Miracle-dz/UniFAR-FTUs huggingface dataset:
Validation of Arabic Version of the Modified Dental Anxiety Scale and Assessment of Cut-off Points for High Dental Anxiety in a Saudi Population

Background: Dental anxiety is a common problem faced by the patients and dental health professionals globally. High levels of anxiety in anticipation of encounters in a dental setting have been linked to a myriad of dental problems such as appointment avoidance and increased chair time. To validate the Arabic version of the modified dental anxiety scale (MDAS) and assess cut‑off points for a high dental anxiety in a Saudi population. Materials and Methods: We conducted a cross‑sectional survey at the King Abdulaziz Medical City in Riyadh, Saudi Arabia in December 2012. The survey included randomly chosen Saudi patients aged 18 or above, who attended dental or family medicine clinics during the survey phase. Results: A total of 24 (37.5%) respondents had missed or cancelled dental appointments due to dental anxiety. The internal consistency of MDAS subscales was high with Cronbach's alpha = 0.90. The factor analysis suggested a single dimension solution accounting for 71.7% of the variance.The cut‑off point of 13 had the highest combination of the sensitivity, specificity and the largest area under the curve compared to cut‑off points of 16 and 19 in our study population. Respondents with a history of missed appointments (due to anxiety) scored significantly higher on the MDAS than those who had no history of missed appointments (14.5 ± 5.6 vs. 10.1 ± 4.0, P = 0.001). Conclusion: The Arabic MDAS showed high reliability and validity, supporting its use in further studies among Arabic‑speakers. A cut‑off point of 13 can be used to identify patients who are more likely to exhibit non‑attendance behavior.
Functional recovery and depression mitigation in a case study of chronic stroke receiving intensive, long-duration mobility/fitness training

Purpose: Depression is prevalent among stroke survivors and is associated with a number of adverse health outcomes. However, for those with severe depression after chronic stroke, there is little to no information regarding response of depression to exercise addressing persistent physical impairments and dysfunction or response to exercise therapy for those who are severely depressed. Methods: We enrolled a male stroke survivor at 1.75 years post stroke, with severe depression. Measures collected at preand post-treatment were as follows: Beck Depression (mood); Fugl-Meyer (FM joint movement coordination); Berg Balance Scale (BBS); Timed Up and Go (TUG; mobility); Functional Independence Measure (FIM; subscales of Self-Care, Transfer, Locomotion); Craig Handicap Assessment and Reporting Technique (CHART; quality of life assessment of how patients with disabilities function in the community and at home); 36-Item Short Form Survey (SF36; quality of life measure); and the Stroke Impact Scale (SIS; stroke-specific quality of life measure). Exercise was scheduled as follows: 6mo therapy, five times/wk (1–2.5hrs/session); and additional 6mo, 2-3times\wk, and included aerobic exercise and coordination/strength training for balance and gait. The treatment protocol included exercises for balance and coordination of the lower limb, strengthening, gait coordination, and aerobics exercise on a stationary cycle. Results: Depression improved from severe to mild. The initial presence of severe depression did not preclude significant improvement in mobility and life role participation. Clinically significant gains were exhibited, not only in depression, but also in balance, mobility, and activities of daily living. Moreover, his quantified changes included clinically significant progression to categories of ‘low fall risk’ and ‘functionally independent’. He achieved important clinical and functional goals, as reflected by improved scores in measures of life role participation and personal milestones. Conclusion: Though this is a case study, it is reasonable to consider that a long-duration exercise program can be of great benefit in terms of functional and quality of life gains, regardless of the initial presence of severe depression. *Correspondence to: Daly JJ, Ph.D., Professor, Department of Neurology, College of Medicine, University of Florida, Director, Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Florida, Tel: 1-216-402-8940; E-mail: janis.daly@neurology.ufl. edu
Novel Biomarkers for Prediction of Response to Preoperative Systemic Therapies in Gastric Cancer

Preoperative chemo- and radiotherapeutic strategies followed by surgery are currently a standard approach for treating locally advanced gastric and esophagogastric junction cancer in Western countries. However, in a large number of cases, the tumor is extremely resistant to these treatments and the patients are exposed to unnecessary toxicity and delayed surgical therapy. The current clinical trials evaluating the combination of preoperative systemic therapies with modern targeted and immunotherapeutic agents represent a unique opportunity for identifying predictive biomarkers of response to select patients that would benefit the most from these treatments. However, it is of utmost importance that these potential biomarkers are corroborated by extensive preclinical and translational research. The aim of this review article is to present the most promising biomarkers of response to classic chemotherapeutic, anti-HER2, antiangiogenic, and immunotherapeutic agents that can be potentially useful for personalized preoperative systemic therapies in gastric cancer patients.
Cognitive assessment in healthy and pathological aging

