Miracle-dz/UniFAR-FTUs huggingface dataset:
Vaginosis bacteriana: diagnóstico y prevalencia en un Centro de Salud

Objective: To evaluate the prevalence of bacterial vaginosis in women of a rural population with vaginal discharge. Design: Prospective, transversal, analytical study. Material and Methods: Vaginal secretion samples were taken from 100 patients with vaginal discharge, and microbiologic analysis and Amsel‘s criteria for bacterial vaginosis diagnosis were applied. Results: Bacterial vaginosis was found in 33% of patients that fulfilled at least 3 of the 4 Amsel‘s criteria, candidiasis in 15%, trichomoniasis in 4% and mixed culture in 5%. Clue cells and the amine test allowed us to identify the largest percentage of patients with bacterial vaginosis; likewise, the presence of clue cells alone, clue cells + odor and odor + pH had high positive and negative predictive value. Vaginal discharge sensitivity is low. Conclusions: Bacterial vaginosis is the most common vaginal infection among reproductive age women from Quilmana City, representing at least one third of such infections. Diagnosis can be done in ambulatory clinical practice applying only two of the Amsel’s criteria, like amine test plus vaginal secretion pH.
Maternal High-Fat Diet During Pregnancy and Lactation has Opposite Effects on Gonadal Expression of Leptin and Leptin Receptor in Rat Dams and Their Offspring

Abstract This study investigated the effect of a high-fat (HF) diet on protein expression of leptin and its receptor in the gonads of dams and their offspring. Female Wistar rats were fed a HF diet (30% fat) or a standard breeding (BD) diet (5% fat) during pregnancy and lactation. At 21 days of lactation, mothers and both sexes of prepubertal offspring were killed by decapitation. The protein expression of leptin and its receptor was assayed by Western blot and immunohistochemistry in gonadal, periovarian, and epididymal white adipose tissue (WAT). We demonstrated that leptin protein expression in ovary, and both leptin and ObRb expression in periovarian WAT was decreased in HF dams compared with BD animals. Immunohistochemistry showed lower leptin expression in growing antral follicles and corpora lutea of HF dams. Conversely, in both gonads and epididymal WAT of HF offspring, leptin and its receptor were significantly higher expressed compared with BD. Immunolocalization of leptin system in HF offspring gonads showed higher expression in growing and antral follicles of the ovary, seminiferous tubules, and interstitial tissue of testes. In conclusion, high gonadal and gonadal-WAT expression of leptin system was observed in the offspring of dams fed a HF diet during pregnancy and lactation.
Mental Health Professionals in Medical Settings: A Primer

One of the most significant events in the history of health care is the development of separate and parallel systems for mental health and medical care. Patients, however, want health care that is better coordinated, more personalized, more accessible, more timely, and less cumbersome to receive. These patient-wants reinforce what we know about patient needs for better integrated care and more collaborative health care, as shown by the following data: *50% of mental health care is delivered by primary care physicians. *67% of all psychopharmacological drugs are prescribed by primary care physicians. *50-70% of all primary care visits are for psychosocial concerns. This book illustrates the importance of taking an integrated approach to health care and outlines the skills that a mental health professional needs for working in a medical setting. The authors, trained in health psychology, psychiatry, family medicine, and marriage and family therapy, build a persuasive case for their holistic, biopsychosocial approach to the traditionally fragmented fields of primary care and mental health care.This is a primer for mental health professionals working in a medical setting. Part I discusses health care settings. Chapters 1 and 2 describe the specific cultures of primary care, specialty care, and mental health care, and Chapter 3 discusses ways to balance the clinical, operational, and financial perspectives of health care. Part II provides information on how to build collaborative medical care, including getting started (Chapter 4), expanding the therapist's identity and role in medical clinics (Chapter 5), working within the medical system's organizational framework (Chapter 6), working with the common problems that patients present in primary care (Chapter 7), and ways to promote healthy behavior change (Chapter 8). The book concludes by highlighting some of the opportunities that exist for therapists who want to be part of this important shift in how health care is provided.
Comparison between two antimicrobial protocols with or without guided bone regeneration in the treatment of peri‐implantitis. A histomorphometric study in dogs

