bluuebunny/crossref_metadata_2025 huggingface dataset:
Waist circumference and blood pressure in Brazilian children
Authors: Grawe Vanessa Heidemann , Mastroeni Silmara Salete de Barros Silva , Corrêa Zaíne Glaci Duarte , Mastroeni Marco Fabio
Published: September 2023

Aim

We aimed to examine the association between waist circumference and blood pressure (BP) in children at 9 years of age.

Methods

This was a cross-sectional study of 142 children enrolled in a cohort study conducted at the participants’ homes in southern Brazil. SBP and DBP were measured using the auscultatory method. Waist circumference was measured with a 150-cm flexible tape. Logistic regression adjusted for important covariates was used to examine the association between waist circumference and BP.

Results

The prevalence of high BP in children was 20.4%. High BP was more prevalent in males (69.0%). The average SBP/DBP on the right arm was 98/60 mmHg in females and 101/62 mmHg in males. An important proportion of children was classified as having high BP and BMI (44.8%) and waist circumference (50.0%) > 85th percentile (P < 0.01). Logistic regression analysis showed that children with high BMI and waist circumference were 3.91 (95% confidence interval, 1.31–11.71, P = 0.015) times more likely to have high BP than those ≤85th percentile, even after adjusting for other covariates.

Conclusion

This study revealed that waist circumference was associated with both SBP and DBP in 9-year-old children and increased waist circumference was the determining factor of cardiovascular risk.
Intestinal proteases
Authors: Rao Sameer , Grover Madhusudan
Published: September 2023

Purpose of review

Proteases constitute a group of enzymes that hydrolyze peptide bonds. Intestinal proteases are an integral part of gut homeostasis and digestion. This review discusses the broader classification of proteases, regulation of proteolytic activity (PA) in the intestinal tract, and how dysregulation of intestinal proteases contributes to the pathophysiology of conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. We also discuss recent advancements in therapeutic modulation that directly or indirectly target intestinal proteases and can be utilized to treat these illnesses.

Recent findings

Host and microbiota derived proteases have been associated with symptoms in subsets of patients with IBS, IBD and celiac disease. Elevated PA mediates barrier dysfunction, visceral hypersensitivity as well as immune activation and inflammation. Recent mechanistic studies have revealed the nature of disease-associated proteases and mechanisms regulating their activity, particularly those driven by the microbiota. Advancements in activity-based probes have allowed novel ways of in vivo imaging of PA. Newer strategies targeting proteases include monoclonal antibodies, engineered microbiota as well as specific protease inhibitors.

Significant progresses made in the detection as well as regulation of PA is likely to provide therapeutic advancements for gastrointestinal diseases.
Gastric varices
Authors: Wang Thomas J. , Ryou Marvin
Published: September 2023

Purpose of review

Gastric varices are a rare cause of gastrointestinal bleeding in patients with portal hypertension. There have been significantly advances within endoscopic ultrasound for treatment of gastric varices over the past 5 years in addition to the conventional endoscopic and endovascular therapies. In this review, we will review the latest literature on gastric varices with emphasis on changes to the conventional classification systems and comparisons among the different treatment options for gastric varices in terms of efficacy and safety.

Recent findings

There have been new guidelines proposed by the American Gastrointestinal Association on a simpler classification system compared to the conventional Sarin classification. In addition, endoscopic ultrasound guided coil embolization, a novel treatment pioneered over the past 5 years for gastric varices, has shown increased efficacy and reduced adverse event profile compared to cyanoacrylate glue, the more traditional therapy for gastric variceal bleeding. Options for endovascular therapy overall have not significantly changed over the recent years.

Based on our literature review, we recommend a step-up approach with initial medical and endoscopic management with consideration of endovascular therapies when initial therapies fail.
Gastroparesis: time for a paradigm change
Authors: Lacy Brian E. , Wise Journey L. , Cangemi David J.
Published: September 2023

Purpose of review

Gastroparesis (GP) is a syndrome defined by symptoms and delayed gastric emptying in the absence of mechanical obstruction. Typical symptoms include nausea, vomiting, abdominal pain, and early satiety. Only one medication is currently FDA-approved for the treatment of GP. This review highlights recent research findings pertaining to GP and provides evidence to support a change in the current GP diagnostic and treatment paradigm.

Recent findings

An analysis of GP trials over the past four decades demonstrates the power of placebo and the need to perform longer studies with clearly defined patient populations. Two studies highlight the need to evaluate patients with suspected GP carefully and to perform gastric emptying studies properly. The misdiagnosis of GP symptoms is reviewed, preceded by a discussion of whether GP should be considered a disorder of gut-brain interaction. Finally, new data on therapies that target the pylorus are highlighted.

Gastroparesis is frequently over-diagnosed and incorrectly diagnosed. Performing a proper gastric emptying study which adheres to standard protocol, and accurately interpreting the results in the context of the individual patient, are critical to making an accurate diagnosis of GP. The treatment paradigm needs to shift from simply aiming to accelerate gastric emptying to treating global symptoms of a chronic syndrome that may represent gut-brain dysfunction in many patients.
Body Mass Index Affects Delayed Chemotherapy-induced Vomiting in Pediatric Malignancy Patients
Authors: Yu Luyan , Zhou Ying , Zhang Wenbo , Wu Qian , Chu Xiaoyi , Zhang Yiran , Lv Danni , Shen Zhipeng
Published: September 2023

Background:

Delayed chemotherapy-induced vomiting (DCIV) is a problem for children undergoing chemotherapy for malignant tumors. The aim of this study was to investigate the association between body mass index (BMI) and DCIV in children.

