bluuebunny/crossref_metadata_2025_split huggingface dataset:
Controversias con los medicamentos sintomáticos de acción lenta para la Osteoartritis (SYSADOAs)
Authors: Vidal Neira Luis Fernando , Vidal Wilman Maritza 
Published: May 2018

La osteoartritis es una enfermedad de patogenia compleja y etiología multifactorial, clínicamente se caracteriza por su naturaleza heterogénea con expresiones fenotípicas distintas. El diagnóstico clásicamente se ha establecido en base a la combinación de las características clínicas y los hallazgos radiológicos compatibles con cambios degenerativos en la articulación afectada. Entre los medicamentos disponibles para el manejo de la osteoartritis se cuenta con los analgésicos de acción rápida (Ej. Paracetamol, antiinflamatorios no esteroideos); los medicamentos sintomáticos de acción lenta (denominados SYSADOAs por sus siglas en inglés: Symptomatic Slow-Acting Drugs for Osteoarthritis); y finalmente se considera un tercer grupo, los medicamentos modificadores de la enfermedad (denominados también DMOA por sus siglas en inglés: “Disease modifying OA drugs”), pero como grupo es inexistente, porque ningún medicamento ha demostrado el potencial para remodelar o renovar la estructura de la articulación afectada. Se reconoce que algunos de los SYSADOA podrían tener también efecto estructural.Se ha propuesto que un SYSADOA, debe de cumplir cuatro objetivos: Proporcionar alivio de los síntomas, disminuir el requerimiento de medicación sintomática concomitante (analgésicos, AINEs, etc.), prevenir el daño estructural y evitar (o retardar) el requerimiento de cirugía de reemplazo articular. Diferentes estudios clínicos y metanálisis encuentran evidencia que apoya la eficacia sobre el control del dolor de los SYSADOAs, pero con una heterogeneidad importante.El propósito de este artículo es revisar las razones por las cuales existe discrepancia sobre la eficacia sintomática de los SYSADOAs, entre las cuales se encuentran la baja calidad metodológica de algunos estudios clínicos, las características y la naturaleza de la molécula específicamente empleada, las variaciones en la molécula original, el estatus de registro (medicamentos de venta libre o bajo prescripción), el procesamiento y la fuente de financiación de los estudios clínicos entre otros.
The Effect of Biologic and Targeted Synthetic Drugs on Work- and Productivity-related Outcomes for Patients with Psoriatic Arthritis: A Systematic Review
Authors: Iragorri Nicolas , Hofmeister Mark , Spackman Eldon , Hazlewood Glen S. 
Published: May 2018

Objective.To systematically review the effects of biologic therapies for psoriatic arthritis [secukinumab, ustekinumab, adalimumab, etanercept, certolizumab pegol (CZP), apremilast, golimumab (GOL), or infliximab (IFX)] on work productivity.Methods.A systematic review of Medline, EMBASE, CENTRAL, andClinicalTrials.govwas conducted to identify randomized controlled trials reporting on work productivity outcomes at the end of the placebo-controlled double-blind period.Results.There were 7959 records identified. Full text of 377 records was further assessed for eligibility, of which 5 trials were included. All included trials were assessed with the Cochrane Risk of Bias Tool, and 4 out of 5 were judged to be of low risk of bias in most domains. Improvements in self-assessed work productivity were observed in 5 trials (IFX, GOL, CZP, ustekinumab, and apremilast), ranging from a mean difference of −0.9 to −1.8 on a 1–10 scale of self-assessed work productivity (negative change represents improvement), although statistical significance of the results was not reported for CZP and apremilast. Treatment with CZP resulted in a statistically significant reduction in absenteeism (200 mg) and presenteeism (200 and 400 mg). IFX and GOL reported a nonsignificant reduction of absenteeism. The Work Productivity Survey, the Work Limitations Questionnaire, and visual analog scales were used to measure work productivity.Conclusion.Treatment with IFX, GOL, CZP, ustekinumab, and apremilast resulted in improvements in self-reported work productivity. A pooled analysis was not possible because of the clinical heterogeneity of the trials and variability in outcome reporting.
An Outsourced Health-enhancing Physical Activity Program for People with Rheumatoid Arthritis: Study of the Maintenance Phase
Authors: Nordgren Birgitta , Fridén Cecilia , Demmelmaier Ingrid , Bergström Gunnar , Lundberg Ingrid E. , Nessen Thomas , Dufour Alyssa B. , Opava Christina H. 
Published: May 2018

