Miracle-dz/UniFAR-FTUs huggingface dataset:
Unmet Needs in Pharmacological Treatment of Apathy in Alzheimer’s Disease: A Systematic Review

Background: Apathy is one of the most prevalent neuropsychiatric symptoms encountered in Alzheimer’s disease (AD) and may be an early sign in the development of dementia persisting over the disease course. It has been associated with poor disease outcome, impaired daily functioning, and significant caregiver distress. Early diagnosis and timely treatment of apathy in AD are of great importance. However, approved agents for apathy are still missing. Methods: Within this context, we conducted an extensive electronic search in the databases included in the National Library of Medicine, PsychInfo, and Google Scholar for studies that have investigated the effect of pharmacological treatments in apathy in AD. There were no limitations regarding study design and all care settings were considered for inclusion. Structured measures for level of evidence and study quality were employed to evaluate the results. Results: A total of 1,607 records were identified; 1,483 records remained after the removal of duplicates and were screened; 166 full-text articles were selected and assessed for eligibility and a remaining 90 unique studies and relevant reviews were included in the qualitative synthesis. Acetylcholinesterase inhibitors, gingko biloba, and methylphenidate were found to be successful in reducing apathy in patients with AD. Methodological heterogeneity in the studies and the small amount of studies where apathy was the primary outcome are limiting factors to assess for group effects. Conclusions: Pharmacological treatment of apathy in AD is an underexplored field. Standardized and systematic efforts are needed to establish a possible treatment benefit. Elucidating the pathophysiology of apathy and its components or subtypes will inform disease models and mechanistic drug studies that can quantify a benefit from specific agents for specific AD groups.
Epidemiology and initial management of pulmonary arterial hypertension: real-world data from the Hellenic pulmOnary hyPertension rEgistry (HOPE)

Pulmonary arterial hypertension (PAH) is a heterogenous clinical entity with poor prognosis, despite recent major pharmacological advances. To increase awareness about the pathophysiology, epidemiology, and management of the disease, large national registries are required. The Hellenic pulmOnary hyPertension rEgistry (HOPE) was launched in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. Baseline epidemiologic, diagnostic, and initial treatment data of consecutive patients with PAH are presented in this article. In total, 231 patients with PAH were enrolled from January 2015 until April 2018. At baseline, about half of patients with PAH were in World Health Organization functional class II. The majority of patients with PAH (56.7%) were at intermediate 1-year mortality risk, while more than one-third were low-risk patients, according to an abbreviated risk stratification score. Half of patients with PAH were on monotherapy, 38.9% received combination therapy, while prostanoids were used only in 12.1% of patients. In conclusion, baseline data of the Greek PAH population share common characteristics, but also have some differences with other registries, the most prominent being a better functional capacity. This may reflect earlier diagnosis of PAH that in conjunction with the increased proportion of patients with atypical PAH could partially explain the preference for monotherapy and the limited use of prostanoids in Greece. Nevertheless, early, advanced specific therapy is strongly recommended.
Transbronchial biopsy in chronic hypersensitivity pneumonitis

Introduction: The diagnosis of chronic hypersensitivity pneumonitis (CHP) is based on relevant exposure, tomographic findings and, in some cases, pathological data. The role of bronchoscopy is uncertain, especially in the fibrotic form of CHP. Aim: To analyze the yield of transbronchial biopsy (TBBx) in patients with CHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. Methods: This retrospective study analyzed patients with CHP who underwent TBBx in São Paulo, Brazil. The TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). Results: One hundred nine patients were included. The presence of characteristic findings of HP was seen in 16 patients (14.7%), and supportive findings were seen in 32 patients (29.4%), with a total yield of 44%. Pathological characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (27.3% vs. 9.2%, p= 0.014), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 9.1%, p= 0.002). Fifty-two patients had differential cytology in BAL fluid. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median lymphocyte count according to nonfibrotic and fibrotic tomographic findings on HRCT. Conclusion: TBBx and BAL fluid cytology have a role in CHP diagnosis.
Movement is Medicine: The Effect of a Structured Mobility Program on Functional Decline in Hospitalized Older Adults

