Miracle-dz/UniFAR-FTUs huggingface dataset:
Electrocardiographic Abnormalities and Cardiovascular Disease Risk in Type 1 Diabetes: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

OBJECTIVE We examined the association between the prevalence and incidence of electrocardiographic (ECG) abnormalities and the development of cardiovascular disease (CVD) in patients with type 1 diabetes, among whom these ECG abnormalities are common. RESEARCH DESIGN AND METHODS We conducted a longitudinal cohort study involving 1,306 patients with type 1 diabetes (mean age 35.5 ± 6.9 years; 47.7% female) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. ECG abnormalities were defined by the Minnesota Code ECG classification as major, minor, or no abnormality. CVD events were defined as the first occurrence of myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure, or death from any CVD. RESULTS During a median follow-up of 19 years, 155 participants (11.9%) developed CVD events. In multivariable Cox proportional hazard models adjusted for demographics and potential confounders, the presence of any major ECG abnormalities as a time-varying covariate was associated with a more than twofold increased risk of CVD events (hazard ratio [HR] 2.10 [95% CI 1.26, 3.48] vs. no abnormality/normal ECG, and 2.19 [1.46, 3.29] vs. no major abnormality). Also, each visit (year) at which the diagnosis of major ECG abnormality was retained was associated with a 30% increased risk of CVD (HR 1.30 [95% CI 1.14, 1.48]). The presence of minor ECG abnormalities was not associated with a significant increase in CVD risk. CONCLUSIONS The presence of major ECG abnormalities is associated with an increased risk of CVD in patients with type 1 diabetes. This suggests a potential role for ECG screening in patients with type 1 diabetes to identify individuals at risk for CVD.
Tooth crown tissue proportions and enamel thickness in Early Pleistocene Homo antecessor molars (Atapuerca, Spain)

Tooth crown tissue proportions and enamel thickness distribution are considered reliable characters for inferring taxonomic identity, phylogenetic relationships, dietary and behavioural adaptations in fossil and extant hominids. While most Pleistocene hominins display variations from thick to hyper-thick enamel, Neanderthals exhibit relatively thinner. However, the chronological and geographical origin for the appearance of this typical Neanderthal condition is still unknown. The European late Early Pleistocene species Homo antecessor (Gran Dolina-TD6 site, Sierra de Atapuerca) represents an opportunity to investigate the appearance of the thin condition in the fossil record. In this study, we aim to test the hypothesis if H. antecessor molars approximates the Neanderthal condition for tissue proportions and enamel thickness. To do so, for the first time we characterised the molar inner structural organization in this Early Pleistocene hominin taxon (n = 17) and compared it to extinct and extant populations of the genus Homo from African, Asian and European origin (n = 355). The comparative sample includes maxillary and mandibular molars belonging to H. erectus, East and North African Homo, European Middle Pleistocene Homo, Neanderthals, and fossil and extant H. sapiens. We used high-resolution images to investigate the endostructural configuration of TD6 molars (tissue proportions, enamel thickness and distribution). TD6 permanent molars tend to exhibit on average thick absolute and relative enamel in 2D and 3D estimates, both in the complete crown and the lateral enamel. This condition is shared with the majority of extinct and extant hominin sample, except for Neanderthals and some isolated specimens. However, while the total crown percentage of dentine in TD6 globally resembles the low modern values, the lateral crown percentage of dentine tends to be much higher, closer to the Neanderthal signal. Similarly, the H. antecessor molar enamel distribution maps reveal a relative distribution pattern that is more similar to the Neanderthal condition (with the thickest enamel more spread at the periphery of the occlusal basin) rather than that of other fossil specimens and modern humans (with thicker cuspal enamel). Future studies on European Middle Pleistocene populations will provide more insights into the evolutionary trajectory of the typical Neanderthal dental structural organization.
Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews

Objective Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions. Methods Scoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed. Results Of 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. ‘Complementary medicine’ interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered. Conclusions Further research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.
Auditory Brainstem Response Testing in the Surgical Intensive Care Unit*

