cyrilzakka/clinical-trials huggingface dataset:
Emergency Medicine Pulmonary Embolism Testing Multicentre Study

It is important to diagnose pulmonary embolism in a timely manner to prevent death and long-term disability. More than half a million people (4-5% of emergency department patients) are tested for pulmonary embolism, although the positive rate is low. Imaging for PE testing exposes patients to radiation, is expensive, adds time to the emergency visit, and can lead to a false positive diagnoses. Existing protocols aimed at reducing unnecessary pulmonary embolism imaging are complex and seldom used by emergency physicians. Too many patients undergo unnecessary pulmonary embolism imaging.

A new tool (called Adjust-Unlikely) could safely reduce pulmonary embolism imaging in Canada. A research group composed of researchers, emergency physicians, and patients developed the Adjust-Unlikely clinical decision rule: a rule which has been customized for emergency physicians and emergency patients. Adjust-Unlikely is highly sensitive at the bedside, meaning there are very few false negative results.

The study aim is to prospectively validate Adjust-Unlikely pulmonary embolism testing in emergency patients with suspected pulmonary embolism.


Eligibility Criteria:
Inclusion Criteria:

* Emergency department patient who is tested by an emergency physician for PE

Exclusion Criteria:

* Patient is \< 18 years of age
* No documentation of whether PE is the most likely diagnosis
* D-dimer is not tested or else not resulted during the emergency visit
* The D-dimer level is known before documentation of whether PE is the most likely diagnosis
* The D-dimer is ordered prior to the physician assessing the patient
* The patient has previously registered that they opt out of all research at the participating site
* The patient leaves against medical advice
* The patient has had PE or deep vein thrombosis imaging (CT pulmonary angiogram, ventilation-perfusion scan or lower limb ultrasound) within prior 30 days
* There is a new (non-PE) indication for anticoagulation
* The patient was initiated on treatment for presumed PE prior to PE testing
* The patient has previously been enrolled into the study
* The patient has a prior history of lower extremity deep vein thrombosis without availability of a baseline ultrasound scan
* The patient was transferred from another hospital organization
* The patient does not reside in Ontario
* The patient has no valid Ontario Health Insurance Plan card
Physiotherapy for Non-specific Neck Pain in Working Age Persons

The goal of this clinical trial is to learn about the effects of two different physiotherapy methods on non-specific neck pain in working age individuals. The main questions it aims to answer are:

* What is the effect of self stretching exercise on non-specific neck pain, functional disability, range of motion of the cervical spine and hand muscle strength in working age individuals?
* What is the effect of post-isometric relaxation exercise on non-specific neck pain, functional disability, range of motion of the cervical spine and hand muscle strength in working age individuals?
* Is any of the applied interventions (self-stretching or post-isometric relaxation exercise) superior to each other?

Participants will:

* be evaluated by an experienced physiotherapist who will perform the interview and physical examination. Interview includes questions about the age, sex, work profile, pain intensity and duration, and other complaints. Physiotherapy examination includes a range of motion measurement, hand grip muscle strength and functional disability index evaluation.
* Two different interventions will be prescribed to the randomly assigned study participants: post-isometric relaxation and self-stretching. Duration of interventions for both groups is 4 weeks (3 times per week, 12 sessions). Duration of one session - 45 min.

The goal of this clinical trial is to learn about the effects of two different physiotherapy methods on non-specific neck pain in working age individuals. The main questions it aims to answer are:

What is the effect of self stretching exercise on non-specific neck pain, functional disability, range of motion of the cervical spine and hand muscle strength in working age individuals? What is the effect of post-isometric relaxation exercise on non-specific neck pain, functional disability, range of motion of the cervical spine and hand muscle strength in working age individuals? Is any of the applied interventions (self-stretching or post-isometric relaxation exercise) superior to each other?

Participants will:

be evaluated by an experienced physiotherapist who will perform the interview and physical examination. Interview includes questions about the age, sex, work profile, pain intensity and duration, and other complaints. Physiotherapy examination includes a range of motion measurement, hand grip muscle strength and functional disability index evaluation.

Two different interventions will be prescribed to the randomly assigned study participants: post-isometric relaxation and self-stretching. Duration of interventions for both groups is 4 weeks (3 times per week, 12 sessions). Duration of one session - 45 min.

Eligibility Criteria:
Inclusion Criteria:

* current neck pain,
* neck pain duration for at least 12 weeks,
* admission through outpatient clinic in Lithuania.

