Miracle-dz/UniFAR-FTUs huggingface dataset:
Thyroid Gland Involvement and the Efficiency of Thyroidectomy in Patients Having Larynx and Hypopharyngeal Cancers Treated with Surgery

Background: Thyroid gland involvement and invasion during larynx and hypopharynx cancers is rare, but due to the anatomical closeness of the thyroid gland and the larynx, it could occur through local invasion. Thyroidectomy is usually performed in patients with thyroid gland involvement having larynx and hypopharyngeal cancers. A lot of controversies exist regarding the thyroid gland involvement and efficiency of a different kind of thyroidectomy intraoperatively in these types of cancers. Objectives: Thus, elucidating the exact role of thyroidectomy, its efficiency, and parameters associated with thyroid gland involvement is critical in treating the patients with the larynx and hypopharyngeal cancers. Methods: In this retrospective study, the medical records of 117 patients admitted to Loghman Hakim Hospital from 2001 to 2015 with laryngeal and hypopharyngeal carcinoma, who underwent laryngectomy with or without thyroidectomy as a primary treatment of cancer, were evaluated. Several parameters, including gender, prevalence, location of the thyroid gland and lymph node involvement, the exact type of malignancy, differentiation stage of the tumor cells, the exact method of thyroidectomy, thyroid function, and its post-surgical cancer recurrence were assessed. Results: The prevalence of laryngeal cancers was significantly higher in males than females and most of the malignancies were squamous cell carcinoma (SCC). The location of the malignancy was mostly at supraglottis, glottis, transglottis, and subglottis, respectively. The rate of thyroid gland involvement was approximately 11.96%. Lobectomy was performed in 57.14 %, total thyroidectomy was performed in 35.71 %, and in 7.14% of the patients, and thyroidectomy was not performed. After the initial surgery, out of 11.96% of all patients with thyroid gland involvement, 28.5% had a recurrence of the thyroid gland. Only 21% of the patients with thyroid gland involvement had hypothyroidism after the surgery. Conclusions: The rate of thyroid gland involvement in the pathology report after surgery was approximately 3.41% of the thyroid gland involvement, which is low. We concluded that thyroidectomy is a very efficient way, but it should be limited to cases of subglottic or transglobic involvement or in cases of bilateral tumors, high staging, post-cricoid involvement, and clear radiological evidence or in the event of muscle involvement.
Do teenagers return to normal physical activity levels after limb fractures? A longitudinal, accelerometry-based, activity monitoring study

Abstract Purpose This study aimed to elucidate whether levels of physical activity (PA) return to normal after bone healing or whether long-term behavioural changes in PA are to be expected in children and teenagers who have sustained limb fractures. Methods In all, 100 children and teenagers with a first episode of limb fracture and 100 sex- and age-matched healthy controls (CTRL) were recruited for a prospective study. PA in limb fracture patients was assessed at 18-month follow-up using accelerometer measurements, and values were compared with those of CTRL. Time spent in PA at different levels of intensity was determined for each participant and expressed in minutes and as a percentage of total validly measured time. Results Mean levels of PA at different levels of intensity by previously injured children and teenagers were similar than CTRL (42 sets of paired data). However, time spent in moderate-to-vigorous PA (MVPA) was lower than 60 minutes among limb-fracture patients at 18-month follow-up. Conclusion The amount of skeletal loading in children and teenagers returns to normal values by 18 months after limb fracture. Even if time spent in MVPA is not significantly lower in children and teenagers with limb fractures, it no longer reached the international recommendations for school-aged children (MVPA > 60 minutes), which may be interpreted as a lifestyle modification or a behavioural change to avoid new trauma. Level of Evidence II
Tibia Fractures Overview

