Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessment of the documentation completeness level of the medical records in Basrah General Hospital

Background: Medical records documentation is an important legal and professional requirement for all health professionals. They include information which describes all aspects of patient's care. But, despite the importance of medical records to support better quality service provided at the health facilities, incomplete documentation is very common all over the world. Objective of the study: to assess the documentation completeness level of the medical records in the different inpatient wards of Basrah General Hospital. Methodology: The study was a descriptive cross-sectional one. Medical records of 268 inpatients from Basrah General Hospital during June 2016 were included from four departments of the hospital (medicine, surgery, pediatrics and obstetrics and gynecology). A standard Iraqi Ministry of Health inpatient medical record with a two-level scoring system for assessing the level of documentation completeness were used in the study. Results: the overall documentation level for the medical records included in the study was generally poor in 78% of the records. Surgical department was found to be the worse in documenting patient's notes related to medical history, while Gynecology and Obstetrics department was found to be the worst in documenting the medical examination assessment and the physician's notes related to the patient's state and details of any improvement / deterioration of his/her condition. Conclusions and recommendations: The present study confirmed obvious incompleteness of documenting medical data for inpatient records in Basrah General Hospital especially in the general surgery, internal medicine and Gynecology and Obstetrics words. This is specifically found for the Physician notes (patient’s state and details of any improvement/deterioration of the condition) and the Clinical pharmaceutical sheet. A hospital based quality improvement project to improve the medical record documentation completion is highly recommended to be implemented by the Quality Assurance Unit of Basrah Directorate of Health.
Hepatitis C virus infection among healthy Egyptian children: prevalence and risk factors

Summary. The aim of this study was to estimate the prevalence and identify the risk factors of hepatitis C virus (HCV) infection among healthy Egyptian children. A representative random sample of 500 children, age between 6 and 15 years, was selected from 10 schools in Alexandria, Egypt. A questionnaire was used to collect demographic data and potential risk factors, while blood samples were collected and analyzed for antibodies to HCV (anti‐HCV). Positive sera were further confirmed by HCV‐RNA. HCV seroprevalence of 5.8% was found, with HCV viraemia in 75% of the studied children. The prevalence of anti‐HCV increased with age from 0% in children aged 6–7 years to 16% in those of 15 years old. It was also shown that history of previous blood transfusion (odds ratio[OR] = 34.8, 95% CI = 4.39–272.95), intravenous injections (OR = 4.68, 1.89–11.59), surgical intervention (OR = 5.64, 2.55–12.52), dental treatment (OR = 6.81, 2.64–17.39), injection (OR = 2.29, 1.08–4.89) and circumcision for boys by informal health care providers (OR = 2.6, 1.0–6.73), age above 10 years (OR = 6.83, 2.44–19.07), very low socioeconomic class (OR = 5.92, 1.3–25.2) and rural area residence (OR = 2.49,1.61–5.29) are the most significant risk factors for HCV infection. Adjusting for all other risk factors by multivariate logistic regression analysis, it has been shown that blood transfusion, surgical procedures, dental treatment, and age above 10 years are still significant risk factors associated with anti‐HCV (P < 0.05). The current study reveals the extremely high HCV seroprevalence among Egyptian children. This mandates immediate preventive strategies to limit further HCV spread.
An optimal mRNA marker for OSNA (One-step nucleic acid amplification) based lymph node metastasis detection in colorectal cancer patients.

