Miracle-dz/UniFAR-FTUs huggingface dataset:
Operative Gradual Reduction in Thoracolumbar Burst Fracture Using the Pedicle Screw-plate Spinal System: Surgical Technique and Neurological Outcomes

Posterior distraction and stabilization using pedicle screws instrumentation for unstable thoracolumbar burst fracture is less extensive approach and offers comparable neurological outcome to anterior direct decompression. However, this method requires spinal column distraction which may result in late kyphotic deformity. Pedicle screws insert at the level of fracture (index screws) confers mechanical advantage for deformity correction and maintain spinal alignment. We suppose that the index screws manipulation with gradual reduction technique could facilitate reduction and restore vertebral height which promotes reduction of retropulsed bone fragments. Therefore, the aim of this study was to present our gradual reduction technique with index pedicle screws applied for treatment of thoracolumbar burst fracture and evaluate the results. There were 14 male and 17 female patients with thoracolumbar burst fracture recruited in this retrospective study. The mean age was 41 years (range, 16 to 79 y). The mean preoperative Cobb angle was 17.5±11.82 degrees. The kyphotic deformity was corrected to −0.23±7.04 degrees (P<0.0001) after operation. At the final follow-up, 1 year after the surgery, mean kyphotic angle was changed to 0.32±8.77 degrees. No statistically significant difference was demonstrated when compared with the immediately postoperative results (P=0.974). No neurological deterioration was found after the operation. The overall motor recovery was 70% with additional simple laminectomy. In conclusion, short-segment pedicle screws instrumentation with gradual reduction technique could achieve the strong implant construction for reduction and maintain kyphosis deformity correction. The neurological recovery could be expected with additional simple laminectomy.
Clinical Role of Silymarin in Oxidative Stress and Infertility: A Short Review for Pharmacy Practitioners

Silymarin (SMN) as an ancient plant has various therapeutic usage in many diseases. Almost all of its properties attributed to antioxidant and anti-inflammatory properties. Currently, infertility problems impose a heavy burden on many developing countries. As a result, effective infertility treatment is indicated. The role of oxidative stress in both male and female infertility has been revealed. Many studies have shown protective and antioxidative properties of SMN against adverse effects of chemotherapy medications and environmental toxins in sperms and oocytes. The antioxidative and clinical role of SMN in infertility has been reviewed. The use of antioxidants such as SMN can help to improve fertility rate by scavenging free radicals and inhibiting nuclear factor kappa B transcription factor. Animal studies in both male and female have indicated a beneficial effect of SMN on fertility recovery. Further clinical studies are needed considering the phytoestrogenic property of SMN, to determine the right dose and duration of treatment.
A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children

Objective: Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluating the effectiveness of colistin loading dose in children. Methods: In a randomized trial, children with ventilator-associated pneumonia or central line-associated bloodstream infection (CLABSI) for whom colistin was initiated, were enrolled. Patients were randomized into two groups; loading dose and conventional dose treatment arms. In the conventional treatment arm, colistimethate sodium was initiated with maintenance dose. In the loading dose group, colistimethate sodium was commenced with a loading dose of 150,000 international unit/kg, then on the maintenance dose. Both treatment arms also received meropenem as combination therapy. Primary outcomes were overall efficacy, clinical improvement and microbiological cure. Secondary outcomes were colistin-induced nephrotoxicity and development of resistance. Findings: Thirty children completed this study. There was a significantly higher overall efficacy in the group received loading dose (42.9 vs. 6.3%, P = 0.031). There weren't any significant differences in the clinical and microbiological endpoints. In the subgroup of children with CLABSI, results illustrated a trend toward (though statistically nonsignificant) better clinical cure for patients receiving loading dose. Conclusion: This preliminary study suggests that colistin loading dose might have some benefits in critically ill children, specifically in children with CLABSI. Further trials are required to elucidate colistin best dosing strategy in critically ill children with severe infections.
Sofosbuvir and daclatasvir in the treatment of chronic hepatitis c virus infection at benghazi medical center: Our experience

