Miracle-dz/UniFAR-FTUs huggingface dataset:
Aseptic Viral Meningitis Secondary to Herpes Simplex Virus 2 Genital Infection

Aseptic viral meningitis is the most common cause of meningitis in the United States. Most cases of herpes simplex virus meningitis are caused by herpes simplex virus type 2 (HSV-2), with HSV-1 primarily causing viral encephalitis. In this report, we present a case of aseptic meningitis generated by the HSV-2 in an immunosuppressed 35-year-old female with a recent diagnosis of genital herpes that was left untreated due to reported side effects of medication.
Incidence, Risk Factors, and Outcomes of Perioperative Atrial Fibrillation following Noncardiothoracic Surgery: A Systematic Review and Meta-Regression Analysis of Observational Studies

Background Atrial fibrillation (AF) occurs in 16–30% of patients after cardiac and thoracic surgery and can lead to serious complications like hypoperfusion of vital organs, pulmonary edema, and myocardial infarction. The evidence on risk factors and complications associated with perioperative AF after noncardiothoracic surgery is limited. Methods The primary objective was to determine demographic and clinical risk factors for new-onset atrial fibrillation associated with noncardiothoracic surgery. A secondary aim was to identify the incidence and odds of perioperative complications associated with the new-onset atrial fibrillation. A systematic search within multiple databases was conducted for studies that explicitly reported on new-onset atrial fibrillation after noncardiothoracic surgery. We reported data on demographics, comorbidities, and perioperative complications as mean difference (MD) or odds ratios (OR) and corresponding 95% confidence interval (CI) using random effects models. A two-sided P value of less than 0.05 was considered significant. We performed meta-regression and sensitivity analysis of various subgroups to confirm the inference of our findings. Results Eleven studies reporting on 121,517 patients were included, of whom 2,944 developed perioperative AF (incidence rate: 3.7%; 95% CI: 2.3%––6.2%). Advanced age (AF group versus control group: 69.36 ± 10.5 versus 64.37 ± 9.53 years; MD: 4.06; 95% CI: 1.67––6.44; P=0.0009), male gender (52.85% versus 43.59%; OR: 1.08; 95% CI: 0.54 to 1.62; I2: 84%; P < 0.0001), preoperative hypertension (60.42% versus 56.51%; OR: 1.15; 95% CI: 1.08 to 1.23; I2: 0%; P < 0.00001), diabetes mellitus (22.6% versus 23.04%; OR: 0.97; 95% CI: 0.89 to 1.05; I2: 0; P < 0.00001), and cardiac disease (30.64% versus 8.49%; OR: 2.3; 95% CI: 0.28 to 4.31; I2: 93%; P=0.03) were found to be significant predictors for perioperative AF. The AF group was at increased odds of developing postoperative cardiac complications (34.1% versus 5%; OR: 5.44; 95% CI: 0.49 to 10.39; I2: 82%; P=0.03), postoperative stroke (0.5% versus 0.1%; OR: 3; 95% CI: 0.65 to 5.35; I2: 0%; P=0.01), and mortality (7.40% versus 1.92%; OR: 3.58; 95% CI: 0.14 to 7.02; I2: 0%; P=0.04). Study quality assessment by meta-regression and sensitivity analysis of the various subgroups did not affect the final inference of the results. Conclusion We identified advanced age, male gender, preoperative hypertension, diabetes mellitus, and cardiac disease as important risk factors for perioperative atrial fibrillation. The atrial fibrillation group was at increased odds for postoperative cardiac complications, stroke, and higher mortality, emphasizing the need for risk stratification and close monitoring.
Combining Cyclosporine With Ustekinumab in Acute Severe Ulcerative Colitis

