Miracle-dz/UniFAR-FTUs huggingface dataset:
Comparing the APACHE II, SOFA, LOD, and SAPS II scores in patients who have developed a nosocomial infection

Background: There have been numerous scores intended to evaluate the severity of patients’ condition upon admission and during their intensive care unit (ICU) stay. However, to our knowledge, no study has ever evaluated the predictive abilities of these scores among nosocomial patients during their ICU stay. The aim of our study is to compare the predictive performances of the Acute Physiology, and, Chronic Health Evaluation (APACHE II) score, Simplified Acute Physiologic Score (SAPS II), Logistic Organ Dysfunction (LOD), and Sequential Organ Failure Assessment (SOFA) scores among intensive care patients who have developed a nosocomial infection. Methods: The study is monocentric and retrospective. The APACHE II, SAPS II, LOD, and SOFA scores were reported from the third day of the patient’s hospital stay, preceding the diagnosis of the first nosocomial event up to the third post diagnosis day. Results: Out of 46 patients contracting at least one ICU-acquired infection, the multiple analyses indicated that on the day of diagnosis, the SOFA score is the most predictive (odds ratio [OR]: 12.3; 95% confidence interval [CI]: 2.33–64.91). The second most predictive was the APACHE II score (OR: 8.29; 95% CI: 1.43–48.14). The third and fourth most predictive were the LOD score (OR: 4.06; 95% CI: 0.81–20.26) and the SAPS II score (OR: 2.26; 95% CI: 0.55–9.24), respectively. Conclusion: The analysis of the receiver operating characteristic areas under the curve of the reported scores in the present study showed that the best predictive performance is in favor of the SOFA score. DOI: http://dx.doi. org/10.3329/bccj.v2i1. 19949 Bangladesh Crit Care J March 2014; 2 (1): 4-9
Alkaptonuria, more than just a mere disease

Alkaptonuria (AKU) is considered a rare autosomal recessive condition that results in an accumulation of homogentisic acid in body tissues and causes long-term clinical, neurological and psychological complications. We present a comprehensive evaluation of an atypical 46-year-old Caucasian male who developed all clinical diagnostic symptoms of AKU (ochronotic pigmentations, dark urine and clinical arthritis of major joints including spine) by 25 years of age, well before the typical age mentioned in many reviews. First signs of ochronotic ear pigmentations unexpectedly started appearing as early as 12 years of age. A long “disease-free” period typical in classical AKU patient was also absent. This case report highlights the importance of considering psychological issues in AKU patients. The patient showed symptoms of dysthymia reporting social isolation, diminished interest in pleasurable activities, feeling of worthlessness and irritability as major psychological issues. Early ochronotic pigmentation, advanced spinal myelopathy and arthropathy of major joints suggests aggressive course of the disease. Our patient underwent bilateral shoulder replacement due to AKU-induced arthropathy resulting in restoration of some range of motions. AKU is not fully understood and we recommend treating it as a multidimensional disease with simultaneous physiological, neurological and psychological effects. Early diagnosis, understanding of disease prognosis and emphasis on psychological health is needed to improve the quality of life of AKU patients.
The impact of decision latitude, psychological load and social support at work on musculoskeletal symptoms

The study was based on questionnaires and the subjects consisted of 755 male and female employees in different occupations. The aim was to explore the relationship between the combined effects of perceived decision latitude (control), psychological load and social support at work on work-related neck, shoulder and low-back symptoms. Prevalence rate ratios, stratified for age and sex, were calculated for different combinations in the 3-dimensional model where the theoretically lowest strain group (i.e. low psychological load, high decision latitude and high social support) was used as a reference category. Persons who perceived their psychological work-load as high and their decision latitude as low reported more musculoskeletal symptoms than persons with low psychological load and high decision latitude. The addition of social support at work is a significant dimension in moderating decision latitude; without support from supervisors and fellow workers it was not sufficient to reduce the impact of psychological load on musculoskeletal symptoms. The use of the 3-dimensional model provided a good picture of what structural characteristics of working life could constitute an increased risk for the occurrence of musculoskeletal symptoms.
Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.
Cardiovascular risk profile of post-menopausal women in a semi-urban community in Nigeria.

