Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical and epidemiological study of acute respiratory infection cases in children below twelve years of age in a tertiary care teaching hospital in Pune, India

Context: Pneumonia is the leading killer of children worldwide. AIMS: To study clinical and epidemiological factors associated with Acute Respiratory Infection (ARI) cases and find the case fatality rate. Setting and Design: Hospital-based cross-sectional study. Materials And Methods: Detailed clinical examination of all ARI cases were done in children below 12 years of age. The relevant socio-demographic and epidemiological information of the cases were collected by interviewing the parents/guardians of the children through a pre-tested proforma. Duration of the study was one year. Statistical Analysis Used: χ² test, P Results: There were 539 (11.3%) ARI cases from a total of 4,764 admissions. There were 317 males and 222 females. Out of 539 ARI cases, 455 (84.4%) were in the age group of 0-5 years. Malnutrition was associated with 360 (79.1%) of the 455 under-five cases. A total of 283 (62.2%) cases were incompletely immunized for age. Case fatality rate was 3.8% in males and 8.1% in females. Conclusion: Children who were incompletely immunized for age suffered from severe forms of ARI, and this was statistically significant. The case fatality rate was much higher in females, and this was statistically significant. The comorbid factors/illnesses with ARI, which were statistically significantly associated with mortality, were malnutrition, acute diarrheal illness, septicemia, meningitis, and congenital anomaly.
Subchronic Oral Methyl Tertiary Butyl Ether (MTBE) Exposure in Male Sprague‐Dawley Rats and Effects on Health of MTBE Exposed Workers *

Subchronic Oral Methyl Tertiary Butyl Ether (MTBE) Exposure in Male Sprague‐Dawley Rats and Effects on Health of MTBE Exposed Workers: Wei Zhou, et al. Department of Environmental Health, Shanghai Medical University—Methyl tertiary‐butyl ether (MTBE) is used to reduce carbon monoxide and ozone in urban air and to boost fuel octane. There are yet no data on the toxicity and health effects of MTBE in China. To evaluate the possible toxicity of domestic MTBE, 40 male, 8‐week‐old Sprague‐Dawley rats, weighing 180‐200 g, were gavaged with different concentrations of MTBE. MTBE, dissolved in soybean oil, was administered at doses of 1000, 600 or 200 mg/kg b.w. , and a control group with soybean oil, once daily, five days per week, for 90 days. There were no marked differences in body weight growth and food intake among the 4 groups. The results showed that MTBE significantly increased the weights of liver and kidneys, but the levels of serum enzymes and proteins were not greatly changed. No apparent pathological changes in the main organs (liver, kidneys, testes, and lungs) were found by light microscopy, but electron microscopy analysis showed significant changes in liver cells of all treatment groups, including cell nuclear condensation, fat drops and lysosomes in cells, and smooth endoplasmic reticulum (SER) dispersion. The effects on the health of 96 MTBE occupationally exposed workers and 102 controls were also investigated by a questionnaire, and we found that workers who reported health complaints in MTBE exposed group (62 cases, 64.6%) were significantly more numerous (Pc.001) than those in the control group (16 cases, 16.7%), and the OR value was 9.80 (95% C.l. is 4.74‐20.53). The most frequently reported symptoms in the exposed group were eye irritation (19.8%), dizziness (18.8%), burning sensation in the nose or throat (17.7%), insomnia (13.5%), nausea or vomiting (13.5%), headache (12.5%), fatigue (12.5%), poor memory (12.5%), irritability (6.3%) and skin irritation or redness (5.2%). The data suggested that MTBE may be toxic to male SD rats at high doses, and MTBE may have harmful effects on exposed workers.
Clinical–pharmacological implications of over-the-counter sales of statins

Recent approval of over-the-counter (OTC) sales of simvastatin (a hydroxy-methylglutaryl coenzyme [HMG-CoA] reductase inhibitor) in the UK raises questions about its expanded use and regarding future OTC regulation of this and other statins in the USA. OTC applications under review currently by the FDA for statins include lovastatin (patent expired) and pravastatin (patent expiring soon). The consequences of OTC sales of statins may be far-reaching and deserve critical scrutiny regarding: a) scientific issues relating to patient healthcare and safety; b) health insurance economics and c) consumer–medical care provider interaction dynamics. Meanwhile, deciding on approval of OTC statins in the USA and/or other countries may become more feasible after 1–2 years of practice if the UK experience is found to be safe and effective. Arguments can be made for and against, so I have elected to review the most valid facts and let the readers reach their own conclusions.
Ten years after the beginning of Crimean-Congo hemorrhagic fever outbreak in Iran: a promising report.

