Miracle-dz/UniFAR-FTUs huggingface dataset:
Increased Level of Interleukin-17 in Children and Adolescents with Type 1 Diabetes Mellitus and its Association with Vitamin D Deficiency

Introduction: The up-regulation of interleukin-17 (IL-17) has been reported to be the pathogenesis of type 1 diabetes mellitus (T1D). On the other hand, vitamin D deficiency is fairly prevalent in T1D. This study aims to investigate IL-17 and vitamin D status and its correlation in children and adolescents with T1D. Material and Methods: A cross sectional study was carried out between January to March 2017. A total of 20 patients aged 12.25±3.74 years old with T1D and 20 healthy control group were involved. Their parents signed an informed consent. Demographic data were obtained using structured questionnaires. Physical, and laboratory examination were also performed. Blood samples were collected and serum vitamin D and IL-17 levels were measured by indirect ELISA were. Results: The serum level of vitamin D serum and IL-17 level between both groups were significantly different (p<0.001). A positive correlation between vitamin D and IL-17 levels (p<0.05; r=+0.566) was found. Conclusion: T1D is a T cell-mediated autoimmune disorder which targets and destroys insulin-producing pancreatic beta-cells. Children and adolescents with T1D show an increased level of IL-17 immunity and vitamin D deficiency. IL-17 immunity control and vitamin D supplementation could be potential targets for further development of T1D therapeutic strategies.
The effects of preoperative carbohydrate loading on postoperative nausea and vomiting: An integrative review

Background: Postoperative nausea and vomiting (PONV) is a very common problem among surgical patients. Despite improved methods of risk identification, the incidence of PONV remains as high as 20–40%. It can increase hospital length of stay and greatly reduce patient satisfaction. The purpose of this integrative review is to examine the effects of both oral and IV preoperative carbohydrate loading on the incidence of postoperative nausea and vomiting in surgical patients. Methods: A review the literature was completed by searching for the terms related to preoperative carbohydrate loading and PONV. Results: Twenty studies met the criteria and were analyzed for this review. Twelve publications showed that PONV or antiemetic usage was reduced by either oral or IV preoperative carbohydrate intake. Seven publications showed that PONV was not changed significantly by these interventions. One study had no patients with PONV. There was a low rate of complications discussed among the research with only one case of aspiration. Conclusion: There is a need for more research to be done in this area. However, preoperative carbohydrate loading shows evidence of some decreased PONV with low instance of complications.
Infrared skin thermometer good alternative for newborns

♦ De Curtis M, et al. Arch Dis Child Fetal Neonatal Ed 2008;93:F55-F57. [OpenUrl][1][Abstract/FREE Full Text][2]. An infrared skin thermometer is a comfortable and reliable way to measure body temperature in newborns, according to a study of 107 infants. While the rectal thermometer has been the
Anesthesia for Spine Surgery

Spine surgery is a common procedure performed in both elective and emergency scenarios. Over the last two decades, there have been a multitude of advances in surgical and anesthetic techniques that have improved patient safety and postoperative outcomes. The recent focus of anesthetic management for patients undergoing spine surgery is not only limited to successful perioperative assessment or intraoperative stability but also to rapid recovery and prevention of postoperative complications. In recent years, enhanced recovery after surgery (ERAS) programs have emerged within the specialty of spine surgery. These programs include a multidisciplinary, patient-focused approach along with multimodal analgesic strategies aimed at decreasing complications, relieving postoperative pain, and consequently hastening recovery and reducing length of stay. Although general anesthesia for spine surgery has been widely accepted, a new era of regional anesthesia brings growing evidence to supporting its use in lumbar spine surgery. Regional techniques have been associated with reduction in intraoperative blood loss, length of hospital stay, and incidence of postoperative nausea and vomiting. This recent evidence has provoked further discussion of this topic, and, to date, there is still no definite answer regarding optimal anesthesia for spine surgery. This chapter serves to summarize the available evidence on management of anesthesia for patients undergoing spine surgery.
Anatomical Variants in Frontal Recess Region and their Impact on Frontal Sinus Surgery in Chronic Sinusitis