Aims: Menopause is associated with a myriad of chronic health risks. This study assessed the Cardiovascular Disease (CVD) risk profile of post-menopausal women from a semi-urban community in Nigeria. Study Design: Cross-sectional study Place and Duration of Study: Ife Central Local Government, Ile Ife, Nigeria Methodology: One hundred and twenty menopausal women aged 55 years and older participated in this study. The respondents were recruited using a multistage sampling Short Research Article British Journal of Medicine & Medical Research, 4(29): 4780-4790, 2014 4781 technique. The Framingham Heart Study Questionnaire was used to assess CVD risk level. Risk scores were classified as low (0-19), medium (20-29) and high risk (40+). Socio-Economic Status (SES) was assessed using a validated questionnaire while cardiovascular and anthropometric parameters were measured following standard procedures. Data were analyzed using descriptive and inferential statistics. Alpha level was set at 0.05. Results: The mean age, weight and Body Mass Index (BMI) of respondents were 64.9±8.4 years, 73.4±15.2kg and 27.3±5.4kg/m2 respectively. A majority, 84(70.0%) of the respondents had high blood pressure, 77(64.2%) had over five years duration of onset of menopause while 13(10.8%) had high cardiovascular risk. Half of the respondents, 64(53.3%) were in the low SES class. High CVD risk was higher among individuals with over five years of menopause. Pearson Product Moment Correlation revealed significant relationship between CVD risk and each of age (r = 0.507; P = 0.01), body weight (r = 0.257; P = 0.01), onset time of menopause (0.359; P = 0.01), blood pressure status (r = 0.665; P = 0.01), occupation (r = 0.330; P = 0.01) and SES (r = 0.406; P = 0.01) among post-menopausal women. Conclusion: Prevalence of CVD risk was high among Nigerian post-menopausal women in a semi-urban community. Age, body weight, years of onset menopause, blood pressure, occupation and socio-economic status level had significant relationship with high cardiovascular disease risk.
Magnitude and determinants of depression in acute stroke patients admitted in a rural tertiary care hospital

Background: Depression is one of the most frequent neuropsychiatric disturbances after a cerebrovascular stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. Settings and Design: A cross-sectional hospital-based study was performed in acute stroke patients admitted in the department of Medicine of a rural teaching tertiary care hospital in central India. Materials and Methods: In all consecutive acute stroke inpatients, the intensity of depression was assessed by a trained person through a questionnaire, Montgomery-Asberg Depression Rating Scale (MADRS), who is blind of the diagnosis and investigations of the patient. Another study person collected the data including demographics, co-morbid diseases or risk factors. Radiological imaging data was noted from the CT/MRI head reports of stroke patients. Results: Of the total 107 stroke patients, 60 (56%) were males and 47 (44%) were females. Sixty-one (57%) of the 107 stroke patients had depression. Of the 107 stroke patients, 35 (33%) had mild depression, 22 (20%) had moderate depression and 4 (4%) had severe depression. The age, gender, education status and co-morbidities of the stroke patient were not associated with depression. The association of socio-economic status and left-sided lesions with depression was found to be statistically significant (P < 0.05). Type and location of the lesion were not associated with depression. Conclusion: Post-stroke depression was present in more than half of the stroke patients and was related to socio-economic status and left-sided hemisphere lesions.
Organic dairy farming 2. Management and control of disease

Cows do not know they are being organically managed and, contrary to many new organic farmers' expectations, the same diseases and problems that occur on conventional farms will also exist on organic ones. However, there are differences between the two systems in the prevalence of these diseases and the measures used to control them. This article reviews these differences in respect of the major disease areas. An article in the July/August issue (In Practice, volume 34, pp 412 – 416) reviewed the structure and overall veterinary approach to the organic dairy sector.
Introduction to Yoga: Through an Interactive Module

The concept of yoga has changed from being a path to spiritual enlightenment to a more aerobic activity since its arrival from India to the United States in the early 1970's. Instead of practicing one on one with a yogi, participants now attend large classes with people of varying levels of experience and ability. When the poses are performed correctly, yoga can have many health benefits. However, when poses are done incorrectly over a period of time it can result in pain and long-term injuries. These large classes can often be intimidating and yogis often do not have time to cover background information and safety information. This module fills the gaps by providing, via the Internet, an interactive multimedia instructional module covering those specific topics. The purpose of this instructional design project was to develop and evaluate an interactive multimedia instructional module for teaching adults with varied levels of yoga experience basic background and safety information that would aid in the comfort and safety of a person attending their first yoga class. Volunteer participants evaluated the module and data was collected by surveys to measure attitude towards the module as well as knowledge gained by participating. Overall the participants found the module to be a valuable resource in learning yoga.
Diet modelling: How it can inform the development of dietary recommendations and public health policy

†‡ § ‡ ¶ † ‡ § ¶ Summary With the global population expected to increase to 9 billion by 2050 coupled with concerns about food security in relation to climate change and increasing prosperity in many parts of the world causing desire for a less monotonous diet, efficient use of resources such as food becomes ever more important. While the prevalence of obesity is a cause for concern in many parts of the world, many people still go to bed hungry, and in many communities, obesity co-exists with poor diet quality. The result is a series of complex and challenging nutrition problems, such as the access to nutritionally adequate and affordable diets and the development of dietary recommendations. Diet modelling is a useful tool to help identify solutions to such complex questions and this paper summarises a session on this topic at the International Congress of Nutrition that took place in September 2013.
Mild traumatic brain injuries in adults

