Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical score to detect congenital heart defects: Concept of second screening

Introduction: Neonatal screening for congenital heart defects at birth can miss some heart defects, sometimes few critical ones, and the scenario is even worse in those neonates who had never undergone a neonatal checkup (home deliveries). Immunization clinic can serve as a unique opportunity as the second checkpoint for the screening of the children. A history- and examination-based test can serve as an effective tool to screen out children with heart defects. Aims and Objectives: The aim of this study was to establish the sensitivity and specificity of a clinical screening tool for the identification of congenital heart defects at the first visit of an infant after birth for immunization. Materials and Methods: This is a cross-sectional observational study which the consecutive children presenting at 6 weeks of age for immunization or any child presenting for the first time (outborn delivery) till 6 months of age in the immunization clinic were subjected to detailed history and examination and findings were recorded on a predesigned pro forma and a clinical score was calculated. All these children were then subjected to echocardiography for confirmation of the diagnosis of congenital heart disease (CHD), and the sensitivity and specificity of the test were recorded Observations and Results: A total of 970 babies were screened, out of them 31 were diagnosed with CHD and 18 had undergone neonatal screening at birth. A clinical score of 3 or more had more chances of detecting CHD. The sensitivity of the cutoff score as 3 was 96.77% and specificity was 98.72, with a positive predictive value of 71.43%, a negative predictive value of 99.89%, and an accuracy of 98.66%. Conclusions: The history- and examination-based tool is an effective method for early identification of CHD and can easily be used by peripheral workers working in remote places with poor resources enabling prompt referral.
Prevalence of depression and anxiety in college students

Context: Depression and anxiety are the most common mental disorders existing today among the youngsters owing to academic excellence pressure and societal living expectations. They are overlooked most of the times and can have a grave impact on a student's personal, academic, and social life. Aim: The aim of the study was to find the prevalence of depression and anxiety in college students. Methods: A prospective study was done in 400 college students in the age group of 18–25 years. A self-made questionnaire, along with the Beck's Depression and Anxiety Inventory, was administered. Results: We found that depression was prevalent in about 48.30% of the students, whereas anxiety was prevalent in 50% of these students. Conclusion: Hence, moderate-to-severe levels of depression and anxiety exist in college students, which need to be confirmed and diagnosed clinically and treated at the earliest.
Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P≤ 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar (P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P≤ 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards.
Status of Serum Prolactin Levels among Male Cohort in Infertile Couples

Background: Abnormalities of serum prolactin adversely impact the reproductive functions among infertile men. Hence, this study was aimed to determine the influence of prolactin abnormalities on gonadal functions of male cohorts of infertile unions in Port Harcourt, Nigeria. Methods: This was a retrospective survey of 1845 males of infertile unions who presented in a health-care facility for reproductive endocrine evaluation following abnormal semen parameters between 2007 and 2018. The demographic, clinical, and laboratory variables were evaluated among study cohorts. Results: Hyperprolactinemia was observed in 16.7% of the study cohorts with 9.6%, 5.0%, and 2.1% of mild, moderate, and severe grades, respectively. The hyperprolactinemic cohorts had depressed levels of follicle-stimulating hormone (FSH), luteinizing hormones (LH), and total testosterone (TT) which worsened further with worsening grades of hyperprolactinemia. Inverse relationship of prolactin levels existed with FSH (crude β: −0.651; P < 0.001; adjusted β: −0.666; P < 0.001), LH (crude β: −0.481; P < 0.001; adjusted β: −0.536; P < 0.001), and TT (crude β: −0.525; P < 0.001; adjusted β: −0.546; P < 0.001) in crude analysis and amplified on age and body mass index (BMI) adjustment. The greatest risk of depressive impact of hyperprolactinemia was on serum TT (crude hazard ratio [HR]: 35.185; P < 0.001; age and BMI-adjusted HR: 35.086; P < 0.001). Erectile dysfunction (ED) was the single most isolated sexual abnormality (n = 111; 35.6%) recorded among the general hyperprolactinemics; however, the ED was specifically more prevalent (n = 15; 38.5%) among the severely hyperprolactinemics. Conclusion: The present study revealed a high frequency of hyperprolactinemia among studied participants. Since the hyperprolactinemia was associated with a large number of cases with other endocrine and sexual dysfunctions, diagnostic and treatment protocols should include prolactin measurement and management during infertility evaluation in males.
Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46.07±23.54 cmH2O in the fixed volume group and 33.72±9.14 cmH2O in the MLT group (P=0.05) which is significantly higher in the fixed volume group (P=0.028). In addition, 56.4% and 78.2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P=0.025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.
Dento-Maxillary Disharmony by Default in Mixed and Permanent Dentition at Odontostomatology Department of Donka National Hospital, Guinea

