Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of Lifestyle Modification and Metformin on Fetuin-A and Transforming Growth Factor-ß (TGF- ß) in Metabolic Syndrome

Fetuin-A is a liver-synthesized protein that is secreted into serum. Transforming growth factor-β (TGF-β) is a polypeptide member of the TGF-β superfamily of cytokines. The purpose of this study is to evaluate the effects of lifestyle modification and metformin on fetuin-A and Transforming Growth Factor-ß (TGF- ß) in metabolic syndrome (MetS). Forty MetS subjects were randomly assigned to treatment with placebo (n=20) or metformin (n=20) in addition to lifestyle modification for 12 weeks. All 40 participants completed the study. After 12 weeks, both groups had significant reductions in weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (all p<0.001). The placebo group also had significant improvement in fasting plasma glucose (FPG) and C-reactive protein (CRP) (p<0,001 ; p<0.05 respectively). Weight, BMI, WC, FPG, 2-hour postprandial glucose (2h-PPG), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), fetuin-A and TGF- ß in the metformin group decreased significantly compared to the placebo group. Reduction of plasma fetuin-A was significantly associated with TG in the metformin group. Lifestyle modification and treatment with metformin for 12 weeks improved cardio-metabolic risk factors in MetS and reduced fetuin-A levels.
A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation

Background and purpose Previous studies have identified many risk factors related to the recurrence of chronic subdural hematomas (CSDHs). Among these factors, there may be deviations in measuring the midline shift, preoperative hematoma volume (PreHV), postoperative hematoma residual volume, and postoperative pneumocephalus in bilateral CSDHs. The aims of this study were to eliminate the impact of complicated situations on parameter measurement and to identify actual predictors for CSDH recurrence, and finally, to develop a grading system to predict unilateral CSDH (uCSDH) recurrence. Patients and methods A total of 342 patients with uCSDH were identified. Predictors of uCSDH recurrence were obtained from univariable and multivariable logistic regression models. A prognostic grading system was developed based on the results of multivariable logistic regression and receiver operating characteristic (ROC) analyses. All patients were scored according to the grading system, and differences in the recurrence rate were reanalyzed according to the scores. Results Age, antiplatelet or anticoagulant use, midline shift, severe brain atrophy, drainage volume, and the ratio of the postoperative pneumocephalus volume (PostPV) to the postoperative hematoma cavity volume (PostHCV) were identified as independent risk factors for predicting the recurrence of uCSDH. The cut-off values of age, drainage volume, midline shift, and the ratio of the PostPV to the PostHCV were 67 years, 101 mL, 11.2 mm, and 31.61%, respectively. The recurrence rates were 1.7%, 12.4%, 19.4%, 53.3%, and 58.3% for scores of 0–1, 2, 3, 4, and 5–6, respectively, which significantly increased as the score increased (P<0. 001). Conclusion The prognostic grading system for uCSDH on the basis of multivariable logistic regression and ROC analyses is applicable and reliable.
SKIN LESIONS IN TYPE 2 DIABETIC PATIENTS

Bachground: Skin lesions are common in type 2 diabetic patients and its association with microvascular complications been reported. Methods: In this study, 1135 type-2 diabetic patients were included and examined by a dermatologist for diabetes mellitus related skin lesions, skin infections and cutaneous complications of the treatment. Smear, culture and biopsy of the lesions were done for definite diagnosis. Weight, height, blood pressure were also done. FBS and HbA1C were measured for all patients Results: The mean age of the study population was 54±11 years; 619 were (55%) female and 516 were (45%) male. Mean duration of the disease was 9±7 years and HbA1c was 7.8±1.6. The prevalence of skin lesions was 64% (95%CI: 61.2-66.8). The most common solitary skin lesion was diabetic dermopathy (32.3%) while the most common condition observed overall was skin infections (41.5%). Acanthosis nigricans with a prevalence of 26.4% was the third most common lesion. Other skin conditions had a prevalence of less than 12%. Skin disorders were apparently more prevalent in male than in female patients. Conclusion: More than sixty percent of patients with type-2 diabetes mellitus have skin lesions (Iran J Dermatol 2008;11: 113-117)
Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors.

