<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Posterior urethral valve and explain in detail? [/INST] Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. It is the most common cause of bladder outlet obstruction in male newborns. The disorder varies in degree, with mild cases presenting late due to milder symptoms. More severe cases can have renal and respiratory failure from lung underdevelopment as result of low amniotic fluid volumes, requiring intensive care and close monitoring. It occurs in about one in 8,000 babies.

Presentation
PUV can be diagnosed before birth, or even at birth when the ultrasound shows that the male baby has a hydronephrosis. Some babies may also have oligohydramnios due to the urinary obstruction. The later presentation can be a urinary tract infection, diurnal enuresis, or voiding pain.

Complications
Incontinence
Urinary tract infection
Renal failure
Vesicoureteral reflux
Chronic kidney disease
Oligohydramnios

Diagnosis
Abdominal ultrasound is of some benefit, but not diagnostic.  Features that suggest posterior urethral valves are bilateral hydronephrosis, a thickened bladder wall with thickened smooth muscle trabeculations, and bladder diverticula.Voiding cystourethrogram (VCUG) is more specific for the diagnosis. Normal plicae circularis are variable in appearance and often not seen on normal VCUGs.  PUV on voiding cystourethrogram is characterized by an abrupt tapering of urethral caliber near the verumontanum, with the specific level depending on the developmental variant. Vesicoureteral reflux is also seen in over 50% of cases. Very often the posterior urethra maybe dilated thus making the abrupt narrowing more obvious. the bladder wall may show trabeculations or sacculations or even diverticuli.Diagnosis can also be made by cystoscopy, where a small camera is inserted into the urethra for direct visualization of the posteriorly positioned valve. A limitation of this technique is that posterior valve tissue is translucent and can be pushed against the wall of the urethra by inflowing irrigation fluid, making it difficult to visualize. Cystoscopy may also demonstrate the bladder changes.Centers in Europe and Japan have also had excellent results with cystosonography, although it has not been approved for use in the United States yet.

Classification
Posterior urethral obstruction was first classified by H. H. Young in 1919 </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Fibroma of tendon sheath and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Single umbilical artery and explain in detail? [/INST] Occasionally, there is only the one single umbilical artery (SUA) present in the umbilical cord. This is sometimes also called a two-vessel umbilical cord, or two-vessel cord. Approximately, this affects between 1 in 100 and 1 in 500 pregnancies, making it the most common umbilical abnormality. Its cause is not known.
Most cords have one vein and two arteries. The vein carries oxygenated blood from the placenta to the baby and the arteries carry deoxygenated blood from the baby to the placenta. In approximately 1% of pregnancies there are only two vessels —usually a single vein and single artery. In about 75% of those cases, the baby is entirely normal and healthy. One artery can support a pregnancy and does not necessarily indicate problems. For the other 25%, a 2-vessel cord is a sign that the baby has other abnormalities—sometimes life-threatening and sometimes not.Doctors and midwives often suggest parents take the added precaution of having regular growth scans near term to rule out intrauterine growth restriction, which can happen on occasion and warrant intervention. Yet the majority of growth restricted infants with the abnormality also have other defects. Finally, neonates with the finding may also have a higher occurrence of renal problems, therefore close examination of the infant may be warranted shortly after birth. Among SUA infants, there is a slightly elevated risk for post-natal urinary infections.

Presentation
Associations
SUA does increase the risk of the baby having cardiac, skeletal, intestinal or renal problems </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Urinary tract obstruction and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Evil eye and explain in detail? [/INST] The evil eye (Turkish: Nazar boncuğu; Ancient Greek: ὀφθαλμὸς βάσκανος; Greek: μάτι; Hebrew: עַיִן הָרָע; Romanian: Deochi; Italian: malocchio; Spanish: mal de ojo; Arabic: عين الحسد, ayn al-hasad; Persian: چشم زخم, Cheshm Zakhm; Dari: چشم مهره Cheshem Mohra; Kazakh: Көз) is a supernatural belief in a curse, brought about by a malevolent glare, usually given to a person when one is unaware.
The evil eye dates back about 5,000 years. This iconic symbol is present across various religions and cultures, but most importantly Witchcraft. The earliest known belief in the power of the evil eye predates ancient Roman and Greek times classical antiquity, there has been literature that mentions at 6th century BC it appeared on Chalcidian drinking vessels, known as eye-cups, as a type of apotropaic magic. It is found in many cultures in the Mediterranean region, with such cultures often believing that receiving the evil eye will cause misfortune or injury, while others believe it to be a kind of supernatural force that casts or reflects a malevolent gaze back-upon those who wish harm upon others (especially innocents). Older iterations of the symbol were often made of ceramic or clay; however, following the production of glass beads in the Mediterranean region in approximately 1500 BC, evil eye beads were popularised with the Phoenicians, Persians, Greeks, Romans and Ottomans.The idea expressed by the term causes many different cultures to pursue protective measures against it, with around 40% of the worlds population believing in the evil eye. The concept and its significance vary widely among different cultures, but it is especially prominent in the Balkans, Mediterranean and West Asia. The idea appears multiple times in Jewish rabbinic literature. Other popular amulets and talismans used to ward off the evil eye include the hamsa, while Italy (especially Southern Italy) employs a variety of other unique charms and gestures to defend against the evil eye, including the cornicello, the cimaruta, and the sign of the horns.
While the Egyptian Eye of Horus is a similar symbol of protection and good health, the Greek evil eye talisman specifically protects against malevolent gazes. Similarly, the Eye-Idols (c. 8700–3500 BC) excavated at the Tell Brak Eye Temple are believed to have been figurines offered to the gods, and according to the Metropolitan Museum of Art, are unrelated to a belief in the evil eye.

History
Belief in the evil eye dates all the way back to at least Ancient Ugarit, as it is attested to in texts from this city (ruins in modern-day Syria). Given that the city was destroyed circa 1250BC, during the late Bronze Age collapse to never be rebuilt, the belief dates back at least to this point, and likely earlier. Later in Greek Classical antiquity, it is referenced by Hesiod, Callimachus, Plato, Diodorus Siculus, Theocritus, Plutarch, Heliodorus, Pliny the Elder, and Aulus Gellius. Peter Walcots Envy and the Greeks (1978) listed more than one hundred works by these and other authors mentioning the evil eye. Noting that Greeks are an ethnic group indigenous to Greece and the Levant, artefacts can be found from this region. Ancient authors frequently mention the ὀφθαλμὸς βάσκανος (evil eye).

Classical authors attempted both to describe and to explain the function of the evil eye. Plutarch in his work entitle Symposium has a separate chapter describing such beliefs. In his scientific explanation stated that the eyes were the chief, if not sole, source of the deadly rays that were supposed to spring up like poisoned darts from the inner recesses of a person possessing the evil eye. Plutarch treated the phenomenon of the evil eye as something seemingly inexplicable that is a source of wonder and cause of incredulity. Pliny the Elder described the ability of certain African enchanters to have the "power of fascination with the eyes and can even kill those on whom they fix their gaze".The idea of the evil eye appears in the poetry of Virgil in a conversation between the shepherds Menalcas and Damoetas. In the passage, Menalcas is lamenting the poor health of his stock: "What eye is it that has fascinated my tender lambs?".
Ancient Greeks and Romans believed that the evil eye could affect both humans and animals, for example cattles.

Protection from the eye
The belief in the evil eye during antiquity varied across different regions and periods. The evil eye was not feared with equal intensity in every corner of the Roman Empire. There were places in which people felt more conscious of the danger of the evil eye. In Roman times, not only were individuals considered to possess the power of the evil eye but whole tribes, especially those of Pontus and Scythia, were believed to be transmitters of the evil eye.Many different objects and charms were used for protection from fascination. The protective items referred by the Greeks with a variety of names such as apotropaia, probaskania, periammata, periapta and profylaktika.The phallic charm called fascinum in Latin, from the verb fascinare, "to cast a spell" (the origin of the English word "fascinate") is one example of an apotropaic object used against the evil eye. They have been found throughout Europe and into the Middle East from contexts dating from the first century BC to the fourth century AD. The phallic charms were often objects of personal adornment (such as pendants and finger rings), but also appeared as stone carvings on buildings, mosaics, and wind-chimes (tintinnabula). Examples of stone phallic carvings, such as from Leptis Magna, depict a disembodied phallus attacking an evil eye by ejaculating towards it.
In describing their ability to deflect the evil eye, Ralph Merrifield described the Roman phallic charm as a "kind of lightning conductor for good luck".Peisistratus hung the figure of a kind of grasshopper before the Acropolis of Athens for protection.Another way for protection from fascination used by the ancient Greeks and Romans was by spitting into the folds of the clothes.Ancient Greeks also had an old custom of dressing boys as girls in order to avert the evil eye.