Objective.To describe changes of health-enhancing physical activity (HEPA), health perception, and functioning during the second year of a 2-year support program, determine aspects of adherence and response, and describe perceptions of the program.Methods.Out of 220 individuals with rheumatoid arthritis (RA), 177 participated in the followup. Group support, strength training, and moderate-intensity aerobic activity were encouraged. Data collection included HEPA, perceived health, functioning, and perceptions of the program. Participants with unchanged/improved general health perception and at least 2 of aerobic capacity, grip strength, or timed standing were considered responders.Results.Current and maintained HEPA decreased from 82% to 75% (p = 0.0141) and from 41% to 27% (p < 0.0001) during the second year. Minor declines in quality of life and activity limitation occurred (p = 0.0395 and 0.0038, respectively), while outcome expectations for benefits of physical activity increased (p = 0.0010 and 0.0186) and waist circumference tapered off (p = 0.0070). Strength training was performed on average 41 and 35 times among responders (n = 54) and nonresponders (n = 105), respectively (p = 0.2708); HEPA 194 and 171 days, respectively (p = 0.0828); and support group meetings 12 and 10 times, respectively (p = 0.0943). Strength training, aerobic activity, and short text message reminders were perceived as most valuable; step registration and the self-monitoring walk tests were less appreciated.Conclusion.About one-fourth of the originally sedentary individuals with RA sustained their new HEPA behaviors after 2 years and most improvements of health and functioning were sustained. Structured use of behavior change techniques and a second year to support maintenance with a reduced program might help patients with RA to sustain HEPA behavior.
Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis
Authors: Mo Ying-Qian , Yang Ze-Hong , He Hai-Ning , Ma Jian-Da , Liang Jin-Jian , Zeng Wei-Ke , Shi Guang-Zi , Shen Jun , Dai Lie 
Published: May 2018

Objective.To explore the advantages of magnetic resonance imaging (MRI) of bilateral hands in rheumatoid arthritis (RA).Methods.Consecutive patients with active RA were recruited for clinical assessments, radiographs, and MRI of bilateral hands. Bilateral hands were scanned simultaneously on 3.0 T whole-body MRI system and were scored on synovitis, osteitis, and bone erosion according to the RA MRI scoring (RAMRIS) system.Results.Among 120 patients included, wrist bones and metacarpophalangeal joint (MCPJ) 2 proximal showed bone erosion in early RA. The second to fifth metacarpal bases and the second to fourth MCPJ distal showed more bone erosion in mid-stage or late-stage RA. When MRI of dominant unilateral hand was analyzed, MRI synovitis and osteitis in 5% of wrists and 3 MRI features in 5–14% of MCPJ were misdiagnosed (McNemar test, all p < 0.05). There were 46% wrist synovitis, 29–52% MCPJ2–5 synovitis, 45% wrist osteitis, and 20%–34% MCPJ2–5 osteitis not detected by joint tenderness and/or swelling. When the clinically more severe hand was selected for MRI of unilateral hand according to physical examination, MRI synovitis in 5% of wrists and 3 MRI features in 7–15% of MCPJ were misdiagnosed (all p < 0.05). Scatter plots and linear regression analyses were used to illustrate RAMRIS between dominant or selected hand (Y values) and nondominant or nonselected hand (X values). All linear models were markedly different from a Y = X linear model, indicating the dominant or clinically more severe hand could not represent the contralateral hand to evaluate RAMRIS.Conclusion.MRI of bilateral hands is more optimal than MRI of the unilateral hand in RA.
La chatte et le psychanalyste (Le cas Colette)
Authors: Ardeven François 
Published: May 2018

