Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of vascular access before kidney transplantation in patients with successful kidney transplantation

Introduction: The status of embedded fistula before kidney transplant is one of the problems in patients after kidney transplant and without correct management, surely it can lead to severe complications. The vascular access of arteriovenous fistula (AVF) and its possible complications can be found using the registered data in patients who had undergone successful kidney transplant. This information may be useful to prevent possible complications in future. Objectives: This study was aimed to determine the status of vascular access before kidney transplant in patients with successful transplantation in Urmia city, Iran. Patients and Methods: This study was a historical cohort conducted on 201 patients from March 2009 to March 2012 who had undergone vascular access before kidney transplant. The related information about complications and functions of fistula were extracted from available records. Results: According to results, the patients were divided into four groups regarding fistula function including 104 patients (51.7%) with functional fistula after kidney transplant, 49 patients (24.4%) with spontaneously closed fistula, 37 patients (18.4%) with closed fistula through surgery and 11 patients (5.5%) with reduced blood flow of fistula. Conclusion: Despite the low incidence of heart failure in functional vascular access after successful renal transplantation, these patients should be followed up by cardiologists to avoid complications. Generally, closing vascular accesses after successful transplantation is not necessary.
Pregnancy outcome in women with previous preeclampsia versus women normotensive in previous pregnancy

Background: Women with history of preeclampsia have reportedly higher risk of development of preeclampsia in subsequent pregnancies, along with other adverse pregnancy outcomes. Authors aimed to study the incidence of recurrent preeclampsia and compare the pregnancy outcome in women with history of preeclampsia in previous pregnancy with those who were normotensive in previous pregnancy and further compare outcomes in women with recurrent preeclampsia between their previous and index pregnancy.Methods: Pregnancy outcome was studied in women with preeclampsia in previous pregnancy (cases) and compared with women normotensive in previous pregnancy (controls). Further analysis of cases was done by dividing them into subgroups: those with recurrent preeclampsia in index pregnancy (A1) and those normotensive in index pregnancy despite being pre-eclamptic in previous pregnancy (A2). Total 100 cases and 100 controls were enrolled in the study, which was conducted at present tertiary care centre from January 2012 to June 2013.Results: Out of total 200 participants (100 cases, 100 controls) enrolled in the study; 58 out of 100 cases had recurrent preeclampsia and remaining 42 remained normo-tensive in index pregnancy. Among 100 controls, 93 were normotensive in index pregnancy.Conclusions: Women with history of preeclampsia in previous pregnancy had adverse maternal and perinatal outcome in subsequent pregnancy when compared to the women who were normotensive in the previous pregnancy. But when compared with their own previous preeclamptic pregnancy, they had better pregnancy outcome with good perinatal outcome in their index pregnancy.
Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients - an update.

INTRODUCTION Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. METHODOLOGY We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. RESULTS The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. CONCLUSIONS Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.
Skeletal class II case presentation: Utilization of the advansync 2 appliance

The Herbst appliance has been used routinely in the specialty of orthodontics for nearly 40 years. Over this time, many design variations have been utilized. One of the recent designs is the AdvanSync 2 appliance, manufactured by Ormco. The AdvanSync 2 appliance is smaller than the conventional Herbst appliances and allows the clinician to place braces on all the permanent teeth forward of the first molars. In the case presented, the patient presented with a skeletal Class II, division 2 malocclusion. Facially, it was determined that mandibular advancement would be advantageous for ideal facial esthetics. The result of treatment utilizing the Damon System braces and the AdvanSync 2 Class II corrector was an excellent outcome both dentally and in regard to facial esthetics.
A study on clinicopathology of fistula in ano

