Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictive Value of Depression and Social Support with Respect to Alcohol Abstinence

Context: Two co-morbid conditions which have been found in high proportions among treatment-seeking alcohol-dependent subjects are depression and low social support. Aim: We attempted to study both the factors simultaneously in the setting of Alcoholics Anonymous centers in Mumbai. The study intends to understand (1) if pre-existing depression affected the probability of a person abstaining from alcohol and (2) if social support affected the probability of a person abstaining from alcohol. A thorough review of the existing literature was done before initiating the study. Materials and Methods: A single-observer, cross-sectional study was conducted. Subjects with a history of alcohol dependence were included. However, those with other substances abuse and those with a history of anti-depressant usage were excluded. Questionnaires were administered. The Hamilton Depression Scale assessed depression. Similarly, social support was assessed by Social Provisions Scale by Weiss. Results: According to this study depression does not affect alcohol abstinence as the χ2 test shows an insignificant result. Social support also showed a negative correlation with alcohol abstinence. Conclusion: This result is consistent with the findings of other studies such as Davidson et al. (1998). However it is not consistent with the results of the studies having a longer follow-up period. The study had some limitations primarily due to time constraints, the main one being that this study would reveal more significant results if done as a longitudinal study as opposed to a cross-sectional study. Also while interacting with subjects in a group like Alcoholics Anonymous it is important to gain the confidence of the group before obtaining confidence of the individual.
PERIPHERAL VASCULAR DISEASE Original Studies Synchronous Carotid Stenting and Cardiac Surgery: An Initial Single-Center Experience

Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy, although it is still controversial. We report in-hospital and midterm outcome of 30 patients who received carotid stenting and synchronous cardiac surgery. All received carotid stenting under aspirin and regular unfractioned heparin (UFH) and were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All patients received aspirin and clopidogrel once bleeding was ruled out, after surgery. In-hospital complications were: three surgical related deaths, one TIA, and no patient suffered stroke or myocardial infarction. Hospital stay was 14 6 11.8 days. Survivors were followed for 18.4 6 14 months. There were two non-related deaths, but no stroke nor cardiac or carotid reinterventions. In conclusion, this small series showed that synchronous carotid stenting and cardiac surgery was feasible with an acceptable complication rate in a high-surgical-risk population which could not undergo staged procedures. ' 2006 Wiley-Liss, Inc.
Prediction of neuropsychological outcome after mild traumatic brain injury using clinical parameters, serum S100B protein and findings on computed tomography

Abstract Primary objective: To identify if demographics, clinical and computed tomographic (CT) characteristics at first presentation and S100B concentrations at 3 and 6 hours after mild traumatic brain injury (MTBI) predict the development of post-concussion syndrome (PCS) after 1 month. Research design and methods: All consecutive MTBI patients (Glasgow Coma Scale [GCS] score 13–15) admitted to the Emergency Department aged older than 15 were included in this prospective, observational study. Outcome was assessed using a Rivermead Post-Concussion Symptoms Questionnaire to identify the patients with and without PCS 1 month after the injury. Main outcomes and results: A total of 176 patients with isolated MTBI were included in the study. After multivariate analysis of the demographics, clinical variables, and CT abnormalities, headache (OR = 2.09, 95% CI = 1.04–4.21, p = 0.038), seizure (OR = 5.64, 95% CI = 1.55–20.54, p = 0.009), the presence of subarachnoid haemorrhage on CT (OR = 3.67, 95% CI = 1.46–9.24, p = 0.006) and 6-hour S100B concentration (OR = 2.22, 95% CI = 1.15–4.28, p = 0.017) were independently significant predictors of the outcome. Conclusions: Outcome prediction using baseline characteristics (post-traumatic headache and seizure), CT and laboratory findings (6-hour S100B) were valuable factors for identification of the individual MTBI patient at risk for developing PCS 1 month after the injury.
EFFECTS OF CONJUGATED LINOLEIC ACID ON BODY COMPOSITION PARAMETERS IN AGED AND CACHECTIC MICE

