Miracle-dz/UniFAR-FTUs huggingface dataset:
Prescribing of inappropriate medication in patients with limited life expectancy: a prospective study in a specialist palliative care unit.

For patients with limited life expectancy – typically surviving for less than one year – polypharmacy is very common because medication is prescribed to manage acute symptoms associated with the life limiting illness (e.g. cancer) and to treat or prevent other long-term conditions (e.g. cardiovascular disease). As a consequence, this polypharmacy is linked with an increased risk of developing a drug-related toxicity due to the potential of drug-drug or drug-disease interactions. This risk is further heightened in patients with limited life expectancy owing to their unique and dynamic pharmacokinetic and pharmacodynamic parameters (e.g. variation in volume of distribution or altered drug excretion due to declining renal and/or hepatic function). In view of the potential for polypharmacy to cause harm in patients with limited life expectancy, it is essential to optimize patients’ medication to align with therapeutic goals and life expectancy. To date, however, there is a growing body of evidence that suggests inappropriate medication continues to be prescribed to patients with limited life expectancy.
Das Syndrom der renalen Osteopathie

Zusammenfassung Das Syndrom der renalen Osteopathie ist komplex und führt zu einer erheblichen Zunahme der Morbidität und Mortalität dieser Patienten. Primär sollte der Entstehung eines sekundären Hyperparathyreoidismus (sHPT) präventiv begegnet werden. Hier gilt es, frühzeitig und dauerhaft einen Vitamin-D-Mangel auszugleichen und dann bei Einschränkung der GFR unter 60 ml/min zusätzlich mit niedrigen Dosen aktiver Vitamin-D-Metabolite die fehlende renale Aktivierung von Calcitriol zu ersetzen. In diesem Stadium der Niereninsuffizienz sollte die Hyperphosphatämie bereits behandelt werden. Die Vitamin-D-Therapie hat aufgrund ihrer pleiotropen und wahrscheinlich antiatherogenen Effekte auch einen Stellenwert in der Langzeittherapie. Neue Medikamente wie das Kalzimimetikum Cinacalcet, das aktive Vitamin-D-Analogon Paricalcitol und die kalziumfreien Phosphatbinder Sevelamer und Lanthanumkarbonat haben die Therapie der renalen Osteopathie entscheidend verbessert und tragen dazu bei, dass bei mehr Patienten die in den Leitlinien empfohlenen Referenzwerte für PTH, Serumkalzium und Phosphat erreicht werden können. Dadurch wird die Notwendigkeit der Parathyroidektomie, die bei Patienten mit autonomem HPT immer noch indiziert ist, in den nächsten Jahren noch weiter zurückgehen.
Vitamin E Attenuates the Degree of Histopathological Lung Damage Following Toluene Diisocyanate Administration in Rats

In the current study we used a rat model of bronchial hyperreactivity induced by intranasal administration of toluene diisocyanate TDI in Wistar rats. Four experimental groups of were formed: TDI administration (TDI), control - administration of ethyl acetate (C), administration of vitamin E and TDI (TDI+E) administration of ethyl acetate and vitamin E (M+E). Our aim was to evaluate the efficiency of Vitamin E in attenuating the histopathological lesions induced by TDI in the lungs. The presence of anti-TDI IgE antibodies was demonstrated through the passive cutaneous anaphylaxis assay. Histopathological analysis of lung changes was performed by comparing the degree of peribronchiolar inflammation and goblet cell percentage between the different groups studied. Our results showed that rats sensitized to TDI presented severe inflammation of the airways, eosinophilic infiltration was present in the mid bronchi, and not limited to the central airways. Bronchial associated lymphoid tissue (BALT) hyperplasia and perivascular lymphoplasmacytic infiltrate were also identified, which is evidence of chronic inflammation of the airways. These changes were consistent with the inflammatory symptoms of bronchial hyper-reactivity observed which are similar to those in asthma patients. Vitamin E administration resulted in a statistical significant reduction in the percentage of goblet cells in the bronchial mucosa associated with a decrease inflammatory semiquantitative score, compared to the TDI group, but without statistical significance. Our data suggest that administration of vitamin E could be beneficial in attenuating the effects of TDI in individuals that develop bronchial asthma following TDI exposure.
Modulation of the immune response to Mycobacterium tuberculosis during malaria/M. tuberculosis co‐infection

