Miracle-dz/UniFAR-FTUs huggingface dataset:
Trombo en aurícula derecha en paciente pediátrico con leucemia linfoblástica aguda. ¿Cuál tratamiento elegir: trombolisis o cirugía?

Right side atrial thrombus in the pediatric population represents an unusual disease process with high morbidity and mortality. The mainstays of therapy include surgical thrombectomy and thrombolysis, with no clear beneit of one over the other. We present a detailed case report of a ive-year-old child, with the diagnosis of acute lymphoblastic leukemia in which a large catheter-related right thrombus was treated by surgical thrombectomy after failed thrombolysis. Relevant literature is reviewed.
Treatment of mucopolysaccharidosis type III (Sanfilippo syndrome)

Introduction: Mucopolysaccharidosis type III (MPS III or Sanfilippo syndrome or Sanfilippo disease) is caused by a deficiency in one of four enzymes involved in heparan sulfate (HS) degradation, leading to lysosomal HS accumulation. MPS III is characterized by severe central nervous system (CNS) disease, leading to progressive neurocognitive deterioration. Patients show a broad spectrum of disease progression and severity. To date, no disease modifying treatment is available for MPS III. Areas covered: An overview of the different pathophysiological mechanisms involved in MPS III is presented. We discuss the different therapies for MPS III which are currently being investigated, either in animal models or in clinical trials and the advantages and limitations of each therapeutic approach. Expert opinion: The blood–brain barrier (BBB) is the bottleneck in the development of drugs for MPS III and a number of very promising approaches to target the BBB are currently studied. To assess the full therapeutic potentials of any drug or combination of drugs, trials including very early diagnosed or even fully asymptomatic patients in combination with information on the natural history of the disease are necessary. However, almost all MPS III patients are diagnosed because of developmental delay with behavioral difficulties. At that time substantial and irreversible damage to the central nervous system (CNS) may already be present. In the best case scenario, disease-modifying therapy may only halt disease progression. Early diagnosis and initiation of treatment are therefore essential. This will only be feasible through family screening and perinatal diagnosis of patients' siblings or, in the general population, via newborn screening.
Prognostische indicatoren van primair mammacarcinoom in relatie tot het risicoprofiel van patiënten = Prognostic indicators of primary breast cancer in relation to patient's risk profile

In chapter 2 is described that patients with tumours with non-cT4/pT4 skin involvement, but with dermal lymphatic involvement had a particularly dismal prognosis similar to that of patients with cT4/pT4 breast cancers. Therefore, this type of tumour should be included into the UICC/TNM cT4/pT4 category. In Chapter 3 is described that mitotic indices did not show better results compared to histological grade in respect to prognosis and therefore, changing of guidelines for treatment of breast cancer in favour of the mitotic indices in stead of histological grade is not recommended. In chapter 4 a review of the literature is presented concerning the prognostic impact of micro-metastases. In only one of eight studies, occult metastases were an independent risk factor for reduced survival. However, the outcome was dependent on the size of the nodal metastasis. In chapter 5 the pathology protocol which was used to examine the sentinel node (SN) was studied in four hospitals. In the hospital with the more intensified examination of the SN more patients were diagnosed with a positive SN, which resulted in more completion axillary lymph node dissections, but more positive non-SNs. Whether additional surgery and upstaging of a part of the breast cancer cases can offer better survival for the patients remains to be determined. In chapter 6-8 the findings of prophylactic mastectomy specimen in patients with a high risk for developing breast cancer are presented. The prevalence of high-risk lesions was high, equal in women with a BRCA1 or a BRCA2 mutation, but even higher in non-BRCA mutation carriers and was positively correlated with age older than 40 years. In chapter 9 the pathological examination of prophylactically removed breasts, with specimen radiography, is described in detail. This procedure made it possible to detect normally occult high-risk lesions as described in chapter 6-8.
Resolving the mysteries of the renin-angiotensin system in diabetes

In 1985, Luetscher et al. reported that an increase in plasma prorenin levels predicts the development of nephropathy and retinopathy in diabetic patients, and since then many studies have reported similar findings. However, why an elevated plasma prorenin level predicts diabetic microvascular complications remained unclear. On the other hand, low plasma renin levels were observed when diabetic microvascular complications developed, suggesting that it was not necessary for the circulating renin-angiotensin system (RAS) to be elevated. Nevertheless, many clinical studies have reported that RAS inhibitors have a protective effect on the kidneys of diabetic patients. These findings suggest that in diabetic kidneys, the tissue RAS must be activated independently of the circulating RAS. However, the mechanism accounting for the circulating RASindependent regulation of the tissue RAS also remained undetermined. Previous studies in transgenic rats over-expressing prorenin in the liver showed that elevated plasma prorenin levels caused end-organ damage in the heart and kidneys without hypertension or plasma RAS activation. An intravenous infusion of prorenin had no effect on blood pressure or plasma renin activity. Thus, prorenin can stimulate the tissue RAS and subsequent end-organ damage independently of the circulating RAS. We then focused on prorenin as a key factor in the development of diabetic microvascular complications.
Prevalence and Genotype Identification of Toxoplasma gondii in Wild Animals from Southwestern Spain

