Miracle-dz/UniFAR-FTUs huggingface dataset:
Non-medical prescription opioid use and opioid use disorder in the military population in Nigeria

ABSTRACT Objective: Aim of the study was to determine 12-month prevalence of non-medically prescribed opioid use (NMPOU) and NMPOU disorder among a military population in Nigeria. Method: In this descriptive cross sectional study, 224 military officers were interviewed by multistage stratified systematic sampling method. The Composite International Diagnostic Interview (CIDI) version 7.0 was used to generate data on 12-month prevalence of NMPOU and NMPOU disorder. Associated factors and predictors were determined using SPSS Version 17.0, IBM, Chicago, Illinois. Results: Prevalence of NMPOU was 6.7% and NMPOU disorder, 3.6%. Predictors of NMPOU were: 12-month tobacco use, OR = 2.01, 95% CI (1.12–6.42) and 12-month cannabis use disorder OR = 2.96, 95% CI (1.35–7.38), Predictors of 12-month NMPOU disorder were: 12-month alcohol use disorder OR = 1.59, 95% CI (1.13–3.29), 12-month tobacco use disorder OR = 3.94, 95% CI (1.95–5.04) and 12-month cannabis use disorder OR = 3.0, 95% CI (2.06–8.87) Conclusion: NMPOU and NMPOU disorder is a major health issue in the military. This population requires substance use prevention and intervention programs.
Exploring the role of ceftaroline in the treatment of community-acquired pneumonia

A critical appraisal and clinical application of File TM Jr, Low DE, Eckburg PB, Talbot GH, Friedland HD, Lee J, Llorens L, Critchley IA, Thye DA, FOCUS 1 investigators. FOCUS 1: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia. J Antimicrob Chemother. 2011 Apr;66 Suppl 3:iii19-32. doi: 10.1093/jac/dkr096.
Metabolic Reprogramming by c-MET Inhibition as a Targetable Vulnerability in Glioblastoma

The elucidation of better treatments for solid tumors and especially malignant glial tumors is a priority. Better understanding of the molecular underpinnings of treatment response and resistance are critical determinants in the success for this endeavor. Recently, a battery of novel tools have surfaced that allow to interrogate tumor cell metabolism to more precise extent than this was possible in the earlier days. At the forefront of these developments are the extracellular flux and carbon tracing analyses. Through utilization of these techniques our group made the recent observation that acute and chronic c-MET inhibition drives fatty acid oxidation that in turn can be therapeutically targeted for drug combination therapies. Herein, we summarize and comment on some of our key findings related to this study.
Outcome of Watchful Waiting in Asymptomatic Severe Mitral Regurgitation

Background— The management of asymptomatic severe mitral regurgitation remains controversial. The aim of this study was to evaluate the outcome of a watchful waiting strategy in which patients are referred to surgery when symptoms occur or when asymptomatic patients develop left ventricular (LV) enlargement, LV dysfunction, pulmonary hypertension, or recurrent atrial fibrillation. Methods and Results— A total of 132 consecutive asymptomatic patients (age 55±15 years, 49 female) with severe degenerative mitral regurgitation (flail leaflet or valve prolapse) were prospectively followed up for 62±26 months. Patients underwent serial clinical and echocardiographic examinations and were referred for surgery when the criteria mentioned above were fulfilled. Overall survival was not statistically different from expected survival either in the total group or in the subgroup of patients with flail leaflet. Eight deaths were observed. Thirty-eight patients developed criteria for surgery (symptoms, 24; LV criteria, .
Role of radiofrequency ablation in Barrett’s esophagus