Patients and Methods:

Clinical data were collected from patients with malignancies who underwent chemotherapy at our center. Independent risk factors for DCIV derived by logistic regression. The Youden Index, which calculates BMI, divides patients into a high-risk group and a low-risk group, and the difference in DCIV between the two groups was analyzed. The relationship between BMI and DCIV was assessed by calculating the frequency of vomiting episodes and the severity of vomiting.

Results:

A total of 283 patients were included in this cohort study. BMI (odds ratio [OR]: 0.811; 95% CI: 0.699-0.941), age (OR: 1.014; 95% CI: 1.006-1.021), and emetogenic grade (OR: 2.858, 95% CI: 1.749-4.671) were independent risk factors for the development of DCIV in children. Patients in the high-risk group experienced vomiting more frequently and with greater severity than those in the low-risk group (P < 0.05).

Conclusions:

BMI in children with malignancy is associated with DCIV, and the incidence of DCIV decreases as BMI increases. Physicians may be able to arrange a more elaborate antiemetic prevention regimen based on the patient’s BMI.
Relationship between metalloproteinase-9 (MMP-9) expression and clinicopathology in colorectal cancer: a cross-sectional study
Authors: Mudatsir  , Labeda Ibrahim , Uwuratuw Julianus Aboyaman , Hendarto Joko , Warsinggih  , Lusikooy Ronald Erasio , Mappincara  , Sampetoding Samuel , Kusuma Muhammad Ihwan , Syarifuddin Erwin , Arsyad Arham , Faruk Muhammad
Published: September 2023

Introduction:

According to the WHO’s GLOBOCAN database, ~1,931,590 new colorectal cancer (CRC) cases and 915,607 CRC-related deaths occurred in 2020. The incidence of CRC in Indonesia is 8.6%, making it the fourth most common cancer. With CRC, matrix metalloproteinase-9 (MMP-9) has a role in tumour development and progression, such that patients with a higher MMP-9 expression had poorer survival. This study aimed to analyze the relationship between MMP-9 expression and clinicopathology in CRC patients.

Methods:

This was an analytic observational study with a cross-sectional research design. It was conducted from November 2021 to June 2022 with 52 patient tissue samples: these were subjected to MMP-9 immunohistochemistry stain, with the GeneTex (Irvine) MMP-9 monoclonal antibody. Patient data were collected with clinical variables based on medical records and histopathological examination by anatomy pathologists.

Results:

Primary tumour location, cancer staging, and histopathology grading were associated with MMP-9 (P=0.016, P=0.001, P=0.049). The more proximal to the primary tumour, the higher the stage of cancer, and the higher the histopathological grade, thus the greater the expression of MMP-9.

Conclusion:

A significant relationship existed of primary tumour location, cancer staging, and histopathology grading with MMP-9 expression in CRC patients. MMP-9 expression could be a useful indicator for the clinical assessment of tumour biologic behaviour and prognosis in CRC patients.
Does ozaki procedure have a future as a new surgical approach for aortic valve replacement? a systematic review and meta-analysis
Authors: K. Awad Ahmed , Farahat Ramadan A. , Reda Gad Eman , Shaban Abdelgalil Mahmoud , Hassaballa Aly Sherif
Published: September 2023

Background:

In 2014, Ozaki et al. introduced the neo-cuspidation (Ozaki procedure), a new valve from the pericardium, to reduce or even prevent the risk of chronic autoimmune inflammation and subsequent rejection or valve degeneration. Thus, the authors aimed to assess the safety and efficacy of the Ozaki technique in treating aortic valve diseases.

Materials and methods:

A comprehensive search was performed via PubMed, the Cochrane Library, Scopus, and the Web of Science up to 20 February 2022. Random-effects meta-analysis models were employed to estimate the pooled mean and SD or event to the total of the Ozaki procedure. Relevant records were retrieved and analyzed by OpenMeta analyst software.

Results:

A total of 2863 patients from 21 studies were finally included in our analysis. Ac. Ozaki technique showed statistical significance in terms of mean cardiopulmonary bypass time of 148 mins (95% CI 144–152.2, P<0.001), mean aortic cross-clamp time of 112.46 mins (95% CI 105.116, 119.823, P<0.001), reoperation with a low risk of 0.011 (95% CI 0.005, 0.016, P=0.047), conversion to aortic valve replacement with a low risk of 0.004 (95% CI −0.001, 0.008, P=0.392), finally ICU stay (days) and hospital length of stay (days) with a mean of 2.061 days (95% CI 1.535, 2.587, P<0.001) and 8.159 days (95% CI 7.183–9.855, P<0.001), respectively.

