Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events ( te ) . at least 20% of patients with univentricular hearts have reported to experience te , of which 25% are fatal . despite the high incidence of te , no consensus has been reached regarding the role of long - term anti - thrombotic treatment in this group of patients . here ,
we present a case of a 19-year - old woman with a univentricular heart who suffered a major stroke .
a 19-year - old woman born with a univentricular heart was found unconscious in her bed in the morning .
she was respiratory and circulatory stable with no fever at admission to the local hospital .
the glasgow coma scale score was 5 ( eyes , 1 ; verbal , 1 ; motor , 3 ) .
an electrocardiogram showed sinus rhythm , left axis deviation , and left - sided hypertrophy , but was otherwise normal .
a test of arterial blood gasses revealed a fully compensated metabolic acidosis with ph 7.37 ( normal range 7.377.45 ) and base excess 7.7 mm ( 3.0 to 3.0 mm ) .
venous blood tests showed raised plasma lactate 3.7 mm ( 0.72.1 mm ) , plasma myoglobin 280 g / l ( 1949
g / l ) , plasma glucose 8.6 mm ( 4.27.2 mm ) , plasma fibrin d - dimer 1.0 mg / l ( 0.00.5 mg / l ) , and inr 1.5 ( < 1.2 ) , whereas the remaining standard tests were all normal , including hemoglobin , leucocyte differential count , electrolytes , c reactive protein , liver and pancreas enzymes , renal parameters , plasma ethanol , plasma paracetamol , and plasma salicylate .
shortly after admission , the patient developed babinski reflexes and a pronounced decorticate posture with spontaneous flexion of the arms over the chest and extended legs with feet turned inward .
after a tracheal tube was inserted and assisted ventilation was initiated , the patient was transferred to the neurological intensive care unit at a tertiary hospital .
a repeated computed tomography scan and magnetic resonance imaging of the head were performed , as well as a computed tomography angiography of the head and the neck .
these scans unveiled a major stroke located in the left cerebral ( figure 1 ) and cerebellar hemispheres , corresponding to the areas supplied by the left middle and posterior cerebral arteries and the left superior cerebellar artery .
a segmental occlusion in the top of the basilar artery was identified ( figure 3 ) .
finally , a transthoracic echocardiography was performed , revealing a well - functioning univentricular heart with no detectable thrombi .
warfarin was prescribed and the patient gradually regained consciousness . however , a severe right - sided hemiparesis persisted and the patient was transferred to a local neurorehabilitation unit .
later , a magnetic resonance imaging scan of the thorax and upper abdomen was performed ( figure 4 ) .
the patient had been referred to a cardiologist at the age of 5 months due to shortness of breath and failure to thrive .
cardiac ultrasound and catheterization had revealed a double inlet left ventricle ( figure 5 ) and a hypoplastic right ventricle without transposition of the great arteries .
symptoms were caused by heart failure due to high pulmonary flow , which was treated by pulmonary artery banding . at the age of 6 years , a total cavopulmonary connection ( tcpc ) , including a lateral tunnel with fenestration to the right atrium , was established .
the surgical procedure markedly improved the patient s well - being , and , at the age of 13 years , the fenestration was closed .
life - long prophylactic antithrombotic treatment with salicylic acid was prescribed . during the last surgical intervention ,
the patient suffered mild brain damage and was now described as behaving at the level of a 12-year - old .
postoperative echocardiography revealed good systolic function of the left ventricle and mild right atrioventricular valve regurgitation .
since no cardiac thrombi were identified , it is not known whether the described stroke was caused by a cardiac - derived embolus or spontaneous cranial thrombi .
spontaneous thrombi in 19-year old patients are , however , extremely rare . hence , seen in the light of a known cardiac malformation , the probability of a cardiac - derived cerebral embolus is very high .
the incidence of univentricular hearts is reported to be between 0.5 and three cases per 10,000 live births.1 today , patients with univentricular heart conditions are usually treated surgically with a three - stage tcpc / fontan procedure,2 which separates the systemic and pulmonary venous return  a precondition for adequate oxygenation of the arterial blood entering systemic circulation .
the technique has evolved from the classic fontan3 ( right atrium - to - pulmonary artery connection ) through an intracardiac lateral tunnel procedure , and it is currently performed in many centers as an extracardiac tunnel procedure by insertion of a tube graft between the inferior vena cava and the pulmonary artery.4 te , both systemic venous and arterial , are a major cause of early and late mortality in tcpc patients .
the reported incidence of te in these patients varies from 3% to 25% , depending on study design , imaging technique , and follow - up period duration .
studies with longer follow - up periods and more sensitive imaging studies suggest an incidence of at least 20% , of which the mortality rate is 25%.59 asymptomatic pulmonary emboli have been detected in 16% of tcpc patients .
although the etiology for the high risk of te is not well defined , possible explanations include abnormal blood flow in the univentricle , arrhythmias , venostasis , dehydration , protein - losing enteropathy , and coagulation abnormalities .
no stratification of te risk has been made between the different types of surgical intervention .
such data would be very useful and should be compared against the efficacy of each treatment .
procoagulant factors ( factors ii , v , vii , ix , and x ; plasminogen ; and fibrinogen ) and anticoagulant factors ( protein c and antithrombin iii ) are lower than normal controls prior to stage two or three of tcpc completion.10,11 increased platelet reactivity prior to tcpc completion has also been shown . a recent report , however , found no significant differences in thromboelastography ( a global whole - blood assay of coagulation ) in pediatric tcpc patients compared with healthy children.12 despite the high incidence of te , no consensus has been reached about the role of long - term antiplatelet or anticoagulation therapy in those patients who remain in stable sinus rhythm .
some studies advise against routine anticoagulation,13 whereas others recommend routine antiplatelet14 or anticoagulation therapy.15,16 one recent study suggests that antiplatelet and anticoagulation therapy are equally effective in preventing te.17 te reduce quality of life18 and cause sudden death19 in adult patients with fontan circulation .
therefore , in these patients , the benefit of long - term prophylactic antiplatelet or anticoagulation therapy must be carefully considered and weighed against the risk of detrimental hemorrhagic side effects .
disagreement about antithrombotic therapy in tcpc patients warrants future study that compares the different therapeutic strategies .
future studies should most likely be observational case - control studies due to the practical and ethical problems associated with randomized controlled trials .
the need for such studies is emphasized by the presented case , which might suggest that more aggressive antithrombotic strategies should be routinely introduced .

Answer:
patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events .
 we present a case of a 19-year - old woman born with a univentricular heart who suffered a major stroke while being treated with only salicylic acid .
 at least 20% of patients with univentricular hearts have been reported to experience thromboembolic events , of which 25% are fatal . despite the high incidence of thromboembolic events
 , no consensus has been reached regarding the role of long - term anti - thrombotic treatment in this group of patients .
 this lack of consensus warrants future studies that compare the different therapeutic strategies .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
it presents with various obstructive and irritative lower urinary tract symptoms ( luts ) like frequency , urgency , nocturia , intermittency , weak urinary stream etc .
the international prostate symptom score ( ipss ) is a tool which is very commonly used in the evaluation of the severity of symptoms of the patients .
it is a self - administered questionnaire which scores the symptoms the patient has experienced over of the preceeding 4 weeks .
it helps the clinician understand the severity of patient 's symptoms and can guide treatment .
hence the responses can depend upon the level of education and understanding of the patient .
this can have a significant bearing on the ultimate score and can lead to improper selection of treatment .
it can lead to significant distress both to the patient and to the treating physician due to the lack of optimum response by the treatment based on the ipss .
the ipss questionnaire has been translated and validated in various languages but it has not been validated in any of the indian languages .
we commonly employ the english version of the questionnaire . for a population that does not have english as its primary language
, this issue may have a serious impact on the understanding of questions and the scoring . in this study
, we evaluate the patient 's ability to understand the ipss by comparing the scores when the questionnaire was self - administered versus when it was administered using the assistance of a clinician .
patients who presented with luts suggestive of bph , those who had passed at least twelfth grade school and had a reasonable command over english ( assessed by their ability to have a conversation in english with the clinician ) were included in the study .
those who had previously filled an ipss questionnaire or those who were < 40 years of age were excluded from the study .
the patients were first given the ipss questionnaire and were allowed to self - administer it .
the score sheet was taken away and then a blinded clinician ( 2 year resident in urology ) , who was not aware of the score on the self administered questionnaire , assisted the patient in filling the responses ( english version ) by interpreting and explaining the meaning of the questions in english .
the second questionnaire was administered on the same day , 4 - 5 hours after the administration of the first questionnaire .
the ipss questionnaire comprises of eight questions , seven regarding the symptoms over a period of the preceedinglast 1 month and one assessing the quality - of - life .
the seven questions assessing the symptoms include incomplete emptying , frequency , intermittency , urgency , weak stream , straining and nocturia .
each of these symptoms is assigned a score from 0 to 5 for a maximum 35 points .
the scores of these seven questions are added to determine the severity of patient urinary symptoms as follows , mild - 0 - 7 , moderate - 8 - 19 and severe - 20 - 35 .
the eighth question assesses the quality of life is assigned a score of 0 - 6 . for each question ,
the score in both the questionnaires was noted and kappa agreement statistical test was used to assess the level of agreement between them . by convention , a kappa of 0.0 means that the agreement is no better than a chance event .
