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The dataset generation failed
Error code:   DatasetGenerationError
Exception:    TypeError
Message:      Couldn't cast array of type
struct<id: int64, from_id: int64, to_id: int64, type: string>
to
[{'id': Value(dtype='int64', id=None), 'from_id': Value(dtype='int64', id=None), 'to_id': Value(dtype='int64', id=None), 'type': Value(dtype='string', id=None)}]
Traceback:    Traceback (most recent call last):
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1870, in _prepare_split_single
                  writer.write_table(table)
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/arrow_writer.py", line 622, in write_table
                  pa_table = table_cast(pa_table, self._schema)
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2292, in table_cast
                  return cast_table_to_schema(table, schema)
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2245, in cast_table_to_schema
                  arrays = [
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2246, in <listcomp>
                  cast_array_to_feature(
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 1795, in wrapper
                  return pa.chunked_array([func(chunk, *args, **kwargs) for chunk in array.chunks])
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 1795, in <listcomp>
                  return pa.chunked_array([func(chunk, *args, **kwargs) for chunk in array.chunks])
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2108, in cast_array_to_feature
                  raise TypeError(f"Couldn't cast array of type\n{_short_str(array.type)}\nto\n{_short_str(feature)}")
              TypeError: Couldn't cast array of type
              struct<id: int64, from_id: int64, to_id: int64, type: string>
              to
              [{'id': Value(dtype='int64', id=None), 'from_id': Value(dtype='int64', id=None), 'to_id': Value(dtype='int64', id=None), 'type': Value(dtype='string', id=None)}]
              
              The above exception was the direct cause of the following exception:
              
              Traceback (most recent call last):
                File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1417, in compute_config_parquet_and_info_response
                  parquet_operations = convert_to_parquet(builder)
                File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1049, in convert_to_parquet
                  builder.download_and_prepare(
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 924, in download_and_prepare
                  self._download_and_prepare(
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1000, in _download_and_prepare
                  self._prepare_split(split_generator, **prepare_split_kwargs)
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1741, in _prepare_split
                  for job_id, done, content in self._prepare_split_single(
                File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1897, in _prepare_split_single
                  raise DatasetGenerationError("An error occurred while generating the dataset") from e
              datasets.exceptions.DatasetGenerationError: An error occurred while generating the dataset

