Miracle-dz/UniFAR-FTUs huggingface dataset:
A tertiary care audit of using abiraterone acetate in patients of metastatic castrate-resistant prostate cancer

Abstract Introduction: This is a retrospective analysis to assess the safety and efficacy of abiraterone acetate (AA) in metastatic castrate-resistant prostate cancer (mCRPC) patients treated at tertiary care institute. Materials and Methods: The clinical records of mCRPC patients treated with AA at our tertiary care institute between July 2013 and December 2015 were reviewed. The treatment efficacy, toxicities, and its determinants were analyzed. Results: A total of 59 mCRPC patients treated with AA were reviewed, of whom 37 were chemo-naive and 22 had received prior chemotherapy (postchemo). The median follow-up duration was 10.0/15.0 months for chemo-naïve/postchemotherapy patients. 43.2%/36.36% of chemo-naive/postchemo patients had visceral metastases. The median overall survival (OS) and progression-free survival (PFS) were 15/7.8 months and 10/5.3 months for chemo-naive/postchemo patients, respectively. Median time to best prostate-specific antigen response was 3.4 months. Abiraterone was relatively well tolerated with no grade 4 toxicity or treatment-related death. We found the presence of previous taxene use and baseline symptoms to be significantly determinant of OS with abiraterone. Conclusion: The present study reported the efficacy of abiraterone in both chemo-naïve and postchemo patients of mCRPC outside clinical trial setting. We found lower OS and PFS with abiraterone as compared to that reported in the clinical trial setting in both chemo-naïve and postchemo patients, and particularly in those patients with the visceral disease, and further clinical trial for abiraterone in this subgroup of patients is warranted.
External root surface temperature changes during high-temperature injectable thermoplasticized root canal obturation in simulated immature teeth

Introduction: The present study evaluated the change in the temperature of the external root surface of simulated immature teeth obturated with high-temperature injectable thermoplasticized gutta-percha. Materials and Methods: Root canals of 60 mandibular premolars were enlarged till size # 6 peeso freely passed through the apex. After placement of an apical barrier of 4 mm of mineral trioxide aggregate (MTA), two K-type thermocouples were attached at middle and apical thirds. The canals were obturated using high-temperature injectable thermoplasticized gutta-percha with either no sealer; AH plus sealer; or MTA Fillapex sealer. Maximum temperature rise was measured and evaluated. The data were analyzed using two-way ANOVA test. Results: The temperature increased after 4 s of placement of heated gutta-percha. There was no significant effect of sealer placement on the peak rise in temperature at the middle third (P < 0.05). There was no difference between the AH plus and MTA Fillapex groups (P = 0.42). Conclusions: The use of thermoplasticized gutta-percha can significantly increase the temperatures on the external root surface.
Outcomes in rhabdomyosarcoma: Indian perspective

In their article, Bhuvan et al. reported disease characteristics and outcomes of rhabdomyosarcoma (RMS) patients treated at a tertiary care center. [1] They reported higher incidence of RMS at parameningeal sites (44%) and extremity (24%) as compared to the Intergroup Rhabdomyosarcoma Study (IRS‐IV) (25% and 13%, respectively). The lack of patients with head and neck (excluding parameningeal sites) and orbit as primary site, which together constituted 16% in IRS‐IV study, is intriguing and may be explained by the late presentation of patients in our population, resulting in a more extensive stage at the initial presentation. This unfavorable site presentation may be a reason for dismal outcomes in the Indian population compared to Western literature.
Concomitant use of corticosteroids and immune checkpoint inhibitors in patients with solid neoplasms: A real-world experience from a tertiary cancer center