Background: The treatment of hepatitis C virus (HCV) has changed dramatically with the rapid advent of numerous new antiviral agents, including direct-acting antivirals which become the standard of care for HCV infection. Our aim was to investigate the safety and efficacy of combined sofosbuvir (SOF)/daclatasvir (DCV) for HCV in our patients. Patients and Methods: The cohort comprises 157 HCV-infected patients followed from October 2016 to May 2018. The inclusion criteria were treatment experienced or naïve and 18 years or older. Cirrhotic patients included were Child-Turcotte-Pugh A (CTP-A) whereas CTP-B-C patients were excluded. All patients had been treated with SOF/DCV 400/60 mg with or without ribavirin. The primary endpoint was sustained virological response at week 12 (SVR12) and significant adverse events. Results: A total of 157 patients were enrolled in the study with a mean age of 47.74 ± 18.2 years including 48.2% males. Ninety percent of patients were Libyan. One hundred and fifteen (72.9%) patients were treatment naïve. Fifty-eight (36.9%) patients were cirrhotic. The adverse effects of the drug were reported in 25/157 (15.9%); the most commonly reported side effects were gastrointestinal upset and dizziness, whereas hepatic decompensation occurred in five patients and all were cirrhotic and none required drug cessation. Undetectable viremia at the end of treatment was observed in 156 patients (99.3%), and one patient had been labeled as nonresponder. Undetectable viremia 12 weeks after the end of treatment was achieved in 155 patients (98.8%), and only one relapsed. Conclusion: SOF and DCV are safe and efficacious with an SVR12 of about 99.0% among our cohorts. The next step is to improve screening and access to these therapies for eradication of hepatitis C infection from the world and Libya as well in the near future.
Brain-derived neurotrophic factor and coenzyme Q10 levels in blood of children with learning disorder

Background Learning disorder (LD) is manifested by significant difficulties in the acquisition and use of reasoning, reading, writing, or mathematical abilities, despite average intelligence and proper education. Its etiological factors were suggested to be related to neurodevelopmental alterations. Measurement of the levels of brain-derived neurotrophic factor (BDNF) and coenzyme Q10 (CoQ10) was targeted in children with LD in comparison with typically developing (TD) ones. Materials and methods This study included 82 Egyptian Arabic-speaking children matched for age and sex and socioeconomic status, comprising 42 with specific LD (group I) and 40 TD children (group II). All participants were subjected to clinical and full neurological examination after reporting a full medical history. Furthermore, LD group was subjected to Stanford–Binet intelligence scale, dyslexia assessment test, and phonological awareness test, which evaluates cognitive and learning aptitudes. The levels of BDNF and CoQ10 were determined in serum by enzyme-linked immunosorbent assay. Results All children with LD obtained a score of 1 or more as at-risk quotient by the dyslexia assessment test, which indicated a specific reading disorder. The BDNF and CoQ10 levels in the LD group were significantly less than those in the TD group. No correlations were found between the measured markers and each other or between them and the measured factors of the used tests. Conclusion The detected low levels of BDNF and CoQ10 in children with specific LD with impairment in reading would be suspected to be related to etiological or exaggerating factors for the deficits in such children.
Cryptococcal meningitis with pulmonary cryptococcoma in an immunocompetent patient: A case report

Rationale: Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons. Patient concerns: A 32 year old lady, active smoker presented with right chest pain, dry cough and loss of weight. Initial chest radiograph showed a lobulated lung mass in the right lower lobe. She developed headache and right cranial nerve palsy during admission. Various investigations were done including lumbar puncture, brain and chest imaging. Diagnosis: Cryptococcal meningitis with pulmonary cryptococcoma. Interventions: She received five months of effective antifungal treatment; however, the patient did not respond well. Subsequently, removal of pulmonary cryptococcoma was done. Outcomes: Her condition improved and she no longer had any headache. Lessons: Disseminated cryptococcosis is rare in immunocompetent patient. Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body, thus facilitating better response to antifungal therapy.
Epidemiology and clinical features of retinoblastoma: A tertiary care center's experience in India

