Miracle-dz/UniFAR-FTUs huggingface dataset:
Adverse effects of medical cannabinoids: a systematic review

Background: The therapeutic use of cannabis and cannabis-based medicines raises safety concerns for patients, clinicians, policy-makers, insurers, researchers and regulators. Although the efficacy of cannabinoids is being increasingly demonstrated in randomized controlled trials, most safety information comes from studies of recreational use. Methods: We performed a systematic review of safety studies of medical cannabinoids published over the past 40 years to create an evidence base for cannabis-related adverse events and to facilitate future cannabis research initiatives. We critically evaluated the quality of published studies with a view to identifying ways to improve future studies. Results: A total of 321 articles were eligible for evaluation. After excluding those that focused on recreational cannabis use, we included 31 studies (23 randomized controlled trials and 8 observational studies) of medical cannabis use in our analysis. In the 23 randomized controlled trials, the median duration of cannabinoid exposure was 2 weeks (range 8 hours to 12 months). A total of 4779 adverse events were reported among participants assigned to the intervention. Most (4615 [96.6%]) were not serious. Of the 164 serious adverse events, the most common was relapse of multiple sclerosis (21 events [12.8%]), vomiting (16 events [9.8%]) and urinary tract infection (15 events [9.1%]). The rate of nonserious adverse events was higher among participants assigned to medical cannabinoids than among controls (rate ratio [RR] 1.86, 95% confidence interval [CI] 1.57–2.21); the rates of serious adverse events did not differ significantly between these 2 groups (RR 1.04, 95% CI 0.78–1.39). Dizziness was the most commonly reported nonserious adverse event (714 events [15.5%]) among people exposed to cannabinoids. Interpretation: Short-term use of existing medical cannabinoids appeared to increase the risk of nonserious adverse events. The risks associated with long-term use were poorly characterized in published clinical trials and observational studies. High-quality trials of long-term exposure are required to further characterize safety issues related to the use of medical cannabinoids.
Nurses' career commitment and job performance: differences between intensive care units and wards

Few studies explore the concepts of nurses' career commitment and job performance. This study aimed to address this by using a survey method. A convenient sample of 640 registered nurses was obtained, with a response rate of 58.1%. All nurses in the sample `agreed' to keep committed to their careers and they felt that they were performing `well' their jobs. There were some significant differences between responses from intensive care units and wards in terms of demographics, career commitment and job performance. The correlation of total scores of nurses' career commitment and job performance indicated a significant and positive relationship. For increased career commitment and improved job performance, nurses need to be offered various professional development opportunities.
The emergence of Lyme disease in Canada

Lyme disease, caused by the bacterium Borrelia burgdorferi and transmitted by tick vectors, is the most commonly reported vector-borne disease in the temperate zone. [1][1] More than 20 000 cases are recorded annually in the United States. [2][2] In about 80% of cases, early Lyme disease is
Skeletal Function and Form. Mechanobiology of Skeletal Development, Aging, and Regeneration.

Dennis R. Carter and Gary S. Beaupre. Cambridge, United Kingdom: Cambridge University Press; 2001. 330 pages. $80.00. This splendid book has been thoughtfully and eloquently written by two renowned bioengineers from California (Carter is from Stanford and Beaupre, from Palo Alto), who have collaborated for many years in their research. The essence of the book is “about how function determines form” in the skeletal system. The authors’ objective is to present a consistent approach for understanding the regulatory role of mechanical factors in the biology of skeletal development, growth, aging, functional adaption, and regeneration. They merit our congratulations because they achieve their goal in keeping with the wisdom of Solomon, who …
Mandibular Premolar Impaction

Literature specific to impacted premolars is not extensive despite the fact that mandibular 2nd premolars alone account for 2.4% of dental impactions. The purpose of this paper is to describe the radical approach (extraction) of a transversally impacted 2nd premolar in the mandible through a lingual approach due to its peculiar position presuming it will contribute toward the literature regarding impacted mandible premolars.
Multidrug-resistant Neisseria gonorrhoeae

In this issue of CMAJ , Ota and colleagues[1][1] report a substantial increase in infections of quinolone-resistant Neisseria gonorrhoeae in the province of Ontario. The increase, from 4% in 2002 to 28% in 2006, has been occurring in a time of rising rates of gonorrhea. The epidemiologic
Estudo da estimulação elétrica nervosa transcutânea (TENS) nível sensório para efeito de analgesia em pacientes com osteoartrose de joelho

