Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk of Breast Cancer According to Use of Antidepressants, Phenothizaines, and Anthistamines

In laboratory studies, some antidepressants caused increased growth of mammary tumors. The relation of use of these drugs to the development of breast cancer was examined in a hospital-based case-control study. Information, including lifetime medication history, was collected by interview from 5,814 women with primary breast cancer diagnosed within the previous year, 5,095 women with primary malignancies of other sites, and 5,814 women with other conditions. Relative risks were estimated by using unconditional multiple logistic regression for regular use (> or =4 days per week for > or =4 weeks beginning > or =1 year before admission) of antidepressants and structurally similar drugs. With reference to never use of each drug, relative risks were statistically compatible with 1.0 for selective serotonin reuptake inhibitors (SSRI), tricyclics, other antidepressants, phenothiazines, and antihistamines; results were very similar using both control groups. There were no significant increases in risk for any category of regular use, stratified according to cumulative duration of use or time interval since the most recent use or for any individual drug within the broader classes. However, the estimate for regular SSRI use in the previous year, 1.8, was of borderline statistical significance (95% confidence interval: 1.0, 3.3). The findings do not support an overall association between the use of antidepressants, phenothiazines, or antihistamines and breast cancer. However, the results for SSRIs are not entirely reassuring.
Patient Perceptions of Having 1st- and 2nd-Year Medical Students Involved in Their Care

Background: Medical student education has shifted to earlier clinical experiences and increased use of ambulatory settings. Little is known about patient perceptions of having 1st- and 2nd-year medical students involved in their care. Purposes: The purpose of this article is to study patient perceptions of having 1st- and 2nd-year medical students involved in their care in an ambulatory setting. Methods: In 2011 we surveyed 314 patients seen in 2 primary care clinics who saw 1st- or 2nd-year medical students. The survey included questions regarding patient visit satisfaction and perception of overall quality of the visit, adequacy of visit time, benefit of having a student involved in their care, and willingness to see a student in clinic again. Comparisons were made for patients who saw a student and a preceptor (n = 201) and patients who saw only the preceptor (n = 113). Results: Overall visit satisfaction was very high for patients who saw students (83% very satisfied) and patients who saw only the preceptor (91% very satisfied). More than 95% of patients were satisfied with the visit time, and all patients rated the overall quality of their visit as good or excellent. Eighty-five percent of patients would want to see a student again or had no preference. Forty-three percent of patients felt the presence of a student added value to their visit. White patients were more likely than non-White patients to be very satisfied with their visit and rated the overall quality of the visit as excellent. There were no differences based on student gender or year of training. Conclusions: Our results suggest that 1st- and 2nd-year students can be successfully integrated into clinical settings while maintaining patient satisfaction and perceived value of the care they receive.
Responsibly Managing Students’ Learning Experiences in Student-Run Clinics: A Virtues-Based Ethical Framework

Background: Many medical schools now offer students a distinctive clinical and learning opportunity, the student-run clinic (SRC), in which generalist physicians often play the major role. Although SRCs have become popular, they pose as-yet unexplored ethical challenges for the learning experiences of students. In SRCs students not only take on a significant administrative role especially in coordinating care, but also provide direct patient care for a clinically challenging, biopsychosocially vulnerable, medically indigent population of patients. SRCs provide an exemplar of the ethical challenges of care for such patients. Summary:The ethical framework proposed in this article emphasizes that these valued learning opportunities for students should occur in the context of professional formation, with explicit attention to developing the professional virtues, with faculty as role models for these virtues. Conclusions: The valued learning opportunities for students in SRCs should occur in the context of professional formation, with explicit attention to developing the professional virtues of integrity, compassion, self-effacement, self-sacrifice, and courage, which are required for the appropriate care of the vulnerable populations served by SRCs.
Computer Versus Paper—Does It Make Any Difference in Test Performance?

