Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of efficacy of topical povidone-iodine and different types of fluoroquinolones in the sterilization of bacterial flora on the conjunctiva.

PURPOSE To compare the sterilization effectivity of topical povidone-iodine, ciprofloxacin, and ofloxacin on the conjunctival bacterial flora. METHODS One hundred sixty-four eyes of 164 patients scheduled for cataract surgery were prospectively analyzed. Conjunctival cultures were obtained 1 day before the surgery without any topical application in all patients. Conjunctival flora was examined in 53 eyes of 53 patients (Group I) 15 min after 5% topical povidone-iodine application on the day of the surgery. Fifty-four eyes of 54 patients (Group II) received 1 drop 0.3% ciprofloxacin at 12 pm 1 day before the operation and 4 drops at 15 min intervals on the day of the surgery. Another 57 eyes of 57 patients (Group III) received 0.3% ofloxacin in the same application mode as ciprofloxacin. Conjunctival cultures were taken in all patients 15 min after last drop of topical antibiotic application. RESULTS Only coagulase-negative staphylococci were isolated from 75.4% in Group I, 72.2% in Group II, and 59.6% in Group III on pretreatment culture. Different types of bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Proteus spp. , Micrococcus spp. were identified in other patients. Pretreatment conjunctival flora of Group I and Group II were similar (P>0.05), but it was significantly different in Group III (P<0.05). After topical application no bacterial growth was observed in 77.3% in Group I, 92.5% in Group II, and 66.6% in Group III. The difference between Group I and III was insignificant (P>0.05), but bacterial eradication effectiveness was significantly higher in Group II than that of other groups (P<0.05). Post-treatment cultures showed same bacterial flora as pretreatment cultures in 14.9% in Group I, 1.8% in Group II, and 19.2% in Group III. The difference between Group I and Group III was statistically insignificant (P>0.05) and the difference between Group II and other groups was statistically significant (P<0.05). Four eyes (7.5%) showed different types of bacterial growth from pretreatment flora in Group I, which were seen in 3 eyes (5.5%) in Group II and in 8 eyes (14%) in Group III. The differences between groups were statistically insignificant (P>0.05). CONCLUSION Ciprofloxacin seems to be more effective in conjunctival sterilization. In consideration with high variety of bacterial flora in pretreatment period in ofloxacin group, ofloxacin seems to be superior to povidone-iodine on the reduction of bacterial flora on the conjunctiva.
Characteristics and outcomes in community‐acquired versus hospital‐acquired acute kidney injury

Relatively little is known about the prevalence of acute kidney injury developing outside a hospital setting (CA‐AKI) or the impact of CA‐AKI on short‐term or long‐term clinical outcomes. The objective of this study was to compare the prevalence, causes, severity and outcomes of patients with CA‐AKI and hospital‐acquired (HA)‐AKI.
An accessory digastric abductor pollicis longus muscle: report of a case

SUMMARY During routine dissection, a variant muscle had a proximal fleshy belly arising from the upper part of the posterior surface of the radius, an intermediate tendon and a distal fleshy belly that joined the abductor pollicis brevis muscle. A branch from the posterior interosseous nerve innervated the proximal belly and the median nerve innervated the distal belly. It was adjacent to the abductor pollicis longus muscle. It was a digastric muscle that can be called the ‘accessory digastric abductor pollicis longus muscle’. The tendon of the palmaris longus muscle divided into two. One tendon joined the flexor retinaculum and the other tendon attached to the abductor pollicis brevis muscle. This slip to which the abductor pollicis brevis attached crossed over the median nerve. The two bellies of the variant muscle, which were supplied by the nerves of the flexor and extensor compartments of the forearm, had developed from extensor and flexor muscles and were connected by an intermediate tendon. Although a similar muscle has been mentioned previously, here we report this variant muscle with a nerve supply and a new name for the first time in the Southern Indian population. This accessory muscle may be associated with joint and neural symptoms.
In vitro efficacy of contact lens solutions against various corneal fungal isolates.

