Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of various drugs used in conservative therapy of hepatorenal syndrome: A retrospective drug utilization study

Objectives: To analyze the impact of various drugs used in conservative therapy on renal failure and mortality in hepatorenal syndrome (HRS) at a tertiary care teaching hospital. Materials and Methods: Retrospective review of hospital admission records was conducted for case records with HRS as diagnosis. Demographic and clinical data and drug utilization pattern were collected in a pre-designed patient information sheet. Impact of various drugs especially hepatoprotector antioxidant, silymarin, on survival benefits in terms of number of patients alive, change in mean arterial pressure (MAP) and change in serum creatinine at the end of treatment period were estimated by univariate and followed by multivariate analysis. Results: Of the total 89 case records, 31 met the eligibility criteria and were included in the analysis. On multivariate analysis, a significant correlation between use of intravenous fluids (IVFs) and survival benefits was observed (P < 0.05); wherein patients treated with IVFs had an increase in log odds of survival by 2.42 (95% CI = 1.06 to 121.13) as compared to patient not treated with IVF. However, MAP was not affected by any of the treatment modalities. While change in serum creatinine level was not significantly (P = 0.06, regression correlation = −0.3) correlated with duration of treatment with IVFs. Conclusion: Use of IVFs may be associated with better short-term survival benefits and favor HRS reversal. Use of silymarin as hepatoprotector antioxidant has no beneficial effects on HRS reversal or survival benefits.
Bioterrorism and Public Health Service: Defining Management and Treatment Systems

Abbreviations: BASIS: Detect-to-treat technology; BRICK: Bio Risk Initiative for Capacity building and Knowledge base development; BSA: Biosafety Associations; BSCL: Biosafety Cabinet; BLS1: Biosafety Level 1 (BSL-1); BWT: Biological and Toxin Weapons Convention; CBRN: Chemical, Biological, Radio Nuclear; CDC: Centers for Disease Control and Prevention; CWTC: Chemical Waste Treatment Centre; DSUS: Distributed Sampling Units; DNA: Deoxyribo Nucleic Acid; EBSA: European Biosafety Association; ECDC: European Centre for Disease Prevention and Control; EC: European Commission; EMEA: European Evaluation of Medicinal Products; EURONET-P4 : European Network of P4 Laboratories; EU: European Union; GMMs: Genetically Modified Micro-Organisms; GHSI: Global Health Security Initiative; HANAA: Handheld Advanced Nucleic Acid Analyzer; HSC: Health Security Committee; HSR: Health Systems Response; HEPA: High Efficiency Particulate Air filter; IFBA: International Federation of Biosafety Associations; LAI: Laboratory Associated Infections; LIDARs: Light Detection and Ranging; LIBS: Laser-Induced Breakdown Spectroscopy; NIAID: National Institute of Allergy and Infectious Disease; OSHA: Occupational Safety and Health Administration; PCR: Polymerase Chain Reaction; WHO: World Health Organization;
Transcription-based and acoustic analyses of rhotic vowels produced by children with and without speech sound disorders: Further analyses from the Memphis Vowel Project

Abstract The acquisition of rhotic monophthongs (/ɝ/ and /ɚ/) and diphthongs (/ɪ͡ɚ, ɛ͡ɚ, ɔ͡ɚ and ɑ͡ɚ/) was examined in 3- and 4-year-old children with and without speech sound disorders (SSDs), using both transcription-based and acoustic analyses. African–American (AA) and European–American (EA) participants (n = 40) with and without SSD were selected from archival data collected as part of the Memphis Vowel Project. Dialect variation influenced rhotic vowels differently for EA and AA children, thus their data were reported separately. Transcription-based analyses showed wide variation in the accuracy of different rhotic vowels. The most frequent error pattern for children with SSD was Derhoticization to a Back Rounded Vowel (e.g. /ɝ/ → [ʊ]; /ɪ͡ɚ/ → [ɪ͡о]). Rhotic diphthong reduction errors were less frequent; however, Coalesence (/ɑ͡ɚ/ → [ɔ]) was often observed for /ɑ͡ɚ/. F2, F3 and F3-F2 spectral movement patterns revealed differences between productions transcribed as correct and incorrect.
Archives of Pathology and Laboratory Medicine: Volume 1, 1926, Pages 1–24

