Miracle-dz/UniFAR-FTUs huggingface dataset:
Body composition analysis on elderly living in nursing homes

Body composition is a good indicator of an individual’s health and physical status. In addition to total body fat, fat distribution is a major risk factor for cardiovascular diseases and insulin resistance/diabetes in elderly. There are a limited number of studies focused on the body composition of elderly populations in Turkey. The primary objective of this study is to evaluate body composition in the Turkish elderly living in nursing homes. The sample included a total of 164 adults (91 females and 73 males), aged 65 years and over, living in Ankara nursing homes. According to the standard anthropometric protocols weight, height, skinfold thicknesses, and arm circumference were taken, and the body mass index (BMI), fat mass, fat free mass and arm fat area were calculated. The study results showed that males were significantly heavier and taller, whereas BMI were higher in females. The comparison of arm fat area between sexes showed that females have significantly (p<0.001) greater values. Total body fat (kg) was higher in females and decreases with age for both sexes, where this decline is greater in elderly females. In conclusion, the body composition of elderly can provide information on the general health status, and support clinicians to understand more in their treatment progress.
Predicting weight loss in people with cancer

Background: Malnutrition and the cachexia syndrome are common in people with cancer. A combination of reduced nutritional intake and abnormal metabolism can lead to physical and psychological disturbances which may impair quality of life and reduce survival. Improved patient outcomes are more likely if treatments and nutritional support can be initiated before significant weight loss has occurred. Methods: A three phase, mixed methods study was undertaken. The primary aim was to gain a greater understanding of the complex factors that have an effect on, and can predict, weight loss in people with cancer. Phases I and II involved the psychometric testing of the Cancer Appetite and Symptom Questionnaire (CASQ). The instrument was tested for reliability among patients receiving radiotherapy (n=34). Predictive validity of the CASQ, using ROC curve analysis, was determined in patients with lung or upper GI cancer (n=185). Total CASQ scores (possible range, 0 to 48) were assessed at baseline, together with percentage weight change after 3 months. An exploratory qualitative study, following the principles of grounded theory, was conducted to explore the causes and influencing factors on weight change. Results: When tested for reliability, the intra-class correlation coefficient of the CASQ was 0.80 (95% CI 0.68 to 0.92) and the difference between total CASQ scores at the two time points was -0.20 (95% CI -1.21 to 0.80). The optimum cut point of the total CASQ score to predict >5% weight loss was 31/32 (C statistic = 0.64; sensitivity 65%, specificity 62%, PPV 33%, NPV 86%), and to predict >10% weight loss was 29/30 (C statistic = 0.75; sensitivity 71%, specificity 66%, PPV 19%, NPV 95%). Exploratory modelling using multiple linear regression techniques suggested that BMI, MUST score, age and the CASQ items of enjoyment of food and pain, were most predictive of weight loss. Nine patients with lung or upper GI cancer and three carers participated in semi-structured interviews. Analysis of the data confirmed the vulnerability of this patient group in terms of symptom burden and nutritional risk. From the findings, a conceptual model that explains the influences on weight change in people with cancer was proposed. Conclusions: Patients with lung and upper GI cancer are at high risk of malnutrition. Psychometric testing of the CASQ suggests that the instrument can predict weight loss in this patient group. Due to the low PPV, further refinements are needed before the instrument is able to be used in clinical practice. A conceptual model which explains the complex process of influences on weight change in people with cancer can improve knowledge and understanding, ultimately informing healthcare practice.
Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes.

