Miracle-dz/UniFAR-FTUs huggingface dataset:
A primary care provider's guide to preventive and acute care management of adults and children with sickle cell disease

Purpose: To familiarize primary care providers (PCPs) with the pathophysiological processes, diagnostic evaluation, and medical management of sickle hemoglobinopathies and their complications. Current standards of care, clinical research advances, and new treatment options will also be addressed to assist PCPs in the management of sickle cell disease (SCD). Data sources: A selective search and review of the current literature on SCD and the authors' experience. Conclusions: Management of individuals with SCD is very complex, requiring a multidisciplinary approach that includes the patient or parent, PCP, specialist, nurse, and social worker. More patients living with SCD are relying on PCPs in nonspecialty practices for comprehensive disease management. Implications for practice: Newborn screening detects new cases of SCD annually. The median life expectancy has more than doubled for individuals with sickle cell anemia. Healthcare providers are now in an era of increased routine screening, assessment, and management of chronic complications from this illness not previously seen in the care of adults with SCD.
Effectiveness of box trainers in laparoscopic training

Rationale and Objectives: Various devices are used to aid in the education of laparoscopic skills ranging from simple box trainers to sophisticated virtual reality trainers. Virtual reality system is an advanced and effective training method, however it is yet to be adopted in India due to its cost and the advanced technology required for it. Therefore, box trainers are being used to train laparoscopic skills. Hence this study was undertaken to assess the overall effectiveness of the box-training course. Study Procedure: The study was conducted during six-day laparoscopic skills training workshops held during 2006. Twenty five surgeons; age range of 26 to 45 years, of either sex, who had not performed laparoscopic surgery before; attending the workshop were evaluated. Each participant was given a list of tasks to perform before beginning the box-training course on day one and was evaluated quantitatively by rating the successful completion of each test. Evaluation began when the subject placed the first tool into the cannula and ended with task completion. Two evaluation methods used to score the subject, including a global rating scale and a task-specific checklist. After the subject completed all sessions of the workshop, they were asked to perform the same tasks and were evaluated in the same manner. For each task completed by the subjects, the difference in the scores between the second and first runs were calculated and interpreted as an improvement as a percentage of the initial score. Statistical Analysis: Wilcoxon matched-paired signed-ranks test was applied to find out the statistical significance of the results obtained. Results: The mean percentage improvement in scores for both the tasks, using global rating scale, was 44.5% ± 6.930 (Mean ± SD). For task 1, using the global rating scale mean percentage improvement was 49.4% ± 7.948 (Mean ± SD). For task 2, mean percentage improvement using global rating scale was 39.6% ± 10.4 (Mean ± SD). Using Wilcoxon matched-paired signed-ranks test, 2-tailed P-value<0.0001 which is extremely significant. Conclusion: This study confirms that a short-term, intensive, focused course does improve laparoscopic skills of trainees. Box-trainers can be used to change the present day didactic training into objective and competency-based. Global rating scale and checklist provide an inexpensive and effective way of objective assessment of performance of laparoscopic skills.
Motivación interna y rendimiento académico de los estudiantes de inglés de la ULA Táchira.

Se hizo un estudio descriptivo correlacional con 169 estudiantes de ingles como lengua extranjera para determinar la relacion existente entre la motivacion interna y el rendimiento academico. Asimismo, se determinaron las actitudes motivacionales mas comunes de los participantes y sus caracteristicas demograficas. La recoleccion de los datos se hizo a traves de un cuestionario donde se pidio a los participantes reportar su componente motivacional hacia el aprendizaje del ingles. Los resultados sugieren diferentes tipos de relacion entre la motivacion interna y el rendimiento academico, dependiendo de si este ultimo es excelente, bueno, o regular. De igual manera, los resultados evidencian el interes en el aprendizaje del idioma y el placer por el estudio del ingles como las actitudes mas representativas del comportamiento motivacional de los participantes
Jordanian nurses' attitudes toward older patients in acute care settings.

