Miracle-dz/UniFAR-FTUs huggingface dataset:
The association of disease type, pre-transplant hemoglobin level and platelet count with transfusion requirement after autologous hematopoietic stem cell transplantation

Background: Autologous hematopoietic stem cell transplantation (auto-HSCT) has become an effective treatment for a wide range of hematologic and non-hematologic diseases. Patients undergoing HSCT might require multiple platelets and red blood cell (RBC) transfusions during aplasia phase until engraftment, which could profoundly affect patients’ conditions. Identification of risk factors associated with blood product requirements could help in decreasing transfusion-related complications. We evaluated the association of disease type, pre-transplant hemoglobin level, and pre-transplant platelet count with RBC/platelet transfusion requirement after auto-HSCT. Methods: In this retrospective study, 324 patients diagnosed with multiple myeloma (MM), Hodgkin disease (HD), and non-Hodgkin lymphoma (NHL) and underwent auto-HSCT were included. The associations of disease type, pre-transplant hemoglobin level, and platelet count with post-transplant packed cell and single-/random-donor platelet transfusions were evaluated. Results: Our study results illustrated that the higher pre-transplant hemoglobin level significantly decreased the post-HSCT requirement for packed cell (IRR=0.81, [CI: 9.73-0.90], P=0.0001), while the pre-transplant platelet showed no significant relationship with platelet requirement after HSCT. HD was associated with increment in packed cell (IRR=2.04, [CI: 1.35-3.08], P=0.001) and single donor platelet (IRR=1.39, [CI: 1.09-1.78], P=0.008) requirement after transplant. The trends showed that a higher platelet level led to a lower need for platelet transfusion. Conclusion: Pre-transplant hemoglobin level could be valuable markers for predicting post-HSCT RBC requirements and might be beneficial for better management of transfusion requirements to minimize the transfusion-related complications. Patients with HD seem to be more prone to blood product requirements post-transplant.
Accelerated Course of Alveolar Echinococcosis After Treatment With Steroids in a Patient With Autoimmune Encephalitis

Human alveolar echinococcosis (AE) is a zoonotic infection caused by the fox tapeworm Echinococcus multilocularis. We report the case of a patient who developed an accelerated course of AE with diffuse liver involvement after high-dose steroid treatment for autoimmune encephalitis. Immunosuppressive therapies present us with new challenges regarding the management of AE. With this article, we would like to draw attention to the importance of a screening program for AE before planned immunosuppressive therapy.
Design of an Intramuscular Injection Simulator: Accommodating Cultural Differences

We had developed an inexpensive intramuscular (IM) injection simulator and gathered feedback from Canadian hospital-based practicing nurses about the design features of the simulator. While the feedback critiqued the density of the simulator as being too stiff and suggested making the shape more realistic, it was also unanimously agreed that this IM injection simulator is more realistic than any other previous models they have used, therefore deeming it an acceptable training tool for nursing students in Canada. For this simulator to serve as a training tool in other countries, such as Singapore, we partnered with SingHealth, a hospital network in Singapore, to conduct identical product testing in a different ethnic context and compare the data to our previous work. This article is based on this study. We had 21 nurses from Singapore General Hospital test the IM injection simulator and fill out the same survey the Canadian nurses had done. With a 100% response rate, only 26% of the Singapore hospital-based nurses agreed that this IM injection simulator is a more ethnically appropriate representation of anatomy than previous simulators they have used. There were numerous other differences in feedback compared to the Canadian nurses, such as the fat layer being too thick. These differences in feedback highlight the importance of including ethnicity as a factor during the design of simulators. Therefore, despite the silicone IM injection simulator being a cost-effective solution to practice IM injections, the features of the simulator need to be improved to make it a valuable teaching tool for nursing students, especially those in Singapore.
Impact of the Covid-19 Pandemic on Women’s Health in Brazil

