Miracle-dz/UniFAR-FTUs huggingface dataset:
Dopamine agonist therapy in early Parkinson's disease.

BACKGROUND Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa. OBJECTIVES This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications. SELECTION CRITERIA Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease. DATA COLLECTION AND ANALYSIS Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality. MAIN RESULTS Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse. AUTHORS' CONCLUSIONS This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.
Oral contraceptives containing drospirenone for premenstrual syndrome.

BACKGROUND Premenstrual syndrome (PMS) is a common problem. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Combined oral contraceptives (COCs), which have both progestin and estrogen, have been examined for their ability to relieve premenstrual symptoms. A COC containing drospirenone and low estrogen has been approved for treating PMDD in women who choose COCs for contraception. OBJECTIVES To review all randomized controlled trials comparing combined oral contraceptives containing drospirenone versus a placebo or another COC for effect on premenstrual symptoms. SEARCH STRATEGY We searched the computerized databases MEDLINE, POPLINE, CENTRAL, EMBASE, LILACS, PsycINFO, and CINAHL for studies of drospirenone and premenstrual syndrome. We also examined references lists of relevant articles, and wrote to known investigators to find other trials. SELECTION CRITERIA We included randomized controlled trials in any language that compared a COC containing drospirenone versus a placebo or another COC for effect on premenstrual symptoms. Primary outcome was the prospective recording of premenstrual symptoms (affective and physical). Adverse events related to COC use were examined. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed study quality. MAIN RESULTS We included five trials with a total of 1600 women. Two placebo-controlled trials of women with PMDD showed less severe premenstrual symptoms after three months with drospirenone (plus ethinyl estradiol (EE) 20g) than with the placebo (WMD -7.83; 95% CI -10.91 to -4.75). The drospirenone group had greater decreases in impairment of productivity (WMD -0.42; 95% CI -0.64 to -0.20), social activities (WMD -0.39; 95% CI -0.62 to -0.15), and relationships (WMD -0.38; 95% CI -0.61 to -0.51). Side effects more common with COC use were nausea, intermenstrual bleeding, and breast pain. Little effect was found on less severe symptoms when comparing drospirenone plus more estrogen to another COC. A six-month study showed fewer symptoms with drospirenone, while a two-year trial found the groups to be similar. AUTHORS' CONCLUSIONS Drospirenone plus EE 20 mug may help treat premenstrual symptoms in women with PMDD. The placebo also had a large effect. We do not know whether the COC works after three cycles, for women with less severe symptoms, or better than other COCs. Larger and longer trials of higher quality are needed to address these issues. Trials should follow CONSORT reporting guidelines.
"Hay fever" in children : the real story

Rhinitis, allergic (AR) and non-allergic (NAR), and chronic rhinosinusitis (CRS) are different expressions of upper airway inflammation. Chronic upper airway symptoms are common in childhood and adolescence. There is a need for more epidemiologic data of these different entities of upper airway symptoms in the aspects of prevalence, natural course, co-morbidity and risk factors. The aim of this thesis was to provide epidemiologic data from a pediatric general population for a better understanding of the different phenotypes of upper airway inflammation from childhood to adolescence. To do this, we used the BAMSE birth cohort with 4089 children followed from birth up to 16 years of age with repeated questionnaires and clinical follow-ups. We found that AR was already common at 4 years (5.4%) and that the prevalence increased to 14% at 8 years. 87% of the 4-year-olds with AR had persistent disease up to 8 years. In contrast, among the 8.1% with NAR at 4 years, 74% had no rhinitis symptoms at 8 years. We also found that co-morbidity with asthma and eczema was common, not only for AR, but also for NAR. Oral allergy syndrome (OAS) was found among 31% of 8-year-olds and 63% of the 16-year-olds with allergic rhinitis to birch pollen. Parental allergic disease increased the risk of the child of developing AR as well as NAR at 8 years of age. There was an increased risk of AR in particular if the parents had hay fever or if both parents were allergic. An increased risk of NAR was seen if one parent had two or more allergy-related diseases. We found no difference in risk between maternal and paternal heredity. The prevalence of reported symptoms of allergic rhinitis to birch pollen (ARbp) increased from 2.5% at 4 years to 10.6% at 8 years and 17.8% at 16 years. Bet v 1-specific IgE was the most prevalent specific IgE against PR-10 allergen molecules and had the highest median levels. We found an increased probability for the onset of ARbp at 16 years with increasing levels of Bet v 1-specific IgE or increasing number of other IgE-reactive PR-10 proteins at 4 years. In addition we found that the levels of Bet v 1 at 4 years were associated with severity of ARbp at 16 years. The prevalence of CRS at 16 years of age was estimated to be between 0.3% and 1.5%. Adolescents with CRS more often reported symptoms of allergic rhinitis and asthma and had a lower health-related quality of life than those without CRS.
Simple stricture of œsophagus