OBJECTIVE The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. METHODS This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. RESULTS Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). CONCLUSIONS Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice.
Carotid intima-media thickness seems not to correlate with the severity of diabetic retinopathy

Diabetic retinopathy and vascular complications of diabetes have been studied for decades, with the aim of defining better their pathogenesis and time profile. The severity of diabetic retinopathy has clear consequences on the quality of life of patients, and trying to find correlates in other vascular territories will help a better understanding of the issue and early as well as more efficacious interventions. We tried to define the association between carotid intima-media thickness with the severity of diabetic retinopathy, since the first parameter has been widely considered as a reliable marker of the progression of atherosclerosis. However, our findings suggest that the value of carotid intima-media thickness although statistically higher in patients suffering from diabetic retinopathy compared to controls, was not correlated with the severity of the retinopathy itself.
A comparative study of pregnancy outcome of sequential versus day 3 versus only blastocyst (day 6) transfer at a single IVF center over one year

Background: The recent introduction of sequential media has refocused attention upon the role of human blastocyst in IVF. For optimisation of extended cycles, one needs to give importance to all the aspects of treatment cycle like the stimulation regimens, medium composition, endometrial quality and uterine receptivity. This study was done to know the pregnancy outcomes of Day 3 transfer vs Day3/Day 6 transfer vs only Day 6 transfer. Methods: It was a retrospective study in which 342 patients undergoing ICSI were included. 199 women underwent Day 3/Day 6 sequential transfers, 112 underwent only Day 3 transfer and only 30 women were given only Blastocyst i.e. day 6 transfer. Pregnancy outcomes of all the three groups were studied. Results: Sequential transfer was found to give maximum pregnancy rate and highest implantation rate. But it was also associated with highest number of multiple pregnancies. Conclusions: Sequential transfer is a very good efficacious approach in ART cycles if extended media are available as it gave maximum pregnancy rate and implantation rate. However it is associated with multiple pregnancies. Thus the ultimate goal is to have a single blastocyst transfer with better outcomes and lower multiple pregnancy rates.
Determination of cause of death in decomposed bodies–A regional study

Once we die, the tissues have to reach the food chain, which is brought by various processes. But this can cause misinterpretation of ante mortem findings. In order to assess the extent of these changes, its effect on injuries, assessment of cause of death in such cases, the extent of certainty etc one year study was conducted at Thrissur Government Medical College during the year 2007. All decomposed bodies were included in this study. Males were more with a ratio 5.13:1. Maximum incidence was in the age group of 31 to 50 years; with mean age 38.46 years ±14.2361 years. The age ranged from newborn to 92 years in male and 75 years in female. All were found dead cases and majority recovered from water. On Postmortem opinion was arrived at in 101 cases and not in 40 cases. A taught standard rule of thumb does not hold true as postmortem changes are influenced by various variables. Despite technical difficulties in handling the decomposed the autopsy was still a useful diagnostic exercise to find out both the cause and manner of death.
The development of executive function in children exposed to alcohol in utero: An exploratory study

Children who have been exposed to alcohol in utero have well documented deficits in executive function. However, previous research in the field has not situated the executive deficits displayed by these children within a developmental framework. The present study endeavoured to address this shortcoming by investigating the development of executive function in children exposed to alcohol in utero, through the use of 10 subtests from the NEPSY that assess attention and executive function. It was hypothesised that the executive abilities of children would mature with age. In addition, it was hypothesised that children who were exposed to alcohol in utero would display deficits in executive function and that these deficits would become more pronounced with age. The study made use of cross-sectional design that compared the performance of younger children (6to 7-year-olds) with that of older children (12to 13-year-olds) on various measures of executive function. Within this, it made use of a natural experimental design, with children exposed to alcohol in utero as the experimental group and non-exposed children as the control group. Participants were recruited from a school and a clinic in two towns in the Western Cape. Twenty children with confirmed in utero exposure to alcohol took part in the study. Twenty non-exposed volunteers constituted the control group. These two groups were each divided equally into two age groups: 6to 7-year-olds and 12to 13-year-olds. The Health Professions Council of South Africa’s regulations with regard to research was adhered to. Two-way factorial analysis of variance (ANOVA) was utilised for each subtest of the NEPSY to investigate the main effects of age group (6to 7-year-olds and 12to 13-year-olds) and exposure (exposed and non-exposed) as well as any interaction effects. Significant interaction effects were evident on the Tower subtest, the Auditory Attention task, the Auditory Response Set task and the accuracy score of the Visual Attention subtest of the NEPSY. In concordance with previous research in the field, the executive abilities of children were found to improve with age. Incidental findings suggested that the executive abilities of children exposed to alcohol in utero may develop at a slower rate than those of non-exposed children. Furthermore, the findings of the present study suggest that children exposed to alcohol in utero present with deficits in executive function which dissipates with age. The findings are discussed in terms of theories of recovery of function after brain damage.
Umbilical Cord Clamping Timing in Preterm Infants Delivered by Cesarean Section