BACKGROUND Although P2Y12 antagonists are effective in patients with non-ST-segment elevation (NSTE) acute coronary syndromes, the effect of the timing of administration--before or after coronary angiography--is not known. We evaluated the effect of administering the P2Y12 antagonist prasugrel at the time of diagnosis versus administering it after the coronary angiography if percutaneous coronary intervention (PCI) was indicated. METHODS We enrolled 4033 patients with NSTE acute coronary syndromes and a positive troponin level who were scheduled to undergo coronary angiography within 2 to 48 hours after randomization. Patients were randomly assigned to receive prasugrel (a 30-mg loading dose) before the angiography (pretreatment group) or placebo (control group). When PCI was indicated, an additional 30 mg of prasugrel was given in the pretreatment group at the time of PCI and 60 mg of prasugrel was given in the control group. RESULTS The rate of the primary efficacy end point, a composite of death from cardiovascular causes, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa inhibitor rescue therapy (glycoprotein IIb/IIIa bailout) through day 7, did not differ significantly between the two groups (hazard ratio with pretreatment, 1.02; 95% confidence interval [CI], 0.84 to 1.25; P=0.81). The rate of the key safety end point of all Thrombolysis in Myocardial Infarction (TIMI) major bleeding episodes, whether related or not related to coronary-artery bypass grafting (CABG), through day 7 was increased with pretreatment (hazard ratio, 1.90; 95% CI, 1.19 to 3.02; P=0.006). The rates of TIMI major bleeding and life-threatening bleeding not related to CABG were increased by a factor of 3 and 6, respectively. Pretreatment did not reduce the rate of the primary outcome among patients undergoing PCI (69% of the patients) but increased the rate of TIMI major bleeding at 7 days. All the results were confirmed at 30 days and in prespecified subgroups. CONCLUSIONS Among patients with NSTE acute coronary syndromes who were scheduled to undergo catheterization, pretreatment with prasugrel did not reduce the rate of major ischemic events up to 30 days but increased the rate of major bleeding complications. (Funded by Daiichi Sankyo and Eli Lilly; ACCOAST ClinicalTrials.gov number, NCT01015287.).
Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya.

INTRODUCTION This research examines the institutional dynamics of tobacco control following the establishment of Kenya's 2007 landmark tobacco control legislation. Our analysis focuses specifically on coordination challenges within the health sector. METHODS We conducted semi-structured interviews with key informants (n = 17) involved in tobacco regulation and control in Kenya. We recruited participants from different offices and sectors of government and non-governmental organizations. RESULTS We find that the main challenges toward successful implementation of tobacco control are a lack of coordination and clarity of mandate of the principal institutions involved in tobacco control efforts. In a related development, the passage of a new constitution in 2010 created structural changes that have affected the successful implementation of the country's tobacco control legislation. DISCUSSION We discuss how proponents of tobacco control navigated these two overarching institutional challenges. These findings point to the institutional factors that influence policy implementation extending beyond the traditional focus on the dynamic between government and the tobacco industry. These findings specifically point to the intragovernmental challenges that bear on policy implementation. The findings suggest that for effective implementation of tobacco control legislation and regulation, there is need for increased cooperation among institutions charged with tobacco control, particularly within or involving the Ministry of Health. Decisive leadership was also widely presented as a component of successful institutional reform. CONCLUSION This study points to the importance of coordinating policy development and implementation across levels of government and the need for leadership and clear mandates to guide cooperation within the health sector. The Kenyan experience offers useful lessons in the pitfalls of institutional incoherence, but more importantly, the value of investing in and then promoting well-functioning institutions.
Antisense Inhibition of Apolipoprotein C-III in Patients with Hypertriglyceridemia.

BACKGROUND Apolipoprotein C-III (APOC3) is a key regulator of plasma triglyceride levels. Elevated triglyceride levels are associated with a risk of adverse cardiovascular events and pancreatitis. ISIS 304801 is a second-generation antisense inhibitor of APOC3 synthesis. METHODS We conducted a randomized, double-blind, placebo-controlled, dose-ranging, phase 2 study to evaluate ISIS 304801 in untreated patients with fasting triglyceride levels between 350 mg per deciliter (4.0 mmol per liter) and 2000 mg per deciliter (22.6 mmol per liter) (ISIS 304801 monotherapy cohort), as well as in patients receiving stable fibrate therapy who had fasting triglyceride levels between 225 mg per deciliter (2.5 mmol per liter) and 2000 mg per deciliter (ISIS 304801-fibrate cohort). Eligible patients were randomly assigned to receive either ISIS 304801, at doses ranging from 100 to 300 mg, or placebo, once weekly for 13 weeks. The primary outcome was the percentage change in APOC3 level from baseline. RESULTS A total of 57 patients were treated in the ISIS 304801 monotherapy cohort (41 received active agent, and 16 received placebo), and 28 patients were treated in the ISIS 304801-fibrate cohort (20 received active agent, and 8 received placebo). The mean (±SD) baseline triglyceride levels in the two cohorts were 581±291 mg per deciliter (6.6±3.3 mmol per liter) and 376±188 mg per deciliter (4.2±2.1 mmol per liter), respectively. Treatment with ISIS 304801 resulted in dose-dependent and prolonged decreases in plasma APOC3 levels when the drug was administered as a single agent (decreases of 40.0±32.0% in the 100-mg group, 63.8±22.3% in the 200-mg group, and 79.6±9.3% in the 300-mg group, vs. an increase of 4.2±41.7% in the placebo group) and when it was administered as an add-on to fibrates (decreases of 60.2±12.5% in the 200-mg group and 70.9±13.0% in the 300-mg group, vs. a decrease of 2.2±25.2% in the placebo group). Concordant reductions of 31.3 to 70.9% were observed in triglyceride levels. No safety concerns were identified in this short-term study. CONCLUSIONS We found that treatment with ISIS 304801 was associated with significant lowering of triglyceride levels, among patients with a broad range of baseline levels, through selective antisense inhibition of APOC3 synthesis. (Funded by Isis Pharmaceuticals; ClinicalTrials.gov number, NCT01529424.).
Allogeneic red blood cell transfusion in coronary artery bypass surgery