PURPOSE To identify and describe Jordanian nurses' attitudes toward older patients in acute care settings. The effects of socio-demographics and nursing work characteristics on nurses' attitudes were also examined. METHOD Descriptive correlational design was used. Kogan's (1961) Attitudes Toward Old People Scale was administered to a total population of Jordanian nurses (n = 200) working in selected units in acute care settings of three public hospitals in northern Jordan. Nurses' attitudes were described by using descriptive statistics. ANOVA and Pearson correlation were used to examine the effects of selected socio-demographic details and work characteristics on nurses' attitudes. RESULTS Jordanian nurses who participated in this study had marginally positive attitudes toward older patients in acute care settings. Years of clinical experience correlated significantly with their attitudes. Male nurses had significantly more positive attitudes than their female counterparts. Surgical nurses also demonstrated significantly more positive attitudes than those working in medical units. CONCLUSION Although positive attitudes emerged towards older people, it was also apparent that efforts should be made to enhance them further so that quality care is delivered to this population. In addition, Jordanian nurse educators should put a greater focus on issues related to the care of the older person in their nursing curriculum.
Reciprocal translocations in myelodysplastic syndromes and chronic myelomonocytic leukemias: Review of 5,654 patients with an evaluable karyotype

The infrequency of translocations in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemias (CMML) makes their identification and reporting interesting for the recognition of the recurrent ones and the genes involved in these neoplasias. The aims of this study were to identify new translocations associated with MDS and CMML and to establish their frequency in a cohort of 8,016 patients from the Spanish Group of MDS database. The karyotype was evaluable in 5,654 (70%) patients. Among those, 2,014 (36%) had chromosomal abnormalities, including 213 (10%) translocations identified in 195 patients. The translocations were balanced in 183 (86%) cases and unbalanced in 30 (14%) cases. All chromosomes were found to be involved in translocations, with the single exception of the Y chromosome. The chromosomes most frequently involved were in decreasing frequency: 3, 1, 7, 2, 11, 5, 12, 6, and 17. Translocations were found in karyotypes as the unique chromosomal abnormality (33%), associated with another chromosomal abnormality (11%), as a part of a complex karyotype (17%), and as a part of a monosomal karyotype (38%). There were 155 translocations not previously described in MDS or CMML and nine of them appeared to be recurrent. © 2013 Wiley Periodicals, Inc.
The Role of Parainfluenza Viruses in Inspiratory Difficulties in Children

ABSTRACT. Viral findings were prospectively studied in middle and lower respiratory tract infections in 449 hospitalized children during a 12‐month follow‐up period. A viral aetiology was found in 30 of the 65 children (46%) with inspiratory difficulties. Parainfluenza viruses were the infective agents in 24 of the 30 cases with viral diagnoses (80%), type 2 being the most prominent. There were 38 cases of parainfluenza infections, type 2 being the infective agent in 58% of the 24 cases of parainfluenza infections with inspiratory difficulties but in only 21% of the 14 cases of parainfluenza infections without inspiratory difficulties. Type 2 parainfluenza virus produced inspiratory difficulties in 82% of the cases as opposed to 56 and 50% of the cases for type 1 and 3, respectively. It is concluded that the type 2 parainfluenza virus has a particular association with inspiratory difficulties in children. Viral diagnosis was reached using direct antigen detection in nasopharyngeal specimens by radioimmunoassay in 59% and using complement fixation serology in 76% of parainfluenza infections. Ditect antigen detection was especially useful in infants. We suggest that direct antigen detection should be used as a primary virological diagnostic method in small children with middle and lower respiratory tract infections.
Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure

ABSTRACT Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years. Subjects and Methods: We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component. Results: Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%). Conclusions: Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.
Does radial artery pressure accurately reflect aortic pressure?

