Miracle-dz/UniFAR-FTUs huggingface dataset:
Adecuación del uso de antibióticos de “Categoría Especial” en el Servicio de Urgencias de un hospital de tercer nivel

RESUMEN Objetivo Analizar la adecuación de las prescripciones de antibióticos de categoría especial (ATB de CE) en el Servicio de Urgencias Hospitalario (SUH) de un centro urbano de tercer nivel. Material y métodos Se seleccionó una muestra aleatoria de 100 pacientes diferentes a los que se les inició un ATB de CE en Urgencias durante el año 2018. El equipo investigador revisó la historia clínica del episodio de urgencias y de ingreso. Se determinó mediante regresión logística los factores independientes asociados con el grado de adecuación del tratamiento. Resultados Se analizaron 97 prescripciones de las cuales 66 (68%) cumplían los criterios de prescripción adecuada. El grado de adecuación fue del 70% si la infección estaba relacionada con la asistencia sanitaria y del 75% si el paciente tenía factores de riesgo de infección por microorganismos multirresistentes (MMR). El porcentaje de adecuación fue mayor en los casos en los que se especificó el foco de la infección (72%) y la gravedad del episodio (73%). Las variables independientes que se asociaron a una prescripción adecuada fueron: la presencia de factores de riesgo de infección por MMR (OR: 2,35 IC 95%: 1,65 – 3,17 p: 0,01), el especificar el foco de la infección (OR: 3,79 IC 95%: 1,72 – 4,22 p: 0,02) y señalar la gravedad del episodio (OR: 3,09 IC 95%: 1,12 – 3,09 p: 0,03). Conclusiones La prescripción de los ATB de CE en el SUH es adecuada en la medida que se tenga en cuenta el ámbito de adquisición de la infección, los factores de riesgo de MMR, el foco de infección y la gravedad del cuadro clínico.
Spatiotemporal reconstruction and transmission dynamics during the 2016–17 H5N8 highly pathogenic avian influenza epidemic in Italy

Summary Effective control of avian diseases in domestic populations requires understanding of the transmission dynamics facilitating viral emergence and spread. In 2016–17, Italy experienced a significant avian influenza epidemic caused by a highly pathogenic A(H5N8) virus, which affected domestic premises housing around 2.7 million birds, primarily in the north‐eastern regions with the highest density of poultry farms (Lombardy, Emilia‐Romagna and Veneto). We perform integrated analyses of genetic, spatiotemporal and host data within a Bayesian phylogenetic framework. Using continuous and discrete phylogeography, we estimate the locations of movements responsible for the spread and persistence of the epidemic. The information derived from these analyses on rates of transmission between regions through time can be used to assess the success of control measures. Using an approach based on phylogenetic–temporal distances between domestic cases, we infer the presence of cryptic wild bird‐mediated transmission, information that can be used to complement existing epidemiological methods for distinguishing transmission within the domestic population from incursions across the wildlife–domestic interface, a common challenge in veterinary epidemiology. Spatiotemporal reconstruction of the epidemic reveals a highly skewed distribution of virus movements with a high proportion of shorter distance local movements interspersed with occasional long‐distance dispersal events associated with wild birds. We also show how such inference be used to identify possible instances of human‐mediated movements where distances between phylogenetically linked domestic cases are unusually high.
Adrenoleukodystrophy in the era of newborn screening.

PURPOSE OF REVIEW Adrenoleukodystrophy (ALD) is a peroxisomal disorder with varying clinical presentations, including adrenal insufficiency, neurologic disease, and testicular dysfunction. The present review is intended to describe the current knowledge of the pathophysiology of ALD and provide an update regarding newborn screening, diagnosis, monitoring, and treatment. RECENT FINDINGS New York State initiated newborn screening for ALD on December 30, 2013. Successful ALD newborn screening has led to its addition on other state newborn screens and recommendations for universal screening. Initial incidence reports, based on newborn screening, suggest ALD may be more common than previously described. The Pediatric Endocrine Society has published guidance for monitoring newborn males with ALD and case reports suggest biochemical adrenal insufficiency can be present during early infancy. Allogeneic hematopoietic stem cell transplant and gene therapy have been effective at halting the progression of cerebral ALD. SUMMARY Early diagnosis and monitoring for progression of ALD can prevent adrenal crisis and treat the cerebral form of the disease. Initial guidelines for surveillance are likely to evolve as newborn screening not only aids in early detection and therapeutic interventions for ALD, but also expands our knowledge of the natural history of ALD.
Non-linear is not superior to linear aerobic training periodization in coronary heart disease patients

