Miracle-dz/UniFAR-FTUs huggingface dataset:
An analysis of the challenges in recruiting clinical teachers in Iranian medical universities: A qualitative analysis

BACKGROUND: Employing appropriate and deserving staff is goal of human resource management (HRM). A group of staff at medical science universities are clinical teachers. Considering the position and importance of these peoples, this study addresses the challenges of recruiting clinical teachers. MATERIALS AND METHODS: This is a qualitative study of the conventional content analysis done in Isfahan medical university in 2018. The participants were selected through intensity sampling of purposive sampling method, and data were obtained through semi-structured interviews conducted to survey 23 experts and clinical faculty members concerning the challenges involved in employing clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013. RESULTS: Two main categories and ten subcategories were classified as follows: HRM inadequacy in educational departments with six subscales such as indefiniteness of the workforce status for HR managers, reluctance of educational departments to increase human resources, nonproportionality of the teacher–student ratio, recruitment of faculty based on the needs in the treatment sector, weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment as a faculty and weakness of the selection process with four subscales based on data analysis such as undesirable manner of selection, recruitment based on the score given by the national board of medical examiners, purpose-based calls to recruit predefined individuals, and personal and emotional issues, rather than managerial standards, governing cooperation with teachers. CONCLUSION: Recruitment process is part of HRM tasks. Employment system in a medical sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy in educational departments and weakness of the selection process are challenges that affect the employment system. According to these findings, it is necessary to review the regulations and tasks of HRM in medical sciences universities.
Machine-learning method for localization of cerebral white matter hyperintensities in healthy adults based on retinal images

Abstract Retinal vessels are known to be associated with various cardiovascular and cerebrovascular disease outcomes. Recent research has shown significant correlations between retinal characteristics and the presence of cerebral small vessel disease as measured by white matter hyperintensities from cerebral magnetic resonance imaging. Early detection of age-related white matter changes using retinal images is potentially helpful for population screening and allow early behavioural and lifestyle intervention. This study investigates the ability of the machine-learning method for the localization of brain white matter hyperintensities. All subjects were age 65 or above without any history of stroke and dementia and recruited from local community centres and community networks. Subjects with known retinal disease or disease influencing vessel structure in colour retina images were excluded. All subjects received MRI on the brain, and age-related white matter changes grading was determined from MRI as the primary endpoint. The presence of age-related white matter changes on each of the six brain regions was also studied. Retinal images were captured using a fundus camera, and the analysis was done based on a machine-learning approach. A total of 240 subjects are included in the study. The analysis of various brain regions included the left and right sides of frontal lobes, parietal–occipital lobes and basal ganglia. Our results suggested that data from both eyes are essential for detecting age-related white matter changes in the brain regions, but the retinal parameters useful for estimation of the probability of age-related white matter changes in each of the brain regions may differ for different locations. Using a classification and regression tree approach, we also found that at least three significant heterogeneous subgroups of subjects were identified to be essential for the localization of age-related white matter changes. Namely those with age-related white matter changes in the right frontal lobe, those without age-related white matter changes in the right frontal lobe but with age-related white matter changes in the left parietal–occipital lobe, and the rest of the subjects. Outcomes such as risks of severe grading of age-related white matter changes and the proportion of hypertension were significantly related to these subgroups. Our study showed that automatic retinal image analysis is a convenient and non-invasive screening tool for detecting age-related white matter changes and cerebral small vessel disease with good overall performance. The localization analysis for various brain regions shows that the classification models on each of the six brain regions can be done, and it opens up potential future clinical application.
Acquired pulmonary vein stenosis resulting in haemoptysis: a case series

Abstract Background Acquired pulmonary vein stenosis (PVS) is an infrequent complication of atrial fibrillation ablation that is often misdiagnosed due to predominant respiratory symptoms. It can result in pulmonary venous hypertension, with varying presentations, ranging from shortness of breath to haemoptysis. Case summary We report two patients with a history of paroxysmal atrial fibrillation treated with radiofrequency ablation and pulmonary vein (PV) isolation, who subsequently developed PVS. Case 1 initially presented with indolent symptoms of shortness of breath and cough. He was initially diagnosed with and treated for pneumonia. In contrast, Case 2 presented with massive haemoptysis, requiring intubation and intensive care unit admission. Both patients were eventually diagnosed with PVS by computed tomography. They were treated with PV angioplasty and stenting. Discussion While previously limited to the congenital heart disease population, PVS is occurring more frequently now in adult patients as a complication of ablation procedures. It is most effectively treated with angioplasty and stent implantation but has a high rate of recurrence.
Family disability, poverty and parenting stress: Analysis of a cross-sectional study in Kenya

