Miracle-dz/UniFAR-FTUs huggingface dataset:
Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation

Background: Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation. Methods: This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 245 patients undergoing primary arthroplasty (n = 23), revision for aseptic failure (n = 86), revision for PJI (n = 57), or reimplantation (n = 29) or who had infection in a site other than a joint (n = 50). PJI was defined using the Musculoskeletal Infection Society criteria. In all patients, serum D-dimer level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were measured preoperatively. Results: The median D-dimer level was significantly higher (p < 0.0001) for the patients with PJI (1,110 ng/mL [range, 243 to 8,487 ng/mL]) than for the patients with aseptic failure (299 ng/mL [range, 106 to 2,571 ng/mL). Using the Youden index, 850 ng/mL was determined as the optimal threshold value for serum D-dimer for the diagnosis of PJI. Serum D-dimer outperformed both ESR and serum CRP, with a sensitivity of 89% and a specificity of 93%. ESR and CRP had a sensitivity of 73% and 79% and a specificity of 78% and 80%, respectively. The sensitivity and specificity of ESR and CRP combined was 84% (95% confidence interval [CI], 76% to 90%) and 47% (95% CI, 36% to 58%), respectively. Conclusions: It appears that serum D-dimer is a promising marker for the diagnosis of PJI. This test may also have a great utility for determining the optimal timing of reimplantation. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
The frequency of perceptual deficits after stroke

The frequency of perceptual problems in stroke patients was assessed using a standardised assessment, The Rivermead Perceptual Assessment Battery.1 One hundred and fifty stroke patients (75 right hemiplegic and 75 left hemiplegic), admitted consecutively to two general hospitals, were assessed one month after stroke, to identify the proportion with perceptual difficulties. Perceptual difficulties were identified in 71 % of right hemiplegic stroke patients and 81 % of left hemiplegic patients. They were identified in 97% of dysphasic right hemiplegic patients, compared to 47% of nondysphasic right hemiplegic patients and 84% of female hemiplegic patients, compared to 67% of male hemiplegic patients. Unilateral neglect was identified in both right and left hemiplegic patients. The proportion of patients with neglect varied according to the measure chosen. The results indicate that perceptual problems are common following both right and left hemiplegic stroke, with unilateral neglect accounting for a relatively small proportion of the problems.
Frequency of Suicide Ideation and Attempt in HIV infected patients referred to behavioral health counseling center of Rafsanjan (RUMS) and Kerman University of medical sciences (KUMS) in 2012

Background: Suicidal behavior and HIV/AIDS are considered as significant public health concerns. HIV infection has been associated with elevated risk of suicidal ideation.Methods and Materials: Cross-sectional and descriptive research design was used to record socio-demographic data of the study. The suicidal ideation scale BECK was used to determine and measure the frequency of suicide ideation and attempt in HIV infected (HIV+) persons referred to behavioral health counseling center of Rafsanjan University of medical sciences (RUMS) and Kerman University of medical sciences (KUMS) in 2012.Results: Men had more suicidal ideation than women after the diagnosis of infection with HIV. More cases of HIV positive persons with duration of less than 10 and more than 14 years, and most cases of less than 40 years-old had suicidal ideation. There was no significant difference between suicidal ideation in HIV-infected individuals and factors such as gender, age, and duration of HIV-infection (p >0.05). Conclusion: Suicidal ideation and attempt is common in HIV infected patients which needs more assessment and prevention.
Lemierre’s Syndrome: The Controversy of Anticoagulation

In this issue of Pediatrics , Schmid et al1 present an important case of respiratory failure and hypercoagulability in a toddler with Lemierre’s syndrome (LS). The first significant finding is the young age of the patient. Given the increasing prevalence of LS, one needs to have a high index of suspicion in all pediatric age groups, not just adolescents.2,3 The second important finding includes the potential implications of … Address correspondence to K. Sarah Hoehn, MD, Mbe, Department of Anesthesiology and Critical Care Medicine, 9th Floor, Main Building, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104. E-mail: hoehn{at}email.chop. edu
American academy of orthopaedic surgeons clinical practice guideline on: the treatment of glenohumeral joint osteoarthritis.