Abstract Introduction: Retinoblastoma (RB) is a prototype of heritable cancers. It is more common in the lower socioeconomic strata. Delayed presentation significantly reduces the overall outcome. We have analyzed the epidemiological and clinical data of children who were diagnosed with RB between the years 2009 and 2014. Aim: RB being a disease of the poor, delayed presentation is common due to lack of awareness. We have analyzed the epidemiological profile of our patients and tried to establish the link between delayed presentation and the presence of high-risk features. High-risk features are associated with higher chance of metastasis and poor rates of vision salvage in RB. Methodology: Data were collected in a retrospective manner from the patient case files retrieved from the Medical Records Department, Kidwai cancer Institute. The data were analyzed using Excel and SPSS software (IBM Corp. released 2016, IBM SPSS statistics software for Mac OS, version 24, IBM Corp., Armonk, NY). Results: A total of 53 patients were diagnosed with RB in the years 2009–2014. There was a male predominance with 1.2:1 incidence. Bilateral RB was present in 21 cases. The mean age of children with bilateral RB was 2.1 years, against 1.5 years in unilateral cases. High-risk features such as optic nerve invasion, choroidal invasion, intracranial extension, and orbital involvement were found in 12, 6, 5, and 5 eyes, respectively. Bone marrow involvement was detected in 5% and lung metastasis in 2%. Intracranial involvement was found in 10.4% and cerebrospinal fluid positivity in 15%. Children with high-risk features had a significant delay in presentation in comparison to those without high-risk features (P = 0.035). Conclusion: Incidence of metastatic disease and delayed presentation is still high in developing countries. Routine eye examination during vaccination visits can ensure early diagnosis and appropriate referral in many of these children.
From systemic to selective brain cooling – Methods in review

Therapeutic hypothermia (TH) remains one of the few proven neuroprotective modalities available in clinical practice today. Although targeting lower temperatures during TH seems to benefit ischemic brain cells, systemic side effects associated with global hypothermia limit its clinical applicability. Therefore, the ability to selectively reduce the temperature of the brain while minimally impacting core temperature allows for maximizing neurological benefit over systemic complications. In that scenario, selective brain cooling (SBC) has emerged as a promising modality of TH. In this report, we reviewed the general concepts of TH, from systemic to selective brain hypothermia, and explored the different cooling strategies and respective evidence, including preclinical and clinical data. SBC has been investigated in different animal models with promising results, wherein organ-specific, rapid, and deep target brain temperature managements stand out as major advantages over systemic TH. Nevertheless, procedure-related complications and adverse events still remain a concern, limiting clinical translation. Different invasive and noninvasive methods for SBC have been clinically investigated with variable results, and although adverse effects were still reported in some studies, therapies rendered overall safe profiles. Further study is needed to define the optimal technique, timing of initiation, rate and length of cooling as well as target temperature and rewarming protocols for different indications.
Ovarian cancer practice survey from the South Asian Association for Regional Cooperation (SAARC) Nations

