Miracle-dz/UniFAR-FTUs huggingface dataset:
Pernicious Anemia Presenting With Pseudo Thrombotic Microangiopathy and Falsely Elevated B 12 Levels

Pseudo thrombotic microangiopathy is a distinct clinical entity that is seen in patients with B12 deficiency. We describe a patient who presented with microangiopathic hemolytic anemia, thrombocytopenia, altered mentation and renal insufficiency. Thrombotic thrombocytopenic purpura was a major concern; however the peripheral blood smear showed hypersegmented neutrophils and the altered mental status as well as renal dysfunction improved with red cell transfusions. It was concluded that her clinical picture was more consistent with ineffective erythropoiesis, which can mimic thrombotic thrombocytopenic purpura (TTP). She was ultimately diagnosed with pernicious anemia based on positive intrinsic factor antibody, elevated methylmalonic acid, and homocysteine levels. Her B12 levels were falsely elevated which confounded the diagnosis. Distinguishing between these two conditions is imperative to avoid unwarranted plasmapheresis.
Late onset depression: Association with clinical and imaging indicators of prodromal Parkinson’s disease

The pathology of late onset depression (LOD) is unclear, with vascular and structural abnormalities reported through the use of magnetic resonance imaging (MRI). Parkinson’s disease (PD) can be preceded by LOD several years before overt motor symptoms. Use of the Dopamine Transporter Single Photo Emission Computerised Tomography (DAT SPECT) has been approved by the Food and Drugs Administration (FDA) for imaging pre synaptic dopaminergic dysfunction; aiding diagnosis in disorders such as PD. We investigated; a) presence of early clinical features associated with PD in patients with LOD (pLOD), b) dopaminergic functioning in pLOD, c) structural and vascular pathology associated with LOD. This thesis also compared visual and semi quantitative analysis (SQA) methods when rating DAT SPECTs. When compared with healthy controls (HC) (n=30) overall, pLOD (n=36) scored significantly higher on symptoms of apathy, REM sleep behaviour disorder (RBD), sleep symptoms associated with PD and autonomic and motor dysfunction. Seven pLOD were visually rated with abnormal uptake in comparison to one HC, also confirmed by the SQA which additionally found that overall, pLOD (n=29 with a DAT SPECT) had significantly lower binding in the caudate nuclei (CN). The pLOD with visually abnormal SPECTs had significantly lower clinical scores relating to olfactory dysfunction, cognition and autonomic dysfunction compared to pLOD with normal SPECTs. There were no significant group differences in structural or vascular pathology. There were significant correlations between age and left and right hippocampi (HIPP) and amygdala (AMY) and global white matter (WM) and grey matter (GM) volumes in pLOD (n=28 with an MRI). Overall, in controls (n=25), age and gender correlated with global WM. Severity of depression was not associated with regional volumes. An audit of the correct use of clinical indications for the DAT SPECT at an NHS trust confirmed correct use in all cases (n=74) and a comparison of visual and SQA methods when rating DAT SPECTS in clinical cases also confirmed very good agreement between methods.
Entomofaunistic study in of the cultivation of amaranth (Amaranthus hypochondriacus L.) in Puebla Mexico

Amaranth is a very important crop for the agricultural producers association around the Popocatepetl, Puebla, for its high nutrients content and for the preparation of various enriched food products. But losses from damage caused by insect pests, make not satisfactory yields for farmers. The aim of this study was to taxonomically determinate the amaranth cultivation related insects and to describe each species role in the agrosystem. To catch insects during the 2008 agricultural cycle, surveys were conducted at three plots where collections were made with vacuum, netting and manually; looking at the stems, knots, between knots, leaves (beam and back), panicle and roots. The larval stage organisms collected were preserved in 70% alcohol, while adults were mounted on entomological pins, all the material was identified and deposited in the entomological collection of the Institute of Sciences of the Autonomous University of Puebla (BUAP). Obtaining 1 883 morphospecies out of which 20 genera and 18 species were identified as the most abundant during the crop cycle, the next eight species were the cause of crop damage: Sphenarium purpurascens, Epicauta cinerea, Spodoptera exigua,
Angiopoietin-2 Expression in B-Cell Chronic Lymphocytic Leukemia: Association with Clinical Outcome and Immunoglobulin Heavy-Chain Mutational Status.

