Miracle-dz/UniFAR-FTUs huggingface dataset:
Achilles Tendon Xanthoma and Cholestanol Revealing Cerebrotendinous Xanthomatosis: A New Case Report

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid storage disease rarely reported in Africa. Therefore, we report a Moroccan first case report of CTX. A 20-year-old woman was presented in our department for bilateral swelling of the posterior aspect of ankles and the anterior aspect knees with gait disturbances evolving since the age of 7. The patient was the first child of consanguineous marriage. She had bilateral cataracts and developmental delay. Laboratory findings revealed that the plasma cholestanol level was remarkably elevated, and plasma and urine bile alcohol levels were elevated. MRI of ankles showed a bilateral diffuse thickening of the Achilles tendon with hypointense in T1 and heterogeneous hypersignal in T2 with spots in hypersignal in T1 and T2. Brain MRI revealed bilateral and symmetrical T2 hypersignal of dentate nuclei, without white matter signal alterations or cerebral or cerebellar atrophy. A biopsy obtained of the Achilles swelling with a histological study showed an aspect of tendon xanthoma. Hence, the diagnosis of CTX was made. MRI, especially brain MRI, plays an important role in the diagnosis of CTX.
Role of Growth Hormone in Countering the Effects of Anxiety and Depression in Women Undergoing in-vitro Fertilization-Embryo Transfer [Letter]

Dow Medical College, Karachi, Pakistan Dear editor I have read the article entitled “The analysis of anxiety and depression in different stages of in-vitro fertilization-embryo transfer in couples in China” by Liu et al published in Neuropsychiatric Disease and Treatment. I want to acknowledge the authors for this successful research article and make some contributions. In the article, the effect of anxiety and depression on the outcomes of IVF-ET has been studied indicating that there is high incidence of anxiety and depression in couples undergoing IVF-ET, particularly in women. Although the study concluded that there is no significant association between anxiety and depression and IVF-ET outcomes (p>0.05), there is still a need of a much more extensive investigation. Regarding this matter, I have something to suggest. I think that this study should have included an examination of changes in hormonal index of women involved in the study. While the study conducted by An et al did an examination on the changes in stress influencing the outcomes of IVF via the activation of hypothalamus-pituitary-adrenal (HPA) axis, there is still a need of a thorough study which involves hormones that are part of the HPA axis. In this matter, role of Growth Hormone should be investigated in increasing the efficacy of IVF-ET in women with high level of anxiety and depression. The randomized control trial, conducted by Hart, conclusively showed that pretreatment with GH alleviates Oxidative Stress (OS), involved in the pathogenesis of Poor Ovarian Responders (POR), and improves oocyte quality and outcomes of PORs. Therefore, the potential applications of GH in women with anxiety and depression related issues does warrant attention and should be thoroughly investigated. For this, I suggest that a study consisting of two groups of women diagnosed with clinical anxiety and depression undergoing IVF should be done, with one group pretreated with GH, and both examined to find any conclusive indication that GH pretreatment increases the efficacy of the IVF-ET procedures by countering the effects of severe anxiety and depression.
Value of adjunctive evidence from MII-pH monitoring and high-resolution manometry in inconclusive GERD patients with AET 4–6%

Objectives: Gastro-esophageal reflux disease (GERD) is a common disease in gastroenterology outpatients. However, some patients with typical reflux symptoms does not satisfy diagnostic criteria. This study was to explore the value of adjunctive evidence from multichannel intraluminal impedance-pH (MII-pH) monitoring and esophageal high-resolution manometry (HRM) in inconclusive GERD patients with acid exposure time (AET) 4–6%. Methods: Endoscopy, MII-pH monitoring and esophageal HRM were retrospectively analyzed from consecutive patients with typical reflux symptoms in a tertiary hospital from 2013 to 2019. Patients were categorized as conclusive or inconclusive GERD according to AET. Adjunctive evidence for GERD diagnosis from Lyon Consensus were collected and analyzed. Results: Among 147 patients with typical reflux symptoms, conclusive GERD was found in only 31.97% of patients (N = 47). The remaining 100 patients (68.03%) were inconclusive GERD, of whom 28% (N = 28) had AET 4–6%. These patients suffered similar reflux burden and impaired esophageal movement. Inconclusive GERD patients with AET 4–6% had lots of positive adjunctive evidence from HRM and MII-pH monitoring. In receiver operating characteristic analysis, mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWI) had an area under the curve (AUC) of 0.839 (CI: 0.765–0.913, p < 0.001) and 0.897 (CI: 0.841–0.953, p < 0.001), respectively, better than total reflux episode (AUC of 0.55, p = 0.33). When MNBI was combined with PSPWI, the AUC was elevated to 0.910 (CI: 0.857–0.963, p < 0.001). Conclusions: Inconclusive GERD patients with AET 4–6% have similar acid burden and esophagus motility dysfunction to GERD patients. MNBI and PSPWI are pivotal adjunctive evidence for diagnosing GERD when AET is borderline.
Prevalence and Predictors of Vitamin D Inadequacy: A Sample of 2,547 Patients in a Mediterranean Country

