bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study
Authors: Falchenberg Åsa , Andersson Ulf , Wireklint Sundström Birgitta , Bremer Anders , Andersson Henrik
Published: April 2021

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.
Falling Behind and Feeling Bad: Unmet Expectations and Mental Health during the Transition to Adulthood
Authors: Culatta Elizabeth , Clay-Warner Jody
Published: April 2021

How do perceived expectations of what it means to be an adult affect mental health? We draw from life course and social psychological literature to argue that falling behind perceived expectations for reaching markers of adulthood is associated with depression and anxiety. We test predictions with data from an original sample of more than five hundred 18- to 29-year-olds in the United States. Consistent with predictions, we find a positive relationship between falling behind expectations and both anxiety and depression even while controlling for own expectations about the accomplishment of markers of adulthood. In particular, we find that falling behind perceived expectations of peers regarding markers of adulthood is associated with anxiety and that falling behind perceived expectations of parents and society regarding markers of adulthood is associated with depressive symptoms.
How Can Policymakers be Encouraged to Support People With Spinal Cord Injury—Scoping Review
Authors: Arejan Roya Habibi , Azadmanjir Zahra , Ghodsi Zahra , Dehghan Hamid Reza , Sharif-Alhoseini Mahdi , Tabary Mohammadreza , Khaleghi-Nekou Melika , Naghdi Khatereh , Vaccaro Alexander R. , Zafarghandi Mohammad Reza , Rahimi-Movaghar Vafa
Published: April 2021

Study Design:

Scoping review.

Objective:

Regarding that inappropriate medical care approaches, absence of rehabilitation services, and existing barriers in physical, social, and policy environments lead to poor outcomes in individuals with spinal cord injury (SCI) and provision for appropriate interventions and care must be created by health policymakers, we conducted this scoping review to investigate how policymakers can be persuaded to set new plans for individuals with SCI.

Methods:

This review was performed according to Arksey and O’Malley’s framework. PubMed was searched in February2019 without language limitation. We looked for other potential gray literature sources and some professional websites. References sections of selected articles were also scanned for other relevant literature.

Results:

We included literature that met inclusion criteria to answer our research question. The literature was divided into 3 categories. The first category included economic impact of SCI. The second category included the role of research and developing research strategy. The third category included effective interaction and communication with policymakers.

Conclusion:

It is essential to consider multiple factors for influencing policymakers’ decisions. These factors include knowing how to communicate with policymakers and presenting constructive ideas, providing a source of valid, reliable, and consistent data, considering the role of patients’ advocacy groups and Non-Governmental Organizations (NGOs), and presentation of the importance of early intervention in reducing healthcare system costs. Ultimately, the goal is to have a comprehensive and flexible plan for influencing policymakers.
Outcomes of Naviculectomy for Severe Recurrent Clubfoot Deformity
Authors: Westberry David E. , Carpenter Ashley M. , Brown Katherine , Hilton Samuel B.
Published: April 2021

Background:

Naviculectomy was originally described for resistant congenital vertical talus deformity but was later expanded to use in rigid cavus deformity. This study reviews the operative outcomes of complete excision of the navicular for recurrent deformity in the talipes equinovarus (TEV) population.

Methods:

After institutional review board approval, all patients undergoing naviculectomy at a single institution were identified. Clinical, radiographic, and pedobarographic data (minimum 2 years’ follow-up) were reviewed.

Results:

Twelve patients (14 feet) with TEV from 1984 to 2019 were included. All feet had minimum 1 prior operative intervention on the affected foot (mean age = 4.0 years, range 0.2-14.5), with 8/14 having at least 3 prior operative procedures. Complete navicular excision with concomitant procedures was performed in all patients (mean age = 11.7 years, range 5.5-16.1). Mean clinical follow-up from naviculectomy was 5.1 years (range, 2.2-11.2). During follow-up, 6 patients required subsequent surgery, most often secondary to pain and progressive deformity. One patient underwent elective below-knee amputation of the affected extremity. Of the remaining 11 patients, 7 of 11 reported continued pain and 8 of 11 maintained adequate range of motion at the ankle at the most recent follow-up.

Conclusion:

Clinical follow-up demonstrated deteriorating results in a large percentage of patients. The high rate of additional procedures and continued pain in the current series suggests that even as a salvage procedure, naviculectomy may not provide adequate results for patients.

