Miracle-dz/UniFAR-FTUs huggingface dataset:
Cutaneous Leishmaniasis in Kuwait

Abstract: Twenty‐four patients suffering from single or multiple lesions of cutaneous leishmaniasis were included In this study. Most of the lesions were on the extremities. The patients were randomly divided into two groups. Most of the patients in the first group who were given oral itraconazole for a period of 6–8 weeks showed excellent clinical response. On the other hand, only one patient in the second control group who was given placebo showed good clinical improvement. Systemically administered itraconazole may prove to be a valuable modality for the treatment of cutaneous leishmaniasis.
The Role of the Tissue Factor Pathway in the Hypercoagulable State in Patients with the Antiphospholipid Syndrome

Summary The antiphospholipid syndrome (APS) is characterised by both arterial and venous thrombosis, recurrent pregnancy loss and thrombocytopaenia in association with antiphospholipid antibodies (aPL). To explore further the pathogenesis of thrombosis in APS, we evaluated the behaviour of tissue factor (TF) pathway in patients with APS. Plasma antigen levels of soluble TF and tissue factor pathway inhibitor (TFPI), a physiological regulator of TF dependent coagulation activation, were measured in 57 APS patients (36 primary and 21 secondary to systemic lupus erythematosus). Significantly elevated levels of both TF and TFPI were found in APS patients compared with 25 healthy controls (279 ± 15 vs. 217 ± 17 pg/ml, p = 0.01; 56.24 ± 2.00 vs. 47.92 ± 2.22 ng/ml, p = 0.01, respectively), suggesting in vivo upregulation of TF pathway in patients with APS. By flow-cytometry, monocytes from a healthy donor displayed higher TF antigen expression when incubated in the presence of APS plasmas than in control plasmas (24.23 ± 3.11 vs. 12.78 ± 1.57%, p = 0.002). Peripheral blood mononuclear cells (PBMC) also expressed more procoagulant activity (PCA) when incubated in the presence of APS plasmas than in control plasmas (1.80 ± 0.12 vs. 1.35 ± 0.054, p = 0.001) implying that TF up-regulation in APS was reproducible in vitro. Human monoclonal anticardiolipin antibodies induced PCA on PBMC and also TF mRNA on both PBMC and human umbilical vein endothelial cells shown by reverse-transcription polymerase chain reaction. These data strongly suggest that the TF pathway is implicated in the pathogenesis of aPL related thrombosis.
Feeding and oral hygiene habits of preschool children in Hong Kong and their caregivers' dental knowledge and attitudes.

OBJECTIVES This study was designed to gather data on infant feeding habits and oral hygiene practices of Hong Kong preschool children, on the dental knowledge and attitudes of their caregivers and on the oral health status of the same group of children. DESIGN Cross-sectional study. SAMPLE AND METHODS Data was gathered for a total of 369 boys and 297 girls (207 1-year-olds, 269 2-year-olds and 190 3-year-olds) with a mean age of 20.19 (+/- 0.38) months. Information related to children attending six randomly selected Maternity and Child Health Centres. It was obtained by examining the children and by interviewing the attending caregivers and completing a questionnaire. Each child was given an oral examination using a torch, disposable mirror and wooden tongue spatula. RESULTS Only 7% of the children were exclusively breast-fed. More than 98% (656/666) of infants used a nursing bottle for at least some drinks. Over 62% (411/656) had used a nursing bottle to take fluids other than water and infant formula. At bedtime, 56% (361/656) were given a nursing bottle prior to sleep and 96% (340/361) of these bottles contained formula milk. Of these children, only 37% (131/361) finished the contents of the bottle before falling asleep. Over 73% (139/190) of the children continued to use a feeding bottle after 2 years of age. Non-nutritive sucking habits were practised by 35.6% (237/666) of the children. Visible plaque, on the labial surface of at least two maxillary incisors, was found in 19.5% (120/615) of the children. Oral cleansing habits were practised for 66.2% (441/666) of the children. Toothbrushing habits were reported for 42.3% (260/615) of the dentate children, of whom 19% (49/260) had their teeth brushed twice daily. Toothpaste was used by 49.23% (128/260) of the children and 57.3% (149/260) brushed their own teeth. Caries was seen in 7.6% of the infants (47/615). Of the caregivers, 67.7% said they did not think carious primary teeth needed to be restored. Among the mothers, 12.6% (43/342) did not know the oral condition of their child. Reportedly, 82% (417/510) and 87.5% (446/510) of the mothers had not received any oral health care information during the ante- or postnatal periods. Nearly all, 97%, of the respondents said that they would like to receive more information on oral health care.
Validation study of Nexfin® continuous non-invasive blood pressure monitoring in critically ill adult patients.

