Miracle-dz/UniFAR-FTUs huggingface dataset:
Knowledge, attitudes, and practices pertaining to cotton-bud usages and the complications related to their mi suse among outpatients in an ear, nose, and throat clinic

Introduction: Cotton buds are small plastic rods with cotton-covered tips. They have been widely misused since their development. Objectives: This study aims to determine the prevalence of cotton bud usage and examine patients' attitudes toward their utilization. It also aims to investigate the complications associated with their misuse. Methodology: This cross-sectional observational study was conducted in King Abdulaziz University Hospital, on patients attending the ear, nose, and throat outpatient clinics between January and March 2018. Data were collected using paper-based questionnaires and analyzed using SPSS. Results: A total of 378 patients completed the survey. Most respondents (69.6%) confirmed that they had used cotton buds previously. However, only 18% of the respondents suffered ear canal complications associated with cotton bud use. Respondents reported ear wax impaction as the most common complication (41.2%), followed by ear pain (39.7%). The majority (63.2%) of the respondents stated that they had received at least one educational session warning them against improper cotton bud use. Almost half of the patients were unsure whether cotton buds could cause complications or not. The mean overall rating of the attitude of the patients toward using cotton buds resulted in a score of 12 out of 20, thereby denoting that these patients were slightly inclined toward using cotton buds. Furthermore, patients who reported having used cotton buds had significantly greater attitudes toward cotton bud usefulness (mean, 13.4; standard deviation, 2.8; P < 0.001). Conclusion: Overall, patients seem to have relatively insufficient knowledge and lax attitudes toward cotton bud usage and the complications related to their use. Further studies on a broader scale are warranted to evaluate the extent of cotton bud use.
A case report on achalasia cardia type - II

Achalasia cardia is the rare chronic neurodegenerative disorder of the esophagus which causes progressive delay in contractility of lower esophageal muscles during swallowing leading to backup of food contents and fluids in later stages within the region of esophagus. It is considered as the common leading cause of motor dysphagia. The underlying etiology include autoimmune disorder, nervous degeneration due to loss of inhibitory ganglion in myenteric plexus of esophagus, presence of inhibitory neurotransmitters such as nitric oxide and its receptors in lower esophagus. At initial presentation drugs are prescribed as the symptoms mimic other GI disorders which often lead to delayed diagnosis. The symptoms mainly include severe pain or discomfort of chest after eating, weight loss, regurgitation of bland undigested food or saliva, severe heartburn, dysphagia, aspiration. Initial treatment includes the pharmacotherapeutic management to alleviate the symptoms and improve the esophageal outflow. Surgical treatment involves pneumatic dilatation, Heller’s myotomy, preoral endoscopic myotomy, esophagectomy. Heller’s myotomy may be performed by open or laparoscopic procedure. It is done along with Dor’s fundoplication. Case report discussed below is of a 55 years old female patient presented with dysphagia for one year. The symptoms of which worsened for 2 months along with vomiting of undigested foul-smelling food.
ESRA19-0146 Efficacy of ultrasound-guided radiofrequency ablation for genicular nerve in patients with chronic knee pain after total knee arthroplasty

Background and aims Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Radiofrequency ablation (RFA) for genicular nerve has recently gained popularity as an intervention for chronic knee pain in patients who have failed other conservative treatment. In the present study, we aimed to evaluate the efficacy of ultrasound-guided RFA for genicular nerve in patients with chronic knee pain after TKA. Methods This study included 14 knees of 10 patients with chronic knee pain after TKA. Ultrasound-guided RFA was performed 80°C for 90 seconds. Pain intensity was assessed by Numeric Rating Scale (NRS 0–10) and knee disability was assessed by the Western Ontario McMaster OA Index (WOMAC). Each assessment was observed before procedure (baseline) and at 2, 4, 8, 12 weeks after procedure. All measurement values were expressed as mean ± SD. Outcome measures over time were evaluated using the repeated measurement general linear model. a value of p<0.05 was considered statistically significant. Results Baseline NRS was 7.1±1,1, and WOMAC was 76.9±10.3. Significant decrease in pain and significant improvement in knee function were observed at 2 weeks (NRS; 3.9±1.3, WOMAC; 51.6±12.6, p<0.05), 4 weeks (NRS; 4.9±1.5, WOMAC; 51.7±12.4, p<0.05), and 8 weeks (NRS; 5.8±1.1, WOMAC; 53.7±10.8, p<0.05), compared to baseline values. No serious complication was found in any patient. Conclusions Ultrasound-guided RFA for genicular nerve could be safe and beneficial treatment in the patients with chronic knee pain after TKA.
TNNT2 Missplicing in Skeletal Muscle as a Cardiac Biomarker in Myotonic Dystrophy Type 1 but Not in Myotonic Dystrophy Type 2

