bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Quality of Life and Sleep Quality in Saudi Women with Breast Cancer-Related Lymphedema: A Cross-Sectional Correlational Study
Authors: Tamam Nissren , Al-mugren K. S. , Alrebdi H. I. , Sulieman Abdelmoneim , Abdelbasset Walid Kamal
Published: September 2021

Background

Among the different cancers found in women, breast cancer is the most common. Breast cancer-related lymphedema is a serious health complication affecting the quality of life and sleep quality. This study evaluates the quality of life and sleep quality among Saudi women with different stages of lymphedema following the treatment of breast cancer.

Methods

This cross-sectional correlational study included 163 Saudi women with breast cancer-related lymphedema (Stages I-III), aged 28 to 56 years. From the patients identified for this study, women who suffered from mental and psychological dysfunctions or other malignant disorders were excluded. Copies of structured questionnaires were given to each participant during their visits to outpatient physiotherapy clinics. Quality of life was assessed using a valid questionnaire (EORTC QLQ-C30), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The differences between the different lymphedema stages have been assessed.

Results

Of the total number of participants 27 women had been diagnosed with stage I lymphedema, 84 women had been diagnosed with stage II lymphedema, and 52 women had been diagnosed with stage III lymphedema. All participants have shown low scores on both EORTC QLQ-C30 and PSQI. While analyzing the differences between the 3 stages of lymphedema with the Kruskal–Wallis test, noteworthy statistical differences between the 3 stages of lymphedema ( P < .05) have been found. The Stage III lymphedema patients have been shown the lowest quality of life values in all scales when compared with the stage I and stage II lymphedema patients. For PSQI scores, the stage III lymphedema patients worse values than the stage I and stage II lymphedema patients ( P < .05).

Conclusion and Recommendations

Both quality of life and quality of sleep have significantly decreased in Saudi women with different stages of breast cancer-related lymphedema. Quality of life and quality of sleep are the worst in stage III lymphedema patients. Future research should consider repeat and enlarge these results as well as assess the risk factors that affect the quality of life and quality of sleep among Saudi women suffering from breast cancer-related lymphedema.
Examination of the multiple-input multiple-output space-time block-code selective decode and forward relaying protocol over non-homogeneous fading channel conditions
Authors: Shankar Ravi , Krishna Patteti , R Naraiah
Published: September 2021

With the tremendous increase in wireless user traffic, investigation on the end-to-end reliability of wireless networks in practical conditions such as non-homogeneous fading channel conditions is becoming increasingly widespread. Because they fit well to the experimental data, generalized channel fading distributions like κ–μ are well suited for modeling diverse fading channels. This paper analyzes the symbol error rate (SER) and outage probability (OP) performance of multiple-input multiple-output (MIMO) space-time block-code (STBC) selective decode and forward (S-DF) network over κ–μ fading channel conditions considering the additive white Gaussian noise (AWGN). First, the closed-form (CF) analytical expressions for the probability density function (PDF) and the cumulative distribution function (CDF) of the received signal-to-noise ratio (SNR) as well as its moment generating function (MGF) are derived. Second, the OP performance is then investigated for various values of the channel fading parameter and SNR regimes. The simulation findings show an increase in SER performance with an improved line-of-sight (LOS) component. Furthermore, the results show that the S-DF relaying systems can function properly even when there is no fading or LOS component. The OP has been increasing with the increase in the value of μ and κ. In medium and high SNR regimes, simulation results exactly match with analytical results.
Contribution of neutrophil/lymphocyte ratio to the diagnostic efficiency of computed tomography and polymerase chain reaction in COVID-19 patients
Authors: Örün Serhat , Erdem Mustafa Numan
Published: September 2021

Background:

6.5% of the country’s population was diagnosed with COVID-19 disease. Computed tomography scanning and polymerase chain reaction tests are considered reliable methods for the detection of COVID-19. However, the specificity and reliability of polymerase chain reaction tests and ground-glass opacity (GGO) on thorax computed tomography images in diagnosing COVID-19 are still being disputed. Our aim was to compare the neutrophil/lymphocyte ratio, whose efficiency in differentiating between viral and bacterial infections has previously been studied, with computed tomography and polymerase chain reaction for COVID-19 diagnosis.

