Miracle-dz/UniFAR-FTUs huggingface dataset:
A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative

Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.
HEMOGLOBIN WAYNE VARIANT INTERFERING WITH HEMOGLOBIN A1C MEASUREMENT.

Objective To describe the effect of hemoglobin Wayne variant on hemoglobin A1c (A1c) accuracy and to stress the importance of patient-physician communication and trust. Methods We present the clinical history and laboratory findings of 2 patients, with a review of related literature. Results Two older patients were diagnosed with diabetes mellitus (DM) and suffered from frequent hypoglycemia resulting from titrating their diabetes medications based on an extremely elevated A1c (>11% [97 mmol/mol]) obtained through high-performance liquid chromatography. Discrepancies were noticed between their blood glucose logs and their A1c results. Ultimately, both were found to have heterogenous hemoglobin Wayne variant by hemoglobin electrophoresis. Repeat immunoassay found the A1c to be very low, in the 5 to 6.2% (31 to 44 mmol/mol) range. One of the patients did not even meet diagnostic criteria for DM. Conclusion A1c testing is susceptible to misinterpretation due to multiple interfering factors. Hemoglobin variants should be considered as a differential when there are discrepancies between A1c and blood glucose levels. Trust between the patient and the physician is essential in raising clinical suspicion and avoiding potentially lethal outcomes.
Cadaver Pylorus Simulates Hypertrophic Pyloric Stenosis

Citation: Brisson PA, DeLuca CC, Lemes K, Purkey SC (2018) Cadaver Pylorus Simulates Hypertrophic Pyloric Stenosis. Int J Surg Res Pract 5:083. doi.org/10.23937/2378-3397/1410083 Accepted: August 06, 2018 ; Published: August 08, 2018 Copyright: © 2018 Brisson PA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. International Journal of Surgery Research and Practice Open Access ISSN: 2378-3397
Systematic Review of Obesogenic Environmental Determinants of Diet and the Implications of Obesity Prevention and Intervention Efforts

— The environment plays a crucial role in the development of obesity. Obesity rates continue to escalate, bringing into question the efficacy of prevention, intervention, and treatment efforts. This paper identifies the previous research examining obesogenic environmental factors and sets out to determine whether physical, social, cultural, and economic environmental factors are associated with obesogenic dietary behaviors. The study searched five databases for full-text English articles, of which 103 were included in the literature review. The selection was based on keywords searching, peer-reviewed publications, stated research methodology, strategic analysis, and substantial increments in knowledge. One of the results showed an increasing pace of urbanization, media influence, and advertising emphasis on unhealthy food are associated with obesogenic dietary behavior. The discussion focuses on the most susceptible factors for obesity and the implications for future research in communities with a dense population. The objective of addressing the obesity epidemic is to employ strategies to curtail sugar use, restrict marketing efforts of unhealthy food, and increase the availability of healthy food. aim of this study is to assess the relationship between in
ANTIBIOGRAM PROFILE AND BIOFILM FORMING POTENTIAL OF PSEUDOMONAS SPECIES ISOLATED FROM VARIOUS CLINICAL SPECIMENS

Objective: The present study aimed at finding the resistance pattern of Pseudomonas aeruginosa and other Pseudomonas species isolated from various clinical specimens in the laboratory.Methods: A total of 150 isolates of different species of Pseudomonas obtained from various clinical specimens processed at the Microbiology laboratory of Kasturba Medical College, Manipal Academy of Higher Education, were taken for this study. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method and interpreted according to the CLSI guidelines. Biofilm assay was performed by modified O’Toole and Kolter method. The results were analyzed using SPSS 17.0 and Student’s unpaired t-test, Kruskal–Wallis, Mann–Whitney, ANOVA, and Chi-square test. p<0.05 was considered statistically significant.Results: Increased resistance was observed by P. aeruginosa to cefotaxime, cotrimoxazole, levofloxacin, ofloxacin, and ticarcillin clavulanate. There was also a good correlation between antibiotic resistance to aztreonam, netilmicin, and ceftazidime and biofilm production. Results of the present study, therefore, demonstrated the occurrence of resistance to various antipseudomonal agents among the biofilm-producing P. aeruginosa isolates.Conclusion: The present study may help in assessing the seriousness of drug resistance caused by biofilm formation in P. aeruginosa and devise strategies through antibiotic policies to minimize such problems.
A prospective study of hybrid external fixation for proximal tibial fractures

