Miracle-dz/UniFAR-FTUs huggingface dataset:
„Affenmalaria“ nach Thailandreise

Zusammenfassung Es wird über eine nach Deutschland importierte Malariaerkrankung durch Plasmodium knowlesi bei einer 52-jährigen Patientin nach Rückkehr von einer Thailandreise berichtet. P. knowlesi ist ein in Südostasien bei Makaken verbreiteter Malariaerreger, der erst in den letzten Jahren als bedeutsamer Erreger der menschlichen Malaria erkannt wurde. Bisher wurden 16 Fälle bei international Reisenden publiziert. Dazu gehören insgesamt 4 in Deutschland diagnostizierte Patienten, die alle dicht bewaldete Gebiete in Südthailand besucht hatten, in denen geeignete Reservoirwirte und Vektoren beheimatet sind. Die Erkrankung kann einen schweren, lebensbedrohlichen Verlauf nehmen. Die Diagnose stützt sich auf die Mikroskopie. Malariaschnelltests erkennen diesen Erreger nur unzureichend. Morphologisch ähnelt der Erreger allerdings sowohl P. malariae als auch wie P. falciparum, so dass für die Artdifferenzierung häufig eine molekulare Typisierung mittels PCR erforderlich ist. Der verstärkte Trend zum Ökotourismus könnte zu einer Zunahme dieser Infektion bei Reisenden führen, des Weiteren muss aber auch eine fortschreitende Ausweitung der Malaria-knowlesi Endemiegebiete diskutiert werden.
Emancipatory pedagogy through serialized heuristic reflection: Fostering self-awareness of dental students' prejudicial beliefs

EMANCIPATORY PEDAGOGY THROUGH SERIALIZED HEURISTIC REFLECTION: FOSTERING SELF-AWARENESS OF DENTAL STUDENTS’ PREJUDICIAL BELIEFS by Deborah Narcisso This study investigated dental students’ prejudicial beliefs towards underserved patient populations as an upstream constituent of provider attitudinal barriers to care. The objectives were to explore the scope and nature of prejudicial beliefs, to assess the value of critical reflection as essential preparation for patient care, and to identify insights that would inform the preclinical curriculum that, ultimately, reduce oral health disparity. The research used an integrated approach with qualitative and quantitative methods. An original serialized reflection assignment was introduced into the preclinical curriculum of 142 first year dental students to critically journal about the legitimacy of their a priori prejudicial beliefs. A purposive sample of 44 participants was obtained. Journals were analyzed for emergent themes and questionnaires for relevant context. Results indicated dental students identified a range of prejudicial beliefs and, through self-direction, experienced awareness and transformation of their beliefs. Participants agreed that reflection had personal and educational value. Insights were identified that could enhance the preclinical curriculum. This contributes to the evidence base on pedagogical strategies historically focused on post-experiential reflection. Themes that were explored include concepts defining the nature of prejudicial beliefs that could guide and inform professional practice. A need was identified to conduct grounded theory research on awareness of prejudicial beliefs as an antecedent to attitude change.
SLEEP AND ATHLETIC PERFORMANCE

Sleep deprivation or fragmentation may impact upon psychological, hormonal and glucose metabolism of elite and recreational athletes. The effect of sleep on performance is now part of the conventional wisdom of sport science. The physiology and pathology associated with sleep are important as potential causes of poor performance. The physiology includes the basics of sleep and sleep hygiene. The pathology is what may be present to a minimal or mild degree but will impact on sleep hygiene and performance the following day. The interaction between sleep and athletic performance is evident by published papers but the question is raised as how to apply this information in the athletic setting. An evidence based approach is difficult to be established due to the complex physiology of sleep and the intervariability among athletes. Sleep should be incorporated in the training programme based on the individualised needs of athletes whereas all athletes should be investigated for potent sleep disorders.
Beta-Cell Function and Failure in Type 1 Diabetes