2011;93:203-205. J Bone Joint Surg Am. Anderson, Kevin Boyer, Laura Raymond, Patrick Sluka and Kristin Hitchcock William C. Watters, III, Michael J. Goldberg, Michael Keith, Charles M. Turkelson, Janet L. Wies, Sara Rolando Izquierdo, Ilya Voloshin, Sara Edwards, Michael Q. Freehill, Walter Stanwood, J. Michael Wiater, Guideline on: The Treatment of Glenohumeral Joint Osteoarthritis American Academy of Orthopaedic Surgeons Clinical Practice
Investigation of the effects of Prosopis farcta plant extract on Rat's aorta

Ischemic heart diseases are the most common causes of death in the developed and developing societies. Because vegetable based medications have lower side effects and are well adapted to body’s physiology, a global trend to use these kinds of medications for cardiovascular diseases is increasing. To investigate the effect of Prosopis farcta plant extract (P.F.P.E) on rat’s thoracic aorta. P. farcta plant extract was firstly prepared. Then 2 centimetres of rat’s thoracic aorta was dissected and was divided into 4 pieces of 5 mm. After contraction of these pieces by phenylephrine (1 µm), different dosages of plant extraction (0.5, 1, 2 mg/ml) were examined and the effect of P.F. P.E on rat’s aorta with and without endothelium layer was measured. Different dosages of P. farcta extract (1, 2 mg/ml) at the presence and absence of L- NAME (a nitric oxide synthetas inhibitor) was examined. P. farcta plant extract showed a dose dependent relaxing effect on contracted aorta. The relaxing effect of P.F. P.E on aorta with endothelium was more significant than that on aorta without endothelium in the different dosages (p < 0.05). The relaxing effect of P.F. P.E in the presence of L- NAME was reduced significantly (p < 0.05). The relaxing effect of P.F. P.E was more than that by acetylcholine (p < 0.05). Relaxing effect of acetylcholine was inhibited by atropine but it did not show any effect on the relaxing effect of P.F. P.E (p < 0.001). P. farcta plant extract showed a dose dependent as well as an endothelium dependent relaxing effect on thoracic aorta in rats. Endothelium layer showed an important role in the relaxing effect of P.F. P.E on rat’s aorta. Also nitric oxide had a significant role on the relaxing effect of P.F. P.E.
Work Characteristics and Musculoskeletal Disorders among Postgraduate Dental Students: A Pilot Study

Abstract Objectives: Dentists are at high risk of musculoskeletal disorders [MSD], which is one of the occupational health issues in healthcare workers. The aim of this study is to determine the prevalence and risk factors of MSD and to identify ergonomic conditions of postgraduate students in the Ankara University Faculty of Dentistry. Methods: A questionnaire was administered to 264 postgraduate dental students in different departments. After the students had completed the questionnaire, observers noted the ergonomic working conditions of the students and recorded their observations. Results: The prevalence of musculoskeletal pain was found to be 49 percent in postgraduate dental students. The lower back was found to be the most commonly affected area [34%]. No statistically significant difference was found among daily working time, duration of employment, and presence and intensity of pain [p > 0.05]. The prevalence of pain was higher among female than among male students participating in this study [p < 0.05]. Conclusions: These results emphasize the need for ergonomic preventive measures in dentistry including training on ergonomic principles from the beginning of the clinical period. Also, special attention should be paid to the design of the working environment in faculties conforming to ergonomic principles.
Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique.

BACKGROUND Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively. RESULTS A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two. CONCLUSIONS A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.
Prevalence, diagnosis and treatment of gastro-oesophageal reflux disease in institutionalised persons with an intellectual disability

The prevalence of gastro-oesophageal reflux disease (GERD) has been suggested to be high in persons with an intellectual disability (ID). However, this has never been randomly investigated. Also, the therapeutic approach to GERD in IDI has not been studied extensively. Therefore, we studied the prevalence of GERD among IDI and the effects of omeprazole on healing and symptom relief. Four hundred and thirty-five persons with an IQ < 50 underwent 24 hour oesophageal pH testing, and after endoscopy the effects of omeprazole were evaluated. Almost 50% showed a pathological pH test. In almost 90% the treatment scheme was effective in healing the oesophagitis and keeping the patients in remission, independent of the severity of the oesophagitis. A marked improvement in symptoms was seen. GERD is a major clinical problem in IDI, and is frequently overlooked and underrated. The prevalence of GERD is high. In this difficult group of patients it appeared to be relatively easy to diagnose GERD by pH testing and/or endoscopy. Also, it was demonstrated that in IDI, omeprazol is highly effective with only a few minor side-effects.
A changing pattern in antimicrobial susceptibility of Salmonella enterica serotype isolated In North India

