may also lead to<unk> . Consistent intoxication (ie excess use of alcohol and drugs) may also cause a lesion in the brain, eventually leading to<unk> . Lyme disease, the great "new imitator", has been known to mimick depression, schizophrenia, depersonalization disorder, and obsessive-compulsive disorder. Although the cause varies by each individual case, localization of the atrophy in the brain can occur due to aging and without external causes. Prevention includes proper and regular use of Preventive Personal Equipment (PPE) in work environments that involve organic chemicals and limiting alcohol and drug substance intake. | Psychoorganic syndrome | Substance-induced psychosis | Unitary psychosis | Post-stroke depression | Jurosomatic illness | Diving disorders | Stimulant psychosis | Amotivational syndrome | 00
| 32,535 |
right side lung, side S2–S3<unk> <unk> of the lung usually presents in the central airways and infiltrates the submucosa leading to narrowing of bronchial airways. Common symptoms include cough, dyspnea, weight loss, and debility. Over 70% of patients with<unk> present with metastatic disease; common sites include liver, adrenals, bone, and brain. Due to its high grade neuroendocrine nature,<unk> s can produce ectopic hormones, including adrenocorticotropic hormone (ACTH) and anti-diuretic hormone (ADH). Ectopic production of large amounts of ADH leads to syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). Lambert-Eaton myasthenic syndrome (LEMS) is a well-known paraneoplastic condition linked to<unk> .<unk> -cell lung cancer Histopathologic image of<unk> of the lung. CT-guided core needle biopsy. H&E stain. When associated with the lung, it is sometimes called "oat<unk> carcinoma" due to the flat<unk> shape and scanty cytoplasm. Caution is required when diagnosing SCLC because<unk> <unk> mesothelioma – an extremely rare subtype of lung cancer – can be mistaken for<unk> <unk> lung cancer. It is thought to originate from neuroendocrine<unk> s (APUD<unk> s) in the bronchus called Feyrter<unk> s (named for Friedrich Feyrter). Hence, they express a variety of neuroendocrine markers, and may lead to ectopic production of hormones like ADH and ACTH that may result in paraneoplastic syndromes and Cushing's syndrome. Approximately half of all individuals diagnosed with Lambert-Eaton myasthenic syndrome (LEMS) will eventually be found to have a<unk> of the lung.<unk> is most often more rapidly and widely metastatic than non-small-cell lung carcinoma (and hence staged differently). There is usually early involvement of the hilar and mediastinal lymph nodes. The mechanisms of its metastatic progression are not well-understood. Combined<unk> -cell lung carcinoma (c-SCLC)<unk> -cell lung carcinoma can occur in combination with a wide variety of other histological variants of lung cancer, including extremely complex malignant tissue admixtures. When it is found with one or more differentiated forms of lung cancer, such as squamous<unk> carcinoma or adenocarcinoma, the malignant tumor is then diagnosed and classified as a combined<unk> <unk> lung carcinoma (c-SCLC). C-SCLC is the only currently recognized subtype of SCLC. Although combined<unk> -cell lung carcinoma is currently staged and treated similarly to "pure"<unk> of the lung, recent research suggests surgery might improve outcomes in very early stages of this tumor type. Smoking is a significant risk factor. Symptoms and signs are as for other lung cancers. In addition, because of their neuroendocrine<unk> origin,<unk> s will often secrete substances that result in paraneoplastic syndromes such as Lambert-Eaton myasthenic syndrome. Extrapulmonary<unk> Very rarely, the primary site for<unk> is outside of the lungs and pleural space; in these cases, it is referred to as extrapulmonary<unk> (EPSCC). Outside of the respiratory tract,<unk> can appear in the cervix, prostate, liver, pancreas, gastrointestinal tract, or bladder. It is estimated to account for 1,000 new cases a year in the U.S. Histologically similar to<unk> -cell lung cancer, therapies for<unk> -cell lung cancer are usually used to treat EPSCC. First-line treatment is usually with cisplatin and etoposide. In Japan, first-line treatment is shifting to irinotecan and cisplatin. When the primary site is in the skin, it is referred to as a Merkel-cell carcinoma. Extrapulmonary<unk> localized in the lymph nodes This is an extremely rare type of<unk> <unk> , and there has been little information in the scientific community. It appears to occur in only one or more lymph nodes, and nowhere else in the body. Treatment is similar to<unk> <unk> lung cancer, but survival rates are much higher than other<unk> s.<unk> of the prostate<unk> of the prostate <unk> P) is a rare form of prostate cancer (approx. 1% of PC). Due to the fact that there is little variation in prostate specific antigen levels,<unk> P is normally diagnosed at an advanced stage, after metastasis. Symptomatic metastasis of<unk> P to the brain is rare, and carries a poor prognosis. | Small-cell carcinoma | Adenomatoid tumor | Mucinous carcinoma | Sarcomatoid carcinoma | Spindle cell carcinoma | Signet ring cell carcinoma | Adenosarcoma | Adenocarcinoma | 00