Conclusion:

The Ozaki procedure provides a safe surgical technique with low mean cardiopulmonary bypass time and aortic cross-clamp time; moreover, a mean of 2-day-postoperative hospital stay was observed with the Ozaki procedure with a low risk of conversion to aortic valve replacement, reoperation, ICU and hospital stay, and death.
Incidence and predictors of postoperative severe acute pain within 24 hours after cesarean section performed under spinal anesthesia at public hospitals in West Shoa, Ethiopia, 2022 prospective cohort study
Authors: Bekele Zenebe , Ayana Mulatu , Haile Merga , Tesfaye Adamu , Tasew Asaminew
Published: September 2023

Background:

Acute postoperative pain is common after a caesarean section; the mother suffers severe pain in the first 24 h after the caesarean section compared to spontaneous birth. Failure to discover predictors of pain leads to maternal dissatisfaction, increased expenses, and restricted movement; it increases the risk of deep vein thrombosis, lengthens hospital stays, and decreases social intimacy.

Methods and materials:

An institution-based prospective cohort study was conducted among 422 women who went to undergo caesarean sections under spinal anaesthesia at public hospitals in West Shoa from 30 July to 30 October. Participants were selected by systematic random sampling. Data were collected by a structured questionnaire, and the collected data were entered into SPSS version 20 and exported into STATA 64 for analysis. The results were presented in tables and figures. Risk factors were assessed by Poisson regression with a robust standard error.

Results:

The overall incidence of severe postoperative pain after a caesarean section performed under spinal anaesthesia within 24 h of follow-up was 50.4% [95% confidence interval (CI): 40.7, 60.1]. Preoperative anxiety risk ratio 1.7 (95% CI: 1.4–2.0), preoperative pain risk ratio 1.3 (95% CI: 1.0–1.48), type of incision risk ratio 11.3 (95% CI: 1.1–1.6), spinal anaesthesia without adjuvants risk ratio 4.1 (95% CI: 1.5–10.9), and duration of surgery risk ratio 1.5 (95% CI: 1.3–1.8) were found to be predictors for postoperative severe acute pain after caesarean section performed under spinal anaesthesia.

Conclusion:

In this study, the overall incidence of severe acute pain after a caesarean section under spinal anaesthesia was high. Preoperative fear, duration of the operation, preparatory pain, spinal anaesthesia without the use of adjuvants, and the type of incision were risk factors for severe acute postoperative pain after a caesarean section under spinal anaesthesia.
Association of urinary albumin-to-creatinine ratio with lipid abnormalities and glycemic control in patients with type 2 diabetes mellitus
Authors: Khadka Sitaram , Yadav Gopal K. , Subedi Prativa , Amgain Kapil , Sharma Arun , Joshi Rinku
Published: September 2023

Introduction:

While proteinuria aggravates dyslipidemia in diabetic patients, dyslipidemia further worsens proteinuria via inflammatory cytokines-mediated glomerular damage. Urinary albumin creatinine ratio (ACR) is an easy and reliable method of detecting proteinuria. This study aims to determine the association of ACR with lipid abnormalities and glycemic control in the Nepalese population.

Methods:

This was a cross-sectional study conducted among 201 diabetes patients visiting the outpatient department of internal medicine. Based on ACR values, patients were categorized as nonalbuminuric (less than 300 μg/mg) or albuminuric (more than 300 μg/mg). An unpaired t-test was used to compare the mean of various lipoproteins in these two categories. Binary logistic regression was used to check the association of ACR with sociodemographic factors (age, sex, and education), hypertension, and glycated hemoglobin.

Results:

Albuminuric patients had higher mean cholesterol (192.8±53.5 vs. 184.2± 37.6; P=0.209), triglyceride (194.9±97.8 vs. 164.4±73.7; P=0.017) and low-density lipoprotein (99.9±38.4 vs. 90.0±27.4; P=0.034) but lower high-density lipoprotein (53.9±18.5 vs. 61.3±19.9; P=0.008) compared to nonalbuminuric patients. There was a significant difference in mean HbA1c values across albuminuria and nonalbuminuria groups (7.1±1.1 vs. 6.7±0.8; OR: 1.4, 95% CI=1.1–1.9, P=0.030).

Conclusions:

Urine ACR of more than 30 mg/gram was associated with higher triglyceride and low-density lipoprotein levels and lower high-density lipoprotein levels. The HbA1c level strongly correlates with the development of albuminuria.
Clinical manifestations and outcomes of COVID-19 in maintenance hemodialysis patients of a high infectious epidemic country: a prospective cross-sectional study
Authors: Mondal Mina , Islam Muhammad Nazrul , Ullah Ahsan , Haque Md Rezwanul , Rahman Motiur , Bosak Liza , Rahman Md. Foyzur , Zaman Shaikh Riaduz , Rahman Mohammad Meshbahur
Published: September 2023

Introduction:

The outbreak of COVID-19 poses great challenges for patients on maintenance haemodialysis. Here, we reported the clinical characteristics and laboratory features of maintenance haemodialysis (MHD) patients with COVID-19 in Bangladesh.

Methods:

Altogether, 67 MHD patients were enroled in the study from two dedicated tertiary-level hospitals for COVID-19 after the prospective cross-sectional execution of selection criteria. Data were collected from medical records and interviews. Different statistical analysis was carried out in the data analysis.

