Miracle-dz/UniFAR-FTUs huggingface dataset:
Tumours of the Serosal Membranes. Armed Forces Institute of Pathology Atlas of Tumour Pathology, Fourth Series, Fascicle 3

Edited by B S Levy, D H Wegman, S L Baron, R K Sokas. PA: Philadelphia, 2006, $69.95, pp 773. ISBN 0-7817-5551-4 This text carries on in the good tradition of the previous editions, directed at practitioners and students in the health and safety professions. The book’s editors and many of the authors are of international repute, although its focus is mainly US directed. There is a welcome inclusion of some authors and examples from other countries. The chapter by McMichael and others on “Global environmental changes” is a particularly good example of this. Nevertheless, readers outside the USA may have to use it as a “companion …
Puberty phase specific growth charts: a radically new approach to the assessment of adolescent growth

Background Current growth charts depict a child's height allowing for age and gender, but they ignore pubertal development. In adolescence height depends on pubertal development as well as age and gender, so assessment should ideally be a two-step process; first, to clinically assess puberty, and second, to assess height relative to puberty-specific centiles. Aim To design new 4-20 year growth charts for the UK, based on the UK 1990 reference, focusing on pubertal progression as well as growth, in order to define normality. Methods Tanner's five puberty stages were simplified into three phases of puberty – Pre-puberty (Tanner stage 1), In puberty (stages 2 and 3) and Completing puberty (stages 4 and 5). Using data for height, age and Tanner stage from the 1980 Dutch National Survey (N = 6563), Puberty Phase Specific (PPS) centile lines were estimated for each phase separately using the LMS method. Height centiles ignoring stage were also constructed with the same data, and the resulting median curve was adjusted using Cole's SITAR method to closely match the median of the UK 1990 growth reference. The same SITAR adjustments were then applied to the puberty centiles, thus recalibrating the Dutch data to match the UK 1990 reference. These PPS centiles were used to develop various chart designs for consideration by the RCPCH chart design group, along with testing in evaluation workshops. Results The new PPS centiles demonstrate a stepwise increment of growth through puberty. Because the phases overlap widely in age, presentation on one chart is challenging, but they can be presented in a 3-page specialist Puberty Phase Specific chart used in conjunction with a new version of the existing cross-sectional UK 1990 chart. The age ranges of the phases will be presented on the cross-sectional charts as two puberty zones. These will illustrate the normal range for age at the start and end of puberty and for each puberty phase. Conclusions This novel approach to growth chart design allows evaluation of a child's growth adjusted for phase of puberty, as well as age and gender, which should greatly improve the assessment of growth during adolescence.
Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation. Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index ≥35 kg·m-2) were assigned to NIV via nasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation. Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9–29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group. In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.
APOE ε4 is not associated with Alzheimer's disease in elderly Nigerians

Since 1992, research teams from Indiana University and the University of Ibadan have been collecting and comparing data from two diverse, elderly populations to identify risk factors for dementia and Alzheimer's disease. Apolipoprotein E (APOE) was genotyped in 2,245 Nigerian samples. Of these, 830 had a diagnosis: 459 were normal, and 140 had dementia including 123 diagnosed with Alzheimer's disease. In contrast with other populations, the APOE ε4 allele was not significantly associated with Alzheimer's disease or dementia. This lack of association in the Yoruba might reflect genetic variation, environmental factors, as well as genetic/environmental interactions. Ann neurol 2006
Drug delivery systems against leishmaniasis? Still an open question

Background: Leishmania amastigotes live inside resident macrophages in different anatomic sites. Their hidden location is responsible for impairing the accession of therapeutic drugs. Drug delivery systems (DDSs) should allow the adverse effects caused by problematic routes of administration to be avoided as well as enhancing the antileishmanial activity and reducing the toxicity of the medication. However, after 30 years of research in the field, and since leishmaniasis is mostly a disease affecting the poorest populations, currently AmBisome® is the only DDS used against the visceral form, and most experimental development only relates to parenteral administration. Objective: We critically review the main DDSs designed against the different clinical forms of leishmaniasis. Methods: A literature search was performed on PubMed and through Google. Conclusions: On reviewing the experimental and clinical therapeutic performance of former and current DDSs and considering the main obstacles to be overcome, we discuss how nanomedicine can contribute to the development of new and more efficient strategies.
Can massage and aromatherapy benefit the users of forensic psychiatric services

This article reports on the contribution that complementary therapies can make to the well‐being of service users who are recovering from mental distress. As part of a wider strategy to promote awareness of a range of self‐management techniques at a forensic psychiatric hospital, complementary therapies (massage and aromatherapy) were provided. This article reports on a review of the evidence of the mental health benefits of the regular provision of these therapies. Further research is needed to establish the effectiveness of massage and aromatherapy for the forensic psychiatric population.
A análise do conceito segurança do paciente: a visão evolucionária de Rodgers

