Miracle-dz/UniFAR-FTUs huggingface dataset:
Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120–140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials

Aims Current guidelines of hypertensive management recommend upper limits for systolic (SBP) and diastolic blood pressure (DBP). J-curve associations of BP with risk exist for some outcomes suggesting that lower limits of DBP goals may also apply. We examined the association between mean attained DBP and cardiovascular (CV) outcomes in patients who achieved an on-treatment SBP in the range of 120 to <140 mmHg in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND) trials on patients with high CV risk. This SBP range was associated with the lowest CV risk. Methods We analysed the outcome data from patients age 55 years or older with CV disease from the ONTARGET and TRANSCEND trials that randomized high-risk patients to ramipril, telmisartan, and the combination. In patients with controlled SBP (on-treatment 120 to <140 mmHg), the composite outcome of CV death, myocardial infarction, stroke and hospital admission for heart failure, the components thereof, and all-cause mortality were analysed according to mean on-treatment DBP as categorical (<70, 70 to <80, 80 to <90, and ≥90 mmHg) and continuous variable as well as the change of DBP according to baseline DBP. Pulse pressure (PP) was related to outcomes as a continuous variable. Results In 16 099 of 31 546 patients, mean achieved SBP was 120 to <140 mmHg. The nominally lowest risk for all outcomes was observed at an achieved DBP of 70 to <80 mmHg. A higher achieved DBP was associated with a higher risk for the outcomes of stroke and of hospitalization for heart failure (≥80 mmHg) and myocardial infarction (≥90 mmHg). A lower achieved DBP (<70 mmHg) was associated with a higher risk for the primary outcome [hazard ratio (HR) 1.29, 95% confidence interval (95% CI) 1.15-1.45; P < 0.0001], myocardial infarction HR 1.54 (95% CI 1.26-1.88, P < 0.0001) and hospitalization for heart failure HR 1.81 (95% CI 1.47-2.24, P < 0.0001) and all-cause death (HR 1.19, 95% CI 1.04-1.35; P < 0.0001) while there was no signal for stroke and CV death compared to DBP 70 to <80 mmHg. A decrease of DBP was associated with lower risk when baseline DBP was >80 mmHg. The associations to outcomes were similar when patients were divided to SBP 120 to <130 mmHg or 130 to <140 mmHg for DBP or PP. Conclusion Compared to a DBP of 70 to <80 mmHg, lower and higher DBP was associated with a higher risk in patients achieving a SBP of 120 to <140 mmHg. Associations of DBP and PP to risk were similar notably at controlled SBP. These data suggest at optimal achieved SBP, risk is still defined by low or high DBP. These findings support guidelines which take DBP at optimal SBP control into consideration.
Maffucci syndrome with the spindle cell hemangiomas in the mucosa of the lower lip: a rare case report and literature review

The presence of non‐cutaneous vascular lesions in the syndrome of multiple enchondromas and subcutaneous hemangiomas, also named Maffucci syndrome, is exceedingly rare. Until now, non‐cutaneous vascular lesions have been described in nine patients, while only three cases were present in the oral cavity; they were found in the tongue in two patients and in the lower lip in one patient. Herein, we report the second case of vascular lesions localized in the mucosa of lower lip in a patient with Maffucci syndrome. Histopathologic examination showed spindle cell hemangioma.
Amodiaquine-induced dystonic reactions: Case reports and implications for policy change in Ghana

Ten cases of amodiaquine-induced dystonic reactions observed in a single ward in Ghana's Premier Teaching Hos- pital, over a period of 4 years are presented. All the reactions resolved without sequalae on treatment with diazepam and ben- ztropine. The importance of increased safety monitoring of amodiaquine as it is (in combination with artesunate) introduced as first line treatment for uncomplicated malaria in Ghana is highlighted.
Frequency of human hemochromatosis (HFE) gene mutations in Egyptians with β-thalassemia

