Miracle-dz/UniFAR-FTUs huggingface dataset:
Efficacy of community-based rehabilitation for children with or at significant risk of intellectual disabilities in low- and middle-income countries: a review.

BACKGROUND Community-based rehabilitation (CBR) is being implemented in more than 90 countries. Concerns have been voiced about the adequacy of the evidence base regarding the efficacy, effectiveness and efficiency of CBR. This review summarizes evidence on the efficacy of CBR for children with intellectual disabilities. MATERIALS AND METHOD Electronic literature database searches were conducted to identify articles in the English language published since 1980 relating to the efficacy of CBR for children with intellectual disabilities. Requests for information were also sent to membership of International Association for the Scientific Study of Intellectual Disabilities and relevant organizations in selected low- and middle-income countries. RESULTS Thirteen studies were identified for inclusion in the review. The quality of evidence for the efficacy of CBR for children with intellectual disabilities was 'very low'. CONCLUSION Improving the evidence base will require greater investment in evaluation and addressing the marginalization of people with intellectual disabilities in CBR.
The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients

Context and objective We hypothesised that head and neck position could affect the effectiveness of ventilation with the i-gel airway. To test this hypothesis, we investigated the influence of different head and neck positions on oropharyngeal sealing pressures and ventilation scores during ventilation with i-gel. Methods A single, experienced supraglottic airway device user inserted the i-gel in 20 paralysed, anaesthetised patients who were scheduled for oral surgery. Oropharyngeal leak pressures and ventilation scores were measured with the head and neck in the neutral position, flexed, extended or rotated to the right. Ventilation was scored from 0 to 3 based on three criteria (no leakage with an airway pressure of 15 cmH2O, bilateral chest excursion and a square wave capnogram; each item scoring 0 or 1 point). Results Compared with the neutral position (25.8 ± 5.2 cmH2O), oropharyngeal leak pressure was significantly higher with flexion (28.5 ± 3.4 cmH2O, P = 0.015) and lower with extension (23.0 ± 4.2 cmH2O, P = 0.015), but similar with rotation (26.7 ± 5.1 cmH2O, P = 0.667). Flexion of the head and neck [2 (1–3)] adversely affected the ventilation score compared with the neutral position [3 (2–3), P = 0.004]. Conclusion Effective ventilation with an i-gel can be performed in patients in whom the head and neck is extended or rotated, whereas flexion of the head and neck adversely affects ventilation. Clinically, flexion of the head and neck should be avoided during ventilation with the i-gel.
Patient Education: An Efficient Adjuvant Therapy for Hyperphosphatemia in Hemodialysis Patients

Background. Hemodialysis and phosphate (P) binder therapy are the major methods to reduce the phosphate level in dialysis patients. However, dietary P restriction is necessary for adequate control. The successful dietary control is based on patient compliance. Patient education is the best method to assure the knowledge and drive of dietary control, which are the key features for patient compliance. The aim of the study is to investigate quantitatively the effect of patient education on serum P levels in hyperphosphatemic hemodialysis patients. Methods. We conducted a prospective self-control study. Fifty hemodialysis patients with a pre-dialysis serum P level greater than 6.0 mg/dL were studied. Intensified patient education was given. Serum P, calcium (Ca), and intact parathyroid hormone (iPTH) were evaluated before and one month after patient education. Results. Thirty-six (72%) patients had improved pre-dialysis P level (pre-education: 7.50 ± 1.33; post-education: 5.85 ± 1.20 mg/dL, p < 0.001) and Ca × P product (pre-education: 68.17 ± 12.70; post-education: 54.70 ± 11.87 mg2/dL2, p < 0.001). The effect lasted for at least three months. There is no significant change on calcium levels. The only predictor of a successful patient education is the iPTH level (improved: 348.8 ± 277.6; non-improved: 668.0 ± 674.1 ng/mL, p = 0.021). Conclusions. Patient education could be helpful and efficient in hyperphosphatemic control in dialysis patients. The patient education should be given before the serum iPTH level getting high.
Randomised comparison of hyperbaric articaine and hyperbaric low-dose bupivacaine along with fentanyl in spinal anaesthesia for day-case inguinal herniorrhaphy