Abstract Functional decline is defined as the consequence of physiological changes of aging resulting in the inability to perform self-care activities independently. Hospitalized older adults are more likely to decline in functional status resulting in longer length of stay. Hospital care is often focused on treating acute illness while functional status is overlooked. Low mobility and bedrest are common occurrences during hospitalization. The most predictable and probably most preventable cause of functional decline is deconditioning from bedrest and reduced mobility. The purpose of this study was to determine if an early ambulation program can maintain functional levels for hospitalized older adults who were mobile preadmission. The research design was a quantitative, quasi-experimental, equivalent control group. The intervention tested the effects of a structured walking program on functional status in hospitalized older adults. The independent variable was the mobility protocol and the dependent variables were functional status and length of stay. Data were analyzed to address the two research questions. The intervention group tends to have higher HARP scores indicating that they were more at risk for functional decline. The majority of them had the same HARP scores upon discharge which was a goal of the researcher, signifying that patients did not leave the hospital with a decline in the function with which they had originally been admitted. Those participants admitted with respiratory or cardiac disorders benefited the most from the walking intervention which speaks to their strengthening activity intolerance. Evidence exists that targeted interventions can impact the degree of functional independence for hospitalized older adults. Further research on a larger sample with more inclusion criteria is warranted. Degree Type Dissertation Degree Name Doctor of Education (EdD) Department Executive Leadership First Supervisor Dianne Cooney Miner Second Supervisor William Stroud Subject Categories Education This dissertation is available at Fisher Digital Publications: http://fisherpub.sjfc. edu/education_etd/8 i Movement is Medicine: The Effect of a Structured Mobility Program on Functional Decline in Hospitalized Older Adults
Primary Sjögren's syndrome beyond Sicca symptoms: A rheumatology clinic experience

Background: Primary Sjogren's syndrome (pSS) is an autoimmune inflammatory disorder characterized by both exocrine glandular as well as extraglandular disease. Despite having known for a primarily glandular affection, the extraglandular manifestations are also frequently reported but not well studied. This study aims to evaluate extraglandular clinical features of pSS occurring as initial manifestations. Patients and methods: This retrospective cohort study was conducted from 1stJanuary 2014 to 1stJanuary 2019 at Liaquat National Hospital, Karachi. It comprised of collected data of patients who presented with extraglandular symptoms as initial manifestations and were diagnosed as pSS. Results: Of the 36 patients, 31 (86.1%) were female while 5 (13.9%) were males. Commonest extra glandular manifestations were arthralgia in 10 (27.7%), fatigue in 6 (16.6%), renal tubular acidosis in 6 (16.6%), peripheral neuropathy in 3 (8.3%), lymphoma in 3 (8.3%), optic neuritis in 3 (8.3%), interstitial lung disease in 2 (5.5%), and Raynaud s phenomenon in 1 (2.7%), Transient ischaemic attacks (TIA) and stroke in 1 (2.7%), and posterior reversible encephalopathy syndrome (PRES) in 1 (2.7%) patient. Conclusion: Primary syndrome is a rare auto immune disease which apart from glandular symptoms may initially manifest with extraglandular symptoms. Though these distressing presentations are rare, they can become potentially life threatening if not recognized early. It is important to keep a high index of suspicion for early diagnosis and management to prevent devastating effects of these complications.
Knowledge of Breast Cancer and Associated Factors among Women Reproductive Age in Bale Zone, Southeast Ethiopia: A Community based Cross Sectional Study

