Miracle-dz/UniFAR-FTUs huggingface dataset:
Factores de virulencia en cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda en Cuba

RESUMEN O BJETIVO : se realizo un estudio en cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda en Cuba, paraconocer la expresion fenotipica de la citotoxina y la enterotoxina como factores de virulencia. M ETODOS : se investigaron46 cepas ( A. hydrophila, A. veronii biovar sobria, A. caviae, A. veronii biovar veronii y Aeromonas spp.) , aisladas de heces depacientes con enfermedad diarreica aguda, en el periodo comprendido entre 2005 y 2006. Todas las cepas tenian identificado supatron de susceptibilidad antimicrobiana. Se comprobo la expresion fenotipica de la citotoxina y la enterotoxina en la lineacelular Vero. R ESULTADOS : el estudio demostro que 91,31 % de las cepas mostraron actividad citotoxica y 43,48 % actividadenterotoxica. De las cepas multirresistentes, 93,75 % presento al menos un factor de virulencia estudiado. C ONCLUSIONES : losresultados demostraron que los 2 factores de virulencia investigados estuvieron presentes en las cepas estudiadas, contribuyendoasi a los multiples esfuerzos que se realizan para conocer los mecanismos de enteropatogenicidad de este genero bacteriano.
The Hypothalamic-Pituitary-Adrenal Axis in Depression

The hypothalamic-pituitary-adrenal (HPA) axis is the core endocrine stress system in humans. While corticotropin-releasing hormone (CRH) and vasopressin are the major secretagogue peptides of the HPA axis/stress system, glucocorticoids play a pivotal feedback role in the regulation of the HPA axis. Both the peak and the nadir in circulating cortisol concentrations are elevated in depression, but overall there is little reduction in amplitude of the circadian rhythm and neither is its timing signifycantly shifted. CRH has been administered following pretreatment with dexamethasone, which results in augmented adreno corticotropic hormone and cortisol responses in depressed patients compared to normal controls. Studies have also shown that women who were sexually or physically abused in childhood exhibit a markedly enhanced activation of the HPA axis. To date, most large-scale studies of compounds targeting the HPA axis have produced disappointing results. Whether or not the HPA axis is an appropriate target for novel antidepressants has yet to be convincingly demonstrated.
Graft‐derived macrophage migration inhibitory factor correlates with hepatocellular injury in patients undergoing liver transplantation

Experimental studies suggest that macrophage migration inhibitory factor (MIF) mediates ischemia/reperfusion injury during liver transplantation. This study assessed whether human liver grafts release MIF during preservation, and whether the release of MIF is proportional to the extent of hepatocellular injury. Additionally, the association between MIF and early allograft dysfunction (EAD) after liver transplantation was evaluated. Concentrations of MIF, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) were measured in effluents of 38 liver grafts, and in serum of recipients. Concentrations of MIF in the effluent were greater than those in the recipients’ serum before and after reperfusion (58 [interquartile range, IQR:23‐79] μg/mL vs 0.06 [IQR:0.03‐0.07] μg/mL and 1.3 [IQR:0.7‐1.8] μg/mL, respectively; both P<.001). Effluent MIF concentrations correlated with effluent concentrations of the cell injury markers ALT (R=.51, P<.01), AST (R=.51, P<.01), CK (R=.45, P=.01), and LDH (R=.56, P<.01). Patients who developed EAD had greater MIF concentrations in effluent and serum 10 minutes after reperfusion than patients without EAD (Effluent: 80 [IQR:63‐118] μg/mL vs 36 [IQR:20‐70] μg/mL, P=.02; Serum: 1.7 [IQR:1.2‐2.5] μg/mL vs 1.1 [IQR:0.6‐1.7] μg/mL, P<.001).
Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial.