Construct: In this study, we examine the differences in test performance between the paper-based and the computer-based version of the Berlin formative Progress Test. In this context it is the first study that allows controlling for students’ prior performance. Background: Computer-based tests make possible a more efficient examination procedure for test administration and review. Although university staff will benefit largely from computer-based tests, the question arises if computer-based tests influence students’ test performance. Approach: A total of 266 German students from the 9th and 10th semester of medicine (comparable with the 4th-year North American medical school schedule) participated in the study (paper = 132, computer = 134). The allocation of the test format was conducted as a randomized matched-pair design in which students were first sorted according to their prior test results. The organizational procedure, the examination conditions, the room, and seating arrangements, as well as the order of questions and answers, were identical in both groups. Results: The sociodemographic variables and pretest scores of both groups were comparable. The test results from the paper and computer versions did not differ. The groups remained within the allotted time, but students using the computer version (particularly the high performers) needed significantly less time to complete the test. In addition, we found significant differences in guessing behavior. Low performers using the computer version guess significantly more than low-performing students in the paper-pencil version. Conclusions: Participants in computer-based tests are not at a disadvantage in terms of their test results. The computer-based test required less processing time. The reason for the longer processing time when using the paper-pencil version might be due to the time needed to write the answer down, controlling for transferring the answer correctly. It is still not known why students using the computer version (particularly low-performing students) guess at a higher rate. Further studies are necessary to understand this finding.
Ambroxol: A CNS Drug?

For almost three decades ambroxol has been used in the therapy of airway diseases. In 2002, ambroxol lozenges were marketed for the treatment of sore throat making use of its local anesthetic effect. Detailed investigations of ambroxol with modern pharmacological methods yielded additional interesting results: ambroxol has been found to have profound effects on neuronal voltage‐gated Na+, as well as Ca2+ channels, and to effectively reduce chronic inflammatory and neuropathic pain in rodents. The question was raised whether ambroxol affects the central nervous system (CNS) directly, or whether its effects can be explained solely by a peripheral action. This issue was addressed by reexamining pharmacokinetics, as well as toxicology of ambroxol. It has been concluded that even at the highest clinically used doses ambroxol does not have significant direct effects on the CNS. At clinically relevant plasma concentrations ambroxol either does not penetrate blood‐brain barrier, or its brain levels are too low to cause relevant effects. The analgesic effects of ambroxol by either systemic administration to animals, or by topical application in humans can be explained by ambroxol‐induced blockade of ion channels in peripheral neurons.
Lamotrigine inhibits postsynaptic AMPA receptor and glutamate release in the dentate gyrus

Purpose: The dentate gyrus (DG) is a gateway that regulates seizure activity in the hippocampus. We investigated the site of action of lamotrigine (LTG), an effective anticonvulsant, in the regulation of alpha‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole propionic acid (AMPA) and N‐methyl‐D‐aspartic acid (NMDA) receptor‐mediated excitatory synaptic transmission on DG.
Chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common problem in the elderly. The disease is characterised by intermittent worsening of symptoms and these episodes are called acute exacerbations. The best estimate, based on several lines of evidence, is that approximately half of all exacerbations are caused by bacteria. These lines of evidence include studies of lower respiratory tract bacteriology during exacerbations, correlation of airways’ inflammation with results of sputum cultures during exacerbations, analysis of immune responses to bacterial pathogens, and the observation in randomised, prospective, placebo-controlled trials that antibacterial therapy is of benefit. The most important bacterial causes of exacerbations of COPD are nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Chlamydia pneumoniae.
Sternum Sparing Thoracotomy Incisions in Lung Transplantation Surgery a Superior Technique to the Clamshell Approach

