Miracle-dz/UniFAR-FTUs huggingface dataset:
Classification and clinical characterization of metabolically “healthy” obese children and adolescents

Abstract Background: Some obese children do not show cardiometabolic complications such as prediabetes, dyslipidemia or insulin resistance. The objective of the study was to classify obese children and adolescents as metabolically “healthy” obese (MHO) on the basis of three different definitions, and to compare cardiometabolic features with metabolically unhealthy obese (MUO) children and adolescents. Methods: The study included 156 obese children and adolescents aged between 10 and 18. Subjects were classified as MHO or MUO using three definitions based on the: (1) pediatric International Diabetes Federation (IDF) criteria; (2) homeostatic model assessment of insulin resistance (HOMA-IR); (3) combination of the previous two definitions. Cardiometabolic features were compared between MHO and MUO subjects. Results: Six to 19% obese children and adolescents were classified as MHO, and showed a better insulin sensitivity, lower prevalence of prediabetes, lower triglycerides and lower triglyceride-to-HDL-C ratio compared to MUO. Conclusions: Less than 20% obese children and adolescents are identified as MHO and show a healthier cardiometabolic profile as compared to MUO. Implementation of the proposed classifications in future clinical research could contribute towards the standardization of the MHO definition and offer new insights into the manifestation of the pediatric MHO phenotype.
Concurrent nonfunctional paraganglioma of the retroperitoneum and urinary bladder: A case report with literature review

Abstract Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology.
Effects of Breathing O2 or O2 + CO2 and of the Injection of Neurohumors on the PO2 of Cat Cerebral Cortex

Tissue PO2 was measured in the outer 1.7 mm of the brain of the lightly anesthetized cat by means of a micro O2 electrode introduced through a small hole in the skull. There was considerable variation from one location to another and from animal to animal. The interindividual variation was not related to the level of the arterial pressure or to rectal temperature. Individual values for the PO2 in 569 locations in the 11 cats ranged from 0 to 90 mm Hg with a mean of 25. There was a significant downward trend in PO2 from the surface layers inward. When the electrode was left in one location, the PO2 usually fluctuated, though not often rhythmically as seen in skeletal muscle. Breathing pure O2 (N = 41) or 95% O2 – 5% CO2 (N = 33) caused an equal (50%) increase in PO2. The intravenous injection of epinephrine or norepinephrine caused a primary rise in PO2 usually with a secondary decrease. Acetylcholine caused a primary decrease and usually a secondary increase.
Resolution of liver biopsy alterations in three siblings with bile acid treatment of an inborn error of bile acid metabolism (Δ4‐3‐oxosteroid 5β‐reductase deficiency)

Identical male twins and their brother, cholestatic from birth, with Δ4‐3‐oxosteroid 5δ‐reductase deficiency, were studied by serial liver biopsy. Spectrometry documented defective primary bile acid synthesis and markedly increased levels of atypical oxo and allo bile acids in urine and serum. Hepatocellular cholestásis and giant‐cell transformation resolved in parallel with clinical and biochemical recovery during oral bile acid administration. In the twins, portal fibrosis stabilized at a mild level; they are well as 5‐yr‐olds at this writing. Follow‐up biopsy in their brother at 8 mo was normal, and he is doing well at 3 yr of age. Hepatic ultrastructural alterations in all three were characterized by abnormalities of bile canaliculi including small bile plugs, diverticulae and latticelike elaborations of hepatocellular membranes adjacent to bile canaliculi that were shown to have resolved completely on subsequent biopsies. Eight additional cases have been detected on urine screening; only two of these patients have survived, on bile acid therapy. Early diagnosis and treatment improves the prognosis of this otherwise lethal inborn error of bile acid synthesis. (HEPATOLOGY 1993; 18:1096‐1101).
Glycemic variability predicts inflammation in adolescents with type 1 diabetes