kappa scores of 0.01 - 0.20 , 0.21 - 0.40 , 0.41 - 0.60 , 0.61 - 0.80 and 0.81 - 0.99 are interpreted as showing poor , fair , moderate , substantial and almost perfect agreement , respectively .
the kappa values of the scores for each question have been shown in table 1 . no question had a perfect agreement of scores in the self - administered and the clinician assisted scoring scenarios . only the scores of questions about weak stream and nocturia showed  moderate
the overall mean scores , kappa value and its interpretation for each question of the ipss questionnaire the total scores for each patient were calculated for both the clinical scenarios and they were classified into mild , moderate and severe categories as per the criteria mentioned before .
it was found that total scores in the self - administered and the clinician assisted scoring agreed  poorly  with each other as the kappa value was 0.19 .
the categorization of patient 's symptoms as per the ipss questionnaire when it was self - administered compared to when it was administered by an assessor
ipss questionnaire is recommended by the american urological association during the work up of a patient with luts . apart from helping the clinician in assessing the severity of the symptoms of a patient
, it also acts as a guide in selecting the appropriate mode of treatment which can vary from watchful waiting to surgery .
studies in the western population have pointed out that there can be significant misinterpretation of the ipss by the patients .
some of these studies have shown that it depends upon the level of education , with patients having a low level of education showing marked misinterpretation .
the issue of non - availability of the questionnaire in a local language and its impact on the ability of a patient to self - administer a questionnaire in english has been highlighted by ogwuche et al .
we also believe that a validated ipss questionnaire in an indian language may be helpful in decreasing the error in interpretation , but additional studies will be needed to prove this .
it has also been reported that the error in interpretation of the ipss questionnaire can lead to miscategorization of the patients symptoms and selection of a treatment that may not be effective for him .
for example , a patient who on self - administered ipss questionnaire has a score of 6 ( mild symptoms ) may be offered only watchful waiting while he actually may be having moderate or severe symptoms which becomes evident when the questionnaire is explained to him by a medical assistant .
johnson et al . have pointed out that 25% of patients who self - reported a mild score on ipss actually had a moderate or severe score . in our study too , there was a misinterpretation of the ipss questionnaire by the patients .
the scores for each question showed a poor agreement for five out of seven questions .
there was also significant miscategorization of patients symptoms ( mild / moderate / severe ) when the scores on self - administered questionnaire were compared to the clinician assisted questionnaire .
thus it is important to realize that although ipss questionnaire is an important tool in the work up of patients with luts , it should not be the sole guide for the treatment offered .
our study shows that there are some questions that are more prone for misinterpretation by the patients hence assistance by a clinician may be desirable .
we administered the questionnaire on the same day which might have an effect on the results as the patients might have been able to recall their responses in the first questionnaire .
the second issue is that we did not stratify our results according to the level of education of the patients included in the study .
it is possible that people with a higher education may have a lesser chance of misinterpretation of the questions .
our results show that our patients , who do not have english as their primary language , misinterpret the ipss questionnaire .
there are significant differences in the symptom scores when the ipss is self - administered as compared to the assisted scoring .
this problem can lead to errors in interpretation of the symptom severity of patients by the health care providers ; may affect the choice of treatment and ultimately , the clinical outcome .

Answer:
introduction : the international prostate symptom score ( ipss ) is commonly used in the evaluation of the severity of symptoms of patients with prostatic enlargement .
 it is a self - administered questionnaire .
 it has not been validated in any indian language and an english version is used which can be difficult to interpret by our patients who do not have english as their primary language . in this study , we evaluate the patient 's ability to understand the ipss by comparing the scores when the ipss questionnaire was self - administered versus when it was administered using the assistance of a clinician.materials and methods : patients who presented with lower urinary tract symptoms suggestive of benign prostatic hyperplasia , who had passed at least twelfth grade of school and had a reasonable command over english were included in the study .
 they were allowed to self - administer the ipss questionnaire following which a clinician , blinded to these scores , assisted the patient in filling the questionnaire . for each question ,
 the score in both the questionnaires was noted and kappa agreement statistical test was used to assess the agreement between the two scores.results:a total of 87 patients were included in the study . it was found that none of the questions had a perfect agreement of scores in the self - administered and
 the assisted administration.conclusion:our results show that our patients misinterpret the ipss questionnaire .
 this problem can lead to significant errors in interpretation of the symptom severity .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
diabetes is a metabolic disease that leads to high blood sugar due to either insulin insufficiency , insulin resistance or both .
according to the world health organization at least 171 million people ( 2.8% of the world population ) suffered from diabetes in year 2000 .
it is expected that more than 70% of total diabetic patients in the world will be from developing countries by year 2030 .
the prevalence of type 2 diabetes in iran ranges from 1.3% to 14.5% which will increase as the population ages in both males ( 10.6% ) and females ( 11.3% ) .
vascular diseases are one of the most common causes of morbidity and mortality in diabetic patients .
although , there is positive relation between insulin resistance and vascular disease , the exact mechanisms by which diabetes leads to arthrosclerosis is not well- understood .
c - reactive protein ( crp ) and interleukin 6 ( il-6 ) the two most sensitive markers of inflammation have been elevated in patients with type 2 diabetes . in addition , high crp level is shown to be a risk factor for developing type 2 diabetes , which may be atherogenic .
oxidative stress is a component of cellular damage and has an important role in the pathogenesis of a number of human diseases including atherosclerosis .
mechanisms that contribute to increased oxidative stress in diabetes may include not only increased non - enzymatic glycosylation and auto - oxidative glycosylation but also to decreasing antioxidant defence potential .
fao / who , define probiotics as live microorganisms which when administered in adequate amounts confer a health benefit on the host .
lactic acid bacteria ( lab ) and bifidobacteria are the most common types of microbes used as probiotics .
animal studies showed that lactobacillus gg treatment not only reduces glucose intolerance but also significantly decrease hyperglycemia in streptozotocin induced diabetes rats . among other beneficial effects of probiotics and prebiotics ,
lactobacilli and bifidobacteria are the primary probiotic bacteria which are associated with cholesterol reduction , although comparable effect may be produced by other lactic acid bacteria , such as enterococci .
it has also been reported that oral administration of heat killed lactobacillus casei to non - obese diabetic ( nod ) mice reduces the incidence of diabetes , but the mechanism underlying this effect has not been clarified .
this study was designed to determine the effect of probiotics on lipid profile , glycemic control , insulin level , oxidative stress and inflammatory markers in patients with type 2 diabetes .
this single - blinded clinical trial comprised 40 patients with type 2 diabetes recruited from medical clinic affiliated with shiraz university of medical sciences ( sums ) shiraz iran .
diabetic patients with fasting blood glucose 126 mg / dl , aged from 25 to 65 years , and diagnosed as having diabetes for less than 15 years were eligible for the study .
exclusion criteria were current smokers , subjects on non - steroidal anti - inflammatory drugs and multivitamin , as well as patients undergoing hormone replacement therapy , and those with any chronic diseases involving kidney , liver , and lung .
the research was approved by the ethics committee of sums , and written informed consent was obtained from all patients prior to commencement of the study .
subjects were initially studied during a screening visit   after an overnight fast starting from 8 pm in previous evening baseline plasma samples were collected and analyzed for triglyceride , total cholesterol , ldl - c , hdl - c , glucose , insulin , malondialdehyde , hs - crp and il-6 . using balanced block random sampling , subjects were then divided into two groups of intervention ( probiotics ) and placebo .
patients in the intervention or treatment group received 1500 mg probiotic capsules twice daily , after lunch and evening meal for 6 weeks .
the lactobacillus probiotics contained l. acidophilus , l. bulgaricus , l. bifidum , and l. casei .
patients in placebo group received 1500 mg capsules containing 1000 mg magnesium stearate twice daily for six weeks .
magnesium stearate is generally considered safe for human consumption at levels below 2500 mg / kg per day . according to the fda s subcommittee report on gras ( generally recognized as safe ) substances ( scogs ) , adding magnesium stearate directly to human food
after six weeks of experiment , fasting blood samples were collected and analyzed for all aforementioned parameters .