Background: Perianal fistula is a common surgical problem which poses great discomfort to patients and causes prolonged morbidity when improperly managed or developed complications. Its management protocols are ill defined, and the efficacy of newer treatment modalities are not well established. The aim of the study was to study the clinicopathology of Perianal fistula and its prognostic factors.Methods: This was a prospective study conducted at the Department of General Surgery, Rajiv Gandhi Government General Hospital between August 2014 and July 2015. Purposive sampling method was used select patients with fistula in ano. After obtaining informed consent, patient details were collected in pre-tested structured questionnaire. Data entry and analysis were done using SPSS software.Results: Males between thirty and fifty years were the most affected population. Most of the patients had no co-morbidities while Diabetes Mellitus was the prevalent co-morbid factor, seen especially in the elderly. MRI fistulogram was the investigation of choice. Fistulotomy was the preferred procedure. Recurrence of fistula was an unavoidable morbidity.Conclusions: Proper preoperative evaluation which includes MRI fistulogram and planning the treatment is essential to prevent complications. Fistulotomy is the preferred treatment especially in patients with trans-sphincteric fistula and those with evidence of infection or secondary tract. The prognosis, if properly managed is very good, so proper management protocols need to be established.
Causes for Deficient Coverage of MMR Vaccine in the Balkan States and the Way Forward

Objectives: To evaluate the causes for low MMR vaccination coverage in the 9 Balkan States, and provide solutions for this public health concern. Methods: Credible articles published 5 years ago, from 2012 up to date were sought for, to ascertain and analyze information on the cause for low MMR vaccine coverage in the Balkan States, and also to provide strategies for mitigation. These journals were sought for in the following reference libraries available online: PubMed, EMBASE, CAB Abstracts, the World Health Organization, the Cochrane Library, Popline, European Centre for Disease Prevention and Control, Centre for Disease and Control, and Google/Google Scholar. Results : This study evaluated MMR vaccinations in nine Balkan States (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Macedonia, Montenegro, Slovenia, Serbia and Romania) from 2012 to 2016. While Albania ranked highest in maintaining the WHO recommended 95% vaccination coverage, other states fluctuated in their percentage of coverage with Bosnia and Herzegovina, Serbia, and Romania having the lowest coverage respectively. Conclusion: Socio-economic and Administrative factors have been the major challenge affecting MMR vaccination coverage in the Balkan States. Anti-vaccination movements recently increased their influence by encouraging the rejection of vaccination by parents. To curb these challenges, research institutes and governmental agencies should sensitize the society about the benefits of vaccination in children and further publicize clinical trials of vaccines in order to prove their safety and efficacy to the public. Keywords: MMR vaccination, vaccine coverage, measles, public health.
Lifestyle Risk Factors in Hospital Attendants in Kumasi, Ghana: Cross-Sectional Study

Majority of noncommunicable diseases have strong association and are causally linked with four behavioral risk factors and these are the harmful use of alcohol, unhealthy diet, physical inactivity and tobacco use. The objective for this study was to determine the prevalence of alcohol consumption, smoking, physical activity, fruit and vegetable consumption among the participants and to determine the relationship between these risk factors and measures of obesity like body mass index, waist to hip ratio and waist circumference. This was a cross-sectional study undertaken in the outpatient clinics of Komfo Anokye Teaching Hospital (KATH) and a total of 424 patients were recruited. These were patients aged 20 years and over who were reporting for the first time to KATH. A questionnaire was administered (including the WHO STEPwise approach to Surveillance questionnaire) after obtaining informed consent, anthropometric measurements were then taken and blood investigations including fasting blood glucose were undertaken. The prevalence of current smoking was 3% while the prevalence of alcohol consumption was very high with 43% of participants having ever consumed alcohol and with 42% having consumed alcohol in the past 12 months. The proportion of participants who consumed fruits was 48% while 89% consumed vegetables. In all 66% were involved in some form of physical activity (work, moving from one place to another, recreation, sport or leisure time activity). In conclusion, these lifestyle factors were common among these participants. There is the need to promote the healthy aspects of these risk factors among these patients.
Preoperative anemia optimization: role of iron supplementation