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Polymorphisme insertion\délétion du gène de l‘apolipoprotéine B : effet sur les concentrations lipidiques chez les sujets obèses

L‘apolipoproteine B (apo B) est le composant proteique principal des LDL, des VLDL et des chylomicrons. De nombreux polymorphismes du gene de l‘apolipoproteine B ont ete rapportes. En particulier, un polymorphisme d‘insertion\deletion situe dans la partie codante du peptide signal de l‘apo B est associe a des modifications de concentrations lipidiques et du risque cardiovasculaire dans la population generale. Les dyslipoproteinemies sont frequentes au cours de l‘obesite. Le but de notre travail etait d‘etudier les effets du polymorphisme d‘insertion\deletion du gene de l‘apo B sur les lipides des sujets obeses ; 234 sujets obeses non apparentes (74 hommes et 160 femmes, âges de : 39,3 ± 10,5 ; indice de masse corporelle (IMC) : 32,8 ± 4,7) ont ete recrutes. Le polymorphisme insertion\deletion etait determine par electrophorese sur gel de polyacrylamide apres amplification de l‘ADN par PCR. Les frequences alleliques etaient de 0,71 pour l‘insertion et 0,29 pour la deletion. Ces frequences sont comparables a celles trouvees dans les populations caucasiennes. Dans la population totale, on observe chez les homozygotes pour la deletion (del\del) une augmentation significative du rapport cholesterol‐total\cholesterol‐HDL (p ∓ 0,004), du rapport cholesterol‐LDL\cholesterol‐HDL (p ∓ 0,01) et des TG‐VLDL (p ∓ 0,05). Chez ces memes sujets, on note egalement une tendance a l‘augmentation des triglycerides (p ∓ 0,09) et une tendance a la baisse du cholesterol‐HDL, de l‘apolipoproteine AI et de la fraction LpAI. La deletion entraine l‘absence de 3 acides amines (Leu‐Ala‐Leu) dans le peptide signal de l‘apo B. Chez les sujets obeses, ces changements de structure pourraient retentir sur le metabolisme des lipoproteines et entrainer ainsi des variations des concentrations lipidiques.
A ‘navigator’ model in emerging mental illness?

While there is clearly much to be gained from ensuring that youth with emerging mental illness across a variety of psychiatric illnesses receive care that reduces symptoms and improves functioning, it is not at all clear how best to achieve these results within a health‐care system that has limited resources. Outside of the area of psychosis, there is little evidence to guide us around a model of care that might be effective, efficient and linked to existing mental health systems.
Sleep and rest activity measured by wrist actigraphy in an HIV-infected patient with Steven–Johnson syndrome

The Steven–Johnson syndrome (SJS) is characterized by a sudden onset of mucous membrane erosion (predominantly oral mucosa, lips, and conjunctivae) with widespread blistering of the skin involving up to 10% of the body surface area. It is almost always a drug-related reaction, although it can be caused by infections and immunizations. A 33-year-old man with recent diagnosis of HIV infection developed antiretroviral treatment (ART)-associated SJS. Physical activity and sleep parameters were recorded by wrist actigraphy in four different consecutive scenarios: baseline assessment, first ART regimen, hospitalization, and second ART regimen. Significant differences were observed in physical activity patterns between the four phases. No differences in sleep parameters were found. To our knowledge, this is the first study recording physical activity changes and sleep during a SJS reaction.
Back to basics: could behavioural therapy be a good treatment option for youth depression? A critical review

Recent findings from systematic reviews and primary research studies have shown more modest effects of cognitive behavioural therapy (CBT) for youth depression than previously shown, highlighting the need to further enhance the effectiveness of this intervention, or components of this intervention. Therefore, the aim of this review is to summarize the work that has been done to identify the different components of CBT and their varying effectiveness for young people with depression.
Fractional flow reserve-guided PCI for stable coronary artery disease.