ABSTRACT We have demonstrated the effectiveness and safety of combining cyclosporine and vedolizumab to treat ulcerative colitis (UC). We present 2 cases of hospitalized acute severe UC who had failed therapy with antitumor necrosis factor and vedolizumab and were treated successfully with induction cyclosporine and safely bridged to ustekinumab maintenance therapy. Both patients have avoided colectomy. There were no adverse events. We propose this novel treatment combination in medically resistant acute severe UC.
Lidocaine Infusion Improves the Functionality of Intraoperative Nerve Monitoring During Thyroid Surgery: A Prospective, Randomized, Double-Blinded Study

Background Intraoperative nerve monitoring (IONM) to assess the recurrent laryngeal nerve function during thyroid surgery is becoming the standard of care across many institutions. The successful deployment and data analysis from the IONM require complete laryngeal relaxation and reflex suppression. We investigated the role of intravenous lidocaine infusion (IVLI) to provide such operating conditions, under a lighter plane of anesthesia and fewer hemodynamic fluctuations. Methods Sixty-five patients were randomly assigned to lidocaine group (LG) or placebo group (PG) based on the computer-generated coding developed by the pharmacy department. The study medication (SM) was delivered by the pharmacist in a pre-filled coded syringe to the investigator 30 min prior to the surgery. All the patients were anesthetized by narcotic and inhalation based general anesthesia. The SM was administered at the rate of 1.5mg/kg/h following a loading dose of 1 mg/kg. Dragonfly® laryngeal surface electrode and Nerveana® nerve locator system were used for IONM during surgery. Results The proportion of patients requiring lower strength stimulating current (StMC) at 0.5 mA was significantly higher in the LG than in the PG (X2 (1, N = 61) = 10.1615, P = 0.001434). Similarly, the proportion of patients with the drop in the aggregate impedance level (DAIL) by < 50% at the end of surgery was significantly higher in the LG than in the PG (X2 (1, N = 61) = 15.982, P = 0.000064). In addition, the proportion of patients with the hypotensive episodes requiring rescue medications more than twice during surgery was significantly lower in the LG than in the PG (X2 (1, N = 61) = 0.0183, P < 0.05). Conclusions The enhanced laryngeal relaxation and the reflex suppression afforded by the IVLI could have enabled a lower StMC to elicit a positive signal. The lower StMC promotes less intense laryngeal alterations as evidenced by the lower DAIL in the LG. IVLI can enhance the functionality of the IONM during prolonged operating time and the resultant increased number of IONM stimulations, while providing a stable hemodynamic environment.
Late-Onset Isolated Corticotrope Deficiency in a Woman with Down Syndrome

Isolated corticotrope deficiency is a rare cause of secondary adrenocortical insufficiency. Its occurrence in patients with Down syndrome is exceptional. Herein, we report a case of an isolated corticotrope deficiency diagnosed at the age of 33 years in a woman with Down syndrome and discuss its possible mechanisms. A 33-year-old woman with Down syndrome was referred to our department for the investigation of low blood pressure. She complained of asthenia, dizziness, and palpitation with arterial hypotension for the past 4 years. The thyroid function was normal and anti-thyroperoxidase antibodies were negative. The peak of cortisol level in response to the insulin-induced hypoglycemia test was 9.4 μg/dl. ACTH level was normal, indicating corticotrope deficiency. Other pituitary hormones were normal. Magnetic resonance imaging scan revealed a partially empty sella turcica. Genetic analysis showed no mutations and no copy number variants of the TBX19 and NFKB2 genes. The mechanism of isolated corticotrope deficiency is unclear, but it may be induced by autoimmune mechanism in similar to other disorders of patients with Down syndrome.
Resin Composite Materials for Chairside CAD/CAM Restorations: A Comparison of Selected Mechanical Properties