BACKGROUND We previously reported that the one-step nucleic acid amplification assay is effective for lymph node metastasis detection in breast cancer patients. This paper describes the identification of CK19 mRNA as an optimal marker and its cut-off value for use in the detection of one-step nucleic acid amplification-based lymph node metastasis in colorectal cancer patients. METHODS Candidate mRNA markers selected from the genome-wide expressed sequence tag database were evaluated by quantitative RT-PCR using a mixture of metastasis-positive and another mixture of metastasis-negative lymph nodes (n = 5 each), followed by quantitative RT-PCR using metastasis-positive and -negative lymph nodes (n = 10 each) from 20 patients. The one-step nucleic acid amplification assay for mRNA markers selected above was examined using 28 positive lymph nodes from 19 patients and 38 negative lymph nodes from the 11 pN0 patients. RESULTS Quantitative RT-PCR analyses of the 98 mRNAs selected from the genome-wide expressed sequence tag database and the subsequent quantitative RT-PCR analyses of the nine mRNAs selected above indicated that CK19 and CEA mRNAs have the highest capability for distinguishing between positive and negative lymph nodes. CK19, CEA and CK20 mRNAs were evaluated by the one-step nucleic acid amplification assay. An area under a receiver-operating-characteristic curve for CK19 mRNA (0.999) was slightly larger than that for CEA mRNA (0.946; P = 0.062) and significantly larger that than for CK20 mRNA (0.875; P = 0.006). CONCLUSION We found that CK19 mRNA has the best diagnostic performance and its cut-off value for discriminating positive from negative lymph nodes can be set in the range of 75-500 copies/µl with 96.4% sensitivity and 100% specificity.
123I‐MIBG imaging for detection of anthracycline‐induced cardiomyopathy

Due to improvements in early detection and treatment of malignant disease, the population of cancer survivors is constantly expanding. Cancer survivors are faced with chemotherapy‐related long‐term side effects, including irreversible cardiac injury with risk of heart failure (HF). Numerous antineoplastic regimens are associated with risk of cardiac side effects, but anthracyclines in particular carry a severe risk of cardiotoxicity. Currently, serial echocardiographic evaluation of resting left ventricular ejection fraction (LVEF) is the gold standard for monitoring anthracycline‐induced cardiac side effects from chemotherapy. LVEF measurements are, however, limited by their low sensitivity. A normal LVEF does not exclude cardiotoxicity and declines in LVEF are usually not observed before the occurrence of irreversible cardiomyopathy. Hence, a clinically applicable high‐sensitivity diagnostic tool for early detection of chemotherapy‐related cardiotoxicity is still lacking and alternative non‐invasive imaging modalities are therefore being investigated. 123I‐MIBG is a noradrenaline (NA) analogue used for evaluation of cardiac adrenergic function, including assessment of HF prognosis and evaluation of HF treatment response. However, the role of 123I‐MIBG for monitoring chemotherapy‐related cardiotoxicity is still unclear. Here, we review the value of 123I‐MIBG imaging for early detection and prevention of anthracycline‐induced cardiomyopathy.
Financing Medicare: a general equilibrium analysis

This paper develops a general equilibrium, overlapping-generations model of the U.S. economy where households face random fluctuations in health status. Health status determines households’ productivity, mortality rate and their medical expenditures. Households make consumption and labor supply decisions, and can imperfectly insure medical expenditure shocks through markets. In addition, the government provides partial insurance against expenditure shocks through Medicare and a “social assistance” programs, and it runs a pay-as-you-go social security system. We calibrate the model based on the projected demographic and medical expenditure trends for the next 75 years. The model is used to study the macroeconomic and welfare implications of alternative funding schemes for Medicare. In the baseline closed-economy model, we find that the labor income tax will have to increase from 23% in 2005 to 36% in 2080 to finance the rising costs of Medicare. However, under an open-economy scenario, the tax would have to rise by much less. Limiting the increase in the wage tax through either a rise in the Medicare premium or a delay in the age of retirement is welfare improving.
Reply to letter : “ Reflections on Vascular Ageing and Microvascular Pulsatility ”

Manuscript Number: JH-D-14-00432 Full Title: Reply to "Reflections on Vascular Ageing and Microvascular Pulsatility" Article Type: Correspondence Corresponding Author: Francesco Stea, M.D. National Research Council, Institute of Clinical Physiology Pisa, ITALY Corresponding Author Secondary Information: Corresponding Author's Institution: National Research Council, Institute of Clinical Physiology Corresponding Author's Secondary Institution: First Author: Francesco Stea, M.D. First Author Secondary Information: Order of Authors: Francesco Stea, M.D. Francesco Faita Rosa Maria Bruno, M.D., PhD Lorenzo Ghiadoni, M.D., PhD Order of Authors Secondary Information:
Immediate Postpartum IUCD (PPIUCD) Insertion: An Opportunity Not to be Missed

