Miracle-dz/UniFAR-FTUs huggingface dataset:
Weighted Association Rules and Scoring Methodology for Cardiovascular Diseases

: Cardiovascular diseases (CVD), including coronary artery disease (CAD), myocardial infarction, and stroke are a group of highly prevalent and deadly diseases. The deaths from cardiovascular diseases were announced as 17.9 million in 2016 and it is expected that this number will reach approximately to 23.6 million by 2030. In order to facilitate the diagnosis and treatment of CVD, several computational approaches and data mining methods have been proposed until now. In this study, Apriori algorithm is utilized to find associations between features and rules based on UCI’s publicly available Cleveland dataset. Additionally, we generate different weighted association rules, which can help medical doctors to stratify patients and thus, propose different treatment approaches for each patient’s sub-category. Performance results show that the Apriori algorithm creates 58 rules when support and confidence parameters are set to 0.1 and 0.9, respectively. Utilizing weighted association rule approach, 6 important rules have been created based on Clinical Important Factors (CIF) and Framingham Heart Study Risk factors (FHS RF) on CVD.
Primary retroperitoneal mucinous cystadenoma in a male patient: a case report

Primary retroperitoneal mucinous cystic neoplasms are very rare, especially in men. To our knowledge, only 13 cases of such neoplasms have been reported in men to date. The most common type is the primary retroperitoneal mucinous cystadenoma, which almost invariably affects females. Most patients present with non-specific symptoms. In this case report, we will describe a case of a 53 year old male patient who presented with raised CEA tumour marker and vague right sided abdominal discomfort. A computed tomography (CT) scan was performed, which revealed a 4.9 × 4.7 × 7.5 cm lobulated retroperitoneal cystic lesion abutting the posterior wall of the mid ascending colon. A laparoscopic excision was eventually performed with complete removal of the retroperitoneal cystic lesion. Subsequent histological assessment confirmed the diagnosis of a primary retroperitoneal mucinous cystadenoma with borderline malignancy. On comparison with a prior CT scan performed about seven and a half years earlier, we managed to derive a doubling rate of about 626 days, which is the first reported case in English literature to document the growth rate of such a tumour. The patient has since been discharged well, with no evidence of tumour recurrence on an interval CT scan.
Infection Control for the Dental Team

Micro-organisms and their properties infection and the spread of micro-organisms infectious diseases of special concern in dentistry patient evaluation and personal protection principles of sterilization and disinfection instrument sterilization surface and equipment disinfection infection control in the laboratory instrument recirculation and office design high-risk patients and health care workers belonging to high-risk groups.
Applicants to Professional Physical Therapist Programs in 2000

&NA; A survey was administered to applicants to physical therapist professional education programs in response to anecdotal reports and discussions among physical therapist educators regarding the perceived decline in applicant pools to physical therapist professional programs. These reductions may have implications on the viability of programs. The American Physical Therapy Association conducted a series of studies of applicants to physical therapist professional education programs between 1991 and 1994. The purposes of the current study were to describe the characteristics of the applicant pool to physical therapist programs for academic year 2000‐2001 and to provide information on the number of programs to which respondents applied. Results confirm that there has been a decline in applicants since the early 1990s. However, the pool of applicants continues to be strong academically. Based on survey results, the authors conclude that academic programs need to be creative and resourceful in developing strategies to reverse the decrease in the number of program applicants.
A SIR Model for Measles Disease Case for Albania

Many models for the spread of infectious diseases in populations have been analyzed mathematically and applied to specific diseases. In this paper we have used SIR model to study the outbreak of measles epidemic in Albania during the year 2018. Two basic parameters of SIR model are determined using least square principle and other numerical techniques. The model can be used to predict in advance the dynamics of the disease and this can help finding the best possible strategies to control its spread.
Discovering opioid users’ medical comorbidities: a data mining approach

