Miracle-dz/UniFAR-FTUs huggingface dataset:
Surgical Site Infection Rates Following Implementation of a Colorectal Closure Bundle in Elective Colorectal Surgeries

BACKGROUND: Surgical site infections of up to 27% are reported for colorectal surgery. Care bundles have been introduced to decrease surgical site infection rates, but are variable in composition. OBJECTIVE: This study aimed to determine whether the addition of a “Colorectal Closure Bundle” in our Enhanced Recovery After Surgery pathway decreased surgical site infection rates. DESIGN: This is a retrospective study of elective colon resections before and after the addition of a closure bundle. SETTINGS: This study was conducted at a single academic institution. PATIENTS: Patients undergoing consecutive elective colon resections with primary anastomosis, December 2012 to July 31, 2014, enrolled in our Enhanced Recovery After Surgery pathway. Exclusion criteria were stoma creation and closure and preoperative chemoradiation. INTERVENTION: The “Colorectal Closure Bundle,” which includes a change in gown and gloves, redraping, wound lavage, and a new set of instruments for closure, was added to the Enhanced Recovery After Surgery pathway. MAIN OUTCOME MEASURE: The primary outcome measured was surgical site infections as defined by CDC criteria. RESULTS: Two hundred five patients were reviewed, 111 preintervention and 94 postintervention. Overall surgical site infection rates were 25.2% preintervention vs 26.6% postintervention (p = 0.82). Surgical site infections were subdivided into “superficial” and “deep and organ space” and were 14.4% and 10.8% preintervention vs 14.9% and 11.7% postintervention (p = not significant). Smoking and diabetes mellitus were found to be independently associated with surgical site infections on multivariate analysis, with adjusted odds ratios of 4.32 (95% CI, 1.70–10.94), p = 0.002, and 2.87 (95% CI 1.30–6.34), p = 0.009. LIMITATIONS: Limitations include the retrospective nature of the study and the small sample size. CONCLUSIONS: There was no change in surgical site infection rates after implementation of the “Colorectal Closure Bundle. ” Smoking and diabetes mellitus were the only significant risk factors associated with increased surgical site infections. Our infection rates remain high and further change in our perioperative protocol is needed.
In-silico interaction studies suggest RND efflux pump mediates polymyxin resistance in Acinetobacter baumannii

Bacterial efflux pumps have emerged as antibiotic resistance determinants and confers multi-drug resistance to a broad range of antimicrobials as well as non-antibiotic substances. A study about translocation of antibiotic molecules through the efflux transporter, will contribute in determining substrate specificity. In the present study, we have explored RND family efflux pump extensively found in Acinetobacter baumannii i.e. AdeABC. Besides, another well studied RND efflux pump, AcrAB-TolC together with a non-RND efflux pump, NorM was investigated for comparative analysis. We employed a series of computational techniques ranging from molecular docking to binding free energy estimation and molecular dynamics simulations to determine the binding affinity for different classes of drugs, namely aminoglycosides, polymyxins, β-lactams, tetracyclines, glycylcyclines, quinolones and metronidazole with AdeB, AcrB, and NorM efflux proteins. Our results revealed that class polymyxins has the highest binding affinity with the RND efflux pumps i.e. AcrAB-TolC and AdeABC as well as non-RND efflux pump, NorM. The experimental validation study demonstrated bigger zone of inhibition in presence of efflux pump inhibitor than polymyxin alone thus unveiling its specificity toward efflux pump. The reported experimental data comprising of minimum inhibitory concentration of antibiotics toward these efflux pumps also support our finding based on in silico approach. To recapitulate the outcome, polymyxins shows maximum specificity toward RND as well as non-RND efflux pump and may unlatch the way to rationally develop new potential antibacterial agents as well as efflux pump inhibitors in order to combat resistance.
Diagnostic value of retrospectively ECG synchronised cardiopulmonary computed tomographic angiography in patients with clinically suspected acute pulmonary embolism

