Miracle-dz/UniFAR-FTUs huggingface dataset:
The Evolution of Nursing Care in Multiple Sclerosis

Abstract Multiple sclerosis (MS) is a chronic, frequently debilitating neurologic disease that affects young adults in the prime of their lives. Until recently, treatment focused on symptom management rather than on disease modification. Patients’ contacts with the health care system were limited to the diagnostic period, episodes of acute attacks, and periods of disease progression. With the advent of disease-modifying agents, the focus of care in MS has changed from one of maintenance and crisis intervention to a more positive and proactive approach. The nurse working in the field of MS has emerged as an important member of the health care team, playing a vital role in the ongoing care of and interaction with patients and their families. Nursing care in MS is a collaborative effort whose goal is self-awareness and self-responsibility; its activities involve supporting a great deal of self-care by patients, families, and care partners. The nurse working with MS patients is a care provider, facilitator, a.
Recent advances in T‐cell regulation relevant to inflammatory dermatopathology

Inflammatory dermatoses encompass an enormous area of dermatopathology. Our understanding of the subject comes from combination of histopathological observations and relevant clinical information. Diagnoses are generally reached at the hematoxylin and eosin (H&E) level by using various pattern recognition approaches including one devised by Dr Ackerman et al. 1 Recent advances in cell biology and immunology especially the field of T‐cell regulation shed light to the intricate cellular interactions, associations and connect to inflammatory dermatopathology. This review attempts to identify and put into context the most significant advances in cellular biology relevant to the topic. Most of the information presented here is not necessarily relevant to our regular work at the moment; however, the new information will surely channel into our practice to provide a better, more accurate, semi‐individualized diagnostic approach in the not too far future.
Pathogenesis of preeclampsia

Purpose of reviewPreeclampsia is a gestational kidney disease characterized by glomerular endothelial injury, leading to maternal hypertension and proteinuria. If not addressed promptly, there is significant maternal and fetal morbidity and mortality. When severe, this disorder can cause hepatic and neurologic dysfunction. Understandably, this placental disease enters the focus of the obstetrician first; however, with progression, the nephrologist can also be enlisted. Typical complications include acute kidney injury, refractory hypertension, and acute pulmonary edema. This review summarizes recent literature on the pathogenesis of this condition and will highlight new diagnostic and therapeutic options for preeclampsia. Recent findingsOver the past decade, the role of soluble vascular factors in preeclampsia has shed light on the mechanism underlying this disease. During the last 2 years, several new therapeutics have been developed that target implicated circulating angiogenic factors, including soluble fms-like tyrosine kinase 1, an endogenous vascular endothelial growth factor inhibitor. Serum levels of angiogenic factors have been correlated with a constellation of hemodynamic and pathophysiologic changes. Thus, circulating levels of these factors may serve both diagnostic and prognostic purposes. SummaryOverall, our understanding of preeclampsia has developed significantly and the future holds promise for mechanism-based novel diagnostics and therapeutics.
Allergic Sensitization Is Associated With Rhinovirus-, but not Other Virus-, Induced Wheezing in Children

T Jartti, H Kuusipalo, T Vuorinen. Pediatr Allergy Immunol. 2010;21(7):1008–1014 Building on recent studies that have suggested a link between early wheezing caused by rhinovirus and the development of asthma, these researchers sought to characterize the relationship of respiratory viral infections with atopy in hospitalized wheezing children. The authors studied a subgroup from among a previously described cohort of 293 hospitalized wheezing Finnish children aged 3 months to 16 years who …
HYDATIDOSIS CONTROL — A GLOBAL VIEW

SUMMARY: A brief review has been made of some of the important advances in knowledge that have occurred in research on and control of hydatidosis (Echinococcus spp.) during the past 20 years. Included among the subjects reviewed are new information on the geographical distribution, host-parasite relationships, socio-cultural factors and the dynamics of transmission. A description has also been given of the factors found to be important in the setting up of control programs. These include structure, functions, priorities, surveillance and education in veterinary public health. Current options for methods of control have been described and the problems to be resolved following the change in method from ‘arecoline surveillance’ with its educational component to mass dog-treatment programs have been discussed.
Clearance of cardiovascular medications during hemodialysis