Les animaux domestiques parfois s’invitent en séance. Et c’est Freud lui-même qui dans son étude du petit Hans y insiste : s’il y avait une pédagogie de la psychanalyse, ce serait en somme juste de rappeler que l’humain est d’abord un Erdtier, un mammifère terrestre. On veut étudier ici d’un point de vue métapsychologique le cas de La chatte de Colette (dont l’Enfant et les Sortilèges, avec Ravel à la musique, avait poussé Mélanie Klein à écrire un article sur cette œuvre en affinité avec ses propres concepts). On veut aussi de façon très pragmatique à travers la réflexion d’un analyste sur la présence de sa chatte – souvent juste évanescente – pendant les séances, étudier le transfert (à trois) que cela induit chez les patients, et le relier aux quatre « dispositions de l’être » qu’en écart avec Claude Lévi-Strauss étudie Philippe Descola dans son œuvre majeure Par-delà nature et culture.
Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative
Authors: Colwell Blair R. L. , Williams Cydni N. , Kelly Serena P. , Ibsen Laura M. 
Published: May 2018

Background
Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children.

Objective
To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients.

Methods
A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater.

Results
In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P &lt; .001) patients and were less likely to have barriers (P &lt; .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred.

Conclusions
A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.
GROWTH AND ENDOCRINE FUNCTION IN TUNISIAN THALASSEMIA MAJOR PATIENTS
Authors: GUIRAT Naouel 
Published: May 2018

Beta-thalassemia major (TM) is among prevalent hereditary disorders imposing high expenses on health-care system worldwide. The patient’s survival is dependent on lifetime blood transfusion which leads to iron overload and its toxicity on various organs including endocrine glands. This article provides an overview of endocrine disorders in beta-TM patients. This single center investigation enrolled 28 beta-TM patients (16 males, 12 females) regularly transfused with packed red cell since early years of life. For each patient were determined: age, sex, number of transfusions received, history of splenectomy and anthropometric parameters. Evaluation for hormonal status including growth, gonadal, thyroid, adrenal cortex, and parathyroid glands was done for all patients. Dual energy X-ray absorptiometry was used to diagnose osteoporosis. Assessment of iron overload status was performed by measuring the serum ferritin concentration and the results of magnetic resonance imaging T2*. Growth retardation was found in 16 of the 28 studied patients (57 %).Thirteen among them had delayed puberty. Spontaneous puberty was achieved in 16 cases. Growth hormone (GH) deficiency was found in 10 cases (35 %). Seventeen among the studied patients (60 %) developed disorders of glucose homeostasis. Subclinical hypothyroidism was found in six patients (21 %). Intensive chelation therapy had allowed the reversibility of this complication in five cases. Adrenal Insufficiency was found in 9 cases (32%). Hypoparathyroidism has occurred in one case. Ten of the 28 studied patients had osteoporosis (35%). Twenty-three of the 28 studied patients (82%) had at least one endocrine complication.
Online Continuing Professional Education: An Evaluative Case Study
Authors: Pullen Darren L. 
Published: May 2018

An evaluation study, assessing the pedagogical and instructional design (e-pedagogy) effectiveness of online continuing professional education (CPE) courses offered by a large Australasian CPE provider to health care professionals (HCPs). The study used a naturalistic theory approach in conjunction with a multilevel evaluation to examine the impact of Web-based learning on over 300 HCPs. Several evaluative criteria (participant satisfaction, learning achievement, self-reported practice performance change and e-pedagogical courseware characteristics) were assessed by various qualitative and quantitative data collection methods. The evaluation revealed that learning online was an effective means for increasing CPE knowledge (p < 0.05) and improving self-reported practice performance change (p < 0.05). Additionally the study revealed that of the 42 courses examined, those which included a pedagogically scaffolded clinical or diagnostic learning support tool (57 per cent) resulted in an increased self-reported practice performance change compared with those courses which did not include the scaffolded support tool (Zobs 3.757). Participants were very satisfied with the self-paced instruction, timing of both the facilitator and server-generated course comments and the amount of learning content which could be undertaken in a learning sitting.
Seroprevalance of ToRCH Infection –A Laboratory Profile
Authors: Poudyal Anup , Poudyal Nimesh , Khanal Basudha 
Published: May 2018