Diagnostic value of retrospectively ECG synchronised cardiopulmonary computed tomographic angiography in patients with clinically suspected acute pulmonary embolism Objectives: We used retrospectively ECG synchronized cardiopulmonary computed tomographic angiography (CPCT) for the evaluation of pulmonary arterial thromboembolism (PATE) and aimed at defining the value of this technique in comprehensive anatomic and functional evaluation of cardiopulmonary system in the setting of this severe cardiovascular emergency. Methods: Study population comprised of 75 consecutive patients with suspected acute PATE referred for CPCT. Acute PATE was diagnosed in 30 patients (PATE group) and in 45 patients it was ruled out (control group). Right and left ventricular functional parameters were compared between groups and associations with pulmonary arterial thromboembolic burden were defined. Quality of CPCT images for the analysis of the coronary arteries was evaluated using 4 point rating scale in four major coronary arteries - left main, left anterior descending, left circumflex and right coronary artery. Results: There were statistically significant differences of the right and left ventricular morphometric and functional parameters between PATE and control group. Multiple linear regression analysis showed that pulmonary artery clot load and left ventricular ejection fraction are significant predictors of reduced right ventricular ejection fraction (beta coefficients -0.516, p < 0.05 and 0.490, p < 0.05 respectively). The most accurate predictor of markedly reduced right ventricular ejection fraction was right and left ventricular end-diastolic volumes ratio (area under the curve 0.933, p < 0.005). Reliable exclusion of significant coronary artery disease was possible in 38 (84.4%) patients of control group and 3 (10%) patients of PATE group. Conclusions: In patients with acute PATE, right ventricular dysfunction is accompanied by detectable changes of the left ventricle. Most accurate predictors of markedly reduced right ventricular ejection fraction are right and left ventricular end-diastolic volumes ratio and right and left ventricular diameters ratio. Quality of CPCT images is sufficient for the evaluation of coronary arteries and thoracic aorta allowing exclusion of significant coronary artery disease and dissection of thoracic aorta.
Impact of long‐term treatment with neurotoxic dideoxynucleoside antiretrovirals: implications for clinical care in resource‐limited settings

A minority of HIV‐infected patients taking an antiretroviral (ARV) regimen containing dideoxynucleosides (d‐drugs) such as stavudine (d4T) and didanosine (DDI) experiences dose‐limiting neuropathic pain and paraesthesias, usually within weeks of starting these drugs. Because d‐drugs are among the few affordable options available in developing countries, continuing d‐drug therapy would be a desirable strategy for many HIV‐infected individuals. Therefore, we evaluated the safety of continuing d‐drug therapy.
Tumor Budding Detection by Immunohistochemical Staining is Not Superior to Hematoxylin and Eosin Staining for Predicting Lymph Node Metastasis in pT1 Colorectal Cancer

BACKGROUND: Tumor budding is recognized as an important risk factor for lymph node metastasis in pT1 colorectal cancer. Immunohistochemical staining for cytokeratin has the potential to improve the objective diagnosis of tumor budding over detection based on hematoxylin and eosin staining. However, it remains unclear whether tumor budding detected by immunohistochemical staining is a significant predictor of lymph node metastasis in pT1 colorectal cancer. OBJECTIVE: The purpose of this study was to clarify the clinical significance of tumor budding detected by immunohistochemical staining in comparison with that detected by hematoxylin and eosin staining. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at Niigata University Medical & Dental Hospital. PATIENTS: We enrolled 265 patients with pT1 colorectal cancer who underwent surgery with lymph node dissection. MAIN OUTCOME MEASURES: Tumor budding was evaluated by both hematoxylin and eosin and immunohistochemical staining with the use of CAM5.2 antibody. Receiver operating characteristic curve analyses were conducted to determine the optimal cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining. Univariate and multivariate analyses were performed to identify the significant factors for predicting lymph node metastasis. RESULTS: Receiver operating characteristic curve analyses revealed that the cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining for predicting lymph node metastases were 5 and 8. On multivariate analysis, histopathological differentiation (OR, 6.21; 95% CI, 1.16–33.33; p = 0.03) and tumor budding detected by hematoxylin and eosin staining (OR, 4.91; 95% CI, 1.64–14.66; p = 0.004) were significant predictors for lymph node metastasis; however, tumor budding detected by CAM5.2 staining was not a significant predictor. LIMITATIONS: This study was limited by potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens. CONCLUSIONS: Tumor budding detected by CAM5.2 staining was not superior to hematoxylin and eosin staining for predicting lymph node metastasis in pT1 colorectal cancer.
Urinary Incontinence After Unilateral Hemispheric Stroke: A Neurologic-Epidemiologic Perspective

