Miracle-dz/UniFAR-FTUs huggingface dataset:
Antimicrobial Resistance in Isolates of Streptococcus pneumoniae during January 2016 to December 2017 in Dr. Lal Path Labs, Delhi

Aims and Objectives: The aim and objectives of this study is to assess drug resistance pattern of Streptococcus pneumoniae in Dr Lal Path Labs, Delhi. We did retrospective study from January 2016 to December 2017 on 86 isolates of Streptococcus pneumoniae. Materials and Methods: At study sites, total 86 isolates from pulmonary and extra pulmonary grown on Columbia 5% sheep Blood agar (BioMerieux) plates after incubation for 24 to 48 hours at 36± 1°C in 5% CO2 incubator. Identified by MALDI TOF-MS (Bruker Daltonics) & Antibiotic susceptibility testing were also done using VITEK® 2 GP card. / S. pneumoniae susceptibility card (AST ST01 Card –BioMerieux, India) as per as CLSI M100-S-28. Results: A total 86 isolates from pulmonary (21%) and extra pulmonary (79%) specimens were analysed for their antibiotic resistance pattern. 30% were from samples collected from children below between 0-10 years and 17.4% were collected from adults above 60 years of age. The most prevalent source was blood (45.34%), followed by Sputum (20.93%), CSF (12.79%), Pus (n= 9.3%) throat (4.76%), ear (3.5%), nasal (2.3%) and eye (1.19%). Evaluating the antimicrobial susceptibility with 12 antibiotics we found strains were most susceptible to Chloramphenicol (98.8%), Linezolid (93%) and Vancomycin (88.37%). However most resistance were seen in Erythromycin (62.8%), Tetracycline (59.3%), Co-trimoxazole (62.8%) and Penicillin resistance were (22.1%). Discussion and Conclusion: In our study we found the infection is most common in extremes of age i e: 30% (0-10 y) & 17.4% (60-80y). Alarming thing found is the emergence of resistance in Vancomycin (11.62%) and Linezolid (6.97%) in India which is also reported by other studies. We found Chloramphenicol and Linezolid are most susceptible drugs against Streptococcus pneumoniae whereas maximum resistance was observed for Erythromycin (62.8%), Tetracycline (59.3%), Co-trimoxazole (62.8%) and Penicillin resistance is very much present in pulmonary isolates in comparision to extrapulmonary isolates.
Clinical Implications of Microsatellite Instability in Early Gastric Cancer

Purpose We aimed to evaluate the clinical characteristics of microsatellite instability in early gastric cancer. Materials and Methods The microsatellite instability status of resected early gastric tumors was evaluated using two mononucleotide repeat markers (BAT25 and BAT26) and three dinucleotide repeat markers (D5S346, D2S123, and D17S250). Tumors with instability in two or more markers were defined as microsatellite instability-high (MSI-H) and others were classified as microsatellite stable (MSS). Results Overall, 1,156 tumors were included in the analysis, with 85 (7.4%) classified as MSI-H compared with MSS tumors. For MSI-H tumors, there was a significant correlation with the female sex, older age, tumor location in the lower gastric body, intestinal histology, lymphovascular invasion (LVI), and submucosal invasion (P<0.05). There was also a trend toward an association with lymph node (LN) metastasis (P=0.056). In mucosal gastric cancer, there was no significant difference in MSI status in tumors with LN metastasis or tumors with LVI. In submucosal gastric cancer, LVI was more frequently observed in MSI-H than in MSS tumors (38.9% vs. 25.0%, P=0.027), but there was no difference in the presence of LN metastases. The prognosis of MSI-H tumors was similar to that of MSS tumors (log-rank test, P=0.797, the hazard ratio for MSI-H was adjusted by age, sex, pT stage, and the number of metastatic LNs, 0.932; 95% confidence interval, 0.423–2.054; P=0.861). Conclusions MSI status was not useful in predicting prognosis in early gastric cancer. However, the frequent presence of LVI in early MSI-H gastric cancer may help guide the appropriate treatment for patients, such as endoscopic treatment or limited LN surgical dissection.
Impact of a Mobile Phone App to Increase Vegetable Consumption and Variety in Adults: Large-Scale Community Cohort Study