| 19,797 |
To classify postoperative outcomes for epilepsy surgery, Jerome<unk> proposed the following scheme, the<unk> Epilepsy Surgery Outcome Scale, which has become the de facto standard when reporting results in the medical literature: * Class I: Free of disabling seizures * Class II: Rare disabling seizures ("almost seizure-free") * Class III: Worthwhile improvement * Class IV: No worthwhile improvement | Engel classification | Gartland classification | Wassel classification | Frykman classification | Pipkin classification | Mayfield classification | Nissen-Lie classification | Kauffman–White classification | 00
| 56,921 |
<unk> is a species of bacteria in the genus Prevotella. It is gram-negative. It is one cause of pelvic inflammatory disease. Other Prevotella spp. are members of the oral and vaginal microbiota, and are recovered from anaerobic infections of the respiratory tract. These infections include aspiration pneumonia, lung abscess, pulmonary empyema, and chronic otitis media and sinusitis. Other species have been isolated from abscesses and burns in the vicinity of the mouth, bites, paronychia, urinary tract infection, brain abscesses, osteomyelitis, and bacteremia associated with upper respiratory tract infections. Prevotella spp. predominate in periodontal disease and periodontal abscesses. The genus also includes gut bacteria. Prevotella species dominate with high fiber, plant-based diets. Human Prevotella spp have been compared genetically with species derived from different body sites of humans. | Prevotella bivia | Prevotella intermedia | Neisseria mucosa | Campylobacter upsaliensis | Leptospira wolffii | Entamoeba coli | Bacteroides dorei | Bartonella bacilliformis | 00
| 67,387 |
Regardless of the trigger, the mechanism of syncope is similar in the various vasovagal syncope syndromes. The nucleus tractus solitarii of the brainstem is activated directly or indirectly by the triggering stimulus, resulting in simultaneous enhancement of parasympathetic nervous system (vagal) tone and withdrawal of sympathetic nervous system tone. This results in a spectrum of hemodynamic responses: # On one end of the spectrum is the cardioinhibitory response, characterized by a drop in heart rate (negative chronotropic effect) and in contractility (negative inotropic effect) leading to a decrease in cardiac output that is significant enough to result in a loss of consciousness. It is thought that this response results primarily from enhancement in parasympathetic tone. # On the other end of the spectrum is the vasodepressor response, caused by a drop in blood pressure (to as low as 80/20) without much change in heart rate. This phenomenon occurs due to dilation of the blood vessels, probably as a result of withdrawal of sympathetic nervous system tone. # The majority of people with vasovagal syncope have a mixed response somewhere between these two ends of the spectrum. One account for these physiological responses is the Bezold-Jarisch reflex. Vasovagal syncope may be part of an evolved response, specifically, the fight-or-flight response. | Reflex syncope | Hypotonic-hyporesponsive episode | Heat syncope | Laughter-induced syncope | Reflex asystolic syncope | Panic attack | Hair-grooming syncope | Postural orthostatic tachycardia syndrome | 00
| 17,290 |
<unk> , or recurrent<unk> (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sore is also used, mainly in North America, although it may also refer to other types of mouth ulcers. The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, or some food additives. These ulcers occur periodically and heal completely between attacks. In the majority of cases, the individual ulcers last about 7–10 days, and ulceration episodes occur 3–6 times per year. Most appear on the non-keratinizing epithelial surfaces in the mouth – i.e. anywhere except the attached gingiva, the hard palate and the dorsum of the tongue – although the more severe forms, which are less common, may also involve keratinizing epithelial surfaces. Symptoms range from a minor nuisance to interfering with eating and drinking. The severe forms may be debilitating, even causing weight loss due to malnutrition. The condition is very common, affecting about 20% of the general population to some degree. The onset is often during childhood or adolescence, and the condition usually lasts for several years before gradually disappearing. There is no cure, and treatments such as corticosteroids aim to manage pain, reduce healing time and reduce the frequency of episodes of ulceration. | Aphthous stomatitis | Herpes labialis | Contact stomatitis | Denture-related stomatitis | Bovine papular stomatitis | Oral candidiasis | Adenoviral keratoconjunctivitis | Dermatophagia | 00
