Kornimate/medical-research-clean huggingface dataset:
ratio of ''central venous-to-arterial co2 gap'' to ''arterial-to-central venous o2 content gap'' in septic shock

Conditions: Septic Shock

Summary: the high ratio of "central venous to arterial carbon dioxide" to "arterial to central venous oxygen content " is associated with elevated lactate in patients with septic shock. so, the aim of the present study is to evaluate the ratio of "central venous-to-arterial co2 tension or content" to "arterial-to-venous o2 content'' as an indicator of anaerobic metabolism in septic shock.

this is a prospective single center observational study that will be conducted in adult intensive care unit of ain shams university after being approved by local institutional ethic committee (ain shams university, egypt). informed consent was obtained from each participant's next of kin. the investigator will study mechanically ventilated participants. the attending physician's decision is to give iv fluids to participants due to the presence of at least one clinical sign of inadequate tissue perfusion due to septic shock : (a) systolic arterial pressure \ 2 mmo/l; or (d) urinary output \<0.5 ml/kg/h for ≥2 h. jugular central venous and arterial catheters will be in place by the attending physician. investigator will confirm the position of the tip of the central venous catheter in the superior vena cava or upper part of the right atrium on chest radiograph. participants will be monitored by flo trac device as a part of routine management in local icu. a first set of measurements will be performed, including hemodynamic and tissue oxygenation variables (heart rate, mean arterial pressure, cardiac index (ci), oxygen delivery (do2), oxygen consumption (vo2), central venous oxygen saturation (scvo2), arterial lactic acid level, central venous to arterial carbon dioxide tension difference (∆pco2), central venous to arterial co2 content difference (∆contco2), arterial-to-central venous oxygen content difference (∆conto2), ∆contco2/∆conto2 ratio and ∆pco2/∆conto2 ratio. 500 ml of isotonic saline 0.9% will be infused to the participants via a specific venous line over 15 minutes. immediately after volume expansion, a second set of the previous measurements will be recorded. ventilation parameters, norepinephrine dose and sedation drugs will be kept constant during the fluid challenge. after fluid challenge, participants with an increase in cardiac index ≥15% will be defined as fluid responders. fluid responders will be divided into 2 groups based on increase in oxygen consumption (vo2) ( \< or ≥15%).

Eligibility criteria:
inclusion criteria: 1. age \>18 years. 2. suspected infection focus 3. mean blood pressure \<65 mmhg, or required vasopressor infusion. 4. lactic acid level \>2 mmol/l. 5. mechanically ventilated patients. exclusion criteria: 1. age equal or less than 18 years. 2. pregnant women. 3. liver cirrhosis child-pugh c. 4. chronic obstructive pulmonary disease. 5. previous episode of septic shock within the last 3 months. 6. patients with a contraindication to volume expansion.

Keywords: sepsis pco2 gap pco2 gap/ o2 content gap
decitabine in treating patients with myelodysplastic syndrome

Conditions: Leukemia; Myelodysplastic Syndromes

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. purpose: phase ii trial to study the effectiveness of decitabine in treating patients with myelodysplastic syndrome.

objectives: i. determine the response of patients with myelodysplastic syndromes (including chronic myelomonocytic leukemia) to decitabine. outline: this is an open label, multicenter study. patients are stratified by disease (low risk myelodysplastic syndrome (mds) vs. high risk mds vs. chronic myelomonocytic leukemia). patients receive decitabine as a 4 hour infusion every 8 hours on days 1-3. treatment continues every 6-8 weeks for 4-6 courses. patients are followed at 6 and 12 months. projected accrual: approximately 75 patients will be accrued for this study over 1 year.