ABSTRACT Background: To combat the opioid crisis, scholars have investigated medical comorbidities associated with opioid use; however, the findings are often contradictory. The main problem resides in the lack of controlling for polydrug use, as the combined use of drugs can cause additive and/or synergistic effects. Methods: This study employed the apriori association rule mining algorithm, which has the capability to discover direct associations between opioid use and its comorbidities and further identify new medical comorbidities buried in the dataset as this method can process thousands of variables. Results: After controlling for polydrug use, findings show that sole opioid use associates with high systolic and diastolic blood pressures and high HbA1c, but the combined use of opioids and benzodiazepine or marijuana did not elevate systolic or diastolic blood pressure. Additionally, by including every variable in the database, this study discovered new medical comorbidities such as elevated red blood cell and gastrointestinal problems, which have not been reported in existing studies. Conclusions: The proposed analytical strategy made significant steps toward resolving the conflicting findings, as the combined use can have additive and/or synergistic effects on the medical comorbidities from opioid use. The newly discovered medical comorbidities offer future research topics. Abbreviations: BZD: benzodiazepine; MRN: marijuana; BPS: blood pressure systolic; BPD: blood pressure diastolic; AST: aspartate aminotransferase; ALT: alanine transaminase; BMI: body mass index; RBC: red blood cell count; BUN: blood urea nitrogen; MPV: mean platelet volume; EMR: electronic medical records; IRB: Institutional Review Board; CHFDW: Cerner HealthFacts® Data Warehouse.
Next generation sequencing in early diagnosis of pneumocystis jirovecii pneumonia after chemotherapy: a case report

The incidence of Pneumocystis pneumonia is increasing in immunosuppressive patients. How to diagnose and treat Pneumocystis pneumonia in the early stage has become an important issue for clinicians. The development of Next-generation Sequencing (NGS) provides technical support for the diagnosis of Pneumocystis pneumonia. Case report: A 14-year-old male patient was diagnosed with T lymphoblastoma and treated with chemotherapy. After chemotherapy, the patient developed bone marrow suppression and was complicated with severe pneumonia. He was given endotracheal intubation and ventilator assisted respiration. Samples of patients' alveolar lavage fluid were obtained, and Next-generation Sequencing (NGS) was used for diagnosis, confirming the pathogen as Pneumocystis jiroveci, which was treated by TMP/SMX. The patient's condition gradually improved, and was finally removed from ventilator and endotracheal tube. Pneumocystis jiroveci is a common opportunistic pathogen in immunosuppressive patients, and Next-generation Sequencing (NGS) can be used for rapid diagnosis of Pneumocystis pneumonia, thus improving the clinical therapeutic effect.
Fast Facts for the Clinical Nursing Instructor: Clinical Teaching in a Nutshell

This book provides readers with the theoretical background needed to help them prepare for clinical teaching. As a concise and comprehensive guidebook, "Fast Facts" contains everything a clinical instructor needs to know in order teach both the science and art of nursing, including: organizing the clinical experience; developing relationships with the staff in the clinical facilities; making clinical assignments; planning orientation days; developing clinical rotations; clinical evaluations; and legal issues of clinical education.
Practical approach to a patient with chronic pain of uncertain etiology in primary care

Abstract Chronic pain of uncertain etiology often presents a challenge to both patients and their health care providers. It is a complex condition influenced by structural and physiological changes in the peripheral and central nervous systems, and it directly influences, and is modulated by, psychological well-being and personality style, mood, sleep, activity level and social circumstances. Consequently, in order to effectively treat the pain, all of these need to be evaluated and addressed. An effective management strategy takes a multidisciplinary biopsychosocial approach, with review of all current medications and identification and careful withdrawal of those that may actually be contributing to ongoing pain. The management approach is primarily nonpharmacological, with carefully considered addition of medication, beginning with pain-modulating treatments, if necessary. In this article, we present a primary care approach to the assessment and management of a patient with chronic pain where the cause cannot be identified.
PREVALENCE OF EPISIOTOMY AND FACTORS ASSOCIATED WITH PRACTICE OF EPISIOTOMY AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE: A CROSS SECTIONAL STUDY