Exclusion Criteria:

* neurological disorders related to neck pain,
* red flags (night pain, severe muscle spasm, loss of involuntary weight, symptom mismatch),
* previous neck surgery,
* low back pain,
* medications used for pain.
Antibiotic Concentration in Internal Mammary Graft Preparation

The negative effect of internal mammary harvesting on sternal perfusion is well known, especially in diabetic subjects. Microdialysis previously showed increased lactate tissue concentration after mammary artery preparation. Although high antibiotic concentration is of utmost importance in this region, no study previously measured the effect of internal mammary artery harvesting on target tissue antibiotic concentration.

Study hypothesis:

Internal mammary artery harvesting imposes an additional risk for deep sternal wound infection by impairing antibiotic tissue penetration. This effect is mediated by altered perfusion patterns and may be seen in cephalosporin and/or Teicoplanin treatment.

Study objective:

To evaluate the impact of left internal mammary artery preparation on target tissue antibiotic concentration of Cefazolin and Teicoplanin during cardiac surgery

Design:

This study is designed as an observational pharmacokinetic trial. Patients are their own controls by measuring antibiotic concentration in different subcutaneous tissues.

Study population:

Patients referred for coronary artery bypass grafting to the Department of Cardiothoracic Surgery with planned unilateral left internal mammary artery preparation and a high risk profile for deep sternal wound infections will be asked to participate in this trial.


Eligibility Criteria:
Inclusion Criteria:

* Written informed consent
* Planned coronary artery bypass grafting with unilateral internal mammary artery bypass
* Planned used of cardiopulmonary bypass

Exclusion Criteria:

* Inability to give informed consent
* Know allergy to cephalosporins, penicillin or Teicoplanin
* Re-operation
* Additional planned valve surgery
* Dialysis
* BMI \> 30
* Long standing diabetes mellitus (\> 7 years)
* Ejection fraction below 20% measured with transthoracic echocardiography
* Chronic severe renal insufficiency
* Childbearing potential
Effect of Diet-induced Weight Loss on HIV-associated Metabolic Syndrome

Obese HIV-positive women with Metabolic Syndrome (HIV-MS) and obese HIV-negative women with Metabolic Syndrome will be studied before and after achieving moderate (6%-8%) diet-induced weight loss. The investigators hypothesize that health markers will improve in both groups but that the improvement will be blunted in the women with HIV-MS.


Eligibility Criteria:
Inclusion Criteria:

* Sedentary
* Obese
* Have either dyslipidemia (HDL \< 50 or triglycerides \> 150), waist circumference \> 88cm, and impaired glucose tolerance or homeostasis model assessment value of \> 3
* Subjects with HIV-MS must have been receiving HAART for \> 6 months

Exclusion Criteria:

* Medication changes in the last 3 months
* Diabetes mellitus
* Medical problems that in the opinion of the principal investigator may interfere with patient safety
* Substance abuse
Effect of Manual Medicine or Cognitive Behavioral Therapy With Chronic Uncontrolled Diabetes

Effects of manual medicine or cognitive behavioral therapy with chronic uncontrolled diabetes within a shared primary care visit. An evaluation of the effectiveness of manual therapy vs cognitive behavioral therapy (CBT) vs traditional primary care visit care is in need.

Integrating cognitive behavioral health nutritional therapy (hereafter CBT) and primary care services plays an important role in healthcare outcomes and the prevalence of chronic disorders treated in primary care. The Center of Disease Control has published some disturbing numbers: 9.3% of the U.S. population is affected by diabetes. Ninety-five percent of these individuals will receive treatment from their primary care provider, less than 5% will consult with a dietitian or behavioral health provider. Diabetes is projected to triple in the US despite numerous treatment options and greatly increased medical resources devoted to this problem. There is need for treatments that demonstrate an effectiveness that is low risk and wide spread.

A person's state of mind can play an important role in physical and psychosocial health conditions such as diabetes. Depression and diabetes share a bidirectional association. A recent meta-analysis reported that depressed individuals have a 60% increased risk of developing diabetes. An association was found between the risks of developing diabetes and non-severe depression, persistent depression, and untreated depression. Cognitive behavioral therapy, among others, has demonstrated effectiveness for a variety of chronic conditions.

By implementing a shared visit with primary care we encourage the advancement of this new approach. A focus on stress reduction by using mindfulness to encourage patients to think of their body as a whole and heal through not only the use of CBT, but with nutrition and manual therapy. Demonstrating the beneficial effects CBT has on uncontrolled diabetes will offer another psychosocial treatment option for the large number of suffering US residents. CBT and other mindfulness-based interventions have been recognized as helpful for a range of conditions including chronic pain. However, only 1 large randomized clinical trial (RCT) has evaluated CBT for chronic low back pain, and that trial was limited to older adults.