Introduction: Checkpoint inhibitors (CPIs) are rapidly becoming the standard of care in solid tumors for multiple indications. Steroids due to their immunosuppressive nature might decrease the efficacy of these agents. To test this hypothesis, we performed an audit of our patients who had received CPI and concomitant steroids. Patients and Methods: This was a retrospective audit of a prospectively maintained database at Tata Memorial Hospital, Mumbai, between August 2015 and November 2018. Patients who received CPI for palliative indication were included. Overall survival (OS) was calculated from the date of the start of immunotherapy to the date of death. Data regarding the use of steroids and cumulative number of days of use were noted. Time-to-event analysis was done using Kaplan–Meier estimator, and hazard ratio (HR) was calculated using Cox proportional model. Results: A total of 155 patients were identified to have received CPI during the study period, of which 38 (24.5%) patients received steroids with prednisolone equivalent of ≥10 mg/day. The median age of the patients receiving steroids was 58.7 years (range, 22–85), and 31 (81.6%) patients were male. The median duration of steroid use was 7 (range, 2–30) days. The median OS for patients who received steroids was 3.9 months (95% confidence interval [CI], 1.8–11.4) versus 5.47 months (95% CI, 1.3–9.6) in patients who did not receive steroids (P = 0.23). The median progression-free survival for patients who received steroids for <10 days was 1.4 months (95% CI, 0.9–1.9) versus 3.8 months (95% CI, 0–8.6) for patients who received steroids for 10 or more days (P = 0.009). Using duration of steroid use as a continuous variable, HR for death was 1.0 (95% CI, 0.90–1.04, P = 0.991). There was a statistically significant better OS in patients who did not receive antibiotics (median OS, 11.4 months [95% CI, 8.5–14.3] vs. 2.8 months [95% CI, 1.5–4.1], P = 0.047). Conclusions: There was no statistical difference in OS in patients on immunotherapy with or without the use of steroids supporting the notion that steroids can be judiciously used along with CPI.
The Role of Students with Practical Nursing Diplomas in the Process of Undergraduate Nursing Education: A Qualitative Study

Background: Awareness of the experiences of students and educators in the educational process plays an important role in facilitating and improving this process. This study aimed to explain and investigate the experiences of nursing educators and students about the presence of students with practical nursing diplomas in the process of undergraduate education. Materials and Methods: In this qualitative study conducted from 2016 to 2018, which adopted a content analysis approach, 24 nursing students and educators of Lorestan University of Medical Sciences were selected using the purposive sampling method and were interviewed in depth. The data were manually recorded and analyzed using the Graneheim and Lundman method. Results: The three main themes of “from contrast to alignment with professional competence,” “peaceful coexistence in the educational process,” and “reflection of the perceived reality of the clinical environment,” along with six categories and 30 subcategories were extracted from the interviews. Conclusions: It seems that monitoring and managing undergraduate courses more thoroughly, as well as raising the awareness of educators about the positive and negative dimensions of the presence of nursing students with practical nursing diplomas in undergraduate nursing courses can make it possible to optimize and improve students' learning process.
Author Reply to Chadha KG, et al.

Regarding the letter to the editor, ‘Reviewing ROS1 immunohistochemistry vis‐à‐vis fluorescence in situ hybridization (FISH) in non‐small cell lung cancer’ by Chadha et al.,[1] we are glad to note that the authors concur with our paper[2] and the editorial[3] that immunohistochemistry (IHC) presents a viable, more affordable alternative to FISH for ROS1 screening in non‐small cell lung cancer (NSCLC). We are also glad to read that ROS1‐positivity percentage in Chadha et al.’s experience was low, and similar to that of our study, both of which corroborate previous observations of <1% positivity of ROS1 by FISH in Indian patients. It would be useful to know how many of their 130 NSCLC cases tested for ROS1 were adenocarcinomas versus squamous cell carcinomas.
Impact of adherence to antiepileptic medications on quality of life of epileptic patients in the Eastern Province of Saudi Arabia: A cross-sectional study

