Miracle-dz/UniFAR-FTUs huggingface dataset:
One-stop haematuria clinic: First experience in South Africa

Background. Haematuria is the most common symptom of urological cancers, specifically bladder cancer, and timely diagnosis can prevent disease from progressing to a more advanced or incurable stage. One-stop haematuria clinics (OSHCs) have become commonplace in urological services in developed countries during the past three decades. Objectives. To assess the efficacy of this specialised clinic, aimed at providing an investigative service for patients with haematuria, in decreasing morbidity and mortality by earlier diagnosis of urological malignancy. We also report on the outcomes of this study. Methods. A total of 275 patients who attended the weekly OSHC at Groote Schuur Hospital, Cape Town, South Africa (SA), between January 2012 and October 2015 were retrospectively included in the study (out of 477 folders reviewed). Only patients with visible haematuria (275/477) were included, and characteristics such as gender, age, self-identified ethnicity, and outcomes following OSHC attendance (diagnoses and stage/grade/type of cancers) were recorded. Results. While the majority of cases were classified as indeterminate following investigation, one-fifth (55/275) of the patients were diagnosed with urological neoplasms, mainly bladder cancer (87.2%, n =48). The 50 - 69-year age group was the most common window for diagnosis of a neoplasm. Forty-six patients (46/55) with urothelial cancers were diagnosed at a relatively early stage and were therefore offered curative management; 5 patients presented with late-stage disease and risked poor outcomes after management. The remaining 4 identified cases were adenocarcinomas and squamous cell carcinomas. Most patients presented with high-grade cancers (43.2%). A small subset of patients were diagnosed with renal cell carcinoma (11.6%) and upper-tract transitional cell carcinoma (1.6%). Conclusions. This audit revealed that an OSHC can streamline diagnosis of urological malignancies in the SA setting, and highlights the fact that the patients most at risk for developing malignant conditions were the ones frequently diagnosed at a later stage and hence potentially facing a poorer prognosis. These findings support the setting up of such clinics in other SA hospitals to improve ease of early access to the urological service.
Early treatment of progressive vertebral arteriovenous fistula caused by cervical penetrating injury

Penetrating injury of the vertebral artery (VA) is uncommon because it lies deep in the neck and is surrounded by a bony foramen. Vertebral–venous fistula is a rare vascular condition in which there is direct aberrant communication among the extracranial vertebral artery, its radicular or muscular branches, and adjacent venous structures.
Functional Classification of TP53 Mutations in Acute Myeloid Leukemia

Mutations of the TP53 gene occur in a subset of patients with acute myeloid leukemia (AML) and confer an exceedingly adverse prognosis. However, whether different types of TP53 mutations exert a uniformly poor outcome has not been investigated yet. Here, we addressed this issue by analyzing data of 1537 patients intensively treated within protocols of the German-Austrian AML study group. We classified TP53 mutations depending on their impact on protein structure and according to the evolutionary action (EAp53) score and the relative fitness score (RFS). In 98/1537 (6.4%) patients, 108 TP53 mutations were detected. While the discrimination depending on the protein structure and the EAp53 score did not show a survival difference, patients with low-risk and high-risk AML-specific RFS showed a different overall survival (OS; median, 12.9 versus 5.5 months, p = 0.017) and event-free survival (EFS; median, 7.3 versus 5.2 months, p = 0.054). In multivariable analyses adjusting for age, gender, white blood cell count, cytogenetic risk, type of AML, and TP53 variant allele frequency, these differences were statistically significant for both OS (HR, 2.14; 95% CI, 1.15–4.0; p = 0.017) and EFS (HR, 1.97; 95% CI, 1.06–3.69; p = 0.033). We conclude that the AML-specific RFS is of prognostic value in patients with TP53-mutated AML and a useful tool for therapeutic decision-making.
Use of Laryngeal Mask Airways in Pediatric Tonsillectomies and Adenoidectomies Retrospective Outcome Study

Pediatric tonsillectomies and adenoidectomies (T & A’s) have historically been done using endotracheal tubes with general anesthesia. This study is a retrospective comparison study of a large number of pediatric cases done in one institution using laryngomask Airways (LMA’s) in the pediatric surgical population. Coblation was used for hemostasis. Data collected showed a statistically significant decrease in post op complications when compared to T & A’s done with endotracheal tubes.
Vasculitis in a patient with mixed cryoglobulinemia treated with rituximab biosimilar CT-P10: a case report