Abstract We used PCR to detect Toxoplasma gondii in the principal game species in southwestern Spain. We detected T. gondii in 32.2% of animals tested. Prevalences varied from 14.7% in wild boar (Sus scrofa) to 51.2% in red fox (Vulpes vulpes). The most prevalent genotype was type II (50.0%), followed by type III (20.6%) and type I (5.9%). Mixed infections (11.8%) were detected in wild boar (types I+III) and red fox (types II+III). Polymorphic strains (11.8%) were detected in several species. The high prevalence and the genetic variability shown could have implications for infection of farm animals and humans.
Novel Sequence Types of Chlamydia pecorum Infect Free-Ranging Alpine Ibex (Capra ibex) and Red Deer (Cervus elaphus) in Switzerland

Abstract Chlamydia pecorum, a recognized pathogen of domesticated ruminants and koalas (Phascolarctos cinereus), has been recently reported in a broad range of other wildlife species including water buffalo (Bubalus bubalis), ibex (Capra ibex), chamois (Rupicapra rupicapra), red deer (Cervus elaphus), and birds. This identification raises questions as to whether cross-host transmission may be a factor in the epidemiology of infections in these species. To begin to address this question, we employed a C. pecorum species-specific multi-locus sequence typing (MLST) scheme to characterize a small collection of C. pecorum-positive samples from wild, free-range ibex, a chamois, and a red deer from Grison, Switzerland, a canton where domesticated and wild ruminants graze in close proximity during the summer. Screening by PCR confirmed low to moderate levels of Chlamydia pecorum DNA in the eyes of healthy ibex (n = 4) and in the deer fecal sample (n = 1). The MLST analysis revealed three novel sequence types (STs; 88, 90, and 89) in these samples. On phylogenetic analysis, the ibex and deer sequences clustered by host species in their own well-supported clades and away from C. pecorum STs found in other hosts. Even though the analyzed sample size was small, the identification of unique C. pecorum STs infecting free-ranging Alpine ibex and red deer provides useful information for further C. pecorum epidemiologic studies.
Evaluation of the population based integrated Care System “Gesundes Kinzigtal”: Results from the health care utilisation study over six years of observation

Background: TheGesundes Kinzigtal Integrated Care' (GKIC) is a complex population based intervention implemented in the Kinzigtal region in Baden-Wuerttemberg (federal state of Germany in the south west). Central aims of GKIC are to increase the quality of care and to improve the health status of the population. It started in 11/2005. Different to most of the other IC-programs, GKIC is responsible for all insurants of the two cooperating health insurers (AOK and LKK Baden- Wuerttemberg) in the region. The contract between GKIC and the health insurers implied an extensive evaluation with different topics and methods applied (1). One of those evaluation projects aimed at analysing health care utilisation with respect to quality of care. The leading research questions was whether GKIC succeeds in improving the quality of care compared to usual care by reducing inappropriate services and enhancing therapy according to guidelines. Method: The evaluation is a quasi-experimental controlled study based on pseudonymised claims data of insurants of the both sickness funds (data reported for AOK; in 2011: 21,411 AOK insurants, of those: 5,268 members of the IC). For comparison, data of a control group (500,000 insurants) of the same sickness fund from the federal state Baden-Wuerttemberg was provided for adults (20 years and older). Indicators have been derived both from literature and evidence based guidelines. Recommendations for specialist visits, diagnostic procedures and medication recommendations were taken as process-related indicators. Hospital stay of patients with CHD, heart failure or diabetes (as ambulatory care sensitive conditions (2)), long term sick leave due to back pain and the fracture rate in osteoporosis patients have been chosen as outcome indicators. For descriptive analysis, controls were adjusted to the Kinzigtal population according to sex and age. For analytical purpose, further variables for adjustment (Charlson Index (3), multimorbidity) were applied.
The impact of parental education on infant mortality in Gaza strip, Palestine

