Miracle-dz/UniFAR-FTUs huggingface dataset:
Blood pressure management in stroke

Purpose of review Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. Recent findings Hypotension and hypertension are correlated with poor outcome in acute ischemic stroke, but the effect of reducing or augmenting BP is unclear. In most cases, BP should be treated only when SBP is greater than 220 or greater than 180 in candidates for thrombolysis. There is a lack of evidence to support the choice of specific agents. Use of vasopressor drugs to treat hypotension in acute stroke should be limited to selective situations. In acute hemorrhagic stroke, SBP greater than 140 has been correlated with poor outcomes. Two recent studies report the safety and feasibility of early BP reduction in hemorrhagic stroke. Summary Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
A morphogenetic regulatory role for ethyl alcohol in Candida albicans

Regulation of morphogenesis through the production of chemical signalling molecules such as isoamyl alcohol, 2‐phenylethyl alcohol, 1‐dodecanol, E‐nerolidol and farnesol is reported in Candida albicans. The present study focuses on the effect of ethyl alcohol on C. albicans dimorphism and biofilm development. Ethyl alcohol inhibited germ tube formation induced by the four standard inducers in a concentration‐dependent manner. The germ tube inhibitory concentration (4%) did not have any effect on the growth and viability of C. albicans cells. Ethyl alcohol also inhibited the elongation of germ tubes. Four percentage of ethyl alcohol significantly inhibited biofilm development on polystyrene and silicone surfaces. We suggest a potential morphogenetic regulatory role for ethyl alcohol, which may influence dissemination, virulence and establishment of infection.
Hyperparathyroidism: An Unusual Cause of Acute Pancreatitis Detected by Endoscopic Ultrasound

A 45-year-old male, non-alcoholic and non-smoker, presented to us with acute pain abdomen and investigations revealed elevated serum amylase and lipase. Contrast enhanced computed tomography performed 5 days after the onset of pain revealed features of acute pancreatitis with peripancreatic fat stranding and less than 30% pancreatic necrosis (Fig. 1). His liver function tests, renal function tests, serum calcium and phosphate, lipid profile, and blood sugar were within normal limits. Ultrasound of the abdomen did not reveal any gall bladder stones. There was no history of drug intake prior to onset of abdominal pain. He was treated conservatively and his symptoms improved. He was discharged 10 days after admission and was planned for further etiological work up for acute pancreatitis. Endoscopic ultrasound (EUS) done 4 weeks later with a linear echoendoscope revealed enlarged pancreas with altered echotexture and no collection or pancreatic calcification was observed. The pancreatic duct was normal as was the gall bladder and common bile duct. On withdrawal of the scope, examination from the upper esophagus on the right side revealed a well-defined heterogeneously echotextured lesion that was located posterior to the inferior border of the thyroid lobe (Fig. 2). This lesion measured 1.4 cm in diameter, had small cystic spaces (Fig. 2) and there was no increased vascularity seen on power Doppler (Fig. 3). Repeat calcium levels were elevated (12.2 mg%; N <11 mg%) as was the serum intact parathormone (iPTH) levels (132 pg/ mL; N <60 pg/mL). The 99Tm sestamibi scan revealed increased uptake in the right inferior parathyroid gland. The patient underwent right inferior parathyroidectomy and the histopathological examination of the resected gland revealed parathyroid adenoma. He had an uneventful post-surgical course and is asymptomatic over a follow up period of 10 months. Hyperparathyroidism: An Unusual Cause of Acute Pancreatitis Detected by Endoscopic Ultrasound
Experiences With Beta-Adrenergic Blockade

* Director of the Cardio-Respiratory Laboratory. † Associate, Cardio-Respiratory Laboratory. ‡ Fellow, Cardio-Respiratory Laboratory, supported by the Connecticut State Heart Association and the Hartford Heart Association. 1 Propranolol (inderal) kindly supplied by A. Sahagian-Edwards, M.D., Ayerst Laboratories. The possible presence of a peripheral receptor mechanism was first suggested by J. N. Langley in his efforts to explain the action of curare on skeletal muscle in 1905 (1). One year later Sir Henry Dale suggested that sympathetic nervous activity was mediated via two different peripheral receptors, and in 1948 Ahlquist named these alpha and beta receptors, defined according to their response (2, 3). The alpha-adrenotropic receptor was defined as associated primarily with excitatory functions, particularly vasoconstriction, but did include an inhibitory intestinal relaxation action. The beta-adrenotropic receptor was defined as associated with most inhibitory functions, particularly vasodilatation, but did include the all important excitatory (inotropic) action un the myocardium. Over the years a number of agents capable of blocking both alphaand betaadrenergic responses have been found. It is not the purpose of this paper to enumerate the effects of these agents but rather to concentrate on our experiences with the adrenergic beta-receptor blocking agent, propranolol.1 Our attention was drawn to the beta-receptor blocking agents by a patient with severe chronic orthostatic hypotension. Luria, Miller and Kaplan had reported the successful treatment of two such cases with a beta blocker and
The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven®) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4; for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.
What is the role of the (1→3)‐β‐d‐glucan assay in the screening of patients undergoing autologous haematopoietic stem‐cell transplantation?

