Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictive Value of Pretreatment Peripheral Neutrophil-to-Lymphocyte Ratio for Response to Neoadjuvant Chemotherapy and Breast Cancer Prognosis

Background Neutrophil-to-lymphocyte ratio (NLR) is connected with the response to neoadjuvant chemotherapy (NAC) and prognosis. In addition, residual lymph node burden after NAC is likely important for prognosis. However, most studies have focused on the predictive value of NLR for NAC pathological complete response (pCR) rate. The relationship between NLR and post-operative residual lymph node ratio (LNR), and their prognostic values remain to be determined. Methods We retrospectively studied 282 patients with breast cancer who underwent curative surgery after NAC from 2008 to 2018. We collected pretreatment NLR in peripheral blood, the response to NAC, and the amount of axillary lymph nodes (positive and total) from patients who received axillary lymph node dissection (ALND). We followed up all patients from 2 to 116 months, with an average of 63 months. We analyzed the predictive value of pretherapeutic NLR in peripheral blood on the response of NAC, including pCR rate and postoperative LNR. The prognostic value of NLR and LNR was also analyzed. Results A pCR was achieved in 20 (27.0%) of 74 patients with low NLR, and 34 (16.3%) of 208 with high NLR (P = 0.045). In luminal A and luminal B tumors, patients with high NLR tended to have elevated LNR (LNR>0.5; P=0.041). In Kaplan–Meier analysis, overall survival of patients with low NLR (NLR < 1.8; P = 0.033) was longer than that of patients with high NLR (NLR ≥ 1.8). Moreover, by multivariable analysis, LNR was negatively correlated with overall survival (P < 0.05) and disease-free survival (DFS) (P < 0.05). Conclusion pCR rate, post-operative remaining lymph node involvement and overall survival in all patients who received NAC may be predicted by NLR. Low NLR and LNR may suggest favorable outcomes.
Rational Drug Use Evaluation Based on World Health Organization Core Drug Use Indicators in Ethiopia: A Systematic Review

Background Rational use of medicines plays a vital role in avoiding preventable adverse drug effects, maximizing therapeutic outcomes with promoting patient adherence, and minimizing the cost of drug therapy. Irrational use of drugs is often observed in countries with weak health care systems. No review has been done that systematically expresses rational drug use practice based on the three WHO core drug use indicators in Ethiopia. Thus, this study was aimed to review systematically the prescribing, health-facility, and patient-care indicators based on WHO core drug use indicators in Ethiopia. Methods A systematic article search was conducted in different electronic databases including PubMed/ MEDLINE, the Cochrane Library, EMBASE, Web of Science, POPLINE, the Global Health, and Google scholar. Quality assessment was conducted using Newcastle-Ottawa quality assessment scale. Studies were synthesized and grouped in to prescribing, patient care and health facility indicators. Results From a total of 6239 articles, 21 studies were found suitable for the review. The highest average number of drugs per encounter was 2.5 while the lowest was 0.98. The percentage of generic drug use was ranged from 70.5% to 100%. The highest percentage of encounters with an antibiotic was 85%. The lowest percentage of drugs prescribed from essential drugs list was 81.4%. The highest percentage of drugs actually dispensed and adequately labeled was 96.16% and 96.25%, respectively. Conclusion This study showed that the practice of rational drug use varied across region of the country. The average number of drugs per prescription, percentage of drugs encounter with antibiotics, drugs prescribed by their generic name, average consultation time, average dispensing time, percentage of drugs adequately labeled, and availability of essential drugs showed deviation from the standard recommended by WHO. Thus, provision of regular training for prescribers and pharmacists, and ensuring the availability of essential drugs should be encouraged.
Prepatellar Bursitis with Abscess due to Corynebacterium ulcerans