Purpose The aim is to verify the impact of the Covid-19 pandemic on women’s healthcare and medical assistance in Brazil. Patients and Methods This exploratory cross-sectional study evaluated a non-probabilistic sample of women above 20 years old, carried out between August and September of 2020, through a snowball sampling using a Google Forms application. Results From a total of 2495 women, more than 70% have not been screened for cervical cancer (77.8% of 2244 women aged for screening), and more than 80% have not been screened for breast cancer (80.2% from 1325 women aged for mammography) during the pandemic. Also, 55.2% of the women did not undergo routine blood tests during the same period. The most frequent reasons for not performing screening and routine tests were: they were up to date; fear of contracting Covid-19; they decided to postpone it until after the end of the pandemic; they were unable to schedule the appointment at the healthcare center for whatever reason; and the healthcare center was only attending Covid-19 patients. Women with no comorbidities have performed significantly more mammograms and routine blood tests than women with comorbidities. In addition, women with comorbidities who were used to perform periodic medical follow-up have done it substantially more than women with no comorbidities during the pandemic. Conclusion As observed, there was a significant decrease in women’s access to the healthcare system during this pandemic. Many participants reported that they had not attended any screening tests, and some reasons included fear of getting infected and due to the public measures of social distancing. The consequences are late diagnoses and a worse prognosis. It might impact the healthcare systems around the world in the next few years. Further studies should be done to follow these consequences.
Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance. Methods and findings On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19–specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population. Conclusions In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.
A Three-Dimensional Cinematographic Analysis of Upper Limb Movement during Fastball and Curveball Baseball Pitches

Joint angle kinematics of the throwing limb from the early-cocking phase to ball release were investigated for the fastball (FB) and curveball (CB) baseball pitches through use of a three-dimensional film analysis technique. Small sticks were fixed to the hand and forearm to permit rotations of the radioulnar and wrist joint to be calculated. The actions were very similar for two pitches within one subject. There were no differences in the motions of the shoulder and elbow joints or in the temporal sequences between FB and CB pitches. However, there was a significant difference (p<0.05) in the motion of supination/pronation of the forearm and dorsiflexion/palmar flexion of the wrist prior to the ball release; the forearm was supinated more in the CB (maximum supination: 39.9 ±6.0° at 0.072 ±0.045 s before ball release, or BRL) compared to the FB (19.4 ±8.5° at 0.076 ±0.046 s before BRL), whereas the wrist was dorsiflexed more in the FB (maximum dorsiflexion: 41.7 ±6.5° at 0.039 ±0.011 s before BRL) compar.
Sensitivity analysis of a reduced model of thrombosis under flow: Roles of Factor IX, Factor XI, and γ‘-Fibrin

A highly reduced extrinsic pathway coagulation model (8 ODEs) under flow considered a thin 15-micron platelet layer where transport limitations were largely negligible (except for fibrinogen) and where cofactors (FVIIa, FV, FVIII) were not rate-limiting. By including thrombin feedback activation of FXI and the antithrombin-I activities of fibrin, the model accurately simulated measured fibrin formation and thrombin fluxes. Using this reduced model, we conducted 10,000 Monte Carlo (MC) simulations for ±50% variation of 5 plasma zymogens and 2 fibrin binding sites for thrombin. A sensitivity analysis of zymogen concentrations indicated that FIX activity most influenced thrombin generation, a result expected from hemophilia A and B. Averaging all MC simulations confirmed both the mean and standard deviation of measured fibrin generation on 1 tissue factor (TF) molecule per μm2. Across all simulations, free thrombin in the layer ranged from 20 to 300 nM (mean: 50 nM). The top 2% of simulations that produced maximal fibrin were dominated by conditions with low antithrombin-I activity (decreased weak and strong sites) and high FIX concentration. In contrast, the bottom 2% of simulations that produced minimal fibrin were dominated by low FIX and FX. The percent reduction of fibrin by an ideal FXIa inhibitor (FXI = 0) ranged from 71% fibrin reduction in the top 2% of MC simulations to only 34% fibrin reduction in the bottom 2% of MC simulations. Thus, the antithrombotic potency of FXIa inhibitors may vary depending on normal ranges of zymogen concentrations. This reduced model allowed efficient multivariable sensitivity analysis.
Ultrasonographic placental thickness versus fetal outcome: A prospective study in Southern India