Background: Dento-maxillary disharmony is a disproportion between the size or the mesiodistal diameter of the teeth and the perimeter of the corresponding alveolar arches. The objective of this study is to describe frequency and management of default dento-maxillary disharmonies in the department of Odontostomatology of Donka National Hospital. This was a descriptive prospective study with all patients seeking dental care at the department of Odontostomatology of Donka National Hospital. The study was conducted over 13 months from June 2016 to 30 June 2017. Among the 485 patients seeking dental care, the frequency of dento-maxillary disharmonies was 7.21%. The mean age of patients was 8.75 years, with extreme ages of 7 and 26 years. Females were the most represented with 77.15% that is a sex ratio of 0.29. The upper arch was the most concerned by the dento-maxillary disharmony with a proportion of 57.14%. The orthodontic treatment was the commonest treatment with 57.14%. Dento-maxillary disharmony had many clinical signs that allowed the practitioner making early diagnosis. Early management could help remodeling the bone genome and reducing the risk of relapse, and the length of orthodontic treatment.
Unilateral bacteriostatic effect of two kinds of common wild herbs collected from Zhoukou area

we extracted the active ingredients of Indian Dendranthema Flower and Sun Euphorbia Herb,and tested their bacteriostatic effect to Staphylococcus aureus and Escherichia coli by using the paper filtering method.The results showed that Indian Dendranthema Flower and Sun Euphorbia Herb have significant bacteriostatic effect to Staphylococcus aureus and Escherichia coli.The best bacteriostatic concentration of Sun Euphorbia Herb to Staphylococcus aureus and Escherichia coli both is 1.0mg/mL.However,the best bacteriostatic concentration of Indian Dendranthema Flower to Escherichia coli is 1.0g/mL,but to Staphylococcus aureus is 0.25 g/mL.
A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial

Objective: Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. Design: Prospective multi-centre randomised controlled trial. Setting: Four hand surgery departments in Sweden. Subjects: A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52). Intervention: A smartphone application to facilitate rehabilitation. Main outcome measures: Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. Results: Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8–13.3), 11.8 (CI 11.0–12.8) for the intervention group, and 13.3 (CI 12.6–14.0), 12.8 (CI 12.0–13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9–99.5) compared to the controls 82.9 (CI 76.9–88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. Conclusion: The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. Level of evidence: I. Randomised controlled trial
Pathways of Participation by Older Adults Living in Continuing Care Homes: A Constructivist Grounded Theory Study

ABSTRACT Introduction and objectives: Participation in meaningful activities has psychological, physical, social and cognitive benefits for older adults living in continuing care homes. The subjective experiences of the process of participation for cognitively competent older adults living in a continuing care home and how personal and environmental features influenced the process were explored. Methods: Using a constructivist grounded theory approach to collection and analysis in the tradition of Charmaz, data were gathered with observation and a series of in-depth, semi-structured interviews with nine older adults (aged ≥ 70 years). Results: Participants actively engaged in an individualized, activity-specific process of positioning themselves to make choices and enact core values through meaningful activities. Personal and environmental barriers to participation could sometimes be managed through this process, although at other times barriers resulted in activity loss. Discussion: These findings reinforce the importance of participation in the lives of older adults living in a continuing care home, and present a model of how participants were actively occupied in a continuous process of negotiating opportunities for meaningful activity engagement. Implications address possible ways to facilitate this process of participation by care partners.
Benznidazole for the treatment of Chagas disease