Glucose is an essential energy source for all cells. Therefore, maintaining glucose levels within a normal range is essential for life in vertebrates. Glucose homeostasis in the organism is tightly regulated by insulin, a hormone that acts on the major glucose metabolic tissues such as muscle, liver and adipose tissue. Insulin’s main effects include promoting glucose uptake, glycogen synthesis in the liver and muscle, triglyceride formation to be stored in adipocytes, and protein synthesis. Insulin secretion is held by the pancreatic betacells, and it is modulated by glucose levels. Insufficient insulin secretion and consequent impairment of insulin’s actions lead to Diabetes Mellitus. Diabetes is a group of metabolic diseases characterized by hyperglycemia, caused by a defect on insulin production, insulin action or both. Type 1 diabetes in particular is due to an autoimmune destruction of the insulin producing pancreatic beta-cell, which usually leads to absolute insulin deficiency (ADA 2009). This type of diabetes accounts for 5-10% of the total cases of diabetes worldwide, and although its onset is commonly during childhood and adolescence, it can occur at any age, even during late adulthood. As the loss of beta-cells is determinant for the development of overt type 1 diabetes, understanding beta-cell’s normal physiology, namely insulin secretion, and how it may be affected during the progression of this disease is essential. Moreover, the development of new therapeutic interventions for type 1 diabetes, such as islet transplantation, beta cell maintenance and replacement, or stem cell therapy, requires a profound knowledge of how the presence of different nutrients and signals may regulate insulin secretion and beta-cell mass. In this chapter we aim to review the mechanisms involved in normal beta-cell function and beta-cell mass regulation, and how this function may be modulated by glucose, nutrients and signals in the beta-cell milieu. We also review how these mechanisms may be affected by the onset and progression of type 1 diabetes.
Crosslinking del colágeno corneano por técnica convencional y transepitelial para queratocono

El crosslinking corneano es una tecnica para el tratamiento del queratocono que incrementa la rigidez corneana con su fortalecimiento, mediante la fotopolimerizacion de las fibras del colageno estromal. este efecto se logra a traves de la fotoxidacion, que se presenta en el estroma al liberarse O², por la fototestimulacion de sustancias sensitivas (riboflavina al 0,1%) al someterse a exposicion de radiacion ultravioleta controlada (uVA 3mW/cm²). Para permitir el paso de la macromolecula de riboflavina al estroma, con el crosslinking convencional es necesario efectuar desepitelizacion de la cornea en una area entre 9 mm de diametro y entre 50 a 60 micras de profundidad. esta desepitelizacion se ha asociado con dolor y mayor riesgo a infecciones postratamiento, por lo que recientemente se han propuesto vehiculos farmacologicos como la carboximetilcelulosa o el cloruro de benzalconio, que abren la membrana epitelial debilitando las uniones celulares y logrando permitir el paso, la absorcion y la difusion al estroma de la riboflavina con preservacion del epitelio; esta tecnica se denomina crosslinking corneano transepitelial. son escasos los estudios realizados a nivel mundial y no se referencia ninguno en suramerica. en optometria, mantener el epitelio podria permitir el remoldeamiento corneal por orthoqueratologia acelerada inmediatamente posterior al tratamiento, logrando disminuir la curvatura corneal conica de manera estable y sin regresion, por lo que el trabajo interdisciplinario y multidisciplinario podria ofrecer al paciente con queratocono mayores beneficios terapeuticos y funcionales.
A 5‐HT2A/2C receptor agonist, 1‐(2,5‐dimethoxy‐4‐iodophenyl)‐2‐aminopropane, mitigates developmental neurotoxicity of ethanol to serotonergic neurons