methods of data gathering
  demographic data including age , sex , weight , height , body mass index ( bmi ) , and waist to hip ratio ( whr ) were measured before and after the intervention .
auto - analyzer bio - systems a-25 was used to determine the lipid profile and blood glucose concentration .
elisa method was employed to determine insulin levels , high sensitive crp ( hscrp ) and il-6 .
comparison between different groups was performed through two independent samples t - test . in the absence of normal distribution , comparison between groups
was made using non - parametric wilcoxon on signed ranks and mann - whitney tests .
the study was conducted on 34 patients , of which 26 were females and 8 males .
there were no significant differences in bmi and whr between placebo and treatment groups ( table 1 ) .
the mean anthropometric data in the placebo and treatment groups * standard deviation ; * * waist to hip ratio ; * * * body mass index
 table 2 shows changes in biochemical markers after probiotic treatment . the fasting blood sugar did not change significantly after probiotic treatment ( table2 ) .
serum triglyceride concentration was reduced in probiotic treated group but the change was not significant ( table2 ) .
there were no significant differences in total serum cholesterol , ldl - c , and hdl - c levels , between probiotic and placebo groups ( table2 ) . fasting plasma insulin level did not change in probiotic group compared to placebo group ( table2 ) .   the mean parameters in placebo and treatment groups * non - parametric wilcoxon on signed ranks test ; insulin - sensitivity measure : quicki ( quantitative insulin sensitivity check index ) : 1/log ( glucose0 ( mg / dl))+log ( insulin0 ( mu / ml ) ) ; insulin - resistance measures : homa ir ( homeostasis model for insulin resistance ) : insulin0(mu / ml)glucose0 ( mmol / l)/22.5 , firi ( fasting insulin - resistance index ) : insulin0 ( mu / ml)glucose0 ( mmol / l)/25 , bennetts index : 1/log ( glucose0 ( mmol / l))log ( insulin0 ( mu / ml ) ) , insulin / glucose : insulin0 ( mu / ml)-to - glucose0 ( mmol / l ) ratio although mda and il-6 levels were reduced in treatment group , but the changes were not statistically significant ( table 2 ) .
there were an increase in crp levels in treatment group compared to placebo , but the change was not significant ( table2 ) .
insulin - sensitivity was determined through quantitative insulin sensitivity check index ( quicki ) and insulin - resistance by homa ir , firi , bennett s index and ins / gluc ratio but there were no significant changes in these indices ( table 2 ) .
diabetic complication , such as cardiovascular disease on the one hand and the dramatic growth of diabetic incidence on the other , demands a natural and safe solution to control and delay these complications .
a strong association has been found between the level of oxidative stress and risk of cardiovascular disease .
oxidative stress not only causes much pathopysiological complication but is also linked to insulin resistance which in turn causes diminished glucose uptake and disposal in peripheral tissues , and increasing glucose production in the liver .
it has also been reported that postprandial hyperlipidemia and hyperglycemia are associated with increasing ldl - c oxidation and higher risk for cardiovascular disease .
studies showed that probiotic containing foods may reduce the concentration of serum lipid and decreases both fasting and postprandial blood sugars in human .
mann and spoerry reported that lactic acid bacteria are associated with a marked reduction in the total serum cholesterol .
yun si et al , reported a significant reduction in fasting and postprandial glucose and decreasing hba1c in probiotic ( bnr17 ) treated rats . in the present study ,
we were not able to demonstrate any significant effect on fasting blood glucose after treating with probiotics . serum triglyceride concentration was decreased but the change was not statistically significant .
the reasons for these unexpected results can be related to either the small sample size or short duration of the study .
observed some strains of lactobacillus acidophilus may decrease cholesterol absorption by enhancing the binding of cholesterol to the intestinal lumen .
other possible cholesterol lowering properties of probiotics are deconjugation of bile by bile salt hydrolyses , binding of cholesterol to cellular surface and coprecipitation of cholesterol with deconjugated bile .
this study showed no significant improvement in serum total cholesterol , ldl - cholesterol and or hdl - cholesterol after treating diabetic patients with probiotics .
yadav et al . in their study on diabetic rats reported a marked reduction in pancreatic tissue oxidative damage due to a significant decrease in lipid peroxidation . in another study the same investigators showed that probiotic dahi not only decreases oxidative damage but also increases the antioxidant content and activities of catalase , glutathione peroxidase and superoxide dismutase in diabetic rats .
the mechanism by which oxidative stress results in diabetic complications and tissue damage is the overproduction of the reactive oxygen species and reduction of the antioxidant defense function of the body .
lipid peroxidation is one of the main biological targets of oxidative stress , which leads to formation of secondary products such as malondialdehyde that exacerbates oxidative damage .
mda has been found to significantly increase in pathological conditions , which is considered as a common oxidative stress biomarker in recent years .
the present study , showed a reduction in mda levels in probiotic - treated group ; however , the reduction was not statistically significant .
. showed a significant reduction in blood glucose and mda level in type 2 diabetic patients after consuming probiotic yogurt .
evaluated the functional efficacy of antioxidative properties of probiotic in healthy subjects and found a significant improvement in blood total antioxidant activity ( taa ) and total antioxidant status ( tas ) after receiving probiotics .
harisa et al . also reported a significant decrease in mda concentration after treating diabetic rats with l. acidophilus .
divergent evidence is available on the anti - inflammatory properties of probiotics . while some studies reported beneficial effect , others showed no effect at all . in this study , interleukin-6 ( il-6 )
examined the effect of probiotic bacteria on in vivo cytokine , antibody , and inflammatory responses in allergy - prone infants and showed that infants receiving probiotic had higher plasma levels of crp , and il-10 compared with those in the placebo group .
studied the effect of lactobacillus rhamnosus gg ( lgg ) on rheumatoid arthritis ( ra ) patients and reported an increase in serum il-1 beta after lgg treatment with no significant change in il-6 , tnf - alpha , myeloperoxidase ( mpo ) , and il-10 .
a reduction in oxidative stress and cardiovascular risk factor seems to be an ideal treatment strategy in type 2 diabetic patients .
the result of this study demonstrated that a 6 weeks oral treatment with probiotics decreased the concentration of tg , mda , and il-6 level in type 2 diabetic patients ; however the change were not statistically significant .
these finding could warrant future studies to determine the therapeutic effects of probiotic on diabetic patients .

Answer:
background :   the dramatic increase in the incidence of diabetes and its associated complications require a natural and safe solution to control and delay such complications .
 the present study tested the hypothesis that probiotics may affect biochemical indices of diabetic patients
 methods : thirty four types 2 diabetic patients aged between 25 to 65 years , and diagnosed with diabetes for less than 15 years were selected for this single- blinded clinical trial . using balanced block random sampling ,
 the patients were divided into two groups of intervention ( probiotics ) and placebo .
 blood samples tested for baseline glucose , insulin , tg , total cholesterol , ldl - c , hdl - c , malondialdehyde , high sensitive crp ( hs - crp ) and il-6 .
 after six weeks of experiment , fasting blood samples were re - tested and the data obtained were analyzed using spss software .

 results : there were no significant differences between anthropometric data including body mass index and waist to hip ratio in placebo and treatment groups .
 there was no significant difference in fbs , serum tg concentration total cholesterol and ldl - c levels between placebo and treatment groups .
 hdl - c levels were slightly elevated after probiotic treatment , which were not statistically significant .
 insulin , mda and il-6 levels were reduced and high sensitive crp hs.crp levels were elevated , although , not statistically significant .

 conclusion : the result of this study indicates a non- significant declining trend in the level of tg , mda and il-6 and insulin resistance after consumption of probiotics .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
tuberculosis of oral cavity is a rare entity . even before antitubercular chemotherapy era , oral lesions occurred less commonly in patients with pulmonary tuberculosis .
a 55-year - old labourer was referred to the outpatient department of our centre as a case of suspected gingivobu - ccal carcinoma for further evaluation and management .
he had a non - healing ulcer in the oral cavity for one and a half months , which was associated with pain .
he had been well until six weeks earlier when he noticed a lesion in his oral cavity .
he visited the local doctor for this and was given symptomatic treatment and vitamin supplements .
on enquiry , he had no systemic symptoms of chronic disease like fever , weight loss , and loss of appetite or weight .
he also had no history of tuberculosis or contact with a tuberculosis patient . on clinical examination ,
the patient had an ulcer in the right lower gingivobuccal sulcus of size about 21 cm and was covered with slough .
there was also mild fullness and soft tissue induration in the cheek below the lip .
the patient 's height was 167 cm ; weight , 62 kg ; blood pressure , 124/76 mm hg ; and pulse , 74 beats per minute .
on further investigation , haemoglobin was 13.9 gm% , total white blood cell count was 6,400 cells / dl , and erythrocyte sedimentation rate was 13 mm at the end of one hour .
these are usually accompanied by associated history like a stressor event or the presence of a sharp tooth , etc , pointing to diagnosis .
. the most common cause of a non - healing ulcerative lesion in the oral cavity is malignancy .
the history is usually that of a rapidly growing lesion that does not respond well to any form of management . in most cases
it is also usually accompanied by weight loss and features of chronic disease . in a developing country
every year , approximately 2.2 million people develop tuberculosis , of which about one million are new - smear positive highly infectious cases and about 5 lakh people die of tuberculosis every year .
this should be considered in the differential diagnosis , particularly in a non - healing lesion that does not respond to the usual therapy .
actinomycosis is a rare , chronic , spreading , suppurative , granulomatous and fibrosing infection characterised by the formation of multiple abscess , draining sinuses and the release of characteristic  sulphur granules  .
peak incidence occurs between 15 and 30 years , and males are more frequently infected than females .
the majority of examples of the clinical disease are cervicofacial ( 55% ) , with only 20% occurring in an abdo - minopelvic form and 15% as a thoracopulmonic form .