The current demographical development leads to a growing number of older people and thereby to an increase in patients suffering from age-related diseases like dementia. Facing this healthcare challenge requires an efficient and accurate diagnostic process. An understanding of healthy cognitive aging is essential to recognize and investigate pathological states. Further the diagnostic accuracy of a given tool needs to be assessed in the clinical setting where it is ultimately applied. The aim of the present doctoral thesis is to provide insights into the cognitive performance of cognitively healthy older individuals and to assess the diagnostic accuracy of a well-known tool in a realistic clinical routine setting. We found demographic-related effects on cognitive performance in 283 cognitively healthy individuals who were assessed with two different cognitive assessment tools: the Montreal Cognitive Assessment (MoCA) and a newly developed computerized cognitive assessment (CogCheck). Adjusting for these effects by converting raw scores to standard scores, lead to higher specificity of the MoCA. In a second study, we investigated the diagnostic accuracy of the original MoCA cut-off (25/26) in a clinical routine setting to differentiate cognitive normal findings from patients with a neurocognitive disorder (NCD; N = 496). While the original cut-off yielded high sensitivity, its specificity was poor. The classification rate increased when a lower cut-off score (23/24) was applied. However, sensitivity to detect mild NCD was low. We therefore proposed a new way to evaluate cognitive performance: Combining two separate cut-offs (23/24 and 26/27) with a gray area allows for both, high specificity and high sensitivity. Additional examinations are required in the gray area between these two cut-offs. Finally, we have found important heterogeneities in the methodology of cognitive normative studies. This information may guide future endeavors to create guidelines for the definition of cognitive health, which is a baseline requirement to investigate pathological changes. As an outlook, methodological reflections on the evaluation of cognitive assessments are given and the role of neuropsychology in the age of digitalization is discussed.
Determinant of Quality of Life in Patients with Chronic Cerebral Infarct

This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.
Risk factors of knee fractures: A clinical study

Background: Knee fractures are a common encountered condition in the orthopedic OPD these days. Hence; the present study was undertaken for assessing the risk factors of knee fractures. Materials & methods: A total of 86 patients with knee fractures were enrolled in the present study. Complete demographic details of all the patients were obtained. A Performa was prepared for recording the risk factors for knee fractures. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. One-way Chisquare test was used for assessment of level of significance. Results: Mean age of the patients of the present study was 62.5 years. 46 patients in the present study were male while the remaining 40 patients were females. Among the 40 females with knee fractures in the present study, 28 were postmenopausal. There were 55 obese patients. Osteoporosis was found to be present in 48 patients. Conclusion: Increasing age, postmenopausal status and presence of obesity are all significant risk factors for the occurrence of knee fractures.
Correlation Between Birth Defects and Dietary Nutrition Status in a High Incidence Area of China

Objective To investigate the association between birth defects and dietary nutrient intake in a high risk area of China. Methods A dietary survey was performed and serum folic acid was measured in women whose pregnancy was affected by neural tube defects (NTDs) or unaffected by any birth defects (BDs) in Zhongyang and Jiaokou Counties in Shanxi Province of China. Results The local average consumption of foods including dark green vegetables, fruits, fat and meat, and nutrient intake (e.g. energy, protein, retinol, riboflavin, vitamin E, and selenium) were lower than the national average level. In women of childbearing age, these regions, the intake of nutrients was much lower than the recommended nutrient intake (9%-77%). The case-control dietary nutrition study of women whose pregnancy was affected by BDs (including NTDs and congenital heart defects) demonstrated that, in early pregnancy, adequate nutrition (i.e. eating meat, fresh vegetables, fruit more than once a week) was a protective factor, while eating germinated potatoes was a risk factor. The geometrical mean (p5-p95) of serum folic acid in women with NTD birth defects was 9.6 nmol/L (3.6, 23.03), which was significantly lower than that in normal women (14.03 nmol/L). Conclusion Women of childbearing age in the two counties of Shanxi Province, China, have a marked insufficient intake of some nutrients, especially folic acid, zinc, vitamins A and B12. This nutrient deficiency may be an important risk factor for the high prevalence of birth defects in these regions. Therefore, adequate dietary nutrition in early pregnancy can prevent BDs.
From cardiac output to peripheric perfusion: the perfusional pathway—a case report