The purpose of this report is to give the results of some simple experiments designed for the purpose of characterizing pathologically (on a histopathologic basis) the scorbutic condition. We have followed the histologic sequences in bone, connective tissue and teeth during the development of the absolute scor-butic condition and the immediate reparative processes following administration of antiscorbutics. The pathology of human and experimental scorbutus has been extensively studied, and the main facts clearly established in a literature too extensive to be reviewed here. Hess, in his admirable book, gives a good review of the pathology up to 1920. Special mention, however, must be made of the monograph of Aschoff and Koch in 1919, though adequately quoted by Hess, and the monograph of Höjer. The work of Aschoff and Koch is based on human postmortem material, that of Höjer principally on the experimental disease in guinea-pigs. Aschoff and Koch review previous contributions, and their paper deals largely with the changes in bone and cartilage found at costochondral junctions, and at the junctions of diaphyses and epiphyses. From previous work reviewed by them and from their own observations, the important features in the bone pathology may be enumerated as follows: cessation of new bone formation and rare-faction of existing bone of cortex and spongiosa; irregularities, absorption and disappearance of cartilage columns, yielding of the bone under strain and a zone
Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study

Abstract Background: As part of the immune defense during infection, an increase in enzyme activity of indoleamine 2,3-dioxygenase (IDO) leads to a breakdown of tryptophan to kynurenine. In previous animal studies, therapeutic antagonism of IDO resulted in reduced sepsis mortality. We investigated the prognostic ability of tryptophan, serotonin, kynurenine and IDO (represented by the ratio of kynurenine/tryptophan) to predict adverse clinical outcomes in patients with community-acquired pneumonia (CAP). Methods: We measured tryptophan, serotonin and kynurenine on admission plasma samples from CAP patients included in a previous multicenter trial by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). We studied their association with inflammation (C-reactive protein), infection (procalcitonin) and clinical outcome. Results: Mortality in the 268 included patients was 45% within 6 years of follow-up. IDO and kynurenine showed a strong positive correlation with markers of infection (procalcitonin) and inflammation (C-reactive protein) as well as sepsis and CAP severity scores. Tryptophan showed similar, but negative correlations. In a multivariate regression analysis adjusted for age and comorbidities, higher IDO activity and lower tryptophan levels were strongly associated with short-term adverse outcome defined as death and/or ICU admission within 30 days with adjusted odds ratios of 9.1 [95% confidence interval (CI) 1.4–59.5, p=0.021] and 0.11 (95% CI 0.02–0.70, p=0.021). Multivariate analysis did not reveal significant associations for kynurenine and serotonin. Conclusions: In hospitalized CAP patients, higher IDO activity and lower tryptophan levels independently predicted disease severity and short-term adverse outcome. Whether therapeutic modulation of IDO has positive effects on outcome needs further investigation.
Determination of reference intervals for urinary steroid profiling using a newly validated GC-MS/MS method

Abstract Background: Urinary steroid profiling (USP) is a powerful diagnostic tool to asses disorders of steroidogenesis. Pre-analytical factors such as age, sex and use of oral contraceptive pills (OCP) may affect steroid hormone synthesis and metabolism. In general, USP reference intervals are not adjusted for these variables. In this study we aimed to establish such reference intervals using a newly-developed and validated gas chromatography with tandem mass spectrometry detection method (GC-MS/MS). Methods: Two hundred and forty healthy subjects aged 20–79 years, stratified into six consecutive decade groups each containing 20 males and 20 females, were included. None of the subjects used medications. In addition, 40 women aged 20–39 years using OCP were selected. A GC-MS/MS assay, using hydrolysis, solid phase extraction and double derivatization, was extensively validated and applied for determining USP reference intervals. Results: Androgen metabolite excretion declined with age in both men and women. Cortisol metabolite excretion remained constant during life in both sexes but increased in women 70–79 years of age. Progesterone metabolite excretion peaked in 30–39-year-old women and declined afterwards. Women using OCP had lower excretions of androgen metabolites, progesterone metabolites and cortisol metabolites. Method validation results met prerequisites and revealed the robustness of the GC-MS/MS method. Conclusions: We developed a new GC-MS/MS method for USP which is applicable for high throughput analysis. Widely applicable age and sex specific reference intervals for 33 metabolites and their diagnostic ratios have been defined. In addition to age and gender, USP reference intervals should be adjusted for OCP use.
Cognitive grammar and aphasic discourse