Abstract Rituximab represents a milestone in the treatment of mixed cryoglobulinemic vasculitis. Despite usually well-tolerated, rituximab may induce different types of adverse drug reactions, including exacerbation of vasculitis. Rituximab biosimilar have been recently approved in Europe in the treatment of rheumatoid arthritis, but no data are available about effectiveness and safety of rituximab biosimilar in the treatment of mixed cryoglobulinemic vasculitis. We describe a severe skin vasculitis reactivation in a patient affected by rheumatoid arthritis and mixed cryoglobulinemic vasculitis treated with rituximab biosimilar. After 7 days from the first infusion, a severe purpuric rash at lower limbs appeared, that resolved in about 2 weeks with high dose-corticosteroid. Rituximab-induced vasculitis has also been described since 2001, but its pathophysiology is still controversial due to the anecdotical descriptions in literature and the variability of the time between the rituximab infusion and the onset of skin lesions. Up to date, this is the first report describing a vasculitic flare in a patient affected by mixed cryoglobulinemic vasculitis treated with rituximab biosimilar.
Estimated societal costs of stroke in the UK based on a discrete event simulation

ABSTRACT Background there are around 100,000 new stroke cases and over a million people living with its consequences annually in the UK. This has large impacts on health and social care, unpaid carers and lost productivity. We aimed to estimate associated costs. Methods we estimated 2014/2015 annual mean cost per person and aggregate UK cost of stroke for individuals aged ≥40 from a societal perspective. Health and social care costs in the first and subsequent years after stroke were estimated from discrete event simulation modelling, with probability of progression and length of receipt of different health and social care services obtained from routine registry and audit data. Unpaid care hours and lost productivity were obtained from trial data. UK unit costs were applied to estimate mean costs. Epidemiological estimates of stroke incidence and prevalence were then applied to estimate aggregate costs for the UK. Results mean cost of new-onset stroke is £45,409 (95% CI 42,054-48,763) in the first year after stroke and £24,778 (20,234–29,322) in subsequent years. Aggregate societal cost of stroke is £26 billion per year, including £8.6 billion for NHS and social care. The largest component of total cost was unpaid care (61%) and, given high survival, £20.6 billion related to ongoing care. Conclusion the estimated aggregate cost of stroke substantially exceeds previous UK estimates. Since most of the cost is attributed to unpaid care, interventions aimed at rehabilitation and reducing new and recurrent stroke are likely to yield substantial benefits to carers and cost savings to society.
Fall Prevention Efforts in Hospitals

Falls are deadly and costly events in health care facilities and have become a primary focus of most hospital quality improvement programs. Falls can occur to patients with simple medical problems as well as those with more complex diagnosis and treatment. From the emergency room, intensive care unit, general inpatient floor to outpatient settings falls can turn a routine patient care encounter into a complicated matter with potential for significant mortality, cost, morale, quality, and public image repercussions. Falls can result in no or minimal harm with injuries ranging from scrapes, bumps, and bruises up to lengthened, expensive, and stressful patient stays for significant injuries or may even result in traumatic death. Falls among hospitalized patients occur frequently and some repeatedly. Of those who fall, 28% have bruises and minor injuries, 11.4% have severe soft tissue wounds, and 5% have fractures. An additional 2% have head trauma, which can lead to a subdural hematoma, long-term disability, or death [1]. Evidence supports the need for interventions aimed at reducing the risk of falls and decreasing the number and severity of falls events. The Collaborative Alliance for Nursing Outcomes and the National Data Base of Nursing Quality Indicators have identified falls as a primary nursing quality indicator. In 2005 The Joint Commission added requirements that both acute and long-term care facilities assess and periodically reassess patients for risk of falls. In 2006 the Centers for Medicare and Medicaid Services [2] identified falls as “never events”, which are defined as serious, preventable and costly medical errors with the potential for death. CMS proposed and promoted strategies to prevent and reduce falls to lower the incidence of “never events” [2].
Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

