Miracle-dz/UniFAR-FTUs huggingface dataset:
Pulmonary vein isolation and left atrial complex-fractionated atrial electrograms ablation for persistent atrial fibrillation with phased radio frequency energy and multi-electrode catheters: efficacy and safety during 12 months follow-up.

AIMS Ablation for persistent atrial fibrillation (AF) remains a difficult and time-consuming procedure with varying degrees of success. We evaluated the long-term effects of a novel approach for ablation of persistent AF using multi-electrode catheters. METHODS AND RESULTS In 89 patients with longstanding persistent AF (>1 year), multi-electrode ablation was performed with a pulmonary vein ablation catheter (PVAC), a multi-array septal catheter (MASC), and a multi-array ablation catheter (MAAC) for ablation of complex-fractionated atrial electrograms (CFAE) at the septum, left atrial (LA) roof, floor, posterior wall, and mitral isthmus. Follow-up was performed at 6 and 12 months with electrocardiogram, 7 days Holter, and occasionally ambulant event recordings. Average procedure and fluoroscopy times were 112 ± 32 and 21 ± 10 min. The pre-specified endpoint of pulmonary vein isolation and LA CFAE ablation was reached in all patients. No procedural complications were observed. At 12 months after a single treatment 44 of 89 (49%) remained in sinus rhythm, including direct current cardioversion in 12 patients. At 12 months, after a redo PVAC/MASC/MAAC, an additional 6 of 15 patients (40%) were free of AF. In 18 of 89 (20%) patients AF was changed to paroxysmal. CONCLUSIONS In this single centre study, ablation for longstanding persistent AF with the PVAC/MASC/MAAC resulted in 56% freedom of AF at 1 year after 1.2 ± 0.4 procedures. This approach is time efficient and has a favourable safety profile.
POSSUM and Portsmouth POSSUM for predicting mortality

There is a need for an accurate measure of surgical outcomes so that hospitals and surgeons can be compared properly regardless of case mix. POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) uses a physiological score and an operative severity score to calculate risks of mortality and morbidity. In a previous small study it was found that Portsmouth POSSUM (P‐POSSUM; a modification of the POSSUM system) provided a more accurate prediction of mortality.
Antibiotics for acute otitis media: yes or no.

Patients, their families, and their physicians may have different perspectives about the risks and benefits of treatment options for children’s middle ear infections.1 For instance, patients and their family members may favor aggressive use of antibiotics to treat otitis media, hoping to alleviate pain and discomfort as quickly as possible. In contrast, pediatricians and other physicians must remain cognizant of public health issues related to the overuse of antibiotics. There is no doubt antibiotics have been overused since their introduction decades ago. Nevertheless, the allure of antibiotics is powerful because they can save lives, cure illness, and hasten recovery from common maladies like middle ear infections.
Evaluation and Treatment of Carotid Artery Stenosis

Stroke is the fourth leading causes of death in the United States. Annually, about 795,000 people suffer from a stroke with about 140,000 people, or 1 in 19, dying each year due to stroke related causes. [1] Between 1995-2005 overall stroke death rate fell 30%, even so, annual health care related costs for stroke patients in 2012 were up to 38.6 billion. [1] It is well recognized that cerebrovascular disease, specifically carotid atherosclerosis and subsequent stenosis, is a leading cause of ischemic stroke, which makes up 87% of all strokes. Due to the significant morbidity and mortality incurred by these patients the identification, management, and treatment of carotid disease is of paramount importance.
Reduced connexin40 protein expression in the right atrial appendage of patients bearing the minor connexin40 allele (-44 G --> A).

AIMS The occurrence of connexin40 (Cx40) minor polymorphism (-44 G → A) was increased in patients with idiopathic atrial fibrillation (AF), although its effect on atrial Cx40 protein expression is unknown. We aimed to evaluate whether alterations in Cx40 are directly linked to the development of AF, we studied the effect of this polymorphism on Cx40 expression and distribution in patients without any history of AF and in patients who developed post-operative AF. METHODS AND RESULTS Hundred and eight patients (mean age 67 ± 9 years), without a history of AF or conditions that predispose to AF, were included. During heart surgery, 10 cc blood was collected for DNA genotyping and the right atrial appendage was partly excised. Ten patients (9%) were homozygous for the minor allele (AA, Group 1), 30 (28%) were heterozygous (AG, Group 2), and 68 (63%) were non-carriers (GG, Group 3). Ten age- and sex-matched tissue samples per group were analysed for Cx40 expression by: (i) real-time quantitative polymerase chain reaction (Q-PCR), (ii) western blotting, and (iii) immunohistochemistry on cryosections. Real-time quantitative polymerase chain reaction showed no significant differences of Cx40 mRNA among the groups. Western blot analysis, however, revealed a reduction in Cx40 protein in Groups 1 (-36.4%) and 2 (-39.5%) as compared with Group 3. Immunohistochemistry confirmed this reduction but indicated an unaltered subcellular distribution of the remaining Cx40. Incidence of post-operative AF (28%) was age-dependent but unrelated to the presence of the polymorphism or fibrosis. CONCLUSION Presence of the Cx40 minor allele (-44 G → A) results in a uniform down-regulation of right atrial appendage Cx40 protein which was not significantly related to development of post-operative AF.
Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction.

