bluuebunny/crossref_metadata_2025 huggingface dataset:
Normalization of γ-glutamyl Transferase Levels is Associated with Better Metabolic Control in Individuals with Nonalcoholic Fatty Liver Disease
Authors: Ma Qianqian , Liao Xianhua , Shao Congxiang , Lin Yansong , Wu Tingfeng , Sun Yanhong , Feng Shi-Ting , Ye Junzhao , Zhong Bihui
Published: November 2020

Background: The normalization of liver biochemical parameters usually reflects the histological response to treatment for nonalcoholic fatty liver disease (NAFLD). Researchers have not clearly determined whether different liver enzymes exhibited various metabolic changes during the follow-up of patients with NAFLD.Methods: We conducted a retrospective analysis of patients with NAFLD who were receiving therapy from January 2011 to December 2019. Metabolism indexes, including glucose levels, lipid profiles, uric acid levels and liver biochemical parameters, were measured. Magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) and liver ultrasound were used to evaluate steatosis.Results: Overall, 1048 patients with NAFLD were included and received lifestyle and pharmaceutical interventions, including 637 (60.7%) patients with abnormal GGT levels and 467 (44.6%) patients with abnormal ALT levels. Patients with concurrent ALT and GGT abnormalities presented higher levels of metabolism indexes and higher liver fat contents than patients with single or no abnormalities. After 12 months of follow-up, the cumulative normalization rate of GGT was much lower than that of ALT (33% vs. 52%, P < 0.001). Greater weight loss resulted in higher cumulative normalization rates of GGT and ALT. Weight loss (OR = 1.27, 95%CI: 1.15~1.41, P < 0.001), ALT normalization (OR = 4.32, 95%CI: 1.87~9.96, P = 0.01) and HOMA-IR decreased to normal levels (OR = 3.48, 95%CI: 1.60~7.57, P = 0.01) were independent protective factors for GGT normalization. Elevated baseline GGT (OR = 0.99, 95%CI: 0.98~0.99, P = 0.01), CHOL (OR = 0.47, 95%CI: 0.23~0.96, P = 0.04) and fasting insulin levels (OR = 0.91,95%CI: 0.86~0.96, P = 0.01) were risk factors.Conclusions: For NAFLD patients with concurrently increased ALT and GGT levels, a lower normalization rate of GGT was observed rather than ALT. Good control of weight and insulin resistance was reliable predictors of GGT normalization.
Systematic Review and Meta-analysis:Real-world Data Rates of Deep Remission With Anti-TNFα in Inflammatory Bowel Disease
Authors: Alipour Omeed , Gulati Alakh , Shao Ling , Zhang Bing
Published: November 2020

Background & Aims Deep remission (DR) is a treatment target in IBD associated with reduced hospitalization and improved outcome. Randomized control trial (RCT) data demonstrates efficacy of anti-TNFα agents in achieving DR; however, RCTs may not be generalizable to clinical practice. In this systematic review with meta-analysis, we use real-world data (RWD) to determine rates of DR in IBD treated with anti-TNFα. Methods We completed a systematic search of MEDLINE and EMBASE on July 8, 2019 with review of major gastrointestinal conference abstracts from 2012-2019. Studies utilizing RWD (data not from phase I-III RCTs) of adult IBD patients treated with anti-TNFα agents were included. DR was defined by clinical and endoscopic remission at minimum. DR was assessed at 8 weeks, 6 months, 1 year, and 2 years.Results 29,033 publications were found on initial search. Fifteen publications, nine manuscripts and six conference abstracts, were included encompassing 1,212 patients (769 Crohn’s disease-CD, 443 ulcerative colitis-UC). Rate of DR was 36.4% (95%-CI: 12.6-69.4%) at eight weeks, 39.1% (95%-CI: 10.4-78%) at six months, 44.4% (95%-CI: 34.6-54.6%) at one year, and 36% (95%-CI: 18.7-58%) at two years. DR in CD at one year was 48.6% (95%-CI: 32.8-64.7%) and in UC was 43.6% (95%-CI: 32.8-55.1%).Conclusions The rate of DR was highest after one year of therapy, in nearly 45% of IBD patients treated with anti-TNFα. Similar rates were achieved between patients with UC and CD. The findings highlight the efficacy of anti-TNFα in real-world setting. Future studies using RWD can determine efficacy of newer IBD therapeutics in routine clinical practice.
Technology-Based Innovative Solutions for Improving Perinatal Care Utilization: A Network Meta-Analysis
Authors: Rahman Md. Obaidur , Islam Md. Rashedul , Rahman Md. Shafiur Shafiur , Alam Md. Ashraful , Taniguchi Hiroko , Jung Jenny , Lohan Maria , Ota Erika , Rahman Md Mizanur
Published: November 2020