Purpose of reviewTo review the current understanding of hemodialysis-mediated clearance of commonly used cardiovascular medications. Recent findingsAlthough cardiovascular drug dialyzability is poorly understood, many drug classes appear to include agents with substantially different degrees of dialyzability. Recent data suggest that more readily dialyzable beta-blockers associate with higher short-term mortality in patients initiating these drugs when on hemodialysis. Although this relationship was not observed in a later study with angiotensin-converting enzyme inhibitors of varying dialyzability, studies of this kind are currently limited by pharmacokinetic data that are either incomplete or no longer applicable to modern hemodialysis procedures. SummaryThere are substantial deficits in our understanding of cardiovascular medication dialyzability, which relates in large part to advances in the process of hemodialysis that have rendered older studies of dialyzability irrelevant. The importance of cardiovascular disease in patients receiving hemodialysis demands a better understanding of the effect hemodialysis exerts on cardiovascular drug pharmacokinetics.
Qual o valor da sedimentoscopia em urinas com características físico-químicas normais?

The consequence of omitting urine sediment microscopy in dipstick physicochemical normal samples has been highly questioned in non Brazilian literature, in which many authors consider it not necessary. Considering that most of Brazilian laboratories always perform the complete urine examination and in order to clear this doubt, a study was done in 10.234 urine samples from essentially outpatients. Among these samples, 5000 showed normal dipstick physicochemical examination. In those, an evaluation of clinical possible relevant sediment microscopy elements was studied. Casts (29 samples - 0,58%) and more than five leukocytes per field (26 samples - 0,52%) showed to have the highest incidence, while all other sediment elements had their incidence numbers in 0,4% or less. No abnormal sediment elements were found in 98,02% of these samples. The X2 method (p < 0,01) was used to perform the statistical analysis; the results showed that there is no need to do the urine sediment microscopy in dipstick physicochemical normal samples. Based on these findings, it can be suggested that the suppression of the sediment examination in dipstick physicochemical normal samples will cause no impairment for both patient and physician. Then, significant savings of time and costs will be obtained, as 48,85% sediment microscopy examination routinely performed in Brazilian laboratories could be safely suppressed.
A comparative study of the modeled effects of atrazine on aquatic plant communities in midwestern streams

Potential effects of atrazine on the nontarget aquatic plants characteristic of lower‐order streams in the Midwestern United States were previously assessed using the Comprehensive Aquatic System Model (CASMATZ). Another similar bioenergetics‐based, mechanistic model, AQUATOX, was examined in the present study, with 3 objectives: 1) to develop an AQUATOX model simulation similar to the CASMATZ model reference simulation in describing temporal patterns of biomass production by modeled plant populations, 2) to examine the implications of the different approaches used by the models in deriving plant community‐based levels of concern (LOCs) for atrazine, and 3) to determine the feasibility of implementing alternative ecological models to assess ecological impacts of atrazine on lower‐order Midwestern streams. The results of the present comparative modeling study demonstrated that a similar reference simulation to that from the CASMATZ model could be developed using the AQUATOX model. It was also determined that development of LOCs and identification of streams with exposures in excess of the LOCs were feasible with the AQUATOX model. Compared with the CASMATZ model results, however, the AQUATOX model consistently produced higher estimates of LOCs and generated non‐monotonic variations of atrazine effects with increasing exposures. The results of the present study suggest an opportunity for harmonizing the treatments of toxicity and toxicity parameter estimation in the CASMATZ and the AQUATOX models. Both models appear useful in characterizing the potential impacts of atrazine on nontarget aquatic plant populations in lower‐order Midwestern streams. The present model comparison also suggests that, with appropriate parameterization, these process‐based models can be used to assess the potential effects of other xenobiotics on stream ecosystems. Environ Toxicol Chem 2015;34:2590–2602. © 2015 SETAC
Pharmacotherapy of acute coronary syndrome: the ACUITY trial