IMPORTANCE Evidence supporting the choice of intravenous colloid vs crystalloid solutions for management of hypovolemic shock remains unclear. OBJECTIVE To test whether use of colloids compared with crystalloids for fluid resuscitation alters mortality in patients admitted to the intensive care unit (ICU) with hypovolemic shock. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial stratified by case mix (sepsis, trauma, or hypovolemic shock without sepsis or trauma). Therapy in the Colloids Versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was open label but outcome assessment was blinded to treatment assignment. Recruitment began in February 2003 and ended in August 2012 of 2857 sequential ICU patients treated at 57 ICUs in France, Belgium, North Africa, and Canada; follow-up ended in November 2012. INTERVENTIONS Colloids (n = 1414; gelatins, dextrans, hydroxyethyl starches, or 4% or 20% of albumin) or crystalloids (n = 1443; isotonic or hypertonic saline or Ringer lactate solution) for all fluid interventions other than fluid maintenance throughout the ICU stay. MAIN OUTCOMES AND MEASURES The primary outcome was death within 28 days. Secondary outcomes included 90-day mortality; and days alive and not receiving renal replacement therapy, mechanical ventilation, or vasopressor therapy. RESULTS Within 28 days, there were 359 deaths (25.4%) in colloids group vs 390 deaths (27.0%) in crystalloids group (relative risk [RR], 0.96 [95% CI, 0.88 to 1.04]; P = .26). Within 90 days, there were 434 deaths (30.7%) in colloids group vs 493 deaths (34.2%) in crystalloids group (RR, 0.92 [95% CI, 0.86 to 0.99]; P = .03). Renal replacement therapy was used in 156 (11.0%) in colloids group vs 181 (12.5%) in crystalloids group (RR, 0.93 [95% CI, 0.83 to 1.03]; P = .19). There were more days alive without mechanical ventilation in the colloids group vs the crystalloids group by 7 days (mean: 2.1 vs 1.8 days, respectively; mean difference, 0.30 [95% CI, 0.09 to 0.48] days; P = .01) and by 28 days (mean: 14.6 vs 13.5 days; mean difference, 1.10 [95% CI, 0.14 to 2.06] days; P = .01) and alive without vasopressor therapy by 7 days (mean: 5.0 vs 4.7 days; mean difference, 0.30 [95% CI, -0.03 to 0.50] days; P = .04) and by 28 days (mean: 16.2 vs 15.2 days; mean difference, 1.04 [95% CI, -0.04 to 2.10] days; P = .03). CONCLUSIONS AND RELEVANCE Among ICU patients with hypovolemia, the use of colloids vs crystalloids did not result in a significant difference in 28-day mortality. Although 90-day mortality was lower among patients receiving colloids, this finding should be considered exploratory and requires further study before reaching conclusions about efficacy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00318942.
Can mobile health technologies transform health care?

There is substantial enthusiasm for the concept of mobile health (mHealth), a broad term typically used to describe the use of mobile telecommunication technologies for the delivery of health care and in support of wellness. In 2011, US Secretary of Health and Human Services Kathleen Sebelius referred to mHealth as “the biggest technology breakthrough of our time” and maintained that its use would “address our greatest national challenge. ”1 This level of exuberance for mHealth is driven by the convergence of 3 powerful forces. First is the unsustainability of current health care spending and the recognition of the need for disruptive solutions. Second is the rapid and ongoing growth in wireless connectivity— there now are more than 3.2 billion unique mobile users worldwide—and the remarkable capability this brings for the bidirectional instantaneous transfer of information. Third is the need for more precise and individualized medicine; a refinement in phenotypes that mandates novel, personal data streams well beyond the occasional vital sign or laboratory data available through intermittent clinic visits. But there are multiple obstacles to the acceptance and widespread utilization of mHealth technologies. Foremost are the complexities of the health care system, especially the current drivers of reimbursement. In addition, clinicians are concerned about the possible further weakening of the patient-physician relationship and the possible increase in their workload. Also, and somewhat paradoxically, the unbridled enthusiasm of the mHealth technology development community, coupled with consumers’ appetite for alternative health and wellness resources, can create challenges to the appropriate use and validation of mHealth technologies. For example, there are tens of thousands (estimates vary between 30 000 to more than 90 000) health care– related apps available for download, in contrast to the US Food and Drug Administration estimate of the approximately 100 it has reviewed. This lack of oversight is worrisome and contributes to the increasingly high likelihood of useless and possibly even dangerous apps being downloaded by unsuspecting consumers.2 When such a high level of interest and promise coexists with such a paucity of evidence, there is potential for hype to dominate the discussion around mHealth. To move beyond that, in this Viewpoint we offer examples of how mHealth technologies can transform health care by addressing inefficient practices and challenges faced by consumers and clinicians in the current system.
Manifestation okkulter Malignome als rheumatologische Systemerkrankung