Materials and methods:

This was a retrospective study that included patients treated in a tertiary care hospital emergency service pandemic polyclinic between 14 March and 1 June 2020. The neutrophil/lymphocyte ratios of patients with polymerase chain reaction tests and ground-glass opacities on computed tomography were calculated. The neutrophil/lymphocyte ratios of polymerase chain reaction-negative patients with computed tomography images were compared with the neutrophil/lymphocyte ratios of polymerase chain reaction-positive patients with computed tomography images.

Results:

A total of 631 patients were included in this study. Thorax computed tomography scans were obtained from all patients. The mean neutrophil/lymphocyte ratio of patients with ground-glass opacities was 3.50 ± 2.12, whereas that of patients without ground-glass opacities was 2.90 ± 2.01. This difference was also statistically significant. Polymerase chain reaction swab samples were obtained from 282 patients (44.7%). The mean neutrophil/lymphocyte ratio of polymerase chain reaction-positive patients was 2.38 ± 1.02, whereas that of polymerase chain reaction-negative patients was 3.97 ± 2.25. The difference was statistically significant.

Conclusion:

Many studies are undoubtedly required to determine the efficiency of the neutrophil/lymphocyte ratio in COVID-19 diagnosis. However, we postulate that evaluating the neutrophil/lymphocyte ratio along with computed tomography and polymerase chain reaction can assist in the diagnosis of patients.
Tibial tuberosity transposition advancement for treatment of concomitant cranial cruciate ligament rupture and medial patellar luxation in four feline stifles
Authors: Bula Edyta , Perry Karen L
Published: September 2021

Case series summary

Three cats (four stifles) were diagnosed with varying grades of medial patellar luxation and stifle instability in cranial tibial thrust. Radiographs showed periarticular osteophytosis, intra-articular mineralization and opacification encroachment of the infrapatellar fat pad. Stifle exploration revealed either partial (n = 2) or complete (n = 2) cranial cruciate ligament tear and medial meniscal injury in all cases. Medial meniscectomy, partial parasagittal patellectomy, femoral trochleoplasty and tibial tuberosity transposition advancement using a 6 mm cage, two-fork plate and 4 mm spacer were performed in four stifles. Screws (2.0 mm) and washers were used in the cranial cage ears rather than conventional 2.4 mm screws. By the 2-week recheck, lameness was minimal and stifles were stable. Radiographic follow-up at 8 weeks showed appropriate progression of osseous union in all cases. One cat experienced a major complication, suffering tibial fracture following a lapse in exercise restriction, and revision surgery was performed successfully with subsequent osseus union of the osteotomy site. At the mid-term follow-up, all cats had a return to previous level of function, as assessed by both owner questionnaire and clinical evaluation.

Relevance and novel information

Tibial tuberosity transposition and advancement has been shown to be successful in dogs for the treatment of concomitant medial patellar luxation and cranial cruciate ligament rupture. To date, there have been no reports of tibial tuberosity transposition and advancement in cats. A benefit of this approach is concomitant alignment of the extensor mechanism and neutralization of the femorotibial shear force. Our case series describes successful use of tibial tuberosity transposition advancement in cats.
The “Lucky Money” That Started It All—The Reinvention of the Ancient Tradition “Red Packet” in Digital Times
Authors: Xu Yusi (Aveva)
Published: September 2021

In August 2020, President Trump attempted to ban WeChat, indicating the growing impact of the most widely used social medium in China. WeChat enjoys a monthly active user base of 1.2 billion, but the Internet giant’s story started with a humble function, “Red Packet.” The function of Red Packet paved the way for WeChat to intelligently integrate into the Chinese financial sphere. This study examines the cultural, economic, and relational implications of the digital reinvention of traditional red packet gifts, and monetary giving that represents good luck and well wishes in festive situations. Drawing upon Mauss’ conceptualization of gift economy within the context of contemporary China and the art of social relationships, “ guanxi,” the author closely examines Tencent’s annual report and conducts semi-structured interviews to study WeChat Red Packet (hereafter WCRP) gifting. This article concludes that (1) the obligatory feeling of guanxi management renders WCRP giving, receiving, and reciprocity compulsory practices; (2) WCRP facilitates “immediate reciprocity,” in which, instrumental guanxi may be produced and dissolved instantaneously; (3) the phenomena of social comparison and social hierarchy are mirrored in virtual groups; (4) with platformed sociality and monetizing connectivity, WCRP paved the way for alternative economic practices within Chinese authoritarian capitalism; and (5) WCRP contains characteristics of a personalized gift and materialist commodity.
CADCAM Arch Bars: A Technical Note
Authors: Tache Ana , Huys Stijn E. F. , Mommaerts Maurice Y.
Published: September 2021

Study Design:

Technical note.

