Miracle-dz/UniFAR-FTUs huggingface dataset:
Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide and Tacrolimus Ointment in Management of Localized Alopecia Areata

Background: Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA. Aim: To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA. Materials and Methods: 105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using “HRG Scale”; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%). Results: Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus. Conclusion: Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.
Extensive Alopecia Areata: Not Necessarily Recalcitrant to Therapy!

Background: Extensive alopecia areata includes alopecia universalis, alopecia totalis, ophiasis and patients having more than 50% scalp involvement. Alopecia universalis (AU) and totalis (AT) are considered to be resistant to single modalities of treatment. Our study highlights the efficacy and safety of combination therapy in extensive alopecia areata. Aim: To evaluate the efficacy and safety of a combination treatment with oral bethametasone mini-pulse, topical minoxidil and short contact anthralin in long-standing, treatment-resistant, extensive alopecia areata. Materials and Methods: Fifteen patients aged 7 to 45 years with extensive, treatment-resistant alopecia areata (AU: 7; AT: 1; ophiasis: 4; patients with more than 50% scalp involvement: 3) were treated with betamethasone oral mini-pulse (0.1 mg per kg body weight per dose on two consecutive days per week) along with short contact anthralin (1.15%) and 2-5% minoxidil lotion daily, till response. The response was assessed by the severity of alopecia tool (SALT) score. Cosmetic response was defined as regrowth obviating the need of a wig. Failure of treatment was defined as no growth or vellus hair on the scalp. Results: Out of eight patients with AU/AT, two attained cosmetic response as early as three months, two at six months and one had partial response. Cosmetic response was attained in all four patients with ophiasis and all three patients with more than 50% scalp involvement at six months. All responders maintained their response without systemic steroids beyond 12 months. Among a total of twelve responders (80%), two with AU showed a mild relapse and were effectively treated with intralesional steroids. Side effects to therapy were mild and reversible. Conclusion: A combination therapy of oral steroid minipulse with topical anthralin and minoxidil acts synergistically, being effective as well as safe in treatment-resistant, extensive, long-standing alopecia areata.
Die sitzende Lebensweise: Ein metabolisch riskantes Verhalten? Wartet der Diabetes im Stuhl?

Does Type-2 Diabetes Sit in a Chair? In the scientific literature, inactivity is defined as missing at least 150 minutes per week with mod- erate or 75 minutes with highly intense physical activity, respectively. The role of sedentariness has been recently discussed. In industrialized countries, sedentariness is a widespread phe- nomenon. The question is whether this behav- iour causes an independent health-detrimental risk. There is convincing evidence that physical activity even in a light intensity reduces the risk of premature death and cardio-metabolic mor- bidity. Inactivity is by contrast a risk-enhancing behaviour. Despite these evident facts most peo- ple in industrialized countries spend most of their time sitting. Sedentariness is defined as sitting with only a very small amount of energy expenditure. This review summarizes what is known about the health-detrimental effects of a sedentary lifestyle. It shows that sedentariness is an independent risk for the incidence of type-2 diabetes and for all-cause and cardio-metabolic mortality. The underlying pathophysiological me- chanisms explaining these effects are not fully understood. Preliminary findings and promising hypotheses focus on an impaired segregation of lipoprotein lipase, impaired glucose tolerance, and inflammatory processes. Because there is by now consistent evidence that sedentariness in- creases and that light-intense physical activity reduces the risk for mortality and metabolic mor- bidity, public health recommendations should address this behaviour besides inactivity. Breaks in sedentary time should be done as often as possible to avoid longer sitting periods. J Klin Endokrinol Stoffw 2013; 6 (4): 22-5.
Significance of Scraping Scalp Lesions in Adults