Level of Evidence:

Level IV, case series.
Improving the mechanical properties of polypropylene composites with coconut shell particles
Authors: Obasi Henry C , Mark Uchechi C , Mark Udochukwu
Published: April 2021

Conventional inorganic fillers are widely used as fillers for polymer-based composites. Though, their processing difficulties and cost have demanded the quest for credible alternatives of organic origin like coconut shell fillers. Dried shells of coconut were burnt, ground, and sifted to sizes of 63, 150, 300, and 425 µm. The ground coconut shell particles (CSP) were used as a filler to prepare polypropylene (PP) composites at filler contents of 0% to 40% via injection melt blending process to produce PP composite sheets. The effect of the filler particle size on the mechanical properties was investigated. The decrease in the size of filler (CSP) was found to improve the yield strength, tensile strength, tensile modulus, flexural strength, flexural modulus, and hardness of PP by 8.5 MPa, 15.75 MPa, 1.72 GPa, 7.5 MPa, 100 MPa, and 10.5 HR for 63 µm at 40%, respectively. However, the elongation at break and modulus of resilience of the PP composites were seen to increase with increase in the filler size. Scanning electron microscope analysis showed that fillers with 63 µm particle size had the best distribution and interaction with the PP matrix resulting in enhanced properties.
Comprehensive analysis and identification of drought-responsive candidate NAC genes in three semi-arid tropics (SAT) legume crops
Authors: Singh Sadhana , Kudapa Himabindu , Garg Vanika , Varshney Rajeev K.
Published: April 2021

Background

Chickpea, pigeonpea, and groundnut are the primary legume crops of semi-arid tropics (SAT) and their global productivity is severely affected by drought stress. The plant-specific NAC (NAM - no apical meristem, ATAF - Arabidopsis transcription activation factor, and CUC - cup-shaped cotyledon) transcription factor family is known to be involved in majority of abiotic stresses, especially in the drought stress tolerance mechanism. Despite the knowledge available regarding NAC function, not much information is available on NAC genes in SAT legume crops.

Results

In this study, genome-wide NAC proteins – 72, 96, and 166 have been identified from the genomes of chickpea, pigeonpea, and groundnut, respectively, and later grouped into 10 clusters in chickpea and pigeonpea, while 12 clusters in groundnut. Phylogeny with well-known stress-responsive NACs in Arabidopsis thaliana, Oryza sativa (rice), Medicago truncatula, and Glycine max (soybean) enabled prediction of putative stress-responsive NACs in chickpea (22), pigeonpea (31), and groundnut (33). Transcriptome data revealed putative stress-responsive NACs at various developmental stages that showed differential expression patterns in the different tissues studied. Quantitative real-time PCR (qRT-PCR) was performed to validate the expression patterns of selected stress-responsive, Ca_NAC (Cicer arietinum - 14), Cc_NAC (Cajanus cajan - 15), and Ah_NAC (Arachis hypogaea - 14) genes using drought-stressed and well-watered root tissues from two contrasting drought-responsive genotypes of each of the three legumes. Based on expression analysis, Ca_06899, Ca_18090, Ca_22941, Ca_04337, Ca_04069, Ca_04233, Ca_12660, Ca_16379, Ca_16946, and Ca_21186; Cc_26125, Cc_43030, Cc_43785, Cc_43786, Cc_22429, and Cc_22430; Ah_ann1.G1V3KR.2, Ah_ann1.MI72XM.2, Ah_ann1.V0X4SV.1, Ah_ann1.FU1JML.2, and Ah_ann1.8AKD3R.1 were identified as potential drought stress-responsive candidate genes.

Conclusion

As NAC genes are known to play role in several physiological and biological activities, a more comprehensive study on genome-wide identification and expression analyses of the NAC proteins have been carried out in chickpea, pigeonpea and groundnut. We have identified a total of 21 potential drought-responsive NAC genes in these legumes. These genes displayed correlation between gene expression, transcriptional regulation, and better tolerance against drought. The identified candidate genes, after validation, may serve as a useful resource for molecular breeding for drought tolerance in the SAT legume crops.
Mass propagation of Juniperus procera Hoechst. Ex Endl. From seedling and screening of bioactive compounds in shoot and callus extract
Authors: Salih Abdalrhaman M. , Al-Qurainy Fahad , Khan Salim , Tarroum Mohamed , Nadeem Mohammad , Shaikhaldein Hassan O. , Alabdallah Nadiyah M. , Alansi Saleh , Alshameri Aref
Published: April 2021

Background

Juniperus procera Hoechst. ex Endl. is a medicinal tree in Saudi Arabia, primarily in the Enemas region, but it is locally threatened due to die-back disease and difficulties regarding seed reproduction (seed dormancy and underdeveloped embryonic anatomy, and germination rate < 40%). Hence, the alternative methods for reproduction of Juniperus procera are really needed for conservation and getting mass propagation for pharmaceutical uses.

