Miracle-dz/UniFAR-FTUs huggingface dataset:
Health Literacy in Non-Communicable Diseases: Contexts and Cases

The chapter highlights some of the methods used to embed health literacy principles into patient outreach and education materials about non-communicable diseases: chronic conditions including mental health conditions. A person’s or population’s understanding and engagement with health represents its health literacy. Health literacy is a form social capital. The authors use an ecological, socially contextualized model of health literacy and demonstrate how it guides the structure and content of health education material in case examples from New York City, United States, and Greece in Europe. While the specific methods used in these cases vary, the essential principal is that it is critical to identify and build on information about an individual’s health literacy contextualized in the individual’s or group’s socio-cultural and lived experiences. Only this way can an individual’s or group’s health literacy be advanced so that they can engage in behavior changes for both shortand long-term health outcomes.
The role of anaesthesia and enhanced recovery in the future of thoracic surgery

The development of enhanced recovery after surgery (ERAS) for thoracic surgery has created new challenges for the anaesthetist. The preoperative phase is critical not only to identify high-risk patients, but to optimise organ function. An anaesthetic is required which adequately suppresses the surgical stress response, the mainstay of ERAS, but also promotes rapid recovery with minimal side effects. Locoregional anaesthesia is the key. The use of a non-intubated, spontaneous breathing technique may confer some benefits. Effective analgesia is essential to allow early postoperative mobilisation and to reduce complications.
Carcinoma de células escamosas da conjuntiva : caso clínico

Introduction: The spectrum of neoplastic changes of the conjunctiva is broad, with tumors of epithelial origin being among the most common. Within these tumors we highlight the so-called surface squamous cell carcinoma (OSSN), which begins with the pre-cancerous lesions, dysplasia and carcinoma in situ, entities together known as conjunctival intraepithelial neoplasia (CIN), that can later break through the basement membrane and acquire invasive and metastatic potential originating the invasive squamous cell carcinoma of the conjunctiva. Purpose: This paper’s main purpose is the study of squamous cell carcinoma and risk factors associated with its development, through the analysis of a case report of a black man with recurrent conjunctival neoplastic lesions. Case report: African man, 61 years-old, history of AIDS and high sun exposure. In 2010 was diagnosed with SCC in situ of the conjunctiva in the LE, excised in January 2010 with recurrence after 3 months and new excision. He was referred to Santa Maria Hospital in the end of 2013 because of an invasive SCC of the left orbit with origin in conjunctiva of the LE (T4N0M0) having made RT. During the first observation in SMH a new SCC in situ was detected in the RE which was treated with topical chemotherapy with mitomycin followed by surgical excision, with apparent resolution. In 2014 a high grade dysplasia is detected in the RE and completely excised. Conclusions: HIV infection and sunlight exposure are among the most important risk factors for OSSN, and HIV+ patients exhibit rapid progression of disease, a greater rate of relapse and a poor response to treatment. These patient should be monitored closely, since early detection of these recurrences allow for a quick response with good prognosis. Treatment of OSSN is composed mainly of surgical excision of the lesions, which can be associated with other adjuvant therapies.
Severe asthma and cystic fibrosis: Overlapping phenotypes?

Abstract RATIONALE: Cystic fibrosis (CF) is known to mimic severe asthma. It is not known whether some severe asthma patients have a CF transmembrane conductance regulator-related disorder (CFTR-RD) or whether CFTR mutations contribute to asthma severity. OBJECTIVES: To compare the clinical features of CFTR-RD and the prevalence of CFTR mutations in those with severe asthma and non-severe asthma. METHOD: This retrospective observational study investigated individuals with suspected or confirmed asthma as identified with a diagnostic code of asthma between January 2010 and December 2012. Confirmed asthma and severe asthma were classified based on the Canadian Thoracic Society and American Thoracic Society/European Respiratory Society guidelines, respectively. Patient characteristics and investigations were abstracted. RESULTS: Of 314 charts abstracted, 87 patients (28%) had confirmed asthma, of whom 64 (74%) had severe asthma, 16 (18%) had non-severe asthma and 7 (8%) had unknown asthma severity. Rhinosinusitis, nasal polyposis and bronchiectasis were more prevalent in severe versus non-severe asthma (53% vs. 19%, p = 0.023; 20% vs. 0%, p = 0.061; and 20% vs. 0%, respectively, p = 0.061). Sweat chloride values ≥30 mmol/L were detected in 5 (6%) patients with confirmed asthma, all of whom had severe asthma, and 5 (2%) patients with non-confirmed asthma. Of the 24 (8%) patients who underwent CFTR genotyping, 20 had mutations, 7 of whom had severe asthma. Ten patients met criteria for CF or CFTR-RD. CONCLUSIONS: Features of CFTR-RD were seen frequently in severe asthma. Cases of CF, CFTR-RD and non-disease-causing mutations were detected in those with sweat chloride values in and below the borderline range. The clinical relevance of non-disease-causing mutations in severe asthma patients merits further research.
A Study of Haematological Profile and Serum Iron Indices in Non Dialysis Chronic Kidney Disease Patients