The treatment of proximal tibial fractures or intraarticular fractures are often challenging. Many surgeons encounter problems with wound healing even in closed tibial fractures because of co-existing soft tissue injuries. External fixation of these fractures have yielded satisfactory results, but some studies had reported problems in the achievement and maintenance of fracture reduction. Hybrid external fixator presents with mechanical characteristics that differ from other systems of external fixator. The mechanical characteristics of hybrid external fixation system can be called as SOLID ELASTIC. It is solid enough for stabilization and providing micromotion which enhances good callus formation the purpose of this study is to assess the utility of this hybrid external fixation system and to analyze the functional outcome, soft tissue healing and fracture union.
Family environmental factors associated with underage drinking

ABSTRACT Background: Alcohol-related health and social problems amongst underage are increasing globally. Most studies have focused on the quality of parental relationships. However, less evidence is available to support the association between alcohol consumption and the birth order or the interaction between siblings. The objective of this study was to analyze the association between underage alcohol consumption and family structure and family relationships. Methods: A cross-sectional survey was conducted among schoolchildren in Murcia Region (Southern Spain) (n = 2290) using an anonymous questionnaire delivered in school settings. Statistical analyses used logistic regression to identify independent predictors of alcohol use. Separate analyses were carried out by sexes. Results: About one-third of the 2290 surveyed students (33.2%) reported alcohol consumption, being significantly higher in boys than girls (35.4% vs. 31.3%, p = 0.041). In general, attending second to fourth course of secondary education (grades 7–10 in North America), being a second child, mother with low educational level or working outside home, and having a bad relationship with parents or siblings were associated with higher risk of alcohol consumption. Conclusion: Our results suggest that the complexity of family interactions, including order or birth and quality of relationship with parents and siblings, may impact alcohol consumption in underage population. However, further studies are warranted to confirm and extend our finding, particularly about the order of siblings.
Stable Redox-Cycling Nitroxide Tempol Has Antifungal and Immune-Modulatory Properties

Invasive mycoses remain underdiagnosed and difficult to treat. Hospitalized individuals with compromised immunity increase in number and constitute the main risk group for severe fungal infections. Current antifungal therapy is hampered by slow and insensitive diagnostics and frequent toxic side effects of standard antifungal drugs. Identification of new antifungal compounds with high efficacy and low toxicity is therefore urgently required. We investigated the antifungal activity of tempol, a cell-permeable nitroxide. To narrow down possible mode of action we used RNA-seq technology and metabolomics to probe for pathways specifically disrupted in the human fungal pathogen Candida albicans due to tempol administration. We found genes upregulated which are involved in iron homeostasis, mitochondrial stress, steroid synthesis, and amino acid metabolism. In an ex vivo whole blood infection, tempol treatment reduced C. albicans colony forming units and at the same time increased the release of pro-inflammatory cytokines, such as interleukin 8 (IL-8, monocyte chemoattractant protein-1, and macrophage migration inhibitory factor). In a systemic mouse model, tempol was partially protective with a significant reduction of fungal burden in the kidneys of infected animals during infection onset. The results obtained propose tempol as a promising new antifungal compound and open new opportunities for the future development of novel therapies.
Effect of Nutrition Education Intervention on Knowledge Attitude and Practice of Mothers/caregivers on Infant and Young Child Feeding in Shabelle (Gode) Zone, Somali Region, Eastern Ethiopia

Optimal Infant and Young Child Feeding is very important for their health, growth and development. The impact of long term nutrition education intervention on child feeding in underprivileged community is not well documented. Therefore, this study was designed to document the effect of nutrition education intervention on knowledge, attitude and practice of mothers/caregivers towards optimal infants and young child feeding in Shabelle Zone of Somali Region. With regards to the materials and the methods, a randomized controlled trial study was conducted in August, 2015. Data were collected from 404 participants, after eight months of nutrition education intervention. SPSS version 20 software were used. A Chi-square and Fishers exact tests for categorical variables, and t-test for continues variables were used. Out of the total 415 participants assessed at baseline study, 404 were secured in the post intervention study. The majority (>80%) of the participants in both groups were illiterate, and housewives. The intervention group had shown statistical significant improvement in knowledge, attitude and practice of the mothers/caregivers ( p <0.05) compared to control group in all tests; independent sample t-test mean score difference of the difference ( p <0.001), and paired sample t-test mean score in intervention group ( p <0.001). At the end, the nutrition education intervention was found effective in improving mothers/caregivers behaviours related to child feeding practices. Therefore, nutrition education intervention should be further scaled up and adapted to other areas in the Region.
Exercise Prescription Recommendations for Parkinson's Disease

