Miracle-dz/UniFAR-FTUs huggingface dataset:
Treatment Outcomes in AIDS-Related Diffuse Large B-cell Lymphoma in the Setting Roll Out of Combination Antiretroviral Therapy in South Africa

Background:Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown. Methods:We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated. Results:Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/&mgr;L), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87). Conclusions:Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.
Characterization of the Streptococcus sobrinus acid-stress response by interspecies microarrays and proteomics.

Streptococcus mutans and Streptococcus sobrinus are considered the primary organisms responsible for human dental caries. The ability to generate acids and to adapt to low pH conditions is directly associated with the cariogenic potential of these bacteria. To survive acidic conditions, both species have been shown to mount an acid-tolerance response (ATR). However, previous characterization of the S. sobrinus ATR identified critical differences in the mechanisms of acid adaptation between S. mutans and S. sobrinus. Here, interspecies microarray and proteomic approaches were used to identify novel, previously unrecognized genes and pathways that participate in the S. sobrinus acid-stress response. The results revealed that, among other things, metabolic alterations that enhance energy generation and upregulation of the malolactic fermentation enzyme activity constitute important acid-resistance properties in S. sobrinus. Some of these acid adaptive traits are shared by S. mutans and might be considered optimal targets for therapeutic treatments designed to control dental caries.
Magnetic Resonance Imaging Volumetry for Noninvasive Measures of Phenotypic Flexibility during Digestion in Burmese Pythons

Pythons are renowned for the profound phenotypical flexibility of their visceral organs in response to ingestion of large meals following prolonged fasting. Traditionally, the phenotypic changes are studied by determining organ mass of snakes killed at different times during digestion. Here we evaluate the use of magnetic resonance imaging (MRI) for in vivo measurements of the visceral organs in fasting and digesting snakes. Twelve snakes were MRI scanned immediately before the organs were removed and weighed to provide direct comparison of the two methods. Both methods provided similar estimates for the mass of liver, gallbladder, and pancreas, whereas MRI overestimated the size of the heart and small intestine, probably because blood and digesta contributed to the volume determined by MRI. The correlations were used to derive wet organ mass from MRI-based volumes to evaluate the mass development through repeated MRI scans of five digesting snakes. MRI was performed at fasting and 24, 48, 72, 132, and 500 h after eating a meal corresponding to 25% of body mass. This observation period revealed a reversible volume upregulation of the visceral organs, supporting the view that successive MRI facilitates in vivo investigations of structural changes accompanied by digestion.
Intimate Partner Violence and Condom and Diaphragm Nonadherence Among Women in an HIV Prevention Trial in Southern Africa

Background:We longitudinally examined the effect of intimate partner violence (IPV) on condom and diaphragm nonadherence among women in the Methods for Improving Reproductive Health in Africa study, a phase III HIV prevention trial in southern Africa. Methods:Recent IPV (fear of violence, emotional abuse, physical violence, or forced sex, in past 3 months), condom nonadherence, and diaphragm nonadherence were assessed at baseline, 12 month, and exit visits (up to 24 months). The association between IPV and (1) condom nonadherence or (2) diaphragm nonadherence across visits was modeled using Generalized Estimating Equations adjusting for potential confounders. Results:Of 4505 participants, 55% reported recent IPV during their trial participation. Women reported fearing violence (41%), emotional abuse (38%), being physically assaulted (16%), and forced sex (15%) by their regular male partner. IPV was associated with condom nonadherence in both study arms [adjusted odds ratio (AOR): 1.41, 95% confidence interval (CI): 1.24 to 1.61 (control arm) and AOR: 1.47, 95% CI: 1.28 to 1.69, (intervention arm)] and with diaphragm nonadherence (AOR 1.24, 95% CI: 1.06 to 1.45) adjusting for age, study sites, number of sex partners, and knowledge of male partner infidelity. Modeling effects of each form of IPV separately on nonadherence outcomes yielded similar results. Conclusions:Prevalence of recent IPV was high and associated with condom and diaphragm nonadherence during the trial. Counseling in prevention trials should proactively address IPV, for its own sake, and in product and risk-reduction counseling. Strategies to encourage men's positive involvement in product use and prevent IPV perpetration should be considered.
Social Network Characteristics and HIV Risk Among African American, Asian/Pacific Islander, and Latino Men Who Have Sex With Men

