Miracle-dz/UniFAR-FTUs huggingface dataset:
Surgery for small asymptomatic abdominal aortic aneurysms.

BACKGROUND An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, including size: risk of rupture increases with aneurysm size. Large asymptomatic AAAs (> 5.5 cm in diameter) are usually operated on; very small AAAs (< 4.0 cm diameter) are monitored with ultrasonography. The optimal timing of surgery would benefit from further evidence. OBJECTIVES This review compared long-term survival in patients with AAAs of diameter 4.0 to 5.5 cm who received immediate surgical repair versus routine ultrasound surveillance. SEARCH STRATEGY Trials were identified through searching the Cochrane Peripheral Vascular Diseases Group Specialised Register and reference lists of relevant articles, supplemented by handsearches of recent conference proceedings and information from experts in the field. SELECTION CRITERIA Randomised controlled trials in which men and women with asymptomatic AAAs of diameter 4.0 to 5.5 cm were randomly allocated to immediate surgery or imaging-based surveillance at least every 12 months. Outcomes had to include mortality or survival. DATA COLLECTION AND ANALYSIS One author (GF) abstracted the data which were cross-checked by the other authors (DJB, FGRF, JTP). Due to the small number of trials, formal tests of heterogeneity and sensitivity analyses were not conducted. MAIN RESULTS Two trials, the UK Small Aneurysm Trial (UKSAT) and the Aneurysm Detection and Management (ADAM) trial, fulfilled the inclusion criteria. Both showed an early survival benefit in the surveillance group (due to 30-day operative mortality with surgery) but no significant differences in long-term survival (adjusted hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.75 to 1.02, mean follow up 10 years) (UKSAT); HR 1.21, 95% CI 0.95 to 1.54, mean follow up 4.9 years) (ADAM). The meta-analysis of mortality at six years revealed a non-significant association (Peto odds ratio 1.11, 95% CI 0.91 to 1.34). Neither trial independently had sufficient power for subgroup analyses (for example, by age or aneurysm size). AUTHORS' CONCLUSIONS The results from the two trials to date suggest no overall advantage to early surgery for small AAA (4.0 to 5.5 cm) but provide no additional guidelines for 'best-care' management of subgroups of patients. An individual patient-level data meta-analysis using the combined data from these studies will have sufficient power to conduct subgroup analyses, which are expected to elucidate risks and benefits of each treatment option for subgroups based on age, fitness and aneurysm size.
Opioid antagonists for alcohol dependence.

BACKGROUND Alcohol dependence belongs to the globally leading health risk factors. Therapeutic success of psychosocial programs for relapse prevention is moderate and could be increased by an adjuvant treatment with the opioid antagonists naltrexone and nalmefene. OBJECTIVES To determine the effectiveness and tolerability of opioid antagonists in the treatment of alcohol dependence. SEARCH STRATEGY We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL in January 2010 and inquired manufacturers and researchers for unpublished trials. SELECTION CRITERIA All double-blind randomised controlled trials (RCTs) which compare the effects of naltrexone or nalmefene with placebo or active control on drinking-related outcomes. DATA COLLECTION AND ANALYSIS Two authors independently extracted outcome data. Trial quality was assessed by one author and cross-checked by a second author. MAIN RESULTS Based on a total of 50 RCTs with 7793 patients, naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Significant effects were also demonstrated for the secondary outcomes of the review including heavy drinking days, MD - 3.25 (95% CI -5.51 to -0.99), consumed amount of alcohol, MD - 10.83 (95% CI -19.69 to -1.97) and gamma-glutamyltransferase, MD - 10.37 (95% CI -18.99 to -1.75), while effects on return to any drinking, RR 0.96 (95 CI 0.92 to 1.00) missed statistical significance. Side effects of naltrexone were mainly gastrointestinal problems (e.g. nausea: RD 0.10; 95% CI 0.07 to 0.13) and sedative effects (e.g. daytime sleepiness: RD 0.09; 95% CI 0.05 to 0.14). Based on a limited study sample, effects of injectable naltrexone and nalmefene missed statistical significance. Effects of industry-sponsored studies, RR 0.90 (95% CI 0.78 to 1.05) did not significantly differ from those of non-profit funded trials, RR 0.84 (95% CI 0.77 to 0.91) and the linear regression test did not indicate publication bias (P = 0.765). AUTHORS' CONCLUSIONS Naltrexone appears to be an effective and safe strategy in alcoholism treatment. Even though the sizes of treatment effects might appear moderate in their magnitudes, these should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.
Low protein diets for chronic kidney disease in non diabetic adults.