Eligibility criteria:
disease characteristics: histologically proven myelodysplastic syndrome refractory anemia (ra) ra with ringed sideroblasts (rars) ra with excess blasts (raeb) raeb in transformation chronic myelomonocytic leukemia (cmml) ra and rars: platelet count less than 50,000/mm3 cmml: if wbc greater than 10,000/mm3, then must have at least 8% monocytes in the blood or marrow patient characteristics: age: 15 and over performance status: zubrod 0-2 life expectancy: not specified hematopoietic: see disease characteristics hepatic: bilirubin no greater than 2.0 mg/dl renal: creatinine no greater than 2.0 mg/dl cardiovascular: no new york heart association class iii or iv heart disease other: no active or uncontrolled infection not pregnant or nursing fertile patients must use effective contraception no other active cancer except skin cancer prior concurrent therapy: biologic therapy: not specified chemotherapy: no more than one prior chemotherapy regimen for myelodysplastic syndromes at least 3 weeks since chemotherapy and recovered no prior high-dose cytarabine (at least 0.5 g/m2 for at least 4 doses) endocrine therapy: not specified radiotherapy: not specified surgery: not specified

Keywords: refractory anemia refractory anemia with ringed sideroblasts refractory anemia with excess blasts refractory anemia with excess blasts in transformation chronic myelomonocytic leukemia de novo myelodysplastic syndromes previously treated myelodysplastic syndromes secondary myelodysplastic syndromes childhood myelodysplastic syndromes
the depot study (dry eye prescription options for therapy)

Conditions: Dry Eye

Summary: assessing dextenza efficacy and safety when placed within the lower eyelid canaliculus for dry eye flares in comparison to topical loteprednol suspension.

the depot study (dry eye prescription options for therapy): a randomized controlled clinical trial assessing the efficacy and safety of dextenza, sustained release dexamethasone 0.4 mg insert, when placed within the lower eye eyelid canaliculus in comparison to topical loteprednol suspension for the treatment of episodic dry eye.

Eligibility criteria:
inclusion criteria: * patients 18 years and older * patients willing to take an electronic survey about their tolerability of either study medication. * patients with a recent exacerbation of dry eye characterized by ocular surface discomfort. exclusion criteria: * active, systemic or local disease condition other than des that causes clinically significant ocular surface irritation that could interfere with the evaluation and treatment of dry eye. * any of the following ocular (eye or eyelid) conditions in either eye within 1 months prior to the enrollment visit: * ocular surgery (e.g., intraocular, oculoplastic, corneal or refractive surgery procedure) * clinically significant ocular trauma. * active ocular herpes simplex or herpes zoster (eye or eyelid) infection. * ocular inflammation (uveitis, iritis, scleritis, episcleritis, keratitis, conjunctivitis) * ocular infection (e.g., viral, bacterial, mycobacterial, protozoan or fungal infection of the cornea, conjunctiva, lacrimal gland, lacrimal sac or eyelids including hordeolum/stye) * moderate to severe (grade 2-4) allergic, vernal or giant papillary conjunctivitis * eyelid abnormalities that significantly affect lid function (e.g., entropion, ectropion, tumor, edema, blepharospasm, lagophthalmos, severe trichiasis, severe ptosis) * ocular surface abnormality that may compromise corneal integrity (e.g., prior chemical burn, recurrent corneal erosion, corneal epithelial defect, grade 3 corneal fluorescein staining, or map dot fingerprint dystrophy) * participation in another ophthalmic clinical trial involving a therapeutic drug or device within 30 days prior to the distribution of the survey * participation in this trial in the same patient's fellow eye. * patients who are pregnant or breastfeeding or who may become pregnant during participation in the study.
platelet rich plasma and perineural injection therapy for carpal tunnel syndrome