A society's infant mortality rate is considered an important indicator of its health status. Maternal education has been accepted almost unanimously as a major socio-economic factor in infant mortality. In addition, it is one of the few measures of health status for which data are widely available in most countries. Many research studies have been done on this topic, but never in Palestine. This study was carried out in 2008 with the objective of determining the relationship between educational level of parents and infant mortality in the Gaza strip. Face to face interviews were carried out on 550 mothers of infants (275 dead infants and 275 live births) in the Gaza strip. Binary logistic regression analyses were used to identify the relationship between health behavioral factors and infant mortality. The result of this study showed that the families with lower educational level had a much higher risk of infant mortality. There was a positive statistical association between parental education and survival of infants. The findings underscore the importance of explicit attention to health education.
Seiberg-Witten invariants of generalised rational blow-downs

One of the main problems in Seiberg-Witten theory is to find (SW)-basic classes and their invariants for a given smooth 4-manifold. The rational blow-down procedure introduced by Fintushel and Stern is one way to compute these invariants for some smooth 4-manifolds. In this paper, we extend their results to the general case. That is, we find (SW)-basic classes and Seiberg-Witten invariants for generalised rational blow-down 4-manifolds by using index computations.
Health literacy: a study of internet-based information on advance directives.

AIM The aim of this study was to evaluate the quality and value of web-based information on advance directives. Internet-based information on advance directives was selected because, if it is inaccurate or difficult to understand, patients risk making decisions about their care that may not be followed in practice. METHOD Two validated health information evaluation tools, the Suitability Assessment of Materials and DISCERN, and a focus group were used to assess credibility, user orientation and effectiveness. FINDINGS Only one of the 34 internet-based information items on advance directives reviewed fulfilled the study criteria and 30% of the sites were classed as unreadable. In terms of learning and informing, 79% of the sites were considered unsuitable. CONCLUSION Using health literacy tools to evaluate internet-based health information highlights that often it is not at a functional literacy level and neither informs nor empowers users to make independent and valid healthcare decisions.
Role of endocrine therapy in ER+/HER2+ breast cancers

SUMMARY The ER+/HER2+ subtype accounts for up to 10% of all breast cancers and is an important subtype as these cancers have a worse prognosis than ER+/HER2- breast cancers. While there is now considerable preclinical and clinical evidence that ER+/HER2+ cancers exhibit intrinsic and acquired resistance to endocrine therapy, it remains unclear what is driving this resistance to therapy. Clearly this is a pressing clinical issue as endocrine therapy remains at the forefront of systemic treatment for all women with ER+ disease. However, the majority of patients with ER+/HER2+ disease do respond well to endocrine therapy. The challenge, therefore, is in identifying, early in the process of treatment decision-making, who will respond to endocrine therapy and who might benefit from combined endocrine and HER2-targeted agents.
Relying on informal care in the new century? Informal care for elderly people in England to 2031

The research reported here is concerned with the future of informal care over the next thirty years and the effect of changes in informal care on demand for formal services. The research draws on a PSSRU computer simulation model which has produced projections to 2031 for long-term care for England. The latest Government Actuary's Department (GAD) 1996-based marital status projections are used here. These projections yield unexpected results in that they indicate that more elderly people are likely to receive informal care than previously projected. The underlying reason is that the GAD figures project a fall in the number of widows and rise in the number of elderly women with partners. What this implies is that ‘spouse carers’ are likely to become increasingly important. This raises issues about the need for support by carers since spouse carers tend to be themselves elderly and are often in poor health. The article explores a number of ‘scenarios’ around informal care, including scenarios in which the supply of informal care is severely restricted and a scenario in which more support is given to carers by developing ‘carer-blind’ services. This last scenario has had particular relevance for the Royal Commission on Long Term Care.
Attitudes towards caring for older people in Scotland, Sweden and the United States.

AIM To explore the attitudes of nurses and nursing students in Scotland, Sweden and the US towards working with older people. METHOD This quantitative study used the 20-item Multifactorial Attitudes Questionnaire (MAQ) to elicit attitudes on ageism, resources, working environment, education and professional esteem. Researchers from each country distributed the questionnaires to nursing students and nurses, giving a convenience sample of 1,587 respondents. Data were entered on the Statistical Package for Social Sciences version 18 and merged into one large dataset. RESULTS Scottish participants had the highest (positive) and Swedish participants the lowest mean MAQ score. The Kruskal-Wallis test showed significant differences in mean scores across the countries in 18 of the 20 statements, even when controlling for age and experience. Most participants gave positive responses, but agreed that negative attitudes towards working with older people pervade among peers due to working conditions, poor career prospects and a perceived lack of professional esteem. CONCLUSION Inspirational educators, excellent clinical placements and increasing the professional esteem of those working with older people are required to promote the specialty as an attractive career option.
The Effect of Levothyroxin on Pulmonary Function Tests of Hypothyroid Patients

