Miracle-dz/UniFAR-FTUs huggingface dataset:
Uso del drenaje pleural permanente en el manejo ambulatorio del derrame pleural maligno recidivante

Introduccion El objetivo del estudio ha sido analizar la eficacia y seguridad del cateter de drenaje pleural permanente en el manejo de pacientes con diagnostico de derrame pleural maligno. Pacientes y metodos Se ha realizado un estudio prospectivo y multicentrico de 63 pacientes consecutivos de 4 hospitales espanoles. Se incluyo a 43 varones y 20 mujeres, con una mediana de edad de 67 anos, diagnosticados de derrame pleural maligno sintomatico. En 7 casos el tratamiento se indico tras fracaso de pleurodesis, en 5 por encontrarse el pulmon atrapado, en otros 5 tras toracocentesis repetidas y en el resto como indicacion preferente a la pleurodesis. A todos los pacientes se les inserto de forma ambulatoria un cateter tunelizado permanente (PleurX®, Denver Biomedical). Resultados La mayoria de los pacientes (95,4%) refirio mejoria parcial o completa de los sintomas respiratorios (tos y disnea) y de su capacidad funcional. La mediana de duracion de uso del cateter fue de 45 dias (rango: 6�222). La mediana diaria de liquido pleural drenado fue de 75ml. En 22 casos (34,9%) se produjo una pleurodesis espontanea. No se registraron complicaciones durante la insercion del cateter. Las complicaciones durante el seguimiento fueron las siguientes: empiema (3 casos), dolor toracico (2 casos) y diseminaciones del tumor por el lugar de insercion del tubo (3 casos). Conclusiones El cateter de drenaje pleural permanente es eficaz en el manejo ambulatorio del paciente con derrame pleural maligno sintomatico. Es un procedimiento sencillo que no precisa ingreso hospitalario, de facil manejo para el paciente en su domicilio y con escasas complicaciones. Palabras clave: Derrame pleural maligno. Cateter pleural tunelizado permanente. Paciente ambulatorio.
L'analyse des réseaux sociaux appliquée au système de santé

Situation du probleme. L’analyse des reseaux sociaux est une methode de description et de modelisation de la structure relationnelle d’un ensemble d’acteurs. L’objectif de ce travail est d’analyser les relations entre les differents etablissements du systeme de sante, a travers un exemple : celui de la prise en charge de l’infarctus du myocarde dans la region Provence Alpes Cote-d’Azur (PACA). Methodologie. Etude retrospective de tous les sujets hospitalises pour un infarctus aigu du myocarde dans tous les etablissements de sante de la region PACA entre janvier et juin 2000. Une analyse descriptive a consiste a realiser un graphe decrivant les transferts entre etablissements, a calculer les indicateurs de centralite et de prestige des etablissements, a determiner quels sont les sous-groupes cohesifs (cliques) puis a decrire la densite du reseau hospitalier. Resultats. Le nombre total d’etablissements de sante ayant pris en charge un infarctus du myocarde est de 78. Le nombre de patients hospitalises pour un infarctus du myocarde est de 2049. Le nombre total de transferts est de 867. Le nombre de cliques mis en evidence est de 51. Vingt-neuf etablissements ne participent a aucune clique. Parmi les 49 etablissements participant a des sous-groupes, 50 % contribuent a plus de 2 cliques. Huit etablissements participent a plus de 8 cliques. Le maximum est une participation a 12 cliques. La densite du reseau hospitalier est de 0,12. Conclusions. L’analyse des reseaux sociaux constitue donc un champ de recherche ouvert en Sante Publique. Cette methode pourrait etre appliquee dans l’evaluation des reseaux de sante et le fonctionnement d’un hopital.
Knowledge, attitude, and practice of exercise during pregnancy among antenatal mothers

Introduction: Safe maternity with improved neonatal outcomes is predicated on proper antenatal health care services. Regular exercise is promoted for its overall health benefits. The American Congress of Obstetricians and Gynecologists, recommends that pregnant women can exercise moderately for 30 min on most days of the week. Methodology: A total of 200 antenatal mothers were included in the study, who filled in the questionnaire. The questionnaire comprised of 25 questions (21 on knowledge, 3 on attitude and 1 on practice). For knowledge items categorical responses (yes, I don't know and no) were applied with an item score of '2', '1', '0' respectively for positive knowledge. For attitude and practice the answers were either yes, no. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: Response rate was 100%. The age range of the study group was 18-35 years with a mean age of 25 ± 4.51 years. The majority of the study population were Hindus (81%), had undergone primary education (63%) and were homemakers (74%). The total mean knowledge score was 20.53 ± 2.08. 51% felt it was necessary to do exercise during pregnancy. 18% were practicing exercise in pregnancy. Conclusion: The knowledge of our women on exercise during pregnancy was less than average, and their attitude was favorable. However a very few were actually practicing exercise in pregnancy.
Social Work Roles in Drug Treatment with Youth

