Miracle-dz/UniFAR-FTUs huggingface dataset:
Tramadol Blood Level and Prediction of Seizures in Patients with Acute Tramadol Poisoning

Tramadol is a centrally acting synthetic opioid that is widely used for its analgesic effect. Tramadol abuse is increasing in Egypt, and seizure is possible among abusers. Hence, the aim of this study was to evaluate the characteristics of acute tramadol overdosed patients and the possibility of prediction of seizures among them. Fifty participants were recruited from acutely intoxicated tramadol patients admitted to the Poison Control Center (Emergency Hospital, Tanta University) between January, 2014 and December, 2015. For each patient history, clinical data and tramadol blood level as well as urine screen were recorded. The study showed a significant difference between different groups of age, gender, tramadol dose and period of hospital stay. The majority of cases were males, between 15 and 25 years-old, who ingested a dose ranging from 1000 to 3000 mg and stayed for less than 10 hours in the hospital. The occurrence of seizures was higher among patients exposed to a tramadol dose more than 1000 mg, those who developed hyper-reflexia and those with higher blood tramadol levels. At a cut off value >600 ng/ml, blood tramadol level had a sensitivity of 73.91%, a specificity of 74.91%, positive predictive value of 70.83% and negative predictive value of 76.92%. It could be concluded that hyper-reflexia, the amount of tramadol taken and tramadol blood concentration could be used to predict the development of seizures among tramadol overdosed patients.
Morphometric Measurements of the Maxillary Sinus Based on Cone Beam Computed Tomography in a Selected Kenyan Population

: Objective: To assess the maxillary antrum (sinus) volume, dimensions, and to establish the sinus floor relation ship to posterior maxillary teeth roots and the prevalence of septation using Cone beam Computed Tomogram (CBCT) scans in a selected Kenyan population. Study design: A descriptive, cross-sectional retrospective study. Study Area: The study was carried out in Nairobi, the capital city of Kenya, a cosmopolitan city that has the largest referral hospital in Kenya. Study material: Cone beam Computed Tomogram (CBCT) scans of the midface region obtained with permission from a private maxillofacial imaging centre in Nairobi. The study population was determined using convenient sampling method, obtaining 55 scans of the Maxillary sinus. Results: Fifty-five scans were analyzed with 20(36.4%) belonging to males and 35(63.6%) being scans of females. The mean septum height was 4.5mm±1.9mm and the mean exostosis height was 4.2mm±2.2mm. The closest root apex to the antral floor was the mesiobuccal root apex of the second permanent molar: 2.2mm±1.5mm. There was a statistically significant difference between gender and the anteroposterior dimension of the sinusp=0.02, The mean sinus volume was larger in males, 13980.4±5024.4mm 3 (13.9ml±5.0ml) than in females, 10,885±3305.6 mm 3 (10.8ml±3.3ml). The difference was not statistically significant. Conclusion: There is variation of the maxillary sinus size, within the same individual and among different individuals, thereby emphasizing the need for a complete imaging in treatment planning in the para-antral region. para-antral
Evaluation of Ventriculoperitoneal Shunt Infections in Children

1 Department of Pediatric Infectious Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey 2 Department of Pediatrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey 3 Department of Pediatrics Neurology, Karadeniz Technical University School of Medicine, Trabzon, Turkey 4 Department of Medical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey 5 Department of Neurosurgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey DOI: 10.5578/ced.201843 • J Pediatr Inf 2018;12(4):e147-e152 Original Investigation / Özgün Araştırma
Application of Negative Pressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience

Recent therapeutic advances in the management of severe abdominal sepsis (SAS) have improved patient mortality and morbidity. However, SAS and its impact on multiple organ failure remain a serious, life-threatening condition with a high mortality rate. The open abdomen (OA) technique has become an effective alternative to repeat laparotomy. The use of OA negative pressure wound therapy (OA NPWT) has been a significant advancement in the management of the open abdomen. Similarly, negative pressure wound therapy (NPWT) with instillation and dwell time (NPWT-i) has been used in patients with multiple comorbidities, with an American Society of Anesthesiology Classification ≥ 2, severe traumatic wounds, diabetic foot infections, and wounds complicated by invasive infection or extensive biofilm. Controlled instillation of saline during NPWT-i may further enhance healing by facilitating automatic and contained volumetric wound irrigation and cleansing and diluting local levels of inflammatory cytokines, improving the local as well as the systemic response to infection. Although the soft tissue and intra-abdominal compartments differ anatomically, they share very similar biologic responses to infections. Therefore, from a biologic and physiologic aspect, intraperitoneal instillation therapy may play a role as an adjunctive treatment of abdominal compartment inflammation from trauma or infection. The addition of saline solution instillation to OA NPWT (OAI) in a programmed, controlled manner may offer the clinician an effective adjunctive therapy for the treatment of the complex septic abdomen. The technical aspects of instillation into the OA and a pooled multicenter case study cohort utilizing OAI with saline solution, bacitracin, or hypochlorous acid in the management of the septic abdomen is presented.
Visual tests predict dementia risk in Parkinson disease

Objective To assess the role of visual measures and retinal volume to predict the risk of Parkinson disease (PD) dementia. Methods In this cohort study, we collected visual, cognitive, and motor data in people with PD. Participants underwent ophthalmic examination, retinal imaging using optical coherence tomography, and visual assessment including acuity and contrast sensitivity and high-level visuoperception measures of skew tolerance and biological motion. We assessed the risk of PD dementia using a recently described algorithm that combines age at onset, sex, depression, motor scores, and baseline cognition. Results One hundred forty-six people were included in the study (112 with PD and 34 age-matched controls). The mean disease duration was 4.1 (±2·5) years. None of these participants had dementia. Higher risk of dementia was associated with poorer performance in visual measures (acuity: ρ = 0.29, p = 0.0024; contrast sensitivity: ρ = −0.37, p < 0.0001; skew tolerance: ρ = −0.25, p = 0.0073; and biological motion: ρ = −0.26, p = 0.0054). In addition, higher risk of PD dementia was associated with thinner retinal structure in layers containing dopaminergic cells, measured as ganglion cell layer (GCL) and inner plexiform layer (IPL) thinning (ρ = −0.29, p = 0.0021; ρ = −0.33, p = 0.00044). These relationships were not seen for the retinal nerve fiber layer that does not contain dopaminergic cells and were not seen in unaffected controls. Conclusion Visual measures and retinal structure in dopaminergic layers were related to risk of PD dementia. Our findings suggest that visual measures and retinal GCL and IPL volumes may be useful to predict the risk of dementia in PD.
Association between benzodiazepine prescriptions and potential risk factors of adverse drug reactions among elderly and very elderly: findings from Friuli Venezia Giulia region, Italy

Background: benzodiazepines (BDZs) highly increase the risk of adverse drug reactions (ADRs), especially in the elderly with certain medical conditions. Methods: point-prevalence study in December 2017; 2,456 patients ≥65 years were included from 14 regional public and private hospitals, 24 long-term chronic care facilities (LTCCFs) and 20 nursing homes (NHs). Data regarded BDZ prescriptions and comorbidities, co-prescriptions, or concurrent diseases, which could increase the risk of ADRs in BDZ users. Univariate and multivariate logistic regression analyses were used to assess associations between ADRs in BDZ users vs. non-users, as well as within users. Results: 671 patients were prescribed BDZ, whose half were in NHs. Being prescribed 10 or more drugs was twice more common among BDZ users compared to non-users. BDZs were prescribed for long-term to 80% of patients in NHs, while proportions were halved in hospitals and LTCCFs. In the analyses within BDZ users, patients in NHs and LTCCFs were at higher risk of dementia and concurrent use of opioid analgesic and antipsychotics compared to hospitalized patients. Conclusions: the use of BDZs in older patients is common in FVG. A great extent of comorbidities and concurrent medications at higher risk of ADRs was found. Analyses in different healthcare settings can allow to drive evidence-based interventions in order to discourage the use of BDZs and monitor the raise of ADRs.
Repressive Transcription