B-cell Chronic Lymphocytic Leukemia (B-CLL) follows an extremely variable clinical course. For some patients CLL is an indolent disease that never progresses to the point of requiring therapy and these patients have a survival time similar to age-matched controls. On the contrary, other patients experience rapidly deteriorating blood count and organomegaly which requires prompt treatment. The overall survival (OS) times range from months to decades. B-CLL patients can be divided into two subgroups on the basis of the presence or absence of somatic mutations in the specific immunoglobulin heavy-chain variable region (IgVH) genes used by leukemic cells. Patients with unmutated IgVH genes usually have an advanced stage and an unfavourable cytogenetic features, require therapy and have a short survival. The biological reasons of the different behaviour of Ig-mutated and Ig-unmutated leukemic clones have not been fully elucidated yet. Angiogenesis is a very complex network which is closely regulated by the orchestrating functions of many angiogenic factors. The balance of cellular expression of all these angiogenic factors determines vascular stabilization or angiogenic remodelling and sprouting or vessel regression. Increasing evidence shows that neovascularization plays a role in the biology of chronic lymphocytic leukemia. The goal of this study was to evaluate the angiogenic status of Ig-mutated and Ig-unmutated CLL in the attempt to identify a possible role of angiogenesis in the adverse clinical outcome of Ig-unmutated CLL patients. So, we first performed a large scale gene-expression analysis on 29 B-CLL patients using microarrays comprising about 20,000 probes and 208 angiogenesis-related genes. We identified 64 up-regulated genes in Ig-unmutated CLL relative to Ig-mutated CLL. Among them, we found angiopoietin-2 (Ang-2) as one of the highest differentially expressed gene (p=3.02x10 −6 ). Then, we evaluated the Ang-2 expression both at transcript and protein level in a wide cohort of CLL, in normal controls and in other haematological malignancies. The data showed an extremely wide range of Ang-2 expression in B-CLL: Ang-2 high-expressing cases were characterized by advanced Binet stage (p=0.032) and significantly shorter progression-free survival than Ang-2 low-expressing subset (median, 16 vs. 146 months) (p=0.006). Moreover, there was a strong correlation between the IgVH mutational status and the Ang-2 gene expression level (p
Early Onset Polymorphic Post-transplant Lymphoproliferative Disease Mimicking a Solitary Necrotizing Abscess in a Graft Liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. J Liver Cancer 2019;19(2):165-170 pISSN 2288-8128 • eISSN 2383-5001 https://doi.org/10.17998/jlc.19. 2.165 Case Report
THE RELATIONSHIP BETWEEN RESILIENCY AND BURNOUT IN NURSES

Background and objective: Burnout is one of the key factors in reduccei nnncicneie and it causes loss of manpower and physical complications. Personality characteristics such as resiliency ci r buffer against stressful events and work-related psychological problems such as burnout. Given the important role of nurses in health-care ieisns , this study cetniscirsni The rnorscleiace between resiliency and burnout in nurses. Material and Methods: This descriptive study was conducted on 304 nurses working in the hospitals in Tehran, 2010. The subjects were chosen by multi-stage cluster sampling. The instruments were Maslach burnout inventory (MBI), Connor-Davidson Resiliency Scale (CD-RISC) and a demographic check-list. The data was analyzed by SPSS-18. Results: Overall, the findings showed high emotional exhaustion, (32.6% in frequency; 9.9% in intensity), depersonalization (25.7% in frequency; 18.1% in severity) and personal failure (42.1% in frequency; 60.9% in severity). The relationship between burnout and resiliency was significant (0.01). Conclusion: Given the resiliency is one of the predictors of burnout; we recommend some workshops to increase the resiliency-related skills of the nurses.
What screening should immigrants have during their first medical visit in the United States

HelpDesk Answers are intended to provide the same quality response to a clinical question as would be achieved by a searchsavvy physician spending an hour or so on the Internet. Authors of HelpDesk Answers are required to search PrimeEvidence (http://www.primeanswers.org) and the TRIP database (www.tripdatabase.com). These portals provide access to more than a dozen sources of the highest quality evidence-based clinical information, including BMJ Clinical Evidence, the Guide to Clinical Preventive Services, AHRQ Evidence Reports, and others. Searches of the Cochrane Database, Medline, and other databases are also included, as needed.
Toll-Like Receptor 4 Gene Polymorphisms in patients withUrinary Tract Infection

