Miracle-dz/UniFAR-FTUs huggingface dataset:
Antimicrobial Stewardship Knowledge, Attitudes, and Practices among Health Care Professionals at Small Community Hospitals

Background Very little is known about antimicrobial stewardship knowledge, attitudes, and practices (KAP) among health care practitioners in small, community hospitals (SCHs) compared to large community hospitals (LCHs). Objective To compare infectious diseases (ID) clinical resources and describe KAP pertaining to antimicrobial stewardship among prescribers, pharmacists, and administrators from a large hospital network including a comparison between SCHs and LCHs. Methods An anonymous 48-item antimicrobial stewardship KAP survey was administered to pharmacists, prescribers, and administrators at 15 SCH (<200 beds) and 5 LCHs (>200 beds) within an integrated health care network. Results In total, 588 (14%) completed the survey: 198 from SCHs and 390 from LCHs. Most respondents were familiar or very familiar with the term antimicrobial stewardship and felt that antimicrobial stewardship was necessary. Most pharmacists and prescribers agreed that antimicrobials were overused at their hospital. However, SCH pharmacists and prescribers were more likely to disagree that antibiotic resistance is a significant problem locally. Pharmacists saw restrictions as a reasonable method of controlling antibiotic use more than prescribers. SCH practitioners were less familiar with IDSA guidelines and less likely to rely on ID specialists to a greater extent than LCH practitioners. Most respondents strongly agreed they would like more antimicrobial education. Conclusion SCH and LCH pharmacists, prescribers, and administrators are aware of antimicrobial resistance and overuse and agree that antimicrobial stewardship programs are necessary. SCHs are less likely to contact ID for information. These results support the development of antimicrobial stewardship programs at SCHs, while recognizing the significant differences in availability and utilization of resources.
Precision medicine in type 2 diabetes

Type 2 diabetes is a progressive disease characterised by raised blood glucose levels. Lowering of blood glucose is required to prevent symptoms of diabetes and to reduce the risk of people with type 2 diabetes developing diabetesrelated complications. Metformin is the initial drug of choice to lower blood glucose for most people. However, for many people metformin eventually fails to control blood glucose and additional medication is required. At least four different types of glucoselowering medication are recommended after metformin in current type 2 diabetes treatment guidelines. Choosing the best medication is left to the clinician and patient and is a major clinical dilemma. The degree of glucose-lowering appears to vary greatly between people for all the medication options. The same medication may appear to have a marked effect in one patient but little effect in another. Similarly, only some people develop side-effects. Despite this apparent variation it is largely unknown whether differences in treatment response and risk of side-effects can be predicted based on an individual patient’s characteristics. The aim of this thesis is to establish whether simple patient characteristics are associated with differences in treatment effect for common glucose-lowering medications. If they are, this could inform a precision medicine approach in type 2 diabetes, where medications are targeted to those people most likely to benefit. In Chapter 1 we review current type 2 diabetes treatment, the opportunity for precision medicine, and methodological challenges in studying precision medicine in type 2 diabetes. In Chapter 2 we describe the marked changes in prescribing patterns of glucose-lowering therapy in the United Kingdom in recent years, and demonstrate there have been relatively modest changes in important short-term patient outcomes including HbA1c reduction, weight change and hypoglycaemia over the same period. In Chapter 3 and 4 we demonstrate that simple patient characteristics are associated with response to DPP4 inhibitor therapy, and that simple patient characteristics can identify people with different patterns of response and risk of side-effects with sulfonylurea and thiazolidinedione therapy. In Chapter 5 we apply joint-longitudinal survival modelling to demonstrate important insights in the association between the benefits (glucose-lowering) and risks (side-effects) of metformin, sulfonylureas and thiazolidinedione therapy. In Chapter 6 we compare two precision medicine strategies: 1) a recently proposed strategy of using clinical features to assign people with type 2 diabetes into five subgroups; 2) a strategy of using specific continuous clinical features to predict specific outcomes for individual people. We find the strategy using continuous clinical features has greater clinical utility. Chapter 7 presents an overview of main findings, conclusions, limitations and future work generated by this thesis. Table of contents Page
Establishing Genotype-phenotype Correlation in USH2A-related Disorders to Personalize Audiological Surveillance and Rehabilitation.