Objectives:To examine how social networks influence HIV risk among US racial/ethnic minority men who have sex with men (MSM) and whether the associations of social network characteristics with risk vary by race/ethnicity. Methods:A chain-referral sample of 403 African American, 393 Asian/Pacific Islander, and 400 Latino MSM recruited in Los Angeles County, California, completed a questionnaire, which asked about their egocentric social networks, safer sex peer norms, and male anal intercourse partners. HIV-nonconcordant partnerships were those reported by respondents as serodisconcordant or where self and/or partner serostatus was unknown. Results:Overall, 26% of the sample reported HIV-nonconcordant unprotected anal intercourse (UAI) with a nonprimary male partner in the previous 6 months. In a generalized estimating equation (GEE) logistic model that controlled for race/ethnicity, age, nativity, incarceration history, and HIV status, being in a more dense network was associated with less HIV-nonconcordant UAI [adjusted odds ratio (AOR) = 0.92, 95% confidence interval (CI): 0.86 to 0.99, P = 0.0467]. In addition, the effect of safer sex peer norms on HIV-nonconcordant UAI was moderated by ego-alter closeness (P = 0.0021). Safer sex peer norms were protective among those reporting “medium” or “high” ego-alter closeness (AOR = 0.70, 95% CI: 0.52 to 0.95, P = 0.0213 and AOR = 0.48, 95% CI: 0.35 to 0.66, P < 0.0001, respectively), but not among those reporting “low” ego-alter closeness (AOR = 0.96, 95% CI: 0.63 to 1.46, P = 0.8333). The effects of density, closeness, and norms on HIV-nonconcordant UAI did not differ by race/ethnicity. Conclusions:The significant association of social network characteristics with UAI point to network-level factors as important loci for both ongoing research and HIV prevention interventions among US MSM of color.
Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills

Abstrast Background. Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems. Objective. To identify the most common performance deficiencies in paramedics' management of three simulated pediatric emergencies. Methods. Paramedics from five EMS agencies in Michigan were eligible subjects for this prospective, observational study. Three clinical assessment modules (CAMs) were designed and validated using pediatric simulators with varying technologic complexity. Scenarios included an infant cardiopulmonary arrest, sepsis/seizure, and child asthma/respiratory arrest. Each scenario required paramedics to perform an assessment and provide appropriate pediatric patient care within a 12-minute time limit. Trained instructors conducted the simulations by following strict guidelines for sequences of events and responses. Videos of CAMs were reviewed by an independent evaluator to verify scoring accuracy. Percentage of steps completed for each of the three scenarios and specific performance deficiencies were recorded. Results. Two hundred twelve paramedics completed the CAMs. The average percentages of steps completed were as follows: arrest CAM, 45.3%; asthma CAM, 51.6%; and sepsis CAM, 47.1%. Performance deficiencies included lack of airway support or protection; lack of support of ventilations or cardiac function; inappropriate use of length-based treatment tapes; and inaccurate calculation and administration of medications and fluids. Conclusion. Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.
Fusobacterium nucleatum GroEL induces risk factors of atherosclerosis in human microvascular endothelial cells and ApoE(-/-) mice.

Infection and inflammation are risk factors in the initiation and progression of atherosclerosis. Periodontitis is one of the most prevalent chronic inflammations of the oral cavity, and has been reported to be associated with systemic disease. In this study, we evaluated whether the heat-shock protein GroEL of Fusobacterium nucleatum, one of the most prevalent bacteria in periodontitis, induces factors that predispose to atherosclerosis in human microvascular endothelial cells (HMEC-1) and apolipoprotein E-deficient (ApoE(-/-)) mice. GroEL induced the expression of chemokines such as monocyte chemoattractant protein-1 and interleukin-8 as well as cell adhesion molecules, such as intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and E-selectin. GroEL induced the activity of tissue factor and reduced the activity of the tissue factor pathway inhibitor. Foam cell formation was induced by GroEL. GroEL-injected ApoE(-/-) mice showed significant atherosclerotic lesion progression compared with control mice. Serum levels of risk factors for atherosclerosis such as interleukin-6, C-reactive protein, and low-density lipoprotein were increased in GroEL-injected ApoE(-/-) mice compared with control mice, whereas serum levels of high-density lipoprotein were decreased. We could detect significantly higher levels of anti-F. nucleatum GroEL antibody in serum and F. nucleatum DNA in gingival crevicular fluid from patients with periodontitis than in that from healthy subjects. Our results indicate that the host response to the GroEL of periodontal pathogens like F. nucleatum may be a mechanism involved in atherosclerosis, supporting the association of periodontitis and systemic infection.
Hypertriglyceridaemia in statin‐treated type 2 diabetic patients

