Miracle-dz/UniFAR-FTUs huggingface dataset:
Epidemiology and predictors of repeat positive chlamydia tests: The Brant County cohort, Ontario, Canada

Repeat positive tests for chlamydia (CR) may help explain current high rates of chlamydia despite years of screening, partner notification and treatment to reduce sequelae. We wanted to determine the numbers of CRs over time as a proportion of all chlamydia cases, and define the differences in demographic, clinical, behavioural, and public health management indicators, between individuals who have experienced a CR and individuals who experienced a single infection in Brant County, Ontario.A retrospective cohort was developed using notifiable disease data extracted from the integrated public health system. Cases were laboratory confirmed chlamydia and gonorrhea infections in Brant County between January 1st, 2006 and December 31st, 2015. During the study period, 3,499 chlamydia cases and 475 gonorrhea cases were diagnosed. The total number of individuals with chlamydia in that period was 3,060, including 157 coinfections with gonorrhea. Differences between those with reinfection and those with single infection were evaluated using univariate and multivariate (Cox proportional hazards model) methods.Four hundred and ninety-nine (16.30%) individuals experienced CR 28 days from initial infection; of which 328 (65.73%) occurred within 2 years and 211 (42.28%) within 1 year. The median time to CR was 276 days, consistent with existing Canadian literature. Independent risk factors for CR included being male, 25 years old or younger, and not receiving recommended treatment for initial and/or subsequent infection.These findings suggest that inadequate treatment play a significant role in CR, while accounting for young age and male gender, likely due to untreated sex partners.Sixteen percent of people experienced a second positive chlamydia test more than 28 days after their initial positive test in a cohort of 3,499 patientsThose who had a second positive test were more likely to be male, younger than 25 and had not received recommended antimicrobialsConfirmation of any kind of partner notification was missing in 88% of records
Colistin nephrotoxicity in critically ill patients after implementation of a new dosing strategy.

INTRODUCTION Intravenous colistin is increasingly used to treat multidrug-resistant Gram-negative infections. Highly variable nephrotoxicity rates have been reported. Recent PK/PD studies propose a loading dose and a maintenance dose for better efficacy, but data on the renal toxicity of such regimens are rare. This study aimed to evaluate the incidence and risk factors for nephrotoxicity related to colistin after implementation of a new dosing regimen including a loading dose. METHODOLOGY This was a prospective observational study that was made between adult patients who received a minimum of 48 hours of intravenous colistin from December 2012 to January 2014 at the medical and surgical intensive care units (ICU) of a university hospital. The severity of acute kidney injury (AKI) was defined by the RIFLE criteria. RESULTS Fifty-nine patients met the inclusion criteria, and 31 (52.5%) developed nephrotoxicity. The APACHE-II score was > 15 in 81% of patients. The median time to nephrotoxicity was 7 days. Patients with AKI were in risk (10.2%), injury (16.9%), failure (25.4%), and none of the patients developed permanent renal insufficiency. A logistic regression model identified three predictors of colistin-associated nephrotoxicity: age; the number of days that estimated target plasma concentrations of colistin were ≥ 3.5 mg/L in the first week of therapy; and baseline creatinine level. CONCLUSION In this cohort of severely ill ICU patients, colistin led to a relatively high rate of nephrotoxicity. Further studies are needed to identify the optimal dose for both efficacy and safety.
A phenomenological study exploring the first year experiences of neophyte nurses in Taiwan