Results:

The mean age was 55.0±9.9 years, with 40 males (59.7%). The mean dialysis duration was 23.4±11.5 months. The most common symptoms were fever (82.1%), cough (53.7%), and shortness of breath (55.2%), while the common comorbid condition was hypertension (98.5%), followed by diabetes (56.7%). Among MHD patients, 52.2% to 79.1% suffered from severe to critical COVID-19, 48 patients (71.6%) had 26-75% lung involvement on high resolution computed tomography of the chest, 23 patients (34.3%) did not survive, 20 patients (29.9%) were admitted to ICU, and nine patients (13.4%) needed mechanical ventilation. Patients who did not survive were significantly older (mean age: 63.0 vs. 50.86 years,P=0.0001), had significantly higher cardiovascular risk factors (69.6% vs. 43.2%,P=0.04), severe shortness of breath (82.6% vs. 40.9%,P=0.0001), and longer hospital stays (mean days: 17.9 vs. 13.0,P=0,0001) compared to the survivor group. The white blood cell count, C-reactive protein, lactate dehydrogenase, pro-calcitonin, and thrombocytopenia were significantly (P<0.0001) higher, while the albumin level was significantly lower (P=0.0001) in non-survivor compared to patients who survived.

Conclusion:

Maintenance haemodialysis patients had severe to critical COVID-19 and had a higher risk of non-survival if they were older and had comorbidities such as hypertension and diabetes. Therefore, MHD patients with COVID-19 need close monitoring to improve their outcomes.
Esophageal squamous cell carcinoma metastasizing to the oral cavity: a case report and literature review
Authors: Sittitrai Pichit , Ruenmarkkaew Donyarat , Lekawanvijit Suree
Published: September 2023

Introduction and Importance:

Metastatic esophageal carcinoma to the oral cavity has been rarely reported, and most cases were adenocarcinoma metastasizing to the mandible. This first report of a case of metastatic esophageal squamous cell carcinoma to the floor of the mouth is crucial due to its rarity and difficulties in diagnosing and managing this condition.

Case Presentation:

A 53-year-old male had a painful submucosal mass on the left side of the floor of the mouth for 2 months. A biopsy indicated a moderately differentiated squamous cell carcinoma. Six months before the intraoral mass appeared, the patient had a moderately differentiated squamous cell carcinoma of the thoracic esophagus and was treated with concurrent chemoradiotherapy. With the previous history and pathological review, the diagnosis of metastatic esophageal squamous cell carcinoma to the floor of the mouth was made. Panendoscopy and an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan revealed no other abnormality or other distant metastasis. The patient underwent surgical resection with postoperative chemoradiotherapy. He was able to take a regular diet and had good speech function. Ten months after treatment completion, he has had recurrent disease at the floor of the mouth with lung metastasis.

Conclusions:

Oral metastasis from esophageal squamous cell carcinoma is very rare and should be differentiated from primary oral cancer using clinical and pathological features. 18F-fluorodeoxyglucose positron emission tomography-computed tomography scanning is the preferred imaging method to exclude primary tumor persistence and other metastases. Treatment is usually palliative; however, function-preserving surgery may be an option for a patient with limited disease in the oral cavity.
Non-adherence to anti-hypertensive medications in a low-resource country Nepal: a systematic review and meta-analysis
Authors: Pokharel Pashupati , Jha Saroj Kumar , Adhikari Alisha , Katwal Srijana , Ghimire Sagun , Shrestha Abhigan Babu , Poudel Nahakul
Published: September 2023

Background:

Nepal is a low resource country with cardiovascular diseases being the number one cause of mortality. Despite hypertension being the single most important risk factor for cardiovascular diseases, non-adherence to anti-hypertensive medications has not been assessed systematically. So, this systematic review and meta-analysis aims to analyze the prevalence of non-adherence to anti-hypertensive medications in Nepal.

Methodology:

This systematic review and meta-analysis was piloted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases of Embase, PubMed, Scopus, Web of Science, Cochrane Library, Cinhal Plus, and Google Scholar were searched from inception till 1 February 2023. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate.

Results:

Altogether, 14 studies with a total of 3276 hypertensive patients were included in the meta-analysis. The pooled prevalence of non-adherence to anti-hypertensive medications was 49% (95% CI: 0.37–0.62, I
2=98.41%, P<0.001). The non-adherence rate using Morisky Medication Adherence Scale (MMAS) was 55% (95% CI: 0.34–0.76, I
2=99.14%, P<0.001), and using Hill–Bone Compliance Scale, the non-adherence rate was 45% (95% CI: 0.37–0.54, I
2=84.36%, P<0.001). In subgroup analysis, the non-adherence was higher in rural areas 56% (95% CI: 0.51–0.61, I
2=0.0%, P=0.46) compared to urban areas 42% (95% CI: 0.31–0.54, I
2=96.90%, P<0.001). The trend of non-adherence was increasing after 2020. Additionally, forgetfulness, carelessness, cost of medications, number of comorbidities, and using an alternate form of medication were common factors associated with non-adherence.