Life table analysis of urinary incontinence after unilateral hemispheric stroke in patients without previous history of incontinence shows the prevalence of incontinence at 1 month after stroke to range from 70% for patients with hemiplegia, proprioception deficit, and visual neglect to 10% for patients with pure motor hemiplegia. Classification of patients according to the presence of motor, proprioception deficit, and visual neglect at 1 month after stroke proved to be a sensitive (86%) and reasonably specific (70%) predictor of incontinence. Assessments of lesion size and location by CTT head scan parameters were not significantly different for continent versus incontinent patients. The cystometrogram and urogenital diaphragm electromyography studies showed "failure to store" type urge incontinence with increased detrusor irritability, decreased cortical awareness of bladder filling, and decreased voluntary control of the external sphincter. Detrusor-sphincter dyssynergy was not observed. Urinary tract infection and detrusor irritability were the only treatable causes for incontinence found. A postvoid residual urine volume less than 100 ml, normal microscopic urine analysis, and normal culture argue against further urologic evaluation. An anticholinergic trial can be attempted for symptomatic management of associated urge incontinence.
Accuracy of MRI in Restaging Locally Advanced Rectal Cancer After Preoperative Chemoradiation

BACKGROUND: Patients with a locally advanced rectal carcinoma benefit from preoperative chemoradiotherapy. MRI is considered the first choice imaging modality after preoperative chemoradiation, although its reliability for restaging is debatable. OBJECTIVE: The purpose of this study was to determine the accuracy of MRI in restaging locally advanced rectal cancer after preoperative chemoradiation. DESIGN: This was a retrospective study. SETTINGS: The study was conducted in a Dutch high-volume rectal cancer center. PATIENTS: A consecutive cohort of 48 patients with locally advanced rectal cancer treated with a curative intent was identified. MAIN OUTCOME MEASURES: Three readers independently evaluated the MRI both for primary staging and for restaging after preoperative chemoradiation and were blinded to results from the other readers as well as histological results. Interobserver variability was determined. Accuracy of the restaging MRI was assessed through the comparison of tumor characteristics on MRI with histopathologic outcomes. RESULTS: T stage was correctly predicted by the 3 readers in 47% to 68% and N stage in 68% to 70%. Overstaging was more common than understaging. Positive predictive values (PPV) among the 3 readers for T0 were 0%, and negative predictive values (NPVs) varied from 84% to 85%. For T1/2, PPVs and NPVs were 50% to 67% and 72% to 90%, and for T3/4 they were 54% to 62% and 33% to 78%. PPVs and NPVs for N0 stage were 81% to 95% and 58% to 73%. Tumor regression grade on MRI did not correspond with histopathologic tumor regression grade; PPVs for good response (tumor regression grade on MRI 1–2) were 48% to 61%, and NPVs were 42% to 58%. Interobserver agreement was fair to moderate for T stage, N stage, and tumor response (&kgr; = 0.20–0.41) and fair to substantial for the relation with the mesorectal fascia (&kgr; = 0.33–0.77). In none of the patients was the surgical plan changed after the restaging MRI. LIMITATIONS: This study was limited by its small sample size and retrospective nature. CONCLUSIONS: MRI has low accuracy for restaging locally advanced rectal cancer after preoperative chemoradiation, and the interobserver variability is significant.
Anorectal Function and Quality of Life in Patients With Early Stage Rectal Cancer Treated With Chemoradiation and Local Excision

