Miracle-dz/UniFAR-FTUs huggingface dataset:
Designing and Evaluating an Empowering Program for Breastfeeding: A Mixed-Methods Study.

BACKGROUND Breastfeeding empowerment is a key motivational, psychological and flexible factor influencing the continuance of breastfeeding. The purpose of this mixed-methods study was to design and evaluate the empowering program for breastfeeding. METHODS We used a mixed-methods study with a sequential exploratory approach. In the qualitative phase, we explored the experiences of women about empowerment for breastfeeding using conventional content analysis. In the intervention phase, we designed and implemented a breastfeeding empowerment program based on the findings of the qualitative phase and evaluated it 2 weeks, 2 months and 4 months after childbirth. This randomized clinical trial is registered under IRCT2015081723657N1. RESULTS Analysis of data from the interviews in the qualitative phase yielded three main categories, namely "adequate knowledge and skills about breastfeeding", "overcoming breastfeeding problems" and "perception of family support for breastfeeding". In the qualitative phase, after implementing the program, the mean scores of breastfeeding empowerment were significantly higher in the intervention compared to the control group at 2 weeks (mean difference= -25.30; 95% CI = -5.36, -15.23), 2 months (mean difference = -21.71; 95% CI = -31.24, -12.19), and 4 months (mean difference = -17.72; 95% CI = -27.14, -8.30) after childbirth (P<0.001). In addition, exclusive breastfeeding was significantly higher in the intervention group at 2 weeks, 2 months and 4 months after childbirth (P=0.003, P=0.003, P=0.044, respectively). CONCLUSION To empower women for breastfeeding, the mother, father and key family members should be educated using practical and visual teaching techniques during pregnancy and postpartum period. Moreover, since breastfeeding empowerment is established 2 weeks after childbirth, empowering programs should be implemented prior to this period.
Brivaracetam in the treatment of epilepsy: a review of clinical trial data

Abstract Brivaracetam (BRV), an analog of levetiracetam (LEV), was discovered during a target-based rational drug discovery program that aimed to identify potent synaptic vesicle protein 2A (SV2A) ligands. Among the 12,000 compounds screened in vitro, BRV was found to have 15–30 times greater affinity for SV2A and faster brain permeability than LEV. Although preclinical and post-marketing studies suggest broad spectrum of efficacy, BRV is currently only approved as monotherapy and adjunctive therapy of focal-onset seizures in patients age 4 years and older. This review examines the use of BRV as add‐on (5–200 mg/day) therapy for epilepsy with a particular emphasis on the six regulatory randomized clinical trialsinvolving 2399 participants. Participants receiving BRV add‐on at doses of 50–200 mg/day were more likely to experience a 50% or greater reduction in seizure frequency (pooled risk ratio [RR]) 1.79 with 95% CI of 1.51–2.12) than those receiving placebo. Participants receiving BRV were also more likely to attain seizure freedom (57 [3.3%] vs 4 [0.5%]; RR 4.74, 95% CI 2.00–11.25) than those receiving placebo. In addition, BRV demonstrated a favorable safety profile similar to placebo across all BRV doses. Treatment emergent adverse events significantly associated with BRV were irritability, fatigue, somnolence, and dizziness. Post-hoc analysis of regulatory trials, post-marketing studies, and indirect comparison meta-analyses demonstrated equivalent efficacy and better tolerability of BRV when compared to other antiseizure drugs. Further, these studies appear to suggest that behavioral adverse events are likely to be less frequent and less severe with BRV than LEV. Therefore, switching to BRV may be considered for patients who have seizure control with LEV, but who cannot tolerate its behavioral adverse effects. In this setting, immediate switch from LEV to BRV at a 10:1–15:1 ratio without titration is feasible. Further research is needed to examine the long-term tolerability and efficacy of BRV as well as its role in the treatment of other types of epilepsies, particularly dementia-related epilepsy and brain tumor-related epilepsy.
Plasticidad neuronal funcional

