Miracle-dz/UniFAR-FTUs huggingface dataset:
HIV antiviral drug resistance: patient comprehension

Abstract A patient's understanding and use of healthcare information can affect their decisions regarding treatment. Better patient understanding about HIV resistance may improve adherence to therapy, decrease population viral load and extend the use of first-line HIV therapies. We examined knowledge of developing HIV resistance and explored treatment outcomes in a cohort of HIV+ persons on highly active antiretroviral therapy (HAART). The longitudinal investigations into supportive and ancillary health services (LISA) cohort is a prospective study of HIV+ persons on HAART. A comprehensive interviewer-administrated survey collected socio-demographic variables. Drug resistance knowledge was determined using a three-part definition. Clinical markers were collected through linkage with the Drug Treatment Program (DTP) at the British Columbia Centre for Excellence in HIV/AIDS. Categorical variables were compared using Fisher's Exact Test and continuous variables using the Wilcoxon rank-sum test. Proportional odds logistic regression was performed for the adjusted multivariable analysis. Of 457 LISA participants, less than 4% completely defined HIV resistance and 20% reported that they had not discussed resistance with their physician. Overall, 61% of the cohort is ≥95% adherent based on prescription refills. Owing to small numbers pooling was preformed for analyses. The model showed that being younger (OR=0.97, 95% CI: 0.95–0.99), having greater than high school education (OR=1.64, 95% CI: 1.07–2.51), discussing medication with physicians (OR=3.67, 95% CI: 1.76–7.64), having high provider trust (OR=1.02, 95% CI: 1.01–1.03), and receiving one-to-one counseling by a pharmacist (OR=2.14, 95% CI: 1.41–3.24) are predictive of a complete or partial definition of HIV resistance. The probability of completely defining HIV resistance increased from 15.8 to 63.9% if respondents had discussed HIV medication with both a physician and a pharmacist. Although the understanding of HIV resistance showed no differences in treatment outcomes in this cohort, overall adherence and complete understanding of HIV resistance were low. If patient understanding could be improved through discussions with physicians and pharmacists, potential exists to enhance overall adherence and treatment outcomes.
Resistant Hypertension Optimal Treatment Trial: A Randomized Controlled Trial

The prevalence of resistant hypertension (ReHy) is not well established. Furthermore, diuretics, angiotensin‐converting enzyme inhibitors or angiotensin‐receptor blockers, and calcium channel blockers are largely used as the first 3‐drug combinations for treating ReHy. However, the fourth drug to be added to the triple regimen is still controversial and guided by empirical choices. We sought (1) to determine the prevalence of ReHy in patients with stage II hypertension; (2) to compare the effects of spironolactone vs clonidine, when added to the triple regimen; and (3) to evaluate the role of measuring sympathetic and renin‐angiotensin‐aldosterone activities in predicting blood pressure response to spironolactone or clonidine. The Resistant Hypertension Optimal Treatment (ReHOT) study (ClinicalTrials.gov NCT01643434) is a prospective, multicenter, randomized trial comprising 26 sites in Brazil. In step 1, 2000 patients will be treated according to hypertension guidelines for 12 weeks, to detect the prevalence of ReHy. Medical therapy adherence will be checked by pill count monitoring. In step 2, patients with confirmed ReHy will be randomized to an open label 3‐month treatment with spironolactone (titrating dose, 12.5–50 mg once daily) or clonidine (titrating dose, 0.1–0.3 mg twice daily). The primary endpoint is the effective control of blood pressure after a 12‐week randomized period of treatment. The ReHOT study will disseminate results about the prevalence of ReHy in stage II hypertension and the comparison of spironolactone vs clonidine for blood pressure control in patients with ReHy under 3‐drug standard regimen.
The role of the Na+/Ca2+ exchanger, INa and ICaL in the genesis of dofetilide‐induced torsades de pointes in isolated, AV‐blocked rabbit hearts

Background and purpose: The Na+/Ca2+ exchanger (NCX) may contribute to triggered activity and transmural dispersion of repolarization, which are substrates of torsades de pointes (TdP) type arrhythmias. This study examined the effects of selective inhibition of the NCX by SEA0400 on the occurrence of dofetilide‐induced TdP.
Loss of Ca2+‐mediated ion transport during colitis correlates with reduced ion transport responses to a Ca2+‐activated K+ channel opener

Background and purpose: Epithelial surface hydration is critical for proper gut function. However, colonic tissues from individuals with inflammatory bowel disease or animals with colitis are hyporesponsive to Cl‐ secretagogues. The Cl‐ secretory responses to the muscarinic receptor agonist bethanechol are virtually absent in colons of mice with dextran sodium sulphate (DSS)‐induced colitis. Our aim was to define the mechanism underlying this cholinergic hyporesponsiveness.
Tailored Hospital-based Risk Reduction to Impede Vascular Events After Stroke (THRIVES) study: qualitative phase protocol.