ABSTRACTINTRODUCTION: Episiotomy is a surgical incision made on the perineum to widen the vaginal opening for delivery. Although rate of episiotomy decreased, it is still one of the most commonly performed procedures in obstetrics (1). OBJECTIVE: The objective of the study is to determine the prevalence of episiotomy and identify risk factors associated with the practice of episiotomy at (Saint Paul’s Hospital Millennium Medical College) SPHMMC. METHODOLOGY: Hospital-based cross-sectional study was conducted from February 1/2016 to July 1/2016. All mothers who gave birth vaginally were included in the study. Data was entered in to epi info version 7 and exported into SSPS statistical package version 16 and analyzed. Both bivariate and multivariate analysis were used to see the association of the dependent and independent variables with p-value <0.05 considered statistically significant. RESULT: A total of 405 participants were included in the study. The prevalence of episiotomy was 65.4%. Both Bivariate & Multivariate analysis showed that nulliparity, duration of second stage of labor more than 90-minute, instrumental delivery, assisted breech delivery & birth weigh more than 4,000 gm were strongly associated with episiotomy (p- value < 0.005). CONCLUSIONS AND RECOMMENDATIONS: The prevalence of episiotomy (65.4%) at SPHMMC is higher than the findings in other studies in Ethiopia & the WHO’s recommendation of 5- 10%. Nulliparity, duration of second stage of labour more than 90 minutes, instrumental & breech vaginal deliveries and birth weight of more than 4000 gm were independent risk factors for episiotomy. KEYWORDS: Episiotomy, prevalence, risk factors
Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties

PURPOSE Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale. METHODS We performed a longitudinal analysis of the UK Biobank community cohort (502,538 participants, baseline age: 37-73 years, median years of follow-up: 6.2). The ACB was calculated at baseline using 10 scales. Baseline data were linked to national mortality register records and hospital episode statistics. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular event (MACE). Secondary outcomes were all-cause mortality, MACE, hospital admission for fall/fracture, and hospital admission with dementia/delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between ACB scales and outcomes adjusted for age, sex, socioeconomic status, body mass index, smoking status, alcohol use, physical activity, and morbidity count. RESULTS Anticholinergic medication use varied from 8% to 17.6% depending on the scale used. For the primary outcome, ACB was significantly associated with all-cause mortality/MACE for each scale. The Anticholinergic Drug Scale was most strongly associated with mortality/MACE (HR = 1.12; 95% CI, 1.11-1.14 per 1-point increase in score). The ACB was significantly associated with all secondary outcomes. The Anticholinergic Effect on Cognition scale was most strongly associated with dementia/delirium (HR = 1.45; 95% CI, 1.3-1.61 per 1-point increase). CONCLUSIONS The ACB was associated with adverse outcomes in a middle- to older-aged population. Populations identified and effect size differed between scales. Scale choice influenced the population identified as potentially requiring reduction in ACB in clinical practice or intervention trials.
Video-assisted thoracoscopic surgery (VATS) uniportal intrathoracic esophagectomy

Uniportal video-assisted thoracoscopic surgery (VATS) for esophagectomy is becoming popular and several papers have been published in recent years. Our approach is through a 5th or 6th intercostal space on the posterior axillary line and direct view of the posterior mediastinum is possible. Technical details include en bloc dissection of the esophagus with lymph nodes taking pericardium and aorta as the anatomic guides. Azygos vein is divided. Anastomotic technique is based on a double barrel principle with a posterior wall and lateral wall closure using linear staplers. In recent papers results of uniportal VATS esophagectomy are comparable with multiport VATS and open approach in terms of bleeding, oncologic adequacy and operation times. Uniportal VATS intrathoracic esophagectomy is utilized more frequently and despite differences of technical peculiarities in initial reports, it appears to be feasible and applicable in most of the cases.
Therapeutic plasma exchange in familial hemophagocytic lymphohistiocytosis

