Miracle-dz/UniFAR-FTUs huggingface dataset:
Herb -Drug Interactions -An Update on Synergistic Interactions

Herbal drugs are bestowed with a number of properties due to which they are used in healthcare since ancient times. Several of them are reported to enhance immunity and natural resistance to disease and have recuperative power of the body. Such drugs are being consumed along with modern allopathic drugs particularly by geriatric patients. In recent years a number of herb-drug interactions have been reported some of which are serious in nature; for example consumption of Gingko biloba along with anticoagulant warfarin may result in excessive bleeding or concomitant use of St. John wort and antidepressant drugs may result in serotonin syndrome. Through pharmacodynamics and pharmacokinetic processes the herb-drug interaction often results in potentiation of action of the drug by synergistic mechanism. Several such synergistic reports on herb-drug interactions in the area of antimicrobials, antineoplastics, antidiabetics, cardiovascular actives, antihepatotoxics, CNS actives etc are discussed.
Two Tiers of Biomedicalization: Methadone, Buprenorphine, and the Racial Politics of Addiction Treatment

Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use. Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine. Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices. Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.
A novel therapeutic target for triple negative breast cancer

Received: April 10, 2016; Accepted: April 20, 2016; Published: April 22, 2016 Breast cancer is the fifth most common cause of cancer death, and the leading cause of cancer death in women. Breast cancer is a complex disease entity with different biological characteristics and clinical behavior. The heterogeneity of breast cancers makes them both a fascinating and challenging solid tumor to diagnose and treat. The treatment options currently available to patients diagnosed with breast cancer are surgery, radiation therapy, chemotherapy, and hormone therapy with an aim to eliminate the cancer, avoid the production of metastases, and prevent future remission. Gene expression profiling has yielded expression signatures from which prognostic tests can be derived to facilitate clinical decision making in breast cancer patients. The use of cytotoxic chemotherapy in both advanced and early stage breast cancer has made significant progress in the last decade or so with several landmark studies identifying clear survival benefits for newer therapies [1].
Could sugar intake initiate or aggravate non-alcoholic fatty liver during aging? An Integrative Review

Introduction: Non-alcoholic fatty liver disease (NAFLD) is part of the metabolic syndrome (MS) which is a clustering of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). The population aging process brings with it higher prevalence of MS. The prevalence of NAFLD has increased considerably, simultaneously with the expansion of MS, ranging from 15% to 25% in the general population. In Brazil, overweight plus obesity corresponds to 40% of the adult population and the prevalence found in the elderly age group reaches 81%. Thus, the carbohydrate intake has been identified as a key factor for the development of NAFLD. Objective: The purpose of this integrative review is to assess whether the sugar consumption by adults and elders may influence in the development and progression of NAFLD in individuals with or without metabolic syndrome. Materials and methods: The integrative review search was performed on PubMed database during September 2015. The selection criteria was adults and elderly people; sugar intake, such as, glucose or fructose; liver fat or NAFLD. Our major outcome was the hepatic profile because it is related to the sugar intake. We excluded review papers and studies with animals, as well as papers that were not related to our selection criteria. Results: The studies analyzed the sugar intake on hepatic de novo lipogenesis or NAFLD. Conclusion: We conclude in the most of the articles sugar intake and NAFLD have a positive correlation. However further studies are needed to elucidate the mechanism that sugars intake, mainly fructose, leads to NAFLD, or aggravating it.
Rescue of exhausted CD8 T cells by PD-1–targeted therapies is CD28-dependent

Immunotherapeutic PD-1–targeted therapies require CD28 to promote cancer cell killing. CD28 is a critical target for PD-1 blockade PD-1–targeted therapies have been a breakthrough for treating certain tumors and can rejuvenate T cells to unleash the anticancer immune response (see the Perspective by Clouthier and Ohashi). It is widely believed that PD-1 suppresses signaling through the T cell receptor (TCR). However, Hui et al. find instead that the TCR costimulatory receptor, CD28, is the primary target of PD-1 signaling. Independently, Kamphorst et al. show that CD28 is required for PD-1 therapies to kill cancer cells efficiently and eliminate chronic viral infections in mice. Lung cancer patients that responded to PD-1 therapy had more CD28+ T cells, which suggests that CD28 may predict treatment response. Science, this issue p. 1428, p. 1423; see also p. 1373 Programmed cell death–1 (PD-1)–targeted therapies enhance T cell responses and show efficacy in multiple cancers, but the role of costimulatory molecules in this T cell rescue remains elusive. Here, we demonstrate that the CD28/B7 costimulatory pathway is essential for effective PD-1 therapy during chronic viral infection. Conditional gene deletion showed a cell-intrinsic requirement of CD28 for CD8 T cell proliferation after PD-1 blockade. B7-costimulation was also necessary for effective PD-1 therapy in tumor-bearing mice. In addition, we found that CD8 T cells proliferating in blood after PD-1 therapy of lung cancer patients were predominantly CD28-positive. Taken together, these data demonstrate CD28-costimulation requirement for CD8 T cell rescue and suggest an important role for the CD28/B7 pathway in PD-1 therapy of cancer patients.
Predictors of Postoperative Mechanical Ventilation Time, Length of ICU Stay and Hospitalization Period after Cardiac Surgery in Adults

