Miracle-dz/UniFAR-FTUs huggingface dataset:
A Hybrid Approach for Modeling Type 2 Diabetes Mellitus Progression

Type 2 Diabetes Mellitus (T2DM) is a chronic, progressive metabolic disorder characterized by hyperglycemia resulting from abnormalities in insulin secretion, insulin action, or both. It is associated with an increased risk of developing vascular complication of micro as well as macro nature. Because of its inconspicuous and heterogeneous character, the management of T2DM is very complex. Modeling physiological processes over time demonstrating the patient’s evolving health condition is imperative to comprehending the patient’s current status of health, projecting its likely dynamics and assessing the requisite care and treatment measures in future. Hidden Markov Model (HMM) is an effective approach for such prognostic modeling. However, the nature of the clinical setting, together with the format of the Electronic Medical Records (EMRs) data, in particular the sparse and irregularly sampled clinical data which is well understood to present significant challenges, has confounded standard HMM. In the present study, we proposed an approximation technique based on Newton’s Divided Difference Method (NDDM) as a component with HMM to determine the risk of developing diabetes in an individual over different time horizons using irregular and sparsely sampled EMRs data. The proposed method is capable of exploiting available sequences of clinical measurements obtained from a longitudinal sample of patients for effective imputation and improved prediction performance. Furthermore, results demonstrated that the discrimination capability of our proposed method, in prognosticating diabetes risk, is superior to the standard HMM.
Determination and Comparison of Radiation Absorbed dose to the Blood, by Applying Different Techniques, for Patients, Suffering from Differentiated Thyroid Cancer

Background: Radiation absorbed dose to the red bone marrow, in the therapy of differentiated thyroid carcinoma (DTC) with 131I (radioiodine), cannot be measured directly. The absorbed dose to the blood seems to be a good first- order approximation of the radiation absorbed dose to the hematopoietic system and a better means to quantify exposure from therapy than the total amount of activity administered. Objective: The aim of this research was to determine the radiation absorbed dose to the blood, for patients suffering from differentiated thyroid cancer. Materials and Methods: Twenty seven patients, 22 women and 5 men, suffering from DTC were enrolled in this study. We applied four formulas and we compared between the estimated values of absorbed dose that were obtained by three formulas and those that obtained by fourth (standard one). Results: All the values of absorbed dose that obtained by one of the techniques were regularly highly estimated, even though they have an excellent correlation (99%) with the standard value. Conclusions: Highly overestimated or highly underestimated results that can be obtained by certain method or technique are not desirable, because they tend to exaggerate, by increasing or decreasing, the radiation protection procedures. Conversion radiation Units: To convert the values of absorbed dose from S.I unit (mGy/MBq) to traditional unit (rad/mCi), we can simply multiply the values that expressed in S.I units by a factor of 3.7, and we don't need to apply complicated formulas, which were applied by other researches.
Upside-down kidney transplantation using single-suture single-knot technique

Aim: The aim of the study was to evaluate the outcomes of upside-down transplanted kidney with single-suture single-knot technique.Methods: From August 2013 till date, a total of 299 living-related kidney transplantations were done in the Department of Urology and Kidney Transplantation Surgery TU Teaching Hospital and Grande International Hospital, Kathmandu, Nepal. Out of them, 71 upside-down kidney transplantations were performed using single-suture single-knot technique. In this study, their overall outcome is evaluated. Results: Our study showed no difference in the overall outcome between upside-down and standard kidney transplantation and even less blood transfusion rate in upside-down group. Conclusion: There should be no hesitation to perform the upside-down kidney transplantation.
Levosimendan attenuates myocardial injury induced by coronary microembolization in swine by inhibiting myocardial inflammation and apoptosis

