Miracle-dz/UniFAR-FTUs huggingface dataset:
The performance of medical record review as an instrument for measuring and improving patient safety

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Multicenter Study of Ruxolitinibcombined DEP Regimen As a Salvage Therapy for Refractory/Relapsed Hemophagocytic Lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a refractory immune disorder with a significant risk of death.Current therapies have improved the survival of HLH patients; however, approximately 30% patients do not respond to current therapies. At present, there is nounanimously recommended salvage HLH treatment regimen, and there are a few case reports or clinical reports with small sample sizes concerning salvage therapy after first line treatment failure. Therefore, alternative therapies for relapsed/refractory HLH is needed. Previous studies have found that ruxolitinib can improve the inflammatory status well, but the remission depth is not sufficient. This prospective study aimed to investigate the efficacy of ruxolitinib combined with our previous DEP (doxorubicin-etoposide-methylprednisolone) regimen(DEP-Ru) as a salvage therapy for refractory/relapsed(R/R)HLH.All patients who did not achieve at least partial response 2 weeks after initial standard HLH therapy or relapsed after remission with HLH-94 regimen were enrolled in this study between June 2018 and June 2019. Response to salvage therapy was assessed every 2 weeks after initiation of DEP-Ru therapy and patients were followed until death or until July 2019. Fifty-four R/R HLH patients were enrolled, including 28 cases of Epstein-Barr virus-associated HLH(EBV-HLH), 5 cases of macrophage activation syndrome (MAS), 3 cases of lymphoma-associated HLH, and 6 cases of familial HLH, 1case of pregnancy, 1 case of drug, and 2 cases of infection. There were 8 cases with unknown underlying diseases. One case was lost to follow-up, Eight cases (15.1%) achieved complete response and 31 cases (58.5%) achieved partial response. The overall response was 73.6% (39/53). Thirty two of the 54 patients survived to subsequent chemotherapy or allogenic hematopoietic stem cell transplantation. Our study suggests that DEP-Ru regimen compared with DEP regimen had similar efficacy, and no serious complications such as gastrointestinal bleeding occurred in DEP regimen. DEP-Ru has higher efficacy for MAS and HLH with unknown reason , while EBV-HLH and lymphoma-associated HLH have lower efficacy. DEP-Ru regimen is an effective salvage regimen for R/R HLH, which can prolong patient survival and bridge the gap between HLH and its underlying diseases. This study was registered in the Clinical Trail (ClinicalTrails.gov Identifier: NCT03533790). No relevant conflicts of interest to declare.
Identification of miRNAs correlating with stage and progression of colorectal cancer

Aim: miRNAs control biological processes that are implicated in carcinogenesis, and have been researched as potential biomarkers for colorectal cancer (CRC). The aim of the current study was to evaluate the miRNA expression profile in CRC patients to determine their potential to be used as biomarkers in the disease. Materials & methods: Total 47 tissues and their matched marginal tissues, as control group, were obtained from CRC patients. The transcript levels of a selected panel of 15 cancer-associated miRNAs were quantified via real-time gene expression method. Results: miR-155, miR130a, miR-181b, miR-196a, miR-200c and miR-224 were significantly upregulated, while miR122, miR-132, miR-203b, miR330, miR-323, miR-378a-3p and miR-598 we significantly downregulated in CRC. Conclusion: We identified a panel of miRNAs that may be involved in the etiology and pathogenesis of CRC, and may be used for novel diagnostic and therapeutic strategies.
DYNAMICS OF THE CHANGE OF LEUKOTRIENES SYNTHESIS AND LIPOPEROXIDATION ACTIVITY DURING THE EARLY PERIOD OF THE TREATMENT OF THE PATIENTS WITH DUODENAL PEPTIC ULCER IN COMBINATION WITH ESSENTIAL HYPERTENSION

DYNAMICS OF THE CHANGE OF LEUKOTRIENES SYNTHESIS AND LIPOPEROXIDATION ACTIVITY DURING THE EARLY PERIOD OF THE TREATMENT OF THE PATIENTS WITH DUODENAL PEPTIC ULCER IN COMBINATION WITH ESSENTIAL HYPERTENSION
Carvone Prevents and Alleviates Hepatic Steatosis in Rat Model with Nonalcoholic Fatty Liver Disease