Objective: The present study was planned to evaluate the safety and efficacy of immediate postpartum IUCD insertion in women delivering vaginally or by caesarean section. Method: This prospective study was carried out at Sobhraj Maternity Hospital from 1st July 2012 to 30th June 2013. Women delivering in the hospital fulfilling inclusion criteria were included in the study. W omen with prelabour rupture of membranes for >18 hours, chorioamnionitis, temperature >38 0 C during or af ter labour, continued excessive postpartum bleeding were excluded from the study. The women included in the study underwent immediate postpartum insertion of Copper T 380A after delivery of placent a in vaginal or caesarean delivery. These women were followed up at 6 weeks and 6 months after delivery. Results: A total of 1238 women were included in the study who underwent immediate postpartum IUCD insertion. 56% of insertions were performed after vaginal delivery and 44% insertions were done at caesarean sections. The follow up rate at 6 weeks was 51% and 14% at 6 months. There were no serious complications associated with immediate postpartum IUCD insertion. The expulsion rate at 6 weeks and 6 months were 5% and 6%. The removal rate was 5% at 6 weeks and 10% at 6 months. The continuation rates were 90% at 6 weeks and 84% at 6 months respectively. Conclusion: This study indicates that immediate PPIUCD insertion is safe and effective. However, the expulsion rate for immediate postpartum IUCD insertions are higher than for interval insertions, but the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country like ours where women have limited access to healthcare.
Physico-chemical compositions of the red seedless watermelons (Citrullus Lanatus)

Changes of physico-chemical properties such as size, weight, moisture content, total soluble solid (TSS), colour, pH, total acidity and sugar content of red seedless watermelon during storage at room temperature (± 28°C; 70-80% RH) were investigated. The average weight, diameter and length of red seedless watermelon were 5.94 kg, 22.0 cm and 21.8 cm respectively. The length to diameter ratio was 1.02. The statistical analysis indicated that total soluble solids of fruit decreased significantly (p<0.01), but no significant changes were found in pH and total acidity during ripening. Weight loss, moisture content and freezing point was found to be increased significantly (p<0.01) during ripening. Colour L* was found no significant changes but colour a* and b* increased significantly (p<0.1) throughout the ripening process. For sugar analysis, significant changes (p<0.1) in fructose and glucose were obtained, but no significant changes were observed in sucrose content during storage time. From the observation, the optimum eating quality of watermelon stored in room temperature (± 28°C; 70-80% RH) was within one week after harvest, although they can be stored up to 2 weeks. The data obtained is vital in order to apply in different field, purpose and application.
Therapeutic amelioration of jaundice: Old and new strategies

Hepatic excretion of bilirubin and other cholephiles involves multiple steps (l) , one or more of which may be altered in hepatobiliary diseases (Table 1). The resulting jaundice, in itself, usually produces only cosmetic distress, but severe unconjugated hyperbilirubinemia, especially in the neonate, may produce serious damage to the nervous system and possibly other tissues (2). Over the past 2 decades, various strategies have evolved for decreasing severe hyperbilirubinemia (27). They fall into four broad categories: (i) modification of the activity of specific catalytic or transport proteins involved in the uptake, storage, biotransformation and biliary secretion steps of the excretory process; (ii) replacement of the deficient transport step(s) or their products; (iii) simulation or bypass of the impaired step(s), and (iv) alteration of the supply (load) of bilirubin transported to the liver. The paper in this issue of Hepatology by Berglund et al., which describes specific inhibition of bilirubin formation to ameliorate jaundice (28), falls into the fourth category. Modification of specific steps in hepatic bilirubin transport has been achieved by: (a) inducing new protein synthesis or (b) altering the structure of the membranes in which the protein is anchored. Induction historically began with the treatment of severe congenital (29, 30) and neonatal (31, 32) unconjugated hyperbilirubinemia with phenobarbital. Other drugs are effective also (27), and prenatal administration to the mother may decrease the severity of jaundice in the neonate (31, 33). Phenobarbital enhances hepatic bilirubin clearance (34, 35), due to increased uptake (36) and storage (37), the latter due to increased councentrations of ligandin (37-39). Bilirubin-UDPGA transferase is induced in neonatal (40,41) and adult (40-43) animals, in nonjaundiced humans (44) and in patients with Crigler-Najjar syndrome type I1 (29,30), but this apparently does not occur during phenobarbital treatment of patients with Gilbert’s syndrome (13, 35, 45). In animals, phenobarbital also increases the activity of UDPG-dehydrogenase, expanding the supply of UDP-glucuronic acid (46, 47). It is disputed whether phenobarbital affects biliary secretion of bilirubin and bile salts, as well as bile flow, in part due to relatively small effects and considerable species differences (27, 48). In patients with cholestatic jaundice, however, phenobarbital does enhance organic anion se(i)
Electrophysiologic evaluation of upper motor neuron involvement in amyotrophic lateral sclerosis