Background Large-scale initiatives to improve diet quality through increased vegetable consumption have had small to moderate success. Digital technologies have features that are appealing for health-related behavior change interventions. Objective This study aimed to describe the implementation and evaluation of a mobile phone app called VegEze, which aims to increase vegetable intake among Australian adults. Methods To capture the impact of this app in a real-world setting, the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was utilized. An uncontrolled, quantitative cohort study was conducted, with evaluations after 21 and 90 days. The app was available in the Apple App Store and was accompanied by television, radio, and social media promotion. Evaluation surveys were embedded into the app using ResearchKit. The primary outcomes were vegetable intake (servings per day) and vegetable variety (types per day). Psychological variables (attitudes, intentions, self-efficacy, and action planning) and app usage were also assessed. Descriptive statistics and multiple linear regression were used to describe the impact of the app on vegetable intake and to determine the characteristics associated with the increased intake. Results Data were available from 5062 participants who completed the baseline survey; 1224 participants completed the 21-day survey, and 273 completed the 90-day survey. The participants resided across Australia and were mostly women (4265/5062, 84.3%) with a mean age of 48.2 years (SD 14.1). The mean increase in intake was 0.48 servings, from 3.06 servings at baseline to 3.54 servings at the end of the 21-day challenge (t1223=8.71; P<.001). The variety of vegetables consumed also increased by 0.35 types per day (t1123=9.59; P<.001). No changes in intake and variety were found from day 21 to the 90-day follow-up. Participants with the highest app usage increased their vegetable intake by 0.63 (SD 2.02) servings per day compared with 0.32 (SD 1.69) servings per day for those with the lowest app usage. On the basis of multiple linear regression, gender; age; BMI; psychological variables of self-efficacy, attitudes, intentions, and action planning specific to vegetable intake; baseline vegetable intake; and active days of app usage accounted for 23.3% of the variance associated with the change in intake (F9,1208=42.09; P<.001). Baseline vegetable intake was the strongest predictor of change in intake (beta=−.495; P<.001), with lower baseline intake associated with a greater change in intake. Self-efficacy (beta=.116; P<.001), action planning (beta=.066; P=.02), BMI (beta=.070; P=.01), and app usage (beta=.081; P=.002) were all significant predictors of the change in intake. Conclusions The VegEze app was able to increase intake by half a serving in a large sample of Australian adults. Testing the app in a real-world setting and embedding the consent process allowed for greater reach and an efficient, robust evaluation. Further work to improve engagement is warranted.
Multiparametric Magnetic Resonance Elastography Improves the Detection of NASH Regression Following Bariatric Surgery

Disease monitoring in nonalcoholic steatohepatitis (NASH) is limited by absence of noninvasive biomarkers of disease regression or progression. We aimed to examine the role of multiparametric three‐dimensional magnetic resonance elastography (3D‐MRE) and magnetic resonance imaging proton density fat fraction (MRI‐PDFF) in the detection of NASH regression after interventions. This is a single‐center prospective clinical trial of 40 patients who underwent bariatric surgery. Imaging and liver biopsies were obtained at baseline and 1 year after surgery. The imaging protocol consisted of multifrequency 3D‐MRE to determine the shear stiffness at 60 Hz and damping ratio at 40 Hz, and MRI‐PDFF to measure the fat fraction. A logistic regression model including these three parameters was previously found to correlate with NASH. We assessed the model performance in the detection of NASH resolution after surgery by comparing the image‐predicted change in NAFLD activity score (delta NAS) to the histologic changes. A total of 38 patients (median age 43, 87% female, 30 of 38 with NAS ≥ 1, and 13 of 38 with NASH) had complete data at 1 year. The NAS decreased in all subjects with NAS ≥ 1 at index biopsy, and NASH resolved in all 13. There was a strong correlation between the predicted delta NAS by imaging and the delta NAS by histology (r = 0.73, P < 0.001). The strength of correlation between histology and the predicted delta NAS using single conventional parameters, such as the fat fraction by MRI‐PDFF or shear stiffness at 60 Hz by MRE, was r = 0.69 (P < 0.001) and r = 0.43 (P = 0.009), respectively. Conclusion: Multiparametric 3D‐MRE and MRI‐PDFF can detect histologic changes of NASH resolution after bariatric surgery. Studies in a nonbariatric setting are needed to confirm the performance as a composite noninvasive biomarker for longitudinal NASH monitoring.
Using 2-mSv Appendiceal CT in Usual Practice for Adolescents and Young Adults: Willingness Survey of 579 Radiologists, Emergency Physicians, and Surgeons from 20 Hospitals