Chromatin repression is ironically controlled by the initiation of transcription at specific sites in the genome. How are active and repressed portions of the genome established and maintained during development? In vertebrates, about 2 m of DNA is packaged into chromatin in a manner that allows for active transcription of some loci and repression of others. Most chromatin regulators do not recognize specific DNA sequences, so how are they recruited to specific sites throughout the genome? For actively transcribed genes, transcription factors or the transcription initiation apparatus recruit regulators associated with active chromatin (1). For genes that are repressed, recent studies suggest a counterintuitive model: Transcription initiates the formation of repressive chromatin (2–9).
Alginates: From the ocean to gastroesophageal reflux disease treatment.

Serhat Bor1 , İsmail Hakkı Kalkan2, Altay Çelebi3 , Dinç Dinçer4 , Filiz Akyüz5 , Peter Dettmar6 , Hasan Özen7 1Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, Ege Reflux Study Group, İzmir, Turkey 2Department of Gastroenterology, TOBB University of Economics and Technology School of Medicine, Turkey 3Division of Gastroenterology, Kocaeli University School of Medicine, Kocaeli, Turkey 4Division of Gastroenterology, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey 5Division of Gastroenterology, Department of Internal Medicine İstanbul School of Medicine, Istanbul University, İstanbul, Turkey 6RD Biomed Limited, Castle Hill Hospital, Cottingham, UK 7Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
Cord Blood Hemoglobin A1c and MCP-1 as Predictors for Cardiomyopathy in Infants of Mothers with Gestational Diabetes

Introduction: Diabetes is one of the commonest and important metabolic disorder that affects the health of pregnant women and infants. MCP-1 in the myocardium was correlated with the degree of impairment of cardiac function and HbA1c concentration is also regarded as a treatment marker in patients with diabetes.Objectives: The study aimed at measure the levels of cord blood Hemoglobin A1c and MCP-1 and correlate their levels with echocardiographic findings in infants of diabetic mothers (IDMs) in comparison to healthy neonates of healthy mothers.Patients and methods: The current study was a descriptive cross-sectional comparative one included 110 full term neonates divided in to two groups, the first group included 70 full term neonates born to diabetic mothers and the second group included 40 full term apparently healthy neonates born to healthy mothers as a control group. This study was conducted from April 2016 to April 2017 at Maternal and Children Hospital of El Minia. All Patients were assessed during the first week of life, this assessment included complete medical history, thorough clinical examination with stress on cardiac examination, and laboratory investigations included CBC and neonatal blood sugar as a routine investigations& HbA1c and MCP-1 as a specific investigations and echocardiographic assessment.Results: IDMs have increased cardiac dimensions, impaired diastolic function and lower fractional shortening compared to control group. There was a strong positive correlation between levels of cord blood MCP-1 and echocardiographic measurements in IDMs. There was a strong positive correlation between levels of cord blood HbA1c and echocardiographic measurements in IDMs.Conclusion: HbA1c and MCP-1 were good predictors for occurrence of cardiomyopathy in Infants of diabetic mothers with gestational diabetes.
Serum Neurofilament Light, Glial Fibrillary Acidic Protein and Tau Are Possible Serum Biomarkers for Activity of Brain Metastases and Gliomas