AIM : To assess the Haematological profile and Serum Iron indices in non-dialysis Chronic Kidney Disease patients BACKGROUND AND OBJECTIVES: Anemia is a common and early complication of chronic kidney disease patients. One contributing factor is iron deficiency, which may be particularly problematic during erythropoietin therapy. MATERIALS AND METHODS: It is a cross-sectional study conducted in Department of Medicine and Nephrology, Govt Rajaji Hospital, Madurai. A total of 54 patients were included in our study who satisfied the diagnostic criteria of CKD and patients underwent clinical and renal parameters, haematological profile and iron status. For comparison of the results with the general population adequate number of controls were taken. RESULTS: Our study results showed low level of Haemoglobin, and packed cell volume with increase in severity of chronic kidney disease. Bleeding time was increased in 5.6% patients and elevated ESR was present in more than half of patients. Anemia was universal in our population. Normocytic normochromic anemia was found in 70.4 % of the patients and microcytic hypochromic anemia in another 20.4%, and 9.2% had both type of peripheral smear picture. Applying the NKF-K/DOQI guidelines for nondialysis chronic kidney disease to our population it was found that nearly 38.9% of the study population did not have target serum ferritin of 100 ng/ml and 44.4% of study population did not have target TSAT of >20%. CONCLUSION: So it is vital to address this issue of iron deficiency in patients with chronic kidney disease so that necessary investigations can be undertaken to find the cause of iron deficiency if any. So every effort should be done to identify the cause of anemia in CKD patients and treat the coexistent iron deficiency anemia in chronic kidney disease patients. And other haematological parameters should be monitored to find out coexisting abnormality.
Is Multiclass Automatic Text De-Identification Worth the Effort?

Summary Objectives: Automatic de-identification to remove protected health information (PHI) from clinical text can use a “binary” model that replaces redacted text with a generic tag (e.g., “”), or can use a “multiclass” model that retains more class information (e.g., “”). Binary models are easier to develop, but result in text that is potentially less informative. We investigated whether building a multiclass de-identification is worth the extra effort. Methods: Using the 2014 i2b2 dataset, we compared the accuracy and impact on document readability of two models. In the first experiment, we generated one binary and two multiclass versions trained with the same machine-learning algorithm Conditional Random Field (CRF). Accuracy (recall, precision, f-score) and secondary metrics (e.g, training time, testing time, minimum memory required) were measured. In the second experiment, three reviewers accessed the readability of two redacted documents using the binary and multiclass methods. We estimated a pooled Kappa to estimate the inter-rater agreement. Results: The multiclass model did not demonstrate a clear accuracy advantage, with lower recall (−1.9%) and only slightly better precision (+0.6%), despite requiring additional computing resources. Three raters reached a very high agreement (Kappa = 0.975, 95% Confidence Interval (0.946, 1.00), p < 0.0001) that both binary and multiclass models have the same impact on document readability. Conclusions: This study suggests that the development of more sophisticated classification of PHI may not be worth the effort in terms of both system accuracy and the usefulness of the output.
Low-level laser therapy and dry needling for myofascial pain syndrome of the upper trapezius muscle: An interventional study