Objective: To study the prevalence of anatomical variants in frontal recess region and their impact on frontal sinus surgery. Setting: University referral center. Patients and Methods: This was a clinical trial prospective study approved by Menoufia University research ethics board (REB) and included 50 Egyptian patients selected from the ENT department of Menoufia University between June 2011 to November 2014, who were suffering from chronic frontal sinusitis. Preoperative CT with coronal, axial and sagittal cuts were examined to show anatomical variants. Frontalsinusotomy was doneendoscopically and surgicall easiness was evaluated. Results: Increased aggernasi cell size was associated with increased operative easiness. Increase danteroposteri or diameter of frontal sinus ostium was associated with increased operative easiness.Type3frontoethmoidal air cell and interfrontal sinusseptal cells were more difficult in surgery than other frontoethmoidal air cells. Operativeeasiness correlated with different types of uncinate process superior attachment. Conclusions: Preoperative meticulous study of CT is very important for decision making in endoscopic frontal sinus surgery. Each anatomical variant in frontal recess area can be a predictor for operative easiness.
Demographic and Regional Trends of Smoking among Thai Females from 1986 to 2014

Background: Smoking is a major public health burden causing substantial morbidity and mortality. The aim of the study was to assess the prevalences and demographic trends of smoking among Thai females. Methods Data from Thailand’s National Statistics Office for 1986 to 2014 were used. Multiple logistic regression was implemented to identify the prevalences and trends of female smoking by region (Bangkok, Central, Northeast, North, and South) and area (Rural and Urban). Results: The overall prevalence of smoking was 3.4% among females aged 15 years and above in 2014. Gradually decreasing trends of smoking were observed from 1991 to 2007. Afterwards, the trends of smoking was found higher in 2011 to 2014 among aged 15-39 years. Furthermore, there were substantial differences in female smoking in different regions and areas. Of those, the Northern Thailand and rural areas had the highest prevalence of smokers. Conclusion: Smoking among Thai females in the past 20 years had a decreasing trend, but it can be seen that since 2007 the trend of smoking had shown an increasing trend and a variation among the regions. This imply that, tobacco control policies are important and in need particularly for young females, living in rural areas and Northern provinces.
Turmeric, Pepper, Cinnamon, and Saffron Consumption and Mortality

Background Previous studies have reported the beneficial effects of spice consumption on lipid profiles, fasting glucose, and blood pressure, which suggests that spice consumption could affect the risk of cardiovascular disease, diabetes mellitus, and consequently mortality. The objective of this study was to evaluate the relationship between consumption of turmeric, black or chili pepper, cinnamon, and saffron with overall and cause‐specific mortality in an adult population in Iran. Methods and Results We used data from the Golestan Cohort Study, which has followed 50 045 participants aged 40 to 75 years from baseline (2004–2008). After establishing the exclusion criteria, 44 398 participants were included in the analyses. Spice consumption data were extracted from the baseline Food Frequency Questionnaire. Cox models were used to estimate hazard ratios (HR) and 95% CI for overall and cause‐specific mortality, comparing the ever consumers to the never consumers as a reference group for each type of spice (adjusted for known and suspected confounders). During 11 years of follow‐up, 5121 people died. Turmeric consumption was associated with significantly reduced risk of overall mortality (HR=0.90, 95% CI=0.85–0.96) and cardiovascular mortality (HR=0.91, 95% CI=0.82–0.99). Black or chili pepper consumption was associated with significantly reduced risk of overall mortality (HR=0.91, 95% CI=0.86–0.98). Saffron consumption was associated with significantly reduced risk of overall (HR=0.85, 95% CI=0.77–0.94) and cardiovascular mortality (HR=0.79, 95% CI=0.68–0.92). We found no associations with cinnamon consumption or between any of these spices and cancer mortality. Conclusions Consuming turmeric or saffron was associated with decreased risk of overall and cardiovascular mortality. The hypothesis of a protective effect of spice consumption on mortality should be tested in other prospective studies.
Five-year clinical outcomes with endoscopic transforaminal outside-in foraminoplasty techniques for symptomatic degenerative conditions of the lumbar spine.

