Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of chronic treatment with acetylsalicylic acid and clopidogrel on atheroprogression and atherothrombosis in ApoE-deficient mice in vivo

Summary Acetylsalicylic acid (ASA) and the thienopyridine clopidogrel are established anti-platelet drugs that significantly reduce secondary cardiovascular events in patients with manifest atherosclerosis. However, their impact on atherosclerotic lesion development remains controversial. Four-week-old ApoE-deficient mice were randomly assigned to four groups receiving a cholesterol diet together with either ASA (5 mg/kg), or clopidogrel (25 mg/kg), or a combination of both ASA and clopidogrel, or vehicle for 8–12 weeks. Using intravital microscopy we found that daily administration of ASA in combination with clopidogrel reduces platelet thrombus formation following rupture of atherosclerotic plaque in vivo by ∼50%. However, therapy with ASA or clopidogrel alone, or in combination for a period of 8–12 weeks had no significant effect on adhesion of platelets to dysfunctional endothelial cells or on atherosclerotic lesion formation in the aortic root or the carotid artery. In conclusion, anti-platelet therapy is effective in reducing platelet adhesion and subsequent thrombus formation following rupture of atherosclerotic plaque in vivo. However, our data do not support a role of either drug in the primary prevention of atherosclerosis in ApoE-deficient mice.
Case Report: Guillain-Barré Syndrome following Renal Transplantation - A Diagnostic Dilemma

Background: Guillain-Barré syndrome (GBS) is an acute polyneuropathy caused by an autoimmune response towards a foreign antigen, notably viral infections. It is characterised by a symmetrical ascending paralysis with treatment remaining largely supportive; however, plasma exchange or intravenous immunoglobulins can be used to shorten recovery time. Case Report: We describe a case of severe acute GBS in a patient post-renal transplantation. The 44-year-old gentleman's induction therapy consisted of methyl prednisolone and basiliximab, with subsequent tacrolimus and mycophenolate mofetil as immunosuppressive agents. Tacrolimus was discontinued immediately on suspicion of a temporal relationship with the patient's condition, and substituted with a combination of ciclosporin, mycophenolate mofetil and prednisolone. Due to extensive patient screening prior to transplant, negative virology/immunology and normal nerve biopsy findings, both tacrolimus and basiliximab may be indicated as causative agents. Conclusion: Immunosuppressive-induced GBS should be considered a differential diagnosis in patients on tacrolimus or basiliximab with acute-onset limb weakness, especially if recently commenced. Discontinuation of tacrolimus and initiation of plasma exchange for the treatment for tacrolimus-associated GBS may be beneficial.
The Changing Role of Pathology in Breast Cancer Diagnosis and Treatment

Pathological examination has been the gold standard for diagnosis in cancer and its role has also included the elucidation of etiology, pathogenesis, clinicopathological correlation, and prognostication. The advent of newer technologies and the realization that breast cancer is heterogeneous has shifted the focus to prognostication, with increased attention being paid to the identification of morphological features and immunohistochemical markers of prognostic relevance. However, despite the massive efforts invested in the identification of immunohistochemical biomarkers in breast cancer the majority have not proven to be of value in multivariate analyses and only estrogen receptor, progesterone receptor, and Her2/neu expression have remained essential components of pathological examination. These 3 markers were initially employed for prognostication but their role in treatment also rendered them of predictive value. Newer molecular methods, especially high-throughput technologies, have shown that even morphologically similar subtypes of breast cancer can show molecular heterogeneity; moreover, infiltrating ductal carcinoma can be separated into at least 4 molecular subtypes designated luminal (ER+, PR+, and Her2/neu–), Her2 overexpressing (ER–, PR–, and Her2/neu+), basal-like (ER–, PR–, Her2/neu–, and CK5/6+, EGFR+), and normal breast-like (ER–, PR–, and Her2/neu–), each with different clinical outcomes. The importance of proliferative gene expression in these subtypes has been demonstrated and surrogate immunohistochemical markers include ER, PR, Her2/neu, and Ki67 for the more expensive molecular tests. Molecular technologies, importantly, have not only provided further insights into the heterogeneity of breast cancer but have also opened new avenues for treatment through the identification of signaling molecules important in the proliferation and survival of the neoplastic cells. The treatment of cancer thus shifts from the conventional approach of ‘one size fits all’ to one of personalized treatment tailored to the specific characteristics of the tumor. Pathologists continue to play their traditional role in diagnosis but, as purveyors of the excised tissue, pathologists now have the additional role of identifying biomarkers responsive to therapeutic manipulation, thus playing an inextricable role as diagnostic oncologists in the management of breast cancer.
Self-efficacy, decisional balance and stages of change for condom use among women at risk for HIV infection