Corynebacteria are ubiquitous and reside as skin and mucosa commensals in animals. They are considered contaminants in clinical specimens, but significant clinical data points to their virulence and pathogenic potential over the last two decades. Corynebacteria can cause both community-acquired and nosocomial infections. Corynebacterium diphtheriae (C. diphtheriae) responsible for diphtheria has declined over the previous two decades with an increase in a similar clinical syndrome by Corynebacterium ulcerans (C. ulcerans) in Europe. As per recent studies, C. ulcerans shares similar virulence factors with C. diphtheriae. C. ulcerans has been implicated in airway infections, skin and soft tissue infections, lymphadenitis, wound infections, and rarely necrotizing fasciitis. Pet or farm animals have been the source of these infections to humans, as per recent reports. Strains can be either toxigenic or nontoxigenic. Due to recent advances, methods to characterize strains have become easier with mass spectrometry. Antimicrobial susceptibility testing is a must for definite treatment as C. ulcerans can be resistant to first-line antibiotic therapy. If resources are available, it is prudent to find if there is any toxin production. Here, we describe a rural farmer in central Missouri presenting with acute-onset right knee pain diagnosed with right prepatellar bursitis with abscess due to C. ulcerans infection. He recovered with surgical debridement and antimicrobial therapy. This is the first case of C. ulcerans causing prepatellar bursitis with an abscess as per medical literature review.
Interpectoral Lymph Node Dissection Can Be Spared in pN0/N1 Invasive Breast Cancer Undergoing Modified Radical Mastectomy: Single-Institution Experience from Mainland China

Purpose Interpectoral lymph nodes (IPNs) are one of the lymphatic drainage pathways in breast cancer. However, the clinical significance of IPN dissection is controversial, and there is no international consensus regarding the management of IPN for resectable breast cancer. Our study aims to identify the independent predictors of IPN metastasis in invasive breast cancer (IBC) and provide some evidence for rational decision-making. Methods Data from 214 IBC patients who were treated with modified radical mastectomy (MRM) plus IPN dissection or biopsy in Ningbo Medical Center Lihuili Hospital were retrospectively reviewed. Univariate analysis and multivariate logistic regression analysis were used to analyse the correlations between IPN occurrence or metastasis and clinicopathological characteristics. Results The occurrence rate of IPN in overall population was 75.2%. Univariate analysis showed that tumour size, involvement of axillary lymph nodes (ALNs), histological grading, Ki67 index and molecular subtype were associated with the occurrence of IPN. However, involvement of ALN was the only independent predictor by multivariate logistic regression analysis. In 161 patients whose IPNs were detected, 46 (28.6%) patients had one or more metastatic IPNs. Univariate analysis showed that tumour size, involvement of ALN, oestrogen receptor status and molecular subtype were associated with IPN metastasis. However, involvement of ALN was the only predictor by multivariate logistic regression analysis. In total, 0%, 5.0%, 26.1% and 84.2% of pN0, pN1, pN2, and pN3 patients had metastatic IPNs, respectively. Conclusion The relatively low rate of IPN metastasis in patients with pN0/N1 breast cancer suggests that IPN dissection can be safely spared in patients with low tumour burden in axillary lymph nodes (pN0/N1), when MRM even breast conservation surgery is performed.
Prevalence of recurrent herpes labialis in Western Maharashtra

Background: Recurrent herpes labialis (RHL) is a disorder with serious health and social consequences and which affects most of the adults. However, high degree of research paucity pertaining to its prevalence was observed, especially from India. Objective: The objective of this study was to assess the prevalence of RHL in western Maharashtra. Materials and Methods: In this prospective study, 1368 patients of either sex, satisfying the inclusion criteria, were included in the study after screening 34,560 patients for RHL lesions. Demographic data such as age, gender and risk factors, namely stress, menstruation and common cold, were recorded. Further, data regarding history of itching, fever, malaise and burning on lips followed by vesicles and frequency of lesions and duration were also recorded. After clinical examination site, size and nature of lesion were noted on a clinical pro forma. Results were compared statistically, and P < 0.05 was considered statistically significant. Results: The majority of the patients were in the age group of 30–39 years, with a female predominance (63.89%) (male:female = 0.33:0.59). Stress (43%) was the most common risk factor in the occurrence of RHL, followed by disturbed menstruation cycle (21%). Most of the patients had two episodes of RHL (42.4%), whereas some had just one episode of recurrence (25.4%) in the past 1 year. The most commonly occurring location for RHL was upper lip (47%), especially the left side (19.1%) and right side (18.2%) of the upper lip. The overall prevalence rate of RHL in our study was 3.9%. Conclusion: An established prevalence (3.9%) of RHL occurs among patients in western Maharashtra.
An assessment of students’ emotional intelligence, learning outcomes, and academic efficacy: A correlational study in higher education

