Miracle-dz/UniFAR-FTUs huggingface dataset:
Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population

Hepatitis C virus (HCV) is spontaneously cleared in 15% to 45% of individuals during primary infection. To define the role of alcohol, race, and HBV or HIV coinfections in natural HCV clearance, we examined these parameters in 203 spontaneously HCV‐recovered subjects (HCV Ab+/RNA‐ subjects without prior antiviral therapy) and 293 chronically HCV‐infected patients (HCV Ab+/RNA+). Subjects were identified from 1,454 HCV antibody‐seropositive US veterans tested for HCV RNA between January 2000 and July 2002 at the Philadelphia Veterans Affairs Medical Center. In univariate analysis, alcohol use disorder (odds ratio [OR] 0.52; 95% CI, 0.31‐0.85; P = .006) and black race (OR 0.65; 95% CI, 0.44‐0.96; P = .024) were both associated with decreased likelihood of spontaneous HCV clearance. In multivariate analyses adjusting for race, HIV infection, age, and alcohol use disorder, alcohol remained strongly associated with reduced HCV clearance (OR 0.49; 95% CI, 0.30‐0.81; P = 0.005). In contrast, the association between black race and viral clearance was no longer statistically significant (adjusted OR 0.72; 95% CI, 0.48‐1.09; P = .125). HIV coinfection was negatively associated with HCV clearance (OR 0.37; 95% CI, 0.16‐0.83; P = .016), while HBV coinfection was positively associated with HCV clearance (unadjusted OR 5.0; 95% CI, 1.26‐28.6; P = .008). In conclusion, the likelihood of spontaneous clearance of HCV may be influenced by alcohol and viral coinfections. (Hepatology 2004;40:892‐899).
Glutathione S‐transferase and liver function in intrahepatic cholestasis of pregnancy and pruritus gravidarum

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy‐specific liver disease associated with poor maternal and fetal outcome. The diagnosis is based on pruritus with abnormal liver function in the absence of other pathological conditions. However, pruritus in pregnancy is common, and it may be the only presenting feature in ICP. No reliable test currently exists that can discriminate between those women destined to develop ICP and those with the benign condition of pruritus gravidarum (PG). The purpose of this prospective study was to investigate longitudinally the serum concentration of glutathione S‐transferase alpha (GSTA, a specific marker of hepatocellular integrity) and to compare this with the temporal profile of conventional liver function markers in women with ICP (n = 63), PG (n = 43), and normal pregnant controls (n = 26). Blood was sampled on at least 3 separate occasions between 16 weeks of gestation and 4 weeks postpartum. Serum concentrations of GSTA increased with gestation in ICP, being significantly higher from 24 (±2) weeks compared with controls (400% difference; 95% CI, 240%–734%; P < .001). GSTA was also higher in ICP versus PG (433% difference; 95% CI, 228%‐790%; P < .001) throughout the gestational period studied. Significant differences in the ICP compared with control and PG groups were also found for total bile acids, alanine aminotransferase, aspartate aminotransferase, γ‐glutamyl transpeptidase and alkaline phosphatase. In conclusion, the measurement of GSTA provides a test of liver dysfunction that distinguishes women with ICP from those with PG. Additionally, on the basis of this study, reference ranges for biochemical markers of liver function require reevaluation in pregnancy. (HEPATOLOGY 2004;40:1406–1414.)
The Propensity of Junior Enlisted Personnel to Remain in Today's Military

This study examines the effects of both economic and noneconomic factors on the propensity of junior enlisted (El-E4) personnel to remain in the military, using data from the Armed Forces 1996 Equal Opportunity Survey. Among the findings: (1) years of service, job satisfaction (as a whole), and pride in service are all highly correlated with self-reports of respondents' likelihood of remaining in service; (2) among junior enlisted personnel, African-American men are more inclined to remain in the military than are men and women of other subgroups; and (3) while satisfaction with pay benefits has a significant positive effect on the likelihood that respondents will stay in the military, pride in service is more robust.
Prevalence of delirium in geriatric rehabilitation in Israel and its influence on rehabilitation outcomes in patients with hip fractures

The aim of this study was to assess the prevalence of delirium among geriatric patients with hip fractures and to examine the influence of delirium on rehabilitation outcomes. A prospective study was carried out among 95 hip fracture patients admitted to an orthopedic geriatric rehabilitation ward. At admission, the following data were gathered: sociodemographic data, prefracture Activities of Daily Living (ADL), Functional Independence Measure (FIM), Mini-Mental State Examination, comorbidities, and medication. Delirium was assessed using the Confusion Assessment Method. The severity of delirium among patients with a positive score on the Confusion Assessment Method was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). Rehabilitation outcomes were evaluated by comparing FIM and ADL at admission and at discharge. The research findings showed that the prevalence of delirium among patients was 30%. In addition, a significant difference was found between patients who developed delirium and those who did not. Patients who developed delirium were mostly Jewish, with lower ADL levels at admission, more significant renal failure, lower levels of FIM, and lower Mini-Mental State Examination scores. Furthermore, FIM at discharge and delta FIM were lower among patients who developed delirium than among those who did not. The research conclusions indicated that the functional recovery of patients with delirium is slower. Therefore, it is important to adjust the therapeutic approach to these patients.
Laparoscopic cholecystectomy: Our experience in a rural setup