Background: Typhoid fever is one of major causes of intestinal perforation in India and is one of the common surgical emergencies for which intervention is required. The study aims to evaluate the clinical presentation, operative findings, outcome of surgical procedures, postoperative complications and associated mortality among the patients managed for typhoid ileal perforation in a tertiary care hospital.Methods: This was a retrospective study evaluating the patients who were operated for typhoid ileal perforation peritonitis in FH Medical College, Agra, UP, India between April 2017 and September 2019. Diagnosis of typhoid ileal perforation was made with the combination of clinical presentation, laboratory investigations, radiological results and per-operative findings.Results: In the present study, 57 patients were managed for typhoid ileal perforation. Majority of the patients were young. In our study 40 patients (70.18%) were male and 17 patients (29.82%) were female. All patients presented with pain in abdomen and abdominal distension. However there was no history of fever in 19.3% of patients. Free gas under the right diaphragm was present in 60% of patients. Exploratory laparotomy was done in all the patients and multiple perforations were found in 59.65% of patients. Ileostomy was made in 75% of patients. Most common post-operative complication was wound infection (85.96%) and mortality was 12.28%. Conclusions: Perforation peritonitis is an alarming complication of typhoid fever which needs urgent and aggressive management. Mortality rate is high (12.28%) and may be attributed to delayed presentation.
Facilitators, barriers and implications of immediate skin-to-skin contact after caesarean section : an ethnographic study

xxiv 1 Chapter One: Introduction . 1 1.1 Current caesarean section rates . 2 1.2 Definition of skin-to-skin contact . 2 1.3 Recommendations for skin-to-skin contact . 2 1.4 The physiological impact of skin-to-skin contact . 3 1.5 The benefits of skin-to-skin contact . 4 1.6 Skin-to-skin contact and breastfeeding . 5 1.7 Prevalence of skin-to-skin contact after caesarean section . 6
CT Imaging of the Thoracic Aorta: Size assessment and follow-up after surgical and endovascular intervention

Objectives: A dedicated software package that could semi-automatically assess di#erences in aortic maximal cross-sectional diameters from consecutive CT scans would most likely reduce the post-processing time and e#ort by the physicians. The aim of this study was to present and assess the quality of a new tool for the semi-automatic quanti! cation of thoracic aorta dilation dimensions. Methods: Twenty-nine patients with two CTA scans of the thoracic aorta for which the o$cial clinical report indicated an increase in aortic diameters were included in the study. Aortic maximal cross-sectional diameters of baseline and follow-up studies generated semi-automatically by the software were compared with corresponding manual measurements. The semi-automatic measurements were performed at seven landmarks de! ned on the baseline scan by two operators. Bias, Bland-Altman plots and intraclass correlation coe$cients were calculated between the two methods and, for the semiautomatic software, also between two observers. Results: The average time di#erence between the two scans of a single patient was 1188 ±622 days. For the semi-automatic software, in 2 out of 29 patients, manual interaction was necessary; in the remaining 27 patients (93.1%), semi-automatic results were generated, demonstrating excellent intraclass correlation coe$cients (all values ≥0.91) and small di#erences, especially for the proximal aortic arch (baseline: 0.19±1.30 mm; follow-up: 0.44±2.21mm), the mid descending aorta (0.37±1.64mm; 0.37±2.06mm), and the diaphragm (0.30±1.14mm; 0.37±1.80mm). The inter-observer variability was low with all errors in diameters ≤1mm, and intraclass correlation coe$cients all ≥0.95. The semiautomatic tool decreased the processing time by 40% (13 vs 22 minutes). Conclusions: In this work, a semi-automatic software package that allows the assessment of thoracic aorta diameters from baseline and follow-up CTs (and their di#erences), was presented, and demonstrated high accuracy and low inter-observer variability. | 65 A new software for aortic dilation progression assessment
the differences of intrapartum types to the risk of postpartum depression on primiparous mother in public hospital of yogyakarta municipality