Background: Urinary tract infection (UTIs) are considered to be the most common infections in humans. Aims:The present study aimed to investigate the association between single nucleotide polymorphisms (SNPs) in the toll-like receptor 4 (Tlr4) gene (Thr399Ile) and the incidence of Urinary Tract Infection. Subjects and Methods:A total of 49 patients with Urinary Tract Infection and 25 apparently healthy control were enrolled in this study. Urine samples from patients with UTI was collected in AL-Imam AL-Hussain teaching hospital in Thi- Qar province, during the period from February 2014 to March 2015. Urinary isolates were identified by conventional methods.DNA was extracted from the blood samples taken from these participants. TLR4 gene was amplified with polymerase chain reaction (PCR) using specific primers. Genotyping of the SNPs of interest was done by restriction fragment length polymorphism (RFLP). Results:The present study was showed 26 (53.06%)isolates Escherichia coli; 9 (18.37%) isolates had Pseudomonas aeruginusa;7 (14.29 %) isolates had Klebsiella pneumonia; 4 (8.16%) had Proteus and 3 (6.12%) isolates had Klebsiellaoxytoca, the results showed the presence of heterozygous in one sample from study group at site 399 (C / T) after using restriction enzyme Hinf1. Conclusion: Escherichia coli was most common causative agent in UTI, Thr399Ile may be considered as a risk factor that increases susceptibility to Urinary TractInfection
Practice Preferences: Temporal Artery Biopsy versus Doppler Ultrasound in the Work-Up of Giant Cell Arteritis

ABSTRACT To determine whether temporal artery biopsy (TABx) or Doppler ultrasound (US) of the temporal artery is the preferred confirmatory test for giant cell arteritis, an online survey of ophthalmologists and neurologists in North America, Europe and Israel was conducted in 2019; Canadian rheumatologists were also included. There were 406 survey participants with an estimated survey response rate of 18%. Ninety-four per cent of North American practitioners preferred TABx compared with 74% of their European counterparts. Two per cent of North American practitioners preferred Doppler US versus 24% of European physicians. Regional differences were statistically significant (p < .001).
Dietary behaviours in the context of nutrition transition: a systematic review and meta-analyses in two African countries

Abstract Objective: To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition. Design: Systematic review and meta-analyses, including six online databases and grey literature, 1971–2018 (Protocol CRD42017067718). Setting: Urban Ghana and Kenya. Participants: Population-based studies of healthy adolescents and adults. Results: The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out. Conclusions: Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.
The effects of epigenetic regulation on phenotypic expressivity in Turkish patients with familial Mediterranean fever

Introduction: In this study, we aimed to characterize the effect of methylation on clinical diversity and gene expression levels in familial Mediterranean fever. Materials and Methods: Forty children, who were diagnosed with FMF according to the Tel-Hashomer criteria, were included in the study. The control group consisted of 32 healthy children. Demographic data, results of molecular studies, physical examination findings, number of attacks, response to treatment were recorded. To test the possibility that methylation is responsible for different phenotypic reflections of mutations, we classified FMF patients with respect to MEFV mutations and studied the differences of MEFV mRNA, pyrin and methylation levels between different subgroups. Results: MEFV mRNA expression levels were significantly lower in FMF patients, compared to control subjects (P = 0.049). Consistent with this observation, pyrin levels were significantly lower in FMF patients (P = 0.037). In addition, we found that MEFV methylation level was higher in FMF patients compared to control subjects (P = 0.376). Conclusions: There was no evidence that differences in methylation levels could be responsible for variable effects of different mutations and variable clinics in the MEFV gene. Further studies on larger patient groups are necessary to identify the effects of different factors.
THE PERCEIVED SOCIAL SUPPORT AND PSYCHOSOCIAL HEALTH STATUS IN WOMEN WITH INTENDED AND UNINTENDED PREGNANCY

Pregnancy intention can change emotional response, psychological adjustment and care requirements for pregnancy. In a relatively few studies, the effect of pregnancy intention on psychosocial health and perceived social support was examined. This study aims to compare the perceived social support and psychosocial health in pregnant women according to their pregnancy intention. This descriptive study was conducted in the obstetrics and gynecology outpatient clinic of a public hospital in Turkey. In the study, 342 women aged between 18-49 years who were in gestational age of >10 weeks were included. The data were collected using a Personal Information Form, the Pregnancy Psychosocial Health Assessment Scale (PPHAS), and the Multidimensional Scale of Perceived Social Support (MSPSS). It was determined in the study that 31.6% of the women in the antenatal period continued an unintended pregnancy. PPHAS scores (3.69 vs. 3.91) and MSPSS scores (68.41 vs. 72.25) of the unintended pregnant women were lower than intended ones (p<0.05). There was a positive correlation between MSPSS and PPHAS mean scores of women in both unintended (r=0.271, p=0.004) and intended pregnancies (r=0,181, p=0,006). Psychosocial health of both intended and unintended pregnant women varies depending on the characteristics related to the pregnancy, spouse relationship, anxiety, stress, domestic violence, and requirement of psychosocial health counseling (p<0.05). Healthcare professionals should consider that the women being in the antenatal period and having the history of unintended pregnancy may have less social support and more psychosocial health care needs while determining their care needs.
Is sore throat an underreported and under-estimated quality indicator for endoscopic procedures? Results from a large prospective cohort