Background: Variations in placental thickness are associated with increased perinatal morbidity and mortality. However, only very few studies have been established on the correlation between placental thickness with birth outcomes. This study correlated placental thickness in 2nd and 3rd trimesters with neonatal outcome, maternal weight gain, and body mass index (BMI). Methods: A total of 116 patients aged between 20 to 50 years with singleton pregnancy and regular menstrual history (and sure about their last menstrual period) were included. Placental thickness was measured at 24 and 36 weeks by ultrasound and was divided into three groups: Group A (normal placenta), Group B (thin placenta), and Group C (thick placenta); and correlated with neonatal outcome, maternal weight gain, and BMI. Results: Out of the 116 pregnant women, 55 (47.4%) were primigravida and 61 (52.6%) were multigravida. Six patients (3.6%) delivered pre-term before 36 weeks. In the 2nd and 3rd trimesters, most cases had normal placental thickness (Group A; 93.1% and 92.7%), followed by thin placenta (Group B; 5.2% and 7.3%) and thick placenta (Group C; 1.7% and 0), respectively. Two patients with thin placenta had neonatal death. A significant positive correlation was found between birth weight and placental thickness (at 24 weeks; 0.516r, P<0.00001 and at 36 weeks; 0.669r, P<0.00001) and maternal weight gain and birth weight (0.563r, P<0.00001). Conclusion: Placental thickness on ultrasonography demonstrated well the correlation between birth weight in 2nd and 3rd trimesters and increased incidence of antenatal and postpartum complications resulting from thin placenta.
Using ultra-widefield red channel images to improve the detection of ischemic central retinal vein occlusion

Purpose To examine the usefulness of red channel fundus imaging to detect the ischemic status in eyes with central retinal vein occlusion (CRVO). Methods Ultra-widefield (UWF) fundus images were obtained from 42 eyes with CRVO. Twenty-one eyes were ischemic, and 21 eyes were non-ischemic. Rubeosis was found in 11 ischemic eyes. UWF images were split into red and green channels using ImageJ software. Both the color and red channel images were used to predict the presence or absence of ischemia when examined by masked graders. The sensitivity and specificity of UWF imagings for the detection of ischemia were calculated in Group A (total 42 eyes), Group B (32 eyes excluding non-rubeotic ischemic CRVO) and Group C (31 eyes excluding rubeotic ischemic CRVO), respectively. Moreover, a linear mixed model was conducted to investigate the relationship between the type of images and the accuracy of prediction in each group. Results No significant difference in the sensitivity of color fundus imaging was seen between Group A and Group B. By contrast, a significant difference in the sensitivity of red channel imaging was seen between Group A and Group B (p = 0.031). The accuracies of the predictions were not associated with the type of image in Group A and Group B, but were significantly associated in Group C (p = 0.026). Conclusions UWF red channel imaging enabled more accurate detection of the ischemic status, compared with color fundus images, especially in non-rubeotic CRVO eyes.
Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh

Background In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. Methods Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. Results 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23–26.04, p<0.05). Conclusion HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
Machine learning for DCO-OFDM based LiFi

Light fidelity (LiFi) uses different forms of orthogonal frequency division multiplexing (OFDM), including DC biased optical OFDM (DCO-OFDM). In DCO-OFDM, the use of a large DC bias causes optical power inefficiency, while a small bias leads to higher clipping noise. Hence, finding an appropriate DC bias level for DCO-OFDM is important. This paper applies machine learning (ML) algorithms to find optimum DC-bias value for DCO-OFDM based LiFi systems. For this, a dataset is generated for DCO-OFDM using MATLAB tool. Next, ML algorithms are applied using Python programming language. ML is used to find the important attributes of DCO-OFDM that influence the optimum DC bias. It is shown here that the optimum DC bias is a function of several factors including, the minimum, the standard deviation, and the maximum value of the bipolar OFDM signal, and the constellation size. Next, linear and polynomial regression algorithms are successfully applied to predict the optimum DC bias value. Results show that polynomial regression of order 2 can predict the optimum DC bias value with a coefficient of determination of 96.77% which confirms the effectiveness of the prediction.
Microirrigation Scheduling and Tube Placement for Cotton in the Southeastern Coastal Plain