Background: Epilepsy is one of the most common neurological diseases, characterized by recurrent epileptic seizures. Adherence to antiepileptic drugs (AEDs) is vital in establishing seizure control. The adherence, in turn, impacts the quality of life (QoL) in epileptic patients. Methodology: This was a hospital-based cross-sectional study conducted at King Fahd Hospital of the University, Qatif Central Hospital, and Dammam Central Hospital in the Eastern region of Saudi Arabia during the period from January 2018 to April 2018. Epileptic patients from all age groups treated with at least single AED and who had follow-up in hospital for the past 6 months were included in the study. Patients with intellectual disabilities and those who received AEDs for other indications were excluded. The participants were interviewed in Arabic, and validated translated version of questionnaire was completed under the following sections: sociodemographic characteristics, adherence assessment using the General Medication Adherence Scale (GMAS), and QoL in epilepsy patients using EQ-5D-5L. Results: We report 48% of participants with high adherence, 34% with moderate adherence, while 19% exhibited low adherence toward AEDs. Of 80 participants, 25 (31%) reported perfect health status (11,111) and 2 (3%) reported extremely worst health status (55,555). Further, the study revealed a significant (P = 0.045 and 0.035) improvement of QOL in patients with moderate and high adherence compared to patients with low adherence. Conclusion: This study reports high health-related quality index (QoL) in participants with moderate–high adherence. The relationship between adherence and overall HRQoL was directly proportional.
Comparative effectiveness of cognitive-behavioral group therapy and reality therapy on the quality of life of patients with seborrheic dermatitis

Context: Skin diseases contribute to considerable psychological consequences and low quality of life (QOL) in these patients; it is believed that psychological status can be effective in the improvement of the disease. Aims: Therefore, this study aimed to compare the effect of cognitive-behavioral therapy (CBT) with reality therapy (RT) on QOL in patients with seborrheic dermatitis. Setting and Design: This semi-experimental study with pre- and posttest conducted in the private clinics of Sari and Ghayemshahr. Materials and Methods: Forty-eight cases selected by purposive method and randomized in three groups of control, cognitive-behavioral, and RT. Participants in three groups' evaluated pre-posttest and follow-up (3 months after intervention) by skin QOL index Wang (1994). Intervention groups received 10 weeks intervention, whereas the control group did not receive any intervention during this study. Statistical Analysis Used: The data were analyzed using SPSS-20 software through mixed covariance analysis. Results: There was no significant difference found between the two intervention groups (P > 0.05). The comparison of the effect size of two groups showed higher effect size for CBT group 0.81 versus 0.51. Conclusion: According to the findings of the research, it can be concluded that CBT and RT are effective on QOL and severity of skin disease.
Colonoscopy appropriateness in a libyan hospital: The experience with a modified open-access system

Background and Aim: In the absence of guidelines for referring patients for colonoscopy in the Benghazi Medical Center, the use of a modified open-access system of referral may decrease the rate of inappropriate colonoscopies. This study aimed to assess the impact of modified open-access system of referral on colonoscopy appropriateness using the American Society of Gastrointestinal Endoscopy guidelines as a reference. Subjects and Methods: In this observational, cross-sectional, and retrospective study, all colonoscopies performed in the Benghazi Medical Center during the period from January 1, 2015, to December 31, 2016, were retrospectively studied. Colonoscopy reports were retrieved from the paper-based hospital medical archives. Results: After exclusion of colonoscopy records with inadequate data, only 344 colonoscopies were included in the study. Three hundred and nine (89.8%) colonoscopies were found to be appropriate and 35 (10.2%) were inappropriate. The most common appropriate indication was rectal bleeding (61, 19.7%). Examination results were negative in 135 (39.2%) and positive in 209 (60.75%) colonoscopies. Among colonoscopies with positive findings, the number of colonoscopies with positive relevant findings was 126 (60.3%). Of these, the indication was appropriate in 122 (96.8%) and inappropriate in 4 (3.2%) colonoscopies. Appropriate colonoscopies were significantly more likely to be associated with positive relevant findings (P = 0.0029). Conclusion: Modified open-access system of colonoscopy referral increases the rate of appropriate colonoscopies, even if no definite guidelines for colonoscopy appropriateness are followed, neither by referring physicians nor endoscopists.
The Effect of Family-Oriented Educational Intervention on Postoperative Pain after Orthopedic Surgery