Objective The aim was to evaluate the flexural strength, flexural modulus, microhardness, Weibull modulus, and characteristic strength of six resin composite blocks (Grandio Blocs-GR, Tetric CAD-TE, Brilliant Crios-CR, Katana Avencia-AV, Cerasmart-CS, and Shofu Block HC-HC). Methods Flexural strength and flexural modulus were measured using a three-point bending test and microhardness using the Vickers method. Weibull analysis was also performed. Results The materials showed flexural strength ranging from 120.38 (HC) to 186.02 MPa (GR), flexural modulus from 8.26 (HC) to 16.95 GPa (GR), and microhardness from 70.85 (AV) to 140.43 (GR). Weibull modulus and characteristic strength ranged from 16.35 (CS) to 34.98 (TE) and from 123.45 MPa (HC) to 190.3 MPa (GR), respectively. Conclusions GR, TE, and CR presented significantly higher flexural strength, modulus, Weibull modulus, and characteristic strength than the others.
An Investigator-Initiated, Prospective, Single-Center, Open-Label Clinical Study to Evaluate Safety and Performance of Intra-Articular Hyaluronic Acid (IA-HA) (Biovisc Ortho) in Patients with Osteoarthritis (OA) of the Knee

Objective IA-HA is injected into the osteoarthritis knee as a viscosupplementation for therapeutic purposes. This clinical trial was carried out for evaluating the efficacy and safety of Biovisc Ortho IA-HA (20 mg/2 mL) in a 2 mL prefilled syringe. Design The study was conducted as an open-label, single-center, single-arm clinical trial in India. Patients of knee OA with moderate to severe symptoms for a minimum duration of 3 months were included in the study. Five visits were conducted at weekly intervals and the investigational product was administered at each visit. Two follow-up visits were conducted at 3 and 6 months after the completion of the last injection cycle. The primary outcome variable was change in KOOS pain score from baseline. The secondary outcome variables were analyzed for other KOOS scales and safety of the device. Results Change in KOOS pain score at 6 months from baseline was 29.71±15.74 and the change in mean KOOS score for pain was statistically significant (p<0.0001) for all post-baseline visits. Statistically significant improvement was observed for mean values of efficacy assessments (KOOS) during the study period (6 months) for all the domains evaluated, including pain, joint function and quality of life. Conclusion Despite being an open, noncomparative study, the safety and efficacy results of IA-HA establish the therapeutic effect of the treatment throughout the study period of 6 months and are safe.
Cough, coronavirus disease 2019, the vaccines, and allergy

https://apallergy.org Cough is a physiological defense mechanism, and one of the most common symptoms for seeking a medical service. The common etiology of chronic cough could be related with allergic diseases such as asthma, upper airway cough syndrome due to allergic rhinitis, non-allergic rhinitis, or chronic rhinosinusitis, and eosinophilic bronchitis. In this issue, Won and Song [1] features the impact and disease burden of chronic cough. Readers will enjoy the journey composed of the physiologic and pathologic cough, cough duration, cough hypersensitivity syndrome, its impact, and patients’ experience. Because cough is one of the most common symptoms of coronavirus disease 2019 (COVID-19), people with chronic cough can experience more isolation from their colleagues, friends and even family. Readers will also find out the voices of patients with chronic cough in the time of COVID-19.
Spiritual Well-Being and Associated Factors in End-Stage Renal Disease

People with CKD depend on religion and spirituality to deal with their chronic illness, and those are essential means of coping for those living with chronic diseases. The present study aims to evaluate ESRD patients' spiritual wellbeing undergoing hemodialysis treatment and to identify critical variables associated with the spiritual wellbeing of those patients. Methods. A cross-sectional study was conducted, in which 367 patients undergoing HD participated. Patients were randomly selected from six HD units in various geographical areas of Greece. Data were collected through an anonymous self-completed questionnaire consisting of two parts. The first part contained questions regarding demographic, social, and clinical information such as age, gender, marital status, and duration of dialysis comorbidities. The second part assessed the patients' spiritual wellbeing with the use of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12. Multivariate analysis was performed to extract predictors or determinants of spiritual wellbeing of hemodialysis patients. Results. From the total of the 367 participants, 228 (62.1%) were males and 139 (37.9%) were females, and the mean age was 61.80 ± 15.11. Spiritual wellbeing had a mean value of 30.55 (SD = 8.22), which means that patients had a satisfactory spiritual wellbeing level. Multivariate analysis revealed that place of residence, marital status, educational level, and comorbidities could predict spiritual wellbeing in ESRD patients. Conclusions. There is much evidence in the literature supporting the positive effect of spirituality, health (physical and mental), and quality of life. Integration of spiritual wellbeing evaluation and spiritual care in everyday practice as a part of clinical care can increase the quality of the provided care and improve health outcome for patients undergoing hemodialysis.
SGLT2 promotes cardiac fibrosis following myocardial infarction and is regulated by miR-141