Around the world
Belief in the evil eye is strongest in West Asia, Latin America, East and West Africa, Central America, South Asia, Central Asia, and Europe, especially the Mediterranean region; it has also spread to areas, including northern Europe, particularly in the Celtic regions, and the Americas, where it was brought by European colonists and West Asian immigrants.Belief in the evil eye is found in the Islamic doctrine, based upon the statement of the Islamic prophet Muhammad, "The influence of an evil eye is a fact..." [Sahih Muslim, Book 26, Number 5427]. Authentic practices of warding off the evil eye are also commonly practiced by Muslims: rather than directly expressing appreciation of, for example, a childs beauty, it is customary to say MashaAllah, that is, "God has willed it", or invoking Gods blessings upon the object or person that is being admired.A number of beliefs about the evil eye are also found in folk religion, typically revolving around the use of amulets or talismans as a means of protection.
In the Aegean Region and other areas where light-colored eyes are relatively rare, people with green eyes, and especially blue eyes, are thought to bestow the curse, intentionally or unintentionally. Thus, in Greece and Turkey amulets against the evil eye take the form of eyes looking back at someone, and in the painting by John Phillip, we witness the culture-clash experienced by a woman who suspects that the artists gaze implies that he is looking at her with the evil eye.
Among those who do not take the evil eye literally, either by reason of the culture in which they were raised or because they simply do not believe it, the phrase, "to give someone the evil eye" usually means simply to glare at the person in anger or disgust. The term has entered into common usage within the English language. Within the broadcasting industry, it refers to when a presenter signals to the interviewee or co-presenter to stop talking due to a shortage of time.

Protective talismans and cures
Attempts to ward off the curse of the evil eye have resulted in a number of talismans in many cultures. As a class, they are called "apotropaic" (Greek for "prophylactic" / προφυλακτικός or "protective", literally: "turns away") talismans, meaning that they turn away or turn back harm.
Disks or balls, consisting of concentric blue and white circles (usually, from inside to outside, dark blue, light blue, white, and dark blue) representing an evil eye are common apotropaic talismans in West Asia and the Balkans, found on the prows of  boats and elsewhere; in some forms of the folklore, the staring eyes are supposed to bend the malicious gaze back to the sorcerer.
Known as nazar (Turkish: nazar boncuğu or nazarlık), this talisman is most frequently seen in Turkey, found in or on houses and vehicles or worn as beads.

The word hamsa, also spelled khamsa and hamesh, means "five" referring to the fingers of the hand. In Jewish culture, the hamsa is called the Hand of Miriam; in the Levantine Christian culture is called the Hand of Mary, in some Muslim and Balkan cultures, the Hand of Fatima. Though condemned as superstition by doctrinaire Muslims, it is almost exclusively among the Near East and Mediterranean that the belief in envious looks containing destructive power or the talismanic power of a nazar to defend against them. To adherents of other faiths in the region, the nazar is an attractive decoration.
A variety of motifs to ward off the evil eye are commonly woven into tribal kilim rugs. Such motifs include a cross (Turkish: Haç) to divide the evil eye into four, a hook (Turkish: Çengel) to destroy the evil eye, or a human eye (Turkish: Göz) to avert the evil gaze. The shape of a lucky amulet (Turkish: Muska; often, a triangular package containing a sacred verse) is often woven into kilims for the same reason.

By religion
In Judaism
The evil eye is mentioned several times in the classic Pirkei Avot (Ethics of Our Fathers). In Chapter II, five disciples of Rabbi Yochanan ben Zakai give advice on how to follow the good path in life and avoid the bad. Rabbi Eliezer says an evil eye is worse than a bad friend, a bad neighbor, or an evil heart.
Talmudic exegete, Rashi, says in the wake of the words of Israels Sages that when the ten sons of Jacob went down into Egypt to buy provisions, they made themselves inconspicuous by each entering into a separate gate, so that they would not be gazed upon by the local Egyptians and, thereby, trigger a malevolent response (the Evil eye) by their onlookers, seeing that they were all handsome and of brave and manly dispositions.Some Jews believe that a "good eye" designates an attitude of goodwill and kindness towards others. Someone who has this attitude in life will rejoice when his fellow man prospers; he will wish everyone well. An "evil eye" denotes the opposite attitude. A man with "an evil eye" will not only feel no joy but experience actual distress when others prosper and will rejoice when others suffer. A person of this character represents a great danger to moral purity, according to some Jews.Rabbi Abraham Isaac Kook explained that the evil eye is "an example of how one soul may affect another through unseen connections between them. We are all influenced by our environment... The evil eye is the venomous impact from malignant feelings of jealousy and envy of those around us."Many observant Jews avoid talking about valuable items they own, good luck that has come to them and, in particular, their children. If any of these are mentioned, the speaker and/or listener will say bli ayin hara (Hebrew), meaning "without an evil eye", or kein eina hara (Yiddish; often shortened to kennahara), "no evil eye". Another way to ward off the evil eye is to spit three times (or pretend to). Romans call this custom "despuere malum," to spit at evil. It has also been suggested the 10th Commandment: "Do not covet anything that belongs to your neighbor" is a law against bestowing the evil eye on another person.

In Christianity
Christianitys beliefs of the evil eye can be located in some passages of the Bible. In Luke 11:34 Jesus referenced to the eye as the lamp of the body. If a persons eye is generous, then their whole body will be full of light. If their eye is evil, then their whole body will be full of darkness.
Cross necklaces are worn by some Christians who believe the cross offers protection from Satan.
A simple and instant way of protection in European Christian countries is to make the sign of the cross with your hand and point two fingers, the index finger and the middle finger, towards the supposed source of influence or supposed victim as described in the first chapter of Bram Stokers novel Dracula published in 1897:When we started, the crowd round the inn door, which had by this time swelled to a considerable size, all made the sign of the cross and pointed two fingers towards me. With some difficulty, I got a fellow passenger to tell me what they meant. He would not answer at first, but on learning that I was English, he explained that it was a charm or guard against the evil eye.

In Islam
In Islam, the evil eye, or al-’ayn العين, also عين الحسودة), is a common belief that individuals have the power to cause harm to people, animals or objects, by looking at them in a way that indicates jealousy. Although envy activates the evil eye, this happens (or usually happens) unconsciously, and the person who casts it is not responsible (or usually not responsible) for it. In addition to being looked at, astrology may play a part. Someone may become a victim of the evil eye by virtue of an "unfavorable celestial configuration" at the time of victims birth, "according to some scholars".Among the rituals to ward off the evil eye are to say "TabarakAllah" (تبارك الله) ("Blessings of God") or "MashaAllah" (ما شاء الله) ("God has willed it") if a compliment is to be made.

By geographic region
Caribbean/West Indies
In Trinidad and Tobago, the evil eye is called maljo (from French mal yeux, meaning bad eye). The term is used in the infinitive (to maljo) and as a noun (to have/get maljo) referring to persons who have been afflicted. Maljo may be passed on inadvertently, but is believed to be more severe when coming from an envious person or one with bad intentions. It is thought to happen more readily when a person is stared at- especially while eating food. A person who has been taken by the ‘bad eye’ may experience unexplained illness or misfortune. In traditional rural legends, ‘The general belief is that doctors cannot cure maljo----only people who know prayers can "cut" the maljo and thus cure the victim.’There are several secular approaches to combatting maljo, but more extreme cases are usually referred to as spiritual rituals, with a particularly strong influence from the Hindu religion.
In non-religious respects, there is a strong cultural association between the evil eye and the color blue. It is believed to ward off maljo when worn as clothing or accessories, so much so that some striking shades are referred to as ‘maljo blue’. Blue ornaments may be used to protect a household, and blue bottles from Milk of Magnesia have been hung on trees or placed in the yard surrounding a property.Blue soap and Albion Blue (an indigo dye referred to Trinbagonians simply as ‘blue’) are traditionally used for domestic washing, but are also considered to prevent maljo if used in bath water or to anoint the soles of the feet.
Jumbie beads are the poisonous seeds of the Rosary Pea tree which are used to make jewelry that also wards off maljo and evil spirits.
One superstition is that a pinch can reverse maljo following interpersonal interactions, especially if one is stared at or given a compliment. Some also believe that rubbing ones own saliva in their hair will counteract maljo in general, but particularly from envy of the hair texture and length.
A bath in the sea is also thought to relieve an afflicted person.
Maljo believers are particularly concerned with safeguarding babies and children, who are considered to be most vulnerable to its effects. It may be ‘caused by someone born with a "blight" in the eye when such a person looks admiringly at a child. It can also occur with a pat on the head, or with just a glance. Whether it is intended or not, compliments (...) can cause maljo. It can be caused by a stranger, a member of the childs immediate family, or by another relative.’ It may even be passed on by a parent who is obsessed with their own child. A baby with maljo ‘refuses to eat or drink, cries continually, and "pines away.". It may have an "attack of fever".’Bracelets made of jet beads are traditionally given to newborns to wear as a preventative measure, while elders also recommend securing a bag of blue (dye) to the babys clothes. This is because a newborn is viewed as most vulnerable.
Following East Indian influence, a tikka is a black dot that is placed on a babys forehead- thought to distract the attention of the evil eye and protect the child as such.
The most common maljo remedy comes in the form of a Hindu ritual called a jharay. It may be practiced at home (usually by parents or elders) or by a Pandit or spiritual practitioner. There are many variations to the ritual, and non-Hindu persons readily participate if they are considered to have been affected by maljo.
The main implement in a jharay is either a peacock feather or a cocoyea broom- a traditional broom made using the midrib of the coconut palm leaf. Some also report a knife or machete being used. In some instances, the cocoyea broom is measured against a particular part of the body at the beginning of the ceremony, and it is believed to be confirmation of maljo if the recorded length has changed by the end of the session. The officiant will say a prayer while using the tool of choice to brush the person from head to toe. The prayer is conventionally said in Hindi, but may also be said in English.
A jharay may focus on a specific point of affliction or pain (head, hair, back, feet and so on).
It is not unusual for a jharay ceremony to be carried out on children and babies. ‘People believe that maljo can cause death. Two types were reported: the "dragging" kind, where the baby gets smaller and smaller and goes through all of the symptoms mentioned above, before withering and dying; the "Twenty-four hour" maljo, said to kill in just twenty-four hours if effective help is not obtained.’Another Hindu ritual called the oucchay is also employed to heal maljo- though this might also be interchangeably called a jharay. Ingredients such as onion skin, salt, cobweb, hot pepper or mustard seeds, piece of a cocoyea broom, a lock of the victims hair (in the case of children, it is a lock of the mothers hair) are wrapped in a tissue or newspaper. The officiant will circle the wrapped objects around the victims body before burning them all. It is believed that if the items create a large, crackling flame and a foul stench, it is an indication that the victim had a severe case of maljo. At the end of the ritual, the victim may be asked to walk away without looking back while the objects burn.
In Afro-Caribbean Spiritual Baptist and Orisha tradition, a special piece of jewelry called a guard will be blessed by an elder, who invokes its protection on the wearer. It may be a waist bead, anklet, bracelet, or necklace. For babies, a large safety pin might be used as a guard.