BACKGROUND: The demonstration of upper motor neuron (UMN) dysfunction in patients with amyotrophic lateral sclerosis (ALS) with predominantly lower motor neuron (LMN) signs is clinically sometimes difficult. METHODS: We analyzed the possible role of F and H waves in the diagnosis of UMN dysfunction in 36 patients with different clinical forms of ALS and 20 controls. In both lower limbs we evaluated F-wave persistence and the F/M ratio of tibial nerves, H max /M max ratio, vibratory and recurrent (paired) inhibition of the H-reflex. RESULTS: The persistence of the F-response was decreased significantly in the LMN group only. The F/M amplitude ratio, vibrated-H/rest-H amplitude ratio and conditioned H/rest H amplitude ratio were significantly increased in patients with predominantly UMN, as well as in those with predominantly LMN signs. H/M amplitude ratios did not differ between the various patient groups. CONCLUSION: These findings show that ALS patients, including those without clinical evidence of UMN involvement, have a marked disinhibition of anterior horn motor neurons. The simple tests described could support an UMN abnormality when clinical signs are lacking, and help to establish a diagnosis sooner and more accurately.
Exaggerated Blood Pressure Response to Exercise Is Not Associated With Masked Hypertension in Patients With High Normal Blood Pressure Levels

The association between exaggerated blood pressure (BP) response to exercise (ExBPR) and “masked hypertension” is unclear. Medical records of patients with high‐normal BP who were evaluated in the Chaim Sheba Screening Institute Ramat Gan, Israel, during the years 2002–2007 and referred for 24‐hour ambulatory BP monitoring (ABPM) and exercise test were reviewed. Data on exercise tests performed in the preceding 5 years were retrieved. Reproducible ExBPR was defined when it was recorded at least twice. BP levels on 24‐hour ABPM were compared between patients with a normal BP response and those with an ExBPR (systolic BP ≥200 mm Hg). Sixty‐nine normotensive patients with high normal BP levels were identified. ExBPR was recorded in 43 patients and was reproducible in 28. BP levels on 24‐hour ABPM were similar in patients with and without ExBPR. In patients with high‐normal BP levels, ExBPR is not associated with masked hypertension.
Regulation of dopamine system responsivity and its adaptive and pathological response to stress

Although, historically, the norepinephrine system has attracted the majority of attention in the study of the stress response, the dopamine system has also been consistently implicated. It has long been established that stress plays a crucial role in the pathogenesis of psychiatric disorders. However, the neurobiological mechanisms that mediate the stress response and its effect in psychiatric diseases are not well understood. The dopamine system can play distinct roles in stress and psychiatric disorders. It is hypothesized that, even though the dopamine (DA) system forms the basis for a number of psychiatric disorders, the pathology is likely to originate in the afferent structures that are inducing dysregulation of the DA system. This review explores the current knowledge of afferent modulation of the stress/DA circuitry, and presents recent data focusing on the effect of stress on the DA system and its relevance to psychiatric disorders.
The Rho–ROCK pathway as a new pathological mechanism of innate immune subversion in chronic myeloid leukaemia