BACKGROUND There is an urgent need to develop effective strategies to improve stroke outcomes in Sub-Saharan Africa (SSA), where use of evidence-based therapies among patients receiving conventional care is poor. Designs of behavioral interventions to improve stroke care in SSA need to be sensitive to both individual and community factors (including local perceptions and public policies) contributing to the likelihood of compliance with recommended therapeutic goals. This article presents a community-based participatory research protocol that will evaluate systems and processes affecting the continuum of stroke-preventive care in an SSA country. METHODS Phase 1 of the Tailored Hospital-based Risk Reduction to Impede Vascular Events study will be implemented from 2013 to 2014 at 4 different types of hospital settings in Nigeria. Six adult stroke survivor focus group discussions and six caregiver focus group discussions, each lasting about 120 minutes will be conducted. Each group will comprise 6 to 8 participants. We will also conduct 22 semi-structured key informant interviews (informed by the Theoretical Domains Framework) with several types of providers and hospital administrators. Purposive and maximum variation sampling will be used to identify and recruit participants from participating hospitals. Transcript data will be analyzed by reviewers in an iterative process to identify recurrent and unifying themes using a constructivist variant of the grounded theory methodology, and will involve participatory co-analysis with key stakeholders to enhance authenticity and veracity of findings. DISCUSSION On the basis of the results of Tailored Hospital-based Risk Reduction to Impede Vascular Events phase 1, we intend to develop a culturally sensitive, system-appropriate, multipronged intervention whose efficacy to boost adherence to evidence-based stroke-preventive care will be tested in a future randomized trial (phase 2).
Facial Nerve Electrophysiology: Electroneurography and Facial Nerve Monitoring

With increasing regularity the audiologist is called upon to perform electroneurography and intraoperative facial nerve monitoring. The audiologist involved with these studies needs to understand the basic anatomy and physiology of the facial nerve. Electroneurography (ENOG), also referred to as evoked electromyography (EEMG) and electroneuronography, involves electrical stimulation of the facial nerve with simultaneous electromyographic (EMG) recording. ENOG is useful to determine the quantity of electrically stimulable facial nerve fibers when a patient presents with a facial paralysis. Intraoperative facial nerve monitoring with electrical stimulation (IFNMES) is used to identify, protect, and preserve the facial nerve during surgery. IFNMES is ordered any time the facial nerve is at risk for injury during surgery. Despite ideal IFNMES, this technology is no substitute for anatomic and surgical knowledge. ANATOMY OVERVIEW
Bovine glycomacropeptide induces cytokine production in human monocytes through the stimulation of the MAPK and the NF‐κB signal transduction pathways

Background and purpose: Bovine glycomacropeptide (BGMP) is a natural milk peptide that is produced naturally in the gastrointestinal tract during digestion. Glycomacropepide has intestinal anti‐inflammatory activity, but the mechanism of action is unknown. Here we have characterized the effects of BGMP on monocytes.
Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362

Abstract Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.
Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home-based care in South Africa

Abstract Despite its benefits for people living with HIV/AIDS (PLWHA), home-based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV-related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7%) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HIV stigma scale. Eighty-eight percent had low to moderate levels of caregiver burden. People with higher level of burden and higher income were more likely to hold stigmatizing beliefs. Caregivers with the following characteristics: support from a nurse, support from community careworker, HIV stigmatizing beliefs, and personal experience of discrimination as result of caring for PLWHA and low caregiver burden, had more than twice the odds of wanting to care for another PLWA in the future. Overall, caregivers in HBC experience low level of severe caregiver burden. The support offered to caregivers from the hospice and relatively low levels of discrimination encourage expansion of HBC programs for PLWHA.
Less is more: reducing the reliance on animal models for nausea and vomiting research

Animals have been used as experimental models for centuries and their use has enabled researchers to make significant advances in many areas of human health and disease. However, this is not always the case and there are limitations in using animal models as surrogates for humans, which have hampered the development of efficacious therapeutics for some pathologies. Scientific limitations, together with ethical concerns, legislative changes and the current economic climate are driving researchers to look for and develop alternative non‐animal research tools. Technological advances in tissue engineering, ‘omics’ approaches and in silico modelling for example, are enabling scientists to conduct their research without using animals in a broad range of disciplines, including complex multi‐system reflexes such as nausea and vomiting.
QRS duration, an indirect reflection of ventricular synergy, is not altered in decompensated heart failure.

