Miracle-dz/UniFAR-FTUs huggingface dataset:
Prevalence and Associations of Subclinical Peripheral Artery Disease among Patients with Type 2 Diabetes without Clinical Macrovascular Disease

Background: Peripheral arterial disease (PAD) is an important marker of cardiovascular (CV) risk and the risk of PAD is markedly increased in patients with type 2 diabetes mellitus (T2DM). Consequently, early diagnosis and treatment of PAD in patients with T2DM are critically important to reduce the risk of CV events. The aim of this study was to determine the prevalence of asymptomatic PAD in patients with T2DM and to investigate the demographic and clinical associations of PAD among them. Methods: This cross-sectional study included 2423 diabetic patients >20 years old, who were regularly followed up at the regional diabetes clinic, Galle, Sri Lanka. Data were obtained using structured questionnaires for information on demographic characteristics and risk factors. Assessment of ankle-brachial pressure index (ABPI) was performed in all. PAD was diagnosed when ABPI was < 0.9 on either leg. Results: The overall prevalence of PAD was 15.3% with no significant age or gender difference. Patients with PAD had significantly higher systolic blood pressure (SBP) (127 vs 125 mmHg, P = 0.002) and diastolic blood pressure (DPB) (80 vs 78 mmHg, P = <0.001) and significantly lower estimated glomerular filtration rate (eGFR) (80 vs 84 ml/min, P = 0.007) than those without PAD. No significant relationships were found between the duration of diabetes mellitus, hypertension, dyslipidemia, and PAD. Conclusions: Prevalence of PAD was relatively high in the diabetic population of this study when compared with findings from other countries. There is a significant association of subclinical PAD with reduced eGFR among patients with T2DM.
One-Year Efficacy and Safety of Combined Photorefractive Keratectomy and Accelerated Corneal Collagen Cross-Linking after Intacs SK Intracorneal Ring Segment Implantation in Moderate Keratoconus

Purpose To report one-year outcomes of a modified version of two-stage multimodal surgical protocol for moderate keratoconus which has been suggesting promising preliminary results. Materials and Methods 30 eyes of 25 patients with moderate keratoconus who exhibited visual complaints and/or disease progression were included for this retrospective case study. Approximately 3 months after implantation of intracorneal ring segment (Intacs SK™), a combination of corneal wavefront-guided transepithelial photorefractive keratectomy (CWG-transPRK, Schwind Amaris® 1050, and Schwind Sirius) and accelerated collagen cross-linking (accCXL, Avedro KXL™) was performed. Patients were examined for uncorrected and corrected distance visual acuity (UDVA; CDVA), keratometric power (K), corneal thickness, and corneal higher-order aberrations (HOAs) preoperatively and at postoperative 1, 3, 6, and 12 months. Results The median UDVA and mean CDVA were enhanced from 6/38 to 6/12 and from 6/19 to 6/7.5, respectively, through 12 months after CWG-transPRK/accCXL. The 12-month CDVA of all patients was better than 6/12 Snellen, and no subject lost one or more lines of CDVA. The magnitudes of both myopia and corneal steepness were decreased in turn by Intacs SK implantation and also by CWG-transPRK/accCXL, but the reduction in HOA was largely the result of CWG-transPRK/accCXL. The magnitude of corneal thinning stabilized within 3 months after CWG-transPRK/accCXL. Conclusion This approach may allow patients with moderate keratoconus to obtain satisfactory vision without the need for contact lens wear. This surgery appeared to be effective and safe through 1 year of follow-up.
Integrated Care Models for Managing and Preventing Frailty: A Systematic Review for the European Joint Action on Frailty Prevention (ADVANTAGE JA)

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peer-reviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Union-funded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors.
Deterioration in Clinical Status Is Not Enough to Suspend Eculizumab: A Genetic Complement-Mediated Atypical Hemolytic Uremic Syndrome Case Report