The purpose of this empirical study is to investigate the effects of Emotional Intelligence (EI) on learning outcomes (social, cognitive, self-growth outcomes and satisfaction with the university experience) of students in Chinese research universities. This study further examines the mediating role of student trust in teachers (emotional and cognitive learning) and learning orientation (commitment to learning) in the relationship between EI and learning outcomes. This intent of this study was to examine the direct effects of learning outcomes on students’ academic efficacy (cognitive skills and standardised tests). This study used a sample frame of 454 students from research universities in China. The relationships were tested through the partial least squares’ structural equation modelling method. The results reveal that EI has a significant impact on learning outcomes. Furthermore, an indirect relation between EI and learning outcomes is established through student trust in teachers and in the learning orientation. The direct relation between learning outcomes and student academic efficacy is also established. There is a lack of studies that investigate the relationship of EI, student trust in teachers, learning orientation, learning outcomes and student academic efficacy. This is one of the initial research studies that not only empirically examine the interface of EI and learning outcomes of students of Higher Education Institutions (HEIs) but offers insights into the existing literature by concurrent investigation of the mediating role of student trust in teachers and in the learning orientation in fundamental association, while explaining the association between learning outcomes and students’ better academic efficacy.
Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19

Abstract Objective Ensuring an efficient response to COVID-19 requires a degree of inter-system coordination and capacity management coupled with an accurate assessment of hospital utilization including length of stay (LOS). We aimed to establish optimal practices in inter-system data sharing and LOS modeling to support patient care and regional hospital operations. Materials and Methods We completed a retrospective observational study of patients admitted with COVID-19 followed by 12-week prospective validation, involving 36 hospitals covering the upper Midwest. We developed a method for sharing de-identified patient data across systems for analysis. From this, we compared 3 approaches, generalized linear model (GLM) and random forest (RF), and aggregated system level averages to identify features associated with LOS. We compared model performance by area under the ROC curve (AUROC). Results A total of 2068 patients were included and used for model derivation and 597 patients for validation. LOS overall had a median of 5.0 days and mean of 8.2 days. Consistent predictors of LOS included age, critical illness, oxygen requirement, weight loss, and nursing home admission. In the validation cohort, the RF model (AUROC 0.890) and GLM model (AUROC 0.864) achieved good to excellent prediction of LOS, but only marginally better than system averages in practice. Conclusion Regional sharing of patient data allowed for effective prediction of LOS across systems; however, this only provided marginal improvement over hospital averages at the aggregate level. A federated approach of sharing aggregated system capacity and average LOS will likely allow for effective capacity management at the regional level.
Parent reports of children’s emotional and behavioral problems in a low- and middle- income country (LMIC): An epidemiological study of Nepali schoolchildren

