Miracle-dz/UniFAR-FTUs huggingface dataset:
Lepromatous leprosy presenting as Erythema multiforme â€“ A rare presentation

A 30 year old female presented as Erythema multiforme (EMF) with classic target lesions. Histology was also consistent with EMF. Differential diagnoses of Sweet’s syndrome & Urticarial vasculitis were entertained. Two weeks later she developed Erythema Nodosum Leprosum (ENL) like lesions. Skin Slit smears at second visit were positive for Acid fast bacilli (lepra) [AFB(L)] and histopathological / Fite Faraco stain for lepra bacilli was consistent with leprosy. We are reporting this case because of rare presentation of lepromatous leprosy as EMF.
Compliance with a mandated step-up program

OBJECTIVE To assess compliance with a step-up approach to proton pump inhibitor (PPI) therapy before implementation of a new provincial policy to promote histamine-type 2 receptor antagonist (H2RA) use before PPI therapy. DESIGN Population-based, retrospective, open cohort study using prescribing and medical procedure data from January 1, 1995, to April 30, 1999. SETTING Health administration databases for the universal health care system in Ontario. PARTICIPANTS Approximately 1.4 million residents of Ontario older than 65 years. MAIN OUTCOME MEASURES Proportion of patients who received a trial of H2RA therapy or gastrointestinal diagnostic testing 12 months before starting PPI therapy in 1996. RESULTS Among the 25870 patients who met study criteria in 1996, about 63% had received H2RAs 12 months before starting PPI therapy and 73% had had a trial of H2RAs or gastrointestinal diagnostic testing. Repeat analysis for January through April 1999, following the new policy implementation, showed that about 72% of patients had had a trial of H2RAs within 12 months of starting PPI therapy. CONCLUSION A modest gain (9%) in compliance with using H2RA therapy within 12 months before starting PPI therapy was seen following introduction of the step-up intervention. In future, costs and benefits of potential interventions should be carefully considered before implementing new policies.
EFFECT OF FOOT MASSAGE ON RELIEVING MOTHER'S POST CESAREAN SECTION INCISIONAL PAIN

Objective: To assess the effect of foot massage on relieving mother’s post cesarean section incisional pain. Hypothesis: Was foot massage had a significant effect on relieving post cesarean section incisional pain? Design: An intervention study was followed. Settings: The study was conducted in the cesarean section postnatal rooms at Benha University Maternity hospitals. Sample: It was involved 148 mothers, divided into 74 mothers as control group that received post cesarean section hospital routine care for pain relief and 74 mothers as intervention group that received 10 minutes foot massage for pain relief every 6 hours, 12 hours, and 18 hours. Sample type: A convenience sample type. Tools of Data collection included: structured interviewing questionnaire, modified McGill pain questionnaire short form and likert Scale. Results: There was significant relieving of pain level among intervention group compared to control group at different assessment times (p˂0.001). Findings indicated that, the most cited description of pain among the study group mothers were fearful, tender, heavy and stabbing pain. While, the most prominent factors that aggravating pain were sitting, walking and carrying of the newborn. Also, more than half of subjects among control and less than half of intervention groups reported that, they had information about post cesarean section incisional pain relief measures. There was better satisfaction among mothers in the intervention group regarding post cesarean section pain relief measures than among the control group subjects. Recommendations: Designing health education training program for nurses about foot massage because it is an inexpensive pain relief measure, with no harm to mothers. In addition, there is need for further studies in this area also studies to investigate the health team attitude regarding this method.
Efficacy of a Tetravalent Dengue Vaccine in Healthy Children and Adolescents.

BACKGROUND Dengue, a mosquito-borne viral disease, was designated a World Health Organization top 10 threat to global health in 2019. METHODS We present primary efficacy data from part 1 of an ongoing phase 3 randomized trial of a tetravalent dengue vaccine candidate (TAK-003) in regions of Asia and Latin America in which the disease is endemic. Healthy children and adolescents 4 to 16 years of age were randomly assigned in a 2:1 ratio (stratified according to age category and region) to receive two doses of vaccine or placebo 3 months apart. Participants presenting with febrile illness were tested for virologically confirmed dengue by serotype-specific reverse-transcriptase polymerase chain reaction. The primary end point was overall vaccine efficacy in preventing virologically confirmed dengue caused by any dengue virus serotype. RESULTS Of the 20,071 participants who were given at least one dose of vaccine or placebo (safety population), 19,021 (94.8%) received both injections and were included in the per-protocol analysis. The overall vaccine efficacy in the safety population was 80.9% (95% confidence interval [CI], 75.2 to 85.3; 78 cases per 13,380 [0.5 per 100 person-years] in the vaccine group vs. 199 cases per 6687 [2.5 per 100 person-years] in the placebo group). In the per-protocol analyses, vaccine efficacy was 80.2% (95% CI, 73.3 to 85.3; 61 cases of virologically confirmed dengue in the vaccine group vs. 149 cases in the placebo group), with 95.4% efficacy against dengue leading to hospitalization (95% CI, 88.4 to 98.2; 5 hospitalizations in the vaccine group vs. 53 hospitalizations in the placebo group). Planned exploratory analyses involving the 27.7% of the per-protocol population that was seronegative at baseline showed vaccine efficacy of 74.9% (95% CI, 57.0 to 85.4; 20 cases of virologically confirmed dengue in the vaccine group vs. 39 cases in the placebo group). Efficacy trends varied according to serotype. The incidence of serious adverse events was similar in the vaccine group and placebo group (3.1% and 3.8%, respectively). CONCLUSIONS TAK-003 was efficacious against symptomatic dengue in countries in which the disease is endemic. (Funded by Takeda Vaccines; TIDES ClinicalTrials.gov number, NCT02747927.).
Hepato-Renal Syndrome in Patients with Hepatic Cirrhosis