Greece
The evil eye, known as μάτι (mati), "eye", as an apotropaic visual device, is known to have been a fixture in Greece dating back to at least the 6th century BC, when it commonly appeared on drinking vessels. In Greece, the evil eye is cast away through the process of xematiasma (ξεμάτιασμα), whereby the "healer" silently recites a secret prayer passed over from an older relative of the opposite sex, usually a grandparent. Such prayers are revealed only under specific circumstances, as according to their customs those who reveal them indiscriminately lose their ability to cast off the evil eye. There are several regional versions of the prayer in question, a common one being: "Holy Virgin, Our Lady, if [insert name of the victim] is suffering of the evil eye, release him/her of it." Evil repeated three times. According to custom, if one is indeed afflicted with the evil eye, both victim and "healer" then start yawning profusely. The "healer" then performs the sign of the cross three times, and emits spitting-like sounds in the air three times.
Another "test" used to check if the evil eye was cast is that of the oil: under normal conditions, olive oil floats in water, as it is less dense than water. The test of the oil is performed by placing one drop of olive oil in a glass of water, typically holy water. If the drop floats, the test concludes there is no evil eye involved. If the drop sinks, then it is asserted that the evil eye is cast indeed. Another form of the test is to place two drops of olive oil into a glass of water. If the drops remain separated, the test concludes there is no evil eye, but if they merge, there is. There is also a third form where in a plate full of water the "healer" places three or nine drops of oil. If the oil drops become larger and eventually dissolve in the water there is an evil eye. If the drops remain separated from water in a form of a small circle there isnt. The first drops are the most important and the number of drops that dissolve in water indicates the strength of the evil eye. Note that a secret chant is spoken when these tests are conducted. The words of the chant are closed practiced and can only be passed from man to woman, or woman to man.There is another form of the "test" where the "healer" prepares a few cloves by piercing each one with a pin. Then she lights a candle and grabs a pinned clove with a pair of scissors. She then uses it to do the sign of the cross over the afflicted whilst the afflicted is asked to think of a person who may have given him the evil eye. Then the healer holds the clove over the flame. If the clove burns silently, there is no evil eye present; however, if the clove explodes or burns noisily, that means the person in the thoughts of the afflicted is the one who has cast the evil eye. As the clove explodes, the evil eye is released from the afflicted. Cloves that burn with some noise are considered to be λόγια - words - someone foul-mouthing you that you ought to be wary of. The burned cloves are extinguished into a glass of water and are later buried in the garden along with the pins as they are considered to be contaminated. Greek people will also ward off the evil eye by saying φτου να μη σε ματιάξω! which translates to "I spit so that I wont give you the evil eye." Contrary to popular belief, the evil eye is not necessarily given by someone wishing you ill, but it stems from admiration - if one considers admiration to be a compelled emotion of astonishment at a rivals success over ones evil plan. Since it is technically possible to give yourself the evil eye, it is advised to be humble.
The Greek Fathers accepted the traditional belief in the evil eye, but attributed it to the Devil and envy. In Greek theology, the evil eye or vaskania (βασκανία) is considered harmful for the one whose envy inflicts it on others as well as for the sufferer. The Greek Church has an ancient prayer against vaskania from the Megan Hieron Synekdemon (Μέγαν Ιερόν Συνέκδημον) book of prayers.

Assyrians
Assyrians are also strong believers in the evil eye. They will usually wear a blue/turquoise bead around a necklace to be protected from the evil eye. Also, they might pinch the buttocks, comparable to Armenians. It is said that people with green or blue eyes are more prone to the evil eye effect.

Turkey
A typical nazar is made of handmade glass featuring concentric circles or teardrop shapes in dark blue, white, light blue and black, occasionally with a yellow/gold edge.Cultures that have nazars or some variation include Turkey, Romania, Albania, North Macedonia, Bosnia and Herzegovina, Greece, Cyprus, Syria, Lebanon, Jordan, Palestine, Egypt, Armenia, Iran, India, Israel, Pakistan, Uzbekistan, Afghanistan, Türkmenistan, Iraq and Azerbaijan, where the nazar is often hung in homes, offices, cars, childrens clothing, or incorporated in jewellery and ornaments.They are a popular choice of souvenir with tourists.

Ethiopia
Belief in the evil eye, or buda (var. bouda), is widespread in Ethiopia. Buda is generally believed to be a power held and wielded by those in a different social group, for example among the metalworkers. Some Ethiopian Christians carry an amulet or talisman, known as a kitab, or will invoke Gods name, to ward off the ill effects of buda. A debtera, who is either an unordained priest or educated layperson, will create these protective amulets or talismans.

Senegal
The equivalent of the evil eye in Wolof would be the "thiat". It is believed that beautiful objects may break if enviously stared at by others. To repel the effect of the evil eye, Senegalese people may wear cowrie shell bracelets. The sea shells are said to absorb the negative energy of the thiat, and gradually darken until the bracelet breaks. It is also common for superstitious people to wear "gris-gris" made by a marabouts to avoid misfortune.

Indian subcontinent
India
In the northern states of India, like the Punjab, Uttar Pradesh, Rajasthan, Haryana, Uttarakhand, and Himachal Pradesh, the evil eye is called "nazar" (meaning gaze or vision) or more commonly Buri Nazar. A charm bracelet, tattoo or other object (Nazar battu), or a slogan (Chashme Baddoor (slogan)), may be used to ward off the evil eye. Some truck owners write the slogan to ward off the evil eye: "buri nazar wale tera muh kala" ("O evil-eyed one, may your face turn black").
In Andhra Pradesh and Telangana, people call it as Disti or Drusti, while people of Tamil Nadu call it drishti or kannu (translated, means evil eye). The people of Kerala also call it “kannu”, which translates to “eye”. To remove Drishti, people follow several methods based on their culture/area. Items often used are either rock salt, red chilies, white pumpkins, oiled cloth, or lemons coated with kumkuma. People remove Drishti by rotating any one of these items around the affected person. The person who removes it will then burn the item, or discard it in a place where others are not likely to stamp on these items. People hang pictures of fierce and scary ogres in their homes or vehicles, to ward off the evil eye.In India, babies and newborn infants will usually have their eye adorned with kajal, or eyeliner. This would be black, as it is believed in India that black wards off the evil eye or any evil auras. The umbilical cord of babies is often preserved and cast into a metal pendant, and tied to a black string — babies can wear this as a chain, bracelet or belt—the belief, once more, is that this protects the infant from drishti. This is a practice that has been followed right from historical times. People usually remove drishti on full-moon or new-moon days, since these days are considered to be auspicious in India.
Indians often leave small patches of rock salt outside their homes, and hang arrangements of green chilies, neem leaves, and lemons on their stoop. The belief is that this will ward away the evil eye cast on families by detractors.

Pakistan
In Pakistan, the evil eye is called Nazar (نظر). People usually may resort to reading the last three chapters of the Quran, namely Sura Ikhlas, Sura Al-Falaq and Sura Al-Nas. "MashaAllah" (ما شاء الله) ("God has willed it") is commonly said to ward off the evil eye. Understanding of the evil eye varies by the level of education. Some perceive the use of black color to be useful in protecting from the evil eye. Others use "taawiz" to ward off the evil eye. Truck owners and other public transport vehicles may commonly be seen using a small black cloth on the bumpers to prevent the evil eye.