Aims: In addition to its cardiotonic effect, Levosimendan (Levo) has been thought to have multiple cardiovascular benefits, including anti-inflammatory and anti-apoptotic effects. The present study was undertaken to determine whether the Levo pretreatment could attenuate myocardial apoptosis and inflammation and improve cardiac function in a swine model of coronary microembolization (CME). Materials and Methods: A total of 15 swine were randomly and equally divided into a sham-operated (control) group, CME group, and CME plus Levo group. Swine CME was induced by intracoronary injection of inertia plastic microspheres (42 μm diameter) into the left anterior descending (LAD) coronary artery, with or without pretreatment of Levo. Echocardiological measurements, a pathological examination, Terminal-deoxynucleoitidyl Transferase-Mediated dUTP Nick End-Labeling (TUNEL) staining, H and E staining, and Western blotting were performed to assess the functional, morphological, and molecular effects in CME. Results: The expression levels of caspase-3 and tumor necrosis factor-α (TNF-α) were increased in cardiomyocytes following CME. Downregulation of caspase-3 and TNF-α with Levo pretreatment was associated with improved cardiac troponin I (cTnI) and high sensitivity C-reactive protein. In addition, through Pearson correlation analysis, the left ventricular ejection fraction was negatively correlated with caspase-3, TNF-α, and cTnI. Conclusion: This study demonstrated that Levo pretreatment could significantly inhibit CME-induced myocardial apoptosis and inflammation and improve cardiac function. The data generated from this study provide a rationale for the development of myocardial apoptosis and inflammation-based therapeutic strategies for CME-induced myocardial injury.
Impact of single classroom-based peer-led organ donation education exposure on high-school students and their families

Aims: The aim of the study is to assess the impact of single classroom-based, organ donation education session by high-school students on improvement in knowledge and intent to donate organs in their peers and their families. Settings and Design: Quantitative interventional study with before-after design done in high-school sections of two private schools of Delhi in July and August 2018. Subjects and Methods: Participants were all 1583 high-school students present on the day of activity. Organ donation education was provided by 30-min presentation in individual classrooms, along with distribution of frequently asked questions booklet on organ donation by 44 self-motivated high-school students to the peers. We collected pre- and post-intervention questionnaire and family interaction feedback responses from participants, within 1 week before, on intervention day and 3 weeks after it. Main outcome measures were improvement in students' knowledge, intent to donate, family discussion, and actual organ donor pledge registrations. Results: There was a significant improvement in students' knowledge (mean scores increased from 9.16 to 13.91 [P = 0.000]). Significantly increased (P = 0.000) proportion of students had positive intent to donate (66.9% vs 80.9%) and wanted to encourage their family members for organ donation (72.6% vs 87.2%) after the intervention. 1144 (84.2%) students reported discussion in their families, 250 (18.4%) students' families planned to take, and 67 (4.9%) families (one or more persons) actually took organ donor pledge after the intervention. Conclusions: The educational intervention by peers, instead of health-care personnel, led to significant improvement in high-school students' knowledge, intent to donate, family discussion, and actual organ donor pledge registrations.
Self-efficacy in cosmetic surgery applicants compared to nonapplicants

Context: The decision for cosmetic surgery (CS) can be influenced by psychological issues. Self-efficacy (SE) is one of the psychological factors affecting this decision. Aims: The purpose of this study was to compare SE between the CS applicants (study group) and nonapplicants (control group). Setting and Design: In this cross-sectional study, 65 samples were recruited for each of the study and control groups. Materials and Methods: The study group was selected from among the beauty centers and the control group was selected among the ordinary people who did not intend to do CS. Convenience sampling was used to select the samples of the study and control groups. The control was matched with the study group with respect to gender, age, marital status, occupation, and education. To measure SE, Sherer et al.'s General Self-Efficacy Scale was used. Statistical Analysis Used: Data were analyzed using SPSS software using descriptive and inferential statistics (Kolmogorov–Smirnov test, Chi-square test, Mann–Whitney U-test, one-way ANOVA, and independent t-test). Results: The average SE was significantly lower in the study group than the control group (P = 0.008). In the study group, there was a significant relationship between SE and education (P = 0.03). However, there was no significant relationship between SE and other demographic variables. Conclusions: The study group had lower SE than that of the control group. It seems that low SE can affect the decision to undergo CS. To avoid unnecessary cosmetic surgeries, the SE of applicants is suggested to be investigated before surgery.
Comparison of topographic indices and corneal higher order aberrations in eyes with an extreme asymmetry of keratoconus with control eyes

