Miracle-dz/UniFAR-FTUs huggingface dataset:
Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

Background and Aim: Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs). Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS) to help in standardizing best practices in these areas in the ICU. Materials and Methods: A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Society of Anesthesiologists (ISA) was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods. Results: Most ICUs function in a semi-closed model. Midazolam (94.99%) and Fentanyl (47.04%) were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay's Sedation Scale (56.1%) and Visual Analogue Scale (48.07%) were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method)-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation. Conclusion: The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.
Prognostic value of extension patterns on follow-up magnetic resonance imaging in patients with necrotizing otitis externa.

OBJECTIVES To analyze the clinical characteristics of necrotizing otitis externa (NOE) and to evaluate the prognosis according to the progression of disease in terms of extension patterns on follow-up magnetic resonance images. DESIGN A retrospective clinical study. SETTING Tertiary academic center. PATIENTS We reviewed medical records of 36 patients with NOE followed up by temporal bone magnetic resonance images on a regular basis from January 1, 1992, through December 31, 2008. MAIN OUTCOME MEASURES The initial compartments affected by NOE were defined as 4 categories: anterior, medial, midline, and intracranial and extracranial. The extensions of NOE were evaluated by comparison between initial and follow-up magnetic resonance images 6 months later and defined by the direction of spread from one to another compartment and/or disease progression within the same compartment. The patients were divided into 3 groups (limited, single, and multiple extension groups) on the basis of the multiplicity of extension routes. The clinical characteristics and prognostic factors were investigated, and overall survival rates were compared according to extension patterns. RESULTS Retrocondylar fat infiltration (86%) was the most common finding, followed by parapharyngeal fat infiltration (81%) and ipsilateral nasopharyngeal musculature thickening (75%). Anterior and medial extension patterns were observed in 3 (8%) and 5 (14%) patients, respectively. Eighteen patients (50%) with combined extension patterns showed a significantly lower overall survival rate than those with single and limited extension patterns (P = .01). CONCLUSION The retrocondylar fat infiltration was the earliest change in NOE, and combined extension patterns may be a poor prognostic factor in patients with NOE.
The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors.

AIMS AND OBJECTIVES To investigate the prevalence of perineal morbidity at 12 months postnatal and its relationship to type of birth and birth risk factors. BACKGROUND It is well documented that women endure short-term postnatal perineal morbidity following childbirth (e.g. incontinence, perineal pain and sexual morbidity). However, to date, very little research has been carried out on the long-term effects of perineal morbidity and its relationship to the type of birth the women experienced and other birth risk factors (e.g. ethnic origin, age, parity, length of labour, epidural anaesthesia). DESIGN A retrospective, cross-sectional community survey of postnatal women within two maternity units in Birmingham. METHODS A total population sample of 2,100 women were surveyed using a self-administered postal questionnaire. The questionnaire included self-assessment of perineal pain, perineal healing, urinary incontinence, flatus incontinence, faecal incontinence, sexual morbidity and dyspareunia. Demographic details, type of birth and birth risk factors were taken from the hospital's computerized maternity information system. RESULTS Four hundred and eighty-two women responded to the questionnaire (23.3%). Overall, a high level of enduring perineal morbidity was reported with 87% complaining of at least one index of morbidity. Instrumental births were associated with higher levels of certain types of perineal morbidity than women following a caesarean section or normal vaginal birth (stress and urge urinary incontinence, flatus incontinence, sexual morbidity and dyspareunia). In particular, women following a forceps birth reported higher levels of morbidity than normal or ventouse birth (continual, stress and urge urinary incontinence and flatus incontinence), even when comparing with the same degree of perineal trauma. Increasing age, increasing birth weight, length of labour and particularly Asian ethnic origin were also identified as risk factors for certain types of perineal morbidity. CONCLUSIONS The study concludes that enduring perineal morbidity in women following childbirth is common, especially with women following a forceps birth and certain birth risk factors (i.e. age, ethnic origin, length of labour and birth weight). RELEVANCE TO CLINICAL PRACTICE These findings highlight the need for further research and provide a number of challenges for health-care services and health-care professionals.
Biotypes of Haemophilus encountered in clinical laboratories

