Miracle-dz/UniFAR-FTUs huggingface dataset:
Case Study of the Four-Year Neuropsychological Changes in an Elderly Male with Possible Chronic Traumatic Encephalopathy

CASE STUDY OF THE FOUR YEAR NEUROPSYCHOLOGICAL CHANGES IN AN ELDERLY MALE WITH POSSIBLE CHRONIC TRAUMATIC ENCEPHALOPATHY Sarah Martin Shreeve Antioch University Seattle Seattle, WA Research demonstrates that the brain’s response to Traumatic Brain Injury (TBI) is variable with age and the effects of TBI on the elderly are a critical and global public health concern, from both a medical and a neuropsychological perspective. Currently, there is scant research on the effects of TBI, including Chronic Traumatic Encephalopathy (CTE), on the elderly. Specifically, there is a paucity of literature regarding longitudinal neuropsychological changes in elderly postTBI individuals. This dissertation will present a Single Case Research Design (SCRD) analysis of an elderly individual with possible Chronic Traumatic Encephalopathy and the associated neuropsychological changes over 49-months. This dissertation is available in open access at AURA, http://aura.antioch. edu/ and Ohio Link ETD Center, https://etd.ohiolink. edu/etd.
Postoperative Occlusion of the Small Bowel with Flanges and/or Adhesions in General Surgery of Kati BSS CHU

Objectives were to determine the frequency, describe the epidemiological and clinical aspects, therapeutic and analyze the postoperative course. Methodology: This was a retrospective study that covered 08 years (January 2009-December 2017). Inclusion criteria: all patients operated for obstruction of the small bowel by hail and/or flanging. Exclusion criteria: other types of occlusion and non-operated patients. Result: We recorded a total of 162 cases of hail obstruction by adhesions and/or flanges at 2.87%. The average age was 32.04, the sex ratio was 1.2. The average consultation time was 4 days. Abdominal pain associated with stopping of material and gas was present in all our patients. X-ray of the abdomen without preparation carried out in all the patients made it possible to objectify in 150 patients (92.6%) of the hydro-hail levels. Inoperative occlusion of hail on flange was present in 80 patients (49.4%). Occlusion of the small bowel on flange and adhesion was present in 69 patients. Adhesion obstruction of hail accounted for 6.8% (11 cases). The most commonly used surgical technique was flange resection in 91 patients (56.2%). The follow-up was simple in 151 patients (93.2%). Mortality was 1.2% of cases, i.e. 2 deaths. The average duration of hospitalization was 6 days. Conclusion: Occlusion of the small bowel by flanging and/or adherence is a surgical emergency whose prognosis depends on early management.
A Scoping Review of Joint Protection Programs for People with Hand Arthritis

Joint Protection (JP) can be enhanced by incorporating recent evidence and innovations in collaboration with people with hand arthritis to be salient, useful and effectively implemented.The purpose of this study is to map the current research on JP principles and guide future research on JP programs for the management of hand arthritis.A search was performed in 4 databases (PubMed, EMBASE, Google SCHOLAR, CINHAL) from January 1990 to February 2017. A Grey literature was also conducted through the Google web search engine. A combination of search terms was used such as hand osteoarthritis, rheumatoid arthritis, joint protection and/or self-management strategies.Our search found 8,788 citations in which 231 articles were deemed relevant and after duplication 111 articles were retrieved for a full-text review. In total, 40 articles were eligible for data extraction. The majority of the articles were randomized controlled trials (RCTs), systematic reviews and overviews of reviews that investigated joint protection for hand arthritis. Joint protection was tested mostly in rheumatoid arthritis (RA) population and to a lesser extent on hand osteoarthritis and was provided mainly by an occupational therapist.This review synthesized and critically examined the scope of JP for the management of hand arthritis and found that RCTs, systematic reviews and overviews of reviews constituted two-thirds of the current body of literature. Furthermore, it identified a lack of clarity regarding the specific elements of joint protection programs used in clinical studies.
Effect of Evening Primrose Oil and Vitamin B6 on Pain Control of Cyclic Mastalgia Associated with Fibrocystic Breast Changes: A Triple-Blind Randomized Controlled Trial