The high neophyte nurses’ turnover rate has been recognized as one of the most important issues in Taiwan’s nursing profession. Although Taiwanese nursing researchers have started to investigate the reasons why neophyte nurses’ leave their jobs, most of the studies use quantitative research methodologies. Consequently, we still know very little about how neophyte nurses experience their first year after graduating. Therefore, in order to comprehensively understand more about the phenomenon of neophyte nurses’ experiences following graduation, the research question was posed to guide the study: How do neophyte nurses experience their first year after graduating in Taiwan? The aim of the study was to explore the first year experiences of Taiwanese neophyte nurses. The study was undertaken using a hermeneutic phenomenological approach. The participants were recruited from two sources: a nursing junior college and a healthcare institute in central Taiwan. One hundred and forty-three neophyte nurses from a local junior nursing college and one hundred and thirty-six neophyte nurses from a healthcare institute were the potential participants. Thirty-one neophyte nurses participated in this study. Data were collected via in-depth interviews and analyzed using phenomenological methods. The findings of the study uncovered the phenomenon of how neophyte nurses experience their first year of practice in Taiwan. Three themes emerged from the analysis process, which are: hesitation, a hard beginning, and achievement. Prior to entering work and during their first year of practice, the neophyte nurses felt hesitant. This period of hesitation has not yet been fully discovered either in Taiwanese literature or in that of the English-speaking countries. This is relevant to our understanding of the experiences of the neophyte nurses. When the participants started nursing, they experienced a hard beginning period. They learnt through tears, felt frustrated but also gained others’ support. Then, they recognized that, in order to master the nurse role, they had to go through the transition period. It is important that keep practising nursing in the same unit and not to frequently change their posts during the transition period because entering any new post may need another period of time to adapt to their new role. By gaining positive feedback from the patients and their families, they finally felt a sense of achievement from nursing work. The findings not only bridge the gap in the knowledge of how neophyte nurses experience their first year of practice, but also provide valuable insights for future neophyte nurses, and nurse administrators, preceptors and nurse educators who may wish to guide neophyte nurses. They will also help policy-makers to understand what efforts could be made to facilitate the neophyte nurses’ transition from student to nurse and to reduce the number of neophyte nurses who leave the profession at an early stage.
Monocyte / high-density lipoprotein ratio and neutrophil-to-lymphocyte ratio in age-related macular degeneration

Aim To evaluate the monocyte/high-density lipoprotein (HDL) ratio (MHR) and neutrophil-to-lymphocyte ratio (NLR) as biomarkers of systemic inflammation in age-related macular degeneration (AMD). Materials and Methods: HDL, hematological profiles, erythrocyte sedimentation rates, C-reactive protein, MHRs, and NLRs were evaluated in 30 patients with neovascular AMD (Group 1), 30 with non-neovascular AMD (Group 2), and 30 controls (Group 3). Results: MHRs and NLRs were significantly higher in Group 1 than in Group 3 (p = 0.002 and p < 0.001, respectively) and were independent predictors of neovascular AMD in multivariate analysis (odds ratio = 1.231 and 3.332; 95% confidence interval = 1.035– 1.466 and 1.385–8.019; p = 0.019 and 0.007, respectively). The areas under the receiver operating characteristics curve for MHR and NLR were 0.669 and 0.769. The sensitivity and specificity of MHRs and NLRs in predicting neovascular AMD were 47% and 97% versus 63% and 80%, respectively. Conclusions: By reflecting the balance of proand anti-inflammatory responses, the MHR can reliably indicate systemic inflammation
An Internist’ Journey with Behavioural Medicine

This is the story of a Behavioural Medicine Unit that was developed in 1975 at St. Joseph’s Hospital in Hamilton Ontario. It explains why a general internist decided to assemble a team skilled in the principles of cognitive behavioural therapy to help patients who were responding poorly to traditional medical care. The principles that were applied at that time continue to be as important in 2015. Despite the success of the program and of others that were developed over the next 40 years, these principles have not been adequately utilized by ‘main stream’ medicine nor have they been emphasized sufficiently in undergraduate or residency curricula. It is hoped that the story will stimulate the promotion and integration of the principles of cognitive behaviour into medical education and patient care.
Effects of Three Different Frequencies of Aerobic Physical Activity on Heart and Kidney Tissues in Type 2 Diabetes-Induced Rats

