Miracle-dz/UniFAR-FTUs huggingface dataset:
Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

Background Pregnant uncorrected congenital heart disease patients, especially those who already developed pulmonary hypertension, have increased risk for maternal mortality. The pulmonary hypertension severity and right ventricle function may be associated with higher maternal mortality. The study aimed to investigate the mortality rate of pregnant uncorrected congenital heart disease and the impact of pulmonary hypertension severity on mortality. Methods This is the sub study of COngenital HeARt Disease in adult and Pulmonary Hypertension Registry. The data of pregnant uncorrected congenital heart disease patients were analyzed from registry database. The maternal mortality was recorded. The data of demography, clinics, obstetrics, and transthoracic echocardiography were collected. The factors that influenced maternal mortality were analyzed. A statistical significance was determined when p value < 0.05. Results From 2012 until 2017, there were 78 pregnant congenital heart disease patients. Of them, 56 patients were eligible for analyses. The majority of congenital heart disease was atrial septal defect (91.1%). The maternal mortality rate was 10.7% (6 of 56). Pulmonary hypertension occurred in 48 patients, therefore the maternal mortality rate among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5% (6 of 48). Among nonsurvivors, 100% suffered from severe pulmonary hypertension as compared to survivors (56.0%), p = 0.041. Most nonsurvivors were Eisenmenger syndrome (83.3%), significantly higher compared to survivors (22.0%), p = 0.006. Nonsurvivors had significantly worsened WHO functional class, reduced right ventricle systolic function, and right heart failure. The modes of maternal death were severe oxygen desaturation (66.7%) and respiratory failure and sepsis (33.3%). Most of the maternal deaths occurred within 24 h postpartum period. Conclusion Maternal mortality rate among pregnant uncorrected congenital heart disease with majority of atrial septal defect was 10.7% and among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5%. Factors related with maternal mortality were severe pulmonary hypertension, Eisenmenger syndrome, and reduced right ventricle systolic function.
HIV-infected pregnant women and vertical transmission in Europe since 1986: European collaborative study

Objective: To describe changes over a 15-year period in characteristics and management of HIV-infected pregnant women in Europe. Design: Prospective study. Methods: Analysis of prospective data on 2876 pregnant HIV-infected women and their 3076 infants. Factors examined included maternal socio-demographic, immunological and virological characteristics, antiretroviral therapy and pregnancy outcome. Results: Among women enrolled, the proportion with heterosexual acquisition of infection has increased significantly from 59% (201/342) in 1985-1987 to 69% (327/471) after 1997 while the proportion acquiring HIV through injecting drug use has declined. Overall median CD4 cell count was 440 × 106/l and 41% of women had undetectable viral load at delivery. In 1995 28% (72/256) of mother-child pairs received the full 076 regimen to reduce risk of vertical transmission, rising significantly to 89% (116/130) by 1999. Use of triple therapy started in pregnancy has increased significantly from Conclusions: Changes in treatment of adult HIV disease have affected the management of infected pregnant women. Despite therapeutic and surgical interventions, vertical transmission still occurs.
Comparative study of postmortem blood, urine and vitreous humor methamphetamine

Methamphetamine (MA) is a highly addictive and toxic central nervous system stimulant. Urine samples are used as evidences of MA abuse under the Narcotics Laws, whereas blood samples are specimens for investig ation of MA poisoning. However, both specimens are occasionally not available or contaminated. Vitreous humor is a specimen which is less contaminated and easy to work with analytically. The aim of this study is to examine the relationships between MA concentrations in blood, urine and vitreous humor. Those three specimens were collected from 40 deceased and their MA concentrations were quantitatively analyzed by headspace-solid phase microextraction/gas chromatography-mass spectrometry technique. The results showed that the relationships between MA concentrations in urine vs blood, urine vs vitreous humor, and vitreous humor vs blood were linearly correlated with a correlation coefficient (r) of 0.89, 0.99, and 0.88, respectively. Linear regression equations of those relationships between urine vs blood, urine vs vitreous humor, and vitreous humor vs blood were y = 0.001x + 8.08, y = 0.056x - 262.86, and y = 0.027x + 16.20, respectively. This study suggests vitreous humor as an alternative specimen for MA in vestigation.
Assessment of Tuberculosis Underreporting by Level of Reporting System in Lagos, Nigeria

