bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracellular vesicles in low volume uterine lavage and serum: novel and promising biomarker for endometritis in Arabian mares
Authors: Ibrahim Sally , Hedia Mohamed , Taqi Mohamed O. , Derbala Mohamed K. , Mahmoud Karima Gh. M. , Ahmed Youssef , Sosa A. S. , Saber Yasser H. A. , Hasanain M. H. , Nawito M. F. , Seidel George E.
Published: January 2022

Background

Extracellular vesicles (EVs) are a promising biomarker and play a vital role in cell–cell communication. This study aimed (I) to identify and characterize EVs from low volume uterine lavage (LVL) and serum in mares with endometritis, compared to healthy controls and (II) to measure serum levels of interleukin 6 (IL-6), and prostaglandins (PGF2αand PGE2). Mares were divided into 30 sub-fertile (endometritis) and 20 fertile (controls). Serum and LVL was collected for EV isolation, and determination of serum levels of inflammatory mediators. Characterization and visualization of EVs were done by electron microscopy, dynamic light scattering and flow cytometry.

Results

Serial ultracentrifugation of LVL and use of a commercial kit for serum were strategies for EVs isolation. Mares with endometritis released higher amounts of larger size EVs. The EVs from mares with endometritis differentially expressed CD9 and CD63, compared to controls. Mares suffering from endometritis evoked higher levels of inflammatory mediators.

Conclusions

Thus, EVs could be used for a better understanding the regulatory mechanisms associated with developing endometritis in mares.
4,5-Dimethoxycanthin-6-one is a novel LSD1 inhibitor that inhibits proliferation of glioblastoma cells and induces apoptosis and pyroptosis
Authors: Li Wei , Huang Bai-sheng , Xiong Yuan-yuan , Yang Li-jian , Wu Li-xiang
Published: January 2022

Background

Glioblastoma is one of the most common fatal intracranial malignancies. Lysine-specific demethylase 1 (LSD1) reportedly has therapeutic effects on a variety of tumors. This study explored the therapeutic effect of LSD1 inhibition on glioblastoma cell lines and the possible underlying mechanisms.

Methods

The MTT assay was utilized to screen for the sensitivity of U87, U251 and T98G cells to 4, 5-dimethoxycarrageenin-6-one. qRT-PCR and western blot were used to measure the proliferation, apoptosis, and pyroptosis signaling pathway expression to observe the effect of LSD1 inhibition on U251 and T98G cells. Flow cytometry, immunofluorescence, immunohistochemistry, wound scratch, clone formation, and TUNEL assay were used to analyze the effects of 4, 5-dimethoxycanthin-6-one on glioblastoma cells. The effect of 4, 5-dimethoxycanthin-6-one was examined in vivo in BALB/c nude mice injected with U251 cells. HE staining was used to detect the histopathology of the tumor.

Results

LSD1 specifically catalyzes the demethylation of monomethylated and demethylated histone H3 lysine at position 4 (h3k4me1, h3k4me2, h3k4me3) and lysine at position 9 (h3k9me1). This regulated the transcriptional activity of proliferation, apoptosis, and pyroptosis signaling pathway genes. In vitro, the proliferation of glioblastoma cells was decreased in the 4, 5-dimethoxycanthin-6-one group. The expression of Caspase1 in glioblastoma cells treated with 4, 5-dimethoxycanthin-6-one increased, and the number of apoptotic cells increased. The tumor volume of mice injected with 4, 5-dimethoxycanthin-6-one decreased significantly.

Conclusion

4, 5-Dimethoxycanthin-6-one could act as a novel inhibitor of LSD1 to regulate glioblastoma, which could inhibit the proliferation of U251 and T98G cells and induce their apoptosis and pyroptosis. It is a potential drug for the treatment of glioblastoma.
Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review
Authors: Beroukhim Gabriela , Esencan Ecem , Seifer David B.
Published: January 2022

Sleep is vital to human bodily function. Growing evidence indicates that sleep deprivation, disruption, dysrhythmia, and disorders are associated with impaired reproductive function and poor clinical outcomes in women. These associations are largely mediated by molecular-genetic and hormonal pathways, which are crucial for the complex and time sensitive processes of hormone synthesis/secretion, folliculogenesis, ovulation, fertilization, implantation, and menstruation. Pathologic sleep patterns are closely linked to menstrual irregularity, polycystic ovarian syndrome, premature ovarian insufficiency, sub/infertility, and early pregnancy loss. Measures of success with assisted reproductive technology are also lower among women who engage in shift work, or experience sleep disruption or short sleep duration. Extremes of sleep duration, poor sleep quality, sleep disordered breathing, and shift work are also associated with several harmful conditions in pregnancy, including gestational diabetes and hypertensive disorders. While accumulating evidence implicates pathologic sleep patterns in impaired reproductive function and poor reproductive outcomes, additional research is needed to determine causality and propose therapeutic interventions.
10.6-μm infrared laser as adjuvant therapy for diabetic peripheral neuropathy: study protocol for a double-blind, randomized controlled trial
Authors: Lin Lin , Chen Yi , Li Yuxia , Cheng Ke , Deng Haiping , Lu Jianping , Zhao Ling , Shen Xueyong
Published: January 2022