Background: Technology-based interventions (TBIs) are widely being tested to integrate into the existing health system to increase preventative healthcare utilizations. Despite an uptake of TBIs, evidence remains inconclusive regarding its effectiveness due to a lack of comprehensive and concrete evaluations. This study aims to evaluate the impact and effectiveness of TBIs in improving antenatal visits, postnatal visits, and delivery care services in LMICs using Bayesian network meta-analysis. Methods: To identify the relevant studies, we will perform a comprehensive search of electronic databases and grey literatures with no language or publication date restriction. We will include experimental studies if they assess effectiveness of TBIs on improving perinatal care utilization among pregnant women. The primary outcomes are antenatal visits, postnatal visits, and delivery care. Two reviewers will independently identify eligible study and perform data extraction and quality assessment. We will use Bayesian meta-analysis to summarize the effect size of individual interventions for each outcome separately. In addition, Bayesian network meta-analyses will be used to pool the direct and indirect effects of all possible comparisons and to provide a hierarchy of all interventions for our primary outcomes. Furthermore, we will assess publication bias and certainty of evidence by GRADE approach for NMA.Discussion: The findings of this review will fill the gaps in evidence by synthesizing the impact of TBIs on a comprehensive range of reported outcomes in antenatal, postnatal, and delivery care. Furthermore, our meta-analyses will further guide policymakers or stakeholders on the potential use of TBIs in given contexts. Systematic review registration: PROSPERO Protocol ID CRD42019137331
Microarray Analysis of Hub Genes and Pathways in Damaged Cartilage Tissues of Knee
Authors: Aoqierbatu  , Luo Aqilatu , Ren Yizhong , Shi Yuting , Han Changxu , Na Yuyan
Published: November 2020

Background: The aim of this study was to identify genes and functional pathways associated with damaged cartilage tissues of knee using microarray analysis.Methods: The gene expression profile GSE129147 including including 10 knee cartilage tissues from damaged side and 10 knee non-weight-bearing healthy cartilage was downloaded and bioinformatics analysis was made. Results: A total of 182 DEGs including 123 up-regulated and 59 down-regulated genes were identified from the GSE129147 dataset. GO and pathway enrichment analysis confirmed that extracellular matrix organization, collagen catabolic process, antigen processing and presentation of peptide or polysaccharide antigen, and endocytic vesicle membrane were strongly associated with cartilage injury. Furthermore, 10 hub DEGs with a higher connectivity degree in PPI network were found such as POSTN, FBN1, LOX, IGFBP3, C3AR1, MMP2, ITGAM, CDKN2A, COL1A1, COL5A1.Conclusion: These hub genes and pathways provide a new perspective for revealing the potential pathological mechanisms and therapy strategy of cartilage injury.
Septic Hip Arthritis in Patients with Osteonecrosis of Femoral Head: Two Cases Report and Review of the Literature
Authors: Zhao Zhiping , Wang Xiangyu , Wang Changyao , Wang Yingzhen , Zhang Yongtao
Published: November 2020

Background: In patients with osteonecrosis of femoral head (ONFH), septic arthritis of the hip is rare, especially in the absence of factors likely to cause infection, which are often ignored by surgeons. Methods: Two patients seen at our hospital who had ONFH and concomitant septic arthritis of the hip joint were selected for inclusion in the study. Results: The clinical course suggests that ONFH developed prior to the hip infection. The two patients were not immune-compromised, and no remote septic focus was identified. The 2 patients, clinical manifestations of infection included fever and elevated white blood cell count. Elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were observed in all 2 patients. In all patients, the results of hip magnetic resonance imaging (MRI) indicated hip infection. For 1 patients, culturing joint fluid revealed the presence of bacteria. In the second case, joint fluid was not cultured. In each case, the hip was debrided, and a spacer made of bone cement and containing vancomycin was implanted in the hip. Intravenous antibiotics were administered for 6 weeks postoperatively. There was no recurrence of infection, and total hip arthroplasty (THA) was performed 6 months after the operation. Conclusions: Septic hip is rare but exist in patients with ONFH. Elevated ESR and CRP contributed to the initial diagnosis; the results of hip MRI help to confirm the diagnosis. Overall, THA was an effective treatment.
Identification of Key Pathways and Genes in Polycystic Ovary Syndrome via Integrated Bioinformatics Analysis and Prediction of Small Therapeutic Molecules
Authors: Devarbhavi Praveenkumar , Telang Lata , Vastrad Basavaraj , Tengli Anandkumar Revanasiddapa , Vastrad Chanabasayya Mallikarjunayya , Kotturshetti Iranna
Published: November 2020