Cardiac involvement is one of the most important manifestations of the multisystemic phenotype of patients affected by myotonic dystrophy (DM) and represents the second cause of premature death. Molecular mechanisms responsible for DM cardiac defects are still unclear; however, missplicing of the cardiac isoform of troponin T (TNNT2) and of the cardiac sodium channel (SCN5A) genes might contribute to the reduced myocardial function and conduction abnormalities seen in DM patients. Since, in DM skeletal muscle, the TNNT2 gene shows the same aberrant splicing pattern observed in cardiac muscle, the principal aim of this work was to verify if the TNNT2 aberrant fetal isoform expression could be secondary to myopathic changes or could reflect the DM cardiac phenotype. Analysis of alternative splicing of TNNT2 and of several genes involved in DM pathology has been performed on muscle biopsies from patients affected by DM type 1 (DM1) or type 2 (DM2) with or without cardiac involvement. Our analysis shows that missplicing of muscle-specific genes is higher in DM1 and DM2 than in regenerating control muscles, indicating that these missplicing could be effectively important in DM skeletal muscle pathology. When considering the TNNT2 gene, missplicing appears to be more evident in DM1 than in DM2 muscles since, in DM2, the TNNT2 fetal isoform appears to be less expressed than the adult isoform. This evidence does not seem to be related to less severe muscle histopathological alterations that appear to be similar in DM1 and DM2 muscles. These results seem to indicate that the more severe TNNT2 missplicing observed in DM1 could not be related only to myopathic changes but could reflect the more severe general phenotype compared to DM2, including cardiac problems that appear to be more severe and frequent in DM1 than in DM2 patients. Moreover, TNNT2 missplicing significantly correlates with the QRS cardiac parameter in DM1 but not in DM2 patients, indicating that this splicing event has good potential to function as a biomarker of DM1 severity and it should be considered in pharmacological clinical trials to monitor the possible effects of different therapeutic approaches on skeletal muscle tissues.
Health and social care educators' ethical competence

Background and purpose Educators’ ethical competence is of crucial importance for developing students’ ethical thinking. Previous studies describe educators’ ethical codes and principles. This article aims to widen the understanding of health- and social care educators’ ethical competence in relation to core values and ethos. Theoretical background and key concepts The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. Methods Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. Ethical considerations The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. Findings The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. Conclusion Educators’ personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators’ training regarding ethical competence.
Update 2019 zur MIBI-Szintigrafie bei hypofunktionellen Schilddrüsenknoten