Purpose: To compare topographic indices and anterior corneal higher order aberrations (HOAs) of forme fruste keratoconus (KC) (fellow eyes) with clinical KC and control eyes. Setting: Tertiary Eye Hospital, India. Materials and Methods: This study retrospectively reviewed 298 patients with KC. Patients were evaluated with placido-based topographer. KC was diagnosed according to Rabinowitz and McDonnell criteria and clinical sign. Twenty-one patients with clinical KC in one eye (Group A), fellow eye (Group B) with normal topography with no clinical sign, and 21 control eyes (Group C) were included in the study. Topographic indices (keratometry, inferior superior ratio, irregularity, shape factor, and eccentricity) and HOAs (trefoil, coma, spherical aberration, total root mean square [RMS], HOAs RMS of third to seventh order for 6 mm diameter) were obtained. Group B was compared with Groups A and C. Results: The prevalence of an extreme asymmetry of KC in our study population is 7.04% with mean age of 21.98 ± 7.39 years. All topographic indices were higher in Group A compared to Group B (P < 0.01) and no significant difference was found between Groups B and C. All HOAs were higher in Group A compared to Group B (P < 0.05). HOAs RMS, oblique trefoil and spherical aberration were significantly higher in Group B compared to Group C (P < 0.02). Of these 21 patients, four had severe to advanced KC in one eye. Conclusions: Corneal HOAs changes are first to appear in fellow eyes of unilateral KC, which may makes them useful tool in monitoring progression and early detection of KC changes in fellow eyes.
Indications for transoral endoscopic-assisted methods in condylar process fractures

Objective: Endoscopic-assisted mandibular subcondylar fracture repair is a different way of performing open reduction internal fixation and also includes surgical equipment and manipulations other than those used in the classical methods. The criteria for patient selection should be different from that of the classical methods. Materials and Methods: Between April 2012 and June 2017, treatment protocols which were applied to 56 patients with mandibular subcondylar fracture were evaluated retrospectively. The first step of this study was to evaluate why patients with mandibular subcondylar fractures were not operated endoscopically. In 34 patients, methods other than endoscopic methods were used. Characteristics of these patients and fractures were demonstrated. Results: Twenty-four patients were followed conservatively. Twenty-two patients were treated with transoral endoscopic method while ten patients were treated with the conventional open surgery. This open surgical treatment was reported by determined the patient records for why the endoscopic method was not preferred. The determined criteria were; condyle with excessive medial deviation, patient age, fracture type, general condition/anesthesia risk, and time of injury. Conclusion: In accordance with clinical experience, some criteria have been defined for patient selection preoperatively in mandibular subcondylar fractures. It believes that with the right patient selection, it will be possible to achieve better results and reduce complications.
Correlation between pterygium and dry eye