To add a enhance understanding of polycystic ovary syndrome (PCOS) at the molecular level, this investigation aimed to find the genes and crucial pathways linked with PCOS by using integrated bioinformatics analysis. Based on the expression profiling by high throughput sequencing data GSE84958 derived from the Gene Expression Omnibus, the differentially expressed genes (DEGs) between PCOS samples and normal controls were identified. With DEGs, we performed a series of functional enrichment analyses. Then, a protein–protein interaction (PPI) network, miRNA - target genes and TF - target gene networks were constructed and visualized, with which the hub gene nodes were screened out. Finally, validation of hub genes was performed by using receiver operating characteristic (ROC) and RT-PCR. Molecular docking studies performed. A total of 739 DEGs were screened out, among which 360 genes were up regulated and 379 genes were down regulated. GO enrichment analysis indicated that up regulated genes were mainly involved in peptide metabolic process, organelle envelope and RNA binding and the down regulated genes were significantly enriched in plasma membrane bounded cell projection organization, neuron projection and DNA-binding transcription factor activity, RNA polymerase II-specific. REACTOME pathway enrichment analysis showed that the up regulated genes were mainly enriched in translation and respiratory electron transport and the down regulated genes were mainly enriched in generic transcription pathway and transmembrane transport of small molecules. The top 10 hub genes in the constructed PPI network, miRNA - target gene network and TF - target gene network were SAA1, ADCY6, POLR2K, RPS15, RPS15A, CTNND1, ESR1, NEDD4L, KNTC1 and NGFR. The modules analysis showed that genes in the top 2 significant modules of PPI network were mainly associated with respiratory electron transport and signalling by NGF, respectively. We find a series of crucial genes along with the pathways that were most closely related with PCOS initiation and advancement. Our investigations provide a more detailed molecular mechanism for the progression of PCOS, detail information on the potential biomarkers and therapeutic targets.
Initial engagement and persistence of health risk behaviors through adolescence: longitudinal findings from urban South Africa
Authors: Kowalski Alysse , Addo O. Yaw , Kramer Michael R , Martorell Reynaldo , Norris Shane A , Waford Rachel N , Richter Linda M , Stein Aryeh
Published: November 2020

Background: Little is known about longitudinal patterns of adolescent health risk behavior initial engagement and persistence in low- and middle-income countries. Methods: Birth to Twenty Plus is a longitudinal birth cohort in Soweto-Johannesburg, South Africa. We used reports from Black African participants on cigarette smoking, alcohol, cannabis, illicit drug, and sexual activity initial engagement and adolescent pregnancy collected over 7 study visits between ages 11 and 18 y. We fit Kaplan-Meier curves to estimate behavior engagement or adolescent pregnancy, examined current behavior at age 18 y by age of first engagement, and performed a clustering analysis to identify patterns of initial engagement and their sociodemographic predictors. Results: By age 13 y, cumulative incidence of smoking and alcohol engagement were each >21%, while the cumulative incidence of other behaviors and adolescent pregnancy were <5%. By age 18 y (15 y for cannabis), smoking, alcohol, and sexual activity engagement estimates were each >65%, cannabis and illicit drug engagement were each >16%; adolescent pregnancy was 31%. Rates of engagement were higher among males. Current risk behavior activity at age 18 y was generally unrelated to age of initial engagement. We identified three clusters reflecting low, moderate, and high-risk patterns of initial risk behavior engagement. One-third of males and 17% of females were assigned to the high-risk cluster. Sociodemographic factors were not associated with cluster membership.Conclusions: Among urban dwelling Black South Africans, risk behavior engagement across adolescence is common and clusters into distinct initial engagement patterns unrelated to the sociodemographic factors assessed. Patterns of risk behavior initial engagement have implications for the timing of primary and secondary public health interventions and supports integrated prevention efforts that consider multiple behaviors simultaneously.
Tumor Response Prediction in 90Y Radioembolization with PET-based Radiomics Features and Absorbed Dose Metrics
Authors: Wei Lise , Cui Can , Xu Jiarui , Kaza Ravi , Naqa Issam El , Dewaraja Yuni K
Published: November 2020