Introduction: Globally, Breast Cancer (BC) is the most prevalent cancer and the second reason of cancer deaths among women, and it is the most common women’s cancer in unindustrialized countries. It is also considered to be a progressive disease with a poor prognosis if detected late.Methods: A community based cross sectional study was conducted among reproductive age group women in Bale zone, southeast Ethiopia. Interviewer administered questionnaire were used for quantitative part of the study and supplemented qualitatively using Focus Group Discussions (FGD). Data were interred into EPI info version 3.5. 3 and analysed using SPSS version 20. Bivariate logistic regression was done to examine the relationship between each explanatory and outcome variable. To retain for subsequent multiple logistic regression p-value<0.25 wasconsidered. The strength of association was tested using adjusted odds ratio, 95% CI and value<0.05. Results: Four hundred twenty (50.2%) of participants heard about breast cancer. Out of these, 236 (56.2%) of respondents had knowledge score of greater than or equal to the mean knowledge score which categorized them as knowledgeable about breast cancer. Media (television and radio) was reported as a major source of information for nearly half 204 (48.6%) of the participants.Conclusion: Factors such as residing in urban, having better monthly income, knowing the seriousness of breast cancer, knowing the treatability of breast cancer and previous information or health education on BC at health facility were the factors which can raise the odds of breast cancer knowledge. Therefore, it is very important to develop health service programs that can address all mothers according to their auspicious place and time to increase knowledge of breast cancer through information and health education regarding its sign and symptoms, risk factors, early detection, and management systems to reduce the burden of BC among rural community.
An Intervention Using Quality of Life and Symptom Information as a Clinical Tool in Patients with Advanced Cancer

Purpose: The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) recognizes the individuals’ values with no pre-judgement. The objective of this study was to determine if clinician awareness and understanding of individual patients’ subjective quality of life (SQoL), bothersome symptoms and symptom interference on SQoL, would lead to improvement over time in the SQoL of patients with advanced cancer. Methods: SEIQoL-DW and symptom bother/interference with SQoL was measured up to 4 time points on Sixty-five (n=65) patients receiving chemotherapy for advanced cancer. Measurements from the intervention group (n=33) was reported to the clinical team at each time point via an info-graph placed in the clinical notes. Measurements from the control group (n=32) was not reported to the clinical team. Results: SEIQoL-DW of all patients improved from baseline to time point 4 (p >0.05). A significant improvement in patient’s perception of health functioning was seen in the intervention group compared to the control group (51% v 19%, p=0.014). Symptom interference in SQoL reduced by 9% in the intervention group versus 37% increase in the control group. In totality, a 46% difference was observed between groups (p < 0.05). Interpretation: Translating SEIQoL-DW and symptom bother/interference into a format for use as a ‘Clinical Tool’ in routine practice improves patient reported health functioning and symptom interference on their SQoL. This patient centered approach could lead to a paradigm shift in our understanding of patient’s needs and in harmony with other clinical interventions, should be considered a valuable step towards personalized medicine.
Establishment of Diagnostic Reference Levels and Estimation of Effective Dose from Computed Tomography Head Scans at a Tertiary Hospital in South Africa

Introduction: Head scans are the most frequently performed computed tomography (CT) examinations worldwide. However, there is growing concern over the probability of increased cancer risks among the exposed populations. Diagnostic reference levels (DRLs) identify radiation dose that is not commensurate with clinical objectives. The aim of this study was to establish DRLs for CT head procedures and estimate effective dose (ED). Material and Methods: The dose absorbed by the head slice of a Rando Alderson phantom was measured using calibrated lithium fluoride thermoluminescent dosimeters (TLDs) exposed to a CT scanner operated on clinical parameters. The measurements were done at the periphery and center of the slice, and repeated twice with a new set of TLDs. The radiation dose absorbed by the TLDs was read using a Harshaw TLD reader, Model 5500. The measured doses were used to calculate the weighted CT dose index (CTDIw), CT dose index volume (CTDIv), and dose length product (DLP). Finally, the ED was calculated using the formula; ED = k × DLP, where k was considered as 0.0021. Results: The mean absorbed dose was 30.9 mGy, while the established CTDIv and DLP values for the head protocol were 40 mGy and 990 mGy.cm, respectively. Additionally, the ED was calculated as 2.1 mSv. These values compared well with some international values. Conclusion: According to the results of the present study, the established CTDIv, DLP, and ED for head scan were well-compared with some international values, except in the cases using different scan lengths and scanner algorithms.
Association between residential greenness and cognitive function: analysis of the Chinese Longitudinal Healthy Longevity Survey