Hepatorenal syndrome is a particular form of functional renal failure which may develop in patients with liver cirrhosis. Precise diagnostic criteria have been established to clearly define this entity, whereas recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms. During the course of cirrhosis, sinusoidal portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arterial blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. Innovative therapies have shown promise to prolong survival in patients with hepatorenal syndrome, including the administration of analogs of vasopressin, the insertion of transjugular intrahepatic portosystemic shunts. On a preventive viewpoint, several simple measures have been shown to reduce the risk of hepatorenal syndrome in cirrhotic patients including the appropriate use of diuretics, the avoidance of nephrotoxic drugs, the prophylaxis of spontaneaous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis.
DENTAL ANXIETY IN CHILD PATIENTS: A REVIEW

Dental anxiety in child patient is a situation which all dentists face in their clinical practice. There are various reasons for these anxieties which vary from child to child; and it results in the uncooperativeness and lower pain threshold in the child patients. Therefore it is important to understand the anxiety in a child patient on the dental chair to avoid the further consequences. The present article summarizes the causes, types, effects and the management of the anxiety of children in dental clinics.
Insulin Receptor Substrate Gene Knockdown Accelerates Behavioural Maturation and Shortens Lifespan in Honeybee Workers

In animals, dietary restriction or suppression of genes involved in nutrient sensing tends to increase lifespan. In contrast, food restriction in honeybees (Apis mellifera) shortens lifespan by accelerating a behavioural maturation program that culminates in leaving the nest as a forager. Foraging is metabolically demanding and risky, and foragers experience increased rates of aging and mortality. Food-deprived worker bees forage at younger ages and are expected to live shorter lives. We tested whether suppression of a molecular nutrient sensing pathway is sufficient to accelerate the behavioural transition to foraging and shorten worker life. To achieve this, we reduced expression of the insulin receptor substrate (irs) gene via RNA interference in two selected lines of honeybees used to control for behavioural and genetic variation. irs encodes a membrane-associated protein in the insulin/insulin-like signalling (IIS) pathway that is central to nutrient sensing in animals. We measured foraging onset and lifespan and found that suppression of irs reduced worker bee lifespan in both genotypes, and that this effect was largely driven by an earlier onset of foraging behaviour in a genotype-conditional manner. Our results provide the first direct evidence that an IIS pathway gene influences behavioural maturation and lifespan in honeybees and highlight the importance of considering social environments and behaviours when investigating the regulation of aging and lifespan in social animals.
Comparative Efficacy of Liv.52 and Andrographis paniculata, (Nees.) in Experimental Liver Damage in Rabbits

The comparative efficacy of Liv.52 vs. Andrographis paniculata was evaluated in carbon tetrachloride (CTC)-induced liver damage in rabbits divided into 4 groups. Those animals treated with these drugs showed marked clinical recovery from liver damage as compared to control animals, being seen earlier in the Liv.52-treated animals.
Effect of Empagliflozin on Erythropoietin Levels, Iron Stores and Red Blood Cell Morphology in Patients with Type 2 Diabetes and Coronary Artery Disease.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve cardiovascular outcomes including hospitalization for heart failure and mortality in people with and without diabetes.1, 2 The mechanism(s) underlying this benefit remain unclear. While several hypotheses have been suggested (including SGLT2 inhibitor mediated diuresis and natriuresis, reduction in blood pressure and afterload, direct effects on myocardial sodium and calcium handling, alterations in myocardial energetics, reduction in left ventricular mass and improved progenitor cell response),3 a mediation analysis from the EMPA-REG OUTCOME trial suggests that an increase in hematocrit may account for over half of the mortality benefit observed. The consistent observation of an increase in hematocrit, even in those without diabetes, has led to the hypothesis that SGLT2 inhibitors may increase erythropoiesis via enhanced erythropoietin (EPO) secretion by the kidney.4 This SGLT2 inhibitor mediated increase in EPO production (and resultant rise in hematocrit) could lead to systemic organ protection by virtue of its capacity as a circulating pleiotropic cytokine, known to favorably influence cardiomyocyte mitochondrial function, angiogenesis, cell proliferation and inflammation. In addition, an increase in EPO-induced hematocrit may also improve myocardial function by directly enhancing myocardial and systemic tissue oxygen delivery.
Comparison of Dual Level Fusion and Hybrid Treatment in the Cervical Spine Based on Patient Outcome