Checked for Plagiarism: Yes Peer reviewers approved by: Dr. Melika Andrew Language Editor: Dr. Valentina Apakidze Editor who approved publication: Prof. Dr. Nanuli Doreulee Abstract Background and purpose: Nonalcoholic fatty liver disease (NAFLD) is known as condition in which fat significantly aggregates in the liver and the use of antioxidants can alleviate its adverse effects. This study was aims to evaluate the effects of carvone on hepatic steatosis and NAFLD by investigation of the lipids in serum and liver. Materials and Methods: Animals were grouped into four groups and studied for 42 days, including rats fed with 1) control diet (Control), 2) high fat diet (HF), 3) HF+50 mg/kg body weight of carvone (50 Carv) and HF+100 mg/kg body weight of carvone (100 Carv). Animals were killed, and blood and liver samples were obtained to evaluate the biochemical analyses including triglyceride, cholesterol, nonesterified fatty acids and thiobarbituric acid-reactive substances (TBARS). Results: Rats fed with HF diet showed higher levels for TBARS, triglycerides and cholesterol in comparison to control group (P<0.05). Dietary inclusion of carvone, especially in the higher levels, could reverse effects of HF on TBARS, cholesterol and triglycerides (P<0.05). Conclusion: Carvone can alleviate hepatic steatosis in animals with NAFLD. It can be suggested to use of the carvone for patients with NAFLD.
Reducing Fall Recurrence in Institutionalized Elderly Residents on Narcotics

Reducing Fall Recurrence in Institutionalized Elderly Residents on Narcotics by Paul Niyungeko MS, Walden University, 2016 BS, University of Burundi, 1994 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2019
Inhalation technique assessment and evaluation for the need of pharmaceutical intervention in respiratory pathologies patients.

OBJECTIVE To evaluate rate and type of errors in inhalation technique of patients seen in hospitals at the observation area in the emergency department, as well as patients seen in the outpatients clinic at the primary care pharmaceutical consultation, and at the community pharmacy. METHOD Descriptive observational study carried out by a hospital pharmacist, along with a primary care pharmacist and a community pharmacist. An anonymous survey was performed in order to collect different analyzed data. Each patient was asked to execute a complete demonstration on how they used their inhalers, to actively check the inhalation technique. Two checklists regarding the type of inhaler were established in order to assess said technique. Results were tabulated through Microsoft Excel® 2010 software and analyzed through R 3.5 statistical program. RESULTS A total of 66 patients (42 male, 24 female; mean age 67) were recruited. Out of all patients, 48.5% used more than one inhaler, which 34.4% used different types of inhaler, and 65.6% used different systems. A total of 39 patients were under dry powder inhaler therapy, and 38 were using pressurized metered dose inhalers. The most frequent errors -both in dry powder inhalers and pressurized metered dose inhalers-were: not performing a 10 second apnea and not slowly expelling air from the lungs. Around 50% of patients needed new learning after assessing their inhalation technique, even though 88.5% had already received previous training. Older aged patients performed a worse inhalation technique. CONCLUSIONS There is a high rate of errors in the use of inhaled therapy, being even higher among older aged patients. The inhalation technique training by the medical staff seems inadequate, as it is crucial to raise awareness about the importance of health education for patients and their use of inhalers, to which a scheduled follow up and a technical and feedback obtained from the patient assessment is required.
Lifestyle Issues and Prevention of Recurrent UTIs

Recurrent UTIs (RUTIs) are mostly caused by frequent sexual intercourse, heterosexual lack of circumcision receptive anal intercourse (without a condom), multiple sexual partners (each sex partner shares his/her UGT microbiota with the other), use of spermicide and a new sexual partner, sexual intercourse with addicted partners, sexual intercourse with sex workers, sexual intercourse with online dating friends, sexual intercourse with a new sex partner within less than 2 months [9-20]. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now [15]. UTIs account for nearly 25% of all infections [16]. Sexual intercourse ≥3 times/week was associated with greater frequency of UTI [21]. Close proximity of the urethral meatus to the anus and shorter urethra, is a likely factor [22-26].
Herpesvirus infections in transplant recipients

