Miracle-dz/UniFAR-FTUs huggingface dataset:
Providing better care to HIV-infected pregnant women, children and their families in a rural sub-Saharan African clinic

Novel strategies to increase the uptake of prevention of mother-to-child HIV transmission (PMTCT) services are needed in sub-Saharan Africa to reach the goal of elimination of paediatric HIV. In this same region, HIV diagnosis, linkage into care, antiretroviral treatment coverage and treatment outcomes of children need to be improved. Family-centered approaches may facilitate access to HIV care and improve the clinical management. This thesis was developed mainly as an operational and implementation science research. The main objective of this PhD was to improve maternal and paediatric HIV services in Ifakara, Tanzania, to move towards the UNAIDS goals: 1) elimination of paediatric HIV and 2) “90-90-90” target (i) 90% of children living with HIV know their HIV status, ii) 90% of children with diagnosed HIV receive ART, iii) 90% of children receiving ART are virologically suppressed). First, we conducted a cross-sectional study to assess the PMTCT services uptake in Ifakara. Second, we designed and implemented a package of measures as a strategy to improve the paediatric and maternal HIV care. Third, we evaluated the impact of the strategy. Forth, we did a prospective study evaluating the PMTCT cascade after the implementation of the package of measures and we compared the results with the initial cross-sectional assessment. Last, we investigated the prevalence and determinants of virological failure and acquired antiretroviral drug resistances in HIV-infected children. The studies included in this thesis show that with an operational approach, real changes can be implemented in a rural Tanzanian setting. The work in Ifakara documents a feasible and scalable model for maternal and paediatric HIV care that if extended to other sub-Saharan African settings can contribute to the goals of zero new HIV infections among children, keep mothers in good health and close the paediatric treatment gap.
Strategies for improving patient fulfilment with quality of nursing care in northwestern hospitals of Saudi Arabia

Patient fulfilment with nurses’ nature of care in three tertiary hospitals in Ha'il Region, Saudi Arabia was studied in this research. The goals were to build up patients' fulfilment through one review and rate nurses' activity execution through another, studying unit head nurses. A quantitative research setup was picked in perspective of a 5-point Likert scale. The estimation of the staff nurses’ job execution by unit head nurses and nurses’ chiefs was led utilizing the Ministry of Health's 46-item survey. Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ) was used to measure patient fulfillment and contained 22 items in light of the nature of care given via group of nurses. A sum of 90 head nurses and 87 patient have been investigated using a facilitating method for analyzing over a -month span in 2015. This examination has revealed a good level of nature of nursing care regarding the high appraisals on nurses' job execution in the wards and patient fulfilment. Statistically, significant results had been found among patient fulfillment and conjugal status, health before admission, and ward measure. Measurably, essential effects were discovered between staff nurses’ job performance and wellness earlier than admission, and prior admittance. Strategic plans for continuous satisfactory enhancement need to be focused on across the physical set-up of the health center as some distance as ward measure; admission techniques, such as patient enjoy amid admission; training and support for nursing workforce; and family-situated healthcare.
Anticoagulation therapy in pregnant women with mechanical heart valve.

Background This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen. Methods Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. Results Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded. Conclusion Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ≤5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman.
Incremento de Linfocitos Intraepiteliales en pacientes con Síndrome de Intestino Irritable

Diversos trabajos reportan aumento en el numero de linfocitos intraepiteliales (LIE), mastocitos y celulas enterocromafines en pacientes con Sindrome de Intestino Irritable (SII). Muchos de estos hallazgos se basan en el uso de inmunohistoquimica que son de poca disponibilidad en hospitales generales. El objetivo del presente trabajo es estudiar los hallazgos histologicos en la biopsia de colon solo con histoquimica en pacientes con SII comparandolos con un grupo sin SII. Fueron incluidos 25 pacientes: 16 (64%), con criterios diagnosticos de SII y 9 (36%), sin SII. Se encontro un mayor numero de LIE en el grupo de SII (p=0,002). Un grupo de pacientes con criterios Roma III (41,9%) presento LIE en el rango de Colitis Linfocitica por lo que fueron excluidos de este estudio. No se encontro diferencia estadisticamente significativa en el numero de mastocitos, celulas enterocromafines y eosinofilos.
The Subtype Specific and Cross-Reactive T Cell Responses to Influenza Viruses in Humans: A Dissertation