Background: ToRCH infection (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus) causes severe consequences in child in ongoing pregnancy. Screening for ToRCH etiologies are sought for those females who have had bad obstetrics history and in children born with birth defects. Such screening helps the couple and the clinicians to develop a consensus for preparedness of adverse fetal outcome, future prevention and planning for next conception.Objectives: This retrospective study was conducted to have an understanding on the burden of ToRCH infection in various clinically suspected cases encountered in BPKIHS.Methods: Laboratory record of 52 serum samples submitted from August 2012 to July 2013 for screening of ToRCH infections was analyzed.Result: Among 52 adult female serums, most (50) were positive for Cytomegalovirus (CMV) IgG, but none were reactive for Rubella IgM. Both IgG and IgM were positive for CMV in 10 cases, Herpes Simplex Virus (HSV) in 1 case and Toxoplasma in 1 case.Conclusion: This study shows, CMV as the most common and Toxoplasma as the least common etiology among the ToRCH profile, in our setup.
Study of cutaneous manifestation of chikungunya and its serological correlation
Authors: Shinde Geeta B. , Popere Sanjay 
Published: May 2018

Aim: To assess the hyperpigmentation after fever and joint pain as a cutaneous marker of chikungunya fever and to assess with serological correlation.Methods: A total of 15 patients comprised of 9 males, 6 females and neonate have aged between 14 days to 60 years presented with the pigmentation after the fever subsided were enrolled in the study. The diagnosis of chikungunya was made by detecting virus specific IgM ELISA in the serum.Results: Serological immunoglobulin M enzyme – linked immunosorbent assay (IgM ELISA) test or chikungunya virus was positive in all the patients. Generalized dark coloured pigmentation was the most common finding after the fever subsided. On examination, out of 15 cases, in most of the cases, hyperpigmentation was observed all over the body with the facial involvement. Few cases showed pigmentation over nose, centre of upper lip, on palm, sole, eyelid, dorsum, centrofacial, reticulate pattern on the face and blotchy pigmentation.Conclusion: The presence of pigmentation after fever and joint pain helps to make a retrospective diagnosis of chikungunya fever and this may be considered as a cutaneous marker of chikungunya fever in recent past.
Evaluating psychiatric outcomes associated with direct-acting antiviral treatment in veterans with hepatitis C infection
Authors: Sackey Bryan , Shults Jana G. , Moore Troy A. , Rogers Rachel , Mehvar Mina , King Joshua G. 
Published: May 2018

Abstract

Introduction:
Approximately 70% of veterans with hepatitis C virus infection have at least one psychiatric illness. The advent of direct-acting antiviral (DAA) therapy provided an alternative to interferon-alpha regimens and revolutionized treatment, however, the extent of psychiatric effects attributed to these agents are unclear. The primary objective of this pilot study was to prospectively analyze psychiatric outcomes, specifically depression, in veterans with hepatitis C virus infection who are initiated on DAA therapy.

Methods:
In this single center, prospective cohort study, psychiatric outcomes were analyzed using Patient Health Questionnaire assessments at baseline and weeks 4, 8, and 12 of complete DAA treatment. Outcome analysis were stratified based on specific DAA therapy and preexisting mental illness (mental health [MH] subjects and non-MH subjects), with a sub-analysis of major depressive disorder patients.

Results:
Analysis included 48 patients, majority males (96%), with a mean age of 59.4 years (±8.0). Twenty-four (50%) patients had a preexisting MH diagnosis, with major depressive disorder being the most common MH diagnosis (50%, n = 12). Despite a trend toward improvement, no significant changes in questionnaire scores after 12 weeks of DAA therapy were observed for all patient groups (P &gt; .05). Neither MH subjects nor non-MH subjects displayed a significant change in questionnaire scores from baseline to end of treatment (P &gt; .05). No patients required acute psychiatric interventions during DAA treatment.