Conclusions:

This meta-analysis showed that half of the hypertensive population of Nepal are non-adherent to their anti-hypertensive medications, thereby posing a significant long-term cardiovascular consequence among Nepali population.
A diagnostic challenge: misdiagnosing Blau syndrome as juvenile dermatomyositis in a pediatric patient
Authors: Deek Soud M.S. , Shubietah Abdalhakim R.M. , Atatri Yazid , Najjar Mohab , Zakaria Zaid , Abu Tayyem Nours , Habayeb Lanah , Maree Mosab , AbuMohsen Haytham
Published: September 2023

Introduction:

Blau syndrome (BS) and juvenile dermatomyositis (JDM) are distinct conditions with different pathophysiological mechanisms. Accurate diagnosis of BS can be challenging due to overlapping clinical features with other inflammatory conditions. This case is being reported to highlight a pediatric case initially diagnosed with JDM, and subsequently found to have BS through genetic testing.

Case Presentation:

We present the case of a 4-year-old Arab male initially diagnosed with JDM based on skin manifestations, negative histology for another disease, and no other clinical features suggestive of an alternate diagnosis. However, subsequent symptoms suggestive of BS emerged, leading to genetic testing confirmation of BS, marking the second reported case in the region. This unique clinical scenario highlights the challenges in diagnosing BS and the potential for misinterpretation of the skin rash as JDM. Accurate differentiation between these conditions is crucial to guide appropriate management and prevent delays in treatment.

Discussion:

The diagnostic process for JDM involves clinical evaluation, laboratory investigations, imaging, and biopsy findings. However, muscle biopsy may yield false-negative results. BS has been misdiagnosed as other conditions, such as Kawasaki disease and juvenile idiopathic arthritis, due to overlapping clinical features. This case highlights the significance of a thorough diagnostic strategy for BS that takes into account any potentially negative histopathology findings. A precise diagnosis is essential since misdiagnosis can result in inadequate or delayed therapy.

Conclusion:

The diverse presentation of the skin rash in BS can pose difficulties for physicians in distinguishing it from other pediatric rheumatological conditions, such as JDM.
Autism in Africa: prevalence, diagnosis, treatment and the impact of social and cultural factors on families and caregivers: a review
Authors: Aderinto Nicholas , Olatunji Deji , Idowu Oluwatobi
Published: September 2023

This paper presents a narrative review of current knowledge on autism in Africa, including prevalence, diagnosis, treatment and the impact of social and cultural factors on families and caregivers. The prevalence of autism in Africa is estimated to be similar to that in other regions. However, diagnosis and treatment access remain limited due to various challenges, such as a shortage of specialised healthcare professionals and resources, a lack of awareness and understanding of autism spectrum disorder (ASD) among healthcare providers, and cultural stigma surrounding mental health and developmental disorders. Alternative therapies are commonly used with other therapies, but their effectiveness is often unproven. The impact of ASD on families and caregivers in Africa is significant, with many facing challenges in accessing support services and coping with stigma. Efforts are being made to increase awareness and reduce the stigma around ASD in African communities, but more research is needed on effective interventions and culturally appropriate treatments. Policy recommendations include increasing resources and training for healthcare professionals, improving access to evidence-based interventions and promoting community awareness and support. With improved understanding and investment, the quality of life of individuals with ASD in Africa can be significantly improved.
Explaining the barriers to donor participation in the field of health: a qualitative study
Authors: Mirzadeh Koohshahi Masoud
Published: September 2023

Background:

Iran’s health system is facing increasing costs and a lack of resources. Developing the financial participation of donors is one of the ways to strengthen the financial health system.

Objective:

This research was done to explain the barriers to donors’ participation in the field of health.

Method:

This qualitative study was conducted in 2022 using semi-structured interviews with 22 experts, health donors, policymakers, and managers in Iran. The conventional content analysis method was also used for data analysis.

Results:

The review and classification of the interviews showed that the participation of donors in the health system includes four main issues: the incompleteness of legal processes, the lack of continuous communication with the charity, management, and resources problems, and the insufficient awareness of the donors about the problems and needs of the health system and 18 subtopics.

Conclusions:

Donors play an important role in financing, developing resources, providing health services, and financially supporting patients in Iran’s health system. Therefore, by recognizing and removing obstacles to the participation of donors, policymakers and managers of the health system should target the participation of donors with proper planning, organization, guidance, and supervision, and avoid parallel work and waste of resources.
Outcome of Emergency Blood Transfusion in Children Seen at a Tertiary Children's Hospital in Freetown
Authors: Ikhurionan Paul Ehiabhi , Bell Nellie V. T. , Ofovwe Gabriel Egberue
Published: September 2023

Objective

This study sought to describe the prevalence and clinical outcome after emergency blood transfusion among children presenting with severe anemia in a tertiary children's hospital in Sierra Leone.

Method

This was a retrospective study of 395 children who received emergency blood transfusion at the Ola During Children's Hospital in Freetown. Association between mortality and sociodemographic and clinical factors was assessed using χ2 test. Statistical significance was set at P < 0.05.

