Miracle-dz/UniFAR-FTUs huggingface dataset:
Proteína C reactiva en el servicio de urgencias: ¿ha encontrado una aplicación clínica?

La investigacion de los factores de riesgo, de los fenomenos tromboticos y mas recientemente del papel de la inflamacion vascular ha sido fundamental para avanzar en nuestro conocimiento, tanto de la etiopatogenia como de la fisiopatologia de la enfermedad aterosclerotica. Asi, hemos entendido de que manera se establece y se desarrolla una placa ateromatosa estable y de que forma se transforma en «vulnerable», lo cual representa la causa subyacente mas comun del sindrome coronario agudo (SCA). Dado que en ambos procesos la inflamacion tiene un papel preponderante, numerosos estudios, de forma individual o conjunta, han investigado si la utilizacion de marcadores del proceso inflamatorio puede mejorar el diagnostico, la estratificacion pronostica o incluso el tratamiento de forma convincente, para que puedan ser utilizados en la practica clinica1. Sabemos que en los SCA, asi definidos desde la irrupcion en el uso clinico del biomarcador troponina, una complejisima serie de fenomenos inflamatorios y tromboticos altamente imbricados lleva a la rotura o la fisura de una placa ateromatosa, hasta entonces estable. Comienzan con una cascada que concluira con la oclusion parcial o total de una o mas arterias coronarias, con las consecuencias clinicas conocidas2. Una pregunta clave, que se han formulado tanto los investigadores como los medicos clinicos en la ultima decada, es si los marcadores inflamatorios pueden ser utilizados para mejorar la estratificacion clinica de Proteina C reactiva en el servicio de urgencias: ? ha encontrado una aplicacion clinica? Juan C. Kaskia y Daniel Fernandez-Bergesb
Pain quality assessment scale: practical implications of factor analysis.

To the Editor: The authors of this article offered a model of classification of pain quality domains on the basis of the factor analysis of Pain Quality Assessment Scale (PQAS). Authors suggest that their approach ‘‘may provide clinicians and researchers with a useful way to summarize data from pain quality measures and may also provide meaningful end points that would allow for treatment differentiation between various pharmacologic entities. ’’ We suggest extending this approach to the area of interventional pain management. We believe the use of the pain quality domains in interventional pain management routine might improve patient safety and have economic implications. The following is the clinical primer that best demonstrates our position: A 21-year-old woman was admitted to the hospital because of a headache. She reported severe, 8 out of 10 frontal headaches, accompanied by nausea and photophobia, and was referred to pain management service for a postdural puncture headache (PDPH) blood patch. It is a typical example of the clinical settings when a pain specialist was called to perform a routine pain management intervention on the basis of a patient’s pain score only, without consideration of the domains of qualities of pain. However, on an extended interview, the patient reported her headache to be multifactorial, with her pain score being combined with different characteristics of pain. Specifically, there were migraines (paroxysmal+ deep pain domains), chronic sinusitis (deep pain domain), and acute respiratory virus infection (superficial pain), all according to the PQAS factor analysis classification, and a new pain that was positional and mechanical (the domain yet to be defined). This pain with new qualities was likely associated with PDPH. The following day, the patient felt well after conservative management and she was discharged home with mild residual headache. This clinical primer demonstrates the importance of use of pain score quality assessment domains in addition to traditional numerical pain scores. If the intervention (the epidural blood patch that is a standard of care for PDPH) had been performed on this patient as requested by the Emergency Department services to correct the spinal tap complication, it is unlikely that it would have provided any substantial relief. It would have exposed the patient to known risks, such as a worsened headache and infection, and unjustified costs. We encourage the conducting of PQAS factor analysis for the interventional pain management patient populations and its clinical settings. The domains that were discovered by the authors and new domains to be found might serve as important check points of patient safety, not only for pharmacologic, but also for interventional pain management.
Risk Estimation of Type 2 Diabetes and Dietary Habits among Adult Saudi Non-diabetics in Central Saudi Arabia

