Syphilis is an infection caused by the bacterium Treponema pallidum.
Syphilis is a sexually transmitted infection that is acquired through genital, oral, or anal sex. Syphilis can also be passed to a fetus during pregnancy, causing congenital syphilis. Early diagnosis and treatment of syphilis is important to prevent progression of the disease and avoid transmission to others. Syphilis infections can be decreased by use of condoms during sex.


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Natural History of Chronic Hepatitis D. Chronic hepatitis D is associated with a more rapid progression to cirrhosis and a higher risk of hepatocellular carcinoma than HBV monoinfection. Identifying patients in whom fibrosis progresses rapidly would be crucial for determining the prognosis, but mechanisms of fibrotic progression are poorly understood. Histologic findings (hematoxylin and eosin stain) are shown. Liver fibrosis is assessed with the use of Metavir staging, which ranges from F0 (no fibrosis) to F4 (cirrhosis). Some HDV genotypes may influence disease activity. Persistent HDV viremia is a factor in disease progression and a predictor of death. In liver disease in general, factors associated with fibrosis are male sex, older age at infection, excessive alcohol consumption, obesity, diabetes, and immunodeficiency.


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Stages of HPV-Mediated Carcinogenesis

This depicts the necessary, sequential stages of HPV-mediated carcinogenesis: HPV infection, intraepithelial precancer, and cancer. The images illustrate what a clinician might see on physical examination at each stage of carcinogensis. HPV genotype is a major influence on risks of progression to precancer and cancer compared with immune control and regression to negative results on HPV testing. Familiar and overlapping microscopic (cytologic and histologic) morphologic grading as well as visual classifications have been used to indicate the increasing severity of HPV-induced changes. However, morphologic and visual grading classifications have imperfect reproducibility and accuracy, and many diagnoses are equivocal. Molecular tests (eg, p16/Ki67 dual stain) are increasingly used to identify the likelihood of prevalent and incipient precancer.

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Opill is a progestin-only pill that contains the progestin hormone (norgestrel) but not estrogen. Progestin-only pills prevent pregnancy by stopping sperm from entering the uterus and may prevent egg release from the ovary in some individuals. Opill will likely be available over the counter in US pharmacies in 2024.

Progestin-only pills should be taken daily at the same time of day. Individuals who miss a dose by more than 3 hours are recommended to use a backup birth control method (such as a condom) and should take the missed dose as soon as possible.
If taken as recommended, progestin-only pills are highly effective at preventing pregnancy. Common side effects include irregular, lighter, or more frequent periods. Less commonly, people may experience nausea, vomiting, headache, or fatigue while taking progestin-only pills.

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Model of Systemic Inflammation, Immune Dysregulation, and a Structurally Hostile Tumor Microenvironment (TME) Associated With High Tumor Burden and Related Implications on the Chimeric Antigen Receptor (CAR) T-Cell Therapeutic Cycle. Systemic and local implications of high tumor burden and its association with CAR T-cell therapy. A, Patients with advanced-stage disease may display a tumor-burdened immune system consisting of high levels of circulating immunosuppressive factors and immune cells, resulting in a global suppression of T cells. The latter may affect the CAR T-cell manufacturing process and final effector CAR T-cell quality. B, The CAR T-cell products generated from patients with a highly tumor-burdened immune system may display defective capacity to overcome the tumor load by means of impaired expansion capacity and reduced persistence.

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Topical nonprescription pain medications are over-the-counter drugs applied to the skin to treat pain.
Topical pain medications can effectively treat pain caused by several acute and chronic conditions.

Topical Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Topical NSAIDs include diclofenac and methyl salicylate. These may be applied as a gel, cream, lotion, ointment, patch, or topical solution pump.


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W
hile high blood pressure is more common in adults, it can affect children too.
Each time the heart beats, it pumps blood through tubes called arteries to all parts of the body. As blood moves through these arteries, it pushes against the walls of the arteries—this is known as blood pressure.
Pediatric hypertension, or high blood pressure in children, occurs when a child’s blood pushes too forcefully against the artery walls. Children are at a higher risk if there is a family history of high blood pressure, if they are carrying too much weight, or if they do not stay active.
Most children with hypertension do not have symptoms. Because hypertension is “silent,” the American Academy of Pediatrics recommends checking children’s blood pressure at pediatrician visits starting at age 3 years, or even earlier for children who had a low birth weight…

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Clinical Manifestation of Age-Related Macular Degeneration (AMD) A, Early AMD with multiple medium-sized drusen (asterisks) without pigment abnormalities. Drusen shown as yellowish material on color fundus image (left panel), variable signal on fundus autofluorescence (middle panel), and dome-shaped elevations on optical coherence tomography (OCT) (right panel). Note increase in size from early AMD (A) to intermediate AMD (B). B, Intermediate AMD with large drusen (asterisks) and pigment abnormalities. C, Late-stage AMD. Area of geographic atrophy (pink arrowheads) with well-demarcated borders on fundus autofluorescence (middle panel) that correspond to the area of photoreceptors and retinal pigment epithelium loss on OCT (right panel). D, Exudative neovascular AMD. Asterisks indicate drusen; black arrowheads, small hemorrhage; white arrowheads, leakage on fluorescein angiography (middle panel)

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alpha-gal syndrome is a type of food allergy to mammalian (red) meat products.
Alpha-gal syndrome is associated with tick bites, most commonly from the Lone Star tick in the US, but also from different types of ticks in other areas of the world. During a bite, a tick injects a type of sugar molecule (galactose-alpha-1,3-galactose), also called alpha-gal, which leads to formation of an antibody. Because alpha-gal is present on cells of most mammals, including cows, pigs, lambs, and goats, when affected individuals eat these animal products, an allergic reaction may occur.

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Mechanisms of Respiratory Failure in Patients with Botulism.
The botulinum neurotoxin can lead to respiratory failure by affecting the muscles involved in respiration, the muscles involved in maintaining airway tone, or the muscles involved in airway clearance. In addition, autonomic dysfunction may contribute to the development of respiratory failure.

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