Results

Three hundred ninety-five of 4719 children (8.4%) admitted to the emergency room of the Ola During Children's Hospital received emergency blood transfusion within 24 hours of presentation. Twenty-five (6.3%) were excluded because of incomplete data. The median age of the subjects was 24 months (interquartile range, 14–48). There were 191 boys (51.6%) and 179 girls (48.4%), giving a male/female ratio of 1.06:1. The most common indication for emergency transfusion was severe malaria anemia (67.8%). The mean hemoglobin concentration before transfusion was 4.8 g/dL (±1.4 g/dL). A total of 339 children (91.6%) were discharged home, 8 (2.2%) were discharged against medical advice, and 23 children (6.2%) died. The median length of stay on admission was 3 days (interquartile range, 2–5). Children with severe sepsis (P < 0.001) and those with pretransfusion hemoglobin concentration less than 5% (P = 0.047) were significantly more likely to die after transfusion compared with the other categories of patients. In a multivariate regression analysis, none of the factors were independently associated with clinical outcome after blood transfusion in children who received emergency blood transfusion.

Conclusion

The study suggests that emergency blood transfusion in children with severe anemia may improve in-hospital survival.
Reducing Vaccination Disparities During a National Emergency Response: The US Mpox Vaccine Equity Pilot Program
Authors: Bautista Gregorio J. , Madera-Garcia Valerie , Carter Rosalind J. , Schwitters Amee , Byrkit Ramona , Carnes Neal , Prejean Joseph
Published: September 2023

Context:

In response to the first reported mpox cases in May 2022, the US government implemented plans to bring testing, treatment, and vaccines to communities disproportionately affected by mpox—including the population of men who have sex with men (MSM) and Black/African American and Hispanic/Latino men, 2 subpopulations experiencing vaccination disparities. We describe the development and implementation of the US Mpox Vaccine Equity Pilot Program (MVEPP), characteristics of completed vaccination projects, and challenges that occurred. We also discuss opportunities for reducing vaccination disparities in future outbreaks.

Program:

To address reported vaccination disparities, the US government launched MVEPP in 2 phases. Phase 1 centered around public events attended by large numbers of gay, bisexual, and other MSM, such as Pride festivals. Phase 2 asked health departments to propose mpox vaccination projects specifically aimed at reducing or eliminating racial/ethnic and other demographic disparities in mpox vaccination.

Implementation:

MVEPP received 35 vaccination project proposals. We analyzed data from 22 completed projects that resulted in 25 675 doses of JYNNEOS administered. We note 3 innovative strategies that were implemented in several projects: direct collaboration with organizations providing services to MSM and transgender women; implementation of MVEPP projects in unique nonclinical community settings and at venues frequented by MSM and transgender women; and offering an array of services as part of mpox vaccination projects, rather than offering only mpox vaccination.

Evaluation:

MVEPP highlighted the importance of recognizing and working to eliminate racial/ethnic and other disparities in access to medical countermeasures during a public health emergency. Jurisdictions developed and implemented innovative strategies to bring mpox vaccination and related services to communities disproportionately affected by mpox—including MSM and the subpopulations of Black/African American and Hispanic/Latino MSM. Lessons learned from MVEPP may inform efforts to reduce disparities during future public health responses.
The Effect of Telerehabilitation-Based Exercise and Education on Pain, Function, Strength, Proprioception and Psychosocial Parameters in Patients with Knee Osteoarthritis
Authors: Tümtürk İsmet , Bakırhan Serkan , Özden Fatih , Gültaç Emre , Kılınç Cem Yalın
Published: September 2023

Objective

In middle-aged individuals with early-stage knee osteoarthritis (OA), follow-up with remote rehabilitation methods may provide effective clinical outcomes. The present study aimed to investigate the effect of telerehabilitation (TR) on pain, function, performance, strength, proprioception, and psychosocial parameters in patients with knee OA.

Design

A randomized controlled study was conducted with 54 participants with knee OA. All patients were randomized into two groups: the home-based telerehabilitation group (TRG) (n = 29) and the home-based paper group (PG) (n = 28). The home exercise program and training were provided with an instruction manual to PG. The same home exercise and education prescriptions were given to individuals in TRG via an online platform. Pain, function, quality of life, physical performance, muscle strength, and proprioception were evaluated at baseline and after eight weeks of intervention. In addition, satisfaction and usability were evaluated at week 8.

Results

TRG demonstrated better improvement in terms of pain, function, quality of life index score, and left extremity proprioception (p < 0.05). TRG was not superior to PG in terms of muscle strength and performance tests (except the Five Times Sit to Stand Test) (p > 0.05).

Conclusions

The home-based TR program was superior to the home-based PG program for pain, function, quality of life, and proprioception in patients with knee OA.
Eight Clinical Cases and the Lessons They Taught
Authors: Preskorn Sheldon H.
Published: September 2023

Eight different cases are presented in this column, along with the lessons and principles that can be learned from each. The lessons and principles are general in nature and hence they are applicable to patients that readers will likely encounter.
Contending With Polarization in the Expanding Scope of Psychotherapy
Authors: Allen Jon G.
Published: September 2023

The author queried 32 colleagues about their sense of polarization in the field of psychotherapy, using as an example the contrast between generalists (like himself) and specialists. This query was inspired by the proliferation of brands of psychotherapy coupled with the dominance of cognitive-behavioral therapies. His key conclusions: (a) tensions in the field are associated with a multitude of polarities and individual differences; (b) it is folly to reduce polarization to any single polarity; and (c) given the field’s huge diversity, we are all specialists. While the author advocates greater integration of theories and methods, he also argues for expansion by including ethical thought into the scientific zeitgeist. He proposes skill in being human as a broad aspiration for therapists and patients.
Incidence of Hospital-Acquired Conditions During Pediatric Clinical Research Inpatient Hospitalizations: A Matched Cohort Study
Authors: Milliren Carly E. , Denhoff Erica R. , Hahn Phillip D. , Ozonoff Al
Published: September 2023

Objectives

In this matched cohort study using data from pediatric hospitals, we compared the incidence of hospital-acquired conditions (HACs) during clinical research hospitalizations to nonresearch hospitalizations.