The biochemical characteristics of 464 strains of Haemophilus influenzae and 83 strains of Haemophilus parainfluenzae isolated over an 18-month period are described. Of 22 characteristics obtained, only 6 were necessary to biochemically identify and biotype the isolates. The key substrates or tests were urease, ornithine, indole, o-nitrophenyl-beta-D-galactopyranoside, sucrose, and xylose. Five biotypes of H. influenzae and four of H. parainfluenzae were commonly recognized. Some strains were encountered which could not be accommodated in the recognized taxa but which constituted separate biotypes of the two species, H. influenzae biotype I was recovered principally from blood, cerebrospinal fluid, and upper respiratory secretion, and biotypes II and III were recovered from eye and sputum cultures. Biotype I was recovered primarily from children less than 1 year of age, whereas biotypes II and III were from persons 1 to 5 years old and from those over 20 years of age. Multiple isolates recovered from the same patient were almost always of the same biotype. Strains of H. parainfluenzae were isolated primarily from sputum, with others being isolated from body sources such as dental abscesses, gastric aspirates, and peritoneal fluid. An inverse relationship was noticed between hemolysis and mannose fermentation among H. parainfluenzae biotype III strains, whereas the relationship was absent among the other biotypes.
Cosmetic and functional outcomes of two-stage hypospadias repair: an objective scoring evaluation and uroflowmetry.

OBJECTIVE The functional outcome following hypospadias repair is as important as the cosmetic outcome. Currently, structured scoring systems, patient questionnaires and evaluations of photographs and uroflowmetry are used to assess the results of hypospadias repair. In the present study, we assessed the outcomes of two-stage hypospadias repair using Hypospadias Objective Scoring Evaluation-HOSE and measures of uroflowmetry. MATERIAL AND METHODS Over a period of eight years, from January 1997 to December 2004, 126 hypospadias patients were treated, 90 of these patients received two-stage repairs and 36 patients received single-stage repairs. HOSE questionnaire and uroflowmetry data were obtained to evaluate the long-term outcome of the two-stage hypospadias repairs. RESULTS The age at the time of assessment ranged from 8 to 23 years-old, with a mean follow-up time of 39.78 months. Thirty-five patients had proximal hypospadias, and 20 had distal hypospadias. Of the 55 patients who received complete two-stage hypospadias repair and agreed to participate in the study, nineteen patients had acceptable HOSE scores and 36 patients had non-acceptable scores. The uroflow rates of 43 of the subjects were below the fifth percentile in three patients, equivocal (between the 5(th) and 25(th) percentile) in four patients and above the 25(th) percentile in 36 patients. CONCLUSION Two-stage repair is a suitable technique for all types of hypospadias with varying outcomes. HOSE and uroflowmetry are simple, easy, non-invasive and non-expensive tools for objectively assessing the long-term outcomes of hypospadias repair.
Abnormal folate metabolism and genetic polymorphism of the folate pathway in a child with Down syndrome and neural tube defect.

The association of neural tube defects (NTDs) with Down syndrome (trisomy 21) and altered folate metabolism in both mother and affected offspring provide a unique opportunity for insight into the etiologic role of folate deficiency in these congenital anomalies. We describe here the case of a male child with trisomy 21, cervical meningomyelocele, agenesis of corpus callosum, hydrocephaly, cerebellar herniation into the foramen magnum, and shallow posterior cranial fossa. Molecular analysis of the methylenetetrahydrofolate (MTHFR) gene revealed homozygosity for the mutant 677C-->T polymorphism in both the mother and child. The plasma homocysteine of the mother was highly elevated at 25.0 micromol/L and was associated with a low methionine level of 22.1 micromol/L. Her S-adenosylhomocysteine (SAH) level was three times that of reference normal women, resulting in a markedly reduced ratio of S-adenosylmethionine (SAM) to SAH and significant DNA hypomethylation in lymphocytes. The child had low plasma levels of both homocysteine and methionine and a reduced SAM/SAH ratio that was also associated with lymphocyte DNA hypomethylation. In addition, the child had a five-fold increase in cystathionine level relative to normal children, consistent with over-expression of the cystathionine beta synthase gene present on chromosome 21. We suggest that altered folate status plus homozygous mutation in the MTHFR gene in the mother could promote chromosomal instability and meiotic non-disjunction resulting in trisomy 21. Altered folate status and homozygous TT mutation in the MTHFR gene in both mother and child would be expected to increase the risk of neural tube defects. The presence of both trisomy 21 and postclosure NTD in the same child supports the need for an extended periconceptional period of maternal folate supplementation to achieve greater preventive effects for both NTD and trisomy 21.
Use of buccal cells collected in mouthwash as a source of DNA for clinical testing.