Background

Diabetic peripheral neuropathy (DPN) is the most common chronic neurological complication. It is the main cause of disability in diabetes mellitus (DM) patients and seriously affects the quality of life of patients. Pharmacological treatments always associate with limited efficacy and adverse effects. Moxibustion has been recommended to treat DPN as an adjuvant therapy to conventional medical treatment to accelerate alleviation of the symptoms of DPN. 10.6-μm laser moxibustion (LM), whose wavelength is close to the peak of infrared radiation spectrum of the traditional moxibustion as well as human acupoints, produces the thermal effect similar with moxibustion but with no smoke or smell. The purpose of this sham controlled clinical trial is to determine the effect and safety of 10.6-μm LM as adjuvant therapy in patients with DPN.

Methods

This is a protocol for a randomized, double-blind, sham-controlled trial. One hundred fourteen patients meeting the inclusion and exclusion criteria will be recruited and randomly assigned to the LM group or the sham LM group with a 1:1 allocation ratio. Patients in both groups will receive a basic integrated treatment of Chinese and Western medicine and a total of 12 sessions of true or sham LM treatments over 4 weeks with 3 sessions a week. The primary outcome is nerve conduction velocity (NCV), and the secondary outcomes include Michigan Neuropathy Screening Instrument (MNSI) scores, Diabetes-Specific Quality of Life (DSQL) scores, blood rheology parameters, and assessments of safety and blinding. Outcome measures will be collected at baseline, 2 weeks after treatment, the end of LM treatments (4 weeks), and 4, 8 weeks after the end of LM treatment (8, 12weeks).

Discussion

This study will be conducted to compare the efficacy of LM versus sham LM combined with medical treatment. 10.6-μm LM may alleviate symptoms, improve quality of life, and reduce the dosage of drugs as well as avoid causing serious side effects.

Trial registration

Chinese Clinical Trial Registry ChiCTR2000029329. Registered on 25 January 2020.
Statistical analysis plan for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a randomised controlled trial of the effect of intravenous fluid therapy with balanced crystalloid versus saline on the incidence of delayed graft function in deceased donor kidney transplantation
Authors: Pascoe Elaine M. , Chadban Steven J. , Fahim Magid A. , Hawley Carmel M. , Johnson David W. , Collins Michael G. ,   for the BEST-fluids Investigators and the Australasian Kidney Trials Network
Published: January 2022

Background

Delayed graft function, or the requirement for dialysis due to poor kidney function, is a frequent complication of deceased donor kidney transplantation that is associated with inferior outcomes. Intravenous fluids with a high chloride content, such as isotonic sodium chloride (0.9% saline), are widely used in transplantation but may increase the risk of poor kidney function. The primary objective of the BEST-Fluids trial is to compare the effect of a balanced low-chloride crystalloid, Plasma-Lyte 148 (Plasmalyte), versus 0.9% saline on the incidence of DGF in deceased donor kidney transplant recipients. This article describes the statistical analysis plan for the trial.

Methods and design

BEST-Fluids is an investigator-initiated, pragmatic, registry-based, multi-centre, double-blind, randomised controlled trial. Eight hundred patients (adults and children) in Australia and New Zealand with end-stage kidney disease admitted for a deceased donor kidney transplant were randomised to intravenous fluid therapy with Plasmalyte or 0.9% saline in a 1:1 ratio using minimization. The primary outcome is delayed graft function (dialysis within seven days post-transplant), which will be modelled using a log-binomial generalised linear mixed model with fixed effects for treatment group, minimization variables, and ischaemic time and a random intercept for study centre. Secondary outcomes including early kidney transplant function (a ranked composite of dialysis duration and the rate of graft function recovery), treatment for hyperkalaemia, and graft survival and will be analysed using a similar modelling approach appropriate for the type of outcome.

Discussion

BEST-Fluids will determine whether Plasmalyte reduces the incidence of DGF and has a beneficial effect on early kidney transplant outcomes relative to 0.9% saline and will inform clinical guidelines on intravenous fluids for deceased donor kidney transplantation. The statistical analysis plan describes the analyses to be undertaken and specified before completion of follow-up and locking the trial databases.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12617000358347. Prospectively registered on 8 March 2017

ClinicalTrials.gov identifier NCT03829488. Registered on 4 February 2019
Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a study protocol for a randomised controlled trial of a Resource Kit
Authors: Coleston-Shields Donna Maria , Challis David , Worden Angela , Broome Emma , Dening Tom , Guo Boliang , Hoe Juanita , Lloyd-Evans Brynmor , Moniz-Cook Esme , Morris Steve , Poland Fiona , Prothero David , Orrell Martin
Published: January 2022

Background

Improving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia.