OBJECTIVE USH2A-related disorders are characterised by genetic and phenotypic heterogeneity, and are associated with a spectrum of sensory deficits, ranging from deaf blindness to blindness with normal hearing. It has been previously proposed that the presence of specific USH2A alleles can be predictive of unaffected hearing. This study reports the clinical and genetic findings in a group of patients with USH2A-related disease and evaluates the validity of the allelic hierarchy model. PATIENTS AND INTERVENTION USH2A variants from 27 adults with syndromic and nonsyndromic USH2A-related disease were analyzed according to a previously reported model of allelic hierarchy. The analysis was replicated on genotype-phenotype correlation information from 197 individuals previously reported in 2 external datasets. MAIN OUTCOME MEASURE Genotype-phenotype correlations in USH2A-related disease. RESULTS A valid allelic hierarchy model was observed in 93% of individuals with nonsyndromic USH2A-retinopathy (n = 14/15) and in 100% of patients with classic Usher syndrome type IIa (n = 8/8). Furthermore, when two large external cohorts of cases were combined, the allelic hierarchy model was valid across 85.7% (n = 78/91) of individuals with nonsyndromic USH2A-retinopathy and 95% (n = 123/129) of individuals with classic Usher syndrome type II (p = 0.012, χ test). Notably, analysis of all three patient datasets revealed that USH2A protein truncating variants were reported most frequently in individuals with hearing loss. CONCLUSION Genetic testing results in individuals suspected to have an USH2A-related disorder have the potential to facilitate personalized audiological surveillance and rehabilitation pathways.
Clinical course of treatment of proximal one third ulna fracture by plate osteosynthesis in skeletally mature individuals

Objective: To study the clinical course including radiological union, fracture union time and functional outcome of plate osteosynthesis for proximal one third ulna fracture in skeletally mature individuals. Method: 30 patients of proximal ulna fractures who were treated by plate osteosynthesis were included in this study. Result: 30 patients were followed up for minimum duration of 6 months and the clinical outcomes were assessed according to the Mayo Elbow Performance Score (MEPS). Out of 30, our study included 21 olecranon fractures and 9 monteggia fractures. At final follow up of 6 month, our case series of olecranon fractures resulted mean MEPS of 89.3with 57.1% excellent results and 42.9 % good results, and all patients returning to pre-injury daily activities. For monteggia fractures, resulted mean MEPS score is 93.8 with 88.9% excellent result & 11.1 % good results. All fractures in our study had united by 6 months, both clinically and radiologically. Our study group had reported the complication of delayed union in 6 cases of olecranon fractures. No complications reported in treatment of monteggia fractures. Conclusion: Our study has yielded excellent results in respect of functional outcome, radiological and clinical union without any implant related complications in internal fixation of proximal one third ulna fracture including olecranon fractures and monteggia fractures with plate osteosynthesis. Monteggia fractures treated with plate osteosynthesis yielded slightly better outcome in respect of functional outcome, radiological and clinical union than olecranon fractures. Plate osteosynthesis can be done in comminuted along with non-comminuted proximal one third ulna fractures. We recommend plate osteosynthesis for proximal one third ulna fracture, because of its consistent results with respect to fracture union, stability across the fracture site and early mobilization for better functional results.
Ultrasound-guided biopsy of transplanted pancreas: evaluation of 20 cases