The aim of this study is to determine the clinical contribution of (1→3)‐β‐d‐glucan (BDG) screening in the case of patients undergoing autologous haematopoietic stem‐cell transplantation (HSCT). The records at our stem‐cell transplantation centre were reviewed to identify the patients who underwent autologous HSCT between April 2009 and December 2010. Patients were classified as having proven invasive aspergillosis (IA), probable IA, or possible IA on the basis of the criteria established by the European Organization for Research and Treatment of Cancer and Mycoses Study Group (independent of the BDG results). During the study period, the patients were screened for BDG twice a week from transplant (day 0) until engraftment. Three patients were diagnosed with probable IA and five were diagnosed with possible IA. A total of 354 serum samples from79 patients who met the study inclusion criteria were used for statistical analysis. At the cut‐off value of 80 pg ml−1, the sensitivity was 27.2% [95% confidence interval (CI); 7.3–60.6]; specificity, 94.4% (95% CI; 91.3–96.5); positive predictive value, 6.2%; and negative predictive, 93.7%. The clinical contribution of the BDG assay as a screening test was relatively limited in this cohort of patients undergoing autologous HSCT.
Regadenoson Injection

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I. X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I. X. , call The Formulary at 800–322–4349. The January 2009 monograph topics are on lacosamide, fesoterodine, C1 inhibitor (human), silodosin, and cethromycin. The DUE is on lacosamide.
Chronic disease management in primary care: Quality and outcomes

This is a good-practice orientated book that uses a problem-based learning (PBL) approach to address common chronic disease problems encountered in primary health care. It offers a format for primary health care teams based in General Practice to review and discuss current practice and agree how care might be improved in the light of what is the best available evidence. The first part of the book introduces the reader to the principles of problem-based learning and team learning. Following chapters cover a range of subjects familiar to primary care such as chronic heart disease, diabetes, medicines management, COPD and palliative care. It is also a useful resource for addressing the indicators and standards required by the Quality Outcomes Framework for General Practice. It is accompanied by a CD Rom that has PDF files of all the chapters. It has been written by and for General Practitioners and as such reflects a particular view and understanding of primary care. It does engage with the other members of the primary health care team but the assumptions and priorities of General Practice prevail. There is minimal discussion of how social care needs interface with health care needs or the contribution of other disciplines and approaches (e.g., case management) to the care of people with long term conditions outside the General Practice setting. The particular needs of older people and the impact of co-morbidity on treatment and approaches to care is not particularly well discussed. Nevertheless, for those working as Practice-based facilitators and involved in the education of GPs and medical students undertaking their primary care placements this is an accessible and useful text.
Evolutionary contributions to the study of human fertility

Demography, lacking an overarching theoretical framework of its own, has drawn on theories in many other social sciences to inform its analyses. The aim of this paper is to bring to the demographic community’s attention research in the evolutionary sciences on fertility, and to demonstrate that evolutionary theory can be another useful tool in the demographer’s toolkit. I first dispel some myths which impede the incorporation of evolutionary theory into demography: I make it clear that evolutionary explanations do not assume that all human behaviour is hardwired and functions to maximize genetic fitness; that they are able to explain variation in human behaviour; and that they are not necessarily alternatives to social science explanations. I then describe the diversity of work on fertility by evolutionary researchers, particularly human evolutionary ecologists and cultural evolutionists, and illustrate the usefulness of the evolutionary approach with examples of its application to age at first birth and the fertility transition.
Screening and Brief Intervention for Unhealthy Drug Use in Primary Care Settings: Randomized Clinical Trials Are Needed

The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.
Persistence on a Stress-challenge Task Before Initiating Buprenorphine Treatment Was Associated With Successful Transition From Opioid Use to Early Abstinence

Objectives:Lapse to opiate use after initiation of buprenorphine treatment is common and is a strong predictor of poor treatment retention and increased risk of long-term opiate use. Drug cues and situations or events associated with distress are known to provoke craving and increase risk for lapse. This study evaluated the predictive validity of a behavioral index of persistence during a stress challenge among opiate users identified as affectively vulnerable to lapse risk due to elevated depressive symptoms. Methods:Patients from an ongoing clinical trial (n = 48) completed a stress-challenge task before receiving their first dose of buprenorphine. Results:After controlling for levels of craving on their induction day, persistence on the stress-challenge task before initiating buprenorphine treatment was associated with successful transition to early abstinence, and lower rates of opiate use during the initial 3 months of buprenorphine treatment across antidepressant and placebo groups. Conclusions:Results from this preliminary study suggest the promise of laboratory-based behavioral paradigms in facilitating an understanding of important mechanisms of early lapse. Identifying individual behavioral responses to drug and stress cues before attempts at abstinence may facilitate delivery of adjunctive behavioral treatments to prevent early lapse.
The Synthetic Cannabinoid Withdrawal Syndrome