CD1d‐restricted invariant natural killer T (iNKT) cells are believed to play a key role in cancer immune surveillance, and are functionally deficient in patients with chronic myeloid leukaemia (CML). Herein, we have hypothesized that this defect might originate from BCR‐ABL‐dependent dysfunctions in myeloid dendritic cells (mDCs). Indeed, flow cytometry and confocal microscopy revealed that cell surface expression of CD1d was downregulated in CML mDCs, relative to healthy donor (HD) controls. The decreased cell surface display of CD1d could not be ascribed to defective mDC differentiation, as attested by normal expression of HLA‐DR and the CD86 maturation marker. On the other hand, reduced membrane expression was not associated with decreased intracytoplasmic levels of CD1d or its mRNA transcripts, consistent with intracellular retention. In vitro treatment of CML mDCs with the Rho‐associated protein kinase (ROCK) inhibitor Y‐27632 partially restored both cell surface CD1d expression and CD1d‐mediated antigen presentation, whereas it had no effect on HD mDCs. An inhibitor of BCR‐ABL tyrosine kinase (TK), imatinib mesylate (IM), had no such activity. Similar recovery of CD1d expression occurred with fasudil, another ROCK inhibitor that is commonly used in clinical trials. Our data support the conclusion that BCR‐ABL‐dependent ROCK, but not TK, is involved in CD1d downregulation. We propose that ROCK, which is most likely activated by the DH/PH domain of BCR‐ABL, mediates iNKT‐cell immune subversion in CML patients by downregulating CD1d expression on CML mDCs. Our study reveals the ROCK–mDC axis as a new potential target to restore immune surveillance in patients with CML, offering new therapeutic perspectives for CML treatment. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
HIV Prevalence Among Pulmonary Tuberculosis Patients in Guangxi, China

Objective:To determine the HIV prevalence rate among tuberculosis (TB) patients in Guangxi, China. Methods:Stratified cluster sampling and systematic sampling methods were used to select 16 clinics from which pulmonary TB patients were recruited to participate in this study. Two thousand three hundred pulmonary TB patients provided information on sociodemographic characteristics, HIV-related knowledge and high-risk behaviors, and method of TB diagnosis. Five-milliliter blood sample from the regular TB check up was retained and tested for HIV antibody. Results:HIV prevalence among pulmonary TB patients was 0.5% (12 of 2300). There was statistical difference in HIV prevalence neither between urban and rural nor between male and female patients; however, TB patients from higher HIV prevalence areas had a higher rate of HIV infection than TB patients from a lower HIV prevalence areas for both rural or urban areas (0.8% vs. 0, χ2 = 7.49, P < 0.01). Conclusions:HIV prevalence is higher among pulmonary TB patients than among the general population in Guangxi. Program to address the dual infections of HIV/TB are needed.
SECONDARY HYPERPARATHYROIDISM IN ALL THE STAGES OF CHRONIC KIDNEY DISEASE IN SOUTHERN INDIAN POPULATION

Objectives: 1.To estimate serum intact parathormone(iPTH) and other biochemical parameters (calcium, inorganic phosphate, urea and creatinine) in chronic renal failure and healthy volunteers. 2. To compare and find out correlation between serum intact parathormone and biochemical parameters in the study group. Methods: For the study of 5 stages of chronic renal failure(CRF) totally 150 patients( 30 patients in each stage of CRF and 30 healthy controls) in the age group of 20-60 years were taken. Serum intact parathormone was estimated by chemilumino-metric assay and other biochemical parameters were estimated using standard methods. Creatinine clearance was calculated by using Cockcroft and Gault equation. Results: The serum iPTH (331.68 ± 204.99 pg/ml) was significantly higher in more advanced renal failure(CRF stage 5) which confirms the relationship between severity of hyperparathyroidism and the degree of renal impairment. The increased levels of serum iPTH (156.94 ± 44.26 pg/ml for CRF stage 2) were present even in early renal failure and it was related to low serum calcium level (8.46 ± 1.21 mg/dl for CRF stage 2) and progressive rise of serum inorganic phosphate from early to advanced renal failure. Therefore serum iPTH is negatively correlated with creatinine clearance(r = -0.718, p<0.001) and serum total calcium(r = -0.454, p<0.001). However, the serum iPTH is positively correlated with inorganic phosphate(r = +0.621, p<0.001), urea(r = +0.526, p<0.001) and creatinine. (r = +0.656, p<0.001). Conclusion: The estimation of serum iPTH and other biochemical parameters can help to diagnose the secondary hyperparathyroidism in the early stage of CRF which inturn has advantage to manage the patients of CRF accordingly to prevent the future complications.