Introduction Theory-based models of HTV prevention need to be tested using appropriate measures with populations at high risk. Data from interviews with 4036 women recruited from facilities and randomly sampled from high-risk communities were used to examine the mediating variables specified by the Transtheoretical Model (TM). The analysis aimed to test the reliability of brief self-efficacy and decisional balance measures, assess the relationships of these measures to stages of change for condom and contraceptive use, and examine the extent to which these findings are consistent for women interviewed in different settings. The results indicated that the scales measuring self-efficacy and advantages (pros) of the behaviors were moderately to highly reliable, while those measuring disadvantages (cons) were much less reliable. Results were similar for women recruited from community and from facility settings. Possible explanations for the low reliabilities for cons were examined. Significant differences in mean scores by stage of change were found for all measures of self-efficacy , pros and cons. These findings are consistent with patterns predicted byTM.
Turbinoplasty Using Submucosal Microdebrider, Radiofrequency And Conventional Surgical, What Is The Best?

Background: Nasal inferior turbinate hypertrophy is one of the most common causes of nasal obstruction. Many different surgical methods are currently available. Study Design and Objectives: This retrospective observational study was conducted for 3.5 years (between 2009 - 2012) to determine the best objective result technique of powered submucosal inferior turbinoplasty using special microdebrider blade for turbinoplasty comparing it with Radiofrequency turbinoplasty and conventional surgical turbinoplasty and follow up of the patients to detect any possible complications and an objective result. This operation was done in Al-Azhar University Hospitals in Egypt. The mean follow-up time was 2 years. Results: The study showed significant difference in bleeding between the three groups postoperatively (P 0.05). Acoustic rhinometry showing significant improvement in width of minimal cross sectional area in all groups after 6 months, 1 and 2 years (P 0.05) between the three groups after 6 months postoperatively but after 1 and 2 years there was a significant difference between the three groups (P <0.05). Conclusion: Radiofrequency turbinoplasty is the procedure, which can be done under local anesthesia. The microdebrider submucosal turbinoplasty is the procedure of highest efficacy and least complication so it must be the procedure of choice if the device is available
Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis

Background: With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV. Methods: We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV. Results: In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8–83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68–2.77). Over the past 26 years, the global population–attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%–0.56%) to 0.92% (95% CI, 0.55%–1.41%), and DALYs increased from 0.74 (95% CI, 0.44–1.16) to 2.57 (95% CI, 1.53–3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43–1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23–0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho. Conclusions: People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions. Clinical Trial Registration: URL: https://www.crd. york.ac. uk/prospero. Unique identifier: CRD42016048257.
Patient and Provider Views on Informed Consent for Cardiac Catheterization: A Pilot Study

Background: Patient provision of informed consent is foundational to medical decisionmaking. However, clinical informed consent is not as well studied as consent for research. Cardiac catheterization (CC) is a complex medical procedure with many potential variations, making informed consent challenging. Objective: To determine patient and provider attitudes toward the informed consent process for CC and to test a new measure for measuring patient capacity to consent for CC. Design: A mixed methods pilot study. Setting: Academic medical center. Participants: 8 patients who consented for non-emergent CC, cardiology fellows and faculty (21 surveyed, 7 interviewed). Measurements: Patients and providers underwent semi-structured interviews, which were qualitatively coded for themes. Patients completed an instrument designed to measure capacity to consent for CC. Providers completed a survey to gauge attitudes about the consent process for CC. Results: Most patients (75%) did not meet the 70% performance testing for capacity derived from a provider survey as a minimum for providing consent. Patients did not view the consent discussion as part of medical decision-making. In emergent situations, patients requested that providers apply pressure to convince patients to undergo necessary procedures. Providers believed proper informed consent was important, but admitted to less emphasis in emergencies, and they often used family to help patient consent in such situations. Patient and providers described common themes in informed consent. Conclusions: The instrument developed herein for measuring capacity to consent for CC has promise for providing valid and reliable data. Most patients tested did not have capacity by criteria set by providers, suggesting that the informed consent process was inadequate. Patients and providers expressed a role for applying pressure to convince patients to consent to emergent procedures.
Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants.