Purpose To evaluate whether lesion radiomics features and absorbed dose metrics extracted from post-therapy 90Y PET can be integrated to better predict outcomes in microsphere radioembolization of liver malignancies. Methods Given the noisy nature of 90Y PET, first, a liver phantom study with repeated acquisitions and varying reconstruction parameters was used to identify a subset of robust radiomics features for the patient analysis. In 36 radioembolization procedures, 90Y PET/CT was performed within a couple of hours to extract 46 radiomics features and estimate absorbed dose in 105 primary and metastatic liver lesions. Robust radiomics modeling was based on bootstrapped multivariate logistic regression with shrinkage regularization (LASSO) and Cox regression with LASSO. Nested cross-validation and bootstrap resampling were used for optimal parameter/feature selection and for guarding against overfitting risks. Spearman rank correlation was used to analyze feature associations. Area under the receiver-operating characteristics curve (AUC) was used for lesion response (at first follow-up) analysis while Kaplan-Meier plots and c-index were used to assess progression model performance. Models with absorbed dose only, radiomics only and combined models were developed to predict lesion outcome.Results The phantom study identified 15/46 reproducible and robust radiomics features that were subsequently used in the patient models. A lesion response model with zone percentage (ZP) and mean absorbed dose achieved an AUC of 0.729 (95%CI: 0.702-0.758) and a progression model with zone size nonuniformity (ZSN) and absorbed dose achieved a c-index of 0.803 (95% CI: 0.790-0.815) on nested cross validation (CV). Although the combined models outperformed the radiomics only and absorbed dose only models, statistical significance was not achieved with the current limited data set to establish expected superiority.Conclusion We have developed new lesion-level response and progression models using textural radiomics features, derived from 90Y PET combined with mean absorbed dose for predicting outcome in radioembolization. These encouraging, but limited results, will need further validation in independent and larger datasets prior to any clinical adoption.
The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up
Authors: Afghanyar Yama , Joser Sebastian , Tecle Jonas , Drees Philipp , Dargel Jens , Rehbein Philipp , Kutzner Karl Philipp
Published: November 2020

BackgroundThe newest generation of cementless titanium coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) has been introduced to the market in 2009. Aim of the present study was to obtain mid-term data including the analyses of migration and wear.MethodsThe present prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfication on visual analogue scale (VAS) were assessed during a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Additionally, radiological alterations in the acetabular bone and complications were documented.ResultsAt mid-term follow-up (mean 79.0 months (range: 51.8 – 101.7)), 81 cases with complete clinical and radiological data were analyzed. In 42 hips utilisable EBRA measurements were obtained. HHS was 91.1 (range 38.0 – 100.0), satisfaction on VAS was 9.6 (range 6.0 – 10.0), rest pain on VAS was 0.2 (range 0.0 – 4.0), and load pain on VAS was 0.6 (range 0.0 – 9.0). Mean migration was 0.86 mm (range: 0.0 – 2.56) at 24 months and 1.34 mm (range: 0.09 – 3.14) at 5 years. Mean annual migration rate was 0.22 (range: -0.24 – 1.34). Mean total wear was 0.4 mm (range: 0.03 – 1.0). The mean annual wear rate was 0.06 mm per year (range: 0.0 – 0.17). Radiographic analysis showed osteolysis in none of the cases and no revision surgeries had to be performed.ConclusionUsing vitamin-E blended HXLPE in cementless isoelastic monoblock cups, no signs of osteolysis were obvious and no cases of aseptic loosening occurred. There was no need of revision surgery at mid-term. Values for cup migration and wear stay well below the benchmarks which are considered predictive for potential future failure.Trial registrationThe trial registration number on ClinicalTrial.gov: NCT04322916 (retrospectively registered at 26.03.2020).
Hand injuries in sports – a retrospective analysis of 364 cases
Authors: Stoegner Viola-Antonia , Kaltenborn Alexander , Laser Hans , Vogt Peter Maria
Published: November 2020

Background: Hand injuries are common in sports and associated with high dropout rates and costs. Hence, efforts should strive for further risk prevention measures in order to increase safety in sports. This implies knowledge of sports injury risk profiles. So far, major surveillance programs exist mainly in Anglo-American countries, reflecting the specific concerns of sports in this part of the world. Data on sports injuries within Europe are scarce. As sports behaviour appears to vary demographically, we hypothesised that risk injury profiles differ as well. Methods: To assess, whether the described sports injuries of the hand are applicable to the German population, we performed a five-year retrospective, single-centre analysis of sports-related hand injuries, using the data of the Enterprise Clinical Research Warehouse of the Hannover Medical School.Results: Notable differences in comparison to other data were observed. Ball sports, cycling and equestrian sports caused most of the recorded hand injuries, which were predominantly fractures of the wrist and hand. Hand injuries in equestrian sports were associated with significantly higher operation and hospitalisation rates as well as a significantly longer inpatient treatment. Conclusion: Risk profiles for sports-related hand injuries appear to differ not only age- and sex-dependent, but also geographically. National as well as European hand trauma registries as well as a broad registry participation are necessary in order to accurately assess these risk patterns in Europe and hence reduce hand injuries and the sequelae.
Comparison of three treatment methods for simple bone cyst in children
Authors: Zhang Ke Xue , Chai Wei , Zhao Jia Jia , Deng Jun Hao , Peng Zhan , Chen Ji Ying
Published: November 2020