OBJECTIVES This study used a dog model to evaluate two antimicrobial protocols with or without guided bone regeneration (GBR) in the surgical reconstruction of peri-implantitis defects. MATERIAL AND METHODS Eight beagle dogs subject to ligature-induced peri-implantitis were used. The animals either received antimicrobial photodynamic therapy or topical tetracycline hydrochloride combined with GBR or as stand-alone surgical interventions. Block biopsies of the defect sites for histological analysis were obtained at euthanasia, 12 weeks postsurgery. The primary outcome of the study was re-osseointegration; secondary outcomes included alveolar bone gain and remaining defect characteristics. The effects of the implant site, early exposure, and type of antimicrobial protocol on bone regeneration were also evaluated. RESULTS No significant differences were observed between the two antimicrobial protocols, and the adjunctive use of GBR failed to significantly improve re-osseointegration or bone gain using either protocol. Buccal sites and implant early exposure negatively affected bone regeneration. CONCLUSION Both antimicrobial therapies stand-alone or combined with GBR allowed similar and limited bone gain.
Long‐term outcomes of narrow diameter implants in posterior jaws: A retrospective study with at least 8‐year follow‐up

OBJECTIVE The aim of this study was to evaluate the long-term survival, complications, peri-implant conditions, marginal bone loss, and patient satisfaction of fixed dental prostheses supported by narrow diameter implants (NDIs) in the posterior jaws. MATERIALS AND METHODS This study was designed as a retrospective cohort study with a mean follow-up time of 10.1 years (SD: 2.5 years). Patients receiving NDIs in posterior jaw were reviewed. Implant survival, hardware complication, modified plaque index (mPI), peri-implant probing depth (PPD), percentage of bleeding on probing (BOP%), marginal bone loss (MBL), and patient satisfaction were evaluated. Log-rank test and t test were used to detect the influence of implant location and restoration type. RESULTS Sixty-seven patients with 98 NDIs (Premolar site: 81, Molar site: 17, Single crowns: 33, Splinted restorations: 65) were included. The overall implant survival rates were 96.9% at implant level and 97.0% at patient level. Veneer chipping was the most common hardware complication. The veneer chipping rates were 19.4% at patient level and 18.4% at implant level. All patients showed acceptable oral hygiene. Thus, the average MBL was 1.19 mm at implant level and 1.15 mm at patient level. Eight implants (8.5%) and six patients (9.2%) were diagnosed with peri-implantitis. Fifty-eight patients (89.2%) were satisfied with the esthetics of the restorations, while 55 patients (84.6%) were satisfied with the function of the restorations. CONCLUSION Narrow diameter implants could be a predictable treatment option in the long term. High survival rates, high patient satisfaction, acceptable complication rates and marginal bone loss could be achieved. Further long-term studies are needed to evaluate the predictability of NDIs in molar sites.
Nosocomial transmission of human granulocytic anaplasmosis in China.

CONTEXT Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease in China. A cluster of cases among health care workers and family members following exposure to a patient with fulminant disease consistent with HGA prompted investigation. OBJECTIVE To investigate the origin and transmission of apparent nosocomial cases of febrile illness in the Anhui Province. DESIGN, SETTING, AND PATIENTS After exposure to an index patient whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases with febrile illness who were suspected of being exposed were tested for antibodies against Anaplasma phagocytophilum and by polymerase chain reaction (PCR) and DNA sequencing for A. phagocytophilum DNA. Potential sources of exposure were investigated. MAIN OUTCOME MEASURE Cases with serological or PCR evidence of HGA were compared with uninfected contacts to define the attack rate, relative risk of illness, and potential risks for exposure during the provision of care to the index patient. RESULTS In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of 9 febrile patients with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels were diagnosed with HGA by PCR for A. phagocytophilum DNA in peripheral blood and by seroconversion to A. phagocytophilum. No patients had tick bites. All 9 patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation. The attack rate was 32.1% vs 0% (P = .04) among contacts exposed at 50 cm or closer, 45% vs 0% (P = .001) among those exposed for more than 2 hours, 75% vs 0% (P < .001) among those reporting contact with blood secretions, and 87.5% vs 0% (P = .004) among those reporting contact with respiratory secretions from the index patient. CONCLUSION We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions.
Spousal care of Alzheimer's disease patients in nursing home versus in-home settings: patient impairment and caregiver impacts

