Miracle-dz/UniFAR-FTUs huggingface dataset:
Self-Measured Blood Pressure Monitoring in the Management of Hypertension

BACKGROUND Clinical guidelines recommend that adults with hypertension self-monitor their blood pressure (BP). PURPOSE To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. DATA SOURCES MEDLINE (inception to 8 February 2013) and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter 2012). STUDY SELECTION 52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension. DATA EXTRACTION Data on population, interventions, BP, other outcomes, and study method were extracted. Random-effects model meta-analyses were done. DATA SYNTHESIS For SMBP monitoring alone versus usual care (26 comparisons), moderate-strength evidence supports a lower BP with SMBP monitoring at 6 months (summary net difference, -3.9 mm Hg and -2.4 mm Hg for systolic BP and diastolic BP) but not at 12 months. For SMBP monitoring plus additional support versus usual care (25 comparisons), high-strength evidence supports a lower BP with use of SMBP monitoring, ranging from -3.4 to -8.9 mm Hg for systolic BP and from -1.9 to -4.4 mm Hg for diastolic BP, at 12 months in good-quality studies. For SMBP monitoring plus additional support versus SMBP monitoring alone or with less intense additional support (13 comparisons), low-strength evidence fails to support a difference. Across all comparisons, evidence for clinical outcomes is insufficient. For other surrogate or intermediate outcomes, low-strength evidence fails to show differences. LIMITATION Clinical heterogeneity in protocols for SMBP monitoring, additional support, BP targets, and management; follow-up of 1 year or less in most studies, with sparse clinical outcome data. CONCLUSION Self-measured BP monitoring with or without additional support lowers BP compared with usual care, but the BP effect beyond 12 months and long-term benefits remain uncertain. Additional support enhances the BP-lowering effect. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
Natalizumab and the role of α4-integrin antagonism in the treatment of multiple sclerosis

Natalizumab is a powerful new therapy with a novel mechanism of action for the treatment of multiple sclerosis. In a randomized, double-blind, Phase III study (the AFFIRM [Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis] study), natalizumab monotherapy 300 mg intravenous every 4 weeks reduced the risk of sustained disability progression by 42% and annualized relapse rate by 68% over 2 years (both p < 0.001 versus placebo). Natalizumab was approved in the US in November 2004 for the treatment of relapsing multiple sclerosis, but was voluntarily withdrawn in February 2005 due to three cases of progressive multifocal leukoencephalopathy. Following a safety evaluation and regulatory review, the US FDA approved natalizumab as monotherapy for the treatment of relapsing multiple sclerosis in June 2006 generally for patients who have had an inadequate response to, or are unable to tolerate, alternative treatments.
Educator Experience with the U.S. Diabetes Conversation Map® Education Program in the Journey for Control of Diabetes: The IDEA Study

It is widely accepted that educating patients about ways to better understand and self-manage type 2 diabetes is a cornerstone for managing the disease.1 However, there is still much debate over the educational approach that is most effective in delivering such crucial health information in a way that leads to measurable changes in patient behavior and improved clinical outcomes.2 In an effort to help resolve this debate, the Journey for Control of Diabetes: The IDEA Study, a multisite randomized trial, is underway, conducted by researchers at Health-Partners Research Foundation (HP) in Minneapolis, Minn. , and LCF Research (LCF), in Albuquerque, N.M. The study aims to evaluate the effectiveness of two methods of education: 1 ) a traditional individual educational approach and 2 ) a more novel group-based, interactive learning experience called IDEA (Interactive Dialogue to Educate and Activate) using the U.S. Diabetes Conversation Map education program (created by Healthy Interactions in collaboration with the American Diabetes Association [ADA] and sponsored by Merck & Co.). This form of group education, using the Conversation Map education tools as a vehicle to facilitate interaction between educators and patients, shows promise to change patient attitudes toward diabetes, improve self-efficacy, and lead to better clinical outcomes. The purpose of this article is to describe the IDEA Study educator experience with implementing the Conversation Map education approach to inform and assist others in integrating this learning tool in their care settings. The IDEA Study enrolled 623 participants with a history of suboptimally controlled type 2 diabetes through HP and LCF from June 2008 to May 2009, with the purpose of evaluating the effectiveness of an interactive, group-based diabetes educational experience using the Conversation Map tools. Individuals interested in the study were eligible to participate if they had an A1C value within the past 6 months of ≥ …
Sarcoma de Ewing extraesquelético del raquis dorsal: presentación de dos casos