Background We aimed to compare: (1) two different periodized aerobic training protocols (linear (LP) versus non-linear (NLP)) on the cardiopulmonary exercise response in patients with coronary heart disease; (2) the proportion of responders between both training protocols. Design A randomized controlled trial. Methods A total of 39 coronary heart disease patients completed either LP (n = 20, 65 ± 10 years) or NLP (n = 19, 66 ± 5 years). All patients completed a cardiopulmonary exercise testing with gas exchange measurements. Patients underwent a 12-week supervised exercise program including an isoenergetic aerobic periodized training and a similar resistance training program, 3 times/week. Weekly energy expenditure was constantly increased in the LP group for the aerobic training, while it was deeply increased and intercepted with a recovery week each fourth week in the NLP group. Peak oxygen uptake (peak V̇O2), oxygen uptake efficiency slope, ventilatory efficiency slope (V̇E/V̇CO2 slope), V̇O2 at the first (VT1) and second (VT2) ventilatory thresholds, and oxygen pulse (O2 pulse) were measured. Responders were determined according the median value of the Δpeak V̇O2 (mL.min−1.kg−1). Results We found similar improvement for peak V̇O2 (LP: +8.1%, NLP: +5.3%, interaction: p = 0.37; time: p < 0.001) and for oxygen uptake efficiency slope, VT1, VT2 and O2 pulse in both groups (interaction: p > 0.05; time: p < 0.05) with a greater effect size in the LP group. The proportion of non-, low and high responders was similar between groups (p = 0.29). Conclusion In contrast to the athletes, more variation (NLP) does not seem necessary for greater cardiopulmonary adaptations in coronary heart disease patients.
A Clinical Profile of Patients on Immune Checkpoint Inhibitors Referred to Rheumatology

Median age (range) 63 (36–78) Gender (male:female) 6:8 Malignancy Lung, 4 Melanoma, 4 Renal, 3 I mmune checkpoint inhibitor (ICI) use is becoming increasingly widespread. They inhibit negative T-cell regulatory mechanisms, thereby promoting immune response. However, this mechanism of action can produce immune-related adverse events (IrAEs), including exacerbation or development of autoimmune disease. Rheumatological manifestations reported thus far are clinically heterogeneous, with reports of polyarthritis, sicca symptoms, polymyalgia rheumatica, giant cell arteritis, reactive arthritis, seronegative spondyloarthritis, vasculitis, inflammatory myopathy, eosinophilic fasciitis, and lupus nephritis. Incidence of ICI-associated rheumatological disease has increased in recent years, but there is a paucity of evidence for its prognosis and treatment. Lesser is known about patients with preexisting rheumatic disease subsequently started on ICIs.
Disruptions of frontoparietal control network and default mode network linking the metacognitive deficits with clinical symptoms in schizophrenia

The metacognitive deficit in awareness of one's own mental states is a core feature of schizophrenia (SZ). The previous studies suggested that the metacognitive deficit associates with clinical symptoms. However, the neural mechanisms underlying the relationship remain largely unknown. We here investigated the neural activities associated with the metacognitive deficit and the neural signatures associated with clinical symptoms in 38 patients with SZ using functional magnetic resonance imaging with a perceptual decision‐making task accompanied with metacognition, in comparison to 38 age, gender, and education matched healthy control subjects. The metacognitive deficit in patients with SZ was associated with reduced regional activity in both the frontoparietal control network (FPCN) and the default mode network. Critically, the anticorrelational balance between the two disrupted networks was substantially altered during metacognition, and the extent of alteration positively scaled with negative symptoms. Conversely, decoupling between the two networks was impaired when metacognitive monitoring was not required, and the strength of excessive neural activity positively scaled with positive symptoms. Thus, disruptions of the FPCN and the default mode network underlie the metacognitive deficit, and alternations of network balance between the two networks correlate with clinical symptoms in SZ. These findings implicate that rebalancing these networks holds important clinical potential in developing more efficacious therapeutic treatments.
Diagnóstico clínico de HNPCC: caracterização de famílias amsterdam positivas