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id
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entities
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Comments
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248
#Diagnosis - Abdominal Pain - MD81.4 Generally abdominal pain goes with time, but if the pain does not subside, then one should seek medical help: Abdominal discomfort that lasts 1 week or longer, Abdominal pain that does not improve in 24 - 48 hours, or becomes more severe and frequent and occurs with nausea and vomiting, Bloating that persists for more than 2 days, Burning sensation or increase in frequency on urination, Diarrhoea for more than 5 daysFever (over 100°F for adults or 100.4°F for children) with pain, Prolonged poor appetite, Prolonged vaginal bleeding, Unexplained weight loss.
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[ { "id": 1886, "from_id": 4910, "to_id": 4913, "type": "has_complication_R" }, { "id": 1889, "from_id": 4910, "to_id": 4926, "type": "has_symptom_R" }, { "id": 1890, "from_id": 4910, "to_id": 4930, "type": "has_symptom_R" }, { "id": 1891, "from_id": 4910, "to_id": 4932, "type": "has_symptom_R" }, { "id": 1892, "from_id": 4910, "to_id": 4934, "type": "has_symptom_R" }, { "id": 1893, "from_id": 4910, "to_id": 4936, "type": "has_symptom_R" }, { "id": 1895, "from_id": 4910, "to_id": 4941, "type": "has_symptom_R" }, { "id": 1896, "from_id": 4910, "to_id": 4945, "type": "has_symptom_R" }, { "id": 1897, "from_id": 4910, "to_id": 4947, "type": "has_symptom_R" } ]
[]
249
#Overview - Abdominal Pain - MD81.4 Abdominal pain can be felt anywhere between thorax ( chest ) and pelvis. Pain could be mild, moderate or severe. It may be dull or acute. Almost everyone has experienced abdominal pain, one time or other. Most of the time, stomach pain is not serious, but severe abdominal pain is a cause of concern. If pain starts suddenly and unexpectedly, it should be regarded as an emergency, and investigated accordingly.
[ { "id": 4900, "label": "Disease_E", "start_offset": 12, "end_offset": 26 }, { "id": 4902, "label": "Disease_E", "start_offset": 36, "end_offset": 50 }, { "id": 4905, "label": "Anatomy_E", "start_offset": 80, "end_offset": 96 }, { "id": 4906, "label": "Anatomy_E", "start_offset": 101, "end_offset": 107 }, { "id": 4912, "label": "Complication_E", "start_offset": 110, "end_offset": 114 }, { "id": 4915, "label": "Disease_E", "start_offset": 207, "end_offset": 221 }, { "id": 4917, "label": "Complication_E", "start_offset": 261, "end_offset": 273 }, { "id": 4918, "label": "Disease_E", "start_offset": 301, "end_offset": 315 }, { "id": 4919, "label": "Complication_E", "start_offset": 343, "end_offset": 347 } ]
[ { "id": 1875, "from_id": 4902, "to_id": 4905, "type": "affects_R" }, { "id": 1876, "from_id": 4902, "to_id": 4906, "type": "affects_R" } ]
[]
251
#Treatment - Abdominal Pain - MD81.4 Generally, treatment for abdominal pain depends upon its cause. Treatment usually is with medications for inflammation of Gastroesophageal reflux disease (GERD) or Ulcers, Use antibiotics in case of infections, Modify your eating habits, Surgical treatment is indicated in conditions like appendicitis or hernia (inguinal and umbilical). Seek doctors advice before going in for any treatment.
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[ { "id": 1908, "from_id": 4923, "to_id": 4921, "type": "prescribed_for_R" }, { "id": 1909, "from_id": 4931, "to_id": 4921, "type": "prescribed_for_R" }, { "id": 1910, "from_id": 4937, "to_id": 4921, "type": "surgery_for_R" } ]
[]
252
#Causes - Abdominal Pain - MD81.4 Various conditions are associated with abdominal pain. Causes of abdominal pain include: Constipation, Irritable bowel syndrome, Food allergy, Food poisoning, Menstrual pain. Sudden, severe abdominal pain: Abdominal infection, Appendicitis, A perforated peptic ulcer, Gallstones, Kidney stones, Diverticulitis : Inflammation of small pouches that are part of the bowel. Other common causes in adults are: Irritable bowel syndrome, Crohn's disease, Urinary tract infection, Long term Peptic ulcer, Constipation, Heartburn and acid reflux. Common Causes in children: Constipation, Urinary tract Infection, Anxiety, Heartburn and acid reflux.
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[ { "id": 1878, "from_id": 4904, "to_id": 4908, "type": "caused_by_R" }, { "id": 1879, "from_id": 4904, "to_id": 4909, "type": "caused_by_R" }, { "id": 1880, "from_id": 4904, "to_id": 4911, "type": "caused_by_R" }, { "id": 1881, "from_id": 4904, "to_id": 4914, "type": "caused_by_R" }, { "id": 1882, "from_id": 4904, "to_id": 4920, "type": "caused_by_R" }, { "id": 1883, "from_id": 4928, "to_id": 4938, "type": "caused_by_R" }, { "id": 1884, "from_id": 4928, "to_id": 4939, "type": "caused_by_R" }, { "id": 1885, "from_id": 4928, "to_id": 4943, "type": "caused_by_R" }, { "id": 1887, "from_id": 4928, "to_id": 4944, "type": "caused_by_R" }, { "id": 1888, "from_id": 4928, "to_id": 4946, "type": "caused_by_R" }, { "id": 1894, "from_id": 4928, "to_id": 4948, "type": "caused_by_R" }, { "id": 1898, "from_id": 4924, "to_id": 4949, "type": "caused_by_R" }, { "id": 1899, "from_id": 4924, "to_id": 4950, "type": "caused_by_R" }, { "id": 1900, "from_id": 4924, "to_id": 4951, "type": "caused_by_R" }, { "id": 1901, "from_id": 4924, "to_id": 4952, "type": "caused_by_R" }, { "id": 1902, "from_id": 4924, "to_id": 4953, "type": "caused_by_R" }, { "id": 1903, "from_id": 4924, "to_id": 4954, "type": "caused_by_R" }, { "id": 1904, "from_id": 4924, "to_id": 4955, "type": "caused_by_R" }, { "id": 1905, "from_id": 4924, "to_id": 4956, "type": "caused_by_R" }, { "id": 1906, "from_id": 4924, "to_id": 4957, "type": "caused_by_R" }, { "id": 1907, "from_id": 4924, "to_id": 4958, "type": "caused_by_R" } ]
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253
#Symptoms - Abdominal Pain - MD81.4 Pain in abdomen can be of various intensities and nature. It can be: Sharp, stabbing cramp like pain, Brief pain that may come or go, Pain associated with vomiting.
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[ { "id": 1871, "from_id": 4894, "to_id": 4895, "type": "affects_R" }, { "id": 1872, "from_id": 4897, "to_id": 4896, "type": "has_symptom_R" }, { "id": 1873, "from_id": 4897, "to_id": 4898, "type": "has_symptom_R" }, { "id": 1874, "from_id": 4897, "to_id": 4899, "type": "has_symptom_R" }, { "id": 1877, "from_id": 4916, "to_id": 4895, "type": "influence_R" } ]
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426
#Causes - Abducens nerve Palsy - 9C81.2 The causes of Abducens nerve palsy are varied. Common aetiologies in children are Congenital, Raised intracranial pressure, Trauma, Tumour, Infection. In addition to the aetiologies seen in children, adults are affected by vasculopathies (most common acquired causes) also, such as Diabetes mellitus, Hypertension. Other conditions include Disorders of subarachnoid space, Cavernous sinus syndrome, Orbital apex syndrome.
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[]
427
#Diagnosis - Abducens nerve Palsy - 9C81.2 Patients with CN VI paresis present with esotropia (inward deviation) of the affected eye. Outward movement beyond primary position or midline is lost or reduced. Patients presenting with partial or mild palsy adopt posture with head turn toward the affected side to minimise diplopia by keeping the affected eye adducted (inward movement). Severe cases may shut the eye or cover it to avoid diplopia. Presentation depends upon the aetiology. Congenital CN VI palsy may present with congenital esotropia reported to occur about six to eight weeks of life. Most cases without peripheral misdirection of nerves are transient and probably are due to perinatal trauma. There are two types of transient CN VI palsy: Neonatal esotropia with an obvious unilateral abduction deficit, Neonatal esotropia with no obvious unilateral abduction deficit. Acquired CN VI palsy may be due to varied aetiology: Benign recurrent CN VI palsy in children may occur after benign acute viral sickness or immunisation. This is an isolated condition with acute onset, and is associated with restriction of abduction.
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[ { "id": 3352, "from_id": 7644, "to_id": 7645, "type": "has_complication_R" }, { "id": 3353, "from_id": 7648, "to_id": 7649, "type": "has_complication_R" }, { "id": 3354, "from_id": 7651, "to_id": 7653, "type": "has_complication_R" }, { "id": 3355, "from_id": 7651, "to_id": 7654, "type": "has_complication_R" }, { "id": 3356, "from_id": 7657, "to_id": 7658, "type": "caused_by_R" } ]
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428
#Symptoms - Abducens nerve Palsy - 9C81.2 Symptoms include Diplopia (double vision), worse in the field of palsy, Esotropia (inward deviation of eyeball), Head turn towards the affected side to maintain fusion and thus to avoid diplopia in mild cases, Closure of one eye voluntarily to avoid diplopia in severe unilateral palsy or bilateral involvement.
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[ { "id": 3357, "from_id": 7659, "to_id": 7660, "type": "has_symptom_R" }, { "id": 3358, "from_id": 7659, "to_id": 7661, "type": "has_symptom_R" }, { "id": 3360, "from_id": 7659, "to_id": 7663, "type": "has_symptom_R" }, { "id": 3359, "from_id": 7659, "to_id": 7662, "type": "has_symptom_R" } ]
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#Overview - Abducens nerve Palsy - 9C81.2 Abducens (or Abducent) nerve Palsy or Cranial nerve six palsy (CN VI) is a common neuro-ophthalmic disorder. Since CN VI has a long intracranial course, it may be affected by multiple aetiologies. It may be unilateral or bilateral condition. CN VI is a pure motor nerve that innervates ipsilateral (same side) lateral rectus muscle of the eye and controls abduction (outward movement) of the eyeball. This nerve has the longest intracranial course amongst all the cranial nerves. A palsy affecting this nerve alone is less common. Usually, seventh (CN VII or facial) and eighth (CN VIII or vestibulocochlear) cranial nerves are also affected along with it, which signals a central cause. Children are more likely to be affected by a tumour, and older people are more likely to have vasculopathy producing ischaemia. CN VI palsy may present with ‘false localising sign’, suggesting impingement, when in fact, the causative reason/tumour may be remotely present, or there may not be any detectable reason/tumour. Similarly, raised intracranial pressure may stretch CN VI, and perhaps compression of its vascular supply. The sixth cranial nerve is the most commonly affected motor nerve to the eye in adults.