Background: Management of ovarian cancer has evolved over time with innovations in surgical management as well as in systemic therapy. In the real world, treatment is often adapted to distinct settings based on the socioeconomic factors, physician and patient preference, availability of resources, need for referral, and controversies in the standard treatment. These deviations from conventional treatment can lead to suboptimal results and a better comprehension of this variability can help us to plan corrective measures for improvement in community practice. Methods: The survey instrument consisted of four sections dealing with baseline details of participants, early-stage ovarian cancer practice patterns, surgical practice patterns, and adjuvant/neoadjuvant chemotherapy (NACT) in advanced-stage ovarian cancer. It was an anonymous survey sent as an email and the responses were electronically captured. No incentive was provided. Descriptive statistics were performed using the SPSS software version 20 and R studio. Results: Seventy-five of 258 participants responded. Majority of participants (n = 67, 89.3%) were in favor of doing a fertility-preserving surgery in early-stage ovarian cancer with 86.7% opting for open surgery (n = 65) and only 13.3% (n = 10) using minimally invasive methods. The proportions of early-stage ovarian cancer patients receiving chemotherapy were >90% in 14.7% (n = 11), 75%–90% in 24% (n = 18), 50%–75% in 18.7% (n = 14), 10%–50% in 32% (n = 24), and <10% in 10.7% (n = 8). In the advanced stage, few centers had high rates of microscopically margin negative (R0) resection with primary cytoreduction. About 90.7% of participants (n = 68) avoided doing multiorgan resection for achieving an R0 resection. Sixty percent (n = 45) of the 75 participants offered NACT to all Stage III–IV patients. Conclusion: Ovarian cancer management in the South Asian Association for Regional Cooperation countries is largely congruent with international guidelines. Differences in the administration of intensive chemotherapy schedules and targeted therapy are observed.
Breakfast consumption as a test anxiety predictor among paramedical students

Context: Having breakfast is an important part of healthy eating behaviors. Based on evidence, it is effective in improving cognitive and psychological performance of individuals. Aims: The purpose of this study is the examination of having breakfast association with test anxiety of paramedical students. Settings and Design: This cross-sectional study was conducted in Qom University of Medical Sciences (QUMS), Qom, Iran. Materials and Methods: Two hundred and twenty-three university students were selected from paramedical faculty of QUMS through random sampling. A self-administered questionnaire (demographic information and test anxiety inventory) was used for data gathering. Statistical Analysis Used: Data were analyzed using logistic regression to examine the association between breakfast consumption and test anxiety. Results: The prevalence of skipping breakfast was 40.1%. In the multivariate logistic regression model, it was found that being male (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.30–0.94) and breakfast consumption (OR: 0.54, 95% CI: 0.30–0.95) had a significant relationship with lower test anxiety. Conclusion: It was found that the considerable number of students skip breakfast. Therefore, based on the significant relationship between breakfast skipping and higher level of test anxiety, it is important to identify the causes of breakfast skipping.
Health-related quality of life: Is it a missing feature in the Indian cancer setting?

213 Health‐related quality of life (HRQOL) in an advanced cancer setting is a person‐centered comprehensive care of an individual. It has four determinants. First, the person with advanced cancer has access to complete health‐related information, where the patient understands the diagnosis and prognosis and knows what is to be expected and can be prepared. Second, the person has access to pain and symptom management and receives emotional, social, and spiritual support. Third, the person’s autonomy is preserved wherein the wishes of the person regarding nature, timing, and place of care are respected. Fourth, the person is able to receive person‐centered comprehensive care across various settings, including care in the hospital, at home, or hospice and has access to good, peaceful, and dignified end‐of‐life care. [1,2]
Knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of tertiary care hospital of Western India

Aims and Objectives: The aim of the study is to assess the knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of a tertiary care hospital. Materials and Methods: The data were collected by the questionnaire method from 500 patients waiting in outpatient department of ophthalmology. The questionnaire included questions pertaining to demographic profile, literacy, occupation, awareness about eye donation, willingness to donate, reasons for not pledging, and the sources of information. Results: Percentage of awareness of eye donation was equal in males and females. Significantly less awareness of eye donation was found in illiterate individuals (P < 0.0001) and Muslims (P < 0.0001). 66.6% participants were aware of eye donation and eye camps were the major source of information. 51.50% were willing to pledge their eyes. Lack of awareness was the major reason for not willing to pledge in 32.91% participants. Chi-square analysis between “awareness” and “willingness” groups showed that age group, gender, residency, and occupations were independent factors contributing to willingness to donate, while religion and education showed significant association between awareness and willingness (P < 0.05). Participants who were initially not aware about eye donation (33.6%), after being counseled showed positive responses of willingness to pledge. Conclusion: The data showed that most of the people were aware about eye donation and were willing to donate their eyes; however, the attitude and practice showed mixed responses. Participants had misconceptions about eye donation. Therefore, to reduce the burden of avoidable corneal blindness effective measures should be taken by ophthalmologists, physicians, and especially religious leaders to educate and motivate people for eye donation.
Hypothermia: Impact on plasticity following brain injury