Methods/design

It is a pragmatic randomised controlled trial of an online Resource Kit to enhance practice in teams managing crises in dementia care. Thirty teams managing mental health crises in dementia in community settings will be randomised between the Resource Kit intervention and treatment as usual. The primary outcome measure is psychiatric admissions to hospital for people with dementia in the teams’ catchment area recorded 6 months after randomisation. Other outcomes include quality of life measures for people with dementia and their carers, practitioner impact measures, acute hospital admissions and costs. To enhance understanding of the Resource Kit intervention, qualitative work will explore staff, patient and carers’ experience.

Discussion

The Resource Kit intervention reflects current policy to enable home-based care for people with dementia by addressing the management of crises which threaten the viability of care at home. It is based upon a model of best practice for managing crises in dementia designed to enhance the quality of care, developed in partnership with people with dementia, carers and practitioners. If the Resource Kit is shown to be clinically and cost-effective in this study, this will enhance the probability of its incorporation into mainstream practice.

Trial registration

ISRCTN 42855694; Registered on 04/03/2021; Protocol number: 127686/2020v9; Research Ethics Committee, 09/03/2021, Ref 21/WM/0004; IRAS ID: 289982
Laparoscopically guided transversus abdominis plane block versus local wound analgesia in laparoscopic surgery for peritoneal endometriosis: study protocol for a prospective randomized controlled double-blinded LTAP-trial
Authors: Terho Anna , Puhto Terhi , Laru Johanna , Uimari Outi , Ohtonen Pasi , Rautio Tero , Koivurova Sari
Published: January 2022

Background

Ultrasound-guided transversus abdominis plane block (TAP) performed by anesthesiologist has been shown to be an effective and safe analgesia method in abdominal surgery, reducing postoperative opioid consumption. Recently, there has been growing interest to insert TAP under laparoscopic vision (LTAP) by surgeon. LTAP has been used in laparoscopic gastrointestinal surgery, but studies on LTAP in gynecologic laparoscopic surgery are sparse and inconsistent. The purpose of this study is to compare the efficacy of LTAP and local wound analgesia in laparoscopic surgery due to suspected or diagnosed superficial peritoneal endometriosis.

Methods

The LTAP-trial is a prospective randomized controlled double-blinded study comparing the efficacy and safety of LTAP with local wound analgesia in laparoscopic endometriosis surgery. Patients are randomized to receive LTAP with levobupivacaine and wound infiltration with placebo or wound infiltration with levobupivacaine and LTAP with placebo. The primary outcome is postoperative opioid consumption measured by patient-controlled analgesia (PCA) pump. Secondly, subjective postoperative pain up to 24 h postoperatively will be measured by Numeric Rating Scale (NRS). Additional outcome measures are factors related to recovery and length of stay in the hospital as well as a 6-month follow-up survey regarding pain (NRS) and endometriosis-related wellbeing (endometriosis-related health profile, EHP-30) after surgery. A total of 46 patients will be randomized in a proportion of 1:1.

Discussion

Patients with peritoneal endometriosis are often prone to severe postoperative pain that may prohibit their enhanced recovery after laparoscopy. Thus, there is a need for effective postoperative pain management with minimal side-effects. This study focusing on laparoscopically inserted transversus abdominis plane block may provide new insight in dealing with postoperative pain after laparoscopic endometriosis surgery as well as after other gynecologic surgery.

Trial registration

The LTAP-trial -protocol has been prospectively registered toClinicalTrials.gov, ID:NCT04735770. Registered on February 2021.
ClinGen Variant Curation Interface: a variant classification platform for the application of evidence criteria from ACMG/AMP guidelines
Authors: Preston Christine G. , Wright Matt W. , Madhavrao Rao , Harrison Steven M. , Goldstein Jennifer L. , Luo Xi , Wand Hannah , Wulf Bryan , Cheung Gloria , Mandell Mark E. , Tong Howard , Cheng Shaung , Iacocca Michael A. , Pineda Arturo Lopez , Popejoy Alice B. , Dalton Karen , Zhen Jimmy , Dwight Selina S. , Babb Lawrence , DiStefano Marina , O’Daniel Julianne M. , Lee Kristy , Riggs Erin R. , Zastrow Diane B. , Mester Jessica L. , Ritter Deborah I. , Patel Ronak Y. , Subramanian Sai Lakshmi , Milosavljevic Aleksander , Berg Jonathan S. , Rehm Heidi L. , Plon Sharon E. , Cherry J. Michael , Bustamante Carlos D. , Costa Helio A. ,   on behalf of the Clinical Genome Resource (ClinGen)
Published: January 2022

Background

Identification of clinically significant genetic alterations involved in human disease has been dramatically accelerated by developments in next-generation sequencing technologies. However, the infrastructure and accessible comprehensive curation tools necessary for analyzing an individual patient genome and interpreting genetic variants to inform healthcare management have been lacking.

