Miracle-dz/UniFAR-FTUs huggingface dataset:
ACTIVE VERSUS CONSERVATIVE MANAGEMENT OF PRELABOUR RUPTURE OF MEMBRANES AT TERM

Objective: To compare maternal and foetal outcome of active versus conservative management ofpremature rupture of membranes after 37 completed weeks of pregnancy. Methodology: This quasi-experimental study was carried out at Gynae unit, Lady Reading Hospital,Peshawar from September 2004 to September 2005 and included 100 patients out of which 50 weremanaged conservatively and 50 actively. After confirming the leakage of amniotic fluid, patients wererandomized by lottery method to conservative or induced group. The patients in the group that wasmanaged conservatively were shifted to obstetrical ward to await the onset of regular uterine activity for atleast 48hrs. After Bishops scoring, patients were induced with vaginal prostaglandin E2 tablet. Bothgroups received intravenous antibiotics. Results: Total number of patients with PROM at term was 3.84%. Total cost of stay in hospital andmanagement was greater in induced group (P. value 0.05) was observed in respect ofperinatal outcome and infectious morbidity in babies. Conclusion: Conservative management of PROM at term should be viewed more positively for at least48hrs under appropriate antibiotic cover and with active management of 3rd stage of Labour.
Avaliação da toxicidade aguda e subaguda, em ratos, do extrato etanólico das folhas e do látex de Synadenium umbellatum Pax.

The use of medicinal plants has been being very significant in the last years, being the use encouraged by WHO. Synadenium umbellatum Pax, Euphorbiacea (popularly known as cola-note, cancerola, miraculous) has the latex used empirically as anti-cancerous and anti-inflammatory. For there being toxic species in this family and aiming at the safety in the use of vegetable extracts, such study evaluated the pre-clinical toxicity of the latex and of the ethanolic extract of the leaves (EEL) of S. umbellatum, administrated by oral route, in Wistar female rats. The study followed OECD's Guidelines for test of acute toxicity (Guideline 423) and for subacute toxicity (Guideline 407). In the acute toxicity of latex and EEL, behavioral and physiological alterations were not observed neither animal's death in the dose level of 2,000 mg/kg. However, the latex caused congestion and leukocytes infiltration of the kidneys, liver and lungs, effects not observed with EEL. In the subacute toxicity, dose levels of 50, 100 and 200 mg/kg of EEL did not produced significant dose-dependent alterations in the lab results and no physiologic, macroscopic and hystopathological alterations. EEL of S. umbellatum is practically poisonless in acute exposure; already the latex can cause hystological damages. The chronic use of S. umbellatum needs more specific studies.
Predominância do sexo masculino em recém-nascidos portadores da Síndrome de Down em diferentes situações citogenéticas

Nesta pesquisa investigamos, mediante estudo retrospectivo, a ocorrencia da predominância do sexo masculino entre os recem-nascidos portadores da sindrome de Down, diagnosticados clinica e citogeneticamente em nosso Servico de Genetica Clinica nos ultimos vinte anos. As analises cromossomicas foram realizadas em 50 metafases de linfocitos em coloracao convencional de Giemsa e bandamento G, demonstrando a presenca de 76 criancas do sexo masculino para 50 do sexo feminino, ou seja, “Sexratio” de 1,52 com x² calculado = 5,3650 (p < 0,05 ou 5%). Os nossos dados diferem dos da populacao geral e sao indicados de selecao biologica contra o sexo feminino nesta sindrome.
[INFOGRAPHIC] Medication use in autism spectrum disorders: What is the evidence?