Background Primary central nervous system (CNS) tumors and brain metastases (BMs) are major causes of morbidity and mortality, accompanied by low survival rates. Efforts to early discovery of CNS malignancies are critical. However, to date, there are no biomarkers approved for detection of cancer activity in the brain. Blood levels of neurofilament light (NfL) and tau, as well as glial fibrillary acidic protein (GFAp), show promise as biomarkers for brain injury in previous studies. Therefore, we performed a cross-sectional study to investigate correlations of those biomarkers with CNS activity of gliomas and BMs. Methods Serum samples of 36 participants of a single centered institution were tested for NfL, GFAp and tau with Simoa immunoassay, and correlated with clinical and radiological data. Results NfL and GFAp levels were significantly associated with the state of intracranial disease (analysis of variance (ANOVA), PsNfL = 0.03; ANOVA, PGFAp = 0.03). Although statistically significant (P = 0.04), differences in concentrations were not clinically meaningful for tau levels. Serum NfL (sNfL) and GFAp concentrations were higher in the group of patients with CNS tumors with disease in progression versus CNS with stable disease (P = 0.03 and P = 0.01, respectively). In addition, sNfL were higher in patients with metastatic solid tumors with known BMs than in those with metastatic tumors with no BM (P = 0.0004). Conclusion sNfL and GFAp both apparently vary closely with presence and activity of gliomas and BMs. Further studies in larger populations are needed to expand these findings.
Authors’ reply to call for caution in the use of PainDETECT to stratify patients into neuropathic and nociceptive pain without additional clinical assessment

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.40801 This article is protected by copyright. All rights reserved. Article type : Reply to Letter to the Editor
The Safety and the Efficacy of First-line Antiretroviral Treatment Regimens in Children: A Single Center Experience in Turkey

Özge Kaba, Selda Hançerli Törün, Manolya Kara, Muammer Osman Köksal, Ali Ağaçfidan , Ayper Somer 1 Department of Pediatric Infectious Diseases, Istanbul University School of Istanbul Medicine, Istanbul, Turkey 2 Department of Microbiology and Medical Microbiology, Istanbul University School of Istanbul Medicine, Istanbul, Turkey DOI: 10.5578/ced.67663 • J Pediatr Inf 2018;12(4):e135-e139 Original Investigation / Özgün Araştırma
Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context

Abstract Aim The purpose of this study was to investigate the psychometric properties of the EQ-5D-3L and the EQ-5D-5L in patients with back and neck pain. Materials and methods Participants from two independent clinical survey studies was included in this study. In total 164 participants were answering either the EQ-5D-3L or the EQ-5D-5L after their visit to a physiotherapist in primary care for back and neck pain. Rasch analysis was performed to measure the psychometric properties of the two instruments. Main findings Overall, the EQ-5D-5L showed preliminary evidence of good psychometric properties. The items in both the EQ-5D-5L and the EQ-5D-3L showed acceptable goodness-of-fit indicating unidimensionality for both instruments measuring the concept health-related quality of life. All test persons fit the model, but the person separation reliability and person separation index were only barely acceptable for the EQ-5D-5L. Conclusions The results indicate that the EQ-5D-5L should be the preferred option when evaluating health-related quality of life with the EQ-5D, especially for patients with back and neck pain.
Factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital

Background An evidence-based practice suggests that the birth position adopted by women during labour has a significant impact on the maternal and neonatal birth outcomes. The birth positions are endorsed by guidelines of maternity care in South Africa, which documented that women in labour should be allowed to select the birth position of their choice, preferably alternative birth positions (including upright, kneeling, squatting and lateral positions) during labour. Thus, the lithotomy birth position should be avoided. However, despite available literature, midwives routinely position women in the lithotomy position during normal vertex births, which causes several adverse maternal outcomes (namely prolonged labour, postpartum haemorrhage) and adverse neonatal outcomes (such as foetal asphyxia and respiratory compromise). Aim The aim was to explore and describe factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. Setting A public hospital in the Tshwane district, Pretoria were used in the study. Methods This study used the qualitative, exploratory and descriptive research design. This design gathered quality information on factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. Results The study revealed the following themes: (1) midwives’ perceptions on alternative use of birth positions and (2) barriers to utilisation of alternative birth positions. The themes were discussed and validated through the use of a literature review. Conclusion The lack of skills and training during the midwifery undergraduate and postgraduate programme contributes to the midwives being incompetent to utilise alternative birth positions during clinical practice.
Cone beam computed tomography in assessment on pharynx effects of orthopedic-surgical treatment - a review of the literature