Background: International Diabetes Federation ranked Saudi Arabia on third among the top 10 countries for prevalence of diabetes in 2010. Identifying people those are at increased risk for diabetes, followed by blood glucose testing to establish the diagnosis, and are considered to be an appropriate way of dealing with this problem. Objectives and methods: This cross-sectional study was conducted for the first time in Saudi Arabia to estimate the 10-years risk of developing type 2 diabetes using the Finnish Diabetes Risk Score and to investigate the dietary habits in such individuals among the Saudi non-diabetic population from July 2009 to March 2010. A total of 2007 Saudi citizens from all 11 provinces of Al-Qassim region were assessed using combined pre-piloted questionnaires. Statistical analysis was done utilizing SPSS version 13.0. Results: The gender ratio of the study participants was 1.6 male: 1.0 female. The mean (SD) age was 26.6 (10.2) years. The mean (SD) weight and height for males were 75.7 (19.6) kg and 169.4 (30.1) cm and for females were 64.4 (17.8) kg and 157.2 (10.4) respectively. Males had significantly higher body weight (kg), height (cm), and waist circumstance (cm) as compared to females (p <0.05). Our findings estimated that more than one-fourth of Saudi non-diabetics were found to be at moderate (one in six), high (one in three), and very high (one in two) risk to develop type 2 diabetes within 10 years. Majority of them were overweight and obese (36.8% and 60% respectively). More than ninety percent were found to have very limited physical activity with poor dietary habits. Conclusion: This study provides insight into progression and onset of type 2 diabetes in Saudi non-diabetic population within next 10 years using FINDRISC. The population at risk characterized by the sedentary activities, unhealthy dietary habits, obesity, and central obesity. Our findings suggest the need for urgent efforts to increase the level of physical activity, minimize sedentary lifestyle, and to improve the pattern of dietary habits especially among the population at risk in Saudi general population.
Back Muscle Activation Patterns in Chronic Low Back Pain During Walking: A “Guarding” Hypothesis

Objectives:To investigate whether patients with chronic low back pain (CLBP) show “guarded” movements during walking. It is hypothesized that guarding will be reflected by increased lumbar muscle activity during all periods of stride and secondary, relatively lesser relaxation during periods of swing compared with double support. Furthermore, it is hypothesized that higher levels of perceived fear and disability are related to increased muscle activity and less relative relaxation. Materials and Methods:In a cross-sectional study 63 patients with CLBP and 33 healthy controls walked on a treadmill at 3.8 km/h. Surface electromyography (sEMG) data of the erector spinae were obtained and smoothed rectified sEMG (SRE) values were calculated per period of swing and double support. The ratio of SRE values in swing to double support was used as a measure of relative relaxation (SRE ratio). In addition, the relationship between SRE values, the Roland Morris Disability Questionnaire, and the Tampa Scale for Kinesiophobia was analyzed in patients with CLBP. Results:Mean SRE values were significantly higher in patients with CLBP than in controls both during periods of double support and swing. SRE ratios were not significantly different between groups. Results showed no influence of disability or fear of movement on either SRE values or ratios. Discussion:In patients with CLBP, increased lumbar muscle activity during all periods of stride, with comparable alteration between swing and double support, suggests difficulties with total muscle relaxation. On the basis of this evaluation, it is concluded that patients with CLBP show a guarding mechanism during walking. No relationship is found between perceived fear, disability, and muscle activity.
Evaluación Morfométrica Directa de la Asimetría Condilar sobre Mandíbulas Humanas