Autism spectrum disorders (ASD) are complex neurodevelopmental disorders that involve significant social functional impairment and behavioral inflexibility. Autism is the most severe form of ASD and includes significant impairment in communication skills. Treatment of ASD is complex and involves a comprehensive educational interventional plan. Medications are used only as adjuncts, and only in cases in which maladaptive behaviors are severe or life-threatening, or to enable a patient to participate in their behavioral therapies. The most commonly used medications include second-generation antipsychotics (SGAs), selective serotonin reuptake inhibitors (SSRIs), and psychostimulants. Risperidone and aripiprazole are the only medications to carry an FDA indication to treat ASD-related symptoms. There is interest in using newer agents, such as atomoxetine, galantamine, rivastigmine, and memantine, to treat ASD-associated symptoms, but data are lacking to support their use.
Assisted Reproduction Techniques (Art): The State of the Art in Nigeria

Background: Infertility has become a social stigma in our environment because of the erroneous belief that a childless marriage is a failed marriage. This has placed a lot of marriages under pressure. Therefore any solution to infertility is a welcome relief. This is where Assisted Reproduction Techniques (ART) belongs. Aim: To present an overview of ART and review the state of the practice in Nigeria highlighting the benefits, limitations and the future of the ART. Findings: ART has grown from its humble beginning with IUI and IVF & ET in only one centre in Nigeria to more advanced techniques like ICSI and TESE in 3 notable centres. ICSI has enjoyed a better pregnancy rate than even the conventional IVF because of high male infertility in Nigeria. High cost of procedure, lack of skilled personnel and poor infrastructures are the major obstacles to the growth of ART in Nigeria. However, the coming of more centres has led to a price reduction and partnership with foreign centres has also provided the needed skill and experience. The joy of an infertile couple having a child of their own remains a driving force for ART is Nigeria and any success is a reduction in the infertility scourge. Conclusion: ART has therefore brought a ray of hope for the infertile couple. It is becoming more available and affordable in Nigeria with improving success rate. It should not be condemned entirely as it can be a last resort for some infertile couple who can afford it. Key words: Assisted Reproduction Techniques, Benefits and Limitations, Nigeria. (J College Med: 2003 8(1): 1-6)
Biomarkers for Huntington’s Disease

The core clinical features of Huntington’s Disease (HD) were outlined by George Huntington in 1872 (Huntington 1872). Like nowadays , in George Huntington’s time no cure for HD was yet available. However, genetic testing for HD that is now available can reliably predict the individuals at risk that will develop the disease. In such premanifest individuals slowing down the disease process may potentially delay the onset of disease symptoms. Therefore, there is an increasing need of finding the markers for the disease progression in premanifest HD individuals.
Effect of nursing implemented sedation and pain protocol on the level of sedation, pain and amount of sedative and analgesic drugs use among opium addicted critically ill patients

Background and Aim: Control of pain and sedation in addicted critically ill patients could be different from other admitted patients to intensive care unit (ICU). This study aimed to assess the effect of nursing implemented sedation and pain protocol on the level of sedation, pain and amount of sedative and analgesic drugs use in opium addicted critically ill patients. Methods: In a prospective, randomized, controlled trial from September 2011 to June 2012, this study has been conducted in Kerman, Iran. We randomly assigned 37 addicted mechanically ventilated patients who admitted to ICU in two groups; while in intervention group (group I), patients sedated using sedation and pain protocol, in control group (group II), addicted patients received usual, none protocol directed sedation and pain. Using Richmond Agitation Sedation Scale (RASS) and behavioral pain scale (BPS), the level of sedation and pain of patients was assessed in the time of ICU admission and every 4 hours for the first 2 days. Dosage of sedative and analgesic medications used (Morphine and Midazolam) was recorded in special chart every 6 hours by researcher during this period. Finding: Mean score of the RASS in time of ICU admission was -1.74±1.1 in group I and -1.81±1.1 in group II. During hospitalization in ICU, score of this scale reached up to -1.10±1.0 in group I and -1.63±1.1 in group II. In the time of ICU admission, mean of BPS in patients in group I and II were 7.9±1.3 and 8.0±1.6, respectively. During ICU stay, score of this scale reached to 5.8±1.6 in group I and 6.9±2.1 in group II. In addition, our results showed that group I patients have received less amount of Morphine and Midazolam in comparison with patients in group II. Conclusion: Our results suggested that using nursing implemented sedation and pain protocol for opium addicted critically ill, could lead to experience better sedation and lower level of pain as well as decreasing amount of sedative and analgesics drugs use with implementation of protocol.
Paraspinal amyotrophy in DNM-2-related centronuclear myopathy