Background: The timing of umbilical cord clamping may affect the need to bloodtransfusion and other morbidities of preterm infants. This study aimed to compare three different cord clamping timing (immediate cord clamping, delayed cord clamping and umbilical cord milking) in preterm infants delivered by cesarean section (CS). Materials and Methods A controlled randomized clinical trial was done in preterm infants with gestation age less than 32 weeks delivered by CS in AlZahra hospital, Tabriz, Iran from June 2018 up to the end of January 2019. They were randomly allocated in three groups consisted of 30 neonates in each group. Umbilical cord was clamped within 10 seconds after infant delivery in immediate cord clamping (ICC) group, 60 seconds after delivery in delayed cord clamping (DCC) group. Cord was milked toward the infant three times over two seconds duration in umbilical cord milking (UCM) group. All patients were followed until discharge for needing the blood transfusion, bronchopulmonary dysplasia and mortality. Results: A total of 20 neonates of 90 studied neonates needed blood transfusion during hospital stay, of which, 4 neonates (13.3%) were in UCM group, 7 neonates (23.3%) in DCC group and 9 patients (30%) in ICC group (P= 0.27). The mean hemoglobin was significantly higher in UCM group at admission and 30 days after birth (P<0.05). Conclusion UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.
Husband’s smoking behaviors associated with women’s depression in China: the importance of a smoke-free household

ABSTRACT Background: Passive smoking is a significant public health problem worldwide. The aim of this study was to examine the association between passive smoking and women’s depression. Methods: Data for this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), and panel data analysis was applied. Data from a total of 10,498 Chinese women were selected for analysis, including 2,919 who were interviewed in 2011, 3,490 in 2013, and 4,089 in 2015. Results: Passive smoking was found to be significantly associated with depression. Compared with those living in nonsmoking households, women who had lived with a smoking husband for over 20 years had significantly more depressive symptoms. In addition, compared with individuals with lower educational levels, and residing in nonsmoking households, those with more education were less likely to develop depression, although exposed to smoking. Conclusions: The results suggest that passive smoking within households is a risk factor for depression among Chinese women. Smoke-free policies should be promoted, to help push forward tobacco control in China. Provision of more educational opportunities for Chinese women should also be promoted, as these will also help to protect them against the negative effects brought on by passive smoking. Abbreviations: CHARLS: China health and retirement longitudinal study; CES-D: center for epidemiological studies depression Scale; SES: socio-economic status
Cultural Issues in the Consumer Health Library

Diversity and cultural issues continue to be an area of intense focus within the healthcare industry and the library world. New initiatives and models are constantly being developed to improve knowledge and skills and to decrease health care disparities. This column will look at some of the terminology and issues involved when talking about meeting the needs of cross-cultural patrons and coworkers. Diversity occurs in many forms. Economic, cultural, ethnic, racial, religious, and sexual orientation are areas of diversity that are in the news regularly. Effectively interacting with other cultures is essential for everyone in the healthcare system, including the consumer health librarian. Librarians interact with diverse patrons and coworkers daily. Like most professional associations, the Medical Library Association (MLA) has addressed the needs of cross-cultural patrons in their code of ethics. The MLA Code of Ethics for Health Sciences Librarianship states that
Clinical assessment of dermatological manifestations of dengue fever in a tertiary care center of Karimnagar

1 Assistant Professor, Department of Dermatology, Prathima Institute of Medical Sciences, Karimnagar, Telangana 2 Assistant Professor, Department of Dermatology, Prathima Institute of Medical Sciences, Karimnagar, Telangana *Corresponding Author Dr Ramesh Rachakonda Rachaconda Skin and Mind Clinic, H. No.6-6-444, Near SBI Bank, Choppadandi Road, Karimnagar-505001 Telangana State, India Abstract Background: The changing epidemiology of dengue fevers in terms of strains, severity and geographic distribution is raising concern in India. Dengue virus infection, the most common and widespread arthropod-borne viral infection has grown dramatically in the last 50 years globally. Most commonly adults are affected by dengue, but the pediatric population is more vulnerable. Method: A hospital-based study was conducted for a period of 2 months (June –July 2019) among 134 cases of dengue fever between the age group of 3 months to 15 years presenting with symptoms & signs suggestive of dengue fever as per WHO criteria were recorded and were analyzed in detail with more emphasis on onset of skin lesions, their morphology, distribution, sites involved and progression in study area. Results: About 134 patients with dengue fever were enrolled, 70.1 % were males and 29.9 % were females. Cutaneous manifestations were present in 50.7% of patients while mucous manifestation was seen in 8.9% of patients. Bleeding manifestations were seen in 28.4% of cases with petechiae (26.3%) was the commonest manifestation. Conclusion: Though dengue is a systemic illness, more than half of the patients showed cutaneous involvement and 50% of patients had an onset of skin rash consistently with fever which can help in suspecting dengue illness. Thus skin can be involved in various ways in children with dengue fever and can help diagnose the illness clinically, especially in places with inadequate laboratory support.
Association Between Convenience of Transportation and Unmet Healthcare Needs of Rural Elderly in Korea