Background Households with a disabled member, be they a caregiver or a child, are poorer than households not affected by disability. Poverty, caregiving as a person with a disability and being the caregiver of a child with a disability can lead to increased parenting stress. Objectives The objective of this study was to examine whether parenting stress experienced by caregivers in a household with a disabled member is greater when the disabled member is the caregiver, or the child, and how much of these respective relationships is explained by poverty. Method We collected cross-sectional data using a demographic survey, the Washington Group Questions on adult disability, the 10 Questions on child disability and the Parenting Stress Index-Short Form, from 465 caregivers enrolled in a non-governmental child development programme in Kenya. Results Households with a disabled member were poorer than households without a disabled member. Parenting stress of disabled caregivers was higher than parenting stress of non-disabled caregivers; however, this relationship disappeared when socio-economic status was controlled for. Caregivers of disabled children were more stressed than caregivers of non-disabled children, and this effect was not explained by differences in socio-economic status. Conclusion Our findings highlight the importance of developing a comprehensive understanding of the stressors facing households with a disabled member, particularly if that member is a child, so that supportive interventions can adequately cater to the needs of caregivers, and their children, in the context of poverty.
The Effect of Applying the Information-Motivation-Behavioral Skills Model on Treatment Adherence in Patients with Cardiovascular Disease: A Quasi-Experimental Study

ABSTRACT Background: Non-adherence complicates the management of patients with cardiovascular disease. This study aimed to determine the effect of applying the information-motivation-behavioral skills (IMB) model on the treatment adherence among these patients Methods: This quasi-experimental study was conducted on 112 patients with cardiovascular disease in Nemazee and Al-zahra hospitals in Shiraz, Iran, from October 2019 to July 2020. Eligible patients were selected and divided into intervention and control groups. The intervention was based on an integration of IMB model constructs and included 10 motivational-educational sessions for three months, followed by telephone consultations for six months. Data were collected before, and three and six months after the end of the motivational-educational sessions using adherence questionnaire in patients with chronic diseases, and adherence in chronic disease scale for medication adherence. Data were analyzed using SPSS 22, and descriptive statistics, chi-square, independent t-test, and repeated measure ANOVA were performed. P<0.05 was considered significant Results: The intervention and control groups were homogenous based on demographic characteristics. Repeated measure ANOVA findings revealed an increasing trend in the mean scores of the intervention group in treatment adherence from 51.10±3.20 at baseline to 66.40±5.50 three months and 73.80±6.80 six months after the end of the intervention (P<0.001). Furthermore, based on repeated measure ANOVA findings, the mean score of the intervention group in medication adherence significantly increased from 20.10+3 at baseline to 24.10+2.40 three months and 24.50+3.20 six months after the end of the intervention (P<0.001). Conclusion: Applying the IMB model promoted adherence to treatment and medication among patients with cardiovascular disease. Therefore, such interventions are recommended for these patients
Photosensitivity of Aqueous Sodium Nitroprusside Solutions: Nitric Oxide Release versus Cyanide Toxicity