The proximal tibia is triangular in shape with a vast metaphyseal region narrowing distally. The tibia shaft is a long bone that articulates with the talus, fibula and the distal femur. The vascular anatomy is extensive and dependent on the compartment of muscles it supplies. The anterior tibial artery is the first branch of the popliteal artery, passes between the 2 heads of the tibialis anterior and Extensor hallucis longus (EHL) terminating as the dorsalis pedis. The posterior tibial artery is a continuation of the popliteal artery coursing in the deep compartment of the leg terminating as the medial and lateral plantar arteries. The peroneal artery terminates as the calcaneal arteries. It is important to understand the nerves and the compartments these nerves supply. The tibial nerve passes deep to the soleus, traveling down to the posterior aspect of the medial malleolus. The muscular branches of this nerve innervate muscles in the superficial and deep posterior compartments. The common peroneal nerve divides into the superficial and deep peroneal nerves. The superficial peroneal nerve is seen along the border between the lateral and anterior compartments and supplies the peroneus longus and brevis. The deep peroneal nerve, on the other hand, supplies the musculature of the anterior compartment and is sensory to the first web space. The saphenous nerve innervates the medial aspect of the foot and leg. The muscles of the deep compartment include popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. The muscles of the superficial posterior compartment include the gastrocnemius, soleus, and plantaris. Lateral compartment is composed of the peroneus longus and brevis. The anterior compartment is composed of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.
HIV Prevalence and Related Risk Behaviors among Men Who Have Sex with Men in Kinshasa, the Democratic Republic of the Congo

The purpose of this study was to determine the prevalence of HIV and syphilis and examine the HIV-related behaviors among men who have sex with other men (MSM) in Kinshasa, Congo. A modified snowball sampling was used to recruit the participants. The results showed that among the 401 men studied, 23.7% and 11.2% were infected with HIV and syphilis, respectively. HIV risk behaviors were rampant in this population. In the last 6 months preceding the survey, 83.3% of MSM reported receptive anal sex (RAS) with an average of 7 sexual partners. As high as 37.7% of MSM did not use condoms during the last RAS. About 65.9% (n = 249) reported drinking alcohol before sex. Logistic regression model indicated that being diagnosed with syphilis and not using lubricant were associated with positive HIV test. High-risk behaviors coupled with high prevalence of HIV among MSM underscore the need for the National HIV Control program to design new interventions to prevent HIV transmission from the MSM community into the general population.
Study Design of the Prospective Non-Randomized Single-Arm Multicenter Evaluation of the Durability of Aortic Bioprosthetic Valves with RESILIA Tissue in Subjects under 65 Years Old (RESILIENCE Trial)

ABSTRACT Background: Structural valve deterioration (SVD) is the Achilles heel of bioprosthetic valves used for aortic valve replacement (AVR). SVD has been traditionally defined based upon the requirement for valve reintervention. Recent expert consensus documents have proposed more granular and sensitive definitions of SVD based on the occurrence of morphological and hemodynamic valve deterioration measured by transthoracic echocardiography (TTE) and computed tomography (CT). RESILIA™ tissue is a new tissue technology incorporating a stable-capping process which permanently blocks residual aldehyde groups known to bind with calcium. Methods: Two clinical trials of RESILIA tissue valves have shown promising safety and effectiveness outcomes through early follow up. We here describe the design of the RESILIENCE trial (ClinicalTrials.gov: NCT03680040), which evaluates the long-term durability of RESILIA tissue bioprosthetic AVR in patients <65 years of age. Up to 250 patients implanted with a RESILIA tissue valve will prospectively undergo a TTE and non-contrast CT at 5, 7, 9, and 11 years; the echos and CTs will be analyzed by core laboratories. Results: The primary outcome is the occurrence of valve re-intervention or death related to structural valve failure. The secondary outcomes are the volume of valve leaflet calcification measured by CT and the occurrence of Stage 2 (moderate) or 3 (severe) hemodynamic SVD measured by TTE. Conclusion: The RESILIENCE trial is the first prospective study to associate both clinical and imaging definitions of SVD with long-term (11 years) bioprosthetic valve durability.
Tratamento cirúrgico da fratura-luxação de Lisfranc*

Os autores apresentam o estudo crítico de 16 pacientes (16 pés) com fratura-luxação da articulação de Lisfranc tratados pelo método cruento através de incisões longitudinais e fixação com fios de Kirschner. Os deslocamentos da junta de Lisfranc são ferimentos que apresentam grande potencial para incapacidade crônica quando não diagnosticados e tratados de maneira correta. Discutem neste trabalho os aspectos clínicos, anatômicos e radiográficos para avaliação do diagnóstico e detalhes da técnica cirúrgica, evolução e complicações. Obtiveram 80% de bons resultados com o tratamento cruento. Os casos considerados como maus geralmente se associam a cominuição da fratura, lesões de partes moles ou redução anatômica inadequada. Concluem que o melhor tratamento para as lesões de Lisfranc é a redução aberta com fixação das fraturas por meios de fios de Kirschner ou parafusos.
The Variable Rate Intravenous Insulin Infusion in Clinical Practice 2015: an audit against the new JBDS guidance