Italy
The cornicello, "little horn", also called the cornetto ("little horn", plural cornetti), is a long, gently twisted horn-shaped amulet. Cornicelli are usually carved out of red coral or made from gold or silver. The type of horn they are intended to copy is not a curled-over sheep horn or goat horn but rather like the twisted horn of an African eland or a chili pepper. A tooth or tuft of fur of the Italian wolf was worn as a talisman against the evil eye.One idea that the ribald suggestions made by sexual symbols distract the witch from the mental effort needed to successfully bestow the curse. Another is that since the effect of the eye was to dry up liquids, the drying of the phallus (resulting in male impotence) would be averted by seeking refuge in the moist female genitals. Among the ancient Romans and their cultural descendants in the Mediterranean nations, those who were not fortified with phallic charms had to make use of sexual gestures to avoid the eye. Such gestures include scratching ones testicles (for men), as well as the mano cornuta gesture and the fig sign; a fist with the thumb pressed between the index and middle fingers, representing the phallus within the vagina. In addition to the phallic talismans, statues of hands in these gestures, or covered with magical symbols, were carried by the Romans as talismans.

The wielder of the evil eye, the jettatore, is described as having a striking facial appearance, high arching brows with a stark stare that leaps from his eyes. He often has a reputation for clandestine involvement with dark powers and is the object of gossip about dealings in magic and other forbidden practices. Successful men having tremendous personal magnetism quickly gain notoriety as jettatori. Pope Pius IX was dreaded for his evil eye, and a whole cycle of stories about the disasters that happened in his wake were current in Rome during the latter decades of the 19th century. Public figures of every type, from poets to gangsters, have had their specialized abilities attributed to the power of their eyes.

Malta
The symbol of the eye, known as "l-għajn", is common on traditional fishing boats which are known as luzzu. They are said to protect fishermen from storms and malicious intentions.

Brazil
Brazilians generally will associate mau-olhado ("act of giving a bad look") or olho gordo ("fat eye" i.e. "gluttonous eye") with envy or jealousy on domestic and garden plants (that, after months or years of health and beauty, will suddenly weaken, wither and die, with no apparent signs of pest, after the visitation of a certain friend or relative), attractive hair and less often economic or romantic success and family harmony.
Unlike in most cultures mau-olhado is not seen to be something that risks young babies. "Pagans" or non-baptized children are instead assumed to be at risk from bruxas (witches), that have malignant intention themselves rather than just mau-olhado. It probably reflects the Galician folktales about the meigas or Portuguese magas, (witches), as Colonial Brazil was primarily settled by Portuguese people, in numbers greater than all Europeans to settle pre-independence United States. Those bruxas are interpreted to have taken the form of moths, often very dark, that disturb children at night and take away their energy. For that reason, Christian Brazilians often have amulets in the form of crucifixes around, beside or inside beds where children sleep.
Nevertheless, older children, especially boys, that fulfill the cultural ideals of behaving extremely well (for example, having no problems whatsoever in eating well a great variety of foods, being obedient and respectful toward adults, kind, polite, studious, and demonstrating no bad blood with other children or their siblings) who unexpectedly turn into problematic adolescents or adults (for example lacking good health habits, extreme laziness or lacking motivation towards their life goals, having eating disorders, or being prone to delinquency), are said to have been victims of mau-olhado coming from parents of children whose behavior was not as admirable.
Amulets that protect against mau-olhado tend to be generally resistant, mildly to strongly toxic and dark plants in specific and strategic places of a garden or the entry to a house. Those include comigo-ninguém-pode ("against-me-nobody-can"), Dieffenbachia, espada-de-são-jorge ("St. Georges sword"), Sansevieria trifasciata, and Guiné ("Guinea"), Petiveria alliacea (the guinea henweed). For those lacking in space or wanting to "sanitize" specific places, they may all be planted together in a single sete ervas ("seven [lucky] herbs") pot, that will also include arruda (common rue), pimenteira (Capsicum annuum), manjericão (basil) and alecrim (rosemary). (Though the last four ones should not be used for their common culinary purposes by humans.)
Other popular amulets against evil eye include: the use of mirrors, on the outside of your homes front door, or also inside your home facing your front door; an elephant figurine with its back to the front door; and coarse salt, placed in specific places at home.

Spain and Latin America
The evil eye or Mal de Ojo has been deeply embedded in Spanish popular culture throughout its history and Spain is the origin of this superstition in Latin America.
In Mexico and Central America, infants are considered at special risk for the evil eye (see mal de ojo, above) and are often given an amulet bracelet as protection, typically with an eye-like spot painted on the amulet. Another preventive measure is allowing admirers to touch the infant or child; in a similar manner, a person wearing an item of clothing that might induce envy may suggest to others that they touch it or some other way dispel envy.
One traditional cure in Latin America involves a curandero (folk healer) sweeping a raw chicken egg over the body of a victim to absorb the power of the person with the evil eye. The egg is later broken into a glass with water and placed under the bed of the patient near the head. Sometimes it is checked immediately because the egg appears as if it has been cooked. When this happens it means that the patient did have Mal de Ojo. Somehow the Mal de Ojo has transferred to the egg and the patient immediately gets well. (Fever, pain and diarrhea, nausea/vomiting goes away instantly) In the traditional Hispanic culture of the Southwestern United States and some parts of Latin America, the egg may be passed over the patient in a cross-shaped pattern all over the body, while reciting The Lords Prayer. The egg is also placed in a glass with water, under the bed and near the head, sometimes it is examined right away or in the morning and if the egg looks like it has been cooked then it means that they did have Mal de Ojo and the patient will start feeling better. Sometimes if the patient starts getting ill and someone knows that they had stared at the patient, usually a child, if the person who stared goes to the child and touches them, the childs illness goes away immediately so the Mal de Ojo energy is released.In some parts of South America the act of ojear, which could be translated as to give someone the evil eye, is an involuntary act. Someone may ojear babies, animals and inanimate objects just by staring and admiring them. This may produce illness, discomfort or possibly death on babies or animals and failures on inanimate objects like cars or houses. Its a common belief that since this is an involuntary act made by people with the heavy look, the proper way of protection is by attaching a red ribbon to the animal, baby or object, in order to attract the gaze to the ribbon rather than to the object intended to be protected.

Mexico
Mal de ojo (Mal: Illness - de ojo: Of eye. "To be made ill by an eyes gaze") often occurs without the dimension of envy, but insofar as envy is a part of ojo, it is a variant of this underlying sense of insecurity and relative vulnerability to powerful, hostile forces in the environment. In her study of medical attitudes in the Santa Clara Valley of California, Margaret Clark arrives at essentially the same conclusion: "Among the Spanish-speaking folk of Sal si Puedes, the patient is regarded as a passive and innocent victim of malevolent forces in his environment. These forces may be witches, evil spirits, the consequences of poverty, or virulent bacteria that invade his body. The scapegoat may be a visiting social worker who unwittingly cast the evil eye ... Mexican folk concepts of disease are based in part on the notion that people can be victimized by the careless or malicious behavior of others".Another aspect of the mal ojo syndrome in Ixtepeji is a disturbance of the hot-cold equilibrium in the victim. According to folk belief, the bad effects of an attack result from the "hot" force of the aggressor entering the childs body and throwing it out of balance. Currier has shown how the Mexican hot-cold system is an unconscious folk model of social relations upon which social anxieties are projected. According to Currier, "the nature of Mexican peasant society is such that each individual must continuously attempt to achieve a balance between two opposing social forces: the tendency toward intimacy and that toward withdrawal. [It is therefore proposed] that the individuals continuous preoccupation with achieving a balance between heat and cold is a way of reenacting, in symbolic terms, a fundamental activity in social relations."

Puerto Rico
In Puerto Rico, Mal de Ojo or "Evil Eye" is believed to be caused when someone gives a wicked glare of jealousy to someone, usually when the person receiving the glare is unaware. The jealousy can be disguised into a positive aspect such as compliments or admiration. Mal de Ojo is considered a curse and illness. It is believed that without proper protection, bad luck, injury, and illness are expected to follow. Mal de Ojo impact is believed to affect speech, relationships, work, family and most notably, health. Since Mal de Ojo centers around envy and compliments, it creates fear of interacting with people that are outside of their culture. Indirect harm could be brought to them or their family. When it comes to children, they are considered to be more susceptible to Mal de Ojo and it is believed that it can weaken them, leading to illness. As a child grows every effort is taken to protect them. When diagnosing Mal de Ojo, it is important to notice the symptoms. Physical symptoms can include: loss of appetite, body weakness, stomach ache, insomnia, fever, nausea, eye infections, lack of energy, and temperament.
Environmental symptoms can include financial, family, and personal problems as simple as a car breaking down. It is important for those who believe to be aware of anything that has gone wrong because it may be linked to Mal de Ojo. Puerto Ricans are protected through the use of Azabache bracelets. Mal de Ojo can also be avoided by touching an infant when giving admiration. The most common practice of protection in Puerto Rico is the use of Azabache bracelets. These bracelets traditionally have a black or red coral amulet attached. The amulet is in the shape of a fist with a protruding index finger knuckle.