RESUMO: A utilização dos critérios de Amsterdam permanece ainda hoje o método mais acessível para o diagnóstico de HNPCC, uma vez que testes genéticos são pouco disponíveis e têm seu emprego restrito a centros de alta complexidade. Contudo, a maioria das informações clínico-epidemiológicas relativas ao HNPCC deriva das populações da Europa setentrional e dos Estados Unidos da América, sendo os dados brasileiros praticamente inexistentes. Objetivo: Caracterização clínico-epidemiológica de famílias brasileiras com diagnóstico clínico de HNPCC. Pacientes e Método: 20 famílias que preenchem os critérios de Amsterdam foram avaliadas através entrevista para obtenção de dados clínico-epidemiológicos e os tumores dos casos índice submetidos ao teste de instabilidade de microssatélites. Resultados: A média de idade ao diagnóstico de CCR foi de 49 anos e de 48,5 anos para tumores extra-cólicos. Identificaram-se 103 casos de CCR em 94 indivíduos; e 88 casos de cânceres extra-cólicos em 86 pacientes. Os tumores extra-cólicos mais freqüentes relacionados ao HNPCC foram: gástrico, de ovário e endométrio. Entre outros tumores de grande prevalência encontraram-se o câncer de mama e de próstata. 65% dos CCR apresentaram alta instabilidade de microssatélites, 15% baixa instabilidade e 20% foram estáveis. Discussão: Os dados clínico-epidemiológicos nesta série de famílias brasileiras portadoras de HNPCC parecem se sobrepor aos dados mundiais existentes, especialmente em relação à forma e idade de apresentação do CCR e câncer extra-cólico. Espera-se que a implementação de registros permita a obtenção de um perfil próprio do HNPCC em nossa população, com os benéficos da redução do impacto desta doença nos pacientes acometidos.
A four-gene expression-based signature predicts the clinical outcome of melanoma.

PURPOSE Although clinical indicators provide effective prognostic information, the prognosis of melanoma is difficult due to its genomic and biological complexity. Our goal was to elucidate the impact of genes on survival. METHODS Public cohorts of melanoma gene expression and machine learning were used to develop a model for prognosis. A four-gene model was developed to predict the clinical outcome of melanoma in TCGA datasets. The performance was further validated in four independent cohorts. The relationship between clinical indicators and melanoma score was assayed and the correlated pathways were identified. RESULTS The samples with high melanoma scores had a significantly better survival rate than those with low melanoma scores in the training cohort. This observation was confirmed in four independent cohorts, GSE22138, GSE54467, GSE65904 and E-MTAB-4725. In addition, the melanoma score was independent of most clinically used indicators. Cox univariate regression showed that the melanoma score was significantly associated with survival. Multiple significantly enriched pathways were identified between the high-score and low-score groups.
Folic acid supplementation, dietary folate intake and risk of small for gestational age in China

Abstract Objective: To investigate the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of small for gestational age (SGA) and to examine the joint effect of folic acid supplementation and dietary folate intake on the risk of SGA. Design: Participants were interviewed by trained study interviewers using a standardized and structured questionnaire. Information on birth outcomes and maternal complications was abstracted from medical records and dietary information was collected via a semi-quantitative FFQ before conception and during pregnancy. Setting: A birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital. Participants: Women (n 8758) and their children enrolled in the study. Results: Folic acid supplementation was associated with a reduced risk of SGA (OR = 0·72, 95 % CI 0·60, 0·86), with the reduced risk seen mainly for SGA at ≥37 weeks of gestational age (OR = 0·70, 95 % CI 0·58, 0·85) and nulliparous SGA (OR = 0·67, 95 % CI 0·54, 0·84). There was no significant association between dietary folate intake and SGA risk. Conclusions: Our study suggested that folic acid supplementation was associated with a reduced risk of SGA and the risk varied by preterm status and parity.
Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand