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#Treatment - Abducens nerve Palsy - 9C81.2 Like other cranial nerve palsies, root cause of palsy should be treated. Microvascular ischaemia/vasculopathy secondary to diabetes mellitus and hypertension may lead to Isolated CN VI palsy. Observation. Patient should be observed for three to six months. Most cases resolve on their own within three to six months. Therapies vary from controlling vasculopathic risk factors to neurosurgical interventions. Medical therapy. Prismatic glasses: Cases of non-healing CN VI palsy may be prescribed with prismatic spectacles, and is most effective in cases with some preserved function of the nerve. Amblyopia therapy: Prescribed standard amblyopia therapy should be instituted. A small face turn adopted by children is beneficial and should be encouraged. Loss of head posture with esotropia indicates loss of fusion and probability of subsequent development of amblyopia. Surgical therapy. Muscle splitting surgery: Parts of superior and inferior rectus muscle are split and are attached to provide function of new abducting extraocular muscle. Unmanageable cases of complete CN VI palsy may be patched to avoid diplopia. Patching each eye alternately for a few hours each day, may be done to prevent amblyopia in the affected eye. Prognosis. Prognosis varies with aetiology. Cases due to vasculopathy usually resolve completely. Other CN VI cases have guarded prognosis. Patients are normally observed for six months for spontaneous resolution.
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#Diagnosis - Abnormal uterine bleeding - GA2Y Examination: Physical examination of the woman having AUB includes: Assessment of weight pallor thyroid breasts acne hirsutism scoring (if present), Abdominal palpation, Visualization of the cervix, Bimanual (internal) examination. Laboratory Testing: A complete blood count (CBC), full blood count test should be carried out on all women with HMB to detect anaemia, Blood type and cross match, Urine pregnancy test to rule out pregnancy. Imaging: Ultrasonography is used in AUB cases to evaluate uterus, adnexa and endometrial thickness. Transvaginal ultrasonography may reveal leiomyoma, endometrial thickening, or focal masses. Sonohysterography: It is more specific and sensitive in diagnosing lesions inside the uterine cavity and endometrial hyperplasia. Hysteroscopy: It is an examination of the uterine cavity and the surface of the endometrium (inner lining of uterus) using a hysteroscope for diagnosis and characterization of intrauterine abnormalities. MRI (magnetic resonance Imaging): MRI can be used to differentiate between fibroids and adenomyosis and for mapping exact location of fibroids while planning conservative surgery and prior to therapeutic embolization for fibroids.
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#Causes - Abnormal uterine bleeding - GA2Y The components of the PALM group are structural causes that can be located visually with imaging techniques and/or histopathology. These causes are polyp; adenomyosis; leiomyoma; malignancy and hyperplasia. Polyp (AUB-P): Uterine polyps are growths from endometrium, (inner lining of the uterus) found into the uterine cavity. These are usually benign but some may be precancerous or cancerous. Adenomyosis (AUB-A): This is a condition in which the inner lining of the uterus (endometrium) grows in to the muscle wall of the uterus ( myometrium). Leiomyoma (AUB-L): These are benign fibromuscular tumors of the myometrium. Leiomyomas are known by several names, including myoma, and fibroid. Malignancy and hyperplasia (AUB-M): Malignancy and atypical hyperplasia are associated with, AUB and must be considered in nearly all women of reproductive age. Coagulopathy (AUB-C): The term coagulopathy includes the systemic disorders of hemostasis that may be associated with AUB. Ovulatory dysfunction: Disorders of ovulation may present as different menstrual abnormalities ranging from amenorrhea (absence of periods), extremely light and infrequent bleeding, to unpredictable heavy menstrual bleeding. Endometrial (AUB-E): When uterine bleeding occurs due of the abnormalities of endometrium with normal ovulatory function, and without any coagulopathy it is known as AUB-E. Iatrogenic (AUB-I): Abnormal uterine bleeding associated with the use of exogenous gonadal steroids, intrauterine devices, or other systemic or local agents is classified as iatrogenic (AUB-I). Not yet classified (AUB-N): A category of “not yet classified” was created to accommodate entities that are rarely encountered or are ill-defined.
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#Prevention - Abnormal uterine bleeding - GA2Y Though there are no specific measures to prevent abnormal uterine bleeding (AUB), but early diagnosis and treatment helps to prevent long-term complications, such as infertility, anaemia, hypovolemia. Sometimes AUB resulting from hormonal changes can be prevented/ reduced by life style interventions include eating healthy diet and exercising, not smoking, maintaining healthy weight.
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#Overview - Abnormal uterine bleeding - GA2Y Abnormal uterine bleeding (AUB) is a common problem among (non-pregnant) women in the reproductive age. Formerly, it was known as dysfunctional uterine bleeding (DUB). AUB is responsible for significant health problem and social embarrassment and it is one of the common reasons women seek health care. It has a significant impact on the quality of life for the women. Women with abnormal bleeding have a lower quality of life than the general female population.
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#Treatment - Abnormal uterine bleeding - GA2Y Medical therapy is considered the preferred initial treatment. Conservative and uterine-preserving treatment options are used initially; however, ineffective medical treatment and certain situations need prompt surgical management. Surgery- When AUB does not respond to medical therapy, a surgical procedure is required to control the bleeding. Surgical treatment is based on the clinical diagnosis, the severity of bleeding, contraindications and response to medical management, the underlying medical condition, age and fertility status of women (whether she wants to have children). Hysteroscopic surgical removal of polyp- Polyps that cause AUB can be removed for controlling symptoms and even asymptomatic polyps need to be removed to exclude the chances of cancer. Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Dilation and curettage with concomitant hysteroscopy may be of value for those patients in whom intrauterine pathology is suspected or a tissue sample is required.
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#Symptoms - Abnormal uterine bleeding - GA2Y Abnormal uterine bleeding may present as any of the following symptoms: Bleeding or spotting between periods, Heavy bleeding during period, Menstrual cycles that are longer than 38 days or shorter than 24 days, Irregular periods in which cycle length varies by more than 7-9 days, Bleeding or spotting after sex, Bleeding after menopause.
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#Treatment - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 Definitive cure for AIDS is yet to be discovered. However, some medicines, given at certain stage of the disease, depending upon CD4 count in the blood of the patient, can prolong life of HIV positive persons. Reverse transcriptase (RT) inhibitors - It interferes with a critical step during the HIV life cycle and keep the virus from making copies of itself. Protease inhibitors - It interferes with a protein that HIV uses to make infectious viral particles. Fusion inhibitors - It blocks the virus from entering the body cells. Integrase inhibitors - It blocks an enzyme HIV needs, to make copies of itself. Multidrug combinations - It combines two or more different types of drugs into one. These medicines help people with HIV, but they are not perfect. They do not cure HIV/AIDS. People with HIV infection still have the virus in their bodies. They can still spread HIV to others through unprotected sex and needle sharing, even when they are taking their medicines. *NHP provides indicative information for better understanding of health. For any treatment and diagnosis purpose you should consult your physician.
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#Symptoms - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 There are 3 main stages of AIDS: Acute symptoms, clinical latency and severe symptoms. Acute symptoms: The majority of people infected by HIV develop Influenza (flu) like illness within a month or two, after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include: Headache, Fever, Sore throat, Muscle soreness, Rash, Mouth or genital ulcers, Swollen lymph glands, mainly on the neck, Joint pain, Diarrhoea, Night sweats. Clinical latency: There is persistent swelling of lymph nodes during clinical latent HIV. Else, there are no specific signs and symptoms. However, body remains infected with the virus. Severe symptoms: Headaches, Blurred and distorted vision, Cough and shortness of breath, Persistent white spots or unusual lesions on tongue or in mouth, Soaking night sweats, Shaking chills or fever higher than 100 F (38 C) for several weeks, Chronic diarrhoea, Persistent, unexplained fatigue, Weight loss, Skin rashes.
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#Prevention - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 HIV prevention refers to practices done to prevent spread of HIV/AIDS. HIV prevention practices may be done by individuals to protect their own health: Spreading awareness among masses. Protected sexual contact through the use of condoms, reduces the risk of HIV/AIDS. Providing awareness among population about their HIV status especially in high risks population. High risks population involves sex workers and their partners, Intravenous drug users, truck drivers, labuor migrants, refugees and prisoners. Safe injections: Use of auto disposal syringes help to prevent HIV infections. Male circumcision: It is the surgical removal of the foreskin (prepuce) from the human penis. Safe blood transfusion procured only from authorized and accredited blood banks. Counselling of HIV positive pregnant mother on the issue of how to prevent parent to child transmission (PPTCT).
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#Overview - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 AIDS is caused by human immunodeficiency virus (HIV). HIV kills or damages the body's immune system cells. There are two types of HIV. Type I and Type II. Type I is more common in India. AIDS is generally caused by unprotected sex with an infected partner. It may also spread through the use of infected syringes of HIV infected people and blood transfusions. The first sign of AIDS is influenza (flu) like symptoms or may be swollen glands, but at times, symptoms might not appear. Symptoms may appear after two or three months. Generally, blood test is done to confirm the diagnosis. There is no cure, but there are many medicines to fight/ control HIV infection.
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#Causes - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 A person becomes infected with HIV/AIDS by several ways: Blood transfusions: In some cases, the virus may be transmitted through blood transfusions. Sharing infected needles: HIV can be transmitted through needles and syringes contaminated with infected blood. Sexual Contact: The most frequent mode of transmission of HIV is through sexual contact with an infected person. From mother to child: A pregnant woman infected with HIV virus can transmit the virus to her foetus through their shared blood circulation, or an infected nursing mother can transmit it to her baby through her breast milk.
