Miracle-dz/UniFAR-FTUs huggingface dataset:
Mifepristone in the induction of labour at term

Objectives: To assess the ability of mifepristone to prime the cervix and induce labor at term. When mifepristone alone is insufficient, to determine if vaginal misoprostol used sequentially, is effective in inducing labor. Methods: Hospital based, prospective randomized comparative study conducted in Lady Goschen Hospital and Kasturba Medical College, Mangalore. Inclusion criteria were women with singleton pregnancy (confirmed by USG) with gestational age 37-42 weeks and cervical Bishop’s score 5, scarred uterus, hypersensitivity to prostaglandins or mifepristone, major cephalopelvic disproportion, impaired renal hepatic or adrenal function, antepartum haemorrage and severe oligohydramnios. Statistical analysis was performed using the χ2 test and p<0.05 was considered significant. Results: The study demonstrated significant efficacy of mifepristone for cervical ripening and induction of spontaneous labor after drug administration as more women had favorable Bishop’s scores at the end of 48h. In the present study 66% of women entered labor spontaneously or had a sufficiently ripened cervix within 48h of intake of mifepristone, but there was no difference in time between prostaglandin administration and delivery interval between the groups. There were less no. of caesarean section in the study group but the difference was not statistically significant. Maternal complications and neonatal out comes were comparable in both the group. Even though, there is a theoretical risk of hypoglycemia in the newborn, the present study showed no difference in the same among the 2 groups. Conclusion: Mifepristone (RU 486) is a safe, efficient and suitable agent for cervical ripening and for initiation of labor when given 48h before labor induction.
Professional burnout of personnel working in summer camps of people with disabilities

Introduction: Professional burnout constitutes a syndrome of physical and mental exhaustion occurring in working environment with symptoms that are present after frequent and long-term exposure in difficult working conditions especially in special education settings where a higher burnout in noticed due to tne nature of the profession. Purpose: The purpose of this study was to examine professional burnout of working personnel in summer camps for people with disabilities. Materials – Methods: The sample consisted of 35 participants (11 men and 25 women) all camp personnel escorting people with disabilities in summer camps. Each participant completed the Maslach Burnout Inventory (Maslach & Jackson, 1986) comprised of 22 items that assess the variables of exhaustion, accomplishment and depersonalization. Omega total reliability analysis revealed an internal consistency ranging from good (ω total= .72) to high (ω total = .91) and a positive interaction between all factors. Independent samples t-test revealed differences personal accomplishment (t = -1.9 , df = 33, p = 0.32) και depersonalization t = -2.59 , df = 33, p = . 014) according to participation in physical activity during the summer camp period. ANOVA analysis showed statistically significant differences in depersonalization (F (3, 33) = 2.81, p = . 043, η 2 =. 076 ), exhaustion (F (3, 33) = . 335, p = . 032, η 2 =. 084 ) , and personal accomplishment (F (3, 33) = 4.67, p = . 008, η 2 =. 090 ) in relation to work satisfaction and type of disability. Conclusions: Professional burnout of personnel working in summer camps for people with disabilities appears high due to many hours and high working load that is affected by the nature of disability, participation of personnel in physical activities and their satisfaction derived from primary profession other than summer camp work.
Treatment decisions on antidepressants in nursing homes: A qualitative study

Objective. To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. Design and subjects. A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. Results. The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. Conclusions. This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.
Kallikrein-related peptidase 6 exacerbates disease in an autoimmune model of multiple sclerosis

Abstract Kallikrein-related peptidase 6 (Klk6) is elevated in the serum of multiple sclerosis (MS) patients and is hypothesized to participate in inflammatory and neuropathogenic aspects of the disease. To test this hypothesis, we investigated the impact of systemic administration of recombinant Klk6 on the development and progression of MOG35-55-induced experimental autoimmune encephalomyelitis (EAE). First, we determined that Klk6 expression is elevated in the spinal cord of mice with EAE at the peak of clinical disease and in immune cells upon priming with the disease-initiating peptide in vitro. Systemic administration of recombinant Klk6 to mice during the priming phase of disease resulted in an exacerbation of clinical symptoms, including earlier onset of disease and higher levels of spinal cord inflammation and pathology. Treatment of MOG35-55-primed immune cells with Klk6 in culture enhanced expression of pro-inflammatory cytokines, interferon-γ, tumor necrosis factor, and interleukin-17, while reducing anti-inflammatory cytokines interleukin-4 and interleukin-5. Together these findings provide evidence that elevations in systemic Klk6 can bias the immune system towards pro-inflammatory responses capable of exacerbating the development of neuroinflammation and paralytic neurological deficits. We suggest that Klk6 represents an important target for conditions in which pro-inflammatory responses play a critical role in disease development, including MS.
Evaluation of Ahmed glaucoma valve implantation through a needle-generated scleral tunnel in Mexican children with glaucoma