Results

In this manuscript, we articulated the successful in vitro shoot multiplication and callus induction of J. procera by using young seedling as explants and detected an important antibacterial and antitumor product. Explants were grown on different types of media with the supplement of different combinations of Plant Growth Regulators (PGRs) at different concentrations. The best media for shoot multiplication was Woody Plant Media (WPM) supplemented with PGRs (0.5 μM of IAA and 0.5 μM BAP or 0.5 μM IBA and 0.5 μM BAP). Whereas for callus induction and formation Woody Plant Media (WPM) with the addition of PGRs (0.5 μM 2,4-D and 0.5 μM BAP) was better than the Chu Basal Salt Mixture (N6), Gamborg’s B-5 Basal Medium (B5), and Murashige and Skoog media. The possibility of multiplication of J. procera in vitro creates significant advantages to overcome the difficulties of seeds dormancy for the reproduction of plants, conservation of trees, and getting mass propagation material for pharmaceutical studies. The shoot and callus extract of J. procera was detected using gas chromatography-mass spectrometry analysis and revealed more than 20 compounds related to secondary metabolites, which contained antibacterial and antitumor agents, such as ferruginol, Retinol, and Quinolone as well as confirmed by Direct Analysis in Real Time, Time of Flight Mass Spectrometry (DART-ToF-MS). Podophyllotoxin (PTOX) was detected in callus material by HPLC with sigma standard and confirmed by DART-ToF-MS and UV spectra.

Conclusion

We successfully conducted in vitro shoot multiplication and callus induction from J. procera seedlings using WPM and a different combination of PGRs and, detected an important antibacterial and antitumor product such as ferruginol and podophyllotoxin. According to our findings, J. procera has become a new natural source of novel bioactive compounds.
The role of RNA-binding protein, microRNA and alternative splicing in seed germination: a field need to be discovered
Authors: Xue Xiaofei , Jiao Fuchao , Xu Haicheng , Jiao Qiqing , Zhang Xin , Zhang Yong , Du Shangyi , Xi Menghan , Wang Aiguo , Chen Jingtang , Wang Ming
Published: April 2021

Seed germination is the process through which a quiescent organ reactivates its metabolism culminating with the resumption cell divisions. It is usually the growth of a plant contained within a seed and results in the formation of a seedling. Post-transcriptional regulation plays an important role in gene expression. In cells, post-transcriptional regulation is mediated by many factors, such as RNA-binding proteins, microRNAs, and the spliceosome. This review provides an overview of the relationship between seed germination and post-transcriptional regulation. It addresses the relationship between seed germination and RNA-binding proteins, microRNAs and alternative splicing. This presentation of the current state of the knowledge will promote new investigations into the relevance of the interactions between seed germination and post-transcriptional regulation in plants.
Genome-wide identification and functional characterization of LEA genes during seed development process in linseed flax (Linum usitatissimum L.)
Authors: Li Zhen , Chi Hui , Liu Caiyue , Zhang Tianbao , Han Lida , Li Liang , Pei Xinwu , Long Yan
Published: April 2021

Background

LEA proteins are widely distributed in the plant and animal kingdoms, as well as in micro-organisms. LEA genes make up a large family and function in plant protection against a variety of adverse conditions.

Results

Bioinformatics approaches were adopted to identify LEA genes in the flax genome. In total, we found 50 LEA genes in the genome. We also conducted analyses of the physicochemical parameters and subcellular location of the genes and generated a phylogenetic tree. LuLEA genes were unevenly mapped among 15 flax chromosomes and 90% of the genes had less than two introns. Expression profiles of LuLEA showed that most LuLEA genes were expressed at a late stage of seed development. Functionally, the LuLEA1 gene reduced seed size and fatty acid contents in LuLEA1-overexpressed transgenic Arabidopsis lines.

Conclusion

Our study adds valuable knowledge about LEA genes in flax which can be used to improve related genes of seed development.
Development and validation of a difficult laryngoscopy prediction model using machine learning of neck circumference and thyromental height
Authors: Kim Jong Ho , Kim Haewon , Jang Ji Su , Hwang Sung Mi , Lim So Young , Lee Jae Jun , Kwon Young Suk
Published: April 2021

Background

Predicting difficult airway is challengeable in patients with limited airway evaluation. The aim of this study is to develop and validate a model that predicts difficult laryngoscopy by machine learning of neck circumference and thyromental height as predictors that can be used even for patients with limited airway evaluation.

Methods

Variables for prediction of difficulty laryngoscopy included age, sex, height, weight, body mass index, neck circumference, and thyromental distance. Difficult laryngoscopy was defined as Grade 3 and 4 by the Cormack-Lehane classification. The preanesthesia and anesthesia data of 1677 patients who had undergone general anesthesia at a single center were collected. The data set was randomly stratified into a training set (80%) and a test set (20%), with equal distribution of difficulty laryngoscopy. The training data sets were trained with five algorithms (logistic regression, multilayer perceptron, random forest, extreme gradient boosting, and light gradient boosting machine). The prediction models were validated through a test set.