Objetivo: analisar a evolucao do conceito seguranca do paciente empregado nas producoes cientificas sob a visao evolucionaria de Rodgers. Metodo: trata-se de uma analise conceitual na visao evolucionaria de Rodgers acerca do conceito seguranca do paciente. Para tanto, foram analisadas, a partir de uma leitura reflexiva-critica-indutiva, oito producoes cientificas: quatro dissertacoes de mestrado e quatro teses de doutoramento. Resultados: sao apresentados em tres pilares tematicos: 1) antecedentes e consequentes; 2) termos substitutos e conceitos relacionados; 3) atributos e conceitos. Consideracoes finais: destarte, promovem-se reflexoes acerca da tematica; proporciona-se embasamento conceitual para os diversos estudos acerca da seguranca do paciente, independentemente de sua metodologia; fortalece-se a cultura de seguranca de paciente e desmotivam-se as respostas punitivas ante os erros individuais. doi: 10.5294/aqui.2015. 15.4. 7
Prevalência e perfil de sensibilidade de amostras de Staphylococcus aureus isoladas de casos clínicos de infecções hospitalares

This study investigated the prevalence and the susceptibility profile of Staphylococcus aureus samples isolated from clinical infections in a teaching hospital, Parana - Londrina, cases between 2001 and 2004. The sensitivity test results for 74 strains to oxacillin and vancomycim, obtained by MicroScan® automated system (Dada Bering, Sacramento, California, USA, employing MicroScan® PC 12- gram positive Panels) were compared with the results obtained from the dilution agar method using different concentrations of antimicrobials. The data was obtained from the Hospital Infection Committee Control Data bank. The Staphylococcus aureus samples showed a large spectrum of resistance to the antimicrobials tested. The medium rate of prevalence of the S. aureus hospital infections was 16,3% and the medium rate of prevalence of the hospital infection, by oxacillin resistant S. aureus strains was 70,75%. It was not detected samples resistant to vancomycin using both methods. Among this 74 samples identified as oxacillin-resistant by MicroScan® system, 65 (83,75%) had their resistance confirmed by Dilution Agar Method. The difference between the results was not statistically significant. To the vancomycin, there was 100% of concordance in both methods.
Treating pregnant women with highly active antiretroviral therapy

The considerable reduction in HIV transmission from mother to child is one of the major successes of antiretroviral therapy in resource-rich settings. In this article, we review the multidisciplinary antenatal management, from preconception to postdelivery, of women living with HIV infection, focusing on antiretroviral prescribing.
Symptomatic internal carotid artery occlusion: a long-term follow-up study

Background Information on outcome of patients with occlusion of the internal carotid artery (ICA) is limited by the short duration of follow-up and lack of haemodynamic studies on the brain. Methods The authors prospectively investigated 117 consecutive patients with transient or moderately disabling cerebral or retinal ischaemia associated with ICA occlusion between September 1995 and July 1998, and followed them until June 2008. The authors determined the risk of recurrent ischaemic stroke and other vascular events and prognostic factors, including collateral pathways and transcranial Doppler CO2 reactivity. Results Patients (mean age 61±9 years; 80% male) were followed for a median time of 10.2 years; 22 patients underwent endarterectomy for contralateral ICA stenosis and 16 extracranial/intracranial bypass surgery. Recurrent ischaemic stroke occurred in 23 patients, resulting in an annual rate of 2.4% (95% CI 1.5 to 3.6). Risk factors for recurrent ischaemic stroke were age (HR 1.07, 1.02 to 1.13), cerebral rather than retinal symptoms (HR 8.0, 1.1 to 60), recurrent symptoms after documented occlusion (HR 4.4, 1.6 to 12), limb-shaking transient ischaemic attacks at presentation (HR 7.5, 2.6 to 22), history of stroke (HR 2.8, 1.2 to 6.7) and leptomeningeal collaterals (HR 5.2, 1.5 to 17) but not CO2 reactivity (HR 1.01, 0.99 to 1.02). The composite event of any vascular event occurred in 57 patients, resulting in an annual rate of 6.4% (95% CI 4.9 to 8.2). Conclusion The prognosis of patients with transient ischaemic attack or minor stroke and ICA occlusion depends on age, several clinical factors and the presence of leptomeningeal collaterals. The long-term risk of recurrent ischaemic stroke is much lower than that of other vascular events.
Características epidemiológicas de pacientes con enfermedad de Parkinson de un hospital de referencia en México