Abstract Background: Adolescents with type 1 diabetes (T1D) have increased risk of cardiovascular disease as well as elevations in biomarkers of systemic inflammation, plasma protein oxidation and vascular endothelial injury. It is unclear whether hyperglycemia itself, or variations in blood glucose are predictors of these abnormalities. Methods: This study was designed to determine the relationship of inflammatory (C-reactive protein, CRP), oxidative (total anti-oxidative capacity, TAOC) and endothelial injury (soluble intracellular adhesion molecule 1, sICAM1) markers to glycemic control measures from 3 days of continuous glucose monitoring (CGM) and to hemoglobin A1c (HbA1c), and HbA1c×duration area under the curve (A1cDur). Results: Seventeen adolescents (8 F/9M; age, 13.1±1.6 years (mean±SD); duration, 4.8±3.8 years, BMI, 20.3±3.1 kg/m2; A1c, 8.3±1.2%) were studied. Log CRP but was not related to age, duration, body mass index (BMI), HbA1c, or A1cDUR. TAOC increased as logA1cDUR increased (n=13, r=0.61, p=0.028). CRP and sICAM were not related to CGM average glucose but log CRP increased as 3 day glucose standard deviation increased (r=0.66, p=0.006). TAOC increased as glucose standard deviation increased (r=0.63, p=0.028). Conclusions: Increased glucose variability is associated with increased inflammation in adolescents withT1D. Increased TAOC with increasing variability may be an effort to compensate for the ongoing oxidative stress.
Ultrasound-guided omental biopsy: Review of 173 patients

Background: Omental biopsy has conventionally been performed using a surgical approach. USG-guided omental biopsy is a safe and effective alternative. The purpose of this study was to assess the utility of USG guidance for biopsy of the greater omentum. Study design: Retrospective study. Materials and Methods: We retrospectively reviewed all omental biopsies performed under USG guidance from April 2006 to March 2010 in a tertiary care hospital. Results: One hundred and seventy-three patients were included. Out of these, 82 (47%) patients were diagnosed to have malignancies, 58 (34%) patients had granulomatous inflammation either suggestive of or consistent with tuberculosis, 29 (17%) patients were diagnosed to have inconclusive biopsy results, and 4 (2%) patients had an inadequate sample for histopathological examination. There were no major procedure-related complications. Conclusion: USG-guided biopsy of the omentum is a safe and effective procedure. A thickened omentum can serve as an easily accessible site for biopsy, especially in patients who have ascites of unknown etiology and in those with a history of previous malignancy.
Interstitial MRI lymphangiography of the lower limbs

Dear Sir, We read the article “Technical note: MRI lymphangiography of the lower limb in secondary lymphedema” by Kamble et al., published recently in your journal with great interest. [1] We concur with the authors that the investigation of secondary lymphedema has been enigmatic with direct lymphangiography being too invasive and lymphiscintigraphy having poor spatial and temporal resolution. The authors have rightly pointed out that indirect contrast-enhanced MRI lymphangiography offers excellent visualization of the lower limb lymphatics in secondary lymphedema. The greatest advantage of this technique is the absence of radiation exposure, the multiplanar capability of MRI allowing for precise compartmental localization (epifascial/subfascial/intramuscular) and accurate depiction of the extent of abnormality. We would like to point out that one of the major limitations of the technique is poor visualization of inguinal lymph nodes after intradermal injection of contrast in the feet. We would also like to share our experience of indirect MRI lymphangiography with a newer MRI contrast agent with high relaxivity, gadobenate dimeglumine (0.5 mmol/L MultiHance, Bracco, Milano, Italy). We have found gadobenate dimeglumine to provide more detailed depiction of the lymphatic anatomy in the small number of patients that we have done [Figure 1A and B]. Lohrmann et al. have demonstrated frequent visualization of inguinal lymph nodes after injection of gadoteridol (ProHance, Bracco-Altana, Konstanz, Germany) one of the newer contrast agents. [2] The use of newer contrast agents with higher relaxivity thus offers the possibility of simultaneous depiction of the lymphatic channels and the lymph node groups.
Severity of Menopausal symptoms and the quality of life at different status of Menopause: a community based survey from rural Sindh, Pakistan