Background: Mastalgia is the most common symptom of fibrocystic breast changes. It causes concern and fear of breast cancer and has negative effects on quality of life. The study aimed to compare the effectiveness of evening primrose oil (EPO) and vitamin B6 in the pain control of cyclic mastalgia. Methods: This triple-blind randomized controlled clinical trial was conducted on 94 patients with mastalgia referring to the breast clinic of Milad hospital, Tehran, Iran. The participants were randomly assigned to three groups: EPO (n = 33), vitamin B6 (n = 31), and placebo (n = 30). The mastalgia severity in the three groups was measured using Visual analogue scale (VAS) before intervention and at the first, second, and third months after the beginning of the intervention using SPSS 18. Results: The results of this study showed that the mean severity of breast pain significantly reduced at the first, second, and third months after the intervention in the EPO (2.61 ± 2.35) and vitamin B6 groups (2.81 ± 1.97) (P < 0.001). However, the mean score of pain severity in the placebo group before and after the intervention did not show a statistically significant difference (5.38 ± 2.28) (P = 0.815). In addition, the difference in the mean score of pain severity between the two groups of EPO and vitamin B6 was not statistically significant (P = 0.999). Conclusions: The results of this study showed that vitamin B6 and EPO have the same therapeutic effects in the treatment of cyclic mastalgia. Because of the low cost and more availability of vitamin B6 compared to EPO, it can be used in the first line of treatment.
Proven Safety of Alternative Sedation Regimens for Esophagogastroduedonoscopy: A Retrospective Comparative Study

Objectives: In this retrospective study, we aimed to compare cardiopulmonary side effects, sedation characteristics, and patient satisfaction of propofol–meperidine and propofol–ketamine sedation for esophagogastroduodenoscopy (EGD). Methods: Data were extracted from the anesthesia and endoscopy records of the patients. Patients aged >18 years who underwent elective diagnostic EGD under sedation between January 2015 and December 2016 were enrolled in the study. Depending on the sedation procedure, the patients were divided into two groups: propofol–meperidine group (Group PM) and propofol–ketamine group (Group PK). Cardiopulmonary side effects (hypotension, bradycardia, apnea and hypoxemia), procedure times, and patient satisfaction were compared between the groups. Results: In total, 154 consecutive patients who underwent elective diagnostic EGD between January 2015 and December 2016 under sedation with propofol–meperidine and propofol–ketamine were included in the study. The overall incidence of side effects did not differ between the groups, but the incidence of hypotension was significantly higher in Group PM compared with Group PK (7.8% vs. 0%, p=0.028). There was no significant difference in hypoxemia (p=0.597) and apnea (p>0.999) between the two groups. Awake time (time interval between the removal of the endoscope and responds readily to name spoken in normal tone) was significantly shorter in Group PM compared with Group PK (7.21±3.70 vs. 8.91±4.10 min, p=0.008). Patient satisfaction for the two groups were similar (p=0.245). Conclusion: The propofol–ketamine sedation regimen seems to be superior compared with the propofol–meperidine sedation regimen in terms of hemodynamic stability. Both sedation regimens have similar respiratory safety profile. P ropofol–meperidine s edation p rovided f aster r ecovery t imes t han p ropofol–ketamine s edation f or E GD. Furthermore, high patient satisfaction levels were obtained with both sedation regimens.
ADVANCED JOURNAL OF EMERGENCY MEDICINE. 2018; 2(2): e15