Objectives: To study the effect of perioperative factors on patients’ recovery after cardiac surgery in adults. Methods: This is a prospective observational analysis of 101 adult patients (age range 19-78 years) who had undergone coronary artery grafting, heart valve(s) replacement / repair or combined (coronary and valve) surgeries, was conducted at Queen Alia Heart Institute. The influence of 22 perioperative parameters (age, gender, co-morbidities, body mass index, type of surgical procedure, left ventricular function, cardiopulmonary bypass time (CPB), inotropic support, analgesia, postoperative blood losses,. ) on recovery variables (time of extubation, ICU and hospital discharge) was studied. European system for cardiac operative risk evaluation (EUROSORE) has been calculated. Univariate and multivariate analysis of results was performed. Results: Mean time of mechanical ventilation was 11±8.5 hours. Delay in extubation was noticed in patients with left ventricular impairment, chronic respiratory disease, morbid obesity, urgent surgery, age above 61 years, patients who had reopening for control of bleeding and lower temperatures during deliberate hypothermic cardiopulmonary bypass. The mean length of ICU stay was 1.8 ± 1.2 days. The average length of hospitalization was 5.1±1.2 days. There was a correlation between Length of intensive care unit stay and CPB (p-value=0.02), and between Length of intensive care unit stay and aortic cross clamp time (p-value=0.006). Prolonged operative time (OT) was associated with increased length of hospitalization (p-value=0.008). Average EUROSCORE value was 1.4 (ranged between 0.5 5.3). Conclusion: Left ventricular dysfunction, urgent surgery, inotropic support, considerable postoperative bleeding, morbid obesity, longer cardiopulmonary bypass and aortic clamp times, are main risk factors of delayed (or prolonged) extubation, and ICU/ hospital discharge.
Overcoming Psychological Barriers to Insulin Use

Despite the well-known benefits of achieving glycemic targets that prevent long-term complications associated with diabetes, the transition to insulin therapy (IT) remains a difficult threshold for many patients to cross. In addition to provider obstacles such as lack of staff time, lack of resources, and clinical inertia, psychological barriers common among patients with type 2 diabetes constitute significant obstacles to IT initiation. In fact, these psychological barriers are so prevalent that they are described as a syndrome called ‘psychological insulin resistance’ (PIR). Exploring, addressing, and eventually overcoming these psychological barriers is essential in order to achieve effective treatment outcomes and prevent prolonged and unnecessary exposure to hyperglycemia.
HIV epidemics among transgender populations: the importance of a trans‐inclusive response

Transgender women are at high risk for the acquisition and transmission of HIV. However, there are limited empiric data characterizing HIV‐related risks among transgender women in sub‐Saharan Africa. The objective of these analyses is to determine what factors, including sexual behaviour stigma, condom use and engagement in sex work, contribute to risk for HIV infection among transgender women across three West African nations.
Using Student and Staff Perceptions to Guide Training and Practice

Despite the notable positive outcomes SWPBIS has for students, schools sometimes struggle with effective and successful implementation. SWPBIS is a complex systems change effort which may prove to be overwhelming for some schools to effectively implement without the necessary preliminary supports in place. System change efforts provide an avenue to approach the work of implementing SWPBIS. The present case study examined use of staff and student perceptions of behavior and discipline to design and provide targeted staff training through PLCs. Findings demonstrate some improvements in Tier I SWPBIS implementation. However several barriers were also identified in the course of this work. Using perceptions and beliefs of staff and students to implement positive behavior practices is a complex process and can be influenced by administrator support, district supports, and the priorities and collaboration of a school staff. USING STUDENT AND STAFF PERCEPTIONS TO GUIDE TRAIN 3
Pomegranate Peel and Fruit Extracts: A Novel Approach to Avert Degenerative Disorders – Pomegranate and Degenerative Diseases