Abstract Background and study aims Patients often develop sore throat after upper endoscopy procedures but there data are very limited on the magnitude of the problem. The aim of this study was to evaluate and identify independent risk factors of sore throat in patients undergoing endoscopy. Patients and methods Data were collected prospectively on consecutive outpatient endoscopy procedures performed at Cedars-Sinai Medical Center from October 2018 to February 2019. Procedure nurses collected pre-procedure, intra-procedure, and immediate post-procedure surveys including evaluation of sore throat (pain scale from 1 – 10). Significant univariate variables (P < 0.05) were entered into a multivariate logistic regression model. Results Data were collected on 715 patients. Four hundred seventy-two patients (mean age = 61 years, females = 53 %) were included in the analysis and 85 patients (18 %) experienced post-procedure sore throat. On univariate analysis, female gender, oral endoscopic ultrasound (EUS), oral double balloon enteroscopy (DBE), fellow involvement, throat suctioning, general anesthesia, oral airway, and prolonged procedure (> 30 minutes) were risk factors for sore throat (all P < 0.05). On the multivariate analysis, independent risk-factors for post-procedure sore throat were oral DBE (odds ratio [OR] 5.2), oral airway (OR 4.8), general anesthesia (OR 2.7), fellow involvement (OR 2.5), oral EUS (OR 2.4), and female gender (OR 2.0). Conclusions Contrary to popular belief, our study found that post-procedural sore throat is more common (18 %) than previously reported. Two types of endoscopic procedures, two anesthesia maneuvers, female gender, and fellow involvement were all independent risk factors. This is of particular concern for interventionalists who perform EUS and oral DBE as these patients are at higher risk for sore throat.
FORCE dual-energy CT in pathological grading of clear cell renal cell carcinoma

The aim of the present study was to examine the value of FORCE dual-energy CT in grading the clear cell renal cell carcinoma (ccRCC). A total of 35 cases of ccRCC were included. Hematoxylin and eosin staining was performed, and the cases were divided into low- (Fuhrman I–II) and high-grade (Fuhrman III–IV) groups. FORCE dual-energy CT parameters, including virtual network computing CT value (VNCV), iodine overlay value (IOV), mixed energy CT value (MEV), iodine concentration (IC), normalized iodine concentration (NIC), NIC based on aorta (NICA), NIC based on cortex (NICC) and NIC based on medulla (NICM), were analyzed and compared. Receiver operating characteristic analysis was also performed. There were significant differences in the arterial phase IOV, MEV and IC, and the venous phase IOV and IC between the low- and high-grade groups. No significant differences were observed in VNCV and MEV between the low -and high-grade groups in the venous phase. Significant differences were observed in the NICA and NICC between these two groups, however no difference was observed in NICM. There were significant differences in the tumor CT values for the arterial phase at the 40, 60, 80 and 100 kiloelectron volt (keV) between the low- and high-grade groups, while no significant differences were observed at the 120–140 keV levels. The k-slope for the low-grade group was significantly higher than the high-grade group. In addition, the area under curve for the arterial phase IOV, arterial phase MEV, arterial phase IC, aortic NIC, cortical NIC, venous phase IOV, venous phase IC and curve slope K of mono-energy CT value suggested high value in diagnosis of low- and high-grade ccRCC cases.
Addressing the Disease Burden of Vertically Acquired Hepatitis C Virus Infection Among Opioid-Exposed Infants

Abstract Background This study aims to estimate the disease burden of vertically acquired hepatitis C virus (HCV) in a large Midwestern hospital and to identify factors associated with HCV diagnostic testing among high-risk infants. Methods This is a retrospective analysis of an infant cohort (n = 58 427) born from 2014 to 2016 in the Greater Cincinnati region, where universal maternal urine testing is conducted at delivery to assess for intrauterine drug exposure (IUDE). Demographics and birth characteristics were analyzed among high-risk infants to identify factors associated with receiving HCV testing. A nested, matched, case-control analysis examined the association of pediatric HCV infection and IUDE. Results The HCV prevalence rate among high-risk infants who received testing was 3.6%–5.2% of births. Approximately 66.7% of maternally acquired HCV infections may be missed using current testing recommendations. Prenatal care had no significant effect (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 0.4–3.5) on the odds of a high-risk infant receiving HCV testing. Opioid-exposed cases had a more than 6-fold increase in the odds of HCV infection (aOR, 6.2; 95% CI, 2.3–16.6]) compared with nonopioid exposed infants. Conclusions The IUDE was significantly associated with increased odds of pediatric HCV infection in this population. The gaps in pediatric HCV testing identified in this study, despite known risk level and maternal infection, suggest the need for increased focus on HCV identification in the pediatric population.