Results

The model’s performance using random forest was best (area under receiver operating characteristic curve = 0.79 [95% confidence interval: 0.72–0.86], area under precision-recall curve = 0.32 [95% confidence interval: 0.27–0.37]).

Conclusions

Machine learning can predict difficult laryngoscopy through a combination of several predictors including neck circumference and thyromental height. The performance of the model can be improved with more data, a new variable and combination of models.
The association of baseline N-terminal pro-B-type natriuretic peptide with short and long-term prognosis following percutaneous coronary intervention in non-ST segment elevation acute coronary syndrome with multivessel coronary artery disease: a retrospective cohort study
Authors: He Wen-fei , Jiang Lei , Chen Yi-yue , Liu Yuan-hui , Chen Peng-yuan , Duan Chong-yang , Zeng Li-huan , Fan Hua-lin , Wei Xue-biao , Guo Wei , Chen Wei , Li Jun , Li Wen-sheng , Guo Zhi-qiang , Liu Zhi-kai , Tan Ning , Chen Ji-yan , He Peng-cheng
Published: April 2021

Background

Several studies have shown that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly correlated with the complexity of coronary artery disease and the prognosis of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS), However, it remains unclear about the prognostic value of NT-proBNP in patients with NSTE-ACS and multivessel coronary artery disease (MCAD) undergoing percutaneous coronary intervention (PCI). Therefore, this study aimed to reveal the relationship between NT-proBNP levels and the prognosis for NSTE-ACS patients with MCAD undergoing successful PCI.

Methods

This study enrolled 1022 consecutive NSTE-ACS patients with MCAD from January 2010 to December 2014. The information of NT-proBNP levels was available from these patients. The primary outcome was in-hospital all-cause death. In addition, the 3-year follow-up all-cause death was also ascertained.

Results

A total of 12 (1.2%) deaths were reported during hospitalization. The 4th quartile group of NT-proBNP (> 1287 pg/ml) showed the highest in-hospital all-cause death rate (4.3%) (P < 0.001). Besides, logistic analyses revealed that the increasing NT-proBNP level was robustly associated with an increased risk of in-hospital all-cause death (adjusted odds ratio (OR): 2.86, 95% confidence interval (CI) = 1.16–7.03, P = 0.022). NT-proBNP was able to predict the in-hospital all-cause death (area under the curve (AUC) = 0.888, 95% CI = 0.834–0.941, P < 0.001; cutoff: 1568 pg/ml). Moreover, as revealed by cumulative event analyses, a higher NT-proBNP level was significantly related to a higher long-term all-cause death rate compared with a lower NT-proBNP level (P < 0.0001).

Conclusions

The increasing NT-proBNP level is significantly associated with the increased risks of in-hospital and long-term all-cause deaths among NSTE-ACS patients with MCAD undergoing PCI. Typically, NT-proBN P > 1568 pg/ml is related to the all-cause and in-hospital deaths.
Shifting research culture to address the mismatch between where trials recruit and where populations with the most disease live: a qualitative study
Authors: Rai Tanvi , Dixon Sharon , Ziebland Sue
Published: April 2021

Background

Research participation is beneficial to patients, clinicians and healthcare services. There is currently poor alignment between UK clinical research activity and local prevalence of disease. The National Institute of Health Research is keen to encourage chief investigators (CIs) to base their research activity in areas of high patient need, to support equity, efficiency and capacity building. We explored how CIs choose sites for their trials and suggest ways to encourage them to recruit from areas with the heaviest burden of disease.

Methods

Qualitative, semi-structured telephone interviews with a purposive sample of 30 CIs of ongoing or recently completed multi-centre trials, all of which were funded by the UK National Institute of Health Research.

Results

CIs want to deliver world-class trials to time and budget. Approaching newer, less research-active sites appears risky, potentially compromising trial success. CIs fear that funders may close the trial if recruitment (or retention) is low, with potential damage to their research reputation.

We consider what might support a shift in CI behaviour. The availability of ‘heat maps’ showing the disparity between disease prevalence and current research activity will help to inform site selection. Embedded qualitative research during trial set up and early, appropriate patient and public involvement and engagement can provide useful insights for a more nuanced and inclusive approach to recruitment. Public sector funders could request more granularity in recruitment reports and incentivise research activity in areas of greater patient need. Accounts from the few CIs who had ‘broken the mould’ suggest that nurturing new sites can be very successful in terms of efficient recruitment and retention.