Background Unicameral bone cyst (UBC) is a benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM) and the combination of ESIN and ABM in the treatment of simple bone cyst of children.Methods 83 children with simple bone cyst were analyzed retrospectively. 28 cases were treated with ABM. 28 cases were treated with ESIN. 27 cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT or MRI scans. For the suspicious ones, pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for the postoperative evaluation of the three methods.Results All the cases accomplished the follow-up. The effective rate of ABM+ESIN group was significantly higher than that of the ABM group (P<0.05), and the cure rates of ESIN group and ABM+ESIN group were higher than that of ABM group (P<0.05, respectively). The cure time in ESIN group was lower than that of the other two groups (P<0.05, respectively). The times for admission were 2.0±0.0 in ESIN group, 5.7±1.9 in ABM group and 4.7±2.4 in ABM+ESIN group (P<0.05 when compared with each other).Conclusions The method of ABM combined with ESIN for children bone cyst has the highest effective and curative rates. For individual method, ESIN has a higher effective rate and curative rate than that of ABM with the lowest time of admission.
Canine helminthiases and associated risk factors in Kigali city, Rwanda
Authors: Ntampaka Pie , Niragire François , Nyaga Philip Njeru , Habarugira Gervais
Published: November 2020

Background: Canine helminthiases pose a public health risk to humans and livestock. However, the prevalence of canine helminthiases in Rwanda is unknown. This study aimed to determine the prevalence of canine helminthiases and to identify the associated risk factors in Kigali city. A cross-sectional study involved 93 dogs selected across Kigali city. Faecal samples were collected from apparently healthy dogs and helminth eggs were identified and quantified under microscope using McMaster technique. Risk factors for canine helminthiases were analysed by multivariable binary logistic regression analysis.Results: The overall prevalence of intestinal helminthiases in dogs was 39.8%, 95% CI: 29.84- 49.73. The most prevalent species was Ancylostoma spp with 32.3%, 95% CI: 22.76-41.76. About 38.7% and 3.4% (n= 31) of dogs having ancylostomosis and toxocarosis had high egg counts per gram of faeces (≥ 550) each. Logistic regression analysis showed that dog's age, dog feeding practices and location were significantly associated with the prevalence of canine helminthiases. Compared to dogs aged < 1 year, the adjusted odds ratio (AOR) of developing helminthiases was more than 10 times higher for dogs aged between 1- 2.5 years (AOR=10.310; 95% CI: 1.557- 68.288), more than 5 times greater for dogs aged between 2.5-5 years, and more than 7 times greater for dogs that were at least 5 years old (AOR=7.543; 95% CI: 1.1360.101). Furthermore, the AOR was more than 5 times higher (AOR=5.41; 95% CI: 1.28- 22.87) for dogs fed on raw animal origin supplements, leftovers from family food and restaurants and more than 13 times higher (AOR=13.581; 95% CI: 2.194-84.050) for dogs that ate leftovers from household food and scavenged compared to those that ate food prepared for them, respectively. Conclusions: All the identified helminths including Ancylostoma spp, Toxocara canis, and tapeworms are zoonotic, and they pose a public health risk to humans. There is an urgent need of increasing the awareness among pet owners on the role of dogs in transmitting zoonotic helminthiases to other animals and to humans. The control of zoonotic helminthiases in dog population should focus on taking appropriate measures to promote hygienic dog feeding practices at all ages.
Patient perceptions of students in a longitudinal clerkship in Taiwan: a qualitative study
Authors: Chang Yaw-Wen , Hirsh David A. , Fang Wen-Hui , Li Honghe , Tzeng Wen-Chii , Kao Senyeong
Published: November 2020

Background: Patient-centered care is a core component of medical professionalism. East Asian cultures hold different conceptualizations of medical professionalism than Western cultures. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship (LIC) in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context.Methods: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students.Results: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood.Conclusion: In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.
Education of Pharmacists in Ghana: evolving curriculum, context and practice in the journey from Dispensing Certificate to Doctor of Pharmacy Certificate.
Authors: Koduah Augustina , Kretchy Irene , Sekyi-Brown Reginald , Asiedu-Danso Michelle , Ohene-Agyei Thelma , Duwiejua Mahama
Published: November 2020