Background: Variable rate intravenous insulin infusion (VRIII) is an established method to achieve normoglycaemia in unwell or fasting patients. The Joint British Diabetes Societies (JBDS) released new guidance for the use of VRIII in medical inpatients in October 2014. This specifies the appropriate clinical circumstances in which a VRIII should be used and how it should be initiated, managed and discontinued safely. Methods: We developed an audit tool based on the guidelines and audited the current practice at the Royal Sussex County Hospital, Brighton, prior to the roll out of the new standards. We have audited 50 patients on VRIII under non-specialist medical and surgical care. Results: Several parameters were checked. VRIII prescription was signed appropriately as per the guidance in 98% of patients. Oral hypoglycaemic medications were omitted in 83%. Short-acting and mix insulins were omitted only in 88%. Long-acting insulin was administered only in 77% of the patients. Blood glucose was tested 1–2 hourly in 90% of patients. All patients with hypoglycaemic episodes were treated as per protocol. On the occasions where VRIII was discontinued, it was reinitiated within 20 min as per the guidelines only in 36% of cases. In patients with persistent hyperglycaemia, the rate was increased in 80% of cases. Discussion: Clinical practice surrounding the use, appropriate management and monitoring parameters appeared to fall short of the standards suggested by the latest JBDS guidance. Our audit outcome was to prepare a protocol for the trust summarising the indications for VRIII, target capillary blood glucose, how and when to stop VRIII for patients with diabetes and also a prompt to prescribe basal insulin for patients with diabetes and when a referral should be made to the diabetes inpatient team. Introducing teaching sessions to all the professionals and raising the awareness through a hospital communication programme on the wards would also help to theoretically improve the results. Conclusions: The majority of patients on VRIII are managed by non-diabetic teams and practice may vary from set guidance due to unfamiliarity and lack of diabetes specific knowledge. The appropriate use of VRIII needs to be tackled through remedial education, introduction of the new JBDS guidance and allied to improvements in systems and processes.
Avoiding Breach of Patient Confidentiality: Trial of a Smartphone Application That Enables Secure Clinical Photography and Communication

Background: To evaluate a smartphone application for clinical photography that prioritizes and facilitates patient security. Methods: Ethics was obtained to trial the application Sharesmart. Calgary plastic surgeons/residents used the application for clinical photography and communication. Surveys gauging the application usability, incorporated consent process, and photograph storage/sharing were then sent to surgeons and patients. Results: Over a 1-year trial period, 16 Calgary plastic surgeons and 24 residents used the application to photograph 84 patients. Half (56%) of the patients completed the survey. The majority of patients found the applications consent process acceptable (89%) and felt their photograph was secure (89%). Half (51%) of the surgeons/residents completed the survey and would use the application as is (67%) or with modifications (33%). The consent process was felt to be superior (73%) or equivalent (23%) to participant’s prior methods and was felt to resolve issues present with current photography practices of secure transmission and storage of photographs by 100% and 95% of respondents, respectively. Perceived limitations of the application included difficulties in use with poor cellphone service or Internet, decreased speed compared to current practices, the lack of a desktop platform, video capability, and ability to transmit the photograph directly to the patient’s medical record. Conclusions: A smartphone clinical photography application addresses the risks of patient confidentiality breach present with current photography methods; broad implementation should be considered.
Results of the implementation of the code stroke protocol in a Portuguese hospital