Background Dynamin 2-related centronuclear myopathy (DNM2-CNM) is a rare congenital myopathy, and clinically, slowly progressive muscle weakness in the distal or proximal limbs, calf muscle atrophy, and pes cavus are features that are highly suggestive of DNM2-CNM. We experienced a case of DNM2-CNM who exhibited marked paraspinal amyotrophy on CT and showed a mutation in the GTPase effector domain (GED) of DNM2. Case presentation A 50-year-old man presented with a 5-year history of lumbar pain and slow progression of foot weakness. He showed bilateral pes cavus. Electromyography revealed a myopathic pattern, and nerve condition velocities and amplitudes were normal. Muscle CT showed marked fat replacement in the posterior compartment of the lower extremities, and also demonstrated severe involvement of the erector spinae muscles. Muscle biopsy from quadriceps femoris showed nuclear centralization in the majority of fibers. Sequence analysis of Dynamin 2 (DNM-2) demonstrated heterozygous c.1948G>A (p.E650 K) mutation compatible with the diagnosis of DNM2-CNM. Conclusions This case suggests that marked paraspinal amyotrophy may be a characteristic feature of DNM2-CNM. The selective involvement of the erector spinae muscles and posterior compartment of the lower extremities could offer a valuable feature for the diagnosis of DNM2-CNM.
Reversed Clinical and Morphologic Characteristicsof Idiopathic Childhood Nephrotic Syndrome

Background and Aims: Minimal change disease (MCD) is uncommon in Nigeria; in the sixties and eighties quartan malaria nephropathy accounted for more than 80.0% of all cases of childhood nephrotic syndrome (CNS). There is paucity of current clinical and morphologic data on CNS. This study therefore determined the incidence and prevalence of CNS, pre-treatment glomerular pathology of idiopathic CNS (ICNS), renal and patient outcome in steroid sensitive ICNS. Methods: A non-randomized prospective study of consecutive cases of Nigerian children with idiopathic nephrotic syndrome was conducted over a 9-year period. Results: CNS accounted for 1.26% of pediatric admissions. Fifty-four of 78 (69.2%) nephrotic children had ICNS (incidence, 0.44/100000/year). Median NS onset age was 7.1 (2.5-14.0) years. Male: female ratio was 1.7. The histopathologic lesions were membranoproliferative glomerulonephritis (MPGN, 44.4%), focal segmental glomerulosclerosis (FSGS, 25.9%), MCD (18.5%), mesangial proliferative glomerulonephritis (7.4%) and membranous nephropathy (3.7%). Overall cumulative complete remission (CR) rate 4 to 8 weeks post prednisolone treatment was 49.6%. Twenty-two of 25 with CR were early steroid responders while 3 were late responders. Median time to CR was 12.0 (3.0 – 46.0) days. Thirty relapses occurred; median time to first relapse was 11.0 months. Cumulative five-year relapse-free rate was 26.6%. Five-year renal survival was 16.1%. All patients with CR were followed-up for 6-93 (median, 22.0) months. Conclusions: Prevalence of non-MCD was very high with significant resistance to prednisolone; poor renal survival was due to high frequency of MPGN and FSGS. Pre-treatment renal biopsy is advocated in our kind of patients so that steroid-sparing agents can be started early.
Teenage Mothers and Their Partners. A Survey in England and Wales.