Background: Understanding the origin and evolution of education of pharmacists is important for practice and health system reforms. In Ghana, education of pharmacists started in the 1880s with the training of dispensers in a government hospital. Over the years, the curriculum and institutional arrangements changed and currently pharmacists are trained in universities. In this study we explored how and why education of pharmacists evolved in Ghana.Methods: We used a case study design to systematically describe education of pharmacists reforms. Data was collected from October 2018 and December 2019 through document review and in-depth interviews. The data was analysed based on institutional arrangements and contextual factors influencing reforms from the 1880s through 2012, when the Doctor of pharmacy programme was initiated in Ghana.Results: Reforms occurred around four main periods when institutional arrangements including the certificate awarded and expected roles were modified by educators and government. These are: (1) the Certificate of dispensing with dispenser-in-training and nurse-dispenser schemes (1880s to 1942), when dispensers were trained to assist doctors in dispensing or directly diagnosing and treating specific disease conditions. (2) the Diploma and Certificate of competency with the dispenser-in-training and pupil pharmacist schemes (1943 to 1960), where in addition to existing roles, pharmacists operated village dispensers. (3) the Bachelor of pharmacy degree (1961 to 2017), when pharmacists were trained mainly as medicines experts with a strong science base on all aspects of medicines from production, distribution and use; and over time with a gradual move to patient-oriented practice. (4) the Doctor of pharmacy degree (2012 to date), where in addition to existing roles, trainees are exposed to advance professional practice experiences. Important factors influencing the reforms included, health systems demands for village dispensaries and clinically oriented pharmacists, and harmonization with regional and international training and practice.Conclusion: Reasons influencing education of pharmacists reforms are context specific and are driven by historical experiences, national and international expectations as well as educators and regulators abilities to influence change. These reforms call for direct corresponding change in professional practice laws and regulation to enable pharmacists contribute fully to health care delivery in Ghana.
Virologic Response of Treatment Experienced HIV-infected Ugandan Children and Adolescents on NNRTI based first-line regimen, Previously Monitored without Viral Load
Authors: Ssemambo Phionah Kibalama , Nalubega-Mboowa Mary Gorrethy , Owora Arthur H. , Serunjogi Robert , Kironde Susan Kizito , Nakabuye Sarah , Ssozi Francis , Nannyonga Maria , Musoke Philippa , Barlow-Mosha Linda
Published: November 2020

Background: Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of “Test and Treat” WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS).Methods: HIV-infected Ugandan children aged 1-12 years from HIV-care programs with >1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and >400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. Results: At baseline all children (n=142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5-9) and 43% were female. Overall, the odds of viral suppression were not different between study arms: (arm by week interaction, p=0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17, p=0.57) and did not change over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46, p=0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74, p=0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61; 95% CI: 0.42, 0.87, p<.01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL.Conclusion: With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure in RLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial Registration: ClinicalTrials.gov NCT04489953, 28 Jul 2020. Retrospectively registered.
Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations
Authors: Farley Jason E. , Ndjeka Norbert , Mlandu Khaya , Lowensen Kelly , Geiger Keri , Nguyen Yen , Budhathoki Chakra , Stamper Paul D
Published: November 2020

Background: Treatment for rifampicin-resistant Mycobacterium tuberculosis (RR-TB) is complex, however, shorter treatment, with newer antimicrobials are improving treatment outcomes. The South African National Department of Health (NDoH) recently accelerated the rollout of 9-month, all oral, RR-TB short-course regimens. We sought to evaluate an inter-professional training program using pre-test and post-test performance of Professional Nurses (PNs), Advanced Practice Professional Nurses (APPNs) and Medical Officers (MOs) to inform: a) training needs across cadres; b) knowledge performance, by cadres; and c) training differences in knowledge by nurse type. Methods: A 4-day didactic and case-based clinical decision support course for RR-TB regimens in South Africa (SA) was developed, reviewed and nationally accredited. Between February 2017 and July 2018, 12 training events were held. Clinicians who may initiate RR-TB treatment, specifically MOs and PN/APPNs with matched pre-post tests and demographic surveys were analyzed. Descriptive statistics are provided. Pre-post test evaluations included 25 evidence-based clinically related questions about RR-TB diagnosis, treatment, and care. Results: Participants (N=842) participated in testing, and matched evaluations were received for 800 (95.0%) training participants. Demographic data was available for 793 (99.13%) participants, of whom 762 (96.1%) were MOs, or nurses, either PN or APPNs. Average correct response pre-test and post-test scores were 61.7% (range 7-24 correct responses) and 85.9% (range 12-25), respectively. Overall, 95.8% (730/762) of participants demonstrated improved knowledge. PNs improved on average 25% (6.22 points) whereas MOs improved 10% (2.89 points) with better mean test scores on both pre- and post-test (p<0.000). APPNs performed the same as the MOs on post-test scores (p=NS). Conclusions: The inter-professional training program in short-course RR-TB treatment improved knowledge for participants. MOs had significantly greater pre-test scores. Of the nurses, APPNs outperformed other PNs, and performed equally to MOs on post-test scores, suggesting this advanced cadre of nurses might be the most appropriate to initiate and monitor treatment in close collaboration with MOs. All cadres of nurse reported the need for additional clinical training and mentoring prior to managing such patients.
Knowledge among the rural parents about the vaccinations and vaccination coverage of children in the first year of life in Papua New Guinea – analysis of data provided by Christian Health Services.
Authors: Gowin Ewelina , Kuzma Jerzy , Januszkiewicz-Lewandowska Danuta
Published: November 2020