Background: Laparoscopic cholecystectomy has become the gold standard in symptomatic gallstone disease. Today more than 80% of cholecystectomies worldwide are carried out laparoscopically. The present study describes our experience with laparoscopic cholecystectomy in a rural setup. Aim: To study the results of laparoscopic cholecystectomy in a rural setup. Settings and Design: Prospective study done at R. L. Jallapa Hospital Tamaka Kolar from January 2003 to November 2012. Materials and Methods: A total of 120 patients undergoing laparoscopic cholecystectomy by the same surgeon were included. Results: Out of the 120 patients, 108 (90%) were females and 12 (10%) were males. Their age ranged from 16 to 75 years. Majority were in fourth decade of life. Majority of the patients [70 (58.3%)] had gallstones. The procedure was converted to open cholecystectomy in six patients. Twenty-four patients had minor complications. Majority of the patients stayed in the hospital postoperatively for less than 5 days. Conclusion: Laparoscopic cholecystectomy in our setup proved to be a safe procedure and an effective treatment for gallstone disease.
The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource limited settings to optimize effectiveness and cost effectiveness estimates

Background: In sub-Saharan Africa, rates of sustained HIV virologic suppression remain below international goals. HIV resistance testing, while common in resource-rich settings, has not gained traction due to concerns about cost and sustainability. Objective: We designed a randomized clinical trial to determine the feasibility, effectiveness, and cost-effectiveness of routine HIV resistance testing in sub-Saharan Africa. Approach: We describe challenges common to intervention studies in resource-limited settings, and strategies used to address them, including: (1) optimizing generalizability and cost-effectiveness estimates to promote transition from study results to policy; (2) minimizing bias due to patient attrition; and (3) addressing ethical issues related to enrollment of pregnant women. Methods: The study randomizes people in Uganda and South Africa with virologic failure on first-line therapy to standard of care virologic monitoring or immediate resistance testing. To strengthen external validity, study procedures are conducted within publicly supported laboratory and clinical facilities using local staff. To optimize cost estimates, we collect primary data on quality of life and medical resource utilization. To minimize losses from observation, we collect locally relevant contact information, including Whatsapp account details, for field-based tracking of missing participants. Finally, pregnant women are followed with an adapted protocol which includes an increased visit frequency to minimize risk to them and their fetuses. Conclusions: REVAMP is a pragammatic randomized clinical trial designed to test the effectiveness and cost-effectiveness of HIV resistance testing versus standard of care in sub-Saharan Africa. We anticipate the results will directly inform HIV policy in sub-Saharan Africa to optimize care for HIV-infected patients.
The psychometric properties of the Turkish Stroke and Aphasia Quality Of Life Scale-39

The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing the quality of life in aphasic patients. Our purpose was to translate the SAQOL-39 into the Turkish language (SAQOL-39/TR) and assess its reliability and validity in patients who had aphasia. SAQOL-39/TR was obtained using the ‘translation–backward translation’ method and administered to 40 patients with aphasia. The reliability studies were performed by means of internal consistency and test–retest reliability. The validation studies were carried out by means of construct validity using within-scale analyses and analyses against the external criteria. Correlation analysis was performed between scales and the Ege Aphasia Test, the Barthel index, the 12-item General Health Questionnaire and the Brunnstrom recovery stages (BRS) of the arm, hand, and lower extremity. In the results, the scores of the SAQOL-39 were not different between groups. Cronbach’s &agr; variables were good for all domains (0.80, 0.88, 0.89, 0.82, and 0.83). Test–retest reliability was also high (0.96, 0.97, 0.91, 0.70, and 0.96). There were significant correlations with coefficients ranging from 0.36 to 0.60 among the domains of scale and other measures. Moderate–high correlations were also seen with BRS-arm, BRS-hand, and BRS-lower extremity (r, 0.27–0.58). It was found that all domains were highly related with all domains of Ege aphasia test, except praxia (P<0.001). This study showed that the SAQOL-39/TR has acceptable validity and reliability in assessing the quality of life. However, similar results of the scale in patients with dysarthria suggest that the SAQOL-39 may not be specific to only aphasic patients.
The Effects of Prenatal Exposure of Mice to Cigarette Smoke on Offspring Immune Parameters