Barrett’s esophagus (BE) with and without dysplasia results from gastroesophageal reflux and harbors and increased cancer risk. Radiofrequency ablation (RFA) represents a novel tool for effective BE treatment and cancer prevention. This web-based research examined the role of RFA for treatment of BE ± dysplasia and early cancer. RFA ± endoscopic resection prevents cancer and cancer progression in those with dysplastic BE and early cancer, respectively. High cancer risk positive individuals with nondysplastic BE should be offered RFA within controlled trials. Post RFA management includes proton pump inhibitor (PPI) therapy. The efficacy anti-reflux surgery (+ hiatal repair) for cancer prevention prior, during or after RFA (± endoscopic resection) awaits further proof and should therefore only be offered within controlled trials. Accurate follow-up endoscopies are required for adequate management monitoring. Regular consumption of concentrated sugar containing food and beverages associates with an increased risk for gastroesophageal reflux disease (GERD), BE and cancer. RFA ± endoscopic resection is recommended for treatment of dysplastic BE and early cancer. Within controlled trials RFA should be offered to persons with cancer risk positive BE without dysplasia. The efficacy of anti-reflux surgery (prior, during, after RFA) for cancer prevention awaits further proof and should be offered within controlled trials. A low carb diet should be included into the management of GERD and BE.
Prescription Drug Monitoring Programs and Opioid Poisoning: Evaluating the Impact of Prescriber Use Mandates on Prescription Opioid Poisoning Emergency Department Visits

Background: Mandatory use of prescription drug monitoring program (PDMP) databases by prescribers has been recommended as a way to influence prescription opioid abuse. Methods: this study explored that recommendation by comparing emergency department (ED) visits related to prescription opioid poisoning among individuals ≥ 12 years old in a mandatory use state, Kentucky, with a non-mandatory use state, North Carolina. Data from the State Emergency Department Databases (SEDD) and the State Inpatient databases (SID) were used to identify prescription opioid poisoning ED visits among patients. Main findings: the analysis revealed that the odds of having a prescription opioid poisoning ED visit in the mandated use state of Kentucky were 11% to 35% (95% CI= 6.0% - 39.0%) lower than in North Carolina between 2012 to 2014. Conclusion: this study provides evidence that a prescriber use mandate is effective in reducing prescription opioid poisoning ED visits.
Oral manifestations of autoimmune connective tissue diseases

Autoimmune connective tissue diseases possess difficulty in diagnosis and treatment due to uncertainty in etiology, a wide array of clinical presentation, and unpredictable disease course. Many such diseases like Sjogren syndrome, Rheumatoid arthritis, Systemic Lupus Erythematosus, Systemic Sclerosis, have characteristic oral findings, the identification of which may allow for early diagnosis and treatment. For the purpose of this narrative review we searched the databases such as MEDLINE the Embase and Cochrane library using search terms including “rheumatic” “autoimmune,” “connective tissue diseases,” “dental,” “oral,” and “manifestations” and the names of individual known diseases and also a manual search of bibliographies of these articles and of previously published reviews and animal studies. In this review, we describe the oral manifestation and dental considerations associated with these diseases which will allow the practitioner in holistic management of these patients.
Serial circulating tumor DNA (ctDNA) analysis as a prognostic marker and a real-time indicator of adjuvant chemotherapy (CT) efficacy in stage III colon cancer (CC).

3516Background: Adjuvant CT in stage III CC prevents recurrence by eradicating minimal residual disease (MRD) not visible on imaging. However, many patients (pts) will not have MRD and not all pts with MRD will benefit from standard CT. In this study, we determined (i) if the presence of ctDNA following surgery was predictive of recurrence following CT; (ii) if ctDNA could be used to determine the effectiveness of CT during treatment and (iii) if the presence of ctDNA following CT completion was predictive for later recurrence. Methods: Serial plasma samples from stage III CC pts planned for adjuvant CT were collected post-surgery, during CT and at treatment completion. Somatic mutations in individual tumors were identified via massively parallel sequencing of 15 genes commonly mutated in colorectal cancer. Personalized Safe-SeqS assays to quantify ctDNA in plasma samples were designed. Clinicians were blinded to ctDNA results. Results: 95 pts were enrolled from Nov-2014 to May-2017, median age was 64 yea.
BAX/BCL-2 expression in granulosa cells was not altered in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), a hyperandrogenic disturbance commonly found in women of reproductive age (6%), can disturb normal fertility. The symptoms of PCOS include hyperandrogenism, oligomenorrhea, chronic anovulation, and hyperinsulinemia. Hyperandrogenism causes oocytes to be of poor quality (immature). Meanwhile, granulosa cell apoptosis could also affect oocyte quality. This study aimed to identify differences in the expression of the pro-apoptotic gene BCL-2–associated X (BAX) and anti-apoptotic gene B-cell lymphoma-2 (BCL-2) between patients with PCOS and healthy controls. In this cross-sectional study, 40 respondents (20 women with a confirmed diagnosis of PCOS and 20 controls) were recruited at the Yasmin IVF Clinic of Cipto Mangunkusumo Hospital (Jakarta, Indonesia). These respondents provided informed consent. BAX and BCL-2 levels were assayed using real-time PCR. There were no significant differences in terms of BAX (p = 0.38) or BCL-2 levels (p = 0.223) between the PCOS and control groups. The BAX/BCL-2 ratio was also not significantly different between the groups (p = 0.31). In conclusion, BAX/BCL-2 gene expression did not significantly differ between the patients with PCOS and control subjects. Further studies using larger sample sizes are warranted to confirm these findings.
Emotional working memory training as an online intervention for adolescent anxiety and depression: A randomised controlled trial