aim of the present study was to demine the effect of levothyroxin on pulmonary function of patients th hypothyroidism. aim of the present study was to determine the effect of levothyroxin on the pulmonary function of patients with hypothyroidism. Materials and Methods Materials and Methods: In this Quaziexperimental study, all patients who were diagnosed as hypothyroid for first time and had no history of known pulmonary disease or smoking or recent abdominal or chest surgery were recruited. Levothyroxin was prescribed for all patients (1.7 µg/kg). Spirometry was done with the standard methods for all patients at the beginning of the study and again after at least 3 months of euthyroidism. Results: 30 patients (24 females and 6 males) with a mean age of 37.5+12 years were studied. At the beginning of the study, 16 patients had mild restrictive pulmonary abnormalities and 10 patients had moderate restrictive pulmonary disease. 4 patients were normal. At the end of the study, the results of spirometry were normal in 12 patients and mild restrictive abnormalities were found in 14, and moderate restrictive abnormalities in 4 patients. Significant increases in FEV1, FVC and FEF25-75% were found after treatment with levothroxin (p<0.05), especially in patients over 40 years of age and those with a body mass index <30 kg/m2. Conclusion: This report shows that respiratory restrictive abnormalities are prevalent in hypothyroidism and may be reversible after treatment with levothyroxin.
Estudio comparativo entre dos fuentes alimentarias aportadoras de ácidos grasos poliinsaturados n-3 y su efecto sobre el timo y el perfil lipídico de ratas

In the present paper we analyzed the effect caused by different recovery diets enriched with n-3 polyunsaturated fatty acids (PUFA n-3) on thymus and serum lipid pattern. Severe depleted weanling Wistar rats (D) were divided in three groups that received during 10 days a 20% casein diet supplemented with EPA+DHA (group Cas), a 20% protein milk diet prepared using a commercial reduced-fat product enriched with linolenic and linoleic acids (group L) and a 20% casein diet as control group C. Cas and L gave each other 24 mg/day of PUFA n-3 being the ratio n-6/n-3 8.1/1 and 7.6/1, respectively. Thymus was removed and weighted and cell number were determined; blood was recollected and Total cholesterol, triacylglycerol, HDL and LDL-cholesterol fractions and myristic, palmitic, stearic, oleic, linoleic, linolenic, araquidonic, EPA and DHA fatty acid concentrations were measured in serum. Statistical analysis was performed using Anova test. Cell number were higher (p<0.01) in Cas (44.48+/-8.20) and in L (56.45+/-14.72) when compared to group D (1.80+/-0.70) and group C (23.70+/-4.04). L presented lower values of cholesterol, HDL and LDL-cholesterol (p<0.01) and higher values of triacylglycerol (p<0.05) when compared to Cas, being EPA (p<0.05) and DHA (p<0.01) higher in Cas. Being PUFA n-3 contribution the same in Cas and L, both diets were able to reverse the thymic athropy presenting a different hipolipemic behavior due to the different sources of PUFA n-3 used in the diets.
Engaging men with penile cancer in qualitative research: reflections from an interview-based study.

AIM To explore the challenges of engaging men with penile cancer in qualitative interview research. BACKGROUND Qualitative interviewing offers an ideal tool for exploring men's experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researcher's experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. REVIEW METHODS This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researcher's experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. IMPLICATIONS FOR PRACTICE/RESEARCH The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. CONCLUSION Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.
Variation of Kozinets' framework and application to nursing research.

BACKGROUND Online communities are new sites for undertaking research, with their textual interactions providing a rich source of data in real time. 'Ethnonetnography' is a research methodology based on ethnography that can be used in these online communities. In this study, the researcher and a specialist breast care nurse (SBCN) were immersed in the online community, adding to patients' breast cancer care and providing a nursing research component to the community. AIM To examine Kozinets' ( 2010 ) framework for ethnonetnography and how it may be varied for use in a purpose-built, disease-specific, online support community. DISCUSSION The online community provided an area where members could communicate with each other. Kozinets' ( 2010 ) framework was varied in that the research was carried out in a purpose-built community opf which an SBCN was a member who could provide support and advice. The application of the ethnonetnographic methodology has wide implications for clinical nursing practice and research. CONCLUSION Ethnonetnography can be used to study disease-specific communities in a focused manner and can provide immediate benefits through the inclusion of an expert nurse and contemporaneous application of research findings to patient care. IMPLICATIONS FOR PRACTICE With ethical permission and the permission of online community members, nurse researchers can enter already established online communities. Ethnonetnography is ideally suited to nursing research as it provides the immediacy of evidence-based interaction with an expert nurse. These real-time responses improve support for those experiencing a critical life event.