CONTEXT To maximize the participation rate in population genetic studies, alternatives to invasive whole blood collection are increasing. One such alternative is buccal epithelial cell collection, which, in contrast to venipuncture and finger sticks, is painless. Buccal cells, if collected and purified efficiently, offer an acceptable source for DNA to be used in research and clinical applications. OBJECTIVE To develop a noninvasive sampling method for collecting cells for routine DNA testing in a clinical laboratory setting. DESIGN Five factors were used to evaluate several brands of mouthwash: (1) compatibility with the DNA purification chemistry, (2) DNA yield, (3) DNA quality, (4) DNA stability at room temperature, and (5) mouthwash taste. Next, an optimization study was undertaken to maximize DNA yield. Finally, a validation study was undertaken with the optimized protocol to test a panel of 14 donors for DNA yield and performance and to test for the stability of DNA held in mouthwash. SETTING Industrial research and development laboratory. RESULTS Of 5 mouthwashes tested, Scope brand mouthwash received the highest overall ranking. The addition of proteinase K and glycogen to the protocol significantly enhanced DNA yields, with a test panel (n = 14) giving a range of 12 to 60 microg of DNA per donor. In a 4-week room temperature stability study, the DNA in mouthwash samples was found to be stable for at least 2 weeks. CONCLUSION A clinically validated DNA purification chemistry was adapted to a noninvasive specimen collection method. This method used a commercially available mouthwash, Scope, to collect buccal epithelial cells for the preparation of high-quality DNA in high yield.
Accounting for ligand‐bound metal ions in docking small molecules on adenylyl cyclase toxins

The adenylyl cyclase toxins produced by bacteria (such as the edema factor (EF) of Bacillus anthracis and CyaA of Bordetella pertussis) are important virulence factors in anthrax and whooping cough. Co‐crystal structures of these proteins differ in the number and positioning of metal ions in the active site. Metal ions bound only to the ligands in the crystal structures are not included during the docking. To determine what effect these “missing” metals have on docking results, the AutoDock, LigandFit/Cerius2, and FlexX programs were compared for their ability to correctly place substrate analogues and inhibitors into the active sites of the crystal structures of EF, CyaA, and mammalian adenylate cyclase. Protonating the phosphates of substrate analogues improved the accuracy of docking into the active site of CyaA, where the grid did not account for one of the three Mg2+ ions in the crystal structure. The AutoDock ranking (based on docking energies) of a test group of compounds was relatively unaffected by protonation of carboxyl groups. However, the ranking by FlexX‐ChemScore varied significantly, especially for docking to CyaA, suggesting that alternate protonation states should be tested when screening compound libraries with this program. When the charges on the bound metal were set correctly, AutoDock was the most reliable program of the three tested with respect to positioning substrate analogues and ranking compounds according to their experimentally determined ability to inhibit EF. Proteins 2007. © 2007 Wiley‐Liss, Inc.
Role of Anion Exchange Transporter PAT1 (SLC26A6) in Intestinal Absorption of Organic Anions

