Miracle-dz/UniFAR-FTUs huggingface dataset:
Self-medication among Undergraduate Medical Students of Alexandria Faculty of Medicine: Where do We Stand?

Background: The aim of the present study was to assess the prevalence of self-medication among undergraduate medical students in Alexandria Faculty of Medicine and recognize the patterns and the attitude of students towards intake. Methods: A cross-sectional study was conducted among undergraduate medical students attending Alexandria Faculty of Medicine from both national and international programs during the period of June 2013 until October 2013. A self-administrated, semi-constructed questionnaire was used to assess the practice of self-medication among 408 students who were randomly selected using a stratified random sample technique. Results: Self-medication was reported by 208 (52.7%) students, with no significant difference between males and females. The highest percentage of self-medication was reported among those who have completed six years of academic study and the lowest was reported among those who have completed two years of academic study. There was a statistically significant association between educational stage (preclinical and clinical) practice of self-medication. Most common medications involved were analgesic and anti-inflammatory followed by decongestants, antimicrobials and antihistaminic drugs. 309 (78.8%) students believed that self-medication is acceptable. Conclusion: The present study demonstrated that self-medication is practiced by more than half of undergraduate medical students in the Faculty of Medicine - Alexandria University. Acquiring medical knowledge seems to be associated with the practice of self-medication. Therefore, more attention should be paid to medical curricula to raise awareness and limit the hazardous effects of this phenomenon
Risk Factors for Fracture in Alcohol-dependent, Pre-menopausal Females

Aims: Alcoholism is known to be associated with increased risk of fracture. This study aimed to study bone turnover following alcohol detoxification and to investigate lifestyle factors for low bone density that might coexist with alcohol dependency, which might be amenable to modification. Method: Pre-menopausal female participants were recruited from an alcohol-use dependency unit to a cross-sectional study. A lifestyle questionnaire, including alcohol history, smoking, physical activity, dietary calcium intake, falls, and fracture history was completed. Quantitative heel ultrasonography was performed and broadband ultrasound attenuation (BUA), speed of sound (SOS), t score, and z score were recorded. Blood was taken for bone-turnover markers at baseline and day 5 following admission for alcohol withdrawal.Results: The mean age (SD) of alcohol dependent participants was 41.6 (8.3) years, with participants reporting high levels of current cigarette smoking, physical inactivity, and falls. BUA, SOS, t scores, and z scores were lower than the age-matched reference range in alcohol-dependent participants. Levels of type 1 procollagen (P1NP) increased significantly after five days (p < .001). Conclusions: Alcohol-dependent, pre-menopausal individuals have multiple risk factors for fracture, beyond alcohol excess. These should be addressed and targeted as modification may reduce fracture risk, especially given the apparent recovery of bone turnover on the withdrawal of alcohol.
IL-4 Alleviates Ischaemia-Reperfusion Injury by Inducing Kupffer Cells M2 Polarization via STAT6-JMJD3 Pathway after Rat Liver Transplantation

Background Liver ischaemia-reperfusion injury (IRI) remains a problem in liver transplantation. Interleukin-4 (IL-4) has been found to reduce liver IRI, but the exact mechanism remains unclear. Methods Donor livers were infused with recombinant IL-4 or normal saline during cold storage, and the hepatocellular apoptosis and the inflammatory response were detected. The effect of IL-4 treatment on Kupffer cells (KCs) polarization and expression of the STAT6-JMJD3 pathway was evaluated in vivo and in vitro. KCs in donor livers were depleted by clodronate liposome treatment or JMJD3 was inhibited by GSK-J4 before liver transplantation to determine whether the protective effect of IL-4 treatment was dependent on KCs. Results IL-4 treatment decreased sALT and sAST levels and alleviated hepatocellular apoptosis and inflammation at 6 h after liver transplantation. IL-4 treatment induced KCs alternatively activated (M2) polarization in vitro. KCs in donor livers were depleted by clodronate liposome treatment or JMJD3 was inhibited by GSK-J4 before liver transplantation to determine whether the protective effect of IL-4 treatment was dependent on KCs. in vivo and in vitro. KCs in donor livers were depleted by clodronate liposome treatment or JMJD3 was inhibited by GSK-J4 before liver transplantation to determine whether the protective effect of IL-4 treatment was dependent on KCs. Conclusions IL-4 treatment-induced KCs M2 polarization was dependent on the STAT6-JMJD3 pathway and protected liver grafts from IRI after liver transplantation.
Assessment of depression, anxiety, and stress among medical students enrolled in a medical college of New Delhi, India