INTRODUCTION: Extraskeletal Ewing sarcomas are a rare type of soft tissue tumors and represent the two percent of neoplasm in adults. It is characterized by the aggressiveness, high incidence of local recurrence and metastases. Central nervous system affection is uncommon. CLINICAL CASES: Two patients of 21 and 27 years old each are presented treated by the Neurosurgery service of the University Hospital “Manuel Ascunce Domenech” of Camaguey in 2012 and 2013. They complaint dorsal pain followed by a dorsal incomplete medullar compression syndrome. The Magnetic Resonance Imaging showed the presence of intraspine tumors, that´s why surgical treatment was mandatory for decompression of neurologic structures and tumor removal. The anatomopathologic diagnosis suggests an extra skeletal Ewing sarcoma and inmunohistochemistry techniques confirmation were required. Two month after surgery, recurrence appeared with unfavorable clinic evolution. Multidrug chemotherapy did not control local reappearance of the disease. CONCLUSIONS: the highly malignance of this kind of tumor required wide removal, supported by transoperatory histopathology to guarantee surgery effectiveness, followed by multidrug chemotherapy to help systemic control and prevent recurrence. The key for better results are a precocious diagnosis before metastases appearance and a multidisciplinary multimodal treatment.
Cutaneous leishmaniasis presenting as a submandibular nodule - a case report

A 42 year old male from Kinnaur district of Himachal Pradesh presented with a subcutaneous nodule in the submandibular region. It was 2x3 cm in size, firm, mobile and non-tender. Lymphadenitis and sialadenitis were kept as differential diagnosis. Fine-needle aspiration revealed Leishman Donovan (L-D) bodies along with non-caseating epithelioid cell granulomas. We are presenting this report for its rarity.
Lung myofibroblasts as targets of salmeterol and fluticasone propionate : inhibition of α-SMA and NF-κB

Lung myofibroblasts play a major role in the pathophysiology of asthma, contributing not only to tissue remodelling but also to airway inflammation. Nevertheless, only recently, attention has been focused on these cells as potential targets for anti-allergic drugs. Herein, we analysed the pharmacological response of lung myofibroblasts to b2-agonists associated or not to inhaled corticosteroids, investigating their effects on (i) the constitutive and transforming growth factor-b (TGF-b)-induced expression of a-smooth muscle actin (a-SMA), the main functional marker of myofibroblastic differentiation and contractility; (ii) isometric contraction and (iii) tumour necrosis factor-a (TNF-a)-induced nuclear translocation of the pro-inflammatory transcription factor nuclear factor-jB (NF-jB). The b2-agonist salmeterol (SMl) has on human lung myofibroblasts new direct anticontractile/anti-inflammatory effects that are amplified by the combined use of low concentrations of the glucocorticoid fluticasone propionate (FP). First, SMl and/or FP (10 12 M) inhibits the constitutive and TGF-b-induced expression of a-SMA. Second, the two drugs block the TNF-a-induced nuclear translocation of the pro-inflammatory transcription factor NF-jB. Finally, SMl decreases TNFa-induced production of the inflammatory cytokine IL-6. The complementary anti-inflammatory/ anti-contractile effects displayed by SMl and FP on lung myofibroblasts in vitro may be related to the improvement in lung function and symptom control obtained in vivo by the early use of low doses of glucocorticoids in combination with long-acting b2-agonists.
Systemic therapy for colorectal cancer