OBJECTIVES. The objectives of this study were to determine the prevalence of hyperglycemia in extremely low birth-weight infants and to determine whether hyperglycemia increases the risk of early adverse outcomes (death or intraventricular hemorrhage of grade 3 or 4) and/or affects the length of hospital stay among survivors without intraventricular hemorrhage. METHODS. The charts of all extremely low birth-weight infants (n = 93) admitted to Texas Children9s Hospital (Houston, TX) during 2001 were reviewed. The highest daily blood glucose concentrations, highest dopamine infusion rates, highest daily percentage of inspired oxygen, and mean blood sodium concentrations were averaged over the first week of life or before death or occurrence of grade 3 or 4 intraventricular hemorrhage. Among survivors without severe intraventricular hemorrhage, the time ratio for blood glucose concentrations of >150 mg/dL was calculated. RESULTS. More than 50% of the infants had persistent blood glucose concentrations of >150 mg/dL during their first week of life. Early adverse outcomes were associated with the average highest daily blood glucose concentration through interaction with the Clinical Risk Index for Babies score and with the average highest daily percentage of inspired oxygen. The length of hospital stay was associated with the time ratio for blood glucose concentrations of >150 mg/dL through interaction with birth weight and the average highest daily percentage of inspired oxygen. CONCLUSION. These data confirm the high prevalence of hyperglycemia among parenterally fed, extremely low birth-weight infants and show that high blood glucose concentrations increase the risk of early death and grade 3 or 4 intraventricular hemorrhage and the length of hospital stay among survivors without intraventricular hemorrhage, which suggests that prevention and treatment of hyperglycemia may improve the outcomes of extremely low birth-weight infants.
Evaluation, Awareness, Practice and Management of Cold Chain at the Primary Health Care Centers in Coastal South India

Introduction : Vaccination is one of the most effective disease prevention strategies and potency of vaccines is dependent on effective management of cold chain at all levels of vaccine handling. The objective was to assess the status of cold chain at the primary health centers and to assess the knowledge and practices of medical officers at these centers regarding cold chain management. Materials and Methods : This cross sectional study was conducted at 70 primary health centers of Dakshina Kannada District of Coastal South India. Cold chain equipment and maintenance process was noted following direct observation on uninformed visits. Data regarding the knowledge and practices of cold chain management was obtained by interviewing the medical officers using structured pretested questionnaire. Results: Ice lined refrigerators and deep freezers were available in 69 (98.6%) and 67(95.8%) of centers. Dial thermometer was present in all the centers. Cold boxes, frozen packs and automated voltage stabilizers were available in 68(97.2%) centers. Improper vaccine storage was observed in 7 (10%) centers. Majority of medical officers had knowledge and correct practices in fields like ideal equipment, OPV administration, vaccine requiring diluents but only 47 (61.8%) medical officers had correct practice of defrosting the deep freezers. Conclusions: The availability of equipment is near universal. Improper vaccine storage practices and poor knowledge in some fields of cold chain management may adversely affect the quality of administered vaccine. Relevant training for those handling the cold chain is recommended. Key words : Cold Chain; India; Primary health center; Temperature monitoring DOI: http://dx.doi. org/10.3126/jnps.v32i1. 5946 J. Nepal Paediatr. Soc. Vol.32(1) 2012 19-22
Prescription Omega-3-Acid Ethyl Esters for the Treatment of Very High Triglycerides