Prenatal ethanol exposure causes the reduction of serotonergic (5‐HTergic) neurons in the midbrain raphe nuclei. In the present study, we examined whether an activation of signaling via 5‐HT2A and 5‐HT2C receptors during the fetal period is able to prevent the reduction of 5‐HTergic neurons induced by prenatal ethanol exposure. Pregnant Sprague–Dawley rats were given a liquid diet containing 2.5 to 5.0% (w/v) ethanol on gestational days (GDs) 10 to 20 (Et). As a pair‐fed control, other pregnant rats were fed the same liquid diet except that the ethanol was replaced by isocaloric sucrose (Pf). Each Et and Pf group was subdivided into two groups; one of the groups was treated with 1 mg/kg (i.p.) of 1‐(2,5‐dimethoxy‐4‐iodophenyl)‐2‐aminopropane (DOI), an agonist for 5‐HT2A/2C receptors, during GDs 13 to 19 (Et‐DOI or Pf‐DOI), and another was injected with saline vehicle only (Et‐Sal or Pf‐Sal). Their fetuses were removed by cesarean section on GD 19 or 20, and fetal brains were collected. An immunohistological examination of 5‐HTergic neurons in the fetuses on embryonic day 20 using an antibody against tryptophan hydroxylase revealed that the number of 5‐HTergic neurons in the midbrain raphe nuclei was significantly reduced in the Et‐Sal fetuses compared to that of the Pf‐Sal and Pf‐DOI fetuses, whereas there were no significant differences between Et‐DOI and each Pf control. Thus, we concluded that the reduction of 5‐HTergic neurons that resulted in prenatal ethanol exposure could be alleviated by the enhancement of signaling via 5‐HT2A/2C receptors during the fetal period.
Impact of ICP instability and hypotension on outcome in patients with severe head trauma

✓ This study describes the relationship between raised intracranial pressure (ICP), hypotension, and outcome from severe head injury. The study is based on information derived from the Traumatic Coma Data Bank where ICP records from a relatively large number of patients were available to help delineate the major factors influencing outcome. From the total data base of 1030 patients, 428 met minimum monitoring duration criteria for inclusion in the present analysis. Outcome was classified according to the Glasgow Outcome Scale score determined at 6 months postinjury. Arrays of comparably defined summary measures describing the patient's course were considered for ICP, blood pressure (BP), central perfusion pressure, and therapy intensity level. For instance, the array of ICP summary descriptors included the proportion of ICP readings greater than x, for x = 0 to 80 mm Hg by increments of 5 mm Hg. A total of 187 candidate summary descriptors were considered. A stepwise ordinal logistic regression was used t.
CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety

Aims We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes. Methods and results Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection. Conclusions In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases.
La cafeína como un fármaco preventivo de la enfermedad de Parkinson: evidencias epidemiológicas y sustrato experimental

Introduccion y desarrollo. Los estudios epidemiologicos prospectivos realizados en grandes cohortes de varones (total: 374.003 sujetos) coinciden en que el riesgo de padecer la enfermedad de Parkinson disminuye progresivamente cuanto mayor es el consumo de cafe y otras bebidas con cafeina. En el caso de las mujeres (total: 345.184 sujetos), el efecto protector de la cafeina solo se observa en las mujeres con menopausia que no reciben terapia de reemplazo con estrogenos. Estudios con modelos de parkinsonismo agudo en roedores han mostrado que la cafeina reduce la perdida de las neuronas dopaminergicas nigroestriatales inducida con las neurotoxinas 6-hidroxidopamina y 1-metil-4-fenil-1,2,3,6-tetrahidropiridina, efecto que parece estar mediado a traves del bloqueo de los receptores A2A de adenosina. Recientemente se demostro que las ratas macho tratadas con dosis moderadas de cafeina (5 mg/kg/dia) durante seis meses, seguida de un periodo de abstinencia de cuando menos dos semanas, desarrollaron una mayor resistencia a la catalepsia provocada con el antagonista dopaminergico haloperidol, posiblemente mediada por un aumento de la transmision dopaminergica en el cuerpo estriado. Conclusiones. Se necesitan mas estudios para demostrar inequivocamente que la cafeina previene la degeneracion de las neuronas dopaminergicas en modelos animales de parkinsonismo moderado, cronico y progresivo, pues ello podria conducir al descubrimiento de farmacos mas eficaces para la prevencion de las enfermedades degenerativas del sistema nervioso central asociadas con el envejecimiento.
Frequent association of cochlear nerve canal stenosis with pediatric sensorineural hearing loss.