While direct exposure to cigarette smoke (CS) was shown in numerous human and animal studies to impair host immune responses, effects on the offspring following in utero CS exposure are relatively unknown. Thus, a toxicological study was performed that extended our previous investigations examining the effects of relatively low-dose CS exposure on immune tumor surveillance parameters of the prenatally exposed offspring. In the current study, pregnant B6C3F1 mice were exposed by inhalation to mainstream CS (at a concentration equivalent to smoking ∼1 pack of cigarettes/d) for 5 d/wk, 4 h/d from gestational day 4 to parturition. Smoke-induced effects on a number of immune parameters were examined in 3- (and/or 5-), 10-, and 20-wk-old male and female offspring, including lymphoid organ weight/cellularity; blood and bronchopulmonary lavage cell numbers/profiles; splenic lymphocyte proliferation; mixed lymphocyte reactions; and, host resistance against transplanted melanoma cells. Exposure in utero to CS significantly increased circulating white blood cell and lymphocyte numbers in both sexes for up to 2.5 mo after birth (compared to their age-/sex-matched, air-exposed counterparts). In addition, 3-wk-old male and female offspring from smoke-exposed mothers had decreased mitogen-stimulated T-lymphocyte proliferation, while 5-wk-old male pups had increased mixed lymphocyte response compared to their sex-matched, air-exposed counterparts. Although effects of prenatal smoke exposure on overall offspring immunity were relatively modest, these findings could suggest that early toxic insult by CS may alter subsequent immune homeostasis in the offspring, leading, possibly, to changes in disease vulnerability.
CD161 expression on hepatitis C virus–specific CD8+ T cells suggests a distinct pathway of T cell differentiation

Hepatitis C virus (HCV) causes chronic infection accompanied by a high risk of liver failure and hepatocellular carcinoma. CD8+ T cell responses are important in the control of viremia. However, the T cell response in chronic infection is weak both in absolute numbers and in the range of epitopes targeted. In order to explore the biology of this response further, we analyzed expression of a panel of natural killer cell markers in HCV compared with other virus‐specific T cell populations as defined by major histocompatibility complex class I tetramers. We found that CD161 was significantly expressed on HCV‐specific cells (median 16.8%) but not on CD8+ T cells specific for human immunodeficiency virus (3.3%), cytomegalovirus (3.4%), or influenza (3.4%). Expression was seen in acute, chronic, and resolved disease and was greatest on intrahepatic HCV‐specific T cells (median 57.6%; P < 0.05). Expression of CD161 was also found on hepatitis B virus–specific CD8+ T cells. In general, CD161+CD8+ T cells were found to be CCR7− “effector memory” T cells that could produce proinflammatory cytokines (interferon‐γ and tumor necrosis factor‐α) but contained scanty amounts of cytolytic molecules (granzyme B and perforin) and proliferated poorly in vitro. Expression of CD161 on CD8+ T cells was tightly linked to that of CXCR6, a chemokine with a major role in liver homing. Conclusion: We propose that expression of CD161 indicates a unique pattern of T cell differentiation that might help elucidate the mechanisms of HCV immunity and pathogenesis. (HEPATOLOGY 2008;47:396–406.)
Tropical Medicine and Parasitology

In its 5th edition, Peters and Pasvol's textbook (or atlas) sustains its reputation as a valuable source of information for a wide variety of persons including parasitologists, microbiologists, pathologists and specialists in infectious disease (ID), tropical medicine, genitourinary medicine and dermatology. It will also be appreciated by under-graduates and those undertaking courses in tropical medicine or ID who require a quick review of a subject. There are maps showing the geographical distribution of major diseases, and the life cycles of parasites are presented in clear form with good illustrations, particularly helpful to the general reader. Accounts of rare parasites and micropathogens are supplemented by details of diagnostic techniques and illustrations of pathological specimens. The introduction to each section provides a useful overview, with a note on advances in control. Content is up-to-date, particularly on HIV infection and viral haemorrhagic fevers. The CT and MRI scans of brain infections are helpful. There are only a few minor errors and one photograph seems to be upside-down. Diphtheria does not seem to be included. There is a rather old-fashioned habit of referring to ‘tropical diseases’ when the condition also occurs in the subtropics and even temperate areas, e.g. tuberculosis. At times, ‘developing’ or ‘low-resource’ might be a better descriptor than ‘tropical’. Today, with the enormous amount of information available, many people tend to skip even the latest edition of a textbook and go straight to an electronic literature search. So, is an atlas of tropical medicine, parasitology and ID still useful? Most authors of textbooks do try to provide the essentials of a subject and also an up-to-date review of the best evidence. The current text keeps up with the subjects that are advancing. Many who teach or practise tropical medicine or parasitology will wish to possess this latest edition, and I would like to see it in medical libraries for students to browse and acquire a taste for this fascinating subject. For those requiring essential information on tropical medicine or ID, first call should be this book before they turn to a larger work or an electronic source.
Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education.
Variant anatomy of coronary arteries