SIMPLE stricture of the oesophagus as the sequel to swallowing caustic soda is a relatively frequent condition encountered in Malaya. The very name, ' simple stricture ', perhaps disguises the serious disability from which these patients suffer, especially when the degree of stenosis necessitates a gastrostomy. It may not be appreciated that in many instancesquite apart from the difficulty of the actual mechanism of feeding by a gastrostomy tube and the social disability resulting therefrom-the cost of the special diet required imposes on many of these unfortunate folk a financial burden which they cannot meet. In one of my cases the need for operative intervention of a more radical character was to overcome an economic problem which was leading to critical starvation. The report by Allison (1946) on the modern employment of oesophagojejunostomy for inoperable malignant stricture of the lower oesophagus suggested that the same type of operation would be suitable for simple stricture. Unfortunately, in most cases the level of the stricture is such that the anastomosis must be carried out above the level of the arch of the aorta. The operation has been attempted in 10 patients and has been successful in 5 of these.
RE: The Diesel Exhaust in Miners Study (DEMS): a nested case-control study of lung cancer and diesel exhaust.

Because our original publication (1) generated considerable interest over the past two years, we now provide additional data from our nested case-control study that are valuable in evaluating the relation between diesel exhaust exposure and lung cancer. Here we include results based on alternative exposure metrics (Table 1) and alternative approaches for adjusting for cigarette smoking as a confounder (Table 2), for comparison with results that appeared in Table 3 of Silverman et al. (1). Table 1. Odds ratios and 95% confidence intervals for average and cumulative REC lagged 15 years based on alternative exposure metrics*, † Table 2. Odds ratios and 95% confidence intervals for average and cumulative REC lagged 15 years with alternative approaches for smoking adjustment In Table 1, we estimate the lung cancer risk associated with average respirable elemental carbon (REC) intensity and cumulative REC, lagging exposure by 15 years, based on three alternative exposure metrics (2–6). The “. 58” REC metrics assume that changes in REC over time are not directly proportional to changes in carbon monoxide (CO) over time, whereas the original REC metrics assumed direct proportionality (1). The “5-year mean” REC metrics use 5-year averages in CO between 1976 and the last year of the exposure assessment at each mine (1998–2001) and the ratio of horsepower over ventilation before 1976 (when CO measurements were unavailable) in the time trend models to predict historical REC levels. The “median” REC metrics were based on the median of the REC measurements instead of the mean of the REC measurements to derive the 1998–2001 reference values used in the original time trend models. Results based on these alternative exposure metrics closely reflect those originally reported in Table 3 (1), each with consistent positive trends in risk with increasing exposure. Trends tended to be highly statistically significant for cumulative REC and statistically significant or borderline significant for average REC intensity. In Table 2, we estimate the lung cancer risk associated with average REC intensity and cumulative REC, lagging 15 years, based on three approaches for smoking adjustment. We present odds ratios by increasing exposure levels adjusting for: 1) smoking status (never, former, current smoker) and duration smoked; 2) status and pack-years smoked; and 3) status and both duration and packs/day in the same model. Regardless of the approach for smoking adjustment, we observed consistent highly statistically significant trends for cumulative REC and borderline significant trends for average REC intensity. Results are strikingly consistent with the previously published odds ratios in Table 3 (1). In conclusion, these sensitivity analyses underscore the robustness of our original findings (1) and provide further evidence that diesel exhaust causes lung cancer in humans.
Histopathological changes in the pancreas of laboratory rats

'Chronic relapsing pancreatitis' was seen in 81 per cent of 108 rats of 3 inbred strains. Clinically, even in advanced cases, there were no symptoms of disease and the physical status of the animals was satisfactory. The least histological sign of involvement was a decrease or loss of cytoplasmic basophilia in acinar cells in some lobules, and infiltration of the intralobular connective tissue by mononuclear cells. More severe forms of the disease were characterized by flattening of the epithelium of acini by 'microcystic-transformation' of the gland, and fatty atrophy. Fibrosis of the connective tissue and dilatation of the ducts were usual events. In few cases 'polyarteritis-like' lesions of the arteries of the pancreas were observed. Microbiological investigation of the aetiology is in progress.
Psychosocial interventions for women enrolled in alcohol treatment during pregnancy.