INTRODUCAO: A osteoartrose de joelho (OAJ) e uma das patologias que mais afetam o aparelho locomotor e interferem de forma consideravel nas atividades da vida diaria, acometendo os individuos em faixa etaria variavel e em diversos graus e niveis de dor articular. OBJETIVOS: Por causa da importância da articulacao do joelho nas atividades locomotoras, os pacientes com osteoartrose de joelho sofrem com a limitacao de movimento e rigidez articular. O objetivo do presente estudo foi avaliar o efeito da estimulacao eletrica nervosa transcutânea (TENS) nivel sensorio para tratamento de dor em pacientes com diagnostico de osteoartrose de joelho, utilizando escalas de avaliacao de dor. METODOS: Foram estudados 10 pacientes com diagnostico de osteoartrose de joelho, utilizando uma modalidade fisioterapeutica, a eletroterapia, especificamente a (TENS), com parâmetros de 80 Hz e 140 µs, com um total de 10 sessoes, 30 minutos para cada sessao, o periodo total de tratamento compreendeu 4 semanas. Nesse total de 10 sessoes, cada paciente foi entrevistado com um questionario na 1a sessao, na 5a e na 10a sessao. Os formularios utilizados foram questionario da dor McGill - Melzack, escala Analogica visual da dor, escala numerica com expressao facial de sofrimento. RESULTADOS: O resultado com a TENS nivel sensorio para efeito de analgesia mostra que as diferencas foram estatisticamente significativas (p < 0,05) para escala Analogica visual da dor e o Questionario da Dor McGill. CONCLUSAO: Nossos resultados sugerem que a TENS nivel sensorio reduz a dor e melhora a funcionalidade do joelho.
Integrated learning: An EBL approach to pharmaceutical chemistry

This paper reports on the evaluation of an enquiry based learning (EBL) module in pharmaceutical chemistry which has been developed for first year pharmacy students. The module aims to encourage integration of knowledge within the multi-disciplinary pharmacy degree, leading to an appreciation of the importance that chemical properties have on the action of medicines. In teams, students selected a therapeutic area and medicines for its management. Following an introductory workshop, the teams completed an information retrieval and analysis exercise. Assessment included a poster or oral presentation, which confirmed, through questioning, that the teams appropriately applied chemical properties of their medicines to broadly rationalise their clinical efficacy. Evaluation by questionnaire showed that the students rated the module as being of relevance to pharmacy. Evaluation and peer assessment provided evidence of the development of key skills, and also showed that networking of teams of first year students from diverse backgrounds had social and academic benefits.
Modelling mitigation strategies for pandemic (H1N1) 2009

Background: The 2009 influenza A (H1N1) pandemic has required decision-makers to act in the face of substantial uncertainties. Simulation models can be used to project the effectiveness of mitigation strategies, but the choice of the best scenario may change depending on model assumptions and uncertainties. Methods: We developed a simulation model of a pandemic (H1N1) 2009 outbreak in a structured population using demographic data from a medium-sized city in Ontario and epidemiologic influenza pandemic data. We projected the attack rate under different combinations of vaccination, school closure and antiviral drug strategies (with corresponding “trigger” conditions). To assess the impact of epidemiologic and program uncertainty, we used “combinatorial uncertainty analysis. ” This permitted us to identify the general features of public health response programs that resulted in the lowest attack rates. Results: Delays in vaccination of 30 days or more reduced the effectiveness of vaccination in lowering the attack rate. However, pre-existing immunity in 15% or more of the population kept the attack rates low, even if the whole population was not vaccinated or vaccination was delayed. School closure was effective in reducing the attack rate, especially if applied early in the outbreak, but this is not necessary if vaccine is available early or if pre-existing immunity is strong. Interpretation: Early action, especially rapid vaccine deployment, is disproportionately effective in reducing the attack rate. This finding is particularly important given the early appearance of pandemic (H1N1) 2009 in many schools in September 2009.
Effectiveness of disease-management programs for improving diabetes care: a meta-analysis

