Miracle-dz/UniFAR-FTUs huggingface dataset:
India: Towards Universal Health Coverage 1 Continuing challenge of infectious diseases in India

leptospirosis, anthrax) are not in the process of being systematically controlled. Big gaps in the surveillance and response system for infectious diseases need to be addressed. Replication of the model of vertical single-disease control for all infectious diseases will not be effi cient or viable. India needs to rethink and revise its health policy to broaden the agenda of disease control. A comprehensive review and redesign of the health system is needed urgently to ensure equity and quality in health care. We recommend the creation of a functional public health infrastructure that is shared between central and state governments, with professional leadership and a formally trained public health cadre of personnel who manage an integrated control mechanism of diseases in districts that includes infectious and noninfectious diseases, and injuries.
Permanent Consequences in Langerhans Cell Histiocytosis Single Center Study

Introduction: Langerhans cell Histiocytosis (LCH) is a rare disease characterized by clonal proliferation of Histiocytosis in different tissues. Permanent consequences (PC) described among subjects with Langerhans cell histiocytosis (LCH). In this study we report the prevalence of permanent sequel among long – term survivors of LCH in our center. Methods: We had 30 cases of LCH from 1989 – 2001 who came for at least 3 years after diagnosis. Information has been collected from their disease history, and on type and date of onset of any PC. The cumulative risks of developing a PC have been calculated from the date of LCH diagnosis using the Kaplan-Meier and non-parametric method. Results: Among 30 patients 53.3% were female, 46.67% male, mean age at diagnosis 56.86%±7.79 months (range 7-156), median 42.5 months. 19 (63.33%) had single system (SS) and 11 (36.66%) multisystem (MS). Mean age at SS 5.97 ±1.03 yr, mean age of MS 7.59±1.05 yr. Mean age at follow up 11.3 ± 0.9 yr, median 11.5 yr, range 4.16-22 yr. Mean duration of follow up 6.57 ± 0.76 yr, median 5 yr, and range 3-18 yr. Nine of 30 cases (30%) had at least 1PC; in SS (26.3 %) and in MS (36.7%). The most frequent PC was diabetes insipidus (DI) 16.7%, in SS 5.26% , in MS 36.36%, the difference is significant P<0.05. Orthopedic abnormalities 10% which was only in SS (15.79 %), growth retardation (GR) 13.34%. Conclusion: The prevalence of PC in our patients is low which could be due to a small sample and on the other hand as most of our patients had single system involvement, the exact prevalence of PC is not clear. Analysis of cumulative risk shows that some types of PC may become manifest many years from
FEASIBILITY STUDY OF BREAST CANCER RISK MONITORING USING THERMOGRAPHY TECHNIQUE IN MALAYSIA

Breast cancer remains as a serious health issue in Malaysia and most presentation of breast cancer incidences are at the later stage which will reduce the survival rate. Breast Self-Examination for all women (BSE), Clinical Breast Examination for women above 40 years old (CBE) and Mammography for the older and high-risk groups are the current policies that are available in the government hospitals and selected clinics. However, BSE and CBE could not detect the early stage breast cancer while Mammography is less sensitive in detecting tumor in high dense breast tissue. Both factors have caused an increase in the overall percentage of later stage presentation of breast cancer in Malaysia. In this paper, a feasibility study of breast cancer screening and risk monitoring using Thermography technique is presented. Thermography technique is capable in identifying any physiological changes occur prior to lump formation. This technique is simple, cheaper, and produce no radiation which will allow a safe regular screening. In this study, a series of screenings has been performed on carcinogenic induced rats and thermal images acquired were then analyzed for risk monitoring. Visual analysis shown that the presence of hotspot and asymmetrical temperature profile could be an indicator of a high risk patient while temperature measurement on both induced and control groups shows a significant difference in standard deviation of the surface temperature with smaller deviation of 0.31±0.08 observed in control group while bigger deviation of 2.23±0.78 observed in the induced group. Hence, it is shown that Thermography technique could be a potential modality for upfront breast screening in Malaysia.
A NEW PRIMER PAIR IN ITS1 REGION FOR MOLECULAR STUDIES ON ECHINOCOCCUS GRANULOSUS

Background: Echinocuccus granulosus, the causative agent of cystic echinococcosis has long been recognized as having a high degree of genetic divergence. The strains characterization seems to be essential for the establishment of a preventive and control strategy in every endemic area. Using DNA based methods for strain /genotype characterizations of E. granulosus have some difficulties, especially access to an efficient and pure concentration of DNA and proper primers. Methods: Using grinder method, a pure and high concentration DNA was extracted from 10 human hydatid cysts collected from Isfahan (central Iran) hospitals, and processed for PCR reaction. Results: Using DNASIS, the primers were designed in internal transcribed spacer 1 (ITS1) region, following analysis of 30 E. granulosus nucleotide sequences, extracted from gene bank. Conclusion: This new and specific E. granulosus primer which amplified DNA thoroughly can be applied for molecular studies on echinococcosis.
Clec10a regulates mite-induced dermatitis