Background Hereditary hemochromatosis is a disorder of iron metabolism characterized by increased iron intake and progressive storage and is related to mutations in the HFE gene. Two point mutations have been described and are referred to as H63D and C282Y. On the other hand, iron overload is a well-documented complication in thalassemia syndromes. Interactions between thalassemia and hemochromatosis may further increase iron overload. This work aimed at studying the frequency of the H63D and C282Y mutations of the HFE gene in an Egyptian population with β-thalassemia (thalassemia major, intermedia, and minor) by comparing it with normal individuals without hemoglobinopathies. Participants and methods This study included 86 patients with β-thalassemia; 40 of these patients had β-thalassemia major and intermedia and the other 46 patients had β-thalassemia minor (carriers). In addition, 70 individuals were included in the study and served as controls. All the populations studied were screened for H63D and C282Y mutations of the HFE gene using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. Results The allelic frequencies found for H63D and C282Y mutations in this study were 18.6 and 0%, respectively, among the total alleles of individuals with β-thalassemia and 12.8 and 1.4% among controls without hemoglobinopathies. On comparing thalassemia cases, thalassemia carriers, and the control group, the allele frequency of the H63D mutation was significantly higher among β-thalassemia carriers (24%) compared with patients with β-thalassemia (12.5%) and controls (12.8%) ( P =0.049). Our study also found an almost significantly higher frequency of the heterozygote genotype for the H63D mutation in patients with β-thalassemia (30.2%) than the controls (17.1%) (Fisher’s test, P =0.06). Compound heterozygosis for H63D and C282Y was found in one of the individuals in our control group. Conclusion The frequent occurrence of β-thalassemia disease with the H63D gene mutation raises the possibility of genetic interactions and emphasizes the value of screening for HFE mutations in thalassemias to detect early cases of iron overload and to modify its treatment modalities.
Inhibition of dipeptidyl peptidase IV activity as a therapy of Type 2 diabetes

Dipeptidyl peptidase IV (DPP IV) is a ubiquitous, multifunctional, serine protease enzyme and receptor with roles in the control of endocrine and immune function, cell metabolism, growth and adhesion. As an enzyme, DPP IV cleaves the N-terminal dipeptide from the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide. This inactivates the hormones, thereby cancelling their prandial insulinotropic effect. One approach to restore incretin activity as a therapy for Type 2 diabetes has been the development of DPP IV inhibitors. Inhibitors of DPP IV have shown efficacy and tolerability when used to control the hyperglycaemia of noninsulin-dependent animal models and human Type 2 diabetes. These DPP IV inhibitors prolong active incretin hormone concentrations and may exert additional antidiabetic effects. If long-term clinical trials confirm sustained and safe control of blood glucose, DPP IV inhibitors (known as ‘gliptins’) may be expected to provide a new treatment modality for Type 2 diabetes.
Measuring patient satisfaction with anaesthesia care in Enugu: a preliminary study.

Aim To measure patients’ satisfaction with anaesthesia care and use it as a tool to provide a feedback on the quality of practice of anesthesia in our centre. To examine the validity of this tool as a means of evaluating anaesthetic care. Study design This is a prospective questionnaire based study. They were standardised postoperative face to-face interviews with open-and close-ended questions. Patients were chosen by simple random sampling. The questionnaires were administered on the second postoperative day. The questionnaire was subdivided into a set of questions. Anaesthesia specific rating of preoperative visit, preparation, and anaesthetic administered were assessed on a 3-point scale. A 5-point scale was used to assess the overall rating of anaesthetic care. Results A total of 43 patients were interviewed. They were 17 males and 26 females. Anaesthesia specific rating showed that 90.1% of patients were satisfied with the preoperative visit, 95.3% with preparation, and 74.4% with anaesthesia. Study design was rated 40/60 using Patient Satisfaction with Anesthesia Care–Analysis Tool (PSACAT). Conclusion We conclude that the anaesthetic service offered in our centre is reasonably tolerated and acceptable to patients. Key words: Patient satisfaction, Anaesthesia, Enugu
Fourth universal definition of myocardial infarction (2018).