Introduction: It could be claimed that extended focused assessment with sonography for trauma (e-FAST) is the most important use of ultrasound in every emergency department (ED). It is a rapid, repeatable, noninvasive bedside method that was designed to answer one single question, which is, “whether free fluid is present in the peritoneal, pleural and pericardial cavity or not? ” This examination may also be used to evaluate the lungs for pneumothorax. Objective: The current comparative study was conducted to assess the accuracy and reproducibility of eFAST performed by emergency medicine residents (EMRs) and radiology consultants (RCs) in multiple trauma patients. Method: This diagnostic accuracy study was conducted prospectively in patients presenting over a period of 12 months from January 1, 2013, to December 31, 2013 to the ED of Kerala Institute of Medical Sciences (KIMS), Kerala, India. All multiple trauma patients older than 18 years of age presenting within 24 hours of their traumatic event, who underwent both e-FAST and thoracoabdominal computed tomography (CT) scan were included. The e-FAST exams were first performed by the EMRs and then by RCs. The thoracoabdominal CT scan findings were considered as the gold standard. The results were compared between both groups to assess the inter-observer variability. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated both for EMRs and RCs. Results: In the study period, 150 patients with a mean age of 42.06 ± 18.1 years were evaluated (76.7% male). Only 19 cases (12.7%) had a history of fall from a height, and the others were admitted due to RTA. Thirty-four cases (22.7%) did not require surgery; but the others underwent various interventions. Both EMRs and RCs reported positive findings in 20 cases (13.3%) and negative findings in 130 cases (86.7%). The correlation of e-FAST done by EMRs with that by RCs was 100%. E-FAST exam had a sensitivity of 90.4%, specificity 99.2%, PPV 95.0%, NPV 98.4%, and accuracy 98%, both for EMRs and RCs. Conclusion: Based on the findings, the sensitivity, specificity, and accuracy of e-FAST exams performed by EMRs were equal to those performed by RCs. It seems that e-FAST performed by EMRs were almost accurate during the initial trauma resuscitation in the ED of a level one trauma center in India.
A cross-sectional study on menstrual hygiene practices among school going adolescent girls (10-19 years) of Government Girls Inter College, Saifai, Etawah

Background: Menstrual hygiene is a key concern of adolescent health. Females spend around six to seven years of their lives menstruating. Still the menstrual hygiene management (MHM) is mostly neglected. Menstrual hygiene is a taboo; even females are uncomfortable discussing and educating their daughters about this topic. To understand the problem faced by females during menstruation specially in their adolescent age this study was conducted. This study was done to find out knowledge about menstrual hygiene, to study hygiene related practices among school going adolescent girls of Government Girls Inter College (GGIC), Saifai, Etawah.Methods: School based cross-sectional study was undertaken among the adolescent school going girls of GGIC, who were purposively selected. All girls of between the age group of 10 19 years who have attained menarche were selected and the sample size came out to be 212.Results: The mean age of attainment of menarche was 13.17 years with majority of girls having no idea about menstruation before menarche (76.4%). 48.6% girls used only sanitary pads as the absorbent material. It was concluded that there is significant association between the absorbent material used and the socio-economic status of the family (p=0.03173). Conclusions: There is a need of accurate and adequate information about menstruation and its effective management. The restrictions which are imposed on girls during menstruation should be understood and dealt in a proper way. Thus this study was conducted.
Weight Lifting, Weight Loss and What to Eat Addressing the Unmet Medical Curriculum of Health Maintenance

Background: Nutrition is essential for health and wellbeing. However, less than 50% of general doctors give nutritional advice to patients. These studies aims to measure medical students’ perceptions about the importance of nutrition, measure their confidence in giving nutritional advice to patients, and suggests proper teaching interventions. Methods: Students enrolled in the 2016 entry program in RCSI, Dublin (N 1200) completed a confidential 19 item online survey. Surveys were completed by 365 students (30%). The survey assessed student’s confidence in their ability to address diet with patients, diet habits, and perceptions about the importance of nutrition and nutrition’s teaching. Results: Most students (63%) are either “confident” or “extremely confident” in prescribing nutrition to patients. However, 25% reported eating more than 4 servings of fatty foods regularly. Up to 83% of students rated healthy eating as “very important” for patient’s health and wellbeing. Conclusion: The majority of students believe nutrition is hugely important for patients. Generally, they are confident in their ability to address diet with patients. However, a considerable number have negative health habits which must be addressed. We suggest integrating an innovative nutrition’s course to increase students’ confidence in relation to nutrition.
Relationship between lichen planus and dyslipidemia: A case-control study from Southwest Iran

Background: Lichen planus (LP) is a chronic inflammatory skin condition which leads to changes in lipid metabolism. It may cause chronic atherosclerosis and metabolic syndrome. The objective of this study is to compare lipid levels of patients with LP to healthy controls. Methods: This case-control study recruited 100 total participants, 50 (25 male and 25 female) patients with LP and 50 healthy controls admitted to the Dermatology Clinic of Imam Hospital, Ahvaz, Iran. Serum triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels were measured in samples drawn after a 12-hour fasting period. Results: Patients with LP had significantly higher triglycerides (147.7 vs. 118.4 mg/dl, P<0.05), total cholesterol (188 vs. 173 mg/dl, P<0.05), LDL (122 vs. 106 mg/dl, P<0.05), and lower HDL (49 vs. 57 mg/dl, P<0.05) levels compared to controls. Conclusion: This study showed an association between LP and dyslipidemia. Screening of serum lipids in patients with LP might be valuable to prevent cardiovascular diseases. © 2017 Iranian Society of Dermatology.
Seasonal Outbreak of Dengue Fever in Northern India - A Clinical Perspective and Predicting Length of Hospital Stay