. are anaerobic or aerotolerant ( facultatively anaerobic ) , non - sporulating , gram - positive bacteria that tend to form branching rods and filaments and have a fermentative type of carbohydrate metabolism .
are not regarded as virulent human pathogens and are best considered as opportunistic pathogens , as they are normally present in healthy individuals as commensals of the mouth cavity and the upper respiratory tract .
their presence in the oral and respiratory specimens does not necessarily signify clinical disease and might often not be reported .
are polymicrobial . the copathogens are most commonly colonisers of the respective organ systems involved .
they act synergistically by inhibiting host - defense mechanisms or reducing the oxygen tension in the affected tissue , which promotes the growth of actinomyces spp .
syphilis is an infectious disease caused by a spirochete called treponema pallidum ( tp ) , which has a tropism for several organs and tissues in the body , causing complex clinical manifestations .
transmission of syphilis occurs mostly through sexual intercourse and sites of inoculations are usually genitals , though it can also be extragenital .
it is characterised by several different dermatological lesions , involving both skin and mucous membrane . in the first stage of the disease ( primary syphilis ) , oral chancres
syphilitic chancre is a solitary , painless , indurated , hard in consistency , reddish ulcer , accompanied by regional lymphadenopathy , which is localised at the site of tp inoculation and usually resolves after approximately one month without scarring . in secondary syphilis ,
the oral manifestations are characteristic lesions , which are multiple mucous patches that are slightly raised and covered by grayish , white pseudomembranes and surrounded by erythema .
oral lesions are often painful and snail track ulcers result when multiple mucous patches become confluent .
the diagnosis is confirmed by the specific serology and the demonstration of tp in the lesion .
tp has a slender , coiled morphology and when examined by dark - field microscopy , it was seen moving in a drifting rotary motion ( corkscrew ) .
naat is better than dark - field microscopic examination in the case of oral lesions because of the possible presence of saprophytic tp in the mouth .
chest x - ray revealed an ill - defined patchy opacity and reticulo - nodular opacities in the upper and mid zone of both lungs [ figure 2 ] .
sputum was positive for the presence of acid - fast bacilli 1 + in two consecutive samples .
these are usually accompanied by associated history like a stressor event or the presence of a sharp tooth , etc , pointing to diagnosis .
. the most common cause of a non - healing ulcerative lesion in the oral cavity is malignancy .
the history is usually that of a rapidly growing lesion that does not respond well to any form of management . in most cases
it is also usually accompanied by weight loss and features of chronic disease . in a developing country
every year , approximately 2.2 million people develop tuberculosis , of which about one million are new - smear positive highly infectious cases and about 5 lakh people die of tuberculosis every year .
this should be considered in the differential diagnosis , particularly in a non - healing lesion that does not respond to the usual therapy .
actinomycosis is a rare , chronic , spreading , suppurative , granulomatous and fibrosing infection characterised by the formation of multiple abscess , draining sinuses and the release of characteristic  sulphur granules  .
peak incidence occurs between 15 and 30 years , and males are more frequently infected than females .
the majority of examples of the clinical disease are cervicofacial ( 55% ) , with only 20% occurring in an abdo - minopelvic form and 15% as a thoracopulmonic form .
are anaerobic or aerotolerant ( facultatively anaerobic ) , non - sporulating , gram - positive bacteria that tend to form branching rods and filaments and have a fermentative type of carbohydrate metabolism .
are not regarded as virulent human pathogens and are best considered as opportunistic pathogens , as they are normally present in healthy individuals as commensals of the mouth cavity and the upper respiratory tract .
their presence in the oral and respiratory specimens does not necessarily signify clinical disease and might often not be reported .
they act synergistically by inhibiting host - defense mechanisms or reducing the oxygen tension in the affected tissue , which promotes the growth of actinomyces spp .
syphilis is an infectious disease caused by a spirochete called treponema pallidum ( tp ) , which has a tropism for several organs and tissues in the body , causing complex clinical manifestations .
transmission of syphilis occurs mostly through sexual intercourse and sites of inoculations are usually genitals , though it can also be extragenital .
it is characterised by several different dermatological lesions , involving both skin and mucous membrane . in the first stage of the disease ( primary syphilis ) , oral chancres
syphilitic chancre is a solitary , painless , indurated , hard in consistency , reddish ulcer , accompanied by regional lymphadenopathy , which is localised at the site of tp inoculation and usually resolves after approximately one month without scarring . in secondary syphilis ,
the oral manifestations are characteristic lesions , which are multiple mucous patches that are slightly raised and covered by grayish , white pseudomembranes and surrounded by erythema .
oral lesions are often painful and snail track ulcers result when multiple mucous patches become confluent .
the diagnosis is confirmed by the specific serology and the demonstration of tp in the lesion .
tp has a slender , coiled morphology and when examined by dark - field microscopy , it was seen moving in a drifting rotary motion ( corkscrew ) .
naat is better than dark - field microscopic examination in the case of oral lesions because of the possible presence of saprophytic tp in the mouth .
chest x - ray revealed an ill - defined patchy opacity and reticulo - nodular opacities in the upper and mid zone of both lungs [ figure 2 ] .
sputum was positive for the presence of acid - fast bacilli 1 + in two consecutive samples .
primary tuberculosis of the oral cavity is rare , as it occurs in young individuals and is associated with cervical lymphadenopathy.[258 ] secondary tuberculosis of the oral cavity usually occurs following pulmonary tuberculosis .
it is more common than the primary variety and occurs more often in old age.[257 ] tuberculosis of the oral cavity is rare because the intact mucosa is resistant to tuberculous infection and saliva has a protective effect .
other possible causes for the relative rarity of oral tuberculosis include the presence of saprophytes in the oral cavity and resistance of stratified muscles to bacterial invasion .
there are reports in which dentists with pulmonary tuberculosis have infected patients during dental manipulation .
nasolabial infection occurred in a physician who administered mouth - to - mouth resuscitation to a tuberculosis patient .
other sites include the gingiva , soft palate , lip , buccal mucosa , floor of the mouth , and gingivobuccal sulcus . oral tuberculosis may present as single or multiple , painful or painless ulcers with irregular border .
it can also present as nodules , fissures , vesicles , or peri - apical granulomas .
the oral tuberculous ulcers have some characteristic clinical features including chronicity , hyperemic changes , and multiple or satellite lesions , which lead to the suspicion of a tuberculous lesion .
oral tuberculosis occurs in 0.4 - 1.5% of patients with pulmonary tuberculosis . at present , with improved community health and anti - tubercular medication , the incidence of tuberculosis has decreased .
oral tuberculosis is not considered in the differential diagnosis of patients with oral ulcer by many clinicians ; hence , it is missed or the treatment is delayed .
the purpose of this paper is to alert clinicians to consider oral tuberculosis in patients with non - healing oral ulcer . on consultation with the physician ,
anti - tubercular therapy was initiated with isoniazid ( 10 mg / kg of body weight ) , rifampicin ( 10 - 20 mg / kg of body weight ) , and pyrazinamide ( 10 - 20 mg / kg of body weight ) and ethambutol for two months , followed by isoniazid and rifampicin for the following four months . during the period , the patient was instructed not to undergo any surgical procedure within the oral cavity and was warned of transmitting the disease to others .
tuberculous ulcer of the oral cavity secondary to pulmonary tuberculosis . from the department of head and neck oncology , tata memorial hospital , mumbai .

Answer:
tuberculosis of the oral cavity is a rare condition .
 a 55-year - old labourer was referred as a case of oral cancer for further management .
 the patient had no systemic symptoms .
 biopsy of the lesion revealed caseating granulomatous inflammation .
 chest x - ray and sputum revealed evidence of asymptomatic pulmonary tuberculosis .
 the purpose of this paper is to sensitize clinicians to consider oral tuberculosis as a differential diagnosis in patients with an non - healing oral cavity ulcer .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
when evaluating patients for clinical trial , intrauterine pregnancy is commonly considered an exclusion criteria , however guidelines do not exist to determine what to do should a pregnancy test result as positive .
the patient underwent standard - of - care therapy upfront with progression of disease and was referred to investigational therapeutics for phase i treatment .
pelvic ultrasound and -hcg heterophilic antibody testing were negative ruling out intrauterine and ectopic pregnancy or phantom hcg .
her elevated -hcg appeared consistent with paraneoplastic syndrome reflected in a decline in -hcg that correlated with a response to treatment .
a 34-year - old african american female with metastatic mucinous ovarian carcinoma presented with a pelvic mass discovered during her annual gynecological examination .
an ultrasound showed a 7.7    8.7  cm left ovarian mass with complex appearance .
laparoscopic left salpingo - oophorectomy showed a moderately differentiated mucinous ovarian carcinoma , stage ic1 , due to intraoperative rupture of the ovarian mass .
tumor cells were diffusely positive for keratin 7 and very focally positive for keratin 20 .
the patient was taken for diagnostic laparoscopy with appendectomy , omentectomy , and multiple peritoneal biopsies by a gynecologic oncologist ; all of which were negative for malignancy .
eight weeks later the patient started adjuvant chemotherapy with one cycle of capecitabine and oxaliplatin ( xelox ) , transitioned to four months of fluorouracil and oxaliplatin ( folfox ) due to insurance issues .
the ct abdomen and pelvis post folfox chemotherapy showed an enhancing 2.6  cm nodule in rectus abdominis muscle .
the patient underwent an exploratory laparotomy with excision of a 5    6  cm abdominal mass involving fascia and muscle , consistent with metastatic adenocarcinoma .
after recovery , the patient received chemotherapy with carboplatin and paclitaxel for 6  months .
the ct abdomen and pelvis performed following 6  months of carboplatin and paclitaxel showed progression of disease with new nodal and perihepatic implants .
