Miracle-dz/UniFAR-FTUs huggingface dataset:
Induction of Vogt-Koyanagi-Harada Disease by Interferon-Alpha and Ribavirin Treatment in Patients with Hepatitis C: A Case Report and Review of the Literature

ABSTRACT Purpose: To describe a case of Vogt-Koyanagi-Harada disease (VKH) presenting in a hepatitis C patient after interferon-alpha (IFN-α) and ribavirin treatment. Methods: A retrospective review of our patient and a review of the published literature. Results: A 59 year-old man developed VKH after the four months of IFN-α and ribavirin therapy for hepatitis C. The patient’s VKH was controlled by systemic corticosteroids. The relationship between VKH and IFN-α is discussed based on the published literature. Conclusions: VKH is a rare autoimmune complication triggered by interferon-alpha therapy; the T-cell modulatory properties of IFN-α possibly contribute to this association. Early diagnosis of VKH and aggressive systemic corticosteroid intervention are essential for this type of IFN-α -related autoimmune complication.
Use of Cataract Services in Eastern Africa—A Study from Tanzania

Purpose: To establish the proportion of patients who are blind or have low vision prior to undergoing cataract surgery at tertiary referral centers in Tanzania. To assess which patient groups presenting for cataract surgery are more likely to be blind or visually impaired. Methods: Using pre-existing computerized audit systems we gathered data on pre-operative visual status, age, gender and presentation mode (walk-in or outreach) for 3765 patients undergoing 4258 cataract operations at 2 hospitals in Tanzania. Visual status was defined based on vision in the better eye. Results: 32% of operations were performed on blind patients, 37% on patients with low vision and 31% on normally sighted patients. Predictors of blindness at presentation were: female sex (OR 1.15; 95% CI 1.00–1.32); referral from a rural outreach program (OR 1.75; 95% CI 1.51–2.02) and older age (OR 1.02; 95% CI 1.01–1.02). Conclusions: It is not only the blind who present to cataract services in Tanzania. The demand for surgery amongst patients who or are normally sighted represents a positive move towards prevention, and not only cure of cataract blindness in Tanzania. However, it also highlights the need to target those left blind from cataract in order to deliver services to those most in need. Cataract programs targeting patients in rural areas and older patients are likely to increase the number of blind patients benefiting from cataract services.
Contrasting effects of prenatal life stress on blood pressure and body mass index in young adults

Background: Various environmental stressors in pregnancy have been reported to affect high blood pressure (BP) in adult offspring. However, few studies have examined the effect of prenatal maternal psychological stress on offspring BP and BMI in early adulthood. Method: In 957 Raine cohort participants, regression analyses were used to examine the association between the count of maternal life stress events experienced during pregnancy and offspring BP and BMI at age 20. Results: Prenatal life stress associated positively with offspring BMI but inversely with SBP. After adjustment for confounders each additional prenatal life stress event reduced offspring SBP by 0.66 mmHg (P = 0.013) in those with an average BMI and lowered the odds of systolic (pre)hypertension by 17% (odds ratio = 0.83; P = 0.008). The inverse relationship between prenatal life stress and adult SBP was stronger in offspring with higher BMI. On the contrary, each unit increase in prenatal life stress score predicted a BMI increase of 0.37 kg/m2 (P = 0.022). Longitudinal analysis showed similar effects of prenatal life stress for offspring BMI from age 8 and SBP from age 14. Conclusion: This study has shown that maternal stress in pregnancy significantly associated with BMI from early childhood, but contrary to our hypothesis predicted lower resting SBP and lower odds of systolic (pre)hypertension in young adult offspring. The effect of prenatal life stress on BP was accentuated by a higher BMI. Fetal programming events as a result of prenatal stress may underpin some of these relationships.
The impact of an arts program in a children's cancer and hematology center

The Arts in Medicine (AIM) program is an established, 13-year-old program in a major children's Cancer and Hematology Center that provides meaningful artistic opportunities to cancer patients and their families in inpatient and outpatient settings. We report the results of a survey-based program evaluation assessing the clinical effectiveness of AIM-facilitated activities. The survey consisted of questions designed to assess patient familiarity with and participation in art opportunities. Among 460 patients and family members, we found low familiarity with the actual AIM program but high participation in and perceived benefit of AIM-facilitated activities. To raise awareness, implementing a daily activity schedule and providing AIM program information to all newly diagnosed patients and families is recommended. Teenagers perceived art activities to be especially beneficial. To increase older children's involvement in AIM activities, expanding performance arts and increasing specific efforts to engage teenager involvement should be considered.
Partial absorption of hard exudates in patients with diabetic end-stage renal disease and severe anemia after treatment with erythropoietin.