BACKGROUND: Little is known about anorectal function and quality of life after chemoradiation followed by local excision, which is an alternative to total mesorectal excision for selected patients with early rectal cancer. OBJECTIVE: The purpose of this study was to prospectively assess anorectal function and health-related quality of life of patients with T2N0 rectal cancer who were treated with an alternative approach. DESIGN: This was a prospective, phase II trial. SETTINGS: The study was multicentric (American College of Surgeons Oncology Group trial Z6041). INTERVENTIONS: Patients with stage cT2N0 rectal adenocarcinomas were treated with an oxaliplatin/capecitabine-based chemoradiation regimen followed by local excision. MAIN OUTCOME MEASURES: Anorectal function and quality of life were assessed at enrollment and 1 year postoperatively with the Fecal Incontinence Severity Index, Fecal Incontinence Quality of Life scale, and Functional Assessment of Cancer Therapy-Colorectal Questionnaire. Results were compared, and multivariable analysis was performed to identify predictors of outcome. RESULTS: Seventy-one patients (98%) were evaluated at enrollment and 66 (92%) at 1 year. Compared with baseline, no significant differences were found on Fecal Incontinence Severity Index scores at 1 year. Fecal Incontinence Quality of Life results were significantly worse in the lifestyle (p < 0.001), coping/behavior (p < 0.001), and embarrassment (p = 0.002) domains. There were no differences in the Functional Assessment of Cancer Therapy overall score, but the physical well-being subscale was significantly worse and emotional well-being was improved after surgery. Treatment with the original chemoradiation regimen predicted worse depression/self-perception and embarrassment scores in the Fecal Incontinence Quality of Life, and male sex was predictive of worse scores in the Functional Assessment of Cancer Therapy overall score and trial outcome index. LIMITATIONS: Small sample size, relatively short follow-up, and absence of information before cancer diagnosis were study limitations. CONCLUSIONS: Chemoradiation followed by local excision had minimal impact on anorectal function 1 year after surgery. Overall quality of life remained stable, with mixed effects on different subscales. This information should be used to counsel patients about expected outcomes.
Biological markers of severity in acute pancreatitis

AbstractNone of the definitions of severity used in acute pancreatitis (AP) is ideal. Many of the scoring systems used to predict and measure its severity are complex, cumbersome and inaccurate.Aimto evaluate the usefulness of the most commonly used early markers for predicting severity, necrosis and mortality in patients with AP, and the need for surgery or Intensive Care Unit (ICU) admission.Material&methodsProspective study was performed from March 2009 to August 2010 based on patients diagnosed with AP seen consecutively at a secondary hospital. The early prognostic markers used were Apache II score ≥8 and Ranson’s score ≥3, RCP>120mg/l and Ht>44% in the first 24 hours.Results131 patients were prospectively enrolled. Median age was 63 years, 60% were men. The most frequent etiology of AP was biliary (68%). Fifteen patients were admitted to the ICU (11.6%) and five (3.9%) required surgery. Twelve patients (9.2%) had necrosis on CT. Four patients (3%) died, all of them in the Severe AP group. Only hematocrit>44 was predictor of mortality in univariate analysis.Conclusionhematocrit ≥ 44% was a significant predictor of mortality. The other indicators present limitations for predicting severity, necrosis and mortality, especially in the first 24 hours.
A System of Care for Severely Emotionally Disturbed Children & Youth.

This monograph explores the development of comprehensive systems of care for severely emotionally disturbed childrEn and adolescents. It is intended as a technical assistance tool for states and communities interested in improving services and as a review of the state of the art for develorthg systems of care. A generic model of a system of care is presente along with principles for service delivery and alternative system management approaches. The components of the system of care include mental health services, social services, educational services, health services, vocational services, recreational services, and operational services. Management of the system of care involves consideration of state-community relationships, alternative models for system management, and the role of case management and case review committees. Assessment of the characteristics of an effective system is also featured, and worksheets to assess the status of the system of care are provided. References accompany each chapter. (JDE) *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) F(crrlis ctocui lint has been reproduced as received from the Person or orgamtation originating it r Minor changer have been made to improve reproduction quality Points of view or opinions stated in this dock: ment do not necessarily represent official OERI position or policy A System of Care 4or Severely Emotionally Disturbed Children & Youth
Assessments of the Importance of Provider Characteristics for Abortion Care: Data From Women in Rajasthan, India