Colorectal cancer alone accounts for around 200,000 deaths in Europe and represents a significant health problem. Although about fifty percent of patients are cured by surgery alone, the other half will eventually die due to metastatic disease, which includes approximately 25% of patients who have evidence of metastases at the time of diagnosis. Surgical resection of the primary tumor and regional lymph nodes is the only curative therapy for colorectal cancer. However, adjuvant chemotherapy in stage III for colon cancer following curative resection has been shown to reduce the risk of recurrence by 19-40% and of death by 16-33%. Today, 5-fluoroUracil and Leucovorin given for six months may represent the best adjuvant treatment available The contribution of levamisole to adjuvant treatment seems to be marginal, if any. The benefit of adjuvant chemotherapy for the patients with Dukes B colon cancer is less clear. A meta-analysis of 1,381 patients with advanced colorectal cancer showed a significant increase in response rate with the bolus 5-fluoroUracil and Leucovorin versus 5-fluoroUracil alone but no significant difference in median survival. Continuous infusion allows higher doses of 5-FU than rapid bolus infusion and improves response rate survival and time to progression. Oral fluoropyrimidines (capecitabine and Uracil/Tegafur [UFT]) are as active as intravenous fluoropyrimidines. Compared to intravenous 5FU, oral fluoropyrimidines have safety advantages clinical benefits, and are more convenient for patients. Phase III randomized clinical trials in patients with metastatic colorectal cancer demonstrate the significant superiority of combining irinotecan with 5-fluoroUracil and Leucovorin or oxaliplatin with 5-fluoroUracil and Leucovorin over the same 5-fluoroUracil and Leucovorin alone. Several phase II studies have shown that the combination of the oral fluoropyrimidines plus irinotecan or oxaliplatin is very active in metastatic colorectal cancer. Trials with agents acting on novel targets in colorectal cancer are progressing rapidly, including doxifluridine, new inhibitors of thymidylate synthase (ZD9331), oral camptothecins (Rubitecan), multitarget antifolate antimetabolite (Premetrexet), inhibitors of epidermal growth factor receptor (Cetuximab), COX-2 inhibitors (celecoxib) and farnesyltransferaze inhibitors (Zarnestra). However, a few randomized trials failed to show a survival advantage compared with placebo in patients with advanced refractory colorectal cancer.
Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines.

Conflicts of interest (COIs) have been defined by the American Thoracic Society as "a divergence between an individual's private interests and his or her professional obligations such that an independent observer might reasonably question whether the individual's professional actions or decisions are motivated by personal gain, such as direct financial, academic advancement, clinical revenue streams, or community standing. " In the context of guideline development, the concerns are not simply about identifying and disclosing direct financial or indirect COIs. Despite this recognition, the management of COIs in guidelines is often unsatisfactory. In response to requests from its international membership and informed by existing syntheses of the evidence and policies of international organizations, the Guidelines International Network Board of Trustees developed guidance on the disclosure of interests and management of COIs. Current approaches are relatively similar throughout the guideline development community, with an increasing recognition of the importance of disclosing and managing indirect COIs. Although there are differences in detail among the approaches, the similarities allow for the formulation of 9 core principles for managing COIs. In formulating these principles, the Guidelines International Network Board of Trustees recognizes that COIs cannot be totally avoided when panel members are being chosen for certain guidelines or in certain settings; thus, the important issue is the management of COIs in a fair, judicious, transparent manner.
Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial.