Background Atypical hemolytic uremic syndrome (aHUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Mutations in CFI gene coding for complement regulation factors and in THBD gene coding for endothelial cell receptor thrombomodulin could predispose to the disease and hypertension can trigger the onset. Case Presentation A 51-year-old female patient who had received kidney transplant eighteen years ago presented with hypertensive peak and hemolysis pattern. Normal ADAMTS13 levels as well as negative culture and serology for Shiga-toxin excluded, respectively, thrombotic thrombocytopenic purpura (TTP) and typical HUS caused by Shiga toxin-producing Escherichia coli (STEC-HUS). In suspicion of aHUS, we administered eculizumab and hemodialysis sessions were started as the patient showed severe renal failure. After an initial response, the patient developed cerebral hemorrhage. After last eculizumab administration, according to hematological parameters, an unsatisfactory response was observed: given the worsening clinical scenario, we withdrew eculizumab. Pathogenic mutations in CFI and THBD genes were found. After eculizumab reinitiation, looking at hemolysis indexes, we observed a suboptimal response as well as an otherwise adequate renal one: renal graft function was recovered despite persistence of hemolysis signs, after 6 months on regular dialysis. Conclusion For the first time, we report an aHUS case in which a peculiar combination of mutations in CFI and THBD is found. We describe the importance of continuing eculizumab despite deterioration of patient's clinical conditions.
Causes and Clinical Profiles of Ascites at University of Gondar Hospital, Northwest Ethiopia: Institution-Based Cross-Sectional Study

Background Ascites is a common clinical condition encountered by physicians in day-to-day practice. It is caused by various underlying diseases. Knowing the etiologies is vital because further investigations and definitive treatment largely rely on the specific disease entity considered. Objective The aim of this study was to determine the epidemiology of causes of ascites and complications among patients with ascites from the medical department at the University of Gondar Hospital. Methods Data on sociodemography, major symptoms, and signs, risk factors, past medical illnesses, and results of important investigations were collected using pretested questionnaires among all patients with ascites in the University of Gondar Hospital in a sample size of 52. Data were collected by well-trained physicians and analyzed by using SPSS 16. Results were depicted descriptively with measures of central tendency, dispersion, and using tables and graphs. Results A total of 52 patients were included in this study from November 1, 2018 to March 30, 2019. Thirty (57.7%) of them were males and the majority (77%) of the participants were fifty years old or younger. The mean age was 43.8 (± 14). The majority (86.5%) of the participants were from a rural area. Thirty-eight (73%) patients take alcohol occasionally while 11(21.2%) patients take alcohol frequently or massively. Eight (15.4%) patients reported a history of multiple sexual partners. Herbal medicine use was reported by 28 patients (53.8%). Only 5 (9.6%) patients were overweight. Chronic liver disease (CLD) was the major cause of ascites in this study in 24 (46.2%) patients. The other main causes of ascites were heart failure from various causes (19.2%), tuberculosis and hepatosplenic schistosomiasis contributing to 11.5% each and chronic kidney disease (5.8%). Five (20.8%) CLD patients had spontaneous bacterial peritonitis as a complication. Five (20.8%) and 4 (16.7%) CLD patients had hepatocellular carcinoma and hepatic encephalopathy as complications, respectively. Nine (17.3%) patients had variceal bleeding; six of the patients were diagnosed to have CLD while the remaining patients were having hepatosplenic schistosomiasis. Conclusion In conclusion, liver cirrhosis is the major cause of ascites in Gondar, Ethiopia, while chronic viral hepatitis infections (hepatitis B (HBV) and C (HCV) viruses) are the main causes of liver cirrhosis. The other major causes included heart failure, tuberculosis, and hepatosplenic schistosomiasis. It is wise to consider and give priority to these diseases whenever one is evaluating a patient with ascites.
Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016