While client satisfaction is a widely recognized component of effective reproductive health care services, little is known about women's perspectives toward abortion care and providers. We use data from a large, community-based abortion knowledge, attitudes, and practices survey in Rajasthan, India, to describe women's assessments of the importance of eight attributes of potential abortion providers and to investigate the sociodemographic differentials in these assessments. Women prioritized technical aspects of abortion care, including provider skill and an equipped facility, and they deemphasized distance and postabortion contraceptive requirements. Although assessments were stable across many sociodemographic factors, the priorities of urban and rural women varied significantly. Women's prioritization of provider attributes should be incorporated into abortion services.
Family Profile of Heroin Users in Mansoura, Egypt

ObjectiveThe primary aim of this study was to compare family structures and functions in male patients dependent on heroin and normal controls. MethodEighty patients and 20 controls were recruited from inpatient units at 2 teaching hospitals in Mansoura, Egypt. A predesigned questionnaire was administered to assess family functioning (self-reports), and the DSM IV clinical criteria were used to assess psychopathology. ResultsA wide range of family dysfunctions was reported by these patients: parental separation/divorce was higher in the group of dependents compared with the control group (18.8% vs. 10%), having a step mother (31.3% vs. 15%), the main caring person in the family was father (11.3% vs. 0%), mother (8.8% vs. 35%), or both parents (33.8% vs. 60%). Positive family history for substance abuse was significantly higher among heroin users (siblings 12.5% vs. 5%; father 6.3% vs. 5%; mother 3.8% vs. 0%; both parents 15% vs. 5%). Negative feelings toward parents were common in heroin users. In addition, perceptions of a negative attitude from parents were also higher. Moreover, aggressive response as a result of unacceptable behaviors was higher among heroin users: verbal aggression (12.5 vs. 0%), physical aggression (16.3% vs. 0%). Furthermore, religious affiliation was more likely to be less in heroin users' families as 61.3% compared with 85% of nonusers' families with marginally significant differences. ConclusionThe results of this study indicate that family dysfunctions are common in this group of patients. This will need to be considered in the treatment of this group of patients.
Experiences of Recall After Mammography Screening—A Qualitative Study

Women participating in biannual mammography screening for 20 years have a cumulative risk of 20% of being recalled. We conducted a prospective qualitative interview study with eight nonsymptomatic women recalled after mammography screening. These women expressed mixed emotions over being recalled. Information about recall rates and breast cancer risk was seen as alarming, and cancer risk estimates were seen by some as high. The short time between recall and examination was reassuring, but it was also perceived as an indication of malignancy. Despite distress from examinations, most of the women continued to want medical examinations to detect cancer early.
Total Antioxidant Status, Vitamins A, C and ß-carotene Levels of Children with P. falciparum Infection in University of Calabar Teaching Hospital (UCTH), Calabar

By using standard procedures, total antioxidant level, vitamins A, C, and $-carotene were assessed in 122 malaria infected children. The haemoglobin and parasite density status of the children were also measured. Sixty healthy children were used as controls. It was observed that all parameters measured were significantly lower in malaria infected children when compared with the respective control values. Malaria parasitemia correlated strongly and negatively with total antioxidant and haemoglobin levels (r=0.-432 and 0.-503, P<0.01) respectively but weakly with vitamin A level (r=0.-196, P<0.05). Reductions in the levels of total antioxidant and vitamin A were dependent on the severity of malaria. The more severe the malaria the lower the levels of total antioxidant and vitamin A. Ratios of vitamin A to vitamin C and beta-carotene to vitamin C were similar in both malaria-infected children and controls indicating a constant proportional relationship between vitamin A and beta-carotene to vitamin C. From this study it is observed that there is a general depression in antioxidant levels suggesting that antioxidant intervention may be crucial in the treatment of malaria infection. Furthermore lowered levels of antioxidants especially of vitamin C in malaria infection also suggest lowered immunity of host, which may be responsible for some of the complications of malaria infection