BACKGROUND For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe kidney failure and the need for maintenance dialysis have not been resolved. OBJECTIVES To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. SEARCH STRATEGY Cochrane Renal Group studies register, the Cochrane Central Register of Controlled studies, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators. SELECTION CRITERIA Randomised studies comparing two different levels of protein intake in adult patients suffering from moderate to severe kidney failure, followed for at least one year. DATA COLLECTION AND ANALYSIS Two authors independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the study. MAIN RESULTS Ten studies were identified from over 40 studies. A total of 2000 patients were analysed, 1002 had received reduced protein intake and 998 a higher protein intake. There were 281 renal deaths recorded, 113 in the low protein diet and 168 in the higher protein diet group (RR 0.68, 95% CI 0.55 to 0.84, P = 0.0002). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year. AUTHORS' CONCLUSIONS Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 32% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.
Assisted hatching on assisted conception (IVF and ICSI).

BACKGROUND Failure of implantation and conception may result from an inability of the blastocyst to escape from its outer coat, known as the zona pellucida. Artificial disruption of this coat is known as assisted hatching (AH) and has been proposed as a method for improving the success of assisted conception. OBJECTIVES To determine whether assisted hatching (AH) of embryos facilitates live births and clinical pregnancy. SEARCH STRATEGY We previously searched the Cochrane Menstrual Disorders and Subfertility Group Specialsed Register (February 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to February 2007) and EMBASE (1980 to February 2007). SELECTION CRITERIA Two authors identified and independently screened trials. We included randomised controlled trials (RCTs) of AH (mechanical, chemical or laser disruption of the zona pellucida prior to embryo replacement) versus no AH, which reported live birth or clinical pregnancy rates. DATA COLLECTION AND ANALYSIS Two authors independently performed qualitative assessments and data extraction. MAIN RESULTS Twenty-eight trials reported clinical pregnancy data, including 1228 clinical pregnancies in 3646 women. There was no significant difference in the odds of live births in the AH compared with control groups (seven RCTs; OR 1.13, 95% CI 0.83 to 1.55; 255 births from 719 women, with no heterogeneity (P = 0.37) or inconsistency I(2) = 8%)). We also analysed the clinical pregnancy rate from the seven studies that reported live births, which was non-significant (OR 1.13, 95% CI 0.83 to 1.54). Inclusion of studies which were more robust in methodology showed an increase in clinical pregnancy rate which was just statistically significant (16 RCTs; OR 1.20, 95% CI 1.00 to 1.45, P = 0.05). Analysis of all the studies included in this update (28 RCTs) showed a marked increase in clinical pregnancy rate (OR 1.29, 95% CI 1.12 to 1.49). Miscarriage rates per women were similar in both groups (14 RCTs; OR 1.13, 95% CI 0.74 to 1.73). Multiple pregnancy rates per woman were significantly increased in women who were randomised to AH compared with women in control groups (12 RCTs; OR 1.67, 95% CI 1.24 to 2.26). AUTHORS' CONCLUSIONS The improvement in clinical pregnancy rate (CPR) with AH means that a clinic with a success rate of 25% could anticipate improving the CPR to between 29% and 49%, all things being equal. The included trials provided insufficient data to investigate the impact of assisted hatching on several important outcomes.
Heparin-Bonded Viabahn and Drug-Eluting Bare Metal Zilver (PTX) Sandwich Stents in Femoral Chronic Total Occlusion: A Retrospective Review of Mid-Term and Long-Term Outcomes

Articles describe a retrospective cohort study to assess the feasibility of reducing neointimal hyperplasia following interventions in chronic total occlusive peripheral vascular disease. The “sandwich” technique implemented is a novel modified angioplasty technique that combines heparin-bonded (Viabahn) stents with drug-eluting stents (Zilver PTX) deployed during arterial recanalisation. A review of 46 cases underwent this procedure at our institution as a limb saving procedure is conducted to determine mid-long-term patency outcomes and identify any subsequent interventions. Followup demonstrates favourable mid-long-term patency in 50% of TASC-C cases. No documented postprocedural complications were noted with unrelated observed mortality rates in either TASC-C or TASC-D subgroups. An observed advantage could be gained by using this new stenting technique via the subintimal recanalisation route. Albeit not statistically significant, type II diabetics and patients on aspiring had better sustained patency angioplasties. The sandwich technique has been shown to effectively offer symptoms relief and reduce total duration of hospital stay. Study findings support the need to evaluate the long-term efficacy through a larger longitudinal prospective study. However, to overcome the encountered study limitations, a well-structured methodology for comparison with conventional angioplasty techniques is essential to assess the synergetic potential of the sandwich technique.
Development of a Low-Cost and Effective Trapping Device for Apple Maggot Fly (Diptera: Tephritidae) Monitoring and Control in Mexican Commercial Hawthorn Groves.