BACKGROUND Diabetic retinopathy improved in three patients with renal insufficiency after a rise in hematocrit induced by administration of recombinant erythropoietin. The change involved significant resorption of hard exudates in patients who were not eligible to receive laser treatment. METHODS Three patients with diabetic nephropathy had the associated chronic anemia of renal insufficiency. In each patient, diabetic retinopathy with foveal/parafoveal hard exudates (but no clinically significant macular edema) was initially evaluated ophthalmoscopically. Fluorescein angiography demonstrated a low-grade diffuse leakage pattern. Treatment with subcutaneous recombinant erythropoietin (4000 IU twice weekly) was initiated within 1 to 3 months of initial evaluation. The resolution of hard exudates was observed on ophthalmoscopic examination and graded fundus photography (ETDRS seven standard field). RESULTS Within 6 months of initiation of erythropoietin treatment, a substantial reduction of exudate was observed in all three patients, the hematocrit having increased from a mean of 21% to a mean of 33% (a mean increase of 33% in each patient). Visual acuity improved in two patients and stabilized in the other. Follow-up fluorescein angiographic examination demonstrated no change in the leakage pattern. CONCLUSION Although no direct cause and effect relationship can be established, raising the red cell mass by treatment with recombinant erythropoietin may serve as adjunctive treatment of diabetic retinopathy in patients with diabetic renal insufficiency.
Effect of birth weight on life-course blood pressure levels among children born premature: the Cardiovascular Risk in Young Finns Study

Objectives: Both fetal growth restriction and prematurity have been associated with elevated blood pressure (BP). However, their combined effects on adult BP are unclear. Methods: Our analyses were based on 1756 participants in the population-based Cardiovascular Risk in Young Finns Study who had information on birth weight and gestational age, together with longitudinal data on cardiovascular risk markers from age 3–18 years in 1980 to age 34–49 years in 2011. Three groups were defined by birth data: those born at term (term); those born preterm (<37 weeks) with an appropriate birth weight (>−1 SD z score according to national sex and gestational week-stratified data) for gestational age (preterm appropriate birth weight for gestational age); and those born preterm with low birth weight (⩽−1 SD z score) for gestational age [preterm small birth weight for gestational age (SGA)]. Results: There were no differences between the three groups in BP at baseline, but at the 31-year follow-up (mean age 41 years), mean SBP in the preterm SGA group was 7.2 mmHg (95% confidence interval = 2.3–12.1 mmHg, P = 0.004) higher than the preterm appropriate birth weight for gestational age group and 7.3 mmHg (95% confidence interval = 5.2–9.4 mmHg, P < 0.0001) higher than the term group, adjusted for age and sex. In addition, preterm SGA individuals had a higher prevalence of adult hypertension compared with those born at term (36.9 vs. 25.4%; age, sex, and risk factors adjusted P = 0.006). Conclusion: These longitudinal data suggest that elevated BP levels associated with prematurity are more likely to be present in those with fetal growth restriction.
Swim training attenuates oxidative damage and promotes neuroprotection in cerebral cortical slices submitted to oxygen glucose deprivation

Although it is well known that regular exercise may promote neuroprotection, the mechanisms underlying this effect are still not fully understood. We investigated if swim training promotes neuroprotection by potentiating antioxidant pathways, thereby decreasing the effects of oxidative stress on glutamate and nitric oxide release. Male Wistar rats (n=36) were evenly randomized into a trained group (TRA) (5 days/week, 8 weeks, 30 min) and a sedentary group (SED). Forty‐eight hours after the last session of exercise, animals were killed and brain was collected for in vitro ischemia. Cortical slices were divided into two groups: a group in which oxidative stress was induced by oxygen and glucose deprivation (OGD), and a group of non‐deprived controls (nOGD). Interestingly, exercise by itself increased superoxide dismutase activity (nOGD, SED vs. TRA animals) with no effect on pro‐oxidative markers. In fact, TRA‐OGD slices showed lowered levels of lactate dehydrogenase when compared with SED‐OGD controls, reinforcing the idea that exercise affords a neuroprotective effect. We also demonstrated that exercise decreased glutamate and nitrite release as well as lipid membrane damage in the OGD cortical slices. Our data suggest that under conditions of metabolic stress, swim training prevents oxidative damage caused by glutamate and nitric oxide release.
Variables de resultado combinadas en los ensayos clínicos