Herpesvirus infections are common and can cause serious and life-threatening conditions in transplanted individuals. In this thesis, consisting of 4 papers (I-IV), we investigated primary infection and reactivation of Cytomegalovirus (CMV), Human Herpesvirus type 6 (HHV-6), Varicella Zoster Virus (VZV) and Epstein-Barr Virus (EBV) in transplant patients. The overall aim was to expand our knowledge on the incidence, prophylaxis, management and long-term effects of herpesvirus infections after transplantation. The studies were all retrospective. Results from serum and whole blood analyses by quantitative polymerase chain reaction (PCR) for CMV and HHV-6 in a cohort of 97 adult allo-SCT patients (papers I and II) and CMV and EBV in 58 renal transplanted children (paper IV) were compiled. VZV antibodies were analyzed using ELISA assays and immunofluorescence from blood samples of 85 renal transplanted children (paper
Meningioma - A common tumor with diagnostic challenge

1 Prof. Pathology, Dept. of Pathology, IMS & SUM Hospital 2 Asst. Prof. Pathology, Dept. of Pathology, IMS & SUM Hospital 3 Prof. Neurosurgery, IMS & SUM Hospital 4 Tutor, Dept. of Pathology, IMS & SUM Hospital IMS & SUM Hospital, S‘O’A (Deemed to be University), Kalinga Nagar, Bhubaneswar, Odisha Bhubaneswar *Corresponding Author Dr Anima Hota Asst. Prof. Pathology, Dept. of Pathology, IMS & SUM Hospital, K8, Kalinga Nagar, Bhubaneswar, Odisha Abstract Background: Meningioma are generally solid tumor. Rarely they are associated with cysts and mistaken as glial or metastatic tumor with cystic or necrotic changes. It is easily recognized with modern imaging techniques. Method: A prospective study of 21 meningioma cases was conducted out of total 98 intracranial CNS tumors within a period of 2& 1⁄2 yr i.e., from Sept 2015 to Feb 2018. Cases were studied with clinical findings, radiological appearance and reviewed with histopathological examination using routine haemotoxylene and eosin stain, also immunohistochemical whenever necessary. Results: Of the 21 cases of meningioma; were presented mostly in 5-6 decade with female predominance. Histopathological diagnoses were found to be meningothelial meningioma, transitional meningioma with extremely rare forms like intraparenchymal cystic meningioma, chordoid meningioma, microcystic meningioma & NF2 associated Schwannoma and meningioma.
Gynaecological malignancies after breast cancer diagnosis: A population-based study

Background: Breast cancer (BC) is one of the most prevalent malignancies. BC survivors have higher risk of second primary cancers than the general population. There is an increased interest in BC survivor management, including the prevention of these second cancers. The aim of this study was to assess the risk of gynaecological malignancy (GM) as second neoplasm among BC patients in our population. Methods: Patients with invasive BC diagnosed from 1980 to 2014 included in the Girona Cancer Registry were included. The incidence of second GM in these patients was compared to those in the general population. Second primary cancer was stated as a tumour diagnosed after 2 months from the BC diagnosis. Standardized incidence ratios (SIR) and absolute excess of risk (AER) were calculated. Results: 9,717 patients were diagnosed with invasive BC during this period, with a median age at diagnosis of 61 years, and a median follow-up of 7.9 years. 117 of them developed a second GM. By tumour type, the only statistically signifi cant higher SIR was observed for corpus uteri cancer (SIR:2.28 95% CI 1.82-2.83; AER:6.43 95% CI 4.13-9.14). After reviewing the histology of the corpus uteri cancer cases, we found that 71.4% were type I (endometrioid adenocarcinoma), 15.5% type II (serous adenocarcinomas and clear cell carcinomas), 10.7% carcinosarcomas, 2.4% sarcomas and there were no unspecifi ed malignant neoplasms. Conclusion: BC survivors have an increased risk of corpus uteri cancer, with an increase in unfavourable histologies compared to the general population. Lifelong primary and secondary prevention interventions should be recommended for these patients.
Circadian‐timed quick‐release bromocriptine lowers elevated resting heart rate in patients with type 2 diabetes mellitus