Aims: India reports frequent outbreaks of dengue fever every year. Scarcity of hospital beds during these outbreaks can be fatal to some. In this study we looked into the clinical and laboratory features of dengue fever in children and predictors of prolonged hospital stay. Study Design: Prospective cross-sectional descriptive study Place and Duration of Study: Department of Pediatrics, Hamdard Institute of Medical Sciences and Research from September to December 2017. Methodology: This prospective study was conducted in admitted patients in the Pediatric department of a teaching hospital in Delhi to determine the clinical and laboratory features of all children admitted with dengue fever and find out any predictive factor for prolonged hospital admission. All clinical and laboratory confirmed dengue cases were included in the study. Patients were divided into dengue fever without warning signs (DF), dengue fever with warning signs (DWS) and severe dengue (SD) as per WHO Classification. Original Research Article Chakravarty and Krishnan; IJTDH, 32(3): 1-8, 2018; Article no.IJTDH. 44585 2 Results: Of the 92 cases, 78 had positive IgM ELISA/NS1 Ag, 14 were clinical cases. The M:F is 1.7:1, the mean age is 7+ 4.2 years. The common clinical features were fever (94%), abdominal pain (61%), vomiting (53%) and lethargy (52%). 61% patients were categorised as DWS, 30% as DF and 9% SD. The mean duration of hospital stay was 5 ± 2.8 days. 43% were hospitalised for > 5 days. Prolonged hospital stay (>5days) was significantly associated with high grade fever (>102°F) and lethargy (p<0.05). Conclusion: A high proportion of patients with DWS required hospitalisation. Admission during the critical phase of dengue is essentially life-saving. For clinical practice, the doctors working in the front line should be aware of the factors significantly prolonging LOS in the management of dengue fever. This can identify the patients at highest risks and help focus time and resources during seasonal outbreaks.
Association of High Sensitive C - Reactive Protein with Severity of the Left Ventricular Systolic Dysfunction in Acute Anterior ST Elevation Myocardial Infarction

High Sensitive C-reactive protein (hs- CRP) is an established risk marker in coronary artery disease. It is a marker of inflammation activated early after Acute Myocardial Infarction (AMI) and its quantity depends upon extent of myocardial damage. Release of inflammatory marker occur after acute myocardial infarction leading to cardiac remodeling which clinically manifests as Heart failure (HF). Heart failure is a common complication after acute anterior myocardial infarction (AMI). The prevalence of post-infarct Left Ventricular Systolic Dysfunction (LVSD) ranges from 27 to 60 % and half of patients having early post-infarct LVSD subsequently develop chronic heart failure. The purpose of this study is to show association between hs-CRP with LVSD in AMI and early detection of HF. This was a cross-sectional analytical study in which hs-CRP was done among all the study subjects between 24-48 hours after onset of AMI. The study population was categorized into groups I, II, II according to the lowest to highest hs-CRP level. Transthoracic echocardiography was done between 24-48 hours of anterior ST Elevation Myocardial Infarction (STEMI). Then LVSD was assessed between those three groups and searched for association. Severely reduced ejection fraction (EF) was found in patients of group III (highest hs-CRP tertile) only. Severe and moderately reduced EF and FS was found significantly more in group III and II than group I (mid and lowest hs-CRP tertile) (p<0.001). High level of hs-CRP in patient of acute anterior STEMI patients was associated with moderate to severe reduction in EF and Fractional Shortening (FS). So hs- CRP may be a prognostic marker in acute anterior STEMI complicating LVSD and early management would improved the short and long term prognosis.
Effect of 528 Hz Music on the Endocrine System and Autonomic Nervous System

