Miracle-dz/UniFAR-FTUs huggingface dataset:
Ozone Is Associated With an Increased Risk of Respiratory Exacerbations in Patients With Cystic Fibrosis

Background Tropospheric oxidant pollutants may injure the respiratory tract. Cystic fibrosis (CF) respiratory disease involves significant inflammation and excessive oxidative stress, and exposure to air pollutants can magnify the lung damage. The objective of this study was to investigate the association between the short-term variation in the concentration of air pollutants in metropolitan São Paulo, Brazil, and the occurrence of respiratory exacerbations in children and adolescents with CF. Methods A longitudinal panel of repeated measurements was obtained from 103 patients attending the outpatient center of our institution from September 6, 2006 through September 4, 2007. Daily concentrations of inhaled particulate matter, sulfur dioxide, nitrogen dioxide, ozone (O3), carbon monoxide, and meteorologic variables, such as the minimum temperature and relative humidity, were evaluated. The generalized estimation equation model for binomial distribution was used to assess the impact of these measurements on the occurrence of acute respiratory exacerbations. Results In total, 103 patients with CF (median age, 8.9 years) made 408 visits, with a mean ± SD of 4 ± 1.74 visits per patient (range, 2-9). A respiratory disease exacerbation was diagnosed on 142 visits (38.4%). An interquartile range increase in the O3 concentration (45.62 μg/m3) had a positive, delayed (2 days after exposure) effect on the risk of a respiratory exacerbation (relative risk = 1.86; 95% CI, 1.14-3.02). Conclusions This study demonstrates that exposure to short-term air pollution in a large urban center increases the risk of a pulmonary exacerbation in patients with CF.
Phosphine intoxication following oral exposure of horses to aluminum phosphide-treated feed.

CASE DESCRIPTION 66 horses were potentially exposed to phosphine (a gas) 14 hours after being fed a pelleted ration treated with aluminum phosphide. CLINICAL FINDINGS 28 horses had clinical signs of profuse sweating, tachycardia, tachypnea, pyrexia, ataxia, seizures, and widespread muscle tremors. Clinically relevant laboratory findings included hypoglycemia and high plasma concentrations of lactate and ammonia and activities of gamma-glutamyl transpeptidase, aspartate aminotransferase, and alkaline phosphatase. At least 4 horses had signs consistent with hepatic encephalopathy. Necropsy findings included petechial and ecchymotic hemorrhages in multiple organs, widespread vascular congestion, hepatic lipidosis, and neuronal necrosis in the brain. Phosphine was detected in the stomachs of the 3 horses tested. TREATMENT AND OUTCOME On the farm, horses were treated with gastric lavage followed by administration of di-tri-octahedral smectite, atropine, fluids, and sedatives. Six horses were hospitalized, and lactated Ringer's solution and flunixin meglumine were administered IV. Additionally, 10% dextrose, corn syrup, and di-tri-octahedral smectite were administered PO. Twenty-seven horses died within 2 days after exposure. Two survivors (1 without clinical signs of toxicosis) made a complete recovery. CLINICAL RELEVANCE Progression of clinical signs in affected horses in this report was rapid, with few treatment options available, leading to a high case fatality rate. Fumigation with aluminum phosphide is commonly performed to eliminate weevils and other insects from stored grains. When appropriate precautions are used during fumigation, risk to livestock is typically minimal.
Baseline regional perfusion impacts exercise response to endobronchial valve therapy in advanced pulmonary emphysema.