La asimetria condilar (AC) es una alteracion morfologica estructural considerada un importante factor de riesgo para los trastornos de la articulacion temporomandibular. Diversas tecnicas evaluan la AC, principalmente basadas en mediciones sobre radiografias panoramicas, dado su amplio uso. Sin embargo, los metodos sobre radiografias no son muy sensibles por la magnificacion, distorsion, superposicion de estructuras y posicionamiento mandibular. El objetivo de este estudio fue determinar los valores reales de los indices de asimetria condilar para una muestra normal con medicion directa sobre mandibulas humanas. Se utilizaron 30 mandibulas humanas adultas secas pertenecientes a poblacion chilena, y la asimetria condilar fue evaluada las tecnicas de Habets y de Kjellberg, y se realizaron los analisis descriptivos de los valores promedios, desviacion estandar, minimo y maximo y los indices de asimetria/simetria de cada metodo. Segun el indice de asimetria condilar de Habets 7 casos (un 23,3%) mostraron valores superiores a un indice de 3% de asimetria, con un rango entre 3,64 y 27,26%. Los parametros morfologicos del lado derecho e izquierdo no mostraron diferencias significativas (p < 0,05). Segun el indice de simetria de Kjellberg, 19 casos (63,3%) mostraron valores inferiores al 93% y fueron clasificados como asimetricos. Los parametros morfologicos del lado derecho e izquierdo tampoco mostraron diferencias significativas. Al comparar las asimetrias reportadas con ambos metodos, solo en 4 casos hubo una coincidencia de diagnostico. Al eliminar factores de distorsion y angulacion en las mediciones realizadas, se confirma la existencia de asimetria vertical entre los condilos mandibulares del lado derecho e izquierdo, y por otra parte, es evidente que hay diferencias en los valores de asimetria debido a los diferentes metodos utilizados. Sin embargo, todavia no esta claro que la asimetria condilar puede considerarse fisiologica.
The effect of deydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life

Dehydroepiandrosterone (DHEA), an androgenic steroid hormone, exhibits an age-related decline. Perimenopausal women have only approximately 50% of peak DHEA levels. Despite limited scientific data, DHEA has gained recognition as a dietary supplement to reduce the symptoms of aging and improve well-being. This randomized, double-blind placebo-controlled trial examined the effects of 50 mg/day of oral DHEA supplementation, for 3 months, on 60 perimenopausal women with complaints of altered mood and well-being. Changes in the serum endocrine profile of women in the DHEA group were significantly greater than the placebo group, including a 242% [95% confidence interval (CI) +60.1, +423.9] increase in DHEAS, a 94.8% (95% CI +34.2, +155.4) increase in testosterone, and a 13.2% (95% CI− 27.88, +0.5) decline in cortisol compared to baseline. Women receiving DHEA had a 10.1% (95% CI −15.0, −5.1) decline in high-density lipoprotein and an 18.1% (95% CI −32.2, −3.9) decline in Lp(a) from baseline, but these declines .
Acute alveolitis following infliximab therapy for psoriasis

Infliximab is a high‐affinity recombinant chimeric immunoglobulin‐1 monoclonal antibody directed against tumour necrosis factor‐alpha. It is used to treat a range of inflammatory disorders including psoriatic joint and skin changes. Acute interstitial lung disease is a rare but potentially fatal complication of therapy. We report the case of a 67‐year‐old man with severe psoriasis who presented with acute alveolitis shortly after his third infusion of infliximab. The infliximab was discontinued and investigations did not reveal an infective cause. His respiratory signs and symptoms improved quickly with corticosteroid therapy. Clinicians should be aware of this uncommon but potentially serious complication.
Challenges, Coping Strategies, and Unmet Needs of Families with a Child with Autism Spectrum Disorder in Goa, India

Autism Spectrum Disorders (ASD) are increasingly recognized in developing countries like India. However, little is known about the experiences of parents raising a child with ASD. This study aimed to describe the experiences of families in Goa, India with a view to understanding the unmet needs of families raising a child with ASD. Twenty in‐depth interviews and nine focus group discussions were carried out with families of children with ASD and key community stakeholders such as special educators, teachers, and parents of typically developing children. This qualitative data was triangulated to explore the experiences, life impact, and unmet needs of raising a child with ASD. Key findings suggest that raising a child with ASD puts a tremendous strain on families due to competing commitments, often leading to initial social withdrawal with later reintegration into social networks. Second, the impact is multidimensional, involving the personal sphere but also extending into the wider community with negative experiences of discrimination. Third, parents actively respond to these challenges through a range of approaches with help from existing and new social support networks and health care providers. Fourth, professionals from the health, education, and religious sectors have a low awareness of the unique needs of families living with ASD which leads to a considerable economic and emotional burden on families. Finally, as a consequence of these experiences, several unmet needs can be identified, notably for supporting increasingly isolated families and the limited access to multidisciplinary evidence‐based services for ASD. Autism Res 2012, 5: 190–200. © 2012 International Society for Autism Research, Wiley Periodicals, Inc.
Prediction of virologic response in difficult-to-treat chronic hepatitis C patients during high-dose interferon induction therapy