Objective: The objective of this study was to determine the prevalence of depression, anxiety, and stress among medical students. Materials and Methods: Students underwent face-to-face interview using predesigned, pretested, anonymous interview schedule using standardized survey instrument and Depression Anxiety Stress Scale 21 item. Information was also collected on sociodemographic, academic profile, and personal characteristics of students. All the students enrolled in the medical college from first to final year were invited to participate, and the study was conducted during mid-semester to ensure that there was no university examination or college festival/event. Results: A total of 187 students participated in the study giving a response rate of 94%. The participants were predominantly male (66%) and majority (65.8%) residing in hostel. It was noted that 7.5% reported parental conflict; 15.0% were “always” fearful about future life; 21.9% had poor relationship with family members; 22.5% were not satisfied with their body image; and 18.7% were globally dissatisfied. It was observed that 60 (32.0%), 75 (40.1%), and 82 (43.8%) students were affected by symptoms suggestive of depression, anxiety, and stress, respectively. On bivariate analysis, higher proportion of students with anxiety had a history of some medical condition (P < 0.05). Similarly, family history of chronic noncommunicable disorder was significantly (P < 0.05) associated with stress only while students with family history of mental illness had a higher proportion of depression (P < 0.05) only. It was also found that dissatisfaction with body image and global dissatisfaction with life was statistically (P < 0.05) associated with depression and anxiety while fair (poor) relationship with family members was statistically (P < 0.05) associated with depression only. Subjective (self) assessment of ability to cope with medical syllabus was inversely associated (P < 0.01) with ability, i.e., as the student's ability to cope with syllabus increases by one unit, the probability of occurrence of depression and anxiety decreases by 1.29 units and 0.71 units, respectively. Conclusion: It is noted that emotional distress is common among medical students, and there is an urgent need for attention, support, and personalized counseling.
Primary Transanal Swenson’s Pull through in Hirschsprung’s Disease in SRHF, Mizoram, India

Purpose: The authors describe their experience of primary transanal Swenson’s operation and its short and intermediate term outcome in neonates, infants and children. Methods: Twenty four patients with rectosigmoid HD (Hirschsprung’s Disease) underwent single-stage transanal Swenson’s procedure. The contrast enema finding with definite transition zone was relied upon for diagnosis. Full thickness rectal dissection was done starting from 0.5-1 cm above the dentate line. The mobilized colon was resected about 5 cm or more above the transition zone. Full thickness colo-anal anastomosis was then performed. Results: There were 21 male and 3 female patients and the ages of the patients ranged from 4 days to 3 yrs. The mean length of the resected colon was 19.54 ± 9.85 cm. The anatomical transition zone correlated with the pathological transition zone in all the cases. The mean follow up period was 8.28 ± 3.9 months. Two patients had post-operative enterocolitis, and one patient had stricture of the anastomosis. Two patients expired during the follow up period, one due to sepsis and the other due to community acquired pneumonia. One patient continued to have occasional fecal soiling and one patient developed perianal fistula for which diverting colostomy was done. Two patients had ongoing occasional constipation. None of the patients had voiding disturbances or incontinence. Conclusion: Primary trans-anal Swenson’s pull through is a safe and viable alternative technique for patients with rectosigmoid HD. The procedure is feasible even in neonates and in upper sigmoid colon HD. A long term study is required to determine the incidences of recurrent enterocolitis, gas bloating as well as to assess sexual and urinary functions as the patients grow up.
NON-INVASIVE ASSESSMENT OF LIVER STEATOSIS AND FIBROSIS USING TRANSIENT ELASTOGRAPHY AND CONTROLLED ATTENUATION PARAMETER IN TYPE 2 DIABETES PATIENTS.