Eggs are the most common method to cure Mal De Ojo. The red string and oils also used are more common in other cultures but still used in Puerto Rico depending on the Healer, or the person who is believed to have the ability to cure those who have been targeted. Ultimately, the act of giving someone the "Evil Eye" is a rather simple process and is practiced throughout the world.

United States
In 1946, the American occultist Henri Gamache published a text called Terrors of the Evil Eye Exposed! (later reprinted as Protection against Evil), which offers directions to defend oneself against the evil eye.

Media and press coverage
In some cultures, both over-complimenting and envy are said to cast a curse. Since ancient times such maledictions have been collectively called the evil eye. According to the book The Evil Eye by folklorist Alan Dundes, the beliefs premise is that an individual can cause harm simply by looking at anothers person or property. However, protection is easy to come by with talismans that can be worn, carried, or hung in homes, most often incorporating the contours of a human eye. In Aegean countries, people with light-colored eyes are thought to be particularly powerful, and amulets in Greece and Turkey are usually blue orbs. Indians and Jews use charms with palm-forward hands with an eye in the center; Italians employ horns, phallic shapes meant to distract spell casters.

Names in various languages
In most languages, the name translates literally into English as "bad eye", "evil eye", "evil look", or just "the Eye". Some variants on this general pattern from around the world are:

In Albanian it is known as "syri i keq" (Standard and Tosk), or as "syni keq" (Gheg) meaning "bad eye". Also "mësysh" is used commonly, meaning "cast an evil eye".
In Arabic, ʿayn al-ḥasūd, عين الحسود, "the eye of envy". ʿAyn ḥārrah (عين حارّة) is also used, literally translating to "hot eye".
In Armenian, char atchk (չար աչք) "evil eye" or "bad eye". Regarding the act of giving an evil gaze, it is said (directly translated), "to give with the eye" or in Armenian, "atchkov tal".
In Azerbaijani, "Göz dəyməsi" – translating as being struck by an eye
In Chinese it is called 邪惡之眼 (Traditional Chinese characters) / 邪恶之眼 (Simplified Chinese characters) (xié è zhī yǎn, literally "evil eye") or simply 邪眼 (xié yǎn).
In Corsican it is called "lOchju" (The Eye).
In Dutch it is called "het boze oog", literally "the malicious eye" or "the angry eye".
In Esperanto, it is called "malica okulo" (malicious eye).
In Estonian, its called "kuri silm" (evil/angry eye)
In Finnish, its called "paha silmä" (evil/bad eye)
In French, it is named "le mauvais œil" (The bad eye)
In Galician, it is called "meigallo", from meiga, "witch" (and maybe -allo, diminutive or aumentative suffix; or contracted with either ollo, "eye"; or allo, "garlic").
In German, it is called "böser Blick", literally "evil gaze".
In Greek, to matiasma (μάτιασμα) or mati (μάτι) someone refers to the act of casting the evil eye (mati being the Greek word for eye); also: vaskania (βασκανία, the Greek word for jinx)
In Hebrew, ʿáyin hā-ráʿ (עַיִן הָרַע, "eye of evil")
In Hindi and other languages of South Asia, (Hindi: nazar (नज़र); nazar lagna (नज़र लगना)) means to be afflicted by the evil eye. (However, it generally has no evil connotations because a doting mothers eye can supposedly also cause harm.)
In Hungarian, gonosz szem means "evil eye", but more widespread is the expression szemmelverés (lit. "beating with eye"), which refers to the supposed/alleged act of harming one by an evil look
In Irish, the term drochshúil is used for the evil eye, being a compound of droch (bad, poor, evil, ill) and súil (eye). This can also be used to refer to someone with weak eyesight.
In Indonesian the word  dengki  refers to evil eye.
In Italian, the word malocchio (pronounced [maˈlɔkkjo]) refers to the evil eye.
In Japanese it is known as "邪視" ("jashi").
In Kurdish, it is called "Çav pîs/Chaw pis/ چاو پیس"
In Lithuanian evil eye is known as "pikta akis", while act of evil watching is called "nužiūrėjimas" (noun), "nužiūrėti" (verb).
In Malay, it is called mata jahat, meaning literally "bad/evil eye".
In Malayalam it is known as kannu veykkuka – to cast an evil eye while "kannu peduka" means to be on the receiving end of the malefic influence. "kannu dosham" refers to a bad effect caused by an evil eye.
In Maltese it is known as "l-għajn". It is a common symbol for warding off evil intentions.
In Neapolitan it is known as "o mmauocchje" which translates literally into "the evil/bad/maleficent eye", which afflicts people, especially women and children who are supposedly the most vulnerable, with multiple issues and problems, stemming from pre-natal issues, miscarriages, early childhood death or sickness or death of a mother during birth, as well as afflicting women with infertility, sexual problems, early widowhood, etc., while afflicted men suffer from cancer, laziness, greed, gluttony, and other diseases, disabilities and ailments.
In Persian it is known as "چشم زخم" (injurious look/eyes causing injury) or "چشم شور" (omen eye) "Cheshmeh Hasood", meaning Jealous eye, or "Cheshme Nazar" meaning evil eye.
In Polish it is known as "złe oko" or "złe spojrzenie" (evil eye/an evil glare).
In Portuguese, it is called "mau olhado", ou "olho gordo" (literally "fat eye"). The first expression is used in Portugal and the second one is more common in Brazil.
In Romanian, it is known as "deochi", meaning literally "By-eye": a curse put on you by a gaze with evil intentions/ jealousy.
In Russian, "дурной глаз" (durnoy glaz) means "bad/evil eye"; "сглаз" (sglaz) literally means "from eye".
In Sanskrit, an ancient Indo-Aryan language, it is called "drishti dosha" (दृष्टि दोष) meaning malice caused by evil eye </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Persistent polyclonal B-cell lymphocytosis and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Skin tag and explain in detail? [/INST] A skin tag, or acrochordon (pl. acrochorda), is a small benign tumor that forms primarily in areas where the skin forms creases (or rubs together), such as the neck, armpit and groin. They may also occur on the face, usually on the eyelids. Though tags up to half an inch (12.7 mm) long have been seen, they are typically the size of a grain of rice. The surface of an acrochordon may be smooth or irregular in appearance and is often raised from the surface of the skin on a fleshy stalk called a peduncle </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Thunderstorm asthma and explain in detail? [/INST] Thunderstorm asthma (also referred to in the media as thunder fever or a pollen bomb) is the triggering of an asthma attack by environmental conditions directly caused by a local thunderstorm </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Dysplasia and explain in detail? [/INST] Dysplasia is any of various types of abnormal growth or development of cells (microscopic scale) or organs (macroscopic scale), and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopic scale include epithelial dysplasia and fibrous dysplasia of bone. Dysplasias on a mainly macroscopic scale include hip dysplasia, myelodysplastic syndrome, and multicystic dysplastic kidney.
In one of the modern histopathological senses of the term, dysplasia is sometimes differentiated from other categories of tissue change including hyperplasia, metaplasia, and neoplasia, and dysplasias are thus generally not cancerous. An exception is that the myelodysplasias include a range of benign, precancerous, and cancerous forms. Various other dysplasias tend to be precancerous. The words meanings thus cover a spectrum of histopathological variations.

Microscopic scale
Epithelial dysplasia
Epithelial dysplasia  consists of an expansion of immature cells (such as cells of the ectoderm),  with a corresponding decrease in the number and location of mature cells. Dysplasia is often indicative of an early neoplastic process. The term dysplasia is typically used when the cellular abnormality is restricted to the originating tissue, as in the case of an early, in-situ neoplasm.Dysplasia, in which cell maturation and differentiation are delayed, can be contrasted with metaplasia, in which cells of one mature, differentiated type are replaced by cells of another mature, differentiated type.

Myelodysplastic syndrome
Myelodysplastic syndromes (MDS) are a group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells. Problems with blood cell formation result in some combination of low red blood cells, low platelets, and low white blood cells </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Thermal burn and explain in detail? [/INST] A thermal burn is a type of burn resulting from making contact with heated objects, such as boiling water, steam, hot cooking oil, fire, and hot objects. Scalds are the most common type of thermal burn suffered by children, but for adults thermal burns are most commonly caused by fire. Burns are generally classified from first degree up to fourth degree, but the American Burn Association (ABA) has categorized thermal burns as minor, moderate, and major, based almost solely on the depth and size of the burn.

Causes
Hot liquids and steam
Scalding is a type of thermal burn caused by boiling water and steam, commonly suffered by children. Scalds are commonly caused by accidental spilling of hot liquids, having water temperature too high for baths and showers, steam from boiling water or heated food, or getting splattered by hot cooking oil. Scalding is usually a first- or second-degree burn, and third-degree burn can sometimes result from prolonged contact. Nearly three quarters of all burn injuries suffered by young children are scalds.

