Miracle-dz/UniFAR-FTUs huggingface dataset:
Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients.

BACKGROUND Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. METHODS Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. RESULTS A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). CONCLUSIONS Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218.).
EARLY DETECTION OF HYPOPHARYNGEAL CANCER BY NARROW‐BAND IMAGING

Twelve years ago, a presently 66‐year‐old male underwent resection of esophageal cancer. He was followed up with annual endoscopy, which in April of 2005 found and by endoscopic mucosal resection removed two small, low‐grade carcinomas of less than 10 mm from his hypopharynx. Before the development of narrow‐band imaging, such early stage cancer could not have been detected. Now, narrow‐band imaging is useful for screening high‐risk groups.
The Child Protection System from the Perspective of Young People: Messages from 3 Studies

This article reports findings and reflections based on the results of three different research projects conducted between 2008 and 2013 and focusing on the perspective of young care leavers in Spain. The overall aim was to examine these young people’s perceptions and evaluations of how they were treated while in the public care system, mainly residential care. Reviewing these qualitative studies, the most common and relevant issues highlighted by young people were related to the following themes: (a) entering care; (b) stability and emotional bonds in care; (c) education; (d) friends; (e) labelling, stigmatization, rights and opportunities; (f) autonomy and responsibility versus overprotection; (g) contact with parents, siblings and extended family; (h) maltreatment in care; and (i) leaving care. One of the main elements used in their assessments was comparison (i) between their previous situation within their birth family and the quality of care experienced in the residential home; and (ii) between what these young people commonly refer to as “normal children” and children in care. Recommendations deriving from their advice and opinions are also debated.
Outcomes and treatments of patients with immunoglobulin light chain amyloidosis who progress or relapse postautologous stem cell transplant

Immunoglobulin light chain (AL) Amyloidosis is a condition whereby misfolded proteins generated by plasma cells deposit in tissues causing organ dysfunction. Chemotherapy and autologous stem cell transplant when eligible are standard treatment options. Several studies report long‐term outcomes of patients post‐transplant. However, there is a paucity of literature describing outcomes of relapsed patients post‐transplant. We performed a retrospective study to assess outcomes and therapies employed upon relapse after transplant. Between 1996 and 2009, 410 patients received transplant at the Mayo Clinic as first‐line therapy. Of those patients, 42 (10%) died within 3 months of transplant, 64 (16%) died without documented relapse, 158 (38%) were alive without documented progression, and 146 (36%) had documented progression. Those 146 patients are the subject of our study, and their median time to hematologic relapse/progression was 23.6 months (95%CI 18.3, 26.3 months). Their median overall survival and 5‐yrs overall survival from post‐transplant relapse/progression was 51.7 months (95%CI 34.1–62.3) and 39%, respectively. The most common first regimen for treatment after relapse was lenalidomide or thalidomide. In conclusion, our study indicates that patients with AL amyloidosis fare well post‐transplant relapse/progression. Additionally, it provides a yardstick to design clinical trials to determine best treatment options.
Nutrition screening and assessment of patients attending a multidisciplinary falls clinic.