Context Nonalcoholic fatty liver disease is common in type 2 diabetes mellitus patients, being difficult to diagnose. Objective To find a correlation between elastographic parameters and lab results, for facilitating the diagnosis of nonalcoholic fatty liver disease. Design This is a cross sectional study, conducted at the Departments of Diabetes, Nutrition and Metabolic Diseases, and Gastroenterology and Hepatology, of the Clinical Emergency Hospital "Pius Brinzeu" Timisoara. Subjects and Methods We included 190 type 2 diabetes mellitus patients, collected data regarding medical history, clinical and biological features and applied the Alcohol Use Disorders Identification Test. We excluded patients with other causes of liver disease. Liver steatosis and fibrosis were evaluated through transient elastography, yielding two parameters: liver stiffness as an indicator of liver fibrosis stage, expressed in kPa, and liver steatosis stage, assessed by controlled attenuation parameter, expressed in dB/m. Data were analyzed using SPSS 15. Results The analyzed group comprised 113 patients. Elastographic measurements showed that 93.8% of the patients had steatosis (controlled attenuation parameter ≥232.5 dB/m) and 70.8% severe steatosis (controlled attenuation parameter ≥290 dB/m). Severe steatosis was more common in women (75.7%) than in men (68.1%) (p<0.0001). From the patients with steatosis, 47.2% had liver stiffness values suggestive for fibrosis and 19.8% for cirrhosis. Most patients with steatosis and severe fibrosis were obese (66.7%). Triglycerides/HDLc ratio >4 correlated with hepatic steatosis (p=0.04), being more common in patients with severe fibrosis/cirrhosis (58.3%) than in those with absent or mild fibrosis (36.2%). Conclusions Our study found a clear correlation between type 2 diabetes mellitus and the presence of liver steatosis. It correlates with body mass index, waist circumference (in men) and triglycerides/HDLc ratio. Controlled attenuation parameter is a useful noninvasive method for detection and quantification of liver steatosis.
PENGARUH PENYULUHAN DAN PELATIHAN MELALUI MEDIA LEAFLET TERHADAP PENGETAHUAN KADER PHBS DI KECAMATAN RATOLINDO KABUPATEN TOJO UNA-UNA

Masih rendahnya cakupan Perilaku Hidup Bersih Dan Sehat (PHBS) dan belum banyak masyarakat yang benar-benar menerapkan PHBS. Di kecamatan Ratolindo, untuk itulah perlu dilakukan peningkatan pengetahuan keluarga dan pembinaan kader dengan memberikan penyuluhan.dan latihan pemberdayaan. Tujuan penelitian ini adalah untuk mengetahui pengaruh efektifitas Penyuluhan dan pelatihan melalui media Leaflet terhadap pengetahuan Kader PHBS Di Kecamatan Ratolindo Kabupaten Tojo Una-una tahun 2017. Penelitian ini menggunakan desain penelitian quasi eksperimental dengan quasi-experimental one group pretest-posttest design. Pengukuran dilakukan sebelum dan setelah pemberian penyuluhan kesehatan dan pembinaan kader tentang konsep PHBS dengan metode leaflet.Dengan jumlah sampel sebanyak 40 sampel. Analisis data dengan menggunakan program SPSS, dan dilakukan uji normalitas. Uji hipotesis yang digunakan dalam penelitian ini adalah independent sample t-test, paired t-test. Hasil penelitian ini menunjukan bahwa terdapat perbedaan rata-rata frekuensi pengetahuan kader PHBS setelah dilakukan intervensi penyuluhan dan pelatihan, Hasil Uji Paired Sample t test diperoleh nilai signifikan dengan nilai ρ Value = 0.010. bahwa ada pengaruh penyuluhan dan pelatihan melalui media Leaflet terhadap pengetahuan Kader PHBS Di Kecamatan Ratolindo Kabupaten Tojo Una-una tahun 2017. Pada hasil analisis univariat diperoleh hasil pengetahuan kader PHBS mengalami peningkatan peningkatan walaupun masih ada sebagian yang dari kader PHBS yang memiliki pengetahuan rendah.
Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps.