Background Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.
Prevalence, Influence Factors and Cognitive Characteristics of Mild Cognitive Impairment in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is considered as an independent risk factor for mild cognitive impairment (MCI). This study was performed to investigate the prevalence, influencing factors and cognitive characteristics of MCI in elderly patients with T2DM in China. Methods: In the cross-sectional study, we performed cluster random sampling of 3,246 people age 60 years and older across the country. All participants were interviewed and screened for T2DM and MCI. A total of 341 subjects were diagnosed of MCI according to the criteria of Petersen, and a total of 256 subjects were diagnosed of T2DM by using the American Diabetes Association criteria Among the 256 T2DM people, 56 were also diagnosed with MCI. Logistic regression analyses were performed to evaluate risk and protective factor for MCI with T2DM. We also assessed their cognitive function by using the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit span, Associative Learning Test (ALT), Visual Identification Test (VIT), Verbal Fluency (VF), Wechsler Adult Intelligence Scale (WAIS)-III Block Design, WAIS-III picture completion and Auditory Verbal Learning Test (AVLT). Results: Among the 256 T2DM patients, 56 were diagnosed with MCI, and the prevalence of MCI in T2DM was 21.8%. Multivariate logistic regression analyses showed that depression (p = 0.002, OR = 6.220, 95% CI: 2.005–19.290) was a risk factor for MCI among T2DM patients, while education (p < 0.001, OR = 0.869, 95% CI: 0.805–0.983) was a protective one. All the scores of neuropsychological tests (except for MMSE) in T2DM patients with MCI were lower than those without MCI (p < 0.05), but there was no statistical difference (p > 0.05) in neuropsychological tests between T2DM-MCI group and No-T2DM-MCI group. Linear regression analysis showed that the drug treatment of diabetes was positively correlated (t = 2.263, p = 0.025) with the total score of auditory word tests. Conclusions: The present study suggests a high prevalence of MCI among Chinese T2DM patients. Depression is a risk factor for MCI, while education is a protective one. T2DM patients with MCI often show comprehensive cognitive impairment, and the drug treatment of diabetes might help to improve cognitive function.
Gut Microbiome Biomarkers and Functional Diversity Within an Amazonian Semi-Nomadic Hunter–Gatherer Group

Human groups that still maintain traditional modes of subsistence (hunter–gatherers and rural agriculturalists) represent human groups non-impacted by urban-industrialized lifestyles, and therefore their gut microbiome provides the basis for understanding the human microbiome evolution and its association with human health and disease. The Yanomami is the largest semi-nomadic hunter–gatherer group of the Americas, exploring different niches of the Amazon rainforest in Brazil and Venezuela. Here, based on shotgun metagenomic data, we characterized the gut microbiome of the Yanomami from Brazil and compared taxonomically and functionally with the Yanomami from Venezuela, with other traditional groups from the Amazon and an urban-industrialized group. Taxonomic biomarkers were identified to each South American traditional group studied, including each Yanomami group. Broader levels of functional categories poorly discriminated the traditional and urban-industrialized groups, but the stratification of these categories revealed clear segregation of these groups. The Yanomami/Brazil gut microbiome presented unique functional features, such as a higher abundance of gene families involved in regulation/cell signaling, motility/chemotaxis, and virulence, contrasting with the gut microbiomes from the Yanomami/Venezuela and the other groups. Our study revealed biomarkers, and taxonomic and functional features that distinguished the gut microbiome of Yanomami/Brazil and Yanomami/Venezuela individuals, despite their shared lifestyle, culture, and genetic background. These differences may be a reflection of the environmental and seasonal diversity of the niches they explore. Overall, their microbiome profiles are shared with South American and African traditional groups, probably due to their lifestyle. The unique features identified within the Yanomami highlight the bias imposed by underrepresented sampling, and factors such as variations over space and time (seasonality) that impact, mainly, the hunter–gatherers.
Shelving the Coast With Vertipools: Retrofitting Artificial Rock Pools on Coastal Structures as Mitigation for Coastal Squeeze

Coastal squeeze caused by sea level rise threatens the size, type and quality of intertidal habitats. Along coastlines protected by hard defences, there is a risk that natural rocky shore habitat will be lost, with remaining assemblages characteristic of hard substrata confined to sea walls and breakwaters. These assemblages are likely to be less diverse and different to those found on natural shores as these structures lack features that provide moist refugia required by many organisms at low tide, such as pools and crevices. Engineering solutions can help mitigate the impacts of sea level rise by creating habitats that retain water on existing structures. However, as experimental trials are strongly affected by local conditions and motivations, the development of new techniques and solutions are important to meet the needs of local communities and developers. Following a small scale community project, a feasibility study retrofitted five concrete-cast artificial rock pools (‘Vertipools’) on to a vertical seawall on the south coast of England. After 5 years, the artificial pools increased the species richness of the sea wall and attracted mobile fauna previously absent, including fish and crabs. The Vertipools had assemblages which supported several functional groups including predators and grazers. Although disturbance of algal assemblages on the seawall from the retrofitting process was still evident after 3 years, succession to full canopy cover was underway. Collaboration between policy makers, ecologists, children and artists produced an ecologically sensitive design that delivered substantial benefits for biodiversity and that could be adapted and scaled-up to both mitigate habitat loss and enhance coastal recreational amenity.
The Complete Mitochondrial Genome and Expression Profile of Mitochondrial Protein-Coding Genes in the Bisexual and Parthenogenetic Haemaphysalis longicornis