BACKGROUND Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. To our knowledge there have been no systematic reviews of randomised control trials (RCT) in this population. OBJECTIVES To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention. SEARCH STRATEGY We searched the Cochrane Drugs and Alcohol Group's Trial register (December 2007); MEDLINE (1950 to 2007); PsycINFO (1806 to 2007); EMBASE (1974 to 2007); CINAHL (1982 to 2007) SELECTION CRITERIA We sought to include randomised or quasi-randomised studies comparing any psychosocial intervention versus pharmacological interventions or placebo or non-intervention or another psychosocial intervention for treating alcohol dependence in pregnancy. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion in review. Studies were to be assessed using standardized data extraction and quality assessment forms. No suitable trials were identified. MAIN RESULTS The search strategy identified 958 citations. 17 citations were deemed relevant for full text review, an additional 9 articles were retrieved through hand searching references, for a total of 26 articles. Following full text review no articles met the inclusion criteria. Data extraction and assessment of methodological quality were therefore not possible. AUTHORS' CONCLUSIONS The review question remains unanswered as there were no randomised control trials found relevant to the topic. There is a need for high quality randomised controlled trials to determine the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs.
Quality of life in young adults with head injury living in nursing homes : a comparative study

Background: Little is known about young adults with Head Injury (HI) who are discharged to nursing homes; particularly with regards to the impact that living environment has on their quality of life (QOL). To date QOL profiles in HI are limited and much of this research has also been confined to those who live in the community. The degree to which existing profiles are meaningful in young adults with HI living in nursing homes is uncertain and further investigation is required. Methods: The present study aims to investigate whether QOL differs for individuals with HI living in nursing homes compared to individuals with HI living in the community and healthy peers. 33 participants were recruited into one of three groups; HI nursing home (n = 11), HI community group (n = 11) and a healthy control group (n = 11). The groups were compared on generic and disease specific self-report measures of QOL. In order to create a picture of factors which are associated with QOL following HI; the HI groups completed a number of measures assessing psychosocial variables (depression, self-esteem, contact with family and friend and completion of recreational activities). Results: No differences in ratings of QOL between the HIN group and HICC and healthy control groups were found. Relationships were found between levels of depression, self-esteem and QOL after HI. Conclusion: No evidence was found to support the hypothesis that QOL is poorer for young adults with HI living in nursing homes. Further support is provided for a number psychological variables associated with QOL. Further research is required to replicate and extend these findings.
Avaliação da qualidade da formação: contribuição à discussão na área da saúde coletiva

Visando contribuir com a discussao da implantacao e implementacao de mecanismos de avaliacao de qualidade da formacao na area da saude coletiva, sao abordadas neste artigo as principais caracteristicas de processos de avaliacao educacional a partir de alguns autores que tomam por base o conceito de qualidade. Entende-se ser necessaria a criacao de instrumentos de avaliacao em todos os niveis da educacao e que os instrumentos de avaliacao das instituicoes de ensino devam ser calcados em principios determinados pelos setores e representacoes pertinentes.
Tirilazad for aneurysmal subarachnoid haemorrhage.

BACKGROUND Delayed cerebral ischaemia is a significant contributor to poor outcome (death or disability) in patients with aneurysmal subarachnoid haemorrhage (SAH). Tirilazad is considered to have neuroprotective properties in animal models of acute cerebral ischaemia. OBJECTIVES To assess the efficacy and safety of tirilazad in patients with aneurysmal SAH. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched October 2009); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2009); MEDLINE (1966 to October 2009); EMBASE (1980 to October 2009); and the Stroke Trials Directory, the National Center for Complementary and Alternative Medicine, and the National Institute of Health Clinical Trials Database (searched October 2009). We handsearched 10 Chinese journals, searched the reference lists of relevant publications, and contacted the manufacturers of tirilazad. SELECTION CRITERIA Randomised trials of tirilazad started within four days of SAH onset, compared with placebo or open control in patients with aneurysmal SAH documented by angiography and computerised tomography (CT) scan or cerebrospinal fluid examination, or both. DATA COLLECTION AND ANALYSIS We extracted data relating to case fatality, poor outcome (death, vegetative state, or severe disability), delayed cerebral ischaemia (or symptomatic vasospasm), cerebral infarction and adverse events of treatments. We pooled the data using the Peto fixed-effect method for dichotomous data. MAIN RESULTS We included five double-blind, placebo-controlled trials involving 3821 patients; there was no significant heterogeneity. Oral or intravenous nimodipine was used routinely as a background treatment in both groups in all trials. There was no significant difference between the two groups at the end of follow up for the primary outcome, death (odds ratio (OR) 0.89, 95% confidence interval (CI) 0.74 to 1.06), or in poor outcome (death, vegetative state or severe disability) (OR 1.04, 95% CI 0.90 to 1.21). During the treatment period, fewer patients developed delayed cerebral ischaemia in the tirilazad group than in the control group (OR 0.80, 95% CI 0.69 to 0.93). Subgroup analyses did not demonstrate any significant difference in effects of tirilazad on clinical outcomes. Leukocytosis and prolongation of Q-T interval occurred significantly more frequently in the treatment group in only one trial evaluating tirilazad at high dose. There was no significant difference in infusion site disorders or other laboratory parameters between the two groups. AUTHORS' CONCLUSIONS There is no evidence that tirilazad, in addition to nimodipine, reduces mortality or improves poor outcome in patients with aneurysmal SAH.
Interventions for treating painful sickle cell crisis during pregnancy.