PURPOSE To investigate the susceptibility of different fungal corneal isolates to commercially available contact lens disinfecting solutions. METHODS Thirteen filamentous fungal isolates (9 Aspergillus spp, 3 Fusarium spp, 1 Curvularia sp.) recovered from corneal infections were used. The following solutions were tested: Arion Cronos, Complete Revitalens, Dua Elite, Opti-Free Express, Regard, Oxysept Comfort, and Oxysept Comfort without catalase. Suspensions of the different fungal isolates were made in the solutions (10(6) colony-forming units/mL). After 1 h (Arion Cronos only), 6, 8, and 24 h, aliquots of suspension were removed and seeded on Sabouraud agar plates. RESULTS After a 6-h exposure, only 3% hydrogen peroxide-based Oxysept Comfort without catalase eradicated all the fungi tested. All the other solutions were partly ineffective at killing some of the fungal isolates, even after a 24-h exposure. The worst performance was given by Regard and Dua Elite, which, after a 6-h exposure, showed growth of 12 and 10 of the 13 fungal strains tested, respectively. CONCLUSIONS Most contact lens disinfecting solutions may not be sufficiently effective, if contact lens care systems become contaminated with filamentous fungi. In our experiment, only an exposure to 3% hydrogen peroxide without a neutralizer for at least 6 h was always able to kill an inoculum of different fungal strains.
Extended high cut‐off haemodialysis for myeloma cast nephropathy in Auckland, 2008–2012

Myeloma cast nephropathy contributes to high morbidity and early mortality associated with the development of end‐stage renal disease. Treatment with extended high cut‐off haemodialysis coupled with novel anti‐myeloma therapies enables significant reduction of serum‐free light chains and has been shown to improve renal outcomes. In this case series, medical records of 6 patients who received high cut‐off haemodialysis for biopsy‐proven cast nephropathy were retrospectively reviewed. Patients received a total of 344 hours of high cut‐off haemodialysis and concurrent chemotherapy. Only 50% became dialysis independent following treatment. One patient who achieved sustained remission remained dialysis dependent. The added benefit of high cut‐off haemodialysis in the light of novel anti‐myeloma therapies requires further evaluation.
The importance of klotho in phosphate metabolism and kidney disease

The discovery of fibroblast growth factor‐23 (FGF23) and its co‐receptor α‐klotho has broadened our understanding of mineral metabolism and led to a renewed research focus on phosphate homeostatic pathways in kidney disease. Expanding knowledge of these mechanisms, both in normal physiology and in pathology, identifies targets for potential interventions designed to reduce the complications of renal disease, particularly the cardiovascular sequelae. FGF23 has emerged as a major α‐klotho‐dependent endocrine regulator of mineral metabolism, functioning to activate vitamin D and as a phosphatonin. However, increasingly there is an appreciation that klotho may act independently as a phosphate regulator, as well as having significant activity in other key biological processes. This review outlines our current understanding of klotho, and its potential contribution to kidney disease and cardiovascular health.
The anatomy of visual neglect

The brain regions that are critically associated with visual neglect have become intensely disputed. In particular, one study of middle cerebral artery (MCA) stroke patients has claimed that the key brain region associated with neglect is the mid portion of the superior temporal gyrus (STG), on the lateral surface of the right hemisphere, rather than the posterior parietal lobe. Such a result has wide-ranging implications for both our understanding of the normal function these cortical areas and the potential mechanisms underlying neglect. Here, we use novel high resolution MRI protocols to map the lesions of 35 right-hemisphere patients who had suffered either MCA or posterior cerebral artery (PCA) territory stroke. For patients with MCA territory strokes, the critical area involved in all neglect patients was the angular gyrus of the inferior parietal lobe (IPL). Although the STG was damaged in half of our MCA neglect patients, it was spared in the rest. For PCA territory strokes, all patients with neglect had lesions involving the parahippocampal region, on the medial surface of the temporal lobe. PCA patients without neglect did not have damage to this area. We conclude that damage to two posterior regions, one in the IPL and the other in the medial temporal lobe, is associated with neglect. Although some neglect patients do have damage to the STG, our findings challenge the recent influential proposal that lesions of this area are critically associated with neglect. Instead, our results implicate the angular gyrus and parahippocampal region in this role.
Half-dose verteporfin combined with half-fluence photodynamic therapy for chronic central serous chorioretinopathy.

