bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study
Authors: Pham Thi Anh Mai , Forse Rachel , Codlin Andrew J. , Phan Thi Hoang Yen , Nguyen Thanh Thi , Nguyen Nga , Vo Luan Nguyen Quang , Dat Phan Thuong , Minh Ha Dang Thi , Nguyen Lan Huu , Nguyen Hoa Binh , Nguyen Nhung Viet , Bodfish Miranda , Lönnroth Knut , Wingfield Tom , Annerstedt Kristi Sidney
Published: December 2023

Background

Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam.

Methods

Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches.

Results

Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0–516] USD vs. 656 [IQR: 462–989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548–5418] USD vs. 301 [IQR: 0–824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household’s primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6–80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5–344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7–470.3]) were associated with experiencing catastrophic costs.

Conclusion

Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household’s primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.
Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis
Authors: Toleha Husien Nurahmed , Bayked Ewunetie Mekashaw
Published: December 2023

Background

Ethiopia aims to achieve universal healthcare using health insurance. To do so, it has been implementing community-based health insurance since 2011. However, the retention of members by the scheme has not yet been evaluated nationally. The systematic review and meta-analysis aimed to evaluate the dropout rate and associated factors among the scheme’s beneficiaries in Ethiopia.

Methods

On December 19, 2022, searches were conducted in Scopus, Hinari, PubMed, Semantic Scholar, and Google Scholar. Searches were also conducted on the general web and electronic repositories, including the Ethiopian Health Insurance Service, the International Institute for Primary Health Care-Ethiopia, and various higher education institutions. The Joanna Briggs Institute’s tools and the “preferred reporting items for systematic reviews and meta-analyses 2020 statement” were used to evaluate bias and frame the review, respectively. Data were analyzed using Stata 17 and RevMan 5. To assess heterogeneity, we conducted subgroup analysis and used a random model to calculate odds ratios with a p value less than 0.05 and a 95% CI.

Results

In total, 14 articles were included in the qualitative synthesis, of which 12 were selected for the quantitative analysis. The pooled estimate revealed that the dropout rate of beneficiaries from the scheme was 34.0% (95% CI: 23-44%), provided that the renewal rate was 66.0%, and was found to be influenced by socio-demographic, health status, length of enrolment, knowledge, attitude, the scheme, and health service-related variables. The southern and Oromia regions reported the lowest and highest dropout rates, with 27.0% (95% CI: 24-29%) and 48.0% (95% CI: 18-78%), respectively. The dropout rates increased from 12.3% in 2012–2015 to 34.4% in 2020–2021.

Conclusion

More than one-third of the scheme’s beneficiaries were found to have dropped out, and this has been found to increase over time, dictating that a community-based strategy and intervention, from the supply, insurer, and demand sides, seem indispensable in minimizing this huge dropout rate.
Effects of treatment with corticosteroids on human rhinovirus-induced asthma exacerbations in pediatric inpatients: a prospective observational study
Authors: Kan-o Keiko , Washio Yasuyoshi , Oki Takeshi , Fujimoto Tsuguto , Ninomiya Takahito , Yoshida Makoto , Fujita Masaki , Nakanishi Yoichi , Matsumoto Koichiro
Published: December 2023

Background

Human rhinoviruses (HRVs) infection is a common cause of exacerbations in pediatric patients with asthma. However, the effects of corticosteroids on HRV-induced exacerbations in pediatric asthma are unknown. We conducted a prospective observational study to determine the viral pathogens in school-age pediatric inpatients with asthma exacerbations. We assessed the effects of maintenance inhaled corticosteroids (ICS) on the detection rates of HRV species and treatment periods of systemic corticosteroids during exacerbations on pulmonary lung function after exacerbations.

Methods

Nasopharyngeal samples and clinical information were collected from 59 patients with asthma exacerbations between April 2018 and March 2020. Pulmonary function tests were carried out 3 months after exacerbations in 18 HRV-positive patients. Changes in forced expiratory volume in 1 second (FEV1)% predicted from baseline in a stable state were compared according to the treatment periods of systemic corticosteroids.

Results

Fifty-four samples collected from hospitalized patients were analyzed, and viral pathogens were identified in 45 patients (83.3%) using multiplex PCR assay. HRV-A, −B, and -C were detected in 16 (29.6%), one (1.9%), and 16 (29.6%) patients, respectively. The detection rates of HRV-C were lower in the ICS-treated group compared with those in the ICS-untreated group (p = 0.01), whereas maintenance ICS treatment did not affect the detection rate for viral pathogens in total and HRV-A. Changes in FEV1% predicted in patients treated with systemic corticosteroids for 6–8 days (n = 10; median, 4.90%) were higher than those in patients treated for 3–5 days (n = 8; median, − 10.25%) (p = 0.0085).