BACKGROUND Nexfin® (BMEYE, Amsterdam, The Netherlands) is a totally non-invasive blood pressure and cardiac output (CO) monitor based on finger arterial pulse contour analysis. METHODS We performed an open observational study in a mix of medical-surgical-burns critically ill patients (N.=45) to validate Nexfin obtained blood pressures (MAPnex) against PiCCO (MAPfem) derived blood pressure measurements. MAPnex, MAPfem and corresponding systolic (SBP) and diastolic (DBP) blood pressures were measured continuously and registered with a 2 hour interval during the 8-hour study period. Statistical analysis was performed by Pearson regression, Bland and Altman, Concordance plot and Polar plot analysis. RESULTS MAPnex shows excellent correlation with MAPfem (R² 0.88, mean bias ± LA -2.3±12.4 mmHg, 14.7% error) and may be used interchangeably with invasive monitoring. The excellent MAPnex -MAPfem correlation was preserved in subgroup analysis for patients with severe hypotension, high systemic vascular resistance, low CO, hypothermia and in patients supported by inotropic/vasopressive agents. MAPnex is able to follow changes in MAPfem during the same time interval (level of concordance 85.5%). Nexfin SBP and DBP show significant correlation with PiCCO but the criteria for interchangeability were not met. Finally, polar plot analysis showed that trending capabilities were excellent when changes in MAPnex (ΔMAPnex) were compared to ΔMAPfem (96.1% of changes were within the level of 10% limits of agreement). CONCLUSION In this sample of critically ill patients we found a good correlation between MAPnex and invasive blood pressures obtained by PiCCO.
Evidence for a Tetrahydrobiopterin Deficit in Schizophrenia

Tetrahydrobiopterin (BH4) is a vital cofactor maintaining availability of the amine neurotransmitters [dopamine (DA), noradrenaline (NA), and serotonin (5-HT)], regulating the synthesis of nitric oxide (NO) by nitric oxide synthase (NOS), and stimulating and modulating the glutamatergic system (directly and indirectly). These BH4 properties and their potential relevance to schizophrenia led us to investigate the hypothesis of a study group (healthy controls, n = 37; schizophrenics, n = 154) effect on fasting plasma total biopterin levels (a measure of BH4). Study analysis showed a highly significant deficit of total biopterins for the schizophrenic sample after partialling out the effects of potential confounds of gender, age, ethnicity, neuroleptic use history and dose of current use, 24-hour dietary phenylalanine/protein ratio (a dietary variable relevant to BH4 synthesis), and plasma phenylalanine (which stimulates BH4 synthesis). A mean decrement of 34% in plasma total biopterins for schizophrenics from control values supports clinical relevance for the finding. In a subsample (21 controls and 23 schizophrenics), sequence analysis was done of the GTP cyclohydrolase I feedback regulatory gene and no mutations were found in the coding region of the gene. A deficiency of BH4 could lead to hypofunction of the systems of DA, NA, 5-HT, NOS/NO, and glutamate, all of which have been independently implicated in schizophrenia psychopathology. Further, evidence has been accumulating which implicates the critical interdependence of these neurotransmitter systems in schizophrenia; this concept, along with the present study finding of a biopterin deficit, suggests that further study of the BH4 system in schizophrenia is warranted and desirable.
Molecular Analysis of RIM1 in Autosomal Recessive Retinitis pigmentosa

Retinitis pigmentosa (RP) is a frequent retinal dystrophy characterized by a progressive loss of photoreceptors along with retinal degeneration. RIM1, encoding a presynaptic protein involved in the glutamate neurotransmission, is the responsible gene for autosomal dominant cone-rod dystrophy CORD7, whose locus overlaps partially with a locus of autosomal recessive RP (arRP), RP25. Given the genetic heterogeneity that features RP, it is plausible that mutations in RIM1 are also implicated in the disease in arRP families genetically linked to the CORD7 region. To test our hypothesis we analysed the complete RIM1 gene in 8 arRP families by DNA sequencing. Even though the absence of pathogenic mutations suggests that RIM1 is notinvolved in arRP, a role for this gene in other inherited forms of RP as well as other retinal dystrophies needs to be elucidated.
A case of primary mucoepidermoid carcinoma of the thyroid: molecular evidence of its origin