We reported the case of a 75-year-old man, who undergone pulmonary lobectomy and on whom we performed renal doppler ultrasound measuring renal doppler resistive index (RDRI) to detect renal and global hypoperfusion. RDRI turned out be earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion. He developed septic shock and a myocardial infarction. His laboratory test and vital parameters suggested a critical condition, on the other hand the blood gas test showed a normal value of lactate and the central venous oxygen saturation (SvcO2) wasn’t altered. During an episode of hypotension, we performed a cardiopulmonary ultrasound that revealed a condition of fluid responsiveness. His renal (RDRI) was 0.75. After a fluid challenge both vital signs and ultrasound measurement improved as we expected. RDRI also decreased to normal values, suggesting an enhancement of kidney and global perfusion. We may point out that performing renal doppler ultrasound and measuring RDRI could allow to detect renal and global hypoperfusion evidently earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion.
Anterior cruciate ligament injury risk is modified by the timing of the successful identification of directional cues

Despite our best efforts, anterior cruciate ligament injury rates remain high in many athletic populations. Over the past two decades, investigations have sought to identify the potential role cognition may play in the functional injury mechanism. Across the body of literature, there is a general consensus that rapid, reactive environments found in team sports increase injury risk. But the precise biomechanical change in lower extremity control has been inconsistently identified across multiple investigations. We previously identified that an important, often uncontrolled component of rapid reactive movements is the timing of the directional cue to which the athlete responds. Reductions in time that the athletes have available to react to this directional cue undermines lower extremity control and may increase injury risk. In sport, this may be caused by a deceptive opponent masking their movement direction. We sought to further explore components of perception and action that may alter this available time to react. Across three investigations, we explored the potential effects of performance demands, erroneous movement direction predisposition, and more information-rich, probabilistic directional cues and their impacts on ACL injury risk factors. We identified that contexts that may delay the identification of the correct directional cue are likely to result in a reduction of lower extremity control, which may alter injury risk and decrease performance. We suggest that factors that may alter perception and action time, such as neurocognitive ability and sports expertise, be trained to reduce the risk of injury in reactive environments.
Medication Adherence During Adjunct Therapy With Statins and ACE Inhibitors in Adolescents With Type 1 Diabetes

OBJECTIVE Suboptimal adherence to insulin treatment is a main issue in adolescents with type 1 diabetes. However, to date, there are no available data on adherence to adjunct noninsulin medications in this population. Our aim was to assess adherence to ACE inhibitors and statins and explore potential determinants in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS There were 443 adolescents with type 1 diabetes recruited into the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) and exposed to treatment with two oral drugs—an ACE inhibitor and a statin—as well as combinations of both or placebo for 2–4 years. Adherence was assessed every 3 months with the Medication Event Monitoring System (MEMS) and pill count. RESULTS Median adherence during the trial was 80.2% (interquartile range 63.6–91.8) based on MEMS and 85.7% (72.4–92.9) for pill count. Adherence based on MEMS and pill count dropped from 92.9% and 96.3%, respectively, at the first visit to 76.3% and 79.0% at the end of the trial. The percentage of study participants with adherence ≥75% declined from 84% to 53%. A good correlation was found between adherence based on MEMS and pill count (r = 0.82, P < 0.001). Factors associated with adherence were age, glycemic control, and country. CONCLUSIONS We report an overall good adherence to ACE inhibitors and statins during a clinical trial, although there was a clear decline in adherence over time. Older age and suboptimal glycemic control at baseline predicted lower adherence during the trial, and, predictably, reduced adherence was more prevalent in subjects who subsequently dropped out.
Adverse Childhood Experiences and Trauma-Informed Care: An Online Module for Pediatricians

Introduction The epidemic of adverse childhood experiences (ACEs) has many known health consequences. Robust research has linked ACEs to increased morbidity and mortality. Because of their frequent interaction with children and their families, pediatricians should be educated to recognize ACEs and practice trauma-informed care (TIC). There is a lack of education for pediatric residents on ACEs despite their significance. Our goals were to identify residents’ baseline perceived importance, confidence, and frequency of discussion of ACEs, TIC, toxic stress, and resiliency and evaluate the efficacy of an educational module addressing these topics. Methods A 25-minute self-directed module was created for pediatric residents. The module was accessible online and independently completed by residents during the child advocacy rotation. Pre- and postmodule surveys using a 5-point Likert scale (1 = low, 5 = high) were administered, and median scores of 11 participants who completed both surveys were compared using the Wilcoxon signed rank test. Results Presurvey results demonstrated that residents were not confident discussing ACEs, TIC, or resiliency (median = 2). Residents reported that it was very important to discuss ACEs, toxic stress, and resiliency with families (median = 5), although they were rarely discussed in clinic (median = 1 or 2). Matched pre/post data showed significant increases in knowledge, confidence, and discussion frequency. Discussion The results demonstrated a need for ACE education for pediatric residents. The matched survey results showed the module's success in knowledge and behavior change. The module can be adapted to other learners to enhance understanding of ACEs.
Epidemiological and nosological structure of patients with chronic heart failure according to institutions of tertiary level of healthcare of the Kyrgyz Republic