Background We conducted a meta-analysis of randomized controlled trials to assess the effectiveness of disease-management programs for improving glycemic control in adults with diabetes mellitus and to study which components of programs are associated with their effectiveness. Methods We searched several databases for studies published up to December 2009. We included randomized controlled trials involving adults with type 1 or 2 diabetes that evaluated the effect of disease-management programs on glycated hemoglobin (hemoglobin A1C) concentrations. We performed a meta-regression analysis to determine the effective components of the programs. Results We included 41 randomized controlled trials in our review. Across these trials, disease-management programs resulted in a significant reduction in hemoglobin A1C levels (pooled standardized mean difference between intervention and control groups −0.38 [95% confidence interval −0.47 to −0.29], which corresponds to an absolute mean difference of 0.51%). The finding was robust in the sensitivity analyses based on quality assessment. Programs in which the disease manager was able to start or modify treatment with or without prior approval from the primary care physician resulted in a greater improvement in hemoglobin A1C levels (standardized mean difference −0.60 v. −0.28 in trials with no approval to do so; p < 0.001). Programs with a moderate or high frequency of contact reported a significant reduction in hemoglobin A1C levels compared with usual care; nevertheless, only programs with a high frequency of contact led to a significantly greater reduction compared with low-frequency contact programs (standardized mean difference −0.56 v. −0.30, p = 0.03). Interpretation Disease-management programs had a clinically moderate but significant impact on hemoglobin A1C levels among adults with diabetes. Effective components of programs were a high frequency of patient contact and the ability for disease managers to adjust treatment with or without prior physician approval.
Recombinant human tumor necrosis factor-alpha: evidence of an indirect mode of antitumor activity.

The antitumor activity of recombinant human tumor necrosis factor (rTNF-alpha) was examined on murine tumors in mice and in cultured cells in vitro. Mice were implanted intradermally with Meth A fibrosarcoma (Meth A) on day 0. rTNF-alpha caused tumor necrosis and inhibited the tumor growth when given i.v. on day 7 or 10, but not when given on day 3. When rTNF-alpha was given i.v. in doses of 0.1-3.2 micrograms/mouse twice a week for 3 weeks beginning on day 7 or 11, the growth of solid Meth A, Colon 26 adenocarcinoma, Colon 38 carcinoma, Sarcoma-180, and M5076 reticulum cell sarcoma tumors implanted s.c. or intradermally was markedly inhibited, and the life of the mice bearing these tumors, except M5076 reticulum cell sarcoma, was prolonged. The growth of Meth A implanted i.m. was also markedly inhibited by rTNF-alpha given i.v. However, the life of mice bearing i.p. Colon 26 adenocarcinoma, MH134 hepatoma, Sarcoma-180, and Ehrlich carcinoma was not prolonged by rTNF-alpha given i.p. nine times (days 1-9) in doses up to 1.0 or 3.2 micrograms/mouse. Only in the case of mice bearing i.p. Meth A, the life was slightly prolonged by i.p. treatment with rTNF-alpha but not by i.v. treatment. In experiments against in vitro cultured cells, rTNF-alpha did not show any direct cytotoxicity against mouse tumor cells: Meth A, Colon 26 adenocarcinoma, Colon 38 carcinoma, and Sarcoma-180, but had a cytotoxic effect against L929 mouse fibroblast. The results suggest that rTNF-alpha is a unique antitumor drug with potent necrotizing activity against solid tumors in mice, and that this activity may derive from indirect mechanisms related to the growth of tumors and not to the direct cytotoxicity of the drug.
Insomnia in the elderly : Prevalence, gender differences and relationships with morbidity and mortality

A sample of 1070 people aged 65 and over living in the Liverpool community was interviewed in 1982/3. Those traced were then reinterviewed 3 years later. Information was collected on the prevalence of perceived insomnia using a community version of the Geriatric Mental State (GMS), which also provided a diagnosis using AGECAT. Thirty‐five per cent reported trouble sleeping, which was twice as common in women as men and was not wholly accounted for by the increased prevalence of mental illness in elderly women. There was no change in prevalence with age, but insomnia was more frequent in the depressed group (70%). Insomnia is more likely with increasing serverity of depression but was also common in the well group and hence is not a specific indicator. No relationship was found between mortality at year 3 and insomnia or hypnotic use at year 0. Use of hypnotics was related to the presence of sleep disturbance, but not to having a psychiatric diagnosis. Medical intervention may be much more successful in reducing the prevalence of benzodiazepine usage than may have been realized.
Normative data for pharyngeal pressure generation during saliva, bolus, and effortful saliva swallowing across age and gender