Objective: The aim of this study is to evaluate the correlation between dry eye and pterygium. Materials and Methods: A total of 50 patients, aged between 26 and 70 years, were included in this study. Tear film breakup time (TF-BUT) and Schirmer's test (ST) results were compared in pterygium eye and contralateral normal eye of the same patient. TF-BUT and ST results were compared in pterygium eye and contralateral normal eye for different sizes. The paired t-test was used for the analysis. The Pearson correlation was used to assess the correlations of tear BUT and ST with pterygium size. Results: The mean horizontal size of pterygium ± standard deviation (SD) was 2.35 ± 0.54 mm. The mean ± SD of TF-BUT in pterygium eyes was 7.1 ± 2.34 s compared with 9.18 ± 3.21 s in contralateral normal eyes (P < 0.05). The mean ± SDs of ST results in pterygium eyes and the opposite normal eyes were 8.96 ± 2.66 and 10.94 ± 3.88 mm, respectively (P < 0.05). On analysis, the overall difference in the mean TF-BUT between the pterygium eyes, and the contralateral control eyes was significant (P < 0.01). The difference in the ST between the pterygium eyes and the contralateral eyes was not significant for size < 1 (P = 0.17) and 1-2 (P = 0.4) but was highly significant for size <2 mm (P < 0.001). Most patients with pterygium complained of mild-to-severe ocular discomfort. Ocular Surface Disease Index score was found to be 30.6. Conclusion: Results of the present study strongly suggest that pterygium induce abnormal ocular surface conditions, which lead to dysfunctional TF and development of the dry eye.
Evaluation of foam sclerotherapy in treatment of lower limbs – primary varicose veins

Objective The aim was to evaluate the efficacy of foam sclerotherapy for treating primary varicose veins. Background Foam sclerotherapy is a standard method of treatment of primary varicose veins. It is a less invasive method, simple, effective, and can be done in outpatient. Materials and methods This is a prospective study on 50 consecutive patients who were diagnosed to have clinical and radiological evidence of primary varicose veins in the Department of Vascular Surgery Unit in Menoufia University hospitals from February 2017 to February 2018. Local ethics committee's approval and a written consent were obtained. The foam was generated by Tessari method. Results Fifty lower limbs of 50 patients were presented with primary varicose veins and competent saphenofemoral junction. There were 35 (70%) females and 15 (30%) males with mean age of 35.4 ± 10.125 years (range: 22–55 years). Fifty limbs included 20 (40%) right limbs and 30 (60%) left limbs. Twenty-five (50%) patients complained of disfigurement, 30 (60%) patients of pain, 30 (60%) patients of heaviness, and 35 (70%) patients of swelling. The complications were pain at injection sites in 32 (64%) patients, itching in four (8%) patients, ecchymosis in 18 (36%) patients, and superficial thrombophelibitis in eight (16%) patients. Conclusion Foam sclerotherapy is safe, effective, and less complicated in treating primary varicose veins.
Chronic obstructive pulmonary disease phenotypes: Are they really useful in clinical practice?

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It is a complex and heterogeneous disease. In recent years, studies showed that forced expiratory volume in 1 s solely was not enough to describe heterogeneity of COPD patients, and subsequently, phenotypes of COPD were identified. The aim of phenotyping is the classification of patients into distinct subgroups according to the prognosis and response to therapy so that the selection of optimal therapy can be possible, and this clinical approach may improve prognosis. In the assessment and management of the disease, it is important to consider phenotype of a COPD patient. The aim of this article is to review predefined COPD phenotypes, their clinical and epidemiological features, and usefulness in clinical practice for accurate diagnosis and appropriate treatment of COPD patients.
Ciclosporin A in ophthalmology: A systematic review

Aim: To systematically analyse data from randomized controlled trials of topical Ciclosporin with the aim of assessing the uses and effectiveness of Ciclosporin in different conditions, optimal dosage and adverse effect profile. Methods: 24 RCTs that had evaluated the uses and efficacy of Ciclosporin in different ocular conditions were selected and were used in this review. Articles published upto December 2018 were identified from the following sources- Medline, Scopus, Web of science and references from relevant articles. Results: The average JADAD score was 3.16. Symptomatic relief and objective improvement of ocular signs were noted in most cases of allergic eye disease, moderate to severe dry eye disease and lid margin inflammatory disease. It was also found to accelerate post surgical corneal nerve healing and recovery of corneal sensation. It was not effective in post keratoplasty graft rejection. Adverse effects reported were minimal and included symptoms like ocular stinging. Conclusions: Even though topical Ciclosporin A is an attractive treatment option in many ocular conditions, more structured RCTs are needed to standardize the dose and provide a detailed adverse effect profile.
Acute Pain Medicine: Novel Analgesic Techniques