Background: Non-pharmacological methods including the improvement of knowledge of patients and his/her family members in the management and control of pain can reduce patients' experiences of pain. The present study aimed to investigate the effects of family-oriented educational intervention on postoperative pain after orthopedic surgery. Materials and Methods: This study is a non-randomized controlled trial with the control group, which was carried out on 46 patients in orthopedic surgery units of Mousavi Hospital in Zanjan in 2017. Patients were selected based on convenience sampling and categorized into two groups of experimental (n = 23) and control (n = 23) groups. In the experimental group, educational intervention was performed with the attendance of the patient and his/her family members in two sessions of the preoperative and postoperative period. The control group received routine care. The pain intensity was measured by Visual Analog Scale (VAS) for 3 days in both control and experimental group. Data were analyzed by using Chi-square, Fisher exact test, independent t-test, and Analysis Of Variance (ANOVA) with repeated measures and Greenhouse–Geisser. Results: Mean (SD) of pain intensity in the experimental and control groups was 5.21 (1.47) vs 6.74 (1.30) on the first day, 2.91 (1.20) vs 4.81 (1.32) on the second day, and 1.75 (0.67) vs 3.38 (1.53) on the third day, respectively. Pain severity reduction was significant in the experimental group compared to control group in every 3 days after surgery (F = 152.30, df = 1.62, p = 0.005). Conclusions: Family-oriented educational intervention resulted in reducing the intensity of pain and the use of narcotic drugs after orthopedic surgery.
Radiographic evaluation of root canal treatments performed by undergraduate students at the Dakar Dental School

Aim: The aim of this study is to assess radiographically the technical quality of root canal treatments (RCTs) performed by students at the Dakar Dental School. Materials and Methods: Out of 420 patients who had undergone RCTs, 501 teeth were randomly selected. Forty-eight teeth were excluded and the final sample involved 453 endodontically treated teeth. The length and the density of the root filling were evaluated for each filled root of each tooth. The presence of procedural errors was also evaluated. Descriptive statistics were used for expressing the frequencies of criteria and Chi-square test was used for comparing qualities of RCTs in terms of tooth locations, tooth types and academic level of students. The level of students, the significance level was set at 0.05. Results: From the 453 RCTs, 63.6% were acceptable. The rate of adequate RCTs was higher in the maxilla than in the mandible (P = 0.022) and in the premolars (75.5%) followed by the anterior teeth (69.7%) and the molars (49.2%) (P = 0.026). The difference was not significant in terms of level of students (P = 0.429). Inadequate density was found in 27.8%, whilst underfilling and overfilling were found in 26.5% and 7.3%, respectively. The frequency of procedural errors was 2%. Conclusion: The technical quality of RCTs performed by undergraduate students at the Dakar Dental School using step-back preparation and cold lateral condensation was classified as acceptable in 63.6% of the cases.
Infusion warm during selective hypothermia in acute ischemic stroke

INTRODUCTION: Mechanical thrombectomy (MT) has dramatically improved the prognosis for acute ischemic stroke (AIS) patients. Despite high recanalization rates, up to half of the patients will not present a good neurological outcome after MT. Therapeutic hypothermia is perhaps the most robust neuroprotectant studied preclinically. MATERIALS AND METHODS: We explored various warming effects that can reduce the effectiveness or potency of selective hypothermia during AIS under conditions similar to actual clinical care. Four different selective hypothermia layouts were chosen. Layouts 1 and 2 used a single catheter without and with an insulated IV bag. Layouts 3 and 4 used two catheters arrange coaxially, without and with an insulated IV bag. Independent variables measured were IV bag exit temperature, catheter inlet temperature, and catheter outlet temperature at four different flow rates ranging from 8 to 25 ml/min over an infusion duration of 20 min. RESULTS: Dominant warming occurs along the catheter pathway compared to warming along the infusion line pathway, ranging from 66% to 72%. Coaxial configurations provided an approximate 4°C cooler temperature benefit on delivered infusate over a single catheter. Brain tissue temperature predictions show that the maximum cooling layout, Layout 4 at maximum flow provides a 1°C within 5 min. CONCLUSION: Significant rewarming effects occur along the infusate flow path from IV bag to site of injury in the brain. Previous selective hypothermia clinical work, using flow rates and equipment at conditions similar to our study, likely produced rapid but not deep tissue cooling in the brain (~ 1°C).
Serum Tryptophan-Derived Quinolinate and Indole-3-Acetate Are Associated With Carotid Intima-Media Thickness and its Evolution in HIV-Infected Treated Adults