Objective: Very few studies researched the treatment modalities in treating degenerative disc disease for two adjacent levels of the cervical spine. In order to reduce distress on the adjacent segments and minimize implant subsidence we analyzed the use of a hybrid approach combining arthroplasty with cage fusion. Methods: 64 “fusion-only” and 47 hybrid patients between the age of 30 and 60 years were clinically evaluated using ODI, Odon’s criteria. X-rays in two planes of the cervical spine were taken, measuring alpha and C2-C7 beta angles using Harrison’s tangent. Signs of subsidence in the sagittal plane were recorded, where subsidence was defined as a shift by more than 40% of the respective implant height. Results: 10 cages combined with arthroplasty and 2 prostheses showed signs of subsidence compared to 47 cages in the fusion group (25 singe level and 11 on two levels). Overall subsidence after two years was found in 49% of the fusion group opposing 18% in our arthroplasty group. Patients with subsidence showed a longer recovery time to work, 14 weeks vs. 26, p=0.21; compared to the fusion group, 13/22 weeks, p=0.34. Odon’s criteria and Oswestry results were favorable and comparable in both groups. Revision rates were higher for arthroplasty 10.6% vs. 3.1%. Conclusion: We found two level ACDF implants to subside more frequently than in ACDF in combination with arthroplasty, indicating a reduced distress in the arthroplasty group. Absence of subsidence may have led to a faster return to work as may the implementation of arthroplasty. Overall the clinical outcome of both groups was comparable. However with the hybrid approach a higher revision rate occurred.
The relation of salivary antioxidants to dental caries among overweight and obese adult aged 30-40 year-old at textile factory in Mosul city

Overweight and obese people are at higher risk for systemic diseases as well as oral diseases like dental caries. The aim of this study was to explore the relationship of salivary antioxidants (albumin, vitamin E, and vitamin C) in addition to salivary flow rate and magnesium level with dental caries severity among overweight and obese adult aged 30-40 year-old at Textile Factory in Mosul City. Material and method: The sample for this study consisted of all subjects aged 30-40 year-old (thirty five subjects) at the Textile factory in Mosul city. Body weight can be measured by using the Body Mass Index (BMI). Dental caries was recorded by lesion severity through the application of D1-4 MFS index. Salivary flow rate was measured after collection of unstimulated saliva then salivary samples were analyzed for the measurement of salivary antioxidants (albumin, vitamin E, and vitamin C) and magnesium level. Results: Salivary vitamin E and C levels were higher among overweight and obese subjects respectively compared with non-obese though statistical differences were not significant. Albumin level was significantly higher among overweight than non-obese subjects. In addition Obese and overweight subjects revealed reduced salivary flow rate compared with non-obese but with no significant difference; whereas salivary magnesium level was elevated among obese compared to non-obese individuals though statistical difference was not significant. Regarding caries severity, obese and overweight subjects revealed higher dental caries severity (i.e. DMFS, MS, DS, D 3 and D 4 mean values) compared with non-obese. Conclusions: Overweight and obesity could be risk factor for increasing dental caries severity thus educational and preventive programs that include dietary counseling (for lowering body weight and caries severity as well), oral hygiene practices, and regular visits for the dentist are needed.
Prevalence of severe psychological distress and its association with behavioral risk factors, quality of life indicators, and health outcomes: Colorado Behavioral Risk Factor Surveillance System, 2007

The Colorado Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing statewide telephone health survey of Colorado adults ages 18 years and older. Interviews with 11,908 respondents were completed in 2007. All households with telephones have a chance of being selected to participate in the survey, with individual survey respondents being randomly selected from each successfully contacted household. In 2007, the Colorado BRFSS included 10 questions on mental illness and stigma. The mental illness and stigma questions were asked of one half of the sample, for a total of 5,938 completed interviews. The first six questions comprised a scale known as the Kessler 6, or K/6. The K/6 is designed to measure nonspecific psychological distress. The questions also ascertained characteristics and health risk factors and outcomes of those who were currently taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem. Finally, the questions assessed the stigma associated with mental illness. Variables were tested to determine if significant differences existed between the responses for various groups: ninety-five percent confidence intervals (CIs) were calculated, and significance was determined by examining overlap of the CIs between the prevalence estimates. All differences reported here are statistically significant unless otherwise noted. Data were analyzed using SAS version 9.1 and SUDAAN Release 9.0. 0 (Windows Individual User SAS-Callable version). Methods
Measuring process indicators and adverse events to assess the quality of care for inpatients with psychosis