Objective Bilateral anterior transsternal thoracotomy incision (clamshell technique) is the standard approach used for bilateral sequential lung transplantation (LTX). The morbidity and wound complications of this large incision can be considerable and costly. Muscle sparing anterior thoracotomies without division of the sternum may lead to decreasing the sequelae of wound complications. The objective of this study was to determine the rate of wound complications in the nonsternal incising lung transplant patients. Methods We used the single-institution-based transplant data bank, phone questionnaire, and ambulatory care unit follow-up data to investigate retrospectively the incidence of wound healing complications following muscle and sternum sparing and mammary artery protecting limited access small submammary anterior thoracotomy incisions (AT) for LTX surgery. In the need for cardiopulmonary bypass, the femoral artery and vein were cannulated. Results After exclusion of seven clamshell operations for LTX combined with cardiac surgery, 91 recipients (65% male), aged 19 to 68 years (mean, 54 ± 8 years), underwent 84 AT and 48 lateral thoracotomies (LT) for idiopathic pulmonary fibrosis (IPF) (48%), obstructive disease (40%), cystic fibrosis (CF) (5%), and pulmonary arterial hypertension (PAH) (7%). AT ranged from 5.5 to 26 cm (mean, 20.3 ± 4.8 cm) and LT from 12 to 25 cm (mean, 19.8 ± 2.4 cm) and was not significantly different (P = 0.37). Warm ischemic times ranged from 30 to 92 minutes (mean, 56 ± 11 minutes). Four patients required rethoracotomy for bleeding/hematoma formation. Cardiopulmonary bypass/intraop extracorporeal membrane oxygenation (ECMO) was used in 64%. Superficial wound infection and subsequent drainage/care was needed in four LTX incisions. Reoperation for lung herniation using patch repair technique for thoracic wall stabilization was required in two AT and three LT. Conclusions Sternum sparing and mammary artery protecting limited access submammary anterior and lateral thoracotomy incisions for LTX surgery are safe and effective. This approach avoids complications related to sternal transaction and may minimize the development of severe wound complications following LTX surgery.
Double foramen transversarium in dried cervical vertebra: An osteological study with its clinical implications

Objectives: The aim of the present study was to know the incidence of double foramen transversarium (FT) in the dried cervical vertebrae and its clinical importance. Materials and Methods: A total number of 150 dried cervical vertebrae were collected from the department of anatomy to investigate the presence of double FT. The occurrence of double foramina was observed on both sides of the same vertebrae. Results: In the present study out of 150 cervical vertebrae, double FT was observed in 33 (22.00%) vertebrae among them double foramen seen unilaterally in 16 (10.67%) vertebrae and bilaterally in 17 (11.33%) vertebra. Conclusion: In the present study, bilateral double FT was found to be more common than unilateral, contrary to the findings as mentioned in most of the previous similar studies. This anatomical knowledge is clinically important since the course of the vertebral artery may be distorted in such situations and may result in certain clinical conditions like posterior headache, migraine, fainting attack, etc. This study may be useful to neurosurgeons and radiologists.
Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access to conception planning information and services among PLWHIV in Ontario, Canada. PLWHIV from three large and two small urban sites in Ontario were recruited (n = 63). Participants completed a cross-sectional survey assessing demographics, expectations and plans for conception, and knowledge about and access to existing conception information and services for PLWHIV. Univariate correlations and ranked analyses were used to assess the associations between the need for, knowledge of, and access to conception planning resources with various demographic variables. Participants’ median age was 40 years (interquartile range = 33–45) with 52% being female, 73% identified as heterosexual, and 27% as lesbian, gay, bisexual, queer, transgender, two-spirited, or other. Univariable analysis indicated that male PLWHIV and those from small urban areas were less likely to expect children in the future and less likely to speak to healthcare providers about conception planning. Although 63% of all participants intended to conceive and 44% had a plan for conception in the near future, only 30% had spoken to a healthcare provider about pregnancy and only 30% had some knowledge about conception planning and assisted reproductive services for safer conception for PLWHIV. Knowledge of and access to resources on conception planning for PLWHIV varied by sexual orientation and geographic location in Ontario. Our results show a gap between the need for conception information and knowledge of and access to adequate information and resources among PLWHIV in Ontario, which may impact the psychosocial well-being of PLWHIV and their children.
Coffee Adulteration: More than Two Decades of Research