Objective:

Computer-aided design and computer-aided manufacturing (CADCAM) is commonly used in craniomaxillofacial (CMF) surgery because of its advantage in customizing medical devices. We used this technology to create individualized, resin-bonded 3-dimensionally printed titanium arch bars.

Method:

This article describes a patient specific, three-dimensionally (3D) printed, resin-bonded arch bar as an alternative to the classical intermaxillary fixation systems.

Results:

The ease of application and removal, as well as the protection of the periodontal and cheek tissues, and operator fingers, made this a comfortable technique for both the patient and practitioner.

Conclusions:

A patient-specific 3D-printed titanium arch bar can be useful in the arsenal of the maxillofacial surgeon.
Osmophobia in primary headache patients: associated symptoms and response to preventive treatments
Authors: Delussi Marianna , Laporta Anna , Fraccalvieri Ilaria , de Tommaso Marina
Published: September 2021

Background

Osmophobia, is common among primary headaches, with prevalence of migraine.

The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients.

Methods

This was an observational retrospective cohort study based on data collected in a tertiary headache center.

We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up.

Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10.

Results

The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia).

Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia.

Conclusions

While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety.

Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.
Vision-related quality of life and psychosocial well-being of patients with episcleritis and scleritis: a neglected essence?
Authors: Tamrakar Apurva Ratna , Kharel Sitaula Ranju , Joshi Sagun Narayan , Bajracharya Manjita
Published: September 2021

Background

To assess the change in vision-related quality of life and psychosocial well-being of the patients with episcleritis and scleritis patients before and after treatment.

Results

This one-and-a-half-year prospective study was conducted among 76 eyes of 71 new patients of episcleritis and scleritis. A structured questionnaire was used to assess the visual and to analyze the change in effect size. The male-to-female ratio was 1:1.536. Episcleritis was seen in 41 cases (57.7%) while scleritis was seen in 30 cases (42.3%). Patients with episcleritis had statistically significant improvement in general function score (GF) (p < 0.05) using paired t-test. The effect size showed medium improvement (approximately 0.5). Whereas there was no statistically significant change in psychosocial impact (PI), visual symptoms (VS) scoring, and a total score (p < 0.05) using paired t-test. The effect size showed no improvement for PI and total score and small improvement for VS score. Patients with scleritis had statistically significant improvement in general function score (GF), visual symptoms (VS) scoring and total score (p < 0.05) using paired-t-test. The effect size showed medium improvement (approximately 0.5) for general function score (GF) and total score. However, the effect size showed only a small improvement (approximately 0.2) for psychosocial impact (PI) score.

Conclusions

VisionRelated Quality of Life of patients with scleritis showed significant improvement following treatment unlike episcleritis indicating scleritis more adversely affecting psychosocial well-being.
Sequencing refractory regions in bird genomes are hotspots for accelerated protein evolution
Authors: Huttener R. , Thorrez L. , Veld T. In’t , Granvik M. , Van Lommel L. , Waelkens E. , Derua R. , Lemaire K. , Goyvaerts L. , De Coster S. , Buyse J. , Schuit F.
Published: September 2021

Background

Approximately 1000 protein encoding genes common for vertebrates are still unannotated in avian genomes. Are these genes evolutionary lost or are they not yet found for technical reasons? Using genome landscapes as a tool to visualize large-scale regional effects of genome evolution, we reexamined this question.