ABSTRACT Social workers working with youth, who are prescribed psychotropic medication, are routinely faced with tasks pertaining to psychopharmacologic treatment. Little is known, however, about how these workers contribute to the medication treatment process or the impact of their contributions. The purpose of this national survey of social workers practicing with youth was to explore three areas: (1) the frequency of medication-related functions with adolescent clients; (2) the worker, client, and contextual factors associated with greater involvement; and (3) social workers' perceptions of the effects of greater involvement on treatment processes and outcomes. Our findings suggested that in relation to medication treatment, social workers more frequently interfaced with clients than physicians, and that various treatment context and individual factors are associated with greater involvement. Social workers also perceived their involvement as associated with some desirable treatment processes/outcomes, especially the inclusion of adolescents in decision-making.
(Tpeak - Tend)/QRS and (Tpeak - Tend)/(QT × QRS): novel markers for predicting arrhythmic risk in the Brugada syndrome.

I read the recent paper by Zumhagen et al . with great interest, who demonstrated that the interval from the peak to the end of the electrocardiographic T wave (Tpeak − Tend) and (Tpeak − Tend)/QT ratio, were strong risk markers for Brugada patients with life-threatening ventricular arrhythmias.1 These ratios reflect the transmural dispersion of repolarization (TDR), increases in which can lead to unidirectional conduction block and reentry. …
Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.

IMPORTANCE New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV). OBJECTIVE To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus. RESULTS Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency. CONCLUSIONS AND RELEVANCE After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
Endoscopic ultrasound‐guided celiac plexus block and neurolysis

Endoscopic ultrasound‐guided celiac plexus neurolysis (EUS‐CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real‐time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS‐CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS‐guided direct celiac ganglia neurolysis (EUS‐CGN) was introduced recently. Pain relief is achieved by EUS‐CPN in 70–80% of patients with pancreatic cancer and in 50–60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS‐CGN may provide greater pain relief than conventional EUS‐CPN. Procedure‐related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur.
Haematological and Serum Biochemical Variables in rats Treated with Ethanol Extract of the Root of Moringa oleifera

The haematology and serum biochemical effects of oral administration of the ethanolic extract of the root of Moringa oleifera at 50, 100 and 150 mg/kg were investigated in 30 mated female Wistar rats. The rats were assigned into five groups of six rats each. Group A was given 50mg/kg of the extract; group B, 100mg/kg; group C, 150 mg/kg; group D, 0.2ml of corn oil; and group E, 0.2ml of distilled water. Groups D and E, corn oil and distilled water treatment groups respectively, served as the controls while groups A, B and C were the treatment groups. There was no significant difference (P>0.05) between the two control groups and the treatment groups for the RBC, WBC, PCV, MCV, MCH and MCHC and Hb. However, the mean lymphocyte values for groups B and C were significantly different (P 0.05) between the two control groups and the treatment groups. There were no significant differences (P>0.05) in the values of AST, ALP, creatinine, urea, GGT, glucose, cholesterol and ALT between the treatment groups and the control groups. It can therefore be concluded that oral administration of ethanolic extract of the root of M. oleifera is harmless to the rats since no adverse effects were detected in haematological and serum biochemical investigations . Keywords: Moringa oleifera , haematology, serum biochemistry, female rats
Aliskiren , Enalapril , or Both in Heart Failure