BACKGROUND Advanced heterogeneous emphysema with hyperinflation impacts exercise tolerance in COPD. Bronchoscopic lung volume reduction using Zephyr endobronchial valves (EBVs) has been shown to improve lung function in patients with heterogeneous emphysema. It is unclear whether the target lobe perfusion of patients receiving EBV therapy impacts exercise tolerance as measured by the 6-min walk test distance (6MWTD). METHODS We performed a retrospective analysis on the treatment group of the Endobronchial Valve for Emphysema Palliation Trial (VENT) to evaluate the impact of perfusion, measured by 99mTc-MAA-perfusion scintigraphy, on the 6-month improvement in 6MWTD. A mixed-model analysis was performed for the treatment outcome, adjusting for other variables such as age, target lobe position, fissure integrity, BMI, sex, destruction score, and lobar exclusion. RESULTS Dichotomized at the median, of the 169 patients who received EBV therapy, 88 had a low target lobe regional perfusion and 81 had high target lobe regional perfusion at baseline. Patients with a low target lobe regional perfusion had a significant improvement in 6MWTD when compared with those with a high baseline target lobe regional perfusion (30.24 m vs 3.72 m, P = .03). Shifts in perfusion after EBV therapy occurred only in patients with high baseline perfusion and did not correlate with improved 6MWTD. CONCLUSIONS Patients having heterogeneous emphysema with a low baseline target lobe regional perfusion benefit from EBV therapy, independent of the degree of target lobe destruction. This effect is attenuated if the EBV therapy is not occlusive. Characterization of baseline perfusion may enhance clinical results of patients with emphysema undergoing EBV therapy. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00000606; URL: www.clincialtrials. gov.
Thromboprophylaxis and VTE rates in soldiers wounded in Operation Enduring Freedom and Operation Iraqi Freedom.

OBJECTIVES US soldiers suffer catastrophic injuries during combat. We sought to define risk factors and rates for VTE in this population. METHODS We gathered data each hospital day on all patients injured in Afghanistan or Iraq who were admitted to the Walter Reed Army Medical Center (WRAMC). We analyzed prophylaxis rates and efficacy and identified risk factors for VTE. RESULTS We recorded data on 506 combat casualties directly admitted to WRAMC after medical air evacuation. The average injury severity score for the group was 18.4 ± 11.7, and the most common reason for air evacuation was injury by improvised explosive device (65%). As part of the initial resuscitation, patients received 4.7 ± 9.0 and 4.00 ± 7.8 units of packed RBCs and fresh frozen plasma, respectively, and 42 patients received factor VIIa. Forty-six patients (9.1%) were given a diagnosis of VTE prior to discharge, 18 (3.6%) during air evacuation, and 28 (5.5%) during the hospital stay. In Cox regression analysis, administration of 1 unit of packed RBCs was associated with a hazard ratio (HR) of 1.04 (95% CI, 1.02-1.07; P = .002), and enoxaparin, 30 mg bid, administered subcutaneously for the majority of hospital days was associated with a HR of 0.31 (95% CI, 0.11-0.86; P = .02) for VTE during the hospitalization. CONCLUSIONS Patients who suffer traumatic injuries in combat overseas are at high risk for VTE during evacuation and recovery. Those with large resuscitations are at particularly high risk, and low-molecular-weight heparin is associated with a decrease in VTE.
Long-term outcome of treatment of dental abscesses with a wound-packing technique in pet rabbits: 13 cases (1998-2007).

OBJECTIVE To evaluate the effectiveness and treatment outcome of a minimal surgical debridement and antimicrobial-impregnated gauze packing technique for treatment of dental abscesses in rabbits. DESIGN Retrospective case series. ANIMALS 13 rabbits with 14 dental abscesses. PROCEDURES Medical records of pet rabbits with dental abscesses were reviewed. Rabbits that underwent a wound-packing treatment protocol with a follow-up period of > 6 months were included. Pretreatment evaluation included physical examination, skull radiography, CBC and plasma biochemical profile, and an endoscopically guided dental examination. The surgical procedure consisted of lancing the abscess, cleaning the cavity, minimal debridement, and packing with strips of synthetic gauze impregnated with a selected antimicrobial. Purulent material from abscesses was submitted for bacterial culture. The procedure was repeated weekly until abscess resolution. Rabbits also received systemic treatment with antimicrobials. RESULTS Rabbit ages ranged from 1 to 5 years. Anaerobic bacteria were cultured from 6 abscesses and aerobic bacteria from 5; no bacteria were cultured from 4 abscesses. Antimicrobials most commonly used in packing procedures were ampicillin and clindamycin; trimethoprim-sulfamethoxazole with metronidazole and azithromycin were given most often for systemic treatment. Thirteen of 14 abscesses resolved, and rabbits were followed for a mean ± SD period of 32.6 ± 24.3 months. Number of packing procedures used to obtain resolution of infection was 4.8 ± 2.2. CONCLUSIONS AND CLINICAL RELEVANCE Minimal surgical debridement followed by antimicrobial-impregnated gauze packing of the abscess cavity is an effective and practical option for the long-term resolution of dental abscesses in rabbits when combined with systemic treatment with appropriate antimicrobials.
Lower plasma levels of selenium and glutathione in smear-positive tuberculosis patients in Malawi