This monograph discusses the problems that face teenage mothers in the 15 months after the birth of their baby. A random sample was taken from births that occurred in 26 areas of England and Wales during 1979. Interviewers from the Office of Population Censuses and Surveys first visited the mothers in their homes when the babies were 2 to 4 months old. Of the 623 teenage women who were selected for inclusion in the study 533 were interviewed the 1st time round and 456 the 2nd time round. At both stages structgured questionnaires were used seeking primarily factual information. Some of the fathers were also interviewed. Of the 533 women interviewed 10% were aged 16 or younger when they gave birth to their baby and 20% were aged 17. The vast majority were aged 18 or 19. Teenage mothers tend to come disproportionately from working-class families. A slightly high proportion of the sample babies were of low birthweight; a relatively high proportion of the babies were premature. At the initial interview 2/3 of the teenage mothers thought things had worked out bette than they had expected when they 1st discovered their pregnancy. A year later nearly 90% of the mothers said they were still pleased they has their sample baby when they did. Though there had been some improvement in the womens hhousing situation between the 2 interviews 23% said they were now worse off financially than the previous year. In addition the proportion who described their marriage as happy the proportion who thought their sample baby was easy to look after the proportion who thought things had worked out better than they had expected and the proportion who thought things wer going very well for them were all lower than in the previous year. Problems such as marital violence and breakdown poor housing depression smoking and birth control failures are analyzed.
Gallstone and Diabetes Mellitus

Diabetes Mellitus (DM) is a metabolic disease which has high prevalence among the population. The prevalence is increasing in accordance to life style changes in the society. Gallstone is frequently found in diabetic patients especially in women with type 2 DM. Nevertheless, studies on the prevalence of gallstone among diabetic patients population have shown inconsistent/contradictive results. Insulin resistance which is frequently found in type 2 DM patients is the underlying factor that correlates obesity, central adiposity, and low physical activity with gallstone disease. Two important physiological reasons in diabetic patients that may increase the risk of gallstone formation are: (1) Increased total cholesterol synthesis that causes bile becomes more easily transformed into cholesterol stone (lithogenic); (2) Diabetic patients have larger size and probably reduced motility of the gallbladder that cause increased formation of cholesterol crystals. However, recent study demonstrated that DM that merely exists without any contribution of other factors is not significant to increase the risk of gallstone formation. The gallstone management in diabetic patients is the same as the management in non-diabetic patients. Elective surgery with laparoscopic cholecystectomy is the treatment of choice for symptomatic cases. Drug treatment is indicated for patients with cholesterol stone, small stone (diameter <5 mm), and well-functioned cystic duct. Keywords: diabetes mellitus, gallstone, insulin resistance, cholesterol synthesis, motility, laparoscopic cholecystectomy
Intracellular Renin Protects Cardiomyocytes from Ischemic Injury in Diabetic Heart

Background: Local Renin-Angiotensin-Aldosterone system (RAS) is important in cardiac pathophysiology. We investigated the expression and distribution of intracellular renin after ischemia, and the effects of renin on mitochondrial function in diabetic heart. Methods: In Goto-Kakizaki (DM) and Wistar (non-DM) rats, Langendorff-perfused hearts were subjected to ischemia by coronary artery ligation for 90 min. Infarct Size (IS) and expression of RAS components were examined. Mitochondrial membrane potential (ΔΨm), uncoupling protein-2 (UCP2), NAD/NADH ratio, and ATP were measured in renin-treated myocytes or isolated mitochondria. Results: After ischemia, LV function (LVDP; 76 ± 4 vs. 52 ± 4 mmHg, LVEDP; 18 ± 2 vs. 29 ± 4 mmHg, p<0.05, DM; n=9, non-DM; n=9, respectively) was prevented and IS (44.2 ± 2.1 vs. 53.7 ± 2.9 %, p<0.05) was significantly small in DM hearts. These cardioprotective effects were abolished when DM hearts were treated with direct renin inhibitor (LVDP; 77 ± 3 vs. 55 ± 4 mmHg, LVEDP; 16 ± 1 vs. 27 ± 3 mmHg, IS; 40.8 ± 2.9 vs. 52.1 ± 3.4 %, p<0.05, DM; n=5, DM plus DRI; n=5, respectively). Renin expression in the ischemic area was increased in DM hearts. Electron microscopy showed predominant renin localization within mitochondria. In permeabilized myocytes or isolated mitochondria, renin hyperpolarized ΔΨm, increased NAD/NADH ratio and preserved ATP content. Ischemiainduced UCP2 expression was reduced in DM. Conclusions: Intracellular renin, which mainly localizes within mitochondria, increased during ischemia and protected cardiomyocytes in diabetic hearts. This protective effect of renin is at least partially because of the reduction of UCP2 and the acceleration of electron transport chain, which resulted in the prevention of mitochondrial depolarization and ATP production.
Tactical Medicine: An Examination of Medical Training in Law Enforcement