Abstract Familial hemophagocytic lymphohistiocytosis is a rare, life-threatening disorder characterized by impaired cytotoxicity, hypercytokinemia and immune-mediated organ injury. We report a 7-week-old male of consanguineous parents who presented with fever, pancytopenia and multi-organ failure. Elevated inflammatory markers and hypercytokinemia led to the diagnosis of familial hemophagocytic lymphohistiocytosis, which was confirmed with genetic testing. With the fulminant multiorgan failure, therapeutic plasma exchange was instituted, using the Prismaflex® platform, followed by standard chemo-immunotherapy. There was dramatic reversal of the multi-organ failure and stabilization of the coagulopathy with this neo-adjuvant therapy. Thereafter, he was maintained in clinical remission with chemo-immunotherapy for 3 mo while awaiting stem cell transplantation.
The Predictive Value of Early-Life Trauma, Psychopathy, and the Testosterone–Cortisol Ratio for Impulsive Aggression Problems in Veterans

Background In this study, we examined whether early-life trauma, psychopathy, and the testosterone/cortisol ratio predicted impulsive aggression problems in veterans. Method A sample of 49 male veterans with impulsive aggression problems and 51 nonaggressive veterans were included in the study. Logistic regression analysis was performed with early-life trauma, primary and secondary psychopathy, and testosterone/cortisol ratio as continuous predictor variables; impulsive aggression status was entered as a binary outcome measure. Correlation analyses were conducted to examine pairwise relations among the predictors. Results Results indicated that early-life trauma and secondary psychopathy, but not the testosterone/cortisol ratio or primary psychopathy, were significant predictors of impulsive aggression status. Conclusions The current results indicate that early-life trauma and secondary psychopathy are risk factors for impulsive aggression problems among veterans. Future studies are needed to determine the exact causal relations among the variables examined here.
Sahabat Ibu Balita" Program to Improve Mother's Knowledge and Skills in Monitoring The Growth of Infants Aged 0-6 Months

The first 6 months of infant life is a golden opportunity for early detection, as well as a growth assessment. Special forms of growth and development are stimulation. Stimulation should be done routinely, continuously at every opportunity and in all infants and toddlers. Based on the fact that there are many mothers who do not know how to perform good stimulation and unskilled in stimulating the result is still found the existence of parents who do not provide stimulation of the baby with routine. The purpose of this study was to determine "differences in mother's knowledge and skills in monitoring of growth and development infants aged 0-6 months among mothers who applied “Sahabat Ibu Balita” and those who did not apply the “Sahabat Ibu Balita”. The design of this research was quasi-experiment with pre-posttest with control group. The samples used were parents who had babies aged 0-6 months in the work area of Babakansari Community Health Center. Sample sizw was 66, then divided into 2 groups that was intervention group and control group. They were selected by multistage sampling and executed in December 2016 to January 2017. Result of research by Chi square test there was a significant difference of intervention group and control group on the knowledge and skills. The application of “Sahabat Ibu Balita” as a strategy to support the use of “KIA book” for mother's knowledge and skill in monitoring the growth and development was more optimal. Keywords: Infant, Growth, Knowledge, Skills, “Sahabat Ibu Balita” program
Upregulation of SHIP2 participates in the development of breast cancer via promoting Wnt/β-catenin signaling