Background The aim of this retrospective study was to identify prevalence and risk factors for vitamin D inadequacy in a sunny Mediterranean country. Methods Results of 2,547 patients aged 19 to >60 years were included in this study. Data were derived from the laboratory database at Rafik Hariri University Hospital, Beirut, Lebanon, over a period of two years (2016-2017). Data included patient’s age, gender, date of test, and vitamin D level. Females were questioned through phone call for marital status, parity, and veiling. Results The prevalence of vitamin D inadequacy was 83.5% overall, 86.4% in males, and 82.3% in females. At a cut-off of 20 ng/mL, vitamin D deficiency affected 63% of the studied population. A significant association was observed between vitamin D and age. The highest prevalence (71.2%) was found in females in the age group of 19-39 years, while no significant correlation with age was observed in males. Vitamin D levels were lower in veiled women (mean 25(OH)D = 17.9 ng/mL) compared to non-veiled women, although this difference was not significant. In addition, vitamin D inadequacy does not show a significant association with gender, parity, marital status, and season of the year. Conclusion The high prevalence of vitamin D inadequacy in our study in both males and females of all age groups calls for urgent actions at the national level to increase awareness in the population and to prevent the serious complications of vitamin D deficiency in all patients, especially those who are at a high risk.
Providers’ View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present

Introduction: Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center. Methods: A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel. Result: The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets. Conclusion and Recommendation: A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.
Is the use of dual antiplatelet therapy following urgent and emergency coronary artery bypass surgery associated with increased risk of cardiac tamponade?

Background and aim: Cardiac tamponade is a recognized post-cardiac surgery complication, resulting in increased morbidity and mortality. The 2016 American College of Cardiology and American Heart Association Guidelines recommended the use of Dual Antiplatelet Therapy (DAPT) in the management of patients undergoing urgent or emergency coronary artery bypass grafting (CABG). The effect of DAPT on cardiac tamponade rates was investigated in comparison to aspirin monotherapy (AMT). Materials and methods: Prospectively collected data from a tertiary cardiac surgery center was analyzed to identify the patients who underwent urgent and emergency CABG between January 2015 and January 2018. The patients were categorized as aspirin monotherapy (AMT) and Dual Antiplatelet Therapy (DAPT) groups. The primary outcome was total cardiac tamponade rate and secondary outcomes were length of hospitalization and 30-days and 1-year mortality. Results: A total of 246 eligible patients were included across both arms and compared for confounding variables. Cardiac tamponade was observed in 9 (7.3%) and 8 (6.5%) of AMT and DAPT groups, respectively (P=0.802). The average hospital stay in days was similar in both groups (AMT=8.4 vs. DAPT=8.1, P=0.82), whereas tamponade patients experienced a significantly longer hospitalization when compared to non-tamponade patients (9.8 vs. 8.1 days, P=0.047). The 30-days and 1-year mortality were similar in both groups and were 0.8% and 1.6%, respectively. Conclusion: Overall, this study demonstrated that DAPT in urgent or emergency CABG patients is not associated with an increased risk of cardiac tamponade, length of hospital stay or mortality. Relevance for patients: This study demonstrated that the use of DAPT in patients undergoing CABG as an urgent or emergency procedure following myocardial infarction is not associated with an increased risk of bleeding and has many associated benefits.
Ferumoxytol for the treatment of iron deficiency and iron-deficiency anemia of pregnancy

