Miracle-dz/UniFAR-FTUs huggingface dataset:
Infection by Spotted Fever Rickettsiae in People, Dogs, Horses and Ticks in Londrina, Parana State, Brazil

Spotted fever is a disease caused by bacteria from the genus Rickettsia of the spotted fever group (SFG). Rickettsia rickettsii is likely the main agent of Brazilian spotted fever (BSF). With the objective of gathering information on the circulation of SFG rickettsiae in Londrina, Parana state, ticks from dogs and horses and also blood from dogs, horses and humans were collected in a neighbourhood of the city which presented potential for circulation of rickettsiae between hosts and vectors. Amblyomma cajennense, Dermacentor nitens, and Rhipicephalus sanguineus ticks were subjected to Polymerase Chain Reaction targeting a fragment of the Rickettsia gltA gene. This specific gene encodes the enzyme citrate synthase of Rickettsia spp. , and results on all ticks were negative. Human and animal sera were tested by Indirect Immunofluorescence Assay in which R. rickettsii and R. parkeri were used as antigens. Sera from 4.7% human, 2.7% canine and 38.5% equine were positive for R. rickettsii. For R. parkeri, 0.9% human, 2.7% canine and 11.5% equine samples were positive. All samples reactive to R. parkeri also reacted to R. rickettsii. An epidemiological questionnaire was applied, but there were no statistically significant results. Comparison of our serological results with previous studies in Brazil, among BSF endemic and non‐endemic areas, indicates that there is no established rickettsial infection in the study area, a statement corroborated with our molecular analysis. Nonetheless, as humans of the present study are highly exposed to tick infestations, health education within the population is needed to obtain efficient tick control.
Assessment of Work-Related Injury Risk for Farmers and Ranchers with Physical Disabilities

This article reports on a study to determine the risk of work-related injury as perceived by farmers and ranchers with physical disabilities and whether or not this population actually experiences different frequencies or types of work-related injuries when compared to their able-bodied counterparts. The study was also designed to explore strategies for promoting safe work practices and preventing secondary injuries* while completing farm-related work following a disability. A survey instrument was developed and administered to 1,954 farmers and ranchers whose names appear on the mailing list of Purdue University’s Breaking New Ground Resource Center and who are known to have severe physical disabilities. The population surveyed was not a random sample of all farmers and ranchers who have a physical disability but rather a census of the largest known population of farmers and ranchers who have reported to be actively involved in agricultural production with significant physical disabilities. Slightly over 41% of those responding to the survey reported spinal cord injury as their disability and 29.7% reported either an upper or lower limb amputation. Thirty-one percent were farming full time with another 37.1% farming part-time. Twenty-five percent of the respondents reported having had a farm-related injury they believed was the result of their physical disability. Most secondary injuries were livestock-related, primarily beef cattle, followed by falls. The survey found that the nature of work-related injuries of farmers with physical disabilities tended to mirror those occurring to able-bodied farm operators except for the higher incidence of bruising and pressure sores occurring among the population reporting spinal cord injury as their disability type. The survey found that 60.1% of the respondents believed they were at a greater risk of being injured on their farm or ranch because of their physical disability. Survey results also indicated a need for specially designed educational materials related to safe work practices and preventing secondary injuries while completing farm-related work following a disability.
Advanced survey of tuberculosis transmission in a complex socioepidemiologic scenario with a high proportion of cases in immigrants.