Mild traumatic brain injury (mTBI) is the commonest form of TBI. Though the name implies, it may not be mild in certain cases. There is a lot of heterogeneity in nomenclature, classification, evaluation and outcome of mTBI. We have reviewed the relevant articles on mTBI in adults, particularly its definition, evaluation and outcome, published in the last decade. The aspects of mTBI like pediatric age group, sports concussion, and postconcussion syndrome were not reviewed. There is general agreement that Glasgow coma score (GCS) of 13 should not be considered as mTBI as the risk of intracranial lesion is higher than in patients with GCS 14–15. All patients with GCS of <15 should be evaluated with a computed tomography (CT) scan. Patients with GCS 15 and risk factors or neurological symptoms should also be evaluated with CT scan. The outcome of mTBI depends on the combination of preinjury, injury and postinjury factors. Overall outcome of mTBI is good with mortality around 0.1% and disability around 10%.
Reduction of interleukin-1β induced matrix metalloproteinase-3 release by extracts of six plants: inhibitory screening of 35 traditional medicinal plants

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease associated with matrix metalloproteinase (MMP)-3, leading to destruction of the cartilage. The objective of this study was to investigate and discuss the suitability of the 35 medicinal plants as therapeutic candidates to treat RA. Fibroblast-like synoviocytes (FLSs), derived from patients with RA, were adjusted to 2 × 106 cells/mL in a 24-well plate and pretreated with the distilled water extracts of the 35 plants (1, 10, and 100 µg/mL) for 1 h followed by interleukin-1β (IL-1β) (1 ng/mL) for 24 h. The concentration of MMP-3 was then determined using a Duoset ELISA Kit. The six plants (Artemisiae Capillaris Herba, AC; Bambusae Caulis In Taeniam, BC; Cassiae Semen, CS; Corni Fructus, CF; Leonuri Herba, LH; Schizonepetae Spica, SS) showed no toxicity, including MMP-3. The MMP-3 level was increased by 3.38-fold (212.23 μg/mL) in IL-1β-stimulated FLSs. The IL-1β-induced MMP-3 level was significantly and dose-dependently reduced by >50% by the six plants (P < 0.01: at 100 μg/ mL of CS and LH, P < 0.001: at 10 μg/mL of all plants, and at 100 μg/mL of AC, BC, CF, and SS). This is the first study on the MMP-3 inhibitory effect of the examined plants in FLSs isolated from RA patients. From our original research, the six candidate plants were identified.
Pharmacotherapy of atrial fibrillation: an old option with new possibilities

Background: Atrial fibrillation is the most common sustained arrhythmia observed worldwide. Despite modern ablative treatment options, pharmacotherapy remains the first-line therapy in patients with atrial fibrillation. Objective: Based on recently published guidelines for the management of atrial fibrillation, the present paper reviews the current and emerging concepts of pharmacotherapy in atrial fibrillation. Methods: A MEDLINE search was conducted using the keyword ‘atrial fibrillation’ and ‘drug therapy’. The reviewed literature included clinical trials and published reviews as well as clinical guidelines. Results: The mainstay of atrial fibrillation therapy is the prevention of thromboembolic events. With growing knowledge of the pathophysiology of atrial fibrillation new drug targets have been identified that promise improved outcomes in atrial fibrillation management and this will allow individual drug treatment in the near future.
The ENHANCE Study: an unusual publication of trial data raises questions beyond ezetimibe

Background: Over the past 2 years two unsuccessful clinical trials of lipid-modifying agents, the ILLUMINATE Study for raising high-density lipoprotein and the ENHANCE Study for lowering low-density lipoprotein, have been reported. These results have surprised the field and led to a reassessment of the scientific and clinical basis for the overall mechanisms. Objective: This paper aimed to consider the impact of the two trials, particularly the ENHANCE Study, on drug discovery and developments in dyslipidaemia and atherosclerosis. Methods: The ILLUMINATE Study, which was a trial of the cholesteryl ester transfer protein inhibitor torcetrapib is briefly reviewed, followed by a more detailed discussion of the press release of the ENHANCE Study with ezetimibe, a cholesterol absorption inhibitor. The reaction of opinion leaders in the field with respect to low-density lipoprotein-lowering strategies and imaging methods is discussed. Conclusion: Even when accessible surrogate end-points such as plasma lipoprotein levels are available, the development of anti-atherosclerotic drugs acting by new mechanisms may be becoming more challenging. Imaging studies as an intermediate between early clinical studies and major outcome trials may be the way forward.
Cellular immunotherapy for ovarian cancer