Conclusions

Maintenance ICS reduced the detection rates of HRV (mainly HRV-C) in school-age inpatients with asthma exacerbations, and the treatment periods of systemic corticosteroids during exacerbations affected lung function after HRV-induced exacerbations. The protective effects of corticosteroids on virus-induced asthma exacerbations may be dependent upon the types of viral pathogen.
Using a developed co-culture device to evaluate the proliferation of bone marrow stem cells by stimulation with platelet-rich plasma and electromagnetic field
Authors: Chang Chia-Wei , Lee Chih-Chin , Liao Jen-Chung
Published: December 2023

Backgrounds

Bone marrow stem cell can differentiate to osteoblast by growth factors, pulsed low-intensity ultrasound and electric magnetic field. In the research, bone marrow stem cells were cultured; bone marrow stem cells in culture can be stimulated by platelet-rich plasma and electric field.

Methods

The culture well of the co-cultivation device has a radius of 7.5 mm and a depth of 7 mm. It is divided into two sub-chambers separated by a 3 mm high and 1 mm wide barrier. The bone marrow stem cells were seeded at a density of 2 × 104 cells and the medium volume was 120μl. Platelet-rich plasma (PRP) or platelet-poor plasma (PPP) was added to the other sub-chamber at a volume of 10μl. The bone marrow stem cells were subjected to different electric fields (0 ~ 1 V/cm) at a frequency of 70 kHz for 60 min.

Results

The highest osteogenic capacity of bone marrow stem cells was achieved by addition of PRP to electric field stimulation (0.25 V/cm) resulted in a proliferation rate of 599.78%. In electric field stimulation (0.75 V/cm) with PPP, the proliferation rate was only 10.46%.

Conclusions

Bone marrow stem cell with PRP in the co-culture device combined with electric field at 0.25 V/cm strength significantly promoted the growth of bone marrow stem cells.
The knee kinematic patterns and associated factors in healthy Thai adults
Authors: Patathong Tanyaporn , Klaewkasikum Krongkaew , Angsnuntsukh Chanika , Woratanarat Thira , Kijkunasathian Chusak , Sanguantrakul Jongsook , Woratanarat Patarawan
Published: December 2023

Background

Reference values for normal knee kinematics were limited in Asian population and were influenced by race and other factors. This study was aimed to establish the reference values and identify the factors associated with knee kinematics in healthy Thai adults, aged 18–40 years.

Methods

A retrospective cohort study was conducted between 2016 and 2020. Healthy Thai adults aged 18–40 years old with body mass index (BMI) between 18.5 and 24.9 kg/m2 were included. All eligible participants were attached with reflective markers. Their walking was captured by 8-digital cameras, and assessed by motion analysis software. The primary outcomes were average knee kinematic data (degrees) in three dimensional planes as valgus-varus, flexion-extension, and internal-external rotation. Paired t-test and multiple linear regression were applied to compare the outcomes and to determine their associated factors.

Results

Ninety-eight participants (60 females and 38 males) were included with mean age 28.5 ± 5.4 years, and BMI 21.1 ± 2.0 kg/m2. Knee kinematics showed slight adduction during the swing phase, flexion during the stance phase, and obvious external rotation throughout the gait cycle, with a peak of 30–31 degrees during mid-swing. Right knee was significantly more adducted, flexed and externally rotated than the left side, particularly at mid-stance (P = 0.047, 0.017, and < 0.001, respectively). Females had more knee abduction, flexion and external rotation than males. Age, sex, and BMI were significantly correlated with knee abduction at terminal stance (correlation coefficient − 0.12, 95% confidence interval (CI) -0.23, -0.01; -1.37, 95%CI -2.54, -0.20; and − 0.32, 95%CI -0.61, -0.39, respectively), and rotation at mid-swing (correlation coefficient − 0.36, 95%CI -0.69, -0.02; -7.37, 95%CI -10.82, -3.92; and 0.89, 95%CI 0.01, 1.78, respectively).

Conclusion

Knee kinematics demonstrates external tibial rotation throughout the gait cycle, significant side differences, and are associated with age, sex, and BMI. Reference values from this study will be useful for functional gait assessment in healthy Thais. However, further comprehensive knee kinetic study including spatio-temporal parameter is recommended.
A model of purchase intention of complementary and alternative medicines: the role of social media influencers’ endorsements
Authors: Gülpınar Gizem , Uzun Mehmet Barlas , Iqbal Ayesha , Anderson Claire , Syed Wajid , Al-Rawi Mahmood Basil A.
Published: December 2023

Background

Social Media Influencers (SMIs) are a fashionable way of marketing products by creating electronic word-of-mouth (e-WOM) on social media. The marketing of complementary and alternative medicines (CAMs) by SMIs is becoming increasingly popular and gaining credibility within consumers on social media platforms. Nonetheless, advising about healthcare products on social media should be examined as it is different from endorsing other kinds of commercial products. The aim of this study is to develop a model that provides the underlying mechanisms of the stimuli of SMIs on social media towards consumers’ purchase intention of CAMs.

Methods

This study used best fit framework synthesis methods to develop the model. A priori theory selection was conducted by identifying a BeHEMoTh strategy (Behavior of Interest, Health context, Exclusions and Models or Theories) to systematically approach identifying relevant models and theories relative to the research aim. Further evidence derived from primary research studies that describe the behavior identified is coded against selected a priori theory to develop the model.