In this cross-sectional study, we investigated the prevalence of hypertriglyceridaemia (hyperTG) in 182 statin-treated type 2 diabetic (T2DM) patients. Predictors of hyperTG (≥2.3mmol/L) were investigated using logistic regression. The prevalence of hyperTG was 20.9%, with lower prevalence in patients with low-density lipoprotein (LDL)-cholesterol <2.5mmol/L (13.7%), and LDL-cholesterol <2.0mmol/L (8.8%). The prevalence of hyperTG plus low high-density lipoprotein (HDL)-cholesterol (≤0.9mmol/L) was lower at 6.0%. The independent predictors of hyperTG were waist circumference (odds ratio [OR] 1.033 [95% confidence interval 1.004–1.063], p=0.027) and glucose (OR 1.30 [1.05–1.61], p=0.01), with glucose being the sole predictor in patients with LDL-cholesterol <2.5mmol/L (OR 1.45 [1.11–1.89], p=0.01) and LDL-cholesterol <2.0mmol/L (OR 1.59 [1.12–2.26], p=0.01). In this group of statin-treated T2DM patients, the prevalence of hyperTG was relatively high, but lower in patients with lower LDL-cholesterol levels. Residual hyperTG in statintreated patients could be addressed by therapeutic lifestyle interventions aimed at weight loss and improved glycaemic control and by further lowering of LDL-cholesterol. Copyright © 2011 John Wiley & Sons. Practical Diabetes 2011; 28(6): 257–260
A Randomized Control Study to Determine the Effects of Unlimited Oral Intake of Water in Patients with Identified Aspiration

No statistical differences were found in the moderator variables of age, gender, eth nicity, stroke location, amount of initial aspiration, or presence/absence of a cough reflex. Using a t-test for independent means, a significant difference (p = 0.03) oc curred between groups on average intake of thickened liquids. Conclusion : Until further larger scale research utilizing water intake with known aspirators is conducted, it is recommended that water (and ice chips) be given presently only in instances of patient refusal to drink thickened liquids or when hydration is sues cause medical concern.
USE OF PLEURAL FLUID C-REACTIVE PROTEIN LEVEL AS A DIAGNOSTIC MARKER FOR PLEURAL EFFUSIONS

Background: Our objective was to determine the usefulness of pleural effusion C reactive protein levels in the di- agnosis of pleural effusions. Patients and Methods: A comparison of serum and pleural fluid C-reactive protein (CRP) levels in different subgroups of 286 patients with pleural effusion was made. We assessed prospectively the sensitivity, specificity, positive and negative predictive values, accuracy, Youden index, likelihood ratio and ROC curve of the test, for a period from February 2008 to November 2011. Results: Among 286 patients with pleural effusion, 67 patients were included in the transudate group, 219 patients were included in the exudate group. In transudates the cut-off value of pleural fluid CRP ≤15 mg/L had a Youden index of 0.678 and the area under curve = 0.86 comparing with exudative pleural effusions. In malignant pleural effusions, the cut-off value of pleural fluid CRP ≤20mg/L had a Youden index of 0.728 and the area under curve = 0.89 comparing with tuberculous effusions. In tuberculous effusions, the cut-off value of pleural fluid CRP >20mg/L had a Youden index of 0.45 and the area under curve=0.96 comparing with malignant effusions. The values of pleural fluid/blood CRP ratios had a very small Youden index and the area under curve in all subgroups of patients with pleural effusion. Conclusions: Levels of CRP in exudative pleural effusions less than 20 mg/L are strongly suggestive of malignant effusion and chronic tuber - culous effusion.A CRP pleural fluid level > 20mg/L almost excludes transudative pleural effusion while the levels of CRP above 30mg/L are suggestive of an inflammatory etiology and almost exclude malignant pleural effusion.
Noonan Syndrome: Auxological and Endocrinological Investigation

We have analyzed the auxological and endocrinological data of nine Japanese patients (5 male, 4 female) with Noonan syndrome, and have started growth hormone (GH) therapy in four patients. Eight children were short (height SD score -2.70 to -4.88). The growth curve for height of nine patients with this syndrome followed below normal or along -2.0SD curve, and three males who attained adulthood had a tendency to delayed puberty.The GH response to standard provocation tests done in seven patients was almost normal with normal levels of urine GH excretion, but four of seven showed low levels of plasma insulin-like growth factor-I (IGF-I). Mean concentrations of serum GH during the first three hours of sleep were normal in three patients and low in one. The discrepancy of GH and IGF-I may suggest some dysfunction of GH and IGF-I axis.We treated four patients with GH in doses of 0.5 iu per kg weight per week. Three of them showed increased height velocity, and two of these showed increased height velocity SD. One male, who started GH therapy during puberty, showed no improvement of height velocity or height velocity SD. During GH therapy one male had a convulsion, another male had arthrosis of the jaw, and one female had pains in her knee joints. However, their symptoms were all transient.We conclude that GH therapy in Noonan syndrome is effective if started earlier than puberty, without any major side-effects.
The role of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections

Purpose of review Methicillin-resistant Staphylococcus aureus (MRSA) has become a major public health issue worldwide over the last years. MRSA is frequently implicated in the development of skin and soft tissue infections, leading to significant increases in morbidity, mortality and overall healthcare costs. Recent findings In order to face the threat of MRSA, major changes in clinical management of skin and soft tissue infections are required. The identification of populations at risk for the acquisition of infections due to MRSA, together with the improvement of the diagnostic techniques, is paramount. Moreover, a number of new antimicrobials with activity against MRSA have been recently developed and approved for the treatment of skin and soft tissue infections, however, the use of the new drugs in the wide clinical practice remains limited. Summary We reviewed the current epidemiology of MRSA in skin and soft tissue infections, with particular focus on implications for clinical management. The potential role of new antibiotic options against MRSA infections is also discussed.
Interspecific Differences in Hypoxia-Induced Gill Remodeling in Carp

The gills of many fish, but in particular those of crucian carp (Carassius carassius) and goldfish (Carassius auratus), are capable of extensive remodeling in response to changes in oxygen (O2), temperature, and exercise. In this study, we investigated the interspecific variation in hypoxia-induced gill modeling and hypoxia tolerance in 10 closely related groups of cyprinids (nine species, with two strains of Cyprinus carpio). There was significant variation in hypoxia tolerance, measured as the O2 tension (Po2) at which fish lost equilibrium (LOEcrit), among the 10 groups of carp. In normoxia, there was a significant, phylogenetically independent relationship between mass-specific gill surface area and LOEcrit, with the more hypoxia-tolerant carp having smaller gills than their less hypoxia-tolerant relatives. All groups of carp, except the Chinese bream (Megalobrama pellegrini), increased mass-specific gill surface area in response to 48 h of exposure to hypoxia (0.7 kPa) through reductions in the interlamellar cell mass (ILCM) volume. The magnitude of the hypoxia-induced reduction in the ILCM was negatively correlated with LOEcrit (and thus positively correlated with hypoxia tolerance), independent of phylogeny. The hypoxia-induced changes in gill morphology resulted in reduced variation in mass-specific gill surface area among species and eliminated the relationship between LOEcrit and mass-specific gill surface area. While behavioral responses to hypoxia differed among the carp groups, there were no significant relationships between hypoxia tolerance and the Po2 at which aquatic surface respiration (ASR) was initiated or the total number of ASR events observed during progressive hypoxia. Our results are the first to show that the extent of gill remodeling in cyprinids is associated with hypoxia tolerance in a phylogenetically independent fashion.
Sanitation provision in Ethiopia's regional schools — girls’ and women's experiences

Girls in Ethiopia? s rural boarding schools often have to deal with inadequate or no sanitation, and the problems of menstruation, without being able to talk to their teachers, who are mainly men. It is small wonder that they frequently drop out of school early. and women? s learning environment was students there appears to be a quiet
The relationship between social support and the health of HIV-positive caregivers of children: A review of the empirical literature

A wealth of global literature suggests that social support can play an important protective role for the well-being of caregivers of children and the children in their care. In Southern Africa, where the caregiving burden is intensifying and the prevalence of HIV and other physical and mental health disorders is elevated, strengthening social support resources may be the key to more effective carer and child health interventions. This may be especially true for HIV-positive and/or AIDS-ill carers, who face heightened caregiving challenges and health risks. This review aims to consolidate the existing international literature in this area by summarizing methodologies and empirical findings of published and unpublished studies that quantitatively assess the association between one or more measurable dimension of social support and one or more measurable physical or mental health outcome, among HIV-positive and/or AIDS-ill adult caregivers of children. Limitations, strengths and key findings of the 15 identified studies are discussed, as are gaps and implications for future research. Overall, study findings highlight a positive relationship between social support and health, particularly mental health, reinforcing the importance of social support as an integral element of mental health interventions for HIV-positive caregivers of children. The absence of research in Southern Africa, and other parts of the developing world most affected by the HIV/AIDS epidemic, highlights the need for future investigation in these contexts. Recommendations for further research include larger and more representative studies; longitudinal studies; studies with caregivers of non-biological children; and research linking caregiver social support to parenting and child outcomes. Moreover, mixed methodology approaches would be useful to better understand the sources and types of social support most relevant for health outcomes in this specific population, as well as the mechanisms through which this support may be affecting health.