Cardiac fibrosis is a primary event during myocardial infarction (MI) progression, which impairs cardiac function. The present study aimed to investigate the effect of SGLT2 on cardiac ﬁbrosis following MI. To validate the role of SGLT2 in the regulation of cardiac fibrosis in vivo, an MI rat model was established. Echocardiography was performed to determine cardiac function at 4 weeks post-MI. MI model rats were transfected with short hairpin RNA (sh)-SGLT2 or sh-negative control lentiviruses to investigate the effect of SGLT2 on rat heart function post-MI. Subsequently, the effects of SGLT2 on the cardiac fibrosis of infarcted hearts were assessed by performing Masson's trichrome staining. To further clarify the effect of SGLT2 on cardiac fibroblast proliferation, TGFβ was used to stimulate primary cardiac fibroblasts in vitro. The results demonstrated that SGLT2 served a key role in cardiac fibrosis. SGLT2 expression levels in infarct tissues were significantly increased at week 1 post-MI compared with the sham group. Compared with the control group, SGLT2 knockdown attenuated cardiac ﬁbrosis by inhibiting the expression of collagen I and collagen III in cardiac fibroblasts in vitro and in vivo. Furthermore, the results indicated that SGLT2 expression was modulated by miR-141 in cardiac fibroblasts. In summary, the present study indicated that upregulated SGLT2 expression in cardiac fibrosis following MI was regulated by miR-141 and SGLT2 that knockdown reduced cardiac fibrosis and improved cardiac function after MI.
The Controversial Role of Glucose-6-Phosphate Dehydrogenase Deficiency on Cardiovascular Disease: A Narrative Review

Cardiovascular disorders (CVD) are highly prevalent and the leading cause of death worldwide. Atherosclerosis is responsible for most cases of CVD. The plaque formation and subsequent thrombosis in atherosclerosis constitute an ongoing process that is influenced by numerous risk factors such as hypertension, diabetes, dyslipidemia, obesity, smoking, inflammation, and sedentary lifestyle. Among the various risk and protective factors, the role of glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common inborn enzyme disorder across populations, is still debated. For decades, it has been considered a protective factor against the development of CVD. However, in the recent years, growing scientific evidence has suggested that this inherited condition may act as a CVD risk factor. The role of G6PD deficiency in the atherogenic process has been investigated using in vitro or ex vivo cellular models, animal models, and epidemiological studies in human cohorts of variable size and across different ethnic groups, with conflicting results. In this review, the impact of G6PD deficiency on CVD was critically reconsidered, taking into account the most recent acquisitions on molecular and biochemical mechanisms, namely, antioxidative mechanisms, glutathione recycling, and nitric oxide production, as well as their mutual interactions, which may be impaired by the enzyme defect in the context of the pentose phosphate pathway. Overall, current evidence supports the notion that G6PD downregulation may favor the onset and evolution of atheroma in subjects at risk of CVD. Given the relatively high frequency of this enzyme deficiency in several regions of the world, this finding might be of practical importance to tailor surveillance guidelines and facilitate risk stratification.
Dry Eye Treatment with Topical Cyclosporine 0.1% in Chondroitin Sulfate Ophthalmic Emulsion