Abstract Background Research into the quality of care in psychiatry is scarce. Data collection is falling behind that for other fields of medicine and therefore the opportunity to improve care is missed. Aims In this medical record study we aim to determine: (i) whether or not patients’ physical health indicators are assessed and pharmacological and behavioural treatment interventions applied; (ii) the incidence and nature of adverse events in psychotic inpatients. Methods Medical records of inpatients with psychosis admitted to psychiatric wards at Amsterdam UMC, location AMC, Department of psychiatry, were screened with a previously developed and tested two-step patient safety tool. Results Data of 299 admissions were included. Physical health indicators were not assessed in one-third of cases. Fifty-five percent of the patients were smokers but only 1% received an intervention. The family was actively involved in 43% of the cases. During 11,403 admission days, 235 adverse events had been recorded. The most frequent adverse event was adverse drug reactions (40%), which were mostly related to antipsychotic medication. Conclusions In conclusion, quality of care auditing is useful to prioritize areas that need improvement. Future research should focus on interventions to improve the quality of psychiatric care.
Problems Experienced by Midwifery And Nursing Students in Turkey During Clinical Practice and their Recommended Solutions to the Problems

AIMS: The purpose of this research was to identify nursing and midwifery students’ problems during clinical practice, their recommended solutions for problems and to use the research results to improve midwifery and nursing education. METHODOLOGY: The population of this descriptive study was comprised of the second, third and fourth year students at Canakkale Onsekiz Mart University School for Health Science. No sampling was done, 169 (84.5%) of the students participated voluntarily in the study. Research data were collected on a questionnaire. Prior to beginning the study written permission was obtained from the school administration and verbal consent from all participant. Research data were analyzed with descriptive statistics were used to analyse the data. RESULTS: According to the study results 94.1% of the students reported that the teaching staff were not with them during clinical practice, 92.9% that they were not able to transfer theoretic knowledge they had learned into practice, 87% that they were used to do tasks other than their primary patient care on the ward, 81.1% that the teaching staff was not able to establish cooperation with the hospital employees, 79.9% that they were excluded from clinical practice, 75.1% that the teaching staff were not able to form objective assessment criteria for students on the ward, 74.4% that the students were not shown tolerance and patience, and 60.9% that they perceived being closely checked according to guidelines to be a problem. CONCLUSION: The students were found to have problems with teaching staff about clinical practice and problems with hospital employees, and inadequate supplies and physical conditions on the wards. Recommendations were made based on the results. KEY-WORDS: Clinical practice, midwifery, nursing, student, problem, recommendation
Organ Transplantation - Assessment of Dental Procedures

Purpose: Organ transplantation is now an established therapeutic strategy for treating many end-stage organ diseases and dysfunctions. The obligatory lifetime immunosuppressive therapy, which is necessary to prevent graft failure, predisposes the patient to infection. Because the oral cavity represents an important port of entry for systemic infections, a comprehensive clinical and radiographic oral examination and dental management of patients prior to transplantation will ensure the elimination of any active infection and minimize the possibility of infection after the transplantation. The aim of this retrospective study was to evaluate the significance of dental management prior to organ transplantation and to determine its relationship with graft rejection, morbidity and mortality of the patients. Materials and Methods: A total of 102 patients (67 men, 35 women, median age: 42.8 years) who had undergone an organ transplantation were studied. 58 patients received allogeneic or autologous stem cell transplantation (SCT) and 44 patients had undergone liver (LTx) or heart (HTx) transplantation. Seventy of these received dental treatment prior to surgery. Lack of time and the individual health condition of the other 32 patients made possible only the initiation or reinforcement of a preventive dental and oral hygiene program. Prior to any invasive procedures screening laboratory tests were performed in order to reveal the coagulation status; additionally the need for antibiotic coverage was always discussed with the transplant surgeon. Results: Postoperative complications such as infections, rejection of the transplant, GvHD, relapse of the malignancy and oral mucositis occurred in 80% of the patients who had undergone organ transplantation without dental interventions and only in 45.8% of the patients with completed dental treatment. Statistical analysis of data showed significant correlations (p<0,05), between complications and semi-impacted or impacted teeth making obvious the need for dental management before transplant surgery. A causative relationship between dental foci and life-threatening infections, graft rejection, morbidity and mortality could not be established in our study, a fact, which is probably the result of the great advances in immunosuppressive therapy. Conclusions: Thus, it can be concluded that the dental concept prior to SCT, LTx and HTx does not have to be a radical one. Further research should clarify the causative association between oral and dental foci and the transplantation outcome.