Conclusion

While improvements in equity and capacity building certainly matter to CIs, most are primarily motivated by their commitment to delivering successful trials. Highlighting the benefits to trial delivery is therefore likely to be the best way to encourage CIs to focus their research activity in areas of greatest need.
Growth mixture models: a case example of the longitudinal analysis of patient‐reported outcomes data captured by a clinical registry
Authors: Kwon Jae-Yung , Sawatzky Richard , Baumbusch Jennifer , Lauck Sandra , Ratner Pamela A.
Published: April 2021

Background

An assumption in many analyses of longitudinal patient-reported outcome (PRO) data is that there is a single population following a single health trajectory. One approach that may help researchers move beyond this traditional assumption, with its inherent limitations, is growth mixture modelling (GMM), which can identify and assess multiple unobserved trajectories of patients’ health outcomes. We describe the process that was undertaken for a GMM analysis of longitudinal PRO data captured by a clinical registry for outpatients with atrial fibrillation (AF).

Methods

This expository paper describes the modelling approach and some methodological issues that require particular attention, including (a) determining the metric of time, (b) specifying the GMMs, and (c) including predictors of membership in the identified latent classes (groups or subtypes of patients with distinct trajectories). An example is provided of a longitudinal analysis of PRO data (patients’ responses to the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire) collected between 2008 and 2016 for a population-based cardiac registry and deterministically linked with administrative health data.

Results

In determining the metric of time, multiple processes were required to ensure that “time” accounted for both the frequency and timing of the measurement occurrences in light of the variability in both the number of measures taken and the intervals between those measures. In specifying the GMM, convergence issues, a common problem that results in unreliable model estimates, required constrained parameter exploration techniques. For the identification of predictors of the latent classes, the 3-step (stepwise) approach was selected such that the addition of predictor variables did not change class membership itself.

Conclusions

GMM can be a valuable tool for classifying multiple unique PRO trajectories that have previously been unobserved in real-world applications; however, their use requires substantial transparency regarding the processes underlying model building as they can directly affect the results and therefore their interpretation.
Association between primary caregiver type and mortality among Chinese older adults with disability: a prospective cohort study
Authors: Liu Yangyujin , Li Haoxue , Wu Bei , Liu Xiaoting , Chen Honglin , Jin Hai-Yu , Wu Chenkai
Published: April 2021

Background

Socio-demographic transitions have dramatically changed the traditional family care settings in China, caused unmet care needs among older adults. However, whether different primary caregiver types have different influences on disabled older adults’ health outcomes remain poorly understood. We aimed to examine the association between the type of primary caregiver (e.g., spouse and children) and death among community-dwelling Chinese older adults disabled in activities of daily living.

Methods

We used data from Chinese Longitudinal Healthy Longevity Survey. The analytic sample comprised 4278 eligible adults aged ≥ 80 years. We classified primary caregiver type into five categories: spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and domestic helper. We used Cox regression model to examine the association between primary caregiver type and all-cause mortality. Covariates included age, sex, residence, years of education, co-residence status, financial independence, whether living with children, number of ADL disability, number of chronic conditions, and self-reported health, cognitive impairment, and caregiving quality.

Results

Married older adults whose primary caregivers were son/daughter-in-law had a 38% higher hazard of death than those who had spouse as the primary caregiver. Married men who received care primarily from son/daughter-in-law or daughter/son-in-law had a 64 and 68% higher hazard of death, respectively, than those whose primary caregiver was spouse. The association between primary caregiver type and mortality among widowed older adults differed between urban and rural areas. Urban residents who had domestic helpers as the primary caregiver had an 16% lower hazard of death, while those living in rural areas had a 50% higher hazard of death, than those having son/daughter-in-law as the primary caregiver.

Conclusions

The quality of care of the primary caregiver may be a risk factor for mortality of disabled older adults in China. Interventions are necessary for reducing unmet needs and managing care burden.
HPV infection and bacterial microbiota in the semen from healthy men
Authors: Tuominen Heidi , Rautava Jaana , Kero Katja , Syrjänen Stina , Collado Maria Carmen , Rautava Samuli
Published: April 2021

Background

Aberrant microbiota composition has been linked to disease development at numerous anatomical sites. Microbiota changes in reaction to viral infections, such as human papillomavirus (HPV), have been investigated almost exclusively in the female reproductive tract. However, HPV infection may also affect male health by reducing semen quality and fertility. The aim of this study was to investigate whether present HPV DNA is associated with detectable changes in semen bacterial microbiota composition and diversity.

Methods

This study relied on stored semen samples from 31 fertile healthy men who participated in the Finnish family HPV Study during the years 1998–2001. DNA was extracted from semen with PCR template preparation kit. HPV was genotyped using Luminex-based Multimetrix® assay. Microbiota was analyzed from the V3-V4 region of 16S rDNA gene following sequencing on an Illumina MiSeq platform. All statistical analyses were performed with Calypso software version 8.84.