Results

This study presents a novel model for understanding the purchase behavior of CAMs using SMIs as a marketing strategy. The model included two well-known theories (theory of planned behaviour theory and source credibility theory) as well as extensive existing research from a multidisciplinary perspective. The model is exclusively designed to help identify elements affecting perceived source credibility and factors that have an influence over consumers’ preferences to purchase CAMs by taking into consideration SMIs’ endorsements.

Conclusions

This study provides unique insights introducing new research areas to health literature and offers, new roles for healthcare professionals in this digital era by gaining new skills and competencies required to provide more credible and accurate information about CAMs. The study also highlights the new marketing era of online health-related product endorsements and recommends that policymakers and researchers carefully evaluate the impact of SMI’s on the use of CAMs, as well as to regulate the content of these promotional materials.
Cross-cultural code-switching – the impact on international medical graduates in New Zealand
Authors: Mannes Mariska M. , Thornley Davinia J. , Wilkinson Tim J.
Published: December 2023

Background

New Zealand relies on International Medical Graduates (IMGs); however, the retention of IMGs is not optimal. This research uses a lens of cross-cultural code-switching to explore how professional and cultural differences impact on International Medical Graduates’ (IMGs’) journeys to practise effectively and remain in New Zealand.

Methods

Utilising theory-informing inductive analysis within a constructivist approach, framework analysis was conducted following 14 face-to-face interviews with IMGs. The analysis then explored the degree to which their experiences could be explained by cross-cultural code-switching’s psychological challenges (authenticity, competence, and resentment).

Results

Analysis showed there was an expectation for IMGs to code-switch. The greater the cultural and professional difference of IMGs (compared to New Zealand), the greater the intensity of psychological challenges experienced when switching. Moreover, IMGs received minimal support, making it difficult to overcome psychological challenges, especially the competence challenge. This led to feelings of frustration and vulnerability. Code-switching could also explain why complaints about IMGs were more likely when IMGs were stressed or tired.

Conclusion

Cross-cultural code-switching can be used to explain and identify how cultural differences cause psychological challenges. These findings inform how programmes can better support IMGs in orientation and ongoing training. Additionally, establishing, and allocating IMG cultural mentors would assist in addressing IMGs’ vulnerability and isolation. With this support, the journey may prove more manageable and encourage IMGs to continue practising in their adopted country.
Cost of simulation-based mastery learning for abdominal ultrasound
Authors: Post Julie H. , Teslak Kristina E. , Tolsgaard Martin G. , Rasmussen Sten , Friis Mikkel L.
Published: December 2023

Background

Ultrasound is an essential diagnostic examination used in several medical specialties. However, the quality of ultrasound examinations is dependent on mastery of certain skills, which may be difficult and costly to attain in the clinical setting. This study aimed to explore mastery learning for trainees practicing general abdominal ultrasound using a virtual reality simulator and to evaluate the associated cost per student achieving the mastery learning level.

Methods

Trainees were instructed to train on a virtual reality ultrasound simulator until the attainment of a mastery learning level was established in a previous study. Automated simulator scores were used to track performances during each round of training, and these scores were recorded to determine learning curves. Finally, the costs of the training were evaluated using a micro-costing procedure.

Results

Twenty-one out of the 24 trainees managed to attain the predefined mastery level two times consecutively. The trainees completed their training with a median of 2h38min (range: 1h20min-4h30min) using a median of 7 attempts (range: 3–11 attempts) at the simulator test. The cost of training one trainee to the mastery level was estimated to be USD 638.

Conclusion

Complete trainees can obtain mastery learning levels in general abdominal ultrasound examinations within 3 hours of training in the simulated setting and at an average cost of USD 638 per trainee. Future studies are needed to explore how the cost of simulation-based training is best balanced against the costs of clinical training.
Estimated distribution of malaria cases among children in sub-Saharan Africa by specified age categories using data from the Global Burden of Diseases 2019
Authors: Oshagbemi Olorunfemi A. , Lopez-Romero Pedro , Winnips Cornelis , Csermak Katalin R. , Su Guoqin , Aubrun Elodie
Published: December 2023

Background

Children in sub-Saharan Africa (SSA) remain the most vulnerable to malaria and malaria mortality. This study estimated the disease burden and distribution of Plasmodium falciparum malaria among children with age categories (0 to < 2 years, 2 to < 6 years, 6 to < 12 years, ≥ 12 years) in SSA.

Methods

Data on the number of cases and incidence rates of P. falciparum malaria by age group from the Institute of Health Metrics and Evaluation (GBD 2019) for 11 countries in SSA was employed in this study. The best-fitting distribution of P. falciparum malaria cases by prespecified age categories was derived using a combination of a Log-normal and Weibull distribution.

Results

Plasmodium falciparum malaria was 15.4% for ages 0 to < 2 years, 30.5% for 2 to < 6 years, 17.6% for 6 to < 12 years, and 36.5% for ≥ 12 years based on data from countries in SSA. The results have important implications for the current drive by the FDA and EMA to ensure the representativeness of real-world populations in clinical trials evaluating the safety and efficacy of medication exposure.