Human influenza is a contagious respiratory disease resulting in substantial morbidity and mortality worldwide. With the recent cases of avian influenza infections in humans and the heightened concern for an influenza pandemic arising from these infections, it is essential to understand host responses that would confer protective immunity to influenza. The cell-mediated immune responses to influenza virus play an important role during influenza infection. To analyze the specificity and diversity of memory T-cell responses, we performed a genome-wide screening of T cell epitopes to influenza A virus in healthy adult donors. We identified a total of 83 peptides, 54 of them novel, to which specific T cells were detectable in interferon-(IFN-γ) enzyme-linked immunosorbent spot assays (ELISPOT) using peripheral blood mononuclear cells (PBMCs) from four healthy adult donors. We found that among 11 influenza viral proteins, hemagglutinin (HA) and matrix protein 1 (M1) had more T-cell epitopes than other viral proteins. The donors were not previously exposed to H5N1 subtype, but we detected H5 HA T cell responses in two of the four donors. To confirm that HA is a major target of T cell responses we also analyzed H1 and H3 HA-specific T-cell responses using PBMC of additional 30 adult donors. Fifteen out of thirty donors gave a positive response to H3 HA peptides, whereas five of thirty donors gave a positive response to H1 HA peptides. Because we detected T cell responses to the H5 HA peptides in donors without prior exposure to H5N1 subtype, we asked if cross-reactive T cells to H5 HA peptides
Risk Factors for the Development of Low Quality of Life in Adults with Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis is known to persist into adulthood which is associated with the development of a large number of long-term consequences, including low quality of life. The objective of the research was to evaluate quality of life in young adults with juvenile idiopathic arthritis and to analyze the risk factors for the development of its low level using the 36-Item Short Form Health Survey. Materials and methods. There were examined 135 adult patients with juvenile idiopathic arthritis without severe comorbidity at the age of 18 to 40 years and 25 apparently healthy young adults of the same age and gender. Quality of life was evaluated using the 36-Item Short Form Health Survey. Results. In patients with juvenile idiopathic arthritis, the physical health score (44.8±9.9) was lower (p=0.001) as compared to healthy individuals (55.7±6.9). Patients with juvenile idiopathic arthritis had lower indicators of physical functioning (p=0.001), role functioning (p=0.001) and bodily pain (p=0.001) than healthy individuals. However, in patients with juvenile idiopathic arthritis, the indicators of the mental health score and associated vitality, social functioning, role limitations due to emotional problems and mental health did not differ from those in the control group. Prolonged morning stiffness (p<0.05) and polyarticular variant of joint damage (p<0.05) were the risk factors for the development of low physical health score in young adults with juvenile idiopathic arthritis. According to the articular juvenile arthritis damage index (p<0.001), the presence of long-term articular damage was associated with high physical health score. There were found no risk factors for the development of low mental health score. Conclusions. Young adults with juvenile idiopathic arthritis at the age of 18 to 40 years had worse quality of life than healthy individuals of the same age and gender. They had worse physical well-being scores including physical functioning, role functioning and bodily pain. The risk factors for the development of low physical health score in young adults with juvenile idiopathic arthritis were the presence of prolonged morning stiffness as a manifestation of disease activity and polyarticular variant of joint damage, while the presence of prosthetic joints improved their physical health score.
Postnatal Care within Six Hours Following Delivery at Two Selected General Hospitals of Zambia—Mothers’ Experiences

Background: The days and weeks following childbirth (the postnatal period or puerperium), are a critical phase in the lives of mothers and new-born babies. The most vulnerable time for both is during the few hours and days after birth. The period places major demands on the physiological processes of mother and new-born as they adapt the changes of pregnancy and intrauterine life respectively. However, this is the most neglected time for the provision of quality services. Postnatal care is an integral part of the midwife’s role in providing care and support to the individual mother and her baby. Postnatal care encompasses aspects of observing and monitoring the health of the mother and her baby, as well as offering support and guidance in breastfeeding and parenting skills. Aim of the study: The aim of the study was to explore the experiences and expectations of mothers concerning care during the immediate postnatal period. Methods and materials: A qualitative approach was utilised to collect data from mothers in their immediate postnatal period using recorded in-depth interviews. A total of thirty (30) mothers were interviewed from two general hospitals. Thematic content analysis was used to analyse the data. Findings: From the study, three main themes emerged; inadequate physical examination, information needs and professional support, and varied staff attitude. The findings of the study have highlighted the inadequacies that are still there regarding immediate postnatal care. Conclusion and recommendations: It can be concluded that mothers have a lot of needs and expectation during this period which are usually not met. One most important conclusion is the lack or poor information given to the women regarding the care of the new-born and subsequent care. This could be one of the reasons mothers do not come back for the subsequent postnatal visit. There is an evidence of poor quality of postnatal care being offered to women during the immediate postnatal period. There are also some negative experiences that postnatal mothers have had and these have led them to being unsatisfied with the care they receive during the immediate postnatal period. However, despite all the above, there is still room for improving the care given during this time. This can help reduce maternal and neonatal morbidity and mortality.
A review of the PD-1/PD-l1 checkpoint in bladder cancer: from mediator of immune escape to target for treatment