BACKGROUND An increase in the incidence of tuberculosis (TB) in immigrants has changed the socioepidemiologic scenario in Spain. It is generally assumed that TB in immigrants is the result of importation of infection, but the role of recent transmission is rarely considered. Standard contact tracing is not suitable for the survey of transmission in this complex scenario. METHODS During the study period (2003-2006), we genotyped 356 (90.4%) of 394 isolates from patients with microbiologically confirmed TB in Almería, the province with the highest percentage of TB cases among immigrants in Spain. The epidemiologic survey of TB transmission was performed by active data collection using standardized interviews of the patients with TB and subsequent interviews of the clustered patients (who were clustered on the basis of the restriction fragment-length polymorphism types of their isolates) to identify transmission locations (supported by nominal and/or photographic recognition by the clustered patients). RESULTS Of all 356 genotyped isolates, 131 (36.8%) were clustered, suggesting recent transmission. The difference between the clustering rate for immigrants (32.8%) and that for native patients (41.6%) was not statistically significant (P = .087); of the 45 clusters, 15 (33.3%) involved only immigrants, 17 (37.8%) involved only autochthonous patients, and 13 (28.9%) involved both immigrants and autochthonous patients. The advanced system to investigate the clustered patients succeeded in detecting links in 10 of the 12 clusters that involved >4 patients, whereas the conventional approach, based on contact tracing, could detect links in only 2 clusters. CONCLUSIONS Recent transmission among immigrants and transmission permeability between the immigrant and autochthonous populations were found. Epidemiologic strategies that combine universal genotyping and refined surveys of the clustered patients are needed to investigate transmission patterns in complex scenarios.
Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era

Objective To assess predictors and reported treatment strategies of HIV-related fatigue in the combined antiretroviral (cART) era. Method Five databases were searched and reference lists of pertinent articles were checked. Studies published since 1996 on predictors or therapy of HIV-related fatigue measured by a validated instrument were selected. Results A total of 42 studies met the inclusion criteria. The reported HIV-related fatigue prevalence in the selected studies varied from 33 to 88%. The strongest predictors for sociodemographic variables were unemployment and inadequate income. Concerning HIV-associated factors, the use of cART was the strongest predictor. Comorbidity and sleeping difficulties were important factors when assessing physiological influences. Laboratory parameters were not predictive of fatigue. The strongest and most uniform associations were observed between fatigue and psychological factors such as depression and anxiety. Reported therapeutic interventions for HIV-related fatigue include testosterone, psycho-stimulants (dextroamphetamine, methylphenidate hydrochloride, pemoline, modafinil), dehydroepiandrosterone, fluoxetine and cognitive behavioural or relaxation therapy. Conclusion HIV-related fatigue has a high prevalence and is strongly associated with psychological factors such as depression and anxiety. A validated instrument should be used to measure intensity and consequences of fatigue in HIV-infected individuals. In the case of fatigue, clinicians should not only search for physical mechanisms, but should question depression and anxiety in detail. There is a need for intervention studies comparing the effect of medication (antidepressants, anxiolytics) and behavioural interventions (cognitive-behavioural therapy, relaxation therapy, graded exercise therapy) to direct the best treatment strategy. Treatment of HIV-related fatigue is important in the care for HIV-infected patients and requires a multidisciplinary approach.
Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa

Background:We assessed risk factors for viremia and drug resistance among long-term recipients of antiretroviral therapy (ART) in South Africa. Methods:In 2008, we conducted a cross-sectional study among patients receiving ART for 12 months or more. Genotypic resistance testing was performed on individuals with a viral load higher than 400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations. Results:Of 998 participants, 75% were women with a median age of 41 years. Most (64%) had been on treatment for more than 3 years. The prevalence of viremia was 14% (n = 139): 12% (102/883) on first-line [i.e. nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen] and 33% (37/115) on second-line (i.e. protease inhibitor (PI)-based regimen) ART. Of viremic patients, 78% had drug resistance mutations. For NRTIs, NNRTIs and PIs, the prevalence of mutations was 64, 81 and 2%, respectively, among first-line failures and 29, 54 and 6%, respectively, among second-line failures. M184V/I, K103N and V106A/M were the most common mutations. Significant risk factors associated with viremia on first-line regimen included concurrent tuberculosis treatment [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2–18.8, P < 0.01] and a recent history of poor adherence (OR 2.7, 1.3–5.6, P = 0.01). Among second-line failures, attending a public clinic (OR 4.6, 95% CI 1.8–11.3, P < 0.01) and not having a refrigerator at home (OR 6.7, 95% CI 1.2–37.5, P = 0.03) were risk factors for virological failure. Conclusion:Risk factors for viral failure were line regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI drug resistance mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.
Hormonal contraception and HIV acquisition: reanalysis using marginal structural modeling