Fire
Fire causes about 50% of all cases of thermal burns in the United States. The most frequent event where people get burned by fire is during house fires encountered by firefighters and trapped occupants, where 85% of all fire deaths take place. Fireworks are another notable cause of fire burns, especially among adolescent males on holidays such as Independence Day in the US. The most common cause of injury by fire or flame in children is touching candle flame. In some regions, such as the western United States, wildfires are responsible for an increase in burn injuries. Wildfires can suddenly shift due to changing wind directions, making it harder for firefighters and eyewitnesses to avoid getting burned.
If clothing catches fire, third-degree burn can develop in a matter of just a few seconds.

Hot objects
Solid objects that are hot can also cause contact burns, especially in children, who may intentionally touch things they dont know are too hot to touch. Such burns imprinted on the skin usually form a pattern that resembles the object. Sources of burns from solid objects include ashes and coal, irons, soldering equipment, frying pans and pots, oven containers, light bulbs, and exhaust pipes.

Pathophysiology
There are three (or sometimes four) degrees of burns, in ascending order of severity and depth. For more information, see Signs and symptoms.
According to Jacksons thermal wound theory, there are three zones of major burn injury.

Zone of coagulation is the area that sustained maximum damage from the heat source.  Proteins become denaturated, and cell death is imminent due to destruction of blood vessels, resulting in ischemia to the area.  Injury at this area is irreversible (coagulative necrosis & gangrene)
Zone of stasis surrounds the coagulation area, where tissue is potentially salvageable.  This is the main area of focus when treating burn injuries.
Zone of hyperemia is the area surrounding the zone of stasis. Perfusion is adequate due to patent blood vessels, and erythema occurs due to increased vascular permeability.

Prevention
It is important to teach children how to avoid fire and scalding. Firefighters and community leaders often lead such programs in schools and clinics.Smoke alarms installed in homes can reduce deaths resulting from fire by half. Homeowners should change batteries at least once a year and replace smoke alarms every decade. Before fire occurs, a family should practice evacuating the home, and when fire occurs the family must leave the residence immediately (within two minutes). Sources of flame, like matches, should be kept out of childrens reach. Stoves, ovens, space-heaters, and candles must not be left unattended, and flammable objects must be kept at least 30 cm away from open flames. Fire extinguishers should be stored in the kitchen, where most house fires start.To prevent children from getting burned, water temperature must not be set too high when taking baths or washing hands, nonflammable sleepwear should be worn, back burners should be used when cooking something on the stove, and hot foods, drinks, and irons should be kept away from the edge of counter and table. Oven mitts and potholders must be used in handling hot containers. Care should be taken when taking hot foods out of microwave ovens, and covers should be opened gently to reduce the risk of steam burns.

Treatment
The most important first action is to stop the burning process. The source of the burn should promptly be removed (or the patient removed from the source). If the person is on fire, he/she must be told to stop, drop and roll, or extinguish the fire by covering them with heavy blanket, wool, coat, or rug. Burning clothing should be removed as should all jewelry that could act as a tourniquet as swelling occurs, but burned clothing stuck to the skin must not be removed. Cooling the burn with cold running water has been shown to be beneficial if accomplished within 30 minutes of the injury. The pain or inflammation can then be effectively treated using acetaminophen (paracetamol), or ibuprofen </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Aminoaciduria and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Bilateral frontoparietal polymicrogyria and explain in detail? [/INST] Bilateral frontoparietal polymicrogyria is a genetic disorder with autosomal recessive inheritance that causes a cortical malformation. Our brain has folds in the cortex to increase surface area called gyri and patients with polymicrogyri have an increase number of folds and smaller folds than usual. Polymicrogyria is defined as a cerebral malformation of cortical development in which the normal gyral pattern of the surface of the brain is replaced by an excessive number of small, fused gyri separated by shallow sulci and abnormal cortical lamination. From ongoing research, mutation in GPR56, a member of the adhesion G protein-coupled receptor (GPCR) family, results in BFPP. These mutations are located in different regions of the protein without any evidence of a relationship between the position of the mutation and phenotypic severity. It is also found that GPR56 plays a role in cortical pattering.

Presentation
Symptoms: Developmental delay, Psychomotor delay, Mental retardation - moderate to severe, Exaggerated reflexes and Seizures (epilepsy)

Associated conditions
BFPP is a cobblestone-like cortical malformation of the brain. Disruptions of cerebral cortical development due to abnormal neuronal migration and positioning usually lead to cortical disorders, which includes cobblestone lissencephaly. Cobblestone lissencephaly is typically seen in three different human congenital muscular dystrophy syndromes:  Fukuyama congenital muscular dystrophy, Walker-Warburg syndrome, and muscle-eye-brain disease.   In cobblestone lissencephaly, the brain surface actually has a bumpy contour caused by the presence of collections of misplaced neurons and glial cells that have migrated beyond the normal surface boundaries of the brain. Sometimes regions populated by these misplaced cells have caused a radiologic misdiagnosis of polymicrogyria. However, the presence of other abnormalities in these cobblestone lissencephaly syndromes, including ocular anomalies, congenital muscular dystrophy, ventriculomegaly, and cerebellar dysplasia, usually distinguishes these disorders from polymicrogyria. There are no anatomopathologic studies that have characterized the pattern of cortical laminar alterations in patients with GPR56 gene mutations, but it has been suggested that the imaging characteristics of BFPP, including myelination defects and cerebellar cortical dysplasia, are reminiscent of those of the so-called cobblestone malformations (muscle-eye-brain disease and Fukuyama congenital muscular dystrophy) that are also associated with N-glycosylation defects in the developing brain.Lissencephaly ("smooth brain") is the extreme form of pachygyria. In lissencephaly, few or no sulci are seen on the cortical surface, resulting in a broad, smooth appearance to the entire brain. Lissencephaly can be radiologically confused with polymicrogyria, particularly with low-resolution imaging, but the smoothness and lack of irregularity in the gray-white junction, along with markedly increased cortical thickness, distinguishes lissencephaly.
GPR56 mutation also can cause a severe encelphalopathy which is associated with electro clinical features of the Lennox-Gastaut syndrome. Lennox-Gastaut syndrome can be cryptogenic or symptomatic, but the symptomatic forms have been associated with multiple etiologies and abnormal cortical development. BFPP caused by GPR56 mutations is a manifestation of a malformation of cortical development that causes Lennox-Gastaut Syndrome.Polymicrogyria is often confused  with pachygyria; therefore, it needs to be distinguished from pachygyria, a distinct brain malformation in which the surface folds are excessively broad and sparse. Pachygyria and polymicrogyria may look similar on low-resolution neuroimaging such as CT because the cortical thickness can appear to be increased and the gyri can appear to be broad and smooth in both conditions. This is why higher resolution neuroimaging, such as an MRI, is necessary for proper diagnosis.

Genetics
The GPR56 is grouped in the B family of GPCRs. This GPCR group have long N termini characterized by an extracellular “cysteine box” and hydrophilic, potentially mucin-rich. The cysteine box contains four conserved cysteines and two tryptophans arranged in a specific fashion (C-x2-W-x6-16-W-x4-C-x10-22-C-x-C) just before the first transmembrane domain and serves as a cleavage site in some members of this group of G protein–coupled receptors. Although, the molecular and cellular mechanisms of how GPR56 regulates brain development remain largely unknown. These types of receptors play an essential role in biological processes including embryonic development, central nervous system (CNS), immune system, and tumorigenesis.

Mode of inheritance
Parents of a proband

The parents of an affected individual are obligate heterozygotes and therefore carry one mutant allele.
Heterozygotes (carriers) are asymptomatic.Sibs of a proband

At conception, each sibling of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier.
Once an at-risk sibling is known to be unaffected, the risk of his/her being a carrier is 2/3.
Heterozygotes (carriers) are asymptomatic.Offspring of a proband

Offspring of a proband are obligate heterozygotes and will therefore carry one mutant allele.
In populations with a high rate of consanguinity, the offspring of a person with GPR56-related BFPP and a reproductive partner who is a carrier of GPR56-related BFPP have a 50% chance of inheriting two GPR56 disease-causing alleles and having BFPP and a 50% chance of being carriers.Other family members of a proband.