Results

HPV DNA was detected in 19.4% (6/31) of the semen samples. HPV status in the semen did not impact the α-diversity estimations, as measured by Chao1 and Shannon indices, nor ß-diversity. Nevertheless, HPV-positive semen samples exhibited differences in the taxonomic composition of the bacterial microbiota including higher abundances ofMoraxellaceae(p = 0.028),Streptococcus(p = 0.0058) andPeptostreptococcus(p = 0.012) compared to HPV-negative semen samples.

Conclusion

HPV infection is associated with altered bacterial microbiota composition in semen, and this might have in impact to male health in general. As of present, it is unclear whether these changes result from HPV infection or whether altered bacterial microbiota increases susceptibility to HPV infection. More research is needed on viral-bacterial interactions in the male reproductive system.
Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar
Authors: Warrell Clare E. , Macrae Catriona , McLean Alistair R. D. , Wilkins Edmund , Ashley Elizabeth A. , Smithuis Frank , Tun Ni Ni
Published: April 2021

Background

Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon.

Method

This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7–1.0 mg/kg) and oral fluconazole (800 mg orally/day).

Results

Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies.

Conclusion

Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.
Gastrointestinal manifestations of Talaromyces marneffei infection in an HIV-infected patient rapidly verified by metagenomic next-generation sequencing: a case report
Authors: Zhou Ying , Liu Yongfeng , Wen Ying
Published: April 2021

Background

The manifestation of Talaromyces marneffei infection in some HIV-infected patients may be atypical. Cases with gastrointestinal involvement have rarely been reported. It is hard to make a diagnosis when patients are lacking the characteristic rash and positive blood culture.

Case presentation

Here, we described a patient living with HIV who complained of fever and abdominal pain, and was rapidly diagnosed with Talaromyces marneffei infection by metagenomic next-generation sequencing (mNGS) using formalin-fixation and paraffin-embedded (FFPE) samples of omentum majus tissue. We also reviewed reported related cases.

Conclusions

Talaromyces marneffei is an unusual cause of clinical presentations involving obvious abdominal pain and lower gastrointestinal bleeding, but can be included in the differential diagnosis. As an important diagnostic tool, the significance of mNGS using FFPE samples of lesions provides a more targeted diagnosis.
Changes in health-related quality of life and the associated factors among Myanmar migrants with tuberculosis: a cohort study
Authors: Oo Myo Minn , Boonathapat Naris , Aung Htet Ko Ko , Pungrassami Petchawan , Liabsuetrakul Tippawan
Published: April 2021

Background

Migrants are known to be predominantly poor population which are predisposing to social and health problems, particularly infectious diseases including tuberculosis (TB). TB itself and effect of treatment may further result in substantial morbidity and lowering the quality of life. This study aimed to assess the changes in health-related quality of life (HRQOL) within six months of anti-TB treatment initiation, and the associated factors in Myanmar migrants under anti-TB treatment within this border area.

Methods

This was a prospective cohort study of adult Myanmar migrants with new TB who were within two months of treatment initiation in two TB clinics in Mae Sot, a Thai-Myanmar border area between September 2019 and July 2020. Eight individual domain scores of the HRQOL and Physical and Mental Component Summary (PCS and MCS) scores measured by SF-36 were calculated at month-2 (T1) as baseline, and at the month-4 (T2) and month-6 follow-up visits (T3). Generalized estimation equation models were used to assess the longitudinal changes in PCS and MCS scores of HRQOL.

Results

Of the 155 patients recruited, 93 (60.0%) and 65 (69.9%) completed the month-4 and month-6 follow-ups, respectively. Both the PCS (+ 6.1) and MCS (+ 6.3) scores significantly improved between T1 and T3, with the lowest scores being general health, with the least improvement in social function (+ 1.5) compared with the other domains. Migrants with ethnic origin of Burmese or other were associated with higher PCS and MCS. Those living with family and having higher numbers of initial TB symptoms were associated with lower PCS and MCS scores. Those diagnosed during routine medical checkup were positively associated with PCS scores, whereas patients diagnosed during active case findings were negatively associated with MCS scores. Patients who received residential TB care had higher PCS scores than those with OPD-based TB care.