Hormonal contraceptives are used widely worldwide; their effect on HIV acquisition remains unresolved. We reanalyzed data from the Hormonal Contraception and HIV Study using marginal structural modeling to reduce selection bias due to time-dependent confounding. Replicating our original analysis closely, we found that depo-medroxyprogesterone acetate (DMPA) but not combined oral contraceptive (COC) was associated with increased HIV acquisition. Also, young (18–24 years) but not older women who used DMPA and COCs were at increased HIV risk.
Prevalence and Characteristics of Staphylococcus aureus in Connecticut Swine and Swine Farmers

This study explores the characteristics of Staphylococcus aureus (S. aureus) in swine and their human handlers in a convenience sample of 35 farms in Connecticut. Husbandry practices are clearly different from better‐known concentrated animal feeding operations (CAFOs) with less intensive rearing conditions. Nasal samples were collected from 263 pigs and nine humans on 35 farms during the 2010 rearing season. Samples were analysed using established microbiology methods, and resulting methicillin‐sensitive (MSSA) and resistant (MRSA) isolates were typed by pulsed‐field gel electrophoresis (PFGE) and spa typing. PCR was used to detect the presence of the Panton‐Valentine Leukocidin (PVL) gene, a cytotoxin usually associated with CA‐MRSA infection. A farm assessment form and questionnaire were used to obtain the information about husbandry practices and human exposure risk, respectively. Staphylococcus aureus colonized swine and humans were found in 51% (18/35) of the farms sampled at a rate of 30% (85/259) and 22% (2/9), respectively. Eight pigs and two humans were MRSA positive on five farms. MRSA in swine was related to healthcare‐associated (HA), community‐associated (CA) or livestock‐associated (LA) MRSA strains, whereas humans were colonized with HA‐MRSA. On the basis of spa typing, there was evidence of human–animal transmission thereby signifying humanosis/reverse zoonoses. The PVL gene was found in 88% (7/8) of MRSA swine isolates, the first time this gene has been seen in colonized pigs sampled on US farm. MSSA isolates belonged to six spa types: t337 (41%), t034 (12%), t334 (12%), t4529 (12%), t8760 (18%) and t1166 (6%) including LA strains. This is the first time spa type t8760 has been reported and the only MSSA with the PVL gene. In summary, MRSA including LA strains (LA‐MRSA) can be found on small farms with different husbandry practices from CAFOs, suggesting that preventive measures for zoonotic MRSA infection should address a range of animal production.
Increased epicardial adipose tissue volume in HIV-infected men and relationships to body composition and metabolic parameters

Epicardial fat accumulation may have important clinical consequences, yet little is known regarding this depot in HIV patients. We compared epicardial fat volume in 78 HIV-infected men and 32 HIV-negative controls. Epicardial fat volume was higher in HIV-infected patients than that in controls (P = 0.04). In HIV patients, epicardial fat volume was strongly associated with visceral adipose tissue area (ρ = 0.76, P < 0.0001), fasting glucose (ρ = 0.41, P = 0.001) and insulin (ρ = 0.44, P = 0.0003). Relationships with glucose and insulin remained significant controlling for age, race, BMI, adiponectin, visceral adipose tissue and antiretroviral therapy. Epicardial fat may be an important fat depot in HIV-infected patients.
Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis.