Introduccion. Gracias a las aportaciones de la investigacion en neurociencias y las evidencias clinicas en relacion con la recuperacion funcional del sistema nervioso central, en las distintas esferas motora, cognitiva, linguistica y sensorial, conocemos mas sobre la construccion del cerebro y sus modificaciones. La base de esta recuperacion reside en la plasticidad cerebral, capacidad de reorganizar y modificar funciones adaptandose a los cambios externos e internos. Es inherente a las celulas cerebrales, permite la reparacion de circuitos corticales, integra otras areas corticales para realizar funciones modificadas y responde a diversas afecciones. Depende de factores geneticos, neuronales y neuroquimicos, y sus limites pueden manipularse desde la intervencion clinica y farmacologica. Desarrollo. La capacidad del cerebro de adaptarse a los cambios es crucial en el neurodesarrollo y tiene importantes implicaciones en el aprendizaje. Los cambios neuroanatomicos, neuroquimicos y funcionales que acontecen durante la reorganizacion por plasticidad facilitaran la recuperacion-adquisicion de funciones afectadas (plasticidad adaptativa) y podran dificultar el desarrollo de otras (plasticidad maladaptativa). Esta variabilidad de respuesta tiene relacion con la cronologia de la lesion, el locus afectado, el estado de los sustratos que pueden asumir la funcion y el tipo de funcion alterada. Los mecanismos responsables de facilitar esta plasticidad son diferentes en cada momento (plasticidad rapida y tardia), dependiendo de la funcion alterada con expansion de representaciones somatotopicas en el cortex motor adyacente al dano, transferencia interhemisferica de lenguaje o plasticidad cruzada en funcion auditiva o visual. La patologia neuropsicologcia puede aparecer de forma asociada a la lesion o de forma secundaria a una plasticidad maladaptativa. Conclusion. Aproximarnos a los mecanismos intrinsecos de plasticidad neuronal y regulacion sinaptica nos llevara a comprender la recuperacion de funciones danadas o perdidas en el cerebro de los ninos con necesidades especiales, y a intervenir favoreciendo la misma desde el plano clinico y farmacologico.
AFC1 Compound Attenuated MI/R-Induced Ventricular Remodeling via Inhibiting PDGFR and STAT Pathway

Background: Effective interventions to improve the outcome of patients subjected to myocardial ischemia reperfusion (MI/R) are urgent in clinical settings. Tanshinone IIA (TSA) is reported to attenuate myocardial injury and improve ventricular remodeling post MI/R. Here, we evaluated the efficacy of AFC1 compound that is similar to TSA structure in murine MI/R models. We found that AFC1 had a comparable effect of improving murine cardiac function after MI/R while it was superior to TSA in safety profile. Administration of AFC1 reduced reactive oxygen species (ROS) production, inflammatory cells infiltration, and the expression of platelet derived growth factor receptors (PDGFR) in infarcted myocardium. Treatment with AFC1 also attenuated MI/R-induced cardiac remodeling and contributed to the recovery of cardiac function. Additionally, AFC1 reversed the elevation of PDGFR expression induced by PDGF-AB in both neonatal rat cardiomyocytes (NCMs) and neonatal rat cardiac fibroblasts (NCFs) and suppressed PDGF-AB induced NCM hypertrophy via STAT3 pathway and NCF collagen synthesis through p38-MAPK signaling in vitro. Similarly, AFC1 may contribute to the recovery of cardiac function in mice post MI/R via suppressing STAT signaling. Our results confirmed that AFC1 exerts anti-hypertrophic and anti-fibrotic effects against MI/R-induced cardiac remodeling, and suggest that AFC1 may have a promising potential in improving the outcome of patients who suffered from MI/R.
Methadone vs. morphine SR for treatment of neuropathic pain: A randomized controlled trial and the challenges in recruitment