Pomegranate (Punica granatum L.), the fruit and its peel have been shown to hold tremendous potential for the treatment of various ailments. Incorporation of pomegranate, peel and their extracts, as key functional ingredients in various ethnopharmacological formulations are widely accepted in almost all cultures of the World. In addition to their disease ameliorating features, pomegranate and the peel extracts have gained significant popularity in functional food market as ingredient of choice in foods designed to prevent onset of various non-communicable diseases. Health promoting features of the pomegranate peel and fruit extracts define the scope of this natural reserve in global nutraceutical and functional food industry. On account of their unique phytochemicals profile, plentiful pool of antioxidants, dietary fibers, minerals and natural colors, both the valuable reserves have been remained as highly explored plant material in last two decades. Building levels of interest in this fruit has created a deeper insight among researchers to understand actual potential and pathways of pomegranate biomolecules reactivity in human models. The chapter in hand meticulously deals with pomegranate and its extracts as source of innovative healthy components responsible for averting cardiovascular diseases, inflammatory and non-inflammatory disorders, type 2 diabetes, gastric ulcers, various types of cancers and neurodegenerative disorders. Pomegranate Peel and Fruit Extracts: A Novel Approach to Avert Degenerative Disorders – Pomegranate and Degenerative Diseases
Investigating acceptance of nursing information systems through UTAUT lens

It is widely known that nurses are pivotal in coordinating and communicating patient care information in the complex network of healthcare professionals and service delivery. Yet, despite their pivotal role, information communication technologies have historically rarely been designed around nurses’ operational needs. This could explain the poor integration of technologies into nursing work processes and consequent rejection by nursing professionals. The complex nature of acute care delivery in hospitals and the frequently interrupted patterns of nursing work suggest that nurses require flexible intelligent systems that can support and adapt to their variable workflow patterns. This study is designed to explore nurses’ initial reactions to a new integrated point of care solution for acute healthcare contexts. We report on the first stage of a longitudinal project to use an innovative approach involving nurses in the development and refinement of this solution. Unified Theory of Acceptance and Use of Technology was used to evaluate acceptability of the proposed system by nurses.
Bioequivalence of Two Co-formulations of Emtricitabine/TenofovirAlafenamide Fixed-Dose Combinations with 200/10 mg and 200/25 mg

Emtricitabine/tenofovir alafenamide (FTC/TAF) is the next advancement in nucleotide reverse transcriptase inhibitor (NRTI) backbone for the treatment of HIV-1 in adults. Tenofovir disoproxil fumarate (TDF), an oral prodrug of tenofovir (TFV), is a preferred NRTI, but it is also associated with nephrotoxicity and reduced bone mineral density (BMD). TDF has been replaced by TAF, a novel, prodrug of TFV with a unique metabolic pathway leading to >90% lower circulating plasma of TFV. Less nephrotoxicity, less BMD reduction in treatment-naive subjects, and BMD increase in virologically suppressed patients on TAF in clinical trials. The two studies presented here were conducted in healthy subjects. Study 1472 evaluated the pharmacokinetics (PK) and bioequivalence (BE) of the components of FTC/TAF 200/10 mg fixed-dose combination (FDC) administered with elvitegravir 150 mg and cobicistat 150 mg tablets to elvitegravir (E)/cobicistat (C)/FTC (F)/TAF (150/150/200/10 mg) single-tablet regimen (STR). Study 1473 evaluated the PK and BE of the components of FTC/TAF 200/25 FDC to E/C/F/TAF STR. One-hundred and 116 subjects were randomized into the single-dose, open-label, 2-way, crossover Phase 1 Study 1472 and Study 1473, respectively; two subjects did not complete Study 1472. Serial blood samples were obtained over 144 hours after administration of each treatment, and pharmacokinetic parameters were calculated. Formulation bioequivalence was assessed by 90% confidence intervals (CIs) for the geometric least-squares mean (GLSM) ratios of pharmacokinetic parameter AUClast, AUCinf, and Cmax for each component of FTC/TAF FDC to FTC and TAF administered as E/C/F/ TAF STR. The test and reference treatments were generally well tolerated. The 90% CIs for the GLSM ratios of the primary pharmacokinetic parameter AUClast, AUCinf, and Cmax for test versus reference treatments were within the protocol-specified bioequivalence boundary of 80% to 125% for FTC and TAF. FTC/TAF 200/10 mg and 200/25 mg are the next advancement in NRTI backbone for treatment of HIV-1 adults and adolescents, with an emphasis on safety while maintaining the efficacy and convenience of its predecessor.
DRUG TAKEN SUPERVISOR AS AN INDICATOR FOR SUPPORTING TB HIV PASIENT AT RSUD DOK II JAYAPURA PERIODE JANUARI 2011- SEPTEMBER 2012

Papua as the highest HIV-AIDS prevalence region in Indonesia will be against Tuberculosis (TB) as opportunistic infection of the majority of patients with HIV-AIDS. The success of the treatment is determined by how the patients handle the side effects of FDC (Fixed Drug Combination) successfully during taking the drug for 6-8 months. This study was aimed to find out some influenced factors leading to fail treatment for HIVAIDS patients after getting FDC (Fixed Dose Combination) drug, from Januari 2011 to
Medication Error Propagation In Intensive Care Units