Background and objective Low-dose mixture of hyperbaric bupivacaine and fentanyl is commonly used in day-case spinal anaesthesia. Using hyperbaric articaine, the onset may be faster and duration more predictable than with bupivacaine–fentanyl. We compared these two spinal anaesthetics for inguinal herniorrhaphy. Methods Adult patients were randomised to spinal anaesthesia with hyperbaric articaine 84 mg (group A, n = 40) or hyperbaric bupivacaine 7 mg along with fentanyl 10 &mgr;g (group B+F, n = 40). A blinded observer tested the block characteristics. Aiming at sensory block spread to T10 dermatome, the operating table was tilted head-end up or down 10° (once or twice), as required. Postoperative telephone interviews were performed. Results All patients in group A had a sensory block to T10 in a median time of 4 (range 2–20) min. In group B+F, the median onset time of T10 analgesia was 10 (2–30) min (P < 0.001), but T10 analgesia was not reached in seven of 40 B+F patients. A head-up tilt was needed in 37 of 40 group A patients to prevent from too extensive cephalad spread of block, and 34 of 40 group B+F patients needed a head-down tilt to enhance cephalad spread of analgesia. To treat hypotension, 6.4 mg of ephedrine was required, on average, in group A and 1.8 mg in group B+F (P = 0.01). Median time to recovery from sensory block was significantly shorter in group A (2.5 h) than in group B+F (3 h; P = 0.002). General anaesthesia was needed in three patients (group A, two patients: sensory block too short; group B+F, one patient: sensory block too limited). Conclusion Hyperbaric articaine leads to faster onset of block and faster recovery than bupivacaine along with fentanyl. Hypotension is more common with articaine. The onset and extension of the spinal block are unpredictable when using these techniques.
Myocardial oxidative stress protection by sevoflurane vs. propofol: a randomised controlled study in patients undergoing off-pump coronary artery bypass graft surgery

Context Myocardial oxidative stress plays an essential role in the pathogenesis of ischaemia–reperfusion injury associated with coronary artery bypass grafting (CABG). Both propofol and volatile anaesthetics have been shown to reduce reactive oxygen species in experimental and clinical studies. Main objective To compare the influence of sevoflurane and propofol on myocardial oxidative stress markers (F2-isoprostanes and nitrates/nitrites) in coronary sinus blood samples from patients undergoing off-pump CABG. Design and setting Randomised controlled clinical study of patients scheduled for off-pump CABG in a tertiary academic university hospital from June 2007 to August 2009. Forty patients consented to enrolment and were assigned to receive either propofol or sevoflurane. Interventions Upon completion of the proximal anastomosis, a retroplegia cannula was inserted in the coronary sinus to obtain blood samples, according to the study protocol. Main outcome measures Markers of lipoperoxidation (F2-isoprostanes) and nitrosative stress (nitrates/nitrites) were measured in coronary sinus blood samples at three time points: after the end of the proximal anastomosis (T1), after completion of all grafts (T2) and 15 min after revascularisation (T3). Results Of the 40 recruited patients, 38 fully completed the study. In the sevoflurane group (n = 20), concentrations of oxidative stress markers in the coronary sinus remained almost constant and were significantly lower than those in the propofol group (n = 18) at all time points. F2-isoprostanes concentrations were as follows at T1: sevoflurane group 37.2 ± 27.5 pg ml−1 vs. propofol group 170.7 ± 30.9 pg ml−1 [95% confidence interval (CI) 112.16–155.08, P < 0.0001); at T2: sevoflurane group 31.94 ± 24.6 pg ml−1 vs. propofol group 171.6 ± 29.7 pg ml−1 (95% CI 119.78–159.63, P < 0.0001); and at T3: sevoflurane group 23.8 ± 13.0 pg ml−1 vs. propofol group 43.6 ± 31 pg ml−1 (95% CI 2.87–36.63, P = 0.023). Conclusion In patients undergoing off-pump CABG, sevoflurane showed better antioxidative properties than propofol.
Influence of Different Stages of Experimental Chronic Kidney Disease on Rats Locomotor and Postural Skeletal Muscles Microcirculation