Research for this thesis consisted of three parts; determining CLA effects on 1) whole animal body composition in aged mice, 2) whole animal body composition parameters in a murine model of cachexia, 3) specific muscles, adipose depots, and organs as well as the effects on parameters of muscle degradation in aged mice. The first study indicates CLA decreased fat mass and increased whole animal protein mass in aged mice. In the second study, infection resulted in changes in carcass water, fat, and protein. CLA caused an increase in protein mass in the controls but was unable to increase protein mass in cachectic animals. In the third study, no changes in muscle weights were observed with CLA and there was no effect on parameters of muscle degradation. These results demonstrate the complex nature of CLA and the need for further investigation.
Head to head evaluation of the analytical performance of two commercial methotrexate immunoassays and comparison with liquid chromatography-mass spectrometry and the former fluorescence polarization immunoassay

Abstract Background: Monitoring of plasma drug levels is mandatory in patients receiving high-dose methotrexate. This study evaluated the analytical performance of the novel Architect and the established ARK™ methotrexate immunoassay (running on the Roche Cobas© c502 analyzer) in comparison with liquid chromatography-mass spectrometry (LC-MS) and the TDx/TDxFLx Methotrexate II assay. Methods: Imprecision and linearity were verified for the Architect and ARK assay according to CLSI EP15-A3 and EP6-A guidelines, respectively. The reported limit of quantitation (0.04 μmol/L) was tested for both assays according to the CLSI EP17-A2 guideline. Correlation and agreement between the different assays were evaluated using residual plasma samples (n=153). Results: Total imprecision was <6.3% and <9.5% for the Architect and ARK assay, respectively. The claimed linearity and limit of quantitation were confirmed for the Architect assay. For the ARK assay, imprecision at the limit of quantitation was <18% with a positive bias resulting in a high total error up to 58%, and hence the linearity could not be confirmed. Both assays showed strong correlations with the TDX assay and LC-MS but a positive bias of 12.2% and 20.5% in comparison to LC-MS for the Architect and ARK assay, respectively. For the ARK assay this bias increased dramatically for samples with concentrations towards the limit of quantitation. Conclusions: The Architect assay is suitable for monitoring plasma methotrexate, but the ARK assay showed unsatisfactory performance in the analysis of low concentrated samples. Unlike the TDX assay, both assays require manual dilution of samples at higher concentrations, which delays sample processing in clinical routine.
Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant

Background: Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program. Methods: At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters. Results: Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm3 and not at established cut-off of CD4 350 cells/mm3. This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively. Conclusions: Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
Evaluation of risk factors in patients attending STI clinic in a tertiary care hospital in North India

Background: In the past few years, the interest in STDs and their management has increased tremendously because of their proven role in facilitation of HIV infection, which, in turn, also increases the risk of acquiring STIs. Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. Aims: (i) To screen the new patients attending the STI clinic for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) and (ii) to evaluate the role of various risk factors in the prevalence of STIs. Materials and Methods: The present study was conducted on 200 patients attending the STI clinic. They were evaluated for the prevalence of HIV and bacterial STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) along with the role of risk factors particularly circumcision. Results: The prevalence of HIV was 7% and prevalence of other STI was 20%. The causative agents were Chlamydia 8%, Gonorrhea 7.5%, Bacterial Vaginosis 2.7% and Syphilis 2%. Conclusion: The factors found to be significantly associated with the prevalence of STI were circumcision, positive HIV status, education, religion, multiple sexual partners, contact with Commercial sex workers (CSW), non use of contraception, profession involving long stay away from home, and past history of STI. The present study suggests that circumcision is a protective factor for acquisition of STIs but other factors like sexual behavior, use of barrier contraceptives, drug abuse etc., also play a role.
Apathetic symptom presentations in patients with severe traumatic brain injury: Assessment, heterogeneity and relationships with psychosocial functioning and caregivers’ burden