Abstract Triglyceride (TG) levels can increase for numerous reasons, including a sedentary lifestyle, an unhealthy diet, especially one rich in refined carbohydrates, and comorbidities. According to the National Cholesterol Education Program (NCEP), the normal TG level is < 150 mg/dL. Patients with very high TG (VHTG) levels (≥ 500 mg/dL) should be promptly managed and treated to reach lipid treatment goals, as determined by the NCEP. Lowering TG levels is the primary management goal in these patients, while lowering low-density lipoprotein cholesterol and non–high-density lipoprotein cholesterol levels are secondary goals. Therapeutic lifestyle changes are often recommended initially for patients with elevated TGs; however, concomitant drug therapy is often required. Data show that intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can significantly decrease serum TGs, along with plasma concentrations of certain lipoproteins. Omega-3-acid ethyl esters are available by prescription or as dietary supplements. Clinical trials in adult patients with VHTGs show that four 1 g capsules of prescription omega-3 fatty acids, which contain 465 mg of EPA and 375 mg of DHA per capsule, can effectively decrease TG levels by up to 45%, and is generally well tolerated.
Alzheimer's Disease Effects on Semantic Memory: Loss of Structure or Impaired Processing?

Results of several prior studies, in which Alzheimer's disease (AD) patients missed the same concepts on multiple tasks, have been used to substantiate the theory that AD causes concept-specific loss of information from semantic memory However, sample sizes in these studies are modest, test-retest intervals small, and typically only a few tasks were used. In the present study 69 An subjects were annually administered 11 tasks, each using the same 13 concepts. Only a few instances were observed in which a concept was missed across all 11 tasks. When performances on the Oral Reading and Dictation tasks were removed from analysis, because of their questionable reliance on semantic memory, the number of missed concepts rose only modestly. A substantial rise in the number of missed concepts occurred, however, when performances on the four multiple- choice tasks were removed. Interpreting the larger number of missed concepts on the five remaining generative semantic tasks as evidence of item-specific loss is problematic, nonetheless, because the generative semantic tasks were among the hardest in the battery and the frequency with which an individual subject missed a concept across all tasks accorded with the subject's dementia severity level. Results also indicate that task difficulty, more than concept specificity, determine whether a concept is missed. Overall, results suggest that a concept will disappear when all of the tasks in which it is a stimulus become too difficult for the patient to perform. Study results call into question the appropriateness of using batteries of effortful, attention demanding tasks for ascertaining whether AD causes item-specific loss of conceptual knowledge.
Flexible Coding of Task Rules in Frontoparietal Cortex: An Adaptive System for Flexible Cognitive Control

How do our brains achieve the cognitive control that is required for flexible behavior? Several models of cognitive control propose a role for frontoparietal cortex in the structure and representation of task sets or rules. For behavior to be flexible, however, the system must also rapidly reorganize as mental focus changes. Here we used multivoxel pattern analysis of fMRI data to demonstrate adaptive reorganization of frontoparietal activity patterns following a change in the complexity of the task rules. When task rules were relatively simple, frontoparietal cortex did not hold detectable information about these rules. In contrast, when the rules were more complex, frontoparietal cortex showed clear and decodable rule discrimination. Our data demonstrate that frontoparietal activity adjusts to task complexity, with better discrimination of rules that are behaviorally more confusable. The change in coding was specific to the rule element of the task and was not mirrored in more specialized cortex (early visual cortex) where coding was independent of difficulty. In line with an adaptive view of frontoparietal function, the data suggest a system that rapidly reconfigures in accordance with the difficulty of a behavioral task. This system may provide a neural basis for the flexible control of human behavior.
Perfil epidemiológico do atendimento antirrábico humano em Porto Alegre, RS, Brasil

Animal bites are injuries that carry the risk of rabies transmission, a disease with a 100% mortality rate. The purpose of this study was to determine the epidemiologic profiles of post exposure human anti-rabies treatments and to analyze whether prescriptions were appropriate. This cross-sectional study collected data from the forms of the Brazilian Notification System (Sistema Nacional Agravos de Notificacao - SINAN), which were filled out by the professionals responsible for treatment in healthcare services in the second semester of 2006. Of the 2,223 cases identified, 50.3% of the individuals were male, the age group with the greatest number of cases was 20 to 59 years (47.6%); the type of injury responsible for the largest number of medical consultations was animal bite (87.4%), and 35.3% of the injuries were in the lower extremities. Dogs were the animals that caused the most injuries (91.7%). The analysis of type of treatment showed that vaccination was prescribed for 78.1% of the individuals, and anti-rabies serum, for 6.4%. Of the all treatments, 96.2% were classified as correctly prescribed. Although treatments were classified as necessary, the option of keeping animals that cause aggressions under observation should be considered so that the number of treatments administered can be reduced.