Kristian Thygesen∗ (Denmark) Joseph S. Alpert∗ (USA) Allan S. Jaffe (USA) Bernard R. Chaitman (USA) Jeroen J. Bax (The Netherlands) David A. Morrow (USA) Harvey D. White∗ (New Zealand) Hans Mickley (Denmark) Filippo Crea (Italy) Frans Van de Werf (Belgium) Chiara Bucciarelli-Ducci (
Increased 36 week survival with high oxygen saturation target in extremely preterm infants

Background Five trials in infants <28 weeks' gestation are investigating outcomes after randomisation to SpO2 targets of 85–89% vs 91–95%. In the SUPPORT trial, the high target increased severe ROP (p<0.001) and survival to discharge (Relative Risk (RR) 1.27, 95% CI 1.01 to 1.60, p=0.04). The DMCs of the UK, Australian and New Zealand BOOST II trials found no reason to stop recruiting. These trials used similar oximeters except that by early 2009, a revised calibration algorithm was installed that improved SpO2 targeting. Objective In December 2010, the UK and ANZ DMCs performed an interim safety analysis of survival to 36 weeks gestation in 2315 infants in the UK and ANZ trials and the 1316 infants in SUPPORT. Design/methods Guidelines specified that investigators be unblinded if a difference between groups in survival exceeded three standard errors (99.73% CI, equivalent to p<0.0027) for all infants or for those recruited after revising the oximeter calibration. Results The high SpO2 target was associated with higher survival in all 3631 infants (RR 1.21 (99.73% CI, 0.96 to 1.52, p=0.015), test for interaction for RRs for new vs old algorithm: p=0.006) and in the 1055 UK and ANZ infants enrolled after revising the oximeters (RR 1.65 (99.73% CI 1.09 to 2.49, p=0.0003, risk difference 8.6%)). The UK and Australian trials closed recruitment. Conclusions Survival to 36 weeks gestation is higher when SpO2 is targeted at 91–95%. Until the five trials report disability-free survival to 2 years, we consider it prudent not to target SpO2 85–89%.
Acute cutaneous graft‐vs.‐host disease compared to drug hypersensitivity reaction with vacuolar interface changes: a blinded study of microscopic and immunohistochemical features

Complications from graft‐vs.‐host disease (GVHD), a major contributor to morbidity and mortality following hematopoietic cell transplantation, may be mitigated by early diagnosis and intervention. However, differentiation between acute cutaneous GVHD and other common skin eruptions that develop in the post‐transplantation period, such as drug hypersensitivity reaction, can be challenging clinically and microscopically. Because recent evidence indicates that CD123, a marker of plasmacytoid dendritic cells, can help to distinguish gastrointestinal GVHD from the clinicopathologic mimic cytomegalovirus colitis, we aimed to determine whether CD123 could aid in the diagnosis of acute cutaneous GVHD.
Bone Substitute Materials in Implant Dentistry

Although bone autografts have been routinely used as “gold standard” for reconstruction/ replacement bone defects, because they have osteogenic, osteoinductive, osteoconductive properties, they have a high number of viable cells and are rich in growth factors. However, the use of autograft is limited by several factors, being one of them the insufficient amount of donor tissue. Therefore, bone substitute materials have been extensively studied in order to develop an ideal material for substitution of bone grafts, due to some disadvantages presented by autografts, allografts and xenografts, such as poor bone quality, an inadequate amount of bone and possible immunogenicity for allografts and xenografts, which limit the use of these grafts in specific surgical protocols. These disadvantages have led tissue engineering and biotechnology to develop new materials and promising methods for tissue repair, especially for bone tissue. Thus, bone substitutes, synthetic and/or biotechnologically processed have become potential materials for clinical applications in different areas of health.
Heterosexuals importing HIV from Africa [letter]