Objective: The objective of this study was to investigate selenium and glutathione levels in pulmonary tuberculosis patients and controls in Malawi. Methods: The case-control study included 19 patients and 15 apparently healthy controls for whom, levels of selenium and glutathione were measured. Results: The plasma selenium levels were significantly lower in tuberculosis patients compared with the controls (p = 0.02). Conclusion: No significant differences were observed for the plasma glutathione levels (p = 0.39). [Ethiop. J. Health Dev. 2011;25;(3):230-232] Background Both protein-energy malnutrition and deficiencies in micronutrients are associated with a significant impairment of various interactions and functions of the cell-mediated immune system (1). A study in Malawi showed that selenium deficiency occurred in 87 % of tuberculosis (TB) patients (2) while a study in Ethiopia, on antioxidants status in untreated TB patients, showed that the patients were deficient in glutathione (GSH) compared to healthy controls (3). Selenium via selenoproteins and GSH are important endogenous antioxidants that protect against oxidative damage and regulate immune functions (4, 5). The objective of this study was thus to investigate plasma levels of selenium and GSH in pulmonary TB patients and controls in Malawi. Methods
Ovulation Induction, Pregnancy and Delivery in a Patient with Partial Hypopituitarism due to Lymphocystic Hypophysitis: A Case Report

Abstract Lymphocystic hypophysitis is an unusual autoimmune disease that causes partial or total hypopituitarism and often associated with chronic anovulation. We report a case of ovulation induction, uneventful pregnancy and vaginal delivery in one of our patient with lymphocystic hypophysitis. Key words: Lymphocystic hypophysitis, chronic anovulation and ovulation induction.
Interdog household aggression: 38 cases (2006-2007).

OBJECTIVE To analyze factors associated with interdog household aggression and determine treatment outcomes. DESIGN Retrospective case series and survey. Animals-38 pairs of dogs with interdog household aggression. Each pair of dogs was considered 1 case. PROCEDURES Records of dogs with interdog household aggression that were examined during initial or follow-up consultations at a veterinary teaching hospital from December 5, 2006, to December 5, 2007, were analyzed for clinical features. Data regarding outcome, owner compliance, and efficacy of recommended treatments obtained by use of a follow-up survey were evaluated. RESULTS Most cases (30/38 [79%]) of interdog household aggression involved same-sex pairs; 26 of 38 (68%) cases involved 1 female or a pair of females. Instigators and recipients of aggression were clearly identified in 27 of 38 (71%) cases; most instigators were the younger of the pair (20/27 [74%]) or were newer additions to the household (19/27 [70%]). Fight-eliciting triggers included owner attention, food, excitement, and found items. Some dogs had risk factors for behavior problems such as a history of living in multiple households (21/51 [41%]), adoption after 12 weeks of age (20/51 [39%]), or being acquired from a shelter (17/51 [33%]). Effective treatment recommendations included implementing a so-called nothing-in-life-is-free program, giving 1 dog priority access to resources, and administering psychotropic medication. Frequency and severity of fighting were significantly reduced after consultation. Owners reported a 69% overall improvement following treatment. CONCLUSIONS AND CLINICAL RELEVANCE Most treatment strategies were considered effective. Consistency and predictability of social interactions are essential in resolving interdog household aggression.
The effect of a brief motivational intervention on community psychiatric patients' attitudes to their care, motivation to change, compliance and outcome: A case control study