Results

Here we present the ClinGen Variant Curation Interface (VCI), a global open-source variant classification platform for supporting the application of evidence criteria and classification of variants based on the ACMG/AMP variant classification guidelines. The VCI is among a suite of tools developed by the NIH-funded Clinical Genome Resource (ClinGen) Consortium and supports an FDA-recognized human variant curation process. Essential to this is the ability to enable collaboration and peer review across ClinGen Expert Panels supporting users in comprehensively identifying, annotating, and sharing relevant evidence while making variant pathogenicity assertions. To facilitate evidence-based improvements in human variant classification, the VCI is publicly available to the genomics community. Navigation workflows support users providing guidance to comprehensively apply the ACMG/AMP evidence criteria and document provenance for asserting variant classifications.

Conclusions

The VCI offers a central platform for clinical variant classification that fills a gap in the learning healthcare system, facilitates widespread adoption of standards for clinical curation, and is available athttps://curation.clinicalgenome.org
Fibrinogen function indexes are potential biomarkers of diabetic peripheral neuropathy
Authors: Zhuang Yong , Lin Xiahong , Chen Xiaoyu , Wu Xiaohong , Zhang Jinying
Published: January 2022

Background and objectives

Research suggests that diabetic peripheral neuropathy (DPN) is related to plasma fibrinogen (Fib) concentrations, although its correlation with Fib function has not been reported. Here, the k value and angle α, reflecting the plasma Fib function, were used to analyse its correlation with DPN, and their potential as biological indicators for diagnosing DPN was explored.

Subjects and methods

This prospective observational clinical study enrolled 561 type 2 diabetes mellitus (T2DM) patients, who were divided into the diabetes with symptomatic neuropathy (161 cases), diabetes with asymptomatic neuropathy (132 cases) and diabetes with no neuropathy (268 cases) groups. Meanwhile, 160 healthy unrelated subjects were recruited as controls.

Results

Fib levels increased slightly in diabetic subjects with neuropathy compared with those without. The angle α levels increased slightly in subjects with asymptomatic DPN compared with those with no neuropathy and increased greatly in subjects with symptomatic DPN compared with those without. The k value levels slightly decreased in subjects with asymptomatic DPN compared with those with no neuropathy and greatly decreased in subjects with symptomatic DPN compared with those without. The association of the k value and angle α with diabetic neuropathy was independent of the hyperglycaemic state and other potential confounders (odds ratio 0.080 [0.051–0.124], P < 0.001; odds ratio 1.131 [1.063–1.204], P < 0.001). The k value and angle α levels were closely correlated with neuropathy stage (r  = − 0.686, P < 0.000; r  = 0.314, P < 0.001). The optimal cut-off point for k value levels to distinguish patients with diabetic neuropathy from those without was 1.8 min, with a sensitivity of 73.7% and a specificity of 83.2% (AUC = 0.873). The optimal cut-off point for angle α levels was 60°, with a sensitivity of 41.0% and a specificity of 95.6% (AUC = 0.669).

Conclusions

The k value and angle α are closely associated with DPN. The levels of the k value and angle α may be helpful in the early diagnosis of DPN.
Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity
Authors: Krishnasastry Suma T. , Mackenzie Charles D. , Sadanandan Rajeev
Published: January 2022

Background

Lymphatic filariasis (LF) remains one of the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations’ Sustainable Development Goals. The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district, through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.

Methods

Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State’s health administration. The six training sessions (from 5 June 2017 to 25 May 2018) included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed by pre- and post-training tests. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, 6 months after the conclusion of the training sessions.

Results

One hundred and eighty-four medical personnel (91 doctors and 93 nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3,477 new patients receiving training in EPC.

Conclusions

Generalist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings and patients when provided services close to their home, are willing to access them. This is a feasible strategy for integrating long term care for LF patients into the national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.

Graphical Abstract
Influence of extracellular volume fraction on peak exercise oxygen pulse following thoracic radiotherapy
Authors: Canada Justin M. , Weiss Elisabeth , Grizzard John D. , Trankle Cory R. , Gharai Leila Rezai , Dana Franklin , Buckley Leo F. , Carbone Salvatore , Kadariya Dinesh , Ricco Anthony , Jordan Jennifer H. , Evans Ronald K. , Garten Ryan S. , Van Tassell Benjamin W. , Hundley W. Gregory , Abbate Antonio
Published: January 2022

Background

Radiation-induced myocardial fibrosis increases heart failure (HF) risk and is associated with a restrictive cardiomyopathy phenotype. The myocardial extracellular volume fraction (ECVF) using contrast-enhanced cardiac magnetic resonance (CMR) quantifies the extent of fibrosis which, in severe cases, results in a noncompliant left ventricle (LV) with an inability to augment exercise stroke volume (SV). The peak exercise oxygen pulse (O2Pulse), a noninvasive surrogate for exercise SV, may provide mechanistic insight into cardiac reserve. The relationship between LV ECVF and O2Pulse following thoracic radiotherapy has not been explored.