BACKGROUND Sickle cell disease is a group of genetic haemoglobin disorders. All over the world, about 300,000 children with these disorders are born each year. Acute sickle cell pain episodes are the most common cause of hospitalisation. Pregnancy in women with sickle cell disease is associated with an increased incidence of maternal and fetal morbidity and mortality. The painful crisis is a severe complication of this illness, and it requires several interventions: packed red cell transfusion, fluid replacement therapy, analgesic drugs, oxygen therapy and steroids; but the approach is not standardised. OBJECTIVES To assess the effectiveness and safety of different regimens of packed red cell transfusion, oxygen therapy, fluid replacement therapy, analgesic drugs, and steroids for the treatment of painful sickle cell crisis during pregnancy. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2007), the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (October 2007), LILACS database (1982 to December 2007) and the following web sites: ClinicalTrials.gov (http://www.clinicaltrials.gov) (December 5, 2007); Current Controlled Trials (http://controlled-trials.com/) (December 5, 2007), and Sistema de Información Esencial en Terapéutica y Salud (http://www.icf.uab.es/informacion/Papyrus/sietes.asp) (December 1, 2007). We also handsearched the European Haematology Association conference (June 2007), the American Society of Hematology conference (December 2007) and reference lists of all retrieved articles. SELECTION CRITERIA We intended to include randomised clinical trials. DATA COLLECTION AND ANALYSIS We intended to summarise data by standard Cochrane Collaboration methodologies. MAIN RESULTS We could not find any randomised clinical trials on interventions (packed red cell transfusion, oxygen therapy, fluid replacement therapy, analgesic drugs, and steroids) for the treatment of painful sickle cell crisis during pregnancy. AUTHORS' CONCLUSIONS This review found no randomised clinical trials on the safety and efficacy of interventions for treating painful sickle cell crisis during pregnancy. The effects of interventions need to be tested in randomised clinical trials.
Diagnosis of Basal-Like Breast Cancer Using a FOXC1-Based Assay.

BACKGROUND Diagnosis of basal-like breast cancer (BLBC) remains a bottleneck to conducting effective clinical trials for this aggressive subtype. We postulated that elevated expression of Forkhead Box transcription factor C1 (FOXC1) is a simple and accurate diagnostic biomarker for BLBC. METHODS Accuracy of FOXC1 expression in identifying BLBC was compared with the PAM50 gene expression panel in gene expression microarray (GEM) (n = 1992) and quantitative real-time polymerase chain reaction (qRT-PCR) (n = 349) datasets. A FOXC1-based immunohistochemical (IHC) assay was developed and assessed in 96 archival formalin-fixed, paraffin-embedded (FFPE) breast cancer samples that also underwent PAM50 profiling. All statistical tests were two-sided. RESULTS A FOXC1-based two-tier assay (IHC +/- qRT-PCR) accurately identified BLBC (AUC = 0.88) in an independent cohort of FFPE samples, validating the accuracy of FOXC1-defined BLBC in GEM (AUC = 0.90) and qRT-PCR (AUC = 0.88) studies, when compared with platform-specific PAM50-defined BLBC. The hazard ratio (HR) for disease-specific survival in patients having FOXC1-defined BLBC was 1.71 (95% CI = 1.31 to 2.23, P < .001), comparable to PAM50 assay-defined BLBC (HR = 1.74, 95% CI = 1.40 to 2.17, P < .001). FOXC1 expression also predicted the development of brain metastasis. Importantly, unlike triple-negative or Core Basal IHC definitions, a FOXC1-based definition is able to identify BLBC in both ER+ and HER2+ patients. CONCLUSION A FOXC1-based two-tier assay, by virtue of being rapid, simple, accurate, and cost-effective may emerge as the diagnostic assay of choice for BLBC. Such a test could substantially improve clinical trial enrichment of BLBC patients and accelerate the identification of effective chemotherapeutic options for this aggressive disease.