Objectives In rural areas of Korea, where public transportation infrastructure is lacking and alternative systems are poor, the elderly experience inconveniences in using healthcare, although their need is high. This study aimed to analyze the association between the convenience of transportation and unmet healthcare needs among the rural elderly. Methods The data used were collected in the 2016 Community Health Survey among rural elderly individuals aged 65 or older. Dependent variable was the unmet healthcare needs, explanatory variable was the convenience of transportation. The elderly were divided into 3 groups: with no driver in the household, with a driver, and the elderly individual was the driver (the self-driving group). Covariates were classified into predisposing, enabling, and need factors. They included gender, age, education, income, economic activity, household type, motor ability, subjective health level, number of chronic diseases, anxiety/depression, and pain/discomfort. The data were analyzed using logistic regression and stratification. Results A significant association was found between the convenience of transportation and unmet healthcare needs. When examined unadjusted odds ratio of the group with a driver in the household, using the group with no driver as a reference, was 0.61 (95% confidence interval [CI], 0.54 to 0.68), while that of the self-driving group was 0.34 (95% CI, 0.30 to 0.38). The odds ratios adjusted for all factors were 0.69 (95% CI, 0.59 to 0.80) and 0.79 (95% CI, 0.67 to 0.91). Conclusions We confirmed a significant association between inconvenient transportation and unmet healthcare needs among the rural elderly even after adjustment for existing known factors. This implies that policies aimed at improving healthcare accessibility must consider the means of transportation available.
Treatment of severe aortic stenosis and left ventricular outflow tract mass with transcutaneous aortic valve implantation: a case report

Abstract Background Percutaneous implantation of aortic valve for severe aortic stenosis (AS) in the presence of pedunculated mobile left ventricular outflow tract (LVOT) mass not reported before. In this case report, we address the feasibility of this procedure. Case summary An 80-year-old patient who presented with presyncope, transthoracic echocardiogram (TTE), and transoesophageal echocardiography (TOE) revealed severe calcific AS and LVOT mass measuring 2.1*1.5 cm. The patient was turned down for surgery. It was decided that transcatheter aortic valve implantation (TAVI) be performed because the valve compresses the mass against the proximal part of the interventricular septum. The mass peduncle was 1.4 cm, and it was 4 mm away from the annulus. This meant the valve was needed to be deployed 18 mm below the annulus to cover the mass completely. Gentle manipulation and direct valve deployment without preballoon dilation to decrease the possibility of fragment embolization were necessary. Self-expandable core valve deployed as low as possible, after initial deployment, the distance of LVOT covered by the valve measured by TOE 1.66 cm, the whole mass was covered, then the valve was fully deployed. The patient was extubated in the catheterization room; there was no clinical evidence of embolization. The patient was discharged home after 2 days. A follow-up TTE after 6 months showed a well-functioning valve and the LVOT mass then disappeared. Discussion Pedunculated LVOT mass should be resected surgically. In high-risk surgical patients, direct TAVI to compress the mass is feasible in experienced canters. The safety issues need more research and more cases to judge. Transoesophageal echocardiography during the procedure is mandatory to guide the valve position.
Trends in Infant and Child Mortality in Nigeria: A Wake-Up Call Assessment For Intervention Towards Achieving the 2015 MDGS

A child's right to survival is fundamental. It is the building block towards the realisation of a child's potential and on it hinges other basic rights of the child. Yet, many children do not enjoy this right. This paper examined trends in infant and child mortality in Nigeria as a wake-up call for intervention towards achieving the 2015 MDGs target. Between 1990 and 2008, under-five mortality in Nigeria only falls from 199 to 157 against the 62 MDGs target by 2015. Currently, about 5.9 million babies are born in Nigeria every year, and nearly one million children die before the age of five years. One quarter of all under-five deaths are newborns - 241,000 babies each year. Many deaths occur at home and are therefore unseen and uncounted in official statistics. However, Vaccine Preventable Diseases (VPD) are the major causes of childhood mortality in Nigeria due to low vaccination uptake, poor health care system, inadequate personnel etc. The study therefore, call for an urgent action and greater national priority on child survival through interventions that will be integrated at community and family levels, targeting pregnant women, under-five children and accessing the hard-to-reach in order to meet the 2015 MDGs.