Typhoid fever continues to remain a health problem as the causative organism Salmonella typhi has developed resistance to many of the antibiotics used. This study was undertaken to determine the current pattern of resistance to antimicrobial agents of S. typhi isolates obtained in a tertiary Health care Hospital. 309 samples were taken. Sensitivity to ampicillin, chloramphenicol, cotrimoxazole, ciprofloxacin and ceftriaxone was determined by disc diffusion, and the minimum inhibitory concentration (MIC) was determined. Antibiotic sensitivity was carried out by Kirby-Bauer method. ESBL screening and phenotype confirmation were done following National Committee for Clinical Laboratory Standards (NCCLS) recommendations for Escherichia coli. Isolation rates of Salmonella typhi was prominent in 2002 - 2003 and have remained stable. S. paratyphi-A is showing an increasing trend. The 3 common antibiotics which were showing resistance earlier are now showing sensitivity. The study indicates that MDR S. typhi is on the rise. There is also re-emergence of chloramphenicol sensitivity. Sensitivity pattern of causative organism must be sought before instituting appropriate therapy to prevent further emergence of drug resistance. Indiscriminate use of ciprofloxacin or ceftriaxone should be strongly discouraged. They should be used as second line agents. Also, the treatment must not be completely dependent on the Widal test. Blood culture and clinical history must be taken into consideration for treatment.
Psychiatric Comorbidity in Patients With Substance Use Disorders Attending an Addiction Treatment Center in India Over 11 Years: Case for a Specialized “Dual Diagnosis Clinic”

Objective: Dual diagnosis of substance use disorders and psychiatric illness presents a distinct clinical challenge. These patients have been found to have more complications and poorer outcomes compared to patients with a single disorder only. Data from India are sparse. Methods: The study was a retrospective chart-based review of consecutive patients attending an addiction treatment center in a tertiary care hospital in north India from January 2000 until December 2010. Diagnoses were originally made clinically by face-to-face psychiatric interview and collateral information from family members and were confirmed by consultant psychiatrists following the detailed evaluation. Data on demographics, substance use disorder and psychiatric diagnoses, treatment, and short-term outcomes were extracted from the records. Results: Out of 5,283 patients registered over a span of 11 years, 5,116 (97%) records were available. Of these, 678 (13.2%) had a diagnosis of another non-substance psychiatric disorder. The comorbid psychiatric illnesses included mood disorders (n = 286, 42.2%), psychotic disorders (n = 186, 27.5%), anxiety disorders (n = 113, 16.7%), personality disorders (n = 68, 10.1%), organic disorders (n = 30, 4.5%), and others (n = 31, 4.6%). Alcohol use disorder was significantly more likely to be present with organic, mood, and anxiety disorders. Cannabis use disorder was significantly more likely in the dual diagnosis group as a whole and in particular with psychotic, mood, and personality disorders. Patient attrition from follow-up was substantive, but short-term outcomes among those few who did follow up were favorable. Conclusions: Though the proportion of dual diagnosis patients was relatively low among all patients attending the addiction treatment center, the cumulative number of patients in absolute figures over the years was appreciable. Given the high dropout rates but relatively favorable outcome for those retained in treatment, these patients need special and intensive focus with trained manpower and resources. There is indeed a case for a “dual diagnosis clinic. ”
Drug-related Kidney Injury and Safe Pharmacotherapy in the Elderly

__Abstract__ The kidney performs two functions that are essential for life. First, it participates in the homeostasis of the extracellular environment that is required for adequate functioning of the cells. This is achieved by excretion of some of the waste products of metabolism and by specifically adjusting the urinary excretion of water and electrolytes to match net intake and endogenous production. Second, it secretes hormones that participate in the regulation of systemic and renal hemodynamics, red blood cell production, and bone metabolism. Many medicines have nephrotoxic potential, either by direct damage of tubular cells or by glomerular or interstitial damage following immune-complex formation. Well-known examples of nephrotoxicity include cytotoxic chemotherapeutic agents such as cisplatin and aminoglycoside antibiotics such as gentamycin. Despite the risk of nephrotoxicity, use of these drugs is justified in case no safer alternatives are available and if the underlying condition is more serious than the risk of renal damage. However, history provides several examples where these conditions were not met. Examples are the chronic nephropathy caused by non-steroidal anti-inflammatory drugs (NSAIDs) and related analgesics, most notably phenacetin, that was ultimately withdrawn in 1983, and the acute renal failure associated with lactic acidosis from phenformin that was ultimately withdrawn in 1976. A more recent example is the combined use of drugs affecting the renin-angiotensin system. In relation to this, the Pharmacovigilance Risk Assessment Committee (PRAC) issued a negative advice against combined use of these drugs in 2014.
Regarding the Pain of Others