Photolysis of the pentacyanonitrosylferrate (II) ion in sodium nitroprusside (SNP) solutions involves a competition between photosubstitution and photo-oxidation reactions, where the nitrosyl and cyanide ligands can be released as free nitric oxide (NO) or NO+ and free CN- or CN radical. We have irradiated aqueous SNP solutions at several narrow wavelength ranges in the UV/Vis region (314–576 nm), with the aim of investigating the photolability of the CN and NO ligands. Kinetics of photolysis were used to characterize the photosensitivity of SNP solutions in the range 314–576 nm. Spectral changes in the UV/Vis and IR regions upon irradiation and assays for the detection of free CN- and NO, provided additional evidences for the absence of photoprocesses leading to the release of CN- with λirr > 480 nm. In this condition, the main photoproducts were found to be the [FeIII(CN)5(H2O)]2- ion and NO, formed in a intramolecular photo-oxidative process. Irradiation with unfiltered UV/Vis light and with λirr < 480 nm, lead to the release of both CN- and NO and to a mixture of ferrocyanide and ferricyanide products. These results confirm that the exposure of SNP solutions to UV/Vis light below λirr = 480 nm can lead to cyanide poisoning and further support that above this wavelength limit, a selective NO release from SNP can be achieved, with possible implications for its biochemical action.
Anticancer, Free Radicals, and Digestive Enzyme Inhibitory Activities of Rubus sanctus Schreb Root Four Solvent Fractions

Background Humankind used herbal products as a source of medicines since they understood their therapeutic benefits from ancient times. Therefore, the current research aimed to determine the anticancer, antioxidant, and metabolic enzyme inhibitory activities of Rubus sanctus (RS) root four solvent fractions for the first time. Methods The antioxidant, antilipase, and anti-α-amylase potentials of (RS) four solvent fractions were evaluated using standard biomedical assays. Moreover, the DNA cell cycle of liver cancer was assessed using a propidium iodide (PI) assay. At the same time, the apoptosis activity was estimated utilizing flow the cytometry method. Results The methanol and acetone (RS) fractions showed the highest antioxidant activity with IC50 values of 0.078 ± 0.22 and 0.67 ± 0.25 μg/ml, respectively, compared with Trolox, which has an antioxidant IC50 value of 2.039 ± 0.52 μg/ml. Moreover, the methanol (RS) fraction has the highest anti-α-amylase activity with an IC50 value of 20.12 ± 0.34 μg/ml compared with acarbose, which has an IC50 value of 6.565 ± 0.3 μg/ml. Also, the acetone (RS) fraction revealed the highest antilipase activity with an IC50 value of 6.03 ± 1.23 μg/ml compared with the positive control orlistat which has an IC50 value of 0.39 ± 0.45 μg/ml. The aqueous, methanol, acetone, and hexane fractions of the (RS) roots decreased the secretion of the α-fetoprotein in the liver cancer cells. The acetone fraction was the most potent α-fetoprotein inhibitor with an average of 237 ± 12.5% compared with the average of the untreated cells, which was 4066.6 ± 202%. The hexane fraction was the most effective in diminishing apoptosis with an average of 14.5 ± 1.6%, compared with 49% ± 2 untreated cells' average. In inhibiting cell cycle progression, it was recognized that methanol fraction seems to be the most powerful amplifier of the (RS) effect, as it increased the proportion of the cells with an average of 24.5 ± 2.2%, compared with 7.4 ± 1.8% in the doxorubicin (DOX). Data indicated a decrease in cell proliferation rate by prolonging the G2-M phase and thus slowing cancer progression. Our results suggest that (RS) roots four solvent fractions have potential anticancer activity. Conclusion The (RS) roots four solvent fractions have potential anticancer, antioxidant, antilipase, and α-amylase inhibitory activities. It could be a promising source for applications in the functional food, nutraceutical, and pharmaceutical industries.
Study of re-transplantation and prognosis in liver transplant center in Iran