Conclusions

The theoretical distributions of P. falciparum malaria will help guide researchers in ensuring that children are appropriately represented in clinical trials and other interventions aiming to address the current burden of malaria in SSA.
Integrated particle image velocimetry and fluid–structure interaction analysis for patient-specific abdominal aortic aneurysm studies
Authors: Özcan Can , Kocatürk Özgür , Işlak Civan , Öztürk Cengizhan
Published: December 2023

Background

Understanding the hemodynamics of an abdominal aortic aneurysm (AAA) is crucial for risk assessment and treatment planning. This study introduces a low-cost, patient-specific in vitro AAA model to investigate hemodynamics using particle image velocimetry (PIV) and flow-simulating circuit, validated through fluid–structure interaction (FSI) simulations.

Methods

In this study, 3D printing was employed to manufacture a flexible patient-specific AAA phantom using a lost-core casting technique. A pulsatile flow circuit was constructed using off-the-shelf components. A particle image velocimetry (PIV) setup was built using an affordable laser source and global shutter camera, and finally, the flow field inside the AAA was analyzed using open-source software. Fluid–structure interaction (FSI) simulations were performed to enhance our understanding of the flow field, and the results were validated by PIV analysis. Both steady-state and transient flow conditions were investigated.

Results

Our experimental setup replicated physiological conditions, analyzing arterial wall deformations and flow characteristics within the aneurysm. Under constant flow, peak wall deformations and flow velocities showed deviations within − 12% to + 27% and − 7% to + 5%, respectively, compared to FSI simulations. Pulsatile flow conditions further demonstrated a strong correlation (Pearson coefficient 0.85) in flow velocities and vectors throughout the cardiac cycle. Transient phenomena, particularly the formation and progression of vortex structures during systole, were consistently depicted between experimental and numerical models.

Conclusions

By bridging high-fidelity experimental observations with comprehensive computational analyses, this study underscores the potential of integrated methodologies in enhancing our understanding of AAA pathophysiology. The convergence of realistic AAA phantoms, precise PIV measurements at affordable cost point, and validated FSI models heralds a new paradigm in vascular research, with significant implications for personalized medicine and bioengineering innovations.
hsa_circ_0007919 induces LIG1 transcription by binding to FOXA1/TET1 to enhance the DNA damage response and promote gemcitabine resistance in pancreatic ductal adenocarcinoma
Authors: Xu Lei , Ma Xiao , Zhang Xiuzhong , Zhang Chong , Zhang Yi , Gong Shuai , Wu Nai , Zhang Peng , Feng Xinyu , Guo Jiaxuan , Zhao Mengmeng , Ren Zeqiang , Zhang Pengbo
Published: December 2023

Background

Circular RNAs (circRNAs) play important roles in the occurrence and development of cancer and chemoresistance. DNA damage repair contributes to the proliferation of cancer cells and resistance to chemotherapy-induced apoptosis. However, the role of circRNAs in the regulation of DNA damage repair needs clarification.

Methods

RNA sequencing analysis was applied to identify the differentially expressed circRNAs. qRT-PCR was conducted to confirm the expression of hsa_circ_0007919, and CCK-8, FCM, single-cell gel electrophoresis and IF assays were used to analyze the proliferation, apoptosis and gemcitabine (GEM) resistance of pancreatic ductal adenocarcinoma (PDAC) cells. Xenograft model and IHC experiments were conducted to confirm the effects of hsa_circ_0007919 on tumor growth and DNA damage in vivo. RNA sequencing and GSEA were applied to confirm the downstream genes and pathways of hsa_circ_0007919. FISH and nuclear-cytoplasmic RNA fractionation experiments were conducted to identify the cellular localization of hsa_circ_0007919. ChIRP, RIP, Co-IP, ChIP, MS-PCR and luciferase reporter assays were conducted to confirm the interaction among hsa_circ_0007919, FOXA1, TET1 and the LIG1 promoter.

Results

We identified a highly expressed circRNA, hsa_circ_0007919, in GEM-resistant PDAC tissues and cells. High expression of hsa_circ_0007919 correlates with poor overall survival (OS) and disease-free survival (DFS) of PDAC patients. Hsa_circ_0007919 inhibits the DNA damage, accumulation of DNA breaks and apoptosis induced by GEM in a LIG1-dependent manner to maintain cell survival. Mechanistically, hsa_circ_0007919 recruits FOXA1 and TET1 to decrease the methylation of the LIG1 promoter and increase its transcription, further promoting base excision repair, mismatch repair and nucleotide excision repair. At last, we found that GEM enhanced the binding of QKI to the introns of hsa_circ_0007919 pre-mRNA and the splicing and circularization of this pre-mRNA to generate hsa_circ_0007919.

Conclusions

Hsa_circ_0007919 promotes GEM resistance by enhancing DNA damage repair in a LIG1-dependent manner to maintain cell survival. Targeting hsa_circ_0007919 and DNA damage repair pathways could be a therapeutic strategy for PDAC.
Giant non-parasitic splenic cyst: a case report
Authors: Karbasian Fereshteh , Ataollahi Maryam , Mashhadiagha Amirali , Moosavi Seyed Ali , Forooghi Mehdi , Ansary Narges , Hosseinian Hamed , Geramizadeh Bita
Published: December 2023

Background

Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas.