Background As epidemiological data on child mental health in low- and middle-income countries are limited, a large-scale survey was undertaken to estimate the prevalence and amount of child emotional and behavioral problems (EBP) in Nepal as reported by the parents. Methods 3820 schoolchildren aged 6–18 years were selected from 16 districts of the three geographical regions of Nepal, including rural, semi-urban and urban areas. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 years as screening instrument. Comparisons of child problems between genders and between the seven largest castes and ethnic groups were carried out by analysis of variance. Prevalence was computed based on American norms. Results Adjusted prevalence of Total Problems was 18.3% (boys: 19.1%; girls:17.6%). The prevalence of internalizing problems was higher than externalizing problems. The mean scores of Total, Externalizing, and Internalizing problems were 29.7 (SD 25.6), 7.7 (SD 8.0), and 9.1 (SD 8.1), respectively. The Khas Kaami (Dalit) group scored the highest, and the indigenous Tharu group scored the lowest on all scales. In the Mountains and Middle Hills regions, problem scores were higher in the rural areas, whereas in the Tarai region, they were higher in the urban areas. Conclusion The prevalence and magnitude of emotional and behavioral problems in Nepali children were found to be high compared to findings in meta-analyses worldwide. Problem scores varied according to gender, castes /ethnic groups, and living areas. Our findings highlight the need for a stronger focus on child mental problems in a low-and middle-income country like Nepal.
Prevalence and Molecular Profile of Breast Carcinoma Using Immunohistochemistry Markers in Mexican Women

Background In Mexico, breast cancer is the leading cause of death by malignant tumors in women aged 20 and older. The World Health Organization estimates that 69% of deaths caused by breast cancer occur in developing countries. Little is known about the prevalence of breast carcinoma in Mexico and its molecular subclassification. Methods This retrospective cross-sectional study included patients who underwent a mastectomy (single, radical or lumpectomy) or a breast tumor biopsy (core-needle or excisional) from January 2002 to December 2018. The primary purpose of the study was to determine the prevalence and molecular profile of breast in comprehensive cancer center in Mexico and compare our results with those published in the US. This study was approved by our scientific and bioethical committee. Results The final analysis included 379 patients. The youngest patient was 23 years old and the oldest patient was 89; the mean age at diagnosis was 54.63 years. Patients of 40 years old or younger accounted for 48 of the cases (12.66%) and those older than 40 accounted for 331 of the cases (87.33%). The molecular subclassification showed luminal A subtype in 139 cases (36.67%), luminal B subtype in 143 cases (37.73%), human epidermal growth factor receptor 2-positive carcinomas in 32 cases (8.44%) and triple-negative carcinomas in 65 cases (17.15%). Diabetes mellitus was present in 43 patients (11.34%), hypertension in 78 patients (20.58%), obesity in 82 patients (21.63%) and 66 patients reported being treated with exogenous hormone therapy (17.41%). Conclusions Breast carcinoma occurs at an earlier age in Mexican women compared to women in the US. Hormone-positive tumors were found to be more prevalent in older patients, while high-grade tumors were more frequently identified in younger patients.
Heterogeneity of immune cells in human atherosclerosis revealed by scRNA-Seq.

Immune cells in atherosclerosis include T, B, natural killer (NK) and NKT cells, macrophages, monocytes, dendritic cells (DCs), neutrophils and mast cells. Advances in single cell RNA sequencing (sRNA-Seq) have refined our understanding of immune cell subsets. Four recent studies have used scRNA-Seq of immune cells in human atherosclerotic lesions and peripheral blood mononuclear cells (PBMCs), some including cell surface phenotypes revealed by oligonucleotide-tagged antibodies, which confirmed known and identified new immune cell subsets and identified genes significantly upregulated in PBMCs from HIV+ subjects with atherosclerosis compared to PBMCs from matched HIV+ subjects without atherosclerosis. The ability of scRNA-Seq to identify cell types is greatly augmented by adding cell surface phenotype using antibody sequencing. In this review we summarize the latest data obtained by scRNA-Seq on plaques and human PBMCs in human subjects with atherosclerosis.
Clinical variability of neurofibromatosis 1: A modifying role of cooccurring PTPN11 variants and atypical brain MRI findings