Methods

Patients who underwent thoracic radiotherapy for chest malignancies with significant incidental heart dose (≥5 Gray (Gy), ≥10% heart) without a pre-cancer treatment history of HF underwent cardiopulmonary exercise testing to determine O2Pulse, contrast-enhanced CMR, and N-terminal pro-brain natriuretic peptide (NTproBNP) measurement. Multivariable-analyses were performed to identify factors associated with O2Pulse normalized for age/gender/anthropometrics.

Results

Thirty patients (median [IQR] age 63 [57–67] years, 18 [60%] female, 2.0 [0.6–3.8] years post-radiotherapy) were included. The peak VO2 was 1376 [1057–1552] mL·min− 1, peak HR = 150 [122–164] bpm, resulting in an O2Pulse of 9.2 [7.5–10.7] mL/beat or 82 (66–96) % of predicted. The ECVF, LV ejection fraction, heart volume receiving ≥10 Gy, and NTproBNP were independently associated with %O2Pulse (P < .001).

Conclusions

In patients with prior radiotherapy heart exposure, %-predicted O2Pulse is inversely associated markers of diffuse fibrosis (ECVF), ventricular wall stress (NTproBNP), radiotherapy heart dose, and positively related to LV function. Increased LV ECVF may reflect a potential etiology of impaired LV SV reserve in patients receiving thoracic radiotherapy for chest malignancies.
Cell-free DNA from plasma as a promising alternative for detection of gene mutations in patients with Maffucci syndrome
Authors: Sun Yi , Fan Xindong , Rao Yamin , Wang Zhenfeng , Wang Deming , Yang Xitao , Zheng Lianzhou , Wen Mingzhe , Cai Ren , Su Lixin
Published: January 2022

Maffucci syndrome (MS, OMIM 166000) is an extremely unusual, nonhereditary, multisystemic disorder that is characterized with multiple enchondromas and vascular lesions, most of which are spindle cell hemangiomas. Complications of MS, such as bone deformities and dysfunction caused by enchondromas, usually increase during childhood and adolescence. Malignant transformation of enchondromas and other malignancies are the most severe complications. MS is caused by somatic mosaic IDH1/2 mutations, 65% of which are the IDH1 p.Arg132Cys variant. Due to its rarity, there is no international consensus for the most appropriate treatment option of MS.

Here, we report a case of a female patient presenting with multiple enchondromas and spindle cell hemangiomas (SCHs) on bilateral hand and feet diagnosed as MS. A detailed clinical, pathological and genetic diagnosis of MS was rendered. Integrative Genomics Viewer (IGV) visualization of next-generation sequencing (NGS) data revealed the consistent detection of the low-frequency somatic IDH1 p.Arg132Cys mutation between SCH tissue and cystic blood-derived cfDNA. This is the first successful molecular diagnosis of MS complicated with SCH utilizing minimally invasive cfDNA techniques. We suggest that cfDNA sequencing could potentially be used as an alternative, reliable and sensitive method to identify molecular information for genetic diagnosis and for future targeted therapies of MS.
Roasted fox nuts (Euryale Ferox L.) contain higher concentration of phenolics, flavonoids, minerals and antioxidants, and exhibit lower Glycemic Index (GI) in human subjects
Authors: Liaquat Marrium , Pasha Imran , Ahsin Muhammad , Salik Abdullah
Published: January 2022

Fox nut (Euryale ferox) is categorized among superior quality foods because of its highly nutritious profile. It also serves as a good protein source for vegetarian diets. However, it is not widely consumed, due to soggy texture and bland flavor as compared to other nuts. In this study, we used roasting and seasoning to enhance its consumer acceptance. Furthermore, we have also compared biochemical, nutritional and physical properties of the roasted and unroasted fox nuts; and their Glycemic Index (GI) in human subjects. Results showed that roasting significantly (P ≤ 0.05) improved the minerals content (from 0.58 to 0.66%), protein content (from 11.40 to 14.57%), total phenolics (from 346.02 to 470.62 mg GAE/100 g), flavonoids (from 4.15 to 4.43 mg CE/g), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity (from 48.54 to 79.13% inhibition) and Ferric Reducing Antioxidant Power (from 662.46 to 957.14 μmol FeSO4/g). Consumer acceptance was evaluated with and without seasoning; both salt and spice seasoned roasted nuts had greater overall acceptability as compared to plain roasted and unroasted nuts. Fox nuts also reported low GI (37%) in human subjects (ethical approval #1772/01-06-2020). Thus, roasted fox nuts can be consumed as nutrient rich and low GI snack; not only as a component of healthy diet but can also be served to patients with metabolic disorders like obesity and diabetes.
Impact of compulsory admission on treatment and outcome: A propensity score matched analysis
Authors: Hofmann Andreas B. , Schmid Hanna M. , Hofmann Lena A. , Noboa Vanessa , Seifritz Erich , Vetter Stefan , Egger Stephan T.
Published: January 2022

Background

Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients.

Methods

We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected.

Results

Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ.