Primary mucoepidermoid carcinoma (MEC) of the thyroid is very rare, and its origin has not been fully determined. We report a case of MEC, the origin of which was demonstrated by thyroid specific genes expressed in a metastatic lymph node. A 52‐year‐old male presented with chest pain, weight loss and diffuse goitre. Ultrasonography showed the thyroid to be diffusely enlarged with numerous small calcifications. The tumour was found to be infiltrating the thyroid, lung, lymph nodes and first thoratic vertebra. A variant type of papillary thyroid carcinoma was suspected by fine needle aspiration cytology of the thyroid. An open biopsy specimen from an axillary lymph node revealed the tumour to be composed of three distinct cell types: mucin‐producing cells, intermediate cells and a small amount of epidermoid cells with scattered psammoma bodies. Immunohistochemical studies showed the tumour cells to be negative for thyroglobulin and calcitonin, but positive for CEA. To examine the primary origin of the tumour, the expression of thyroid specific genes in the lymph node specimen was examined by RT‐PCR. TTF‐1, TTF‐2, Pax‐8, Na‐I symporter and thyroid peroxidase mRNA were detected. The presence of these thyroid‐specific mRNAs indicates that this MEC originated from thyroid follicular epithelium. This is the first molecular evidence of dedifferentiation from thyroid follicular cells to MEC.
Effects of betaine, organic acids and inulin as single feed additives or in combination on bacterial populations in the gastrointestinal tract of weaned pigs

A study was carried out to investigate whether blends of betaine, organic acids and inulin may improve their efficacy to modulate intestinal bacterial populations in weaned pigs compared with the single application of these additives. Moreover, potential postprandial diurnal variations in ileal bacterial numbers were determined in piglets fed the control diet. Twenty-four piglets in two consecutive experiments received a wheat-barley-soybean meal control diet (Con) or the Con diet supplemented with betaine (BET; 0.2%), an organic acid blend (AC; 0.4%) or inulin (IN; 0.2%) as single additives or in combination. Ileal bacterial numbers of total bacteria, lactobacilli, bifidobacteria (p < 0.05) and enterobacteria (p < 0.10) showed a postprandial diurnal variation, thus spot sampling of ileal digesta for the determination of bacterial numbers may not be representative. There were only small effects of BET, AC and IN on ileal and faecal bacterial populations. BET + AC increased total ileal bacterial numbers compared to the Con and AC treatments. BET reduced lactobacilli numbers in faeces, whereas BET + IN increased ileal numbers of bifidobacteria compared to AC and IN. There is evidence that BET, AC, IN and their combinations may affect proliferation of beneficial bacterial populations, although this has to be confirmed in further studies.
Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study

Background Antiretroviral treatment (ART) has significantly reduced HIV mortality in South Africa. The benefits have not been experienced by all groups. Here we investigate the factors associated with these inequities. Design This study was located in a rural South African setting and used data collected from 2007 to 2010, the period when decentralised ART became available. Approximately one-third of the population were of Mozambican origin. There was a pattern of repeated circular migration between urban areas and this community. Survival analysis models were developed to identify demographic, socioeconomic, and spatial risk factors for HIV mortality. Results Among the study population of 105,149 individuals, there were 2,890 deaths. The HIV/TB mortality rate decreased by 27% between 2007–2008 and 2009–2010. For other causes of death, the reduction was 10%. Bivariate analysis found that the HIV/TB mortality risk was lower for: those living within 5 km of the Bhubezi Community Health Centre; women; young adults; in-migrants with a longer period of residence; permanent residents; and members of households owning motorised transport, holding higher socioeconomic positions, and with higher levels of education. Multivariate modelling showed, in addition, that those with South Africa as their country of origin had an increased risk of HIV/TB mortality compared to those with Mozambican origins. For males, those of South African origin, and recent in-migrants, the risk of death associated with HIV/TB was significantly greater than that due to other causes. Conclusions In this community, a combination of factors was associated with an increased risk of dying of HIV/TB over the period of the roll-out of ART. There is evidence for the presence of barriers to successful treatment for particular sub-groups in the population, which must be addressed if the recent improvements in population-level mortality are to be maintained.
Medical education scholarship: An introductory guide: AMEE Guide No. 89