Introduction Proximity to vegetated green space has been linked to better physical and mental health. However, the relationship between residential greenness and cognitive function and its decline among older adults is not clear in large cohort studies. Methods Our study used the 2000, 2002, 2005, 2008 and 2011 wave of the Chinese Longitudinal Healthy Longevity Survey. We calculated the Normalised Difference Vegetation Index (NDVI) using a 500 m radius around participants’ residential addresses. Mini-Mental State Examination (MMSE) was applied to measure cognitive function. Our study included the cross-sectional analysis using the linear regression, and logistical regression, and also the longitudinal analysis using the linear mixed effects regression, and mixed effects logistic regression. Our study also conducted a sensitivity analysis using the survey-weighted regression. Additionally, our study participants were categorised into those living in areas of positive and negative changes in NDVI in relation to MMSE. All regression models were adjusted for a range of covariates. Results Among 38 327 participants at baseline, the mean MMSE score was 21. Annual average NDVI ranged from −0.11 to 0.76. In the cross-sectional analysis, each 0.1-unit increase in NDVI was associated with a 0.23-point increase in MMSE score (95% CI 0.16 to 0.29) in the linear regression, and an OR of 0.94 (95% CI 0.92 to 0.96) of having cognition impairment in the logistic regression. In the second analysis, looking at changes in NDVI and MMSE score, compared with the participants living in areas with an increase in NDVI, those living in areas with a decrease in greenness had an OR of 1.25 (95% CI 1.18 to 1.34) of a decrease in MMSE, and an OR of 0.90 (95% CI 0.84 to 0.96) of an increase in MMSE. In the longitudinal analysis, we found a significantly weak association (coefficient 0.069, 95% CI 0.0048 to 0.13) in the linear mixed effects regression, but not in the mixed effects logistic regression. Conclusion We found evidence of an association between higher residential greenness and better cognitive function among older adults. Our finding provides insight into neurodegeneration and has implications for preventing dementia and Alzheimer’s disease in China.
Fellow-Eye Conversion and Treatment in Exudative Age-Related Macular Degeneration

Purpose: This article assesses anatomical and visual outcomes after intravitreal antivascular endothelial growth factor (anti-VEGF) treatment in fellow eyes with wet age-related macular degeneration (AMD). Methods: A retrospective chart review was conducted of 349 patients diagnosed with wet AMD between 2005 and 2017 at a single academic institution. Initial diagnosis of unilateral wet AMD and a minimum follow-up time of 1 year after diagnosis were required for inclusion. Individuals were excluded if the initial diagnosis of wet AMD was made at an outside institution, if they had received prior treatment at another institution, or if they had bilateral wet AMD at the time of inclusion. Best-corrected visual acuity, optical coherence tomography (OCT) parameters, and frequency and type of intravitreal anti-VEGF injections were recorded. MedCalc Statistical Software version 17.6 (MedCalc Software) and GraphPad Software (GraphPad Software, Inc) were used for statistical analysis. Results: Of the 349 patients with wet AMD, 192 were included in the study (55%). Of these, 47 (24.5%) developed wet AMD in the fellow eye. The average time to second-eye conversion was 2.6 years, with fellow-eye conversion more likely to occur after 2 years of unilateral disease. On average, patients received 2.16 fewer injections per year in the fellow eye compared with the initially diagnosed eye (P = .03), and fellow eyes tended to have better OCT results after 12 months of treatment. In addition, compared with ranibizumab and bevacizumab, aflibercept injections appeared to improve visual acuity both in initially diagnosed and fellow eyes. Conclusions: Exudative AMD in the fellow eye has a decreased treatment burden and better visual outcomes compared with the initial eye, which may be attributed to more frequent surveillance and early diagnosis.
Severe hemolytic crisis due to cold agglutinins associated with Mycoplasma pneumoniae infection that complicated the compatibility tests

