Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessing Barriers to and Level of Adherence to Hypertension Therapy among Palestinians Living in the Gaza Strip: A Chance for Policy Innovation

Introduction Hypertension is a major health concern, especially in low-income countries. Nonadherence and poor or no persistence in adhering to hypertension treatment regimens result in uncontrolled high blood pressure, increasing rates of mortality and morbidity, and preventable healthcare costs. The aim of this study was to assess the level of adherence and barriers to treatment regimens among hypertensive patients living in the Gaza Strip, Palestine. Methods A convenience sample of 648 participants completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale. The great majority of participants (n = 521, 80.4%) was highly adherent to their treatment regimen, 123 participants (18.98%) were classified as moderately nonadherent, and 4 (0.62%) participants were classified as highly nonadherent to their hypertension treatment regimen. Participants of this study showed the highest adherence rate to the domain of medication adherence (mean of 1.42 out of 4) followed by appointment keeping (mean 1.8), while they were least adherent to diet (mean of 2.18). The greatest three barriers to adherence to the recommended treatment regimen reported by participants were inability to exercise, inability to resist fast and fried food, and inability to keep themselves away from salty foods. Conclusion Overall adherence to medication in Gaza was surprisingly good in patients with a diagnosis of hypertension for at least one year. However, adherence to lifestyle advice or dietary regimes remains poor. A combination of interventions using low-cost mobile technology, combined with face-to-face interventions by healthcare professionals, can be applied to improve adherence to hypertension treatment regimens in order to reduce the consequences of uncontrolled blood pressure.
Cancer Care Management During the COVID-19 Pandemic

Abstract New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.
Lofexidine for acute opioid withdrawal: A clinical case series

Introduction Maintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility. Methods Seventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported. Results Patients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time. Discussion Lofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.
Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block

Abstract Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in “Pubmed” and “Google Scholar” database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.
Renesting ecology of northern pintails on the Yukon-Kuskokwim Delta, Alaska

We used radio telemetry to study renesting by wild, free-ranging Northern Pintails (Anas acuta) on the coastal Yukon-Kuskokwim Delta in 1994 and 1995. Fifty-six percent of females (n = 39) renested at least once. Propensity to renest declined among females that initiated later first nests. Renesting interval was not related to female weight, year, or initiation date of first nests. Mean interval between first and second nests was 11.4 ± 1.0 days, and mean interval between second and third nests was 11.3 ± 1.5 days. Median distance observed between first and second nest attempts was 276 m (range 33-6,098 m). Clutch size declined 2.3 ± 0.4 eggs between first and second nests. Weight of females captured on first nests in early incubation declined with nest initiation date. Our results suggest that food availability does not limit renesting ability of pintails in coastal tundra.
NDM-1 Carbapenemase-Producing Enterobacteriaceae are Highly Susceptible to Ceragenins CSA-13, CSA-44, and CSA-131

Background and Purpose Treatment of infections caused by NDM-1 carbapenemase-producing Enterobacteriaceae (CPE) represents one of the major challenges of modern medicine. In order to address this issue, we tested ceragenins (CSAs – cationic steroid antimicrobials) as promising agents to eradicate various NDM-1-producing Gram-negative enteric rods. Materials and Methods Susceptibility to CSA-13, CSA-44, and CSA-131 of four reference NDM-1 carbapenemase-producing strains, ie, Escherichia coli BAA-2471, Enterobacter cloacae BAA-2468, Klebsiella pneumoniae subsp. pneumoniae BAA-2472, and K. pneumoniae BAA-2473 was assessed by MIC/MBC testing of planktonic cells as well as biofilm formation/disruption assays. To define the mechanism of CSAs bactericidal activity, their ability to induce generation of reactive oxygen species (ROS), permeabilization of the inner and outer membranes, and their mechanical and adhesive properties upon CSA addition were examined. Additionally, hemolytic assays were performed to assess CSAs hemocompatibility. Results All tested CSAs exert substantial bactericidal activity against NDM-1-producing bacteria. Moreover, CSAs significantly prevent biofilm formation as well as reduce the mass of developed biofilms. The mechanism of CSA action comprises both increased permeability of the outer and inner membrane, which is associated with an extensive ROS generation. Additionally, atomic force microscopy (AFM) analysis has shown morphological alterations in bacterial cells and the reduction of stiffness and adhesion properties. Importantly, CSAs are characterized by low hemolytic activity at concentrations that are bactericidal. Conclusion Development of ceragenins should be viewed as one of the valid strategies to provide new treatment options against infections associated with CPE. The studies presented herein demonstrate that NDM-1-positive bacteria are more susceptible to ceragenins than to conventional antibiotics. In effect, CSA-13, CSA-44, and CSA-131 may be favorable for prevention and decrease of global burden of CPE.
EGLIF-CAR-T Cells Secreting PD-1 Blocking Antibodies Significantly Mediate the Elimination of Gastric Cancer