Assessment of Tuberculosis Underreporting by Level of Reporting System in Lagos, Nigeria by Gidado Mustapha MSc-HPE, Maastricht University, 2008 MPH, Ahmadu Bello University, 2007 PGDM, Ahmadu Bello University, 2000 MBBS, Ahmadu Bello University, 1997 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health
Papillon lefevre syndrome- A literature review and case report

Papillon-Lefèvre syndrome (PLS) is an extremely rare genetic disorder. This disorder is mostly observed in children from 1-5 years of age. Alteration of CTSC gene which regulates the production of enzyme cathepsin C is responsible for this syndrome. The common characteristics are palmoplantar keratosis and aggressive form of periodontitis. The patient might become completely edentulous in the absence of appropriate and early treatment. Early lose of teeth in young children may have two important concerns1. Pychological impact. 2. Prosthetic rehabilitation. Till date, there is no definitive treatment protocol for PLS cases. This article provides a detailed review about the various possible etiologies, clinical features, differential diagnosis and treatment protocols followed for the periodontal management of PLS. This article reports a Case of Papillon Lefèvre syndrome and its management with long term follow up.
Inter-Examiner Reliability of the Manual Muscle Strength Testing

Standardized physical examination using manual muscle testing is a widely accepted method for evaluating strength. This study determines the inter-examiner reliability of manual test grades in assessing muscle strength in patients with a diagnosis of neuropathy or myopathy. Subjects were 11 patients, aged 10 to 40 years. 3 physical therapists participated in this study. 18 muscle groups in upper limb were tested bilaterally, using modification of the Medical Research council scale. Reliability of muscle strength grades obtained for individual muscle groups and individual muscle strength grades was analyzed using Cohen's weighted kappa. The reliability of grades for individual muscle groups was from 0.62 to 0.82, with the proximal muscles having the higher reliability values. The reliability of individual muscle strength grades from 0.52 to 0.88, with those in the gravity eliminated range scoring the highest. We find the MMT grades are reliable for assessing muscle strength in muscular weakness.
Kokua Naauao - Learning through Service: Evaluation of a Values-based Health Scholarship program

Background. Many Native Hawaiians live in rural areas of Hawaii that are medically underserved. Contributing to the shortage of healthcare profes- sionals in rural areas is the disproportionately low enrollment of Native Hawaiians in healthcare education. The Native Hawaiian Health Scholarship Program (NHHSP) of Papa Ola Lokahi addresses the shortage by providing scholarships to Native Hawaiians in healthcare professions and facilitating their employment in Hawaiian underserved communities to meet their ser- vice obligation. Objectives. This paper highlights evaluation findings of a values-based scholarship program and its impact on Native Hawaiian health through the capacity building efforts of scholars. 1. Address correspondence to Palama Lee, MSW, LSW, QCSW, Director, Native Hawaiian Health Scholarship Program of Papa Ola Lokahi, 345 Queen St. Ste. 706, Honolulu, Hawaii 96813; (808) 585- 8999; fax (808) 585-8081; email palama@nhhsp.org. Acknowledgements: This evaluation was funded by the Bureau of Health Professions of the Health Resources and Services Administration. The author expresses his thanks to the kupuna or elders who guided the Native Hawaiian Health Scholarship Program's spiritual and cultural development, my mother's sister Aunty Lilia Hale who is now in spirit, Aunty Aggie Cope, Aunty Betty Jenkins, and Aunty Malia Craver. Also, a special thanks to Sandy Ritz for her tireless work, Kathryn Braun for her inspiration, Kamaoha Kahiwa for his consultation, Katy Miller, Doremy Tyrrell, Jaime Boyd, and Donna Palakiko for their support, and lastly all the Native Hawaiian health scholarship staff and scholars for their participation.
MALDI-TOF MS for the rapid identification and drug susceptibility testing of filamentous fungi