Abstract Background HIV-infected individuals undergoing effective antiretroviral therapy (ART) present an increased risk of atherosclerotic cardiovascular disease. We identified serum metabolites associated with carotid intima-media thickness (c-IMT) and its evolution. Methods One hundred forty-three hydrophilic serum metabolites were measured by ultraperformance liquid chromatography coupled with high-resolution mass spectrometry in 49 HIV+ ART+, 48 HIV+ ART-naïve and 50 HIV-negative, age-matched, never-smoking male triads. Metabolites differentially altered between groups (“features”) were defined as having a Benjamini-Hochberg-adjusted P value <. 05 from a t test and >0.25 log2 absolute mean fold change in metabolite levels. c-IMT was measured across 12 sites at inclusion in all individuals and at the carotid artery (cca) after a median of 5.1 years in 32 HIV+ ART+ individuals. The difference in c-IMT (cross-sectional analysis) and slope of cca-IMT regression/progression per year (longitudinal analysis) for each log10 (area) increase in metabolite level were estimated with linear regression. Results Compared with HIV-, metabolite features of HIV+ ART+ were increased N6,N6,N6-trimethyl-L-lysine and decreased ferulate and 5-hydroxy-L-tryptophan, whereas features of HIV+ ART-naïve were increased malate, kynurenine, 2-oxoglutarate, and indole-3-acetate and decreased succinate and 5-hydroxy-L-tryptophan. In HIV+ ART+ individuals, quinolinate and/or indole-3-acetate were positively associated with c-IMT (P < .03), cca-IMT (P < .03), and cca-IMT progression (P < .008). These associations were not observed in HIV+ ART-naïve or HIV-negative individuals. In HIV+ ART+ individuals, the metabolites xanthosine and uridine, from nucleotide metabolism, and g-butyrobetaine, from lysine/dietary choline degradation, were also positively or negatively associated with c-IMT and/or cca-IMT (all P < .01), but not its evolution. Conclusions In these highly selected HIV-positive ART-controlled males, 2 novel metabolites derived from tryptophan catabolism, indole-3-acetate and quinolinate, were associated with c-IMT and its progression.
A step‐by‐step protocol for isolation of murine nucleus pulposus cells

The intervertebral disc (IVD) is composed of three separate tissues with distinct origins and properties. Elucidating changes occurring in these tissues in response to injury or age is paramount to identify new therapies to better manage disc and spine degenerative conditions, including low back pain. Despite their small size and different mechanical load pattern compared to higher species, the use of mouse models represents a cost‐effective and powerful approach to better understand the formation, maintenance, and degeneration of the IVD. However, the isolation of the different compartments of the IVD is complicated by their diminutive size. Here, we describe a simple, step‐by‐step protocol for the isolation of the nucleus pulposus (NP) tissues that can then be processed for further analyses. Analysis from mouse NP tissues shows sufficient quantities of RNAs, purity of the NP fraction, and overall RNA quality for gene expression studies, and reveals no increase in expression of disc degeneration markers, including TNFa, IL1b, and Mmp1 up to 15 months of age in C57BL6 wildtype mice.
ANALYSIS OF PRE-ANALYTICAL NON-CONFORMANCE IN A MEDIUM SIZED PRIVATE PATHOLOGY LABORATORY

Aims: To determine the types and frequency of pre-analytical incidences of non-conformance in a medium-sized private pathology laboratory and evaluate corrective actions. Methods: A retrospective audit was performed at Southern IML Pathology in Wollongong and Nowra, NSW Australia, to identify incidences of non-conformance over a 12 month period from October 2012 to September 2013. Data were obtained using an in-house non-conformance reporting system and from the quarterly Royal College of Pathologists of Australasia Key Incident Monitoring and Management System. Results: There were 584,012 patient episodes tested and 2,726,597 tests performed at Southern IML Pathology during the study period. There were 11,266 incidences of non-conformance during the study period, of which 3613 (32%) were from collection, 2164 (19%) were from specimen reception area and 2242 (20%) were from data entry. There were 3045 (27%) incidences that required a recollection. There were a total of 10,972 patients who had an incidence of pre-analytical non-conformance, which is 1.9% of patients who had tests performed during the study period. Conclusions: This is one of few studies of pre-analytical non-conformance in a medium sized private laboratory setting. Monitoring non-conformance for a pathology laboratory is essential to determine areas where further improvements can be made.