the patient subsequently consulted with the md anderson cancer center department of investigational cancer therapeutics for phase i clinical trial options .
the patient was treated with a phosphatidylinositol-4,5-bisphosphate 3-kinase ( pi3k ) inhibitor plus a mitogen / extracellular signal - regulated kinase ( mek ) inhibitor with progression of disease after 5  months .
she then started on a second phase i trial with a polymeric micellar nanoparticle of the substance dach - pt ( 1,2-diaminocyclohexane platinum ) , an in vivo metabolite of oxaliplatin , with progression following 1  cycle of therapy .
the patient was then enrolled in a trial with paclitaxel , bevacizumab and temsirolimus ( pat ) . on the day of clearance to start treatment , she was found to have a positive urine and serum pregnancy test .
the left ovary was surgically absent however the right ovary was enlarged with complex cystic mass with solid components measuring 9.5    6.6  cm .
the work - up for false positive elevation of -hcg including serial dilutions , incorporation of animal serum and outside institutional validation testing for -hcg heterophile antibody , was negative .
therefore , the -hcg elevation was not thought to be related to a phantom hcg .
dilation and curettage to rule out trophoblastic disease was planned , but not completed due to discovery of a deep vein thrombosis and initiation of therapeutic anticoagulation .
as no intrauterine or extrauterine pregnancy could be identified , after several weeks , the patient returned to clinic and was cleared to start treatment . at that time , her -hcg was 210.3 .
three weeks post treatment with pat , the -hcg decreased to 27.5 and ct scans showed partial response ( fig .
, the patient was admitted to the intensive care unit for weakness due to guillain barre syndrome .
nearly all female patients undergoing enrollment on clinical trial are evaluated for pregnancy as part of standard exclusion criteria .
an elevated -hcg in the absence of viable pregnancy can occur for multiple reasons and has a broad differential diagnosis including miscarriage , ectopic pregnancy , pituitary hcg production , trophoblastic disease and phantom hcg .
ectopic pregnancy is frequently suspected when -hcg levels plateau or fail to double within 48  h without evidence of intrauterine pregnancy with ultrasound . when intrauterine and extrauterine pregnancy are ruled out ,
pituitary hcg may be produced in perimenopausal or postmenopausal women . as estrogen and progesterone production decreases , releasing gonadotropin releasing hormone ( gnrh ) from negative feedback , luteinizing hormone ( lh ) and follicular stimulating hormone ( fsh ) rise .
the  subunit gene of lh is found in a sequence of 7 hcg  subunit genes and therefore uncontrolled gnrh stimulation may lead to hcg production by pituitary gonadotrope cells ( cole , 2005 ) . using an fsh level of 45.0  miu
/ ml identified hcg of perimenopausal women , ages 4155  years , with mildly increased serum hcg concentrations ( 5.014.0  miu / ml ) , an fsh cutoff of 45.0  miu / ml identified hcg of placental origin with 100% sensitivity and 75% specificity .
fsh levels greater than 45  miu / ml were never observed when hcg was of placental origin . when hcg is less than 5.0  miu / ml , fsh testing is not performed as pregnancy is unlikely .
when hcg is greater than 14.0  miu / ml , fsh testing is not performed as this is consistent with pregnancy ( gronowski et al . , 2008 ) .
in one study , two weeks of estrogen - progesterone therapy suppressed pituitary hcg and may help confirm diagnosis ( cole et al . , 2007 ) .
gestational trophoblastic disease is a group of conditions that may be classified as either premalignant , in the case of a partial or complete hydatidiform mole , or malignant , including invasive mole , choriocarcinoma , placental - site trophoblastic tumor and epithelioid trophoblastic tumor .
although not always the case , -hcg is commonly found to be elevated in these conditions and these diseases are considered high on the differential diagnosis list when found .
phantom hcg is a phenomenon first described in 1998 by laurence cole , ph.d . , where patients have persistent mild elevations of -hcg , occasionally following miscarriage .
the elevated -hcg often falsely interpreted and misleads physicians to evaluate or incorrectly treat patients with cytotoxic agents for trophoblast disease ( cole , 1998 ) .
heterophilic antibodies against mouse , goat , rabbit , cow , horse , or sheep antigens can interfere with two - site immunoassays by creating complexes between the two anti--hcg antibodies without -hcg being present .
this leads to a false - positive result ( vladutiu et al . , 1982 ) .
people can develop heterophilic antibodies by exposure to the serum , tissue , or other antigens of nonhuman species .
heterophilic antibodies do not appear to be excreted in the urine and therefore urine assays can be used to identify false - positive serum results .
serial dilutions may also be performed to assess for interference . to avoid false positives ,
the excess of nonspecific antibodies saturates heterophilic antibodies in human serum and usually eliminates their interference with the assay ( johnson et al . , 2000 ) .
additionally , serum samples can be sent to outside laboratories with different assay systems to validate results . in our patient 's case ,
the patient continued to have normal menstrual cycles and was using two forms of contraception with her husband who had history of vasectomy .
the work up , including pelvic ultrasound and ct scans , was negative for pregnancy and trophoblastic disease .
it was therefore believed that the patient 's -hcg production was due to the patient 's tumor , consistent with a paraneoplastic syndrome .
paraneoplastic syndromes occur in about 8% of cancer patients and frequently develop with advanced disease .
they may appear earlier than symptoms of the primary tumor itself , leading to new diagnosis of cancer ( pelosof and gerber , 2010 ) .
it can also be found in the testis , liver , lung , colon , and stomach in small amounts .
malignancies in these organs may lead to an increased serum levels ( demirtas et al .
a gastric origin is the most frequent , ranging from 11% to 17% of this rare subset ( germann et al . , 2002 ) .
in our case , the patient had a primary ovarian neoplasm with metastases within the abdomen .
-hcg levels rose while the patient was on a treatment break , nearly impeding her from further treatment . with re - initiation of therapy
, the -hcg declined , corresponding to a partial response per response evaluation criteria in solid tumors ( recist ) on radiographic imaging .
urine hcg remained positive despite decline in serum hcg as the level was still over the detection threshold of 25
interesting enough , other tumor markers ( ca 125 , ca 15 - 3 , ca 19.9 and cea ) all increased .
the decreased size of tumor within the pelvis corresponded with decreasing -hcg levels while increased hepatic metastasis corresponded to increases in other markers .
this lends evidence to the idea that the patient had tumoral heterogeneity with different markers produced by tumors in different areas of the body .
this is the first case of paraneoplastic -hcg production from an ovarian adenocarcinoma reported in the literature .
we provide a treatment algorithm to evaluate for paraneoplastic hcg production when assessing for clinical trial eligibility ( fig .
paraneoplastic syndrome should remain in the differential diagnosis in patients found to have elevated levels of -hcg without evidence of intra- or extra - uterine pregnancy .
informed consent to publish the information was granted from the patient . none of the authors have conflict of interest or competing interest .
jg participated in the design of the manuscript , analyzed the biomarker data and drafted the manuscript .
pp jg participated in the design of the manuscript , analyzed the biomarker data and drafted the manuscript .
sp conceived of the study , and participated in its design and coordination and helped to draft the manuscript .

Answer:
there is a broad range of possible diagnoses for an elevated beta human chorionic gonadotropin ( -hcg ) in the absence of intrauterine or ectopic pregnancy . when women of child bearing potential undergo evaluation for clinical trial , it is often unclear what course of evaluation to take when a pregnancy test is positive .
 we describe the clinical course of a patient with widely metastatic mucinous ovarian carcinoma with metastasis to the peritoneum , lymph nodes and liver . the patient was found to have a mildly elevated -hcg during initial evaluation for clinical trial .
 extensive work up for ectopic pregnancy , trophoblastic disease , and phantom -hcg were negative .
 the patient 's -hcg levels continued to rise until initiation of therapy .
 she was treated on a phase i protocol with restaging scans revealing a partial response .
 the -hcg was retested and declined in conjunction with her response , consistent with paraneoplastic -hcg . here
 , we propose a decision making algorithm to evaluate a patient with an elevated -hcg undergoing assessment for clinical trial .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
a 45-year - old man presented to our outpatient department with painless progressive diminution of vision both eyes for the past 10 days .
medical history included xdr - tb on treatment with linezolid ( 600 mg / day ) , ethambutol ( 800 mg / day ) , moxifloxacin ( 400 mg / day ) , cycloserine ( 500 mg / day ) , ethionamide ( 500 mg / day ) , and kanamycin ( 750 mg / day ) for the past 6 months .
on examination , his visual acuity was 20/200 ( ou ) , not improving with pin hole .
anterior segment examination was unremarkable and pupils were 3 mm , round , regular , and reacting to light in both eyes ( direct and indirect ) .
fundus examination revealed hyperemic disc with blurred margins ( ou ) [ figs . 1 and 2 ] .
visual field evaluation by humphrey field analyzer showed peripheral constriction and quadrantanopia in the right eye [ fig . 3 ] and low reliable fields in the left eye [ fig . 4 ] .
optical coherence tomography ( oct ) revealed increased retinal nerve fiber layer ( rnfl ) thickness in both eyes [ fig . 5 ] .