Postpartum depression is one of serious problems that women experience after giving birth. Depression symptoms found in postpartum mothers include sadness, anxiety, crying, temperament, lack of appetite, insomnia, and inattentive to the baby. It is a part of the symptoms of maternal psychological disorders that lead to the postpartum depression. This study used quantitative research with analytic observational research design. The population of primiparous postpartum mothers is 60 people consisting of 20 postpartum mothers of Sectio Caesarea, 20 spontaneous postpartum mothers, and 20 vacuum extraction postpartum mothers in the Public Hospital of Yogyakarta Municipality. The sampling teachnique used consecutive sampling. The study utilized Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Bivariate analysis used ANOVA statistical test followed by post hoc test and Chi-Square test with 95% of confidence level. The results of the analysis show Respondents data who were at risk of postpartum depression in Sectio Caesarea intrapartum (16 or 80%) compared to vacuum extraction intrapartum (5 or 13%) and spontaneous intrapartum (7 or 35%). There was a difference on the type of Sectio Caesarea intrapartum with spontaneous intrapartum and vacuum extraction with the risk of postpartum depression of p-value = 0.001 (p <0.05). The difference of the risk was significant on the type of Sectio Caesarea intrapartum when compared with vacuum extraction and spontaneous intrapartum, while between vacuum extraction and spontaneous intrapartum was not significantly different. The conclusion of this study is that there are differences in the type of Sectio Caesarea intrapartum with spontaneous intrapartum and vacuum extraction on the risk of postpartum depression among primiparous mothers in Public Hospital of Yogyakarta Municipality.
Evaluation of Risk Factors Associated with Reinfarction: A Multicenter Observational Study

Introduction: Reinfarction after incidence of myocardial infarction is a serious complication and is responsible for high mortality. Various factors are responsible for reinfarction including smoking, prior procedures or surgeries, and use of medications such as aspirin, β-blocker, and angiotensin-converting enzyme Iihibitor or angiotensin receptor blockers. Material and Methods: This prospective study was conducted with 243 participants. Participants were divided into two groups: patients who had a reinfarction during hospital and patients who did not. Results: There were 142 (58.4%) men and 101 (41.6%) women in the study. A total of 17 (6.9%) patients had reinfarction. Age (68.4±10.9 vs. 64.4±11.8; 0.001), diabetes (47.05% vs. 22.12%; 0.02), and history of myocardial infarction (29.5% vs. 11.4%; 0.02) were identified as risk factors for reinfarction Conclusion: Our study reports that certain parameters such as age, obesity, diabetes mellitus,, and history of myocardial infarction can be used to assess the risk of reinfarction among these patients.
Modulatory role of lauric acid supplement on lipid peroxidation and some antioxidant enzymes activity in high fat diet, streptozotocin-induced type 2 diabetic male wistar rats

Background: Diabetes mellitus is a major health challenge in the world and is diagnosed by the presence of sustained hyperglycemia (high glucose levels in the blood). Oxidative stress is known to be actively involved in the onset and progression of diabetes and its complications. Antioxidants have important roles in biological systems by scavenging free radicals which may result in oxidative damage of biological molecules such as lipids, proteins and DNA. Aim: This study was designed to evaluate the effect of lauric acid on lipid peroxidation (serum malondialdehyde concentration) and some antioxidant enzymes (superoxide dismutase and Catalase) activities in high fat diet/streptozotocin-induced type 2 diabetic male wistar rats. Study Design: Thirty-five apparently healthy male wistar rats aged 6-8 weeks, weighing between 70-90 g were assigned into seven groups of five animals each (n=5) and administered graded doses of lauric acid supplement after validation of diabetes for a period of twenty-one (21) days. Methodology: Group 1: (Normal control), Group 2: (Diabetic control untreated), Groups 3: (Normoglycemic) received 125 mg/kg Lauric acid, Group 4, 5 and 6 were administered 125, 250 and 500 mg/kg body weight of lauric acid, Group 7: (Standard control) received metformin 100 mg/kg. At the end of twenty-one (21) days, rats were anaesthetized using ketamine and xylazine at 75 and 25 (mg/kg). Blood samples were taken from all treated groups for evaluation of serum MDA, SOD and CAT level. Results: Serum malondialdehyde (MDA) levels were significantly (P < 0.05) reduced (1.32±0.04, 1.40±0.04 and 1.42 ± 0.06 nmol/l) respectively when compared with the diabetic control (untreated) group with a value of (2.25±0.10 nmol/l), while there was up-regulated activities of serum endogenous antioxidant enzymes: SOD (1.97±0.08, 2.02±0.16, 1.98±0.12 IU/L), CAT (44.5±0.64, 43.2±0.85, 43.7±0.85 IU/L) relative to diabetic control (untreated) (1.35±0.02 and 34.0±0.91 IU/L) respectively. Conclusion: In conclusion, lauric acid decreases lipid peroxidation while increasing serum antioxidant activity in high fat diet/streptozotocin-induced type 2 diabetic male wistar rats after 21 days oral administration. Keywords: Lipid peroxidation; antioxidant enzymes; lauric acid; metformin; type 2 diabetes
Effects of pulse consumption in women presenting components of the metabolic syndrome: a randomized controlled trial