Zusammenfassung In der Differenzialdiagnostik entzündlich rheumatischer Systemerkrankungen müssen Malignome stets berücksichtigt werden. Anhand der fünf vorgestellten Fällen wird demonstriert, wie trotz umfassender Vordiagnostik ein Malignom zunächst nicht erkannt und fälschlich eine rheumatologische Diagnose gestellt wird. Die Vordiagnosen Sklerodermie, Sjögren-Syndrom mit Neuropathie, Polymyalgia rheumatika und rheumatische Serositis wurden widerlegt zu Gunsten eines kleinzelligen Bronchialkarzinoms, eines Uteruskarzinoms, eines Morbus Hodgkin, eines Mesothelioms und eines malignen fibrösen Histiozytoms.
Rituximab, B-lymphocyte depletion, and beta-cell function.

n engl j med 362;8 nejm.org february 25, 2010 761 Lunardi C, Bason C, Navone R, et al. Systemic sclerosis im1. munoglobulin G autoantibodies bind the human cytomegalovirus late protein UL94 and induce apoptosis in human endothelial cells. Nat Med 2000;6:1183-6. Bason C, Corrocher R, Lunardi C, et al. Interaction of anti2. bodies against cytomegalovirus with heat-shock protein 60 in pathogenesis of atherosclerosis. Lancet 2003;362:1971-7. Chari ST, Longnecker DS, Klopper G. The diagnosis of auto3. immune pancreatitis: a Western perspective. Pancreas 2009;38: 846-8. Zamboni G, Lüttges J, Capelli P, et al. Histopathological fea4. tures of diagnostic and clinical relevance in autoimmune pancreatitis: a study of 53 resection specimens and 9 biopsy specimens. Virchows Arch 2004;445:552-63.
Mechanisms of Ca2+-Triggered Arrhythmias

The first evidence that altered intracellular Ca2+ homeostasis is causally involved in ventricular tachyarrhythmias was revealed by investigations of the pathophysiology of digitalis intoxication (Ferrier et al., 1973; Rosen et al., 1973). More recently, spontaneous Ca2+ release from the sarcoplasmic reticulum (SR) through the cardiac ryanodine receptor (RyR2) has been found to play a fundamental role in the generation of lethal arrhythmias. Such arrhythmias occur in both acquired forms of cardiac diseases (e.g., heart failure, atrial fibrillation) and in a number of congenital arrhythmia syndromes associated with mutations of RyR2 or calsequestrin1, such as cathecholaminergic polymorphic ventricular tachycardia (CPVT2). The currently incomplete understanding of the mechanism underlying disrupted Ca2+ regulation in arrhythmogenesis in heart failure has led scientists to the consideration that CPVT as a simplified human and experimental model may help to clarify the disruption of Ca2+ homeostasis as a substrate for triggered activity (Priori & Napolitano, 2005). Therefore, a better understanding of the similarities and differences between the mechanisms underlying triggered arrhythmias in acquired and inherited cardiac diseases, holds the promise to develop new specific diagnostic and therapeutic approaches for effective treatment of defective ion handling.
Proximal Hamstring Tendinopathy—Overview of the Problem With Emphasis on the Surgical Treatment

Proximal hamstring tendinopathy is a remarkable clinical problem that expresses itself by lower gluteal pain, especially during running at a faster pace or sprinting, causing impaired athletic performance. This chronic disorder affects athletes and recreational exercisers of various sports activities, but it has been especially seen in sprinters and middle- and long-distance runners. However, it can also affect inactive people. It is known to be difficult to treat, often requiring long rehabilitation times. If conservative treatment is not successful, then surgery relieves pain in most cases. This article overviews the problem of proximal hamstring tendinopathy focusing on the surgical treatment and surgical technique.
Identifying Barriers to Healthcare to Reduce Health Disparity in Zuni Indians Using Focus Group Conducted by Community Health Workers

The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo.
Public awareness, perception, and use of online physician rating sites.