BACKGROUND Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations. OBJECTIVE To compare the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments (EDs) with acute gout. DESIGN Multicenter, double-blind, randomized equivalence trial. Patients were randomly assigned (1:1 ratio) to receive either indomethacin or prednisolone. (ISRCTN registry number: ISRCTN45724113). SETTING Four EDs in Hong Kong. PARTICIPANTS 416 patients aged 18 years or older. MEASUREMENTS Analgesic effectiveness was defined as changes in pain (at rest or with activity) greater than 13 mm on a 100-mm visual analogue scale. Outcomes were measured during the first 2 hours in the ED and from days 1 to 14. RESULTS 376 patients completed the study. Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone in the ED (approximately 10 mm [rest] and 20 mm [activity]) and from days 1 to 14 (approximately 25 mm [rest] and 45 mm [activity]). No major adverse events occurred during the study. During the ED phase, patients in the indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P < 0.001). During days 1 to 14, 37% of patients in each group had minor adverse events. LIMITATION Diagnosis of gout was usually based on clinical criteria rather than examination of joint fluid. CONCLUSION Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout. Prednisolone is a safe, effective first-line option for treatment of acute gout. PRIMARY FUNDING SOURCE Health and Health Services Research Grant Committee of the Hong Kong Government.
Celebrating the ACP Centennial: From the Annals ArchiveAnkylosing Spondylitis

During the 2015 centennial year of the American College of Physicians, publisher of Annals of Internal Medicine, Annals editors will link an article in each issue with an earlier paper from our archives addressing the same disease or clinical question. We hope our readers find this interesting and we welcome comments, especially from physicians who were practicing at the time of publication of the original paper who might offer insight into the impact of the earlier paper on their knowledge or practice. In this issue, Haroon and colleagues (1) report the results of a population-based study of ankylosing spondylitis and conclude that it is associated with increased cardiovascular and cerebrovascular mortality. Over the years, many articles, abstracts, reviews, and letters have been published in Annals of Internal Medicine about ankylosing spondylitis and related spondyloarthropathies. One of the most compelling is a 2002 On Being a Patient essay by Dr. Muhammad Asim Khan (2), a rheumatologist and expert on ankylosing spondylitis who himself has the disease. In the article, Khan provides an unusually rich clinical report, including his presentation in early adolescence, a long period of misdiagnosis and futile treatments, and of being both pulled and pushed to the specialty of rheumatology due to his likely future physical limitations and his empathy for fellow sufferers. Dr. Khan reviews his lifetime of complications and surgeries, as well as the many failures of the medical system that he has endured with both grace and humor. Of relevance to the findings of the Haroon and colleagues, Khan had required coronary angioplasty for angina 2 years before the article appeared. Also the author of several related papers published earlier in Annals, Khan was the first author of a comprehensive update on spondyloarthropathies (3) a year after the appearance of the On Being a Patient piece. The article was written as knowledge concerning the genetics of the disease was increasing and as new therapies, including antitumor necrosis factor, were being introduced.
Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement.

DESCRIPTION Update of the 2006 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for iron deficiency anemia. METHODS The USPSTF reviewed the evidence on the association between change in iron status as a result of intervention (oral supplementation or treatment) in pregnant women and adolescents and improvement in maternal and infant health outcomes. POPULATION This recommendation applies to pregnant women and adolescents living in the United States who do not have symptoms of iron deficiency anemia. It does not address pregnant women who are malnourished, have symptoms of iron deficiency anemia, or have special hematologic conditions or nutritional needs that may increase their need for iron. RECOMMENDATIONS The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women to prevent adverse maternal health and birth outcomes. (I statement). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine iron supplementation for pregnant women to prevent adverse maternal health and birth outcomes. (I statement).
REALIZAR O NO UNA TESIS: RAZONES DE ESTUDIANTES DE MEDICINA DE UNA UNIVERSIDAD PÚBLICA Y FACTORES ASOCIADOS