Objective Anxiety and depression are highly prevalent disorders in adolescence. They are associated with deficits in working memory (WM), which also appears to increase rumination, worry, and negative mood. WM training, especially in an emotional context, might help in reducing or preventing these disorders. The current study investigated the direct effects of online emotional WM training on WM capacity, and short‐ and long‐term effects on symptoms of anxiety and depression, and secondary measures of emotional functioning. Methods Unselected adolescents (n = 168, aged 11–18) were randomised over an active or placebo emotional WM training. WM was assessed before and after 4-weeks of bi‐weekly training. Emotional functioning was assessed pre‐ and post‐training and at 3, 6, and 12-months follow‐up. Results Improvements in WM capacity and both short‐ and long‐term emotional functioning were found in both training groups, with the only group difference being a trend for a larger increase in self‐esteem in the active group compared to the placebo group. Conclusions The general improvements irrespective of training condition suggest non‐specific training or time effects, or some shared active ingredient in both conditions. Future research is necessary to detect potentially effective components of (emotional) WM training and to increase adolescent engagement with online training.
Exosome liquid biopsies of NSCLC patients for longitudinal monitoring of ALK fusions and resistance mutations.

e24090Background: Molecular profiling of mutations in NSCLC patients is of increasing relevance for direction of targeted therapy. Assessing such biomarkers directly from plasma overcomes hurdles associated with biopsies, including significant risk and difficulties to monitor molecular changes longitudinally. Here we applied molecular testing for detection of EML4-ALK fusions and ALK resistance mutations in exosomal nucleic acids from plasma of lung cancer patients. In a prospective cohort of ALK-positive patients the longitudinal monitoring of response to treatment by liquid biopsies in correlation to routine diagnostics was investigated. Methods: In an accredited laboratory the ExoDx Lung(ALK) test was used for variant-specific detection of EML4-ALK from exosomal RNA of patient plasma using a validated qPCR panel. In parallel, ALK resistance mutations were analyzed on exosomal RNA as well as cfDNA using our ExoLution Plus platform that simultaneously isolated exosomal RNA and cfDNA. 11 ALK exon23-based .
Probabilistic model based on circular statistics for quantifying coverage depth dynamics originating from DNA replication