Background Preoperative differentiation of malignant and premalignant gallbladder polyps (GBPs) from benign lesions is a key imperative to guide treatment decision-making. We aimed to characterize the various types of GBPs and sought to identify the risk factors for neoplastic polyps. Our findings may help optimize treatment strategy. Methods Retrospective analysis of 686 patients with post-cholecystectomy pathologically-proven GBPs between January 2003 and December 2016. The patients were classified into non-neoplastic polyp group, benign neoplastic polyp group, and adenoma canceration group. Clinical features, ultrasound findings, and results of laboratory investigations and histopathological examination were reviewed and compared between the groups. Results Out of 686 patients, 542 (79.0%) had non-neoplastic polyps, 134 (19.5%) had neoplastic polyps, and 10 (1.5%) had adenoma canceration. The mean age was 46.06±12.12 years; 383 (55.8%) patients were female. The median (25th percentile, 75th percentile) time between diagnosis and surgery in the cholesterol polyp group [24 (3.5, 60) months] was significantly longer than that in adenoma [12 (2, 60) months] and adenoma canceration [5 (0.475, 12) months] groups. The mean diameter was 1.14±0.61 cm (range, 0.5-8.4 cm). Three hundred twelve (45.5%) patients had solitary polyps and intralesional blood flow was observed in 41 (6.0%) patients. On univariate analysis, age >49.5 years, polyp size >1.15 cm, solitary polyp, intralesional blood flow, absence of symptoms, and lack of cholecystitis showed a significant association with adenoma. On multivariate analysis, polyp size (>1.15 cm), intralesional blood flow, and lack of cholecystitis were independent predictors of adenoma. Conclusions Polyp size >1.15 cm, intralesional blood flow, and lack of cholecystitis were predictors of neoplastic polyps. Malignant transformation of adenoma may occur over a relatively short time.
Nutritional evaluation of urea molasses multi-nutrient blocks containing agro-industrial wastes in buffaloes

The present study was undertaken to formulate and compare the nutritional worth of conventional urea molasses multinutrient block (UMMB) with UMMB containing spent sugar syrup (SSP) from aamla (Phyllanthus emblica) preserve (murabba) industries, sundried waste bread (WB) and/or tomato pomace (TP) in buffaloes. The wheat flour and oil mustard cake in the conventional UMMB were replaced, respectively, with WB and TP on nitrogen basis, while molasses was replaced by SSS on weight by weight basis. The blocks were iso-nitrogenous and iso- caloric as indicated by comparable CP and EE contents in different UMMBs. Male Murrah buffaloes (12; 5–6 yr old; 456.8±5.3 kg body weight) randomly distributed into 3 equal groups were offered either conventional-UMMB, UMMB containing SSS (SSS-UMMB) or UMMB containing SSS, WB and TP (SSS-WB-TP-UMMB) for 45 days. In addition to the respective UMMBs, the animals in all the groups were offered 1 kg conventional concentrate mixture, 5 kg green fodder and 9 kg wheat straw. The daily intake of block varied from 0.49 kg (SSS-UMMB) to 1.08 kg (conventional-UMMB). Simultaneously, each diet was fed to 3 rumen fistulated male buffaloes to assess the impact on rumen metabolites. The DM and water intake, digestibility of nutrients, concentration of rumen metabolites, blood profile, urinary purine derivatives and N-retention were statistically comparable in all the groups. All the animals maintained their body weights. It was concluded that agro-industrial wastes like spent sugar syrup, waste bread and tomato pomace could be incorporated into UMMBs without any adverse effect on palatability, nutrient utilization or health of animals. Above all the preparation of UMMB could be economized and conventional ingredients could be spared for more vulnerable species.
Middlemen and Smallholder Farmers in Cassava Marketing in Africa