Abstract Objectives: Apathy is frequently described following traumatic brain injury (TBI) and defined on the basis of three dimensions (emotional blunting, lack of initiative, lack of interest), which are commonly assessed by the Apathy Inventory (AI). The aims were (1) to explore the psychometric properties of this scale in the TBI population and the relationships between the dimensions; and (2) to determine whether sub-groups of patients differing with respect to the three AI dimensions could be identified and to examine their differences on psychosocial functioning and caregivers’ burden. Participants and measures: Close relatives of 68 patients with severe TBI were given the AI and two questionnaires to assess their subjective burden and patients’ changes in psychosocial functioning. Results: The scores distribution and the sensitivity of each sub-scale showed that the AI can be used as a screening tool in the TBI population. Four clusters were identified: one group with high scores on each dimension, one group with low scores on each dimension, one group with high emotional blunting alone and another with elevated lack of initiative/interest. The high apathetic group and the lack of initiative/interest group were associated with poorer psychosocial functioning and the high apathetic group was related to subjective burden. Conclusions: These results shed new light on the concept of apathy in patients with TBI and underline the necessity to take into account the various profiles of symptoms of apathy.
Is accuracy of serum free light chain measurement achievable?

Abstract The serum free light chain (FLC) assay has proven to be an important complementary test in the management of patients with monoclonal gammopathies. The serum FLC assay has value for patients with plasma cell disorders in the context of screening and diagnosis, prognostic stratification, and quantitative monitoring. Nonetheless, serum FLC measurements have analytical limitations which give rise to differences in FLC reporting depending on which FLC assay and analytical platform is used. As the FLC measurements are incorporated in the International Myeloma Working Group guidelines for the evaluation and management of plasma cell dyscrasias, this may directly affect clinical decisions. As new certified methods for serum FLC assays emerge, the need to harmonise patient FLC results becomes increasingly important. In this opinion paper we provide an overview of the current lack of accuracy and harmonisation in serum FLC measurements. The clinical consequence of non-harmonized FLC measurements is that an individual patient may or may not meet certain diagnostic, prognostic, or response criteria, depending on which FLC assay and platform is used. We further discuss whether standardisation of serum FLC measurements is feasible and provide an overview of the steps needed to be taken towards harmonisation of FLC measurements.
Interference of daratumumab in monitoring multiple myeloma patients using serum immunofixation electrophoresis can be abrogated using the daratumumab IFE reflex assay (DIRA)

Abstract Daratumumab is a fully human anti-CD38 IgG1-κ monoclonal antibody (mAb) currently being evaluated in several Phase 2 and 3 clinical studies for the treatment of multiple myeloma (MM). In this clinical case study we demonstrate that daratumumab can be detected as an individual monoclonal band in serum immunofixation electrophoresis (IFE). M-protein follow-up by IFE is part of the International Myeloma Working Group (IMWG) criteria to assess treatment response. Therefore, it is crucial that the daratumumab band is not confused with the endogenous M-protein of the patient during IFE interpretation. Moreover, a significant number of IgG-κ M-proteins co-migrate with daratumumab. Co-migration introduces a bias in the M-protein quantification since pharmacokinetic studies show that daratumumab peak plasma concentrations reach up to 1 g/L. More importantly, co-migration can mask clearance of the M-protein by IFE which is necessary for classification of complete response by IMWG criteria (negative serum IFE). For optimal M-protein monitoring the laboratory specialist needs to be informed when patients receive daratumumab, and it is essential that the laboratory specialist is aware that a slow migrating band in the γ-region in those patients may be derived from the daratumumab. A daratumumab specific IFE reflex assay (DIRA) has been developed and can be utilized to abrogate interference. The here described mAb interference is not limited to daratumumab, and as therapeutic antibodies gain approval and enter into common clinical practice, laboratory specialists will need additional processes to characterize IFE interference and distinguish endogenous M-protein from therapeutic antibodies.
Long-term outcomes after moderate-to-severe traumatic brain injury among military veterans: Successes and challenges