Conclusions

Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.
Decreased Electroencephalographic Alpha Power During Anesthesia Induction Is Associated With EEG Discontinuity in Human Infants
Authors: Chao Jerry Y. , Gutiérrez Rodrigo , Legatt Alan D. , Yozawitz Elissa G. , Lo Yungtai , Adams David C. , Delphin Ellise S. , Shinnar Shlomo , Purdon Patrick L.
Published: January 2022

BACKGROUND:

Electroencephalogram (EEG) discontinuity can occur at high concentrations of anesthetic drugs, reflecting suppression of electrocortical activity. This EEG pattern has been reported in children and reflects a deep state of anesthesia. Isoelectric events on the EEG, a more extreme degree of voltage suppression, have been shown to be associated with worse long-term neurologic outcomes in neonates undergoing cardiac surgery. However, the clinical significance of EEG discontinuities during pediatric anesthesia for noncardiac surgery is not yet known and merits further research. In this study, we assessed the incidence of EEG discontinuity during anesthesia induction in neurologically normal infants and the clinical factors associated with its development. We hypothesized that EEG discontinuity would be associated with sevoflurane-induced alpha (8–12 Hz) power during the period of anesthesia induction in infants.

METHODS:

We prospectively recorded 26 channels of EEG during anesthesia induction in an observational cohort of 54 infants (median age, 7.6 months; interquartile range [IQR] [4.9–9.8 months]). We identified EEG discontinuity, defined as voltage amplitude <25 microvolts for >2 seconds, and assessed its association with sevoflurane-induced alpha power using spectral analysis and multivariable logistic regression adjusting for clinically important variables.

RESULTS:

EEG discontinuity was observed in 20 of 54 subjects (37%), with a total of 25 discrete events. Sevoflurane-induced alpha power in the posterior regions of the head (eg, parietal or occipital regions) was significantly lower in the EEG discontinuity group (midline parietal channel on the electroencephalogram, International 10-20 System [Pz]; 8.3 vs 11.2 decibels [dBs]; P = .004), and this association remained after multivariable adjustment (adjusted odds ratio [aOR] = 0.51 per dB increase in alpha power [95% CI, 0.30–0.89]; P = .02). There were no differences in the baseline (unanesthetized) EEG between groups in alpha power or power in any other frequency band.

CONCLUSIONS:

We demonstrate that EEG discontinuity is common during anesthesia induction and is related to the level of sevoflurane-induced posterior alpha power, a putative marker of cortical-thalamic circuit development in the first year of life. This association persisted even after adjusting for age and propofol coadministration. The fact that this difference was only observed during anesthesia and not in the baseline EEG suggests that otherwise hidden brain circuit properties are unmasked by general anesthesia. These neurophysiologic markers observed during anesthesia may be useful in identifying patients who may have a greater chance of developing discontinuity.
Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan
Authors: Arshad Verda , Inam Maha , Awan Safia , Ismail Faisal Wasim
Published: January 2022

Objectives: Celiac Disease (CD) is a disorder that impacts physical, social and emotional health. Requiring life-long treatment, it poses a major economic burden on the healthcare system. Our objective was to study CD in patients from initial presentation to diagnosis and to ascertain the effect of a low resource setting on improvement in disease process.

Methods: This is a retrospective cross-sectional study conducted at a Aga Khan University Hospital (AKUH), a tertiary care center in Karachi, Pakistan. Medical records of patients (≥18 years) from 2008 to 2018 with a diagnosis of CD were reviewed. Data on demographics, presenting complaints, investigations, endoscopy results and follow up visits was collected.

Results: One hundred and twenty-six patients were included (61.6% females, mean age 35.5 years). The most common intestinal and extra-intestinal symptoms were abdominal pain (56.3%) and fatigue (24.6%) respectively. After microcytic anemia (36.5%), increased ALT (27.2%) was the most common laboratory derangement. On endoscopy, visible fissuring (29.4%) and atrophic mucosa (29.4%) were reported. Biopsy findings showed increased intraepithelial lymphocytes (92.9%) and villous atrophy (77.8%). Improvement in at least one of three parameters (symptoms, laboratory values or EGD) was reported by 42.0% of subjects, whereas 48.4% subjects were lost to follow-up.

Conclusion: The most commonly reported symptoms by CD patients were abdominal pain, diarrhea and anemia. Thus, patients presenting with vague abdominal symptoms and anemia should be worked up for CD. A concerning majority of subjects was lost to follow up for reasons such as inability to afford advised GFD and a poor understanding of the disease process.

doi: https://doi.org/10.12669/pjms.38.3.4446

How to cite this:Arshad V, Inam M, Awan S, Ismail FW. Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4446

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Do Maya women have the chance to improve their quality of life?
Authors: Siniarska Anna , Wolański Napoleon
Published: January 2022

Background: Maya families suffered greatly during the henequen industry in the Yucatan, but the lives of the Maya women at the time were perhaps worse than anywhere in the world. Changes in Maya body height over the 20th century were assessed in order to show secular changes. The use of the sexual dimorphism index (SDI) allowed for the evaluation of the living conditions prevailing during the existence of the henequen haciendas to the Mexican revolution and a gradual improvement of these conditions by the end of the 20th century.