Background. Chronic kidney disease (CKD) is associated with muscle excess fatigue and diminished maximal whole body oxygen consumption, which in part could be depended on poor muscle microcirculatory network. The aim of this study was to assume the influence of different stages of CKD on microcirculation vessels in functionally different skeletal muscles—locomotor, the gastrocnemius muscle, and postural, the longissimus thoracis muscle. Methods. Male Wistar rats underwent sham operation (CON), uninephrectomy (CKD 1/2) and subtotal nephrectomy (CKD 5/6). Muscle samples were stained for an alkaline phosphatase to differentiate capillaries. The number of capillaries was estimated by a single observer in 10 μm transverse sections by point counting at a magnification of ×125 using an Image Analysis System Q 500 MC of Leica. Blood pressure and serum creatinine, haptoglobin, MCP-1, VEGF, and PDGF were measured. Results. There were significant differences (p < 0.05) in CD (number of capillaries per 1 mm2 of muscle tissue), C:F (capillary to fiber ratio), and CC/F (capillary contact per fiber). The CKD 1/2 group in gastrocnemius and longissimus muscle had 53% and 33% lower C:F; 56% and 33% lower CD; and 44% and 20% less CC/F than CON, respectively. The CKD 5/6 group in gastrocnemius and longissimus muscle had 46% and 20% lower C:F; 47% and 11% lower CD; and 48% and 25% less CC/F versus control, respectively. Blood pressure was higher in CKD 5/6 vs. CKD 1/2 and CON (145/95 vs. 107/87 and 119/77 mmHg, p < 0.05, respectively). CKD 5/6 had higher creatinine than CKD 1/2 and CON (1.22 vs. 0.83 and 0.74 mg/dL, p < 0.05, respectively). Haptoglobin was higher in CKD 1/2 and CKD 5/6 versus CON (1.68 and 1.63 vs. 0.70 mg/mL, p < 0.05, respectively). MCP-1 was higher in CKD 5/6 and CKD 1/2 versus CON (609 and 489 vs. 292 pg/mL, p < 0.05, respectively). There were no significant differences in serum growth factors concentration between groups. Conclusion. Capillary rarefaction is present in early stages of CKD. These changes are independent of blood pressure and progression of CKD. We suspected that muscle function has a big impact on microvasculature as capillaries rarefaction has been reduced more in locomotor than postural skeletal muscle.
Epidemiological Review of Injuries in Rugby Union

Rugby is a sport that is growing in popularity. A contact sport par excellence, it causes a significant number of injuries. In Rugby Union, there are 30 to 91 injuries per 1000 match hours. This epidemiological review of injuries incurred by rugby players mentions the position and type of injuries, the causes, time during the match and season in which they occur and the players’ positions as well as the length of players’ absences following the injury.
The Effect of Low-Dose Cholecalciferol and Calcium Treatment on Posttransplant Bone Loss in Renal Transplant Patients: A Prospective Study

Background/Aim. Posttransplant steroid doses have been reduced with the use of new and potent immunosuppressive agents. However, posttransplant osteoporosis is still a serious problem. Our aim in this study was to investigate the effect of low-dose cholecalciferol and calcium supplementation on bone loss after transplantation in renal transplant patients. Methods. Fifty-eight renal transplantation patients were included in the study. Fourteen newly transplanted patients (group 1) and 44 renal transplantation patients with a graft age of at least six months (group 2) were involved. All patients received 400 IU/day orally cholecalciferol (vitamin D3) and 600 mg/day orally calcium replacement starting from the second day posttransplantion. All patients baseline serum and urine biochemistry, serum 25-hydroxy vitamin D3 (25 (OH)D3), and bone mineral density (BMD) tests were performed. Also, the same measurements were performed at the 12th month in group 1. Results. After one year of treatment, BMDs were improved in group 1. Patients in group 1 had a nonsignificant increase of lumbar spine (8.12 ± 18.64% of baseline BMD) and femoral total (7.10 ± 13.48% of baseline BMD) BMD at the end of the first year. On the other hand, there was a significant increase in femoral neck (10.06 ± 15.70% of baseline BMD, p < 0.05) measurements. The baseline results of group 2 were similar to group 1. In group 1, 25 (OH)D3 levels were increased while PTH levels were decreased at the end of the year. Conclusion. In renal transplant patients who use low-dose metilprednisolon and new immunosuppressive agents together, low doses of vitamin D3 and calcium replacement for one year provides a reduction in lumbar spine, femoral neck, and femoral total bone loss and prevents bone loss in group 2. In addition, it contributed to the normalization of PTH levels.
Temperature corrected thromboelastography in hypothermia. Is it necessary?