Parkinson’s disease is one of the most frequent neurodegenerative disorders. Mexico currently lacks reliable epidemiological studies regarding this disease. Objective: to describe the prevalence and associations of the demographic, clinical and theraputhic features of Parkinson’s disease patients attending to the National Institute of Neurology and Neurosurgey in Mexico City in order to assess external validity. Patients and methods: we conducted an analytic cross-sectional study of all cases seen at the Abnormal Movement betwewn june 2007 and july 2009. Results: a total of 402 clinical files were reviewed from which 212 corresponded to Parkinson’s disease. Mean age was 63.1±11.4 years, 93% had mild to moderate disease, 70% were on levodopa preparations and 95% has at least one non-motor dysfunction symptom. Mean age of disease onset was around 3 years lower compared to other studies with men having an earlier onset (54.5 vs 59.9 years). Conclusions: with the only exception of age of disease onset, all other features of our hospital-based population are similar and therefore comparable with international population-based studies. Since actual epidemiologic data of Parkinson’s disease in Mexico is still missing this study may provide a broad picture of the current state of the disease in the country.
Gastro-oesophageal reflux disease in primary care in Europe: Clinical presentation and endoscopic findings

Objective: To determine the characteristics of patients presenting in primary care with gastroesophageal reflux disease (GORD), in terms of clinical features and endoscopic diagnosis.Design: European multi-national, multi-centre, non-therapeutic study, in which detailed documentation of presenting symptoms was followed within seven days by upper gastrointestinal endoscopy.Setting: 52 primary care centres in United Kingdom, Germany and Ireland.Subjects: 806 patients aged over 18 years presenting with symptoms which, in the opinion of the primary care physician, are suggestive of GORD.Main outcome measures: Presenting reflux-symptom profile, reflux-symptom history, endoscopic findings.Results: The majority of patients (66.7%) reported experiencing symptoms daily and almost half (49.4%) experienced symptoms both during the day and at night. Posture and stress/anxiety were reported by patients as the main factors aggravating their symptoms. Most patients rated their symptoms as moderate to severe (90.4%). The.
Pharmacotherapy for people with Alzheimer's disease: A Markov-cycle evaluation of five years therapy using donepezil

This article combines data from a clinical trial of donepezil with costing figures to evaluate expected direct costs of care over 5 years after diagnosis of Alzheimer's disease (AD) for patients aged 75 years and over at diagnosis. A Markov model simulates the progression of elderly persons through changing levels of severity. The model compares three treatment regimes for each of two patient groups: mild AD at start of treatment; moderate AD at start of treatment. Patients are followed until 5 years after the start of the treatment. Despite the acquisition costs, use of donepezil is approximately cost‐neutral for both 5 mg and 10 mg treatment groups and for patients initially at either mild or moderate states of illness. Expected costs are slightly higher than for the placebo group, but higher expenditure on drugs is partly offset by lower costs of care consequent on treated patients not declining as rapidly as those untreated. The model showed that donepezil patients spent less time in the state of severe dementia, where costs of care are higher. Sensitivity analysis on key assumptions demonstrated that expected costs were highly dependent on discount rate and, more significantly, on the mortality rate. © 1998 John Wiley & Sons, Ltd.
Effects of severe malnutrition on oxidative stress in Wistar rats

Oxidative stress was examined in three different types of induced-malnutrition such as marasmus, kwashiorkor and marasmic-kwashiokor. Biomarkers such as superoxide dismutase (SOD), catalase and total protein were determined to assess oxidative stress. The activity of SOD and catalase showed that there was an increased oxidative stress in rats fed with the lowest protein diet (protein-calorie malnutrition group). The study confirmed that of the three states of malnutrition, oxidative stress was more pronounced in marasmic-kwashiokor than in the other two groups.
Epidemiology of chronic pelvic pain

An overview is given of the current knowledge of the epidemiology of chronic pelvic pain (CPP) in terms of prevalence, incidence, and associated risk factors. However, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Although data are limited, the prevalence of CPP in the general population appears to be high. A single study found a 3-month prevalence (pelvic pain of at least 6 months' duration) of 15% in women aged 18-50 in the general US population. In the UK, an annual prevalence in primary care of 38/1000 was found in women aged 15-73, a rate comparable to that of asthma (37/1000) and back pain (41/1000). The monthly incidence in primary care was 1.6/1000. No incidence figures exist for the general population. Analysis of risk factors for CPP is highly complicated owing to its multifactorial aetiology. At present, it is only of some value using women with CPP identified at community level, since those in primary, secondary or tertiary care are likely to constitute highly selected sub-groups.
'Inappropriate attended' in A&E.