Few efforts have been made in Mexico to monitor Rhagoletis pomonella (Walsh) (Diptera: Tephritidae) in commercial hawthorn (Crataegus spp.) crops. Therefore, the main objectives of this study were to evaluate infestation levels of R. pomonella in feral and commercial Mexican hawthorn and to assess the efficacy of different trap-lure combinations to monitor the pest. Wild hawthorn was more infested than commercially grown hawthorn at the sample site. No differences among four commercial baits (Biolure, ammonium carbonate, CeraTrap, and Captor + borax) were detected when used in combination with a yellow sticky gel (SG) adherent trap under field conditions. However, liquid lures elicited a slightly higher, although not statistically different, capture. Cage experiments in the laboratory revealed that flies tended to land more often on the upper and middle than lower-bottom part of polyethylene (PET) bottle traps with color circles. Among red, orange, green, and yellow circles attached to a bottle trap, only yellow circles improved fly captures compared with a colorless trap. A PET bottle trap with a red circle over a yellow background captured more flies than a similar trap with yellow circles. An SG adherent yellow panel trap baited with ammonium carbonate was superior to the improved PET bottle trap (red over a yellow background) baited with different liquid proteins, but a higher proportion of females and no differences in fly detection were measured in PET traps baited with protein lures. These trials open the door for future research into development of a conventional nonadherent trap to monitor or control R. pomonella.
Heritability of Intelligence

Abstract This article discusses findings of two recent studies conducted in collaboration with the East Flanders Prospective Twin Survey in the field of cognitive ability. The first study examined the effect of chorion type on heritability estimates of intelligence in children. The second study investigated the causes of association between child psychopathology and lower cognitive ability. Findings of these studies are discussed in the light of the current view on cognitive ability (or ‘g’) and recommendations for future research are made.
Correlation of dyspnea and physiological impairment in COPD exacerbation

Dyspnea is a primary symptom of COPD. The Medical Research Council (MRC) scale, Baseline Dyspnea Index (BDI), Visual Analogue Scale (VAS) and Borg scale are widely used for evaluation of limitation of activities due to dyspnea in patients with COPD. There is limited information on how these scales relate with parameters of physiological impairment. To aim of the prospective study was to analyze the correlation between MRC, BDI, VAS and Borg dyspnea scales and multiple measures of physiological impairments in COPD exacerbation. Forty five patients (age 62.7±9.9) with COPD exacerbation (GOLD stages III and mostly IV) were analyzed at admission to the hospital. Physiological impairments were assessed by spirometry (FVC, FEV1), body pletismography (TLC, RV, FRC, IC), respiratory muscle strength (PImax), arterial blood gas analysis (ABG) and 6-min walking distance (6MWD). The correlation between MRC scale and FEV1 is r= -0.427 (p In our study all dyspnea scales have correlated with FEV1 and PImax. According to our results it could be concluded that Borg scale is a good tool for assesing dyspnea during exercize and the therapeutic response in COPD exacerbation.
Opioid antagonists with minimal sedation for opioid withdrawal.

BACKGROUND Managed withdrawal is a necessary step prior to drug-free treatment or as the end point of long-term substitution treatment. OBJECTIVES To assess the effectiveness of opioid antagonists in combination with minimal sedation to manage opioid withdrawal. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966-July 2008), EMBASE (January 1985-2008 Week 31), PsycINFO (1967 to 7 August 2008) and reference lists of articles. SELECTION CRITERIA Controlled studies of interventions involving the use of opioid antagonists in combination with minimal sedation to manage withdrawal in opioid-dependent participants compared with other approaches or different opioid antagonist regimes. DATA COLLECTION AND ANALYSIS One author assessed studies for inclusion and undertook data extraction. Inclusion decisions and the overall process were confirmed by consultation between all authors. MAIN RESULTS Nine studies (6 randomised controlled trials), involving 837 participants, met the inclusion criteria for the review.The quality of the evidence is low, but suggests that withdrawal induced by opioid antagonists in combination with an adrenergic agonist is more intense than withdrawal managed with clonidine or lofexidine alone, while the overall severity is less. Delirium may occur following the first dose of opioid antagonist, particularly with higher doses (> 25mg naltrexone). In some situations antagonist-induced withdrawal may be associated with significantly higher rates of completion of treatment, comp[ared to withdrawal managed primarily with adrenergic agonists. However, this outcome has not been produced consistently, and the extent of any benefit is highly uncertain. AUTHORS' CONCLUSIONS The use of opioid antagonists combined with alpha(2)-adrenergic agonists is a feasible approach to the management of opioid withdrawal. However, it is unclear whether this approach reduces the duration of withdrawal or facilitates transfer to naltrexone treatment to a greater extent than withdrawal managed primarily with an adrenergic agonist.A high level of monitoring and support is desirable for several hours following administration of opioid antagonists because of the possibility of vomiting, diarrhoea and delirium.Further research is required to confirm the relative effectiveness of antagonist-induced regimes, as well as variables influencing the severity of withdrawal, adverse effects, the most effective antagonist-based treatment regime, and approaches that might increase retention in subsequent naltrexone maintenance treatment.
Spontaneous remission of hepatitis B virus reactivation during direct‐acting antiviral agent‐based therapy for chronic hepatitis C