PURPOSE This study evaluated the safety and efficacy of half-dose verteporfin combined with half-fluence photodynamic therapy (half-half photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). METHODS This was a retrospective case series. Fourteen eyes with chronic CSC receiving half-half PDT were included in group 1. Another 28 eyes receiving half-dose verteporfin combined with standard fluence PDT were included in group 2 as a control group. Main outcome measures were the success rates, major complications, best-corrected visual acuity (BCVA), and central subfield foveal thickness (CFT) on optical coherence tomography (OCT) at 6 months in both groups. Success of treatment was defined as complete resolution of subretinal fluid on OCT after treatment without recurrence. RESULTS There was no significant difference between groups in their age, gender, duration of symptoms, baseline BCVA, baseline CFT, PDT spot size, and follow-up duration. The success rate was 64% (9/14 eyes) in group 1 and 93% (26/28 eyes) in group 2 at 6 months (P=0.031). No major complications were found in either group. Mean CFT showed significant reduction at 6 months in both groups (-115 μm and P<0.001 in group 1; -150 μm and P<0.001 in group 2). The mean BCVA in group 2 improved significantly (P<0.001) at 6 months. The mean BCVA in group 1 showed a trend of improvement but was not statistically significant (P=0.25) at 6 months. CONCLUSIONS Half-half PDT is a feasible treatment for chronic CSC. However, there was a lower success rate at 6 months compared with the control group.
Environmentally sustainable health and social care: Scoping review and implications for the English NHS

Objectives To review the evidence on environmental sustainability in health and social care, describe what the implications of sustainability might be for service models and policy, and explore the connection between environmental and financial sustainability. Methods Literature review of 78 published articles and qualitative analysis of 28 semi-structured interviews. Results Provision of health and social care has a substantial impact on the environment, and opportunities exist at a number of levels to deliver services in a more sustainable way. While there is some scope to improve efficiency at the operational level, significant improvements in sustainability may require a more fundamental transformation in service models, for example, with a stronger emphasis on prevention. The current policy framework in England is perceived to create a number of barriers that discourage professionals from redesigning services in ways which could promote both environmental and financial sustainability. Conclusions Increasingly, health and social care will need to be delivered in ways that are not only financially sustainable, but environmentally sustainable too. Close conceptual connections exist with improving productivity – focusing on cost-effectiveness, value and prevention of avoidable activity could enhance sustainability from both an environmental and a financial perspective. Priorities for health care organisations could include prevention, exploring the opportunities presented by new technologies, and improving medicines management and prescribing practices. Policy-makers need to explore what changes are needed to create a more enabling environment, as well as how existing policies can be delivered in the most sustainable way.
Vascular access for intensive maintenance hemodialysis: a systematic review for a Canadian Society of Nephrology clinical practice guideline.

BACKGROUND Practices in vascular access management with intensive hemodialysis may differ from those used in conventional hemodialysis. STUDY DESIGN We conducted a systematic review to inform clinical practice guidelines for the provision of intensive hemodialysis. SETTING & POPULATION Adult patients receiving maintenance (>3 months) intensive hemodialysis (frequent [≥5 hemodialysis treatments per week] and/or long [>5.5 hours per hemodialysis treatment]). SELECTION CRITERIA FOR STUDIES We searched EMBASE and MEDLINE (1990-2011) for randomized and observational studies. We also searched conference proceedings (2007-2011). INTERVENTIONS (1) Central venous catheter (CVC) versus arteriovenous (AV) access, (2) buttonhole versus rope-ladder cannulation, (3) topical antimicrobial cream versus none in buttonhole cannulation, and (4) closed connector devices among CVC users. OUTCOMES Access-related infection, survival, hospitalization, patency, access survival, intervention rates, and quality of life. RESULTS We included 23, 7, and 5 reports describing effectiveness by access type, buttonhole cannulation, and closed connector device, respectively. No study directly compared CVC with AV access. On average, bacteremia and local infection rates were higher with CVC compared with AV access. Access intervention rates were higher with more frequent hemodialysis, but access survival did not differ. Buttonhole cannulation was associated with bacteremia rates similar to those seen with CVCs in some series. Topical mupirocin seemed to attenuate this effect. No direct comparisons of closed connector devices versus standard luer-locking devices were found. Low rates of actual or averted (near misses) air embolism and bleeding were reported with closed connector devices. LIMITATIONS Overall, evidence quality was very low. Limited direct comparisons addressing main review questions, small sample sizes, selective outcome reporting, publication bias, and residual confounding were major factors. CONCLUSIONS This review highlights several differences in the management of vascular access in conventional and intensive hemodialysis populations. We identify a need for standardization of vascular access outcome reporting and a number of priorities for future research.
The cause of brachial plexopathy in robot‐assisted transaxillary thyroidectomy—A neurophysiological investigation

