Miracle-dz/UniFAR-FTUs huggingface dataset:
National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994–2004

Background: Rates of death from cardiovascular and cerebrovascular diseases have been steadily declining over the past few decades. Whether such declines are occurring to a similar degree for common disorders such as acute myocardial infarction, heart failure and stroke is uncertain. We examined recent national trends in mortality and rates of hospital admission for these 3 conditions. Methods: We analyzed mortality data from Statistic Canada’s Canadian Mortality Database and data on hospital admissions from the Canadian Institute for Health Information’s Hospital Morbidity Database for the period 1994–2004. We determined age- and sex-standardized rates of death and hospital admissions per 100 000 population aged 20 years and over as well as in-hospital case-fatality rates. Results: The overall age- and sex-standardized rate of death from cardiovascular disease in Canada declined 30.0%, from 360.6 per 100 000 in 1994 to 252.5 per 100 000 in 2004. During the same period, the rate fell 38.1% for acute myocardial infarction, 23.5% for heart failure and 28.2% for stroke, with improvements observed across most age and sex groups. The age- and sex-standardized rate of hospital admissions decreased 27.6% for stroke and 27.2% for heart failure. The rate for acute myocardial infarction fell only 9.2%. In contrast, the relative decline in the inhospital case-fatality rate was greatest for acute myocardial infarction (33.1%; p < 0.001). Much smaller relative improvements in case-fatality rates were noted for heart failure (8.1%) and stroke (8.9%). Interpretation: The rates of death and hospital admissions for acute myocardial infarction, heart failure and stroke in Canada changed at different rates over the 10-year study period. Awareness of these trends may guide future efforts for health promotion and health care planning and help to determine priorities for research and treatment.
Electrophysiology and arrhythmogenesis in heart failure

Heart failure was induced in rabbits by a combined volume and pressure overload. Fifteen out of 23 of these rabbits developed nonsustained ventricular tachycardia, against none of 15 control rabbits. In rabbits that died suddenly, sinus rate was faster than normal, in rabbits that survived, sinus rate slowed. In isolated ventricular trabeculae from failing rabbit and human hearts, triggered activity based on delayed afterdepolarizations was found in about 50% of preparations, but only during exposure to catecholamines and low K+(3mM). Measurements of intracellular calcium in isolated myocytes from failing rabbit hearts showed that the delayed afterdepolarizations were caused by spontaneous release of calcium from the sarcoplasmatic reticulum. Betaadrenergic stimulation markedly increased the calcium content of the sarcoplasmic reticulum in failing myocytes, and had little effect on control myocytes. In conclusion, altered calcium homeostasis in heart failure sets the stage for spontaneous calcium release from the sarcoplasmic reticulum, especially at rapid heart rates and adrenergic stimulation. This leads to activation of the Na+/Ca++ exchanger, and the resulting transient inward current is responsible for delayed afterdepolarizations and triggered activity. About half of the deaths of patients with heart failure are classified as sudden, and about half of the patients suffer from ventricular arrhythmias. Yet the relationship between presence of arrhythmias and sudden death is far from clear, with some studies claiming a relationship, other studies denying it. It appears that sudden death is more often due to a tachyarrhythmia in patients with NYHA class I or II, while in patients with more severe heart failure, sudden death is more often due to bradyarrhythmias or electromechanical dissociation(1). We have attempted to elucidate the mechanisms of arrhythmias using a rabbit model of heart failure, induced by combined volume overload (aortic valve insufficiency) and pressure overload (partial constriction of the abdominal aorta). Holter monitoring demonstrated that 15 out of 23 of these rabbits developed non sustained ventricular tachycardias, against none of 15 control rabbits. In rabbits that died suddenly, sinus rate was faster than normal, in rabbits that survived for a long time, sinus rate was decreased. In isolated sinus node
Scottish audit of ectopic pregnancy

Objective To evaluate the use of laparoscopic procedures in the treatment of ectopic pregnancies by a cross-section of gynaecologists in Scotland Design A prospective registration of cases of laparoscopically treated ectopic pregnancy by gynaecologists. Case-note review was also performed in selected hospitals. Setting 13 hospitals in seven Scottish Health Board areas. Subjects Women having laparoscopic treatment of ectopic pregnancy. Results Between April 1994 and March 1996, 85 ectopic pregnancies were treated laparoscopically. Contraindications for laparoscopic surgery were most commonly size of the ectopic gestation (53%), presence of intraperitoneal bleeding (42%) and tubal rupture (44%). Salpingotomy was performed in 16% overall with only 86% of consultants monitoring serial human chorionic gonadotrophin levels. Conclusions Laparoscopic treatment of ectopic pregnancies in Scotland is infrequent. Lack of availability of adequate equipment and trained staff was often quoted as the reason preventing surgeons from developing their skills in these techniques. Complication rates were low and patient satisfaction high.
Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit

The last century witnessed dramatic changes in the practice of health care, and coming decades promise advances that were not imaginable even in the relatively recent past. Science and technology continue to offer new insights into disease pathways and treatments, as well as mechanisms of protecting health and preventing disease. Genomics and proteomics are bringing personalized risk assessment, prevention, and treatment options within reach; health information technology is expediting the collection and analysis of large amounts of data that can lead to improved care; and many disciplines are contributing to a broadening understanding of the complex interplay among biology, environment, behavior, and socioeconomic factors that shape health and wellness. On February 25 - 27, 2009, the Institute of Medicine (IOM) convened the Summit on Integrative Medicine and the Health of the Public in Washington, DC. The summit brought together more than 600 scientists, academic leaders, policy experts, health practitioners, advocates, and other participants from many disciplines to examine the practice of integrative medicine, its scientific basis, and its potential for improving health. This publication summarizes the background, presentations, and discussions that occurred during the summit.
Status of zinc in pulmonary tuberculosis

Background: To study the status of zinc as a micronutrient in pulmonary tuberculosis, in our population, with the aim to see the effectiveness of therapy. Methodology: This prospective study includes 50 patients with pulmonary tuberculosis and 30 subjects as the control group. The patients were placed into three stages (1 to 3) on the basis of chest radiographic findings. Serum zinc levels were estimated before, during, and after completion of antitiberculosis therapy. Results: Statistically significant fall in serum zinc levels was seen with advanced age and disease, and the levels improved after initiation of antituberculosis therapy. Conclusion: Estimation of serum zinc levels is an important tool in diagnosis and monitoring of response to treatment in pulmonary tuberculosis, and even a booster of the immunological mechanisms if instituted during the course of treatment.
The cost-effectiveness of screening for colorectal cancer

Background: Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy. Methods: We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars. Results: Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit. Interpretation: Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.
Seroepidemiology of HBV Infection in Kermanshah- West of Iran; A Population Based Study

Background: hepatitis B virus (HBV) infection is a major public health problem that affects billions of people worldwide. The lack of information on HBV prevalence among the general population is an obstacle to formulate effective policies to reduce the bur den of viral hepatitis. Objectives: This population based serological survey was conducted in Kermanshah province to determine the local prevalence and risk factors of HBV infection. Patients and Methods: 1979 healthy subjects were selected from all districts of Kermanshah province (in the west of Iran) using random cluster sampling. Subjects between 6 and 65 years of age were included with mean age of 35 ± 13. Serum samples were tested for HBcAb, HBsAg and anti-HDV antibody. To carry out lab tests the third generation of ELISA was used. Various risk factors were recorded and multivariate analysis was performed. Results: The prevalence of HBsAg and HBcAb in Kermanshah was 0.75% (95% CI 0.44; 1.21) and 8.28% (95% CI 7.13; 9.56), respectively. One case of HDV-Ab was found. Predictors of HBsAg or HBcAb in multivariate analysis were: old age, being male, history of tattooing and history of dental procedure. Conclusions: approximately 8% and less than 1% of general population in Kermanshah are HBcAb seropositive and active carriers of HBV infection, respectively. Age, sex and history of tattoo and dental procedures are major risk factors of HBV seropositivity in this province.
Population pharmacokinetics of rosuvastatin: implications of renal impairment, race, and dyslipidaemia

ABSTRACT Objectives: To build the structural model of pharmacokinetics for rosuvastatin and evaluate the impact of demographic characteristics including renal function on its pharmacokinetic parameters. Methods: A population pharmacokinetic analysis of rosuvastatin in healthy volunteers, subjects with dyslipidaemia, and renal failure patients was performed using non-linear mixed-effects modelling and a two-compartment pharmacokinetic model with simultaneous first- and zero-order absorption. Demographic covariates, dyslipidaemic state and renal function were evaluated for their impact on pharmacokinetic parameters by step-wise additions or deletions using the likelihood ratio test. Results: Typical pharmacokinetic parameters were estimated for a healthy white male subject. For example, apparent oral clearance (CL/F ) was estimated to be 257 L/h. Age, smoking status, weight, body surface area, and lean body mass had no significant effect on rosuvastatin pharmacokinetics. The model predicted that CL/F for subjects with creatinine clearance (CLCR ) of 30 mL/min (moderate renal impairment) and of 50 mL/min (mild renal impairment) was 17% and 9.7% lower, respectively, relative to subjects with CLCR of 94 mL/min, the data set median value. CL/F was reduced by 71.1% and 43.7% in subjects with dyslipidaemia and in Asian subjects, respectively. Conclusions: Reduction of CL/F of rosuvastatin is not considered clinically significant for patients with mild-to-moderate renal impairment. Rosuvastatin CL/F was reduced in subjects with dyslipidaemia, but it is important to realise that the safety/efficacy profile of rosuvastatin has been well established in this population. However, the potential for increased exposure in Asian subjects should be considered when initiating rosuvastatin treatment or increasing dose in this population.
Auto-rotação cefálica ativa em pacientes com tontura/ vertigem