Tuberculosis (TB) causes significant morbidity and mortality on a global scale. The African region has 24% of the world's TB cases. TB overlaps with other infectious diseases such as malaria and HIV, which are also highly prevalent in the African region. TB is a leading cause of death among HIV‐positive patients and co‐infection with HIV and TB has been described as a syndemic. In view of the overlapping epidemiology of these diseases, it is important to understand the dynamics of the immune response to TB in the context of co‐infection. We investigated the cytokine response to purified protein derivative (PPD) in peripheral blood mononuclear cells from TB patients co‐infected with HIV or malaria and compared it to that of malaria‐ and HIV‐free TB patients. A total of 231 subjects were recruited for this study and classified into six groups; untreated TB‐positive, TB positive subjects on TB drugs, TB‐ and HIV‐positive, TB‐ and malaria‐positive, latent TB and apparently healthy control subjects. Our results demonstrate maintenance of interferon (IFN)‐γ production in HIV and malaria co‐infected TB patients in spite of lower CD4 counts in the HIV‐infected cohort. Malaria co‐infection caused an increase in the production of the T helper type 2 (Th2)‐associated cytokine interleukin (IL)‐4 and the anti‐inflammatory cytokine IL‐10 in PPD‐stimulated cultures. These results suggest that malaria co‐infection diverts immune response against M. tuberculosis towards a Th‐2/anti‐inflammatory response which might have important consequences for disease progression.
Impaired virus replication and decreased innate immune responses to viral infections in nasal epithelial cells from patients with allergic rhinitis

The aim of this study was to assess the immune response to parainfluenza virus type 3 (PIV3), rhinovirus 1B (RV1B) and intracellular Toll‐like receptors (TLR) agonists in nasal epithelial cells (NECs) from patients with allergic rhinitis and healthy controls. NECs were obtained from eight patients with allergic rhinitis (AR) and 11 non‐atopic healthy controls (HC) by nasal scraping, grown to confluence and exposed to PIV3, RV1B infection or TLR‐3 and TLR‐7/8 agonists. Interferon (IFN)‐λ1, IFN‐α, IFN‐β and regulated on activation, normal T expressed and secreted (RANTES) release into the cell culture supernatants was assessed at 8, 24 and 48 h upon infection or 8 and 24 h after stimulation with poly(I:C) and R848. mRNA levels of IFNs, RANTES, interferon regulatory transcription factor (IRF)3, IRF7 and viral gene copy number were determined using real‐time polymerase chain reaction (RT‐PCR). PIV3 but not RV1B replication 48 h after infection was significantly lower (P < 0·01) in NECs from AR patients compared to HC. PIV3 infection induced significantly less IFN‐λ1 (both protein and mRNA) in NECs from AR compared to HC. IFN‐β mRNA expression and RANTES protein release and mRNA expression tended to be smaller in AR compared HC cells in response to both viruses. Stimulation with TLR‐3 agonist [poly (I:C)] induced similar IFN‐λ1 and RANTES generation in AR and HC subjects. Viral infections in NECs induced IRF7 expression, which correlated with IFN and RANTES expression. These data suggest that virus proliferation rates and the immune response profile are different in nasal epithelial cells from patients with allergic rhinitis compared to healthy individuals.
Properdin deficiency protects from 5‐fluorouracil‐induced small intestinal mucositis in a complement activation‐independent, interleukin‐10‐dependent mechanism

Intestinal mucositis is a serious complication of chemotherapy that leads to significant morbidity that may require dose or drug adjustments. Specific mitigating strategies for mucositis are unavailable, due partly to an incomplete understanding of the pathogenic mechanisms. We have previously shown an effect of properdin, a positive regulator of complement activation, in models of colitis. Here we use properdin‐deficient (PKO) mice to interrogate the role of properdin and complement in small intestinal mucositis. Mucositis was induced by five daily injections of 5‐fluorouracil (5‐FU) in wild‐type (WT), PKO, interleukin (IL)‐10–/– and properdin/IL‐10–/– double knock‐out (DKO) mice. At the time of euthanasia their jejunum was collected for histology, immunohistochemistry and cytokine and complement activation measurements. Complement became activated in mice receiving 5‐FU, indicated by increased intestinal levels of C3a and C5a. Compared to WT, PKO mice experienced significantly less mucositis, despite C3a levels as high as inflamed WT mice and slightly less C5a. Conversely, PKO mice had higher intestinal levels of IL‐10. IL‐10 expression was mainly by epithelial cells in both uninflamed and inflamed PKO mice. IL‐10–/– mice proved to be highly susceptible to mucositis and DKO mice were equally susceptible, demonstrating that a lack of properdin does not protect mice lacking IL‐10. We interpret our findings to indicate that, to a significant extent, the inflammation of mucositis is properdin‐dependent but complement activation‐independent. Additionally, the benefit achieved in the absence of properdin is associated with increased IL‐10 levels, and IL‐10 is important in limiting mucositis.
Overexpression of A kinase interacting protein 1 attenuates myocardial ischaemia/reperfusion injury but does not influence heart failure development.