During robot‐assisted transaxillary thyroidectomy, the patient's arm is maintained in an overhead flexed position for a prolonged time, which poses a risk of postoperative brachial plexopathy. The aim of the study was to identify the causes of brachial plexopathy and to assess the benefit of intraoperative neurophysiological monitoring (IONM) in preventing positional brachial plexopathy in this setting.
Rationality as Process and as Product of Thought

The opportunity to deliver the Richard T. Ely Lecture, from which this chapter is derived, afforded me some very personal satisfactions. Ely, unbeknownst to him, bore a great responsibility for my economic education, and even for my choice of profession. The example of my uncle, Harold Merkel, who was a student of Commons and Ely at Wisconsin before World War I, taught me that human behavior was a fit subject for scientific study, and directed me to economics and political science instead of high energy physics or molecular biology. Some would refer to this as satisficing, for I had never heard of high energy physics or molecular biology, and hence was spared an agonizing weighing of alternative utiles. I simply picked the first profession that sounded fascinating. Ely's influence went much further than that. My older brother's copy of his Outlines of Economics – the 1930 edition – was on our bookshelves when I prepared for high school debates on tariffs versus free trade, on the Single Tax of Henry George. It provided me with a sufficiently good grounding in principles that I was later able to take Henry Simons' intermediate theory course at the University of Chicago, and the graduate courses of Frank Knight and Henry Schultz without additional preparation. The Ely textbook, in its generation, held the place of Samuelson (1947) or Bach in ours.
Prolonged QT interval is linked to all‐cause and cardiac mortality in chronic peritoneal dialysis patients

Prolonged QT interval is related to changes of electrolytes in haemodialysis (HD) and is associated with all‐cause mortality in HD patients. It is unknown if prolonged QT interval is associated with all‐cause mortality in peritoneal dialysis (PD) patients as the electrolytes were relatively stable in PD. We therefore investigated the association of prolonged QT interval and all‐cause mortality in chronic PD patients.
Relationships among communicative acts, social well-being, and spiritual well-being on the quality of life at the end of life in patients with cancer enrolled in hospice.

BACKGROUND The importance of communication in close, personal relationships has been well-documented. At the end of life, communication, social relationships, and spirituality seem to have greater importance. Some studies suggest that the quality of life at the end of life (QOLEOL) involves these components. OBJECTIVE The primary aim of this study was to investigate the communicative acts of love, gratitude, and forgiveness, and to explore the extent to which the communicative acts, social well-being, and spiritual well-being predict the overall QOLEOL when controlling for physical symptoms. DESIGN Cross-sectional, descriptive, correlational design. SETTING/SUBJECTS A convenience sample of all adult hospice patients, aged 35-80, with a cancer diagnosis, residing in their private home in a community setting, was recruited from a large, non-profit hospice program in the midwestern United States. MEASUREMENTS Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) social/family well-being subscale, the JAREL Spiritual Well-Being tool, an investigator-designed tool to measure communicative acts, and the global, single-item QOL indicator of the QUAL-E. RESULTS Strong, positive correlations among social and spiritual well-being, communicative acts, and QOLEOL were found (p < 0.01). Spiritual well-being most significantly predicted the QOLEOL, explaining 53.5% of explained variance in the QOLEOL. Although not statistically significant, the communicative acts of love and gratitude made a small contribution to the overall model. The communicative act of forgiveness did not perform well. CONCLUSIONS The knowledge gained through this investigation laid the groundwork for future studies in identifying the importance of explicitly assessing relationships and supporting patients and families in their communication. In order to learn more about this phenomenon and establish a foundation for intervention, confirmation is required regarding the connections between the spiritual and social domains, the relationships between the specific communicative acts and the QOLEOL, as well as establishment of valid measurement approaches.
Early Detection of Childhood Hearing Impairment