BACKGROUND It has been axiomatic that echinocandins (e.g., caspofungin) are ineffective against mucormycosis. However, on the basis of preclinical data, we recently began treating rhino-orbital-cerebral mucormycosis (ROCM) with combination polyene-caspofungin therapy. METHODS To determine the impact of polyene-caspofungin therapy, ROCM cases identified by an International Classification of Diseases, Ninth Revision search were retrospectively reviewed to gather data on demographic characteristics, clinical history, and outcomes. The predefined primary end point was success (i.e., the patients was alive and not in hospice care) at 30 days after hospital discharge. RESULTS Forty-one patients with biopsy-proven ROCM were identified over 12 years; 23 (56%) of these patients were Hispanic, and 34 (83%) were diabetic. Patients treated with polyene-caspofungin therapy (6 evaluable patients) had superior success (100% vs. 45%; Pp.02) and Kaplan-Meier survival time (Pp.02), compared with patients treated with polyene monotherapy. Patients treated with amphotericin B lipid complex had inferior success (37% vs. 72%; Pp.03) and a higher clinical failure rate (45% vs. 21%; Pp.04), compared with patients who received other polyenes. However, patients treated with amphotericin B lipid complex plus caspofungin had superior success (100% vs. 20%; Pp.009) and survival time (Pp.01), compared with patients who received amphotericin B lipid complex alone. The benefit of combination therapy, compared with monotherapy, was most pronounced in patients with cerebral involvement (success rate, 100% vs. 25%; Pp.01). In multivariate analysis, only receipt of combination therapy was significantly associated with improved outcomes (odds ratio, 10.9; 95% confidence interval, 1.3- ;Pp.02). CONCLUSIONS Combination polyene-caspofungin therapy represents a promising potential alternative to polyene monotherapy for patients with ROCM. Randomized, prospective investigation of these findings is warranted.
EFFECT OF FIXATION DISPARITY ON STEREO‐ACUITY*

&NA; It is hypothesized that fixation disparity does play an important role in impairing stereo‐acuity. The basis for this hypothesis is discussed, as well as the apparatus and procedure used in the investigation. The experimental data are given, and it is seen that there is an increase in stereothreshold (decrease in stereo‐acuity) as fixation disparity is increased, although the relationship is not a simple linear one, but is rather complex. Some sources of error and suggestions for further research are then given.
Publication of clinical trial results: Time to wake-up

Scientific publications are important by-product of clinical trials and play a key role in the advancement of medical practice and research. Besides disseminating the efficacy and safety information for new drugs and indications, publications also bring forward the newer trends and techniques, and the drawbacks and limitations of clinical trials. This knowledge is indispensable and contributes to focused growth of clinical research. Importantly, the published data form the base of medical practice and decisions and hence important for physicians, patients, and healthcare payers. Nonetheless, it is a tribute to patients who participated in the trial so that several other patients like them can avail the benefit of the treatment if a drug is safe and efficacious. However, if the data from clinical trials are not adequately published, it thus prohibits the physicians, patients, and researchers from getting the desired benefit. Even the published data are incomplete and biased at times when compared to the study protocols, especially when results are unfavorable or negative. Despite the mandates from regulatory authorities, recommendations, and guidelines, the adherence to publication of clinical trial data remains partial and biased. Thus, this review describes the need for publishing clinical trial data, the challenges, and solutions in light of recommendations and threats.
Pilot Trial of N-acetylcysteine and Tigecycline as a Catheter-Lock Solution for Treatment of Hemodialysis Catheter–Associated Bacteremia

We evaluated a catheter-lock solution consisting of N-acetylcysteine, tigecycline, and heparin for catheter salvage in patients with hemodialysis catheter-associated bacteremia. Eighteen case patients received the catheter-lock solution for 14 days plus systemic antibiotic therapy. Treatment was successful for 15 (83%) of the 18 case patients within 90 days of follow-up, with a median catheter retention interval of 64.5 days. Trial registration. ClinicalTrials.gov identifier: NCT00614679.
Health and Mental Health Needs and Experiences of Minority Clients in Portugal