Objective To investigate the anti-tumor effects of programmed cell death protein 1 (PD-1) scFv-secreting EGFR-chimeric antigen receptor-modified (CAR)-T cells against gastric cancer. Methods Second-generation EGFR-CAR-T cells and fourth-generation PD-1 scFv-secreting EGFR-CAR-T cells were engineered. The anti-tumor activities of chimeric antigen receptor-modified (CAR)-T cells were analyzed in vitro by long-term co-culture with gastric cancer cells. The tumor scavenging capacity in vivo was evaluated in xenograft and PDX mouse models. Results EGFR-CAR-T cells secreting PD-1 scFv showed enhanced long-term tumor cell killing capacity in vitro. These cells also showed significant anti-tumor effect in the subcutaneous xenograft model of gastric cancer as well as in the PDX model, and autocrine PD-1 antibody secretion significantly increased tumor infiltration of the CAR-T cells. Conclusion EGFR-CAR-T cells secreting PD-1 scFv are highly effective against gastric cancer and offer new insights into anti-cancer immunotherapy.
SARS-CoV-2 in Myelodysplastic Syndromes: A Snapshot From Early Italian Experience

Sandra Mossuto, Enrico Attardi, Francesco Alesiani, Emanuele Angelucci, Enrico Balleari, Massimo Bernardi, Gianni Binotto, Costanza Bosi, Anna Calvisi, Isabella Capodanno, Antonella Carbone, Andrea Castelli, Marco Cerrano, Rosanna Ciancia, Daniela Cilloni, Marino Clavio, Cristina Clissa, Elena Crisà, Monica Crugnola, Matteo G. Della Porta, Nicola Di Renzo, Ambra Di Veroli, Roberto Fattizzo, Carmen Fava, Susanna Fenu, Ida L. Ferrara, Luana Fianchi, Carla Filì, Carlo Finelli, Valentina Giai, Francesco Frattini, Valentina Gaidano, Gianluca Guaragna, Svitlana Gumenyuk, Roberto Latagliata, Stefano Mancini, Emanuela Messa, Alfredo Molteni, Pellegrino Musto, Pasquale Niscola, Esther Oliva, Giuseppe A. Palumbo, Annamaria Pelizzari, Federica Pilo, Antonella Poloni, Marta Riva, Flavia Rivellini, Chiara Sarlo, Mariarita Sciumé, Roberto Secchi, Carmine Selleri, Agostino Tafuri, Valeria Santini
Doppler Interrogation of the Femoral Vein in the Critically Ill Patient: The Fastest Potential Acoustic Window to Diagnose Right Ventricular Dysfunction?

Supplemental Digital Content is available in the text. Objectives: To report the use of common femoral vein Doppler interrogation as a simple technique to diagnose right ventricular dysfunction. Design: Case report. Setting: Cardiac surgical ICU. Patients: Postoperative cardiac surgical patients. Interventions: Common femoral pulsed-wave and color Doppler examination associated with hepatic, portal, and renal venous Doppler measurement were obtained in both patients and before and after treatment in patient number 1. In addition, right ventricular pressure waveform examination was obtained in patient number 2. Measurements and Main Results: The technique to obtain common femoral venous Doppler is described. Two cases of patients presenting with right ventricular dysfunction and fluid overload with portal and renal venous congestion in the perioperative period undergoing complex multivalvular cardiac surgery are presented. Hemodynamic waveform monitoring was performed alongside echocardiographic, hepatic, and renal venous flow Doppler assessment, and spectral Doppler profiles of the common femoral veins were examined. Those findings were useful in confirming our diagnosis and guiding our response to treatment. An algorithm was developed and tested on two additional hemodynamically unstable patients. Conclusions: Doppler examination of the common femoral vein is a simple, fast, and noninvasive technique that could be useful to rule in the presence of right ventricular dysfunction with venous congestion and help guide the management of such patients.
Diagnosis and Treatment of Chronic Lymphocytic Leukemia: Recommendations of the French CLL Study Group (FILO)