Abstract Objective: Exercise has many beneficial effects in the treatment and prevention of Type 2 Diabetes Mellitus (T2DM). The aim of this study was to evaluate the effect of physical activities with different frequencies performed within a total total duration of one week on the heart and kidney tissues and vascular endothelial growth factor (VEGF) expressions in experimental T2DM model. Method: Rats (n: 30) were divided into sedentary control (SC), sedentary T2DM (SD), T2DM and continuous exercise (DEc, 30 min/day, 5 days/week), T2DM and short bouts exercise (DEsb, 3x10 min/day, 5 days/week), T2DM and weekend warrior exercise (DEww, 35+40 min/day, 2 days/week) groups. Rats were administered streptozotocin (65 mg/kg) and nicotinamide (110 mg/kg) through intraperitoneal route. After 6-weeks of swimming exercise (total duration 150 min/week), biochemical analyzes were performed to measure oral glucose tolerance test, insulin sensitivity and cytokines. Histopathological and immunohistochemical analyses [VEGF, capillary density, Transforming growth factor beta (TGF-β)] were performed in heart and kidney tissues. Results: Compared with sedentary T2DM rats, significant improvements were observed in all exercise groups in terms of blood glucose level, insulin sensitivity, capillary density in heart tissue, VEGF expressions in tissues, TGF-β expressions in kidney tissue and all histopathological analysis (p<0.05). Conclusion: This study shows that physical activity at various frequencies may significantly ameliorate harmful effects of T2DM on heart and kidney tissue without significant differences between exercise frequencies, provided that the total duration of aerobic exercise remains the same (150 min/week).
Treating HIV and African ethnicity : towards chronic care

Since the introduction of antiretroviral therapy (ART) almost two decades ago, the course of an HIV infection has shifted from acute illness with high mortality towards a chronic disease with good life expectancy. Alongside the improved survival, new comorbidities have emerged as well amongst the group of patients that is living with chronic HIV. Until now, most research on long-term comorbidities in this population has been performed among Western patients in Europe and the United States. Relatively little is known about the long-term effects of HIV in people with African ethnicity, while the majority of the worldwide HIV population resides in Sub-Saharan Africa (SSA). The course of an HIV infection may be different among people of African ethnicity compared with Western populations. This thesis aimed to address some aspects of treating HIV and African origin, both looking at the role of African ethnicity within a Western country such as the Netherlands, and studying some long-term effects of HIV in a rural area in South Africa. In part 1, we looked into the role of genetic diversity by comparing individuals from African origin with people originating from Western European countries within the Dutch HIV population. We made use of the observational AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort. We investigated the occurrence of Pneumocystis jirovecii pneumonia (PJP), a frequently diagnosed opportunistic infection among HIV-infected people. Moreover, we studied the role of African ethnicity as a risk for chronic kidney disease (CKD) in HIV in the current treatment era. The results showed that host factors such as genetic variability play a role in the occurrence of opportunistic infections and long-term complications such as CKD. Knowledge on the potential effects of a different genetic makeup in people of African ancestry will contribute to improved HIV care. For the second part of the thesis, treatment of HIV infection and some of its associated long-term complications were studied in SSA. The setting of the research was Elandsdoorn, a township situated in a poor, rural area in Limpopo, a province in the northeast of South Africa. The results of a study looking into the efficacy of second-line ART show that good long-term clinical and virological outcomes following first-line failure can be achieved. On-going evaluation of the efficacy of ART is warranted. In addition, we performed a cross-sectional observational study focusing on renal and cardiovascular disease to have a look into the prevalence of non-communicable diseases (NCDs) in HIV infection. Over 900 patients were screened. Albuminuria and atherosclerotic disease were observed in a substantial proportion of the study population, and were associated with traditional lifestyle-related risk factors. On the other hand, HIV determinants were not related to subclinical atherosclerosis. Prevention and treatment of cardiovascular risk factors are not routinely implemented in the current health service delivery in SSA, while the burden of NCDs is…
Cardiovascular responses to ischemia, hypoxia, and hypercapnia of the central nervous system