Methods: In 1994, 364 men and 320 women aged 20-98 years were studied in Merida, Yucatan, Mexico. They were divided into six age groups and by sex: 20-29, 30-39, 40-49, 50-59, 60-69 and 70+ years. Stature for both sexes, and age at menarche for women were considered. SDI in stature was calculated to assess living conditions.

Results: There were smaller (0.25 cm/10 years) changes in height in men than in women (0.9 cm/10 years) and no significant changes in acceleration of maturation. SDI results showed changes from 9.9 to 7.6, and this may indicate a constant, but very small improvement of living conditions. The age at menarche of women did not show statistically significant acceleration with age.

Conclusions: In the colonial period of the late 19th century until the Mexican Revolution, women were worse off than men. Previous research has shown that when living conditions change, men always react faster than women, e.g. by lowering or increasing body height. Our study of the Maya population in the 20th century showed otherwise; female height increased more than male height. This may reflect that the living conditions of Maya men have not changed over the 20th century, but have improved for women.
The indigenous meaning of dysmenorrhea: using modified photovoice to document perspectives of traditional health practitioners (THPs) and indigenous knowledge holders (IKHs)
Authors: Rasweswe Melitah Molatelo , Peu Mmapheko Doriccah , Mulaudzi Fhumulani Mavis
Published: January 2022

Background: Globally, health understanding and beliefs vary across sub-cultural groups, depending on geographical location. Increasingly, various parts of the world recognize these perspectives to offer culturally sensitive healthcare services at primary level. Understanding the indigenous perspectives of dysmenorrhea meaning from the custodians of knowledge holders may add to the value of literature that may be used to advocate humanized culturally sensitive healthcare. This article aimed to explore and describe the perspectives regarding the meaning of indigenous dysmenorrhea among Batlokwa traditional health practitioners (THPs) and indigenous knowledge holders (IKHs).

Methods: A qualitative, explorative study with a modified photovoice design, which included photographs, interviews and lekgotla discussion was employed to engage THPs and IKHs residing in Botlokwa Limpopo province, South Africa. Initially, a purposive sampling technique was used to select the participants, followed by snowball sampling. The participants themselves analyzed the photographs and described their meaning during individual interview using the acronym “PHOTO”. The researchers employed thematic analysis of interviews and Lekgotla discussion, in which themes were identified, formulated and analyzed from the codified data set.

Results: In total, eight women participated in the photovoice study. The findings showed that indigenous understanding of dysmenorrhea stems from the African belief about health and illness with special emphasis on importance of holistic meaning. To the THPs and IKHs dysmenorrhea was a broad and integrated trend of a normal or abnormal process of illness that occurs periodically during menstruation.

Conclusions: The THP’s and IKH’s indigenous meaning of dysmenorrhea reflects physical, mental, emotional, social, environmental, political and economic dimensions. Therefore, dysmenorrhea should be understood from a holistic approach. With appropriate partnerships and processes in place, this knowledge may be well represented in dominant healthcare systems and health research.
GNOSIS: an R Shiny app supporting cancer genomics survival analysis with cBioPortal
Authors: King Lydia , Flaus Andrew , Coughlan Simone , Holian Emma , Golden Aaron
Published: January 2022

Exploratory analysis of cancer consortia data curated by the cBioPortal repository typically requires advanced programming skills and expertise to identify novel genomic prognostic markers that have the potential for both diagnostic and therapeutic exploitation. We developed GNOSIS (GeNomics explOrer using StatistIcal and Survival analysis in R), an R Shiny App incorporating a range of R packages enabling users to efficiently explore and visualise such clinical and genomic data. GNOSIS provides an intuitive graphical user interface and multiple tab panels supporting a range of functionalities, including data upload and initial exploration, data recoding and subsetting, data visualisations, statistical analysis, mutation analysis and, in particular, survival analysis to identify prognostic markers. GNOSIS also facilitates reproducible research by providing downloadable input logs and R scripts from each session, and so offers an excellent means of supporting clinician-researchers in developing their statistical computing skills.
Creating equity in health research to drive more and better evidence
Authors: Lang Trudie , Reeder John , Moorthy Vasee , Trindade Lima Nísia , Gray Glenda , Kaleebu Pontiano , Ihekweazu Chikwe , Nsanzimana Sabin , Kang Gagandeep , Makanga Michael , Swaminathan Soumya
Published: January 2022

Health research is rapidly changing with evidence being gathered through new agile methods. This evolution is critical but must be globally equitable so the poorest nations do not lose out. We must harness this change to better tackle the daily burden of diseases that affect the most impoverished populations and bring research capabilities to every corner of the world so that rapid and fair responses to new pathogen are possible; anywhere they appear.