The administration of direct‐acting antiviral agents (DAAs) to treat hepatitis C virus (HCV) infection has been reported to cause hepatitis B virus (HBV) reactivation. However, the actual conditions of HBV reactivation and the ideal timing of medical intervention have not been fully evaluated. We report the cases of two female patients dually infected with HBV and HCV. Both patients were inactive HBV carriers. Although the serum HCV RNA levels promptly decreased after the initiation of DAA‐based therapy, the serum HBV DNA levels gradually increased during DAA‐based therapy, with the peak serum HBV DNA levels observed at 16 weeks after the initiation of DAA‐based therapy in both cases. Subsequently, we checked the serum HBV DNA levels closely every week several times. Fortunately, the serum HBV DNA levels gradually decreased without medical intervention. Neither case developed an alanine aminotransferase flare‐up. The HCV genotypes were 2a and 1b, and the DAA‐based therapies of Cases 1 and 2 were 12 weeks of sofosbuvir/ribavirin and ombitasvir/paritaprevir/ritonavir, respectively. The significance of our case reports is the demonstration of the existence of spontaneous remission of HBV reactivation that developed during DAA‐based therapy, the avoidance of intervention of nucleot(s)ide analogs by frequent monitoring of serum HBV DNA levels, and development of HBV reactivation regardless of the viral genotype or class of DAA. In conclusion, the close monitoring of serum HBV DNA levels during and after DAA‐based therapy is essential and medical intervention for HBV reactivation should be carefully considered on an individual basis.
Traditional healers formalised

Traditional healers are the first to be called for help when illness strikes the majority of South Africans. Their communities have faith in their ability to cure or alleviate conditions managed by doctors, and much more. A visit to such practitioners’ websites (they are up with the latest advertising technology! ) shows that they promise help with providing more power, love, security or money, protection from evil people and spirits, enhancing one’s sex life with penis enlargement and vagina tightening spells, etc. Contemplating such claims, it is easy to be dismissive of traditional healers. But in this issue of the SAMJ Nompumelelo Mbatha and colleagues1 argue that the traditional healers’ regulatory council, promised by an Act of Parliament, should be established, followed by (or preferably preceded by) formal recognition by employers of sick certificates issued by traditional healers. Can matters be so simply resolved? What does this mean for doctors and other formally recognised healthcare professionals, and how to respond to such claims and social pressures?
Manejo de pacientes con trastornos mentales en servicios ambulatorios de Medicina General en tres hospitales de Lima.

La literatura mundial describe diversos estudios sobre el manejo de trastornos mentales (TM) en servicios no psiquiatricos; sin embargo, en el Peru los estudios estan basicamente dirigidos a determinar la prevalencia de trastornos mentales en poblacion general o en poblacion hospitalaria no-psiquiatrica. Objetivo: Obtener informacion sobre las caracteristicas y actitudes de los medicos generales (MGs) y los patrones de manejo de pacientes con probables TM. Materiales y metodos: Se administro una encuesta a 73 medicos que trabajaban en servicios ambulatorios de medicina general en tres hospitales de Lima – Peru. Resultados: El 23% de los MGs recibieron algun curso de salud mental luego de haber concluido los estudios universitarios, 56% se siente confiado en su propia habilidad para diagnosticar un TM, 82% reporta interes en manejar medicamente a pacientes con TM y 66% de siente capaz de ayudarlos. Como practica usual, 37% reporta realizar evaluacion del estado mental (EEM), 48% dice preguntar sobre conducta sexual y 37% sobre historia personal y familiar de TM. La confianza en hacer un diagnostico fue significativamente mas elevada en MGs varones y en asistentes, pero el interes para manejarlos medicamente fue mayor en MGs mujeres. La actualizacion en salud mental en post-grado se asocio significativamente con la confianza en diagnosticar TM, preguntar sobre historia psiquiatrica y salud sexual, y realizar EEM. Los TM listados como mas frecuentemente vistos fueron: depresion, trastornos somaticos sin explicacion y trastornos de ansiedad. Los psicotropicos listados como mas utilizados fueron: hipnoticos/sedantes; tonicos, vitaminas y hierbas; y antidepresivos, particularmente triciclicos. Diagnosticado un TM, 93% dice referirlo a un psiquiatra. Conclusiones: Factores relacionados a los MGs pueden influenciar los patrones de tratamiento de pacientes psiquiatricos en atencion primaria.