The present study aimed to evaluate the applicability of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for identifying filamentous fungi and assessing the in vitro activities of common antifungal drugs against different kinds of filamentous fungi that are commonly encountered in a clinical setting. A total of 123 strains of filamentous fungi (24 species) were submitted for identification by MALDI-TOF MS, and the findings were compared with those obtained by conventional methods. The discrepancies were further investigated by internal transcribed spacer (ITS) sequence analysis. Then, 79 strains were randomly selected for further testing by the minimum inhibitory concentration Etest method. MALDI-TOF MS correctly identified 114 (92.70%) of the 123 filamentous fungi and failed to identify six isolates (4.9%). By contrast, the conventional identification methods made 113 (91.9%) correct identifications. In addition, 15 isolates of filamentous fungi were further identified by ribosomal DNA-ITS sequencing. In the in vitro antifungal susceptibility test, voriconazole showed the strongest antifungal activity among the tested drugs against a broad range of filamentous fungi. Caspofungin showed a better in vitro antifungal activity than fluconazole, itraconazole, and amphotericin B. MALDI-TOF MS offers a cost/time-saving, high-throughput and accurate working protocol for identifying filamentous fungi. Voriconazole could still serve as the first-line drug for treating serious infections caused by filamentous fungi, while caspofungin may be another treatment option for fungal infections.
Consanguinity in unexplained recurrent pregnancy loss and preterm delivery among Saudi females

Objectives: Consanguinity is considered as a factor which influences reproductive health. This study aimed to investigate the role of cousin marriages on the occurrence of recurrent pregnancy loss (RPL) and preterm delivery (PTD) in Saudi females. Methods: The study included 300 Saudi women (RPL = 100; PTD = 50; control = 150). Demographic and clinical data were entered on forms specially designed for the study, and the women were interviewed about the relationship with their husbands. The degree of consanguinity as the first and second cousins was recorded, and the prevalence of PTD and RPL was calculated in consanguineous and nonconsanguineous marriages. Results: The results revealed that consanguinity occurs at a higher frequency in RPL and PTD (RPL = 55%; PTD = 52%) compared to the control group (36%) and the difference compared to the controls were statistically significant for both PTD and RPL (P < 0.05). Conclusion: The results of this study show that the frequency of consanguinity is significantly higher in the females giving preterm birth (PTB) and those with RPL. Since consanguinity increase homozygosity of autosomal recessive conditions, our result implicates the involvement of some autosomal recessive genes, in the pathogenesis of PTD and RPL. Further studies are required to identify gene mutations or polymorphisms which are involved in early fetal loss and PTD, conduct genetic screening for such genetic mutations and polymorphisms, and conduct genetic counseling to decrease the frequency of both conditions. Furthermore, there is a greater need to increase awareness about complications that may occur among consanguineous families, in an attempt to decrease the frequency of consanguinity.
Influence of Pharmacist Intervention on Re-Elevation of Glycated Hemoglobin for Diabetic Outpatients

Purpose: The effect of pharmacist intervention on blood sugar control in diabetic outpatients in a pharmacist-managed clinic was studied by focusing on the re-elevation of the glycated hemoglobin (A1c) level defined as a continuous variable. Methods: A retrospective chart review was performed at the Mizushima Kyodo Hospital from April 2014 to March 2016. Of the 221 diabetic outpatients who were provided guidance by nurses and nutritional managers, 62 further consulted the pharmacist-managed clinic. The remaining 159 patients were enrolled in a nonintervention group. Finally, the data of 115 patients with A1c level of ≥7.5% and A1c re-elevation were extracted. Intergroup comparison was performed between the pharmacist intervention (n = 26) and nonintervention (n = 89) groups. In both the groups, the starting point (baseline) was the time when the A1c level of ≥7.5% was observed. Subsequent monitoring was performed once in every 3 months. The average cumulative level of A1c re-elevation (CARE) was compared between groups. Patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, and male and female patients were also compared. Furthermore, the number of days until the re-elevation of the A1c level from the baseline was also compared. Results: The CARE values were 0.89 ± 0.86% and 1.51 ± 1.25% in the pharmacist intervention and nonintervention groups, respectively, showing a significant difference (P = .0195). There were no significant differences between patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, or between males and females. The number of days until the re-elevation of A1c level from the baseline also showed no significant difference. Conclusion: Pharmacist intervention for diabetic outpatients in pharmacist-managed clinics significantly suppressed CARE when compared with effects of no intervention, and this could be useful for preventing the exacerbation of diabetes.
Accuracy of Tuffier’s Line Identification by Palpation Method: Cross-Sectional Comparative Study Among Obese, Pregnant and Control Groups