Clec10a on skin macrophages recognizes a mucin-like molecule of house dust mite and suppresses mite-induced dermatitis. Dermatitis details House dust mite (HDM) is an allergen associated with a variety of diseases, including asthma and atopic dermatitis (AD). The NC/Nga mouse strain develops severe AD in response to HDM, and Kanemaru et al. have now identified a stop-gain mutation, the Clec10a C-type lectin receptor, that is associated with this response. HDM-induced dermatitis was driven by TLR4-mediated inflammatory responses, and asialoglycoprotein receptor 1 (Asgr1) functions as a Clec10a homolog in humans. They also identified a mucin-like molecule in HDM that can function as a ligand for Clec10a and Asgr1. These results provide insight into mechanisms associated with HDM-mediated dermatitis. House dust mite (HDM) is a major allergen that causes allergic diseases such as atopic dermatitis. However, the regulatory mechanisms of HDM-induced immune responses are incompletely understood. NC/Nga mice are an inbred strain that is more susceptible to HDM and develops more severe dermatitis than other strains. Using whole-exome sequencing, we found that NC/Nga mice carry a stop-gain mutation in Clec10a, which encodes a C-type lectin receptor, Clec10a (MGL1/CD301a). The repair of this gene mutation using the CRISPR-Cas9 system ameliorated HDM-induced dermatitis, indicating that the Clec10a mutation is responsible for hypersensitivity to HDM in NC/Nga mice. Similarly, Clec10a−/− mice on the C57BL/6J background showed exacerbated HDM-induced dermatitis. Clec10a expressed on skin macrophages inhibits HDM-induced Toll-like receptor 4 (TLR4)–mediated inflammatory cytokine production through the inhibitory immunoreceptor tyrosine activating motif in its cytoplasmic portion. We identified asialoglycoprotein receptor 1 (Asgr1) as a functional homolog of mouse Clec10a in humans. Moreover, we found that a mucin-like molecule in HDM is a ligand for mouse Clec10a and human Asgr1. Skin application of the ligand ameliorated a TLR4 ligand-induced dermatitis in mice. Our findings suggest that Clec10a in mice and Asgr1 in humans play an important role in skin homeostasis against inflammation associated with HDM-induced dermatitis.
LOW-ANGLE FIXATION IN FRACTURES OF THE FEMORAL NECK

The successful management of femoral neck fractures is obviously based upon many factors. The forces acting upon the proximal end of the femur are believed to be mainly compressive in nature, and the low-angle nail by stabilising the fully reduced fracture in the line of these forces is held to allow weight bearing to take place. Low-angle nailing is believed to offer many advantages over conventional methods of treatment but only in the presence of stability. Stable reduction is the essential preliminary to any form of treatment, and low-angle fixation with early weight bearing in the absence of stability is regarded as futile. It is suggested that those subcapital separations which follow trivial injury may originate as stress fractures accompanying the process of bone remodelling in the aged, and that many of these fractures may remain unrecognised and heal spontaneously. With rare exceptions, subcapital fractures are regarded as being of the same essential pattern, and their varying radiological appearance is considered to be due to the different degrees of displacement to which they have been subjected. A new classification based on this premise has been suggested. In a series of eighty subcapital fractures the incidence of avascular necrosis was not adversely affected by early weight bearing, but reduction in the extreme valgus position was invariably followed by this disaster. This is probably also true of any malposition in extreme rotation which must stretch and obliterate the vessels in the ligamentum teres. A rough alignment index of reduction was found to provide an almost infallible guide to the prognosis both in regard to union and to avascular change. It may therefore be possible to base prognosis on the quality of reduction before the fixation appliance has been inserted. The unsatisfactory results in those cases apparently destined to non-union or avascular necrosis may then be avoided by alternative means of treatment at an early stage. Whether this will prove to be true must depend upon a much longer experience of low-angle fixation, and, in common with almost every communication on this subject, premature publication must largely offset the value of the present findings.
PROSPECTS AND CONSEQUENCES OF HORMONE REPLACEMENT THERAPY IN CANCERS A REVIEW