Myofascial pain syndrome is a frequently encountered musculoskeletal problem characterized by a hypersensitive trigger point. It presents with pain, increased pain threshold, and limited range of motion (ROM). This study compared the effectiveness of low-level laser therapy and dry needling to treat patients with myofascial pain syndrome. Men and women from 20 to 55 years of age with myofascial pain syndrome of the upper trapezius muscle and meeting the study criteria were randomly assigned to 4 weeks of low-level laser therapy three times weekly and dry needling once weekly. Responses were measured with a visual analog scale (VAS), pain threshold meter, and ROM of the cervical spine. Thirty-one patients completed the study, 15 received laser therapy, and 16 received dry needling. The median pretreatment VAS score was 6 in both groups. After 4 weeks of therapy, the severity of pain decreased in both groups. The decrease in VAS score was greater with low-level laser therapy than with dry needling, but the difference was not significant. Post treatment differences in pain threshold and cervical ROM were also not significant. Low-level laser treatment and dry needling were equally effective in reducing pain and increasing the pain threshold and cervical ROM in patients with myofascial pain syndrome of the upper trapezius muscle. Changes in VAS scores, pain tolerance values, and ROM were larger with low-level laser therapy than with dry needling.
Situação epidemiológica da Dengue, Chikungunya e Zika vírus no município de Camaçari - BA

Objective: To describe the epidemiological characteristics of dengue, chikungunya and zika viruses occurring in Camaçari, in the State of Bahia, Brazil, from 2013 to 2017. Methods: This is a descriptive, epidemiological study. The selected population covers all cases of dengue, chikungunya and zika viruses occurring in the period from 2013 to 2017 in the municipality of Camaçari, in the State of Bahia, Brazil. Results: Dengue, chikungunya and zika viruses were present simultaneously in the municipality surveyed in 2015 and 2017. The year of greatest epidemiological relevance was 2015. The diseases were more common among females, aged 20-34 years, with a low hospitalization rate. Serotypes DENV-2 and DENV-4 were predominant. Conclusion: Controlling the three diseases poses a challenge for the whole society. Continuous investments are needed for engaging the participation of all in preventive measures: health professionals, the population, and managers.
Patient-specific quality control for intensity-modulated radiation therapy and volumetric-modulated arc therapy using electronic portal imaging device and two-dimensional ion chamber array

Abstract Aim The purpose of this study was to develop the patient-specific quality control (QC) process by most commonly used dosimeters in Bangladesh and recommend a suitable passing rate for QC, irrespective of the dosimetric tools used. Materials and methods Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans of five head-and-neck (HN) and five prostate patients were selected for the patient-specific QC. These plans were generated using the Eclipse TPS v11·0 (Varian Medical Systems, Inc., Palo Alto, CA, USA) 6 MV X-ray from a Varian TrueBeam linear accelerator (Varian Medical Systems, Inc.) for each case. Each IMRT and VMAT plans were measured by two-dimensional (2D) ion chamber arrays (I’matriXX) and electronic portal imaging devices (EPID), respectively. The passing rates of the dosimetric tools were calculated using criteria of 3%/3 mm. Results The average passing rates (±SD) of I’matriXX for prostate and HN were 97·9±0·76 and 98·88±0·24, respectively. For VMAT verification, the average passing rates of EPID for prostate for arc1 and arc2 were 96·15±0·49 and 97·8±0·70, respectively; similarly, for HN the rates were 97·85±0·63 and 97·2±0·56, respectively. Conclusion The results showed that both the dosimeters can be used in patient-specific QC, although the EPID-based IMRT and VMAT QC is more advantageous in terms of time-saving and ease of use. Hence, for patient-specific QC, one can use the ion chamber arrays (I’matriXX) or EPID in hospital, but the systems need to be cross-checked.
CORRELATION BETWEEN DURATION SPENT IN FITNESS CENTER AND VO2 MAX LEVEL AMONG ADULTS