This clinical trial also includes chiropractic manipulative treatment (CMT) with uncontrolled diabetes patients. This study is unique due to the lack of any pre-existing trials of this nature. CMT has demonstrated improvement in physical function. A compromise of the peripheral nervous system is a common long-term complication of diabetes. In severe cases, this can lead to limb amputations and sudden cardiac death secondary to autonomic polyneuropathy. Proper recognition of the musculoskeletal manifestations of patients with diabetes will aid the treating chiropractor and alert them to the possible neurological consequences of diabetes.

Eligibility Criteria:
Inclusion Criteria:

Hemoglobin A1c above 9%

Exclusion Criteria:

* 0-18 years old
Study of UK Adults With Congenital Adrenal Hyperplasia.

Congenital Adrenal Hyperplasia (CAH) is one of the commonest inherited diseases, affecting 1:14,200 live births. It is the result of a genetic defect in one of the enzymes (in most cases 21-hydroxylase) required for cortisol biosynthesis, leading to reduced levels of cortisol and aldosterone, increased ACTH concentrations and consequently increased adrenal androgen production. Patients suffer from problems with growth and development and as adults patients may have problems with fertility, virilisation in women, testicular masses in men and both men and women have an impaired quality of life. Patients have to take life-long therapy. Despite its frequency knowledge surrounding the management of adults with CAH remains fairly limited. There has been a lot of work describing the management of children with CAH but to date there is no consensus on how to manage adults. To address this issue a number of adult endocrinologists in the UK under the auspices of the Society for Endocrinology have established a country wide study (CaHASE) to undertake research in order to set standards of care for adult patients with CAH.

In CAH the severity of the symptoms experienced by affected individuals varies depending on the mutation and the genetic background of the individual. The ability to tailor CAH therapy on an individual basis, as determined by the severity of the underlying defect and an understanding of the likely natural history of the disease, is a key goal in clinical management. Correlation of phenotype (clinical status) and genotype (the underlying 21 hydroxylase gene mutation) will facilitate stratification of severity and provide an important contribution to the debate on potential mechanisms of individualised therapy. For instance it may become clear that certain CAH genotypes are associated with specific long term outcomes. In time, this could lead to suggesting different treatment strategies in certain groups. Moreover, genotype data are important if we are to address the relative contribution of environment (e.g. treatment) vs. genetics on long term outcomes.

This multi-centre study aims to:

1. - Investigate the medical health of adults with congenital adrenal hyperplasia.
2. - Investigate the relationship between the genotype of the patient and the phenotype.
3. - Investigate the quality of life of adults with congenital adrenal hyperplasia.


Eligibility Criteria:
Inclusion Criteria:

* Age over 18
* Clinical and genetic diagnosis of congenital adrenal hyperplasia

Exclusion Criteria:

* Pregnant females
* Under 18
A Clinical Trial to Assess the Effects of a Vitamin Shot on Energy Levels

This is a virtual, single-arm clinical trial that will last 30 days. Participants will drink 1 bottle of the Vitamin Energy® shot daily and complete questionnaires at baseline, Day 7, Day 14, and Day 30.

Participants' energy, mood, and cognitive function will be evaluated at baseline and at each check-in. Bodyweight will also be assessed at baseline and Day 30. Likert scale responses will be examined from baseline to each check-in. Participant responses on product feedback will be presented as % scores.


Eligibility Criteria:
Inclusion Criteria:

Men and women 18 years and over

Self-reported issues with:

* Energy
* Focus
* Brain fog Participants who often feel fatigued Willing to maintain the same caffeine consumption during the study period Generally healthy - don't live with any uncontrolled chronic disease

Exclusion Criteria:

Any pre-existing chronic conditions that would prevent participants from adhering to the protocol, including oncological and psychiatric disorders.

Anyone with known severe allergic reactions. Women who are pregnant, breastfeeding, or attempting to become pregnant Unwilling to follow the study protocol.
Pharmacokinetics and Safety of Meropenem in Infants Below 90 Days of Age With Probable and Confirmed Meningitis

This phase I-II multicenter international trial is designed to study the pharmacokinetics of meropenem and to characterize the safety profile of meropenem in the treatment of infants ≤ 90 days of postnatal age with probable or confirmed bacterial meningitis.

The primary objective will be to study the pharmacokinetics (plasma and cerebrospinal fluid) of meropenem in infants ≤ 90 days of postnatal age with probable or confirmed bacterial meningitis and to characterize the safety profile of meropenem in the treatment of infants ≤ 90 days of postnatal age with probable or confirmed bacterial meningitis.