STUDY OBJECTIVE Our objective was to determine whether the systolic, diastolic, and mean arterial pressures measured in the radial artery accurately reflect corresponding pressures in the ascending aorta in narcotic-anesthetized patients with known obstructive coronary artery disease, before being subjected to cardiopulmonary bypass (CPB). DESIGN This was a prospective study. SETTING The cardiac operating room of a large, tertiary-care university medical center. PARTICIPANTS Fifty-one patients (45 men and six women; age range, 48 to 77 years) with documented atherosclerotic coronary artery disease were studied. All patients underwent elective coronary artery bypass grafting after the study. INTERVENTIONS Patients were premedicated with lorazepam and morphine 60 min before administration of Fentanyl-pancuronium anesthesia. The radial artery was cannulated before induction of anesthesia and the aorta approximately 45 min later. Comparisons of radial and aortic pressures were then performed. MEASUREMENTS AND RESULTS Radial and aortic pressures were recorded through standard, fluid-filled, high-pressure, 91-cm (36-in) long tubing and disposable transducers, meticulously cleared of air bubbles. Additional measurements included cardiac output, central venous pressure, core temperature, blood gas levels, and hematocrit reading. Radial-aortic pressure differences were as follows: systolic arterial pressure (SAP), 12 +/- 1 mm Hg; mean arterial pressure (MAP), -0.8 +/- 0.3 mm Hg; and diastolic arterial pressure (DAP), -1.0 +/- 0.3 mm Hg. All were significant (p < 0.001), but the SAP difference was more than ten times that of either the MAP or the DAP values. The coefficients of determination (r2) indicated that the radial-aortic dependence was 0.44 for the SAP, 0.90 for the DAP, and 0.98 for the MAP relationship. Plotting the respective differences against the arithmetic mean of simultaneously measured pressures indicated that the radial SAP was 4 to 35 mm Hg higher than the aortic in 42 patients (82 percent) and was 10 to 35 mm Hg higher in 26 patients (51 percent); radial-aortic MAP differences clustered within 3 mm Hg in 47 patients (92 percent); radial DAP was +/- 3 mm Hg different from the aortic in 46 patients (90 percent). The largest MAP difference was -6 mm Hg in one patient. The largest DAP difference was +/- 5 mm Hg in three patients. CONCLUSIONS In this group of patients, who were studied before undergoing CPB, the radial SAP gave a poor estimate of that present in the ascending aorta, since in more than 50 percent of the cases, the radial SAP was 10 to 35 mm Hg higher than that in the aorta. The radial MAP and DAP are reliable, since in 90 percent and 92 percent of the patients, respectively, the pressure differences were within +/- 3 mm Hg of those in the aorta.
Reproducibility of Mental Stress-Induced Myocardial Ischemia in the Psychophysiological Investigations of Myocardial Ischemia (PIMI)

Objective Many patients with coronary artery disease (CAD) develop myocardial ischemia in response to mental stress. This has been documented both in the natural environment and in the laboratory. However, the reproducibility of laboratory mental stress-induced ischemia has not been investigated. Method Sixty patients with documented CAD and a positive exercise stress test discontinued cardiac medications and underwent two standardized mental stress tests (a timed Stroop Color-Word test and a public speaking task) in a nuclear cardiology laboratory (Visit 1), and repeated this procedure between 2 and 8 weeks later (Visit 2). Measurements of cardiovascular function and neurohormonal responses were obtained throughout testing, and mood state was assessed before and after testing. Results Sixty-eight percent of the 56 patients with detailed radionuclide data from both visits had consistent responses (ie, ischemia either present during both sessions or absent during both) to the Stroop task (kappa = .29, p = .03), 61% had consistent responses to the speech task (kappa = .20, p = .12), and 60% had consistent responses when ischemia was considered present if it occurred during either the Stroop test, the speech task, or both, and absent if it did not occur during either task (kappa = .22, p = .07). Hemodynamic and neuroendocrine responses to the tests were moderately reproducible. Conclusions We conclude that two popular laboratory tests for mental stress-induced myocardial ischemia are modestly reproducible. The relatively low reproducibility is probably influenced by uncertainties in detecting relatively small changes in wall motion, habituation of the patient to repeated exposure to psychological stressors, and physiological differences in threshold for ischemia on different days of testing.
Management of complications from 820 temporal bone fractures.

OBJECTIVE To review the incidence of complications resulting from temporal bone fractures and analyze the outcomes from surgical and nonsurgical management. STUDY DESIGN A retrospective review of 699 patients with 820 temporal bone fractures occurring over a 5-year period. SETTING A single level 1 trauma center. PATIENTS All patients with clinical or radiologic evidence of a temporal bone fracture. RESULTS A total of 820 fractured temporal bones resulted in 58 facial nerve injuries, 122 CSF fistulae, and 15 cases of meningitis. The two most important prognostic factors in recovery of facial paralysis were severity and delay of onset. All patients with incomplete paralysis recovered. All but one of the delayed onset palsies had good recovery of function. A total of 40% of patients with immediate onset complete paralysis had poor recovery of function. Ninety-five of the 122 CSF fistulae closed spontaneously within 1 week. CSF fistulae persisting for > 7 days had a significantly increased risk of developing meningitis (23%) compared with patients whose fistulae closed within 7 days (3%) (p = 0.001). Another important risk factor for the development of meningitis was concurrent infection. CONCLUSIONS Facial function following temporal bone fractures should be evaluated in the emergency room. If facial motion is noted at any time after the injury, surgical intervention is rarely indicated. Prophylactic antibiotics should be considered in temporal bone fractures when CSF fistulae are present. Surgical closure of a CSF fistula is indicated if it persists for > 7-10 days.
Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study.