Hormone replacement therapy (estrogens with or without progestogens) is widely used medication therapy worldwide for alleviating post menopausal symptoms. The association of Hormone replacement therapy (HRT) and risk of cancers leads to many studies. A lot of controversial results regarding the risk of cancers arises which leads to many questions that are still unanswered and can be cleared by further extensive research. There is considerable uncertainty among general practitioners to balance the beneficial and harmful effects of long term HRT particularly regarding the risk of cancers (breast, ovarian, endometrial, colorectal, lung cancers, lymphoma’s and leukaemia’s). The goal of HRT is not only to normalize the follicle stimulating hormone value, but rather to use the minimum effective dosage to suppress vasomotor reactions, treat urogenital atrophy, prevent trabecular and cortical bone loss, and reduce cardiac risk. Use of HRT should be individualized for risks and benefits of each patient that is being taken into consideration.
EVALUATION OF APHRODISIAC ACTIVITY OF METHANOLIC EXTRACT OF Cicer arietinum SEEDS IN SEXUALLY SLUGGISH MALE ALBINO RATS

The present study was designed to evaluate the potential aphrodisiac effect of seeds of methanolic extract of Cicer airetinum (MECA) in sexually sluggish male albino rats. Sexual behavioral parameters like mount frequency (MF), intromission frequency (IF),ejaculation frequency (EF), ejaculation latency (EL), mount latency(ML) and intromission latencies (IL) were observed in male rats. The male serum cholesterol and testosterone concentrations were also recorded. Oral administration of MECA at 200 and 400 mg/kg body weight significantly increased the MF, IF, EF and EL (P < 0.05)in comparison to control groups. ML and IL significantly decreased (p<0.05). The extract also significantly (p<0.05) increased the serum cholesterol and testosterone levels. From these effects the MECA posses significant increase in the sexual activity in male rats.The augmented sexual behavior in male rats might be due to the presence of alkaloids, saponins and flavonoids found in MECA.
Prospective Implementation of the Ottawa Subarachnoid Hemorrhage Rule and 6-Hour Computed Tomography Rule

Background and Purpose— The Ottawa subarachnoid hemorrhage (SAH) rule identifies patients with headache requiring no testing for SAH, while the 6-hour computed tomography (CT) rule guides when to forgo a lumbar puncture. Our objectives were to: (1) estimate the clinical impact of the Ottawa SAH rule and the 6-hour-CT rule on testing rates (ie, CT, lumbar puncture, CT angiography); (2) validate the 6-hour-CT rule for SAH when applied prospectively in a new cohort of patients. Methods— We conducted a multicenter prospective before/after implementation study from 2011 to 2016 with 6 months follow-up at 6 tertiary-care Canadian Academic Emergency Departments. Consecutive alert, neurologically intact adults with headache were included. For intervention period, physicians were given a 1-hour lecture, pocket cards, posters were installed, and physicians indicated Ottawa SAH rule criteria when ordering CTs. SAH was defined by blood on CT, xanthochromia in cerebrospinal fluid, or >1×106/L red blood cells in cerebrospinal fluid with aneurysm. Results— We enrolled 3672 patients, 1743 before and 1929 after implementation, including 188 with SAH. Proportions undergoing CT was unchanged (88.0% versus 87.5%; P=0.643). Lumbar puncture use decreased (38.9% versus 25.9%; P<0.0001). Additional testing following CT (ie, lumbar puncture or CT angiography) decreased (51.3% versus 42.2%; P<0.0001). Admissions declined (9.8% versus 7.4%; P=0.011). Mean emergency department stay was unchanged (6.3±4.0 versus 6.4±4.2 hours; P=0.685). The Ottawa SAH rule was 100% (95% CI, 98.1%–100%) sensitive, and the 6-hour-CT rule was 95.5% (95% CI, 89.8–98.5) sensitive for SAH. The 6-hour-CT rule missed 5 SAHs: 1 radiology misread, 2 incidental aneurysms, 1 nonaneurysmal cause, and 1 profoundly anemic patient. Conclusions— The Ottawa SAH rule and the 6-hour-CT rule are highly sensitive and can be used routinely when SAH is considered in patients with headache. Implementing both rules was associated with a meaningful decrease in testing and admissions to hospital.
Coarse-Grained Models of Aqueous Solutions of Polyelectrolytes: Significance of Explicit Charges.