Purpose Src homology 2-containing inositol 5-phosphatase 2 (SHIP2) gene is associated with arthrosclerosis, gastric cancer and diabetes. In this study, we revealed that overexpression of SHIP2 is closely implicated with the development of breast cancer (BC). Methods The BC tissue and adjacent cancerous tissue were obtained from BC patients who had underwent mastectomy. BC cells with either overexpression or knockdown of SHIP2 were analyzed to determine cell proliferation, migration, invasion and apoptosis using the CCK-8 assay, colony formation assay, scratch assay, transwell assay and flow cytometry, respectively. A rat BC xenograft model was constructed to explore the role of SHIP2 on tumor growth in vivo. Results The expression levels of SHIP2 in BC tissues and cells were significantly higher than those in adjacent tissues and normal breast cells, respectively. Silencing SHIP2 suppressed BC cells proliferation and promoted apoptosis. Overexpression of SHIP2 enhanced the cells migration/invasion in BC. Moreover, SHIP2 participated in the Wnt/β-catenin pathway by regulating GSK-3β and its downstream genes. β-Catenin activator LiCl could significantly eliminate the effect of si-SHIP2 on BC cells. Moreover, overexpression of SHIP2 increased tumor volume and weight in rat model, and Wnt/β-catenin pathway inhibitor ICG001 reversed the promoting effect of SHIP2 on tumorigenesis. Conclusion Upregulation of SHIP2 could increase the migration, invasion, proliferation, and decrease apoptosis in BC cells. Moreover, SHIP2 participated in the progression of BC via activating the Wnt/β-catenin pathway.
Pain Management and Menopausal Health Outcomes in Multiple Sclerosis

PAIN MANAGEMENT AND MENOPAUSAL HEALTH OUTCOMES IN MULTIPLE SCLEROSIS By Rachel Hannah Jawahar, MPH, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Saba W. Masho, MD DrPH Associate Professor, Division of Epidemiology, Department of Family Medicine and Population Health Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. Methods: We identified 256 post-menopausal women with MS in the Women's Health Initiative Observational Study and examined changes from baseline to 3 years in activities of daily living, physical activity, SF-36 mental and physical component scales (MCS, PCS), and menopausal symptoms. In all adults, experimental studies published after 1965 were included if the sample was not restricted to participants with spasticity or trigeminal neuralgia and participant-reported pain was a primary or secondary outcome. Pain scores were reported as Cohen’s d. Results: Nine percent of post-menopausal women with MS were current smokers and 51% reported current MHT use. Smoking and MHT use had no effect on physical functioning, activities of daily living, or menopausal symptoms. Women with early age at smoking initiation experienced declines in MCS (adjusted β <20 vs. ≥ 25 years: 10.50, 95% Confidence Interval (CI) -2.1 to -18.1; adjusted β 20-24 vs. ≥ 25 years: 8.81, 95% CI: 0.6 to -17.4), but not in PCS. Relative to never MHT users, ever MHT users had higher MCS scores at year 3 compared to baseline (adjusted β: 3.0, 95% CI: 0.4 to 5.6), but no change in PCS. For all adults, transcutaneous electrical nerve stimulation (TENS; Cohen’s d: -3.34), nabixomols (Cohen’s d: -0.61), and dextromethorphan/quinidine (Cohen’s d: -0.22) were reported effective in reducing pain. Conclusions: Smoking prevention efforts should be increased for women with MS. Women with MS may also experience HrQOL gains with MHT, but contemporaneous data on MHT use is needed. TENS may be more effective than pharmacological methods in reducing MS pain.
Safety And Efficacy Of The Application Of The Tumor-Treating Fields (Ttfields) Mechanism Associated With Temozolomide After The Standardized Protocol Of Chemotherapy And Radiotherapy In Patients With Recently Diagnosed Glioblastoma

Abstract: Tumor-Treating Fields is an antineoplastic treatment modality that consists in the application of alternating electric currents directly to the skin in the tumor region. Glioblastoma multiforme is the most common primary brain tumor. Treatment options are limited. A bibliographical review addressing what is significant and new in the medical literature regarding the treatment of glioblastoma with the Tumor-Treating Fields or Novocure mechanism is presented, based on the main research portals. The main objective of this study was to establish the safety and efficacy of the Tumor-Treating Fields approach in the treatment of recently diagnosed glioblastoma. After confirming its safety and efficiency the secondary objective was to establish this approach as the treatment of choice for this pathology. The main articles in English concerning this issue were searched on the portals PUBMED, Cochrane, Lilacs, and Embase. The investigated approach should be added to the first line treatment of glioblastoma in association with microneurosurgery, radiotherapy, and temozolomide.