OBJECTIVE To examine the association between cochlear nerve canal (CNC) dimensions and sensorineural hearing loss (SNHL). DESIGN Retrospective review. SETTING Tertiary pediatric hospital. PATIENTS Children with SNHL and CNC stenosis. INTERVENTION The CNCs measured in axial and 45° oblique planes on temporal bone computed tomography (TBCT) in children with SNHL were compared with TBCT from children with normal hearing and 100 normal temporal bone specimens. Additional inner ear abnormalities were recorded. Hearing was measured using 4 frequency pure-tone averages (PTAs). MAIN OUTCOME MEASURE The degree of CNC stenosis related to the degree of SNHL. RESULTS Fifty-three patients (32 female) with SNHL had CNC stenosis in 85 ears (32 bilateral, 21 unilateral). The mean (SD) axial CNC measurement for 85 ears was 0.98 (0.57) mm (range, 0-1.75 mm). The mean (SD) Poschl CNC measurement was 1.30 (0.69) mm (range, 0-2.80 mm). Of 85 ears, 64 had at least 1 additional inner ear abnormality. The mean (SD) PTA was 56.2 (40.8) dB. For each ear separately axial and Poschl plane CNC measurements were highly correlated (P < .001). The degree of CNC stenosis was significantly (P = .02) related to degree of hearing loss, and PTA decreased in the CNC stenosis population by 1.4 dB per year (P = .054). In addition, PTA and additional inner ear abnormalities were found to be significantly correlated (P = .002). CONCLUSIONS Cochlear nerve canal stenosis is associated with SNHL, and the degree of stenosis predicted the degree of SNHL. In addition, the presence of CNC stenosis with additional inner ear abnormalities may affect the severity of SNHL.
Nucleotide variants of genes encoding components of the Wnt signalling pathway and the risk of non‐syndromic tooth agenesis

Tooth agenesis is one of the most common dental anomalies, with a complex and not yet fully elucidated aetiology. Given the crucial role of the Wnt signalling pathway during tooth development, the purpose of this study was to determine whether nucleotide variants of genes encoding components of this signalling pathway might be associated with hypodontia and oligodontia in the Polish population. A set of 34 single nucleotide polymorphism (SNPs) in 13 WNT and WNT‐related genes were analyzed in a group of 157 patients with tooth agenesis and a properly matched control group (n = 430). In addition, direct sequencing was performed to detect mutations in the MSX1, PAX9 and WNT10A genes. Both single‐marker and haplotype analyses showed highly significant association between SNPs in the WNT10A gene and the risk for tooth agenesis. Moreover, nine pathogenic mutations within the coding region of the WNT10A gene were identified in 26 out of 42 (62%) tested patients. One novel heterozygous mutation was identified in the PAX9 gene. Borderline association with the risk of non‐syndromic tooth agenesis was also observed for the APC, CTNNB1, DVL2 and WNT11 polymorphisms. In conclusion, nucleotide variants of genes encoding important components of the Wnt signalling pathway might influence the risk of tooth agenesis.
Echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction

Aims To determine if markers of diastolic dysfunction are associated with atrial fibrillation (AF) development among patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results We examined the association of several echocardiographic measures of diastolic dysfunction with incident AF in 573 patients (mean age = 68 ± 9.5 years; 48% men; 79% white) with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT) who were free of baseline AF. Echocardiograms were analysed at a core laboratory. Incident AF cases were identified by follow-up study electrocardiograms and review of relevant medical records through May of 2013. Over a median follow-up of 3 years, 40 patients developed AF (incidence rate = 2.2 per 100 person years). Increasing values of the E/A ratio [per 0.1 increase: hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 1.06–1.17], left atrial volume (per 5 mL increase: HR = 1.13, 95% CI = 1.03–1.23), and left atrial area (per 5 cm2 increase: HR = 1.51, 95% CI = 1.03–2.22) were associated with greater risk of AF. The risk of AF decreased with increasing peak A wave velocities (per 10 cm/s increase: HR = 0.83, 95% CI = 0.72–0.96). The risk of AF was not materially altered when peak A wave velocity was further adjusted for left atrial volume (HR = 0.83, 95% CI = 0.71–0.96) and area (HR = 0.83, 95% CI = 0.71–0.96). However, the associations of left atrial volume (HR = 1.10, 95% CI = 0.99–1.22) and area (HR = 1.48, 95% CI = 0.96–2.28) were no longer significant when accounting for peak A wave velocity. Conclusion Diastolic parameters of left atrial function possibly are more important markers of AF risk than left atrial dilation in HFpEF.
Distal Simetrik Polinöropati Tanısı Konulmuş Tip 2 Diabetes Mellitus Hastalarında Klinik ve Elektrofizyolojik Test Bulgularının Karşılaştırılması

Objective: Distal symmetric sensorimotor polyneuropathy is a common complication of diabetes mellitus. On the other hand,the early diagnosis of neuropathy is very important for many reasons. Neuropathy due to other reasons may be present in diabetic patients. Besides diabetic polyneuropathy may be asymptomatic in nearly fifty per cent of the patients. But these patients are under risks of occurence foot ulcerations, infections and subsequent amputations. This serious complicaton can be reduced by early recognition and appropriate management. The aim of this study is to search the importance of clinical tests which are used for diagnosis of distal symetrical diabetic polyneuropathy in evaluation of neuropathy severity. Material and Methods: 50 patients with diabetic distal symetrical polyneuropathy were enrolled in this study. Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Diabetic Neuropathy Symptom (DNS) score and Diabetic Neuropathy Examination (DNE) score tests were used. Besides, ENMG tests were done. The most important abnormality in nerve conduction studies was either decrease in amplitute of compound muscle action potentials/of sensory nerve action potentials or loss of action potentials. We quantified the severity of neuropathy by taking into consideration of this parameter. We assessed the correlation between clinical test scores and the severity of neuropathy. Results: Severity of neuropathy correlated with MDNS very significantly (p<0.001). On the other hand there were no correlations in terms of these parameters in other tests. Conclusion: The results of our study showed that MDNS test is not only a diagnostic test of diabetic polyneuropathy but also is useful in assesment of the severity of neuropathy.
Anthropometric predictors of blood pressure in women between the ages 26–45 years

The study of 199 (26 to 45 years) women of Latvia was undertaken to study the anthropometric predictors of blood pressure between age groups. The data were collected in the years 2001–2005. The women were divided into two agegroups: I (26–35 years) and II (36–45 years) for making even sample analysis. Anthropometric variables of each woman including height, weight, waist and hip circumferences (WC, HC), and blood pressure (BP) were measured. Mean arterial blood pressure (MBP), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body mass index (BMI) were also calculated through standard equation. The relationships between blood pressure and different anthropometric variables were determined in both age groups. The mean age of the participants was 35.18±2.85. The mean±SD systolic blood pressures were 124.25±12.81 and 131.52±17.04 mmHg while the mean diastolic blood pressures were 82.78±9.78 and 88.71±12.44 mmHg in both age groups. The mean values of systolic and diastolic blood pressures increased with age. In this study anthropometric measurements such as weight, waist and hip circumferences (WC, HC), waist-to-height ratio (WHtR) and body mass index (BMI) indicated a strong positive relation with blood pressure in both age groups. Waist-to-hip ratio (WHR) was not a significant predictor for systolic and diastolic blood pressures of women at the age of 26–35 years. According to this study, selected anthropometric measures were significant predictors of systolic and diastolic blood pressures. Therefore, it is important that early measurements of blood pressure, weight, waist and hip circumferences (WC, HC), and some indices become a routine in health services in order to prevent conditions or risk factors of different diseases.