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Functional study of TNF-α promoter polymorphisms in psoriasis.

TNF-α is an important mediator in the pathogenesis of psoriasis and polymorphisms influence its transcription and could be implicated in psoriasis risk and modify certain aspects of disease, such as age at onset of psoriasis vulgaris and disease severity. Six TNF-α single nucleotide polymorphisms (SNPs) in promoter region has been identified and studied but with discordant results. The aim of this study was to evaluate whether the polymorphisms in TNF-α (-238 (rs361525), -308 (rs1800629), -857 (rs1799724), -1031 (rs1799964)) are associated with gravity, prurity, early onset or response to drug therapy in psoriasis in Caucasian Italian patients.

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Mutation Analysis and Disease Features at Presentation in a Multi-Center Cohort of Children with Monogenic Cholestasis.

To advance our understanding of monogenic forms of intrahepatic cholestasis.

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Impact of closed loop stimulation on prognostic cardiopulmonary variables in patients with chronic heart failure and severe chronotropic incompetence: a pilot, randomized, crossover study.

Clinical effects of rate-adaptive pacing in heart failure patients with chronotropic incompetence (CI) undergoing cardiac resynchronization therapy (CRT) remain unclear. Closed loop stimulation (CLS) is a new rate-adaptive sensor in CRT devices. We evaluated the effectiveness of CLS in CRT patients with severe CI, focusing primarily on key prognostic variables assessed by cardiopulmonary exercise (CPX) testing.

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Immobilization induced symptomatic hypercalcemia treated with zoledronate in a child with a left ventricular assist device.

Differential diagnosis of hypercalcemia in children includes hyperthyroidism, infection, inflammatory processes, malignant tumors. Immobilization-induced hypercalcemia is rare in healthy individuals; it can occur in adolescent males, especially after a fracture. Immobility caused increased skeletal calcium release and hypercalcemia, and this condition is also known as resorptive hypercalcemia. We present here a 10-year-old adolescent girl with advanced heart failure who underwent HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. She had symtomps abdominal pain, vomiting, and constipation on the 5th month of hospitalization. She subsequently developed immobilization-induced symptomatic hypercalcemia (serum calcium, 12.1 mg/dL; corrected calcium 12.8 mg/dL; parathormone (PTH), 1.9 pg/mL; calcium/creatinine ratio in spot urine, 1.21). Hypercalcemia is uncommon in children with advanced heart failure (HF). The bisphosphonate therapy was initiated because our patient did not respond to hydration and furosemide treatment, and she had abdominal pain, vomiting, and constipation. The patient's complaints were resolved on the second day after administrating bisphosphonate and hypercalcemia did not recur.

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The Effect of Pethidine Analgesia on Labor Duration and Maternal-Fetal Outcomes.

Opioid analgesics had been used from time to time for treating labor pain. However, their use have been concerning. The aim of this study is to evaluate the effect of pethidine on duration of active phase of labor, labor pain and maternal-neonatal outcomes.

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Investigating the impact of search results for fever, headache, cough, diarrhea, and nausea on the incidence of COVID-19 in India using Google Trends.

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Neuromodulation in the treatment of postoperative epidural fibrosis: Comparison of the extent of epidural fibrosis and the effect of stimulation.

The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale deltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and deltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.

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Review article: Paramedic pain management of femur fractures in the prehospital setting: A systematic review.

Femur shaft and neck of femur (NOF) fractures are often undertreated in the prehospital setting. These injuries can present unique clinical and logistical concerns in the prehospital setting. This systematic review aimed to investigate paramedic prehospital pain management of patients who had suffered NOF or femur fractures, and to investigate which interventions are effective. A systematic review was conducted in line with Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched from inception date 23 March 2020. Articles were independently reviewed by two authors and conflicts resolved by a third author, followed by a hand search of the included reference lists. References were included if they addressed paramedic interventions for NOF or femur shaft fractures. Outcomes of interest were the effectiveness and complications of different modalities administered by paramedics. The search yielded 6868 articles, of which 19 met the final inclusion criteria. Studies investigated a variety of interventions including traction splints, intravenous (IV) analgesia and alternative analgesic options. Traction splinting and IV analgesia were consistently reported as underutilised. Alternative analgesics such as auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and fascia iliaca compartment block were found to be effective techniques that could be safely and competently employed by paramedics, reducing pain for patients with limited adverse events. NOF and femur shaft fractures are an undertreated injury in the prehospital setting. Traction splinting and IV analgesia remain the traditional methodologies of treatment for these injuries; however, there are alternatives such as TENS, auricular acupressure and fascia iliaca compartment block that appear to be emerging as safe and effective options for the prehospital setting.

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ADEM post-Sars-CoV-2 infection in a pediatric patient with Fisher-Evans syndrome.

Sars-CoV-2 is a single-strained RNA virus belonging to Coronaviridae's family. In pediatric age, the majority of patients is asymptomatic; however, several neurological manifestations associated with Sars-CoV-2 infection have been detected in a percentage of cases ranging from 17.3 to 36.4%. Acute disseminated encephalomyelitis (ADEM) has been recently included among the potential complications of Sars-Cov2 infection. The available data regarding pediatric patient show only one case.

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Diagnostic delay is common for patients with axial spondyloarthritis: results from the National Early Inflammatory Arthritis Audit.

Updated guidelines for patients with axial spondyloarthritis (axSpA) have sought to reduce diagnostic delay by raising awareness amongst clinicians. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe baseline characteristics and time to diagnosis for newly-referred patients with axSpA in England and Wales.

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