AIMS A kinase interacting protein 1 (AKIP1) stimulates physiological growth in cultured cardiomyocytes and attenuates ischaemia/reperfusion (I/R) injury in ex vivo perfused hearts. We aimed to determine whether AKIP1 modulates the cardiac response to acute and chronic cardiac stresses in vivo. METHODS AND RESULTS Transgenic mice with cardiac-specific overexpression of AKIP1 (AKIP1-TG) were created. AKIP1-TG mice and their wild-type (WT) littermates displayed similar cardiac structure and function. Likewise, cardiac remodelling in response to transverse aortic constriction or permanent coronary artery ligation was identical in AKIP1-TG and WT littermates, as evidenced by serial cardiac magnetic resonance imaging and pressure-volume loop analysis. Histological indices of remodelling, including cardiomyocyte cross-sectional diameter, capillary density, and left ventricular fibrosis were also similar in AKIP1-TG mice and WT littermates. When subjected to 45 min of ischaemia followed by 24 h of reperfusion, AKIP1-TG mice displayed a significant two-fold reduction in myocardial infarct size and reductions in cardiac apoptosis. In contrast to previous reports, AKIP1 did not co-immunoprecipitate with or regulate the activity of the signalling molecules NF-κB, protein kinase A, or AKT. AKIP1 was, however, enriched in cardiac mitochondria and co-immunoprecipitated with a key component of the mitochondrial permeability transition (MPT) pore, ATP synthase. Finally, mitochondria isolated from AKIP1-TG hearts displayed markedly reduced calcium-induced swelling, indicative of reduced MPT pore formation. CONCLUSIONS In contrast to in vitro studies, AKIP1 overexpression does not influence cardiac remodelling in response to chronic cardiac stress. AKIP1 does, however, reduce myocardial I/R injury through stabilization of the MPT pore. These findings suggest that AKIP1 deserves further investigation as a putative treatment target for cardioprotection from I/R injury during acute myocardial infarction.
Heterogeneity of myocardial oxygen consumption in relation to local blood flow

Myocardial blood flow and oxygen consumption are heterogeneously distributed. Perfusion and myocardial oxygen consumption are closely correlated in the normal heart. It is unknown how this metabolism–perfusion relation is influenced by sympathetic denervation. We investigated this question in seven chloralose-anaesthetized dogs, 3–4 weeks after regional sympathetic denervation of the left circumflex coronary artery area of supply of the left ventricle. Measurements were made of local myocardial blood flow (MBF, in ml min −1 (g dry wt) −1 ), measured with microspheres, and myocardial oxygen consumption (MVO 2 , in μmol min −1 (g dry wt) −1 ) in the same location, calculated from the 13 C spectrum of tissue extracts after intracoronary infusion of 3– 13 C-lactate. Since both innervated and denervated regions are subject to the same arterial pressure, lower blood flow indicates higher resistance. Mean MBF was 5.56 ml min −1 (g dry wt) −1 (heterogeneity of 3.47 ml min −1 (g dry wt) −1 ) innervated, 7.48 ml min −1 (g dry wt) −1 (heterogeneity of 3.62 ml min −1 (g dry wt) −1 ) denervated (n.s.). Significant linear relations were found between MBF and MVO 2 of individual samples within the innervated and denervated regions. The slopes of these relations were not significantly different, but the adjusted mean was significantly higher in the denervated regions (+1.92 ml min −1 (g dry wt) −1 , an increase of38%of the mean MBF at the pooled mean MVO 2 ,P =0.028, ANCOVA). The ratio MBF/MVO 2 (in ml μmol −1 ) was significantly higher, being 0.296 ± 0.167 ml μmol −1 in the denervated region compared with the innervated region, 0.216 ± 0.126 ml μmol −1 , P =0.0182, Mann–Whitney U test. These results indicate that sympathetic tone under chloralose anaesthesia imposes a moderate vasoconstrictive effect in the myocardium that is not detected by comparison of the mean blood flow or resistance.
Síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) y su relación con complicaciones perioperatorias: revisión de la literatura