Case presentation

We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst.

Conclusions

Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.
Higher intake of certain nutrients among older adults is associated with better cognitive function: an analysis of NHANES 2011–2014
Authors: Devarshi Prasad P. , Gustafson Kelsey , Grant Ryan W. , Mitmesser Susan Hazels
Published: December 2023

Background

An increasing number of adults are over the age of 65, and there is concern about the increasing prevalence of age-associated cognitive decline and poor mental health status in older adults in the United States. Several nutrients are known to have important biological roles in brain health and neurological function, but many individuals fall short of recommended intake levels. The objective of this study was to examine the association between nutrient intake and cognitive function. We also explored whether nutrient intake was associated with depression.

Methods

This cross-sectional study was based on data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 and included participants ≥ 60 years of age who had reliable day 1 dietary recall data and either valid cognitive function data (n = 2713) or valid depression score data (n = 2943). The sample was stratified by gender, and cognitive functioning test (CFT) composite z-scores were analyzed by quartiles. Depression status was assessed using the Patient Health Questionnaire (PHQ-9).

Results

Higher intake and adequacy of a number of different nutrients from food were associated with higher cognitive function in both males and females. Nutrients that showed the most consistent associations with cognitive function across intake and adequacy analyses for food in both males and females were vitamin A, vitamin E, thiamin, riboflavin, vitamin B6, folate, magnesium, potassium, zinc, vitamin K, and lutein and zeaxanthin (p < 0.05 for all). These associations were positive with increasing intake and adequacy being associated with higher CFT composite z-scores. Analysis of nutrient intake and depression yielded results that differed by gender. In females, the nutrients that showed consistent inverse associations with depression scores across both intake and adequacy analyses for food were vitamin A, vitamin C, magnesium, vitamin K, potassium, and dietary fiber (p < 0.05 for all). In males, no significant associations between nutrient intake from food and depression scores were observed.

Conclusions

Our findings suggest that older adults with sufficient intakes of certain essential nutrients have higher cognitive function. Future studies are needed to confirm whether a well-balanced diet and/or dietary supplements which emphasize these nutrients are effective for prevention of age-related declines in cognitive function and mood.
Advanced analytical techniques for microplastics in the environment: a review
Authors: Randhawa Jatinder Singh
Published: December 2023

Background

Due to the increasing usage of plastic, microplastics or plastic particles with a length of 1 to 5 mm are omnipresent in the environment, including freshwater, agricultural soil and seas. The majority of plastic trash is made up of microplastic debris, which has lately started to threaten ecosystems. This calls for immediate management and analysis to ensure the traceability of microplastics in the environment.

The main body of the abstract

The polymeric variety, irregular shape and microscopic size of microplastics make it difficult to quantify their presence in the environment. In this review, the analytical techniques for evaluating microplastics are discussed. The techniques included Fourier transform infrared spectroscopy, Raman spectroscopy, laser diffraction particle, thermal analysis, scanning electron microscope, pyrolysis gas chromatography, dynamic light scattering, and atmospheric solid analysis probe (ASAP) paired with quadrupole mass spectrometry (MS).

Short conclusion

The purpose of the present review is to give a summary of the most efficient cutting-edge techniques for more accurate and precise microplastic examination in the environmental samples.
State capacities and municipal education policies during the COVID-19 pandemic
Authors: Lui Lizandro , Segatto Catarina , Albert Carla , Marques Rodrigo
Published: December 2023

The development of pedagogical activities through remote teaching became common during the pandemic. Based on a survey carried out by the National Confederation of Municipalities, a set of heterogeneities was identified regarding the actions adopted in the area of education in Brazil. This study finds support in the concept of state capacities and aims to deepen the understanding of the factors that contributed to the increase of municipalities’ capacity to respond to the crisis. A regression was performed considering a set of variables linked to the characteristics of the local governments. It was concluded that variables related to technical-administrative and political-relational capacities related to the existence of participatory channels were fundamental in this process.
Ineffective ventilation in a very low birth weight infant with H-type Tracheoesophageal Fistula with bilateral chemical pneumonitis. A lesson learned
Authors: Ahmad Faraz , Niaz Sana , Durrani Naveed , Kumar Vikram
Published: December 2023

Tracheoesophageal fistula (TEF) with or without associated esophageal atresia (EA) in the neonate is challenging to diagnose and manage its complications like aspiration, respiratory distress, and other associated anomalies. To stabilize, ventilate and prepare for surgical correction, understanding the H-nature of disease and anticipation of problems and their management will improve survival. We present a newborn with tracheoesophageal fistula without atresia from resource-limited settings and lessons we learned from the case.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8958

How to cite this: Ahmad F, Niaz S, Durrani N, Kumar V. Ineffective ventilation in a very low birth weight infant with H-type Tracheoesophageal Fistula with bilateral chemical pneumonitis. A lesson learned. Pak J Med Sci. 2024;40(2):S91-93. doi: https://doi.org/10.12669/pjms.40.2(ICON).8958

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Concordance and discordance of GeneXpert MTB/RIF and conventional culture method for diagnosis of Extra-Pulmonary Tuberculosis at a tertiary care hospital in Pakistan
Authors: Zahid Qurat-ul-Ain , Khursheed Nazia , Adnana Fareeha , Zafar Adeel
Published: December 2023

Objective: To identify concordance and discordance between GeneXpert MTB/RIF assay and gold standard bacteriologic culture for the diagnosis of Mycobacterium tuberculosis (MTB) in Extra-Pulmonary tuberculosis (EPTB) specimens in our region.