1. Trüeb RM. Chemotherapy-induced hair loss. Skin Therapy Lett 2010;15:5-7. 2. Miteva M, Misciali C, Fanti PA, Vincenzi C, Romanelli P, Tosti A. Permanent alopecia after systemic chemotherapy: A clinicopathological study of 10 cases. Am J Dermatopathol 2011;33:345-50. 3. Imanishi H, Tsuruta D, Tateishi C, Sugawara K, Paus R, Tsuji T, et al. Laminin-511, inducer of hair growth, is down-regulated and its suppressor in hair growth, laminin-332 up-regulated in chemotherapy-induced alopecia. J Dermatol Sci 2010;58:43-54. 4. Katikaneni R, Ponnapakkam T, Suda H, Miyata S, Sakon J, Matsushita O, et al. Treatment for chemotherapy-induced alopecia in mice using parathyroid hormone agonists and antagonists linked to a collagen binding domain. Int J Cancer 2011 Nov 30. [Epub ahead of print] 5. Maurer M, Handjiski B, Paus R. Hair growth modulation by topical immunophilin ligands: Induction of anagen, inhibition of massive catagen development, and relative protection from chemotherapy-induced alopecia. Am J Pathol 1997;150:1433. 6. Jimenez JJ, Roberts SM, Mejia J, Mauro LM, Munson JW, Elgart GW, et al. Prevention of chemotherapy-induced alopecia in rodent models. Cell Stress Chaperones 2008;13:31-8.
Imaging of pleural disease

Chest radiography is the imaging modality of choice in the initial investigation of pleural disease.Ultrasound is useful in the detection of pleural fluid and in guiding interventional procedures such as thoracentesis, needle biopsy and placement of drainage catheters. It may have a role in the rapid detection of pneumothorax in the acute setting.CT is used for further characterization of pleural abnormalities seen on ultrasound and chest radiography and may also be used to guide interventional procedures.MRI and nuclear medicine have a limited role at present.
A Hospital-based Retrospective Study on Frequency and Distribution of Viral Hepatitis

Background: Viral hepatitis is a major public health problem throughout the world. It is the inflammation of the liver due to the infection of any of the five main hepatic viruses A to E and it affects the liver through different modes of transmission. This study mainly aims at the frequency and distribution of viral hepatitis based on age and sex during a time period of 5 years. Materials and Methods: This is a hospital-based retrospective study of 5 years at a tertiary level hospital in Kerala state in India. Medical records department of the hospital follow the guidelines of International Classification of Diseases-10 for coding the diseases. The data on frequency and distribution of viral hepatitis based on age and sex during a period of 5 years from April 2005 to March 2010 were collected and analyzed and ‘z’ test was used for finding out the difference in proportions. Result: Out of 818 cases, 76.03% were males and 23.96% were females. The preponderance of males was apparent in all types of viral hepatitis infection. The high risk groups were the adults in the age group of 20-39 years. The main cause in the present study was hepatitis E virus (HEV) and followed by hepatitis A virus (HAV). Of total viral hepatitis cases, 31.54% were due to HAV, 6.35% hepatitis B virus, 0.85% hepatitis C virus and 61.24% were due to HEV respectively. In the present study, there was no case of hepatitis D virus has reported. The case fatality rate of viral hepatitis in the present study was minor than 1% (0.98%); whereas males were 0.96%; females of 1.02%. Conclusion: Taking the safety measures including vaccination and proper management of waste materials are the only solution to control or eradicate this infection.
Effect of Multi-Dimensional Education on Disease Progression in Pre-Dialysis Patients in China