The aim of this article is to make a literature review of the importance of Obstructive Sleep Apnea-Hypopnea Syndrome (OSA) in the population that will be taken to surgery and how to detect preoperatively patients at high risk for perioperative complications by the STOP-BANG questionnaire. Thus, we performed a search in PubMed, Science and SciELO databases. OSA is a major medical problem with variable prevalence (up to 26 % in the general population depending on the centre where they are evaluated). It is a disease with an insidious and progressive onset, in which there are recurrent episodes of apneas or hypopneas caused by obstruction of the upper airway during sleep, resulting in a significant impairment of quality of life. Therefore, we want to assess whether this instrument can be used to identify, preoperatively, patients who have perioperative complications, probably because it identifies patients with undiagnosed OSA.
MULTIPLE FORMS OF GLUCAGON-LIKE PEPTIDE-1 AND GLUCAGON-LIKE IMMUNOREACTIVITIES IN CANINE GASTROINTESTINAL TRACT AND THEIR RELEASE INTO CIRCULATION

The distribution in the canine small intestine of glucagon-like peptide-l (GLP-1) and glucagon-like immunoreactivities (GLI), coencoded by the mammalian preproglucagon gene, and their release into the regional mesenteric vein were investigated. GLP-l immunoreactivity (GLP-l-IR) and GLI were present in high concentra-tion in the ileum and colon. Plasma levels of GLP-l-IR and GLI in the mesenteric vein drained from the ileum were elevated in parallel after the instillation of glucose. Gel permeation and reverse phase high pressure liquid chromatography (HPLC) of the ileal extract revealed one major peak of GLP-l-IR that coeluted with synthetichuman GLP-l-(1-37). In the mesenteric plasma, the amount of another form, chromatographically different from GLP-l-(1-37) and GLP-l-(7-36 amide), was increased by the intra-ileal infusion of glucose. Similarly, GL1 in the tissue and plasma consisted of at least four different molecular forms. These observations suggest that the intestine stores and secretes GLP-l-IR and GLI with several molecular forms as the cleavage products of their common precursor, preproglucagon.
Behavioral science in clinical medicine

Reading is a hobby to open the knowledge windows. Besides, it can provide the inspiration and spirit to face this life. By this way, concomitant with the technology development, many companies serve the e-book or book in soft file. The system of this book of course will be much easier. No worry to forget bringing the behavioral science in clinical medicine book. You can open the device and get the book by on-line.
Serogrupos y susceptibilidad antimicrobiana en cepas de Shigella

INTRODUCTION: Shigella ssp. is one of the more important causal agents of acute diarrhea in children. Present research has as aim to know serogroups frequency and antimicrobial susceptibility to choice drugs, and to its alternatives. METHODS: A descriptive retrospective study was carried out between January 2004 and December 2006 of 34 strains of Shigella isolated from children lower than 5 years admitted in "Aleida Fernández Chardiet" Hospital in Güines Municipality by acute diarrheic disease. RESULTS: Serogroups included S. sonnei (70,5%), and S. flexeneri (29,5%). Both serogroups showed high levels of resistance to Trimethoprim-Sulfamethoxaxole and to Ampicillin and to in strains of S. sonnei there was resistance to nalidixic acid, and in that of S. flexeneri, to Chloramphenicol. All strains showed high percentages of sensibility to Cephtriaxone, Norphloxacine, and to Cyprophloxacine. The 70% of strains of S. sonnei were multi-resistant. Multiresistance pattern (Ampicillin, Trimetroprim-Sulfamethoxaxole and nalidixic acid) was present in both serogroups. CONCLUSIONS: Assessment and surveillance of resistance patterns allow control of policy on use of antibiotics in study region, and to foresee rise of strains resistant to new generation-drugs.
Association of subdural hematoma with increased mortality in lobar intracerebral hemorrhage.

OBJECTIVE To determine the prevalence of subdural hematoma (SDH) in patients presenting with primary nontraumatic lobar intracerebral hemorrhage (ICH) and characteristics associated with the presence of SDH. DESIGN Retrospective analysis of data collected in a prospective cohort study. SETTING Hospital. PATIENTS Consecutive sample of 200 patients with primary lobar ICH and 75 patients with deep hemispheric ICH. MAIN OUTCOME MEASURES Presence of SDH and mortality. RESULTS Subdural hematoma was present in 40 of 200 patients (20%) with primary lobar ICH. By contrast, SDH was not present in any of 75 consecutive patients with deep hemispheric ICH (P < .001 for comparison with lobar ICH). Intracerebral hemorrhage volume higher than 60 cm3 was the only independent predictor of SDH (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.14-6.34; P = .02). Subdural hematoma thickness more than 5 mm was an independent predictor of increased 30-day mortality (OR, 7.60; 95% CI, 1.86-30.99; P = .005) after controlling for other factors including ICH volume. Further analysis showed that the effect of SDH on mortality depended on ICH volume, with larger odds for mortality in those with low ICH volume (OR, 12.85; 95% CI, 2.42-68.23; P = .003 for those with ICH volume <30 cm3). Cerebral amyloid angiopathy was present in 8 of 9 patients with pathological specimens. CONCLUSIONS Nontraumatic SDH frequently accompanies primary lobar ICH and is associated with higher 30-day mortality, particularly when the ICH volume is relatively low. Rupture of an amyloid-laden leptomeningeal vessel, with extravasation into the brain parenchyma and subdural space, may be the pathogenic mechanism.
Nursing ethics through the life span