Neurofibromatosis 1 (NF1) is a disorder characterized by variable expressivity caused by loss‐of‐function variants in NF1, encoding neurofibromin, a protein negatively controlling RAS signaling. We evaluated whether concurrent variation in proteins functionally linked to neurofibromin contribute to the variable expressivity of NF1. Parallel sequencing of a RASopathy gene panel in 138 individuals with molecularly confirmed clinical diagnosis of NF1 identified missense variants in PTPN11, encoding SHP2, a positive regulator of RAS signaling, in four subjects from three unrelated families. Three subjects were heterozygous for a gain‐of‐function variant and showed a severe expression of NF1 (developmental delay, multiple cerebral neoplasms and peculiar cortical MRI findings), and features resembling Noonan syndrome (a RASopathy caused by activating variants in PTPN11). Conversely, the fourth subject, who showed an attenuated presentation, carried a previously unreported PTPN11 variant that had a hypomorphic behavior in vitro. Our findings document that functionally relevant PTPN11 variants occur in a small but significant proportion of subjects with NF1 modulating disease presentation, suggesting a model in which the clinical expression of pathogenic NF1 variants is modified by concomitant dysregulation of protein(s) functionally linked to neurofibromin. We also suggest targeting of SHP2 function as an approach to treat evolutive complications of NF1.
Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019)

ABSTRACT Despite the introduction of the trivalent vaccine (measles, mumps, rubella) more than 20 years ago, measles outbreaks have occurred in Europe, including Italy, due to its underutilization. In Italy mandatory vaccination was established in 2017 (Decree Law 119/2017). This study aimed at evaluating the impact of mandatory vaccination and determining the trend in vaccination coverage for measles and rubella in Italy. We retrieved data from the Annual Status Update, a form sent annually by the Italian National Verification Committee to the Regional Verification Committee for Europe, from 1st January 2013 to 31st December 2019. Since the beginning of 2013, 14,788 cases of measles have been reported, ranging from 256 (3.9 x 1,000,000) to 5,397 (88.4 x 1,000,000) compared to 259 rubella cases for the same period. From 2013 to 2015, vaccination coverage decreased for the first dose of measles (90.4% to 85.3%) and rubella vaccine (90.3% to 85.2%), but then it increased significantly, reinforced by the Italian Decree Law, reaching 94.4% in 2019. The trend for the second dose showed a decrease from 2013 to 2016 (84.1% to 82.2% for measles and 83.7% to 82.0% for rubella), but then increased significantly and reached 90.2% in 2019 for measles and 90.0% for rubella. The mandatory vaccination law has resulted in a significant increase in vaccination coverage for measles and rubella in Italy, and demonstrates encouraging progress toward the 95% target and the restriction of measles transmission. Special attention should be paid to maintaining and further improving vaccination coverage.
Prevalence and correlates of COVID‐19 vaccine hesitancy in the general public in Iraqi Kurdistan: A cross‐sectional study

Low vaccine acceptance is a major barrier to vaccination coverage in every health system. This study aimed to explore the prevalence and associated factors of the COVID‐19 vaccine hesitancy in a sample of the general population in Iraqi Kurdistan. The general population with both genders with different educational levels and sociodemographic characteristics from the Duhok governorate was eligible to participate in this cross‐sectional study in 2021. Therefore, an online Google form was sent to main pages and social groups through two main social media platforms. To obtain a representative sample of individuals with different educational levels, the author visited the main shopping center in Duhok city to collect the information from illiterate and low‐level education individuals. The study found that 83.5% (n = 773) of the participants have not received and 51.4% (n = 476) did not intend to receive the COVID‐19 vaccine. A small percentage has not decided to receive a COVID‐19 vaccine yet (n = 17, 1.8%). The intention to receive a COVID‐19 vaccine was increased with increasing level of education; 25.9%, 26.7%, 39.8%, and 53.6% in illiterate, under high school, high school, and college and higher, respectively (p < 0.0001). Healthcare workers were more likely to intend to receive a COVID‐19, 57.5% vs 40.1%, p < 0.0001. Individuals who had concerns about the side effects of a COVID‐19 vaccine were more likely to not receive and not intend to receive the COVID‐19 vaccine. Prevalence of COVID‐19 vaccine hesitancy was high in this region and was correlated with lower education and concerns about side effects.