Background: Menopause is the time in women’s life when her ovaries stops producing Estrogen and Progesterone, the deficiency of these hormones elicit various somatic, psychological, vasomotor and sexual symptoms that affect the overall quality of life of women. Assessment of quality of life during menopause deserves special attention as with increase in the life expectancy women lives about one third of their lives with hormone deficient state. Studies on menopause and quality of life of menopausal women are scarce and none is conducted before among rural women of Sindh Province, Pakistan. Objective: To investigate the severity of menopausal symptoms associated with menopausal status and to determine the quality of life of menopausal women from rural Sindh. Material and Methods: This cross-sectional survey was conducted in 19 Union Councils of Matiary district, Hyderabad Division from November 2007 to October 2008. Among 5, 25,082 population dwelling in 1509 villages and 56,053 households of these Union Councils, 3062 women were selected by multistage random sampling method within the age range of 40-70 years. Along with collection of socio-demographic data the Menopause rating Scale (MRS) and WHO Quality of life Brief (WHO QOL Brief) Questionnaire translated in Sindhi Language were filled for each individual subject. Data was entered and analyzed by SPSS V 15. Results: The mean age at Menopause was 49.38±14.29 years; the mean scores of menopause rating Scale were high in all domains, the significant difference was found in the mean somatic scores of women in Premenopause, perimenopause and post menopause status (P=<0.001). The psychological symptoms were more severe for women in perimenopause and post menopause status while the scores for urogenital symptoms were found to be higher in perimenopause women (P=<0.001). The mean scores for the physical, psychological, social and environmental domains of WHO QOL questionnaire were found significantly impaired for all women at different status of menopause. Conclusion: To best of our knowledge this is the first attempt to provide data on menopause and quality of life of women from rural Sindh. The mean scores of all the domains of Menopause rating scale were significantly high in Peri and postmenopausal women fromrural Sindh. The severity of menopausal symptoms decreases the quality of life in everyday life of these rural women.
Sunitinib induced nephrotic syndrome and thrombotic microangiopathy

Sunitinib is an oral, multitargeted receptor tyrosine kinase inhibitor of targets such as vascular endothelial growth factor and platelet derived growth factor receptor. It is used for the treatment of metastatic renal cell carcinoma (RCC). Use of sunitinib has been associated with renal dysfunction and nephrotic syndrome. However, simultaneous occurrence of nephrotic syndrome and renal dysfunction in a patient treated with sunitinib is rare. We report a case of metastatic RCC treated with sunitinib for 22 months who presented with nephrotic syndrome and renal dysfunction. Renal biopsy was diagnostic of thrombotic microangiopathy with diffuse effacement of podocytic foot process.
Emphysematous pyelonephritis: A single center study

We present our experience of 22 cases of emphysematous pyelonephritis (EPN) treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT) scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females) of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22). Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV) with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.
Relation between circulating oxidized-LDL and metabolic syndrome in children with obesity: the role of hypertriglyceridemic waist phenotype