Results

On basis of gene annotation in non-avian vertebrate genomes, we established a list of 15,135 common vertebrate genes. Of these, 1026 were not found in any of eight examined bird genomes. Visualizing regional genome effects by our sliding window approach showed that the majority of these "missing" genes can be clustered to 14 regions of the human reference genome. In these clusters, an additional 1517 genes (often gene fragments) were underrepresented in bird genomes. The clusters of “missing” genes coincided with regions of very high GC content, particularly in avian genomes, making them “hidden” because of incomplete sequencing. Moreover, proteins encoded by genes in these sequencing refractory regions showed signs of accelerated protein evolution. As a proof of principle for this idea we experimentally characterized the mRNA and protein products of four "hidden" bird genes that are crucial for energy homeostasis in skeletal muscle: ALDOA, ENO3, PYGM and SLC2A4.

Conclusions

A least part of the “missing” genes in bird genomes can be attributed to an artifact caused by the difficulty to sequence regions with extreme GC% (“hidden” genes). Biologically, these “hidden” genes are of interest as they encode proteins that evolve more rapidly than the genome wide average. Finally we show that four of these “hidden” genes encode key proteins for energy metabolism in flight muscle.
Recombination mapping of the Brazilian stingless bee Frieseomelitta varia confirms high recombination rates in social hymenoptera
Authors: Waiker Prashant , de Abreu Fabiano Carlos Pinto , Luna-Lucena Danielle , Freitas Flávia Cristina Paula , Simões Zilá Luz Paulino , Rueppell Olav
Published: September 2021

Background

Meiotic recombination is a fundamental genetic process that shuffles allele combinations and promotes accurate segregation of chromosomes. Analyses of the ubiquitous variation of recombination rates within and across species suggest that recombination is evolving adaptively. All studied insects with advanced eusociality have shown exceptionally high recombination rates, which may represent a prominent case of adaptive evolution of recombination. However, our understanding of the relationship between social evolution and recombination rates is incomplete, partly due to lacking empirical data. Here, we present a linkage map of the monandrous, advanced eusocial Brazilian stingless bee, Frieseomelitta varia, providing the first recombination analysis in the diverse Meliponini (Hymenoptera, Apidae).

Results

Our linkage map includes 1417 markers in 19 linkage groups. This map spans approximately 2580 centimorgans, and comparisons to the physical genome assembly indicate that it covers more than 75 % of the 275 Megabasepairs (Mbp) F. varia genome. Thus, our study results in a genome-wide recombination rate estimate of 9.3–12.5 centimorgan per Mbp. This value is higher than estimates from nonsocial insects and comparable to other highly social species, although it does not support our prediction that monandry and strong queen-worker caste divergence of F. varia lead to even higher recombination rates than other advanced eusocial species.

Conclusions

Our study expands the association between elevated recombination and sociality in the order Hymenoptera and strengthens the support for the hypothesis that advanced social evolution in hymenopteran insects invariably selects for high genomic recombination rates.
Skin dysbiosis in the microbiome in atopic dermatitis is site-specific and involves bacteria, fungus and virus
Authors: Bjerre Rie Dybboe , Holm Jacob Bak , Palleja Albert , Sølberg Julie , Skov Lone , Johansen Jeanne Duus
Published: September 2021

Background

Microbial dysbiosis with increased Staphylococcus aureus (S. aureus) colonization on the skin is a hallmark of atopic dermatitis (AD), however most microbiome studies focus on bacteria in the flexures and the microbial composition at other body sites have not been studied systematically.

Objectives

The aim of the study is to characterize the skin microbiome, including bacteria, fungi and virus, at different body sites in relation to AD, lesional state, and S. aureus colonization, and to test whether the nares could be a reservoir for S. aureus strain colonization.

Methods

Using shotgun metagenomics we characterized microbial compositions from 14 well defined skin sites from 10 patients with AD and 5 healthy controls.

Results

We found clear differences in microbial composition between AD and controls at multiple skin sites, most pronounced on the flexures and neck. The flexures exhibited lower alpha-diversity and were colonized by S. aureus, accompanied by S. epidermidis in lesions. Malassezia species were absent on the neck in AD. Virus mostly constituted Propionibacterium and Staphylococcusphages, with increased abundance of Propionibacterium phages PHL041 and PHL092 and Staphylococcus epidermidis phages CNPH82 and PH15 in AD. In lesional samples, both the genus Staphylococcus and Staphylococcus phages were more abundant. S. aureus abundance was higher across all skin sites except from the feet. In samples where S. aureus was highly abundant, lower abundances of S. hominis and Cutibacterium acnes were observed. M. osloensis and M. luteus were more abundant in AD. By single nucleotide variant analysis of S. aureus we found strains to be subject specific. On skin sites some S. aureus strains were similar and some dissimilar to the ones in the nares.