Background Lumbar foraminal stenosis in the extraforaminal zone is best directly visualized with the outside-in transforaminal endoscopic technique. Stenosis in that area is often missed with traditional translaminar surgery. The authors analyzed the long-term 5-year clinical results, reoperation rates, and unintended after care with the outside-in endoscopic transforaminal foraminoplasty for symptoms from lumbar foraminal stenosis to better establish clinical indications and prognosticators of favorable outcomes. Methods Long-term 5-year Macnab outcomes, visual analog scale (VAS) scores, complications, and unintended aftercare were analyzed in a series of 90 patients treated with the transforaminal outside-in selective endoscopic discectomy (SED™) with foraminoplasty for foraminal and lateral recess stenosis. Results At minimum 5-year follow-up, excellent results according to the Macnab criteria were obtained in 61 (67.8%) patients, good in 23 (25.6%), fair in 6 (6.7%), respectively. The mean preoperative VAS 7.55. The mean postoperative VAS was 2.87 and at last follow-up 2.53. Both postoperative VAS and last follow-up VAS were statistically reduced at a significance level of P<0.0001. Postoperative dysesthesia occurred in 8 patients (8.9%). While most of the 32 follow-up surgeries following SED™ were additional endoscopic decompressions and rhizotomies (24/32; 75%) were non-fusion procedures, only 8 of the whole study series of 90 patients (8.9%) underwent fusion at the index SED™ level within the minimum 5-year follow-up period. One patient opted for an open laminectomy (1.1%). Conclusions Patients with symptomatic foraminal stenosis may be treated successfully in a staged manner with outside-in transforaminal endoscopic decompression while maintaining favorable long-term outcomes without the excessive need for fusion in the vast majority of patients. The reoperation fusion rate at 5-year follow-up was approximately 3 times lower when compared to recently reported reoperation rates following traditional translaminar decompression/fusion.
Survival Analysis of Lung and Bronchus Cancer Patients Segmented by Demographic Characteristics

We propose a Weibull mixture model considering both covariates and unobserved heterogeneity to examine how demographic variables affect individual survival times and to derive the annual number of deaths. We analyze the records of patients diagnosed with lung and bronchus cancer, the most common cancer in the United States. The result shows that the diagnosis year as well as age, gender, race, and registry significantly affect individual survival times. including unobserved heterogeneity, we remove a bias in hazard rates and provide better performance in forecasting the annual number of cancer deaths than other benchmarks. Furthermore, from segmenting patients into several groups, we specify the difference between groups and assess their group-specific survival probabilities within a given period. Our study is distinctive in that a bottom-up strategy is adopted to predict aggregate-level units. This makes health forecasting available in two sides: public and private sector. For the public sector, our study enables a more precise allocation of the government’s health and welfare budget. Also for the private sector, our segmentation results provide guidance to the insurance industry for targeting customers more specifically.
Phytochemistry, acute toxicity and blood profile of albino rats treated with fruit extract of 
Solanum macrocarpon

Phytochemical screening of the methanolic fruit extract of Solanum macrocarpon was performed using standard method. Eighteen male albino mice, assigned into six groups (n=3) were used to determine the acute toxicity (LD50) of the extract. Haematological effect of the extract was determined using forty eight adult male rats assigned into four groups (A-D; n=12). The treatment groups received daily oral administration of the extract at doses of 400, 800 and 1600 mg/kg of body weight (bw) respectively for 21 days. The phytochemical screening of the extract revealed the presence of flavonoids, saponins, alkaloids, phenols, phytates, tannins, cyanides and terpenoids. The extract showed no mortality even at the dose of 5000 mg/kg bw. The highest treatment dose (1600 mg/kg) showed significant reduction in the white blood cell (WBC) count compared to rest of the treatment groups. There were no significant difference (p<0.05) in red blood cell (RBC), packed cell volume (PCV) and haemoglobin (Hb) levels of the treatment groups compared to control. Similarly, the mean cell volume (MCV), mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC) results showed no significant difference from days 0 to 21 in all the treatment groups. Findings from this study suggest that except for the fact that the high dose of the extract antagonizes immunity; it has no serious adverse effect on the various haematological parameters, especially as it improves haemoglobin levels on prolonged administration. Key words: Acute toxicity, blood profile, phytochemistry, Solanum macrocarpon.
Bir tıp fakültesindeki öğrencilerin depresyon, anksiyete ve stres düzeylerinin değerlendirilmesi