We must seize this opportunity to make research easier, better and more equitable. Currently too many nations are unable to generate the evidence or translate it to directly change health outcomes in their own communities. It is essential to act and harness this emerging change in how research data can be generated and shared, so that all nations sustainably gain from this development. There are positive examples to draw on from COVID-19, but we now need to act. Here we present an initiative to develop a new framework that can guide researchers in the design and execution of their studies. This highly agile system will work by adapting to risk and complexity in any given study, whilst generating quality, safe and ethical data.
patient with appendicitis acuta?
Authors: Stępińska Katarzyna
Published: January 2022

Acute appendicitis has always been correlated with a short patient’s medical history and a sudden onset of symptoms. Nevertheless, in some patients the duration of the symptoms is prolonged, up to several days. The following case illustrates this course of the disease.
Dear Madeleine Françoise,
Authors: Gelbart Nina Rattner
Published: January 2022

Not long ago I sat under the cedar of Lebanon planted in 1734 by Bernard de Jussieu while you and everyone in the garden looked on. It is a huge, wide tree now, its lush needles and spreading branches providing welcome shade to visitors at the Jardin des Plantes as your beautiful park is now called. This gigantic evergreen, shaped like a little pyramid when you saw it but luxuriously broad and open now, outlived you and will long outlive me. Other trees planted centuries ago are still here too: I recognized an Acacia, grown from seed originating in my part of the world, North America, which was already here in your day, and there is the tall Sophora Japonica, transplanted in 1747 by Bernard de Jussieu, again while you all watched, from the Place Dauphine where it first took root. Next to the cedar is the Labyrinth, a tall hill with rows of hedges in rising circular paths that take you around and up to the gazebo at the top, one of the oldest metal constructions in the world built at Buffon’s orders and from which one can see all of Paris. I strolled through the majestic avenues of plane trees, for which we also have Buffon to thank, and enjoyed the famous banks of roses, irises, and peonies, picturing you bent over them as you sketched and painted. The Jardin Alpin, the materials for which were accumulated during your day, is now a secluded space for plants from mountain climates that you can only get to through a tunnel passage. The big old pistachio tree, grown out of seeds from China and still there, fascinated an earlier Jardin botanist, Sébastien Vaillant, who figured out—by observing its sterility until he mingled its flowers with those of another tree of the same species—that plants reproduce sexually just like animals. He was the first to introduce terms like male, female, and ovary into discussions of floral anatomy. This nomenclature initially created a scandal but was soon picked up by Linnaeus, whom you met in the garden in 1738 and for whom plant sexuality was central. He wrote and spoke freely about it with you and Bernard de Jussieu. It wasn’t shocking anymore....
Chemist and Experimentalist
Authors: Gelbart Nina Rattner
Published: January 2022

This chapter introduces chemist Marie Geneviève Charlotte Thiroux d'Arconville, who studied organic decomposition, echoing Newton's view, in Query #30 of the Opticks, that decay was a natural breakdown process in which substances were reduced to their component elements. The chapter then tracks her early life, in which she was born into a rich tax farmer family in 1720, and the rudimentary experiments she performed as a child. It also narrates her shift to intellectual pursuits after she contracted smallpox at twenty-two. Turning her energies to learning, d'Arconville taught herself languages starting with English and Italian, translating over the many next decades literary and scientific works that she admired, and publishing many original ones of her own on morality, history, fiction, and science. The chapter then presents the intellectuals with whom d'Arconville developed a close kinship: chemist Pierre-Joseph Macquer, doctor chemist François Paul Lyon Poulletier de la Salle, and surgeon Jean-Joseph Sue.
Symptomatic Improvement in Cicatricial Pemphigoid of the Trachea Achieved with Laser Ablation Bronchoscopy
Authors:   HCA Healthcare MountainView Hospital, Las Vegas, NV, USA, Benge Elizabeth , Tran Vincent , Sheikan Nazanin , Bhatia Sapna , McWhorter Yi , Collier John , Chung Arnold
Published: January 2022

Cicatricial pemphigoid (CP) with tracheal involvement is a rare and potentially deadly condition. Here, we report the first case in which Nd:YAG laser (1064nm) laser ablation bronchoscopy was used to treat CP with tracheal involvement. Our patient is a 71-year-old male with a history of CP refractory to medical therapy affecting his trachea who presented to the emergency department with dyspnea. He ultimately underwent bronchoscopy with Nd: YAG laser (1064nm) laser ablation, which resulted in a temporary alleviation of his respiratory symptoms. A repeat laser ablation was planned in hopes of prolonging the patient’s remission, but due to interval changes in the patient’s airway anatomy, it was deemed unsafe. While our patient’s uniquely advanced disease was not amenable to further laser-mediated intervention, it is possible that patients with less advanced disease may experience better outcomes with similar therapy. This case shows the promise laser ablation could hold for patients with tracheal cicatricial pemphigoid.
Revisiting young people’s participation: an introduction
Authors: Bruselius-Jensen Maria , Kay E. , Tisdall M. , Pitti Ilaria
Published: January 2022

The introduction introduces key concepts and controversies within existing literature, aiming at problematising and broadening the current understanding of young people’s participation in itself. It introduces the three themes of the book, discussing the existing evidence and conceptualisations, and putting forward key questions that is addressed in the book. The introduction presents the book’s structure and the different chapters.