Background: Bivalirudin, a direct thrombin inhibitor, has unique attributes including predictable pharmacokinetics, a reduction in bleeding complications and avoidance of heparin induced thrombocytopenia. Objective: We critically review the role of bivalirudin in the management of patients with acute coronary syndrome in light of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Methods: Data from the ACUITY trial was critically reviewed along with other contemporary data. Results/conclusion: In the ACUITY trial, bivalirudin monotherapy was associated with rates of ischemic events that were noninferior to those associated with heparin plus glycoprotein IIb/IIIa inhibition, but was associated with a significantly reduced incidence of major bleeding. Bivalirudin seems to be an attractive antithrombotic agent in patients with acute coronary syndrome undergoing early invasive management.
Human MTHFR-G1793A transition may be a protective mutation against male infertility: a genetic association study and in silico analysis

Abstract In this paper, we evaluate the association of the human methylenetetrahydrofolate reductase (MTHFR)-G1793A transition with male infertility using a case-control study, a meta-analysis and an in silico analysis. In the case-control study, 308 blood samples (169 infertile and 139 fertile men) were collected. MTHFR-G1793A genotyping was performed by PCR-RFLP. The study revealed a significant protective association between the GA genotype (OR: 0.3737, 95%CI: 0.1874–0.7452, p = 0.0052) and A allele (OR: 0.4266, 95%CI: 0.2267–0.8030, p = 0.0083) with male infertility. Meta-analysis showed that the G1793A transition might be a protective mutation against male infertility in both A vs. G (OR: 0.608, 95%CI: 0.466–0.792, p < 0.001), and GA vs. GG (OR: 0.534, 95%CI: 0.394–0.724, p < 0.001) genetic models. In silico-analysis revealed that although G1793A could not make fundamental changes in the function and structure of MTHFR, it could modify the structure of the mRNA (Distance =0.1809, p = 0.1095; p < 0.2 is significant). The results suggest that G1793A substitution might be a protective genetic factor against male infertility. However, further case-control studies are required to provide a more robust conclusion.
A Case of Acute Eosinophilic Pneumonia after Hematopoietic Stem Cell Transplantation.

Pulmonary complications occur in 40~60% of patients who receive hematopoietic stem cell transplantation (HSCT) and are a source of substantial morbidity and mortality. Acute eosinophilic pneumonia (AEP) is an uncommon, non-infectious pulmonary complication occurring in HSCT recipients. We now report the case of a 52-year-old man with AEP who was treated with allogenic HSCT due to acute myeloid leukemia. He complained of fever, cough and dyspnea 390 days after allogenic HSCT. He also had skin and hepatic graft versus host disease (GVHD). Hypoxemia, diffuse pulmonary infiltrates on a chest x-ray and eosinophilia in bronchoalveolar lavage fluid were also noted in several tests. His symptoms, pulmonary infiltrates, hepatic dysfunction and skin lesions rapidly improved after treatment with corticosteroid therapy. Our case supports the idea that AEP is a late phase non-infectious pulmonary complication and one of the manifestations of chronic GVHD.
Rheumatology in the 21 st century: Progress, promise and challenges

Journal of Mahatma Gandhi Institute of Medical Sciences Dr. Mihir D. Wechalekar trained in Internal Medicine at the Mahatma Gandhi Institute prior to migrating to Australia where he underwent specialist training in rheumatology. He then went on to join a full time PhD as a National Health and Medical Research Council (NH and MRC) Scholar. He is also a one of the 10 world-wide multinational fellows of the “3e” (evidence, expertise, exchange), a global multinational program that aims to create worldwide guidelines for rheumatological diseases. His areas of interest include early rheumatoid arthritis, arthroscopic synovial biopsy and synovial pathology in health and disease and markers of disease activity and remission. Dr. Wechalekar has been the recipient for several awards including recipient of gold and silver medals in medicine and grants and awards including from the NH and MRC, Arthritis Australia and Australian Rheumatology Association and the Flinders Centre for Clinical Change and Health Care Research. In addition to research, he currently practices as a part time Consultant Rheumatologist in Adelaide, Australia. Editorial
Paediatric chemoprophylaxis for child contacts of patients with drug-resistant tuberculosis: Are current guidelines effective in preventing disease?