IMPORTANCE Little information exists about the anatomical characteristics and clinical relevance of non-infarct-related artery (IRA) disease among patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES To investigate the incidence, extent, and location of obstructive non-IRA disease and compare 30-day mortality according to the presence of non-IRA disease in patients with STEMI. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of patients pooled from a convenience sample of 8 independent, international, randomized STEMI clinical trials published between 1993 and 2007. Follow-up varied from 1 month to 1 year. Among 68,765 patients enrolled in the trials, 28,282 patients with valid angiographic information were included in this analysis. Obstructive coronary artery disease was defined as stenosis of 50% or more of the diameter of a major epicardial artery. To assess the generalizability of trial-based results, external validation was performed using observational data for patients with STEMI from the Korea Acute Myocardial Infarction Registry (KAMIR) (between November 1, 2005, and December 31, 2013; n = 18,217) and the Duke Cardiovascular Databank (between January 1, 2005, and December 31, 2012; n = 1812). MAIN OUTCOMES AND MEASURES Thirty-day mortality following STEMI. RESULTS Overall, 52.8% (14,929 patients) had obstructive non-IRA disease; 29.6% involved 1 vessel and 18.8% involved 2 vessels. There was no substantial difference in the extent and distribution of non-IRA disease according to the IRA territory. Unadjusted and adjusted rates of 30-day mortality were significantly higher in patients with non-IRA disease than in those without non-IRA disease (unadjusted, 4.3% vs 1.7%, respectively; risk difference, 2.7% [95% CI, 2.3% to 3.0%], P < .001; and adjusted, 3.3% vs 1.9%, respectively; risk difference, 1.4% [95% CI, 1.0% to 1.8%], P < .001). The overall prevalence and association of non-IRA disease with 30-day mortality was consistent with findings from the KAMIR registry (adjusted, 3.6% for patients with non-IRA disease vs 2.5% in those without it; risk difference, 1.1% [95% CI, 0.6% to 1.7%]; P < .001), but not with the Duke database (adjusted, 4.7% with non-IRA disease vs 4.3% without it; risk difference, 0.4% [95% CI, -1.4% to 2.2%], P = .65). CONCLUSIONS AND RELEVANCE In a retrospective pooled analysis of 8 clinical trials, obstructive non-IRA disease was common among patients presenting with STEMI, and was associated with a modest statistically significant increase in 30-day mortality. These findings require confirmation in prospectively designed studies, but raise questions about the appropriateness and timing of non-IRA revascularization in patients with STEMI.
Comparison of lower limit of normal values with a fixed ratio assessed by spirometry in obstructive and restrictive lung diseases in Indian population

Background and Aim: Spirometric parameters are approximated by the normal distribution and using lower limit of normal (LLN) minimize the misclassification with fixed-ratio protocol in interpretation of spirometry results. This study investigates prevalence and characterization of obstructive and restrictive lung function impairments, and dissimilarities between two guidelines interpreting spirometry. Methods: This study was conducted to assess the lung function in students and patients (n = 74) of MGM Medical College, Kishanganj, Bihar, between September 2012 and May 2014, using computerized Spirometer. Results: Forced vital capacity (FVC), forced expiratory volume in the 1st s (FEV1)/FVC, forced expiratory flow25-75% (FEF25-75%), peak expiratory flow rate (PEFR) were normally distributed with inflection at their mean ± standard deviation. FEF25-75%, and PEFR were higher in normal individuals compared to individuals with respiratory disease. FEV1/FVC were lower, and FVC were higher in obstructive disease while the reverse results were obtained in restrictive disease category. Restrictive disease by fixed-ratio was found with 55% negative predictive value (NPV) and 5% positive predictive value (PPV), while the normal cases by fixed-ratio criteria was found with 91% NPV and 15% PPV versus LLN criteria. There were 58 individuals with normal spirometries under the LLN method but a discrepant of only 12 fixed-ratio normal results. Concordance analysis by kappa statistics yielded a κ = 0.017. Conclusion: Older adults are more pulmonary susceptible. The performance of LLN criteria in differentiating respiratory diseases is better than the fixed-ratio criteria. Poor agreement exist between the fixed-ratio and LLN protocols in interpreting spirometric results. There is the difference between the LLN and fixed-ratio criteria which need to be redressed with population-specific reference values.
Prevention of VTE in orthopedic surgery patients