Summary Cassava is a basic food staple and a major source of farm income in Africa. Efficiency in cassava marketing is therefore a very important determinant of consumers living cost and producers’ income. Exploitation of one marketing agent by another in the course of product distribution could contribute to increased marketing costs and hence inefficiency. The paper examines the extent to which the widely held view that middlemen exploit farmers through monopsony purchases and usury apply to cassava farmers. The paper is based on primary data collected within the framework of the collaborative study of cassava in Africa (COSCA). The result of the analysis fails to support the view that middlemen generally engage in monopsony purchases of cassava products, because farmers had on average, higher volume of cassava products for sale in the market than middlemen. Prices of cassava products appeared more stable in Nigeria than in the other countries, because of the more elaborate involvement of middlemen, which encouraged competition. The intermediaries between the farmer and the consumer were at most three in each of the countries – the processor, the semi-wholesaler and the retailer. Cassava farmers and traders combined the role of the processor apparently because of the low development stage of mechanized processing technology. For both farmers and middlemen, transactions in cash were the predominant practice, followed by delayed payments. Advanced payment was non-existent except in Uganda. Marketing margins, though generally high, decline with good market access conditions. And the margins for granules were substantially lower than those of dried roots not only because of substantial differences in processing resource demand but also because of differences in marketing costs. This suggests that investments towards improving market access conditions, and in cost saving processing technologies for the production of granules are needed for the improvement of cassava marketing efficiency and development.
Determination of a Cut-off Point for Prostatic Specific Antigen to Avoid Unjustified Biopsy Among Asymptomatic Elderly Men

Background: To our knowledge, there is no national screening program for prostate cancer in Egypt. The Uro-surgery department in Alexandria University established a screening program for prostate cancer among men aged 55 years or more in January 2012. Objective: To determine a valid Prostatic Specific Antigen (PSA) cut-off point for performing Transrectal Ultrasonography (TRUS) guided biopsy among asymptomatic elderly men. Methods: A screening cross sectional study was conducted on a convenient sample of 1207 men aged ≥55 years who were attending urology department, Alexandria University for non-prostatic symptoms during years 2013 and 2014. Digital Rectal Examination (DRE) and PSA level measurement were performed for all included subjects. TRUS guided biopsy was done for those who found to have PSA ˃ 4ng/ ml and or suspicious DRE. Results: Among subjects who had PSA level of 4.1-10, the Positive Predictive Value (PPV) for cancer prostate was 54% among those with suspicious DRE findings as compared to 0 among those with nonsuspicious DRE. For PSA level of 10.1-20 and >20 with suspicious DRE, PPV was (77% and100% respectively). The mean serum total PSA was 77 and 0.6 ng/ ml for patients with and without prostatic cancer respectively (p= 0.0001). The yield of cancer prostate among all screened men was 103/1207= 8% and 103/157= 66% among those with PSA˃ 4 ng/ ml and or having suspicious DRE and were biopsied. Considering all men who had biopsy, ROC curve could derive a cut-off value of 10.05 ng/ml with a sensitivity of 92% and a specificity of 92.6%. Inability to perform biopsy for men with PSA ≤4 ng/ml was the main limitation. Conclusion: In a country of relatively low prevalence of prostate cancer like Egypt, a cut-off point of PSA in combination with DRE for doing TRUS biopsy could be 10.05 ng/ ml among asymptomatic men ≥55 years of age with a likelihood ratio of 12.43.
The “Big Five” in 100 Clinical Ethics Consultation Cases

Abstract Background: The study aims at shedding light into the practice of Clinical Ethics Consultation (EC) thereby making a contribution to bet - ter understanding its triggers, contents and outcomes. It was carried out in 2 (out of 3) local University Hospitals. Material and method: 100 full ECs (50 ECs conducted at the somatic/ USB, 50 at the Psychiatric University Hospital/UPK) over 3 years were analysed on the basis of its rich and highly standardised documentation. Results: Overall, the majority of all ECs (84%) feature ethical issues referring to at least one of the following 5 topics: coercion (28%), care management (24%), treatment-plan evaluation (17%), end-of-life care (16%), or pregnancy / assisted reproduction (12%). In USB ECs, the top 3 main ethical issues concern end-of-life care (28%), pregnancy / assisted reproduction (22%), and coercion (20%), followed by treatment limitation (8%), and care management (6%). The single most significant main ethical issue in UPK ECs is coercion (34%), fol - lowed by care management and treatment-plan evaluation (both 20%). Discussion: The prevalence of end-of-life issues in somatic health care is in line with previous research, while the evidence for coercion as a major topic in ECs in general is new. Comparable studies are hardly available from other European centres, and the existing North American papers do not display a prevalence of this concern. Conclusions: The thematic shift to a double focus on end-of-life deci - sions and coercion and the “big five” themes revealed altogether stim- ulate the catalogue of clinical ethics education, both for ethics consul - tants and health care professions.