Conditions: Carpal Tunnel Syndrome

Summary: carpal tunnel syndrome (cts) is the most common peripheral entrapment neuropathy with involving compression of the median nerve in the carpal tunnel. rather than other progressive disease, cts is characterized by remission and recurrence. although many conservative managements of cts, the effectiveness of these methods is insignificant or only persist for a short duration. the platelet rich plasma (prp) is a new and potential treatment for patients with kinds of musculoskeletal disorders and recent reports showed being beneficial for peripheral neuropathy in animal studies. since 2014, two small clinical trials showed the positive effect of prp in peripheral neuropathy. one study shown the prp has therapeutic effect for peripheral neuropathy in patients with leprosy. in addition, prp having protective effect against neurological deficit of facial nerve during superficial parotidectomy. however, these studies have not entirely proved the effects of prp on peripheral neuropathy because these studies enrolled small number of patients and lacked controlled design. in addition, the prp was not used for treating cts so far. the investigators design a randomized, double-blind, controlled trail to assess the effect after ultrasound-guided prp injection in patients with cts.

after obtaining written informed consent, patients of clinically diagnosed with cts were randomized into intervention and control group. participants in intervention group received one-dose ultrasound-guided prp injection and control group received one-dose ultrasound-guided 5% dextrose injection. no additional treatment after injection through the study period. the primary outcome is visual analog scale (vas) and secondary outcomes include boston carpal tunnel syndrome questionnaire (bctq), cross-sectional area (csa) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. the evaluation was performed pretreatment as well as on the 2nd, 4th, 8th, 12th, 16th and 24th week after the treatment.

Eligibility criteria:
inclusion criteria: * age between 20-80 year-old. * diagnosis was confirmed using an electrophysiological study exclusion criteria: * cancer * coagulopathy * pregnancy * inflammation status * cervical radiculopathy * polyneuropathy, brachial plexopathy * thoracic outlet syndrome * previously undergone wrist surgery or steroid injection for cts

Keywords: platelet rich plasma perineural injection therapy
added value of ultrasonography in the diagnosis, management, and follow-up of carpal tunnel syndrome

Conditions: Ultrasonography; Diagnosis; Management; Follow-Up; Carpal Tunnel Syndrome

Summary: this study aims to assess the ultrasound (us) and nerve conduction studies (ncs) as a tool for diagnosis, treatment planning and follow-up of patients with carpal tunnel syndrome (cts).

carpal tunnel syndrome (cts) is one of the most common upper extremity compression neuropathies and is caused by compression of the median nerve in the carpal tunnel at the wrist. the ultrasound (us) is a follow-up option as a diagnostic tool in cts. it is a readily available non-invasive tool which has a shorter examination time. it can measure a number of median nerve parameters, including size, vascularity (using power doppler) and mobility (using dynamic imaging). in addition,the us provides information on anatomical variations of the median nerve and surrounding structures that may be a causative factor in cts.

Eligibility criteria:
inclusion criteria: * age ≥18 years old. * both sexes. * patients with carpal tunnel syndrome. exclusion criteria: * history of wrist surgery (including carpal tunnel injection) or fracture. * clinical or electrophysiological evidence of an accompanying condition that mimics carpal tunnel syndrome or interferes with its evaluation, such as proximal median neuropathy, cervical radiculopathy or polyneuropathy. * history of underlying disorders associated with carpal tunnel syndrome such as diabetes mellitus, rheumatoid arthritis, pregnancy, acromegaly or hypothyroidism. * electrodiagnostic findings suggestive of co-existing neurological disorders. * subclinical sensory polyneuropathy.
intraoperative eeg monitoring and postoperative delirium in elderly patients with sevoflurane anesthesia

Conditions: Postoperative Delirium; Sevoflurane; Electroencephalogram

Summary: delirium is an acute onset of attentional and cognitive impairment. bis guided anesthesia can reduce the incidence of postoperative delirium. long term electroencephalogram (eeg) suppression during operation is related to postoperative delirium. the latest research shows that the anesthesia depth guided by eeg does not reduce the incidence of postoperative delirium. the purpose of this study was to explore the relationship between anesthesia exposure with different minimum alveolar concentration(mac) and postoperative delirium(pod), and to observe the characteristics of eeg.