Paracetamol is a common agent taken in deliberate self‐poisoning and in accidental overdose in adults and children. Paracetamol poisoning is the commonest cause of severe acute liver injury. Since the publication of the previous guidelines in 2015, several studies have changed practice. A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence‐based guidance.
Cultural Adaptation and Validation of the Methotrexate Intolerance Severity Score in Brazilian Portuguese for Adults With Rheumatoid Arthritis

Introduction The Methotrexate Intolerance Severity Score (MISS) questionnaire is used to identify intolerance to methotrexate (MTX), but it is not available in the Brazilian Portuguese language. Objective The aim of this study was to adapt and validate the MISS in Brazilian Portuguese. Methods The Brazilian Portuguese version of the MISS was developed following the Guidelines for the Process of Cross-cultural Adaptation of Self-report Measures. The new version was tested in 120 patients with rheumatoid arthritis. For the reliability assessment, the Cronbach α coefficient was used. The receiver operating characteristic curve was constructed with the objective of finding the best cutoff point for MTX intolerance and weighing the sensitivity and specificity. The concordance among the results was analyzed using the κ coefficient and factorial analysis with varimax rotation. Results This methodological study developed and applied a culturally acceptable Brazilian Portuguese version of the MISS. The MISS questionnaire presented internal consistency classified as “very good” because Cronbach α is equal to 0.83 (95% confidence interval, 0.79–0.87). The suitability of the data for factorial analysis was demonstrated using the Kaiser-Meyer-Olkin sample adequacy test (KMO = 0.723) and Bartlett sphericity test (χ2 = 499.98, p < 0.001). It was observed that a factorial analysis with 3 factors is preferred; the receiver operating characteristic curve of the MISS score was considered the cutoff point at 6 points (sensitivity 100% and specificity 89.4%). Conclusions The Brazilian Portuguese version of the MISS is valid and reliable for the detection of MTX intolerance in clinical practice.
Men's perspectives on HIV self-testing in sub-Saharan Africa: a qualitative systematic review protocol.

OBJECTIVE The aim of this review is to synthesize the best available evidence on men's perspectives on human immunodeficiency virus (HIV) self-testing in sub-Saharan Africa. INTRODUCTION Many factors influence men's poor HIV testing uptake in healthcare facilities, including stigma and confidentiality. Due to men's low engagement with healthcare facilities, there remains a high proportion of HIV-positive men who are unaware of their HIV status. The HIV self-testing models enable individuals to conduct and interpret their own HIV test at their own convenient time and private space, removing some of the barriers associated with accessing healthcare facility-based HIV testing services. INCLUSION CRITERIA This review will consider studies that explore men's perspectives and experiences on the use of HIV self-testing in sub-Saharan Africa. The studies will be considered regardless of the men's age. The studies must provide evidence on HIV self-testing, present analysis of qualitative data, and be published from January 2005, with no language restrictions. This review will consider studies of qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography and action research. METHODS An initial search of PubMed and CINAHL will be conducted, followed by an analysis of text words contained in the title and abstract, and of the index terms used to describe the articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Retrieval of full-text studies and critical appraisal will be conducted by two independent reviewers. Data will be extracted and pooled for meta-aggregation, and a Summary of Findings will be presented.
Use of low field nuclear magnetic resonance to monitor lung inflammation and the amount of pathological components in the sputum of cystic fibrosis patients

To develop a novel approach to monitor lung ventilation/inflammation in cystic fibrosis (CF) patients. Lung assessment in CF patients is relevant given that most patients succumb to respiratory failure. Respiratory functional tests (forced expiratory volume in the first second; FEV1) and inflammatory markers are used to test pulmonary ventilation/inflammation, respectively. However, FEV1 is effort dependent and might be uncomfortable for CF patients. Furthermore, inflammatory marker detection is costly and not rapid. To overcome these limitations, we propose the measurement, by means of low field nuclear magnetic resonance, of the spin‐spin relaxation time (T2m) of water hydrogens present in CF patient sputum. In CF sputum, different biological components are pathologically increased and inversely related to lung functionality. Moreover, we showed that these components alter in a dose‐dependent manner the T2m in synthetic CF sputum.
Comparison of Free and Bound Advanced Glycation End Products (AGEs) in Food: A Review on the Possible Influence on Human Health.