Objective. To determine (i) whether early viral kinetics or other markers during a modified treatment regimen are predictors of treatment outcome and (ii) whether fast responders can be treated for 24 weeks, without compromising the sustained virologic response (SVR) rate. Material and methods. One hundred “difficult-to-treat” chronic hepatitis C patients (46 previous non-responders/relapsers (any genotype), 54 treatment-naive patients genotypes 1 and 4) were treated with triple antiviral induction therapy: amantadine hydrochloride and ribavirin, combined with 6 weeks interferon alfa-2b induction (weeks 1–2: 18 MU/day, weeks 3–4: 9 MU/day, weeks 5–6: 6 MU/day), thereafter combined with weekly peginterferon alfa-2b. Fast responders (≥3 log10 HCV RNA decline at week 4) were randomized to 24 or 48 weeks. Slow responders (<3 log10 HCV RNA decline at week 4) were treated for 48 weeks. Treatment was stopped in patients with detectable HCV RNA at week 24. Results. Thirty-six patients achieved SVR: 28 of 60 fast responders (47%) versus 8 of 32 slow responders (25%, p<0.05). Relapse rates among fast responders treated for 24 or 48 weeks were 27% and 20%, respectively (p=NS). SVR in fast responders was independent of baseline HCV RNA ≥ or <600,000 IU/mL. All treatment-naive patients with HCV RNA <5 IU/mL at week 1 or 2 achieved SVR; all treatment-naive patients with HCV RNA ≥5 IU/mL at week 16 became non-SVR. In previous non-responders/relapsers, the predictive value for SVR was 83% if HCV RNA was <5 IU/mL at week 2; all previous non-responders/relapsers with HCV RNA ≥5 IU/mL at week 8 became non-SVR. Conclusions. With high-dose interferon induction, SVR and non-SVR can be predicted reliably within 16 weeks. Fast responders can be treated for 24 weeks, and SVR is independent of baseline viral load in fast responders.
Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: A nationwide study

Objective. Autoimmune hepatitis (AIH) is a chronic liver disease, which if untreated can lead to cirrhosis and hepatic failure. The aim of the study was to investigate the incidence, prevalence, diagnostic tradition and clinical initial presentation of AIH. Material and methods. Analyses were performed in 473 patients identified as having probable or definite AIH. Results. The incidence of AIH was 0.85/100,000 (95% CI 0.69–1.01) inhabitants, which is somewhat lower than reported previously. The point prevalence amounted to 10.7/100,000 (95% CI 8.8–13.1), and 76% of the cases were females. The age-related incidence curve was bimodal but men were found to have only one incidence peak in the late teens, whereas women had a peak after menopause. AIH was presented as a spectrum of clinical settings from detected “en passant” to acute liver failure. Almost 30% of patients already had liver cirrhosis at diagnosis. Autoantibodies indicative of AIH type 1 were found in 79% of cases. Other concomitant autoimmune diseases were frequently found (49%). Conclusions. The incidence and prevalence figures confirm that AIH is a fairly uncommon disease in the Swedish population. Symptoms at presentation were unspecific, but almost half of the patients were jaundiced, with around 30% having liver cirrhosis. The majority of Swedish AIH patients had AIH type 1.
Improvement in Social Deficits in Autism Spectrum Disorders Using a Theatre‐Based, Peer‐Mediated Intervention