ABSTRACT Introduction Accumulating evidence has identified a number of advantages for methadone over other opioids for the treatment of chronic pain including: agonist action at both μ and δ opioid receptors, N-methyl-d-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines. It was hypothesized that with these three mechanisms of action methadone might be a good option for the treatment of neuropathic pain. Methods This was a double-blind randomized controlled trial comparing methadone to controlled-release morphine. The primary objective was to determine whether methadone is clinically inferior versus noninferior to morphine as an analgesic. Results We attempted recruitment at three academic pain centers over a 3-year period. In the end only 14 participants were able to be recruited; 5 withdrew and only 9 completed the trial. This study was underpowered. All participants showed a mean reduction in pain intensity according to the Numeric Rating Scale for Pain Intensity (morphine 5.86 to 4.38, methadone 6.11 to 4.5) and reported pain relief compared to pretreatment, but the sample size was too small for statistical analysis. Discussion Reasons for challenges in recruitment included tight inclusion and exclusion criteria and high participant burden. In addition, there was significant heterogeneity of patients between the three sites, leading to differences in reasons for exclusion. This included seemingly disparate reasons at the different sites, including few participants who were methadone naïve vs. avoidance or fear of opioids. In the end, we were unable to answer the question of the study.
A case report of retrograde suction decompression of a large paraclinoid aneurysm

Surgical clipping of large Paraclinoidal IC (Internal carotid) aneurysm pose a great challenge as there are adhesions hindering exposure of aneurysm dome and parent artery . Obtaining adequate visualization of the aneurysm neck is very difficult in these aneurysms, also in the access of proximal control. There are many methods to obtain a proximal control in these aneurysms. Retrograde suction decompression provides adequate visualization of the aneurysm neck and its relation with the optic apparatus. Retrograde suction decompression can be done by many methods. The technique done via open catheterization of superior thyroid artery is readily accessible and provides adequate relaxation of the aneurysm dome enabling complete dissection of the aneurysm from the surrounding important neurovascular structures. In this report of a case of left Paraclinoidal ICA aneurysm which was clipped applying this method, we elaborate on the technique and discuss other methods available for proximal control in these difficult aneurysms.
IL-6 Activities in the Tumour Microenvironment. Part 1

The predominant role of IL-6 in cancer is its key promotion of tumour growth. IL-6 binds IL-6 receptor (IL-6R) and the membrane-bound glycoprotein gp130. The complex I-6/IL-6R/gp130 starts the Janus kinases (JAKs) and signal transducer and activator of transcription 3 (STAT3) or JAK/STAT3 pathway. IL-6 R exits in two forms: a membrane-bound IL-6Rα subunit (mIL-6R) that participates in classic signalling pathway and soluble IL-6R subunit (sIL-6R) engaged in trans-signalling. The pro-tumour functions of IL-6 are associated with STAT3, a major oncogenic transcription factor that triggers up-regulation of target genes responsible for tumour cell survival. IL-6 combined with TGF-β induces proliferation of pathogenic Th17 cells. The anti-tumour function of IL-6 is the promotion of anti-tumour immunity. IL-6 trans-signaling contributed to transmigration of lymphocytes in high endothelial venules (HEV). Dendritic cell (DC) secreted IL-6 in the lymph node influences the activation, distribution and polarisation of the immune response. Elevated serum levels of IL-6 and increased expression of IL-6 in tumour tissue are negative prognostic marker for patients’ survival.
The Comparison of the Effects of Intra-articular Ozone and Polynucleotide Gel Injections in Pain Management of Knee Osteoarthritis