Abstract Background: The association between oxidative stress (OS) and metabolic syndrome (MetS) has been reported in adults. We analyzed the relation between circulating oxidized low-density lipoproteins (Ox-LDL) and MetS in pediatric ages in order to define whether plasma Ox-LDL levels are correlated to obesity and whether oxidative damage, using serum Ox-LDL levels as a proxy, are associated with MetS. Methods: We enrolled 178 children (11.8±2.6 years). On the basis of a body mass index (BMI) threshold, the subjects were classified as: normal weight BMI <75th percentile; overweight BMI 75–97th percentile; obese BMI >97th percentile. Patients were classified as having MetS if they met three or more of the following criteria for age and sex: BMI >97th percentile, triglyceride levels >95th percentile, high-density lipoprotein (HDL) cholesterol level <5th percentile, systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) >95th percentile and impaired glucose tolerance. Results: Obese children showed increased MetS prevalence (p=0.001) and higher Ox-LDL levels compared to normal- and overweight subjects (p<0.05), with a limited relation between Ox-LDL and MetS (p=0.06). Waist-to-height ratio (W/HtR) (p=0.02), triglycerides (TG) (p=0.001) and LDL-cholesterol (p<0.001) resulted independent predictors of increased plasma Ox-LDL levels. Conclusions: Oxidative damage was correlated with a hypertriglyceridemic waist phenotype and can be a precocious marker of MetS and cardiometabolic risk in obese children.
No detection of Helicobacter pylori in atherosclerotic plaques in end stage renal disease patients undergoing kidney transplantation

Chronic infection known to be a predisposing factor for the development of atherosclerosis. Several studies have found a possible role of Helicobacter pylori in the pathogenesis of atherosclerosis. The aim of this study was to investigate the presence of H. pylori in atherosclerotic plaques in iliac arteries in 25 end stage renal disease (ESRD) patients undergoing kidney transplantation. Esophagogastroduodenoscopy was performed in all patients before transplantation. Biopsy specimens obtained from gastric antrum were sent for pathologic evaluation. Gastric H. pylori infection was confirmed by microscopic assessment and rapid urease test. Arterial specimens were obtained from iliac arteries during kidney transplantation. Presence of H. pylori DNA in atherosclerotic plaques and healthy vessel samples was evaluated by the polymerase chain reaction (PCR). The mean age of patients was 44.1 ± 22.6 years. Risk factors in patients with atherosclerosis were hypertension (68%), diabetes mellitus (20%), hyperlipidemia (20%), positive family history (16%). Atherosclerotic plaques were found in 21 (84%) patients. PCR analysis did not detect H. pylori in any case. There was a significant relationship of atherosclerosis with hypertension (P = 0.006) but not with diabetes mellitus and hyperlipidemia (P = 0.5). There was no significant relationship between atherosclerosis and gastric H. pylori infection (P = 0.6). This study revealed no association between the presence of H. pylori as a pathogen of vessel walls and atherosclerosis in ESRD.
Acute interstitial nephritis due to proton pump inhibitors

Proton pump inhibitors (PPI) are commonly prescribed for dyspepsia and acid peptic disease. Acute interstitial nephritis (AIN) is an uncommon though important side-effect of these classes of drugs. We describe four cases: three females and one male. PPIs implicated were pantoprazole in two, omeprazole and esomeprazole in one each. AIN developed after an average period of 4 weeks of drug therapy. The symptoms were vomiting, loin pain, and oliguria. Minimal proteinuria with pyuria were seen and the mean serum creatinine was 4.95 ± 4 mg/dl. Two patients required hemodialysis. Renal biopsy showed interstitial mononuclear, plasma cell and eosinophilic infiltrates in all cases. PPI was stopped and steroids were started in all. Renal recovery was total in two and partial in two. A high index of suspicion is required to diagnose PPI induced AIN. Renal biopsy for confirmation followed up by prompt steroid therapy results in renal functional improvement.
Cross sectional studies: advantages and disadvantages

A cross sectional study design was used to investigate the extent of chronic fatigue and the associated psychosocial exposures in a developing country. The setting was a primary health centre catchment area in Goa, India. Participants were women aged 18-50 years. The primary outcome was reporting of fatigue for at least six months. Data on the primary outcome and psychosocial exposures were obtained by a structured interview. The psychosocial exposures that were investigated included mental health and gender disadvantage factors. The presence of anaemia was determined from a blood sample.1 The sampling frame consisted of 8595 eligible women listed in family health registers. In total, 3000 randomly sampled women were invited to participate and 2494 (83%) consented. Recruitment took place from November 2001 to May 2003. It was reported that 12.1% (95% confidence interval 10.8 to 13.4%) of women experienced chronic fatigue. Those psychosocial exposures most strongly associated with chronic fatigue were poor mental health and sexual violence by the husband. Which of the following statements, if any, are true?
Toxicity and efficacy of carbon nanotubes and graphene: the utility of carbon-based nanoparticles in nanomedicine