Methods: This is a retrospective cross-sectional study conducted at the Indus Hospital and Health Network. Data from 1st January, 2020 to 31st December, 2021 was analyzed. A total of 1499 EPTB specimens were included for which GeneXpert was requested along with acid-fast bacteria (AFB) culture from the same specimen. Specimens were processed according to specimen type following standard operating procedures of the laboratory. Fluorescent staining was performed on all specimens along with bacteriologic culture. The GeneXpert MTB/RIF assay was carried out in exact accordance with the manufacturer’s instructions.

Results: Out of 1499 EPTB specimens, 1370 (91.39%) specimens exhibited concordance between GeneXpert and conventional culture method, while 129 (8.60%) specimens showed discordance. GeneXpert exhibited sensitivity and specificity of 69.4% and 94.3% respectively in comparison to culture.

Conclusion: GeneXpert sensitivity for the diagnosis of EPTB varied with the site involved. Lower sensitivity was observed in ascitic and pleural fluids as compared to higher sensitivity observed among urine samples and pus aspirates. However, given the quick turnaround time and ease of use, it is a helpful tool in the diagnosis of EPTB when utilized in the appropriate clinical context. Caution is advised while interpreting negative GeneXpert results in endemic settings and should be interpreted along with other supporting clinical and diagnostic features.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8967

How to cite this: Zahid QA, Khursheed N, Adnan F, Zafar A. Concordance and discordance of GeneXpert MTB/RIF and conventional culture method for diagnosis of Extra-Pulmonary Tuberculosis at a tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(2):S64-S69.  doi: https://doi.org/10.12669/pjms.40.2(ICON).8967

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Burnout and patient safety culture assessment in a secondary care hospital
Authors: Ziarukh Sharmeen , Sabir Aamina
Published: December 2023

Objectives: To identify employee burn-out and assess its impact on patient safety culture.

Methods: This cross-sectional study was carried out amongst healthcare providers (HCP) of Tehsil Head Quarter Manawan Hospital, Lahore from April 1st till 30th, 2023, who had been working for at least one year and directly involved in patient care. Two questionnaires were used; the Maslach Burnout Inventory (MBI) to assess level of burnout, and Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey. After obtaining informed consent, 59 participants were enrolled in this study.

Results: High degree of occupational exhaustion (OE) 42.9% was seen amongst doctors and 57.1% had low degree of personal accomplishment (PA) compared to all other health care providers. Significant association was observed between two sub-scales of MBI (p<0.05). No significant association was observed in working hours, designated positions and burnout (p>0.05). Statistically weak correlation existed between burnout and patient safety culture (r=0.075, p=0.580). Awareness on incident reporting was in 43.3% of participants; of which 31% had reported at least one event in last 12 months. Overall, 76% employees consider their work unit reliable for providing safe patient care.

Conclusions: Burnout was observed in employees, particularly high degree in attending physicians. However, team work, high level of personal accomplishment and incident reporting culture, served as protective factors for patient safety and safe working environment and culture.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8970

How to cite this: Ziarukh S, Sabir A. Burnout and patient safety culture assessment in a secondary care hospital. Pak J Med Sci. 2024;40(2):S58-S63.  doi: https://doi.org/10.12669/pjms.40.2(ICON).8970

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A large abdominal cyst as a manifestation of pelviureteric junction obstruction in a neonate
Authors: Usman Syed Faisal , Razaq Athar , Ahmad Ejaz , Rashid Abdulrehman , Shehzadi Maham
Published: December 2023

Intraabdominal cystic lesions diagnosed during antenatal period are uncommon. They are found to have varying origins, with renal tract being the most common site. Rarely, a large unilateral cystic lesion of renal origin is caused by Pelviureteric junction obstruction, crossing the midline, leading to compression of the contralateral kidney. We present a case of a neonate who was diagnosed with a large abdominal cyst in the antenatal period. The cyst persisted and crossed the midline causing hydronephrosis on the contralateral side. This is an unusual presentation of a commonly occurring condition, usually such large cyst at birth origins from alimentary tract rather renal system. It is important to understand unusual presentations of intraabdominal lesions and the associated pathology. It is mandatory to rule out renal obstruction, if there is any decompression of renal function, it is mandatory to save renal function till the time of definitive surgery.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8980

How to cite this: Usman SF, Razaq A, Ahmad E, Rashid AR, Shehzadi M. A large abdominal cyst as a manifestation of pelviureteric junction obstruction in a neonate . Pak J Med Sci. 2024;40(2):S87-S90. doi: https://doi.org/10.12669/pjms.40.2(ICON).8980

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy of 0.5% timolol maleate gel in the management of infantile hemangiomas
Authors: Mazhar Aqsa , Ghouse Afza Naureen , Mallick Yousuf Abd , Samad Lubna
Published: December 2023

Objective: This study aimed to evaluate the efficacy and safety of 0.5% timolol maleate gel, reported as an efficacious option for management of infantile hemangiomas (IH) in children.