Objective Performance of safe central neuraxial blocks requires identification of accurate vertebral interspace. This study aimed to evaluate the accuracy of palpation method by confirmation with ultrasound in high-risk groups like obesity and pregnancy. Methods This cross-sectional comparative study was conducted after approval from the hospital ethics committee and written informed consent from participants. Participants were enrolled into four groups: normal weight non-pregnant (N), full-term pregnant (P), obese (O) and obese full-term pregnant (PO). Tuffier’s line at L4–L5 interspace was determined by palpation method and marked as P-line. Another examiner blinded to the marking done by palpation method confirmed it by ultrasound. The primary endpoint was to determine the accuracy of the palpation method, defined as true identification of Tuffier’s line at the L4–L5 interspace by confirming it with ultrasound among four groups. Proportion and percentage were computed and analysed the true identification of Tuffier’s line at L4–L5 by chi-square test at 0.008 adjusted level of significance for multiple comparisons. Results Tuffier’s line identification by palpation method was confirmed by ultrasound scanning at L4–L5 interspace in 75.3% (226/300) of participants. Proportion difference of true identification of Tuffier’s line at L4–L5 by palpation and ultrasound was statistically significant among the groups (p=0.0005). True identification was significantly lower in group PO [36.4%; p=0.0005<0.008] and group O [34%; p=0.0005<0.008] as compared to that in group N. Conclusion Palpation method was found to be the inaccurate surrogate for the L4–L5 vertebral interspace for obesity with or without pregnancy.
Effect of Fixed Oil of Ocimum sanctum against Experimentally Induced Arthritis and Joint Edema in Laboratory Animals

The fixed oil of O. sanctum seeds was screened for antiarthritic activity using Freund's adjuvant arthritis, formaldehyde-induced arthritis and also turpentine oil-induced joint edema in rats. The oil was administered intraperitoneally for 14 days in the case of adjuvant-induced arthritis and 10 days in formaldehyde-induced arthritis. The mean changes in diameter of paw were noted at regular intervals. X-rays of paws were taken at the end of study and SGOT & SGPT levels were also estimated. The fixed oil showed significant anti-arthritic activity in both models and anti-edema activity against turpentine oil-induced joint edema.
Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review

Background Post-anesthetic shivering incurs discomfort to patients or even exacerbates their condition. However, no ideal drug has been well established for preventing post-anesthetic shivering. Currently, subarachnoid and epidural dexmedetomidine have demonstrated to have an anti-shivering effect. Methods An electronic search was conducted to identify randomized placebo-controlled trials reporting shivering and then compared subarachnoid and epidural dexmedetomidine with placebo in adults undergoing selective surgery. Data assessment and pooling were analyzed by Review Manager 5.3, STATA 15.0 and GRADE-pro 3.6 software. Results Twenty-two studies (1389 patients) were subjected to this meta-analysis. The incidence of post-anesthetic shivering decreased from 20.10% in the placebo group to 10.30% in the dexmedetomidine group (RR, 0.48; 95% CI, 0.39–0.59; Z=6.86, P<0.00001, I2=32%). Non-Indian, epidural-space route and cesarean subgroups indicated a better anti-shivering effect. In the subarachnoid-space route subgroup, a dosage of >5 μg showed significantly superior anti-shivering effects than that of ≤5 μg. Subarachnoid and epidural dexmedetomidine increased the incidence of bradycardia, had no impact on nausea and vomiting, shortened the onset of block and lengthened the duration of block and analgesia. However, its effect on hypotension and sedation remained uncertain. The overall risk of bias was relatively low. The level of evidence was high, and the recommendation of voting results was strong. Conclusion Dexmedetomidine as a subarachnoid and epidural adjunct drug could decrease the incidence of post-anesthetic shivering in a dose-dependent manner. However, caution should be taken in patients with original bradycardia.
The Efficacy of Response Prevention with Multiple Treatments