Amac: Bu calismada bir tip fakultesindeki ogrencilerin depresyon, anksiyete ve stres duzeylerinin belirlenmesi ve bu durumlarla iliskili faktorlerin incelenmesi amaclandi. Yontem: Kesitsel tipte olan calismanin evrenini Mersin Universitesi Tip Fakultesi’nde ogrenim goren 1387 ogrenci olusturmaktadir. En kucuk ornek buyuklugu %50 siklik, %95 guven araligi ve ±3 hata payi ile 603 olarak hesaplandi. 631 ogrenci calismaya katildi, 606 anket degerlendirmeye alindi. Veri toplama araclari; ogrencilerin sosyodemografik bilgilerini iceren anket formu ve Depresyon-Anksiyete-Stres Olcegi idi. Verilerin degerlendirilmesinde; Student T testi, Mann-Whitney U testi, ANOVA ve Kruskal Wallis varyans analizi, Spearman korelasyon testi, Lineer Regresyon analizi kullanildi. Bulgular: Ogrencilerin %54.6’si erkekti, %32.3’u yurtta yasiyordu. Yas ortalamasi 21.9±2.4’tu. Katilimcilarin ortalama depresyon puani 13.5±9.3, anksiyete puani 10.2±6.8, stres puani 16.7±8.1 idi. Ogrencilerde ileri/cok ileri duzeyde depresyon, anksiyete ve stres sikliklari sirasiyla %22.2, %22.1 ve %15.5 olarak belirlendi. Saglik durumu orta/kotu olanlarda, aile ile iliskileri iyi olmayanlarda depresyon, anksiyete ve stres puanlarinin ucu de yuksek bulundu. Fiziksel aktivite yapmayanlarda, okul basarisi kotu olanlarda depresyon ve anksiyete puanlari; kronik hastaligi olanlarda anksiyete ve stres puanlari yuksek bulundu. Okulu istemeyerek secenlerde depresyon puani, sinif tekrari yapmayanlarda anksiyete puani, kadinlarda, annesi calisanlarda, ekonomik sikinti yasayanlarda stres puani yuksekti. Sonuc : Ogrencilerin yaklasik beste birinin onemli duzeyde depresyon, anksiyete ve stres yasadiklari goruldu. Egitimleri sirasinda ogrencilerin ruhsal durumlarini etkileyen fiziksel saglik durumlariyla, aile iliskileriyle, akademik basarilariyla ilgilenilmeli ve sorunu olan ogrencilere rehberlik hizmetleri verilmelidir.
Retinal structural changes in patients with Alzheimer's disease

Baku (Azerbaijan) Background: Retinal disorders in patients with Alzheimer's disease (AD) are given special attention. Purpose: To identify optical coherence tomography (OCT)-based retinal structural changes in patients with mild or moderate AD. Materials and Methods: Forty-five AD patients (88 eyes; age, 66.2 ± 3.44 years) with mild or moderate cognitive impairments were involved into the study. All subjects underwent a conventional eye examination and OCT measurements. For Cirrus HDOCT imaging, the Macular Cube 512 × 128 Combo protocol was used. The RNFL, retinal ganglion cell layer (RGCL), and internal plexiform layer (IPL) thicknesses were determined using RNFL and ganglion cell complex (GCC) protocols. Results: Compared with controls, patients with AD had 53.2% lower Mini Mental State Examination (MMSE) scores (p < 0.05). In addition, RNFL thicknesses in the temporal, superior and inferior quadrants in patients with AD were significantly (31.4%, 21.8% and 33.1%, respectively; p < 0.05) thinner compared to controls. Moreover, compared to controls, focal loss volume (FLV) and global loss volume (GLV) of GCC in AD patients were 1.7 times (p < 0.05) and 2.8 times (p < 0.01), respectively, increased, whereas central macular thickness, overall macular cube volume and average macular cube thickness were 14%, 17.8% and 3.5% decreased. Conclusion: Our findings confirm the reports of changes in the retinal structure in patients with mild or moderate AD, particularly, the decreased GCC thickness and increased GCC FLV and GLV.
Asthma in electronic health records : validity and phenotyping