To determine the reasons to do or not to do a thesis and factors related to this decision in pre-internship medical students from the Universidad Nacional Mayor de San Marcos in Lima, Peru. We surveyed all students, 102 agreed to participate (72%) and 9 were eliminated. Twenty-two (23.7%) had the intention to prepare a thesis. Main reasons for not to do it involved from self-perception of research knowledge deficiencies to scare financial resources. The main reason for conducting a thesis was that the student enjoys doing research (76.2%). Multivariated analysis showed that had taken extracurricular courses related to research was the only factor associated to the intention to prepare a thesis (RPa = 2.54; IC95% = 1.19 to 5.43). Strategies to increase the number of thesis should involve strengthening knowledge of scientific methodology using new teaching experiences; and motivation of alumni by the example, use of mentorship and active participation in research projects, research institutes or in the scientific student associations.
Meal Patterns of Older Adults in Rural Communities: Life Course Analysis and Implications for Undernutrition

Mealfrequency and composition data were collected in home interviews from a random sample of 556 adults age 55 to 96 years from two rural Kentucky counties Only 65% consumed three meals every day, and less than one third regularly snacked. Factor analysis distinguished patterns of hot, cooked meals from cold, uncooked meals at each meal; patterns varied by sociodemographic characteristics. Qualitative data from in-depth interviews with key infor mants provide context for understanding the influence of life course experiences These data show both continutty of local rural meal patterns and changes informants attribute to life course transitions—the most salient related to family, work, and health status. Knowledge of how meals are patterned and how patterns are distributed can inform efforts to correct or prevent nutritional problems, particularly undernutrition. We suggest ways in which these findings can be applied in programs to improve the nutritional status of elders.
Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study.

Background Interval colorectal cancer (CRC) accounts for 3% to 8% of all cases of CRC in the United States. Data on interval CRC by race/ethnicity are scant. Objective To examine whether risk for interval CRC among Medicare patients differs by race/ethnicity and whether this potential variation is accounted for by differences in the quality of colonoscopy, as measured by physicians' polyp detection rate (PDR). Design Population-based cohort study. Setting Medicare program. Participants Patients aged 66 to 75 years who received colonoscopy between 2002 and 2011 and were followed through 2013. Measurements Kaplan-Meier curves and adjusted Cox models were used to estimate cumulative probabilities and hazard ratios (HRs) of interval CRC, defined as a CRC diagnosis 6 to 59 months after colonoscopy. Results There were 2735 cases of interval CRC identified over 235 146 person-years of follow-up. A higher proportion of black persons (52.8%) than white persons (46.2%) received colonoscopy from physicians with a lower PDR. This rate was significantly associated with interval CRC risk. The probability of interval CRC by the end of follow-up was 7.1% in black persons and 5.8% in white persons. Compared with white persons, black persons had significantly higher risk for interval CRC (HR, 1.31 [95% CI, 1.13 to 1.51]); the disparity was more pronounced for cancer of the rectum (HR, 1.70 [CI, 1.25 to 2.31]) and distal colon (HR, 1.45 [CI, 1.00 to 2.11]) than for cancer of the proximal colon (HR, 1.17 [CI, 0.96 to 1.42]). Adjustment for PDR did not alter HRs by race/ethnicity, but differences between black persons and white persons were greater among physicians with higher PDRs. Limitation Colonoscopy and polypectomy were identified by using billing codes. Conclusion Among elderly Medicare enrollees, the risk for interval CRC was higher in black persons than in white persons; the difference was more pronounced for cancer of the distal colon and rectum and for physicians with higher PDRs. Primary Funding Source American Cancer Society.
Developing an ESP Curriculum: English for Medical Clinics *

The article is an attempt to (i) develop an ESP curriculum specifically related to medical secretary English, (ii) implement in a classroom, and (iii) examine whether it would be helpful for learners. In this regard, employing a theoretical model of ESP materials’ design, first a need analysis is conducted to decide the contents of a syllabus. In view of the syllabus, materials are designed following the instructions given in the model. Lastly, the effectiveness of the curriculum is argued based on the ESP learning theories and feedback comments given by the course participants. Implications are discussed as regards how the curriculum can be used for a wider range of English required in medical offices such as English for nurses, nurse-teacher-training staff, dental assistants and welfare office secretaries.