Context Hypothermia is known to influence thromboelastography (TEG). TEG reproducibility is generally low. Objective The aim of this study was to evaluate the rationale of TEG temperature adjustment in patients during hypothermia. We hypothesised that temperature adjustment would not be important because of low TEG reproducibility. Design Prospective observational study. Setting Single-centre, secondary care study performed 01/2009 to 07/2010. Patients Survivors of cardiopulmonary resuscitation in whom therapeutic hypothermia (32 to 34°C) was indicated for 24 h were recruited to the study which lasted 36 h. Four hundred samples from 30 patients (22 men and eight women) were obtained. No specific exclusion criteria were defined. Main outcome measures Temperature adjusted and non-adjusted Kaolin–Heparinase and Rapid-TEG were done at 12-h intervals during the first 36 h. Results Bland–Altman plots were used for analysis. During hypothermia, the bias of adjusted measurements was greater in clot formation variables for both Kaolin–Heparinase-TEG (from −15 to −19%) and Rapid-TEG (−9 to −25%) compared to normothermia (from −3 to 3% for Kaolin–Heparinase-TEG and −10 to 2% for Rapid-TEG). Bias of clot strength variables was not influenced by temperature adjustment (median −1%). The 95% limits of agreement were wide for clot formation variables and independent of temperature. In Kaolin–Heparinase-TEG (R −42 to 40% normothermia, −47 to 18% hypothermia) and in Rapid-TEG (R −117 to 97% normothermia, −114 to 95% hypothermia). Limits of agreement of clot strength variables were narrower and independent of temperature in Kaolin–Heparinase-TEG (MA −16 to 13% normothermia, −9 to 10% hypothermia) and also in Rapid-TEG (MA −27 to 24% normothermia, −18 to 20% hypothermia). Conclusion Although TEG analysis with temperature adjusted to the in-vivo value during hypothermia yields results with small systematic bias, the importance of temperature adjustment in clinical routine is low because of the precision limits of TEG measurement itself. Therefore, we see no need to perform TEG analysis at the in-vivo temperature.
An Altered Th1/Th2 and Pro-Inflammatory Cytokine Profile in Patients with End-Stage Renal Disease Detected by Suspension Array Technology

Background. Patients with end-stage renal disease (ESRD) have an impaired immune response with a dysregulated Th1/Th2 cytokine network. Methods. Twelve ESRD patients on HD were enrolled, and their data of cytokines alterations were divided into pre- and post-HD groups, while data from 12 healthy volunteers served as control. Th1/Th2 and pro-inflammatory cytokines were all measured by suspension array (SA) technology with interleukin (IL)-8 detected simultaneously by ELISA. The correlation between SA technology and ELISA for IL-8 was calculated to compare these two methods. Results. In ESRD patients, as compared with controls, the level of IL-10 increased just prior to HD and IL-1β level decreased only following HD, while the levels of TNF-β and IL-8 decreased both before and after HD. After HD, the levels of IL-1β, IL-4, IL-8, and IL-10 in ESRD patients decreased when compared with those before HD. Statistical analysis by Spearman's rho's test showed significant correlations between SA technology and ELISA on IL-8 (p < 0.001, correlation coefficient 0.946). Conclusions. ESRD patients on HD show an altered cytokine profile with an increase in Th2 cytokine IL-10 and a decrease in Th1 cytokine TNF-β as well as a reduction in pro-inflammatory cytokine IL-8. HD did affect cytokine profile of ESRD patients, decreasing IL-1, IL-4, IL-8, and IL-10. SA technology is useful in the detection of cytokine changes within detection limits of this technology in ESRD patients.
Health-Related Quality of Life, Treatment Efficacy, and Hemodialysis Patient Outcome

The aim of the study was to examine the influence of improved treatment of hemodialysis (HD) patients on their health-related quality of life (HrQoL) and to assess the predictive value of HrQoL dimensions on patient outcome. The prospective cohort study involved 102 HD patients, and their clinical and laboratory parameters and HD adequacy indices were followed from 2001 to 2007. HrQoL was measured using KDQOL-SF Version 1.3 in 2001, 2004, and 2007. During a six-year period, quality of HD and anemia treatment improved and resulted in significant increase of mean Kt/V (1.2–1.56) and hemoglobin levels (86.5–115.6 g/L). All four HrQoL dimensions (i.e., physical, mental health, kidney disease target issues, and patient satisfaction) remained unchanged, but significant improvement in several HrQoL physical health domains and the effects of kidney disease domain was found. Mortality rate decreased from 18.6% to 7.14% per year. Age was associated positively, but kidney disease target issue score negatively, with patient death. Improved HD adequacy and anemia treatment in HD patients were followed with maintenance of all four HrQoL dimensions unchanged over six years. Moreover, an improvement in several physical health domains and the effects of kidney disease domain was found. Age and kidney disease target issue appeared as significant predictors of patients' death.
Cardiac Function in an African Dialysis Population with a Low Prevalence of Pre-Existing Cardiovascular Disease