Three irrigation scheduling methods and two microirrigation tube placements were evaluated on three cotton (Gossypium hirsutum L.) cultivars for three years on a southeastern Coastal Plain soil. Irrigation scheduling methods included two computer models, GOSSYM/COMAX and PRISM, and a method using tensiometers. Microirrigation tubing was placed on the soil surface, either adjacent to every row or in alternate furrows. Growing-season rainfall amounts ranged from 313 mm in 1990 to 544 mm in 1988. Rainfall distribution also varied widely within each year. In a similar manner, irrigation amount and frequency varied among scheduling methods and years, but no method consistently required the largest or smallest amount of irrigation. Cotton lint yields ranged from 850 to 1105 kg/ha over all years, but there were few significant differences among irrigation treatments within a year, even between the rainfall-only and irrigated treatments. Lint yields were significantly greater for the PD3 and DPL90 cultivars than for the Coker 315 cultivar during the three-year period, and the PD3 cultivar had a greater yield response to irrigation. The tensiometer-every row tube placement is the only irrigation treatment that produced cotton lint yields significantly higher than the rainfall-only treatment each year. The tensiometer scheduling method also produced significantly greater yields each year. Although yield differences occurred, they were relatively small. This fact, along with the inconsistent differences in the amount of irrigation water required, suggests that the preferred method for a particular application will probably depend more upon water or labor requirements, cost, or personal preference. Also, there was no difference in yield between the two tube placements. Because the alternate-furrow placement requires only half as much tubing, which will reduce installation costs by about 30%, it appears to be the preferred placement for this soil. Further research is needed to refine irrigation scheduling for cotton in this region.
Cardiac Biomarkers in COVID-19: A Narrative Review

The diagnosis and risk stratification of coronavirus disease 2019 (COVID-19) is primarily based on discretionary use of laboratory resources. Several lines of evidence now attest that cardiovascular disease not only is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but its pre-existence may increase the risk of morbidity, disability, and death in patients with COVID-19. To this end, routine assessment of biomarkers of cardiac injury (i.e., cardiac troponin I or T) and dysfunction (e.g., natriuretic peptides) has emerged as an almost essential practice in patients with moderate, severe, and critical COVID-19 illness. Therefore, this narrative review aims to provide an overview of cardiac involvement in patients with SARS-CoV-2 infection as well as the clinical background for including cardiac biomarkers within specific panels of laboratory tests for managing COVID-19 patients.
Low risk of relapse and deformity among leprosy patients who completed multi-drug therapy regimen from 2005 to 2010: A cohort study from four districts in South India

Introduction Relapse of leprosy among patients released from treatment (RFT) is an indicator of the success of anti-leprosy treatment. Due to inadequate follow-up, relapse in leprosy patients after RFT is not systematically documented in India. Relapsed leprosy patients pose a risk in the transmission of leprosy bacilli. We determined the incidence of relapse and deformity among the patients RFT from the leprosy control programme in four districts in South India. Methods We conducted two follow-up surveys in 2012 and 2014 among the leprosy patients RFT between 2005 and 2010. We assessed them for any symptoms or signs of relapse, persistence and deformity. We collected slit skin samples (SSS) for smear examination. We calculated overall incidence of relapse and deformity per 1000 person-years (PY) with 95% confidence intervals (CI) and cumulative risk of relapse. Results Overall, we identified 69 relapse events, 58 and 11, during the first and second follow-up surveys, respectively. The incidence of relapse was 5.42 per 1000 PY, which declined over the years after RFT. The cumulative risk of relapse was 2.24%. The rate of deformity among the relapsed patients was 30.9%. The overall incidence of deformity was 1.65 per 1000 person years. The duration of M. leprae detection in smears ranged between 2.38 and 7.67 years. Conclusions Low relapse and deformity rates in leprosy RFT patients are indicative of treatment effectiveness. However, a higher proportion of detection of deformity among relapsed cases is a cause for concern. Periodic follow-up of RFT patients for up to 3 years to detect relapses early and ensure appropriate treatment will minimize the development of deformity among relapsed patients.