Treatment of bladder cancer has evolved over time to include the traditional modalities of chemotherapy and surgery, and it has been greatly impacted by the use of immunotherapy. Modern immunotherapy focuses on checkpoint protein inhibitors, which are molecules impeding immune function, thereby allowing unregulated tumor cell growth and proliferation. Several immune checkpoint targets (programmed death ligand-1 [PD-L1], programmed cell death protein-1 [PD-1], and cytotoxic T-lymphocyte-associated protein 4 [CTLA-4]) have received the most attention in the treatment of bladder cancer, whereas inhibitor agents have either been approved or are in late-stage development. This review describes the most recent data on PD-L1-inhibiting agents, found on the surface of tumor cells, and PD-1, found on activated T and B cells and macrophages. Aim. A review of modern PD-1 and PD-L1 inhibitors as target immunotherapeutic agents for the treatment of bladder cancer. Materials and methods. We performed a comprehensive literature review using MEDLINE/PubMed and EMBASE. Results. The PD-1/PD-L1 pathway is possibly manipulated by cancer cells to suppress the immune system. PD-1/PD-L1 blockade has been tested in clinical trials for various malignancies, including metastatic urothelial carcinoma, with significant response rates and limited adverse effects. PD-L1 expression has mixed results as a prognostic marker for bladder cancer. Conclusions. PD-1 is a key receptor mediating immune escape, and agents targeting its ligand, PD-L1, have already been successful in patients with metastatic urothelial cancer. Further research is warranted to standardize the criteria for PD-L1 positivity and to optimize its use in the treatment of bladder cancer. (For citation: Gorelov AI, Simbirtsev AS, Zhuravskiy DA, Gorelova AA. A review of the PD-1/PD-l1 checkpoint in bladder cancer: from mediator of immune escape to target for treatment. Urologicheskie vedomosti. 2018;8(2):64-72. doi: 10.17816/uroved8264-72).
The Acute Effects of L-Arginine Supplementation on Flow-Mediated Dilation after Resistance Training to Fatigue

The purpose of this study was to determine the effects of acute L-arginine supplementation on the endothelial health in healthy adults by assessing flow-mediated dilation (FMD) and cardiovascular indicators both before and after resistance exercise to fatigue. Thirty (15 male, 15 female) physically active healthy participants (mean ? SD: age 20.4 ? 1.8 years, height 176.9 ? 10.2 cm, body mass 76.0 ? 12.2 kg) volunteered for a randomized, cross-over, double-blind, placebo controlled clinical trial. Participants completed five sets of isokinetic elbow extension/flexion exercise after consumption of either placebo or 3 g L-arginine one hour prior. Baseline brachial artery diameter significantly increased post FMD (p<0.001), post-exercise (p<0.001), post-exercise FMD (p<0.001). There was no significant supplement effect on FMD (p=0.179). The increase in brachial diameter due to fatiguing exercise was not enhanced by acute supplementation with L-arginine nor did supplementation alter FMD responses after exercise.
Assessment of Right Heart function and dimensions following device closure of Atrial Septal Defect.

INTRODUCTION : Atrial septal defect (ASD) represents one among the most common congenital heart disease manifested in adult life. It accounts 7% to 10% of all congenital heart disease in children. Ostium secundum being the most predominant type and common among females often comes to light in young adults. Most of the infants and children presenting with ASD remain asymptomatic and clinical examination may be unimpressive, making their survival to adulthood as normal as others. The right heart is exposed to chronic volume overload due to an increased pulmonary flow which leads to dilatation of the right atrium and right ventricle (RV). Some patients might progress to various stages of pulmonary hypertension and right sided heart failure. Patients may manifest with dyspnoea, fatigue, recurrent lower respiratory tract infection, arrhythmias, and thromboembolic complications. There has been consensus by the American Heart Association and European society of cardiology that complete closure of the inter atrial communication is the management of choice for ASD with significant pulmonary to systemic flow ratio, particularly in the presence of right ventricular volume overload along with right atrial and right ventricular dilatation, even if the patient has few or no symptoms. AIMS AND OBJECTIVES : To assess right heart function, right atrial and right ventricular dimensions pre and post transcatheter closure of atrial septal defect (ASD) and to assess magnitude of resolution of right heart enlargement, and impact on right ventricular function by echocardiography using 2D and tissue Doppler imaging. To compare the final outcomes after 3 months of percutaneous transcatheter closure of atrial septal defect with that of surgical closure. CONCLUSION : We conclude that percutaneous transcatheter device closure is a reliable, safe and cost effective option for ideally selected Ostium Secundum defect patients. The maximum beneficial effects on right heart functions, dimensions and remodeling begins immediately after device closure and the continued benefit is observed even at three months The beneficial impact on functional capacity, right heart dimensions, functions and hemodynamics are comparable and non inferior to surgical closure patients.
The Prognostic Significance of Lymph Node Ratio and Log Odds Ratio in Laryngeal Squamous Cell Carcinoma