Background With the development of DNA sequencing technology, static omics profiling in microbial communities, such as taxonomic and functional gene composition determination, has become possible. Additionally, the recently proposed in situ growth rate estimation method allows the applicable range of current comparative metagenomics to be extended to dynamic profiling. However, with this method, the applicable target range is presently limited. Furthermore, the characteristics of coverage depth during replication have not been sufficiently investigated. Results We developed a probabilistic model that mimics coverage depth dynamics. This statistical model explains the bias that occurs in the coverage depth due to DNA replication and errors that arise from coverage depth observation. Although our method requires a complete genome sequence, it involves a stable to low coverage depth (>0.01×). We also evaluated the estimation using real whole-genome sequence datasets and reproduced the growth dynamics observed in previous studies. By utilizing a circular distribution in the model, our method facilitates the quantification of unmeasured coverage depth features, including peakedness, skewness, and degree of density, around the replication origin. When we applied the model to time-series culture samples, the skewness parameter, which indicates the asymmetry, was stable over time; however, the peakedness and degree of density parameters, which indicate the concentration level at the replication origin, changed dynamically. Furthermore, we demonstrated the activity measurement of multiple replication origins in a single chromosome. Conclusions We devised a novel framework for quantifying coverage depth dynamics. Our study is expected to serve as a basis for replication activity estimation from a broader perspective using the statistical model.
Inpatient nursing staff knowledge on hypoglycaemia management

Hypoglycaemia is a major barrier to intensive glycaemic control and although the 2016 National Diabetes Inpatient Audit showed that the prevalence of hypoglycaemia has decreased from 26% to 20% since 2011, 1 in 5 inpatients with diabetes still experience hypoglycaemia during their hospital stay. Consequently, it is vital to evaluate whether nursing staff have the right knowledge to manage hypoglycaemia and if not, the reasons why. Using a questionnaire, a study was carried out at a large inner-city hospital in order to identify any gaps in hypoglycaemia management between nursing staff on the diabetes, vascular and critical care wards. As expected, the snapshot audit showed more hypoglycaemia episodes occurred in the diabetes wards and patients across the three wards mostly experienced hypoglycaemia during the night. Therefore, the difference between the day and night shift nurses' hypoglycaemia management was also evaluated. © 2018 SB Communications Group. All Rights Reserved.
The Unmet Supportive Care Needs of Nigerian Patients With Cancer

Background: Cancer is an important cause of morbidity and mortality globally, and its incidence has been on the increase in Nigeria, and the rest of the world. The diagnosis and treatment of cancer is associated with significant psychological distress and patients face a broad range of challenges which create a huge vacuum of “unmet needs” that patients feel as a loss of personal control and frustration. This impacts negatively on their quality of life and other care outcomes. Aim: This study was aimed at determining the magnitude, distribution, and predictors of unmet needs in Nigerian cancer patients. Methods: Using a descriptive cross-sectional approach, 205 cancer patients attending oncology outpatient clinics at Lagos University Teaching Hospital (LUTH), Idi-Araba, were assessed for unmet needs. Eligible patients were given the self-administered Supportive Care Needs Survey - Short Form (SCNS-SF34) questionnaire with focus on five domains of need - psychological, health system and information, physical and daily living, patient care and support, and sexuality. Data analysis was carried out with SPSS version 20, and the level of significance was set at < 0.05. Results: The mean age of the 205 cancer patients was 47.4 ± 12.3 years, who are predominantly females (96.6%). The most common diagnosis was breast cancer (92.2%), and the mean duration since diagnosis was 20.9 ± 21.9 months for all the patients. The mean SCNS score was 83.9 ± 24.8, and at least 46% of the participants indicated unmet needs in 15 items of the SCNS. The most frequent unmet needs were related to the health information (53.4%), physical and daily living (49.4%), and psychological (48.5%) need domains. The most frequently met needs were in the sexuality, and patient care and support need domains. None of the factors considered (age, gender, marital status, family type, educational attainment, employment status, economic status, presence of financial support, social support, and cancer type) were significantly predictive of unmet needs in these patients ( P > 0.05). Conclusion: Nigerian cancer patients experience high levels of unmet needs, particularly in the areas of health information, physical and daily living, and psychological health. Hence, there is an urgent need to provide sustainable and long-term interventions and support for these patients to help them achieve increased care satisfaction, improved treatment outcomes, and a better quality of life.
Effects of lumbar stabilisation and treadmill exercise on function in patients with chronic mechanical low back pain