Abstract Objective: To assess long-term outcomes after traumatic brain injury (TBI) among veterans and service members. Setting: Regional Veterans Affairs medical centre. Participants: One hundred and eighteen veterans and military personnel, aged 23–70 years (median = 35 years), 90% male, had moderate-to-severe TBI (82% in coma > 1 day, 85% amnesic > 7 days), followed by acute interdisciplinary rehabilitation 5–16 years ago (median = 8 years). Design: Cross-sectional analysis of live interviews conducted via telephone. Main measures: TBI follow-up interview (occupational, social, cognitive, neurologic and psychiatric ratings), Community Integration Questionnaire, Disability Rating Scale (four indices of independent function) and Satisfaction with Life Scale. Results: At follow-up, 52% of participants were working or attending school; 34% ended or began marriages after TBI, but the overall proportion married changed little. Finally, 22% were still moderately-to-severely disabled. However, 62% of participants judged themselves to be as satisfied or more satisfied with life than before injury. Injury severity, especially post-traumatic amnesia, was correlated with poorer outcomes in all functional domains. Conclusions: After moderate–severe TBI, most veterans assume productive roles and are satisfied with life. However, widespread difficulties and functional limitations persist. These findings suggest that veteran and military healthcare systems should continue periodic, comprehensive follow-up evaluations long after moderate-to-severe TBI.
Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

Objective: To describe the experience with upper gastrointestinal bleeding (UGIB) in two major Latin American hospitals, its main causes, treatment and prognosis, while exploring some risk factors associated with death. Design: Prospective cohort study. Patients and Methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association between those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty-nine patients (77.4%) were seen for gastrointestinal bleeding (outpatient bleeding) and 105 patients (22.6%) were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI endoscopy (EGD) within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty-four patients died (9.5%). Patients who presented with bleeding due to other causes during hospitalization had a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6). An increasing number of comorbidities, such as those described in the Rockall score, were also associated with a higher risk of mortality (RR 2.5, 95% CI 1.1-5.4). Conclusion: Intrahospital upper GI bleeding and the presence of comorbidities are risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.
Diffuse cutaneous leishmaniasis – A rare cutaneous presentation in an HIV-positive patient

1. UNAIDS Report on the Global AIDS Epidemic. Available from: http://www.unaids. org/en/media/unaids/contentassets/documents/ unaidspublication/2010/20101123_globalreport_en. pdf. [Last accessed on 2010 Feb 15th]. 2. Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44:56-9. 3. Fauci AS, Lane HC. Human Immunodeficiency Virus Disease: AIDS and Related Disorders. In: Kasper DL, editor. Harrison’s Principles of Internal Medicine, 16th ed. U.S.A: Mc GrawHill Medical Publishing Division; 2005. p. 1076-139. 4. Stanley SK, Ostrowski MA, Justement JS, Grant K, Hedayati S, Mannix M, et al. Effect of immunization with a common recall antigen on viral expression in patients infected with human immunodeficiency virus type 1. N Engl J Med 1996;334: 1222-30. 5. Danish FA, Koul SS, Subhani FR, Rabbani AE, Yasmin S. Managing HCV/HIV coinfection. Indian J Sex Transm Dis 2009;30:120-1.
Renoprotective effect of aged garlic extract in streptozotocin-induced diabetic rats

Objective: Aged garlic extract (AGE) has been proven to exhibit antioxidant, hypolipidemic, hypoglycemic and antidiabetic properties. However, its effect on diabetic nephropathy was unexplored. Therefore, the present study was designed to investigate the renoprotective effect of AGE in streptozotocin-induced diabetic rats. Materials and Methods: Albino Wistar rats were induced with diabetes by a single intraperitoneal injection of 45 mg/kg b.w. of streptozotocin. Commercially available AGE was supplemented orally at a dose of 500 mg/kg body weight/day. Aminoguanidine, which has been proven to be an anti-glycation agent was used as positive control and was supplemented at a dose of 1 g/L in drinking water. The serum and urinary biochemical parameters were analyzed in all the groups and at the end of 12 weeks follow up, the renal histological examination were performed using H & E and PAS staining. Results: The diabetic rats showed a significant change in the urine (P < 0.001) and serum (P < 0.01) constituents such as albumin, creatinine, urea nitrogen and glycated hemoglobin. In addition, the serum lipid profile of the diabetic rats were altered significantly (P < 0.05) compared to that of the control rats. However, the diabetic rats supplemented with aged garlic extract restored all these biochemical changes. The efficacy of the extract was substantiated by the histopathological changes in the kidney. Conclusion: From our results, we conclude that aged garlic extract has the ability to ameliorate kidney damage in diabetic rats and the renoprotective effect of AGE may be attributed to its anti-glycation and hypolipidemic activities.