The hemodynamic responses to CNS ischemia and to perfusing the CNS with hypoxic or hypercapnic blood were observed in the dog. A dual, rotating disc oxygenator system was employed to separately perfuse the brachiocephalic artery distribution following confirmed bilateral carotid sinus area denervation. Cerebral ischemia produced a marked increase of blood pressure, peripheral vascular resistance, heart rate, and atrial and ventricular contractility. These same responses were also produced by lowering the pO2 or raising the pCO2 of the CNS perfusate, but were somewhat less marked. The hemodynamic findings resulting from these interventions are similar to those observed during systemic hypoxia. It is, therefore, suggested that the gas composition of the blood perfusing the central nervous system may importantly influence the response of the organism to systemic hypoxia.
Nurses' Perceptions and Barriers for Adoption of Evidence Based Practice in Primary Care: Bridging the Gap

Evidence Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences. The aim of this study was to investigate nurse's perceptions and barriers to adopt evidence based practice in their Primary Care setting. Design: descriptive correlation design was used. Setting; this study was conducted in: 1) Maternal & Child Health Centers Governorate (2) Faculty of Nursing- Menoufia University. The sample (1) A convenience sample of 120 clinical nurse specialists who have a bachelor degree in nursing science and working in MCHC was selected. (2) A convenience sample of 80 academic faculty educators who finished their Master or/ Doctorate degree in nursing were selected. Tools; a structured questionnaire to collect Socio-demographic data such as: age, educational level and experiences. II. Nursing' Attitudes towards Evidence-Based Practice and Perceptions of its Related Barriers Questionnaire: It was developed by the researchers based on the current related literatures. This tool measures Nurses' perceptions and barriers for adoption of evidence-based practice. The results of this study; All nurses had a positive attitude toward EBP; the total mean score of nurses' was 7.38±1.73 having a maximum of 10 and minimum of 5. Two third of nurse' educator and clinical nurse specialists (73.8.0 % and 85.8 % respectively) reported that they had insufficient time at work place to search & read research articles. Conclusions: This study revealed a positive attitude among nurses toward EBP. But it was found that several barriers were hindering nurses from adopting EBP. Recommendations: to close the gap between research findings and nursing practice; A) Education and training are required on evidence-based nursing. B) Increase time availability to conduct online search C) Equipped the health facilities with new informatics infrastructure.
Anterior lumbar interbody fusion in a lateral decubitus position: technique and outcomes in obese patients.

Background Multilevel lumbar interbody fusion (LIF) surgery in obese patients is problematic, with positioning and anaesthetic risks during posterior approaches, vascular and visceral complications during anterior approaches, and lack of access to L5/S1 during lateral approaches. Modified anterior LIF (ALIF) via an anterolateral retroperitoneal approach in the lateral decubitus position permits access to L3/4, L4/5, and L5/S1 levels without patient repositioning. This study reports our initial experience with this lateral ALIF in obese patients and describes modifications of existing lateral and anterior techniques. Methods We retrospectively analysed a prospectively maintained registry including the first 30 consecutive patients who underwent lateral ALIF. In all patients, supine ALIF was relatively contraindicated because of obesity or previous abdominal surgery. All patients had a body mass index (BMI) ≥30 kg/m2. Fusion was assessed by high-definition computed tomography. Patient-reported outcomes included visual analogue scale pain scores, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) physical and mental component scores (PCS and MCS). All patients underwent ≥2 years follow-up. Results At last follow-up (mean, 35.0 months) mean back pain improved 64%, leg pain improved 67%, ODI improved 54%, and PCS and MCS both improved 37% (P<0.05 versus preoperative for all). Mean BMI was unchanged postoperatively (P=0.83). Complications occurred in 7 (23%) patients: dysesthesia [2], retroperitoneal hematoma [2], radiculopathy [1], and subsidence [2]. Solid interbody fusion occurred in 19 (63%) patients at 12 months postoperatively and in 26 (87%) patients at 24 months. Conclusions Lateral ALIF enables L5/S1 anterior fusion in obese patients and permits multilevel fusion using a single position. Satisfactory clinical outcomes and complication rates are achieved despite unchanged BMI and 87% radiological fusion rates. Lateral ALIF appears to be a reasonable alternative to posterior, lateral, and supine-position anterior approaches for L3/4, L4/5, and L5/S1 interbody fusions.
Effect of Basketball Specific Endurance Circuit Training On Body Composition and Aerobic Capacity of High School Male Basketball Players