Conclusions

Continuous improvement in quality of life was found among Myanmar migrants with TB during treatment but their quality of life is still low. Patients with low mental health, especially in the social domain, requires further attention. Active screening policy and supportive strategies during treatment are essential to TB migrants.
C3 glomerulonephritis associated with ANCA positivity: a case report
Authors: Li Ling , Liu Li-qin , Yang Ying-ying , Hu Zhang-Xue
Published: April 2021

Background

C3 glomerulopathy (C3G) is a recent disease classification that is characterized by the presence of glomerular deposits (composed of C3) in the absence of significant amounts of immunoglobulin and comprises dense deposit disease and C3 glomerulonephritis (C3GN). Most C3GN manifests as membranoproliferative, mesangial proliferative glomerulonephritis patterns via light microscopy. Pure membranous nephropathy (MN)-like glomerular lesions are rare manifestations of C3GN. Anti-neutrophil cytoplasmic antibodies (ANCAs) are also seldomly reported to be positive in C3GN. Herein, we report the case of a C3GN patient presenting with an MN-like glomerular pattern with ANCA positivity.

Case presentation

A 68-year-old woman was admitted to a local hospital with elevated serum creatinine for two weeks. Laboratory tests showed a hemoglobin level of 85 g/L. Urinalysis was positive for 2 + protein and 360 RBCs/HPF. Blood biochemistry analysis revealed the following concentrations: albumin, 30.3 g/L; globulin, 46.2 g/L; blood urea nitrogen, 19.9 mmol/L; and serum creatinine, 234 µmol/L. The serum C3 level was 0.4950 g/L, and the serum C4 level was 0.1050 g/L. The direct Coombs test was positive. Serologic testing for ANCA revealed the presence of p-ANCA (1:10) by indirect immunofluorescence microscopy assay, as well as the presence of PR3 1.2 (normal range < 1) and MPO 3.5 (normal range < 1) by enzyme immunoassay. Renal biopsy sample pathology showed 2/6 cellular crescents and thickened glomerular basement membranes. Immunofluorescence testing revealed only diffuse, finely granular depositions of C3 along the glomerular capillary walls in frozen and paraffin-embedded tissue sections. Electron microscopy demonstrated the presence of subepithelial electron-dense deposits, similar to those that are observed in membranous nephropathy. Corticosteroid and cyclophosphamide were administered, with a subsequent improvement in renal function.

Conclusions

We present the rare case of a patient with MN-like C3GN with ANCA positivity. C3GN with ANCA positivity may be represented by more crescents, severe renal dysfunction and more extrarenal manifestations. More cases are needed to elucidate the clinicopathologic features and optimal treatments of these patients.
Performance of Mattis dementia rating scale-Chinese version in patients with mild cognitive impairment and Alzheimer’s disease
Authors: Qian Shuxia , Chen Keliang , Guan Qiaobing , Guo Qihao
Published: April 2021

Background

To identify the applicability of the Chinese Version of Mattis Dementia Rating Scale (DRS-CV).

Methods

The DRS-CV was administered to 483 participants, including 136 normal controls, 167 patients with mild cognition impairment (MCI), and 180 patients with Alzheimer’s disease (AD). Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the scale.

Results

The scores of DRS-CV were ranked in the order of NC > MCI > mild AD > moderate AD group. Memory was the sensitive function affected at a relatively earlier stage of AD. ROC curve analysis indicated the DRS-CV total score and memory subscale showed excellent sensitivity and specificity in the discrimination between MCI from mild AD and mild AD from moderate AD, but poor sensitivity and specificity in the discrimination between MCI and NC.

Conclusion

The DRS-CV is useful to the early diagnosis and severity of AD, not to the early identification of MCI.
Assessment of cognitive functions in patients with multiple sclerosis applying the normative values of the Rao’s brief repeatable battery in the Portuguese population
Authors:   on behalf of the Group for Validation of the BRBN-T in the Portuguese MS Population, Sousa Claudia , Rigueiro-Neves Mariana , Passos Ana Margarida , Ferreira Aristides , Sá Maria José
Published: April 2021

Background

The Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) is one of the most sensitive and used measures for detecting cognitive impairment in Multiple Sclerosis (MS).

Objective

The aim of this study was to adapt and validate this battery to the Portuguese population of MS patients.

Methods

The Portuguese version of the BRBN-T was applied to a stratified control national sample of 326 individuals considering sex, age, educational level and geographic location and also a clinical sample of 115 MS patients from several national hospitals. Through the exploration of its psychometrics properties, the Portuguese BRBN-T norms were produced.

Results

The normative data is presented as a regression-based formula to adjust test scores for gender, education and age, and the results reveal the BRBN-T has the ability to differentiate between MS patients and healthy participant’s cognitive performance.