Background: The latest therapies for stroke are time-sensitive and require the implementation of care protocols. Objective: To analyze the results of the implementation of a code stroke protocol. Methodology: Quantitative and retrospective analysis of all cases with cerebrovascular disease admitted in the emergency room of a Portuguese hospital, from 2010 to 2016 (n = 1200). Demographic data, times for stroke care, comorbidities, and other clinical variables were collected. All activations of the protocol were studied using electronic records. Results: The patients showed 63.0% ischemic stroke, 17.2% of hemorrhagic stroke, and 19.8% of transient ischemic attacks. The code stroke protocol covered 37.3% (n = 282) of the ischemic stroke cases, performing fibrinolysis in 18.4% (n = 52) of these patients. The mean door-to-needle time was 69.5 minutes. In patients who underwent fibrinolysis, neurological improvements were significant (p < 0.05). Conclusion: There was a high rate of activation of the code stroke protocol, but only 52 patients underwent fibrinolysis. Age, comorbidities, and high rate of rural origin of patients may have influenced the therapeutic window and the inclusion/ exclusion criteria for fibrinolysis.
Gefitinib in combination with pemetrexed in patients with advanced non-small cell lung cancer harboring EGFR mutations: is there any difference in acquired resistance mechanism between gefitinib monotherapy and the combination treatment?

Somatic mutations within the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) are the most reliable predictors of efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with non-small cell lung cancer (NSCLC). In randomized phase III trials, EGFR-TKIs in patients with advanced EGFR mutant NSCLC were associated with longer progression-free survival (PFS) and higher radiographic response rates than the standard first-line platinum-based chemotherapy (1-7). Based on these results, three types of EGFR-TKIs, gefitinib, erlotinib and afatinib have been approved for treatment of advanced EGFR-mutant NSCLC as a first-line setting. Despite an initially marked response, almost all patients treated with EGFR-TKIs eventually acquire resistance to these drugs, with an average PFS of around 1 year. To improve these results, several combinations of EGFR-TKIs and other drugs, such as targeted drugs and chemotherapy, have been developed.
Do abnormalities in dynamic cerebral auto-regulation underlie the pathophysiological processes behind syncope in older people?

Do abnormalities in dynamic cerebral auto-regulation underlie the pathophysiological processes behind syncope in older people? Introduction: The aim of this thesis was to investigate whether abnormalities in dynamic cerebral auto-regulation (dCA) explain the symptoms associated with orthostatic (OH) and post-prandial hypotension (PPH). Methods: Based on clinical symptoms and signs for the OH study: 4 Groups: Asymptomatic No OH (control), Symptomatic No OH, Asymptomatic OH, and Symptomatic OH. PPH study: double-blind placebo controlled cross-over study of glucose (50g) drink. 2 Groups: No PPH (control) and PPH. Baseline and head-up-tilt (HUT, for OH maximum 30 minutes study or to symptoms; PPH study maximum 60 minutes per visit). All had Transcranial Doppler ultrasound, beat-to-beat BP, ECG and CO2 monitoring. Baseline autonomic function, arterial stiffness, cardiac baroreceptor sensitivity (BRS) were calculated and dynamic cerebral auto-regulation (as the autoregulatory index ARI) assessed before and during tilt. Results: OH: n=85, mean age 73.9±7.1 years; PPH: n= 40, mean age 73.4±7.3 years Baseline: No significant differences were found between groups for cardiac BRS, arterial stiffness, cerebral blood flow velocity (CBFV) or dCA in either study. HUT both studies: falls in BP, CO2 and CBFV, increases in HR, and fall in ARI amongst symptomatic subjects prior to the end of HUT (maximum duration or symptom onset) compared to pre-HUT values. PPH study: fall in ARI with HUT irrespective of whether glucose or placebo phase. Conclusions: The development of symptoms during tilt in both studies was related to a fall in CBFV and impaired cerebral auto-regulation. Abnormalities in cerebral autoregulation may explain the symptoms of OH and PPH although these changes can only be detected during head-up-tilt.
Parental Disclosure of Own HIV Status to Children in Two Ghanaian Regions; Examining the Determinants within a Child Vulnerability Context