BackgroundThis analysis aimed to assess rural parents' knowledge about the diseases prevented by vaccinations and establish vaccination coverage in PNG. MethodsKnowledge on vaccinations was checked through a standard questionnaire (five open questions). We analyzed data on vaccination coverage from 2016 to 2018 from all Catholic health facilities. Analyzed vaccinations were the pentavalent vaccine (DTaP-HiB-HepB) and measles vaccine given in the first year of life. Coverage was calculated based on the number of vaccines used compared to the number of eligible children.Analysed vaccinations were the pentavalent vaccine (DTaP-HiB-HepB) and measles vaccine given in the first year of life.Results56 parents, including 52 mothers and four fathers, participated in the interview. Many parents (46%) understood that the vaccine prevents diseases. During the analyzed period, a total of 25,502 doses of measles vaccine was given, 31,428 children were vaccinated with the pentavalent vaccine. In 2016, the coverage rate for the measles vaccine was 26.6% and 33.4% for the pentavalent vaccine. In 2017, the coverage rate for measles and pentavalent vaccines was 12.5% and 16.6%, respectively. There were significant differences in immunization coverage between provinces. A decreasing trend in the number of administered vaccinations was observed.ConclusionThe results of this analysis demonstrate that in PNG, the majority of children are not fully immunised. There are big differences in the vaccination coverage between provinces. As protection from diseases is low, there is a very high risk of an outbreak of the vaccine-preventable disease in the community.Delivery of vaccinations in PNG encounters many barriers from access to healthcare services to natural disasters and inter-tribial conflicts.Trial registration NA
A Real-Time PCR Assay for Rapid Identification of Inducible and Acquired Clarithromycin Resistance in Mycobacterium abscessus
Authors: Sharma Meenu Kaushal , La Yanni , Janella Debra , Soualhine Hafid
Published: November 2020

Background: Mycobacterium abscessus is a rapidly growing mycobacteria involved in severe infections of the lung, skin, or soft tissue. Macrolides such as clarithromycin are the recommended first line drugs for treatment of M. abscessus infections. However, M. abscessus has dual mechanisms of resistance to macrolides, making treatment by macrolides difficult. A functional erm(41) gene confers for inducible resistance while acquired mutations on the 23S rRNA rrl gene confer for constitutive resistance. Methods: We have developed a real-time PCR assay to detect both inducible and acquired resistance to clarithromycin, and compared the results to traditional erm(41) and rrl sequencing and phenotypic susceptibility testing using Sensititre™ plates. Results: Of the total 126 M. abscessus isolates tested, truncated erm(41) was found in 23/126 (18.3%) of the samples, 27/126 (21.4%) had a T28C mutation in erm(41), and 2/126 (1.6%) had an acquired A2058C mutation in rrl. The phenotypic results correlated with the expected sequencing results in 121/126 samples (96%). Phenotypic testing compared to real-time PCR resolved 2 of these discrepancies by showing the existence of both erm(41) alleles in the isolates that sequencing missed. One culture was found to be mixed with two M. abscessus subsp. as per hsp65 sequencing and 2 isolates had discordance between molecular and phenotypic results. It was presumed that 3 isolates showed discrepancy between sequencing and real-time PCR, but one culture was mixed and other 2 detected both alleles by real-time PCR leading to 100% concordance when compared to sequencing. Conclusion: In conclusion, real-time PCR is more accurate for detection of both acquired and induced clarithromycin resistance, specifically when mixed genic profiles are present in a sample.
Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes
Authors: Au Jessie Kit Ling , Suen Lorna Kwai Ping , Lam Simon Ching
Published: November 2020