Objective: To report the experience with percutaneous biopsies of pancreatic grafts guided by ultrasonography. Methods: Series of cases referred from outpatient's clinic for biopsy of pancreas transplant, between December 2006 and March 2008. Data were collected from medical electronic records for age, sex and histopathology. The indication for the procedure was obtained from medical and laboratory records. Doppler ultrasonography was performed for control and to guide biopsy in real time. Results: Twenty patients referred for biopsy of their transplanted pancreas over a one-year period were evaluated. In one patient, biopsy was not performed for having no safe access for ultrasound. It was used 18 gauge needles, mostly automatic-cut type. The main indications were increased blood glucose and pancreatic enzyme levels as well as reduction of urinary amylase. The sonographic aspect of the pancreatic graft was normal in 18 cases. In all 19 biopsies performed, satisfactory samples for histopathological study were obtained. There were no complications. Conclusions: This series of cases demonstrated low sensitivity and specificity of ultrasound in diagnosis of pancreatic transplants disorders, but showed to be very useful to guide transplanted pancreas biopsies. Although no complications occurred in this experience, the risk-benefit relation should always be assessed for every patient. Objetivo: Relatar experiencia com biopsias percutâneas de enxerto pancreatico guiadas por ultrassonografia. Metodos: Serie de casos encaminhados ambulatorialmente para biopsia de pâncreas transplantado no periodo de dezembro de 2006 a marco de 2008. Dados referentes a idade, sexo e resultados histopatologicos foram colhidos a partir dos registros de prontuarios eletronicos. A indicacao do procedimento foi obtida a partir dos pedidos medicos bem como de registros laboratoriais. A ultrassonografia com Doppler foi realizada para controle antes e apos o procedimento e para guiar a puncao em tempo real. Resultados: Vinte pacientes encaminhados para biopsia de pâncreas transplantado no periodo de um ano foram avaliados. Em um paciente, a biopsia nao foi realizada por falta de uma via de acesso segura por ultrassom. O aspecto ultrassonografico do orgao transplantado foi normal em 18 casos. Em todas as 19 biopsias executadas, foram obtidas amostras satisfatorias para o estudo histopatologico e nao houve complicacoes. Conclusoes: Esta serie de casos reforca as baixas sensibilidade e especificidade da ultrassonografia no diagnostico de disfuncoes de enxertos pancreaticos, porem mostra sua grande utilidade no auxilio de biopsias do orgao transplantado. Apesar de nao terem ocorrido complicacoes nesta experiencia, o procedimento deve sempre ser avaliado quanto ao risco-beneficio para todos os pacientes.
A Comparative Study of Serum Lipid Profile in Short-Term, Moderate Alcohol Drinkers and Abstainers

Background and Objectives: it is well known that, long-term alcohol abusers have altered lipid profile, but whether short-term, moderate alcohol drinkers have altered lipid profile or not has not been established. In the present study, we examined lipid profile in a group of short-term moderate drinkers and age matched controls. Methods: we recruited thirty young (20-40 years) men with history of daily 2 to 3 units of alcohol intake for the past 1 to 3 years duration. They were non-smokers and non-obese. They were not having any nutritional deficiency or any pre-existing cardiopulmonary or hepatobiliary disorders. Another thirty age matched men, who were alcohol abstainers, served as controls. Two ml of blood was collected after 12 hours of fasting. Serum lipid profile was estimated by Random Access Clinical Chemistry Analyzer ERBA-XL-300. Data were presented as means ± SD, and analysed using the one tailed unpaired (equal variance) "t" test. The level of significance was taken at P values < 0.05. Results: all lipid profile parameters except HDL-C were significantly higher in moderate drinkers compared to abstainers. Conclusions: In conclusion, significantly altered lipid profile is found in short-term, moderate drinkers compared to abstainers, which indicates that, the short-term moderate drinkers have an increased risk of cardiovascular diseases.
Death Due To Traumatic Asphyxia in Varanasi Region, India

Background: Traumatic asphyxia occurs when a powerful compressive force is applied to the thoracic cavity. This is most often observed in motor vehicle accidents, industrial and farming accidents, as well as the collapse of bridges, mansions, and during stampedes. Methods: During the period of October 2016 to May 2018, 33 cases of traumatic asphyxia were recorded in the Varanasi district autopsy center, i.e. the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Utter Pradesh State, India. We conducted a prospective study on these incidents. Results: The incidence of traumatic asphyxia is irrespective of gender. However, men are more viable to it due to their outdoor activities. In the present study, males outnumbered females in the distribution of cases. The external and internal features in combination were congestion 26(78.8%), cyanosis 25(75.0%), and subconjunctival hemorrhage 10(30.3%). In the internal examination, rib fracture with flail chest was recorded in 5(15.2%) cases. Conclusion: Accidental death as a result of traumatic asphyxia is a major contributing factor to violent asphyxia. It results in asphyxia due to the compression of the chest by an external powerful compressive force.
Early synaptic hippocampal deficits in the Q175FDN mouse model of Huntington Disease