ABSTRACT Coffee is a ubiquitous food product of considerable economic importance to the countries that produce and export it. The adulteration of roasted coffee is a strategy used to reduce costs. Conventional methods employed to identify adulteration in roasted and ground coffee involve optical and electron microscopy, which require pretreatment of samples and are time-consuming and subjective. Other analytical techniques have been studied that might be more reliable, reproducible, and widely applicable. The present review provides an overview of three analytical approaches (physical, chemical, and biological) to the identification of coffee adulteration. A total of 30 published articles are considered. It is concluded that despite the existence of a number of excellent studies in this area, there still remains a lack of a suitably sensitive and widely applicable methodology able to take into account the various different aspects of adulteration, considering coffee varieties, defective beans, and external agents.
Predictors of pharmacoresistant epilepsy: Pharmacoresistant rats differ from pharmacoresponsive rats in behavioral and cognitive abnormalities associated with experimentally induced epilepsy

Purpose: Patients with intractable temporal lobe epilepsy (TLE) exhibit an increased risk of psychiatric comorbidity, including depression, anxiety, psychosis, and learning disorders. Furthermore, a history of psychiatric comorbidity has been suggested as a predictor of lack of response to therapy with antiepileptic drugs (AEDs) in patients with epilepsy. However, clinical studies on predictors of pharmacoresistant epilepsy are affected by several confounding variables, which may complicate conclusions. In the present study, we evaluated whether behavioral alterations in epileptic rats are different in AED nonresponders versus responders.
Risk of autism spectrum disorders after infantile spasms: A population‐based study nested in a cohort with seizures in the first year of life

Purpose: No population‐based study has investigated the risk of autism spectrum disorders (ASDs) in children after unprovoked seizures with onset in the first year of life. Our objective was to determine whether infantile spasms were related to risk of ASD as compared to unprovoked seizures with onset in the first year of life after adjusting for symptomatic origin of seizures.
Comparison of Mycobacterium lentiflavum and Mycobacterium avium-intracellulare Complex Lymphadenitis

Background: Mycobacterium lentiflavum is considered a rare pathogen causing nontuberculous mycobacterial (NTM) lymphadenitis. Methods: A multicenter, retrospective study was performed in immunocompetent children <14 years of age with microbiologically confirmed NTM lymphadenitis treated at 6 hospitals in Madrid, Spain, during 2000–2010. We compared children with M. lentiflavum and Mycobacterium avium-intracellulare complex infection. Results: Forty-five microbiologically confirmed NTM lymphadenitis patients were identified: 19 (45.2%) caused by M. avium-intracellulare complex, 17 (40.5%) by M. lentiflavum, 1 by both and 5 by other mycobacteria. Out of 17 M. lentiflavum cases, 14 were diagnosed in the past 5 years. Regarding M. lentiflavum cases, median age was 23 months. Submandibular nodes were the most frequently involved (76.5%), with multiple locations seen in 41% of the children and spontaneous drainage in 41% of them. Drug susceptibility tests were performed in 14 isolates and showed a complete susceptibility to clarithromycin and cycloserine, whereas 93% were resistant to rifampin, 33% to quinolones and full resistance to other tested antimycobacterial drugs was detected. All but 1 child required surgery and 11 were treated additionally with various drug combinations. Total resolution was achieved in 50% of children within 6 months. Compared with M. avium-intracellulare complex cases, children were younger and laterocervical nodes were significantly less frequently involved. No statistically significant differences were found related to clinical characteristics, treatment and outcome. Conclusions: M. lentiflavum is an emerging pathogen producing NTM lymphadenitis in Madrid.
A phase 1, randomized study to assess the pharmacokinetic comparability of siltuximab derived from two different cell lines in healthy subjects