Cardiac dysfunction is highly prevalent in dialysis patients in the developed world, and is a major cause of morbidity and mortality. The relative impact of pre-existing cardiac disease and dialysis/uremia on cardiovascular morbidity are not clear. We conducted a retrospective, cross-sectional analysis of cardiac function and mortality in 202 incident and prevalent dialysis patients over an 18-month period in a population with a low prevalence of cardiovascular disease at dialysis initiation. Systolic dysfunction was defined as an ejection fraction (EF) of <50%. Left ventricular hypertrophy (LVH) was determined by echocardiography or electrocardiogram. Clinical data was collected by chart review. Ninety-nine percent of patients were black, with a mean age of 41.7 ± 10.1 years, and median follow up 28 months (range 1–216 months). Echocardiograms were available in 132 patients. Seventy-seven patients received hemodialysis, and 55 received peritoneal dialysis. Mean EF was 63.2 ± 11.1. EF was not lower in patients with greater duration of dialysis, although LVH tended to increase (not statistically significant). In 39 patients who died during the study period, cardiac function was not different from survivors, and no patient died of ischemic heart disease or heart failure. In conclusion, in a population of patients with a low prevalence of cardiovascular disease at dialysis initiation, cardiac function appears preserved over time, and cardiac morbidity and mortality are low. This finding suggests that dialysis and uremia per se, in the absence of pre-existing cardiac disease, may not be major contributors to cardiovascular morbidity.
Effects of pomegranate seed oil on oxidative stress markers, serum biochemical parameters and pathological findings in kidney and heart of streptozotocin-induced diabetic rats

Abstract Purpose: Oxidative stress due to hyperglycemia is a major cause of diabetes complications. The aim of this study was to evaluate the effects of pomegranate seed oil (PSO) on serum biochemical parameters, cardiomyopathy and nephropathy induced by diabetes mellitus. Method: W/A adult rats were divided into four groups (12 each): group 1, received saline (1 mL/kg), group 2, received streptozotocin (STZ, 65 mg/kg, a single dose as i.p.), groups 3 and 4, received STZ + PSO (0.4 and 0.8 mL/kg, daily by gavage, respectively). After three weeks, six rats of each group and one week later the remaining animals were anesthetized, blood samples were taken for measuring serum biochemical parameters. Sections of heart and kidneys were used for histopathological studies and the remaining tissues were homogenized for measuring malondialdehyde (MDA) and total sulfhydryl groups. Results: Significant elevation of serum creatinine and urea, LDL, triglyceride, glucose levels as well as urine markers, MDA levels in tissue homogenates and a significant decrease in total thiol content and serum HDL were observed in STZ-treated group as compared with control group. PSO treatment resulted in a significant decrease in tissue MDA content, serum creatinine and urea levels as well as urine markers as compared with STZ-treated group. Lipid profile was ameliorated with PSO treatment. PSO also significantly reversed STZ-induced depletion in thiol content and histological abnormality. Effect of PSO was more specific at 28th than 21th days of study. Conclusion: The results showed that PSO has a protective effect against diabetes complications in rats.
Serum indoleamine 2,3 dioxygenase and tryptophan and kynurenine ratio using the UPLC-MS/MS method, in patients undergoing peritoneal dialysis, hemodialysis, and kidney transplantation

Abstract Background: The level and activity of indoleamine 2,3-dioxygenase (IDO) and the concentrations of L-tryptophan and its metabolite L-kynurenine were determined in association with various renal diseases. However, there have been no data regarding these parameters in patients on peritoneal dialysis compared to those undergoing hemodialysis or kidney transplantation. Methods: This study investigated the level and activity of IDO and determined oxidative balance by calculating the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). We enrolled 60 kidney disease patients, including 20 on peritoneal dialysis (PD group), 19 on hemodialysis (HD group), and 21 with kidney transplantation (KT group), as well as 21 control group. Results: IDO levels were increased in the PD, HD, and KT groups compared to the control group. The concentration of kynurenine was significantly increased in the PD group compared to the other groups (p < 0.01). The kynurenine/tryptophan ratio was increased in the PD group compared to the other groups (all p < 0.01). TAS levels in the PD and HD groups were significantly decreased compared to the control group (both p < 0.05). TAS levels in the PD group were significantly decreased compared to the KT group. TOS levels in the PD group were higher than in the HD and KT groups. Conclusion: The results showed that IDO levels were increased in peritoneal dialysis and hemodialysis patients and in renal transplant recipients, while oxidative stress was found to be related to IDO activity and was most increased in the patients on peritoneal dialysis.