Objective: To describe the nutritional health and current nutritional management of a representative sample of patients attending an Australian falls clinic. Design: Descriptive study. Subjects: Ninety adults (65 years old and over) attending the Falls Clinic. Setting: Fall and Injury Risk Assessment Clinic, Repatriation General Hospital, Daw Park, South Australia. Main outcome measures: The Australian Nutrition Screening Initiative (ANSI) tool was administered. Measurements of height, weight, mid-upper arm circumference (MAC) and triceps skinfold thickness (TSF) were taken by a trained investigator on one occasion. Body mass index (BMI) was calculated for each participant. A BMI of less than 22 kg per m2 and greater than 30 kg per m2 were classified as underweight and overweight respectively. A BMI of less than 22 kg per m2 and MAC or TSF less than the fifteenth percentile were considered undernourished. Case notes were audited to determine the number of referrals to the dietetics department. Statistical analysis: Descriptive statistics were used to summarise the data. To identify significant differences between variables and genders, independent sample t-tests were used for continuous data and chi-square tests of significance for categorical data. A significance level of P < 0.05 was applied to all statistical tests. Results: According to the ANSI checklist 41 of 90 participants were assessed as 'high nutritional risk'. The most common ANSI risk factors were 'taking three or more different medications daily' (n = 65), 'eating alone most of the time' (n = 41), having a 'history of unintentional weight change' (n = 28), and having an 'illness or condition that affects dietary intake' (n = 26). Seventeen participants were considered overweight with a BMI > 30 kg/m2 and 11 were classified as undernourished with a BMI < 22 kg/m2 and a MAC or TSF less than the fifteenth percentile. One referral was made to the dietetics department at the Repatriation General Hospital. Conclusion or application: The results of this study have shown that a substantial number of older adults susceptible to falling are at risk of poor nutritional health and that there is limited nutritional management of this population. While weight and height are routinely collected in this falls clinic and the possibility to monitor weight is available, there is an opportunity to raise awareness of the nutritional health of these patients.
Prevalence and Antimicrobial Susceptibility Patterns of Salmonella and Shigella in HIV Patients in Ile-Ife, Osun State

Introduction: Diarrhoea is a clinical manifestation of HIV/AIDS infected people. These people have increased risk of Non-typhoidal Salmonella (NTS) and Shigella infections compared to immunocompetent people. The goal of this study is to determine the prevalence and antimicrobial susceptibility patterns of Salmonella and Shigella in HIV Seropositive patients. Methods: A total of 150 HIV patients attending Obafemi Awolowo University teaching hospital were enrolled in this study with age range of 18 – 70 years. Stool samples were collected and cultured on a selective medium for the isolation of Salmonella and Shigella strains. Isolates were subjected to antimicrobial susceptibility testing by disc diffusion method. Interpretation was done based on Clinical and Laboratory Standard Institute criteria. Results: The prevalence of Salmonella and Shigella found in the stool samples examined were found to be 10(6.6%). Salmonella accounted for 2(1.3%). The species consisted of Salmonella enterica serovar Enteritidis (n=2). Shigella accounted for 8(5.3%). The species comprised of S. flexneri (n=7), S. dysenteriae (n=1). All Salmonella and Shigella strains were 100% resistant to Tetracycline and Ampicillin and 100% sensitive to Nitrofurantoin and Ciprofloxacin. It was observed that 90% of all the patients had a CD4 count˃200 cells/mm 3 as a result of the administration of antiretroviral therapy. Conclusion: The high proportion of HIV patients who had diarrhoea in the absence of Salmonella and Shigella strongly indicate that other infectious agent are responsible for diarrhoea like Campylobacter or Escherichia coli especially Diarrhoeagenic Escherichia coli. Out of the antimicrobial drugs tested against the isolates, drugs of the class of Fluoroquinolones seemed to be the most effective.
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.

BACKGROUND Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. METHODS We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments. RESULTS Among 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002). CONCLUSIONS The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .).
Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015

BACKGROUND Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low‐income and middle‐income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study. METHODS We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod‐MR 2.1, were used to produce estimates of mortality and prevalence, including estimates of uncertainty. RESULTS We estimated that there were 319,400 (95% uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart disease in 2015. Global age‐standardized mortality due to rheumatic heart disease decreased by 47.8% (95% uncertainty interval, 44.7 to 50.9) from 1990 to 2015, but large differences were observed across regions. In 2015, the highest age‐standardized mortality due to and prevalence of rheumatic heart disease were observed in Oceania, South Asia, and central sub‐Saharan Africa. We estimated that in 2015 there were 33.4 million (95% uncertainty interval, 29.7 million to 43.1 million) cases of rheumatic heart disease and 10.5 million (95% uncertainty interval, 9.6 million to 11.5 million) disability‐adjusted life‐years due to rheumatic heart disease globally. CONCLUSIONS We estimated the global disease prevalence of and mortality due to rheumatic heart disease over a 25‐year period. The health‐related burden of rheumatic heart disease has declined worldwide, but high rates of disease persist in some of the poorest regions in the world. (Funded by the Bill and Melinda Gates Foundation and the Medtronic Foundation.)
Therapeutic Potential of Polyphenols in Parkinson’s Disease