fundus photograph showing disc edema in right eye fundus photograph showing disc edema in left eye visual field showing peripheral constriction and superotemporal quadrantanopia in right eye visual field left eye showing quadrantanopia ( low reliability ) stratus oct showing increase in retinal nerve fiber layer thickness involving superior and inferior quadrants in right eye and superior , inferior , and nasal quadrants in left eye ( arrows ) ethambutol - induced toxic optic neuropathy was initially suspected and tablet ethambutol was discontinued after discussing with the treating physician .
after two weeks , the patient 's visual acuity had dropped to 20/400 in both eyes , and the fundus picture remained unchanged .
hence , the possibility of toxic optic neuropathy due to linezolid was considered as reported in the literature and linezolid was discontinued ( a total cumulative dose of 126 g had been already consumed by the patient ) .
color vision was restored to normal and patient 's vision was restored to 20/20 after one month .
fundus examination revealed resolved optic disc edema with setting in of temporal pallor in both eyes [ figs .
the patient is under regular follow - up and no toxic effects have been noted at three months of follow - up .
fundus photograph showing resolved disc edema with temporal pallor of optic disc in right eye fundus photograph left eye showing temporal pallor of optic disc follow - up visual field after discontinuation of linezolid showing partial recovery in right eye follow - up visual field in left eye after discontinuation of linezolid stratus oct showing reduction in retinal nerve fiber layer edema in both eyes
toxic optic neuropathies are characterized by gradual , progressive , painless , bilaterally symmetric visual loss affecting central vision , and causing central or centrocecal scotoma .
xdr - tb is defined as resistance to at least rifampicin and isoniazid among the first - line anti - tb drugs ( which is the definition of multidrug - resistant tb ) in addition to resistance to any fluoroquinolone and at least one of the three injectable second - line anti - tb drugs ( capreomycin , amikacin , kanamycin ) .
linezolid inhibits protein synthesis by preventing formation of the ribosome complex that initiates protein synthesis .
its unique binding site located on 23s ribosomal rna of the 50s subunit results in no cross resistance with other drug classes .
hence , linezolid is being increasingly used for the treatment of infections caused by multidrug - resistant gram - positive bacteria .
long - term linezolid interferes with bacterial ribosomes and also with mammalian ribosomes , thereby disrupting mitochondrial oxidative phosphorylation and protein synthesis .
serious adverse reactions demanding withdrawal of the drug include myelosuppression , peripheral and optic neuropathy , lactic acidosis , and serotonin syndrome .
the safety of linezolid treatment has been established for use only up to 28 days .
there are several case reports of linezolid - induced optic or peripheral neuropathy in patients treated for a time period beyond 28 days .
only two cases of toxic optic neuropathy have been reported following short - term linezolid treatment of 16 days .
fundus picture can be varied , showing temporal pallor , disc edema , or essentially normal .
the most common indication for long - term linezolid therapy in these patients has been infection with methicillin - resistant staphylococcus aureus . in our case
, neuropathy occurred after linezolid had been used for six months at a dose of 600 mg per day for infection with mycobacterium tuberculosis .
we attribute toxic optic neuropathy to linezolid in our patient because even two weeks after stopping ethambutol there was deterioration of vision , and it was only after withdrawal of linezolid that visual improvement started .
linezolid is recommended by the world health organization ( who ) to treat drug - resistant tuberculosis as a medicine with  unclear efficacy  .
linezolid , approved for gram - positive infections in 2000 has been used off - label for drug - resistant tuberculosis .
there is limited data available regarding the efficacy and safety of linezolid in multidrug - resistant tb since it is always administered as part of combination therapy .
linezolid may improve the chance of bacteriological cure only in the most complicated xdr - tb cases .
its safety profile precludes its use in cases for which there are other alternatives . with increasing emergence of xdr - tb , for which treatment options are limited , physicians are compelled to resort to new drug therapies .
although ethambutol is the most common antitubercular drug implicated to cause toxic optic neuropathy , it is pertinent to be aware that if withdrawal of one drug does not show visual recovery or there is further deterioration of vision , the possibility of toxicity due to other drugs should be thought of . with our country bearing the brunt of tuberculosis ,
ophthalmologists and physicians must be aware that monitoring of visual function is important in patients on long - term linezolid therapy and that early recognition of toxicity and discontinuation of drug results in complete visual recovery .

Answer:
many systemic antimicrobials have been implicated to cause ocular adverse effects .
 this is especially relevant in multidrug therapy where more than one drug can cause a similar ocular adverse effect .
 we describe a case of progressive loss of vision associated with linezolid therapy . a 45-year - old male patient who was on treatment with multiple second - line anti - tuberculous drugs including linezolid and ethambutol for extensively drug - resistant tuberculosis ( xdr - tb ) presented to us with painless progressive loss of vision in both eyes .
 color vision was defective and fundus examination revealed optic disc edema in both eyes .
 ethambutol - induced toxic optic neuropathy was suspected and tablet ethambutol was withdrawn .
 deterioration of vision occurred despite withdrawal of ethambutol .
 discontinuation of linezolid resulted in marked improvement of vision .
 our report emphasizes the need for monitoring of visual function in patients on long - term linezolid treatment .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
primary hyperhidrosis is a common disease that is characterized by excessive sweating of face , palms , or axilla , occurring in 0.6 - 3% of a population ( 1 , 2 ) .
since kux performed endoscopic thoracic sympathetic surgery ( 3 ) , it has been popular during the past few decades as the surgical treatment of choice for facial , palmar , and axillary hyperhidrosis ( 4 - 6 ) .
although endoscopic thoracic sympathetic surgery offers permanent cure for hyperhidrosis , it is often accompanied by serious complications , such as compensatory hyperhidrosis . in order to decrease compensatory hyperhidrosis , endoscopic thoracic
sympathetic surgery has attempted to reduce the extent of resection of the sympathetic nerve , but these procedures did not significantly decrease the occurrence of compensatory hyperhidrosis ( 7 ) .
we performed sympathetic nerve reconstruction surgery using intercostal nerve in 19 patients with severe compensatory hyperhidrosis after endoscopic thoracic sympathetic surgery and evaluated the results of the procedure .
from february 2004 to august 2007 , we performed endoscopic thoracic sympathetic surgery in 184 patients with primary hyperhidrosis . among theses
patients , reconstruction surgery of sympathetic nerve using intercostal nerve was performed in 19 patients with severe compensatory hyperhidrosis after endoscopic thoracic sympathetic surgery .
fourteen patients were male and 5 were female ( median age : 28 yr , range : 19 - 61 ) .
this study was approved by the institutional review board of our hospital ( irb no : 3 - 20080021 ) .
all procedures of reconstruction surgery were performed under general anesthesia with a single lumen endotracheal tube .
the patients were in a semi - fowler position with their arms extended . in 18 patients except for one patient with severe pleural adhesion ,
starting on the left side , two separate skin incisions were made along the previous thoracoscopic scars and thoracoscopic ports were placed .
after co2 gas insufflation into the thoracic cavity with less than 10 mmhg of pressure to deflate the lung , the pleural space was inspected with 5-mm thoracoscope .
the intercostal neurovascular bundle was dissected in lengths of 5 - 7 cm and the distal part was resected .
after the proximal and distal part of previously operated sympathetic nerve was exposed , the nerve sheaths of proximal and distal part of exposed sympathetic nerve and harvested intercostal nerve end were removed with an electro - surgical tip cleaner ( surgisite , ethicon , gargrave , skipton , uk ) .
the intercostal nerve end was placed between the proximal and distal part of the exposed sympathetic nerve and the fibrin glue was applied to contact surface of the sympathetic and intercostal nerve ( fig .
the same procedure was repeated on the right side . in cases of sympathetic nerve clipping
, this procedure was performed after clip removal . in one patient with severe pleural adhesion
we reviewed the clinical charts of all patients who underwent sympathetic nerve reconstruction surgery using the intercostal nerve .
patients were followed by telephone questionnaire on the effects of the surgery and postoperative complications .
the degree of improvement of compensatory hyperhidrosis was graded as " definite " , " mild " , or " absent " .