Purpose To evaluate the efficacy of topical cyclosporine 0.1% in chondroitin sulfate emulsion for the treatment of dry eye. Methods This retrospective multicenter study included 100 eyes of 50 dry eye patients aged ≥18 years, with preoperative ocular surface disease index (OSDI) score >12 or corneal staining grade >1 (in either eye) who underwent dry eye treatment with topical cyclosporine 0.1% in chondroitin sulfate emulsion (Klarity-C, ImprimisRx) for 3 months. Postoperative evaluation included comparison of the changes in OSDI score and corneal staining grade after 3 months of treatment from baseline. Results From baseline to 3 months, a statistically significant improvement in mean OSDI scores (38.19 vs 24.18, p <0.001) as well as mean corneal staining grade (3.62 vs 2.20, p <0.001) was observed. The proportion of subjects with severe dry eye decreased from 62% to 20% and more than one-third (34%) of patients were in the normal OSDI range. The percentage of eyes with corneal staining grade of 2 or 3 decreased from 21% (baseline) to 8% at 3 months; 50% of the eyes had corneal staining grade of 0. The treatment was found to be safe with no adverse events observed in the study. Conclusion Dry eye treatment with twice daily cyclosporine 0.1% in chondroitin sulfate emulsion was found to be safe and effective in reducing signs and symptoms of dry eye.
The changing face of Australian data reforms: impact on pharmacoepidemiology research

Abstract Objective A wealth of data is generated through Australia’s universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia’s Pharmaceutical Benefits Scheme (PBS) data (2014–2018) and discussed these outputs in the context of previously implemented and new data reforms. Methods We conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus. Results We identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review. Conclusions The studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.
Severe Cystic Echinococcosis-Associated Immune Thrombocytopenic Purpura: A Case Report

We present a case of immune thrombocytopenic purpura (ITP), which leads to the diagnosis of severe cystic echinococcosis. Our patient presented with platelets of 5 × 109/L, and investigations uncovered multiple large echinococcal hepatic cysts, the largest of which measured 19.4 × 15 × 12 cm, and peritoneal implants. While initially refractory to prednisone and immunoglobulins, the ITP responded to dexamethasone. The echinococcosis was treated with albendazole followed by surgical resection of all lesions. Our patient’s disease course has evolved favorable since his initial treatment with an isolated episode of recurrent thrombocytopenia 2 years later, and has remained in remission for the past 2 years. While a causal association between echinococcosis and ITP cannot be confirmed, this case is a reminder of the importance of remaining inquisitive for atypical potential triggers of ITP. We also present a review of the limited literature on the association of parasitic infections and ITP.
The effect of gamma ray on total leukocytes, lymphocytes and neutrophils on blood samples of smokers compared to non-smoker donors

Background: The immune system depends on white blood cells (WBCs) to fight infections in the human body. Smoking tobacco causes the increasing of WBCs comparing with nonsmokers due to virus infection and bronchitis. Exposing blood samples of smokers and non-smokers donors to gamma-ray (γ-ray) will affect the structure of the WBCs then as a result will cause the declination in the values of total leukocytes, lymphocytes, and neutrophils in the smokers' blood is greater than of nonsmokers and this confirms that these cells are more fragile, weak, and less tolerant to external stimuli. Objectives: The objective of this study is to compare the effects of increasing doses of γ-ray on total leukocyte, neutrophil, and lymphocyte count between smokers and non-smokers. Materials and Methods: Ethylenediaminetetraacetic acid blood samples were collected from healthy donors: Ten smokers and ten nonsmokers. Samples of both groups were exposed to incremental doses of γ-ray (5–40 Gy). Total and differential leukocyte count for each sample was performed by autoanalyzer. Results: Smokers had higher average total leukocyte, lymphocyte, and neutrophil counts than nonsmokers before exposure to radiation. However, they showed more decline than nonsmokers after exposure to increasing doses of γ-ray. Conclusions: By increases the doses of γ-ray, the declining in the values of WBCs, lymphocytes, and neutrophils in the smokers blood is greater than of nonsmokers and this confirms that these cells are more fragile, weak, and less tolerant to external stimuli.