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#Diagnosis - Acquired Immuno Deficiency Syndrome (AIDS) - 1C62.3 HIV test is done to detect human immunodeficiency virus in saliva, serum or urine. The conduct of HIV testing of individuals must address: Confidentiality: The entire process of testing and results are kept confidential to give boost to individuals, couples, and families to learn about their HIV status in the convenience and privacy of their home environment. Window period: There is a period of time between HIV infection and the appearance of anti-HIV antibodies that can be measured which is called "window period". CD4 count: CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. Rapid or point-of-care tests: The rapid test is an immunoassay used for screening, and it produces quick results, in 20 minutes or less. Rapid tests use blood or oral fluid to look for antibodies to HIV. ELISA (enzyme-linked immunosorbent assay): ELISA is set of blood tests used to diagnose HIV infection. ELISA test is performed by inserting a needle to draw blood. RNA tests : It detects the virus directly (instead of the antibodies to HIV) and thus can detect HIV at about 10 days after infection, as soon as it appears in the bloodstream, before antibodies develop. Western Blot: A positive ELISA test is always followed by a Western blot test which confirm HIV infection.
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#Causes - Acute encephalitis syndrome - 1D00.Z Acute Encephalitis Syndrome (AES) has a very complex etiology. Causative agents of AES include a wide variety of viruses, bacteria, protozoa, fungi, and non- infectious agents. While Japanese encephalitis virus (JEV) is a leading cause of acute encephalitis syndrome in India (ranging from 5-35%), the etiology in a large number of cases however remains unidentified. In India during 2018, 15% of cases of AES were found positive for infection due to JEV. Herpes simplex virus, Influenza A virus, West Nile virus, Chandipura virus, mumps, measles, dengue, Parvovirus B4, enteroviruses and scrub typhus, S.pneumoniae are the other causes of AES in sporadic and outbreak cases in India. In many cases, however, no etiological agent is determined. Tick-borne encephalitis virus – TBEV, Zika virus, Nipah virus are also found positive in AES cases. Some are the zoonotic disease, that transmitted from animals to humans via mosquitoes (e.g. Japanese encephalitis virus, and West Nile virus) or ticks, (Tick-borne encephalitis virus), while for other flaviviruses humans are the natural hosts; these include dengue virus (DENV), and Zika virus (ZIKV).
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#Complications - Acute encephalitis syndrome - 1D00.Z The disease affects the central nervous system and can cause severe complications, seizures and even death. The Case Fatality Rate (CFR) of this disease is very high and those who survive may suffer from various degrees of neurological sequeale. (An estimated 25% of the affected children die, and among those who survive, about 30- 40% suffers from physical & mental impairment).
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#Overview - Acute encephalitis syndrome - 1D00.Z Acute encephalitis syndrome (AES) is a serious public health problem in India. It is characterized as acute-onset of fever and a change in mental status (mental confusion, disorientation, delirium, or coma) and/or new-onset of seizures in a person of any age at any time of the year. The disease most commonly affects children and young adults and can lead to considerable morbidity and mortality. Viruses are the main causative agents in AES cases, although other sources such as bacteria, fungus, parasites, spirochetes, chemicals, toxins and noninfectious agents have also been reported over the past few decades. Japanese encephalitis virus (JEV) is the major cause of AES in India (ranging from 5%-35%).Herpes simplex virus, Influenza A virus, West Nile virus, Chandipura virus, mumps, measles, dengue, Parvovirus B4, enteroviruses, Epstein-Barr virus and scrub typhus, S.pneumoniae are the other causes of AES in sporadic and outbreak form in India. Nipah virus, Zika virus are also found as causative agents for AES. The etiology in a large number of AES cases still remains unidentified.
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#Diagnosis - Acute encephalitis syndrome - 1D00.Z The National Vector Borne Disease Control Programme in India has set up country wide surveillance for AES through sentinel sites with a focus on detecting Japanese encephalitis (JEV). In the sentinel surveillance network, AES/JE is diagnosed by lgM Capture ELISA, and virus isolation is done in National Reference Laboratory. Laboratory-Confirmed case is a suspected case with any one of the following markers: Presence of lgM antibody in serum and/ or CSF to a specific virus including JE/Entero Virus or others, Four-fold difference in lgG antibody titre in paired sera, Virus isolation from brain tissue, Antigen detection by immunofluroscence, Nucleic acid detection by PCR
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#Prevention - Acute encephalitis syndrome - 1D00.Z National Programme for Prevention and Control of Japanese Encephalitis(JE)/ Acute Encephalitis Syndrome (NPPCJA): Considering the complexity of AES problem and to reduce morbidity, mortality and disability in children due to JE/AES, Government of India has developed a multi-pronged strategy with convergence of the concerned Ministries Ministry of Health and Family Welfare: Strengthening and expanding JE vaccination. Strengthening of public health activities. Better clinical management of JE/AES Cases. Physical medicine and rehabilitation (PMR). Establishing of district counselling centres. Monitoring, supervision and coordination. Research-cum-intervention project
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#Symptoms - Acute encephalitis syndrome - 1D00.Z Acute Encephalitis Syndrome (AES) is a general description of the clinical presentation of a disease characterized by high fever altered consciousness mostly in children below 15 years of age. Clinically, a case of AES is defined as a person of any age, at any time of year with the acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) AND/OR new onset of seizures (excluding simple febrile seizures). Other early clinical findings may include an increase in irritability, somnolence or abnormal behavior greater than that seen with usual febrile illness.
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#Treatment - Acute encephalitis syndrome - 1D00.Z Management of AES is essentially symptomatic. First line of management should be started at grass root level. To reduce severe morbidity and mortality it is important to identify early warning signs and refer patient to higher health facility. Danger Signs- Fever with any one of the following: Lethargy/ Unconsciousness/ Convulsions. Pre referral care- Sponging with tap water if fever is present Nothing to be given orally, Management of airway and breathing- Clear Airways, Patient’s position – Turn the patient on the side to reduce risk of aspiration. Keep the neck slightly extended and stabilize by placing cheek on one hand. Bend one leg to stabilize the body position. Referral to nearest first referral health facility.
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#Complications - Adult Inclusion Conjunctivitis - 1D84.0 Complications of adult inclusion conjunctivititis may be: Systemic complications: Urethritis, vaginitis and mucopurulent cervicitis in females. Pelvic inflammatory disease (PID). Perihepatitis (Fitz-Hugh-Curtis syndrome) in women with PID. Urethritis in males. Epididymitis in males. Co-infection with another sexually transmitted disease like gonorrhoea. Reiter syndrome (syndrome of urethritis, conjunctivitis and reactive arthritis) may be associated with chlamydial infection. Ocular complications: In adult inclusion conjunctivitis secondary to genital tract infection, there is not the same likelihood of re-infection. Thus, conjunctival scarring is rarely a complication of adult inclusion conjunctivitis, although micro-pannus (superficial fibrovascular proliferation that extends 1-2 mm beyond normal vascular arcade) and micro-ulceration of the cornea following punctate keratitis may rarely take place.
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#Causes - Adult Inclusion Conjunctivitis - 1D84.0 Chlamydia trachomatis causes trachoma (serotypes A, B, Ba and C) and also genital infections (serotypes D to K) and disease Lymphogranuloma venereum (serotypes L1 to L3). Infection with genital serotypes D to K can cause isolated episodes of ophthalmia neonatorum in infants or inclusion conjunctivitis in adults. The incubation period for adult inclusion conjunctivitis is 4-12 days. Genital serotypes do not cause trachoma blindness since they do not enter stable transmission cycles within communities. Serotypes D to K occasionally cause subacute follicular conjunctivitis but conjunctival scarring is rare. Usually, adult inclusion conjunctivitis is observed in young sexually active people. It is most common in persons aged 15-35 years.
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#Diagnosis - Adult Inclusion Conjunctivitis - 1D84.0 Physical Exam. Physical examination may show weak or absent pulse (e.g. in leg or foot). A weak or Diagnosis of adult inclusion conjunctivitis depends upon clinical presentation and laboratory diagnosis. Women with chlamydial infection often have a concomitant urethritis or vaginal discharge secondary to chronic vaginitis and/or cervicitis. Men may have symptomatic or asymptomatic urethritis. Laboratory diagnosis: Nucleic acid amplification tests (NAATs): Nucleic acid amplification test is the best laboratory technique, of which polymerase chain reaction (PCR) is an example. NAATs have high sensitivity and specificity but are expensive and not widely available. Giemsa cytology: Giemsa cytology is microscopic examination of stained conjunctival scrapings for basophilic intra-cytoplasmic epithelial inclusion bodies (Halberstaedter-Prowazek bodies). This test is highly specific but has low sensitivity. Chlamydial culture: Chlamydial cultures may be obtained from conjunctiva. Direct fluorescent antibody (DFA) assay: Direct fluorescent antibody assay of conjunctival smears is less sensitive than NAATs. Enzyme immunoassay (EIA): Enzyme immunoassay of conjunctival smears is also less sensitive than NAATs Serum immunoglobulin G (IgG) titers: Serum immunoglobulin G (IgG) titers may be obtained against chlamydia species.
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#Overview - Adult Inclusion Conjunctivitis - 1D84.0 Adult inclusion conjunctivitis or Paratrachoma results due to infection by obligate intracellular bacterium, Chlamydia trachomatis (serotypes D to K), which causes chronic follicular conjunctivitis (follicular conjunctivitis lasting for more than 16- 28 days). These organisms infect the epithelium of mucoid surfaces and were once identified as the trachoma-inclusion conjunctivitis agents (TRIC agents). These organisms can also infect a neonate during birth and may lead to neonatal conjunctivitis. Chlamydia trachomatis also includes the agents of classic trachoma (serotypes A, B, Ba and C). Lymphogranuloma venereum, a sexually transmitted infection, is caused by Chlamydia trachomatis (serotypes L1 to L3) which infect tissues deeper to the epithelium. Adult inclusion conjunctivitis is transmitted sexually (oro-genital activities) or from hand-to-eye contact. Gonorrhoea is the most common co-infection associated with adult inclusion conjunctivitis. Rarely, adult inclusion conjunctivitis is transmitted through eye-to-eye contact (e.g. by sharing mascara).