Dear Editor, We have read the whole article with great interest. We would like to congratulate Albis-Donado et al.[1] for such a large series of cases evaluating success rate of Ahmed glaucoma valve (AGV) in refractory cases of glaucoma very sincerely. We have few comments to make on the study and those are as follows: 1. There had been changes in the technique of AGV implantation over a period of time (e.g. making scleral fl ap for the tunnel of entry or direct entry with needle), the success rate would be biased by the technique variations as described in your study. 2. Those cases which were not included in the study because of short follow-up period could add to failure rates in your case series. So it is diffi cult to draw a conclusion from the success rates in three diff erent categories shown in the study. 3. In the case which underwent endophthalmitis, you have described the site of infection as the previous site of surgery and not the intervention site done for AGV. If the eye was quite before AGV intervention, it is diffi cult to determine the site of infection. [2] 4. There are no defi nite data on failure rates because of fi brosis or bleb failures of previous surgeries done. 5. There is no control group to show the comparison of your technique and its success rate. There may be bias based on cases selection in your series. 6. Preoperative data previous to fi rst surgery on the eye could matt er a lot to decide how benefi cial was the fi rst surgery to achieve target pressure and how long it served the purpose. Considering complete success group, e.g., even you have achieved a pressure of 20 mm Hg, it may not serve the purpose if the previous target pressure was 15 mm Hg. So, the higher IOP would have a role to play on optic nerve even though you have kept that eye in complete success group without medication. Vandana Dwivedi, Neeraj Pandey
Strategies in Comparison of Methods for Scoring Patient Managementproblems

The study was designed to determine whether alternative scoring strategies result in improved measurement properties of patient management problems (PMP). For each of 16 PMPs used in a certifying examination, thefollowingscoringsystems were developed: proficiency, efficiency, select, omit, data gathering, therapy, absolute (dichotomouspass/fail), goal-oriented, and an empiric expert score. Scores with each system were developedfor 4,590firsttime takers and compared to two external criterion measures, namely, the examinees' "clinical-competence" rating by their program director, and the examinees'membership in a "high" or "low" criterion status group. The results demonstrated high correlations between all scoring systems and high correlations with simultaneous multiple-choice (MCQ) scores. Each showed moderate correlation with the validity measures. Using regression analysis, none of the PMPs coresprovided significant unique incremental validity not provided by MCQ scores. The implications of these data in the use of PMPs in certifying or licensure examinations are discussed.
National Library of Medicine Classification compared with Bliss class H

A comparison of the National Library of Medicine Classification with class H of Bliss' Bibliographic Classification is made under three headings. Firstly the author's 12 criteria for judging classification schemes are used to compare these two schemes in detail. These criteria cover basis, order, universality, hospitality, adaptability, terminology, indication of relations, synthesis, notation, ease of use, revision and practical use. Bliss is shown to be superior in all except one aspect of notation. In the second part the twelfth criterion is used to compare the practical use of the schemes, a test file of 13 titles being classified by the two schemes and relative merits and disadvantages discussed. Bliss always gives specific if sometimes long class marks, but the National Library of Medicine Classification has the disadvantages of lack of specificity, lack of synthesis and two places for some subjects. The third part compares the indexes of the two schemes, showing that Bliss contains more indexing terms despite the National Library of Medicine Classification's larger bulk, and that Bliss gives clear, unambiguous, full and specific subject indexing. The disadvantages of alphabetic subject indexing are mentioned. Finally some defences put forward for the National Library of Medicine Classification are criticized.
Breast magnetic resonance imaging findings in women treated with toremifene for premenstrual mastalgia

Background: Toremifene, a selective estrogen receptor modulator, has been shown to be effective in alleviating premenstrual breast pain. However, the exact mechanism by which toremifene and related compounds work in premenstrual mastalgia is poorly understood. Purpose: To find out if the effect of toremifene on breast would be detectable with dynamic magnetic resonance imaging (MRI). Material and Methods: This randomized, double-blind crossover study was performed on women suffering from marked premenstrual mastalgia. Ten women were randomized to receive either toremifene (20 mg) or placebo from cycle day 15 until next menstruation for three menstrual cycles. After a washout period, the treatment was crossed over for three additional cycles. The MRI evaluations were performed premenstrually at the end of each treatment phase. Breast pain and quality-of-life scores were collected from one baseline cycle and from all the treatment cycles. Results: Nine patients were evaluable for this analysis. Both the enhancement ratio and the maximum slope of enhancement tended to be smaller during the toremifene cycles as compared to placebo. On the left side, the difference in the maximum slope of enhancement between toremifene and placebo was statistically significant (median 5.150 [range 3.7–6.7] and 6.500 [range 4.9–9.5], respectively; P=0.047). T2 relaxation times as well as breast pain and quality-of-life scores were inconsistent. Conclusion: Use of toremifene is associated with measurable changes in dynamic breast MRI findings in women with cyclic breast pain.
Prevalence and determinants of age-related macular degeneration in the 50 years and older population: A hospital based study in Maharashtra, India