The presence of anemia in the surgical patient is highly prevalent and is associated with adverse clinical outcomes in the perioperative period. One of the three pillars of perioperative blood management is the optimization of the red blood cell mass. However, the use of allogeneic blood transfusions for anemia optimization is associated with increased risk of adverse clinical outcomes as well as increase healthcare financial costs. Therefore, the optimization of anemia has been shifted toward preference for a non-transfusional approach. Efforts aimed to mitigate the risk of allogeneic blood transfusion in anemic surgical patients by means of hematinic and nutrient supplementation are pursued to enhance perioperative outcomes. Iron deficiency is the most commonly associated etiology of anemia in surgical patients, and depending on the total body iron deposits as well as its bioavailability, it can be divided in absolute and relative iron deficiency. In both types of iron deficiency, the supplementation with parenteral iron is an effective and safe therapy to optimize the preoperative hemoglobin values, mitigating the risk of allogeneic blood transfusion by means of raising the postoperative hemoglobin nadir and avoiding reaching the transfusional threshold. There are multiple parenteral iron preparations, and its safety has been well validated.
Serum Calcium Concentrations, Chronic Inflammation and Glucose Metabolism: A Cross-Sectional Analysis in the Andhra Pradesh Children and Parents Study (APCaPS)

Abstract Background Evidence suggests a role for elevated serum calcium in dysregulated glucose metabolism, linked through low-level chronic inflammation. Objectives We investigated the association of elevated serum calcium concentrations (corrected for albumin) with markers of dysregulated glucose metabolism and type II diabetes and tested if these associations were accounted for by chronic inflammation in a rural Indian population. Methods A cross-sectional analysis of participants aged 40–84 y from the Andhra Pradesh Children and Parents Study (APCaPS; n = 2699, 52.2% women) was conducted. Comprehensive information on household, sociodemographic, and lifestyle factors; medical and family history; physical measurements; blood measurements including fasting plasma glucose (FPG), fasting insulin (FI), serum calcium, albumin, phosphorous, vitamin D (in a subset), and creatinine were analyzed. Additionally, in a random sample of healthy participants (n = 1000), inflammatory biomarkers (interleukins 6 and 18, soluble intercellular adhesion molecule 1, adiponectin, and high-sensitivity C-reactive protein) were measured and an inflammatory score (IScore) calculated. Results After adjustments for sociodemographics, lifestyle factors, and anthropometry the highest calcium quartile (Q4 compared with Q1) was associated with FI (β = 1.4 µU/ml; 95% CI: 1.2, 1.5 µU/ml; P-trend < 0.001), the homeostasis model assessment for insulin resistance (HOMA-IR) (β = 1.4; 95% CI: 1.2, 1.5; P-trend < 0.001), and was modestly associated with FPG (β = 2.1 mg/dL; 95% CI: −0.9, 5.2 mg/dL; P-trend = 0.058) and prevalent type II diabetes (OR = 1.6; 95% CI: 1.0, 2.6; P-trend= 0.020). In the healthy subgroup, the association of the highest calcium quartile was similar for FI and HOMA-IR. Additional adjustment with IScore did not alter the associations. Further, in a subset, all these associations were independent of endogenous regulators of calcium metabolism (serum vitamin D, phosphorus, and creatinine). Independently, after accounting for potential confounders, the highest IScore quartile (Q4 compared with Q1) was positively associated with FPG, FI, HOMA-IR, and prevalent prediabetes, and also with serum calcium concentrations in men. Conclusions Elevated serum calcium was positively associated with markers of dysregulated glucose metabolism and prevalent type II diabetes in a rural Indian population. Chronic inflammation did not mediate this association but was independently associated with markers of dysregulated glucose metabolism. Inflammation might be responsible for elevated serum calcium concentrations in men.
Negotiating femininities on campus: Sexuality, gender and risk in an HIV environment

Objective: In South Africa, Black African women between the ages of 15 and 24 years are especially vulnerable to HIV. The heterosexual transmission of the disease is exacerbated by social and cultural conditions that perpetuate gender relations of inequality. Problematic conceptualisations of femininity increase sexual risk. The objective of this article is to examine the ways in which undergraduate university Black African female students make meaning of gender and sexuality on campus and the social processes through which femininities are produced. Design: Qualitative research study. Setting: University of KwaZulu-Natal, South Africa. Method: In total, 10 in-depth interviews and focus group discussions with 25 Black African undergraduate female students aged between 18 and 24 years old. Results: Campus life was conceived as a place of heterosexual freedom, sexual enjoyment and engagement with dating relationships. Relationships were forged based on romantic notions of love and versions of femininity based on trust lead to sexual risk and unwanted pregnancy. In the context of material inequalities, ‘sugar daddy’ relationships further limited female students’ ability to negotiate safe sex. The overall climate on campus was structured along gender power inequalities. Female students feared and were victims of verbal, physical assault and sexual coercion. The lack of campus security exacerbated female students’ vulnerability to violence on campus. Conclusion: Addressing the specific meanings expressed by Black African female students on campus can help to improve the effectiveness of campus-based health education interventions promoting safe sex, gender equality and student safety.
The effect of nurses' communication skills with Nulliparous mothers on exclusive breastfeeding: A Clinical Trial Study