Mouse PAT1 (putative anion transporter, CEFX, slc26a6), an orthologue of human SLC26A6, was recently identified at the intestinal brush-border membrane and shown to transport organic anions such as formate and oxalate, as well as inorganic ions. In this study, we conducted functional characterization of the uptake of formate by HEK293 cells transfected with PAT1. The uptake of formate by PAT1 was increased in the presence of an outwardly-directed Cl- gradient, whereas Na+ had no effect, and the uptake was independent of pH. The Km of PAT1 for formate was 3.75 mM. Various organic acids exhibited a cis-inhibitory effect on the uptake of formate by PAT1. Furthermore, the uptake was increased by preloading with l-lactate, nicotinate, valproate and short-and medium-chain fatty acids, showing a trans-stimulatory effect. Thus, it was suggested that PAT1 transports organic acids as well as inorganic anions, demonstrating that it is involved in the intestinal absorption of anionic organic weak acids in the small intestine.
Matching Anonymized and Obfuscated Time Series to Users’ Profiles

Many popular applications use traces of user data to offer various services to their users. However, even if user data are anonymized and obfuscated, a user’s privacy can be compromised through the use of statistical matching techniques that match a user trace to prior user behavior. In this paper, we derive the theoretical bounds on the privacy of users in such a scenario. We build on our recent study in the area of location privacy, in which we introduced formal notions of location privacy for anonymization-based location privacy-protection mechanisms. Here, we derive the fundamental limits of user privacy when both anonymization and obfuscation-based protection mechanisms are applied to users’ time series of data. We investigate the impact of such mechanisms on the tradeoff between privacy protection and user utility. We first study achievability results for the case where the time-series of users are governed by an independent and identically distributed (i.i.d.) process. The converse results are proved both for the i.i. d. case as well as the more general Markov chain model. We demonstrate that as the number of users in the network grows, the obfuscation-anonymization plane can be divided into two regions: in the first region, all users have perfect privacy; and, in the second region, no user has privacy.
The effect of inhibition of aldehyde dehydrogenase on nasal uptake of inspired acetaldehyde.

At exposure concentrations of 750 ppm or more, acetaldehyde is a rodent inhalation carcinogen that induces nasal tumors. Aldehyde dehydrogenase (ALDH) is thought to be an important detoxifying enzyme for aldehydes. Although nasal tissues express ALDH, the importance of this enzyme relative to delivered dosage rates at high-inspired concentrations is not well defined. To provide such information, uptake of inspired acetaldehyde was measured at an inspiratory flow rate that approximated the minute ventilation rate in the surgically isolated nasal cavity of F 344 rats pretreated with either saline (control) or the ALDH inhibitor, cyanamide (10 mg/kg s.c.). ALDH activities (substrate concentration 3 times the K(m)) in anterior (respiratory mucosa) and posterior (olfactory mucosa) nasal tissues averaged 160 and 210 nmol/min), respectively, in control animals (total activity 370 nmol/min), compared to 60 and 80 nmol/min, respectively, in cyanamide-pretreated rats (p < 0.05), indicating that approximately 60% inhibition was obtained. Nasal uptake was measured at 3 inspired concentrations: 10, 300, and 1500 ppm. At these concentrations, acetaldehyde uptake efficiency averaged 54, 37, and 34% in saline-pretreated rats, respectively (p < 0.05). In absolute terms, the delivered dosage rates at these exposure concentrations averaged 21, 420, and 1990 nmol/min. The concentration dependence on uptake suggests a saturable process was involved. At inspired concentrations of 300 ppm or more, the delivered dosage rates exceeded the measured specific activity for nasal ALDH of 370 nmol/min. Cyanamide pretreatment abolished the concentration dependence. Specifically, uptake efficiencies in cyanamide-pretreated rats averaged 30, 27, and 31% at inspired concentrations of 10, 300, and 1500 ppm, respectively (p > 0.05); delivered dosage rates were 12, 310, and 1780 nmol/min. Thus, cyanamide pretreatment reduced nasal-delivered dosage rates at inspired concentrations of 10, 300, and 1500 ppm, respectively by 9, 110, and 210 nmol/min, values that correspond well with the total nasal ALDH activity of 370 nmol/min. In toto, these results suggest that inspired acetaldehyde is metabolized in situ by ALDH, but at exposure concentrations of 300 ppm or greater, the delivered dosage rate may equal or exceed the capacity of this enzyme.
Differential effect of glucose ingestion on the neural processing of food stimuli in lean and overweight adults