Abstract Carbon-based nanomaterials have attracted great interest in biomedical applications such as advanced imaging, tissue regeneration, and drug or gene delivery. The toxicity of the carbon nanotubes and graphene remains a debated issue although many toxicological studies have been reported in the scientific community. In this review, we summarize the biological effects of carbon nanotubes and graphene in terms of in vitro and in vivo toxicity, genotoxicity and toxicokinetics. The dose, shape, surface chemistry, exposure route and purity play important roles in the metabolism of carbon-based nanomaterials resulting in differential toxicity. Careful examination of the physico-chemical properties of carbon-based nanomaterials is considered a basic approach to correlate the toxicological response with the unique properties of the carbon nanomaterials. The reactive oxygen species-mediated toxic mechanism of carbon nanotubes has been extensively discussed and strategies, such as surface modification, have been proposed to reduce the toxicity of these materials. Carbon-based nanomaterials used in photothermal therapy, drug delivery and tissue regeneration are also discussed in this review. The toxicokinetics, toxicity and efficacy of carbon-based nanotubes and graphene still need to be investigated further to pave a way for biomedical applications and a better understanding of their potential applications to humans.
Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial

ABSTRACTObjective: Understanding how nonpharmacologic interventions differentially affect the subgroups of patients with chronic fatigue syndrome (CFS) might provide insights into the pathophysiology of this illness. In this exploratory study, baseline measures of normal versus abnormal cortisol were compared on a variety of immune markers and other self-report measures. Normal versus abnormal cortisol ratings were used as predictors in a nurse-delivered nonpharmacologic intervention. Methods: Participants diagnosed with CFS were assigned to 6-month nonpharmacologic interventions. Individuals were classified as having abnormal or normal cortisol levels on the basis of scores over the five testing times. Cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time. Results: Across interventions, those with abnormal cortisol at the baseline appeared not to improve over time, whereas those with normal baseline cortisol evidenced improvements on a number o.
Molecular serotyping of Streptococcus pneumoniae

v ABSTRACT Streptococcus pneumoniae, known as the pneumococcus, remains the leading cause of mortality and morbidity worldwide in children <5 years due to pneumonia, with the highest burden of disease in developing countries. The pneumococcus is responsible for a variety of diseases, from localised infections such as otitis media and sinusitis, to life-threatening diseases such as meningitis and pneumonia. The polysaccharide capsule, exterior to the cell wall, is the major virulence factor of the organism. To date, 93 different capsular types, called serotypes, have been described. These differ in their chemical structures, and <15% of serotypes are responsible for majority of pneumococcal disease worldwide. Some serotypes have a higher invasive potential than others, while some are associated with more severe outcome than others. There is also a geographic and age-specific variation in the distribution of serotypes. Pneumococcal diseases are largely vaccine preventable. The current vaccine formulations contain serotypes that are most prevalent across regions. The licensed polysaccharide and polysaccharide conjugate vaccines (PCV) contain at least 23 and 10 or 13 of most prevalent serotypes, respectively. Serotypes that were historically not commonly associated with invasive pneumococcal disease (IPD) are increasing in prevalence due to the reduction of vaccine serotypes. Thus, it is important to monitor serotype distribution for future vaccine formulations and to determine the vaccine effectiveness in the region. The “gold standard” for serotyping, the Quellung reaction, is dependent on the viability of the organism, and hence it is problematic in settings where a culture cannot be obtained due to insensitivity of blood cultures, incorrect culturing techniques, initiation of antibiotic therapy