The World Health Organization estimates that there were 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB) in 2013. Alarmingly, 40% of MDR-TB cases for which second-line drug susceptibility test results were reported originated in South Africa (SA). This has important implications in vulnerable pop- ulations, such as children, where infection with drug-resistant strains of TB are usually attributable to transmission rather than acquisition of resistance.
Intersex and liver alterations induced by long‐term sublethal exposure to 17α‐ethinylestradiol in adult male Cnesterodon decemmaculatus (Pisces: Poeciliidae)

The aim of the present study was to assess the responses of the gonopodium morphology and the gonadal and liver histology of adult male Cnesterodon decemmaculatus to sublethal long‐term exposure concentrations of 17α‐ethinylestradiol (EE2). Two experiments were conducted exposing the fish to waterborne concentrations of EE2 ranging from 20 ng/L to 200 ng/L for 8 wk, 12 wk, and 16 wk. Intersex gonads were observed after 8 wk and 16 wk in fish exposed to 200 ng EE2/L and 100 ng EE2/L, respectively. Oocytes’ development from testis germ cells and replacement of the efferent duct periodic acid‐Schiff–positive secretion surrounding spermatozeugmata by parenchymal tissue and duct structure alterations were the major observed changes in the gonads. In contrast, no response was observed in the gonopodium morphology. Liver histology was also altered, showing increasing steatosis, single‐cell necrosis to generalized necrosis, and disruption of acinar organization from 100 ng EE2/L to 200 ng EE2/L. In summary, the present results showed that although EE2 was not able to alter the morphology of a developed gonopodium, it was capable of inducing development of testicular oocytes in adult male C. decemmaculatus at environmentally relevant concentrations. Thus, externally normal but intersex C. decemmaculatus males would be expected in the wastewater‐receiving streams that the species inhabits. According to the literature, the present study would be the first indicating estrogen‐induced intersex in adult male poeciliid. Environ Toxicol Chem 2017;36:1738–1745. © 2016 SETAC
Randomized Controlled Trial of a Drug Regimen That Includes Ciproftoxacin for the Treatment of Pulmonary Tuberculosis

The fluoroquinolones are promising new antituberculous agents. A randomized controlled trial of 200 adult patients with sputum smear-positive pulmonary tuberculosis was conducted in Tanzania. Patients received either a trial regimen (HRC) consisting of isoniazid (300 mg), rifampin (600 mg), and ciprofloxacin (750 mg) or a control regimen (HRZE) consisting of isoniazid (300 mg), rifampin (600 mg), pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg). The 168 evaluable patients all had negative smears and cultures by month 6, but the time to conversion to negativity was longer for the HRC group than for the HRZE group because of the poor response of patients infected with human immunodeficiency virus (HIV) to the HRC regimen. Relapse was more frequent in the HRC group. The sterilizing activity of ciprofloxacin does not appear to be equal to that of the combination of pyrazinamide and ethambutol, but the difference in outcome was significant only among HIV-infected patients.
Comparison of trout hepatocytes and liver S9 fractions as in vitro models for predicting hepatic clearance in fish

Isolated hepatocytes and liver S9 fractions have been used to collect in vitro biotransformation data for fish as a means of improving modeled estimates of chemical bioaccumulation. To date, however, there have been few direct comparisons of these 2 methods. In the present study, cryopreserved trout hepatocytes were used to measure in vitro intrinsic clearance rates for 6 polycyclic aromatic hydrocarbons (PAHs). These rates were extrapolated to estimates of in vivo intrinsic clearance and used as inputs to a well stirred liver model to predict hepatic clearance. Predicted rates of hepatic clearance were then evaluated by comparison with measured rates determined previously using isolated perfused livers. Hepatic clearance rates predicted using hepatocytes were in good agreement with measured values (<2.1‐fold difference for 5 of 6 compounds) under 2 competing binding assumptions. These findings, which may be attributed in part to high rates of PAH metabolism, are similar to those obtained previously using data from liver S9 fractions. For 1 compound (benzo[a]pyrene), the in vivo intrinsic clearance rate calculated using S9 data was 10‐fold higher than that determined using hepatocytes, possibly due to a diffusion limitation on cellular uptake. Generally, however, there was good agreement between calculated in vivo intrinsic clearance rates obtained using either in vitro test system. These results suggest that both systems can be used to improve bioaccumulation assessments for fish, particularly when vitro rates of activity are relatively high, although additional work is needed to determine if the chemical domain of applicability for each system differs. Environ Toxicol Chem 2017;36:463–471. Published 2016 SETAC. This article is a US government work and, as such, is in the public domain in the United States of America.
Clinical assessment of phosphorus status, balance and renal handling in normal individuals and in patients with chronic kidney disease