Heterosexual transmission is an important route of human immunodeficiency virus (HIV) infection in Africa. The sex distribution of AIDS in Africa is nearly 1:1 in contrast to the 19:1 male-to-female ratio in Europe and the US. In 1986 of 212 Danes returning from Africa 7 heterosexual males (average age 28) were seropositive by ELISA and confirmed by western blotting. All 7 had had vaginal intercourse at least once with local Africans during the 1st year of their stay which varied from 1-6 years. None of the 7 had had homosexual or heterosexual anal intercourse in Africa or Europe. All the seropositive men had been working in rural areas and none was in an AIDS-risk group. None had received blood or blood products but 2 patients (seen in table) had received intramuscular injections in Africa. Patient 2 had an African wife and 1 year old child who were seropositive upon arrival in Denmark. No signs of HIV-related disease were found at the time of investigation although some of those affected could have been infected up to 5 years earlier. These probably sexually active men can be considered an imported reservoir of HIV. In Africa the rates of heterosexual transmission of HIV seem high enough to sustain an epidemic; this may or may not prove the same in Europe. Findings strongly suggest support for providing HIV antibody screening to people returning from regions where AIDS is endemic. (authors modified)
Family caregivers of the elderly: quality of life and coping in Estonia

The purpose of the study was to analyse the assessments of elderly people aged 65 and more about family caregiving as a factor influencing their quality of life and coping. The study is based on the project SUFACARE—‘Supporting family carers and care receivers in Estonia and in Finland’—in the framework of which the Institute of Social Work of Tallinn University carried out postal surveys in 2010. The Estonian survey was conducted in Tallinn and Lääne-Viru County. The total number of respondents was 581 (70% female and 30% male), of whom 98 (n=74 female and n=24 male) were family caregivers. Caregiving has not influenced the physical and mental health of caregivers, the reason being that many people who receive care are not of very ill health or suffer from dementia. People mostly take care of their spouses. Based on the Estonian Family Law Act (RT I 2009, 60, 395), adult descendants are required to provide maintenance if their relatives are not able to care for themselves. Caregivers whose health is below average consider caring to be physically demanding. We cannot speak of the social isolation of respondents who have care duties—they communicate actively and do not feel lonely. Women report caregiving to be physically strenuous more often than men. The mental health of male caregivers is better—fewer male respondents claimed to feel unhappy or depressed compared to female respondents.
Toxoplasma gondii Antibodies in Type 1 Diabetes Mellitus

Toxoplasmosis represents an important public health problem and is of great clinical importance in man in two major situations: as a cause of congenital infection and as an opportunistic infection of high mortality in immunosuppressed individuals.3,4 Individuals with normal immunity and acute acquired Toxoplasma infection usually have a self-limited clinical course and rarely require specific treatment.5 After the acute infection period, T. gondii remains viable in the form of tissue cysts, which reproduce slowly throughout the life of the host, thus characterizing the chronic in-
Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report

Psoriatic arthritis (PsA) is among the most disabling forms of arthritis, even though it affects fewer people than other types of arthritis. PsA has a highly variable presentation, which generally involves pain and inflammation in joints and progressive joint involvement and damage. The condition is associated with the skin disease psoriasis, but not all people with psoriasis will develop PsA. Additionally, PsA may predate the development of skin disease, leading to some diagnostic uncertainty. Among people with psoriasis, the prevalence of arthritis varies from 6 percent to 42 percent. In the general population, the prevalence of PsA is estimated to be 0.3 percent to 1 percent. Based on estimates from the 2000 U.S. Census, 520,000 people ages 18 or older in the United States have PsA.
Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation

To study the transrectal ultrasonographic findings in benign and malignant prostatic lesions with respect to its site, echopattern, capsular status, local invasion and their histopathological correlation. Material and Method: A total of 100 patients with clinical suspicion of prostatic disease were examined by transrectal ultrasonography (TRUS) followed by their histopathological correlation to study the sensitivity and specificity of transrectal ultrasonography for diagnosis of carcinoma prostate. Result and conclusion: The sensitivity and specificity of TRUS for diagnosis of carcinoma prostate was found to be 86.96 percent and 71.43 percent respectively. The relative low specificity reflects the difficulty of interpretation of lesion and overlapping echogenic pattern. The percentage of false negative was 13.04 percent and the percentage of false positive was 28.57 percent.
Insights into keratoconus from a genetic perspective