Huntington Disease (HD) is an inherited neurodegenerative disease caused by a CAG repeat expansion in the gene encoding the huntingtin protein. The resultant mutant huntingtin triggers numerous and severe neuronal abnormalities. Although motor deficits manifest during midlife, subtle cognitive aberrations can be detected prior to the onset of an overt behavioural phenotype. However, knowledge surrounding the cognitive deficits in the early stages of HD is scarce. Here, we studied hippocampal synaptic properties, including activity-dependent plasticity and nanoscale architecture in a mouse model of HD prior to the onset of motor symptoms. We focused on the hippocampus due to its involvement in cognitive function and the debilitating cognitive symptoms described by HD patients. Multi-electrode array recordings of synaptic activities revealed impairments in plasticity, while super-resolution microscopy elucidated clear alterations in synaptic nanoarchitecture of the hippocampus. Our data demonstrate detrimental effects of mHtt expression on hippocampal structure and function in presymptomatic HD.
Assessment of motivational factors and career aspirations of dental interns in Davangere city: A cross-sectional survey

Purpose: To assess the motivational factors and future career aspirations of dental interns. Materials and Methods: A descriptive cross-sectional survey was carried out among 88 dental internees. A self-designed questionnaire was used to collect information regarding motivational factors in choosing dentistry as a career, future career plan, and students' attitude toward the profession. Chi-square test was employed to find the association between motivation factors and career aspirations among male and female interns. Results: The study results showed that majority of students (48.9%) were self-motivated (own interest) for choosing dentistry as a career and 31.8% had chosen dentistry due to parent's interest. About 28.4% chose dental profession as it has good job security and 27.3% of students for financial security. On completion of their undergraduate course in dentistry, 35.2% preferred to pursue postgraduation in India, 29.5% wanted to go abroad for further studies, and 6.8% desired to establish private practice. There was a marginal significant association between male and female study participants to join postgraduation as a career choice (P = 0.05). Majority (83%) of the study participants were happy with their dental profession and almost 72.7% of the study participants agreed that they have enough abilities to treat the patients. Conclusions: The study concludes that student's own interest, job, and financial security are the major reasons for pursuing a master degree. The reasons for choosing dentistry have important implications for the selection and training of students as well as for their future job satisfaction.
Anaesthesia for cardioversion — clinical experiences with propofol and thiopentone

A 1‐year population of anaesthesias for cardioversion of supraventricular tachyarrhythmias was studied. Propofol and thiopentone were used alternately for every other procedure, and the anaesthetic‐ and monitoring procedures were prospectively standardized. Twenty‐one thiopentone‐ and 23 propofol‐anaesthetized patients, who had been subjected to elective cardioversions of atrial fibrillation were compared, particularly regarding possible differences in the energy requirements for cardioversion and in the time intervals to initial awakening. There were no significant differences between the two drugs in the maximum systolic blood pressure drop, in the total mean energy requirements per kg bodyweight, or in the distribution of the number of patients over the various energy levels needed for restoration of sinus rhythm. Somewhat unexpectedly, however, the mean time interval to initial awakening was significantly longer in the propofol‐anaesthetized group. Apart from this minor drawback, propofol proved to be as useful an anaesthetic agent as thiopentone for the cardioversion procedure, and may be considered as an alternative drug in selected cases.
Enterotoxin A Gene Barrier Staphylococcus aureus Within Traditionally Dairy Products of Tehran