INTRODUCTION Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection described in about 30 countries. It has the most extensive geographic distribution of the medically important tick-borne viral diseases (1-6). Human can be infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viremic livestock. Health-care workers have a serious risk of infection, particularly during care of patients with hemorrhages from the nose, mouth, gums, vagina, and injection sites (4-8). Following an incubation period of two to fourteen days, clinical features commonly show a dramatic progression characterized by hemorrhage, myalgia, and fever. Petechial rash and hemorrhagic signs such as hematemesis, melena and intracranial hemorrhage could be other presenting sings (6-10). Mortality rate of CCHF is up to 80% of clinically apparent cases, however, despite this high lethality rate, up to 80% of the infections may be subclinical (5-7). The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and prolongation of bleeding markers are another laboratory findings. Infection of the endothelium has a major pathogenic role. Besides
Prospective gating with 320-MDCT angiography: effect of volume scan length on radiation dose.

OBJECTIVE The purpose of this study was to evaluate the relation between radiation dose reduction and volume scan length for prospectively ECG-gated 320-MDCT angiography in the diagnosis of coronary artery disease. MATERIALS AND METHODS MDCT with prospective ECG gating was performed at one of the three volume scan lengths depending on heart length. Of 175 patients, 95 (55%; body mass index, 29 ± 5.9; mean heart rate, 59 ± 7 beats/min) underwent scanning at 160 mm; 46 (26%; body mass index, 30 ± 4.1; mean heart rate, 56 ± 5.74 beats/min) at 140 mm; and 34 (19%; body mass index, 30 ± 3.71; mean heart rate, 58 ± 3.96 beats/min) at 120 mm. RESULTS The median radiation doses were 6.5 mSv (95% CI, 6.03-7.2 mSv) for the 95 patients who underwent scanning at a volume scan length of 160 mm, 4.33 mSv (95% CI, 4.06-6.62 mSv) for the 46 patients who underwent scanning at 140 mm, and 3.47 mSv (95% CI, 3.15-3.62 mSv) for the 34 patients who underwent scanning at 120 mm. The reduction in scan length from 160 to 140 mm represented a reduction in scan length of 12.5% and the reduction to 120 mm a reduction of 25%. The median radiation dose was reduced 33% when volume scan length was changed to 140 mm and 47% when the length was changed to 120 mm. CONCLUSION Dose optimization remains an important concern in cardiac CT, and for 320-MDCT angiography, substantial dose reduction can be achieved by reducing volume scan length so that it is in concert with the patient's heart length.
How to use high-sensitivity cardiac troponins in acute cardiac care

Recommendations for the use of cardiac troponin (cTn) measurement in acute cardiac care have recently been published.1 Subsequently, a high-sensitivity (hs) cTn T assay was introduced into routine clinical practice.2 This assay, as others, called highly sensitive, permits measurement of cTn concentrations in significant numbers of apparently illness-free individuals. These assays can measure cTn in the single digit range of nanograms per litre (=picograms per millilitre) and some research assays even allow detection of concentrations 10% at the 99th percentile URL limiting that ability.5–7 However, the less precise cTn assays do not cause clinically relevant false-positive diagnosis of acute myocardial infarction (AMI) and a CV <20% at the 99th percentile URL is still considered acceptable.8 We believe that hs-cTn assays, if used appropriately, will improve clinical care. We propose criteria for the clinical interpretation of test results based on the limited evidence available at this time. ‘Sensitive’ and ‘high-sensitive’ are terms often used by manufacturers to describe their assays for marketing purposes. In some cases, it reflects higher sensitivity than former assays developed by the same company, and in other situations it reflects a higher sensitivity than most assays on the market. Although there is still no consensus regarding when the terms ‘sensitive’ and ‘high-sensitive’ should be applied, we advocate that cTn assays should be labelled ‘high-sensitive’ only if they fulfil the analytical criteria suggested by …
Pharmacokinetic Considerations for Selection of HAART in Treatment-Naive HIV-Infected Individuals, 2008: More Than it Seems?