Abstract Background: There is an increasing body of evidence showing that educational interventions aiming at empowering patients are successful in chronic disease management. The aim of this study was to conduct an evaluation of the systematic effectiveness of a multi-dimensional education intervention program in a group of pre-dialysis chronic kidney disease (CKD) patients. In addition, we investigated whether the outcome of the program was related with the amount of education. Methods: We collected data retrospectively from 302 patients with CKD stages 3, 4, and 5, who were followed up from February 2006 to March 2008. The patients were divided into long-time education group and short-time education group depending on the number of provided hours of education. Survival analysis was undertaken to see if the progression of the kidney function differed between these two groups. Results: The percentage of patients receiving long-time education was highest with severe degree of impairment of renal function (45.5%, 61.3%, and 66.7% in CKD stages 3, 4, and 5 groups, respectively). In a multivariate regression analysis, adjusting for age, gender, Charlson comorbidity index, and other traditional risk factors of renal failure, such as smoking, hypertension, and renal function (glomerular filtration rate), the length of time until a decline of renal function by 25% was noted and was significantly shorter in the short-time education group as compared to the long-time education group (p = 0.0334). Conclusion: Multi-component structured empowerment intervention is effective in pre-dialysis CKD patients and may lead to a delay in the progression of kidney disease.
Percepção dos profissionais sobre o tratamento no fim da vida, nas unidades de terapia intensiva da Argentina, Brasil e Uruguai

ABSTRACT OBJECTIVE: To evaluate end-of-life procedures in intensive care units. METHODS: A questionnaire was prepared by the End-of-Life Study Group of the Argentinean, Brazilian and Uruguayan Intensive Care societies, collecting data on the participants’ demographics, institutions and limit therapeutic effort (LTE) decision making process. During this cross sectional study, the societies’ multidisciplinary teams members completed the questionnaire either during scientific meetings or online. The variables were analyzed with the Chi-square test, with a p<0.05 significance level. RESULTS: 420 professionals completed the questionnaire. The Brazilian units had more beds, unrestricted visit was less frequent, their professionals were younger and worked more recently in intensive care units, and more non-medical professionals completed the questionnaire. Three visits daily was the more usual number of visits for the three countries. The most influencing LTE factors were prognosis, co-morbidities, and therapeutic futility. In the three countries, more than 90% of the completers had already made LTE decisions. Cardiopulmonary resuscitation, vasoactive drugs administration, dialysis and parenteral nutrition were the most suspended/refused therapies in the three countries. Suspension of mechanic ventilation was more frequent in Argentina, followed by Uruguay. Sedation and analgesia were the less suspended therapies in the three countries. Legal definement and ethical issues were mentioned as the main barriers for the LTE decision making process. CONCLUSION: LTE decisions are frequent among the professionals working in the three countries’ intensive care units. We found a more proactive LTE decision making trend In Argentina, and more equity for decisions distribution in Uruguay. This difference appears to be related to the participants’ different ages, experiences, professional types and genders.
Outbreak of Human Buffalopox Infection

An outbreak of febrile illness with vesicular lesions on hands and forearms of six persons was investigated. There was simultaneous outbreak of similar illness in buffaloes that were milked by these persons. Buffaloes had lesions on many parts of body including udder and teats. Manual milking without gloves exposed the persons to the infection. Investigations proved that both the outbreaks were due to buffalopox virus infection. Improved dairy practices like wearing gloves while milking might help in prevention of spread of infection to other animals and humans.
Toxoplasmosis: A Global Threat

Toxoplasmosis, a disease described worldwide, which is caused by the protozoan Toxoplasma gondii, commonly involves the retina. The disease has a higher impact in immunocompromised individuals and in congenital infection because of the severity of central nervous system involvement. Although simple prophylactic measures could reduce transmission, T. gondii seroprevalence is still high, especially in South America. Educational campaigns and the development of new drugs to prevent primary infection could potentially reduce the burden of the disease.
Development of novel therapy of schizophrenia in children and adolescents