Discussion:
Treatment with DAA therapy was not associated with psychiatric decompensation. Data from this pilot study supports the safe utilization of DAA therapy in hepatitis C virus patients with preexisting MH illness as it appears to be devoid of depressive and psychiatric side effects.
Levocarnitine for valproate-induced hyperammonemia in the psychiatric setting: A case series and literature review
Authors: Brown Lauren M. , Cupples Nicole , Moore Troy A. 
Published: May 2018

Abstract

Introduction:
Hyperammonemia is a potential adverse effect of valproic acid (VPA) therapy, which is often asymptomatic but can lead to severe, life-threatening encephalopathy. Carnitine deficiency due to VPA is the proposed mechanism for hyperammonemia and the development of VPA-induced hyperammonemic encephalopathy (VHE). Levocarnitine, the active form of carnitine, has been suggested for treatment and prevention of VHE.

Methods:
Data was collected by chart review of 3 patients who received oral levocarnitine supplementation in the psychiatric setting for VPA-induced hyperammonemia. Review of the literature was performed through June 2017 using the following PubMed search terms: valproate, valproic acid, hyperammonemia, altered mental status, encephalopathy, and levocarnitine. Articles were included if they described use of levocarnitine in VPA-treated patients with psychiatric disorders.

Results:
One patient developed encephalopathy with resolution of symptoms after VPA discontinuation. Valproic acid was restarted with the addition of levocarnitine to prevent VHE reoccurrence. In the other 2 cases, levocarnitine was started prophylactically in patients who developed hyperammonemia without emergence of any clinical symptoms. Ammonia levels were reduced to normal in all cases, and no symptoms consistent with encephalopathy were reported. The literature search identified 6 additional cases with 5 of 6 reports supporting use of levocarnitine for decreased ammonia levels as well as an observational trial.

Discussion:
This literature review and case series illustrates successful use of levocarnitine supplementation for reduction of ammonia levels in the setting of VPA-induced hyperammonemia among patients with psychiatric disorders. However, clinical significance of ammonia reduction in asymptomatic patients is difficult to determine.
A case report of guardian-consent forced paliperidone palmitate for behavioral disturbance due to traumatic brain injury
Authors: Douglass Amber R. , Smyth Uyen 
Published: May 2018

Abstract
Psychosis after traumatic brain injury (TBI) occurs in up to 10% of cases. Although guideline consensus is lacking regarding drugs of choice for this condition, current literature points to the use of atypical antipsychotics. This case describes a 58-year-old male with major neurocognitive disorder due to TBI with behavioral disturbance that was successfully treated with paliperidone palmitate. In addition to the off-label use of paliperidone, this case also explores the use of forced medication as the initial injection was given per guardian consent. After completion of a literature review, this appears to be the first case report describing the use of a long-acting antipsychotic for the treatment of TBI-related psychosis. This case suggests that paliperidone palmitate may be efficacious for psychosis following TBI; however, further study is warranted.
Real‐Time Imaging of Brain Tumor for Image‐Guided Surgery
Authors: Hu Shuang , Kang Homan , Baek Yoonji , El Fakhri Georges , Kuang Anren , Choi Hak Soo 
Published: May 2018

AbstractThe completion of surgical resection is a key prognostic factor in brain tumor treatment. This requires surgeons to identify residual tumors in theater as well as to margin the proximity of the tumor to adjacent normal tissue. Subjective assessments, such as texture palpation or visual tissue differences, are commonly used by oncology surgeons during resection to differentiate cancer lesions from normal tissue, which can potentially result in either an incomplete tumor resection, or accidental removal of normal tissue. Moreover, malignant brain tumors are even more difficult to distinguish from normal brain tissue, and resecting noncancerous tissue may create neurological defects after surgery. To optimize the resection margin in brain tumors, a variety of intraoperative guidance techniques are developed, such as neuronavigation, magnetic resonance imaging, ultrasound, Raman spectroscopy, and optical fluorescence imaging. When combined with appropriate contrast agents, optical fluorescence imaging can provide the neurosurgeon real‐time image guidance to improve resection completeness and to decrease surgical complications.