Venous thromboembolism (VTE) is defined as the obstruction, partial or complete, of one or more veins of deep circulation. It is a condition that can lead to a deterioration in his state of health until death, manifesting as deep vein thrombosis (DVT) or pulmonary embolism (PE). The major orthopedic surgery and the surgical oncology are frequently associated with thromboembolic complications, because of conditions that are often critical in these patients. It is estimated that in Italy DVT has an incidence that varies between 50 and 150 new cases per 100,000 population, while the prevalence would be between 2.5 and 5%. In the absence of thromboprophylaxis, the orthopedic surgery lead to a high increased risk of VTE. In elective hip replacement, in the absence of prophylaxis, the incidence of DVT and of fatal PE is about 50% and 2% respectively. In elective knee arthroplasty the risk of venous thromboembolic complications is even higher. It is estimated that 56.2% of the costs of prophylaxis with Low Molecular Weight Heparin (LMWH) in patients undergoing major orthopedic surgery are attributable to the cost of drugs (about € 200), followed (with 44.8%) by the cost of administration (approximately € 159). The average total cost/day was estimated at € 8 per patient. In Italy, it has been estimated an annual cost for new cases between 215 and 260 million €. The clinical advantages of the New Oral Anticoagulants (NOA) appear to be substantially clear, the major concern with regard to their reimbursement is therefore linked to the financial impact, due to the higher cost per day of the NOA compared with LMWH. To this end, it was built a model of budget impact, in the perspective of the Italian NHS, from the data related to cases of major surgical orthopedic procedures and a meta-analysis on the pivotal RCT, which aims to measure the differential effects in terms of prevention of VTE. The results show that the financial impact of the NOA in the prophylaxis of major orthopedic surgery is not particularly relevant. In fact, the major pharmaceutical costs that, at national level, amount to € 10.8 mil. (€ 15.2 mil. in the case of prolonged prophylaxis in knee operations) would be more than offset by savings in terms of fewer treatments of VTE, which is based on the assumption of more than 4,000 cases, up to about 6,600 in hypothesis best efficacy.
Cause-specific risk of hospital admission related to extreme heat in older adults.

IMPORTANCE Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases. OBJECTIVES To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. DESIGN, SETTING, AND POPULATION Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data. EXPOSURES Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non-heat wave periods by county and week. MAIN OUTCOMES AND MEASURES Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach. RESULTS Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non-heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12-1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06-1.23) for renal failure, 1.10 (95% CI, 1.04-1.16) for urinary tract infections, 1.06 (95% CI, 1.00-1.11) for septicemia, and 2.54 (95% CI, 2.14-3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22-0.46) excess admissions per 100,000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12-0.39) for renal failure, 0.24 (95% CI, 0.09-0.39) for urinary tract infections, 0.21 (95% CI, 0.01-0.41) for septicemia, and 0.16 (95% CI, 0.10-0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days. CONCLUSIONS AND RELEVANCE Among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.
Lumbosacral epidurography with different volumes of iohexol in cats

Objetivou-se neste trabalho determinar a migracao cranial de diferentes doses de iohexol, administradas pela via epidural lombossacra, analisando possiveis efeitos sobre algumas variaveis fisiologicas, em felinos. Foram utilizados 10 felinos sem raca definida, cinco machos e cinco femeasnao prenhes, clinicamente sadios, com 1±0,5 anos de idade e pesando 2,2±3,1kg. Os animais foram sedados com xilazina (1 mg/kg IM) e, 15 min. apos, foi administrado o iohexol na dose de 0,22 mL/kg (G1) e de 0,3 mL/ kg (G2), pela via epidural. Foram analisados: a migracao cranial do meio de contraste, a ataxia produzida, a frequencia cardiaca (FC), a duracao da onda P, o intervalo P-R, o complexo QRS, o intervalo Q-T, a frequencia respiratoria ( f ) e a temperatura corporea (ToC). No G1 o meio de contraste migrou em media ate a vertebra L2 (10,2±1,7cm), valores menores que os obtidos no G2 (L1 e 12,1±2,9cm). Nao houve variacao estatisticamente significativa em FC, duracao da onda P, intervalo P-R, duracao do complexo QRS, intervalo Q-T e f . A ToC diminuiu significativamente no G1 a partir do T40, sendo inferior a do G2 no T60. Concluiu-se que a dose de 0,3 mL/kg e potencialmente a mais indicada para o bloqueio anestesico dos pediculos ovarianos de felinos, quando empregando anestesicos locais, e que o iohexol nao altera os parâmetros fisiologicos.
Medicines adherence in people with diabetes and disability, and the role of insulin delivery devices