The objective of the study is to evaluate the effects of pulse consumption in women presenting at least two primary components of the metabolic syndrome (MS). One hundred and thirty-four women were randomly assigned to consume for a 16-week period either 750 ml of pulses weekly or control meals without pulses. Main out- comes measure were primary and secondary components of the MS and body fatness. A significant increase in dietary fibers and a significant decrease in dietary cholesterol were observed in the pulse group. For all components of the MS and body fatness, no significant differences were observed between the group consuming pulses or in the control group; however, plasma fibrinogen concentration decreased significantly only in the pulse group. In con- clusion, a nutritional intervention providing 750 ml of pulses weekly had no effect on primary and secondary components of the MS and on body fatness.
No decrease of muscle strength, function and exercise found after reverse shoulder arthroplasty follow-up

Abstract Purpose To assess muscle strength and the correlation with physical functioning, pain, time interval since surgery and self-reported exercise after reverse shoulder arthroplasty (RSA). Materials and methods Fourteen patients with primary RSA (mean age 68.9 years; mean follow-up 48.6 months), were assessed twice within a 9-month interval. Outcome measures were the Bostrom function test, the Shoulder Pain and Disability Index (SPADI), isometric strength measured with a handheld dynamometer, and the self-reported amount of specific shoulder exercises. Results The mean isometric strength did not significantly change on the operated side over 9 months (flexion: –1.6 N, p = .638; abduction: 6.1 N, p = .433) nor between the operated and nonoperated sides (flexion: 5.1 N, p = .551; abduction: 2.8 N, p = .826). There was no significant correlation between strength and time interval since surgery or self-reported amount of exercise. Abduction strength showed a small to moderate correlation with SPADI at baseline (–0.529, p = .05) and the Bostrom function score at follow-up (0.573, p = .05). Strength difference between the operated and nonoperated sides for abduction showed a small to moderate correlation with the Bostrom pain score at baseline (–0.565, p = .05). Conclusions In this study, we found that strength after RSA did not decrease over time and was not associated with self-reported exercise. A small to moderate correlation was found between absolute strength in abduction and SPADI at baseline and the Bostrom function score at follow-up. Strength difference between the operated and nonoperated sides for abduction showed a small to moderate correlation with the Bostrom pain score at baseline.
Perception of Pharmacovigilance by Nurses and Midwives of the Cocody University Teaching Hospital in Abidjan

Objective: To assess the perception on pharmacovigilance by the nurses and midwives at the University Teaching Hospital (CHU) of Cocody in 2017. Methodology: Descriptive and analytic cross-sectional study conducted in 17 services of the University Teaching Hospital (CHU) of Cocody using an anonymized and standardized questionnaire. Results: The response rate was 39.33% for the 86 nurses and 21 midwives with at least 10 years of professional experience (50.6%). 57.94% of the respondents (n = 62) have already heard about pharmacovigilance during their basic training (40.18%, n = 43). However, only 19.63% (21/107) of the respondents knew about the existence of a pharmacovigilance unit which they wrongly located to the pharmacy (11/21) of the CHU of Cocody. 40.18% of respondents (n = 43) had previously experienced an adverse drug reaction that was reported (76.74%, n = 33) to a hierarchical supervisor (60.60%, n = 20). The causes of non-reporting were either the frequent occurence (4/10) or the benign nature (2/10) of the adverse drug reaction. Specific actions to be taken (37.38%, n = 40) and a feedback (28.97%, n = 31) were the respondents’ main expectations for the stimulation of the reporting system. They also wanted the pharmacovigilance monitors to regularly visit their services (34.57%, n = 37) and to provide them with the reporting forms (30.84%, n = 33). Conclusion: Our study has allowed us to highlight the lack of knowledge of the pharmacovigilance and to identify certain factors that could improve the perception of the pharmacovigilance by the nurses and the midwives in Ivory Coast.