The purpose of this thesis was to investigate the e f feet of repeated Response Prevention (RP) treatments on the persistence of avoidance behavior using an animal model. Response prevention has been used as a treatment in many laboratory studies to reduce avoidance responding. Although past research shows that one episode of RP facilitates ex tine tion of avoidance behavior when tested once, complete elimination of the avoidance response has seldom been found. In fact, some studies have demonstrated the existence and even recovery of residual fear after a single RP treatment indicated by an increase in avoidance behavior upon repeated testings. It was hypo the sized that additional RP treatments would cause greater and more permanent reduction of avoidance responding. One hundred and twenty Sprague-Dawley male rats were randomly assigned to one of 12 experimental conditions. There were four treatment levels in each of the following groups; Control, (receiving no avoidance training), Response Prevention, or Nonresponse Prevention. The four levels consisted of the following number and length of treatments: one massed level of 36 min, or distributed levels; two of 18 min, or three of 12 min, or four of 9 min. Fear was tested at 0, 1, and 30 days after treatment for all subjects.
P1758The novel small leucin-rich repeat protein podocan is an independent predictor of major adverse cardiac events in patients with angiographically-defined coronary artery disease

Smooth muscle cell (SMC) function determines the clinical course of vascular disease via fibrous cap stability. Podocan is an inhibitor of SMC function and is circulating in peripheral blood rendering it a candidate biomarker to predict MACE in patients with Coronary Artery Disease (CAD). We designed a prospective cohort study assessing the predictive value of Podocan for cardiovascular outcome (MI, CVA or death) in patients with CAD. 308 patients with angiographic evidence of CAD were enrolled. At index cardiac catheterization Syntax Score was calculated. For patient baseline characteristics see Table. Podocan and CRP-1 were measured using a human Podocan and CRP-1 ELISA. The Kaplan-Meier method was used to construct survival curves, which were compared using the log-rank test. Cox proportional hazard modeling was used for all univariate/multivariate analyses. Statistical analysis was performed using STATA. Podocan was detected in 212 patients (69%) with a detection threshold of 0.01 ng/ml. The median Podocan level observed was 1.4±8.2 ng/ml. 96 patients did not have a detectable Podocan level. Mean CRP-1 was 0.117±0.15 mg/ml. Mean Syntax Score was 12±9. Podocan did not correlate with CRP-1. There was also no association between Podocan and Syntax Score, age, BMI, smoking, LDL, and HDL, HgbA1c, LVEF and GFR. At the univariate level, presence of Podocan was associated with an increased rate of MACE (17% Podocan present vs. 7% Podocan absent, p=0.02). Kaplan-Meier survival analysis showed higher event free survival in patients with no detectable Podocan vs. detectable Podocan level (Figure). In a limited multivariate Cox proportional Hazard analysis, Podocan remained an independent predictor of MACE (HR: 2.5; P=0.042) in addition to diabetes, and LV ejection fraction. Baseline Characteristics Total (N=308) Chronic ischemic heart disease (N=273) Acute coronary syndrome (N=35) Age (Year) 66.5±9.5 67±9 61±11 Female (Sex) 106 (33%) 90 (31%) 16 (46%) Hypertension 282 (89%) 244 (89%) 26 (74%) Diabetes 142 (44%) 124 (45%) 11 (31%) Hyperlipidemia 269 (87%) 243 (89%) 26 (74%) CRP (mg/dL) 0.11±0.14 0.10±0.13 0.18±0.19 LVEF (%) 49±10 49±10 48±9.5 CRP, C-reactive protein; LVEF, Left ventricular ejection fraction. Kaplan Meier Survival Curves by Podocan Podocan is a novel biomarker independently predicting MACE in secondary prevention of CAD warranting to be further studied in a Multicenter Clinical Trial.