Methods

Using Pediatric Health Information System data for inpatient discharges January 2017–June 2022, we matched research hospitalizations (identified by International Classification of Diseases, Tenth Revision, diagnosis code) to nonresearch hospitalizations within hospital on age (±3 y), sex, discharge year (±2), and All Patients Refined Diagnosis Related Groups classification, severity of illness (±1), and risk of mortality (±1). We calculated the incidence (per 1000 discharges) and incidence rate (per 10,000 patient days) of HAC identified by International Classification of Diseases, Tenth Revision, codes and compare research versus nonresearch using logistic and Poisson regression, accounting for matching using generalized estimating equations and adjusting for sociodemographic factors and hospital utilization.

Results

We matched 7000 research hospitalizations to 26,447 nonresearch from 28 hospitals. Median age was 6.0 years (interquartile range, 10.6 y). Median length of stay was 4.0 days (interquartile range, 11.0 days) with longer stays among research hospitalizations (P < 0.001). Incidence of HAC among research hospitalizations was 13.1 versus 7.2 per 1000 for nonresearch (P < 0.001) and incidence rate 6.7 versus 4.5 per 10,000 patient days. Adjusting for sociodemographic and clinical factors, research stays had 1.65 times the odds of any HAC (95% confidence interval, 1.27–2.16; P < 0.001) and 1.38 times the incidence rate (95% confidence interval, 1.09–1.75; P = 0.009).

Conclusions

Our findings indicate that pediatric research hospitalizations are more likely to experience HACs compared with nonresearch hospitalizations. These findings have important safety implications for pediatric inpatient clinical research that warrant further study.
Multiomics Data Reveal the Important Role of ANXA2R in T Cell–mediated Rejection After Renal Transplantation
Authors: Zhang Di , Zhang He , Lu Jun , Hu Xiaopeng
Published: September 2023

Background.

T cell–mediated rejection (TCMR) is a severe issue after renal transplantation, but research on its T cell–receptor (TCR) repertoire is lacking. This study intended to elucidate the TCR repertoire landscape in TCMR and hence identify novel potential targets.

Methods.

A total of 12 multiomics data sets were collected. The TRUST4 algorithm was used to construct and analyze the TCR repertoire in renal allografts with TCMR and stable renal function. Then, novel TCR-related key genes were identified through various criteria and literature research. In bulk transcriptome, cell line, single-cell transcriptome data sets, multiple immune cell infiltration algorithms, and gene set enrichment analysis were used to analyze potential mechanisms of the identified key gene. Twenty-three pathological sections were collected for immunofluorescence staining in the clinical cohort. Finally, the diagnostic and prognostic values of ANXA2R were evaluated in multiple renal transplant data sets.

Results.

Allografts with TCMR showed significantly increased clonotype and specific clonal expansion. ANXA2R was found to be a novel key gene for TCMR and showed strong positive connections with the TCR complex and lymphocyte cells, especially CD8+ T cells. Immunofluorescence staining confirmed the existence of ANXA2R+ CD8+ T cells, with their percentage significantly elevated in TCMR compared with stable renal function. Finally, both mRNA and protein levels of ANXA2R showed promising diagnostic and prognostic value for renal transplant recipients.

Conclusions.

ANXA2R, identified as a novel TCR-related gene, had critical roles in clinicopathology, diagnosis, and prognosis in renal transplantation, which offered promising potential therapeutic targets.
Sprinting with bilateral transtibial running-specific prostheses versus biological limbs – are they comparable? Comments on Beck
et al
. (2022)
Authors: Connick M. J. , Beckman E. M. , Tweedy S. M.
Published: September 2023

Since publication of this paper (Royal Society open science, 2022.
9
(1): p. 211799), the authors have published a correction clarifying that the paper presents a case study that ‘… did not meet the definition for research with regard to human subjects'. The data are incorrectly referred to as experimental because the study has no experimental control. Furthermore, the paper has been presented previously but the version presented here selectively omits several analyses, posing a significant risk of bias. Of the prosthetic-related disadvantages identified by the authors, the most substantive was a 40% increase in time to 20 m (59.5 s.d. below the mean for NA sprinters). However the analysis was incomplete: acceleration modelling for NA sprinters continued up to 98% of maximum velocity, while Fastest BA was truncated at approximately 80%. We extrapolated the model, revealing the duration of maximum acceleration for Fastest BA is approximately 100% longer than NA sprinters. Important differences in Fastest BA contact lengths (0.10–0.15 m) were also identified. We posit that together, these large and important differences in sprint biomechanics and their likely physiological consequences suggest that running with and without prosthetics are so different that, although running times may be similar, the precautionary principle should apply and, in the interests of athletic competition integrity, runners with and without prosthetics should continue to compete separately.
Phylogenetic meta-analysis reveals system-specific behavioural type–behavioural predictability correlations
Authors: Horváth Gergely , Garamszegi László Zsolt , Herczeg Gábor
Published: September 2023