ABSTRACT: Debate on the hazard of advanced glycation end products (AGEs) in food has continued for many years, due to their uncertain bioavailability and ability to bind to their receptors (RAGEs) in vivo. There are increasing evidences that free and bound AGEs have many differences in gastrointestinal digestion, intestinal absorption, binding with RAGEs, in vivo circulation and renal clearance. Therefore, this paper compares these aspects between free and bound AGEs by summarizing the available knowledge. Based on the current knowledge, we conclude that it is time to differentiate free AGEs from bound AGEs in food in future studies, since they vary in many aspects that are closely related to their influence on human health. Several perspectives were proposed at the end of this review for further exploring the difference between free and bound AGEs in food.
Upconversion Nanoparticle Powered Microneedle Patches for Transdermal Delivery of siRNA

Microneedles (MNs) permit the delivery of nucleic acids like small interfering RNA (siRNA) through the stratum corneum and subsequently into the skin tissue. However, skin penetration is only the first step in successful implementation of siRNA therapy. These delivered siRNAs need to be resistant to enzymatic degradation, enter target cells, and escape the endosome–lysosome degradation axis. To address this challenge, this article introduces a nanoparticle‐embedding MN system that contains a dissolvable hyaluronic acid (HA) matrix and mesoporous silica‐coated upconversion nanoparticles (UCNPs@mSiO2). The mesoporous silica (mSiO2) shell is used to load and protect siRNA while the upconversion nanoparticle (UCNP) core allows the tracking of MN skin penetration and NP diffusion through upconversion luminescence imaging or optical coherence tomography (OCT) imaging. Once inserted into the skin, the HA matrix dissolves and UCNPs@mSiO2 diffuse in the skin tissue before entering the cells for delivering the loaded genes. As a proof of concept, this system is used to deliver molecular beacons (MBs) and siRNA targeting transforming growth factor‐beta type I receptor (TGF‐βRI) that is potentially used for abnormal scar treatment.
Prediction of Epithelial Ovarian Cancer Outcomes With Integration of Genomic Data

Some of the patients with epithelial ovarian cancer will not respond to initial therapy. These patients have a poor prognosis. Our aim was to identify patients with a worse prognosis by integrating clinical, pathologic, and genomic data. Using publicly available genomic data and integrating it with clinical data, we significantly improved the prediction of patients with worse surgical outcomes and those who do not respond to initial chemotherapy. We further improved these models with more precise data collection and better understanding of the genetic background of the studied population. Better prediction will lead to better patient classification and opportunities for individualized treatment.
Probiotics to manage inflammation in HIV infection.

PURPOSE OF REVIEW To evaluate the current scientific basis for administering probiotics to people living with HIV (PLHIV) to alleviate chronic inflammation and subsequently improve their prognosis. RECENT FINDINGS The gut microbiome is a potential contributing factor to low-grade inflammation in HIV infection, and there is a scientific rationale for attempting to attenuate inflammation by administering probiotics. Sixteen reports from clinical studies in antiretroviral therapy (ART)-treated PLHIV assessing inflammation after probiotic intervention have been identified; half of them randomized control trials (RCT). Some of the studies report improvement in some parameters of inflammation, but results are inconsistent. No studies report improvement of CD4 counts. None of the RCTs report improvements in any markers of inflammation when analyzed according to protocol. SUMMARY Current scientific evidence does not support the use of probiotics to alleviate inflammation in HIV infection. The potential effect of probiotic intervention in ART-treated PLHIV with high risk for inflammation remains to be investigated.