Abstract Pharyngeal manometry provides information on both temporal and amplitude aspects of pressure generation during swallowing. This report provides normative data for three channel pharyngeal manometry on these parameters of pressure generation, providing the normal range of swallowing pressure against which impaired swallowing pressures can be compared. Participants were equally divided into four groups according to age and sex: young females (n = 20), young males (n = 20), older females (n = 20), and older males (n = 20). A discrete-sensor 3-channel manometric catheter measured pharyngeal pressure during three swallowing conditions: saliva swallowing, 10 ml bolus swallowing, and effortful saliva swallowing. Amplitude of peak pressure (mmHg) was recorded for each sensor during the swallow. The latency (ms) between peak pressure at Sensor 1 (approximately BOT) and Sensor 2 (approximately laryngeal additus) and total duration of upper esophageal sphincter relaxation were recorded. Additionally, a pharyngeal composite measure, consisting of an average of the peak amplitude of the two sensors in the pharyngeal segment, was generated to compensate for potential imprecision in recording due to intra-swallow catheter movement. Statistical analyses included derivation of means and 95% confidence intervals across swallowing conditions and participant groups. Clinically, these data provide a comparative database for identification of pathologic pharyngeal functioning in patients with swallowing impairment, and may aid in future studies of swallowing biomechanics.
Renal tubular acidosis: the clinical entity.

The term renal tubular acidosis (RTA) is applied to a group of transport defects in the reabsorption of bicarbonate (HCO3−), the excretion of hydrogen ion (H+), or both. This condition was first described in 1935 ([1][1]), confirmed as a renal tubular disorder in 1946 ([2][2]), and designated “
Core Temperature Measurement During Submaximal Exercise: Esophageal, Rectal, and Intestinal Temperatures

ABSTRACT The purpose of this study was to determine if intestinal temperature (Tin) might be an acceptablealternative to esophageal (Te_) and rectal temperature (Tree) to assess thermoregulation duringsupine exercise. We hypothesized that T_, would have values similar to T_ and a response timesimilar to Tr_, but the rate of temperature change across time would not be different betweenmeasurement sites.Seven subjects (5 male, 2 female; 38 + 3 yrs; 173.5 + 4.2 cm; 75.9 + 10.6 kg) completed acontinuous supine protocol of 20 min of rest, 20 rain of cycle exercise at 40% peak oxygenconsumption (VO2p0, 20 min of cycle exercise at 65% VO2pk, and 20 min of recovery. Te_, T,ec,and %, were recorded each rain throughout the test. Temperatures were not different after 20min of rest, but Tr_c was less than the T_ and T_n at the end of the 40% (Tr_: 37.20 + 0.10;Te_: 37.38 + 0.11 ; T_n: 37.35 + 0.06°C) and 65% VO2pk stages (Tr_c: 37.63 + 0.08; T¢_: 37.83 +0.10; T_n: 37.75 + 0.05°C). After 20 rain of recovery, Te_ (37.24 + 0.011 °C) was less than eitherT_e_or Tin, which were not different from each other (Tr_c: 37.44 + 0.09; Tin: 37.39 + 0.09°C). Time to threshold for increased temperature from rest (+0.10°C) was greater for T_c (15.7 +1.6 rain) than T_, (10.0 + 1.1 rain) but not different from Tin (14.0 + 1.2 min). Time to reachpeak temperature was greater for Tin (40.6 + 0.9 min) and Tr_ (41.4 + 0.5 rain) than T_ (36.6 +1.8 min). Similarly, time to a decrease in temperature (-0.10°C) after exercise was greater forTre_ (10.6 + 1.9) than T_,_(3.7 + 0.4 rain), but not different from Tin (7.1 + 1.5 min). The rate oftemperature change from threshold to the end of the 40% VO2pk stage was not different betweenmeasurement sites (T_: 0.022 + 0.005; Tr_: 0.016 + 0.004; Ti,: 0.021 + 0.004°C/min). However,the rate of change during recovery was more negative for Te, (-0.030 + 0.002°C/rain) than Tin(-0.023 + 0.003°C/min) and Tr_ (-0.010 + 0.003°C/rain), which were different from each other.In summary,
Management of Depression in Terminally Ill Cancer Patients

