A comparative dataset: Bridging COVID-19 and other diseases through epistemonikos and CORD-19 evidence

The COVID-19 pandemic has underlined the need for reliable information for clinical decision-making and public health policies. As such, evidence-based medicine (EBM) is essential in identifying and evaluating scientific documents pertinent to novel diseases, and the accurate classification of biomedical text is integral to this process. Given this context, we introduce a comprehensive, curated dataset composed of COVID-19-related documents. This dataset includes 20,047 labeled documents that were meticulously classified into five distinct categories: systematic reviews (SR), primary study randomized controlled trials (PS-RCT), primary study non-randomized controlled trials (PS-NRCT), broad synthesis (BS), and excluded (EXC). The documents, labeled by collaborators from the Epistemonikos Foundation, incorporate information such as document type, title, abstract, and metadata, including PubMed id, authors, journal, and publication date. Uniquely, this dataset has been curated by the Epistemonikos Foundation and is not readily accessible through conventional web-scraping methods, thereby attesting to its distinctive value in this field of research. In addition to this, the dataset also includes a vast evidence repository comprising 427,870 non-COVID-19 documents, also categorized into SR, PS-RCT, PS-NRCT, BS, and EXC. This additional collection can serve as a valuable benchmark for subsequent research. The comprehensive nature of this open-access dataset and its accompanying resources is poised to significantly advance evidence-based medicine and facilitate further research in the domain.

[Ethical reflections on errors in medicine]

It is usually inevitable to save the physician-patient relationship from the effects of medical errors. It is so because either the professional responsibility, the patients trust and the principles that govern the medical action are compromised by such events. The possibility to learn from it, prevent its appearance, improve the procedures and curtail its consequences, is linked to developing ethical attitudes to overcome these circumstances without further legal accountability.

[Rheumatoid arthritis. Therapeutic efficacy of methotrexate and its hepatotoxic effects]

The efficacy and toxicity (specially hepatic) of methotrexate in low doses (7.5 mg/week) was prospectively assessed in 21 patients with rheumatoid arthritis refractory to treatment with gold or penicillamine, during two years. Three patients were prematurely withdrawn from the protocol. A fast and significant improvement of RA was observed during the first six months, which tapered thereafter. Erythrocyte sedimentation rate decreased from 51.5 +/- 20.1 to 27.7 +/- 11.5 mm/h (p < 0.05). A rise in serum transaminases, always raising to less than twice the normal value, was observed in 75% of patients in some moment of the follow up. Hepatic scintigraphy did not show significant changes. Hepatic histological alterations were mild and no changes were observed after two years of treatment. The main secondary effects were moderate and transitory gastrointestinal and hematological disturbances. The prednisone dose was decreased from 6.8 +/- 2.6 to 4.8 +/- 1.9 mg/day at twelve months. There were no withdrawals due to drug toxicity. It is concluded that methotrexate proved to be efficacious in the treatment of rheumatoid arthritis refractory to conventional treatments. Its secondary effects, although frequent, were discrete and transitory and there were no changes in liver histology.

[Adult non-insulin-dependent diabetic: limitation of articular mobility and soft tissue involvement]

Periarticular involvement and joint mobility were investigated in 100 non insulin dependent diabetic patients, compared to 100 healthy control subjects of similar age and sex. Periarticular involvement was much more common in diabetics (p < 0.01) including limitation of joint mobility (hands) (40% vs 9%), Dupuytren (29% vs 2%), palmar synovitis (59% vs 7%) and capsulitis (16% vs 1%). Diabetic patients with limitation of joint mobility had more neuropathy (80% vs 56%), retinitis proliferans (35% vs 17%) and alterations of the skin of the hands, compared to diabetics without limitation of joint mobility. Diabetes should be investigated in subjects with periarticular manifestations such as those described in this paper. Also, a more advanced stage of diabetes may be suspected in diabetics with such manifestations.

[Juvenile dermatomyositis: clinical manifestations and laboratory tests]

Juvenile dermatomyositis (JDM) is a chronic, inflammatory degenerative entity with multisystemic involvement, particularly of skin and striated muscle. This is a description of the clinical features, laboratory findings and treatment results in 10 children with JDM which were under control along a 14 years period (1974-1988) in a general hospital at metropolitan Santiago, Chile. Onset was insidious in 8 cases and acute in the remaining patients. All children had muscle and skin involvement, 90% of them showed heliotrops erythema and 6 cases (among the total 10) had one or more additional skin signs. Ninety percent of patients had risen serum activity of muscle associated enzymes, lactic dehydrogenase (LDH) being the most constantly elevated: 7/7 studied cases. All patients showed abnormal electromyographic and histologic findings in muscle biopsy. Treatment was based upon rehabilitation, prednisone (average daily dose: 1.5 mg.kg of body weight) associated or not with cytotoxic drugs, accordingly to each individual case. Clinical course was considered to be favourable in 9 of the 10 cases because all of them showed no evidence of disease activity on last follow up control 26 to 93 months after initial consultation, six had only slight restriction to wider range movements of affected joints and three showed no sequelae. Only one death occurred in this series, to a patient who rejected treatment.

[Systemic lupus erythematosus and pregnancy. Clinical experience in 57 patients]

We reviewed the obstetric history of 57 patients with systemic lupus erythematosus (SLE). The number and outcome of pregnancies before and after the diagnosis of SLE was recorded. The clinical course of 21 patients who became pregnant during the observation period was noted. Before the diagnosis of SLE, 158 pregnancies resulted in a 20% rate of fetal loss (abortion, pre and neonatal death). This was lower than a 35% rate of fetal loss during pregnancies developed after the diagnosis of SLE. Both rates are significantly higher than the 10% which is considered normal for our reference population (p less than 0.001). A higher rate of fetal loss was observed in active SLE (37%) compared to inactive SLE (19%) and in the presence of SLE nephropathy (34%) than in its absence (17%), (p less than 0,01). A flourishing of SLE was observed in 50% of pregnancies, especially during the first trimester (59%) and after delivery (35%). We conclude that pregnancy occurs frequently in patients with SLE. The fetal risk is high although the clinical course of the disease is usually benign. Results in both terms are unfavourably influenced by the activity of SLE and the presence of nephropathy.

Successful renal transplantation in polyarteritis nodosa

Hemodialysis and renal transplantation were performed in a patient with end stage renal disease caused by polyarteritis nodosa. Severe peripheral neuropathy developed during hemodialysis. Five years after transplantation, marked improvement of the neuropathy associated with adequate function of the allograft has been noted. There has been no detectable clinical or pathologic signs of recurrent disease. These observations favor the consideration of renal transplantation in patients with polyarteritis nodosa and renal failure, particularly in the absence of extensive organ involvement.

Acute renal failure as a complication of hypertonic saline abortion in a kidney allograft recipient

Acute renal failure following abortion by intra-amniotic hypertonic saline administration has been described only occasionally. This report concerns a patient with end-stage renal failure who was successfully treated with a kidney allograft and developed reversible acute renal failure following the termination of her pregnancy by intra-amniotic infusion of saline. We suspect that the combination of hemoglobinuria and low grade intravascular coagulation might have been a contributing factor in the development of renal insufficiency in this patient. To our knowledge this modality of abortion has not been used previously in pregnant women with transplanted kidneys. From our experience with one patient it seems wise to express a word of caution on the use of this technique in patients with a functioning kidney allograft.