Using a mailed survey, responses from 105 individuals caring for spouses afflicted with Alzheimer's Disease (AD) were analyzed with regard to the impact of caregiving on the caregiver. Spouses rendering care to an AD patient in an "in-home" setting were contrasted with those caring for an AD patient in a nursing home. Results indicate that spousal caregivers of institutionalized AD patients experienced negative impacts of caregiving that are at least on par with those encountered by in-home caregivers. Clinicians who work with spousal caregivers should make them aware that while placing an AD patient in a nursing home placement may alleviate some of the stress they experienced as in-home caregivers, nursing home placement does not necessarily eliminate this stress, especially in the case of spousal caregivers who maintain close contact with their impaired partner after placement.
Wurzelbewegung an einem oberen mittleren Schneidezahn mithilfe von Alignern – einwirkende Kräfte und biomechanische Grundlagen*

The forces delivered by aligners during torquing have still not been investigated. The purpose of this study was to measure the forces delivered to an upper central incisor during torquing with three different materials of the same thickness, and to describe the biomechanical principles of torquing with aligners. Five identical appliances were manufactured from each of three materials, all with a thickness of 1.0 mm (Ideal Clear®, Erkodur®, and Biolon®). An upper central incisor, as part of the measuring device, was torqued in defined steps in the vestibular and palatal directions with the respective appliance in place. For statistical analysis, the resulting forces, Fx (forces acting in the palatal and facial directions) and Fz (intrusive force as a side-effect) at a displacement of ±0.15 and ±0.8 mm from the tooth at the gingival margin were calculated. The mean Fx forces for ±0.15 mm displacement ranged from -1.89 N [standard deviation (SD) 0.48] to 0.11 N (SD 0.1). The mean Fz forces were between -0.97 N (SD 0.57) and -0.07 N (SD 0.22). The highest intrusive forces were measured during palatal displacement of the measuring tooth. An influence of direction of displacement on the levels of force was observed, especially for Fz at the greater displacement of ±0.8 mm. In relation to the intended amount of root movement during torquing, aligners tend to 'lift up' and therefore no effective force couple can be established for further root control. The force delivery properties are also influenced by the material used and the shape of the tooth.
IODIXANOL AND IOHEXOL IN CARDIOANGIOGRAPHY

Purpose: The non-ionic dimeric contrast medium (CM) iodixanol is isotonic with blood through the addition of electrolytes. In this study, we evaluated computerised dynamic vectorcardiography (VCG) as a tool in CM research by comparing the electrophysiological effects of iodixanol with those of the low-osmolar CM iohexol. Material and Methods: A total of 119 patients referred for cardioangiography were included in this double-blind, randomised, parallel comparison of iodixanol (320 mg I/ml) and iohexol (350 mg I/ml). VCG was recorded and different VCG parameters were analysed. General tolerability, safety and radiographic efficacy were also assessed. Results: Iodixanol induced less changes than iohexol in all VCG parameters and the sensation of warmth was significantly milder after iodixanol, but both CM were well tolerated. VCG might be useful in future studies to analyse electrophysiological effects caused by CM.
Tuberculosis retreatment in Northern Portugal