ABSTRACT Introduction Chagas disease affects 6–7 million people, mainly in the Americas, and benznidazole is one of the two therapeutic options available. Trypanocide treatment aims to eliminate the parasite from the body to prevent the establishment or progression of visceral damage, mainly cardiac and/or digestive. Remarkably, it helps interrupt vertical transmission when administered to women of childbearing age. Areas covered We discuss the basic and scarce data regarding chemical, pharmacokinetic, and pharmacodynamic structure. We also collect the most important data from previous phase II and III studies, as well as studies currently underway and upcoming. We reflect on the main indications for treatment and its challenges, such as the profile of adverse effects in adults, the pharmaceutical formulations, the search for reliable biomarkers, as well as regulatory aspects and access barriers. Alternative strategies such as shorter regimens, lower doses, and fixed doses are currently being evaluated to improve access and the safety profile of this treatment. Expert opinion Benznidazole is likely to continue to be the drug of choice for Chagas disease in the coming years. However, it would probably be with a different treatment scheme.
The value of skeletal standardized uptake values obtained by quantitative single-photon emission computed tomography-computed tomography in differential diagnosis of bone metastases

Purpose The aim of this study was to explore the value of skeletal standardized uptake value (SUV) obtained by quantitative single-photon emission computed tomography-computed tomography (SPECT/CT) in differential diagnosis of bone metastases from benign lesions. Materials and methods Retrospective analysis has been conducted to 51 patients with extraskeletal malignant tumors who underwent whole-body bone scan with quantitative SPECT/CT imaging, and there are no more than three hotspots that were visually detected in the SPECT/CT imaging range. Fifty-one patients were enrolled, including 28 men and 23 women with an average age of 58.8 ± 9.5 (37–77) years. A total of 88 hotspots, including 40 benign lesions and 48 metastatic lesions, and corresponding normal sites were obtained. The region of interest (ROI) of the hotspots was sketched. The ROI of the normal bone of the spinal vertebral body adjacent to the lesions or normal bone of the symmetric side of the lesions of other locations was delineated to obtain the maximum SUV (SUVmax) and the average SUV (SUVave). Results The SUVmax value of all lesions was 20.73 ± 14.01 (3.90–92.61), and the SUVmax value of the corresponding normal parts was 5.88 ± 2.36 (2.08–12.52). The difference between the two groups was statistically significant (t = 10.343, P < 0.01). The SUVave of all lesions was 8.42 ± 4.81 (37–77), and the SUVave of the corresponding normal sites was 3.10 ± 1.51 (0.65–7.54). The difference between the two groups was statistically significant (t = 11.342, P < 0.01). The SUVmax of metastases was 24.77 ± 16.32 (3.90–92.61), and the SUVmax of benign lesions was 15.89 ± 8.51 (4.68–42.32). The difference between the two groups was statistically significant (t = 3.273, P = 0.002). The SUVave of metastases was 9.09 ± 5.59 (0.81–29.08), and the SUVave of benign lesions was 7.61 ± 3.57 (1.66–17.48). There was no significant difference between the two groups (t = 1.44, P = 0.154). The area under the curve (AUC) values of the SUVmax curves was greater than that of the SUVave curve. AUCs of the SUVmax and SUVave were 0.687 (P = 0.03) and 0.576 (P = 0.223), respectively. SUVmax had greater accuracy for discriminating bone metastasis from benign lesions. Hotspots of the patients with malignant neoplasms in bone SPECT/CT may be discriminated using SUVmax with certain accuracy, and the optimal cutoff value was 17.705. Conclusion The SUVmax of bone metastases was significantly larger than that of benign lesions, and there was no significant difference in SUVave between the two groups. Therefore, the SUVmax has a certain value for the differential diagnosis of metastases from benign lesions.
Mind the gaps: challenges in the clinical management of invasive candidiasis in critically ill patients

Purpose of review Strict adherence to clinical practice guidelines is recognized to improve outcomes but the inconvenient truth is that only a small subset of what is done in medicine has been tested in appropriate, well designed studies. In this article, we aim to review controversial aspects of the clinical management of invasive candidiasis recommended by guidelines. Recent findings Despite still being recommended by guidelines, we fail to identify a single randomized clinical trial documenting that the use of antifungal drugs in high-risk critically ill patients without microbiologic documentation of Candida infection decreases mortality. Regarding deep-seated Candida infections, most cohort studies of patients with candidemia found less than 5% of patients developed endophthalmitis and endocarditis. In this scenario, it is reasonable to reconsider routine universal screening of both complications in candidemic patients. Finally, a large number of studies have shown that critically ill patients usually have lower echinocandin exposure when compared with other populations. We need more data on the clinical relevance of this finding. Summary We need robust studies to validate new strategies for the clinical management of candidemia in ICU, including: the use of fungal biomarkers in the early initiation or interruption of antifungal therapy in high-risk patients to replace the conventional empirical antifungal therapy driven by predictive rules; validation of targeted screening of eye infection and endocarditis with the aid of fungal biomarkers only in high-risk patients; we should clarify if higher doses of candins are necessary to treat invasive candidiasis in critically ill patients, especially in the case of intra-abdominal infections where drug penetration is suboptimal.
Evaluation of a telethermographic system for temperature screening at a large tertiary-care referral hospital during the coronavirus disease 2019 (COVID-19) pandemic