Background: Staphylococcus aureusis a serious agent that often colonize dairy products all over the world. Staphylococcal enterotoxins are the essential causes of food poisoningin human societies. Enterotoxin type A is an importantstaphylococcal exotoxin. Objectives: The aim of present study was to detect the enterotoxin producing Staphylococcus.aureus within different dairy products collected from Tehran, Iran. Materials and Methods: Two hundreds twenty dairy products samples were collected from local dealers across the city. The samples were first screened for S. aureus contaminations. All isolated strains of S. aureus were then investigated for enterotoxin a gene, usind spesific primer sets. Results: Staphylococcus aureus was isolated from 43% of dairy samples: 22% from milk and 18% from cheese samples. The SEA genes were detected in 10 isolates (22%) originated from raw milk and in two isolates (25%) from domestic cheese. Conclusions: Since, the staphylococcal enterotoxins are heat stable, heat had no effect on the toxicity of the enterotoxins within positive samples. Our primer stets confirmed previous studies that introduced PCR as rapid, sensitive, and specific method for dairy products screening system. Our data showed that routine screening and surveillance is vital for different food materials including dairy products.
THE VASOACTIVE EFFECTS OF SEROTONIN IN NORMAL AND SINGLE UMBILICAL ARTERY CORDS IN NORMOTENSIVE AND HYPERTENSIVE PREGNANCIES

Objective: To investigate the vasoactive effects of serotonin in umbilical cord arteries from pregnancies complicated with severe or moderate pre-eclampsia or hypertension without proteinuria as compared to normotensive pregnancies matched for gestational age.Methods: Umbilical cord arteries from severe preterm preeclamptic (n = 9) and moderate term preeclamptic (n = 10) pregnancies, hypertensive term pregnancies without proteinuria (n = 7), and normotensive preterm (n = 8) and term (n = 12) pregnancies were perfused in vitro. Serotonin was administrated through a side infusion. Five umbilical cords with single umbilical artery (SUA) were included in the study.Results: Serotonin induced a monophasic pressure increase or a biphasic pressure response with a transient vasodilatation succeeded by a constrictory response. Two preparations from normotensive term pregnancies were serotonin insensitive. These were excluded from the calculations. At a serotonin dose of 10−7 M, the proportion of preparations giving.
Importance of estimation of follicular output rate (FORT) in females assisted by intracytoplasmic sperm injection

Background: We aimed to estimate pregnancy outcome after ICSI in terms of oocyte parameters, embryo quality, endometrial thickness, hormone and cytokine levels in women stratified on the basis of follicular output rate (FORT). Methods: Quasi experimental design was carried out after approval from “Ethical review board of Islamabad clinic serving infertile couples” from July 2010 to August 2013. One thousand and fifty females were selected with the criteria of age between 21-40 years, infertility of more than 2 years, body mass index of 18-35 kg/m 2 , menstrual cycle of 25 ± 7 days, both ovaries present with normal uterine cavity, serum FSH levels less than 8 IU/ml and normal thyroid-stimulating hormone levels. Females on short agonist or antagonist protocol with diagnosis of polycystic ovarian syndrome, fibroids or in their male partner sperms retrieved by testicular biopsy were excluded from the study. Down regulation of ovaries was followed by controlled ovarian stimulation, Ovulation Induction (OI), oocyte pick up, in vitro fertilization, Embryo Transfer (ET) and confirmation of pregnancy was done by serum beta hCG of more than 25 mIU/ml and cardiac activity on trans vaginal scan. Enzyme linked immuno sorbent assay was used for peak and mid luteal estradiol (E2), progesterone (P) and interleukin I-β estimation on OI and ET days respectively. FORT (ratio of preovulatory follicle count to antral follicle count × 100 on OI day) stratified females into low under the 33 rd percentile, medium between the 33 rd and the 67 th percentile and high above the 67 th percentile. Characteristics of groups were compared by one way analysis of variance. Results: Females 276 (33%), 288 (34%) and 282 (33%) comprised of low, medium and high FORT groups respectively. The number of retrieved, mature and fertilized oocytes, cleaved embryos, endometrial thickness and number of gestational sacs in the high FORT group was significantly high (P <0.001). High peak and midluteal E2 (P = 0.0025, 0.0001), low P (P = 0.0001) and high peak interleukin-1β (P = 0.0001) was observed in high FORT in comparison with medium FORT with resultant greater number of clinical pregnancies 183 (65%). Conclusions: The FORT in non PCOS patients may reflect good reproductive outcome after ICSI with maximum clinical pregnancies in high FORT group.