Introducao: A auto-rotacao cefalica ativa e um teste rapido, de simples realizacao, nao invasivo, que nao causa desconforto ao paciente, pode ser realizado com facilidade em criancas e avalia o reflexo vestibulo-ocular nas frequencias fisiologicas de movimentacao da cabeca, utilizadas na vida cotidiana (de 1 a 4 Hz). Forma de estudo: clinico retrospectivo nao randomizado. Objetivo: Avaliar pacientes com queixas de tontura/vertigem atraves da auto-rotacao cefalica ativa comparando os sintomas com as alteracoes encontradas. Material e metodo: Um grupo de 1281 pacientes com queixa de tontura/vertigem foi submetido ao teste de auto-rotacao cefalica ativa horizontal com alvo fixo, como uma etapa da avaliacao otoneurologica. Resultados: As idades variaram de tres a 93 anos com media de 49,6 anos, sendo 946 (73,8%) do sexo feminino e 335 (26,2%) do sexo masculino. A queixa de vertigem foi relatada por 896 (69,9%) dos pacientes e a tontura por 385 (30,1%). A faixa de frequencia de resposta a prova de auto-rotacao cefalica variou de 1,5 a 7,5Hz com media de 3,5Hz. A prova de auto-rotacao cefalica ativa foi normal em 937 (73,1%) e alterada em 344 (26,9%) dos pacientes. As alteracoes mais frequentes foram as relacionadas ao ganho (aumento, reducao) isoladas ou associadas a alteracoes de fase e simetria, em 241 (19%) pacientes. O aumento do ganho isolado foi verificado em 92 pacientes (7,2%). Conclusao: Nao houve relacao entre as alteracoes na prova de auto-rotacao cefalica ativa horizontal e as queixas de tontura e vertigem.
Predictors for patients with knee complaints receiving physiotherapy

Abstract The aim of the study was to identify factors that predict impairment in daily life for patients of working age with knee complaints 6 months after receiving physiotherapy. A prospective, multicentre observational study was conducted in private physiotherapy practices. Patients (n = 237) aged 18–65 years with a physiotherapy referral because of knee complaints were studied. Treatment was documented on a standardized form by the physiotherapists and was not influenced by the investigators. The 16-item version of the Musculoskeletal Function Assessment Questionnaire was used as primary outcome measure. Baseline scores for impairment in daily life, symptom characteristics, socio-demographic and psychosocial factors, physical activity, nicotine consumption and comorbidities were investigated as possible predictors of recovery. Predictors identified by multiple linear regression were: self-prognosis on work ability, mental resources, obesity, diagnostic subgroup anterior knee pain and the comorbidities rheumatoid arthritis and diabetes. An active primary therapy approach enhanced recovery. Variables explained 38% of variance (adjusted R2). The knowledge of the identified factors supports the setting of therapy goals together with the patient. Therefore, only a short questionnaire is necessary. Moreover, the results underpin the importance of an active therapy plan.
Comparative osmotic fragility of three erythrocyte genotypes (HbAA, HbAS and HbSS) of male participants administered with five antimalarial drugs.

TM , Halfan TM , Quinine, Coartem TM , and Chloroquine phosphate) were administered to male participants. Clinically confirmed healthy non-malarious and malarious male participants enrolled for this study. Erythrocytes obtained from these individuals were suspended in two separate sets of Phosphate buffer saline (PBS) solution of decreasing concentrations in the following order: 0.9, 0.7, 0.6, 0.4, 0.3 and 0.2 g / 100 ml. Spectrophotometric method was used to determine the level of erythrocyte osmotic fragility. The mean (±S.D) MCF values of the three genotypes were in the order: HbAA 0.05) between the MCF values of HbAA and HbAS erythrocytes. Comparatively, parasitized erythrocytes exhibited significantly (p < 0.05) increased MCF values. The five antimalarial drugs were agents of erythrocyte destabilization in both categories of participants. However, the overall capacities of the drugs to disturb erythrocyte stability diminished as the experimental time progressed.
Comparison of the Skin-Prick Test and Phadia Immunocap as Tools to Diagnose House-Dust Mite Allergy