n engl j med 375;7 nejm.org August 18, 2016 701 Samarendra mentions the greater frequency of withdrawals in patients who were randomly assigned to surgery than in those who were assigned to TAVR. This greater frequency, which was also seen in the PARTNER 1 cohort A trial, suggests a lack of equipoise with respect to patients and providers. We also agree that assessment of the durability of bioprosthetic valves will require at least 5 to 10 years of follow-up, although the 5-year echocardiographic results look encouraging.2 Although the rate of total (of mild or greater severity) paravalvular aortic regurgitation in the PARTNER 2 cohort A trial was indeed 26.2%, moderate or severe paravalvular regurgitation was present in only 8.0% of patients, and mild paravalvular regurgitation was not associated with subsequent mortality. Finally, although neuroimaging studies suggest increased perfusion deficits with TAVR versus surgery, the size of the deficits was twice as large in the surgical patients.3 We do not think that rates of clinical stroke were underreported, since careful neurologic assessments were performed in all patients. In reply to Santarpino et al.: it is incorrect to label the surgical techniques in our trial as “outdated” and to imply that the surgical outcomes were therefore substandard. In the 57 surgical centers in the trial, the all-cause mortality at 30 days after surgery was 4.1% and the ratio of observed-to-expected mortality was 0.71, according to the Society of Thoracic Surgeons (STS) risk scores. The STS score equals the predicted mortality expressed as a percentage. Moreover, although specific surgical techniques were not mandated, 15% of the patients did receive minimally invasive aortic-valve replacement and there were no differences in outcomes; this is consistent with the surgical literature, which shows no differences in outcomes between patients who undergo surgery with a minimally invasive approach and those who do not. Short-term or longterm data on sutureless aortic valves are lacking, and none show clear benefits. An inpatient cost differential favors surgery because of the high cost of the transcatheter valve, but recently this differential has narrowed because of lower inhospital costs associated with reduced lengths of stay in the intensive care unit and the hospital among patients undergoing TAVR. Martin B. Leon, M.D. Craig R. Smith, M.D.
A Study of Dyslipidemia in Type 2 Diabetes Mellitus

Abstract: Introduction: Diabetes is an “iceberg disease” affecting at least 347 million people in the world, with a prevalence of 10%. Type 2 Diabetes Mellitus, the commonest variety of diabetes, is characterized by either deficiency of insulin or resistance to action of insulin or both. Insulin has important effects on key steps in the metabolism of lipids and lipoproteins, which are altered in diabetes, possibly leading to dyslipidemia. Objective: The study was done to investigate association of obesity indices, lipid profile and blood glucose levels with diabetes. Methodology: This is a case control study consisting of 60 (35males & 25 females) cases & 60 age and sex matched controls, in the age group of 30-60 years. Participants fulfilling the inclusion and exclusion criteria were included in the study. Obesity indices (i.e., body mass index, skin fold thickness, waist hip ratio, and percentage fat in the body); lipid profile (including serum total cholesterol, triglyceride, VLDL, LDL, and HDL Cholesterol) levels & blood glucose levels (Fasting & Post prandial) were investigated in both the cases & controls. The values thus obtained were analysed by Student‘t’ test. Results: On comparison, plasma glucose levels, obesity indices, cholesterol, triglyceride, VLDL, LDL were significantly higher (p<0.01) and HDL levels were significantly low in Type 2 Diabetes Mellitus cases as compared to controls (p<0.01). Conclusions: By this study, we can conclude that obesity indices, cholesterol, Triglyceride, VLDL, LDL were higher and HDL levels were low in Type 2 Diabetes Mellitus, which may be the cause for increased incidence of coronary artery complications in type 2 diabetes. Keywords: Type 2 Diabetes Mellitus, Dyslipidemia, Obesity Indices
A prospective randomized trial of KRN8602 and cytosine arabinoside vs. daunorubicin and cytosine arabinoside in adult patients with newly diagnosed acute myelogenous leukemia

A prospective randomized study was conducted to compare the efficacy and toxicity of two anthracyclines for the treatment of patients with acute myelogenous leukemia (AML). Fifty-eight patients were randomized and received induction therapy consisting of cytosine arabinoside (AraC) 100 mg/m 2 /day for 7 days combined with either KRN8602 (3'-deamino-3'-morpholino-13-deoxo-10-hydroxycarminomycin hydrochloride [KRN]) 15 mg/m 2 /day for 5 days (KRN/AraC group) or daunorubicin (DNR) 40 mg/m 2 /day for 3 days (DNR/AraC group). Complete remission rate was 78.6% (22/28) in the KRN/AraC group and 73.1% (19/26) in the DNR/AraC group. There was a higher incidence of nausea/vomiting and anorexia observed in the KRN/AraC group compared to the DNR/AraC group, while the incidence of other adverse effects (stomatitis, diarrhea, and infectious complications) were similar between both groups. No electrocardiogram (ECG) abnormalities were observed after treatment in the KRN/AraC group, while in the DNR/AraC group, one patient showed ECG abnormality and three patients exhibited either arrhythmia, heart failure, or tachycardia. Mental disorder was reported in two cases in the KRN/AraC group. These findings suggest that KRN/AraC is similar in effectiveness to DNA/AraC but more toxic in central nervous system and gastrointestinal symptoms and less toxic regarding cardiac function in patients with previously untreated AML.
Ozanimod Treatment for Ulcerative Colitis.