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#Symptoms - Adult Inclusion Conjunctivitis - 1D84.0 Adult inclusion conjunctivitis presents as a unilateral (less commonly bilateral) affliction of eye. Symptoms do not always exist with adult inclusion conjunctivitis in large number of patients and is often transmitted unknowingly. Almost half of patients with adult inclusion conjunctivitis do not have a systemic infection of Chlamydia. In addition to eye, Chlamydiae are found in parts of the body with mucosal membrane such as respiratory tract and the genitourinary tract. Symptoms of adult inclusion conjunctivitis may wax and wane and the patient may be asymptomatic. Patient may present with symptoms like:- Ocular (Eye) symptoms: Red eye. Muco-purulent discharge. Sticking of eyelashes on awakening. Watering. Itching. Irritation of eyes. Foreign body sensation. Photophobia or intolerance to light. Pain. Swelling of eyelids. Systemic symptoms: Urethritis in males. Genito-urinary symptoms viz. urethritis, vaginal discharge in females. Mild ear infection on same side of infected eye.
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#Prevention - Adult Inclusion Conjunctivitis - 1D84.0 To prevent adult inclusion conjunctivitis, patients should follow safe sexual practices. Patients should be educated about the risks of sexually transmitted diseases.
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#Treatment - Adult Inclusion Conjunctivitis - 1D84.0 Management should be carried out under medical supervision. Adult inclusion conjunctivitis is usually self-limiting. To prevent re-infection, all sexual partners should be treated simultaneously. All sexual partners should also be examined for other sexually transmitted diseases such as gonorrhoea, syphilis and Human immunodeficiency virus (HIV). It is prudent to treat all members of the household with antibiotics. There should be abstinence from sexual activity until the course of treatment is complete. The goal of pharmacotherapy is to reduce morbidity and to prevent any complications. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathological organisms. Conjunctivitis is usually an ocular manifestation of a sexually transmitted uro-genital infection. Therefore, adult inclusion conjunctivitis does not respond and topical use of antibiotic is relatively not effective. Patients should be followed-up for about 2-6 weeks after initiation of treatment, depending upon the severity of initial symptoms. Treatment consists of: Systemic antibiotics: Systemic antibiotics are usually recommended for about 3-6 weeks. Systemic oral antibiotics such as erythromycin, azithromycin, tetracycline or doxycycline may be used. Topical antibiotics: Topical antibiotics are relatively ineffective.
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#Overview - Alcohol Abuse and Alcoholism - 6C40.1Z Alcoholism is a condition when a person have signs of physical addiction to alcohol and continues to drink , despite problems with physical and psychological health. Alcohol abuse is when person's drinking habits leads to problems, but not physical addiction. These problems can lead to a number of harmful physical, psychological and socioeconomic effects such as alcohol poisoning, cirrhosis of the liver, inability to work and socialize and destructive behaviors(violence and vandalism).
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#Diagnosis - Alcohol Abuse and Alcoholism - 6C40.1Z The medical professional will perform a physical examination and ask questions about person's medical and family history, including use of alcohol. Tests to rule out, if a person is alcoholic or not: Blood alcohol level, Complete blood count, Liver function test, Magnesium blood test.
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#Treatment - Alcohol Abuse and Alcoholism - 6C40.1Z Treating alcoholism depends on how much a person drinks. Further treatment options are: Detoxification - It involves a nurse or doctor supporting the person to safely give up drinking. It can be done by helping the person to slowly reduce the alcohol intake over time or by medications. Thus reducing the withdrawal symptoms. Counseling - It includes self-help groups and talking therapies, such as cognitive behavioral therapy (CBT). Medication - There are two main types of medicines to facilitate a person to stop drinking. The first is to help reduce withdrawal symptoms and is generally given in tapering doses over a short period of time.
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#Symptoms - Alcohol Abuse and Alcoholism - 6C40.1Z People who have alcoholism or alcohol abuse often: Continue to drink, even after knowing the ill effects of drinking, Drink alone, Become hostile when asked about drinking, Unable to control drinking, Make excuses to drink, Miss work or school, or have a decrease in performance because of drinking, Stop taking part in activities because of alcohol, Need to consume alcohol on most days to get through the day, Become violent if somebody tries to stop them to drink.
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#Causes - Alopecia (hair loss) - ED70.Z There are many reasons for hair loss. It include following reasons: Hair Disorders. Hereditary thinning or baldness, Alopecia areata, Cicatricial (scarring) alopecia. Disease. Underlying medical condition, Some cancer treatments, Ringworm of the scalp, Trichotillomania. Stress and Hormones. Stress, Hormone fluctuations. Diet: Weight loss, Vitamin A excess, Protein intake too low, Iron intake too low. Eating disorder. An eating disorder such as anorexia or bulimia is the other cause of hair loss. Medication. Medications that can cause hair loss include: Blood thinners, High-dose vitamin A, Medicines for arthritis, depression, gout, heart problems, and high blood pressure, Birth control pills. Hair Care Practices. Hair cosmetics, Blow dryers, flat irons, and similar devices, Hairpins, clips, and rubber bands, Too much or vigorous grooming.
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#Diagnosis - Alopecia (hair loss) - ED70.Z Dermatologists can diagnose hair loss by asking questions about medical history, family history. A dermatologist may also carefully look at the scalp to know the condition of scalp.
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#Overview - Alopecia (hair loss) - ED70.Z Partial or complete loss of hair is called alopecia. Hair loss usually develops gradually and may be patchy or diffuse (all over). One loses up to 100 hair from the scalp everyday. Baldness is not usually caused by disease. It is also related to aging, heredity or changes in the hormones. There can be male pattern baldness or female pattern baldness.
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#Treatment - Alopecia (hair loss) - ED70.Z Treatment of hair loss depends upon the cause of disease. Treatment available without a prescription. Minoxidil: This medicine is applied to the scalp. It can stop hair from getting thinner and also stimulate hair growth on the top of the scalp. Laser devices: Brushes, combs, and other hand-held devices that emit laser light also stimulate hair growth. These devices might make hair look more youthful in some people. Prescription medicine. Finasteride: The FDA approved this medicine to treat men with hair loss. It comes in pill form and helps slow hair loss in most (about 88%) men. It helps stimulate hair re-growth in many (about 66%) men. Corticosteroid: If your hair loss is caused by inflammation in body, a dermatologist may inject a medicine called a corticosteroid into scalp. This can help stop the inflammation that happens when a person has alopecia areata. Procedures. To achieve the best results, a dermatologist may use one or more of the following procedures: Hair transplantation, Scalp reduction, Scalp expansion, Scalp flaps.
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#Diagnosis - Alzheimer Disease - 8A20 Early, accurate diagnosis is crucial for several reasons. It can tell people whether their symptoms are due to Alzheimer’s disease or another cause, such as stroke, tumour, Parkinson’s disease, sleep disturbances, side effects of medications, or other conditions that may be treatable and possibly reversible. Although definitive diagnosis of Alzheimer's can be made only after death, yet the doctors can usually diagnose the disease with the help of: Past medical history and current health status. Changes in the behavior and personality of the patient. Conducting cognitive tests involving memory, problem solving, language, etc. Standard medical tests, such as blood and urine tests, in order to rule out other causes. Brain scans including CT/MRI scans.
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#Causes - Alzheimer Disease - 8A20 Scientists have not yet understood the exact cause of Alzheimer's disease. It is postulated to have multifactorial etiology like: Genetic: The Apolipoprotein E (ApoE) gene is implicated in Alzheimer’s Disease. This gene has several forms. One of them, ApoE ε4, seems to increase a person’s risk of getting the disease. However, carrying the ApoE ε4 form of the gene does not necessarily mean that a person will develop Alzheimer’s disease, and people carrying no ApoE ε4 can also develop the disease. Environmental/ Lifestyle factors: Diseases like heart disease, stroke, high blood pressure, diabetes, obesity, hyperlipidemia etc. have also shown to be linked with the Alzheimer's disease.
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#Prevention - Alzheimer Disease - 8A20 There is no definitive evidence to support that any particular measure is effective in preventing. However, there are certain steps that could be taken which may help to delay the onset of dementia. Staying mentally healthy by: Reading, Writing for pleasure, Playing musical instruments, Taking part in adult education courses, Playing games, Swimming, Group sports such as bowling, Walking, And other recreational activities.
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#Overview - Alzheimer Disease - 8A20 Dementia is a disorder characterized by serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. Alzheimer's Disease is the most common form of dementia. It is more common in older individuals. Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks of daily living. Although scientists are learning more every day, right now, they still do not know what causes Alzheimer’s disease. Thus it is an Idiopathic disease.