Las variables de resultado combinadas en los ensayos clinicos son un recurso metodologico usado con frecuencia, especialmente en los estudios cardiovasculares. Las motivaciones mas importantes para su utilizacion son aumentar la potencia estadistica del estudio, valorar el beneficio neto de una intervencion y evitar una interpretacion erronea del resultado en presencia de riesgos competitivos. Sin embargo, su interpretacion puede ser problematica si hay heterogeneidad entre los componentes en cuanto a su importancia, la frecuencia de eventos o el efecto de la intervencion. En la discusion que sigue se presenta un revision conceptual de los problemas del uso y la interpretacion de las variables de resultado combinadas en ensayos clinicos, especialmente los cardiovasculares. Se presenta ademas una sencilla guia de interpretacion de los resultados de los estudios que utilizan variables de resultado combinadas a partir de la cual se puede valorar nuestra confianza en dichos resultados. Finalmente, se presenta un estudio empirico sobre cual ha sido el uso real de variables de resultado combinadas potencialmente problematicas en ensayos clinicos cardiovasculares.
DETERMINAÇÃO DOS NÍVEIS SÉRICOS DE PROTEÍNA C- REATIVA (CRP) EM CÃES COM ALTERAÇÕES DOS PARÂMETROS HEMATOLÓGICOS

The natural immune response to infectious agents is partially mediated by a group of proteins named acute phase proteins; one of the major and most important proteins from the acute phase is the C-Reactive Protein (CRP). The aim of the present study was to investigate the correlation between alterations on white blood cell counts (WBC) and the presence of circulating CRP. Blood samples from 70 dogs were submitted to hematological examination and detection of CRP; in addition, blood samples from 12 dogs experimentally inoculated with an inactivated sample of Micrococcus luteus (ATCC 7468) were also analyzed. According to the hematological parameters and CRP values, the samples were classified in 5 different groups: group A) dogs without CRP and normal WBC; group B) dogs with elevated levels of CRP but normal WBC; group C) dogs with elevated CRP values and altered WBC (neutrophilia and leukocytosis); group D) dogs with both CRP and increased neutrophils values; and group E) dogs with elevated CRP values but with leukopenia. Dogs experimentally inoculated with M. luteus had a significant and promt increase in CRP values between 24 and 48 hr p.i. , which declined up to the 10 th day when the experiment was completed. In these dogs, a discrete neutrophilia and leukocytosis was observed coincidently with the CRP elevation. Thus, it can be suggested that the detection of CRP in the blood of dogs should be used as an indication of an infection or inflammation and, because of the low amount of blood needed, low cost and easiness to perform the test, monitoring CRP levels might be useful to evaluate the recovery from an infection disease. KEYWORDS: acute phase proteins; blood cell count; diagnosis; inflammation.
Blood pressure variability after catheter-based renal sympathetic denervation in patients with resistant hypertension