Therapeutic hypothermia (TH) is a potent neuroprotectant against multiple forms of brain injury, but in some cases, prolonged cooling is needed. Such cooling protocols raise the risk that TH will directly or indirectly impact neuroplasticity, such as after global and focal cerebral ischemia or traumatic brain injury. TH, depending on the depth and duration, has the potential to broadly affect brain plasticity, especially given the spatial, temporal, and mechanistic overlap with the injury processes that cooling is used to treat. Here, we review the current experimental and clinical evidence to evaluate whether application of TH has any adverse or positive effects on postinjury plasticity. The limited available data suggest that mild TH does not appear to have any deleterious effect on neuroplasticity; however, we emphasize the need for additional high-quality preclinical and clinical work in this area.
Head-and-neck dermatofibrosarcoma protuberans: Scooping out data even in dearth of evidence

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by a high propensity for local relapse and low metastatic potential. [2] Although 90% of all DFSPs represent low‐grade tumors, 10‐15% contain a component of high‐grade fibrosarcoma which is characterized by a higher incidence of local relapse and distant metastasis. [2] The accompanying editorial by Pandey and Singh noted that the majority of patients had high‐risk features such as over 50% had a tumor size more than 5 cm, with 44% having fibrosarcoma variant and one‐third of patients presenting with metastatic disease. [3] The reason for this higher percentage of fibrosarcomatous component (44%) in this study as compared to the usual 10‐15% could be the referral bias to the medical oncology department for neoadjuvant or adjuvant therapy.
Awareness and knowledge of radiation in common radiological investigation and associated risks among medical students in Saudi Arabia: A cross-sectional study

Background: According to previous similar studies, health-care professionals have limited knowledge about radiation doses, and their related risks with medical imaging examinations are deficient. With a proper level of knowledge, future doctors can play a significant role in attributing to patient safety regarding ionizing radiation. Objective: The objective of the study was to estimate and establish a national parameter of awareness and knowledge regarding ionizing radiation doses and its accompanying adverse effects among medical students in Saudi Arabia. Participants and Methods: This cross-sectional study was done during the academic year 2018–2019. An online survey was distributed to collect the needed data. Students were asked to estimate the most commonly used radiological studies' radiation doses to see if students are aware that the magnetic resonance imaging and ultrasound are nonionizing imaging studies. Results: A total of 518 students responded, the mean ± standard deviation (SD) age of studied students was 22.64 ± 1.92, 62.5% were males, and 40% of studied students were 5th-year medical students. About 5.3% of the students were very confident in their knowledge of the ionizing radiation dose, 27.2% were moderately confident, 36.5% not really confident, and 21% do not know. Most of the students, 49.6%, do not know exactly the risk of inducing fatal cancer from an abdominal computed tomography scan. About 63.7% of the students said that children are the most sensitive group to radiation. The total knowledge mean score was 2.25 (SD: ±1.97, median: 2, range: 0–8). We found a significant correlation between the total knowledge score and age, sex, university, and academic year, all with P = 0.001. Conclusion: The assessment of students' awareness of ionizing radiation exposures in diagnostic imaging demonstrates that there is a low level of confidence in the knowledge of the ionizing radiation dose and low total knowledge mean score; this advocates introducing the radiation protection instruction into the undergraduate medical curriculum.