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#Treatment - Alzheimer Disease - 8A20 There is no cure for Alzheimer's disease; though symptomatic relief can be provided. Current treatments can be divided into Medical, Psychosocial and Care giving. Various medications to treat Alzheimer's are: Donepezil, Rivastigmine, Galantamine. Psychosocial interventions are used as an adjunct to medicinal treatment and can be classified as supportive, cognitive and behavioural approaches. Care giving: Since patient with Alzheimer's has no cure, it gradually renders people incapable of tending for their own needs, thus care giving essentially is the treatment and must be managed carefully over the course of the disease.
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#Symptoms - Alzheimer Disease - 8A20 Common symptoms of Alzheimers Disease are: Forgetfulness, Language difficulties including difficulty in remembering names, Difficulty in planning and problem solving, Difficulty in doing previously familiar tasks, Difficulty in concentration, Difficulty in spatial relationships like remembering roads and routes to a particular, destination, Difficulty in social behavior.
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#Diagnosis - Amaurosis Fugax - 8B10.0 Diagnosis depends upon clinical history and examination. Patients present with sudden monocular loss of vision that usually is less than fifteen minutes, and it rarely exceeds thirty minutes. Vision loss may be complete or partial. It is described as a curtain falling down in front of the eye or as a generalised darkening. Patient may experience one to multiple episodes, which usually resolve spontaneously. The attacks may sometimes be associated with ipsilateral cerebral TIA, with contralateral neurological features. Investigations Besides general examination, following investigations may help in assessment of vessels. Doppler test: Doppler of carotid vessels may help in assessment of vessels. Magnetic resonance imaging: It may help in assessment of vascular patency. Computed tomography: Vascular patency may also be assessed by computed tomography. Electrocardiogram/ Holter monitoring: This helps to localise any cardiac arrhythmia or any possible source of cardiac emboli. Neuroimaging: It may be done to rule out any other cause of vision loss.
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#Causes - Amaurosis Fugax - 8B10.0 The causes of Amaurosis fugax are divided into five groups Embolic, Haemodynamic, Neurologic, Ocular, Idiopathic. Usually Amaurosis fugax is typically used to refer to transient visual loss of embolic origin. Episodic attacks of blindness occur as arteriosclerotic plaques progressively narrow the lumen of ipsilateral internal carotid artery (ICA), leading to reduced pressure and flow in ophthalmic artery. Cholesterol crystals (Hollenhorst plaques) or ulcerating plaque may embolise to ophthalmic or central retinal artery, without causing permanent visual loss. TMB is regarded as one variety of transient ischaemic attack (TIA) and should be recognised as a warning sign of impending stroke. Frequency of attacks may vary from several times in a day to once only every few months. Cerebral ischaemia may affect both eyes with ipsilateral hemifield defect. Amaurosis usually occurs in elderly patients over fifty years of age who have vascular risk factors such as hypertension, hypercholesterolaemia, history of smoking, or previous episodes of TIAs.
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#Symptoms - Amaurosis Fugax - 8B10.0 Symptoms vary according to the type of Amaurosis depending upon visual loss occurrence: Type I: It is characterised by sudden brief attack of partial or complete diminution or obscuration of vision, lasting for seconds to minutes, followed by total recovery. Partial impairment presents as ascending or descending curtain or a blind moving sideways across the eye. Visual field defect is complete or partial. It is due to retinal ischaemia, embolisation or arteritis. Type II: It is less rapid in onset and may be associated with loss of contrast vision and photopsiae. It lasts from minutes to hours. Pain may be rarely associated and the recovery is complete. Visual field defect is complete or partial. It is produced due to retinal hypoperfusion and carotid occlusive disease. Type III: It is of abrupt onset and show photopsiae, scintillating sparkles, and is often accompanied by pain. It is due to vasospasm and migraine. Visual field defect is complete and may lead to progressive contraction. It lasts for minutes only and the recovery is usually complete. Type IV: It is of abrupt onset and may alternate between two eyes. It occurs in association with antiphospholipid antibodies but also include cases due to unknown causes. Visual field defect may resemble any of the types from one to three as mentioned above. Duration may go up to any length of time and the recovery is complete.
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#Overview - Amaurosis Fugax - 8B10.0 Amaurosis Fugax or transient monocular blindness (TMB) refers to transient brief blindness, blurring, fogging, or dimming of vision, varying in duration from few seconds to minutes or even hours in some cases. The duration of visual impairment is brief usually less than fifteen minutes and rarely exceeding thirty minutes. The term Amaurosis fugax has been used not only for monocular condition, but also for the transient loss of vision in both eyes (less common). Most of the patients are affected for about one to five minutes only. Generally, recovery is in the same pattern as the visual loss, although usually more gradual. Amaurosis is also known as blackout. It is thought to occur from transient occlusion of the ophthalmic circulation and is a risk factor for acute stroke. Fundus examination is commonly normal but may show prior retinal arterial emboli or attenuation of arteries. Investigations like carotid ultrasonography and cardiac echography may help in finding source of embolus.
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#Treatment - Amaurosis Fugax - 8B10.0 Management. Treatment of amaurosis fugax may help in prevention of ischaemic attacks. Systemic diseases such as hypertension, diabetes mellitus, cardiac arrhythmias, and hyperlipidaemia state should be managed with appropriate treatment. Medical therapy. It may include Aspirin: Aspirin, an antiplatelet agent may be used as an antithrombotic agent to prevent arterial thrombosis. Anticoagulants: Anticoagulants may be given to prevent stroke. Surgical therapy. Since embolisation is one of the important reason, treating amaurosis may help in prevention of full-blown stroke. It requires treatment of carotid artery stenosis. It may be managed by Angioplasty, Stenting. Patients who either are unfit for surgery or those who are not having any symptoms, endovascular approach may be instituted.
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#Causes - Amblyopia - 9D46 A distinction must be made between potentially reversible functional amblyopia and irreversible organic amblyopia. Organic amblyopia is a term used to describe visual impairment due to obvious or non obvious ocular pathology, commonly affecting retina or optic nerve. Examples of organic amblyopia are optic nerve hypoplasia, optic atrophy and foveal hypoplasia. Functional amblyopia may occur along with organic amblyopia. Functional amblyopia normally occurs in an eye that is anatomically normal. Functional amblyopia is caused by either form of vision deprivation or abnormal binocular interaction. Form- vision deprivation occurs due to conditions that obstruct the visual axis such as cataract, corneal opacity, vitreous haemorrhage, or severe ptosis, but it may also be produced by severe anisometropia. Abnormal binocular interaction refers to the condition in which the image projected onto the fovea of each eye is dissimilar enough to preclude fusion, thus prompting suppression and ultimately amblyopia of the suppressed eye. While strabismus may be the most obvious cause of abnormal binocular interaction, unilateral opacity of the media and anisometropia may participate in this mechanism as well.
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#Symptoms - Amblyopia - 9D46 The main symptom of amblyopia is decreased foveal visual acuity. Commonly used diagnostic criteria, is the loss of visual acuity of two or more lines on the Snellen vision chart. Amblyopic eye presents an abnormal contour interaction which shows decrease in acuity for objects placed in a row compared with acuity for the same objects viewed separately (crowding phenomena). Eccentric fixation. Decreased contrast sensitivity. Improved vision in dim background illumination. Decreased brightness perception. Binocular suppression of amblyopic eye.
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#Overview - Amblyopia - 9D46 Amblyopia is often defined as a difference in visual acuity of two lines or more on Snellen or equivalent chart in a child with, otherwise, healthy eyes. Amblyopia may be present any time visual acuity is reduced, and the reduction of acuity cannot be explained by findings on clinical examination, even if the difference is even one line only. Amblyopia is a functional reduction in the visual acuity of an eye caused by disuse during critical period of visual development. The mechanism of vision loss is not known, but it is thought to originate in the visual cortex. Amblyopia results in reduced visual acuity, binocularity, depth perception, and contrast sensitivity. Fusion and stereopsis, the central formation of three dimensional images, are dependent upon receiving clear images from each eye simultaneously.
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#Treatment - Amblyopia - 9D46 Early management of amblyopia is critical for best visual acuity results. The basic strategy for treating amblyopia is to first provide a clear retinal image, and then correct ocular dominance if ocular dominance is present, as early as possible during the period of visual plasticity (birth to eight years of life). I. Clear retinal image: Patients with bilateral hypermetropia (> + 5.00 D) should receive the full hypermetropic correction, as amblyopic eyes do not fully accommodate. Patients who are given partial correction of their high hypermetropia often shows very slow or no improvement in their amblyopia. Prescribe full astigmatic correction to provide a clear retinal image. II. Correct ocular dominance: Correction of ocular dominance is accomplished by forcing fixation to the amblyopic eye through patching or blurring the vision of the sound eye by: Occlusion, Penalisation, Occlusive contact lens, Bilateral light occlusion, Levodopa/ carbidopa in the treatment of amblyopia, Pleoptics, Active stimulation. Prognosis: The prognosis of amblyopia depends upon the age of the patient, severity of amblyopia, and type of amblyopia. The earlier the amblyopia occurs and longer it remains untreated, the worse is the prognosis. In general, bilateral amblyopia responds better than unilateral amblyopia, and myopic anisometropic amblyopia responds better than hypermetropic anisometropic amblyopia.