Introduction: Wide variations exist in the size, position, and shape of various body organs, finger prints, and proteins in different individuals. Some variations are of considerable clinical importance, such as the coronary arteries. Variations of coronary arteries can cause important clinical manifestation, including sudden death of the individual. Materials and Methods: Coronary arteries were dissected in 10% formalin-fixed cadaveric hearts. The normal and variant anatomy of coronary arteries was studied. Result: In 100% of cases, the right coronary artery (RCA) and main left coronary artery (LCA) were found to arise from anterior aortic sinus and left posterior aortic sinus, respectively. In 8% of cases, the conus was found to have independent origin from the anterior aortic sinus. The RCA was found to be dominant in 90% of cases. In 66.7% of cases, the length of RCA ranged from 4.5 cm to 7 cm. The average length of LCA was found to be 7 mm. In 10% of cases, the circumflex coronary artery was found to be dominant, where the length of the artery ranged 9-11 cm. In 10% of cases, LCA trifurcated, where the obtuse marginal branch was replaced by the ramus intermedius branch. Also, 43.3% of LAD showed myocardial bridging predominantly in the middle 1/3 rd segment, and 6.7% of cases of RCA showed myocardial looping. Discussion: Coronary arteries show immense variation in their origin, termination, branching pattern, myocardial bridging, looping, and dominance pattern. This knowledge is clinically and surgically important to manage coronary artery diseases.
FcγRIIa polymorphism in Japanese patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an immune complex-mediated disease and organ damage is caused by the deposition of immune complex. Receptors which recognize the Fc portion of immunoglobulin G (FcgR) play a key role in the phagocytosis of immune complexes. As the gene encoding for FcgR of class IIa (FcγRIIa) has two allelic forms, H131 and R131, which differ in their affinity to IgG2, this polymorphism might have implications in handling immune complex. We studied the distribution of the FcγRIIa polymorphism in 90 Japanese patients with SLE. We also examined the association between FcγRIIa polymorphism and the disease activity of SLE and the histopathological findings of lupus nephritis. FcγRIIa polymorphism was determined by PCR and dot blot analysis. The allelic frequency of H131 in patients with SLE was significantly lower (H131/R131 ‘ 0.44/0.56) than that of normal controls (H131/R131 ‘ 0.62/0.38; P < 0.05). No significant association was observed between FcγRIIa polymorphism and the clinical parameters for the activity of SLE. There was no association between FcγRIIa polymorphism and the histological findings in lupus nephritis. The difference in the distribution of FcγRIIa alleles between patients with SLE and normal subjects indicates that this polymorphism is a candidate of susceptibility gene for SLE in Japanese.
How Do Gender, Age and Travel Time Impact on the Need for Social Support of Patients to Have Access to Cancer Treatment?

Purpose: Disparities in cancer treatment for geographical and socioeconomic reasons have been demonstrated in several countries. In Valais, a canton in Switzerland, to travel to one of the oncology wards can be time consuming, cost intensive and make support by relatives or external persons and institutions necessary. Method: We investigated which kind of support cancer patients in Valais need today to make a treatment possible, quantified it and identified subgroups with particular needs. All patients who came in February 2012 for a consultation or an ambulant therapy to one of the four centres of the “Departement Valaisan d’Oncologie” or the unique private practice in the region were asked to answer to a questionnaire. Results were summarised and analysed. Results: 84% of the patients need support. 40% of the patients need two or more kinds of support. Kind and quantity of support depend on gender, age and distance. Cancer patients in Valais need support to make their treatments possible. Some subgroups have a complex pattern of support and need specific assistance as younger women or elderly patients. Conclusions: We demonstrate that cancer patients in Valais need social support to handle their treatment days and that their out of the pocket travel expenses increase rapidly with distance. The pattern of support needed varies according to patient characteristics as gender, age and distance to treatment centre.
Schoolteachers' Experiences With Childhood Chronic Illness

The objective of this study was to examine the degree to which educators face problems associated with chronic illness in their pupils, the extent to which they feel responsible for addressing such problems, and the amount of training to deal with these problems. One hundred schools randomly selected from 10 counties in a midwest state stratified on substance abuse deaths, mental health costs, and socioeconomic status (percentage of free lunches) were approached, and 17 agreed to participate. Of the 1,184 eligible educators, 480 provided complete surveys (response rate = 40%). Nearly every respondent (98.7%) reported knowing a student in the school with a chronic illness, and 43% felt moderately to very responsible for dealing with issues of chronic illness, yet 59% reported no academic training and 64% reported no on-the-job training for dealing with issues of chronic illness. Schoolteachers are ill-prepared to deal with issues of chronic illness in the schools. Practice implications are discussed.