ABSTRACT In cognitive grammar (CG), there is no clear division between language and other cognitive processes; all linguistic form is conceptually meaningful. In this pilot study, a CG approach was applied to investigate whether people with aphasia (PWA) have cognitive linguistic difficulty not predicted from traditional, componential models of aphasia. Narrative samples from 22 PWA (6 fluent, 16 non-fluent) were compared with samples from 10 participants without aphasia. Between-group differences were tested statistically. PWA had significant difficulty with temporal sequencing, suggesting problems that are not uniquely linguistic. For some, these problems were doubly dissociated with naming, used as a general measure of severity, which indicates that cognitive linguistic difficulties are not linked with more widespread brain damage. Further investigation may lead to a richer account of aphasia in line with contemporary linguistics and cognitive science approaches.
Evaluating new HbA1c methods for adoption by the IFCC and NGSP reference networks using international quality targets

Abstract Background: As a reference laboratory for HbA1c, it is essential to have accurate and precise HbA1c methods covering a range of measurement principles. We report an evaluation of the Abbott Enzymatic (Architect c4000), Roche Gen.3 HbA1c (Cobas c513) and Tosoh G11 using different quality targets. Methods: The effect of hemoglobin variants, other potential interferences and the performance in comparison to both the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and the National Glycohemoglobin Standardization Program (NGSP) reference systems was assessed using certified evaluation protocols. Results: Each of the evaluated HbA1c methods had CVs <3% in SI units and <2% in NGSP units at 46 mmol/mol (6.4%) and 72 mmol/mol (8.7%) and passed the NGSP criteria when compared with six secondary reference measurement procedures (SRMPs). Sigma was 8.6 for Abbott Enzymatic, 3.3 for Roche Cobas c513 and 6.9 for Tosoh G11. No clinically significant interference was detected for the common Hb variants for the three methods. Conclusions: All three methods performed well and are suitable for clinical application in the analysis of HbA1c. Partly based on the result of this study, the Abbott Enzymatic method on the Architect c4000 and the Roche Gen.3 HbA1c on the Cobas c513 are now official, certified IFCC and NGSP SRMPs in the IFCC and NGSP networks. Sigma metrics quality criteria presented in a graph distinguish between good and excellent performance.
Long‐Term Results with a Slow‐Release Gonadotrophin‐Releasing Hormone Agonist in Central Precocious Puberty

ABSTRACT. As part of an ongoing international multicentre study, 19 children (14 girls, 5 boys) with central precocious puberty (CPP) were treated with a slow‐release gonadotrophin‐releasing hormone (GnRH) agonist, triptorelin, for 4 years. After 3 years of treatment, height velocity stabilized at 4.0 cm/year. Predicted adult height (mean ± SD) increased from 158.9 ± 6.8 to 164.9 ± 6.6 cm in girls (n = 14, p < 0.01), and from 174.4 ± 18.5 to 184.3 ± 17.1 cm in boys (n = 4, p < 0.05). In 12 additional girls who had started the multicentre study but discontinued triptorelin treatment after 2.2 ± 0.5 years, menses started 9.8 ± 3.7 months after cessation of treatment in all but one patient. Height velocity increased over the first 6 months after discontinuation of treatment, from 3.6 ± 0.1 to 5.4 ± 2.5 cm/year, and remained higher than pretreatment values in the second 6 months, but decreased subsequently. Bone maturation increased, and no significant improvement in predicted adult height was observed. For auxological reasons, therefore, it may be advisable to continue triptorelin treatment for as long as possible. Concomitant growth hormone (GH) therapy was initiated in three girls with CPP with height velocities of 3.2–3.6 cm/year after 3 years of treatment with triptorelin and predicted adult heights of less than the third centile for Dutch girls. Prior to the administration of GH, all patients had subnormal 24‐hour GH profiles and GH responses to arginine provocation. GH treatment increased height velocity markedly in all girls, and improved predicted adult height. It is concluded that triptorelin therapy improves predicted adult height. In children with CPP and genetic short stature, with a markedly decreased height velocity during triptorelin therapy, concomitant administration of a GnRH agonist and GH may have advantages. Further extensive studies are required.
Integrating genetic risk assessment for multi-factorial conditions into primary care