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#Diagnosis - Amblyopia - 9D46 Diagnosis of amblyopia is based mainly on measurement of visual acuity. Visual acuity measurement: Subjective and objective methods to test visual acuity have been proposed. Optical grating: The different stimuli consist of repetitive gratings of predictable and precise luminance variations. Sinusoidal and square- wave gratings are some other forms to test visual acuity. Optokinetic nystagmus: The primary use of optokinetic nystagmus is a rapid screen for the gross integrity of the visual system. Acuity may be measured as the finest grating that elicits a visible optokinetic nystagmus when different sizes of stripes are used. Preferential looking test: It is based on the principle that infants tend to fixate a pattern stimulus rather than a homogeneous field. With this, inter-ocular acuity may be detected in children less than one year of age. Visually evoked potential: Visually evoked potential is a summed cortical response to changes in some characteristics of a visual stimulus. The visual stimulus may be either a simple flash or a more complex pattern. Visuscope: Visuscope is a type of direct ophthalmoscope that projects a focused image onto the retina so that the examiner can see the image on the retina.
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#Complication - Amoebiasis - 1A36.Z Complications of amoebic colitis include the following: Fulminant or necrotizing colitis, Toxic megacolon, Amoeboma, Recto vaginal fistula. Complications of amoebic liver abscess include the following: Intraperitoneal, intrathoracic, or intrapericardial rupture, with or without secondary bacterial infection, Direct extension to pleura or pericardium, Dissemination and formation of brain abscess. Other complications due to amoebiasis include the following: Bowel perforation, Gastrointestinal bleeding, Stricture formation, Intussusception, Peritonitis,Empyema.
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#Causes - Amoebiasis - 1A36.Z Amoebiasis is caused by parasite Entamoeba histolytica. Several protozoan species in the genus Entamoeba colonize humans, but not all of them are associated with disease. Transmission occurs via: Faecal–oral route, either directly by person-to-person contact or indirectly by eating or drinking faecally contaminated food or water. Sexual transmission by oral-rectal contact is also recognized especially among male homosexuals. Vectors such as flies, cockroaches and rodents can also transmit the infection.
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#Overview - Amoebiasis - 1A36.Z Amoebiasis is a disease caused by the parasite Entamoeba histolytica. Only about 10% to 20% of people who are infected with E. histolytica become sick from the infection. Amoebiasis is a common infection of the human gastro-intestinal tract. Amoebiasis is more closely related to poor sanitation and socioeconomic status than to climate. In addition to being a potentially lethal disease, invasive amoebiasis has important social and economic consequences. Amoebiasis may cause clinical problems in persons with immunodeficiency, homosexuals and immigrants from certain tropical countries, and travellers.
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#Diagnosis - Amoebiasis - 1A36.Z Entamoeba histolytica must be differentiated from other intestinal protozoa. Microscopic identification of cysts and trophozoites in the stool is the common method for diagnosing E. histolytica. In addition, E. histolytica trophozoites can also be identified in aspirates or biopsy samples obtained during colonoscopy or surgery. Immunodiagnosis - Antibody Detection- a) Enzyme immunoassay (EIA) is most useful in patients with extra-intestinal disease (i.e., amoebic liver abscess) when organisms are not generally found on stool examination. b) Indirect hemagglutination (IHA). If antibodies are not detectable in patients with an acute presentation of suspected amoebic liver abscess, a second specimen should be drawn 7-10 days later. Antigen Detection- Antigen detection may be useful as an adjunct to microscopic diagnosis in detecting parasites and to distinguish between pathogenic and nonpathogenic infections. Molecular Diagnosis- Radiography, Ultrasonography, Computed tomography (CT) and Magnetic resonance imaging (MRI) can be used for detection of liver abscess, cerebral amoebiasis.
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#Symptoms - Amoebiasis - 1A36.Z The clinical spectrum ranges from asymptomatic infection, diarrhoea and dysentery to fulminant colitis and peritonitis as well as extra-intestinal amoebiasis. Acute amoebiasis can present as diarrhoea or dysentery with frequent, small and often bloody stools. Chronic amoebiasis can present with gastrointestinal symptoms plus fatigue, weight loss and occasional fever. Extra-intestinal amoebiasis can occur if the parasite spreads to other organs, most commonly the liver where it causes amoebic liver abscess. Other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites.
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#Prevention - Amoebiasis - 1A36.Z Amoebiasis can be prevented and controlled both by non-specific and specific measures. Non-specific measures are concerned with- Improved water supply, Sanitation, Food safety, Health education of the public as well as health personnel at all levels about sanitation and food hygiene, General social and economic development. Specific measures that should be undertaken when possible are- community surveys to monitor the local epidemiological situation with regard to amoebiasis; improvement of case management, i.e., rapid diagnosis and adequate treatment of patients with invasive amoebiasis at all levels of the health services, including the community and health centre levels; surveillance and control of situations that may encourage the further spread of amoebiasis, e.g., refugee camps, contaminated public water sources.
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#Treatment - Amoebiasis - 1A36.Z For symptomatic intestinal infection and extra intestinal disease, treatment with antiamoebic drugs should be taken with consultation of a physician. Asymptomatic patients infected with E. histolytica should also be treated with antiamoebic drugs, because they can infect others and because 4%–10% develop disease within a year if left untreated. Liver aspiration- Liver aspiration is indicated only if abscesses are large (> 12 cm), abscess rupture is imminent, medical therapy has failed, or abscesses are present in the left lobe.
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#Causes - Anaemia - 3A9Z Three main cause of anaemia are: Blood loss, Lack of red cell production, High rates of red blood cell destruction. 1) Blood loss: Blood loss is the most common cause of anaemia, especially in iron-deficiency anaemia. Blood loss can be short term or long term depending upon the conditions. Bleeding in the digestive or urinary tract can cause blood loss. Surgery, trauma, or cancer also can cause blood loss. Heavy blood loss due to menstruation. Lack of Red Blood cell production: It can be due to "acquired" or "Inherited". "Acquired" means that the person is not born with the condition, but may develop it at later stages. "Inherited" means that the condition has been passed by the parents. Acquired conditions and factors that can lead to anaemia include: Poor diet, Unusual hormonal levels, Chronic diseases. High rates of RBCs destruction: Factors that can cause destruction of red blood cells. One condition can be an enlarged or diseased spleen.This is an acquired condition.
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#Overview - Anaemia - 3A9Z The condition of having a lower-than-normal number of red blood cells or quantity of hemoglobin. Normal results vary. Anaemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction. Conditions that may lead to anaemia include Heavy periods, Pregnancy, Ulcers, Colon polyps or colon cancer, Inherited disorders A diet that does not have enough iron, folic acid or vitamin B12, Blood disorders such as sickle cell anaemia and thalassemia, or cancer, Aplastic anaemia, a condition that can be inherited or acquired. Anaemia can make you feel tired, cold, dizzy, and irritable. You may be short of breath or have a headache.
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#Diagnosis - Anaemia - 3A9Z Medical History: Signs and symptoms like weakness, malaise or body aches. Blood tests: To check for the levels of hemoglobin (it is a protein that transports oxygen). Red blood cells (cells that contain hemoglobin)is lower than normal. Physical examination: Rapid or irregular heartbeat, Rapid or irregular breathing, Enlarged liver or spleen Complete blood count (CBC): A CBC is generally done to know the number of blood cells in the blood. To check anaemia, physician will see the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in blood. A test to determine the size and shape of your red blood cells: Some of red blood cells may also be examined for unusual size, shape and color. This will help in diagnosis.
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#Treatment - Anaemia - 3A9Z Iron supplements: The most commonly prescribed supplement is ferrous sulphate, taken orally (by mouth) two or three times a day. Dietary supplements: Iron-rich foods include: Dark-green leafy vegetables, such as spinach, Iron-fortified cereals Whole grains, such as brown rice, Beans, Nuts Meat, Apricots.
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#Symptoms - Anaemia - 3A9Z The most common symptom of anaemia is fatigue or weakness. Other signs and symptoms of anaemia include: Shortness of breath, Dizziness, Headache Coldness in the hands and feet, Pale skin, Chest pain.
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#Complications - Anaemia - 3A9Z Iron deficiency anaemia rarely causes any serious or long-term complications. However, some of the complications are listed below: Tiredness. Iron deficiency anaemia can leave a person tired and lethargic (lacking in energy), as a result person may be less productive and active at work. Immune system. Iron deficiency anaemia can affect immune system (the body’s natural defence system), making a person more susceptible to illness and infection. Heart and lung complications. Adults with severe anaemia may be at risk of developing complications that affect their heart or lungs. For example, Tachycardia (an abnormally fast heartbeat), Heart failure, when your heart is not pumping blood around your body very efficiently Pregnancy. Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after the birth. They may also develop postnatal depression (a type of depression some women experience after having a baby).
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#Causes - Aniseikonia - 9D00.5 Aniseikonia may occur naturally or is produced secondary to correction of refractive error. Up to 7% of aniseikonia between two eyes is usually tolerated well, and it corresponds to about 3 dioptres (D) of anisometropia. The measuring unit for refractive error is dioptre (D), which is defined as the reciprocal of the focal length in meters. Causes includes: I. Optical: Inherent, Acquired. II. Anatomical or retinal: Displacement of retinal elements, Separation of neuroepithelial elements, Streching of retina, Retinal oedema. III. Central or cortical: Asymmetrical simultaneous perception by cerebral cortex.
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Disease A-Z Datasets