" definite " means that patients felt fully satisfied after the reconstruction surgery , " mild " means that patients felt satisfied to a certain extent , and " absent " means that patients felt no improvement .
median interval between the sympathetic nerve reconstruction surgery and questionnaire was 22 ( range : 1 - 45 ) months .
in one patient ( patient number 17 in table 1 ) , digital infrared thermographic imaging was performed preoperatively and postoperatively .
primary hyperhidrosis patients were composed of 9 facial , 8 palmar , and 1 axillary , and one patient had both facial and palmar hyperhidrosis .
initial endoscopic thoracic sympathetic surgery for primary hyperhidrosis was t3 sympathicotomy in 5 patients ; t2 sympathicotomy in 8 ; t2 , 3 sympathicotomy in 1 ; t2 , 3 , 4 sympathicotomy in 1 ; t2 clipping in 2 ; t2 , 3 clipping in 1 ; and t2 clipping with t3 sympathicotomy in 1 patient .
the median interval between the first endoscopic thoracic sympathetic surgery for primary hyperhidrosis and sympathetic nerve reconstruction surgery was 47 ( range , 4 - 111 ) months .
r3 intercostal nerve was used for sympathetic nerve reconstruction surgery in 15 patients , r4 intercostal nerve in 2 , r2 intercostal nerve in 1 , and r3 with r5 intercostal nerve in 1 patient .
three patients replied that the effects of reconstruction were " definite " , 6 responded with " mild " , and 8 said " absent " .
postoperative complications were numbness of the chest wall in 2 patients , chest wall pain in 2 patients , and temporary ptosis in 1 patient in whom ptosis spontaneously resolved after 3 months .
preoperative and postoperative digital infrared thermographic imagings performed in one patient showed the thermal change in chest and back .
since kux advocated thoracoscopic sympathetic surgery ( 3 ) , recent developments in thoracoscopy and specialized instruments have facilitated the procedure . and , it became the treatment of choice for hyperhidrosis because of its low morbidity , short hospital stay , and excellent cosmetic results ( 6 ) .
although it has many advantages , some patients suffer from compensatory hyperhidrosis , which is by far the most common and disagreeable complication after endoscopic thoracic sympathetic surgery . according to the previous reports
, compensatory hyperhidrosis occurs in 59.8 - 90% of patients after sympathetic surgery ( 8 - 10 ) .
the mechanism of compensatory hyperhidrosis is not clear , but it seems to be associated with compensation for thermoregulatory function ( 11 , 12 ) . because the incidence and degree of compensatory hyperhidrosis appear to be related to the extent of resection of the sympathetic chain , some clinicians have suggested that the extent of resection should be limited ( 13 ) . for these reasons , many treatment methods , such as different level sympathectomy or sympathicotomy , ramicotomy , and clipping ,
have been attempted to reduce the extent of resection ( 14 - 18 ) , although the effects of these methods remain controversial . in mild compensatory symptoms , antiperspirants including aluminum - based compounds , iontophoresis , and systemic or topical anticholinergic drugs can be used . however ,
if the symptoms are severe , the management is more difficult and results are unsatisfactory .
since philipeaux and vulpian reported the first experimental nerve graft in 1870 , many successful nerve grafts were reported in the field of orthopedic surgery . in the field of thoracic surgery ,
schoeller et al . ( 19 ) reported successful phrenic nerve reconstruction using sural nerve in patient with mediastinal tumor resection .
telaranta reported that reconstruction of the sympathetic chain using sural nerve graft diminished compensatory sweating in a male patient who underwent sympathicotomy for palmar hyperhidrosis ( 20 ) .
miura et al . ( 21 ) reported that sympathetic nerve reconstruction surgery using the intercostal nerve was useful after resection of the sympathetic nerve involved by tumor .
although the sural nerve is the most commonly used for nerve graft , the intercostal nerve has several advantages over the sural nerve .
first , the intercostal nerve has more sympathetic nerve fibers than the sural nerve , hence the intercostal nerve is more appropriate for sympathetic nerve reconstruction surgery .
second , the sural nerve can be used only as free graft but the intercostal nerve can be used as pedicled graft and harvested as a neurovascular bundle . therefore , a sufficient blood supply in the graft can be maintained .
so , an additional incision is not needed and donor site morbidity decreases . in our experience ,
thoracoscopic intercostal nerve could be harvested in all patients except 1 patient with severe pleural adhesion , leading us to believe that the intercostal nerve is a useful graft for sympathetic nerve reconstruction surgery .
epineural and fascicular sutures are the most used for nerve anastomosis , but the foreign body reaction caused by suture material to nerve is another possible problem ( 22 , 23 ) .
some reports demonstrated the successful nerve anastomosis using fibrin sealant without suture technique ( 24 , 25 ) .
if microscopic suture technique is used in sympathetic nerve reconstruction surgery , it inevitably needs thoracotomy .
the type of anastomosis performed in this procedure is the modification of end - to - side neurorrhaphy where axonal sprouting occurs ( 26 ) . the nerve is generally anastomosed in the original direction , but the free graft should be prepared to be anastomosed in the original direction in this operation .
some reports revealed the anastomosis in reverse orientation did not influence the nerve conduction ( 27 , 28 ) . in the questionnaire on the effects of sympathetic nerve reconstruction surgery , nine patients replied " definite " or " mild " . in 3 patients who replied that the results were " definite " ,
compensatory sweating decreased and anhidrosis of the affected areas after endoscopic thoracic sympathetic surgery improved .
patients , who replied mild improvement , complained still uncomfortable compensatory hyperhidrosis , although amount and frequency of perspiration decreased .
these results of the reconstruction surgery were not different between variables such as age , sex , affected area , and interval from endoscopic thoracic sympathetic surgery due to the small number of cases in this study .
the digital infrared thermographic imaging is a useful tool in evaluation of body temperature distribution . in the image ,
before and after sympathetic nerve reconstruction , we performed the digital infrared thermographic imagings in 22 yr - old man complaining of compensatory hyperhidrosis in chest after t3 sympathicotomy .
after the reconstruction surgery , trunk temperature has increased , and this result corresponded with patient 's symptom . even though the number of patients is not sufficient for data analysis , outcome of the reconstruction surgery did not correlate with the interval between the sympathetic surgery and reconstructive surgery . to evaluate the exact effects of sympathetic nerve reconstruction , more cases and longer
postoperative complications of the reconstruction surgery were seen in 5 patients ; prolonged chest wall pain which was tolerable in 2 patients , and numbness of chest wall in 2 patients .
in addition , because compensatory hyperhidrosis depends on climate and season , the timing of a questionnaire survey is important . in this study , the questionnaire was performed on october when it is relatively cool and dry in korea .
, our results suggest that sympathetic nerve reconstruction with intercostal nerve may be one of the useful surgical methods in severe compensatory hyperhidrosis patients .
the reconstruction surgery must be decided very carefully in highly selected patients with severe compensatory hyperhidrosis .

Answer:
we performed sympathetic nerve reconstruction using intercostal nerve in patients with severe compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis , and analyzed the surgical results . from february 2004 to august 2007 , sympathetic nerve reconstruction using intercostal nerve was performed in 19 patients .
 the subjected patients presented severe compensatory hyperhidrosis after thoracoscopic sympathetic surgery for primary hyperhidrosis .
 reconstruction of sympathetic nerve was performed by thoracoscopic surgery except in 1 patient with severe pleural adhesion .
 the median interval between the initial sympathetic surgery and sympathetic nerve reconstruction was 47.2 ( range : 3.5 - 110.7 ) months .
 compensatory sweating after the reconstruction surgery improved in 9 patients , and 3 out of them had markedly improved symptoms .
 sympathetic nerve reconstruction using intercostal nerve may be one of the useful surgical options for severe compensatory hyperhidrosis following sympathetic surgery for primary hyperhidrosis .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
hemophilia a is a congenital disease transmitted by the x chromosome with a recessive trait , characterized by a deficiency in the production of factor viii .
the hemophilic pseudotumor affects 12% of patients with a severe disease , frequently associated with a traumatic injury .
the hemophilic pseudotumor develops from repeated episodes of bleeding , either from fracture sites or bleeding or subperiosteal hemorrhage of any soft tissue .
the interior of the pseudotumor consists of blood products at different stages of development , surrounded by a fibrous capsule containing hemosiderin - laden macrophages .
it appears as a painless tumor of slow growth that can compress key organs causing bone destruction , muscle and skin necrosis .
the objective of case presentation is to describe a patient with a hemophilic pseudotumor of the abdomen , and to review the literature on hemophilic pseudotumor .
this is a case of a 31 year old male , diagnosed with severe hemophilia a at 2 years of age , treated with factor vii 2000  iu weekly since , whit a family history of 2 cousins with hemophilia ( no other specified ) . in september 2011 , he underwent drainage of a hematoma of the left pelvic limb . in october 2011
blood transfusion on multiple occasions . in august 2012 had a hematoma in the left thigh surgically removed . in september 2012 presented upper gastrointestinal bleeding requiring hospitalization with remission of the symptoms .
an abdominal tumor diagnosed 10 years ago during routine screening that progressively grew to encompass the entire abdominal area , with no associated symptoms . during his last hospital admission , hematology referred him to general surgery due to bowel obstruction symptoms , and to evaluate surgical treatment of a pelvic tumor referred as a possible teratoma . a ct scan of the abdomen ( figs . 1 and 2 )
was performed , showing a tumor in the pelvis with clear borders , 241  mm    192  mm of diameter , from the pelvis and projected into the bladder , rectum and adjacent structures , including the kidneys .
the lesion had irregular wall thickness , with a density of 195 houndsfield units in its interior , with heterogeneous enhancement and vascularity present within ; with tomographic diagnosis of abdominal pelvic teratoma .
the patient underwent surgery with surgical findings that included a cyst - like tumor of 40  cm    30  cm displacing loops of small bowel , colon and bladder , with adhesions to the great omentum , small intestine , descending colon and bladder .
macroscopically appeared as an old , organized , and calcified clots with a volume of 5000  ml .
an abdominal tumor diagnosed 10 years ago during routine screening that progressively grew to encompass the entire abdominal area , with no associated symptoms . during his last hospital admission , hematology referred him to general surgery due to bowel obstruction symptoms , and to evaluate surgical treatment of a pelvic tumor referred as a possible teratoma . a ct scan of the abdomen ( figs . 1 and 2 )
was performed , showing a tumor in the pelvis with clear borders , 241  mm    192  mm of diameter , from the pelvis and projected into the bladder , rectum and adjacent structures , including the kidneys .