Patients with postoperative pain continue to have unmet needs. Despite guidelines for pain management and improving technology, patient experiences with pain have not significantly improved after surgery. Although more effective application of current therapies would likely improve patient experience, available technologies still leave much to be desired. Although effective, intravenous patient-controlled analgesia (IV-PCA) is a burdensome technology. Further, medication errors, pump programming errors, and other technology-related problems may lead to patient injury and under or over dosing. Continuous epidural analgesia by catheter has frequent failures and it requires a high level of staffing. Moreover, recent efforts to reduce the incidence of postoperative venous thromboembolism by the use of anticoagulants has placed limitations on the use of indwelling epidural catheters. No large series have examined the failure rates of continuous peripheral nerve blocks. Current standard therapies in postoperative pain management largely depend on cumbersome technologies requiring pumps and indwelling catheters. In addition to the opportunities for failure and medical errors, these technologies are inherently complex and place a heavy labor burden on the healthcare team. Patients spend an inordinate amount of time tethered to equipment that limits ambulation, physical therapy, and activities of daily living. Opioids remain commonly used in postoperative pain management. Unfortunately, the well-known side effects (nausea, vomiting, sedation, respiratory depression, confusion, constipation) are not only dangerous but cause significant patient misery. Patients treated with opioids typically attempt to find a balance between analgesia and side effects. Patients will often choose less complete pain relief to avoid opioid side effects. Almost all patients require parenteral therapy at some point during the perioperative period. Unfortunately, the choices for injectable nonopioid pain therapies are limited. Clearly, improvements are needed. There is ample room for new and emerging technologies.
Small incision lenticule extraction – Current perspective

Femtosecond lenticule extraction (FLEx) (also known as ReLEx®, small incision lenticule extraction [SMILE], or FLEx) has emerged in recent years as an alternative paradigm to femtosecond laser in situ keratomileusis (FS-LASIK). The early outcomes of FLEx surgery, which is considered a step toward transition to SMILE, were first published in 2008, whereas the early outcomes of SMILE were first reported in 2011. SMILE became commercially available in 2012. [1] ReLEx® or SMILE requires only a femtosecond laser to perform the entire refractive procedure, and it has various clinical, practical, and scientific advantages over the more traditional and well-known two-laser solution of LASIK.
Neonatal hypoxic encephalopathy: Correlation between post-cooling brain MRI findings and 2 years neurodevelopmental outcome

Abstract Objective: This study aims to evaluate the magnetic resonance imaging (MRI) brain patterns among hypoxic-ischemic encephalopathy (HIE) babies who underwent post-cooling MRI brain as well as to correlate the post-cooling brain scoring with patient’s neurodevelopmental outcome at 2 years. Subjects and Methods: It was a retrospective cross sectional study carried out at a tertiary university hospital. Record of patients diagnosed with neonatal HIE from 2007 until 2016 who completed 72 h of cooling therapy and had MRI brain within 2 weeks of life were included in this study. A new scoring system by Trivedi et al. that emphasizes on subcortical deep gray matter and posterior limb internal capsule injury were utilized upon MRI assessment, using TW, T2W, and diffusion-weighted imaging (DWI) sequences. Cumulative MRI brain score was obtained and graded as none, mild, moderate, and severe brain injury. The MRI brain scoring was then correlated with patient’s 2 years neurodevelopmental outcome using Fisher’s Exact Test. Results: A total of 23 patients were eligible of which 19 term neonates were included. 13% of these neonates (n = 3) had mild MRI brain injury grading with 52.2% (n = 12) moderate and 34.8% (n = 8) severe. There was no significant correlation seen between MRI brain grading and developmental outcome at 2 years old (P > 0.05). Conclusion: There was no significant correlation between neonatal MRI brain injury grading and 2 years neurodevelopmental outcome. Nevertheless, the new MRI brain scoring by Trivedi et al. is reproducible and comprehensive as it involves various important brain structures, assessed from different MRI sequences.