Continuous casting process for the production of hollow ingot using an improved direct chill casting equipment having a molding system comprising a hollow mold and a movable platform, wherein at least one core and a pipe for introducing outer air are provided, said core being made from a refractory material unwettable with a molten metal and having a convergent taper at the side and an air runner for introducing outer air, which is packed with an air-permeable material, at the bottom, and said pipe for introducing outer air extending upwards from the air runner and passing through the core. The continuous casting process comprises continuously pouring a molten metal into a space surrounded with the hollow mold and the core of the above equipment; cooling the molten metal only at the side wall of the hollow mold without cooling at the side of the core; thereby solidifying the molten metal to form an ingot having a hollow, wherein the interface of the frozen metal and the liquid metal is present at the position around the core; and continuously lowering the ingot thus formed while introducing spontaneously outer air into the hollow part via the pipe for introducing outer air and the air runner of the core.
Arthroscopically detected intra-articular lesions associated with acute ankle fractures.

BACKGROUND Anatomic surgical realignment of ankle fractures may still be associated with poor clinical outcomes, possibly as a result of occult intra-articular injury. The aim of this study was to determine if the severity of an acute ankle fracture is correlated with an increased number of arthroscopically detected intra-articular chondral lesions. METHODS We conducted a retrospective review of the medical charts on 283 ankle fractures that had been treated with open reduction and internal fixation and for which ankle arthroscopy had been routinely performed. The severity of the ankle fractures was categorized, with use of the arthroscopic findings derived from the operative reports as well as the findings on preoperative radiographs, according to the Lauge-Hansen criteria. RESULTS Of the 283 patients, eighty-four (forty-four female and forty male) met our inclusion criteria. Chondral lesions were found in sixty-one patients (73%). Of seventeen fractures graded as pronation-external rotation or supination-external rotation type I according to the Lauge-Hansen classification, fifteen were associated with one or no chondral lesion and two, with two or more chondral lesions. Of ten fractures graded as pronation-external rotation or supination-external rotation type II, nine were associated with one or no chondral lesion and one, with two or more chondral lesions. Of fifty-six fractures graded as pronation-external rotation or supination-external rotation type IV, twenty-seven were associated with one or no chondral lesion and twenty-nine, with two or more chondral lesions. Type-IV pronation-external rotation and supination-external rotation ankle fractures were more likely to be associated with two or more chondral lesions than type-I fractures (odds ratio = 8.1, 95% confidence interval = 1.7 to 38.6; p = 0.0044) or type-II fractures (odds ratio = 9.7, 95% confidence interval = 1.1 to 81.5; p = 0.0172). CONCLUSIONS Chondral lesions are commonly found after an acute ankle fracture. This retrospective study demonstrated that the number of intra-articular chondral lesions associated with the more severe ankle fracture patterns (pronation-external rotation and supination-external rotation type-IV fractures) was greater than the number associated with the less severe ankle fracture patterns.
Anatomic diameter femoral heads in total hip arthroplasty: a preliminary report.

BACKGROUND The stability of total hip replacements has been directly related to the diameter of the femoral head in several studies; however, durability has necessitated the use of femoral heads with a relatively small diameter. Recent developments in metal-on-metal technology have allowed for the use of femoral head bearings that are anatomic in diameter. In this case series, we report on the early results of patients who were at greater risk for dislocation because of anatomic deficiencies or increased range-of-motion activities and underwent hip arthroplasty with implants that had articulating surfaces approaching anatomic dimensions. METHODS Thirty-four patients underwent forty total hip arthroplasties with use of a modular metal-on-metal articulation with an anatomic diameter femoral head and a press-fit stem. Thirty patients were active, and four patients were profoundly disabled and had bone or soft-tissue deficiencies that would increase the risk for dislocation. Dislocation precautions were maintained for six weeks, and patients were allowed extreme ranges of motion at three months. RESULTS There were no dislocations. Active patients continued in extreme range-of-motion activities. Disabled patients improved but were limited by their comorbidities. CONCLUSIONS Anatomic diameter femoral heads offer distinct theoretical advantages in total hip arthroplasty. These short-term results are encouraging, and further study of this new technology in a larger series with a longer follow-up period is warranted.