Patients are increasingly turning to online physician ratings, just as they have sought ratings for other products and services. Much of what is known about these sites comes from studies of the ratings left on them.1 Little is known about the public’s awareness and use of online physician ratings, and whether these sites influence decisions about selecting a physician.
Análisis clínico-epidemiológico de la portación intestinal de enterococos resistentes a vancomicina en una unidad de terapia intensiva

SUMMARY Clinical and epidemiologic analysis of intestinal tract colonization with vancomycin-resistant enterococci in an intensive care unit. Intestinal tract colonization with vancomycin resistant enterococci (VRE) was studied during five months and 25 days. Out of 171 patients hospitalized in the intensive care unit, 124 (73%) were included in this study. Thirty five of them (28%) were recognized as colonized with VRE. VRE isolates (n = 35) were identified as Enterococcus faecium (n=18), Enterococcus gallinarum (n=16), and Enterococcus raffinosus (n=1). All of them were resistant to vancomycin (MIC90 = 512 µg/ml) and to teicoplanin (MIC90 = 32 µg/ml), having the vanA gene. By means of molecular methods a high homology was found among E. faecium and E. gallinarum isolates, respectively, suggesting their spread as a kind of outbreak. No significant differences in age or sex were found among colonized and non- colonized patients (p>0.05). On the other hand, the hospitalization time and the use of broad-spectrum antibiotics were associated with colonization. From this study we highlight the importance of enhancing all measures of control and prevention of hospital infections, carefully analyzing the empiric antimicrobial schemes, trying to reduce the hospital stage, and following the surveillance to evaluate the efficacy of such procedures.
Assessment of Diagnostic Testing to Guide the Surgical Management of Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by organizing throm‐ botic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. It is defined as precapillary PH as assessed by right heart catheterization (mean pulmonary arterial pressure, mPAP ≥ 25 mmHg with a pulmonary arterial occlusion pressure, (PAOP) ≤ 15 mmHg and pulmonary vascular resistance (PVR) > 3 wood units, in the presence of one or more mismatched segmental or larger perfusion defects by ventilation-perfusion lung scintigraphy, computerized tomogra‐ phy, and/or pulmonary angiography after at least 3 months of effective anticoagulation (Lang, 2010) (Table 1).
The Renin-Angiotensin System in the Eye

The renin-angiotensin system (RAS) is a phylogenetically old hormonal system which serves to control blood pressure, volume and electrolyte homeostasis. Apart from these main systemic effects, the RAS – when overactivated – is further involved in a broad spectrum of cardiovascular diseases ranging from arterial hypertension, atherosclerosis, and cardiac hypertrophy to diabetic or autoimmune nephropathy. Experimental data have provided strong evidence that a local RAS is also expressed in the eye, in particular in the retina and in retinal vessels, and that this ocular RAS is overactivated in diabetes, thus contributing to the pathogenesis of diabetic retinopathy. In this context, the ocular RAS promotes retinal damage by (a) direct effects of angiotensin II via the angiotensin AT1-receptor, and (b) bidirectional interaction with the ‘classical’ hyperglycemia-induced pathobiochemical pathways (generation of advanced glycation end products, increased polyol pathway flux, activation of protein kinase C, increased hexosamine pathway flux, overproduction of superoxide). The involvement of the RAS in the pathomechanisms underlying diabetic retinopathy suggests pharmacological RAS inhibition as a therapeutic option in this disease. Preclinical data in fact indicate that angiotensin-converting enzyme inhibitors and AT1 receptor blockers are able to confer retinoprotection, and this was further supported by recent clinical trials (EURODIAB, DIRECT).
Metabool syndroom bij de behandeling met clozapine