Depression is common in terminally ill cancer patients, and the management of depression in these patients is very important because this condition is associated with distress, suicidal ideation, and decreased quality of life. Antidepressants and psychostimulants are frequently used in the pharmacological treatment of depression in terminally ill cancer patients. The effectiveness of several Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of depression in this population has been reported; however, such improvement only occurred approximately 2-4 weeks after the medications were initiated. Psychostimulants offer the advantage of rapid action, an especially important consideration given that terminally ill patients have a short life expectancy. Moreover, methylphenidate has been reported as reversing the sedating effect of opioids, decreasing fatigue, and reducing pain. However, the adverse effect of methylphenidate must be considered. Additionally, psychotherapy also seems to improve depression and anxiety. Members of the treatment teams delivering palliative care often experience emotional burnout. Because emotional burnout results in depression and depersonalization, psychological care for the treatment team is crucial. The end-of-life period of patients is very important because it is the time at which individuals review their lives. Management of the depression in these patients will improve their quality of life and contribute to resolving their end-of-life issues. Korean J Psychopharmacol 2010;21:51-61
ANTI - INFLAMMATO RY A CTIVITY AND PHARMACOGONOSTICAL STUDY OF FICUS ARNOTTIANA ( MIQ ) LEAVES EXTRACT

Different species of Ficus have been studied for the anti inflammatory activity. In spite of being one of the well - known medicinal plants used in Indian traditional medicine to treat several ailments, studies pertaining to the pharmacological properties of Ficus arn ottiana are very scarce. The aim of this study was to evaluate, experimentally, the anti inflammatory effect of ethanolic extract of the leaves of F. arnottiana in carragenan induced paw edema in rats at a dose level of 100, 200 and 300 mg/kg, orally. The extract was administered for the anti - inflammatory activity 1 h prior to carragenan injection in the sub plantar region. Paw edema was measured by plethysmometer on 1st and 3rd h, after carragenan injection. The extracts at all the doses significantly prev ented the inflammation in dose dependent manner which was comparable to that of Diclofenac Sodium (5 mg/kg, intra peritoneal ). Our results showed that F. arnottiana ethanolic extract could prevent inflammation in rats in a dose - dependent manner. The extract did not show any acute toxicity even at the dose of 5000 mg / kg indicating that the extract has no lethal effect. Preliminary phytochemical screening of this extract identified the presence of important secondary metabolites like flavonoids and tannins. KE YWORDS: Ficus arnottiana, Anti inflammation, Pharmacogonosy, Flavonoids.
Don't Resist Using U-500 Insulin and Pramlintide for Severe Insulin Resistance

W e have all had that patient: you keep increasing the insulin doses, and now they add up to > 200 units/day. And yet, blood glucose levels are still beyond the goal range. The patient says, “Maybe insulin doesn't work for me,” and you and the patient both feel hopeless and helpless. It is important to help such patients understand that it is not their fault. Insulin resistance is frustrating for both patients and health care professionals (HCPs) and requires a multipronged approach: first, finding the right combination of medications to manage the glucose levels, and, second, addressing lifestyle issues that can help reduce insulin resistance. This is the time to consider using U-500 regular insulin. U-500 is an insulin formulation that is five times more concentrated than usual U-100 insulin. Made by Eli Lilly, it is the only concentrated insulin currently available in the United States. Concentrated U-500 insulin allows people who require very high doses of insulin to get their doses in a lower volume. For example, a patient who is taking 100 units of U-100 insulin would take an injection with a 20-unit volume of U-500 insulin. U-500 is a human regular insulin, but its time action is not the same as the usual U-100 formulation. It has the same peak as U-100 regular insulin, but its duration is more like that of NPH insulin, ~ 12 hours. Given these characteristics, U-500 works as both basal and prandial (bolus) insulin, so patients who use it not only take less insulin by volume, but also typically need only one type of insulin. Another major difference is the cost. Although patients may be shocked to learn that the cost of a 20-ml vial (twice the amount of a usual 10-ml vial) is ~ $500, it is actually equivalent unit …