Background: Individuals referred to psychiatric services are often ambivalent about service involvement. Aims: The aim of this study was to assess the impact of a brief motivational intervention during initial consultation with community psychiatric patients. Method: 45 patients referred to a Community Mental Health Team received an initial consultation followed by a feedback letter, both of which drew on the principles of motivational interviewing. These users were compared with matched controls who received a standard psychiatric assessment. The impact of the initial consultation, with or without motivational enhancement, on users' attitudes to their care, motivation to change, compliance and outcome was assessed at one month post-consultation and 3-4 months later. Results: After initial consultation, patients in both groups had similar problem severity ratings. Those patients who had received the intervention were more motivated to change, and had more positive attitudes to their consultation and care. Attitudinal differences tended to persist up to 3-4 months follow-up. Conclusions: A brief motivational intervention has at least short-term effects on motivation, and it improves attitude to care.
Complement metabolism in man: hypercatabolism of the fourth (C4) and third (C3) components in patients with renal allograft rejection and hereditary angioedema (HAE)

Abstract Highly purified and radioiodinated human C4 and (or) C3 were administered to patients with renal allografts in rejection, with hereditary angioedema (HAE), with chronic glomerulonephritis, and to control subjects. The latter group included normal individuals, anephric patients before transplantation, and stable renal allograft recipients. The catabolic rates of these complement proteins were determined by analysis of the disappearance of plasma protein-bound radioactivity (km), and by direct measurement of urinary excretion of radioactivity (ku). The correlation coefficient between these two methods was 0.96. The mean ±2 SD for catabolic rates in the control subjects was 0.9-2.7% plasma pool/hr for C4 and 0.9-2.0% plasma pool/hr for C3. Patients experiencing renal allograft rejection had unstable levels of C4 and C3, and exhibited moderate hypercatabolism of both proteins. One patient with chronic glomerulonephritis had hypercatabolism of C4 and C3 in the presence of stable normal serum levels. In patients with HAE who had extremely low levels of C4, catabolic rates for C4 were markedly elevated (3.7, 5.8, 7.0 and 8.8%/hr). Analysis of plasma curves in HAE revealed a three component disappearance curve instead of the two component curve in control subjects receiving the same preparation. Even though C3 levels were normal, moderate hypercatabolism of C3 was also present in HAE (2.6, 2.8, 2.8, and 3.2% of pool/hr). The marked hypercatabolism of C4 in HAE constitutes the first direct evidence for the in vivo destruction by uninhibited C1 esterase of its natural substrate C4. The moderate hypercatabolism of C3 is consistent with the in vivo formation of C3-convertase.
Long-term consequences of open abdomen management

Background There is little data on the long-term results of the open abdomen technique regarding subsequent bowel obstruction, enterocutaneous fistula and ventral hernia rates. This study represents our follow-up of these complications. Methods A retrospective review of patients undergoing open abdomen management was performed. Patient demographics and development of subsequent ventral hernia, enteric fistula and/or bowel obstruction were evaluated. Results Seventy-three men and 47 women with a mean age of 51 underwent open abdomen management; 85 for inflammatory conditions and 35 for haemorrhagic conditions. Only 27 patients did not achieve definitive fascial closure and were left open for secondary closure or had a biologic mesh bridge; 13 patients had component separation to achieve fascial closure. With a mean follow-up of 21 months, 30 patients (25%) developed a ventral hernia, 13 patients (11%) experienced an enterocutaneous fistula and two patients developed bowel obstruction. Ventral hernias and enterocutaneous fistulae occurred in 78% and 41%, respectively, of patients not definitively closed compared with 10% and 2%, respectively, of patients closed primarily at initial management (p < 0.05). Conclusions There is a high incidence of ventral hernia and enterocutaneous fistula when open abdomen management necessitates leaving the abdomen open or using a biologic mesh bridge. Strategies for primary fascia closure including component separation should be employed.
Decreased cough sensitivity and aspiration in Parkinson disease.

BACKGROUND Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia. METHODS Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 μM capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale. RESULTS Most participants with PD did not have a consistent two-cough response to 200 μM capsaicin. UTC ratings and total number of coughs produced at 200 μM capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC). CONCLUSIONS UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population.
Insulin glargine treatment of a ferret with diabetes mellitus.