Background: Renal denervation (RDN) reduces sympathetic activity and blood pressure (BP) in patients with resistant hypertension. Increased 24-h BP variability is associated with adverse cardiovascular outcomes and related to sympathetic activation. Methods and results: This multicenter study investigated the effect of RDN on BP variability in 84 patients with uncontrolled hypertension (office systolic BP ≥140 mmHg) despite treatment with greater than three antihypertensive agents. BP variability was assessed by means of standard deviation, coefficient of variation (standard deviation/mean), and average real variability of 24-h ambulatory SBP at 3-month and 6-month follow-up. RDN significantly reduced office BP by 17/6 mmHg at 3-month and 19/7 mmHg at 6-month follow-up (P < 0.001 for all) and 24-h ambulatory BP by 9/5 mmHg (P < 0.001/P = 0.001) after 3 months and 12/7 mmHg (P < 0.001/P < 0.001) after 6 months. Standard deviation significantly decreased from 17.1 to 14.9 mmHg (P = 0.008) and 15.3 mmHg (P = 0.037), consistent with a reduction of coefficient of variation from 0.116 to 0.103 (P = 0.035) and 0.104 (P = 0.071) and average real variability from 12.3 to 10.9 (P = 0.029) and 11.0 (P = 0.054) after 3-month and 6-month, respectively. Interestingly, also BP nonresponders (change in office systolic BP < 10 mmHg after 6 months) showed a significant reduction of standard deviation after 3 months (P = 0.041, n = 26) and a borderline significant reduction at 6-month (P = 0.057, n = 28). Conclusions: RDN reduces office and ambulatory BP and BP variability in patients with resistant hypertension. Improvement in BP variability was also documented in patients characterized as office BP nonresponders after 6 months.
Genetic association of left ventricular mass assessed by M-mode and two-dimensional echocardiography

Background: Left ventricular mass offers prognostic information for assessing cardiovascular disease risk. M-mode and two-dimensional (2D) echocardiographically-derived left ventricular mass values have shown high accuracy and reproducibility; however, no studies to date have compared left ventricular mass genetic association findings on the basis of both the methods. The aim of this study was to compare associations of single-nucleotide polymorphisms (SNPs) from genome-wide association study analyses of left ventricular mass using both methods in the same cohort. Methods and results: Left ventricular mass was determined using 2D and M-mode echocardiography in 711 patients (390 women); SNP genotype data were obtained using the Genome-wide Human SNP Array 6.0. Genome-wide association study analyses were performed to obtain panels of SNPs associated with left ventricular mass and left ventricular mass index. The unindexed left ventricular mass showed excellent agreement [M-mode: 170 ± 47 vs. 2D: 178 ± 56 g; intraclass correlation coefficient 0.929 (95% confidence interval 0.932, 0.909)]. The presence of left ventricular hypertrophy based on M-mode and 2D-derived left ventricular mass index values showed moderate agreement (kappa = 0.49). Eleven SNPs showed suggestive association with at least two of the four left ventricular mass traits, with one SNP in CDH13 common to all four derived traits. Conclusion: M-mode and 2D echocardiography left ventricular mass measurements in the same cohort identified suggestive genetic associations, both shared and unshared, suggesting common left ventricular mass biology underlying the two measures of left ventricular mass. The combined use of M-mode and 2D echo is a novel approach that may increase the yield of genetic association with left ventricular mass.
Current Clinical Practice

How does this book differ from the standard textbooks of medicine? In the preface, the editor states that the book focuses on "patient management in a broad range of diseases and disorders [as practiced] by the specialists and superspecialists of the major private clinics in the United States. " He notes that such clinics are committed to excellence in medical care and to cost-efficient practices. The editor further notes that the authors tried to be thorough but make no claim to cover completely the clinical practice of internal medicine. The text was written by approximately 270 contributing authors who practice at 14 reputable private clinics, including the Cleveland Clinic, Lahey Clinic (Burlington, Mass), Mayo Clinic (Rochester, Minn), Ochsner Clinic (New Orleans), and Palo Alto (Calif) Medical Clinic. It includes 232 chapters divided among one section on general patient care and 13 sections based on organ systems. At the end of each
Prevalence and prognosis of ECG abnormalities in normotensive and hypertensive individuals

