Miracle-dz/UniFAR-FTUs huggingface dataset:
Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline

Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement). Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.
The effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery: a systematic review and metaanalysis

Background/aim With the increase in the elderly population, the elderly proportion needing emergency surgery is also increasing. Despite medical advances in surgery and anesthesia, negative postoperative outcomes and high mortality rates are still present in elderly patients undergoing emergency surgery. Comorbidities are described as the main determining factors in poor outcomes. In this metaanalysis, it was aimed to investigate the effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery. Materials and methods The studies published between 2010-2019 were scanned from databases of Google Scholar, Cinahl, Pub Med, Medline and Web of Science. Quality criteria proposed by Polit and Beck were used in the evaluation of the included studies. Interrater agreement was calculated by using the Kappa statistic, effect size by using the odds ratio, and heterogeneity among studies by using the Cochran’s Q statistics. Kendall’s Tau-b coefficient and funnel plot were used to determine publication bias. Results A total of 9 studies were included in the research. There was a total of 1330 cases in the studies. The total mortality rate was 21% (n = 279), the total rate of having a comorbid factor was 83.6% (n = 1112), and the rate of having a comorbid factor in mortality was 89.2% (n = 249). According to the fixed effects model, the total effect size of comorbid factors on causing mortality was not statistically significant with a value of 1.296 (C.I; 0.84-1.97; P > 0.05). Conclusion Our study revealed that comorbidity had no significant effect on causing mortality in geriatric patients undergoing emergency abdominal surgery. There are controversial results in the literature, and in order to reach more precise results, studies involving wider groups of patients and further studies examining the specific effect of certain comorbid conditions are needed.
Convolutional neural network proposal for wrist position classification from electromyography signals

Commonly, electromyography (EMG) signals have been employed for movements or pattern classification. For this, different digital signals processing methods are applied to extract features, before a classification stage. The present work deals with a proposal based on the use of image classification employing deep learning techniques. The images were obtained from a spectrogram analysis as a previous process of the convolutional neural network employment. Then, a classification of five positions from wrist movements is carried out the model. Results showed that the accuracy is comparable to similar techniques employed with a shallow neural network and a deep neural network applied to the same dataset.
Comparing the Effect of continuous and Intermittent Physiotherapy on the Pain and Function in Moderate Knee Osteoarthritis; A Pilot Randomized Clinical Trial Study

Introduction: Osteoarthritis is one of the common types of joint disorder. This study compared the effects of continuous and intermittent physiotherapy on the pain and function of the individuals with moderate knee osteoarthritis. Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA. Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10 th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10 th session and follow up period). Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects.
E-Learning perception and satisfaction among health sciences students amid the COVID-19 pandemic.

BACKGROUND E-learning is increasingly used during the COVID-19 pandemic, however the impact of this change on students is not known. This study aimed to evaluate perception and satisfaction of health sciences students towards E-learning during the COVID-19 lockdown. METHODS A structured questionnaire was distributed to 2000 health care students either through email or social media platforms. The questionnaire was divided into two sections: the first section addressed demographic information such as age, education level, course of study, number of lectures attended and country. The second section gathered information on perception and satisfaction of students using 13 close-ended questions. Frequencies and percentages were assessed for demographic data, perception and satisfaction level of students. The paired sample t-test, independent t test and Spearman correlation were applied to evaluate statistical significance between different variables of the study. A p-value of <0.05 was considered significant. RESULTS Data from 1255 participants were included at a response rate of 66.4%. More than one third (37%) of the students took 25 or more online E-learning sessions and 47% preferred Zoom as an online platform. Participants belonged to 11 countries from developed and developing nations. 41% reported interference of E-learning due to network problems. 60% considered that clinical and practical skills are best learned in clinics and laboratories. More than one third of the students preferred classroom teaching and 34% of the students did not feel confident enough to take exit exams after E-learning sessions. CONCLUSION E-learning satisfaction levels were better among developed countries (7.34) compared to developing countries (5.82). The majority of participants agreed that E-learning was satisfactory in acquiring knowledge, however not effective in acquiring clinical and technical skills. As the COVID-19 lockdown eases, there is a need for improvement in the methods employed in E-learning and more blended learning among healthcare students is recommended.
A Multidisciplinary Approach to Fungal Infections: One-Year Experiences of a Center of Expertise in Mycology