Conclusions

Our data indicate a global and site-specific dysbiosis in AD, involving both bacteria, fungus and virus. When defining targeted treatment clinicians should both consider the individual and skin site and future research into potential crosstalk between microbiota in AD yields high potential.
Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation
Authors: Samaras Athanasios , Vrana Eleni , Kartas Anastasios , Moysidis Dimitrios V. , Papazoglou Andreas S. , Doundoulakis Ioannis , Fotos George , Rampidis Georgios , Tsalikakis Dimitrios G. , Efthimiadis Georgios , Karvounis Haralambos , Tzikas Apostolos , Giannakoulas George
Published: September 2021

Background

Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF.

Methods

This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction.

Results

In total, 983 patients with non-valvular AF (median age 76 [14] years) were analyzed over a median follow-up period of 32 [20] months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 6.5%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p = 0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR 1.70, 95% CI 1.09–2.66; p = 0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p = 0.02). The prognostic effect of sVHD was particularly evident in patients aged < 80 years and in those without history of heart failure (p for interaction < 0.05, in both subgroups). After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization.

Conclusion

Among patients with non-valvular AF, sVHD was highly prevalent and beared high prognostic value across a wide spectrum of clinical outcomes, especially in patients aged < 80 years or in the absence of heart failure. Predominantly AS, as well as MR and TR, were associated with worse prognosis.
Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson’s Disease: a systematic review and meta-analysis
Authors: Ismail Sophia Rasheeqa , Lee Shaun Wen Huey , Merom Dafna , Megat Kamaruddin Puteri Sofia Nadira , Chong Min San , Ong Terence , Lai Nai Ming
Published: September 2021

Background

Patients with Parkinson’s Disease (PD) usually experience worsening of both motor and non-motor symptoms. Dancing has been postulated to help patients with Parkinson’s via several mechanisms that lead to improved physical, cognitive and social functions.

Methods

This systematic review was conducted following Cochrane methodology and reported following the PRISMA guideline. Four databases (up to June 2021) were searched for RCTs comparing dance to standard or other physical therapy for improvements in disease severity, quality of life, cognitive and physical outcomes as well as adverse events in patients with PD. We synthesised data using RevMan and included certainty-of-evidence rating (GRADE) for major outcomes.

Results

A total of 20 RCTs (N = 723) articles that evaluated Tango, Ballroom, Irish, Waltz-Foxtrot, Folk, Turo, mixed dances and a PD-tailored dance were included. Dancers (versus non-dancers) had better motor experience (MDS-UPDRS 3) (MD -6.01, 95 % CI -9.97 to -3.84; n = 148; 5 RCTs) and improved balance (MiniBest Test) (MD 4.47, 95 % CI 2.29 to 6.66; n = 95; 3 RCTs), with no consistent differences on gait, agility and cognitive outcomes. Small samples and methodological limitations resulted in low-certainty-evidence across outcomes.

Conclusions

Apart from a suggestion that dance intervention modestly reduced motor disease severity and improved certain aspects of balance, there is insufficient evidence on all other outcomes, such as agility and motor function, cognitive, mood and social outcomes, quality of life as well as adverse events including the risk of fall. As evidence is insufficient to inform practice, evidence of benefits on motor disease severity and balance needs to be considered in the context of user-perception of benefit versus harm and acceptability in the development of practice guideline recommendations.
Impact of a hospital-wide computerised approach to optimise the quality of antimicrobial prescriptions in patients with severe obesity: a quasi-experimental study
Authors: Sirard Stéphanie , Nault Vincent , Langlois Marie-France , Perron Julie , Valiquette Louis
Published: September 2021

Background

Rates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity.

Methods

This quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption.

Results

Overall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, −0.8% per 2-month period [95% CI −1.1 to −0.5], p < 0.001; intercept, 11.3% [95% CI 8.2 to 14.5], p < 0.001), which led to a reduction of 35% over an eight-year period (from pre-intervention level of 19.1%). Intervention 1 resulted in a downward trend in antimicrobial consumption, followed by an increasing trend after intervention 2. In these patients, the most frequent interventions made by pharmacists targeted posology (46%).