Diz osteoartriti tedavisinde farmakolojik ve farmakolojik olmayan bircok tedavi yontemi mevcuttur. Intra-artikuler ozon ve polinukleotid jel (Condrotide) enjeksiyonlari da son yillarda diz osteoartriti tedavisinde populer olmustur. Buna ragmen bu tedavi yontemlerinin klinik degeri ve maliyet-etkinlikleri tam olarak ortaya konmamistir. Bu calismada osteoartrite bagli diz agrili hastalarda intra-artikuler ozon ve polinukleotid jel enjeksiyonlarinin 12 haftalik takip surecinde etkinliklerini karsilastirmak amaclanmistir. Calismanin verileri Ocak 2018 ve Agustos 2018 tarihleri arasinda diz osteoartritine bagli diz agrisi olan hastalarin verileri retrospektif olarak taranarak elde edilmistir. Calismaya diz bolgesine rutin bir protokolde intra-artikuler ozon (n=30) veya polinukleotid jel (n=32) uygulanan hastalar dahil edilmistir. Birinci gruptaki hastalara haftada bir olacak sekilde 4 seans intra-artikuler ozon enjeksiyonu; 2. gruptaki hastalar 1 seans polinukleotid jel uygulanmistir. Hastalarin agriya yonelik degerlendirmeleri tedavi oncesi, tedaviden 5 hafta sonra ve tedaviden 12 hafta sonra Numerik Agri Skalasi kullanilarak yapilmistir. Her iki grupta da tedavi oncesi ile kiyaslandiginda 5. hafta ve 12. hafta degerlendirmelerinde anlamli gelisme gozlenmistir (p<0.001). Gruplar arasinda 5. hafta (p=0.855) ve 12. hafta (p=0.554) degerlerinde istatistiksel olarak anlamli fark gozlenmemistir. Tedavi sureclerinde beklenmeyen bir yan etki raporlanmamistir. Bu nedenle, osteoartrite bagli diz agrisi olan hastalarda intra-artikuler ozon enjeksiyonu tedavisinin agriyi azaltmada en az polinukleotid jel enjeksiyonu kadar etkili olabilecegi dusuncesindeyiz. Bu veriler isiginda daha ileri duzeyde bilimsel kanit icin daha fazla calismaya ihtiyac vardir.
Prevalence and Associated Factors of Anemia among Pregnant Women Receiving Antenatal Care (ANC) at Fatima Hospital in Jashore, Bangladesh: A Cross-Sectional Study

Since anemia is one of the most skyrocketed public health problems worldwide, an investigation has thus been conducted to assess the prevalence and associated factors of anemia among the pregnant women receiving antenatal care (ANC) at Fatima Hospital in Jashore, Bangladesh. Facility-based cross-sectional study was carried out among 384 pregnant women at Fatima hospital, Bangladesh from February to April, 2019. Data were obtained using a structured questionnaire and participant’s current medical record card. Binary logistic regression analysis was used to identify factors associated with anemia and a P-value 62.4% (141/226) were moderately anemic and 1.3% (3/384) was severely anemic. Binary logistic regression analysis revealed that the following variables were significantly associated with anemia: Monthly family income (11,000 - 20,000 Taka) [AOR (95% CI) = 0.45 (0.21 - 0.98)], Family size (joint) [AOR (95% CI) = 1.59 (1.03 - 2.45)], Gestational age (third trimester) [AOR (95% CI) = 2.18 (1.40 - 3.40)], birth spacing
Biochemical and Oxidative Changes in High Fat Diet/Streptozotocin-induced Diabetic Rats Treated with Metformin and the Polyherbal Diawell

Diabetes mellitus is an epidemic, with a huge disease burden on the patients. This has led to an increase in the use of herbal remedies and combination therapies to reduce this burden. Aim: This study evaluates the biochemical and oxidative changes in type 2 diabetic rats, treated with metformin and the polyherbal drug diawell. Methodology: A total of 35 male Wistar albino rats weighing between 120-220 g were used for this study. The rats were placed on high fat diet, and diabetes was induced by a single intraperitoneal injection of freshly prepared streptozotocin (STZ) (45 mg/kg body wt). Fasting plasma glucose (FPG) was determined using the glucose oxidase method. Fasting plasma insulin (FPI), total oxidant status (TOS), total antioxidant status (TAS) and superoxide dismutase (SOD) levels were quantitatively determined by a rat-specific sandwich-enzyme linked immunosorbent assay (ELISA) method. Insulin resistance (IR) was determined using the homeostatic model assessment for insulin resistance (HOMA-IR) method. Oxidative stress index (OSI) was determined by the ratio of TOS to TAS. Phytochemical analysis was also done on the herbal tablet. Results: Mean FPG levels were significantly lower (p˂0.05) in all groups, except the group administered diawell, which was not significantly different (p>0.05), compared to the diabetic control. Mean FPG levels were significantly higher (p˂0.05) in the metformin group, diawell group, but showed no significant difference (p>0.05) in the combination group, compared to the negative control. HOMA-IR was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The metformin and diawell groups had significantly higher (p˂0.05) HOMA-IR values, whereas the combination (metformin + diawell) showed no significant difference (p>0.05) when compared to the negative control. TOS was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The metformin and diawell groups had significantly higher (p˂0.05) TOS values, whereas the combination (metformin + diawell) showed no significant difference (p>0.05) when compared to the negative control. There was significantly lower (p˂0.05) TAS levels in the diabetic and treatment groups, compared to the negative control. OSI values were significantly lower (p˂0.05) in all groups when compared to the diabetic control. Also, OSI values were significantly higher (p˂0.05) in the treatment groups compared to the negative control. Conclusion: There was depletion of antioxidant parameters and an increase in oxidative stress in the diabetic rats. Administration of metformin and the polyherbal tablet diawell individually, were not effective in correcting the pathological and biochemical changes associated with diabetes. However, the combination treatment produced a better glycaemic response and attenuated the oxidant status in the rats. Antioxidant therapy should be incorporated in diabetes management, and anti-diabetic herbals properly evaluated.
Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis

Background The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.
Comparative evaluation of colposcopy, cytology and histopathology for diagnosis of cervical lesions

Background: Cervical cancer is the fourth most frequent cancer globally in women with an estimated 570,000 new cases and 311,000 deaths in 2018 representing 6.6% of all female cancers. To correlate the cytology, colposcopy and histopathology of cervical lesions in patients attending gynaecology OPD in a tertiary care centre, Ghaziabad.Methods: 208 women were enrolled from Gynaecology OPD of Santosh Medical College and Hospital, Ghaziabad, irrespective of their chief complaints. Women aged 19-80 years were included in the study group. Those with pregnancy and already diagnosed or treated with CIN, Cervical cancer or Cervical HPV infection were excluded from the study. PAP-smear was taken for all the patients followed by colposcopy without waiting for PAP-smear report. Cervical biopsy was taken from patients with abnormal colposcopic findings (90 patients). Results: Majority of women were in age group 30-39 years. 37.5% had unhealthy, 21.6% had hypertrophied cervix and only 9.1% had normal cervix. It was found that PAP -smear has a sensitivity of 33.33%, specificity of 92.59%, accuracy of 68.89%, positive predictive value of 75% and negative predictive value of 67.57%. Test parameters calculated for colposcopy revealed that it has sensitivity of 73.33%, specificity of 92%, PPV of 64.7%, NPV of 94.52% and accuracy of 88.89%. Conclusions: The results from the current study conclude that it is better to use cytology and colposcopy together as part of routine screening for cervical cancer rather than pap smear alone in order to detect maximum number of lesions.
Manejo farmacológico de la hipertensión materna durante la lactancia: un reto terapéutico

Introducción. Los trastornos hipertensivos del embarazo pueden aparecer y persistir en el puerperio, pudiendo requerir tratamiento durante el periodo de lactancia. Actualmente, no existe consenso acerca del manejo farmacológico, y representa un reto terapéutico para el clínico. Objetivo. Revisar la literatura acerca del manejo farmacológico de la hipertensión materna durante la lactancia. Métodos. Se realizó una búsqueda estructurada de la literatura en las siguientes bases de datos: ScienceDirect, PubMed-Medline, Embase biomedical, SciELO y Cochrane Library, con los términos: ‘pregnancy induced hypertension, AND therapeutics’, ‘postpartum hypertension AND therapeutics’, ‘pregnancy induced hypertension AND treatment’, ‘postpartum hypertension AND treatment’. Resultados. Se encontró 44 artículos relevantes para llevar a cabo la presente revisión. Conclusiones. No existe evidencia suficiente para demostrar la seguridad de cualquiera de los fármacos utilizados en el tratamiento de la hipertensión materna durante la lactancia. La literatura sugiere que nifedipino, enalapril, captopril y metoprolol, son los fármacos empleados con seguridad relativa para el lactante.