CASE DESCRIPTION A 7.5-year-old spayed female ferret was evaluated because of weight loss despite a good appetite. Pancreatic insulinoma had been diagnosed at another animal hospital on the basis of detection of low blood glucose concentration on 1 occasion; however, concurrent determination of blood insulin concentration was not performed. The ferret had been treated SC with methylprednisolone acetate (unknown dosage) every 30 days for 2 years. No follow-up data regarding blood glucose concentration were available. CLINICAL FINDINGS On physical examination, the ferret was thin (weight, 0.619 kg [1.36 lb]) and bruised easily. Serum biochemical analysis revealed hyperglycemia (blood glucose concentration, 855 mg/dL; reference range, 63 to 134 mg/dL). TREATMENT AND OUTCOME Glucocorticoid injections were discontinued, and the ferret was administered prednisolone (1.13 mg/kg [0.51 mg/lb], q 12 h for 14 days, then 0.56 mg/kg [0.25 mg/lb], q 12 h for 7 days) orally. After prednisolone administration was discontinued, hyperglycemia and weight loss persisted. The ferret was administered insulin glargine (0.5 U) SC; blood glucose concentration was monitored every 2 hours for 24 hours, at which time the value had decreased to nearly within reference range. The owner continued insulin glargine administration at that dose every 12 hours; after 77 days of treatment, the ferret's weight was 0.731 kg (1.61 lb), which was considered normal, and blood glucose concentration was within reference range. CLINICAL RELEVANCE Regular SC administration of insulin glargine was successful in the treatment of diabetes mellitus in the ferret of this report and may be effective for other diabetic ferrets.
Long-term neurologic outcome of hemilaminectomy and disk fenestration for treatment of dogs with thoracolumbar intervertebral disk herniation: 831 cases (2000-2007).

OBJECTIVE To determine the proportion of dogs with thoracolumbar intervertebral disk herniation (IVDH) that successfully recovered following hemilaminectomy and fenestration, the time to ambulation (TTA) in affected dogs after surgery, and the frequency of urinary and fecal incontinence in recovered dogs and to document long-term complications. DESIGN Retrospective case series. ANIMALS 831 dogs with thoracolumbar IVDH treated by hemilaminectomy and concomitant disk fenestration by the same surgeon. PROCEDURES For all dogs, neurologic deficits before surgery had been assessed with a modified grading system. Dogs were reexamined after surgery over a period of 3 to 6 months, and follow-up evaluation was performed at > 12 months. The proportion of dogs that neurologically improved after surgery, TTA, and incidence of fecal or urinary incontinence in recovered dogs were compared among dogs with various grades of neurologic dysfunction before surgery. RESULTS Of 831 dogs, 122 had unsuccessful outcomes and 709 had successful outcomes. Of 620 dogs with intact deep nociception before surgery, 606 (97.7%) were ambulatory after surgery. Despite maintaining the ability to walk, 7 dogs were judged to have an unsuccessful outcome because the severity of ataxia did not improve. Of 211 paraplegic dogs with loss of deep nociception, 110 (52.1%) dogs became ambulatory after surgery. Long-term complications included incontinence, permanent neurologic deterioration, and self-mutilation. Dogs with paraplegia before surgery had a higher frequency of urinary or fecal incontinence, compared with dogs that were ambulatory. CONCLUSIONS AND CLINICAL RELEVANCE Prognosis for dogs with thoracolumbar IVDH that retain deep nociception in at least 1 of the pelvic limbs or tail before surgery was good.
Relapsing encephalopathy in a patient with α-methylacyl-CoA racemase deficiency

α-Methylacyl-CoA racemase (AMACR) deficiency is a rare disorder of fatty acid metabolism which has recently been described in three adult cases. We have identified a further patient with clinical features of a relapsing encephalopathy, seizures and cognitive decline over a 40 year period. Biochemical studies revealed grossly elevated plasma pristanic acid levels, and a deficiency of AMACR in skin fibroblasts. Sequence analysis of AMACR cDNA identified a homozygous point mutation (c154T>C). This case adds to the phenotypic variation seen in this peroxisomal disorder and highlights the importance of screening for plasma pristanic acid levels in patients with unexplained relapsing encephalopathies.