To the Editor: The extensive exclusion criteria that were used in the TOUCHSTONE trial conducted by Sandborn et al. (May 5 issue),1 along with the short duration of the trial and the small size of the population, make it very hard to assess the safety of ozanimod. The authors raise the possibility that extended treatment might enhance the efficacy of ozanimod in patients with ulcerative colitis, which at 8 weeks is itself a small benefit, as compared with placebo. One would be wary of the side-effect profile with extended use; substantial lymphopenia (which increases the risk of infection) and hepatotoxic effects are the major concerns. Hemant R. Mutneja, M.D.
Comparing the Effect of a Single-Session Aerobic and Resistance Exercise on Blood Glucose in Women with Type 2 Diabetes

Introduction: Type 2 diabetes is a common disease in the world. Exercise has consistently been shown to improve glucose control. The purpose of this study was to compare the effect of a single-session aerobic and resistance exercise on blood glucose in women with type 2 diabetes. Methods: Twenty four women with type 2 diabetes were voluntarily and randomly selected and divided into aerobic exercise, resistance exercise and control groups. Aerobic exercise(rhythmic exercise) was performed for 40 min at 60% HRmax and resistance exercise(weight lifting) for 40 min utilizing 60% of 1-RM. Blood samples were collected before and after exercise. Results: Results of paired sample t-test showed a single-session aerobic and resistance exercise significantly decreased blood glucose(p<0.05). ANOVA test found a significant difference in blood glucose among three groups(p<0.05). Conclusion: A single-session aerobic and resistance exercise could decrease blood glucose in women with type 2 diabetes. However, a single-session aerobic exercise is more effective than resistance exercise on decreasing blood glucose.
Neuropathology : a reference text of CNS pathology

Solve your toughest neurodiagnostic challenges with "Neuropathology, 3rd Edition" - the most information-packed, extensively illustrated neuropathology reference available! An expert author team presents more than 3,000 high-quality images - nearly all in full colour - to provide unmatched visual guidance on the microscopic and gross pathologic presentation of a full range of neurologic diseases.
Acute HIV-1 Infection in Adults in East Africa and Thailand.

To the Editor: The study by Robb et al. (June 2 issue)1 provides valuable data to aid in understanding the onset and dynamics of acute HIV-1 viremia. We compared the results from that study with data that we obtained from 2011 through 2015 regarding the viral load in 164 men who have sex with men and who had detectable HIV-1 RNA with a concurrent negative HIV-antibody result at our clinical site in Los Angeles. The median plasma viral RNA level in our patients was 5.9 log10 copies per milliliter, which is between the initial viral load found in East Africa and Thailand (4.0 log10 copies per milliliter) and the sample 13 days later (6.7 log10 copies per milliliter). The HIV subtypes differ between the one found in the majority of patients in the United States (subtype B) and those found in East Africa (subtype A) and Thailand (subtype E). The identification of patients with acute HIV-1 infection is critical in the effort to accelerate the elimination of viral transmission. Additional analyses are needed to determine the roles of the subtype on the duration of peak viremia and the viral-load set point in transmission dynamics and disease progression, respectively.2,3 Dvora Joseph Davey, M.P.H. , Ph.D.
Influences of vowel and tone variation on emergent word knowledge: a cross-linguistic investigation.

To learn words, infants must be sensitive to native phonological contrast. While lexical tone predominates as a source of phonemic contrast in human languages, there has been little investigation of the influences of lexical tone on word learning. The present study investigates infants' sensitivity to tone mispronunciations in two groups of infants. For one group (Chinese learners), tone is phonemic in their native language, and for the second group (English learners), tone is non-phonemic and constituted suprasegmental variation. In Experiment 1, English learners were trained on novel word-object pairings and tested on their recognition of correct pronunciations, tone and vowel mispronunciations of these words at 18 and 24 months. In Experiment 2a, bilingual English-Chinese learners were tested on a similar task translated into Chinese at the same age intervals. Results demonstrate that non-tonal learners treated tonal and vowel substitutions alike as mispronunciations at 18 months but only treated vowel substitutions as mispronunciations at 24 months. Tonal learners treated both tonal and vowel substitutions as mispronunciations at both ages. In Experiment 2b, bilingual non-tone language learners were tested on the same set of tasks replicating a similar set of results as monolingual non-tone language learners (Experiment 1). Findings point to an early predisposition to treat tone as a defining characteristic of words regardless of its lexical relevance at 18 months. Between 18 and 24 months, learners appear to ascribe lexical relevance to tone in a language-specific manner. The current study identifies the influences of tone variation on memories for newly learned words and the time period during which lexical tone - a highly frequent constituent of human languages - actually becomes lexical for early learners. Findings are contextualized with prevailing models of the developing lexicon.