Abstract As a result of significant recent developments, the management of patients with chronic lymphocytic leukemia (CLL) is changing, and new therapeutic options will continue to emerge in the near future. The recommendations of the French Innovative Leukemia Organization (FILO-CLL) group presented here are intended to provide practical recommendations for physicians taking care of CLL patients, taking into account the availability of both biological tests and therapies in daily practice in France at the time of publication. This text details the documented information and guidelines on diagnosis, indications for treatment, infectious complications and therapeutic strategies in frontline and relapsed CLL as well as in particular conditions such as autoimmune cytopenia or Richter syndrome.
Predicting Postoperative Length of Stay for Isolated Coronary Artery Bypass Graft Patients Using Machine Learning

Purpose Predictive analytics (PA) is a new trending approach in the field of healthcare that uses machine learning to build a prediction model using supervised learning algorithms. Isolated coronary artery bypass grafting (iCABG), an open-heart surgery, is commonly performed in the treatment of coronary heart disease. Aim The aim of this study was to develop and evaluate a model to predict postoperative length of stay (PLoS) for iCABG patients using supervised machine learning techniques, and to identify the features with the highest contribution to the model. Methods This is a retrospective study that uses historic data of adult patients who underwent isolated CABG (iCABG). After initial data pre-processing, data imputation using the kNN method was applied. The study used five prediction models using Naïve Bayes, Decision Tree, Random Forest, Logistic Regression and k Nearest Neighbor algorithms. Data imbalance was managed using the following widely used methods: oversampling, undersampling, “Both”, and random over-sampling examples (ROSE). The features selection process was conducted using the Boruta method. Two techniques were applied to examine the performance of the models, (70%, 30%) split and cross-validation, respectively. Models were evaluated by comparing their performance using AUC and other metrics. Results In the final dataset, six distinct features and 621 instances were used to develop the models. A total of 20 models were developed using R statistical software. The model generated using Random Forest with “Both” resampling method and cross-validation technique was deemed the best fit (AUC=0.81; F1 score=0.82; and recall=0.82). Attributes found to be highly predictive of PLoS were pulmonary artery systolic, age, height, EuroScore II, intra-aortic balloon pump used, and complications during operation. Conclusion This study demonstrates the significance and effectiveness of building a model that predicts PLoS for iCABG patients using patient specifications and pre-/intra-operative measures.
Role of metformin and glibenclamidein controlling gestational diabetes mellitus

Aim of the work: The aim of this study is to compare metformin and glibenclamide in treatment of gestational diabetes mellitus regarding the efficacy in glycemic control and safety.Patients and Methods: Eighty patients aged between 18 and 40 years who were diagnosed to have gestational diabetes mellitus between 16 and 34 weeks that was failed to be controlled by diet and exercise and required medical therapy were recruited. They were allocated to either metformin or glibenclamide therapy. The primary outcome was failure of glycemic control according to fasting and postprandial glucose values. Secondary outcomes were obstetric outcomes, maternal and neonatal complications.Results: Patients in metformin group had significantly higher failure of glycemic control than patients in glibenclamide group (10 cases in metformin group versus 3 cases in glibenclamide group; p=0.003). Also, mean fasting glucose level was significantly higher in metformin group than glibenclamide group (87.38 ± 7.4 and 82.42 ± 6.4 mg/dl, respectively, p= 0.005), while both groups had comparable post-prandial glucose levels (p= 0.11). Both groups had comparable rate of maternal and neonatal complications. There was no significant difference between both groups regarding gestational age and mode of delivery.However, more neonates developed hypoglycemia <40 mg/dl in glibenclamide group than metformin group (11 and 6, respectively, p= 0.025). Conclusion: Metformin and glibenclamide are comparable oral drugs for treatment of gestational diabetes that requires medical treatment regarding maternal and fetal outcomes with preference of glibenclamide in terms of better glycemic control.
Severity of Acne Vulgaris: Comparison of Two Assessment Methods