The aim of the study was to evaluate the effectiveness of a basketball specific endurance circuit training on body composition and aerobic capacity of high school male basketball players. We have selected twenty four (24) male high school basketball players were selected from Neyveli Lignite Corporation Sports School, Neyveli and St. Joseph Higher Secondary School, Manjakuppam, Cuddalore. These subjects were randomly distributed into two groups namely training group (TG: N=12) and control group (CG: N=12). The mean age of the selected players was 16.85 ± 0.67. The selected players had 3.8 ± 3.1 years of playing experience and regularly participate in training prior to the commencement of this study. Body composition and aerobic capacity were selected as dependent variables. Percent body fat, lean body mass, fat mass were measured using skinfold calliper and aerobic capacity through multi stage fitness test. TG is supplemented with basketball specific endurance circuit training was administered 3 days per week for six week. TG and CG were tested before and after six weeks of training. The collected data was evaluated using Analysis of Covariance (ANCOVA). The result of the study showed that percent body fat, lean body mass and fat mass between the groups remained unaltered significantly, indicating that after adjusting pre-test scores, there was no significant difference between the two groups on post- test scores. However, aerobic capacity showed significant difference between the group (F = 7.890, p = 0.011) and it elicited 3.29% of changes from pre to post in training group. It is concluded that six weeks of basketball specific endurance circuit training is effective in improving aerobic capacity without altering the body composition of male high school basketball players during competitive phase.
Diagnosis and Surgical Treatment of Colonic Endometriosis

• Endometriosis is sufficiently common that it should always be considered in the differential diagnosis of colon lesions of women of childbearing age. Seven selected cases illustrate problems in diagnosis and management of endometriosis of the colon. Characteristic of colon endometriosis are large bowel symptoms frequently associated with gynecologic complaints, usual sigmoid and rectosigmoid location, extramucosal radiologic appearance, and difficult diagnosis by endoscopic biopsy. Suspicion of malignancy and presence of a symptomatic colon lesion are indications for bowel resection, which is an effective form of therapy. ( Arch Surg 114:169-175, 1979)
Granzyme B in vascular remodeling and pathological angiogenesis

Granzyme B (GZMB) is a serine protease that is expressed by a variety of immune cells and is abundant in a large number of chronic inflammatory disorders. GZMB is highly expressed in cytotoxic lymphocytes where it serves as the main effector molecule of the granule exocytosis pathway by which cytotoxic immune cells mediate target cell death through intracellular delivery of GZMB, leading to activation of apoptotic signaling cascades. GZMB can also accumulate extracellularly during inflammation, where it can cleave a range of extracellular matrix (ECM) proteins that may disrupt cell-matrix interactions and modulate the bioavailability of matrixbound growth factors. In this dissertation I have explored the intracellular and extracellular roles of GZMB in vascular remodeling in disease. By examining human atherosclerotic plaques, I discovered an imbalance between GZMB and its endogenous inhibitor, proteinase inhibitor 9 (PI-9). PI-9 expression by vascular smooth muscle cells (VSMC) in plaques was reduced with increased disease severity. Elevated levels of GZMB in advanced lesions were correlated with reduced PI-9 expression and increased VSMC apoptosis. These findings suggest that VSMC are more susceptible to GZMB-induced apoptosis in advanced lesions due to reduced PI-9 expression. While examining the extracellular activities of GZMB on vascular remodeling, I focused on the role of GZMB-mediated cleavage of fibronectin (FN), a known GZMB substrate. FN has a major role in regulating angiogenesis as it facilitates endothelial cell (EC) migration and capillary formation, as well as binding to angiogenic growth factors in the ECM including vascular endothelial growth factor (VEGF). VEGF is a potent vascular permeabilizing agent that is sequestered in the ECM by binding FN. GZMB-mediated FN cleavage resulted in reduced EC adhesion, migration and capillary tube formation. In addition, GZMB-mediated FN cleavage induced the release of VEGF from the ECM and promoted VEGF-dependent vascular leakage in