Background: Ovarian cancer is frequently diagnosed at an advanced stage, and although initially responsive to surgery and chemotherapy, has a high rate of recurrence and mortality. Cellular immunotherapy may offer the prospect of treatment to prevent or delay recurrent metastatic disease. Objective: To provide an overview of current innovations in cellular immunotherapy for ovarian cancer, with an emphasis on dendritic cell vaccination and adoptive T-cell immunotherapy. Methods: Three key areas are explored in this review: first, an appraisal of the current state of the art of cellular immunotherapy for treatment of ovarian cancer; second, a discussion of the immunological defenses erected by ovarian cancer to prevent immunological attack, with an emphasis on the role of tumor-associated regulatory T cells; and third, an exploration of innovative techniques that may enhance the ability of cellular immunotherapy to overcome ovarian tumor-associated immune suppression. Results/conclusion: Ovarian cancer is recognized as a paradigm for tumor-associated immune suppression. Innovative approaches for antagonism of tumor-associated regulatory T-cell infiltration and redirection of self antigen-driven regulatory T-cell activation may provide the key to development of future strategies for cellular immunotherapy against ovarian cancer.
Recent advances in pharmacogenetic approaches to anticancer drug development

A great deal of effort has been spent in defining the pharmacokinetics and pharmacodynamics of investigational and registered anticancer agents. There is often a marked variability in drug handling between individual patients, which contributes to variability in the pharmacodynamic effects of a given dose of a drug. A combination of physiological variables, genetic characteristics (pharmacogenetics), and environmental factors are known to alter the relationship between the absolute dose and the concentration–time profile in plasma. A variety of strategies is now being evaluated in patients with cancer to improve the therapeutic index of anticancer drugs, by implementation of pharmacogenetic imprinting through genotyping or phenotyping individual patients. The efforts have mainly focused on variants in genes encoding the drug‐metabolizing enzymes thiopurine S‐methyltransferase, dihydropyrimidine dehydrogenase, members of the cytochrome P450 family, including the CYP2B, 2C, 2D, and 3A subfamilies, members of the UGT family, as well as the ATP‐binding cassette transporters ABCB1 (P‐glycoprotein) and ABCG2 (breast‐cancer resistance protein). Several of these genotyping strategies have been shown to have substantial impact on therapeutic outcome and should eventually lead to improved anticancer chemotherapy. Drug Dev. Res. 62:233–253, 2004. © 2004 Wiley‐Liss, Inc.
Relationship of the Job Tenure of Nursing Home Top Management to the Prevalence of Pressure Ulcers, Pain, and Physical Restraint Use

The association of job tenure among nursing home administrators (NHAs) and directors of nursing (DONs) with the prevalence of pressure ulcers, pain, and physical restraint use was examined. Data sources included the 2004 National Nursing Home Survey and quality measures from the Centers for Medicare and Medicaid Services. Regression models examined NHA tenure (n = 787) and DON tenure (n = 703). Control variables included prior prevalence of the respective outcome, NHA/DON education, and facility characteristics among others. Increasing NHA and DON tenure were both associated with decreases in the prevalence of pressure ulcers and pain but not restraint use. DON tenure had more impact on outcomes in earlier stages of tenure than NHA tenure. Effects of NHA tenure were in later stages of tenure. Increasing tenure among NHAs and DONs may influence better resident outcomes within their facility.
Oleanolic acid prevents progression of streptozotocin induced diabetic nephropathy and protects renal microstructures in Sprague Dawley rats

Objective: To study the effect of oleanolic acid (OA) on streptozotocin induced diabetic nephropathy in Sprague Dawley rats. Materials and Methods: Four weeks after intra-peritoneal injection of streptozotocin (STZ; 55 mg/kg), the rats with proteinuria were grouped as: Control (non-diabetic, treated orally with vehicle), diabetic control (treated orally with vehicle) and three diabetic groups receiving 20, 40 and 60 mg/kg/day oral doses of OA. At the end of 8 weeks, urine and serum samples from the rats were processed for determination of creatinine, BUN and GFR. The kidney samples were processed for determination of weight changes, oxidative stress related parameters like catalase, superoxide dismutase and reduced glutathione levels. A part of one kidney from each rat was used for transmission electron microscopy (TEM). Result: As evident in TEM, OA inhibited the nephropathy induced alterations in podocyte integrity, basement membrane thickness and spacing between the podocytes at 60 mg/kg dose. It increased GFR and reduced oxidative stress in the kidneys in a dose dependent manner. These findings conclusively demonstrate the efficacy of OA in diabetic nephropathy. Significant decrease in the oxidative stress in kidneys indicates the role of anti-oxidant mechanisms in the effects of OA. However, OA is known to act through multiple mechanisms like inhibition of the generation of advanced glycation end products and improving the insulin secretion. These mechanisms might have contributed to its efficacy. Conclusion: These results conclusively demonstrate the efficacy of OA in diabetic nephropathy through its possible antioxidant activity.