Background: We present the magnitude and determinants of age-related macular degeneration (ARMD) among the 50 year and older population that visited our hospital. Materials and Methods: This was a cohort of eye patients with ARMD, seen from 2006 to 2009. Optometrist noted the best-corrected vision. Ophthalmologists examined eyes using a slit-lamp bio-microscope. The ARMD was confirmed by fluoresceine angiography and optical coherent tomography. The age, sex, history of smoking, sun exposure, family history of ARMD, diet, body mass index (BMI), hypertension, and diabetes were associated with ARMD. Result: Of the 19,140 persons of ≥ 50 years of age-attending eye clinic in our hospital, 302 persons had ARMD in at least one eye. The proportion of overall ARMD was 1.38% (95% CI 1.21--1.55). The proportion of age-related maculopathy (ARM) and late ARMD was 1.14% (95% CI 0.99--1.29) and 0.24% (95% CI 0.21–0.24) respectively. ARM was unilateral and bilateral in 64 (29.2%) and 155 (70.8%) persons respectively. Dry ARMD was found in 47.8%. On regression analysis, old age (OR = 1.05), male (OR = 0.54), and history of smoking (OR = 2.32) were significant risk factors of ARMD. A total of 4.2% of persons with ARMD were blind (vision <3/60). Only 43% of persons with ARMD had J6 grade of the best-corrected near vision. Conclusion: ARMD does not seem to be of public health magnitude in the study area. Early stages of ARMD were common among patients. ge, being male, and history of smoking were significant risk factors for ARMD.
Differentiation between grade 3 and grade 4 articular cartilage defects of the knee: Fat-suppressed proton density-weighted versus fat-suppressed three-dimensional gradient-echo MRI

Background: Fat-suppressed (FS) proton density (PD)-weighted magnetic resonance imaging (MRI) and FS three-dimensional (3D) gradient-echo imaging such as spoiled gradient-recalled (SPGR) sequence have been established as accurate methods for detecting articular cartilage defects. Purpose: To retrospectively compare the diagnostic efficacy between FS PD-weighted and FS 3D gradient-echo MRI for differentiating between grade 3 and grade 4 cartilage defects of the knee with arthroscopy as the standard of reference. Material and Methods: Twenty-one patients who had grade 3 or 4 cartilage defects in medial femoral condyle at arthroscopy and knee MRI were included in this study: grade 3, >50% cartilage defects; grade 4, full thickness cartilage defects exposed to the bone. Sagittal FS PD-weighted MR images and FS 3D gradient-echo images with 1.5 T MR images were independently graded for the cartilage abnormalities of medial femoral condyle by two musculoskeletal radiologists. Statistical analysis was performed by Fisher's exact test. Inter-observer agreement in grading of cartilage was assessed using κ coefficients. Results: Arthroscopy revealed grade 3 defects in 17 patients and grade 4 defects in 4 patients in medial femoral condyles. For FS 3D gradient-echo images grade 3 defects were graded as grade 3 (n=15) and grade 4 (n=2), and all grade 4 defects (n=4) were correctly graded. However, for FS PD-weighted MR images all grade 3 defects were misinterpreted as grade 1 (n=1) and grade 4 (n=16), whereas all grade 4 defects (n=4) were correctly graded. FS 3D gradient-echo MRI could differentiate grade 3 from grade 4 defects (P=0.003), whereas FS PD-weighted imaging could not (P=1.0). Inter-observer agreement was substantial (κ=0.70) for grading of cartilage using FS PD-weighted imaging, whereas it was moderate (κ=0.46) using FS 3D gradient-echo imaging. Conclusion: FS 3D gradient-echo MRI is more helpful for differentiating between grade 3 and grade 4 cartilage defects than is FS PD-weighted imaging.
Children and Domestic Violence: A System of Safety in Clinical Practice

Abstract The present paper provides a framework for working with children and families where there are domestic violence and child protection concerns. A model of practice developed by the St George Domestic Violence Counselling Service and the St George Child and Adolescent Mental Health Service in the South East Sydney and Illawarra Health Service (NSW, Australia) is outlined. The present paper includes a discussion on a recently developed service agreement between the two services and a case study focusing on a ‘system of safety’ when working with children. The present paper focuses on the effects of domestic violence on women and children by male perpetrators. We do not ignore that men may be victims of domestic violence; however, the authors recognise the gendered nature of domestic violence and the significant number of women and children who experience and live with domestic violence.
Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of alopecia areata.