Increased human life expectancy has resulted in larger geriatric population throughout the world. Consequently, there is increased prevalence of age-associated neurodegenerative diseases including Parkinson’s disease (PD) with serious impact on healthcare. This has intensified the scientific research on the pathology and therapy of the central nervous system (CNS). Although modern approach in biomedical research has made major breakthroughs in understanding the pathological basis of PD, the knowledge about therapy is limited. Consequently, PD does not have a permanent cure. During recent years, there have been several options for PD therapy including both pharmacological and neurosurgical approaches. These strategies are primarily aimed at improving the motor symptoms without any major side effects ultimately improving the quality of the life of the patient. Drugs such as L-dihydroxyphenyl alanine (levodopa or LDOPA) replenish the lost dopamine in the brain in early PD and provide symptomatic relief. Apart from L-dopa therapy, other drugs including dopamine receptor agonists, MAO-B inhibitors and anti-cholinergic drugs have been utilized in the pharmacotherapy of PD (Almeida & Hyson, 2008). But, each class of drugs is limited by potential side effects and motor complications with chronic treatment. Further, most PD medications do not effectively tackle tremor, postural instability and cognitive deficits. Moreover, most of these drugs are not completely effective against degeneration of the remaining dopaminergic neurons (Almeida & Hyson, 2008). Due to these serious lacunae, there is a tremendous momentum to develop newer treatments involving disease modifying, restorative, possibly curative drugs with lesser side effects. Most importantly, these drugs should protect the dying neurons thus preventing further neuronal loss. In this direction there have been novel strategies of PD pharmacotherapy applicable either as independent therapies or as a supplement with the existing therapies. These have been tested in experimental models and although many of these molecules show promise, their toxicology, bioavailability and clinical efficacy in human subjects needs to be examined thoroughly before application to PD.
Evaluation of Interventions to Prevent Disability in Leprosy

textabstractWhat is leprosy? Leprosy is an infecti ous disease dati ng back to ancient ti mes before Christ. Most likely, the infecti on spread slowly from Asia to Europe and from there to the Americas, Australia and New Zealand. In Europe, the number of infected people reached its peak in the 13th century. Aft er the 16th century, leprosy was on the decline over most of Europe and the number of people aff ected by leprosy fell rapidly. Nowadays, many people only know leprosy from stories, pictures or books since the disease has become less and less prevalent. Cause. Leprosy is caused by the bacillus Mycobacterium leprae. Leprosy bacilli are most probably spread through ti ny droplets from the nose or mouth from infected and untreated individuals. Most people will never know that they have been infected because their immune system functi ons well. But when the immune system fails to respond eff ecti vely to the anti gens of the bacilli, the disease will develop. The ti me between infecti on and the fi rst visible signs of leprosy varies greatly and is usually between two and twelve years, but someti mes more than 20 years. Signs, symptoms and classification. To confi rm whether a person has leprosy, at least one of three signs should be found during a clinical examinati on: loss of feeling in typical skin patches, enlargement of peripheral nerves and the presence of leprosy bacilli in a skin smear. In the early stage of leprosy, called indeterminate, one or few unusual spots or patches on the skin may occur. Oft en the disease heals spontaneously, but someti mes the disease progresses to an advanced form. This depends mainly on how the immune system of an individual responds.
Diabetes and Cause-Specific Mortality in Mexico City.