VO 2 max or oxygen consumption maximum value is a gold standard indicator towards cardiovascular and aerobic endurance because it refers to the maximum amount of oxygen used by an individual in one minute during maximum physical activity. The study purpose was to see the correlation between duration spent in the fitness center and VO 2 max value among adults. This study used analytical study method, cross-sectional type. We chose the participant from members of Gold’s Gym fitness center at Cihampelas, aged 18-45 years old, with 3 months minimum of activity, and exercise frequency around three times per week. The participants who had the cardiovascular and pulmonary disease, serious physical injury, had already exercised during the time of observation, or professionally trained athletes were excluded. We used Queen College step test for the instrument. There were 47 participants in this study. Spearman’s correlation coefficient was calculated to measure the correlation between duration spent and VO 2 max, and the result was 0.77(95% CI 0.64; 0.85), p<0.001 which is categorized as strong correlation. From this study, we found that with the increase of duration spent in the fitness center, the VO 2 max level is also increasing, and vice versa. This result is supported by a study from the United States which finds a correlation between VO 2 max and performance times of recreational triathletes. In conclusion, there is a positive correlation between duration spent in the fitness center and VO 2 max level among adults.
Molecular Detection of Hepatitis A Virus and Rotavirus in Water Samples Collected from Albaha, Saudi Arabia

Viral contamination of the water bodies is neglected area of research in Saudi Arabia. The study, first of its kind, using RT- PCR technique, reports Hepatitis A virus (HAV) and Rotavirus (RV) presence in almost 13% of the samples collected. This report may trigger the detection of accurate viral contamination status in Saudi Arabia’s environmental waters.
Multiple Outcomes in Heart Failure Research: Composite Endpoints and Multivariate Modelling

Composite endpoints are increasingly popular outcomes in clinical trials of heart failure. Uptake has outpaced guidance on their use and little consistency is seen in their construction. We must consider how best to handle multiple outcomes statistically and clinically, ie in a way that is both cogent for the clinical audience and statistically powerful. The clinical interpretation of composites has been emphasised along with its straightforward analysis and presentation. However there is a loss of information and a more thorough statistical analysis may offer advantages that are not easily dismissed, most obviously a gain in statistical efficiency and power. The modelling approach offers a number of other advantages: 1) adjustment for covariates, 2) a simple test of heterogeneity as the interaction between treatment and outcome, 3) analyses of the individual component endpoints are a consequence of the model, 4) correlations among outcomes are acknowledged, 5) recognises a constellation of risk factors or manifestations of the syndrome without blending them, 6) clinical weights are easily incorporated, and 7) an overall estimate of the effect is obtainable making it comparable with the results from a composite endpoint. Thus the multivariate modelling approach yields a more powerful and thorough analysis without the loss of information that occurs when multiple outcomes are reduced to a single univariate composite measure. We use data simulations and real clinical trial data to illustrate and evaluate clinical composite endpoints and multivariate modelling. We developed SAS macros for data simulations and analysis methods which we make available.
Non-Neoplastic Lesions that may Mimic Serous Tubal Intra-Epithelial and Invasive Carcinoma of the Fallopian Tube: Morphological and Immunohistochemical Analysis

In this paper the author describes the morphological and immunohistochemical features of the most common benign epithelial lesions of the salpinx, which can be mistaken for neoplastic malignancies (pseudoneoplastic lesions), on microscopic and, sometimes, also on macroscopic examination. Moreover, here it was demonstrated that both morphologic clinical data and immunohistochemical features are useful for an accurate differential pathological diagnosis from non-neoplastic lesions and serous tubal intraepithelial carcinoma (STIC) and invasive carcinoma.
Survey of HIV mothers in Botswana: Feeding methods, support, status disclosure and infant testing

A survey of HIV positive mothers in Botswana, Africa, all enrolled in a PMTCT programme, was conducted. A total of 305 mothers from randomly selected sites volunteered and completed the survey related to infant feeding, disclosure of HIV status, infant testing, and support from family and clinic services. The majority of mothers used formula feeding (64%) with their infants and almost half of the mothers indicated that they believed breastfeeding to be unsafe. The majority of mothers reported having disclosed their HIV status to partners and family and felt they had benefited from having done so. Social stigma did not appear to be a significant concern for the mothers in this study. Overall, mothers were very positive concerning the support they received from partners, family, and medical/clinic services. HIV testing was reported for 178 babies with 5 (3%) found to be positive for HIV. A discussion of the findings, along with recommendations for areas needing further study and attention, is provided.
Smoking Exposure Leads Physiological andPathological Transfer, Especially in the Elderly