Introduction: A litany of recent evidence supports the morbidity of intra-natal iron-deficiency anemia and its prodrome, iron deficiency. Oral iron administered during second and third trimesters does not get to the developing fetus if the mother is iron deficient. This is especially concerning as the rapidly developing fetal brain is in particular need of iron sufficiency. Intra-natal iron deficiency is associated with autism, schizophrenia and abnormal brain structure. The obstetrical literature reports an unacceptably high incidence of gastrointestinal adverse events with oral iron. The time iron honored standard in the United States for intravenous iron replenishment in gravidas is iron sucrose. While safe and effective, four to seven visits are required to accomplish what newer formulations can achieve with one. Methods: Ferumoxytol is a superparamagnetic iron oxide linked to polyglucose sorbitol carboxymethylether-binding elemental iron tightly allowing administration of complete replacement doses in 15–30 min. Herein, we report the results of 131 consecutive, non-selected, iron-deficient second- and third-trimester pregnant women who received either 510 mg of intravenous (IV) ferumoxytol twice or 1020 mg once. Results: Hemoglobin and iron parameter increments were highly statistically significant. No adverse events were reported. We report how a single infusion is safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. Conclusion: Ferumoxytol represents an efficacious and safe method of administration of IV iron which improves convenience for patients and practitioners, and is cost saving due to fewer visits. Plain language summary One or two infusions of intravenous iron for iron deficiency or iron-deficiency anemia of pregnancy simplifies care This study was conducted to highlight the inconvenience of multiple doses of IV iron and how administering the same dose in one or two infusions simplifies care. We report how a single infusion is as safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. This study supports a growing body of evidence, to date, unreported, with ferumoxytol in pregnancy, reporting improved convenience and decreased costs with higher doses of IV iron in one or two visits.
Intrinsic attention to pain is associated with a pronociceptive phenotype

Capacity for modulation of incoming nociceptive signals is a determinant of our tendency to attend to pain. Abstract Introduction: Evidence suggests that attention to pain is a product of both incoming sensory signals and cognitive evaluation of a stimulus. Intrinsic attention to pain (IAP) is a measure that captures an individual's natural tendency to attend to a painful stimulus and may be important in understanding why pain disrupts cognitive functioning in some individuals more than others. Objective: In this study, we explored the extent to which IAP was associated with the modulation of incoming sensory signals characteristic of a pronociceptive phenotype: temporal summation (TS) and conditioned pain modulation (CPM). Method: 44 healthy participants (23 female; Mage=23.57, S.D.=5.50) were assessed on IAP, TS and CPM. Results: We found that IAP was positively correlated with TS and CPM. A regression model showed that TS and CPM explained 39% of the variance in IAP scores. Both mechanisms seem to contribute independently to the propensity to attend to pain. Conclusion: These findings highlight that modulatory mechanisms at the spinal/supraspinal level exert a strong influence on an individual's ability to disengage from pain.
Human Leukocyte Antigen-DR Isotype Expression in Monocytes and T Cells Interferon-Gamma Release Assay in Septic Patients and Correlation With Clinical Outcome

Background Sepsis is a life-threatening dysregulated host response to infection responsible of multiple organs dysfunction (Sepsis-3 International Consensus Definition), during which clinical outcome is a balance between inflammation and immune suppression. Monocytes and lymphocytes may play an important role in immune paralysis, and their impaired functional activity can decrease overall immune system efficiency. We evaluated sepsis-induced changes in monocytes human leukocyte antigen-DR isotype (HLA-DR) expression and T cell capacity of interferon (IFN)-γ production in relation with patient’s clinical outcome. Methods Analysis of HLA-DR expression on blood monocytes (mHLA-DR) was performed in 55 patients with high procalcitonin (hPCT, > 0.5 ng/mL,) and suspected/confirmed sepsis, and 20 controls. HLA-DR absolute quantification and IFN-γ release assay were monitored in 16 septic patients for 4 weeks following sepsis confirmation. Results Cytofluorimetric analysis revealed a significant decrease of mHLA-DR percentage in septic patients with adverse outcome compared to patients with better clinical outcome (88.4% vs. 98.6% with P < 0.05), in combination with a significant decrease of absolute number of HLA-DR molecules per monocyte (P < 0.05, starting at 1 week of follow-up). Lymphocytes stimulation with phytohemagglutinin (PHA), Staphylococcus aureus (S. aureus) and Candida albicans (C. albicans) showed a severe declining of IFN-γ release related to fatal clinical outcome of patients. Conclusions This immunologic anergy of innate and adaptative immunity showed an early immune paralysis during sepsis which appears correlated with the impairment of clinical outcome.
The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review