taken for other pathologies. It designates inflammation and fibrosis occurring predominantly in membranous and respiratory bronchioles walls and contiguous tissues, sparing distal respiratory bronchioles, with resultant lumen narrowing. Histology is characterized by focal changes, which are difficult to read, making diagnosis sometimes problematical. Clinically, patients usually report dyspnea and cough and, like both our patients, have functional airflow limitation. This reflects the effect of bronchiolar lumens concentric narrowing and eventually luminal obliteration. It is a chronic, slowly progressive disease. Chest X-ray is often normal or shows signs of hyperinflation or decreased vascular reticulum. Chest CT scan may help diagnosis, sometimes demonstrating the existence of a mosaic pattern, with areas of air-trapping caused by constricted and partially obstructed bronchioles. There are also frequently parenchymal densifications and bilateral ground glass opacities. There are several causes attributed to this entity. Even though it may be idiopathic, most commonly it is secondary to sequelae from childhood infections or inhalation of toxic gases. It can also occur in patients with connective tissue diseases and is a well-known complication of bone and lung transplantation. More recently, it has been associated with ulcerative colitis, proliferation of neuroendocrine cells in the lung or with cystic fibrosis. Treatment is based on oral systemic corticosteroid therapy. However, it appears that most cases are steroid-resistant, with development of irreversible airway obstruction. Association with other immunosuppressants is also controversial, due to the absence of directed studies. Recent trials have also shown that macrolide in the form of azithromycin (250 mg three times a week) may be important in reducing the inflammatory component. Prognosis is difficult to establish since most of the available studies only enrolled patients with constrictive bronchiolitis associated to organ transplantation. In such patients, the overall mortality rate is 25%. However, for 87% of patients who were asymptomatic there was resolution or stabilization of the disease, compared with 38% of those with moderate symptoms and 40% of those with severe symptoms. The authors describe two patients with histological diagnosis of constrictive bronchiolitis in order to highlight an uncommon entity that in clinical practice is often misread. Further studies targeting treatment regimens are needed in the near future.
Iron‐regulated surface determinant B (IsdB) promotes Staphylococcus aureus adherence to and internalization by non‐phagocytic human cells

Staphylococcus aureus is a human pathogen that causes invasive and recurring infections. The ability to internalize into and persist within host cells is thought to contribute to infection. Here we report a novel role for the well‐characterized iron‐regulated surface determinant B (IsdB) protein which we have shown can promote adhesion of 293T, HeLa cells and platelets to immobilized bacteria independently of its ability to bind haemoglobin. IsdB bound to the active form of the platelet integrin αIIbβ3, both on platelets and when the integrin was expressed ectopically in CHO cells. IsdB also promoted bacterial invasion into human cells. This was clearly demonstrated with bacteria lacking fibronectin‐binding proteins (FnBPs), which are known to promote invasion in the presence of fibronectin. However, IsdB also contributed significantly to invasion by cells expressing FnBPs in the presence of serum. Thus IsdB appears to be able to interact with the broader family of integrins that bind ligands with the RGD motif and to act as a back up mechanism to promote interactions with mammalian cells.
Patterns of abuse among unintentional pharmaceutical overdose fatalities.

CONTEXT Use and abuse of prescription narcotic analgesics have increased dramatically in the United States since 1990. The effect of this pharmacoepidemic has been most pronounced in rural states, including West Virginia, which experienced the nation's largest increase in drug overdose mortality rates during 1999-2004. OBJECTIVE To evaluate the risk characteristics of persons dying of unintentional pharmaceutical overdose in West Virginia, the types of drugs involved, and the role of drug abuse in the deaths. DESIGN, SETTING, AND PARTICIPANTS Population-based, observational study using data from medical examiner, prescription drug monitoring program, and opiate treatment program records. The study population was all state residents who died of unintentional pharmaceutical overdoses in West Virginia in 2006. MAIN OUTCOME MEASURES Rates and rate ratios for selected demographic variables. Prevalence of specific drugs among decedents and proportion that had been prescribed to decedents. Associations between demographics and substance abuse indicators and evidence of pharmaceutical diversion, defined as a death involving a prescription drug without a documented prescription and having received prescriptions for controlled substances from 5 or more clinicians during the year prior to death (ie, doctor shopping). RESULTS Of 295 decedents, 198 (67.1%) were men and 271 (91.9%) were aged 18 through 54 years. Pharmaceutical diversion was associated with 186 (63.1%) deaths, while 63 (21.4%) were accompanied by evidence of doctor shopping. Prevalence of diversion was greatest among decedents aged 18 through 24 years and decreased across each successive age group. Having prescriptions for a controlled substance from 5 or more clinicians in the year prior to death was more common among women (30 [30.9%]) and decedents aged 35 through 44 years (23 [30.7%]) compared with men (33 [16.7%]) and other age groups (40 [18.2%]). Substance abuse indicators were identified in 279 decedents (94.6%), with nonmedical routes of exposure and illicit contributory drugs particularly prevalent among drug diverters. Multiple contributory substances were implicated in 234 deaths (79.3%). Opioid analgesics were taken by 275 decedents (93.2%), of whom only 122 (44.4%) had ever been prescribed these drugs. CONCLUSION The majority of overdose deaths in West Virginia in 2006 were associated with nonmedical use and diversion of pharmaceuticals, primarily opioid analgesics.
Financial incentive-based approaches for weight loss: a randomized trial.