The cold agglutinins (CAs) associated with Mycoplasma infection may give rise to autoimmune hemolytic anemia (AIHA), and in rare cases, results in severe crises requiring hospitalization. The present case was this kind with severe hemolytic crises due to clinically significant CA that had caused the life-threatening AIHA in association with the infection by Mycoplasma pneumoniae. The blood specimens were collected in the warm environment to obviate spontaneous autoagglutination. Autoimmune nature of the CA involved was established by the direct antiglobulin test (DAT) using reagents obtained from commercial sources. The serological specificity of the CA was ascertained by titration by saline tube test against the red blood cells (RBCs) from the adults and the newborn infants as well as the hemagglutination inhibition study using human milk as a source of the soluble I antigen. The patient's clinical and other details were obtained from the hospital records. A 20-year-old male admitted to the hospital with a severe hemolytic crisis that required blood transfusion. DAT on his RBCs was positive due to the presence of C3d complement fraction, in concurrence with a high-titer CAs with anti-I specificity and positive serological test for M. pneumoniae. A severe hemolytic crisis was evident by sudden drop in hemoglobin, presence of reticulocytes and erythroblasts in circulation. The patient was conservatively treated with antibiotics, steroid, and blood transfusions with improvement in condition and was discharged after 7 days of hospitalization. He was followed up for the next 3 months through which he continued to be in good condition. The investigations showed a rare case of the CA, with anti-I specificity, causing severe hemolytic crisis in association with M. pneumoniae infection that required hospitalization.
Lip Changes Following Non-Extraction Orthodontic Treatment

The purpose of this study was to predict the lip changes in Class I adolescents and adults following non-extraction orthodontics treatment. Methods: This longitudinal retrospective study evaluated the pre- and post-treatment lateral cepha-lograms of 40 adults and 72 adolescents with Angle Class I molar relationships and crowding in both arches. The horizontal and vertical changes of 15 landmarks, along with lip thickness and taper, were evaluated. The sample was randomly divided into two group; 76% of the subjects were used to develop the multivariate regression formulas; the remaining 24% served as a validation sample. Result: Adolescent lips moved inferiorly and anteriorly during treatment; adult lips showed lesser inferior movement, little or no anterior movement and decreases in thickness. Males demonstrated signifi
Expression of ALDH1A1 and CD133 is associated with the prognosis and effect of different chemotherapeutic regimens in gastric cancer

Gastric cancer (GC) is one of the most common malignant tumors worldwide. Previous studies have reported that aldehyde dehydrogenase-1A1 (ALDH1A1) and cluster of differentiation (CD)-133 are considered to be cancer stem cell markers in GCs. The present study immunohistochemically examined the distribution and expression of two tumor stem cell markers, CD133 and ALDH1A1, in both primary tumors and para-tumor tissues. In 91 cases with stage III, 57 (62%) were positive for ALDH1A1 and 60 (66%) were positive for CD133. ALDH1A1 was detected in para-tumors and cancerous tissues of the stomach, and the immunoreactivity of the tumors was stronger than that in para-tumor tissues. CD133 was only detected in tumors. The expression of ALDH1A1 was significantly associated with advanced T/N stage (T stage, P=0.012; N stage, P=0.023) and poor differentiation (P=0.020), while CD133 was associated with advanced T stage (P=0.007). Univariate and multivariate Cox proportional hazards analysis revealed that tumor stage, CD133 expression, vascular invasion and sex were independent predictors of disease-free survival (DFS) time, and tumor size, vascular invasion and sex were independent predictors of overall survival (OS) time in patients with GC. Patients with CD133+ GC had poorer DFS (P=0.042), while ALDH1A1+ GC was not associated with poorer DFS. In regard to chemotherapy, improvements in survival were not observed after the addition of taxane compared with two-drug therapy. However, the subgroup analysis indicated that in the ALDH1A1− subgroup, and CD133+ and ALDH1A1− subgroups, an increased OS was observed in two-drug therapy (P=0.043). The results of the present study indicate that ALDH1A1 and CD133 may play an important role in tumor invasion, metastasis and prognosis, and ALDH1A1− expression does not benefit the taxane-based triple chemotherapeutic regimen in patients with GC.