BACKGROUND Intralesional corticosteroids are the treatment of choice for adults with less than 50% of scalp area involvement with alopecia areata. The sensitivity of picking up clinical response to treatment by clinical examination is very variable and has inter individual variation. AIMS To evaluate the efficacy of intralesional triamcinolone acetonide in the treatment of alopecia areata and to use dermoscopy to identify signs of early clinical response and adverse effects. METHODS Seventy patches in 60 patients were injected with steroid at 4 weeks interval and followed up for 24 weeks. Treatment response was evaluated using regrowth scale (RGS). Heine DELTA 20; dermatoscope was used to assess disease activity, response to treatment and side effects. RESULTS Twenty eight patients responded early and achieved RGS of 4 within 12 weeks and 29 patients responded late and achieved RGS of 4 within 24 weeks of initiating therapy. There were 3 patients who did not achieve RGS of 4 at 24 weeks. Late and incomplete responders showed statistically significant association with family history of alopecia areata (p < 0.0001), presence of recurrent disease (p = 0.0147) and presence of nail changes (p = 0.0007). Dermoscopically, 60 patches demonstrated regrowth of new vellus hair at 4 weeks. Tapering hair disappeared maximally at 4 weeks. At 12 weeks, complete disappearance was seen in tapering hairs, broken hairs and black dots whereas for yellow dots to disappear completely in all patches it took 16 weeks. The adverse effects were observed at an earlier stage using dermoscopy than clinically. CONCLUSION Intralesional triamcinolone acetonide is efficacious for treatment of localized patchy alopecia areata. Dermoscopy is very useful to identify signs of early clinical response, adverse effects and markers of disease activity.
The Current State of Elective off-Pump Coronary Bypass Surgery

Copyright: © 2014 Durukan AB. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In recent years of coronary bypass surgery, despite the accelerated development of surgical techniques and equipment, the debate over off-pump and on-pump surgery has not lost its popularity. Classically the off-pump procedures are suitable for the patients with high rates of morbidity and potential mortality including low ejection fraction, stroke, chronic obstructive pulmonary disease and renal failure. However, the recommended surgical patient should preferentially have single vessel disease with anterior location without calcification, should be hemodynamically stable and should have every risk factor as low as possible [1]. Even this controversy creates a conflict in every single cardiac surgery resident beginning early in their education period. So, how can we decide on off-pump or on-pump “? ”.
Primary cryoglobulinemia with cutaneous features.

The initial presentation in most cases of nasolacrimal tuberculosis is a non‐specific symptom like epiphora which was also the presenting symptom in both our patients. This explains the time delay of up to 3 years between the onset of symptoms and diagnosis in most of the previous reports on nasolacrimal tuberculosis. [4,6] Delay in diagnosis and treatment can lead to extension of the infectious process to intraocular tissues, causing severe visual impairment. The appearance of cutaneous lesion in our patients helped us to clinch the correct diagnosis relatively early, thus minimizing morbidity to the patients. Moreover, the use of MRI technique helped us to localize the site of infection in the lacrimal sac without any invasive exploratory surgery. Whereas, in almost all the previous studies, some form of invasive surgery had to be done to confirm the primary site of pathology. [5,6]
RisKit: The participatory development and observational evaluation of a multi-component programme for adolescent risk behaviour reduction

Aims: to develop and observationally evaluate a multi-component programme for the reduction of risk behaviours in vulnerable adolescents. Methods: the programme was theoretically informed by Catalano and Hawkins’ social development model. It was developed using a combination of participatory consultation with young people and a review of evidence reviews. The resulting programme involved screening of school pupils at ages 14–16 years to identify those at risk, inviting them to attend two generic drug and alcohol awareness sessions, and then eight targeted life skills training sessions, alongside one-to-one motivational interviews and the creation of contacts with youth services. Evaluation was carried out using qualitative methods and the quantitative analysis of timeline follow-back questionnaires on drug and alcohol use at entry, exit and six-month follow-up from 226 programme participants. Findings: qualitative data showed that the programme was feasible, acceptable and positively viewed by participants, delivery staff and school staff. The professional skills of delivery staff were important in making it feasible and acceptable. Quantitative evaluation showed significant reductions in alcohol use (as measured by percentage days abstinent and drinks per drinking day). There were also reductions in illicit drug (mostly cannabis) use, although these were not statistically significant. Conclusion: the participatory development process produced a theoretically and evidence informed programme that was highly acceptable and appreciated by its target participants. This evaluation provides evidence of potential effectiveness that is worthy of further evaluation using more rigorous scientific approaches. The RisKit programme is available for use under a Creative Commons licence.