Zusammenfassung 99 m Tc-MIBI ist ein nicht-spezifisches Radiopharmakon zur Tumordiagnostik und wurde historisch zum Nachweis radioiodnegativer Metastasen differenzierter Schilddrüsenkarzinome eingesetzt. 99 mTc-MIBI hat einen klinischen Nutzen zur Abklärung hypofunktioneller („kalter“) Schilddrüsenknoten, wenngleich bisher kein kommerziell verfügbares Kit hierfür eine offizielle Zulassung hat. Seit der letzten Übersichtsarbeit zum klinischen Nutzen von 99 mTc-MIBI zur Abklärung hypofunktioneller Schilddrüsenknoten in dieser Zeitschrift sind weitere Arbeiten publiziert worden, die den positiven und negativen Vorhersagewert der Methode präzisierten und auch die Kosteneffizienz der Methode belegten. Nach Injektion von 99 mTc-MIBI wird die Retention des Radiopharmakons im abzuklärenden Knoten und dessen Anreicherung im Vergleich zum paranodulären Schilddrüsengewebe und im Vergleich zum Schilddrüsen-Szintigramm mit Pertechnetat beurteilt. Ein Match-Befund im Sinne einer konkordant verminderten Anreicherung hat einen hohen negativen prädiktiven Wert von ca. 94 % zum Ausschluss eines differenzierten Schilddrüsenkarzinoms. Ein Mismatch mit vermehrter Anreicherung des 99 mTc-MIBI in einem hypofunktionellen Schilddrüsenknoten erhöht die Malignitätswahrscheinlichkeit auf ca. 15 – 20 % in Deutschland. Eine isointense Anreicherung des 99 mTc-MIBI in dem hypofunktionellen Schilddrüsenknoten geht nach eigener Datenlage mit einer niedrigen Malignitätswahrscheinlichkeit einher, allerdings findet man in dieser Befundkategorie kleine papilläre Karzinome, die sich bei geringer Größe noch nicht eindeutig 99 mTc-MIBI-mehranreichernd demarkieren müssen. SPECT hat hier in 17 – 34 % einen diagnostischen Zugewinn. Bei guter Indikationsstellung ist die 99 mTc-MIBI-Szintigrafie eine wertvolle ergänzende Methode zur Feinnadelaspirationsbiopsie und dient einem optimierten Patientenmanagement, um im Falle eines Match-Befundes ein konservatives Vorgehen zu vertreten oder im Falle eines Mismatch-Befundes ein operatives Vorgehen unter Berücksichtigung von Alter, Begleiterkrankungen und in Kenntnis des vollständigen Schilddrüsenbefundes zu rechtfertigen. Die offizielle Zulassung dieser Indikation ist überfällig.
Positioning and physiologic changes during feeding of infants with congestive heart failure secondary to congenital heart disease

A descriptive design was used in this study to describe the feeding behaviors (as defined by changes in body position) in infants with congestive heart failure secondary to congenital heart disease. In addition, short term physiologic changes associated with the behaviors were measured through the use of pulse oximetry and cardiorespiratory monitors. Nine infants were observed in this study as they v/ere being fed by their nurses. The method chosen was naturalistic observation. Descriptive statistics were used to analyze the demographic data and the measured physiologic variables. A point by serial correlation was conducted to describe any relationships between the position changes and the measured physiologic variables. Statistically significant relationships were found between certain positions and oxygen saturation, heart rate and respiratory rate. The results indicate that infants do experience position changes that are accompanied by changes in physiologic variables during feeding. These position changes can be categorized as infant-mediated or nursemediated.
Role of radiotherapy in diffuse large B‐cell lymphoma in advanced stages on complete response after administration of cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab

The role of radiotherapy (RT) as adjuvant therapy in patients with diffuse large B‐cell lymphoma and nodal bulky disease at diagnosis remains unclear. Thus, we carried out an open‐label clinical trial to assess if RT in patients with complete response after immunochemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) improves progression‐free survival and overall survival.
Development and application of novel analytical methods for molecularly targeted cancer therapeutics

A detailed understanding of correlations of drug levels with drug action is an important aspect of the pre-clinical, clinical development and routine use of anti-cancer drugs. In furtherance of this important aim, the research in this thesis sought to develop and apply novel, highly sensitive, analytical methods to examine and understand correlations of drug levels with drug resistance mechanisms, therapeutic efficacy and side effects. LC-MS/MS is a state of the art analytical technique used to characterise and quantify both bio-molecules and pharmaceutical agents. Based on LC-MS/MS techniques, novel sensitive analytical methods were developed for the quantification of 1) tyrosine kinase inhibitor anti-cancer drugs to examine the interaction of these agents with drug resistance mechanisms, and 2) the multiple myeloma drug thalidomide as a pilot study to identify potential correlations between serum drug levels and toxicity/efficacy. Acquired resistance to chemotherapeutics through the over-expression of ABC transport proteins has presented a significant clinical challenge. The up-regulation of ABC transporters such as P-glycoprotein (P-gp), Breast Cancer Resistant Protein (BCRP) and Multidrug Resistance-associated Protein (MRP-1) is an important cellular mechanism of resistance in vivo and in vitro. Using cell-line models and the developed LC-MS/MS quantification method it was established that dasatinib, an agent used in treatment of chronic myelogenous leukaemia, is a substrate of ABC transporters P-gp and BCRP but not of MRP-1, and that dasatinib does not inhibit these transporters at clinically relevant concentrations. Another Tyrosine Kinase Inhibitor (TKI) being used in breast cancer, Lapatinib, was shown to be an inhibitor of P-gp but not a substrate of this resistance mechanism. Levels of other TKIs were also found to vary in their uptake in primary models of brain cancer. Using LC-MS/MS, the circulating serum levels of thalidomide in multiple myeloma patients were studied. A clear correlation between dosing regime and serum level was seen; however, the research also unearthed evidence of a significant incidence of non-compliance which could have far reaching consequences for patient treatment. Overall, LC-MS/MS methods for the quantification of chemotherapeutic agents in complex biological matrices produced sensitive and accurate data which we successfully exploited to characterise resistance to new drugs and examine correlations between serum levels and treatment variables.
COPD self-management education : Vietnamese nurses' intention to educate, influencing factors and knowledge base