This PhD thesis explores the validation of asthma in electronic health records (EHR) and the characteristics of asthma phenotypes in the UK using CPRD GOLD, HES and ONS data. The absence of a universal case definition, the overlap with other diseases and the incomplete recording of diagnostic markers makes the identification of asthma patients in EHR challenging. Furthermore, asthma phenotypes have previously been established based on cluster analysis in small populations, but their prevalence, treatment and outcomes in the general population have not been investigated. Firstly, I conducted a systematic review to understand how past epidemiological studies have validated asthma recording in EHR, including a critical appraisal and list of test measure values for the selected studies. Secondly, I validated algorithms to reliably ascertain the asthma status of patients in CPRD GOLD. This validation study identified multiple algorithms with PPV greater than 80%. The most practical algorithm (presence of a specific asthma diagnostic code) had a PPV of 86.4 (95% CI:77.4-95.4). Thirdly, I quantified the concomitant occurrence of asthma in COPD patients and vice versa in CPRD GOLD. After detailed case review, concomitant asthma and COPD was concluded in 14.8% of validated asthma patients and in 14.5% of validated COPD patients. However, asthma diagnoses may be unreliable in COPD patients, as over 50% of COPD patients had received an asthma code. Finally, I examined the prevalence, treatment, outcomes and characteristics of established asthma phenotypes in CPRD GOLD. Only a minority of patients (37.3%) were classified into these phenotypes using stringent inclusion criteria. Exacerbation rates/1000PY were lowest for benign asthma (106.8 [95% CI:101.2-112.3]), and highest for obese non-eosinophilic asthma (469.0 [95% CI:451.7-486.2]). In conclusion, this thesis provides information on the validation of asthma diagnoses in EHR and the prevalence, treatment, outcomes of predefined asthma phenotypes in the UK primary care population.
Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Supplemental Digital Content is available in the text. Objectives: This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. Data Sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. Study Selection: Two independent reviewers screened citations. Eligible studies included randomized controlled trials comparing efficacy and safety of an adjuvant-plus-opioid regimen to opioids alone in adult ICU patients. Data Extraction: We conducted duplicate screening of citations and data abstraction. Data Synthesis: Of 10,949 initial citations, we identified 34 eligible trials. These trials examined acetaminophen, carbamazepine, clonidine, dexmedetomidine, gabapentin, ketamine, magnesium sulfate, nefopam, nonsteroidal anti-inflammatory drugs (including diclofenac, indomethacin, and ketoprofen), pregabalin, and tramadol as adjunctive analgesics. Use of any adjuvant in addition to an opioid as compared to an opioid alone led to reductions in patient-reported pain scores at 24 hours (standard mean difference, –0.88; 95% CI, –1.29 to –0.47; low certainty) and decreased opioid consumption (in oral morphine equivalents over 24 hr; mean difference, 25.89 mg less; 95% CI, 19.97–31.81 mg less; low certainty). In terms of individual medications, reductions in opioid use were demonstrated with acetaminophen (mean difference, 36.17 mg less; 95% CI, 7.86–64.47 mg less; low certainty), carbamazepine (mean difference, 54.69 mg less; 95% CI, 40.39–to 68.99 mg less; moderate certainty), dexmedetomidine (mean difference, 10.21 mg less; 95% CI, 1.06–19.37 mg less; low certainty), ketamine (mean difference, 36.81 mg less; 95% CI, 27.32–46.30 mg less; low certainty), nefopam (mean difference, 70.89 mg less; 95% CI, 64.46–77.32 mg less; low certainty), nonsteroidal anti-inflammatory drugs (mean difference, 11.07 mg less; 95% CI, 2.7–19.44 mg less; low certainty), and tramadol (mean difference, 22.14 mg less; 95% CI, 6.67–37.61 mg less; moderate certainty). Conclusions: Clinicians should consider using adjunct agents to limit opioid exposure and improve pain scores in critically ill patients.
Conceptual basis for rural nursing

This book establishes a theoretical basis for the practice of rural nursing. It is the culmination of nearly 20 years of work by a dedicated group of rural nurse educators based at Montana State University to identify and define the concepts important to rural nursing. This book represents a significant milestone in the development of a knowledge base for health care practice in rural areas. It is designed to prepare students and practicing nurses with knowledge, skills, and abilities necessary to understand and care for people in sparsely populated areas.