Background:Little is known about the effects of synthetic cannabinoids. There has been only one previous report of a withdrawal syndrome from synthetic cannabinoids. We report two cases of a withdrawal syndrome from prolonged habitual use of synthetic cannabinoids. Discussion:Withdrawal from delta-9-THC has been described as a syndrome of anxiety, myalgias, chills, and anorexia. Synthetic cannabinoids are potent than delta-9-THC and thus the withdrawal syndrome is similar but more severe; however the symptoms do not seem to improve with delta-9-THC. The differences in presentation could be due to the fact that synthetic products may contain several heterogeneous compounds, including amphetamine-like substances. Conclusions:The acute withdrawal syndrome appears to be characterized mainly by anxiety and tachycardia in the absence of any neurological findings or electrolyte disturbances. We describe two patients with symptoms consistent with withdrawal presumably due to synthetic cannabinoid use. The most appropriate treatment for such patients remains unknown, however benzodiazepines are a reasonable first line approach and quetiapine may have some efficacy.
The uptake of health checks for adults with learning disabilities in England: 2008/9‐2011/12

Purpose – The purpose of this paper is to report on trends in the provision of health checks for adults with learning disabilities over the period 2008/9‐2011/12.Design/methodology/approach – Analysis of data collected by the Information Centre for Health and Social Care from Primary Care Trusts in England.Findings – Over the four years the percentage of eligible adults receiving a health check has consistently increased and now stands at 53 percent. There remain marked variations across both Strategic Health Authority areas and Primary Care Trusts.Research limitations/implications – There remains considerable distance to travel before minimum standards of satisfactory performance in the provision of health checks are achieved nationally. It is important to consider possible obstacles to provision and how these can be addressed to improve uptake further.Originality/value – The paper examines consistency of good and poor performance by local areas over time. It is clear that significant improvements are re.
The comparison of antioxidative/oxidative profile in colostrum, milk and blood of early post-partum cows during their first and second lactation.

The aim of the study was to compare antioxidative/oxidative profile in blood, colostrum and milk of early post-partum cows during their first and second lactation. A total of 19 healthy, primiparous cows were included in experiment and samples were collected during 2 years from the same animals immediately after parturition, 24, 48 h as well as 6 and 12 days later. All parameters including the activity of glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), the content of vitamin A, C as well as the contents of products of lipid and protein peroxidation were determined by the use of spectrophotometric methods. Comparing the profile within lactation, TAC and GSH-Px activity in blood showed decreasing trends, while parameters of lipid and protein peroxidation fluctuated. All examined parameters in colostrum and milk except from intermediates of lipid peroxidation exhibited increasing trends. These results which showed dynamic changes of antioxidative/oxidative profile not only in blood but also in colostrum/milk within examined period of time suggested appropriate answer of organism to current challenge. Moreover, not uniform but detectable changes between first and second lactation suggested that two consecutive lactations are not the same. Comparing first and second lactation, TAC and parameters of lipid and protein peroxidation in blood showed increasing tendency in second as first lactation while GSH-Px activity was opposite. The content of antioxidative vitamins and SH groups in colostrum/milk showed increasing tendency in second as first lactation, while TAC and content of end products of lipid peroxidation showed opposite trend, and GSH-Px together with intermediates of lipid peroxidation remained stable. Molecular and biochemical background for it require further elucidation.
Aiming for remission in adults with attention-deficit/hyperactivity disorder: The primary care goal

Abstract Attention-deficit/hyperactivity disorder (ADHD) is often undiagnosed and undertreated in adults, resulting in wide-ranging problems and functional deficits in patients’ lives. In addition, psychiatric comorbidities unrelated to symptom severity may be present. However, effective treatment that can alleviate symptoms and bring about meaningful improvements in functionality is available. Primary care providers can play a crucial role in recognizing and diagnosing ADHD, initiating and monitoring treatment, and obtaining consultations or arranging referrals when necessary, all with the goal of achieving and maintaining remission. Fulfillment of this role requires a practical understanding of the diverse clinical manifestations of ADHD in patients stratified by age and sex, and familiarity with current treatment guidelines. Although there is no absolute consensus on the criteria by which remission is defined, treatment response may be guided by objective ratings of global symptom severity and patients’ self-reports of changes in their ability to cope with routine daily tasks, academic and vocational responsibilities, and social relationships. Although there has been much research into the genetic and neurophysiologic basis of ADHD, it is more important for primary care providers to appreciate that ADHD is a chronic condition requiring lifelong follow-up and that clinical presentation and response to treatment can vary widely among patients and over time in the same patients. Such variability makes the management of ADHD challenging, but the opportunity to bring about dramatic improvement in patients’ lives makes it imperative for primary care providers to be competent in this area. This review provides primary care clinicians with a practical definition of remission in adults with ADHD, to emphasize that symptom reduction does not necessarily mean intact functionality, and to suggest a multidisciplinary approach aimed at achieving the greatest possible reduction of symptoms and normalization of functionality.