Sympathetic nervous system (SNS) overactivity is a risk factor for insulin resistance and cardiovascular disease (CVD). We evaluated the impact of bromocriptine‐QR, a dopamine‐agonist antidiabetes medication, on elevated resting heart rate (RHR) (a marker of SNS overactivity in metabolic syndrome), blood pressure (BP) and the relationship between bromocriptine‐QR's effects on RHR and HbA1c in type 2 diabetes subjects.
HUBUNGAN PENGETAHUAN DAN SIKAP DENGAN STATUS GIZI PADA SISWA SEKOLAH DASAR DI JAKARTA

ABSTRACT Background: In between 1980 and 2013, there was a remarkable increased of obesity prevalence globally in adults and childhood which are 27,5% and 47,1%, respectively. In addition, good knowledge and positive attitude are very related in order to prevent obesity particularly the behavior. Research Objective: This study had been conducted to find any differences regarding the relationship between knowledge-attitude in both private and public elementary school students (SDS and SDN) with their nutritional status. Method: This was a cross-sectional observational analytic research with a total of 403 students in two private and two public elementary schools in Jakarta.Data was taken with knowledge and attitude questionnaires as the instrument in terms of knowledge. Results: There were 62,7% SDS students with good knowledge whilst 58,1% in SDN. Moreover, more than half participants both in SDN and SDS had a positive attitude with 50,3% and 55,9%, respectively. Meanwhile, SDS participants were more overweight (19,1%; 16,2%) and obese (24,2%; 10,8%) than SDN. Conclusion: A Significant association was found between knowledge and nutritional status in SDN. SDS tended to have a higher number of overweight and obese students than SDN. Keywords: Knowledge, attitude, obesity, elementary school students ABSTRAK Latar Belakang: Prevalensi obesitas meningkat dengan pesat antara tahun 1980 dan 2013 yaitu sebesar 27,5% pada orang dewasa dan 47,1% pada anak-anak. Obesitas dapat menimbulkan berbagai masalah kesehatan baik medis dan psikososial, yang pada akhirnya berdampak pada peningkatan biaya kesehatan suatu negara. Pengetahuan yang baik dan sikap yang positif berkaitan dengan perilaku pencegahan kegemukan dan pada akhirnya akan memengaruhi status gizi seseorang. Tujuan: Penelitian ini dilakukan untuk melihat perbedaan hubungan pengetahuan dan sikap antara siswa SDN dan SDS dengan status gizi mereka. Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain studi potong-lintang. Sampel penelitian adalah semua siswa SD kelas IV dan V di 2 SDN dan 2 SDS berjumlah 403 murid. Pengambilan data menggunakan kuesioner pengetahuan dan sikap. Hasil: Terdapat 62,7% responden SDS memiliki pengetahuan tinggi, sedangkan 58,1% pada siswa SDN memiliki pengetahuan rendah. Lebih dari separuh responden baik di SDN dan SDS mempunyai sikap positif (50,3%; 55,9%). Responden SDS lebih banyak mempunyai status gizi gemuk (19,1%; 16,2%) dan obesitas (24,2%; 10,8%) dibandingkan responden SDN. Kesimpulan: Terdapat hubungan bermakna antara pengetahuan dan status gizi pada SDN. Siswa SDS cenderung mempunyai status gizi gemuk dan obesitas dibandingkan SDN. Kata kunci: pengetahuan, sikap, obesitas, siswa SD
Rotational Atherectomy: A Contemporary Appraisal

Rotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of ‘differential cutting’ and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a ‘pecking’ motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA.
Evaluation of antiulcer activity of Manilkara zapota (Linn) leaves extract in Wistar rats

Aim of the Study: The aim of the study was to evaluate the gastroprotective activity of Manilkara zapota leaf extract in Wistar rats. Materials and Methods: The leaf of M. zapota was air dried in the shade, powdered, and subjected to successive extraction in Soxhlet apparatus. The gastroprotective activity of the ethanol extract of M. zapota was evaluated using aspirin plus pylorus ligation and HCl plus ethanol-induced ulcer models. Results: Phytochemical analysis of various extracts of M. zapota revealed the presence of glycoside, flavonoid, tannins, and phenolic compounds. Ethanolic extract of M. zapota (EEMZ) extract treatment shows potent and effective gastroprotection against aspirin plus pylorus ligation and HCl plus ethanol-induced ulcer models. In pylorus-ligated rats, the extract decreases the secretion of pepsin, gastric acidity, volume, and increases gastric pH, glycoprotein, protein, superoxide dismutase, catalase, and non-protein sulfhydryl levels. In the HCl plus ethanol-induced rats, the EEMZ treatment significantly increased the prostaglandin secretion and protects the gastric mucosa compared to the control group rats. Conclusion: The results of the study showed that EEMZ possesses a preventive effect against gastric ulcer model in the experimental animals.
Survival prediction in patients with chronic obstructive pulmonary disease following a pulmonary rehabilitation programme in Hong Kong