more and more studies have focused on the relationship between eeg inhibition and postoperative delirium in general anesthesia. at present, there are two kinds of commonly processed quantitative eeg monitoring to evaluate the depth of anesthesia, one is bispectral index (bis) and the other is patient state index (psi). the relationship between intraoperative anesthetic exposure and postoperative delirium is unclear, or whether potential patient characteristics increase the risk of eeg suppression and postoperative delirium. gastrointestinal surgery can lead to long-term changes in colonic flora, which can remotely regulate brain function through the gut brain axis. we speculated that the abnormal composition of intestinal flora before abdominal operation might be the influencing factor of pod.

Eligibility criteria:
inclusion criteria: * clinical diagnosis of gastrointestinal diseases * patients were aged 60 to 90 years * american society of anesthesiologists (asa) risk classification ii-iv * patients were scheduled to undergo elective major abdominal operation(with a anticipated time of 2-6 h) exclusion criteria: * preoperative dementia or cognitive impairment * mental instability or mental illness * patients with any factors affecting cognitive assessment, such as language, vision and hearing impairment * any cerebrovascular accident occurred within 3 months, such as stroke etc * previous history of delirium * known hypersensitivity to sevoflurane or history of malignant hyperthermia * abuse of narcotic sedative and analgesic drugs * those who have reoperation within 7 days after operation
exploring clinical predictors of copd exacerbation in a community cohort

Conditions: COPD Exacerbation

Summary: the aim of our study is to assess the feasibility and benefits of the implementation of an interactive telemonitoring system for earlier detection of copd exacerbations in a community cohort preventing further deterioration requiring hospital admissions.


Eligibility criteria:
inclusion criteria: * diagnosis of copd * aged 40 years or above * must be enrolled in health centres from braga
long term health outcomes of women veterans' service during the vietnam era

Conditions: Post-Traumatic Stress Disorder; Depression; Diabetes; Cardiovascular Disease

Summary: little is known about the long-term health and mental health status of women vietnam veterans. for many of these women, the effects of this war are still present in their daily lives. as these women approach their mid-sixties, it is important to understand the impact of wartime deployment on health and mental health outcomes nearly 40 years later. the investigators propose to assess the prevalence of posttraumatic stress disorder (ptsd) and other mental and physical health conditions for women vietnam veterans, and to explore the relationship between ptsd and other conditions and the vietnam deployment experience. the investigators are interested in studying women vietnam veterans who may have had direct exposure to traumatic events. for the first time, the investigators also want to study those who served in facilities near vietnam. these women may have had similar, but less direct exposures. this cross-sectional study will seek to contact approximately 10,000 women for participation in a mailed survey, telephone interview and a review of their medical records. women identified as serving in vietnam, near vietnam (in asia during the vietnam ware) and in the u.s. during the vietnam war will be identified from an established cohort and sent a survey on demographics, behaviors, disability, health-related quality of life, and medical conditions. women agreeing to be contacted will also be interviewed by study investigators using the modified cidi to ascertain current and lifetime mental health conditions (including ptsd) and exposure to traumatic events. a more extensive chart review will be conducted by a clinician to validate self-report of key medical conditions.


Eligibility criteria:
inclusion criteria: * women alive as of survey receipt who were active duty military personnel in one of the four armed services between july 4, 1965, and march 28, 1973, with a 30 day minimum period of service. * this will include those who served in vietnam, near vietnam (guam, the philippines, japan, korea, okinawa, or thailand), or in the 50 united states. exclusion criteria: * unable or unwilling to provide informed consent

Keywords: cvd
efficacy of acupuncture in refractory irritable bowel syndrome

Conditions: Irritable Bowel Syndrome

Summary: the trial aims to examine the efficacy and safety of acupuncture in the treatment of refractory irritable bowel syndrome (ibs). the investigators will include 170 participants to receive acupuncture plus usual care or sham acupuncture plus usual care. twelve sessions of acupuncture will be delivered to participants over a period of 4 weeks. the primary outcome is defined as proportion of participants with adequate relief of global ibs symptoms at week 8, which is defined as \>50% reduction in ibs-sss scale.