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.
Comparison of distribution of blood groups in inflammatory rheumatic diseases and healthy subjects

Objective: The present study investigates whether a relationship exists between the ABO and Rh blood groups and the type of rheumatic disease in patients with inflammatory rheumatic disease. Method: The present study was based on the data of 1,272 healthy subjects and 1,028 patients with an inflammatory rheumatic disease who were followed up in our clinic between June 2016 and January 2019. The type of rheumatic disease and the ABO and Rh blood groups of the participants were recorded. Results: The A blood group was more prevalent in patients with inflammatory rheumatic disease and in the healthy subjects, followed by the O, B and AB blood groups in respective order, although there was no significant difference between the ABO groups in terms of distribution(p>0.05). The Rh (+) blood group was more prevalent than Rh (-) in both groups, although there was a statistically significant difference in terms of the distribution of the Rh blood group among the groups(p<0.05). According to the results of a logistic regression analysis, the Rh (-) blood type decreases the likelihood of developing a rheumatic disease (p<0.05). Conclusions: The A and Rh (+) blood groups were more commonly observed in patients with inflammatory rheumatic diseases, followed by the O, B and AB blood groups. Furthermore, patients with the Rh (-) blood type were less likely to develop rheumatic disease. The present study may serve as a guide for future clinical studies evaluating the relationship between rheumatic diseases and blood types in terms of genetic predisposition and pathogenesis.
Comparison of Lumbar Laminectomy Alone, Lumbar Laminectomy and Fusion, Stand-alone Anterior Lumbar Interbody Fusion, and Stand-alone Lateral Lumbar Interbody Fusion for Treatment of Lumbar Spinal Stenosis: A Review of the Literature

Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many factors must be taken into account before choosing a surgical approach. In addition, the patient’s anatomy and pathology, lifestyle, and desires should be analyzed to help determine the ideal surgical strategy
Outcomes of interfacility helicopter transportation in acute stroke care.

Objective To evaluate the long-term functional outcome of interhospital transfer of patients with stroke with suspected large vessel occlusion (LVO) using Helicopter Emergency Medical Services (HEMS). Methods Records of consecutive patients evaluated through 2 telestroke networks and transferred to thrombectomy-capable stroke centers between March 2017 and March 2018 were reviewed. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to address confounding factors. Multivariate logistic regression analysis with IPTW was used to determine whether HEMS were associated with good long-term functional outcome (modified Rankin scale score ≤ 2). Results A total of 199 patients were included; median age was 67 years (interquartile range [IQR] 55-79 years), 90 (45.2%) were female, 120 (60.3%) were white, and 100 (50.3%) were transferred by HEMS. No significant differences between the 2 groups were found in mean age, sex, race, IV tissue plasminogen activator (tPA) receipt, and thrombectomy receipt. The median baseline NIH Stroke Scale score was 14 (IQR 9-18) in the helicopter group vs 11 (IQR 6-18) for patients transferred by ground (p = 0.039). The median transportation time was 60 minutes (IQR 49-70 minutes) by HEMS and 84 minutes (IQR 25-102 minutes) by ground (p < 0.001). After weighting baseline characteristics, the use of HEMS was associated with higher odds of good long-term outcome (OR 4.738, 95% CI 2.15-10.444, p < 0.001) controlling for transportation time, door-in-door-out time, and thrombectomy and tPA receipt. The magnitude of the HEMS effect was larger in thrombectomy patients who had successful recanalization (OR 1.758, 95% CI 1.178-2.512, p = 0.027). Conclusions HEMS use was associated with better long-term functional outcome in patients with suspected LVO, independently of transportation time.