Aim: This this study aimed to investigate the causes and prognoses of liver re-transplantation in patients referred to Imam Khomeini Hospital Liver Transplantation Center. Background: Organ shortage is a major problem in the world, a high demand for liver transplantation has exacerbated this problem. Thus, providing more information on the causes of liver re-transplantation, its prognosis, and other issues related to this procedure is of great importance. Methods: This study was conducted in 2018 as a historical cohort. In this study, the records of liver transplantation patients at Imam Khomeini Hospital Liver Transplantation Center between 2000 and 2016 were studied, and data was extracted from the records of patients undergoing liver transplantation. Patient data was entered into SPSS 20 software and analyzed. Results: In this study, 1030 patients with a mean age of 43.15 ± 14.57 years were studied. There were 426 women (41.4%) and 604 men (58.6%). The number of primary transplants was 966 with a mean age of 43.19 ± 14.72, and the number of re-transplants was 64 with a mean age of 42.56 ± 12.82. Significant differences were found between the two groups in terms of MELD and CHILD scores, cold ischemic time, total and direct bilirubin levels, liver function factors (ALT, AST, and alkaline phosphatase), hemoglobin, and WBC. There was no significant difference between the two groups in terms of age, sex, or platelets (> 0.05). The mortality rate was 241 (23.39%) in all patients and the mortality rate was 206 (21.32%) and in liver transplant patients was 35 (54.68%). The mortality rate in the transplant group was statistically higher (p<0.001). Secondary was primary non-functional graft (PNF) (37.5%) with 1-, 3, and 5-year survival rates of 82%, 81%, and 70% in primary group and 59%, 43% and 32% in re-transplantation, respectively. There was a significant difference in survival between the two groups (p <0.05). Hemoglobin and alkaline phosphatase were predictors of survival rates in transplant patients. Conclusion: The results of this study showed that the survival rate of re-transplant patients was significantly lower than that of primary transplant patients, and the mortality rate in re-transplant patients was significantly higher.
Assessment of knowledge, attitude and practice towards COVID-19 among paramedical staff in Central India: A cross-sectional, online survey

BACKGROUND: Knowledge of a disease can influence paramedic's attitudes and practices, and incorrect attitudes and practices directly increase the risk of infection. Understanding paramedic's knowledge, attitudes, and practices (KAPs) and possible risk factors helps to predict the outcomes of planned behavior. To assess KAP regarding COVID-19 through Google form among paramedical staff at tertiary care teaching institutes of central India. MATERIALS AND METHODS: A cross-sectional, multicentric, questionnaire-based study was conducted from May 2020 to August 2020 among 230 paramedical staff from two tertiary care teaching institutes through Google form. Data were analyzed by Chi-square test and parametric test using GraphPad prism software version 5.0. RESULTS: All participants had knowledge about symptomatology of COVID-19. However, significantly more participants in nursing cadre know about definition of close contact. The mean knowledge score was 4.84 ± 0.6. The mean score for attitude was 4.48 ± 0.83. Overall, 54.78% of paramedical staff follow correct prevention strategies. Of them, significantly more nursing staff correctly practice infection control measures upon arrival of COVID-19 patients (P = 0.033). There was a significant difference among both groups regarding wearing of appropriate personal protective equipment while transporting/accompanying patients who are confirmed with COVID 19 (P = 0.009). The overall score for practice is 3.97 ± 1.03. The practice score was significantly better in nursing cadre as compared to nonnursing cadre (P = 0.038). CONCLUSION: Majority of the participants had good knowledge and positive attitude. Nursing cadre follows better preventive practices as compared to nonnursing cadre while performing COVID-related duties. Considering these facts, dodges responsible for poor practices should be identified and resolved so that India will be able to conquest the battle against the disease.
Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as “status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawal of anesthesia. ” This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.
Pediatric Stroke: Overview and Recent Updates

Stroke can occur at any age or stage in life. Although it is commonly thought of as a disease amongst the elderly, it is important to highlight the fact that it also affects infants and children. In both populations, strokes have a high rate of morbidity and mortality. Arguably, it is more detrimental in the pediatric population given the occurrence at a younger age and therefore, a longer duration of disability, potentially over the entire lifespan. The high rate of morbidity and mortality in pediatrics is attributed to significant delays in diagnosis, as well as misdiagnosis. Acute stroke management is time dependent. Patients who receive acute treatment with either intravenous (IV) tissue plasminogen activator (tPA) or mechanical thrombectomy, have improved mortality and functional outcomes. Additionally, the earlier treatment is initiated, the higher the likelihood of preserving penumbra, restoring cerebral blood flow and potentially reversing symptoms, thereby limiting disability. Prompt identification is essential as it leads to improved patient care in such a narrow therapeutic window. It enhances the care received during hospitalization and reduces the risk of early stroke recurrence. Despite limited data and lack of large randomized clinical trials in pediatrics, both IV tPA and mechanical thrombectomy have been successfully used. Bridging the gap of acute stroke management in the pediatric population is an essential part of minimizing adverse outcomes. In this review, we discuss the epidemiology of pediatric stroke, the diverse etiologies, presentation as well as both acute and preventative management.