The selection of highly active antiretroviral therapy for treatment-naive HIV-infected individuals is complex. In addition to patient adherence, exposures of antiretroviral agents (ARVs) can be influenced by patient population, gender, drug–drug and drug–food interactions, and comorbid medical conditions. In contrast to pharmacokinetic sampling performed under controlled conditions, ARV exposures in “real-world” clinical practice display substantial interpatient variability. The interactions between ARVs and other medications commonly used by HIV-infected patients could significantly impact ARV exposures and need to be considered when selecting therapies. Pharmacogenomic differences have been identified for a number of ARVs, resulting in increased plasma exposures (efavirenz, nelfinavir) or increased risk for adverse drug events (atazanavir, abacavir, indinavir). Despite increasing populations of HIV-infected females and people 50 years or older, the pharmacokinetics of many ARVs has not been adequately studied in these patient populations. The clinical significance of many of these pharmacokinetic differences is unknown.
Left ventricular systolic performance in asymptomatic aortic stenosis

Some asymptomatic patients with aortic stenosis (AS) are at higher risk of impending symptom onset or adverse clinical outcome than others. This article explores whether parameters of left ventricular (LV) systolic performance may identify asymptomatic patients with AS who are most likely to benefit from aggressive treatment interventions. Studies evaluating the influence of LV systolic function on outcomes in asymptomatic patients with AS were reviewed. Several factors are associated with poor outcomes in AS, including low chamber function (assessed by LV ejection fraction; LVEF) and depressed myocardial contractility (assessed by low midwall fractional shortening; MFS). In most patients, LV wall stress is inversely correlated with LVEF; LV hypertrophy and LV systolic dysfunction develop from the high wall-stress and afterload mismatch. Depressed myocardial contractility may as well identify patients with poor prognoses before clinical symptoms. High global afterload (reflected by a valvulo-arterial impedance Zva � 5.5 mmHg/mL/m 2 ) seen in patients with paradoxically low-flow/low-gradient AS can identify patients at high risk of adverse outcomes, and finally high LV stroke work loss (� 25%) can also identify patients at risk. Parameters of LV systolic performance can identify patients with asymptomatic AS who are at high risk of impending symptoms of heart failure and adverse clinical outcomes. Such patients may benefit from more aggressive treatment interventions, including aortic valve replacement.
A phantom study comparing ultrasound-guided liver tumor puncture using new real-time 3D ultrasound and conventional 2D ultrasound.

OBJECTIVE The purpose of this study is to compare the accuracy of ultrasound-guided puncture using new real-time 3D (4D) ultrasound and conventional 2D ultrasound for focal hepatic masses using a liver phantom. MATERIALS AND METHODS A 4D ultrasound system equipped with a 5-MHz 4D probe displayed both axial and orthogonal images parallel to a puncture line plane. We used a liver phantom that contained four simulated spherical masses in an acrylic box (length × width × height, 300 × 299 × 150 mm) with two different sizes (15 and 30 mm in diameter) in two different positions (30 and 80 mm from the surface). Four inexperienced and four experienced physicians attempted punctures on these four simulated masses twice using 2D and 4D ultrasound guidance in a total of 128 punctures (eight operators, two techniques, and eight punctures per session). The error distance of the puncture was defined as the perpendicular distance from the center of a target mass (sphere) to the line of the puncture needle in the coronal plane of the target center, which was measured manually on the basis of the 3D volume data on off-line analysis. RESULTS On each tumor model, the average error distance with 4D ultrasound was significantly smaller than that with 2D ultrasound, except for one tumor model that was 15 mm in diameter and 30 mm in depth. The average error distances for the experienced group tended to be smaller than those for the inexperienced group, with both techniques and on each tumor model, and there was a statistically significant difference between the two groups on one tumor model (30 mm in diameter and 80 mm in depth) on 4D ultrasound (p < 0.05). CONCLUSION Four-dimensional ultrasound-guided puncture for liver tumors can markedly improve puncture accuracy for both experienced and inexperienced physicians compared with conventional 2D ultrasound guidance.
Relationship of Alcohol Use to Delinquency and Illicit Drug Use in Adolescents: Gender, Age, and Racial/Ethnic Differences