textabstractAbstract Metabolic syndrome during clozapine treatment Objective: To assess the prevalence of metabolic syndrome in inpatients with psychotic disorders treated with clozapine for at least one year. Design: Chronically admitted patients were screened on the use of clozapine and the presence of metabolic side effects. Methods: The Third Adult Treatment Panel was used tot assess metabolic syndrome. In addition, patient variables, dosage and plasma concentration of clozapine were recorded. Results: Included were 62 patients with a most prevalent diagnosis of schizophrenia. Mean duration of treatment with clozapine was 9.2 years. Metabolic syndrome was present in 60% of the patients and more frequent in cases with comedication of mood stabilizers. Conclusion: Metabolic syndrome is highly prevalent among patients treated with clozapine for psychotic disorders. Additional factors in the emergence of metabolic syndrome are: unhealthy life style, inactivity and comedication.
Interaction of clopidogrel and omeprazole.

To the Editor: The label for clopidogrel warns physicians to “avoid concomitant use of . strong or moderate CYP2C19 inhibitors. ” Such inhibitors (e.g., omeprazole) decrease the formation of the active metabolite of clopidogrel, the source of its antiplatelet effects. The results of the Clopidogrel and the Optimization of Gastrointestinal Events Trial (COGENT; ClinicalTrials.gov number, NCT00557921), described by Bhatt and colleagues1 in this issue of the Journal, have been interpreted as showing that the clopidogrel–omeprazole interaction is unimportant. The study, however, does not support that conclusion. Clopidogrel therapy reduces the rate of major cardiovascular events in patients with an acute .
Factores desencadenantes de estrés en pacientes ingresados en Cuidados Intensivos

Intensive care units have been considered stress generating areas. Knowing the causes why this happens will allow us to take specific measures to prevent or minimize it. This study has been performed with the aim to identify stress raising factors, as they are perceived by intensive care patients. The study has been performed in 49 patients most of whom were being attended in postoperatory control. The valuation of the degree of stress was performed using the "Scale of Environmental Stressors in Intensive Care" by Ballard in 1981, modified and adapted to our environment, with a result of 43 items distributed in six groups; Immobilization, Isolation, Deprivation of sleep, Time-spacial disorientation, Sensorial deprivation and overestimulation, and depersonalization and loss of autocontrol. The level of stress perceived by patients was low. The factors considered as most stressing were those related to physical aspects; presence of tubes in nose and mouth, impossibility to sleep and presence of noise, whereas those less stressing referred to Nursing attention. We conclude that patients perceive ICU as a little stressing place in spite of the excessive noise, remark the presence of invasive tubes and the difficulty to sleep as the most stressing factors, and in the same way, express a high degree of satisfaction about the attention received.
An experimental protocol for fertility preservation in prepubertal boys recently diagnosed with cancer: a report of acceptability and safety.

BACKGROUND Gonadal damage is a consequence of therapy for pediatric malignancies. Prepubertal males have no semen or mature spermatozoa, posing a challenge for fertility preservation. Testicular tissue cryopreservation is a potential option but is still experimental. We report on a pilot protocol that offered testicular biopsy cryopreservation to families of prepubertal boys with newly diagnosed malignancy. The aims were to determine the acceptability and safety of this procedure. METHODS Parents of prepubertal boys with diagnoses at highest risk for treatment-related gonadal damage were offered the option of testicular cryopreservation. Half of the biopsy was frozen for the subject's potential future use and the remainder used for research. Data on negative intraoperative and/or 7 day post-operative sequelae of testicular biopsies were assessed. Two to four weeks later, parents were asked to complete a questionnaire on factors influencing their decision to have the biopsy or not. RESULTS Since January 2008, 24 boys have met the eligibility criteria but three required immediate treatment and were excluded. Sixteen of 21 families (76%) consented to testicular biopsy, indicating the prospective acceptability of this option to parents of boys aged 3 months to 14 years; 14 underwent the procedure without any negative intra- or post-operative sequelae. Although the time at diagnosis is stressful, families can give thoughtful consideration to this option. Factors such as religion, finance, ethics and the experimental nature of cryopreservation did not play a major role in decision-making. CONCLUSIONS Parents of prepubertal boys with cancer are willing to pursue testicular tissue cryopreservation at diagnosis, and testicular biopsy caused no acute adverse effects.