*Presented in part at the 17th Colorado Otology Audiology Workshop, Aspen, Colorado, March 7, 1983. University of Cincinnati Medical Center, Cincinnati, Ohio. The use of auditory brainstem response (ABR) audiometry for various clinical applications has grown remarkably since initially described by Jewett and Williston (1971). One such application is the use of ABR in patients who are comatose. In these patients, there are two primary purposes for measuring the ABR: to assess brain death and to predict the neurological outcome of patients who have severe head injuries and are comatose. In an early publication, Starr (1976) investigated ABR in a population of 27 patients who due to various causes fulfilled the clinical criteria of brain death. In his study, Starr found that ABR is a useful objective measure of functional states of the brainstem in patients in whom the question of brain death has been raised. His results show gradual dissolution of brainstem function, evident from prolonged latency and decreased amplitude of components of the ABR waveform. In patients with brain death, the response is either absent or consists of an initial component of wave I that may have increased latency and reduced amplitude. Since Starr's original contribution, several authors have reported on ABR responses in comatose patients resulting from severe head injury. Uziel and Benezech (1978) report that a clear relationship exists between ABR alterations and the levels of dysfunction of the central nervous system (CNS) as determined by clinical examination. They examined both posture and occular signs to assess the level of coma. Tsubokawa et al. (1980) studied 64 patients with severe head injury and Glasgow coma ratings less than 7. They found that ABR was useful in assessing the site of damage to the brainstem. In addition, when ABR responses deteriorated, the finding was useful in predicting the patients' eventual outcome. Two studies have also looked at the predictive accuracy of ABR in comatose patients. The first reported by Brewer and Resnick (1981) studied 52 patients in surgical intensive care who were comatose at the time of testing. They interpret their ABR results in three categories, including
Improvement of Glucose Control and Reduction of Hypoglycemia Following Intravenous Immune Globulins in a Child With Type 1 Diabetes and High Levels of Insulin Antibodies

Anti-insulin antibodies (AIA) usually have no impact on glucose control in type 1 diabetes (1). However, high titers of AIA with low/medium affinity for insulin may form unstable immune complexes resulting in high glucose variability (2). Corticosteroids, plasmapheresis, mycophenolate mofetil (3), and rituximab (4) have been tried to solve this issue. We report a case of interest owing to significant improvement following intravenous infusions of human immune globulins (IVIg). A lean 8-year-old Caucasian boy was diagnosed with type 1 diabetes 3 years before being referred to our clinic. No autoantibodies against islet antigens, GAD, IA2, or zinc transporter 8 were detected, but testing for AIA was not done at onset and no GCK , HNF1A , HNF4A , HNF1B , ABCC8 , KCNJ11, or INS gene mutations were found. Under multiple daily insulin injections or an insulin pump, high glucose variability included uncontrollable postmeal hyperglycemia and recurrent severe hypoglycemia in fasting/nighttime periods. Despite a sensor-augmented …
Sodium–Glucose Cotransporter 2 Inhibitors and Diabetic Ketoacidosis: A Case Series From Three Academic Institutions

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have recently been associated with diabetic ketoacidosis (DKA). Initial case reports were largely among patients using SGLT2i off label in the setting of type 1 diabetes and were unusual because of limited associated hyperglycemia (1). More recently, the problem has been specifically noted in patients with type 2 diabetes (2). Meta-analysis of data from initial randomized controlled trials of SGLT2i suggests little risk of DKA (<0.1%) in patients with type 2 diabetes (3). To better define the scope of the problem in clinical practice, we conducted a search of three academic health care systems’ electronic health records. The study was approved by institutional review boards. Patients were selected from all emergency and inpatient encounters between 1 January 2013 and 30 April 2016 that contained the diagnosis codes for ketosis or acidosis (ICD-9 …
Spirituality within Dementia Care: Perceptions of Health Professionals