The genetic basis of many common, multi-factorial conditions is increasingly being understood but use of the knowledge created, raises major dilemmas for primary care. Identification of individuals that may be genetically predisposed to serious medical conditions provides the opportunity to offer screening or prophylactic treatment, for early detection or prevention and delay in disease onset in many complex conditions. We describe a new pilot service development to introduce genetic risk assessment for a wide range of conditions to primary care, and discuss the findings from its evaluation. The evaluation highlighted the issues about the incorporation of genetic risk assessment in primary care. The results of the evaluation along with findings from other studies, juxtaposed with the implications of developments in genetics suggest that changes are required to accommodate the integration of genetic risk assessment into primary care clinical practice. We discuss what these changes are, the benefits and drawbacks, and whether primary care can and is ready to make the changes required, further shifting the focus from disease treatment to disease prevention.
Customized Aspheric IOL Design by Raytracing through the Eye Containing Quadric Surfaces

Purpose: The purpose of the present study was to demonstrate a method of how to calculate intraocular lenses with a customized asphericity and how to apply this strategy to clinical examples in cases where biometric data of the cornea (front and back surface topography) as well as distances in the eye are known. Methods: (1) we demonstrated an algebraic method for tracing a bundle of rays through a schematic eye containing surfaces which can be represented by 2nd order surfaces (quadric surfaces), and (2) we introduced a strategy for customization of the lens’ back surface for compensating the optical path length differences of the rays from object to image in terms of a wave front correction while predefining the lens front surface. Results: The presented method was applied to three working examples: example 1 referred to a centered optical system with a spherical cornea (front and back surfaces) and a predefined spherical lens front surface, example 2 referred to a centered optical system with aspherical surfaces for the corneal front and back surfaces and a predefined spherical lens front surface, and example 3 referrred to a non-centered system with a decentered aspherical cornea (front and back surface), and a predefined spherical lens front surface. The parameterized ray intersection points with the lens back surface were optimized in terms of equalizing the ray path lengths and a quadric surface was fitted to these ray intersection points to characterize the customized lens. The fitting error, ray spot diagram, and the optical path length of the rays are provided. Conclusion: This simple calculation strategy may be the first step in developing individual aspherical lenses, which have the potential to fully compensate spherical aberrations based on individual measures of the eye.
THE ROLE OF SMARTPHONES IN THE RECORDING AND DISSEMINATION OF MEDICAL IMAGES