Hearing loss in infants and children, despite its relatively high incidence and possible detrimental outcomes, is commonly overlooked. Currently, no program for newborn hearing screening has been established in Korea, although early detection and early intervention of hearing loss in infants will significantly influence the developmental course of speech and language skills. The Joint Committee on Infant Hearing recommends that all children should be screened for hearing impairment before age 3 months of age and medical or audiologic interventions be instituted before 6 months of age when indicated. Generally, a two-staged protocol employing automated auditory brainstem response(AABR) and otoacoustic emission(OAE) is recommended for newborn hearing screening, and its sensitivity reaches nearly 100%. Once hearing loss is diagnosed, further evaluation of the severity, nature, and the cause of hearing loss should follow, and interventions including amplification and rehabilitation should be started as soon as possible.
Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management.

UNLABELLED Introduction The diagnosis of concussion is a critical step in the appropriate management of patients following minor head trauma. The authors hypothesized that wide practice variation exists among pediatric emergency medicine physicians in the application of physical and cognitive rest recommendations following an acute concussion. METHODS The authors developed a 35-item questionnaire incorporating case vignettes to examine pediatric emergency physician knowledge of concussion diagnosis, understanding of initial management using return-to-play/school/work guidelines, use of existing concussion protocols, and perceived barriers to protocol use. Using a modified Dillman technique, the authors distributed an online survey to members of Pediatric Emergency Research Canada, a national association of pediatric emergency physicians. RESULTS Of 176 potential participants, 115 (65%) responded to the questionnaire, 89% (95% confidence interval [CI]: 0.81, 0.93) of whom reported having diagnosed 20 or more concussions annually. Although 90% (95% CI: 0.83, 0.94) of respondents adequately diagnosed concussion, only 64% (95% CI: 0.54, 0.72) correctly applied graduated return-to-play guidelines. Cognitive rest recommendations were also frequently limited: 40% (95% CI: 0.31, 0.49) did not recommend school absence, 30% (95% CI: 0.22, 0.39) did not recommend schoolwork reduction, and 35% (95% CI: 0.27, 0.45) did not recommend limiting screen time. Eighty percent (95% CI: 0.72, 0.87) of respondents reported having used guidelines frequently or always to guide clinical decisions regarding concussion. CONCLUSION Despite a proficiency in the diagnosis of concussion, pediatric emergency physicians exhibit wide variation in recommending the graduated return to play and cognitive rest following concussion.
Etiology and epidemiology in dermatophytosis in Goiânia, State of Goiás, Brazil

Dermatophytoses are superficial infections that may lead to lesions of keratinized tissues, like skin, hair and nails. A total of 6068 individuals from Goiânia,GO, with suspected dermatophytic lesions were examined over a period of five years (1993-1997) in order to determine the incidence and etiology of dermatophytosis. Material collected from different body parts was submitted to direct microscopic examination using KOH, cultured in Sabouraud agar and microscopically examined for colony morphology, with the identification of 1595 dermatophytes. Trichophyton rubrum (37.4%), T. mentagrophytes (36.4%) and Microsporum canis (16%) were the species most frequently isolated. Dermatophytes were more frequently found producing lesions in the feet (30.5%), inguinal and crural regions (17,8%) and glabrous body regions (15.5%). The distribution of the different infected body sites was determined in terms of the respective etiologic agents found. Better hygiene conditions and an early diagnosis are the most important tools to control and reduce the incidence of dermatophytosis in Goiânia, GO.