QRS duration is frequently used to identify left ventricular dyssynchrony and is a primary qualification for cardiac resynchronization therapy. While QRS duration can be wider with higher heart rates due to aberrant conduction, there is little information on fluctuations of QRS duration due to decompensated heart failure, which is relevant with regard to optimal timing to assess patients for cardiac resynchronization therapy (CRT). Therefore, we sought to identify and characterize fluctuations of QRS duration during inhospital treatment for acute decompensated heart failure (ADHF). We analyzed the medical records of all patients admitted to our cardiology service for ADHF. Demographic and clinical data were obtained including analysis of initial and discharge electrocardiogram for QRS duration and determination of left ventricular systolic function. Data were obtained on 107 patients. There was no significant difference in QRS duration from admission to discharge during which patients' clinical status improved from ADHF to the compensated state. Subgroup analysis also did not reveal significant differences in QRS duration in this patient population.QRS duration did not change significantly in these patients during acute heart failure exacerbation or its resolution.
The cyclophilin inhibitor Debio 025 normalizes mitochondrial function, muscle apoptosis and ultrastructural defects in Col6a1−/− myopathic mice

Background and purpose: We have investigated the therapeutic effects of the selective cyclophilin inhibitor D‐MeAla3‐EtVal4‐cyclosporin (Debio 025) in myopathic Col6a1−/− mice, a model of muscular dystrophies due to defects of collagen VI.
Percutaneous Coronary Intervention for Bifurcation: How Can We Outperform the Provisional Strategy?

In the era of drug‐eluting stents, the provisional stenting strategy has been established as the default strategy in percutaneous coronary intervention for bifurcation lesions. However, emerging evidence shows that, in selected situations, the complex strategy of stenting both vessels regardless could reduce side‐branch restenosis without penalty. In particular, the double kissing crush technique has been proven to outperform the provisional strategy and other complex strategies in randomized trials. In this review, we present the evidence comparing the 2 strategies and individual stenting techniques and discuss the roles of other optimization techniques such as final kissing balloon inflation, proximal optimization technique, intravascular ultrasonography, and optical coherence tomography. Finally, we suggest a practical approach for choosing the optimal strategy for intervention with coronary bifurcation lesions.
Agonism and allosterism: the pharmacology of the free fatty acid receptors FFA2 and FFA3

The free fatty acid receptors FFA2 and FFA3 are recently de‐orphanized G protein‐coupled receptors that share a group of short‐chain free fatty acids as endogenous ligands. The expression of FFA2 and FFA3 by immune cells, in parts of the gastro‐intestinal tract and by white adipocytes has suggested their potential as therapeutic targets in conditions including inflammation and obesity. However, although FFA2 and FFA3 display distinct structure–activity relationships for stimulation by short‐chain free fatty acids, the overlap between these endogenous agonists and the lack of synthetic small molecule ligands that display selectivity between these two receptors has, until recently, hindered efforts to resolve their individual functions. Recently, chloro‐α‐(1‐methylethyl)‐N‐2‐thiazolylbenzeneacetamide has been described as an FFA2 selective ago‐allosteric ligand, not only being a direct agonist but also acting as a positive allosteric modulator of the function of short‐chain free fatty acids at FFA2. Mutation of a pair of key arginine residues near the top of transmembrane domains V and VII of both FFA2 and FFA3 eliminates the function of short‐chain free fatty acids but is without effect on the direct agonist action of chloro‐α‐(1‐methylethyl)‐N‐2‐thiazolylbenzeneacetamide at FFA2, confirming the distinct nature of the binding site of the ago‐allosteric regulator from the orthosteric binding site for free fatty acids. An understanding of structure–activity relationships for ligands related to chloro‐α‐(1‐methylethyl)‐N‐2‐thiazolylbenzeneacetamide is likely to provide greater insight into the mode of action and site of binding of this ligand, but further FFA2 and FFA3 selective ligands, preferably with higher potency/affinity, will be required to fully explore the physiological function of these receptors.
Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults

Abstract The role of specific psychiatric diagnoses in emergency department use and/or inpatient hospitalizations (acute care) has not been extensively examined among HIV-infected, unstably housed persons. A community-recruited sample of 284 HIV-infected, unstably housed adults completed the Diagnostic Interview Schedule for DSM-IV. One-third of participants screened positive for major depression and stimulant use disorders. Sleeping on the street [adjusted odds ratio (AOR) = 4.21], major depression (AOR = 2.88) and stimulant use disorders (AOR = 4.45) were associated with greater odds of acute care use. Housing and effective treatment of depression and stimulant use disorders may decrease use of acute care services in this population.
Intimate relationships in young adults with perinatally acquired HIV: Partner considerations

Abstract Due to developments in anti-retroviral treatment, an increasing number of children with perinatally acquired HIV are now surviving into late adolescence and young adulthood. This cohort is facing normative challenges in terms of their intimate relationships as well as challenges that face all individuals with HIV regardless of the route of transmission (for example, concerns about disclosure). There may be additional issues specific to having grown up with HIV that affect intimate relationships, for example, the awareness of being HIV positive before the onset of intimate relationships and the way that identity is shaped by having lived with HIV from a young age. To date there has been some limited research on the experience of intimate relationships in perinatally infected adolescents but none in young adults. This exploratory study examined, in depth, experiences of intimate relationships in perinatally acquired young adults and how they perceived having grown up with HIV to have affected such relationships. Seven participants (five females, two males) aged 18–23 years, were interviewed, with the data analysed according to the principles of interpretative phenomenological analysis (IPA). Three themes emerged that related to partners' perceptions of HIV: (1) HIV being viewed by partners as being linked to AIDS and sexual transmission, (2) discrepancy between young people and their partners' views of HIV, (3) partner views of risk of HIV transmission. There were strong links between participants' personal experiences of HIV-related challenges, for example, disclosure and HIV-related stigma, and their thinking about the perceptions of partners. These findings have important implications for supporting young people in disclosing their HIV status to intimate partners in appropriate ways. Suggestions for future research are offered.
Diagnostic Use of C-Reactive Protein (CRP) in Assessment of Neonatal Sepsis

After completing this article, readers should be able to: 1. Explain factors that render neonatal blood culture results less reliable when neonatal sepsis is suspected. 2. Describe the factors that confound results of C-reactive protein (CRP) measurement. 3. Explain the relevance of two negative CRP results within 48 hours in a stable patient when bacterial sepsis is being considered. 4. Delineate promising new markers for neonatal sepsis. A 2005 National Library of Medicine PubMed literature search on C-reactive protein (CRP) limited to human neonates and English language identified about 160 citations. Only two of these articles referenced a randomized, controlled clinical trial. Despite the large body of literature on CRP, there is no established standard of practice for the use of CRP in assessment of neonatal sepsis. Data from the National Institute of Child Health and Human Development Neonatal Research Network indicate that the rate of early-onset sepsis is 1.5% in very low-birthweight (VLBW) infants; almost half (46%) of neonates born at less than 25 weeks’ gestation develop late-onset sepsis. Current recommendations for the treatment of neonates who have possible or proven sepsis are intravenous antibiotics for 48 to 72 hours for stable infants who have negative blood culture results and for 7 to 14 days for blood culture-positive or clinically probable infection. It has been estimated that this approach results in treatment of up to 30 uninfected infants for every 1 infected infant. In addition, since the implementation of the Centers for Disease Control and Prevention guidelines for maternal intrapartum antibiotic prophylaxis, blood culture results as the “gold standard” are often unreliable. Identification of a diagnostic sepsis marker that has high negative predictive value may reduce the short- and long-term adverse effects of antibiotics and reduce health care costs and length of hospital stay. CRP was described initially in 1930 by Tillet and …
Ethanol sclerosis can be a safe and useful treatment for pericardial cyst

We report the case of a 41‐year‐old man with a pericardial cyst treated by percutaneous aspiration and ethanol injection. He was referred to our hospital because of elec‐trocardiographic abnormality. On admission, chest x‐ray revealed a large pericardial cyst in the right cardiophrenic angle. The cyst was examined by echocardiograpy, computed tomography, and cytological analysis of aspiration fluid from the cyst. Ethanol sclerosis was applied for treatment of the cyst, which had continued to increase in size. There was no recurrence of the cyst 6 months after the treatment. Percutaneous ethanol sclerosis can be the first choice of treatment for pericardial cyst.