Invasive fungal diseases (IFDs) often represent complicated infections in complex patient populations. The Center of Expertise in Mycology Radboudumc/CWZ (EMRC) organizes a biweekly multidisciplinary mycology meeting to discuss patients with severe fungal infections and to provide comprehensive advice regarding diagnosis and treatment. Here, we describe the patient population discussed at these meetings during a one-year period with regards to their past medical history, diagnosis, microbiological and other diagnostic test results and antifungal therapy. The majority of patients discussed were adults (83.1%), 62.5% of whom suffered from pulmonary infections or signs/symptoms, 10.9% from otorhinolaryngeal infections and/or oesophagitis, 9.4% from systemic infections and 9.4% from central nervous system infections. Among children, 53.8% had pulmonary infections or signs/symptoms, 23.1% systemic fungal infections and 23.1% other, miscellaneous fungal infections. 52.5% of adult patients with pulmonary infections/symptoms fulfilled diagnostic criteria for chronic pulmonary aspergillosis (CPA). Culture or polymerase chain reaction (PCR) demonstrated fungal pathogens in 81.8% of patients, most commonly Aspergillus. A multidisciplinary mycology meeting can be a useful addition to the care for patients with (I)FDs and can potentially aid in identifying healthcare and research needs regarding the field of fungal infections. The majority of patients discussed at the multidisciplinary meetings suffered from pulmonary infections, predominantly CPA.
Household latrine utilization and associated factors in semi-urban areas of northeastern Ethiopia

Background Latrine utilization is the actual behavior in a practice of regularly using existing latrines for safe disposal of excreta. Latrine utilization is a common problem in semi-urban areas of developing countries, including Ethiopia. Since the status of latrine utilization and associated factors among semi-urban areas of northeastern Ethiopia, including Alansha in South Wollo Zone is unknown, local data is needed in order to assess the need for planning of intervention programs for the improvement of latrine utilization to support consistent and sustained latrine utilization. This study is designed to address this knowledge gap. Methods A cross-sectional study was conducted from February to March, 2019 among 401 systematically selected households. Data were collected by trained workers using a pre-tested, structured questionnaire via face-to-face interviews and on-the-spot observations of the latrines. A systematic random sampling method was used to select participant households. Data were entered using EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The wealth index status of participants was estimated using principal component analysis. Data were analyzed using a binary logistic regression model at 95% confidence interval (CI). From the multivariable logistic regression analysis, variables with p-value < 0.05 were taken as statistically significant and independently associated with latrine utilization. Model fitness was checked using Hosmer-Lemeshow test. Result We found that the prevalence of latrine utilization among households was 71.8% (95% CI [67.5–76.1%]) while 28.2% (95% CI [23.9–32.5%]) did not utilize latrines. About one-fifth (21.7%) of participant households were found to have a pit latrine with slab and 78.3% (311) used pit latrines without slab. The hygienic condition of the majority (82.9%) of the latrines was dirty and only 17.1% clean. Household family size from one to three persons (AOR: 3.99, 95% CI [1.20–6.24]), presence of primary or secondary school student in a house (AOR: 2.33, 95% CI [1.42–3.83]), number of years since latrine was constructed (≥ 2 years) (AOR: 1.82, 95% CI [1.12–2.95]) and a frequency of daily cleaning of the latrine (AOR: 2.19, 95% CI [1.12–4.28]) were factors significantly associated with latrine utilization. Conclusion Seven out of ten households utilized a latrine. Factors significantly associated with latrine utilization were household family size from one to three persons, presence of primary or secondary school student in the house, time since household latrine had been constructed of two or more years and daily frequency of latrine cleaning. Therefore, it is recommended that measures to promote behavioral change towards further improvement in sustainable and consistent latrine utilization should be carried out based on the evidence of the determinant factors found in this study.
Dominance of the ON1 Genotype of RSV-A and BA9 Genotype of RSV-B in Respiratory Cases from Jeddah, Saudi Arabia

Human respiratory syncytial virus (HRSV) is a main cause of hospital admission for lower respiratory tract infection. In previous studies from Saudi Arabia, higher prevalence of the NA1 genotype in group A was observed from Riyadh and Taif. This study recruited respiratory cases from Jeddah during January to December, 2017. RSV represented 13.4% in the recruited cases with 64% of them belonging to group A and 36% to group B. All group A cases in this study were ON1 type characterized by duplication of 72 nucleotides, 24 amino acids in the C-terminal in the second hypervariable region of the G gene. In addition, for group B all of the cases were clustered under BA9, which had uniquely characterized as duplication of 60 nucleotides in the G protein. Our sequences showed similarity with earlier sequences from Saudi Arabia, Kuwait, Thailand, South Africa, Spain, the USA and Cyprus. Some amino acid substitutions in the investigated sequences would cause a change in potential O-glycosylation and N-glycosylation profiles from prototype ON1. The predominance of the ON1 and BA9 genotype of RSV-A in Jeddah compared to previous Saudi studies showing predominance of the NA1 genotype for group A. This difference in genotype prevalence could be due to fast spread of the ON1 genotype worldwide or due to the flux of travelers through Jeddah during hajj/umrah compared to Riyadh and Taif. This shift in genotype distribution requires continuous surveillance for genetic characterization of circulating respiratory infections including RSV. These findings may contribute to the understanding of RSV evolution and to the potential development of a vaccine against RSV.
Virology and Serological Characteristics of Chronic Hepatitis B Patients with the Co-existence of HBsAg and Anti-HBs Antibodies.