The paper addresses diversity, multi‐culturalism and mental health. It reports qualitative data from a larger project on multi‐cultural counselling competencies in Portugal which sought to meet the needs identified by specific minority groups by developing integrative, responsive and culturally sensitive treatments. A qualitative study is presented, with the aim of exploring the representations of mental health and illness held by ethnic minority groups in Portugal, as well as their specific needs and obstacles encountered in their interactions with health professionals. Semi‐structured interviews were conducted, and the results indicate that the meanings of health and mental health varied. Meanings of psychological health were related to general well‐being. Help‐seeking behaviours were associated with providing and receiving family and social support, mainly among participants of African descent. Although the great majority of participants had had no experience of counselling or psychotherapy, they expec.
Risk factors of highly pathogenic avian influenza H5N1 occurrence at the village and farm levels in the Red River Delta Region in Vietnam.

A case-control study at both village and farm levels was designed to investigate risk factors for highly pathogenic avian influenza H5N1 during the 2007 outbreaks in one province of Northern Vietnam. Data related to human and natural environments, and poultry production systems were collected for 19 case and 38 unmatched control villages and 19 pairs of matched farms. Our results confirmed the role of poultry movements and trading activities. In particular, our models found that higher number of broiler flocks in the village increased the risk (OR = 1.49, 95% CI: 1.12-1.96), as well as the village having at least one poultry trader (OR = 11.53, 95% CI: 1.34-98.86). To a lesser extent, in one of our two models, we also identified that increased density of ponds and streams, commonly used for waterfowl production, and greater number of duck flocks in the village also increased the risk. The higher percentage of households keeping poultry, as an indicator of households keeping backyard poultry in our study population, was a protective factor (OR = 0.95, 95% CI: 0.91-0.98). At the farm level, three risk factors at the 5% level of type I error were identified by univariate analysis: a greater total number of birds (P = 0.006), increase in the number of flocks having access to water (P = 0.027) and a greater number of broiler flocks in the farm (P = 0.049). Effect of vaccination implementation (date and doses) was difficult to investigate because of a poor recording system. Some protective or risk factors with limited effect may not have been identified owing to our limited sample size. Nevertheless, our results provide a better understanding of local transmission mechanisms of HPAI H5N1 in one province of the Red River Delta region in Vietnam and highlight the need to reduce at-risk trading and production practices.
Innate immunity to pneumococcal infection of the central nervous system depends on toll-like receptor (TLR) 2 and TLR4.

BACKGROUND Recent studies have suggested that, in addition to Toll-like receptor (TLR) 2, other pattern recognition receptors mediate activation of the immune response after infection of the central nervous system (CNS) with Streptococcus pneumoniae (SP). METHODS Using a mouse meningitis model, we investigated the influence of TLR4 single deficiency (TLR4(-/-)), TLR2/TLR4 double deficiency (TLR2/4(-/-)), and TLR2/TLR4/TLR9 triple deficiency (TLR2/4/9(-/-)) on the immune response of the CNS to SP infection. To identify the cell populations that mediate the responses to SP, we generated TLR2/4(-/-)-wild-type (wt) bone marrow (BM) chimeras. RESULTS Compared with infected wt mice, infected TLR2/4(-/-) and TLR2/4/9(-/-) mice had similar reductions in brain cytokine levels, pleocytosis, and cerebral pathologic findings, whereas no such effect was noted in infected TLR4(-/-) mice. The attenuated immune response was paralleled by an impaired host defense that resulted in worsening of disease. Analysis of the chimeric mice after infection showed that mere TLR2/4 deficiency, either of radioresistant cells or of transplanted BM-derived cells, was sufficient to mount a substantial cerebral immune response, such as that noted in wt mice. CONCLUSION In murine SP meningitis, TLR2 and TLR4 expressed on radioresistant and transplanted BM-derived cells were major cellular sensors of invading SP inducing inflammatory responses.