Objective To survey care providers' willingness to use 2-mSv computed tomography (CT) in their usual practice for adolescents and young adults with suspected appendicitis. Materials and Methods An ethical committee approved this prospective study. We introduced 2-mSv CT in 20 hospitals through a pragmatic clinical trial. At the final phase of the trial, we invited 698 potentially-involved care providers in the survey regarding their willingness to use 2-mSv CT. Multivariable logistic regression analyses were performed to identify factors associated with willingness. Nine months after the completion of the trial patient recruitment, we surveyed whether the hospitals were using 2-mSv CT in usual practice. Results The analyses included responses from 579 participants (203 attendings and 376 trainees; 221 radiologists, 196 emergency physicians, and 162 surgeons). Regarding the willingness to immediately change their standard practice to 2-mSv CT, 158 (27.3%), 375 (64.8%), and 46 (7.9%) participants responded as “yes” (consistently), “partly” (selectively), and “no”, respectively. Willingness varied considerably across the hospitals, but only slightly across the participants' departments or job titles. Willingness was significantly associated with attendings (p = 0.004), intention to maintain the dedicated appendiceal CT protocol (p < 0.001), belief in compelling evidence on the carcinogenic risk of conventional-dose CT radiation (p = 0.028), and hospitals having more than 1000 beds (p = 0.031). Fourteen of the 20 hospitals kept using 2-mSv appendiceal CT in usual practice after the trial. Conclusion Despite the extensive efforts over the years of this clinical trial, many care providers were willing to use 2-mSv CT selectively or not willing to use.
Prevalence of nosocomial infections by multidrug resistant organisms in patients admitted to the critical care area of the Regional cancer center, Gujarat, India

Introduction: Nosocomial infection is a main cause of mortality and morbidity among patients admitted in different critical areas [post-operative, Intensive Care Units (ICU), and for bone marrow transplantation (BMT)] in a hospital. Availability of a clinical microbiology service for patients admitted to critical areas can significantly improve clinical outcome. Methods: During the study period (January 2014 to March 2014) 330 patients from different oncology departments were admitted to critical areas of the hospital. Conventional and molecular methods were used to determine resistance mechanisms [methicillin resistance (MRSA), extended spectrum β-lactamase (ESBL), carbapenemases and Amp C) of clinically significant isolates. Results: Of 330 patients admitted to critical care areas during the study period, 84 (25.4%) were identified as having acquired infection during their stay in the critical areas. Of these 84 patients 16 had dual infections. The mean age of patients was 44.5 yrs. The most common infection in the ICU was wound infection (49%) followed by respiratory infection (19%). The most common isolated organisms from wound infection were Escherichia coli (42.8%) followed by Pseudomonas aeruginosa (14.2%). The majority of bacterial isolates were multidrug resistant (MDR). Using both conventional and molecular methods of 88 isolated Gram negative bacilli (GNB), 45.9% were found to be ESBL producers, 16 % Amp C producers and 4.5% carbapenemase producers. The prevalence of MRSA was 30.7% (4/13) by a conventional method and 23% (3/13) using a molecular method. Conclusion: From this study, we concluded that cancer patients admitted to critical areas are at a greater risk of acquiring nosocomial infection. However, the increasing prevalence of MDR-GNBs, especially those resistant to cephalosporins and carbapenems, could contribute to both increased morbidity and mortality due to non-response to routinely used first line antibiotics and resultant recourse to colistin
E-cigarette use and cigarette smoking initiation studies: A word of caution

1 Published by European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP). © 2019 Miguel R.T. D. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0) Dear Editor, In a recent review, published in Tobacco Prevention & Cessation, entitled: ‘Is adolescent e-cigarette use associated with smoking in the United Kingdom? : A systematic review with meta-analysis’, Aladeokin and Haighton examined the possible relationship between e-cigarette use and initiation of cigarette smoking in the UK. In their meta-analysis of three longitudinal studies, the authors found an unusually large pooled odds ratio (OR) of 26.01 (95% CI: 5.35–126.44). On close examination it is revealed that the very large OR is in fact erroneous and has resulted by entering as log odds the published adjusted ORs from the three longitudinal studies in their generic inverse variance meta-analysis. Thus, the ORs being pooled were exponentiated values of the ORs from the studies. Correcting this error shows that the OR remains significant (OR=3.86; p<0.00001) (Figure 1) but much lower than the published OR value of 26.01. It is noteworthy that this amended meta-analysis has a lower pooled OR (3.86) than the meta-analysis of unadjusted ORs by Aladeokin and Haighton (OR=5.55). This finding may suggest that controlling for confounders can significantly impact on the outcomes of studies examining the relationship between e-cigarette use and initiation of cigarette smoking. A report by McNeill et al., synthesising evidence investigating e-cigarette use and its association with initiation of cigarette smoking among adolescents in the UK, supports the importance of controlling for variables in e-cigarette studies. The report found that although e-cigarette users were more likely than non-users of e-cigarettes to try cigarette smoking, there was no established evidence to suggest progression to cigarette smoking. In reaching the foregoing conclusion, McNeill et al. cited two of the three studies used by Aladeokin and Haighton, viz Conner et al. and Best et al., and suggested that these studies were challenged by their inability to properly control for all relevant confounders, which limited their capacity to determine causality. Until further studies are conducted, evidence linking e-cigarette use to cigarette smoking initiation must be interpreted with caution. AFFILIATION 1 Thera Business Inc., Ottawa, Canada
Assessment the Incidence of Transitional Cell Carcinoma (TCC) of the Bladder Cancer