Background When the skin-prick test (SPT) and in vitro test such as ImmunoCAP assay are performed simultaneously, results do not always coincide in some patients. Our objectives, therefore, were (1) to assess differences in allergic test results according to age group and (2) to establish appropriate guidelines for diagnosing mite allergy according to age. Methods A total of 692 participants complaining of allergic rhinitis symptoms participated. Patients were divided according to age; the mean age was 32 years (range, 8–76 years). The SPT and ImmunoCAP assays were performed to detect allergies to house-dust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae). The association between age and the result of each allergy test were examined, and a cutoff age for proper application of each test was than estimated. Results Three hundred thirty-six patients (48.6%) were allergic to D. pteronyssinus and 350 patients (50.6%) were allergic to D. farinae. In the case of D. pteronyssinus, SPT was proved to be more useful in detecting allergy for subjects <50 years old (p < 0.0001). However in case of D. farinae, ImmunoCAP was useful for all age groups, but SPT showed decreased ratio of positive result for subjects >30 years old (p < 0.0001). Conclusion This study was the first to compare results of allergy tests according to age using true allergens. For patients >50 years of age, the ImmunoCAP was found to be the preferred method for detecting allergy to house-dust mites and for patients <30 years old, SPT is the recommended first choice.
Drug utilization study in the otorhinolaryngology department in a tertiary care hospital

Background: Drug utilization is defined by the World Health Organization (WHO) as the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. The aim of this study was to evaluate the pattern of prescription and then drug utilization in outpatient (OPD) of the Department of Otolaryngology in a tertiary care teaching hospital. Methods: This was a retrospective study conducted at the A.C. S. medical college and hospital, Chennai for a period of 7 months. All the patients who attended the Ear Nose and Throat (ENT) OPD were included. The total number who attended the OPD was 10,249 which include 6,956 new cases and 3313 old cases. Results: The antibacterials commonly used were β Lactams (56%), macrolides (14%), fluoroquinolones (12%), aminoglycosides (8%). Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (27%), in cephalosporins was cefixime + clavulanic acid (19%). Aminoglycosides include gentamycin in refractory cases. Fluoroquinolones include ciprofloxacin and levofloxacin. Others Drugs like antihistamines and mucolytics were prescribed in 27%, anti- ulcer drugs in 36% cases, analgesics in 33% cases and herbal medicines in 4%. The average number of drugs used in each prescription was 3.20. All the drugs were prescribed with brand names. The average cost per prescription per day for OPD patients is 37 Rupees. Conclusions: β Lactams were commonly used antibacterials in the otorhinolaryngology department.
Antidepressants and pregnancy: complexities of producing evidence-based information

See related research article by Nakhai-Pour and colleagues, page [1031][1], and letter by Berard and colleagues, page [1079][2] The prevalence for depression in women peaks during the childbearing years, from the age of 25 to 44 years, and can occur in up to 15% of all pregnant women. [1][3]
Physical punishment of children: lessons from 20 years of research

See related editorial by Fletcher on page [1339][1] and at [www.cmaj. ca/lookup/doi/10.1503/cmaj.121070][2] Over the past two decades, we have seen an international shift in perspectives concerning the physical punishment of children. In 1990, research showing an association between physical
One-way Valve Bottle Contamination Rates in the Immediate Post–functional Endoscopic Sinus Surgery Period

Background Sinonasal saline irrigation has become an accepted practice in the immediate postoperative management of functional endoscopic sinus surgery (FESS) patients. Recent studies have found that valveless delivery systems of sinonasal irrigation are colonized with bacteria. An alternative delivery system uses a one-way valve to reduce saline backflow and may limit bottle contamination. Our sole objective was to determine whether this system in post-FESS patients eliminates microbial bottle contamination. Methods Eight patients undergoing FESS were given one-way valve irrigation bottles to use immediately after surgery. Bottles were collected after 1 week of use and another set of bottles after an additional week. Endoscopic-directed cultures of the middle meatus were performed at the time of surgery. Returned used bottles were swabbed for bacteria and the valve system of the bottle was analyzed under scanning electron microscopy (SEM) for the presence of bacteria. Results All sinus swabs collected at the time of surgery grew bacteria with Staphylococcus sp. present in all samples. After the 1st week of use, 5/8 bottles grew bacterial cultures and showed bacterial presence on the valves by SEM. After the 2nd week, 4/5 bottles had positive culture results and also showed bacterial presence on the valves by SEM. Conclusion Despite commercial claims that the use of valves and limit of backflow into the bottle will eliminate contamination, our study showed that one-way valve delivery systems become contaminated with bacteria after 1 week of use. We also showed that the bottle valves themselves harbor bacteria after 1 week of use.