There is an increasing awareness that people with dementia should have their spiritual needs addressed. The aim of this study was to investigate health professionals' understanding of spirituality within dementia care and their perceptions of how patients' spiritual needs are met and by whom. A phenomenological approach was used, with semi-structured interviews undertaken with four nurses, two occupational therapists, two physiotherapists, two doctors and one speech and language therapist (n = 11). All the health professionals found defining ‘spirituality’ difficult, although common terminology was used. They agreed that spirituality was not solely related to religion. Chaplaincy staff were associated with the provision of spiritual care, but 10 of the health professionals identified themselves as staff who should address such spiritual needs. The majority (n = 10), however, reported a lack of confidence with spiritual care and agreed that training would be valuable. The findings indicate that all health professionals should address the spiritual needs of patients with dementia. A working definition of ‘spirituality’ is needed and further research is also warranted into the type of training needed by health professionals with regard to the spiritual care of patients.
Renal Handling of Ketones in Response to Sodium–Glucose Cotransporter 2 Inhibition in Patients With Type 2 Diabetes

OBJECTIVE Pharmacologically induced glycosuria elicits adaptive responses in glucose homeostasis and hormone release, including decrements in plasma glucose and insulin levels, increments in glucagon release, enhanced lipolysis, and stimulation of ketogenesis, resulting in an increase in ketonemia. We aimed at assessing the renal response to these changes. RESEARCH DESIGN AND METHODS We measured fasting and postmeal urinary excretion of glucose, β-hydroxybutyrate (β-HB), lactate, and sodium in 66 previously reported patients with type 2 diabetes and preserved renal function (estimated glomerular filtration rate ≥60 mL · min−1 · 1.73 m−2) and in control subjects without diabetes at baseline and following empagliflozin treatment. RESULTS With chronic (4 weeks) sodium–glucose cotransporter 2 inhibition, baseline fractional glucose excretion (<2%) rose to 38 ± 12% and 46 ± 11% (fasting vs. postmeal, respectively; P < 0.0001) over a range of BMIs (range 23–41 kg/m2) and creatinine clearance (65–168 mL · min−1 · m−2). Excretion of β-HB (median [interquartile range]: 0.08 [0.10] to 0.31 [0.43] µmol · min−1), lactate (0.06 [0.06] to 0.28 [0.25] µmol · min−1), and sodium (0.27 [0.22] to 0.36 [0.16] mEq · min−1) all increased (P ≤ 0.001 for all) and were each positively related to glycosuria (P ≤ 0.001). These parameters changed in the same direction in subjects without diabetes, but changes were smaller than in the patients with diabetes. Although plasma N-terminal pro–B-type natriuretic peptide levels were unaltered, plasma erythropoietin concentrations increased by 31 (64)% (P = 0.0078). CONCLUSIONS We conclude that the sodium–glucose cotransporter 2 inhibitor–induced increase in β-HB is not because of reduced renal clearance but because of overproduction. The increased lactate excretion contributes to lower plasma lactate levels, whereas the increased natriuresis may help in normalizing the exchangeable sodium pool. Taken together, glucose loss through joint inhibition of glucose and sodium reabsorption in the proximal tubule induces multiple changes in renal metabolism.
Breast-cancer screening with mammography in women aged 40–49 years

For some years, there has been a perceived need for more information on the effect of screening for breast cancer in women aged 40 to 49. Our approach was to gather the most recent data on screening in this age group, to assess the following quantities: the likely benefit in mortality terms, measures of screening performance and arrest of tumour progression through screening, costs and public-health implications, and prospects for future screening and research. A collaborative meeting was held in Falun, Sweden, for which data were gathered in advance from all the randomized trials of breast-cancer screening that included women in this age group and all identifiable substantial databases on service screening of women aged 40 to 49. Updated results from the Swedish overview of mammographic screening trials indicated relative mortality associated with invitation to screening of 0.77 (95% confidence interval 0.59–1.01). Combining all population-based randomized trials gave the relative-mortality figure of 0.76 (0.62–0.93), and combining all trials gave 0.85 (0.71–1.01). Relative-mortality figures in individual trials could be predicted by the rates of advanced cancers in those trials. Detailed analysis suggested faster tumour progression in the age group 40 to 49 compared with groups aged 50 or more. It is likely that mammographic screening of women aged 40 to 49 can reduce subsequent mortality from breast cancer, and studies on tumour progression indicate that to obtain substantial benefit it is probably necessary to screen every 12 to 18 months, with 2-view mammography and double reading of films. This represents a greater outlay in resources and in commitment of the population. Further work remains to be done on the time taken for a mortality benefit to emerge, on age at diagnosis in some of the trials, and on costs and public-health aspects© 1996 Wiley-Liss, Inc.
Improving health worker performance through text messaging: A mixed-methods evaluation of a pilot intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy in West Nile, Uganda

Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and outcomes of an mHealth intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in two districts of West Nile, Uganda. In both districts, selected health workers (N = 48) received classroom training on malaria in pregnancy. All health workers in one district (N = 49) subsequently received 24 text messages reinforcing the training content. The intervention was evaluated using a mixed-methods approach, including four focus group discussions with health workers and three in-depth interviews with district health officials, health worker knowledge assessments one month (N = 90) and six months (N = 89) after the classroom training, and calculation of IPTp coverage from participating health facilities’ (N = 16) antenatal care registers covering six months pre- and post-intervention. Complementing classroom training with text messaging was found to be a feasible, acceptable and inexpensive approach to improving health worker performance. The messages served as reminders to those who had attended the classroom training and helped spread information to those who had not. Health workers in the district where text messages were sent had significantly better knowledge of IPTp, achieving an increased composite knowledge score of 6.00 points (maximum score: 40) compared with those in the district where only classroom training was provided. Average facility coverage of three doses of IPTp was also significantly higher where text messages were sent (85.8%) compared with the district where only classroom training was provided (54.1%). This intervention shows promise for the improvement of health worker performance for delivery of IPTp, and could have significant broader application.
Can Secure Patient-Provider Messaging Improve Diabetes Care?

OBJECTIVE Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. RESEARCH DESIGN AND METHODS Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011–2014 were studied (N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering. RESULTS Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages. CONCLUSIONS Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.
Basic reptile husbandry, history taking and clinical examination

AS reptiles continue to gain popularity as pets, their owners' expectations of their veterinary care are increasing. The expansion in the general knowledge of reptile husbandry, medicine and surgery has resulted in the provision of a comparable level of veterinary care for reptilian patients as is already available for dogs and cats. The aim of this article is to introduce the practitioner to reptiles, and to provide details on taking a comprehensive history and performing a thorough clinical examination that will point the clinician towards further laboratory and ancillary tests and that previously elusive diagnosis.
EFFECT OF OINTMENT FROM COMBINED Centella asiatica (L.) Urban AND Coleus amboinicus EXTRACTS ON SKIN WOUND TISSUE REPAIR IN DIABETIC RATS

Background: A single Centella asiatica L. Urban (CALU) extract stimulated cellular proliferation in granulation tissue, while a single Coleus amboinicus L. (CAL) extract acted as antiseptic agent. Diabetic wound closure is sensitively difficult to be done because proliferation is likely inhibited by antiseptic alteration resulted as infectious wound. Both extracts may give synergy in combination into ointment. Objective: to investigate the effect of combinedextracts ointment on angiogenesis, inflammatory cells and microscopic wound diameter. Methods: posttest only group design was experimentally conducted, sixty rats were randomly divided into 5 groups; each group was treated with different ointment constituent: single 1,5% CALU extract; single 5% CAL extract; both extracts (1,5%CALU+ 5%CAL); placebo and Sanoskin Melladerm Plus® (SMP). Diabetic rat’s skin was excised and treated with hydrocarbonbased ointment. Assessment on angiogenesis, inflammatory cells and wound diameter were observed histopathologically on day 3, 7 and 14 after treatment. The data were analyzed by one-way ANOVA and LSD. Results: combinedextracts ointment effect was significantly different (p 0,05) compared to SMP® in term of wound diameter reduction. Conclusion: Combined-extracts ointment is better than either single extract, placebo or SMP® in improving angiogenesis and reducing number of inflammatory cells, but not better than SMP® in reducing wound diameter. Keywords: combined-extracts, single extract, angiogenesis, inflammatory cells, wound diameter. 1. Medical School, Faculty of Medicine, Universitas Tanjungpura, Pontianak 2. Departement of Pathology Anatomy, Faculty of Medicine, Universitas Tanjungpura, Pontianak 3. Departement of Physiology, Faculty of Medicine, Universitas Tanjungpura, Pontianak