Conclusions

Antimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes.
The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy
Authors: Tóth Márton , Barsi Péter , Tóth Zoltán , Borbély Katalin , Lückl János , Emri Miklós , Repa Imre , Janszky József , Dóczi Tamás , Horváth Zsolt , Halász Péter , Juhos Vera , Gyimesi Csilla , Bóné Beáta , Kuperczkó Diána , Horváth Réka , Nagy Ferenc , Kelemen Anna , Jordán Zsófia , Újvári Ákos , Hagiwara Koichi , Isnard Jean , Pál Endre , Fekésházy Attila , Fabó Dániel , Vajda Zsolt
Published: September 2021

Background

When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients.

Methods

In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI.

Results

The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention.

Conclusions

The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making.

Trial registration

Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.
Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study
Authors: Gomaa Khaled , Abdelraheim Ahmed R. , El Gelany Saad , Khalifa Eissa M. , Yousef Ayman M. , Hassan Heba
Published: September 2021

Background

Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%.

This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital.

Methods

This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics.

Results

The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%.

Conclusions

The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases.

Registration

Local ethical committee (Registration number: MOBGYN0040).
Cardiovascular disease in women with breast cancer – a nationwide cohort study
Authors: Jakobsen Marie , Kolodziejczyk Christophe , Jensen Morten Sall , Poulsen Peter Bo , Khan Humma , Kümler Thomas , Andersson Michael
Published: September 2021

Background

There is increasing concern about cardiovascular disease (CVD) after breast cancer (BC). The aim of this study was to estimate the prevalence of different types of CVD in women diagnosed with BC compared to cancer-free controls as well as the incidence of CVD after BC diagnosis.

Methods

We performed a cohort study based on data from national registries covering the entire Danish population. We followed 16,505 cancer-naïve BC patients diagnosed from 2003 to 2007 5 years before and up to 10 years after BC diagnosis compared to 165,042 cancer-free controls.

Results

We found that 15.6% of BC patients were registered with at least one CVD diagnosis in hospital records before BC diagnosis. Overall, BC patients and controls were similar with regard to CVD comorbidity before BC diagnosis. After BC diagnosis, the incidence of all CVD diagnoses combined was significantly higher in BC patients than controls up to approximately 6 years after the index date (BC diagnosis). After 10 years, 28% of both BC patients and controls (without any CVD diagnosis up to 5 years before the index date) had at least one CVD diagnosis according to hospital records. However, the incidence of heart failure, thrombophlebitis/thrombosis and pulmonary heart disease including pulmonary embolism remained higher in BC patients than controls during the entire 10-year follow-up period. After 10 years, 2.7% of BC patients compared to 2.5% of controls were diagnosed with heart failure, 2.7% of BC patients compared to 1.5% of controls were diagnosed with thrombophlebitis/thrombosis, and 1.5% of BC patients compared to 1.0% of controls were diagnosed with pulmonary heart disease according to hospital records. Furthermore, we found that the risk of heart failure and thrombophlebitis/thrombosis was higher after chemotherapy.

Conclusions

Focus on CVD in BC patients is important to ensure optimum treatment with regard to BC as well as possible CVD. Strategies to minimise and manage the increased risk of heart failure, thrombophlebitis/thrombosis and pulmonary heart disease including pulmonary embolism in BC patients are especially important.
Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece
Authors: Tsamadou E. , Voultsos P. , Emmanouilidis A. , Ampatzoglou G.
Published: September 2021

Background

A subset of adolescents with mental disorders are likely to have decision-making capacity that facilitates their therapy engagement. However, there are high rates of drop-out in mental health settings.

Aim

This study aims to identify perceived barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece.

Methods

A qualitative study was conducted using semi-structured interviews of adolescents with a wide range of mental health problems. In addition, two psychometric assessment measures were used to define who to include or exclude from the study sample.