We examined propagation of medication errors at various stages of the medication management process (ordering, transcription, preparation, dispensing, administration and monitoring) in two ICUs of a medical center. We performed a secondary analysis of 1,732 medication events identified in a group of 630 ICU patients. A Markov Chain model showed that errors propagate throughout the medication management process, in particular between the stages of preparation, dispensing and administration.
Two Cases of Polycystic Ovary Syndrome with Metabolic Syndrome Presenting with Hirsutism in Adolescence

다낭성난소증후군(Polycystic Ovary Syndrome, PCOS) 은 고안드로겐증(다모증 혹은 고안드로겐혈증), 난소기능장 애(희소-무배란 혹은 초음파에서 다낭성 난소)를 특징으로 하는 질환으로서 병인은 성선자극호르몬(leutenizing hormone, LH)의 증가와 비정상적인 스테로이드호르몬 생성 및 고인 슐린혈증 등이 알려져 있다. 가임여성에서는 ~10% 정도로 발생하는 흔한 내분비 질환이나 1,2) 청소년기에는 생리적인 무배란과의 감별이 난이하고 다난포성 난소의 정확한 초음 파진단의 어렵고 청소년기 정상 안드로겐 수치가 없어 고안 드로겐 혈증을 진단하기 어려운 제한점 등으로 인해, 소아 기의 PCOS 에 관한 연구보고는 극히 드물다. 3,4) PCOS는 무월경 및 불임 등의 생식기계 문제 이외에도 대사증후군, 제 2형 당뇨병, 심혈관 질환 등의 위험을 증가시킨다고 알 려져 PCOS의 위험성이 있는 환자를 조기에 발견하고 치료 를 시작하는 것이 장기적인 합병증을 예방하는데 중요하다. 저자들은 다모증을 주소로 내원하여, 대사증후군이 동반된 청소년기 다낭성 난소증후군으로 진단된 2예를 경험하였기 에 보고하는 바이다. 다모증을 주소로 내원하여 대사증후군을 동반한 청소년기 다낭성 난소증후군으로 진단된 2예
CASE REPORT: HYPERSENSITIVITY AND CROSS-REACTIVITY TO CISPLATIN AND CARBOPLATIN

Platinum-based compounds were first synthesized in the nineteenth century and their clinical use against cancer started in the 1970s (1,2). These drugs have been approved for the treatment of numerous malignancies, such as ovarian, primary peritoneal carcinoma, bladder, head and neck, colorectal, pancreatic, esophageal, gastric, testicular, endometrial, biliary tract, lung cancer, and mesothelioma (3). Cisplatin was the first of the platinum drugs to be used (1). Second-generation platinum derivative carboplatin differs from cisplatin in the substitution of 2 chlorides. Its efficacy in the treatment of many of the above malignancies is equal to that of cisplatin, and its toxicity profile is more favorable. Therefore, carboplatin has often been used in place of cisplatin (4,5). Cisplatin has some toxicity and adverse effects such as nausea, vomiting, anorexia, diarrhea, constipation, tinnitus, taste alteration, alopecia, hypocalcaemia, nephrotoxicity, and peripheral neurotoxicity (6,7). Several side effects of cisplatin such as hypersensitivity and electrolyte disturbance are uncommon (8,9). Hypersensitivity reactions (HSRs) in patients receiving cisplatin was first described in the 1970s in patients who had been retreated with this drug (10). Extensive use of platinum compounds in chemotherapy during the last decade has led to a significant increase in the incidence of HSRs. Hypersensitivity to carboplatin is rarely observed during the first course of treatment (11,12). During the first five cycles, the overall risk is less than 1% and it rises sharply to 6.5% with the sixth cycle and has been reported as high as 27% in patients receiving more than seven cycles of treatment (13,14). The incidence of cisplatin hypersensitivity exhibits similar characteristics to those observed with carboplatin. It seems to range from 5% to 20% and increases with concomitant radiation (11).
Improving the accuracy of FNA lung biopsies in a community hospital.

7639 Background: Until 2008 it was believed that outcomes in NSCLC were independent of histologic type. Until then, all doublet combinations of platinum compounds showed comparable efficacy in the treatment of NSCLC, and there was no urge for pathologists to differentiate the specific histologic subtypes. There is now data to support improved efficacy with agents such as pemetrexed in non-squamous cell carcinoma or gemcitabine in squamous cell histology. We evaluated the rate of non-specific NSCLC diagnosis in FNA biopsies in our institution before and after raising awareness among our pathologists and interventional radiologists and making changes in the immunoperoxidase panel used in lung cancer samples. Methods: We evaluated all FNA biopsies of lung cancer patients obtained in 2008 classifying them in adenocarcinoma; squamous cell ca; SCLC; NSCLC NOS and neuroendocrine carcinoma. For 2009 some changes were implemented by pathology including: increased awareness of the therapeutic importance of a specif.