Objective To investigate whether lymph node ratio (LNR) and log odds ratio (LODDS) have prognostic significance for overall survival (OS) and disease-free survival (DFS) in patients with laryngeal squamous cell cancer (LSCC) treated with curative intent. Study Design Case-control study. Setting University hospital. Subjects and Methods Records of 229 patients with LSCC who underwent surgery with a curative intent with or without adjuvant treatment from 2000 to 2014 were reviewed. The clinicopathological parameters LNR and LODDS were analyzed; univariate and multivariate analysis was performed to evaluate the prognosis of each for OS and DFS. Results The 5-year OS was 81.7% for LNR ≤0.233 and 47.1% for LNR >0.233, and the 5-year OS was 79.6% for LODDS ≤–0.1 and 51.8% for LODDS >–0.1, respectively. In the univariate analysis, the independent variables were subsites, pT stage (pT1 and pT2 vs pT3 and pT4), pN, pTNM, alcohol consumption, and LNR and LODDS (P < .05). By multivariate analysis, we determined that subsites, pT stage, alcohol consumption, LNR, and LODDS were independent prognostic predictors of survival (P < .05). Univariate and multivariate models identified that both LNR and LODDS were significant prognostic factors for survival. However, the hazard ratio (HR) for LNR >0.233 vs ≤0.233 was 8.95 (95% confidence interval [CI], 3.18-25.16; P < .001) in OS, and the HR was 11.37 (95% CI, 4.02-32.15; P < .001) in DFS. The risk of LNR was noticeably greater than other factors. Conclusions LNR and LODDS were both prognostic factors for OS and DFS. However, LNR was confirmed as a more reliable indicator for evaluating the prognosis, and it can be used to increase the prognostic value of the traditional TNM classification of LSCC.
How Your Body Language Affects Patient Care

Patient surveys reveal communication to be one of the most important competencies a physician should possess.1 However, communication is not only what is spoken. A physician’s nonverbal communication or “body language” sets the trajectory for treatment from the moment the patient first sees the physician. Body language includes all forms of communication other than words,2 such as vocal tone, posture, and facial and body movements. Being mindful of such behaviors can provide physicians with greater access to their patients. Effective nonverbal communication can have significant effects on patient engagement, compliance, and outcome.
Pulmonary spindle cell carcinoma with unusual morphology

Rationale: Pulmonary spindle cell carcinoma (PSCC) is a highly malignant carcinoma that often exhibits the histopathological characteristic of cell pleomorphism. Patient concerns: Here, we report a PSCC case in a 59-year-old woman with multiple metastases. The pathological manifestation of this case did not show high-grade pleomorphism or atypia, and was easily mimicked by other borderline or low-grade malignant tumors such as an inflammatory myofibroblastic tumor (IMT). Diagnoses: Based on the results of immunohistochemistry and fluorescence in situ hybridization after the operation, IMT was ruled out, and PSCC was confirmed. Interventions: Resection of the right middle lobe and dissection of the lymph nodes were performed. The patient was given 2 cycles of chemotherapy with cisplatin and 1 cycle of radiotherapy after the operation. Outcomes: Metastatic lesions in the left kidney, the right lung, the first thoracic vertebrae, the retroperitoneal lymph nodes, and the mediastinal lymph nodes were identified by positron emission tomography/computed tomography 4 months after the operation, and the patient died 2 months later. Lessons: PSCC is a highly malignant carcinoma, but it rarely shows a low-grade malignant histological morphology. So, efforts should be focused on differentiating it from other borderline or low malignant tumors (such as IMT) to avoid misdiagnosis.