Background: The elderly population in Hong Kong is rapidly growing, and the need for residential care homes (RCHs) is increasing. The risk of being infected with micro-organisms increases among the frail and the vulnerable elderly population as their immunity system begins to deteriorate. Furthermore, the residents in RCHs are at high risk of healthcare-associated infections (HAIs) due to the confined living environments and individual co-morbidities. In relation to this, infection control practice (ICP) is considered a crucial and effective approach in preventing HAIs. This study aimed to observe the daily ICP of healthcare workers in RCH settings.Methods: An observational study was conducted to observe daily ICP among healthcare workers in private and subsidized RCHs. Each RCH was separated into different units based on the location (common area and bedroom area) and nature of residents for successive days. The ICP episodes were observed until 200 opportunities in each unit. The ICP episodes were recorded by an electronic tool called “eRub,” which is an ICP checklist based on international guidelines.Results: The most frequent observed ICP episodes were hand hygiene (n=1053), the use of gloves (n=1053) and respiratory protection (n=1053). The overall compliance of hand hygiene was poor, with only 15% of participants performing this during the “five moments for hand hygiene.” Furthermore, the observations showed that 77.9% improperly performed the use of gloves, and 31.8% failed to wear a mask during the care provision for the elderly. However, the results showed that most healthcare workers can wear the mask in a proper way when they should. Generally, the personal care workers were the worst in terms of hand hygiene and use of gloves compared with the other types of healthcare workers. Conclusions: Despite the fact that the practice of hand hygiene, the use of gloves, and respiratory protection were the important elements of ICP, overall compliance to these elements was still poor. Personal care workers had the most frequent contact with the residents, but they had the worst compliance rate. Hence, continued monitoring and training among healthcare workers is needed, particularly personal care workers, in this healthcare service setting.
Splenic Infarction and Infectious Diseases in Korea
Authors: Im Jae Hyoung , Chung Moon-Hyun , Lee Hye-Jin , Kwon Hea Yoon , Baek JiHyeon , Jang Ji-Hun , Lee Jin-Soo
Published: November 2020

Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.
Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017
Authors: Speidel Arne Jorma , Woelfle Lena , Mayer Benjamin , Posovszky Carsten
Published: November 2020

Background: Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of on different object categories over a 13-year time period. Methods: A structured retrospective data analysis of patients who presented in between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed.Result: In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n=619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p<0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2=0.57; b=0.753; p=0.003). The annual rate of complications also increased significantly (R2=0.42; b=0.647; p=0.017).Conclusion: We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.
Specific Dynamic Variations in the Peripheral Blood Lymphocyte Subsets in COVID-19 and Severe Influenza A Patients: A Retrospective Observational Study
Authors: Qian Fang , Gao Guiju , Song Yangzi , Xu Yanli , Wang Aibin , Wang Sa , Yiwei Hao , Chen Meiling , Ma Xiaoyang , Zhao Tianwei , Guo Xiaodi , Chen Zhihai , Zhang Fujie
Published: November 2020

Background:Both COVID-19 and influenza A contribute to increased mortality among the elderly and those with existing comorbidities. Changes in the underlying immune mechanisms determine patient prognosis. This study aimed to analyze the role of lymphocyte subsets in the immunopathogenesisof COVID-19 and severe influenza A, and examined the clinical significance of their alterations in the prognosis and recovery duration.Methods:By retrospectively reviewing of patients in four groups (healthy controls, severe influenza A, non-severe COVID-19 and severe COVID-19) who were admitted to Ditan hospital between 2018 to 2020, we performed flow cytometric analysis and compared the absolute counts of leukocytes, lymphocytes, and lymphocyte subsets of the patients at different time points (weeks 1- 4).Results:We reviewed the patients’ data of 94 healthy blood donors, 80 Non-severe-COVID-19, 19 Severe-COVID-19 and 37 severe influenza A. We found total lymphocytes (0.81 ×109/L vs 1.74 ×109/L, P = 0.001; 0.87 ×109/L vs 1.74 ×109/L, P < 0.0001, respectively) and lymphocyte subsets (T cells, CD4+ and CD8+ T cell subsets) of severe COVID-19 and severe influenza A patients to be significantly lower than those of healthy donors at early infection stages. Further, significant dynamic variations were observed at different time points (weeks 1–4).Conclusions:Our study suggests the plausible role of lymphocyte subsets in disease progression, which in turn affects prognosis and recovery duration in patients with severe COVID-19 and influenza A.