Background and objective Pulmonary rehabilitation programme (PRP) is an important component in the management of chronic obstructive pulmonary disease (COPD). However, to date so far there has been limited literature on the survival outcomes of patients with COPD after a PRP in Hong Kong. This study aimed to investigate the outcomes of a pulmonary rehabilitation programme on the survival rates of a retrospective cohort of patients with COPD. Methods This was a retrospective study that included subjects who participated in the PRP in a rehabilitation hospital from the year 2003 to 2015. A total of 431 patients with chronic obstructive pulmonary disease were identified from the electronic record system of the hospital. The dataset were split into two age groups for reporting and analysis using the mean age of 72 as the cut-off. Their median survival times were calculated using Kaplan–Meier analysis. Cox-proportional regression model was used to explore factors that predicted better survival. The most significant predictors were used as strata, and their respective effects on survival functions were analysed with Kaplan–Meier analysis again. Results The overall median survival of the cohort was 4.3 years. The median survival times of the younger patient group (aged <72) and the older patient group (aged ≥72) were 5.3 and 3.6 years, respectively. For the patients, aged <72 years old, Moser’s Activities of Daily Living class and the pulmonary rehabilitation programme completion rate were the most significant survival predictors. For the patients aged ≥72 years old, Monitored Functional Task Evaluation score was the most significant survival predictor. Conclusion Moser’s Activities of Daily Living class ≥2 and non-completion of PRP for younger group, low exercise capacity with Monitored Functional Task Evaluation score <17 for older group were identified as significant predictors of poor survival. The findings of this study helped identifying those patients with COPD who have the needs to be more intensively treated and closely monitored.
Prevalence of Ametropia, Amblyopia and visual impairment in schoolchildren in Ireland

I DECLARATION . III ACKNOWLEDGEMENTS . IV ABBREVIATIONS . V TABLE OF CONTENTS . 1 LIST OF TABLES . 13 LIST OF FIGURES . 16 1 AMETROPIA, AMBLYOPIA AND VISUAL IMPAIRMENT IN SCHOOLCHILDREN IN IRELAND . 21 1.1 Importance of epidemiological eye care studies . 21 1.2 Introduction . 22 1.2. 1 Study aims and objectives. 22 1.3 Ireland Eye Study background . 23 1.3. 1 Refractive errors . 23 1.3. 2 The cost burden of uncorrected refractive error . 25 1.3. 3 Amblyopia . 28 1.3. 4 Academic attainment and visual impairment. 30 1.3. 5 Paediatric eye care services in Ireland . 30 1.4 Conclusion . 34 2 EPIDEMIOLOGICAL REFRACTIVE ERROR AND VISUAL IMPAIRMENT STUDY REVIEW . 36 2.
The Adrenergic Mechanism in the Implementation of the Cholinergic Anti-Inflammatory Pathway

Experiments on random-bred albino mice showed that application of β2ARs agonist (hexaprenaline sulfate, 1,5 μg/kg, a single dose) and α7nAChRs agonist (GTS-21, 15 mg/kg, a single dose) cause a significant decrease in the mortality of mice from experimental sepsis (i.p., E. coli O157:H7) when it is modeling 2h after using these drugs due to a decrease of the concentration of proinflammatory cytokines TNF-α, IL-1β, and IL-6 (implementation of the cholinergic anti-inflammatory pathway). It has been experimentally established that the adrenergic mechanism (action of β2ARs agonist) is an important component in the implementation of the cholinergic anti-inflammatory pathway. The combined use of β2ARs and α7nAChR agonists determines their additive effect.