Purpose: Parent informing children and adolescents about their own HIV infection status is crucial for harmonious and interfamilial relationship despite the associated dilemma. This study assessed the factors associated with parental disclosure of own HIV status to their biological children. Methods: The facility based cross-sectional design approach informed the recruitment of 192 HIV positive parents. This was done through a two-stage stratified (rural/urban) and random sampling technique across 7 ART clinics and hospitals in the Ashanti and Brong Ahafo regions in Ghana between June 2018 and June 2019. Data was collected through interviewer-administered structured questionnaires. Parental disclosure to children was defined as parent own verbal statement of having mentioned HIV or AIDS as the name of his/her illness to at least one of his or her biological children. The study compared weighted proportions for variables measured categorically by the use of chi-square (χ2) significant at P < 0.05 and binary logistic regression to find out the predictors of parental HIV status disclosure to children. Results: Of the 192 HIV positive parents aged 20 to 64 years (M, SD = 38.56, 8.34), 89.1% were females, averagely having 3 children with 89.5% having only one child being HIV positive, out of which one in every four parent was without formal education. Parental disclosure to biological children was 11% while parental own status disclosure to any child under the parent’s care was 14.6%. Parental disclosure was associated with being married or living with a sexual partner (OR = 3.4; 95% CI: 1.08 - 10.66, P < 0.036), disclosing to HIV positive child (OR = 169.9, 95% CI: 34.16 - 845.32, P < 0.000), parental perception of disclosure improving child wellbeing (OR = 10.6, 95% CI: 1.48 - 76.08, P < 0.019) and parental knowledge of someone else having disclosed status to children (OR = 5.9, 95% CI: 2.13 - 16.42, P < 0.001). None of the variables showed a significant independent association with parental disclosure when adjusted in the multivariate logistic regression. The dominant barrier to disclosure concerned parental view that children may not understand the disclosure and the parents’ discomfort on finding answers to child potentially questioning parent on how the parent got infected with HIV. Conclusions: Only a tenth of all HIV positive parents had told their children about their own (parents) HIV status. Parental disclosure should be encouraged and interventions designed to improve it particularly as they contribute to shaping the vulnerability context of HIV and AIDS positive children.
Zusammenfassung, Replizierbarkeit und methodologische Qualität von Frühmobilisation im Akutkrankenhaus bei Patienten mit Schädel-Hirn-Trauma – Systematische Literaturübersicht

Zusammenfassung Hintergrund Die Implementierung von Frühmobilisation in der Akutversorgung bei Patienten mit Schädel-Hirn-Trauma (SHT) könnte sowohl in Bezug auf die funktionelle Erholung als auch auf die Hospitalisationsdauer von großer Bedeutung sein. Derzeit fehlen hierzu jedoch detaillierte, replizierbare Interventionsbeschreibungen. Ziel Der Beitrag bietet eine Zusammenfassung der aktuellen Literatur zu Therapieinterventionen der Frühmobilisation einschließlich detaillierter Interventionsbeschreibung mit einer Bewertung der berichteten Interventionsparameter und der methodologischen Qualität der randomisierten klinischen Studien (RCT). Methode In 5 Datenbanken (Medline-Ovid, Embase, CINAHL, PsychINFO, Cochrane Library) erfolgte eine systematische Literatursuche. Unabhängig voneinander bewerteten 2 Autoren die berichteten Interventionsparameter mittels Template for Intervention Description and Replication (TIDieR) Checkliste und überprüften die methodologische Qualität der RCT anhand der Downs-and-Black-Checkliste 1. Ergebnisse In den Review wurden 2 RCT eingeschlossen 2 3. Die Überprüfung anhand der TIDieR-Checkliste zeigte, dass diese jeweils 6 bzw. 8 von 12 TIDieR-Items beschrieben. Die Informationssammlung bezog sich auf die verwendeten Materialien (Item 3), die Fachexpertise der Behandler (Item 5), den Zeitpunkt und die Häufigkeit der Frühmobilisation (Item 8), den Zeitpunkt einer eventuellen Anpassung (Item 9), die mögliche Modifikation der Intervention (Item 10), die Art der Überprüfung der Adhärenz (Item 11) und die Adhärenz (Item 12). Beide RCT erhielten 20 bzw. 22 von 28 möglichen Punkten der Down-and-Black-Checkliste 1. Die Items 8 (Beschreibung von Nebenwirkungen), 12 (Repräsentativität der eingeschlossenen Patienten), 14 (Verblindung der eingeschlossenen Patienten) und 25 (statistische Korrektur einer Verzerrung) waren in beiden Studien nicht erwähnt. Schlussfolgerungen Die Replizierbarkeit der Frühmobilisation bei Patienten mit SHT im Akutkrankenhaus ist derzeit nicht gegeben. Um die Qualität der Interventionsbeschreibungen zu verbessern und somit die Replizierbarkeit der Interventionen für Folgestudien und den Transfer in den klinischen Alltag zu gewährleisten, wird eine konsequente Verwendung der TIDieR-Checkliste in klinischen Studien empfohlen.