With the current emphasis on reducing patient waiting times, accident and emergency nurses may be tempted to close the doors on what they consider to be 'inappropriate attendees'. The author warns that public perceptions of A &E are often at odds with the nurses view, and that all patients should have access to accident and emergency services. This article takes a critical look at triage since its inception as a means of assessing wounded soldiers during the first world war. He explores patient assessment in accident and emergency departments and nurses' attitudes to- wards the 'inappropriate attended, highlighting the need for caution when dealing with enquiries from the general public.
Gender Difference in Presentation, Management and Inhospital Mortality in St Elevation Myocardial Infarction in a Tertiary Cardiac Center

Background : Studies have shown that women are less likely to receive reperfusion therapy and have higher inhospital death in ST Elevation myocardial infarction(STEMI) as compared to men. This study aims to examine presentation, acute therapy, and inhopital mortality in women admitted with diagnosis of acute STEMI in a tertiary care cardiac center. Methods: Patients admitted with diagnosis of acute STEMI from 1st June 2013 to 31st May 2015 were included in the study. Gender difference in baseline characterstics, comorbidities, prehospital delay, type of treatment received and inhospital death were measured. Variables that might have impact on inhospital deaths were analyzed on multivariate regression analysis to find out other variables adjusted effect of gender on inhospital deaths. Results : Majority of the patients were men (Men 69% vs women 31%). Women were older, were more likely to be diabetics and smoker. Prehospital delay was more in women ( women 22 hours vs men 12 hours, p value-0.02). About 46% of both men and women received reperfusion therapy. There was more inhospital mortality in women (women 13.5% vs men 6.5%, p value – 0.02). Women had more inhospital mortality even after adjustment with other covariables (OR = 3.110, 95% CI = 1.411-6.902, p value-0.005). Conclusion : Women were more likely to be elderly, diabetics, smoker and presented later than men after symptoms onset. Women received reperfusion therapy similar to that of men. After adjustment with other covariates, women remained a significant variable to inhospital death. Journal of Nobel College of Medicine Vol.4(1) 2015: 6-11
A guide to drug evaluation for chronic pain

In the past, management of pain was more empirical but with the understanding of mechanisms, biochemistry and molecular basis of pain, future drug development will be more rational. This article provides a brief overview of the pathomechanism of pain, the clinical situation, current treatments and methods of evaluation of pain therapies such as measurement of pain in clinical trials. A wide spectrum of agents are available, including non-steroid anti-inflammatory drugs (NSAIDs), opioids and adjuvant analgesics, such as antidepressants and certain anticonvulsants that are useful in neuropathic pain. Current management of pain is inadequate due to lack of understanding of pain mechanisms by healthcare providers and the lack of availability of adequate analgesic medications. Acute pain, if treated inadequately, changes into chronic pain with changes in the nervous system. Chronic pain, particularly neuropathic pain, is a neurological disorder, which is more difficult to treat. The total value of the pain management market, including drugs and devices, is estimated to be $5 billion in the year 2000, and will increase to $9 billion in the year 2005. A large number of drugs in development for pain include opioid receptor agonists and antagonists of glutamate receptors, adenosine triphosphate (ATP), serotonin (5-HT) and vanilloid receptors (VR1). Analgesics acting on ion channels and NSAIDs, which inhibit the cyclooxygenase (COX) pathways, are still in development. The ideal analgesic is defined and methods of pain drug delivery are also reviewed. A novel compound with an effective method of delivery has a better chance in the competitive marketplace of analgesic drug development.
Morbidity in Pregnant Women Associated with Unverified Penicillin Allergies, Antibiotic Use, and Group B Streptococcus Infections.

CONTEXT The morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillin allergy testing is safe during pregnancy but is done infrequently. OBJECTIVE To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillin allergy, and with and without GBS. DESIGN Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified. MAIN OUTCOME MEASURES Penicillin allergy status at delivery, delivery method, maternal and infant hospital utilization, peripartum antibiotic exposures, new antibiotic-associated adverse drug reactions, and new Clostridium difficile infections. RESULTS There were 170,379 unique women who had 201,316 pregnancies during the study period. There were 16,084 pregnancies in women with an active, but unverified, penicillin allergy at delivery. There were 42,524 pregnancies in GBS-positive women, and 3500 also had a penicillin allergy. Women with a penicillin allergy, with or without GBS, had significantly (about 10%) higher cesarean section rates and spent significantly more (about 0.1) days in the hospital after delivery. Among GBS-positive women, those with an unverified penicillin allergy were exposed to significantly more cefazolin, clindamycin, vancomycin, and gentamicin and had significantly higher rates of adverse drug reactions associated with all antibiotic use. CONCLUSIONS Unverified penicillin allergy is associated with more hospital utilization and additional morbidity. Penicillin allergy testing of pregnant women with a history of penicillin allergy may help reduce these unwanted outcomes.