Methods: A retrospective study was conducted among patients diagnosed with IH from January 2019 to December 2021. All patients were treated 0.5% timolol gel. Data parameters, including photographs, at baseline and the final or most recent follow-up visit, were reviewed. Outcomes based on photographic assessment were categorized as excellent, good, fair or poor.

Results: Sixty-four children with 76 lesions were enrolled. Median age was eight months (two months to 36 months) with most lesions (75.0%) presenting during the first year of life. Female preponderance (84.4%) was seen and the cervicofacial region was most commonly involved (52.6%). The majority of lesions (54, 84.4%) were solitary and most were treatment naïve (n=61, 80.3%). Excellent, good, fair, and poor responses were seen in 24 (31.5%), 39 (51.3%), 6 (7.9%), and 7 (9.2%) lesions. No complications were seen and no statistically significant difference was observed with respect to gender, age group, region involved and treatment naïve versus previously treated patients.

Conclusion: Timolol maleate 0.5% gel is an effective and safe treatment option for IH irrespective of location of lesion, age and history of prior treatment.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8983

How to cite this: Mazhar A, Naureen A, Mallick YA, Samad L. Efficacy of 0.5% timolol maleate gel in the management of infantile hemangiomas. Pak J Med Sci. 2024;40(2):S75-S79. doi: https://doi.org/10.12669/pjms.40.2(ICON).8983

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Esophageal Liposarcoma: A rare tumor
Authors: Kumar Ameet , Ishaqi M. Saqib Qamar , Baig Mehak Ali , Khan Rafeah
Published: December 2023

Esophageal liposarcoma is a rare type of tumor. This case report documents the presentation, diagnosis, and management of a 74-year-old male with a medical history including diabetes mellitus, asthma, and hypertension. The patient’s primary complaint was dysphagia, accompanied by regurgitation and substantial weight loss over a six-month period. Diagnostic evaluation revealed a sizable esophageal liposarcoma, which was successfully resected through surgery. Follow-up assessments demonstrated the absence of residual mass. Esophageal liposarcomas, though rare, should be considered in patients presenting with dysphagia or chest discomfort. Surgical resection is the mainstay of treatment, with the recommendation for extended postoperative surveillance given the limited available data regarding long-term prognosis.

doi: https://doi.org/10.12669/pjms.40.2(ICON).8989

How to cite this: Kumar A, Ishaqi MSQ, Baig MA, Khan R. Esophageal Liposarcoma: A rare tumor. Pak J Med Sci. 2024;40(2):S103-S105.  doi: https://doi.org/10.12669/pjms.40.2(ICON).8989

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Laryngo-Onycho-Cutaneous Syndrome (LOCS)
Authors: Hemani Fatima , Khurram Uzma , Naveed Anjum
Published: December 2023

Shabbir Syndrome or commonly known as Laryngo-onycho-cutaneous syndrome (LOCS) is an autosomal recessively inherited syndrome, caused due to mutations in the laminin alpha-3 (LAMA3) gene. This syndrome affects the epidermal layer and results in granulation formation in the eyes, larynx, and nails. One of the most dreadful complications of this syndrome can be due to granulation formation in the larynx or sub-glottis region resulting in laryngeal stenosis and death. According to the latest Online Mendelian Inheritance in Man (OMIM) classification, LOCS has been reclassified as a subtype of Junctional epidermolysis bullosa (JEB). But it is still considered a rare syndrome with limited cases reported worldwide. In this case report, we have discussed a case of a four year old, Pakistani boy, who presented with stridor, fragile skin, and granulation of nails, with no family history of LOCS.

doi: https://doi.org/10.12669/pjms.40.2(ICON).9035

How to cite this: Hemani F, Khurram U, Naveed A. Laryngo-Onycho-Cutaneous Syndrome (LOCS). Pak J Med Sci. 2024;40(2):S100-102.  doi: https://doi.org/10.12669/pjms.40.2(ICON).9035

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Δίκτυα, δημόσια έργα και υποδομές στην Ανατολική Κρήτη από τα τέλη του 18ου αιώνα μέχρι και το μεσοπόλεμο
Authors: Κυπριωτάκης Δημήτριος
Published: December 2023