This thesis used a cross-sectional survey to examine how Vietnamese nurses educate COPD patients about the self-management of their disease. Further, the study also describes the characteristics of Vietnamese nurses working in COPD specialty areas as well as examining their COPD knowledge and the factors which influence their delivery of COPD self-management education when caring for COPD patients. The study found that while Vietnamese nurses are likely to deliver self-management education to the COPD patients they care for, there are areas for improvement in nurses' knowledge in all areas of COPD management and self management education.
Dysbiosis of Gram-negative gut microbiota and the associated serum lipopolysaccharide exacerbates inflammation in type 2 diabetic patients with chronic kidney disease

Lipopolysaccharide (LPS), a potent endotoxin present in the outer membrane of Gram-negative bacteria, causes chronic immune responses associated with inflammation. In the present study, the association between LPS and the dysbiosis of Gram-negative bacteria in the gut microbiome was determined in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (T2DM-CKD; stages 4 and 5, not on dialysis) compared with healthy individuals. Microbiome diversity was analyzed in patients with T2DM-CKD and healthy controls by sequencing the hypervariable sub-regions of the 16S ribosomal RNA gene from stool samples. Serum samples were assayed by ELISA for LPS, C-reactive protein (CRP), tumor necrosis factor-α (TNFα), interleukin-6 (IL6) and endothelin-1. A total of four gut Gram-negative phyla (Bacteroidetes, Proteobacteria, Fusobacteria and Verrucomicrobia) were identified in the gut microbiome of the T2DM-CKD and control groups. Proteobacteria, Verrucomicrobia and Fusobacteria exhibited significantly increased relative abundance in patients with T2DM-CKD when compared with controls (P<0.05). The levels of serum LPS were significantly increased in patients with T2DM-CKD compared with controls (P<0.05). Elevated serum LPS was significantly correlated with increased levels of TNFα, IL6 and CRP. The dysbiosis of Gram-negative bacteria in the gut microbiome of patients with T2DM-CKD may contribute to the elevated serum levels of LPS and the consequential effects on the inflammatory biomarkers in these patients. The association between the dysbiosis of Gram-negative bacteria in the gut microbiome of patients with T2DM-CKD, increased LPS levels and the effects on inflammatory biomarkers may provide insight into potential diagnostic and therapeutic approaches in the treatment of T2DM-CKD.
Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Aim To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p = 0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p = 0.6), 14% were amputated (p = 0.2), and 12.8% were dead within one year in 2011/2012 (p < 0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. Conclusion The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.
Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study

Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study—Health, Well-Being, and Aging Survey—a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self‐reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11–3.19), being uninsured (OR: 1.77, CI: 1.04–3.03), overweight (OR: 2.38, CI: 1.09–5.19), higher education (OR: 0.46, CI: 0.22–1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13–0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34–3.05), age ≥80 (OR: 2.73, CI: 1.72–4.31), nonwhite skin color (OR: 1.48, CI: 1.01–2.18), being uninsured (OR: 1.70, CI: 1.18–2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06–3.25), obesity (OR: 2.50, CI: 1.61–3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94–4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23–2.43), being uninsured (OR: 1.38, CI: 1.02–1.87), and female gender (OR: 0.61, CI: 0.43–0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.