Background/Aims: Multifidus muscle is an important contributor to low back pain as it atrophies and is inhibited during the first episode of low back pain. This study aims to compare the effectiveness of lumbar stabilisation exercise with treadmill walking on multifidus muscle activation, pain intensity and functional disability among people with chronic mechanical low back pain. Methods: Individuals with chronic mechanical low back pain were randomised into two groups: Group 1 (n=25) performed lumbar stabilisation exercises following the McGill protocol; and Group 2 (n=25) followed the modified Bruce treadmill walking protocol. Participants walked or exercised three times a week for 8 weeks. Pain intensity (measured using a visual analogue scale), functional disability (using the Oswestry Disability Index Questionnaire) and amplitude of multifidus muscle activation (using a surface electromyography machine) were assessed at baseline and at the end of week 8. Data were analysed using descriptive statistic.
Blood-free risk scores and neuropathy assessment tools to detect undiagnosed type 2 diabetes in Peru.

The prevalence of type 2 diabetes mellitus is rising, especially in low- and middle-income countries, where the situation is worsened because around half of cases are unaware of the disease. Universal screening utilizing blood markers can be challenging in resource-constrained settings. The identification of these individuals can be potentially addressed using risk scores and neuropathy assessment tools. This study aimed to assess the diagnostic accuracy of the FINDRISC, a blood-free risk score, three neuropathy assessment tools (EZSCAN, pupillometer, and biothesiometer), alone and in combination. A population-based study was conducted enrolling a sex-stratified random sample of participants from Tumbes, a semiurban area in the north of Peru. Undiagnosed T2DM was the outcome, defined using WHO OGTT thresholds. Diagnostic accuracy of the FINDRISC and neuropathy tools was evaluated using the area under the ROC curve (aROC) and respective 95% confidence intervals (95%CI). Data from 1609 participants were analysed, mean age 48.2 (SD: 10.6) years, 810 (50.3%) females. A total of 176 (10.9%) individuals had T2DM, and only 71 (4.7%) had undiagnosed T2DM. The diagnostic accuracy of the FINDRISC was aROC = 0.69 (95% CI: 0.64–0.74), with a sensitivity of 69% and specificity of 67%. Among devices, the EZSCAN (aROC = 0.59; 95%CI: 0.53–0.66; sensitivity of 59% and specificity of 54%) and biothesiometer in the third metatarsal head (aROC = 0.60; 95%CI: 0.53–0.67; sensitivity of 31% and specificity of 85%) performed best. A combination of the FINDRISC and the biothesiometer had the best diagnostic accuracy, with a similar aROC of FINDRISC alone (AROC = 0.69; 95%CI: 0.68–0.78), with a sensitivity of 79% and a specificity of 59%. Our results confirm that combination of the FINDRISC and biothesiometer can improve diagnostic accuracy of the FINDRISC and biothesiometer alone, increasing sensitivity without affecting specificity or the area under the ROC curve.
Evaluation of cardiac function in patients with liver cirrhosis using tissue Doppler study

Background and aim Cardiac dysfunction is a prevalent finding in patients with liver cirrhosis. We aimed to evaluate left ventricular function by tissue Doppler imaging in patients with liver cirrhosis. Patients and methods This is a cross-sectional case–control study that involved 90 patients with liver cirrhosis: 30 patients with Child A, 30 patients with Child B, and 30 patients with Child C cirrhosis. Moreover, 45 healthy volunteers were included in the study as a control group. All patients and controls were examined by conventional Doppler and tissue Doppler echocardiography. Results Patients with liver cirrhosis showed significantly lower ejection fraction (EF) levels than control group (P=0.001), but only nine patients showed EF levels less than 55. Moreover, there is significantly decrease in EF in patients with decompensated cirrhosis than those with compensated cirrhosis (P=0.005). A total of 60 patients showed diastolic dysfunction: 10 patients with Child A, 20 patients with Child B, and 30 patients with Child C cirrhosis. There were significantly differences between patients with liver cirrhosis and control group in the other parameters of systolic (S wave and myocardia performance index) and diastolic (early and late velocity and deceleration and isovolumetric relaxation time) functions. Conclusion Patients with liver cirrhosis showed significantly decreased left ventricular systolic and diastolic functions than control group, which is more pronounced in decompensated than compensated patients.