Objective: To define epidemiological and nosological structure of patients with chronic heart failure (CHF) according to hospitals of tertiary level of the Kyrgyz Republic (National Center of Cardiology and Therapy and Scientific Research Institute of Heart Surgery and Organs Transplantation). Methods: Overall, 25415 patients medical records, patients of all ages provided treatment in the period of 2017 - 2018 in hospitals of tertiary level of the city of Bishkek were studied and analyzed. We also retrospectively studied cases with CHF referred to SRIHSOT outpatients department from city of Bishkek, observed from 2005 to 2018. In total, we included 3420 outpatient cards in the analysis. Results: According to National Center of Cardiology and Therapy, patients with NYHA FC I-II - 57.18% (14533) prevail and in this category, female persons - 57.60% prevail. The basic etiological reason of development of CHF in adult patients with FC – I-II is coronary heart disease in 33.00% of cases. Arterial hypertension, which occurred in 5624 patients (24.43%), was the most frequent accompanying pathology. According to Scientific Research Institute of Heart Surgery and Organs Transplantation among the referred patients with CHF the females (1930, 56.4%) prevail and patients with CHF and preserved ejection fraction (50% and more) (2706, 79.1%) prevail. Conclusion: Thus, in patients with CHF referred to NCCT, patients with FC I-II prevail and in this category female sex prevail. The main etiological reason of development of CHF in adult patients with FC – I-II is coronary artery disease followed by arterial hypertension. Among patients with CHF referred to SRIHSOT, female sex and CHF with preserved ejection fraction prevail. The 1st stage of CHF is registered in the majority of patients. Overall 72.4% of patients referred to SRIHSOT with CHF underwent surgery.
Effects of intravenous methylprednisolone on intraoperative
 neurophysiological monitoring during spinal cord tumor surgery: a case
 report

In spinal cord tumor surgery, muscle motor-evoked potentials (mMEPs) and direct wave (D-wave) have been used to predict neurological outcomes. A severe deterioration of mMEPs in the presence of intact D-wave may indicate temporary postoperative weakness. A 58-year-old man complaining of lower extremities’ weakness was diagnosed as cavernous malformation at T3/T4 level. During removal surgery, the amplitudes of mMEPs were reduced more than 80% in the right tibialis anterior and abductor halluces compared to the baseline in the absence of a change in D-wave. After administration of high-dose intravenous methylprednisolone (IVMP), the D-wave considerably amplified while the mMEPs did not change. The postoperative motor score was increased. This is the first report of the large amplification of D-waves immediately after administration of IVMP. It is suggestive that perioperative administration of high-dose IVMP immediately after the detection of the significant reduction of mMEPs amplitudes may improve neural conduction during spinal cord surgery.
Assessment of epicardial adipose tissue in young obese children

ABSTRACT Objective: Epicardial adipose tissue thickness (EATT) is suggested to play a role in the development of cardiovascular disease. In adolescents it is correlated with BMI z-score, cardiovascular risk factors, and pro- and anti-inflammatory markers. EATT of overweight/obese children was compared with EATT of normal weight peers (cross-sectional design). We investigated the association between EATT, cardiovascular risk factors and pro- and anti-inflammatory markers and the effect of a one year, multidisciplinary, treatment program on EATT in overweight/obese children (longitudinal design). Methods: EATT was measured by echocardiography (25 obese, 8 overweight and 15 normal weight children; median age 5.1 years). In the overweight/obese children blood pressure, lipid profile, glucose, insulin, high sensitive CRP, and adiponectin concentrations were measured. In overweight/obese children participating in a multidisciplinary treatment program, measurements were repeated after 4 and 12 months. Results: EATT was significantly higher in the overweight (median 1.38mm) and obese (median 1.57mm) children compared to normal weight children (median 0.87mm). Among obese children EATT was significantly inversely associated with adiponectin (r = −0.485). Conclusions: EATT is increased in overweight/obese children and is inversely associated with adiponectin. Echocardiographic measurement of EATT is easy and might serve as a simple tool for cardio-metabolic risk stratification.