The biological significance of behavioural predictability (environment-independent within-individual behavioural variation) became accepted recently as an important part of an individual's behavioural strategy besides behavioural type (individual mean behaviour). However, we do not know how behavioural type and predictability evolve. Here, we tested different evolutionary scenarios: (i) the two traits evolve independently (lack of correlations) and (ii) the two traits' evolution is constrained (abundant correlations) due to either (ii/a) proximate constraints (direction of correlations is similar) or (ii/b) local adaptations (direction of correlations is variable). We applied a set of phylogenetic meta-analyses based on 93 effect sizes across 44 vertebrate and invertebrate species, focusing on activity and risk-taking. The general correlation between behavioural type and predictability did not differ from zero. Effect sizes for correlations showed considerable heterogeneity, with both negative and positive correlations occurring. The overall absolute (unsigned) effect size was high (Zr = 0.58), and significantly exceeded the null expectation based on randomized data. Our results support the adaptive scenario: correlations between behavioural type and predictability are abundant in nature, but their direction is variable. We suggest that the evolution of these behavioural components might be constrained in a system-specific way.
Navigating the COVID-19 infodemic: the influence of metacognitive efficiency on health behaviours and policy attitudes
Authors: Lisi Matteo
Published: September 2023

The COVID-19 pandemic has been accompanied by an infodemic of misinformation and increasing polarization around public health measures, such as social distancing and national lockdowns. In this study, I examined metacognitive efficiency—the extent to which the subjective feeling of knowing predicts the objective accuracy of knowledge—as a tool to understand and measure the assimilation of misleading misinformation in a balanced sample of Great Britain’s population (N= 1689), surveyed at the end of the third national lockdown. Using a signal-detection theory approach to quantify metacognitive efficiency, I found that at the population level, metacognitive efficiency for COVID-19 knowledge was impaired compared with general knowledge, indicating a worse alignment between confidence levels and the actual ability to discern true and false statements. Crucially, individual differences in metacognitive efficiency related to COVID-19 knowledge predicted health-protective behaviours, vaccination intentions and attitudes towards public health measures, even after accounting for the level of knowledge itself and demographic covariates, such as education, income and political alignment. These results reveal the significant impact of misinformation on public beliefs and suggest that fostering confidence in accurate knowledge should be a key target for science communication efforts aimed at promoting compliance with public health and social measures.
Group singing is globally dominant and associated with social context
Authors: Shilton Dor , Passmore Sam , Savage Patrick E.
Published: September 2023

Music is an interactive technology associated with religious and communal activities and was suggested to have evolved as a participatory activity supporting social bonding. In post-industrial societies, however, music's communal role was eclipsed by its relatively passive consumption by audiences disconnected from performers. It was suggested that as societies became larger and more differentiated, music became less participatory and more focused on solo singing. Here, we consider the prevalence of group singing and its relationship to social organization through the analysis of two global song corpora: 5776 coded audio recordings from 1024 societies, and 4709 coded ethnographic texts from 60 societies. In both corpora, we find that group singing is more common than solo singing, and that it is more likely in some social contexts (e.g. religious rituals, dance) than in others (e.g. healing, infant care). In contrast, relationships between group singing and social structure (community size or social differentiation) were not consistent within or between corpora. While we cannot exclude the possibility of sampling bias leading to systematic under-sampling of solo singing, our results from two large global corpora of different data types provide support for the interactive nature of music and its complex relationship with sociality.
The limestone spheroids of ‘Ubeidiya: intentional imposition of symmetric geometry by early hominins?
Authors: Muller Antoine , Barsky Deborah , Sala-Ramos Robert , Sharon Gonen , Titton Stefania , Vergès Josep-Maria , Grosman Leore
Published: September 2023

Spheroids are one of the least understood lithic items yet are one of the most enduring, spanning from the Oldowan to the Middle Palaeolithic. Why and how they were made remains highly debated. We seek to address whether spheroids represent unintentional by-products of percussive tasks or if they were intentionally knapped tools with specific manufacturing goals. We apply novel three-dimensional analysis methods, including spherical harmonics and surface curvature, to 150 limestone spheroids from ‘Ubeidiya (ca1.4 Ma), presently the earliest Acheulean occurrence outside of Africa, to bring a new perspective to these enigmatic artefacts. We reconstruct the spheroid reduction sequence based on trends in their scar facets and geometry, finding that the spheroid makers at ‘Ubeidiya followed a premeditated reduction strategy. During their manufacture, the spheroids do not become smoother, but they become markedly more spherical. They approach an ideal sphere, a feat that likely required skilful knapping and a preconceived goal. Acheulean bifaces are currently thought to represent the earliest evidence of hominins imposing a premeditated, symmetrical shape on stone. The intentional production of sphere-like objects at ‘Ubeidiya similarly shows evidence of Acheulean hominins desiring and achieving intentional geometry and symmetry in stone.