Results

Positive attitudes and experiences with therapy were reported as strong (“major”) facilitators of therapy engagement for adolescents with mental disorders, whereas negative experiences with therapy were reported as strong barriers to it. Furthermore, and most importantly, a “good” adolescent-therapist relationship was reported as a strong facilitator, whereas negative experiences of participants with their therapist were reported as strong barriers. Moreover, goals such as getting rid of symptoms, improving personal well-being, and improving social skills and relationships (especially with peers) emerged as strong facilitators of therapy engagement. Importantly, the early remission of symptoms emerged from the study as a strong barrier to therapy engagement for participants. Among the weaker (“minor”) perceived facilitators were goals such as confessing to a trustworthy person, becoming able to achieve personal expectations and life goals, enhancing independence and self-esteem, and developing a positive self-image. The (active or supportive) role of family emerged as a facilitator. The stigma related to mental health emerged as both a (“minor”) facilitator of and barrier to therapy engagement for participants. Friends were reported as having a role ranging from neutral to mildly supportive.

Conclusion

A number of more or less strong barriers and facilitators were identified that, for the most part, were consistent with prior literature. However, the authors identified some nuances that are of clinical importance. For instance, adolescents are most likely to terminate the treatment prematurely if they experience early symptom remission. Highlighting the role of therapy in achieving their goals or improving their families’ well-being might be used by therapists to reduce the attrition rate.
The effect of price on cigarette consumption, distribution, and sale in Tehran: a qualitative study
Authors: Golestan Younes Panahi , Ebrahimi Kalan Mohammad , Ben Taleb Ziyad , Ward Kenneth D. , Fazlzadeh Mehdi , Bahelah Raed , Masjedi Mohammad Reza , Charkazi Abdurrahman , Dehghan Nasir , Sighaldeh Shirin Shahbazi
Published: September 2021

Background

Appropriate increases in tobacco taxes and prices are an essential component of comprehensive tobacco control strategies. This study investigates factors related to the use, sale, and distribution of cigarettes in Iran, focusing on the relationship between cigarette price and its consumption.

Methods

This interview-based qualitative study was conducted among 20 participants, including cigarette smokers, retail shop owners, large-scale distributors, and an expert in tobacco control research.

Results

Seven themes were extracted from participant interviews, including the type and price of cigarette, the best time to sell cigarettes, profits from the sale of cigarette, affordability, rise in cigarette price and smokers’ reaction to it, lobbying and black-market sales of cigarettes, and the sale and distribution of cigarettes across the country. Although the price of cigarettes in Iran has shown some increases in the past decade, the timing of these increases are not predictable and the limited amount of these increases has not reduced the use of cigarettes. Following a price increase, consumers are more likely to switch from buying packets to single cigarettes, or buy a less expensive brand, then to quit. Moreover, increases in prices may encourage smokers and sellers to buy a large number of cigarettes and store them for a rainy day. Another adverse effect may be increased smuggling of illicit cigarettes to balance the pressure caused by rising prices.

Conclusions

Our findings highlight two important aspects concerning cigarette pricing in Iran. First is the change in the type of purchase from the whole box of cigarettes to the single stick cigarette or swapping to less expensive cigarettes. Second, increase in cigarette price (either through taxing or regular increases) could be offset by flooding smuggled cigarettes into the market. Therefore, in addition to raising cigarette prices, reducing cigarette consumption rates in Iran requires the development and effective implementation of regulatory policies to control cigarette smuggling, reduce purchasing, and subsequently curb the use of this leading cause of premature morbidity and mortality.
Diagnosis patterns of sickle cell disease in Ghana: a secondary analysis
Authors: Sims Alexandra M. , Bonsu Kwaku Osei , Urbonya Rebekah , Farooq Fatimah , Tavernier Fitz , Yamamoto Marianna , VanOmen Sheri , Halford Brittne , Gorodinsky Polina , Issaka Rachel , Kpadenou Tulana , Douglas Rhonda , Wilson Samuel , Fu Clementine , Canter Danielle , Martin Duña , Novarra Austin , Graham Lewis , Sey Fredericka , Antwi-Boasiako Charles , Segbefia Catherine , Rodrigues Onike , Campbell Andrew
Published: September 2021

Background

Despite having the highest prevalence of sickle cell disease (SCD) in the world, no country in Sub-Saharan Africa has a universal screening program for the disease. We sought to capture the diagnosis patterns of SCD (age at SCD diagnosis, method of SCD diagnosis, and age of first pain crisis) in Accra, Ghana.