The structure of polyelectrolytes is highly sensitive to small changes in the interactions between its monomers. In particular, interactions mediated by counterions play a significant role, and are affected by both specific molecular effects and generic concentration effects. The ability of coarse-grained models to reproduce the structural properties of an atomic model is thus a challenging task. Our present study compares the ability of different kinds of coarse-grained models: (i)~to reproduce the structure of an atomistic model of a polyelectrolyte (the sodium polyacrylate), (ii)~to reproduce the variations of this structure with the number of monomers and with the concentration of the different species. We show that the adequate scalings of the gyration radius of the polymer~$R_{\rm g}$ with the number of monomers~$N$ and with the box size~$L_{\rm box}$ are only obtained, first, if the monomer charges and the counterions are explicitely described, and second, if an attractive Lennard-Jones contribution is added to the interaction between distant monomers. Also, we show that implicit ion models are relevant only to the high electrostatic screening regime.
A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration

Abstract Objective Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation. Methods This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression. Results A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation. Conclusions The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.
Neonatal sepsis evaluation across the pond

One of the most uncommon, life-threatening and feared issues newborn clinicians struggle to measure is the likelihood that a newborn has acquired a bacterial infection during the process of birth. Early-onset neonatal sepsis (EONS) occurs at a rate of 1/1000 to 1/2000 term-born infants in high-income areas such as the UK and the USA; most of those affected require neonatal intensive care, and 2%–3% die despite such care. The optimal approach to this low-incidence, high-consequence condition has vexed neonatal clinicians for decades. An understanding of the pathogenesis of EONS as ascending colonisation and invasion of the uterine compartment and fetus with maternal genitourinary and gastrointestinal flora informs specific risk factors for infection. The definitive diagnostic for EONS is isolation of a pathogenic species from blood or cerebrospinal fluid culture; this test requires adequate volumes of these fluids, and the answer is not available in most cases for 12–48 hours. Assuming that inflammation accompanies infection, laboratory tests such as the complete blood count (CBC), C reactive protein and procalcitonin are measured to predict the presence of infection before culture can confirm it. In USA, the Centers for Disease Control and Prevention and professional societies such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics provide guidance on how to approach risk of EONS. In the UK, the National Institute for Health and Care Excellence …
Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) Using the Mode of Observation in Children Undergoing Inpatient Rehabilitation: A Reliability and Validity Study

Abstract Aims: To investigate inter-rater reliability, concurrent validity, and feasibility of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in a Swiss inpatient rehabilitation setting with the Functional Independence Measure for Children (WeeFIM®) as criterion. Methods: Cross-sectional clinimetric study including 36 children and adolescents with median age 10.8 (quartiles 8.7, 13.0) years with neurological/neuro-orthopedic disorders. Data were collected by healthcare professionals through observation. Analyses were performed using intraclass correlation coefficients (ICC2,1), standard error of measurement (SEMAgreement), Bland-Altman plots, Cohen’s Kappa κ, percentage agreement, and correlations. Results: Excellent inter-rater reliability (ICCs2,1 ≥ 0.97), small SEMs and acceptable limits of agreement for the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) were found. No systematic differences between raters existed. Cohen’s Kappa for inter-rater agreement of the Modifications Scale (MS) ranged from poor to strong (-0.06 ≤ κ ≤0.85). Excellent concurrent validity for FSS and CAS with the WeeFIM® (ρ ≥ 0.96), and excellent correlations of FSS and CAS with each other (ρ ≥ 0.98) were identified. Conclusion: The German PEDI-G seems to be a reliable and valid, but time-consuming tool when applied in an inpatient setting using observation.
Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

The prevalence and treatment response of depression and anxiety symptoms in obstructive sleep apnoea (OSA), although widely addressed in research and clinical settings, still remain unclear due to overlapping symptoms. The ADIPOSA study sought to elucidate the presence of non-overlapping symptoms of depression and anxiety in patients with moderate to severe OSA before and after continuous positive airway pressure (CPAP) treatment. Forty-eight adults aged 18–80 (68.75% men) with moderate to severe OSA were enrolled in this twelve-week longitudinal single-arm trial and completed a full-night ambulatory sleep diagnostic test and an assessment of cognitive-affective depression and anxiety symptoms using the Beck-Depression Inventory-Fast Screen (BDI-FS), the State-Trait Depression Inventory (IDER) and the State-Trait Anxiety Inventory (STAI). We found no cognitive-affective depression or anxiety symptoms of clinical relevance at baseline. The amelioration of depression and anxiety symptoms after CPAP use was only statistically significant when considering anxiety-trait (p < 0.01; d = 0.296) and euthymia (p < 0.05; d = 0.402), the distinctive component of depression. Although dysthymia or high negative affect remained unchanged, CPAP may be effective at reducing the lack of positive affect, a well-established health-protective factor. However, not until depression and anxiety disorders related to OSA are accurately measured in clinical and research settings will it be possible to obtain robust conclusions on the occurrence and amelioration of these symptoms after treatment.