Evaluation Data

To address data sparsity via enrichment during data integration, our intrinsic evaluation accounts for a wide variety of entity types and a complex schema (Fig. Schema). For our comparative evaluation, we utilize the TEST portion of our annotated text dataset (refer to Table: Annotated Text Dataset Statistics). The task-specific fine-tuning employs the structured data for LM-SD, and the same data is used to build patterns for the Baseline and to fine-tune the embedding vector in our approach, THOR. The LM-Human is fine-tuned with a contextualized training set from the annotated text. For both language models, the validation data is used to learn optimal hyperparameters.

The text dataset is split based on the Diseases files, aiming to distribute the total number of entities into approximately 70% for training, 20% for validation, and 10% for testing. There are some deviations in the entity counts due to the difficulty in splitting them exactly into 70/20/10 percentages.

Annotated Text Dataset (Disease A-Z) Statistics

# Training Validation Test Total
Disease 240 61 13 314
Documents 1438 366 90 1894
Entities 18539 3989 2222 24750
Relations 10269 2145 867 13281
Tokens 168816 38722 19237 226775

The following is the individual class-wise statistics of our TEST data:


*Figure: Individual Class-wise Statistics of Annotated Test Data.*

Statistics of Structured Data

Sources Concepts Subject Instances Instances
10 11 284 4,706

Disease A-Z Dataset Description

We consider a health-related data scenario containing Disease A-Z information with Conditions. The following sections describe the data sources and schema used.

Structured Data Sources and Integrated Schema

Our structured data sources contain disease and condition information in tabular format (CSVs), following the integrated schema (Fig. Schema). Each structured data source contains two columns relating concepts such as Disease and Anatomy or Surgery and Anatomy. We have 10 structured sources containing instances of 11 concepts.


*Figure: The Integrated Schema for our Use Case Datasets.*


Text Data Sources

We annotated a text dataset with concepts and relations shown in our schema (Fig. Schema). The dataset aggregates Disease/Conditions A-Z information from major health portals like WHO, NHS, and CDC. We manually collected texts about 1100+ diseases, out of which 314 diseases were annotated. Each disease information is organized into up to eight different text documents indicating major aspects (conditions) of those diseases such as - Overview, Causes, Symptoms, Complications, Diagnosis, Treatment, Prevention, and Risk-factors. Each text file has been named according to the corresponding ICD-11 disease code and name, adhering to the latest 11th edition of International Classification of Diseases (ICD), which can be found at ICD-11. This gives a 360º view of the diseases, making it a good candidate for Information Extraction and NLP related tasks. A sample disease data source from one of the portal looks like this: NHS.

Text Data Annotation Guidelines:

The following guidelines pertain specifically to the Text Data Annotation portion of our dataset. To facilitate Named Entity Recognition and Relation Extraction, we have compiled a comprehensive health dataset encompassing detailed information on individual diseases. From an initial collection of 1100+ diseases, a total of 314 diseases have been meticulously annotated. Our annotation efforts have been focused on ensuring the highest quality of data. The guidelines adhered to in the annotation process are as follows:

  • Development of a specialized schema tailored for the annotation task, serving as a structured guideline.
  • Adhering to the Entity labels and Relation labels defined in the schema for the manual annotation process.
  • Incorporating several pre-processing such as punctuation corrections, adding abbreviations, processing of bullet points, and integration of disease codes.
  • Marking the span of words followed by the selection of appropriate labels from the predefined set of entities, ensuring correct entity annotation.
  • Identification and establishment of dependencies between entities, followed by connecting these into corresponding relations, chosen from a list of available relation labels.
  • Introduction of global entity type corresponding to the name of the disease to mark implicit relations in text.
  • Rigorous validation of chosen entity and relations against the schema to ensuring consistency and accuracy.

By strictly following these guidelines, we aim to create a dataset that is not only precise but also aligns with the intended use-case scenarios.

Annotation Tool and Sample:

We utilized the open-source tool doccano to annotate our dataset. The annotation process involves identifying and labeling entities such as diseases, symptoms, and anatomy, as well as the relations between them, such as causality and symptoms association.

The following image represents a snippet of our annotated text, showcasing how entities and relations are structured within the dataset:


*Figure: A snippet of the annotated text showing entities and relations for Tuberculosis.*

Entities are denoted with suffix _E and relations with _R, allowing for a clear and concise representation of complex medical information. This structured annotation facilitates the training of models for Named Entity Recognition and Relation Extraction tasks.

Manual Annotation Process (Labeling):

The annotation process requires meticulous attention to two types of labeling: Entity Labeling and Relation Labeling (Entity Linking).

  • Entity Labeling: Entities within the text are labeled by selecting one or multiple contiguous words that represent a coherent concept or category.

    1. Begin annotating the text data by selecting the appropriate label for each entity from the list provided in Doccano's interface.
    2. Highlight and label the relevant text segments. This process is repeated for each document within the dataset.
    3. Conduct periodic reviews of the annotated data to identify and rectify any errors or inconsistencies.
    4. Utilize Doccano's functionality to modify or delete incorrect annotations, ensuring the high quality and precision of the dataset.
    5. Recognize that annotation is an iterative process; repeat the review and correction steps as necessary to refine the annotations.
  • Relationship Labeling: Relationships are established by linking two appropriately labeled entities and specifying the nature of their relationship.

    1. Upon completion of entity annotation, examine the text to determine if there are any logical relationships between the entities.
    2. Select the first entity and then the second, noting that the order of selection implies the directionality of the relation.
    3. After both entities are selected, choose the appropriate relation label that accurately describes their interaction.
    4. Review the relationships to ensure they are consistent with the predefined schema and accurately reflect the text's content.

Annotation Agreement and Efforts

Three annotators, each with specialized knowledge, annotated the dataset individually. In cases of disagreement, a separate expert with linguistic expertise ensured the accuracy of the annotations (please check the Annotation_Agreement.xlsx file). Thus we ensured 100% Annotation Agreement. Each annotator dedicated between 3 to 6 hours per day to this task, spanning over a period of more than 3 months. Another 1 month is spend for the Agreement and Validation process. Collecting and pre-processing the texts from the sources took about 2 months. Thus the whole process took over 6 months. The table below shows the minimum and maximum time taken for annotating an instances of disease, document, and tokens. It also indicates the approximate total duration of hours it took to annotate the entire dataset by a single annotator.

Annotation Efforts In Terms of Minimum and Maximum Time

Single Disease (min-max) Single Document (min-max) Single Token (min-max) Total Duration (Hours)
80m – 150m 7m – 25m 8s – 13s 600+

Cite the THOR Paper:

@inproceedings{rahman2024mitigating,
 title={Mitigating Data Sparsity in Integrated Data through Text Conceptualization},
 author={Rahman, Md Ataur and Nadal, Sergi and Romero, Oscar and Sacharidis, Dimitris},
 booktitle={2024 IEEE 40th International Conference on Data Engineering (ICDE)},
 pages={3490--3504},
 year={2024},
 organization={IEEE}
}
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