Alcohol use has been linked to other substance use and delinquency in adolescents. However, few studies have examined variations in these relationships in representative subsamples of gender, age and racial/ethnic groups. Respondents in this study were 19,321 New York State 7–12th grade students. After controlling for significant sociodemographic factors in a regression analysis, all of the alcohol measures remained strong predictors of both delinquency and illicit drug use. Significant interactions between alcohol measures and gender, age and racial/ethnic groups were also found. For example, the relationship between binge drinking and delinquency was stronger for males than females. The relationships between alcohol measures and both delinquency and illicit drug use were stronger for younger adolescents than older adolescents. American Indians showed an added risk over other groups of being delinquent and using illicit drugs if they began drinking at an early age. Prevention efforts to delay initiation into alcohol use are likely to have effects not only on alcohol misuse but also on the development of other substance use and delinquency.
Membrane probe with pyramidal tips for a bare chip testing

Bare chips are used in multichip modules for high packaging density and high processing speed devices. Obtaining known good dies (KGD) is a significant problem in achieving high MCM yields. Therefore, a probing technique for bare chips with high reliability is a matter of importance. In order to achieve good contact properties at a low probing pressure, a new membrane probe with pyramidal tips is developed for bare chip testing. By using anisotropic etching of silicon, quadrangular pyramidal pits are formed as the cast of probe tips. By nickel plating these pits, nickel pyramidal tips with copper wiring are formed on the polyimide film. The silicon wafer cast is then dissolved completely by etching. This membrane probe is then attached to a socket. This pyramidal probe is vertically inserted into an aluminum pad. Contact resistance remained stable at 0.1-0.2 /spl Omega/.
Retrospective Cross-sectional Study of Dengue Cases in IPD with Reference to Treatment- Monitoring & Outcome in KEM Hospital, Mumbai

Dengue is the most important vector-borne viral disease of humans and likely more important than malaria globally in terms of morbidity and economic impact [8]. Transmission of dengue is now present in every region of the world and more than 125 countries are known to be dengue endemic. Maharashtra has the highest dengue mortality rate (3.4%) in India, as per data obtained from National Vector Borne Diseases Control Program (NVBDCP-2013). The case fatality rate is significantly high as compared that with other infectious diseases. This observational study was done to obtain the information on treatment given & its outcome in clinical profile & also to assess treatment gap & outcome of Dengue patients admitted in KEM Hospital. The data was collected from the case records of dengue diagnosed patients from Medical record department and it was filled in case record form. The statistical-analysis & the conclusion were drawn with the help of observations. The study revealed that maximum number (121) of dengue cases were in the age group of 21-30 yrs. There was an association between platelet count and treatment outcome. Severity in sign & symptoms lead to complication (n=23) and death (n= 21) in dengue cases. There were 22 deaths occurred in year 2013 because of dengue. Out of which maximum 12 cases reported in months of September (n=6) & October (n=6). There was no treatment gap found in cases of Deaths in study but 36% of died patients received antimalarial treatment even after diagnosed with Dengue. Remaining 64% of died patients received appropriate, rational and life saving treatment for dengue.
A qualitative study to investigate service user experience of participating in research