In recent years, there has been a trend towards making law enforcement officers more well-rounded first responders by increasing their required medical competencies. The required medical competencies of six law enforcement agencies of varying sizes in Northeast Ohio were examined by interviews conducted with a representative from each agency. Interview question topics included information on current training requirements and the types of medical equipment issued to officers. The study found that all six of the agencies surveyed offered medical training to officers as part of required continuing education, and all six agencies currently issued, or planned to issue in the near future, first aid kits to officers. Many agencies indicated that in recent years additional medical competencies had been added to their agency’s training, including the use of tourniquets, which all agencies surveyed use and the anti-overdose drug Naloxone, which two departments use. Results of the surveys indicate that medical training is now considered a core part of law enforcement training and that law enforcement agencies view responding to medical emergencies as part of their role as first responders.
The Role of the Hypothalamus-Pituitary-Gonadal Axis in Breast Cancer: a candidate gene approach

textabstractThis chapter provides a general overview of breast cancer, including the possible role of genetic and exogenous factors and an overview of the role of hormones in carcinogenesis of the breast. Variability in susceptibility to the disease, timing of development, as well as tumor characteristics upon presentation and outcome of breast cancer, are likely to be affected by differences in both genetic and exogenous factors. The role of polymorphic variation in genes involved in hormonal control of carcinogenesis will be introduced. Breast cancer is the most frequently occurring malignancy in women, affecting women of all ages. More than 1 million new cases are diagnosed each year, accounting for almost one third of incident cases of cancer in women in Western industrialized countries . The cumulative lifetime risk, documented between 2000 and 2002, for women in the USA is 13% (1:8), while in The Netherlands the approximate lifetime risk is currently about 11% (1:9) (www.kankerregistratie.nl). In total over 400,000 women die each year worldwide of breast cancer (www.iarc.fr), making it the leading cause of death among women 35 to 55 years of age (3). Important aims of breast cancer research are prevention, early detection and reduction of mortality. Both basic molecular biological research and epidemiological investigations can help to achieve these goals by identification of women at risk, development of techniques for early diagnosis, prediction of outcome and response to therapy and finally optimization of targeted therapies resulting in tailoredtreatment. In essence, breast cancer, like all cancers, is a genetic disease resulting from an accumulation of somatic mutations and/ or altered expression of genes. In addition, breast cancer is a complex, multifactorial disease in which environmental factors and individual genetic background, including germline mutations and polymorphisms, may influence susceptibility, prognosis and response to treatment.
Dizziness: Interfacing Psychiatry and Neuro-Otology

Dizziness is one of the most frequent complaints in a medical office, for both primary and specialized care, and continues to be a challenge to clinical thinking. In the United States, dizziness is responsible for over 8 million medical visits per year. Its diagnostic investigation is expensive. According to an American study, it may cost up to US$2,532 to diagnose, and most of the time it is still inconclusive [1]. Thus, investigators are currently trying to find a controlled and multidisciplinary approach, in order to broadly and directly interfere on the causal and predisposing factors identified [2]. The life-time prevalence of dizziness in general population is estimated from 5.5% to 25– 30% in the United States depending on the criteria adopted [1, 3, 4]. Dizziness and other symptoms related to abnormalities in vestibular function or postural control are of particular interest for psychiatrists for two main reasons [5]. First, it is estimated that 20–50% of all patients with dizziness complaints also have important psychiatric symptoms capable of influencing the illness course [6]. In psychiatric practice, complaints of dizziness can be found as (a) symptom of a primary psychiatric disorder, like generalized anxiety disorders (GAD) or panic disorder, (b) prominent symptom without other medical condition clearly identified [7], or (c) symptom of coexisting psychiatric and medical conditions (comorbidity of an anxiety