Introduction: Typical and atypical antipsychotics are efficacious treatments for early-onset schizophrenia (EOS) with very subtle differences in their efficacy. Therefore, when choosing an antipsychotic, the side-effect profile of the individual antipsychotic needs to be taken into account. There is a growing body of neurobiological and genetic evidence for early-onset patients, but these findings have not yet translated into the clinic. Areas covered: The authors summarize the current treatment options for EOS and discuss the novel treatment options that are under evaluation. The authors focus specifically on Phase II and Phase III clinical trials. Expert opinion: Currently, there are no truly groundbreaking pharmacological treatment options emerging in EOS. There are several newer antipsychotic agents (iloperidone, lurasidone, asenapine, blonanserin) that are currently in clinical trials. It is unclear whether therapeutic efficacy of any of these agents will be superior or even similar to the existing treatment and the main differentiating factor between individual drugs remains to be their side-effect profile. Beyond these antipsychotics, oxytocin and N-acetylcysteine are the only new pharmacological treatment options that are being evaluated in EOS. Therefore, a major change in the treatment development paradigm is necessary to identify novel and efficacious drugs.
Ticagrelor for the treatment of peripheral arterial disease

Introduction: Peripheral arterial disease (PAD) is a manifestation, and marker of severity, of a generalized atherosclerotic process. Antiplatelet therapy is recommended to prevent cardiovascular events but much of the evidence to support this is drawn from studies on older drugs. Areas covered: In this review, the authors discuss the available evidence for the basis of current recommendations and review the data from Phase I to III trials on ticagrelor as a potential future treatment. This paper also reviews the properties of ticagrelor, its adverse effects, and how it differs from current recommended antiplatelet agents. As it is also more potent, a personalized approach to antiplatelet therapy may prove useful. It further highlights the additional effects of ticagrelor mediated by adenosine and their potential benefits, which may provide an explanation to its superior outcomes in trials comparing it with clopidogrel. Expert opinion: Although there is a current lack of evidence to support the use of ticagrelor in patients with PAD, its unique pleomorphic properties make it attractive for future investigations and development of similar drugs.
History of Urinary Tract Infection and Risk of Renal Cell Carcinoma

Limited data exist regarding whether a history of urinary tract infection (UTI) increases risk of developing renal cell carcinoma (RCC). Furthermore, it is unclear whether any association of RCC with a history of UTIs is modified by known risk factors for RCC (i.e., smoking, obesity). The authors report data from a 1986–1989 populationbased case-control study in Iowa. RCC cases (233 males, 139 females) were identified through the Iowa Cancer Registry; controls (1,497 males, 751 females) were randomly selected from the general population, frequency matched on age and sex. Subjects provided detailed information on demographic, anthropometric, lifestyle, dietary, and medical history risk factors. In age-adjusted analysis, risk increased for subjects who self-reported a history of physician-diagnosed kidney or bladder infection (odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.5, 2.5) compared with those reporting no such history. Both sex and smoking status modified the risk of RCC associated with a history of UTI, with the strongest risk reported for males (OR = 2.7, 95% CI: 1.9, 3.8) and current smokers (OR = 4.3, 95% CI: 2.7, 6.7). The strongest risk was reported for male current smokers with a history of UTI (OR = 9.7, 95% CI: 5.0, 18.1). Multivariate adjustment for anthropometric, lifestyle, and dietary factors did not alter these findings. Results suggest a positive association of UTI history with RCC development, with elevated risks most notable for males with a history of smoking.
Adrenal rests associated with ectopic testis in an adult: Clinical significance

Ectopic adrenal tissue may be present along the path of the testis and discovered during groin surgery. The condition has been mainly reported in the pediatric population and very rarely in adults. Here, we report on the case of an adult male with undescended testis who received orchidectomy, and ectopic adrenal tissue was discovered in the removed specimen. The clinical significance of such a condition is discussed.
Integrin antagonists as potential therapeutic options for the treatment of Crohn’s disease