BACKGROUND Obese patients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obese patients with ARDS. METHODS Morbidly obese patients (BMI ≥ 35 kg/m²) with ARDS (Pao₂/FIo₂ ratio ≤ 200 mm Hg) were matched to nonobese (BMI < 30 kg/m²) patients with ARDS in a case-control clinical study. The primary end points were safety and complications of PP; the secondary end points were the effect on oxygenation (Pao₂/FIo₂ ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections, and mortality. RESULTS Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese patients were matched with 33 nonobese patients. Median (25th-75th percentile) PP duration was 9 h (6-11 h) in obese patients and 8 h (7-12 h) in nonobese patients (P = .28). We collected 51 complications: 25 in obese and 26 in nonobese patients. The number of patients with at least one complication was similar across groups (n = 10, 30%). Pao₂/FIo₂ ratio increased significantly more in obese patients (from 118 ± 43 mm Hg to 222 ± 84 mm Hg) than in nonobese patients (from 113 ± 43 mm Hg to 174 ± 80 mm Hg; P = .03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27% vs 48%, P < .05). CONCLUSIONS PP seems safe in obese patients and may improve oxygenation more than in nonobese patients. Obese patients could be a subgroup of patients with ARDS who may benefit the most of PP.
Sex steroid modulation of cortisol secretion in sheep.

There is strong evidence that the gonads modulate the hypothalamic-pituitary-adrenal axis. To investigate these sex differences at the adrenal glands of sheep we compared the cortisol response to ACTH (experiment 1) and measured the relative expression of oestrogen receptor alpha (ERS1), androgen receptor (AR), melanocortin 2 receptor (MC2R) and steroid acute regulatory protein (STAR) mRNA in adrenal glands (experiment 2) of gonadectomised rams and ewes either with or without sex steroid replacement. In experiment 1 six castrated adult rams and four ovariectomised adult ewes were used in two ACTH trials. On each trial blood samples were taken every 15 min for 4 h through an indwelling jugular catheter and each animal received 0.5 mg of an ACTH analogue i.v. , immediately after the sample at 1 h from the beginning of the trial. Four days after the first trial the males received 100 mg of Testosterone Cyclopentilpropionate (TC) i.m. and the females received 2.5 mg of Oestradiol Benzoate (EB) i.m. At 72 h after TC or EB administration the second trial was performed. In experiment 2 the adrenal glands were obtained from gonadectomised adult rams (n=8) and adult ewes (n=8). Four rams received 100 mg of TC i.m. and four females received 0.5 mg of EB i.m. Blood samples were taken at 0, 12, 24, 48 and 72 h relative to steroid replacement and the animals were thereafter slaughtered. Cortisol, testosterone and 17β-oestradiol were determined by radioimmunoanalysis. The transcripts of ERS1, AR, MC2R and STAR were determined by real-time reverse transcription PCR in adrenal tissue. Cortisol secretion was higher in female sheep than in male sheep, and higher in EB-treated than non-treated ewes. No difference in cortisol secretion was observed between TC-treated and non-treated rams. Gonadectomised rams treated with TC presented greater AR mRNA and MC2R mRNA expression than males without the steroid replacement. Gonadectomised ewes treated with EB tended to present lower AR mRNA than the ones without steroid replacement. Gonadectomised rams with TC also had greater AR mRNA, ERS1 mRNA and MC2R mRNA expression than ewes treated with EB. The relative amount of STAR transcript was not different among the different groups. The results confirm sex differences in ACTH-induced cortisol secretion in sheep, as well as in the expression of the receptor proteins for both 17β-oestradiol and testosterone in the sheep adrenal gland. However, the underlying mechanisms for sex steroid modulation remain unresolved.
Australian Healthcare Professionals’ Knowledge of and Attitudes toward Binge Eating Disorder

Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED). Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case vignette, as well as weight bias toward obese patients. Results: Results suggested that participants demonstrated a reluctance to diagnose comorbid BED and obesity, that their knowledge of physical complications associated with BED was limited, and that they indicated a narrow range of evidence-based treatment options. When compared with levels of weight bias expressed by healthcare professionals in previous international studies, Australian clinicians were significantly less biased, however, still largely endorsed ‘negative’ attitudes toward obesity. Conclusion: Findings suggest that future clinical training in eating disorders should therefore focus not only on diagnostic criteria, physical complications and treatment options, but also on practitioner attitudes toward eating and weight.