CONTEXT Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity. OBJECTIVE To determine whether common decision errors identified by behavioral economists such as prospect theory, loss aversion, and regret could be used to design an effective weight loss intervention. DESIGN, SETTING, AND PARTICIPANTS Fifty-seven healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008. MAIN OUTCOME MEASURES Weight loss after 16 weeks. RESULTS The incentive groups lost significantly more weight than the control group (mean, 3.9 lb). Compared with the control group, the lottery group lost a mean of 13.1 lb (95% confidence interval [CI] of the difference in means, 1.95-16.40; P = .02) and the deposit contract group lost a mean of 14.0 lb (95% CI of the difference in means, 3.69-16.43; P = .006). About half of those in both incentive groups met the 16-lb target weight loss: 47.4% (95% CI, 24.5%-71.1%) in the deposit contract group and 52.6% (95% CI, 28.9%-75.6%) in the lottery group, whereas 10.5% (95% CI, 1.3%-33.1%; P = .01) in the control group met the 16-lb target. Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups (9.2 lb; t = 1.21; 95% CI, -3.20 to 12.66; P = .23, in the lottery group and 6.2 lb; t = 0.52; 95% CI, -5.17 to 8.75; P = .61 in the deposit contract group) than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start (P = .01 for the lottery group; P = .03 for the deposit contract group) whereas controls did not. CONCLUSIONS The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained. The longer-term use of incentives should be evaluated. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00520611.
Nurses’ Knowledge, Beliefs and Practices towards Hand Hygiene

Article type: Original Article Received: Jan. 2015 Accepted: Apr. 2015 Corresponding author: Zahra Abbasnejad e-mail: z.abbasnejad@yahoo.com Background & Aim: Nurses’ hands are important channels of microorganisms transmission and hospital acquired infections. This study aimed to investigate knowledge, beliefs and practices of nurses regarding hand hygiene. Methods & Materials: This was a cross-sectional study conducted in 2012. All nurses (n=282) working in three hospitals of Lorestan University of Medical Sciences participated in the study. Data were gathered using a demographic form, social desirability questionnaire, and hand hygiene knowledge, belief and practice questionnaire. Data were analyzed through descriptive and statistical tests (Independent ttest, ANOVA, Pearson Coefficient) in the SPSS-PC (v.21.0). The level of significance was set at below 0.05. Results: The mean scores of nurses’ hand hygiene knowledge, beliefs and practices were 4.6±2.00, 3.8±0.40, and 4.33±0.50, respectively. Nurses washed their hands after contact with patients more often in compare with prior to contact with patient. There was a statistically positive and significant correlation between nurses’ practice in required situations and nurses’ beliefs regarding hand hygiene. Conclusion: According to the results, nurses’ knowledge regarding hand hygiene was low; and hand hygiene practice in required situations was undesirable. Many nurses had negative and false beliefs regarding hand hygiene. Based on these results, it is necessary to plan programs to increase nurses’ knowledge, belief and practice regarding hand hygiene.