BACKGROUND To investigate the virological and serological characteristics of chronic hepatitis B patients concurrently positive for HBsAg and anti-HBs. METHODS Chronic hepatitis B patients with coexistence of HBsAg and anti-HBs were screened by electrochemiluminescence immunoassay (ECLIA). The serum biomarkers such as HBV markers, HBV DNA load, AFP, and liver function were detected, and the virological and serological features were analyzed. RESULTS The simultaneous seropositivity for hepatitis-B surface antigen and anti-HBS antibodies was 3.867%. There was no significant difference in the detection rate between men and women (p > 0.05). The HBV DNA detection rate, HBV DNA load, and liver function index of the high HBsAg titer group were significantly higher than those of the low titer group. There was no significant difference in HBV DNA load, AFP, and liver function between different levels of anti-HBs (p > 0.05). CONCLUSIONS In chronic hepatitis B patients, there is a certain proportion of patients with coexistence of HBsAg and anti-HBs. The emergence of anti-HBs does not mean that HBsAg can be completely and effectively eliminated. HBV DNA load can be replicated continuously with the presence of anti-HBs, and its follow-up is worthy of clinical attention.
Evaluation of the Electromagnetic Forces in the Shunt Reactor by using Finite Element Analysis

Reactive power in the electrical network can be controlled by using shunt-reactors. Electromagnetic forces and power losses play a vital role in the designing of the shunt reactor. Due to the higher efficiency of the finite element method, reactors can be developed by using the finite element models prior to the experimental design of the reactor. The main aim of this work is to calculate the electromagnetic forces in the reactor. Finite element analysis was used to calculate the current, electromagnetic forces, magnetic flux, no-load losses, and load losses in the shunt reactor. Numerical calculation of the current, magnetic flux, no-load losses, and load losses are also compared with the experimental results.
Clinical course of COVID-19 disease in immunosuppressed renal transplant patients

Background/aim We aimed to identify clinical settings of renal transplant patients with COVID-19. Materials and methods In this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented. Results Twenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients. Conclusion Renal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.
Psychological response of children to home confinement during COVID-19: A qualitative arts-based research

Background: The evidence has shown that children are more susceptible to the emotional effects of traumatic events such as outbreaks with the possible disruption in their daily lives. Aim: In this paper, we discussed the psychological wellbeing of children during the COVID-19 outbreak through the art-based qualitative study using the drawing method among children in Iraqi Kurdistan. Methods: In this qualitative arts-based research study, 15 children aged 6 to 13 years old who were confined at home during the COVID-19 outbreak for at least 1 month were included following obtaining the consent from their parents. The children were asked to draw his/her feelings, reflections, and responses during the COVID-19 on a paper. The children were guided to paint their reflections during the COVID-19 based on the following criteria: if they experienced loneliness, tiredness, insomnia, depression, worry or anxiety, or have behavior changes and their relationship with their parents and other siblings. Results: This study showed that children have a high level of stress at home during the COVID-19 outbreak. The children had great fear about the coronavirus. They experienced loneliness and stress, and felt sad, depressed due to home confinement and social distancing. The possibility of infection by coronavirus has occupied their entire mind. Mental health care providers must take the experiences of children who are caught in this global pandemic seriously and ensure that appropriate care is offered to the children and their parents. Conclusions: The children exhibited a strong feeling of distress, loneliness, and fear during the COVID-19 outbreak. This has implications for mental health care.
Melanoma Lesion Detection and Segmentation Using YOLOv4-DarkNet and Active Contour

Melanoma is the skin cancer caused by the ultraviolet radiation from the Sun and has only 15-20% of survival rate. Late diagnosis of melanoma leads to the severe malignancy of disease, and metastasis expands to the other body organs i.e. liver, lungs and brain. The dermatologists analyze the pigmented lesions over the skin to discriminate melanoma from other skin diseases. However, the imprecise analysis results in the form of a series of biopsies and it complicates the treatment. Meanwhile, the process of melanoma detection can be expedited through computer vision methods by analyzing the dermoscopic images automatically. However, the visual similarity between the normal and infected skin regions, and artifacts like gel bubbles, hair and clinical marks indicate low accuracy rates for these approaches. To overcome these challenges, in this article, a melanoma detection and segmentation approach is presented that brings significant improvement in terms of accuracy against state-of-the-art approaches. As a first step, the artifacts like hairs, gel bubbles, and clinical marks are removed from the dermoscopic images by applying the morphological operations, and image regions are sharpen. Afterwards, for infected region detection, we used YOLOv4 object detector by tuning it for melanoma detection to discriminate the highly correlated infected and non-infected regions. Once the bounding boxes against the melanoma regions are obtained, the infected melanoma regions are extracted by applying the active contour segmentation approach. For performance evaluation, the proposed approach is evaluated on ISIC2018 and ISIC2016 datasets and results are compared against state-of-the-art melanoma detection, and segmentation techniques. Our proposed approach achieves average dice score as 1 and Jaccard coefficient as 0.989. The segmentation result validates the practical bearing of our method in development of clinical decision support system for melanoma diagnosis in contrast to state-of-the-art methods. The YOLOv4 detector is capable to detect multiple skin diseases of same patient and multiple diseases of various patients.