the lesion had irregular wall thickness , with a density of 195 houndsfield units in its interior , with heterogeneous enhancement and vascularity present within ; with tomographic diagnosis of abdominal pelvic teratoma .
the patient underwent surgery with surgical findings that included a cyst - like tumor of 40  cm    30  cm displacing loops of small bowel , colon and bladder , with adhesions to the great omentum , small intestine , descending colon and bladder .
macroscopically appeared as an old , organized , and calcified clots with a volume of 5000  ml .
the hemophilic pseudotumor of the abdomen is a rare but often disabling condition , potentially fatal in patients with severe hemophilia . diagnosing a hemophilic pseudotumor with invasive techniques such as , aspiration and biopsy
imaging techniques of which mri is preferred , allows recognition of blood products in various stages of evolution .
ultrasonography ( usg ) shows a central anechoic region with increased echoes behind the lesion due to enclosed fluid in the pseudotumor . computed tomography ( ct )
identifies the thick pseudocapsule , but can not differentiate a hematoma from a chronic abscess .
ct is particularly helpful in the evaluation of bone , whereas mri is superior to ct for delineating soft tissue . at the moment ,
however , there are instances where surgical extraction of the lesion is not feasible . in such situations ,
the decision to operate on this patient was made based on the gradual increase in the tumor size , the symptoms that the displayed by the patient . in this patient
this type of procedure is associated with complications such as bleeding , bowel perforation , and damage to nearby structures due to firm vascular , and nervous adhesions . surgical resection after performing arterial embolization to reduce the vascularization of the pseudotumor is a good alternative , thereby reducing the size of the pseudotumor and the risk of bleeding complications during surgery , at best about 2  weeks prior to surgery .
it is a rare pathological entity , but it must be considered in the hemophilic patient with a long - standing abdominal tumor and trauma history , to plan appropriate treatment .
the abdominal hemophilic pseudotumor is a rare pathological entity , with few reports worldwide , but must be considered in hemophilic patients with a well documented abdominal tumor , as a complication of the hematologic disease .
signs and symptoms of compression should be evaluated by ct or mri because its early diagnosis is crucial for evaluation and proper surgical planning , and treatment in conjunction with other specialties .
written informed consent was obtained from the patient for publication of this case report and case series and accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal on request .
the study conception and design , as well as writing the manuscript works were all equally distributed among all the authors.key learning pointshemophilic pseudotumor etiology.hemophilic pseudotumor management .

Answer:
introductionhemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia .
 results from multiple episodes of bleeding into the bones and soft tissues.presentation of casea 31 years old male patient , with severe hemophilia a. diagnosed with an abdominal tumor 10 years ago during routine screening , that progressively grew to encompass the entire abdominal area , with symptoms of intestinal obstruction.discussionhemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction , muscle and skin necrosis .
 the tumor may have fistulas or break spontaneously.conclusionthe abdominal hemophilic pseudotumor is a rare pathological entity , with few reports worldwide , but must be considered in hemophilic patients with a well documented abdominal tumor .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
skin wounds are caused by the loss of connection in the skin and recovery requires cellular and biochemical reactions .
chronic wounds arise from the lack of physiological processes and the disease due to complications ( e.g. infection and amputation ) has devastating consequences on societies . according to the principles of iranian traditional medicine ( itm )
this is a systematic review study that involved gathering data from three traditional medical textbooks , namely canon of medicine , tib - e - akbari and exir - e - azam with the keyword  chronic wound  or
few tables were developed for nutrition measures as well as edible and topical medicinal herbs .
electronic databases such as pubmed , scopus , web of science , and cochrane library were searched for relevant articles and those related to effective medicinal herbs in the treatment of wounds were obtained .
depending on appearance and secretions , wounds are divided into two categories , namely simple and compound wounds .
the prognostic factors are based on the age , weight , accompanied disease , as well as the quality and quantity of the wound secretions .
patient s diet is very important and oral medications have a major role in the whole body detoxification .
topical medications are used together with the above - mentioned treatments ; noting that without detoxification , these medications are not effective entirely .
body detoxification is the first medical step , after which topical medications could lead to a better wound healing result .

Answer:
background : skin is the body s first defense against stressful factors .
 skin wounds are caused by the loss of connection in the skin and recovery requires cellular and biochemical reactions .
 chronic wounds arise from the lack of physiological processes and the disease due to complications ( e.g. infection and amputation ) has devastating consequences on societies . according to the principles of iranian traditional medicine ( itm )
 , these disorders can be treated in a step - by - step procedure.methods:this is a systematic review study that involved gathering data from three traditional medical textbooks , namely canon of medicine , tib - e - akbari and exir - e - azam with the keyword  chronic wound  or  ghorha  . in the next step ,
 few tables were developed for nutrition measures as well as edible and topical medicinal herbs .
 electronic databases such as pubmed , scopus , web of science , and cochrane library were searched for relevant articles and those related to effective medicinal herbs in the treatment of wounds were obtained.results:depending on appearance and secretions , wounds are divided into two categories , namely simple and compound wounds .
 the prognostic factors are based on the age , weight , accompanied disease , as well as the quality and quantity of the wound secretions .
 wound treatments include medical nutrition therapy , edible medications , and manipulation therapies .
 patient s diet is very important and oral medications have a major role in the whole body detoxification .
 topical medications are used together with the above - mentioned treatments ; noting that without detoxification , these medications are not effective entirely.conclusion:wound healing requires physiological processes within the body . from the perspective of itm ,
 body detoxification is the first medical step , after which topical medications could lead to a better wound healing result .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
clear - cell sarcoma ( ccs ) is a rare malignant connective tissue tumor that was first described by enzinger in 1965 .
ccs occurs most commonly in adolescents and young adults and the patients aged > 60 years are rare .
it has a high rate of local recurrence , regional lymph node metastasis , and distant metastasis [ 1 , 2 ] .
ccs occurs most commonly in the deep soft tissues of the extremities , with rare involvement of the head , neck , and trunk .
we experienced a very rare case of primary ccs in the mediastinum with successful surgical resection in an elderly patient .
in october 2011 , a 63-year - old man presented with a mass in the right upper mediastinum on chest radiograph .
computed tomography showed a large oval mass ( 55  55  85 mm ) with clear margins and heterogeneous enhancement in the right upper posterior mediastinum between the phrenic nerve and vertebrae ( fig .
1b ) , and 18f - fluorodeoxyglucose positron emission tomography showed abnormal uptake with a maximum standardized uptake value of 15.1 .
the tumor was excised by video - assisted thoracoscopic surgery , with negative surgical margins .
the tumor was soft , well circumscribed , encapsulated , and did not invade the pleura .
histological examination of the resected tumor with hematoxylin and eosin ( he ) staining showed morphological features compatible with conventional soft tissue ccs .
the tumor cells were distributed in nests separated by fibrous connective tissue , showing an alveolar pattern ( fig .
the tumor cells had eosinophilic and clear cytoplasm and oval vesicular nuclei of varying sizes with characteristic prominent eosinophilic nucleoli .
2c ) , s-100 protein , calretinin , cd34 , cd56 , cd68 , and cd117 ; and negative for melan - a , cytokeratins ae1ae3 , cytokeratin cam5.2 , chromogranin a , desmin , caldesmon , myogenin , epithelial membrane antigens , cd57 , cd99 , and d2 - 40 .
ccs is a very rare soft tissue neoplasm , which occurs in the extremities in 9095% of cases .
our case was diagnosed with a primary ccs in the mediastinum . a search of the english literature revealed only one previously reported case of primary ccs in the mediastinum .
recent cytogenetic studies showed that ccs is associated with the translocation t(12;22 ) ( q13;q12 ) ; this translocation is observed in up to 93% of patients with ccs , but never observed in malignant melanoma . in our case
, we were unable to determine whether this translocation was present , because of the lack of availability of such analysis in japan .
the rarity of ccs in the mediastinum makes it difficult to draw conclusions regarding prognostic factors .
reported that complete excision of the primary tumor with wide surgical margins appears to be the optimal approach to treatment , with or without adjuvant radiation therapy .
ccs is an aggressive malignant tumor , and unlike most soft tissue sarcomas , it often metastasizes to regional lymph nodes . in our case
, we did not have a definitive diagnosis at the time of operation , and therefore we did not perform excision of the tumor with wide margins or dissect the regional lymph nodes . in most cases , ccs has a relentlessly progressive course and results in death because of widespread dissemination .
the reported overall survival rates without local recurrence are 30% at 5 years and 16% at 10 years .
some patients experience rapidly fatal progression , and late metastasis after many years of freedom from disease is also relatively common .
we believe that regular long - term follow - up with computed tomography , magnetic resonance imaging , and 18f - fluorodeoxyglucose positron emission tomography examination is important to identify local recurrence or distant metastasis as early as possible .

Answer:
we report a case of primary clear - cell sarcoma ( ccs ) in the mediastinum . in october 2011
 , a 63-year - old man was admitted to our hospital for surgical resection .
 the tumor was completely excised by video - assisted thoracoscopic surgery .
 the tumor was well encapsulated and did not invade the pleura .
 histological examination led to a final diagnosis of primary ccs in the mediastinum .
 the patient remains alive without evidence of recurrence at 15 months after surgery .