Siltuximab, a monoclonal antibody (mAb) against interleukin (IL‐6), is under development by Janssen Research & Development, LLC. During early clinical development, siltuximab was produced in a murine Sp2/0 myeloma cell line. The production cell line was switched to stably transfected Chinese hamster ovary (CHO) cell line for subsequent clinical development. A two‐part, parallel‐group, phase 1 study was designed to evaluate the safety and pharmacokinetics (PK) of a single IV administration of Sp2/0‐ and CHO‐derived siltuximab in healthy subjects. The results from this study demonstrated PK comparability of siltuximab produced from Sp2/0 and CHO cell lines. The 90% confidence interval of the ratios of geometric means of Cmax and AUC0–84day following 1.4 mg/kg doses was (99.4%, 111.3%) and (98.1%, 109.6%), respectively, both within the pre‐specified comparability range of 80–125%. Siltuximab derived from either the Sp2/0 or CHO cell lines was in general well tolerated and was not found to be immunogenic in this study.
Efficacy and Safety of Tipranavir Coadministered with Ritonavir in HIV-1-Infected Children and Adolescents: 5 Years of Experience

Background: To evaluate the long-term (up to week 292) safety, efficacy and tolerability of ritonavir-boosted tipranavir in HIV-1-infected pediatric patients. Long-term follow up of patients enrolled in the randomized, open-label pediatric trial (1182.14/PACTG1051). Methods: HIV-1-infected pediatric patients (2–18 years) who participated in the PACTG 1051 trial were followed for ritonavir-boosted tipranavir-based regimen efficacy, safety and tolerability through week 292. Results: In patients <12 years of age, 51/62 (82%) were receiving drug at week 48 and 13/62 (21%) at week 288. Among adolescents (12–18 years of age), 35/53 (66%) were receiving drug at week 48 and 2/53 (4%) at week 288. Among patients 2 to <6 years of age, 18/25 (72%) had viral loads <400 copies/mL at week 48. By week 292, 9/25 (36%) of patients had viral loads <400 copies/mL. Among older patients, week 48 responder rates were 35% (13/37 of patients 6 to <12 years of age) and 32% (17/53 of patients 12 to 18 years of age). By week 292, 6/37 (16%) of those 6 to <12 years of age and 2/53 (4%) of those 12 to 18 years of age had viral loads <400 copies/mL. Overall safety and tolerability profiles were best for children who initiated treatment between 2 and <6 years of age. Drug-related adverse events (investigator defined) were similar across all age groups (55–65%). Conclusions: Pediatric patients who begin treatment at the earlier ages, and who are stable on a ritonavir-boosted tipranavir-based regimen at week 48, generally continue to demonstrate good safety, tolerability and virologic efficacy profiles up to 292 weeks of treatment.
Population pharmacokinetic analysis of dutogliptin, a selective dipeptidyl peptidase‐4 inhibitor

Dutogliptin is a selective dipeptidyl peptidase‐4 inhibitor shown to be efficacious and safe in patients with type 2 diabetes mellitus (T2DM). Population pharmacokinetic (PK) analysis of dutogliptin was performed based on data collected in 561 healthy subjects and patients with T2DM enrolled in Phase I and II studies to assess sources of variability and support dosing rationale. The effect of extrinsic (formulations, fed/fasting conditions, potential drug–drug interaction with metformin) and intrinsic (baseline characteristics, markers of renal function, renal impairment category, and disease status) covariates was evaluated using non‐linear mixed effect modeling. Plasma concentrations of dutogliptin were best fitted with a two‐compartment model with a first‐order rate constant of absorption (Ka) and a lag time. No differences were observed between healthy subjects and patients with T2DM. Apparent clearance (CL/F) and terminal elimination half‐life of dutogliptin were 176 L/h and 12.2 hours, respectively. Typical CL/F values in patients with mild and moderate renal impairment were 121 and 79 L/h, respectively. No drug–drug interaction was observed with metformin. These results suggest that a reduction in dosing from 400 to 200 mg daily is warranted in T2DM patients with moderate renal impairment. No dose adjustments were deemed necessary for other evaluated patient characteristics and coadministration with metformin.