Exclusive breastfeeding (EBF) in the first six months of life has many benefits for mother and newborn. The purpose of the present study was to investigate the effect of medical staff communication skills training on breastfeeding in nulliparous mothers. This is a clinical trial study. One hundred- seventy nulliparous pregnant women were selected from Vali-e-Asr Hospital of Tehran. The samples were divided into two groups of intervention (n=85) and control (n=85) by randomized blocks method. The intervention in this study was in the form of therapeutic communication training to the ten nurses in delivery emergency department ward on how to communicate with mothers. The Therapeutic communication skills training course consisted of four communication skills (Empathy skills, Interpersonal skills, Stress and emotional management). Chi-square test and analysis of variance were used to analyze the data and compare the groups. There was a significant difference between the two groups regarding the exclusive breastfeeding for 6 months (P=0.046). The frequency of exclusive breastfeeding in interventional group was higher than the control group (37.5% vs. 23.5%). At six months old, the babies in the study group grew more than the control group (8218.82 ± 2308.57 vs. 7442.23 ± 1923.27 gr, p=0.018) The professional therapeutic relationship of medical staff with the mothers led to an increase in exclusive breastfeeding and continuation of breastfeeding in the first 6 months of childbirth. It seems that breastfeeding is associated with the higher baby growth and lower use of formula feeding.
Norwegian General Practitioners Contribution and Participation in Emergency Medicine

Background: Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting. Methods: We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation. Results: The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis. Conclusions: EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call.
Steroid Pulse Therapy in the Management of Neuro-psychiatric Manifestations in an Atypical Presentation of Typhoid Fever

The Typhoid fever often presents with a variety of clinical symptoms and numerous systemic complications. Neurological complications of enteric fever are relatively insidious and rare and many times late and often undiagnosed complication of typhoid fever which can change the course of illness. This is a case of blood culture-proven typhoid fever with neuropsychiatric manifestations responded well with appropriate antibiotics and steroid pulse therapy (1 gram Methylprednisolone for 3 days).
Education, Employment, and America’s Opioid Epidemic

America is embroiled in an opioid epidemic that continues to take a toll on American citizens’ quality of life, utility, and mortality rates, as well as the nation’s economy. Researchers have examined information from Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Episode Data Set (TEDS) (Drug and Alcohol Services Information Systems [DASIS], 2009) in order to get an idea about which populations are able to access opioid treatment in America, the District of Columbia, and Puerto Rico. Details of education levels and employment rates for those being treated could offer answers about individuals and populations impacted by the opioid epidemic. The purpose of this study was to examine whether individuals who had been in treatment for heroin and/or opioids in 2014 have a higher level of education than individuals in treatment for heroin and/or opioids in 1998, and to determine if individuals in treatment for heroin and/or opioids in 2014 have higher rates of employment than individuals in treatment for heroin and/or opioids in 1998 (DASIS, 2009). Researchers used a T-test on the TEDS and found statistically significant changes in levels of education and static rates of employment from 1998 to 2014 (DASIS, 2009).
Antibacterial activity of Holarrhena Antidysenterica [Kurchi] against the enteric pathogens

The present study was undertaken to find the antibacterial activity of the crude aqueous and alcoholic extracts of stem bark of Holarrhena antidysenterica against the known enteric pathogens. Holarrhena is a genus of trees or shrubs distributed throughout the tropical and subtropical regions of the world. It is a small deciduous tree with white flowers and found throughout the dry forests of India even as far as as Travancore1. The different parts of the plant were used since antiquity in the indegenous system of medicine. As far as our knowledge goes, antibacterial activity of H. antidysenterica against the enteric pathogens has not been reported from India .