Methods

We administered an in-person, voluntary survey to parents of offspring with SCD between 2009 and 2013 in Accra as a part of a larger study and conducted a secondary data analysis to determine diagnosis patterns. This was conducted at a single site: a large academic medical center in the region. Univariate analyses were performed on diagnosis patterns; bivariate analyses were conducted to determine whether patterns differed by participant’s age (children: those < 18 years old whose parents completed a survey about them, compared to adults: those > = 18 years old whose parents completed a survey about them), or their disease severity based on SCD genotype. Pearson’s chi-squared were calculated.

Results

Data was collected on 354 unique participants from parents. Few were diagnosed via SCD testing in the newborn period. Only 44% were diagnosed with SCD by age four; 46% had experienced a pain crisis by the same age. Most (66%) were diagnosed during pain crisis, either in acute (49%) or primary care (17%) settings. Children were diagnosed with SCD at an earlier age (74% by four years old); among the adults, parents reflected that 30% were diagnosed by four years old (p < 0.001). Half with severe forms of SCD were diagnosed by age four, compared to 31% with mild forms of the disease (p = 0.009).

Conclusions

The lack of a robust newborn screening program for SCD in Accra, Ghana, leaves children at risk for disease complications and death. People in our sample were diagnosed with SCD in the acute care setting, and in their toddler or school-age years or thereafter, meaning they are likely being excluded from important preventive care. Understanding current SCD diagnosis patterns in the region can inform efforts to improve the timeliness of SCD diagnosis, and improve the mortality and morbidity caused by the disease in this high prevalence population.
Effect of urban air pollution on CRP and coagulation: a study on inpatients with acute exacerbation of chronic obstructive pulmonary disease
Authors: Tang Lingling , Shi Suofang , Wang Bohan , Liu Li , Yang Ying , Sun Xianhong , Ni Zhenhua , Wang Xiongbiao
Published: September 2021

Purpose

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an important event in the course of chronic obstructive pulmonary disease that negatively affects patients’ quality of life and leads to higher socioeconomic costs. While previous studies have demonstrated a significant association between urban air pollution and hospitalization for AECOPD, there is a lack of research on the impact of particulate matter (PM) on inflammation and coagulation in AECOPD inpatients. Therefore, this study investigated the association of changes in coagulation function and C-reactive protein (CRP) with PM levels in the days preceding hospitalization.

Patients and methods

We reviewed the medical records of AECOPD patients admitted to Putuo Hospital, Shanghai University of Traditional Chinese Medicine, between March 2017 and September 2019. We analyzed the association of coagulation function and CRP level in AECOPD patients with PM levels in the days before hospitalization. Multivariate unconditional logistic regression analyses were used to evaluate the adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of CRP data with hospitalization day. Kruskal–Wallis tests were used to evaluate mean aerodynamic diameter of ≥ 2.5 μm (PM2.5) exposure on the day before hospitalization; we assessed its association with changes in prothrombin time (PT) in AECOPD inpatients with different Global Initiative for Chronic Obstructive Lung Disease (GOLD) classes.

Results

The peripheral blood PT of AECOPD patients with PM2.5 ≥ 25 mg/L on the day before hospitalization were lower than those of patients with PM2.5 < 25 mg/L (t = 2.052, p = 0.041). Patients with severe GOLD class exposed to greater than 25 mg/L of PM2.5on the day before hospitalization showed significant differences in PT (F = 9.683, p = 0.008). Peripheral blood CRP levels of AECOPD patients exposed to PM2.5 ≥ 25 mg/L and PM10 ≥ 50 mg/L on the day before hospitalization were higher than those of patients exposed to PM2.5 < 25 mg/L and PM10 < 50 mg/L (t = 2.008, p = 0.046; t = 2.637, p = 0.009). Exposure to < 25 mg/L of PM2.5 on the day before hospitalization was significantly associated with CRP levels (adjusted OR 1.91; 95% CI 1.101, 3.315; p = 0.024).

Conclusion

Exposure of patients with AECOPD to high PM levels on the day before hospitalization was associated with an increased CRP level and shortened PT. Moreover, PM2.5 had a greater effect on CRP level and PT than mean aerodynamic diameter of ≥ 10 μm (PM10). AECOPD patients with severe GOLD class were more sensitive to PM2.5-induced shortening of PT than those with other GOLD classes.