Katherine C. Leach MD1, Misti G. Ellsworth DO1, Luis Z. Ostrosky MD2, Cynthia S. Bell MS1, Kathy Masters MS, Six Sigma MBB3, John Calhoun MS, Six Sigma MBB3, Lance Ferguson MHA, MBA3, Susie Distefano MSN, RN3 and Michael L. Chang MD1 1Department of Pediatrics, UTHealth McGovern Medical School, Houston, Texas, 2Department of Internal Medicine, UTHealth McGovern Medical School, Houston, Texas and 3Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
Cerebellar developmental deficits underlie neurodegenerative disorder spinocerebellar ataxia type 23

Spinocerebellar ataxia type 23 (SCA23) is a late‐onset neurodegenerative disorder characterized by slowly progressive gait and limb ataxia, for which there is no therapy available. It is caused by pathogenic variants in PDYN, which encodes prodynorphin (PDYN). PDYN is processed into the opioid peptides α‐neoendorphin and dynorphins (Dyn) A and B; inhibitory neurotransmitters that function in pain signaling, stress‐induced responses and addiction. Variants causing SCA23 mostly affect Dyn A, leading to loss of secondary structure and increased peptide stability. PDYNR212W mice express human PDYN containing the SCA23 variant p.R212W. These mice show progressive motor deficits from 3 months of age, climbing fiber (CF) deficits from 3 months of age, and Purkinje cell (PC) loss from 12 months of age. A mouse model for SCA1 showed similar CF deficits, and a recent study found additional developmental abnormalities, namely increased GABAergic interneuron connectivity and non‐cell autonomous disruption of PC function. As SCA23 mice show a similar pathology to SCA1 mice in adulthood, we hypothesized that SCA23 may also follow SCA1 pathology during development. Examining PDYNR212W cerebella during development, we uncovered developmental deficits from 2 weeks of age, namely a reduced number of GABAergic synapses on PC soma, possibly leading to the observed delay in early phase CF elimination between 2 and 3 weeks of age. Furthermore, CFs did not reach terminal height, leaving proximal PC dendrites open to be occupied by parallel fibers (PFs). The observed increase in vGlut1 protein—a marker for PF‐PC synapses—indicates that PFs indeed take over CF territory and have increased connectivity with PCs. Additionally, we detected altered expression of several critical Ca2+ channel subunits, potentially contributing to altered Ca2+ transients in PDYNR212W cerebella. These findings indicate that developmental abnormalities contribute to the SCA23 pathology and uncover a developmental role for PDYN in the cerebellum.
Occupational risk factors for chronic kidney disease in Andhra Pradesh: ‘Uddanam Nephropathy’

Abstract Background CKD of unknown etiology (CKDu) has been reported in several countries including India. We previously showed a prevalence of CKD in India to be 17.2% and we found a CKD epidemic in Andhra Pradesh (AP) to be 46.8%. We conducted this study to further explore the unexplained CKD epidemic in AP. Methods We recruited 1201 adult participants through systematic random sampling from eight administrative divisions. Demographic, medical, and detailed occupational history was collected. Anthropometric measurements and blood pressure were taken and blood and urine samples were collected. Poisson regression model was used to identify potential predictors for CKD. Results We analyzed data for 1184 individuals with mean age of 44.6 ± 14.0 years, of whom 44% were male. Prevalence of CKD was 32.2%. Working as a farmer had 20% more prevalence of CKD compared to non-farmers in the fully adjusted model (PR 1.2, 95% CI 1.01–1.42). Age, alcohol consumption, and chewing tobacco were also independent predictors of CKD. Gender, hypertension, and diabetes were not associated with CKD. Conclusions The prevalence of CKD in AP is 32.2%. Occupational exposure among farmers could play a potential role in this epidemic. Large longitudinal epidemiologic research studies are needed to trace the causes of this problem.