I. MORAL PATHWAYS IN NURSING. 1. The Moral Significance of Nursing. 2. Models of Professional Relationships. 3. Self-Interest Morality. 4. Virtue Ethics in Nursing. 5. Consequentialist or Utilitarian Ethics. 6. Duty-Based Ethics: Universal Moral Principles. 7. Rights-Based Ethics. 8. Ethical Decision Making in Nursing. II. NURSING ETHICS THROUGH THE LIFE SPAN. 9. Nursing Ethics in the Procreative Family. 10. Ethics and the Problem of Abortion. 11. Ethical Issues in the Nursing Care of Infants. 12. Ethical Issues in the Nursing Care of Children. 13. Ethical Issues in the Nursing Care of Adolescents. 14. Ethical Issues in the Nursing Care of Adults. 15. Ethical Issues in the Nursing Care of the Elderly. 16. Ethical Issues in the Nursing Care of the Dying. Glossary of Selected Terms. Appendix. Index.
Characteristics of established and proposed sporadic Creutzfeldt-Jakob disease variants.

BACKGROUND The classic Creutzfeldt-Jakob disease (CJD), Heidenhain, and Oppenheimer-Brownell variants are sporadic CJD (sCJD) phenotypes frequently described in the literature, but many cases present with neuropsychiatric symptoms, suggesting that there may be additional sCJD phenotypes. OBJECTIVE To characterize clinical, diagnostic, and molecular features of 5 sCJD variants. DESIGN Retrospective analysis. SETTING The Johns Hopkins and Veterans Administration health care systems. PARTICIPANTS Eighty-eight patients with definite or probable sCJD. MAIN OUTCOME MEASURES Differences in age at onset, illness progression, diagnostic test results, and molecular subtype. RESULTS The age at onset differed among sCJD variants (P = .03); the affective variant had the youngest mean age at onset (59.7 years). Survival time (P < .001) and the time to clinical presentation (P = .003) differed among groups. Patients with the classic CJD phenotype had the shortest median survival time from symptom onset (66 days) and those who met criteria for the affective sCJD variant had the longest (421 days) and presented to clinicians significantly later (median time from onset to presentation, 92 days; P = .004). Cerebrospinal fluid analyses were positive for 14-3-3 protein in all of the affective variants, regardless of illness duration. Periodic sharp-wave complexes were not detected on any of the electroencephalography tracings in the Oppenheimer-Brownell group; basal ganglia hyperintensity was not detected on brain magnetic resonance imaging in this group either. All of the Heidenhain variants were of the methionine/methionine type 1 molecular subtype. CONCLUSIONS The classic CJD phenotype and the Heidenhain, Oppenheimer-Brownell, cognitive, and affective sCJD variants differ by age at disease onset, survival time, and diagnostic test results. Characteristics of these 5 phenotypes are provided to facilitate further clinicopathologic investigation that may lead to more reliable and timely diagnoses of sCJD.
The drug-minded protein interaction database (DrumPID) for efficient target analysis and drug development

The drug-minded protein interaction database (DrumPID) has been designed to provide fast, tailored information on drugs and their protein networks including indications, protein targets and side-targets. Starting queries include compound, target and protein interactions and organism-specific protein families. Furthermore, drug name, chemical structures and their SMILES notation, affected proteins (potential drug targets), organisms as well as diseases can be queried including various combinations and refinement of searches. Drugs and protein interactions are analyzed in detail with reference to protein structures and catalytic domains, related compound structures as well as potential targets in other organisms. DrumPID considers drug functionality, compound similarity, target structure, interactome analysis and organismic range for a compound, useful for drug development, predicting drug side-effects and structure–activity relationships. Database URL: http://drumpid.bioapps. biozentrum.uni-wuerzburg.de