This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.
Emotional experiences of reading health educational manga encouraging behavioral changes: a non-randomized controlled trial

ABSTRACT Objective Educational health manga are used to promote health behavior change. This study thus seeks to achieve the following objectives: identify the emotional experience of reading educational health manga, understand the effects of facilitating the psychological mediators of behavior change through emotional experiences, and compare the effectiveness of educational health manga with conventional materials. Design A non-randomized controlled trial with six conditions was conducted. Target behaviors were physical activity and healthy diet. Individuals aged 20–69 years (n = 1,680) were assigned three manga intervention conditions and three control conditions (visual image-based, narrative text, and general text material). Main Outcome Measures Participants were asked about their emotional experience while reading either intervention material or control material and its perceived positive influence on enhancing psychological mediators. Results Four factors relevant to emotional experiences were identified: risk perception, familiarity, satisfaction, and realism. Emotional experience strongly predicted the psychological mediators of behavior change. Analysis of differences among the six conditions revealed that exposure to educational health manga led to greater satisfaction and increased knowledge. Participants assigned manga conditions experienced superior emotional experiences and outcomes. Conclusions Those assigned manga conditions experienced superior emotional experiences and outcomes. The efficacy of educational health manga in encouraging psychological mediators of change was confirmed. Trial registration: UMIN Japan identifier: UMIN000034369.
Three dimensional porous scaffolds derived from collagen, elastin and fibrin proteins orchestrate adipose tissue regeneration

Current gold standard to treat soft tissue injuries caused by trauma and pathological condition are autografts and off the shelf fillers, but they have inherent weaknesses like donor site morbidity, immuno-compatibility and graft failure. To overcome these limitations, tissue-engineered polymers are seeded with stem cells to improve the potential to restore tissue function. However, their interaction with native tissue is poorly understood so far. To study these interactions and improve outcomes, we have fabricated scaffolds from natural polymers (collagen, fibrin and elastin) by custom-designed processes and their material properties such as surface morphology, swelling, wettability and chemical cross-linking ability were characterised. By using 3D scaffolds, we comprehensive assessed survival, proliferation and phenotype of adipose-derived stem cells in vitro. In vivo, scaffolds were seeded with adipose-derived stem cells and implanted in a rodent model, with X-ray microtomography, histology and immunohistochemistry as read-outs. Collagen-based materials showed higher cell adhesion and proliferation in vitro as well as higher adipogenic properties in vivo. In contrast, fibrin demonstrated poor cellular and adipogenesis properties but higher angiogenesis. Elastin formed the most porous scaffold, with cells displaying a non-aggregated morphology in vitro while in vivo elastin was the most degraded scaffold. These findings of how polymers present in the natural polymers mimicking ECM and seeded with stem cells affect adipogenesis in vitro and in vivo can open avenues to design 3D grafts for soft tissue repair.
Jackfruit Anaphylaxis in a Latex Allergic Non-Healthcare Worker

Introduction Anaphylaxis to jackfruit (Artocarpus heterophyllus) is rare. Two previously reported cases have been published in two healthcare workers from jackfruit endemic regions. Latex allergy and birch pollen cross reactivity have both been associated with jackfruit anaphylaxis, providing two separate mechanisms of sensitization. We present a case of jackfruit anaphylaxis in a young latex allergic non-healthcare worker in a non-endemic region. Case Report A 21-year-old male had an anaphylactic reaction immediately after ingesting dried jackfruit. He had a history of allergic rhinitis and latex allergy. He was born premature and required neonatal intensive care and multiple surgeries in infancy, which could possibly be the source of his latex sensitization. Skin prick testing was positive for jackfruit and latex. Discussion Jackfruit anaphylaxis has only been described in conjunction with a latex allergy or a birch pollen allergy. As jackfruit becomes more available across the world, it is important for physicians and patients with these sensitivities to be aware of these possible cross reactions. Fruit sensitivities in latex allergic patients have been well established as Latex-fruit syndrome. Our case highlights the association of latex sensitization and jackfruit anaphylaxis. Conclusion We present a case of Jackfruit anaphylaxis associated with latex allergy in a non-healthcare worker from Midwestern United States. As jackfruit becomes more popular in non-endemic regions, its possible cross reactivity with latex, as well as birch pollen should be recognized.