Objective: To define the prevalence and prognosis of ECG abnormalities in hypertensive individuals. Methods: ECG, blood pressure and other cardiovascular risk factors were recorded in a nationwide population sample of 5800 Finns. The presence of 15 ECG abnormalities was evaluated. Participants were divided into categories by blood pressure and followed for coronary heart (CHD) and cardiovascular disease (CVD) events. Results: Mean follow-up was 10.4 ± 2.2 years. The age- and sex-adjusted prevalence rates of ECG abnormalities were generally higher in the hypertensive participants than in normotensive individuals. In multivariable-adjusted Cox models, the following ECG abnormalities predicted CHD in hypertensive participants: left ventricular hypertrophy (LVH) by Sokolow-Lyon criteria [hazard ratio, 1.47; 95% confidence interval (CI), 1.07–2.01; P = 0.02], LVH with ST-depression and negative T wave (ST/T changes) (hazard ratio, 2.31; 95% CI, 1.20–4.43, P = 0.01), ST/T changes (hazard ratio, 2.12; 95% CI, 1.34–3.36; P = 0.001), positive T wave in lead aVR (AVRT+) (hazard ratio, 1.74; 95% CI, 1.15–2.64; P = 0.009) and poor R-wave progression (hazard ratio, 2.02; 95% CI, 1.27–3.22; P = 0.003). These ECG abnormalities were also significant predictors of CVD in hypertensive participants (P ⩽ 0.03 for all). Nonspecific intraventricular conduction delay predicted CVD in the whole population (hazard ratio, 1.50; 95% CI, 1.06–2.13; P = 0.02). Prolonged QT interval, abnormal P-wave indices, left axis deviation and early repolarization pattern were not associated with CHD or CVD. Conclusion: ECG abnormalities are highly prevalent in hypertensive individuals. LVH is still the cornerstone of cardiovascular risk assessment in hypertensive patients. The additional assessment of ST/T changes, AVRT+ and poor R-wave progression in ECGs could improve risk prediction in hypertensive patients.
Witnessing and experiencing domestic violence: a descriptive study of adolescents.

OBJECTIVE The aim of the study was to describe the experiences of different types of domestic violence among adolescents and associations between the family background and different types of domestic violence. METHODS The survey included 1393 ninth-graders from one Finnish municipality. RESULTS Domestic violence is fairly common in the lives of adolescents. Sixty-seven percent of respondents had experienced parental symbolic aggression, 55% mild violence and 9% severe violence during their childhood. Twelve percent of adolescents had witnessed parent-to-parent violence. Witnessing domestic violence and exposure to parental violence is associated with a number of adolescents' background factors such as self-perceived health, satisfaction with life, family relationships, parenting practice, school bullying and sexual activity. CONCLUSIONS The findings stress the relevance of corporal punishment and witnessing domestic violence as a risk factor for more severe domestic violence and sexual abuse. Different types of domestic violence have a major effect on adolescent well-being and risk behaviours. To break the negative cycle, nurses and other professionals working with adolescents in different settings should pay attention to all forms of violence, including the milder ones.
Pediatric adrenocortical tumors: diagnosis, management and advancements in the understanding of the genetic basis and therapeutic implications

Adrenocortical tumors (ACTs) may be sporadic or related to inherited genetic syndromes. Uncovering the molecular defects underlying these genetic syndromes has revealed key signaling pathways involved in adrenocortical tumorigenesis. Although the understanding of ACT biology has improved, to date, very few potential prognostic molecular markers of childhood ACTs have been identified. In this review, we summarize the current knowledge of the epidemiology, clinical presentation, diagnosis, prognosis and treatment options for pediatric patients with ACTs. A review of the genetic basis of adrenocortical tumorigenesis is presented, focusing on the main molecular abnormalities involved in the tumorigenic process and potential novel therapy targets that have been generated, or are being generated, with the discovery of these molecular defects.
Rapid assessment team reduces waiting time

Objective: In an effort to reduce waiting times and improve the performance of the clinical indicator waiting time relative to triage category, a rapid assessment team was implemented. Methods: The rapid assessment team consists of the rapid assessment team doctor and triage nurse. The rapid assessment team ensured, wherever possible, that patients were medically assessed prior to expiration of the waiting time appropriate to their National Triage Scale. Waiting time performance indicators, median waiting time and length of stay during the 3 months the rapid assessment team was operative were compared with the same period 1 year before. Results: During the 3 month period where the rapid assessment team was operative, 59.0% of patients (n = 5877) were seen within accepted time standards and the median waiting time was 32 min. This compared with 39.1% (n = 3901) and 50 min, respectively, in the same period 1 year before (P < 0.001). There was no significant difference in median length of stay (3.2 h for both, P = 0.18). Improvements in waiting times occurred in all triage categories except category 1. Due to a lack of resources and funds, the rapid assessment team was discontinued on 4 October 1997. Conclusions: The rapid assessment team reduces doctor waiting times. Departments considering implementing a rapid assessment team should ensure it is funded as a separate resource.