Each sibling of the probands parents is at a 50% risk of being a carrier

Diagnosis
Diagnostic criteria for a BFPP patient entails a heterozygous genotype for a deletion of chromosome 16q12.1-q21 region,
including GPR56 gene. To date the only gene known to be associated with polymicrogyria is GPR56. Testing for GPR56-related bilateral frontoparietal polymicrogyria is available clinically. Mutations in GPR56 hinders Collagen III, its specific ligand, to bind in a developing brain. To date, a total of fourteen BFPP-associated mutations have been identified, including one deletion, two splicing, and eleven missense mutations. Two mutations in the GPCR proteolytic site (GPS) domain, C346S and W349S, cause a brain malformation through trapping the mutated proteins in the endoplasmic reticulum.GPR56 are a part of the B class of the GPCR family, the largest cell surface gene family in the human genome. Within this family there are different types of bio-active molecules that transduce their signal to the intracellular compartment via interaction with this type of receptor. Children often present with developmental delay, spasticity, or seizures; they are also often microcephalic. Some patients with polymicrogyria go undiagnosed until they produce children with the disorder who have more severe manifestations. Retrospectively, these patients will often report some difficulty in their medical or educational history. BFPP patients demonstrate mental retardation, language impairment, motor developmental delay, and seizure disorders such as epilepsy. The association of epilepsy is in approximately 50% to 85% of affected BFPP patients.
The clinical manifestations of polymicrogyria are stable neurologic deficits:
In the mildest form, polymicrogyria is unilateral with only one small region of the brain involved;  neurologic problems may not be evident.
In more severe forms, focal motor, sensory, visual, or cognitive problems may be present, depending on the location of the brain region affected.
In the most severe forms, polymicrogyria is bilateral and generalized, resulting in severe intellectual disability, cerebral palsy, and refractory epilepsy.
Individuals with the milder forms of polymicrogyria survive into adulthood, while those with the most severe forms, such as BFPP, may die at a young age as a result of such complications as seizures or pneumonia.
The prevalence of isolated polymicrogyria is unknown. Researchers believe that it may be relatively common overall, although BFPP is probably rare.
Radiological findings (MRI) demonstrated symmetric generalized polymicrogyria with decreasing anterior-posterior gradient, most prominent in frontoparietal cortex.
Numerous gyrus on the cortex
Small gyri and sulci
Thin cortex

Methods/tests
There are different tests or methods used to determine GPR56 expression or visuals of the brain to analyze the specific sections that are affected. These tests for example, using animals such as mice, RNAi, Behavioral assay, Electron microscopy, CT scan, or MRI demonstrate different results that concludes an affected BFPP patient. MRIs reveal either irregularity to the cortical surface suggestive of multiple small folds or an irregular, scalloped appearance of the gray matter-white matter junction.
Neuroimaging The diagnosis of polymicrogyria is typically made by magnetic resonance imaging (MRI) since computed tomography (CT) and other imaging methods generally do not have high enough resolution or adequate contrast to identify the small folds that define the condition.  The cerebral cortex often appears abnormally thick as well because the multiple small gyri are fused, infolded, and superimposed in appearance.Neuropathology Gross neuropathologic examination reveals a pattern of complex convolutions to the cerebral cortex, with miniature gyri fused and superimposed together, often resulting in an irregular brain surface. The cortical ribbon can appear excessively thick as a result of the infolding and fusion of multiple small gyri.Microscopic examination demonstrates that the cerebral cortex is in fact abnormally thin and has abnormal lamination; typically the cortex is unlayered or has four layers, in contrast to the normal six layers. The most superficial layers between adjacent small gyri appear fused, with the pia (layer of the meninges) bridging across multiple gyri </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Agoraphobia without history of panic disorder and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Familial hypocalciuric hypercalcemia and explain in detail? [/INST] Familial hypocalciuric hypercalcemia (FHH) is an inherited condition that can cause hypercalcemia, a serum calcium level typically above 10.2 mg/dL; although uncommon.  It is also known as familial benign hypocalciuric hypercalcemia (FBHH) where there is usually a family history of hypercalcemia which is mild, a urine calcium to creatinine ratio <0.01, and urine calcium <200 mg/day.

Signs and symptoms
Most cases of familial hypocalciuric hypercalcemia are asymptomatic. Laboratory signs of FHH include:
High blood levels of calcium (hypercalcemia)
A low amount of calcium excreted in the urine (Ca excretion rate < 0.02 mmol/L)
High blood levels of magnesium (hypermagnesemia)
High normal to mildly elevated parathyroid hormone

Causes
Types include:

Pathogenesis
Most cases of FHH are associated with loss of function mutations in the calcium-sensing receptor (CaSR) gene, expressed in parathyroid and kidney tissue </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Pituitary stalk interruption syndrome and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Rash and explain in detail? [/INST] A rash is a change of the human skin which affects its color, appearance, or texture.
A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell, and may be painful.
The causes, and therefore treatments for rashes, vary widely </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Focal cortical dysplasia and explain in detail? [/INST] Focal cortical dysplasia (FCD) is a congenital abnormality of brain development where the neurons in an area of the brain failed to migrate in the proper formation in utero. Focal means that it is limited to a focal zone in any lobe. Focal cortical dysplasia is a common cause of intractable epilepsy in children and is a frequent cause of epilepsy in adults. There are three types of FCD with subtypes, including type 1a, 1b, 1c, 2a, 2b, 3a, 3b, 3c, and 3d, each with distinct histopathological features. All forms of focal cortical dysplasia lead to disorganization of the normal structure of the cerebral cortex :

Type 1 FCD exhibits subtle alterations in cortical lamination.
Type 2a FCD exhibits neurons that are larger than normal that are called dysmorphic neurons (DN). FCD type 2b exhibits complete loss of laminar structure, and the presence of DN and enlarged cells are called balloon cells (BC) for their large elliptical cell body shape, laterally displaced nucleus, and lack of dendrites or axons. The developmental origin of balloon cells is currently believed to be derived from neuronal or glial progenitor cells.  Balloon cells are similar in structure to giant cells in the disorder tuberous sclerosis complex.
Type 3 FCDs are cortical disorganisation associated with other lesions such as hippocampal sclerosis (type 3a), long-term epilepsy-associated tumors (3b), vascular malformations (3c) or scar/hypoxic damages (3d).Recent studies have demonstrated that FCD types 2a and 2b result from somatic mutations in genes that encode components of the mammalian target of rapamycin (mTOR) pathway. Causative gene mutations for types 1 and 3 have not been identified. The mTOR pathway regulates a number of functions in the brain including establishment of cell size, cell motility, and differentiation. Gene mutations associated with FCD2a and FCD 2b include MTOR, PI3KCA, AKT3, and DEPDC5 </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Oroantral fistula and explain in detail? [/INST] Oroantral fistula (OAF) is an epithelialised oroantral communication (OAC). OAC refers to an abnormal connection between the oral cavity and antrum (or maxillary sinus). The creation of an OAC is most commonly due to the extraction of a maxillary (upper) tooth (typically a maxillary first molar) closely related to the antral floor (floor of the maxillary sinus). A small OAC (up to 5mm wide) may heal spontaneously but a larger OAC would require surgical closure to prevent the development of persistent OAF and chronic sinusitis.

Classification
Signs and symptoms of an OAC/OAF can include the following
When looking in the mouth, a communication in the upper jaw (i.e. a hole) can be seen connecting the mouth to the maxillary sinus. Sometimes this can be the only sign, as pain (+/- other symptoms) is not always present.

Symptoms
· Same side nose blockage (unilateral nasal obstruction). When an OAC or OAF is present, the passage to the maxillary sinus can results in infection and inflammation in the maxillary sinus. This subsequently results in mucus build up presenting as a unilateral nasal blockage
· Sinusitis can progress – this can present as a pain in the midface. Pain can be referred to the upper teeth and be mistaken for toothache· Fluid can flow from the mouth through the communication and into the maxillary sinus. The maxillary sinus is connected to the nose and therefore fluid can come out of the nostrils when drinking· Change in sounds produced from the nose and the voice – specifically a whistling sound whilst speaking· Taste can be affected

Signs
· Visible hole between mouth and sinus
· Fracture of the floor of the maxillary sinus creating a communication to the oral cavity (e.g. as seen following trauma).· Air bubbles, blood or mucoid secretion around the orifice can be seen as air passes from the sinus into the oral cavity through the communication.

Diagnosis
- Patient history - Diagnosis is usually based on clinical examination and reported symptoms. Therefore, a good history and understanding of the patient’s symptoms is key.
- Undertake a complete extraoral and intraoral examination using a dental mirror alongside good lighting. When assessing the socket following an extraction look for granulation tissue in the socket which may represent normal healing. Assess for the presence of visible an opening/hole between the oral cavity and the maxillary sinus.
- Imaging can be useful. However, radiographs only show if there is a breach in the bony floor of the antrum. Even if there is a breach in the bony floor then the Schneiderian membrane may still be intact. Depending on the size of the potential communication and in what context, a small radiograph inside the mouth may be sufficient (a periapical) to assess for any break in the bone of the sinus floor which may indicate an OAC.
- Panoramic radiographs can also be used to confirm the presence of an OAC. If simple radiographs are deemed not to give enough information, cone beam computed tomography (CBCT) (special x-ray equipment that can scan in 3 dimensions) may be used.  Imaging can help locate the communication, determine the size of it and can give an indication as to whether there is any sinusitis and foreign bodies in the sinus.
- Normally clinicians should be cautioned against probing or irrigating the site a newly formed OAC as this may reduce the chance of spontaneous healing.
- Valsalva test (nose blowing test) The patient is asked to pinch their nostrils together and open their mouth and then blow gently through the nose. The clinician must observe if there is passage of air or bubbling of blood in the post extraction alveolus as the trapped air from closed nostrils is forced into the mouth through any oroantral communication. Gentle suction applied to the socket often produces a characteristic hollow sound. However, there are differing opinions about the appropriateness of carrying out this test.  It can be argued that by performing this test, a small OAC may be made bigger thus preventing spontaneous healing.