The secondary objectives are :

* To describe the efficacy of meropenem on day 3, at end of allocated treatment (EOAT), at test of cure (TOC) and at follow up (FU).
* To evaluate survival at FU
* To evaluate further episodes of meningitis (relapse or new infection) occurring between TOC and FU visits
* To define the organisms causing neonatal meningitis
* To describe the antibacterial susceptibility of meningitis-causing organisms and to describe the clinical and microbiological response according to this
* To evaluate mucosal colonization by resistant organisms before and after treatment with meropenem
* To evaluate bacterial eradication
* To evaluate functional genetic parameters that may affect response to therapy

Eligibility Criteria:
Inclusion Criteria:

* Informed consent form signed by the parents/carers
* Chronological age below 90 days inclusive
* The presence of:

  * clinical signs consistent with BM (hyperthermia or hypothermia or temperature instability PLUS 1 or more neurological findings among coma, seizures, neck stiffness, apnoea, bulging fontanelle),
  * OR CSF pleocytosis (≥ 20 cells/mm3)
  * OR a positive Gram stain of CSF.

Exclusion Criteria:

* Presence of a CSF device
* Proven viral or fungal meningitis
* Severe congenital malformations if the infant is not to expect to survive for more than 3 months
* Other situations where the treating physician considers a different empiric antibiotic regimen necessary
* Known intolerance or contraindication to the study medication
* Participation in any other clinical study of an investigational medicinal product
* Renal failure and requirement of haemofiltration or peritoneal dialysis
* Meningitis with an organism known to be resistant to meropenem
The Effect of Subcutaneous Immunoglobulin Gammanorm on the Distribution of IgG Subclasses and on Immunity of Patients With Secondary Immunodeficiency

Patients with Myeloma or CLL with severe secondary hypogammaglobinemia and recurrent infections will be included in this study; for whom an IgSC treatment was prescribed. The IgSC prescription will be the decision of the treating physician. Patient care and follow up will be performed according to the current clinical practice and the recommendations of HAS.


Eligibility Criteria:
Inclusion Criteria:

1. Adult male or female (≥18 years old), Myeloma or Chronic Lymphocytic Leukemia patients with secondary hypogammaglobinemia and recurring infections.
2. Patients with indication for IgSC treatment but who have not started the treatment yet. Prior IgSC or IgIV treatment 6 months before inclusion is accepted (with a washout period of 6 months minimum).
3. Patient having received all the necessary information about the study and signed an informed consent document.

Exclusion Criteria:

1. Patient having initiated an IgSC treatment.
2. Patient having received IgSC or IgIV treatment within 6 months prior to inclusion.
3. Incapacity/Inability to attend the follow-up visits.
4. Patient refusing to participate in the study.
5. HIV positive patients.
6. Incapacity to understand the study objective and process, to agree or to give informed consent to participate in the study.
7. Pregnant or breast-feeding women
Planter Pressure and Body Mass Index Affect Balance in Normal Children

is there relation between planter pressure, body mass index and balance in normal children?

is there relation between planter pressure, body mass index and balance in normal children?

Eligibility Criteria:
Inclusion Criteria:

* Normal children from both sex
* Age from 8 to 12 years

Exclusion Criteria:

* recent fractures or procedures
* open wounds on the lower limbs,
* any fixed deformities in the lower limbs
Post Operative Atrial Fibrillation Post Cardiac Surgery ( CABG and VALVE REPLACEMENT )

This study aims to assess the percent and risk factors of postoperative atrial fibrillation in patients undergoing cardiac surgery in Assiut university heart hospital

Arrhythmias are common complications after cardiac surgery, with postoperative atrial fibrillation (POAF) being the most frequently observed arrhythmia. The incidence rate of POAF ranges from 20% to 50%, depending on factors such as the type of surgery, patient population, and criteria used for diagnosis. Notably, POAF has been associated with increased morbidity, mortality, and health care costs. Patients who develop POAF are at a higher risk of experiencing complications such as stroke, heart failure (HF), and prolonged hospital stays. Moreover, POAF has been linked to long-term adverse outcomes, including a greater risk of recurrence of AF/atrial flutter and increased mortality. The accurate prediction of POAF can help guide therapy and facilitate targeted interventions to prevent its occurrence. Early identification of patients at risk for POAF allows for the timely initiation of prophylactic measures, such as the use of β-blockers, amiodarone, or other antiarrhythmic drugs, which have been shown to reduce the incidence of POAF. In this study we are searching for the percent and risk factors of POAF in patients undergoing cardiac surgery in Assiut university hospital.

Eligibility Criteria:
Inclusion Criteria:

1. ≥18 years scheduled for first-time planned cardiac surgery ( CABG and Valve replacement)
2. Patients who are in sinus rhythm and not taking any antiarrhythmic medication, other than beta-adrenergic blocking agents, at the time of surgery.
3. Willingness to participate and provision of informed consent

Exclusion Criteria:

1. Prior history of cardiac surgery.
2. Pediatric population less than 18 years.
3. Patients with history of hyperthyroidism
4. Patients with electrolyte disturbance
5. Where follow-up is not possible.
6. The patient refused to sign the informed consent to participate in the research.