Background: Transitional cell carcinoma (TCC) of the bladder is the second most common malignancy of the genitourinary tract and the third most common cause of death among people with genitourinary tumors, besides, tumors of the bladder are an important source of both morbidity and mortality. Objectives: The purpose of the study are 1. formulate an idea about the number of patients with bladder cancer (TCCs) in sample of Iraqi population. 2. Study the histopathological features of TCCs of bladder 3. Assessment the prevalence of (TCC) of bladder in both sex (male and female) with smoking as risk factor. Patients and Methods: A study was conducted at one institution were identified that teaching-hospital of Baghdad. All patients included in the present study diagnostic with TCC of bladder. The total of subjects participated in the study were 42 patients and 20 subjects as control through six months’ period from July 2014 to January 2015. Results: The mean of participates age was 655.7 years and the youngest was 21years and the oldest was 75 years. Out of 42 patients, the most common age group was 54-64years (52.38%) with Male to female ratio was 5.2:1.32 were male 32 and 10 were females. However, the prevalence bladder cancer (TCCs) was higher in male than in female, with more pronounced decreases in younger age (≤31year) 3(7.14), have been found. In addition, age specific rate was observed higher in the older age groups for most patients with cancer. The population attributable risk for ever smoking in our study was 33(78.57) out of 42 patients. Moreover, current study shows there was a correlation between grade and stage of bladder TCC, 24(57.14%) bladder TCCs that classified as grade I, while 2(4.76%) of bladder TCC were classified as grade II. Conversely, of the bladder TCC lesions (11.9%, 14.28%, 57.14 and 4.76) were stage (pTa-T1-T2-T3) respectively. Although this study showed 5(11.9) little-known stage and grade. The area of histopathological changes included were showed hyperplastic changes, involving the entire bladder lining, that ranged from flat hyperplasia to small areas of nodular and papillary hyperplasia. The smallest recognizable nodular and papillary lesions were associated with angiogenesis in the contiguous stroma. In addition, there were chromatin irregularities and nucleoli of variable numbers, shape and size. Nuclear chromatin irregularity and mitoses were easily identified, these cells continued to have the appearance of hyperplastic epithelium. The changes noted by generalized and orderly proliferative reaction and appeared reparative. Conclusions: Our study has revealed that the bladder TCC, where appeared the high prevalence and incidence rate of TCC of bladder in sample of Iraqi population were of concern, especially for older age groups.
Maternal diet and its association with human milk energy and macronutrient composition among exclusively breastfeeding Malaysian Malay mothers

Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding. Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation. Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake. Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.
Steroid Induced Femoral Osteonecrosis in Multiple Sclerosis: Two Case Reports

Osteonecrosis is a serious condition involving trabecular bone destruction. Direct injury may result from trauma, major arterial disease, Gaucher’s and Caisson disease, sickle cell and thalassemias. Many risk factors have been listed, such as connective tissues and rheumatological diseases, haematological and vascular conditions, but it’s often difficult to determine whether the main trigger is the underlying disease or its treatment (e.g. steroids). Genetic factors may also play a role [1].
Analysis of Factors Affecting the Functional Outcome of Intra Articular Distal Femoral Fractures

Distal femoral fractures are difficult to manage because they are involved with extensive soft tissue injuries, comminution, and involvement of articular surface. There are several implants used to treat includes condylar buttress plate fixation, locking compression plate, dynamic condylar screw, and cancellous screws. Methods: Kakatiya Medical College and MGM Hospital, Warangal. A total of n=25 patients were studied during the period of which in n=23patients mode of injury was due to road traffic accidents [RTA] and the remaining 2 cases are due to slip and fall. They there are n=23 compound fractures (80%) and among them, n=1 case belongs to type I, n=2 cases classified under type II and remaining are type III (80%). During follow up, those patients who visited the outpatient department once in every four weeks assessed fracture union clinically and radiologically and the range of motion of knee and power of quadriceps was also assessed. At the end of 12 weeks, partial weight-bearing was allowed with the help of axillary crutches or walker and full weight-bearing was allowed at the end of 4months after confirming the clinical and radiological union of the fracture. Results: The majority of the study subjects n=20(80%) had Range of knee flexion up to 80 degrees of knee flexion range of movement. More than 80 degrees of motion was found in n=5(20%) of the subjects shown in table 6. Most n=11(44%) of the study population were found to have excellent NEER'S score followed by good n=9 (36%) and fair with n=3 (12%), failure n=2 (8%) NEERs score was found to be least in our study. Conclusion: An analysis of results of the present study based on the type of fractures shows good results were seen with Muller's type B fractures than type C. The younger individuals aged less than 18-38 years had better functional outcome when compared to the elderly patients. Among the different implants used for fixation of fractures in the present study, CBP was found to be the best choice as compared to other implants.
Contemporary Approach to Heavily Calcified Coronary Lesions

Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.