Causes
Extraction of maxillary teeth
The maxillary sinus is known for its thin floor and close proximity to the posterior maxillary (upper) teeth. The extraction of a maxillary tooth (typically a maxillary first molar which lies close to the lowest point of antral floor although any premolar or molar can be affected) is the most common cause of an OAC (which can then progress to an OAF as described above). Extraction of primary teeth are not considered a risk of OAC due to the presence of developing permanent teeth and the small size of the developing maxillary sinus.

Other causes
Other causes of an OAC are: maxillary fractures across the antral floor typically Le Fort I, displacement of posterior maxillary molar roots into antrum and direct trauma. An OAC can happen for many other more unusual reasons, such as acute or chronic inflammatory lesions around the tip of a tooth root which is in close proximity with the maxillary antrum, destructive lesions/tumours of the maxilla, failure of surgical incisions to heal (e.g. Caldwell-luc antrostomy), osteomyelitis of the maxilla, careless use of instruments during surgical procedures, Syphilis, implants and as a results of complex surgery (for example removal of a large cysts or resections of large tumours involving the maxilla.

Diagnosis
Clinical examination and x rays can help diagnose the condition. For examples :
Valsalva test (nose blowing test): Ask the patient to pinch the nostrils together and open the mouth, then blow gently through the nose. Observe if there is passage of air or bubbling of blood in the post extraction alveolus as the trapped air from closed nostrils is forced into the mouth through any oroantral communication. Gentle suction applied to the socket often produces a characteristic hollow sound.
Perform a complete extra- and intra-oral examination using a dental mirror under good lighting, look for granulation tissue in the socket and openings into the antrum.
Panoramic radiograph or paranasal computed tomography can help to locate the fistula, the size of it and to determine the presence of sinusitis and other foreign bodies. Other methods like radiographs (occipitomental, OPG and periapical views) can also be used to confirm the presence of any oroantral fistulas.
To test the patency of communication the patient is asked to rinse the mouth or water is flushed in the tooth socket.
Unilateral epistaxis is seen in case of collection of blood in the sinus cavity.
Do not probe or irrigate the site, because it may lead to sinusitis or push foreign bodies, such as contaminated fragments, or oral flora further into the antrum. Hence, leading to the formation of a new fistula or widen an existing one.

Complications
OAF is a complication of oroantral communication. Other complications may arise if left untreated. For example:

Candidal infection
Chronic maxillary sinus infection of bacterial origin
Osteomyelitis
Rhinosinusitis
Sinus pathologyTherefore, OAF should be dealt with first, before treating the complications.

Prevention
Whilst in some circumstances, preventing development of an OAF following extraction of a tooth can be difficult, careful assessment is important. The following should be considered prior to carrying out any dental treatment:
Size of the antrum and proximity to teeth – this can be assessed radiographically
Shape and size of teeth and roots – this can be assessed radiographically
Presence of periapical pathology – this can be assessed radiographically
The age of the patient
The patient’s past dental historyIf the above factors are assessed as increasing the risk of OAC development, the clinician should take appropriate steps to carefully remove the tooth in question, possibly carrying out a surgical extraction and in an appropriate setting. Hence, in such cases:

Avoid using too much of apical pressure during tooth extraction
Perform surgical extraction with roots sectioning
Consider referral to OMFS at local hospital

Treatment
The primary aim of treatment of a newly formed oroantral communication is to prevent the development of an oroantral fistula as well as chronic sinusitis. The decision on how to treat OAC/OAF depends on various factors. Small size communications between 1 and 2 mm in diameter, if uninfected, are likely to form a clot and heal by itself later. Communications larger than this require treatments to close the defect and these interventions can be categorised into 3 types: surgical, non-surgical and pharmacological.

Surgery
Surgical methods are required if a large defect is present or if a defect persists. Surgery involves creating a flap utilising local tissue to close the communication. There are a number of different flaps that can be used such as the buccal advancement flap, the buccal fat pad flap, a combination of the two and a palatal flap. The flap used is dependent on the size and position of the defect.

Buccal advancement flap
The buccal advancement flap is the most commonly used due to its simplicity, reliability and versatility. It involves cutting a broad based trapezoid shaped mucoperiosteal flap with two vertical incisions. The flap is cut buccally, is three sided and extends to the full depth of the sulcus.

Buccal fat pad flap
The buccal fat pad flap is also a popular option due to its high success rate. It is a simple procedure where the buccal extension of the anatomical fat pad is used for closure. These two flaps can be used in combination where the buccal fat pad covers the communication followed by a further covering via the buccal mucosal flap described above. This double layer flap has advantages over a single layer as it provides stable soft tissue covering, reduces the incidences of wound breakdown and defect recurrence as well as reducing the risk of postoperative infection.Sutures, either non-resorbing or slowly resorbing, are generally used in the surgical repairs of OAC.

Non-surgical interventions
Ultimately, surgery is usually required to close an OAC/OAF </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Primary hyperoxaluria and explain in detail? [/INST] Primary hyperoxaluria is a rare condition (autosomal recessive), resulting in increased excretion of oxalate (up to 600 mg a day from normal 50 mg a day), with oxalate stones being common.

Signs and symptoms
Primary hyperoxaluria is an autosomal recessive disease, meaning both copies of the gene contain the mutation. Both parents must have one copy of this mutated gene to pass it on to their child, but they do not typically show signs or symptoms of the disease.
A single kidney stone in children or recurrent stones in adults is often the first warning sign of primary hyperoxaluria. Other symptoms range from recurrent urinary tract infections, severe abdominal pain or pain in the side, blood in the urine, to chronic kidney disease and kidney failure. The age of symptom onset, progression and severity can vary greatly from one person to another, even among members of the same family. Some individuals may have mild cases that go undiagnosed well into adulthood; others may develop severe complications during infancy, which may result in early death.

Pathophysiology
The buildup of oxalate in the body causes increased renal excretion of oxalate (hyperoxaluria), which in turn results in kidney and bladder stones.  Stones cause urinary obstruction (often with severe and acute pain), secondary infection of urine and eventually kidney damage. Primary hyperoxaluria is caused by genetic defects that result in the overproduction of oxalate. This is different from secondary hyperoxaluria, which is caused by the increase in dietary and intestinal absorption of oxalate or excessive intake of oxalate precursors.Oxalate stones in primary hyperoxaluria tend to be severe, resulting in relatively early kidney damage (in teenage years to early adulthood), which impairs the excretion of oxalate leading to a further acceleration in  accumulation of oxalate in the body.After the development of kidney failure patients may get deposits of oxalate in the bones, joints and bone marrow.  Severe cases may develop haematological problems such as anaemia and thrombocytopaenia.  The deposition of oxalate in the body is sometimes called "oxalosis" to be distinguished from "oxaluria" which refers to oxalate in the urine.

Diagnosis
A diagnosis of primary hyperoxaluria is suspected based on presenting patient characteristics such as kidney stones in infants or children, recurrent kidney stones in adults, or family history of hyperoxaluria. In these patients, stone analysis and urine analysis are recommended to rule out secondary causes of hyperoxaluria. A definitive diagnosis of primary hyperoxaluria requires genetic testing. This is performed using a gene panel covering known mutations for all three types of primary hyperoxaluria.

Classification
The three main types of primary hyperoxaluria (PH1, PH2, and PH3) are each associated with mutations in specific genes involved in the metabolism of glyoxylate, the precursor of oxalate. These mutations result in decreased production or activity of the proteins that are involved in the normal breakdown of glyoxylate, which results in an overproduction of oxalate. Mutations in the genes AGXT  and GRHPR cause PH1 and PH2, respectively, through decreased production or activity of the proteins they make, which stops the normal breakdown of glyoxylate. Similarly, mutations in the gene HOGA1 cause PH3 due to loss-of-function mutations resulting in impaired protein function.PH1 is considered to be the most common and rapidly progressing form, accounting for about 80% of all currently diagnosed cases and PH2 and PH3 accounting for approximately 10% each of the current cases. However, recent evidence has suggested that PH2 and PH3 are not as benign as previously thought, with up to 50% of patients with PH2 developing kidney failure (chronic kidney disease [CKD] stage 5). While current estimates indicate that kidney failure is rarer in patients with PH3 compared to PH1 and PH2, CKD has been reported in patients with PH3. Moreover, the genetic prevalence based on known PH3 variants is much higher than the diagnosed prevalence of the disease, which could mean either incomplete penetrance (i.e. variant present with no clinical symptoms) or underdiagnosis (i.e </s>