Purpose of reviewThe concepts of steady state, external balance, total body status and internal distribution are not always appreciated or even considered in clinical practice. The current tests available for clinical assessment of phosphorus physiology and pathophysiology are valid in some aspects, but also have many limitations. The purpose of this review is to clarify the above concepts and discuss the utility of the currently available tests to assess phosphorus disorders. Recent findingsBoth epidemiologic and preclinical data have shown that disturbances in mineral metabolism contribute significantly to the morbidity and mortality in chronic kidney disease. There are also emerging data supporting the notion that phosphotoxicity may exist even in individuals with normal renal function. In chronic kidney disease (CKD), hyperphosphatemia is a relative late event and is a suboptimal indicator of phosphorus balance and status. The judicious use of plasma and urine chemistry and hormonal biomarkers such as fibroblast growth factor 23 should be considered. SummaryThere is a dire need to increase awareness of what physiologic parameters should be monitored in terms of phosphorus pathophysiology. Although the current available tests in the clinical armamentarium are not ideal, understanding their implications and limitations will improve patient care and motivate practitioners and investigators to develop better tests.
Exercise Nutrition for Adults Older Than 40 Years

In general, nutrient needs do not change much for older individuals who exercise regularly yet moderately for the purposes of chronic disease risk reduction. Overall diets should reflect those recommended by such authorities as the American Dietetic, Heart, and Diabetes Associations, with special attention to ensuring ample protein and antioxidant intakes. Proper timing and amounts of nutrients consumed before physical activity should be practiced, to ensure adequate fueling while minimizing gastrointestinal discomfort. Consuming energy during activities lasting less than 90 minutes is unnecessary if the individual is well fueled before starting. After exercise, consuming a blend of carbohydrate and protein is often advocated for glycogen resynthesis and muscle protein repair, but the importance of this for those not engaging in regular vigorous activity remains to be clarified. Adequate hydration is critical to physical performance and health during exercise, particularly in the heat. Because thirst might not sufficiently reflect fluid needs of older individuals, this matter deserves special attention. Sports drinks are generally not necessary for events lasting less than 60 minutes and may provide unwanted calories, sugars, and sodium for older exercisers. Naturally occurring sources of electrolytes may be preferable.
Lethal and behavioral impacts of diesel and fuel oil on the Antarctic amphipod Paramoera walkeri

Toxicity testing with Antarctic species is required for risk assessment of fuel spills in Antarctic coastal waters. The lethal and sublethal (movement behavior) sensitivities of adults and juveniles of the Antarctic amphipod Paramoera walkeri to the water accommodated fractions (WAFs) of 3 fuels were estimated in extended‐duration tests at –1 °C to 21 d. Response of P. walkeri for lethal hydrocarbon concentrations was slow, with 50% lethal concentrations (LC50s) first able to be estimated at 7 d for adults exposed to Special Antarctic Blend diesel (SAB), which had the highest hydrocarbon concentrations of the 3 fuel WAFs. Juveniles showed greater response to marine gas oil (MGO) and intermediate residual fuel oil (IFO 180) at longer exposure durations and were most sensitive at 21 d to IFO 180 (LC50 = 12 μg/L). Adults were initially more sensitive than juveniles; at 21 d, however, juveniles were more than twice as sensitive as adults to SAB (LC50 = 153 μg/L and 377 μg/L, respectively). Significant effects on movement behavior were evident at earlier time points and lower concentrations than was mortality in all 3 fuel WAFs, and juveniles were highly sensitive to sublethal effects of MGO. These first estimates of Antarctic amphipod sensitivity to diesel and fuel oils in seawater contribute to the development of ecologically relevant risk assessments for management of hydrocarbon contamination in the region. Environ Toxicol Chem 2017;36:2444–2455. © 2017 SETAC