The tick Haemaphysalis longicornis is widely distributed in eastern Asia, New Zealand and Australia, and is well-known as a vector of multiple zoonotic pathogens. This species exhibits two reproductive strategies, bisexual and obligate parthenogenetic reproduction. Hence, in the current study, the complete mitochondrial genomes of the bisexual and parthenogenetic populations were assembled and analyzed, and the expression of the mitochondrial protein-coding genes was evaluated and compared between the two reproductive populations. The results indicated that the length of the mitochondrial genomes of the two reproductive populations is 14,694 and 14,693 bp in the bisexual and parthenogenetic populations, respectively. The AT content in the mitochondrial genome of the bisexual and obligate parthenogenetic population reached 77.22 and 77.34%, respectively. The phylogenetic tree was constructed combining 13 protein-coding genes, which showed that the genetic distance between the bisexual and parthenogenetic populations was less than that between the subspecies. The expression of the mitochondrial protein-coding genes was quantitatively analyzed at different feeding status for the bisexual and parthenogenetic populations, and the results showed significant differences in the expression patterns of these genes, suggesting that they might trigger specific energy utilization mechanisms due to their different reproductive strategies and environmental pressures.
Infant Can Visually Differentiate the Fresh and Degraded Foods: Evidence From Fresh Cabbage Preference

Perceiving and judging food quality is indispensable in daily life. The present study examined this ability’s development in infants during the early postnatal months. We tested if infants aged 5–8 months can discriminate different degree of freshness in cabbage, strawberry, carrot, and spinach. In Experiment 1, images of fresh and degraded vegetables were presented side by side; infants aged 7–8 months significantly preferred fresh over degraded cabbage images. In Experiments 2 and 3, infants aged 7–8 months maintained their preference when the images were achromatic, but no longer preferred the fresh cabbage images when pixels in those images were randomized. Given these results, we suggest that the ability to discriminate different degrees of freshness, at least for cabbage, develops at approximately 7–8 months of age, which is the time probably prior to taste learning.
The Emergence of Rare Clinical Aspergillus Species in Qatar: Molecular Characterization and Antifungal Susceptibility Profiles

Aspergillus are ubiquitous mold species that infect immunocompetent and immunocompromised patients. The symptoms are diverse and range from allergic reactions, bronchopulmonary infection, and bronchitis, to invasive aspergillosis. The aim of this study was to characterize 70 Aspergillus isolates recovered from clinical specimens of patients with various clinical conditions presented at Hamad general hospital in Doha, Qatar, by using molecular methods and to determine their in vitro antifungal susceptibility patterns using the Clinical and Laboratory Standards Institute (CLSI) M38-A2 reference method. Fourteen Aspergillus species were identified by sequencing β-tubulin and calmodulin genes, including 10 rare and cryptic species not commonly recovered from human clinical specimens. Aspergillus welwitschiae is reported in this study for the first time in patients with fungal rhinosinusitis (n = 6) and one patient with a lower respiratory infection. Moreover, Aspergillus pseudonomius is reported in a patient with fungal rhinosinusitis which is considered as the first report ever from clinical specimens. In addition, Aspergillus sublatus is reported for the first time in a patient with cystic fibrosis. In general, our Aspergillus strains exhibited low MIC values for most of the antifungal drugs tested. One strain of Aspergillus fumigatus showed high MECs for echinocandins and low MICs for the rest of the drugs tested. Another strain of A. fumigatus exhibited high MIC for itraconazole and categorized as non-wild type. These findings require further analysis of their molecular basis of resistance. In conclusion, reliable identification of Aspergillus species is achieved by using molecular sequencing, especially for the emerging rare and cryptic species. They are mostly indistinguishable by conventional methods and might exhibit variable antifungal susceptibility profiles. Moreover, investigation of the antifungal susceptibility patterns is necessary for improved antifungal therapy against aspergillosis.