BACKGROUND We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years. RESULTS The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P=0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P=0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495.).
Fatty Acids, Cardiovascular Diseases, and Diabetes Mellitus

Cardiovascular disease (CVD) is the number one cause for mortality and morbidity around the world. Meanwhile, diabetes mellitus (DM) has become an emerging epidemic, causing 1.5 million deaths in 2012, with 80% occurring in lowand middle-income countries. Substantial evidence has linked both lifestyle and metabolic risk factors to increased risk of CVD and death, with suboptimal diet being the single leading modifiable cause of poor health (Lim. SS, et al, Lancet 2012). Of 20 top individual causes of disease burden worldwide, 8 are related to poor nutrition, including suboptimal intakes of various dietary fatty acids. Although previous studies have found divergent health effects of different dietary fatty acids on health, gaps still exist in terms of the scientific knowledge (e.g. how individual circulating vs. dietary trans fatty acid subtypes affect health) and related disease burdens (e.g. national CHD mortality burdens attributable to suboptimal intakes of fatty acids). These gaps have motivated my dissertation researches. In chapter one and two, I investigated the prospective associations of five subtypes of plasma phospholipid trans fatty acid (TFA) levels with the risk of various disease endpoints, including total, CVD and non-CVD mortality, incident coronary heart disease (CHD) and DM. In chapter two, I also examined the prospective associations of total and subclasses dietary TFA with risk of DM. The analyses were conducted using the Cardiovascular Health Study, a community-based multicenter prospective cohort consisted of older Americans. The risks were estimated using the Cox proportional hazard model.
Combined vemurafenib and cobimetinib in BRAF-mutated melanoma.

BACKGROUND The combined inhibition of BRAF and MEK is hypothesized to improve clinical outcomes in patients with melanoma by preventing or delaying the onset of resistance observed with BRAF inhibitors alone. This randomized phase 3 study evaluated the combination of the BRAF inhibitor vemurafenib and the MEK inhibitor cobimetinib. METHODS We randomly assigned 495 patients with previously untreated unresectable locally advanced or metastatic BRAF V600 mutation-positive melanoma to receive vemurafenib and cobimetinib (combination group) or vemurafenib and placebo (control group). The primary end point was investigator-assessed progression-free survival. RESULTS The median progression-free survival was 9.9 months in the combination group and 6.2 months in the control group (hazard ratio for death or disease progression, 0.51; 95% confidence interval [CI], 0.39 to 0.68; P<0.001). The rate of complete or partial response in the combination group was 68%, as compared with 45% in the control group (P<0.001), including rates of complete response of 10% in the combination group and 4% in the control group. Progression-free survival as assessed by independent review was similar to investigator-assessed progression-free survival. Interim analyses of overall survival showed 9-month survival rates of 81% (95% CI, 75 to 87) in the combination group and 73% (95% CI, 65 to 80) in the control group. Vemurafenib and cobimetinib was associated with a nonsignificantly higher incidence of adverse events of grade 3 or higher, as compared with vemurafenib and placebo (65% vs. 59%), and there was no significant difference in the rate of study-drug discontinuation. The number of secondary cutaneous cancers decreased with the combination therapy. CONCLUSIONS The addition of cobimetinib to vemurafenib was associated with a significant improvement in progression-free survival among patients with BRAF V600-mutated metastatic melanoma, at the cost of some increase in toxicity. (Funded by F. Hoffmann-La Roche/Genentech; coBRIM ClinicalTrials.gov number, NCT01689519.).
Polyunsaturated fatty acids in emerging psychosis: a safer alternative?

A promising approach of indicated prevention in individuals at increased risk of psychosis was based on the finding of potential neuroprotective properties of omega‐3 polyunsaturated fatty acids (PUFAs). Considering the rising interest in omega‐3 PUFA supplementation as preventive treatment strategy in young people at risk of psychosis, the question of safety issues must be addressed.
An Introduction to the Symptoms and Signs of Surgical Disease

Now in its third edition, An Introduction to the Symptoms and Signs of Surgical Disease has become a best-selling, innovative textbook. The text teaches the clinical symptoms and signs of surgical disease, stressing the importance of a thorough history and bedside examination. By presenting the symptoms and signs in a formalised, systematic manner and by describing in detail the techniques of clinical examination, this text enables students to elicit key symptoms and make sound clinical decisions. Written for medical students and junior doctors, 'An Introduction to the Symptoms and Signs of Surgical Disease' continues to be an essential resource for study and reliable companion in clinical practice.