This study examined the stress-reducing effect on the endocrine system and the autonomic nervous system of music with a frequency of 528 Hz, which has recently attracted attention as a “healing” type of music. Nine healthy participants (one man and eight women, aged 26 - 37 years) listened to 528 Hz and standard 440 Hz music on separate days. We measured salivary biomarkers of stress (cortisol, chromogranin A, and oxytocin) before and after exposure to music, and continuously recorded the activity of the autonomic nervous system. The Profile of Mood State, 2nd edition, was also administered as a subjective indicator of stress. In the 528 Hz condition, mean levels of cortisol significantly decreased, chromogranin A tended to decrease, and oxytocin significantly increased after music exposure. However, no significant change was observed in any salivary biomarkers in the 440 Hz condition. The ratio of low frequency to high frequency autonomic nervous system activity significantly decreased after exposure to both types of music, and the coefficient of variation of R-R intervals also significantly decreased, but only after exposure to 528 Hz music. Tension-anxiety and Total Mood Disturbance scores were significantly reduced after exposure to 528 Hz music, while there was no significant difference following 440 Hz music. These results suggest that the influence of music on the autonomic nervous system and endocrine system varies depending on the frequency of the music, and furthermore, that 528 Hz music has an especially strong stress-reducing effect, even following only five minutes of exposure.
A Study of clinicopathological features and proliferation marker KI-67 expression in ocular surface squamous neoplasia

BACKGROUND: Ocular Surface Squamous Neoplasia (OSSN), is the most common primary ocular surface neoplasm and in the later decades of life, the third most common tumor of the ocular region after Melanoma and Lymphoma. OSSN ranges from mild epithelial dysplasia on one end of the spectrum to invasive squamous cell carcinoma on the other end. It is common in tropical regions and there is an increasing trend of OSSN in developing nations with high prevalence of HIV infection. Most of the cases are undetected as they are usually asymptomatic and slow growing. AIMS AND OBJECTIVES: To analyze the clinical and histopathological characteristics of Ocular Surface Squamous Neoplasia (OSSN) cases and to study the proliferation marker Ki-67 expression and evaluate its usefulness in various grades of OSSN. MATERIALS AND METHODS: This is a Retrospective & Prospective study done at the department of Pathology, Regional Institute of Ophthalmology & Government Ophthalmic hospital, Madras Medical College, Chennai for a period of 3 years from May2014 to April 2017. 50 histologically confirmed cases of OSSN were taken for the study. The paraffin blocks were obtained, slides reviewed and Ki-67 immunostaining was performed to evaluate the proliferation activity. RESULTS: In this study, OSSN age ranges from 25 to 84 years, mean age being 53.6 years. The commonest presentation was growth, in the nasal region of conjunctiva. Gelatinous type of OSSN was the most common morphological type. Only 4 % of the cases had HIV infection. The majority of OSSN are treated by surgical excision (96%) with wide margin clearance and the rate of recurrence was 4%. Pre-invasive OSSN especially conjunctival intraepithelial neoplasia grade III (CIN III) was more common than invasive OSSN (Squamous cell carcinoma) in the study.Ki-67 proliferation index had shown a statistically significant association with the grade of OSSN, with high grade invasive OSSN showing higher Ki-67 proliferation index (mean 36.7%) and pre-invasive lesions show a lower Ki-67index (mean 18.9). CONCLUSION: Histopathology is the gold standard in diagnosing the distinct types and grades of OSSN and also gives a good insight about the clinical outcome of the disease.Ki-67 proliferation index had shown a statistically significant association with the grade of OSSN. Larger sample size and follow up could throw more light on the progression of OSSN and added value of this marker in OSSN.
Targeting Atrial Fibrillation Patients for Left Atrial Appendage Occlusion with Epicardial Closing Devices

The left atrial appendage (LAA) is a key source of thrombi in patients with non-valvular atrial fibrillation (AF) and a major clinical focus for stroke prevention. Current surgical exclusion remains suboptimal and percutaneous approaches targeting the LAA, although well validated, fail to offer complete and durable occlusion for all patients. The high anatomical variability of the LAA demands a more tailored and targeted treatment approach. Epicardial LAA clip occlusion represents an important alternative approach for AF patients not amenable to catheter closure or where anticoagulation is contraindicated. In this article, we briefly review the clinical evidence for epicardial devices in LAA occlusion, with a focus on the AtriClip and discuss their role in stroke prevention strategies.