Purpose Numerous tools are available to assess acne severity. It is important to have an acceptable and easy to use tool for acne assessment for many reasons, such as initial assessment and follow-ups, clinical trials, and comparisons of clinical studies. The aim was to investigate the agreement between different observers (inter-observer variation) in the evaluation using the Global Acne Grading System (GAGS) and Investigator Global Assessment of Acne (IGA). Besides, to investigate the correlation between the assessment scores and its relation to the quality of life scales Dermatology Life Quality Index (DLQI) and the Cardiff Acne Disability Index (CADI). Patients and Methods This was a prospective study. Four investigators involved to evaluate the study subject surveyed 54 patients complaining of acne using IGA and GAGS scores (DLQI and CADI). Results A significant relation was seen between GAGS and IGA (Pearson chi-square test p= 0.001), and they demonstrated excellent inter-rater reliability. There was no correlation between IGA and quality of life measures (CADI nor DLQI). However, there was a significant weak correlation between GAGS and CADI. Conclusion The two methods for acne severity assessment are reliable, and they are correlated. Quality of life concerning acne is not correlated with the severity of the disease.
Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors in Nepal: Findings from a Community-based Household Survey

Background Despite chronic obstructive pulmonary disease (COPD) being the commonest non-communicable disease in Nepal, there is limited research evidence estimating the spirometry-based burden of COPD. This study aims to estimate the prevalence of COPD and its correlates through a community-based survey in Pokhara Metropolitan City, a semi-urban area of Western Nepal. Methods A cross-sectional household survey was conducted among 1459 adults ≥40 years. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as a post-bronchodilator ratio of forced expiratory volume in 1st second (FEV1) to forced vital capacity (FVC) <0.70 with the presence of symptoms. COPD was also defined by the lower limit of normal (LLN) threshold – FEV1/FVC < LLN cut-off values with the presence of symptoms. Study participants were interviewed about sociodemographic and behavioural characteristics and respiratory symptoms. Descriptive statistics and logistic regression analysis were applied. Results Spirometry reports were acceptable in 1438 participants. The mean age of the participants was 55 (±10) years, and, 54% were female. The prevalence of GOLD-defined COPD was 8.5% (95% CI: 7.1–10.0) and based on the LLN threshold of 5.4% (95% CI: 4.2–6.6). The multivariate logistic regression showed that increasing age, low body mass index, illiterate, current or former smoker, and biomass fuel smoke increased the odds of COPD in both the definitions. Conclusion COPD is highly prevalent at community level and often underdiagnosed. Strategies aiming at early diagnosis and treatment of COPD, especially for the elderly, illiterate, and reducing exposure to smoking and biomass fuel smoke and childhood lung infection could be effective.
Serum interleukin-6 level is correlated with the disease activity of systemic lupus erythematosus: a meta-analysis

Interleukin-6 (IL-6) plays a crucial role in systemic autoimmunity and pathologic inflammation. Numerous studies have explored serum IL-6 levels in systemic lupus erythematosus (SLE) and their correlation with disease activity. Here, we performed a meta-analysis to quantitatively assess the correlation between the serum IL-6 levels and SLE activity. The PubMed and EMBASE databases were thoroughly searched for relevant studies up to September 2019. Standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were used to describe the differences between serum IL-6 levels in SLE patients and healthy controls and between those in active SLE patients and inactive SLE patients. The correlation between the serum IL-6 levels and disease activity was evaluated using Fisher’s z values. A total of 24 studies involving 1817 SLE patients and 874 healthy controls were included in this meta-analysis. Serum IL-6 levels were significantly higher in SLE patients than in the healthy controls (pooled SMD: 2.12, 95% CI: 1.21-3.03, Active SLE patients had higher serum IL-6 levels than inactive SLE patients (pooled SMD: 2.12, 95% CI: 1.21-3.03). Furthermore, the pooled Fisher’s z values (pooled Fisher’s z=0.36, 95% CI: 0.26-0.46, p<0.01) showed that there was a positive correlation between the serum IL-6 levels and SLE activity. This study suggested that serum IL-6 levels were higher in patients with SLE than in healthy controls, and they were positively correlated with disease activity when Systemic Lupus Erythematosus Disease Activity Index>4 was defined as active SLE. More homogeneous studies with large sample sizes are warranted to confirm our findings due to several limitations in our meta-analysis.