Eligibility criteria:
inclusion criteria: * adults aged 18-70 years (either sex); * fulfilled rome iv criteria for ibs; * patients with normal occult blood in stool in recent one month; * the age is above 50, the results of colonoscopy are normal in near year; * symptoms are present for ≥12 months; * there is an absence of response to a minimum of 6 weeks of dietary intervention or advice; * there is an absence of response to an adequate dose of at least one conventional pharmacological agent tried for a minimum of 6 weeks; * signed the written informed consent form. exclusion criteria: * previous colonoscopy, meal barium fluoroscopy, abdominal ultrasound and other examinations found severe intestinal organic lesions (including but not limited to ulcerative colitis, familial multiple intestinal polyps, colorectal cancer patients); * the presence of one or more of the following warning symptoms: unexplained rectal bleeding, a positive faecal occult blood test result; anaemia, abdominal mass, ascites, fever, and emaciation; * the presence of other severe medical conditions, such as cardiovascular disease, endocrine disorders, hepatic dysfunction, renal diseases, and cognitive disorders that can affect the outcome assessment results; * unconscious, unable to express subjective symptoms of discomfort and clearly diagnosed severe mental disorders; * an unstable psychological state or accompanying psychological disorders (sds\>56); * with pregnancy or lactation; * accepting acupuncture treatment in the last 3 months; * difficulties in attending the trial, such as fear of acupuncture.
iraqi trial for lung cancer screening

Conditions: Lung Cancer

Summary: lung cancer is a global problem. worldwide, 1.2 million people die of lung cancer each year. in iraq, lung cancer is the most common malignancy after breast cancer and the leading cause of cancer-related death. tobacco smoking plays a major role in lung cancer; it is reported in 85-90% of lung cancer patients yet environmental tobacco smoke, environmental and domestic air pollution, work-related risk factors, radon exposure, and viruses may also have an impact on lung cancer incidence rates. early detection of the disease before patients develop symptoms considers the best way to improve patient outcomes. it lucas is designed to evaluate the utility of low-dose computed tomography (ldct) screening in early detection and management of lung cancer in high-risk people.

background lung cancer is a global problem. worldwide, 1.2 million people die of lung cancer each year. in iraq, lung cancer is the most common malignancy after breast cancer and the leading cause of cancer-related death. tobacco smoking plays a major role in lung cancer; it is reported in 85-90% of lung cancer patients yet environmental tobacco smoke, environmental and domestic air pollution, work-related risk factors, radon exposure, and viruses may also have an impact on lung cancer incidence rates. early detection of the disease before patients develop symptoms considers the best way to improve patient outcomes. screening for lung cancer using low dose computed tomography (ldct) has been the subject of research studies since the 1990s. it has been reported to be superior to cxr and septum cytology for small tumors detection. aim of the study it lucas is designed to evaluate the utility of ldct screening in early detection and management of lung cancer in high-risk people in iraq. study design 500 healthy participants aged 50-75 years with a history of smoking of at least 30 pack year of smoking were recruited from ministries of oil and transport. they were offered low dose ct of the chest. nodules with suspicious (lung rads 4a or 4b) findings were classified as positive and referred to the respiratory department for further workup and biopsy. nodules with lung rads 3 features are reviewed after 6 months while those with lung rads 2 offered a ldct after 12 months.

Eligibility criteria:
inclusion criteria: * male or female * aged between 50 and 75 * smokers or ex-smoker * tobacco exposure of more than 30 pack-years exclusion criteria: * history of cancer within the last 5 years other than non-melanoma skin cancer or carcinoma in situ, * heart or respiratory severe co-morbidity with contraindications to thoracoscopy

Keywords: smoking envirumental polution