Service user and carer involvement in research and health services is mandated by policy and has been taken up with different degrees of success in the NHS. This study employs a phenomenological approach to consider the service user and carer experience of participating in a service evaluation of a health centre in the North West of England. This was a small-scale study nested within a larger knowledge transfer project. Semi-structured interviews were undertaken with members of the review team, comprising a service user and carer assuming research roles, as well as an academic, an NHS manager and a project coordinator. Data was subject to qualitative, phenomenological analysis. The service user and carer perspectives take centre stage in this thesis, but are framed by the perspectives of the other participants in the study. Findings account for the features and experiences of involvement as described by the participants and exemplify how they made sense of involvement practices. They are structured in three broad themes: Work/Occupation, Personal Identity/sense of self, and Purpose. Several subthemes reflect wider discussion around the key concepts. Work/Occupation comprises the sub-themes: Motivation/background, Professionalism, Experience transfer and Relations with staff. Personal identity/Sense has subthemes: Yearning for a different status, Duality of role and Fulfilment or reward. Finally, the Purpose theme was constituted by four subthemes including: For self/for others dichotomy, Opportunity, Gaining transferrable skills and Social relations/democratic. Notions of Professionalism were prominent in the participants’ narratives, both as perceived requirement and personal development opportunity. This contrasts with existing literature in the field of service user and care involvement on professionalism. Competition within a work context is seen as positive and motivating and is not seen as antithetical to cooperative ideals. Reflexivity is found to be an important added dimension for the participating service user and carer.
Falls, older adults, and the trend in utilization of CT in a level I trauma center.

OBJECTIVE The purpose of this article is to evaluate the trend in the utilization of CT for fall victims older than 55 years admitted to a level I trauma center. MATERIALS AND METHODS We used trauma registry data (1996-2006) of a level I trauma center. By using the International Classification of Disease, Ninth Revision (Clinical Modification) codes, we identified the type and frequency of CT examinations for each patient. We used negative binomial regression to evaluate the association between CT utilization rates and age, year of admission, sex, insurance status, ethnicity, ICU admission status, injury severity score, and final disposition (i.e., deceased vs alive). We used logistic regression to evaluate predictors of repeat (i.e., ≥ 2) CT scans. RESULTS During the study period, the utilization rate of head, abdomen, thorax, and other body region (including spine and extremities) CT examinations increased, on average, by 7%, 16%, 14%, and 15% per year, respectively. Older age was associated with a higher utilization of head CT. Male sex and ICU admission were associated with higher utilization for all types of CT examinations. Repeat head and abdominal CT scans increased, on average, by 28% (95% CI, 20-36%) and 24% (95% CI, 2-51%) per year, respectively. CONCLUSION We quantified the increase in utilization rates of all types of CT scans for fall victims admitted to a level I trauma center. We found a marked increase in CT use over time, both for initial as well as repeat studies, and an association between CT use and variables such as sex. Future studies should focus on the evaluation of CT appropriateness and their influence on patient outcomes.
Program evaluation: A study to evaluate the effectiveness of an alternative education program in a rural county of a mid-Atlantic U.S. state

There has been growing concern regarding family violence and its effect on school-age children. The impact of such trauma manifests in this group in several ways, among them bullying acts upon one’s peers and the destruction of school property. Eventually, some are referred to alternative education programs (AEPs) upon returning to school. Therefore, this research study sought to address this problem by evaluating an existing alternative educational program design to assist high-risk students in an alternative education program located in a rural county of a mid-Atlantic U.S. state. A purposive sample population of 3 females and 16 males from 6th through 12th grades who were enrolled in an alternative school, 12 parents of these children, and 23 middle-/high-school certified personnel were used as the study sample population. A quantitative approach based on a survey design was used to collect data. Results showed differences were seen in the total number of disciplinary referrals between the treatment and comparison groups. Additionally, students in the AEP had better behavior at the posttest phase compared to their peers who were identified as needing the program but still attending regular middle or high school. What was not supported in the results was the attendance: there were no differences in attendance at posttest between the groups. Although the study indicated that the program was effective, administrators need to do a more comprehensive job in communicating the goals of the program to middleand highschool staff to support the children. Additionally, a formative evaluation of the program every 3 to 5 years should be developed to assure objectives for success are carried out in the program.