ABSTRACT Introduction: Anti-integrin therapy for the treatment of patients with Crohn’s disease is rapidly evolving. Two agents, natalizumab and vedolizumab, are approved by the United States Food and Drug Administration for the treatment of Crohn’s disease, with vedolizumab the primary anti-integrin used due to a more favorable safety profile. Several other anti-integrins are in various stages of development. Areas Covered: This review discusses the current state of anti-integrin therapy as well as suggestions for positioning of these agents in clinical practice. Emerging anti-integrin therapies, their underlying mechanisms of action, and available safety and clinical data are also reviewed. Expert Opinion: Anti-integrins are effective for the treatment of Crohn’s disease, even in patients refractory to other therapies. Their use should be considered in patients with Crohn’s disease who do not respond to, develop non-response to, or have contraindications to anti-TNF therapy. Anti-integrin therapies can be offered as a first biologic therapy, in particular for older patients, patients with concurrent multiple sclerosis (natalizumab only), and in patients with contraindications to anti-TNF therapy. In patients with more severe symptoms, providers should consider co-induction with corticosteroids if possible to hasten remission.
Hypertriglyceridaemia: Aetiology, Complications and Management

Abstract The bulk of plasma triglycerides are carried by chylomicrons in the fed and very low-density lipoproteins in the fasted state. These triglyceride-rich lipoproteins are metabolised to remnant lipoproteins by lipoprotein lipase (LPL). Hypertriglyceridaemia results if triglyceride-rich lipoproteins accumulate either due to defective clearance, overproduction or a combination of both mechanisms. Genetic and environmental factors interact in the genesis of hypertriglyceridaemia but occasionally a single factor may be dominant. At a molecular level the most common cause of severe primary hypertriglyceridaemia is loss of function mutations in both alleles of LPL. The most common environmental contributors include diabetes, diet, alcohol and medications (including oestrogen, steroids, retinoids and protease inhibitors). Severe hypertriglyceridaemia can trigger acute pancreatitis while mild to moderate hypertriglyceridaemia is an independent cardiovascular risk factor. Treatment strategies are determined by the severity and aetiology of hypertriglyceridaemia as well as the patient's cardiovascular risk profile. General strategies include lifestyle modifications with restriction of dietary fat intake, cessation of alcohol intake and increased exercise. Contributing metabolic disorders should be controlled and aggravating medications withdrawn or reduced where possible. Moderate hypertriglyceridaemia may be treated with high doses of omega-3 fatty acids (4 g/day), fibrates, niacin or statins. Fibrates are the agents of choice in severe hypertriglyceridaemia.
Cross-protection from human papillomavirus 16/18 against types 45 and 31: fact or fancy?

Human papillomavirus (HPV) types 16 and 18 are responsible for approximately 70% of all cervix cancers, followed by HPV types 45 and 31, which represent an additional 10%. In total, there are 15 HPV types that have been associated with the development of cervical cancer [1,2]. HPV vaccination has been shown to be highly effective in preventing precancerous cervical lesions in several large, international, randomized trials [3–6]. A multivalent vaccine to all types of HPV known to cause cervical cancer may be ideal; however, the costs of large international studies may be prohibitive. There is evidence that cross-neutralization occurs, thereby broadening the coverage of the HPV vaccines and increasing the benefits of vaccine to a larger range of infected people. However, this concept remains controversial. This editorial reviews the evidence for cross-protection in current clinical trials, in vitro work and epidemiologic studies. Recently, Paavonen et al. published an interim analysis of a large, randomized, placebo-controlled trial of a HPV 16/18 L1 virus-like particle (VLP) vaccine [6]. While the primary end point was a decrease in high-grade cervical intraepithelial neoplasia (CIN 2+) associated with HPV 16 and 18, a decrease in persistent infections with other nonvaccine HPV types was also noted. This effect is termed ‘cross-protection. ’ A decrease in persistent 6-month infections of 59.9 and 36.1% for HPV 45 and 31, respectively, was found, although this effect did not reach statistical significance against 12-month infections. Cross-protection of 31.6 and 46.5% was found for HPV 52 against 6and 12-month infections, respectively. Previous studies with longer follow-up (4.5 years) did not show protection against HPV 52, suggesting that this protective effect