Studies show that approximately 20–30% of diabetes medication is not taken as recommended and this is associated with higher healthcare costs. The rate of disability due to diabetes complications is also increasing as many people with diabetes are living longer. These disabilities, which include cognitive decline, vision loss and impaired dexterity, can impact on a person’s ability to self-manage their diabetes. This article outlines some of these disabilities and discusses the role of insulin delivery devices on adherence, and the need for research involving these devices to include people with disabilities.
Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success.

AIMS Long-term efficacy following cryoballoon (CB) ablation of atrial fibrillation (AF) remains unknown. This study describes 5 years follow-up results and predictors of success of CB ablation in patients with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS In total, 163 patients were enrolled with symptomatic, drug refractory PAF. Pulmonary vein isolation (PVI) with CB technique was performed. Primary endpoint of this consecutive single-centre study was first electrocardiogram-documented recurrence of AF, atrial tachycardia or atrial flutter (AFLAT). Five years success rate after single CB ablation was 53%. In 70% of the patients acute complete PVI was achieved with a single 28 mm balloon. The univariate predictors of AFLAT recurrence were (1) size of left atrium, with normalized left atrium (NLA) ≥10.25 [hazard ratios (HR) of 1.81, 95% confidence interval (CI): 1.28-2.56] when compared with NLA <10.25 (35% vs. 53%, P = 0.0001) and (2) renal function, with impaired glomerular filtration rate (GFR) <80 ml/min (HR of 1.26, 95% CI: 1.02-1.57) when compared with GFR ≥80 ml/min (45% vs. 53%, P = 0.041). Normalized left atrium ≥10.25 was the sole independent predictor for outcome (HR 2.11; 95% CI: 1.34-3.31; P = 0.0001). CONCLUSIONS Sinus rhythm can be maintained in a substantial proportion of patients with PAF even 5 years after circumferential PVI using CB ablation. The rate of decline in freedom from AFLAT was highest within the first 12 months after the index procedure. The patients with enlarged left atrium and/or impaired renal function have lower outcome.
GAMBARAN KETERSEDIAAN PANGAN, KECUKUPAN ENERGI, DAN PROTEIN SERTA STATUS GIZI IBU HAMIL PASCAPENGUNGSIAN ERUPSI GUNUNG SINABUNG KABUPATEN KARO TAHUN 2014

Pregnant women is one of the vulnerable groups in nutritional problems because pregnancy term need a large number of nutrients. Natural disaster can affect the household food available such as the eruption of Sinabung which is cause the destruction of agricultural that give impact in the collapse of population economy. This is affect the nutritional status of pregnant women when natural disaster occurs to leave the refugee. The purpose of this research is to find out the household food available, the number of energy and protein adequacy and the nutritional status of pregnant women post Sinabung’s eruption. This is a descriptive research with cross sectional design. The 33 samples of this research are the whole population in 2nd and 3rd trimester range. This research takes the household food availabel, the number of energy and protein adequacy, and nutritional status data were analyzed by univariate to get the frequency distributions. The research shows that most of the nutritional status of pregnant women based on Upper Arm Circle did not have a high risk in Energy Chronic Malnutrition (<23,5 cm) is about 90,9%. Pregnant women food available shows 54,5% in non adequate category and the adequacy of protein in pregnant women shows 66,7% in non adequate category. The household food available shows only 45,5% household in a good level of food available, and the rest shows the households food available are insecure because the economy of people is unstable yet caused of agriculture is not giving the crops yet. It is required for the increase of pregnant women awareness in health nutritional needed which is increased in the term of pregnancy and the centred effort from government to make sure the food available in population in case of natural disaster ( eruption) which is affect the collapse of agricultural and economical. Keywords: food available, energy and protein adequacy, nutritional status, post evacuation