Aging is a physiological process involving progressive impairment of normal functions, due to an increasing vulnerability to injuries, which reduces the ability of the organism to survive. The physiologic changes of the aging cardiac include left ventricular hypertrophy, increased cardiac fibrosis and valve degeneration [1]. However, cardiovascular disease is a major risk factor for aging cause of death. Aging-related cardiac disease changes in cardiac morphology and functions include decreased myocyte numbers, increased myocyte size, increased left ventricular wall thickness, and decreased conduction fiber density, while functional alterations include a decrease in intrinsic contractility, increased myocardial contraction time, decreased myocardial contraction velocity, and increased myocardial stiffness in left ventricular function [2]. Smoking increases arterial stiffness and coronary cardiac disease. Smoking exposure involves the combination of the smoke emitted by the burning end of a tobacco cigarette and the smoke exhaled by the smoker into the environment [3]. Cardiac pathological hypertrophy due to smoking exposure was observed in old-age patients, which leads to left ventricular remodeling and loss of function. Left ventricular hypertrophy is an initial adaptive response [4]. During LVH development, there is an imbalance of progressive remodeling at the cellular level, involving aging cardiomyocytes physiological and pathological disease transfer. Aging changes of the elderly heart is associated with physiological cardiac hypertrophy, which is expected or normal aging changes, smoking exposure is associated with pathological hypertrophy. Smoking exposure induced age-related cardiac hypertrophy is associated with numerous molecular and biochemical changes [5]. Calcineurin/NFAT is an originally implicated as pathological hypertrophy signaling pathway. Calcineurin/NFAT is regulated by MAPKs cascades mediated directly and indirectly [6]. However, calcineurin/NFAT regulate cardiac hypertrophy is associated with MEK1-ERK1/2 (physiologic) and MEK5/ERK5 (pathologic) signaling pathways [7]. The subclassified branches MEK5/ERK5 pathways have been implicated in pathological hypertrophy regulation in the heart [8]. In addition, MEK1-ERK1/2 regulate myocytes growth and physiological cardiac hypertrophy function [9]. Indeed, age-associated disease underlies much of the physiological deterioration of old age. Distinctions may be made between “physiological aging” and “pathological aging”. The most well recognized risk factor for many chronic diseases in pathological aging. Interactions between the aging process and the agedrelated disease has not been seriously addressed or systematically explained. Aging is an inevitable process of life [10]. Become progressively disorganized and degraded with age occurring as consequence of physiological aging. Aging process can be described Mini Review Open Journal of Cardiology & Heart Diseases C CRIMSON PUBLISHERS Wings to the Research
Dyslipidemia and Hypertension in Obese Patients with Correlation to Body Mass Index

The study “DYSLIPIDEMIA AND HYPERTENSION IN OBESE PATIENTS WITH CORRELATION TO BODY MASS INDEX” is a cross- sectional study among patients attending medical Outpatient Department and Medical Wards in Govt Rajaji Hospital for varying illness, 80 Patients (40 Males and 40 Females) whose BMI were ≥ 25 selected for the study Group (Group II, III, IV) and 20 Patients (9 males and 11 Females) whose BMI < 25 were selected in the same age group as controls (Group I). Subjects divided into four groups according to BMI Group I BMI 25 - Healthy weight, Group II BMI ≥ 25 – 26.9 Overweight, Group III BMI ≥27 – 29.9 Overweight, Group IV BMI ≥30 - Obesity. Patients and controls who satisfied the inclusion and exclusion criteria underwent various investigations like fasting blood sugar, and lipid profile were taken. Relationship of various anthropometric measurements like body mass index ,waist circumference, waist hip ratio were analyzed. A high BMI showed significant correlation with hypertension, diabetes and dyslipidemia. Thus our study highlights the significance of a simple measurement of BMI in day to day clinical practice in detecting the patients with high cardiovascular risk like hypertension, diabetes, obesity, dyslipidemia and metabolic syndrome. The cut off values for and BMI, waist circumference, and waist hip ratio should be defined according to the different ethnic populations. This will help in early detection of the people at risk so that we can advice healthy life style and nutritional habits for the high risk group and start specific therapy when ever necessary.