ABSTRACTPARKINSON'S DISEASE (PD) IS ASSOCIATED WITH MOTOR AND NONMOTOR IMPAIRMENTS THAT RESULT IN PHYSICAL DECONDITIONING, INABILITY TO PERFORM ACTIVITIES OF DAILY LIVING, AND REDUCED QUALITY OF LIFE. THIS COLUMN WILL DISCUSS EXERCISE TESTING AND PRESCRIPTION RECOMMENDATIONS FOR PERSONS WITH PD AS A
Quality of life – an important parameter of cardiac rehabilitation in heart failure patients

Abstract Heart failure is a significant healthcare problem, because of its impact at the individual and populational level, through multiple rehospitalizations and increased morbi-mortality. At the individual level, the multidimensional impact of this clinical condition and its treatment on patients' daily lives is reflected in the quality of life (QoL). QoL needs to be accurately measured, because it’s related to high hospitalization and mortality rates and provides valuable information that cannot be directly obtained using clinical, biological or imaging measurements. For these reasons, QoL evaluation (global score, subscale scores, answers to various items, etc.) is a significant parameter for assessing the impact of and for structuring the cardiac rehabilitation programs (exercise training, nutritional counseling, psychosocial support and interventions, etc). In order to increase the long-term efficiency, these programs need also to include strategies to optimize and increase adherence to lifestyle changes and to medical therapy.
Looking for Perfection in the Evaluation of Mitral Regurgitation

Background: Currently, there is no single echocardiographic parameter for assessing the severity of mitral regurgitation. Two conceptually similar methods have been published. One method is the mitral valve to LVOT velocity time integral ratio (MOTVTI), and the other the mitral E wave peak velocity to LVOT velocity time integral ratio (EVTI). Objectives: Our goals were to compare the ability of both methods to diagnose severe mitral regurgitation and establish the best cutoff points for the diagnosis. Methods: We included patients with and without mitral regurgitation. The area under the ROC curve for MOTVTI and EVTI was analyzed to compare their diagnostic ability of both methods and estimate the best diagnostic cutoff points. Results: A total of 135 patients were included in the study, 51 with various degrees of mitral regurgitation and the rest as controls. Patients with severe mitral regurgitation had an effective regurgitant orifice area of 0.73±0.34 cm2, vena contracta of 8.3±2.2 mm and regurgitant volume of 99±42 ml. The analysis showed an area under ROC curve of 0.83 (95% CI: 0.75 to 0.89) for MOTVTI and 0.92 (95% CI: 0.86 to 0.96) for EVTI, without significant differences. The best cutoff point was> 1.84 for MOTVTI (sensitivity 80%, specificity 94%) and >6.25 for EVTI (sensitivity 100%, specificity 79%). Conclusions: Both methods are useful for the diagnosis of severe MR and have similar diagnostic capacity. The best cutoff points differ from those originally published.
Biomarkers in Relation to Disease Manifestations in Psoriatic Arthritis

Background: In psoriatic arthritis (PsA), a complex disease with a lack of measurable laboratory parameters, there is a need for diagnostic and prognostic tools to meet the challenge of early diagnosis and assessment of disease severity. Objective: To analyze whether soluble biomarkers could discriminate between disease phenotypes in PsA. Methods: Two-hundred and seventy-four patients with established disease and 30 healthy controls were included in this cross-sectional study. Thirty-nine different serological biomarkers were investigated in relation to disease activity, disease manifestations and in comparison with controls. In addition to standard statistical methods, orthogonal partial least squares discriminant analysis (OPLS-DA) was used to investigate different phenotypes of PsA. Results: Psoriatic arthritis activity was significantly associated with CRP (pc = 0.0008), IL-6 (pc = 0.001), IL-16 (pc = 0.007), calprotectin (pc = 0.014), IL-12/IL-23p40 (pc = 0.02), and ICAM-1 (pc = 0.045). Different PsA disease phenotypes were associated with different biomarkers, e.g., axial disease (with or without peripheral disease) was associated with IL-6 (pc = 0.044), IL-16 (pc = 0.044), MIP-1β (pc = 0.039) and polyarthritis was associated with IL-6 (pc = 0.0006), SAA (pc = 0.009), CRP (pc = 0.012) and IL-8 (pc = 0.04), although it was not possible to statistically separate the different phenotypes with OPLSDA. An association was also seen in patients with PsA who, at any time had been prescribed bDMARD, (TNFβ (pc = 0.0001), TNFα (pc = 0.0003), calprotectin (pc = 0.0009), CRP (pc = 0.016) and lower levels of Tie-2 (pc = 0.027)). No significant differences were detected when PsA patients were compared with healthy controls. Conclusions: In this study, inflammatory/pro-inflammatory biomarkers were associated with different disease phenotypes in PsA, however the impact of the various biomarkers is not evident as OPLS-DA analyses could not separate between groups.
The Direct Oral Anticoagulants Apixaban, Rivaroxaban, and Edoxaban