Social Emotional NeuroScience Endocrinology Theatre is a novel intervention program aimed at improving reciprocal social interaction in youth with autism spectrum disorder (ASD) using behavioral strategies and theatrical techniques in a peer‐mediated model. Previous research using a 3‐month model showed improvement in face perception, social interaction, and reductions in stress. The current study assessed a 2‐week summer camp model. Typically developing peers were trained and paired with ASD youth (8–17 years). Social perception and interaction skills were measured before and after treatment using neuropsychological and parental measures. Behavioral coding by reliable, independent raters was conducted within the treatment context (theatre) and outside the setting (playground). Salivary cortisol levels to assess physiological arousal were measured across contexts (home, theatre, and playground). A pretest–posttest design for within‐group comparisons was used, and prespecified pairwise comparisons were achieved using a nonparametric Wilcoxon signed‐rank test. Significant differences were observed in face processing, social awareness, and social cognition (P < 0.05). Duration of interaction with familiar peers increased significantly over the course of treatment (P < 0.05), while engagement with novel peers outside the treatment setting remained stable. Cortisol levels rose on the first day of camp compared with home values yet declined by the end of treatment and further reduced during posttreatment play with peers. Results corroborate previous findings that the peer‐mediated theatre program contributes to improvement in core social deficits in ASD using a short‐term, summer camp treatment model. Future studies will explore treatment length and peer familiarity to optimize and generalize gains. Autism Res 2014,7: 4–16. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
A Multi-institutional Study Analyzing Effect of Prophylactic Medication for Prevention of Opioid-induced Gastrointestinal Dysfunction

Objectives:The aim of this study was to evaluate the effectiveness of prophylactic treatment with laxatives and antiemetics on the incidence of gastrointestinal adverse reactions such as constipation, nausea and vomiting in cancer patients who received oral opioid analgesics for the first time. Methods:A multi-institutional retrospective study was carried out, in which 619 eligible hospitalized patients receiving oral opioid analgesics for cancer pain were enrolled from 35 medical institutions. The primary endpoint was the incidence of opioid-induced side effects in patients receiving prophylactic medication. Odds ratios of the incidence of adverse reactions in the absence or presence of premedication obtained from several institutions were subjected to a meta-analysis. Results:Among 619 patients, the incidence of constipation was significantly lower in patients receiving laxatives, including magnesium oxide, as premedication than in those without them (34% vs. 55%, odds ratio=0.432, 95% confidence interval=0.300-0.622, P<0.001). However, the incidence of nausea or vomiting was similar regardless of prophylactic medication with dopamine D2 blockers. The results of the meta-analysis revealed that prophylactic laxatives significantly reduced the incidence of constipation (overall odds ratio=0.469, 95% confidence interval=0.231-0.955, P=0.037), whereas dopamine D2 blockers were not effective in preventing opioid-induced nausea or vomiting. Discussion:We showed evidence for the effectiveness of premedication with laxatives for prevention of opioid-induced constipation. However, premedication with dopamine D2 blockers was not sufficient to prevent nausea or vomiting.
Nursing workforce in very remote Australia, characteristics and key issues.

OBJECTIVE To describe the nursing workforce in very remote Australia, characteristics and key issues. METHODS Data were collected from four main sources: the refined CRANAplus database of remote health facilities; the 2006 census which provided population and percentage of Indigenous people in communities in very remote Australia; a national survey on occupational stress among nurses and an earlier study into violence and remote area nurses conducted in 1995. A descriptive analysis of the data was conducted. SETTING Health facilities in very remote Australia. RESULTS The registered nursing workforce in very remote Australia is mostly female (89%) and ageing, with 40.2% 50 years or over, compared to 33% nationally. Many (43%) are in remote Indigenous communities. Over the last decade, there has been a significant decrease in registered nurses with midwifery qualifications (55%) and in child health nurses (39%) in very remote Australia. Only 5% have postgraduate qualifications in remote health practice. CONCLUSION The nursing workforce in very remote areas of Australia is in trouble. The workforce is ageing, the numbers of nurses per population has fallen and the numbers of midwives and child health nurses have dropped significantly over the last 15 years. As many of these nurses work in Indigenous communities, if these trends continue it is likely to have a negative effect on 'closing the gap' in Indigenous health outcomes.