Keratoconus is a progressive and non‐inflammatory thinning of the cornea, which may result in severe visual impairment due to irregular curvature and scarring. It can occur in isolation but is often seen in association with other systemic or ocular disorders. There is a well‐recognised genetic component to keratoconus, as evidenced by family and twin studies; however, the aetiology of the disease is complex with both genetic and environmental factors playing a role. Over the last decade significant progress has been made in identifying genetic risk factors for keratoconus. Multiple approaches have been taken including candidate gene studies and genome‐wide studies. VSX1 remains as the best characterised keratoconus gene but only accounts for rare cases. Other candidate genes with a role to play include SOD1, other corneal dystrophy genes such as ZEB1 and TGFBI and collagen genes. Family‐based studies have recently led to the identification of the MIR184 gene for keratoconus with cataract and to the DOCK9 gene in a family with isolated keratoconus. Numerous other linkages have been reported and new sequencing technologies are set to rapidly expand the number of identified keratoconus genes in these regions. Similarly, recent genome‐wide association studies in case‐controlled cohorts have identified common variations in and around HGF, RAB3GAP1 and LOX as candidate risk factors for keratoconus. These gene identifications are beginning to reveal the molecular aetiology of keratoconus but despite this recent progress, there remain numerous genetic risk factors to be identified for this relatively common yet complex disease.
Cardiac Raynaud's phenomenon induced by cold provocation as a predictor of long‐term left ventricular dysfunction and remodelling in systemic sclerosis: 7‐year follow‐up study

The clinical importance of cold‐induced reversible myocardial ischaemia, known as cardiac Raynaud's phenomenon (C‐Raynaud), has not been established in systemic sclerosis (SSc). This prospective study investigated the impact of C‐Raynaud on long‐term irreversible left ventricular (LV) functional and morphologic deterioration in SSc.
Myopic anisometropia: ocular characteristics and aetiological considerations

Anisometropia represents a unique example of ocular development, where the two eyes of an individual, with an identical genetic background and seemingly subject to identical environmental influences, can grow asymmetrically to produce significantly different refractive errors. This review provides an overview of the research examining myopic anisometropia, the ocular characteristics underlying the condition and the potential aetiological factors involved. Various mechanical factors are discussed, including corneal structure, intraocular pressure and forces generated during near work that may contribute to development of anisomyopia. Potential visually guided mechanisms of unequal ocular growth are also explored, including the influence of astigmatism, accommodation, higher‐order aberrations and the choroidal response to altered visual experience. The association between binocular vision, ocular dominance and asymmetric refraction is also considered, along with a review of the genetic contribution to the aetiology of myopic anisometropia. Despite a significant amount of research into the biomechanical, structural and optical characteristics of anisometropic eyes, there is still no unifying theory, which adequately explains how two eyes within the same visual system grow to different endpoints.
Intervening to Improve Psychological Outcomes after Cancer: What Is Known and Where Next?

Cancer is a leading cause of burden of disease in Australia. The diagnosis of cancer is a major life stress with heightened psychological distress common and unmet psychological supportive care needs highly prevalent. There is a clinical imperative to provide accessible evidence‐based psychosocial therapies to patients and their families in order to reduce distress and optimise psychological outcomes. A range of theoretical approaches have been proposed to guide psychological interventions in the context of cancer, including theories of stress and coping and social cognitive theories of adjustment. In addition, there is a well‐established body of evidence demonstrating that psychosocial interventions improve psychological outcomes after cancer, and clinical practice guidelines for intervention to reduce distress in people affected by cancer have been developed based on this evidence. However, despite relevant theoretical models, empirical evidence, and the availability of guidelines, evidence‐based psychosocial care for cancer patients is the exception rather than the norm. The answer to this problem may lie in research translation. A model for research translation is overviewed in this article with barriers to research translation discussed and a case study presented. Finally, recommendations for how health psychology can contribute to psycho‐oncology research and practice are proposed.