Abstract This AMEE Guide provides an overview of medical education scholarship for early career scholars, based upon a summary of the existing literature and pragmatic advice derived from the experience of its authors. After providing an introduction to the principles of scholarship and describing questions that the Guide addresses, the authors offer a conceptual description of the complementary traditions of teaching and educational discovery, and advocate for the development of educational scholars with both traditions. They then describe the attributes of effective mentor–mentee relationships and how early career scholars can identify potential mentors who can fulfill this role. In the subsequent sections, they describe the appropriate development of scholarly questions and other components of a complete scholarly plan, including how to use conceptual frameworks in guiding such plans. From here, they describe methods that align with both the teaching and discovery traditions and provide concrete examples of each. They then provide guidelines for assessing the impact of scholarship, identify the various opportunities for sharing it, and how to effectively interpret and describe it. Additionally, they provide practical advice on how appropriately to demonstrate the scholarship in a promotional packet, including the principle of reflectivity in scholarship. Finally, they address the principles of applied research ethics for educational scholarship and when to consider soliciting approval for scholarly activities by a human research board.
Elevated plasma levels of vascular endothelial growth factor is associated with marked splenomegaly in chronic myeloid leukemia

Recent investigations support the idea that angiogenesis is involved in the pathophysiology of hematologic malignancies, including chronic myeloid leukemia (CML). The aim of the present study was to evaluate plasma levels of VEGF and bFGF in a cohort of 51 chronic-phase CML patients at the time of diagnosis, as well as to investigate the effect of imatinib therapy on VEGF amounts in CML patients. Plasma VEGF levels were significantly higher in patients studied as compared with the 20 healthy subjects (p<0.001), the median plasma VEGF level detected in patients analysed and healthy controls was 433.4 pg mL−1 (range 65.2–2452.7 pg mL−1) and 81.6 pg mL−1 (range 44.2–338.7 pg mL−1), respectively. On the other hand, no difference in bFGF plasma levels could be found between chronic-phase CML patients and the control group. There were significant associations between plasma VEGF levels and some characteristics of patients evaluated, with trends for higher VEGF values in patients with enlarged spleens (p = 0.02) and those with higher platelet count (p<0.001). Of the patients, 11 received imatinib treatment. The initial VEGF levels markedly decreased after 6 months of imatinib therapy in each patient (p<0.001). These data support the important pathophysiological role of VEGF in CML. Further studies aiming to explore the detailed angiogenic profile of CML may help in developing new therapeutic strategies for this myeloproliferative disorder.
Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments

BACKGROUND:Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome. OBJECTIVE:To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients. METHODS:In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken. RESULTS:Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030). CONCLUSION:Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.
“Picking up the pieces”—Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area

Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients’ strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context.
Transcript Scanning Reveals Novel and Extensive Splice Variations in Human L-type Voltage-gated Calcium Channel, Cav1.2 α1 Subunit*

The L-type (Cav1.2) voltage-gated calcium channels play critical roles in membrane excitability, gene expression, and muscle contraction. The generation of splice variants by the alternative splicing of the poreforming Cav1.2 α1-subunit (α11.2) may thereby provide potent means to enrich functional diversity. To date, however, no comprehensive scan of α1 1.2 splice variation has been performed, particularly in the human context. Here we have undertaken such a screen, exploiting recently developed “transcript scanning” methods to probe the human gene. The degree of variation turns out to be surprisingly large; 19 of the 55 exons comprising the human α11.2 gene were subjected to alternative splicing. Two of these are previously unrecognized exons and two others were not known to be spliced. Comparisons of fetal and adult heart and brain uncovered a large IVS3-S4 variability resulting from combinatorial utilization of exons 31–33. Electrophysiological characterization of such IVS3-S4 variation revealed unmistakable shifts in the voltage dependence of activation, according to an interesting correlation between increased IVS3-S4 linker length and activation at more depolarized potentials. Steady-state inactivation profiles remained unaltered. This systematic portrait of splice variation furnishes a reference library for comprehending combinatorial arrangements of Cav1.2 splice exons, especially as they impact development, physiology, and disease.