Conclusion

This study demonstrated in our clinical population a good ability to detect cognitive impairment. Its clearly contributed to reinforcing the neuropsychological assessment in Portugal in patients with MS, by providing a new set of instruments, which can be used in the clinical practice, and in future studies. Moreover, it will allow a rigorous and precise support in relation to neuropsychological assessment for future longitudinal studies and clinical trials.
Serial magnetic resonance imaging findings during severe attacks of familial hemiplegic migraine type 2: a case report
Authors: Fear David , Patel Misha , Zand Ramin
Published: April 2021

Background

Hemiplegic migraines represent a heterogeneous disorder with various presentations. Hemiplegic migraines are classified as sporadic or familial based on the presence of family history, but both subtypes have an underlying genetic etiology. Mutations in the ATP1A2 gene are responsible for Familial Hemiplegic type 2 (FHM2) or the sporadic hemiplegic migraine (SHM) counterpart if there is no family history of the disorder. Manifestations include migraine with aura and hemiparesis along with a variety of other symptoms likely dependent upon the specific mutation(s) present.

Case presentation

We report the case of an adult man who presented with headache, aphasia, and right-sided weakness. Workup for stroke and various infectious agents was unremarkable during the patient’s extended hospital stay. We emphasize the changes in the Magnetic Resonance Imaging (MRI) over time and the delay from onset of symptoms to MRI changes in Isotropic Diffusion Map (commonly referred to as Diffusion Weighted Imaging (DWI)) as well as Apparent Diffusion Coefficient (ADC).

Conclusions

We provide a brief review of imaging findings correlated with signs/symptoms and specific mutations in the ATP1A2 gene reported in the literature. Description of the various mutations and consequential presentations may assist neurologists in identifying cases of Hemiplegic Migraine, which may include transient changes in ADC and DWI imaging throughout the course of an attack.
Social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, Democratic Republic of Congo: a mixed methods study
Authors: Angèle Musau Nkola , Abel Ntambue Mukengeshayi , Jacques Omewatu Mungomba , Henri Mundongo Tshamba , Françoise Malonga Kaj
Published: April 2021

Background

The aim of this study was to explore and measure the social and economic consequences of the costs of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo.

Methods

We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 mothers of newborns, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected mothers of newborns were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care.

Results

Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and caesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women giving birth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in the prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the increase in length of stay did not generate any additional financial benefits. Mothers no longer had confidence in nurses; they were sometimes separated from their babies, and they could not access certain prescribed medications or treatments.

Conclusion

The government of the DRC should implement a mechanism for subsidizing care and associate it with a cost-sharing system. This would place the country on the path to achieving universal health coverage in improving the physical, mental and social health of mothers, their babies and their households.
Preconceptional and prenatal exposure to diurnal temperature variation increases the risk of childhood pneumonia
Authors: Zheng Xiangrong , Kuang Jian , Lu Chan , Deng Qihong , Wu Haiyu , Murithi Rachael Gakii , Johnson McSherry Brownel , Peng Wang , Wu Maolan
Published: April 2021

Background

Pneumonia is the leading cause of death and hospitalization among young children worldwide, but its risk factors remain unclear.

Objective

To evaluate the effect of maternal exposure to diurnal temperature variation (DTV) during preconceptional and prenatal periods on childhood pneumonia.

Methods

A retrospective cohort study by case-control design was conducted for pneumonia (N = 699) and normal (N = 811) children under age of 14 who were enrolled in XiangYa Hospital, Changsha, China from May 2017 to April 2019. Demographic data including gender, age, birth season, gestational age, parity, mode of delivery, and parental atopy were collected from the electronic medical records in the hospital system. We obtained the data of daily DTV in Changsha during 2003–2019 from China Meteorological Administration. Maternal exposure to DTV during preconceptional and prenatal periods was respectively calculated by the average of daily DTV during one year and three months before conception and entire pregnancy as well as the three trimesters. The association between maternal exposure to outdoor DTV and childhood pneumonia was analyzed by multiple logic regression model.

Results

We found that childhood pneumonia was significantly associated with exposure to an increase in DTV during one year before conception and entire pregnancy, with ORs (95 % CI) = 2.53 (1.56–4.10) and 1.85 (1.24–2.76). We further identified a significant risk of pneumonia of DTV exposure during the first and second trimester of pregnancy. Sensitivity analysis showed that boys were more susceptible to the effect of prenatal exposure to outdoor DTV during pregnancy particularly in the first two trimesters compared to girls.

Conclusions

Preconceptional and prenatal exposure to DTV plays an important role in development of childhood pneumonia, especially during the first and second trimesters of pregnancy.
A community intervention to reduce alcohol consumption and drunkenness among adolescents in Sweden: a quasi-experiment
Authors: Svensson Robert , Johnson Björn , Kronkvist Karl
Published: April 2021

Background

Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking.

Method

The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7–9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016–2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents’ alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol.

Results

Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents’ drinking habits, or on their perceptions of their parents’ attitudes towards adolescent drinking.

Conclusion

This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people’s alcohol consumption or their past-year or past-month drunkenness, nor on their parents’ perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study.

Trial registration

ISRCTN registry: Study ID: 51635778, 31th March 2021 (Retrospectively registered).