Αντικείμενο της παρούσας διατριβής αποτελεί η διερεύνηση του τρόπου διαμόρφωσης των συγκοινωνιακών δικτύων στην Ανατολική Κρήτη από το 18ο αιώνα μέχρι το τέλος του Μεσοπολέμου. Ειδικότερα, εξετάζεται η διαμόρφωση του οδικού δικτύου, των κύριων λιμενικών υποδομών, το ζήτημα της ακτοπλοΐας και οι προσπάθειες για την ανάπτυξη του σιδηροδρόμου. Ως κριτήρια για την προσέγγιση των παραπάνω πεδίων τέθηκαν εφτά παράμετροι, 1. το φυσικό περιβάλλον, 2. τα ιδιαίτερα χαρακτηριστικά της τοπικής παραγωγής και της οικονομίας, 3. το πολιτικό και διοικητικό σύστημα, 4. το νομικό πλαίσιο, 5. οι δυνατότητες χρηματοδότησης, 6. η διαθέσιμη τεχνολογία και τεχνογνωσία και, τέλος, 7. η προσφορά εργασίας σε συνδυασμό με τη διαθεσιμότητα του αναγκαίου ειδικευμένου προσωπικού, μηχανικών, εργοδηγών, εργολάβων και εργολαβικών εταιριών. Η έρευνας βασίστηκε σε πρωτογενές υλικό, περιηγητικά κείμενα, τον τοπικό τύπο, το αρχείο της Λιμενικής Επιτροπής Ηρακλείου, το αρχείο του Δήμου Ηρακλείου κ.α.
The study of the Jordan canonical forms of Killing tensor in the frame of general theory of relativity
Authors: Κόκκινος Διονύσιος
Published: December 2023

Η Μελέτη των Κανονικών Jordan μορφών του τανυστή Killing στο πλαίσιο της Γενικής Θεωρίας της Σχετικότητας εστιάζει στην απόκτηση αναλυτικών λύσεων της Γενικής Σχετικότητας που αποδέχονται τις κανονικές μορφές του τανυστή Killing. Η ύπαρξη του τανυστή Killing σε ένα Χαμιλτονιανό πρόβλημα είναι ισοδύναμο με την ύπαρξη των ολοκληρωμάτων της κίνησης. Σε αυτό το πλαίσιο αναζητούμε α ναλυτικές λύσεις των εξισώσεων Einstein που αποδέχονται κρυμμένες συμμετρίες. Συγκεκριμένα, σκοπεύουμε είτε να ανακαλύψουμε νέες λύσεις είτε να συσχετίσουμε τις κρυμμένες συμμετρίες των γνωστών λύσεων με τις κανονικές μορφές του τανυστή. Για να πετύχουμε κάτι τέτοιο πρέπει να λύσουμε ταυτόχρονα τις εξισώσεις πεδίου με τις εξισώσεις ολοκληρωσιμότητας των κανονικών μορφών του τανυστή Killing. Η διατριβή έχει ως αφετηρία μια σύντομη σύνοψη της Γενικής Θεωρίας της Σχετικότητας και μια βιβλιογραφική έρευνα των ήδη γνωστών ακριβών λύσεων σε κάποιες από τις οποίες αναφερόμαστε συχνά. Η διαδικασία επίλυσης πραγματώνεται με τη χρήση του φορμαλισμού των ισότροπων τετράδων των Newman-Penrose. Σε αυτό το πλαίσιο, έπειτα από την παρουσίαση των βασικών στοιχείων της Γενικής Σχετικότητας και των ακριβών λύσεων, εισάγουμε πολύ συντομα τις βασικές αρχές του φορμαλισμού καθώς και τον αντίστοιχο συμβολισμό συναρτήσει των ισότροπων τετράδων. Το επόμενο στάδιο αφορά τον ορισμό του τανυστή Killing, σε αυτό το κεφάλαιο αποκτούμε τις τέσσερεις κανονικές Jordan μορφές και τις εξισώσεις ολοκληρωσιμότητάς τους, που αποτελούν την αρχική μας υπόθεση, με σκοπό την επίλυση των εξισώσεων πεδίου. Στην διατριβή αυτή θα ασχοληθούμε μόνο με τις τρεις κανονι-κές μορφές. Η ομοιότητα των μορφών K2 και K3 μας επιτρέπει να τις χειριστούμε ταυτόχρονα. Το πρώτο μας αποτέλεσμα είναι ο τύπος κατά Petrov της κάθε μορφής, που αποτελεί έναν αναλοίωτο χαρακτηρισμό του βαρυτικού πεδίου. Καταφέραμε να καταλήξουμε σε αυτό εφαρμόζοντας μια στροφή γύρω από το ισότροπο σύστημα τετράδων μιας και έτσι απλοποιούνται οι συντελεστές συνοχής spin. Οι τύποι κατά Petrov που αποδέχονται τις μορφές K2 και K3 περιλαμβάνουν μια αρκετά ενδιαφέρουσα λύση τύπου D. Αποκτήσαμε διάφορες εκδοχές αναλυτικών λύσεων αυτού του τύπου. Κάποιες από αυτές καταλήγουν σε γνωστούς χωροχρόνους. ́Ενας από τους αναδυόμενους χώρους ο οποίος αποδέχεται μόνο την μορφή K2, είναι η περίπτωση [D] των χώρων του Carter την οποία αναλύσαμε εκτεταμμένα. Παρουσιάζουμε ειδικές περιπτώσεις των ειδικών χώρων του, καθώς και τις τροχιές των γεωδαισιακών του. Τέλος η χρήση του τανυστή Killing μας παρέχει εκφράσεις που συσχετίζουν τις ιδιοτιμές του με τις σταθερές της κίνησης αναδεικνύοντας τη σημαντικότητά του.