Background:Smartphones have evolved rapidly in the medical profession, and can now produce highquality medical images, providing a quick and simple method of image distribution. This has thepotential to improve clinical care of patients, but comes with specific ethical and medico-legalconsiderations that include issues of confidentiality, privacy and policy control.Aim: To quantify the use, distribution and storage of medical images taken using smartphones byclinicians, along with their perceptions regarding policies, practices and patient care.Methods: All clinicians and medical students employed or undergoing rotation at Peninsula Healthduring March 2012 were asked to participate in a de-identified, 36 item, online survey administeredby SurveyMonkey. The survey questioned respondent’s demographics, and issues surrounding therecording and dissemination of medical images using smartphones.Results: 134 responses were received. Most respondents were from the surgical discipline, followedby medicine, then emergency. Sixty five per cent admitted to taking medical images on theirsmartphones, yet no consent was obtained in almost a quarter (24%). When consent was taken, itwas predominantly verbal, but only documented 23% of the time. Of those who took medicalimages, 64% stored them personally and 82% shared them with someone else, mostly for input fromanother clinician. Forty three per cent were aware that an institutional policy existed, but only 28%had read the policy.Conclusion: Whilst the use of smartphones in a hospital setting is inevitable, the results obtainedhighlight issues related to privacy, confidentiality and patient care. This study will enable discussionand formulation of an evidence-based hospital policy
A Comparison of Active Ingredients and Preservatives Between Brand Name and Generic Topical Glaucoma Medications Using Liquid Chromatography-Tandem Mass Spectrometry

Background: This work compares the concentration of active ingredients and preservatives in commonly used brand name versus generic glaucoma medications. Materials and Methods: Active ingredient and benzalkonium chloride (BAK) concentrations in brand name latanoprost and dorzolamide-timolol were each compared to two generic counterparts using liquid chromatography–mass spectrometry at baseline and after exposure to 25°C and 50°C for 30 days. Micro flow imaging was used to quantify particulate material greater than one micron in diameter. Results: Brand name formulations contained active ingredients and BAK in concentrations that were generally in agreement with their package inserts at baseline. The two generic formulations of latanoprost contained baseline levels of active ingredients that were 10% greater than their labeled value. Generic latanoprost formulations had significant loss of active ingredient concentration after exposure to 25°C and 50°C for 30 days. Both generic and brand name dorzolamide-timolol appeared relatively resistant to degradation. BAK concentrations remained stable at 25°C but decreased in some bottles at 50°C. Bottles of both generic medications had higher levels of particulate matter compared to brand name versions. Conclusions: Exposure to temperatures at the high end of the labeled value may lead to a significant decrease in concentration of active ingredients in generic formulations that could influence clinical efficacy. Re-evaluation of intraocular pressure lowering efficacy may be indicated in glaucoma patients switching from brand name to generic formulations.
Moving out: from sterol transport to drug resistance – the ABCG subfamily of efflux pumps

Abstract The ATP binding cassette (ABC) proteins are typically ATP-driven transmembrane pumps that have been evolutionarily conserved from bacteria to humans. In humans these transporters are subdivided into seven subfamilies, ranging from A to G. The ABCG subfamily of transporters is the primary focus of this review. This subfamily of proteins has been conserved throughout evolution and plays a central role in several cellular processes, such as sterol homeostasis and multidrug resistance. Functional polymorphisms/mutations in some of these G-subfamily transporters have clinical consequences in humans.
Detection of the classical G2576U mutation in linezolid resistant Staphylococcus aureus along with isolation of linezolid resistant Enterococcus faecium from a patient on short-term linezolid therapy: First report from India

Purpose: Linezolid is an effective drug against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). We describe the emergence of linezolid resistance in MRSA and VRE from India. Material and Methods: One MRSA and two VRE strains were isolated from a patient on linezolid therapy of one week duration. All three isolates were resistant to linezolid with minimal inhibitory concentrations (MIC) ≥4 mg/L. The 746-bp region flanking the possible G2576U mutation on the corresponding DNA from the 23S rRNA was amplified by polymerase chain reaction (PCR) and amplicons were sequenced for all the three isolates. Conjugation experiments using the linezolid resistant MRSA (LRMRSA) and linezolid resistant VRE (LRVRE) isolates as donors and wild strains of corresponding genera as recipients were performed. Results: The MRSA isolate had the classical G2576U mutation. High quality value scores in the sequencing software validated the mutation. Conjugation studies did not indicate presence of transferable resistance for linezolid. Sequencing did not indicate presence of any mutation in the two LRVRE isolates. Conclusions: This is the first report from India citing resistance in Staphylococcus and Enterococcus against Linezolid.