Eating behavior is crucial in the development of obesity and Type 2 diabetes. To further investigate its regulation, we studied the effects of glucose versus water ingestion on the neural processing of visual high and low caloric food cues in 12 lean and 12 overweight subjects by functional magnetic resonance imaging. We found body weight to substantially impact the brain's response to visual food cues after glucose versus water ingestion. Specifically, there was a significant interaction between body weight, condition (water versus glucose), and caloric content of food cues. Although overweight subjects showed a generalized reduced response to food objects in the fusiform gyrus and precuneus, the lean group showed a differential pattern to high versus low caloric foods depending on glucose versus water ingestion. Furthermore, we observed plasma insulin and glucose associated effects. The hypothalamic response to high caloric food cues negatively correlated with changes in blood glucose 30 min after glucose ingestion, while especially brain regions in the prefrontal cortex showed a significant negative relationship with increases in plasma insulin 120 min after glucose ingestion. We conclude that the postprandial neural processing of food cues is highly influenced by body weight especially in visual areas, potentially altering visual attention to food. Furthermore, our results underline that insulin markedly influences prefrontal activity to high caloric food cues after a meal, indicating that postprandial hormones may be potential players in modulating executive control. Hum Brain Mapp 35:918–928, 2014. © 2013 Wiley Periodicals, Inc.
Lactulose Is Highly Potential in Prophylaxis of Hepatic Encephalopathy in Patients with Cirrhosis and Upper Gastrointestinal Bleeding: Results of a Controlled Randomized Trial

Background and Aims: Upper gastrointestinal bleeding (UGB) is an important precipitating factor for the development of hepatic encephalopathy (HE) in cirrhotic patients. The aim of this study was to evaluate the efficacy of lactulose in a controlled randomized trial for prophylaxis of HE after UGB. Patients and Methods: 128 cirrhotic patients with UGB were consecutively classified according to Child-Pugh criteria and randomized to receive lactulose (group A, n = 63) or no lactulose (group B, n = 65) treatment after the symptoms of active bleeding disappeared. Curative effects were observed for 6 days. Results: Two patients in group A and 11 in group B had developed HE; the incidence rates were 3.2 and 16.9% (χ2 5.2061, p < 0.05). After treatment, a significant increase in ammonia level and higher number connection test (NCT) in the non-lactulose group, median blood ammonia levels (60.0 vs. 52.0), p < 0.05, and median NCT (43 vs. 38), p < 0.05, were observed. Patients who had developed HE had a significantly higher baseline Child-Turcotte-Pugh score (10.15 ±1.82 vs. 6.35 ± 1.60, p < 0.05), alanine aminotransferase (111.25 ± 91.62 vs. 48.32 ± 47.45, p < 0.05), aspartate aminotransferase (171.42 ± 142.68 vs. 46.33 ± 42.68, p < 0.05), total bilirubin (73.44 ± 47.20 vs. 29.75 ± 22.08, p < 0.05), serum albumin (24.65 ± 5.04 vs. 33.43 ± 6.49, p < 0.05), plasma prothrombin time (22.18 ± 4.60 vs. 17.12 ± 4.62, p < 0.05), and lower hemoglobin level (72.31 ± 15.15 vs. 87.45 ± 19.79, p < 0.05) as compared to patients who did not develop HE. On unconditional logistic regression analysis, patients who had developed HE were significantly associated with a higher baseline Child-Turcotte-Pugh score (OR 9.92, 95% CI 1.94-50.63, p < 0.05) and lactulose therapy (OR 0.02, 95% CI 0-0.74, p < 0.05) but were not associated with other parameters. Conclusions: Lactulose is an effective prophylaxis agent of HE for cirrhotic patients who had developed UGB.