| 24,142 |
It can be diagnosed clinically in the appropriate context, but may be difficult to confirm radiologically using conventional imaging techniques. Changes are more prominent on MRI than on CT, but often take days or weeks after acute symptom onset to develop. Imaging by MRI typically demonstrates areas of hyperintensity on T2-weighted images. | Central pontine myelinolysis | Paraneoplastic cerebellar degeneration | Leukoencephalopathy | Bickerstaff brainstem encephalitis | Acute flaccid myelitis | Acute disseminated encephalomyelitis | Cerebellar stroke syndrome | Tropical neuropathy | 00
| 760 |
<unk> (INN, also known as L-5-MTHF, L-methylfolate and L-5-methyltetrahydrofolate and (6S)-5-methyltetrahydrofolate, and (6S)-5-MTHF) is the primary biologically active form of folate used at the cellular level for DNA reproduction, the cysteine cycle and the regulation of homocysteine. It is also the form found in circulation and transported across membranes into tissues and across the blood–brain barrier. In the cell, L-methylfolate is used in the methylation of homocysteine to form methionine and tetrahydrofolate (THF). THF is the immediate acceptor of one carbon unit for the synthesis of thymidine-DNA, purines (RNA and DNA) and methionine. The un-methylated form, folic<unk> (vitamin B9), is a synthetic form of folate, and must undergo enzymatic reduction by dihydrofolate reductase (DHFR) to become biologically active. It is synthesized in the absorptive cells of the small intestine from polyglutamylated dietary folate. It is a methylated derivative of tetrahydrofolate.<unk> is generated by methylenetetrahydrofolate reductase (MTHFR) from 5,10-methylenetetrahydrofolate (MTHF) and used to recycle homocysteine back to methionine by methionine synthase (MS). L-Methylfolate is water-soluble and primarily excreted via the kidneys. In a study of 21 subjects with coronary artery disease, peak plasma levels were reached in one to three hours following oral or parenteral administration. Peak concentrations were found to be more than seven times higher than folic<unk> (129 ng/ml vs. 14.1 ng/ml). | Levomefolic acid | Retinol | Zinc sulfate | Ferrous salt/folic acid | Pyridoxine | Iron sucrose | Piscivorin | Gadobenic acid | 00
| 45,382 |
Complications can ensue. If surgical retractors are not placed carefully under the edges of the incision, they can damage the femoral nerve or other nerves in the area. If during wound closure, tendons are sewn directly to the pubic symphysis, osteitis pubis or osteomyelitis can result. | Cherney incision | Maylard incision | Joel-Cohen incision | Barbed suture | Pfannenstiel incision | Serdev suture | Side stitch | Catgut suture | 00
| 67,542 |
Frequent serum GH measurements in normal subjects (left panel) demonstrate that GH can fluctuate between undetectable levels most of the time interspersed with peaks of up to 30 μg/L (90 mIU/L); in<unk> (right panel) GH hypersecretion is continuous with no undetectable levels. If<unk> is suspected, medical laboratory investigations followed by medical imaging if the lab tests are positive confirms or rules out the presence of this condition. IGF1 provides the most sensitive lab test for the diagnosis of<unk> , and a GH suppression test following an oral glucose load, which is a very specific lab test, will confirm the diagnosis following a positive screening test for IGF1. A single value of the GH is not useful in view of its pulsatility (levels in the blood vary greatly even in healthy individuals).Magnetic resonance image of a pituitary macroadenoma that caused<unk> with compression of the optic chiasm GH levels taken 2 hours after a 75- or 100-gram glucose tolerance test are helpful in the diagnosis: GH levels are suppressed below 1 μg/L in normal people, and levels higher than this cutoff are confirmatory of<unk> . Other pituitary hormones must be assessed to address the secretory effects of the tumor, as well as the mass effect of the tumor on the normal pituitary gland. They include thyroid stimulating hormone (TSH), gonadotropic hormones (FSH, LH), adrenocorticotropic hormone, and prolactin. An MRI of the brain focusing on the sella turcica after gadolinium administration allows for clear delineation of the pituitary and the hypothalamus and the location of the tumor. A number of other overgrowth syndromes can result in similar problems. Differential diagnosis Pseudoacromegaly is a condition with the usual<unk> id features, but without an increase in growth hormone and IGF-1. It is frequently associated with insulin resistance. Cases have been reported due to minoxidil at an unusually high dose. It can also be caused by a selective post receptor defect of insulin signalling, leading to the impairment of metabolic, but preservation of mitogenic, signalling. | Acromegaly | Pachydermoperiostosis | Micromegaly | Hyperaldosteronism | Cinchonism | Pheochromocytoma | Hypoaldosteronism | Primary polydipsia | 00
| 53,450 |