Traditionally, anticoagulant therapy has been conducted through the administration of vitamin K antagonists (VKAs) and parenteral alternatives. Direct Oral Anticoagulants (DOACs) such as apixaban, rivaroxaban and edoxaban provide the convenience of the VKA in that they are administered orally yet they lack many of the disadvantages associated with VKA therapy. Unlike VKAs, measuring DOAC levels is usually unnecessary. However, there are instances with plasma concentrations should be determined. The chromogenic anti-Xa assay is the best linear quantitative assay that is easily accessible to most clinical laboratories for this purpose. However, since the calibrators and controls for apixaban, rivaroxaban and edoxaban are awaiting Federal Drug Administration (FDA) clearance, measurement may have to be performed using the Prothrombin Time assay that lacks the sensitivity of the chromogenic anti-Xa. Results should be periodically verified using liquid chromatography in tandem with mass spectrometry which is the reference method for measuring DOAC levels in plasma. ABBREVIATIONS: AF-atrial fibrillation, DOAC – direct oral anticoagulant, DVT – deep vein thrombosis, FDA – Food and Drug Administration, HPLC – high performance liquid chromatography, LMWH – low molecular weight heparin, PE – pulmonary embolism, PT – prothrombin time, UFH – unfractionated heparin, UPLC – ultra-performance liquid chromatography, VKA – vitamin K antagonist, VTE – venous thromboembolism
The Prevalence of Depression and Its Association with Self-Management Behaviors in Chronic Disease Patients

Background: Co-morbid depression in patients with chronic disease is associated with weak self-care and high complications. Objective: The study aimed to determine the relationship of self-care behaviors and the kind of chronic disease with depression in adults with chronic disease in Isfahan, Iran. Methods: This cross-sectional study was conducted in government healthcare centers. A total of 483 eligible consent respondents participated from March 2015 to June 2015. The “Stanford self-management questionnaire” and the patient health questionnaire (PHQ-9) were used for the assessment of self-management behaviors and depression. Data were analyzed using the SPSS 17 software. Results: The prevalence of depression in participants was 14.7%. There was a significant relationship between self-management behaviors such as physical activity (P 0.001) and skeletal disease patients (OR = 1.70, 95% CI (1.03 - 2.77), P < 0.05) than in other chronic disease patients. Conclusions: We found a negative association between depression and self-care activities in Iranian patients with chronic diseases. Psychological treatment for depression should be considered to improve the prognosis of chronic diseases.
Adherence to Treatment and Retention to Care of Adult Patients on Antiretroviral Therapy

The introduction of antiretroviral therapy came as a relief to people living with HIV and AIDS as it improved their quality of life and chances of survival, and delayed the progression to AIDS. Maintaining high adherence levels to antiretroviral therapy remains a challenge for many, yet strict adherence and retention to care are critical for the successful suppression of the human immunodeficiency virus. The objective of the study was to determine factors that influence adherence and retention to care for adult patients who are undergoing antiretroviral therapy. A qualitative research design was used. Purposive sampling was used to select 23 participants who met the specified criteria. Data were collected by means of in-depth individual unstructured interviews. A thematic analysis revealed six themes, namely staff-patient relationships, adherence support networks, patients’ knowledge of antiretroviral therapy, motivation to live, counselling, and factors related to medication. The study concluded that adherence to antiretroviral therapy and retention to care were facilitated by good interpersonal relationships between hospital staff and patients and efficient service delivery at the institutions.