BACKGROUND Most large, prospective studies of the effects of diabetes on mortality have focused on high-income countries where patients have access to reasonably good medical care and can receive treatments to establish and maintain good glycemic control. In those countries, diabetes less than doubles the rate of death from any cause. Few large, prospective studies have been conducted in middle-income countries where obesity and diabetes have become common and glycemic control may be poor. METHODS From 1998 through 2004, we recruited approximately 50,000 men and 100,000 women 35 years of age or older into a prospective study in Mexico City, Mexico. We recorded the presence or absence of previously diagnosed diabetes, obtained and stored blood samples, and tracked 12-year disease-specific deaths through January 1, 2014. We accepted diabetes as the underlying cause of death only for deaths that were due to acute diabetic crises. We estimated rate ratios for death among participants who had diabetes at recruitment versus those who did not have diabetes at recruitment; data from participants who had chronic diseases other than diabetes were excluded from the main analysis. RESULTS At the time of recruitment, obesity was common and the prevalence of diabetes rose steeply with age (3% at 35 to 39 years of age and >20% by 60 years of age). Participants who had diabetes had poor glycemic control (mean [±SD] glycated hemoglobin level, 9.0±2.4%), and the rates of use of other vasoprotective medications were low (e.g., 30% of participants with diabetes were receiving antihypertensive medication at recruitment and 1% were receiving lipid-lowering medication). Previously diagnosed diabetes was associated with rate ratios for death from any cause of 5.4 (95% confidence interval [CI], 5.0 to 6.0) at 35 to 59 years of age, 3.1 (95% CI, 2.9 to 3.3) at 60 to 74 years of age, and 1.9 (95% CI, 1.8 to 2.1) at 75 to 84 years of age. Between 35 and 74 years of age, the excess mortality associated with previously diagnosed diabetes accounted for one third of all deaths; the largest absolute excess risks of death were from renal disease (rate ratio, 20.1; 95% CI, 17.2 to 23.4), cardiac disease (rate ratio, 3.7; 95% CI, 3.2 to 4.2), infection (rate ratio, 4.7; 95% CI, 4.0 to 5.5), acute diabetic crises (8% of all deaths among participants who had previously diagnosed diabetes), and other vascular disease (mainly stroke). Little association was observed between diabetes and mortality from cirrhosis, cancer, or chronic obstructive pulmonary disease. CONCLUSIONS In this study in Mexico, a middle-income country with high levels of obesity, diabetes was common, glycemic control was poor, and diabetes was associated with a far worse prognosis than that seen in high-income countries; it accounted for at least one third of all deaths between 35 and 74 years of age. (Funded by the Wellcome Trust and others.).
Hematopoietic stem cell transplantation for sickle cell disease: state of the science

Sickle cell disease (SCD) is an inherited disorder secondary to a point mutation at the sixth position of the beta chain of human hemoglobin resulting in the replacement of valine for glutamic acid. This recessive genetic abnormality precipitates the polymerization of the deoxygenated form of hemoglobin S inducing a major distortion of red blood cells (S‐RBC), which decreases S‐RBC deformability leading to chronic hemolysis and vaso‐occlusion. These processes can result in severe complications including chronic pain, end‐organ dysfunction, stroke, and early mortality. The only proven curative therapy for patients with SCD is myeloablative conditioning and allogeneic stem cell transplantation from HLA‐matched sibling donors. In this review, we discuss the most recent advances in allogeneic stem cell transplantation in patients with SCD including more novel approaches such as reduced toxicity conditioning and the use of alternative allogeneic donors, including matched unrelated donors (MUDs), unrelated cord blood donors (UCBT), and familial haploidentical (FHI) donors. The results to date are very encouraging regarding allogeneic stem cell transplantation for patients with SCD including high survival rates and enabling a greater number of patients suffering from this chronic and debilitating condition to receive curative allogeneic stem cell therapies. However, we still have several areas to investigate and barriers to overcome to successfully cure the majority of patients with severe SCD through allogeneic stem cell therapies.